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HYMS FINALS REVISION > MEDICINE > Flashcards

MEDICINE Flashcards

1
Q

management of sarcoidosis (first and second line)

A
  1. steroids

2. classical immunosuppressants

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2
Q

Acute management of hypercalcaemia

A
  • IV fluids

- Zoledronic Acid

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3
Q

Management of Hyperkalaemia

A
  • calcium gluconate
  • insulin
  • nebulised salbutamol
  • sodium bicarbonate if associated acidosis
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4
Q

What electrolyte abnormalities are seen in Addison’s disease?

A

HypOnatraemia
HypERkalaemia
Hypotension (postural)

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5
Q

Why is early morning cortisol not a v sensitive test for Addison’s?

A

false negative results common

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6
Q

What investigations are used to diagnose Addison’s?

A

short synacthen test

adrenal autoantibodies

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7
Q

How is Addison’s Managed?

A

Hydrocortisone 10mg am, 5mg lunch, 5mg 5pm (Double dose for intercurrent illness)
fludrocortisone 500mcg OD
DHEA

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8
Q

How is Addisonian Crisis Managed?

A

100mg hydrocortisone STAT; further 100mg hydrocortisone every 6 hrs
resuscitation fluids
correct hypoglycaemia

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9
Q

what is the cause of Cushing’s disease?

A

ACTH secreting Pituitary adenoma (→ bilateral adrenal hyperplasia)

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10
Q

Name 3 other causes of cushing’s syndrome

A

adrenal adenoma
ectopic ACTH secretion from SCLC or carcinoid tumour
long term use of exogenous steroids

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11
Q

Investigations (and results) for Cushing’s disease (2)

A
  1. Plasma cortisol (raised)
  2. overnight dexamethasone suppression test:
    • low dose - doesnt suppress cortisol level
    • high dose - suppresses cortisol level if cushing’s disease (pituitary adenoma); doesn’t suppress if adrenal adenoma or ectopic ACTH)
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12
Q

What is a Phaeochromocytoma?

A

tumour of chromaffin cells of the adrenal medulla - secrete catecholamines

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13
Q

What familial condition is Phaeochromocytoma associated with?

A

MEN2

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14
Q

Which 2 investigations are useful for investigation of phaeochromocytoma?

A
  1. 24hr urinary catecholamines

2. plasma free metanephrines

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15
Q

What needs to be done before definitive surgery for phaochromocytoma?

A

medical control of symptoms with alpha and beta blockers to reduce anaesthetic risk

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16
Q

What is the pathophysiology of congenital adrenal hyperplasia?

A
  • autosomal recessive deficiency of enzymes involved in cortisol synthesis pathway
  • reduced cortisol secretion → increased ACTH → adrena; hyperplasia
  • steroid precursors are diverted along androgenic pathways → androgen excess
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17
Q

What is the classical presentation of congenital adrenal hyperplasia?

A
  • salt wasting crisis in young

- may have ambiguous genitalia

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18
Q

What is the non-classical presentation of congenital adrenal hyperplasia?

A
  • androgen excess in mid-teens
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19
Q

How is congenital adrenal hyperplasia managed?

A
  • ACTH suppression

- exogenous steroid

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20
Q

Name the 2 most common causes of primary hyperaldosteronism

A
  • idiopathic bilateral adrenal hyperplasia

- adrenal adenoma

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21
Q
  1. What is the first line investigation of primary hyperaldosteronism?
  2. what other investigations can be performed to confirm dx
A
  1. plasma aldosterone:renin ratio

2. adominal CT; adrenal vein sampling

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22
Q

What are the biochemical/clinical fx of primary hyperaldosteronism

A

HTN (treatment resistant; young; associated with hypokalaemia prior to treatment)
hypokalaemia
alkalosis

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23
Q
  1. What is the most common cause of hypothyroidism?

2. how can this be clinically distinguished from

A
  1. primary atrophic hypothyroidism

2. no goitre/painless

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24
Q

Which causes of hypothyroidism are associated with a transient phase of thyrotoxicosis? (3)

A
  1. Hashimoto’s thyroiditis
  2. Post-Partum Thyroiditis
  3. De Quervain’s Thyroiditis
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25
Q

Fatigue, weight gain, cold intolerance, hair thinning
Painful neck swelling
previous viral infection couple of weeks ago

What is the dx?

A

De Quervain’s Thyroiditis

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26
Q

What autoantibodies are present in Hashimoto’s Thyroiditis?

A

anti-TPO

anti-thyroglobulin

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27
Q

What antibodies are specific for Grave’s Disease?

A

anti-TSHr

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28
Q
  1. What blood count derrangements are commonly caused by carbamazepine?
  2. What are the clinical repercussions of this?
A
  1. agranulocytosis and neutropenia

2. patients need to inform medical professionals if unwell, including colds

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29
Q

What is the pathophysiology surrounding thyroid eye disease?

A

autoimmune response → retro-orbital inflammation

30
Q

Name the clinical features of thyroid eye disease

A
  1. exophthalmos
  2. conjunctival oedema
  3. optic disc swelling
  4. ophthalmoplegia
  5. dry eyes
31
Q

What are the biochemical derangements of “sick euthyroid syndrome”?

A

TSH, T3, and thyroxine all low (although TSH may be on low side of normal)

32
Q

Name the three complications associated with thyroid surgery

A
  1. recurrent laryngeal nerve damage
  2. damage to parathyroid gland
  3. haematoma/bleeding (which can rapidly compromise the airway)
33
Q

What is the most common type of thyroid cancer?

A

Papillary

34
Q
  1. Which MEN syndrome is associated with medullary thyroid cancer?
  2. what biochemical derangements are seen with this type of thyroid cancer?
A
  1. MEN2 and MEN3

2. raised calcitonin

35
Q

Name 4 causes of secondary hypothyroidism

A
  1. pituitary adenoma
  2. HPA dysfunction
  3. Sheehan’s syndrome (pituitary ischaemia secondary to PPH)
  4. infiltrative disease - sarcoidosis, malignancy etc
36
Q

which enzyme has been implicated in Sarcoidosis?

A

Angiotensin Converting Enzyme (ACE)

37
Q

What condition can develop if sodium levels are corrected too quickly?

A

cerebral pontine myelinolysis (osmotic demyelination syndrome)

38
Q

What are the biochemical derangements in NEPHROTIC syndrome?

A
  • proteinuria (>3g/24h)
  • hypoalbuminaemia (<30g/L)
  • hyperlipidaemia
  • hypercoagulability
  • (peripheral oedema)
39
Q

Name 6 causes of nephrotic syndrome

A
  1. minimal change disease
  2. membranous glomerulonephritis
  3. FSGS
  4. membranoproliferative glomerulonephritis
  5. amyloidosis
  6. diabetic nephropathy
40
Q

How is nephrotic syndrome managed?

A
  1. fluid and salt restriction + loop diuretics to reduce odema
  2. ARB/ACEi to reduce proteinuria
  3. VTE prophylaxis
  4. treat underlying cause - e.g. steroids for minimal change
41
Q

What is the biochemical derangement of NEPHRITIC syndrome?

A
  • haematuria
  • mild/moderate proteinuria
  • (HTN)
  • (Oliguria)
  • red cell casts in urine
42
Q

Name 5 causes of nephritic syndrome

A
  • IgA nephropathy
  • Henoch Schönlein Purpura
  • Post Strep GN
  • anti-GBM disease (goodpastures)
  • Rapodly progressicw glomerulonephritis
43
Q

How is Nephritic Syndrome managed?

A
  • fluid and salt restriction
  • ACEi/ARB
  • treat underlying cause
  • RRT if severe kidney failure
44
Q

Management of DKA

A
  • fluid resuscitation - initial 1L saline over 1hr (or stat if SBP <90)
  • IV fixed rate insulin (0.1unit/kg/hr)
  • monitor and replace K+
  • ECG monitoring
  • VTE prophylaxis
45
Q

Stepwise treatment of COPD

A
  1. PRN SABA/SAMA
  2. LABA + LAMA or LABA + ICS
  3. Triple therapy - LABA + LAMA + ICS
46
Q

Management of Acute Exacerbation of COPD

A
  1. ABG to determine O2 sats
  2. nebulised bronchodilators
  3. corticosteroids - oral pred 30mg OD for 5 days
  4. Abx following local guidelines
47
Q
  1. Which vaccinations are patients with COPD eligible for?

2. When is prophylactic azithromycin recommended for patients with COPD?

A
  1. Influenza; pneumococcal

2. non smokers; optimised medical management + 4+ exacerbations per year

48
Q

Causes of Hypercalcaemia

A 
C - excessive Ca supplimentation
H - hyperparathyroidism
I - iatrogenic; immobilisation
M - myeloma; mx (lithium)
P - parathyroid adenoma
A - alcohol
N - neoplasm
Z - zollinger ellison syndrome
E - excess vit D
E - excess vit A
S - sarcoidosis
49
Q

Biochemical features of primary hyperparathyroidism

A

Increased/normal PTH
high Ca
low PO4

50
Q

Biochemical features of secondary hyperparathyroidism

A

raised PTH
low Ca
high PO4

51
Q

Biochemical features of tertiary hyperparathyroidism

A

raised PTH
high or normal Ca
low or normal PO4

52
Q

Medical cause of hypocalcaemia

A

acute pancreatitis

53
Q

autoantibody in Eosinophillic granulomatosis with polyangitis

A

pANCA

eosinoPhills

54
Q

autoantibody in granulomatosis with polyangitis

A

cANCA

55
Q

Rheumatological condition (A) associated with a vasculitis (B)

A

Polymyalgia rheumatica commonly co-occurs with giant cell arteritis

56
Q

Prognosis of FSGS

A

50% progress to ESKD

57
Q

difference between cushing’s disease and syndrome

A

Cushing’s disease is caused by a PITUITARY TUMOUR (producing ACTH)

Cushing’s syndrome is any other cause of excess cortisol

  • exogenous steroids
  • adrenal adenoma/hyperplasia
  • ectopic ACTH production
58
Q

common causative organisms of viral meningitis

A

enteroviruses - e.g. coxackie
Herpes simplex
varicella zoster

59
Q

Common causative organisms of bacterial meningitis in neonates

A

E.coli
group B strep
LIsteria

60
Q

Antibiotic choice for meningitis in neonates

A

Intravenous cefotaxime + amoxicillin

61
Q

common causative organisms of bacterial menningitis

A

N. meningitidis
S. pneumoniae
H. influenzae (partic in over 50s)

62
Q

antibiotic management of bacterial meningitis

A

Cefotaxime/ceftriaxone (+amoxicillin in >50yrs)

63
Q

Antibiotic management of meningococcal disease

A

IV benzylpenicillin

64
Q

prophylactic antibiotic choice for meningococcal contacts

A

oral ciprofloxacin or rifampicin

65
Q

What criteria is used in the diagnosis of infective endocarditis?

A

Modified Dukes
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

MAJOR: 2 positive blood cultures of typical organisms; persistent bacteraemia; evidence of endocardial involvement

Minor: predisposing heart condition or intravenous drug use; microbiological evidence does not meet major criteria; fever > 38ºC; vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura; immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots

66
Q

Management of pericarditis

A

colcichine and NSAIDs

67
Q

Name the 5 frailty syndromes

A
  1. increased risk of falls
  2. immobility
  3. delirum and dementia
  4. incontinence
  5. increased risk of polypharmacy/iatrogenic harm
68
Q

What staging system is used for lymphoma?

A

Ann Arbor

69
Q

Most common type of Non-Hodgkin Lymphoma

A

diffuse large B cell

70
Q

Chemotherapy regimes for

  1. Hodgkin’s Lymphoma
  2. Non-Hodgkin’s lymphoma
A
  1. AVBD - doxorubicin, vinblastine, bleomycin, decarbazine

2. R-CHOP - rituximab, cyclophosphamide, hydroydaunomycin, vincristine, prednisolone

71
Q

Components of CHA2DS2-VASc Score

A

C - congestive Heart Failure (1)
H - Hypertension (1)
A - Age (2 if ≥75; 1 if between 65 and 74)
D - diabetes (1)
S2 - prior stroke, TIA or Thromboembolism (2)
V - vascular disease (1)
Sc - Female Sex (1)

HYMS FINALS REVISION (9 decks)

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