MEDICINE Flashcards
management of sarcoidosis (first and second line)
- steroids
2. classical immunosuppressants
Acute management of hypercalcaemia
- IV fluids
- Zoledronic Acid
Management of Hyperkalaemia
- calcium gluconate
- insulin
- nebulised salbutamol
- sodium bicarbonate if associated acidosis
What electrolyte abnormalities are seen in Addison’s disease?
HypOnatraemia
HypERkalaemia
Hypotension (postural)
Why is early morning cortisol not a v sensitive test for Addison’s?
false negative results common
What investigations are used to diagnose Addison’s?
short synacthen test
adrenal autoantibodies
How is Addison’s Managed?
Hydrocortisone 10mg am, 5mg lunch, 5mg 5pm (Double dose for intercurrent illness)
fludrocortisone 500mcg OD
DHEA
How is Addisonian Crisis Managed?
100mg hydrocortisone STAT; further 100mg hydrocortisone every 6 hrs
resuscitation fluids
correct hypoglycaemia
what is the cause of Cushing’s disease?
ACTH secreting Pituitary adenoma (→ bilateral adrenal hyperplasia)
Name 3 other causes of cushing’s syndrome
adrenal adenoma
ectopic ACTH secretion from SCLC or carcinoid tumour
long term use of exogenous steroids
Investigations (and results) for Cushing’s disease (2)
- Plasma cortisol (raised)
- 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)
What is a Phaeochromocytoma?
tumour of chromaffin cells of the adrenal medulla - secrete catecholamines
What familial condition is Phaeochromocytoma associated with?
MEN2
Which 2 investigations are useful for investigation of phaeochromocytoma?
- 24hr urinary catecholamines
2. plasma free metanephrines
What needs to be done before definitive surgery for phaochromocytoma?
medical control of symptoms with alpha and beta blockers to reduce anaesthetic risk
What is the pathophysiology of congenital adrenal hyperplasia?
- 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
What is the classical presentation of congenital adrenal hyperplasia?
- salt wasting crisis in young
- may have ambiguous genitalia
What is the non-classical presentation of congenital adrenal hyperplasia?
- androgen excess in mid-teens
How is congenital adrenal hyperplasia managed?
- ACTH suppression
- exogenous steroid
Name the 2 most common causes of primary hyperaldosteronism
- idiopathic bilateral adrenal hyperplasia
- adrenal adenoma
- What is the first line investigation of primary hyperaldosteronism?
- what other investigations can be performed to confirm dx
- plasma aldosterone:renin ratio
2. adominal CT; adrenal vein sampling
What are the biochemical/clinical fx of primary hyperaldosteronism
HTN (treatment resistant; young; associated with hypokalaemia prior to treatment)
hypokalaemia
alkalosis
- What is the most common cause of hypothyroidism?
2. how can this be clinically distinguished from
- primary atrophic hypothyroidism
2. no goitre/painless
Which causes of hypothyroidism are associated with a transient phase of thyrotoxicosis? (3)
- Hashimoto’s thyroiditis
- Post-Partum Thyroiditis
- De Quervain’s Thyroiditis
Fatigue, weight gain, cold intolerance, hair thinning
Painful neck swelling
previous viral infection couple of weeks ago
What is the dx?
De Quervain’s Thyroiditis
What autoantibodies are present in Hashimoto’s Thyroiditis?
anti-TPO
anti-thyroglobulin
What antibodies are specific for Grave’s Disease?
anti-TSHr
- What blood count derrangements are commonly caused by carbamazepine?
- What are the clinical repercussions of this?
- agranulocytosis and neutropenia
2. patients need to inform medical professionals if unwell, including colds
What is the pathophysiology surrounding thyroid eye disease?
autoimmune response → retro-orbital inflammation
Name the clinical features of thyroid eye disease
- exophthalmos
- conjunctival oedema
- optic disc swelling
- ophthalmoplegia
- dry eyes
What are the biochemical derangements of “sick euthyroid syndrome”?
TSH, T3, and thyroxine all low (although TSH may be on low side of normal)
Name the three complications associated with thyroid surgery
- recurrent laryngeal nerve damage
- damage to parathyroid gland
- haematoma/bleeding (which can rapidly compromise the airway)
What is the most common type of thyroid cancer?
Papillary
- Which MEN syndrome is associated with medullary thyroid cancer?
- what biochemical derangements are seen with this type of thyroid cancer?
- MEN2 and MEN3
2. raised calcitonin
Name 4 causes of secondary hypothyroidism
- pituitary adenoma
- HPA dysfunction
- Sheehan’s syndrome (pituitary ischaemia secondary to PPH)
- infiltrative disease - sarcoidosis, malignancy etc
which enzyme has been implicated in Sarcoidosis?
Angiotensin Converting Enzyme (ACE)
What condition can develop if sodium levels are corrected too quickly?
cerebral pontine myelinolysis (osmotic demyelination syndrome)
What are the biochemical derangements in NEPHROTIC syndrome?
- proteinuria (>3g/24h)
- hypoalbuminaemia (<30g/L)
- hyperlipidaemia
- hypercoagulability
- (peripheral oedema)
Name 6 causes of nephrotic syndrome
- minimal change disease
- membranous glomerulonephritis
- FSGS
- membranoproliferative glomerulonephritis
- amyloidosis
- diabetic nephropathy
How is nephrotic syndrome managed?
- fluid and salt restriction + loop diuretics to reduce odema
- ARB/ACEi to reduce proteinuria
- VTE prophylaxis
- treat underlying cause - e.g. steroids for minimal change
What is the biochemical derangement of NEPHRITIC syndrome?
- haematuria
- mild/moderate proteinuria
- (HTN)
- (Oliguria)
- red cell casts in urine
Name 5 causes of nephritic syndrome
- IgA nephropathy
- Henoch Schönlein Purpura
- Post Strep GN
- anti-GBM disease (goodpastures)
- Rapodly progressicw glomerulonephritis
How is Nephritic Syndrome managed?
- fluid and salt restriction
- ACEi/ARB
- treat underlying cause
- RRT if severe kidney failure
Management of DKA
- 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
Stepwise treatment of COPD
- PRN SABA/SAMA
- LABA + LAMA or LABA + ICS
- Triple therapy - LABA + LAMA + ICS
Management of Acute Exacerbation of COPD
- ABG to determine O2 sats
- nebulised bronchodilators
- corticosteroids - oral pred 30mg OD for 5 days
- Abx following local guidelines
- Which vaccinations are patients with COPD eligible for?
2. When is prophylactic azithromycin recommended for patients with COPD?
- Influenza; pneumococcal
2. non smokers; optimised medical management + 4+ exacerbations per year
Causes of Hypercalcaemia
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
Biochemical features of primary hyperparathyroidism
Increased/normal PTH
high Ca
low PO4
Biochemical features of secondary hyperparathyroidism
raised PTH
low Ca
high PO4
Biochemical features of tertiary hyperparathyroidism
raised PTH
high or normal Ca
low or normal PO4
Medical cause of hypocalcaemia
acute pancreatitis
autoantibody in Eosinophillic granulomatosis with polyangitis
pANCA
eosinoPhills
autoantibody in granulomatosis with polyangitis
cANCA
Rheumatological condition (A) associated with a vasculitis (B)
Polymyalgia rheumatica commonly co-occurs with giant cell arteritis
Prognosis of FSGS
50% progress to ESKD
difference between cushing’s disease and syndrome
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
common causative organisms of viral meningitis
enteroviruses - e.g. coxackie
Herpes simplex
varicella zoster
Common causative organisms of bacterial meningitis in neonates
E.coli
group B strep
LIsteria
Antibiotic choice for meningitis in neonates
Intravenous cefotaxime + amoxicillin
common causative organisms of bacterial menningitis
N. meningitidis
S. pneumoniae
H. influenzae (partic in over 50s)
antibiotic management of bacterial meningitis
Cefotaxime/ceftriaxone (+amoxicillin in >50yrs)
Antibiotic management of meningococcal disease
IV benzylpenicillin
prophylactic antibiotic choice for meningococcal contacts
oral ciprofloxacin or rifampicin
What criteria is used in the diagnosis of infective endocarditis?
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
Management of pericarditis
colcichine and NSAIDs
Name the 5 frailty syndromes
- increased risk of falls
- immobility
- delirum and dementia
- incontinence
- increased risk of polypharmacy/iatrogenic harm
What staging system is used for lymphoma?
Ann Arbor
Most common type of Non-Hodgkin Lymphoma
diffuse large B cell
Chemotherapy regimes for
- Hodgkin’s Lymphoma
- Non-Hodgkin’s lymphoma
- AVBD - doxorubicin, vinblastine, bleomycin, decarbazine
2. R-CHOP - rituximab, cyclophosphamide, hydroydaunomycin, vincristine, prednisolone
Components of CHA2DS2-VASc Score
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)
