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Medicine Flashcards

1
Q

Definition of Acute Coronary Syndrome

A

Myocardial ischaemia caused atherosclerotic coronary artery disease and includes:
⁃ STEMI
⁃ Non-STEMI
⁃ Unstable Angina

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2
Q

Epidemiology of Acute Coronary Syndrome

A
  • Coronary heart disease is the leading cause of death. ACS is common affecting 15 in 1000 people
  • 1/3rd% of ACS patients have STEMIs, 1/3rd NSTEMIs, 1/3rd Unstable angina
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3
Q

Aetiology and risk factors for acute coronary syndrome

A

Aetiology:
• Unstable atherosclerotic plaques that lead to coronary artery narrowing and myocardial ischaemia

Risk factors:
• HTN
• Diabetes
• Dyslipidaemia
• Smoking
• Family Hx (< 50 years)
• Age & Sex (male)
• High BMI

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4
Q

Pathophysiology of Acute Coronary Syndrome

A

Pathophysiology:
• Disruption of vulnerable or unstable plaques –> plaque rupture
• Platelet activation and thrombus formation
• Blood flow disruption leading to myocardial ischaemia (inadequate O2 supply for myocardial demand)
• More than 90% of STEMIs have evidence of coronary artery thrombosis compared to 35%-75% in UA or NSTEMI

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5
Q

Clinical presentations of Acute Coronary Syndrome

A
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6
Q

Differential diagnosis for Acute Coronary Syndrome - things that cannot be missed

A
  1. Aortic dissection
  2. PE
  3. Tension pneumothorax
  4. Oesophageal bleed
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7
Q

Investigations for Acute Coronary Syndrome

A
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8
Q

Management of Acute Coronary Syndrome

A
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9
Q

Lifestyle modifications for Acute Coronary Syndrome

A

Lifestyle Modification:

  • Alcohol reduction
  • Blood pressure and BMI management
  • Cease smoking, cholesterol reduction
  • Diabetes management, diet
  • Exercise (3 x 10min a day)
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10
Q

Complications of Acute Coronary Syndrome

A

Complications:
- Death
- Arrhythmias
- Ruptures
- Tamponade
- Heart Failure
- Valvulopathy
- Aneuryms
- Dressler’s syndrome
- Embolism
- Recurrence/regurgitation

  • Death
  • Arrhythmias
  • Myocardial damage
  • Valvular damage/papillary muscle rupture
  • Ventricular septal rupture (3-5 days post MI)
  • Free wall rupture –> tamponade (3-5 days post MI)
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11
Q

Evolution of acute infarct on ECG

A
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12
Q

Admission vs discharge for Non-ST elevated ACS

A
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13
Q

Extra info Acute Coronary Syndrome

A
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14
Q

Definition of Acute Renal Failure

A

Definition: (Acute kidney injury)

  • An acute decline in the GFR from baseline, usually reversible, resulting in the retention of urea and other nitrogenous wastes
  • The resulting effects include impaired clearance and derangement in metabolic homeostasis, pH regulation, electrolyte regulation and volume regulation
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15
Q

Epidemiology and risk factors for acute renal failure

A
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16
Q

Aetiology of Acute Renal Failure

A

1. Pre-renal causes (reduced renal perfusion):

  • Hypovolaemia (burns, 3rd spacing of fluid etc.)
  • Shock (cardiogenic, septic, hypvolaemic, neurogenic)
  • Haemorrhage
  • Diarrhoea
  • Renal artery stenosis + ACE inhibitors or NSAIDs
  • Congestive Heart failure
  • Burns

2. Intra-renal causes (direct injury to the renal parenchyma):

  • Acute tubular necrosis – 85%
  • Glomerulonephritis – 5%
  • Interstitial nephritis – 15%
  • Haemolytic uraemic syndrome
  • Renal infarction
  • Renal vein thrombosis
  • Drugs (e.g. aminoglycosides)/toxins/radiocontrast
  1. Post-renal causes (obstruction of urinary flow):
  • Tumour
  • Prostate hyperplasia
  • Stricture
  • Renal calculi
  • Ascending UTI
  • Urinary retention
  • Retroperitoneal fibrosis
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17
Q

Pathophysiology of acute renal failure

A
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18
Q

Clinical features of Acute Renal Failure

A
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19
Q

Investigations for acute renal failure

A
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20
Q

Diagnosis and classification of Acute Renal Failure

A
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21
Q

Management of acute renal failure

A
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22
Q

Complications of acute renal failure

A

Complications:

  • Hyperkalaemia
  • Acute Tubular Necrosis
  • Metabolic acidosis
  • Post-obstructive diuresis – Requires careful fluid replacement and electrolyte management
  • Hyperphosphataemia (long-term high)
  • Chronic progressive kidney disease (high-risk if patient Rx by dialysis)
  • End-stage renal disease (up to 10%)
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23
Q

Prognosis of acute renal failure

A

Prognosis:

  • ARF is associated with increased risk of in-hospital and long term mortality
  • More likely to die prematurely after leaving the hospital, even if their renal function has recovered
  • Dialysed patients are also at extremely high risks of developing chronic progressive kidney disease
  • Up to 10% develop ESRD
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24
Q

Definition of Cushing’s Syndrome

A

Definition:

• Clinical manifestation of hypercortisolism

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25
Q

Epidemiology of Cushing’s Syndrome

A

Epidemiology:

  • Relatively uncommon
  • Females > males (5:1)
  • Diagnosed usually 20-50s but can occur at any age, including paediatrics
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26
Q

Aetiology for Cushing’s Syndrome

A
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27
Q

Classification of Cushing’s Syndrome

A
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28
Q

Clinical Features of Cushing’s Syndrome

A
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29
Q

Investigations for Cushing’s Syndrome

A
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30
Q

Treatment for Cushing’s Syndrome

A
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31
Q

Complications of Cushing’s Syndrome

A
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32
Q

Definition of adrenal insufficiency

A

Definition:

  • Results from inadequate secretion of cortisol and/or aldosterone
  • Potentially fatal from adrenal crisis
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33
Q

Epidemiology of adrenal insufficiency

A

Most commonly encountered in patients where the underlying disease is treated with exogenous corticosteroids ⁃ E.g. Asthma, COPD or arthritis

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34
Q

Aetiology of adrenal insufficiency

A
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35
Q

Pathophysiology of adrenal insufficiency

A

Pathophysiology:

  • Exposure to excess glucocorticoids, be it endogenous or exogenous, results in negative feedback
  • Both the hypothalamus and pituitary reduce the amounts of CRH and ACTH produced, leading to ↓serum cortisol
  • This suppression persists, especially in sudden removal of the corticosteroid, leading to symptoms of adrenal insufficiency
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36
Q

Clinical features of adrenal insufficiency

A
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37
Q

Investigations for adrenal insufficiency

A
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38
Q

Treatment for adrenal insufficiency

A
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39
Q

Complications and prognosis of adrenal insufficiency

A

Complications:

  • Secondary Cushingʼs syndrome - due to over replacement of glucocorticoids
  • Osteopenia/osteoporosis - from long term glucocorticoid use
  • Rx-related HTN - due to excessive use of mineralocorticoids

Prognosis:

• Adrenal insufficiency 2° to corticosteroid treatment has a generally good prognosis

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40
Q

What is Conn’s Syndrome and its:

  • Causes
  • Clinical features
  • Investigations
  • Treatment
A
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41
Q

What is Phaeochromocytoma and its:

  • Clinical features
  • Investigations
  • Treatment
  • Complications
  • Prognosis
A
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42
Q

Definition of alcohol withdrawal

A

A syndrome that occurs in alcohol abusers as a result of cessation or reduction in alcohol intake, resulting in lower levels of blood alcohol to which the pt is habituated to.

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43
Q

Epidemiology and risk factors for alcohol withdrawal

A

Epidemiology:

• The prevalence of disorders related to alcohol use is ~2% in developed countries • Common problem

Aetiology:

  • Aetiology of withdrawal is unknown. Due to neurochemical changes that occur in the brain
  • Risk Factors: ⁃ Abrupt withdrawal of alcohol
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44
Q

Pathophysiology and classification of alcohol withdrawal

A
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45
Q

Clinical features of alcohol withdrawal

A
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46
Q

Investigations for alcohol withdrawal

A

Investigations:

  • FBC, UECs, LFTs (all parameters may be elevated)
  • Toxicology screen (may be positive for other drugs)
  • CT head (consider) – to exclude other potential causes of presentation
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47
Q

Differential diagnosis for alcohol withdrawal

A

DDx:

  • Sympathomimetic intoxication
  • Hepatic encephalopathy
  • Encephalitis/meningitis
  • Wernickeʼs encephalopathy
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48
Q

Management of alcohol withdrawal

A
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49
Q

Complications and prognosis of alcohol withdrawal

A

Complications:

  • Oversedation – short term due to benzodiazapines
  • Delirium tremens – occurs in 5% of patients
  • Alcohol withdrawal seizures

Prognosis:

  • 50% remain abstinent for a year
  • Relapse prevention can be achieved by counselling and self-help groups
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50
Q

Description of alcohol withdrawal delirium

A
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51
Q

What is Wernicke’s encephalopathy

  • Causes
  • Pathophysiology
  • Complications
  • Prognosis
A
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52
Q

add in angina slides – Gobi’s incomplete

A
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53
Q

Definition of atrial fibrillation

A

Definition:

  • AF: A supraventricular tachycardia characterised by a loss of atrioventricular synchrony, causing an irregularly irregular heart rhythm
  • Acute AF = new onset or a first detectible episode of AF, whether symptomatic or not
  • Atrial Flutter: A macro-reentrant atrial tachycardia with atrial rates between 240 - 320 bpm
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54
Q

Epidemiology of atrial fibrillation

A
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55
Q

Aetiology of atrial fibrillation

A

Aetiology:

• Risk factors:

⁃ Increasing age

⁃ HTN

⁃ IHD including MI

⁃ CHF

⁃ Valvular heart disease & Rheumatic heard disease

⁃ Diabetes ⁃ Hyperthyroidism

⁃ PE

⁃ Heavy alcohol intake

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56
Q

Pathophysiology and classification of atrial fibrillation

A
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57
Q

Clinical features of atrial fibrillation

A
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58
Q

Investigations and diagnosis of atrial fibrillation

A
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59
Q

Differential diagnosis for atrial fibrillation

A
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60
Q

Management of atrial fibrillation

A
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61
Q

Complications of atrial fibrillation

A
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62
Q

Prognosis of atrial fibrillation

A
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63
Q

Example of ECG changes in atrial fibrillation

A
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64
Q

Definition of blood components

A

Blood components are those products that are derived from whole blood (or platelet-rich plasma) by phlebotomy using differential centrifuge

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65
Q

Fresh blood products:

  • Components
  • Composition of each component
  • Use of each component
A
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66
Q

Plasma derivatives products:

  • Components
  • Composition of each component
  • Use of each component
A
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67
Q

Screening and pre-transfusion testing for blood products

A
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68
Q

When is transfusion of blood recommended

A
  1. Transfusion recommended for Hb < 70g/L - May not be required for a well patient or other Rx available
  2. Transfusion is not associated with reduced mortality for Hb 70-100g/L
  3. Transfusion is not recommended for Hb >100g/L (increased mortality)
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69
Q

Practice points for usage of blood products

A

Practice Points:

  • RBC transfusion should not be based on Hb concentration alone but patientʼs clinical status
  • Single transfusion at a time and re-assess
  • Fe2+ replacement is required in deficient patients regardless of transfusion indication
  • 1 unit of RBCs will raise Hb by 1g/L
  • Wet purpura in mouth is associated with increase risk of internal bleeding
  • Note: Warfarin is hyper-coagulant when initially given as it inhibits protein C and S
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70
Q

Use of platelet therapy

A
  • Bleeding where thrombocytopenia is considered a major factor (e.g. massive haemorrhage)
  • If platelets < 50 or 100 with diffuse vascular bleeding
  • 1 Platelet pool will increase platelet count by 25 x 10^9
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71
Q

Use of fresh frozen plasma

A
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72
Q

Factor concentrates in blood products

A
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73
Q

Different types of transfusion reactions

A
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74
Q

Summary chart of product name, what it is and common uses of blood products

A
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75
Q

Adverse transfusion reactions

A
  • Death occurring due to transfusion incompatibility is rare but a serious consequence
  • Relatively minor symptoms of transfusion reactions occur in 1% of cases (itch, fever, urticaria) and usually in patients that have repeated transfusions
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76
Q

Acute Haemolytic Transfusion Reaction:

  • Definition
  • Epidemiology
  • Pathophysiology
  • Clinical Features
  • Treatment
  • Prognosis
A
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77
Q

Septic transfusion reactions

  • Definition
  • Pathophysiology
  • Clinical Features
  • Investigation
  • Management
A
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78
Q

Transfusion Related Acute Lung Injury (TRALI)

  • Definition
  • Risk factors
  • Pathophysiology
  • Clinical Features
  • Investigation
  • Management
A
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79
Q

Transfusion Associated Circulatory Overload (TACO)

  • Definition
  • Risk Factors
  • Clinical Features
  • Investigations
  • Management
A
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80
Q

Delayed Transfusion Reactions

  • Symptoms
  • Pathogenesis
  • Investigations
  • Management
A
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81
Q

Severe Allergic Reactions

  • Description
  • Clinical Features
  • Management
A
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82
Q

Transfusion associated Graft Vs Host disease

  • Description/cause
  • Clinical features
  • investigations
  • Management
A
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83
Q

Minor allergic transfusion reactions:

  • Description
  • Clinical Features
  • Investigations
  • Management
A
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84
Q

Febrile non-haemolytic reaction:

  • Definition
  • Pathophysiology
  • Clinical Features
  • Treatment
A
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85
Q

Definition of Bronchiectasis

A

Definition:

• Permanent dilation of bronchi due to the destruction of the elastic and muscular component of the wall, 2° to chronic infection

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86
Q

Aetiology of bronchiectasis

A
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87
Q

Pathophysiology and classification of bronchiectasis

A
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88
Q

Clinical features of bronchiectasis

A
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89
Q

investigations for bronchiectasis

A
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90
Q

Differential diagnosis for bronchiectasis

A

DDx:

  • COPD – diminished breath sounds in COPD. Rhonchi may be auscultated in bronchiectasis. CT dx
  • Asthma – no inspiratory squeaks and crackles as heard in bronchiectasis
  • Pneumonia – short course as opposed to bronchiectasis which may be years
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91
Q

Treatment for bronchiectasis

A

Rx

  • Exercise and improved nutrition – helps with mucus clearance & improves exercise capacity
  • Airway clearance therapy – postural drainage, percussion and vibration methods at least 2x daily
  • Abx may be necessary (check sensitivity) – inhaled options or short term course with acute exacerbations
  • Inhaled bronchodilator (adjunct)
  • Sx – complete resection of affected areas may be appropriate; Lung transplantation if FEV < 30% predicted
  • Prevention – Vaccination against influenza and pneumococcal infections + measles and pertussis
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92
Q

Complications and prognosis of bronchiectasis

A

Complications:

  • Massive haemoptysis – Massive life-threatening bleeding can occur (> 250mL) - (variable low)
  • Respiratory failure
  • Cor pulmonale

Prognosis:

  • Irreversible condition
  • Disease course is consistent with symptom control followed by acute exacerbations
  • ↑ Mortality associated with hypoxia, hypercapnoea, dyspnoea, radiological extent of disease
  • Pseudomonas species in sputum indicate more extensive lung disease
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93
Q

Definition of cardiac arrhythmias

A

Definition:

• Disturbance of the normal sinus cardiac rhythm

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94
Q

Epidemiology and aetiology of cardiac arrhythmias

A
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95
Q

Describe a sinus arrhythmia

A
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96
Q

Describe a sinus bradycardia

A
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97
Q

Describe sinus tachycardia

A
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98
Q

Describe Atrial Ectopic Beats including ECG features

A
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99
Q

Describe atrial tachycardia

A
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100
Q

Describe atrial flutter

A
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101
Q

Describe Atrial Fibrillation including risk factors, treatment and ECG features

A
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102
Q

Describe AVNRT

A
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103
Q

Describe ventricular tachycardia including ECG

A
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104
Q

Describe Torsades De Pointes

A
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105
Q

Describe Ventricular Fibrillation

A
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106
Q

Describe sick sinus syndrome

A
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107
Q

ECG AV block

A
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108
Q

Describe bundle branch block including causes

A
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109
Q

Definition of cerebral aneurysms

A
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110
Q

Epidemiology of cerebral aneurysms

A

Epidemiology:

  • 1-5% of the population have cerebral aneurysms
  • Female > male (2:1)
  • Typically become symptomatic at age 40-60s
  • Location: 85% anterior circulation; 10% posterior circulation
  • 10-30% will have multiple aneurysms
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111
Q

Aetiology of cerebral aneurysms

A

Aetiology:

  • Haemodynamically induced
  • Atherosclerosis
  • Vasculopathy
  • High flow states (AV Malformation or AV Fistula)
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112
Q

Risk factors for cerebral aneurysms

A
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113
Q

Pathophysiology of cerebral aneurysms

A

Pathophysiology:

  • Arise from the bifurcation of the major arteries that form the COW
  • Site of turbulent flow and sheer forces
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114
Q

Clinical features of cerebral aneurysms

A
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115
Q

Management and prognosis of cerebral aneurysms

A
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116
Q

Definition of constipation

A

Definition:

  • Infrequent passage of hard stools
  • Normal stool frequency is 3x a day to 3x per week
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117
Q

Epidemiology of constipation

A

Epidemiology:

  • Female > males (2:1)
  • Age > 65 years
  • Black ancestry
  • Pregnancy
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118
Q

Aetiology of constipation

A
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119
Q

Red flags of constipation

A

Red Flags:

  • Middle-aged/Elderly
  • Rectal bleeding
  • Pain
  • Weight loss
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120
Q

Clinical features of constipation

A

Clinical Features:

  • Excessive straining
  • Sense of incomplete evacuation
  • Failed or lengthy attempts to evacuate
  • Hard stool and less frequency
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121
Q

Investigations for constipation

A
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122
Q

Treatment for constipation

A
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123
Q

Definition of chronic kidney disease

A

Definition:

  • Irreversible deterioration in renal function, which classically develops over a period of years
  • Defined as – evidence of kidney damage on pathology, imaging or laboratory findings such as haematuria, proteinuria or reduction in eGFR ≤ 60mL/min/1.73m2 for > 3 months
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124
Q

Epidemiology of chronic kidney disease

A

Epidemiology:

  • Common condition – 15% of Australian population had CKD stage 3-5
  • Incidence is rising due to ageing population
  • Death rate 25-30x higher in ESRF than general population – 50% from complications of CVD
  • DM and HTN are responsible for > 80% of the causes of CKD
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125
Q

Aetiology of chronic kidney disease

A
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126
Q

Risk factors for chronic kidney disease

A

Risk Factors:

  • DM
  • HTN
  • Age > 50 years
  • Smoking, obesity, FHx, autoimmune disease (weak); CV disease; Indigenous and Afro-Caribbean’s
  • Male sex
  • Long-term NSAID use
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127
Q

Pathophysiology and classification of chronic kidney disease

A
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128
Q

Clinical features of chronic kidney disease

A
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129
Q

Investigations for chronic kidney disease

A
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130
Q

Management of chronic kidney disease

A
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131
Q

Complications of chronic kidney disease

A
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132
Q

Prognosis of chronic kidney disease

A
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133
Q

Definition of SLE

A

Definition:

• Chronic multi-system, autoimmune connective tissue disorder characterised by the presence of antinuclear Antibodies

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134
Q

Epidemiology of SLE

A

Epidemiology:

  • Incidence is 0.1%
  • Age: 30-50s
  • F > M (9:1)
  • More common in Asians and Afro-Caribbean populations
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135
Q

Aetiology of SLE

A

Aetiology:

  • Unknown. Multifactorial
  • Genetic factors (25% in monozygotic twins) + epigenetic changes
  • Hormones – premenopausal women
  • Drugs – Sulfasalazine, phenytoin, carbamazepine
  • Viral Infections – EBV exposure
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136
Q

Risk factors for SLE

A

Risk Factors:

  • Premenopausal women (20-50s)
  • Drugs
  • Family Hx
  • Other autoimmune diseases
  • UV light exposure triggers SLE flares
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137
Q

Pathophysiology of SLE

A
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138
Q

Clinical features of SLE

A
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139
Q

Investigations for SLE

A
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140
Q

Management of SLE

A
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141
Q

Complications and prognosis of SLE

A
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142
Q

Description and treatment of anti-phospholipid syndrome

A
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143
Q

Systemic Sclerosis (Scleroderma):

  • Definition
  • Epidemiology
  • Aetiology
A
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144
Q

Pathophysiology and types of systemic sclerosis

A
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145
Q

Clinical features of scleroderma

A
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146
Q

Investigations for systemic sclerosis

A
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147
Q

Treatment for systemic sclerosis

A
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148
Q

Complications and prognosis of systemic sclerosis

A
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149
Q

Definition, epidemiology and histological features of polymyositosis and dermatomyositosis

A

Polymyositis and Dermatomyositis

  • Inflammatory autoimmune disorder of the muscles
  • F > M (3:1)
  • Can occur at any age but peak is 50s
  • Histological features: muscle fibre necrosis with regeneration and inflammatory cell infiltrate
  • Dermatomyositis has skin involvement and has an increased risk of cancer (15%)
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150
Q

Clinical features of Polymyositis and Dermatomyositis

A
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151
Q

Investigation, management and prognosis of Polymyositis and Dermatomyositis

A
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152
Q

Description and clinical features of inclusion-body myositosis

A
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153
Q

Description and causes of inflammatory myopathies

A
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154
Q

Definition of COPD

A
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155
Q

Epidemiology of COPD

A
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156
Q

Aetiology of COPD

A
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157
Q

Pathophysiology of COPD

A
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158
Q

Influence of smoking on airflow - COPD

A
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159
Q

Clinical features of COPD

A
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160
Q

Physical examination for COPD

A
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161
Q

Investigations for COPD

A
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162
Q

Diagnosis and staging for COPD

A
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163
Q

Differential diagnosis for COPD

A
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164
Q

Management for COPD

A
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165
Q

Complications of COPD

A
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166
Q

Prognosis of COPD

A
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167
Q

Definition of gout

A

Definition:

• Inflammatory arthritis associated with hyperuricaemia and deposition of intra-articular sodium urate crystals

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168
Q

Epidemiology of gout

A

Epidemiology:

  • 1% of Western populations
  • Incidence increases with age (> 50 years)
  • Males > females (10:1)
  • Rare in pre-menopausal women or young
  • Differs geographically and racially - E.g. Maori population 6.5%
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169
Q

Aetiology and risk factors for gout

A
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170
Q

Pathophysiology of gout

A

Pathophysiology:

  • Crystal formation and deposition in joints due to supersaturated solution of uric acid in blood
  • Inflammatory response by phagocytes + complement activation
  • Tissue damage due to immunological response
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171
Q

Clinical features of gout

A
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172
Q

Investigations for gout

A
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173
Q

Management of gout

A
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174
Q

Complications and prognosis of gout

A
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175
Q

Pseudogout:

  • Description
  • Risk factors
  • Clinical features
  • Investigation
  • Management
A
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176
Q

Definition of delirium

A

Definition:

  • Acute, fluctuating change in mental status, with inattention, disorganised thinking and altered level of consciousness
  • It is a medical emergency due to high morbidity and mortality
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177
Q

Epidemiology of delirium

A

Epidemiology:

  • Most common psychosis in general hospitals
  • Affects 1 in 5 general admissions
  • More common in elderly (> 60 years)
  • High cause of mortality (14% within 1 month of diagnosis)
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178
Q

Aetiology of delirium

A
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179
Q

Risk factors and pathophysiology of delirium

A

Risk Factors:

  • Age
  • Dementia or cognitive impairment
  • Visual/hearing impairment
  • Functional impairment or immobility
  • Hx of delirium
  • Decreased oral intake (dehydration)
  • Polypharmacy
  • Co-existing medical illnesses
  • Surgery

Pathophysiology: • Remains unclear

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180
Q

Diagnosis of delirium

A

Diagnosis is Clinical – DSM-V criteria:

  • Disturbance in attention (orientation, focus, consciousness)
  • A change in cognition (memory impairment, disorientation, language disturbance)
  • Disturbance that develops over a short time (usually hours to days)
  • Evidence from Hx, Physical examination or Ix of organic cause (e.g. substance intoxication/withdrawal)
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181
Q

Physical exam for delirium

A
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182
Q

Investigations for delirium

A
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183
Q

Management of delirium

A
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184
Q

Delirium Vs Dementia

A
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185
Q

Definition of Diabetes Insipidus

A

Definition:

• A metabolic disorder characterised by a defective ability to concentrate urine in the kidneys, resulting in polyuria, polydipsia and hypotonic urine

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186
Q

Epidemiology of Diabetes Insipidus

A

Epidemiology:

• Uncommon • M = F and no ethnic preference

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187
Q

Aetiology of Diabetes Insipidus

A
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188
Q

Pathophysiology of Diabetes Insipidus

A
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189
Q

Clinical features of Diabetes Insipidus

A
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190
Q

Investigations for Diabetes Insipidus

A
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191
Q

Differential diagnosis for Diabetes Insipidus

A

DDx:

  • 1° polydipsia – due to excess water intake
  • DM chronic
  • Diuretic use
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192
Q

Management of Diabetes Insipidus

A
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193
Q

Complications and prognosis of Diabetes Insipidus

A

Complications:

  • Hypernatraemia (short term medium)
  • Hypovolaemia

Prognosis:

  • Depends on cause. In majority of cases DI is life-long
  • In certain patients it may be transient 2° to trauma, Sx, metabolic
  • Majority of pts with chronic central DI are well controlled
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194
Q

Drug overdose of Paracetamol:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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195
Q

Drug overdose of TCAs (Tricyclic Antidepressants):

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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196
Q

Drug overdose of organophosphates:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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197
Q

Drug overdose of Digoxin:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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198
Q

Drug overdose of Benzodiazepines:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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199
Q

Drug overdose of Opioids:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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200
Q

Drug overdose of Methanol/Ethylene Glycol:

  • Mechanism of action
  • Use of drug
  • Outcome and clinical features of overdose
  • Management of overdose
A
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201
Q

Diuretics:

  • Class
  • Description
  • Example
A
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202
Q

Drugs that damage the kidney

A
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203
Q

Definition and epidemiology of hyponatraemia

A
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204
Q

Clinical features of hyponatraemia

A
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205
Q

Classification of hyponatraemia

A
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206
Q

Pathophysiology of hyponatraemia

A
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207
Q

Investigation, management and complications of hyponatraemia

A
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208
Q

SIADH (Syndrome of Inappropriate ADH):

  • Description
  • Aetiology
  • Pathophysiology
  • Management
A
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209
Q

Epidemiology of falls in elderly

A

Epidemiology:

  • Common in the elderly
  • Causes significant morbidity and mortality
  • Aetiology is often multifactorial
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210
Q

Risk factors for falls in elderly

A

Risk Factors:

  • Age > 65
  • Prev fall in last 12 months
  • Poor mobility, use of walking aids
  • Visual impairment
  • Dementia, delirium, confusion
  • Syncope
  • Polypharmacy
  • Inappropriate footwear
  • Poor nutrition
  • Osteoporosis & steroid use
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211
Q

Classification of falls in elderly

A
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212
Q

Circumstances surrounding falls in elderly

A
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213
Q

Definition of Non-Alcoholic Fatty Liver Disease (NAFLD)

A

Definition:

  • Steatosis of the liver that is not due to excessive alcohol use
  • NASH (non-alcoholic steatohepatitis) is the most extreme form of NAFLD and can progress to liver failure
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214
Q

Risk factors for Non-Alcoholic Fatty Liver Disease

A

Risk Factors:

  • Obesity
  • Insulin resistance
  • Dyslipidaemia
  • T2DM
  • Metabbolic syndrome
  • Rapid weight loss
  • Total parenteral nutrition
  • Wilsonʼs disease
  • Alpha1-antitrypsin deficiency
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215
Q

Epidemiology and Aetiology of Non-Alcoholic Fatty Liver Disease

A
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216
Q

Pathophysiology of Non-Alcoholic Fatty Liver Disease

A
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217
Q

Clinical features and Investigations for Non-Alcoholic Fatty Liver Disease

A
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218
Q

Diagnosis and management of Non-Alcoholic Fatty Liver Disease

A
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219
Q

Differential diagnosis of Non-Alcoholic Fatty Liver Disease

A

DDx:

  • Alcoholic liver disease
  • Hepatitis B/C
  • Drug-induced (methotrexate)
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220
Q

Complications and prognosis of Non-Alcoholic Fatty Liver Disease

A
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221
Q

Definition of Alcoholic Liver Disease

A
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222
Q

Epidemiology of Alcoholic Liver Disease

A
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223
Q

Risk factors for Alcoholic Liver Disease

A

Risk Factors:

  • Prolonged/heavy alcohol use
  • Hepatitis C
  • Women > men (more rapidly and at lower doses)
  • Obesity
  • Genetic predisposition
  • Smoking
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224
Q

Aetiology of Alcoholic Liver Disease

A
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225
Q

Pathophysiology of Alcoholic Liver Disease

A
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226
Q

Clinical presentation of Alcoholic Liver Disease

A
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227
Q

Investigations for Alcoholic Liver Disease

A
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228
Q

Diagnosis and management of Alcoholic Liver Disease

A
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229
Q

Complications and prognosis of Alcoholic Liver Disease

A
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230
Q

Alcohol withdrawal and management

A
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231
Q

Definition of Glomerulonephritis

A

Definition:

• A group of conditions characterised by glomerular injury +/- inflammatory changes in the glomerular capillaries, and BM

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232
Q

Epidemiology of glomerulonephritis

A
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233
Q

Aetiology of glomerulonephritis

A
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234
Q

Pathophysiology of glomerulonephritis

A
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235
Q

Clinical features of glomerulonephritis

236
Q

Types of non-proliferative glomerulonephritis and their features

237
Q

Types of nephritic syndrome glomerulonephritis and their features

238
Q

Investigations and management of glomerulonephritis

239
Q

Prognosis of glomerulonephritis

240
Q

Definition of Heart Failure

241
Q

Epidemiology of Heart Failure

A

Epidemiology:

  • Prevalence of 2-3%, increasing to 7% in the elderly
  • Men > women (under the age of 80)
  • Incidence and prevalence rises steeply with age
  • Coronary artery disease accounts for 2/3rds of cases in developed countries
242
Q

Aetiology of Heart Failure

A

Aetiology:

  • Coronary artery disease – 2/3rds
  • HTN
  • Valvular disease
  • Myocarditis
  • Infections
  • Toxins: Cocaine, amfetamines, alcohol, chemotherapy
  • Genetic: HOCM, Duchenneʼs muscular dystrophy
  • Tachycardia-induced – AF, Atrial flutter, thyrotoxycosis
243
Q

Precipitating factors for heart failure

A

Precipitating Factors:

  • Acute coronary syndrome
  • Severe HTN
  • Atrial and ventricular arrhythmias
  • Infection
  • Pulmonary emboli
  • Renal failure
  • Medical or dietary non-compliance
244
Q

Pathophysiology and classification of heart failure

245
Q

Clinical features of heart failure

A

Clinical Features:

  • Exertional dyspneoa – most common symptom of systolic HF
  • Orthopnoea & PND
  • Fatigue, muscle weakness and tiredness
  • Ankle swelling
  • Wheeze (cardiac asthma)
  • Night cough
  • Haemotysis (rare)
246
Q

Clinical signs of heart failure

A

Clinical Signs:

  • Tachypnoea
  • Tachycardia
  • Neck vein distension (↑JVP)
  • S3 gallop (3rd heart sound)
  • Cardiac murmur – mitral
  • Lateral displacement of apex beat
  • Course crepitations
  • Pleural effusion
  • Hepatomegaly
  • Hepato-jugular reflux
  • Pitting oedema
247
Q

Investigations and NYHA classification of heart failure

248
Q

Management of heart failure

249
Q

Prognosis of heart failure

A

Prognosis:

  • Poor! Complications include pleural effusion, acute renal failure, acute decompensation of HF
  • 30% of patients in UK are dead at 6 months from diagnosis
  • NYHA class 4 – annual mortality of 40-60%; NYHA class 1-2 – annual mortality of 5-10%
  • Quality of life is reduced to a greater extent than other chronic medical disorders (including arthritis and stroke)
250
Q

Definition of HIV/AIDS

A

Definition:

  • HIV = Chronic infection caused by the Human Immunodeficiency Virus (HIV) - Lentivirus family
  • AIDS = The development of specific opportunistic infections, tumours or presentations with CD4 T count < 200 cells/mm3
251
Q

Epidemiology of HIV/AIDS

252
Q

Aetiology of HIV/AIDS

253
Q

Risk factors for HIV/AIDS

A

Risk Factors:

  • MSM (men who have sex with men)
  • Travellers
  • Unprotected sex
  • IV drug users, tattoos
  • High maternal viral load (vertical transmission)
254
Q

Pathophysiology of HIV/AIDS

255
Q

Classification of HIV/AIDS

256
Q

Clinical features of HIV/AIDS and AIDS-defining Diseases

257
Q

Investigations for HIV/AIDS

258
Q

Differential diagnosis for HIV/AIDS

A
  • EBV,
  • CMV,
  • influenza infection,
  • 2° syphilis – resembles 1° HIV infection symptoms
259
Q

Management of HIV/AIDs

A

*May need to add in info about PrEP etc - need to check up to date guidelines and add to this card

260
Q

Complications and prognosis of HIV

261
Q

Common malignancies in HIV

262
Q

Common opportunistic infections in HIV

263
Q

Life cycle of HIV and drug targets

264
Q

Definition of hyperkalaemia

A

Definition:

  • Normal serum K+ is 3.8-4.9mM
  • Can be difficult to diagnose due to vague symptoms
265
Q

Causes of hyperkalaemia

266
Q

Clinical features and diagnosis of hyperkalaemia

267
Q

Investigations for hyperkalaemia

A

Ix:

  • ABG/VBG – if acidosis suspected
  • Metabolic panel (serum K+, bicarb, UECs)
  • BUN and Creatinine – evaluation of renal function
  • Serum Calcium – hypocalcaemia can exacerbate cardiac dysfunction
  • Glucose level – diabetics
  • Digoxin level –
  • ECG
268
Q

Management of hyperkalaemia

269
Q

Extra information of ion exchange in cells

270
Q

Definition of hypertension

271
Q

Epidemiology of hypertension

A

Epidemiology:

  • 30% of Australians over 25yrs have HTN
  • Males > females
  • Incidence increases with age
  • Increases cardiac mortality by 2-3x
272
Q

Risk factors for hypertension

A

Risk Factors:

  • Obesity
  • Metabolic syndrome
  • DM
  • Family Hx of HTN of CAD
  • Age > 65 yrs
  • Sleep apnoea
  • Black ancestry
  • High alcohol intake
  • Smoking
  • High Na+ intake
273
Q

Aetiology of hypertension

274
Q

Pathophysiology of hypertension

275
Q

Clinical presentation of hypertension

276
Q

Differential diagnosis of hypertension

277
Q

Investigations for hypertension

278
Q

Diagnosis of hypertension

279
Q

Target blood pressure for management of hypertension

280
Q

Non-pharmacological management of hypertension

A

Non-Pharmacological Management:

⁃ Smoking cessation, alcohol reduction

⁃ Regular physical activity

⁃ Moderate sodium restriction and healthy eating plan

⁃ Weight reduction

⁃ Management of Obstructive Sleep Apnoea

281
Q

Pharmacological management of hypertension:

  • Drug class
  • Example
  • Mechanism of action
  • Side effects
282
Q

Complications and prognosis of hypertension

283
Q

Drug targets in control of blood pressure

284
Q

Definition and epidemiology of hypopituitarism disorders

A

Definition:

• The partial or complete deficiency in or more pituitary hormones

Epidemiology:

  • Relatively rare with incidence 4 per 100,000 per year
  • Prevalence of incidental pituitary adenomas found at autopsy is relatively high – 27% of post mortem studies
  • High incidental finding on MRI (10%) – therefore only investigate if symptoms are present
  • No gender, geographical or ethnic trends
285
Q

Aetiology of hypopituitarism disorders

286
Q

Pathophysiology of hypopituitarism disorders

287
Q

Clinical features for hypopituitarism disorders

288
Q

Investigations for hypopituitarism disorders

289
Q

Management of hypopituitarism disorders

290
Q

Complication and prognosis of hypopituitarism disorders

A

Complications:

  • Male/female infertility (variable high)
  • Cushingʼs syndrome – due to corticosteroid over-replacement (variable med)
  • Osteoporosis/arrhythmias (thyroxine over-replacement)
  • GH over-replacement – peripheral oedema, HTN, paraesthesia, hyperlipidaemia and glucose intolerance
  • Testosterone over-replacement – prostatic hypertrophy, hyperlipidaemia

Prognosis:

  • Hypopituitarism is associated with a 1.8 fold higher mortality compared to the general population
  • High death rates due to cardiovascular and cerebrovascular causes (attributed to GH deficiency and increased adiposity/lipid profile)
291
Q

Definition of Infective Endocarditis

A

Definition:

  • Infection of the endocardial surface of the heart
  • The disease may occur as an acute (fulminant) infection, but more commonly runs an insidious course (Subacute Bacterial Endocarditis)
292
Q

Aetiology of infective endocarditis

293
Q

Risk factors for infective endocarditis

A

Risk Factors:

  • Prosthetic heart valve
  • Poor dental hygiene
  • IVD use
  • Soft tissue infection
  • Iatrogenic – dental Rx, cannula, cardiac Sx
  • Immunocompromised
294
Q

Pathophysiology of infective endocarditis

A

Pathophysiology:

  • Damaged vascular endocardium promotes platelet and fibrin deposition
  • These small thrombi allow organisms to adhere and grow –> more fibrin deposition and platelet aggregations
  • More likely to develop where haemodynamic turbulence is greatest
  • Aortic and mitral valves are most commonly affected
  • Right-sided endocarditis is related to IVD use or central venous catheter or temporary pacemaker insertion
  • Acute endocarditis – more likely S. aureus; Sub-acute endocarditis – more likely S. viridans or S. epidermides
295
Q

Clinical features of infective endocarditis

296
Q

Diagnostic criteria for infective endocarditis

297
Q

Investigations for infective endocarditis

A

Investigations:

  • Serial blood cultures – Pts should have 3 sets of blood cultures of 2-3 hours before initiating Abx
  • CXR – evidence of heart failure, multiple emboli or pulmonary infiltrates
  • Echo – Transthoracic or TOE (more sensitive and specific
298
Q

Management of infective endocarditis

A

Management:

  • Empirical Rx – IV Benzylpenicillin + Flucocloxacilin + Gentamycin
  • Difficult to eradicate bacteria from avascular vegetations –> require long Rx
  • Sx – Extensive valve damage, persistant infection, prosthetic valve, fungal endocarditis, serious emboli
299
Q

Prognosis of infective endocarditis

A

Prognosis:

• Mortality ~100% without Rx. Significant morbidity and mortality even with Rx.

300
Q

Features of bone marrow failure

A

Features of BM Failure:

  • Red cells – Anaemia –> lethargy, dyspnoea, pallor
  • White cells – Neutropenia –> Recurrent infections, fever
  • Platelets – Thrombocytopenia –> Bleeding, bruising, purpura
301
Q

Definition of leukemia

302
Q

Epidemiology, Aetiology and Risk factors of Acute Lymphoblastic Leukemia (ALL)

A

Epidemiology and Aetiology:

  • 12% of all leukaemias
  • Most common malignancy in children < 15 years (60%)
  • M > F
  • Peak age of onset is 5 years or 35 years
  • Only 15% occur in adults

Aetiology is unknown.

Risk factors:

Genetic predisposition (FHx),

Down syndrome,

male

303
Q

Pathology of Acute Lymphoblastic Leukemia (ALL)

A

Pathology:

  • Lymphoblasts proliferate uncontrollably in the BM leading to BM failure (pancytopenia)
  • Circulating blasts can infiltrate LNs, liver, spleen, kidneys, testes and CNS, causing organ failure
  • 80% due to B-cell precursors & 20% due to T-cell precursors
304
Q

Clinical features of Acute Lymphoblastic Leukemia (ALL)

A

Clinical Features:

  • Hx can be short (days to weeks) due to disease aggression
  • Fatigue, dizziness, palpitations and dyspnoea - due to BM failure
  • Fever
  • Pallor, echymoses or petechiae - due to anaemia and thrombocytopenia
  • Bone pain (uncommon)
  • Lymphadenopathy
  • Hepatosplenomegaly, unilateral testicular enlargement, renal enlargement - due to infiltration of leukaemic blasts
  • Meningism, nuchal rigidity, papilloedema - due to CNS infiltration of blasts
305
Q

Investigations for Acute Lymphoblastic Leukemia (ALL)

306
Q

Management of Acute Lymphoblastic Leukemia (ALL)

307
Q

Prognosis of Acute Lymphoblastic Leukemia (ALL)

A

Prognosis:

  • Better with decreasing age
  • 5 year survival in children = 70-80%
  • 3 year survival in pts > 60 = 12%
308
Q

Epidemiology, Aetiology and risk factors for Acute Myeloid Leukemia (AML)

309
Q

Pathology of Acute Myeloid Leukemia (AML)

A

Pathology:

  • Accumulation of immature myeloid blast cells in the BM that can lead to BM failure
  • Blast cells can infiltrate the gums, liver, spleen, skin and less commonly CNS
310
Q

Clinical features and classification of Acute Myeloid Leukemia (AML)

311
Q

Investigations for Acute Myeloid Leukemia (AML)

312
Q

Management for Acute Myeloid Leukemia (AML)

313
Q

Prognosis for Acute Myeloid Leukemia (AML)

314
Q

Description, Epidemiology and Aetiology of Chronic Lymphocytic Leukemia (CLL)

315
Q

Clinical features of Chronic Lymphocytic Leukemia (CLL)

A

Clinical Features:

  • Develops and progresses slowly over months to years
  • Majority of pts are asymptomatic in early stages of disease
  • Malaise, weight loss, night sweats (uncommon)
  • Recurrent infections (due to dysfunctional WBCs and hypgammaglobulinaemia)
  • Bleeding or symptoms of anaemia
  • Painless lymphadenopathy (common – 60%)
  • Splenomegaly (common – 50%); sometimes massive
316
Q

Investigations and staging of Chronic Lymphocytic Leukemia (CLL)

317
Q

Management of Chronic Lymphocytic Leukemia (CLL)

318
Q

Prognosis of Chronic Lymphocytic Leukemia (CLL)

A

Prognosis:

  • Depends on staging
  • Median survival of 10 years
  • 10% of CLL, Richter transformation occurs –> high-grade lymphoma and is terminal
319
Q

Description, Epidemiology and Aetiology of Chronic Myeloid Leukemia (CML)

320
Q

Pathology of Chronic Myeloid Leukemia (CML)

321
Q

Clinical features of Chronic Myeloid Leukemia (CML)

A

Clinical Features:

  • Weight loss and night sweats
  • Splenomegaly (75%)
  • Fever, pallor, bruising, SOB (uncommon)
322
Q

Investigations for Chronic Myeloid Leukemia (CML)

323
Q

Management of Chronic Myeloid Leukemia (CML)

A

Rx:

  • Tyrosine kinase inhibitor
  • Cytotoxic therapy
  • IFN
324
Q

Prognosis of Chronic Myeloid Leukemia (CML)

A

Prognosis:

• Chronic phase (2-6 years); TKIs 93% are progression free at 6 years; Transformation to AML (2/3rd) & ALL

325
Q

Definition and epidemiology of Lung Cancer

326
Q

Aetiology of Lung Cancer

327
Q

Risk Factors for Lung Cancer

328
Q

Classification of Lung Cancer

329
Q

Pathophysiology of Lung Cancer

330
Q

Clinical features of Lung Cancer

331
Q

Investigations for Lung Cancer

332
Q

Differential diagnosis of Lung Cancer

A

DDx:

  • Metastatic cancer
  • TB
  • Pneumonia/bronchitis
  • Sarcoidosis
333
Q

Diagnosis, management and prognosis of Lung Cancer

334
Q

Extra info about symptom findings in Lung Cancer

335
Q

Staging and detailed treatment of Lung Cancer

336
Q

Definition of Lymphoma

337
Q

Description, Aetiology and Epidemiology of Hodgkins Lymphoma

338
Q

Pathology of Hodgkins Lymphoma

A

Pathology:

  • Characterised by Reed-Sternberg cells
  • RS cells are large bi/multi nucleated cells with prominent ʻowl eyeʼ nucleoli
  • Progresses via contiguous spread
339
Q

Clinical features of Hodgkins Lymphoma

A

Clinical Features:

  • Painless rubbery LN enlargement – especially cervical, axillary and mediastinal
  • Constitutional B symptoms: Fever, drenching night sweats (25%), weight loss of > 10% body weight over 6 months
  • Pallor and hepatosplenomegaly
340
Q

Ann Arbor Staging for Lymphomas

A

Ann Arbor Staging for Lymphomas:

  • Stage 1 - Restricted to 1 lymph node region
  • Stage 2 - 2> nodal involvement on 1 side of diaphragm
  • Stage 3 - Lymphatic involvement on both sides
  • Stage 4 - Liver, marrow or extensive extra nodal
341
Q

Investigations for Hodgkins Lymphoma

342
Q

Management of Hodgkin’s Lymphoma

A

Rx:

  • Chemotherapy ± radiotherapy – ABVD (Adriamycin (dixirubicin), Bleomycin, Vinblastin, Dacarbazine) regimen
  • Extensive disease (stage 3 & 4) are Rx with chemo alone
  • Relapse Rx with alternative chemo followed by stem cell transplant
343
Q

Prognosis of Hodgkin’s Lymphoma

A

Prognosis:

  • Predominantly good for young people
  • 10 year survival of 97% with early Rx – may relapse > 15 years post Rx
  • Advanced disease has 5 year survival of 50%
344
Q

Description of Non-Hodgkin’s Lymphoma (NHL)

A

Non-Hodgkinʼs Lymphoma:

• Clonal malignancies arising from somatic mutations in lymphocyte progenitor

345
Q

Aetiology and Epidemiology of Non- Hodgkins Lymphoma (NHL)

A

Epidemiology:

  • Accounts for 90% of lymphomas
  • Incidence increases with age
  • Males > females

Aetiology:

• Genetic predisposition, immunosuppression (HIV, transplant recipients), EBV virus (Burkittʼs lymphoma)

346
Q

Pathology of Non-Hodgkin’s Lymphoma

A

Pathology:

  • Subtypes: B cells (70%), T cells & NK cells (30%)
  • 1° site of origin is nodal (80%) and extra nodal (20%) - GIT or bone
  • Type of NHL depends on stage of development of cell before malignancy
347
Q

Clinical features of Non-Hodgkins Lymphoma (NHL)

348
Q

Investigations for Non-Hodgkins Lymphoma (NHL)

349
Q

Management of Non-Hodgkin’s Lymphoma (NHL)

350
Q

Prognosis of Non-Hodgkin’s Lymphoma (NHL)

A

Prognosis:

  • Low grade – indolent course is incurable. Median survival 8-10 years
  • High grade – aggressive and potentially curable (40% are disease-free at 5 years)
351
Q

Definition of a Medical Emergency

A

Definition:

• Medical Emergency: Acute medical event that usually results in harm if untreated and requires urgent medical intervention

352
Q

Vital signs and PACE criteria

353
Q

Examination of medical emergency

354
Q

Description, Aetiology and Examination of coma

355
Q

Essentials of diagnosis for Acute Heart Failure and Pulmonary Oedema

356
Q

Definition and classification of Acute Respiratory Failure

357
Q

Description and classification of Acute Renal Failure

358
Q

Description of Liver Failure

359
Q

Description, causes and clinical signs of Mesenteric Vascular Ischaemia

360
Q

Description, causes and clinical signs of Mesenteric Vascular Ischaemia

361
Q

Description, essentials of diagnosis and causes of aplastic anaemia

362
Q

Description of Severity of Illness Score

363
Q

Definition of Meniere’s Disease

A

Definition:

  • Auditory disease characterised by an episodic sudden onset of vertigo, low frequency roaring tinnitus and sensation of fullness in the ear
  • Vertigo: A sensation of movement, often rotatory, of the patients or their surroundings. Always worse on movement
364
Q

Epidemiology of Meniere’s disease

A

Epidemiology:

  • True incidence and prevalence not known
  • Primarily a disease of adulthood (40s)
  • 50% have a family hx • Females > Males (1.1:1)
  • Degree of bilateral disease varies
365
Q

Risk factors for Meniere’s disease

A

Risk Factors (weak):

  • Recent viral infection
  • Genetic predisposition
  • Autoimmune disease
366
Q

Aetiology of Meniere’s disease

A

Aetiology:

  • Unknown (multifactorial) – Peripheral cause of Vertigo
  • Best model: Endolymphatic malabsorption or overproduction leads to subsequent hydrops (oedema due to fluid accumulation)
367
Q

Pathophysiology of Meniere’s disease

368
Q

Clinical features of Meniere’s Disease

369
Q

Diagnostic Features of Meniere’s Disease

370
Q

Investigations for Meniere’s Disease

371
Q

Differential diagnosis for Meniere’s Disease

A

DDx:

  • Acoustic neuroma (Vestibular Schwannoma)
  • Vestibular neuronitis (labrynthinitis) – Neural degeneration of CN 8 post viral infection
372
Q

Management for Meniere’s Disease

373
Q

Complications and prognosis of Meniere’s Disease

A

Complications:

  • Falls
  • Profound deafness (rare)

Prognosis:

  • Symptoms get worse overtime despite Rx
  • Can go into periods of remission
374
Q

Definition of a migraine

A

Definition:

• A chronic episodic neurovascular disorder characterised by nausea, photophobia, disability and headache

375
Q

Epidemiology of Migraines

A

Epidemiology:

  • Common (10% of population)
  • Females > Males
  • 75% have first attack before age 20
  • RF – FHx, childhood motion sickness, caffeine intake, menstruation, stressful life events
376
Q

Aetiology of migraines

A

Aetiology:

  • Genetic susceptibility – hyper-excitability
  • Environmental exposure – stimulating events
377
Q

Pathophysiology of migraines

378
Q

Classification and triggers of migraines

379
Q

Investigations for migraines and differential diagnosis

A

Ix:

• Clinical diagnosis

DDx

  • Stroke
380
Q

Treatment for migraines

381
Q

Complications and prognosis of migraines

A

Complications:

  • Status migrainosus – lasting > 72 hours
  • Migraine triggered seizures

Prognosis:

• Most with episodic migraine do well with Rx

382
Q

Definition of multiple myeloma

A

Definition:

  • A plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of the BM by plasma cells and the presence of mono-clonal Abs in serum and/or urine
  • Produce a paraprotein (Ig light chain) - IgG (50%) or IgA (20%)
383
Q

Epidemiology and Aetiology of multiple myeloma

A

Epidemiology:

  • Disease of elderly (rare <40) mean of 60y
  • 1% of all malignancies and 10-15% of haematological malignancies
  • Males > females

Aetiology

  • Unknown
384
Q

Pathogenesis of multiple myeloma

385
Q

Clinical features of Multiple Myeloma

A

Clinical Features:

  • Bone pain (vertebral involvement 60%)
  • Symptomatic anaemia – shortness of breath, pallor, fatigue
  • Fevers and infections
  • Renal failure – occurs in 50%! Nephrotic syndrome
  • Hyperviscosity syndrome (rare) – due to paraprotein in blood
386
Q

Investigations for Multiple Myeloma

387
Q

Treatment and prognosis for Multiple Myeloma

A

Rx:

  • Low dose chemo and corticosteroids
  • High dose chemo + stem cell transplant
  • Plasma exchange for hyperviscosty
  • Bisphosphonates to correct hypercalcaemia and improve bone density

Prognosis:

  • Incurable
  • Median survival of 5 years
388
Q

Definition of Multiple Sclerosis

A

Definition:

• An inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 different areas of the CNS, separated in time and space

389
Q

Epidemiology of Multiple Sclerosis

390
Q

Aetiology and risk factors for Multiple Sclerosis

A

Aetiology:

  • Not completely understood
  • Environmental factors – viral exposure (EBV), toxin exposure, UV light exposure
  • Genetic susceptibility (20-40x more likely if in a 1° relative)

Risk Factors:

  • Female sex and northern latitude (strong)
  • Genetic factors, smoking, VIt D deficiency, Autoimmune disease
391
Q

Pathophysiology of Multiple Sclerosis

392
Q

Classification of Multiple Sclerosis

A

Classification:

  • Relapsing remitting (85%)
  • Secondary progressive: >55% of RRMS will progress within 10 years to progressive
  • Primary progressive (15-20%). Gradual progressive symptoms from onset
  • Relapsing progressive: Mixture of relapsing and progressing
393
Q

Clinical features of Multiple Sclerosis

394
Q

Signs of Multiple Sclerosis

A

Signs:

  • Swelling of the optic disc (optic neuritis)
  • Uthoffʼs phenomenon (exacerbated by increased temp)
  • Afferent pupillary defect
395
Q

Investigations for Multiple Sclerosis

396
Q

Diagnosis of Multiple Sclerosis

A

Diagnosis:

• 2 or more lesions disseminated in time and space (by MRI)

397
Q

Differential diagnosis of Multiple Sclerosis

A

DDx

  • Myelopathy due to cervical spondylosis – pt may show signs and symptoms below the neck
  • Neuromyolitis optica (Devicʼs disease) – recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis)
  • Vit 12 deficiency – numbness, fatigue and possible memory loss
  • Infection – Lyme disease, associated myelopathy)
398
Q

Management of Multiple Sclerosis

399
Q

Complications and prognosis of Multiple Sclerosis

A

Complications:

  • UTI (high)
  • Osteopenia/osteoporosis – poor intake of Ca2+, Vit D or use of corticosteroids
  • Depression
  • Visual impairment
  • Erectile dysfunction
  • Cognitive impairment (medium)

Prognosis:

  • No cure
  • Disease will get progressively worse
  • Current Rx only aimed at shortening length of episode NOT disease course
  • 5-10 years shortened life expectancy
400
Q

Side effects of steroids

401
Q

Definition of Osteoarthritis

A

Definition:

  • A non-inflammatory degenerative disorder that affects mainly the weight-bearing joints (e.g. hips and knees)
  • Mainly a disease of the cartilage, which becomes progressively eroded and thinned

Epidemiology:

  • Most common joint condition and affects ~ 50% of the population by 60 years
  • Females > males, esp. postmenopausal
402
Q

Aetiology and risk factors of osteoarthritis

403
Q

Pathophysiology of osteoarthritis

404
Q

Clinical features of osteoarthritis

405
Q

Investigations for osteoarthritis

406
Q

Management for osteoarthritis

407
Q

Complications and prognosis for Osteoarthritis

A

Complications:

  • Functional decline and inability to perform activities of daily living (long-term high)
  • Spinal stenosis in cervical or lumbar OA (medium)
  • NSAID-related GIT bleeding

Prognosis:

  • Chronic slowly progressive disease that is almost ubiquitous with old age
  • No cure
  • Despite Rx, most patients have some degree of pain and functional limitation affecting their quality of life
408
Q

Osteoarthritis Vs Rheumatoid Arthritis

409
Q

Definition of hyperparathyroidism

A

Hyperparathyroidism Definition:

• Results from excess PTH in circulation, which consequently increases serum Ca2+ levels

410
Q

Aetiology of Hyperparathyroidism

411
Q

Pathophysiology of Hyperparathyroidism

412
Q

Clinical features of Hyperparathyroidisim

413
Q

Investigations for hyperparathyroidism

414
Q

Management for Hyperparathyroidism

415
Q

Description of Familial Hypocalciuric Hypercalcaemia

416
Q

Definition of Hypoparathyroidism

A

Hypoparathryoidism Definition:

• Results from inadequate secretion of PTH

417
Q

Aetiology of Hypoparathyroidism

418
Q

Clinical features of Hypoparathyroidism

419
Q

Investigations for Hypoparathyroidism

A

Ix:

  • Serum calcium = low
  • Phosphate = high
  • PTH = low or normal
  • Magnesium = low (exacerbates hypocalcaemia and impairs PTH)
  • UECs – normal
  • ECG = prolonged QT
420
Q

Management of Hypoparathyroidism

A

Rx:

  • Severe hypocalcaemia = IV Ca + Mg2+ (if depleted) + correction of respiratory alkalosis
  • Asymptomatic = Oral calcium and low dose Vit D
  • Ongoing – Oral calcium + Vit D supplements + oral Mg2+, specific Rx of underlying cause
421
Q

Complications of Hypoparathyroidism

A

Complications:

  • Dystrophic calcification – chronic hypocalcaemia can lead to calcification of tendons, blood vessels, brain, pinna of ear and scars (long-term high)
  • Cataracts (long term med)
422
Q

Description of Pseudohypoparathyroidism

A

Pseudohypoparathyroidism:

  • An extremely rare genetic condition that causes resistance to PTH
  • Pts have low Ca2+ and high PO4 and PTH is appropriately high but end-organs like the kidneys and bone are resistant to its effects
  • It is associated with intellectual impairment, short stature and round face
423
Q

Description of Pseudpseudohypoparathyroidism:

A

Pseudpseudohypoparathyroidism:

  • Inherited disorder that is similar to pseudohydoparathyroidism but with normal calcium levels
  • PTH resistance only affects the bone with a normal renal response
424
Q

PTH Homeostasis

425
Q

Definition of Parkinson’s Disease

426
Q

Epidemiology of Parkinson’s Disease

427
Q

Aetiology of Parkinson’s Disease

428
Q

Pathophysiology of Parkinson’s Disease

429
Q

Clinical Features of Parkinson’s Disease

430
Q

Investigations for Parkinson’s Disease

A

Ix:

  • Dopaminergic agent trial – performed if diagnosis is in question and symptoms should improve
  • MRI brain – normal in most pts with Parkinsonʼs disease
  • Neurological special testing
431
Q

Management of Parkinson’s Disease

432
Q

Complications and prognosis of Parkinson’s Disease

433
Q

Definition and epidemiology of Peptic Ulcer Disease

434
Q

Aetiology of Peptic Ulcer Disease

435
Q

Pathophysiology of Peptic Ulcer Disease

436
Q

Clinical features of Peptic Ulcer Disease

437
Q

Investigations and diagnosis of Peptic Ulcer Disease

438
Q

Differential diagnosis of Peptic Ulcer Disease

A

DDx:

  • GORD
  • Oesophageal cancer
  • Stomach cancer
  • Functional dyspepsia
  • Acute pancreatitis
439
Q

Management of Peptic Ulcer Disease

440
Q

Complications and prognosis of Peptic Ulcer Disease

441
Q

Definition of Pneumonia

A

Definition:

• Pneumonia = Inflammation of the pulmonary parenchyma with consolidation or interstitial lung infiltrates on CXR

442
Q

Epidemiology of Pneumonia

A

Epidemiology:

  • Incidence is 1 in 100 but risk increases with age
  • Children < 4yrs, elderly (>65 yrs) and the immunocompromised are most at risk
  • Seasonal variation
  • Bacterial causes are the most common
443
Q

Aetiology of Pneumonia

A

Aetiology:

  • Bacteria
  • Viruses
  • Mycoplasma
  • Fungus
444
Q

Risk factors of Pneumonia

A

Risk Factors:

  • Age: < 4yrs or > 65 yrs
  • Recent resp infection
  • Smoking and heavy alcohol
  • Immunosuppressed (AIDs or Rx with cytotoxic drugs
  • Intubation
  • Recent travel
  • Chronic diseases: Asthma, COPD & heart disease
445
Q

Classification of Pneumonia

446
Q

Pathophysiology of Pneumonia

447
Q

Clinical Features of Pneumonia

448
Q

Differential diagnosis of Pneumonia

A

DDx:

  • Lung Cancer
  • TB
  • PE
  • Pulmonary haemorrhage
  • Exacerbation of COPD
449
Q

Investigations for Pneumonia

450
Q

Severity assessment for Pneumonia

451
Q

Management of Pneumonia

A

1st Line:

  • Antibiotic Treatment:
  • Start broad-spectrum empirical antibiotics if severe
  • Macrolide or Tetracycline are used to Rx atypical infections (mycoplasma etc. & covers S. pneumoniae)
  • Oxygen - PaO2 > 8 or > 94% saturation
  • IV fluids - Anorexia, volume depletion, shock
  • Analgesia if pleurisy
  • Follow up CXR at 6 weeks post treatment
452
Q

Treatment summary of different types of Pneumonia

453
Q

Complications of Pneumonia

454
Q

Prognosis of Pneumonia

455
Q

Chest Xrays for Pneumonia

A

Google images to explore what it looks like

456
Q

Definition and epidemiology of Liver Cirrhosis

457
Q

Risk factors of Liver Cirrhosis

A

Risk Factors:

  • IV drug use
  • Chronic alcohol consumption
  • Unprotected intercourse
  • Obesity
  • Blood transfusions
  • Tattooing
458
Q

Aetiology of Liver Cirrhosis

459
Q

Pathophysiology of Liver Cirrhosis

460
Q

Classification of Liver Cirrhosis

461
Q

Clinical Features of Liver Cirrhosis

462
Q

Incomplete cards for LIVER Cirrhosis - need to be added - gobi’s notes are incomplete for investigations + management

463
Q

Definition and epidemiology of Psoriasis

A

Definition:

  • Chronic inflammatory skin disease characterised by well defined erythematous plaques with silvery scales, affecting the extensor surfaces of the limbs, elbows, knees & scalp
  • Disease is typically life-long, with fluctuating courses of exacerbations and remissions

Epidemiology:

  • Affects 2% of the population
  • Mean age of onset is 28 years
  • M = F
  • Asians have a very low prevalence
  • 10% have psoriatic arthritis
464
Q

Aetiology of Psoriasis

A

Aetiology:

  • Unknown. Multifactorial
  • Genetic – genetic predisposition and strong FHx
  • Immunological – associated with increased T-cell activity in the skin
  • Infection – Guttate psoriasis is linked with post-streptococcal pharyngitis
  • Stress, trauma and smoking (weaker associations)
465
Q

Pathophysiology of Psoriasis

466
Q

Clinical features and investigations for Psoriasis

467
Q

Management of Psoriasis

468
Q

Complications and prognosis for Psoriasis

469
Q

Definition and epidemiology of Pulmonary Embolism

A

Definition:

  • Venous thromboembolism = Encompasses both DVT and PE
  • PE = Obstruction of the pulmonary arteries due to embolisation of a venous thrombus
  • Potentially life-threatening and frequently under-diagnosed

Epidemiology:

  • One of the most common cardiovascular conditions (3rd most common in USA)
  • Incidence is 1 in 1000
  • Occurs in 50% of DVT cases (symptomatic or asymptomatic)
  • M = F
  • Accounts for 10% of maternal deaths
470
Q

Risk factors of Pulmonary Embolism

A

Risk Factors:

  • increasing age
  • Diagnosis of DVT
  • Sx within last 2 months
  • Bed rest > 5 days
  • Previous DVT
  • Active malignancy
  • Trauma/recent fracture
  • Pregnancy
  • Thrombophilia
471
Q

Aetiology of Pulmonary Embolism

472
Q

Pathophysiology of Pulmonary Embolism

473
Q

Clinical Features of Pulmonary Embolism

474
Q

Investigations for Pulmonary Embolism

475
Q

Management of Pulmonary Embolism

476
Q

Complications and Prognosis of Pulmonary Embolism

477
Q

Notes about calculating renal function

478
Q

Definition of Renal Osteodystrophy

479
Q

Pathophysiology of Renal Osteodystrophy

480
Q

Investigations for Renal Osteodystrophy

481
Q

Types of Renal Osteodystrophy

482
Q

Consequences of Renal Osteodystrophy

483
Q

Management of Renal Osteodystrophy

484
Q

Definition of Respiratory Failure

A

Definition:

• Dysfunction of gas exchange resulting in abnormalities in O2 or CO2, enough to impair the function of vital organs

485
Q

Classification of Respiratory Failure

486
Q

Clinical Features of Respiratory Failure

487
Q

Investigations for Respiratory Failure

A

Ix:

  • ABG
  • FBC, UECs, CRP
  • Blood cultures if pyrexic
  • CXR + ECG
  • CTPA if PE suspected
488
Q

Management of Respiratory Failure

489
Q

Prognosis of Respiratory Failure

A

Prognosis:

  • Dependent on underlying pathophysiology
  • COPD no Rx by ventilator = Good
  • ARDS associated with seticaemia = Poor (90% mortality) • Poorer outcomes for pts managed on ventilators
490
Q

Definition of Restrictive Lung Disease

A

Definition:

• A heterogenous group of conditions that are characterised by reduced lung volumes, either due to alterations in lung parenchyma or because of disease of the chest wall, pleura or neuromuscular apparatus

Epidemiology:

• Most common cause is occupational exposure

491
Q

Aetiology/Classification of Restrictive Lung Disease

492
Q

Pathophysiology of Restrictive Lung Disease

493
Q

Clinical Features of Restrictive Lung Disease (and Acute Respiratory Distress Syndrome)

494
Q

Investigations for Restrictive Lung Disease

495
Q

Management of Restrictive Lung Disease

A

Rx:

  • Corticosteroids +/- other immune suppressing drugs (methotrexate, cyclosporins) - not
  • O2 therapy for symptomatic patients
  • Pulmonary rehab – to improve endurance, lung efficiency
  • Lung transplantation
496
Q

Categories of Pulmonary Disease

497
Q

Respiratory function tests in health and disease

498
Q

Definition of Rheumatoid Arthritis

499
Q

Epidemiology of Rheumatoid Arthritis

A

Epidemiology:

  • Affects 1% of the population
  • 2nd most common arthritis after osteoarthritis
  • Age 30-50y
  • Female > Males (3:1) - premenopausal particularly
  • Can occur at any age, even in childhood
500
Q

Risk Factors of Rheumatoid Arthritis

A

Risk Factors:

  • Females (pre-menopause)
  • Age > 30
  • Family Hx
  • Smoking
  • Other autoimmune diseases
501
Q

Aetiology of Rheumatoid Arthritis

A

Aetiology - Unknown:

  • Multifactorial
  • Genetic - accounts for 60% susceptibility (HLA-DR4)
  • Family Hx - monozygoitc twins = 15%
  • Females
502
Q

Symptoms and Clinical Manifestations of Rheumatoid Arthritis

503
Q

Pathogenesis of Rheumatoid Arthritis

504
Q

Investigations for Rheumatoid Arthritis

505
Q

Management of Rheumatoid Arthritis

506
Q

Complications and Prognosis of Rheumatoid Arthritis

507
Q

Drugs (MOA + side effects) used in Rheumatoid Arthritis

508
Q

Description of Seronegative Spondylo-Arthopathies

509
Q

Definition and epidemiology of Ankylosing Spondylitis

A

Definition:

• Chronic progressive inflammatory arthropathy predominantly affecting the spine and sacroiliac joints

Epidemiology:

  • Males > females (3:1)
  • Age before 40 years
  • Affects around 1 in 2000
510
Q

Aetiology and Pathology of Ankylosing Spondylitis

A

Aetiology:

• Genetic predisposition (HLA-B27 mutation in >90%) + unknown triggers

Pathology:

  • White cell infiltration of ligament insertions
  • Erosion of bone
  • Syndesmophytes lay down new bone –> Fuse joints - Esp. sacro-iliac joint
511
Q

Clinical features of Ankylosis Spondylitis

512
Q

Investigations and Treatment for Ankylosing Spondylitis

513
Q

Complications and Prognosis of Ankylosing Spondylitis

514
Q

Definition, Epidemiology and Aetiology of Psoriatic Arthritis

A

Psoriatic Arthritis:

Definition:

• Chronic inflammatory joint disease that is associated with psoriasis

Epidemiology:

  • Occurs in 10-15% of pt with psoriasis
  • M = F • Indianʼs esp. effected
  • Rarely precedes psoriasis
  • Any age 20-30s; 50-60s

Aetiology:

  • Unknown
  • Genetic predisposition (HLA markers)
  • Some precipitated by trauma
515
Q

Clinical Features of Psoriatic Arthritis

516
Q

Investigations for Psoriatic Arthritis

517
Q

Management of Psoriatic Arthritis

518
Q

Complications and prognosis of Psoriatic Arthritis

519
Q

Description, Aetiology and Management of Enteropathic Arthropathies

520
Q

Definition, Epidemiology and Aetiology of Reactive Arthritis

A

Reactive Arthritis:

Definition:

• Inflammatory arthritis that occurs after an exposure to certain GIT and GUT infections

Epidemiology:

  • Males > females (10:1)
  • Affects young adults

Aetiology:

  • Genetic factors (HLA-B27 mutation)
  • Bacterial triggers include:

⁃ Salmonela

⁃ Yersinia

⁃ Campylobacter

⁃ Shigella

⁃ Chlamydia trachomatis

521
Q

Clinical Features of Reactive Arthritis

522
Q

Clinical Features of Reactive Arthritis (body systems review)

523
Q

Investigations for Reactive Arthritis

524
Q

Management of Reactive Arthritis

525
Q

Complications and prognosis of reactive arthritis

526
Q

Definition of Stroke

527
Q

Epidemiology of Stroke

528
Q

Aetiology of Stroke

529
Q

Risk Factors for Stroke

530
Q

Pathophysiology of Stroke

531
Q

Clinical Features of Stroke

532
Q

Clinical Features according to Stroke sub-type

533
Q

Investigations for Stroke

534
Q

Management of Stroke

535
Q

Prevention of Stroke

536
Q

Overview of locating site of injury in Stroke

537
Q

Prognosis of Stroke

538
Q

Definition of Syncope

539
Q

Causes of Syncope

540
Q

Urgent consideration of Syncope

541
Q

Definition, key points and main mechanisms of Thrombocytopenia

542
Q

Epidemiology of Thrombocytopenia

543
Q

Clinical Features of Thrombocytopenia

544
Q

Investigations and management of Thrombocytopenia

545
Q

Idiopathic Thrombocytopenia Purpura (ITP):

  • Definition
  • Epidemiology
  • Aetiology
  • Associated Conditions
546
Q

Clinical Features of Idiopathic Thrombocytopenia Purpura (ITP)

A

Clinical Features:

  • Insidious onset
  • Bleeding, easy bruising, epistaxis, menorrhagia
  • Absent lymphadenopathy, hepatoplenomegaly or systemic symptoms
547
Q

Investigations for Idiopathic Thrombocytopenia Purpura (ITP)

A

Ix:

  • FBC – low Plt
  • Peripheral blood smear – normal with low platelet count
  • BM biopsy – increased megakaryocytes; no evidence of malignancy
  • Consider HIV serology, Hep B and C serology, TFTs, Helicobactor antigen testing
548
Q

Management of Idiopathic Thrombocytopenia Purpura (ITP)

549
Q

Prognosis for Idiopathic Thrombocytopenia Purpura (ITP)

A

Prognosis:

  • Most pts respond to 1st line corticosteroids
  • Additional Rx required in 50%
  • Prognosis is good with only 2-5% being refractory to medical Rx & requiring splenectomy
550
Q

Definition and Epidemiology of Thyrotoxicosis

A

Definition:

• Condition resulting from raised levels of free T3 and T4

Epidemiology

  • Affects around 0.1% of males and 1% of females
  • Females > males (10-1)
551
Q

Aetiology of Thyrotoxicosis

552
Q

Clinical Features of Thyrotoxicosis

553
Q

Investigations for Thyrotoxicosis

554
Q

Management of Thyrotoxicosis

555
Q

Thyrotoxic Crisis (“Thyroid Storm”)

556
Q

Definition and Epidemiology of Hypothyroidism

A

Definition:

• Results from a deficiency of T4 or T3

Epidemiology:

  • Incidence is 2% in women
  • Females > males (5:1)
557
Q

Aetiology of Hypothyroidism

558
Q

Clinical Features of Hypothyroidism

559
Q

Investigations for Hypothyroidism

560
Q

Management of Hypothyroidism

561
Q

Myxoedema Coma

562
Q

Definition of Tuberculosis

563
Q

Epidemiology of Tuberculosis

564
Q

Aetiology of Tuberculosis

565
Q

Pathophysiology of Tuberculosis

566
Q

Clinical Features of Tuberculosis

567
Q

Investigations for Tuberculosis

568
Q

Management of Tuberculosis

569
Q

Complications and Prognosis of Tuberculosis

570
Q

Definition and Epidemiology of UTIs and Pyelonephritis

571
Q

Aetiology of UTIs and Pyelonephritis

572
Q

Risk Factors for UTIs and Pyelonephritis

573
Q

Precipitating Factors for UTIs and Pyelonephritis

574
Q

Pathophysiology and Classification of UTIs and Pyelonephritis

575
Q

Clinical Features of UTIs and Pyelonephritis

576
Q

Investigations for UTIs and Pyelonephritis

577
Q

Management of UTIs and Pyelonephritis

578
Q

Prevention of UTIs and Pyelonephritis

579
Q

Complications and Prognosis of UTIs and Pyelonephritis

580
Q

Definition and Epidemiology of Valvular Heart Disease

A

Definition:

• Any disease that affects any of the 4 heart valves

Epidemiology:

• Left sided valvular heart disease and tricuspid regurgitation are the most common

581
Q

Principal causes of valve disease

582
Q

Mitral Stenosis:

  • Pathophysiology
  • Clinical Features
  • Management
583
Q

Mitral Regurgitation:

  • Key points
  • Clinical Features
  • Management
584
Q

Aortic Stenosis:

  • Key points
  • Pathophysiology
  • Clinical Features
  • Management
585
Q

Aortic Regurgitation:

  • Key Points
  • Pathophysiology
  • Clinical Features
  • Management
586
Q

Tricuspid Regurgitation:

  • Key points
  • Clinical Features
  • Management
587
Q

Key points of Pulmonary Valve Lesions

P2 (5 decks)

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