Medicine Flashcards
Describe the laboratory features of haemochromatosis
Low TIBC, high ferritin, high transferrin saturation
Describe Peutz-Jeghers syndrome
AD condition
Clinical features
> Hamartomatous polyps in GI tract (causing intussusception)
> can lead to SBO
> Pigmented freckles on the lips, face, palms and soles
Describe the management of BPH
First-line: tamsulosin (alpha 1 antagonist)
> adverse effects: dizziness, postural hypotension
Second-line: finasteride (5 alpha reductase inhibitor) - takes 6 months to see results
> adverse effects: ED, reduced libido, gynaecomastia
anti-muscarinics such as tolterodine or darifenacin may be tried
Transurethral resection of the prostate (TURP) if medical management fails
Describe balanitis xerotica obliterans
Causes multiple itchy hyperkeratotic lesions on foreskin and glans
features
- dysuria
- reduction in sensation of glans
- can cause phimosis due to scarring
Describe the clinical features associated with Hodgkin’s lymphoma
Bimodal age distribution: peaks around 20-25 and 80 years
Usually B cell origin
> nodular sclerosing is the most common type
> lymphocyte depleted is the most aggressive
> lymphocyte predominant has best prognosis
Associated with history of glandular fever (EBV infection)
Presentation
> Asymmetrical painless lymphadenopathy (usually single rubbery lymph node in cervical, axillary or inguinal region) - may become painful after alcohol ingestion
> B symptoms: weight loss, sweating, fever, pruritis and general lethargy
Diagnosis
> excisional node biopsy: Reed-Sternberg cells (large malignant B cells).
> staging: PET-CT
Spread - Ann Arbor system
I = one node region involved
II = 2+ ipsilateral regions
III = bilateral node involvement
IV = extranodal disease
> Suffix “A” (B symptoms absent) or “B” (B symptoms present).
Management
> Early stage disease: radiotherapy alone
> Advanced: radiotherapy + chemotherapy
Describe the clinical features associated with Klinefelter’s syndrome
Karyotype 47XXY
Primary hypogonadism in patients with male external genitalia
Examination
> tall stature, low-volume testes, sparse pubic hair, and gynecomastia
Hypergonadotrophic hypogonadism
> High FSH and LH
> Low testosterone
Semen analysis - azoospermia
> infertility
Describe the mechanism of action of DPP-4 inhibitors such as sitagliptin
Reduce peripheral breakdown of incretins e.g. GLP-1
Describe allergic bronchopulmonary aspergillosis and its management
Due to allergy to Aspergillus spores
clinical features
- asthma
- bronchiectasis
investigations
- eosinophilia
- raised IgE
- sputum microscopy - eosinophils and fungal hyphae
- CXR - proximal bronchiectasis, consolidation
Treatment
- Oral prednisolone
- Oral itraconazole (second-line)
Describe Heberden’s nodes, Bouchard’s nodes and Oslers nodes
Bouchard’s: PIP joints, osteoarthritis
Heberden’s: DIP joints, osteoarthritis
Oslers nodes: tender purple/red raised lesions with pale centre, shows immune complex deposition. Causes: infective endocarditis, SLE, gonorrhoea, typhoid, haemolytic anaemia.
Describe Chronic Myeloid Leukaemia (CML)
BCR-ABL - t(9:22) - Philadelphia chromosome
Presentation 60-70 years of age
clinical features
- anaemia
- weight loss
- sweating
- splenomegaly
investigations
- bloods: increase in granulocytes, thrombocytosis
May undergo blast transformation - AML in 80%, ALL in 20%
Management
> Tyrosine kinase inhibitor (TKI) - imatinib
> Hydroxyurea
> Interferon-alpha
> Allogeneic bone transplant
Describe small bowel bacterial overgrowth syndrome (SBBOS)
Features
> chronic diarrhoea
> bloating, flatulence
> abdominal pain
Diagnosis
> hydrogen breath test
> small bowel aspiration and culture
Management
> correction of underlying disorder
> antibiotic therapy
» rifaximin
» Co-amoxiclav / metronidazole
Which enzyme must be checked before starting azathioprine or mercaptopurine therapy?
TPMT: thiopurine methyltransferase
Describe the clinical features of superior vena cava obstruction
Causes
- External pressure (e.g. malignancy, usually lung)
- Thrombus
- Direct tumour invasion
Clinical features
> facial flushing / swelling
> pain worsened leaning forward
> distended neck veins / bulging facial veins
> blurred vision
> papilloedema on fundoscopy
> Pemberton sign: bilateral arm elevation causes facial plethora
Treatment
- Sitting the patient up
- Oxygen
- Stat dose of dexamethasone
- Definitive management: SVC stenting, radiotherapy and chemotherapy
Describe the features of organophosphate insecticide poisoning
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Management - atropine
Describe features associated with different gastroenteritis-causing bacteria
Staphylococcus aureus: severe vomiting after a short incubation period (30 minutes - 8 hours)
> Symptoms usually resolve within two days
Escherichia coli: incubation period of 3-4 days. Causes diarrhoea that usually becomes bloody, lasting up to a week. Common amongst travellers.
Giardia: watery diarrhoea at least 5 days after infection.
Salmonella: diarrhoea and fever; symptoms usually occur between 6 hours - 6 days
Shigella: fever and (sometimes bloody) diarrhoea begin1-2 days after infection
Cholera: profuse, watery diarrhoea
> Severe dehydration resulting in weight loss
Campylobacter: flu-like prodrome followed by crampy abdominal pains, fever and diarrhoea which may be bloody
> Complications include Guillain-Barre syndrome
Bacillus cereus: vomiting within 6 hours, stereotypically due to rice.
Amoebiasis: gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks
Describe the differences between pneumonia caused by different bacteria
Community acquired pneumonia (CAP) :
> Streptococcus pneumoniae (80% of cases) - associated with cold sores
> Haemophilus influenzae
> Staphylococcus aureus: commonly after influenza infection
> atypical pneumonia
> Mycoplasma pneumoniae: dry cough, erythema multiforme, reticulo-nodular shadowing on CXR, RBC agglutination (haemolytic anaemia)
> can cause immune-mediated neurological disease
> serology is diagnostic
> viruses
Klebsiella pneumoniae: alcoholics, cavitating upper lobe pneumonia, red currant jelly sputum, empyema
Describe the diagnosis and management of IBS
Clinical diagnosis - diarrhoea/constipation, mucus in stool, abdominal discomfort relieved by defaecation, normal blood tests.
First-line - according to predominant symptom
> pain: antispasmodic agents
> constipation: laxatives but avoid lactulose
> if not responding to conventional laxatives try linaclotide
> diarrhoea: loperamide is first-line
Second-line pharmacological treatment
> low-dose tricyclic antidepressants (e.g. amitriptyline)
> sertraline
Psychological interventions - CBT, hypnotherapy
List and describe transfusion reactions as well as their management
acute haemolytic
> fever, abdo/lumbar pain, tachycardia, hypotension, tachypnoea
> caused by ABO incompatible blood
- management: stop transfusion, check patient identity/name, send blood for direct Coombs test, repeat typing and cross-matching. Supportive care (fluid resuscitation)
non-haemolytic febrile reaction
> fever and chills but no systemic upset
- management: slow/stop transfusion; paracetamol; monitor
minor allergic reaction
> pruritus, urticaria
- management: temporarily stop transfusion, give antihistamine, monitor
allergic/anaphylaxis
> hypotension, dyspnoea, wheezing, angioedema
- management: stop transfusion, IM adrenaline, oxygen, fluids
infective
transfusion-related acute lung injury (TRALI): hypoxia, pulmonary infiltrates, fever, hypotension, normal/unchanged JVP
- normal pulmonary capillary wedge pressure (PCWP systolic 7mmHg, diastolic 10mmHg)
- management: stop transfusion. O2, IV fluids & consider escalation of care
transfusion-associated circulatory overload (TACO): pulmonary oedema, hypertension, raised JVP, afebrile, S3 present
- raised PCWP
- management: slow/stop transfusion, consider IV diuretics and O2
other: hyperkalaemia, iron overload, clotting
First step is stopping transfusion
IgA deficiency increases risk of anaphylactic transfusion reactions
Describe autosomal dominant polycystic kidney disease (ADPKD)
Two disease loci have been identified, PKD1 and PKD2, which code for polycystin-1 and polycystin-2 respectively
Screening - renal USS
Clinical features
- Extensive cysts, enlarged kidneys
- Haematuria, abdominal pain, recurrent UTIs, renal failure
- extra-renal manifestations
> mitral regurgitation, mitral valve prolapse
> cerebral berry aneurysms
> hepatic, splenic, pancreatic, ovarian and prostatic cysts
> colonic diverticula
Management
- tolvaptan (vasopressin receptor 2 antagonist)
Describe Q fever
Caused by Coxiella burnetti, a rickettsia
Features: farmer, fever, transaminitis
also atypical pneumonia and culture-negative infective endocarditis
contact with sheep, cattle
management - doxycycline
Describe sideroblastic anaemia
feature
- Hypochromic microcytic anaemia
- High ferritin iron and transferrin saturation
- Basophilic stippling of red blood cells
Congenital cause: delta-aminolevulinate synthase-2 deficiency
Acquired causes
myelodysplasia
alcohol
lead
anti-TB medications
symptoms of anaemia + hepatosplenomegaly
Management - supportive, treat underlying cause, pyridoxine may help
Describe an Addisonian crisis
Lab features: hyponatraemia, hyperkalaemia, hypoglycaemia
clinical features
- circulatory shock with severe hypotension
- unexplained pyrexia
- nausea and vomiting
- abdominal pain
- diarrhoea
- muscle cramps
Can be precipitated by
- sepsis or surgery causing exacerbation of chronic insufficiency
- adrenal haemorrhage e.g. Waterhouse-Friderichsen syndrome (fulminant meningococcaemia)
- steroid withdrawal
Management
- hydrocortisone 100mg IM or IV, no fludrocortisone required as high steroids exert mild mineralocorticoid effect
- 1 litre saline over 30-60 mins or with dextrose if hypoglycaemic
Describe the indications for LTOT in COPD patients
COPD - LTOT if pO2 of 7.3 - 8 kPa AND one of the following:
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension
Describe seborrhoeic dermatitis
clinical features
- erythematous, greasy, pruritic lesions
- affect the scalp, glabella, nasolabial folds, posterior auricular skin, and anterior chest
> due to over-proliferation of the Malassezia furfur fungus
> complications: otitis externa, blepharitis
> linked to Parkinson’s disease and HIV