MEDICINE Flashcards
Chronic myeloid leukemia is associated with
Philadelphia chromosome
Presentation chronic myeloid leukemia
Presentation (60-70 years)
anaemia: lethargy
weight loss and sweating are common
splenomegalymay be marked → abdo discomfort
an increase in granulocytes at different stages of maturation +/- thrombocytosis
decreased leukocyte alkaline phosphatase
may undergo blast transformation (AML in 80%, ALL in 20%)
Light’s criteriastate that a pleural effusion is an exudate if:
-Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid protein divided by serum protein >0.5
ITP labs
Isolated thrombocytopenia [low platelets]
ITP management
first-line treatment for ITP is oral prednisolone
pooled normal human immunoglobulin (IVIG) may also be used
it raises the platelet count quicker than steroids, therefore may be used if active bleeding or an urgent invasive procedure is required
Features of myeloma
CRABBI
High Ca
Renal impairment
Anaemia
Bleeding
Bony pain/ fractures
Infectiom
Roleux formation
Heinze bodies
Howell jolly
Schistocytes
Roleux formation - myeloma
Heinze bodies - G6PD
Howell jolly - post splenectomy / hyposplenic disorder
Schistocytes - fragmented rbcs seen in metallic hv or hemolytic anemia
Nefrotic syndrome in children and young adults
Minimal change glamorillo nefrightens
Mx salicylate od
urinary alkalinization with IV bicarbonate
haemodialysis
Von Willebrand Disease features
Most common inherited bleeding disorder
Autosomal dominant
epistaxis and menorrhagia
VWD labs
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
What are the high risk characteristics of symptomatic pneumothorax?
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
Management of pneumothorax
<2cm - Conservative
> 2cm ambulatory device or needle drajn
High risk characteristics and > 2cm- chest drain
Most common organisms isolated from patients with bronchiectasis:
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
CA125
CA199
CA153
CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer
CA125
CA199
CA153
CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer
Bleomycin side effects
Lung fibrosis
Anthracyclines (doxorubicin)
Cardiomyopathy
Vincristine side effects
Peripheral neuropathy
Carcinormbryonic antigen associated with
Colorectal cancer
Monitoring parameters for statins
LFTs at baseline, 3 months and 12 months
Monitoring parameters for ACEi
U&E prior to treatment
U&E after increasing dose
U&E at least annually
Amiodarone monitoring parameters
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
Peutz-Jeghers syndrome features
Autosomal dominant condition
hamartomatous polyps in the gastrointestinal tract
pigmented freckles
What is beta thalassemia
disorders characterised by a reduced production rate of either alpha or beta chains
thalassemia major, thalassemia intermedia, and thalassemia minor.
Disproportionate microcytic anaemia - think beta-thalassaemia trait
Hypersplenomegaly and gallstones. mostly found in thalassemia major and intermedia patients.
beta thalassemia major usually present within the first two years of life with severe anaemia, poor growth, and skeletal abnormalities during infancy.
What size the P450 system
Enzymes that metabolise stuff
Inducers increase activity leading to increased clearance of certain drugs
Inhibitors decrease clearance of drugs
P450 inducers
CRAP GPs - because crap GPs induce rage ;)
Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, Sulphonylureas (also St. John’s Wort and smoking)
P540 inhibitors
SICKFACES.COM - I remember the alcoholic binge part because a hangover = sick face!
Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Alcohol (binge), Chloramphenicol, Erythromycin, Sulphonamides, Ciprofloxacin, Omeprazole, Metronidazole
When is acetylcysteine used in paracetamol OD
Plasma paracetamol concentration above graph
there is a staggered overdose
patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol even if the plasma-paracetamol concentration is not yet available
patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
Management b12 deficiency
if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months
if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord
Features b12 deficiency
macrocytic anaemia
sore tongue and mouth
neurological symptoms
the dorsal column is usually affected first (joint position, vibration) prior to distal paraesthesia
neuropsychiatric symptoms: e.g. mood disturbances
Labs in haemochromatosis
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
Hepatitis A Features
Prodromal phase; flu-like symptoms, gastrointestinal symptoms (such as anorexia, nausea, vomiting, and abdominal right upper quadrant discomfort), and occasionally headache, cough, pharyngitis, constipation, diarrhoea, itch, and urticaria. Usually, there are no specific signs on examination.
Icteric phase; jaundice, pale stools, and dark urine (if there is cholestasis), pruritus, fatigue, anorexia, nausea, and vomiting — symptoms often improve once jaundice occurs. Hepatomegaly, splenomegaly, lymphadenopathy, and hepatic tenderness are often present on examination.
Convalescent phase; includes malaise and hepatic tenderness
Hepatocellular carcinoma features
hard/craggy mass
longer history of abnormal liver function blood tests as this cancer occurs most commonly in patients with chronic liver disease.
CKD stages
1 Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2 60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a 45-59 ml/min, a moderate reduction in kidney function
3b 30-44 ml/min, a moderate reduction in kidney function
4 15-29 ml/min, a severe reduction in kidney function
5 Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed
Subacute thyroiditis / known as De Quervain’s thyroiditis phases
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
De Quervain’s thyroiditis ix
thyroid scintigraphy: globally reduced uptake of iodine-131
Graves disease features
eye signs (30% of patients)
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation
Graves disease antibodies
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
Graves disease causes tender or non tender goitor
Non tender
COPD stable management
SABA/SAMA
-> non steroid responsive add LABA+LAMA
-> steroid responsive LABA + ICS
Triple therapy if remains unresponsive LABA+ LAMA+ ICS
Lights criteria
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
Diagnosis of asthma
Patients >= 17 years
patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma
all patients should have spirometry with a bronchodilator reversibility (BDR) test
all patients should have a FeNO test
Children 5-16 years
all children should have spirometry with a bronchodilator reversibility (BDR) test
a FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test
Patients < 5 years
- diagnosis should be made on clinical judgement
Local anaesthetic toxcity mx
IV 20% lipid emulsion
