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Year 5/6 > Medicine: GenMed > Flashcards

Medicine: GenMed Flashcards

1
Q

SOB DDx

A

Asthma (reversible), AECOPD (irreversible), pulmonary oedema (HF), pleural effusion (malignancy), pneumonia, pneumothorax, PE, ILD, TB

Also: anaemia, anxiety, DKA

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2
Q

List common causes of HF (6)

A

IHD, valve disease, myocarditis, HTN, dilated cardiomyopathy, arrhythmias

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3
Q

Why do you get pulm oedema w HF?

A

When the pressure of venous blood > oncotic pressure

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4
Q

The acute mx of pulm oedema

A

Sit up, oxygen, diuretics, cardio review, monitor daily weights and UO

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5
Q

Furosemide: dose and route

A

40mg oral OD

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6
Q

What can you give for acute pulm oedema if furosemide fails?

A

Diamorphine

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7
Q

Which antiemetic works well w morphine?

A

Metoclopramide

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8
Q

Tx for chronic HF

A

Conserv: exercise, red alcohol, stop smoking, dietary, red salt

Medical: ACEi, beta blocker, aldosterone antag, digoxin

Surg: implantable cardioverter defib and cardiac resynchronisation therapy

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9
Q

Ramipril: dose and route

A

1.25mg oral OD

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10
Q

What are the top three causative organisms of pneumonia?

A
  1. Pneumococcus
  2. Haemophilus
  3. Mycoplasma
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11
Q

At which hb do you transfuse?

A

Usually 70 but threshold inc to 80 in ACS pts

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12
Q

When bleeding what is the order of bottles by draw?

A 
Cultures
Blue
Yellow
Purple
Pink
Grey
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13
Q

Which blood culture bottle do you take first?

A

Aerobic -> Anaerobic

NB: clean the tops w a different wipe before use and collect at least 3ml per bottle

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14
Q

What is the blue bottle for?

Mix 3-4

A

Coag, INR, D-dimer

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15
Q

What is the yellow bottle for?

Mix 5-6

A 
CRP
U+Es
LFTs
TFTs
Iron Studies
Bone Profile
Lipid Profile
Troponin
Amylase
Hormones
Toxicology
Complement
Immunoglobulins
Tumour Markers
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16
Q

What is the purple bottle for?

Mix 8-10

A 
FBC
ESR
PTH
HbA1c
Film
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17
Q

What is the pink bottle for?

Mix 8-10

A

G+S, XM, DAT

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18
Q

What is the grey bottle for?

Mix 8-10

A

Glucose + Lactate

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19
Q

What happens if you leave the tourniquet on? (3)

A

Bruising, nerve palsies, ALI

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20
Q

List the seven types of glomerulonephritis

A

Nephrotic Syndrome: minimal change, membranous, focal segmental

Nephritic Syndrome: post streptococcal, berger disease, crescentic, alport syndrome

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21
Q

What is a/w nephrotic syndrome? (3)

A

Hypercholesterolaemia, hypoalbuminaemia, peripheral oedema

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22
Q

What are the end of life PRNs? (4)

A

Analgesic
Anti-Emetic
Anti-Secretion
Relaxant

Morphine
Levomepromazine
Glycopyrronium
Haloperidol/Midazolam

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23
Q

What are the causes of crackles during insp?

A

Fine - Fibrosis + HF

Coarse - Pneumonia + Bronchiectasis

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24
Q

Resp Failure: Type 1 vs Type 2

A

Type 1 - Hypoxaemic (V/Q Mismatch): pneumonia, pulm oedema, pulm fibrosis, pulm HTN, pneumothorax, PE, ARDS, obesity

Low O2 + N CO2 = Give CPAP

Type 2 - Hypercapnic (Hypoventilation): severe asthma, COPD, drug OD, CNS injury, primary muscle disorders, NMJ disorders, chest wall deformities, Pickwickian syndrome

Low O2 + High CO2 = Give BiPAP

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25
What is low PaO2 and high PaCO2?
PaO2 <8kPa (60mmHg) PaCO2 >6kPa (50mmHg)
26
What is Westermark’s sign?
Focal area of reduced vasc markings due to oligaemia from a massive PE
27
What is COPD?
Chronic Bronchitis (clinical dx - productive cough for 3m/yr for two consecutive yrs) + Emphysema (histological dx - permanent airspace dilatation)
28
What are the spirometry results in COPD?
FEV1 <0.8, FEV1/FVC ratio <0.7, not fully reversible
29
What are the values of FEV1 for COPD severity set by NICE?
Mild >80%, Mod 50-80 and Sev 30-50, V Sev <30%
30
What are the causes of COPD? (3)
Smoking, A1AT-D, Environmental/Occupational
31
What ca are A1AT-D pts at risk of?
Hepatocellular Carcinoma
32
Rx of COPD
Bronchodilators, ICS, FLORES: FluOxygenREhabSmoking Flu and Pneumococcal Vaccines LTOT if PaO2 <7.3 twice at least 3wks apart in stable pts OR <8 w secondary polycythaemia, pulm HTN, cor pulmonale, nocturnal hypoxaemia Pulmonary Rehab + Stop Smoking
33
Mx of AECOPD
It’s a medical emerg therefore A-E plus three main issues: RF, infection, chronic mx RF: controlled O2 therapy w venturi, air driven bronchodilators, BiPAP to improve V/Q mismatch Infection: steroids + abx Chronic Mx: FLORES
34
Comps of COPD + Lung Fibrosis (4)
Chest infection, resp failure, cor pulmonale, cancer
35
What cardiac drug can lead to fibrotic lung disease?
Amiodarone ?Skin Pigmentation ?AF
36
What is ILD?
Umbrella term for a group of conditions related to different pathologies that all cause a restrictive defect, hypoxia and breathlessness
37
The five broad cats of ILD
Idiopathic, IPF, NSIP, EAA, Pneumoconiosis
38
What are the causes of APICAL fibrosis?
Any environmental cause except asbestosis PLUS sarcoidosis + ank spond
39
What are the causes of BASAL fibrosis?
Asbestosis PLUS idiopathic, connective tissue diseases, drugs
40
What is Hamman-Rich syndrome?
Rapidly progressive fibrosis w very poor prognosis
41
What can be seen on HRCT for ILD?
IPF - honeycombing NSIP - ground glass appearance
42
What imaging is required for upper lobe fibrosis?
MRI
43
What does lymphocytosis on a BAL predict?
Steroid responsiveness and therefore better prognosis
44
Mx of ILD
C: stop smoking + look for reversible causes M: steroids guided by a specialist + PPIs if any sx of reflux disease S: consider if focal disease to improve V/Q mismatch
45
What can ILD pts be switched onto if steroids aren’t working? (2)
Azathioprine | Cyclophosphamide
46
How does RA affect the lungs?
Lung fibrosis directly as autoimmune or secondary to methotrexate tx Pleural effusions usually asx, small, self remitting Intrapulmonary nodules inc Caplan’s syndrome Obliterative bronchiolitis presenting w breathlessness + high pitched wheeze
47
What is bronchiectasis?
Permanent dilatation of terminal bronchioles
48
What are the causes of bronchiectasis?
Bronchial obstrc - foreign body + tumour Childhood infections - measles, pertussis, TB Defect of mucociliary clearance - CF + ciliary dyskinesia PLUS ig immunodeficiency + yellow nail syndrome
49
What is the chromosomal error in CF?
Ch7 deletion of F508
50
What tests can you perform for suspected ciliary dysfunction?
Saccharin test OR cilial electron microscopy
51
What immunodeficiency classically causes bronchiectasis?
IgA
52
What can you see on CXR in pts w bronchiectasis?
Tramline shadows due to bronchial thickening
53
What is pathognomonic of bronchiectasis on HRCT?
Signet ring sign
54
Mx of Bronchiectasis
C: stop smoking, chest physiotherapy, psychological support M: oxygen, rotating abx, carbocysteine S: consider lobectomy if sx uncontrolled Tx w MDT approach - chest PT for mucous clearance, O2 therapy assessment, meds to aid chest clearance and prevent infections - important to immunise these pts and take serial sputum samples looking for pseudomonas colonisation
55
What abx do you give in the acute setting for bronchiectasis?
Standard tx for pneumonia PLUS cover for pseudomonas NB: always check local trust guidelines
56
What are the indications for a lobectomy? (3)
Main Points: bronchiectasis, TB, malignancy Small Print: CF, abscess, single pulm nodule
57
What paraneoplastic syndromes are a/w small cell lung ca? (3)
SIADH, Cushings, Lambert-Eaton
58
What paraneoplastic syndromes are a/w squamous cell lung ca? (2)
HyperCa (PTHrP) + Hyperthyroidism (TSH)
59
What paraneoplastic syndromes are a/w adeno lung ca? (3)
Clubbing, HPOA, Gynaecomastia
60
How does pancoast syndrome cause shoulder/ant chest wall pain, arm weakness, ipsilateral horners?
It invades the brachial plexus and cervical sympathetic nerves
61
Typical ABPA pt
Chronic asthma, new copious mucopurulent sputum, high IgE It’s a hyperactive response to aspergillus fumigatus NOT an infection Rx w 16wks of antifungals
62
ABG: acidosis + low CO2
Met Acidosis w pt breathing heavily to compensate
63
ABG: alkalosis + low CO2
Resp Alkalosis w pt breathing heavily due to asthma or panicking etc
64
What does a raised lactate make you worried about?
End organ hypoperfusion
65
How can you tell an AV fistula is working? (2)
A thrill can be felt and a bruit can be heard
66
Comps of AV fistula (3)
If it’s large enough you get elements of high output cardiac failure PLUS thrombosis and infection
67
Indications for RRT (5)
Uraemia w comps, refractory hyperK/pulm oedema/met acidosis, drug OD
68
What are the different RRT options? (4)
1. Haemofiltration: used for emergencies in ITU 2. Haemodialysis: via tunnelled line or fistula 3. Peritoneal Dialysis: via continuous ambulatory or automated 4. Renal Transplant
69
HF vs HD
HF - 24hrs; uses convection; fluid volume IS replaced; prevents intravasc depletion, BP swings, dec risk of cerebral oedema HD - 4hrs; uses diffusion; fluid is NOT replaced; haemodynamically stable but catabolic, hyperK, fluid overloaded
70
What is the risk w haemodialysis?
Endocarditis of the tricuspid valve
71
What are the comps of peritoneal dialysis? (2)
Sclerosing peritonitis and hyperglycaemia
72
Typical PBC pt
40+ F w liver failure and signs of autoimmune conditions complaining of itching that started BEFORE the jaundice, fatigue, xanthelasma
73
What is a/w PBC? (3)
RA, Sjogrens, hypothyroidism
74
Bloods for PBC (2)
Anti mitochondrial ab subtype M2 Raised bilirubin, alk phos, gamma gt
75
Tx for PBC (3)
Fat soluble vitamin supplementation, cholestyramine for the pruritis, ultimately a liver transplant
76
What are the consequences of deficiencies in the fat soluble vitamins?
A - night blindness D - tiredness, bones, schizophrenia E - generalised weakness, myopathy, dysarthria K - elevated INR NB: the impact on vitamin D deficiency on bones is compounded by the chronic inflammation
77
What is a/w APCKD? (3)
Berry aneurysms, HTN, family screening
78
What is a/w Wilsons? (2)
Dysarthria + Tremor
79
What are the causes of hepatomegaly? (6)
3C’s: cirrhosis, cancer, congestion 3I’s: infiltrative (sarcoidosis, amyloidosis, haemochromatosis), inflam (alcoholic, viral, AI hepatitis), Riedel’s lobe structural variant
80
What is pathognomonic for cirrhosis?
Hepatic venous hum
81
What are the neuro comps of alcohol XS? (3)
Wernicke encephalopathy, cerebellar syndrome, delirium tremens on withdrawal
82
Triad of Wernicke encephalopathy
Ophthalmoparesis w nystagmus, ataxia, confusion
83
Consequences of an impaired synthetic function of the liver
Coagulopathy + Hypoalbuminaemia
84
At what neutrophil count following an ascitic tap would you start abx?
>250/ml
85
How much does one unit of Novorapid reduce BMs by as a rule of thumb?
3mmol/L
86
What should you be wary of when giving insulin to newly diagnosed type 1s?
Hypos as they’ll be insulin sensitive
87
What should you check if a pt has low hb post op?
The pre op hb + estimated blood loss
88
When would it be urgent to receive NG tube confirmation?
For Parkinson pts so they can have their meds on time
89
Typical PSC pt
Mostly men with UC presenting w obstructive jaundice
90
What does ‘beads on a string’ on ERCP indicate?
PSC
91
Which ca do pts w PSC get?
1 in 5 get cholangiocarcinoma
92
Why do pts w PSC receive ursodeoxycholic acid when it doesn’t improve sx?
It improves the LFTs and increases the time until a transplant is required
93
IBD: UC vs CD
UC: continuous mucosal inflam w main sx of urgency, tenesmus, wt loss, bloody diarrhoea CD: non-continuous transmural inflam w cobblestoning, skip lesions, ulcers, strictures, fistulae, perforation NB: extra-intestinal manifestations in both inc large joint arthritis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis
94
A/w UC
Greater ca risk, PSC, uveitis
95
A/w CD
Worse in smokers, gallstones and oxalate renal stones, episcleritis
96
Can you get a terminal ileitis w UC?
Despite not affecting the small bowel you can get backwash ileitis, less common than w CD, but can also have B12 def w UC
97
What infective disease can also cause a terminal ileitis?
Yersinia Enterocolitica
98
RIF pain ddx
GI: appendicitis, terminal ileitis, yersinia infection, mesenteric adenitis, meckels diverticulitis Gynae: ectopic, ovarian/testicular torsion, PID Uro: UTI + stone
99
LIF pain ddx
GI: diverticulitis, IBD, IBS, constipation, hernia Gynae: ectopic, ovarian/testicular torsion, PID Uro: UTI + stone
100
Ix for IBD (3)
Bloods - anaemia, B12, vit D Stool - inc faecal calprotectin + occult blood AXR - obstruction, UC: toxic megacolon, CD: perforation
101
Ddx for increased faecal calprotectin (5)
IBD, coeliac disease, infective colitis, colon cancer, NSAID use
102
What is a toxic megacolon?
Colonic diameter >6cm on clear abdominal film PLUS signs of systemic inflam: tachycardia, febrile, leukocytosis, low albumin count
103
Mx for IBD
Medical - 5-ASA PO/PR, steroid foams PR, budesonide PO, biologics Surgical - UC: panproctocolectomy + CD: elective terminal ileum resection
104
The three types of chronic AI hepatitis
Type 1: ANA, anti-SM, IgG hyperglobulinaemia Type 2: anti LKM1 + responds to interferon Type 3: SLA + liver-pancreas antigen
105
Hep B Abs/Ags
HBsAb - cleared or vaccinated HBcAb - cleared HBsAg - active or chronic HBeAg - active
106
Tx for Hep B
Peg-IFNα + an antiviral agent such as entecavir or tenofovir
107
Hep B vs Hep C: DNA vs RNA? Which is more likely to become chronic?
Hep B - DNA Hep C - RNA NB: it’s Hep C that’s much more likely to become chronic
108
Associate features of Hep C
Mixed cryoglobulinaemia causing a vasculitic rash and Raynaud’s phenomenon
109
Ix for Hep C
Rheumatoid Factor + complement screen for normal C3 and low C4
110
Tx for Hep C
Peg-IFNα + antiviral or ribavirin
111
What is the most common Hep C genotype in the UK?
1
112
What causes your ALT to go above 1000? (2)
Ischaemia + Paracetamol OD
113
List three other non-hepatic causes of an elevated ALT
Addisons, coeliac, anorexia
114
What comes to mind for sudden onset severe abdo pain in elderly pt w AF?
Mesenteric Infarction
115
Outline the associated sx to ask for a neck and throat hx
``` Voice Dysphagia Odynophagia Dyspnoea Haemoptysis Neck Lumps Referred Ear Pain Thyroid Sx FLAWS ```
116
Outline the examination of the neck
Inspect: asymmetry, oral cavity, w tongue out, sipping water Palpate: tender, lumps, temp, trachea, LNs Percuss: thyroid borders Auscultate: bruits + stridor SRV: tremor, pulse, eye signs
117
What does specificity equal?
True Neg / (True Neg + False Pos) Therefore high specificity means the test has few false positives
118
What does sensitivity equal?
True Pos / (True Pos + False Neg) Therefore high sensitivity means the test has few false negatives
119
Specificity vs Sensitivity
SPIN + SNOUT SPecific tests are good at ruling things IN - low false pos SeNsitive tests are good at ruling things OUT - low false neg
120
What features suggest activity in Graves disease? (2)
Lid Lag + Tachycardia
121
What features suggest activity in acromegaly? (2)
HTN + Glycosuria
122
What features suggest activity in Cushing’s syndrome? (3)
HTN, Glycosuria, Proximal Myopathy
123
Dx DKA
CBG >11mmol/L or know diabetes mellitus Ketones >3mmol/L or significant ketonuria Venous pH <7.3 or HCO3 <15mmol/L
124
Priorities of DKA Mx
1. Fluids 2. Insulin 3. Potassium 4. Anticoag
125
Why do you give fixed rate insulin in DKA?
Ketones > Glucose
126
Dx HHS
CBG >30mmol/L w/o sig hyperketonaemia or acidosis Hypovolaemia + OsmolaLity >320mosmol/kg
127
Priorities of HHS Mx
1. Fluids 2. Potassium 3. Anticoag 4. Insulin
128
Why might the plasma sodium show as falsely low in HHS?
The hyperglycaemia results in water shift from IC -> EC
129
What are the precipitating factors leading to DKA/HHS?
The 6I’s ``` Infection Ischaemia Iatrogenic Intoxication Ignorance Infant ```
130
How would you explain DKA/HHS to the pt?
Check pt understanding Explain comp of their diabetes causing high blood sugars +/- acidic blood Tx will require admission for fluids insulin monitoring + sx control w analgesia and anti sickness Explore ICE eg length of stay and amount of needles
131
What is the calculation to work out an IV infusion drip rate?
Volume/Time(mls/mins) x Drop Factor
132
What is acanthosis nigricans a/w?
Insulin resistance, obesity, GI malignancy
133
HyperNa Causes
Hypotonic: Dehydration Diabetes Insipidus Hypertonic: Conn’s Syndrome Inappropriate Saline XS Salt Ingestion
134
What biopsy features are suggestive of carcinoma in any site of the body?
Nuclear enlargement, hyperchromasia and pleomorphism
135
How can you tell if the T2RF is acute or chronic?
If the pt is acidotic it’s acute
136
HyperK ECG
Diminished p waves, prolonged PR, broad QRS, tall tented t waves
137
Which class of meds typically causes a hyperK?
ACEi therefore check U+Es a wk after starting to detect those that may be affected w renal impairment or marked hyperK
138
Which ix confirm the dx of ILD following a suspicious CXR?
Lung function tests show a restrictive picture and high res chest CT +/- biopsy
139
Causes of cavitating lung mass
Bacterial lung abscess, SCC, GPA and pulm infarct
140
Causes of lung abscess
Staph aureus, klebsiella, TB and anaerobic spp.
141
What causes surgical emphysema?
Any condition which can cause pneumothorax or pneumomediastinium
142
What are the five D’s of a Charcot joint?
``` Density Destruction Debris Distension Dislocation ```
143
What is likely to have caused extensive air in a soft tissue?
Infection w gas forming organism
144
Tx of gas gangrene
IV tazocin + clindamycin and surgical debridement
145
Caecal Volvulus
Presence of haustra
146
Sigmoid Volvulus
Coffee bean appearance and absence of haustra
147
The 3-6-9 rule
The normal bowel calibre: small bowel <3cm, large bowel and appendix <6cm, caecum <9cm
148
Where can volvulae coniventes be found?
Small bowel only
149
Which hepatitis can go on to cause cirrhosis?
B or C
150
Acute Hep
A or E - spotty necrosis
151
Chronic Hep
B or C - peicemeal necrosis
152
The major causes of cirrhosis
Micronodular: alcoholic and biliary tract disease Macronodular: viral, Wilsons disease, A1AT def
153
Categorise anaemia w causes
Microcytic anaemia is associated with iron deficiency, chronic infection, lead poisoning, thalassemias, sideroblastic and haemoglobinopathies. Normocytic anaemia is associated with malignancy, chronic disease, primary marrow disorders and haemoglobinopathies. Macrocytic anaemia is associated with B12, folate deficiency, liver and alcohol disease, metabolic and marrow disorders and haemoglobinopathies.
154
Syphilis causative organism
The spirochaete bacterium treponema pallidum
155
Syphilis ix
Dark ground microscopy of ulcer samples, nontreponemal ab tests (VDRL & rapid plasma reagin), treponemal ab tests (haemagglutination assay & fluorescent ab testing) NB: in primary syphilis where sx have only been px for a few days baseline testing may be -ve but should be +ve within 2w so repeat tests then
156
Which ab do nontreponemal tests detect?
Cardiolipin
157
Which abs are quantifiable?
Nontreponemal
158
Which abs remain positive after tx?
Treponemal
159
What should you always test for following a dx of syphilis?
HIV
160
Syphilis tx
IM benzathine penicillin (oral doxycycline if penicillin allergic), full sexual health screen, hep B vac if MSM, partner notification, advise no sex regardless of protected or not until after tx
161
What may occur after initiation of abx tx?
A Jarisch-Herxheimer reaction
162
How does a Jarisch-Herxheimer reaction px?
Acute febrile illness w headache, myalgia, chills and rigors resolving <24 hrs
163
Describe the relationship b/w a Jarisch–Herxheimer reaction and early/late syphilis
Early - common but usually not clinically sig Late - uncommon but may be life-threatening
164
When does neurosyphilis occur?
10-20yrs after primary infection
165
What is tabes dorsalis?
The involvement of the posterior columns of the spinal cord (sensory ataxia, shooting pain, Charcot joints)
166
What is the Argyll-Robertson pupil?
It is fixed and constricted that responds to accommodation but not to light
167
How is neurosyphilis dx?
CSF
168
What can neurosyphilis comprise of?
Psychosis, dementia, tabes dorsalis, Argyll-Robertson pupil
169
When does the secondary vasculitic phase occur?
4-8w after primary infection
170
When does cardiovascular syphilis occur?
10-30yrs after primary infection
171
What can cardiovascular syphilis comprise of?
Aortitis, aneurysm of ascending aorta, aortic incompetence, heart failure
172
When does gummatous syphilis occur?
3-12yrs after primary infection
173
Where does gummatous syphilis usually affect?
Skin & bone
174
When are syphilis pts most infectious?
During primary infection
175
What can a widespread maculopapular rash in a pt w fever and malaise be indicative of?
HIV seroconversion or secondary syphilis Ddx pityriasis rosea & guttate psoriasis
176
When would you get a rash w EBV?
After concomitant amoxicillin administration
177
What would a rash affecting the palms and soles be more indicative of?
Syphilis > HIV
178
How long after exposure is HIV seroconversion illness likely to develop?
2-12w
179
How long after exposure is secondary syphilis likely to develop?
6w-6m
180
How long is the window period for HIV post exposure prophylaxis?
72hrs
181
When is resp acidosis usually seen?
COPD or type 1 respiratory failure when they tire
182
Which features suggest PCP?
Dry cough over mnths, SOBOE, constitutional sx CXR - interstitial and bilateral hilar shadowing ABG - profoundly hypoxic w type 1 respiratory failure
183
Where does cryptogenic fibrosing alveolitis typically affect?
Basal interstitial shadowing
184
Tx for PCP
Oxygen, 3w co-trimoxazole or clindamycin/promaquine if allergic, steroids if PO2 <8kPa
185
What is another name for co-trimoxazole?
Septrin
186
What is the PCP prophylaxis for HIV-positive pts w CD4 <200?
1. Septrin 480mg OD | 2. Dapsone 100mg OD
187
How do you dx PCP?
Bronchoscopy, BAL, staining and PCR
188
RFs for HIV transmission
Order of prevalence: MSM, heterosexual contact in sub-Saharan Africa, IVDU, vertical transmission
189
Difference b/w type 1 and type 2 respiratory failure
Type 1 - low/N CO2 - VQ mismatch Type 2 - high CO2 - inadequate alveolar ventilation
190
Which hormones are stored and released from the posterior pituitary?
Vasopressin | Oxytocin
191
What are the micro/macro vascular problems w DM?
Micro: retinopathy, nephropathy, neuropathy Macro: stroke, MI, limb ischaemia
192
Ddx of Hypercalcaemia
Malignancy 1° HyperPTH Sarcoidosis
193
Tx of Hypercalcaemia
Correct dehydration, single dose of pamidronate, tx underlying cause
194
Ddx of a Goitre
Diffuse: physiological, Grave’s disease, Hashimoto’s thyroiditis, subacute thyroiditis Nodular: multinodular, adenoma, carcinoma
195
What are the sx and signs of thyroid eye disease?
Sx: discomfort, inc/dec lacrimation, photophobia, diplopia, dec acuity Signs: exophthalmos, proptosis, lid retraction, lagophthalmos, corneal ulceration, conjunctival scarring, chemosis, periorbital swelling, ophthalmoplegia, lid lag, loss of colour vision, papilloedema, afferent pupillary defect
196
Exophthalmos vs Proprosis
Both is the appearance of eye protrusion however in proptosis it must go beyond the orbit
197
What is the main known risk factor for thyroid eye disease?
Smoking
198
Which tx of thyrotoxicosis worsens thyroid eye disease?
Radioiodine
199
Mx of Thyroid Eye Disease
Get specialist help, tx the sx and any thyroid disease, stop smoking, high dose steroids, surgical decompression if sight threatening
200
What are the extrathyroidal features of Grave’s disease?
GES plus acropachy, dermopathy, pretibial myxoedema
201
What are the cut offs for impaired glucose tolerance?
Fasting: >=6.1 but <7mmol/L 2h OGTT: >=7.8 but <11.1mmol/L
202
What is the International Diabetes Federation definition of metabolic syndrome?
Central obesity ie BMI >30 or inc waist circ plus two of: BP >=130/85, triglycerides >=1.7, HDL <=1.03 if male and <=1.29 if female, fasting glucose >=5.6 or T2DM
203
What is important to try and distinguish b/w in the diabetic foot?
Ischaemia vs Peripheral Neuropathy
204
When would you consider dual therapy for treating T2DM?
If the HbA1c rises to 58mmol/mol despite monotherapy w metformin
205
Why should you avoid using metformin if the pt has a low eGFR?
Risk of Lactic Acidosis
206
What are the causes of hypoglycaemia in a non-diabetic?
EXPLAIN: exogenous drugs, pituitary insufficiency, liver failure, Addison’s disease, islet cell tumour and anti-insulin receptor antibody in Hodgkin’s disease, non-pancreatic neoplasm
207
What are the causes of hypoglycaemia with low insulin and no excess ketones?
Anti-Insulin Receptor + Non-Pancreatic Neoplasm
208
What are the causes of hypoglycaemia with low insulin and inc ketones?
Alcohol Pituitary Addison’s
209
What is Whipple’s triad?
Recorded hypoglycaemia with sx that are resolved following gluocse
210
What are the patterns of features in the MEN syndrome?
1. Parathyroid, Pancreas, Pituitary 2a. Thyroid, Phaeo, Parathyroid 2b. Above + Mucosal Neuromas and Marfanoid Appearance
211
What is the 10% rule of phaeochromocytomas?
Malignant Extra-Adrenal Bilateral Familial
212
What are extra-adrenal phaeochromocytomas referred to as?
Paragangliomas
213
Sx of Pheao
Tbc
214
What should you exclude before a water deprivation test?
HyperCa due to HyperPTH
215
How can you best differentiate b/w 1° and 3° hyperparathyroidism?
Renal Function
216
What can an afferent pupillary defect in thyroid eye disease indicate?
It may mean optic nerve compression requiring urgent referral for decompression
217
Why do you get ophthalmoplegia in thyroid eye disease?
Muscle Swelling + Fibrosis
218
What metabolic bone disease can anticonvulsants cause?
Osteomalacia
219
What happens to Na and K in Addison’s disease?
Dec Na + Inc K
220
What happens to Na and K in primary hyperaldosteronism?
Inc Na + Dec K
221
How does thyroid dysfunction affect the menstrual cycle?
Hyper: oligomenorrhoea +/- infertility Hypo: menorrhagia
222
What is Nelson’s syndrome?
A postop comp of a bilateral adrenalectomy causing inc skin pigmentation due to ACTH release from an enlarging pituitary adenoma
223
What features suggest activity in Graves disease?
Lid Lag + Tachycardia
224
What features suggest activity in acromegaly?
HTN + Glycosuria
225
What features suggest activity in Cushing’s syndrome?
HTN, Glycosuria, Proximal Myopathy
226
What are the precipitants to DKA?
``` Infection Ischaemia Iatrogenic Intoxication Ignorance Infant ```
227
What should you think of for a fever in a returning traveller?
``` Malaria Dengue Enteric Hep A HIV ```
228
How do you reverse warfarin?
Stop Warfarin + Vit K, Prothrombin Complex, FFP
229
What are the clotting results in DIC?
Inc APTT and PT + Dec Pl and Fibrinogen
230
What clotting result correlates with severity in DIC?
Fibrinogen
231
What cancers are a/w pernicious anaemia?
Gastric Carcinoid Tumours + Adenocarcinomas
232
Ddx for inc temp and HR, dec BP, collapse 15mins into blood transfusion
Wrong blood: stop transfusion, A-E and IV fluids, repeat G+S and XM Bacterial contamination: same as above plus culture bag and pt then start IV empirical abx
233
What is febrile non-haemolytic transfusion reaction?
Rise in temp <=1°C w/o circulatory collapse and haematuria likely due to cytokine release during storage If temp keeps rising and BP falls think about a more serious reaction
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Tx for FNHTR
Slow the transfusion and give paracetamol
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Tx for Allergic Reaction
Slow the transfusion and give antihistamine
236
How soon do you have to give anti-D to D- mum after delivery of a D+ baby?
72hrs
237
What test do you do along giving the mother anti-D?
Kleihauer test: to see if more anti-D is required following baseline dose Acid solution denatures HbA but not HbF - work out ratio of the two
238
How do you tx a sensitised mother w a D+ baby?
Intrauterine transfusion /mnth
239
How can we monitor baby for anaemia?
Doppler US of MCA
240
What pathology can anti-D abs cause in the neonate?
Anaemia + Jaundice (since the placenta is no longer removing the bilirubin)
241
How long can blood be taken out of the fridge for then safely put back?
30mins
242
What temp are blood products stored at?
Red Cells: 4+/-2°C Platelets: 22°C FFP + Cryo: -30°C
243
What is the maximum length of time over which you can infuse a unit of blood to a pt?
4hrs
244
What is the universal donor for RBCs and FFP?
RBCs: O- FFP: AB+
245
When are women usually given anti-D in pregnancy?
500IU @ 28+34wks

Year 5/6 (20 decks)

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