Medicine (mixed) Flashcards
Neuroblastoma features (6)
Abdo mass
Pallor/weight loss
Bone pain/limp
Hepatomegaly
Paraplegia
Proptosis (bulging of the eyes)
What investigations & findingswould you do for suspected neuroblastoma?
Urinary Vanillymandelic acid (VMA) - raised
Urinary Homovanillic acid (HVA) - raised
Abdo x-ray - calcification
Biopsy
Aetiology of neuroblastoma?
Tumour arising from the neural crest tissue of the adrenal medulla and SNS.
Hirschsprung’s disease features
Neonatal period : failure or delay to pass meconium
Older children: Constipation or abdominal distension
Hirschsprung’s disease pathophysiology
Caused by an aganglionic segment of the bowel due to developmental failure of parasympathetic Auerbach and Meissner plexuses.
Parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon leading to developmental failure of the parasympathetic Auerbach and Meissner plexuses. This leads to uncoordinated peristalsis and functional obstruction.
Hirschsprung’s disease investigation and management
INV - Abdo x-ray
rectal biopsy for diagnosis
Management - rectal washout/bowel irrigation
surgery for affected segment of colon.
Hirschsprung’s disease associations
Down’s syndrome
3x more likely in males
What assessment should be used for pneumonia in primary care & interpretation of results?
CRB65
C - confusion, less than 8 on the abbreviated mental test score
R - resp rate more than 30
B - BP systolic less than 90 and diastolic less than 60
65 - age over 65
0 - low risk, treatment at home
1/2 - intermediate risk, hospital assessment
3/4 - high risk, consider urgent admission to hospital
Assessment of pneumonia in secondary care and interpretation?
CURB65
C - confusion of less than 8 on abbreviated mental test score
U - urea of over 7 mmol/L
R - resp rate over 30
B - bp systolic less than 90, diastolic less than 60
65 - pt aged over 65
Interpretation
0/1 - home based care
2 - hospital based care
3 and more - intensive care
Investigations of pneumonia (4)
Chest X-ray
Blood and sputum cultures in intermediate/high risk patients. Pneumococcal and legionella urinary antigen tests
CRP monitoring
(<20 NO ANTIBIOTICS, 20-100 DELAYED ANTIBIOTICS, >100 ANTIBIOTICS)
Management of pneumonia
Low severity - 5 day course amoxicillin or macrolide/tetracycline.
Moderate/high grade severity - 7 day course of dual antibiotic therapy of amoxicillin and macrolide.
Consider a beta-lactamase stable penicillin e.g co amoxiclav, ceftriaxone or piperacillin with tazobactam and a macrolide in high severity community acquired pneumonia
Timeframe of recovery for pneumonia
1 week - Fever resolved
4 weeks - chest pain and sputum production reduced
6 weeks - cough and breathlessness has reduced - repeat chest x ray to ensure that consolidation has resolved.
3 months - Fatigue may be present, but everything else has resolved
6 months - recovered :)
What is metformin drug class and what is it indicated to treat?
Biguanide, which acts by activation of the AMP-activated protein kinase. It increases insulin sensitivity and decreases hepatic gluconeogenesis. it reduces GI absorption of carbohydrates.
Diabetes mellitus type 2, PCOS and non alcoholic fatty liver disease.
Side effects of metformin? (3)
GI upset e.g nausea, anorexia and diarrhoea.
Reduced vit B12 absorption
Lactic acidosis with severe renal or liver failure. (rare)
Contraindications of metformin?
eGFR less than 30, creatinine is more than 150.
Recent MI, sepsis, AKI and severe dehydration
Iodine containing x-ray contrast media e.g peripheral arterial angiography, coronary angiography or intravenous pyelography due to increasing risk of provoking renal impairment. Discontinue metformin on day of procedure and for 48 hours after.
