Miscellaneous Flashcards
what 4 things must a patient demonstrate the ability to do, in order to consent a procedure/refuse treatment?
1) understand relevant info 2) retain that info for long enough to make the decision 3) use/weigh that info 4) communicate their decision
what are the key underpinning principles of the mental capacity act?
presume capacity unless proven otherwise. encourage/enable them to make their own decision. have the right to make unwise decisions. proxy choices must consider best interests + what patient would have wanted.
what is valid consent?
1) given by a patient with capacity to make the decision 2) voluntary + free from undue pressure 3) sufficiently informed 4) continuing - patient may change their mind at any time
what must be included when informing a patient about a procedure?
risks and benefits. possible consequences of treatment and non-treatment. explain other options. disclose uncertainty. encourage questions!
what causes typhoid/paratyphoid?
Salmonella typhi/paratyphi. incubated 3-21d. faecal-oral spread.
how would typhoid present?
malaise, headache, high fever with bradycardia, cough, constipation (then diarrhoea after 1wk). rose spots on truk.
how would you diagnose typhoid/paratyphoid?
blood cultures of S typhi/paratyphi
how would you treat typhoid infection?
fluid replacement + good nutrition. + oral ciprofloxacin.
what causes poliomyelitis?
highly contagious picornavirus. droplet or faecal-oral spread.
describe the signs of poliomyelitis. how is it treated?
flu prodrome. pre-paralytic stage - fever, tachycardia, headache, vomiting, neck stiffness. paralytic stage. no drug treatment available :(
list 4 different ways HIV can be spread
sexual (vaginal and anal), blood products, vertical transmission (natural birth, breastfeeding), IVDU, needle stick injuries, organ donation
describe the brief immunology of how HIV infects the body
HIV binds to CD4 glycoprotein receptors (gp120) on T helper lymphocytes, monocytes, macrophages and neural cells. CD+ve cells migrate to lymphoid tissue where the virus replicates producing countless new virions. These are released and infect more CD4 cells and as the infection progresses, the function of CD4 cells decreases and the actual number of cells depletes.
how does the viral load affect a patient clinically? (in HIV)
as viral load increases, the CD4 count decreases making the disease more severe and the patient more ill. CD4 initially increases dramatically as it tries to fight off the infection, but eventually decreases as the virus takes over.
when does HIV become AIDS?
CD4 count below 200. presence of AIDS defining illness.
explain the stages of infection with HIV.
1) acute infection - asymptomatic, when the virus first enters the body. 2) serocoversion illness - transient illness 2-6wks after exposure - malaise, fever, myalgia, pharyngitis, maculopapular rash or meningoencephalitis. 3) asymptomatic infection - latent stage 4) persistent generalised lymphadenopathy - enlarged nodes for 3+ months, then fever, night sweats, diarrhoea, weight loss, minor opportunistic infections (AIDS-related complex - prodrome to AIDs itself). 5) AIDS - presence of AIDS defining illness and CD4 count of less than 200.
how would you confirm a diagnosis of AIDS?
serum/saliva ELISA test, must be at least 12 weeks after exposure. rapid antibody tests - immunoassays used in primary care.
list 2 respiratory AIDS defining illnesses
pneumocystis jivoreci (PCP), TB, aspergillus, EBV, reticular nodules, strep pneumoniae
list 2 GI AIDS defining illnesses
oral candida, diarrhoea caused by shigella, salmonella, campylobacter, CMV, adenovirus, perianal warts and ulceration
name an eye AIDS defining illness
CMV retinits
give 3 CNS AIDS defining illnesses
cryptococcal meningitis, toxoplasmosis, cerebral lymphoma, encephalopathy.
how is HIV treated?
highly active anti-retroviral therapy (HAART) - started early, at CD4 count 350 and below (starting to be given to all with HIV)
give some examples of HAART drugs
nucleoside reverse transcriptase inhibitors (NRTI) - zidovudine, didanosine, lamivudine. protease inhibitors (PI) - slow cell-to-cell spread, lengthening time to first clinical event. non-nucleoside reverse transcriptase inhibitors. integrase strand transferase inhibitors.
give some ways that HIV can be prevented?
blood screening, Caesarean birth for HIV+ve mothers, bottle feeding, condoms or abstinence, fewer sexual partners, regular testing, decrease alcohol intake, circumcision
give 3 risk factors for HIV
men who have sex with men (MSM). unsafe sex. other STIs. mother-to-child transmission. multiple simultaneous partners. IVDUs - sharing needles. uncircumcised man.
amyloid deposition is a feature of which 2 diseases apart from amyloidosis?
Alzheimer’s and diabetes mellitus type 2.
what is happening in AL amyloidosis and what does it cause?
AL is primary clonal proliferation of plasma cells with production of monoclonal Ig - deposition causes nephrotic syndrome, proteinuria, angina, arrhythmias, neuropathies, carpal tunnel syndrome, malabsorption, periorbital purpura and macroglossia.
what is happening in AA amyloidosis and what does it cause?
AA is secondary to chronic inflammatory disorders, such as RhA, IBD and infections (e.g. TB, osteomyelitis) - presents wtih CKD and hepatosplenomegaly.
what is the amyloid in AA produced from?
serum A amyloid - acute phase protein
what features do you get in AL but NOT in AA?
cardiac involvement or macroglossia.
what is familial amyloidosis?
autosomal dominant mutation of a transport protein made in the liver causing sensory/autonomic neuropathy ± renal/cardiac involvement
what investigation would you perform to diagnose amyloidosis? what stain would you use?
biopsy affected tissue, stain with Congo red stain - used polarised light microscopy
how would you treat the different types of amyloidosis?
treat underlying disease in AA to slow progression. AL - myeloma treatment, so melphalan + prednisolone. liver transplant cures familial. prognosis is 1-2yrs.
what is amyloidosis?
group of disorders characterised by extracellular deposits of a protein in an abnormal fibrillar form, resistant to degradation
what is AL amyloidosis associated with?
myeloma, Waldenstroms, lymphoma
give 4 causes of a breast lump, apart from cancers
fibroadenoma, breast cysts, intraductal papilloma, hamartoma, abscess, intra-mammary lymph node, breast implant, lipoma, fat necrosis