Miscellaneous Flashcards
What are the different leg pulses?
By the big toe - dorsalis pedis
By medial ankle - posterior tibial
What is atopy and what are the atopic cdtns?
A predisposition to having hypersensitivity reactions to allergens.
Atopic cdtns: eczema, asthma, hay fever, allergic rhinitis and food allergies.
What are the 3 main ways to test for allergy?
GS - Food challenge testing
Skin prick testing
RAST testing - bloods for total and specific IgE
Note: Skin prick and RAST assess sensitisation and not allergy and therefore van be unreliable and misleading.
Tx of allergic reactions
- Antihistamines (e.g. cetirizine)
- Steroids (e.g. oral prednisolone, topical hydrocortisone)
- Intramuscular adrenalin in anaphylaxis
Describe type 1 hypersensitivity reaction according to Coombs and Gell classification + give an example
- IgE ab’s to specific allergen trigger mast cells and basophils
- They release histamines and cytokines
- This causes an immediate reaction
Example: food allergy, asthma
Describe type 2 hypersensitivity reaction according to Coombs and Gell classification + give an example
- IgG and IgM antibodies react to an allergen and activate the complement system.
- Leading to direct damage to the local cells.
Example: haemolytic disease of the new born and transfusion reactions.
Describe type 3 hypersensitivity reaction according to Coombs and Gell classification + give an example
Immune complexes accumulate and cause damage to local tissues.
Example: SLE and RA
Describe type 4 hypersensitivity reaction according to Coombs and Gell classification + give an example
- Cell mediated hypersensitivity reactions caused by T lymphocytes.
- T-cells are inappropriately activated, causing inflammation and damage to local tissues.
Example: organ transplant rejection and contact dermatitis
Sx of allergic reaction
Rapid onset:
Urticaria - hives
Itching
Angio-oedema, with swelling around lips and eyes
Abdominal pain
Additional Sx:
Swelling of the larynx
Shortness of breath
Wheeze
Tachycardia
Light headedness
Collapse
Once a diagnosis of anaphylaxis is established, there are three medications given to treat the reaction?
Intramuscular adrenalin, repeated after 5 minutes if required
Antihistamines, such as oral chlorphenamine or cetirizine
Steroids, usually intravenous hydrocortisone
What should be measured in the blood to confirm anaphylaxis and within how many hours should this be measured?
Serum mast cell tryptase within 6 hours of the event.
What are the RF for obstructive sleep apnoea? (3)
Middle age
Male
Obesity
Alcohol
Smoking
Sx of obstructive sleep apnoea?
Episodes of apnoea during sleep (reported by their partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
** Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep
What scoring scale is used if someone has obstructive sleep apnoea?
Epworth Sleepiness Scale
Tx of obstructive sleep apnoea?
Conservative - stop alcohol/smoking, lose weight etc
CPAP machine
Surgery - surgical reconstruction of the soft palate and jaw - uvulopalatopharyngoplasty (UPPP)
Define peripheral arterial disease (PAD).
Narrowing of the arteries supplying the limbs and periphery, reducing the blood supply to these areas - resulting in claudication
Define intermittent claudication.
Sx of limb ischaemia - caused by obstruction of arterial flow
Occurs during exertion and relieved by rest
Crampy, achy pain in the calf (or thigh/buttock) associated with muscle fatigue which occurs after walking a certain distance
Define critical limb ischaemia.
End stage PAD, inadequate supply of blood to a limb to allow it to function normally at rest.
Risk of losing the limb.
Pain at rest, worse at night when leg is raised.
Define acute limb ischaemia
Rapid onset of ischaemia in a limb. Typically, this is due to a thrombus (clot) blocking the arterial supply of a distal limb.
Typical sx of acute limb ischaemia
6 P’s:
Pain
Pallor
Pulseless
Paralysis
Paraesthesia (abnormal sensation or “pins and needles”)
Perishing cold
Define gangrene.
Death of tissue specifically due to inadequate blood supply.
What test is done to assess for peripheral arterial disease in the leg?
Buerger’s test
What causes arterial ulcers and venous ulcers?
Arterial - caused by ischaemia secondary to an inadequate blood supply.
Venous - caused by impaired drainage and pooling of blood in the legs.
Difference between appearance arterial and venous ulcers?
Arterial ulcers - smaller, deeper, well defined borders, have punched out appearance, occur peripherally, reduced bleeding, painful
Venous ulcers - occur after minor leg injury, larger, superficial, irregular + gently sloping borders, affect gaiter leg area (mid-calf down to ankle), less painful than arterial
Ix of leg ulcers (arterial or venous)
Ankle-brachial pressure index (ABPI)
Duplex ultrasound – ultrasound that shows the speed and volume of blood flow
Angiography (CT or MRI)
Intermittent claudication Tx?
Atorvastatin 80mg
Clopidogrel 75mg once daily (aspirin if clopidogrel is unsuitable)
Naftidrofuryl oxalate (peripheral vasodilator)
Surgery - Endovascular angioplasty and stenting
Critical limb ischaemia Tx?
Urgent revascularisation can be achieved by:
Endovascular angioplasty and stenting
Bypass surgery
Amputation
Acute limb ischaemia Tx?
Urgent referral:
Endovascular thrombolysis
or thrombectomy
Surgical thrombectomy – removing the thrombus
Bypass surgery
Amputation
Define varicose veins
Distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.
How does varicose veins occur?
Veins contain valves → so allow blood flow in one direction to heart against gravity + prevent backflow
Incompetent valves → blood pool in veins and feet → dilation of superficial veins → varicose vein
Sx of chronic venous insufficiency in legs + explain how do they happen
Blood pools in distal veins → pressure causes veins to leak blood, so:
1. Haemosiderin around shins (brown discolouration to lower legs) → Hb in leaked blood cx this
- Venous eczema - blood pool → infl occurs → skin becomes dry + inflamed
- Lipodermatosclerosis - skin + soft tissues become fibrotic/tight → thus lower legs become narrow + hard
RF of varicose veins (4)
Increasing age
Family history
Female
Pregnancy
Obesity
Prolonged standing (e.g., occupations involving standing for long periods)
DVT
Tests for varicose veins + how to do the tests?
- Tap test – apply pressure to the saphenofemoral junction (SFJ) and tap the distal varicose vein - feel for thrills
- Cough test – apply pressure to the SFJ and ask the patient to cough, feeling for thrills at the SFJ.
- Trendelenburg’s test – with the patient lying down, lift the affected leg to drain the veins completely. Then apply a tourniquet to the thigh and stand the patient up
Thrills = damaged valve
Tx of varicose veins?
Keep leg elevated
Compression stockings
Endothermal ablation
Sclerotherapy – injecting the vein with an irritant foam that causes closure of the vein
Stripping – the veins are ligated and pulled out of the leg
What are the sx of hypercalcaemia and what ate the top two common causes of it?
Sx -
* Bones (bone pain)
* Stones (renal stones)
* Groans (abdo discomfort + constipation)
* Moans (psychiatric sx i.e. poor conc, mood and fatigue)
Causes:
1. Primary hyperparathyroidism
2. Malignancy
