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1 - Finals > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

what 4 things must a patient demonstrate the ability to do, in order to consent a procedure/refuse treatment?

A

1) understand relevant info 2) retain that info for long enough to make the decision 3) use/weigh that info 4) communicate their decision

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2
Q

what are the key underpinning principles of the mental capacity act?

A

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.

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3
Q

what is valid consent?

A

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

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4
Q

what must be included when informing a patient about a procedure?

A

risks and benefits. possible consequences of treatment and non-treatment. explain other options. disclose uncertainty. encourage questions!

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5
Q

amyloid deposition is a feature of which 2 diseases apart from amyloidosis?

A

Alzheimer’s and diabetes mellitus type 2.

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6
Q

what is happening in AL amyloidosis and what does it cause?

A

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.

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7
Q

what is happening in AA amyloidosis and what does it cause?

A

AA is secondary to chronic inflammatory disorders, such as RhA, IBD and infections (e.g. TB, osteomyelitis) - presents wtih CKD and hepatosplenomegaly.

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8
Q

what is the amyloid in AA produced from?

A

serum A amyloid - acute phase protein

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9
Q

what features do you get in AL but NOT in AA?

A

cardiac involvement or macroglossia.

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10
Q

what is familial amyloidosis?

A

autosomal dominant mutation of a transport protein made in the liver causing sensory/autonomic neuropathy ± renal/cardiac involvement

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11
Q

what investigation would you perform to diagnose amyloidosis? what stain would you use?

A

biopsy affected tissue, stain with Congo red stain - used polarised light microscopy

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12
Q

how would you treat the different types of amyloidosis?

A

treat underlying disease in AA to slow progression. AL - myeloma treatment, so melphalan + prednisolone. liver transplant cures familial. prognosis is 1-2yrs.

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13
Q

what is amyloidosis?

A

group of disorders characterised by extracellular deposits of a protein in an abnormal fibrillar form, resistant to degradation

amyloid tissue deposition

usual pres - unexplained weight loss, fatigue and oedema resistant to diuretics

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14
Q

what is AL amyloidosis associated with?

A

myeloma, Waldenstroms, lymphoma

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15
Q

give a cause of primary and secondary lymphatic insufficiency

A

primary - inherited deficiency of lymphatic vessels (Milroy disease) secondary - obstruction by malignancy, filarial infection, post-irradiation therapy.

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16
Q

how do you treat lymphoedema?

A

compression stockings and physical massage

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17
Q

what is filariasis caused by?

A

mosquito infection causing lymphatic insufficiency

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18
Q

what does an acute filariasis infection cause?

A

fever, lymphadenitis, chyluria - elephantitis.

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19
Q

how would you treat filariasis and what complication could occur?

A

diethlycarbamazine. immune hyperreactivity - cough, wheeze, lung fibrosis

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20
Q

what is lymphoedema?

A

chronic non-pitting oedema due to lymphatic insufficiency, most commonly affecting legs. can cause cobblestone thickening of the skin.

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21
Q

what is Milroy disease?

A

autosomal dominant disease causing congenital lymphoedema. lower leg swelling from birth.

22
Q

give 3 symptoms of opiate poisoning

A

coma, pinpoint pupils, depressed respiratory rate, convulsions, hypotension, cyanosis and apnoea

23
Q

how would you treat opiate poisoning and how does the antidote work?

A

IV naloxone - competitive antagonist causes a rapid blockade, therefore rapid reversal of symptoms - short half life so need repeated doses, causes diarrhoea and cramps

24
Q

how does paracetamol overdose present?

A

asymptomatic, then vomiting and RUQ pain and then jaundice/encephalopathy from liver damage

25
Q

how would you treat a patient presenting with paracetamol overdose, both half an hour after taking it, and 4h later?

A

1h - activated charcoal 4h - N-acetylcysteine, which replenishes glutathione stores

26
Q

what is the mechanism of benzodiazepine overdose and therefore what symptoms does it cause?

A

increases GABA so exerts an excessive inhibitor effect on neurons. symptoms - drowsiness, dizziness, ataxia, coma, respiratory depression.

27
Q

how do you reverse the symptoms of benzodiazepine overdose?

A

IV flumazenil - competitive inhibitor of GABA receptor

28
Q

what changes in the heartbeat can digoxin overdose cause and how do you treat that?

A

bradycardia, prolonged QRS and PR, AV block. can be corrected with atropine.

29
Q

how does cyanide cause death with overdose?

A

binds to iron and inhibits cytochrome oxidase so no ATP produced - reduced aerobic respiration

30
Q

if a patient has inhaled cyanide, how long will they survive?

A

death within minutes

31
Q

if a patient ingests cyanide, what are the stages of overdose?

A

1st phase - anxiety and confusion. 2nd phase - pulse changes 3rd phase - fits and shock and coma

32
Q

how do you treat cyanide overdose?

A

100% oxygen, GI decontamination. if GCS decreasing - IV dicobalt EDTA or sodium nitrite with sodium thiosulphate.

33
Q

what are 5 clinical features of organophosphate overdose?

A

SLUDGEM - salivation, lacrimation, urination, defecation, GI motility, emesis (vomiting), miosis (pupil constriction)

34
Q

how does the treatment for organophosphate overdose work?

A

atropine blocks ACh receptors. pralidoxime regenerates acetylcholinesterase.

35
Q

how does carbon monoxide cause problems?

A

combines with haemoglobin to reduce oxygen carrying capacity of blood, can inhibit cytochrome oxidase

36
Q

what are 3 symptoms of CO poisoning?

A

headache, mild exertional drowsiness, vomiting, stomach pains, anorexia, fits, coma, chest pain, metabolic acidosis

37
Q

how do you treat CO poisioning?

A

100% oxygen. hyperbaric chamber.

38
Q

give 4 reasons why you might suspect a soft tissue sarcoma in a patient with a swelling

A

presents = >5cm diameter, enlarging, painful, deep to fascia, solid mass (not cystic), recurrence at site of previous excision

some sarcomas are associated w/ specific gene mutations (esp. translocations - karyotype) e.g. synovial sarcoma and myxoid sarcoma

39
Q

how would you investigate a sarcoma?

A

MR scan of primary, incisional biopsy, CXR, CT scan of thorax

40
Q

name 3 familial sarcoma syndromes

A

neurofibromatosis-1/-2, retinoblastoma, Gardner’s syndrome, Werner’s syndrome, Gorlin’s syndrome

41
Q

how would you treat a sarcoma?

A

primary - wide excisional surgery, adjuvant radiotherapy. metastatic - palliative surgery, radiotherapy or chemo.

42
Q

what are the commonest primary bone tumours/sarcomas in adolescence/early adulthood?

A

osteosarcoma and Ewing’s sarcoma

43
Q

what sarcomas are secondary to radiation damage?

A

chondrosarcomas and osteosarcomas

44
Q

when would you suspect bone sarcoma?

A

night pain, non-mechanical and swelling not associated with the joint

45
Q

how would you treat organophosphate overdose?

A

wear gloves, remove soiled clothes, wash patient. atropine + pralidoxime

46
Q

what is sarcoma? what are the different types?

A

cancer of connective tissue - all look the same down the microscope.

present as soft-tissue swelling +/- pain (DDx - lymphoma, lipoma, neuroma)

  1. liposarcoma = good prog.
  2. leiomyosarcoma - causes dysunctional urterine bleeding
  3. fibrosarcoma
  4. GIST - upper/lower GI bleed, acute abdo
  5. synovial sarcoma
  6. Kaposi’s sarcoma - aids related, HHV8

very rare!!

47
Q

what is sarcoidosis?

A

chronic granulomatous disorder characterised by accumulation of lymphocytes and macrophages in lung and other organs (can be any but usually - lungs, skin, eyes, lymph nodes)

characterised by non-caseating granulmoas with multinucleated giant cells. CD4 throughout the granulomas, CD8 in cluster at peripherary.

48
Q

how is sarcoidosis classified?

A
  1. Systemic
  2. Pulmonary - 90% have lungs affected
  3. Cutaneous e.g. plaques, lupus pernio
  4. Ocular - anterior uveitis
  5. cardiac - heart block
  6. neurosarcoidosis - headaches, seizures

RFs = 20-40yo, FHx, non-smoker

49
Q

how is pulmonary sarcoidosis staged?

A
  1. bilateral hilar lymphadenopathy
  2. BHL + pulmonary infiltrates
  3. pulmonary infiltrates only
  4. extensive fibrosis
50
Q

how might sarcoidosis present?

A
  • Lung symptoms - Cough (non-prod), dyspnoea, wheezing, rhonchi (airway hyperreactivity),
  • LNs - Lymphadenopathy: enlarged and non-tender, cervical and submandibular
  • Eye symptoms - Photophobia, red painful eye and blurred vision suggestive of uveitis, + conjunctival nodules
  • Skin symptoms - Erythema nodosum, lupus pernio
  • Joint symptoms - Arthralgia and chronic fatigue
51
Q

what might investigations show for sarcoidosis?

A
  • CXR - bilateral hilar lymphadenopathy, bilateral upper zone infiltrates, pleural effusions, egg-shell calcifications
  • LuFT - restrictive, obstructive or mixed
  • ECG - conduction defect
  • FBC - bone marrow involvement - anaemia (20%), leukopenia (40%)
  • Urea and creatanine - renal involvement
  • Liver enzymes - liver involvement
  • Serum calcium - disregulated production of calcitriol by activated MP and granulomas leads to hypercalcaemia
  • Skin biopsy - non caseating granulomas
52
Q

briefly outline management of sarcoidosis

A

1) Lung disease
a. Oral or inhaled corticosteroid (stage 1) - prednisolone, budesonide
b. (stage 2, 3, 4) + Cytotoxics - methotrexate (PO once per week)/azathioprine ±O2
c. Lung transplant
2) Cutaneous
a. Rash/papules -> topical corticosteroid ± oral corticosteroid
b. Lupus pernio -> oral corticosteroid ± cytotoxics
3) Ocular (anterior uveitis -> topical corticosteroid (prednisolone opthalmic)
4) CNS, peripheral nervous, CV -> oral corticosteroid
5) Acute resp failure -> IV/oral corticosteroid + vent support + O2

1 - Finals (15 decks)

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