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!
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
amyloid tissue deposition
usual pres - unexplained weight loss, fatigue and oedema resistant to diuretics
what is AL amyloidosis associated with?
myeloma, Waldenstroms, lymphoma
give a cause of primary and secondary lymphatic insufficiency
primary - inherited deficiency of lymphatic vessels (Milroy disease) secondary - obstruction by malignancy, filarial infection, post-irradiation therapy.
how do you treat lymphoedema?
compression stockings and physical massage
what is filariasis caused by?
mosquito infection causing lymphatic insufficiency
what does an acute filariasis infection cause?
fever, lymphadenitis, chyluria - elephantitis.
how would you treat filariasis and what complication could occur?
diethlycarbamazine. immune hyperreactivity - cough, wheeze, lung fibrosis
what is lymphoedema?
chronic non-pitting oedema due to lymphatic insufficiency, most commonly affecting legs. can cause cobblestone thickening of the skin.
what is Milroy disease?
autosomal dominant disease causing congenital lymphoedema. lower leg swelling from birth.
give 3 symptoms of opiate poisoning
coma, pinpoint pupils, depressed respiratory rate, convulsions, hypotension, cyanosis and apnoea
how would you treat opiate poisoning and how does the antidote work?
IV naloxone - competitive antagonist causes a rapid blockade, therefore rapid reversal of symptoms - short half life so need repeated doses, causes diarrhoea and cramps
how does paracetamol overdose present?
asymptomatic, then vomiting and RUQ pain and then jaundice/encephalopathy from liver damage
