More bits and bobs Flashcards
What is the definition of high blood pressure?
Over 140/90
What are secondary causes of hypertension?
Endocrine disorders (cushings disease, phaeochromocytoma, acromegaly, conn’s syndrome, thyrotoxicosis)
Renal disease (chronic renal failure, renal artery stenosis)
Coarctation of the aorta
Drugs (isotretinoin, corticosteroids, ciclosporin)
How do you check for end organ damage in hypertension?
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease (Left bundle branch block)
What are potential drugs you can take for high blood pressure?
Ace I (first line if you are under 55)
Calcium channel blocker if you are over 55 (or are under 55 but afrocarribean)
Thiazide like diuretic
Angiotensin 2 receptor blocker
Beta blocker
Spironolactone (this is generally when there is low potassium)
What are the side effects of cacium channel blockers?
Flushing
Headache
Swelling of legs
What are the side effects of ace inhibitors?
Hyperkalaemia
Angiodema
Cough
What are the side effects of thiazide like diuretics?
Hyponatraemia
Hypokalaemia
Dehydration
What are non-pharma ways to control blood pressure?
Reduce salt intake
Stop smoking
Reduce alcohol intake
Optimise glycaemic control
What are the symptoms of high blood pressure?
Syncope
Headache
Blurred vision
Epistaxis
Angina
What are the causes of atrial fibrillation?
Ischaemic heart disease
Lung disease
Hypoxia
Hypertension
Rheumatic heart disease
Sepsis
Hypercapnea
Alcohol
Mitral stenosis
Atrial septal defect
Metabolic abnormalities
Thyrotoxicosis
What are symptoms of AF?
Palpitations
Dizziness
SOB
HF
What are the signs of AF?
Irregularly irregular pulse
What would you see on ECG for AF?
Absent P waves
Ireg ireg rhythm
What is the treatment in AF that controls rhythm?
Digoxin, beta blockers, diltiazem
DC cardioversion
What are the drugs used to prevent coagulation in AF?
Warfarin / heparin
What are the complications of AF?
Systemic embolisation
Rapid ventricular rate leading to hypotensin, angina and heart failure
What are the boundaries of the anterior border of the neck?
Anterior border of the Sternocleidomastoid
Lower border of mandible
Anterior midline
What are the contents of the anterior triangle of the neck?
Digastric triangle:
Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve
Muscular triangle:
Strap muscles
External jugular vein
Carotid triangle:
Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis
What are causes of neck swelings?
Reactive lymphadenopathy
Thyroid swelling - moves upward on swallowing
Thyroglossal cyst - More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
Cystic hygroma
Branchial cyst - failure of obliteration of second branchial cleft in embryonic development
How does a thyroglossal cyst form?
Remnant of the thyroglossal duct
What are causes of hypothyroidism?
Hashimotos - autoimmune condition
Subacute thyroiditis (later stages) Insufficient dietary iodine
Drugs (lithium, amiodarone)
Down’s, turners, coeliacs
Post - surgery
What is the presentation of hypothyroidism?
Fatigue
Lethargy
Cold intolerance
Constipation
Weight gain
Carpal tunnel syndrome
Menorrhagia
Low mood
Dry skin
Hair loss
Slow reflexes
Peri-orbital puffiness
What are the levels of thyroid hormones in hypothyroidism?
TSH is high
T4 is low
What are the causes of acute pancreatitis?
GETSMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
What are the features of acute pancreatitis?
Severe epigastric pain that may radiate through to the back
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
What are the necessary investigation for acute pancreatitis?
ERCP
Bloods - amylase / lipase
Abdominal X-Ray (ileus)
Chest X-Ray (pleural effusion)
Abdominal ultrasound (pancreatic oedema, gallstones, pseudocyst)
What are markers of severe pancreatitis?
High white cell count
High blood glucose
High blood urea
High AST
Low serum albumin
Low serum calcium
Low arterial partial pressure oxygen
High CRP
What is the managment of acute pancreatitis?
Analgesia
FLuids
Blood transfusion
NG tube - rest the gland
Oxygen
May require insulin
If pancreatic necrosis - CT guided aspiration - antibiotics and surgery
If gallstones - EUS/MRCP/ERCP - cholecystectomy
Lifestyle modifications - lower alcohol, diet and lipid lowering drugs
What are complications of acute pancreatitis?
Pancreatic necrosis
Abscess
Pseudocyst
What are the different causes of cushings syndrome?
Exogenous vs endogenous
ACTH dependant
ACTH independant
Pseudocushings
What are the ACTH dependant causes of cushings disease?
Pituitary tumour secreting too much ACTH - adrenal hyperplasia
Ectopic ACTH secretion i.e from a small cell lung cancer
What are the ACTH independant causes of cushing’s syndrome?
Steroids
Adrenal Adenoma/carcinoma
Carney complex
I think this also includes alcohol excess and depression
(since there is no excretion of ACTH by a tumour then this is called cushings syndrome not disease)
What are the causes of pseudocushing’s?
Pseudo-Cushing’s
mimics Cushing’s
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate
What are the signs and symptoms of cushings?
Increase weight gain
Poor wound healing
Recurrent infections
Depression
Menstrual disturbances
Low libido
Hirsuitism
Headache
Osteoporosis
Signs:
Moonface
Abdominal striae
Centripetal obesity
Proximal myopathy
Hirsuitism
Thin skin
Easy bruising
Hypertension
Acne
What are the investigations for cushings?
24 hour urinary collection: free cortisol
Random blood cortisol - loss of circadian rhythm (normally secreted in the morning)
Low dose - dexamethasone suppression test - confirm wether ACTH can be suppressed
High dose dexamethasone supression test - differentiate between pituitary and ectopic ACTH secretion
Probably worth having a wee gander
What are the treatments for cushings syndrome?
Medical:
- Metyrapone
- Ketoconazole
Surgery - adrenalectomy
What are the treatments for cushings disease?
Surgery = trans-sphenoidal surgery (this is if there is an ACTH secreting tumour in the pituitary)
What percentage of strokes are TACS?
15%
Which arteries does the total anterior circulation stroke affect?
Involves the middle and anterior cerebral arteries
What are the criteria for TACs?
All 3 of:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
What portion of strokes are partial anterior circulation infarcts
25%
What arteries are involved in the partial anterior circulation?
Smaller arteries of anterior circulation e.g upper or lower division of middle cerebral artery
What are the criteria for a PACS?
2 of the following criteria:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
What percentage of strokes are lacunar infarcts?
25%
Which arteries are involved in a lacunar stroke?
Perforating arteries around the internal capsule, thalamus and basal ganglia
How does a lacunar stroke present?
presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
What percentage of strokes are posterior circulation infarcts?
25%
Which arteries are involved in posterior circulation infarcts?
25%
What are the signs of posterior circulation infarct?
Presents with 1 of the following:
- cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
What are the features of haemorrhagic stroke?
Decreased level of consciousness likely
Headache
Nausea and vomitting
Seizures
What are risk factors for AAA?
Hypertension
Diabetes
Smokers
Marfan’s or other connective tissue diseases
When is surgery usually offered to AAA?
Between 5.5 cm and 6 cm
3-4.4 = annual USS scans
4.5-5.5 = 3 monthly USS scans
What are the clinical features of aortic stenosis?
Chest pain
DYspnoea
Syncope
What are features of severe aortic stenosis?
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
S4
Thrill
Duration of murmur
Left ventricular hypertrophy or failure
What are the causes of aortic stenosis?
degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM
What are the potential managements available for aortic stenosis?
Valve replacement
Balloon valvuloplasty for those that are unfit for surgery
What is the ECG finding of aortic stenosis?
LBBB
What are organisms that cause cellulitis?
Strep pyogenes
Staph aureus
What are the symptoms of celulitis?
commonly occurs on the shins
erythema, pain, swelling
there may be some associated systemic upset such as fever
What is the treatment of cellulitis?
Flucloxicillin
Clairithromycin or clindamycin is recommended in patients allergic to penicillin
Severe cellulitis = iv benzylpenicillin and flucloxicillin
What is meant by an outbreak?
Sudden increase in occurences of a disease in a particular time and place.
What are potential organisms for hospital outbreak?
Group A beta-haemolytic streptococcus
MRSA
influenza A
C.diff
Measles
Meningococcal infections
Parainfluenza
Pertussis
RSV
Varicela
What type of bacteria are gut pathogens?
Gram Negative
Large aeorobic bacilli
What type of orgnism is campylobacter?
Gram negative
Small, curved, microaerophilic bacilli
What type of bacteria are neisseria?
Gram negative Aerobic cocci
When should you suspect a hereditary cancer syndrome?
Cancer in 2 or more close relatives (on same side of family)
Early age at diagnosis
Multiple primary tumors
Bilateral or multiple rare cancers
Characteristic pattern of tumours (e.g. breast and ovary)
Evidence of autosomal dominant transmission
