Mosler 2 Flashcards
Autoimmune hepatitis: symptoms and investigations
Symptoms: often asymptomatic, fatigue, anorexia, nausea, joint pain, itching, jaundice, RUQ pain complications of cirrhosis, acute hepatitis, menorrhagia
Bedside: urine dip
Bloods: FBC, U&E, LFT (raised ALT), coag, CRP ANA or ASMA (type 1), immunoglobulins (raised IgG)
Type 2 autoimmune hepatitis: Anti-liver kidney microsomes-1 (anti-LKM1). Anti-liver cytosol antigen type 1 (anti-LC1)
Imaging: Liver biopsy, fibroscan, US, MRI
Management of autoimmune hepatitis
- Conservative: stop drinking, flu and pneumococcal vaccine, refer to gastroenterologist
- Medicine: steroids (prednisolone), other immunosuppressants like azathioprine, pain management
- Surgery: liver transplant
Parkinson’s features
Bradykinesia (slow movement), gat change, falls, tremor, stiffness, lack of facial expression, change in handwriting, difficulty doing tasks i.e. dressing, drooling, sleep disturbance, fatigue, lack of smell, memory issue
Psychiatric: depression, dementia, psychosis
Parkinson’s investigations
Bedside: diagnose using the ‘UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria’, lying and standing BP, anosmia testing
Bloods: ?
Investigations: DAT scan (reduced uptake in the substantia nigra), MRI if unsure of diagnosis
TB symptoms
Symptoms: weight loss, night sweats, cough, haemoptysis, erythema nodosum, lymphadenopathy, spine pain, short of breath, countries visited, previous vaccinations, exposure to HIV
TB investigations
- Bedside: obs, Montoux test, 3 x sputum culture, HIV test, contact tracing, Ziehl Neelson stain on sputum, NAAT tests on sputum culture (shows mutlidrug resistance)
- Bloods: FBC, U&E, CRP, LFT, blood culture, IGRA, HIV, Hep B and C
- Investigations: CXR, chest CT, bronchoscopy and samples
Special: lymph node aspiration or biopsy
TB Medication
Latent: Isoniazid and rifampicin for 3 months or Isoniazid for 6 months
Active: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 2 months then Rifampicin and Isoniazid for 4 months (if CNS involvement 10 months)
Co-prescribe Pyridoxine or vitamin B6 (Isoniazid causes peripheral neuropathy)
TB management
- Conservative: notifiable disease, isolate active patients for 2 weeks, refer to infectious disease, manage in negative pressure room. Screen and treat contacts
- Long term follow for treatment completion and assess for relapses
Malaria symptoms and complications
Symptoms: fever (pattern), chills, sweats, headache, muscle aches, fatigue, N+V, diarrhoea, jaundice, dark urine, cough, travel history, confusion, any chance they are pregnant
Complications: Severe anaemia, cerebral malaria, ARDS, multi organ failure, Haemoglobinuria (Blackwater fever), Hypoglycaemia, pregnancy complications
Malaria investigations
- Bedside: obs, urine dip
- Bloods: FBC, U&E, LFT, CRP, Blood culture. Thick and thin blood film
- Imaging: CXR in ARDS, CT in cerebral malaria
- Special: flow cytometry, QBC (Quantative buffy coats), PCR if uncertain and determine strain, Carestart combo rapid test
Malaria treatment
- Uncomplicated: artemether-lumefantrine or other artemisinin-based combination therapies (ACTs)
- Severe malaria: hospitalisation and IV artesunate, manage in HDU or ICU
- Prevention of Hypnozoite’s: Primaquine for two weeks
- Prevention: chemoprophylaxis, mosquito spray and nets
Gout symptoms and investigations
Symptoms: affects big toe, tenderness, swelling redness, skin changes, nail changes, stiffness, affect on daily activities, gout tophi (nodules), fever, malaise
-Bedside: BMI
- Bloods: FBC, U&E, LFT, CRP, Anti-CP, RF, Serum Uric acid, fasting glucose, lipid profile
- Imaging: X-ray
- Special: joint aspiration
Management of gout
- Conservative: weight loss, reduce alcohol content, avoid purine rich food i.e. seafood, oily fish and yeast products
- Rationalise medication: i.e. stop thiazides
- Acute flare: NSAID with PPI cover, colchine
- If refractory to treatment: steroid injections
- Prophylaxis: Allopurinol
- Increase vitamin C and use losartan if co-existant hypertension
Psoriasis symptoms, triggers, complications
Symptoms: joint pain, swelling, stiffness, deformity, skin changes (rash), nail changes, bowel issues, visual issues
Skin lesion- pain, appearance, bleeding, leaking
Triggers: alcohol, smoking, stress, hormonal (puberty, menopause), medication (lithium, ibuprofen ,ACEi), skin injury
Psoriasis investigations
Bloods: FBC, U&E, LFT, CRP,RF factor anti-CCP, HLA-B27
Imaging: US, X-RAY (for psoriatic arthritis
Special: skin biopsy