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2b > osce must know conditions! > Flashcards

osce must know conditions! Flashcards

1
Q

What is hypothyroidism?

A

A condition caused by an underactive thyroid leading to underproduction of thyroid hormone

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2
Q

What causes hypothyroidism?

A
  • Autoimmune disease (Hashimoto’s thyroiditis)
  • Response to medication (over-treatment of hyperthyroidism)
  • Thyroid surgery
  • Radiation therapy
  • Medications (e.g. lithium)
  • Pituitary adenoma
  • Iodine deficiency

*derbyshire neck - not enough iodine

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3
Q

Risk factors for hypothyroidism?

A
  • Female sex
  • Family or personal history of autoimmune disease or thyroid disease
  • Recent pregnancy
  • derbyshire neck - not enough iodine
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4
Q

How to investigate hypothyroidism?

A

TSH assay (high), T3 and T4 assay (low)
Thyroid peroxidase antibody assay (high in autoimmune thyroiditis)
Ultrasound only if if suspicious structural abnormalities exist

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5
Q

How should you manage hypothyroidism?

A

Pharmacological:
- Levothyroxine (replacement therapy)

Lifestyle:
- Ensure sleep is adequate (insomnia is a common side effect of Levothyroxine)
- Eat healthily

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6
Q

Symptoms of hypothyroidism?

A

Fatigue
Constipation
Weight gain
Muscle or joint pain
Heavy periods
Alopecia - especially outer 1/3 of eyebrows
Depression
Bradycardia
Goitre
Myxoedema

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7
Q

What is hyperthyroidism?

A

A condition caused by an overactive thyroid leading to overproduction of thyroid hormone

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8
Q

What causes hyperthyroidism?

A

Autoimmune (eg. Graves’ Disease)
Excessive intake of thyroid hormones (over-treating hypothyroidism)
Abnormal secretion of TSH from the anterior pituitary gland (TSH/TRH secreting tumour)

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9
Q

Risk factors for hyperthyroidism?

A

Female sex
Personal or family history of autoimmune disease
Recent pregnancy
Taking iodine supplements
Trauma to the thyroid

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10
Q

How to investigate hyperthyroidism?

A

Blood tests to test for TSH, T3 and T4 levels. TSH will be low, while T3 and T4 levels will be high
Can also do radioactive iodine or technetium capturing tests can evaluate the thyroid gland’s function

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11
Q

How should you manage hyperthyroidism?

A

Pharmacological / Surgical:
- Anti-thyroid drugs, e.g. Carbimazole
- Thyroidectomy
- Supportive treatment of symptoms
- Plasmapheresis to remove auto-antibodies (Graves’)
- Radioactive Iodine

Lifestyle:
- Reduced iodine diet
- Exercise
- Reducing stress

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12
Q

Symptoms of hyperthyroidism? + Graves’ specific?

A
  • Goitre
  • Sweating
  • Tremor
  • Tachycardia
  • Fatigue
  • Weight loss
  • Difficulty concentrating
  • Irregular periods
  • Thinning of hair
  • Anxiety
  • Lid lag

Graves disease specific symptoms: Exophthalmos, Tibial Myxoedema

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13
Q

What is a pulmonary embolism?

A

Blockage of a blood vessel in the lungs caused by a embolus from elsewhere in the body

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14
Q

What causes a pulmonary embolism?

A

Caused by an embolus; most commonly a thrombus from the deep veins in the calf (DVT) (may be anything including; talc, air, fat, bullets). The embolus travels through the veins to the right side of the heart and then lodges in the pulmonary circulation

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15
Q

How to investigate a pulmonary embolism?

A

Well’s score - assesses risk of thromboembolism
D-dimers - to determine presence of clots
CT pulmonary angiography - used to confirm diagnosis

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15
Q

Risk factors for a pulmonary embolism?

A

Over 55 years old
Pregnancy
COCP
Cancer
Heart failure
Smoking
Obesity
Recent surgery
Thrombophilia

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16
Q

How should you manage a pulmonary embolism?

A

Pharmacological / Surgical:
- LMWH to prevent thrombus propagation, e.g. dalteparin
- Thrombolysis treatment
- Thrombectomy
- Oxygen
- Preventative: anticoagulatives such as Warfarin, or DOACs such as Rivaroxaban

Lifestyle:
- Compression stockings
- Regular exercise, and avoiding long periods of immobilisation
- Good hydration
- Maintaining a healthy BMI

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17
Q

Symptoms of a pulmonary embolism?

A

Often doesn’t present with any symptoms, but may have:
- Breathlessness
- Pleuritic chest pain
- Cough
- Haemoptysis (suggests a PE with pulmonary infarction)
- Signs of a DVT (e.g. unilateral leg pain, leg swelling)

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18
Q

What is a deep vein thrombosis?

A

A venous clot that forms in the deep veins of the legs

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19
Q

What causes a deep vein thrombosis?

A

Any thrombosis is generated by 3 factors known as Virchow’s Triad - blood stasis / sluggish flow, abnormal vessel walls, abnormal blood coaguability

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20
Q

Risk factors for a deep vein thrombosis?

A

Recent surgery
Blood vessel damage
Cancer
Heart disease
Hepatitis
Rheumatoid arthritis
Thrombophilia
Pregnancy
Smoking
Dehydration
COCP
HRT
Inactivity for a long period of time (eg. long haul flight)

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21
Q

How to investigate a deep vein thrombosis?

A

D-dimer tests (raised when clots are present)
Ultrasound scan of the leg veins
Venogram (contrast study)

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22
Q

How should you manage a deep vein thrombosis?

A

Pharmacological / Surgical:
- Heparins, e.g. heparin, dalteparin
- Warfarin
- IVC filters

Lifestyle:
- Compression stockings
- Increase exercise
- Losing weight
- Stopping smoking
- Performing regular leg exercises when immobile

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23
Q

Symptoms of a deep vein thrombosis?

A

Pain or swelling in one leg
Warm or red skin
Can cause a pulmonary embolism (clot of the lungs -> breathlessness, chest pain, haemoptysis)

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24
Q

What is peptic ulcer disease?

A

Ulcers occurring within the stomach (gastric ulcer) or duodenum (duodenal ulcers). To be classified as an ulcer it must extend through the muscularis mucosae. Most commonly affects the first part of the duodenum

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25
Q

What causes peptic ulcer disease?

A

Ulcers occur when there is breach in the defences of the stomach which exist to protect the stomach from the acid. This can be due to:
- Chronic use of NSAIDs, such as ibuprofen or aspirin
- H pylori infection
- Chronic alcohol consumption

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26
Q

Risk factors for peptic ulcer disease?

A

Stress
Alcoholism
Smoking

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27
Q

How to investigate peptic ulcer disease?

A

Test for H pylori (urease breath test)
Endoscopy (used to visualise the ulcers and obtain a biopsy to determine if the ulcer is malignant)

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28
Q

How should you manage peptic ulcer disease?

A

Pharmacological / Surgical:
- Proton pump inhibitors
- H2 receptor antagonists
- Antibiotics (if due to H. Pylori infection)

Lifestyle:
- Reduce alcohol intake
- Discontinue NSAIDS
- Avoid aggravating factors eg spicy food
- Reduce stress where possible

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29
Q

Symptoms of peptic ulcer disease?

A

Epigastric pain
Indigestion
Loss of appetite
Nausea and vomiting
Weight loss
Malaena - dark, tar-like stool
Haematemesis (if ulcer has eroded into a blood vessel)

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30
Q

What is rheumatoid arthritis?

A

An autoimmune condition causing damage and destruction of the joint capsule

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31
Q

What causes rheumatoid arthritis?

A

Autoimmune condition leading to a Type 3 hypersensitivity reaction and immune complex deposition within the synovial membranes of the joints

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32
Q

Common risk factors for rheumatoid arthritis?

A

Genetics
Female sex
Smoking (unclear link)

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33
Q

How to investigate for rheumatoid arthritis?

A
  • X-Ray of the joint (no changes will be seen in the early stages of the disease)
  • Blood test for ACPA antibody and RF (non-diagnostic)

(*anti-citrullinated protein antibody)

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34
Q

How should you manage rheumatoid arthritis?

A

Pharmacological / Surgical:
- Methotrexate and folate supplement
- Hydroxychloroquine
- Prednisolone

Lifestyle:
- Ensure to have a annual flu jab and any other vaccinations due to the immunosuppressant properties of the medications
- During flare ups ensure plenty of rest to help ease any pain or inflammation
- Smoking cessation

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35
Q

Symptoms of rheumatoid arthritis?

A

Usually begin in the small joints i.e. hands and toes
- Joint swelling
- Joint pain and stiffness that is usually symmetrical and on waking in the morning
- Tiredness
- Fever
- Poor appetite and weight loss
- Systematic symptoms (e.g. eye pain (Sjogren’s syndrome - dry eyes and dry mouth - commonly presents with RA), chest pain (rheumatoid nodules/lung disease) if they are affected)
- Joint pain lasts longer than 1 hour (as opposed to osteoarthritis, in which joint pain comes in <1 hour “bursts”)

  • worse after periods of inactivity
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36
Q

What is osteoarthritis?

A

Degeneration of the joint hyaline cartilage and erosion of the underlying bone

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37
Q

What causes osteoarthritis?

A

Destruction of the hyaline cartilage of the articulating bones in joints due to age-related degeneration, trauma or infection of the bone

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38
Q

Common risk factors for osteoarthritis?

A

Obesity
Previous injury to the affected joint
Occupational factors (e.g. heavy lifting)
Genetics
Old age
Female sex
Sedentary lifestyle

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39
Q

How to investigate osteoarthritis?

A

X-ray - Signs on an x-ray are subchondral sclerosis, reduced joint space, osteophytes, subchondral cysts
Joint fluid aspirate analysis/blood tests to rule out RA

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40
Q

How should you manage osteoarthritis?

A

Pharmacological / Surgical:
- OTC pain killers/NSAIDs
- Opioid pain killers
- Joint replacement

Lifestyle:
- Weight loss
- Improving lifting techniques

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41
Q

Symptoms of osteoarthritis?

A
  • Deep, aching joint pain that is exacerbated by use
  • Reduced range of motion
  • Crepitus - a grinding sensation on movement of the joint
  • Stiffness during rest
  • symptom often occurs towards end of day after using the affected joint
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42
Q

What is angina?

A

Temporary occlusion of the coronary arteries that causes pain.
Stable Angina: Pain only occurs on exertion
Unstable Angina: Pain at rest

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43
Q

What causes angina?

A

Partial occlusion of the coronary arteries of the heart leading to temporary ischaemia (loss of oxygen supply)

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44
Q

Common risk factors for angina?

A

Increasing age
Tobacco/Smoking
Hypertension
Obesity
Diabetes
Metabolic syndrome
Family history of heart attack

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45
Q

How to investigate angina?

A

ECG - check for changes
Blood test - Troponin I and T- should be negative as no infarction should have occurred
Echocardiogram

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46
Q

How should you manage angina?

A

Pharmacological / Surgical:
- Calcium channel blockers eg. Diltiazem - causes dilation of vessels to relieve ischaemia
- Aspirin (reduces the clotting risk)

Lifestyle:
- Improved diet with reduced fat consumption
- Increased exercise
- Smoking cessation

(* amlodipine is a CCB too)

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47
Q

Symptoms of angina?

A

Chest pain (tight, dull, radiating)
SOB

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48
Q

Chest pain (tight, dull, radiating)
SOB

A

Sudden deprivation of blood supply to the myocardium of the heart causing ischaemic damage leading to infarction

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49
Q

What casues a myocardial infarction?

A

Occlusion of the coronary arteries usually by atherosclerosis/ thrombosis. The lack of blood supply will cause ischaemic damage

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50
Q

Common risk factors of a myocardial infarction?

A

Increasing age
Tobacco/Smoking
Hypertension
Obesity
Diabetes
Metabolic syndrome
Family history of heart attack

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51
Q

How to investigate a myocardial infarction?

A

ECG - check for changes (ST elevation/depression, pathological Q waves)
Blood test - Troponin I and T
Echocardiogram

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52
Q

How should you manage a myocardial infarction?

A

Pharmacological / Surgical:
- PCI (stent to widen blocked vessel)
- CABG (surgery that bypasses blocked artery)
- Aspirin (reduces the clotting risk)
- Clopidogrel (antiplatelet) - prescribed after a heart attack

Lifestyle:
- Improved diet with reduced fat consumption
- Increased exercise
- Smoking cessation

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53
Q

Symptoms of a myocardial infarction?

A

Chest pain (tight, dull, radiating)
SOB
Nausea
Sweating
Dizziness

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54
Q

What is bowel cancer?

A

Bowel cancer is a general term for cancer which originates from the large bowel.

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55
Q

What causes bowel cancer?

A

The exact cause of bowel cancer is unknown, however there are many risk factors which contribute to it. Most develop from polyps within the bowel.

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56
Q

Risk factors for bowel cancer?

A

Older age
A diet high in red or processed meat
Low fibre diet
Obesity
Lack of exercise
Excess alcohol intake
Smoking
Family history of bowel cancer including inherited conditions eg. FNPCC, FAP
Inflammatory bowel disease - Crohn’s or UC

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57
Q

How to investigate bowel cancer?

A

There is a national screening programme in place - faecal occult blood test (looks for blood that may be in stool, available for individuals aged 60-74, every 2 years)
Colonoscopy or flexible sigmoidoscopy
CT scan
Blood test - FBC
Tumour markers

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58
Q

How should you manage bowel cancer?

A

Pharmacological / Surgical:
- Chemotherapy if the primary tumour has metastasised, otherwise there is a high risk of recurrence
- Surgical removal of the tumour if possible
- Treatment of IBD

Lifestyle:
- Balanced diet with plenty of fruit and vegetables, and low in saturated fats and sugars
- Reduce red meat consumption
- Increase fibre consumption
- Smoking cessation
- Alcohol-intake reduction

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59
Q

Symptoms of bowel cancer?

A

Obstruction - results in abdominal distension and pain (distension, obstruction and pain affecting the large bowel generally results in constipation)
Haematochezia - bright-red bleeding from the anus
Change in bowel habit (a change in frequency or consistency)
Weight loss

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60
Q

What is Crohn’s disease?

A

An inflammatory bowel disease that may affect any location in the GI tract, but most commonly the ileum

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61
Q

What causes Crohn’s disease?

A

Idiopathic. Likely a combination of genetic and environmental factors.

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62
Q

Risk factors for Crohn’s disease?

A

Family history of inflammatory bowel disease
Smoking
NSAIDs
Recurrent infections

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63
Q

How to investigate Crohn’s disease?

A
  • Ileocolonoscopy to visualise skip lesions, ulceration with a characteristic ‘cobblestone’ appearance, trans-mural inflammation, strictures and fistulas
  • Biopsy to assess for granulomatous transmural inflammation
  • Blood test for CRP to assess inflammation, and anaemia

+ faecal calprotectin (to distinguish IBD from non-IBD)

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64
Q

How should you manage Crohn’s disease?

A

Pharmacological:
- Steroids for flares
- DMARDS to attempt to achieve and sustain remission
- If fistulas are present, surgery may be needed to remove a small part of the bowel. This surgery is not curative as the disease will recur.

Lifestyle:
- Stop smoking
- Healthy balanced diet
- Avoid NSAIDs
- Get yearly flu vaccinations and the pneumococcal vaccine due to immunosuppressant therapy

(disease-modifying antirheumatic drugs)

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65
Q

Symptoms of Crohn’s disease?

A

Periods of acute exacerbations interspersed with remissions:
- Diarrhoea
- Abdominal pain and tenderness often in the right lower quadrant (right iliac fossa most likely)
- Weight loss
- Anal pathology e.g. fissures, abscesses or tags
- Peri-anal inflammation
- Mouth ulcers
- Anaemia
- Extra-intestinal features such as conjunctivitis, arthritis, malnutrition, fever
- Change in bowel habits

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66
Q

What is ulcerative colitis?

A

Chronic inflammation affecting the rectum and colon, impairing nutrient absorption.

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67
Q

What causes ulcerative colitis?

A

Idiopathic - a combination of genetic and environmental factors.

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68
Q

Risk factors for ulcerative colitis?

A

Recent infection of the colon (shigella)
Family history of IBD
Caucasian ethnicity

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69
Q

How to investigate ulcerative colitis?

A

Blood tests (anaemia)
Abdominal examination
Stool sample (faecal calprotectin)
Sigmoidoscopy
Colonoscopy
Abdominal X-ray/CT

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70
Q

How should you manage ulcerative colitis?

A

Pharmacological / Surgical:
- Immunosuppressants including DMARDS and/or Steroids
- Curative surgery (colectomy)

Lifestyle:
- Reducing trigger foods
- Reducing stress
- Probiotics

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71
Q

Signs and symptoms of ulcerative colitis?

A

Recurrent bloody diarrhoea (may contain mucus)
Abdominal pain and a tender abdomen on examination - commonly left iliac fossa/left lower quadrant
Fatigue, weight loss
Painful red eye, arthritis, tachycardia, fever (severe UC)

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72
Q

What is hypercholestrolaemia?

A

High levels of cholesterol in the blood.

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73
Q

What causes hypercholesterolaemia?

A

Familial hypercholesterolaemia
Obesity
Diabetes
Metabolic syndrome

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74
Q

Risk factors for hypercholesterolaemia?

A

High fat diet
Smoking
Diabetes
Hypertension
Family history of stroke or heart disease

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75
Q

How to investigate hypercholesterolaemia?

A

Blood cholesterol tests
Cardiovascular risk score evaluation

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76
Q

How should you manage hypercholesterolaemia?

A

Pharmacological / Surgical:
- Statins, e.g. atorvastatin
- Aspirin

Lifestyle:
- Reduce fat intake
- Eat a healthy balanced diet
- Smoking cessation
- Increase exercise levels

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77
Q

Signs and symptoms of hypercholesterolaemia?

A

Xanthelasma, tendon xanthoma and corneal arcus, but most commonly causes no symptoms.
It does however drastically increase the risk of many diseases:
- Atherosclerosis
- Heart attack
- Stroke
- Peripheral artery disease
- Coronary heart disease

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78
Q

What is hypertension?

A

Sustained increase in blood pressure, greater than 140/90 mmHg.

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79
Q

What causes hypertension?

A

Primary hypertension has an unknown cause, however several factors may contribute to it
Secondary hypertension has an identifiable cause, such as renal artery stenosis, Cushing’s syndrome (high cortisol), Conn’s syndrome (hyperaldosteronism)

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80
Q

Risk factors for hypertension?

A

Smoking
Obesity
Lack of physical activity
Stress
Old age
Family history
Excess salt in diet
Excess alcohol consumption

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81
Q

How should you manage hypertension?

A

Pharmacological / Surgical:
For a patient <55 years old:
- Step 1: ACE inhibitor, ramipril, or Angiotensin receptor blocker, Losartan
- Step 2: Calcium channel blocker, amlodipine
- Step 3: Diuretic, bendroflumethiazide
- Step 4: β-blocker, spironolactone
For a patient >55 years old, or of Afro-Caribbean descent:
- Step 1: Calcium channel blocker, amlodipine
- Step 2: ACE inhibitor, ramipril, or Angiotensin receptor blocker, Losartan
- Step 3 and 4 are the same as above

Lifestyle:
- Healthy diet and regular exercise
- Smoking cessation
- Reduce stress where possible
- Reduce alcohol intake
- Reduce caffeine intake

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82
Q

Symptoms of hypertension?

A

Hypertension often has no symptoms, however it can present with:
- Severe headache
- Fatigue
- Vision problems
- Difficulty breathing
- Palpitations

83
Q

What is a urinary tract infection / pyelonephritis?

A

Infection of the urinary tract - can affect the lower urinary tract (Cystitis) or the upper urinary tract (Pyelonephritis)

84
Q

What causes a urinary tract infection / pyelonephritis?

A

A number of bacterial organisms, most commonly E. coli and Coagulase Negative Staphylococci

85
Q

Common risk factors for a urinary tract infection / pyelonephritis?

A

Female gender (shorter urethra)
Obstruction of the tract (enlarged prostate, pregnancy, stones) leading to fluid stasis
Neurological problems leading to incomplete voiding and leading to fluid stasis
STIs
Not urinating after sex
Unprotected sex
COCP

86
Q

How to investigate a urinary tract infection / pyelonephritis?

A

Usually none are carried out unless the patient is declared at risk of a “complicated” UTI, in which case the following occurs:
- Mid stream catch urine sample. Observe turbidity, dipstick and culture.

If Sepsis is suspected (a potential risk of UTIs), then the standard “Sepsis 6” package is initiated prior to any testing

BUFALO: (‘take 3, give 3’)
- Blood Cultures
- Urine output
- Fluids
- Antibiotics
- Lactate
- Oxygen (to maintain SpO2 >94%)

87
Q

How should you manage a urinary tract infection / pyelonephritis?

A

Pharmacological / Surgical:
Antibiotics indicated by the nature of the infection
Decompression of the kidney if obstructed using either a JJ stent or a nephrostomy
Lifestyle:
Maintenance of good hydration
Emptying of the bladder soon after intercourse
Avoidance of irritating feminine products
Changing from the COCP

88
Q

Symptoms of a urinary tract infection / pyelonephritis?

A

Lower UTI (Cystitis)
Dysuria
Frequency
Urgency
Possible low grade fever
Upper UTI (Pyelonephritis)
Fever
Loin pain
Dysuria/ frequency
Nausea and vomiting

89
Q

What is meningitis?

A

Infection causing inflammation of the leptomeninges of the brain.

90
Q

What causes meningitis?

A

Bloodstream infection
Ear infection
Sinusitis
Iatrogenic - Surgery in the head or neck / Blood stream infection from a catheter or other line

91
Q

Common risk factors for meningitis?

A

Immunocompromised condition
Living in close proximity (e.g. students)
Extremes of age (< 5 or >60 years)

92
Q

How to investigate meningitis

A

Blood tests and cultures
Lumbar puncture to sample CSF turbidity testing and culture (+ antibiotic sensitivity)

PHOTO
(normal - clear, bacterial - turbid, viral - clear, fungal - fibrin web)

93
Q

How should you manage meningitis?

A

Pharmacological/Surgical:
IV Ceftriaxone empirically until culturing results returned to identify to actual causative organism
Meningococcal Vaccine
Lifestyle:
If immunocompromised give prophylactic antibiotics
Clean living conditions
Good diet
Good dental hygiene

94
Q

Symptoms of meningitis?

A

Fever
Cold hands and feet
Stiff neck
Headache
Vomiting
Drowsiness
Difficult to wake
Confusion and irritability
Severe muscle pain
Non-blanching rash if meningococcal
Photophobia

95
Q

What is pneumonia?

A

Inflammation of the lung parenchyma caused by bacterial or viral infection, in which the alveoli may fill with pus.

96
Q

What causes pneumonia?

A

Viral or bacterial infections of the lung, usually droplet transmitted.

97
Q

Common risk factors for pneumonia?

A

Immunocompromised
Extremes of age
Close-contact-communities

98
Q

How to investigate pneumonia?

A

Chest X-ray (look for consolidation, potentially pulmonary oedema/pleural effusion if later stages)
Sputum sample
Chest examination
Blood test (test for CRP, raised white cell count)

99
Q

How should you manage pneumonia?

A

Pharmacological/Surgical:
* Antibiotics if bacterial cause (Moderate: Amoxicillin, Doxycycline, Serious: Co-amoxiclav and Clarithromycin)
* Aspiration of effusion if present

Lifestyle:
* Smoking cessation
* Should avoid other patients or at risk individuals if immunocompromised and take prophylactic antibiotics
* Good diet with adequate vitamin consumption to improve immune defences

100
Q

Symptoms of pneumonia?

A

Productive cough
Haemoptysis (coughing-up blood)
Shortness of breath
Pleuritic chest pain
Tachycardia
Fever
Sweating/shivering

101
Q

What is heart failure?

A

The inability of the heart to meet the demands of the body, characterised by reduced cardiac output, reduced tissue perfusion and increased pulmonary blood pressure

102
Q

What causes heart failure?

A

Ischaemic heart disease
Hypertension, Aortic stenosis, Aortic regurgitation all leading to left ventricular hypertrophy
Cardiomyopathy
Arrhythmias
Chronic lung diseases e.g. COPD, pulmonary fibrosis, bronchiectasis (cor pulmonale)

103
Q

Risk factors for heart failure?

A

Obesity
Smoking
Diabetes
High alcohol intake
Lack of exercise
Chronic lung disease
Family history
Previous rheumatic fever

104
Q

How should you manage heart failure?

A

Pharmacological/Surgical:
Adopt a ‘start low, go slow’ approach when introducing these drugs due to risks of low blood pressure, or worsening of heart failure symptoms:
* 1st line: ACE inhibitors or Angiotensin receptor blockers if above are not tolerated, hydralazine + nitrate
* 2nd line: β-blocker
* 3rd line: Aldosterone antagonist (spironolactone)

Lifestyle:
* Maintain BMI in a healthy range
* Smoking cessation
* Reduce alcohol consumption
* Exercise
* Weigh yourself regularly (to see if you’re retaining fluid)
* Healthy diet

105
Q

Symptoms of heart failure?

A

Left sided heart-failure:
* Fatigue
* Breathlessness on exertion
* Orthopnoea and Paroxysmal Nocturnal Dyspnoea
* Displaced apex beat due to cardiomegaly

Right sided heart-failure:
* Fatigue
* Breathlessness
* Peripheral oedema
* Raised JVP
* Enlarged and tender liver

106
Q

What are gall stones?

A

A condition caused by stones forming in the gallbladder and causing obstruction.

107
Q

Key risk factors for gall stones?

A

Obesity
High fat diet
Alcoholism

108
Q

How to investigate gall stones?

A

Ultrasound scan
Bloods to test for Bilirubin/AST/ALT/ALP/Gamma-GT levels (Liver function tests)
CRP/white cell count to check for infection (primary ascending cholangitis)

109
Q

How should you manage gall stones?

A

Pharmacological:
* Painkillers (NSAIDs)
* Statins

Surgical:
* Laproscopy (Key hole surgery) to remove the gallbladder (most common)
* Open surgery to remove the gallbladder (indicated in pregnancy, obesity and structural abnormalities of the gallbladder)

Lifestyle:
* Eating a balanced diet
* Avoiding ‘trigger foods’ (can include fatty or spicy foods)
* Avoiding alcohol
* Exercise to lose weight

110
Q

Symptoms + possible complication of gall stones?

A

Biliary colic (abdominal pain common around 30 minutes after eating fatty foods)
Fever
Jaundice
Impaction and development of cholangitis
Pain can radiate to the shoulder tip
Can cause pancreatitis if impacting the Ampulla of Vater

111
Q

What is a headache?

A

A symptom of pain felt anywhere in the head

112
Q

What causes a headache?

A

Headaches can be classed into primary and secondary causes

**Primary **
* Idiopathic
* Stress-related

**Secondary (generally more concerning as may indicate potentially life threatening underlying conditions) **
* Sub-arachnoid haemorrhage
* Medication-induced (e.g. GTN)
* Medication-overuse (e.g. painkillers)
* Brain tumour
* Dehydration

113
Q

Risk factors for a headache?

A

Obesity
Stress
Alcohol overuse
Dehydration
High caffeine intake
Smoking
Hypertension
NSAID/opioid overuse
Bad posture

114
Q

How to investigate a headache?

A

Commonly none, if presenting with “red flags” then refer to secondary care for imaging:
Red flags - SNOOP mnemonic:
* Systemic Signs
* Neurological signs
* Onset unusually or new onset over 55
* Onset in a thunderclap presentation - SAH
* Papilloedema - increased intracranial pressure

115
Q

How should you manage a headache?

A

Pharmacological/Surgical:
* Over the counter painkillers (paracetamol or ibuprofen, an NSAID)
* Prescription medications (codeine = opioid receptor agonist)
* Triptans (for migraines specifically)

Lifestyle:
* Increase exercise
* Improve diet and fluid intake
* Smoking cessation
* Reduce caffeine and alcohol
* Reduce stress levels where possible
* Avoid triggers

116
Q

Symptoms of a headache?

A

Dependent on headache type:
Tension - band like pain across the forehead
Migraine - commonly one sided pain, associated aura and nausea
Cluster - extreme pain behind one eye, commonly occurs for months at a time
Trigeminal neuralgia - electric-shock type pain around one eye, prompted by touch to the face

117
Q

What is depression?

A

Feelings of low mood, depression or hopelessness and a lack of interest or enjoyment in doing things for 2 weeks consistently

118
Q

What causes depression?

A

Stress
Adverse childhood experience
Certain drugs
Death or loss (NB do not confuse depression with an adjustment reaction which has a clear trigger and limited duration)
Genetic pre-disposition
Co-morbidities
Substance abuse

119
Q

Common risk factors for depression?

A

Unstable/ poor home life
Stressful life
Substance abuse
Family history of mental health conditions

120
Q

How to investigate depression?

A

The diagnosis is clinical. Blood tests may be helpful to rule out other differential diagnoses eg. Hypothyroidism
NB - If indicated (eg if the patient has depressive symptoms) you MUST asses suicide risk and self-harm in a sensitive and sympathetic manner. Failure to do so is a patient safety issue.

121
Q

How should you manage depression?

A

Pharmacological/Surgical:
SSRIs
Benzodiazepines (short-term only)
Mood stabilisers (Lithium, Sodium valproate)
Lifestyle:
Reduction in stress within life if possible
Family support
Cognitive behavioural therapy

122
Q

Diagnostic criteria for depression?

A

Must have at least 5/9 of the symptoms with at least one of the core symptoms for 2 weeks.
Two core symptoms:
Feelings of depression, hopeless or generally feeling down most days during the last month
Little interest or pleasure in doing things
Other typical symptoms:
Fatigue/loss of energy
Worthlessness/excessive or inappropriate guilt
Recurrent thoughts of death, suicidal thoughts or suicide attempts
Diminished ability to think or concentrate
Psycho-motor agitation or retardation
Insomnia/hyper-insomnia
Significant appetite and/or weight loss

123
Q

Other symptoms of depression?

A

Low mood
Lack of interest in anything
Lack of enjoyment in things
Fatigue
Feeling hopeless and helpless
Having low self-esteem
Feeling irritable and intolerant of others

124
Q

What is anxiety?

A

Continuous feelings of worry and anxiousness, persisting for most days of the week for 6 months or more.

125
Q

What causes anxiety?

A

Stress within life e.g. at school, work, due to other medical illnesses or due to illicit drug use (eg. cocaine)

126
Q

Common risk factors for anxiety?

A

Stress
Genetic predisposition/ Family history of mental health conditions

127
Q

How to investigate anxiety?

A

The diagnosis is clinical. Blood tests may be helpful to rule out other differential diagnoses

128
Q

How should you manage anxiety?

A

Pharmacological/Surgical:
SSRIs
Benzodiazepines (short-term only)
Mood stabilisers (Lithium, Sodium valproate)
Lifestyle:
Reduction in stress within life if possible
Family/ Self help groups
Cognitive behavioural therapy

129
Q

Diagnositc criteria for anxiety?

A

The patient must have both the core symptoms and 3/6 of the additional symptoms for a period of at least 6 months.
Two core symptoms:
Excessive anxiety and worry - occurs on most days for at least 6 months
Difficulty controlling the worry or feelings of anxiety
Additional symptoms:
Feeling of tension or restlessness
Become easily fatigued
Difficulty concentrating or mind going blank
Irritability
Significant muscle tension
Difficulty sleeping

130
Q

Other symptoms of anxiety?

A

Feeling nervous, restless or tense
Sense of impending danger, panic or doom
Tachycardia
Hyperventilation
Sweating
Tight chest
Fatigue
Trouble concentrating

131
Q

What is epilepsy?

A

A condition characterised by recurrent random electrical activity in the brain causing a seizure. Seizures are broadly categorised into partial or generalsed. Status epilepticus is a medical emergency characterised by a extremely prolonged seizure or multiple seizures without the patient regaining consciousness in between.

132
Q

What causes epilepsy?

A

Although epilepsy is idiopathic in its cause it is linked with:
Low oxygen during birth
Head injuries
Brain tumours
Infections such as meningitis or encephalitis
Stroke or any other type of damage to the brain

133
Q

Common risk factors for epilepsy?

A

Birth injuries
Head trauma
Hypertension
Infections/sepsis
Genetic conditions
Family history
Illegal drug use (e.g. cocaine)

134
Q

How to investigate epilepsy?

A

EEG
CT head
Full blood count
Taking a collateral history from any possible witnesses to a seizure

135
Q

How should you manage epilepsy?

A

Pharmacological/Surgical:
Partial seizures: Carbamazepine
General seizures: Sodium valproate, Lamotrigine
Status epilepticus: Lorazepam
Lifestyle:
Avoidance of epileptic triggers (e.g. noises, flashing lights, stress)
Discussion of how to adjust to life with epilepsy (e.g. loss of driving license)
Regular check-ups
Caution with pregnancy

136
Q

Symptoms of epilepsy?

A

Dependent on seizure type. All involve loss of consciousness.
Tonic - rigidity
Tonic-clonic/ Grand Mal - rigidity with muscular convulsions
Myoclonic - muscular convulsions
Absent- patient will pause for a period of time before continuing as before without noticing the pause.
Atonic - patient will lose all muscle strength and may fall to the floor

137
Q

What is diabetes?

A

Type 1: Autoimmune destruction of Pancreatic B cell leading to inability to produce insulin and chronic hyperglycaemia
Type 2: Resistance to insulin and eventual reduction in production of insulin and chronic hyperglycaemia

138
Q

What causes diabetes?

A

Type 1: Idiopathic cause with potential genetic link
Type 2: Obesity, high-sugar diet, low levels of exercise, pregnancy, metabolic syndrome

139
Q

Common risk factors for diabetes?

A

Genetic predisposition- unmodifiable and can contribute to both types
High sugar diet
Obesity

140
Q

How to investigate diabetes?

A

Blood glucose tests after fasting and after taking a set amount of glucose
HbA1c blood test
Consistent finger-prick testing to check glucose levels throughout the day

141
Q

How should you manage diabetes?

A

Pharmacological:
Type 1: Insulin injections. Frequency depends on specific formulation
Type 2: Multiple treatment options:
Metformin - Decreases resistance to insulin, decreases liver gluconeogenesis
Sulphonylurea - Increases insulin release from B cells
Lifestyle:
Carefully controlled sugars within the diet
Increased exercise
Smoking cessation

142
Q

Symptoms of diabetes?

A

Polydipsia
Dry mouth
Polyuria
Unexplained weight loss
Fatigue
Headaches

143
Q

What is lung cancer?

A

A malignant mass in the lung that can spread and invade other tissues.

144
Q

Common risk factors for lung cancer?

A

Smoking
Obesity
Environmental exposure to carcinogens eg Asbestos, air pollution
Family history

145
Q

How to investigate lung cancer?

A

Chest X-ray
CT/PET-CT
Bronchoscopy, Biopsy of mass

146
Q

How should you manage lung cancer?

A

Pharmacological/Surgical Interventions -
Radiotherapy
Chemotherapy
Surgery
Targeted therapies
Lifestyle interventions -
Smoking cessation (most important)
Weight loss
Personal protective equipment if exposed to dangerous chemicals at work

147
Q

Symptoms of lung cancer?

A

Weight loss
Haemoptysis (coughing up blood)
Shortness of breath
Persistent cough
Persistent chest infections
Fatigue

148
Q

What is asthma?

A

A chronic lung disease causing airways to become hypersensitive and inflamed

149
Q

What casues asthma?

A

Unclear true cause, thought to be attributed to pollution, genetics or hygiene.

150
Q

Common risk factors for asthma?

A

Family history
History of atopy (e.g. hay-fever, eczema, general allergies)

151
Q

How to investigate asthma?

A

Diagnosed using spirometry, which shows a reversible obstructive pattern

152
Q

How should you manage asthma?

A

Pharmacological/Surgical Interventions -
SABA (salbutamol - short-acting B2 agonist)
Corticosteroids (inhaled - beclamethosone)
LABAs (salmeterol - long-acting B2 agonist)
Lifestyle interventions -
Avoidance of possible triggers
Smoking cessation
Compliance with treatment
Consistent check-ups

153
Q

Symptoms of asthma?

A

Cough (worse at night)
Wheeze (either audibly or through a stethoscope)
Breathlessness
Tight chest
Acute exacerbations of bronchoconstriction

154
Q

What is COPD?

A

A long-term progressive lung disease causing increasing breathlessness that isn’t fully reversible. Encompasses emphysema and chronic bronchitis.
Emphysema: airflow obstruction in the in the small airways causing hyperinflation
Chronic bronchitis: chronic mucus hypersecretion

155
Q

What causes COPD?

A

Smoking (may be second hand)
Air pollution
Alpha-1-antitrypsin deficiency (a very small minority of cases

156
Q

How to investigate COPD?

A

Diagnosed using a peak flow meter and spirometry, which shows a non-reversible obstructive pattern

157
Q

How should you manage COPD?

A

Pharmacological/Surgical Interventions -
SABA (salbutamol - short-acting B2 agonist)
Corticosteroids (inhaled - beclamethosone)
LABAs (salmeterol - long-acting B2 agonist)
Mucolytics (reduce mucus production)
Lifestyle interventions -
Smoking cessation
Flu jabs (patients are more prone to infection which can cause exacerbation)
Increased exercise
Oxygen therapy (to reduce mortality- has no effect on breathlessness)

158
Q

Symptoms of COPD?

A

Chronic productive cough
Shortness of breath whilst doing everyday activities
Recurrent respiratory infections
Cyanosis
Fatigue
Increased sputum production
Wheezing

159
Q

What is cerebrovascular disease (TIA/Stroke)?

A

Lack of oxygen supply to the brain either from blockage or bleeding.

160
Q

What causes cerebrovascular disease?

A

Ischaemic (caused by an embolus in a cerebral artery) or Haemorrhagic (caused by a bleed on the brain)

161
Q

Common risk factors for cerebrovascular disease (TIA/Stroke)?

A

Modifiable:
Smoking
Hypertension
Obesity
High cholesterol
High alcohol intake
COCP usage
Atrial Fibrillation
Non-modifiable:
Increasing age
Family History
S. Asian, African or Caribbean ethnicity

162
Q

How to investigate cerebrovascular disease (TIA/Stroke)?

A

To determine stroke risk:
Blood tests for cholesterol level and coagulability (INR)
Blood pressure
BMI
ECG do determine AF or other heart condition
To diagnose stroke or TIA if indicated by symptoms on presentation
CT head
Electrocardiograms
Cerebral angiography

163
Q

How should you manage cerebrovascualr disease (TIA/Stroke)?

A

Pharmacological/Surgical Interventions -
Only to treat underlying co-morbidities increasing stroke risk:
Anticoagulants
Antihypertensives
Antiarrythmics
Lifestyle interventions -
Key in reducing stroke risk:
Increased exercise
Balanced healthy diet (reducing cholesterol intake)
Smoking cessation
Alcohol cessation

164
Q

What is AF?

A

A heart condition causing an irregularly irregular rhythm and tachycardia, with increased risk of clotting related morbidities.

165
Q

What causes AF?

A

Secondary to many conditions:
Myocardial infarction
Hypertension
Congenital heart defects
Overactive thyroid gland

166
Q

Common risk factors for AF?

A

Increasing age
Heart conditions
Co-morbidities listed above

(*Secondary to many conditions:
Myocardial infarction
Hypertension
Congenital heart defects
Overactive thyroid gland)

167
Q

How to investigate AF?

A

ECG
Blood tests (can highlight anaemia, problems with kidney function, or an overactive thyroid gland (hyperthyroidism))

168
Q

How should you manage AF?

A

Pharmacological/Surgical Interventions -
Class 1 antiarrhythmics, e.g. Lidocaine
B-blockers, e.g. Bisoprolol
Anticoagulants to prevent clot formation and minimise risk of embolization
Suspend any prothrombotic or proarrhythmic drugs if possible
Lifestyle interventions -
Diet improvements to reduce further risk of acute coronary syndromes
Avoidance of exacerbations (e.g. alcohol, caffeine, illicit drugs)
Smoking cessation

169
Q

Symptoms of AF?

A

+/- exertion
Fatigue/Lethargy
Palpitations
Shortness of Breath
Chest pain
Feeling faint

170
Q

What is anaemia?

A

A reduction in the haemoglobin concentration of the blood reducing the body’s ability to transport oxygen.

171
Q

What causes anaemia?

A

Iron deficiency
Vitamin B12/folate deficiency
Any inflammatory chronic disease
Haemolytic diseases
Sickle cell disease
Malaria

172
Q

Common risk factors for anaemia?

A

Veganism/Vegetarianism
Poor iron intake
Any inflammatory chronic disease
Menorrhagia
Genetics
Alcoholism

173
Q

How to investigate anaemia?

A

Blood tests (haemoglobin concentration (diagnostic), haematocrit, mean cell volume, reticulocyte count, iron levels, folate levels (to aid identification of specific pathology)
Blood films (identify shapes, sizes and colours of red blood cells)
Kidney function tests (e.g. Creatinine levels, eGFR to identify a loss of EPO production)

174
Q

How should you manage anaemia?

A

Pharmacological/Surgical Interventions -
B12/Folate/Iron supplements
Treatment for underlying chronic conditions
Blood transfusions if sickle cell homozygous
Anti-malarials if malaria causative factor
Lifestyle interventions -
Dietary changes dependent on cause of anaemia (B12/Folate-related cause: eat more meat, or take tablets to replace, Iron-related – eat more “leafy greens”)

175
Q

Symptoms of anaemia?

A

Fatigue
Tachycardia/palpitations
Shortness of Breath
Dizziness
Pale skin
Leg cramps
Insomnia

176
Q

What is non-alcoholic liver cirrhosis?

A

Although alcoholism is the most common cause of cirrhosis it may be caused by any inflammation of the liver.

177
Q

What causes non-alcoholic liver cirrhosis?

A

Hepatitis B/C Virus
Non alcoholic fatty liver disease (NAFLD)
Paracetamol overdose

178
Q

Risk factors for non-alcoholic liver cirrhosis?

A

Illicit IV Drug use
Genetics
High cholesterol
Obesity
Paracetamol overdose

179
Q

How to investigate non-alcoholic liver cirrhosis?

A

Liver function tests

180
Q

How should you manage non-alcoholic liver cirrhosis?

A

Pharmacological / Surgical Interventions:
- Statins
- Anti-virals for HCV
- Prophylactic HBV vaccine
- Acetylcysteine for paracetamol overdose

Lifestyle interventions:
- Exercise
- Smoking cessation
- Lower fat intake
- Healthy balanced diet

181
Q

Symptoms of non-alcoholic liver cirrhosis?

A

Tiredness and weakness
Nausea
Jaundice
Diarrhoea and Vomiting
Fever and shivering attacks
* same as alcoholic liver cirrhosis

182
Q

What is alcoholic liver disease?

A

Damage to liver cells (Hepatocytes) caused by prolonged exposure to large quantities of alcohol. Progresses in 3 stages:
Reversible fatty change in days to weeks
Reversible hepatitis in moths to years
Irreversible Cirrhosis after years

183
Q

What causes alcoholic liver disease?

A

Alcoholism

184
Q

How to investigate alcoholic liver disease?

A

Liver function tests derived from a blood sample

185
Q

How should you manage alcoholic liver disease?

A

Lifestyle interventions -
Reduce alcohol consumption to nothing
Refer to a self help group
Pharamacological interventions -
Disulfiram to aid with compliance to alcohol abstinence
B vitamins especially thiamine to rectify vitamin deficiency
Statins to reduce cholesterol and reduce fat deposition in the liver
Anti-hypertensives eg. amlodipine to reduce blood pressure
Surgical:
Liver transplant

186
Q

Complications of alcoholic liver disease?

A

Liver failure
Portal hypertension

187
Q

Symptoms of alcoholic liver disease?

A

Tiredness and weakness
Nausea
Jaundice
Diarrhoea and Vomiting
Fever and shivering attacks
* Same as non-alcoholic liver cirrhosis

188
Q

What is CKD?

A

The irreversible and sometimes progressive loss of renal function over a period of months to years.

189
Q

What causes CKD?

A

Can be exaggerated/precipitated by an AKI and is often caused by other chronic co-morbidities e.g. Diabetes, hypertension, autoimmune diseases (e.g. Vasculitis) and adult polycystic kidney disease.

190
Q

Common risk factors for CKD?

A

Alcohol
Obesity
Diabetes
Hypertension
Autoimmune conditions, e.g. Vasculitis
Genetic pre-disposition, e.g. Polycystic Kidney Disease

191
Q

How to investigate CKD?

A

CKD progression is staged based off the patient’s eGFR, calculated using serum Creatinine levels
Proteinuria levels
Urinalysis
Bloods
Auto-antibody tests
Ultrasound to check for obstructions

192
Q

How should you manage CKD?

A

Pharmacological and surgical interventions -
Management is generally supportive, pharmacology is based on underlying cause of CKD.
Haemodialysis (HD, 4 hours, 3 times a week, in the hospital, attached to a machine)
Home HD
Peritoneal dialysis
Kidney transplant (if no other available options and donor available)
Lifestyle interventions -
Modifiable risk factors:
Regular exercise (obesity is a risk factor) and a good, regulated electrolyte diet can improve CKD progression rates
Alcohol removal
Smoking cessation
Controlling diabetes adequately
Controlling hypertension adequately
Non-drug lifestyle options:
Vitamin D tablets to make up for reduced Vitamin D synthesis from the kidney
Iron/B12/Folate to make up for reduced EPO production by the kidney

193
Q

Symptoms of CKD?

A

Tiredness (overwhelmingly fatigued)
Difficulty sleeping
Difficulty concentrating
Symptoms and signs of volume overload (SoB, oedema)
Nausea & vomiting / reduced appetite
Cramps, pruritus
Increased frequency of infections

194
Q

What is AKI?

A

A dramatic reduction in kidney function and GFR that occurs over a short period of time

195
Q

What causes AKI?

A

An acute drop in renal function with causes categorised into:
Pre-renal (cardiogenic, mechanical, normovolaemic shock)
Intra-renal (nephrotoxic drugs, autoimmune damage)
Post-renal (obstructive e.g. renal calculi)

196
Q

Common risk factors for AKI?

A

Increasing age
CKD/HF/Liver disease/Diabetes
Infection/Sepsis
Urinary tract obstruction
NSAIDs/Diuretics/Aminoglycosides

197
Q

How to investigate AKI?

A

Urinalysis (always)
Blood tests, most importantly Serum Creatinine and Serum Urea

198
Q

How should you manage AKI?

A

Pharmacological/Surgical Interventions -
Electrolyte balanced diet
Controlling co-morbidities including diabetes, hypertension, heart failure and infection.
Lifestyle Interventions -
Iron/B12/Folate - due to loss of kidney EPO production
Vitamin D - due to loss of kidney production
Regular exercise
Smoking cessation and alcohol reduction

199
Q

Symptoms of AKI?

A

Oliguria (reduced urine production)
Oedema
Fatigue
Shortness of breath
Nausea and Confusion.

200
Q

Which HLA antigen is associated with ankylosing spondylitis?

A

HLA - B27

201
Q

Which HLA antigens are associated with IDDM?
(insulin dependent diabetes mellitus)

A

HLA - DR3 (same as celiac disease)
HLA - DR4 (same as rheumatoid arthritis)

202
Q

Which HLA antigen is associated with rheumatoid arthritis?

A

HLA - DR4 (same as IDDM)

203
Q

Which HLA antigens are associated with celiac disease?

A

HLA - DR3 (same as IDDM)
HLA - DR7

204
Q

Which HLA antigen is associated with multiple sclerosis?

A

HLA - DR2

205
Q

Which HLA antigen is associated with narcolespy?

A

HLA - DQ6

2b (3 decks)

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