Others Long Flashcards
DDx for PUO
- Infection: TB, abscess, endocariditis, pericarditis, OM, cholangitis, pyelonephritis
- Cancer - Solid, lypmhoma, leukemia
- CTDs - RA, SLE, rheumatic fever, stills
- Vasculitis
- Drug fever
- IBD
- Sarcoid/granulomatous disease
- Thyroiditis
- Hemolysis
- Haematoma
Obesity Hx General questions
- Timing of weight gain
- FHx of obesity
- MEds that may have contributed
- Exercise, how often, type, how long
- Eating patterns
- Insight into the problem and willingness to address it
- PRevious attempts to lose weight
- Mood
- Diabetes during pregnancy
Obesity Hx Complications
- Arthritis
- Diabetes
- CVS risk and risk factors
- Sleep apnea
- Fatty liver
- Mobility issues: balance, bathing
- Social life and work
- Mood
Waist circumference
> 88 cm for women
105 cm in men
associated with increased risk of diabetes, lipids, HTN, heart disease, independent of BMI
CRC Cancer screening
- FOBT >50YO - every 2 years until age 75YO
- If mod-high risk - straight to sigmoidoscopy/C’scope
Breast Cancer screening
- For asymptomatic/low risk women, mammograms every 2 years from age 50 to 74YO
- If family history of breast cancer, mammograms every 2 years from age 40YO to 74YO
- More specifically, if 1st-degree relative <50YO with breast cancer, annual mammograms from 40YO to 74YO.
- If deemed high risk - refer to Oncologist for genetic screening/BRCA. Regular self-breast exams, annual mammograms/MRI/USS. Consider prophylaxis mastectomy/oophorectomy
If wanting mammogram >40YO - 50YOF, can have it, just not invited.
Cervical Cancer screening
- ‘HPV test’ every 5 years from age 25 to 74YO (newish guideline)
HIV related conditions with severe immunosuppression
PJP Kaposis Non Hodgkins Disseminated MAC CMV Cerebral toxoplasmosis Oeseophageal candidiasis AIDS dementia complex
Ix for all HIV patients
CD4 count Viral load Hepatitis serology A, B, C CMV IgG Syphillis serology Toxoplasma antibodies LFTs and UEC CXR
Extra Ix in HIV if CD4 <200
Hepatitis C RNA
Cryptococcal antigen
Stool OCP
Extra Ix in HIV if CD4 <100
CMV PCR
Mycobacterial blood cultures
Fundoscopy
ECG
CD4 count 200-500 presentations
HSV Oral candidiasis Hairy leukoplakia Kaposi's sarcoma Pulmonary TB Lymphoid interstiial pneumonitis HIV associated indiopathic thrombocytopenia
CD4 count <200
PJP Microsporidium and Cryptosporidium Esophageal candidiasis PN Wasting Miliary and extrapulmonary TB HSV
CD4 Count <100
Cryptococcal meningitis Cerebral toxo CNS lymphoma Dementia Non hodkins Multifocal leukoencephalopathy
NRTIs (Names)
nucleoside reverse transcriptase inhibitors (NRTIs)
Tenofovir -disoproxil fumarate(TDF) -alafenamide(TAF) Abacavir (ABC) Zidovudine (ZDV/AZT) Emtricitabine (FTC) Lamivudine (3TC)
NNRTIs (Names)
non-nucleoside reverse transcriptase inhibitor
Efavirenz (EFV)
Nevirapine (NVP)
Rilpivirine
Etravirine
PIs (Names)
Protease Inhibitors (PIs): “Navirs”
Atazanavir (ATV)
Darunavir
Lopinavir (LPV)
Ritonavir (RTV)
ISTIs (Names)
Integrase Strand Transfer Inhibitors (ISTIs): “Gravirs”
Raltegravir
Elvitegravir
Dolutegravir
*Bictegravir- licenced 2018
TDF Side effects
Renal failure: Characterised by raised creatinine, proteinuria, glycosuria, hypophosphatemia, and acute tubular necrosis – FANCONI syndrome – proximal renal tubular acidosis. Caution if eGFR <60
Bone loss - decreased bone mineral density - usually stabilizes with continued use
TAF – less toxicity than TDF
Abacavir SEs
Hypersensitivity reaction
May worsen CAD
Lamivudine SE
Pancreatitis
Emtricitabine SE
skin discolouration usually as hyperpigmentation on palms and/or soles
Efavirenz SE
Potent inducer of hepatic cytochrome P450
CNS toxicity, psychiatric – vivid dreams, confusion, dizziness
QTc prolongation
Elevated hepatic transaminases
PI SEs
Nausea, diarrhoea!
Insulin resistance, hyperglycemia, diabetes, hyperlipidemia, lipodystrophy, hepatotoxicity
Interactions: Rifampicin!
Alkylating agents
Chlorambucil,
Cyclophosphamide
Melphalan
Temozolomide
Pulmonary Fibrosis – Chlorambucil, Busulfan
Haemorrhagic cystitis – Ifosfamide, Cyclophosphamide
Bone marrow suppression, gonadal (cumulative effect), nausea – all agents
Platinum agents:
Cisplatin
Carboplatin
Oxaplatin
Renal
Neuropathy
Ototoxicity
Nausea
Antimetabolites:
MTX
Mercaptopurine
5-FU, Capecitabine, Cytarabine
Bone marrow suppression
Mucositis
GIT
Anthracyclines:
Doxorubicin, Idarubicin
Cumulative cardiotoxicity
Mucositis
Alopecia
Bone marrow suppression
Taxanes
Paclitaxel
Docetaxel
Neuropathy
Anaphylaxis
Myalgias
Vinca Alkaloids
Vincristine
Neuropathy
Ileus
Bone marrow suppression
Topoisomerase inhibitors
Etoposide
Bone marrow suppression N+V Alopecia Regarding other CNS side effects: Neurotoxicity + PN
Depression Sx
S: sleep A: appetite D: dysphoria and anhedonia F: fatigue A: agitation/retardation C: concentration E: esteem S: suicide
Ix for urinary incontinence
- Rule out infection/ poorly controlled diabetes
- Check for haematuria - concern for malignancy
- Post void residual on USS + other anatomical issues
- Urodynamics may be required
If concerns about neurological pathology: MRI Brain/Spine, referral to neurologist
Acamprosate
(PBS): GABA agonist. Contraindicated in severe renal impairment. Can use in cirrhosis (Child’s Pugh A/B only). SE: Diarrhoea
Naltrexone
Naltrexone (PBS): Opiate antagonist. Contraindicated: Opioid dependence, acute hepatitis, liver failure
Dilsulfiram
Dilsulfiram (Not PBS - expensive): Alcohol deterrent. Interferes with alcohol breakdown and results in severe headaches, palpitations and vomiting due to acetaldehyde build up
