passmed Flashcards
splenectomy + HbA1C
Splenectomy can give a falsely high HbA1c level due to the increased lifespan of RBCs
Peptic ulceration, galactorrhoea, hypercalcaemi
MEN 1
3 Ps
Parathyroid hyperplasia –> hypercalcaemia (most comm pres)
Pituitary adenoma –> galactorrhoea
Pancreatic disease –> insulinoma, gastrinoma –> PU
nephrogenic DI - water deprivation test findings
urine osmolality - after fluid deprivation LOW
urine osmolality -after desmopressin LOW
EBV virus effect on FBC
neutropaenia
CML novel tx
imatinib - TK inhibitor
most common thyroid c + progn
papillary thyroid C - excellent prognosis despite early spread to cervical LNs
ITP 1st line tx
oral pred
causes of raised prolactin - p’s
pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism Phenothiazines, metocloPramide, domPeridone
most common cause of inherited THROMBOPHILIA –> tendency to develop clots
Factor V Leiden mutation (5% prevalence) results in activated protein C resistance –> 4x risk of VTE
ovaries drain to where
para-aortic LNs
SGLT-2 rare skin SE
nec fasc of genitalia or perineum (Fourniers)
std HbA1c target in T2DM
48mmol/mol
how to change drugs in addisons when intercurrent illnesss
DOUBLE GC + same fludrocortisone
platelet transfusion: active bleeding cut off
- Offer platelet transfusions to patients with a platelet count of <30 x 10 9 with clinically significant bleeding
e. g. WHO bleeding grade 2= haematemesis, melaena, prolonged epistaxis - higher threshold higher (maximum < 100 x 10 9) for patients with severe bleeding (WHO bleeding grades 3&4), or bleeding at critical sites, such as the CNS
- platelet transfusions have highest risk of BACTERIAL CONTAMINATION vs other blood products
platelet transfusions cut off as prophylaxis before surgery
Platelet transfusion for thrombocytopenia before surgery/ an invasive procedure. Aim for plt levels of:
> 50×10 9/L for MOST PTS
50-75×10 9/L if HIGH RISK OF BLEEDING
>100×109/L if surgery at CRITICAL SITE
Platelet transfusion threshold if no active bleeding or planned procedures
A threshold of 10 x 10 9 except where platelet transfusion is CI or there are alternative treatments for their condition
- EG, do not perform platelet transfusion for any of the following conditions:
- ->Chronic bone marrow failure
- ->AI thrombocytopenia
- ->HIT or TTP
antiplatelets for ACS (medically treated)
1st: Aspirin (lifelong) + ticagrelor (12m)
2nd: if aspirin CI, clopi (lifelong)
antiplatelets for PCI
1st: Aspirin (lifelong) + prasurgrel or ticagrelor (12m)
2nd: if aspirin CI, clopi (lifelong)
antiplatelets for TIA
1st: Clopi (lifelong)
2nd: aspirin (lifelong) + dipyridamole (lifelong)
antiplatelets for Ischaemic stroke
1st: Clopi (lifelong)
2nd: aspirin (lifelong) + dipyridamole (lifelong)
antiplatelets for PAD
1st: Clopi (lifelong)
2nd: aspirin (lifelong)
neuroblastoma
tumour arising from NEURAL CREST TISSUE of ADRENAL MEDULLA (most common site) + SYMP NERVOUS SYSTEM
- median age of onset = 20m
- feat: abdo mass, pallor, weight loss, bone pain, limp, hepatomegaly, paraplegia, proptosis
- Ix: raised urinary VMA + HVA levels, calcification on abdo XR, biopsy
venous ulceration iX + MX
IX: 1. ABPI is imp in non-healing ulcers to assess for poor arterial flow which could impair healing
- a ‘normal’ ABPI may be regarded as between 0.9 - 1.2
- Values < 0.9 indicate ARTERIAL disease
- Interestingly, values > 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)
MX:
- COMPRESSION BANDAGING, usu 4 layer (only tx shown to be of real benefit)
- oral PENTOXIFYLLINE, a peripheral VD, impr healing rate
- small evidence base supporting use of FLAVINOIDS
Interpretation of ABPI
> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
1.0 - 1.2: NORMAL
< 0.9: likely PAD.
Values < 0.5 indicate severe disease which should be REFER URGENTLY
what ABPI is compression bandaging acceptable for
Compression bandaging is generally considered acceptable if the ABPI >= 0.8
arterial ulcers
Occur on the toes and heel Painful There may be areas of gangrene Cold with no palpable pulses Low ABPI measurements
Marjolins ulcers
=Squamous cell carcinoma
Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years
Mainly occur on the lower limb
Venous ulcers features + cause
-Most due to venous hypertension, secondary to chronic venous insufficiency (other causes include calf pump dysfunction or neuromuscular disorders)
-Ulcers form due to capillary fibrin cuff or leucocyte sequestration
-Features of venous insufficiency include oedema, brown pigmentation, lipodermatosclerosis, eczema
-Location above the ankle, painless
-Deep venous insufficiency is related to previous DVT and superficial venous insufficiency is associated with varicose veins
-Doppler ultrasound looks for presence of reflux and duplex ultrasound looks at the anatomy/ flow of the vein
-Management: 4 layer compression banding after exclusion of arterial disease or surgery
If fail to heal after 12 weeks or >10cm2 skin grafting may be needed
Neuropathic ulcers
Neuropathic ulcers
- Commonly over plantar surface of metatarsal head and plantar surface of hallux
- The plantar neuropathic ulcer is the condition that most commonly leads to amputation in diabetic patients
- Due to pressure
- Mx: includes CUSHIONED SHOES to reduce callous formation + DIABETIC FOOT CHECKS
Pyoderma Gangrenosum
- Associated with IBD/RA
- Can occur at STOMA sites
- Erythematous nodules or pustules which ulcerate
