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Y3 Medicine > Random 11 > Flashcards

Random 11 Flashcards

1
Q

What is kartagener syndrome?

A

Kartagener syndrome, also known as primary ciliary dyskinesia (PCD), is a rare genetic disorder that affects the movement of cilia in the respiratory and reproductive tracts, as well as other parts of the body where cilia are present.

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2
Q

What does a low fecal elastase indicate?

A

Exocrine pancreas insufficiency

If the fecal elastase levels are low, it indicates a deficiency of pancreatic elastase in the stool. This deficiency suggests that the pancreas is not producing enough enzymes, which can lead to problems with digesting fats and proteins.

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3
Q

What is decompensated heart failure?

A

Decompensated heart failure refers to a situation where the heart, which is already weakened and unable to pump blood effectively, suddenly worsens, leading to the worsening of symptoms and the onset of new complications. It is a serious and potentially life-threatening condition that requires immediate medical attention.

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4
Q

Differentiate between C.diff antigen and toxin.

A

Antigen suggests colonisation but does not indicate active disease.

C. difficile bacteria produce toxins, specifically toxins A and B. Which are responsible for the symptoms of C. difficile infection

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5
Q

What is an antiviral drug used in COVID-19 treatment?

A

Remdesivir

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6
Q

What are features of uremic syndrome?

A
  • Pruritus
  • Fatigue and weakness
  • Nausea and vomiting
  • Loss of appetite
  • Muscle cramps and twitching
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7
Q

What does FiO2 indicate?

A

How much oxygen you are giving the patient.

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8
Q

Describe the anatomy of the pituitary gland

A
  • Located at the base of the skull in the sella turcica
  • The optic chiasm is located superiorly
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9
Q

Which cranial nerves run through the cavernous sinus?

A

3, 4, 5 and 6

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10
Q

Describe the blood supply to the pituitary gland

A

Blood supply to the anterior pituitary is from the hypothalamo-hypophyseal portal system

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11
Q

What are some causes for hypopituitarism?

A
  • Radiotherapy
  • Infection- TB, abscess
    Infarction- stroke or Sheehan’s
  • Infiltration- sarcoidosis, lymphocytic
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12
Q

What is Sheehan’s syndrome?

A

Sheehan’s syndrome, also known as postpartum hypopituitarism, is a rare condition that occurs due to severe bleeding and low blood pressure during or after childbirth, leading to damage to the pituitary gland.

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13
Q

What are some clinical manifestations of growth hormone insufficiency?

A
  • Reduced exercise capacity and lean mass
  • Decreased bone density
  • Fatigue and decreased energy levels
  • Impaired insulin sensitivity
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14
Q

What is defined as a macro pituitary tumor?

A

> 1cm

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15
Q

What PRL level is likely a macro prolactinoma?

A

4000

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16
Q

What are some medications that can cause hyperprolactinemia?

A

Basically reducing dopamine

  • Anti-sickness
  • Anti-psychotics
  • Monoamine oxidase inhibitors
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17
Q

What is the only treatment option for a non-functioning pituitary adenoma?

A

Surgery

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18
Q

What are the clinical features of acromegaly?

A
  • Sweating, headache, joint pain, tiredness
  • Frontal bossing, oily skin, enlarged nose, prognathism (Prognathism refers to a condition where the lower jaw (mandible) protrudes)
  • Macroglossia
  • HTN, DM, OSA, IHD, CHF
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19
Q

How do you investigate acromegaly?

A
  • IGF1 (elevated) and random growth hormone
  • OGTT (GH should suppress <0.33)
  • MRI
  • Pituitary function test
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20
Q

What hormone inhibits the release of growth hormone?

A

Somatostatin

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21
Q

What is a somatostatin analogue?

A

octreotide and lanreotide

22
Q

What is a growth hormone antagonist?

A

Pegvisomant

23
Q

What are dopamine agonists?

A

Bromocriptine and cabergoline

24
Q

What is the treatment for acromegaly?

A

Surgical: surgery to remove the adenoma is the primary treatment of choice.
Transphenoidal (first line)/transfrontal resection of the pituitary +/- radiotherapy
Medical: this may be more appropriate if surgery is contraindicated or the mechanism is not due to a pituitary adenoma, or if the presentation is refractory to surgery
Somatostatin analogues (octreotide, lanreoride), which suppress growth hormone release - first line medical treatment
Growth hormone antagonists (pegvisomant)
Dopamine agonists (bromocriptine, cabergoline)
Follow up:
Monitor for bowel malignancy (colonoscopy) and cardiac failure (with echocardiography) - these often have to continue even after the post-operative period, since the sequelae can be long term
Other monitoring may be required to detect recurrence, in the form of serial IGF-1s/growth hormone, prolactin (concomitant prolactin release in the adenoma occurs in 30% of cases), visual fields, ECGs, plus MRI scans of pituitary

25
Q

What is the difference between ACTH independent and dependent?

A

Independent is a tumor in the adrenal gland that secretes cortisol without the trigger of ACTH.

26
Q

What are symptoms and signs of Cushing’s disease?

A
  • Emotional disturbance
  • Moon face
  • Osteoporosis
  • Buffalo hump
  • Thin, wrinkled skin
  • Abdominal striae
  • Purpura
27
Q

What are associated features of cushing’s disease?

A

HTN, DM, Osteoporosis and recurrent infections.

28
Q

How do you investigate Cushing’s disease?

A
  • 2 x 24 hour urinary free cortisol
  • Low dose dexamethasone test
  • MRI
  • ACTH
29
Q

What will the results be after an overnight low-dose dexamethasone test for exogenous cortisol production?

A

Low ACTH

High Cortisol

30
Q

What will the results be if someone has a pituitary adenoma after a high-dose dexamethasone test?

A

Low ACTH

Low Cortisol

31
Q

What is Nelson’s syndrome?

A

When you remove both of the adrenal glands you have no cortisol production. This causes you to increase more ACTH, hyperplasia of the pituitary gland which can suppress the optic chiasm.

32
Q

What is the treatment of cushing’s disease?

A
  • TSS
  • Radiotherapy
  • Adrenalectomy
  • Medical treatment Medical Management: Initial therapy often involves medications to decrease cortisol levels. These include Metyrapone, an inhibitor of cortisol synthesis; Ketoconazole, an adrenolytic agent; Mifepristone, a glucocorticoid receptor antagonist; and Pasireotide, a somatostatin analog.
33
Q

How can you define diabetes insipidus?

A

Passage of >3L of dilute urine (<300mOsm/kg)

34
Q

What are the baseline investigations for suspected diabetes insipidus?

A

Urea and electrolytes (sodium may be raised)
Blood glucose (to rule out diabetes mellitus)
Urine dip
Paired serum and urine osmolality measurements
Water deprivation test
MRI brain

35
Q

How do you treat cranial DI?

A

Desmopressin

36
Q

How do you treat nephrogenic DI?

A

Thiazide, Indometacin (NSAID) or high dose desmopressin

37
Q

What are the causes of cranial diabetes insipidus?

A

Congenital, infection, infiltration, trauma, inflammation or vascular

38
Q

How do you tell the difference in complete central DI and nephrogenic DI after the water deprivation test?

A

So both will produce large volumes of low osmolality urine.

Increase in urine osmolality after desmopressin (synthetic ADH) is seen in central DI and not in nephrogenic.

39
Q

What is cardiac syncope?

A

Cardiac syncope occurs due to inadequate cardiac output leading to cerebral hypoperfusion. It can be classified as either structural (related to cardiac abnormalities) or electrical (involving arrhythmias).

40
Q

What are some structural causes of cardiac syncope?

A

Aortic stenosis
Ischaemic cardiomyopathy
Hypertrophic obstructive cardiomyopathy (HOCM)
Cardiac tamponade

41
Q

What are some electrical causes of cardiac syncope?

A

Tachyarrhythmias: SVT or VT/VF
Bradyarrhythmias: sick sinus syndrome or AVN block.
Inherited channelopathies: Brugada syndrome.

42
Q

What is a vaso-vagal?

A

The vagus nerve is stimulated innapropriately and causes a faint.

43
Q

What is the worst drug for postural hypotension

A

Tamsulosin. Most men are on tamsulosin and finasteride which are very strong anti-hypertensives.

44
Q

What questions should you ask in a after LOC syncope?

A
  • Do you remember waking up?
  • Do you remember hitting the ground
  • Fractures
  • How long
  • Tongue biting,
45
Q

What questions should you ask a witness in syncope?

A
  • Does the patient lose awareness?
  • Does the patient injure themselves
  • Signs of epilepsey- jerking
  • Incontinence
  • Does the patient bite their tongue
  • How long does it last
  • Any associated symptoms- palpitations, sweats, pallor, dyspnoea
46
Q

What investigations do you do in syncope?

A
  • ECG
  • Us&Es
  • FBC glucose
  • Tilt table
  • EEG
47
Q

What causes of syncope could you pick up on an ECG?

A
  • Structural heart disease
  • Coronary heart disease
  • Sinus node disease
  • Conducting tissue - LBBB
  • Accessory pathways
  • Ion channelopathies
48
Q

What are your concerns with the DVLA after syncope (loss of consciousness) and how do you go about informing them?

A
  • If you are the first healthcare professional it is your responsibility to report them to the DVLA
  • If there is a total loss of consciousness there is an immediate ban on driving for 6 months unless diagnosis and treatment
  • Except a vas-vagal as you are pre-warned and have enough time to pull over
  • IF they disagree let them know that you have no choice but to inform the DVLA yourself.
49
Q

What is palliative care?

A

Treatment and supportive care for patients with terminal illnesses. Physical, psychosocial and spiritual.
- The goal of therapy is to improve the quality of life instead of treating the disease itself

50
Q

Who is in a palliative care team?

A
  • Palliative care specialist
  • Psychologist
  • Speech therapist
  • Physiotherapist
  • Bereavement officer
  • Spiritual care giver
  • Social worker
  • Hospice care providers

Y3 Medicine (17 decks)

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