Random Y3 Content Flashcards
Intrinsic factor antibodies are specific to what?
Pernicious anaemia
Anti-mitochondrial antibodies are associated with what?
Primary biliary sclerosis
Anti-smooth muscle antibodies are associated with what?
Auto-immune hepatitis
Crohn’s (crows NESTS)
- What does NESTS stand for?
N – No blood or mucus (less common)
E – Entire GI tract
S –“Skip lesions” on endoscopy
T – Terminal ileum most affected andTransmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)
Ulcerative Colitis (remember U – C – CLOSEUP).
- What does CLOSE UP stand for?
C–Continuous inflammation
L–Limited to colon and rectum
O–Only superficial mucosa affected
S–Smoking is protective
E–Excrete blood and mucus
U–Useaminosalicylates
P–Primary Sclerosing Cholangitis
Explain the use of faecal calprotectin.
Faecal calprotectin(released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults).
How to induce remission in a flare up of Crohn’s?
First line: Steroids (oral prednisolone or IV hydrocortisone).
If steroids don’t work add an immunosuppressant e.g azathioprine.
Maintaining remission for Crohns
Azathioprine
What role does surgery have in managing Crohn’s
- Resect terminal ileum if limited to here.
- Surgery to manage complications e.g strictures and fistulas.
Revise infective endocarditis flashcards in cardio 2
Revise infective endocarditis flashcards in cardio 2
How to induce remission in an active flare of UC?
Mild to moderate disease
- First line:aminosalicylate(e.g.mesalazine oral or rectal)
- Second line: corticosteroids (e.g. prednisolone)
Severe disease
- First line: IV corticosteroids (e.g. hydrocortisone)
- Second line: IV ciclosporin
How to maintain remission in UC?
- Aminosalicylate (e.g. mesalazine oral or rectal)
- Azathioprine
- Mercaptopurine
Explain the surgical intervention for UC:
Ulcerative colitis typically only affects the colon and rectum. Therefore, removing the colon and rectum (panproctocolectomy) will remove the disease. The patient is then left with either a permanent ileostomy or something called an ileo-anal anastomosis(J-pouch). This is where the ileum is folded back in itself and fashioned into a larger pouch that functions a bit like a rectum. This “J-pouch” which is then attached to the anus and collects stools prior to the person passing the motion.
What is meant by the 5-ASA drugs?
5-aminosalicylic acid e.g mesalazine
What histology is seen in Crohn’s disease?
Segmental, patchy inflammatory bowel disease, often involving the ileum, colon and upper GI tract.
Histologically characterized by chronic active colitis with associated transmural lymphoid aggregates and fissuring ulcers.
Noncaseating granulomas are characteristic but neither sensitive nor specific.
Crypt distortion and a cobble stone appearance.
Treatment of an NSTEMI?
BATMAN
Betablocker, Aspirin, Ticagrelor/antiplatelet, Morphine, Anticoag eg LMWH, Nitrite eg GTN
What scoring systems are used in assessing acute GI bleeding?
Glasgow-Blatchford score at first assessment
Rockall score is used after endoscopy
Stepwise management of variceal bleeding:
- Terlipressin + prophylactic antiobiotics.
- Band ligation.
- TIPS (Transjugular intrahepatic portosystemic shunts).
Resusiciation in a patient with an acute upper GI bleed?
- A-E, get wide bore access.
- Platelet transfusion.
- Blood transfusion if needed.
- Prothrombin complex concentrate to patients who are taking warfarin and actively bleeding.
Epigastric pain a few hours after eating =
Query duodenal ulcer
Features of an upper GI bleed?
Clinical features may include haematemesis, melena, a raised urea, and features associated with a particular diagnosis (such as stigmata of chronic liver disease for oesophageal varices, or abdominal pain for peptic ulcer disease).
What are the differential diagnoses for oesophageal causes of acute upper gastrointestinal bleeding?
Oesophageal varices, oesophagitis, cancer, and Mallory Weiss tear are all possible causes of oesophageal bleeding.
What are the differential diagnoses for gastric causes of acute upper gastrointestinal bleeding?
Gastric ulcer, gastric cancer, Dieulafoy lesion, and diffuse erosive gastritis are all possible causes of gastric bleeding.
What are the differential diagnoses for duodenal causes of acute upper gastrointestinal bleeding?
Duodenal ulcer and aorto-enteric fistula are possible causes of duodenal bleeding.
What are the admission risk markers used in the Glasgow-Blatchford score?
Urea, haemoglobin, systolic blood pressure, pulse, presentation with melena or syncope, and hepatic disease or cardiac failure are all used as admission risk markers in the Glasgow-Blatchford score.
How are electrolytes and glucose affected in addisonian crisis?
- Hypoglycaemia
- Hyponatraemia
- Hyperkalaemia
Management of adrenal crisis?
- OSCE style
- ABCDE approach to initial assessment and arrange transfer to hospital
- Intramuscular or intravenous hydrocortisone (the initial dose is 100mg, followed by an infusion or 6 hourly doses)
- Intravenous fluids
- Correct hypoglycaemia (e.g., IV dextrose)
- Careful monitoring of electrolytes and fluid balance
Signs and symptoms of adrenal insufficiency:
Symptoms of adrenal insufficiency include fatigue, muscle weakness, muscle cramps, dizziness and fainting, thirst and craving salt, weight loss, abdominal pain, depression, and reduced libido. Signs of adrenal insufficiency include bronze hyperpigmentation of the skin and hypotension (particularly postural hypotension - with a drop of more than 20 mmHg on standing).
Diagnosis of adrenal insufficiency:
Short synacthen test
What triad does Budd Chiari Syndrome present with?
Sudden onset abdominal pain
Ascites
Tender hepatomegaly
Causes of Cushings syndrome?
CAPE
C - Cushing’s disease (pituitary adenoma producing excess ACTH).
A - Adrenal adenoma (excess cortisol).
P - Pareneoplastic syndrome
E - Exogenous long term steroids.
Treatment of thyrotoxic storm:
Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone.
Investigations for epididymo-orchitis:
MSU esp if old, STI test for younger sexually active.
- treat the underlying cause.
In an acute upper GI bleed, the what score can identify low risk patients who may be discharged?
Blatchford score
Definitive management for symptomatic hyperparathyroidism?
Parathyroidectomy is the definitive management for symptomatic hyperparathyroidism.
Blood findings in primary hyper parathyroidism?
High Ca2+, Low PO4-, Normal/High PTH!
X-ray findings of hyperparathyroidism:
- Pepperpot skull
- Osteitis fibrosa cystica
Where in the colon is most likely to be affected by ischaemic colitis?
The splenic flexure is the most likely area to be affected by ischaemic colitis.
Gingivostomatitis
Gingivostomatitis is an infection of the mouth and gums that leads to swelling and sores. Inflammation of the gums is called gingivitis.
Turner’s is associated with what cardiac defect?
Turner’s syndrome is associated with aortic coarctation.
1st line for hyperthyroidism?
Carbimazole
2nd line for hyperthyroidism?
Propylthiouracil
(can cause severe liver reactions and death - hence it’s 2nd line lol)
A hyperthyroid patient on carbimazole/propylthiouracil has a sore throat?
You should be worried…
Why?
Both carbimazole and propylthiouracil can cause agranulocytosis, with a dangerously low white blood cell counts. Agranulocytosis makes patients vulnerable to severe infections. A sore throat is a key presenting feature of agranulocytosis. In your exams, if you see a patient with a sore throat on carbimazole or propylthiouracil, the cause is likely agranulocytosis. They need an urgent full blood count and aggressive treatment of any infections.
Symptomatic relief for hyperthyroid patient with…
Propanolol (non-selective beta blocker).
Discuss surgery as an option for a hyperthyroid patient (OSCE).
Surgeryis a definitive option. Removing the whole thyroid gland (thyroidectomy), or the toxic nodules, effectively stops the excess thyroid hormone production. Patients will be hypothyroid after a thyroidectomy, requiring life-long levothyroxine.
What are the causes of hyperthyroidism?
The causes of hyperthyroidism can be remembered with the “GIST” mnemonic:
Graves’ disease
Inflammation (thyroiditis)
Solitary toxic thyroid nodule
Toxic multinodular goitre
What is De Quervain’s thyroiditis?
De Quervain’s thyroiditis, also known as subacute thyroiditis, is a condition causing temporary inflammation of the thyroid gland. There are three phases:
- Thyrotoxicosis
- Hypothyroidism
- Return to normal
Symptoms of the thyrotoxic phase of De Quervain’s thyroiditis:
- Excessive thyroid hormones
- Thyroid swelling and tenderness
- Flu-like illness (fever, aches and fatigue)
- Raised inflammatory markers (CRP and ESR)
What are the Grave’s specific features in a hyperthyroid patient?
- Diffuse goitre(without nodules)
- Graves’ eye disease, including exophthalmos
- Pretibial myxoedema
- Thyroid acropachy (hand swelling and finger clubbing)
Different types of thyroiditis:
- De Quervain’s thyroiditis
- Hashimoto’s thyroiditis
- Postpartum thyroiditis
- Drug-induced thyroiditis
Most common cause of hypothyroidism?
- two answers ;)
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the developed world.
Iodine deficiencyis the most common cause of hypothyroidism in the developing world.
Hashimoto’s thyroiditis - associated antibodies:
It is associated withanti-thyroid peroxidase(anti-TPO)antibodiesandanti-thyroglobulin(anti-Tg)antibodies.
How does lithium affect the thyroid?
Lithium inhibits the production of thyroid hormones in the thyroid gland and can cause a goitre and hypothyroidism.
Causes of secondary hypothyroidism?
- Tumours (e.g., pituitary adenomas)
- Surgery to the pituitary
- Radiotherapy
- Sheehan’s syndrome (where major post-partum haemorrhage causes avascular necrosis of the pituitary gland)
- Trauma
Note: Secondary hypothyroidism is often associated with a lack of other pituitary hormones, such as ACTH, referred to as hypopituitarism.
Presentation of hypothyroidism:
- Weight gain
- Fatigue
- Dry skin
- Coarse hair and hair loss
- Fluid retention (including oedema, pleural effusions and ascites)
- Heavy or irregular periods
- Constipation
Iodine deficiency causes agoitre.
Hashimoto’s thyroiditiscan initially cause agoitre, after which there is atrophy (wasting) of the thyroid gland.
Treatment of hypothyroidism?
Oral levothyroxineis the mainstay of treatment of hypothyroidism.
Levothyroxine is asynthetic version of T4 and metabolises to T3 in the body.
DKA shows what on ABG?
RAISED ANION GAP metabolic acidosis
Test for cushings - what do the results indicate?
Dexamethasone suppression test.
Cushing’s disease, cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone.
Migraine prophylaxis
Topiramate or propranolol
What valvular defect is associated with PCOS?
Mitral valve prolapse is associated with polycystic kidney disease.
How to differentiate a hydro eke from other testicular lumps?
Hydrocoeles can be differentiated from other testicular lumps as they are NOT SEPARATE TO TESTIS and TRANSILLUMINATE.
