SBA revision 2 Flashcards
lower urinary tract symptoms (LUTS)
storage (aka irritative) and voiding (aka obstructive)
symptoms and remembered using the mnemonic FUN (storage) WISE
(voiding): Frequency, Urgency, Nocturia, Weak stream, Intermittency,
Straining, incomplete Emptying.
`Tumor markers
CA 15-3 = Breast cancer
CA 19-9 = Pancreatic cancer
CA 125 = Ovarian cancer
CEA = Colorectal cancer
aFP = Liver cancer, Testicular cancer (non-seminomas)
b-hCG = Choriocarcinoma, Germ cell tumours
S100 = Melanoma
Calcitonin = Medullary thyroid cancer
PSA = Prostate cancer
Thyroglobulin = Thyroid cancer (used post-thyroidectomy to monitor
completeness of removal)
Breathing patterns
Kussmaul breathing is characterised by deep, sighing breaths. It is a
compensatory response to severe metabolic acidosis (e.g. ketoacidosis) —
the deep breaths help to blow off carbon dioxide and raise pH.
Cheyne–Stokes breathing is a cyclic breathing pattern in which breathing
gets progressively deeper, then progressively shallower followed by a
period of apnoea. Causes include brainstem damage or herniation.
Hypoventilation broadly refers to a decrease in ventilation. Biot’s respi
ration is characterised by clusters of rapid, shallow inspirations and
expirations interspersed amongst periods of apnoea. It is also caused by
brainstem damage. Apnoea refers to the temporary cessation of breathing.
Tumors and nodes
Testicular tumours -spread to the para-aortic lymph nodes
Scrotal and penile tumours and
infections -will lead to enlargement of inguinal lymph nodes
HF CXR
ABCDE: Alveolar shadowing, Kerley B lines,
Cardiomegaly, Dilated upper lobe vessels, Effusion
Stroke management
There are two main types of stroke: ischaemic (80%) — in
which the brain is temporarily starved of blood due to thrombosis, emboli
or hypotension — and haemorrhagic — where a bleed within the brain
creates pressure that damages the brain tissue. Such bleeds may come from
microaneurysm rupture, trauma, tumours, vasculitis or arteriovenous
malformations. The single most important risk factor is hypertension, but
others include smoking, hyperlipidaemia and diabetes. Management of
ischaemic and haemorrhagic strokes differ, so an urgent CT head scan is
required to distinguish between the two. Once a bleed has been excluded
(by the absence of bleeding on a CT head scan), you need to determine the
next stage of the management by considering the time since the onset of
symptoms. If the onset of symptoms was less than 4.5 hours ago, the patient
should be thrombolysed with alteplase and given aspirin within 24 hrs. If
the onset of symptoms was more than 4.5 hrs ago, the patient should be
given antiplatelet therapy and undergo a swallow assessment and GCS
monitoring.
Antibody markers
pANCA - Primary sclerosing cholangitis,microscopic
polyangiitis, granulomatosis with polyangiitis and rheumatoid arthritis
AMA - primary biliary cirrhosis (PBC).
ASLA - type 1 autoimmune hepatitis
ALKM-1 - and type 2 autoimmune hepatitis
Causes of dysphagia
• Obstructive • Oesophageal carcinoma • Peptic strictures (D) • Oesophageal web/ring (B) • Gastric carcinoma • Pharyngeal carcinoma (A) • Extrinsic pressure from, for example, lung carcinoma, retrosternal goitre (C) • Oesophageal motility disorders • Achalasia (E) • Systemic sclerosis • Stroke • Myasthenia gravis • Neurological degenerative conditions, e.g. motor neurone disease, Parkinson’s disease • Others • Oesophagitis • Pharyngeal pouch • Oesophageal candidiasis
Budd -Chiari triad
hepatic
vein outflow obstruction
Abdo pain, hepatomegaly, ascites
Causes of Hepatomegaly
The causes of hepatomegaly can be classified according to:
1 Maligancy: primary (e.g. HCC) or secondary.
2 Hepatic congestion secondary to: right heart failure, Budd–Chiari
syndrome.
3 Infection: hepatitis (secondary to viruses, malaria, shistosomiasis,
amoebic abscess, hydatid cyst), infectious mononucleosis.
4 Haematological: leukaemia, lymphoma, myeloproliferative disorders,
such as myelofibrosis, sickle-cell disease, haemolytic anaemias.
5 Anatomical: Riedel’s lobe.
6 Other causes include early cirrhosis, fatty liver, porphyria,
amyloidosis, Gaucher’s disease.
drug induced cholestasis
- Clavulanic acid
- Penicillins
- Oestrogens
- Erythromycin
- Chlorpromazine
Causes of finger clubbing
Inflammatory bowel disease liver cirrhosis, primary biliary cirrhosis, oesophageal leiyomyoma, coeliac disease and achalasia
Causes of upper gastrointestinal bleeding
- peptic ulcers – approximately 35–50 per cent of bleeds (B);
- Mallory–Weis tears – 15 per cent (A);
- oesophagitis – 5–15 per cent;
- gastritis and gastric erosions – 5–15 per cent;
- oesophageal varices – 5–10 per cent (C);
- drugs (e.g. NSAIDs, steroids, anticoagulants) – 5 per cent (D);
- upper GI malignancy – 5 per cent (E);
- rarer causes (<5 per cent):
- Dieulafoy’s lesion;
- angiodysplasia;
- haemobilia;
- aorto-enteric fistula
causes of portal hypertension (>10 mmHg)
1) Pre-hepatic: portal-vein thrombosis, splenic vein
thrombosis; (2) Hepatic: cirrhosis (accounts for 80 per cent of causes of
portal hypertension), shistosomiasis (most common cause worldwide),
sarcoidosis, myeloproliferative disease, congenital hepatic fibrosis; and
(3) Post-hepatic: Budd–Chiari syndrome, right heart failure, constrictive
pericarditis, veno-occlusive disease
Prophylaxis for the prevention of variceal
bleeding portal hypertension (>12 mmHg)
(1) Primary: non-selective β-blockade (e.g.
propranolol) and/or endoscopic banding ligation; (2) Secondary (i.e. after
an initial variceal bleed: non-selective β-blockade, endoscopic banding
ligation, transjugular intrahepatic portosystemic shunting (TIPPS)
