Sunday Flashcards
Emphysema
Histological description of alveolar wall destruction with airway collapse and air trapping
Chest X-ray features of COPD
Hyperinflation over 10 posterior ribs, flat diaphragm
Pulmonary hypertension: prominent pulmonary arteries
Bullae
Management of COPD
MDT
Smoking cessation
Pulmonary Rehabilitation (tailored exercise program, psychosocial support)
Comorbidites and vaccines (pneumococcal and flu)
Med: SABA, SAMA, inhaled corticosteroids
Home emergency pack
Ltot if PaO2
Chronic bronchitis definition
Cough productive of sputum for over 3 months on most days for over 2 consecutive years
Management of Fibrotic lung disease
Find underlying cause
Stop smoking
Pulmonary rehabilitation
LTOT
sympathetic treatment: antitussives, heart failure
Surgery only if Idiopathic Lung Fibrosis
Imaging features of bronchiectasis
X-ray: tramlines and ring shadows(bunch of grapes)
High resolution CT: Signet Ring Sign (thickened dilated bronchi and smaller adjacent vascular bundle)
Pools of mucus in saccule dilatation a
Complications of Bronchiectasis
Cachexia Pulmonary hypertension Massive haemoptysis Type 2 respiratory failure Amyloidosis
Management of Bronchiectasis
Conservative:
MDT and physio
Medical: Antibiotics for exacerbations Bronchodilators Treat underlying cause Vaccination (flu and pneumococcus)
Surgical: may be indicated in severe localised disease or obstruction
Ghon focus
Primary TB, organism multiplies at pleural surface
Ranke Complex
Fibrosis of Ghon complex giving calcified nodule
Investigations in TB
Active TB:
Chest X-ray and cultures, also microscopy for acid fast bacilli
Latent:
Mantoux test,
Elispot (patient lymphocytes incubated with specific TB antigens to see if IFNgamma production)
PCR
Extra pulmonary features of Cystic Fibrosis
Pancreatic: Diabetes, malabsorption
Gut: Distal Intestinal Obstruction Syndrome
Reproductive: infertility
Liver: gallstones and cirrhosis
Management of Cystic Fibrosis
Physiotherapy: postural drainage
Antibiotics: prophylactic and for acute exacerbations
Mucolytics
Segregate from other CF patients (Burkholderia risk)
Vaccination
Pancreatic supplements, ADEK, insulin
Fertility and genetic counselling
Causes of hyperthyroidism
Graves (increased uptake)
Toxic multinodular goitre= plummers
De quervains
Common causes hypothyroidism
Primary atrophic goitre (autoimmune)
Hashimotos
Simple colloid goitre (iodine deficiency)
Triple assessment for suspected thyroid lesion
Clinical examination
Ultrasound
FNAC
Practicalities of thyroid surgery
Render euthyroid pre op with antithyroid drugs but stop 10 days before surgery (they increase vascularity)
Check for phaeo pre op if medullary carcinoma
Laryngoscopy pre and post op
Causes of lump in anterior triangle
Lymph node
Goitre
Branchial cyst
Carotid body tumour (at carotid bifurcation, mostly benign)
Causes lump in posterior triangle
Lymph node
Pharyngeal pouch
Cervical rib (overdevelopment of transverse process of c7)
Causes of a cervical lymphadenopathy
LIST Lymphoma or Leukaemia Infection: EBV, TB, tonsillitis Sarcoidosis Tumours from elsewhere: breast, lung, ENT, gastro
Complications of a parotidectomy
Immediate:
Facial nerve injury
Reactionary haemorrhage
Early:
Temporary facial weakness
Salivary fistula
Loss of pinna sensation (greater auricular nerve damage)
Late:
Frey’s syndrome= facial sweating whilst eating
Risk factors for breast disease
BOOBYS
Bleeding in life (early menarche, late menopause)
Oestrogen: OCP, HRT
Other breast disease: previous cancer, DCIS
Breast feeding is protective
Young un > 35
Sister (family history)
Classification of chronic venous disease (varicose)
CEAP Clinical signs (>6 +symptomatic or asymptomatic) Etiology Anatomy Pathophysiology
Conservative measures for varicose veins
Lose weight and regular exercise
Avoid prolonged standing
Compression stockings
Skin care: emollients
Management of chronic limb ischaemia
Non surgical: Walk through pain Optimise risk factors Antiplatelets and statins Foot care
Interventional:
Angioplasty with or without stenting
Surgical:
Endarterectomy
Bypass grafting
Amputation
What is a DatScan?
Injection of Ioflupane isotope, binds to dopamine rigid neurones and allows visualisation if substantia nigra
Used in diagnosis of Parkinson’s
Causes of cerebellar pathology
DATIES Demyelination Alcohol Tumours or Trauma Inherited eg Wilsons Epilepsy medications eg Phenytoin Stroke
Management of Multiple Sclerosis
MDT
Acute: methylprednisolone
Preventing relapse: disease modifying
IFNbeta
Glatirimir
Preventing Relapse: Biologics
Natalizumab (anti VLa4 antibodies)
Alemtuzumab (Campath)
Symptomatic: fatigue, depression, pain, spasticity, urgency
What is Myasthenia Gravis?
Neuromuscular disease causing fluctuating muscle weakness as a result of antibodies to Acetylcholine receptors on the post synaptic membrane
Management of Myasthenia Gravis
Acute: plasmapheresis or IVIg, monitor FVC and consider ventilation
Chronic:
Pyridostigmine (anticholinesterase inhibitor)
Immunosuppression with steroids and Azathioprine
Thymectomy
