Things to remember Flashcards
DVT - Wells Criteria
- Active cancer (Treatment or palliation within 6 months)
- Bedridden recently >3 days or major surgery within 12 weeks
- Calf swelling >3 cm compared to the other leg (Measured 10 cm below tibial tuberosity)
- Collateral (nonvaricose) superficial veins present
- Entire leg swollen
- Localized tenderness along the deep venous system
- Pitting edema, confined to symptomatic leg
- Paralysis, paresis, or recent plaster immobilisation of the lower extremity
- Previously documented DVT
2 points or below - moderate risk
Over three points - high risk group refer
SNOOPPPP
S – systemic signs + secondary RF (HIV, malignancies, immunosuppression) . Fever, weight loss, myalgia, arthralgias.
N – neurological deficits. Weakness, sensory loss, speech impairment, vison loss, sneezing frequently.
O – old. Greater than or equal to 50y
O – onset of headache is sudden/acute and intense.
P – Papilledema. High intercranial pressure presses on optic nerve, may be visible loss of disc margin in eyes
P – positional. Commonly worse when. Lying down and better when sitting up. Hints at brain tumour
P – Pattern change. Sudden change in symptoms from headache, e.g. Dull ache to stabbing Px
P – precipitated by Valsalva manoeuvre. Tensing whole body e.g. to pass bowls. Increases intra-abdominal and thoracic pressure and decreases venous drainage from veins draining the brain (cerebral veins). Leads to increase in intercranial pressure
5Ds 3Ns 1A
5D’s
Dizziness
Diplopia, blurred vision or transient hemianopia
Drop attacks (loss of power or consciousness)
Dysphagia (problems swallowing)
Dysarthria (problems speaking)
3 N’s
Nystagmus
Nausea or vomitting
Other neurological symptoms
1 A
Ataxia, trouble with balance and co-ordination
Osteoporosis RF
- Early menopause; smoking; hysterectomy; Diet; gastrointestinal morbidity; late menarche; anorexia, break in periods longer than 1 year
Steroid use of 7.5 mg for >3 month increases the risk of osteoporosis. - +ve family history increases risk especially in F.
- Medication for osteoporosis will decreases risk for # in following year by 50-80% (what are some osteoporotic meds?)
- Prev Hx of osteoporotic # have 5.4-fold risk of vert # and 2.8- fold risk of hip #
Osteoporosis DEXA scan
- Peak bone mass is attained in early 20s – bone mineral density in femoral neck, total hip + LSP reaches peak by 20- 24 in M and 19-20 in F (Xue et al 2020).
-1 or higher: Normal bone density
-1 to -2.5: Osteopenia
-2.5 or lower: Osteoporosis
Constitutional signs
Constant pain, unremitting pain, night pain, night sweats, unexplained weight loss, decreased appetite, sores that won’t heal, skin changes, fatigue, unusual lump, frequent infections.
Male most common primary cancer sites
1) Prostate
2) Colorectal
3) Lung
Male most common Metastasise sites
1) Bone
2) Liver
3) Lung
Female most common primary cancer sites
1) Breast
2) Colorectal
3) Lung
Female most common metastasis sites
1) Liver
2) Bone
3) Lung
Bone: Metastasis sites
Bone – Lungs, liver, bone then brain
Previous Hx of cancer must ask/Chance of metastasise
- History of malignancy - Qs: how long ago was primary Dx; stage/size of cancer; lymph involvement; TTT? (chemo, radio, hormonal)
- Lower suspicion (early stae 1 or 2, no lymph involvement, cancers that don’t predilect to bone (ovarian, melanoma)
- Higher suspicion (later stage 3 or 4, lymph involvement, breast, lung, thyroid, renal, prostate.)
Breast cancer metastases can occur @ any time, 50% occur in 1st 5 years and 50% 10 + years - Breast 21%
- Lung 19%
- Prostate 7.5%
- Renal 5%
- Thyroid 2-3%
Tsp - 70%
Lsp - 20%
Csp 10%
SCREENDEM
Skin - Psoriasis
Colitis or Chrons
Relatives
Eyes - Uveitis
Early morning stiffness more than 30mins
Nails - pitting, thickening, onycholysis
Dactylitis
Enthesitis - commonly achilles tendon, PF or patella tendon
Movement and medication - improvement with rest and NSAIDs
6 Ps
Pain
Paresthesia
Pulslessness
Perishing cold
Paralysis
Pallor
CES
- Severe or progressive uni/bilateral neuro deficit in the legs
- Reduced perianal sensation
- Altered bladder function
- Difficulty starting or stopping
- Leaking urine not aware whether bladder is full or empty
- Loss of anal tone
- Inability to stop a bowel movement or leaking
- Sexual dysfunction- change in ability to achieve an erection or ejaculation, Loss of sensation in genitals during sexual intercourse
CES causes:
Congenital
Trauma – fall from height, RTA,
Surgery
Spinal stenosis
Infectious – neurosarcoidosis, abscess formation
Inflammatory conditions
Tumours - primaries (ependymoma, neurofibroma, meningioma,
secondaries
Disc herniation–CESis a complication of herniated discs. How many %?
Screening ages
AAA - 65 or 55 in risk factor males
Breast cancer - 45 every three years - mammogram
Cervical cancer 25 - smear test
Colorectal - 50 - stool sample every two years
Liver and lung metastasis sites
Liver – Brain
Lung - Adrenal gland, bone, brain, liver, other lung
Colon and rectal metastasise sites
Colon and rectal – Liver, lung, peritoneum, bone (Vertebrae, hip, sacrum)
Prostate metastasise sites
Prostate - Adrenal gland, bone (Pelvic, sacrum, vertebral), liver, lung, brain, sacral plexus, Bladder, rectum
Breast and cervix metastasise sites
Breast – Lymphatics - bone, brain, brachial plexus, Blood liver, lung
Cervical – Bladder, rectum, Brain, lungs, bone liver
Bladder overian and thyroid
Bladder – bone (Vertebrae, hip, sacrum)
Ovarian – Nearby organs (bladder, colon, rectum, uterus, fallopian tubes) To spread beyond abdomen is rare
Melanoma – Bone, brain, liver, lung, skin, muscle
Thyroid – Bone, Liver, Lung
Prostate psa levels
Very unreliable
Only 25% of males with raised levels have prostate cancer
40-49 - 2.5
49-59 - 3.5
59 - 69 - 4.5
69-79 - 6.5
