Week 1 Flashcards
What is an antiphospholipid antibody test for?
Helps determine cause of inappropriate blood clot formation eg unexplained thrombus, excessive clotting, miscarriages after week 10, premature births before week 34, 3 or more miscarriages before week 10.
Antiphospholipid syndrome could be indicated.
Normal range is less than 15ig G without GPL, 12 or less igm without MPL, 12 or less igA without APL.
Common types of apl are anticardiolipin and lupus anticoagulant, antibeta2glycoprotein and antiprothrombin
For anticardiolipin:
igG indicates abnormal clots and miscarriage
IgM indicates clots and autoimmune disease like SLE
which also can cause clots and miscarriages
Livido sign can indicate antiphospholipid antibodies
What does raised ribonucleoprotein indicate? / anti-rnp
Commonly high in those with often autoimmune connective tissue conditions like RhA, SLE, Progressive systemic sclerosis, mixed connective tissue disease
If high ANA also/anti ana - likely MCTD or SLE
What are the CIN grades?
Refers to stage of neoplasia for cervical intraepithelium
CIN1 is low grade dysplasia in 1/3 thickness of epithelium
CIN2 is abnormalities in 1/3-2/3 of the layer
CIN3 is a condition of neoplasia in over 2/3 of the depth of the epithelium
What is chronic salpingitis?
The milder inflammation left after acute salpingitis/ Fallopian tube inflammation, detected by cogwheel sign. Often caused by bacteria like mycoplasma, staphyl or strepto, STIs like gonorrhoea or chlamydia. Treat with antibiotics. Risk infertility. Can be granulomatous.
Symptoms uterine pain, cervical pain, fever, elevated crp and esr and wbcs
Sonography shows thick fluid filled tubes
What is GTD/ Gestational trophoblastic disease?
Where abnormal trophoblast cells grow inside the uterus after conception, then a tumour forms. Symptoms are vaginal bleeding in first trimester, bigger than expected uterus, nausea and vomiting. Often nonviable with empty egg and includes molar pregnancies. Treatment includes chemotherapy, surgery, dialation and cuterrage with hcg monitoring
What is folate deficiency?
B12 or B9 deficiency anaemia leads to oversized blood cells. Symptoms include fatigue, lethargy, breathlessness, faintness, headaches, pale skin, palpitations. Severe leads to paraesthesia, numbness, cognitive and visual changes. Usually give daily folic acid tablets. In pregnancy, this deficiency leads to neural tube defects.
What is a quinsy?
An abscess between the tonsil and the wall of the throat. Gives asymmetric sore throat, difficulty opening mouth, pain on swallowing, bad breath and earache. Give Antibiotics, IV if significant size. Can be a complication of tonsillitis. Often treated with amoxicillin with clindamycin or metronidazole.
What is interstitial lung disease?
Lung diseases that cause fibrosis. Most common and dangerous us idiopathic pulmonary fibrosis. also includes acute or non specific interstitial pneumonia, sarcoidosis, cryptogenic pneumonia. RhA fibrosis, SLE, scleroderma, polymyositis, dermatomyositis, Sjögren’s syndrome, chemotherapy, methotrexate, amiodarone, Macrobid
Most common symptoms are breathlessness ( on exertion also), dry hacking cough, weight loss, mild chest pain, haemoptisis, fast shallow breathing
What is bronchiectasis?
Airways are displayed with mucus and scarring.
Commonly short of breath, wheezing, blood, bloody phlegm, chest pain, joint pain. Often given iv antibiotics, eg macrolides for inflammation and bacteria.
3 types- cylindrical, varicose abs cystic. Often caused by cystic fibrosis, pneumonia, whooping cough or TB
What happens in Diabetic ketoacidosis?
Complicating from hyperglycaemia often and also adrenaline depleting insulin. Includes polyuria/dipsia, vomiting, nausea/abdominal pain. Kussmaul deep laboured breathing, fruity breath.
Fluid loss > kidney damage and brain swelling > coma and also fluid on the lungs
Neutrophil count is high for some reason. Hypokalaemia.
Treatment = iv insulin, fluids ( do that first) and electrolytes
What happens in hypoglycaemia?
Deficiency in circulating glucose less than 70mg/dl. Can be from overdose of meds. Can cause DKA. Early signs sweating/tingling, dizzy/shaking, palpitations, fatigue. Later signs are blurred vision, confusion, drunk behaviour, seizures and collapse.
Can give glucose tablets, or iv dextrose solution +/- fluids
hunger irritability trouble concentrating fatigue sweating confusion fast heartbeat shaking headache
What happens in hyperglycaemia?
Excess glucose in circulation over 130mg/dL. Commonly can give hyperosmolar hyperglycaemic syndrome/state/HHS
Symptoms include thirst, dry mouth, polyuria, weight loss, blurred vision, infections, fruity breath, abdominal pain, high blood pressure (not low)
Treated by fast acting insulin
extreme thirst dry mouth weakness headache frequent urination blurry vision nausea confusion shortness of breath
What is Hyperosmolar Hyperglycaemic syndrome/state/HHS?
In type 2 diabetes with over 30-40mmol/L circulating glucose and serum osmolarity > 330mmol/kg. Is without ketoacidosis. ( dKA is from hypo making hyper via ketones) It is treated with IV saline, correction of Hypokalaemia and IV insulin.
A reading between 140mg/dL and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes
Treatment for cystic fibrosis?
Kaftrio ivacaftor, tezacaftor and elexacaftor. The medicine helps lung cells to work better for less mucus.
Antibiotics
Dornase alfa, hypertonic saline and mannitol dry powder for thinner mucus
ivacaftor taken on its own (Kalydeco) or in combination with lumacaftor (Orkambi) also for less mucus
Other medicines based on secondary issues
Adenocarcinoma
Cancer that begins in glandular cells
Carcinoma
Cancer cells of skin or tissue lining organs like the liver or kidney
Adenoma
Non cancerous tumour in glandlike tissues
Hepatocellular carcinoma
Most common type of primary liver cancer. Often started by hep B, C or alcoholic cirrhosis
Cholangiocarcinoma
Bile duct cancer - rare and aggressive. A type of adenocarcinoma.
Urothelial carcinoma
Bladder squamous cell carcinoma often onset by chronic UTIs and bladder irritation eg from a catheter. Often high grade and invasive
Biliary cholesterolosis
Build up of cholesterol esters that stick to the wall of the gallbladder forming polyps. If they block the duct can lead to obstructive jaundice or pancreatitis. GC has a strong negative association with gallbladder cancer
Adenomyosis vs adenomyoma
Adenomyoma- focal region of adenomyosis of a benign fibroid like tumour of glandular tissue surrounded by endometrial stroma that grows into the smooth muscle wall/ myometrium or out into the endometrium like a polyp
Adenomyosis - when this happens extensively so glandular endometrial tissue grows into the myometrium so the uterus thickens and enlarges. Treatment is often hormonal, anti inflammatory or hysterectomy. Symptomatic heavy frequent bleeding.
What is Thoracic outlet syndrome?
Compression of the nerves, arteries or veins in the passageway of the lower neck besides the brachial plexus. It can be neurogenic, venous, arterial.
Neurogenic = common + shows pain, weakness abs sometimes muscle wasting in the thumb.
Venous shows swelling, pain, grey-blue limb
Arterial shows pain, coldness and pallor
Can be trauma, repetitive strain, tumours, pregnancy, cervical rib.
Differentials: rotator cuff tear, cervical disc disorder, fibromyalgia, multiple sclerosis.
Naproxen and surgery, maybe blood thinners
Lithotripsy
Uses an electrohydraulic lithotripsy or a laser probe through a scope can be used to break up main intrahepatic duct stones and allow balloon for dialation if pathway is narrowed. Uses high voltage sparks between two probes to produce increase in fluid pressure to break the stone. Be careful not to damage bile duct wall. Done with peroral cholangioscopy or endoscope.
Spyglass ERCP
Small telescope for looking at strictures and large stones of the biliary system when standers retrograde cholangiopancreatography ercp won’t work
