Yr 3 Conditions Flashcards
1
Q
Characteristics of a BCC?
A
Pearly, rolled edged
May uclerate in middle and bleed
Usually skin coloured or pink
Slow growing
2
Q
Characteristics of SCC?
A
Grow quickly, weeks or months
Ulcerating tender and sore
On the face, lips, ears, hands, forearms and lower legs
3
Q
Treatments of BCC and SCC?
A
Both can be surgical, although BCC can benefit from creams such as 5 FU or imiquimod
4
Q
Erysipelas features and treatment?
A
Red rash, quite superficial often raised, caused by streptococcus.
Usually penicillins used - erythro or clarithro is allergic
Vancomycin if MRSA
5
Q
Features of lichen planus?
A
papules, raised and firm, can be polygonal in shape itchy and shiny.
Crossed by fine white lines
6
Q
Treatment lichen planus?
A
Potent topical steroid, calcineurin inhibitors and topical retinoids usually
7
Q
Bran like scale on discoloured areas of skin? Treatments?
A
Pityriasis versicolour - azole creams and shampoos
8
Q
Bimatoprost and latanoprost useful how?
A
Glaucoma as prostaglandin inhibitors
9
Q
Timolol used for what?
A
B-blocker for glaucoma
10
Q
Flashes of light and increase in floaters most likely to be?
A
PVD
11
Q
PVD can lead to what?
A
Retinal detachment
12
Q
Reflux common in which sex?
A
Men
13
Q
Notorious drugs to stick to throat causing inflammation?
A
Tetracyclines and NSAIDS (also beware of bisphosphonates)
14
Q
Is reflux a risk factor for Oesophageal CA?
A
Yes :(
15
Q
Symptoms of GORD?
A
Retrosternal burning, can feel like rising up pain on swallowing, or water brash
16
Q
Resp symptoms due to GORD?
A
Chronic cough, seen in up to 10%
17
Q
Investigating GORD?
A
Endoscopy ideally but fbc to rule out anaemia often no investigations are needed
18
Q
Treatment for GORD?
A
Full dose PPI 1 month
19
Q
H.pylori associated with which ulcers most?
A
95% duodenal
20
Q
Symptoms of Peptic ulcer?
A
Epigastric pain, 1-3 hrs after food, often relieved by food and can wake at night. Burping, distention. Heartburn can occur but not always.
21
Q
Treatment of peptic ulcer ?
A
h.pylori triple therapy 2 abx and ppi/H2
smoking cessation!
22
Q
Investigating ulcer?
A
FBC- possible anaemia, H.pylori serology or breath/stool test. Endoscopy not usually unless first time and above 55 years, or red flag symptoms!
23
Q
H.pylori drugs?
A
1g amoxicillin, plus clarithromycin or metronidazole twice a day! Plus PPI full dose
24
Q
Symptoms of acute GI bleed?
A
Hypotension, Tachycardia, malaena/blood pr, haematemesis, profuse bleeding from varices.
Rockall risk calcuated!
25
Treatment acute GI bleed?
High flow oxygen, large bore cannulae, iv fluids, catheter, basically as per RRAPID if compromised by bleeding give blood cells and or correct clotting.
26
Symptoms of crohns?
Diarrhoea, abdo pain, weight loss, fever malaise anorexia with acute active disease. Erythema nodosum( non gi signs of crohns)
27
Appearance of crohns on colonoscopy?
Cobblestone but with skip lesions, full mural thickness
28
Crohns treatment ?
Lots of options surgery not normal at first but likely in lifetime... AZA, Sulfasalaxine, methotrexate, and then tnf modifies such as infliximab/Humira
29
UC symptoms?
Relapsing remitting, only affects anus-beginning of colon, particularly the left side.
Gradual onset diarrhoea, which has blood and mucous in it . systemic symptoms and crampy abdo pain
30
UC treatment?
```
Proctitis- Prednisone suppositories
or mesalazine
IV fluid maintenance if systemically unwell
Hydrocortisone
rectal steroids too
```
Surgery can be used in about 20% this is curative usually
31
IBS definition?
GI problems, but no organic cause found.
| Not usually associated with weight loss, onset is a long time coming! Defecation often relieves pain.
32
Infectious gastroenteritis symptoms?
Fever, generally unwell, diarrhoea which is often bloody can make infection more likely.
33
Acute Pancreatitis symptoms?
Most commonly presents as severe upper abdominal pain of sudden onset with vomiting.
Pain is focused in the left upper quadrant of the epigastrium and penetrates to the back.
Pain tends to decrease steadily over 72 hours.
34
Pancreatitis in men more or women?
Equal
35
Which biochemical marker specific for pancreatitis and x what normal range?
amylase 3-4times normal virtually diagnostic
36
Most common causes of pancreatitis?
Alcohol, gall bladder disease.
| ERCP can cause it through trauma
37
Cullen's sign and Grey turner's sign are what?
Bruising in umbilicus and flanks respectively (sever cases of pancreatitis)
38
Treatment for acute pancreatitis?
Pain relief with pethidine or buprenorphine ± intravenous (IV) benzodiazepines.
Nil by mouth
Only ABX for specific infection
NG tube (only for vomiting)
39
Chronic Pancreatitis symptoms and presentation?
```
Abdominal pain, epigastric moving to back
Nausea vomiting and decreased appetite
Weight loss due to malabsorption
Possible onset of diabetes
Steatorrhea
```
40
What does imaging often show in chronic pancreatitis?
Calcified parts of pancreas
41
Management of Chronic pancreatitis?
Depends on individual case, usually adress malbsorption and pain.
Diet modification, alcohol cessation
ERCP can help by dilating ducts
42
Prognosis of chronic pancreatitis?
1/3 die in 10 years so not great!
43
Gallstones symptoms?
Usually asymptomatic
44
Gallstones common with what disorder?
Diabetes, twice as common
45
What are gallstones usually made of ?
Cholesterol
46
Acute cholecystitis symptoms?
Continuous epigastric or RUQ pain, vomiting, fever, local peritonism, or a GB mass
47
Acute cholecystitis vs Biliary colic?
Colic often simialr pain and some vomiting, but not inflammatory componenets such as mass, fever or peritonism.
48
Features of acute hepatitis?
Non specific prodromal
headache, arthralgia, nausea and anorexia
Jaundice (after 2 weeks) Pale stools, dark urine
(usually 3-6 weeks lasting)
49
Complications of acute hepatitis?
Liver failure
aplastic anaemia
chronic liver problems B and C
50
Hep C symptoms?
Usually none until liver failure
51
Drug induce hepatitis investigations?
Can present with features of allergy such as eosinophilia
52
What is Rovsings sign?
Pressing on LIF causes pain in RIF
53
Appendicitis general symptoms?
Fever, unwell, umbilical then RIF pain
Lack of appetite
Peritonism (guarding and rebound)
54
Most common cause of a small bowel obstruction?
Adhesions from previous surgery
55
Most common cause of a large bowel obstruction?
Cancers
56
Faecal vomiting present in which obstruction types?
Low (large bowel)
57
Greater distention in small or large bowel obstruction?
Large
58
What is absolute constipation?
No bowel movements or flatus at all
59
Femoral hernia likely to strangulate?
Yes
60
Direct inguinal hernia?
Through abdo wall reduce easily
61
Indirect inguinal hernia?
Through rings and into scrotum strangulate more often
62
Which is most likely an emergency repair inguinal or femoral herniae?
Femoral 2/3 are emergency repairs
63
on coughing which herniae type reappears after reduction?
Inguinal
64
Pagets disease of the breast affects which part?
Nipple long term "eczema"
65
Most common breast lump?
Fibroadenoma (20-24years of age)
66
Feature of fibro-adenoma?
Firm non-tender and highly mobile
67
Fat necrosis of the breast, causes and risks?
Obesity, old and following trauma
68
Features of breast cysts?
Cysts are most common between the ages of 35 and 50. They are palpable as discrete lumps and may be recurrent. Not easily distinguished on examination.
69
Pain about 1 week before menstruation plus lumpiness in the breast likely to be?
Nodularity
70
which area of the breast is mostly affected by nodularity?
Upper outer qudrant
71
What is a ductal pappiloma?
Benign warty lesion just behind areola
| Sometimes a sticky or bloody discharge is noted
72
Most common cancer in women?
Breast
73
Risk factors for breast CA?
Never having borne a child, or first child after age 30.
Not having breast-fed (breast-feeding is protective).
Early menarche and late menopause.
Radiation to chest (even quite small doses).
HRT - oestrogen and progestogen combined
74
MI, unstable angina and NSTEMI are linked together as what?
ACS acute coronary syndromes
75
Diagnostic criteria for an MI?
```
Cardiac biomarker (troponin) above 99th centile of upper ref range
Plus one of
Ecg changes
Q wave appearance
Angiography
Ischaemic symptoms
```
76
What causes angina?
Ischaemic heart disease
77
typical symptoms of MI?
Central chest pain, epigastric... into jaw
Often into left neck or arm
Sweating, nausea, vomiting, impending doom
78
atypical mi common in?
Women and elderly, often abdo pain, confusion, and jaw pain
79
Symptoms of unstable angina?
Similar to angina, although not usually bought on by activity, and often not relieved by rest or GTN
80
Angina symptoms?
Chest pain and breathlessness on exertion, relieved by rest, and GTN
81
When is angina unlikely ?
stable angina unlikely when the chest pain is continuous or very prolonged, unrelated to activity, worse on inspiration, or associated with symptoms such as dizziness, palpitations, tingling or difficulty swallowing
82
When is Af considered acute?
Onset within 48hrs
83
Symptoms of AF?
```
Breathlessness/dyspnoea.
Palpitations.
Syncope/dizziness.
Chest discomfort.
Stroke/transient ischaemic attack
```
84
Essential Hypertension defined as?
3 stages -
1: 140/90
2: 160/100
3: 180/110
85
Management of HTN?
Lifestyle changes- plus diet etc and salt reduction
ACE if <55 and non black
>55 or black = Calcium blocker
Second line for <55 is ARB
86
Resistant HTN step 2 choices?
ACE + Calcium for <55 or non black
Black = calcium plus ARB
Further steps require betablockers and thiazide diuretics
87
Which two HTN drugs not recommended together?
ACE and ARB
88
Target blood pressures on therapy?
140/90 for <80
| 150/90 for >80
89
DVT symptoms?
```
Limb pain and tenderness
Swelling of the calf or thigh (usually unilateral).
Pitting oedema.
Distension of superficial veins.
Increase in skin temperature.
Skin discolouration
```
90
What well's score suggests a likely DVT?
>=2
91
How many cm calf swelling difference for a well score ?
>3cm
92
Investigations for DVT?
D-dimer and ultrasound scan (duplex)
93
Severe renal failure plus DVT? management?
Unfractioned heparin
94
Normal treatment of DVT?
LMWH- continued for 5 days can use warfarin
95
If pt over 40 with DVT think of what?
Cancer
96
Left sided heart failure is associated with which symptoms?
Decreased cardiac output
Breathlessness
Cyanosis and hypoperfusion
Orthopnea, PND and cough (frothy white)
97
Heart failure diagnosed using what blood test?
BNP >100 pg/ml
98
Right sided failure associated with what symptoms?
Oedema, ascites and liver dysfunction
| Weight loss, Gi distress, congestion
99
Prognosis of heart failure?
Poor ~ 50% die in 4 years
100
CXR not diagnostic but provides evidence
heart size >2/3
pleural effusions
upper pulmonary veins
101
LVH can be cause by which valve abnormality?
Aortic stenosis
102
Cause of type 1 diabetes?
Autoimmune dysfunction
| Absolute deficiency of insulin
103
Type 2 diabetes cause?
Due to resistance to insulin
104
What happens before type 1 crisis?
Autoantibodies have been circulating for a long time, can be there from 6 months of age
105
Possible triggers for type 1?
Dietary, environmental and viruses
106
Antibodies responsible for type 1 ?
Associated with HLA DR3 and DR4 and islet cell antibodies around the time of diagnosis.
107
Which is more common type 1 or 2 diabetes?
Type 2 85%
108
Onset of type 2 diabetes?
Gradual
109
Who does type two diabetes affect?
South Asian, African, African-Caribbean, Polynesian, Middle-Eastern more likely
older people and high BMI
110
Which has a greater genetic component 1 or 2 type diabetes?
2 almost 2.4 times fold increase
111
Symptoms for all diabetes types?
Patients with all types of diabetes may present with polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections
112
Type 1 specific symptoms?
Weight loss, dehydration, ketonuria and hyperventilation
| Often ketoacidotic
113
Diagnosis of diabetes? Serum glucose?
Abnormal plasma glucose (random ≥11.1 mmol/L or fasting ≥7 mmol/L)
114
Hba1c cut off for diagnosing diabetes?
48mmol/l or 6.5%
115
3/4 of those with type two diabetes die of what?
Heart disease
116
Initial treatment of type 2 diabetes?
Metformin standard release
117
Dpp4 inhibitors also known as what?
Gliptins
118
Sulfonylureas work how?
Increasing release of insulin from b cells of pancreas
119
Metformin is what type of drug?
Biguinide
120
Medical treatment of Hyperthyroidism?
Carbimazole or radio-iodine or propylthiouracil
121
Treatment of Hypothyroid?
Levothyroxine
122
Symptoms of hyperthyroid?
weight loss, irritability, confusion, lack of concentration, tremor, sweating, diarrhoea anxiety, psychosis, heat intolerance, loss of libido
123
Most common cause of hyperthyroidism?
Grave's disease
124
Hypothyroid symptoms?
Tiredness, lethargy, intolerance to cold.
Dry skin and hair loss
Poor memory and difficulty concentrating.
Constipation
Decreased appetite with weight gain
Deep hoarse voice
125
Tyrotoxicosis symptoms?
Eye changes such as exophthalmas and proptosis.
Pre-tibial myxoedama
Enlargement of thyroid gland
126
Hypothyroid more common in who?
Women, around 60 years
127
Most common cause worldwide of hypothyroid?
Iodine deficiency
128
Hypothyroid signs?
Dry coarse skin, hair loss and cold peripheries.
Puffy face, hands and feet (myxoedema).
Bradycardia.
Delayed tendon reflex relaxation.
129
Cardiac drug causing hypothyroid and goitres?
Amiodarone
130
Most common cause of goitre?
Iodine deficiency but hashimotos and graves in UK
131
What is Cushing's syndrome?
Prolonged exposure to exogenous or endogenous glucocorticoid steroids (cortisol)
132
Cushing symptoms?
Truncal obesity, supraclavicular fat pads, buffalo hump, weight gain.
Facial fullness, moon facies, facial plethora.
Proximal muscle wasting and weakness.
Diabetes or impaired glucose tolerance.
Gonadal dysfunction, reduced libido.
Hypertension.
Also psychiatric symptoms
133
Two types of cushings?
ACTH dependent and independent (usually iatrogenic)
134
Investigations to confirm cushings?
24hr urine
Dexamethasone suppression tests
Midnight cortisol
135
Treatment for cushings?
Usually surgical if due to tumour or removal of exogenous steroids.
These drugs can be used =Metyrapone, ketoconazole, and mitotane
136
Most common cause of anaemia?
Iron deficiency
137
Define anaemia with Hb?
Haemoglobin (Hb) <13 g/dL in men over 15 years old.
| Hb <12 g/dL in non-pregnant women over 15 years old.
138
Blood test results for iron deficiency?
FBC: shows a hypochromic microcytic anaemia
139
What blood test as well as fbc should be measured in iron deficiency?
Ferritin
140
Iron tablets side effects?
Constipation, nausea, black stools, most get better in time
141
What should you check before giving a patient folic acid for deficiency?
B12! can cause demyelination of spinal cord so treat b12 first is needed
142
Main causes of macrocytic anaemia?
B12 and folate, also liver failure (alcoholism) and AZA
143
Macrocytic anaemia can mim another neurological disease if very severe?
Alzheimers and dementia, b12 deficiencey can cause neurological symptoms
144
Is osteoarthritis better in morning or evening?
Morning, gets worse with activity
145
Most common joints affected by OA?
Knees, Hip and Hands
146
Morning stiffness last no longer than ... in OA?
30 mins
147
Age over what for OA diagnosis clinically?
45 years
148
Pain in joints exacerbated by movement and exercise most likely?
Osteoarthritis
149
OA symptoms
Joint swelling/synovitis (warmth, effusion, synovial thickening).
Periarticular tenderness.
Crepitus.
Absence of systemic features such as fever or rash.
Heberdens DIstal Bouchards proximal
150
Xray findings in OA?
joint space narrowing, osteophytes, bone cysts
151
Treatments for OA?
Weight loss, physio/exercise
Drugs: Topical NSAIDS
NSAID/COX-2 (PPI alongside)
Surgery if substantial impact on lifestyle
152
List some risk factors for gout?
```
Male gender.
Meat.
Seafood.
Alcohol (10 or more grams per day).
Diuretics.
Obesity.
Hypertension.
```
153
Where is usually affected by gout?
50% of all attacks and 70% of first attacks affect the first MTP.
Also Knee
Midtarsal joints
Wrists
Ankles
154
Symptoms of gout?
synovitis and swelling and extreme tenderness with overlying erythema. Untreated
155
Erythema, chalky nodule beneath skin characteristic of?
Chronic gout ... crystal deposition
156
Gout treatment
Non-steroidal anti-inflammatory drugs (NSAIDs).
Colchicine.
Corticosteroids.
157
Patients on anticoagulation with gout should receive what treatment?
Colchicine
158
Allopurinol exhibits it affects how?
Xanthine oxidase inhibitory
159
When can allopurinol be started?
At least 1-2 weeks after an attack not during
160
Allopurinol side effects?
Can cause stone build up in kidneys
161
How can pseudo-gout be differentiated from gout?
Joint aspiration, but x-ray too as calcium pyrophosphate radio-opaque
162
Most common organism for septic arthritis?
Staph Aureus
163
Risks for septic arthritis?
```
Increasing age.
Diabetes mellitus.
Prior joint damage
systemic connective tissue disorders.
Joint surgery.
Immunosuppressed
```
164
Symptoms of septic arthritis?
Mainly one painful red swollen joint. Painful on active and passive movement
Usually fever and rigors present, can have bacteraemia too (vomiting and hypotension)
165
Most common joint with septic arthritis?
Knee >50%
166
ABX for septic arthritis?
Fluclox usually, but if allergic Clindamycin
167
Joints should be splinted in septic arthritis but how?
In position of most use for example extension in the knee
168
Slipped disc red flags?
Saddle anaesthesia, loss of sphincter control, weaknesses in legs.
169
Lumbosacral disc herniation causes what nerve pain?
Sciatica
170
Sciatica symptoms and signs?
Leg pain more severe than back and unilateral, straight leg positive, pain relieved by laying down.
171
Difference between prevalent and incident delirium?
Prevalent is there on admission and incident is after admission or whilst there
172
Male or female a risk for delirium?
Male
173
Difference between stroke and TIA?
TIA symptoms resolve within 24hrs
174
Main causes of Stroke/TIA?
Cardiac emboli(AF, Endocarditis, and MI)
Carotid Thrombis
BP, Trauma, Aneurysm rupture
Antiphospholipid syndrome
175
Risk factors for Stroke?
HTN, Smoking, Diabetes, Heart disease
| Contraceptive pill, alcohol, carotid bruit.
176
Mains symptoms of stroke?
FAST- Face arms speech time
Neuro problems- vertigo, ataxia
Homonymous hemianopia
177
Treatment of Stroke/TIA?
```
02 therapy <95%
Blood sugar control
Control BP
Swallowing screening
Clopidogrel-75mg
ALTEPLASE- up to 4.5 hrs after exclude haemorrhage
```
178
Assessing risk of stroke after TIA score?
ABCD2
179
Most common aneurysm type to burst SAH?
80% saccular
180
Risk factors of SAH?
Smoking, HTN, Alcohol misuse, bleeding disorders
| Post menopausal
181
SAH relatives risk?
3-5 times!! (close relatives)
182
Symptoms of SAH?
```
Usually sudden headache (bang)
vomiting
collapse
seizures
coma, pupil changes
```
183
Diagnosis of SAH ?
CT >90% within 48hrs
| Lumbar puncture - usually blood at first- then more yellow (billirubin)
184
Treatment of SAH?
Regular examination of CNS
Maintain cerebral perfusion
NIMODIPINE - C chanell (stops spasm)
COILING!!!
185
How common is peripheral neuropathy and in who?
10% or population, commonest cause is diabetes!(60-70%) get it
186
Causes of peripheral neuropathy?
Multiple- mostly diabetes, autoimmune diseases
neuromas, chemotherapy patients
viral infections
Alcoholism (deficiency of b12 and folate)
187
Symptom of neuropathy?
Muscle weakness, altered sensation(pins and needles) neuropathic pain affects sleep
Gi problems-diarrhoea and constipation
188
Diagnosis of neuropathy?
nerve conduction, electromyography
189
Neuropathy treatments?
Underlying condition, lifestyle treatments
immunosupressive drugs
TENS
Neuropathic drugs(gabapentn, amitryptiline)
Diabetic (tapendalol)
190
Cause of epilepsy?
75% idiopathic
Structural problems -scarring atrophy or brain injury
Lesions
Trauma, stroke, haemorrhage, increased icp
191
Signs of seizure?
Aura, deja vu, smells, or just a weird feeling
192
Seizure types?
Partial/generalised
One part of brain partial and then generalised involves all of the brain
193
Epilepsy treatments- tonic clonic generalised?
Sodium valproate or lamotrigine 2nd line carbamazepine
194
Absence seizures treatment?
Sodium valproate or lamotrigine
195
Tonic atonic or myoclonic seizures treatment?
Avoid carbamazepine
196
Carbamazepine useful for which seizures?
Partial seizures
197
Levitaracetam (Keppra) used when?
Add on for tonic-conic or partial seizures
198
Kernigs sign for meningitis?
Pain and resistance on passive knee extension when hip flexed
199
Brudzinskis sign meningitis?
hip flex on bending neck forward
200
Highest mortality infectious disease under 5?
Meningitis
201
Most common headache type?
Tension- 4:1 in women
202
What makes a tension headache chronic?
Greater than 15 days a month
203
Features of tension headache?
Non pulsatile, tight band, related to neck usually, gradual onset
204
Tension headache treatment?
Attention to anxiety, stress, depression etc
physio
Avoid opioids
NSAID and paracetamol
205
Parkinsons cardinal triad?
Tremor, Rigidity and increased tone, Bradykinesia and hypokinesia
206
Parkinsons treatment?
L-dopa and carbidopa mainstay of treatment
MAO-B inhibitors
Apomorphine
All either affect dopamine metabolism or increase supply
207
What is ropinirol and pramipexole?
dopamine agonist
208
COMT inhibitors used in what?
Parkinsons- limit l-dopa degradation in PNS
209
What is the definition of a UTI?
Pure growth of >10^5 organism per ml fresh MSU
210
Up to 1/3 or women with with symptoms of UTI have what?
Negative MSU
211
Risk factors for UTI?
```
Sexual intercourse
Females
Spermicide
Diabetes
Pregnancy and menopause
Catheter
```
212
Main organism causing UTI?
E-coli 75% but nor so much in hospital
213
Less common UTI pathogens?
Proteus, klebsiella, staph, pseudomonas
214
Signs and symptoms of pyelonephritis?
High fever, rigors, vomiting loin pain and tenderness, oliguria
215
Signs and symptoms of prostatitis?
Flu like, low back ache swollen prostate not usually many urinary symptoms
216
Signs of uncomplicated UTI?
frequency, urgency, foul smelling and cloudy urine, distended bladder, haematuria
217
What should be positive for a UTI on disptick?
Nitrites and leucocytes
218
When should a lab MSU be sent ?
Symptomatic, males, children, preggers and immunosuppressed
219
Causes of sterile pyuria?
Cancers, appendicitis, treated UTI, prostatitis
220
What should pregnant women be treated with for UTI?
Nitrofurantoin 1st choice then trimethoprim (but give folate 5mg daily)
221
Pyelonephritis initial treatment?
Ciprofloxacin (500mg BD)
| Co-Amoxiclav (500/125) tds 7 days
222
Pain in the back from pyelonephritis is located where?
Costo vertebral angle
223
Urine of a pt with pyelonephritis could show what?
WBC casts
224
Suprapubic tenderness and voiding symptoms more common in pyelo or cystitis?
Cystitis
225
What are the % increases for AKI staging regards creatinine increases?
1= 50-99% 2= 100-199% 3=200% baseline creatinine within 7 days!
226
Pre-Renal causes of AKI?
Hypovolaemia, blood loss
Reduced cardiac output/cardiac failure
Sepsis
227
Renal causes of AKI?
```
Drugs-
vascular problems
Glomerulonephritis
Tubular
Interstitial disease
```
228
Renal failure affects some anti clotting agents such as?
LMWH (half dose needed due to accumulation) OR use UFH
229
Nephrotoxic drugs
Nsaid, ace inhibitors, ARBs, diuretics, contrast agent, gentamicin, metformin
230
Post renal causes of AKI
Obstruction, pyonephrosis, cervical carcinoma, retroperitoneal fibrosis.
231
What is hydronephrosis?
Abnormal enlargement of kidney swelling
232
Causes of hydronephrosis?
Obstruction, Urethral stricture, vesicouretal reflux
| CKD, Prostate cancer
233
Symptoms of hydronephrosis?
Loin and back radiates to groin.
| Haematuria, nausea vomiting, leg swelling shortness of breath. electrolyte imbalance
234
Managment of hydroneprosis?
Treat underlying cause, nephrostomies and stents
235
BPH stand for ?
Benign prostatic hypertrophy
236
BPH unusual before age of?
45
237
Signs and symptoms of BPH?
Nocturia, urgency, frequency, terminal dribble
hesistancy, poor stream incomplete emptying
UTI, bladder stones
238
BPH prostate feels like ?
Hard and firm but smooth well defined median sulcus
239
Investigations into BPH?
Imaging, u and es, PSA, LFT, MSU.
240
Managing BPH?
Alpha blockers, tamsulosin, doxazosin
5-a reductase Finasteride (stop testosterone)
TURP
241
Most common male cancer?
Prostate
242
Most prostate carcinomas are what type?
Adenocarcinoma
243
Presentation of carcinoma of prostate?
As for BPH but can have weight loss, bone pain, and prostate may be hard/irregular
244
Scoring used for prostate ?
Gleason
245
Diagnosis prostate CA?
Transrectal USS/Biopsy PSA bone scan and MRI
246
Treatment of prostate CA?
<70 radical prostatectomy excellent survival
Brachytherapy
>70 active surveillance if low risk
247
what is goseralin?
LNRH antagonist for prostate cancer
248
Causes of CKD?
HTN, Diabetes, nephrotoxic drugs, recurrent stones, bladder voiding problems, SLE
249
Definition
impaired renal function for >3 months egfr <60 for 3 months or more.
250
Stage 3-5 Kidney failure more common in
women
251
Management of CKD?
usually mild to moderate in GP, refer to nephrology for later stages
252
Risk factors for asthma
```
atopy, and family history
obesity
city environment
premature
viral
smoking
```
253
Peak flow in asthma acute is usually?
33-50%
254
Management of more severe asthma GP?
Adding long acting b2 agonist, leukotriene antagonst, theophylline, steroid oral
255
FEv1/FVC ratio for COPD
<0.7
256
Consider COPD in who?
>35, with risk factors such as smoking and have exertional cough and sputum
257
Catamenial pneumothrax is what?
Time of menstruation, over 90% in right lung 24-72 hrs into menstruating
258
Pleural surface to lung edge greater than what for pneumothorax?
>2cm
259
Difference between transudate and exudate?
Transudate <25g/l Exudate >35g/l
260
Transudate is due to what?
cardiac failure and fluid overload
261
Exudate is due to what?
Pneumonia, inflammation, malignancy, TB, mesothelioma
262
Signs and symptoms of pleural effusion?
Stony dull percussion, dyspnoea, pleurit chest pain, lack of breath sounds, tactile and vocal fremitus decreased.
263
In effusion trachea deviates where?
Away
264
Most common organism for Hospital acquired pneumonia?
Pseudomonas and Klebsiella
265
When is an infection hospital acquired?
>48HRs
266
Vocal resonance and tactile fremitus are what in pneumonia?
Increased
267
What does CURB 65 mean?
Confusion, Urea >7 Resp >30
Blood pressure<90
>65
268
Curb score of 0-1 means?
Manage at home
269
curb score 2 means/
IV ABX
270
Curb score 3+
ITU? high mortality
271
Risk factors for PE?
```
Surgery especially bones
Antiphospholipid syndrome
prolonged rest
malignancy
preggers
Pill
Previous
```
272
What might you do if pt cant be anticoagulated?
IVC filter
273
Most common type of oesophageal carcinoma?
Adeno- followed by squamous
274
Risk factors for oesophageal carcinoma?
Tobacco and alcohol
barrets oesophagus (precursor to adeno)
chronic inflammation
Obesity, and hiatus hernia
275
Gastric carcinoma is more common in who?
Men
276
Usually gastric carcinoma is what type?
Adeno
277
carcinoma where in stomach is increasing?
Gastro oesophageal junction
278
95% of cases of gastric cancer in those over ..?
55
279
What infection can double risk of gastric cancer?
H.pylori
280
Which blood group more common to gastric cancer?
A
281
Prognosis for gastric carcinoma?
Very poor
282
Pancreatic cancer more common men or women?
Neither
283
95% of pancreas tumours are?
Adeno
284
Risks for pancreatic CA?
Smoking, Diet, diabetes, alcohol pancreatitis IBD
285
Presentation of pancreatic CA?
Abdo pain, radiating to back
Obstructive jaundice - comes on quick
Dark urine pale stools
Weight loss
286
Which chem used in Pancreatic CA
5 FU
287
Colorectal death rates?
Second most common cause of cancer death
288
Risks for Colorectal CA?
Polyps, genetic FAP HNPP, IBD, Cancer previous, Smoking, Diabetes
289
Presentation of colorectal CA?
Weight loss, anaemia, masses, tenesmus, bowel habit change, malaena
290
Chemo for colorectal ?
FOLFOX -
| 5 FU folinic acid, oxiplatin
291
Prognosis of colorectal?
good >50% 5 year
292
Chronic liver failure causes?
Acohol- most common uk
Hep BCD
genetics, wilsons, autoimmune
Methotrexate, amiodarone and methyldopa
293
Presentation of chronic liver failure?
Fatigue lfts deranged, leuconychia (low albumin)
| Clubbing, palmar erythema, loss of body hair, dupytrens
294
Complications of liver failure?
bleeding varices, ascites, encephalopathy
295
How much fluid to notice ascites?
1.5l
296
Causes of ascites?
Malignancy, cirrhosis, low albumin, pericarditis, myoedema, CCF infection (TB)
297
Presentation of ascites?
Abdo distention, weight gain, nausea and appetite supression
298
Management of ascites?
Diuretics, loops and potassium sparing, drainage
299
Coeliac disease presentation?
Smelly stools, steatorrhoea, diarrhoea, abdo ain, weight loss, fatigue, ostemalacia. Dermatitis herpatiformis
300
Complications of coeliac?
Anaemia, lymphoma, myopathies
301
Mid diastolic murmur best in expiration is what?
Mitral stenosis
302
Mitral stenosis mainly cause by what?
Rheumatic fever ?
303
Mitral stenosis treatment?
Diuretics lower pre-load
304
Pansystolic murmur moving to axilla?
Mitral regurg
305
Mitral regurg treatments?
Diuretics, rate control anticoag, replace
306
Ejection systolic murmur?
Aortic stenosis
307
Aortic regurg therapy before valve?
Treatblood pressure
308
Most common organisms for infective endocarditis?
Staph and strep
309
Risks for Infective endocarditis?
Valvular disease, valve replacement, congenital disease, previous IE, hypertrophic cardiomyopath
310
Presentation of infective endocarditis?
New or changed murmurs?
| Fevers and rigors, weight loss, sweats clubbing splinter blahblah
311
Oslers nodes are where?
Distal phalanges
312
Treatment of postural hypotension?
Fludricortisone or then ephdrine
313
96% of those with hyperparathyroidism have ?
parathyroid adenoma
314
Signs of hyperparathyroidism?
Increased calcium, weakness, thirst depression renal stone, pancreatitis
bone reabsorption, high parathyroid, fractures
Phosphorous excreted
High BP
315
Tests in addisons disease?
low sodium High potassium, low glucose,
316
Management of addisons?
Replace steroid (hydrocortisone)
317
Symptoms of addisons?
Lean and tanned, tired, tearful, weakness, anorexia, low mood, nausea vomiting, palmar pigmented creases, vitiligo
318
Hodgkin vs non hodgkin?
Reed sternberg cells
319
Symptoms of lymphoma?
Enlarged painless rubbery lymph nodes, cervical usually
fever weight loss night sweats pruritis
spleno hepatomegaly
Alcohol induced pain!
320
T score of what indicates normal bone?
T score > or = -1
321
Osteoporosis T score?
-2.5
322
Parotid tumour risks?
Latent radiation 20 yrs ago and smoking
323
Red flags for parotid tumours?
facial nerve weakness, increase rapid, ulceration history of skin cancer
324
Parotid chemo response?
Poor usually surgical resection
325
Malignant parotid presents when?
over 60
326
Most common cause of parotitis?
Mumps, then stones, tumours, sjorgens
327
Proximal myopathy presents?
Weakness o upper or lower libs symmetrical
| atrophy tone is reduced
328
Proximal myopathy causes?
Thyroid disease, drugs such as statins
329
Presentation of MS?
Optic neuritis, numbness tingling, ataxia, erectile dysfunction
330
Diagnosis of MS?
2 attacks or more on 2 areas of body CSF IgG
331
Bladder carcinoma risks?
Smoking, dyes, aromatic amines, radiation to pelvis
332
Presentation of bladder CA
haematuria usually painless
voiding symptoms
women have worse prognosis
333
Chemo for bladder cancer?
Cisplatin
334
Renal carcinoma presentation?
weight loss haematuria, loin pain, abdo mass, anorexia, spreads to bone liver lung,
335
Renal carcinoma from where
Proximal tubular epithelium
336
Cannon ball chest mets from where?
Renal
337
Risk factors for urinary stones?
Horse shoe
gout
dehydration hyperparathyroidism
diuretics
338
Most renal stones contain what ?
Calcium
339
Pain of renal stones?
Severe, radiate to anterior thigh, labia testes scrotum
340
Risk factors of pulmonary fibrosis?
Smoking, silica asbestos heavy metal exposure
pigeon breeding
GORD Nitrofurantoin
341
Presentation of pulmonary fibrosis?
```
Hacking dry cough
Aged over 45
Breathless on exertion
Bilateral inspiratory crackles
clubbing
weight loss
```
342
CXR of fibrosis?
Reticular formation at lung peripheries
