Hypertension, Cholesterol, Diabetes Flashcards
What is the clinical features of Shingles?
What is the rash associated?
What is the management of shingles?
1) Within 72 hours of onset- Vycyclivor
Clinical features:
Herpes zoster usually begins with a prodrome, such as pain, itching or tingling in the area that becomes affected. This may precede the characteristic rash by days or even weeks but is rarely the only clinical manifestation of varicella zoster virus reactivation (sometimes referred to as zoster sine herpete).
Typically, patients experience headache, malaise and sometimes photophobia. Abnormal sensation or pain, often described as burning, throbbing or stabbing, occurs in approximately 75% of patients and may be the first noticeable feature. Often pruritus in the affected region is the most prominent feature.
Allodynia, or pain induced by light touch, may also be described. Before the onset of the rash and depending on the location, symptoms may mimic pain caused by ischaemic heart disease, cholecystitis or renal colic.
Rash
The rash is usually unilateral and may affect adjacent dermatomes, with thoracic, cervical and ophthalmic involvement being the most common. Morphologically it evolves from a maculopapular rash to one comprising clusters of vesicles that ulcerate and crust over the course of 7–10 days (Fig. 1). Healing is usually complete by 2–4 weeks.8 When all lesions have crusted the rash is considered non-infectious. Residual scarring and pigmentation is common (Fig. 2). Once the characteristic unilateral dermatomal rash of herpes zoster appears, the differential diagnosis includes herpes simplex virus, contact dermatitis, insect bites, folliculitis, impetigo, candidiasis and scabies.8
Complications
These occur in a minority of patients and are more frequent in older or immunosuppressed patients.
Postherpetic neuralgia
Postherpetic neuralgia is considered the most common complication and increases with age, affecting up to 30% of people with herpes zoster over the age of 80 years. It is generally defined as pain of at least moderate intensity persisting for three months or longer, although various definitions (and measures of pain severity) have been used in drug trials.9 It may occasionally last for years. Postherpetic neuralgia is characterised by constant or intermittent, usually severe, burning or lancinating pain that occurs almost daily. Allodynia is present in most cases and can make even wearing clothing an arduous task. Quality of life is invariably reduced. Features that appear to be predictive for the development of postherpetic
Management:
Antivirals
Three oral nucleoside analogues – valaciclovir, famciclovir and aciclovir – are available for the treatment of herpes zoster. They reduce the severity and duration of the illness if started within 72 hours of onset of the rash. However, a Cochrane review concluded that evidence was insufficient to determine if antivirals reduce the incidence of postherpetic neuralgia, depending on the definition of postherpetic neuralgia used.10 All patients with zoster ophthalmicus should receive antiviral therapy even if it is delayed beyond 72 hours. Similarly, consideration should be given to treating immunocompromised patients or those with disseminated disease.
Cardiovascular risk assessment? WHose is at high risk automatically?
What is the calcium artery score?
What’s it use?
What
What are limitations of absolute CV risk scoring system?
What age patients should we be screening, and looking for?
What is the Framingham scoring system?
Symptomatic vs asymptomatic?
What is the calcium scoring system?
What does a score of over CAC>100?
CV risk and hyper tense
Excluding secondary hypertension
What are signs and symptoms of secondary hypertension
How Do we exclude Secondary causes of hypertension?
What is familial dyslipidameia?
What is the best resource for T2DM in Australia?
How Do we define diagnose T2DM
Screening, complications, drugs need to be known for exam
How do we screen for diabetes in asymptomatic patients?
1) Test BSL
2) Test HbA1C
If 6.5 HbA1C >, needs to be repeated to confirm diagnosis
FBG- >7mmol Repeat fasting
A Second condcordant tests for both need to be made
What special complications do you need to counsel patients when diagnosing a patient with T2DM
—> Secondary complications - of T2DM- Determine and Take history- And physical examination looking for secondary complications
—> Counsel patient on SNAP, immunisations, al preventive measures
—> ICE, Follow up
What are the 1) clinical and 2) personal management goal for patients with newly diagnosed?
E.g- LDL targets, BP targets, exercise targets?
What are the major agents for T2DM in Australia?
What’s the MOA of each, What are the major side effects
What is role of dietician and Diabetes educator
Case 1
History, Physical examination- looking for end organ damage-
Basic Tests - Urine ACR, LDL, HDL, total cholesterol
Need to look for secondary causes,
Need To optimise SNAP
Need to organise further tests
Weight, BMI, WC
USe AUSDRISK
Organise Diabetes educator, Dietician, Diabetes Australia, Endocrinology
What are the features of Hx, and examination looking for end organ damage?
The Case 3 Months later - after starting Statins,
Case 2
Also STOP 3 days prior to surgery to prevent due to risks of dehydration, UTI
