Handbook Section 2a Flashcards
Heavy menstrual bleeding, common diagnosis
Dysfunctional uterine bleeding—ovulatory
Fibroids
Complications of hormone therapy
Adenomyosis
Heavy menstrual bleeding, must rule out conditions
pregnancy disorders
cancer
endometrial hyperplasia
infection
Most possible histologic examination of curettings in a 48 year old woman with heavy irregular periods for 4 months
Cystic glandular hyperplasia - seen in women with anovulatory cycles (inc estrogen, no progesterone)
CGH is more common than atypical hyperplasia or polyp. Normal secretory endothelium is usually only found in regular menses.
Diagnosis for focal parotid lump with facial nerve involvement?
Malignant primary parotid tumor - focal parotid lump + involvement of other structures
Ruled out:
Benign parotid tumors - will displace structures but no penetration of other structures like the facial nerve (eg pleomorphic adenoma, adenolymphoma)
Adrenal crisis, symptoms
- altered consciousness
- circulatory collapse
- hypoglycaemia
- hyponatraemia
- hyperkalaemia
- seizures
- history of steroid use/withdrawal, or
- any clinical features of Addison disease
Adrenal crisis, management
Acute management is based on emergency resuscitation: restoring and maintaining circulation,
IV hydrocortisone
detection and treatment of hypoglycaemia
identification and treatment of precipitating causes
specialist referral
Usually admitted to ICU
Addison Disease, symptoms
Lethargy/excessive fatigue/weakness
Anorexia and nausea
Diarrhoea/abdominal pain
Weight loss
Dizziness/funny turns, syncope: postural hypotension (common)
Hyperpigmentation
palate, skin creases of hands
Cushing syndrome, symptom
a rounded face
weight around torso, shoulders and neck, but thin arms and legs
hump between the shoulders
high blood sugar or diabetes
high blood pressure
feeling tired or emotional
skin problems (low healing of wounds, bruising and stretch marks)
brittle bones (osteoporosis)
Graves disease, symptoms
classical Graves disease:
exophthalmos, hyperkinesis and a large goitre but if the eye and neck signs are absent it can be misdiagnosed as an anxiety state.
Elderly patients may present with only cardiovascular signs, such as atrial fibrillation and tachycardia, or with unexplained weight loss.
Commonest cause of bilateral nonthyrotoxic goitre in Australia
Hashimoto thyroiditis, or lymphocytic thyroiditis, which is an
autoimmune thyroiditis
Hashimoto thyroiditis (autoimmune thyroiditis), symptom
bilateral goitre, classically described as firm and rubbery
patients may be hypothyroid or euthyroid with a possible early period of thyrotoxicosis
Hashimoto thyroiditis (autoimmune thyroiditis), investigation
T4—subnormal
TSH—elevated (>10 is clear gland failure)
Serum cholesterol level elevated
Anaemia: usually normocytic; may be macrocytic
ECG: sinus bradycardia, low voltage, flat T waves
Asthma treatment choices in young children
1st: MDI + spacer (cheaper)
2nd: nebulizer (easier)
3rd: MDI or breath actuated inhaler (needs cooperation)
4th: Oral solution or suspension (ICS, SABA, Steroid) (might be unavailable, more side effects)
Asthma treatment, usual 1st line for adults and adolescent
low dose ICS + SABA reliever
or
budesonide-formoterol as needed
or
SABA as needed (rare)
Asthma treatment, usual 1st line for children
SABA as needed
Routine physical examination at 6 weeks, parts
Top to toes or vice-versa physical exam
ask for any concerns (eg feeding, illnesses, abnormalities)
The hip examination: Exclude hip dysplasia
Enquiring about the risk factors for developmental hip dysplasia,
Ortolani test - positive if hip jerk or clunk
Barlow test - positive if hip popped out
The abdomen: Exclude organomegaly (esp spleen and liver)
The neurological examination at 6 Weeks
social responsiveness, equal movement of limbs ,
baby in ventral suspension – spine inspection, head tone
The eyes: red reflex
Check for cleft palate
Hip dysplacia, definition
baby’s hip joint does not develop properly. The acetabulum is too shallow. This causes the hip to become dislocated or unstable
Hip dysplacia, symptoms
a hip joint that clicks when rotated (ortolani test)
different length legs
late sitting or walking
legs are difficult to spread apart
not putting weight on one leg
uneven skin near the buttocks
uneven walking or limping
weight on one side when sitting
Postpartum haemorrhage, definition
- After vaginal birth: 500 mL or more
- After caesarean section (CS): 1000 mL or more
- Manifests as increasing tachycardia and hypotension (usually after 1000ml blood loss)
- 10% decline in postpartum haematocrit levels
- Blood transfusion required after a massive blood loss greater than 1000 mL or a postpartum haemoglobin (Hb) of less than 80 g/L
Postpartum haemorrhage, causes
Tone (70%)
Trauma (20%)
* Lacerations of the cervix, vagina and perineum
* Extension lacerations at CS
* Uterine rupture or inversion
* Non-genital tract trauma (e.g. subcapsular liver rupture)
Tissue (10%)
Thrombin (< 1%)
Postpartum haemorrhage, prevention
- Recommend routine blood group and antibody testing
- Identify high antenatal risk (mark chart, refer)
- screen and treat anaemia
- screen and treat for blood disorders
- determine placenta position before birth and refer as needed
- Ensure routine blood results are less than three days old on admission
(IOL and CS)
Postpartum haemorrhage, intrapartum risk prevention (high risk patients)
- Prepare crossmatched blood
- Prophylactic oxytocin
(prefer oxytocin over syntometrine for NSD, prefer carbetocin over syntometrine for CS) - carbetocin 100 micrograms IV over one minute after birth of the baby
Colorectal cancer, incidence
Colorectal cancer (CRC) is the second most common cancer, after breast cancer, in Australia. After lung cancer, it is the second most common cause of cancer death
Colorectal cancer, category 1 screening advice
Category 1 - 1 FDR or SDR, more than 55 yrs of age at diagnosis
Immunochemical faecal occult blood test (iFOBT)
- every two years from age 45 years
For patients aged 50–70 years, low-dose aspirin (100 mg) daily should be considered
Colorectal cancer, category 2 screening advice
Category 2 - 1 FDR diagnosed at less than 55 yrs, 2 FDR diagnosed at any age, 1 FDR + 2 SDR diagnosed at any age
iFOBT - every two years from age 40 to 50 years
Colonoscopy - every five years from age 50 to 74 years
CT colonography can be offered if colonoscopy is contraindicated
Low-dose (100 mg) aspirin daily should be considered
Colorectal cancer, category 3 screening advice
Category 3 - 3 FDR or SDR diagnosed at any age
iFOBT - every two years from age 35 to 45 years
Colonoscopy - every 5 years from age 45 to 74 years
CT colonography can be offered if colonoscopy is contraindicated
Low-dose (100 mg) aspirin daily should be considered
Possible referral to a genetic centre for hereditary cancer
Colorectal Cancer, risk categories
Category 1 - 1 FDR or SDR, more than 55 yrs of age at diagnosis
Category 2 - 1 FDR diagnosed at less than 55 yrs, 2 FDR diagnosed at any age, 1 FDR + 2 SDR diagnosed at any age
Category 3 - 3 FDR or SDR diagnosed at any age
FDR - first degree relative, SDR - second degree relative
Urothelial tumors, definition
Upper tract urothelial cancer (sometimes called transitional cell carcinoma) is a cancer that occurs in either the inner lining of the tube that connects the kidney to the bladder (the ureter) or within the inner lining of the kidney.
The lining of the bladder, kidney and ureter are the same, so there are some similarities between upper tract urothelial cancer and bladder cancer.
Urothelial tumors, symptoms
blood in the urine (haematuria)
pain on one side of the back
weight loss
urinary tract infections.
Urothelial tumors, risk factors
- smoking tobacco
- long-term inflammation of the ureter or kidney
- exposure to certain chemicals over time, such as those used to make plastics, textiles, rubber, paint and dyes
- exposure to arsenic
- prior chemotherapy or radiation therapy
- long-term use of large quantities of painkillers
- family history of bladder cancer
- having Lynch syndrome (an inherited syndrome) or Balkan nephropathy (due to Balkan region diet).
Globus pharyngeus, definition
A relatively common problem in which there is a sense of obstruction or difficulty in swallowing, but food and liquids move normally to the stomach. The globus sensation is most commonly caused by acid refluxing from the stomach causing swelling on the lining of the throat (inflammation)
Shoulder dystocia, management
call for help
mcrobert’s manoeuvre (knees to nipples position)
suprapubic pressure
episiotomy
manoevre by obstetrician
prepare for possible rescucitation
Erb’s palsy, definition
Infant’s arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia.
Klumpke paralysis vs Erb paralysis, difference
Erb’s palsy results from neuronal damage to the upper C5 and C6 nerves. The clinical presentation includes partial or full paralysis of the arm and often accompanied by loss of sensation. Klumpke’s palsy causes paralysis of the forearm and hand muscles as a result of mechanical damage to the lower C8 and T1 nerves.
Types of hearing loss, and common causes
Conductive Hearing Loss
- problems with the outer and/or middle ear
- most common causes are fluid in the middle ear (ear infection), a perforated eardrum, wax (cerumen) build up or damage to the tiny bones in the middle ear (ossicles)
Sensorineural Hearing Loss
- most common cause of hearing loss and is due to damage to the inner ear (hair cells of the cochlea or damage to the auditory nerve)
- most common causes are age and noise exposure
Mixed hearing loss
- has both a conductive and sensorineural hearing loss
Common symptoms of salivary gland stones include:
- Pain and swelling of the gland, especially at mealtimes followed by swelling of the gland
- Dry mouth
- Difficulty swallowing or opening mouth
Salivary gland stone,investigation and treatment
- preferably xray, but may also do sialography
- advise drinking plenty of water or sucking on sugar-free lemon drops as methods for increasing flow of saliva
- application of heat along with gentle massage to the area can help remove stones
- If less invasive treatment do not work then surgical treatment is advised
Prostate cancer signs and symptoms
Early prostate cancer usually does not cause symptoms.
Advanced prostate cancer symptoms can include:
frequent urination
pain while urinating
blood in the urine or semen
a weak stream
pain in the back or pelvis
weak legs or feet.
Causes and risk factors of prostate cancer
- age, increasing rapidly after 50 years of age
- family history of prostate, breast or ovarian cancer, father or brother diagnosed with prostate cancer before the age of 60
- association with high testosterone levels.
Prostate cancer, initial investigation
PSA
DRE
MRI
Biopsy
Cannabis withdrawal common symptoms
Cannabis intake produces euphoria and relaxation, perceptual alteration, time distortion and the intensification of normal sensory experiences such as eating.
withdrawal lasts 1-2 weeks:
- craving
- anxiety, restlessness, irritability
- anorexia (and weight loss)
- disturbed sleep and vivid dreams
- gastrointestinal tract symptoms
- night sweats
- tremor
Ecstasy withdrawal symptoms
ecstasy increases the activity of neurotransmitters—specifically those that influence feelings of happiness and love—in the brain. This increase in activity also quickly depletes the brain’s supply of the chemicals needed to feel this way.
During withdrawal, users typically experience the opposite of what they felt while high, like depression and anxiety. They’ll also intensely crave the drug.
Cocaine withdrawal symptoms
Cocaine is a stimulant that speeds up the workings of the brain.
Intense cravings, depression, anxiety and angry outbursts. Physical withdrawal symptoms include nausea, tremors, sleeping problems and muscle pain
Heroin withdrawal symptoms
Heroin is a depressant drug in the opioid class – it slows down certain functions of a person’s brain and nervous system.
withdrawal symptoms:
cravings
diarrhoea and vomiting
stomach cramps
sweating
bone, joint and muscle pain and twitching
mood swings and crying
Scrotal swelling or pain could be caused by many things, including:
Injury
Infection (Epididymitis is one of the most common)
Cyst (Usually harmless)
Testicular cancer
Testicular torsion (medical emergency)
Problems with the nerves, arteries or veins (eg varicocele)
Common causes of breast mass
Fibroadenoma - smooth, firm breast lump made up of fibrous
and glandular tissue. The term “breast mouse” is also used to refer
to a fibroadenoma. Rarely change into breast cancer.
Cyst - fluid-filled sac, common in women aged 35-50 and in
women who are taking hormone replacement therapy.
Simple cysts are not cancer. In rare cases, cysts may have a cancer growing within them or close to them.
Breast cancer - Most often a disease of ageing – more than
74% of cases occur in women 50 years and older
Schizophrenia definition and presentation
Schizophrenia is a mental illness that causes someone to have an altered experience of reality. Someone with schizophrenia will have symptoms for more than 6 months. They may have unusual ideas or beliefs about themselves or the world around them.
3 most common symptoms
hallucinations: false sensory experience
delusions: false beliefs
confused thinking: thoughts are jumbled and the person can’t make sense of what other people are saying
Refractory errors and required lense
Hyperopia (far sighted): convex lense
Myopia (near sighted): concave lense
Renal artery stenosis, definition and usually causes
A decrease in blood flow through one or both of the main renal arteries or their branches
Usually due to thromboemboli, atherosclerosis, or fibromuscular dysplasia
Symptoms of acute renal occlusion
steady and aching flank pain
abdominal pain
fever
nausea, and vomiting
Gross hematuria, oliguria, or anuria may occur
After 24 hours, symptoms and signs of acute kidney injury may develop
Symptoms of chronic progressive renal occlusion
Hypertension (may begin at an atypical age and may be refractory) abdominal bruit or signs of atherosclerosis
Symptoms and signs of chronic kidney disease
Fibromuscular Dysplasia (FMD), definition
A vascular disease, usually affecting women, that can make the artery walls too weak or too stiff. This can lead to the arteries being either narrowed, known as stenosis, or become enlarged, otherwise known as aortic aneurysm.
Most commonly affects arteries that supply the kidneys, and the carotid and vertebral arteries that supply the brain
Fibromuscular Dysplasia (FMD), symptom
For those whose kidneys are affected, symptoms can include:
High blood pressure
Abnormal kidney function, rarely even kidney failure
Shrinkage of the kidney known as atrophy
FMD in the carotid arteries may cause the following:
Pulsatile tinnitus – a ‘wooshing’ sound in the ears
Headaches – especially migraines
Neck pain
Ringing in your ears
Dizziness
Stroke
