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Medicine year 4 CDM > Mosler 2 > Flashcards

Mosler 2 Flashcards

1
Q

Autoimmune hepatitis: symptoms and investigations

A

Symptoms: often asymptomatic, fatigue, anorexia, nausea, joint pain, itching, jaundice, RUQ pain complications of cirrhosis, acute hepatitis, menorrhagia

Bedside: urine dip
Bloods: FBC, U&E, LFT (raised ALT), coag, CRP ANA or ASMA (type 1), immunoglobulins (raised IgG)
Type 2 autoimmune hepatitis: Anti-liver kidney microsomes-1 (anti-LKM1). Anti-liver cytosol antigen type 1 (anti-LC1)
Imaging: Liver biopsy, fibroscan, US, MRI

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2
Q

Management of autoimmune hepatitis

A
  • Conservative: stop drinking, flu and pneumococcal vaccine, refer to gastroenterologist
  • Medicine: steroids (prednisolone), other immunosuppressants like azathioprine, pain management
  • Surgery: liver transplant
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3
Q

Parkinson’s features

A

Bradykinesia (slow movement), gat change, falls, tremor, stiffness, lack of facial expression, change in handwriting, difficulty doing tasks i.e. dressing, drooling, sleep disturbance, fatigue, lack of smell, memory issue

Psychiatric: depression, dementia, psychosis

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4
Q

Parkinson’s investigations

A

Bedside: diagnose using the ‘UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria’, lying and standing BP, anosmia testing
Bloods: ?
Investigations: DAT scan (reduced uptake in the substantia nigra), MRI if unsure of diagnosis

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5
Q

TB symptoms

A

Symptoms: weight loss, night sweats, cough, haemoptysis, erythema nodosum, lymphadenopathy, spine pain, short of breath, countries visited, previous vaccinations, exposure to HIV

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6
Q

TB investigations

A
  • Bedside: obs, Montoux test, 3 x sputum culture, HIV test, contact tracing, Ziehl Neelson stain on sputum, NAAT tests on sputum culture (shows mutlidrug resistance)
  • Bloods: FBC, U&E, CRP, LFT, blood culture, IGRA, HIV, Hep B and C
  • Investigations: CXR, chest CT, bronchoscopy and samples
    Special: lymph node aspiration or biopsy
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7
Q

TB Medication

A

Latent: Isoniazid and rifampicin for 3 months or Isoniazid for 6 months

Active: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 2 months then Rifampicin and Isoniazid for 4 months (if CNS involvement 10 months)

Co-prescribe Pyridoxine or vitamin B6 (Isoniazid causes peripheral neuropathy)

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8
Q

TB management

A
  • Conservative: notifiable disease, isolate active patients for 2 weeks, refer to infectious disease, manage in negative pressure room. Screen and treat contacts
  • Long term follow for treatment completion and assess for relapses
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9
Q

Malaria symptoms and complications

A

Symptoms: fever (pattern), chills, sweats, headache, muscle aches, fatigue, N+V, diarrhoea, jaundice, dark urine, cough, travel history, confusion, any chance they are pregnant

Complications: Severe anaemia, cerebral malaria, ARDS, multi organ failure, Haemoglobinuria (Blackwater fever), Hypoglycaemia, pregnancy complications

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10
Q

Malaria investigations

A
  • Bedside: obs, urine dip
  • Bloods: FBC, U&E, LFT, CRP, Blood culture. Thick and thin blood film
  • Imaging: CXR in ARDS, CT in cerebral malaria
  • Special: flow cytometry, QBC (Quantative buffy coats), PCR if uncertain and determine strain, Carestart combo rapid test
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11
Q

Malaria treatment

A
  • Uncomplicated: artemether-lumefantrine or other artemisinin-based combination therapies (ACTs)
  • Severe malaria: hospitalisation and IV artesunate, manage in HDU or ICU
  • Prevention of Hypnozoite’s: Primaquine for two weeks
  • Prevention: chemoprophylaxis, mosquito spray and nets
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12
Q

Gout symptoms and investigations

A

Symptoms: affects big toe, tenderness, swelling redness, skin changes, nail changes, stiffness, affect on daily activities, gout tophi (nodules), fever, malaise

-Bedside: BMI
- Bloods: FBC, U&E, LFT, CRP, Anti-CP, RF, Serum Uric acid, fasting glucose, lipid profile
- Imaging: X-ray
- Special: joint aspiration

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13
Q

Management of gout

A
  • Conservative: weight loss, reduce alcohol content, avoid purine rich food i.e. seafood, oily fish and yeast products
  • Rationalise medication: i.e. stop thiazides
  • Acute flare: NSAID with PPI cover, colchine
  • If refractory to treatment: steroid injections
  • Prophylaxis: Allopurinol
  • Increase vitamin C and use losartan if co-existant hypertension
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14
Q

Psoriasis symptoms, triggers, complications

A

Symptoms: joint pain, swelling, stiffness, deformity, skin changes (rash), nail changes, bowel issues, visual issues

Skin lesion- pain, appearance, bleeding, leaking

Triggers: alcohol, smoking, stress, hormonal (puberty, menopause), medication (lithium, ibuprofen ,ACEi), skin injury

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15
Q

Psoriasis investigations

A

Bloods: FBC, U&E, LFT, CRP,RF factor anti-CCP, HLA-B27
Imaging: US, X-RAY (for psoriatic arthritis
Special: skin biopsy

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16
Q

Psoriasis management

A

Emollients
1st: potent topical corticosteroid OD (eg Betnovate) + topical vitamin D applied at different times every day (4 weeks initially)
2nd: stop the topical corticosteroid, apply topical vitamin D twice daily (after 8 weeks)
3rd: stop the topical vitamin D, apply potent topical corticosteroid twice daily (up to 4 weeks)
Dithranol + tar are alternatives

  • Phototherapy with UVB light
  • Systemic: methotrexate, ciclosporin
  • Biologics: Inflixmab
  • Psoriatic arthritis: DMARDs i.e. Methotrexate then Biologics
17
Q

Seronegative spondyloarthropathies

A
  • Conditions: ank spond, psoriatic arthritis, reactive arthritis, enteropathic arthritis
  • Extra-articular conditions: achilles tendonitis, plantar fascitis, uveitis, pulmonary fibrosis, amyloidosis, aortic regurg
18
Q

SLE symptoms and complications

A
  • Symptoms: facial rash, fatigue, joint pain, allopecia, headache, dry eyes and mouth, mouth ulcers, pleuritic chest pain, raynaud’s, recurrent miscarriages, urinary changes
  • Complications: lupus nephritis, peritonitis, anaemia of chronic disease, miscarriage (anti-phospholipid syndrome), pericarditis, pleurisy, arthritis
19
Q

SLE investigations

A
  • Bedside: urine dip, ECG, BP
  • Bloods: FBC, U&E, LFT, ESR, CRP, ANA, dsDNA, complement C3 and C4, Lupus anticoagulant
  • Imaging: X-ray or US of affected joint
20
Q

SLE treatment

A
  • Conservative: sunscreen, prevent exposure to sunlight, stop smoking, educate about condition
  • Medication: NSAID (with PPI) and hydroxychloroquine. Use long term steroids if more prominent organ damage. If refractory to treatment other DMARD’s or biologics

Medicine year 4 CDM (41 decks)

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