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Virtual Ward > Weight loss > Flashcards

Weight loss Flashcards

1
Q

Define weight loss.

A

A measurable decline in body weight either intentionally or from malnutrition or illness.

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2
Q

How would you differentiate between mild, moderate and high weight loss?

A

mild - 5% loss of body weight
moderate - 5-10%
high - more than 10% loss

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3
Q

What is malnutrition?

A

malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients

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4
Q

List some GI causes of weight loss.

A

Malabsorption - coeliac disease, IBD
Structural - pharyngeal pouch, strictures, malignancy
Gastric or duodenal ulcers

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5
Q

What other GI clinical symptoms would you ask about in a patient complaining of weight loss?

A

mouth ulcers, dysphasia, dyspepsia, N/V, early satiety, abdominal pain, change in bowel habit (diarrhoea, constipation, haematochezia, mucus in stool, black stool)

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6
Q

What signs would you be looking for in a weight loss patient’s full blood count?

A

anaemia, thrombocytopenia, leucopenia/leucocyotis

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7
Q

What are the endocrine causes of weight loss?

A

Addison’s, diabetes, hyperthyroid

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8
Q

What are some inflammatory causes of weight loss?

A

rheumatoid arthritis, lupus, polymyalgia rheumatica

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9
Q

Define cancer.

A

An abnormal growth of cells which tend to proliferate in an uncontrolled way and in some cases metastasise or spread

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10
Q

What are the three screening programmes available in the UK?

A

breast - women aged 50-70 every 3 years
bowel - aged 50-74 every 2 years
cervical - women aged 25-64 every 3 years

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11
Q

Differentiate between the cancer types.

A

Carcinoma: derived from epithelial cells e.g. breast, prostate, lung, pancreas, colon
Sarcoma: connective tissues e.g. bone, cartilage, fat, nerve
Lymphoma and leukaemia: arise from haematopoietic cells
Germ cell: derived from pluripotent cells - present in testicles or ovaries
Blastoma: derived from immature ‘precursor’ cells or embryonic tissue

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12
Q

Describe how cancer cells spread through the body.

A
  • growing into or invading nearby normal tissue
  • moving through the walls of nearby lymph nodes or blood vessels
  • travelling through lymphatic system and bloodstream to other parts of the body
  • stopping in small blood vessels in a distant location, invading the blood vessel walls, and moving into the surrounding tissue
  • growing in this tissue until a tumour forms
  • causing new blood vessels to grow, which creates a blood supply that allows the tumour to continue growing
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13
Q

What are the common sites and symptoms of cancer metastasis?

A

Brain: headaches, seizures, vertigo
Respiratory: cough, haemoptysis, dyspnoea
Lymphadenopathy
Liver: hepatomegaly, jaundice
Skeletal: pain, fractures, spinal cord compression

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14
Q

What is frailty?

A

a common clinical syndrome of increased vulnerability and functional impairment due to progressive changes in multiple different organ syndromes

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15
Q

What are the five Fried criteria for frailty?

A
  1. Unintentional weight loss
  2. Exhaustion
  3. Muscle weakness
  4. Slowness while walking
  5. Reduced activity levels
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16
Q

What is sacropenia?

A

loss of skeletal muscle mass and strength as a result of aging

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17
Q

Discuss the different areas for management of frailty.

A

Medical: problems, medications, treatment, cognition
Nursing: continence, sleep, nutrition, behaviour
PT: mobility, gait, balance, aids
OT: ADLs, cognition, environment
Social work: POC
SLT, dietician, podiatry, optician, dentistry

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18
Q

List some of the features of depression.

think SIGECAPS

A 
Sleep disorder (may be increased or decreased)
Interest deficit (anhedonia)
Guilt (worthlessness, hopelessness, regret)
Energy deficit
Concentration deficit
Appetite disorder
Psychomotor retardation or agitation
Suicidality
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19
Q

What are some of the risk factors for the development of depression?

A 
recent bereavement
social isolation
stroke
chronic medical conditions
polypharmacy
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20
Q

Using the DSM-5 criteria, how is a diagnosis of depression made?

A

> /=5 of the following symptoms for 2 weeks:
Core (diagnosis requires >/=1): depressed mood for most of the day, anhedonia in almost all activities
Additional: significant change in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, indecisiveness or decreased ability to concentrate, recurrent thoughts of death or suicide

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21
Q

List some examples of infections associated with weight loss.

A

TB, HIV, Hep C, infective endocarditis

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22
Q

What causes microcytic anaemia?

A 
IDA
thalassaemia
sideroblastic anaemia
lead poisoning
anaemia of chronic disease
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23
Q

What causes normocytic anaemia?

A

haemorrhage
renal failure
anaemia of chronic disease
IDA (early stages)

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24
Q

What causes macrocytic anaemia?

A 
liver disease
alcohol excess
folate deficiency
B12 deficiency
myelodysplastic syndrome
hypothyroidism
haemolysis
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25
Q

List some of the causes of thrombocytosis.

A 
trauma
post surgical
haemorrhage
malignancy
hyposplenism
RA
essential thrombocytosis
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26
Q

What are some of the causes of eosinophilia?

A 
asthma
acute drug allergy
strongyloidiasis
lymphoma
leukaemia
hypoadrenalism
Churg-Strauss
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27
Q

On chest percussion, what are the causes of unilateral dullness, bilateral dullness and hyperresonance?

A

unilateral: pleural effusion, pneumonia, tumour
bilateral: pulmonary oedema (renal or heart failure)
hyperresonance: emphysema, pneumothorax

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28
Q

What two important tests should you run in a patient with suspected TB?

A

sputum culture, AAFB

29
Q

A histology report states the presence of binucleate Reed-Sternberg cells and mononuclear Hodgkin’s cells. What is the diagnosis?

A

Hodgkin’s lymphoma

30
Q

What is the difference between leukaemia and lymphoma?

A

broadly leukaemias affect the bone marrow and often the peripheral blood while lymphomas develop within other tissues

31
Q

How would you differentiate between acute and chronic leukaemia?

A

Acute: rapid onset of symptoms with death in weeks to months without treatment
Chronic: insidious onset over years

32
Q

How does acute myeloid leukaemia happen?

A

Cells of the leukaemic clone proliferate but typically don’t mature, these blasts (immature precursors) then take over the bone marrow causing anaemia and thrombocytopenia

33
Q

How is AML treated?

A

high dose chemotherapy and often allogeneic bone marrow transplant

34
Q

What are some of the presenting features of AML and ALL?

A

splenomegaly, hepatomegaly, lymphadenopathy, pallor, fatigue, SOB, bleeding, bruising, infection

35
Q

In which leukaemia would you see Aeur rods?

A

AML

36
Q

How does CML occur?

A

specific translocation between chromosome 9 and 22 t(9;22) forming the oncogenic fusion gene BCR:ABL1 - Philadelphia chromosome
- results in increased cell proliferation, genomic instability, inhibition of apoptosis

37
Q

Which drugs are used to target the cause of CML?

A

tyrosine kinase inhibitors e.g. imatinib

38
Q

What are the symptoms of CML?

A

fatigue, weight loss, anaemia, sweating, splenomegaly

39
Q

How does CLL occur?

A

result of proliferation of a clone of mature B cells

40
Q

What is the treatment of CLL?

A

many patients will never require treatment

41
Q

How do patients with CLL typically present?

A 
80% incidental (raised lymphocyte count)
lymphadenopathy
anaemia
splenomegaly
hepatomegaly
increased susceptibility to infection
42
Q

It is typical to adopt a watch and wait approach in CLL except in 5 cases. What are they?

A
  • Progressive lymphocytosis
    >50% increase over 2 months
    Lymphocyte doubling time < 6 months
  • Progressive marrow failure (CLL cells take over marrow):
    Hb < 10, plt <100, neutrophils <1
  • Massive or progressive lymphadenopathy/splenomegaly
  • Systemic symptoms
  • Autoimmune cytopenias such as ITP or autoimmune haemolytic anaemia
43
Q

Lymphomas are always of lymphoid lineage. What is the difference between high grade and low grade?

A 
high = aggressive
low = indolent/slow progression
44
Q

How does the cell lineage of Hodgkin v Non Hodgkin lymphoma differ?

A

The neoplastic cell in Hodgkin disease is always of B cell lineage
The neoplastic cell in non Hodgkin lymphoma may be of B, T or NK cell lineage

45
Q

What are the clinical features of Hodgkin’s Lymphoma?

A
  • painless rubbery cervical lymphadenopathy (<10% pain at site when drinking alcohol)
  • cough, SOB, chest pain (mediastinal lymphadenopathy)
  • pruritis
  • B symptoms (weight loss, unexplained fever, night sweats)
46
Q

How would you treat Hodgkin’s Lymphoma?

A
  • Early stage, low-risk disease can be offered 2-4 cycles of chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine ABVD) foolowed by radiotherapy. 90% are cured.
  • Advanced disease patients (stages 3 or 4) are typically offered 6-8 cycles of ABVD chemotherapy followed by irradiation of bulky sites. 50-60% will have a median survival in excess of 5 years.
  • Haematopoietic stem cell transplant may be considered for patients with refractory or relapsed disease
47
Q

What are some of the neurological causes of weight loss?

A

Parkinson’s
MS
MND
Huntington’s

48
Q

What is Parkinson’s disease?

A

progressive neurological condition caused by death of dopamine secreting neurones within the substantia nigra

49
Q

What are the symptoms of PD?

A

bradykinesia
rigidity
tremor
less common: low mood, memory issues, sleep issues,, postural instability, autonomic symptoms (constipation, incontinence)

50
Q

How is PD diagnosed?

A

history examination
improvement with levodopa
DaT scan

51
Q

What is the treatment of PD?

A

medication - levodopa, dopamine agonists, MAO-B inhibitors
MDT
surgery

52
Q

What is MS?

A

a neurological condition caused by demyelination of neuron’s myelin sheath

53
Q

What are the 4 main types of MS?

A

clinically isolated syndrome, relapsing remitting, primary progressive, secondary progressive

54
Q

MS can cause a wide spectrum of neurological symptoms. List some examples.

A 
changes in sensation
pins and needles
numbness
visual disturbance
weakness
muscle spasms
ataxia
speech or swallow difficulties
fatigue
pain
bowel or bladder difficulties
low or unstable mood
55
Q

In relation to MS, what is Uhthoff’s phenomenon?

A

temporary worsening of symptoms following exposure to heat

56
Q

In relation to MS, what is Lhermitte’s sign?

A

an electrical sensation that runs down the back when bending the neck

57
Q

What signs would be present in an examination of a patient with MS?

A 
cerebellar signs
internuclear ophthalmoplegia, diplopia, nystagmus, abnormal extra-ocular movements
spasticity
hyperreflexia and upgoing plantars
muscle weakness
abnormal sensation
tremor or muscle spasms
58
Q

How is a diagnosis of MS made?

A 
history
examination
MRI brain and spine
CSF - oligoclonal bands, raised protein
McDonald's criteria
59
Q

How is MS treated?

A
  • acute ?steroids
  • RR: disease modifying medications e.g. interferon, glatiramer, natalizumab, alemtuzumab, rituximab
  • severe acute ?plasmapheresis
  • non pharmacological: PT, OT, CBT
  • analgesia, neuropathic pain relief, baclofen
60
Q

What is MND?

A

rare neurodegenerative disorders that selectively affect motor neurones

61
Q

What are the symptoms of MND?

A 
muscle weakness
muscle cramps or spasms
bulbar symptoms (speech problems, swallowing problems, excessive saliva)
emotional lability
cognitive impairment
breathlessness
fatigue
62
Q

What would you find on the examination of a patient with MND?

A 
mixture of lower and upper motor signs
muscle wasting
fasciculations
brisk reflexes
upgoing plantars
increased tone and spasticity
dysarthric speech
63
Q

How is a diagnosis of MND made?

A

MRI brain and spine normal
LP normal
nerve conduction studies and EMG - denervation and fasciculations
signs of respiratory failure

64
Q

How is MND treated?

A 
no curative treatments
Riluzole - 10% improvement in survival
treatment of symptoms
NIV for resp failure
PEG
MDT
65
Q

What causes Huntington’s disease?

A

autosomal dominant

repetition of CAG segment of DNA

66
Q

What are the symptoms of Huntington’s disease?

A 
chorea (involuntary jerking or writhing movements)
dystonia
slow or abnormal eye movements
impaired gait or posture
difficulty with speech or swallowing
cognitive impairment
low mood or irritability
fatigue
sleep disturbance
67
Q

How is Huntington’s disease treated?

A

None specific
Symptoms e.g. antipsychotics, tetrabenazine, amantidine, clonazepam, levetiracetam
anti-depressants or mood stabilisers
MDT

68
Q

Discuss the Ann Arbor system for classification of lymphoma.

A

I = one node region involved, II = 2+ ipsilateral regions, III = bilateral node involvement, IV = extranodal disease), suffix “A” (B symptoms absent) or “B” (B symptoms present)

69
Q

What is sarcoidosis?

A

multisystem disease of unknown aetiology characterised by non-necrotising granulomas in many organs

Virtual Ward (11 decks)

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