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Lottie's Question Books > Cases book 3 > Flashcards

Cases book 3 Flashcards

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1
Q

Fatigue, malaise, hepatosplenomegaly, trunkal obesity, RUQ pain. Dx?

A

NASH

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2
Q

List risks of NASH

A

Obesity, T2DM, HTN, high cholesterol
Hx rapid weight loss / paraenteral nutrition
LACK OF HEAVY ALCOHOL USE

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3
Q

List Ix and results of NASH

A

LFTs (raised AST, ALT, BR, ALP, GGT)
FBC (low Hb and platelets)
Metabolic and lipid panel
PT and INR

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4
Q

What is gold standard for diagnosing NASH?

A

Liver biopsy and histology

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5
Q

List Mx of NASH in the absence of end stage liver disease

A

Diet and exercise

Insulin sensitiser and statin

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6
Q

List Mx of NASH + end stage liver disease

A

Liver transplant

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7
Q

Sore throat, fever, fatigue, headache, malaise, anorexia, sweating, abdo pain. Dx?

A

Infectious mononucleosis

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8
Q

List signs O/E of mono

A

Creamy exudates on tonsils
Palatal petichae
Splenomegaly
Pyrexia

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9
Q

Ix of mono

A

FBC, LFTs
Blood film
Paul Bunnel / monospot test
IgG EBNA

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10
Q

What does blood film in EBV show?

A

> 20% atypical lymphocytes

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11
Q

Mx of EBV?

A

Bed rest, paracetamol, NSAIDs

Steroids if severe

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12
Q

What happens if given amoxicillin / ampicillin while pt has EBV?

A

Maculopapular rash all over body

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13
Q

What must you advise EBV patient to do for the next 2 weeks?

A

Avoid contact sports - risk of splenic rupture

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14
Q

Non blanching rash is a specific Sx to what?

A

BACTERIAL meningitis

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15
Q

How do viral meningitis Sx compare to bacterial?

A

Viral arent as severe and dont progress as quickly

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16
Q

What must be done prior to LP in meningitis?

A

Exclude raised ICP - otherwise brainstem herniation

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17
Q

Cloudy CSF with high protein and low glucose. Dx?

A

Bacterial meningitis

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18
Q

What cell is predominant in bacterial meningitis?

A

Neutrophils

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19
Q

Clear CSF with high protein and normal glucose. Dx?

A

Viral meningitis

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20
Q

Fibrinous CSF with high protein and low glucose. Dx?

A

TB meningitis

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21
Q

What cell is predominant in viral / TB meningitis?

A

Lymphocytes

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22
Q

What is cor pulmonale?

A

RHF due to chronic pulmonary HTN

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23
Q

List 3 categories for causes of cor pulmonale. Give an example for each

A

Chronic lung disease - COPD
Pulmonary vascular disease - PE
Neuromuscular disease - MG

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24
Q

List signs O/E of cor pulmonale

A

Cyanosis, raised JVP, hepatomegaly, oedema

TR or PR murmurs

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25
Name the types of systemic sclerosis
Pre-scleroderma Diffuse cutaneous SS Limited cutaneous SS Scleroderma
26
Raynauds, skin changes, joint contracture, organ dysfunction. Dx?
Diffuse cutaneous SS
27
Raynauds, nail fold capillary changes, anti nuclear ABs. Dx?
Pre-scleroderma
28
List Sx of limited cutaneous SS?
CREST - calcinosis - raynauds - oesophageal dysmotility - sclerodactyly - telangiectasia
29
List Sx of scleroderma
Internal organ disease, no skin changes
30
What AB is present in systemic sclerosis
anti nuclear AB
31
Haematuria and proteinuria 1-2 days after sore throat. Dx?
IgA nephropathy
32
Haematuria and proteinuria 1-3 weeks after sore throat. Dx?
Post strep GN
33
Haematuria and proteinuria. Raised urea and creatinine with oliguria. dx?
Rapidly progressive GN
34
Name 3 conditions that can cause rapidly progressive GN
Goodpastures SLE Vasculitides
35
Nephrotic syndrome in a child. Dx?
Minimal change disease
36
What causes minimal change disease?
GBM damage by T cells
37
Nephrotic syndrome in an Afro-Caribean HIV+ adult. Dx?
Focal segmented glomerular sclerosis
38
Nephrotic syndrome in an adult with cancer/infection/SLE. Dx?
Membranous glomerular disease
39
What is the most common cause of nephrotic syndrome in adults?
Membranous glomerular disease
40
Nephrotic syndrome with apple green birefringence on congo red stain. Dx?
Amyloidosis
41
Mx of SVT?
1. Vagal maneouvres 2. Adenosine + cardiac monitoring 3. DC cardiovert if haemodynamically unstable
42
Mx of fast AF?
1. Rate control - beta blockers / digoxin 2. Rhythm control a. ) <48hrs = DC cardiovert OR chemical cardiovert with flecanide or amiodarone b. ) >48hrs = anticoagulate (LMWH then warfarin) then cardiovert after 3-4 weeks
43
Mx of VT in stable pt?
1. IV amiodarone 2. Look for and treat cause 3. ICD
44
Mx of VT in unstable pt?
Defibrillate
45
List the stepwise Mx of T2DM
1. Diet and lose weight 2. Metformin 3. Dual therapy (metormin + gliptin / thiazolidinediones / sulfonylureas / gliflozins) 4. Triple therapy (metformin + sulfonylureas + thiazolidinediones / gliptins)
46
What can be given if metformin is contraindicated?
Gliptin / sulfonylureas / thoazolidinediones
47
Which drug reduces peripheral insulin resistance?
Thiazolidinediones
48
Which drug stimulates beta cells to release insulin?
Sulfonylureas
49
Which drug is a biguanide that increases cell sensitivity to insulin?
Metformin
50
Which drug inhibits DPP-4 to increase insulin secretion and decrease glucagon?
Gliptins
51
Side effects of metformin?
N&V, stomach ache, decreased appetite, metallic taste in mouth
52
Side effects of sulfonylureas?
HYPOGLYCAEMIA | Abdo pain, diarrhoea, nausea
53
Side effects of thiazolidinediones?
Fractures, infections, numbness, change in vision, increased weight
54
Side effects of gliptins?
Headache
55
List cardiac causes of clubbing
Congenital cyanotic heart disease Atrial myxoma Bacterial endocarditis Tetralogy of fallot
56
List resp causes of clubbing
``` Lung cancer Empyema Interstitial lung disease Bronchiectasis CF ```
57
List gastro causes of clubbing
IBD Cirrhosis GI lymphoma Coeliac / chronic malabsorption
58
List other causes of clubbing
Thyrotoxicosis or hereditary
59
Define AKI
Acute decline in kidney function leading to raised creatinine and low urine output
60
List pre renal causes of AKI
Hypovolaemia, low BP, renal artery stenosis, sepsis
61
List renal causes of AKI
GN, vasculitides, acute interstitial nephritis, acute tubular necrosis
62
List post renal causes of AKI
Renal calculi, strictures, pelvic cancer, BPH
63
List Sx / signs of AKI
``` Metabolic acidosis Oliguria Hyperkalaemia Uraemia HTN Anaemia Secondary hyperparathyroidism ```
64
List Ix of AKI
``` Metabolic screen (urea, creatinine, LFTs) FBC U&Es (K) Urinalysis ECG CXR ```
65
List the 4 steps in AKI Mx
1. Protect against hyperkalaemia 2. Optimise fluid balance 3. Stop nephrotoxic drugs 4. Assess dialysis need
66
List nephrotoxic drugs
ACEi, NSAIDs, gentamicin | NOT BETA BLOCKERS
67
List indications for dialysis in AKI
``` Refractory pulmonary oedema Persistent hyperkalaemia Severe metabolic acidosis Uraemia Overdose ```
68
List Sx of amyloidosis
Nephrotic syndrome, renal failure Restrictive cardiomyopathy, HF, arrhytmia, angina Neuropathy (inc autonomic), carpel tunnel Waxy skin, brusining, perioribtal purpura Shoulder pain, arthritis Factor X deficiency (bleeding)
69
List Ix and results of amyloidosis
Tissue biopsy for congo red stain (apple green birefringance) Urine dip (++ protein) CRP, ESR, U&Es, LFTs, Ig levels
70
What inheritance pattern in neurofibromatosis?
Autosomal dominant
71
Sx of type 1 neurofibromatosis?
``` Peripheral and spinal neurofibromas Cafe au lait spots Axillary freckling Optic nerve glaucoma Phaeochromocytoma Skeletal deformities Renal artery stenosis ```
72
Sx of type 2 neurofibromatosis?
``` Bilaterl acoustic neuromas Gliomas Cataracts (All schwanomas) Hearing loss, tinnitus, change in balance, headache ```
73
Which chromosomes are affected in neurofibromatosis?
``` 1 = chr 17 2 = chr 22 ```
74
Which condition is associated with neurofibromatosis type 1?
SAH
75
What are erythema nodosum?
Inflammation of sub cut fat
76
Describe apperance of erythema nodosum
Red/purple domed nodules on shin /thighs Tender and warm Systemic Sx
77
List causes of erythema nodosum
``` LOST BUSH Leprosy / leukaemia OCP / preg Sacroidosis / sulfonamides TB / toxoplasmosis Behcets UC / CD Salmonella / strep Histoplasmosis ```
78
List causes of acute pancreatitis
``` I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bite Hypercalcaemia / hypothermia / hypertriglyceridaemia ERCP Drugs - azothrioprine / sodium valproate ```
79
Sx / signs of acute pancreatitis
Severe epigastric pain, radiating to back, relieved on sitting forward N&V High HR/RR Grey Turners / Cullens
80
List Ix for acute pancreatitis with results
Amylase / lipase (raised) FBC (raised WCC), BGC (raised), U&Es, LFTs, CRP ABG Abdo USS or erect CXR or AXR or CT
81
What score is used to assess severity in pancreatitis?
Modified Glasgow
82
List Mx of acute pancreatitis
``` Fluids, electrolytes Analgesia Catheter ERCP Complications & Mx ```
83
List complications of acute pancreatitis
Necrosis, pseudocyst, abcess, ascites, low Ca, psueodaneurysm, VTE, sepsis, DM, chronic pancreatitis
84
Define chronic pancreatitis
Chronic inflammation of the pancreas with irreversible parenchymal atrophy and fibrosis leading to impaired end/exocrine function
85
What are the 2 main causes of chronic pancreatitis?
Alcohol (70%) | Idiopathic (20%)
86
List PC of chronic pancreatitis
Recurrent severe epigastric pain, radiating to back Worse with alcohol or food Weight loss, bloating, steatorrhoea
87
List Ix and results for chronic pancreatitis
``` BGC (raised), amylase (NORMAL), IgG4 (raised) Faecal elastase (LOW) USS abdo ERCP CT ```
88
List Mx for chronic pancreatitis
Sx relief - diet changes, avoid alcohol, DM Mx, enzyme replacement Surgery - Whipples / drainage / resection
89
List complications of chronic pancreatitis
Pseudocyst, strictures, obstruction, ascites, carcinoma | DM, low QoL, pain
90
List causes of pancreatic carcinoma
Largely unknown | Some familial - MEN / BRCA2 / Peutz-Jeghers
91
List risks of developing pancreatic cancer
Male, 60-80y/o
92
List Sx of pancreatic cancer
Non specific - anorexia, weight loss, malaise | Later - jaundice, epigastric pain
93
What is the classic finding O/E of jaundice?
COURVOISIERS LAW V- painless, palpable gall bladder in jaundiced patient
94
Where in the pancreas are cancers most common?
Head/neck
95
What type of cancer of the pancreas is most common?
Adenocarcinoma
96
Where does pancreatic cancer spread to?
Locally - to liver
97
List Ix for pancreatic cancer
CA 19-9 LFTs USS + FNA CT / ERCP
98
What is Whipples procedure?
Removal of pancreas and duodenum
99
What is the prognosis of pancreatic cancer?
Less than 5% 5 year survival | 4-6 months median survival post diagnosis
100
What is hydrocephalus?
Enlargement of cerebral ventricular system
101
Which type of hydrocephalus has raised ICP?
Obstructive
102
What is obstructive hydrocephalus?
Impaired outflow of CSF from ventricles
103
What is non obstructive hydrocephalus?
Impaired CSF resorption in subarachnoid villi, but with NORMAL ICP
104
What causes obstructive vs non obstructive hydrocephalus?
Obstructive = 3rdV/4thV/aqueduct lesion or aqueduct stenosis Non Ob = tumour, TB, meningitis
105
What is normal pressure hydrocephalus?
A type of non obstructive hydrocephalus where there is chronic ventricular enlargement
106
List risks of hydrocephalus in young / old people
``` Young = congenital or tumours Old = stroke or tumours ```
107
List signs of obstructive hydrocephalus
Low GSC or LOC Diplopia Papilloedema CN 6 palsy
108
List signs of non obstructive hydrocephalus
Chronic cognitive decline, falls, urinary incontinence, shuffling gait, hyperreflexia
109
Which type of hydrocephalus is chronic / acute?
Obstructive = acute | Non obstructive = chronic
110
List Ix for hydrocephalus
CT head | LP / ventricular drain to remove CSF - MC&S
111
When can you NOT do an LP in hydrocephalus?
Obstructive - raised ICP therefore will get brainstem herniation
112
List risks of developing ascending cholangitis
>50y/o | Hx gallstones / PSC / strictures / biliary surgery
113
List Sx of ascending cholangitis
CHARCOTS TRIAD - RUQ pain, fever, jaundice Pale stool, pruritus
114
List Ix for ascending cholangitis
FBC, urea/creatinine, LFTs ABG Abdo USS ERCP
115
Which Ix is gold standard for ascending cholangitis?
ERCP
116
List acute Mx for ascending cholangitis
NBM IV ABx, fluids, analgesia ERCP
117
What is the definitive Mx for ascending cholangitis?
Elective lap chole
118
Define heart failure
Inability of CO to meet body's demands despite normal venous pressures
119
How can heart failure be categorised?
High vs low output | Left vs right
120
List causes of low output left heart failure
IHD, HTN, cardiomyopathy, aortic or mitral valve problems
121
List causes of low output right heart failure
Secondary to LHF, MI, pulmonary HTN, PE, lung conditions, constrictive pericarditis
122
List causes of low output heart failure that can affect both sides
Arrhythmia, cardiomyopathy, drugs, toxicity
123
List causes of high output heart failure
Anaemia, pregnancy, Paget's, hyperthyroidism, AV malformation
124
List signs of LHF
``` High HR, high RR Bibasal creps Displaced apex beat S3 Mitral regurgitation Orthopnoea Paroxysmal nocturnal dyspnoea ```
125
List signs of acute LHF
Tachypnoea, cyanosis, pulses alternans, S3&S4, wheeze, fine crackles
126
List signs of right heart failure
``` Raised JVP Hepatomegaly Ascites Pitting oedema Tricuspid regurgitation ```
127
List Ix of acute LHF
ABG, troponin, BNP
128
List Ix of heart failure
BLOODS: FBC, U&Es, LFTs, CRP, BGC, TFTs, lipids CXR ECG Echo
129
List CXR signs of LHF
``` Alveolar oedema Kerly B lines Cardiomegaly Upper lobe diversion Pleural effusions ```
130
List immediate complications of acute LHF
Cardiogenic shock | Pulmonary oedema
131
List Mx for pulmonary oedema secondary to LHF
``` Sit UP High flow O2 Diamorphine GTN IV furosemide ```
132
List Mx of cariogenic shock secondary to LHF
ITU for inotropes
133
List Mx for chronic heart failure
``` ACEi Beta blocker Loop diuretics Aldosterone antagonist ARB Digoxin +/- ICD ```
134
Why do you give ACEi in chronic heart failure?
Inhibit RAAS which can worsen hypertrophy | Aids survival
135
Why do you give beta blockers in chronic heart failure?
Slow progression of disease and aid survival | Block effects of chronic SNS activation
136
Why do you give ARB in chronic heart failure?
If beta blockers and ACEi aren't enough
137
Which drug do you give in heart failure does not improve survival?
Digoxin
138
Which drugs should you avoid in chronic HF?
CCB and NSAIDs
139
What causes Wernickes?
Thiamine deficiency resulting in biochemical changes to CNS
140
List risks of developing Wernickes?
Alcoholics or chronic malnourishment
141
List triad of Sx for Wernickes
Opthalmoplegia Ataxia Confusion
142
List other Sx you can get as part of Wernickes
Memory loss, hallucinations, abnormal reflexes, hypothermia, low BP, weakness
143
List Ix and Mx of Wernickes
``` Ix = clinical as its a medical emergency Mx = IV thiamine ```
144
List consequences of Wernickes
Korsakoffs
145
Ix for Addisons?
1. 9am cortisol 2. short synacthen test 3. long synacthen test / anti 21-hydroxylase / CT to find cause
146
What are the results of the Ix for Addisons?
1. 9am cortisol <100 | 2. short synacthen test <550
147
List Ix and results for congenital adrenal hyperplasia
1. 9am follicular phase 17OH progesterone (raised)
148
List screening Ix for Conns
Serum K, Na Urine K Plasma aldosterone: renin ratio
149
List positive result for Conns screening Ix
``` Serum K (low) Serum Na (normal) Urine K (high) Plasma aldosterone: renin ratio (high) ```
150
List Ix and positive result for diagnosing Conns
``` Salt load (failure to suppress aldosterone) CT adrenals ```
151
List Ix for Cushings
1. Serum K and BGC 2. 24hrs urinary free cortisol 3. Low dose dexamethasone suppression test 4. Plasma ACTH
152
List positive results for Cushings Ix
1. Serum K and BGC --> low K, high BGC 2. 24hrs urinary free cortisol --> high 3. Low dose dexamethasone suppression test --> high cortisol still 4. Plasma ACTH (low)
153
What is high dose dexamethasone suppression test for?
Adrenal adenoma (Cushings disease) vs Cushing syndrome
154
List Ix for phaeo
1. 24hr urine cathecholamines / metanephrines | 2. CT adrenals
155
List Ix for Carcinoid syndrome
1. 24hr urine 5-HIAA 2. Plasma chomagraffin A&B 3. CT / radioisotope
156
List Ix for acromegaly
1. Serum IGF1 | 2. OGTT
157
List Ix for DI
1. Urine and plasma osmolality 2. Water deprivation test (to diagnose) 3. High dose desmopresin (cranial vs nephrogenic)
158
Flank pain, myalgia, flu like Sx, fever, N&V, LUT Sx. Dx?
Pyelonephritis
159
List risks of developing pyelonephritis
``` PMH UTIs DM Stress incontinence Pregnancy Immunosuppression Anatomical abnormality ```
160
List Ix for pyelonephritis
Urinalysis Urine MC&S FBC, CRP, ESR, U&Es, creatinine Renal USS if ? stones
161
What would urinalysis results of pyelonephritis be?
++ leukocytes ++ nitrites ++ blood
162
List Mx of pyelonephritis
IV ABx - cephalexin | Analgesia
163
What is the inheritance pattern of MEN?
Autosomal dominant
164
List disease that form MEN I
Parathyroid adenoma Pancreatic islet cell tumour Pituitary adenoma
165
List diseases that form MEN 2a
Parathyroid adenoma Thyroid medullary carcinoma Phaeochromocytoma
166
List diseases that form MEN 2b
MEN 2a + multiple mucosal neuromas of GIT + Marfanoid phenotype
167
What is aplastic anaemia?
Pancytopenia and hypo plastic marrow
168
Who gets G6PD deficiency?
Mediterranean patients
169
What precipitates an oxidative crisis in G6PD deficiency?
Flava beans | Drugs
170
What is the pathophysiology of G6PD deficiency?
Low G6PD ---> low NADPH --> low glutathione --> RBCs exposed to oxidative stress
171
List Sx of G6PD deficiency
Jaundice, anaemia
172
What is seen on blood film of G6PD deficiency?
Heinz bodies
173
Positive Coombs test. Dx?
Autoimmmune haemolytic anaemia
174
What does the Coombs test show?
ABs to RBCs
175
What is seen on blood film of autoimmune haemolytic anaemia?
Spherocytes

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