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Year 3 Medicine > CBL Semester 1 > Flashcards

CBL Semester 1 Flashcards

1
Q

NYHA functional classification of Heart Failure

A
  1. HF and no limitation to physical activity
  2. HF and slight limitation to physical activity
  3. HF and marked limitation to physical activity
  4. HF and inability to perform physical activity
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2
Q

Signs of HF on CXR

A

Alveolar oedema

B lines (kerley) - horizontal lines near base of lungs Cardiomegally

Dilated upper vessels

Effusions (pleural)

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3
Q

1st line Pharmacological HF management

A

Start

  • ACEi (ARB if intolerant)

Once stable - Beta blocker

Still symptomatic - Aldosterone antagonist (spironolactone)

Still symptomatic - Digoxin

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4
Q

Clinical Features of Rheumatic fever

A

Effects everything apart from the heart only mildly or transiently.

· General - Fever, Recent sore throat

· CNS - Chorea

· Heart - Carditis

· Joints - Pain, migratory arthritis

· Subcutaneous tissue - nodules

· Skin - rash

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5
Q

Rheumatic fever diagnosis criteria

A

Jones Criteria

Required Criteria

• Evidence of preceding strep infection/ other bacteria that cause it

○ DNAase B

○ Anti-streptolysin O

○ Positive throat culture

○ Rapid Antigen test

Major Criteria - (1 from each involved system)

  • Chorea
  • Carditis
  • Polyarthritis
  • Subcutaneous nodules
  • Erythema marginatum

Minor Criteria

  • Fever
  • Arthralgia
  • Previous rheumatic fever/ RHD
  • Acute phase reactions (CRP, ESR etc)
  • Prolonged PR interval
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6
Q

Types of vegetations of RHD and IE

A

RHD: warty, small along line of closure of valve leaflet

IE: Large friable can extend on chordae tendinae

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7
Q

Clinical Manifestations of IE

A
  • Constitutional - Fever, Malaise, Anorexia/ weight loss
  • Emboli- Splinter haemorrhages, Splenic/ renal infracts, Petechiae
  • Constant bacteraemia
  • IC mediated Glomerulonephritis
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8
Q

Diagnostic Criteria for IE

A

Dukes Criteria

Major Criteria

· Positive blood cultures

· Echocardiographic changes that suggest IE

Minor

· fever

· predisposing factor: (IV drug use, cardiac lesion)

· emboli evidence: · immunological problems: ( glomerulonephritis)

· positive blood culture that doesn’t meet major diagnostic criteria

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9
Q

Complications of IE

A

Local - vavular, shunting, heart block

Emboli

Immunocomplexes

Mycotic abscesses

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10
Q

TB medication regime

A

Rifampicin - 6 months

Isoniazid + VB6 - 6 months

Pyrazinamide 2 months

Ethambutol - 2 months (or until susceptibility tests back) Or streptomycin

All taken orally, daily

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11
Q

TB Medication AEs

A

Isoniazid:

  • Neuropathy - prescribe with vB6 to prevent this
  • Hepatitis (<1%, can be fatal)

Ethambutol:

• optic neuritis (colour vision goes first)

Rifampicin:

  • staining of body fluids
  • P450 inducer
  • flu like symptoms - bad

Pyrazinamide:

  • Hepatic toxicity,
  • Hyperuricaemia

Streptomycin

• Permanent damage to vestibular nerve

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12
Q

Clinical features of acute leukaemia

A

· Abrupt, stormy onset

· Decreased marrow function (from crowding, competition for growth factors, etc) ○ Anaemia ○ Neutropenia ○ Thrombocytopenia

· Neoplastic infiltration (more in ALL) ○ Lymphadenopathy ○ Bone pain ○ Splenomegaly ○ Hepatomegaly

· CNS involvement - meneingeal spread (> in ALL) ○ Headache ○ Vomiting ○ Nerve palsies ○ Meningism

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13
Q

ALL treatment

A

Chemotherapy

  • induction
  • consolidation
  • maintainance

Supportive

  • stop uric acid rise (fluids, allopurinol)
  • Antimicrobials
  • Anti-chemo (semen preservation, blood + growth factors, nutrition)
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14
Q

BPH Investigations?

A

Important

  • Urinalysis
  • PSA
  • International prostate symptom score
  • Global bother score

Consider

  • Uroflowmetry (pee into a container)
  • US - rule out cancer CT
  • Urodynamics
  • Cystoscopy
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15
Q

BPH Treatment

A

Depending on IPSS

  • Watchful waiting
  • Lifestyle management
    • Review meds
    • Fluid restrictions
    • Constipation management
    • Urination education
  • Drugs
    • Alpha Blocker - 1st line
      • Alpha adrenergic receptor blockers, alpha 1 is the most common type in the prostate and inhibiting this leads to smooth muscle relaxation. Also effects bladder and sphincter muscles.
    • 5- Alpha reductase inhibitors - decrease DHT
    • NSAIDs - improve flow and urinary symptoms
  • Surgery
    • TURP
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16
Q

Prostate Cancer Metastasis sites

A
  • Bone - most common
  • Lymph nodes
  • Lung
  • Liver
  • Brain
17
Q

Heparin MOA

A

Increases effect of antithrombin III

Inactivates thrombin.

Decreases the conversion of fibrinogen to fibrin.

18
Q

Prostate cancer treatment (apart from watchful waiting)

A

Original - surgery, radation

metastatic - androgen deprication

  • GNRH agonist (goserelin) + anti-androgen (bicalutamide)
  • OR GNRH antagonist

Catrate resistant - Chemotherapy - anthrocyclines

Bone mets- bisphosphinates, RANKLi (denosumab)

19
Q

HPV protein actions

A
  • E5 - activates growth factors
  • E6 - inactivates p53
  • E7 - stops retinoblastoma
20
Q

Sites of Prostate cancer occurance (and %)

A
  1. Transitional zone 10-20%
  2. Central zone 2.5%
  3. Peripheral zone 70-80%
21
Q

Microbial causes of UTI in males

A

KEEPS

Klebsiella, E.coli, Enterococcus, Proteus

22
Q

Morphology of SIL

A

Koilocytic atypia (nuclear enlargement and variations in size and peri-nuclear halo)

Hyperchromic (dark staining)

Presence of coarse chromatin granules

23
Q

Principles of Screening

A
  • Important health problem
  • Disease should have recognisable latent or early symptomatic stage
  • Well understood natural hx of disease
  • Treatment avaliable for those with disease
  • Suitable test or examination
  • Test acceptable to population
  • Agreed policy on who to treat
  • Facilities for diagnosis and treatment avaliable
  • Costs of screening/diagnosis/treatment economically balanced with other expenses on health care
  • Case finding should be a continuing process
24
Q

Natural Hx of Hep B

A

Acute: 95% adults, 5-30% children

Chronic: 3-5% adults, 70-95% children

25
Q

Natural Hx of Hep C

A

80% from acute to chronic

20% chronic to cirrhosis

1-4% per year HCC

26
Q

Morphology of cirrhosis

A

Proliferation of hepatic stellate cells and conversion to fibrogenic cells

Loss of fenestration of sinusoids

Type 1 and 3 collaged deposited in space of Disse –> Bridging fibrous septae

Disruption of liver architecture

Parenchymal nodules

27
Q

10 steps of outbreak investigation

A

1 Prepare for field work

2 Extablish existance of outbreak

3 Verify diagnosis

4 Define and identify causes

5 Describe and orient data in time, person, place

6 Develop hypotheses

7 Evaluate hypotheses

8 Refine hypotheses

9 Implement control and preventative methods

10 Communicate findings

28
Q

Relative risk

A

Disease incidence in exposed vs Disease incidence in unexposed

a/(a+b) divided by c/(c+d)

29
Q

Functions of Skin

A

1 Physical protection

2 Thermoregulation

3 Metabolic function (Vit D production)

4 Cutaneous sensation

5 Physiological and social functions

30
Q

Local response to burns (zones)

A

Zone of hyperaemia - increase perfusion, will recover 7-10d

Zone of stasis - decrease perfusion, reversible with fluid or will necrose.

Zone of coagulation - point of max damage and irreversible tissue loss

31
Q

Healing of burn depths

A

Superficial - few days

Superficial dermal - 2-3 wks, reepithelialisation, minimal scarring

Deep dermal - longer than 2-3wks, high risk of hypertrophic scarring

Full thickness - no healing, granulation and wound contraction

32
Q

Microbiology of burns

A

Early - Gram +ve Staph aureus and strep pyogenes from sweat glands and hair follicles will colonise

Mid - Gram -ve P. aeruginosa, E.coli, Klebsiella from IT URT, hospital environment

Late - Multiresistant bacteria, Candida or Aspergillus (Fungal)

33
Q

Signs of wound infection

A
  • Change in colour, smell
  • Oedema at margin
  • Fever >38
  • Loss of epithelium from re-epithelialised wounds
  • Apprearance of new eschar
  • Purulent exudate
34
Q

Indications for intubation/Inhalation injury

A

Erythema or swelling of oropharynx

Changes in voice

Stridor tahypnoea or dyspnoea

GCS

Burns to face, neck, upper torso

Singed nasal hair

Soot, Carbonaceous sputum in mouth

Hx burns in enclosed space

35
Q

Parkland formula

A

4ml/(%TBSA)/body weight (kg)

50% in first 8 hrs, 50% in next 16 hrs

Urine output measured at 0.5-1.0ml/kg/hr in adults

Hartmanns solution - Na+, Cl+, lactate, K+, Ca2+

36
Q

Aetiology of Psoriasis

A

Genetic suseptibility - HLA-Cw6

Immunological- related to high levels of TNF-alpha

Strep throat infection (Guttate psoriasis)

Stress

Physical injury (koebner phenomenon)

HIV

Year 3 Medicine (2 decks)

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