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Gen Med Flashcards

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1
Q

Most common cause of hypothyroid

A

Hashimoto

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2
Q

HPT axis

A
  1. Hypothalamus secretes TRH
    1. TRH stimulates ant pit to release TSH
      TSH acts on thyroid to release T3/T4
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3
Q

Investigation of primary hypothyroid

A

High TSH, low T4

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4
Q

Ix of 2ndary hypothyroid

A

Low TSH and T4

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5
Q

Ix of subclinical hypothyroidism

A

High TSH, normal T4

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6
Q

Ix of poor thyroxine compllaiance

A

High TSH, normal T4 - Take thyroxine on day of appt but TSH lags behind and reveals poor compliance

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7
Q

Ix of hashimoto

A

• Anti-TPO (thyroid peroxidase) antibody

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8
Q

S&S of hypothyroid

A 
• Systemic:
		○ Weight gian
		○ Lethargy
		○ Cold intolerance
	• Skin:
		○ Dry
		○ Non pittine oedema
		○ Dry coarse hair
GI - constipation
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9
Q

Tx of hypothyroid

A

Levothyroxine

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10
Q

Tx of hyperthyroid

A

• Propanolol - to control symptoms
• Radioiodine tx
• Carbimazole:
○ Prevents iodinisation of thyroglobulin

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11
Q

ADR of carbimazole

A

agranulocytosis

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12
Q

S&S of hyperthyroid

A 
• Systemic:
		○ Weight loss
		○ Restlessness
		○ Heat intolerance
	• Cardiac:
		○ Palpitations
	• Skin - Increased sweating, clubbing
	• GI - diarrhoea
	• Neuro - anxiety, tremor
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13
Q

Ix of graves

A

TSH receptor antibodies

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14
Q

Precipitating factors of DKA

A

• Infection
• Missed insulin doses
MI

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15
Q

S&S off DKA

A

• Abdo pain
• Polyuria, polydipsia, dehydration
• Deep hyperventilation - Kussmaul resp
Pear drop smelling breath

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16
Q

Ix of DKA

A

• Glucose >11
• pH <7.3
• Bicarb <15mmol
Ketones >3mmol or urine ketones ++

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17
Q

Tx of DKA

A

• Saline fluids
• Insulin IV infusion
Correct hypokalaemia (due to insulin)

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18
Q

Ix of hyperosmolar hyperglycemic state

A 
• Dehydration
	• Osmolality >320mOsmol/kg
	• >30mmol BM
	• pH >7.3
Bicarb >15mmol
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19
Q

S&S of hyperosmolar hyperglycemic state

A

• Focal CNS signs - tremors, motor or sensory impaired
• DIC
Leg ischemia

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20
Q

Tx of Hyperosmolar hyperglycemic state

A

• LMWH
• Saline fluids
• Replace potassium
ONLY USE INSULIN IF BM NOT FALLING WITH ABOVE

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21
Q

S&S of hypoglyc

A 
• Autonomic:
		○ Sweating
		○ Anxiety
		○ Hunger
		○ Tremor
		○ Palpitations
		○ Dizziness
	• Neuro:
		○ Confusion
		○ Aggression
		○ Drowsiness
		○ Visual trouble
Seizures
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22
Q

Tx of hypoglyc

A

Tx:

1. Conscious - 250ml of lucozade, 3 glucose tablets, glucogel
2. IV glucose 200 ml of 10% solution in 50 ml aliquots
3. Repeat glucose testing every 10 mins until stable
4. Review reasons for hypoglyc
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23
Q

Ix of gestational diabetes

A

• Urine dipstick - Glycosuria
• Glucose tolerance test:
○ Fasting >5.6mmol
2 hr glucose >7.8mmol

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24
Q

What proportion of women with gestational diabetes will develop diabetes?

A

50% in 10 years

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25
Tx of gestational diabetes
• Managed with insulin • Perform glucose tolerance test post delivery Advice on reducing risk of developing T2DM
26
RFs on gestational diabetes
• BMI >30 • Previous gestational diabetes • FHx of diabetes Middle eastern, black, south asian
27
Patho of diabetic retinopathy
• Increase retinal blood flow • Therefore, Abnormal metabolism and damage to retinal vessel walls Increase vascular permeability
28
Classification of diabetic retinopathy
Background - microaneurysms, blot hemorrhages (3 or less), hard exudates Pre-proliferative - Cotton wool spots, 3+ blot hemorrhages, cluster hemorrhages Proliferative - Fibrous tissue anterior to retinal disc, retinal neovascularisation
29
Tx of diabetic retinopathy
Laser photocoagulation
30
Tx of hyperlipidaemia - primary and secondary prevention
``` • Primary prevention - atorvastatin 20 Secondary prevention (known IHD or CVD or PAD) - atorvastatin 80 ```
31
CVD screening tool + when to offer statin
• QRISK2 CVD risk assessment | Statin offered if QRISK2 10 yr risk of 10+%
32
Ix of hyperlipidaemia
Full lipid profile - HDL and total most important
33
Secondary causes of hyperllipidaemia
• DM • Obesity • Alcohol Familial hypercholesterolemia
34
S&S of cushings
moon face, buffalo hump, CUSHINGOID
35
Ix of cushings
• Dexamethasone suppression test: ○ Cortisol suppressed - Pituitary source ○ Cortisol not suppressed - Adrenal or ectopic source • Biochemistry - hypokalaemia with HTN, metabolic alkalosis Impaired glucose tolerance
36
ACTH dependent causes of cushings
• Cushings disease - pituitary adenoma secreting ACTH | Ectopic ACTH production - e.g. small cell lung cancer
37
ACTh independent causes of cushings
steroids, adrenal neoplasia
38
State HPA axis of cortisol
CRH from hypothalamus to ACTH from ant pit to Cortisol from adrenal
39
Patho of addisons
• Autoimmune destruction of adrenal glands
40
S&S of addisons
• Lethargy, weakness, weight loss • Hyperpigmentation, vitiligo, hypotension Crisis - collapse, shock, pyrexia
41
Ix of addisons
• ACTH stimulation test (synacthen): ○ No increase in cortisol - Addisons diagnosed Biochemistry - hyperkalaemia, hyponatraemia, hypoglycaemia, metabolic acidosis
42
Tx of addisosn
• Hydrocortisone and fludrocortisone | Illness - double hydrocortisone
43
What do you do to steroids in illness?
double
44
Causes of endocrine HTN
acromegaly, phaeochromocytoma, conns
45
What is pheochromocytoma patho and S&S
``` • Tumour of adrenal gland • Excess adrenaline production --> vasoconstriction • S&S - Sympathetic: ○ Pallor ○ Palpitations ○ Tachy ○ Anxiety Headaches ```
46
What is conns and ix
• Excess aldosterone • Few symptoms Ix - low serum renin, high aldosterone
47
What cancers are MEN type 1, 2a, and 2b associated with?
MEN 1 - 3Ps - Pancreas, Pituitary, Parathyroid MEN 2a - 2 Ps - Parathyroid, pheochromocytoma MEN 2b - 1P - Pheochromocytoma
48
S&S of primary hyperPTHism
abdo pain (moans, stones, groans, psychiatric overtones), HTN
49
Ix of primary hyperPTHism
○ PTH - High ○ Ca - High Phos - Low
50
Cause of primary hyperPTHism and tx
• Cause - adenoma of PT gland (MEN 1 and 2a) | Tx - surgery
51
S&S of secondary hyperPTHism and ix
``` • S&S - bone disease eg osteitis fibrosa cystica • Ix: ○ PTH - high ○ Ca - Normal or low ○ Phos - High Vit D - low ```
52
Cause and Tx of secondary hyperPTHism
• Cause - chronic renal failure --> PT hyperplasia | Tx - Correct renal failure
53
Cause of tertiary hyperPTHism
• Cause - Ongoing hyperplasia of PT after correction of renal disorder
54
S&S and Ix of tertiary hyperPTHism
• S&S - Bone pain/fracture, pancreatitis, met calcification ``` • Ix: ○ Ca - normal or high ○ PTH - high ○ Phos - normal or low ○ Vit D - Normal or low ALP - High ```
55
Tx of tertiary hyperPTHism
• Tx - allow 12 months to elapse before attempting surgery
56
Ix of hypoPTHism
• Decreased PTH • Can be 2ndary to thyroidectomy • Low Ca, high P ECG - prolonged QT
57
S&S of hypoPTHism
hypocalcemia - tetany, weakness, parasthesia
58
Tx of hypoPTHism
Alfacalcidol
59
Give Ix of Klinefelters, Kallmans, androgen insensitivity syndrome, and test secreting tumour
Klinefelter - High LH, low Test Kallmans - Low LH, low Test Androgen insensitivity - High LH, High Test Test secreting tumour- Low LH, high Test
60
Genotype of klinefelter
47,xxy
61
S&S of klinefelter and ix
``` • S&S: ○ Tall ○ Small testes ○ Lack of secondary sexual characteristics ○ Gyno Ix - chromosomal analysis ```
62
Kallman S&S and method of inheritance
• S&S: ○ Delayed puberty with anosmia X linked recessive
63
Androgen insensitivity method of inheritance and phenotype
• X linked recessive | Male children have female phenotype
64
S&S, Ix, Tx of androgen insensitivity syndrome`
• S&S: ○ Primary amenorrhoea ○ Undescended testes cause groin swelling ○ Breast development • Ix - Chromosomal analysis Tx - Counselling, oestrogen therapy, removal of testes
65
GI red flag symptoms
``` ALARMS: A - Anorexia L - Lost weight A - Anaemia R - Recent Rapid onset M - Malaena S - Swallowing difficulty ```
66
Causes of acute diarrhoea
Acute- less 14 days: • Gastroenteritis - abdo pain with N&V • Diverticulitis - Left lower quadrant pain, diarrhoea and fever • Abx therapy - C difficile
67
Causes of chronic diarrhoea
More 14 days - IBS, UC, Crohns, Celiacs
68
S&S of IBS
``` 6 mths+ of - ABC: • Abdo pain • Bloating • Change in bowel habit • Relief by passing stools or urgency NO WEIGHT LOSS ```
69
S&S of UC
○ Bloody diarrhoea ○ Crampy abdo pain and weight loss Faecal urgency and tenesmus may be present
70
S&S of crohsn
○ Crampy abdo pain ○ Maybe bloody diarrhoea but less common Malabsorption, mouth ulcers, intestinal obstruction
71
S&S of celiacs in children and adults
``` • Steatorrhoea or stinking stools • Diarrhoea • Abdo pain & bloating • N&V • Weight loss • Osteomalacia Failure to thrive (children) ```
72
Cause of acute jaundice
Primary biliary cirrhosis, hep virus, gallstones, para OD, gilberts syndrome
73
What is gilberts syndrome
○ Occasional and short lived episodes of jaundice.
74
What is S&S of primary biliary cirrhosis
○ Young woman ○ Itchy Raised ALP and LFTs
75
S&S of liver failure acute
``` • Hepatic encephalopathy: ○ Aggression ○ Confusion ○ Convulsions • Flapping tremor N&V ```
76
Tx of acute jaundice
• Reverse cause • N-acetylcysteine ?transplant
77
S&S of malabsorption
* Bloating * Decrease weight * Lethargy * Steatorrhoea
78
Common cauess of malabsorption
3Cs: • Coeliac • Chronic pancreatitis Crohns
79
Complications of celiacs
anemia, osteoporosis, increase risk of malignancy
80
Ix of celiacs
• Decrease Iron levels | Endoscopy + duodenal biopsy
81
What foods are ok in celiacs?
○ Rice, maize, soya, potatoes, oats and sugar are all ok
82
Chronic liver disease S&S
``` • Portal HTN: ○ Splenomegaly ○ Oeseophagus, stomach and rectal varices ○ Ascites • Coagulopathy • Encephalopathy • Palmar erythema • Gyno • Clubbing Caput medusae ```
83
Causes of chronic liver disease
Hep B or C, Alcohol, Primary biliary cirrhosis, Non alc fatty liver disease, RHF
84
What disease is primary sclerosing cholangitis associated with?
UC
85
Patho of haemachromatosis. Pattern of inheritance?
• Auto recessive | Iron accumulation due to excess absorption
86
S&S of haemachromatosis
``` • Early - fatigue, ED, arthralgia • DM • Liver cirrhosis and hepatomegaly • Hypogonadism Cardiac failure ```
87
S&S of AKI
• Pulmonary and peripheral oedema • Arrhythmias Uraemia features - pericarditis, encephelopathy
88
Ix of AKI
• Reduced UO - <0.5ml/kg/hr • U&Es - Increase Serum potassium, creatinine, urea • Urine dipstick - infection, glomerular disease • Clotting Renal USS
89
RFs of AKI
• CKD • History of AKI • 65+ Iodinated contrast agent used in past week
90
Prerenal causes of AKI
• Hypovolemia • Renal artery stenosis Sepsis
91
Tx of prerenal AKI
○ IV fluids | ○ Sepsis - Abx
92
Renal causes of AKI and tx
``` • Glomerulonephritis ○ Refer to nephrology • ATN ○ Restrict fluid intake ○ Restrict K intake ○ ?Dialysis • Rhabdomyolysis: Dialysis ```
93
Postrenal causes and tx of AKI
``` Postrenal: • Kidney stones • Benign prostatic hyperplasia • Tx: Catheterise ```
94
Difference Ix of pre-renal AKI and ATN
• Urine sodium >30 in ATN • FENa - >1% in ATN Urine:plasma osmolality <1.1 in ATN
95
complications and how to manage of AKI?
• Treat hyperkalaemia - Neb salb, calcium gluconate, iv insulin + dextrose, oral K+ binding Pulmonary oedema - 1. Sit pt upright 2. 100% oxygen non rebreath mask 3. IV access and ECG. Treat arrhythmias 4. Investigations whilst continuing treatment 5. Diamorphine IV 1.25-5mg 6. Furosemide 40-80mg IV 7. GTN spray 2 puffs. DON’T GIVE IF HEMOCOMPROMISED 8. If systolic >100mmHg, nitrate infusion eg isosorbide dinitrate If pt worsening, consider CPAP
96
Staging of AKI
Staging - increase in serum creatinine 1. Stage 1 - 1.5x 2. Stage 2 - 2-3x Stage 3 - >3x
97
Types of renal replacement therapy
Hemodialysis, continuous ambulatory peritoneal dialysis (CAPD)
98
Pros and cons of hemodialysis and CAPD
``` Continuous Ambulatory Peritoneal Dialysis: • 4 cycles every 24 hours • Useful when cardio unstable • Good for more freedom • Risk of peritonitis ``` ``` Haemodialysis: • Semi permeable membrane • Requires heparin • 3-5 times a week Removes urea and excess fluids ```
99
Types of organ rejection and how they occur
Organ rejection types: • Hyperacute - immediate via preformed antigens ○ Immediate loss of graft • Acute - during first 6 months, T cell mediated Chronic - After 6 months. Vascular changes
100
Patho of nephrotic syndrome
``` Patho: • Glomerulonephritis that is large enough to ONLY allow proteins into urine • Proteinuria • Hypoalbuminaemia • Oedema ``` NephrOtic - Oedema (caused by protein in urine and therefore less protein in blood)
101
S&S of nephrotic syndrome and ix
S&S: • Swelling of eyelids and face • Ascites • Urine froth due to protein Ix: • Urine - protein:creatinine ratio • Microscopy for red cells in urine • Blood - albumin, U&E, creatinine, eGFR
102
Causes of nephrotic syndromeq
Causes: • Minimal change GN • DM • SLE
103
Patho of nephritic syndrome and causes
Patho: • Glomerulonephritis that is large enough to allow protein AND RBCs into urine • Blood and protein in urine Causes: • Glomerulonephritis • Vasculitis
104
S&S of nephritic syndrome
``` S&S: • Oligouria • Haematuria • Proteinuria • Oedema • HTN ```
105
S&S of IgA nephropathy and epi
S&S: • Recurrent macroscopic haematuria • Associated with mucosal infections eg URTI Epi: • Young male
106
S&S of renal stones
S&S: • Severe pain with waves of intensity - colicky • Flank pain which radiates to groin as stone progresses down ureter • Pt keeps shifting to get comfortable (peritonitis pts keep still) • Pale and sweaty • Fever - suspect infection
107
Ix of renal stones
Ix: • CT KUB - kidneys, ureters, bladder • Urine dip - microscopic haematuria • Bloods - FBC, U&E, Calcium, phosphate
108
Tx of renal stones
Tx: • Analgesia - diclofenac • <5mm will pass within 4 wks • >5mm: ○ Shock wave lithotripsy - fragments stones can lead to obstruction or solid organ injury ○ Ureteroscopy - removal of stones with scope • If obstructed + infection: ○ EMERGENCY ○ Requires recompression via catheters or nephrostomy tube placement
109
S&S of renal tumours
``` S&S: • Haematuria • Loin pain • Anaemia • HTN • Weight loss • Malaise ```
110
RFs of renal tumours and ix
Ix: • USS • CT CAP RFs: • Smoking • Obesity • FHx - von Hippel-Lindau disease
111
Transient non visible haematuria causes
``` Transient non visible causes: • UTI • Menstruation • Vigorous exercise • Sex ```
112
Persistent non visible haematuria causes
``` Persistent non visible causes: • Cancer - bladder, renal, prostate • Stones • BPH • Prostatitis • Urethritis eg chlamydia • Renal causes - IgA nephropathy, thin BM disease ```
113
Ix of haematuria
Ix: • Urine dipstick • Blood pressure • Renal function
114
Post op cx of renal transplant
``` Post op problems: • ATN of graft • Vascular thrombosis • Urine leakage • UTI ```
115
define hyperacute, acute and chronic graft failure
hyperacute - mins to hours acute < 6mths chronic >6mths
116
Patho of polycystic kidneys
Patho: • Cysts form in kidneys causing gradual reduced function • Common cause of CKD
117
S&S of polycystic kidneys
``` S&S: • Haematuria • UTI • Abdo mass - 30% have mass in liver/pancreas too • Lumbar/abdo pain • HTN ```
118
causes of urinary retention in men and women
Causes: • Men - BPH, prostate cancer, phimosis • Women - Prolapse (cystocoele), pelvic mass (fibroid) • Both - bladder cancer, faecal impaction, Stones, UTI
119
Ix of urinary retention
``` Ix: • PR to exclude impaction • Neurological - check for cauda equina or cord compression • Urinalysis - check for infection • PSA • USS ```
120
Causes of hydronephrosis
``` Cx of blocked ureter - results in dilatation of ureter and swelling of kidney Common causes: • Kidney stones • Pregnancy BPH ```
121
S&S of hydronephrosis and tx
``` S&S: • Pain In back or loin - sudden and severe or fluctuating dull ache • Sx of UTI • Haematuria • Swollen kidneys in severe cases ``` Tx: • Reconstructive ureteric surgery • Double J stent
122
Causes of painful scrotal lumps
○ Torsion of testis ○ Epididymo-orchitis ○ Inguinal hernia Haematocoele
123
Causes of painless scrotal lumps
○ Hydrocele ○ Epididymal cyst ○ Spermatocele Tumour
124
Alcohol withdrawal seizures S&S and tx
occur in patients with a history of alcohol excess who suddenly stop drinking • Peak incidence 36 hrs post cessation Tx - give BZD after stopping drinking
125
Ix of seizures
EEG and MRI
126
Tx of seizures
Tx: • Ketogenic diet • Generalised - sodium valproate Partial - carbamazepine
127
Causes of restless leg syndrome
iron deficiency anaemia, idiopathic, DM, pregnancy
128
Tx of restless leg syndrome
• Walk, stretch, massage affected limbs • Treat iron deficiency Dopamine agonists - ropinirole

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