Flashcards in Gen Med Deck (48):
1
What are the side effects of carbimazole?
Nausea
Liver dysfunction
Transient leucopenia
Granulocytosis - loss of white cells and thus fever and infections (sore throat)
Alopecia
Maculopapular rash
Arthralgia
2
What is the difference between alpha and beta haemolytic streptococcus?
Alpha - partial haemolysis:
- include streptococcus pneumonia and viridans
Beta - complete haemolysis
- include streptococcus pyogenes and enterococcus
3
What is erysipelas ?
Acute infection of upper dermis usually accompanied by skin rash
Caused by streptococcus pyogenes
4
What are the different causes of syndrome of inappropriate ADH release?
Malignant - mainly small cell carcinoma of lung
Neurological: stroke, subarachnoid/subdural haemorrhage, meningitis
Infections : TB
Drugs: SSRIs, carbamazepine , sulphonylureases
5
Describe the structure of the adrenals and relate this to the function
Adrenal cortex - divided into 3:
- zona glomerulosa - mineralocorticoids (aldosterone)
- zona fasciculata - glucocorticoids (cortisol)
- zona reticularis - glucocorticoids and androgens (DHEA)
Adrenal medulla- neurosecretory cells - adrenaline and noradrenaline
6
List the main symptoms of Cushing syndrome
Glucose metabolism impaired- hyperglycaemia and diabetes
Fat metabolism - redistributed to face and abdomen
Protein metabolism - break down of muscle and protein in skin leads to weakness and easy bruising
Immunity inhibited- infections and slow healing
Endocrine- suppression of growth in children
Neurological - psychosis, depression, insomnia, confusion
Water metabolism - has weak mineralocorticoid action so leads to hypertension and heart failure
Calcium - reduced gut absorption, increased kidney excretion, increased bone breakdown- osteoporosis
7
List the causes of Cushing's syndrome
Exogenous use of steroids - most common
Cushings disease - pituitary adenoma
Ectopic ACTH secretion - small cell carcinoma of lung (but also pancreas, thymus, ovary and carcinoid tumours)
8
List the clinical features of cushings disease that differ from Cushing's syndrome
Pigmentation of the skin
Visual field changes
Headaches
9
How can secondary adrenal insufficiency be distinguished from primary based on symptoms?
Secondary will be associated with headaches, visual field changes and possible other endocrine abnormalities
There will be absence of skin pigmentation
No symptoms from mineralocorticoid deficiency
10
How can we treat conns syndrome
Surgery is the treatment of choice - remove the adenoma.
Spironolactone is needed until this is available
Spironolactone is the treatment option for those who can have surgery
11
What is the action of spironolactone and what's are it's side effects?
Action:
- aldosterone receptor antagonist works mainly on distal convoluted tubule and collecting duct
- takes a few days to work because acts on gene expression. Reduces expression of ROMK, Na/K ATPase, Enac and Na/H exchanger
Side effects- gynacomastia , menstrual irregularity, impotence and GI effects
12
What is the treatment for adrenal adenomas causing Cushing's syndrome?
What may be required after surgery
Unilateral adrenectomy
After surgery hydrocortisone is needed due to long term suppression of ACTH
13
What is lupus?
Autoimmune disorder in which there are autoantibodies against a variety of autoantigens (ANA)
Affects multiple organs and varies in severity
Patient experiences flare ups (remitting and relapsing)
14
How is sjrogens syndrome diagnosed?
Schrimers test - less than 5mm in 5mins suggestive of reduced lacrimal gland secretions
Test for autoantibodies ro and la
15
What is sjrogens
A chronic inflammatory autoimmune condition associated with lymphocyte infiltration and fibrosis of exocrine glands (particularly salivary and lacrimal)
May be primary (due to Ro/La autoantibodies) or secondary (SLE, RA, Systemic sclerosis )
16
What are the symptoms of sjrogens?
Dry mouth
- dysphagia
- dry cough
- parotid swelling
Dry eyes
- ulceration
Other systemic features:
- poly arthritis
- raynauds
- vasculitis
- myosotis, peripheral neuropathy
- lung, liver and kidney problems
17
What's the treatment for sjogrens ?
Artificial tears / saliva
Lozenges
Anti- inflammatories
18
What may be the causes of reduced lacrimal gland function be?
Age
Medication
Sjrogens
19
What are the 11 criteria for SLE and how many are needed for a diagnosis?
Malar rash
Discoid rash - keratin scales
Photosensitivity
Oral ulcers
Arthritis involving 2 or more joints
Serositis - e.g. Pleuritis ( pleuritic pain) or pericarditis
Renal problems
CNS disorder - seizures, psychosis
Haematological- haemolytic anaemia, leukopenia, thrombocytopenia
Immunological disorder - positive anti-dsDNA, anti-Sm, or antiphospholipid
ANA positive
4 or more are required for diagnosis
20
What is the normal action of PTH?
Increases osteoclasts activity so ca and phosphate released from bones
Increases kidney ca reabsorption and phosphate excretion
Increase formation of active vit D
Overall increased calcium and reduced phosphate
21
What is the difference between primary, secondary, tertiary and malignant hyperparathyroidism?
Primary - caused by parathyroid gland e.g. Adenoma or parathyroid cancer (rare)
Secondary - low calcium causes increased PTH e.g. Low vitamin D intake or chronic renal failure
Tertiary - occurs after prolonged secondary parathyroidism. The PTH continues to rise inappropriately such that calcium also rises
Malignant parathyroidism : PTHrP produced by squamous cell carcinoma of lung, breast cancers and renal cell carcinoma
22
What is the management for polycystic ovarian syndrome?
Weight loss and metformin - increase insulin sensitivity and so increase SHBG, reduce serum androgens and LH
Oral contraceptive pill - increases SHBG and progestin inhibits LH secretion
GnRH analogs to reduce amount of LH secreted by blocking access by GNRH - rarely used
Androgen receptor blockers - spironolactone
23
What are the features of turners syndrome?
Short stature
Webbed neck
Gonadal dysgenesis
Low set ears
Wide spaced nipples
High arched palate
24
What is MEN1?
Multiple endocrine neoplasia characterised by parathyroid tumour, pituitary adenoma and pancreatic tumours. Two or more are needed for diagnosis or just one if there is a family history
It is an autosomal dominant genetic condition caused by mutation in the MEN1 tumour suppressor gene (TSG)
25
Give examples of some of the pancreatic tumours seen in MEN1
Gastrinoma
Insulinoma
Glucagonoma
Non functioning tumour
26
What is the difference between MEN2a, 2b and FMTC
MEN2a - familial medullary thyroid carcinoma (FMTC) along with pheochromocytomas and parathyroid tumours
MEN2b- FMTC with pheochromocytoma, mucosal neuromas and a marfanoid habitus
FMTC can also occur alone
27
What is the action of orlistat ? When is this drug contraindicated ?
Pancreatic lipase inhibitor and thus reduces fat absorption
Contraindicated in cholestasis and any malabsorption syndromes
28
What is phentermine?
What are the side effects?
A dopamine / noradrenaline release inhibit which acts to reduce appetite in patients with obesity
Side effects include increased heart rate and boood pressure, insomnia, dry mouth, headache and tremor
29
List some drugs that can cause hyperkalaemia
Spironolactone , epleronone and amiloride
Ace inhibitors
NSAIDs
b blockers
Heparin/ LMWH - inhibit aldosterone release
30
What are the different causes of increased potassium release from cells ?
Low insulin - DKA
Acidosis
Rhabdomyolysis
Tumour lysis
Strenuous exercise
Massive haemolysis
31
What are the causes of an increased anion gap (acidosis)
KUSMAL
- ketoacidosis
- uricaemia (CKD)
- salicyclates
- methanol
- aldehydes
- lactic acid
32
What classes as significant haematuria ?
Any single episode of visible haematuria
Any single episode of symptomatic non visible haematuria
Persistent asymptotic non visible haematuria
33
List the renal causes of haematuria
- thin basement membrane in children - persistent microscopic
- IgA nephropathy - transient/ persistent macroscopic
- Alports syndrome
- glomerulonephritis
- tumour
- infection
- polycystic kidneys
- sickle cell
- drugs (NSAIDs, cephalosporins)
- renal vein thrombosis
34
List the non renal causes of haematuria
Ureters: stones, infection, strictures, tumour
Bladder: stones, tumour, infection, cyclophosphamide
Transient : menstruation , exercise
35
What is the criteria for diagnosing AKI?
A rise in creatinine >26uM in 48 hours
A rise in creatinine > 1.5x base line
Drop in urine output <0.5ml/kg/ hour for last 6 hours
36
How is stage 2 AKI defined?
Creatinine 2-2.9x the baseline
Urine output <0.5ml/kg/ hr for 12 hours
37
How is stage 3 AKI defined?
Creatinine of >3x baseline or rise of >354uM or started on renal replacement therapy
Urine output of <0.3ml/kg/hr for > 12 hrs
38
What are the different risk factors for AKI?
- old age
- CKD
- heart failure
- chronic liver failure
- peripheral vascular disease
- dehydration
- diabetes
- drugs
- sepsis
39
State 4 common drugs that contribute to AKI
Gentamicin
NSAIDs
ACEi
Iodinated contrast
40
What are the contraindications of a renal transplant
Active infection
Cancer
Uncontrolled ischaemic heart disease
Active viral hepatitis
Acquired immunodeficiency with opportunistic infections
Extensive peripheral vascular disease
Mental incapacity
41
What are the signs of someone with diabetic ketoacidosis ?
Drowsiness, abdominal pain, vomiting, hyperventilation , dehydration
Other clues: recent infection or treatment e.g. Chemotherapy.
Known type 1 diabetic
42
How is DKA diagnosed?
Acidaemia
Ketonaemia
Hyperglycaemia
43
If a DKA patient has no fever can we rule out infection?
No- often fever is masked
44
How can we define severe DKA?
One or more of the following :
- ketones >6mM
- venous bicarbonate <5mM
- pH<7.1
- GCS <12
- oxygen sats <92
- k <3.5 mM
- systolic BP <90
- tachycardia/ bradycardia
- anion gap
45
what causes polycythaemia (increased no. of RBC)?
Primary
Secondary (chronic hypoxia stimulates erythropoietin e.g. COPD, smoking)
Relative (reduced plasma volume, normal red cell mass), or
Inappropriate (inappropriate erythropoetin production).
46
what are the issues with polycythaemia?
blood is now more viscous and thus more likely to clot so increased risk of DVT, MI , stroke and ischaemic limbs
can also lead to splenomegaly
can also lead to haemorrhagic lesions esp of GIT
47
what cardiac abnormality is ankylosing spondylitis associated with?
aortic regurgitation
also other sero negative arthropathies
48