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General Medicine Flashcards

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1
Q

Encapsulated bacteria (name 3)

A

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis

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2
Q

Risky organisms for post-splenectomy patients (other than encapsulated bacteria)

A

Malaria (+babesiosis)
E. coli + pseudomonas aeruginosa
Capnocytophagia canimorsus

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3
Q

What features suggest immunodeficiency?

A

Severe Persistent Unusual Recurrent infections.

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4
Q

Post-splenectomy management?

A

Antibiotic prophylaxis for 2y
Vax: Hib, niesseria, pneumococcus
Pt education re signs/symptoms of infections
Avoid malaria areas

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5
Q

Definition of Pyrexia of unknown origin

A

Fever >38.3 (>1 occasion) + >3w duration +no diagnosis despite >1w inpt investigations.

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6
Q

PUO subtypes

A

Classic
Nosocomial
Immunodeficient
HIV-related

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7
Q

Common causes of PUO

A

1/3-1/2 infections
1/4- neoplasms
1/10- CTD

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8
Q

Test for encapsulated bacteria?

A

Quellung reaction (capsular swelling)

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9
Q

How do we test for C. Dificile?

A

Detect toxin.

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10
Q

Appropriate tests for ?legionella

A

Detection of antigen in urine: positive early in disease but only detects serogroup 01.
Detect antibody serology: delay in diagnosis
Bronchoalveolar Lavage: invasive, low yield, but detects all stereotypes (NB special media needed)
Cultures: blood/sputum = unhelpful

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11
Q

What does CD4+ T cell count predict in HIV?

A

Current susceptibility to opportunistic infections

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12
Q

What do you measure in HIV to assess stage of disease?

A

CD4+ T cell count

Plasma HIV RNA load

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13
Q

What does plasma HIV RNA load predict?

A

The rate of decline in CD4+ T cell count.

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14
Q

CD4+ count: 600. Likely infections present?

A

No infections seen if >500

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15
Q

CD4 T cell count 200-500 likely infections?

A

HSV
VZV
Oral candida
Progressive stage of disease

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16
Q

CD4+ T cell count if pneumocystis infection?

A

CD4+ <200

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17
Q

CD4+ count if oral candida?

A

200-500

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18
Q

CD4 count when crytococcus infection

A

<200

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19
Q

Infections likely when CD4+ T cell count <200?

A 
TB
Pneumococcus
Salmonella
Pneumocystis
Cryptococcus
Oesophageal candida
Toxoplasma
Cryptosporidium
Isospora
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20
Q

Infections likely when CD4+ <50?

A

Mycobacterium avium intracellulare
Progressive Multifocal Leuko-Encephalopathy
CMV

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21
Q

CD4+ cell count if HIV and CMV infection?

22
Q

CD4 cell count if progressive multifocal leuko-encephalopathy?

23
Q

How to diagnose HIV?

Study These Flashcards
A

Screening assay: ELISA for anti-HIV antibodies and antigens
Confirmation: ELISA + RIBA (reverse line blot assay)
NB. Follow-up sample to rule out error in sample collection.

24
Q

What is successful treatment in HIV?

Study These Flashcards
A

At least 10x decrease in viral load at 8w

No detectable virus (<50 copies/ml) at 4-6m.

25
Features of primary infection in HIV?
Symptoms in >50%. 2-6w after infection for 1-2w. Transient fall in CD4+ (<500) Sustained rise in CD8+ (No antibody) = 'window period'
26
What stage is the pt at if CD4+ 300, and viral load is ~20k? What would you expect in the CD8+ cells?
Asymptomatic/progressive phase. CD4+ slightly reduced-normal. (Impaired function) Strong HIV-specific CD8+ CTL response. Chronic activation of T and B cell lineages.
27
Features of transition to advanced disease?
Increased viral replication (viral load) Progressive decline in CD4+ count and function Reduced CD8+ CTL response Destruction of lymph node architecture.
28
How do we measure CD4+ cell count? Causes of false results?
Fluoro-tagged monoclonal antibody and flow cytometry. Most accurate if measured on day of sampling. Refrigeration = CD4+ shedding and spuriously low count Intercurrent illness = transient lymphopaenia Low CD4+ count also seen in sarcoid, TB, serious bacterial infections.
29
How to diagnose acromegaly?
GH secretion is pulsatile. | OGTT and synchronous [GH]. Expect GH to be suppressed to <2mU/l.
30
How to test for adrenal failure?
Short synACTHen test: baseline cortisol at t=0. Give 250mcg of ACTH at 30min. Measure plasma cortisol at 60min. Adrenal failure if <550nmol/l
31
How to distinguish primary and secondary adrenal failure?
Long SynACTHen test: give 1mg ACTH and measure cortisol after 24h. Primary adrenal failure if <900nmol/l. (Adrenals diseased themselves and not responsive) Secondary if >900 (atrophic adrenals have had time to recover after long period without stimulation from pituitary failure).
32
How to distinguish causes of microcytic anaemia?
Anaemia of chronic disease: raised ferritin Thalassaemia: normal ferritin Fe deficient anaemia: reduced ferritin (raised TIBC, reduced serum Fe) NB. Ferritin also raised 2o to inflammation (acute phase protein)
33
Causes of raised bence-jones protein?
Multiple myeloma Waldenstrom's macroglobulinaemia Amyloid light chain amyloidosis
34
Features of Wilson's disease:
Low plasma caeruloplasmin levels. Autosomal recessive. Defect in copper transporter (copper -> caeruloplasmin) caeruloplasmin degraded in blood. S+S: neurological, psychiatric, iris Keizer-Fleischer rings.
35
Features of Paget's disease?
Impaired bone remodelling, larger new bone that is weaker and prone to fracture. S+S: extreme bone pain, bowing, chalk-stick frx, bossing of skull, CNVIII palsy/hearing loss. X-ray: lytic and sclerotic lesions of bones
36
Biochemistry of Paget's disease?
Ca, Phosphate, vit D, PTH = normal | Alk phos = raised due to increased turnover
37
Features of primary hyperparathyroidism?
Increased PTH Increased ALP (increased bone resorption) Hypercalcaemia (increased Ca resorption in kidneys and by gut via activation of vit D/calcitriol) Normal PO4 (excreted by kidneys)
38
Causes of secondary hyperparathyroidism?
release of PTH due to low Ca due to non-parathyroid pathology e.g. CKD.
39
Features of pseudohypoparathyroidism?
Genetic resistance to PTH. High PTH and phosphate but hypocalcaemic.
40
Ca/PO4/PTH/AlkPho in osteoporosis?
Normal. Just reduced bone density
41
18m, F. Mother concerned by brittle hair and inability to walk. 2 previous convulsions. Likely diagnosis?
Homocystinuria
42
How to confirm a diagnosis of Cushing's?
24h urinary free cortisol excretion (at least 3 separate collections) Loss of diurnal cortisol variation (serum/saliva) Overnight dexamethasone suppression test (1mg at 2300h, measure serum cortisol at 0900h) Low dose dexamethasone suppression test (0.5mg every 6h for 8 doses)
43
Difference between cushing's disease and syndrome?
Cushing's disease = pituitary dependent Cushing's syndrome.
44
Side effects of Rifampicin?
``` Orange secretions Altered LFTs (hepatotoxicity) Potent enzyme inducer ```
45
Side effects of Isoniazid?
``` Peripheral neuropathy (prevented with Vit B6/pyridoxine) Agranulocytosis Myelofibrosis Hepatitis Enzyme inducer ```
46
Pyrazinamide side effects?
Gout (due to Hyperuricaemia) | Hepatitis
47
Ethambutol side effects?
R-G colour blindness | Altered visual acuity (check before/after)
48
How do you monitor treatment of TB?
Direct observed therapy (2-3 times per week) Sputum analysis for TB weekly until conversion. Failure of treatment if blood culture positive after 2m. Monitor for drug toxicty
49
1st line tests for ?immunodeficiency in young child
``` FBC and white cell differential IgGAM IgE functional antibodies lymphocyte subsets ```
50
1st line tests for older child with? immunodeficiency
``` FBC and white cell differential IgGAM IgE functional antibodies lymphocyte subsets IgG subclasses B cell maturation ```

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