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3B GH > GP + palliative > Flashcards

GP + palliative Flashcards

1
Q

people at risk of CKD who should be screened regularly

A

DM

HTN

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2
Q

Sx of CKD give 5

A 
ankle oedema
breathlessness [fluid + anaemia]
pallor/ jaundice
lethargy
anorexia
N+v
RESTLESS LEGS
weakness 
pruritus
bone pain
amenorrhoea/impotence
osteoporosis
epistaxis, bruising
confusion/fits/coma (uraemia)
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3
Q

why do CKD patients get anaemia

A

reduced erythropoetin production by kidney

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4
Q

what is lymphoma

A

neoplasia of B + T cells in lymphoid tissue

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5
Q

signs and Sx of hodgkins lymphoma

A 
enlarged lymph nodes (rubbery)
hepatosplenomeg
fever, night sweats
pruritis
weight loss
anorexia
fatigue
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6
Q

what are the B Sx of hodgkins lymphoma

A

night sweats
fever
weight loss

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7
Q

patient group commonly affected by hodgkins

A

young adults + >50s

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8
Q

Ix for hodgkins

A 
FBC [low Hb]
ESR [^]
LFT [deranged]
lactate [^ - cell turnover]
urate
Ca2+
blood film
CXR [enlarged nodes = mediastinal widening]
lymph node biopsy + histology
CT/PET for staging
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9
Q

what cells found on histology of lymph node biopsy confirm hodgkins?

A

reed-sternberg cells [malignant B lymphocytes]

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10
Q

differentials of lymphadenopathy

A 
infection [TB, tonsilitis]
mets
HIV
leukaemia
EBV [glandular fever]
CMV
SLE
sarcoid
toxoplasma
RA
drug Rn [phenytoin]
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11
Q

Mx of hodgkins

A

chemo
radio
stem cell transplant
PET scan to assess Tx efficacy (active disease vs necrosis)

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12
Q

in the Ann Arbor staging system for hodgkins,

how many stages are there? what does A, B, X and E mean?

A

4 stages [from single lymph node to diffuse]

B. with B Sx
A. without

X. bulky
E. extranodal

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13
Q

local causes of pruritis

A 
psoriasis
eczema
scabies
dermatitis herpetiformis
urticaria
fungal e.g. athletes foot
allergic contact dermatitis
lichen planus
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14
Q

systemic causes of itch

A 
cholestatic jaundice
iron def. anaemia
polycythaemia vera
paraneoplastic [lymphoma, leukaemia, brain, colon, lung]
hypercalcaemia
hypo/hyperthyroid
pregancy
anxiety
renal failure [^urea]
dialysis
opoids, statins
HIV
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15
Q

treatment for the itch ass. w/ cholestatic jaundice

A

cholestyrimine

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16
Q

psoriasis Mx

A 
calcipotriol (vit D analogue)
topical steroid
emollient
phototherapy
coal tar
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17
Q

eczema Mx

A

emollients

topical steroid

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18
Q

topical steroids mild to strong

A

hydrocort
eumovate
betnovate
dermovate

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19
Q

when might you see a ^Hb

A

polycythaemia - primary [rubra vera], or secondary to hypoxia e.g. smoking
dehydration

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20
Q

high WCC =

low WCC =

A

high = infection, haematological CA, steroids, preg

low = imm. supp.

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21
Q

name 2 lymphoid organs affected by hodgkins + 2 non-lymphoid

A

spleen, thymus

non-lymph: liver, lung

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22
Q

migraine Mx

A

PCM/NSAIDs + metoclop
triptans
serotonin agonists
pitozifen/BB/amitrip for prophylaxis

[others: valproate, topiramate, verapamil, naproxen]

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23
Q

Sx of cluster headache

A 
rapid onset
unilateral
multiple over weeks/months + remission periods
pain starts round eye/temple
lacrimation
red eye
rhinnorhoea
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24
Q

mx of cluster headache

A

triptans
100% O2
verapamil

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25
Q

causes of obstruction of the sinuses

A

deviated septum
polyps
viral - mucosal oedema + reduced cilia action

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26
Q

acute bacterial rhinosinusitis is suggested by the presence of at least 3 symptoms and signs. list 4

A

discoloured discharge/ purulent secretion [unilat predominance]
severe pain [unilat predominance]
fever
elevated ESR/CRP
‘double sickening’-deterioration after initial mild phase

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27
Q

swelling is uncommon in sinusitis, what other pathologies might this suggest

A

carcinoma

dental root infection

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28
Q

differentials of sinusitis [non-sinus pain]

A 
migraine
TMJ dysfn.
dental
neuropathic
temporal arteritis
herpes zoster
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29
Q

causes / risk factors for bacterial sinusitis

A 
most follow viral infection
dental root infection
swimming in infected water
septal deviation
polyps
mechanical ventilation
NGT
immunodef
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30
Q

common organisms for bacterial sinusitis

A

strep pneum
Haem infl.
staph aureus

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31
Q

Ix in recurrent / chronic sinusitis

A

CT

nasal endoscopy

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32
Q

Mx sinusitis

A

analgesia
nasal saline irrigation
intranasal decongestants [ephedrine]
amox/doxy

surgery
smoking cessation

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33
Q

complicaitons of sinusitis

A 
orbital cellulitis/abscess
intracranial [meningitis, enceph, cerebral abscess, cavernous sinus thrombosis]
mucocoeles/pyocoeles
osteomyelitis
pott's puffy tumour
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34
Q

Sx of trigem neuralgia

A

unilateral knife like pain

^ed by washing shaving eating

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35
Q

Mx of trigem neur

A

carbamazepine

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36
Q

metoclopramide + domperidone are D2 receptor antagonist antiemetics. Give 2 SEs.

In what condition might you need to reduce the dose?

A

extrapyramidal SEs
QTc prolongation

hepatic impairment

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37
Q

cyclizine is an H1 antagonist / antimuscarinic anti-emetic. Give some SEs + in what condition would you consider reducing the dose?

A

drowsy, headache, dry mouth, constipation

renal impairment

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38
Q

hyoscine butylbromide is an antimuscarinic antiemetic. SEs?

A

dry mouth, constipation

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39
Q

physiology of nausea:- which 4 body systems trigger nausea? Also give the receptor responsible / that is targeted by anti-emetics

A
  1. vestibular [motion sickness/vertigo] - H1, ACh(musc)
  2. gut wall [vagus nerve - constip/obstruction/chemo] - 5HT3
  3. limbic system [emotions/ hyponat] - 5HT3, GABA, neurokinin 1
  4. chemoreceptor trigger zone [uraemia/ drugs/ chemo/^Ca2+] - 5HT3, D2
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40
Q

most common cause of B12 deficiency

A

pernicious Anaemia

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41
Q

pernicious anaemia is the most common cause of B12 deficiency, give 3 other causes

A 
diet [meat + dairy i.e. vegan]
gastrectomy
congenital intrinsic factor def
crohns in ileum
ileal resection
coeliac
NO [inactivates B12]
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42
Q

causes of folate def

A 
diet [green veg, cereals]
alcohol excess
coeliac
crohns
anticonvulsants [phenytoin]
trimethoprim [ie. can give in preg!]
sulfasalazine [RA/UC/crohns]
methotrex
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43
Q

when would you increase a pregnant woman’s folic acid dose?

A

obesity
diabetic
hx of neural tube defect

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44
Q

what is the most common cause of peripheral neuropathy in the UK?

A

DM

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45
Q

peripheral neuropathy causes symmetrical or asymmetircal Sx?

A

symmetrical

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46
Q

name 2 metabolic causes of neuropathy

A

B12, folate def
DM
uraemia
hypocalc

47
Q

name 2 inflamm cause of neuropathy

A 
GBS
CIDP
SLE
vasculitis
polyarteritis nodosa
48
Q

name 3 drugs that can cause neuropathy

A 
chemo [vincristine/vinblastine/cisplatin]
phenytoin
nitrofurantoin
metro
amiodarone
quinine
49
Q

give 3 factors that increase the risk of someone with DM getting neuropathy

A

poor control
smoking
^age
alcohol

50
Q

can peripheral neuropathy be ass. w/ hypo or hyperthyroidism?

A

hypo

51
Q

chronic disease of which 2 organs can cause peripheral neuropathy?

A

liver, kidney

52
Q

name 2 infections that can cause peripheral neuropathy

A

lyme disease
HIV
shingles
diptheria

53
Q

cancer that can cause periphera neurop

A

lymphoma

myeloma

54
Q

Pt experiences rapid onset limb weakness, loss of reflexes, with a recent Hx of infection. Diagnooiss?

A

GBS

55
Q

name 2 side effects of neurpathic pain killers

A

tired
dizzy
drowsy
blurred vision

56
Q

on exam, what is pes cavus

A

excessively arched foot with unnaturally high instep

57
Q

on hand exam in peripheral neuropathy, you might se wasting in what areas?

A

thenar eminence

hypothenar eminence

58
Q

what is the name of the deformed weight bearing joint in diabetic neuropathy

A

charcot joint

59
Q

2 blood tests you may arrange in a patient with neuropathy

A 
glucose
TFT
CRP
LFT
U+E
B12/folate
60
Q

how would speed in a nerve conduction study be affected for a patent with guillain barre or CIDP

A

slow

61
Q

amaurosis fugax can present in ischaemic events i.e. TIA/pre-stroke. In what other condition might it occur?

A

migraine

62
Q

causes of “tired all the time”/ pathologies to rule out

A 
hypothyroid
anaemia
food intolerence/ coeliac
DM
sleep apnoea
insomnia
CFS/ME
depression
63
Q

give 8 health problems ass. w/ obesity

A 
OA hip/knee
psych/depression
gallstones
back pain
IHD
HTN
stroke
^CA risk
DM
GORD
hiatus hernia
infertility
incont
pregnancy complications
surgical complications
sleep apnoea
HF
64
Q

complications of NAFLD

A

cirrhosis

HCC

65
Q

causes of high ferritin

A

haemochromatosis
supplements
infection/inflamm

66
Q

Sx of neuropathy

A 
pain
loss of sensation
burning
pins and needles
deformity
67
Q

causes of a high MCV and neuropathy

A

alcohol

folate/B12 def

68
Q

give 5 causes of cirrhosis

A 
alcohol
NAFLD
haemochrom
hep B/C
PBC
autoimmune hep
budd-chiari
wilsons
drugs [metho]
alpha1 antitripsin def
CF
69
Q

what ix.s best indicate liver fn?

A

INR/PT

albumin

70
Q

which of AST and ALT is more specific to liver damage? and what othrer factors can incerase the other?

A

^ALT = liver

^AST = hepatic necrosis, MI, muscle injury, CCF. present in liver, heart, muscle, kidney, brain

71
Q

on LFT, which aspects look at liver disease and which at biiliary?

A 
liver = AST, ALT + fn [albumin, PT]
biliary/cholestasis = alk phos, GGT
72
Q

which class of Abx related to fatty liver?

A

tetracylcines e.g. doxy

73
Q

rare disorder developing days after viral infection, thought to be linked to aspirin use, causing liver and brain damage

A

reyes

74
Q

most effective Tx for CFS?

A

CBT

75
Q

red flags for patient who is “tired all the time”

A

weight loss
CA hx
fever/night sweats
jaundice

76
Q

give 5 red flags for sinister back pain.

what does the patient need?

A 
<20 / >55
^^^trauma
trauma + osteoporosis
bilat/alternating sciatica
weak legs
weight loss/fever
oral steroids
progressive/continuous/non-mechanical
systemically unwell
HIV/IVDU
pain unrelated to mechanical events
local bony tenderness
CNS deficit at more than 1 root level
thoracic
worse supine
CA Hx

need MRI in <4hrs

77
Q

localised sacro-iliac joint tenderness indicates?

A

spondyloarthropathy

78
Q

causes of sciatica

A

herniated disc [L4-S1]
spinal stenosis
cauda equina
pregnancy

79
Q

non-mechanical causes of back pain

A 
duodenal ulcer
AAA
osteomyelitis [from local infection/ TB]
renal colic/pyelonephritis
myeloma
pancreatic CA
bone mets [breast/bronchus/prostate/thyroid/kidney]
80
Q

cancers that metastiatize ot bone

A 
BLT with koscher pickles, mustard and mayo
Breast
Lung
Thyroid
Kidney
Prostate
Multiple myeloma
81
Q

causes of kyphosis

A 
congential
ank spond
osteoporosis
spina bifida
CA [wedge fracture]
TB, polio
paget's
82
Q

complicoaitons/ problems in adolescent idiopathic scoliosis

A

pain
cosmesis
impaired lung fn

83
Q

10 day old baby, bright green vomiting. Tummy swollen, seems to be in pain and is drawing up his legs. Diagnosis?

A

malrotation

84
Q

7 week old baby vomiting. Irritable/ experiencing discomfort when feeding. Cries a lot. She also has a cough and the mother is concerned she’s lost weight.
Diagnosis?

A

GORD

85
Q

6 week old baby vomiting after feeds. Vomit shooting over the far end of the cot. No diarrhoea, less wet nappies than usual.
Diagnosis?

A

pyloric stenosis

86
Q

lethargic baby, ^RR, vomiting, becoming more sleepy and hot, not feeding.
Diagnosis?

A

sepsis

87
Q

iX and Mx of suspected malrotation

A

abdo XR

r/f to surgery

88
Q

paeds Mx of GORD

A

GAVISCON

89
Q

Ix and mX OF septic baby

A 
Abx e.g. ben pen + gent/ cefotaxime
fluids
ABG, cultures, urine culture, LP, CXR.
FBC, U+E, glucose, CRP.
O2
90
Q

Mx of paeds gastroenteritis

A

encourage fluids
ORT
consider giving ORT via NG

91
Q

electrolyte disturbance in pyloric stenosis?

A

hypochloraemic, hypokalaemic, met acidosis

92
Q

Mx of pyloric stenosis

A

correct electrolytes, then R/F to surgeons

93
Q

differentials of infant vomiting

A 
posseting
GORD
gastroenteritis
cows milk allergy
UTI
sepsis
pyloric stenosis
hirsprungs
congenital atresia/stenosis
malrotation
intesusuption
food intolerance
over feeding
94
Q

Ix in faulire, to thrive

A 
MSU
coeliac serology
U+E, glucose, LFT, Ca, Ig, CRP, TSH, FBC, sweat test
stool MC+S
CXR
skeletal survey [abuse]
ECG, echo
95
Q

how would you manage AF in a haemodynamically unstable patient

A

DCCV + heparin

if cardioversion fails, try IV amiodarone

96
Q

how would you manage AF in a haemodynamically stable patient

A

rate control: bisoprolol/verapamil/digox

[rhythm control: CV, amiod, sotalol/flecainide]

ablation

pakemaker

anticoag: warf/rivaroxaban/apixaban

97
Q

in what situation would you give rhythm control in AF [alongside anticoag + rate control]

A

<65
CCF
symptomatic
recent onset AF <48hrs

98
Q

causes of hyponatraemia with fluid overload

A

nephrotic syndrome
CCF
liver failure

99
Q

causes of hyponatraemia with dehydration

A

diarrhoea
addisons
renal salt wasting

100
Q

causes of hyponatraemia with normal fluid volume

A

diuretics
D+V then drinking ^water
ACEi

101
Q

Ix in TIA

A 
CT/MRI
ECG [AF]
doppler carotid
cholesterol
LFT [monitor statin]
glucose/HbA1c
102
Q

what 4 Sx would you consider prescribing pre-emptive meds for in a palliative pt? give an example med for each

A

Pain [morphine, oxyc, fent, buscopan]

secretions [buscopan, hyosine BUTYLBROMIDE, glycopyronium bromide]

agitation [midaz, haloperidol]

nausea [metoclop, halop, ondan, domper, levomepromazine]

103
Q

levomepromazine is a good antiemetic, but what is a possible unwanted side effect?

A

sedating

104
Q

briefly outline the pain ladder

A

PCM ibup aspirin

codeine

tramadol

morphine/oxy/diamorph/methadone

fentanyl/ alfentanil

[neuropathic - pregab/amitrip/gabapent]

105
Q

Mx of faeculant vomiting due to bowel obstruction in palliative care

A

NG drainage

reduce secretions using buscopan/glycopyronium bromide

106
Q

how do steroids affect sleep

A

reduced

107
Q

how does radiotherapy affect wound healing?

A

reduced

108
Q

what is the purpose of an advanced directive

A

lets health prof.s, family, carers know patient’s wishes about refusing Tx, if they’re unable to make or communicate them themselves

109
Q

give examples of things patients are allowed to refuse [even if they might keep them alive] in an advanced directive

A

CPR
ventilation
antibiotics

110
Q

logistically, what is required in an advanced directive for it to be valid?

A

written down, signed by patient, signed by witness.

111
Q

rules for opoids and driving

A

stable dose - can drive

new altered dose or recently taken PRN - advised not to drive

112
Q

Mx of new stridor in palliative care [head / neck/ lung/ upper GI tumour]

A

dex
urgent ENT r/v
stent/ tracheostomy

non-invasive: steroids, opoids, midaz

113
Q

Mx of massive haemorrhage in palliative pt.

A

stop anticoag
dark towels
midaz
stay with the patient

114
Q

palliative pt. with:

Reduced conscious level
Reduced respiratory rate/SpO2
Myoclonic jerks
Pinpoint pupils
Confusion
Hallucinations

whats happened?

A

opoid overdose

3B GH (16 decks)

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