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3B GH > GP + palliative > Flashcards

GP + palliative Flashcards

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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
causes of obstruction of the sinuses
deviated septum polyps viral - mucosal oedema + reduced cilia action
26
acute bacterial rhinosinusitis is suggested by the presence of at least 3 symptoms and signs. list 4
discoloured discharge/ purulent secretion [unilat predominance] severe pain [unilat predominance] fever elevated ESR/CRP 'double sickening'-deterioration after initial mild phase
27
swelling is uncommon in sinusitis, what other pathologies might this suggest
carcinoma | dental root infection
28
differentials of sinusitis [non-sinus pain]
``` migraine TMJ dysfn. dental neuropathic temporal arteritis herpes zoster ```
29
causes / risk factors for bacterial sinusitis
``` most follow viral infection dental root infection swimming in infected water septal deviation polyps mechanical ventilation NGT immunodef ```
30
common organisms for bacterial sinusitis
strep pneum Haem infl. staph aureus
31
Ix in recurrent / chronic sinusitis
CT | nasal endoscopy
32
Mx sinusitis
analgesia nasal saline irrigation intranasal decongestants [ephedrine] amox/doxy surgery smoking cessation
33
complicaitons of sinusitis
``` orbital cellulitis/abscess intracranial [meningitis, enceph, cerebral abscess, cavernous sinus thrombosis] mucocoeles/pyocoeles osteomyelitis pott's puffy tumour ```
34
Sx of trigem neuralgia
unilateral knife like pain | ^ed by washing shaving eating
35
Mx of trigem neur
carbamazepine
36
metoclopramide + domperidone are D2 receptor antagonist antiemetics. Give 2 SEs. In what condition might you need to reduce the dose?
extrapyramidal SEs QTc prolongation hepatic impairment
37
cyclizine is an H1 antagonist / antimuscarinic anti-emetic. Give some SEs + in what condition would you consider reducing the dose?
drowsy, headache, dry mouth, constipation renal impairment
38
hyoscine butylbromide is an antimuscarinic antiemetic. SEs?
dry mouth, constipation
39
physiology of nausea:- which 4 body systems trigger nausea? Also give the receptor responsible / that is targeted by anti-emetics
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
40
most common cause of B12 deficiency
pernicious Anaemia
41
pernicious anaemia is the most common cause of B12 deficiency, give 3 other causes
``` diet [meat + dairy i.e. vegan] gastrectomy congenital intrinsic factor def crohns in ileum ileal resection coeliac NO [inactivates B12] ```
42
causes of folate def
``` diet [green veg, cereals] alcohol excess coeliac crohns anticonvulsants [phenytoin] trimethoprim [ie. can give in preg!] sulfasalazine [RA/UC/crohns] methotrex ```
43
when would you increase a pregnant woman's folic acid dose?
obesity diabetic hx of neural tube defect
44
what is the most common cause of peripheral neuropathy in the UK?
DM
45
peripheral neuropathy causes symmetrical or asymmetircal Sx?
symmetrical
46
name 2 metabolic causes of neuropathy
B12, folate def DM uraemia hypocalc
47
name 2 inflamm cause of neuropathy
``` GBS CIDP SLE vasculitis polyarteritis nodosa ```
48
name 3 drugs that can cause neuropathy
``` chemo [vincristine/vinblastine/cisplatin] phenytoin nitrofurantoin metro amiodarone quinine ```
49
give 3 factors that increase the risk of someone with DM getting neuropathy
poor control smoking ^age alcohol
50
can peripheral neuropathy be ass. w/ hypo or hyperthyroidism?
hypo
51
chronic disease of which 2 organs can cause peripheral neuropathy?
liver, kidney
52
name 2 infections that can cause peripheral neuropathy
lyme disease HIV shingles diptheria
53
cancer that can cause periphera neurop
lymphoma | myeloma
54
Pt experiences rapid onset limb weakness, loss of reflexes, with a recent Hx of infection. Diagnooiss?
GBS
55
name 2 side effects of neurpathic pain killers
tired dizzy drowsy blurred vision
56
on exam, what is pes cavus
excessively arched foot with unnaturally high instep
57
on hand exam in peripheral neuropathy, you might se wasting in what areas?
thenar eminence | hypothenar eminence
58
what is the name of the deformed weight bearing joint in diabetic neuropathy
charcot joint
59
2 blood tests you may arrange in a patient with neuropathy
``` glucose TFT CRP LFT U+E B12/folate ```
60
how would speed in a nerve conduction study be affected for a patent with guillain barre or CIDP
slow
61
amaurosis fugax can present in ischaemic events i.e. TIA/pre-stroke. In what other condition might it occur?
migraine
62
causes of "tired all the time"/ pathologies to rule out
``` hypothyroid anaemia food intolerence/ coeliac DM sleep apnoea insomnia CFS/ME depression ```
63
give 8 health problems ass. w/ obesity
``` 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
complications of NAFLD
cirrhosis | HCC
65
causes of high ferritin
haemochromatosis supplements infection/inflamm
66
Sx of neuropathy
``` pain loss of sensation burning pins and needles deformity ```
67
causes of a high MCV and neuropathy
alcohol | folate/B12 def
68
give 5 causes of cirrhosis
``` alcohol NAFLD haemochrom hep B/C PBC autoimmune hep budd-chiari wilsons drugs [metho] alpha1 antitripsin def CF ```
69
what ix.s best indicate liver fn?
INR/PT | albumin
70
which of AST and ALT is more specific to liver damage? and what othrer factors can incerase the other?
^ALT = liver ^AST = hepatic necrosis, MI, muscle injury, CCF. present in liver, heart, muscle, kidney, brain
71
on LFT, which aspects look at liver disease and which at biiliary?
``` liver = AST, ALT + fn [albumin, PT] biliary/cholestasis = alk phos, GGT ```
72
which class of Abx related to fatty liver?
tetracylcines e.g. doxy
73
rare disorder developing days after viral infection, thought to be linked to aspirin use, causing liver and brain damage
reyes
74
most effective Tx for CFS?
CBT
75
red flags for patient who is "tired all the time"
weight loss CA hx fever/night sweats jaundice
76
give 5 red flags for sinister back pain. what does the patient need?
``` <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
localised sacro-iliac joint tenderness indicates?
spondyloarthropathy
78
causes of sciatica
herniated disc [L4-S1] spinal stenosis cauda equina pregnancy
79
non-mechanical causes of back pain
``` duodenal ulcer AAA osteomyelitis [from local infection/ TB] renal colic/pyelonephritis myeloma pancreatic CA bone mets [breast/bronchus/prostate/thyroid/kidney] ```
80
cancers that metastiatize ot bone
``` BLT with koscher pickles, mustard and mayo Breast Lung Thyroid Kidney Prostate Multiple myeloma ```
81
causes of kyphosis
``` congential ank spond osteoporosis spina bifida CA [wedge fracture] TB, polio paget's ```
82
complicoaitons/ problems in adolescent idiopathic scoliosis
pain cosmesis impaired lung fn
83
10 day old baby, bright green vomiting. Tummy swollen, seems to be in pain and is drawing up his legs. Diagnosis?
malrotation
84
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?
GORD
85
6 week old baby vomiting after feeds. Vomit shooting over the far end of the cot. No diarrhoea, less wet nappies than usual. Diagnosis?
pyloric stenosis
86
lethargic baby, ^RR, vomiting, becoming more sleepy and hot, not feeding. Diagnosis?
sepsis
87
iX and Mx of suspected malrotation
abdo XR r/f to surgery
88
paeds Mx of GORD
GAVISCON
89
Ix and mX OF septic baby
``` Abx e.g. ben pen + gent/ cefotaxime fluids ABG, cultures, urine culture, LP, CXR. FBC, U+E, glucose, CRP. O2 ```
90
Mx of paeds gastroenteritis
encourage fluids ORT consider giving ORT via NG
91
electrolyte disturbance in pyloric stenosis?
hypochloraemic, hypokalaemic, met acidosis
92
Mx of pyloric stenosis
correct electrolytes, then R/F to surgeons
93
differentials of infant vomiting
``` posseting GORD gastroenteritis cows milk allergy UTI sepsis pyloric stenosis hirsprungs congenital atresia/stenosis malrotation intesusuption food intolerance over feeding ```
94
Ix in faulire, to thrive
``` MSU coeliac serology U+E, glucose, LFT, Ca, Ig, CRP, TSH, FBC, sweat test stool MC+S CXR skeletal survey [abuse] ECG, echo ```
95
how would you manage AF in a haemodynamically unstable patient
DCCV + heparin if cardioversion fails, try IV amiodarone
96
how would you manage AF in a haemodynamically stable patient
rate control: bisoprolol/verapamil/digox [rhythm control: CV, amiod, sotalol/flecainide] ablation pakemaker anticoag: warf/rivaroxaban/apixaban
97
in what situation would you give rhythm control in AF [alongside anticoag + rate control]
<65 CCF symptomatic recent onset AF <48hrs
98
causes of hyponatraemia with fluid overload
nephrotic syndrome CCF liver failure
99
causes of hyponatraemia with dehydration
diarrhoea addisons renal salt wasting
100
causes of hyponatraemia with normal fluid volume
diuretics D+V then drinking ^water ACEi
101
Ix in TIA
``` CT/MRI ECG [AF] doppler carotid cholesterol LFT [monitor statin] glucose/HbA1c ```
102
what 4 Sx would you consider prescribing pre-emptive meds for in a palliative pt? give an example med for each
Pain [morphine, oxyc, fent, buscopan] secretions [buscopan, hyosine BUTYLBROMIDE, glycopyronium bromide] agitation [midaz, haloperidol] nausea [metoclop, halop, ondan, domper, levomepromazine]
103
levomepromazine is a good antiemetic, but what is a possible unwanted side effect?
sedating
104
briefly outline the pain ladder
PCM ibup aspirin codeine tramadol morphine/oxy/diamorph/methadone fentanyl/ alfentanil [neuropathic - pregab/amitrip/gabapent]
105
Mx of faeculant vomiting due to bowel obstruction in palliative care
NG drainage | reduce secretions using buscopan/glycopyronium bromide
106
how do steroids affect sleep
reduced
107
how does radiotherapy affect wound healing?
reduced
108
what is the purpose of an advanced directive
lets health prof.s, family, carers know patient's wishes about refusing Tx, if they're unable to make or communicate them themselves
109
give examples of things patients are allowed to refuse [even if they might keep them alive] in an advanced directive
CPR ventilation antibiotics
110
logistically, what is required in an advanced directive for it to be valid?
written down, signed by patient, signed by witness.
111
rules for opoids and driving
stable dose - can drive | new altered dose or recently taken PRN - advised not to drive
112
Mx of new stridor in palliative care [head / neck/ lung/ upper GI tumour]
dex urgent ENT r/v stent/ tracheostomy non-invasive: steroids, opoids, midaz
113
Mx of massive haemorrhage in palliative pt.
stop anticoag dark towels midaz stay with the patient
114
palliative pt. with: ``` Reduced conscious level Reduced respiratory rate/SpO2 Myoclonic jerks Pinpoint pupils Confusion Hallucinations ``` whats happened?
opoid overdose

3B GH (16 decks)

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