Internal Med CBD Study (PE Case) Flashcards
(28 cards)
How does malignancy increase the risk of PE?
Acquired hypercoagulable state
- Tumours may release prothrombotic molecules
- Tumours may produce proteases that activate factor X
- Tumours may produce cytokines, TNF etc which act on endothelial cells to stimulate prothrombotic molecules
What are the two pathophysiological pathways involved in colorectal cancer and what do they produce?
- Adenoma-Carcinoma Sequence/ Chromosomal Instability sequence
- somatic copy number mutations
- 5q21 –> KRAS + TP53 –> carcinoma - Sessile Serrated Pathway/Microsatellite instability pathway
- mutations in DNA mismatch repair –> high mutation rate
- MSH2 and MLH1 –> BRAF –> carcinoma
What does Lynch syndrome and FAP predispose you to?
FAP: 100% chance of colorectal cancer by 40, Adenoma-carcinoma pathway, prophylactic colectomy by 25
Lynch: colonoscopy every year, Microsatellite pathway
What are the symptoms of parkinsons?
TRAP:
Tremor
Rigidity: cogwheel rigidity
Akinesa/bradykinesia
Postural instability
SMART:
Shuffling gait
Mask-like facies
Akinesia/bradykinesia
Rigidity
Tremor
What is Parkinson’s?
Neurodegenerative disorder
Loss of dopaminergic output from the basal ganglia due to the loss of dopaminergic neurons in the substantia nigra
Might be due to mis-folding on alpha synuclein –> protein aggregation
How do you diagnose Parkinson’s?
Clinically with a dopaminergic agent trial
Levodopa, MAO-B inhibitors, amantadine
What is the aetiology of aortic stenosis?
- Mostly from fibrosis and calcification of the valve
- Congenitally bicuspid
- Rheumatoid heart disease
How does aortic stenosis present?
TRIAD
Exertional angina
Dyspnoea
Syncope
What does an aortic stenosis murmur sound like?
ESM over the aortic auscultation area, loudest mid-systole
Radiates to the carotids
Loudest over the right sternal border
Sometimes there will be a soft P2
How do you manage aortic stenosis?
Valve replacement
Warfarin
Statins and anti-hypertensives
Antibiotic prophylaxis when needed
What are the complications of aortic stenosis?
Acute HF
ACS
Thrombosis
What is rivaroxaban?
NOAC/DOAC
Selective Xa inhibitor. Inhibits free and bound Xa
What is levodopa?
Precursor to dopamine, can cross the BBB whereas dopamine cant.
Bradykinesia and rigidity are the most responsive symptoms.
SEs:
- Hair loss
- Narcolepsy
- Nausea
- Arrhythmias
- HTN
- GIT bleeding
- End of dose deterioration
- Drug resistance in parkinsons
What is denosumab?
RANK-L inhibitor (pre-osteoclasts have a RANK-L receptor) –> prevents the development of pre-osteoclasts into osteoclasts
SEs:
- Joint and muscle pain
- Osteonecrosis of the jaw
- Hypocalcaemia
- HYpersensitivity reactions
- Greater risk of infections
Contraindicated: hypocalcaemia, check Vit D and Ca before commencing
What is frusemide?
Loop diuretic.
Inhibits the NaKCl channel in the thick ascending LOH. Sodium, chloride and potassium stay in the urine so water is drawn in at the DCT. Potassium wasting diuretic
SEs:
- Hypokalaemia
- Hyponatremia
- Hypochloremia
- Ototoxic
- Can increase free thyroid hormone
What is venlafaxine?
SNRI: blocks serotonin and noradrenal reuptake. Also increases prefrontal DA
SEs:
- GI
- Sexual dysfunction
- Headache
What are the tumour markers for colorectal cancer?
CEA and CA19-9
CTPA vs V/Q Scan
CTPA is more sensitive and specific BUT can’t do in renal disease because of contrast nephropathy or young people because of radiation dose
Consensus:
CXR is clear but you’re still concerned for PE, you can do a V/Q scan
CXR has signs of pneumonia, pleural effusion etc, do a CTPA. More sensitive and specific so better when considering PE mimics
What are NOACS?
Non-vitamin K oral anti-coagulants
- Don’t need regular monitory
- Apixaban, rivaroxaban, edoxaban, dabigatran
What is dabigatran?
Selective thrombin antagonist
What are Xa Inhibitors?
Rivaroxaban, apixaban, edoxaban are all direct and selective Xa inhibitors
- Less conversation of prothrombin to thrombin
- Easily manageable, don’t need regular monitory
- Prolong PT and PTT
What is UFH?
MOA: increases the activity of anti-thrombin
- Indirectly inhibits Xa and thrombin
- Short half life, need to monitor the aPTT
- Cleared hepatically
What is LMWH?
MOA: binds anti-thrombin III –> indirectly inhibits Xa
- Renally cleared
What is the prothrombin G20210A mutation?
Increased prothrombin/factor II so you clot more
