Internal Medicine Flashcards
(106 cards)
1
Q
Define TB
A
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis.
2
Q
What is the mode of transmission for TB?
A
Transmission occurs mainly by inhalation of infected particles.
3
Q
What are the characteristics of the TB bacillus?
A
- Humans are the only reservoir
- Aerobic
- Non-spore forming
- Non-motile
- High lipid content in cell wall
- Slow growing
- Acid-fast
4
Q
What are the common presenting signs and symptoms of TB?
A
- Cough lasting more than 3 weeks
- Night sweats
- Poor appetite
- Weight loss
- Weakness or fatigue
- Productive of sputum or blood
- Chest pain
- Fever
5
Q
List some chronic complications of TB.
A
- Respiratory complications
- Musculoskeletal issues
- CNS complications
- Gastrointestinal involvement
- Renal complications
6
Q
How can TB be diagnosed?
A
- Sputum smear and culture
- Biopsy of peripheral lymph nodes
- Imaging studies
- PCR testing
- Clinical evaluation
7
Q
True or False: Infected people are most susceptible to developing active TB during infancy, ages 15-25, and old age.
A
True
8
Q
What are some risk factors for developing active TB?
A
- Malnutrition
- Homelessness
- Alcoholism
- Renal failure
- Immunosuppression
- HIV/AIDS
- Incarceration
9
Q
What role do macrophages and T lymphocytes play in TB?
A
They are involved in immune control of the disease.
10
Q
What is the typical outcome for a patient with TB?
A
The outcome depends on the type and extent of disease, efficacy of management, and patient compliance.
11
Q
What is the first-line treatment for TB?
A
The treatment typically involves a combination of antibiotics, including isoniazid, rifampicin, ethambutol, and pyrazinamide.
12
Q
Fill in the blank: The modern era of tuberculous chemotherapy began in ______.
A
[1946]
13
Q
What is the role of ART in patients living with HIV and TB?
A
All people living with HIV should be screened for TB and start ART if eligible.
14
Q
What is the significance of a TST in TB management for PLHIV?
A
A TST is required to determine eligibility for isoniazid preventive therapy (IPT).
15
Q
What is the most common site of bowel involvement in TB?
A
The ileo-caecal junction.
16
Q
What are some neurological symptoms associated with CNS TB?
A
- Vomiting
- Malaise
- Focal neurological signs
- Meningism
- Confusion
- Headache
17
Q
What is a common diagnostic method for tuberculous pericarditis?
A
Pericardiocentesis should be performed if the patient is haemodynamically unstable.
18
Q
True or False: Ziehl-Neelsen stain is a method used in diagnosing TB.
A
True
19
Q
What is the diagnostic yield of fine needle aspiration biopsy of peripheral lymph nodes?
A
Up to 75%.
20
Q
What is a common presentation of renal tuberculosis?
A
Sterile pyuria and abnormal IVP findings.
21
Q
What is the typical cellular predominance in ascites caused by peritoneal TB?
A
Lymphocyte cellular predominance.
22
Q
What are bronchopleural fistulas associated with?
A
Tuberculous empyemas.
23
Q
A
24
Q
What is pneumonia?
A
An infection of the alveoli of the lung that can be caused by nearly any class of organism.
Pneumonia is also referred to as the forgotten killer.
25
What is the most common infectious cause of death in the world according to WHO?
Lower respiratory tract infection, with almost 3.5 million deaths yearly.
## Footnote
It is the 3rd most common cause of death overall.
26
Name the classifications of pneumonia.
* Community Acquired Pneumonia
* Nosocomial Pneumonia
* Aspiration Pneumonia
* Pneumonia in Immunocompromised
## Footnote
Classifications can also be based on aetiology.
27
According to aetiology, what are the types of pneumonia?
* Bacterial
* Atypical
* Viral
* Fungal
* Mycobacterium
28
What indicates the development of pneumonia?
A defect in host defences, exposure to a virulent microorganism, or an overwhelming inoculum.
29
What are common symptoms of pneumonia?
* Cough, often productive
* Chest Pain, pleuritic
* Fever, malaise, myalgia
* Confusion
* Jaundice, abdominal pain, diarrhoea
* Hypoxia
30
What are the diagnostic tools for pneumonia?
* Chest x-ray
* Blood investigations (CRP, FBC, Blood culture, U&E)
* Sputum M C & S
31
List some complications of pneumonia.
* Empyema
* Parapneumonic effusions
* ARDS
* Sepsis
32
What are the management strategies for pneumonia?
* Antibiotics
* Chest physiotherapy
* Intravenous fluids
33
What is bronchiectasis?
Abnormal and permanent distortion of one or more of the conducting bronchi or airways.
34
What are the symptoms of bronchiectasis?
* Cough (98%) and daily mucopurulent sputum (70%)
* Haemoptysis
* Dyspnea, pleuritic chest pain, wheezing
* Fever, weakness, and weight loss
* Recurrent infections
35
What are the management strategies for bronchiectasis?
* Physiotherapy
* Antibiotics
* Treat underlying condition
* Nutrition
* Bronchodilators
* Surgery
* Oxygen
* Lung Transplantation
36
What are some complications of bronchiectasis?
* Recurrent Infections
* Haemoptysis
* COPD
* MAC infection
* Mycetoma
* Pulmonary Hypertension
* Cor pulmonale
37
What genetic disorder is often associated with bronchiectasis?
Cystic Fibrosis (CF) is an inherited monogenic disorder presenting as a multisystem disease.
38
What is the most common mutation in cystic fibrosis?
A 3 base pair deletion leading to absence of phenylalanine at position 508 (DF508) of the CFTR.
39
What are the gastrointestinal symptoms of cystic fibrosis?
* Exocrine pancreatic insufficiency
* Protein and fat malabsorption
* Frequent bulky, foul-smelling stools
* Vitamin A, D, E, K malabsorption
40
What pathogens are commonly associated with respiratory infections in cystic fibrosis?
* H. influenzae
* S. aureus
* P. aeruginosa
* Xanthomonas xylosoxidans
* Burkholderia gladioli
* Proteus
* E. coli
* Klebsiella
41
42
What are the subgroups of Spondyloarthropathies (SpA)?
* Ankylosing spondylitis
* Inflammatory bowel disease-associated arthritis
* Psoriatic arthritis
* Reactive arthritis
* Undifferentiated SpA
## Footnote
Spondyloarthropathies are a group of inflammatory rheumatic diseases that primarily affect the spine and the entheses.
43
What are common features of Spondyloarthropathies (SpA)?
* Axial involvement
* Peripheral arthritis
* Enthesopathy
* Extra-articular disease
* Radiological evidence of sacroiliitis and spondylitis
* Genetic predisposition – HLA B27
## Footnote
These features help in diagnosing SpA and understanding its clinical presentation.
44
When should you suspect Spondyloarthropathy (SpA)?
* Inflammatory back pain
* Improvement with exercise
* Pain at night
* Insidious onset
* Age at onset <40 years
* No improvement with rest
* Good response to NSAIDs
## Footnote
These symptoms can guide healthcare providers in identifying potential cases of SpA.
45
What are the ESSG criteria for Spondyloarthropathies?
INFLAMMATORY BACK PAIN or + SYNOVITIS (asymmetric, predominately lower limb) and one or more of the following:
* Family history of SpA
* Psoriasis
* Inflammatory bowel disease
* Preceding infection in the urogenital/enteral tract
* Alternating buttock pain
* Enthesopathy
* Sacroiliitis (grade 2 = evidence of erosion and sclerosis)
## Footnote
These criteria are used to aid in the diagnosis of SpA.
46
What are some radiological features of sacroiliitis?
* SI joint space widening
* SI joint sclerosis
## Footnote
These findings can be observed on imaging studies and are indicative of sacroiliitis.
47
What are the dermatological manifestations associated with Spondyloarthropathies?
* Psoriasis
* Uveitis
* Acute anterior uveitis
## Footnote
These conditions can present alongside SpA and may complicate the clinical picture.
48
What is the commonest potentially reversible cause of physical disability?
Rheumatoid arthritis (RA)
## Footnote
RA is a chronic inflammatory disorder affecting synovial joints and can lead to significant disability if not managed properly.
49
What is the pathogenesis of rheumatoid arthritis?
* Environmental and/or genetic predisposition
* Abnormal immune response
* Inflammatory cytokines and antibodies
## Footnote
Understanding the pathogenesis helps in developing targeted therapies for RA.
50
What are the key features of rheumatoid arthritis?
* Symptoms >6 weeks' duration
* Inflammatory synovitis
* Palpable synovial swelling
* Morning stiffness >1 hour
* Symmetrical and polyarticular (>3 joints)
* Typically involves wrists, MCP, and PIP joints
* Typically spares certain joints (thoracolumbar spine, DIPs of the fingers, IPs of the toes)
## Footnote
These features aid in the diagnosis and management of RA.
51
What is the significance of early detection in rheumatoid arthritis?
* Joint damage occurs early and progresses rapidly
* ~75% early RA patients have radiological joint erosions
* Erosions represent permanent structural damage
* MRI changes at onset in >80%
## Footnote
Early intervention is crucial to preserve joint function and prevent severe disability.
52
What are extra-articular manifestations of rheumatoid arthritis?
* General: Fever, malaise, weight loss
* Skin: Nodulosis, vasculitis, pyoderma gangrenosum
* Haematopoietic: Anaemia, thrombocytosis, lymphadenopathy, Felty’s syndrome
* Cardiac: Pericarditis, endocarditis, coronary arteritis
* Pulmonary: Pleural effusion, nodules, pulmonary fibrosis
* Neurological: Entrapment neuropathy, cervical myelopathy
* Renal: Glomerulonephritis, secondary amyloidosis
* Bone: Osteoporosis
## Footnote
These manifestations highlight the systemic nature of RA.
53
What are the treatment principles for connective tissue diseases (CTDs)?
* Education
* Therapy aimed at specific organ manifestations
* Use corticosteroids appropriately and cautiously
* Address co-morbidities (infections, osteoporosis, cardiovascular)
## Footnote
A comprehensive approach is necessary for managing CTDs effectively.
54
What laboratory criteria are used for diagnosing systemic lupus erythematosus (SLE)?
* Positive ANA
* Anti-dsDNA
* Anti-Sm
* APLA
* Low complement
* Direct Coombs’ test
## Footnote
These immunologic criteria assist in confirming a diagnosis of SLE.
55
What are the clinical criteria for systemic lupus erythematosus (SLE)?
* Acute cutaneous lupus
* Chronic cutaneous lupus
* Oral or nasal ulcers
* Non-scarring alopecia
* Arthritis
* Serositis
* Renal
* Neurologic
* Hemolytic anemia
* Leukopenia/Lymphopenia
* Thrombocytopenia
## Footnote
Meeting these criteria is essential for a diagnosis of SLE.
56
What is the prevalence of 'Positive ANA' in systemic lupus erythematosus (SLE)?
>90%
## Footnote
A positive ANA is a common finding in patients with SLE, but not exclusive to it.
57
58
What is the fasting glucose level for diabetes diagnosis?
>5.6 mmol/L
## Footnote
This is a key criterion for diagnosing diabetes mellitus.
59
What waist circumference indicates obesity in men?
≥ 102 cm
## Footnote
Waist circumference is an important measure for assessing obesity.
60
What are the criteria for diagnosing Metabolic Syndrome?
3 or more risk determinants present
## Footnote
According to NCEP III guidelines.
61
What is the BMI of a 56-year-old male with a BMI of 28.5 kg/m²?
Overweight
## Footnote
A BMI of 25-29.9 is classified as overweight.
62
What is the significance of a waist measurement of 104 cm?
Obesity indicator
## Footnote
Indicates increased risk for metabolic syndrome.
63
What fasting blood glucose level indicates a metabolic profile of concern?
8.2 mmol/L
## Footnote
This level indicates potential diabetes.
64
What is the HbA1C level for the patient mentioned?
7.0%
## Footnote
This level confirms poor blood glucose control.
65
What is the total cholesterol level of the patient?
5.9 mmol/L
## Footnote
Important for assessing cardiovascular risk.
66
What are the microvascular complications of Type 2 Diabetes?
* Retinopathy
* Nephropathy
* Neuropathy
## Footnote
These complications arise due to chronic hyperglycemia.
67
What are the macrovascular complications associated with Type 2 Diabetes?
* Cardiovascular disease
* Cerebrovascular disease
* Peripheral vascular disease
## Footnote
These complications significantly increase morbidity and mortality.
68
What is the definition of hypertension?
A 24-hour average BP > 135/85 mmHg
## Footnote
Hypertension is often asymptomatic.
69
What percentage of hypertension cases are primary?
85%
## Footnote
Primary hypertension is more common than secondary.
70
What lifestyle factor is a major risk for hypertension?
Obesity
## Footnote
Weight gain is a significant risk factor.
71
What dietary modifications are recommended for hypertension management?
* Salt restriction
* Balanced low-calorie diets
* Mediterranean diet
## Footnote
Lifestyle modifications are the cornerstone of hypertension management.
72
What is the role of pharmacologic therapy in obesity management?
Used in conjunction with lifestyle modification
## Footnote
Most patients require medication.
73
What is the mode of action of orlistat?
Inhibits GIT fat absorption by 30%
## Footnote
Common side effects include cramps and flatulence.
74
What is the primary pathological process responsible for coronary artery disease?
Atherosclerosis
## Footnote
Atherosclerosis is linked to dyslipidaemia.
75
Which drug class inhibits de novo synthesis of cholesterol?
HMG CoA reductase inhibitors (e.g., atorvastatin)
## Footnote
Important in managing dyslipidaemia.
76
What are common side effects of thiazide diuretics?
* Electrolyte disturbances
* Precipitates gout
## Footnote
Thiazide diuretics are commonly used for hypertension.
77
What is the acceptable range for blood pressure?
< 130/85 mmHg
## Footnote
Blood pressure should be regularly monitored.
78
What defines primary dyslipidaemia?
Genetic factors
## Footnote
Secondary dyslipidaemia can be due to conditions like diabetes.
79
List three major risk factors for atherosclerotic vascular disease.
* Age
* Gender
* Family history
## Footnote
These include both modifiable and non-modifiable factors.
80
What is the definition of dyslipidaemia?
Disorders of lipoprotein metabolism
## Footnote
Includes high total cholesterol, high triglycerides, and low HDL.
81
What is the significance of an albumin excretion rate of 50 μg/min?
Indicates potential kidney damage
## Footnote
Normal AER is <20 μg/min.
82
What is ural hypotension?
A condition characterized by low blood pressure.
83
What do Angiotensin converting enzyme inhibitors do?
Inhibit conversion of angiotensin I to angiotensin II.
84
Name a common Angiotensin converting enzyme inhibitor.
Enalapril.
85
List important/common side effects of Angiotensin converting enzyme inhibitors.
* Chronic cough
* Angioedema
* Hypotension
* Hyperkalaemia
86
What is the function of Angiotensin II receptor blockers?
Block angiotensin II receptor.
87
Name a common Angiotensin II receptor blocker.
Telmisartan.
88
List important/common side effects of Angiotensin II receptor blockers.
* Dizziness/postural hypotension
* Hyperkalaemia
89
What do beta blockers do?
Block beta-adrenoreceptors.
90
Name a common beta blocker.
Atenolol.
91
List important/common side effects of beta blockers.
* Dizziness/postural hypotension
* Bradycardia
92
What is the action of loop diuretics?
Block sodium reabsorption in the ascending limb of the loop of Henle.
93
Name a common loop diuretic.
Furosemide.
94
List important/common side effects of loop diuretics.
* Electrolyte disturbance
* Excessive diuresis with dehydration and hypotension
95
What do potassium-sparing diuretics do?
Act as competitive inhibitors of aldosterone.
96
Name a common potassium-sparing diuretic.
Spironolactone.
97
List important/common side effects of potassium-sparing diuretics.
* Hyperkalaemia
* Gynaecomastia
98
What is the treatment goal for fasting glucose in patients with metabolic syndrome?
Fasting glucose <6 mmol/L.
99
What is the treatment goal for body weight in patients with metabolic syndrome?
Body weight < 25 kg/m2.
100
What is the target for elevated blood pressure in patients with metabolic syndrome?
< 130/80 (120/70) mmHg.
101
What is the treatment goal for total cholesterol in patients with metabolic syndrome?
Total cholesterol ≤ 4.5 mmol/L.
102
What is the treatment goal for LDL cholesterol in patients with metabolic syndrome?
LDL cholesterol ≤ 1.8 mmol/L.
103
What is the treatment goal for HDL cholesterol in patients with metabolic syndrome?
HDL cholesterol ≥ 1.2 mmol/L in females and 1.0 mmol/L in males.
104
What is the treatment goal for triglycerides in patients with metabolic syndrome?
Triglycerides ≤ 1.5 mmol/L.
105
What is the conclusion about metabolic syndrome?
It is a complex disorder including hypertension, obesity, dyslipidaemia, and impaired fasting glucose/diabetes.
106
What should be the management approach for metabolic syndrome?
Utilize a multidisciplinary team.
