What is the pathogenesis of T1D AND T2D?
T1D - autoimmune beta islet cell destruction in pancreas, causes insulin deficiency T2D - acquired insulin resistance due to beta cell fatigue, presents later in life due to poor health
How is diabetes control assessed?
Regular FBG HbA1c - glycosylated haemoglobin 3 monthly (should be under 7% < 53)
What lifestyle factors can be used for diabetes management?
Healthy diet (reduced sat fats, low GI CHO) Exercise Smoking cessation RBG monitoring
What are the oral hypoglycaemics available for diabetes treatment?
Metformin (biguanides): First line treatment, inhibits hepatic glucose production and increases insulin sensitivity, does not cause severe hypoglycaemia, contraindications: renal impairment --> perpetuates lactic acidosis, SE: nausea, diarrhoea (avoid this by using slow release drug) Sulphonylureas: Stimulate beta cell insulin release, may cause weight gain, risk of hypoglycaemia (use with care in drivers, pilots etc.) Add if HbA1C is above target on maximum metformin tolerated, Gliclazide is drug of choice Alpha-Glucosidase Inhibitors: Acarbose, blocks starch digesting enzymes, no weight gain or hypoglycaemia, SE: flatulence, must be used with food Thiazolidinedione's: Reverse insulin resistance, no hypoglycaemia, SE: weight gain, fluid retention, CCF, fractures, bladder cancer DPP4 Inhibitors: Advantage in overweight patients, no hypoglycaemia or weight gain, prolong GLP-1 action, increase insulin secretion, decrease glucagon secretion, inhibits in retina breakdown, SE: nausea, hypersensitivity (rare) GLP-1 Analogues: Advantage in overweight patients, no hypoglycaemia, slow gastric emptying, improve glucose sensing, weight loss, requires injection, SE: nausea, vomiting, pancreatitis SGLT2 Inhibitors: Promote glycosuria to lower blood glucose, mild weight loss, SE: candida infections
What is the investigation for palpitations or syncope?
12 lead ECG Blood glucose U&E
What is the pattern of AF on ECG?
No P waves Irregularly irregular rhythm
What is the pattern of supra ventricular tachycardia on ECG?
Wide QRS complexes, retrograde P waves
What is the pattern of VT on ECG?
Wide QRS (greater than 120msec)
What is the management for AF?
Cardioversion Catheter Ablation (ablate part of heart that is out of rhythm) Beta Blockers Calcium Channel Blockers Digoxin Anti-arhythmics Anticoagulation - warfarin, heparin
What is the score to determine stroke risk in AF patients?
C - chronic heart failure H - hypertension A - age >75 D - diabetes S - stroke V - vascular disease A - age >55 S - sex (female)
What is the management for SVT?
Adenosine (induce AV block to allow SA node to take over rhythm control) IV Verapamil
What is the management for VT?
Cardioversion Amiodarone (if hemodynamically stable)
What is a stroke?
Ischaemic infarct of the brain, lasting over 24 hours, brain damage
What is a TIA?
Brief neurological episode, usually lasting under 24 hours with no permanent brain damage
What is ischaemic penumbra?
Area surrounding the infarcted brain that is also affected by relative ischaemia (but not yet permanently damaged)
What are the types of hemorrhagic stroke?
Deep: hypertensive rupture of deep penetrating arteries, putamen, thalamus, brainstem, cerebellum Lobar: superficial, secondary to amyloid angiopathy, tumour, aneurysm
What are the types of iscahemic stroke?
Large artery thromboembolism (>50% stenosis) Cardiogenic embolism (AF, LV thrombus) Small vessel infarct
What are the major causes of SAH?
Berry aneurysm rupture AVM
How is a stroke diagnosed?
CT (ischaemic vs. haemorrhagic - may not see clot in first few hours but will see haemorrhage)
What is acute stroke management?
Thrombolysis - tPA (ateplase) - under 4.5 hours Anticoagulation Clot Retrieval Mannitol - relieve ICP
What is stroke secondary prevention?
NOAC (dabigatrain, rivaroxaban, apixaban) Warfarin Aspirin Clopidogrel Antihypertensives Statins
What are the common risk factors for stroke?
Age Gender (female) Family History HTN Diabetes Smoking AF Hyperlipidaemia Alcohol TIA/Migraines OCP/HRT OSA Sedentary/obesity
What are the common signs of stroke?
F - facial weakness A - arm weakness S - speech difficulty T - time
What happens if a patient develops a rash 24 hours into penicillin admin?
Change to cephalosporin - ceftriaxone
What is the side effect of ciprofloxacin?
Achilles tendon swelling and tearing
What is the treatment for C.diif?
Metronidazole or vancomycin
What is the treatment for klebsiella UTI and bacteriuria?
What is the treatment for MRSA?
What is the likely pathology: Recent haemoptysis, bright red blood mixed with cream coloured sputum, occasional night sweats, 4kg weight loss (1 month)?
TB - mycobacterium tuberculosis
What is the initial management of TB?
Isolation, bronchoscopy and washings, organism culture