Medical Flashcards

Question

Nutrition advice in elderly and chronic disease?

Answer 1

Malnutrition - W: BMI <18, 10% loss 3-6m, BMI <20 + >5% loss - Causes: reduced appetite, inability, lack of food, meds, impaired absorption, increased requirements, losses, chronic disease, surgery, cancer, CKD - Cx: 4w NG, still has risk of aspiration

Answer 2

Little to no intake for 5+ days - High risk: BMI <16, 15% loss, 10d, low K+, phos, mg prior to feed - Mod risk: BMI <18.5, 10%, 5d, ETOH, insulin, chemo, antacid, diuretics

Answer 3

2 week - known or suspected CRC on imaging or exam - unexplained bleeding WITH IDA - >50 + altered bowels >6w + bleeding 6 week - >50 + altered bowels - >50 + bleeds (x IDA) - <50 + both above - unexplained IDA - >40 + Sx + FH - IBD - polyps >5mm

Answer 4

1 - slight increase - 1 fist deg >55 2 - moderate - one first deg <55 - 2 first deg, same side, any age 3 - high - FAP, syndromes - 1 first + 2, any age - multiple w <55 - any, ca w multiple polyp. OR 1st degree polyp without ca

Answer 5

7% of positive FOB will have bowel cancer FU 5 years after - regular physical exam, DRE and CEA for first couple of years, then annually, imaging once between years 1-3 IBD - baseline 8-10 year post diagnosis - Low risk: then 5y - Intermediate: 3y - High risk: 1y (can extend out if 2x in a row without issue)

Answer 6

W: confirmed or suspected C-19 - Acute: 0-4w - Ongoing symp 4-12 - Long-covid: >12w 6-20% infected with covid have some sx R: severe, F, >BMI, pre-existing dx, hosp Sx: wide-ranging - Impact on life Ex: - pulse, BP, sats, other depending on symps Ix: - Basic +/- ECG +/- CXR, spirometry Mx - Symptom diary on healthify - Pacing resources - Sleep hygeine - Fluids/salt - Exercise as able Resolution mostly <4m if non-hosp <9m if hosp 15% >12m

Answer 7

Asthma - >12% after dilator - variable results COPD - <12%, more fixed DLCO: - diffusing capacity of the lung for carbon monoxide - low in fibrosis, emphysema, PE, anaemia

Answer 8

W: 4th cause of death: IHD, stroke, lung ca D: SOB/cough/sputum - Long-term exposure - Ratio <0.7 on spiro CAT, mMRC scores Spiro: ratio <0.7 - mild: FEV1 60-80% - mod: 40-59% pred - severe: <40% pred Mx: - stop smoking - exercise 30m+ /day - weight loss/nutrition - pulmonary rehab - COPD action plan - Imms (funded flu, pneumo not) Meds improve sx, exercise and QOL, reduce exacerbations. NO EVIDENCE that prevent decline in fx 1. SABA/SAMA/combo - SAMA better 2. LAMA (LABA 2nd) 3. Combo - If CAT score 20+ 4. +ICS if 2+ exac/yr OR eos >0.3. Remove if pneumonia or no exacerbations. ICS has increased risk pneumonia Asthma/COPD overlap 27% - ICS+LABA - FEV1 >400ml post dilator, particularly if asthma <40yr, smoking >10pyhm eos >0.3 + LAMA later on

Answer 9

- increased exac - sensitivity to allergen - tachyphylaxis (tolerance) 3x more dispenses per year (12 >death) - Increased ED risk INDEP of severity Refer to resp after 2 puff BD of symbicort

Answer 10

From resp or immunologist via SA - omalizumab if IgE - mpolizumab / benralizumab if Eos SE's parasitic infections, sensitivity reactions

Answer 11

1. Technique 2. Diagnosis - overlap, rhinitis - GORD, OSA, reflux - Smoking, damp - Occupation - NSAID, beta-block 3. Action plan 4. Addressing above

Answer 12

If SF >1000 μg/L, refer to a gastroenterologist, haematologist or physician with an interest in iron overload. <1000 - ETOH intake - liver disease? - metabolic syndrome, diabetes - HFE genotype if >tsat - maignancy/infection

Answer 13

W: Autosomal recessive Early - lethargy, apathy, tiredness - GI symptoms, abdo pain Later - Arthralgias - loss of libido, ED,

Answer 14

W: 90% de novo, 400 people in NZ, M>F, >40, 50-70 mostly P: 1.5 - 4yr after symptoms

Answer 15

R: 20-40, 2.5F>M, smoking, N/South, vit D deficiency, 1/5 have FH W: ?AI activated by infection agent - CNS white and grey matter - 85% R-R, most relapse 2yrly - 60% develop S-P within 15yr - 10% P-P from outset - 10% benign MS (more like latent) Sx - increase over few days, stabilise days to weeks, part/resolve weeks - 25% present due to ON (x all MS) IX: - MRI. CSF + Serum bands only if MRI -ve. Positive if established dx ON = moving - RAPD and papilloedema on exam - ask r/e BRIGHT red object intensity - INO: eye lags (III + VI not together) Mx - Flu vaccine - DMARD (inferferon, nadalimumab) - Methylpred (in GP but d/w neuro) - Preg: relapse less likely but x DMARD for 3m prior to preg Issues: - Constipation - Bladder emptying and UTI - Spasticity: PT, weed, baclofen - Cognition - Depression - Driving: private ok if good function, NOT HC P: reduces life-expectancy by 6-11y

Answer 16

Mx: - Valproate (FBC

Answer 17

ED Reduced ability to sweat Urine incontinence Dizziness and fainting Cause: - DM - ETOH - Infections - AI disease e.g. lupus, RA - Genetic - Toxins - Physical trauma - MS/PD/amyloid

Answer 18

W: unilateral arm pain, numbness, paraes in derm distribution +/- weakness - 50-55y, M>F, cigs, lumbar - C6/7 disease will affect C7 root - Transitions as NO C8 vertebra C: degen, disc hernation, trauma, cysts, tumours Sx: - Occipital headache - Trapezial pain - Neck pain (disc or mech) - C7 difficulty grip/overhead EX C4: wing, pain/numb base neck C5: weak deltoid/bicep + reflex C6: wrist ext, brachioradialis C7: triceps, wrist flexion, MOST C8: distal phalanx, ulnar pattern T1: intrinsics, axillary, Horners Tests - Spurlings: push down on head when rotating neck -> IL pain - shoulder abduction RELIEVES HELPFUL TO DIFFERENTIATE Ix: Exam, XR inc flex and extension views, MRI spine Mx: non-operative 90% - REST, analgesia, rehab +/- steroid +/- operative Can injury nerves e.g. rec laryngeal, sympathetic chain Diff: plexus and nerve injury - Plexus injury more patchy, trauma/tumour. - Note cell phone use makes cubital tunnel sx worse (excessive flexion), weak pinch, weak grasp

Answer 19

15 min - History, impact, safety, collateral - GPCOG -> <5 -> Mini-ACE - Other causes? Mood? - Arrange investigation Age-related cog impairment DOES NOT HAVE AFFECT on FUNCTION - mild-cog impairment is between, some impact but not significant - 50% MCI -> dementia IX - bloods, inc HIV/syphilis - MSU - CT head IF will help Mx - explain diagnosis and why - discussion course + prognosis - NASC if needed, support - Consider: driving, EPOA, ACP, preparing a will SLOW SX - x smoke,

Answer 20

After 2x meds OR lesion found

Answer 21

Migraine W: - ANY age, often worse peri-men age - Usually UL, sometimes BL, can throb - Mod-severe, aggravated by exercise - Light sensitivity OR nausea and vomiting - Prodrome hrs-days -> Aura 5-60 mins -> headache up to 72hrs -> post-drome up to days IX: - Scan if CHANGES in symptoms ?cause MX: - Treat early, use max dose, combo, avoid opioid, nausea Rx - Triptan BEST (80% respond to SC - works in 15 min). Can't say triptan failed until taken SC. Rizamelt can swallow if dont like taste. Take PO with antinausea to help absorb. SE: tingly, tight throat or chest, strange sensations. Bad: CP. CI: IHD - Codeine 1d per month if not triptan responsive - Paracetamol, caffeine GOOD e.g. with panadol. 600mg brufen, 50-100 quick voltaren, naproxen 500mg, soluble aspirin 900-1000mg. Early - take paracet + nsaid and then triptan if develops. Migraine there -> take the lot - Prophylaxis depends on impact. Propranolol, candesartan, TCAs, topiramate (not in preg). Can't tell which will work better. Use best fit for patient. TCA/venlafaxine/gaba might be better if chronic pain / other chronic pain features - Botox: injected to forehead, above ear, back of head (31 injections - 750$ if generic, >1000$ if more - many insurance wont fund). once every 3 months or less. Works well - MABs: works VERY well but expensive +++ Aimovig (SC), Emgality (SE), Atogepant (tablet). 1st line in US. Few SEs - Related to ovulation -> take COCP back to back, unless aura. Cerazette or depo if aura. Aura less of a concern with oestrogen in HRT as just replacing back to normal. Tension headache - 30m to 7 days!! - BL, pressing/tight, mild-mod, NOT aggravated by activity. No nausea or vomiting. May have light sens. Medication overuse headache - 10 days month w triptan or codeine - 15 days for paracetamol or NSAID. Even if taking for something else - worse in am, neck pain, a/w anxiety - worse with exertion - transient improvement with ^ med Cluster - Very rare, M>F. Lasts 15m to 3hrs. Can have ptosis or miosis. Agitated, restless. IL autonomic features. Up to 8/day - Paroxysmal hemicrania: 20/day, <30 min - SUNCT: very rare, 5-240s, up to 300/day MX: trial of indomethacin, 25-75mg TDS - pred at start, SC sumatriptan, high flow O2 15-20min, build up verapamil - Occipital nerve block, emgality MAB NATIONAL MIGRAINE CENTRE MONTHLY DIARY - comments e.g. periods

Answer 22

Mild TBI (concussion, although this often has a milder implication): - LOC <30min - Amnesia <24hrs -> usually fine, full recovery within 1 year 7d Worse: - vomiting persisting - headache + feeling shit straight away - >40 - how many and how close together - existing mood disorder or headache IX: - BIST is basically Hx, some use, some not - CT most useful initially for ?bleed / skull# - persistent, increasing or vomiting - older + fallen, with delay in symptoms MX: - ACC45 - Letters for work/school - Paracetamol/brufen - TCA when sleep disrupted. Drowsy @ 1st - Get moving! Part-time work ASAP - No sport 14d, no competition 21d - Refer if unsure. Will get home visit and FU. Triaged based on referral. MRI and psych testing further down the line.

Answer 23

Anaemia: destruction/loss IDA: - Oval and pencil cells (cylindrical) - Soluble transferrin high in IDA - TIBC >75 (> bind sites made available) - Can get reactive high platelets - Ret-He also helpful. A high or normal ferritin value together with a low RET-He value can suggest functional iron deficiency. Low ferritin values together with low RET-He suggest a classic iron deficiency. - Transfusion <70 or <80 if CHF. Can tolerate low if chronic - Remember 2hr between PPI and iron - Ferriject 1000g 2 weekly for 2x doses - Pregnancy: ferritin <30, as demand x3, oral 1st line. IV ONLY IN 2ND / 3RD TRIMESTER. Skeletal deformities. Inflammatory anaemia (chronic Dx) - normocytic, microcytosis over time. >hepcidin reduced iron absorption - Iron replacement still helpful - Soluble transferrin receptor negative - raised CRP Haemolysis: - Bili: uncon haemolysis, con in LD - Increases MCV as reticulocytes large +Ve coombs = acquired, Ig mediated - Spherocyte full cells burst in capillaries - Fragments in MAHA, TTP/HUS - Agglutinins in cold immune haemolysis - Blister cells in oxidative, G6PD. - MX: STEROIDS, refer to haematology -> may need transfusion. a-Thalassaemia - 1/4 = asymp - 2/4 = trait (mild, microcytic, raised RBC, n/> ferritin) - 3/4 = HbH (mild-mod anaemia) - 4/4 = Fetal death -> refer to genetics if 2x married partners trait Macrocytosis - MDS in older people -> monitor - B12 often borderline in elderly and pregnancy. Stores last 2-3 years. Can do MMA level if suspicious and still normal. Replace if low in pregnancy, alcohol without anaemia, dementia. - Otherwise only if anaemia, macrocytosis, peripheral neuropathy. - Intrinsic factor Abs if ?pernicious anaemia PCV - low EPO and JAK-2 - High EPO in malignancy OR hypoxia - Otherwise secondary MX: aspirin, venesection - Hydroxyuria if >60, IHD, TIA, HTN Cx: thrombotic events High plt -> check ferritin!!!! Essential thrombocythaemia - Jak2, CALR, MPL - Can -> myelfibrosis or acute leukaemia - Cx: thrombosis Note plt >1000, patients can -> haemolytic - Can cause aquired vWB disease

Answer 24

CML - W: 50-60, M>F - often asymptomatic initially, then B symtpoms and splenomegaly - chronic (stable) -> accelerated -> blast - philadelphia chromosone, BCR-ABL - imatinib works well (TKI inhibitor), stem cell for younger or blast crisis TRANSFORMING SEPARATES CML/CLL AML - Any age but most >65 - fatigue, fever, easy bruising, infection, anaemia and F - often asymptomatic but B symptoms, swollen nodes + infecitions! SLOW - >lymph, small, marrow infiltration - W&W, may need rituximab / cyclo or targeted. Stem cell for young/advanced ALL - W: mostly children 2-5 but older too - fatigue, bleeding, fever, nodes, CNS - lymphoblasts, can still be lymph - Multi drug chemo, intrathecal, stem

Answer 25

Campylobacter Influenza CMV/EBV Zika Mycoplasma HIV

Answer 26

Remission, limit progression to joint destruction If remission not possible, for low disease activity Mod-severe: monthly bloods Mild-Mod: 3-6 monthly bloods

Medical Flashcards

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