Medicine Flashcards
(587 cards)
1
Q
Definition of Acute Coronary Syndrome
A
Myocardial ischaemia caused atherosclerotic coronary artery disease and includes:
⁃ STEMI
⁃ Non-STEMI
⁃ Unstable Angina
2
Q
Epidemiology of Acute Coronary Syndrome
A
- Coronary heart disease is the leading cause of death. ACS is common affecting 15 in 1000 people
- 1/3rd% of ACS patients have STEMIs, 1/3rd NSTEMIs, 1/3rd Unstable angina
3
Q
Aetiology and risk factors for acute coronary syndrome
A
Aetiology:
• Unstable atherosclerotic plaques that lead to coronary artery narrowing and myocardial ischaemia
Risk factors:
• HTN
• Diabetes
• Dyslipidaemia
• Smoking
• Family Hx (< 50 years)
• Age & Sex (male)
• High BMI
4
Q
Pathophysiology of Acute Coronary Syndrome
A
Pathophysiology:
• Disruption of vulnerable or unstable plaques –> plaque rupture
• Platelet activation and thrombus formation
• Blood flow disruption leading to myocardial ischaemia (inadequate O2 supply for myocardial demand)
• More than 90% of STEMIs have evidence of coronary artery thrombosis compared to 35%-75% in UA or NSTEMI
5
Q
Clinical presentations of Acute Coronary Syndrome
A
6
Q
Differential diagnosis for Acute Coronary Syndrome - things that cannot be missed
A
- Aortic dissection
- PE
- Tension pneumothorax
- Oesophageal bleed
7
Q
Investigations for Acute Coronary Syndrome
A
8
Q
Management of Acute Coronary Syndrome
A
9
Q
Lifestyle modifications for Acute Coronary Syndrome
A
Lifestyle Modification:
- Alcohol reduction
- Blood pressure and BMI management
- Cease smoking, cholesterol reduction
- Diabetes management, diet
- Exercise (3 x 10min a day)
10
Q
Complications of Acute Coronary Syndrome
A
Complications:
- Death
- Arrhythmias
- Ruptures
- Tamponade
- Heart Failure
- Valvulopathy
- Aneuryms
- Dressler’s syndrome
- Embolism
- Recurrence/regurgitation
- Death
- Arrhythmias
- Myocardial damage
- Valvular damage/papillary muscle rupture
- Ventricular septal rupture (3-5 days post MI)
- Free wall rupture –> tamponade (3-5 days post MI)
11
Q
Evolution of acute infarct on ECG
A
12
Q
Admission vs discharge for Non-ST elevated ACS
A
13
Q
Extra info Acute Coronary Syndrome
A
14
Q
Definition of Acute Renal Failure
A
Definition: (Acute kidney injury)
- An acute decline in the GFR from baseline, usually reversible, resulting in the retention of urea and other nitrogenous wastes
- The resulting effects include impaired clearance and derangement in metabolic homeostasis, pH regulation, electrolyte regulation and volume regulation
15
Q
Epidemiology and risk factors for acute renal failure
A
16
Q
Aetiology of Acute Renal Failure
A
1. Pre-renal causes (reduced renal perfusion):
- Hypovolaemia (burns, 3rd spacing of fluid etc.)
- Shock (cardiogenic, septic, hypvolaemic, neurogenic)
- Haemorrhage
- Diarrhoea
- Renal artery stenosis + ACE inhibitors or NSAIDs
- Congestive Heart failure
- Burns
2. Intra-renal causes (direct injury to the renal parenchyma):
- Acute tubular necrosis – 85%
- Glomerulonephritis – 5%
- Interstitial nephritis – 15%
- Haemolytic uraemic syndrome
- Renal infarction
- Renal vein thrombosis
- Drugs (e.g. aminoglycosides)/toxins/radiocontrast
- Post-renal causes (obstruction of urinary flow):
- Tumour
- Prostate hyperplasia
- Stricture
- Renal calculi
- Ascending UTI
- Urinary retention
- Retroperitoneal fibrosis
17
Q
Pathophysiology of acute renal failure
A
18
Q
Clinical features of Acute Renal Failure
A
19
Q
Investigations for acute renal failure
A
20
Q
Diagnosis and classification of Acute Renal Failure
A
21
Q
Management of acute renal failure
A
22
Q
Complications of acute renal failure
A
Complications:
- Hyperkalaemia
- Acute Tubular Necrosis
- Metabolic acidosis
- Post-obstructive diuresis – Requires careful fluid replacement and electrolyte management
- Hyperphosphataemia (long-term high)
- Chronic progressive kidney disease (high-risk if patient Rx by dialysis)
- End-stage renal disease (up to 10%)
23
Q
Prognosis of acute renal failure
A
Prognosis:
- ARF is associated with increased risk of in-hospital and long term mortality
- More likely to die prematurely after leaving the hospital, even if their renal function has recovered
- Dialysed patients are also at extremely high risks of developing chronic progressive kidney disease
- Up to 10% develop ESRD
24
Q
Definition of Cushing’s Syndrome
A
Definition:
• Clinical manifestation of hypercortisolism
25
**Epidemiology of Cushing's Syndrome**
Epidemiology:
* Relatively uncommon
* Females \> males (5:1)
* Diagnosed usually 20-50s but can occur at any age, including paediatrics
26
**Aetiology for Cushing's Syndrome**
27
**Classification of Cushing's Syndrome**
28
**Clinical Features of Cushing's Syndrome**
29
**Investigations for Cushing's Syndrome**
30
**Treatment for Cushing's Syndrome**
31
**Complications of Cushing's Syndrome**
32
**Definition of adrenal insufficiency**
**Definition:**
* Results from inadequate secretion of cortisol and/or aldosterone
* Potentially fatal from adrenal crisis
33
**Epidemiology of adrenal insufficiency**
Most commonly encountered in patients where the underlying disease is treated with exogenous corticosteroids ⁃ E.g. Asthma, COPD or arthritis
34
**Aetiology of adrenal insufficiency**
35
**Pathophysiology of adrenal insufficiency**
**Pathophysiology:**
* Exposure to excess glucocorticoids, be it endogenous or exogenous, results in negative feedback
* Both the hypothalamus and pituitary reduce the amounts of CRH and ACTH produced, leading to ↓serum cortisol
* This suppression persists, especially in sudden removal of the corticosteroid, leading to symptoms of adrenal insufficiency
36
**Clinical features of adrenal insufficiency**
37
**Investigations for adrenal insufficiency**
38
**Treatment for adrenal insufficiency**
39
**Complications and prognosis of adrenal insufficiency**
**Complications**:
* Secondary Cushingʼs syndrome - due to over replacement of glucocorticoids
* Osteopenia/osteoporosis - from long term glucocorticoid use
* Rx-related HTN - due to excessive use of mineralocorticoids
**Prognosis:**
• Adrenal insufficiency 2° to corticosteroid treatment has a generally good prognosis
40
**What is Conn's Syndrome and its:**
* **Causes**
* **Clinical features**
* **Investigations**
* **Treatment**
41
**What is Phaeochromocytoma and its:**
* **Clinical features**
* **Investigations**
* **Treatment**
* **Complications**
* **Prognosis**
42
**Definition of alcohol withdrawal**
A syndrome that occurs in alcohol abusers as a result of cessation or reduction in alcohol intake, resulting in lower levels of blood alcohol to which the pt is habituated to.
43
**Epidemiology and risk factors for alcohol withdrawal**
**Epidemiology:**
• The prevalence of disorders related to alcohol use is ~2% in developed countries • Common problem
**Aetiology:**
* Aetiology of withdrawal is unknown. Due to neurochemical changes that occur in the brain
* Risk Factors: ⁃ Abrupt withdrawal of alcohol
44
**Pathophysiology and classification of alcohol withdrawal**
45
**Clinical features of alcohol withdrawal**
46
**Investigations for alcohol withdrawal**
Investigations:
* FBC, UECs, LFTs (all parameters may be elevated)
* Toxicology screen (may be positive for other drugs)
* CT head (consider) – to exclude other potential causes of presentation
47
**Differential diagnosis for alcohol withdrawal**
**DDx:**
* Sympathomimetic intoxication
* Hepatic encephalopathy
* Encephalitis/meningitis
* Wernickeʼs encephalopathy
48
**Management of alcohol withdrawal**
49
**Complications and prognosis of alcohol withdrawal**
**Complications:**
* Oversedation – short term due to benzodiazapines
* Delirium tremens – occurs in 5% of patients
* Alcohol withdrawal seizures
**Prognosis:**
* 50% remain abstinent for a year
* Relapse prevention can be achieved by counselling and self-help groups
50
**Description of alcohol withdrawal delirium**
51
**What is Wernicke's encephalopathy**
* **Causes**
* **Pathophysiology**
* **Complications**
* **Prognosis**
52
**add in angina slides – Gobi's incomplete**
53
**Definition of atrial fibrillation**
**Definition:**
* AF: A supraventricular tachycardia characterised by a loss of atrioventricular synchrony, causing an irregularly irregular heart rhythm
* Acute AF = new onset or a first detectible episode of AF, whether symptomatic or not
* Atrial Flutter: A macro-reentrant atrial tachycardia with atrial rates between 240 - 320 bpm
54
**Epidemiology of atrial fibrillation**
55
**Aetiology of atrial fibrillation**
**Aetiology:**
• Risk factors:
⁃ Increasing age
⁃ HTN
⁃ IHD including MI
⁃ CHF
⁃ Valvular heart disease & Rheumatic heard disease
⁃ Diabetes ⁃ Hyperthyroidism
⁃ PE
⁃ Heavy alcohol intake
56
**Pathophysiology and classification of atrial fibrillation**
57
**Clinical features of atrial fibrillation**
58
**Investigations and diagnosis of atrial fibrillation**
59
**Differential diagnosis for atrial fibrillation**
60
**Management of atrial fibrillation**
61
**Complications of atrial fibrillation**
62
**Prognosis of atrial fibrillation**
63
**Example of ECG changes in atrial fibrillation**
64
**Definition of blood components**
Blood components are those products that are derived from whole blood (or platelet-rich plasma) by phlebotomy using differential centrifuge
65
**Fresh blood products:**
* **Components**
* **Composition of each component**
* **Use of each component**
66
**Plasma derivatives products:**
* **Components**
* **Composition of each component**
* **Use of each component**
67
**Screening and pre-transfusion testing for blood products**
68
**When is transfusion of blood recommended**
1. Transfusion recommended for Hb \< 70g/L - May not be required for a well patient or other Rx available
2. Transfusion is not associated with reduced mortality for Hb 70-100g/L
3. Transfusion is not recommended for Hb \>100g/L (increased mortality)
69
**Practice points for usage of blood products**
**Practice Points:**
- RBC transfusion should not be based on Hb concentration alone but patientʼs clinical status
- Single transfusion at a time and re-assess
- Fe2+ replacement is required in deficient patients regardless of transfusion indication
- 1 unit of RBCs will raise Hb by 1g/L
- Wet purpura in mouth is associated with increase risk of internal bleeding
- Note: Warfarin is hyper-coagulant when initially given as it inhibits protein C and S
70
**Use of platelet therapy**
- Bleeding where thrombocytopenia is considered a major factor (e.g. massive haemorrhage)
- If platelets \< 50 or 100 with diffuse vascular bleeding
- 1 Platelet pool will increase platelet count by 25 x 10^9
71
**Use of fresh frozen plasma**
72
Factor concentrates in blood products
73
**Different types of transfusion reactions**
74
Summary chart of product name, what it is and common uses of blood products
75
**Adverse transfusion reactions**
* Death occurring due to transfusion incompatibility is rare but a serious consequence
* Relatively minor symptoms of transfusion reactions occur in 1% of cases (itch, fever, urticaria) and usually in patients that have repeated transfusions
76
**Acute Haemolytic Transfusion Reaction:**
* **Definition**
* **Epidemiology**
* **Pathophysiology**
* **Clinical Features**
* **Treatment**
* **Prognosis**
77
**Septic transfusion reactions**
* **Definition**
* **Pathophysiology**
* **Clinical Features**
* **Investigation**
* **Management**
78
**Transfusion Related Acute Lung Injury (TRALI)**
* **Definition**
* **Risk factors**
* **Pathophysiology**
* **Clinical Features**
* **Investigation**
* **Management**
79
**Transfusion Associated Circulatory Overload (TACO)**
* Definition
* Risk Factors
* Clinical Features
* Investigations
* Management
80
**Delayed Transfusion Reactions**
* **Symptoms**
* **Pathogenesis**
* **Investigations**
* **Management**
81
**Severe Allergic Reactions**
* **Description**
* **Clinical Features**
* **Management**
82
**Transfusion associated Graft Vs Host disease**
* **Description/cause**
* **Clinical features**
* **investigations**
* **Management**
83
**Minor allergic transfusion reactions:**
* **Description**
* **Clinical Features**
* **Investigations**
* **Management**
84
**Febrile non-haemolytic reaction:**
* **Definition**
* **Pathophysiology**
* **Clinical Features**
* **Treatment**
85
**Definition of Bronchiectasis**
Definition:
• Permanent dilation of bronchi due to the destruction of the elastic and muscular component of the wall, 2° to chronic infection
86
**Aetiology of bronchiectasis**
87
**Pathophysiology and classification of bronchiectasis**
88
**Clinical features of bronchiectasis**
89
**investigations for bronchiectasis**
90
**Differential diagnosis for bronchiectasis**
DDx:
* COPD – diminished breath sounds in COPD. Rhonchi may be auscultated in bronchiectasis. CT dx
* Asthma – no inspiratory squeaks and crackles as heard in bronchiectasis
* Pneumonia – short course as opposed to bronchiectasis which may be years
91
**Treatment for bronchiectasis**
Rx
* Exercise and improved nutrition – helps with mucus clearance & improves exercise capacity
* Airway clearance therapy – postural drainage, percussion and vibration methods at least 2x daily
* Abx may be necessary (check sensitivity) – inhaled options or short term course with acute exacerbations
* Inhaled bronchodilator (adjunct)
* Sx – complete resection of affected areas may be appropriate; Lung transplantation if FEV \< 30% predicted
* Prevention – Vaccination against influenza and pneumococcal infections + measles and pertussis
92
**Complications and prognosis of bronchiectasis**
**Complications:**
* Massive haemoptysis – Massive life-threatening bleeding can occur (\> 250mL) - (variable low)
* Respiratory failure
* Cor pulmonale
**Prognosis:**
* Irreversible condition
* Disease course is consistent with symptom control followed by acute exacerbations
* ↑ Mortality associated with hypoxia, hypercapnoea, dyspnoea, radiological extent of disease
* Pseudomonas species in sputum indicate more extensive lung disease
93
**Definition of cardiac arrhythmias**
Definition:
• Disturbance of the normal sinus cardiac rhythm
94
**Epidemiology and aetiology of cardiac arrhythmias**
95
**Describe a sinus arrhythmia**
96
**Describe a sinus bradycardia**
97
**Describe sinus tachycardia**
98
**Describe Atrial Ectopic Beats including ECG features**
99
**Describe atrial tachycardia**
100
**Describe atrial flutter**
101
**Describe Atrial Fibrillation including risk factors, treatment and ECG features**
102
**Describe AVNRT**
103
**Describe ventricular tachycardia including ECG**
104
**Describe Torsades De Pointes**
105
**Describe Ventricular Fibrillation**
106
**Describe sick sinus syndrome**
107
ECG AV block
108
**Describe bundle branch block including causes**
109
**Definition of cerebral aneurysms**
110
**Epidemiology of cerebral aneurysms**
**Epidemiology:**
* 1-5% of the population have cerebral aneurysms
* Female \> male (2:1)
* Typically become symptomatic at age 40-60s
* Location: 85% anterior circulation; 10% posterior circulation
* 10-30% will have multiple aneurysms
111
**Aetiology of cerebral aneurysms**
**Aetiology:**
* Haemodynamically induced
* Atherosclerosis
* Vasculopathy
* High flow states (AV Malformation or AV Fistula)
112
**Risk factors for cerebral aneurysms**
113
**Pathophysiology of cerebral aneurysms**
Pathophysiology:
* Arise from the bifurcation of the major arteries that form the COW
* Site of turbulent flow and sheer forces
114
**Clinical features of cerebral aneurysms**
115
**Management and prognosis of cerebral aneurysms**
116
**Definition of constipation**
Definition:
* Infrequent passage of hard stools
* Normal stool frequency is 3x a day to 3x per week
117
**Epidemiology of constipation**
**Epidemiology:**
* Female \> males (2:1)
* Age \> 65 years
* Black ancestry
* Pregnancy
118
**Aetiology of constipation**
119
**Red flags of constipation**
**Red Flags:**
* Middle-aged/Elderly
* Rectal bleeding
* Pain
* Weight loss
120
**Clinical features of constipation**
**Clinical Features:**
* Excessive straining
* Sense of incomplete evacuation
* Failed or lengthy attempts to evacuate
* Hard stool and less frequency
121
**Investigations for constipation**
122
**Treatment for constipation**
123
**Definition of chronic kidney disease**
**Definition:**
* Irreversible deterioration in renal function, which classically develops over a period of years
* Defined as – evidence of kidney damage on pathology, imaging or laboratory findings such as haematuria, proteinuria or reduction in eGFR ≤ 60mL/min/1.73m2 for \> 3 months
124
**Epidemiology of chronic kidney disease**
Epidemiology:
* Common condition – 15% of Australian population had CKD stage 3-5
* Incidence is rising due to ageing population
* Death rate 25-30x higher in ESRF than general population – 50% from complications of CVD
* DM and HTN are responsible for \> 80% of the causes of CKD
125
**Aetiology of chronic kidney disease**
126
**Risk factors for chronic kidney disease**
Risk Factors:
* DM
* HTN
* Age \> 50 years
* Smoking, obesity, FHx, autoimmune disease (weak); CV disease; Indigenous and Afro-Caribbean's
* Male sex
* Long-term NSAID use
127
**Pathophysiology and classification of chronic kidney disease**
128
**Clinical features of chronic kidney disease**
129
**Investigations for chronic kidney disease**
130
**Management of chronic kidney disease**
131
**Complications of chronic kidney disease**
132
**Prognosis of chronic kidney disease**
133
**Definition of SLE**
Definition:
• Chronic multi-system, autoimmune connective tissue disorder characterised by the presence of antinuclear Antibodies
134
**Epidemiology of SLE**
**Epidemiology:**
* Incidence is 0.1%
* Age: 30-50s
* F \> M (9:1)
* More common in Asians and Afro-Caribbean populations
135
**Aetiology of SLE**
**Aetiology:**
* Unknown. Multifactorial
* Genetic factors (25% in monozygotic twins) + epigenetic changes
* Hormones – premenopausal women
* Drugs – Sulfasalazine, phenytoin, carbamazepine
* Viral Infections – EBV exposure
136
**Risk factors for SLE**
**Risk Factors:**
* Premenopausal women (20-50s)
* Drugs
* Family Hx
* Other autoimmune diseases
* UV light exposure triggers SLE flares
137
**Pathophysiology of SLE**
138
**Clinical features of SLE**
139
**Investigations for SLE**
140
**Management of SLE**
141
Complications and prognosis of SLE
142
Description and treatment of anti-phospholipid syndrome
143
**Systemic Sclerosis (Scleroderma):**
* **Definition**
* **Epidemiology**
* **Aetiology**
144
**Pathophysiology and types of systemic sclerosis**
145
**Clinical features of scleroderma**
146
**Investigations for systemic sclerosis**
147
**Treatment for systemic sclerosis**
148
**Complications and prognosis of systemic sclerosis**
149
**Definition, epidemiology and histological features of polymyositosis and dermatomyositosis**
Polymyositis and Dermatomyositis
* Inflammatory autoimmune disorder of the muscles
* F \> M (3:1)
* Can occur at any age but peak is 50s
* Histological features: muscle fibre necrosis with regeneration and inflammatory cell infiltrate
* Dermatomyositis has skin involvement and has an increased risk of cancer (15%)
150
**Clinical features of Polymyositis and Dermatomyositis**
151
Investigation, management and prognosis of Polymyositis and Dermatomyositis
152
**Description and clinical features of inclusion-body myositosis**
153
**Description and causes of inflammatory myopathies**
154
**Definition of COPD**
155
**Epidemiology of COPD**
156
**Aetiology of COPD**
157
**Pathophysiology of COPD**
158
**Influence of smoking on airflow - COPD**
159
**Clinical features of COPD**
160
**Physical examination for COPD**
161
**Investigations for COPD**
162
**Diagnosis and staging for COPD**
163
**Differential diagnosis for COPD**
164
**Management for COPD**
165
**Complications of COPD**
166
**Prognosis of COPD**
167
**Definition of gout**
**Definition:**
• Inflammatory arthritis associated with hyperuricaemia and deposition of intra-articular sodium urate crystals
168
**Epidemiology of gout**
**Epidemiology:**
* 1% of Western populations
* Incidence increases with age (\> 50 years)
* Males \> females (10:1)
* Rare in pre-menopausal women or young
* Differs geographically and racially - E.g. Maori population 6.5%
169
**Aetiology and risk factors for gout**
170
**Pathophysiology of gout**
Pathophysiology:
* Crystal formation and deposition in joints due to supersaturated solution of uric acid in blood
* Inflammatory response by phagocytes + complement activation
* Tissue damage due to immunological response
171
**Clinical features of gout**
172
**Investigations for gout**
173
**Management of gout**
174
**Complications and prognosis of gout**
175
**Pseudogout:**
* **Description**
* **Risk factors**
* **Clinical features**
* **Investigation**
* **Management**
176
**Definition of delirium**
**Definition:**
* Acute, fluctuating change in mental status, with inattention, disorganised thinking and altered level of consciousness
* It is a medical emergency due to high morbidity and mortality
177
**Epidemiology of delirium**
**Epidemiology:**
* Most common psychosis in general hospitals
* Affects 1 in 5 general admissions
* More common in elderly (\> 60 years)
* High cause of mortality (14% within 1 month of diagnosis)
178
**Aetiology of delirium**
179
**Risk factors and pathophysiology of delirium**
**Risk Factors:**
* Age
* Dementia or cognitive impairment
* Visual/hearing impairment
* Functional impairment or immobility
* Hx of delirium
* Decreased oral intake (dehydration)
* Polypharmacy
* Co-existing medical illnesses
* Surgery
**Pathophysiology: • Remains unclear**
180
**Diagnosis of delirium**
**Diagnosis is Clinical – DSM-V criteria:**
* Disturbance in attention (orientation, focus, consciousness)
* A change in cognition (memory impairment, disorientation, language disturbance)
* Disturbance that develops over a short time (usually hours to days)
* Evidence from Hx, Physical examination or Ix of organic cause (e.g. substance intoxication/withdrawal)
181
**Physical exam for delirium**
182
**Investigations for delirium**
183
**Management of delirium**
184
**Delirium Vs Dementia**
185
**Definition of Diabetes Insipidus**
Definition:
• A metabolic disorder characterised by a defective ability to concentrate urine in the kidneys, resulting in polyuria, polydipsia and hypotonic urine
186
**Epidemiology of Diabetes Insipidus**
**Epidemiology:**
• Uncommon • M = F and no ethnic preference
187
**Aetiology of Diabetes Insipidus**
188
**Pathophysiology of Diabetes Insipidus**
189
**Clinical features of Diabetes Insipidus**
190
**Investigations for Diabetes Insipidus**
191
**Differential diagnosis for Diabetes Insipidus**
**DDx:**
* 1° polydipsia – due to excess water intake
* DM chronic
* Diuretic use
192
**Management of Diabetes Insipidus**
193
**Complications and prognosis of Diabetes Insipidus**
**Complications:**
* Hypernatraemia (short term medium)
* Hypovolaemia
**Prognosis:**
* Depends on cause. In majority of cases DI is life-long
* In certain patients it may be transient 2° to trauma, Sx, metabolic
* Majority of pts with chronic central DI are well controlled
194
**Drug overdose of Paracetamol:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
195
**Drug overdose of TCAs (Tricyclic Antidepressants):**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
196
**Drug overdose of organophosphates:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
197
**Drug overdose of Digoxin:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
198
**Drug overdose of Benzodiazepines:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
199
**Drug overdose of Opioids:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
200
**Drug overdose of Methanol/Ethylene Glycol:**
* Mechanism of action
* Use of drug
* Outcome and clinical features of overdose
* Management of overdose
201
**Diuretics:**
* Class
* Description
* Example
202
**Drugs that damage the kidney**
203
**Definition and epidemiology of hyponatraemia**
204
**Clinical features of hyponatraemia**
205
**Classification of hyponatraemia**
206
**Pathophysiology of hyponatraemia**
207
**Investigation, management and complications of hyponatraemia**
208
**SIADH (Syndrome of Inappropriate ADH):**
* Description
* Aetiology
* Pathophysiology
* Management
209
**Epidemiology of falls in elderly**
**Epidemiology:**
* Common in the elderly
* Causes significant morbidity and mortality
* Aetiology is often multifactorial
210
**Risk factors for falls in elderly**
**Risk Factors:**
* Age \> 65
* Prev fall in last 12 months
* Poor mobility, use of walking aids
* Visual impairment
* Dementia, delirium, confusion
* Syncope
* Polypharmacy
* Inappropriate footwear
* Poor nutrition
* Osteoporosis & steroid use
211
**Classification of falls in elderly**
212
**Circumstances surrounding falls in elderly**
213
**Definition of Non-Alcoholic Fatty Liver Disease (NAFLD)**
**Definition:**
* Steatosis of the liver that is not due to excessive alcohol use
* NASH (non-alcoholic steatohepatitis) is the most extreme form of NAFLD and can progress to liver failure
214
**Risk factors for Non-Alcoholic Fatty Liver Disease**
**Risk Factors:**
* Obesity
* Insulin resistance
* Dyslipidaemia
* T2DM
* Metabbolic syndrome
* Rapid weight loss
* Total parenteral nutrition
* Wilsonʼs disease
* Alpha1-antitrypsin deficiency
215
**Epidemiology and Aetiology of Non-Alcoholic Fatty Liver Disease**
216
**Pathophysiology of Non-Alcoholic Fatty Liver Disease**
217
**Clinical features and Investigations for Non-Alcoholic Fatty Liver Disease**
218
**Diagnosis and management of Non-Alcoholic Fatty Liver Disease**
219
**Differential diagnosis of Non-Alcoholic Fatty Liver Disease**
**DDx:**
* Alcoholic liver disease
* Hepatitis B/C
* Drug-induced (methotrexate)
220
**Complications and prognosis of Non-Alcoholic Fatty Liver Disease**
221
**Definition of Alcoholic Liver Disease**
222
**Epidemiology of Alcoholic Liver Disease**
223
**Risk factors for Alcoholic Liver Disease**
**Risk Factors:**
* Prolonged/heavy alcohol use
* Hepatitis C
* Women \> men (more rapidly and at lower doses)
* Obesity
* Genetic predisposition
* Smoking
224
**Aetiology of Alcoholic Liver Disease**
225
**Pathophysiology of Alcoholic Liver Disease**
226
**Clinical presentation of Alcoholic Liver Disease**
227
**Investigations for Alcoholic Liver Disease**
228
**Diagnosis and management of Alcoholic Liver Disease**
229
**Complications and prognosis of Alcoholic Liver Disease**
230
**Alcohol withdrawal and management**
231
**Definition of Glomerulonephritis**
**Definition:**
• A group of conditions characterised by glomerular injury +/- inflammatory changes in the glomerular capillaries, and BM
232
**Epidemiology of glomerulonephritis**
233
**Aetiology of glomerulonephritis**
234
**Pathophysiology of glomerulonephritis**
235
**Clinical features of glomerulonephritis**
236
**Types of non-proliferative glomerulonephritis and their features**
237
**Types of nephritic syndrome glomerulonephritis and their features**
238
**Investigations and management of glomerulonephritis**
239
**Prognosis of glomerulonephritis**
240
**Definition of Heart Failure**
241
**Epidemiology of Heart Failure**
**Epidemiology:**
* Prevalence of 2-3%, increasing to 7% in the elderly
* Men \> women (under the age of 80)
* Incidence and prevalence rises steeply with age
* Coronary artery disease accounts for 2/3rds of cases in developed countries
242
**Aetiology of Heart Failure**
**Aetiology:**
* Coronary artery disease – 2/3rds
* HTN
* Valvular disease
* Myocarditis
* Infections
* Toxins: Cocaine, amfetamines, alcohol, chemotherapy
* Genetic: HOCM, Duchenneʼs muscular dystrophy
* Tachycardia-induced – AF, Atrial flutter, thyrotoxycosis
243
**Precipitating factors for heart failure**
**Precipitating Factors:**
* Acute coronary syndrome
* Severe HTN
* Atrial and ventricular arrhythmias
* Infection
* Pulmonary emboli
* Renal failure
* Medical or dietary non-compliance
244
**Pathophysiology and classification of heart failure**
245
**Clinical features of heart failure**
**Clinical Features:**
* Exertional dyspneoa – most common symptom of systolic HF
* Orthopnoea & PND
* Fatigue, muscle weakness and tiredness
* Ankle swelling
* Wheeze (cardiac asthma)
* Night cough
* Haemotysis (rare)
246
**Clinical signs of heart failure**
**Clinical Signs:**
* Tachypnoea
* Tachycardia
* Neck vein distension (↑JVP)
* S3 gallop (3rd heart sound)
* Cardiac murmur – mitral
* Lateral displacement of apex beat
* Course crepitations
* Pleural effusion
* Hepatomegaly
* Hepato-jugular reflux
* Pitting oedema
247
**Investigations and NYHA classification of heart failure**
248
**Management of heart failure**
249
**Prognosis of heart failure**
Prognosis:
* Poor! Complications include pleural effusion, acute renal failure, acute decompensation of HF
* 30% of patients in UK are dead at 6 months from diagnosis
* NYHA class 4 – annual mortality of 40-60%; NYHA class 1-2 – annual mortality of 5-10%
* Quality of life is reduced to a greater extent than other chronic medical disorders (including arthritis and stroke)
250
**Definition of HIV/AIDS**
**Definition:**
* HIV = Chronic infection caused by the Human Immunodeficiency Virus (HIV) - Lentivirus family
* AIDS = The development of specific opportunistic infections, tumours or presentations with CD4 T count \< 200 cells/mm3
251
**Epidemiology of HIV/AIDS**
252
**Aetiology of HIV/AIDS**
253
**Risk factors for HIV/AIDS**
**Risk Factors:**
* MSM (men who have sex with men)
* Travellers
* Unprotected sex
* IV drug users, tattoos
* High maternal viral load (vertical transmission)
254
**Pathophysiology of HIV/AIDS**
255
**Classification of HIV/AIDS**
256
**Clinical features of HIV/AIDS and AIDS-defining Diseases**
257
**Investigations for HIV/AIDS**
258
**Differential diagnosis for HIV/AIDS**
* EBV,
* CMV,
* influenza infection,
* 2° syphilis – resembles 1° HIV infection symptoms
259
**Management of HIV/AIDs**
\*May need to add in info about PrEP etc - need to check up to date guidelines and add to this card
260
**Complications and prognosis of HIV**
261
**Common malignancies in HIV**
262
**Common opportunistic infections in HIV**
263
**Life cycle of HIV and drug targets**
264
**Definition of hyperkalaemia**
**Definition:**
* Normal serum K+ is 3.8-4.9mM
* Can be difficult to diagnose due to vague symptoms
265
**Causes of hyperkalaemia**
266
**Clinical features and diagnosis of hyperkalaemia**
267
**Investigations for hyperkalaemia**
Ix:
* ABG/VBG – if acidosis suspected
* Metabolic panel (serum K+, bicarb, UECs)
* BUN and Creatinine – evaluation of renal function
* Serum Calcium – hypocalcaemia can exacerbate cardiac dysfunction
* Glucose level – diabetics
* Digoxin level –
* ECG
268
**Management of hyperkalaemia**
269
**Extra information of ion exchange in cells**
270
**Definition of hypertension**
271
**Epidemiology of hypertension**
**Epidemiology:**
* 30% of Australians over 25yrs have HTN
* Males \> females
* Incidence increases with age
* Increases cardiac mortality by 2-3x
272
**Risk factors for hypertension**
**Risk Factors:**
* Obesity
* Metabolic syndrome
* DM
* Family Hx of HTN of CAD
* Age \> 65 yrs
* Sleep apnoea
* Black ancestry
* High alcohol intake
* Smoking
* High Na+ intake
273
**Aetiology of hypertension**
274
**Pathophysiology of hypertension**
275
**Clinical presentation of hypertension**
276
**Differential diagnosis of hypertension**
277
**Investigations for hypertension**
278
**Diagnosis of hypertension**
279
**Target blood pressure for management of hypertension**
280
**Non-pharmacological management of hypertension**
**Non-Pharmacological Management:**
⁃ Smoking cessation, alcohol reduction
⁃ Regular physical activity
⁃ Moderate sodium restriction and healthy eating plan
⁃ Weight reduction
⁃ Management of Obstructive Sleep Apnoea
281
**Pharmacological management of hypertension:**
* Drug class
* Example
* Mechanism of action
* Side effects
282
**Complications and prognosis of hypertension**
283
**Drug targets in control of blood pressure**
284
**Definition and epidemiology of hypopituitarism disorders**
**Definition:**
• The partial or complete deficiency in or more pituitary hormones
**Epidemiology:**
* Relatively rare with incidence 4 per 100,000 per year
* Prevalence of incidental pituitary adenomas found at autopsy is relatively high – 27% of post mortem studies
* High incidental finding on MRI (10%) – therefore only investigate if symptoms are present
* No gender, geographical or ethnic trends
285
**Aetiology of hypopituitarism disorders**
286
**Pathophysiology of hypopituitarism disorders**
287
**Clinical features for hypopituitarism disorders**
288
**Investigations for hypopituitarism disorders**
289
**Management of hypopituitarism disorders**
290
**Complication and prognosis of hypopituitarism disorders**
**Complications:**
* Male/female infertility (variable high)
* Cushingʼs syndrome – due to corticosteroid over-replacement (variable med)
* Osteoporosis/arrhythmias (thyroxine over-replacement)
* GH over-replacement – peripheral oedema, HTN, paraesthesia, hyperlipidaemia and glucose intolerance
* Testosterone over-replacement – prostatic hypertrophy, hyperlipidaemia
**Prognosis:**
* Hypopituitarism is associated with a 1.8 fold higher mortality compared to the general population
* High death rates due to cardiovascular and cerebrovascular causes (attributed to GH deficiency and increased adiposity/lipid profile)
291
**Definition of Infective Endocarditis**
**Definition:**
* Infection of the endocardial surface of the heart
* The disease may occur as an acute (fulminant) infection, but more commonly runs an insidious course (Subacute Bacterial Endocarditis)
292
**Aetiology of infective endocarditis**
293
**Risk factors for infective endocarditis**
**Risk Factors:**
* Prosthetic heart valve
* Poor dental hygiene
* IVD use
* Soft tissue infection
* Iatrogenic – dental Rx, cannula, cardiac Sx
* Immunocompromised
294
**Pathophysiology of infective endocarditis**
**Pathophysiology:**
* Damaged vascular endocardium promotes platelet and fibrin deposition
* These small thrombi allow organisms to adhere and grow --\> more fibrin deposition and platelet aggregations
* More likely to develop where haemodynamic turbulence is greatest
* Aortic and mitral valves are most commonly affected
* Right-sided endocarditis is related to IVD use or central venous catheter or temporary pacemaker insertion
* Acute endocarditis – more likely **S. aureus**; Sub-acute endocarditis – more likely S. viridans or S. epidermides
295
**Clinical features of infective endocarditis**
296
**Diagnostic criteria for infective endocarditis**
297
**Investigations for infective endocarditis**
Investigations:
* Serial blood cultures – Pts should have 3 sets of blood cultures of 2-3 hours before initiating Abx
* CXR – evidence of heart failure, multiple emboli or pulmonary infiltrates
* Echo – Transthoracic or TOE (more sensitive and specific
298
**Management of infective endocarditis**
**Management:**
* Empirical Rx – IV Benzylpenicillin + Flucocloxacilin + Gentamycin
* Difficult to eradicate bacteria from avascular vegetations --\> require long Rx
* Sx – Extensive valve damage, persistant infection, prosthetic valve, fungal endocarditis, serious emboli
299
**Prognosis of infective endocarditis**
**Prognosis:**
• Mortality ~100% without Rx. Significant morbidity and mortality even with Rx.
300
**Features of bone marrow failure**
Features of BM Failure:
* Red cells – Anaemia --\> lethargy, dyspnoea, pallor
* White cells – Neutropenia --\> Recurrent infections, fever
* Platelets – Thrombocytopenia --\> Bleeding, bruising, purpura
301
**Definition of leukemia**
302
**Epidemiology, Aetiology and Risk factors of Acute Lymphoblastic Leukemia (ALL)**
**Epidemiology and Aetiology:**
* 12% of all leukaemias
* Most common malignancy in children \< 15 years (60%)
* M \> F
* Peak age of onset is 5 years or 35 years
* Only 15% occur in adults
**Aetiology** is unknown.
**Risk factors:**
Genetic predisposition (FHx),
Down syndrome,
male
303
**Pathology of Acute Lymphoblastic Leukemia (ALL)**
**Pathology:**
* Lymphoblasts proliferate uncontrollably in the BM leading to BM failure (pancytopenia)
* Circulating blasts can infiltrate LNs, liver, spleen, kidneys, testes and CNS, causing organ failure
* 80% due to B-cell precursors & 20% due to T-cell precursors
304
**Clinical features of Acute Lymphoblastic Leukemia (ALL)**
Clinical Features:
* Hx can be short (days to weeks) due to disease aggression
* Fatigue, dizziness, palpitations and dyspnoea - due to BM failure
* Fever
* Pallor, echymoses or petechiae - due to anaemia and thrombocytopenia
* Bone pain (uncommon)
* Lymphadenopathy
* Hepatosplenomegaly, unilateral testicular enlargement, renal enlargement - due to infiltration of leukaemic blasts
* Meningism, nuchal rigidity, papilloedema - due to CNS infiltration of blasts
305
**Investigations for Acute Lymphoblastic Leukemia (ALL)**
306
**Management of Acute Lymphoblastic Leukemia (ALL)**
307
**Prognosis of Acute Lymphoblastic Leukemia (ALL)**
**Prognosis:**
* Better with decreasing age
* 5 year survival in children = 70-80%
* 3 year survival in pts \> 60 = 12%
308
**Epidemiology, Aetiology and risk factors for Acute Myeloid Leukemia (AML)**
309
**Pathology of Acute Myeloid Leukemia (AML)**
**Pathology:**
* Accumulation of immature myeloid blast cells in the BM that can lead to BM failure
* Blast cells can infiltrate the gums, liver, spleen, skin and less commonly CNS
310
**Clinical features and classification of Acute Myeloid Leukemia (AML)**
311
**Investigations for Acute Myeloid Leukemia (AML)**
312
**Management for Acute Myeloid Leukemia (AML)**
313
**Prognosis for Acute Myeloid Leukemia (AML)**
314
**Description, Epidemiology and Aetiology of Chronic Lymphocytic Leukemia (CLL)**
315
**Clinical features of Chronic Lymphocytic Leukemia (CLL)**
**Clinical Features:**
* Develops and progresses slowly over months to years
* Majority of pts are asymptomatic in early stages of disease
* Malaise, weight loss, night sweats (uncommon)
* Recurrent infections (due to dysfunctional WBCs and **hypgammaglobulinaemia**)
* Bleeding or symptoms of anaemia
* Painless lymphadenopathy (common – 60%)
* Splenomegaly (common – 50%); sometimes massive
316
**Investigations and staging of Chronic Lymphocytic Leukemia (CLL)**
317
**Management of Chronic Lymphocytic Leukemia (CLL)**
318
**Prognosis of Chronic Lymphocytic Leukemia (CLL)**
Prognosis:
* Depends on staging
* Median survival of 10 years
* 10% of CLL, Richter transformation occurs --\> high-grade lymphoma and is terminal
319
**Description, Epidemiology and Aetiology of Chronic Myeloid Leukemia (CML)**
320
**Pathology of Chronic Myeloid Leukemia (CML)**
321
**Clinical features of Chronic Myeloid Leukemia (CML)**
**Clinical Features:**
* Weight loss and night sweats
* Splenomegaly (75%)
* Fever, pallor, bruising, SOB (uncommon)
322
**Investigations for Chronic Myeloid Leukemia (CML)**
323
**Management of Chronic Myeloid Leukemia (CML)**
**Rx:**
- Tyrosine kinase inhibitor
- Cytotoxic therapy
- IFN
324
**Prognosis of Chronic Myeloid Leukemia (CML)**
**Prognosis:**
• Chronic phase (2-6 years); TKIs 93% are progression free at 6 years; Transformation to AML (2/3rd) & ALL
325
**Definition and epidemiology of Lung Cancer**
326
**Aetiology of Lung Cancer**
327
**Risk Factors for Lung Cancer**
328
**Classification of Lung Cancer**
329
**Pathophysiology of Lung Cancer**
330
**Clinical features of Lung Cancer**
331
**Investigations for Lung Cancer**
332
**Differential diagnosis of Lung Cancer**
DDx:
* Metastatic cancer
* TB
* Pneumonia/bronchitis
* Sarcoidosis
333
**Diagnosis, management and prognosis of Lung Cancer**
334
**Extra info about symptom findings in Lung Cancer**
335
**Staging and detailed treatment of Lung Cancer**
336
**Definition of Lymphoma**
337
**Description, Aetiology and Epidemiology of Hodgkins Lymphoma**
338
**Pathology of Hodgkins Lymphoma**
**Pathology:**
* Characterised by Reed-Sternberg cells
* RS cells are large bi/multi nucleated cells with prominent ʻowl eyeʼ nucleoli
* Progresses via contiguous spread
339
**Clinical features of Hodgkins Lymphoma**
**Clinical Features:**
* Painless rubbery LN enlargement – especially cervical, axillary and mediastinal
* Constitutional B symptoms: Fever, drenching night sweats (25%), weight loss of \> 10% body weight over 6 months
* Pallor and hepatosplenomegaly
340
**Ann Arbor Staging for Lymphomas**
**Ann Arbor Staging for Lymphomas:**
- Stage 1 - Restricted to 1 lymph node region
- Stage 2 - 2\> nodal involvement on 1 side of diaphragm
- Stage 3 - Lymphatic involvement on both sides
- Stage 4 - Liver, marrow or extensive extra nodal
341
**Investigations for Hodgkins Lymphoma**
342
**Management of Hodgkin's Lymphoma**
Rx:
* Chemotherapy ± radiotherapy – ABVD (Adriamycin (dixirubicin), Bleomycin, Vinblastin, Dacarbazine) regimen
* Extensive disease (stage 3 & 4) are Rx with chemo alone
* Relapse Rx with alternative chemo followed by stem cell transplant
343
**Prognosis of Hodgkin's Lymphoma**
Prognosis:
* Predominantly good for young people
* 10 year survival of 97% with early Rx – may relapse \> 15 years post Rx
* Advanced disease has 5 year survival of 50%
344
**Description of Non-Hodgkin's Lymphoma (NHL)**
**Non-Hodgkinʼs Lymphoma:**
• Clonal malignancies arising from somatic mutations in lymphocyte progenitor
345
**Aetiology and Epidemiology of Non- Hodgkins Lymphoma (NHL)**
**Epidemiology:**
* Accounts for 90% of lymphomas
* Incidence increases with age
* Males \> females
**Aetiology:**
• Genetic predisposition, immunosuppression (HIV, transplant recipients), EBV virus (Burkittʼs lymphoma)
346
**Pathology of Non-Hodgkin's Lymphoma**
Pathology:
* Subtypes: B cells (70%), T cells & NK cells (30%)
* 1° site of origin is nodal (80%) and extra nodal (20%) - GIT or bone
* Type of NHL depends on stage of development of cell before malignancy
347
**Clinical features of Non-Hodgkins Lymphoma (NHL)**
348
**Investigations for Non-Hodgkins Lymphoma (NHL)**
349
**Management of Non-Hodgkin's Lymphoma (NHL)**
350
**Prognosis of Non-Hodgkin's Lymphoma (NHL)**
**Prognosis:**
* Low grade – indolent course is _incurable_. Median survival 8-10 years
* High grade – aggressive and potentially curable (40% are disease-free at 5 years)
351
**Definition of a Medical Emergency**
**Definition:**
• Medical Emergency: Acute medical event that usually results in harm if untreated and requires urgent medical intervention
352
**Vital signs and PACE criteria**
353
**Examination of medical emergency**
354
**Description, Aetiology and Examination of coma**
355
**Essentials of diagnosis for Acute Heart Failure and Pulmonary Oedema**
356
**Definition and classification of Acute Respiratory Failure**
357
**Description and classification of Acute Renal Failure**
358
**Description of Liver Failure**
359
**Description, causes and clinical signs of Mesenteric Vascular Ischaemia**
360
**Description, causes and clinical signs of Mesenteric Vascular Ischaemia**
361
**Description, essentials of diagnosis and causes of aplastic anaemia**
362
**Description of Severity of Illness Score**
363
**Definition of Meniere's Disease**
Definition:
* Auditory disease characterised by an episodic sudden onset of vertigo, low frequency roaring tinnitus and sensation of fullness in the ear
* Vertigo: A sensation of movement, often rotatory, of the patients or their surroundings. Always worse on movement
364
**Epidemiology of Meniere's disease**
Epidemiology:
* True incidence and prevalence not known
* Primarily a disease of adulthood (40s)
* 50% have a family hx • Females \> Males (1.1:1)
* Degree of bilateral disease varies
365
**Risk factors for Meniere's disease**
Risk Factors (weak):
* Recent viral infection
* Genetic predisposition
* Autoimmune disease
366
**Aetiology of Meniere's disease**
Aetiology:
* Unknown (multifactorial) – Peripheral cause of Vertigo
* Best model: Endolymphatic malabsorption or overproduction leads to subsequent hydrops (oedema due to fluid accumulation)
367
**Pathophysiology of Meniere's disease**
368
**Clinical features of Meniere's Disease**
369
**Diagnostic Features of Meniere's Disease**
370
**Investigations for Meniere's Disease**
371
**Differential diagnosis for Meniere's Disease**
**DDx:**
* Acoustic neuroma (Vestibular Schwannoma)
* Vestibular neuronitis (labrynthinitis) – Neural degeneration of CN 8 post viral infection
372
Management for Meniere's Disease
373
**Complications and prognosis of Meniere's Disease**
**Complications:**
* Falls
* Profound deafness (rare)
**Prognosis:**
* Symptoms get worse overtime despite Rx
* Can go into periods of remission
374
**Definition of a migraine**
**Definition:**
• A chronic episodic neurovascular disorder characterised by nausea, photophobia, disability and headache
375
**Epidemiology of Migraines**
Epidemiology:
* Common (10% of population)
* Females \> Males
* 75% have first attack before age 20
* RF – FHx, childhood motion sickness, caffeine intake, menstruation, stressful life events
376
**Aetiology of migraines**
Aetiology:
* Genetic susceptibility – hyper-excitability
* Environmental exposure – stimulating events
377
**Pathophysiology of migraines**
378
**Classification and triggers of migraines**
379
**Investigations for migraines and differential diagnosis**
**Ix:**
• Clinical diagnosis
**DDx**
* Stroke
380
**Treatment for migraines**
381
**Complications and prognosis of migraines**
**Complications:**
* Status migrainosus – lasting \> 72 hours
* Migraine triggered seizures
**Prognosis:**
• Most with episodic migraine do well with Rx
382
**Definition of multiple myeloma**
Definition:
* A plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of the BM by plasma cells and the presence of mono-clonal Abs in serum and/or urine
* Produce a paraprotein (Ig light chain) - IgG (50%) or IgA (20%)
383
**Epidemiology and Aetiology of multiple myeloma**
**Epidemiology:**
* Disease of elderly (rare \<40) mean of 60y
* 1% of all malignancies and 10-15% of haematological malignancies
* Males \> females
**Aetiology**
* Unknown
384
**Pathogenesis of multiple myeloma**
385
**Clinical features of Multiple Myeloma**
**Clinical Features:**
* Bone pain (vertebral involvement 60%)
* Symptomatic anaemia – shortness of breath, pallor, fatigue
* Fevers and infections
* Renal failure – occurs in 50%! Nephrotic syndrome
* Hyperviscosity syndrome (rare) – due to paraprotein in blood
386
**Investigations for Multiple Myeloma**
387
Treatment and prognosis for Multiple Myeloma
**Rx:**
* Low dose chemo and corticosteroids
* High dose chemo + stem cell transplant
* Plasma exchange for hyperviscosty
* Bisphosphonates to correct hypercalcaemia and improve bone density
**Prognosis:**
* Incurable
* Median survival of 5 years
388
**Definition of Multiple Sclerosis**
**Definition:**
• An inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 different areas of the CNS, separated in time and space
389
**Epidemiology of Multiple Sclerosis**
390
**Aetiology and risk factors for Multiple Sclerosis**
**Aetiology:**
* Not completely understood
* Environmental factors – viral exposure (EBV), toxin exposure, UV light exposure
* Genetic susceptibility (20-40x more likely if in a 1° relative)
**Risk Factors:**
* Female sex and northern latitude (strong)
* Genetic factors, smoking, VIt D deficiency, Autoimmune disease
391
**Pathophysiology of Multiple Sclerosis**
392
**Classification of Multiple Sclerosis**
Classification:
* Relapsing remitting (85%)
* Secondary progressive: \>55% of RRMS will progress within 10 years to progressive
* Primary progressive (15-20%). Gradual progressive symptoms from onset
* Relapsing progressive: Mixture of relapsing and progressing
393
**Clinical features of Multiple Sclerosis**
394
**Signs of Multiple Sclerosis**
**Signs:**
* Swelling of the optic disc (optic neuritis)
* Uthoffʼs phenomenon (exacerbated by increased temp)
* Afferent pupillary defect
395
**Investigations for Multiple Sclerosis**
396
**Diagnosis of Multiple Sclerosis**
**Diagnosis:**
• 2 or more lesions disseminated in time and space (by MRI)
397
**Differential diagnosis of Multiple Sclerosis**
**DDx**
* Myelopathy due to cervical spondylosis – pt may show signs and symptoms below the neck
* Neuromyolitis optica (Devicʼs disease) – recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis)
* Vit 12 deficiency – numbness, fatigue and possible memory loss
* Infection – Lyme disease, associated myelopathy)
398
**Management of Multiple Sclerosis**
399
**Complications and prognosis of Multiple Sclerosis**
Complications:
* UTI (high)
* Osteopenia/osteoporosis – poor intake of Ca2+, Vit D or use of corticosteroids
* Depression
* Visual impairment
* Erectile dysfunction
* Cognitive impairment (medium)
**Prognosis:**
* No cure
* Disease will get progressively worse
* Current Rx only aimed at shortening length of episode NOT disease course
* 5-10 years shortened life expectancy
400
**Side effects of steroids**
401
**Definition of Osteoarthritis**
**Definition:**
* A non-inflammatory degenerative disorder that affects mainly the weight-bearing joints (e.g. hips and knees)
* Mainly a disease of the cartilage, which becomes progressively eroded and thinned
**Epidemiology:**
* Most common joint condition and affects ~ 50% of the population by 60 years
* Females \> males, esp. postmenopausal
402
**Aetiology and risk factors of osteoarthritis**
403
Pathophysiology of osteoarthritis
404
**Clinical features of osteoarthritis**
405
**Investigations for osteoarthritis**
406
**Management for osteoarthritis**
407
**Complications and prognosis for Osteoarthritis**
**Complications:**
* Functional decline and inability to perform activities of daily living (long-term high)
* Spinal stenosis in cervical or lumbar OA (medium)
* NSAID-related GIT bleeding
**Prognosis:**
* Chronic slowly progressive disease that is almost ubiquitous with old age
* No cure
* Despite Rx, most patients have some degree of pain and functional limitation affecting their quality of life
408
**Osteoarthritis Vs Rheumatoid Arthritis**
409
**Definition of hyperparathyroidism**
Hyperparathyroidism Definition:
• Results from excess PTH in circulation, which consequently increases serum Ca2+ levels
410
**Aetiology of Hyperparathyroidism**
411
**Pathophysiology of Hyperparathyroidism**
412
**Clinical features of Hyperparathyroidisim**
413
**Investigations for hyperparathyroidism**
414
**Management for Hyperparathyroidism**
415
**Description of Familial Hypocalciuric Hypercalcaemia**
416
**Definition of Hypoparathyroidism**
**Hypoparathryoidism Definition:**
• Results from inadequate secretion of PTH
417
**Aetiology of Hypoparathyroidism**
418
Clinical features of Hypoparathyroidism
419
**Investigations for Hypoparathyroidism**
**Ix:**
* Serum calcium = low
* Phosphate = high
* PTH = low or normal
* Magnesium = low (exacerbates hypocalcaemia and impairs PTH)
* UECs – normal
* ECG = prolonged QT
420
Management of Hypoparathyroidism
Rx:
* Severe hypocalcaemia = IV Ca + Mg2+ (if depleted) + correction of respiratory alkalosis
* Asymptomatic = Oral calcium and low dose Vit D
* Ongoing – Oral calcium + Vit D supplements + oral Mg2+, specific Rx of underlying cause
421
**Complications of Hypoparathyroidism**
Complications:
* Dystrophic calcification – chronic hypocalcaemia can lead to calcification of tendons, blood vessels, brain, pinna of ear and scars (long-term high)
* Cataracts (long term med)
422
**Description of Pseudohypoparathyroidism**
**Pseudohypoparathyroidism:**
* An extremely rare genetic condition that causes resistance to PTH
* Pts have low Ca2+ and high PO4 and PTH is appropriately high but end-organs like the kidneys and bone are resistant to its effects
* It is associated with intellectual impairment, short stature and round face
423
**Description of Pseudpseudohypoparathyroidism:**
Pseudpseudohypoparathyroidism:
* Inherited disorder that is similar to pseudohydoparathyroidism but with normal calcium levels
* PTH resistance only affects the bone with a normal renal response
424
**PTH Homeostasis**
425
**Definition of Parkinson's Disease**
426
**Epidemiology of Parkinson's Disease**
427
**Aetiology of Parkinson's Disease**
428
**Pathophysiology of Parkinson's Disease**
429
**Clinical Features of Parkinson's Disease**
430
**Investigations for Parkinson's Disease**
**Ix:**
* Dopaminergic agent trial – performed if diagnosis is in question and symptoms should improve
* MRI brain – normal in most pts with Parkinsonʼs disease
* Neurological special testing
431
**Management of Parkinson's Disease**
432
**Complications and prognosis of Parkinson's Disease**
433
**Definition and epidemiology of Peptic Ulcer Disease**
434
**Aetiology of Peptic Ulcer Disease**
435
**Pathophysiology of Peptic Ulcer Disease**
436
**Clinical features of Peptic Ulcer Disease**
437
**Investigations and diagnosis of Peptic Ulcer Disease**
438
**Differential diagnosis of Peptic Ulcer Disease**
**DDx:**
* GORD
* Oesophageal cancer
* Stomach cancer
* Functional dyspepsia
* Acute pancreatitis
439
**Management of Peptic Ulcer Disease**
440
**Complications and prognosis of Peptic Ulcer Disease**
441
**Definition of Pneumonia**
**Definition:**
• Pneumonia = Inflammation of the pulmonary parenchyma with consolidation or interstitial lung infiltrates on CXR
442
**Epidemiology of Pneumonia**
Epidemiology:
* Incidence is 1 in 100 but risk increases with age
* Children \< 4yrs, elderly (\>65 yrs) and the immunocompromised are most at risk
* Seasonal variation
* Bacterial causes are the most common
443
**Aetiology of Pneumonia**
Aetiology:
* Bacteria
* Viruses
* Mycoplasma
* Fungus
444
**Risk factors of Pneumonia**
Risk Factors:
* Age: \< 4yrs or \> 65 yrs
* Recent resp infection
* Smoking and heavy alcohol
* Immunosuppressed (AIDs or Rx with cytotoxic drugs
* Intubation
* Recent travel
* Chronic diseases: Asthma, COPD & heart disease
445
**Classification of Pneumonia**
446
**Pathophysiology of Pneumonia**
447
**Clinical Features of Pneumonia**
448
**Differential diagnosis of Pneumonia**
**DDx:**
* Lung Cancer
* TB
* PE
* Pulmonary haemorrhage
* Exacerbation of COPD
449
**Investigations for Pneumonia**
450
**Severity assessment for Pneumonia**
451
**Management of Pneumonia**
1st Line:
* Antibiotic Treatment:
- Start broad-spectrum empirical antibiotics if severe
- Macrolide or Tetracycline are used to Rx atypical infections (mycoplasma etc. & covers S. pneumoniae)
* Oxygen - PaO2 \> 8 or \> 94% saturation
* IV fluids - Anorexia, volume depletion, shock
* Analgesia if pleurisy
* Follow up CXR at 6 weeks post treatment
452
**Treatment summary of different types of Pneumonia**
453
**Complications of Pneumonia**
454
**Prognosis of Pneumonia**
455
**Chest Xrays for Pneumonia**
Google images to explore what it looks like
456
**Definition and epidemiology of Liver Cirrhosis**
457
**Risk factors of Liver Cirrhosis**
Risk Factors:
* IV drug use
* Chronic alcohol consumption
* Unprotected intercourse
* Obesity
* Blood transfusions
* Tattooing
458
**Aetiology of Liver Cirrhosis**
459
**Pathophysiology of Liver Cirrhosis**
460
**Classification of Liver Cirrhosis**
461
**Clinical Features of Liver Cirrhosis**
462
Incomplete cards for LIVER Cirrhosis - need to be added - gobi's notes are incomplete for investigations + management
463
**Definition and epidemiology of Psoriasis**
**Definition:**
* Chronic inflammatory skin disease characterised by well defined erythematous plaques with silvery scales, affecting the extensor surfaces of the limbs, elbows, knees & scalp
* Disease is typically life-long, with fluctuating courses of exacerbations and remissions
**Epidemiology:**
* Affects 2% of the population
* Mean age of onset is 28 years
* M = F
* Asians have a very low prevalence
* 10% have psoriatic arthritis
464
**Aetiology of Psoriasis**
**Aetiology:**
* Unknown. Multifactorial
* Genetic – genetic predisposition and strong FHx
* Immunological – associated with increased T-cell activity in the skin
* Infection – Guttate psoriasis is linked with post-streptococcal pharyngitis
* Stress, trauma and smoking (weaker associations)
465
**Pathophysiology of Psoriasis**
466
**Clinical features and investigations for Psoriasis**
467
**Management of Psoriasis**
468
**Complications and prognosis for Psoriasis**
469
**Definition and epidemiology of Pulmonary Embolism**
**Definition:**
* Venous thromboembolism = Encompasses both DVT and PE
* PE = Obstruction of the pulmonary arteries due to embolisation of a venous thrombus
* Potentially life-threatening and frequently under-diagnosed
**Epidemiology:**
* One of the most common cardiovascular conditions (3rd most common in USA)
* Incidence is 1 in 1000
* Occurs in 50% of DVT cases (symptomatic or asymptomatic)
* M = F
* Accounts for 10% of maternal deaths
470
**Risk factors of Pulmonary Embolism**
Risk Factors:
* increasing age
* Diagnosis of DVT
* Sx within last 2 months
* Bed rest \> 5 days
* Previous DVT
* Active malignancy
* Trauma/recent fracture
* Pregnancy
* Thrombophilia
471
**Aetiology of Pulmonary Embolism**
472
**Pathophysiology of Pulmonary Embolism**
473
**Clinical Features of Pulmonary Embolism**
474
**Investigations for Pulmonary Embolism**
475
**Management of Pulmonary Embolism**
476
**Complications and Prognosis of Pulmonary Embolism**
477
**Notes about calculating renal function**
478
**Definition of Renal Osteodystrophy**
479
**Pathophysiology of Renal Osteodystrophy**
480
**Investigations for Renal Osteodystrophy**
481
**Types of Renal Osteodystrophy**
482
**Consequences of Renal Osteodystrophy**
483
**Management of Renal Osteodystrophy**
484
**Definition of Respiratory Failure**
**Definition:**
• Dysfunction of gas exchange resulting in abnormalities in O2 or CO2, enough to impair the function of vital organs
485
**Classification of Respiratory Failure**
486
**Clinical Features of Respiratory Failure**
487
**Investigations for Respiratory Failure**
**Ix:**
* ABG
* FBC, UECs, CRP
* Blood cultures if pyrexic
* CXR + ECG
* CTPA if PE suspected
488
**Management of Respiratory Failure**
489
**Prognosis of Respiratory Failure**
**Prognosis:**
* Dependent on underlying pathophysiology
* COPD no Rx by ventilator = Good
* ARDS associated with seticaemia = Poor (90% mortality) • Poorer outcomes for pts managed on ventilators
490
**Definition of Restrictive Lung Disease**
**Definition:**
• A heterogenous group of conditions that are characterised by reduced lung volumes, either due to alterations in lung parenchyma or because of disease of the chest wall, pleura or neuromuscular apparatus
**Epidemiology:**
• Most common cause is occupational exposure
491
**Aetiology/Classification of Restrictive Lung Disease**
492
**Pathophysiology of Restrictive Lung Disease**
493
**Clinical Features of Restrictive Lung Disease (and Acute Respiratory Distress Syndrome)**
494
**Investigations for Restrictive Lung Disease**
495
**Management of Restrictive Lung Disease**
**Rx:**
* Corticosteroids +/- other immune suppressing drugs (methotrexate, cyclosporins) - not
* O2 therapy for symptomatic patients
* Pulmonary rehab – to improve endurance, lung efficiency
* Lung transplantation
496
**Categories of Pulmonary Disease**
497
**Respiratory function tests in health and disease**
498
**Definition of Rheumatoid Arthritis**
499
**Epidemiology of Rheumatoid Arthritis**
**Epidemiology:**
- Affects 1% of the population
- 2nd most common arthritis after osteoarthritis
- Age 30-50y
- Female \> Males (3:1) - premenopausal particularly
- Can occur at any age, even in childhood
500
**Risk Factors of Rheumatoid Arthritis**
**Risk Factors:**
- Females (pre-menopause)
- Age \> 30
- Family Hx
- Smoking
- Other autoimmune diseases
501
**Aetiology of Rheumatoid Arthritis**
**Aetiology - Unknown:**
- Multifactorial
- Genetic - accounts for 60% susceptibility (HLA-DR4)
- Family Hx - monozygoitc twins = 15%
- Females
502
**Symptoms and Clinical Manifestations of Rheumatoid Arthritis**
503
**Pathogenesis of Rheumatoid Arthritis**
504
**Investigations for Rheumatoid Arthritis**
505
**Management of Rheumatoid Arthritis**
506
**Complications and Prognosis of Rheumatoid Arthritis**
507
**Drugs (MOA + side effects) used in Rheumatoid Arthritis**
508
**Description of Seronegative Spondylo-Arthopathies**
509
**Definition and epidemiology of Ankylosing Spondylitis**
**Definition:**
• Chronic progressive inflammatory arthropathy predominantly affecting the spine and sacroiliac joints
**Epidemiology:**
* Males \> females (3:1)
* Age before 40 years
* Affects around 1 in 2000
510
**Aetiology and Pathology of Ankylosing Spondylitis**
**Aetiology:**
• Genetic predisposition (HLA-B27 mutation in \>90%) + unknown triggers
**Pathology:**
- White cell infiltration of ligament insertions
- Erosion of bone
- Syndesmophytes lay down new bone --\> Fuse joints - Esp. sacro-iliac joint
511
**Clinical features of Ankylosis Spondylitis**
512
**Investigations and Treatment for Ankylosing Spondylitis**
513
**Complications and Prognosis of Ankylosing Spondylitis**
514
**Definition, Epidemiology and Aetiology of Psoriatic Arthritis**
Psoriatic Arthritis:
**Definition:**
• Chronic inflammatory joint disease that is associated with psoriasis
**Epidemiology:**
* Occurs in 10-15% of pt with psoriasis
* M = F • Indianʼs esp. effected
* Rarely precedes psoriasis
* Any age 20-30s; 50-60s
**Aetiology:**
* Unknown
* Genetic predisposition (HLA markers)
* Some precipitated by trauma
515
**Clinical Features of Psoriatic Arthritis**
516
**Investigations for Psoriatic Arthritis**
517
**Management of Psoriatic Arthritis**
518
**Complications and prognosis of Psoriatic Arthritis**
519
**Description, Aetiology and Management of Enteropathic Arthropathies**
520
**Definition, Epidemiology and Aetiology of Reactive Arthritis**
**Reactive Arthritis:**
**Definition:**
• Inflammatory arthritis that occurs after an exposure to certain GIT and GUT infections
**Epidemiology:**
* Males \> females (10:1)
* Affects young adults
**Aetiology:**
* Genetic factors (HLA-B27 mutation)
* Bacterial triggers include:
⁃ Salmonela
⁃ Yersinia
⁃ Campylobacter
⁃ Shigella
⁃ Chlamydia trachomatis
521
**Clinical Features of Reactive Arthritis**
522
**Clinical Features of Reactive Arthritis (body systems review)**
523
**Investigations for Reactive Arthritis**
524
**Management of Reactive Arthritis**
525
**Complications and prognosis of reactive arthritis**
526
**Definition of Stroke**
527
**Epidemiology of Stroke**
528
**Aetiology of Stroke**
529
**Risk Factors for Stroke**
530
**Pathophysiology of Stroke**
531
**Clinical Features of Stroke**
532
**Clinical Features according to Stroke sub-type**
533
**Investigations for Stroke**
534
**Management of Stroke**
535
**Prevention of Stroke**
536
**Overview of locating site of injury in Stroke**
537
**Prognosis of Stroke**
538
**Definition of Syncope**
539
**Causes of Syncope**
540
**Urgent consideration of Syncope**
541
Definition, key points and main mechanisms of Thrombocytopenia
542
**Epidemiology of Thrombocytopenia**
543
**Clinical Features of Thrombocytopenia**
544
**Investigations and management of Thrombocytopenia**
545
**Idiopathic Thrombocytopenia Purpura (ITP):**
* **Definition**
* **Epidemiology**
* **Aetiology**
* **Associated Conditions**
546
**Clinical Features of Idiopathic Thrombocytopenia Purpura (ITP)**
**Clinical Features:**
* Insidious onset
* Bleeding, easy bruising, epistaxis, menorrhagia
* Absent lymphadenopathy, hepatoplenomegaly or systemic symptoms
547
**Investigations for Idiopathic Thrombocytopenia Purpura (ITP)**
**Ix**:
* FBC – low Plt
* Peripheral blood smear – normal with low platelet count
* BM biopsy – increased megakaryocytes; no evidence of malignancy
* Consider HIV serology, Hep B and C serology, TFTs, Helicobactor antigen testing
548
**Management of Idiopathic Thrombocytopenia Purpura (ITP)**
549
**Prognosis for Idiopathic Thrombocytopenia Purpura (ITP)**
**Prognosis:**
* Most pts respond to 1st line corticosteroids
* Additional Rx required in 50%
* Prognosis is good with only 2-5% being refractory to medical Rx & requiring splenectomy
550
**Definition and Epidemiology of Thyrotoxicosis**
**Definition:**
• Condition resulting from raised levels of free T3 and T4
**Epidemiology**
* Affects around 0.1% of males and 1% of females
* Females \> males (10-1)
551
**Aetiology of Thyrotoxicosis**
552
**Clinical Features of Thyrotoxicosis**
553
**Investigations for Thyrotoxicosis**
554
**Management of Thyrotoxicosis**
555
**Thyrotoxic Crisis ("Thyroid Storm")**
556
**Definition and Epidemiology of Hypothyroidism**
**Definition:**
• Results from a deficiency of T4 or T3
**Epidemiology:**
* Incidence is 2% in women
* Females \> males (5:1)
557
**Aetiology of Hypothyroidism**
558
**Clinical Features of Hypothyroidism**
559
**Investigations for Hypothyroidism**
560
**Management of Hypothyroidism**
561
**Myxoedema Coma**
562
**Definition of Tuberculosis**
563
**Epidemiology of Tuberculosis**
564
**Aetiology of Tuberculosis**
565
**Pathophysiology of Tuberculosis**
566
**Clinical Features of Tuberculosis**
567
**Investigations for Tuberculosis**
568
**Management of Tuberculosis**
569
**Complications and Prognosis of Tuberculosis**
570
**Definition and Epidemiology of UTIs and Pyelonephritis**
571
**Aetiology of UTIs and Pyelonephritis**
572
**Risk Factors for UTIs and Pyelonephritis**
573
**Precipitating Factors for UTIs and Pyelonephritis**
574
**Pathophysiology and Classification of UTIs and Pyelonephritis**
575
**Clinical Features of UTIs and Pyelonephritis**
576
**Investigations for UTIs and Pyelonephritis**
577
**Management of UTIs and Pyelonephritis**
578
**Prevention of UTIs and Pyelonephritis**
579
**Complications and Prognosis of UTIs and Pyelonephritis**
580
**Definition and Epidemiology of Valvular Heart Disease**
**Definition:**
• Any disease that affects any of the 4 heart valves
**Epidemiology:**
• Left sided valvular heart disease and tricuspid regurgitation are the most common
581
**Principal causes of valve disease**
582
**Mitral Stenosis:**
* **Pathophysiology**
* **Clinical Features**
* **Management**
583
**Mitral Regurgitation:**
* **Key points**
* **Clinical Features**
* **Management**
584
**Aortic Stenosis:**
* **Key points**
* **Pathophysiology**
* **Clinical Features**
* **Management**
585
**Aortic Regurgitation:**
* **Key Points**
* **Pathophysiology**
* **Clinical Features**
* **Management**
586
**Tricuspid Regurgitation:**
* **Key points**
* **Clinical Features**
* **Management**
587
**Key points of Pulmonary Valve Lesions**
