osce must know conditions! Flashcards

Question

What is peptic ulcer disease?

Answer 1

Ulcers occurring within the stomach (gastric ulcer) or duodenum (duodenal ulcers). To be classified as an ulcer it must extend through the muscularis mucosae. Most commonly affects the first part of the duodenum

Answer 2

Ulcers occur when there is breach in the defences of the stomach which exist to protect the stomach from the acid. This can be due to: - Chronic use of NSAIDs, such as ibuprofen or aspirin - H pylori infection - Chronic alcohol consumption

Answer 3

Stress Alcoholism Smoking

Answer 4

Test for H pylori (urease breath test) Endoscopy (used to visualise the ulcers and obtain a biopsy to determine if the ulcer is malignant)

Answer 5

Pharmacological / Surgical: - Proton pump inhibitors - H2 receptor antagonists - Antibiotics (if due to H. Pylori infection) Lifestyle: - Reduce alcohol intake - Discontinue NSAIDS - Avoid aggravating factors eg spicy food - Reduce stress where possible

Answer 6

Epigastric pain Indigestion Loss of appetite Nausea and vomiting Weight loss Malaena - dark, tar-like stool Haematemesis (if ulcer has eroded into a blood vessel)

Answer 7

An autoimmune condition causing damage and destruction of the joint capsule

Answer 8

Autoimmune condition leading to a Type 3 hypersensitivity reaction and immune complex deposition within the synovial membranes of the joints

Answer 9

Genetics Female sex Smoking (unclear link)

Answer 10

- X-Ray of the joint (no changes will be seen in the early stages of the disease) - Blood test for ACPA antibody and RF (non-diagnostic) (*anti-citrullinated protein antibody)

Answer 11

Pharmacological / Surgical: - Methotrexate and folate supplement - Hydroxychloroquine - Prednisolone Lifestyle: - Ensure to have a annual flu jab and any other vaccinations due to the immunosuppressant properties of the medications - During flare ups ensure plenty of rest to help ease any pain or inflammation - Smoking cessation

Answer 12

Usually begin in the small joints i.e. hands and toes - Joint swelling - Joint pain and stiffness that is usually symmetrical and on waking in the morning - Tiredness - Fever - Poor appetite and weight loss - Systematic symptoms (e.g. eye pain (Sjogren's syndrome - dry eyes and dry mouth - commonly presents with RA), chest pain (rheumatoid nodules/lung disease) if they are affected) - Joint pain lasts longer than 1 hour (as opposed to osteoarthritis, in which joint pain comes in <1 hour "bursts") * worse after periods of inactivity

Answer 13

Degeneration of the joint hyaline cartilage and erosion of the underlying bone

Answer 14

Destruction of the hyaline cartilage of the articulating bones in joints due to age-related degeneration, trauma or infection of the bone

Answer 15

Obesity Previous injury to the affected joint Occupational factors (e.g. heavy lifting) Genetics Old age Female sex Sedentary lifestyle

Answer 16

X-ray - Signs on an x-ray are subchondral sclerosis, reduced joint space, osteophytes, subchondral cysts Joint fluid aspirate analysis/blood tests to rule out RA

Answer 17

Pharmacological / Surgical: - OTC pain killers/NSAIDs - Opioid pain killers - Joint replacement Lifestyle: - Weight loss - Improving lifting techniques

Answer 18

- Deep, aching joint pain that is exacerbated by use - Reduced range of motion - Crepitus - a grinding sensation on movement of the joint - Stiffness during rest * symptom often occurs towards end of day after using the affected joint

Answer 19

Temporary occlusion of the coronary arteries that causes pain. Stable Angina: Pain only occurs on exertion Unstable Angina: Pain at rest

Answer 20

Partial occlusion of the coronary arteries of the heart leading to temporary ischaemia (loss of oxygen supply)

Answer 21

Increasing age Tobacco/Smoking Hypertension Obesity Diabetes Metabolic syndrome Family history of heart attack

Answer 22

ECG - check for changes Blood test - Troponin I and T- should be negative as no infarction should have occurred Echocardiogram

Answer 23

Pharmacological / Surgical: - Calcium channel blockers eg. Diltiazem - causes dilation of vessels to relieve ischaemia - Aspirin (reduces the clotting risk) Lifestyle: - Improved diet with reduced fat consumption - Increased exercise - Smoking cessation (* amlodipine is a CCB too)

Answer 24

Chest pain (tight, dull, radiating) SOB

Answer 25

Sudden deprivation of blood supply to the myocardium of the heart causing ischaemic damage leading to infarction

Answer 26

Occlusion of the coronary arteries usually by atherosclerosis/ thrombosis. The lack of blood supply will cause ischaemic damage

Answer 27

Increasing age Tobacco/Smoking Hypertension Obesity Diabetes Metabolic syndrome Family history of heart attack

Answer 28

ECG - check for changes (ST elevation/depression, pathological Q waves) Blood test - Troponin I and T Echocardiogram

Answer 29

Pharmacological / Surgical: - PCI (stent to widen blocked vessel) - CABG (surgery that bypasses blocked artery) - Aspirin (reduces the clotting risk) - Clopidogrel (antiplatelet) - prescribed after a heart attack Lifestyle: - Improved diet with reduced fat consumption - Increased exercise - Smoking cessation

Answer 30

Chest pain (tight, dull, radiating) SOB Nausea Sweating Dizziness

Answer 31

Bowel cancer is a general term for cancer which originates from the large bowel.

Answer 32

The exact cause of bowel cancer is unknown, however there are many risk factors which contribute to it. Most develop from polyps within the bowel.

Answer 33

Older age A diet high in red or processed meat Low fibre diet Obesity Lack of exercise Excess alcohol intake Smoking Family history of bowel cancer including inherited conditions eg. FNPCC, FAP Inflammatory bowel disease - Crohn’s or UC

Answer 34

There is a national screening programme in place - faecal occult blood test (looks for blood that may be in stool, available for individuals aged 60-74, every 2 years) Colonoscopy or flexible sigmoidoscopy CT scan Blood test - FBC Tumour markers

Answer 35

Pharmacological / Surgical: - Chemotherapy if the primary tumour has metastasised, otherwise there is a high risk of recurrence - Surgical removal of the tumour if possible - Treatment of IBD Lifestyle: - Balanced diet with plenty of fruit and vegetables, and low in saturated fats and sugars - Reduce red meat consumption - Increase fibre consumption - Smoking cessation - Alcohol-intake reduction

Answer 36

Obstruction - results in abdominal distension and pain (distension, obstruction and pain affecting the large bowel generally results in constipation) Haematochezia - bright-red bleeding from the anus Change in bowel habit (a change in frequency or consistency) Weight loss

Answer 37

An inflammatory bowel disease that may affect any location in the GI tract, but most commonly the ileum

Answer 38

Idiopathic. Likely a combination of genetic and environmental factors.

Answer 39

Family history of inflammatory bowel disease Smoking NSAIDs Recurrent infections

Answer 40

- Ileocolonoscopy to visualise skip lesions, ulceration with a characteristic 'cobblestone' appearance, trans-mural inflammation, strictures and fistulas - Biopsy to assess for granulomatous transmural inflammation - Blood test for CRP to assess inflammation, and anaemia + faecal calprotectin (to distinguish IBD from non-IBD)

Answer 41

Pharmacological: - Steroids for flares - DMARDS to attempt to achieve and sustain remission - If fistulas are present, surgery may be needed to remove a small part of the bowel. This surgery is not curative as the disease will recur. Lifestyle: - Stop smoking - Healthy balanced diet - Avoid NSAIDs - Get yearly flu vaccinations and the pneumococcal vaccine due to immunosuppressant therapy (disease-modifying antirheumatic drugs)

Answer 42

Periods of acute exacerbations interspersed with remissions: - Diarrhoea - Abdominal pain and tenderness often in the right lower quadrant (right iliac fossa most likely) - Weight loss - Anal pathology e.g. fissures, abscesses or tags - Peri-anal inflammation - Mouth ulcers - Anaemia - Extra-intestinal features such as conjunctivitis, arthritis, malnutrition, fever - Change in bowel habits

Answer 43

Chronic inflammation affecting the rectum and colon, impairing nutrient absorption.

Answer 44

Idiopathic - a combination of genetic and environmental factors.

Answer 45

Recent infection of the colon (shigella) Family history of IBD Caucasian ethnicity

Answer 46

Blood tests (anaemia) Abdominal examination Stool sample (*faecal calprotectin*) Sigmoidoscopy Colonoscopy Abdominal X-ray/CT

Answer 47

Pharmacological / Surgical: - Immunosuppressants including DMARDS and/or Steroids - Curative surgery (colectomy) Lifestyle: - Reducing trigger foods - Reducing stress - Probiotics

Answer 48

Recurrent bloody diarrhoea (may contain mucus) Abdominal pain and a tender abdomen on examination - commonly left iliac fossa/left lower quadrant Fatigue, weight loss Painful red eye, arthritis, tachycardia, fever (severe UC)

Answer 49

High levels of cholesterol in the blood.

Answer 50

Familial hypercholesterolaemia Obesity Diabetes Metabolic syndrome

Answer 51

High fat diet Smoking Diabetes Hypertension Family history of stroke or heart disease

Answer 52

Blood cholesterol tests Cardiovascular risk score evaluation

Answer 53

Pharmacological / Surgical: - Statins, e.g. atorvastatin - Aspirin Lifestyle: - Reduce fat intake - Eat a healthy balanced diet - Smoking cessation - Increase exercise levels

Answer 54

Xanthelasma, tendon xanthoma and corneal arcus, but most commonly causes no symptoms. It does however drastically increase the risk of many diseases: - Atherosclerosis - Heart attack - Stroke - Peripheral artery disease - Coronary heart disease

Answer 55

Sustained increase in blood pressure, greater than 140/90 mmHg.

Answer 56

Primary hypertension has an unknown cause, however several factors may contribute to it Secondary hypertension has an identifiable cause, such as renal artery stenosis, Cushing’s syndrome (high cortisol), Conn’s syndrome (hyperaldosteronism)

Answer 57

Smoking Obesity Lack of physical activity Stress Old age Family history Excess salt in diet Excess alcohol consumption

Answer 58

Pharmacological / Surgical: For a patient <55 years old: - Step 1: ACE inhibitor, ramipril, or Angiotensin receptor blocker, Losartan - Step 2: Calcium channel blocker, amlodipine - Step 3: Diuretic, bendroflumethiazide - Step 4: β-blocker, spironolactone For a patient >55 years old, or of Afro-Caribbean descent: - Step 1: Calcium channel blocker, amlodipine - Step 2: ACE inhibitor, ramipril, or Angiotensin receptor blocker, Losartan - Step 3 and 4 are the same as above Lifestyle: - Healthy diet and regular exercise - Smoking cessation - Reduce stress where possible - Reduce alcohol intake - Reduce caffeine intake

Answer 59

Hypertension often has no symptoms, however it can present with: - Severe headache - Fatigue - Vision problems - Difficulty breathing - Palpitations

Answer 60

Infection of the urinary tract - can affect the lower urinary tract (Cystitis) or the upper urinary tract (Pyelonephritis)

Answer 61

A number of bacterial organisms, most commonly E. coli and Coagulase Negative Staphylococci

Answer 62

Female gender (shorter urethra) Obstruction of the tract (enlarged prostate, pregnancy, stones) leading to fluid stasis Neurological problems leading to incomplete voiding and leading to fluid stasis STIs Not urinating after sex Unprotected sex COCP

Answer 63

Usually none are carried out unless the patient is declared at risk of a "complicated" UTI, in which case the following occurs: - Mid stream catch urine sample. Observe turbidity, dipstick and culture. If Sepsis is suspected (a potential risk of UTIs), then the standard "Sepsis 6" package is initiated prior to any testing BUFALO: ('take 3, give 3') - Blood Cultures - Urine output - Fluids - Antibiotics - Lactate - Oxygen (to maintain SpO2 >94%)

Answer 64

Pharmacological / Surgical: Antibiotics indicated by the nature of the infection Decompression of the kidney if obstructed using either a JJ stent or a nephrostomy Lifestyle: Maintenance of good hydration Emptying of the bladder soon after intercourse Avoidance of irritating feminine products Changing from the COCP

Answer 65

Lower UTI (Cystitis) Dysuria Frequency Urgency Possible low grade fever Upper UTI (Pyelonephritis) Fever Loin pain Dysuria/ frequency Nausea and vomiting

Answer 66

Infection causing inflammation of the leptomeninges of the brain.

Answer 67

Bloodstream infection Ear infection Sinusitis Iatrogenic - Surgery in the head or neck / Blood stream infection from a catheter or other line

Answer 68

Immunocompromised condition Living in close proximity (e.g. students) Extremes of age (< 5 or >60 years)

Answer 69

Blood tests and cultures Lumbar puncture to sample CSF turbidity testing and culture (+ antibiotic sensitivity) ***PHOTO*** (normal - clear, bacterial - turbid, viral - clear, fungal - fibrin web)

Answer 70

Pharmacological/Surgical: IV Ceftriaxone empirically until culturing results returned to identify to actual causative organism Meningococcal Vaccine Lifestyle: If immunocompromised give prophylactic antibiotics Clean living conditions Good diet Good dental hygiene

Answer 71

Fever Cold hands and feet Stiff neck Headache Vomiting Drowsiness Difficult to wake Confusion and irritability Severe muscle pain Non-blanching rash if meningococcal Photophobia

Answer 72

Inflammation of the lung parenchyma caused by bacterial or viral infection, in which the alveoli may fill with pus.

Answer 73

Viral or bacterial infections of the lung, usually droplet transmitted.

Answer 74

Immunocompromised Extremes of age Close-contact-communities

Answer 75

Chest X-ray (look for consolidation, potentially pulmonary oedema/pleural effusion if later stages) Sputum sample Chest examination Blood test (test for CRP, raised white cell count)

Answer 76

**Pharmacological/Surgical:** * Antibiotics if bacterial cause (Moderate: Amoxicillin, Doxycycline, Serious: Co-amoxiclav and Clarithromycin) * Aspiration of effusion if present **Lifestyle:** * Smoking cessation * Should avoid other patients or at risk individuals if immunocompromised and take prophylactic antibiotics * Good diet with adequate vitamin consumption to improve immune defences

Answer 77

Productive cough Haemoptysis (coughing-up blood) Shortness of breath Pleuritic chest pain Tachycardia Fever Sweating/shivering

Answer 78

The inability of the heart to meet the demands of the body, characterised by reduced cardiac output, reduced tissue perfusion and increased pulmonary blood pressure

Answer 79

Ischaemic heart disease Hypertension, Aortic stenosis, Aortic regurgitation all leading to left ventricular hypertrophy Cardiomyopathy Arrhythmias Chronic lung diseases e.g. COPD, pulmonary fibrosis, bronchiectasis (cor pulmonale)

Answer 80

Obesity Smoking Diabetes High alcohol intake Lack of exercise Chronic lung disease Family history Previous rheumatic fever

Answer 81

**Pharmacological/Surgical:** Adopt a ‘start low, go slow’ approach when introducing these drugs due to risks of low blood pressure, or worsening of heart failure symptoms: * 1st line: ACE inhibitors or Angiotensin receptor blockers if above are not tolerated, hydralazine + nitrate * 2nd line: β-blocker * 3rd line: Aldosterone antagonist (spironolactone) **Lifestyle:** * Maintain BMI in a healthy range * Smoking cessation * Reduce alcohol consumption * Exercise * Weigh yourself regularly (to see if you’re retaining fluid) * Healthy diet

Answer 82

**Left sided heart-failure:** * Fatigue * Breathlessness on exertion * Orthopnoea and Paroxysmal Nocturnal Dyspnoea * Displaced apex beat due to cardiomegaly **Right sided heart-failure:** * Fatigue * Breathlessness * Peripheral oedema * Raised JVP * Enlarged and tender liver

Answer 83

A condition caused by stones forming in the gallbladder and causing obstruction.

Answer 84

Obesity High fat diet Alcoholism

Answer 85

Ultrasound scan Bloods to test for Bilirubin/AST/ALT/ALP/Gamma-GT levels (Liver function tests) CRP/white cell count to check for infection (primary ascending cholangitis)

Answer 86

**Pharmacological:** * Painkillers (NSAIDs) * Statins **Surgical:** * Laproscopy (Key hole surgery) to remove the gallbladder (most common) * Open surgery to remove the gallbladder (indicated in pregnancy, obesity and structural abnormalities of the gallbladder) **Lifestyle:** * Eating a balanced diet * Avoiding ‘trigger foods’ (can include fatty or spicy foods) * Avoiding alcohol * Exercise to lose weight

Answer 87

Biliary colic (abdominal pain common around 30 minutes after eating fatty foods) Fever Jaundice Impaction and development of cholangitis Pain can radiate to the shoulder tip Can cause pancreatitis if impacting the Ampulla of Vater

Answer 88

A symptom of pain felt anywhere in the head

Answer 89

Headaches can be classed into primary and secondary causes **Primary ** * Idiopathic * Stress-related **Secondary (generally more concerning as may indicate potentially life threatening underlying conditions) ** * Sub-arachnoid haemorrhage * Medication-induced (e.g. GTN) * Medication-overuse (e.g. painkillers) * Brain tumour * Dehydration

Answer 90

Obesity Stress Alcohol overuse Dehydration High caffeine intake Smoking Hypertension NSAID/opioid overuse Bad posture

Answer 91

Commonly none, if presenting with “red flags” then refer to secondary care for imaging: Red flags - SNOOP mnemonic: * Systemic Signs * Neurological signs * Onset unusually or new onset over 55 * Onset in a thunderclap presentation - SAH * Papilloedema - increased intracranial pressure

Answer 92

**Pharmacological/Surgical:** * Over the counter painkillers (paracetamol or ibuprofen, an NSAID) * Prescription medications (codeine = opioid receptor agonist) * Triptans (for migraines specifically) **Lifestyle:** * Increase exercise * Improve diet and fluid intake * Smoking cessation * Reduce caffeine and alcohol * Reduce stress levels where possible * Avoid triggers

Answer 93

Dependent on headache type: Tension - band like pain across the forehead Migraine - commonly one sided pain, associated aura and nausea Cluster - extreme pain behind one eye, commonly occurs for months at a time Trigeminal neuralgia - electric-shock type pain around one eye, prompted by touch to the face

Answer 94

Feelings of low mood, depression or hopelessness and a lack of interest or enjoyment in doing things for 2 weeks consistently

Answer 95

Stress Adverse childhood experience Certain drugs Death or loss (NB do not confuse depression with an adjustment reaction which has a clear trigger and limited duration) Genetic pre-disposition Co-morbidities Substance abuse

Answer 96

Unstable/ poor home life Stressful life Substance abuse Family history of mental health conditions

Answer 97

The diagnosis is clinical. Blood tests may be helpful to rule out other differential diagnoses eg. Hypothyroidism NB - If indicated (eg if the patient has depressive symptoms) you MUST asses suicide risk and self-harm in a sensitive and sympathetic manner. Failure to do so is a patient safety issue.

Answer 98

Pharmacological/Surgical: SSRIs Benzodiazepines (short-term only) Mood stabilisers (Lithium, Sodium valproate) Lifestyle: Reduction in stress within life if possible Family support Cognitive behavioural therapy

Answer 99

Must have at least 5/9 of the symptoms with at least one of the core symptoms for 2 weeks. Two core symptoms: Feelings of depression, hopeless or generally feeling down most days during the last month Little interest or pleasure in doing things Other typical symptoms: Fatigue/loss of energy Worthlessness/excessive or inappropriate guilt Recurrent thoughts of death, suicidal thoughts or suicide attempts Diminished ability to think or concentrate Psycho-motor agitation or retardation Insomnia/hyper-insomnia Significant appetite and/or weight loss

Answer 100

Low mood Lack of interest in anything Lack of enjoyment in things Fatigue Feeling hopeless and helpless Having low self-esteem Feeling irritable and intolerant of others

Answer 101

Continuous feelings of worry and anxiousness, persisting for most days of the week for 6 months or more.

Answer 102

Stress within life e.g. at school, work, due to other medical illnesses or due to illicit drug use (eg. cocaine)

Answer 103

Stress Genetic predisposition/ Family history of mental health conditions

Answer 104

The diagnosis is clinical. Blood tests may be helpful to rule out other differential diagnoses

Answer 105

Pharmacological/Surgical: SSRIs Benzodiazepines (short-term only) Mood stabilisers (Lithium, Sodium valproate) Lifestyle: Reduction in stress within life if possible Family/ Self help groups Cognitive behavioural therapy

Answer 106

The patient must have both the core symptoms and 3/6 of the additional symptoms for a period of at least 6 months. Two core symptoms: Excessive anxiety and worry - occurs on most days for at least 6 months Difficulty controlling the worry or feelings of anxiety Additional symptoms: Feeling of tension or restlessness Become easily fatigued Difficulty concentrating or mind going blank Irritability Significant muscle tension Difficulty sleeping

Answer 107

Feeling nervous, restless or tense Sense of impending danger, panic or doom Tachycardia Hyperventilation Sweating Tight chest Fatigue Trouble concentrating

Answer 108

A condition characterised by recurrent random electrical activity in the brain causing a seizure. Seizures are broadly categorised into partial or generalsed. Status epilepticus is a medical emergency characterised by a extremely prolonged seizure or multiple seizures without the patient regaining consciousness in between.

Answer 109

Although epilepsy is idiopathic in its cause it is linked with: Low oxygen during birth Head injuries Brain tumours Infections such as meningitis or encephalitis Stroke or any other type of damage to the brain

Answer 110

Birth injuries Head trauma Hypertension Infections/sepsis Genetic conditions Family history Illegal drug use (e.g. cocaine)

Answer 111

EEG CT head Full blood count Taking a collateral history from any possible witnesses to a seizure

Answer 112

Pharmacological/Surgical: Partial seizures: Carbamazepine General seizures: Sodium valproate, Lamotrigine Status epilepticus: Lorazepam Lifestyle: Avoidance of epileptic triggers (e.g. noises, flashing lights, stress) Discussion of how to adjust to life with epilepsy (e.g. loss of driving license) Regular check-ups Caution with pregnancy

Answer 113

Dependent on seizure type. All involve loss of consciousness. Tonic - rigidity Tonic-clonic/ Grand Mal - rigidity with muscular convulsions Myoclonic - muscular convulsions Absent- patient will pause for a period of time before continuing as before without noticing the pause. Atonic - patient will lose all muscle strength and may fall to the floor

Answer 114

Type 1: Autoimmune destruction of Pancreatic B cell leading to inability to produce insulin and chronic hyperglycaemia Type 2: Resistance to insulin and eventual reduction in production of insulin and chronic hyperglycaemia

Answer 115

Type 1: Idiopathic cause with potential genetic link Type 2: Obesity, high-sugar diet, low levels of exercise, pregnancy, metabolic syndrome

Answer 116

Genetic predisposition- unmodifiable and can contribute to both types High sugar diet Obesity

Answer 117

Blood glucose tests after fasting and after taking a set amount of glucose HbA1c blood test Consistent finger-prick testing to check glucose levels throughout the day

Answer 118

Pharmacological: Type 1: Insulin injections. Frequency depends on specific formulation Type 2: Multiple treatment options: Metformin - Decreases resistance to insulin, decreases liver gluconeogenesis Sulphonylurea - Increases insulin release from B cells Lifestyle: Carefully controlled sugars within the diet Increased exercise Smoking cessation

Answer 119

Polydipsia Dry mouth Polyuria Unexplained weight loss Fatigue Headaches

Answer 120

A malignant mass in the lung that can spread and invade other tissues.

Answer 121

Smoking Obesity Environmental exposure to carcinogens eg Asbestos, air pollution Family history

Answer 122

Chest X-ray CT/PET-CT Bronchoscopy, Biopsy of mass

Answer 123

Pharmacological/Surgical Interventions - Radiotherapy Chemotherapy Surgery Targeted therapies Lifestyle interventions - Smoking cessation (most important) Weight loss Personal protective equipment if exposed to dangerous chemicals at work

Answer 124

Weight loss Haemoptysis (coughing up blood) Shortness of breath Persistent cough Persistent chest infections Fatigue

Answer 125

A chronic lung disease causing airways to become hypersensitive and inflamed

Answer 126

Unclear true cause, thought to be attributed to pollution, genetics or hygiene.

Answer 127

Family history History of atopy (e.g. hay-fever, eczema, general allergies)

Answer 128

Diagnosed using spirometry, which shows a reversible obstructive pattern

Answer 129

Pharmacological/Surgical Interventions - SABA (salbutamol - short-acting B2 agonist) Corticosteroids (inhaled - beclamethosone) LABAs (salmeterol - long-acting B2 agonist) Lifestyle interventions - Avoidance of possible triggers Smoking cessation Compliance with treatment Consistent check-ups

Answer 130

Cough (worse at night) Wheeze (either audibly or through a stethoscope) Breathlessness Tight chest Acute exacerbations of bronchoconstriction

Answer 131

A long-term progressive lung disease causing increasing breathlessness that isn’t fully reversible. Encompasses emphysema and chronic bronchitis. Emphysema: airflow obstruction in the in the small airways causing hyperinflation Chronic bronchitis: chronic mucus hypersecretion

Answer 132

Smoking (may be second hand) Air pollution Alpha-1-antitrypsin deficiency (a very small minority of cases

Answer 133

Diagnosed using a peak flow meter and spirometry, which shows a non-reversible obstructive pattern

Answer 134

Pharmacological/Surgical Interventions - SABA (salbutamol - short-acting B2 agonist) Corticosteroids (inhaled - beclamethosone) LABAs (salmeterol - long-acting B2 agonist) Mucolytics (reduce mucus production) Lifestyle interventions - Smoking cessation Flu jabs (patients are more prone to infection which can cause exacerbation) Increased exercise Oxygen therapy (to reduce mortality- has no effect on breathlessness)

Answer 135

Chronic productive cough Shortness of breath whilst doing everyday activities Recurrent respiratory infections Cyanosis Fatigue Increased sputum production Wheezing

Answer 136

Lack of oxygen supply to the brain either from blockage or bleeding.

Answer 137

Ischaemic (caused by an embolus in a cerebral artery) or Haemorrhagic (caused by a bleed on the brain)

Answer 138

Modifiable: Smoking Hypertension Obesity High cholesterol High alcohol intake COCP usage Atrial Fibrillation Non-modifiable: Increasing age Family History S. Asian, African or Caribbean ethnicity

Answer 139

To determine stroke risk: Blood tests for cholesterol level and coagulability (INR) Blood pressure BMI ECG do determine AF or other heart condition To diagnose stroke or TIA if indicated by symptoms on presentation CT head Electrocardiograms Cerebral angiography

Answer 140

Pharmacological/Surgical Interventions - Only to treat underlying co-morbidities increasing stroke risk: Anticoagulants Antihypertensives Antiarrythmics Lifestyle interventions - Key in reducing stroke risk: Increased exercise Balanced healthy diet (reducing cholesterol intake) Smoking cessation Alcohol cessation

Answer 141

A heart condition causing an irregularly irregular rhythm and tachycardia, with increased risk of clotting related morbidities.

Answer 142

Secondary to many conditions: Myocardial infarction Hypertension Congenital heart defects Overactive thyroid gland

Answer 143

Increasing age Heart conditions Co-morbidities listed above (*Secondary to many conditions: Myocardial infarction Hypertension Congenital heart defects Overactive thyroid gland)

Answer 144

ECG Blood tests (can highlight anaemia, problems with kidney function, or an overactive thyroid gland (hyperthyroidism))

Answer 145

Pharmacological/Surgical Interventions - Class 1 antiarrhythmics, e.g. Lidocaine B-blockers, e.g. Bisoprolol Anticoagulants to prevent clot formation and minimise risk of embolization Suspend any prothrombotic or proarrhythmic drugs if possible Lifestyle interventions - Diet improvements to reduce further risk of acute coronary syndromes Avoidance of exacerbations (e.g. alcohol, caffeine, illicit drugs) Smoking cessation

Answer 146

+/- exertion Fatigue/Lethargy Palpitations Shortness of Breath Chest pain Feeling faint

Answer 147

A reduction in the haemoglobin concentration of the blood reducing the body's ability to transport oxygen.

Answer 148

Iron deficiency Vitamin B12/folate deficiency Any inflammatory chronic disease Haemolytic diseases Sickle cell disease Malaria

Answer 149

Veganism/Vegetarianism Poor iron intake Any inflammatory chronic disease Menorrhagia Genetics Alcoholism

Answer 150

Blood tests (haemoglobin concentration (diagnostic), haematocrit, mean cell volume, reticulocyte count, iron levels, folate levels (to aid identification of specific pathology) Blood films (identify shapes, sizes and colours of red blood cells) Kidney function tests (e.g. Creatinine levels, eGFR to identify a loss of EPO production)

Answer 151

Pharmacological/Surgical Interventions - B12/Folate/Iron supplements Treatment for underlying chronic conditions Blood transfusions if sickle cell homozygous Anti-malarials if malaria causative factor Lifestyle interventions - Dietary changes dependent on cause of anaemia (B12/Folate-related cause: eat more meat, or take tablets to replace, Iron-related – eat more “leafy greens”)

Answer 152

Fatigue Tachycardia/palpitations Shortness of Breath Dizziness Pale skin Leg cramps Insomnia

Answer 153

Although alcoholism is the most common cause of cirrhosis it may be caused by any inflammation of the liver.

Answer 154

Hepatitis B/C Virus Non alcoholic fatty liver disease (NAFLD) Paracetamol overdose

Answer 155

Illicit IV Drug use Genetics High cholesterol Obesity Paracetamol overdose

Answer 156

Liver function tests

Answer 157

Pharmacological / Surgical Interventions: - Statins - Anti-virals for HCV - Prophylactic HBV vaccine - Acetylcysteine for paracetamol overdose Lifestyle interventions: - Exercise - Smoking cessation - Lower fat intake - Healthy balanced diet

Answer 158

Tiredness and weakness Nausea Jaundice Diarrhoea and Vomiting Fever and shivering attacks * same as alcoholic liver cirrhosis

Answer 159

Damage to liver cells (Hepatocytes) caused by prolonged exposure to large quantities of alcohol. Progresses in 3 stages: Reversible fatty change in days to weeks Reversible hepatitis in moths to years Irreversible Cirrhosis after years

Answer 160

Alcoholism

Answer 161

Liver function tests derived from a blood sample

Answer 162

Lifestyle interventions - Reduce alcohol consumption to nothing Refer to a self help group Pharamacological interventions - Disulfiram to aid with compliance to alcohol abstinence B vitamins especially thiamine to rectify vitamin deficiency Statins to reduce cholesterol and reduce fat deposition in the liver Anti-hypertensives eg. amlodipine to reduce blood pressure Surgical: Liver transplant

Answer 163

Liver failure Portal hypertension

Answer 164

Tiredness and weakness Nausea Jaundice Diarrhoea and Vomiting Fever and shivering attacks * Same as non-alcoholic liver cirrhosis

Answer 165

The irreversible and sometimes progressive loss of renal function over a period of months to years.

Answer 166

Can be exaggerated/precipitated by an AKI and is often caused by other chronic co-morbidities e.g. Diabetes, hypertension, autoimmune diseases (e.g. Vasculitis) and adult polycystic kidney disease.

Answer 167

Alcohol Obesity Diabetes Hypertension Autoimmune conditions, e.g. Vasculitis Genetic pre-disposition, e.g. Polycystic Kidney Disease

Answer 168

CKD progression is staged based off the patient's eGFR, calculated using serum Creatinine levels Proteinuria levels Urinalysis Bloods Auto-antibody tests Ultrasound to check for obstructions

Answer 169

Pharmacological and surgical interventions - Management is generally supportive, pharmacology is based on underlying cause of CKD. Haemodialysis (HD, 4 hours, 3 times a week, in the hospital, attached to a machine) Home HD Peritoneal dialysis Kidney transplant (if no other available options and donor available) Lifestyle interventions - Modifiable risk factors: Regular exercise (obesity is a risk factor) and a good, regulated electrolyte diet can improve CKD progression rates Alcohol removal Smoking cessation Controlling diabetes adequately Controlling hypertension adequately Non-drug lifestyle options: Vitamin D tablets to make up for reduced Vitamin D synthesis from the kidney Iron/B12/Folate to make up for reduced EPO production by the kidney

Answer 170

Tiredness (overwhelmingly fatigued) Difficulty sleeping Difficulty concentrating Symptoms and signs of volume overload (SoB, oedema) Nausea & vomiting / reduced appetite Cramps, pruritus Increased frequency of infections

Answer 171

A dramatic reduction in kidney function and GFR that occurs over a short period of time

Answer 172

An acute drop in renal function with causes categorised into: Pre-renal (cardiogenic, mechanical, normovolaemic shock) Intra-renal (nephrotoxic drugs, autoimmune damage) Post-renal (obstructive e.g. renal calculi)

Answer 173

Increasing age CKD/HF/Liver disease/Diabetes Infection/Sepsis Urinary tract obstruction NSAIDs/Diuretics/Aminoglycosides

Answer 174

Urinalysis (always) Blood tests, most importantly Serum Creatinine and Serum Urea

Answer 175

Pharmacological/Surgical Interventions - Electrolyte balanced diet Controlling co-morbidities including diabetes, hypertension, heart failure and infection. Lifestyle Interventions - Iron/B12/Folate - due to loss of kidney EPO production Vitamin D - due to loss of kidney production Regular exercise Smoking cessation and alcohol reduction

Answer 176

Oliguria (reduced urine production) Oedema Fatigue Shortness of breath Nausea and Confusion.

Answer 177

HLA - DR3 (*same as celiac disease*) HLA - DR4 (*same as rheumatoid arthritis*)

Answer 178

HLA - DR4 (*same as IDDM*)

Answer 179

HLA - DR3 (*same as IDDM*) HLA - DR7