PACES Flashcards

Question

steroids SEs

Answer 1

- Cushings - Weight gain - Thinning of skin - Immunosuppression

Answer 2

- DKA - HHS - Dehydration - Rule out infx

Answer 3

Cons - Frequent monitoring - DVT prophylaxis - Diabetics team/endo r/v - Consider HDU if severely unwell - Consider NG tube for drowsy/vomiting pts

Answer 4

Before meals 4-7mmol/L 2h after meals 5-10mmol/L HbA1C 1) 48mmol/L for dx of diabetes 2) 48mmol/L target if no trx 3) 53mmol/L target if on trx

Answer 5

Blood glucose >= 11mmol/L Ketones pH <7.3

Answer 6

- Rapid acting (15 mins): humalog - Short acting (30 mins): humulin R - Intermediate acting (2-4h): humulin N - Long acting (several hours): lantus

Answer 7

Pseudo-acromegaly (looks like it but w/o incr GH) Causes: obesity, insulin resistance, hypothyroidism

Answer 8

Bedside: BM/HbA1c, ECG Bloods: IGF-1 (insulin-like growth factor 1), oral glucose tolerance test, prolactin, triglycerides, GHRH, cortisol/estradiol/testost Imaging: ECHO, MRI brain/hypothal, CT scan (to check for lung/pancreas/adrenal/ovarian tumours in ectopic production)

Answer 9

Definitive: - Pit adenoma: trans-sphenoidal pituitary tumour removal - Ectopic: ca removal - Familial cause, e.g., MEN 1: genetic counselling Meds to suppress GH: - Somatostatin analogue, e.g., octreotide - Dopamine agonist, e.g., bromocriptine + cabergoline

Answer 10

Pituitary gland releases too much GH -> signals liver to produce insulin-like growth factor I (IGF-I) -> causes bones and body tissue to grow.

Answer 11

benign tumour on vestibular nerve

Answer 12

Ix - Audiometry to assess hearing loss (sensorineural) - MRI or CT head to establish dx Mx - ENT referral Conservative: monitor growth if no syx - Radiotherapy to reduce/stop tumour growth - Microsurg to remove tumour

Answer 13

(!quit smoking) Induce: PO pred / IV hydro Maintain: azathioprine

Answer 14

Induce: if mild- mod, PO/PR mesalazine; if severe, IV hydro Maintain: mesalazine (Aminosalicylates) Surg: panproctocolectomy

Answer 15

1 - no syx/ no limitation ADL 2 - mild syx / slight limitation 3 - only comf at rest / sig limitation 4 - syx at rest / severe limitation

Answer 16

- Jaundice - Pale stool - Dark urine - Itchiness - IVDU

Answer 17

Bloods: - Iron studies (haemochromatosis) - Viral hep screen - Antibodies: Anti-smooth muscle (AI hep), Anti-mitochondiral (PBC), p-ANCA(PSC) - HIV - STI

Answer 18

- Hep ref - Analgesia: paracetamol - Itch: chlorphenamine - minimise transmission - pt education - consider GUM referral - contacts for hep vax Antivirals - hepB:interferon alpha, hepC: ribavirin

Answer 19

- Steroids - Azathioprine (immuno suppr)

Answer 20

Cirrhosis severity and mortality (BR, albumin, INR, ascites, encephalopathy)

Answer 21

- Supportive care: O2, fluids, electr repl - Anti-thyorid meds: PTU - Steroids: prednisolone (reduce inflamm and lower thyroid levels) - v severe: plasmapheresis

Answer 22

Cushings syndrome 1. 24h urinary cortisol OR overnight (low dose) 1mg dexamethasone suppression test OR salivary cortisol 2. If +ve, perform 2nd test from above -> positive = confirmed (dexamethasone is basc acting on same Rs as cortisol, so we should get -ve feedback and thus low cortisol) Cushings disease Serum midnight ACTH -> normal/high ^High dose dexamethasone suppression test - If suppressed -> cushing’s disease -> pituitary MRI - If not suppressed -> ectopic ACTH -> CT TAP Serum midnight ACTH -> low ^ACTH independent cause -> CT TAP ?adrenal carcinoma

Answer 23

Syndrome - Identify + treat underlying cause - Syx mx: HTN, high blood sugar, osteop Disease - First line: transsphenoidal surgery to remove pit tumour ± adjuvant radiation - Medication: Ketoconazole - lower cortisol // neoadjuvant

Answer 24

- SCLC: chemo, e.g., cisplatin - NSCLC: immunotherapy, e.g., tyrosine-kinase inhib - SVCO: IV dexameth -> radiotherapy or SVC stenting Surgical Lobectomy + adjuvant chemo & radio (more for NSCLC which is more localised)

Answer 25

BNP and ECHO !!

Answer 26

- Vaccinations incl pneumococcal, influenza and COVID - Pulm rehab - Personalised self-mx plan - Good inhaler technique

Answer 27

Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Emphysema is damage to alveoli

Answer 28

MART - combo of corticosteroid preventer and long acting bronchodilator

Answer 29

1) Pneumoconiosis 2) Hypersensitivity pneumonitis

Answer 30

Cons - Vacc: pneumococcal, influenza + COVID - Physio + pulm rehab - Advanced care planning Med - IPF: anti-fibrotics, e.g., pirfenidone - Hypersens pneumonitis: avoid antigen, PO gluococorticoids - Advanced: LTOT Surg - Lung transpl

Answer 31

1) Uveitis, IBD 2) Regular:NSAIDs Steroids during flares -> biologics: anti-NF (e.g., infliximab) Surg: may be required to fix spine deform

Answer 32

- Rheumatoid nodules - Secondary sjogrens (dry eyes, dry mouth) - Carpal tunnel

Answer 33

Serum urate

Answer 34

PMR - inflamm disease; bilat pain and stiffness of shoulders, hips, neck; clinical + raised ESR & CRP PM - inflamm disease; proximal muscle weakness; clinical + CK, lactate dehydrog raised, muscle biopsy FM - chronic pain disorder widespread MSK pain and tenderness

Answer 35

Cons: NSAIDs, PT+OT, rheum Med: Steroids + PPI, osteoprophylaxis (bisphos, Ca, vit D), consider steroid-sparing/immunosuppressants (MTX + folate)

Answer 36

1st line (non severe): hydroxychloroquine (±NSAIDs&Corticosteroids&immunosuppr, e.g., MTX, biologics, e.g., rituximab)

Answer 37

In SLE, the immune system produces antibodies that target and attack various parts of the body, including the skin, joints, kidneys, lungs, and other organs.

Answer 38

- Kidney disease - CVD - Pulm disease - Infx - Osteopor

Answer 39

Occurs when damaged muscle tissue releases its proteins and electrolytes (*K+*, Na, Ca) into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death. Ix: - Urine myoglobin - CK, ABG (met acidosis)

Answer 40

- IV fluids - Correct complx, e.g., hyperK or arrhythmia - Consider withholding nephrotoxic drugs - Consider IV mannitol (impr eGFR and oedema surrounding muscle and nerves) - Consider haemodialysis if renal function doesnt improve

Answer 41

High flow O2 + triptans prophy - verapamil

Answer 42

! Refer to acute stroke unit Ischaemic - 300mg STAT dose PO aspirin - Thrombectomy (6h) / thrombolysis (4.5h) Haemorrhagic - Neurosurgeon referral - Reverse if on warfarin - Monitor BP and gradually lower as necessary to prevent further bleed - TED stockings (2ndry prevention incl clopidogrel 75mg daily)

Answer 43

Autoimmune disease of the neuromuscular junction (NMJ) caused by antibodies that attack components of the postsynaptic membrane, impair neuromuscular transmission, and lead to weakness and fatigue of skeletal muscle.

Answer 44

- Myasthenic crisis (worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation) - Dysphagia

Answer 45

- Pt education and support - Ref to specialist neuromusc services - Reg monitoring syx - Syx mx: AChesterase inhib - pyridostigmine - Immunomodulatory mx: corticosteroids/azathioprine/rituximab - pt w mod-severe/don't respond adequately to syx trx ! Thymectomy should be considered for all pts

Answer 46

Generalised tonic clonic & absence & atonic & myotonic: sodium valproate focal: carbamaz/lamotr

Answer 47

- Lack of sleep - Missed meds - Stress - Alcohol

Answer 48

Ddx - Vit B12 deficiency - GBS Ix - Vit b12 - MRI brain/spinal cord (demyelinating lesions) - LP (oligoclonal bands in MS, elevated in GBS - Nerve conduction studies (slow in GBS)

Answer 49

- Relapsing-remitting: immunomodulator - interferon beta - Primary progressive: anti CD20 MAB - Neuropathic pain: amitryptiline - Spasticity: baclofen - Psychotherapy

Answer 50

Optic neuritis (50%) - inflamm of optic N - Pain worse w eye movement - Vision loss one eye - Loss vision colour - FLashing lights

Answer 51

- Fatigue - low mood - Vertigo - Vision - Bowel/bladder - Speech issues

Answer 52

Nodular, superficial spreading, sclerosing, pigmented

Answer 53

1) Dermoscopy, excisional biopsy + histology ± CT/MRI for spread 2) Surgical excision and closure / radiotherapy / 5-fluorouracil / cryotherapy / curettage and ekectodesiccation / Moh's micrographic surgery!

Answer 54

Combo of: excess sebum production + follicular plugging with sebum and keratinocytes + colonisation of follicles by cutibacterium acnes

Answer 55

Topical: 1. Mild-mod: Retinoids 2. Severe: retinoids + benzoyl peroxide + PO abx PO (not resp to topical) 3. Mod-sev: PO abx 4. Sev/scarring: isotetrinoin *referral to derm if severe/scarring or no response to initial treatments

Answer 56

- Hydrocortisone - Eumovate - Betnovate - Dermovate

Answer 57

people with eczema suffer from the condition due to a lack of filaggrin. Filaggrin is a protein responsible for building a strong, protective skin barrier

Answer 58

skin is disrupted and microorganisms invade the subcutaneous tissues

Answer 59

Topical steroids / vit D analogue / phototherapy

Answer 60

Psoriasis - scalp, elbow, knees, lower back; thick, scaly silver/white patches Eczema - backs of knees, inside elbows, face; red, itchy, inflamed skin

Answer 61

- Plaque (most common) - Scalp - Nail - Guttate - Pustular (dangerous)

Answer 62

when GB inflamed and swollen, irritates your phrenic nerve

Answer 63

Acute chole, elicit by asking pt hold deep breath while palpating R subcostal area-> pain

Answer 64

- Bowel perf - Bowel isch - Diverticular disease

Answer 65

- NBM - IV fluids ± NG tube - electrolyte repl - Analgesia - VTE

Answer 66

normal coordinated movements of the muscles of the digestive system become impaired, resulting in a blockage of the intestines due to surgery, injury, infection

Answer 67

Appendicitis - pain referred to RLQ when LLQ palpated

Answer 68

Mild - Admission + monitor - NBM - IV fluids + correct elec disturb - Analgesia Mod-severe as above + - Nutr support via NG - Abx if infx susp/confirm

Answer 69

I - idiopathic G - gallstones E - ethanol (T) (S) M - mumps

Answer 70

Severe abdo pain that worsens w any motion voluntary or invol tensing of abdo muscles

Answer 71

- Melaena - Vomiting - LL abdo pain, worsen by eating - ±pyrexia/shivering

Answer 72

Cons: 1) home ± abx if syx + safety net 2) admit if - Pain not managed w paracetamol - Poor hydration - Syx >48h cons: NBM + IV fluids + analgesia ± NG if vom medical: PO Co-amox 5 days if uncompl // IV if severe acute surg: ref + surg if complx (perf, abscess, sepsis)

Answer 73

sigmoid colon

Answer 74

- Epidiymo-orchitis - Trauma - Cellulitis - Test torsion

Answer 75

NAAT - nucleic acid amplification testing

Answer 76

Mx - Admit if acutely unwell - Abx depending on pathogen: STI - doxy, E coli - cipro - Bed rest + scrotal elevation + analgesia - Abstain sex intercourse + reduce physical activity Complx - Chronic epididymitis - Abscess - Infertility - Sepsis

Answer 77

1) lifestyle: avoid caff/excessive fluid + weight loss + pelvic floor exercise Stress 2) 3/12 pelvic floor exercise if ineffective - surgery: colposuspension, urethral bulking agent, tension free vaginal tape 3) duloxetine Urge 2) BLadder training 3) meds: oxybutynin (anti musc), or mirabegron 4) surg/procedures: botulinum toxin A inj, sacral nerve stim

Answer 78

ddx - Prostatitis - UTI - bladder ca (typically haematuria) ix - Pt voiding diary - PSA - Transrectal US-guided biopsy (confirms dx and Gleason grading)

Answer 79

Depending on Gleason score + staging - Asyx/unsuitable: watchful waiting - annual PSA and mx urinary syx - Low risk + localised: active surveillance - 6 monthly PSA + annual DRE + yearly MRI - Intermed/high risk: radical prostatectomy or radiotherapy - Mets: hormone therapy

Answer 80

- Prostate ca (less likely w/o FLAWS, but should excl) - Prostatitis - UTI Ix ! clinical dx

Answer 81

International prostate syx score - Screen/track syx/suggest mx for syx of BPH

Answer 82

range of urinary symptoms that can affect the bladder, prostate gland, urethra (LUT) Obstructive syx - hesitancy - weak stream - straining - incomplete emptying Irritative syx - Urinary urgency - frequency - nocturia - urinary incont

Answer 83

- Orthostatic HTN - Sexual dysf - decr libido, ED, ejac disord

Answer 84

Cons: physical acitivity, less fluid before med, mod consump alc and caff + intermit self cath if BPH causing frequent retention, UTI or renal failure Med: alpha blocker, e.g., tamsulosin or 5-alpha reductase inhib, e.g., finasteride Surg: transurethral resection of the prostate (TURP) *TURP syndrome: HTN + brady + mental status change (too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream)

Answer 85

1) M 65 USS screening ± F 70 w/ RFs <3cm bye bye, 3-4.4 yearly, 4.5-5.4cm 3-monthly 2) Cons: contact DVLA if >6, stop driving is >6.5cm Med: mx RFs Surg: refer to vasc if >3cm; urgent if >5.5cm vie EVAR (endovascular aneurysm repair) or laporotomy 3) Ruptured AAA - Emerg surg (not to be delayed by diagnostic imaging) - Lower BP than usual

Answer 86

DOAC (apixaban) Provoked: 3 months Unprovoked: up to 6 months (LMWH/UFH if low renal function)

Answer 87

erectile dysfunction and pain in thighs

Answer 88

- Neurogenic claudication (due to spinal canal stenosis) - MSK cause - ?DVT

Answer 89

1) Doppler US 2) 0.5-0.9 peripheral artery disease, <0.5 critical limb ischaemia

Answer 90

Lifestyle - Alc <14 units/week - Exercise programme Med (2ndry prev CVD) - Antiplatelet - Statin - Good control DM and HTN Surg/proced - Interventional - angioplasty + stenting - Bypass surg (last resort)

Answer 91

- Invasive (most common) - Invasive lobular - Paget's disease of the breast - DCIS - LCIS

Answer 92

- Surgery: breast-conservative + adjuv radio/chemo, OR mastectomy - Chemo - Radio - Hormonal: if ER+ -> tamoxifen (premen), or aromatase inhib (postmen) - Targeted: if HER2 +ve -> herceptin

Answer 93

Ddx - Acute vestibular labyrinthitis - Vestibular neuritis - Meniere's Ix - Dix- hallpike (syx of vertigo and rotational nystagmus when head tilted to opposite side of diseased ear) Mx - Consider DVLA/occup risk - Limit syx by moving head slowly - Vestibular rehab, e.g., Brandt-Daroff exercises ±physio input - Epley manoeuvre

Answer 94

1 - Inner ear problem usually caused by viral infx -> vertigo/ hearing loss/tinnitus 2 - Inflamm of vestibular nerve -> no hearing loss/tinnitus 3 - Inner ear problem due to accum fluid -> recurrent episodes of vertigo, tinnitus and hearing loss + syx pressure/fullness 4 - Abnormal bone growth in middle ear -> cond hearing loss

Answer 95

BPPV occurs when small crystals of calcium carbonate, shift in the inner ear and/or fall into another area within the balance canals Cause: inner ear infx (labyrinthitis), fever, head injury, whiplash injury RF: Concussions, meniere's, DM, HTN

Answer 96

Ddx - Tumour - Goitre - Skin abscess / cyst - Lymphadenopathy Ix - Blood film - HIV - Monospot/EBV test - TFT - USS (soft tissue sarcoma) - CT

Answer 97

Cons: SALT, dietitician input, psychosocial support 2ndry prev: smoking/alc/fruit/veg/reduce red meat + fried food / reg dentist/ vax against HPV

Answer 98

- Reactive - Infected - Inflamm - Malignant

Answer 99

- Tonsillitis (most commonly due to group A strep/strep pyogenes) - Pharyngitis/laryngitis - Infx mono/glandular

Answer 100

Cons: avoid spread, analgesia, safety net Med: - ABx: if CENTOR >= 3 or FeverPAIN >=4; if not delayed abx Surg - ENT ref if recurrent >7/year or 5/year for 2 years or 3/year for 3 years

Answer 101

Fever past 24h Purulent tonsils Attend rapidly within3 days Inflamm tonsils severely No cough or coryza

Answer 102

- Otitis media - Quinsy (peritonsillar abscess) - OSA

Answer 103

- Abscess - Stenosis ear canal - Perf tymp membr

Answer 104

Cons - watch & wait, usually resolves 3-7 days - Analgesia - Valsalva manouevre Med - Admit if syst unwell - Immed abx if syst unwell/immunosupp - Delayed prescr after 3 days if syx dont impr Surg - ENT ref if complx -> tympanocentesis or grommet fitting

Answer 105

Pathogens: strep pnum, RSV - Facial N palsy - Mastoiditis - Acute labyrinthitis

Answer 106

Ix - Audiometry (low freq sensorineural hearing loss) - MRI (excl vestibular schwannoma) Mx - Decr salt and caffeine intake - DVLA - Vestibular suppressants for acute eps (prochlorperazine)

Answer 107

- Rest + immobil - Ice - Analgesia (NSAIDs) - Elevation - 6-12 weeks to heal - Night splints to hold foot in neutral position - VTE prophylaxis - Physio input If ruptured - Period of non weight bearing - Brace or plaster cast - Surgical r/v

Answer 108

Compression of median n in risk RFs: overweight, preg, activities repeatedly bend wrist, prev wrist injury Cons - Rest - Minimise activities which exacercbate - Wrist splint - Trial NSAIDs ± PPI cover - physio - ergonomic changes Med - Steroid inj (syx relief) Surg - Carpal tunnel decompr surgery - Sonographically guided carpal tunnel release

Answer 109

- Rotator cuff tear (USS) - Rotator cuff rupture (USS) - Adhesive capsulitis (frozen shoulder) - OA (XR) - #

Answer 110

Cons - Rest - Analgesia - Ice - Adapt activities - Physio Surg - Depends on degree of damage lol

Answer 111

increase in pressure inside a muscle, which restricts blood flow and causes pain ddx - # - Haematoma - RHabdo cause - # - badly bruised muscle - constricting bandages mx - urgent ortho referral for fasciotomy (relieve Pa within compartment and restore blood flow -> prevent tissue necrosis) within 6h - Analgesia - oral hydr - remove any external dressings - elevate leg to heart level

Answer 112

ddx - # - Patellar disloc - meniscal tear ix - MRI - arthroscopy (gold standard to visualise ligaments) Mx - ortho ref Cons - Rest, ice, compression, elevation, rehab - analgsia: NSAID - crutches/knee brace -physio Surg - Ligament reconstruction (arthroscopic surgery) in complete rupture where no local healing detectable

Answer 113

- Primary survey - Lying/standing BP - ECG - Urine dip

Answer 114

Cons - analgesia - VTE prophylaxis - PT/OT input - prophyl abx if open wound - falls assessment (age, presenting w/ fall, meds or med conditions that incr risk fall, hx falls, etc) - r/v meds Surg Intracapsular - Displaced: THR or hemiarthroplasty - Undisplaced: dynamic hip screw Extracapsular - Intertrochanter: dynamic hip screw - Subtrochanter: intramedullary nail

Answer 115

- HTN meds - Benzodiazepines - Antidepressants - Antipsychotics - Opioids - NSAIDs

Answer 116

For subcapital femoral neck #, predicts development of osteonecrosis

Answer 117

Dx: >140/90 (clinic), or 135/85 (home) Stage 1: >140/90, or >135/85 Stage 2: >160/100, or >150/95 Stage 3: >180/120 <80 y/o: <140 S, <90 D >80 y/o: <150 S, <90 D

Answer 118

- Kidney: dipstick -> proteinuria, haematuria // Urine albumin:creatinine ratio // U&Es - Eye: fundoscopy -> hypertensive retinopathy - Bloods: glucose, lipid profile

Answer 119

- Incr age - F - Low BMI - Long term steroids - Alcoh -Smoking

Answer 120

Risk of fragility # over next 10 years

Answer 121

- Local skin ifx - Spinal cord compr - Papilloedema/other signs of raised ICP

Answer 122

fibrosis and thickening of the joint capsule and adherence to the humeral head onset to recovery 12-42 months, most pts recover but normal ROM may not return !diabetes pts at higher risk Mx Cons - Continue using arm but dont exacerbate pain - Physio -> active/passive exercise and stretching - Analgesia ± TENS (transcutaneous electr N stim) for pain mx - Pain clinic/ortho if signif disab + poor pain control Med - Intra-articular steroid injections Surg - Arthroscopy to remove adhesions

Answer 123

Freezing/inflamed -> frozen/stiff -> thawing

Answer 124

Ddx - Prolapsed lumbar disc - Conus medullaris - Peripheral neurop Ix - ER MRI to confirm/exclude Mx - Hosp admission - Neurosurg input -> lumbar decompr surg - VTE proph - Abx if infx cause

Answer 125

Vertebral level CM: most distal end of spinal cord - CNS (L1-2) CE: collection of N roots - PNS (L2-S5) Impacted n roots CM: sacral CE: lumbosacral Symmetry of signs CM: symmetrical CE: asymmetrical Involvement of lower extr, bowel, urin CM: less extr, but more bowel + urin CE: more Reflexes CM: Increased CE: decreased

Answer 126

Narrowing of spinal canal -> compr of spinal n, or sometimes spinal cord. syx: back pain + leg pain ± numbness, mostly when walking rf: - Narrow spinal canal - F - >= 50 yo - Prev inj/spinal surg ix: MRI mx: 1. Cons - Physio: impr spiinal mobility, strength - Pain mx - Overal fitness ++, ± weight loss 2. Med - Spinal injections - Nerve root block 3. Surg - Decompression (*types: lateral, central and foraminal stenosis)

Answer 127

Most commonly due to ascending urethral infx - Groin pain, worse on opening bowels - Dysuria, incr freq, slow stream - Feverish (can be caused by STIs huh) Ddx - UTI - Urinary tract stones - Prostatic abscess

Answer 128

Cons - Analgesia Med - Admission if acutely ill/septic - Abx if <6/12 hx - Alpha blockers, e.g., tamsulosin, to relax smooth muscle and improve syx Surg - Suprapubic cath (if urin reten) - Transrectal aspiration under US guidance for abscess Complx - Abscess - Epididymitis - Sepsis

Answer 129

Swollen vein/group of veins around anorectal region (*Thrombosed -> when blood clots develop -> pain & itch + -> bleed if ulcerated)

Answer 130

- Topical trx to reduce swelling/pain - anusol - Constip: incr fibre + fluid intake - Non-surg: rubber band ligation (cut off blood supply), bipolar diathermy - Surg: haemorrhoidectomy, haemorrhoidal artery ligation

Answer 131

Ddx - Olecranon bursitis - Elbow arthritis Ix - Clinical dx - XR if unclear Mx - Self limiting (most good progn) - Rest - Modify activities that exacerbate syx - NSAIDs - Apply heat/ice - Physio - Orthotics - elbow braces Med: ± steroid inj short term relief Surg: release/repair damaged tendons

Answer 132

Ddx - Monoclonal gammopathy of undetermined significance (MGUS) - Bone metastases - CLL Ix - Urine electrophoresis (Bence Jones protein) - Bone profile (ca) - Serum protein electrophoresis (shows which type of myeloma proteins raised) - Blood film (rule out leukaemia) - XR (lytic bone lesions) Mx Cons: analgesia, hydration, emotional/psych support Med: trx guided by haem and onc specialists - Non chemo regime: combo of dexamethasone and immunomodulatory agent - Conven chemo: as above + chemo, e.g., cyclophosphamide - Cement inj in #/lesions to improve spine stab - Stem cell transpl - Treat any complx myeloma

Answer 133

- infection - renal failure - spinal cord/nerve root compression - neuropathy

Answer 134

MM: malignant cancer of plasma cells that produce abnormal M protein, which can cause bone pain, anaemia, kidney damage, and other symptoms all related to the abnormal growth of plasma cells in the bone marrow, but differ in terms of severity and risk of progression to multiple myeloma MGUS: benign condition presence of small amount of abnormal monoclonal protein (M protein) in blood without any symptoms or organ damage. MGUS does not require treatment and does not progress to multiple myeloma in most cases. SM: higher level of M protein and abnormal plasma cells in the bone marrow than MGUS, but no symptoms or organ damage. Smoldering myeloma has a higher risk of progression

Answer 135

Ca of particular line of stem cells in bone marrow - myeloid v lymphoid Prx - Bruising/petechiae - FLAWS - pallor - hepatosplenomgaly Ddx - HSP - ITP - Meningococcal septicaemia Ix - Blood film! - Bone marrow biopsy

Answer 136

Henoch-Schönlein purpura (HSP) is an IgA mediated vasculitis, tends to occur post-infection with the most common trigger being group A streptococci (URTI or GI) purpura on legs, buttocks, arms (self limiting)

Answer 137

Purpura + low platelets following viral illness (self limiting)

Answer 138

Most common acute adult leukaemia. It can be the result of a transformation from a myeloproliferative disorder (e.g., PCV or myelofibrosis). Associated with Auer rods + blast cells ++.

Answer 139

Has three phases: 1) chronic - 5yr and asyx, 2) accelerated and 3) blast. Associated with the Philadelphia chromosome.

Answer 140

Most common leukaemia in adults overall. Associated with warm haemolytic anaemia, CLL can undergo Richter’s transformation into high grade lymphoma. Blood film shows smudge / smear cells.

Answer 141

- Failure - Infx due to immunodef - Infertility - TLS

Answer 142

Release of uric acid from cells being destroyed by chemo -> forms crystals in interstitial tissue and tubules of kidneys -> AKI mx: allopurinol

Answer 143

Cardiac - Congenital heart disease - Infective endocarditis Respiratory - Lung ca - Bronchiectasis - Pulm fibrosis / ILD GI - IBD - Coeliac

Answer 144

I performed a vascular exam on this x year old pt. The patient appeared comfortable at rest. On examination, there were no signs associated with vascular disease. CRT was <2s both in upper and lower limbs. All pulses were palpable throughout the body. Buergers test was negative.

Answer 145

Once inside the body, HIV gets inside certain types of white blood cell called CD4. These cells are part of the body’s defenses against infection. Without treatment the virus gradually damages the immune system. Eventually people become susceptible to unusual infections that would not normally trouble someone with a healthy immune system.

Answer 146

- Bacterial infx - multiple or recurrent - Kaposi sarcoma - Pneumocystis jirovecii pneumonia

Answer 147

General mx new HIV dx - ART - START study - better health outcomes when starting early - Normal life expectancy - Undetectable = untransmittable - <50 copies/ml undetectable viral load - Contact tracing & PEP - Charities offering support - Once stable - Monitor 2x/year: in-depth annual r/v and six-monthly viral load, hepatitis and syphilis test

Answer 148

Duet to pt’s decreased ability to mount an inflamm response - most common life-threatening complication of cancer therapy - onc emergency - Prompt empirical abx trx

Answer 149

- **5 mg of folic acid per day + Ca + vit D supplementation ± nutritional support if not gaining weight early in preg** - Meds such as sulfalazine interfere folic acid metab - Latter 2 to prevent bone loss

Answer 150

- Paroxysmal: occurs intermittently and stops on its own within 7 days - Persistent: lasts longer than 7 days - Long-standing: lasts longer than a year

Answer 151

- AFib - SVT - Premature ventricular contractions

Answer 152

Acromegaly is a condition that results from excess growth hormone (GH) secretion by the pituitary gland. This excess GH can cause abnormal growth of body tissue, including the heart. One of the most common cardiac problems associated with acromegaly is hypertrophic cardiomyopathy, which is a thickening of the heart muscle. This occurs most commonly at the septum, which can cause reduced, or even obstruction, of blood flow out of heart. You can also get stiffness of the ventricle due to cellular changes that happen in cardiac muscle when it thickens - ventricle can’t relax normally and fill with blood → less blood at end of filling → less blood pumpled to rest of body

Answer 153

- Diabetes - HTN - PKD - SLE - Kidney stone - Chronic pyelonephritis

Answer 154

Fluid filled cysts develop → gradually enlarge + damage kidney → reduced kidney function over time Cause: mutation of PKD1 or PKD2 gene which produce proteins that are important for kidney function.

Answer 155

Syx - Abdo pain - Back pain - Haematuria - HTN Mx - Refer to nephrology - Monitor kidney function - Creatinine - eGFR - urine dip for protein - Mx HTN - ACEi/ARBs - Mx pain - Genetic counselling

Answer 156

- Jaundice - RUQ - Fever

Answer 157

1) Intermittent claudication -> 2) critical limb ischaemia 3) acute limb ischaemia

Answer 158

syx of ischaemia during exertion - crampy/achy pain which resolves on rest

Answer 159

rapid onset limb ischaemia due to thrombus (/clot) blocking supply to distal limb! - 6Ps! - emergency trx needed

Answer 160

end stage disease (chronic) - inadequate blood supply at rest - Pain at rest - Muscle wasting - Hair loss - Non-healing ulcers - small, deep, well-defined borders - More peripherally, e.g., toes - painful - Gangrene

Answer 161

Lipid deposits in artery walls → atheromatous plaques → stiffening (which causes HTN and increased strain on heart) + stenosis (reduced blood flow) + plaque rupture (thrombus)

Answer 162

- Angina - MI - TIA / stroke - Peripheral artery disease - Chronic mesenteric ischaemia

Answer 163

Lifestyle changes - stop smoking - exercise training programme - treatment of medical conditions Medical: - Atorvastatin 80mg - clopidrogel 75mg - naftidrofuryl oxalate (peripheral vaso-dilator) Surgical - Angioplasty and stenting - Inserting catheter through arterial system under xray guidance → balloon inflated at area of stenosis to create space in the lumen → stent to keep artery open - Endarterectomy - cutting vessel open and removing atheromatous plaque - Bypass surgery - Using graft to bypass blockage

Answer 164

- Urgent referral to vasc team - Analgesia to manage pain - Urgent revascularisation - Endovascular angioplasty and stenting - Endardectomy - Bypass surgery - Amputation - If unable to restore blood supply

Answer 165

- Urgent referral to oncall vasc team - Endovascular thrombolysis - Inserting catheter and applying thrombolysis directly to clot - Endovascular thrombectomy - Inserting catheter and removing thrombus via aspiration/mechanical device - Surgical thrombectomy - Cutting open vessel and removing thrombus - Endarterectomy - Bypass surgery - Amputation How do you unblock an artery? - Fogarty catheter

Answer 166

Veins bring blood back to the heart, in venous disease veins become diseased or abnormal so we essentially have a drainage issue. Venous disease can be classified via CEAP classes (Clinical manifestation, etiology, anatomic distr, and pathophysiology), the following is the C bit: C0 - no signs of venous disease C1- telangiectasia/spider vei C2 - varicose veins C3 - oedema C4 - skin changes, e.g., pigmentation C5 - healed venous leg ulcer C6 - active venous leg ulcer

Answer 167

- Larger, more superficial - Irregular border - Affect midcalf down to ankle - Less pain - ±Haemosiderin staining - ±venous eczema

Answer 168

Investigations: duplex USS (look at the speed of blood flow, and structure of the leg veins) Management (venous ulcer) - Conservative: ulcer clinic for compression banding, analgesia, patient education - self-care, including regular exercise, maintaining a healthy weight, keeping limb raised where poss - Medical: corticosteroids for itching, abx for infx

Answer 169

ILD are a group of lung conditions which cause inflamm and scarring PF is what the scarring itself is called

Answer 170

- Multisystem atrophy (LSBP -> shy drager syndrome) - Progressive supranuclear palsy (eye movements -> nystagmus) - Corticobasal degeneration

Answer 171

-Degenerative: age-related calcific - Infx: Rhfever, IE -Structural: HOCM

Answer 172

-Narrow pulse pressure / slow-rising pulse -Delayed closure of A2 or reversed splitting of 2nd HS -Absent 2nd HS -Heaving apex beat -Features of congestive cardiac failure -Symptomatic

Answer 173

-Symptomatic -CCF -Mean transvalvular pressure grdient -> Pa before and after valve >40mmHg; valve area <1cm^2; or jet velocity >4m/s -Concomitant CABG

Answer 174

-Open surg -TAVI :) No bypass / large scars :( ^ risk stroke vs open -Balloon valvuloplasty

Answer 175

TAVI usually inserted via temporal artery and up into aorta Metallic: -Lasts >20-30 yrs - ☑ Warfarian life long -> younger pt - ☑ hyperpanothyr Bio: - Lasts 10-15 yrs -> More likely replacement - Not typically needing warfarin -> older pt - ☑ Kidney disease

Answer 176

Valve -> Warfarin target (INR) -> Duration: ----------------------------------------------------------- Aortic bioprosthetic -> Nil (aspirin) -> n/a }Much lower rates thromboembolic events Mitral bioprosthetic -> 2.5 (2-3) -> 3 months (then aspirin) Aortic mechanical -> 3 (2.5-3.5) -> Life-long !Mech. valve ALWAYS warfarin Mitral mechanical -> 3.5 (3-4) -> Life-long INR target mitral > aortic as mitral valve at greater risk thromboemb. event

Answer 177

Internal thoracic (mammary) ARTERY currently most commonly used

Answer 178

1:-Dual anti-platelets (aspirin + -c-l-o-p-i-d-o-g-r-e-l-) -> ticagrelor -> more common - For 12 months - Then aspirin alone - +/- Specialist opinion [NICE] 2:-Cardio-selective beta-blocker (e.g. bisoprolol) 3:-ACE-inhibitor (or angiotensin receptor blocker) -e.g. ramipril

Answer 179

-Degen: M1 -Infx: RhF, IE -Autoimm: SLE -Structural: conn. tiss dis, e.g. Marfans