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P4 > 100 cases > Flashcards

100 cases Flashcards

1
Q

causes of hyponatraemia

A 
acute renal failure
adrenal insufficiency
cirrhosis + ascites
SIADH
thiazide use
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2
Q

what is SIADH associated with?

A

meningitis
head trauma
pneumonia
SCLC

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3
Q

reasons for elevated prolactin

A

pregnancy
emotion stress
after epilepsy

higher the prolactin, the greater the indication a tumour is present
microadenoma >2000
macroadenom >6000

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4
Q

Mx for prolactin releasing pituitary adenoma

A

domapine agonists

  • bromocriptine
  • cabergoline
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5
Q

why do a faecal calprotectin?

what causes a raised score?

A

calprotectin is produced by neutrophils

elevated in concentrations in faeces associated with inflammation in the intestines

  • marker of inflammatory bowel disease - UC / crohn’s / Bowel Ca
    (differentiate between irritable bowel disease)
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6
Q

causes of hypocalcaemia

A

assoicated with hypophataemia

  • vit D def
  • malabsorption

associated with hyperphosphataemia

  • chronic renal failure
  • hypoPTH

acute pancreatitis
sever hypomagnesaemia

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7
Q

define a major haemorrhage

A
  • loss of 1 blood volume within 24 hours (70ml/kg)
  • 50% of total blood volume in <3hours
  • bleeding excess of 150ml/min

clinically - blood loss leading to:

  • Systolic <90
  • HR >110
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8
Q

types of renal replacement therapy

A 
if independent: 
- peritoneal dialysis
High dextrose fluid draws waste products from blood into abdominal cavity 
1. continuous
2. automated
  • Haemodialysis
    3 times a week app
    surgery 8 weeks prior for AV fistula
  • Haemofiltration (acute setting)
  • Renal Replacement - ideal
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9
Q

what do you have to think about in bite Mx?

A

tetanus screen

IM human tetnaus immunoglobulin given to high risk wounds

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10
Q

what is the most common infection in eczema + abx used

A

staphlococcus

chloramphenicol

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11
Q

what organisim would be specific to conjuctivitis in a neonate?

A

chlamydia trachomatis

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12
Q

gradings of diabetic retinopathy

A

mild
- micro-aneursyms

moderate

  • micro-aneursyms
  • blot haemorrhages
  • cotton wool spots
  • exudates

severe
- aneurysms in all 4 quadurants

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13
Q

what is cataracts

A

the opacification of the crystalline lens

due to trauma, medications or metabolic disorders

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14
Q

RF for cataracts

A

diabetes
long term steroids
eye trauma
smoking

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15
Q

positive signs o/e

A
  • clouding of the lens

- absent red reflex

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16
Q

DDx for cataracts

loss of vision

A
  • maculopathy
  • optic neuritis
  • vitreous haemorrhage
  • TIA
  • renal vein occulation
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17
Q

Mx for cataracts

comp?

A

phacoemulsification

lens is emulified with an ultrasonic handpiece + aspirated

aspirated fluids of ant chamber are replaced with saline

comp:
- early - posterior capsule rupture

  • late - posterior capsule opacification
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18
Q

what is marcus-gunn pupil ?

A

relative afferent pupillary defect

  • diagnosed using the swinging light test

can be found in patients with MS

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19
Q

what is arygll robertson

A

constricted pupil that responds to accomodation BUT not light

bilateral

associated with neurosyphillis + diabetic neuropathy

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20
Q

what is holmes-aide’s pupil

A

benign

unilateral dilated pupil reacts poorly / if at all to light

– once constricted, remains small for abnormally long time

slowly reactions to accomodation

associated absent reflexes

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21
Q

what is strabismus

A

misalignment of the visual axes

concomitant

  • imbalance of extraocular msucles
  • convergent is more common

paralytic
- due to paralysis of extra ocular muscles

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22
Q

how to detect a strabismus

A

corneal light reflection test

  1. shining light midline of patient’s face
  2. reflective light is seen relative to the patients pupils

normal - slightly medial to pupils
esotropia - reflection is lateral to pupil
exotropia - reflection is medial to pupil

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23
Q

how is dry age related macular degeneration characterised by

A

drusen

- yellow round spots on Bruch’s membrane

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24
Q

how is wet age related macular degen characterised by

A

wet
- choroidal neovascularisation

leakage of serous fluid + blood

worse prog

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25
Q

define amaurosis fugax

A

transient monocular visual loss (TMVL) less than 24hrs

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26
Q

sudden painless visual loss

A
  • retinal detachment
  • ischaemic / vascular (RAO/RVO)
  • vitreous haemorrhage (leaking of blood into areas around the vitreous humour of the eye)

vitreous is the clear fluid filling the space between the lens and the retina

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27
Q

what is blephritis

A
  1. meibomian gland dysfunction (common, posterior blepharitis)
  2. seborrhoeic dermatiitis / staphlococal infection (ant. blephritis)

meibomian glands secrete oil on the eye surface to prevent rapid evaporation of the tear film

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28
Q

glaucoma Ix

A
  • slip lamp exam w/ pupil dilation to assess optic n and fundus
  • applanation tonometry to measure IOP
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29
Q

open glaucoma mx

A

1 - prostaglandin analogue - increases uveoscleral outflow

2 - BB, carbonic anhydrase inhib

BB / carbonic / sympotahomimetics - reduces aqueous production

30
Q

difference between preiorbital + orbital cellulitis

A

peri (eyelid swelling, )

  • absence of painful movements
  • no diplopia
  • no visual impairment

orbital (tissues behind the orbital septum)
- protosis

both:
- common in children

31
Q

Herpes zoster ophthalmicus

A

reactivation of the varicella-zoster virus suppling the ophtalmic division of the trigeminal nerve

accounts for 10% of shingles

associated with ant. uveitis

32
Q

what is hutchinson’s sign

A

rash on tip / side of the nose
- in herpes zoster opthalmicus

indicates nasociliary involvement + strong risk factors for ocular involvement

33
Q

Herpes zoster ophthalmicus Mx

A

1 - anti-viral / aciclovir
< 72hrs

2 - topical corticosteroid - inflammation

34
Q

most common cause of perisistent watery eye in infant

A

nasolacrimal duct obstruction

caused by imperforated membrane –> lacrimal duct massage

35
Q

acute glaucoma Mx

A

1 - admit hosp immediately

2 - cholinergic / constricts pupil to increase outflow (pilocarpine)

36
Q

how is papilloedema seen on fundoscopy

A

blurring of the optic disc

loss of optic cup + venous pulsation

37
Q

what is a chalazion

A

meibomian cyst

presents as a firm painless lump in the eyelid

resolve spontaneously
- some require surgical drainage

38
Q

myopia vs hypermetropia RF for glaucoma

A

closed - hypermetropia / far sighted

open - myopia / short sighted

39
Q

causes of papilloedema

A
  • raised ICP
  • space occupying lesion
  • hydrocephalus
  • hypercapnia
40
Q

ARMD Ix

A
  • slit lamp microscopy
  • fluorescein angiogrpahy (neovascularisation suspected)
  • tonometry

Mx:
- vascular endothelial growth factor
(increases vascular permability)
- laser photocoagulatopathy

41
Q

flashes and floaters indicate what?

A

retinal / vitreous detachment

42
Q

what is strongly associated with diabetic retinopathy?

A

vitreous haemorrhage

43
Q

name the classes and individual drugs of Alzheimer’s

A

all patients:
cholinesterase inhibitors
- donepizil
- rivastigmine

severe:
NMDA receptor antagonist:
- Memantine

44
Q

what is a urethroplasty?

A

repairing of the ureter walls

gold standard for uretheral strictures

45
Q

why do they give prophylatic abx for surgery?

what do they give?

A

bowel / prostate /
- disrupting organ flora

Mx - cipro (+/- metron)

46
Q

what is refeeding syndrome

A

develops when eating after long periods of starvation

body shifts back from fat metabolism to carb
- electrolytes move into cells

low potassium
low magnesium
low phosphate

hyperglycaemia
thiamine deficiency

47
Q

Mx of refeeding syndrome

A
  1. adequate electrolytes, vitamins (thiamine), folate, B6

2. micronutrient

48
Q

oesophageal bleeding

  1. prophylaxis
  2. treatment
A
  1. propanolol - vasodialator / reduced MAP + resistance

2. terlipressin - vasoconstrictor / narrowing vessels to reduce blood loss

49
Q

why do coeliac patients get given the pneumococcal vaccine?

A

they have a degree of functional hyposplenism

booster every 5 years

influenza vaccing on an indiviual basis

50
Q

what is gilbert’s syndrome

A

benign disease - inability to metabolise bilirubin due periods of stress / illness

Ix - rise in bilirubin following prolonged fasting

Mx - no treatment

51
Q

what is histologically characteristic of gastric cancer?

A

signet ring cells

higher number –> worse the prognosis

52
Q

RF for gastric cancer

A

h pylori
blood group a (gAstric cAncer)
pernicious anaemia
smoking

53
Q

what is hepatorenal syndrome

A

the development of renal failure in the presence of liver failure

  1. vasomediators cause splanic vasodilation
  2. systemic vascular resistance reduced
  3. hypovolaemia of the kidneys
  4. RAAS gets activated but no enough to counterbalance effects of splanic vasodilation
54
Q

what are you concerned about?

metabolic acidosis w/ partial resp comp (high anion gap)
raised ketones
normal / low glucose

A

alcoholic ketoacidosis

DKA will have a raised glucose

55
Q

alcoholic ketoacidosis

A

a form of euglycaemic ketoacidosis
- common in alcoholics

  • due to poor diets
  • vomiting food when they do eat

food stores deplete and so move onto lipids

56
Q

what is the hartmann’s procedure

A

rectum + sigmoid resection

closure of the anorectal stump + formation of the end colostomy

57
Q

small intestine causes of malabsorption

A

crohn’s
coeliacs
lactose intolerance
small bowel bacterial overgrowth

58
Q

complications of coeliacs

A

MALABSORPTION

  • osteoporosis
  • anaemia

MALIGNANCY

  • intestinal lymphoma
  • oesophageal + small bowel carcinoma
59
Q

how does paracetamol damage the liver?

A
  1. paracetamol get converted into toxic metabolite
  2. toxic metabolite is inactivated by glutathiano
  3. glutathiano stores are depleted
  4. toxicity of metabolite increases –> necrosis of hepatocytes

damage peaks at 72 - 96 hours

60
Q

how to assess encephalopathy bedside

A
  • draw 5 point star
  • concentric circles
  • hepatic liver flap
61
Q

complications of hepatic failure

A 
encephalopathy
hepatorenal syndrome
coagulopathy
cerebral oedema / ascites (hypoalbumin?)
hypoglycaemia (reduced glycogenesis)
62
Q

how to treat paracetamol OD?

A

activated charcoal if <1hr

n-acetylecysteine

63
Q

hep A pathophysiology

+ associations

A

hepatocyte necrosis

associated with:
developing country
contaminated water supply
shellfish

64
Q

reasons for ascites in liver failure

A

hypoalbuminaemia
activated RAAS
salt + water retention

mechanism is the leaking of fluid from the lymph

multi-factorial:

  • high cardiac output
  • increased hydrostatic pressure in splanic organs
65
Q

in a patient who has an a long term alcohol Hx

how would you manage them?

A
  1. seizures prevention - chlordiazepoxide reducing regime
  2. restore deficiencies - thiamine (B1) + B12

for abstinence + maintainance

  • acampostate
  • naltrexone
66
Q

pathophysiology of haemochromatosis

A

autosomal recessive
HFE mutation

excessive iron absorption in gut
excessive tissue deposits in organs
- heart
- pancreas
- pituitary 
- liver

Comps:

  • HCC
  • cirrhosis
67
Q

Mx for haemochromatosis

A

regular venesection

desferoxamine - binds to iron to be eliminated by the kidneys

68
Q

features of wilson’s disease

A

EYE
kayser-fleisher rings - copper deposits in the eye
abnormal extraocular movements

BRAIN
dementia
tremor
speech problems

HEPATIC DISEASE
haemolytic anaemia

liver
brain
cornea

69
Q

pathophysiology of wilson’s

Ix

A

autosomal recessive
failure of proper biliary copper excretion
so deposited in organs

serum caeurloplasmin + copper
urinary copper (24hr)
liver biopsy

70
Q

how do you assess for fluid status on bed side examination? (4)

A

JVP
postural BP
basal lung crackles
peripheral oedema

71
Q

go through hypo / iso / hyper volaemia causes

A
  1. check serum os
  2. check fluid status
HYPO (water loss)
Extra renal:
- Vomitting
- Diarrhoea 
- Fluid shift

Renal:

  • adrenal insufficiency
  • diuretics
  • nephropathy (pylonephritis)
ISO (normal status)
SIADH (urine os - high)
water intoxification (urine os - low)
hyperthyroidism
renal failure
HYPER:
CCF
renal failure
liver failure
nephrotic syndrome
72
Q

vascular disease affecting conditions about the chest

A

BRAIN
vascular dementia
stroke

EYES
retinopathy (RAO / RVO)

P4 (11 decks)

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