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100 cases Flashcards

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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
define amaurosis fugax
transient monocular visual loss (TMVL) less than 24hrs
26
sudden painless visual loss
- 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
27
what is blephritis
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
28
glaucoma Ix
- slip lamp exam w/ pupil dilation to assess optic n and fundus - applanation tonometry to measure IOP
29
open glaucoma mx
1 - prostaglandin analogue - increases uveoscleral outflow 2 - BB, carbonic anhydrase inhib BB / carbonic / sympotahomimetics - reduces aqueous production
30
difference between preiorbital + orbital cellulitis
peri (eyelid swelling, ) - absence of painful movements - no diplopia - no visual impairment orbital (tissues behind the orbital septum) - protosis both: - common in children
31
Herpes zoster ophthalmicus
reactivation of the varicella-zoster virus suppling the ophtalmic division of the trigeminal nerve accounts for 10% of shingles associated with ant. uveitis
32
what is hutchinson's sign
rash on tip / side of the nose - in herpes zoster opthalmicus indicates nasociliary involvement + strong risk factors for ocular involvement
33
Herpes zoster ophthalmicus Mx
1 - anti-viral / aciclovir < 72hrs 2 - topical corticosteroid - inflammation
34
most common cause of perisistent watery eye in infant
nasolacrimal duct obstruction caused by imperforated membrane --> lacrimal duct massage
35
acute glaucoma Mx
1 - admit hosp immediately 2 - cholinergic / constricts pupil to increase outflow (pilocarpine)
36
how is papilloedema seen on fundoscopy
blurring of the optic disc loss of optic cup + venous pulsation
37
what is a chalazion
meibomian cyst presents as a firm painless lump in the eyelid resolve spontaneously - some require surgical drainage
38
myopia vs hypermetropia RF for glaucoma
closed - hypermetropia / far sighted open - myopia / short sighted
39
causes of papilloedema
- raised ICP - space occupying lesion - hydrocephalus - hypercapnia
40
ARMD Ix
- slit lamp microscopy - fluorescein angiogrpahy (neovascularisation suspected) - tonometry Mx: - vascular endothelial growth factor (increases vascular permability) - laser photocoagulatopathy
41
flashes and floaters indicate what?
retinal / vitreous detachment
42
what is strongly associated with diabetic retinopathy?
vitreous haemorrhage
43
name the classes and individual drugs of Alzheimer's
all patients: cholinesterase inhibitors - donepizil - rivastigmine severe: NMDA receptor antagonist: - Memantine
44
what is a urethroplasty?
repairing of the ureter walls gold standard for uretheral strictures
45
why do they give prophylatic abx for surgery? what do they give?
bowel / prostate / - disrupting organ flora Mx - cipro (+/- metron)
46
what is refeeding syndrome
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
Mx of refeeding syndrome
1. adequate electrolytes, vitamins (thiamine), folate, B6 | 2. micronutrient
48
oesophageal bleeding 1. prophylaxis 2. treatment
1. propanolol - vasodialator / reduced MAP + resistance | 2. terlipressin - vasoconstrictor / narrowing vessels to reduce blood loss
49
why do coeliac patients get given the pneumococcal vaccine?
they have a degree of functional hyposplenism booster every 5 years influenza vaccing on an indiviual basis
50
what is gilbert's syndrome
benign disease - inability to metabolise bilirubin due periods of stress / illness Ix - rise in bilirubin following prolonged fasting Mx - no treatment
51
what is histologically characteristic of gastric cancer?
signet ring cells higher number --> worse the prognosis
52
RF for gastric cancer
h pylori blood group a (gAstric cAncer) pernicious anaemia smoking
53
what is hepatorenal syndrome
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
what are you concerned about? metabolic acidosis w/ partial resp comp (high anion gap) raised ketones normal / low glucose
alcoholic ketoacidosis DKA will have a raised glucose
55
alcoholic ketoacidosis
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
what is the hartmann's procedure
rectum + sigmoid resection closure of the anorectal stump + formation of the end colostomy
57
small intestine causes of malabsorption
crohn's coeliacs lactose intolerance small bowel bacterial overgrowth
58
complications of coeliacs
MALABSORPTION - osteoporosis - anaemia MALIGNANCY - intestinal lymphoma - oesophageal + small bowel carcinoma
59
how does paracetamol damage the liver?
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
how to assess encephalopathy bedside
- draw 5 point star - concentric circles - hepatic liver flap
61
complications of hepatic failure
``` encephalopathy hepatorenal syndrome coagulopathy cerebral oedema / ascites (hypoalbumin?) hypoglycaemia (reduced glycogenesis) ```
62
how to treat paracetamol OD?
activated charcoal if <1hr | n-acetylecysteine
63
hep A pathophysiology + associations
hepatocyte necrosis associated with: developing country contaminated water supply shellfish
64
reasons for ascites in liver failure
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
in a patient who has an a long term alcohol Hx how would you manage them?
1. seizures prevention - chlordiazepoxide reducing regime 2. restore deficiencies - thiamine (B1) + B12 for abstinence + maintainance - acampostate - naltrexone
66
pathophysiology of haemochromatosis
autosomal recessive HFE mutation ``` excessive iron absorption in gut excessive tissue deposits in organs - heart - pancreas - pituitary - liver ``` Comps: - HCC - cirrhosis
67
Mx for haemochromatosis
regular venesection | desferoxamine - binds to iron to be eliminated by the kidneys
68
features of wilson's disease
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
pathophysiology of wilson's Ix
autosomal recessive failure of proper biliary copper excretion so deposited in organs serum caeurloplasmin + copper urinary copper (24hr) liver biopsy
70
how do you assess for fluid status on bed side examination? (4)
JVP postural BP basal lung crackles peripheral oedema
71
go through hypo / iso / hyper volaemia causes
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
vascular disease affecting conditions about the chest
BRAIN vascular dementia stroke EYES retinopathy (RAO / RVO)

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