14th March

Question 1

Glasgow Imrie

Answer 1

PaO2 < 8kPa
Age >55
Neutrophils WCC>15 x10^9
Ca2+ <2mmol
Renal fxn Urea >16
Enzymes LDH >600, AST >200
Albumin <32g/L
Sugar >10mM 

used to assess severity and prognosis
score of 3 or greater is severe -> manage in HDU

Used for gallstone or alcohol pancreatitis

Question 2

other criteria to assess pancreatitis

Answer 2

Ranson

• only used for alcoholic pancreatitis
• not useful until 48hrs after admission

Question 3

Type of ABG with acute exacerbation of COPD

Answer 3

Resp acidosis w/ raised bicarb

Question 4

Causes of resp acidosis

Answer 4

Hypoventilation

• resp centre depression ( drugs / head injury )
• disruption of neural transmission or neuromuscular dysfunction
• muscle weakness( myopathy, fatigue)

V/Q mismatch
- COPD, pneumonia, pulmonary haemorrhage or oedema, atelecatasis

Diffusion abnormality
- Fibrosis , severe ARDS

Question 5

Causes of resp alkalosis

Answer 5

Hyperventilation

• anxiety, sepsis, hypoxia
• cerebral disease, pregnancy, excessive mechanical ventilation

Question 6

Causes of HAGMA

there are high amounts of acids in the body

Answer 6

Left total knee replacement
Lactase acidosis - hypoperfusion
Toxins - SALICYLATES, methanol
Ketoacidosis(2) - diabetic, alcoholic 
Renal failure - urea accumulates)

Question 7

Causes of NAGMA

- loss of bases from the body

Answer 7

GI bicarb loss - diarrhoea,
- pancreatic or biliary drainage

Renal bicarb loss - renal tubular acidosis

Question 8

Causes of metabolic alkalosis

Answer 8

Vomiting ( loss of HCl) e.g. pyloric stenosis
Hyperadrenocorticoidism - Conns or cushings
Severe hypokalaemia

Question 9

LTOT for COPD - who?

Answer 9

1. Clinically stable non smokers with PaO2 <7.3kPa despite maximum therapy. (measured on 2 occasions 3 weeks apart)
2. If PaO2 is 7.3-8 and they have pulmonary hypertension ( RVH, loud S2) and cor pulmonale.
3. Palliative in terminally ill.

Question 10

Diffuse thyroid enlargement differential

Answer 10

Multinodular goitre
Toxic goitre - grave's hyperthyroidism 
Simple colloid goitre
Thyroiditis - granulomatous or autoimmune aka Hashimotos
Neoplastic goitre - benign or malignant

Question 11

Differentials for a solitary thyroid nodule

Answer 11

Degenerative cats
Thyroglossal duct cyst - but doesn’t move on protrusion of tongue
Benign neoplasm - follicular adenoma
malignant thyroid tumor ( papillary [mc], follicular, medullary, anapaestic, SCC, lymphoma)
metastatic disease - breast /kidney