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Year 3 difficult topics > 23/05/22 > Flashcards

23/05/22 Flashcards

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1
Q

histopathology findings of coeliac

A

sub-total villous atrophy, crypt hyperplasia, and intra-epithelial lymphocytes

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2
Q

scoring system for cirrhosis

what is it called?

A 
Score	1	2	3
Bilirubin (umol/l)	
<34	
34-51	
>51
Albumin (g/l)	
>35	
28-35	
<28
Prothrombin time (seconds prolonged)	
<4	
4-6	
>6
Encephalopathy	
none	
mild	
marked
Ascites	
none	
mild	
marked

child pugh

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3
Q

child pugh a

A

<7

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4
Q

b child pugh?

A

7-9

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5
Q

child pugh >9?

A

c

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6
Q

mx of decompensated liver disease

A

etoh abstinence
nsaid/opiates/sedatives avoided
uss/ a fetoprotein
colestyramine- to manage pruritus

ascites managment : fluid restrict 1.5l, fureseomide, therpeutic paracentesis
lactulose and rifaximin use

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7
Q

features of liver disease?

A

encephalopathy
abnormal bleeds
ascites
jaundice

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8
Q

hepatic encephalopathy

A

Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
Drowsiness, confusion, slurring of speech and personality change
Incoherency, restlessness, asterixis
Coma

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9
Q

if pt is bleeding what do you give them?

A

FFP

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10
Q

Management of decompensated liver disease

how to avoid encephalopathy?

A

lactulose and rifaximin

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11
Q

high risk of SBP?

A

low albumin, a high INR and low ascitic albumin

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12
Q

in wilsons disease liberation of copper causes what?

A

causes Coomb’s negative haemolytic anaemic, with transient episodes of low-grade haemolysis and jaundice

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13
Q

wilson Ix

A

Urinary copper is high and a 24-hour urine collection is the investigation of choice when screening for Wilson disease

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14
Q

diabetes
jaundice
joint pain

point to ?

A

haemochromatosis
disrupts normal tissue > cirrhosis

pancreatic insufficency and HF

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15
Q

mx for Haemochromatosis

A

desferrioxamine

iron chelating agent

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16
Q

treatment for wilsons?

A

penicillamine

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17
Q

abdo pain
diarrhoea
flush and wheeze?

A

carcinoid

urinary 5-HiAA

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18
Q

non urgent OGD

A 
haematemesis 
>55
dyspepsia 
low haem 
raised platelets
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19
Q

dyspepsia undiagnosed

A

review meds
lifestyle
PPI or H pylori testa nd treat

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20
Q

H pylori

A

carbon 13 urea breath test

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21
Q

mx of severe alcoholic hepatitis

A

corticosteroids

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22
Q

features of wernickes

mx?

A

ophtalmoplegia/ nystagmus

ataxia
confusion

peripheral sensory neuropathy

pabrinex/ urgent thiamine

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23
Q

delirium tremens

chronic alcohol consumption does what to GABA?

A

enhance GABA inhibition and inhibits NMDA glutamte excitatory receptors

so when alcohol withdrawal happens inhibitory GABA is decreased causing

tremor, sweating, tachycardia,anxiety , seizures, confusion, delusions etc

Mx chlordiazepoxide

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24
Q

ulnar nerve damage at elbow

A

radial deviation of wrist

more severe ulnar clawing

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25
ulnar nerve damage at wrist? | motor
claw hand wasting and paralysis of intrinsic hand muscles hypothenar muscles
26
ulnar nerve damage at wrist | sensory?
loss to medial 1 1/2 fingers palmar/dorsal aspect
27
peroneal nerve lesion
foot drop foot eversion is weak - so moving to side weakness of toe extension wasting of anterior tibial and peroneal muscles
28
sensory loss over the dorsum of the foot and the lower lateral part of the leg
common peroneal nerve lesion
29
causes of a bilateral facial nerve palsy
sarcoidosis guillain barre syndrome lyme neurofibromatos type 2
30
``` csf leak headache why? features ix? mx? ```
spontaneous intracranial hypotension marfan is a risk factor strong postural headache worse upright bed bound pt MRI w gadolinium
31
friedrichs ataxia
lateral corticospinal tracts dorsal column bilateral spastic paresis, loss of vibration and proprioception poor coordination bilateral in limbs cerebeller ataxia - intention tremor
32
anterior spinal artery occlusion
bilateral spastic paresis | loss of pain and temp sensation as lateral spinothalemic tracts affected
33
if only sensory loss of proprioception and vibration?
Neurosyphilis - bacterial infection of brain / spinal cord
34
what does an absent cremasteric reflex suggest?
testicular torsion
35
short hx of diarrhoea and vomiting what ? what causative agent CHESS
``` camplyobacter jejuni haemorrhagic e.coli entamoeba histolytica salmonella shigella ```
36
rice water stools?
vibrio cholerae
37
non-bloody diarrhoea, abdominal cramps and foul-smelling flatulence and belching
giardia giardiasis parasite
38
worst headache ever what? if the patient has bilateral palpable masses in abdo what does this then make you think?
subarachnoid haemorrhage on backdrop of PKD
39
Pt young started on acei then suffers an AKI what can be the cause?
renal artery stenosis as it is a secondary cause of AKI acei is contraindicated reduced blood flow to kidneys is compensated by RAAS to maintain pressure across glomerulus
40
why does a acute interstial nephritis occur and how does it present?
adverse reaction to a drug | fever rash nausea and vomiting
41
2 steps of hyperkalaemia mangement?
10ml 10% calcium gluconate | 50ml of 50% dextrose with 1u of insulin
42
most common cause of gas gangrene
c perfringens
43
cavitating lesions lung cancer which type?
squamous cell
44
‘giant V waves’ in the JVP
incompetent tricuspid valve - tri regurg
45
is characterised by slightly depressed reddish-brown patches that most frequently occur on the shins
Diabetic dermopathy
46
Reverse tick sign on ecg? mx?
digoxin toxicity
47
why does intermittent claudication present with erectile dysfunction?
there is partial occlusion of aorta at point it becomes iliac arteries aortoiliac occlusive disease it is defined by cramping pain on exertion
48
cramping pain on walking in buttocks erectile dysfunction absent / reduced distal pulses is what?
Leriche Syndrome - intermittent claudication
49
Lumbar spinal stenosis
narrowing of spinal canal pain in LL when walking or standing for long period of time pain is eased by bending forward or sitting down
50
luts
lower urinary tract symptoms
51
storage system problem urology
FUN frequency urgency nocturia
52
voiding symptoms
``` wise weak stream intermittency straining incomplete Emptying ```
53
what can most reliably confirm a diagnosis of prostate cancer
transrectal ultrasound
54
what set of symptoms are irritative | urology
FUN frequency urgency nocturia
55
what urinary symptoms are obstructive
``` WISE weak stream intermittency straining incomplete Emptying ```
56
prostate cancer metastatic
bone pain | cord compression
57
if prostate cancer suspected but TRUS is negative what should you do?
MP-MRI
58
surgical management of BPH
TURP
59
bladder cancer most common type
urothelial carcinoma
60
rf for urothelial carcinoma
``` smoking carcinogen exposure amines painters hairdressers ```
61
squamous cell carcinoma of bladder cancer causes?
anything that causes inflammation schistomiosis recurrent uti
62
gold standard investigation of bladder cancer
cystoscopy
63
intrinsic causes of AKI?
``` ATN AIN glomerulonephritis rhabdmyolysis tumour lysis syndrome ```
64
prerenal causes of AKI?
hypovolaemia 20 to diarrhoea and vomiting | renal artery stenosis
65
nephrotoxic drug potential - risk of AKI
acei arb diuretics aminoglycosides
66
increased risk of toxicity but doesnt worsen aki?
metformin digoxin lithium
67
safe meds to continue in AKI
``` paracetamol warfarin statins aspirin - 75 clop beta blocker ```
68
when is haemodialysis indicated
hyperkalaemia, pulmonary oedema, acidosis or uraemia
69
A 35-year-old man who has a history of hypertension and subarachnoid haemorrhage presents with recurrent UTIs and episodic haematuria -
autosomal dominant polycystic kidney disease
70
Raised anion gap
lactate: shock, sepsis, hypoxia ketones: diabetic ketoacidosis, alcohol urate: renal failure acid poisoning: salicylates, methanol
71
recent urti and now macroscopic haematuria ?
iga glomerulonephritis
72
Normal serum urea:creatinine ratio
acute tubular necrosis
73
raised serum urea: creatinine
prerenal
74
gynaecostia which drugs?
digoxin | spironolactone
75
normal anion gap met acidosis a 30-year-old man presents with haemoptysis and renal failure. A renal biopsy shows linear IgG deposits along the basement membrane
good pastures
76
urinary retention in 69yr old 670ml of residual volume on catheterisation enlarged prostate on DRE fullness in LLQ dilated loops of bowel on xray cause of retention?
constipation can cause outflow obstruction and trigger episodes of retention in patients with enlraged prostates
77
what class of drugs can inhibit detrusor and trigone activity?
anticholinergics | amitryptilline
78
5alpha Hia reductase example
finesteride
79
complications of arteriovenous fistulas
infection tjrombosis stenosis steal syndrome
80
how long does a arteriovenous fistula take to form?
6-8 weeks
81
what is henoch schonlein purpura
IgA small vessel vasculitis seen in childrene (with localized oedema) over buttocks and extensor surfaces of arms and legs purpuric rash self limiting
82
what variables required for creatinine clearance
age gender weight creatinine
83
which abx for uti is not safe in pregnant women?
trimethorprim use nitrofurantoin instead
84
CKD starting ACEi but eGFR has gone down when should you change the drug?
NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs
85
why is high phosphate of CKD harmful for bones? mx?
phosphate PULLs calcium from bones = osteomalacia sevelamer
86
how do you screen for ADPKD?
ultrasound fallen by 3
87
what is the most common cause of AKI? | if this was an elderly person with a recent fall
acute tubular necrosis on basis of nephrotoxin rhabdomyolsis
88
The mainstay of rhabdomyolysis treatment
is rapid IV fluid rehydration
89
Polyuria and polydipsia with low potassium and without evidence of DM -
think of diabetes insipidus
90
FSGS | nephrotic syndrome biopsy results?
focal and segmental sclerosis on light microscopy and foot process effacement under electron microscopy
91
FEV1 < 0.8 and FEV1:FVC >0.7
is the typical pattern seen in restrictive lung disease, in which both FEV1 and FVC are reduced decrease in FVC is greater than FEV1
92
risk of developing pressure sores
waterlow score
93
symptoms of Conn
hypertension and hypokalaemia due to too much sodium retention which can cause nephrogenic DI leading to polyuria, polydipsia
94
hypokalaemia signs?
u waves
95
red green blindness asscoiated with which TB drug?
ethambutol
96
horner syndrome | is the pupil constricted or dilated?
constricted pupil - myosis partial ptosis anhyidrosis - inability to sweat

Year 3 difficult topics (22 decks)

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