All notes Flashcards
(228 cards)
1
Q
Do type 1 diabetes present acutely with ketosis?
A
Yes
2
Q
Symptoms of Diabetes
A
Tiredness, lethargy
Polyuria and polydipsia–
Glucose SLOWLY rises further
With other co-morbidities it become difficult to drink enough–Osmotic diuresis causes loss of water and a rise in sodium–EVENTUALLY the glucose is VERY high, as is the sodium
3
Q
How do you calculate Ion gap?
A
+ve + -ve = osmolality
4
Q
What are the microvascular complications of diabetes? How?
A
Retinopathy
Nephropathy
Neuropathy
Glycosylation of basement membrane proteins - leaky capillaries
5
Q
What are the microvascular complications of diabetes?
A
Dyslipidaemia, hypertension, hypercholesterolaemia
Leads to:
–IHD–CVA–Peripheral gangrene
6
Q
What do features are there on diabetic retinopathy
A
Hard exudates (cholesterol) •Microaneurysms (“dots”) •Blot haemorrhages
7
Q
Treatment for background diabetic retinopathy?
A
Improve blood glucose control
8
Q
What does ischaemia of the eye cause? Why is that bad?
A
New vessels to grow
Blindness
9
Q
Management of diabetic retinopathy (proliferative and pre proliferative)
A
Cotton wool spot - suggests ischaemia
Pan retinal photocoagulation
10
Q
Management of hyperglycaemia (in order)
A
Diet and exercise
•Biguanide (Metformin)
•Sulphonylureas (eg gliclazide)
•Insulin sensitisers : thiozolidinediones such as rosiglitazone or pioglitazone
•Insulin itself (there are several new insulin analogues now available)
•Incretins (GLP-1 analogues)
•Gliptins (Dipeptidyl peptidase 4 inhibitors)
11
Q
Examples of insulin analogues
A
Long acting - zinc suspension
Short acting - insulatard and actrapid
12
Q
Advantages of using insulin
A
Can give best control of HbA1c when combined with diet and exercise.
•No side effects (compared to : )
•metformin (diarrhoea)
•SU (occasional reactions) •thiazolidinediones (rare hepatic, ?osteoporosis
13
Q
Disadvantages of using insulin
A
If you drive HGV, cannot work •(exenatide exempt) •Hypoglycaemia common with good control •Weight gain •Increased insulin as a consequence •Huge doses required in patients with type 2 diabetes
14
Q
Affects of GLP1
A
Increased insulin
Reduce gastric emptying
increased hypothalamic satiety
15
Q
Examples of GLP1 analogues
A
exanatide
liraglutide
semaglutide
16
Q
Do SGLT2 inhibitors have a cardiovascular benefit
A
Yes
On kidney
17
Q
Signs of diabetic nephropathy
A
Hypertension
Increased proteinuria >3000g
Renal failure
Histological signs
18
Q
Histological features of diabetic nephropathy
A
Glomerular - mesangial expansion, basement membrane thickening, glomerulosclerosis
19
Q
Epidemiology of diabetic nephrology
A
Age
racial factors
loss of cv morbidity
20
Q
Stages for treatment of D. Nephro
A
Diabetic control
•Blood pressure control
•Inhibition of the activity of RAS system
•Stopping Smoking
21
Q
When and when not should you use a ACE inhibitor for diabetic nephropathy
A
decrease microalbinuria
prevent end stage renal failure
causes hyperkalaemia
do not give for renal artery stenosis
22
Q
Signs of renal failure
A
Electrolyte misbalance–Hyperkalaemia, hyponatraemia
- Acidosis
- Fluid retention
- Retention of waste products–Small molecules, e.g., urea, creatinine, urate–Phosphate–Middle molecules, e.g., peptides, ß2‐microglobulin
- Secretory failure–Erythropoietin –1.25 vitamin D
23
Q
Symptoms of renal failure
A
Symptoms–Tiredness, lethargy–Shortness of breath, oedema–Pruritis, nocturia, feeling cold, twitching–Poor appetite, nausea, loss of/nasty taste, weight loss
- Anaemia –exacerbates tiredness
- Renal bone disease –aches & pains, pruritis
24
Q
What happens if no renal replacement treatment is given for renal failure?
A
Hyperkalaemia –arrythmias, cardiac arrest–Pulmonary oedema–Nausea, vomiting–Malnutrition / cachexia–Fits–Increasing coma–DEATH
25
Types of renal replacement therapy
Peritoneal dialysis
Haemodialysis
Transplant
26
When do you give Renal replacement therapy?
When gfr goes below 10
27
Benefits of dialysis
Improve symptoms
correct fluid balance
no acidosis, hyperkalaemia, pulmonary oedema caused by resistance to diuretics
28
Risks of dialysis
Infection, hypotension/ arythmias (h), access
work, family, travel
29
What does dialysis not treat
Getting old
•Lack of erythropoietin–Anaemia
•Lack of 1.25 vitamin D–Hyperparathyroidism–Renal bone disease
•Other diseases –comorbidities–SLE–Diabetes–Vascular disease
30
Pros and cons of transplants
Transplantation
BENEFITS
•Better renal replacement
•Improvement in metabolic disorders–Anaemia–Renal bone disease
•Costs less in long‐term
•Prolonged survival
•Quality of life–Avoids disadvantages of HD/PD–Much easier to travel, work, maintain independence
RISKS
•Older and sicker patients not eligible
•Immunosuppression–Increased infection–Increased malignancy
•Not a cure–Surgical complications–Hospital visits –particularly frequent at start
•Often worse off if/when transplant fails
31
Resp failure
Low O2
1 - normal/low co2 - V/Q mismatch
2- high co2 - hypoventilation
32
How do you assess a acutely unwell patient?
Callforhelp!!
Airway–Patent?,Stridor?Obstructed?–IFyes2222
Breathing - Speech(fullsentences?),RR,Sats,ABG,auscultation,CXR
Circulation–HR,BP,CRT,ECG
Disability–GCS,Glucose,Pupils,Neuro-exam
Exposure/Everythingelse–Abdomen,Signsofoverload
Re-assess!!!!
33
Define asthma
Chronic inflammatory airway disease characterised by reversible airways obstruction
34
What do you give for low sats and high resp rate in an acute situation?
oxygen,salbutamolnebulisers,steroids,magnesiumandreassess
35
What is a moderate asthma attack?
PEF at 50-75% of best or predicted•No signs of severe asthma
36
Severe asthma attack
PEF at 33-50% of best or predicted
•respiratory rate ≥25/min
•heart rate ≥110/min
•Inability to complete sentences in one breath
37
Signs of life threatening asthma
CHEST
```
Cyanosis -SpO2 <92%, PaO2 <8 kPa
•Hypotension
•Exhaustion –Poor inspiratory effort, Confusion, Normal PCO2
•Silent chest
•Tachy-/Brady-Arrhythmias
```
38
How do you manage life threatening asthma
ABCDE
severe - 98% sats, bronchodilators (SABA +/- ipratropium, IV magnesium
Steroids: PO prednisolone/IV Hydrocortisone
-> if improved - TAME (technique, avoid triggers, monitor PEF and educate - discharge if > 75%)
If severe/ not get better
- help
- same treatment
39
Levels of COPD
Mild FEV1 >80% predicted
•Moderate FEV1 50-80% Predicted
•Severe –FEV1 30-50% Predicted
•Very severe –FEV1 <30% Predicted
40
What is COPD
Minimally reversible airflow obstruction characterised by an FEV1/FVC ratio of <0.7
41
How do you manage acute COPD
ABCDE
T2RF - sats 98%, salbutamol,ipratropium,
steroids: OD prednisolone, hydrocortisone IV
No for T2RF - lower sats (94-98 or 88-92 with Venturi) same med. - may need ABs
Improved - check sputum, wean off, smoking cessation, inhaler technique
42
What is BIpAp
Bi level CPAP
Helps with breathing in and out
43
Risk factors for DVT/PE
```
Risk factors
•Immobilisation
•Malignancy
•Recent Surgery
•HRT/COCP
•Thrombophilias
```
44
Gold standard for PE
CT pulmonary angiogram
45
Scoring systems for PE
Wells and geneva
46
Signs of right heart strain on a ECG
Deep S wave - lead 1
Deep q waves - lead 2
T wave inversion - lead 3
Occuled pulmonary circulation
47
How do you manage acute PE?
HS - yes - help, oxygen, fluids, assess for thrombolkysis or percutaneous embolectomy
HS - no - Hestia, PESeverity index, sPESI - high risk - LMWH, oxygen
- low risk - discharge high does LMWH, DOAC and warfarin for three months
48
What is acute pulmonary oedema?
Accumulation of fluid in lung parenchyma - impaired gas exchange
49
Causes of pulmonary oedema
Cardiogenic –Heart Failure, Arrhythmia, Myocardial Infarction
•Renal –Acute, severe Kidney failure
•Acute respiratory distress syndrome (ARDS) –Caused by lung injury, i.e. infection (Cov-Sars-2
50
Management of Acute cariogenic po
ABCDE - sit up
- oxygen, IV diuretics - furosemide, beta blockers if arrhythmia
- consider nitrate infusion if systolic above 100 + CPAP - drives out fluid
Record weight every day
51
X ray changes for a tension pneumothorax
tracheal deviation away from affected side
mediastinal shift away
loss of lung markings on affected side (air)
52
Treatment of PT
Emergency needle decompression
high flow oxygen
chest drain
1 - >2cm - aspirate, less = discharge
2- >2cm - chest drain, less aspirate and admit
53
Issues with obstructive sleep apnoea
Intermittent hypoxia and sleep disruption
54
How do you measure sleep?
ear sleep monitor
55
How do you treat OSA
CPAP - moderate to severe with symptoms of sleepiness
56
Main risk factor for OSA
Obesity and narrowed airway
57
What is a normal GFR
>90ml/min
58
Main symptoms of renal problems
Haematuria •Proteinuria•Nephrotic syndrome•Nephritic syndrome•Hypertension•Acute kidney injury•Chronic kidney disease•Urinary tract infection•Abdominal pain•Complications of hypertension (esp malignant hypertension)•Oliguria or anuria•Polyuria, nocturia
59
Functions of the kidney
```
filtration and excretion
electrolyte homeostasis
hormone production - epo, vit d
blood pressure control
acid base homeostasis
```
60
How do you treat acidosis?
Bicarbonate
61
What factors affect GFR
age, sex, body size, muscle mass
reduced = loss of filtering capacity and accumulation of waste products
62
Test for blood and protein in urine
urine dip
63
Colour of urine and problem
red/brown - myoglobinuria/haemoglobinuria
- food dyes, rifampicin (TB)
white - pyuria, phosphate crystals, chyluria
black - haemoglobinuria, alkaptonuria
64
What does AKI mean
rapid decline in renal function over hours/days
accumulation of wast, metabolic consequences, can have reduced output
rise of serum creatinine by 26ml/mol in 48 hrs or 1.5x reference value or urine output less than 0.5ml over 6 hrs
staged based on severity
65
RF for AKI
risk
ill
surgery
e.g. ensuring adequate hydration is a preventative measure
Recognised risk factors for AKI•Age >75 years•Pre-existing CKD (eGFR <60 mL/kg/1.73 m2)•Previous episode of AKI•Debility and dementia•Heart failure•Liver disease•Diabetes mellitus•Hypotension (Mean arterial pressure <65mmHg, systolic BP <90mmHg)•Sepsis•Hypovolaemia•Nephrotoxins, eg gentamicin, NSAIDs, iodinated contrast•Continued antihypertensives in setting of hypotension, eg ACE inhibitors, loop diuretics
66
Pre renal causes of AKI
Hypovolaemia
low cardiac output
hypotension
renal artery thrombosis
67
Renal causes of AKI
```
Acute tubular necrosis
Glomerulonephritis
Vasculitis
Nephrotoxins, contrast, rhabdomyolysis
Interstitial nephritisHUS/TTP
Malignant hypertension
Myeloma
```
68
Post renal causes of AKI
Ureteric obstruction
Urethral obstruction
Blocked urinary catheter
Bladder tumour
69
Difference between AKI and CKD
AKI is reversible
| CKD - impaired, progressive, eskd, not reversible
70
How do AKI present
non specific symptoms
uraemia (nausea, vomiting and anorexia)
decreased urine output
systemic features (rash, myalgia, arthralgia, headaches)
urea and cr up
acidosis, hyperkalaemia, salt and water retention
71
For UTI history what should you check
```
duration
systemic features
PMx - vascular, childhood renal, UTI, diabetes, hypertension
stroke early death
herbal, recreational drugs
```
72
How to distinguish between a pre renal, glomerular and tubular AKI in urine?
G: red cells, proteinuria
T: minimal blood, less protein, white cell case
Pre-renal - no blood nor protein
73
Things you always want to know with renal patients
```
baseline creat
take an ABG for hypoxia and acidosis
electrolyte
US - kidney size
CXR - for fluid overload, chest infection
urinalysis
```
74
Common causes of AKI
```
Acute tubular necrosis
functional
myeloma
Acute tubular interstitial nephritis
athero embolic
rhabdomyolysis
```
75
Need to find a treatable cause for AKI - so what investigations should you do?
```
volume status (for ATN)
•Urine microscopy and dipstick
•Imaging (U/S) *** Obstruction ***
•ANCA, Anti-GBM, SLE immunology (ANA, dsDNA, complements)
•Creatinine kinase•FBC, clotting
•Inflammatory markers
•Myeloma screen (protein electrophoresis, urine BJP)
•May need biopsy
```
76
How do you treat:
- hyperkalaemia
- PO
- acidosis
- hypertension
- uraemia (damages brain, nerves and heart)
IV calcium
insulin and dextrose
nebulised salbutamol
dialysis
77
What is CKD
syndrome with a cause for renal
kidneys usually smaller
slow progression for eskd
78
5 stages of CKD and action
```
1 normal >90
2 60-89 kidney damage
3 30 - 59 moderate decreasing gfr
4 15-29 - severe - prepare transplant
5 less than 15 = kidney failure - dialysis
```
if macroalubinuria is present - worsening kidney function
79
RF for CKD
ElderlyHypertensionDiabetesIHDFamily History CKDAfrican AmericanObesity
80
Main causes of CKD
```
Diabetes
Chronic glomerulonephritis
vascular diseases IHD, HTN
Autosomal dominant PKD
childhood infections
```
81
How to prevent progression of CVD in CKD patients
BP control - ACEi ARB max doses - need a low blood pressure, reduce proteinuria (SGLT) - glifozins
no smoking
exercise, low salt and protein diets
avoid nephrotoxins like NSAIDS
82
What drug slows the progression of kidney disease
Glifozins - SGLT2 inhibitors
83
Triad for nephrotic syndrome
proteinuria, oedema, hypoalbuinaemia
84
Gold standard for finding out proteinuria problem
Renal biopsy
| Do US first
85
Main causes of proteinuria and nephrotic syndrome
```
Diabetes
Minimal change disease
membranous nephropathy
amyloid
SLE
```
86
Tests for proteinuria
protein:creatinine ratio
serum albumin and cholesterol
serum creatinine
glucose, SLE tests, virology (Hep B, C and HIV), myeloma screen
87
Protein uria management
Control oedema - low salt diet, diuretics
ACEI and ARB
Steroids
88
How does Haematuria present
Pain (stones/cancer)
Age > 40 - cancer - cystoscopy
below 40 glomerular cause
89
Most common haematuria glomerular causes
Alports - basement membrane disease
IgA nephropathy
90
When are neutrophils raised
acute inflammation
91
When are lymphocytes and plasma cells raised
chronic inflammation
| lymphomas
92
When are eosinophils raised + mast cells
allergic reactions
parasitic infections
tumours - Hodgkins disease
93
When are macrophages raised
late acute inflammation
| chronic inflammation - granulomas
94
Site of origin for squamous cancers
```
Skin
head and neck
oesophagus
anus
cervix
vagina
```
mucin stain
95
Stain for adenocarcinoma
melanin on a Fontana stain
96
Stain for haemochromatosis
Prussian blue iron stain positive
97
Stain for amyloid
Congo red positive
| Apple green birefringence
98
Causes of high bilirubin
```
pre hepatic - haemolysis + Gilberts - FBC and film
hepatic disease (viral hep, alcoholic hep, cirrhosis) - LFTS
post hepatic (gallstones, pancreatic cancer) - obstructive jaundice
```
99
How is gibbers inherited
recessive
100
How is liver function measured
Albumin
clotting factors
bilirubin
101
If AST and ALT high
Hepatic damage - excludes obstructive jaundice and pre hepatic
102
Features of alcoholic hep
Liver cell damage, inflammation, fibrosis
fatty change, megamitochondria
NASH (non alcoholic stet hepatitis)
103
How do you treat alcoholic hep
supportive
stop alcohol
B1 - beri beri
104
Signs of CLF
Multiple spider naevi•Dupuytren’s contracture•Palmar erythema•Gynaecomastia
105
How is portal hypertension caused
Cirrhosis
visible veins, splenomegaly and ascites
106
Features of liver failure
Failed synthetic function•Failed clotting factor and albumin•Failed clearance of bilirubin•Failed clearance of ammonia•(encephalopathy)
107
Features of cirrhosis
Whole liver involved.•Nodules of regenerating hepatocytes•Fibrosis•Shunting of blood
108
Causes of cirrhosis
Fatty liver disease ( alcoholic and non-alcoholic) -micronodular•Viral hepatitis ( Hepatitis B, C and D) –macronodular •Others:Haemochromatosis (iron overload)Wilson’s Disease ( copper overload)Primary Biliary CholangitisPrimary Sclerosing Cholangitis.
109
Scratch marks and liver
obstructive jaundice
| pruritus
110
Courvoisiers law
palpable gall bladder
no pain
cause not likely to be gall stones
111
Tests for OJ
US abdominal
112
Symptoms of asthma
wheeze
SOB
chest tight
bronchoconstriction, airway thickening and increased mucus
113
Drugs for asthma (not in order)
Short-actingβ2-adrenoceptoragonists(SABA) –inhaled
Long-actingβ2-adrenoceptoragonists(LABA) –inhaled
Muscarinicreceptor antagonists(SAMA, LAMA) –inhaled
Glucocorticosteroids(GCS) –inhaled/ora
lCOMBINATIONS–LABA/GCS, LABA/LAMA, LABA/LAMA/GCS–inhaled
Leukotriene(cysteinyl) receptor antagonists(LTRA) –oral
Theophylline–oral, asthma
114
Poor controlled asthma
peak flow less than 60% of predicted best
115
What is sarcoidosis?
Systemic disorder of unknown cause(s) characterised by formation of noncaseating granulomas, affecting the lung in >90% of cases
can be transmitted via transplants
116
Test for sarcoidosis
Kveim siltzbach extract - immun repsonse on skin
117
Name a protective factor for sarcoidosis
smoking
| HLA DR1 DR4 alleles
118
How do you diagnose sarcoidosis
X ray nodules
Histology - non caveating granulomas
CT
4 staged staging - ends with fibrosis of the lung
EBUS-TBNA/EUS-TBNA
119
List the staging of sarcoidosis
Stage I: isolated bilateral hilar lymphadenopathy (BHL): good outcomeStage II: pulmonary infiltrates + BHL: progression in one third at 5 yearsStage III: pulmonary infiltrates, no BHL: progression in two thirds at 5 yearsStage IV: overt fibrotic disease, significant mortality
120
How do you assess reversibility of sarcoidosis
pet scan with inflixmab contrast
121
Treatment for sarcoidosis
steroids
likely will still cause resp failure and cardiac failure/arrhythmias
can use immunosuppressants such as methotrexate and azathioprine
122
What is Disseminated Intravascular coagulation? Lab findings?
Paradoxical process of clotting then bleeding leading to organ ischaemia and damage - usually a cause of sepsis or gram negative bacteria infection
```
low platelets
low fibrinogen
low clotting factors
high prothrombin time
high partial thromboplastin time
high d dimer (fibrin degradation product)
schistocytes
```
123
What are the 5Ps for pleuritic chest pain?
```
PE
Pneumothorax
Pericarditis
Pleruisy
Pneumonia
```
Abcess, rib fractures and costochondritis can also cause it
124
What condition causes dome shaped, firm and smooth skin lesions that spreads via sexual contact on umbiclicated centre?
molluscum contagiosa
125
Virus for chicken pox and is it acute
| Difference between shingles
Varicella zoster virus
acute rash - weep, crusty + flu
shingles chronic on stress - painful
126
Virus for syphillis - symptoms
Treponema pallidum
| single ulcer - lymphadenopathy - skin lesions - can cause euro damage
127
Virus for gonorrhoea - symptoms
Neisseria gonorrhoeae
vaginal/urethral discharge, dysuria
128
What is a sebaceous cyst
keratinous, epithelium lined cyst - blocked hair follicle
| smooth and creamy
129
How can hep b be transferred?
Sexual contact, blood and vertical transmission
130
How to distinguish between a susceptible, acute, chronic, cleared and vaccinated person for Hep B
```
S - -ve for all
Acute - only -ve for HBsAB
Chronic - -ve for HBcAb IgM and HBsAb
Cleared - +ve for HbcAB IgG and HBsAb
Vaccinated - +HBsAb
```
131
Most reliable test for prostate cancer
Transrectal ultrasound guided biopsy
132
Difference in histological features of crohns and UC
C - non caveating granulomas
| UC - mucosal ulcers, goblet cell depletion and crypt abscesses
133
Difference between primary and secondary polycythemia vera
1 - clonal proliferation fo myeloid stem cells
| 2 - natural / artificial increase in EPO e.g. chronic hypoxia or abuse
134
What is subclavian steal syndrome?
Stenosis of SCA blood being stolen from brain
Less blood to brain = blackout
Lump likely to be compressed rib
135
What is gout? How to diagnose?
Uric acid crystals within joints
metatarsophalangeal joint - toe
diagnosis - microscopy of aspirate synovial fluid - negatively birefringent needle shaped crystals
136
Difference between gout and pseudo gout
calcium pyrophosphate crystals
knees and wrists
positively birefringement rhomboid shaped crystals
137
What synovial fluid is seen in septic arthritis?
Turbid synovial fluid with high WCC
138
What is pseudohyponatremia
Normal sodium
| high lipids dilute sodium, make it seem lower than actually is
139
What lobe collapse produces sail sign on CXR
Left lower lobe
140
First line investigation for bowel obstruction - first treatment
AXR
| IV fluids and NG tube to aspirate gastric contents and decompress the bowel
141
Postpartum depression features
confusion, low mood, anhedonia and anergia - think child is evil
142
Difference between cushings syndrome and cushings disease
```
Ectopic tumour ACTH (syndrome)
Pit tumour (cushings disease) - suppress acth release after dexamethasone
```
High dose dexamethasone differentiate between them
143
Raised ESR markers and fever with features of hyperthyroidism
De Quervain's thyroiditis
144
What should you measure for diabetes management
glycated Hb
145
If blood glucose and elevated and patient is not overweight you give
sulphonylureas
146
what test for acromegaly
glucose tolerance test to exclude diabetes
GH can be raised during periods of stress
147
Signs of pituitary apoplexy
sudden headache, vomiting, visual disturbances, hormonal dysfunction
148
Main way to find a pituitary adenoma
MRI
149
What is postural hypotension caused by in Addisons
reduced aldosterone
150
Special considerations before surgery
```
Diabetes
Sickle cell
OSA
IHD
Graves
Phaeochromocytoma
```
```
Diabetes
– ?GKI infusion
• Sickle Cell
– Post op CPAP
– ?Pre-op red cell exchange
• Obstructive sleep apnoea
– Post op CPAP
• Ischaemic heart disease
– Pre-op optimisation
• Surgery specific
– Graves’ disease – anti-thyroidals / beta blockade
– Phaeochromocytoma – alpha-blockade
```
151
Define shock
‘Life-threatening condition of circulatory
failure, causing inadequate oxygen delivery
to meet cellular metabolic needs + O2
consumption requirements’
152
Types of shock and their causes
```
Hypovolaemic
– Haemorrhage
– Dehydration
• Distributive
– Sepsis
– Neurogenic
• Cardiogenic
– Arrhymia
– Pump failure
• Obstructive
– Tamponade
– Pneumothorax
```
153
Tests to do for shock causes
```
ECG
• Urine – pregnancy / bedside
urinalysis
• Blood gas – oxygenation / lactate /
acid-base / Hb
• Bloods to lab – FBC, renal function &
elecs, clotting, G+S
• CXR (mobile)
```
154
On a CT scan what appears as what
bone - white
soft tissue - grey
lungs - black
155
On a CXR what area of heart is furthest right and left
right - right atrium
| left - left ventricle
156
Consolidation of a CXR means
Infection
tumour
blood
157
Ground glass opacification
Airspace - haemorrhage
interstitial - hypersensitivity pneumonitis
both - RBILD
158
What does consolidation actually mean?
Displacement of air
159
Why do you starve surgical patients? timings for food and water
decrease aspiration risk
6 hrs for food
2hrs for water
160
Errors in taking an ABG
• Presence of air in the sample
• Collection of venous rather than arterial blood
• An improper quantity of heparin in the syringe, or improper
mixing after blood is drawn
• Delay in specimen transportatio
161
Complications of ABG sampling
* Haematoma
* Nerve damage
* Arteriospasm or involuntary contraction of the artery
* Aneurysm of artery
* Fainting or a vasovagal response
162
Onset of subarachnoid headache? Diagnosis?
Abrupt, sudden,
acute, thunderclap (over
seconds or minutes
CT
163
Recite the GCS
```
Eyes
4- Spontaneous
3- To sound
2- To pressure
1- None
Verbal
5- Orientated
4- Confused
3- Words
2- Sounds
1- None
Motor 6
6- Obey
commands
5- Localising
4- Normal flexion
3- Abnormal
flexion
2- Extension
1- None
```
164
B symptoms of lymphoma
fevers
night sweats
weight loss
165
Tumour markers
```
CEA - lower GI
Ca 19-9 - pancreatic cancer
CA 15-3 breast cancer
CA 125 ovarian
AFP - liver
```
166
What medication do you give for palliative care?
Morphine 2.5mg sc prn (pain)
• Midazolam 2.5mg sc prn (agitation)
• Glycopyrronium 200 mcg sc prn (respiratory
secretions)
• Haloperidol 0.5 mg sc prn (nausea/vomiting)
167
What type of rash does dermatitis herpaformis show? Condition related to?
papulovesicular rash on elbows
coeliac
168
What does histology of the gut look like for coeliac?
Villous atrophy and crypt hyperplasia
169
Features of hypercalcaemia
Calcaemia
Renal failure
Anaemia
Bone pain
170
Multiple myeloma test results
hypercalcaemia - caused by bone lesions
| rouleax due to high conc of plasma proteins
171
Most common urinary tract stone
calcium oxalate
172
First test for pancreatitis
us
173
What is cushings reflex
triad to Raised ICP, high blood pressure, bradycardia and irregular breathing
174
Kussmaul sign
paradoxical rise in JVP on inspiration due to impaired ventricular filling e.g. constrictive pericarditis or restrictive cardiomyopathy
175
Becks triad
cardiac tamponade
raised jvp
muffled heart sounds
low blood pressure
176
Charcots triad
cholangitis
RUQP
jaundice
fever with riggers
177
Baroreceptor reflex
maintains constant blood pressure
178
Causes of onycholysis
DR PITHS
| drugs, reactive arthritis, psoriasis, infection, trauma, hyper and hypo thyroidism, sarcoidosis, scleroderma
179
What thyroid condition would show no uptake of iodine
De quervains thyroiditis
graves would show all over
plummers = one nodule
180
Firm breast lump, without axillary lymphadenopathy, skin changes or nipple discharge
fibroadenoma
| US before radiological assessment (if above 35 mammogram)
181
Whooping cough
Syphilis
Plague
B.pertussis
Treponema pallidum
Yersinia pests
182
```
A wave
c wave
X descent
V wave
Y descent
```
- atrial contraction blood back to SVC (cannon when both contracted at the same time a and v - complete heart block)
- ventricular contraction - tricuspid bulge - pressure wave back to SVC
- atria relaxing
- V wave - increased venous return to right atrium in late systole (tricuspid regurgitate if large)
- rA to rv through tricuspid valve - slow = stenosis
183
Raised JVP without pulsation
SVC obstruction
184
Ankylosing spondylitis
```
seronegative
HLA B27
male
worse in morning better with activity
schobers test - reduced spinal flexion
sacroilitis = first feature
```
185
Causes of obstructive renal impairment
Benign prostatic hypertrophy
Recurrent kidney stones
Retroperitoneal fibrosis
Schistosomiasis
186
Does moderate alcohol consumption reduce coronary heart disease chances
yes
| severe increases it
187
Legionella P
Legionella pneumophila infection will present with non-specific symptoms such as fever, myalgia, headache, confusion and diarrhoea. Blood tests reveal hyponatraemia, abnormal liver function tests (elevated liver enzymes, hypoalbuminaemia) and an elevated creatine kinase. The diagnosis is confirmed by Legionella serology or urine Legionella antigen.
188
How does bladder cancer present
painless macro haematuria
| dye worker
189
Signs of prostate problem
voiding symptoms
190
Triad for acute mesenteric ischaemia
severe abdo pain
shock
normal abdo - gasless
191
First line acute limb ischaemia
IV heparin
192
What csf marker is raised in every infection
protein
193
Signs for wegeners granulomatsis
Respiratory tract
glomerular nephritis
cANCA raised
194
What measure is not included in sepsis
Blood pressure
195
Sepsis 6
```
blood cultures
oxygen
ABs
fluid restriction
lactate
urine output
```
196
What condition is arthritis mutilans related to?
Psoriasis
| deformed fingers
197
Do viral infections cause colour change in eyes?
only eyes water
198
First Line for delirium tremens
chlordiazepoxide
199
Parameter for ACD
raised ferritin
| low iron
200
Feature for beta thal
raised HBA2
201
Features of tissue related lung injury
Pulmonary oedema
cyanosis
hypotension
202
Fever and neutropenia by itself
bacterial infection
203
t(15:17)
Acute myeloid leukaemia
204
Signs of infectious mononucleosis
FLAWS, splenomegaly
205
Schistocytes + Heinz body (G6D)
haemolysis
206
Target cells
jaundice
207
```
Test for
- sickle
- b12
- autoimmune
hereditary spherocytosis
```
- sodium metabisphospahte
- schillings
- Coombs
- osmotic fragility
208
Diagnostic main for leukaemia
Bone marrow aspiration under microscopy
209
Kussmaul breathing
| Cheyne stokes breathing
deep breaths
| deep breaths gradually deeper until apnoea
210
CO2 greater than 6 and hypoxia
type 2 resp failure
211
Measurement for progression of melanoma
depth
212
Risk for acute hypernatraemia
Central pontine myelinalysis
213
What urine measurement for phaeocytochroma
VMA - increased
214
SAAG
serum albumin - serum ascites proteins
>11 = transudative (low protein fluid)
- cirrhosis, pericarditis, chf, budd chiari, hepativ venous obstruction
<11 = exudative (high protein fluid) - malignancy, pancreatitis, bowel obstruction
215
How do you categorise voiding and and storage problems
Storage - irritate - FUN - frequency, urgency and nocturia
Voiding - obstructive - WISE = weak stream, intermittency, straining, incomplete emptying
216
APTT
| PT
APTT - intrinsic pathway
| PT - extrinsic pathway
217
Test for suspected PE in pregnancy
CTPA = no
V/Q yes
218
Procedure to remove perforated divertuicated sigmoid colon
hartmanns
219
What glomerular problem is associated with malignancy?
Membranous nephropathy
220
First line for heart failure with reduced LVEF
ACEi and beta blocker
221
How treated for Addisons split
hydrocortison twice
| majority at start of the day
222
Presentation of syringomyelia
cape like loss of pain and temperature sensation - compression on spinal tract anterior white commissure
223
What can trigger liver decompensation in cirrhotic patients
constipation
224
If minor bleeding happens at 8 INR what do you do
stop warfarin, iv vit k, inr 5
225
What should be done for multiple episodes of loss of consciousness with quick recovery times
24 hr ecg
226
Difference between iron def anaemia and Amaemia of chronic disease
IDA - high TIBC
| ACD - low/normal TIBC
227
How often do you give 300mg of adrenaline in anaphylaxis
every 5 minutes
228
What infection causes rose spots on the abdomen
salmonella typhi
