C - Meeran's Q Time & EFA

Question 1

fasting plasmas glucose cut off for DM

Answer 1

> 7

Question 2

HbA1c cut off for DM

Answer 2

> 6.5% (48mmol/L)

Question 3

2hr OGTT cut off for DM

Answer 3

> 11.1mM

Question 4

2hr OGTT cut off for impaired glucose tolerance

Answer 4

9 to 11

Question 5

48F presents unconscious, dehydrated, vomitting, polyuria, polydypsia.
O/E obese, dehydrated, low BP, glucose in urine. Dx?

Answer 5

hyperosmolar non ketotic coma

Question 6

1st Ix for ?hyperosmolar non ketotic coma

Answer 6

ABG

Question 7

causes of metabolic alkalosis

Answer 7

H+ loss - vomiting
low K+
bicarb ingestion

Question 8

how does compensation for metabolic alkalosis come about

Answer 8

alkalosis inhibits hyperventiliation therefore more CO2 retained to normalise the pH

Question 9

osmolality equation

Answer 9

= charged + uncharged ions
= Na + K + Cl + HCO3 + urea + glucose
= 2(Na + K) + urea + glucose

Question 10

anion gap equation

Answer 10

(Na + K) - (HCO3 + Cl)

Question 11

what is a normal anion gap

Answer 11

12

Question 12

if the anion gap is normal in metabolic acidosis, what does that show?

Answer 12

it is NOT DKA - ketones increase anion gap

Question 13

how are alkalosis and hypoK linked

Answer 13

they cause each other due to swapping of H+ and K+ ions
- low K drives H+ into cells
- alkalosis drives K+ into cells

Question 14

Cushings syndrome clinically
+++ ACTH, +++ cortisol
Dx?

Answer 14

ectopic ACTH or pituitary tumour
–> ectopic slightly more likely due to very high ACTH

Question 15

K+ finding in ectopic ACTH pt & why

Answer 15

VERY low
due to very high cortisol behaving like aldosterone

Question 16

what causes ectopic ACTH

Answer 16

tumours

Question 17

reduced lung expansion
dull to percuss
increased vocal resonance
Dx?

Answer 17

collapse + consolidation

Question 18

what is the problem with rehydrating someone too quickly if they’re anuric

Answer 18

AKI due to raised creatinine
pulmonary oedema from overfilling

Question 19

how do you distinguish between ATN and DM renal disease

Answer 19

renal biopsy

Question 20

Mx of ATN vs DM renal disease

Answer 20

ATN = dialysis for 3 weeks
DM RD = end stage so lifelong dialysis

Question 21

what effect does ectopic ACTH have on adrenals

Answer 21

bilateral hypetrophied adrenals due to xs ACTH

Question 22

Mx of ectopic ACTH

Answer 22

adrenalectomy to reduce cortisol and treat cushings

Question 23

ECG showing inferior STEMI with reciprocal changes. Mx?

Answer 23

aspirin
GTN
beta blocker
analgesia
thrombolysis or primary angioplasty

Question 24

what scan is done for bony mets

Answer 24

bisphosphonate mbp scan

Question 25

what scan is done for metabolically active mets

Answer 25

FDG PET scan

Question 26

where is the apex beat in LV hypertrophy

Answer 26

5th ICS MCL ie NOT DISPLACED

Question 27

ECG of LV hypertrophy

Answer 27

tall R waves

Question 28

cause of LV hypertrophy

Answer 28

undiagnosed HTN

Question 29

in which cardiac condition is apex beat displaced

Answer 29

HF due to dilatation of heart

Question 30

gram -'ve intracellular diplococci from septic arthritis of 19M after returning from holiday ?

Answer 30

neiserria gonorrhoea

Question 31

commonest cause of septic arthritis in 19-30y/o

Answer 31

neiserria gonorrhoea

Question 32

gram -'ve intracellular diplococci from ?meningitis in 19M ?

Answer 32

neisseria meningitidis

Question 33

6M meningitis sigs. Gram -'ve rods on LP ?

Answer 33

haemophillius influenzae

Question 34

who gets haemophillius influenzae ?

Answer 34

unvacc kids

Question 35

19M confused, septic. Blood cultures = gram + diplococci ?

Answer 35

strep pneumoniae

Question 36

19M confused, septic. Blood cultures grow nothing. Cold agglutinins are positive. Dx?

Answer 36

mycoplasma

Question 37

19M boil on leg, pus drained which shows gram + cocci in clusters ?

Answer 37

staph aureus

Question 38

19M mild fever for months with no cause. After 2 months, blood cultures grow gram + cocci ?

Answer 38

strep viridans

Question 39

where is strep viridans found normally

Answer 39

on everyone's teeth physiologically

Question 40

stain and shape of ecoli

Answer 40

+ rod

Question 41

e coli causes ____ in ____ babies

Answer 41

meningitis pre term

Question 42

stain and shape of strep pneumoniae

Answer 42

+ cocci (*** must know this***)

Question 43

what does strep pyogenes cause

Answer 43

strep sore throat can lead to sepsis and death

Question 44

contrast speed and invasion of strep pyogenes and strep viridens

Answer 44

pyogenes = invades all tissues rapidly viridans = slow growing, low virulence

Question 45

what does strep viridens cause

Answer 45

infective endocarditis

Question 46

subacute endocarditis sx

Answer 46

splenomegaly, janeway lesions, spliter haemorrhages, haematuria, clubbing, murmur

Question 47

who gets staph aureus endocarditis

Answer 47

IVDU

Question 48

commonest bacterial cause of lobar pneumonia

Answer 48

strep pneumoniae

Question 49

commonest bacterial cause of bronchopneumonia

Answer 49

haemophillius influenzae

Question 50

how old are SCID kids when they die

Answer 50

3 months

Question 51

commonest CNS infection

Answer 51

coxsackie group B

Question 52

who gets listeria infection

Answer 52

older people eating unpasteurised cheese

Question 53

contrast nucleus of neutrophils and lymphocytes

Answer 53

neut =multi segmented lymph = one

Question 54

what does the CSF look like in bacterial meningitis

Answer 54

+++ neutrophils

Question 55

what does the CSF look like in viral meningitis

Answer 55

+++ lymphocytes

Question 56

what does the CSF look like in TB meningitis

Answer 56

+++ turbid CSF

Question 57

stain and shape of strep pneumoniae

Answer 57

gram + diplococci

Question 58

stain and shape of neisseria

Answer 58

gram - intracellular diplococci

Question 59

what colour do gram + bacteria stain

Answer 59

blue

Question 60

what colour do gram - bacteria stain

Answer 60

red

Question 61

what stain is used for TB

Answer 61

ziel neilson

Question 62

stain and shape of listeria

Answer 62

gram + rods (they are the main gram + rods)