daily mix I Flashcards by Yasmin Wheeler

In terms of urine output what constitutes an AKI

Urine output of <0.5 ml/kg/hr over 6 consecutive hours

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What constitutes an AKI (3 things)

-rise in serum creatinine of 26 micromol/litre or greater within 48 hours
-50% or greater rise in serum creatinine known or presumed to have occurring within the past 7 days
-fall in urine output less than 0.5ml/if/gout more than 6 hours in adults

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why does CKD commonly cause anaemia

Loss of kidney’s production of erythropoietin

Also poor iron absorption

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Treatment of anaemia in CKD

1st = start oral iron replacement

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Which disease gives a hyperchloremic metabolic acidosis ?

Renal tubular acidosis

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what is the first-line screening test for adult poly cystic kidney disease

Renal ultrasounds

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What can cause contrast-induced nephropathy ?

Iodine based CT and X-ray

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What should be given to counter contrast-induced nephropathy ?

Volume expansion via 1L IV 0.9% sodium chloride

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What is the most common extra-renal manifestation of ADPKD

Liver cysts

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what causes subarachnoid haemorrhage in ADPKD

Pancreatic cyst and berry aneurysms (much less common than liver cysts)

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Treatment of Minimal change glomerulonephritis

Prednisolone (steroids + ACEi)

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When does Alports usually present ?

Childhood

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Features seen in Alports

Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
Splitting of lamina densa on electron microscopy
Presents at childhood

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Investigation of Alports

Genetic testing
Renal biopsy

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What is seen on renal biopsy for Alports

Splitting of the Lamina densa of the GBM - resulting in a basket weave appearance

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*basket weave appearance on renal biopsy

Alports

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what to do if a patient has < 0.5ml/kg/hr urine output post-operatively ?

Administer 500ml 0.9% sodium chloride over 15 minutes

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What is the most likely cause of death in someone with CKD on HD

Ischaemic heart disease

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What is acral lentiginous melanoma

Pigmentation of nail bed affecting proximal nail fold = melanoma

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red or black lump / lump that bleeds or oozes

Nodular Malignant melanoma

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What type of lesion is most commonly seen with renal transplantation

Squamous cell carcinoma

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What drug can cause patchy depigmentation in patients with darker skin

Topical steroids (ie clobetasone)

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Steroid cream potency (eczema)

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Where are keloid scars most commonly found

Sternum

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What is used to treat dermatophyte infection

Oral terbafine

What fungus is responsible for pityriasis versicolor

Malassezia furfur

*central dimple, 2mm in diameter, multiple raised lesions

Molluscum contagiosum

What medication can cause toxic epidermal necrolysis

Penicillins ie co-amoxiclav

What is nikolsky’s sign

Epidermis separates with mild lateral pressure

Skin lesion associated with UC

Pyoderma gangrenosum

Most common cause of cauda equina syndrome

Central disc prolapse at L4/5 or L5/S1

Investigation for suspected cauda equina syndrome

Urgent MRI

Management of Cauda equina syndrome

Urgent decompression

Late sign of cauda equina syndrome

Urinary incontinence

What do the Ottawa rules apply to ?

When to use an X-ray for ankle / knee injury

MAIN ASSOCIATION for adhesive capsulitis

Diabetes !!

Dermatomyositis associated antibody

Anti-Jo-I and ANA

what needs to be done after confirmed diagnosis of Dermatomyositis

Screen for underlying malignancy ie breast or lung (typically)

Main side effect of hydroxychloroquine

Bull’s eye retinopathy

*BULLS EYE RETINOPATHY

Hydroxychloroquine use

What do you have to check in a patient before commencing them on azathioprine

Thiopurine methyltransferase deficiency If they have a deficiency then they are predisposed to azathioprine toxicity

S1 compression symptoms

Sensory loss in posterolateral aspect of leg Lateral aspect of foot Weakness in the plantar flexion of the foot

What does S1 innervate

Gastrocnemius and soleus = responsible for plantar flexion

L3 compression symptoms

Sensory loss over anterior thigh Weak hip flexion (iliopsoas) Knee extension (quadriceps) Hip adduction (Adductor) Reduced knee reflex

L4 compressions

Sensory loss over anterior aspect of knee and medial malleolus Weak knee extension Hip adduction Reduced knee reflex

L5 compression

Foot dorsiflexion weakness Sensory loss over the lateral lower leg And normal reflexes

S2 nerve root compression

Sensory loss over posterior thigh and calf Weakness in knee flexion Reduced or absent ankle reflex

*sensory loss over dorsum of foot

L5 nerve root compression

*metaphyseal tumour of long bone with a ‘sunburst’ pattern

Osteosarcoma

Most common primary malignant bone tumour in children and adolescents ?

Osteosarcoma

Protein associated with Ewings

EWS-FLI1

4-year-old girl with a three month history of a limp. Her parents report that she has 'not been right' for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day. What’s going on here ?

Juvenile idiopathic arthritis >more than three months

X-ray of Perthes disease

Widening of joint space and decrease femoral head size/flattening

what’s going on here

SUFE - on the left side

what’s going on here

Perthes - see the destruction of the femoral head / flattening

Should high dose prednisone be given before or after investigation in clinical suspicion of GCA

Before

*pain and tenderness over the lateral side of thigh / hip in a woman 50-70years

Greater trochanteric pain / trochanteric bursitis

*burning sensation over anterio-lateral aspect of the thigh

Meralgia paraesthetica

What is meralgia paraesthetica

Caused by compression of lateral cutaneous nerve

What is pubic symphysis dysfunction

Common in pregnancy Ligament laxity increases in response to hormonal changes of pregnancy Get pain over pubic symphysis with radiation to the groins and medial aspects of the thigh

AC joint injury treatment Grade I - II

Conservative management with sling and immobilisation

AC joint injury treatment Grade III, IV , V

Surgery

Sensory loss over anterior thigh, weak hip flexion, knee extension, hip adduction, reduced knee reflex = what nerve root compression

*reduced knee reflex

What is this

Bakers cyst

What is Bakers Cyst

Popliteal cyst - aren’t actually cysts but a distension of the gastrocnemius - semimembranous bursa

Treatment of bakers cyst in a child

Self-resolving

*reduced sensation over left anterior knee and medial malleolus

L4 nerve root compression

management of acute renal colic

IM diclofenac 75mg

Management of communicating hydrocele

These are common in newborn males and usually will resolve within the first few months of life Surgical repair if does not resolve within 1-2 years

*soft, non-tender swelling of the hemi-scrotum, transilluminates with a pen torch in baby

Hydrocele

Communicating vs non-communicating hydrocele

Non-communicating = excessive fluid production within the tunica vaginalis Communicating = latency of the processes vaginalis allowing peritoneal fluid to drain down into the scrotum

Painful swollen testes - relieved by lifting testes

= epididymo - orchitis

Most common causative organism for epididymo-orchitis

Chlamydia trachomatis

STI but of unknown organism - what is the recommended treatment

500mg IM ceftriaxone + doxycycline 100mg by mouth 2D for 2 weeks

STI treatment for enteric organism ie E.coli

Oral quinolone for 2 weeks

How long do you have to wait to test PSA after doing certain things …

Indications for circumcision

Phimosis Recurrent balanitis Balanitis xerotica obliteratans Paraphimosis

How long does it take a perforated eardrum to heal ?

6-8 weeks

*unexplained hoarseness in a patient aged >45

Urgent referral to ENT

What type of audiogram pattern would Cholesteatoma show ?

Conductive pattern

What mode of inheritance is otosclerosis

Autosomal dominant

T/F there is hearing loss in vestibular neuronitis

F - there is no loss of hearing Features = recent viral infection, recurrent vertigo attacks lasting hours or days

*absent corneal reflex, hearing loss, vertigo, tinnitus

Acoustic neuroma

What disease is acoustic neurome associated with ?

Neurofibromatosis type 2

*pain on palpating of tragic, itching, discharge, and hearing loss

Otitis externa

Management of otitis externa

Topical antibiotic / topical antibiotic + steroid

What is Adies tonic pupil

When aniscoria is greater in bright light There is an issue with the dilated pupil adn its inability to constrict This could be due a problem with the parasympathetic nervous system

what is this