Deck 4 Flashcards
(20 cards)
What are the symptoms of Waldenstrom hyperglobulinaemia?
Headaches
Nose bleeds
Hepatosplenomegaly
Papilloedema
NOTE: resulting from hypercoagulable state (Ix: protein electrophoresis)
What is the standard therapy used for small cell lung cancer?
Cisplatin and Etoposide
NOTE: carboplatin is used for those who cannot tolerate cisplatin
How does syringomyelia manifest?
Weakness in hands then arms (anterior horn cells)
Loss of pain and temperature in upper limbs (cape-like)
Followed by loss of fine touch, vibration and proprioception later on
What is the imidazoline receptor?
A receptor that can stimulate the sympathetic nervous system
Clonidine and Moxonidine block this receptor to achieve a reduction in blood pressure
What are the main consequences of hypophosphatemia?
Haemolytic anaemia Seizures Confusion Cardiomyopathy Skeletal Muscle Weakness
List some causes of hypophosphataemia.
Increased Renal Excretion
- Hyperparathyroidism
- X-Linked Hyperphosphataemia
- Fanconi Syndrome
- Diuretics
Decreased GI Absorption
- Reduced intake
- Phosphate binders (sevelamer)
- Alcohlism
Transcellular Shifts
- Refeeding syndrome
- Insulin
What is the treatment of choice for TTP?
Plasma exchange (steroids may be used as an adjunct)
Damage to which part of the brainstem would result in upgaze and downgaze palsy?
Dorsal Midbrain
It may also be associated with convergence nystagmus and impaired pupillary reflexes
NOTE: known as Parinaud syndrome
What is the treatment of choice for cerebral toxoplasmosis?
Sulfadiazine + Pyrimethamine + Folinic Acid for 6 Weeks
Describe the appearance of the rash in Darier’s disease.
Warty brown papules on the chest and back
Autosomal dominant inheritance pattern
What are the presenting symptoms of variant CJD?
Rapidly Progressive Dementia
Ataxia
Myoclonus
MRI –> Pulvinar Sign (High intensity in pulvinar region of thalamus) - described as ‘hockey stick sign’
Which antiemetic is used in the treatment of nausea and vomiting in hypercalcaemia?
Haloperidol
This is the most potent D2 antagonist and the mechanism of hypercalcaemia induced nausea is via the D2 receptor
Which foramen do crainal nerves IX, X and XI pass through?
Jugular Foramen
What is an appropriate fluid regime for someone who is admitted with DKA?
1 L 0.9% NaCl over 1 Hour 1 L 0.9% NaCl + KCl over 2 Hours 1 L 0.9% NaCl + KCl over 2 Hours 1 L 0.9% NaCl + KCl over 4 Hours 1 L 0.9% NaCl + KCl over 6 Hours
ADD 10% Dextrose at 125 mL/hour once BM < 14 mmol/L
BOLUS: 500 mL NaCl if SBP < 90 mm Hg
How should patients with DKA be monitored after commencing treatment?
HOURLY capillary ketones and glucose
VBG at 1 hour, 2 hours then every 2 hours thereafter
What is diabetic amyotrophy?
Complication of diabetes mellitus that results from damage to the lumbosacral plexus (supplying thighs and buttocks)
Manifests with lower leg pain, weakness, wasting and paraesthesia
List some CYP inhibitors that can increase the effect of warfarin.
Ciprofloxacin Clarithromycin Erythromycin Omeprazole Metronidazole Chloramphenicol Cranberry Juice
What are the manifestations of Brucellosis?
Fever Myalgia Weight loss Headache Abdominal pain
Bloods may show deranged LFTs but everything else may be normal
Blood cultures will be positive after 5 days (slow growing)
Caused by exposure to unpasteurised dairy products
What is high take off on an ECG?
Benign early repolarisation (looks like pericarditis) - common feature in < 50 yrs ST elevation in precordials leads Prominent T waves ST segment/T wave ratio < 0.25 Fishhook appearance in V4 ECG changes are stable over time
Which ECG change is seen in hypocalcaemia?
QT prolongation
NOTE: you get QT shortening in hypercalcaemia
