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MedEd Oddities Flashcards

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1
Q

Main cause ESRD in adults

A

Glomerulonephritis (inflammation of BM and g capillaries)

Dec excretion -> accumulation of waste products -> AKI

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2
Q

Main causes of glmoerulonephritis

A

IgA nephropathy - Inc igA as a result of LUT infections -> episodic haematuria
Enoch-schonlein purpura - systemic IgA variant nephropathy - haematuria, EXTENSOR PURPURA, polyarthritis, scrotal swelling, abdo pain

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3
Q

What is plummer’s disease?

A

A single toxic nodule on a background of suppressed TMNgoitre

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4
Q

What goitre is seen in hashimotos?

A

Diffuse swelling

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5
Q

What is the thyroid cancer mnemonic?

A 
PFMA - poor farmers make amphetamines 
- In order of prevalence
Papillary 
Follicular 
Medullary 
Anaplastic
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6
Q

What does follicular usually result from and what age group tends to get them?

A

40-50s - lung and bone mets

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7
Q

Papillary carcinoma thyroid. Who gets them, what do you see on USS and biopsy?

A

Younger Pts, USS = calcified rings, Biopsy = clear nuclei

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8
Q

What is Med carcinoma ass with?

A

MEN 2A

Inc calcium seen too

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9
Q

What are these mnemonics for?
PPP
PMP
MMMP

A

MENS

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10
Q

What pattern is seen in Men 1?

A

PPP

Pit adenoma, parathyroid hyperplasia, pancreatic tumours

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11
Q

What is seen in Men 2a?

A

PMP

Parathyroid hyperplasia, Med thyroid cancer, phaeo

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12
Q

What pattern. Is seen in MEN2b?

A

MMMP

Med thyroid, Marfanoid, Mucosal neuromas, phaeo

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13
Q

When is RPG used?

A

Used if polyuria, nocturia, WL, polydipsia - > less accurate

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14
Q

HbA1c -what are the percentages as opposed to moms

A 
6% = 42mmol
7% = 53mmol
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15
Q

How many readings if a/symptomatic for DM?

A

Symptomatic - only requires one positive reading

Asymptomatc - requires 2 pos readings

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16
Q

How do sulphonylureas work?

A

Inc secretion insulin (used in poorly controlled)

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17
Q

How does acarbose work? (Tip - its in the name)

A

Competitive inhibitor of the enzymes that break down carbs -> A(op)CARB(ohydrate)os(e)nzyme
Dec glucose intake
Rxs post prandial hyperglycaemia

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18
Q

Rx of hypoglycaemia?

A

Conscious -> oral glucose -> if still <4mmol -> 1ml glucagon IM/10%dec 100ml/hr + long acting carb after
Unconscious -> ABCD -> straight to glucagon + glucose IV

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19
Q

SE of spironolactone?

A

Gynaecomastia / menstrual abnormalities

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20
Q

What can metoclopramide cause?

A

Prolactinomas

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21
Q

What amounts of Dex are used in low and high dose Dex sup tests?

A

0.5mg 6hrly 48 hrs

2mg 6 hrly 48 hrs

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22
Q

What constellation is seen in HPT primary?

A

Ca high, PTH high, Phosphate low, ALP normal, N vit d

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23
Q

PTHrp is increased in what condition other than ectopic release?

A

Pregnancy

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24
Q

Which was can a carotid body tumour move?

A

Side to side not up and down

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25
What level does a cervical rib often originate at?
C7
26
What condition can a cervical rib cause?
Reynaulds - compression of the SC artery
27
What is a cystic hygroma?
Lymph filled transluminous fluid sac
28
What is the Rx for a cluster headache?
O2 + sumatriptan | Prophylaxis with verapamil
29
What is the framework for LOC diags?
BEAT BRAIN BLOOD
30
Name causes of BEAT LOC
BP = HR x SV x TPR HR - arrhythmias (stokes adams) SV - tamponade, pericarditis, outflow ob TPR - vasovagal, peripheral neuropathy
31
What is a vasovagal?
Reflex Bradycardia and vasodilation as a result of pain, fear, prolonged standing, emotion etc....
32
What are BLOOD causes of LOC?
Venous - pooling Arterial - atherosclerosis/shock/bloodloss Anaemia
33
What are BRAIN causes of LOC?
Diffuse - epilepsy, meningitis, SAH Hemi - stroke, epi/subdural Brain stem - ICP herniation
34
List some causes of postural hypotension
Age Hypovolaemia Drugs - nitrates diuretics, HTN drugs, antipsychotics Peripheral neuropathy - DM/autonomic neuropathy Endocrine - addisons/hypothyroid
35
What happens in an anterior cerebral stroke?
Leg hemiparesis > arm Disturbances judgement and personality Mild sensory deficit
36
What happens in a middle cerebral stroke?
Arm / face > leg Brocas and wernickes therefore receptive / expressive aphasias Sensory loss greater
37
What happens in a posterior cerebral artery?
Agnosia | Homonymous hemianopia
38
Partial
Focal
39
Generalised
Diffuse
40
Simple
No LOC
41
Complex
LOC
42
Frontal lobe seizure
Posturing, speech arrest, motor arres, jacksonian march
43
Parietal seizure
Sensory disturbance and strange movements
44
Temporal seizure
Complex -> emotional distancing smell/taste, depersonalisation.
45
Occipital seizure
Spots, lines, flashes
46
TONIC
Stiffening
47
Clonic
Contractions
48
Myoclonic
Isolated muscle contractions
49
Atonic
Loss of tone
50
Status epilepticus
Complex seizure > 30 mins duration or incomplete recovery between 2 seizures
51
What is the treatment for status epilepticus?
ABC IV bolus lorazepam. If fails repeat. If fails - IV phenytoin or diazepam
52
What are the Rx steps for aspirin OD?
If <1hr = charcoal If mod acidosis = sodium bicarbonate If severe = blood transfusion
53
How to treat lithium toxicity
Haemodialysis
54
Features of digoxin toxicity
Xanthopsia (yellow vision), arrhythmia, hypokalaemia
55
How is digoxin toxicity treated?
Digibind
56
Benzo OD features?
Double vision, nystagmus, slurred speech
57
How is benzo OD treated?
Flumenazil
58
What are the features of organophosphate poisoning?
Pinpoint pupils, sweating, salivation, diarrhoea
59
How is organophosphate pointing treated?
IV atropine and pralidoxime
60
How is CO poisoning treated?
With hyperbaric O2
61
What are the features of phenytoin OD?
Nystagmus, confusion, dizziness, ataxia
62
How is phenytoin OD treated?
CHARCOAL
63
Causes of SIADH
Lung - carcinoma, SCC, pneumonia a Drugs - SSRIs, TIA Mass bleeds CNS - tumours
64
Management of SIADH?
Fluid restriction If refractory -> tolvaptan / DMCT Severe cases - hypertonic saline DONT CORRECT TOO FAST - CPM
65
Hypovolaemic hyponataemia
D+V, diuretics
66
Euvolamic hyponatraemia
SIADH, Addisons
67
Hypervolaemic hyponatraemia
Cirrhosis, nephrotic, HF
68
Hypovolaemic Hypernatraemia
D+V, sweating, DM (osmotic diuresis)
69
Euvolaemic hypernatraemia
DI
70
Causes hypokalaemia
Vomiting, diuretic (nonksparing), hyperaldosteronism (cons), redistribution - salbutamol/insulin
71
How is hypokalaemia managed?
``` 3-3.5 = oral potassium chloride <3 = IV potassium chloride ```
72
Symptoms of hypokalamia
Weakness, arrhythmias, polyuria
73
What causes hyperkalaemia?
``` ACEi, ARB, spironolactone Addisons CKD/AKI Rhabdomyolysis Acidaemia ->causes K+ release from cells ```
74
Treatment of hyperkalaemia
10ml 10% calcium gluconate New salbutamol 50ml 50% dextrose (or equivalent ratio) + insulin Treatment of cause
75
Peaked tented t waves
Hyperkalaemia
76
Causes of hypocalcaemia
Vit d def (osteomalacia) | Iatrogenic - thyroid surgery
77
Hypocalcaemia
Vit d def (osteomalacia) | Dec PTH - iatrogenic
78
S+S of hypocalcaemia
Troussaeus, chvosteks Convulsions and parasthesias LONG QT + arrhythmias
79
Rx hypocalcaemia
Vit d def and calcium
80
What are the causes of hypercalcaemia?
PTH suppressed - myeloma, SCC, mets. Sarcoidosis, vit d toxicosis / thyrotox PTH unsupressed - HPTism
81
Presentation of hypercalcaemia
Stones bones groans psychiatric overtones
82
Rx of hypercalcaemia
IV saline | If cancer - + bisphosphonates
83
Management of HF?
1. ACEi + BB 2. Spironolactone/ARB 3. Digoxin (especially if NYHA-IV) Furosemide = symptomatic relief Amlopidine if BP high anticoagulation/aspirin if IHD Decreased salt intake, exercise, dec weight, immunisation and Rx of cause (precipitating)
84
What are the classifications of HTN?
Isolated >160 syst Malignant = >200/130 Stage 1 >140, stage 2 >160, severe >180
85
What are the Rx steps BP?
1. <55 - acei or arb >55 or black - CCB 2. Add to include CCB + ACEi/ARB 3. Add thiazides 4. BB or diuretic Refer if malignant / phaeo Decrease salt, inc exercise, dec caffeine, local initiatives, dec smoking
86
Cough, K+ up, RF, angiooedema
ACEI
87
vertigo, urticaria, pruritus
ARB
88
Ankle oedema, flushes, headache, gum hyperplasia
CCB
89
Dec K+ + Na+
Thiazides
90
Inc K+ and gynaecomastia
Spironolactone
91
HF, brochospasm, lethargy
BBs
92
What is the grace score for?
Risk + mortality of ACS likelihood
93
What are the parts in a grace score? (6 things)
``` Hx MI/CCF/arrest HR BP Creatinine Cardiac biomarkers Ecg changes ```
94
When are troponins taken with ACS?
ON arrival with ecg | 3 HOURS after admission
95
What are the ECG changes for a PE?
Tachycardia, RBBB, inverted t waves v1-4, s1q3t3
96
Wells DVT score = likely DVT?
2 or more
97
Wells PE score likely?
4.5
98
Why is a D diner not specific?
Increased in malignancy, pregnancy, post op
99
Dukes criteria for IE +ve result
If 2 maj, or 1 maj 3 minor, or 5 minor
100
What's in dukes IE score?
Maj - echo confirmed involvement, 2 positive blood cultures | Minor - pre disposition, fever >38, Vascular surg, 1 pos blood culture, +ve echo that doesn't meet criteria
101
What's in DVT wells score?
``` Malignancy Calf swelling >3cm Whole leg swollen Hx DVT Pitting oedema Collaterals Paralysis Bedridden >3days ``` OTHER DIAG AS LIKELY = -2
102
What's in WELLS PE score?
``` Hx DVT/PE - 1.5 HR 100 - 1.5 >3days immobile - 1.5 Current DVT - 3 Haemoptysis - 1 Malignancy - 1 Other diag less likely that PE - 3 ```
103
Wide pulse pressure
AR
104
AVRT where is the reentry?
Bundle of kent
105
Name an AVRT
WPW
106
Where is the reentry in AVNRT
At AVN
107
What is chadvasc for?
AF a/c assessment
108
40s-50s PM women fluctuant and tender
Breast cyst
109
Breast feed
Mastitis
110
Febrile, painful
Abscess
111
Cheesy, thick discharge
Duct ectasia
112
Impalpabel, but microcalcification on imagery
DCIS
113
Breast cancer RFs?
``` Early menarche Late menopause No breast feeding HRT OCP Nulliparity Obesity Smoking Hx/FHx ```
114
Most common invasive breast cancer?
Infiltrative ductal carcinoma (75%) | Lobular (10%)
115
Triple assessment
history + exam, imagery, biopsy | SN biopsy
116
Eczema, scaly skin around nipple, dry crusting,
Pagets breast. Spread of cancer to skin.
117
Rapid, tear drop breast, slit nipple, erythematous skin
Phylloides tumour
118
Multiple lumpy and cyclical
Fibroadenosis
119
G-ve flagellate
H PYLORI!
120
PUD investigation formula
<55 and no alarming symptoms - H pylori stool/breath >55/alarming symptoms - UGI endoscopy If present repeat endoscopy 6/8weeks
121
Multiple ulcers, gastric excreting tumour
Zollinger ellison syndrome
122
UC + Crohns. | Which tenesmus?
UC
123
UC + C which has steatorrheoa?
Crohns
124
UC + C, which is relapsing/remitting and which is constantly unwell?
``` UC = relapsing C = constant ```
125
UC+C which has polyps?
UC
126
UC+C which has skip lesions and cobblestone mucosa?
Crohns
127
Causes of dysentery?
``` CHESS Campylobacter/cdif Haem e coli E Histolyca Shigella Salmonella ```
128
ROME criteria?
IBS - exclusion | Beware WL/elderly/nocturnal symptoms
129
C.dif infection post abx
Pseudomembranous colitis
130
AST:ALT 1:1
Viral hep
131
AST:ALT >2.5:1
ALD
132
Severe mallory weiss is AKA
Boerhauves syndrome (complete rupture of oesophageal wall)
133
Bird beak
Achalasia
134
Oesophageal webs, ID, dysmotility
PLumer-vinson syndrome
135
Calcinosis, raynaulds, (o)esophageal dysmotility, sclerodactylyl, telangectasias, ANA and anti-centromere.
Limited cutaneous scleroderma
136
Asymptomatic Hep
HEP A
137
Enteric, epidermis, expectant mothers
Hep E
138
Prodrome - flu, fever, Malaise, rash, lymhadenopathy, myalgia Illness - nausea, anorexia RUQ, jaundice Rx with tenofovir
Hep B - body fluid,
139
Hep _ needs hep _ to infect
D needs B (DNB!!!!!!!!!)
140
Pale poo dark urine
Ob jaundice
141
Dark urine only
Hepatic Jaundice
142
Just jaundice
Pre hepatic Jaundice
143
VADAM = hepatocellular jaundice
``` Viral - HEPS ALCOHOL Drugs - paracetamol, isoniazid, rifampicin A/i - hep, PBC, PSC Metabolic (rare) ```
144
>1.5x diameter
AAA
145
Riglers sign
Both walls of bowel visible ->peritonitis/perforation
146
GET SMASHED
``` Gallstones Ethanol Trauma Steroids Mumps A/i Scorpion venom Hyperlipidaemia ERCP DRUUUUUGS ```
147
Valves connivantes/haustra visible
BO
148
Embryo sign
Caecal volvulus
149
Coffee bean sign
Sigmoid volvulus
150
Raised anion gap MUDPILES
``` Metformin Uraemia DKA Propyl Glycol Isoniazid Lactate Ethylene Glycol Salicylates ```
151
Causes of increased urea?
Dehydration, increased protein intake, GI bleeds, Protein breakdown - malignancy, trauma, surgery, infection
152
Curb score and results
``` Confusion Urea >7 RR >30 BP <90/60 Age >65 ``` ``` 0-1 = Rx at home 2 = hospital 3 = ITU ```
153
Treatment steps for typical pneumonia
``` Mild = amoxicillin oral Mod = Oral/IV amoxicillin + clarithromycin Severe = IV Co-amoxiclav + clarithromycin ```
154
Smoker, plummer, Aircon, urinary antigen, g-ve, contaminated water, hepatitis/RF
Legionella
155
Clumping of red cells, COLD agglutinin, young people living together
Mycoplasma pneumonia
156
SOB, birds, parrots, birds, diarrhoea, headache, fev, dry cough
Chlamidya psittica
157
Sore throat, hoarseness, otitis + pneumonia
Chlamidya Pneumonia
158
How are chlamidyas treated?
Doxycycline and clarithromycin
159
Mottling in lung fields + vesicular rash
VCZ
160
G+ve cocci, clusters, circular opacities, post influenza, IVDU, bilateral, Rx with rifampicin and flucloxacillin,
Staph A
161
CF, bronchiectasis, pneumonia
P aeruginosa
162
IVDU, reticular perihilar opacities, bilateral creps, boat shaped organisms on BAL
Pneumocystis pneumonia
163
LLQ pain, bloody diarrhoea chronic
Ischaemic colitis
164
What artery for ischaemic colitis?
Inferior mesenteric
165
What artery for acute mesenteric ischaemia has a thrombus occluding it?
Sup mesenteric artery
166
Causes of blood MIXED in the POO
Colonic carcinoma, colitis
167
Blood streaked poo
Anal/rectal tumour
168
Blood in the pan separate from the poo
Colitis, haemorrhoids, diverticula disease (think haemorrhaging)
169
Blood on the paper
Haemorrhoids, anal fissure
170
Rx of pulmonary oedema
Sit up Morphine (dilates veins) Furosemide IV
171
CKD
>3months <60mls/min
172
AKI
>26.5mmol / 1.5x NR / UO <0.5mls
173
CKD complications
1. Progressive acidosis + hyperkalaemia (red excretion) 2. Progressive hormone failure - Anaemia (erythro) + bone disease (vit D) 3. CVD -> calcification and uraemic cardiomyopathy 4. Uraemia and death
174
Rx of renal anaemia
EPO replacement
175
BP target in renal disease
130/80
176
SIGNS OF RENAL TRANSPLANTATION
``` Hockey stick scar AV fistula CUSHINGS Gingival hyperplasia Ear cancer (snipped ears) ```
177
ECG signs of hyperkalaemia (ALL OF EM)
Tall tented T waves Widened QRS Prolonged PR interval Absent/small P waves
178
PKD cheekies that we weren't aware of:
Increased RAS activity - HTN Excess erythropoietin - Raised HB Saccular and berry aneurysms
179
Functional incontinence
Inability to reach toilet in time - ie elderly/immobile
180
Urgency incontinence
UMN lesion = sphincter loss Parkinson's/MS/stroke Or detrussor overactivity Or transient ie with LUT infections
181
If bHCG and aFP are raised with a lump in the testicle:
Teratoma (10% of testicular cancers)
182
Just bHCG raised and lump in the testicle?
Seminoma
183
Contents of hernia stuck by adhesions
Incarcerated
184
Hernia causing BO
Obstructed hernia
185
Hernia with ischaemia
Strangulated hernia
186
MALT = the anagram for the inguinal canal RAFP = the order Say what's what mayteh
Roof - 2 Muscles = transversus abdominus, internal oblique Anterior = two Aponeurosis = external and internal oblique apos FLoor - two Ligaments - inguinal and lacunar ligaments PosTerior - Transversalis fascia and conjoinT Tendon
187
Inferior and lateral to inguinal ligament
Femoral hernia
188
Frequently strangulate/irreducible
Femoral hernia
189
Obesity, ascites, pregnancy hernia
Paraumbilical hernia (surg required)
190
Where is a spigaleon hernia?
Linea semiluminaris | Rare but high risk strangulation
191
Microcytic anaemia fl
<80fl
192
Normocytic anaemia fl
80-100fl
193
Microcytic anaemias - list
ID, thalassaemia (ACD can be)
194
Normocyctic anaemias list em
ACD, BM failure, bloodloss, aplastic anaemia
195
Macrocytic anaemias - list
Megaloblastic - b12/folate | Non megaloblastic - alcohol, haemolysis
196
Low ferritin, poikilocytes, anisocytosis
ID anaemia
197
Normal/high ferritin anaemia
ACD (ferritin is an Acute phase protein)
198
Dec Hb, dec platelets, dec wcc, dec reticulocytes anaemia
Aplastic anaemia. Hypocellular marrow
199
Hypersegmented neutrophils, peripheral neuropathy
B12 def
200
Hypersegmented + alcoholics
Folate def anaemia
201
Mothballs, fava beans, heinz bodies
G6p-Def
202
Coombs +ve/antiglobulin +ve, direct antiglobulin testing
A/i haemolytic anaemia Warm abs = sle and lymphoma Cold abs = lymphomas
203
Schistocytes and reticulocytes anaemia
MAHA - HUS TTP DIC | Fibrin strands cause cell lysis
204
Increased bilirubin, hepatomegaly and splenomegaly are signs of what type of anaemia
Haemolytic
205
MAHA, Acute RF, thrombocytopenia, normal clotting times
HUS
206
HUS + fever + CNS signs
TTP
207
A/bs against Adamts13
TTP
208
Target cells, inc reticulocytes
Thalassaemia
209
Howell jolly bodies
Sickle cell
210
Low hb, low plts, variable WCC, gum swelling, headaches, auer rods and black sudan.
AML
211
Philadelphia 9,22, inc WCC, inc basophils, neutrophils, eosinophils
CML
212
Dec Hb, dec platelets, variable WCC, lymphoblasts, dec neutrophils, children
ALL
213
Asymptomatic, smudge and smear cells, increased lymphocytes, sweats, tiredness, increased infections
CLL
214
Reen sternburg, EBV linked, painless mass in neck, dec hb, dec lymphocytes, variable wcc, inc neutrophils, B = WL, night sweats, fever
Hodgkins
215
Hepato-splenomegaly (rather than just spleno), skin rash, painless enlarging mass, anaemia, thrombocytopenia, neutropenia
Non-hodg lymphoma.
216
CRABS MM
Calcium up, renal failure, anaemia, bone pain. | Inc ESR and CRP
217
Bence-jones proteins (urine), rouleaux, giant plasma cells in aspirate
Multiple myeloma
218
Pancytopenia, hypocellular bone marrow, rigid sideroblasts
Myelodysplasia
219
Pancytopenia, teardrop RBCs, DRY aspiration, trephine biopsy
Myelofibrosis
220
Jak2V617f
Polycythaemia rubra vera
221
Inc HB, inc HCT, dec MCV, inc platelets, inc WCC, dec erythropoetin
Polycythaemia rubra vera [primary]
222
Inc HB, inc HCT, dec MCV, inc platelets, inc WCC, inc erythropoetin
Secondary polycythaemia rubra vera
223
Itchy legs after shower, plethora face, night sweats
Polycythaemia
224
APTT
Intrinsic
225
PT
Extrinsic PeT
226
Isolated thrombocytopenia
ITP
227
Dec plts, dec hb, inc APTT PT, dec fibrinogen, inc fib deg products
DIC
228
Inc APTT normal PT haematomas
Haemophilia
229
Inc iron, ferritin, to sat, deranged LFTs
Haemochromatosis

Sdpeh (50 decks)

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