Medicine Flashcards
(92 cards)
1
Q
name this microbe
A
plasmodium falciparum
(female anopheles is the vector)
2
Q
management of uncomplicated p.falciparum infection (malaria)
A
all patients with falciparum malaria should be admitted to hospital for the first 24 hours - even semi-immune patients may worsen quickly
- artemisinin combination therapy (ACT).
or
- quinine with doxycycline
3
Q
management of non-p.falciparum infection
A
oral artemisinin combination therapy (ACT) or chloroquine (nasty side effects)
4
Q
management of complicated p.falciparum infection
A
intravenous artesunate
if not available IV quinine (needs to be carefully monitored for hypoglycaemia)
5
Q
gram positive bacteria are
A
purple
6
Q
gram negative bacteria are
A
pink
7
Q
name gram positive cocci
A
Staphyloccocus areus
Staphyloccocus epidermis
Streptococcus pneumonia
8
Q
name gram positive rods
A
clostridium difficile
listeria monocytogenes
9
Q
name gram negative cocci
A
neisseria gonorrhoa
neisseria meningiditis
10
Q
name gram negative rods
A
E.coli
salmonella typhi
klebsiella pneumonia
11
Q
Janet is a 30-year-old woman who has a routine urine culture sent at her midwife appointment. She is asymptomatic but has had a history of post-coital cystitis in the past. Janet is currently 10 weeks pregnant.
The urine culture comes back showing the growth of Escherichia coli .
What is the next step in managing this patient?
A
treat with 7 days nitrofurantoin
(trimethoprim is teratogenic in first trimester)
12
Q
management of MI
A
MONA
M-Morphine
Oxygen (<92%)
N-Nitrate
A- Aspirin
BATMAN
B – Beta-blockers unless contraindicated
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative if higher bleeding risk)
M – Morphine titrated to control pain
A – Anticoagulant: Fondaparinux (unless high bleeding risk)
N – Nitrates (e.g. GTN) to relieve coronary artery spasm
Give oxygen only if their oxygen saturations are dropping (i.e. <95%).
13
Q
antiplatelets used in acute MI
A
Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative if higher bleeding risk)
14
Q
name the DOAC
A
Apixiban- Xa
Dabigatron - IIa
Rivaroxaban- Xa
Edoxaban- Xa
15
Q
when are DOAC used
A
Stroke prevention in non-valvular atrial fibrillation (NVAF)
Treatment of deep vein thrombosis and pulmonary embolism
Prevention of recurrent deep vein thrombosis and pulmonary embolism
16
Q
needle decompression vs chest drain in pneumothorax
A
Needle thoracostomy is indicated for emergent decompression of suspected tension pneumothorax.
Drain thoracotomy is indicated after needle thoracostomy, for simple pneumothorax, traumatic hemothorax, or large pleural effusions with evidence of respiratory compromise.
17
Q
during A-E if patient hypoxic (<94%) give
A
15l of oxygen via a non-rebreathe mask
18
Q
normal urine output
A
0.5 ml/kg/hr
<0.5 ml/kg/hr defines decreased urine output.
19
Q
what sort of cannula in an emergency situation
A
2 wide bore cannulas
>bigger than grey
21
Q
where do diuretics work on the nephron
A
22
Q
A 17-year-old female presents to the emergency department feeling generally unwell. The team decides to perform an arterial blood gas (ABG) that shows the following results:
Which of the following could be a cause of the patient’s arterial blood gas results?
A
need to calculate anion gap! (normal is between 10-14mmol/L)
acidosis and the only causes of it from the options is diarrhoea.
The anion gap is calculated by: (sodium + potassium) - (bicarbonate + chloride). A normal anion gap is 10-18 mmol/L. In this case, the anion gap is 13 mmol/L.
Diabetic ketoacidosis and salicylates poisoning cause raised anion gap metabolic acidosis. This happens because there is gaining of strong acid.
Primary hyperaldosteronism causes metabolic alkalosis, by retaining more sodium and excreting more potassium. As a consequence, more hydrogen ions will be expelled, causing alkalosis.
Vomiting causes metabolic alkalosis via the loss of hydrogen ions from the stomach contents.
23
Q
A 5-year-old boy presents with puffiness around his eyes and fatigue. His mum also reports that he has developed dark urine, and has been passing urine less frequently than usual. He is otherwise well, however his mum tells you he did have a crusty lesion above his lip a few weeks ago that was treated with antibiotics.
On examination, he appears comfortable. He has mild oedema affecting the feet and hands, and some peri-orbital oedema. His observations are stable, other than a raised blood pressure reading of 130/80 mmHg.
Urinalysis shows:
What is the most likely diagnosis based on this information?
A
Post-streptococcal glomerulonephritis is the correct answer here. The patient presents with periorbital oedema, oliguria, proteinuria and haematuria after impetigo. This is classical of post-streptococcal glomerulonephritis, which tends to occur 1-3 weeks following an upper respiratory tract infection (URTI), and 3-6 weeks following a skin infection.
24
Q
diabetic retinopathy signs
A
small vessels are damaged- ischaemia or retina
- Abnormality in microvasculature- dot to blot haemorrhage
- If in macula → maculopathy→ loss of central vision
25
treatment for DKA
**Immediate management upon diagnosis: hour 1**
* IV 0.9% sodium chloride with potassium added
* fixed rate intravenous insulin infusion (FRIII) 0.1 units per kilogram body weight
* hourly BG monitoring
26
cushings syndrome vs cushings disease
***Cushing’s Syndrome*** is used to refer to the signs and symptoms that develop after **prolonged abnormal elevation of cortisol**. ***Cushing’s Disease*** is used to refer to the specific condition where a ***pituitary adenoma*** (tumour) secretes excessive ***ACTH. Cushing’s Disease*** causes a ***Cushing’s syndrome***, but ***Cushing’s Syndrome*** is not always caused by ***Cushing’s Disease***.
27
hypercalcaemia with low PTH is
* Malignancy must be excluded in all cases of hypercalcaemia where PTH is suppressed. (i.e. homestasis of calcium is still working because PTH is suppressed because calcium is high)
* bone cancer
* Hypercalcaemia with a low PTH may also be seen in benign granulomatous disease such as TB or sarcoidosis.
28
**Hypercalcaemia with non-suppressed PTH – primary hyper PTH until proved otherwise**
* When PTH is elevated or in the upper part of the normal range, malignancy is unlikely.
* The usual cause is primary hyperparathyroidism which is most commonly due to a single **parathyroid adenoma- US**
* **US**
* **SETAMIBI isotope scanning**
29
management of hyperkalaemia
* calcium gluconate- stabilises myocardium
* insulin dextrose (draws potassium back into cells)
* calcium resonium- potassium excreted in stool
30
**Pheochromocytoma and paraganglioma management**
* Alpha blockade- phenoxybenzamine
* Always do alpha-block before b-block
* B blockade- bisoprolol
* Surgical excision
* Perioperative management
* Specialist anaesthetic team
* Risk of crisis during operation
* Maximal vasodilation and filling with IV fluids
31
hyperaldosteronism blood tests
hypertension, hypernatraemia, and hypokalemia
32
primary hyperaldosteronism treatment
spironolactone (aldosterone antagonist)
33
A 37-year-old man presents with unexplained weight gain over the last 6 months as well as low energy and irritability over the last 1 month.
On physical examination the patient has significant truncal obesity, a rounded face, a dorso-cervical hump as well as abdominal striation.
What is the most common endogenous cause of this clinical presentation?
The most common **endogenous** cause of Cushing’s syndrome is a pituitary adenoma (also known as Cushing's disease)
**exogenous cause-** glucocorticoids
34
A 55-year-old man with type 2 diabetes is brought to the practice by his partner for acting strangely and is acutely confused on questioning. He was recently started on insulin therapy for his diabetes. His observations are quickly taken:
* Blood pressure 145/87 mmHg
* Heart rate 110 beats per minute
* Temperature 37.2ºC
* Oxygen saturation 99% on room air
* Respiratory rate 18 breaths per minute
* Capillary blood sugar level 2.1 mmol/L
What is the most appropriate management of this patient?
if the patient is conscious and able to swallow the first-line treatment is a fast-acting carbohydrate by mouth i.e.. glucose liquids, tablets or gels
if unconscious- IV glucose
35
Over-replacement with thyroxine increases the risk for
osteoporosis
36
A 54-year-old woman attends her regular diabetes outpatient appointment. Due to her poor diabetic control despite taking several anti-diabetic medications, the endocrinologist decides to prescribe lifelong regular insulin. The patient drives a regular car for non-commercial purposes.
What advice regarding driving should the endocrinologist provide?
Insulin-dependent diabetics must check their blood glucose every 2 hours whilst driving
37
A 37-year-old presents to the GP for follow-up after a viral asthma exacerbation. He has been prescribed 7 days prednisolone 40mg alongside his salbutamol inhaler. Today is his last day of treatment.
The patient denies any wheeze or chest tightness but does still have a very occasional dry cough. His chest is clear to auscultate, his saturations are 97% and his respiratory rate is 16 breaths per minute.
The patient has no other medical history, takes no other medications and has never required prednisolone before.
What is the next appropriate step once he has taken the last prednisolone dose?
prednisolone can be stopped without weaning
The BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
* received more than 40mg prednisolone daily for more than one week
* received more than 3 weeks of treatment
* recently received repeated courses
38
A 45-year-old woman presents to her GP with 2 weeks history of feeling constantly weak. She has noticed that she now struggles with climbing stairs and combing her hair.
Her past medical history includes poorly controlled type-2 diabetes and a recent admission for severe pneumonia, in which she was started on a reducing course of steroids.
Observations are normal. Examination reveals bilateral reduced power of the shoulders, biceps and hip flexors/extensors. Tone, sensation, reflexes and cranial nerves are normal, with no fatiguability of speech.
What is the most likely cause of her weakness?
proximal myopathy
**Proximal myopathy** is correct. This patient is complaining of a proximal muscle weakness that matches a proximal myopathy. The prolonged course of steroids could be causing this.
39
A 45-year-old man presents to the emergency department. He describes severe muscle cramps for the past day, alongside muscle weakness and aching. He is currently experiencing homelessness.
On examination, he has central obesity, a round puffy face, and visible striae on his abdomen. He has a heart rate of 82/min, a respiratory rate of 12/min, a blood pressure of 190/85 mmHg, a temperature of 37.2ºC and saturations of 99%.
A diagnosis of Cushing's syndrome is suspected and a plasma cortisol level is sent off. Along with other blood tests, a venous blood gas is taken.
What would be expected to be seen on his blood gas?
Cushing's syndrome - hypokalaemic metabolic alkalosis
This man presents with an initially confusing set of symptoms. He has cushingoid features on examination, including central obesity, 'moon facies' and abdominal striae. His profound hypertension also is in keeping with a diagnosis of Cushing's syndrome. The high cortisol levels seen can exhibit mineralocorticoid (aldosterone) activity causing hypertension. Similarly, this mineralocorticoid-like activity involves cortisol binding the Na+/K+ pump and causing hypokalaemia. This hypokalaemia would explain his symptoms of muscle weakness, tremor and cramping. The mineralocorticoid-like activity also leads to the excretion of hydrogen ions in the renal tubules, with bicarbonate being retained, leading to metabolic alkalosis. Therefore, the correct answer is a **hypokalaemic metabolic alkalosis**.
40
blood test results of addisons
hyponatraemia
hyperkalaemia
41
A 19-year-old man presents to his GP with some concerns regarding his appearance. He has been going to the gym recently, but despite his efforts has found it very difficult to build muscle and bulk up. He has always been tall and slim and is not yet able to grow facial hair.
His blood results show the following:
## Footnote
FSH11.2 IU/L(1 - 7)LH12.6 IU/L(1 - 8)Serum total testosterone182 nanograms/dL(\>300)
Which of the following is the most likely diagnosis?
Klinefelter's syndrome causes high LH and low testosterone
This scenario describes a case of primary hypogonadism. Hypogonadism is suggested by the lack of secondary sexual characteristics that this patient reports (e.g. slim build; difficulty growing facial hair).
Primary hypogonadism would cause a low testosterone level due to testicular failure, which would, in turn, cause a high FSH and LH due to a lack of negative feedback. Conversely, secondary hypogonadism is caused by decreased levels of the gonadotrophins FSH and LH.
42
rate of fixed insulin infusion for DKA
Diabetic ketoacidosis: the IV insulin infusion should be started at 0.1 unit/kg/hour
43
A 45-year-old male is investigated for polyuria. A water deprivation test is done to ascertain the cause.
Water deprivation started at 8 am.
## Footnote
Based on the presumed diagnosis, what feature is this patient most likely to have in their past medical history?
recent transsphenodal pituitary surgery
Water deprivation test: cranial DI
* urine osmolality after fluid deprivation: low
* urine osmolality after desmopressin: high
44
what is associated with nephrogenic diabetes inspidus
Concurrent lithium use is relevant for nephrogenic diabetes insipidus.
45
You see a 42 year-old gentleman who presents feeling tired all the time. You ask if he has been on holiday because he appears tanned, but he says he has not been in the sun. On examination the palmar creases and buccal mucosa show pigmentation. What underlying condition might cause this presentation?
Addison's disease is primary adrenocorticoid deficiency. It often presents insidiously with vague symptoms such as tiredness. Hyperpigmentation, characteristically involving the skin creases, buccal mucosa and scars is a common feature.
**why?**
This occurs because adrenocorticotropic hormone (ACTH), the hormone produced by the pituitary to stimulate the adrenals to produce steroid hormones, has the same precursor molecule as melanocyte-stimulating hormone (MSH), so increased production of ACTH has the side effect of raising MSH levels.
46
A woman presents to her GP with a painful neck, rapid heartbeat, palpitations and feeling warm. A couple of weeks ago, she experienced general malaise and fever and suspected she had influenza - this has since resolved. She is otherwise healthy and takes no regular medications.
On examination, she is tachycardic. A goitre is palpable in the neck and elicits pain when examined. Blood tests are taken:
naproxen
## Footnote
Thyrotoxicosis with tender goitre = subacute **(De Quervain's) thyroiditis**
[t](https://www.passmedicine.com/question/questions.php?q=0#)
The correct answer is naproxen. The diagnosis here is that of subacute (De Quervain's) thyroiditis, given the history of following a viral illness, raised ESR, tender goitre and initial hyperthyroid phase. Ultimately, this condition is usually self-limiting, and simple analgesia is all that is required.
47
**De Quervain's thyroiditis**
a viral illness, raised ESR, tender goitre and initial hyperthyroid phase. Ultimately, this condition is usually self-limiting, and simple analgesia is all that is required.
48
A 23-year-old man is diagnosed as having type 1 diabetes mellitus after presenting with diabetic ketoacidosis. His blood sugars are now stable and he is well. What is the first-line insulin regime he should be offered?
[Basal–bolus insulin regimen with twice-daily insulin detemir](https://www.passmedicine.com/question/questions.php?q=0#)
## Footnote
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a basal–bolus using twice‑daily insulin detemir
49
A 65-year-old man with type 2 diabetes attends his annual diabetic review. His blood glucose control has been very poor and he is about to be started on insulin. Which of the following should be given to this man when he receives his insulin?
Every person treated with insulin should have a glucagon kit for emergencies
50
A 65-year-old man with type 2 diabetes attends his annual diabetic review. His blood glucose control has been very poor and he is about to be started on insulin. Which of the following should be given to this man when he receives his insulin?
Every person treated with insulin should have a glucagon kit for emergencies
51
A 42-year-old non-binary patient is referred to the endocrinology department after presenting to their urgent care centre with a 3-month history of bilateral lower limb oedema, lethargy, muscle weakness, and pleuritic chest pain. They have a 24-pack-year smoking history, drink 2 bottles of wine per week, and take no recreational drugs. A chest x-ray at the urgent care centre shows a mass lesion in the right hilum. During the follow-up, their endocrinologist ordered a high-dose dexamethasone suppression test.
What would be the likely result of this test, given the patient's symptoms and primary investigation findings?
High-dose dexamethasone suppression test with an ectopic source of ACTH
* Cortisol: not suppressed
* ACTH: not suppressed
52
management of variceal bleeding
Q
* Initial action: Fluid resuscitation if haemodynamically compromised (followed by blood)
* IV Terlipressin AND IV antibiotics
* Definitive treatment: endoscopic banding
A
Variceal bleeding is a medical emergency and most often presents with fresh
haematemesis +/- melaena.
* Initial action: gain IV access. Fluid resuscitation if haemodynamically compromised (followed by blood) but remember the systolic blood pressure is often low in patients with cirrhosis
* Prescription: IV Terlipressin (if no ischaemic heart disease or peripheral vascular disease) AND IV antibiotics
* Definitive treatment: refer urgently to the GI team for Upper GI endoscopy
53
management of peptic ulcer bleed
* Initial action: . Fluid resuscitation if haemodynamically compromised (followed by blood)
* Prescription: there is no evidence for giving PPI before the endoscopy
* Definitive treatment: If the bleeding cannot be stopped by endoscopy, radiological embolization or surgery may be possible.
The Endoscopist will advise on the need for any medications (such as PPI to treat ulcers) after the endoscopy.
54
Rockall vs blatchford score
Rockall- risk of death and rebleeding from an upper GI bleed
Blatchford- Predicts need for intervention (blood transfusion or therapeutic endoscopy) - requires bloods tests
55
summarise re-feeding syndrome
1. during starvation insulin stops being secreted and electrolytes and thiamine become very deficient
2. when re-feeding starts insulin is produced- this causes ions like phosphate, magnesium, thiamine and potassium to be pumped back into the cell → process uses ATP which further reduces levels of phosphate
3. As a result the phosphate stores become further depleted and the corresponding fluid shift causes oedema and organ dysfunction
* The hypophosphataemia reduces the production of ATP and impairs function of cardiac muscle
* In addition 2,3-DGP is reduced in red cells and this decreases the ability of red cells to deliver oxygen to tissues
* The combined effect of fluid shifts, reduced tissue oxygenation and impaired cardiac function is potentially catastrophic.
56
**Prevention of refeeding**
* Reintroduction of diet should be very slow
* 5-10kcal/kg/day
* IV Phosphate infusion
* Parenteral multivitamins
* Phosphate magnesium and potassium levels monitored
57
assessing the severity of a patient with liver cirrhosis
Child-Pugh classification
A - albumin
B - bilirubin
C - clotting
D - distention (ascites)
E - encephalopathy
58
A 25-year-old man presents to his GP with a history of watery diarrhoea for several days. Last week the patient had taken IM ceftriaxone for gonorrhoea. There has been no recent travel and his diet has remained unchanged. This is the first time the patient has experienced diarrhoea in his lifetime. The GP carried out some investigations which revealed the following:
positive for C.difficile
## Footnote
What is the most appropriate course of action?
oral vancomycin
59
prophylaxis for high risk oesophageal varices
B-blockers- propanolol
60
A 44-year-old man presents to the emergency department with a 24 hour history of haematemesis and haematochezia. The patient has known alcohol-related liver cirrhosis.
The patient is alert, pale and clammy. His observations show a heart rate of 132/min, blood pressure of 85/45 mmHg, oxygen saturation of 97% on room air and a respiratory rate of 17/min. Physical examination shows hepatomegaly and no other significant findings are noted.
Once the patient is haemodynamically stable, the patient is sent for endoscopy as you suspect variceal haemorrhage.
What must be administered before endoscopy?
terlipressin +- IV antibiotics
61
markers for autoimmune hepatitis
anti-nuclear antibodies
smooth muscle antibodies
treatment: steroids
62
A 19-year-old man is referred to the general medical clinic. For the past six months his family have noted increasing behavioural and speech problems. He himself has noticed that he is more clumsy than normal and reports excessive salivation. His older brother died of liver disease. Given the likely underlying condition what is the most appropriate therapy?
Treatment for Wilson's disease is currently **penicillamine (chelates copper)**
63
A 45-year-old woman was commenced on treatment for a tuberculosis infection, 3 months ago. She has since developed a burning sensation at the base of her feet.
Which of the following medications may have caused this new 'burning sensation'?
Isoniazid therapy can cause a vitamin B6 deficiency causing peripheral neuropathy
64
In life-threatening *Clostridium difficile* infection treatment is
with ORAL vancomycin and IV metronidazole
65
A 40-year-old female presents to her GP with a 6-week history of epigastric pain. This is described as a sharp pain associated with nausea and typically comes on within minutes of eating. Her bowel habit and stools were normal. Physical examination was unremarkable.
Which of the following is the most likely diagnosis?
Gastric ulcers cause pain when, or shortly after, eating
Hydrochloric acid secretion in the stomach is triggered by receptors in the gustatory centre in the brain and mouth when food is detected. The acid only reaches the duodenum and causes irritation later on when the digested food travels there.
66
Primary biliary cirrhosis is most characteristically associated with which antibodies
anti-mitochondrial antibodies
67
Primary biliary cirrhosis is most characteristically associated with which disease
ulcerative colitis
68
The AST/ALT ratio in alcoholic hepatitis is
2:1
69
A 15-year-old boy presents to his general practitioner with a 4-month history of a growing lump on the posterior aspect of his right thigh, which has become extremely painful over the last two weeks. A radiograph is ordered, which identifies a lytic lesion in the diaphysis of the right femur with an 'onion skin' appearance.
What is the most likely diagnosis?
Ewings sarcoma
malignant tumour that occurs most frequently in the diaphysis of the pelvis and long bones
70
A 70-year-old woman has had jaw pain and trouble chewing for the last 2 months. She feels like her 'jaw is heavy'. There is no clicking or locking of her jaw and there is no scalp tenderness or changes to her vision. Her past medical history consists of well-controlled polymyalgia rheumatica and depression. She remembers a medical student explaining that this could be a side effect of one of her drugs. She takes vitamin D supplements, calcium supplements, prednisolone, alendronic acid, and sertraline.
What is the most likely cause of her symptoms?
Bisphosphonates can cause osteonecrosis of the jaw
71
A 45-year-old woman presents to the rheumatology clinic because of poorly controlled rheumatoid arthritis. She has a five-year history of swollen, painful joints in her hands and feet, especially her metacarpophalangeal joints. They are stiff and painful in the morning and the pain improves with usage throughout the day.
She already tried methotrexate and sulfasalazine and they both have been unsuccessful treatments. The doctor decides to put her on a trial of TNF-inhibitors.
Which one of the following would you perform before the commencement of treatment?
X-ray to look for latent TB
biologics can cause reactivation
72
A 48-year-old male presents to his GP with bone pain for the past few weeks. He has also had a reduction in his hearing recently. His blood results show an isolated rise in alkaline phosphate.
Given the likely diagnosis, which bone is most likely to be in pain?
Paget's disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities
It is easy to remember which bones are most commonly affected by Paget's disease by drawing an imaginary line down the centre of a patient. The bones covered are the skull, vertebral bones and pelvis. Along with the femur and tibia, these are the most commonly affected bones by Paget's disease.
73
blood test for renal pathology
FBC
U and E
LFTs - esp albumin
Bone profile (calcium and phosphate)
HbA1c
eGFR
Anion gap
74
urine test for renal pathology
* Urine dipstick: WCC, blood, protein, nitrayr
* infection/ malignancy
* Urine MSU
* albumin: creatinine ratio
75
A 42-year-old man with polyuria undergoes investigation. His results are as follows:
## Footnote
Urine Osmolality before tests285 mOsm/kg \* 109/lAfter water deprivation test283 mOsm/kg \* 109/lAfter exogenous anti-diuretic hormone (ADH)290 mOsm/kg \* 109/l
Which of the following medications may cause this picture?
Lithium is a recognised cause of nephrogenic diabetes insipidus
76
diabetes inspidius investigation findings
* high plasma osmolality, low urine osmolality
* a urine osmolality of \>700 mOsm/kg excludes diabetes insipidus
* water deprivation test
cranial: urine osmolality will increase after desmopressin
nephrogenic: urine osmolality will not change
77
treatment of cranial diabetes insipidus
desmopressin
78
treatment of nephrogenic diabetes insipidus
thiazides, low salt/protein diet
79
You see a 60-year-old woman who recently had urea and electrolytes performed as part of a medication review. You also have previous from 4 months ago to compare with. She has a history of hypertension and takes ramipril. On examination, her blood pressure is 135/80mmHg.
All patients with chronic kidney disease should be started on a statin
80
A 40-year-old woman presents to her GP, anxious to be 'checked out' because her older brother recently passed away from a haemorrhagic stroke. She was told that his autopsy showed cerebral aneurysmal rupture. The patient is well currently, with no fever, weight loss, headache or dysuria but has been treated for recurrent urinary tract infections (UTIs) over the past 3 years. Her father had a history of chronic kidney disease (CKD) and passed away from a stroke at age 65.
What is the most appropriate investigation for diagnosis of this patient's condition?
renal USS best diagnosis for adult polycystic kidney disease
81
how can CKD cause mineral bone disease
The high phosphate levels in chronic kidney disease (CKD) patients 'drags' calcium from the bones, resulting in osteomalacia.
Alendronic acid is a bisphosphonate that reduces the rate of bone turnover and strengthens the bone.
**remember:** CKD patients usually have low levels of calcium due to lack of vitamin D and high phosphate.
82
While working on a paediatrics ward as a junior doctor you are looking after 2-year-old boy with X-linked nephrogenic diabetes insipidus. He was recently diagnosed after his parents noticed that he was experiencing excessive polydipsia and polyuria. What is the pharmacological treatment of choice in this condition from the list below?
chlorthiazide
83
A 3-year-old, originally presented with persistent haematuria, undergoes a renal biopsy showing splitting on the lamina densa resulting in an abnormal glomerular-basement membrane.
Whilst under investigation, the child develops swallowing issues and a recurrent cough. CT chest showed the presence of oesophagus and tracheobronchial leiomyomatosis.
A potential genetic cause is suspect and testing identifies an X-linked dominant inherited protein defect, confirming the syndrome responsible for the child issues.
What other feature is most associated with this child’s likely syndrome?
Alports syndrome- sensinoneural hearing loss
progressive renal failure secondary to glomerular-basement membrane abnormality and **sensorineural hearing loss**. Other features of the syndrome include ocular issues, smooth muscle tumours (leiomyomas) and rarely aortic dissection.
84
A 76-year-old woman with a history of stage 3 chronic kidney disease presents with worsening anaemia. As a result, she is started on erythropoietin.
Which of the following side effects is she most likely to experience?
skin rash
bone ache
flu like symptoms
85
A 25-year-old woman with a history of end-stage renal disease secondary to focal segmental glomerulosclerosis presents to the Emergency Department. For the past 12 months she has used Continuous Ambulatory Peritoneal Dialysis (CAPD). She feels generally unwell with abdominal pain and a fever. She also describes her last bag as being 'cloudy'. Which organism is most likely to be responsible for this presentation?
staphylococcus epidermis
86
most common cause of surgical wound infection
staphylococcus epidermis
87
most common cause of haemolytic uraemic syndrome
E.coli
example presentation: A 14-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days.
88
Causes of transient or spurious non-visible haematuria
* urinary tract infection
* menstruation
* vigorous exercise (this normally settles after around 3 days)
* sexual intercourse
89
A 54-year-old man presents with a 1-month history of a painful lesion on his forehead. He feels the lesion has grown in size over the past month. His past medical history includes a renal transplant six years ago due to autosomal dominant polycystic kidney disease (ADPCKD). He is currently taking tacrolimus, mycophenolate mofetil, and prednisolone. On examination, there is a two-cm, firm, keratotic nodule on the right side of his forehead.
What is the most appropriate management of the lesion?
surgical excision and biopsy
Patients who have received an organ transplant are at risk of skin cancer (particularly squamous cell carcinoma) due to long-term use of immunosuppressants
90
You are a doctor on the acute medical ward. One of your patients is a 25-year-old man who is being treated for paracetamol poisoning. Your senior asks you to order some blood tests to assess the severity of his condition, particularly if there is any evidence of acute liver failure.
Which one of the following results would most support this diagnosis?
Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure
91
A 45-year-old man presents to the Emergency Department with a 3 week history of increasing abdominal pain and diarrhoea. The pain is described as diffuse and is 6/10 in severity. He is now passing around 5 loose, non-bloody stools per day.
His past medical history includes lower back pain for which he takes regular ibuprofen.
## Footnote
An abdominal film is requested:
The abdominal x-ray is consistent a diagnosis of ulcerative colitis showing lead pipe appearance of the colon (red arrows).
92
How many units of alcohol are in a 750ml bottle of red wine with an alcohol by volume of 12%?
9 units
Alcohol units = volume (ml) x ABV (%) / 1,000
