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Flashcards in Meeran Deck (560)
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1

A gram negative intracellular diplococcus that causes meningitis

Neisseria or Neisseria Meningitides

2

A gram positive diplococcus that causes pneumonia

Pneumococcus or streptococcus pneumoniae

3

A gram positive organism that grows in bunches and causes abscesses

Staphylococcus Aureus

4

The organism that causes tetanus

Clostridium tetanae

5

A gram negative rod that commonly causes urinary tract infections

E-coli

6

Cystic dilatation of duct during lactation caused by obstruction

duct ectasia

mammary duct ectasia

fibroadenoma

mastitis

fibrocystic change

galactocoele

galactorrhoea

gynaecomastia

intraductal papilloma

lactating adenoma

galactocoele

7

Infection of the breast that occurs during lactation

duct ectasia

mammary duct ectasia

fibroadenoma

mastitis

fibrocystic change

galactocoele

galactorrhoea

gynaecomastia

intraductal papilloma

lactating adenoma

mastitis

8

Occurs in males with liver disease

duct ectasia

mammary duct ectasia

fibroadenoma

mastitis

fibrocystic change

galactocoele

galactorrhoea

gynaecomastia

intraductal papilloma

lactating adenoma

gynaecomastia

9

Occurs in the presence of a high prolactin

duct ectasia

mammary duct ectasia

fibroadenoma

mastitis

fibrocystic change

galactocoele

galactorrhoea

gynaecomastia

intraductal papilloma

lactating adenoma

galactorrhoea

10

The commonest benign tumour of the female breast

duct ectasia

mammary duct ectasia

fibroadenoma

mastitis

fibrocystic change

galactocoele

galactorrhoea

gynaecomastia

intraductal papilloma

lactating adenoma

fibroadenoma

11

Causes an increased loss of HCO3-

Diabetic ketoacidosis
Intestinal fistula
Metabolic acidosis
Metabolic alkalosis
Poor lung perfusion
Pyloric stenosis
Renal failure
Respiratory acidosis
Respiratory alkalosis


Intestinal fistula

12

2. Causes increased H+ production
Diabetic ketoacidosis
Intestinal fistula
Metabolic acidosis
Metabolic alkalosis
Poor lung perfusion
Pyloric stenosis
Renal failure
Respiratory acidosis
Respiratory alkalosis

Diabetic ketoacidosis

13

3. Causes increased H+ loss
Diabetic ketoacidosis
Intestinal fistula
Metabolic acidosis
Metabolic alkalosis
Poor lung perfusion
Pyloric stenosis
Renal failure
Respiratory acidosis
Respiratory alkalosis

Pyloric stenosis

14

4. Can be compensated by increased renal excretion of H+
Diabetic ketoacidosis
Intestinal fistula
Metabolic acidosis
Metabolic alkalosis
Poor lung perfusion
Pyloric stenosis
Renal failure
Respiratory acidosis
Respiratory alkalosis

Metabolic acidosis

Be aware that compensation for a metabolic acidosis is with hyperventilation. Renal excretion (question 4) of acid is not really compensation, but just correcting the problem.

15

5. Can be compensated by hypoventilation
Diabetic ketoacidosis
Intestinal fistula
Metabolic acidosis
Metabolic alkalosis
Poor lung perfusion
Pyloric stenosis
Renal failure
Respiratory acidosis
Respiratory alkalosis

Metabolic alkalosis

Also although hypoventilation would compensate for a metabolic alkalosis, that effect is minimised in humans by hypoxia.

16

1. Gain in bicarbonate ions or loss of H+ ions resulting in raised pH.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis with Respiratory Compensation
Metabolic Alkalosis with Respiratory Compensation
Respiratory Acidosis with Metabolic Compensation
Respiratory Alkalosis with Metabolic Compensation

a. Metabolic Alkalosis

17

2. 24 year old female presents at A&E with a broken ankle. The interpretation of her blood gas results (pH 7.62, PCO2 3.59, PO2 14.1, HCO3 23, Base Excess 0) demonstrates a ____.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis with Respiratory Compensation
Metabolic Alkalosis with Respiratory Compensation
Respiratory Acidosis with Metabolic Compensation
Respiratory Alkalosis with Metabolic Compensation

a. Respiratory Alkalosis

18

3. 22 year old model is admitted to A&E with weakness and tingling sensations in both hands and feet, and “poor balance”. Patient denies pill ingestion but admits she has been on a strict diet regimen to meet her agency’s expectations. Her ABG results (pH 7.55, PCO2 6.67, PO2 12.0, HCO3 45) demonstrate ____.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis with Respiratory Compensation
Metabolic Alkalosis with Respiratory Compensation
Respiratory Acidosis with Metabolic Compensation
Respiratory Alkalosis with Metabolic Compensation

a. Metabolic Alkalosis

19

4. A 40 year old lady with severe chronic back pain (treated aggressively with OTC NSAIDs) for several years was found to have BP 155/95 at her routine GP visit. Her urine dipstick demonstrated ++ protein and increased white blood cells. Her ABG results (pH 7.30, PCO2 4.27, HCO3 15) demonstrate _____.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis with Respiratory Compensation
Metabolic Alkalosis with Respiratory Compensation
Respiratory Acidosis with Metabolic Compensation
Respiratory Alkalosis with Metabolic Compensation

a. Metabolic Acidosis with Respiratory Compensation

20

5. A 45 year old man with a history of solvent (inhalant) abuse presents to A&E complaining of dyspnoea (SPO2 99% on room air). He is tachypnoeic on examination and demonstrates Kussmaul breathing. His ABG (pH 6.95, PCO2 1.20, PO2 17.0, HCO3- 2) demonstrates ___.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis with Respiratory Compensation
Metabolic Alkalosis with Respiratory Compensation
Respiratory Acidosis with Metabolic Compensation
Respiratory Alkalosis with Metabolic Compensation

a. Metabolic acidosis with respiratory compensation

21

An elderly patient on the ward has RR 16, HR 65, temp 37.5 degrees C. His blood gases are pH 7.35 (7.35-7.45), pCO2 9.0 (4.7-6 kPa), pO2 8.1(10.0-13.3 kPa), HCO3 45 (22-30). Rank the underlying diseases below in order of likelihood, going from most to least likely:

Pulmonary embolism
Tension pneumothorax
COPD
Hyperventilation
Pneumonia

Answer:
1. COPD
2. Pneumonia
3. Pulmonary embolism
4. Tension pneumothorax
5. Hyperventilation

Explanation: this is a picture of respiratory acidosis with metabolic compensation. Hyperventilation would cause alkalosis so is least likely. A tension pneumothorax would not have time to establish compensation so is next least likely. The carbon dioxide is high and the oxygen is low so this is type 2 respiratory failure with no v/q mismatch. while a number of small PEs might result in compensation over time they would give a type 1 picture with low oxygen and normal carbon dioxide. Both pneumonia and COPD might give this blood gas picture but this patient's vital measurements show no sign of infection so COPD is most likely.

22

1. A 42 year old man with heartburn presents with the following blood gases: pH 7.51, pCO2 5.2kPa, bicarbonate = 30 mmol/l.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Compensated Respiratory Alkalosis
Compensated Respiratory Acidosis
Compensated Metabolic Alkalosis
Compensated Metabolic Acidosis
Type I Respiratory Failure
Type II Respiratory Failure

a. Metabolic Alkalosis

23

2. 65 year old long- term smoker is admitted with drowsiness and confusion. ABG reveals pH 7.36, pO2 7kPa, pCO2 8kPa, bicarbonate 24 mmol/l.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Compensated Respiratory Alkalosis
Compensated Respiratory Acidosis
Compensated Metabolic Alkalosis
Compensated Metabolic Acidosis
Type I Respiratory Failure
Type II Respiratory Failure

a. Type II Respiratory Failure

24

3. Treat with IV sodium bicarbonate

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Compensated Respiratory Alkalosis
Compensated Respiratory Acidosis
Compensated Metabolic Alkalosis
Compensated Metabolic Acidosis
Type I Respiratory Failure
Type II Respiratory Failure

a. Metabolic Acidosis

25

4. 24 year old female presents with an aspirin overdose. She appears to be breathing heavily. pH 7.38, pO2 12kPa, pCO2 2.5kPa, bicarbonate 16 mmol/l.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Compensated Respiratory Alkalosis
Compensated Respiratory Acidosis
Compensated Metabolic Alkalosis
Compensated Metabolic Acidosis
Type I Respiratory Failure
Type II Respiratory Failure

a. Compensated Metabolic Acidosis

26

5. 55 year old male with difficulty breathing is diagnosed with Guillain- Barre syndrome. pH 7.25, pO2 12kPa, pCO2 9kPa, bicarbonate 25 mmol/l.

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Compensated Respiratory Alkalosis
Compensated Respiratory Acidosis
Compensated Metabolic Alkalosis
Compensated Metabolic Acidosis
Type I Respiratory Failure
Type II Respiratory Failure

a. Respiratory Acidosis

27

1. 22 year old man presents with a painless, red ulcer on his penis. Microscopy reveals spiral shaped organisms.

Benzylpenicillin
Ceftriaxone
Chloramphenicol
Clarithromycin
Colistin
Gentamicin
Intravenous
Meropenem
Moxifloxacin
Orally
Rifampicin
Trimethoprim
Vancomycin
Rectally

a. Benzylpenicillin

28

2. On a routine swab for a pre-op patient, the lab is able to culture Staphylococcus aureus. The lab also reports that this particular strain is not sensitive to Penicillins.

Benzylpenicillin
Ceftriaxone
Chloramphenicol
Clarithromycin
Colistin
Gentamicin
Intravenous
Meropenem
Moxifloxacin
Orally
Rifampicin
Trimethoprim
Vancomycin
Rectally

a. Vancomycin

29

3. The route of administration when administering Vancomycin to treat serious C.difficile infection.

Benzylpenicillin
Ceftriaxone
Chloramphenicol
Clarithromycin
Colistin
Gentamicin
Intravenous
Meropenem
Moxifloxacin
Orally
Rifampicin
Trimethoprim
Vancomycin
Rectally

a. Orally

30

4. This antibiotic which is usually administered as eye drops, can cause grey baby syndrome in neonates, because of an inability to metabolise the drug.

Benzylpenicillin
Ceftriaxone
Chloramphenicol
Clarithromycin
Colistin
Gentamicin
Intravenous
Meropenem
Moxifloxacin
Orally
Rifampicin
Trimethoprim
Vancomycin
Rectally

a. Chloramphenicol