PP2 Flashcards by Luc Worthington

Hypokalaemia effects

nephrogenic DI –> polyuria/ polydipsia

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ECG changes hypokalaemia

U waves, ST depression, flattened T waves, prolonged PR interval

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Microscopic Haematuria causes

NEPHRITIC SYNDROME/ Urinary tract calculi

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Macroscopic Haematuria causes

BLADDER CANCER

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Young person with Hypertension causes

Conn’s syndrome
Coarction of aorta
Renal artery stenosis

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Treatment of hyperkalaemia

1) 10ml 10% IV calcium gluconate = stabilise myocardium

2) IV insulin + glucose (nebulise salbutamol) = treat hyperkalaemia

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Drugs to avoid with AKI

aminoglycosides, NSAIDS, ACEi

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Criteria for haemodialysis

AEIOU
A = metabolic Acidosis
E = electrolytes = hyperkalaemia
I = intoxication = drug overdose
O = refractory pulmonary oedema (fluid overload)
U = uraemic complication (pericarditis, encaphalopathy)

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Pleuritic chest pain

5 Ps (PE, pneumothorax, pericarditis, pleural effusion, pneumonia) + abcess, rib fracture, costochondritis

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Hypertension treatment

after ABPM (ambulatory blood pressure monitoring) –> treatment
1) < 55 yrs = ACEi (enalopril) or ARB (losartan)
> 55 yrs/ afro = CCB (amlodipine) or Thiazide diuretic (bendroflumethiazide)
2) (ACEi + CCB) or (ACEi + thiazide diuretic)
3) ACEi + CCB + Thiazide diuretic
4) resistant HTN = spirinolactone

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Prostate cancer triad

backpain (bone metastasis), hypercalcaemia (paraneoplastic syndrome), FLAWS

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Investigations for Prostate Cancer

GOLD = transrectal US guided biopsy
Post-diagnosis = CT (local invasion + lymph nodes)
Isotope bone scan = bone metastases
Screening = PSA

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Diagnostic criteria for diabetes

• One fasting blood glucose measurement > 7 mmol/L in a symptomatic patient (2 asymptomatic)
patient
• One random blood glucose measurement > 11.1 mmol/L in a symptomatic
patient (2 asymptomatic)
• Oral glucose tolerance test – 2 hr blood glucose > 11.1 mmol/L
• HbA1c > 48 mmol/mol or > 6.5%

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Lewy body dementia (DLB) triad

hallucinations, confusion, resting tremor (parkinsonian sym)

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Epi of dementia

Alzheimers (1), DLB (2)

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Vascular dementia symptoms

Depressive pseudodementia symptoms

stroke like symptoms, stepwise decline

depression (trauma) –> dementia like symptoms

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What is the red reflex?
what is used to look at it?
what does it mean if you cannot see it?

reflextion of light from retina
fundoscope
obscuring retina = cataract (opacified lens) / retinoblastoma (cancer of retina cells)

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What is Herpes simplex keratitis

infection of cornea –> dendritic ulcer

adults with HSV

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Histological differences between:

Ulcerative Collitis
Crohn’s disease
Coeliac disease
barrets oesaphagus

UC: mucosal ulcers, goblet cell depletion, crypt abcesses
Cr: non-ceseating granulomas
Coeliac: villous atrophy + crypt hyperplasia
Barrets: stratified squamous –> simple columnar

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Polycthaemia (increased Hb conc.) types

Relative = normal RBC mass BUT decreased plasma volume

Absolute = increased RBC mass

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Symptoms of polycthaemia

Hyperviscoity (blurred vision, headache, hearing loss)

Pruritus (after hot bath) = scratch marks

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Causes of polycthaemia

Primary = low EPO =  Polycthaemia rubra vera (proliferation of myeloid stem cells)
Secondary = high EPO (natural - hypoxia/COPD, artificial - athletes/ blood dopping)

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what is subclavian steal syndrome

blackout due to stenosis (e.g. compression of rib, lump) of subclavian artery (comes off vertebral artery)
Retrograde blood flow back from brain down vertebral artery to arm (likely to occur when writing - increased demand)

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Nephrotic syndrome quartet

Study These Flashcards

proteinuria (>3.5g/24hr)
hypoalbuminaemia (<25g/L)
oedema
hyperlipidaemia

Causes of nephrotic syndrome

Primary renal disease = minimal change disease (kids), membranous nephropathy (adult) secondary to systemic disorder = SLE, amyloidosis

what is Guillian Barre syndrome

acute demyelinating polyneuropathy ascending symmetrical limb weakness --> incontinence loss of sensation

empirical antibiotics = co-amoxiclav + clarithromycin treat?

community acquired pneumonia (CAP) - co-amoxiclav (strep.pneumonia) - clarithromycin (atypical organisms)

Co-trimexazole (trimethoprim + sulfamethoxazole) treat?

pneumocystitis pneumonia in HIV pts UTIs Resp tract infections

Metronidazole treat?

against anaerobes severe GI infections (c. difficile colitis) pelvic inflammatory disease aspiration pneumonia

Flucloxacillin (type of penicillin) treat?

against gram +ve bacteria (s. aureus) | skin and soft tissue infection

what analgesic is used for post-op pain?

morphine sulphate

Side effects of morphine sulphate?

constipation --> confusion resp. depression nausea + drousyness

side effects of anti-muscarinics (atropine)?

blurred vision

side effects of ACEI (enalopril)?

cough

side effects of B-adrenoceptor agonist (salbutamol)?

tremor

side effects of ampicillin + amoxicillin (glandular fever)

rash

Gout (cause, place, investigation)

- monosodium urate crystals - metatarsopharyngeal joint of big toes (podagra) - synovial fluid aspirate --> polarised microscopy (negative befringement and needle shaped crystals)

Pseudogout (cause, place, investigation)

- calcium pyrophosphate crystals - knees + wrists - synovial fluid aspirate --> polarized microscopy (positive befringement and rhomboid shaped crystals)

Septic arthritis investigation

turbid synovial fluid and high WCC

what is Adrenal insufficiency?

low cortisol and low aldosterone by adrenal glands

causes of adrenal insufficiency

autoimmune (uk) | TB (worldwide)

adrenal insufficiency triad of symptoms?

increased skin pigmentation dark palmar creases vitiligo

investigation of adrenal insufficiency?

short Synacthen test (inject synthetic ACTH then see cortisol response) = <550nmol/l after 30 mins

Colorectal cancer triad of symptoms

change in bowel habit PR bleed weight loss ``` L = early = bowel habit + pr bleed R = late = abdo pain and anaemic symptoms ```

where is colorectal cancer

``` 1 = rectum 2 = sigmoid colon 3 = caecum ```

investigations of colorectal cancer

DRE (1st line) CEA Colonoscopy + biopsy (gold)

Gastric cancer triad symptoms

dyspepsia + vomitting early satiety + bloating melaenia

Pancreatic cancer + cholangiocarcinoma symptoms

courvoisier's law = painless jaundice + palpable gallbladder

cerebral artery blockages and consequences

ACA = medial frontal + parietal = behaviour change, weak contralateral leg > arm MCA = lateral frontal + parietal = weak contralateral face > arm > leg, aphasia PCA = occipital lobe = contralateral half of visual field loss

sodium, potassium and calcium levels

Na+ : 135-145 mmol/l K+ : 3.5-5 mmol/l Ca2+ : 2.2-2.6 mmol/l

Hyponatraemia symptoms

severe < 120 headache, nauseas, neuro-problesm, cerebral oedema high lipids can dilute the extracellular fluid = decrease apparent na conc. = erroneus reading

lung collapse signs on CXR

R upper lobe = golden S sign | L lower lobe = L tracheal deviation, second heart border, sail shape

Bowel obstruction cardinal signs

vomitting colicky pain constipation (absolute) abdo distention PMHx of surgery SB = vomit earlier than LB, pain high in abdo LB = less vomit, pain constant

Investigation of bowel obstruction

1st line = abdo XRAY = dilated loops | 3(SB)/6(LB)/9(Caecum) rule = normal dilation

Management of bowel obstruction

ABCDE Drip (IV) + Suck (NG - aspiration) Look for peritonism (strangulated/ perforated)

surgical indications of bowel obstruction

conservative tx not improve in 48hrs peritonism palpable mass virgin abdomen (no previous surgery)

Criteria for Congestive cardiac failure

Framingham criteria | 2 major/ 1 major + 2 minor

what is meralgia paraesthesia

wt gain/ tighten belts --> injure lateral femoral cutaneous nerve --> numb/ pain of skin outside thigh

what causes dilation and hypertrophy of heart

dilation (volume overload) = HF | hypertrophy (pressure overload) = HTN, aortic stenosis

PP2 Flashcards

(59 cards)