questions Flashcards
Requirements for maintenance fluids.
In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis
Routine maintenance IV fluids
Body weight Fluid requirement/24 h
First 10 kg 100 ml/kg
Second 10 kg 50 ml/kg
Subsequent kg 20 ml/kg
How to test for diabetic kidney disease
Microalbuminuria is the first indicator of diabetic nephropathy. Albumin/creatinine ratio should be used to screen for diabetic kidney disease. If results are abnormal then repeat with first-pass morning urine specimen.
ACR has a higher sensitivity than PCR for low levels of proteinuria. If abnormal then monitor BP and control it, tight glycemic control, control dyslipidemia.
Hypoglycaemics for breastfeeding
Sulfonlyureas/gliclazide should be avoided when breastfeeding due to theoretical risk of neonatal hypoglycaemia.
Metformin is safe.
Trigeminal neuralgia
Severe unilateral pain. Pain brought on by light tough, including washing, shaving, smoking, talking and brush the teeth. Pain occurs spontaneously.
Management is carbamazepine.
Red flag symptoms: sensory changes, deafness, optic neuritis, FH of MS, <40yrs
Normal pressure hydrocephalus
Triad: ataxia, urinary incontinence, and dementia.
reversible cause of dementia seen in elderly patients. Secondary to reduced CSF absorption at arachnoid villi.
Managed with ventriculoperitoneal shunting - around 10% of patients may experience complications such as seizures, infections and ICH
Huntington’s - dominant or recessive?
autosomal dominant
VWD von willebrand
Prolonged bleeding time, normal platelet count, prolonged APTT.
Autosomal dominant.
Factor VIII may be moderately reduced.
Managed with tranexamic acid for mild bleeding, desmopressin, factor VIII concentrate
Chest X-Ray - white shadowing
trachea towards white out: pneumonectomy, complete lung collapse, pulmonary hypoplasia
trachea central: consolidatorn, bilateral pulmonary odemea, mesothelioma
trachea pushed away: pleural effusion, diaphragmatic hernia, large thoracic mass
Carbimazole
Used to treat hyperthyroidism. Carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4.
Hypothyroidism Management
SE of thyroxine therapy: hyperthyroidism, reduced bone mineral density, worsening of angina, AF
Interacts with iron given at least 2 hrs apart.
SE of SGLT2 inhibitors
genital infections, diabetic ketoacidosis
SE biguanides e.g. metformin
GI upset, lactic acidosis
SE of GLP-1 mimetics
nausea, vomiting, pancreatitis
SE of insulin
weight gain, hypoglycaemia, lipodystrophy
SE of thizolidinediones
weight gain, liver impairment, fluid retention, bladder cancer, increased risk of fractures
gentamycin complication
nephrotoxicity and ototoxisity
Complications of Transurethral Resection:
T ur syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate
NEONATE SEPSIS
Sepsis in the neonate can broadly be divided into early-onset (<48 hours since birth) and late-onset (>48 hours from birth). Early-onset sepsis is associated with acquisition of micro-organisms from the mothers birth canal. Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.
The neonate in this question has early onset sepsis. The most likely pathogen is Group B Strep which is a common commensal of the female genital tract.
NEONATE SEPSIS
Sepsis in the neonate can broadly be divided into early-onset (<48 hours since birth) and late-onset (>48 hours from birth). Early-onset sepsis is associated with acquisition of micro-organisms from the mothers birth canal. Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.
The neonate in this question has early onset sepsis. The most likely pathogen is Group B Strep which is a common commensal of the female genital tract.
Henoch-Schonlein purpura
Henoch-Schonlein purpura (HSP) is an IgA mediated small vessel vasculitis. There is a degree of overlap with IgA nephropathy (Berger’s disease). HSP is usually seen in children following an infection.
Features
palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure
Treatment
analgesia for arthralgia
treatment of nephropathy is generally supportive. There is inconsistent evidence for the use of steroids and immunosuppressants
Pulmonary function tests
obstructive
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced
asthma
COPD
bronchiectasis
Pulmonary function tests
restrictive
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased
pulmonary fibrosis
asbestosis
sarcoidosis
Hashimoto’s thyroiditis
hypothyroidism
goitre
anti-TPO