random questions Flashcards by Csaba Sali

WHO definition of osteoporosis

Being outside the 2.5 x standard deviation of that age group

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RF for osteoporosis

Oestrogen deficiency
Vit D insufficiency
Hyperparathyroidism

Smoking
Alcohol
Previous fracture

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What is Ehlers Danlos syndrome?

Multi system connective tissue disorder characterised by abnormal collagen in skin, joints, blood vessels causing fragile vessels and elastic bones

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In back pain, differentiate MSK from referred

MSK pain is mostly lumbar
Short-lived
Sudden
Relieved by rest

Referred is mostly thoracic
Constant and progressive

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Difference between sepsis and septic shock

Severe sepsis shows organ dysfunction

Septic shock also has hypotension

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What are the effects of persistant proteinuria in nephrotic syndrome

Loss of IgG - susceptibility to infection
Loss of coagulation inhibitors - hypercoagulability
Loss of apoproteins - Hyperlipidaemia

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What are secondary causes of nephrotic syndrome

DM
SLE

Heroin
Malaria
Hepatitis
HIV
NSAIDs

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Constituents and purpose of saline solution (0.9%)

Na 154mmol
Cl 154 mmol

Expands extracellular H2O

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Constituents and purpose of Hartmann’s solution

130 Na
109 Cl
4 K
1.5 Ca
28 Lactate

Normalises pH if acidic

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Constituents and purpose of 5% Dextrose solution

50g dextrose in 1 L H2O.

Expands body water, slightly more towards extracellular (CRYSTALLOID)

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Constituents and purpose of Abumin solution

150 Na
136 Cl
<2 K
40-50 g Albumin

Extracellular volume expander (COLLOID)

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What is used in the treatment of paracetamol overdose

N-acetylcysteine
Within 8-10 hours
Measure paracetamol plasma concentration to decide whether to treat or not

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Causes of microcytic anaemia

TAILS
Thalaessemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia

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Causes of normocytic anaemia

Acute blood loss
Haemolytic anaemia
CKD

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Causes of macrocytic anaemia (megaloblastic)

Folate deficiency (alcoholics, haemolysis, pregnancy)
B12 deficiency (vegetarians, pernicious anaemia, disease of terminal ileum such as Crohn's)

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Character of bacterial meningitis

CSF:
Turbid, purulent
Marked increase in polymorphs
Some increase in protein. 
<50% of blood glucose

There is a higher risk of complications with bacterial meningitis.

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Which patients are at risk of subdural haemorrhage?

Elderly and alcoholics. Patients on anticagulants.

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How does subdural haemorrhage present.

Long prodrome, may be weeks after a trauma until S&S.
Headache, drowsiness, confusion. Focal neurological deficits. Epilepsy. Stupor, coma.

Pressure atrophy of the brain because of fluid between dura and arachnoid.

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Whar are differentials for stroke?

Hypoglycaemia
Tumour
Seizure

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What is the triad of meningism?

Photophobia
Headache
Neck stiffness

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Which scrotal swellings have associations with tumours and which don’t?

Hydrocele has association with tumour.
Also with infection and trauma.

Spermatocele has no association with tumour.

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How many lumps can a hydrocele be?

more than 2 (because of association with tumours?)

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How many lumps can a spermatocele be

only 1

Which factor indicates acute over chronic hepatitis

Raised WCC

What is the triad in nephrotic syndrome

proteinurea hypoalbuminaemia hyperlipidaemia Oedema

What are the symptoms of autosomal PCKD

Haematuria Bilateral palpable kidneys Flank pain Systemic disease (hernias, stones, HTN)

What is often the first indicator of liver damage in paracetamol overdose

Prothrombin time (INR)

What is achalasia

Oesophagus loses motility. Also, the valve at the GOJ does not open properly. Leads to food spillover into lungs. Some relief from dysphagia during eating.

What is the commonest cause of nephropathy?

IgA nephropathy. Leads to concurrent URTIs. | Thin basement membrane disease.

What is the likely diagnosis if a patient has elevated serum urea but only mildly elevated creatinine?

Dehydration

What are the criteria for glomerular nephropathy

haematuria proteinuria hypertension

What is Stevens Johnson Syndrome

Rash on arms, leg, face. Ulceration of lips and mouth. Caused by acute drug sensitivity. Most commonly to antibiotics

Which factors in acute meningitis are suggestive of bacterial origin?

Hypotension Leucocytosis (neutrophilia) Renal impairment

What are causes of hyponatraemia

Often due to excess loss of fluid - sweating, diarrhoea, vomiting, burn. Diuretics and Addison's lead to renal loss of Na and H2O. Hyponatraemia with hypovolaemia occurs with excess retention of water. (eg severe kidney failure). SIADH (malignancy, neurological, or pneumonia). With normovolamia - administration of too much IV hypotonic fluid.

How to rule out a subdural haematoma?

What ar the key clinical features of diabetic ketoacidosis

Hyperventilation | Dehydration (there is high serum K)

What is suggested by an ABPI of <0.97

Arterial disease in the leg

Which extrarenal clinical features can point towards the cause of ARF

Lung basement membranes can be affected in Goodpasture's. Microvascular signs in eyes in DM/HTN. Hepatorenal syndrome. There may be signs of infection, if that is the cause. Muscle pain in rhabdomyolysis. Heart failure and endocarditis may be present.

Symptoms of pancreatic cancer in the body or tail.

Thrombophlebitis migrans (femoral vv, legs, arms - swollen and red). Anorexia. Pain radiating to back, relieved by sitting forward. Acute pancreatitis, late onset DM.

Signs of pancreatic cancer

``` Jaundice Severe weight loss Palpable masses Palpable gall bladder Lymphadenopathy Ascites ``` Signs relating to liver metastasis indicate worse prognosis (eg. low albumin).

Symptoms of bladder TCC

Sterile pyuria Painless haematuria UTIs Obstructive symptoms

Suprapubic pain relieved by lying down

Bladder calculi

The symptoms of adenocarcinoma of the prostate

Back pain Weight loss Anaemia Progressive urinary tract obstruction.q

RF for renal calculi

Metabolic - acidic/alkalic urine Infection Dehydration High Calcium in the diet

What are distinctions in the symptoms of lower and upper UTIs

Upper - loin pain, tenderness, fever, rigors. Lower - suprapubic pain, frequency, dysuria

What is the indication of AXR in upper UTI diagnosis?

Shows most renal stones

Which sensations are lost first in diabetic symmetrical distal sensorymotor polyneuropathy?

"Walking on a cotton wool" Vibration Temp Pain sensation

What is the pattern of callous formation in DM

Formation at the 1st metatarsal head. | Ulceration

Which nerves are most commonly affected in diabetic mononeuropathy

CN3 CN6 Pupillary reflexes are maintained. Carpal Tunnel syndrome is also more common.

What is the aetiology of hyperthyroidism

80% Graves Disease 15% multinodular goitre 5% Solitary toxic adenomas

What are the main features of diabetic nephropathy

Albuminuria More in T1DM Normochromic, normocytic anaemia. Advice high protein diet.

What are possible features of a malignant solitary nodule goitre?

Rapid enlargement. LN enlargement. Pain? T3 toxicosis (production by adenoma).

How do multinodular goitres present?

15% of Hyperthyroidism. Can also be euthyroid. RARE to be hypothyroid or Malignant. Local effects (laryngeal nn palsy, tracheal/oesophageal compression)

Which hormones can be secreted by tumours in the lungs?

ACTH ADH (dilutional hyponatraemia) PTH (hypercalcaemia)

What is a Pancoast tumour?

Invasive lung tumour near brachial plexus. | Pain radiating down to hands, muscle wasting.

What is Horner's syndrome?

``` Lung tumour compresses sympathetic nerves. Triad of: Miosis Hemifacial ptosis Hemifacial anhidrosis ```