Random questions Flashcards
(103 cards)
1
Q
Heparin mechanism of action
A
Antithrombin III inhibitor
2
Q
Warfarin mechanism of action
A
Factor II, VII, IX and X
3
Q
Dabigatran mechanism of action
A
Direct thrombin inhibitor
4
Q
Rivaroxiban, apixoban mechanism of action
A
Factor Xa inhibitors
5
Q
Reed-sternberg cells
A
HL
6
Q
Biochem in addisonian crisis
A
High potassium
Low sodium
Low glucose
7
Q
Beta-blockers antidote
A
Glucagon
8
Q
Benzodiazepines antidote
A
Flumezanil
9
Q
Heparin antidote
A
Protamine
10
Q
Iron antidote
A
Desferroxamine
11
Q
Narcotics antidote
A
N-acetylcysteine
12
Q
Causes of hyponatraemia
A
Diuretics Water excess D&V Intestinal fistulae Renal failure SIADH Addison's Nephrotic Liver failure
13
Q
Causes of hypernatraemia
A
Fluid loss without water replacement Saline excess Diabetes insipidus DKA Conn's
14
Q
Causes of hyperkalaemia
A
Drugs - ACEIs, Spironolactone, suxamethonium Digoxin toxicity Excessive KCl Massive transfusion Burns Rhabdomyolysis Tumour lysis Renal failure Addison's Metabolic acidosis
15
Q
Causes of hypokalaemia
A
Vomiting Diarrhoea Losses from intestinal fistulae Diuretics Cushing's, excess steroids/ACTH Metabolic alkalosis Conn's
16
Q
Signs of hyponatraemia
A
Confusion Seizure HTN HF Muscle weakness Nausea Anorexia
17
Q
Signs of hypernatraemia
A
Thirst Dehydration Confusion Coma Seizure
18
Q
Signs of hyperkalaemia
A
Cardiac arrythmias - tall tented t waves, lengthened QRS, flatp waves, sloping up ST —> VT/VF
Sudden death
19
Q
Signs of hypokalaemia
A
Arrythmia Weakness Hypotonia Cramps Tetany
20
Q
Immediate management of hyperkalaemia
A
Calcium gluconate - stabilise myocardium
Insulin and glucose - get potassium temporarily into the cells (doesn’t affect metabolism)
21
Q
Metabolic acidosis
A
Usually follows an episode of severe tissue hypoxia - hypovolaemic shock, MI, sepsis etc. Inadequate oxygenation leads to lactic acid build-up. In surgical patients may be an indicator of serious intra-abdominal problems such as anastomotic leak. Also seen in renal failure and uncontrolled DKA. Treat underlying cause
22
Q
Signs of metabolic acidosis
A
Rapid deep breathing - Kussmaul respiration
ABG - low or normal pH, low pCO2 if compensated, very low bicarbonate
Plasma K elevated due to shift to extracellular space
23
Q
Respiratory acidosis
A
Results from CO2 retention due to iatrogenic of pathological respiratory depression. Treat underlying cause
24
Q
ABG respiratory acidosis
A
Low or normal pH
High pCO2
High bicarb if compensated
25
Metabolic alkalosis
Usually due to severe and prolonged vomiting, or nasogastric aspiration due to obstruction.
26
CO2 acidis or alkaline
CO2 makes things acidic
| Bicarb makes things alkaline
27
Classical acid-base picture of a patient with gastric outlet obstruction - including pyloric stenosis
Hypochloraemic metabolic alkalosis
28
ROME ABG nmnemonic
Respiratory
Odd
Metabolic
Equal
So if the C02 and HCO3 values are abnormal, if they are both low -"equal" it's likely metabolic, and if they're nt
29
Achalasia management
Medical - only if surgery contraindicated or while waiting for treatment - CCBs, nitrates
Pneumatic dilation
Surgical: laparoscopic or open Heller myotomy
30
Follow up for varices
Follow up every 3-6 months, banding or sclerotherapy of any recurrent varices
31
4 types of benign colonic polyp
Adenomatous
Inflammatory
Metaplastic
Harmatomous
32
Bowel ischaemia ABG picture
metabolic acidosis
33
M rule in PBC
IgM
Middle aged women
Anti-Mitochondial antibodies
34
First line medical management in IBS
Loperamide
35
MEN 1
Pituitary
Parathyroid
Pancreas
36
Artery at risk with duodenal ulcers on the posterior wall
Gastroduodenal
37
Tongue and uvula deviation in hypoglassal nerve injury
Tongue goes t'same side
| Uvula goes utha way
38
Treatments for hyperkalaemia
Calcium gluconate
Insulin and dextrose infusion
Salbutamol nebs
Calcium resonium
39
Pre-renal causes of ARF
Hypovolaemia
Multiple organ failure
Rhabdomyolysis
40
Renal causes of ARF
Vasculitis
Crescentic GN
Acute tubular necrosis
41
Post-renal causes of ARF
Blocked catheter
Prostatic hypertrophy
Extra-ureteric tumour
Retroperitoneal fibrosis
42
Common blood finding in interstitial nephritis
Eosinophil count elevated
43
Good marker in DM patients for assessing risk of future nephropathy
Microalbuminuria
44
Do you stop aspirin in AKI?
In low-dose for cardioprotection, no. Otherwise, yes
45
Most common renal AKI cause
Acute tubular necrosis
46
Diuretic for ascites
Spironolactone
47
Most common and important viral infection in solid organ transplant
CMV
48
Alternative to spironolactione if the patient develops gynaecomastia
Eplenerone
49
Diabetes Insipidus plasma and urine osmolality
high plasma osmolality and a low urine osmolality
50
Why is nephrotic syndrome associated with hypercoagulability?
Loss of antithrombin III
51
High or low urinary sodium in pre-renal vs ATN
Low in pre-renal as the kidney works to reabsorb because of the volume depletion and hold onto fluid
High in ATN
NB that a big difference in osmolality suggests pre-renal
In ATN the osmolality ratio is close to equal
52
Muddy brown casts suggestive of
ATN
53
4 eGFR variabilites
```
CAGE
Creatinine
Age
Gender
Ethnicity
```
54
Screening test for APKD
USS
55
1st line therapy in hyperparathyroidism requiring treatment
Vitamin D supplementation
56
Most common renal stones
Calcium oxalate
57
Gold standard for kidney stone
CT KUB - non-contrast
58
Staghorn composition
Struvium (magnesium ammonium phosphate)
59
6 functions of skin
```
Environmental barrier
Vitamin D synthesis
Cosmesis
Immunosurveillance
Sensation
Temperature regulation
```
60
Mnemonic for describing a lesion
```
SCAM
Size - widest diameter, Shape
Colour
Associated secondary change
Morphology, Margin
```
61
Melanoma screen mnemonic
```
ABCD
Asymmetry
Border
Colour
Diameter - >6mm
```
62
4 cell types of the epithelium
Keratinocytes
Langerhans' cells
Melanocytes
Merkel cells
63
Chondromalacia patellae vs osteochondritis dissecans
Chondromalacia patellae:
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Osteochondritis dissecans:
Pain after exercise
Intermittent swelling and locking
64
Electrolyte abnormality which predisposes to digoxin toxicity
Hypokalaemia
65
Most common side effect of isotretinoin
Dry skin
66
Severe side effect of hydroxychloroquine
Retinopathy
67
Metabolic acidosis with normal anion gap
Addisons
68
How long to wait after prostatitis to do PSA
1 month
69
Possible side effect of intubation and ventilation in a flail chest patient
Tension pneumothorax
70
First line treatment for severe C diff
Vancomycin
71
First and second line choices for MRSA treatment
Vancomycin
| Linezolid
72
Causes of raised prolactin
```
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone
```
73
3 key characteristics of HHS
1. ) Severe hyperglycaemia
2. ) Dehydration and renal failure
3. ) Mild/absent ketonuria
74
Impetigo treatment
topical fusidic acid → oral flucloxacillin / topical retapamulin
75
3 key characteristics of HHS
1. ) Severe hyperglycaemia
2. ) Dehydration and renal failure
3. ) Mild/absent ketonuria
76
Impetigo treatment
topical fusidic acid → oral flucloxacillin / topical retapamulin
77
ECG changes in hyperkalaemia
```
Tall tented t waves
Loss of p waves
Broad QRS complexes
Sine wave
VF
```
78
If a post menopausal woman has a fracture do you medicate, and if so with what
Yes, bisphosphonate and calcium
| You don't need to do a DEXA scan
79
Papillary and medullary thyroid cancer tumour markers
Medullary - Calcitonin - the MC
| Papillary - Thyroglobulin - the PT
80
Things which falsely reduce HbA1c
SCD, G6PDD, HS
81
Things which falsely increase HbA1c
Splenectomy, iron-deficiency anaemia, B12 deficiency, alcoholism
82
Does Grave's disease cause a tender goitre? What does?
No, De Quervain's (subacute) does
83
Medication used in vestibular neuronitis and when
Prochlorperazine, only in the acute phase
84
Most common organism in acute bacterial tonsillitis
Strep pyogenes
85
Differential for tinnitus
```
Meniere's
Acoustic neuroma
Drugs - quinine, aspirin, loop diuretics
Otosclerosis
Hearing loss
```
86
Management of unilateral nasal polyp
Urgent ENT referral - usually bilateral so need to rule out malignancy
87
Otitis media abx, and in diabetics
Amoxicillin, DM - ciprofloxacin
88
How long to wait before ENT referral for tympanic membrane perforation
6 weeks
89
Causes of gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers, AML
90
Addison's antibodies
21-hydroxylase
91
Reason for hyperpigmentation in Addison's
Increased ACTH production
92
U&Es in Addison's
Low sodium
| High potassium
93
Test for addison's other than antibody
Morning cortisol - low
94
Differentials for addison's
Secondary hypoaldosteronism - Cushing's or hypo-pit axis disease
Hyperthyroidism
Hameochromatosis
95
What are the three things a patient is short of in an Addisonian crisis
Steroid
Salt
Glucose
96
Management of an addisonian crisis
IV dexamethasone
IV 0.9 NaCl
IV glucose if hypoglycaemic
Regular monitoring and supportive Rx
97
2 key meds in stable Addison's
Hydrocortisone and fludrocortisone
98
Hormone which reduces in response to surgery
Insulin
99
Test to differentiate between T1DM and T2
C-peptide
100
Causes of SIADH - mnemonic
```
SIADH
S Surgery (24-48 hours post-op)
I Idiopathic/Intracranial/Infection
A Acute and chronic lung disease
D Deficiency of cortisol/Drugs - opiates, cytotoxics, anti- psychotics, anti-epileptics
H Hypothyroidism/Hyponatraemia
```
101
Myeloma screen
Total Protein
Albumin
Calculated Globulins
Serum Protein Electrophoresis (SPE) and free light chain measurement
102
Diagnostic criteria in myeloma
1. Monoclonal plasma cells >10% on bone aspirate
2. Monoclonal antibodies in blood or urine
3. At least one of CRAB
103
Causes of increased INR (drugs)
Allopurinol Influenza Vaccine Tramadol Oxandrolone
H-2 Blockers
Macrolide Antibiotics Metronidazole
Protease Inhibitors Quinolone Antibiotics SSRI Antidepressants Statins and Fibrates Tricyclic Antidepressants
Ethanol
