random things you forget Flashcards
(538 cards)
1
Q
Tx of prolactinoma
A
dopamine AGONISTS eg bromocriptine
2
Q
Dx of cushings
A
overnight dexamethasone suppression test
3
Q
how to determine location of problem in cushings
A
high dose dexa suprresion test. measure ACTH abd cortisol at 9am and midnight.
4
Q
potassium problem in cushi gs
A
HYPOkalemia (alkalosis=¡)
5
Q
diagnosis of addisons
A
short syncathen test. give ACTH 250mg IM, wait 30 mins and measure CORTISOL levels. if less than 100, problem. addisions.
6
Q
cushings and glucose
A
impaired glucose tolerance
7
Q
BP in cushings
A
high
8
Q
BP ijn addisioms
A
low
9
Q
glucoswe in addisons
A
low
10
Q
calcium in addisons
A
high
11
Q
which condition is associated with postual hypotension
A
addisons.
12
Q
cushing TX
A
ketoconazole
13
Q
what to do if sick with addisons
A
doubke gluco . hydrocortisone and keep fludrocortisone normla
14
Q
Tx cushings
A
ketoconazole.
15
Q
what are addisons patients given
A
hydrocortosone to self inject
16
Q
addisons patiet who vomits
A
give hydrocortisone IM until stops vomiting
17
Q
long qt cause
A
hypo0kalemia
18
Q
what can trigger and adisons crisi
A
pregnnacy, sepsis, surgeyr, adrenal hemorrhage (waterhouse fried)
19
Q
what metabolic disturbacne does addisons causse
A
normal anion gap metabolic acidosis.
20
Q
conns potassium
A
low
21
Q
conns serum bicarb
A
high
22
Q
conns metabolic imablancxe
A
metabolic alkalosis
23
Q
conns diagnosis
A
aldosterone renin plasma ratio
24
Q
tx galatocorrhea
A
promocri`tine
25
MEN 1
pituitary parathryoid pacreas
26
MEN2
pheochromocytoma, parathryoid
27
MEN 3
pheocromocytome
28
trousseau sign is a sign of
hypocalcemia
29
tx subactue goitre
nsaids
30
overereplacement w thyroxine
osteoporosis
31
what can reduce levothryozine absorption
iron AND CALCIUM. os have 4 hrs apar.
32
pheochromocytoma diagbosis
urine metaneprhines
33
thrydoid sotrm tx
beta blockrs
34
what do you give to ower HR in gravecs
propranolol
35
what can cause osteonecrosis
steroids
36
what can impair glcoe tolerencce
ciclosphorin, thiazides, steroids
37
calcium in pancreatitis
low
38
diarrhea defined as
more than 4 BM in 24 hrs
39
signet ring cells
gastric adenocarcinoma
40
monotr corhns
WBB
41
cholangitis is raised
ALP
42
fecal protectin high suggests
IBD
43
size of colon small bowel etc
small bowel 3, cecum 9, large bowel 6, appendix 6
44
tumour bowel staging
Tis: in situ. only in the mucosa.
T1 : inner layer of the bowel.
T2 : muscle layer of the bowel wall.
T3 outer lining of the bowel wall but has not grown through it.
T4 is split into 2 stages, T4a and T4b:
T4a spread into the tissue layer (peritoneum) covering the organs in the tummy (abdomen)
T4b means the tumour has grown through the bowel wall into nearby organs
45
VWD inheritence
autosomal dominant
46
CF inheritence
autosomal reessive
47
DMD
x linked rcessive
48
hemoptysis asociated with
mitral stenosis.
49
pulsus paradoxus
cardiac tampoonade
50
elecrtical alternans
pericardial effusion and cardiac tamponade.
51
kussamaul sign
pericarditis.
52
hemophiola A ineheritecnce
x linked recessive
53
hemophila Bineheritecnce
x linked recessive
54
most hemophilias are a or b
hemophilia A
55
hemophilia a is a deficiency in factor
8
56
hemophilia B is a deficiency in factor
9
57
what drug causes ototoxicity
loop diuretics.
58
bisphosphaates work by
reducing bone resportion
59
myxodema coma presents with
hypothermia adn confusion
60
s3
mitral regurug
61
s4
aortic stenosis
62
inheritence HOCM
autosomal dominant
63
patent ductus arteriosus
continuous machine like murmur
64
rhumatic fever causes
mitral stenosis
65
cause of rheumatic fever
streptococcus A pyogenes
66
WPW
hypertrophic dilated cardiomypathy
67
isolated peri anal disease Tx
metrinidazole
68
methotrexate is an alternative to
azathroprine in crohns
69
probiotics is useful for
UC
70
what do you use infliximab for
refractory disease and fistulating crohns
71
1st line crohns to maintain remissio n
aza meto
72
when do you need to check tMPT
before giving aza or meto
73
what to do if you have stricuting terminal ileal disease
ileocecal resection or segmental small bowel resection or stricutorplasty.
74
diff entre simple and co,plex fistula
simple is low, complex is high (through muscle layer)
75
simpyotmatic perianal fistula tx
metronidazole
76
what kind of drug is infliximab
anti TNF
77
what drug helps close and keep closed perianal fistual
infliximab
78
what is draining seton used for
to keep ople fistual because premature closure leads to abcess
79
perianal abcess
drainange and incision and antibioitc
80
complications of crhons
small bowel cancer
colorectal cancer
ostoporosis.
81
HBeAg
marker of infectivity
82
HbsAg
surface antigen. acute if less than 6M chronic if more
| also look at IgM not IgG to determine if acute or chornic
83
anti HBc
current or previous infection
84
anti HBs
immunised (throguh vaccination or previous exposure)
85
most common sx of chrons in kids
abdo pain
86
where do you see kantors string sing (LOOK UP PIC)
crohns
87
crpt abcess is linked with
UC
88
rectal bleeding in children casue
anal fissure
89
most common site affected by UC
rectum
90
Truelove and Witts' severity index
severity of UC
91
what kind of. drug is loperamide? what does it cayse as a SE
anti motility drug. causes toxcic megacolon.
92
anaemia and low ferritin/folate levels,
all characteristic of coeliac disease!!!!!
93
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of
euvolemic hyponatremia
94
what s erious side effect of aminosalicylate
AGRANULOCYTOSIS. so do a FBC if they have an infection and are on mesalazine
95
what makes a c diff infection life threatening
hypotension, shock, or intestinal obstruction
96
other name for pseudomembranous colitis
c diff
97
what drugs are linked with c diff infection
ppi, Cephalosporins, clindamycin
98
SIBO diagnosis
hydrogen breath test
99
SIBO TX
RIFAXIMIN
100
What antibodies do you see in autoimmune hepatitis
anti-nuclear
and/or
anti-smooth muscle antibodies.
101
If SAAG - serum ascitic albumin gradietn is high (hihg protein)
so its portal hypertensino --> TRANSUDATE
102
If SAAG - serum ascitic albumin gradietn is low (low protein)
so its malignancy, infection, pacreatitis--> EXUDATE
103
Exudates are
fluids, CELLS, or other cellular substances that are slowly discharged from BLOOD VESSELS usually from inflamed tissues. examples include: malignancy, nifection, pancreatitis.
104
Transudates
are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES.
105
diagnosis of wilsons
Caeruloplasmin
106
diff entre wilsons and hemochromatosis
wilsons has neuropsychiatric symptoms while this one doesnt. like aggresiion, dysphagia...
107
link beteen hypoxia and liver
ischemic hepatitis
108
methotrexate can cause what bad side effect
pulmonary fibrosis
109
shoudl you give PPI before an endoscopy?
no. giove some AFTER if theres evidence of a non-variceal hemorrhage
110
how can you differentitate entre anemia of chronic disease and iron deficiency anemia
Total Iron Binding Capacity is low in ACD
| high in IDA
111
what is h pylori associated with
gastric adenocarcinoma and atrophic gastritis but the strongest association is with duodenal ulceration.
112
what is a predisposition to gastric carcinoma
pernisious anemia (b12 def)
113
ESR levels in DE quervain
high ESR
114
de quesrvain lab values
high T4, low TSH eventually leading to hypo, high ESr, low iodine uptake
115
psoas sign positive indicates
appendicitis
116
what electroluyte change can enoxaparin (heparin( cause
hyperkalemia
117
how is b12 deficiency managed
intramuscular B12 replacement, a loading regime followed by 2-3 monthly injections
118
what to replace first b12 or folate
b12. because otherwise you night precipitate subacute combined degeneration of the cord.
119
hypercalcemia on ecg
short QT
120
low TSH and low free t4
secondary hypotheyoiridm. do MRI to confirm pituitary hypothryoidism
121
what to give before paracentesis
IV human albumin solution
122
potassium and long QT
hypokalemia
123
hyperkalemia
wide QRS
124
talk to me about renal tubular acidosis type 1
linked with stone formation
urine ph above 5.5
hematuria
hypokalemia and hyperchloremic metabolic acidosis
125
talk to me about renal tubular acidosis type 3
Extremely rare
Caused by carbonic anhydrase II deficiency.
Due to an impaired H+ secretion by the distal convoluted tubule and HCO3- wasting by the proximal convoluted tubule
Presents with a urine pH greater than 5.5, whilst this patient has a pH of 5.3.
126
talk to me about renal tubular acidosis type 4
Ccaused by a reduction in aldosterone that leads in turn to a reduction in proximal tubular ammonium excretion.
cuases hyperkalemia
127
talk to me about renal tubular acidosis type 2
Caused by a dysfunctional proximal convoluted tubule, that is unable to reabsorb HCO3-. BICARB
The defect can either be isolated, affecting only the reabsorption of HCO3- or, more commonly, the dysfunction is generalized in which case the condition is referred to as Fanconi syndrome.
128
talk to me about familial hypercalciuria
stones at an early age.
Generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone.
129
should you give allopurinol to prevent gout
no
130
to diagnose iron deficiency anemia during a concomittant disease what shoudl you use
NOT feritin, use trasnfersin saturation, iron, iron binding capacity.
131
hepatorenal sy drome management
terlispressin
132
cerebral pontine myelonlilsis is seen in treatment of
hyponatremia
133
cerebral edema is seen in the treatment of
hypernatremia
134
lemon tinge to skin is associated with
pernicisou anemia
135
what anemia has reduced vibration sense
pernicious
136
amitryptiline side effect
urinary retention
137
diabetic neuropathy management
duboxetine,
| amitryptilline or pregabalin
138
how many ml in a pint
568
139
tx achalasia
Heller cardiomyotomy
140
simultaneous dilatation of the common bile duct and pancreatic ducts.
pancreatic cancer
141
hypothyroidism and sodium
Hypothyroidism causes a euvolaemic hyponatraemia
The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output.
142
Sister Mary Joseph node
palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen
143
Tx wilson s disease
pennicillamine
144
s3 seen in
hf
145
gallop rythm seen in
hf
146
aortic stenosis
SAD- syncope, angina, dyspnoea
147
3rd heat sounds are soft or loud
soft
148
sound of mitral stenosis
loud first heart soubd
149
what can cause acute resp distress syn
pancreatitis
150
cause of pulm fibrosis
methotrexate, amiodarrone
151
posterior mi
tall r wave in v1 v3
152
calots triangle
inf border liver
cystic duct
common hepatic duct
153
hasselbachs triangle
Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.
154
hepB
hepatocellullar cancer
155
in wilsons is cerruplo`lasmin low or high
low
156
anti phosphlipid sydnrome tx
aspirin and lmwh
157
men who have sex with men should get what vaccine
hepA
158
Animal bite
- co-amoxiclav
159
sudden anemia PLUS low reticulocytes indicates
parvovirus
160
explain asa grades 1-6
5. moribounds
| 6. brain dead.
161
sepsis red flags
not passed urine in 18hrs
| recent chemo
162
msot common esophageal cancer
adenocarcinoma
163
complicaiton of esophagectomy
anastomotic leak
164
gastric cancer is high where
korea
165
blood a group is linked to what cancer
gastric
166
surgery if gastric tumour is middle or distal
distal partial gastrectomy
167
surgery if gastric tumour is proximal
total gastrectomy
168
surgery if gastric tumour is at gastroesphageal junction
total or proximal gastrextomy nad distal esophagectomy
169
statistcal analysis for CCS
odds ratio
170
statistcal analysis for cohort studies
relative risk
171
legal prescribing must have
```
practisinac name
signature
address
bleep
block capital letter
black or blue ineffacable ink
```
172
live attnuated vaccines
BCG
MMR
polio
173
live attnuated vaccines
BCG
MMR
polio
INFLUENZA
174
which vaccines have relatively low efficacy
```
pertussis
pneumococcus
rotavirus
influenxa
BCG
```
175
vaccines for older poeple
shingles at 70 once.
influenxa at 65 eveyr year
pneumococcal at 65 every 5 years
176
rank studies in terms of credibililty
```
meta analysis
RCT
cohort
CCS
cross sectional
```
177
advantage of cross sectional studies
gather data about exposure adn outcome simultaneously at a single point in time. netiher prospective nor retrospective.
178
is termimal sedation lawful
yes
179
parkes phases of grief
DADAR
1. denial, shock
2. anger
3. depression
4. acceptance
5. resoluation and reorganisastion
180
clean hands with sopay water for how long
20s
181
gram stain of ecoli
negative
182
gram stain of c dfiff
positive
183
gram stain of MRSA
positive
184
gram stain pseudomonas
netgative
185
what are some carbapanem resistant enterobacteria
e coli klebsiella
186
enterobacteria are gram
negative
187
when to screen patients for MRSA
3 months before surgery
188
DNAR is a fr¡orm of---
passive euthanasia.
189
UC associated with what antibodies
p ANCA
190
skin complaints with UC and crohns
pyoderma gangernosum
| eyrthema nodosum
191
peaks of UC and crohsn
20 70 UC
| 20 60 crohns
192
what vessel supplies ascending and trasnverse colon
sup mesenteric
193
what vessel supplies desceding colon
inf mesenteric
194
most common polyps in UCpatients
hyperpastic polyps
195
colon adenoma on what side
left
196
in loop stoma which one is spouted and which is flat
proximal is spouted, distal is flat
197
msot common cause of large bowel obstructin
bowel cancer
198
most colorectal cancer is in
rectum
199
what kind of stoma if you do an abdominoperineal resection
end colostomy
200
whats a gastrostomy
its a PEG. things in not out. food.
201
what stoma in hartmans
end ileostomy or colostony with no anastomosis.
202
higest rates of leak in
male rectal anastomoses
203
un emergency what stoma do you use
loop colostomy
204
what do you give for bites
co amox
205
when to give fluxocalicincn
s aureus infection other than MRSA
206
trimethorpimw orks on
tetrohydrofolate metabolosim (folic acid metabolisn)
207
sulfonamides works on
dihyfrofoalte metabolism (folci acod met)
208
DNA gyrase is worked on by
quinonlones
209
which antibiotic is ototoxic
gentamicini
210
which antibiotic is ototoxic
gentamicini, quinine
211
acyclovir is a
guanosine analogue
212
acyclovir is a
guanosine analogue. works by acting on viral DNA polymerase to inhibit it by causeig chain termination. . resistance via mutation of viral thymidine kinase and or DNA polymerase.
213
herpes keratitis Tx
idoxuridine. nucleoside analogue
214
CMV tx
gangiclovir and valgenciclovir,
215
metronidazole works on
dna replication
216
HIV proph
tenofovir and entrititabine
217
post HIV rxposure
tenofovir and entritibine and dolutegraviror retrograve for 28 days
218
what kind of drug is oseltamivir
neuraminidase inhibitor
219
M2 inhibiotr used for what and what examople
influenxa, amantadine
220
celiac antibodies
anti endomylin, DQ2 and DQ8
221
cleiac associated with
anemia folate and iron and b12, aspelnism, SMALL BOWEL LYMPHOMA
222
skin lesion in celiac
dermatitis hepatiformis
223
type 1 hypersensitivity mediated by
Ige --> release of histamines
224
type 2 hypersensitivity mediated by
IgM and IgG --> complement activation and phagocytosis
225
type 3 hypersensitivity mediated by
immune complkexes causing pathology like vasculitis
226
type 4 hypersensitivity mediated by
t cell lymphocyte. w granumolas CD4. wihtout CD8
227
type 5 hypersensitivity mediated by
antibodies that stimulate target cells.
228
cd20 is b cel and t cell is
cd3
229
rouleaux cells seen in
multiple myeloma
230
smear cells seen in
CLL
231
pseudopelger seen in
CML
232
rifampicin MOA
inhibits RNA polymerase
233
isoniazid MOA
inhibits mycolic acid synthesis
234
pyrazinimide MOA
converted into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I. can cause GOUT
235
etham butol MOA
inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
236
heinz bodies seen in
g6pd
237
fever on alternating days
malaria
238
tx malaria SEVERE complicated FALCIPARUM
iv artesunate or IV quinine. blood films DAILY,
239
precautions when you give quinine
cardiac and blood monitoring
240
tx malaria uncomplicated FALCIPARUM
```
oral malarone (atovaquone- proguanil)
riamet (artemeter, CACT not for preggos(
quinine et doxy/clinda
```
241
nonfalciparum
chloroquine followed by primaquine
242
for what drug do you need to check the g6pd sttaus
primquine.
243
what level is good Hba1c control in dibaetic
53
244
t1dm condordance in monozygotic twins
50%
245
addisons is linked with what kind of diabetes
t1dm
246
who to screen for t2dm
```
family hx
south asians
afrocarribean
bmi over 30
pts on diabetes inducing drugs.
```
247
at what glucose level do you get NEUROGENIC symptoms? and what are they
3.6,
| tachycardia, nausea vomiting tremor
248
at what glucose level do you get NEUROGLYCOPENIC symptoms? and what are they
2.7 coma, confusion
249
does alcohol cause hyper or hypoglycemia
hypo
250
how to reverse hypoglycemia awareness
go on hypo holiday. avoid hypo at all costs. use analogue of insuli, or insulin pump therapy.
251
hypo if they can self administer
lucozade, sugar in water.
252
hypo if conscious but cant self administer
buccogel
253
hypo if unconcscious
recovery position and MI glucagon. 0-5-1mg or IV glucose if theres a cannula in already.
254
when will dvla revoque liscence
if theres one or more hypo requiring assistanc.e
255
LADA misdaignosed as
type 2 because patients present late
256
MODY is bascially similar to
type 2
257
LADA is bascially type
1
258
which one is inherited in autosomal diminena tway mody or lada
mody
259
positive coombes test seen in
autoimmune hemolytic anemia
260
Intravenous immune globulin is used for
post-transfusion purpura
261
Oral histamine (e.g. diphenhydramine) is used for (in trasnfusion)
urticarial/ allergic transfusion reactions.
262
The isolated thrombocytopenia in a well patient points to
a diagnosis of ITP
263
First-line treatment for ITP is
oral prednisolone
264
Haemolytic transfusion reactions are usually the result of
IgM type antibodies, rather than IgG binding to red blood cells.
265
The combination of low platelet counts and raised FDP
DIC
266
The management of acute chest syndrome in sickle cell disease includes:
pain relief
oxygen therapy
antibiotics
transfusion
267
features and blood test of hemophilia
Features
haemoarthroses
haematomas
prolonged bleeding after surgery or trauma
Blood tests
prolonged APTT
bleeding time, thrombin time, prothrombin time normal
268
chirstams disease is
hemophilia b
269
features and blood test of hemophilia
Features
haemoarthroses
haematomas
prolonged bleeding after surgery or trauma
Blood tests
LOOOOONG APTT
bleeding time, thrombin time, prothrombin time normal
270
In sickle-cell, acute painful vaso-occlusive crises should be diagnosed
clinically
271
This patient is suffering from post-thrombotic syndrome (PTS). This normally affects people 6 months to 2 years after they have had the initial DVT. It is caused by chronic venous hypertension. Symptoms of PTS include chronic pain, swelling, hyperpigmentation and venous ulcers.
give them compression socks
272
Hirudoid cream is a heparinoid based cream that is useful in the treatment of
superficial thrombophlebitis
273
Disproportionate microcytic anaemia -
think beta-thalassaemia trait
274
DVT in preggo what do you use
LMWH
275
imatinib is. a
tyrosine kinase inhibitor
276
dx meloma
serum protein electrophoresis
277
med while waiting for ctpa or dopller
doac
278
A blood film shows large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.
reed stenberg cells
Patients with Hodgkin's lymphoma are recommended to receive irradiated red cells lifelong to prevent the risk of developing transfusion-related graft-versus-host disease
279
Piperacillin with tazobactam (Tazocin) is the empirical antibiotic of choice for neutropenic sepsis
genre after chemp
280
glandular fever caused by
ebv
281
Definitive diagnosis of sickle cell disease is by
haemoglobin electrophoresis
282
cryoprecipitate is made ofwhat
factor 8, fibrinogen, von Willebrand factor and factor
| 13
283
olanzapine SE
VTE
284
parvovrius is associated w whta kind of crisis
aplastic
285
some patients can get an "allergic type" infection in the kidneys. what is it called? what does it present as?
acute interstitial nephirtis
presents with high urea high creatinine, and WHITE CELL CASTS also raised IgE
can happen after peniclin.
286
what do white cells casts on urinalysis show
acute interstitial nephritis
287
how can you tell if its acute or chronic kidney disease
Hypocalcaemia means chronic and not acute
288
sepsis causes what metabolic disturbance
metabolic acidosis with raised anion gap
289
Hyaline casts may be seen in the urine of patients taking
loop diuretics
290
Anti-GBM disease typically presents with
haemoptysis + AKI/proteinuria/haematuria
291
Autosomal dominant polycistic kidney disease - most common extra renal manifestations
liver cysts
292
Nrphrotic syndrome
Triad of:
1. Proteinuria (> 3g/24hr) causing
2. Hypoalbuminaemia (< 30g/L) and
3. Oedema
293
What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?
loss of antithrombin III
294
is blood in nephirtic or nephrotiuc syndro,e
neprhitic
295
thryoid and nephortic syndrome
Low total thyroxine T4 levels may be seen in nephrotic syndrome
296
memerbaneous glomerulonephritis is associated with
SLE
297
fluid theraoy for patient
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
Maintenance fluid in children is weight dependent: 100ml/kg for the first 10kg, 50ml/kg for the next 10kg and 20ml/kg for every subsequent kg.
298
potassium delivery
The maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour, whereas rates above 20 mmol/hour require cardiac monitoring
299
time for fistual to be ready for use
2 mohths
300
What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?
full recovery and no further episodes
301
what bacteria cause hemolytic uremic syndrome
e coli
302
what to do in patients with with a clinically raised ACR (>3mg/mmol) like in renal artery stenosis and co-existent diabetes mellitus.
give ACEi
303
All patients with chronic kidney disease should be started on
a statin
304
All diabetic patients require annual screening for
albumin:creatinine ratio (ACR) in early morning specimens
305
neprhotic syndrome if caused by minimal change disease in childrne, how should it be managed
oral predniolone and reivew
306
In a patient with suspected anaemia of chronic disease secondary to CKD, what to you do
iron status should be checked prior to commencing EPO
307
do you automatically diagnose someone with CKD stages 1 and 2 or do you look at something else first
: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR. like high urea and high creatinine.
308
dehydration lab values
urea that is proportionally higher than the rise in creatinine
309
Most likely cause of death in someone with CKD on heamodialysis
IHD
310
When should patients with chronic kidney disease be started on an ACE inhibitor
if they have an ACR > 30 mg/mmol
311
typixal cause of acute interstitial nephritis
antibiotic use, NSAIDS
312
Young female patients who develop AKI after the initiation of an ACE inhibitor
Consider fibromuscular dysplasia
313
asthma on AF you give
diltiazem or veraàmil
314
complete heart block
p waves marching through qrs
315
most likely to die from stemi or nstemi
stemi
316
biggest determinant of death in mi
infarct size
317
how do you treat AF if there is coexistent heart failure, first onset AF or an obvious reversible cause
use rythm control so things like flecainide.
318
if there is a structural heart disease, what drug can you NEVER USE and what should you use insteaad.
flecainide!!! isntead, use amiodarone.
319
Anti GBM is also called
goodpastuer
Glomerulonephritis in Goodpasture's syndrome is very commonly preceded by chest symptoms (coughing/chest pain/haemoptysis). It is a disease that affects type IV collagen that is found in both the lungs and the kidneys.
320
high ACR suggests
microalbuminuria. This is a sign of early kidney damage and research has shown that using an ACE inhibitor or angiotensin-II receptor antagonist in these patients can be renoprotective, although the exact mechanism is still unclear. This is recommended by NICE regardless of the patient's blood pressure.
321
Primary and secondary aldosteronism can be differentiated by looking at
the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis. if low then probbalhy a primary.
322
rhabdomyolysis Tx
saline
323
Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
324
Anaemia in CKD which do you start with, correcting iron or correcting EPO
correct iron deficiency before starting erythropoiesis-stimulating agents
325
Management of HUS
treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
NO antibiotics, despite the preceding diarrhoeal illness in many patients
plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
eculizumab (a C5 inhibitor monoclonal antibody) has evidence of greater efficiency than plasma exchange alone in the treatment of adult atypical HUS
326
Calcium resonium results in
removal of potassium from the body, rather than shifting potassium between fluid compartments in the short-term
327
Short-term shift in potassium from extracellular (ECF) to intracellular fluid (ICF)
compartment
combined insulin/dextrose infusion
| nebulised salbutamol
328
what is is an indication for dialysis
uremia (encephalopahy, pericarditis)
329
is warfarin safe in AKI
yes
330
heparin mode of action
inactivates thrombin and activated factor X (factor Xa)
through an antithrombin (AT)-dependent mechanism
331
acute tubular necrosis findings
raised urine sodium
332
causes of AKI
Pre-renal:
Caused by inadequate renal perfusion e.g. dehydration, haemorrhage, heart failure, sepsis
Kidneys act to concentrate urine and retain sodium - urine osmolality high, urine sodium low
Renal:
Most common = acute tubular necrosis
Damage to tubular cells due to prolonged ischaemia or toxins
Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high
Rarer causes = acute glomerulonephritis, acute interstitial nephritis
Post-renal:
Obstruction of urinary tract
Usually identified with hydronephrosis on renal ultrasound
333
Low total thyroxine levels may be seen in
nephrotic syndrome
334
Body builders often have an inappropriately high or low eGFR.
low
335
Patients who are high-risk for contrast-induced nephropathy should
have metformin withheld for a minimum of 48 hours and until the renal function has been shown to be normal
336
daily glucose requirement
50-100 g/day irrespective of the patient's weight
337
Sevelamer is a
non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease
338
Acute tubular necrosis response to fluid challenge
poor
339
Gentamicin causes
an intrinsic AKI
340
HIV infection is a cause of
focal segmental glomerulosclerosis
341
most common cause of nephrotic syndrome in adult
membranous nephropathy
342
Alcohol bingeing can lead to
ADH suppression in the posterior pituitary gland subsequently leading to polyuria
343
muddy brown casts
acute tubular necrosis (necrosis is dark - brown)
344
main causes of AKI
Sepsis and Hypoperfusion
Toxicity (drugs&contrast)
Obstruction (in bladder, ureter, prostate)
Parenchymal disease
345
how do you manage an AKI
Most important is to assess volume status!! If hypo --> give fluid
If >2L given and still hypoperfused --> circulatory support (vasopressin or ianotrophs)
346
which fluid to give in AKI?
hartmanns. because NaCL and cause hyperchloremi metabolic acidosis and dextrose can worsen AKI
347
complication of AKI
Hyperkalemia --> prolonged QRS --> cardiac arrest
348
how do you deal with an AKI caused by an obstruction
neprhostomy, stenting
349
CKD defined as
A GFR less than 60 for more than 3 months
350
cuase od CKD
Diabetes
Glomerulonephritis
Hypertension
Polycystic kidney disease
Pyelonephritis
351
What happens to calcium, phosphate if there is an CKD?
Hypocalcemia, hyperphosphatemia, hyperparathyroidism.
352
What happens to RBC if there is an CKD?
anemia
353
What happens to pH if there is CKD?
Metabolic acidosis
354
What happens to potassium if there is an CKD?
Hyperkalemia
355
treatment of CKD
Treatment of CKD
MAIN PRIORITY: control BP cause HTN makes it worse
SECOND PRIORITY: reduce protenuria. How? ACEi or ARB
THIRD PRIOIRTY: treat overload with salt restriction and diuretics
DIET: LOW sodium, LOW potassium, LOW phosphate
356
what does dialysis do
Removes water, salt, toxins
MAKE EPO
357
minimum hemodialysis schedule
Minimum of 4 hrs three times a week
358
complication of dialysis
Thrombosis
Infection
Hypotension
359
periteoneal dialysis is done how often
every day
360
complications of periotenal dialysis
Infection (peritonitis)
Peritoneal leak
Encapsulating peritoneal sclerosis
361
transplatnation drugs
| Azathioprine
act on inhibit purine synthesis so no clonal expansion of t cell
362
Rapamycin –
acts on motor upstream of clonal expansion
363
Tacrolimus
act to reduce t cell signaling and stop production of IL2 that causse clonal expansion
364
Cyclosporin
act to reduce t cell signaling and stop production of IL2 that causse clonal expansion
365
MMF
act on inhibit purine synthesis so no clonal expansion of t cell
366
transplantation complications
Infections
Viral CMV/wart
Fungal pneumocystis
INCREASED RISK OF TUMORS – skin!! Solid organs. PTLD often driven by EBV
367
Tacrolimus
act to reduce t cell signaling and stop production of IL2 that causse clonal expansion
SE: diabetes AND alopecia
368
Cyclosporin MOa nad SE
act to reduce t cell signaling and stop production of IL2 that causse clonal expansion
SE_ cause hirsuitism
369
MMF
act on inhibit purine synthesis so no clonal expansion of t cell
SE: GI problems
370
nephrotic syndrome criteria
Proteinuria >3g/day
Hypoalbuminemia <30g/dL
Oedema
Raised cholesterol
371
nmephrotic syndrome diagnosis
ACR
| If more than 3g protein per day --> nephrotic syndrome
372
mechanism of edema in NS
underfill hypothesis: low albumin
| overfill; high sidum retenion
373
minimal change disaese biopsy
Fusion of podocytes on EM
374
focal segmental glomerulosclerosis on biopsy
Focal (not all glomeruli are affected)
Segmental – part of the glomerulus is sclerosed
375
membraneous nepohornpathy is secondary to
Secondary SLE/Lupus
376
management of nephrotic syndrome
Non specific
Tx of edema,(salt and water reduction to 1L a day) reduction in proteinuria
Statins for dyslipidemia
Anticoagulation
377
how do ACEi and ARB help in nephiotir c syndrtome
act by reducing intragloñmerular pressure
378
hallmark of nephritic syndrome
URINE DIP HAS BLOOD AND PROTEIN .
| red cell casts
379
biopsy of glomerulonephirits
Red cell casts glomerulonephrotis
380
common cuase of glomeroluopneprhitis
Small vessel vasculitis e.g. ANCA associated vasculitis
IgA nephrophaty
malignancy
381
why do a neprhitic screen
to deter,ine what antibodies are causing a problem.
382
crescent formation seen in
glomerulonephrotis
383
what antibodies are commonly found in glomerulonephritis
ANCA
384
breast pain
Evening primrose oil or soya milk (phytoestrogens) may be helpful
Reduce fat intake.
385
breast pain
Evening primrose oil or soya milk (phytoestrogens) may be helpful
Reduce fat intake.
Tamoxifen
Danazol
Zoladex
Bromocriptine
386
who are one stop breast clinics for
symptomatic patients
387
what is done in one stop breast clinics
Mammography, ultrasound, cytology/histology Imaging, cytology, AND RESULTS all in one day.
388
what are the two view on a mammogram
Craniocaudal
Mediolateral
389
Extremely mobile, discrete, rubbery mass is msot likely
a fibroadenoma
390
what are phyllodes tumour
can be confused with fibroadenoma, women usually older, rare (<1% of breast lumps), fibroepithelial tumour, needs wide local excision. They have a malignant potential. Spreads to adjacent structures.
391
when do breasts cyst usually appear
Usually around perimenopause
392
management of cysts
reassure, aspirate, occasionally operate.
393
if there is a palpable mass with pain.
Sclerosing adenosis
394
whatt is montgomerys gland
small periareolar glands around nipple which may develop a cyst
395
mondors disease
hrombophlebitis of superficial veins of the breast
396
what is meant by tripple assessment
three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNAC and core biopsy).
397
malignancy rating
1 Normal (or Cytology Insufficient)
2 Benign (eg. Fibroadenoma or breats cysts)
3 Indeterminate probably benign
4 Suspicious of cancer
5 Cancer
P5 means on palpation it’s a score of 5
398
commonest breast cnacer
Infiltrating ductal carcinoma
399
Estrogen receptor not expressed on tumor cells- that is linked to
to poor prognosis.
400
endocrine treatment of breast cancer
Tamoxifen
Aromatase Inhibitors
401
risk factors for breast cancer
* Family history of breast cancer
* Prior personal history of breast cancer
* Increased estrogen exposure – Early menarche – Late menopause – Hormone replacement therapy/oral contraceptives
* Nulliparity • 1st pregnancy after age 30
* Diet and lifestyle (obesity, excessive alcohol consumption)
* Radiation exposure before age 40
* Prior benign or premalignant breast changes – In situ cancer – Atypical hyperplasia – Radial scar
402
National Breast Screening programme
mammography every three yeasr for women 50-70
investigation of MRI in premenopausal women
403
types of breast cancer
• Non-invasive carcinoma in situ
– Ductal carcinoma in situ (DCIS)
– Lobular carcinoma in situ (LCIS)
• Invasive carcinoma
– Infiltrating ductal or lobular carcinoma
– Medullary, mucinous, and tubular carcinomas
• Uncommon tumors
– Inflammatory carcinoma
– Paget’s disease of the nipple where cancer invades skin of nipple.
404
MOST INVASIVE BREAST CANCERs
MOST INVASIVE BREAST CANCERS ARE OF DUCTAL PATTERN
405
breast cancer staging
TX Primary tumor cannot be assessed
* T0 No evidence of primary tumor
* TisCarcinoma in situ: Intraductal carcinoma, lobular carcinoma in situ, or Paget’s disease of the nipple with no tumor
* T1 Tumor 2 cm or less in greatest dimension
T1mic Microinvasion less than 0.1 cm
T1a Tumor more than 0.1 cm but not more than 0.5 cm
T1b Tumor more than 0.5 cm but not more than 1 cm
T1c Tumor more than 1 cm but not more than 2 cm
-T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension
* T3 Tumor more than 5 cm in greatest dimension
* T4 Tumor of any size with direct extension to
(a) chest wall or
(b) skin only as described below
T4a Extension to chest wall
T4b Edema (including peau d’orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast
T4c Both (T4a and T4b) T4d Inflammatory carcinoma
406
breats cancer mets where
bones, liver, lungs, and brain
407
treatment of advanced disease
* Endocrine treatment anti-oestrogen
* Chemotherapy with one or two drug regimens
* Targeted biologicals eg trastuzumab, pertuzumab, lapatinib
* Radiotherapy eg bones
* Surgery to chest wall
* Supportive care eg bisphosphonates
* Psychological support eg art therapy
408
endocrine tx of breast cancer in premenauposal
Premenopausal
* Oophorectomy
* GnRH analogues eg goserilin , leuproprelin
* SERMs eg Tamoxifen, Fulvestrant
* Medroxy Progesterone acetate
409
enndocrine tx of breast cancer in post menopausal
* Aromatase inhibitors eg anastrozole, letrozole, exemestane
* And all the above
410
her2 positiev breast cancer is treated with
HErceptin (trastuzumabl ) for Her2 positive breast cacer
411
halo sign radiology
breast cyst
412
duct ectasia
common alteration in the breast that occurs with ageing. As the ducts shorten and dilate a degree of symmetrical slit like retraction occurs. A small amount of cheese like discharge may occur.
413
who to refer for breast cancer
Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral
414
Blood stained discharge is most likely to be associated with a
papiloma
415
First-line management of mastitis is
to continue breastfeeding
416
cause of mastitis and tx
staph aureaus, flucloxacillin
417
cytotoxic theraoy
Cytotoxic therapy may be used either prior to surgery ('neoadjuvanant' chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.
418
cancer premonopose you guve
tamoxifen
419
cancer postmenaupose you guve
aromatase inhibiotr like anastrozole
420
aromatase inhibitor /anastrozole) SE
osteoporosis
421
Duct ectasia:
non-malignant breast disease with thick green nipple discharge, occurring with breast involution
422
murphys sign positive in
cholecystitis
423
Fibroadenosis64
symptoms are worse in premenstrual period
424
mucisnus
acroscopically there is a grey, gelatinous surface.
425
triple negative means
no re eoptors for
estrogen
progresterone
her2
426
a women who is breast feeding presents with a very painful, red swelling above her areola
breast abscess
427
p53 mutatio and breast cancer
increased risk
428
a 40-year-old woman presents with a watery, blood-stained discharge from her nipple. There are no palpable lumps or skin changes
duct papilloma
429
can aspirin be used while breast feeding
nooooooo
430
can warfarin be used while breastfeeding
yes
431
campylobacter tx
clarithromycin
432
legionella tx
macrolides
433
nutmeg liver associated with
right sided hf
434
when does pci pr cabg have a prognostic benefit
in unstable angina, not in stavke angina
435
tx to improve prognosis angina
```
abas
aspirin
bb
acei
statims
```
436
symptomatic relief in angina
bb
| gtn
437
ejection fraction grades
sever less than 35
moderate 36-45
mild 46-55
438
core pulmonale causes what kind of heart fialure
right side
439
right bbb with left axis deviation
left anterior fascicular block. impt i hf. indicates ischemic heart disease.
440
management of acute pulm odema
high flow oxyge
gtn
fureosemide
morphine and antiemetic
441
stenotic valves lead to hypertrophy or dilatation
hypertrophy
442
regurigtnat valves lead to hypertrophy or dilatation
dilatatopm
443
aortic stenosis on ecg
inverted t wave on v4 v5
444
how to determine severity of arotic stenosis
doppler shows more velocity
445
mitral faces seen in
mitral stenosis
446
mitral regur cause
mitral valve prolapsem(genetic)
447
when to intervene in valvular ehart disease
symptomatc, irreversible chanhge in cardiac functiom, improve progosis.
448
medical tx of valvular heart dsiease
bb
acei
diuretics
calcium antagonists
449
mainstay diagnosis of bacterial endocarditis is
presenc eof vegetations on echocardiography.
450
duke criteria of definitive endocarditis criteria
2 majors
1 major and 3 minors
5 mniors
451
minors duke criteria
```
splinter hmorrhage
clubbing
prediposintion (knwn valvle abnormlaity=
splenomegaly
suggestive echo or microbiology
```
452
major u¡duke criteria
typical blood culture
positive q fever serology
postivei echo: presence of abcess. desinhence of prostehtic valve, valvular regur. varying intracardiac amss on vale or supporting structure i te path of a regurgiantant ket
453
what kind of valve require warfarin
mechanical
454
how long do mechanical valves last
30 years
455
how long do tissue valves last
12-15 years
456
what part of neprhons do loop diuretics work on
ascending loop of H
457
ACEi improve mortality in what
HfREdUCED EF
458
ACEi side effects
hyperkalemia
angiodema
dry cough
first dose hypotension
459
ARB
NO dry cough
no angiodema
yes hyperkalemia
yes first dose hypotension
460
ARBimprove mortality in what
HfREdUCED EF
461
spironolactone improve mortality in what
HfREdUCED EF
462
contraindications to bb
asthma
| verapamil therapy
463
bb improve what funciton
diastolic
| but can precipirate acute lvf
464
does ivabradine improve morality
yes
465
problem of digoxin
long half life so may need a loading dose.
466
amiodarone problemd
can cause bradycardia
very long hafl life
pulm fibirsis, hepatitis
467
ivarbradine porblem
acts o sinus noden so can cause bradycardia. It’s an interferon inhibitor
468
side effect of amlodipine
ankle swelling
469
side effect of verapamil
constipated
470
stage 1 hypetension
140/90 and 135/85 ABPM
471
stage 2 hypertension
160/100 and ABPM 150(95
472
stage 3 hypertension
more than 180 more tha 110
473
postural hypo
stand patient for one minute. drop systoly of more tha 20mmHg
474
malignant hyyerptension
more than 180 over 110 /so stag 3( AND sign of papilloedema. or retunalk hemmorhage.
475
if BP drops at night its a good prognosis or bad
good
476
if BP increases at night its a good prognosis or bad
bad
477
BP linked w sleep apnoea
high
478
if coarctation of aorta which rading fo you consider
higher
479
hypertension end organ damage examples
eye problems, protenuir,a
480
bariatric surgery compliations
fat malabsoprtion so fat soluble vitmain deficiency
481
whci type of hyperlipidemia is more common
secondary
482
total serum cholesterol should be less than 5
more than 7.5 think about FH
483
if serum LDL is more than 3
high. if more than 4.9 think about FH
484
FH cause
mutation is LDL receptor. high secretion of VLDL
485
FH inheritence
autosomal dominant. dx: simone broome critieria.
486
dysbetalipoprotenemia cause
mutation of apoe to apoe2
487
simone broome critera
cholesterol total more than 7.5 LDL more than 4.9 and tensdon zantohmanataor evidence of that in first or second degree relatives
488
angular stomatitis sign of
iron def
489
koilonychia sign of
iron def
490
glossitis sign of
b12 def
491
premature greying sign
iron def
492
mean corpuscular hemoglobin definition
average mass of Hb per RBC
493
NCH calculation
total mass of Hb/number of RBC
494
MCH calculation
total mass of Hb/number of RBC
495
if microcytic anemia with high RBC
thalassemia
496
folic acid def leads to what type of anemia
macro
497
lead poisening leads to what type of anemia
microcytic with normal RBC
498
sideroblastic leads to what type of anemia
microcytic with normal RBC
499
most caucasians are what blood group
o
500
ABO mistmatch leads to what
complemetn activationm c' - c3a c5a - cytokine release
501
acute hemolytic reaction is undepined by what mechanism
complement mediated lysis due to ABO incompatible blood.
502
tx acute hemolytic reaction
fluids, STOP trwssnfusion.
503
when does delayed hemolytic transfusion occur
7-10 days after
504
what causes delayed hemolytic tranfusion reaction
red cells Ab - IgG
505
dx delayed hemolytic tranfion reaction
direct antiglobulin test
506
whos most at risk of delayed hemolytic tranf react
SCD pts
507
febrile non hemolytic
give paracteamo. temp rise by 1 degree. plus inus high pulse.
508
if anaphylaxis durinf trasnufision
myabe IgA deficient
509
post trasufusion purpura
7 10 days post strsunfusion. HPA1 negative patients form antibodies after transfuision or pregnancy. destruction of platelerts after further trsnfusion.
510
transfusion associated graft vs host disease
rare but lawyas fatal.
mediated through viable lymphocytes in donors blood trasnfued to immunocompromised host
prevented by giving irradiated blood which makes donors lymphocytes unable to divide
511
how to avoid graft vs host disease
irradiated blood.
512
risk of infection Hep B HIV HepcC
most: HepB
HIV
HepC
513
SO prion disease
leukodepletion
514
tranexemic acid
reduces blood loss preop
515
transfusion triggers
80 if ACS
| 70 if no ACS
516
what causes pharingitis virus or bac
virus. but most common bac is group a
517
scarlet fever tx
penicilion v for 10 days.
518
antiobiotic or not? criteirs?
centor criteria. if 3/4 points then okau give.
1. tonsilar exudate
2- tender cervical ln
3. abscence of cough
4. ho fever
519
pharyingitis tx
penicilin v
520
amoxicilin can cause rash in who
pts with ebv. so give penicilin in sore thorat.
521
otitis media tx
amox for 5.7 cays.
522
sinusitis case
viral
523
pneumoccoocal pneumo tx
amoc.
524
mycoplasma pne tx
no cell wall so use macroilide.
525
legionella is gram what? tx?
negative
| quinolones
526
CURB 65
```
confusion
Urea more than 7
resp rate more than 30
BP less than 90s or less than 60 d
over 65 yo
```
if 0-1 low riks - OUTPATIENT- moral AMOX
2 moderate risk- ADMIT- IV benzylpenniclin and doxy
3-5 URGENT ADMISISON IV coamox and doxy or IV cefrtaicone and doxy if history of travel.
527
HAP definition
more than 48hrs afte admission or within 2 weeks of amdissin.
rcoli. klebsiella, pseudomonas.
tx: mild moderate: doxy
severe: less than 5 days: co amox
more: piperacillin tazobactam
528
whast the only thing that cover sfor pseudomonas
piperacillin tazobactam
529
aspiration pneumonia tx
amoxicilin and mitronidazole which covers for anaerobles.
530
COPD exacerbation tx
doxy or clarithro but only if more than two of high dyspnoea and high sputum purulence and high sputum volume.
531
bronchiectasis tx
if pseudomonas: pipazobactma.
| if not; clarithrymycin or doxyclicne or co amoc.
532
prophylazis bronchiectasis
chest physio and postural drainage.
533
empyema tx
drainage
| prevention is vaccinatin.
534
normal valve infective endocarditis cause
HIGH VIRULENCE staph auresu, strep pneumonia, yeast
535
abnormla valve infective endocarditis cause
Low VIRULENCE viridans streptococcus, coxiella...
536
prostehetic valve endocarditis cause
stap aureus
| coagulase engative.
537
prosthetic valve vs native vlavle IE therapy
prosthetic 6w
| native 4w
538
CURB 65
```
confusion
Urea more than 7
resp rate more than 30
BP less than 90s or less than 60 d
over 65 yo
```
if 0-1 low riks - OUTPATIENT- oral AMOX
2 moderate risk- ADMIT- IV benzylpenniclin and doxy
3-5 URGENT ADMISISON IV coamox and doxy or IV cefrtaicone and doxy if history of travel.
