Renal, Cardio, Endo Flashcards
(107 cards)
1
Q
What to prescribe when ACR >30 + htn (or just >70mg/mmol) in CKD
A
ACEi
2
Q
When to refer to nephrologist for proteinuria
A
when ACR>70 and no diabetes
When ACR>3 + hematuria/rapidly declining egfr
3
Q
How to treat anaemia in CKD
A
Iron studies + iron treatment first before EPO (this will be normocytic + egfr <35)
Bc of inc Herceptin impairs iron absorption
4
Q
ECG changes of hyperkalaemia
A
Tall tented T
Loss p waves
Broad QRS
sinusoidal wave pattern
5
Q
Name some nephrotoxic drugs
A
NSAIDs
Aminoglycosides
ACEi
ARBs
Diuretics
6
Q
ECG changes for hypokalaemia
A
U waves
Small T waves
Prolonged PR interval
ST depression
7
Q
Mx if inc risk of contrast induced nephropathy
A
IV 0.9% nacl 1ml/kg/hr for 12 hours pre and post
withhold metformin 48 hours post normal renal function
8
Q
Mx of CKD BMD
A
Correct hyperphosphataemia first - low pi diet, then pi binders sevelamer
9
Q
What to monitor for HSP
A
urinalysis and bp
10
Q
Symptoms of HSP
A
Palpable purpuric rash on bum/legs/arms
abdo pain
polyarthralgia
hematuria/renal failure
11
Q
When to refer for 2ww cystoscopy
A
> 45 + unexplained visible haematuria
60 + unexplained invisible hematuria + dysuria/inc acc
12
Q
Peritoneal dialysis causative organism
A
staph epidermidis
add vancomycin + ceftazidime to fluid
or vanc to fluid + oral ciprofloxacin
13
Q
Complications of peritoneal dialysis
A
hernia
peritoneal sclerosis
hydrothorax
drainage problems
peritonitis
14
Q
Biopsy findings for nephritic syndrome
- buegers
- post strep
- goodpastures
- alports
- vasculitis
A
- Buergers: mesangial iga deposits in glomeruli
- post strep: igg + Igm + c3 deposits of sub epithelial humps + starry sky immunofluorescence
- Goodpastures: linear igg deposits along bm
- alports: basket weave
- vasculitis: segmental necrotising
15
Q
Wegeners (Granulomatosis with polyangitis) vs churg-strauss syndrome (eosinophilic granulomatosis with polyangitis)
A
GPA: cANCA, binds to pr3 - renal failure (glomerulonephritis), epistaxis, hemoptysis
EGA: pANCA, binds to mpo, eosinophilia, late onset asthma
Both have sinusitis and SOB
16
Q
CVS abnormality in PCKD
A
mitral regurgitation
17
Q
Triad for HUS
A
AKI
Micoangiopathic hemolytic anaemia
Thrombocytopenia
18
Q
Gold standard ix for HUS
A
Blood film - schistocytes
Can also do fbc, u+es, stool culture, Coombs test
19
Q
Features of acute tubular necrosis
A
AKI
Muddy brown casts
Poor response to fluids
20
Q
Causes of acute tubular necrosis
A
ischaemic (sepsis/shock)
nephrotoxins (contrast, aminoglycosides, myoglobin (creatine kinase inc >5x)
21
Q
Features of acute interstitial nephritis
A
Fever
Rash
Arthralgia
Eosinophilia
HTN
Mild AKI
White cell casts
Sterile pyuria
22
Q
Causes of acute interstitial nephritis
A
Drugs (penicillamine, rifampicin, nsaids)
SLE/sjogrens
Staph infection
23
Q
How long do you treat provoked PEs for
A
3 months (6 months if cancer)
6 months if unprovoked
24
Q
Wells score for PE
A
likely - more than 4
unlikely - 4 or less
25
Features of HOMC
Mutation in myosin heavy cain
hAsymptomatic
Exertional dyspnoea, fatigue, syncope, angina
Sudden death (ventricular arrythmias, HF)
Bisferians pulse
Ejection systolic murmur, pan systolic murmur (mitral regurgitation)
S4
26
Ix for HOMC
ECG: LVH (tall R, T inversion, deep Q, AF)
ECHO: MR SAM ASH - mitral regurg, sys anterior motion, asymmetric hypertrophy
27
Mx HOMC
A - amiodarone
B - b blocker
C - cardio defibrillator
D - dual chamber pacemaker
E - endocarditis prophylaxis
28
What to avoid in HOMC
nitrates
acei
intense exercise
29
Poor prognostic indicators after ACS
cardiogenic shock
age
cardiac arrest on admission
elevated initial cardiac markers
high serum creatinine concentration
pulmonary oedema
30
Causes of long QT (which causes torsades)
tcas
antipsychotics
macrolides
amiodarone
SAH
hypothermia
hypocalcaemia
31
When to treat HTN
If stage 1 + <80 + organ damage/cvs disease/renal/diabetes/qrisk>10%
If >180/120 refer same day if papilledema/confusion/chest pain or other signs. If asymptomatic just immediate bloods/urine acr/ecg and if all ok then repeat bp in 7 days
32
Target BP <80 vs >80
<80 140/90
>80 150/90
33
Gold standard ix for aortic dissection
ct angiogram (false lumen)
if unstable transoesophageal echo
34
Which HF causes pulmonary oedema vs which HF causes peripheral oedema
Left: pulmonary oedema
Right: peripheral oedema
35
New York heart association HF classification
1. no symptoms
2. slight limitation on physical activities
3. moderate
4. severe, no physical activity without symptoms, symptoms at rest
36
Indications for surgery for endocarditis
severe valve failure
aortic abscess (inc PR)
resistant infection
HF
recurrent emboli
pregnant
37
Complications of MI
- cardiac arrest - VF
- cardiogenic shock
- chronic HF
- Tachyarrhythmia (VF), and bradyarrhythmia (AV block)
- pericarditis (dresslers if 2-6 weeks post)
- LV aneurysm: persistent ST elevation and LV failure so anticoagulant needed
- LV free wall rupture: 1-2 weeks post causes cardiac tamponade hence HF
- VSD: pansystolic murmur, if interventricular septum rupture
- Acute mitral regurg: if inferoposterior - hypotension + pulmonary oedema
38
Murmur for congenital pulmonary stenosis
Ejection systolic murmur
Loud on inspiration
39
Features of cardiac tamponade
becks triad - hypotension, muffled hs, raised jvp
pulsus paradoxus (large drop in bp when inspiration)
electrical alternans
40
Gold standard diagnostic ix for cardiac tamponade
Echo
41
Name 4 Hs and 4 Ts of cardiac arrest
Hypoxia
Hypothermia
Hypovol
Hyperkal
Thrombosis
Tension pneumothorax
Tamponade
Toxins
42
Paediatric cardiac arrest
Check femoral or brachial pulse
5 rescue breaths
15:2 if professional people and 30:2 if normal people
43
2nd line therapy for HFrEF
SGLT2 inhibitors
44
Signs of HTN emergencies
Encephalopathy
LVF (pulmonary oedema)
Aortic dissection
Renal failure (AKI)
Unstable angina (MI)
Caused by phaeochromocytoma, cushings, primary hyperaldosteronism
45
Following a TIA, If AF Is found when do you start anticoagulation
Immediately with a DOAC
(if its a stroke then 2 weeks post)
46
Indications for surgery for aortic stenosis
Symptoms
Severe LV dysfunction
Exercise intolerance
Having another cardiac surgery
Aortic valve gradient >40
TAVI if high risk patient
INR = 3
47
Periarrest bradycardia mx
atropine up to 3mg if life threatening (if dont monitor unless recent asystole, mobitz2, complete h block, ventricular pause over 3 seconds)
transcut pacing/ aderenaline / isoprenaline
transvenous pacing
48
ECG changes in bi fascicular block vs tri
bi: RBBB + LAD
tri: RBBB + LAD + 1st degree heart block
49
What is takotsubo cardiomyopathy
broken heart syndrome
transient apical ballooning of myocardium
ST elevation
Chest pain, HF symptoms
Self limiting
50
Causes of pericarditis
viral infection (coxsackie, tb)
autoimmune ra/sle
idiopathic
methotrexate
MI
malignancy - lung
hypothyroidism
51
Most common ECG finding for pericarditis
PR depression
52
When to give oxygen in ACS
When sats <92%
53
Most common organisms for endocarditis
staph aures (esp IVDU + <1yr valve)
strep viridians (>1 yr valve)
staph epidermis (following <2 months prosthetic valve surgery)
Enterococcus (GI)
HACEK if - culture - haemophilus, actinobacillus, cardiobacterium, eikenella, kingella
54
biopsy for GPA
necrotising granulomatosis (caseating granulomas)
55
Metabolic abnormality in renal tubular acidosis
Hyperchloraemic metabolic acidosis
Normal anion gap
56
Normal ECG variants in athletes
sinus bradycardia
1st degree AV block
Mobitz type 1
Junctional rhythm
57
ECG signs for MI
hyperacute t waves
st elevation
T waves inverted in 1st 24 hours and can last months
Pathological Q waves after several days indefinitely
58
ECG finding of hypocalcaemia vs hypercalcaemia
Hypo: prolonged QT
Hyper: shortened QT
59
Last line for HTN and K+>4.5
then alpha blocker (carvedilol) or b blocker instead of spironolactone
60
Features of brugada syndrome
cause of sudden cardiac death so need implantable cardio defibrillator
st segment elevation + partial rbbb - more prominent after flecainide so ix of choice
61
Types of RTA
1. in distal: can't secrete H+ therefore hypokal - RA, SLE - leads to renal stones
2. in proximal: less hco3 reabsorption therefore hypokal + osteomalacia - Wilsons + multiple myeloma - leads to osteomalacia
4. hyperkalaemic: less aldosterone means less ammonium secretion so hyperkal - in hypoald, diabetes
mx via oral bicarb to neutralise the acid
62
Hypovolaemic hyponatraemia urine Na <20 vs >20
<20 = non renal problem = d+v + pancreatitis
>20 = renal loss = thiazides, diuretics
63
Mx for hyponatraemia
- if hypovolaemic: normal nacl
- if hypervolaemic or euvolaemic: fluid restrict 500-1000ml/day +/- tolvaptan + furosemide
- if severe <120 or symptomatic then hypertonic saline 3%
64
Correction of hypernatraemia too fast vs hyponatraemia
Hyponatraemia: central pontine myelinolysis
Hypernatraemia: cerebral oedema
65
Causes of SIADH
Post operative
Pneumonia/tb
Head haemorrhage
SSRIs/carbamazepine
SCLC
Meningitis
SAH
66
Mx SIADH
Fluid restrict
Tolvaptan
Demeclocycline
67
Indications for primary prevention statin
QRISK >10%
T1DM >40yrs/>10yrs diagnosis/nephropathy/CVS risk f
CKD
68
Causes for diabetes insipidus
Cranial:
- trauma
- tumour
- tb
- meningitis
- sarcoidosis
- haemochromatosis
Nephrogenic:
- congenital
- lithium
- hypokal/hypercalc
- PCKD
69
Xray findings for primary hyperparathyroidism
osteopenia
erosion of terminal pharyngeal tufts
subperiosteal resorption of bone
70
Metabolic abnormality in addisonian crisis
hyperkalaemic metabolic acidosis
71
Mx for addisonian crisis
hydrocortisone 100mg every 6 hours
Oral replacement may begin after 24 hours and reduced to maintenance over 3-4 days
If hypoglycaemia 0.9% nacl over 1 hour
72
Diagnostic ix for Addisons disease
Short synacthen test
73
Metabolic abnormality for cushings syndrome
hypokalaemic metabolic alkalosis
74
Triad for prolactinoma
Amenorrhoea
Headaches
Bitemporal hemianopia
75
Somatostatin analogue medicine
GH receptor antagonist medicine
S: octreotide
GH: pegvisomant
76
Most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
77
What is a pituitary apoplexy
Sudden enlargement of a NFPA due to haemorrhage or infection
Leads to sudden onset vomit, headache, stiffness, visual defects
Needs urgent mri, steroids + surgery
78
Cancers associated with MEN
Phaeochromocytoma (2)
Medullary thyroid (2)
Insulinoma (1)
79
Mx for pheochromocytoma
a blocker phenoxybenzamine
then b blocker labetalol
then adrenalectomy
80
Complications of phaeochromocytoma
HTN crisis
Arrhythmias
Pulmonary oedema
Hyperglycemia
Encephalopathy
81
Features of CAH
Recessive where impairment of adrenal steroid synthesis so increase in ACTH which increases androgens
In f: ambiguous genitalia, precocious puberty, infertility, accelerated growth, salt wasting crisis
- ACTH stimulation test
82
What is a thyroid storm
- fever, tachycardia, confusion, n+v, htn
- need to treat underlying event, iv propranolol, antithyroid drugs, dexamethasone
83
What is myxoedema coma
Emergency hypothyroidism
Confusion and hypothermia
IV thyroid
IV fluids
IV steroids until adrenal insufficiency ruled out
Correct electrolyte imbalance
84
How to treat subclinical hypothyroidism
If TSH>10 on 2 separate occasions 3 months apart then levothyroxine
If <65yrs and 5.5-10 and symptoms then 6 month trial
If assymp retest in 6 months
85
Black man on amlodipine and needs additional
arb
86
Sick euthyroid syndrome features
asymptomatic
significant illness/trauma
dec t3/4
87
Metabolic abnormality in DKA
metabolic acidosis
increased anion gap
88
Acute vs chronic graft rejection
acute = <6 months
signs of infection
inc creatinine + proteinuria
89
Aldosterone: renin test
if >20 then low renin so primary hyperaldosteronism
if <20 then high renin so secondary hyperaldosteronism
90
Mx bilateral adrenal hyperplasia
spironolactone
91
Gastroparesis in diabetes features
erratic blood glucose control
bloating
vomiting
needs metoclopramide
92
Native endocarditis initial empirical treatment
iv amoxicillin
(vancomycin + rifampicin if prosthetic valve)
93
Causative organism for IVDU IE
staph aures
94
CXR findings for HF
Alveolar oedema (bat's wings)
Kerley B lines (interstitial oedema - perihilar shadowing)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
95
Valvular af + mechanical valve - what medicine??
warfarin
(if bioprosthetic valve = aspirin)
96
Features of takayasus arteritis
large vasculitis of aorta
young asian females
unequal bp in both arms
claudication
aortic regurgitation
renal artery stenosis
MR angiogram
needs steroids
97
Features of posterior stemi
ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
RCA
98
Causes of postural hypotension
hypovolaemia
diabetes
parkinsons
alcohol
diureitcs/antihtn/sedatives
99
Hypomagnesia mx
if <0.4 or seizures then iv mg
if >0.4 then oral mg salt (diarrhoea SE)
100
Mx post partum thyroiditis
propranolol
101
Features insulinoma
hypoglycaemia
rapid weight gain
high c peptide
ct
102
Pre-diabetes
hba1c 42-47 (6-6.4)
fasting 6.1-6.9
ogtt 7.8-11
103
Diagnosis of T2DM
OGTT >11
HbA1c >48 + symptoms (or repeated twice)
104
Diagnosis of T1DM
Fasting >7
Random >11.1
On 2 separate occasions if assymptomatic
105
ALS mx v fib/v tach
1. check pulse
2. if none then 3 synchronised shocks - with 2 mins cpr in between each one
3. adrenaline 1 in 10000 repeat every 3-5 + amiodarone
106
ALS mx pea/asystole
1. check pulse
2. if none then adrenaline + repeat every 3-5 mins and then cpr
107
Acute HF mx
oxygen
250ml bolus
iv furosemide
if htn dobutamine (b agonist makes heart pump harder) or vasopressors like adrenaline to cause vasoconstriction
CPAP if resp failure
