14/4/22 Flashcards
Describe the method used to take blood glucose
- Check expiry date
- Insert strip into machine
- Wash patient hand
- Use lancet to take drop of blood
- PUT IN SHARPS BIN - - Push from proximal to distal
- Have machine vertical and get drop of blood
- Wipe with alcohol wipe and gauze
- Read the reading
What drug may be used in stress urinary incontience patients that don’t want surgery
Duloxetine
How many synapses in a reflex?
1
How can you tell the difference between anterior and posterior roots (beyond just location)?
Posterior root has a lump in it called the ganglion - made up of cell bodies
Once the roots join together they become the spinal nerve - then they split into what?
Anterior and posterior rami
The anterior and posterior roots are responsible for carrying axons responsible for what kind of thing?
Anterior - motor
Posterior - sensory
Where is there localisation in Weber’s test?
Best in normal ear - sensironeural
Best in abnormal ear - conduction
Where is bone marrow biopsied from?
Posterior iliac crest - adults
Tibia - kids
What’s the nice way to remember what ages are affected by different leukemias?
ALL CeLLmates have CoMmon AMbitions
ALL - <5 and >45
CLL - >55
CML - >65
AML ->75
What are leukemias?
Increase in the number of non-functioning WBC
In chronic - slow
In acute - fast process
What investigations would you like to do if you suspect leukemia?
What would make you suspect it?
In chronic typically asymptomatic ~
- huge hepatosplenomegaly
- bone marrow failure - infections, anaemia, bleedings
- painless lymphadenopathy
Acute
- similar but can cause painful lympadenopathy
- bone/joint pain
Full blood count
Blood film
Bone marrow aspirate
Chromosomal analysis (check for Philadelipha’s chromosome)
What blood result would you expect to see in CLL?
What age normally?
Same questions for CML
High levels of WCC (due to huge increase in lymphoblasts)
> 55
High levels of mature granulocytes
> 65
What kind of pain may patients present with in leukemia?
Why?
~ in acute - painful lymph nodes
Upper abdo pain due to hepatsplenomegaly
What lymphadenopathy gets extermely painful when drinking alcohol?
What do you see on biopsy of this?
Hodgkin’s lymphoma
Reed-sternberg cells
What do B symptoms suggest with regard to prognosis?
Presence of B symptoms suggests a worse prognosis
What is used as prophylaxis of tumour lysis syndrome?
In what situations does it occur?
Allopurinol
After chemotherapy - tumours breaking down and releasing potassium - leads to hyperkalaemia
What kind of leukemia is associated with warm autoimmune hameolytic anaemia?
CLL
LL = licking lollies in the sun = warm
Describe the presentation of a patient who has a condition as a result of her JAK2 mutation.
What should she be warned she is at high risk of developing?
Polycythaemia vera = JAK2 mutation
At high risk of STROKE
Present
- plethoric facies (red puffy face - similar to Cushing’s)
- Headaches
- dizziness
- tirednes
Other than generalised purpura what other clinical finding may you see in DIC?
- Remember can be seen in septic patients -
Haematuria
What is found in Fresh Frozen plasma?
Clotting factors
What is the first line management of DIC
FFP
What effect does DIC have on platelets?
Reduces them
What needs to have happened to diagnose tumour lysis syndrome?
- Increased serum creatine
- cardiac arrythmia or sudden death
- seizure
What drug should be used in sickle cell anaemia to reduce disease severity?
Aplastic crisis and sequestrion crisis can present in v similiar ways - how do you tell the difference? What are they?
Hydroxycarbamide
Can both cause worsening of anaemia
- Aplastic crisis is bone marrow suppresion due to parovirus infection and leads to anameia, low reticulocytes
- Sequestrion crisis is when due to sickling blood is pooling in the organs which leads to reduced blood in vasculature -> anaemia BUT HIGH RETICULOCYTES due to body trying to combat the anameia
Philadelphia chromosome is associated with CML. What translocation occurs as a result?
9:22
What is the threshold on blood transfusion in patients without ACS?
ACS = acute coronary syndrome
70
What are each of the following blood cell abnormalities associated with:
- Howell-Jolly bodies
- target cells
- basinophilic stippling
- smear/smudge cells
- spherocytes
- tear drop polikocytes
- rouleaux formation
- pencil polikocytes
- Heinz bodies
- schistocytes
Howell-Jolly bodies
- remenants of nuclei in RBC normally removed by spleen
= no spleen
= hyposplenism e.g. coeliac disease + coeliac disease
Target cells - abnormal Hb = Fe+ anaemia = no spleen/hyposplenism = liver disease = thalassemia
Basinophilic stippling = sideroblastic anaemia
Smear/smudge cells = CLL
Spherocytes = heridertary spherocytosis
Tear drop polikocytes = myelofibrosis
Rouleaux formation = myeloma
Pencil polikocytes = Fe anaemia
Heinz bodies - denatured Hb = G6PD deficency
Schistocytes = damaged RBC
= intravascular haemolysis - due to …
- mechanical causes e.g. mechanical heart valve
- DIC
What is the nice way to remember how to manage and assess AKI?
RENAL DRS26
Record baseline creatine Exclude obstruction Nephrotoxic drugs stopped Asess fluid status Losses +/- cathetirisation
Dipstick
Review meds
Screen (consider acute renal screen)
Describe how you assess AKI stages
Stage 1
- 1.5x increase in creatine
- <0.5ml urine/kg/hr for 6hrs
Stage 2
- 2x increase in creatine
- <0.5ml/kg/hr in 12 hrs
Stage 3
- 3x increase in creatine
- <0.3ml/kg/hr in 24hrs
You are in OSCE just having done a urinalysis station.
Asked what are your causes of AKI.
Most common is pre-renal (due to inadequate blood supply)
- hypovolomeia
- dehydration
- heart failure
Then post-renal (an obstruction in getting urine from the kidneys)
- renal stones
- tumours
- benign prostatic hyperplasia (BPH)
Then renal
- acute tubular necrosis
- glomerulonephritis
What are important to invx AKI?
Bloods
- FBC
- U+E
- LFTs
- albumin (check for nephrotic syndrome)
ABGs
- acidosis
URINE DIP
- check for proteins and blood - if present check for protein:creatine ratio
- osmolality
- ~ Bence Jones protein
USS if think post-renal
How do you manage the different causes of AKI?
REGULAR MONITORING
Pre-renal
- ABCDE
- fluid hydration
Renal
- renal screen
- urine markers to assess
Post-renal
- cathretise
- remove obstruction
~fluid restrict
What drugs are renally excreted that should be suspened?
Metformin, lithium and digoxin
Go over AEIOU again for dialysis
Acidosis (<7.2) Electrolyte imbalance (potassium >7) Intoxication Oedema Uraemia
What blood volume levels do you get in SIADH?
What Na+ results?
EUVOLVOMEIC
Hyponatremia
How do you manage hyponatremia based on different fluid levels.
Hypovolaemic
- IV fluids
Euvoloemic
- SIADH
- restrict fluid intake
- “-vaptans” - block ADH receptors
Hypervolemic
- reduce fluid intake
- treat underlying cause
What is the complication of correcting sodium too quickly?
Central pontine myelinolysis and cerebral oedema
What GI problem can cause high urea?
GI bleed
What do you use to manage hyperphosphatemia
Calcium acetate - calcium binder
What happens to potassium excretion in kidney problems?
Reduced - which means potassium should be high
How do you manage hypokalaemia?
Asymptomatic
- oral potassium chloride
Symptomatic
- IV saline with potassium chloride
- check and correct Mg
A eGFR staging of 1-2 needs signs of what to signify CKD?
Kidney damage - proteinuria or haematuria
Name 4 causes of CKD?
Diabetes HTN Chronic glomerulonephritis PKD - polycystic kidney disease Renal artery stenosis
What makes acute vs chronic rejection of kidney?
Acute <6mnths - cell mediated
Chronic >6mnths
