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Cards on Lead Up to Exams > 14/4/22 > Flashcards

14/4/22 Flashcards

1
Q

Describe the method used to take blood glucose

A
  1. Check expiry date
  2. Insert strip into machine
  3. Wash patient hand
  4. Use lancet to take drop of blood
    - PUT IN SHARPS BIN -
  5. Push from proximal to distal
  6. Have machine vertical and get drop of blood
  7. Wipe with alcohol wipe and gauze
  8. Read the reading
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2
Q

What drug may be used in stress urinary incontience patients that don’t want surgery

A

Duloxetine

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3
Q

How many synapses in a reflex?

A

1

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4
Q

How can you tell the difference between anterior and posterior roots (beyond just location)?

A

Posterior root has a lump in it called the ganglion - made up of cell bodies

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5
Q

Once the roots join together they become the spinal nerve - then they split into what?

A

Anterior and posterior rami

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6
Q

The anterior and posterior roots are responsible for carrying axons responsible for what kind of thing?

A

Anterior - motor

Posterior - sensory

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7
Q

Where is there localisation in Weber’s test?

A

Best in normal ear - sensironeural

Best in abnormal ear - conduction

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8
Q

Where is bone marrow biopsied from?

A

Posterior iliac crest - adults

Tibia - kids

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9
Q

What’s the nice way to remember what ages are affected by different leukemias?

A

ALL CeLLmates have CoMmon AMbitions

ALL - <5 and >45
CLL - >55
CML - >65
AML ->75

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10
Q

What are leukemias?

A

Increase in the number of non-functioning WBC

In chronic - slow
In acute - fast process

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11
Q

What investigations would you like to do if you suspect leukemia?

What would make you suspect it?

A

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)

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12
Q

What blood result would you expect to see in CLL?

What age normally?

Same questions for CML

A

High levels of WCC (due to huge increase in lymphoblasts)

> 55

High levels of mature granulocytes

> 65

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13
Q

What kind of pain may patients present with in leukemia?

Why?

A

~ in acute - painful lymph nodes

Upper abdo pain due to hepatsplenomegaly

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14
Q

What lymphadenopathy gets extermely painful when drinking alcohol?

What do you see on biopsy of this?

A

Hodgkin’s lymphoma

Reed-sternberg cells

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15
Q

What do B symptoms suggest with regard to prognosis?

A

Presence of B symptoms suggests a worse prognosis

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16
Q

What is used as prophylaxis of tumour lysis syndrome?

In what situations does it occur?

A

Allopurinol

After chemotherapy - tumours breaking down and releasing potassium - leads to hyperkalaemia

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17
Q

What kind of leukemia is associated with warm autoimmune hameolytic anaemia?

A

CLL

LL = licking lollies in the sun = warm

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18
Q

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?

A

Polycythaemia vera = JAK2 mutation

At high risk of STROKE

Present

  • plethoric facies (red puffy face - similar to Cushing’s)
  • Headaches
  • dizziness
  • tirednes
19
Q

Other than generalised purpura what other clinical finding may you see in DIC?

A
  • Remember can be seen in septic patients -

Haematuria

20
Q

What is found in Fresh Frozen plasma?

A

Clotting factors

21
Q

What is the first line management of DIC

A

FFP

22
Q

What effect does DIC have on platelets?

A

Reduces them

23
Q

What needs to have happened to diagnose tumour lysis syndrome?

A
  • Increased serum creatine
  • cardiac arrythmia or sudden death
  • seizure
24
Q

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?

A

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
25
Q

Philadelphia chromosome is associated with CML. What translocation occurs as a result?

A

9:22

26
Q

What is the threshold on blood transfusion in patients without ACS?

ACS = acute coronary syndrome

A

70

27
Q

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
A

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

28
Q

What is the nice way to remember how to manage and assess AKI?

A

RENAL DRS26

Record baseline creatine
Exclude obstruction 
Nephrotoxic drugs stopped
Asess fluid status
Losses +/- cathetirisation

Dipstick
Review meds
Screen (consider acute renal screen)

29
Q

Describe how you assess AKI stages

A

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
30
Q

You are in OSCE just having done a urinalysis station.

Asked what are your causes of AKI.

A

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
31
Q

What are important to invx AKI?

A

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

32
Q

How do you manage the different causes of AKI?

A

REGULAR MONITORING

Pre-renal

  • ABCDE
  • fluid hydration

Renal

  • renal screen
  • urine markers to assess

Post-renal
- cathretise
- remove obstruction
~fluid restrict

33
Q

What drugs are renally excreted that should be suspened?

A

Metformin, lithium and digoxin

34
Q

Go over AEIOU again for dialysis

A 
Acidosis (<7.2)
Electrolyte imbalance (potassium >7)
Intoxication 
Oedema 
Uraemia
35
Q

What blood volume levels do you get in SIADH?

What Na+ results?

A

EUVOLVOMEIC

Hyponatremia

36
Q

How do you manage hyponatremia based on different fluid levels.

A

Hypovolaemic
- IV fluids

Euvoloemic

  • SIADH
  • restrict fluid intake
  • “-vaptans” - block ADH receptors

Hypervolemic

  • reduce fluid intake
  • treat underlying cause
37
Q

What is the complication of correcting sodium too quickly?

A

Central pontine myelinolysis and cerebral oedema

38
Q

What GI problem can cause high urea?

A

GI bleed

39
Q

What do you use to manage hyperphosphatemia

A

Calcium acetate - calcium binder

40
Q

What happens to potassium excretion in kidney problems?

A

Reduced - which means potassium should be high

41
Q

How do you manage hypokalaemia?

A

Asymptomatic
- oral potassium chloride

Symptomatic

  • IV saline with potassium chloride
  • check and correct Mg
42
Q

A eGFR staging of 1-2 needs signs of what to signify CKD?

A

Kidney damage - proteinuria or haematuria

43
Q

Name 4 causes of CKD?

A 
Diabetes
HTN 
Chronic glomerulonephritis
PKD - polycystic kidney disease
Renal artery stenosis
44
Q

What makes acute vs chronic rejection of kidney?

A

Acute <6mnths - cell mediated

Chronic >6mnths

Cards on Lead Up to Exams (41 decks)

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