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Year 3 difficult topics > 23/05/22 > Flashcards

23/05/22 Flashcards

1
Q

histopathology findings of coeliac

A

sub-total villous atrophy, crypt hyperplasia, and intra-epithelial lymphocytes

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2
Q

scoring system for cirrhosis

what is it called?

A 
Score	1	2	3
Bilirubin (umol/l)	
<34	
34-51	
>51
Albumin (g/l)	
>35	
28-35	
<28
Prothrombin time (seconds prolonged)	
<4	
4-6	
>6
Encephalopathy	
none	
mild	
marked
Ascites	
none	
mild	
marked

child pugh

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3
Q

child pugh a

A

<7

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4
Q

b child pugh?

A

7-9

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5
Q

child pugh >9?

A

c

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6
Q

mx of decompensated liver disease

A

etoh abstinence
nsaid/opiates/sedatives avoided
uss/ a fetoprotein
colestyramine- to manage pruritus

ascites managment : fluid restrict 1.5l, fureseomide, therpeutic paracentesis
lactulose and rifaximin use

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7
Q

features of liver disease?

A

encephalopathy
abnormal bleeds
ascites
jaundice

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8
Q

hepatic encephalopathy

A

Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
Drowsiness, confusion, slurring of speech and personality change
Incoherency, restlessness, asterixis
Coma

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9
Q

if pt is bleeding what do you give them?

A

FFP

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10
Q

Management of decompensated liver disease

how to avoid encephalopathy?

A

lactulose and rifaximin

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11
Q

high risk of SBP?

A

low albumin, a high INR and low ascitic albumin

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12
Q

in wilsons disease liberation of copper causes what?

A

causes Coomb’s negative haemolytic anaemic, with transient episodes of low-grade haemolysis and jaundice

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13
Q

wilson Ix

A

Urinary copper is high and a 24-hour urine collection is the investigation of choice when screening for Wilson disease

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14
Q

diabetes
jaundice
joint pain

point to ?

A

haemochromatosis
disrupts normal tissue > cirrhosis

pancreatic insufficency and HF

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15
Q

mx for Haemochromatosis

A

desferrioxamine

iron chelating agent

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16
Q

treatment for wilsons?

A

penicillamine

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17
Q

abdo pain
diarrhoea
flush and wheeze?

A

carcinoid

urinary 5-HiAA

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18
Q

non urgent OGD

A 
haematemesis 
>55
dyspepsia 
low haem 
raised platelets
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19
Q

dyspepsia undiagnosed

A

review meds
lifestyle
PPI or H pylori testa nd treat

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20
Q

H pylori

A

carbon 13 urea breath test

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21
Q

mx of severe alcoholic hepatitis

A

corticosteroids

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22
Q

features of wernickes

mx?

A

ophtalmoplegia/ nystagmus

ataxia
confusion

peripheral sensory neuropathy

pabrinex/ urgent thiamine

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23
Q

delirium tremens

chronic alcohol consumption does what to GABA?

A

enhance GABA inhibition and inhibits NMDA glutamte excitatory receptors

so when alcohol withdrawal happens inhibitory GABA is decreased causing

tremor, sweating, tachycardia,anxiety , seizures, confusion, delusions etc

Mx chlordiazepoxide

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24
Q

ulnar nerve damage at elbow

A

radial deviation of wrist

more severe ulnar clawing

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25
Q

ulnar nerve damage at wrist?

motor

A

claw hand
wasting and paralysis of intrinsic hand muscles
hypothenar muscles

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26
Q

ulnar nerve damage at wrist

sensory?

A

loss to medial 1 1/2 fingers palmar/dorsal aspect

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27
Q

peroneal nerve lesion

A

foot drop
foot eversion is weak - so moving to side
weakness of toe extension
wasting of anterior tibial and peroneal muscles

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28
Q

sensory loss over the dorsum of the foot and the lower lateral part of the leg

A

common peroneal nerve lesion

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29
Q

causes of a bilateral facial nerve palsy

A

sarcoidosis
guillain barre syndrome
lyme
neurofibromatos type 2

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30
Q 
csf leak headache 
why?
features
ix?
mx?
A

spontaneous intracranial hypotension
marfan is a risk factor

strong postural headache worse upright
bed bound pt

MRI w gadolinium

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31
Q

friedrichs ataxia

A

lateral corticospinal tracts
dorsal column
bilateral spastic paresis, loss of vibration and proprioception
poor coordination bilateral in limbs

cerebeller ataxia - intention tremor

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32
Q

anterior spinal artery occlusion

A

bilateral spastic paresis

loss of pain and temp sensation as lateral spinothalemic tracts affected

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33
Q

if only sensory loss of proprioception and vibration?

A

Neurosyphilis - bacterial infection of brain / spinal cord

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34
Q

what does an absent cremasteric reflex suggest?

A

testicular torsion

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35
Q

short hx of diarrhoea and vomiting
what ?

what causative agent
CHESS

A 
camplyobacter jejuni
haemorrhagic e.coli
entamoeba histolytica 
salmonella 
shigella
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36
Q

rice water stools?

A

vibrio cholerae

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37
Q

non-bloody diarrhoea, abdominal cramps and foul-smelling flatulence and belching

A

giardia
giardiasis
parasite

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38
Q

worst headache ever
what?

if the patient has bilateral palpable masses in abdo what does this then make you think?

A

subarachnoid haemorrhage on backdrop of PKD

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39
Q

Pt young started on acei
then suffers an AKI
what can be the cause?

A

renal artery stenosis as it is a secondary cause of AKI
acei is contraindicated

reduced blood flow to kidneys is compensated by RAAS to maintain pressure across glomerulus

40
Q

why does a acute interstial nephritis occur and how does it present?

A

adverse reaction to a drug

fever rash nausea and vomiting

41
Q

2 steps of hyperkalaemia mangement?

A

10ml 10% calcium gluconate

50ml of 50% dextrose with 1u of insulin

42
Q

most common cause of gas gangrene

A

c perfringens

43
Q

cavitating lesions lung cancer which type?

A

squamous cell

44
Q

‘giant V waves’ in the JVP

A

incompetent tricuspid valve - tri regurg

45
Q

is characterised by slightly depressed reddish-brown patches that most frequently occur on the shins

A

Diabetic dermopathy

46
Q

Reverse tick sign
on ecg?
mx?

A

digoxin toxicity

47
Q

why does intermittent claudication present with erectile dysfunction?

A

there is partial occlusion of aorta at point it becomes iliac arteries
aortoiliac occlusive disease

it is defined by cramping pain on exertion

48
Q

cramping pain on walking in buttocks
erectile dysfunction
absent / reduced distal pulses is what?

A

Leriche Syndrome - intermittent claudication

49
Q

Lumbar spinal stenosis

A

narrowing of spinal canal pain in LL when walking or standing for long period of time
pain is eased by bending forward or sitting down

50
Q

luts

A

lower urinary tract symptoms

51
Q

storage system problem urology

A

FUN
frequency
urgency
nocturia

52
Q

voiding symptoms

A 
wise
weak stream
intermittency
straining 
incomplete Emptying
53
Q

what can most reliably confirm a diagnosis of prostate cancer

A

transrectal ultrasound

54
Q

what set of symptoms are irritative

urology

A

FUN
frequency
urgency
nocturia

55
Q

what urinary symptoms are obstructive

A 
WISE
weak stream 
intermittency 
straining
incomplete Emptying
56
Q

prostate cancer metastatic

A

bone pain

cord compression

57
Q

if prostate cancer suspected but TRUS is negative what should you do?

A

MP-MRI

58
Q

surgical management of BPH

A

TURP

59
Q

bladder cancer most common type

A

urothelial carcinoma

60
Q

rf for urothelial carcinoma

A 
smoking 
carcinogen exposure 
amines
painters 
hairdressers
61
Q

squamous cell carcinoma of bladder cancer causes?

A

anything that causes inflammation
schistomiosis
recurrent uti

62
Q

gold standard investigation of bladder cancer

A

cystoscopy

63
Q

intrinsic causes of AKI?

A 
ATN
AIN
glomerulonephritis 
rhabdmyolysis 
tumour lysis syndrome
64
Q

prerenal causes of AKI?

A

hypovolaemia 20 to diarrhoea and vomiting

renal artery stenosis

65
Q

nephrotoxic drug potential - risk of AKI

A

acei
arb
diuretics
aminoglycosides

66
Q

increased risk of toxicity but doesnt worsen aki?

A

metformin
digoxin
lithium

67
Q

safe meds to continue in AKI

A 
paracetamol 
warfarin
statins 
aspirin - 75
clop
beta blocker
68
Q

when is haemodialysis indicated

A

hyperkalaemia, pulmonary oedema, acidosis or uraemia

69
Q

A 35-year-old man who has a history of hypertension and subarachnoid haemorrhage presents with recurrent UTIs and episodic haematuria -

A

autosomal dominant polycystic kidney disease

70
Q

Raised anion gap

A

lactate: shock, sepsis, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol

71
Q

recent urti and now macroscopic haematuria ?

A

iga glomerulonephritis

72
Q

Normal serum urea:creatinine ratio

A

acute tubular necrosis

73
Q

raised serum urea: creatinine

A

prerenal

74
Q

gynaecostia which drugs?

A

digoxin

spironolactone

75
Q

normal anion gap met acidosis
a 30-year-old man presents with haemoptysis and renal failure. A renal biopsy shows linear IgG deposits along the basement membrane

A

good pastures

76
Q

urinary retention in 69yr old
670ml of residual volume on catheterisation
enlarged prostate on DRE

fullness in LLQ
dilated loops of bowel on xray

cause of retention?

A

constipation can cause outflow obstruction and trigger episodes of retention in patients with enlraged prostates

77
Q

what class of drugs can inhibit detrusor and trigone activity?

A

anticholinergics

amitryptilline

78
Q

5alpha Hia reductase example

A

finesteride

79
Q

complications of arteriovenous fistulas

A

infection
tjrombosis
stenosis
steal syndrome

80
Q

how long does a arteriovenous fistula take to form?

A

6-8 weeks

81
Q

what is henoch schonlein purpura

A

IgA small vessel vasculitis
seen in childrene

(with localized oedema) over buttocks and extensor surfaces of arms and legs
purpuric rash

self limiting

82
Q

what variables required for creatinine clearance

A

age
gender
weight
creatinine

83
Q

which abx for uti is not safe in pregnant women?

A

trimethorprim

use nitrofurantoin instead

84
Q

CKD starting ACEi but eGFR has gone down when should you change the drug?

A

NICE suggest that a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable, although any rise should prompt careful monitoring and exclusion of other causes (e.g. NSAIDs

85
Q

why is high phosphate of CKD harmful for bones?

mx?

A

phosphate PULLs calcium from bones = osteomalacia

sevelamer

86
Q

how do you screen for ADPKD?

A

ultrasound

fallen by 3

87
Q

what is the most common cause of AKI?

if this was an elderly person with a recent fall

A

acute tubular necrosis

on basis of nephrotoxin rhabdomyolsis

88
Q

The mainstay of rhabdomyolysis treatment

A

is rapid IV fluid rehydration

89
Q

Polyuria and polydipsia with low potassium and without evidence of DM -

A

think of diabetes insipidus

90
Q

FSGS

nephrotic syndrome biopsy results?

A

focal and segmental sclerosis on light microscopy and foot process effacement under electron microscopy

91
Q

FEV1 < 0.8 and FEV1:FVC >0.7

A

is the typical pattern seen in restrictive lung disease, in which both FEV1 and FVC are reduced
decrease in FVC is greater than FEV1

92
Q

risk of developing pressure sores

A

waterlow score

93
Q

symptoms of Conn

A

hypertension and hypokalaemia due to too much sodium retention
which can cause nephrogenic DI
leading to polyuria, polydipsia

94
Q

hypokalaemia signs?

A

u waves

95
Q

red green blindness asscoiated with which TB drug?

A

ethambutol

96
Q

horner syndrome

is the pupil constricted or dilated?

A

constricted pupil - myosis
partial ptosis
anhyidrosis - inability to sweat

Year 3 difficult topics (22 decks)

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