23/05/22 Flashcards
histopathology findings of coeliac
sub-total villous atrophy, crypt hyperplasia, and intra-epithelial lymphocytes
scoring system for cirrhosis
what is it called?
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
child pugh a
<7
b child pugh?
7-9
child pugh >9?
c
mx of decompensated liver disease
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
features of liver disease?
encephalopathy
abnormal bleeds
ascites
jaundice
hepatic encephalopathy
Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
Drowsiness, confusion, slurring of speech and personality change
Incoherency, restlessness, asterixis
Coma
if pt is bleeding what do you give them?
FFP
Management of decompensated liver disease
how to avoid encephalopathy?
lactulose and rifaximin
high risk of SBP?
low albumin, a high INR and low ascitic albumin
in wilsons disease liberation of copper causes what?
causes Coomb’s negative haemolytic anaemic, with transient episodes of low-grade haemolysis and jaundice
wilson Ix
Urinary copper is high and a 24-hour urine collection is the investigation of choice when screening for Wilson disease
diabetes
jaundice
joint pain
point to ?
haemochromatosis
disrupts normal tissue > cirrhosis
pancreatic insufficency and HF
mx for Haemochromatosis
desferrioxamine
iron chelating agent
treatment for wilsons?
penicillamine
abdo pain
diarrhoea
flush and wheeze?
carcinoid
urinary 5-HiAA
non urgent OGD
haematemesis >55 dyspepsia low haem raised platelets
dyspepsia undiagnosed
review meds
lifestyle
PPI or H pylori testa nd treat
H pylori
carbon 13 urea breath test
mx of severe alcoholic hepatitis
corticosteroids
features of wernickes
mx?
ophtalmoplegia/ nystagmus
ataxia
confusion
peripheral sensory neuropathy
pabrinex/ urgent thiamine
delirium tremens
chronic alcohol consumption does what to GABA?
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
ulnar nerve damage at elbow
radial deviation of wrist
more severe ulnar clawing
ulnar nerve damage at wrist?
motor
claw hand
wasting and paralysis of intrinsic hand muscles
hypothenar muscles
ulnar nerve damage at wrist
sensory?
loss to medial 1 1/2 fingers palmar/dorsal aspect
peroneal nerve lesion
foot drop
foot eversion is weak - so moving to side
weakness of toe extension
wasting of anterior tibial and peroneal muscles
sensory loss over the dorsum of the foot and the lower lateral part of the leg
common peroneal nerve lesion
causes of a bilateral facial nerve palsy
sarcoidosis
guillain barre syndrome
lyme
neurofibromatos type 2
csf leak headache why? features ix? mx?
spontaneous intracranial hypotension
marfan is a risk factor
strong postural headache worse upright
bed bound pt
MRI w gadolinium
friedrichs ataxia
lateral corticospinal tracts
dorsal column
bilateral spastic paresis, loss of vibration and proprioception
poor coordination bilateral in limbs
cerebeller ataxia - intention tremor
anterior spinal artery occlusion
bilateral spastic paresis
loss of pain and temp sensation as lateral spinothalemic tracts affected
if only sensory loss of proprioception and vibration?
Neurosyphilis - bacterial infection of brain / spinal cord
what does an absent cremasteric reflex suggest?
testicular torsion
short hx of diarrhoea and vomiting
what ?
what causative agent
CHESS
camplyobacter jejuni haemorrhagic e.coli entamoeba histolytica salmonella shigella
rice water stools?
vibrio cholerae
non-bloody diarrhoea, abdominal cramps and foul-smelling flatulence and belching
giardia
giardiasis
parasite
worst headache ever
what?
if the patient has bilateral palpable masses in abdo what does this then make you think?
subarachnoid haemorrhage on backdrop of PKD
Pt young started on acei
then suffers an AKI
what can be the cause?
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
why does a acute interstial nephritis occur and how does it present?
adverse reaction to a drug
fever rash nausea and vomiting
2 steps of hyperkalaemia mangement?
10ml 10% calcium gluconate
50ml of 50% dextrose with 1u of insulin
most common cause of gas gangrene
c perfringens
cavitating lesions lung cancer which type?
squamous cell
‘giant V waves’ in the JVP
incompetent tricuspid valve - tri regurg
is characterised by slightly depressed reddish-brown patches that most frequently occur on the shins
Diabetic dermopathy
Reverse tick sign
on ecg?
mx?
digoxin toxicity
why does intermittent claudication present with erectile dysfunction?
there is partial occlusion of aorta at point it becomes iliac arteries
aortoiliac occlusive disease
it is defined by cramping pain on exertion
cramping pain on walking in buttocks
erectile dysfunction
absent / reduced distal pulses is what?
Leriche Syndrome - intermittent claudication
Lumbar spinal stenosis
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
luts
lower urinary tract symptoms
storage system problem urology
FUN
frequency
urgency
nocturia
voiding symptoms
wise weak stream intermittency straining incomplete Emptying
what can most reliably confirm a diagnosis of prostate cancer
transrectal ultrasound
what set of symptoms are irritative
urology
FUN
frequency
urgency
nocturia
what urinary symptoms are obstructive
WISE weak stream intermittency straining incomplete Emptying
prostate cancer metastatic
bone pain
cord compression
if prostate cancer suspected but TRUS is negative what should you do?
MP-MRI
surgical management of BPH
TURP
bladder cancer most common type
urothelial carcinoma
rf for urothelial carcinoma
smoking carcinogen exposure amines painters hairdressers
squamous cell carcinoma of bladder cancer causes?
anything that causes inflammation
schistomiosis
recurrent uti
gold standard investigation of bladder cancer
cystoscopy
intrinsic causes of AKI?
ATN AIN glomerulonephritis rhabdmyolysis tumour lysis syndrome
prerenal causes of AKI?
hypovolaemia 20 to diarrhoea and vomiting
renal artery stenosis
nephrotoxic drug potential - risk of AKI
acei
arb
diuretics
aminoglycosides
increased risk of toxicity but doesnt worsen aki?
metformin
digoxin
lithium
safe meds to continue in AKI
paracetamol warfarin statins aspirin - 75 clop beta blocker
when is haemodialysis indicated
hyperkalaemia, pulmonary oedema, acidosis or uraemia
A 35-year-old man who has a history of hypertension and subarachnoid haemorrhage presents with recurrent UTIs and episodic haematuria -
autosomal dominant polycystic kidney disease
Raised anion gap
lactate: shock, sepsis, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
recent urti and now macroscopic haematuria ?
iga glomerulonephritis
Normal serum urea:creatinine ratio
acute tubular necrosis
raised serum urea: creatinine
prerenal
gynaecostia which drugs?
digoxin
spironolactone
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
good pastures
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?
constipation can cause outflow obstruction and trigger episodes of retention in patients with enlraged prostates
what class of drugs can inhibit detrusor and trigone activity?
anticholinergics
amitryptilline
5alpha Hia reductase example
finesteride
complications of arteriovenous fistulas
infection
tjrombosis
stenosis
steal syndrome
how long does a arteriovenous fistula take to form?
6-8 weeks
what is henoch schonlein purpura
IgA small vessel vasculitis
seen in childrene
(with localized oedema) over buttocks and extensor surfaces of arms and legs
purpuric rash
self limiting
what variables required for creatinine clearance
age
gender
weight
creatinine
which abx for uti is not safe in pregnant women?
trimethorprim
use nitrofurantoin instead
CKD starting ACEi but eGFR has gone down when should you change the drug?
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
why is high phosphate of CKD harmful for bones?
mx?
phosphate PULLs calcium from bones = osteomalacia
sevelamer
how do you screen for ADPKD?
ultrasound
fallen by 3
what is the most common cause of AKI?
if this was an elderly person with a recent fall
acute tubular necrosis
on basis of nephrotoxin rhabdomyolsis
The mainstay of rhabdomyolysis treatment
is rapid IV fluid rehydration
Polyuria and polydipsia with low potassium and without evidence of DM -
think of diabetes insipidus
FSGS
nephrotic syndrome biopsy results?
focal and segmental sclerosis on light microscopy and foot process effacement under electron microscopy
FEV1 < 0.8 and FEV1:FVC >0.7
is the typical pattern seen in restrictive lung disease, in which both FEV1 and FVC are reduced
decrease in FVC is greater than FEV1
risk of developing pressure sores
waterlow score
symptoms of Conn
hypertension and hypokalaemia due to too much sodium retention
which can cause nephrogenic DI
leading to polyuria, polydipsia
hypokalaemia signs?
u waves
red green blindness asscoiated with which TB drug?
ethambutol
horner syndrome
is the pupil constricted or dilated?
constricted pupil - myosis
partial ptosis
anhyidrosis - inability to sweat
