4/4/22

Question 1

What are the indications of dialysis?

Answer 1

AEIOU

Alkalosis 
Electrolyte (hyperkalaemia) 
Intoxication (poisoning)
Oedema - pulmonary
Uraemia (urea in blood)

Question 2

How do you diagnose Guillan Barre syndrome?

Answer 2

Nerve conduction studies
Lumbar puncture (L4-5) for CSF = raised protein

Question 3

What antibiotic do you give for neutropenic sepsis patients?

Answer 3

Tazobactam

Question 4

For each of the following urinalysis findings give a reasonable set of DD and what further investigations you would do:

• nitrites and leukocytes
• glucose
• glucose, ketones and low urine pH
• proteinuria
• blood

How do you manage UTI?

Answer 4

Nitrites and leukocytes = ? UTI = microscopy and culture = nitrofurantonin (3 days girls, 7 days boys)
Glucose = ?diabetes = cap blood glucose and HbA1c
Glucose, ketones and low urine pH = DKA = emergency admission = IV fluids, constant rate IV insulin 0.1unit/kg/hr, monitor K+, LMWH
Proteinuria = in pregnancy - pre-eclampsia, otherwise = nephrotic syndrome = HTN and oedema check in pregnancy, U+Es
Blood
= UTI, menstruation, malignancy of urine tract, nephritic syndrome, HUS, rhabdomyolysis
= CT KUB - check for urinary tract calculi
= culture and microscopy = UTI
= cytoscopy = bladder cancer
= FBC
= U+E’s - glomerulonephritis

Question 5

What must you assess in the urine before you put in the dipstick - describe what different findings you could see and what they mean?

Answer 5

Colour, clarity and smell

Colour

• red = blood = UTI, rhabdomyolsis, malignancy of urinary tract, nephritic syndrome, HUS, menstrutation
• dark yellow = increase in urobilinogen = haemolysis = haemolytic anaemia, malaria
• brown = raise in conjugated bilirubin = biliary obstruction

Clarity
= casts = UTI
= frothy = proteinuria

Smell

• fishy = UTI
• pear drop = ketones

Question 6

What is the nice way to remember CKD?

Answer 6

CKD Clock - draw it out now and compare to page under kidney page

Question 7

If complicated UTI that is causing sepsis what drug do you use?

Answer 7

IV amoxicillin and gentamicin

Drop down to PO co-amoxiclav

Question 8

If patient penicllin allergic how do you change IV MAG in sepsis?

Answer 8

IV vancomycin + MG`

Question 9

If patient doesn’t want Cu-IUD what emergency contraception do you offer them?

Answer 9

Ellaone (upsilateral acetate) - 3-5days post sex
- anti-progesterone

Levonelle (levonesgestrel) - =3 days post sex
- mega dose of progesterone

Ella is a mental bitch out all night = 3-5 days and fighting off men = ANTI-progesterone

Question 10

Explain pronator drift.

In what examination would you do it?

What does it indicate if it occurs when eyes open as opposed to when it occurs when eyes are closed?

Answer 10

Get patients to put hands out straight in front of them as though holding a tray and then stay like that for 10s with eyes open and then repeat again with eyes closed

Upper neuro exam

If happens when eyes are open = UMN lesion
If when eyes are closed = problem with propericopetion = dorsal column problem