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All notes Flashcards

1
Q

Do type 1 diabetes present acutely with ketosis?

A

Yes

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2
Q

Symptoms of Diabetes

A

Tiredness, lethargy

Polyuria and polydipsia–

Glucose SLOWLY rises further

With other co-morbidities it become difficult to drink enough–Osmotic diuresis causes loss of water and a rise in sodium–EVENTUALLY the glucose is VERY high, as is the sodium

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3
Q

How do you calculate Ion gap?

A

+ve + -ve = osmolality

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4
Q

What are the microvascular complications of diabetes? How?

A

Retinopathy
Nephropathy
Neuropathy

Glycosylation of basement membrane proteins - leaky capillaries

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5
Q

What are the microvascular complications of diabetes?

A

Dyslipidaemia, hypertension, hypercholesterolaemia

Leads to:

–IHD–CVA–Peripheral gangrene

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6
Q

What do features are there on diabetic retinopathy

A 
Hard exudates (cholesterol)
•Microaneurysms (“dots”)
•Blot haemorrhages
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7
Q

Treatment for background diabetic retinopathy?

A

Improve blood glucose control

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8
Q

What does ischaemia of the eye cause? Why is that bad?

A

New vessels to grow

Blindness

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9
Q

Management of diabetic retinopathy (proliferative and pre proliferative)

A

Cotton wool spot - suggests ischaemia

Pan retinal photocoagulation

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10
Q

Management of hyperglycaemia (in order)

A

Diet and exercise
•Biguanide (Metformin)
•Sulphonylureas (eg gliclazide)
•Insulin sensitisers : thiozolidinediones such as rosiglitazone or pioglitazone
•Insulin itself (there are several new insulin analogues now available)
•Incretins (GLP-1 analogues)
•Gliptins (Dipeptidyl peptidase 4 inhibitors)

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11
Q

Examples of insulin analogues

A

Long acting - zinc suspension

Short acting - insulatard and actrapid

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12
Q

Advantages of using insulin

A

Can give best control of HbA1c when combined with diet and exercise.
•No side effects (compared to : )
•metformin (diarrhoea)
•SU (occasional reactions) •thiazolidinediones (rare hepatic, ?osteoporosis

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13
Q

Disadvantages of using insulin

A 
If you drive HGV, cannot work
•(exenatide exempt)
•Hypoglycaemia common with good control
•Weight gain
•Increased insulin as a consequence
•Huge doses required in patients with type 2 diabetes
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14
Q

Affects of GLP1

A

Increased insulin
Reduce gastric emptying
increased hypothalamic satiety

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15
Q

Examples of GLP1 analogues

A

exanatide
liraglutide
semaglutide

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16
Q

Do SGLT2 inhibitors have a cardiovascular benefit

A

Yes

On kidney

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17
Q

Signs of diabetic nephropathy

A

Hypertension
Increased proteinuria >3000g
Renal failure
Histological signs

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18
Q

Histological features of diabetic nephropathy

A

Glomerular - mesangial expansion, basement membrane thickening, glomerulosclerosis

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19
Q

Epidemiology of diabetic nephrology

A

Age
racial factors
loss of cv morbidity

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20
Q

Stages for treatment of D. Nephro

A

Diabetic control
•Blood pressure control
•Inhibition of the activity of RAS system
•Stopping Smoking

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21
Q

When and when not should you use a ACE inhibitor for diabetic nephropathy

A

decrease microalbinuria
prevent end stage renal failure
causes hyperkalaemia
do not give for renal artery stenosis

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22
Q

Signs of renal failure

A

Electrolyte misbalance–Hyperkalaemia, hyponatraemia

  • Acidosis
  • Fluid retention
  • Retention of waste products–Small molecules, e.g., urea, creatinine, urate–Phosphate–Middle molecules, e.g., peptides, ß2‐microglobulin
  • Secretory failure–Erythropoietin –1.25 vitamin D
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23
Q

Symptoms of renal failure

A

Symptoms–Tiredness, lethargy–Shortness of breath, oedema–Pruritis, nocturia, feeling cold, twitching–Poor appetite, nausea, loss of/nasty taste, weight loss

  • Anaemia –exacerbates tiredness
  • Renal bone disease –aches & pains, pruritis
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24
Q

What happens if no renal replacement treatment is given for renal failure?

A

Hyperkalaemia –arrythmias, cardiac arrest–Pulmonary oedema–Nausea, vomiting–Malnutrition / cachexia–Fits–Increasing coma–DEATH

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25
Q

Types of renal replacement therapy

A

Peritoneal dialysis
Haemodialysis
Transplant

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26
Q

When do you give Renal replacement therapy?

A

When gfr goes below 10

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27
Q

Benefits of dialysis

A

Improve symptoms
correct fluid balance
no acidosis, hyperkalaemia, pulmonary oedema caused by resistance to diuretics

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28
Q

Risks of dialysis

A

Infection, hypotension/ arythmias (h), access

work, family, travel

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29
Q

What does dialysis not treat

A

Getting old
•Lack of erythropoietin–Anaemia
•Lack of 1.25 vitamin D–Hyperparathyroidism–Renal bone disease
•Other diseases –comorbidities–SLE–Diabetes–Vascular disease

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30
Q

Pros and cons of transplants

A

Transplantation

BENEFITS
•Better renal replacement
•Improvement in metabolic disorders–Anaemia–Renal bone disease
•Costs less in long‐term
•Prolonged survival
•Quality of life–Avoids disadvantages of HD/PD–Much easier to travel, work, maintain independence

RISKS
•Older and sicker patients not eligible
•Immunosuppression–Increased infection–Increased malignancy
•Not a cure–Surgical complications–Hospital visits –particularly frequent at start
•Often worse off if/when transplant fails

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31
Q

Resp failure

A

Low O2

1 - normal/low co2 - V/Q mismatch

2- high co2 - hypoventilation

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32
Q

How do you assess a acutely unwell patient?

A

Callforhelp!!
Airway–Patent?,Stridor?Obstructed?–IFyes2222
Breathing - Speech(fullsentences?),RR,Sats,ABG,auscultation,CXR

Circulation–HR,BP,CRT,ECG

Disability–GCS,Glucose,Pupils,Neuro-exam

Exposure/Everythingelse–Abdomen,Signsofoverload

Re-assess!!!!

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33
Q

Define asthma

A

Chronic inflammatory airway disease characterised by reversible airways obstruction

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34
Q

What do you give for low sats and high resp rate in an acute situation?

A

oxygen,salbutamolnebulisers,steroids,magnesiumandreassess

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35
Q

What is a moderate asthma attack?

A

PEF at 50-75% of best or predicted•No signs of severe asthma

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36
Q

Severe asthma attack

A

PEF at 33-50% of best or predicted
•respiratory rate ≥25/min
•heart rate ≥110/min
•Inability to complete sentences in one breath

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37
Q

Signs of life threatening asthma

CHEST

A 
Cyanosis -SpO2 <92%, PaO2 <8 kPa
•Hypotension
•Exhaustion –Poor inspiratory effort, Confusion, Normal PCO2
•Silent chest
•Tachy-/Brady-Arrhythmias
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38
Q

How do you manage life threatening asthma

A

ABCDE

severe - 98% sats, bronchodilators (SABA +/- ipratropium, IV magnesium
Steroids: PO prednisolone/IV Hydrocortisone
-> if improved - TAME (technique, avoid triggers, monitor PEF and educate - discharge if > 75%)

If severe/ not get better

  • help
  • same treatment
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39
Q

Levels of COPD

A

Mild FEV1 >80% predicted
•Moderate FEV1 50-80% Predicted
•Severe –FEV1 30-50% Predicted
•Very severe –FEV1 <30% Predicted

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40
Q

What is COPD

A

Minimally reversible airflow obstruction characterised by an FEV1/FVC ratio of <0.7

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41
Q

How do you manage acute COPD

A

ABCDE
T2RF - sats 98%, salbutamol,ipratropium,
steroids: OD prednisolone, hydrocortisone IV

No for T2RF - lower sats (94-98 or 88-92 with Venturi) same med. - may need ABs

Improved - check sputum, wean off, smoking cessation, inhaler technique

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42
Q

What is BIpAp

A

Bi level CPAP

Helps with breathing in and out

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43
Q

Risk factors for DVT/PE

A 
Risk factors
•Immobilisation
•Malignancy
•Recent Surgery
•HRT/COCP
•Thrombophilias
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44
Q

Gold standard for PE

A

CT pulmonary angiogram

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45
Q

Scoring systems for PE

A

Wells and geneva

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46
Q

Signs of right heart strain on a ECG

A

Deep S wave - lead 1
Deep q waves - lead 2
T wave inversion - lead 3

Occuled pulmonary circulation

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47
Q

How do you manage acute PE?

A

HS - yes - help, oxygen, fluids, assess for thrombolkysis or percutaneous embolectomy

HS - no - Hestia, PESeverity index, sPESI - high risk - LMWH, oxygen

  • low risk - discharge high does LMWH, DOAC and warfarin for three months
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48
Q

What is acute pulmonary oedema?

A

Accumulation of fluid in lung parenchyma - impaired gas exchange

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49
Q

Causes of pulmonary oedema

A

Cardiogenic –Heart Failure, Arrhythmia, Myocardial Infarction
•Renal –Acute, severe Kidney failure
•Acute respiratory distress syndrome (ARDS) –Caused by lung injury, i.e. infection (Cov-Sars-2

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50
Q

Management of Acute cariogenic po

A

ABCDE - sit up
- oxygen, IV diuretics - furosemide, beta blockers if arrhythmia

  • consider nitrate infusion if systolic above 100 + CPAP - drives out fluid

Record weight every day

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51
Q

X ray changes for a tension pneumothorax

A

tracheal deviation away from affected side
mediastinal shift away
loss of lung markings on affected side (air)

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52
Q

Treatment of PT

A

Emergency needle decompression
high flow oxygen
chest drain

1 - >2cm - aspirate, less = discharge

2- >2cm - chest drain, less aspirate and admit

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53
Q

Issues with obstructive sleep apnoea

A

Intermittent hypoxia and sleep disruption

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54
Q

How do you measure sleep?

A

ear sleep monitor

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55
Q

How do you treat OSA

A

CPAP - moderate to severe with symptoms of sleepiness

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56
Q

Main risk factor for OSA

A

Obesity and narrowed airway

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57
Q

What is a normal GFR

A

> 90ml/min

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58
Q

Main symptoms of renal problems

A

Haematuria •Proteinuria•Nephrotic syndrome•Nephritic syndrome•Hypertension•Acute kidney injury•Chronic kidney disease•Urinary tract infection•Abdominal pain•Complications of hypertension (esp malignant hypertension)•Oliguria or anuria•Polyuria, nocturia

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59
Q

Functions of the kidney

A 
filtration and excretion
electrolyte homeostasis 
hormone production - epo, vit d 
blood pressure control 
acid base homeostasis
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60
Q

How do you treat acidosis?

A

Bicarbonate

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61
Q

What factors affect GFR

A

age, sex, body size, muscle mass

reduced = loss of filtering capacity and accumulation of waste products

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62
Q

Test for blood and protein in urine

A

urine dip

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63
Q

Colour of urine and problem

A

red/brown - myoglobinuria/haemoglobinuria
- food dyes, rifampicin (TB)

white - pyuria, phosphate crystals, chyluria

black - haemoglobinuria, alkaptonuria

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64
Q

What does AKI mean

A

rapid decline in renal function over hours/days

accumulation of wast, metabolic consequences, can have reduced output

rise of serum creatinine by 26ml/mol in 48 hrs or 1.5x reference value or urine output less than 0.5ml over 6 hrs

staged based on severity

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65
Q

RF for AKI

A

risk
ill
surgery

e.g. ensuring adequate hydration is a preventative measure

Recognised risk factors for AKI•Age >75 years•Pre-existing CKD (eGFR <60 mL/kg/1.73 m2)•Previous episode of AKI•Debility and dementia•Heart failure•Liver disease•Diabetes mellitus•Hypotension (Mean arterial pressure <65mmHg, systolic BP <90mmHg)•Sepsis•Hypovolaemia•Nephrotoxins, eg gentamicin, NSAIDs, iodinated contrast•Continued antihypertensives in setting of hypotension, eg ACE inhibitors, loop diuretics

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66
Q

Pre renal causes of AKI

A

Hypovolaemia
low cardiac output
hypotension
renal artery thrombosis

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67
Q

Renal causes of AKI

A 
Acute tubular necrosis
Glomerulonephritis
Vasculitis
Nephrotoxins, contrast, rhabdomyolysis
Interstitial nephritisHUS/TTP
Malignant hypertension
Myeloma
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68
Q

Post renal causes of AKI

A

Ureteric obstruction
Urethral obstruction
Blocked urinary catheter
Bladder tumour

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69
Q

Difference between AKI and CKD

A

AKI is reversible

CKD - impaired, progressive, eskd, not reversible

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70
Q

How do AKI present

A

non specific symptoms
uraemia (nausea, vomiting and anorexia)
decreased urine output
systemic features (rash, myalgia, arthralgia, headaches)
urea and cr up
acidosis, hyperkalaemia, salt and water retention

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71
Q

For UTI history what should you check

A 
duration 
systemic features 
PMx - vascular, childhood renal, UTI, diabetes, hypertension 
stroke early death 
herbal, recreational drugs
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72
Q

How to distinguish between a pre renal, glomerular and tubular AKI in urine?

A

G: red cells, proteinuria

T: minimal blood, less protein, white cell case

Pre-renal - no blood nor protein

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73
Q

Things you always want to know with renal patients

A 
baseline creat 
take an ABG for hypoxia and acidosis
electrolyte 
US - kidney size 
CXR - for fluid overload, chest infection
urinalysis
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74
Q

Common causes of AKI

A 
Acute tubular necrosis 
functional
myeloma 
Acute tubular interstitial nephritis 
athero embolic 
rhabdomyolysis
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75
Q

Need to find a treatable cause for AKI - so what investigations should you do?

A 
volume status (for ATN)
•Urine microscopy and dipstick
•Imaging (U/S) *** Obstruction ***
•ANCA, Anti-GBM, SLE immunology (ANA, dsDNA, complements)
•Creatinine kinase•FBC, clotting
•Inflammatory markers
•Myeloma screen (protein electrophoresis, urine BJP)
•May need biopsy
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76
Q

How do you treat:

  • hyperkalaemia
  • PO
  • acidosis
  • hypertension
  • uraemia (damages brain, nerves and heart)
A

IV calcium
insulin and dextrose
nebulised salbutamol
dialysis

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77
Q

What is CKD

A

syndrome with a cause for renal
kidneys usually smaller
slow progression for eskd

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78
Q

5 stages of CKD and action

A 
1 normal >90
2 60-89 kidney damage
3 30 - 59 moderate decreasing gfr
4 15-29 - severe - prepare transplant
5 less than 15 = kidney failure - dialysis

if macroalubinuria is present - worsening kidney function

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79
Q

RF for CKD

A

ElderlyHypertensionDiabetesIHDFamily History CKDAfrican AmericanObesity

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80
Q

Main causes of CKD

A 
Diabetes
Chronic glomerulonephritis 
vascular diseases IHD, HTN
Autosomal dominant PKD
childhood infections
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81
Q

How to prevent progression of CVD in CKD patients

A

BP control - ACEi ARB max doses - need a low blood pressure, reduce proteinuria (SGLT) - glifozins
no smoking
exercise, low salt and protein diets
avoid nephrotoxins like NSAIDS

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82
Q

What drug slows the progression of kidney disease

A

Glifozins - SGLT2 inhibitors

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83
Q

Triad for nephrotic syndrome

A

proteinuria, oedema, hypoalbuinaemia

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84
Q

Gold standard for finding out proteinuria problem

A

Renal biopsy

Do US first

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85
Q

Main causes of proteinuria and nephrotic syndrome

A 
Diabetes
Minimal change disease
membranous nephropathy 
amyloid 
SLE
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86
Q

Tests for proteinuria

A

protein:creatinine ratio
serum albumin and cholesterol
serum creatinine
glucose, SLE tests, virology (Hep B, C and HIV), myeloma screen

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87
Q

Protein uria management

A

Control oedema - low salt diet, diuretics
ACEI and ARB
Steroids

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88
Q

How does Haematuria present

A

Pain (stones/cancer)
Age > 40 - cancer - cystoscopy
below 40 glomerular cause

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89
Q

Most common haematuria glomerular causes

A

Alports - basement membrane disease

IgA nephropathy

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90
Q

When are neutrophils raised

A

acute inflammation

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91
Q

When are lymphocytes and plasma cells raised

A

chronic inflammation

lymphomas

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92
Q

When are eosinophils raised + mast cells

A

allergic reactions
parasitic infections
tumours - Hodgkins disease

93
Q

When are macrophages raised

A

late acute inflammation

chronic inflammation - granulomas

94
Q

Site of origin for squamous cancers

A 
Skin 
head and neck 
oesophagus 
anus 
cervix 
vagina

mucin stain

95
Q

Stain for adenocarcinoma

A

melanin on a Fontana stain

96
Q

Stain for haemochromatosis

A

Prussian blue iron stain positive

97
Q

Stain for amyloid

A

Congo red positive

Apple green birefringence

98
Q

Causes of high bilirubin

A 
pre hepatic - haemolysis + Gilberts - FBC and film
hepatic disease (viral hep, alcoholic hep, cirrhosis) - LFTS
post hepatic (gallstones, pancreatic cancer) - obstructive jaundice
99
Q

How is gibbers inherited

A

recessive

100
Q

How is liver function measured

A

Albumin
clotting factors
bilirubin

101
Q

If AST and ALT high

A

Hepatic damage - excludes obstructive jaundice and pre hepatic

102
Q

Features of alcoholic hep

A

Liver cell damage, inflammation, fibrosis

fatty change, megamitochondria

NASH (non alcoholic stet hepatitis)

103
Q

How do you treat alcoholic hep

A

supportive
stop alcohol
B1 - beri beri

104
Q

Signs of CLF

A

Multiple spider naevi•Dupuytren’s contracture•Palmar erythema•Gynaecomastia

105
Q

How is portal hypertension caused

A

Cirrhosis

visible veins, splenomegaly and ascites

106
Q

Features of liver failure

A

Failed synthetic function•Failed clotting factor and albumin•Failed clearance of bilirubin•Failed clearance of ammonia•(encephalopathy)

107
Q

Features of cirrhosis

A

Whole liver involved.•Nodules of regenerating hepatocytes•Fibrosis•Shunting of blood

108
Q

Causes of cirrhosis

A

Fatty liver disease ( alcoholic and non-alcoholic) -micronodular•Viral hepatitis ( Hepatitis B, C and D) –macronodular •Others:Haemochromatosis (iron overload)Wilson’s Disease ( copper overload)Primary Biliary CholangitisPrimary Sclerosing Cholangitis.

109
Q

Scratch marks and liver

A

obstructive jaundice

pruritus

110
Q

Courvoisiers law

A

palpable gall bladder
no pain
cause not likely to be gall stones

111
Q

Tests for OJ

A

US abdominal

112
Q

Symptoms of asthma

A

wheeze
SOB
chest tight

bronchoconstriction, airway thickening and increased mucus

113
Q

Drugs for asthma (not in order)

A

Short-actingβ2-adrenoceptoragonists(SABA) –inhaled
Long-actingβ2-adrenoceptoragonists(LABA) –inhaled
Muscarinicreceptor antagonists(SAMA, LAMA) –inhaled
Glucocorticosteroids(GCS) –inhaled/ora
lCOMBINATIONS–LABA/GCS, LABA/LAMA, LABA/LAMA/GCS–inhaled
Leukotriene(cysteinyl) receptor antagonists(LTRA) –oral
Theophylline–oral, asthma

114
Q

Poor controlled asthma

A

peak flow less than 60% of predicted best

115
Q

What is sarcoidosis?

A

Systemic disorder of unknown cause(s) characterised by formation of noncaseating granulomas, affecting the lung in >90% of cases

can be transmitted via transplants

116
Q

Test for sarcoidosis

A

Kveim siltzbach extract - immun repsonse on skin

117
Q

Name a protective factor for sarcoidosis

A

smoking

HLA DR1 DR4 alleles

118
Q

How do you diagnose sarcoidosis

A

X ray nodules
Histology - non caveating granulomas
CT

4 staged staging - ends with fibrosis of the lung

EBUS-TBNA/EUS-TBNA

119
Q

List the staging of sarcoidosis

A

Stage I: isolated bilateral hilar lymphadenopathy (BHL): good outcomeStage II: pulmonary infiltrates + BHL: progression in one third at 5 yearsStage III: pulmonary infiltrates, no BHL: progression in two thirds at 5 yearsStage IV: overt fibrotic disease, significant mortality

120
Q

How do you assess reversibility of sarcoidosis

A

pet scan with inflixmab contrast

121
Q

Treatment for sarcoidosis

A

steroids

likely will still cause resp failure and cardiac failure/arrhythmias

can use immunosuppressants such as methotrexate and azathioprine

122
Q

What is Disseminated Intravascular coagulation? Lab findings?

A

Paradoxical process of clotting then bleeding leading to organ ischaemia and damage - usually a cause of sepsis or gram negative bacteria infection

low platelets
low fibrinogen 
low clotting factors
high prothrombin time 
high partial thromboplastin time 
high d dimer (fibrin degradation product)
schistocytes
123
Q

What are the 5Ps for pleuritic chest pain?

A 
PE
Pneumothorax
Pericarditis 
Pleruisy 
Pneumonia

Abcess, rib fractures and costochondritis can also cause it

124
Q

What condition causes dome shaped, firm and smooth skin lesions that spreads via sexual contact on umbiclicated centre?

A

molluscum contagiosa

125
Q

Virus for chicken pox and is it acute

Difference between shingles

A

Varicella zoster virus
acute rash - weep, crusty + flu

shingles chronic on stress - painful

126
Q

Virus for syphillis - symptoms

A

Treponema pallidum

single ulcer - lymphadenopathy - skin lesions - can cause euro damage

127
Q

Virus for gonorrhoea - symptoms

A

Neisseria gonorrhoeae

vaginal/urethral discharge, dysuria

128
Q

What is a sebaceous cyst

A

keratinous, epithelium lined cyst - blocked hair follicle

smooth and creamy

129
Q

How can hep b be transferred?

A

Sexual contact, blood and vertical transmission

130
Q

How to distinguish between a susceptible, acute, chronic, cleared and vaccinated person for Hep B

A 
S - -ve for all
Acute - only -ve for HBsAB
Chronic - -ve for HBcAb IgM and HBsAb
Cleared - +ve for HbcAB IgG and HBsAb
Vaccinated - +HBsAb
131
Q

Most reliable test for prostate cancer

A

Transrectal ultrasound guided biopsy

132
Q

Difference in histological features of crohns and UC

A

C - non caveating granulomas

UC - mucosal ulcers, goblet cell depletion and crypt abscesses

133
Q

Difference between primary and secondary polycythemia vera

A

1 - clonal proliferation fo myeloid stem cells

2 - natural / artificial increase in EPO e.g. chronic hypoxia or abuse

134
Q

What is subclavian steal syndrome?

A

Stenosis of SCA blood being stolen from brain
Less blood to brain = blackout
Lump likely to be compressed rib

135
Q

What is gout? How to diagnose?

A

Uric acid crystals within joints
metatarsophalangeal joint - toe
diagnosis - microscopy of aspirate synovial fluid - negatively birefringent needle shaped crystals

136
Q

Difference between gout and pseudo gout

A

calcium pyrophosphate crystals
knees and wrists
positively birefringement rhomboid shaped crystals

137
Q

What synovial fluid is seen in septic arthritis?

A

Turbid synovial fluid with high WCC

138
Q

What is pseudohyponatremia

A

Normal sodium

high lipids dilute sodium, make it seem lower than actually is

139
Q

What lobe collapse produces sail sign on CXR

A

Left lower lobe

140
Q

First line investigation for bowel obstruction - first treatment

A

AXR

IV fluids and NG tube to aspirate gastric contents and decompress the bowel

141
Q

Postpartum depression features

A

confusion, low mood, anhedonia and anergia - think child is evil

142
Q

Difference between cushings syndrome and cushings disease

A 
Ectopic tumour ACTH (syndrome) 
Pit tumour (cushings disease) - suppress acth release after dexamethasone

High dose dexamethasone differentiate between them

143
Q

Raised ESR markers and fever with features of hyperthyroidism

A

De Quervain’s thyroiditis

144
Q

What should you measure for diabetes management

A

glycated Hb

145
Q

If blood glucose and elevated and patient is not overweight you give

A

sulphonylureas

146
Q

what test for acromegaly

A

glucose tolerance test to exclude diabetes

GH can be raised during periods of stress

147
Q

Signs of pituitary apoplexy

A

sudden headache, vomiting, visual disturbances, hormonal dysfunction

148
Q

Main way to find a pituitary adenoma

A

MRI

149
Q

What is postural hypotension caused by in Addisons

A

reduced aldosterone

150
Q

Special considerations before surgery

Diabetes
Sickle cell 
OSA
IHD
Graves
Phaeochromocytoma
A 
Diabetes
– ?GKI infusion
• Sickle Cell
– Post op CPAP
– ?Pre-op red cell exchange
• Obstructive sleep apnoea
– Post op CPAP
• Ischaemic heart disease
– Pre-op optimisation
• Surgery specific
– Graves’ disease – anti-thyroidals / beta blockade
– Phaeochromocytoma – alpha-blockade
151
Q

Define shock

A

‘Life-threatening condition of circulatory
failure, causing inadequate oxygen delivery
to meet cellular metabolic needs + O2
consumption requirements’

152
Q

Types of shock and their causes

A 
Hypovolaemic
– Haemorrhage
– Dehydration
• Distributive
– Sepsis
– Neurogenic
• Cardiogenic
– Arrhymia
– Pump failure
• Obstructive
– Tamponade
– Pneumothorax
153
Q

Tests to do for shock causes

A 
ECG
• Urine – pregnancy / bedside
urinalysis
• Blood gas – oxygenation / lactate /
acid-base / Hb
• Bloods to lab – FBC, renal function &
elecs, clotting, G+S
• CXR (mobile)
154
Q

On a CT scan what appears as what

A

bone - white
soft tissue - grey
lungs - black

155
Q

On a CXR what area of heart is furthest right and left

A

right - right atrium

left - left ventricle

156
Q

Consolidation of a CXR means

A

Infection
tumour
blood

157
Q

Ground glass opacification

A

Airspace - haemorrhage
interstitial - hypersensitivity pneumonitis
both - RBILD

158
Q

What does consolidation actually mean?

A

Displacement of air

159
Q

Why do you starve surgical patients? timings for food and water

A

decrease aspiration risk
6 hrs for food
2hrs for water

160
Q

Errors in taking an ABG

A

• Presence of air in the sample
• Collection of venous rather than arterial blood
• An improper quantity of heparin in the syringe, or improper
mixing after blood is drawn
• Delay in specimen transportatio

161
Q

Complications of ABG sampling

A
  • Haematoma
  • Nerve damage
  • Arteriospasm or involuntary contraction of the artery
  • Aneurysm of artery
  • Fainting or a vasovagal response
162
Q

Onset of subarachnoid headache? Diagnosis?

A

Abrupt, sudden,
acute, thunderclap (over
seconds or minutes

CT

163
Q

Recite the GCS

A 
Eyes
4- Spontaneous
3- To sound
2- To pressure
1- None
Verbal
5- Orientated
4- Confused
3- Words
2- Sounds
1- None
Motor 6
6- Obey
commands
5- Localising
4- Normal flexion
3- Abnormal
flexion
2- Extension
1- None
164
Q

B symptoms of lymphoma

A

fevers
night sweats
weight loss

165
Q

Tumour markers

A 
CEA - lower GI
Ca 19-9 - pancreatic cancer
CA 15-3 breast cancer
CA 125 ovarian 
AFP - liver
166
Q

What medication do you give for palliative care?

A

Morphine 2.5mg sc prn (pain)
• Midazolam 2.5mg sc prn (agitation)
• Glycopyrronium 200 mcg sc prn (respiratory
secretions)
• Haloperidol 0.5 mg sc prn (nausea/vomiting)

167
Q

What type of rash does dermatitis herpaformis show? Condition related to?

A

papulovesicular rash on elbows

coeliac

168
Q

What does histology of the gut look like for coeliac?

A

Villous atrophy and crypt hyperplasia

169
Q

Features of hypercalcaemia

A

Calcaemia
Renal failure
Anaemia
Bone pain

170
Q

Multiple myeloma test results

A

hypercalcaemia - caused by bone lesions

rouleax due to high conc of plasma proteins

171
Q

Most common urinary tract stone

A

calcium oxalate

172
Q

First test for pancreatitis

A

us

173
Q

What is cushings reflex

A

triad to Raised ICP, high blood pressure, bradycardia and irregular breathing

174
Q

Kussmaul sign

A

paradoxical rise in JVP on inspiration due to impaired ventricular filling e.g. constrictive pericarditis or restrictive cardiomyopathy

175
Q

Becks triad

A

cardiac tamponade
raised jvp
muffled heart sounds
low blood pressure

176
Q

Charcots triad

A

cholangitis
RUQP
jaundice
fever with riggers

177
Q

Baroreceptor reflex

A

maintains constant blood pressure

178
Q

Causes of onycholysis

A

DR PITHS

drugs, reactive arthritis, psoriasis, infection, trauma, hyper and hypo thyroidism, sarcoidosis, scleroderma

179
Q

What thyroid condition would show no uptake of iodine

A

De quervains thyroiditis
graves would show all over
plummers = one nodule

180
Q

Firm breast lump, without axillary lymphadenopathy, skin changes or nipple discharge

A

fibroadenoma

US before radiological assessment (if above 35 mammogram)

181
Q

Whooping cough
Syphilis
Plague

A

B.pertussis
Treponema pallidum
Yersinia pests

182
Q 
A wave
c wave 
X descent 
V wave 
Y descent
A
  • atrial contraction blood back to SVC (cannon when both contracted at the same time a and v - complete heart block)
  • ventricular contraction - tricuspid bulge - pressure wave back to SVC
  • atria relaxing
  • V wave - increased venous return to right atrium in late systole (tricuspid regurgitate if large)
  • rA to rv through tricuspid valve - slow = stenosis
183
Q

Raised JVP without pulsation

A

SVC obstruction

184
Q

Ankylosing spondylitis

A 
seronegative 
HLA B27
male
worse in morning better with activity 
schobers test - reduced spinal flexion 
sacroilitis = first feature
185
Q

Causes of obstructive renal impairment

A

Benign prostatic hypertrophy
Recurrent kidney stones
Retroperitoneal fibrosis
Schistosomiasis

186
Q

Does moderate alcohol consumption reduce coronary heart disease chances

A

yes

severe increases it

187
Q

Legionella P

A

Legionella pneumophila infection will present with non-specific symptoms such as fever, myalgia, headache, confusion and diarrhoea. Blood tests reveal hyponatraemia, abnormal liver function tests (elevated liver enzymes, hypoalbuminaemia) and an elevated creatine kinase. The diagnosis is confirmed by Legionella serology or urine Legionella antigen.

188
Q

How does bladder cancer present

A

painless macro haematuria

dye worker

189
Q

Signs of prostate problem

A

voiding symptoms

190
Q

Triad for acute mesenteric ischaemia

A

severe abdo pain
shock
normal abdo - gasless

191
Q

First line acute limb ischaemia

A

IV heparin

192
Q

What csf marker is raised in every infection

A

protein

193
Q

Signs for wegeners granulomatsis

A

Respiratory tract
glomerular nephritis
cANCA raised

194
Q

What measure is not included in sepsis

A

Blood pressure

195
Q

Sepsis 6

A 
blood cultures
oxygen 
ABs
fluid restriction 
lactate
urine output
196
Q

What condition is arthritis mutilans related to?

A

Psoriasis

deformed fingers

197
Q

Do viral infections cause colour change in eyes?

A

only eyes water

198
Q

First Line for delirium tremens

A

chlordiazepoxide

199
Q

Parameter for ACD

A

raised ferritin

low iron

200
Q

Feature for beta thal

A

raised HBA2

201
Q

Features of tissue related lung injury

A

Pulmonary oedema
cyanosis
hypotension

202
Q

Fever and neutropenia by itself

A

bacterial infection

203
Q

t(15:17)

A

Acute myeloid leukaemia

204
Q

Signs of infectious mononucleosis

A

FLAWS, splenomegaly

205
Q

Schistocytes + Heinz body (G6D)

A

haemolysis

206
Q

Target cells

A

jaundice

207
Q 
Test for 
- sickle 
- b12 
- autoimmune 
hereditary spherocytosis
A
  • sodium metabisphospahte
  • schillings
  • Coombs
  • osmotic fragility
208
Q

Diagnostic main for leukaemia

A

Bone marrow aspiration under microscopy

209
Q

Kussmaul breathing

Cheyne stokes breathing

A

deep breaths

deep breaths gradually deeper until apnoea

210
Q

CO2 greater than 6 and hypoxia

A

type 2 resp failure

211
Q

Measurement for progression of melanoma

A

depth

212
Q

Risk for acute hypernatraemia

A

Central pontine myelinalysis

213
Q

What urine measurement for phaeocytochroma

A

VMA - increased

214
Q

SAAG

A

serum albumin - serum ascites proteins
>11 = transudative (low protein fluid)
- cirrhosis, pericarditis, chf, budd chiari, hepativ venous obstruction

<11 = exudative (high protein fluid) - malignancy, pancreatitis, bowel obstruction

215
Q

How do you categorise voiding and and storage problems

A

Storage - irritate - FUN - frequency, urgency and nocturia

Voiding - obstructive - WISE = weak stream, intermittency, straining, incomplete emptying

216
Q

APTT

PT

A

APTT - intrinsic pathway

PT - extrinsic pathway

217
Q

Test for suspected PE in pregnancy

A

CTPA = no

V/Q yes

218
Q

Procedure to remove perforated divertuicated sigmoid colon

A

hartmanns

219
Q

What glomerular problem is associated with malignancy?

A

Membranous nephropathy

220
Q

First line for heart failure with reduced LVEF

A

ACEi and beta blocker

221
Q

How treated for Addisons split

A

hydrocortison twice

majority at start of the day

222
Q

Presentation of syringomyelia

A

cape like loss of pain and temperature sensation - compression on spinal tract anterior white commissure

223
Q

What can trigger liver decompensation in cirrhotic patients

A

constipation

224
Q

If minor bleeding happens at 8 INR what do you do

A

stop warfarin, iv vit k, inr 5

225
Q

What should be done for multiple episodes of loss of consciousness with quick recovery times

A

24 hr ecg

226
Q

Difference between iron def anaemia and Amaemia of chronic disease

A

IDA - high TIBC

ACD - low/normal TIBC

227
Q

How often do you give 300mg of adrenaline in anaphylaxis

A

every 5 minutes

228
Q

What infection causes rose spots on the abdomen

A

salmonella typhi

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