C - Meeran's Q Time & EFA Flashcards
fasting plasmas glucose cut off for DM
> 7
HbA1c cut off for DM
> 6.5% (48mmol/L)
2hr OGTT cut off for DM
> 11.1mM
2hr OGTT cut off for impaired glucose tolerance
9 to 11
48F presents unconscious, dehydrated, vomitting, polyuria, polydypsia.
O/E obese, dehydrated, low BP, glucose in urine. Dx?
hyperosmolar non ketotic coma
1st Ix for ?hyperosmolar non ketotic coma
ABG
causes of metabolic alkalosis
H+ loss - vomiting
low K+
bicarb ingestion
how does compensation for metabolic alkalosis come about
alkalosis inhibits hyperventiliation therefore more CO2 retained to normalise the pH
osmolality equation
= charged + uncharged ions
= Na + K + Cl + HCO3 + urea + glucose
= 2(Na + K) + urea + glucose
anion gap equation
(Na + K) - (HCO3 + Cl)
what is a normal anion gap
12
if the anion gap is normal in metabolic acidosis, what does that show?
it is NOT DKA - ketones increase anion gap
how are alkalosis and hypoK linked
they cause each other due to swapping of H+ and K+ ions
- low K drives H+ into cells
- alkalosis drives K+ into cells
Cushings syndrome clinically
+++ ACTH, +++ cortisol
Dx?
ectopic ACTH or pituitary tumour
–> ectopic slightly more likely due to very high ACTH
K+ finding in ectopic ACTH pt & why
VERY low
due to very high cortisol behaving like aldosterone
what causes ectopic ACTH
tumours
reduced lung expansion
dull to percuss
increased vocal resonance
Dx?
collapse + consolidation
what is the problem with rehydrating someone too quickly if they’re anuric
AKI due to raised creatinine
pulmonary oedema from overfilling
how do you distinguish between ATN and DM renal disease
renal biopsy
Mx of ATN vs DM renal disease
ATN = dialysis for 3 weeks
DM RD = end stage so lifelong dialysis
what effect does ectopic ACTH have on adrenals
bilateral hypetrophied adrenals due to xs ACTH
Mx of ectopic ACTH
adrenalectomy to reduce cortisol and treat cushings
ECG showing inferior STEMI with reciprocal changes. Mx?
aspirin
GTN
beta blocker
analgesia
thrombolysis or primary angioplasty
what scan is done for bony mets
bisphosphonate mbp scan
what scan is done for metabolically active mets
FDG PET scan
where is the apex beat in LV hypertrophy
5th ICS MCL ie NOT DISPLACED
ECG of LV hypertrophy
tall R waves
cause of LV hypertrophy
undiagnosed HTN
in which cardiac condition is apex beat displaced
HF due to dilatation of heart
gram -‘ve intracellular diplococci from septic arthritis of 19M after returning from holiday ?
neiserria gonorrhoea
commonest cause of septic arthritis in 19-30y/o
neiserria gonorrhoea
gram -‘ve intracellular diplococci from ?meningitis in 19M ?
neisseria meningitidis
6M meningitis sigs. Gram -‘ve rods on LP ?
haemophillius influenzae
who gets haemophillius influenzae ?
unvacc kids
19M confused, septic. Blood cultures = gram + diplococci ?
strep pneumoniae
19M confused, septic. Blood cultures grow nothing. Cold agglutinins are positive. Dx?
mycoplasma
19M boil on leg, pus drained which shows gram + cocci in clusters ?
staph aureus
19M mild fever for months with no cause. After 2 months, blood cultures grow gram + cocci ?
strep viridans
where is strep viridans found normally
on everyone’s teeth physiologically
stain and shape of ecoli
+ rod
e coli causes ____ in ____ babies
meningitis
pre term
stain and shape of strep pneumoniae
+ cocci
(* must know this*)
what does strep pyogenes cause
strep sore throat
can lead to sepsis and death
contrast speed and invasion of strep pyogenes and strep viridens
pyogenes = invades all tissues rapidly
viridans = slow growing, low virulence
what does strep viridens cause
infective endocarditis
subacute endocarditis sx
splenomegaly, janeway lesions, spliter haemorrhages, haematuria, clubbing, murmur
who gets staph aureus endocarditis
IVDU
commonest bacterial cause of lobar pneumonia
strep pneumoniae
commonest bacterial cause of bronchopneumonia
haemophillius influenzae
how old are SCID kids when they die
3 months
commonest CNS infection
coxsackie group B
who gets listeria infection
older people eating unpasteurised cheese
contrast nucleus of neutrophils and lymphocytes
neut =multi segmented
lymph = one
what does the CSF look like in bacterial meningitis
+++ neutrophils
what does the CSF look like in viral meningitis
+++ lymphocytes
what does the CSF look like in TB meningitis
+++ turbid CSF
stain and shape of strep pneumoniae
gram + diplococci
stain and shape of neisseria
gram - intracellular diplococci
what colour do gram + bacteria stain
blue
what colour do gram - bacteria stain
red
what stain is used for TB
ziel neilson
stain and shape of listeria
gram + rods
(they are the main gram + rods)
