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302 > Case of Screaming Agony > Flashcards

Case of Screaming Agony Flashcards

1
Q

caput medusae

A

dilated superficial epigastric veins radiating from central large venous varix

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2
Q

filtration/reabsorption rate rate equation?

A

Qf= Peff (difference between hydrostatic/blood pressure minus oncotic pressure) x Kf (permeability x exchange area)
effective filtration pressure Peff
filtration coefficient Kf

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3
Q

transudate vs exudate?

A

transudate- plasma filtrate with low protein content- change in hydrostatic/oncotic pressure

exudate- unfiltered plasma with high protein count
change in vascular permeability or exchange area

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4
Q

causes of ascites?

A

portal hypertension- liver cirrhosis, alcoholic hepatitis, constrictive pericarditis, congestive heart failure

hypoalbuminaemia- nephrotic syndrome, protein losing enteropathy malnutrition
peritoneal disease- malignancy carcinomatosis, infectious TB, fungal vasculitis peritonitis

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5
Q

how to work out cause of ascites?

A

SAAG serum albumin - ascites albumin

if more than 1.1g/dl then portal hypertension transudate effusion with low protein count

if less than that then not portal hypertenion

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6
Q

contraindications for drainage

A

pt factors- acute abdomen, bowel obstruction
abnormal clotting/platelets

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7
Q

seldinger technique?

A

introduce needle
guide wire
needle removed
skin incision
drain passed over wire
guidewire removed

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8
Q

pouch between kidney and liver is called?

A

morrisons pouch

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9
Q

how do mesothelial cells look?

A

grouped, clusters, balls with windows and microvilli
malignancy- high nuclear to cytoplasm ratio

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10
Q

eosinophil rich tissue?

A

CHARCOT LEYDEN CRYSTALS

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11
Q

ferruginous body?

A

seen in asbestosis- macrophages trying to eat

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12
Q

adenocarcinoma of ovary?

A

huge calcification within cells

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13
Q

granuloma?

A

central collection of histiocytes macrophages surrounded by lymphocytes mainly t lymphocytes

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14
Q

squamous marker?

A

p63

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15
Q

LEVOTHYROXINE?

A

once a day, given on empty stomach for improved absorption, half life 7 days

1.6-1.8 mcg/kg/day

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16
Q

liothyronine?

A

short half life 24-48 hours
avoid in cardiac disease

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17
Q

what percent of t3 is derived from t4?

A

80%

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18
Q

major site of degradation of t3/4?

A

liver

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19
Q

what is myxodema coma?

A

severe hypothyroidism GCS low

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20
Q

in myoxedema coma you give?

A

warming, intravenous t4/t3 and iv hydrocortisone

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21
Q

treatment of myxodemea come?

A

iv levothyroxine 300-400mcg then 50-100mcg daily oral levothyroxine

if no improvement iv liothyronine 10mch 8 hourly

slow rewarming 0.5c/hour

iv hydrocortisone in cortisol deficiency

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22
Q

what happens in pregnancy to levothyroxine?

A

bound to plasma proteins, beta hcg is like tbg, tbg increases

hence increase by 20-30%
25mcg/day

23
Q

treatment for hyperthyroidism

A

carbimazole 40 mg od
beta blockers- symptoms

24
Q

how does carbimazole work?

A

reduces concentration and uptake of iodine by thyroid, prevents thyroid peroxidase enzyme from coupling iodine and thyroglobulin

25
Q

propylthiouracil peripherally inhibits?

A

t4 to t3 conversion

26
Q

carbimazole side effects?

A

hair loss
arthralgia
agranulocytosis- sore throat mouth ulcers, fever
teratogenic- aplasia cutis (problems with developing skin)

27
Q

propythiouracil similar side effects to carbimazole but includes?

A

fulminant liver failure

28
Q

in thyroid storm lab results will show?

A

leukocytosis, elevated ALP and high t4 and t3

29
Q

thyroid storm treatment?

A

underlying cause, itu, PTU 600-1000mg loading dose thne 200-300mg 4 hourly via NG, potassium iodide after PTU to inhibit thyroid hormone release, beta blockers for symptom control, steroids prevent t4 to t3 conversion

30
Q

normal level of cortisol?

A

over 300

31
Q

potency of steroids?

A

dexamethasone then prednisolone then hydrocortisone

dexamethasone has no mineralocorticoid activity whereas hydrocortisone has equal

32
Q

sick day rule?

A

double dose
im/iv if vomiting or cannot take orally

33
Q

steroids side effects?

A

thinning skin/bruising
iatrogenic cushings

34
Q

role of fludrocortisone?

A

sodium reabsorption and potassium excretion

50-100mcg

35
Q

in pituitary apoplexy you should give?

A

hydrocortisone 100mg iv stat and 0.9% NaCl

36
Q

in acromegaly check for?

A

IGF1 and cortisol

37
Q

gold standard test for growth hormone?

A

OGTT, if growth hormone not suppressed

38
Q

if giving testosterone monitor?

A

CHECK PSA AND FBC

39
Q

how does metformin work?

A

decreases gluconeogenesis
and increases peripheral utilisation of glucose

40
Q

side effects of metformin

A

lactic acidosis
gi symptoms- pain, nausea d/v
decreased b12 absorption

41
Q

avoid metformin in?

A

GFR less than 30ml/min, and stop in dehydration or AKI occurs

42
Q

how do sulphonylureas work?

A

increase inculin secretion from pancreas

43
Q

side effects of sulphonylureas?

A

weight gain, hypoglycaemia

44
Q

DPP4 inhibitors work by?

A

incretins- glucose through mouth causes increase of insulin

dpp4 inactivates GIP, GLP hormones

so DPP4 inhibitors, increase insulin secretion and lower glucagon secretion

45
Q

side effects of DPP4 inhibitors?

A

pancreatitis
stevens johnson

46
Q

GLP1 agonist?

A

binds to activate GLP1 receptor to increase insulin secretion
induce weight loss
impact satiety and stomach motility

47
Q

GLP1 agonist side effects?

A

GI side effects
pancreatitis

48
Q

SGLT 2 inhibitors?

A

inhibit SGLT2 sodium glucose cotransporter, reduces glucose reabsorption

49
Q

side effects of SGLT2 inhibitors?

A

genital infections
hypoglycaemia
euglycaemic DKA

50
Q

glitazones?

A

reduced peripheral insulin resistance, liver fat, insulin requirements

51
Q

side effects of glitazones?

A

bladder cancer, heart failure, bone fractures,weight gain

52
Q

hypoglycaemis GCS 3?

A

glucagon im 1mg

53
Q

DKA protocol?

A

iv fluids, fixed rate insulin, potassium replacement
10% dextrose- glucose less than 14
dont omit long acting insulin

302 (24 decks)

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