Causes

Question 1

What is the common trigger for HUS?

Answer 1

Bloody diarrhoea caused by
E. Coli 0157 = verotoxin producing enterococci
Or Shigella

Question 2

What causes TTP?

Answer 2

Deficiency of vWF cleaving protease (ADAMST-13) can be genetic or autoantibody. This leads to uncontrolled platelet activation with no negative feedback loop leading to fibrin and thrombus creating distal ischaemia and shredding rbcs

Question 3

Types of idiopathic interstitial pneumonia

Answer 3

• idiopathic pulmonary fibrosis
• idiopathic nonspecific interstitial pneumonia
• respiratory bronchiolitis ILD
• desquamative interstitial pneumonia
• cryptogenic organising pneumonia
• acute interstitial pneumonia

Question 4

Side effects of bleomycin

Answer 4

Pulmonary fibrosis (oxygen sensitive)

Question 5

Side effects of cisplatin

Answer 5

Renal toxicity
Electrolyte disturbance

Question 6

Side effects of cyclophosphamide

Answer 6

Idiopathic interstitial pneumonitis
haemorrhagic cystitis

Question 7

Side effects of cyclosporin

Answer 7

TTP
hypertension

Question 8

Side effects of Doxorubicin

Answer 8

Cardiomyopathy

Question 9

Side effects of methotrexate

Answer 9

Renal toxicity
Pneumonitis

Question 10

Side effects of 5-flourouracil

Answer 10

Coronary and cerebral vasospasm

Question 11

Commonest cause of anaphylaxis

Answer 11

NAP6 report
- antibiotics (47%, mainly co-amox and teicoplanin)
- NMBs (33%)
- Chlorhexidine (9%)

Question 12

Pathophysiology of DKA

Answer 12

• Insulin deficiency causes rise in glucagon, cortisol, GH and catecholamine secretion
• increased hepatic gluconeogenesis and glycogenolysis causes hyperglycaemia
• enhanced lipolysis increases free fatty acids which are metabolised to ketone bodies
• ketone bodies cause acidosis via Beta hydroxybutyrate, acetone and acetoacetate
• osmotic diuresis causes fluid depletion in hyperglycaemia

Question 13

Hypoglycaemia

Answer 13

Liver failure
Adrenal insufficiency
Self administration of insulin
Sepsis
Drugs (sulphonylureas, flouroquinolones, phenytoin, haloperidol, propranolol, ACEi, NSAIDs)
Hypothyroidism
Insulinoma
Monitoring error

Question 14

Generic causes surgical sieve

Answer 14

Infective
Inflammatory
Autoimmune
Vascular
Metabolic
Neoplastic
Trauma
Congenital
Idiopathic

Question 15

Causes of hypothyroidism

Answer 15

Hashimotos (thyroid peroxidase antibodies)
Thyroid surgery
Radiation therapy
Iodine deficiency
Drugs (lithium, amioderone)
Congenital
Pituitary disorder
Thyroiditis (viral, post partum)

Question 16

Causes of hyperthyroidism

Answer 16

• Graves’ disease (thyroid stimulating antibodies)
• thyroid nodules (toxic multinodular goitre)
• thyroiditis
• excessive iodine intake
• pituitary adenoma
• excessive thyroxine administration

Question 17

Antimicrobial resistance

Answer 17

• change in target site
• enzyme production (E.g. beta lactamase)
• cell membrane changes (transporter change or active transport out)
• intrinsic resistance

Question 18

Lactic acidosis

Answer 18

Type A : impaired oxygen delivery
Type B : normal o2 delivery with increased cellular production, reduced uptake of oxygen or reduced clearance

Question 19

Haemophilia

Answer 19

Haemophilia A : sex linked factor VIII deficiency

Haemophilia B : factor IX deficiency

Treatment = factor replacement or factor 7 for common pathway

Question 20

Von willebrand’s disease

Answer 20

Autosomal dominant and most common coagulopathy

Loss of vWF

Treated with DDAVP or FFP and cryoprecipitate in emergencies

Question 21

Thrombocytopaenia

Answer 21

Decreased production
- leukaemia
- drugs (thiazides, anti TB etc)
- marrow depression

Increased consumption
- sepsis / shock
- ITP
- TTP / HUS / DIC
- HITT

Extracorporeal loss
- haemorrhage
- haemodilution
- CPB / ECMO / RRT

Question 22

Organisms causing CAP

Answer 22

Strep pneumonia 30%
Legionella
H. Influenza
Mycoplasma pneumoniae
Chlamydia pneumoniae

Question 23

Causes of Hospital acquired pneumonia

Answer 23

Pseudomonas aeruginosa
Enterobacter spp
Klebsiella pneumonia
Acinetobacter spp

Question 24

Causes of UGIB

Answer 24

Varices
Ulcers
Portal hypertension
Vascular (Hereditary telangectasia)
Traumatic
Tumours

Question 25

Native valve IE

Answer 25

Staph aureus
Streptococcus
Coagulate negative staph
Enterococcus
Gram negative bacilli

Question 26

Post liver transplant complications

Answer 26

Acute
- reperfusion syndrome
- bleeding and coagulopathy
- acute rejection
- vascular occlusion of graft (venous/arterial) or ischaemia

Intermediate
- VAP
- AKI
- deterioration of associated comorbidity

Cold and warm ischaemic times >30mins associated with poorer graft function

Question 27

Raised anion gap metabolic acidosis

Answer 27

KUSMEL

Ketones
Uraemia
Salicylates
Methanol
Ethylene glycol
Lactate

Question 28

Hypophosphataemia

Answer 28

Increased losses
- diarrhoea
- diuretics
- RRT

Decreased supply
- malnutrition (+ Refeeding syndrome)
- low supply (TPN)

Question 29

Causes of meningitis

Answer 29

Strep pneumonia
Neisseria meningitides
Listeria

Question 30

Causes of Methaemoglobinaemia

Answer 30

Acquired by any medication or chemical that can oxidise haemoglobin

Medications
- local anaesthetics e.g. lidocaine
- nitrates/nitrites (GTN)
- sulfonamides
- trimethoprim

Toxins
- aniline dyes, herbicides
- water contaminated with nitrates

Nitric oxide therapy for PHTN