Condition questions Flashcards
What is Cor Pulmonale
Right sided heart failure caused by respiratory distress
Causes of Cor Pulmonale
main one is COPD PE Interstital lung disease cystic fibrosis primary pulmonary hypertension
presentation of someone with Cor Pulmonale
hypoxia cyanosis raised JVP peripheral oedema 3rd heart sounds murmur hepatomegaly
Management of Cor Pulmonale
treat symptoms
treat underlying cause
long term O2 therapy
Management of antiphospholipid syndrome
long term warfarin with INR range 2-3
LMWH for pregnant women
what is antiphospholipid syndrome
where the patient is in a hypercoagulable state
can occur secondary to SLE
Cushing syndrome
prolonged elevation of cortisol
Pituitary adenoma secretes elevated levels of ACTH
signs of Cushing syndrome
moon face central obesity abdominal striae fat pad on upper back proximal limb wastage
Causes of Cushing syndrome
Cushing disease
exogenous steroids
adrenal adenoma
paraneoplastic cushings
Polymyalgia rhuematica
inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck
polymyalgia reumatica is associated with what condition
giant cell arteritis
Core features of polymalgia rheumatica
bilateral shoulder pain bilateral pelvic girdle pain worse with movement interferes with sleep stiffness > 45 mins in morning
what does anti-nuclear antibody (ANA) test for
SLE
what does anti-CCP (anti-cyclic citrullinated peptide) test for
rheumatoid arthritis
calcium levels in hyperparathyroidism
increased
calcium levels in osteomalacia
decreased
main complications of hyperkalaemia
cardiac arrhythmia = ventricular fibrillation
conditions that cause hyperkalaemia
AKI CKD rhabdomyolisis adrenal insufficiency tumour lysis syndrome
medications that cause hyperkalaemia
aldosterone antagonists ACE inhibitors Arbs NSAIDs K+ supplements
Nephrogenic diabetes insipidus and water deprivation test results
problem with the kidneys themselves
low urine osmolality before
low urine osmolality after synthetic ADH
because kidney cannot respond to it
Causes of nephrogenic diabetes insipidus
Drugs: lithium in BPD
intrinsic kidney disease
Electrolyte disturbances
Cranial diabetes insipidus and water deprivation test results
hypothalamus does not produce ADH
low urine osmolality before
high urine osmolality after synthetic ADH
inherited causes of haemolytic anaemia
hereditary spherocytosis
thalassaemia
sickle cell anaemia
acquired causes of haemolytic anaemia
autoimmune
alloimmune
MAHA
prosthetic valve related
Features of haemolytic anaemia
anaemia
splenomegaly (full of destroyed RBCs)
Jaundice - raised bilirubin from destruction of RBCs
investigations and findings in haemolytic anaemia
FBC - normocytic anaemia
Blood film - schistocytes (broken RBCs)
Coombs test - if positive means it is autoimmune caused
what is MAHA
microangiopathic haemolytic anaemia
small blood vessels have structural abnormalities that cause haemolysis of RBC’s that travel through them
causes of MAHA
haemolytic uraemia syndrome (HUS) DIC TTP SLE cancer
what is TTP
thrombotic thrombocytopenic purpura
tiny blood clots develop throughout small vessels of the body which uses up platelets and so causes thrombocytopenia
What happens in TTP
problem with protein ADAMTS13
shortage of it causes increase in vWF and formation of clots
what does ADAMTS13 typically do
normally inactivates vWF and decreases platelet adhesion to vessel walls
what is nephrotic syndrome
occurs when basement membrane in the glomerulus becomes highly permeable to proteins, allowing them to leak from blood to urine
classic triad of nephrotic syndrome
low serum albumin
oedema
high urine protein content
features of nephrotic syndrome
pallor frothy urine generalised oedema deranged lipid profile (increase cholesterol and TAG decreased LDL) hypertension hyper-coagulability
causes of nephrotic syndrome
secondary to intrinsic kidney disease
secondary to underlying systemic illness: diabetes, HIV, Hepatitis, Malaria
what is haemochromatosis
iron storage disorder that results in excessive loss of iron and deposition in tissues
(most cases problem with gene on chromosome 6)
symptoms of haemachromatosis
chronic fatigue joint pain bronze discoloration hair loss erectile dysfunction amenorrhoea cognitive symptoms most present after age of 40
diagnosis of haemachromatosis
serum ferritin and transferrin because ferritin alone is an acute phase reactant (up in inflammation and alcoholic fatty liver disease)
if both high then diagnosis of haemochromatosis
describe renin-angiotensin system
renin secreted by juxtaglomerular cells in afferent arterioles of kidneys
renin converts angiotensin(released by liver) to angiotensin I
angiotensin I converts to angiotensin II in the lungs with help of ACE
angiotensin II causes vasoconstriction and stimulates release of aldosterone from adrenal glands
aldosterone is a mineralocorticoid and acts on nephrons in kidneys to:
-increase sodium reabsorption
-increase potassium secretion
-increase hydrogen ion secretion
to increase BP
