daily mix I Flashcards
In terms of urine output what constitutes an AKI
Urine output of <0.5 ml/kg/hr over 6 consecutive hours
What constitutes an AKI (3 things)
-rise in serum creatinine of 26 micromol/litre or greater within 48 hours
-50% or greater rise in serum creatinine known or presumed to have occurring within the past 7 days
-fall in urine output less than 0.5ml/if/gout more than 6 hours in adults
why does CKD commonly cause anaemia
Loss of kidney’s production of erythropoietin
Also poor iron absorption
Treatment of anaemia in CKD
1st = start oral iron replacement
Which disease gives a hyperchloremic metabolic acidosis ?
Renal tubular acidosis
what is the first-line screening test for adult poly cystic kidney disease
Renal ultrasounds
What can cause contrast-induced nephropathy ?
Iodine based CT and X-ray
What should be given to counter contrast-induced nephropathy ?
Volume expansion via 1L IV 0.9% sodium chloride
What is the most common extra-renal manifestation of ADPKD
Liver cysts
what causes subarachnoid haemorrhage in ADPKD
Pancreatic cyst and berry aneurysms (much less common than liver cysts)
Treatment of Minimal change glomerulonephritis
Prednisolone (steroids + ACEi)
When does Alports usually present ?
Childhood
Features seen in Alports
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus
Retinitis pigmentosa
Splitting of lamina densa on electron microscopy
Presents at childhood
Investigation of Alports
Genetic testing
Renal biopsy
What is seen on renal biopsy for Alports
Splitting of the Lamina densa of the GBM - resulting in a basket weave appearance
*basket weave appearance on renal biopsy
Alports
what to do if a patient has < 0.5ml/kg/hr urine output post-operatively ?
Administer 500ml 0.9% sodium chloride over 15 minutes
What is the most likely cause of death in someone with CKD on HD
Ischaemic heart disease
What is acral lentiginous melanoma
Pigmentation of nail bed affecting proximal nail fold = melanoma
- red or black lump / lump that bleeds or oozes
Nodular Malignant melanoma
What type of lesion is most commonly seen with renal transplantation
Squamous cell carcinoma
What drug can cause patchy depigmentation in patients with darker skin
Topical steroids (ie clobetasone)
Steroid cream potency (eczema)
Where are keloid scars most commonly found
Sternum
What is used to treat dermatophyte infection
Oral terbafine
What fungus is responsible for pityriasis versicolor
Malassezia furfur
*central dimple, 2mm in diameter, multiple raised lesions
Molluscum contagiosum
What medication can cause toxic epidermal necrolysis
Penicillins ie co-amoxiclav
What is nikolsky’s sign
Epidermis separates with mild lateral pressure
Skin lesion associated with UC
Pyoderma gangrenosum
Most common cause of cauda equina syndrome
Central disc prolapse at L4/5 or L5/S1
Investigation for suspected cauda equina syndrome
Urgent MRI
Management of Cauda equina syndrome
Urgent decompression
Late sign of cauda equina syndrome
Urinary incontinence
What do the Ottawa rules apply to ?
When to use an X-ray for ankle / knee injury
MAIN ASSOCIATION for adhesive capsulitis
Diabetes !!
Dermatomyositis associated antibody
Anti-Jo-I and ANA
what needs to be done after confirmed diagnosis of Dermatomyositis
Screen for underlying malignancy ie breast or lung (typically)
Main side effect of hydroxychloroquine
Bull’s eye retinopathy
*BULLS EYE RETINOPATHY
Hydroxychloroquine use
What do you have to check in a patient before commencing them on azathioprine
Thiopurine methyltransferase deficiency
If they have a deficiency then they are predisposed to azathioprine toxicity
S1 compression symptoms
Sensory loss in posterolateral aspect of leg
Lateral aspect of foot
Weakness in the plantar flexion of the foot
What does S1 innervate
Gastrocnemius and soleus = responsible for plantar flexion
L3 compression symptoms
Sensory loss over anterior thigh
Weak hip flexion (iliopsoas)
Knee extension (quadriceps)
Hip adduction (Adductor)
Reduced knee reflex
L4 compressions
Sensory loss over anterior aspect of knee and medial malleolus
Weak knee extension
Hip adduction
Reduced knee reflex
L5 compression
Foot dorsiflexion weakness
Sensory loss over the lateral lower leg
And normal reflexes
S2 nerve root compression
Sensory loss over posterior thigh and calf
Weakness in knee flexion
Reduced or absent ankle reflex
*sensory loss over dorsum of foot
L5 nerve root compression
*metaphyseal tumour of long bone with a ‘sunburst’ pattern
Osteosarcoma
Most common primary malignant bone tumour in children and adolescents ?
Osteosarcoma
Protein associated with Ewings
EWS-FLI1
4-year-old girl with a three month history of a limp. Her parents report that she has ‘not been right’ for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day.
What’s going on here ?
Juvenile idiopathic arthritis
> more than three months
X-ray of Perthes disease
Widening of joint space and decrease femoral head size/flattening
what’s going on here
SUFE - on the left side
what’s going on here
Perthes - see the destruction of the femoral head / flattening
Should high dose prednisone be given before or after investigation in clinical suspicion of GCA
Before
*pain and tenderness over the lateral side of thigh / hip in a woman 50-70years
Greater trochanteric pain / trochanteric bursitis
*burning sensation over anterio-lateral aspect of the thigh
Meralgia paraesthetica
What is meralgia paraesthetica
Caused by compression of lateral cutaneous nerve
What is pubic symphysis dysfunction
Common in pregnancy
Ligament laxity increases in response to hormonal changes of pregnancy
Get pain over pubic symphysis with radiation to the groins and medial aspects of the thigh
AC joint injury treatment Grade I - II
Conservative management with sling and immobilisation
AC joint injury treatment Grade III, IV , V
Surgery
Sensory loss over anterior thigh, weak hip flexion, knee extension, hip adduction, reduced knee reflex = what nerve root compression
L3
*reduced knee reflex
L3
What is this
Bakers cyst
What is Bakers Cyst
Popliteal cyst - aren’t actually cysts but a distension of the gastrocnemius - semimembranous bursa
Treatment of bakers cyst in a child
Self-resolving
*reduced sensation over left anterior knee and medial malleolus
L4 nerve root compression
management of acute renal colic
IM diclofenac 75mg
Management of communicating hydrocele
These are common in newborn males and usually will resolve within the first few months of life
Surgical repair if does not resolve within 1-2 years
*soft, non-tender swelling of the hemi-scrotum, transilluminates with a pen torch in baby
Hydrocele
Communicating vs non-communicating hydrocele
Non-communicating = excessive fluid production within the tunica vaginalis
Communicating = latency of the processes vaginalis allowing peritoneal fluid to drain down into the scrotum
Painful swollen testes - relieved by lifting testes
= epididymo - orchitis
Most common causative organism for epididymo-orchitis
Chlamydia trachomatis
STI but of unknown organism - what is the recommended treatment
500mg IM ceftriaxone
+ doxycycline 100mg by mouth 2D for 2 weeks
STI treatment for enteric organism ie E.coli
Oral quinolone for 2 weeks
How long do you have to wait to test PSA after doing certain things …
Indications for circumcision
Phimosis
Recurrent balanitis
Balanitis xerotica obliteratans
Paraphimosis
How long does it take a perforated eardrum to heal ?
6-8 weeks
*unexplained hoarseness in a patient aged >45
Urgent referral to ENT
What type of audiogram pattern would Cholesteatoma show ?
Conductive pattern
What mode of inheritance is otosclerosis
Autosomal dominant
T/F there is hearing loss in vestibular neuronitis
F - there is no loss of hearing
Features = recent viral infection, recurrent vertigo attacks lasting hours or days
*absent corneal reflex, hearing loss, vertigo, tinnitus
Acoustic neuroma
What disease is acoustic neurome associated with ?
Neurofibromatosis type 2
*pain on palpating of tragic, itching, discharge, and hearing loss
Otitis externa
Management of otitis externa
Topical antibiotic / topical antibiotic + steroid
What is Adies tonic pupil
When aniscoria is greater in bright light
There is an issue with the dilated pupil adn its inability to constrict
This could be due a problem with the parasympathetic nervous system
what is this
Acute otiis media
What is entropion
In Turning of the eyelids
What can happen if entropion is left untreated
Corneal ulcer
What is extropion
Out-turning of the eyelids
*persistent mouth ulcer
Clinical suspicion of squamous cell carcinoma —> urgent referral to oral and max fax
*red patches on fundoscopy
Intra-retinal or sub-retinal fluid leakage or haemorrhage (wet ARMD)
What are the ototoxic drugs
Quinine, gentamicin, furosemide, aspirin
*bilateral renal artery stenosis
Fibromuscular dysplasia
Where does epidermal proliferation happen
C - the basal layer
Where is vitamin D metabolism carried out
B - by keratinocytes at the basal layer
Where is energy storage
E - subcutaneous fat
Where is tensile strength provided
G - where collagen is found
Which are the common sweat glands on the face
Eccrine glands
Which is the nail matrix
E
Which is the nail bed
F
Which is the lunula
B
Name :
A = keratin layer
B = granular layer
C = prickle cell layer
D = basal layer
E = dermo-epidermal junctions
F = dermis
*dinner fork appearance on x-ray
Distal radius fracture / Colles
*garden spade deformity
Smith fracture
What are the 2 FOOSH injuries
Smiths Colles
What nerve causes wrist drop
Radial nerve compression
Monteggia fracture
Proximal ulnar fracture
Galeazzi fracture
Proximal radial
