Day 2 Flashcards
How is an anion gap calculated?
(sodium + potassium) - (bicarbonate + chloride)
What is a normal anion gap?
8-14 mmol/L
What causes raised anion gap metabolic acidosis?
- lactate : shock, hypoxia
- ketones: DKA, alcohol
- urate: renal failure
- acid poisoning: salicylates, methanol
- 5-oxoproline : chronic paracetamol use
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
- GI bicarbonate loss: diarrhoea
- Renal tubular acidosis
- Drugs: acetazolamide
- ammonium chloride injection
- addisons disease
Renal dysfunction can cause a raised?
serum natriuretic peptide
What is BNP?
Hormone produced by left ventricular myocardium in response to strain
What are the effects of BNP?
- vasodilation
- diuresis and natriuretic
- suppresses sympathetic tone and RAAS system
What is the most common cause of superior vena cava obstruction?
Small cell lung cancer
What are the features of superior vena cava obstruction?
- dyspnoea
- swelling of face, neck and arms
- headache
- visual disturbance
- pulseless JVP distension
If a woman vomits within 3 hours of taking levonorgestrel or ulipristal acetate what should she do?
Take a 2nd dose of emergency contraception ASAP
Levonogestrel and ulipristal are effective for how many hours?
L= 72 U = 120
Which form fluids is indicated in patients with severe hyponatraemia?
Hypertonic saline if less than 120mmol/L
What is the preferred term for trochanteric bursitis?
Greater trochanteric pain syndrome
Which drugs can cause SIADH?
Carbamazepine, sulfonylureas, SSRIs, tricyclics
How is SIADH characterised?
Hyponatraemia secondary to dilutional effects of water retention
How is SIADH managed?
- correction done slowly to prevent pontine myelinolysis
- fluid restriction
- demeclocycline
- ADH receptor antagonists
Which antibiotic should patients with ascities and protein >15g/L be given?
Oral ciprofloxacin or norfloxacin as prophylaxis against SBP
How is SBP managed?
IV cefotaxime
What antibiotics should be avoided with statins?
Macrolides- erythrymycin P450 inhibtor
The gold standard for stopping oral contraceptive pill prior to surgery is…..
one month
What are common first presentations of hereditary haemochromatosis?
Lethargy and arthralgia
How to confirm diagnosis of haemochromatosis?
Serum ferritin
What is 1st line for ank spon?
Exercise regimes and NSAIDs
What is the first-line investigation for suspected osteoporotic vertebral fracture?
X-ray of spine
Parainfluenza
croup
respiratory syncitial virus
bronchiolitis
bordetella pertussis
whooping cough
Management of angina
- aspirin and statin
- sublingual GTN
- B-blocker, CCB
(CCB= verapamil or diltiazem if used as monotherapy)
(CCB + B-blocker= nifedipine)
How does biliary atresia present?
In the first few weeks of life with jaundice, appetite and growth disturbance
- high conjugated bilirubin
- hepatomegaly
- raised GGT
Investigation of narcolepsy
Multiple sleep latency EEG
What is associated with narcolepsy
HLA-DR2
Low levels of orexin
Patients with polymyalgia rheumatica typically respond dramatically to _____, failure to do so should prompt consideration of an alternative diagnosis
Patients with polymyalgia rheumatica typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis
Antidote for TCA overdose
IV bicarbonate
what does any change in vision with thyroid eye disease require?
Referral to eye casualty
What must be ruled out before starting azathioprine
thiopurine methyltransferase deficiency (TPMT) before treatment
- they need it to metabolise azathioprine
What is the investigation for a patient on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA?
CT head
What pattern is asbestosis on PFT?
Restrictive
What is lynch syndrome?
Autosomal dominant
get colonic and endometrial cancer at young age
what is kartagener’s syndrome?
The primary problem is of immotile cilia syndrome. When associated with situs inversus Kartagener’s syndrome is diagnosed.
What tends to be the presenting feature of MEN ii
medulary carcinoma of thyroid
What autoantibodies are found in schirmers?
Anti-RO and anti La
Suspected PE in pregnant women with a confirmed DVT
treat with LMWH first then investigate to rule in/out
Which systolic murmur is louder with inspiration?
Tricuspid regurgitation
What is takotsubo cardiomyopathy?
apical ballooning of myocardium (resembling an octopus pot)
asthma PEFR < 33%
ITU
What can falsely lower BNP?
ACEi, aldosterone antagonists, angiotensin-II receptor antagonists, B-blocker and diuretics
What ECG sign is seen in mitral stenosis?
P Mitrale (left atrial hypertrophy)
What is the first line investigation in suspected primary hyperaldosteronism?
Plasma aldosterone/renin ratio
COPD categories
All post bronchodilator <0.7
Stage 1= FEV1 >80
Stage 2= 50-79
Stage 3= 30-49
Stage 4= >30
How does Kaposi’s sarcoma present?
Raised purple lesions
What can cause membranous glomerulonephtopathy in patients with wilsons disease?
penicillamine
What is FSGS associated with?
Heroin and HIV
What kind of lung cancer causes cushings syndrome?
Small cell lung carcinoma secreting ACTH
How to treat otitis externa in diabetics?
Ciprofloxacin to cover pseudomonas
What must be ruled out in status epilepticus?
Hypoxia and hypoglycaemia
What should be offered to patients with reduced ejection fraction heart failure?
Annual influenza vaccine and once-only pneumococcal vaccination
What medication causes orang tears/urine?
Rifampicin
What is used to control rate in AF?
Beta- blockers
What is containdicated by nitrates and nicorandil?
PDE 5 inhibitors
sildenafil
What do patients who will be taking long term hydrocychoroquine require?
Baseline ophthalmologic examination
What is the first step in infant resus?
Dry baby
Poorly controlled hypertension, already taking a calcium channel blocker - add ….
an ACE inhibitor or an angiotensin receptor blocker or a thiazide-like diuretic
Acute dystonia secondary to antipsychotics is usually managed with
procyclidine
Pregnant women with a UTI should be treated with an antibiotic for….
7 days
What are the features of ank spon?
the ‘A’s
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis
Post-void volumes
50
What can occur in chronic myeloid leukaemia?
thrombocytosis
Cushings syndrome causes what findings on blood gas?
Hypokalaemic metabolic alkalosis
Excess aldosterone which increases acid and potassium excretion in the kidney
All patients with non-ST elevation myocardial infarction should receive ….
300mg aspirin
Dysphagia affecting both solids and liquids from the start
achalasia
Patients with a BMI that classifies them as morbidly obese (> 40) are grade ASA ….
III
What is the treatment for wilsons disease?
Penicillamine (chelates copper)
What is trousseau’s sign?
inflating the blood-pressure cuff to a level above the systolic blood pressure for 3 minutes or more. This causes the patient’s hand to spasmodically contract (hypocalcaemia)
Chvostek’s sign is seen in hypocalcemia; what is it?
tapping over the facial nerve causes twitching of the facial muscles
What causes subdural haemorrhage?
Damage to bridging veins between cortex and venous sinuses
ADPKD is associated with
hepatomegaly
