Deck 1 Flashcards
What is CRP?
Acute phase protein produced by the liver in response to increasing levels of IL6 (produced by macrophages)
CRP binds to damaged and foreign cells, increases complement activation and phagocytosis by macrophages
What does singing of a chest drain mean?
Chest drains should normally swing in response to breathing (inspiration –> fluid level up, expiration –> fluid level down)
Stopping swinging suggests that either the chest drain is blocked or the lung has re-expanded
What is the maximum rate at which you can remove fluid through a chest drain and why?
1 L at a time, followed by clamping for 1 hour
Risk of re-expansion pulmonary oedema
Should a chest drain bubble?
Only if it is a chest drain for a pneumothorax
If it is for a pleural effusion and it is bubbling, it may be suggestive of an air leak
How is digoxin loaded?
500 mcg –> 500 mcg (after 6 hours) then OD of:
125 mcg if tachycardic
67.5 mcg if normocardic
When should digoxin be used for rate control?
Heart failure patients as it is a negative chronotrope and a positive inotrope
How should your choice of antihypertensive change dependent on whether it is right or left heart failure with preserve ejection fraction?
RIGHT: choose venodilators (e.g. nitrates)
LEFT: choose arteriodilators (e.g. hydralazine, amlodipine)
What is a good medical treatment option for SIADH that has not improved with fluid restriction?
Demeclocycline
It is a tetracycline antibiotic that is used to treat Lyme disease and acne. It is good in SIADH as it induces a nephrogenic diabetes insipidus.
What is hidradenitis suppurativa?
Inflammatory skin condition characterised by recurrent painful skin abscesses
Which electrolyte should you be conscious of in patients who are receiving laxido/movicol?
Potassium (laxido/movicol contains potassium)
What dose should a nitrate infusion be started at?
2 mg/hour (50 mg in 50 mL)
Max dose 10 mg/hour
Which group of patients with active GI bleeding still require anticoagulation?
Inflammatory bowel disease (it is a prothrombotic state)
What should you always think about in a patient with normal blood pressure who is tachycardic?
Do they need fluids?
CO = SV x HR (if HR is high and CO is normal, then SV must be low)
NOTE: patients can have AF and be tachycardic without the tachycardia being caused by the AF (i.e. physiological tachycardia with AF)
What are the main types of renal tubular acidosis?
Type 1: DISTAL tubule dysfunction results in inability to excrete H+
Type 2: PROXIMAL tubule dysfunction results in inability to reabsorb bicarbonate
Type 4: ALDOSTERONE DEFICIENCY/RESISTANCE results in hyperkalaemia
NOTE: type 1 and type 2 are associated with hypokalaemia
What is May Thurner syndrome?
Compression of the left common iliac vein by the overlying right common iliac artery
Results in stasis of the blood and an increased risk of DVT
Which medication can be used to treat hiccups?
Chlorpromazine (typical antipsychotic)
NOTE: not to be confused with prochlorperazine which is a related medication used as an antiemetic
What is short bowel syndrome?
Malabsorption caused by a lack of small bowel (leads to diarrhoea, dehydration, malnutrition and weight loss)
Patients are typically given slightly sweet and slightly salty liquids
What dosing should be used for fondaparinux in patients with NSTEMI?
2.5 mg SC OD for up to 8 days (or until hospital discharge if sooner)
What is the link between magnesium deficiency and potassium deficiency?
Magnesium has an inhibitory effect on ROMK channels in the renal tubule, so a lack of magnesium results in increased excretion of potassium.
Magnesium deficiency also causes ineffective Na-K ATPase function
Why is magnesium used in the treatment of AF?
It acts as a weak calcium antagonist (blocks calcium at the AV node), resulting in a slower ventricular response
NOTE: this is the same way in which magnesium is used in asthma (relaxes the smooth muscle)
