extr Flashcards
What anemia occurs with autoimmune thyroid disease
This is the correct answer. Pernicious anaemia is a common cause of B12 deficiency, and the coexistence of autoimmune thyroid disease makes this likely in these cases (manifesting as a megaloblastic anaemia, with glossitis and oral ulcers).
rose coloured spots with fever after trip - typhoid fever
what organism
salmonella typhi
Somatostatin receptor scintigraphy
gastrinoma - zollinson ellison syndrome
what is acute porphyuria and what test shoudl be done
Porphyria is a spectrum of disorders caused by defects in haem synthesis due to alterations in enzyme function or structure.
Urine porphobilinogen level
Acute porphyria can manifest with gastrointestinal symptoms, e.g. abdominal pain, vomiting or neuropsychiatric features (peripheral neuropathy, psychosis, and seizure). Due to the overactivity of the sympathetic system, acute porphyria can also result in hypertension and bradycardia. Urine porphobilinogens are raised during an acute attack. Possible triggers of acute porphyria include antibiotics such as trimethoprim and nitrofurantoin and anaesthetic agents.
pathophysiology of delirium tremens?
Acute alcohol consumption causes an increase in GABA neurotransmission. This is an inhibitory neurotransmitter. However, in those with chronically high alcohol intake, a compensatory decrease in GABA neurotransmission and increase in the excitatory neurotransmitter glutamate occurs.
This means that in cases of acute alcohol cessation, as in cases of delirium tremens, the upregulated glutamate is no longer opposed by GABA. This generates an overall excitatory state.
raised haemocritit
A higher than normal hematocrit can indicate: Dehydration. A disorder, such as polycythemia vera, that causes your body to produce too many red blood cells. Lung or heart disease
what common bone drugs cause dyspepsia
bisphosphonates
Which of the sites in the bowel is affected in Crohn’s disease that contributes to the formation of gallstones?
Terminal ileum
Crohn’s disease is an inflammatory bowel disease (IBD) affecting the gastrointestinal tract from mouth to anus. The most commonly affected sites include the terminal ileum and part of the colon. Terminal ileitis affects the absorption of bile salts, increasing the risk of gallstone formation.
what drugs increase the risk of c.diff diarhhoea
PPI
immunosuppressed as renal tranplantation so more suscpetive to what fungal infection
thrush and candida - fluconazole
A 45-year-old man presents to A&E, acutely confused. He appears dishevelled in appearance, and becomes agitated as he reports there are spiders crawling up the walls and over his skin. On examination he is peripherally warm and well perfused, and flushed and sweaty in appearance. Pupils are equal and reactive to light. His respiratory rate and heart rate are within normal limits, but he is slightly hypertensive (blood pressure 164/101 mmHg).
What is the first-line treatment for this condition?
This patient is showing signs of delirium tremens (DT). Features include confusion, sweating, hypertension and hallucinations: in particular, visual hallucinations and tactile hallucinations. The sensation of crawling insects on or under the skin, which this patient appears to be experiencing, is known as formication. Patients may also show seizures.
This can be differentiated from opiate intoxication, as these patients are more likely to show reduced respiratory rate and heart rate, as well as constricted (‘pinpoint’) pupils.
alcohol withdrawal stages
simple withdrawal - 6-12 hour- insomnia, sweating, nausea
12-24 hours - hallucinosis - visual audiotry and tactile orgin
72hours - delirum tremens
Delusions
Confusion
Seizures
Tachycardia
Hypertension
Hyperthermia
A 65 year old man has pain in his abdomen and is seen on the surgical inpatient ward. He had a closure of his colostomy 5 days ago.
His temperature is 36.5°C, pulse rate is 76 bpm, BP 124/82 mmHg and respiratory rate is 15 breaths per minute. There is a tender, localised fluctuant swelling 4 cm in diameter in the wound.
Which is the most appropriate management?
Abdominal support
Antibiotics
Laparotomy
Local exploration of wound
Observation
D. Local exploration of wound
Explanation:
Diagnosis is a wound abscess following closure of colostomy. Wound exploration and washout would be first line of treatment. Antibiotics alone would likely be insufficient alone to treat an abdominal wound abscess although should also be given whilst waiting for exploration. Observation is not adequate. The patient is not septic and has no indications of an acute abdomen suggesting an intra-abdominal cause and thus requiring laparotomy. Abdominal support is not a treatment for abscess.
A 64 year old man is prescribed regular oramorph for pain relief and develops constipation. What is the most appropriate laxative to prescribe him?
Senna and macrogol
NICE recommends a stimulant (senna) and an osmotic (macrogol) laxative for the treatment of opioid induced constipation or sodium docusate (which has stool softening properties). Senna acts as an irritant on the colonic wall to induce fluid secretion and colonic motility. Macrogol acts by increasing water retention in the bowel causing a softer stool.
