Extra clinical notes (HD) Flashcards
1
Q
Describe the physiology breast feeding
A
There are 2 parts: milk production and milk ejection.
Milk production is achieved through prolactin release from the anterior pituitary. Suckling of the baby on the nipple stimulates mechnoreceptors - this inhibits the release of dopamine from the hypothalamus therefore increasing prolactin release. Prolactin acts on milk gland cells causing milk synthesis.
When nipple mechanoreceptors are stimulated causing the release of oxytocin from the posterior pituitary gland, which causes the contraction of nipple myoepithelial cells, causing milk ejection.
2
Q
What medications can be used to treat hyperprolactinaemia?
A
D2 agonists: bromocriptine, cabergoline
3
Q
What is the difference between acromegaly and gigantism?
A
Both are caused by the over secretion of GH, the difference between gigantism and acromegaly is whether that occurs before or after the fusion of epiphyses respectively.
4
Q
Describe bromocriptine
A
D2 agonist, used to treat hyperprolactinaemia or acromegaly
5
Q
Describe cabergoline
A
D2 agonist, used to treat hyperprolactinaemia or acromegaly
6
Q
Describe octreotide
A
Long lasting somatostatin, used to treat acromegaly
7
Q
Describe pasireotide
A
Somatostatin, used to treat acromegaly and Cushing’s
SST5>SST2
8
Q
Describe lanreotide
A
Somatostatin, used to treat acromegaly and Cushing’s
SST2>SST5
9
Q
How can GH deficiency be treated
A
Recombinant hGH (somatropin) or recombinant hIGF-1 (mecasermin)
10
Q
Describe somatropin
A
Recombinant hGH used to treat GH deficiency
11
Q
Describe mecasermin
A
Recombinant hIGF-1 used to treat GH deficiency
12
Q
Descrine an insulin tolerance test
A
Tests the hyopthalamus, pituitary and adrenal glands.
Hypoglycaemic episode induced by intravenous insulin, GH, ACTH and cortisol should be released with an intact HPA
13
Q
What is the structure which joins the two lobes of the thymus gland
A
Isthmus
14
Q
Which is the hormone and which is the prohormone in T3/4
A
T4 is the prohormone, which is converted to the active T3 hormone in the periphery.
15
Q
Why do patients with hyperthyroidism have tachycardia
A
Binding of thyroid hormones causes an increase in the expression of beta-2 adrenergic receptors on the surface of cardiac myocytes increasing the heart rate
16
Q
How is Hashimoto’s thyroiditis diagnosted serologically?
A
T3+T4 will be low (hypothyroidism)
TSH and TRH will be high (hypothyroidism)
Antiboidies to thyroglobulin or thyroid peroxidase will be present (autoimmune hypothyroidism)
17
Q
How is Hashimoto’s thyroiditis treated?
A
Thyroxine 75-125 mcg o/d
or Levothyroxine 100 mcg p/o
18
Q
Describe thyroxine + its dose
A
Used to treat hypothyroidism
75-125 mcg o/d
19
Q
What is the pathology of myxoedema
A
Increase in size of thyroid gland due to presence of goitregens therefore causing hypertrophy and hyperplasia.
Goitrogens interfere with thyroid iodine uptake therefore causing hypothyroidism. This leads to an increased TSH and so the thyroid gland undergoes hypertrophy, while function does not improve as goitrogens still present.
20
Q
How do you investigate suspected hyperthyroidism
A
Measure TSH, TRH, T3 and T4
Measure calcitonin
Do an ultrasound
21
Q
How can you treat hyperthyroidism
A
Inhibit thryoid hormone synthesis:
Carbimazole (40mg o/d)
Propylthiouracil (200mg b/d)
Radioiodine therapy can be used, but usually causes hypothyroidism within 3-6 months.
Thyroidectomy can be considered if thyrotoxicosis is uncontrolled on anti-thyroid medication and there is a large goitre.
22
Q
Describe carbimazole + its dose
A
Inhibits thyroid hormone synthesis given at 40mg o/d
23
Q
Describe propylthiouracil + its dose
A
Inhibits thyroid hormone synthesis given at 200mg b/d
24
Q
Causes of hyperprolactinaemia
A
1) excess production by pituitary
2) disinhibition by compression of pituitary stalk, reducing local dopamine levels
3) use of a dopamine agonist
Could be: Prolactinoma Stalk damage Pituitary adenoma Surgery, trauma Hypothalamic issue *Hypothyroidism + hyperprolactinaemia due to increased TRH*
25
What are the symptoms of hyperprolactinaemia
Women: Amenorrhoea; infertility; galactorrhoea; dec. libido; inc, weight; dry vagina
Men: Erectile dysfunction; dec. facial hair; galactorrhoea
26
How do you test for hyperprolactinaemia
PRL
Pregnancy test
TFT
U+E
MRI pituitary if needs be
27
What can be used to treat PRL
Cabergoline, bromocriptine (D2 agonist)
28
What are the symptoms of acromegaly
```
Acroparaesthesia
Amenorrhoea
Dec. libido
Headache
inc. sweating
Snoring
Arthralgia
*Developing curly hair*
```
29
How do you test for acromegaly
Blood test: inc. glucose, Ca, PO4
Don't rely on random GH tests as GH release is pulsitile and acromegalic and normal levels overlap
GH is also increased in stress, puberty, sleep and pregnancy giving a false positive
If basal serum GH is >0.4 mcg/l do an oral glucose tolerance test. If lowest GH value during OGTT is >1mcg/l acromegaly is confirmed (glucose inhibits GH secretion)
30
How do you treat acromegaly
1) Trans-sphenoidal surgery to remove tumour
2) If surgery fails to correct hypersecretion; somatostatin analogues are to be used (octreotide)
3) GH antagonist pegvisomant is used if intolerant to SSAs
Radiotherapy can be used instead of surgery if not suitable
31
What are the features of pheochromocytoma
*head ache + sweating + tachycardia*
Inc. HR, palpitations, VT, dyspnoea, headache, visual disorder, dizziness, tremor, anxiety, panic, hyperactivity. confusion, sweats, flushes, heat intolerance
(as with too much Red Bull)
32
How do you test for pheochromocytoma?
24hr urine test (adrenaline, noradrenaline)
| CT/MRI abdomen
33
How is pheochromocytoma treated?
Surgical removal of tumour.
Catecholamines will be released during surgery so there is a pre-treatment with and alpha and beta blockade (phenoxybenzamine doxazonsin are alpha blockers)
34
What is asthma
Reversible airway obstruction which responds to bronchodilators
35
What are the symptoms of asthma
```
Wheeze
Dyspnoea
SOB
dry cough
chest tightness
```
36
What are the signs of asthma
```
Tachypnoea
Hyperinflated chest
hyper-resonance on percussion
decreased air entry
Resp rate >25
can't speak in complete sentances
peak flow 33-50% predicted
```
37
How do you test for asthma
Peak flow
Fractional exhaled nitric oxide (FENO) > 40 ppb in adults, 35 in children
For an acute asthma attack:
ABG: type 2 resp failure
Bloods: FBC, CRP (infection causing attack?)
CXR
38
Describe the long term management options for asthma
Beta 2 adrenergic receptor agonists (salbutamol short acting [SABA], salmeterol long acting [LABA])
Inhaled corticosteroids (ICS) (beclomethasone)
Long acting muscarinic antagonist (LAMA) tiotropium
Leukotriene receptor antagonists (montelukast)
Theophylline - relax brochial smooth muscle and reduce inflammation
* In order*:
1) SABA
2) SABA + low dose ICS
3) 2+LABA
4) Stop LABA increase ICS
5) try leukotriene receptor antagonist, high dose steroid
39
What are the grades for acute asthma attacks?
By PEFR
moderate 50-75%
severe 33-50%
life threatening <33%
Look for sats <92%; signs of becoming tired; silent chest for life threatening asthma
40
How do you manage a moderate asthma attack?
Nebulised beta 2 agonists (salbutamol 5mg repeated as often as needed)
Nebulised ipratropium bromide
Steroids: oral prednisolone or IV hydrocortisone for 5 days
Antibiotics if infection
41
What is prednisolone
A steroid given orally for 5 days following a moderate asthma attack
42
What is hydrocortisone
A steroid given IV for 5 days following a moderate asthma attack
43
How do you manage a severe asthma attack?
O2 keep sats 94-98%
Aminophylline infusion (relieves bronchial spasm)
IV salbutamol
44
How do you manage a life threatening asthma attack?
IV mg sulfate
Admission to ICU
Intubation if really severe, but needs to be decided early as difficult to intubate with severe bronchoconstriction
45
What do you need to monitor in the blood when you give salbutamol?
Serum potassium; causes absorption of K from blood into cells and can cause tachycardia
46
What is the respiratory differential diagnosis for someone presenting with a (dry) cough, wheeze, SOB, dyspnoea
Asthma
Acid reflux (GORD)
Allergic bronchopulmonary Aspergillosis (ABPA)
Churg Strauss Syndrome
47
What is GORD + symptoms
Gastro-oesophageal reflux disease
| Dry cough, wheeze, sob, hoarse voice, dental erosion, chest pain
48
How is GORD treated?
```
OTC antacids (Gaviscon)
Proton pump inhibitors (omeprazole)
H2 blockers (ranitidine)
```
49
What is ABPA + symptoms
Allergic bronchopulmonary Aspergillosis (ABPA)
| Wheeze, cough, dyspnoea, sputum production
50
How do you test for ABPA
Raisied IgE in blood but not all patients have this
51
How do you treat ABPA
Prednisolone
| Itraconazole too possibly
52
What is Churg-Strauss syndrome
Granulomatous vasculitis assoc. with adult onset asthma and eosinophilia
53
How do you test for Churg-Strauss syndrome
pANCA +ve and have raisied IgE levels
54
How is Churg-Strauss syndrome treated?
Steroids + immunological agents (Rituximab)
55
What defines the different stages of COPD
FEV1 as a % of predicted
stage 1: FEV1 >80%
2: 50-79
3: 30-49
4: <30%
56
What are the symptoms of COPD?
```
Chronic SOB
Cough
Sputum production
Wheeze
Recurrent resp infections
```
57
How do you diagnose COPD
Clinical presentation + spirometry
Spirometry- FEV1:FVC <0.75
No response for a test for reversbility of symptoms with B2 agonists ruling out asthma
58
What do you rule out before diagnosing COPD and how
CXR - lung cancer
FBC - polycythaemia
BMI - to assess future weight change cancer and COPD will lead to weight loss and steroids weight gain
Sputum culture - chronic infection (Psuedomonas)
ECG + ECHO - heart function
CT thorax - fibrosis, cancer, bronchiectasis
Alpha 1 antitrypsin - early onset + increased severity for COPD
59
Describe the long term management of COPD
Short acting bronchodilators (salbutamol, terbutaline)
or short acting antimuscarinics (ipratropium bromide)
If no response add a long acting beta agonist and a long acting muscarinic antagonist
If there is a response to first step then use LABA + ICS
No response to 3rd LABA, LAMA and ICS
60
What is carbocysteine
Mucolytic treatement used in COPD patients
61
How do you investigate an exacerbation of COPD
```
ABG
CXR - pneumonia
FBC (WBC) - infection
U+E's - electrolytes
Sputum culture - infection
```
62
What type of oxygen mask should be used for COPD patients?
Venturi mask - aim for 88 - 92% sat
63
What is community acquired pneumonia
Developed outside hostpital
64
What is hospital acquired pneumonia
Develops >48 hrs of hospital admission
65
What are the symptoms of pneumonia
```
Fever
Malaise
Rigors
Cough
Purulent sputum
Pleuritic chest pain
Haemoptysis
```
66
What are the signs of symptoms of pneumonia
```
Tachypnoea
Tachycardia
Hypotension
Cyanosis
Pyrexia
Confusion
Dull percussion of lungs
Crackles
Pleaural rub - pleurisy
```
67
How do you treat atypical pneumonia
Macrolides (clarithromycin)
Fluorquines (levofloxacin)
Tetracyclines (doxycycline)
Atypical pneumonias cannot be treated with penicillins
68
What is the scale used to judge treatment of pneumonia
CURB-65
```
C - confusion
U - urea >7mmol/l
R - resp rate >=30/min
B - BP <90/<60
65 age
Give one point for each
```
```
0-1 = home treatment
2 = consider hospitalisation
3-5 = consider ITU
```
69
How is pneumonia treated in hospital
O2 - sats >94%
Fluids
Analgesia for pleuritic chest pain (paracetamol 1g/6hrs max 4g in 24 hours)
Oral antibiotics, if nil by mouth give IV
mild CAP: 5 day course of antibiotics amoxicillin or macrolide
moderate/severe: 7-10 day course of amoxicillin and macrolide
70
What are the symptoms of pleural effusion
Dyspnoea
Chest pain
SOB
Reduced exercise tolerance
71
What are the signs of pleural effusion
Deviated trachea
Reduced chest expansion on affected side
Stony-dull percussion on affected side
72
What are the different types of pleural effusion?
Exudative and transudative
Difference is protein content of fluid >35g/l is exudative and is due to fluid to leak from tissues into pleural space; transudative is fluid moving across into pleural space
73
What causes exudative pleural effusion
Lung cancer, pneumonia, TB, rheumatoid arthritis
Acute pancreatitis
Pulm infarct
Trauma
74
What causes transudative pleural effusion
Congestive heart failure
Liver cirrhosis, nephotic syndrome, coeliac disease
hypoalbuminaemia
hypothyroidism
Meig's syndrome (ascities, pleural effusion, ovarian tumour) right sided pleural effusion if tumour is malignant
75
What is ALT/AST ratio
Alanine aminotransferase:aspartate aminotransferase (conc of enzymes) is a liver function test of cirrhosis
76
How do you investigate a transudative pleural effusion
FBC
U+E's - raised creatinine = renal impairment
LFT - low albumin + raised ALT:AST = cirrhosis
CXR - shows blunting of costophrenic angle + fluid in lung fissures
Glucose: low = rheum arthiritis, TB, malignancy
pH <7..2 = empyema (look for low glucose, high LDH)
Amylase - raised in pancreatitis
77
How do you manage a transudative pleural effusion
Intercostal drain
Pleural aspiration
Pleurodesis
78
What are the risk factors for a pulmonary embolism
```
Immobility
Recent surgery
Long flights
Pregnancy
Polycythaemia
```
79
Symptoms of pulmonary embolism
Sudden onset SOB
Pleuritic chest pain
Haemoptysis
Big PE: syncope/shock
Small PE: asymptomatic?
80
What are the signs of PE?
```
Tachypnoea
Tachycardia
Hypoxia
Fever
Hypotension
DVT*
```
81
What scoring system is used to grade pulmonary embolism
Well's scoring system
3 pts if:
DVT
No other likely diagnosis
1.5 pts if:
Tachycardia (>100 bpm)
Immobility >3 days or surgery within month
History of PE/DVT
1 pt if:
Haemoptysis
Active malignancy
If score is <4 - measure D dimer then if low PE is exluded, if high do diagnositic imagine
If >4 diagnostic imagine + LMWH
CTPA or V/Q scan
82
How do you investigate pulmonary embolism
CTPA
VQ scan
ABG - resp acidosis due to tachypnoea
83
How do you treat pulmonary embolism
Anti-coagulation with LMWH (enoxaparin or dalteparin) start with a low dose in patients with DVT or suspected PE/there is a delay in scanning.
Switch to long term anticoagulation (warfarin) but LMHW is first line treatment in pregnancy or cancer
84
What is dalteparin
LMHW used to treat pulmoary embolism
85
What is salbutamol
SABA
86
What is an example of a LABA
Salmeterol
87
Give an example of an ICS
Beclomethasone
88
Give an example of a LAMA
tiotropium bromide
89
Give an example of a leukotriene receptor antagonists (LRA)
montelukast
90
What is theophylline
A bronchodilator used to treat asthma
91
What are the causes of primary hypothyroidism
Autoimmune:
Primary atrophic hypothyroidism
Hashimoto's hypothyridism
Other:
Iodine deficiency
Post thyroidectomy or radioiodine
Drug induced
92
What are the causes of hypopituitarism?
Hypothalamic issue: tumour etc.
Pituitary stalk: trauma, surgery, lesion
Pituitary: tumour, irradiation, autoimmunity
93
What causes Grave's disease
Circulating IgG autoantibodies binding to and activating GPCR thyrotropin receptors causing increased hormone production.
94
How is thyrotoxicosis treated
Drugs: Beta blockers (40mg/6hrs); or (a) carbimazole 20-40mgs/day for 4 wks titrate according to TFTs every 1-2 months or (b) carbimazole + levothhyroixine (block and replace, reduces risk of iatrogenic hypothyroidism)
Radioiodine
Thyroidectomy
95
How is Cushing's disease treated?
Cushing's is caused by an ACTH secreting pituitary adenoma; trans-sphenoidal removal of tumour or bilateral adrenalectomy
96
How do you test for Cushing's disease
1) overnight dexamethosone test (1mg at midnight) do serum cortisol at 8am. Usually drops to <50nmol/L; no suppression in Cushing's
2) 48hr dexamethosone test (0.5 mg/6hrs for 2 days) measure cortisol initial and 6hrs and after last dose - no suppression in Cushing's
To distinguish between betweeen pituitary (suppression) and other causes (no/part suppression) do a high dose test (2mg/6hrs)
3) if 1+2 are positive; to find the lesion do an ACTH plasma test (if positive adrenal tumour likely)
If not do adrenal vein sampling.
If ACTH is detectable do a corticotropin releasing hormone test to see if it is a pituitary or ectopic cause of ACTH excess.
Give 100 mcg CRH IV, measure cortisol at 120mins.
Cortisol rises with pituitary disease but not with ectopic ACTH.
97
What are the symptoms of Addison's disease
Low cortisol causes exhaustion, weight loss, postural hypotension, anorexia, GI symptoms, joint aches and pigmentation (due to an increase in ACTH precursors)
98
What is gastroparesis?
GI complication of diabetes related to poor glycaemic control - nerve damage to the ANS causing delayed stomach emptying
99
What are the symptoms of gastroparesis
Delayed gastric emptying, egg smelling burps due to bacterial over growth, early satiety, abnormal wall movements, morning nausea and fluctuations in blood glucose
100
How do you treat hyperthyroidism in the first trimester of pregnancy
Propylthiouracil 200mg bd
101
What is the best diagnostic test for diabetes ispidus
Fluid deprivation test - potential ADH insufficiency is tested here
102
What can cause cranial diabetes
Genetic or trauma, tumours, inflammatory conditions (sarcoidosis), cranial infections, vascular diseases (sickle cell)
103
What type of medications used to treat mental health issues may cause hyperprolactinaemia
SSRIs like fluoxetine
104
How do you test for excess adrenaline release, in a case which is unlikely to be Cushing's?
Plasma metanephrines screen for exceess adrenaline metabolites
105
What medication are patients given preoperatively before the removal of a tumour for Cushing's disease
Metyrapone, blocks steroidogenesis pathway reducing cortisol production
106
What would be a positive result in a water deprivation test for cranial diabetes isipidus
Low urine osmolality after water deprivation; normal after desmopressin IM injection (lack of vasopressin causes DI so giving it should fix the problem; if it remains low then it could be nephrogenic DI)
107
What is the presentation of a patient with SIADH = syndrome of inappropriate ADH secretion
Hyponatraemia
Euvolaemic
Low plasma osmolality
108
How does amiodarone cause thyrotoxicosis
Amiodarone is full of iodine
109
Loss of lateral side of eye brow is a sign of what?
Hypothyroidism
| Leprosy
110
What is exophthalamos
Bulging of the eyes caused by Grave's disease
111
What does metformin do
Increases peripheral sensitivity to insulin by encouraging peripheral glucose uptake
112
What is the target blood pressure for someone with diabetes
140/80
113
What are normal test results for a glucose tolerence test
Fasting <6
| 2h glucose <7
114
What is Fetid foot
Severe bone and soft tissue infection in patients with diabetes
115
Do potassium or sodium imbalances cause ECG changes
Potassium
116
In asthmatic patients, what drugs should be used/avoided to manage heart rate?
Beta blockers should be avoided, verapamil could be used
117
When should synchronised/unsynchronised cardioversion be used
Synchronised when there are signs of life, unsynchronised when there are no signs of life
118
How do you treat a tension pneumothorax
IV cannula places into 2nd intercostal space at mic clavicular line
119
How do you tell the difference between an obstructive and a restrictive lung disease
If FEV1/FVC is >0.7 then it is restrictive
| If <0.7 then obstructive
120
What are the most common causes of metabolic acidosis?
Lactate, ketoacidosis, kidney failure
121
What are the types of shock?
Septic, hypovolaemic, cardiogenic, anaphylactic
122
How do you treat ventricular tachycardia
Class 1,2,3 anti arrhythmic drugs + radio catheter ablation
E.g flecainide, bisoprolol, amiodarone (1,2,3)
123
What diseases do you test for in pregnancy
HIV
Syphilis
Hep B
124
What are the signs of septic
High temp
High hr
Low blood pressure
125
What effect does digoxin have on an ECG
ST downsloping
126
How do you treat supraventricular tachycardia
Sinus massage and then adenosine
127
What are the symptoms of aortic dissection
```
Central sharp chest pain
Aortic regurgitations (mid diastolic murmur)
Cardiogenic shock
Acute head failure
Respiratory problems
```
128
What is the pleural fluid glucose that may be expected with an exudative pleural effusion
<3.3 mmol/L
129
What is sarcoidosis
A multisystem granulomatous disorder of unknown cause
130
How does acute sarcoidosis present
Fever
erythema nodosum
polyarthralgia
bilateral hilar lymphadenopathy
131
How do you test for sarcoidosis
Bloods: inc ESR, lymphopenia (low lymphocyte levels)
24hr urine: inc Ca2+
CXR usually normal but may show bilateral hilar lymphadenopahy
ECG may show arrythmias or BBB
Lung function tests - signs of restrictive lung disease
132
How is sarcoidosis treated?
Patients with bilateral hilar lymphadenopathy alone do not need treatment
Acute sarcoidosis:
Bed rest + NSAIDS (nonsteroidal anti-inflammatory drugs)
Prednisolone (40mg/24h) PO for 4-6 wks, then reduce dose over 1 yr, if cardiac, neuro involvment or if there is hypercalcaemia
133
What are the causes of bilateral hilar lymphadenopathy?
```
Sarcoidosis
Infection (e.g TB)
Malignancy (lymphoma, carcinoma, mediastinal tumours)
Organic dust disease
Hypersensitivity pneumonitis
Histocytosis X
```
134
What are the clinical features of interstitial lung disease?
Dyspnoea on exertion, non productive cough
| Restrictive spirometry
135
What is the most common cause of interstitial lung disease?
Idiopathic pulmonary fibrosis
136
What are the symptoms of intersitial pulmonary fibrosis
```
Dry cough
exertional dyspnoea
malaise
weight loss
arthralgia
```
137
What are the signs of idiopathic pulmonary fibrosis
Clubbing,
cyanosis,
fine end-inspiratory crepitations
138
How do you investigate idiopathic pulmonary fibrosis
CXR = bilateral lower zone reticulo-nodular shadows
Blood: inc CRP, inc immunoglobulins
ABG: reduced O2, usually a normal CO2 but if severe then CO2 will be raised
139
How is idiopathic pulmonary fibrosis treated?
O2,
Palliative care
Pulmonary rehab
Nintedanib, pirfenidone are anitfibrotics they may slow the progression of the disease
140
What are the symptoms of pneumonia
Dyspnoea
Cough
Sputum +/- purulence
Fever
141
What are the signs of pneumonia
```
Tachypnoea
Tachycardia
Hypotension
Pyrexia
Whispering pectriloquy
Central cyanosis
Altered mental state/confusion
```
142
How would you investigate pneumonia
```
ABG
CXR
FBC
U+E's, CRP, LFT
CRP is a good measurement of response to treatment, not necessarily diagnositically useful
Blood + sputum culture
Viral PCR
Atypical serology
Urine Ag for legionella + S. pneumoniae
```
143
What scoring system is used for pneumonia
CURB65
```
Confusion AMTS <= 8
Urea >7 mmol/L
Resp rate >= 30 bpm
BP <90/<=60 mmHg
65 years of age
```
```
0 = oral antibiotics at home
1 = consider hospital admission
2 = consider IV Abx
3 = consider ICU admission
```
144
How do you manage pneumonia
```
A = ensure patient airway
B = O2 to 94%-98%
C = IV fluids if required
D = GCS
E = Analgesia, antipyretics, antibiotics
```
145
Describe antibiotic treatment in pneumonia
Abs should be given within 4 hours
Outpatient: penicillin derivative
Inpatient: penicillin derivative + macrolide
Inpatient (severe): Beta-lactamase resistance abx + macrolide
146
In which patient groups is S.aureus pneumonia more common
Post influenza, ICU, IVDUs
147
How does Legionnaire's disease present?
```
As a normal pneumonia:
Dyspnoea
Cough
Sputum +/- purulence
Fever
+ extra neurological symptoms:
Ataxia
Agitation
Lethargy
```
148
What are the symptoms of atypical pneumonia
Fatigue
Headache
Myalgia
Non-productive cough
149
What are the causes of hypoxaemia
```
V/Q mismatch
Impaired diffusion
Alveolar hypoventilation
Low partial pressure of inspired oxygen
Anatomical R-L shunt
```
150
What is the oxygen level in the blood which defines hypoxaemia
PaO2 < 8 kPa
151
What is the CO2 level in the blood which defines hypercapnia
PaCO2 > 6.0pKa
152
What are the causes of hypercapnia
Imbalance in load, capacity or drive
153
What is type 1 resp failure
Hypoxia with a normal or low CO2
154
What is type 2 resp failure
Hypoxia + hypercapnia
155
What are the symptoms of hypoxia
Dyspnoea, restlessness, agitations, confusion, central cyanosis
156
What are the symptoms of hypercapnia
Headache, peripheral vasodilation, tachycardia, bounding pusle, tremor/flap
157
What artery is an arterial blood gas taken from?
Radial artery
158
What (IV) antibiotics do you give to treat a community acquired pneumonia
Co-amoxiclav + clarithromycin
159
What (IV) antibiotics do you give to treat a hospital acquired pneumonia
Ciproflaxacin
160
In a tension pneumothorax, in which direction does the trachea deviate?
Away from the affected side
161
Why would a loud P2 appear in a patient with a pulmonary embolism?
It is a sign of right heart strain
162
Where do you aspirate the pleural space in a tension pneumothorax
2nd intercostal space, mid clavicular line
163
How do you test for tuberculosis
Ziehl-Nielsen stain for acid fast baccilli
164
How do you test for cystic fibrosis
Genetic test
| Or chloride level >60mmol/L in a sweat test
165
What is the scoring system for pulmonary embolism
Well's:
3 - signs of DVT, no alternative diagnosis other than PE
2 - tachycardia (>100bpm); immobile for 3 days or major sugery in past month, history of PE or DVT
1 - haemoptysis, active malignancy
if 4 or less measure d dimer (low d dimer excludes PE) if more than 4 give LMWH
166
What would you expect to find on auscultation of a patient with COPD
hyperresonant percussion note
167
What is the first investigation you would do to confirm bronchiectasis
High res CT
168
What does a dull percussion note and increased tactile vocal fremitus suggest?
Pneumonia
169
How do you treat TB
Rifampicin
Izoniazid
Pyrazinamide
Ethambutol (RIPE)
170
What does aldosterone do?
Increases Na+ and water reabsorption; increased K+ and H+ secretion in urine
171
Failure of which organs causes fluid overload?
Kidney, liver and heart
172
Why would you give 5% glucose drip?
Glucose only there to make it isotonic; good way of giving water without adding electrolytes
173
What is dextrosaline and why would you give it
NaCl 0.18% + 4% glucose good way of adding a bit of Na + Cl
174
Why would you give a bag of IV saline
Has daily requirements of sodium
175
When would you give a IV balanced crystalloids
Good for replacing large volumes if not hyperkalaemic
176
What's in an IV colloid bag
large molecules which do not cross semi-permeable membranes - therefore fluid remains in circulating space and doesn't enter cells
177
What is parenteral nutrition?
IV nutrition
178
What is the sign for SIADH
Syndrome of inappropriate ADH secretion: hypervolaemia and hyponatraemia
179
What are the classifications of hyponatraemia?
```
Mild = 130-135 mmol/L
Moderate = 121-129
Severe = <120
```
180
What are the symptoms of mild hyponatraemia?
Asymptomatic
181
What are the symptoms of moderate hyponatraemia?
Cramps, weakness, nausea
182
What are the symptoms of sever hyponatraemia
Lethargy, headache, confusion
183
How do you treat hyponatraemia
```
Hypovolaemia = correct volume depletion, IV 0.9% saline
Euvolaemia = treat underlying cause, fluid restriction
Hypervolaemia = underlying cause, fluid restriction, vasopressing receptor antagonists
```
184
What is the maximum rate of change of serum Na that is safe
8mmol/day
185
What is hypernatraemia
Na > 145 mmol/L
186
What is severe hypernatraemia?
Na > 158 mmol/L
187
What are the symptoms of hypernatraemia
Thirst, anorexia, weakness, stupor, seizures, coma
188
How do you treat chronic hypernatraemia
Treat underlying cause, use hypotonic fluid (5% dextrose, slowly)
Lower Na by a max of 10 mmol/L/day
189
How do you treat acute hypernatraemia
```
Hypotonic fluid (5% dextrose)
lower Na by 1-2 mmol/L per hour
```
190
What is hypokalaemia
K < 3.5 mmol/L
191
What are the symptoms of hypokalaemia
Muscle weakness
ECG changes + arrythmias
Renal abnormalities if chronic
192
How does pH of blood effect K+ levels
Increased pH causes drop in K+
193
What are the ECG changes you would expect find in hypokalaemia
Prolonged PR interval
ST depressiong
Shallow T wave and raised U wave
194
What is hyperkalaemia
K > 5.5 mmol/L
195
What are the ECG changes you would expect in hyperkalaemia
```
Flat T wave
Decreased R wave
Widened QRS
ST depression
Tall peaked T wave
```
196
What are the symptoms of hyperkalaemia?
Paraesthesiae
Muscle weakness - paralysis
arrythmias
197
How do you treat hyperkalaemia
IV calcium gluconate
IV insulin + glucose to cause K to move into cells
Remove K from body - loop diuretics; haemodyalisis
treat underlying cause
198
Describe an AKI caused by glomerulonephritis
Happens secondary to an infection elsewhere in the body. Infection itself does not damage kidney, the insoluble antibody-antigen complex produced in the immune response deposits in the glomeruli - damaging the basement membrane.
Some regions of the basement membrane become blocked while some become excessively permeable - allowing proteins and red blood cells to permeate the membrane.
199
Describe how tubular necrosis can cause an AKI
If there is prolonged severe ischaemia of the kidneys, epithelial cells on the inside of the nephron will slough off and block the nephron meaning there is no urine output. Even as blood flow returns to normal the nephrons my remain blocked.
200
How do you biochemically define an acute kidney injury
increase in creatinine of more than 26 mimol/l within 48 hrs
creatinine increase >1.5x baseline within 7 days
urine output of <0.5 ml/kg/hr for >6 hrs
201
What are the common causes of an AKI
Sepsis, surgery, obstruction, cardiogenic shock, hypovolaemia, drugs, hepatorenal syndrome
202
What is digoxin used for
AF
203
What is amiodarone used for
V tachycardia or V fib
204
What is amlodipine used for
hypertension
205
What is furosemide used for
Diuretic - useful when treating heart failure/to reduce blood pressure
206
What effect can digoxin have on an ECG
ST depression/sloping
207
Early diastolic murmur loudest when patient leans forward is a sign of?
Aortic regurgitation
208
mid-diastolic murmur heard loudest at the apex. It is louder on expiration, and is exacerbated by the patient lying on their left side is a sign of?
Mitral stenosis
209
Pan-systolic murmur radiating to axilla is a sign of?
Mitral regurgitation
210
Pan systolic murmer louder on inspiration
Tricuspid regurgitation
211
Murmers heard louder on expiration are on what side of the heart?
Left
212
Murmers heard louder on inspiration oare on what side of the heart?
Right
213
mid-diastolic murmur heard loudest at the apex. It is louder on inspiration is a sign of?
tricuspid stenosis
214
ejection systolic murmur which does not radiate to the carotids
aortic sclerosis
215
What does colicky vs continuous abdominal pain suggest?
Obstruction to hollow viscus
Inflammation of an organ
216
What are the risk factors for gallstones?
Fat, fair, femail, fertile, forty
Family history, sudden weight loss, haemolytics, diabetes, oral contraceptive
217
What causes biliary colic?
Gall stone intermittently obstructs cystic duct when the gall bladder contracts causing pain, then when the gallbladder relaxes, the stone falls back from the cystic duct
218
What are the symptoms of bilibary colic
```
Colicky pain
Pain in right hypochondriac region
Sudden onset
Radiates to right scapula
Lasts 1-4 hours
Relieved by analgesia and rest
```
219
What is murphy's sign
Place hand at R costal margin
| Patient breathes in and diaphragm moves down - pain when inflamed gallbladder contacts palpating hand
220
What is acute cholecystitis
Cystic duct blocked by gallstone - obstruction to secretion of bile from gallbladder - bile becomes concentrated and then causes chemical inflammation
221
What are the complications associated with acute cholecystitis
Empyema of gallbladder = suparative cholecystitis
Gangrene of gallbladder
Perforation of the gallbladder
222
What is Charcot's triad?
Jaundice, fever and RUQ pain
| Sign of cholangitis
223
What is cholangitis
Inflammation of the bile duct
224
What causes ascending cholangitis?
Obstruction of common bile duct; leads to infection/pus proximal to blockage
225
What is the aetiology of pancreatitis
```
IGETSMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertriglyceridaemia/hypercalcaemia/hypothermia
ERCP (Endoscopic retrograde cholangiopancreatography)
Drugs
```
226
How do you diagnose pancreatitis
Symptoms (epigastric pain + vomiting)
| Serum amylase or lipase >3x upper limit of normal
227
What investigations would you do for someone with suspected pancreatitis
Serum amylase/lipase
LFTs, U&E's, WCC, glucose, calcium
ABG - oxygenation and acid-base status
AXR or CXR
CT - assess severity
USS or MRCP gallstones?
228
How do you predict severity of pancreatitis
```
PANCREAS
PO2 <8kPa
Age > 55
Neutrophilia
Calcium <2
Renal function (urea >16 mmol/L)
Enzymes - amylase >3x normal
Albumin <32
Sugar (glucose >10 mmol/L)
If 3 or more criteria then AP is severe
```
229
How does appendicitis usually present?
```
Central abdominal pain then migrates to RIF
Pain worse on moving, coughing etc
Nausea
Vomiting
Diarrhoea
Anorexia
Low grade fever
```
230
Why does appendicitis pain move?
Initially when the inflammation is localised, visceral peritoneal pain is referred pain at the umbilicus. When inflammation gets worse, the pain will migrate to RIF as parietal peritoneum will get inflamed
231
What investigations should you do for suspected appendicitis?
Investigations should be done to exclude other pathology
Urine ip and pregnancy test in premenopausal women to exclude KUB problems
If CRP, ECC, granulocyte count, proportion of polymorphonuclear cells are normal then acute appendicitis is much less likely
USS, MRI or CT with contrast (best)
232
What is diverticulosis
Presence of diverticula without symptoms
233
What is diverticular disease
Diverticula cause intermittent lower abdominal pain, without inflammation or infection
234
What is diverticulitis
Diverticula become infected and or inflamed, causing marked lower abdominal pain, fever and mailase
235
How does smoking affect ulcerative colitis vs Crohn's
Relieves UC and exacerbates Crohn's
236
What is the presentation of ulcerative colitis
```
Diarrhoea
Blood in stool
Cramping, colicky abdo pain
Faecal urgency + freq = tenesmus
Weight loss
```
237
What is the presentation of Crohn's
```
Diarrhoea (+ blood?)
Weight loss
Cramping
Tenesmus
Anorexia
Malnutrition
Anal fissure
```
238
What is IBD
Umbrella term for ulcerative colitis or Crohn's
239
How do you investigate IBD
Faecal calprotectin
Stool culture + microscopy
Bloods (FBC, UE, LFT, ESR, CRP)
Colonoscopy
240
What are the symptoms of glandular fever?
Sore throat, swollen glands, maculopapular rash w/ amoxicillin, fatigue
241
How do you treat glandular fever?
Caused by EBV so treatment is just symptomatic
242
What advice should you give someone with glandular fever?
Caused by EBV so treatment is just symptomatic
| Can cause transient viral hepatitis and splenomegaly so avoid contact sports for 6 weeks
243
What are the symptoms of phaeochromocytoma?
Sweating, anxiousness, raised BP, palpitations
244
Describe the presentation of fat necrosis as a breast lump
Secondary to trauma, surgery, radiation etc.
| Painful
245
What would a cancerous breast lump feel like?
Fixed position
246
Describe the presentation of a breast abscess?
Secondary to infections mainly in breastfeeding women, red and warm skin
Patient is usually systematically unwell with a raised temp
247
Describe the presentation of a fibroadenoma in the breast
Benign breast tumour, occurs in younger women in 20s and 30s, well defined with a smooth edge and are mobile (called breast mice due to their mobility)
248
What woukd peripheral oedema in a child make you think
Nephrotic syndrome
249
What are the symptoms of nephrotic syndrome
Proteinuria, hypoalbuminaemia, oedema
250
What is nephrotic syndrome
Too much protein being passed into the urine
251
What are the initial symptoms of pancreatic cancer
Weight loss and painless jaundice
252
Whart score is used to judge treatment of a suspected pneumonia
CURB 65
```
Confusion
Urea > 7mmol/L
RR > 30
BP <90/<60
65 yrs
```
0-1 pt = home treatment
2 pts = consider inpatient
3-5pts = inpatient; consider ICU
253
Give an example of a calcium channel blocker
Amlodipine
254
What are one of the side effects of statins
Cramps
255
How long after having a one off seizure can you begin to drive again
6 months
256
White vaginal discharge is associated with which condition
Thrush
257
How do you treat AF which is asymptomatic and picked up accidentally
You dont, but calculate the CHADVASC score
258
How may HIV present
Flu like symptoms, maculopapular rash + opportunistic infections
259
How do you calculate the number of units in an alcoholic drink?
Strength x Vol /1000
260
What are the symptoms of a subarachnoid haemorrhage?
Sudden onset, occipital headache, photophobia and nausea/vomiting
261
How does parathyroid hormone affect calcium and phosphate
Increases calcium
| decreases phosphate
262
What are calcium and phosphate levels like in hyperparathyroidism
Increased calcium
| Decreased phosphate
263
What are the calcium and phosphate levels like in chronic kidney disease
Low calcium due to vit. D deficiency
| High phosphate as cannot be excreted
264
What is the range of values of fasting glucose to diagnose a pre-diabetic patient/imparied fasting tolerance
6.1-7mmol/L
265
What is the range of values of 2hr glucose to diagnose a pre-diabetic patient/imparied fasting tolerance
<7.8mmol/L
266
What is indapamide
A thizide like diuretic
267
What is malignant hypertension?
Severe HTN with end organ damage
268
Why does malignant hypertension require a gradual lowering of bp
sudden drop in bp causes ischaemic stroke
269
How do you treat malignant hypertension with hypertensive encephalopathy
IV labetolol and sodium nitroprusside
270
How do you treat malignant hypertension with aortic dissection
IV labetolol and sodium nitroprusside
271
How do you treat malignant hypertension with pul oedema
Dont use B blockers
| IV GTN and sodium nitroprusside
272
How do you treat malignant hypertension which is pregnancy induced
IV MgSO4 and labetolol
273
How do you treat malignant hypertension which is due to phaeochromocytoma?
Alpha and beta blockade
274
How do you treat regular bradycardia
atropine 500mg, blocks the vagus nerve increasing HR
275
How do you treat a haemodynamically stable patient with symptomatic AF
LMWH and non urgent DC cardioversion
276
How do you treat a haemodynamically unstable patient with symptomatic AF
Urgent DC cardioversion
277
What drug would you give if cardiac ejection fraction was <35%
Spironolactone
278
What is the point of birfurcation of the trachea called?
Carina
279
What does CABG stand for
Coronary artery bypass graft
280
What are the two types of shadows in a CXR
Airspace and interstitial
281
What are batswings sometimes a sign of in a CXR
Pulmonary embolism
282
How do you tell a middle lobe pneumonia from a lower lobe pneumonia on a CXR?
Middle lobe will cover the cardiac shadow
| Lower lobe doesn't
283
What would you look for on a CXR to see a pleural effusion
Tracheal deviation
Airspace shadow with no lobar distribution
Meniscus of fluid
284
What is the differential for crackles heard in the lungs
```
Infection
Pul fibrosis
Bronchiectasis
Pul oedema
Heart failure
```
285
What is the normal position of the diaphragm on a CXE
between the 6th and 7th rib anteriorly
286
What is the differential for pleuritic chest pain
Pneumonia, pneumothorax, PE, MSK
287
In a CXR, if you see a portion of a rib has been removied, what would you think?
Pneumonectomy
288
What are staples in the axilla on a CXR evidence of?
Lymphatic removal
289
How should the cardiac shadow look on a cxr?
1/3 on the RHS and 2/3 on the left
290
What is acute AF
Onset within 48 hrs
291
What is paroxysmal AF
Spontaneous termination within a week
292
What is recurrent AF
2+ episodes, could have been paroxysmal or persistant and the arrythmia needed cardioversion
293
What is persistant AF
7+ days, not self terminating
294
What is permanent AF
1+ yr, not helped by cardioversion
295
What are the common causes of AF
```
Coronary heart disease
HTN
Valvular heart disease
Hyperthyroidism
Caffiene/alcohol
```
296
How can you manage AF
Stop caffiene/alcohol
Rate control (beta blocker, calcium channel blocker - dilitazem)
Rhythm control - cardioversion if rate control not working
48+hrs electrical
297
How do you treat AF with haemodynamic instability
Emergency electrical cardioversion therapy
298
What is Addison's disease?
Primary adrenal insufficiency, usually autoimmune
299
What are the symptoms of Addison's disease?
```
Fatigue + weakness (common)
Diarrhoea
Constipation
Vomiting
Muscle cramps
Anorexia
Confusion
```
300
What are the sign's of Addison's disease
Hyperpigmentation of buccal mucosa, lips, palmar creases.
| Hypotension, postural hypotension
301
What investigations would you do for someone with Addison's?
U&E's: low Na and high K
High calcium
FBC - anaemia
Cortisol, ACTH (high in 1* insufficiency, low in 2*)
High renin, low aldosterone
Synthacten test (give ACTH, cortisol won't rise in adrenal insufficiency)
Adrenal autoantibodies - leading causes of Addison's are autoimmune
302
How do you tell primary adrenal insufficiency from secondary
ACTH is high in primary, and low in secondary
303
What is/causes a catemenial pneumothorax
Pneumothorax at time of menstruation, usually in right lung.
Thoracic endometriosis causes necrotic holes to form in the diaphragm allowing air to move into pleural space from genital tract, when the cervical plug liquifies at time of menstruation
304
What is ARDS
Acute respiratory distress syndrome
305
What are the risk factors for ARDS
```
gastric aspiration
sepsis
pneumonia
hypovolaemic shock
trauma w/shock or multiple transfusions
```
306
What is the pathophysiology of ARDS
Damage to alveoli causes an increased permeability in capillary/alveolar membranes; proteinaceous fluis leaks into alveoli causing hypoxia
307
What is the most common cause of mitral stenosis
95% of cases are caused by rheumatic fever
308
How does leggionare's disease present?
As normal pneumonia + confusion, agitation, ataxia (balance and coordination problems) + lethargy
309
What are the symptoms of atypical pneumonia
Fatigue
Headache
Myalgia
Non-productive cough
310
What can cause aspiration pneumonia
Alcohol excess, GORD, dysphagia, altered swallow
| NG tube, tracheostomy etc.
311
What is Meig's syndrome
Benign fibroma + ascites + (usually right sided) pleural effusion
312
Describe the staging of COPD
%FEV1:
1: <80
2: 50-79
3: 30-49
4: <30
313
What is an acute exacerbation of COPD
Any two of:
inc. dyspnoea
inc. sputum volume/purulence
```
Or one above plus one of:
inc cough
wheeze
sore throat
cold
```
314
What is asthma
Paroxysmal and reversible obstruction of airways
315
What are the symptoms of asthma
Wheeze, breathlessness, chest tightness, cough
316
How do you diagnose asthma
Peak flow
Wheeze
Hx or fhx of atopic condition
Spirometry
317
What is the differential diagnosis for wheeze, breathlessness, chest tightness, cough
Adults:
COPD, HF, CHD, malignancy, GORD
Children:
Bronchiolitis, CF (since birth?), congenital heart defect, vomiting and aspiration, inhalation of a foreign body
318
Why is spirometry preferred to peak flow in the diagnosis of asthma?
Less effort dependant and more repeatable. May give false positive if in asymptomatic period
319
Describe the management of asthma
Stage 1: SABA (salbutamol)
Stage 2: ICS (meclomethasone)
Stage 3: LABA (salmeritol)
Stage 4: Leukotriene receptor antagonist (montelukast)
320
What are the definitions of the severity ratings for asthma attacks?
(%FEV1):
Moderate = 50-75
Severe = 33-50
Life threatening = <33
321
What bacteria causes scarlet fever
strep pyogenes
322
What type of bacteria causes scarlet fever
strep pyogenes, GpA BHS
| Group A, beta-haemolytic streptococci
323
Describe the pathophysiology of scarlet fever
Strep pyogenes (GpA BHS) secretes enzymes and toxins and erthrogenic toxins causing the rash
324
What is the incubation period of scarlet fever
2-5 days
325
Describe the onset of the rash in scarlet fever
Onset of illness is sudden w/ fever. The rash follows 12-24 hours after.
Scarlatinform rash (red sandpaper) starts on neck, chest, scapula then will spread to trunk and legs later.
Rash can last for a few days, especially in skin creases. Skin can peel for a few weeks.
326
What are the symptoms of scarlet fever
```
Sore throat
Headache
Vomiting
Abdominal pain
myalgia
tachycardia with fever
```
Throat: tonsilitis
Tongue: white strawberry to red strawberry
327
What investigations do you do for scarlet fever
Throat swap and culture
Antigen testing kits
FBC - polymorphonuclear lymphocytosis
328
How do you manage scarlet fever
Abx - penicillin
| Symptom management; ibuprofen or paracetamol (not aspirin!)
329
What is SLE
Systemic lupus erythematosis
| Inflammatory, multisystem autoiommune disease in which antinuclear antibodies occur
330
What is the presentation of SLE
Vague symptoms:
Fatigue, malaise, fever, splenomegaly, lymphadenopathy, weight loss, headache, parasthesiae
Systemic symptoms:
Renal - nephritis (often asymptomatic, picked up via proteinuria and haematuria)
Pulmonary - pleurisy, fibrosing alveolitis, obliterative bronchiolitis
Neuropsychiatric - basically anything
331
What investigations would you do for SLE
```
FBC (anaemia?)
ESR inc
Antinuclear antibodies test
Investigate affected systems
Urine dipstick test (proteinuria, haematuria)
```
332
How do you manage lupus?
Avoid sun exposure due to photosensitive rash
NSAIDS for inflammation, if not sufficient you can add in a corticosteroid but this can increase mortality
Hydroxychloroquine is useful for skin lesions, myalgia and malaise
333
How does a venous leg ulcer present
On saphenous vein, red and oozing with irregular margins.
334
How does an arterial leg ulcer present
Pale, painful and punched out. Occur with peripheral vascular disease.
335
How does a neuropathic leg ulcer present
Occur on pressure areas, associated with sensory neuropathy and diabetes
336
What amino acids are catecholamines usually derived
Tyr
337
What is the most serious side effect of carbimazole
Sore throat, due to bone marrow suppression and immune suppression
338
What type of lung disease is myasthenia gravis
Restrictive
339
What is endothelin
strong vasoconstrictor, endothelin antagonists are usefull in primary pulmonary hypertension
340
How does aminophylline work?
Binds to adenosine receptors, blocking adenosine mediated bronchoconstriction
341
What is the level of the bifurcation of the abdominal aorta
L4
342
What is ulcerative colitis
idiopathic chronic inflammatory disease of the colon
343
What are the symptoms of ulcerative colitis
Bloody diarrhoea
Colicky abdominal pain, urgency, tenesmus
Disease limited to the rectum may present with constipation and rectal bleeding
General symptoms: fever, malaise, weight loss
344
What are the signs of ulcerative colitis
If severe, pt may be pale, febrile and dehydrated. Tachycardia and hypotension may occur too.
On abdominal exam there may be tenderness, distension or masses.
If patient has abdominal distension and tenderness then admission to hospital is required - toxic megacolon
345
How do you investigate ulcerative colitis
FBC, RFT, U+E, LFT, ESR, CRP, Fe, B12, folate
Faecal calprotectin (more to rule out IBD, IBS)
Sigmoidoscopy, colonoscopy
Imaging
346
How do you manage ulcerative colitis
1) Aminosalicylates (mesalazine), maintenence
2) Corticosteroids, prevention of remission
If insufficient give thiopurines (azathioprine)
347
What are th complications of ulcerative colitis
```
Colorectal cancer (risk doubled)
Osteoporosis
Psychosocial issues, sexual dysfunction
```
348
Give examples of nephritic conditions
```
Rapidly progressing GN
IgA nephropathy
Alport syndrome
Also nephrotic:
Diffuse proliferative GN
Membranoproliferitive GN
Post-strep GN
```
349
Give examples of nephrotic conditions
```
Minimal change
membranous GN
focal segmental glomerulosclerosis
amyloidosis
Diabetic neuropathy
```
350
What are the symptoms of lupus?
```
Fever
Butterfly rash
Skin:
Malar rask
Discoid rash
Photosensitivity
```
Joints:
Arthritis
Brain:
psychiatric symptoms
Blood:
Anaemia
Thrombocytopaenia
Leukopaenia
Mucosa:
Ulcers of mouth and nose
Serosa:
pericarditis
pleuritis
Kidney:
renal problems
351
What is the pathophysiology of rhabdomyalisis
damage to cell membrane(trauma, iscahemia), increased calcium in cell, apoptosis realease of contents (ca, k, creatinine kinase, myoglobin).
Calcium release causes more apoptosis
K release causes hyperkalaemia
352
What are the symptoms of rhabdomyalisis
Fever, myalgia, weakness, swelling, anuric, tea coloured urine, vomiting
353
What electrolyte disturbance would you expect in rhabdomyalisis
Inc K
| Dec Ca
354
How do you diagnose rhabdomyalsis
haematuria
creatine kinase >5x baseline
inc K, decreased Ca, inc PO4 3-
muscle biopsy
355
How do you treat rhabdomyalsis
Fluid
Hyperkalaemia treatment (calcium gluconate then insulin-dextrose)
Treat low Ca, high po4 3-
diuretics if not hypovolaemic
356
What are the complications of rhabdomyalsis
```
Liver damage
Hyperkalaemia
hypocalcaemia
metabolic acidosis
AKI
compartment syndrome
liver damage
```
357
What are the causes of acute pancreatits
I GET SMASHED
```
idiopathic
gall stones (2)
ethanol (1)
trauma
steroids
mumps
autoimmune
scorpion bite
hypercalcaemia, hypertriglyceridaemia
ERCP
drugs
```
358
What is the presentation of acute pancreatitis
Sudden onset epigastric pain radiating to the back with vomiting, pyrexia, tachycardia
Jaundice may be present if gallstone in common bile duct; hypoxaemia
359
What are the investigations for acute pancreatitis
Inc amylase (>3x baseline)
inc. lipase (more sensitive and specific)
inc. bilirubin/aminotransferase if gallstones
hypocalcaemia is common
calcification on imaging
360
What are the causes of increased amylase
```
renal failure
ectopic pregnancy
DKA
perforated duodenal ulcer
acute pancreatitis
```
361
What treatment is contraindicated in pain relief in acute pancreatitis
Morphine -spasicity of sphinter of Oddi
362
What is a SPINK-1 mutation
Can cause heriditary chronic pancreatitis; allows trypsin to be activated in the pancreas
