Extras Flashcards
What are the features of Cushing syndrome secondary to exogenous steroids?
Cataracts
Ulcers
Striae/skin thinning
Hypertension
Infection
Necrosis
Glucose increased
Osteoporosis/obesity
Immunosuppression
Diabetes/depression
What are 3 possible causes for increased WCC?
Infection/inflammation
Steroid use
GCSF
Normal range for the anion gap
10-18mmol/l
If a patient presents with gynaecomastia what type of lung cancer is most likely?
Adenocarcinoma
Treatment for ureteric stones
Stone <5mm = expectant treatment
Stone <2cm = lithotripsy (wave to break stone)
Stone <2cm + pregnant = uteroscopy
Stone complex = nephrolithotomy (invasive)
hydronephrosis/infection = nephrostomy
Imaging
Non - contrast CTKUB
Pain reliever
IM Diclofenac
What drugs can cause ototoxicity?
Ototoxicity is my FAV.Q&A
Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin
What murmur is likely to be heard in hypertrophic obstructive cardiomyopathy?
Ejection systolic murmur louder on performing valsalva and quieter on squatting
What is Klinefelter’s syndrome? how may it present?
karyotype 47XXY, is associated with primary hypogonadism in patients with male external genitalia
-tall stature, low-volume testes, sparse pubic hair, and gynaecomastia.
-hypergonadotrophic hypogonadism, FSH and LH Increased
serum testosterone low.
Gonadal dysgenesis secondary to Klinefelter’s syndrome impairs spermatogenesis, with semen analysis commonly showing azoospermia.
2 hypoglycaemic episodes requiring help = what driving advice?
Notify DVLA and surrender licence until case is reviewed
What can be used to measure recurrence in medullary type thyroid cancers?
Serum calcitonin levels
What is associated with Hereditary non-polyposis colorectal cancer?
Endometrial cancer
Previous spontaneous bacterial peritonitis + ascites requires what prescription?
Prophylactic abx
Ciprofloxacin or Norfloxacin
What is double duct sign?
The presence of dilatation of both the pancreatic and common bile ducts on ultrasound, CT, MRI or ERCP
Tumours arising in the head of the pancreas result in obstruction of the common bile and pancreatic ducts, leading to painless jaundice
What are the common side effects of imipramine, and what drug class is it in?
Tricyclic antidepressant
“can’t pee, can’t see, can’t spit, can’t sh*t”
As well as 5-HT and NA, tricyclics interact with number of other receptors that contribute to their side-effect profile:
antagonism of histamine receptors-drowsiness
antagonism of muscarinic receptors-dry mouth
-blurred vision
-constipation
-urinary retention
antagonism of adrenergic receptors- postural hypotension
-lengthening of QT interval
What is multiple endocrine neoplasia?
autosomal dominant disorder
Development of noncancerous or cancerous tumors in several endocrine glands.
Features of multiple endocrine neoplasia 1
3 P’s
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Also: adrenal and thyroid
MEN1 gene
Most common presentation = hypercalcaemia
Features of multiple endocrine neoplasia 2a
Medullary thyroid cancer (70%)
2 P’s
Parathyroid (60%)
Phaeochromocytoma
RET oncogene
Features of multiple endocrine neoplasia 2b
Medullary thyroid cancer
1 P
Phaeochromocytoma
Marfanoid body habitus
Neuromas
RET oncogene
What is Budd-Chiari syndrome? and its classical features?
Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.
The features are classically a triad of:
abdominal pain: sudden onset, severe
ascites → abdominal distension
tender hepatomegaly
Causes of Budd-chiari syndrome and investigations?
Causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases
Investigations
ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation
What is acute intermittent porphyria?
deficiency of one of the enzymes needed to synthesise haem.
Symptoms of acute intermittent porphyria?
The classical presentation is a combination of abdominal, neurological and psychiatric symptoms:
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
How is acute intermittent porphyria diagnosed?
classically urine turns deep red on standing
raised urinary porphobilinogen (elevated between attacks and to a greater extent during acute attacks)
assay of red cells for porphobilinogen deaminase
raised serum levels of delta aminolaevulinic acid and porphobilinogen
Management of acute intermittent porphyria?
Management
avoiding triggers - e.g. nitrofurantoin
acute attacks
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available
What is Still’s disease?
Adult-onset is a Diagnosis of exclusion has a bimodal age distribution - 15-25 yrs and 35-46 yrs
arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
Management of adult onset still’s disease?
Management
-NSAIDs should be used first-line to manage fever, joint pain and serositis
they should be trialled for at least a week before steroids are added.
-steroids
-may control symptoms but won’t improve prognosis
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
What is Sheehan’s syndrome?
hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock.
Features may include:
agalactorrhoea
amenorrhoea
symptoms of hypothyroidism
symptoms of hypoadrenalism
A 15 y/o girl with family hx of hereditary spherocytosis- what is the most likely cause of episodic upper abdominal pain?
Biliary colic
If a patient has suspected PE and renal impairment what investigation should be used?
Ventilation-perfusion scan
as this avoids nephrotoxic contrast of CTPA
Spot diagnosis:
Sudden onset-
Left eye down and out, pupil fixed and dilated
Reduced power on the right side
Weber’s syndrome- the branches of the posterior cerebral artery that supply the midbrain are affected.
Sudden-onset neurological deficits (weakness and oculomotor palsy) strongly suggestive of a stroke.
patient has an ipsilateral oculomotor nerve palsy and contralateral weakness of the upper and lower extremity, meaning they have Weber’s syndrome.
What medication can be given following a stroke if clopidogrel isn’t tolerated?
Aspirin and dipyridamole
What can be offered in gonorrhoea if the patient refuses IM ceftriaxone?
oral cefixime + oral azithromycin
Indications for haemodialysis?
AEIOU
Acidosis
Electrolyte abnormalities
Intake - drug over dose
Overloads (oedema)
Uraemia
Drugs SLIME
Salicylates
Lithium
Isopropanol
Methanol
Ethylene glycol
How to calculate number needed to treat for a drug?
NNT = 1 / Absolute Risk Reduction.
Calculate event rate in trail and placebo group e.g 30/300=0.1
and 60/300=0.2
0.2-0.1=0.1
1/0.1=10=NNT
What is Conn’s syndrome?
primary hyperaldosteronism, refers to the excessive secretion of the hormone aldosterone.
Normal renin levels
Symptoms of Conn syndrome?
UNCONTROLLABLE
BLOOD PRESSURE
* EXCESSIVE THIRST
* ^ URINARY FREQUENCY
* ^ NOCTURIA
* MUSCLE CRAMPS
* WEAKNESS or TINGLING
* DIZZINESS
* BLURRED VISION
* HEADACHES
Causes of Conn syndrome?
ALDOSTERONE-PRODUCING ADENOMAS
BILATERAL ADRENAL HYPERPLASIA
Tx of Conn syndrome?
aldosterone-producing adenomas and other adrenal tumours may be surgically removed laparoscopically,
Bilateral adrenal hyperplasia can be treated with medications that inhibit aldosterone, such as spironolactone.
In most cases, individuals are also recommended to maintain a low-salt diet, stop smoking, limit alcohol intake, and exercise regularly.
Treatment of invasive diarrhoea?
Ciprofloxacin
What is invasive diarrhoea?
Gastritis causing bloody diarrhoea and fever
Which organism causes desaturation on exercise?
Pneumocystis jirovecii
What is Lemierre’s syndrome?
Caused by a primary infection in the oropharyngeal region.
If left untreated can spread to the carotid sheath which contains the internal jugular vein (IJV).
-can cause a thrombus to be formed and then septic emboli occur which typically goes to the lungs, liver, and other areas in the body.
