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Gen Med Flashcards

1
Q

Most common cause of hypothyroid

A

Hashimoto

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2
Q

HPT axis

A
  1. Hypothalamus secretes TRH
    1. TRH stimulates ant pit to release TSH
      TSH acts on thyroid to release T3/T4
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3
Q

Investigation of primary hypothyroid

A

High TSH, low T4

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4
Q

Ix of 2ndary hypothyroid

A

Low TSH and T4

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5
Q

Ix of subclinical hypothyroidism

A

High TSH, normal T4

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6
Q

Ix of poor thyroxine compllaiance

A

High TSH, normal T4 - Take thyroxine on day of appt but TSH lags behind and reveals poor compliance

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7
Q

Ix of hashimoto

A

• Anti-TPO (thyroid peroxidase) antibody

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8
Q

S&S of hypothyroid

A 
• Systemic:
		○ Weight gian
		○ Lethargy
		○ Cold intolerance
	• Skin:
		○ Dry
		○ Non pittine oedema
		○ Dry coarse hair
GI - constipation
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9
Q

Tx of hypothyroid

A

Levothyroxine

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10
Q

Tx of hyperthyroid

A

• Propanolol - to control symptoms
• Radioiodine tx
• Carbimazole:
○ Prevents iodinisation of thyroglobulin

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11
Q

ADR of carbimazole

A

agranulocytosis

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12
Q

S&S of hyperthyroid

A 
• Systemic:
		○ Weight loss
		○ Restlessness
		○ Heat intolerance
	• Cardiac:
		○ Palpitations
	• Skin - Increased sweating, clubbing
	• GI - diarrhoea
	• Neuro - anxiety, tremor
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13
Q

Ix of graves

A

TSH receptor antibodies

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14
Q

Precipitating factors of DKA

A

• Infection
• Missed insulin doses
MI

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15
Q

S&S off DKA

A

• Abdo pain
• Polyuria, polydipsia, dehydration
• Deep hyperventilation - Kussmaul resp
Pear drop smelling breath

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16
Q

Ix of DKA

A

• Glucose >11
• pH <7.3
• Bicarb <15mmol
Ketones >3mmol or urine ketones ++

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17
Q

Tx of DKA

A

• Saline fluids
• Insulin IV infusion
Correct hypokalaemia (due to insulin)

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18
Q

Ix of hyperosmolar hyperglycemic state

A 
• Dehydration
	• Osmolality >320mOsmol/kg
	• >30mmol BM
	• pH >7.3
Bicarb >15mmol
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19
Q

S&S of hyperosmolar hyperglycemic state

A

• Focal CNS signs - tremors, motor or sensory impaired
• DIC
Leg ischemia

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20
Q

Tx of Hyperosmolar hyperglycemic state

A

• LMWH
• Saline fluids
• Replace potassium
ONLY USE INSULIN IF BM NOT FALLING WITH ABOVE

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21
Q

S&S of hypoglyc

A 
• Autonomic:
		○ Sweating
		○ Anxiety
		○ Hunger
		○ Tremor
		○ Palpitations
		○ Dizziness
	• Neuro:
		○ Confusion
		○ Aggression
		○ Drowsiness
		○ Visual trouble
Seizures
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22
Q

Tx of hypoglyc

A

Tx:

1. Conscious - 250ml of lucozade, 3 glucose tablets, glucogel
2. IV glucose 200 ml of 10% solution in 50 ml aliquots
3. Repeat glucose testing every 10 mins until stable
4. Review reasons for hypoglyc
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23
Q

Ix of gestational diabetes

A

• Urine dipstick - Glycosuria
• Glucose tolerance test:
○ Fasting >5.6mmol
2 hr glucose >7.8mmol

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24
Q

What proportion of women with gestational diabetes will develop diabetes?

A

50% in 10 years

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25
Q

Tx of gestational diabetes

A

• Managed with insulin
• Perform glucose tolerance test post delivery
Advice on reducing risk of developing T2DM

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26
Q

RFs on gestational diabetes

A

• BMI >30
• Previous gestational diabetes
• FHx of diabetes
Middle eastern, black, south asian

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27
Q

Patho of diabetic retinopathy

A

• Increase retinal blood flow
• Therefore, Abnormal metabolism and damage to retinal vessel walls
Increase vascular permeability

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28
Q

Classification of diabetic retinopathy

A

Background - microaneurysms, blot hemorrhages (3 or less), hard exudates

Pre-proliferative - Cotton wool spots, 3+ blot hemorrhages, cluster hemorrhages

Proliferative - Fibrous tissue anterior to retinal disc, retinal neovascularisation

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29
Q

Tx of diabetic retinopathy

A

Laser photocoagulation

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30
Q

Tx of hyperlipidaemia - primary and secondary prevention

A 
• Primary prevention - atorvastatin 20
Secondary prevention (known IHD or CVD or PAD) - atorvastatin 80
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31
Q

CVD screening tool + when to offer statin

A

• QRISK2 CVD risk assessment

Statin offered if QRISK2 10 yr risk of 10+%

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32
Q

Ix of hyperlipidaemia

A

Full lipid profile - HDL and total most important

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33
Q

Secondary causes of hyperllipidaemia

A

• DM
• Obesity
• Alcohol
Familial hypercholesterolemia

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34
Q

S&S of cushings

A

moon face, buffalo hump, CUSHINGOID

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35
Q

Ix of cushings

A

• Dexamethasone suppression test:
○ Cortisol suppressed - Pituitary source
○ Cortisol not suppressed - Adrenal or ectopic source
• Biochemistry - hypokalaemia with HTN, metabolic alkalosis
Impaired glucose tolerance

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36
Q

ACTH dependent causes of cushings

A

• Cushings disease - pituitary adenoma secreting ACTH

Ectopic ACTH production - e.g. small cell lung cancer

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37
Q

ACTh independent causes of cushings

A

steroids, adrenal neoplasia

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38
Q

State HPA axis of cortisol

A

CRH from hypothalamus to ACTH from ant pit to Cortisol from adrenal

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39
Q

Patho of addisons

A

• Autoimmune destruction of adrenal glands

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40
Q

S&S of addisons

A

• Lethargy, weakness, weight loss
• Hyperpigmentation, vitiligo, hypotension
Crisis - collapse, shock, pyrexia

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41
Q

Ix of addisons

A

• ACTH stimulation test (synacthen):
○ No increase in cortisol - Addisons diagnosed
Biochemistry - hyperkalaemia, hyponatraemia, hypoglycaemia, metabolic acidosis

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42
Q

Tx of addisosn

A

• Hydrocortisone and fludrocortisone

Illness - double hydrocortisone

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43
Q

What do you do to steroids in illness?

A

double

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44
Q

Causes of endocrine HTN

A

acromegaly, phaeochromocytoma, conns

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45
Q

What is pheochromocytoma patho and S&S

A 
• Tumour of adrenal gland
	• Excess adrenaline production --> vasoconstriction
	• S&amp;S - Sympathetic:
		○ Pallor
		○ Palpitations
		○ Tachy
		○ Anxiety
Headaches
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46
Q

What is conns and ix

A

• Excess aldosterone
• Few symptoms
Ix - low serum renin, high aldosterone

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47
Q

What cancers are MEN type 1, 2a, and 2b associated with?

A

MEN 1 - 3Ps - Pancreas, Pituitary, Parathyroid
MEN 2a - 2 Ps - Parathyroid, pheochromocytoma
MEN 2b - 1P - Pheochromocytoma

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48
Q

S&S of primary hyperPTHism

A

abdo pain (moans, stones, groans, psychiatric overtones), HTN

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49
Q

Ix of primary hyperPTHism

A

○ PTH - High
○ Ca - High
Phos - Low

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50
Q

Cause of primary hyperPTHism and tx

A

• Cause - adenoma of PT gland (MEN 1 and 2a)

Tx - surgery

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51
Q

S&S of secondary hyperPTHism and ix

A 
• S&amp;S - bone disease eg osteitis fibrosa cystica
	• Ix:
		○ PTH - high
		○ Ca - Normal or low
		○ Phos - High
Vit D - low
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52
Q

Cause and Tx of secondary hyperPTHism

A

• Cause - chronic renal failure –> PT hyperplasia

Tx - Correct renal failure

53
Q

Cause of tertiary hyperPTHism

A

• Cause - Ongoing hyperplasia of PT after correction of renal disorder

54
Q

S&S and Ix of tertiary hyperPTHism

A

• S&S - Bone pain/fracture, pancreatitis, met calcification

	• Ix:
		○ Ca - normal or high
		○ PTH - high
		○ Phos - normal or low
		○ Vit D - Normal or low
ALP - High
55
Q

Tx of tertiary hyperPTHism

A

• Tx - allow 12 months to elapse before attempting surgery

56
Q

Ix of hypoPTHism

A

• Decreased PTH
• Can be 2ndary to thyroidectomy
• Low Ca, high P
ECG - prolonged QT

57
Q

S&S of hypoPTHism

A

hypocalcemia - tetany, weakness, parasthesia

58
Q

Tx of hypoPTHism

A

Alfacalcidol

59
Q

Give Ix of Klinefelters, Kallmans, androgen insensitivity syndrome, and test secreting tumour

A

Klinefelter - High LH, low Test
Kallmans - Low LH, low Test
Androgen insensitivity - High LH, High Test
Test secreting tumour- Low LH, high Test

60
Q

Genotype of klinefelter

A

47,xxy

61
Q

S&S of klinefelter and ix

A 
• S&amp;S:
		○ Tall
		○ Small testes
		○ Lack of secondary sexual characteristics
		○ Gyno
Ix - chromosomal analysis
62
Q

Kallman S&S and method of inheritance

A

• S&S:
○ Delayed puberty with anosmia
X linked recessive

63
Q

Androgen insensitivity method of inheritance and phenotype

A

• X linked recessive

Male children have female phenotype

64
Q

S&S, Ix, Tx of androgen insensitivity syndrome`

A

• S&S:
○ Primary amenorrhoea
○ Undescended testes cause groin swelling
○ Breast development
• Ix - Chromosomal analysis
Tx - Counselling, oestrogen therapy, removal of testes

65
Q

GI red flag symptoms

A 
ALARMS:
A - Anorexia
L - Lost weight
A - Anaemia
R - Recent Rapid onset
M - Malaena
S - Swallowing difficulty
66
Q

Causes of acute diarrhoea

A

Acute- less 14 days:
• Gastroenteritis - abdo pain with N&V
• Diverticulitis - Left lower quadrant pain, diarrhoea and fever
• Abx therapy - C difficile

67
Q

Causes of chronic diarrhoea

A

More 14 days - IBS, UC, Crohns, Celiacs

68
Q

S&S of IBS

A 
6 mths+ of - ABC:
	• Abdo pain
	• Bloating
	• Change in bowel habit
	• Relief by passing stools or urgency
NO WEIGHT LOSS
69
Q

S&S of UC

A

○ Bloody diarrhoea
○ Crampy abdo pain and weight loss
Faecal urgency and tenesmus may be present

70
Q

S&S of crohsn

A

○ Crampy abdo pain
○ Maybe bloody diarrhoea but less common
Malabsorption, mouth ulcers, intestinal obstruction

71
Q

S&S of celiacs in children and adults

A 
• Steatorrhoea or stinking stools
	• Diarrhoea
	• Abdo pain &amp; bloating
	• N&amp;V
	• Weight loss
	• Osteomalacia
Failure to thrive (children)
72
Q

Cause of acute jaundice

A

Primary biliary cirrhosis, hep virus, gallstones, para OD, gilberts syndrome

73
Q

What is gilberts syndrome

A

○ Occasional and short lived episodes of jaundice.

74
Q

What is S&S of primary biliary cirrhosis

A

○ Young woman
○ Itchy
Raised ALP and LFTs

75
Q

S&S of liver failure acute

A 
• Hepatic encephalopathy:
		○ Aggression
		○ Confusion
		○ Convulsions
	• Flapping tremor
N&amp;V
76
Q

Tx of acute jaundice

A

• Reverse cause
• N-acetylcysteine
?transplant

77
Q

S&S of malabsorption

A
  • Bloating
    • Decrease weight
    • Lethargy
    • Steatorrhoea
78
Q

Common cauess of malabsorption

A

3Cs:
• Coeliac
• Chronic pancreatitis
Crohns

79
Q

Complications of celiacs

A

anemia, osteoporosis, increase risk of malignancy

80
Q

Ix of celiacs

A

• Decrease Iron levels

Endoscopy + duodenal biopsy

81
Q

What foods are ok in celiacs?

A

○ Rice, maize, soya, potatoes, oats and sugar are all ok

82
Q

Chronic liver disease S&S

A 
• Portal HTN:
		○ Splenomegaly
		○ Oeseophagus, stomach and rectal varices
		○ Ascites
	• Coagulopathy
	• Encephalopathy
	• Palmar erythema
	• Gyno
	• Clubbing
Caput medusae
83
Q

Causes of chronic liver disease

A

Hep B or C, Alcohol, Primary biliary cirrhosis, Non alc fatty liver disease, RHF

84
Q

What disease is primary sclerosing cholangitis associated with?

A

UC

85
Q

Patho of haemachromatosis. Pattern of inheritance?

A

• Auto recessive

Iron accumulation due to excess absorption

86
Q

S&S of haemachromatosis

A 
• Early - fatigue, ED, arthralgia
	• DM
	• Liver cirrhosis and hepatomegaly
	• Hypogonadism
Cardiac failure
87
Q

S&S of AKI

A

• Pulmonary and peripheral oedema
• Arrhythmias
Uraemia features - pericarditis, encephelopathy

88
Q

Ix of AKI

A

• Reduced UO - <0.5ml/kg/hr
• U&Es - Increase Serum potassium, creatinine, urea
• Urine dipstick - infection, glomerular disease
• Clotting
Renal USS

89
Q

RFs of AKI

A

• CKD
• History of AKI
• 65+
Iodinated contrast agent used in past week

90
Q

Prerenal causes of AKI

A

• Hypovolemia
• Renal artery stenosis
Sepsis

91
Q

Tx of prerenal AKI

A

○ IV fluids

○ Sepsis - Abx

92
Q

Renal causes of AKI and tx

A 
• Glomerulonephritis
		○ Refer to nephrology
	• ATN
		○ Restrict fluid intake
		○ Restrict K intake
		○ ?Dialysis
	• Rhabdomyolysis:
Dialysis
93
Q

Postrenal causes and tx of AKI

A 
Postrenal:
	• Kidney stones
	• Benign prostatic hyperplasia
	• Tx:
Catheterise
94
Q

Difference Ix of pre-renal AKI and ATN

A

• Urine sodium >30 in ATN
• FENa - >1% in ATN
Urine:plasma osmolality <1.1 in ATN

95
Q

complications and how to manage of AKI?

A

• Treat hyperkalaemia - Neb salb, calcium gluconate, iv insulin + dextrose, oral K+ binding
Pulmonary oedema - 1. Sit pt upright
2. 100% oxygen non rebreath mask
3. IV access and ECG. Treat arrhythmias
4. Investigations whilst continuing treatment
5. Diamorphine IV 1.25-5mg
6. Furosemide 40-80mg IV
7. GTN spray 2 puffs. DON’T GIVE IF HEMOCOMPROMISED
8. If systolic >100mmHg, nitrate infusion eg isosorbide dinitrate
If pt worsening, consider CPAP

96
Q

Staging of AKI

A

Staging - increase in serum creatinine
1. Stage 1 - 1.5x
2. Stage 2 - 2-3x
Stage 3 - >3x

97
Q

Types of renal replacement therapy

A

Hemodialysis, continuous ambulatory peritoneal dialysis (CAPD)

98
Q

Pros and cons of hemodialysis and CAPD

A 
Continuous Ambulatory Peritoneal Dialysis:
	• 4 cycles every 24 hours
	• Useful when cardio unstable
	• Good for more freedom
	• Risk of peritonitis
Haemodialysis:
	• Semi permeable membrane
	• Requires heparin
	• 3-5 times a week
Removes urea and excess fluids
99
Q

Types of organ rejection and how they occur

A

Organ rejection types:
• Hyperacute - immediate via preformed antigens
○ Immediate loss of graft
• Acute - during first 6 months, T cell mediated
Chronic - After 6 months. Vascular changes

100
Q

Patho of nephrotic syndrome

A 
Patho:
	• Glomerulonephritis that is large enough to ONLY allow proteins into urine
	• Proteinuria
	• Hypoalbuminaemia
	• Oedema

NephrOtic - Oedema (caused by protein in urine and therefore less protein in blood)

101
Q

S&S of nephrotic syndrome and ix

A

S&S:
• Swelling of eyelids and face
• Ascites
• Urine froth due to protein

Ix:
• Urine - protein:creatinine ratio
• Microscopy for red cells in urine
• Blood - albumin, U&E, creatinine, eGFR

102
Q

Causes of nephrotic syndromeq

A

Causes:
• Minimal change GN
• DM
• SLE

103
Q

Patho of nephritic syndrome and causes

A

Patho:
• Glomerulonephritis that is large enough to allow protein AND RBCs into urine
• Blood and protein in urine

Causes:
• Glomerulonephritis
• Vasculitis

104
Q

S&S of nephritic syndrome

A 
S&amp;S:
	• Oligouria
	• Haematuria
	• Proteinuria
	• Oedema
	• HTN
105
Q

S&S of IgA nephropathy and epi

A

S&S:
• Recurrent macroscopic haematuria
• Associated with mucosal infections eg URTI

Epi:
• Young male

106
Q

S&S of renal stones

A

S&S:
• Severe pain with waves of intensity - colicky
• Flank pain which radiates to groin as stone progresses down ureter
• Pt keeps shifting to get comfortable (peritonitis pts keep still)
• Pale and sweaty
• Fever - suspect infection

107
Q

Ix of renal stones

A

Ix:
• CT KUB - kidneys, ureters, bladder
• Urine dip - microscopic haematuria
• Bloods - FBC, U&E, Calcium, phosphate

108
Q

Tx of renal stones

A

Tx:
• Analgesia - diclofenac
• <5mm will pass within 4 wks
• >5mm:
○ Shock wave lithotripsy - fragments stones can lead to obstruction or solid organ injury
○ Ureteroscopy - removal of stones with scope
• If obstructed + infection:
○ EMERGENCY
○ Requires recompression via catheters or nephrostomy tube placement

109
Q

S&S of renal tumours

A 
S&amp;S:
	• Haematuria
	• Loin pain
	• Anaemia
	• HTN
	• Weight loss
	• Malaise
110
Q

RFs of renal tumours and ix

A

Ix:
• USS
• CT CAP

RFs:
• Smoking
• Obesity
• FHx - von Hippel-Lindau disease

111
Q

Transient non visible haematuria causes

A 
Transient non visible causes:
	• UTI
	• Menstruation
	• Vigorous exercise
	• Sex
112
Q

Persistent non visible haematuria causes

A 
Persistent non visible causes:
	• Cancer - bladder, renal, prostate
	• Stones
	• BPH
	• Prostatitis
	• Urethritis eg chlamydia
	• Renal causes - IgA nephropathy, thin BM disease
113
Q

Ix of haematuria

A

Ix:
• Urine dipstick
• Blood pressure
• Renal function

114
Q

Post op cx of renal transplant

A 
Post op problems:
	• ATN of graft
	• Vascular thrombosis
	• Urine leakage
	• UTI
115
Q

define hyperacute, acute and chronic graft failure

A

hyperacute - mins to hours
acute < 6mths
chronic >6mths

116
Q

Patho of polycystic kidneys

A

Patho:
• Cysts form in kidneys causing gradual reduced function
• Common cause of CKD

117
Q

S&S of polycystic kidneys

A 
S&amp;S:
	• Haematuria
	• UTI
	• Abdo mass - 30% have mass in liver/pancreas too
	• Lumbar/abdo pain
	• HTN
118
Q

causes of urinary retention in men and women

A

Causes:
• Men - BPH, prostate cancer, phimosis
• Women - Prolapse (cystocoele), pelvic mass (fibroid)
• Both - bladder cancer, faecal impaction, Stones, UTI

119
Q

Ix of urinary retention

A 
Ix:
	• PR to exclude impaction
	• Neurological - check for cauda equina or cord compression
	• Urinalysis - check for infection
	• PSA
	• USS
120
Q

Causes of hydronephrosis

A 
Cx of blocked ureter - results in dilatation of ureter and swelling of kidney
Common causes:
	• Kidney stones
	• Pregnancy
BPH
121
Q

S&S of hydronephrosis and tx

A 
S&amp;S:
	• Pain In back or loin - sudden and severe or fluctuating dull ache
	• Sx of UTI
	• Haematuria
	• Swollen kidneys in severe cases

Tx:
• Reconstructive ureteric surgery
• Double J stent

122
Q

Causes of painful scrotal lumps

A

○ Torsion of testis
○ Epididymo-orchitis
○ Inguinal hernia
Haematocoele

123
Q

Causes of painless scrotal lumps

A

○ Hydrocele
○ Epididymal cyst
○ Spermatocele
Tumour

124
Q

Alcohol withdrawal seizures S&S and tx

A

occur in patients with a history of alcohol excess who suddenly stop drinking
• Peak incidence 36 hrs post cessation
Tx - give BZD after stopping drinking

125
Q

Ix of seizures

A

EEG and MRI

126
Q

Tx of seizures

A

Tx:
• Ketogenic diet
• Generalised - sodium valproate
Partial - carbamazepine

127
Q

Causes of restless leg syndrome

A

iron deficiency anaemia, idiopathic, DM, pregnancy

128
Q

Tx of restless leg syndrome

A

• Walk, stretch, massage affected limbs
• Treat iron deficiency
Dopamine agonists - ropinirole

Z IPE (15 decks)

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