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MEDICINE NEW > General Medicine > Flashcards

General Medicine Flashcards

1
Q

Causes of respiratory alkalosis?

A

High pH, low H+

Low C02: 
Anxiety- hyperventilation
Pain
Sepsis
Fever
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2
Q

Causes of metabolic alkalosis:

A

High pH, low H+

Loss of H+:
Burns
Vomiting

Gain of bicarbonate:
Drugs

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3
Q

Calculating the anion gap:

A

[Na+] - [Cl] - [HC03]

Should be between 4-16

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4
Q

What needs to be factored in when measuring the anion gap in liver disease?

A

Albumin is a negatively charged anion which contributes to nearly all the anion gap, which will be low in liver disease. If albumin is low, anion gap will appear low even if all the other anions are raised.

Anion Gap + (0.25 x (40-[albumin]))

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5
Q

Causes of metabolic acidosis with normal anion gap:

A

[Na+] - [Cl] - [HC03] = 4-16

Addisons disease + renal tubule Acidosis
Bicarbonate loss- renal failure
Chloride excess- too much saline or ammonium chloride
Diarrhoea + Drugs- acetazolamide (altitude)

In Addison’s, ENaC normally cause loss of K+, less K+ means more H+ excreted in exchange for Na+ uptake.
In chloride excess- less Cl reabsorption into the body via the HCl cotransporter= more H+ lost.

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6
Q

Metabolic acidosis with high anion gap?

A

[Na+] - [Cl] - [HC03] = 4-16

KARMEL:
Ketones
Aspirin 
Renal failure
Metformin
Ethanol/ethylene glycol (antifreeze)
Lactate
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7
Q

Causes of respiratory acidosis?

A

Low pH, high H+

High C02:
    COPD
     Low respiratory drive
             Brain injury
             Drugs- opioids
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8
Q

Patient has high total calcium levels, how can you determine if it due to primary hypercalcaemia or malignancy?

A

PTH- normal or high despite raised Ca2+ =

Primary hypercalcaemia

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9
Q

A patient has raised PTH and Ca, you suspect primary hyperparathryoid. How can familial hypocalciuric hypercalaemia be excluded?

A

Altered Ca receptor sensing reduces sensitivity to high calcium, so PTH is suppressed less and less is excreted.

Calcium creatinine clearance will be low (despite high Ca)
Magnesium will be normal or high

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10
Q

How does pH affect free ionized calcium levels?

A

Ca++ > Calcium-bound-albumin

When H+ increases (low pH) then equilibrium is pushed towards albumin bound to neutralise unbalanced charge

When H+ decreases (high pH) equilibrium is pushed towards free ionized Ca++

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11
Q

How is mild, moderate or severe hypercalcaemia defined:

A

Mild: <3mmol (or 0.25 above normal range)
Moderate: 3-3.5 (may be asymptomatic)
Severe: >3.5 mmol

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12
Q

How is mild hypercalcaemia managed?

A

<3mmol of Ca++
Often due to ^PTH, no need for surgery unless under 50 years old and renal damage (nephrocalcinosis, nephrolithiasis) or bone damage (fractures, reduced density)

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13
Q

Management of chronic hypercalcaemia with a Ca concentration of 3-3.5mmol (secondary to primary parathyroidism)?

A

Refer for surgery

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14
Q

Management of severe hypercalcaemia (>3.5mmol)

A

Massive fluid replacement: 3-4L over 24 hours
High calcium causes diabetes insipidis, vomiting and fluid loss

Zoledronic acid 4g over 15 minutes IV (bisphosphonate)

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15
Q

Patient is given bisphosphonates and massive fluid replacement and still has dangerously high Ca levels. What Rx may be given?

A

Danusomab (monoclonal Ab to RANK ligand, preventing maturation and differentiation of osteoclasts)

Haemodialysis- useful if renal function is very reduced

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16
Q

What creatinine clearance is needed if you are going to give zoledronic acid for severe hypercalcaemia?

A

> 60mL/min

17
Q

What K+ level is a medical emergency?

A

> 6.5mmol/L

18
Q

ECG changes in hyperkalaemia

A

Small little P waves
Tall tented T waves
Wide QRS
And ventricular fibrillation

19
Q

Which bloods should you take first, FBC or U+Es?

A

Can get a wrong result if taking U+Es after FBC because the EDTA corrupts the sample
So do U+Es first

20
Q

For non urgent hyperkalaemia (<6.5mmol) what can be given to lower it:

A

Fluids + medication review (ACEi, suxamethonium)

Rx: Polystyrene sulfonate resin
Binds K+ in the gut

21
Q

Low K+ exacerbates toxicity of which drug?

A

Digoxin

22
Q

ECG signs of low K+

A

Everything is down: K+, hypotonic, hyporeflexic, ECG waves pointing down

Inverted T waves (opposite of tall tented in hyperkalaemia)
Prominent U waves
Long PR (slow because it’s down)
Depressed ST

23
Q

Which other electrolyte needs to be checked in low K+?

A

Magnesium- low potassium won’t correct until Mg normalises

24
Q

Patient with low K+, high BP and alkolosis, but is not on diuretics. What syndrome should be suspected?

A

Low K+ and potentially high Na+ causing high BP, more H+ loss

Suspect Conn’s (aldosteronism > more ENaC channels > more K+ lost and Na+ gained)

25
Q

How should mild hypokalaemia be treated?

A

If >2.5mmol and no symptoms (muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, light headed)

Sando K

Consider adding K+ sparing diuretic if on thiazides

26
Q

Pleural fluid aspirates with a low glucose suggest:

A

TB or rheumatoid arthritis

27
Q

Pleural fluid with a raised amylase suggest:

A

Pancreatitis

Oesophageal perforation

28
Q

Meds that may precipitate a fall in the elderly:

A 
Beta blockers- bradycardia
Oral hypoglycaemics- hypoglycaemia
Antihypertensives
Benzodiazepines- sedation
Antipsychotics

Polypharmacy in general

29
Q

In a falls exam, what would you include:

A

Up and go test- timed
Gait + balance
Pulse, BP (sitting + standing), listen to heart
Listen to lungs- infection
Check neuro weakness + visual impairment + coordination
Musculoskeletal injuries

30
Q

Causes of a raised anion gap:

A

MUDPILES:

Methanol
Uraemia
Diabetic ketoacidosis
Propylene glycol
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
31
Q

Which drugs are affected by cytochrome 450 inducers/inhibitors?

A

Phyllis Tries To Stop Wars Starting

Pill
Tricyclics
Theophylline
Statins
Warfarin
Steroids
32
Q

What warrants referral to the lung cancer 2 week wait pathway:

A

Suspicious CXR findings

Age 40 + with unexplained haemoptysis

33
Q

Who warrants an urgent 2 week wait CXR for lung related pathology?

A

Age 40 + 2 of the following symptoms:
(Only 1 needed if current smoker)

Cough
Fatigue
SOB
Chest pain
Weight loss
Appetite loss

Or if 40+ with one of:
PC: persistent, recurrent chest infection
EHx: finger clubbing,
Persistent cervical lymphadenopathy, supraclavicular lymphadenopathy, chest signs
IHx: thrombocytosis

34
Q

Who warrants an urgent 2 week wait GI endoscopy?

A

Dysphagia

Or aged 55 with weight loss and 1 of:
Upper abdo pain
Reflux
Dyspepsia

35
Q

Who should you refer to the hospital for upper GI endoscopy immediately?

A

Haematemesis

Or 55 years + with one of:
Treatment resistant dyspepsia
Upper abdo pain + low Hb
Raised platelet count + nausea/vomiting/weight loss/dyspepsia/ reflux/ upper abdo pain
N+V + weightloss/ reflux/ dyspepsia/ upper abdo pain

36
Q

Who warrants 2 week wait referral for CT scan to assess for pancreatic cancer?

A

Those over 60 with weight loss and one of:

Diarrhoea
Back pain
Abdominal pain
Nausea
Vomiting
Constipation
New-onset diabetes
37
Q

Who warrants 2 week wait referral for colorectal cancer?

A

Over 40 and unexplained weight loss + abdo pain

Under 50 and PR bleeding + abdo pain/weight loss/ anaemia/ bowel habit change

Over 50 and unexplained PR bleeding

Over 60 and one of:
Iron deficiency anaemia
Change in bowel habit
Occult blood in faeces

38
Q

Who warrants faecal occult blood testing?

A

Over 50 + unexplained abdo pain or weight loss

Under 60 with change in bowel habit or iron-deficiency anaemia

39
Q

Who warrants a 2 week wait breast cancer referral?

A

Skin changes suggestive of breast cancer
Over 30 + lump in breast or (unexplained in the) axilla
Over 50 + discharge/retraction/changes

NB for under 30s a non-urgent referral may be made

MEDICINE NEW (22 decks)

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