General Medicine Flashcards
Pleural Decompression
Second intercostal space
Mid clavicular line
Insulin Delivery in DKA
= fixed rate IV insulin at 0.1 units/kg/hour
e.g. 60kg = 6 units/hour
Difference between aortic sclerosis VS stenosis on auscultation
Sclerosis has no radiation of murmur to carotids and a normal ECG
U waves
= small deflection after T wave
U waves are a sign of
Hypokalaemia
Complication in fluid resuscitation in DKA (kids)
Cerebral oedema
Can result in seizures
BiPAP =
Non-invasive ventilation
Considered in unresponsive acidosis in COPD
Lung cancer associated with hypercalcaemia
Squamous lung cell carcinoma
MAP needed to maintain cerebral perfusion
65 mmHg
Treatment of PCP
- Normal
- Allergic
- Co-trimoxazole
2. Atovaquone
Differential for SVC syndrome
Lymphoma until proven otherwise
Testicular cancer also considered
Management of HHS
Calculate osmolality to monitor treatment response
Use IV saline 0.9%
Use low dose insulin (0.05 units/kg/hour) if BM not responding to IV fluids
Difference between acute and chronic respiratory acidosis
Look at bicarbonate
Normal = acute respiratory acidosis
High = chronic respiratory acidosis
Oxygen and ABG
If someone is on oxygen you would expect pO2 to be 10 less than % of oxygen
e.g. 60% oxygen, pO2 = 50
Which view enlarges the heart?
AP (beams front > back)
Cause of dextrocardia
Primary ciliary dyskinesia
Cause of air in the mediastinum
Oesophageal rupture
Causes of ‘globe’ heart on CXR
Dilated cardiomyopathy
Cardiac tamponade/pericardial effusion
Appearance of CXR
Post-Pneumonectomy
Fluid accumulates to fill the space
See a total whiteout
Big 3 in Chest Pain
ACS
Aortic - dissection, aneurysm
Pulmonary Embolism
Broad QRS in V1
Up = RBBB Down = LBBB
Biochemical presentation of rhabdomyolysis
Raised CK
AKI
Normal electrolyte maintenance
1mmol/kg of potassium, sodium and chloride
Hormones released by anterior pituitary
FSH LH TSH ACTH Prolactin Growth Hormone
Hormones released by posterior pituitary
Oxytocin
ADH
Mineralocorticoids are…
Aldosterone
Glucocorticoids are…
Cortisol
Management of Grave’s Eye Disease
Oral steroids
Assessment of iodine uptake
Technetium scanning
Conception advice for radioactive iodine
Can’t conceive for 6 months afterwards
Presentation of Thyroid Storm (5)
Association
High temperatures (++) Tachycardia Congestive Heart Failure Extreme Anxiety Seizures Association: under-treated or undiagnosed hyperthyroidism
Management of Thyroid Storm (3)
B blockers
PTU
Hydrocortisone
- Can give iodine to saturate the gland
Sheehan’s Syndrome
= infarction of the pituitary due to a drop in blood pressure
Often used in the context of PPH
Myxoedema Coma =
= decompensated hypothyroidism
Treating hyperthyroidism in pregnancy
PTU is best
Imaging of small bowel
Capsule endoscopy
MRI of small bowel
Consideration in acute GI bleed
IV PPI e.g. omeprazole
Consideration in acute GI bleed (liver stigmata)
Terlipressin
AGM - prevent spontaneous bacterial peritonitis
Ion required for PTH release or action
Magnesium
Medications causing hypercalcaemia
Association
Lithium, vitamin D, thiazides
Association: short QT syndrome
Management of Hypercalcaemia
Fluids
Bisphosphonates - especially in hypercalcaemia associated with malignancy
Biggest risk factor for AF
Hypertension
Rate Limiting Drugs (AF)
Bisoprolol
Verapamil
Diltiazem
Digoxin
Rhythm Limiting Drugs (AF)
Fleccanide
Amiodarone
Orthostatic Hypotension
Classification
Primary = Parkinson's, MS Secondary = Diabetes
Features of Epileptic Seizure
Tongue Biting Jerking Posturing Post-Ictal Confusion Deja Vu
Bad Features of Palpitations (4)
Prolonged
Associated with chest pain
Exertional palpitations
FH/high risk of structural heart disease
Screening tool for Heart Failure
BNP
Management of Heart Failure
Sit up Oxygen IV Furosemide Morphine Consider IV GTN and role of CPAP
Difference between CAP and LRTI
CAP can only be confirmed on CXR
Steroid dose in infective exacerbation of COPD
30mg oral prednisolone
Complication of ipratropium
Acute angle glaucoma
Warfarin reversal in intracerebral haemorrhage
Stop warfarin
IV Vitamin K
PCC - prothrombin concentrate complex
Target INR in Atrial Fibrillation
2.5
Target INR in VTE
2.5
Target INR in VTE whilst on anti-coagulation
3.5
Target INR in Mechanical Aortic Valve
3
Medical Management in TIA
Antiplatelets (Aspirin + Clopidogrel)
Statin
Anti-Hypertensives
Supply of:
- AV node
- Apex
AV node = posterior interventricular artery
Apex = anterior interventricular artery
S/E of adenosine (2)
Chest tightness
Bronchospasm
S/E of sotalol
Torsades de Pointes
Papillary muscle rupture in MI can result in what?
Acute mitral regurgitation
Pain in Diabetic Neuropathy
Amitriptyline or Duloxetine
Management of Post-Partum Thyroiditis
Propranolol
Not PTU or carbimazole
Diuretic in Chronic Heart Failure
Use spironolactone
Consider furosemide where ejection fraction is preserved or in acute decompensations
Medication given before PCI
- Normal
- Already on anti-coagluation
Prasugrel
On A-C = clopidogrel
Verapamil
- Heart Rhythm C-I
- Other Drug C-I
Heart Rhythm = ventricular tachycardia
Drug = don’t use with B-blocker, increased risk of heart block
Requirement for Cardioversion in AF
Need to within 48 hours of symptoms OR anti-coagulated for at least three weeks
Reversing respiratory depression as a result of magnesium sulphate
Calcium gluconate
Management of Hypophosphataemia
- Mild/Moderate
- Severe
Mild/Moderate (0.32-0.8) = oral replacement
Severe (<0.32) = IV infusion
Anti-coagulation in Anti-Phospholipid Syndrome
Use warfarin
Management of pericarditis
NSAIDs
e.g. naproxen or colchicine
Liver enzymes suggesting alcoholic liver disease
AST > ALT
Why do we need to dialyse slowly?
Disequilibrium Syndrome
= can get cerebral oedema if correct too soon or quickly
Management of Glomerulonephritis (AB +VE) (3)
- Plasma exchange = dump the antibodies
- IV Methylprednisolone then PO Prednisolone
- Often followed by pulses of Cyclophosphamide
Medications needed when on Cyclophosphamide and Prednisolone (3)
Co-trimoxazole = PCP protection
Alfacalcidol and Calcichew = bone protection
Lansoprazole = GI bleeding
Causes of normal anion gap acidosis (3)
Diarrhoea
High out put Ileostomy
Tubular Acidosis
Causes of raised anion gap acidosis
M - methanol U - uraemia D - diabetic ketoacidosis P - paraldehyde I - iron or isonazid L - lactic acidosis E - ethylene glycol S - salicylates e.g. aspirin
Anion Gap Calculation
Na+ - (Cl- + HCO3-)
In raised gap, looking at either increased sodium or reduced bicarbonate
Types of Lactic Acidosis
- Type seen with Metformin
A = overproduction of lactate e.g. shock B = normal production, problem with metabolism
In metformin get a type B lactic acidosis
Three ECG Changes associated with Hyperkalaemia
Prolonged PR interval
Absent P waves
Tall tented T waves
Immunosuppression given in Renal Transplant (3)
Prednisolone
MMF - anti-proliferative
Tacrolimus
Sick day rules with steroids and renal transplant
Need to double prednisolone dose
Prophylaxis of CMV in Renal Transplant
Valganciclovir
Presentation of CMV (5)
Mouth ulcers Retinitis Leukopaenia Diarrhoea Meningitis
BV Virus =
Found in uroepithelial tissue, can track up to the glomerular tissue and cause a glomerulonephropathy
Signs = raise in creatinine is all you will see
Threshold for Urgent Treatment of Hypercalcaemia
> 3.5
= use fluids +/- bisphosphonates (strongest evidence in hypercalcaemia caused by malignancy)
Management of severe hypernatraemia (>170)
Use 5% glucose, unless volume depleted then use 0.9% saline
Rate of correction of hypernatraemia
No greater than 10mmol/24 hours
Rate of correction of hypokalaemia
No greater than 10mmol/hour
Low Sodium
- Next step and causes
Plasma osmolality
High = think about urea and glucose
e.g. hyperglycaemia, urea
Normal = alternative/weird causes
e.g. paraproteinaemias, hyperlipidaemia
Low = consider the urine sodium and urine osmolality
If there is a hyponatraemia, then the kidneys SHOULD be conserving sodium
= urine osmolality low
Also need to consider the fluid status
Presentation of Iron Toxicity (5)
- Natural course of Iron Toxicity
- Management
Vomiting Diarrhoea Abdominal Distension Bowel Perforation Liver Failure
Course = gets initially better before a deterioration (iron absorbed into the mitochondria), then see a metabolic acidosis and hypoglycaemia
Management = parenteral desferrioxamine
GLP1 analogues name
VS
DPP4 inhibitors name
GLP-1 = tides
e.g. exanatide
DPP-4 = gliptins
e.g. sitagliptin
Coeliac Disease + Symptoms of Malignancy
Enteropathy associated T cell lymphoma
Phosphate and PTH
PTH promotes the excretion of phosphate via the kidneys
Artery supplying the AV node
Right coronary artery
via the posterior interventricular artery
Indication for dialysis in AKI
If pulmonary oedema (amongst other things)
2nd Line Management for Angina
B blocker + Dihydropyridine CCB
e.g. nifedipine, amlodipine
Dihydropyridine CCB =
Nifedipine
Amlodipine
Associations with Thiazolidinediones (3)
Increased fracture risk
Associated with bladder cancer
Weight gain
Mechanism of VTE in Nephrotic Syndrome
Loss of antithrombin III + others through the glomerular basement membrane in nephrotic syndrome
Presentation of Haemochromatosis
- Mechanism
Hypogonadism
= excess iron deposition in pituitary cells reduces the secretion of FSH and LH
IgA Nephropathy also called…
Berger’s Disease
Test for Bacterial Overgrowth
= H breath test
Treat with tetracyclines
H breath test positive =
= bacterial overgrowth
Discrete lesion seen on endoscopy
Haematemesis but no concerning features =
= gastrointestinal stromal tumour
Daily glucose requirements
50-100g per day
Doesn’t matter how much they weigh
Cause of peritonitis in peritoneal dialysis
Staph epidermidis
Measure of adequacy of dialysis
Urea
SIADH Presentation (4)
Small volumes of urine
Altered mental status
Seizure
Coma
Association of Zollinger-Ellison Syndrome
MEN 1
What is Trosseau Syndrome?
Thrombosis in strange places
Can be a paraneoplastic syndrome
Consequence of chronic atrophic gastritis
Megaloblastic anaemia
Pernicious anaemia
Association with H. pylori
Primary gastric lymphoma = MALT
How does CKD cause osteomalacia?
The high phosphate in CKD draws calcium out of bones
Vitamin D deficiency due to CKD
= osteomalacia
Pathogen seen in bronchiectasis
Association
Pseudomonas
Can be seen in autoimmune conditions e.g. rheumatoid arthritis, ulcerative colitis
Management of minimal change disease
Oral steroids
Acute interstitial nephritis
Finding
Eosinophils
How does calcium resonium work?
Removes potassium from the body
VS insulin - drives the potassium into the cells
What would make someone unsuitable for peritoneal dialysis?
Previous abdominal surgery or conditions e.g. IBD
Management of nephrogenic diabetes insipidus
Use a thiazide diuretic
Urea and creatinine in dehydration
See a greater increase in the urea vs creatinine (proportionally)
Association of Theophylline
Can cause cardiac arrhythmias
Has a narrow therapeutic window
Diagnosis of Diabetes
- Random blood glucose
- Fasting blood glucose
Random = >11.1 Fasting = >7
Murmur heard in Dressler’s Syndrome
Pericardial rub
= heard loudest on leaning forward
Management of Starvation Ketoacidosis (Alcoholic)
- Thiamine
- IV dextrose
Need to give thiamine first as glucose can result in Wernicke’s encephalopathy
