General Medicine/Miscellaneous Flashcards
Which condition will cause a paradoxical decrease in renal function with ACEi use?
Bilateral renal artery stenosis
What is a normal HCO3- in an ABG?
22-26 mmol/L
What is a normal pCO2 in an ABG?
35-45 mmmHg
What is a normal PaO2 in an ABG?
75-100 mmHg
What is morton’s neuroma?
Fibrous enlargement of an interdigital nerve (not a true neuroma)
Related to overuse and inappropriate footwear
What does acral mean?
Pertaining to the distal body parts (fingers, toes, ears, nose)
What are the ECG findings of pericarditis?
Diffuse ST elevation
What is the maximum dose of lignocaine without adrenaline?
3 mg/kg
What is the maximum dose of lignocaine with adrenaline?
7 mg/kg
Where on the body is the use of lignocaine with adrenaline contraindicated?
Areas with end-arterial supply e.g. fingers, toes, ear, penis, nose
List 4 organisms which cause catheter-associated UTIs
- Yeast
- E. coli
- Klebsiella/proteus
- P. aeruginosa
- S. epidermidis
- Enterococci
What is the empirical antibiotic therapy for infected IV cannulae and central lines?
Flucloxacillin
S. aureus most common pathogen
What is the definition of Systemic Inflammatory Response Syndrome (SIRS)?
The presence of two or more of the following:
- Fever (>38) OR hypothermia (<36)
- Tachypnoea (RR > 24)
- Tachycardia (HR > 90)
- Leukocytosis (>12) OR band forms (>10%) OR leukopenia (<4)
What are the 5 W’s of post-operative fever?
- Wind (pulmonary - pneumonia, aspiration, PE)
- Water (UTI)
- Wound (infection)
- Walking (VTE)
- Wonder drug (drug fever)
What antibiotic is added to a sepsis regimen if the patient is thought to have resistant colonises?
Vancomycin
What is third space fluid loss?
Movement of fluid from the intravascular to interstitial space
What is the classic triad of rhabdomyolysis?
- Myalgia
- Generalised weakness
- Darkened urine
What are Howell-Jolly bodies?
Nuclear remnants of the RBCs that are removed from the spleen
When are spherocytes found?
Autoimmune haemolytic anaemia
Hereditary spherocytosis
No central pallor
When are schistocytes found?
Microangiopathic haemolytic anaemia e.g. HUS, DIC, TTP
Mechanical damage e.g. valve replacement, aortic stenosis
Mechanical shearing/destruction of RBCs
When are target cells found?
Thalassemia
Liver disease
Asplenia (they are not removed)
Increased surface membrane to volume ratio
When are Heinz bodies found?
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Thalassemia
Contain denatured haemoglobin
When are bite cells found?
Glucose-6-phosphate dehydrogenase deficiency
Due to the removal of Heinz bodies by splenic macrophages
What is the most potent glucocorticoid?
Dexamethasone (50 x prednisone)
What is the definition of septicaemia?
Microorganisms or toxins in blood
What is bacteraemia?
The presence of bacteria in blood
What is the definition of sepsis?
Life-threatening organ dysfunction due to a dysregulated host response to infection
What is the definition of septic shock?
Sepsis with hypotension (SBP < 90 or >40 less than normal) for at least one hour despite adequate fluid resuscitation
What happens to serum lactate during sepsis?
Elevation
An indicator of tissue perfusion (elevated when oxygen demand exceeds supply. In sepsis, it can be elevated despite poor perfusion due to mitochondrial dysfunction and downregulated oxidative phosphorylation)
What is the function of prothrombin?
Turns into thrombin which cleaves fibrinogen to fibrin
What is the function of plasminogen?
Turns into plasmin which turns fibrin into fibrinogen degradation products
What is Reye syndrome?
Rapidly progressive encephalopathy with hepatic dysfunction
90% of cases are associated with aspirin use
Usually begins several days after recovery from a viral illness, particularly varicella or influenza A or B
What is the triad of Reye syndrome?
Preceding viral illness, acute encephalopathy and fatty liver failure
- Vomiting and confusion which evolves to seizures and coma*
- Viruses alter the metabolism of salicylates → hepatic injury*
- Accumulation of ammonia causes neurological and GI symptoms*
What is a sarcoma?
Tumour of connective tissue e.g. fat, muscle, cartilage, tendons, ligament
What is a carcinoma?
Tumour of epithelial tissue
What is an adenoma?
Benign tumour of glandular tissue
Adenocarcinoma = cancerous
Which pathway(s) does prothrombin time measure?
Extrinsic and common
Which pathway(s) does activated partial thromboplastin time (aPTT) measure?
Intrinsic and common
Which pathway(s) does plasma/thrombin time (PT/TT) measure?
Common pathway
From which test is the INR derived?
Prothrombin time
What is Bactrim?
Trimethoprim/sulfamethoxazole
What are the actions of hepcidin?
- Iron trapping within macrophages
- Iron trapping within liver cells
- Decreased gut iron absorption
* Stimulated by inflammation*
Which corticosteroid has the greatest mineralocorticoid action?
Fludrocortisone
Which test is used to diagnose preceding group A streptococcal (GAS) infection in patients with rheumatic fever?
High antistreptolysin O titre
- Antibodies against metabolites of GAS*
- High titre suggests sequelae of GAS infection but are not as useful for diagnosing acute streptococcal pharyngitis. Titres are often not elevated in acute infection*
Which test is used to diagnose acute streptococcal infection?
Rapid streptococcal antigen test
Or throat culture for GAS
What is the pathophysiology of mitral facies?
Low cardiac output with severe pulmonary hypertension → hypoxaemia → vasodilation
Characteristically found in mitral stenosis but may be found in many causes of low cardiac output
How does post-operative atelectasis present?
Hypoxaemia and increased respiratory effort
Fever can be present
May be asymptomatic
How can post-operative atelectasis be treated?
CPAP
Suctioning
Deep breathing exercises
Directed coughing
Chest physiotherapy (postural drainage and percussion)
What are 3 features involved in the pathogenesis of postoperative atelectasis?
- Pain (poor cough)
- Retained airway secretions
- Airway oedema
- Anaesthetic
- Posterior tongue prolapse
- Poor lung compliance
→ impaired deep breathing and spontaneous coughing
How long following surgery is postoperative atelectasis most prevalent?
2nd post-operative night
(within 72 hours)
On pulmonary examination, what might the findings of atelectasis be?
- Dull percussion
- Diminished breath sounds
- Decreased fremitus (sound dampened by fluid)
Why are immunodeficient patients at a higher risk of developing bronchiectasis?
Recurrent pulmonary infections → inflammation, mucous plugging and airway destruction → abnormal dilation of the bronchial tree
What is the characteristic presentation of bronchiectasis?
A chronic cough with copious mucopurulent sputum
What is the pathophysiology of post-streptococcal glomerulonephritis?
Group A beta-haemolytic strep → immune complex deposition within GBM (molecular mimicry) → complement → inflammation → glomerulonephritis and nephritic syndrome
What is the major adverse effect of gentamicin?
Nephrotoxicity
What is the most common viral cause of meningitis?
Coxsackievirus
Why is CRP a better marker of inflammation than ESR?
- More sensitive
- More specific (renal disease, female sex and old age increase ESR)
- Rises quicker than ESR
- Falls quicker following resolution of inflammation
In which two situations is ESR of more value than CRP?
- Low-grade bone/joint infection e.g. joint prosthesis infections due to low-level pathogens
- Monitoring patients with SLE
How can CRP help differentiate between viral and bacterial infections?
Marked elevation in bacterial infections
Elevation is less dramatic in viral infections
Through which tracts do visceral and somatic pain signals travel?
Visceral: paleospinothalamic
Somatic: neospinothalamic
What does the zoster vac do?
Prevent shingles
Prevention of post-herpetic neuralgia
More than 97% of people over 60 are seropositive for varicella zoster even if they do not have a history of chickenpox. Even so, the vaccination is safe in seronegative individuals
What are the signs of active inflammation?
Heat (calor)
Pain (dolar)
Redness (rubor)
Swelling (tumor)
