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Year 3 Semester 2 > General Medicine/Miscellaneous > Flashcards

General Medicine/Miscellaneous Flashcards

1
Q

Which condition will cause a paradoxical decrease in renal function with ACEi use?

A

Bilateral renal artery stenosis

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2
Q

What is a normal HCO3- in an ABG?

A

22-26 mmol/L

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3
Q

What is a normal pCO2 in an ABG?

A

35-45 mmmHg

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4
Q

What is a normal PaO2 in an ABG?

A

75-100 mmHg

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5
Q

What is morton’s neuroma?

A

Fibrous enlargement of an interdigital nerve (not a true neuroma)

Related to overuse and inappropriate footwear

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6
Q

What does acral mean?

A

Pertaining to the distal body parts (fingers, toes, ears, nose)

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7
Q

What are the ECG findings of pericarditis?

A

Diffuse ST elevation

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8
Q

What is the maximum dose of lignocaine without adrenaline?

A

3 mg/kg

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9
Q

What is the maximum dose of lignocaine with adrenaline?

A

7 mg/kg

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10
Q

Where on the body is the use of lignocaine with adrenaline contraindicated?

A

Areas with end-arterial supply e.g. fingers, toes, ear, penis, nose

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11
Q

List 4 organisms which cause catheter-associated UTIs

A
  1. Yeast
  2. E. coli
  3. Klebsiella/proteus
  4. P. aeruginosa
  5. S. epidermidis
  6. Enterococci
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12
Q

What is the empirical antibiotic therapy for infected IV cannulae and central lines?

A

Flucloxacillin

S. aureus most common pathogen

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13
Q

What is the definition of Systemic Inflammatory Response Syndrome (SIRS)?

A

The presence of two or more of the following:

  1. Fever (>38) OR hypothermia (<36)
  2. Tachypnoea (RR > 24)
  3. Tachycardia (HR > 90)
  4. Leukocytosis (>12) OR band forms (>10%) OR leukopenia (<4)
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14
Q

What are the 5 W’s of post-operative fever?

A
  1. Wind (pulmonary - pneumonia, aspiration, PE)
  2. Water (UTI)
  3. Wound (infection)
  4. Walking (VTE)
  5. Wonder drug (drug fever)
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15
Q

What antibiotic is added to a sepsis regimen if the patient is thought to have resistant colonises?

A

Vancomycin

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16
Q

What is third space fluid loss?

A

Movement of fluid from the intravascular to interstitial space

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17
Q

What is the classic triad of rhabdomyolysis?

A
  1. Myalgia
  2. Generalised weakness
  3. Darkened urine
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18
Q

What are Howell-Jolly bodies?

A

Nuclear remnants of the RBCs that are removed from the spleen

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19
Q

When are spherocytes found?

A

Autoimmune haemolytic anaemia

Hereditary spherocytosis

No central pallor

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20
Q

When are schistocytes found?

A

Microangiopathic haemolytic anaemia e.g. HUS, DIC, TTP

Mechanical damage e.g. valve replacement, aortic stenosis

Mechanical shearing/destruction of RBCs

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21
Q

When are target cells found?

A

Thalassemia

Liver disease

Asplenia (they are not removed)

Increased surface membrane to volume ratio

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22
Q

When are Heinz bodies found?

A

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Thalassemia

Contain denatured haemoglobin

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23
Q

When are bite cells found?

A

Glucose-6-phosphate dehydrogenase deficiency

Due to the removal of Heinz bodies by splenic macrophages

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24
Q

What is the most potent glucocorticoid?

A

Dexamethasone (50 x prednisone)

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25
Q

What is the definition of septicaemia?

A

Microorganisms or toxins in blood

26
Q

What is bacteraemia?

A

The presence of bacteria in blood

27
Q

What is the definition of sepsis?

A

Life-threatening organ dysfunction due to a dysregulated host response to infection

28
Q

What is the definition of septic shock?

A

Sepsis with hypotension (SBP < 90 or >40 less than normal) for at least one hour despite adequate fluid resuscitation

29
Q

What happens to serum lactate during sepsis?

A

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)

30
Q

What is the function of prothrombin?

A

Turns into thrombin which cleaves fibrinogen to fibrin

31
Q

What is the function of plasminogen?

A

Turns into plasmin which turns fibrin into fibrinogen degradation products

32
Q

What is Reye syndrome?

A

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

33
Q

What is the triad of Reye syndrome?

A

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*
34
Q

What is a sarcoma?

A

Tumour of connective tissue e.g. fat, muscle, cartilage, tendons, ligament

35
Q

What is a carcinoma?

A

Tumour of epithelial tissue

36
Q

What is an adenoma?

A

Benign tumour of glandular tissue

Adenocarcinoma = cancerous

37
Q

Which pathway(s) does prothrombin time measure?

A

Extrinsic and common

38
Q

Which pathway(s) does activated partial thromboplastin time (aPTT) measure?

A

Intrinsic and common

39
Q

Which pathway(s) does plasma/thrombin time (PT/TT) measure?

A

Common pathway

40
Q

From which test is the INR derived?

A

Prothrombin time

41
Q

What is Bactrim?

A

Trimethoprim/sulfamethoxazole

42
Q

What are the actions of hepcidin?

A
  1. Iron trapping within macrophages
  2. Iron trapping within liver cells
  3. Decreased gut iron absorption
    * Stimulated by inflammation*
43
Q

Which corticosteroid has the greatest mineralocorticoid action?

A

Fludrocortisone

44
Q

Which test is used to diagnose preceding group A streptococcal (GAS) infection in patients with rheumatic fever?

A

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*
45
Q

Which test is used to diagnose acute streptococcal infection?

A

Rapid streptococcal antigen test

Or throat culture for GAS

46
Q

What is the pathophysiology of mitral facies?

A

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

47
Q

How does post-operative atelectasis present?

A

Hypoxaemia and increased respiratory effort

Fever can be present

May be asymptomatic

48
Q

How can post-operative atelectasis be treated?

A

CPAP

Suctioning

Deep breathing exercises

Directed coughing

Chest physiotherapy (postural drainage and percussion)

49
Q

What are 3 features involved in the pathogenesis of postoperative atelectasis?

A
  1. Pain (poor cough)
  2. Retained airway secretions
  3. Airway oedema
  4. Anaesthetic
  5. Posterior tongue prolapse
  6. Poor lung compliance

→ impaired deep breathing and spontaneous coughing

50
Q

How long following surgery is postoperative atelectasis most prevalent?

A

2nd post-operative night

(within 72 hours)

51
Q

On pulmonary examination, what might the findings of atelectasis be?

A
  1. Dull percussion
  2. Diminished breath sounds
  3. Decreased fremitus (sound dampened by fluid)
52
Q

Why are immunodeficient patients at a higher risk of developing bronchiectasis?

A

Recurrent pulmonary infections → inflammation, mucous plugging and airway destruction → abnormal dilation of the bronchial tree

53
Q

What is the characteristic presentation of bronchiectasis?

A

A chronic cough with copious mucopurulent sputum

54
Q

What is the pathophysiology of post-streptococcal glomerulonephritis?

A

Group A beta-haemolytic strep → immune complex deposition within GBM (molecular mimicry) → complement → inflammation → glomerulonephritis and nephritic syndrome

55
Q

What is the major adverse effect of gentamicin?

A

Nephrotoxicity

56
Q

What is the most common viral cause of meningitis?

A

Coxsackievirus

57
Q

Why is CRP a better marker of inflammation than ESR?

A
  1. More sensitive
  2. More specific (renal disease, female sex and old age increase ESR)
  3. Rises quicker than ESR
  4. Falls quicker following resolution of inflammation
58
Q

In which two situations is ESR of more value than CRP?

A
  1. Low-grade bone/joint infection e.g. joint prosthesis infections due to low-level pathogens
  2. Monitoring patients with SLE
59
Q

How can CRP help differentiate between viral and bacterial infections?

A

Marked elevation in bacterial infections

Elevation is less dramatic in viral infections

60
Q

Through which tracts do visceral and somatic pain signals travel?

A

Visceral: paleospinothalamic

Somatic: neospinothalamic

61
Q

What does the zoster vac do?

A

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

62
Q

What are the signs of active inflammation?

A

Heat (calor)

Pain (dolar)

Redness (rubor)

Swelling (tumor)

Year 3 Semester 2 (7 decks)

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