General stuff Flashcards
HLA-B27
- Ankylosing spondylitis
- Reactive arthritis
- Acute anterior uveitis
- Poor prognostic factor for pt with reactive arthritis (more sudden onset, more severe symptoms, more likely to develop chronic reactive arthritis)
HLA-B47
21-hydroxylase deficiency
HLA-DR2
SLE
Coeliac disease
HLA-DR3
- Autoimmune hepatitis
- T1DM
- SLE
- Sjogren syndrome
- Coeliac disease
HLA-DR4
- RA
- T1DM
HLA-DQ2
HLA-DQ8
Coeliac disease
Opiate antagonists
Methadone
Naltrexone
Buprenorphine
Causes of upper GIB
- Oesophageal tumour
- Mallory Weiss tear
- Oesophagitis
- Oesophageal varices
- Gastric carcinoma
- Gastritis
- Gastric ulcer
- Duodenal ulcer
- Angiodysplasia
look at diagram in epigastric pain
Emergency treatment of hyperkalaemia
- Calcium gluconate - FIRST STEP to protect the heart
- Insulin and dextrose –> They activate the co-transporters on cells which move potassium back into cells and lowers serum potassium for 30-45 minutes SECOND STEP
- Salbutamol nebulisers THRID STEP
Other answers are used in the treatment of hyperkalaemia but not during emergencies
- IV calcium gluconate/chloride can stabilise the myocardium in hyperkalaemia
- Calcium resonium is given orally with aperients (i.e. drugs used to relieve constipation) and will help reduce potassium chronically but takes >24hrs to have an effect. You cannot give it IV.(capsule)
Features of rhambomyolysis
Black/”Smokey” urine (colour of coca cola)
AKI causes
Hypocalcaemia [kidney cant retain it]
Hyperphosphataemia(capsule) [kidney cant excrete it]
How does myoglobin released from rhabdomyolysis (crush injury) damage the kidneys? (3 ways)
it causes renal vasoconstriction
it is toxic to tubular cells
precipitates in the tubules(capsule)
Contra-indication to MRI
Pacemaker(capsule)
How is renal anaemia treated?
Renal anaemia is treated with regular injections of recombinant erythropoeitin
This avoids the complications of repeated transfusion such as
- Iron overload
- Risk of infection with blood born agents
- Sensitisation to potential kidney donor HLA(capsule)
Why is a low phosphate diet recommended to patients with CKD?
With a low GFR phosphate excretion by the kidney is considerably reduced, hyperphosphataemia can cause itching, leads to reduced production of active calcitriol and contributes to hypocalcaemia and hyperparathyroidism
Increased levels of phosphate + FGF23 by osteocytes in bone decrease the activity of 1-alpha-hydroxylase* leading to decreased calcitriol production therefore less Ca is released from bones and this causes an increase in PTH release to try and increase the calcium
*The activity of the enzyme is stimulated by PTH, so decrease in its activity will also cause increased PTH release(capsule)
Sepsis 6
Give
o2
abx
ivf
take
urinary output
blood cultures
lactate + hb measurements
Diffference bn SIRS, sepsis, severe sepsis, shock, MODS
• SIRS (systemic inflammatory response syndrome) body’s response to a wide range of pro-inflammatory processes (not just infection but also pancreatitis, anaphylaxis, PE). Defined as 2 or more of:
o Pulse >90
o T >38 or <36
o RR >20 or PaCO2 <4.3 (hyperventilatory hypocapnia)
o WBC >12 or <4
• Sepsis is SIRS caused by a suspected/proven infection (SIRS + septicaemia)
• Severe sepsis - sepsis causing
o Hypotension – SBP <90mmHg or >40mmHg drop compared to normal for patient
o End organ hypoperfusion – VBGs shows lactic acidosis (e.g. oliguria (kidney hypoperfusion), confusion (brain hypoperfusion) or serum lactate >4 (muscle hypoperfusion))
- Septic shock – severe sepsis refractory to fluid resuscitation (+ therefore in need of vasopressors)
- MODS (multiorgan dysfunction syndrome)/multiorgan failure – evidence of >2 organs failing (e.g. confusion due to cerebral hypoperfusion, respiratory failure, liver failure, renal failure)
Altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention
It usually involves two or more organ systems
Condition usually results from infection, injury, hypoperfusion, hypermetabolism
Sepsis is the most common cause
SLE HLA assosciations
DR2
DR3
T1DM HLA assosciations
DR3
DR4
Light chain protein in urine
MM AL Amyloidosis (primary)
Causes of proximal myopathy
MND MG Idiopathic inflammatory myopathy (polymyositis, dermatomyositis) Hyperthyroidism Osteomalacia Cushing's
AMTS + MMSE scores that indicate cognitive impairement
AMTS <6/10
MMSE <26/30
Dilated vs pinpoint pupils vs asymmetrical pupils
Dilated - drug overdose (e.g. cocaine), TCA, severe hypoxia
Pinpoint- opiate overdose, barbiturate overdose, organophosphates
Asymmetrical - third nerve palsy, coning due to increased ICP, can be normal
CSF
Oligoclonal bands vs albuminocytological dissosciation + which part of the nervous system do they affect
Oligoclonal bands
- MS (affects CNS)
Albuminocytological dissosciation
- GBS (affects PNS)
Most likely cause of confusion in a man with a history of alcoholcim + a 4-day hospital stay + how would you treat
Alcohol withdrawal
Chlordiazepoxide - not intended for long term use (max 4 weeks)
Thiamine (to avoid progression to Wernicke’s encephalopathy)