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Finals Revision > General Things > Flashcards

General Things Flashcards

1
Q

What are the 3 types of interferon, what cells are they produced by and what is their main action?
What are they used to treat?

A

Interferon alpha, beta and gamma

Alpha - leucocytes, antiviral and some anti-cancer
Beta - fibroblasts, antiviral action
Gamma - NK cells, macrophage activation and weak antiviral action

Alpha - hep B&C, kaposi sarcoma, renal cell cancer (SE: flu-like reaction and depression)
Beta - MS, reduces frequency and severity of relapses
Gamma - chronic granulomatous disease and osteoporosis

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2
Q

Daily fluid requirements?
Na, Cl and K?
Glucose?

A

25-30 ml/kg/day water

1 mol/kg/day of Na, Cl and K

50-100g glucose/day (to limit starvation ketosis if fasting)

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3
Q

Does the amount of glucose prescribed in fluids change based on the patient’s weight?

A

No

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4
Q

Specific risks associated with prescribing saline?

Hartmann’s?

A

Hypercloraemic metabolic acidosis

Contains K so do not use in patients with/at risk of hyperkalaemia

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5
Q

How to work out anion gap in metabolic acidosis?

A

Na - (Cl+HCO3), normal range = 4-12

OR

(Na+K) - (Cl+HCO3), normal range = 10-18

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6
Q

Causes of anion gap metabolic acidosis?

A

MUDPILES CAT

Methanol
Urea
DKA
Paraldehyde
Iron/Isoniazid
Lactate
Ethanol
Salicylates

Carbon monoxide
Aminoglycosides
Theophylline

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7
Q

Causes of normal anion gap metabolic acidosis?

A

HARDASS

Hyperalimentation (TPN feeds)
Addison's disease
Renal tubular acidosis
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
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8
Q

How to work out maintenance fluid replacement for a kid?

A

100ml/day for every kg 0-10kg

50ml/day for every kg 11-20kg

20ml/day for every kg >20kg

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9
Q

Max rate of K infusion via peripheral line?

A

10mmol/hour

Any higher than 20mmol/hr needs cardiac monitoring

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10
Q

Shock with warm peripheries?

A

Neurogenic shock

From loss of sympathetic or hyper-parasympathetic innervation - marked vasodilation

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11
Q

Allograft?
Isograft?
Autograft?
Xenograft?

A

Allo - to a non-identical relative

Iso - between identical twins

Auto - within yourself

Xeno - to another unrelated person

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12
Q

7 P450 enzyme inducers?

A 
Phenytoin
Carbamazepine
Rifampicin
Phenobarbitone
St John's Wort
Chronic alcohol intake
Smoking (smokers need to take more aminophylline)
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13
Q

12 P450 inhibitors?

A 
Ciprofloxacin and erythromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
Allopurinol
-azole antifungals
Fluoxetine and Sertraline
Valproate
Acute alcohol intake
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14
Q

As bisphosphonates take around 3 days to work (7 days for maximal effect), what else can be used acutely?
Advice for long term management of hypercalcaemia in malignancy?

A 
Calcitonin 
Steroids (sarcoidosis)

Diuretics - esp in patients who cannot tolerate aggressive fluid resuscitation

Long term:

  • Increase fluid intake
  • No need to have low Ca diet (as gut absorption usually reduced)
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15
Q

Why is hyperkalaemia usually associated with acidosis?

A

K and H are competitors - as K levels rise fewer H ions can enter the cell

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16
Q

Causes of hypokalaemia with alkalosis?

A
  • vomiting
  • thiazide/loop diuretics
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
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17
Q

Causes of hypokalaemia with acidosis?

A
  • Diarrhoea
  • renal tubular acidosis
  • acetazolamide
  • partially treated DKA
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18
Q

Deficiency of what other mineral can cause K deficiency?

A

Mg

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19
Q

Drugs which can cause SIADH?

A 
Carbamazepine
Sulfonylureas
SSRI's
Tricyclics
Vincristine
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20
Q

What malignancy can cause SIADH?

A

Small cell lung cancer

also pancreas and prostate

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21
Q

Neurological causes of SIADH?

A

Stroke
SAH
Subdural haemorrhage
Meningitis/encephalitis/abscess

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22
Q

Infections which cause SIADH?

A

TB

Pneumonia

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23
Q

Can PEEP cause SIADH?

Can porphyrias cause SIADH?

A

Yes

Yes

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24
Q

Management of SIADH?

A

Slow correction to avoid central pontine myelinosis

Fluid restriction

Demeclocycline: reduces responsiveness of collecting tubule cells to ADH

Captains (ADH antagonists)

25
Q

Causes of hyperkalaemia?

A 
AKI
Drugs - spironolactone, ACEI, ARB, ciclosporin, heparin/LMWH, B blockers
Metabolic acidosis
Addison's
Rhabdomyolysis
Massive blood transfusion

Food:

  • salt substitutes (contain K instead of Na)
  • bananas, oranges, kiwi, avocado, spinach, tomato
26
Q

In acute pancreatitis what happens to:

  • glucose?
  • K?
  • Ca?
  • Mg?
A

Hyperglycaemia

Hypokalaemia (vomiting)

Hypocalcaemia

Hypomagnesaemia (vomiting)

27
Q

Causes of hypocalcaemia?

A
  • VitD deficiency (osteomalacia)
  • CKD
  • hypoparathyroidism
  • Pseudohypoparathyroidism
  • Rhabdomyolysis
  • Mg deficiency
  • Massive blood transfusion
  • acute pancreatitis

Blood samples contaminated with EDTA give falsely low Ca

28
Q

Acute management of severe hypocalcaemia?

A

IV Ca gluconate
10ml, 10% over 10 mins

ECG monitoring

Further management depends on cause

29
Q

Causes of hypernatraemia?

Management?

A

Dehydration
Osmotic diuresis (e.g. HHS)
Diabetes insipidus
Excessive saline

Correct hypernatraemia slowly and cautiously, can predispose cerebral oedema and seizures

General rate is no greater than 0.5mmol/hour

30
Q

What are the general causes of hyperuricaemia?
What can cause increased synthesis of urea?
Decreased excretion?

A

Increased cell turnover or decreased renal excretion of uric acid

Increased synthesis:

  • Myeloproliferative disorders
  • Exercise
  • Cytotoxics
  • Psoriasis
  • Lesch-Nyhan disease
  • Diet rich in purines

Decreased excretion:

  • Drugs: low-dose aspirin, diuretics, pyrazinamide
  • pre-eclampsia
  • alcohol
  • renal failure
  • lead
31
Q

2 main causes of hypokalaemia with hypertension?

A

Cushing’s syndrome

Conn’s syndrome

32
Q

Raised ALP and raised Ca?

A

Bone mets

Hyperparathyroidism

33
Q

Raised ALP and low Ca?

A

Osteomalacia

Renal failure

34
Q

Generally, what is reabsorbed in kidney?

A 
Na, Ca, Cl, Mg
H2O
HCO3
Glucose
AA
35
Q

Generally, what is excreted in kidney?

A

K, H, urea

Creatinine

36
Q

Where do PTH and aldosterone work?

A

PTH proximal part of distal convoluted tubule (same as thiazides)

Aldosterone distal part of distal convoluted tubule (same as spironolactone)

37
Q

H1 antagonist antiemetic examples?
MOA?
What are they esp good for?
SE?

A
  • Cyclizine, promethazine, diphenhydramine
  • Block H1 receptors in brain
  • Motion sickness
  • Sedation
38
Q

Antimuscarinic antiemetic example?
MOA?
Esp good for?
SE?

A

Hyoscine (scopolamine)

  • Block muscarinic M1 ACh receptors in brain
  • Motion sickness
  • Dry mouth, tachycardia, constipation
39
Q

5-HT3 receptor antagonist antiemetic examples?
MOA?
SE?

A
  • Ondansetron
  • Block 5-HT3 receptors in the CTZ in the medulla, as well as same receptors in GI tract
  • Constipation, diarrhoea, headache
40
Q

Dopamine antagonist antiemetic examples?

A
  • Chlorpromazine, haloperidol, prochlorperazine, metoclopramide, domperidone
  • D2 antgonists in the CTZ of the medulla (except domperidone) and also the GI tract
  • SE: diarrhoea, EPSE (except domperidone)
41
Q

NK1 antagonist amtiemetic examples?

A

Blocks NK1 receptors in the GI tract and CTZ blocking the effects of substance P (which evokes vomiting)

SE: constipation, headaches

42
Q

Antidiarrhoeal drug examples?
MOA?
SE?

A
  • Main thing is electrolyte replacements
  • Loperamide, diphenoxylate
  • bind mu-opioid receptors in GI tract (less of an effect on the brain)
  • SE: constipation, sedation, respiratory depression
43
Q

Laxative examples?

A

Lspaghula husk - bulk forming

Lactulose - osmotic - hepatic constipation

Senna - stimulant purgative - increases electrolyte/water secretion

44
Q

Hyponatraemia causes with urinary Na >20mmol/L?

A

Sodium depletion/renal loss (often hypovolaemic):

  • diuretics: thiazides, loops
  • Addison’s
  • renal failure

If patients euvolaemic:

  • SIADH (urine osmolality often >500mmol/kg)
  • Hypothyroidism
45
Q

Hyponatraemia causes with urinary Na <20mmol/L?

A

Sodium depletion/extra-renal loss:

  • diarrhoea, vomiting, sweating
  • burns
  • rectal adenoma

Water excess (often hypervolaemic and oedematous):

  • secondary hyperaldosteronism (HF, cirrhosis)
  • nephrotic syndrome
  • IV dextrose
  • psychogenic polydipsia
46
Q

Causes of hyperlipidaemia which result in predominant hypercholesterolaemia?
What is predominantly raised in the other causes?

A

High cholesterol:

  • nephrotic syndrome
  • cholestasis
  • hypothyroidism

Other things cause hypertriglyceridaemia (diabetes, obesity, alcohol, thiazides, unopposed oestrogen, liver disease)

47
Q

Management of acute hyponatraemia (<48 hours)

A

Typically hypertonic saline (3%) is given - can correct more quickly than in chronic as less risk of demyelination

48
Q

Management of chronic hypovolaemia if:

  • hypovolaemic cause (renal failure, diuretics, addison’s)?
  • euvolaemic cause (SIADH)?
  • hypervolaemic cause (HF, liver failure, nephrotic syndrome)?
A

Hypovolaemic: 0.9% saline
Give as trial initially, if Na falls then likely alternative diagnosis such as SIADH

Euvolaemic: fluid restrict to 500ml/day. Consider demeclocycline/vaptans

Hypervolaemic: fluid restrict to 500ml/day. Consider loop diuretics/vaptans

49
Q

Complication of correcting sodium too quickly?
Rate it should be done?
Symptoms of complication?

A

Central pontine myelinosis

Na+ level raised by 4-6mmol/L each day

Symptoms appear after 2 days:

  • dysarthria, dysphagia
  • paraparesis/quadraparesis
  • seizures, confusion, coma
  • locked in syndrome
50
Q

Indications for cyclizine?

A

Indications:
Central causes nausea
Movement related
Bowel obstruction

51
Q

Indications for Dexamethasone as antiemetic?

A

Intracranial disease

Bowel obstruction

52
Q

Indications and contraindications for domperidone antiemetic?

A

Indications:
Gastric stasis
Parkinson’s - doesn’t cross BBB

Contra:
Bowel obstruction

53
Q

Indications and contraindications for metoclopramide antiemetic?

A

Indications:
gastric stasis

Contra:
Not in parkinson’s
Not in bowel obstriction

54
Q

Indications and contraindications for haloperidol as anti-emetic?

A

Chemical causes e.g. opioid

Metabolic causes

55
Q

Indications and contraindications for lorazepam as antiemetic?

A

Anxiety-related

56
Q

Indications and contraindications for ondansetron antiemetic?

A

chemo-induced

57
Q

Causes of hypophosphataemia?

A 
Alcohol excess
Acute liver failure
DKA
Refeeding syndrome
Primary hyperparathyroidism
Osteomalacia

Consequences:

  • RBC haemolysis
  • WCC and platelet dysfunction
  • Muscle weakness and rhabdomyolysis
  • CNS dysfunction (resp depression etc)
58
Q

When is a 150ml bolus of 3% NaCl typically given?

A

Acute hypovolaemia Na <120

Finals Revision (29 decks)

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