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John's 3a Cards > Geris/gen Med > Flashcards

Geris/gen Med Flashcards

1
Q

In a patient with low potassium, what other blood test should you do?

A

Check their magnesium levels

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2
Q

What is a side effect of calcium channel blockers?

A

Fluid retention

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3
Q

What are some side effects of oral steroid use?

Which is the most important

A

Oral thrush

Hypokalaemia

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4
Q

What is the threshold for when you need to investigate and treat long pauses between beats on an ecg?

A

> /= 3 seconds - investigate and treat
Eg pacemaker

> /= 2 + symptomatic - inv and treat

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5
Q

What is the QT interval?

A

The time between the Q wave and end of the T wave

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6
Q

QTc of over what value is worrying

A

450 in men
475 in women

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7
Q

What is empyema?

A

A collection of pus in the pleural space. (can occur in any body cavity or space, technically)

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8
Q

What is syncope?

A

The impairment of consciousness secondary to transient failure to perfuse the brain.

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9
Q

Give 4 causes of syncope

A

Cyanotic breath holding attack
Vasovagal syncope
Valsalva manouevre
Cardiac arrythmias, eg Long QT

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10
Q

Give 3 symptoms of a vasovagal syncope.

A

Pallor
Sweaty
Lightheadedness

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11
Q

What can precipitate a vasovagal syncope?

A

Sudden postural change
After strenuous exercise
Situational (heat)
Emotional change (fear of blood)

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12
Q

What percentage of syncopes are vasovagals?

A

~50%

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13
Q

How may Long QT Syndrome present?

A

Bradycardia
Syncope

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14
Q

When does a UTI become lower, upper or pyelonephritis?

A

Here

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15
Q

How can you test a urine sample? (urinalysis)

A

Visual inspection (colour, clarity, smell)
Dip stick (not in <3 months)
MCS (gold standard)

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16
Q

What would a urine dipstick show in a UTI?

A

Leukocytes
Nitrites

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17
Q

What may you look for in urine MCS for UTI?

A

Microscopy:
- Bacteruria
- Pyuria
Culture:
- Growth
Serology:
- Antibodies

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18
Q

What is the MCS bacteriological definition of a UTI?

A

</= 10^5 of the same organism.

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19
Q

What is a DMSA scan? (Dimercaptosuccinic acid <- don’t bother remembering)

A

A radionuclide scan. It is the gold standard test for measuring the function of each individual kidney.

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20
Q

How does a DMSA scan work?

A

IV isotopes are given.
1hr~ later the scan is done, the result shows how much of the radiographic isotope was filtered by each kidney as a percentage/colour intensity, and where in the kidney it was filtered.

It shows evidence of damage and scarring in areas of the kidney which do not light up, as nothing was filtered through the damaged area.

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21
Q

What can cause the damage/scarring shown on a DMSA scan.

A

Recurrent UTIs/pyelonephritises

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22
Q

When may a DMSA scan be used?

A

When a patients kidney function needs to be assessed after recurrent UTIs/pyelonephritises,.

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23
Q

What is oedema?

A

Increase in interstitial fluid.

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24
Q

Give 3 examples of oedema.

A

Pedal (pitting clinically)
Ascites
Pulmonary

25
Q

Give 4 causes of oedema.

A

Lymphatic obstruction
Venous obstruction
Low oncotic pressure
Salt and water retention

26
Q

Give an example of lymphatic obstruction.

A

Elephantiasis
Congenital lymphoedema

27
Q

Give an example of venous obstruction.

A

DVT

28
Q

Give an example of low oncotic pressure.

A

Hypoalbuminemia.

29
Q

Give an example of salt and water retention.

A

Heart failure -> decreased kidney perfusion -> decreased GFR -> kidney disease causing retention
CKD

30
Q

When shouldn’t you do an MCUG?

A

During active urinary infection - it can push bacteria into the bladder, ureters or kidneys when the contrast is inserted.

31
Q

What are glomerulonephropathies?

A

A set of diseases which cause inflammation in the glomeruli.

They can be classified in a variety of ways, normally ones which cause either a nephrotic or nephritic syndrome.

32
Q

What is a syndrome?

A

A group of symptoms which consistently occur together.

33
Q

What is the triad of symptoms in nephrotic syndrome?

A

PrOteinuria
HypOalbuminemia
O edema

nephrOtic, the 3 Os

34
Q

At what albumin value do would you expect to start seeing oedema?

A

<25g/ml

35
Q

What can nephrotic syndrome put you at risk of, and why?

A

Blood clots

You lose many proteins, not just albumin, including protein S and antithrombin which regulate clot formation in the clotting cascade.

You can also lose Ig, mainly IgG because its small.

36
Q

What is nephritic syndrome also known as clinically?

A

(Acute) Glomerulonephritis

37
Q

What are the clinical features of nephritic syndrome?

A

Macroscopic (usually) Haematuria
Proteinuria (typically in the sub-nephrotic range)
Oedema & HTN (due to salt and water retention, in part due to glomerular damage activating RAAS)
Oliguria (reduced glomerular filtration)
Pyuria (signs of inflammation

38
Q

What is classes as nephrotic range proteinuria?

A

A loss of 3.5g of protein per 24hrs.

Patients may describe passing frothy urine.

39
Q

What are some conditions which predominantly cause nephrotic syndrome?

A

Minimal change disease (/nephropathy)
Membranous glomerulo-nephropathy
Focal segmental Glomerulosclerosis
Amyloidosis

40
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerulo-nephropathy

41
Q

What can Focal segmental Glomerulosclerosis progress to?

A

Chronic renal failure

42
Q

What 3 main pathologies can acute glomerulonephritis (nephritic) be classified as?

A

Immune complex disease (common)
Vasculitis (often pauci-immune) (rare)
Anti-GBM associated diseases (rarer)

43
Q

What are some Immune complex diseases which predominantly cause a nephritic syndrome?

A

Post-streptococcal glomerulonephritis (group A strep (GAS))
IgA (glomerulo)Nephropathy (previously Berger’s)
Membranoproliferative glomerulonephritis (MPGN)

44
Q

Give 3 Pauci-immune diseases which can cause nephritic syndrome.

A

Granulomatosis with polyangiitis (GPA)
(Wegner’s)
Eosinophilic granulomatosis with polyangiitis (EGPA) (churg-strauss syndrome)
Microscopic polyangiitis

45
Q

Give an example of an Anti-GBM associated disease.

A

Anti-GBM disease…

46
Q

What is anti-GBM disease?

A

An autoimmune response where antibodies damaged the type IV collagen in the GBM or the alveoli.

47
Q

If the Lungs are affected in anti-GBM disease as well as the kidneys, what is the syndrome?

A

Goodpasture’s syndrome

48
Q

How may lung involvement in anti-GBM disease manifest?

A

Massive haemoptysis.

49
Q

How long after a group A strep (GAS) infection would post-strep GN present?

A

1-2 weeks.

50
Q

What is a clinical feature of post-GAS GN?

A

Low complement (C3/4)

51
Q

How can you treat post-GAS GN?

A

Treat underlying GAS infection

52
Q

What causes IgA GN?

A

IgA deposition in the kidneys. Typically presents with haematuria hours to days after a recent respiratory infection

53
Q

What is IgA GN associated with?

A

Henoch-schonlein purpura (HSP)
(IgA vasculitis)

54
Q

Are Granulomatosis with polyangiitis (GPA/Wegner’s) and Eosinophilic granulomatosis with polyangiitis (EGPA/Churgg strass syndrome) and microscopic polyangiitis cANCA or pANCA?

A

GPA : Invariably cANCA
EGPA: Often pANCA
MP: Invariably pANCA

55
Q

What is a rarer cause of nephrotic and nephritic disease

A

SLE (lupus) Nephritis

56
Q

In the case of nephrotic and nephritic syndromes, these are descriptive terms for a group of symptoms caused by different diseases. For example, a patient is not diagnosed with nephrotic syndrome. Instead, they are diagnosed with nephrotic syndrome caused by minimal change disease or membranous glomerulonephropathy.

A

In the case of nephrotic and nephritic syndromes, these are descriptive terms for a group of symptoms caused by different diseases. For example, a patient is not diagnosed with nephrotic syndrome. Instead, they are diagnosed with nephrotic syndrome caused by minimal change disease or membranous glomerulonephropathy.

57
Q

How may you test for Coeliac disease?

A

IgA for transglutaminase-2 (TGA-IgA)
Total serum IgA (if IgA is low, TGA test becomes invalid)
(serological tests only accurate if 6 week gluten diet is followed)
Upper GI endoscopy + biopsy

58
Q

What are not obligatory criteria for a coeliac diagnosis?

A

HLA DQ2-/DQ8
Symptoms

59
Q

What would the histopathology of coeliac disease show?

A

Villous atrophy and crypt hyperplasia.

John's 3a Cards (11 decks)

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