Macleod Regurg

Question 1

What joints do OA and RA commonly affect in the hand?

Answer 1

OA = DIP
RA = PIP

Question 2

When might you see macroglossia?

Answer 2

acromegaly, amyloidosis or tumour infiltration

Question 3

When do you see Glossitis?

Answer 3

It is a smooth reddened tongue due to papillae atrophy
alcoholics
iron folate vitamin b12 deficiency and coeliac

Question 4

What features must you note in a lump or swelling?

Answer 4

SPACE SPIT

Size, position, attachments, consistency, edge, surface/shape, pulsations, inflammation, transillumination

Question 5

What is the normal range of body temperatures?

Answer 5

35.8 - 37.2

N=37

Question 6

What surface is psoriasis usually on?

Answer 6

Extensor surfaces

Question 7

What surface is eczema usually on?

Answer 7

Flexor surfaces

Question 8

When ALT is very very high what does this indicate?

Answer 8

Viral or drug induced hepatitis

Question 9

If both aminotransferases are highly raised then what does this indicate?

Answer 9

Almost certainly hepatitis (>1000)

Alcoholic liver disease will not go >1000

Question 10

For AST, what would an elevation of 10-20x and 5-10 the normal indicate?

Answer 10

MI or alcoholic cirrhosis

lower may suggest chronic cirrhosis

High levels of AST general indicate liver OR heart OR muscle damage so cannot be used exclusively

Question 11

In what structures is ALP highest in?

Answer 11

Cells lining bile duct and bone

elevation = damage to these areas

Question 12

What would a raised gamma GT indicate?

Answer 12

Obstructed bile ducts- liver damage due to alcohol

Question 13

What can reduce albumin levels

Answer 13

Diarrhoea, liver disease, poor diet, iron deficiency and infection

Question 14

ALP raised, ALT slightly raised

Answer 14

likely to be a problem n the bile duct

Question 15

ALT raised ALP slightly raised

Answer 15

likely to be a problem in the liver

Question 16

Very high ALT, slightly raised AST

Answer 16

suggests viral drug induced or severe necrosis of the liver

Question 17

AST raised, ALT slightly raised

Answer 17

suggests alcoholic or drug induced cirrhosis

Question 18

What is an obstructive (bile duct obstruction) pattern of LFTs likely to be?

Answer 18

high bilirubin, high ALP and normal ALT

Question 19

What would a hepatic (acute liver inflammation) pattern of LFT results show?

Answer 19

Very high ALT
varying billirubin
slightly raised ALP
Increased PT

Question 20

If there was only an increased bilirubin what would this mean?

Answer 20

likely to be unconjugated indicating haemolysis or gilberts syndrome

Question 21

raised gamma gt only?

Answer 21

alcohol, enzyme inducing drugs or obesity

Question 22

What does a massively raised urea and creatinine indicate?

Answer 22

renal failure

Question 23

increased sodium
decreased pottassium
N: urea and creatinine?

Answer 23

hyperaldosteronism - conns syndrome

aldosterone causes sodium retention at the expense of pottasium

Question 24

What conditions may give you respiratory acidosis?

Answer 24

An acute ventilatory failure with:
severe acute asthma
severe pneumonia
COPD exacerbation
Thoracic skeletal abnormality
Neuromuscular disorder

Question 25

What may cause a respiratory alkalosis?

Answer 25

Hyperventilation: anxiety/panic, CNS causes e.g. stroke, salicylate poisonining

Question 26

What may cause metabolic acidosis?

Answer 26

Increased production of organic acids: DKA, Poisoning (alcohol), ARF, Lactic acidosis, loss of bicarb (renal tubular acidosis, severe diarrhoea, addisons)

Question 27

What may cause metabolic alkalosis?

Answer 27

Loss of acid: severe vomiting

Loss of K+ - excess diuretic therapy, hyperaldosteronism, Cushings syndrome, milk-alkali syndrome