Medical Flashcards
What are the ECG findings in hypocalcaemia?
Prolonged QT interval
Removal of the parathyroid glands can lead to what electrolyte imbalance?
Hypocalcaemia
What are the features of hypercalcaemia on an ECG?
ST segment shortening
What is total iron binding capacity like in iron deficiency anaemia?
High
What is total iron binding capacity like in anaemia of chronic disease?
Low/normal
What levels are required to diagnose someone with diabetes?
- 2 hour post-prandial glucose >= 11.1
- Fasting glucose >= 7
- HbA1c > 47
What are the levels of C-peptide in type 1 and type 2 diabetes?
- Type 1 - low C-peptide
- Type 2 - high C-peptide
(C-peptide is made alongside insulin)
What are the key features of diabetic ketoacidosis?
abdominal pain, polyuria, polydipsia, kussmaul respiration (deep hyperventilation), acetone-smelling breath
What is the management of a myasthenic crisis?
IV IgG and plasmapheresis
What is the pathophysiology of myasthenia gravis?
Autoimmune - antibodies to acetylcholine receptors
What is the first line treatment of myasthenia gravis?
pyridostigmine
In type 1 diabetes when should blood sugar levels be checked?
before each meal and before bed
What are the blood glucose targets for type 1 diabetics?
5-7mmol/l on waking
4-7mmol/l before meals
In which patients with type 1 diabetes can you include metformin in their treatment?
Patients with a BMI > 25
What are the features of cellulitis?
unilateral, erythema usually with well-defined margins, swelling, systemic upset
What bacteria commonly causes cellulitis?
Strep pyogenes
(sometimes staph aureus)
What is the management of cellulitis?
oral abx if mild - flucloxacillin (clarithromycin or erythromycin (in pregnancy) if penicillin allergic)
if severe - IV co-amoxiclav/clindamycin/cef
What is the first line treatment for hypertension in diabetics?
ACE-I/ARBs e.g. Ramipril
What is the mechanism of action of SGLT-2 inhibitors?
Increase urinary glucose excretion
What is the mechanism of action of sulphonylureas (gliclazide)?
Increase insulin release from the pancreas
How do you diagnose type 2 diabetes in an asymptomatic patient?
two elevated fasting/random glucose tests on two separate occasions
what drug is used to treat thyrotoxicosis in pregnancy?
Propylthiouracil in first trimester
Carbimazole in second and third
Which diabetes medication increases risk of ulcers or infection?
SGLT-2 inhibitors (canagiflozin)
What conditions are associated with subclinical hyperthyroidism?
atrial fibrillation, osteoporosis, dementia
Which pain medications slow bone healing?
NSAIDs
How do you diagnose cellulitis?
On clinical observation
What is the management of hypocalcaemia?
IV calcium gluconate
Which drug is a calcimimetic?
Cinacalcet - it mimics the action of calcium on tissue by allosteric activation of the calcium-sensing receptor
Which tumours are most likely to metastasise to bone?
prostate, breast, lung
What are the signs of bone cancer/mets?
Pathological fractures, hypercalcaemia, raised ALP
What is subclinical hypothyroidism?
Raised TSH, but T3 and T4 normal, no symptoms
What is a Mantoux test?
A skin-prick test for TB, if TB is present (active or latent) a skin reaction will occur - unless they are immunosuppressed
What are the features of a phaeochromocytoma?
hypertension, headaches, palpitations, sweating, anxiety
How do you test for a phaeochromocytoma?
24hr urinary collection of metanephrines
What is the treatment of phaeochromocytoma?
Surgery
alpha-blockers (phenoxybenzamine) then beta-blockers (propranolol) in the meantime
What are the sodium levels like in pre-renal uraemia?
High, because they hold onto sodium to preserve volume
What is Kallmann syndrome?
Hypogonadotrophic hypogonadism
What are the features of anti-phospholipid syndrome?
thrombosis, recurrent miscarriage, livedo reticularis (lace-like appearance of skin), prolonged APTT
What is the management of anti-phospholipid syndrome?
Primary thromboprophylaxis - low-dose aspirin
Secondary - lifelong warfarin
What type of crystals are present in gout?
negatively bifringent needles, monosodium urate
What are the features of an adrenal crisis?
hypotension, tachycardia, hyperkalaemia and hyponatraemia
What is the management of an adrenal crisis?
IV hydrocortisone (no need for mineralocorticoids as hydro provides some mineralocorticoid activity)
What are the features of hypomagnesaemia?
Parasthesia, tetany, seizures and arrhythmias
How much adrenaline do you give to an adult in anaphylaxis?
500 micrograms (0.5ml of 1 in 1000)
What is lupus pernio?
A raised purple rash over the nose, in patients with sarcoidosis
What are the features of an acute haemolytic reaction?
Fever, abdo pain, hypotension
What is the management of an acute haemolytic reaction?
stop transfusion, send crossmatch, fluid resuscitation
What is the management of a cardiac arrest with a non-shockable rhythm?
Adrenaline 1mg immediately
What is the management of an acute flare up of RA?
IM methylprednisolone
In ALS if IV access cannot be gained how should drugs be given?
Intra-osseous
What drug should be given in non-shockable rhythms?
adrenaline 1mg
What drug should be give in VF/pulseless VT after shocks have been given?
Amiodarone
What are the 8 reversible causes of cardiac arrest?
Hypoxia, Hypovolaemia, (Hyper/hypo kalaemia, hypoglycaemia, hypocalcaemia), hypothermia.
Thrombosis, tension pneumothorax, tamponade, toxins
What is the triad of Behcet’s disease?
Oral ulcers, genital ulcers and anterior uveitis
What is Behcet’s disease?
A multi-system vasculitis - most likely autoimmune. Causes oral ulcers, genital ulcers, anterior uveitis and DVT. Associated with BLA B51
In patients with a CD4 count less than 200/mm3, what medication should be started?
Co-trimoxazole - antifungal as prophylaxis against pneuocystis jiroveci pneumonia
What commonly causes a metabolic alkalosis with hypokalaemia?
Prolonged vomiting
What commonly causes a metabolic acidosis with hypokalaemia?
Prolonged diarrhoea
Which vitamin deficiencies cause easy bruising?
Vitamin C or K
What are the symptoms of psoriatic arthropathy?
symmetrical polyarthritis or asymmetrical oligoarthritis (hands and feet), psoriasias, soft tissue inflammation
What are the X-Ray findings on psoriatic arthritis?
erosive changes and new bone formation, ‘pencil-in-cup’ appearance
What is the management of psoriatic arthritis?
NSAIDs if mild
Methotrexate if moderate or severe - can add Monoclonal antibodies
What is the maximum rate IV potassium can be given without cardiac monitoring?
10mmol/hour
What are the common features of sarcoidosis?
FABLE. fevers, arthralgia, bilateral hilar lymphadenopathy, lupus pernio, erythema nodosum
How much of the electrolytes are needed per day for maintenance?
1mmol/kg/day of sodium, potassium, chloride
How much fluid should patients have per day for maintenance?
25-30ml/kg/day
How much glucose should patients have per day to limit starvation ketosis?
50-100g/day
What would you give in a heparin overdose?
Protamine sulphate
What are the features of a salicylate overdose on ABG?
respiratory alkalosis (causes hyperventilation initially), then metabolic acidosis
How do you administer TPN?
Through a central vein - subclavian line
What is the sign when you inflate a BP cuff and the patient’s arm twitches?
Trousseau’s sign - hypocalcaemia
What is the name of the sign when you tap on the facial nerve and it twitches?
Chvostek’s sign
Which vitamin can be teratogenic in high quantities?
Vitamin A
What is the most common cause of pseudomembranous colitis?
C.Diff
What is the management of a hyperacute transplant rejection?
Remove graft
What is Behcet’s syndrome?
auto-immune mediated inflammation of the vessels. Causes oral ulcers, genital ulcers and anterior uveitis
When should you start bone protection for those on long-term steroids?
Immediately (alendronate)
What are the three alcohol screening tools?
AUDIT, CAGE, FAST
What is the definition of hypothermia?
Core body temperature < 35
What are the features of oral allergy syndrome?
IgE mediated hypersensitivity to raw, plant-based foods - causing tingling of lips/mouth/tongue. linked with hayfever. Cooked foods do not cause symptoms.
What might you see on an ECG in hypothermia?
ST elevation, J waves or osborn waves
Which chemo meds are toxic to which body parts?
https://pbs.twimg.com/media/BKVx5a3CUAAa1z2.png
What two drugs can be used in the management of obesity?
Orlistat - pancreatic lipase inhibitor
Liraglutide - GLP-1 mimetic
When do you add potassium to fluids in DKA?
If potassium level is less than 5.5 in the first 24hrs
Which conditions are autosomal recessive and which are dominant generally?
- structural = dominant (except frederiech’s ataxia)
- metabolic = recessive (except hypercholesterolaemia and MODY)
What is the definition of death?
irreversible loss of the capacity for consciousness. irreversible loss of the capacity to breathe.
How do you certify death?
use stethoscope to listen to heart and lungs for 5 mins
feel for a palpable central pulse for 5 mins
check response to voice, pain (supra-orbital), pupillary light reflex
What is the management of tachycardia with signs of shock?
if BP < 90, HF, syncope, myocardial ischaemia
DC cardioversion
What is distributive shock and its causes?
systemic vasodilation and leaky capillaries moving blood out of intravascular space: caused by sepsis, anaphylaxis and neurogenic shock
What is obstructive shock and its causes?
When there is physical impedance to the flow of blood, reducing cardiac output. causes: PE, cardiac tamponade
What LFTs are seen in prehepatic jaundice?
Raised bilirubin
What LFTs are seen in intrahepatic jaundice?
raised bilirubin and AST/ALT
What is a common cause of pre-hepatic jaundice?
haemolysis
What is the management of neutropenic sepsis?
IV Piperacillin + tazobactam
Rhabdomyolysis causes with electrolyte abnormalities?
hyperkalaemia - cells die and release K+ (also causes hypocalcaemia)
What is the maximum rate of IC potassium infusion with and without monitoring?
10mmol/hr without monitoring
20mmol/hr with cardiac monitoring
Which blood results would show dehydration?
disproportionately raised urea compared to creatinine due urea being reabsorbed with the water. sodium and albumin can be high too
Which statin and dose should be given in patients with established CVD/PVD?
80mg atorvastatin regardless of lipid profile
Which statin is first line for those with a high Q-Risk score?
Atorvastatin 20mg - should also be given in CKD
Why does acute pancreatitis cause hypocalcaemia?
pancreatic lipases are realised which cause fat necrosis leading to release of free fatty acids, these bind to calcium, so less unbound calcium in the blood
What is the management of severe hypocalcaemia?
IV calcium gluconate, 10ml of 10% over 10 mins
What are the symptoms of hypocalcaemia?
spasms, tetany, seizures and prolonged QT, perioral paraesthesia, Trousseau’s sign (BP cuff), Chvostek’s sign (tap parotid)
Why does alkalosis cause hypocalcaemia?
low H+ ions mean that albumin releases H+ ions and becomes negatively charged, calcium ions bind to this and cause lower free calcium in the blood. Phosphate levels are normal
What is the management of hypercalcaemia?
IV fluids
can also give calcitonin
Why must chronic hyponatraemia be treated slowly?
the brain shrinks fast causing osmotic demyelination of the pons which can lead to locked-in syndrome
What is the management of chronic hyponatraemia?
If hypovolaemic - normal saline
if eu/hypervolaemic - fluid restrict, can give vaptans/loop diuretics
What is the management of acute severe hyponatraemia?
3% NaCl
What is addisons?
ADdisons Autoimmune Destruction of the adrenals
What is Conn’s syndrome?
AdenOma - increased adrenal gland activity
What is a complication of quickly correcting chronic hypernatraemia?
Cerebral oedema
AKi causes which electrolyte abnormality?
A K Increase
What is the management of an arterial occlusion in PAD?
Angioplasty, stent, bypass graft
What is the management of a sickle cell crisis?
Iv fluids, analgesia, oxygen, keep warm, CXR, haematology
What non-pharmacological measures can reduce the rate of sickle cell crisis?
avoid cold/dehydration, avoid alcohol and smoking, altitude
What are two clinical signs of ascites?
Shifting dullness and fluid thrill
Which two liver tests best examine synthetic function of the liver?
INR and albumin
What do you give for arrhythmia in a TCA overdose?
IV sodium bicarbonate
