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Medicine Knowledge Flashcards

1
Q

What does SAAG measure indirectly?

A

Portal pressure- can be used to determine if a patient’s ascitis is due to portal hypertension or other causes

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2
Q

Ascities causes if SAAG over 11g/L?

A

Liver disorders:
Cirrhosis/alcholic liver disease
Acute liver failure
Liver metastses

Cardiac:
Right heart failure
Constrictive pericarditis

Other causes:
Budd-Chiari syndrome
Portal vein thrombosis

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3
Q

Ascities causes if SAAG less than 11g/L?

A

Hypoalbuminaemia- nephrotic syndrome, severe malnutrition

Malignancy

Infections

Pancreatitis

Bowel obstruction

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4
Q

Management of ascities?

A

Reduce dietary sodium

Fluid restriction if sodium is <125mmol/L

Aldosterone antagonists e.g. spironolactone

Drainage if tense ascities- large volume paracentesis requires albumin cover to avoid paracentesis induced circulatory dysfunction

Prophylactic antibiotics

Transjugular intrahepatic portosystemic shunt (TIPS) in some patients

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5
Q

What are the features of idiopathic pulmonary fibrosis?

A

Progressive exertional dyspnoea

Bibasal fine end-inspiratory crepitations on auscletation

Dry cough

Clubbing

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6
Q

Idiopathic pulmonary fibrosis diagnosis?

A

Spirometery- classically a restrictive picture

Impaired gas exchange- reduced transfer factor

High resolution CT scan investigation of choice and required to make a diagnosis- ground glass or honeycombing seen on x-ray

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7
Q

Idiopathic pulmonary fibrosis management?

A

Pulmonary rehabilitation

Few medications give a benefit- small evidence pirfenidone

Many patients require supplementary oxygen and eventually a lung tranplant

Life expectancy of 3-4 years

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8
Q

Cluster headache management?

A

Acute- 100% oxygen
Subcutaneous triptan

Prophylaxis- Verapamil
(some evidence for tapering dose of prednisolone)

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9
Q

CKD and hypertension treatment?

A

ACEi first line - small fall in eGFR and small rise in creatinine is acceptable

Furosemide also useful, also lowers potassium, careful of dehydration

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10
Q

Types of necrotising fasciitis?

A

Type 1- mixed anaerobes and aerobes (often post surgery in diabetics) Most common type

Type 2- streptococcus pyogenesR

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11
Q

Risk factors for necrotising fasciitis?

A

Recent trauma/ burns/soft tissue infections

Diabetes mellitus- paticularly if treated with SGLT-2 inhibitors

IV drug use

Immunosuppression

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12
Q

Most common site for necrotising fasciitis?

A

Perineum

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13
Q

Features necrotising fasciitis?

A

Acute onset

Pain, swelling, erythema at the effected site- often presents as rapidly worsening cellulitis with pain out of keeping with physical features

Extremley tender with skin necrosis a late sign

Fever or tachycardia may be absent or occur late in presentation

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14
Q

Management necrotising fasciitis?

A

Urgent surgical debridement

IV antibiotics

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15
Q

Big side effect of spironolactone in men?

A

Gynaecomastia

Other causes:
Puberty
Syndromes with androgen deficiency: Kallman’s, Klinefelter’s
Testicular failure- mumps
Liver disease
Testicular cancer
Ectopic tumour secretion Hyperthyroidism
Haemodyalysis
Drugs

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16
Q

Drugs that cause gynaecomastia?

A

Spironolactone (most common)
Cimetidine
Digoxin
Cannabis
Finasteride
GnRH agonists- goserelin, buserelin
Oestrogens, anabolic steroids

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17
Q

What is the triad for nephrotic syndrome?

A
  1. Proteinuria
  2. Hypoalbuminemia
  3. Oedema
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18
Q

Causes of nephrotic syndome?

A

Primary causes: minimal change disease, focal segmental glomerulosclerosis (FSGS), membranous nephropathy

Secondary causes: DM, systemic lupus erythematosus (SLE), amyloidosis, infections (HIV, Hep B and C), drugs (NSAIDs, gold therapy).

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19
Q

Nephrotic syndrome and LMWH?

A

Loss of antithrombin 3 etc rise fibrinogen levels and predisposes to thrombosis- prphylactic LMWH required

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20
Q

Nephrotic syndrome and thyroid?

A

Loss of thyroxine- binding globulin lowers the total but not free thyroxine levels

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21
Q

Investigations for nephrotic syndrome?

A

Urine dipstick- proteinuria and microscopic haematuria

MSU to exclude UTI

Quantify proteinuria using early morning urinary protein:creatinine ratio or albumin: creatinine ratio.

FBC and coagulation screen

Urea and electrolytes

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22
Q

Amiodarone vs atropine?

A

Amiodarone bring the HR down

Atropine bring the heart rate up

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23
Q

Adverse signs in Peri-arrest bradycardia and the treatment required?

A

Shock- hypotension, pallor, sweating, cold clammy extremities, confusion or impaired conciousness

Syncope

Myocardial ischaemia

Heart failure

Atropine 500mcg is the first treatment in this situation- used up to a max of 3mg

If inadquate response also-
Transcutaneous pacing

Isoprenaline/adrenaline injection

Specialist led transvenous pacing if no response to above

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24
Q

Features of hepatitis A?

A

Flu-like prodrome

Abdominal pain- typically RUQ

Tender hepatomegaly

Jaundice

Deranged LFTs

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25
What are the three types of multiple endocrine neoplasia (MEN)?
MEN type 1- 3 p's- Parathyroid- hyperparathyroidism, Pituitary, Pancreas- insulinoma MEN type IIa- 2 P's- Parathyroid, Phaeochromocytoma MEN type IIb- 1 P- Phaeochromocytoma
26
What are some red flag symptoms for trigeminal neuralgia?
Sensory changes Deafness FH multiple sclerosis Age onset before 40 Pain only in opthalmic region
27
Management of trigeminal neuralgia?
Carbamazepine Failure to respond=refer to neurology
28
Brief difference between Lambert-Eaton and Myasthenia Gravis?
Lambert-Eaton- Legs affected first/ gets better with movement- linked to SCLC Myasthenia Gravis- eyes/ arms/ face affected first, worse with movement
29
Paraneoplastic features of small cell lung cancer?
ADH- SIADH ACTH- Cushing's Lambert Eaton syndrome
30
Paraneoplastic features of squamous cell lung cancer?
Parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia Clubbing Hypertrophic pulmonary osteoarthropathy (HPOA) Hyperthyroidism due to ectopic TSH
31
Acute management of SVT?
Vagal manoeuvres- valsalva manoeuvres- trying to blow into empty plastic syringe, carotid sinus massage Intravenous adenosine- contraindicated in asthmatics- verapamil preferable Electrical cardioversion Prevention of episodes- beta blockers, radio-frequency ablation
32
Narrow complex vs broad complex tachycardia?
Narrow generally SVT- through normal conduction system- narrow QRS Broad generally VT- outside normal conduction system- broad QRS Exceptions SVT with abberrant conduction like BBB
33
Pain relief in palliative patients with renal failure?
Mild renal failure- oxycodone Sever renal impairment- buprenorphine (or fentanyl) as not renally excreted
34
Starting treatment for pain relief in palliative medicine?
Regular oral modified release morphine with immediate release morphine for breakthrough pain- 1/6th normal dose Laxatives prescribed for all patients starting strong opioids Opioid caution in renal disease- oxycodone for mild-moderate, buprenorphrine/ fentanyl for moderate/severe
35
What is the main test used to screen for latent tuberculosis?
Mantoux test
36
What happens to sodium in SIADH?
Hyponatremia due to dilution from water retention
37
SIADH pathophysiology?
Excessive ADH secretion (vasopressin)- causes water retention and hyponatremia Leads to decreased urine output- no signs of fluid overload due to equal distribution of fluid Concentration of electrolytes in blood- particularly sodium- is depeleted
38
Causes of SIADH?
Malignancy- SCLC (also pancreas/prostate) Neurological- stroke, SAH, subdural, meningitis Infections- tuberculosis, pneumonia Drugs- SSRIs, carbamazepine,
39
SIADH investigations?
Urine osmolality- inappropriately high when compared with serum osmolality Urine sodium concentration- urine sodium concentration is high
40
SIADH mangement?
Fluid restriction Demeclocycline- reduces collecting tubule responsiveness to ADH
41
What is Budd-Chiari syndrome?
Hepatic vein thrombosis Causes: Polycythemia rubra vera COCP Pregnancy Thrombophilia also antiphospholipid syndrome
42
What is the triad for Budd-Chiari?
Abdominal pain- sudden onset, severe Ascities- abdominal distension Tender hepatomegaly
43
Investigation for Budd-Chiari syndrome?
Ultrasound with doppler flow studies
44
What is Hashimoto's thyroiditis?
Chronic autoimmune thyroiditis Typically hypothyroidism but may be period of transient thyrotoxicosis 10x in women
45
Features of Hashimoto's thyroiditis?
Features of hypothyroidism Goitre: firm, non-tender Anti-thyroid peroxidase (TPO) and also anti-thyroglobulin (Tg) antibodies
46
Things associated with Hashimoto's thyroiditis?
Other autoimmune conditions- coeliac disease, T1DM, vitiligo Development of MALT lymphoma
47
What to do if cannot establish intavenous access in advanced life support?
Use intraosseous route to give drugs
48
Chest compression to ventilation ratio in ALS?
30:2
49
Defibrillation in ALS?
Single shock for VF/pulseless VT followed by 2 minutes of CPR If cardiac arrest witnessed in a monitored patients then up to three successive stacked shocks rather than 1 shock followed by CPR
50
Adrenaline in ALS?
Adrenaline given as soon as possible for non-shockable rhythms In VF/VT cardiac arrests adrenaline given once chest compressions have restarted after third shock Repeat adrenaline every 3-5 mins whilst ALS continues
51
Amiodarone and ALS?
Amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered A further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered Lidocaine can be used as an alternative (remember adrenaline needs to be given)
52
Thrombolytic drugs and ALS?
Should be considered if a pulmonary embolus is suspected If given, CPR should be continued for an extended period of 60-90 minutes
53
Causes of a raised TLCO?
Asthma Exercise Male Polycythemia Pulmonary haemorrhage
54
Causes of reduced TLCO?
Pulmonary fibrosis Pneumonia Pulmonary emboli Pulmonary oedema Emphysema Anaemia Low cardiac output
55
What demographic does idiopathic intracranial hypertension occur in?
Obese, young females Causes headaches/ blurred vision
56
Risk factors for idiopathic intracranial hypertension?
Obesity Female Pregnancy Drugs: COCP Steroids Tetracyclines
57
Features of idiopathic intracranial hypertension?
Headache Blurred vision Papillodema Englarged blind spot Sixth nerve palsy
58
Management of intracranial idiopathic hypertension?
Weight loss Acetazolamide Repeated lumbar puncture Surgery
59
Most common precipitating factors for DKA?
Infection, missed insulin doses, MI
60
Features of DKA?
Abdominal pain Polyuria, polydipsia, dehydration Kussmaul respiration Acetone-smelling breath
61
Diagnostic criteria for DKA?
Glucose > 11mmol/l or known DM pH < 7.3 Bicarbonate < 15 mmol/l Ketones > 3mmol/l or urine ketones ++ on dipstick
62
Management of DKA?
Fluid replacement- isotonic saline used initially Insulin- IV infusion started at 0.1 unit/kg/hour Once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime Correction of electrolyte disturbance- Serum potassium often high on admission despite total potassium low, falls on treatment so add potassium into replacement fluids Long-acting insulin continued, short-acting insulin stopped
63
How is DKA resolution defined?
pH >7.3 and Blood ketones < 0.6mmol/L and Bicarbonate > 15 mmol/L Both ketonemia and acidosis should have resolved within 24 hours
64
Complications from DKA/treatment?
Gastric stasis Thromboembolism Arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia Iatrogenic due to incorrect fluid therapy: cerebral oedema*, hypokalaemia, hypoglycaemia Acute respiratory distress syndrome Acute kidney injury
65
Which age group is most as risk of cerebral oedema in DKA?
Children/young adults- often need neuro observation- don't overload with fluid
66
What is Barrett's oesophagus?
Metaplasia of the lower oesophageal muscosa, with the usual squamous epithelium being replaced by columnar epithelium
67
Risk factors for Barrett's oesophagus?
GORD Male Smoking Central obesity
68
Management of Barrett's oesophagus?
High dose PPI Endoscopic surveillance with biopsies- for patients with metaplasia not dysplasia- endoscopy every 3-5 years If dysplasia of any grade is identified endoscopic intervention is offered
69
What are the causes of anaemia in renal failure (CKD)?
Most significant- reduced erythropoietin levels- kidneys produce EPO Reduced absorption of iron More kidney specific reasons
70
Management of anaemia in CKD?
Determination and optimisation of iron status should be carried out prior to the administration of erythropoiesis stimulating agents (ESA) Oral iron should be offered, if not reached target in 3 months switch to IV iron, those on ESA usually require IV ESAs such as erythropoietin and darbepoietin
71
Glucose range for prediabetes?
HbA1c of 42-47mmol Fasting glucose of 6.1-6.9
72
Glucose range for diabetes?
>=48mmol HbA1c >=7mmol fasting glucose
73
Management for prediabetes?
Lifestyle modification- exercise, diet, weight loss At least yearly follow up with blood tests Metformin for adults at high risk progressing towards T2DM despite lifestyle changes
74
Features of a lower UTI in adults?
Dysuria Urinary frequency Urinary urgency Cloudy/offensive smelling urine Lower abdominal pain Fever- typically low-grade in lower UTI Malaise In elderly patients acute confusion is a common feature
75
Urine dipstick vs urine culture in lower UTI?
Urine dipstick- can be used to aid diagnosis in women under 65 years old with no risk factors for complicated UTI Urine culture- should be sent in women >65, men or catheterised patients, reccurent UTI, pregnant patients
76
Hypospelnism causes and features?
Causes: Splenectomy Sickle-cell Coeliac disease Graves' disease SLE Amyloid Features: Howell-Jolly bodies Siderocytes
77
Diabetes diagnosis thresholds?
Fasting glucose greater than or equal to 7 Random glucose greater than 11.1 or after glucose tolerance test If patient asymptomatic the criteria must be demonstrated on two seperate occasions Also HbA1c above 48
78
Conditions where HbA1c may not be useful for diabetes diagnosis?
haemoglobinopathies haemolytic anaemia untreated iron deficiency anaemia suspected gestational diabetes children HIV chronic kidney disease people taking medication that may cause hyperglycaemia (for example corticosteroids) (High turn over of RBC)
79
What condition can cause a sudden deterioration following high pressure non-invasive ventilation?
Pneumothorax
80
What are the types of pneumothorax?
Primary spontaneous pneumothorax- those occuring in tall, young individuals without lung disease Secondary spontaneous pneumothorax- occurs in patients with pre-existing ling disease such as COPD, asthma, cystic fibrosis, lunch cancer Traumatic pneumathorax- penetrating or blunt chest trauma Iatrogenic pneumothorax- complication of medical procedures such as- thoracentesis, central venous catheter placement, ventilation- including non-invasive ventilation or lung biopsy
81
What is a tension pneumothroax?
Severe pneumothorax resulting in the displacement of mediastinal structures
82
Clinical features of pneumothroax?
Sudden symptoms: dyspnoea, chest pain: often pleuritic Signs: Hyper-resonant lung percussion Reduced breath sounds Reduced lung expansion Tachypnoea Tachycardia In tension pnemothorax: Respiratory distress Tracheal deviation away from side of the pneumothorax Hypotension
83
First step in pneumothorax management?
Assess the size of the pneumothorax No or minimal symptoms- conservative care, regardless of pneumothorax size Symptomatic- assess for high-risk characteristics
84
Management for symptomatic pneumothorax?
Determine if there are high risk characteristics: Haemodynamic compromise (suggesting tension) Significant hypoxia Bilateral pneumothroax Underlying lung disease Over 50 with significant smoking history Haemothorax If no high risk patients offered a choice of conservative, ambulatory or needle aspiration If high risk and safe to intervene- chest drain
85
Pneumothroax conservative care summary?
Patient with primary spontaneous pneumothorax this is managed conservaively should be reviewed every 2-4 days as an outpatient Secondary spontaneous managed conservatively should be monitored as an inpatient
86
Ambulatory care for pneumothorax?
Use an ambulatory device that allows controlled escape of air with one way valve
87
Needle aspiration for pneumothorax?
Chest drain should be inserted if unsuccessful If resolved discharge and follow up as outpatient in 2-4 weeks
88
Chest drain insertion?
Daily review as an inpatient Remove drain when resolved Discharge and follow up in outpatients after 2-4 weeks
89
Persistent/recurrent pneumothroax?
Video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy
90
Discharge advice for pneumothorax?
Avoid smoking Avoid flight for 2 weeks after Scuba diving should be permenantly avoided
91
What is acute interstitial nephritis?
Accounts for 25% drug induced AKI- inflammation in kidney
92
Causes of acute interstitial nephritis?
Drugs- most common cause, particularly antibiotics- penicillin, rifampicin, NSAIDs, allopurinol, furosemde Systemic disease- SLE, sarcoidosis, Sjogren's syndrome Infection
93
What are the features of acute interstitial nephritis?
Fever, rash, arthralgia Eosinophillia Mild renal impairment Hypertension
94
Difference between IgA nephropathy and Post streptococcus glomerulonephritis?
PSGN develops 1-2 weeks after URTI IgA nephropathy develops 1-2 days after URTI
95
What criteria are used to calculate eGFR?
Serum creatinine Age Gender Ethnicity Factors affecting the result: Pregnancy Muscle mass (amputees, body builders) Eating red meat 12 hours prior to the sample being taken
96
CKD stages 1 and 2?
If no sign of kidney damage on other test/ kidneys look normal then there is no CKD
97
CKD and anaemia?
CKD can cause a reduction in erythropeitin levels This predisposes to LVH so can cause cardiovascular issues
98

Phase 4 Question Knowledge (36 decks)

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