met rogue Flashcards
Ascites
SAAG gradient >11g/L
high
Liver cirrhosis - portal hypertension
raises anti-mitochondrial antibodies
raised ALP, GGT
Primary biliary cholangitis
T2DM and abnormal LFTSs?
usually non-alcoholic fatty liver disease
check ferritin for haemochromatosis
drugs causing long QTc
cardiac
amiodarone
sotalol
1a antiarrythmic
TCAs SSRIs - citalopram methadone chloroquine erythromycin
hypothyroid in pregnancy
increase levothyroxine up to 50%
Low dose dex - NOT supp
High dose - SUPP
Cushing’s disease
Graves
and which antibodies pls
autoimmune attack on thyroid
overactive
TSH receptor stimulating ABs
anti-thyroid peroxidase ABs
ABC in IBS?
abdominal pain
bloating
change in bowel habits (diarrhoea/constipation)
pharyngeal pouch
dysphagia regurgitation halitosis - bad breath aspiration --> surgical repair
ADH action
anti-diuretic hormone increases aquaporins increases pure water absorbed back to blood decreases plasma osmolality increases urine osmolality
SIADH
inappropriate ADH secretion
–> hyponatraemia
result of dilution / excessive water retention
SIADH treatment?
fluid restriction
…
Effects of hyponatraemia
cerebral oedema lethargy nausea and vomiting headache/confusion decreased GCS
broad spectrum antibiotics & PPIs can cause?
C difficile infection
C difficile
diarrhoea
abdominal pain
raised WCC
severe toxic megacolon
C difficile treatment?
oral metronidazole 10-14 days
2nd line - vancomycin
life threatening?
-> mix oral vanc and IV met
anaemia diagnosis
& infection?
normally ferritin
ferritin = unreliable indicator of iron levels in infection
use transferrin saturation & TIBC instead
differentiate between IBS and IBD in primary care
fecal calprotectin
SIADH causes
small cell lung cancer pancreas, prostate malignancy stroke neuro haemmorhages TB, pneumonia drugs
alcoholic ketoacidosis findings
metabolic acidosis raised ketones normal glucose (raised anion gap)
alcoholic ketoacidosis treatment
saline & thiamine infusion
C difficile investigation results
C dif toxin = current infection
C dif antigen = past exposure/colonies
hyperkalaemia causes?
AKI metabolic acidosis Addisons disease rhabdomyolysis massive blood transfusion drugs: - ACE inhibitors, ARBs - potassium sparing diuretics - spironolactone - heparin - ciclosporin - beta blockers maybe?
painless obstructive jaundice
palpable gall bladder
think malignancy
- cholangiocarcinoma
- pancreatic cancer
Hepatocellular carcinoma causes
liver cirrhosis chronic hep B/C alcohol haemochromatosis PBC ...
HCC features
late presentation cirrhosis/liver failure jaundice ascites RUQ rain hepatomegaly/spleno pruritus raised AFP - alphafetoprotein
hyponatraemia causes? urinary sodium >20mmol/l
diuretics - loop, thiazide Addisons disease renal failure SIADH hypothyroid
hyponatraemia causes? urinary sodium <20 mmol/l
diarrhoea, vomiting, sweating burns, rectal adenoma water excess - secondary hyperaldosteronism from heart failure, liver cirrhosis - nephrotic syndrome - IV dextrose ...
isolated bilirubin rise
Gilberts syndrome (goes away by self)
p-ANCA
primary sclerosing cholangitis
ulcerative colitis/IBD?
hyperkalaemia ECG changes
Tall-tented T waves flat/lost of P waves wide QRS complex increased PR interval sine wave pattern --> VF
severe hyperkalaemia limits
> = 6.5 mmol/L
causes of AKI
= STOP Sepsis, shock Toxicity Obstruction Parenchymal disease
some symptoms of hyperkalaemia
chest pain
palpitations
weakness
hyperkalaemia stabilise cardiac membrane
IV calcium gluconate
does NOT lower serum K
hyperkalaemia - short term ECF–> ICF shift
insulin/dextrose infusion
nebuliser salbutamol
remove K from body
calcium resonium (oral or enema)
loop diuretics
dialysis
diarrhoea acid-base disturbance?
normal anion gap metabolic acidosis
vomiting acid-base disturbance?
normal anion gap metabolic alkalosis
membranous glomerulonephritis findings
- nephrotic/proteinuria
- thick base membrane
- sub-epithelial spikes
cause of membranous glomerulonephritis
APA2 antibodies
infection
malignancy
SLE, thyroid, rheumatoid
membranous glomerulonephritis treatment
ACEi/ARB - reduce proteinuria
immunosuppression
anticoagulation if high risk
anti-GBM disease
autoimmune, against collagen in lungs/glomeruli
- nephritic
- haemoptysis
- linear IgG in basement membrane
IgA nephropathy findings
- macroscopic haematuria in young person, post URTI
- renal biopsy = mesangial proliferation, matrix accumulation
what is IgA nephropathy
IgA builds up in kidneys - leads to inflammation…?
what does aldosterone do?
regulates BP
resorption of Na –> water
post ERCP - epigastric pain radiating to the back, nausea, jaundice, vomiting, fever?
acute pancreatitis - common complication of ERCP
Sildenafil
Phosphodiesterase type V inhibitors
erectile dysfunction, pulmonary hypertension
vasodilation by increasing cGMP –> relaxes smooth muscle/vessels (corpus cavernosum)
