Misc. Flashcards
Why does myeloma cause renal damage?
- Light chain deposition (cast nephropathy)
- NSAID use
- Infection
- Hypercalcaemia
- Amyloid
- Tubular damage (renal fanconi syndrome)
What is cardioversion?
Cardioversion is a medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs
Explain atrial flutter
Continuous atrial depolarisation on ECG. Sawtooth baseline.
Treatment: Cardioversion, Amioderone restores sinus rhythm. Rate control via beta blocker or calcium channel blocker.
Name to signs you might see on a CXR in heart failure?
Cardiothoracic ration >50% indicative of cardiomyopathy
Kerley B lines indicative of fluid or cellular infiltration into the interstitium of the lungs.
Patient has low oxygen saturation and chest is clear what is diagnosis ?
PE
What is internuclear ophthalmoplegia (INO)
When your eyes don’t point in the same direction. One is left in the middle when looking laterally. Most common cause is MS.
What are the two shockable rhythms?
Ventricular fibrillation and pulseless ventricular tachycardia
Types of hyponatraemia
Hypovoleamic hyponatraemia
Hypervoleamic hyponatraemia
Euvolaemic hyponatraemia
Causes of hypovolaemic hyponatraemia
Gastrointestinal fluid loss (e.g., severe diarrhoea or vomiting)
Third spacing of fluids (e.g., pancreatitis, severe hypoalbuminaemia)
Salt-wasting nephropathy
Cerebral salt-wasting syndrome (a rare cause of hyponatraemia resulting from urinary salt wasting; elevated brain natriuretic peptide has been implicated)
Mineralocorticoid deficiency.
Causes of hypervolaemic hyponatraemia
Acute kidney injury/chronic kidney disease (low sodium levels in advanced kidney disease or dialysis patients is due to relatively higher water versus salt intake with poor excretion due to underlying kidney disease)
Congestive heart failure
Cirrhosis
Nephrotic syndrome.
Causes of euvolaemic hyponatraemia
Medications (e.g., vasopressin, diuretics, antidepressants, opioids).
Syndrome of inappropriate antidiuretic hormone (SIADH)
High fluid intake: can result from intense/prolonged physical activity (e.g., marathon running, military training, wilderness exploration)
surgery
primary polydipsia (also referred to as psychogenic polydipsia); or potomania, which is caused by a low intake of solutes and electrolytes with relatively high fluid intake
Causes of syndrome of inappropriate antidiuretic hormone (SIADH):
can result from malignancy (e.g., small cell lung cancer, gastrointestinal tract cancers); central nervous system disorders (e.g., subarachnoid haemorrhage, meningitis, encephalitis); pulmonary disease (e.g., pneumonia); or other non-specific causes (e.g., medications, pain, nausea, stress, general anaesthesia). It can also be idiopathic
ECG changes in hyperkalaemia
Tall tented T waves
Loss of P waves
Wide QRS complex
Causes of hypernatraemia
Hypernatraemia = dehydration
Free water losses: (Osmotic diuresis/renal losses (e.g., recovery from renal failure, poorly controlled diabetes mellitus, use of intravenous mannitol or loop diuretics, diabetes insipidus) Gastrointestinal losses (e.g., severe diarrhoea/prolonged vomiting) Insensible or sweat losses (e.g., exercise, fever, heat exposure, burns)
Inadequate free water intake:
Inability to drink water or limited access to water (e.g., older patients with dementia)
Impaired thirst mechanism
Sodium overload:
Treatment of hyponatraemia
Hypertonic (3%) saline solution
Supportive care
Treat underlying cause
Treatment of hypernatraemia
Oral / iv fluids
Treat underlying cause
Monitor
Causes of hyperkalaemia
- Drugs
Potassium sparing diuretics e.g. spironolactone, NSAIDs, Trimethoprim, ACE I, Heparin, Loop or thiazide-type diuretic therapy - Endocrine (addisons, pseudohypoaldosteronism)
- Acute/chronic kidney disease
- ?dietry - bananas, LoSalt (KCl) background of kidney f.
- Increased cell turn over (burns, rabdomyalysis, tumour lysis syndrome, exercise)
- DKA
Treatment if hyperkalaemia
- Treat underlying cause
- calcium chloride (10% solution) or calcium gluconate (10% solution) - to stabalise myocardium
- beta-adrenergic agonists (nebulised salbutamol)
- intravenous insulin/glucose
- potassium binding resins
- haemodialysis in extreme circumstances
Causes of hypokalaemia
INCREASE SECREATION - Renal renal tubular acidosis, diuretics, high mineralcortiosteroids, high cortisol - GI (vomiting) - Skin (burns, eczema, psoriasis) DECREASED ABSORPTION - Elevation in extracellular pH: metabolic or respiratory alkalosis can facilitate potassium entry into cells - high insulin
Jaundice + palpable gall bladder = ?
Pancreatic tumour until proven otherwise.
Courvoisier sign.
Causes of hyperbilirubinaemia in neonates
- increased biliruben production due to shorter lifespan of RBC
- Decreased biliruben conjugation due to hepatic immaturity
- absecence of gut flora impedes elimination of bile pigment
- exclusive breast feeding esp. If difficulties (decreased intake - dehydration - decreased bilirubin elimination - increased enterohepatic circulation of bilirubin) not a reason to stop !
^ normal
Visible jaundice (>24 hours - pathological) Sepsis Rhesus haemolytic disease ABO incompatabiltiy Red cell abnormalities
Indications for hysteroscopy
Mennoragia Irregular periods Abnormal bleeding Abdnornal discharge Repeated miscarriage Infertility Prior to endometrial ablation or resection
Operative
- removal of polyps
- adhesions
- fibroids
- lost or stuck contraceptive device
- biopsy
Unexplained uterine bleeding
P polyps
A adenomyosis
L leiomas
M malignancy or hyperplasia
C coagulopathy O ovarian dysfunction I iatrogenic N not yet classified - most common E - endometrial
Causes of a focal axillary lump
Infection? Abcess, EBV, TB
Haematological malignancy
Skin cancer
Sarcoidosis, lupus
If nothing on the history that suggests breast ca unlikely then do a breast exam.
Lump then US, x ray, biopsy
Risk factors for ARDS
Sepsis, hypovolaemic shock, Trauma, Pneumonia, Drugs/toxins, burns, DIC, Acute pancreatitis, smoke inhalation, tumour lysis syndome
