Miscellaneous Flashcards
What are the sepsis-6?
- Administer oxygen.
- Take blood cultures.
- Give IV antibiotics According to Trust protocol.
- Give IV fluids if hypotensive/ lactate >2mmol/l
- Check serial lactates.
- Measure urine output.
What is the difference between PT and aPPT?
PT = Prothrombin time. Measures extrinsic system. Involves factor 7. Activated by external trauma.
aPPT = activated Partial thromboPlastin Time. Measures the intrinsic system. Involves factors (8,9,11,12). Activated by internal trauma.
Which factor is prothrombin? Which is thrombin?
Which coagulation pathway is it involved in?
Factor II is prothrombin, IIa is thrombin.
It is involved in the common coagulation pathway.
Which factor is fibrin/ fibrinogen?
Which coagulation pathway is it involved in?
Factor I is fibrinogen, factor Ia is fibrin.
It is involved in the common coagulation pathway.
What is CURB-65 and how is it calculated?
What does each score indicate?
Grades the severity of community acquired pneumonia:
- C - confusion
- U - blood Urea nitrogen
- R - Respiratory rate >30
- B - Blood pressure <90/60
- 65 - Older than 65
Each category adds +1
0-1 indicates outpatient.
2 indicates inpatient.
3+ indicates ICU.
What is the difference between obstructive and restrictive respiratory disease?
How do both present on lung function tests?
Obstructive lung disease:
- Makes it difficult for the patient to exhale the air.
- Presents primarily with reduced FEV1, but also with reduced FVC just to a lesser extent.
- As a result, FEV1/FVC RATIO IS <0.7.
Restrictive respiratory disease:
- Makes it difficult for the patient to fully ventilate their lungs with air.
- Presents primarily with reduced FVC, but also will show reduced FEV1
- FEV1/FVC RATIO WILL BE NORMAL (>0.7)
How is Hodgkins lymphoma staged?
Stage I - found in 1 lymph node area or lymph organ.
Stage II - found in 2 or more lymph node areas the same side of the diaphragm OR the cancer extends from one lymph node area into a nearby organ.
Stage III - found in lymph node areas on both sides of the diaphragm OR in a lymph node above the diaphragm and in the spleen.
Stage IV - spread widely into at least one organ outside the lymphatic system (e.g. liver or bone marrow).
What is the treatment given for alcohol withdrawal?
Chlordiazepoxide (anaphylaxis for seizures).
What is the Glasgow coma score and how is it calculated?
There are 4 behaviours classified on the GCS:
Eye opening response:
- Spontaneously +4
- To speech +3
- To pain +2
- No response +1
Best verbal response:
- Orientated to time, place and person +5
- Confused +4
- Inappropriate words +3
- Incomprehensible sounds +2
- No response +1
Best motor response:
- Obeys command +6
- Moves to localised pain +5
- Flexion withdrawal from pain +4
- Abnormal flexion +3 (adduction, pronation etc.)
- Abnormal extension +2 (abduction, supination etc.)
- No response +1
Normal = 15 Mild = 13-15 Moderate = 9-12 Severe = 8 or lower
What is the difference between anticoagulants and antiplatelets?
Anticoagulants slow down the process of making clots by interfering with coagulation factors.
Antiplatelets prevent platelets from clumping together to make clots.
What are some common examples of both antiplatelets and anticoagulants?
Antiplatelets:
- Clopidogrel (P2Y12 inhibitor)
- Aspirin (COX1/2 inhibitor)
Anticoagulants:
- Heparin (Antithrombin III promoter)
- Warfarin (Vitamin K antagonist)
What are the different readings on an LFT and what do they mean?
- ALT is found in high concentrations in the hepatocytes, and enters the blood following HEPATOCELLULAR INJURY.
- ALP synthesis is increased following CHOLESTASIS (inability of bile to flow into the duodenum) AND BONE BREAKDOWN.
- If ALP is raised and GGT is normal, suggests non-hepatobiliary pathology (e.g. vitamin D defficiency or bone fractures)
- Hyperbilirubinaemia doesn’t always cause jaundice. The stool and urine help identify the cause:
- Normal urine + normal stool = pre-hepatic cause
- Dark urine + normal stool = hepatic cause
- Dark urine + pale stool = post-hepatic cause.
What is pharmacodynamics?
What is pharmacokinetics?
- Pharmacodynamics refers to the effect a drug has on the body.
- Pharmacokinetics refers to the manner in which the body handles a drug.
What class of drugs are: Verapamil? Ramipril? Amlodipine? Bisoprolol?
Verapamil = CCB Ramipril = ACEI Amlodipine = CCB Bisoprolol = B-blocker
What are the different types of hypersensitivity? What are some examples of associated conditions? What are the general response times?
- Type 1. Mediated by IgE. Associated with allergy, anaphylaxis and atopic disease. IMMEDIATE RESPONSE.
- Type 2. Mediated by IgG or IgM. Example is Goodpasture’s syndrome (autoimmune condition involving the breakdown of type IV collagen). HOURS TO DAYS RESPONSE.
- Type 3. Mediated by antigen-antibody complexes. Examples are RA and SLE. HOURS, DAYS OR WEEKS RESPONSE.
- Type 4. T cell mediated, and known as delayed hypersensitivity. An example is contact dermatitis. 24 TO 72 HOUR RESPONSE TIME.
What are the classic X ray findings in heart failure?
“ABCDE”
- Alveolar oedema (“bat wings”)
- Kerley “b” lines
- Cardiomegaly
- Dilated upper lobe vessels
- Effusion (pleural).
What is nephrotic syndrome vs nephritic syndrome?
- Nephrotic syndrome involves significant protein loss via the urine, causing hypoalbuminaemia and proteinuria.
- Nephritic syndrome involves significant haematuria, along with mild to moderate proteinuria.
- Both are usually due to kidney (glomerular) damage/inflammation.
What are the features of rhematoid and osteoarthritis?
Rheumatoid LESS, Osteoarthritis LOSS:
L - Loss of joint space
E - Erosion
S - Soft tissue swelling
S - Soft bones
L - Loss of joint space
O - Osteophytes
S - Subchondral sclerosis
S - Subchondral cysts
Which nerve and nerve routes are associated with carpal tunnel syndrome?
- Median nerve.
- Arrises from the brachial plexus (C5-T1)
How to remember the histological appearance of gout and pseudogout?
- ” N+N” = Negative needles. This is gout.
- Pseudogout is the other one positive bifringent with rhomboid crystals.
How can the symptoms of reactive arthritis be remembered?
- Can’t see, can’t pee, can’t climb a tree!
- Conjunctivitis, urethritis and arthritis.
How can the causes of pancreatitis be remembered?
IGETSMASHED
I - Idiopathic G - Gallstones E - Ethanol (alcohol) T - Trauma S - Steroids M - mumps A - autoimmune S - scorpion stings H - Hyperlipidaemia/calcaemia/parathyroidism. E - ERCP D - Drugs (furosemide, thiazides and many others).
What blood disorder can chronic alcoholism/chronic liver disease cause?
- Macrocytosis.
Which hepatitis is most common in travellers?
- Hep A
What is the pneumonic used to remember the 4 risk factors of cholelithiasis?
What is the other risk factor associated with cholelithiasis that isn’t included in the pneumonic?
” 4 F’s”
- Female
- Fat
- Forty
- Fertile (one or more children)
Also the contraceptive pill.
What is the diagnostic criteria for CKD?
- eGFR<60 in two separate measurements at least 3 months apart.
What hormones are secreted from the anterior pituitary gland?
Which ones are secreted by the posterior pituitary?
Which ones are secreted from the hypothalamus?
ANTERIOR PITUITARY: FSH GH Prolactin TSH ACTH
POSTERIOR PITUITARY:
Oxytocin
Vasopressin (ADH)
Hypothalamus:
TRH
CRH
Other hormones ending in -RH…
What is the pneumonic to remember the symptoms/signs of Addison’s disease?
- Tanned, tired, tearful, throwing up.
- Caused by adrenal insufficiency.
What is a normal PR interval?
- 0.12 - 0.20s
What is HAS-BLED acronym used to calculate?
- Risk of major bleeding for patients on anticoagulation.
Which drugs improve prognosis for patients with heart failure?
- ACEI
- B-blocker
- Diuretics may be prescribed, but only provide symptomatic relief and not a better prognosis.
What are the three types of diuretics and their MOA?
- Loop diuretics. Act on the ascending loop of Henle, and inhibit the sodium/potassium/chloride channels. This causes increased potassium, chlorine, and most importantly sodium (hyponatraemia) excretion and increased water excretion (diuresis). Side effect is increased calcium loss, and increased potassium loss. E.g. furosemide.
- Thiazide diuretics. Inhibit the Na-Cl tube in the distal tubule. These diuretics also increase potassium loss. E.g. Hydrochlorothiazide.
- Potassium sparing diuretics. These drugs do not act directly on sodium transport channels, and therefore do not cause hypokalaemia. E.g. Spironolactone, amiloride.
What is the most common anti-motility agent?
- Loperamide.
Where and how does B12 absorption take place?
- Requires the B12 to be attached to intrinsic factor secreted by the stomach.
Absorbed in the terminal ileum.
What is the mnemonic to remember the ECG changes seen with hyperkalaemia?
“Go, go wide, go tall, go long”
- Small/absent P wave
- Wide QRS complex
- Tall tented T waves
- Long PR interval
