miscellaneous Flashcards
ECG signs of Hyperkalaemia
- loss of P waves
- widened QRS complexes
- tented T waves
- bradycardia
Normal PR interval on ECG?
120-200 ms
Normal QRS complex on ECG
<120ms
Causes of Chronic Pancreatitis
- EtOH
- autoimmune
- Steroids
- malnutrition
- hereditary
- Trauma or obstruction
- Recurrent acute pancreatitis
History of Chronic Pancreatitis
- severe pain radiating to the back
- relieved by sitting forward
- Weight loss
- Loss of exocrine function –> steatorrhea
- Loss of endocrine function –> diabetes
Investigations for Chronic Pancreatitis
NOT amylase (= acute pancreatitis) Check exocrine function: faecal elastase
Management of Chronic Pancreatitis
- Pain - analgesia (NSAIDs, opiates)
- Endocrine function - if diabetic give insulin
- Exocrine function - creon (enzymes)
- Give acid suppression: PPI: omeprazole to stop creon deactivation
- Coeliac nerve block
- Pregabalin
- Low fat diet for steatorrhoea (<20g fat a day)
Complications of Chronic Pancreatitis
- pancreatic pseudocyst
- splenic vein thrombosis
- obstruction (may need ERCP)
Prognosis of Chronic Pancreatitis
High risk of pancreatic Ca
Causes of low phosphate
- malabsorption: vit D
- Increased PTH (1° hyperparathyroidism)
- Insulin: drives phosphate into cells
- Refeeding syndrome (due to insulin secretion when give food)
What is part of a Liver Screen?
Alcohol Autoimmune: (AMA, ANA, LK;M) Drugs Viruses: Hep B, C, A a-fetoprotein if chronic liver disease USS to look for obstruction or dilatation Metabolic: - haemochromatosis (increased ferritin) - Wilson's: excess copper --> measure caeruloplasmin
Causes of pulmonary hypertension
Chronic lung disease: - COPD - fibrosis R heart: - mitral stenosis Congenital heart disease: - VSD etc. HIV --> causes idiopathic pulmonary hypertension Sarcoid Connective tissue disease: SLE
Henoch-Schönlein purpura
= small vessel vasculitis
Presents with purpura (non-blanching purple papules due to intradermal bleeding)
There may be glomerulonephritis, arthritis, and abdominal pain (+/- intussusception) which may mimic an acute abdomen.
Porphyrias
= heterogenous group of rare diseases caused by various errors of haem biosynthesis
Modifiable cardiovascular risk factors
Alcohol Blood pressure Cholesterol (and lipids) Diabetes/diet Exercise Smoking
Non-modifiable cardiovascular risk factors
Age/gender/family history Myocardial infarction Rheumatic fever Claudication Stroke/TIA
Respiratory causes of Clubbing
Lung Ca Mesothelioma Fibrosing Alveolitis Bronchiectasis Cystic Fibrosis Empyema
Causes of COPD
Smoking
Environmental pollutants
Alpha-1-AT deficiency
Occupational exposure (coal minors etc.)
X-ray findings of Heart failure
A - alveolar shadowing (Bat wing) B - Kerley B lines (interstitial oedema) C - Cardiomegaly D - upper lobe diversion E - pleural effusion
3 main drugs indicated in heart failure
Beta-blockers
ACE inhibitors
Spironolactone
Risk factors for jaundice
A - alcohol B - blood (transfusions, taoos, IVDU, needle stick) C - coitus D - drugs E - expeditions (travel history) F - family history
What is Courvoisier’s Law?
A palpable non-tender gallbladder in the presence of jaundice is unlikely to be caused by gallstones.
What are Kayser-Fleischer rings?
Caused by Wilson’s disease. Only visible with a slit light.
GI systems review
Mouth ulcers, dental problems Difficulty swallowing (dysphagia) Odynophagia Nausea & vomiting Haematemesis Indigestion Heartburn Abdominal pain CIBH Change in colour of stools
What is normal serum bilirubin?
17 microM
What is the bilirubin level of visible jaundice?
approximately 35-40 microM
Differentials for abdominal distension?
Fat Foetus Fluid Faeces Flatus
What does faecal calprotectin signify?
First line test for IBD. Neutrophil marker.
In what condition does dermatitis herpetiformis occur?
Coeliac.
Boas’ sign
Sign of pain radiating to back & right scapula. Can be associated with acute cholecystitis or gastric or duodenal disease.
What is Murphy’s sign and what does it indicate?
Murphy’s sign –> place hand under right costal margin and ask Pt to take deep breath in; if Pt experiences pain and takes sharp breath in then positive.
It indicates acute cholecystitis.
3 conditions that cause Rigors
- Malaria
- Ascending cholangitis
- Pyelonephritis
What is a gallstone ileus?
An erosive gallstone causing small bowel obstruction; Inflammation of the gallbladder spreads to duodenum and results in fistula formation. Gallstone can pass through and may lodge in the ileocaecal valve in the terminal ileum & air can pass into the biliary tree.
In what condition does pyoderma granulosum occur?
UC
What are common infective causes of blood in the stool?
C - campylobacter H - haemorrhagic E. coli E - entamoeba histolytica S - salmonella S - shigella Y - Yersinia
What are the cardinal signs of bowel obstruction?
- Distension (5 F’s)
- Vomiting
- Pain, colicky
- Absolute constipation
Causes of Intravascular haemolysis
- Congenital
- G6PD deficiency
- Sickle cell disease
- Thalassaemia - Acquired
- Artificial heart valves
- ABO group mismatch
- DIC
- Malaria
Causes of Extravascular haemolysis
- Congenital
- Hereditary spherocytosis - Acquired
- Autoimmune haemolysis
