Miscellaneous Flashcards
3 Precipitants of hyperosmolar hyperglycaemic state (HHS)
Infection - Resp/UTI
myocardial infarction, pancreatitis, stroke
ERlectrolyte findings in hyperosmolar hyperglycaemic state?
HyperNa
Hyper/HypoK
HyperGlycaemia
Are you more worried about hyper/hypo K in hyperosmolar hyperglycaemic state?
Low insulin -> potassium into blood = hyperK
[despite low body K]
If the level is measured as Low in blood = Dangerously low body levels
->requres vigorous Mx
HHS Mx?
correcting dehydration, electrolyte
imbalance, hyperglycaemia and any other co-morbid factors, e.g. pneumonia.
LMWH - as increased risk of VTE
Initial fluid = 1L Saline over 1 hour
[monitor BP, pulse and urine output]
DDx of confusion
[Immature Muppets Enjoy Drugs Innit]
Infection
Any infection, including UTI, particularly in the elderly
Metabolic disturbance Electrolyte imbalance Liver failure Renal failure Hypoxia
Endocrine disturbance Hypothyroidism Cushing syndrome Vitamin deficiency B12 deficiency Thiamine deficiency (Wernicke – Korsakoff syndrome)
Drugs Alcohol withdrawal Recreational drugs Digoxin Tricyclic antidepressants Anticonvulsants
Intracranial causes Dementia Tumour Abscess Epilepsy Subdural haematoma Subarachnoid haemorrhage
Reversible causes of cardiac arrest
Hypoxia Hypovolaemia Hypothermia Hypo-/hyperkalaemia/hypocalcaemia/ metabolic disturbance
Thromboembolism, cardiac/pulmonary
Tamponade, cardiac
Toxic/therapeutic disturbances
Tension pneumothorax
Dx of nephrotic syndrome
heavy proteinuria (>3 g/24 h),
hypoalbuminaemia (<30 g/L)
Peripheral oedema.
Name 4 specific tests you might do in nephrotic syndrome and why?
Throat swab and ASO (antistreptolysin O)
titre ->Post-streptococcal glomerulonephritis
Anti-nuclear antibody ->Systemic lupus erythematosus
Complement levels -> Glomerulonephritis
Anti-neutrophil cytoplasmic antibody (ANCA) -> Vasculitis
Anti-glomerular basement membrane antibody -> Goodpasture’s syndrome
Hepatitis B and C serology -> Glomerulonephritis
Cryoglobulinaemia -> Malignant lymphoproliferative
disorder / Hepatitis C
Serum free light chains / Immunoglobulins / Serum and urine protein electrophoresis -> Amyloidosis, myeloma
General Mx of nephrotic
Proteinuria- lowering intra-glomerular pressure and hence protein excretion = ACEi /ARB
Peripheral Oedema - Na restriction and Loop diuretics
Hyperlipid - diet / statins
LMWH - [have an hypercoagulable as piss out fibrinolytic proteins]
ABx [If signs of infection] - piss out immunoglobulins -
N-acetylcysteine side effects? Mx of these?
Rash / flushing
antihistamine Eg chlorpheniramine.
3 Causes of each Exudative VS Transudative effusion
Exudative - PINTS Pneumonia Infarction - [Pulm Embolism] Neoplasm TB SLE / connective tissue disorder
Transudative - CHARM Cardiac failure Hypoalbumin / hypothyroid Ascites Renal failure (dialysis and nephrotic syndrome) Meigs syndrome
3 DDx of acute severe headache?
meningitis (viral, bacterial, fungal, cryptococcal and tuberculous), subarachnoid haemorrhage, encephalitis, temporal arteritis acute migraine
What is sterile pyuria?
DDx?
The presence of leukocytes in the urine in the absence of bacterial infection
TB!
• Concurrent use of antibiotics (often due to self-medication with antibiotics)
• Sample contamination, e.g. vaginal leukocytes
• Chronic interstitial nephritis
• Chlamydia infection
• Nephrolithiasis
• Uroepithelial tumours
Gene for PKD
PKD1
2 Signs OE of PKD
HTN
Palpable large kidney
Hepatomegaly
MV regurge - late systolic murmur / mid systolic click
3 comps of PKD
bery aneurysms CKD HTN Stones Chronic pain
4 signs OE of cushings
Bruising moon face central obesity buffalo hump HTN proximal myopathy Hair /skin thinning
2 Ix for cushings
2 imaging
24hr urinary cortisol
dexamethasone suppression test
Pit MRI
CT abdo
CXR
Why bronzing in cushings disease?
ACTH -> stimulates melanocytes
3 options to reduce INR on warfarin
Beriplex - Prothrombin complex
Vit k
Fresh frozen plasma
Why USS in acute pancreatitis
Gallstones
2 bruising signs of pancreatitis
grey turners - flank
Cullens - umbilicus
Myasthenia gravis - 2 associated conditions
thymoma Graves SLE RheumA Diabetes T1 Hashimotos pernicious anaemia
Myasthenia gravis - 3 Ix
3 Mx
Anti-ACH , Anti-MuSK Tensilon test Muscle biopsy CT/MRI (thymoma) Nerve conduction
Ach inhibitors - neostigmine Immuosupression - pred / azia / ciclospoin Plasmapheresis IVIg Thymectomy
Differences in pres between L and R sided large bowel Ca
L - Bleeding / mucus PR
- Tenesmus
- altered bowel habit
R - Weight loss
- Anaemia
- Abdo pain
Classification of bowel Ca
Dukes
3 causes of a midline mass in neck?
Throglossal cyst
Thyroid - Goitre, adenoma etc
Dermoid cyst
How does thyroglosal cyst form?
thyroid gland begins at junction of ant 2/3 and post 1/3 of tongue
Then migrates down but remains connected to tongue by thyroglossal duct
-> cycts can occur at any point
Thyroglossal cyst
2 comps
2 Ix
Mx
Infection, airway compromise, dysphagia, malignancy
TFTs, CT, USS, thyroid scan with radioactive iodine
Surgical
4 Ts of PPH and which accounts for most
aTony - 90%
Tissue - retained eg placenta
Thrombin - coag defect
Trauma - Instument / multiple delivery
Basic Mx of uterine atony -> PPH?
ABCDE
bimanual compression
Oxytocin / Ergometrine
Cystocoele?
Rectocoele?
C - prolapse of anterior vaginal wall containing bladder
-> Residual urine may cause dysuria
R - prolapse of posterior vaginal wall containing rectum
- > may need to manually reduce to poo
2 medical issues that make incontinence worse
Diabetes
UTI
Ix for incontinence?
Urodynamic studies
3 features of Acute Severe asthma
Cant complete sentances
Resp rate >25
tachy cardia >110
peak flow 33-50% predicted
Post exacerbation of asthma 2 things you would do before discharge
Inhaler techinique compliance with meds use of spacer allergen avoidance increase exercise Change meds
Name 2 Ix you could do in acute asthma to rule out other causes?
Sputum culture - infection
CXR - pneumothorax
2 options for Dx of CF in child
Sweat test
Genetic testing
CF 2 resp comps
2 bowel
recurrent infections
pneumothorax
bronchiectasis
aspergilus
Malabsorbsion blockage -> constipation intussuseption reflux cirrhosis
2 differences between superficial and full thickness burns
Sup - pain, blisters, erythema, brisk CRT
Full - Painelss, no blisters, white/grey/black, absent CRT
Way to determine extent of burns?
How to calculate fluid for burns and how is it given?
Wallace rule of 9s / Lund and browder
4 x Weight (Kg) x %Surface area burnt = volume of hartmans in 24hrs
Half volume over 8 hours / second half over 16
2 main causes of death in burns
infection
dehydration
Headache papilloedema key DDx
sinus venous thrombosis
2 funny beats in VT
Capture beats - capture a normal QRS
fusion beat - Atria / ventricle at same time -> large
Why do Mg in broad complex tachy
Need to correct before can correct Ca / K
Torsades
