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Sheff Phase 4 > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

3 Precipitants of hyperosmolar hyperglycaemic state (HHS)

A

Infection - Resp/UTI

myocardial infarction, pancreatitis, stroke

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2
Q

ERlectrolyte findings in hyperosmolar hyperglycaemic state?

A

HyperNa
Hyper/HypoK
HyperGlycaemia

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3
Q

Are you more worried about hyper/hypo K in hyperosmolar hyperglycaemic state?

A

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

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4
Q

HHS Mx?

A

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]

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5
Q

DDx of confusion

A

[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
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6
Q

Reversible causes of cardiac arrest

A 
Hypoxia 
Hypovolaemia 
Hypothermia 
Hypo-/hyperkalaemia/hypocalcaemia/
metabolic disturbance

Thromboembolism, cardiac/pulmonary
Tamponade, cardiac
Toxic/therapeutic disturbances
Tension pneumothorax

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7
Q

Dx of nephrotic syndrome

A

heavy proteinuria (>3 g/24 h),
hypoalbuminaemia (<30 g/L)
Peripheral oedema.

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8
Q

Name 4 specific tests you might do in nephrotic syndrome and why?

A

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

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9
Q

General Mx of nephrotic

A

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 -

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10
Q

N-acetylcysteine side effects? Mx of these?

A

Rash / flushing

antihistamine Eg chlorpheniramine.

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11
Q

3 Causes of each Exudative VS Transudative effusion

A 
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
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12
Q

3 DDx of acute severe headache?

A 
meningitis (viral, bacterial, fungal, cryptococcal and tuberculous), 
subarachnoid haemorrhage,
encephalitis, 
temporal arteritis
acute migraine
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13
Q

What is sterile pyuria?

DDx?

A

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

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14
Q

Gene for PKD

A

PKD1

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15
Q

2 Signs OE of PKD

A

HTN
Palpable large kidney
Hepatomegaly
MV regurge - late systolic murmur / mid systolic click

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16
Q

3 comps of PKD

A 
bery aneurysms 
CKD 
HTN 
Stones 
Chronic pain
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17
Q

4 signs OE of cushings

A 
Bruising 
moon face 
central obesity 
buffalo hump 
HTN 
proximal myopathy 
Hair /skin thinning
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18
Q

2 Ix for cushings

2 imaging

A

24hr urinary cortisol
dexamethasone suppression test

Pit MRI
CT abdo
CXR

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19
Q

Why bronzing in cushings disease?

A

ACTH -> stimulates melanocytes

20
Q

3 options to reduce INR on warfarin

A

Beriplex - Prothrombin complex
Vit k
Fresh frozen plasma

21
Q

Why USS in acute pancreatitis

A

Gallstones

22
Q

2 bruising signs of pancreatitis

A

grey turners - flank

Cullens - umbilicus

23
Q

Myasthenia gravis - 2 associated conditions

A 
thymoma 
Graves
SLE
RheumA
Diabetes T1
Hashimotos 
pernicious anaemia
24
Q

Myasthenia gravis - 3 Ix

3 Mx

A 
Anti-ACH , Anti-MuSK 
Tensilon test 
Muscle biopsy 
CT/MRI (thymoma)
Nerve conduction
Ach inhibitors - neostigmine
Immuosupression - pred / azia / ciclospoin
Plasmapheresis 
IVIg
Thymectomy
25
Q

Differences in pres between L and R sided large bowel Ca

A

L - Bleeding / mucus PR

  • Tenesmus
  • altered bowel habit

R - Weight loss

  • Anaemia
  • Abdo pain
26
Q

Classification of bowel Ca

A

Dukes

27
Q

3 causes of a midline mass in neck?

A

Throglossal cyst
Thyroid - Goitre, adenoma etc
Dermoid cyst

28
Q

How does thyroglosal cyst form?

A

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

29
Q

Thyroglossal cyst
2 comps
2 Ix
Mx

A

Infection, airway compromise, dysphagia, malignancy

TFTs, CT, USS, thyroid scan with radioactive iodine

Surgical

30
Q

4 Ts of PPH and which accounts for most

A

aTony - 90%
Tissue - retained eg placenta
Thrombin - coag defect
Trauma - Instument / multiple delivery

31
Q

Basic Mx of uterine atony -> PPH?

A

ABCDE
bimanual compression
Oxytocin / Ergometrine

32
Q

Cystocoele?

Rectocoele?

A

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

33
Q

2 medical issues that make incontinence worse

A

Diabetes

UTI

34
Q

Ix for incontinence?

A

Urodynamic studies

35
Q

3 features of Acute Severe asthma

A

Cant complete sentances
Resp rate >25
tachy cardia >110
peak flow 33-50% predicted

36
Q

Post exacerbation of asthma 2 things you would do before discharge

A 
Inhaler techinique 
compliance with meds 
use of spacer 
allergen avoidance 
increase exercise 
Change meds
37
Q

Name 2 Ix you could do in acute asthma to rule out other causes?

A

Sputum culture - infection

CXR - pneumothorax

38
Q

2 options for Dx of CF in child

A

Sweat test

Genetic testing

39
Q

CF 2 resp comps

2 bowel

A

recurrent infections
pneumothorax
bronchiectasis
aspergilus

Malabsorbsion 
blockage -> constipation 
intussuseption 
reflux 
cirrhosis
40
Q

2 differences between superficial and full thickness burns

A

Sup - pain, blisters, erythema, brisk CRT

Full - Painelss, no blisters, white/grey/black, absent CRT

41
Q

Way to determine extent of burns?

How to calculate fluid for burns and how is it given?

A

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

42
Q

2 main causes of death in burns

A

infection

dehydration

43
Q

Headache papilloedema key DDx

A

sinus venous thrombosis

44
Q

2 funny beats in VT

A

Capture beats - capture a normal QRS

fusion beat - Atria / ventricle at same time -> large

45
Q

Why do Mg in broad complex tachy

A

Need to correct before can correct Ca / K

Torsades

Sheff Phase 4 (26 decks)

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