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OSCE Notes > miscellaneous > Flashcards

miscellaneous Flashcards

1
Q

How do you treat Status Epliptious?

A

1) ABCDE
2) Lorazepan 4mg IV or 10mg Diazepam PR
3) identify and reverse any underlying cause
4) if contine longer than >30min = phenytoin infusion (15mg/kg @ 50mg/min) and an anaethetist for GA and ITU admission

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2
Q

How do you treat Anaphylaxis?

A 
ABCDE
Adrenaline IM 
Adults 500 micrograms of 1:1000 
Children >12 500 micrograms 
Children 6-12 300 micrograms 
Children < 6 150 micrograms
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3
Q

What is the definition of AKI?

A

A rapid decrease in renal function
leads to a fluid/electrolyte imbalance and acid/base disturbance.
RF= age, co-morbidities and medication

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4
Q

Causes of AKI?

A 
PRE-RENAL:
Sepsis
Hypotension
Hypovalemia 
Renal artery stenosis 
cardiac
liver 
ACEi

INTRINSIC:
Vasculitis
Glomerulonephritis
Tubular Necrosis

POST-RENAL:

renal tract obstruction (has to be bilateral damage or chronic kidney damage)

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5
Q

What is nephrotic syndrome?

A

Oedema, Protein Urea, hypoalbuminaemia and hyperlipidemia

Over 3.5g of protein

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6
Q

Causes of nephrotic syndrome?

A 
Deposition Disease 
Minimal Change Disease
Focal and Segmental Glomerulosclerois
Membranous Nephropathy
Membranoproliferative GN 
Myeloma ( screen in CKD if >50yrs)
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7
Q

What is type 1 rapidly progressing glomerulonephritis?

A

Anti-GMB glomerulonephritis

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8
Q

What causes type 1 RPGN?

A

Good Pasteure’s Disease

Anti-GBM disease (same as good pasteures but involves only kidney)

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9
Q

What is good pasteure’s?

A

Anti-glomerular basement membrane disease + pulmonary haemorrhage.
Caused by an anti-body to the alpha-3 chain of type IV collagen
15% of goodpasture’s syndrome is AGBM disease and the rest is ANCA vasculitis

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10
Q

What is type 2 glomerulonephritis?

A

Deposition of immune complexes

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11
Q

Causes of type 2 glomerulonephritis?

A

SLE, acute proliferative glomerulonephritis and IgA nephropathy, Henoch-Schonlein pupura.

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12
Q

What is type 3 glomerulonephritis and the causes?

A

Vasculitis.
Glomeruli are damaged in an undefined manner perhaps through the activation of neutrophils in response to ANCA.
Isolated to glomerulus= primary
Systemic= secondary = ANCA associated vasculitis, granulomatosis with polyangitis, microscopic polyangitis.

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13
Q

What is IgA nephropathy?

A

Non-aggressive IgA= traditionally slow progression to CKD
Often get episodic haematuria following a sore throat (strep A)
can develop into RPGN
Aggresive IgA= nephritic syndrome 1-4 days post strep A infection

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14
Q

What is post infectious GN?

A

Get nephritic syndrome several weeks post Strep A infection.

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15
Q

Causes of Jaundice

A

PRE-HEPATIC

Haemolysis (unconjugated)

INTRINSIC:
Gilberts (unconjugated) 
Viral Hepatitis
Drugs
Alcoholic Hepatitis 
Cirrhosis 
Pregnancy
Recurrent Idiopathic Cholestasis
Infiltrations 
Congenital
POST HEPATIC:
Common duct stones
Carcinoma (bile duct, pancrease,ampulla)
Biliary stricture
sclerosing cholangitis 
Pancreatitis 
Pseudocyst
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16
Q

Long term consequences of CKD?

A

Reduced GFR= Raised K+ and Creat
Acidosis (reduced acid removal)
reduced EPO secretion= anaemia
renal bone disease- reduced Ca, Increased Phosphate, increased parathyroid (2ndary hyperparathyroidism)
impaired BP regulation- HTN
reduced fluid removal- oedema
impaired iron absorption- iron deficiency
reduced clearance of gastrin- peptic ulceration

17
Q

Causes of CKD?

A

PRE-RENAL:
RAS (discrepency of >1cm in kidney size think) , nephrosclerosis + ACEi

RENAL:
GN, TIN (tubulointerstital Nephritis), ADPKD

POST- RENAL
BPH, RPF (renal blood flow)

18
Q

What is Addison’s disease and how would you diagnose?

A

hypocortisol and adrenal insufficiency
Measure 8am cortisol- Low = adrenal insufficiency
Cosyntropin stimulation test: measure base ACHT test.
administer synacthen (synthetic ACHT)
low cortisol+ high ACTH= primary (adrenals)
low cortisol + low ACTH= secondary (pituitary)

19
Q

Causes of lymphadeonopathy?

A

REACTIVE:
Infective: Bacterial (tonsillitis, cellulitis, TB, primary syphillis), Viral (EBV, CMV, HIV, hepatitis), Other (toxoplasmosis)
Non-infective: Sarcoidosis, amyloidosis, connective tissue disease (RA, SLE), dermatological (eczema, psorasis), drugs (phenytoin, retroviral drugs)

INFILTRATIVE:
Benign Histiocytosis
Neoplastic: Haemotological ( Hodgekins, Non-hodgekins lymphoma, CML,CLL, ALL,AML)

20
Q

Causes of hepatomegaly?

A

SMOOTH AND TENDER: alcoholic hepatitis, Tricuspid regurgitaion w/RHF. Infectious Hepatitis ( acute infection) , RHF/PE, Glandular Fever, Budd-Chiari Syndrome, Abcess.

SMOOTH BUT NOT TENDER: Amyloidosis, leukaemia, early cirrhosis, lymphome, haemochromatosis, Primary Biliary Cholangitis, Fatty Liver, HIV, Sarcoidosis

IRREGULAR AND NON-TENDER: Neoplastic ( Hepatoma, metastatic carcinoma), hyatid cyst, polycystic liver

21
Q

Causes of splenomegaly?

A

FEVERS: Infection (malarie, IE, hepatitis, EBV,TB, CMV, HIV), sarcoid, malignancy (lymphoma, chronic leukaemia)

LYMPHADENOPATHY: Glandular Fever, leukaemias, lymphomas, Sjogren’s Syndrome

PURPURA: Amyloid, Septicaemia, Typus, DIC, Meningiococcaemia

ARTHRITIS: Sjogren’s, RA, SLE, Lyme’s Disease, Vasculitis

ASCITES: Carcinoma, Portal Hypertension

MURMUR: IE, Rhuematic Fever, Hypereosinophillic syndrome, amyloid

MASSIVE SPLENOMEGALY: Malaria, CML, myelofibrosis, leishmaniasis, Gaucher’s

WEIGHT LOSS AND CNS PATHOLOGY:
Cancer, lymphoma, TB, myeloma, arsnic poisoning

ANAEMIA: Haemolytic Anaemia, leishmaniasis, leukaemia, pernicious anaemia.

22
Q

Causes of hypercalcaemia?

A

ENDOCRINE:
Excess PTH: Primary and Tertiary Hyperparathyroidism, Ectopic Parathyroid Hormone
Other: Thyrotoxicosis and Addison’s Disease

MALIGNANT: Myeloma, Bone Mets

EXCESS ACTION OF VIT D: lymphoma, granulomatous disease (sarcoid/TB), self administered Vit D

DRUGS: Thiazides, Vut D analogues, Lithium and Vit A

OTHER: long term immobility, familial hypocalciuric hypercalcaemia.

23
Q

What is IgA vasculitis?

A 
Systemic 
Also known as HSP
Triad of abdo pain, Purpura and arthritis 
most common vasculitis of childhood 
get purpuric rash on legs and buttocks 
can cause intersusseption
can cause nephritic syndrome 
can get IgA nephropathy

OSCE Notes (4 decks)

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