Mock 11 Flashcards
40-year old man + feeling weak and tired + complains of headache + hypertensive at 210/100 + not on any medications + normal serum sodium + hypokalemia at 2.9
Most likely diagnosis?
PRIMARY HYPERALDOSTERONISM
Hypokalemia and hypertension = Think of primary hyperaldosteronism
Differentiate Conn from Addison
Addison’s Disease = ALL DROP - drop in aldosterone, drop in sodium, drop in BP, drop in weight, drop in energy. ONLY POTASSIUM IS INCREASED
Conn’s is exact opposite of Addison - hypertension, hypernatremia (or high of normal), HYPOKALEMIA
How do you manage Conn’s?
Medical: Spironolactone (aldosterone antagonists)
Surgical: definitive - adrenalectomy
When do you think of Conn’s syndrome?
- HTN + hypokalemia
- Refractory hypertension despite more than 3 antihypertensive drugs
- Hypertension occurring before age 40
Lymphatic drainage: skin (scrotum, vulva, perineum)
Superficial inguinal LN
Lymphatic drainage: all below umbilicus except gonad and lateral foot
Superficial inguinal LN
Lymphatic drainage: testes and ovaries
Para-aortic LN
Lymphatic drainage: lateral foot
Popliteal LN (then to the SILN)
Lymphatic drainage: lateral foot
Popliteal LN (then to the SILN)
Lymphatic drainage: deep lymphatic of glans and clitoris
External iliac LN
Superficial inguinal LN drains all structures below the umbilicus except for these structures:
Gonads (ovaries and testes) - para-aortic LN
Lateral foot - popliteal lymph nodes (then later drains into the inguinal LN)
*Deep lymphatics of glans and clitoris - external iliac LN
What is (Arya) Fregoli delusions?
Delusion of doubles - various persons are indeed one person in disguise or changes in apperance
What is the difference between Fregoli and Capgras?
Fregoli (as in Arya Fregoli) is the delusion wherein a person is just in disguise (think of Arya Stark in disguise as other persons) while Capgras is similar identical to the person YOU KNOW but he is not the real person.
What is the difference between Fregoli and Capgras?
Fregoli (as in Arya Fregoli) is the delusion wherein a person is just in disguise (think of Arya Stark in disguise as other persons) while Capgras is similar identical to the person YOU KNOW but he is not the real person.
Ganser syndrome?
Prison psychosis in an attempt to gain leniency from prison
Breastfeeding advice for mother with mastitis
Continue breastfeeding
Breastfeeding advice for mother with breast abscess
Continue
Breastfeeding advice for mother with nipple candidiasis
Continue breastfeeding
Breastfeeding advice for mother with maternal HIV
Avoid breastfeeding
Breastfeeding advice for mother with maternal hepatitis B
Continue (Breastfeeding safe but make sure baby has received HBV prophylaxis)
Management of recurrent UTI with identified trigger
Single-dose antibiotic prophylaxis
Management of recurrent UTI with no identifiable triggers
Low-dose antibiotic prophylaxis daily (TMP, Nitrofurantoin or Cefalexin)
Management of recurrent URI in post-menopausal women
Oestrogen replacement
Management of recurrent UTI with residual urine present
Optimize bladder emptying by intermittent catheterization
Breastfeeding advice for mother with maternal hepatitis C
Continue (BF safe unless mother has cracked or bleeding nipple)
PLABABLE’s 3 never-forget points for DKA
- NSS
- Insulin and KCl
- If glucose falls below 14 mmol/L, started 10% glucose + saline
Other name for RItter’s disease
Staphylococcal Scalded Skin Syndrome
2 y/o boy + irritable and lethargic for the past two days with rash and fever + rash started as red patches which developed into blisters + painful and distressing + fever preceded the rash + no significant PMH + not on any meds + Nikolsky sign positive
SSSS
Common causes of CN XII injury
- LMN Lesions - polio, syringomyelia
- Stroke
- Bulbar palsy
- Neck trauma
- Carotid endarterectomy
Pseudohypoparathyroidism vs. Fanconi syndrome vs. Vit D deficiency vs. Primary hyperparathyroidism
Pseudohyparathyroidism - associated with congenital syndrome; hypocalcemia + elevated PTH and phosphate
Vit D deficiency - reduced Ca absorption from GIT; increased PTH
Fanconi syndrome - Type II RTA where there is defect of the proximal renal tubule; hypocalcemia + hypophosphatemia + hypomagnesemia + metabolic acidosis
Management for neutropenic sepsis
Piperacillin-Tazobactam
When would you suspect neutropenic sepsis?
- Fever more than 38.5ºC or two occasions of high temp two hours apart
- ANC ≤ 0.5 x 10^9/L
- Recipients of chemotherapy within the last 4 weeks
- Recipients of bone marrow transplant
What is the caveat regarding laboratory parameters in DIC?
Everything is elevated except for fibrinogen and platelet.
In DIC, platelet may be decreased or normal. aPTT is elevated. Fibrin products (including D-dimer) are elevated. Protime is elevated. Fibrinogen is decreased.
Laboratory findings in a patient with subclinical hypothyroidism
Elevated TSH
Normal T4
TIA and DVLA
For group 1 driver - do not drive for 1 month. No need to notify DVLA if suffered from 1 TIA only. (Notify DVLA if suffered multiple TIA)
For group 2 driver - Notify DVLA
Which type of antihypertensive medications should be omitted prior to surgery? And how many hours should they be omitted?
Omit ACE inihibitors as well as ARBs 24 hours prior to surgery.
***These medications can result in severe hypotension after induction of general anesthesia.
Treatment for Dressler syndrome
NSAIDs
Maintenance fluid for diarrhea in children
PNSS + 5% dextrose
Painless bilateral swelling of the face + mild-grade fever + dry mouth + CXR finding of bilateral perihilar lymphadenopathy
Mikulicz’s syndrome
Most preferred treatment for trigeminal neuralgia
CARBAMAZEPINE > lamotrigine/ phenytoin/ gabapentin
Presence of Paul-Bunnell would prompt you into this diagnosis + sore throat + palatal petechiae
Glandular fever
When would you consider using Clozapine?
After two failed attempts of antipsychotics
