More SAQ Flashcards
Medical management of Cushings
Metyrapone
Ketoconazole
Where and how does aldosterone act
Distal convoluted tubule and collecting duct of kidney.
Reabsorbs sodium in exchange for potassium and hydrogen. Water follows sodium. Creates hypernatraemia, hypertension, hypokalaemia and metabolic alkalosis.
How to differentiate between primary hyperaldosteronism and secondary aldosteronism and give a cause for each.
Primary e.g. Conn’s (unilateral adrenal hyperplasia) has a high plasma aldosterone but low plasma renin.
Secondary e.g. renal artery stenosis, CHF, diuretics and nephritic syndrome (continuous RAAS activation), will have a high serum aldosterone and renin.
3 features in acute adrenocortical failure (Addisonisn crisis)
Hypotensive shock
Hypovolaemic shock
Hypoglycaemia
- 3 causes of hypontraemia
2. 3 symptoms and signs fo hyponatraemia
- SIADH, thiazide diuretics, oedematous states e.g. liver failure, heart failure, Addison’s and adrenal insufficiency, diarrhoea.
- Symptoms = headache, lethargy, myalgia and cramps, nausea. Signs = altered mental state/confusion, signs of causes e.g. peripheral oedema, tachycardia.
Make sure you correct Na slowly to prevent cerebral oedema!
- 3 causes of hypernatraemia.
2. Symptoms and signs of hypernatraemia
- Diabetes insipidus, excessive sweating e.g. marathon running, Conns and hyperaldosteronism, severe burns.
- Lethargy, weakness, confusion, irritability, myoclonic jerks and seizures.
- 3 causes of hypokalaemia
- Signs and symptoms of hypokalaemia
- ECG changes
- Diuretics, hyperaldosteronism (Conn’s), bulimia, diarrhoea, burns, low magnesium.
- Myalgia, lethargy, paraesthesia, constipation
- U waves, T wave flattening, PR prolongation, ST depression.
- 3 causes of hyperkalaemia
- Signs and symptoms of hyperkalaemia
- ECG changes.
- Addison’s, CKD, AKI, spironolactone.
- Palpitations, nausea, myalgia, paresthesia, bradycardia, muscle weakness
- Tall T waves, flat P waves, sine wave, VF.
- 3 causes of hypocalcaemia.
2. Signs and symptoms of hypocalcaemia.
- Hypoparathyroidism, vitamin D deficiency, tumour lysis syndrome.
- Chvostek’s sign, tetany, seizures, muscle cramps, parasthesia, confusion.
- 3 cause of hypercalcaemia
2. Signs and symptoms of hypercalcaemia
- Hyperparathyroidism, malignancy (breast, lung, bladder), thiazide diuretics, CKD
- Bone pain, osteoporosis, confusion, depression, lethargy, muscle weakness, abs pain, n+v, anorexia, renal colic, polyuria, polydipsia.
2 hormones in calcium homeostasis
Parathyroid and calcitonin.
Do osteoclasts release calcium or use it to lay down bone?
They release is bu breaking bone down.
Osteoblasts use calcium to lay down bone.
2 signs O/E of acute pancreatitis
Periumbilical discolouration - Cullen’s sign
Flank discolouration – Grey-Turner’s sign
Where is the pain in chronic pancreatitis
Epigastric, may radiate to back. Worse 30mins after meals, relieved by sitting forward.
1 investigation (not imaging) for chronic pancreatitis
faecal elastase (reduced in chronic pancreatitis).
Key thing the med school would put in a Hx for HAV
Distaste for cigarettes
Blood tests for Wilson’s disease
Serum caeruloplasmin Serum copper (this is low because the copper is in the tissues not the blood!)
Mechanism of action of Fondaparinux
Activate anti-thrombin III
Mechanism of action of aspirin
Inhibit production of thromboxane A2
Mechanism of action of Clopidogrel
Inhibit ADP binding to platelet receptor
Bone profile blood results in osteoporosis
calcium, phosphate and ALP are mostly normal
Difference between bulbar palsy and pseudo bulbar palsy and give some causes for each
Bulbar palsy = LMN lesion of CN 9, 10 and 12. Causes include MND, poliomyelitis, neurosyphilis, Guillian-Barre.
Pseudobulbar palsy = UMN lesion of CN 9, 10 and 12. Causes include bilateral CVA of internal capsule, MS, head injury.
S+S of bulbar palsy V pseudobulbar palsy
Bulbar = absent gag reflex, wasted fasciculations tongue, nasal speech.
Pseudobulbar = increased gag reflex, spastic tongue, “Donald Duck’ dysphonic voice.
Long term complication of Bell’s palsy
Corneal ulceration
Complete cranial nerve III palsy produces what features?
Cause of an isolated CN3 palsy
Fixed, dilated
Complete ptosis (paralysis of elevator palpebral superioris)
Down and out pupil
Posterior communicating artery aneurysm
Metabolic cause of proximal myopathy
Thyrotoxicosis
Do plantars flex or extend in cauda equina
Flex/normal (LMN)
A lesion of cranial nerves IX and X may produce what features?
Dysphonia due to vocal cord paralysis
Difference in muscles with UMN and LMN lesions
LMN = hypotonia, flaccid weakness, atrophy, fasciculations.
UMN = hypertonia, spastic weakness (stiffness), extensor positive Babinski sign
Clonus
Which of the following is NOT a cause of hepatomegaly malaria chronic renal failure leukaemia right heart failure alcoholic hepatitis
chronic renal failure
Major side effects of statin
Myalgia
Hepatocellular damage + jaundice.
Difference in symptoms between tumours of pancreas head and body/tail
Head = painless jaundice Body/head = epigastric pain, anorexia, weight loss.
What is a complication of transjugaular intrahepatic portosystemic shunt?
Hepatic encephalopathy as ammonia is shunted into systemic system.
Nail sign due to hypoalbuminaemia
Leuconychia
White discolouration
What blood test could be a marker/risk factor for prematurity
Fibronectin.
Difference between induction and augmentation of labour
Induction = initiate labor before spontaneous onset has occurred to achieve a normal vaginal delivery. Augmentation = enhancement of the uterine contractility in a woman who has begun labor
