MRI Block 2 Notes Flashcards
1
Q
Difference between crystalloids and colloids
A
Crystalloids contain small dissolvable solutes e.g sodium chloride. They increase intravascular and interstitial fluid.
Colloids contain larger particles that can not easily go out of the intravascular space so are used in haemorrhage.
2
Q
What hormone, produced by the atria, opposes the renin angiotensin aldosterone system and decrease blood pressure via sodium excretion
A
Atrial natriuretic peptide
3
Q
What is hypovolaemic hyponatraemia
A
Hyponatraemia resulting from salt loss with following water loss
4
Q
What is dilutional hyponatraemia?
A
Hyponatraemia resulting from water excess
5
Q
Blood at start of micturition suggests
A
Urethral disease
6
Q
Blood at end of micturition suggests
A
Prostate or bladder base bleeding
7
Q
Blood seen as even discolouration throughout the urine suggests
A
Bleeding from a source in the bladder or above
8
Q
What type of clotting factors does warfarin reduce?
A
Vit K coagulation factors
9
Q
Name three natural inhibitors of the fibrin clot
A
Protein C, protein S and antithrombin 3
10
Q
How does Heparin work?
A
Increases the effect of antithrombin 3
11
Q
What physiological system dissolves the fibrin clot?
A
Plasminogen/plasmin system
12
Q
What does a 50/50 blood test that corrects indicate?
A
A deficiency of clotting factors in the patients blood
13
Q
What does a 50/50 blood test that doesn’t correct indicate?
A
The presents of a clotting inhibitor in the patients blood
14
Q
What are the clotting factors that affect APTT?
A
8,9,11,12 and vWF.
The intrinsic pathway
15
Q
What’s deficient in haemophilia A?
A
Factor eight deficiency
16
Q
What’s deficient in haemophilia B?
A
Factor nine deficiency
17
Q
Describe the pattern of x-linked recessive
A
Carried by mother, effects one in two sons
18
Q
What is the extrinsic pathway measured by?
A
Prothrombin time
19
Q
What could cause prolonged PT time
A
Low VII or warfarin, could also be low II, V and X but rare
20
Q
Common cause of prolonged PT and APTT
A
K+ deficiency or liver failure
21
Q
What is the diagnostic triad for bleeding disorders
A
Personal history
Family history
Lab tests
22
Q
Commonest coagulopathy
A
VW disease
23
Q
Explain the types of VW disease
A
Type 1: reduced vW protein
Type 2: abnormal vW protein (IIb overactive)
Type 3: little or no vW
24
Q
What tests to do for vW disease?
A
Factor IIV
VW antigen
VW activity
25
Ratio of vW Activity vs antigen for type 1 and type 2 vw disease
>0.6 for type 1
| <0.6 for type 2
26
What should you avoid in type 2b vw
DDAVP use vWF conc instead
27
Severe side effects of heparin
HITT - heparin induced thrombocytopenia and thrombosis
28
What is a DOAC
Direct Oral Anti Coagulant, factor 10a inhibitor
29
Diagnostic imaging test for PE
Ventilation Perfusion scan
30
Treatment for DVT and PE
LWMH or UFH and start warfarin which takes 48 hours to work
31
Signs of DVT
Tender calf
Homan’s sign
3cm circumference swelling
32
PE ECG changes
S1Q3T3
33
Levels of haemophilia A and test values
1 - <1 IU/DL worst
2 - 1-5 occasional spontaneous bleeding
3 - >5 no spontaneous bleeds
34
What would testing someone with haemophilia A show?
Long APTT, low FVII
| Normal PT, bleed time and vWF
35
How do you treat mild Haemophilia A?
Desmopresin
36
How do you treat vWF disease?
Do not give desmopresin, give FIX
37
Inheritance of VW disease?
Type one and two are dominantly inherited and are milder than type 3 which is recessively inherited and worse
38
Upon investigation what would you expect to find in a patient with vW disease?
Prolonged APTT, normal PT, decreased VIII:C and deceased vWF
39
What do you treat vit K deficiency with?
Phytomenadione
40
How does aspirin work?
Antiplatelet, decreased thromboxane A2 by inhibiting cycloxgyenase
41
At what age does you kidney function start to decline?
Age 40
42
What do small kidneys suggest?
CKD
43
Two types of glomerulus kidney disease
Glomurlitis
| Glomerulosclerosis
44
Nephritic syndrome
Blood, oliguria, anurea, hyperension and AKI
45
What happens in Nephrotic syndrome?
Proteinurea of more than 3g
Oedema
Hypoalbuminaemic
Hyper cholesterolamia
46
Are immune mediated Glomerular injury normally nephritic or nephrotic?
Nephritic
47
Non invasive renal tests
Radiological or biochemical
Bloods, urine dipstick, urine microscopy, urine culture
48
White cell cast origin on urine microscopy
Interstitial disease
49
Muddy brown cast origin on urine microscopy
Tubular origin
50
dosage of LWMH for DVT prophylaxis in surgery patients
20mg for low DVT risk and 40mg for high DVT risk
51
What is fondaparinux?
FX inhibitor, similar to LWMH
52
Oral DVT prophylaxis for hip and knee replacement
Dabigatran and rivaroxaban
53
If someone is intolerant to aspirin for anti platelet what can you use instead?
Clopidogrel
54
What can you use to treat the increased GD ulcer risk that aspirin treatment causes?
PPI
55
How long do the effects of anti platelet drugs last?
7-10 days due to the lifespan of platelets
56
Give three examples of thrombin inhibitors, are they usually used for vein or artery problems?
heparin, fondaparinux and bivalirudin. Used for veins.
57
what are anti platelet drugs used for?
Artery problems e.g stroke, ACS
58
If someones renal function is low, what is the risk with giving LWMH?
Chance of hyperkalaemia due to testosterone suppression.
Always check kidney function
59
What type of heparin should you use post surgery?
UFH as it has a short heart life and can be stopped.
60
What reverses UFH?
Protamine sulphate
61
What INR should you aim for with PE?
wafarin INR of 2-3
62
Which DOAG has an antidote and which doesn't?
Dabigatran has an antidote, riveroxaban does not
63
What is the clinical name for spooning of the nails?
Onycholysis
64
What cells make calcitonin?
c cells
65
Out of T4 and T3 which is more powerful and which is there more of in the blood?
There is more T4 in the blood however this is converted to T3 in the peripheries as it is more potent
66
What is T4 bound to in the blood?
TBG
67
Effect of high T4/T3 on TSH
decreases TSH
68
Primary hyperthyroidism
High T4, Low TSH
69
Secondary hyperthyroidism
High T4, High TSH
70
Primary hypothyroidism
Low T4, high TSH
71
secondary hypothyroidism
Low T4, low TSH
72
What does anti TSH receptor antibodies cause
Grave's hyperthyroidism
73
What does anti TPO antibodies cause?
Hypothyroidism
74
What in females specifically raises TBG?
Pregnancy and OCP
75
What anti arrhythmic drug can cause hypothyroidism or thyrotoxicosis?
Amiodarone
76
What are the four main causes of thyrotoxicosis?
Grave's disease, multi-nodular goitre, solitary toxic nodule, drugs
77
What age group do you see multinodular goitre in most?
40-50 yrs +
78
What two drugs cause hypothyroidism?
Amiodarone and interferon
79
What sex does thyroid toxicosis happen in more?
10x more in woman
80
Effect of thyroid toxicosis on the heart
Makes AF three times more likely
81
How do you treat hyperthyroidism with drugs?
Give beta blockers for symptomatic relief.
Carbimazole (Methimazole in U.S)
Propylthiouracil
82
What is the major side effect with antithyroid drugs that you have to look out for?
agranulocytosis in 0.1 to 0.5% of people
83
What is the risk with radioactive iodine treatment for hyperthyroidism?
eventual hypothyroidism
84
What nerve do you risk damaging with near total thyroidectomy?
Recurrent laryngeal nerve palsy
85
What are the reasons to put someone on dialysis?
```
Acidosis
Electrolytes
Intoxication/drugs e.g aspirin
Oedema
Urea
Vit D
```
86
Grave's disease and pregnancy
increased risk of thyroid storm and hyper or hypo thyroid with baby
87
Effect of vomiting and diarrhoea on potassium levels
Can cause hypokalaemia
88
Facts about propanalol
It is not cardiac specific, it can cross the BB barrier so it's good for depression and anxiety, although it can cause nightmares for the same reason.
89
Effect of hypothyroidism on cholesterol
Hypothyroidism can cause hypercholesteroleamia, however giving thyroxine will lower the blood lipid profile, so never give statins to someone with hypothyroidism without treating the thyroid first
90
How long does TSH take to change after you give a drug to change thyroid levels?
Six weeks, so can be used as an indicator of adherence or possibly gastroparesis in diabetes.
91
What part of the adrenal glands does the pituitary control?
The cortex for glucocorticoids, does not effect mineralocorticoids e.g aldosterone
92
How do you diagnose ADPKD?
Ultrasound scan for large kidneys
93
What common medication class can you not give to people with renal failure?
Anti inflammatories
94
Effect of aldosterone on Na+ and K+ conc
Increased Na+ and decreases K+
95
What is the sympathetic receptor on vascular smooth muscle?
Alpha2
96
What type of sympathetic receptors are on cardiac muscle?
Beta
97
In what cardiac emergencies do you give Adrenalin?
Cardiac arrest, cardiogenic shock
98
In what cardiac emergencies do you give noradrenalin?
severe hypertension and septic shock
99
In what cardiac emergencies can you give dopamine?
Acute heart failure
100
What is the brain centre for baroreceptors?
Tractus solitarius
101
What can cause pathological postural hypotension?
Carotid Sinus Hypersensitivity
102
What does primary hyperaldosteronism cause?
Hypokalaemic Alkalosis
103
Causes of secondary hypertension
```
3 renal
Cushings
Primary aldosteronism
pheochiomocytoma
Sleep apnea
Obesity
brain tumours and encephalitis
```
104
What should you check if a urine dipstick is positive for blood
Check for blood on microscopy, could be haemogobin or myoglobin from rhabdomyolysis
105
What happens to platelet levels when a patient is infected?
They increase
106
What is an abdominal bruit a sign of?
Renal artery stenosis
107
What is radio-femoral delay a sign of?
Coarctation of the aorta
108
What are three signs of phaeochromocytoma?
Hypertension, sweating, tachycardia
109
What is Conn's diseases effect on potassium?
It can cause hypekalaemia due to excess aldosterone
110
If a patient is hypertensive, under 40 and has no risk factors for hypertension, what should you do?
Investigate for secondary causes of hypertension
111
What is the BP value for diagnosis of hypertension?
140/90
112
What is the target BP in hypertension?
140/90 but in diabetes, heart disease and CKD 130/80
113
hat is the value for stage oen hypertension and how do you know whether or not to treat?
140/90. check BP again and treat if there is evidence of end organ damage
114
What is the value of stage 2 hypertension and when should you treat?
> or equal to 160/100, always treat
115
What is the value to diagnose severe hypertension?
180/110
116
What is the difference between hypertensive urgency and hypertensive emergency?
both have BP of over 180/110. In emergency you have evidence of severe end organ damage
117
What are the signs of congestive heart failure?
Dysponea
Pulmonary crepitations
Peripheral oedema
Third heart sound S3
118
What are the signs of LVH on ECG?
Left axis deviation
| ST elevation in V1-V3
119
In emergency treatment for hypertension, when can't you give beta blockers?
Heart block or asthma
120
GTN vs beta blockers for emergency hypertension
GTN stops effects after ten minutes whereas BB lasts 2-6 hours.
121
Target for reducing BP in emergency hypertension
Reduce BP slowly to keep brain perfusion high.
| Reduce by 25% of the BP over the first few hours, then faster after
122
Left ventricular strain pattern on ECG
Deep S wave
Tall R wave
T wave inversion on V5 and V6
R+S >35mm in V5 and V6
123
Which anti-hypertensive drug is best for LVH?
ACE-I
124
What are the four most likely causes of hypertension in a healthy 23 year old woman?
Renal disease
Primary hyperalostreronism
phaeochromocytoma
Coarctation of the aorta
125
Where is aldosterone made?
The adrenal glands
126
Where is renin made?
The kidneys
127
Where is ACE made?
The lungs
128
What are the values of aldosterone and renin in primary hyperaldosteronism?
High aldosterone and low renin
129
What are the values of aldosterone and renin in secondary hyperaldosteroneism?
High aldosterone and high renin.
| E.g renal artery stenosis
130
When should you refer a patient with non visible haematuria?
If they are 40 or over
If they are symptomatic
If they have abnormal eGFR or ACR/PCR
131
Wht is sterile pyuria?
pus cells without bacterial infection
132
What are red cell casts in urine a sign of?
Glomerulonephritis
133
What are white cell casts in urine a sign of?
Acute pyelonephritis
134
What is pelvicalyceal dilation a sign of?
Chronic renal obstruction
135
What is a ureteric colic and what is the first line investigation if this is suspected?
Pain in loins from stone in ureter. First line investigation is CT of renal tract.
136
What are the descriptive names of glomerular diseases if inflammation is present or absent?
Glomerulonephritis is inflammation is present, glomerulopathy if it is absent
137
What is nephrotic syndrome?
Massive proteinuria (>3.5g daily)
Hypoalbuminaemia
Oedema
Lipiduria and hyperlipidaemia
138
What is acute nephrotic syndrome or acute glomerulonephritis?
Abrupt onset of haematuria with casts or dysmorphic RBCs
non-nephrotic range proteinuria
Oedema
Hypertension
Transient renal imparment e.g oliguria or anuria
139
What are the two main causes of nephrotic syndrome in adults and the main cause in children?
Membranous nephropathy and focal segmental glomerulosclerosis in adults and minimal change nephropathy in children
140
What are the two main differential diagnoses in nephrotic syndrome and how do you rule them out?
Congestive heart failure: High JVP but not in renal causes
| Liver Cirrhosis, Examination would show signs of chronic liver disease
141
Treatment for general oedema
Thiazide diuretic e.g bendroflumethiazide 5mg daily. If resistant furosemide and amiloride
142
Treatment for minimal change nephropathy in children
Steroids. high dose prednisolone 60gm daily for 4-6 weeks
143
Signs and diagnosis of renal vein thrombosis
Renal pain, haematuria and decreased renal function.
| Diagnosed by ultrasonography
144
Common infective cause of acute glomerulonephritis
Post-streptococcal glomerulonephritis as the bacterial antigen gets trapped in gloms
145
symptoms of acute nephritic syndrome
```
Haematuria
Low proteinuria (Less than 2)
Hypertension and oedema
Oliguia
Uraemia
```
146
What are the most common causes of acute TIN or acute tubulointerstitial nephritis?
Peniccilin and NSAIDS.
| Fever, eosinophilia and eosinphiluria, tubular necrosis.
147
Causes of chronic tubulointerstitial nephritis
Diabetes and chronic over NSAID
148
How do you diagnose renal artery stenosis?
Renal arteriography
149
Common causes of pre renal AKI
Hypovolaemia via dehydration or haemorrhage
Hypotension without hypovolaemia e.g sepsis or cirrhosis
Low cardiac output
150
Biochemical diferential between pre and intra renal AKI
HIgh plasma Na+ and lower than 350 urine osmolality is intrinsic
151
Biochemical abnormalities in AKI
```
Hyperkalaemia
Metabolic acidosis
Hyponatraemia
Hypoxalcaemia
Hyperphosphateaemia
```
152
Symptoms of uraemia
Weakness, fatigue, anorexia, nausea and vomiting, mental confusion, coma, seizures, pericarditis
153
Investigations in AKI
Blood count: anaemia and high ESR suggest myeloma or vasculitis
- Urine and blood cultures
- Urine dipstick and microscopy
- Urinary electrolytes
- Serum calcium, phosphate and uric acid
- Renal ultrasound for obstruction
- Renal biopsy in unexplained AKI
154
Bone diseases that develop following CDK
Osteomalacia, osteoporosis, secondary and tertiary hyperparathyroidism and osteosclerosis
155
What nerve compression is common in dialysis?
Median nerve compression following dialysis due complicated things called amyloidosis
156
What type of anaemia do you get in CKD?
Normochromic anaemia
157
Gene for ADPKD
PKD1 in chromosome 16 or less common PDK2 on chromosome 4
158
Sign if renal tumour obstructs the gonadal vein where it eners the renal vein?
Left-sided scrotal varicocele
159
Symptoms of right sided heart failure
Raised JVP
Hepatomegaly
Ankle oedema
160
Symptoms if left sided heart failure
bibasal crepitations
161
Sudden onset of severe back pain in a lime dialysed patient
Discitis of intervertebral discs
162
What is EPS in peritoneal dialysis?
Encapsulating peritoneal sclerosis
163
If Hb is less than 70 in CKD what should you do?
Investigate for different causes of anaemia
164
What is phimosis?
When the foreskin can't retract
165
What is Paraphimosis?
When the blood supply to the head of the penis is compromised
166
If gram +ve cocci are seen in lumps?
Staph
167
If gram possitive cocci are seen in a chain?
Strep
168
What is granulomatosis with polyangitis also known as?
Wagners granulomatosis - a type of vasculitis with a classic triad of upper and lower respiratory tract infections and pauci-immune glomerulonephritis. Diagnosed via anti-neutrophil cytoplasmic antibody ANCA
169
WHat is another name for anti GBM disease?
Goodpasture's
170
What renal diesease do NSAIDS and PPIs increase the chance of ?
Interstitial nephritis
171
If there is blood on a urine dip what should you do?
Test it for myoglobin and CK
172
What can high K+ do to the heart?
Bradycardia and 3rd degree heart block
173
What are the stages of CKD and how are they classified?
```
Stage 1 >90% eGFR
Stage 2 Less than 90% more than 60% eGFR
Stage 3 Less than 60% more than 30% eGFR
Stage 4 less than 30% more than 15% eGFR
Stage 5 less than 15%
```
174
What should you check before giving erythropoietin?
Iron, B12, Folate
175
If someones Na+ level is off what should you assess?
Asses their hydration level.
176
What is potassium shift?
Acidosis brings K+ out of cells, treat underlying acidosis and K+ levels will fall to normal
177
What is LDH and when does it go up?
Lactate dehydrogenase, goes up in rapid cell turnover
178
If acute fall in Hb what should you think?
Bleeding, haemolysis which is probably autoimmune so do coombs test
179
What drug increase MCv in sickle cell?
Hydroxycarbamide as it increase Hb F
