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Year 3 > MRI Block 2 Notes > Flashcards

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.

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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

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3
Q

What is hypovolaemic hyponatraemia

A

Hyponatraemia resulting from salt loss with following water loss

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4
Q

What is dilutional hyponatraemia?

A

Hyponatraemia resulting from water excess

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5
Q

Blood at start of micturition suggests

A

Urethral disease

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6
Q

Blood at end of micturition suggests

A

Prostate or bladder base bleeding

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7
Q

Blood seen as even discolouration throughout the urine suggests

A

Bleeding from a source in the bladder or above

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8
Q

What type of clotting factors does warfarin reduce?

A

Vit K coagulation factors

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9
Q

Name three natural inhibitors of the fibrin clot

A

Protein C, protein S and antithrombin 3

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10
Q

How does Heparin work?

A

Increases the effect of antithrombin 3

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11
Q

What physiological system dissolves the fibrin clot?

A

Plasminogen/plasmin system

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12
Q

What does a 50/50 blood test that corrects indicate?

A

A deficiency of clotting factors in the patients blood

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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

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14
Q

What are the clotting factors that affect APTT?

A

8,9,11,12 and vWF.

The intrinsic pathway

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15
Q

What’s deficient in haemophilia A?

A

Factor eight deficiency

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16
Q

What’s deficient in haemophilia B?

A

Factor nine deficiency

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17
Q

Describe the pattern of x-linked recessive

A

Carried by mother, effects one in two sons

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18
Q

What is the extrinsic pathway measured by?

A

Prothrombin time

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19
Q

What could cause prolonged PT time

A

Low VII or warfarin, could also be low II, V and X but rare

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20
Q

Common cause of prolonged PT and APTT

A

K+ deficiency or liver failure

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21
Q

What is the diagnostic triad for bleeding disorders

A

Personal history
Family history
Lab tests

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22
Q

Commonest coagulopathy

A

VW disease

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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

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24
Q

What tests to do for vW disease?

A

Factor IIV
VW antigen
VW activity

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25
Q

Ratio of vW Activity vs antigen for type 1 and type 2 vw disease

A

> 0.6 for type 1

<0.6 for type 2

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26
Q

What should you avoid in type 2b vw

A

DDAVP use vWF conc instead

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27
Q

Severe side effects of heparin

A

HITT - heparin induced thrombocytopenia and thrombosis

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28
Q

What is a DOAC

A

Direct Oral Anti Coagulant, factor 10a inhibitor

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29
Q

Diagnostic imaging test for PE

A

Ventilation Perfusion scan

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30
Q

Treatment for DVT and PE

A

LWMH or UFH and start warfarin which takes 48 hours to work

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31
Q

Signs of DVT

A

Tender calf
Homan’s sign
3cm circumference swelling

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32
Q

PE ECG changes

A

S1Q3T3

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33
Q

Levels of haemophilia A and test values

A

1 - <1 IU/DL worst
2 - 1-5 occasional spontaneous bleeding
3 - >5 no spontaneous bleeds

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34
Q

What would testing someone with haemophilia A show?

A

Long APTT, low FVII

Normal PT, bleed time and vWF

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35
Q

How do you treat mild Haemophilia A?

A

Desmopresin

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36
Q

How do you treat vWF disease?

A

Do not give desmopresin, give FIX

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37
Q

Inheritance of VW disease?

A

Type one and two are dominantly inherited and are milder than type 3 which is recessively inherited and worse

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38
Q

Upon investigation what would you expect to find in a patient with vW disease?

A

Prolonged APTT, normal PT, decreased VIII:C and deceased vWF

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39
Q

What do you treat vit K deficiency with?

A

Phytomenadione

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40
Q

How does aspirin work?

A

Antiplatelet, decreased thromboxane A2 by inhibiting cycloxgyenase

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41
Q

At what age does you kidney function start to decline?

A

Age 40

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42
Q

What do small kidneys suggest?

A

CKD

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43
Q

Two types of glomerulus kidney disease

A

Glomurlitis

Glomerulosclerosis

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44
Q

Nephritic syndrome

A

Blood, oliguria, anurea, hyperension and AKI

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45
Q

What happens in Nephrotic syndrome?

A

Proteinurea of more than 3g
Oedema
Hypoalbuminaemic
Hyper cholesterolamia

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46
Q

Are immune mediated Glomerular injury normally nephritic or nephrotic?

A

Nephritic

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47
Q

Non invasive renal tests

A

Radiological or biochemical

Bloods, urine dipstick, urine microscopy, urine culture

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48
Q

White cell cast origin on urine microscopy

A

Interstitial disease

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49
Q

Muddy brown cast origin on urine microscopy

A

Tubular origin

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50
Q

dosage of LWMH for DVT prophylaxis in surgery patients

A

20mg for low DVT risk and 40mg for high DVT risk

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51
Q

What is fondaparinux?

A

FX inhibitor, similar to LWMH

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52
Q

Oral DVT prophylaxis for hip and knee replacement

A

Dabigatran and rivaroxaban

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53
Q

If someone is intolerant to aspirin for anti platelet what can you use instead?

A

Clopidogrel

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54
Q

What can you use to treat the increased GD ulcer risk that aspirin treatment causes?

A

PPI

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55
Q

How long do the effects of anti platelet drugs last?

A

7-10 days due to the lifespan of platelets

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56
Q

Give three examples of thrombin inhibitors, are they usually used for vein or artery problems?

A

heparin, fondaparinux and bivalirudin. Used for veins.

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57
Q

what are anti platelet drugs used for?

A

Artery problems e.g stroke, ACS

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58
Q

If someones renal function is low, what is the risk with giving LWMH?

A

Chance of hyperkalaemia due to testosterone suppression.

Always check kidney function

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59
Q

What type of heparin should you use post surgery?

A

UFH as it has a short heart life and can be stopped.

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60
Q

What reverses UFH?

A

Protamine sulphate

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61
Q

What INR should you aim for with PE?

A

wafarin INR of 2-3

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62
Q

Which DOAG has an antidote and which doesn’t?

A

Dabigatran has an antidote, riveroxaban does not

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63
Q

What is the clinical name for spooning of the nails?

A

Onycholysis

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64
Q

What cells make calcitonin?

A

c cells

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65
Q

Out of T4 and T3 which is more powerful and which is there more of in the blood?

A

There is more T4 in the blood however this is converted to T3 in the peripheries as it is more potent

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66
Q

What is T4 bound to in the blood?

A

TBG

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67
Q

Effect of high T4/T3 on TSH

A

decreases TSH

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68
Q

Primary hyperthyroidism

A

High T4, Low TSH

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69
Q

Secondary hyperthyroidism

A

High T4, High TSH

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70
Q

Primary hypothyroidism

A

Low T4, high TSH

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71
Q

secondary hypothyroidism

A

Low T4, low TSH

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72
Q

What does anti TSH receptor antibodies cause

A

Grave’s hyperthyroidism

73
Q

What does anti TPO antibodies cause?

A

Hypothyroidism

74
Q

What in females specifically raises TBG?

A

Pregnancy and OCP

75
Q

What anti arrhythmic drug can cause hypothyroidism or thyrotoxicosis?

A

Amiodarone

76
Q

What are the four main causes of thyrotoxicosis?

A

Grave’s disease, multi-nodular goitre, solitary toxic nodule, drugs

77
Q

What age group do you see multinodular goitre in most?

A

40-50 yrs +

78
Q

What two drugs cause hypothyroidism?

A

Amiodarone and interferon

79
Q

What sex does thyroid toxicosis happen in more?

A

10x more in woman

80
Q

Effect of thyroid toxicosis on the heart

A

Makes AF three times more likely

81
Q

How do you treat hyperthyroidism with drugs?

A

Give beta blockers for symptomatic relief.
Carbimazole (Methimazole in U.S)
Propylthiouracil

82
Q

What is the major side effect with antithyroid drugs that you have to look out for?

A

agranulocytosis in 0.1 to 0.5% of people

83
Q

What is the risk with radioactive iodine treatment for hyperthyroidism?

A

eventual hypothyroidism

84
Q

What nerve do you risk damaging with near total thyroidectomy?

A

Recurrent laryngeal nerve palsy

85
Q

What are the reasons to put someone on dialysis?

A 
Acidosis 
Electrolytes 
Intoxication/drugs e.g aspirin 
Oedema 
Urea 
Vit D
86
Q

Grave’s disease and pregnancy

A

increased risk of thyroid storm and hyper or hypo thyroid with baby

87
Q

Effect of vomiting and diarrhoea on potassium levels

A

Can cause hypokalaemia

88
Q

Facts about propanalol

A

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
Q

Effect of hypothyroidism on cholesterol

A

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
Q

How long does TSH take to change after you give a drug to change thyroid levels?

A

Six weeks, so can be used as an indicator of adherence or possibly gastroparesis in diabetes.

91
Q

What part of the adrenal glands does the pituitary control?

A

The cortex for glucocorticoids, does not effect mineralocorticoids e.g aldosterone

92
Q

How do you diagnose ADPKD?

A

Ultrasound scan for large kidneys

93
Q

What common medication class can you not give to people with renal failure?

A

Anti inflammatories

94
Q

Effect of aldosterone on Na+ and K+ conc

A

Increased Na+ and decreases K+

95
Q

What is the sympathetic receptor on vascular smooth muscle?

A

Alpha2

96
Q

What type of sympathetic receptors are on cardiac muscle?

A

Beta

97
Q

In what cardiac emergencies do you give Adrenalin?

A

Cardiac arrest, cardiogenic shock

98
Q

In what cardiac emergencies do you give noradrenalin?

A

severe hypertension and septic shock

99
Q

In what cardiac emergencies can you give dopamine?

A

Acute heart failure

100
Q

What is the brain centre for baroreceptors?

A

Tractus solitarius

101
Q

What can cause pathological postural hypotension?

A

Carotid Sinus Hypersensitivity

102
Q

What does primary hyperaldosteronism cause?

A

Hypokalaemic Alkalosis

103
Q

Causes of secondary hypertension

A 
3 renal 
Cushings
Primary aldosteronism
pheochiomocytoma 
Sleep apnea
Obesity 
brain tumours and encephalitis
104
Q

What should you check if a urine dipstick is positive for blood

A

Check for blood on microscopy, could be haemogobin or myoglobin from rhabdomyolysis

105
Q

What happens to platelet levels when a patient is infected?

A

They increase

106
Q

What is an abdominal bruit a sign of?

A

Renal artery stenosis

107
Q

What is radio-femoral delay a sign of?

A

Coarctation of the aorta

108
Q

What are three signs of phaeochromocytoma?

A

Hypertension, sweating, tachycardia

109
Q

What is Conn’s diseases effect on potassium?

A

It can cause hypekalaemia due to excess aldosterone

110
Q

If a patient is hypertensive, under 40 and has no risk factors for hypertension, what should you do?

A

Investigate for secondary causes of hypertension

111
Q

What is the BP value for diagnosis of hypertension?

A

140/90

112
Q

What is the target BP in hypertension?

A

140/90 but in diabetes, heart disease and CKD 130/80

113
Q

hat is the value for stage oen hypertension and how do you know whether or not to treat?

A

140/90. check BP again and treat if there is evidence of end organ damage

114
Q

What is the value of stage 2 hypertension and when should you treat?

A

> or equal to 160/100, always treat

115
Q

What is the value to diagnose severe hypertension?

A

180/110

116
Q

What is the difference between hypertensive urgency and hypertensive emergency?

A

both have BP of over 180/110. In emergency you have evidence of severe end organ damage

117
Q

What are the signs of congestive heart failure?

A

Dysponea
Pulmonary crepitations
Peripheral oedema
Third heart sound S3

118
Q

What are the signs of LVH on ECG?

A

Left axis deviation

ST elevation in V1-V3

119
Q

In emergency treatment for hypertension, when can’t you give beta blockers?

A

Heart block or asthma

120
Q

GTN vs beta blockers for emergency hypertension

A

GTN stops effects after ten minutes whereas BB lasts 2-6 hours.

121
Q

Target for reducing BP in emergency hypertension

A

Reduce BP slowly to keep brain perfusion high.

Reduce by 25% of the BP over the first few hours, then faster after

122
Q

Left ventricular strain pattern on ECG

A

Deep S wave
Tall R wave
T wave inversion on V5 and V6
R+S >35mm in V5 and V6

123
Q

Which anti-hypertensive drug is best for LVH?

A

ACE-I

124
Q

What are the four most likely causes of hypertension in a healthy 23 year old woman?

A

Renal disease
Primary hyperalostreronism
phaeochromocytoma
Coarctation of the aorta

125
Q

Where is aldosterone made?

A

The adrenal glands

126
Q

Where is renin made?

A

The kidneys

127
Q

Where is ACE made?

A

The lungs

128
Q

What are the values of aldosterone and renin in primary hyperaldosteronism?

A

High aldosterone and low renin

129
Q

What are the values of aldosterone and renin in secondary hyperaldosteroneism?

A

High aldosterone and high renin.

E.g renal artery stenosis

130
Q

When should you refer a patient with non visible haematuria?

A

If they are 40 or over
If they are symptomatic
If they have abnormal eGFR or ACR/PCR

131
Q

Wht is sterile pyuria?

A

pus cells without bacterial infection

132
Q

What are red cell casts in urine a sign of?

A

Glomerulonephritis

133
Q

What are white cell casts in urine a sign of?

A

Acute pyelonephritis

134
Q

What is pelvicalyceal dilation a sign of?

A

Chronic renal obstruction

135
Q

What is a ureteric colic and what is the first line investigation if this is suspected?

A

Pain in loins from stone in ureter. First line investigation is CT of renal tract.

136
Q

What are the descriptive names of glomerular diseases if inflammation is present or absent?

A

Glomerulonephritis is inflammation is present, glomerulopathy if it is absent

137
Q

What is nephrotic syndrome?

A

Massive proteinuria (>3.5g daily)
Hypoalbuminaemia
Oedema
Lipiduria and hyperlipidaemia

138
Q

What is acute nephrotic syndrome or acute glomerulonephritis?

A

Abrupt onset of haematuria with casts or dysmorphic RBCs
non-nephrotic range proteinuria
Oedema
Hypertension
Transient renal imparment e.g oliguria or anuria

139
Q

What are the two main causes of nephrotic syndrome in adults and the main cause in children?

A

Membranous nephropathy and focal segmental glomerulosclerosis in adults and minimal change nephropathy in children

140
Q

What are the two main differential diagnoses in nephrotic syndrome and how do you rule them out?

A

Congestive heart failure: High JVP but not in renal causes

Liver Cirrhosis, Examination would show signs of chronic liver disease

141
Q

Treatment for general oedema

A

Thiazide diuretic e.g bendroflumethiazide 5mg daily. If resistant furosemide and amiloride

142
Q

Treatment for minimal change nephropathy in children

A

Steroids. high dose prednisolone 60gm daily for 4-6 weeks

143
Q

Signs and diagnosis of renal vein thrombosis

A

Renal pain, haematuria and decreased renal function.

Diagnosed by ultrasonography

144
Q

Common infective cause of acute glomerulonephritis

A

Post-streptococcal glomerulonephritis as the bacterial antigen gets trapped in gloms

145
Q

symptoms of acute nephritic syndrome

A 
Haematuria
Low proteinuria (Less than 2) 
Hypertension and oedema 
Oliguia 
Uraemia
146
Q

What are the most common causes of acute TIN or acute tubulointerstitial nephritis?

A

Peniccilin and NSAIDS.

Fever, eosinophilia and eosinphiluria, tubular necrosis.

147
Q

Causes of chronic tubulointerstitial nephritis

A

Diabetes and chronic over NSAID

148
Q

How do you diagnose renal artery stenosis?

A

Renal arteriography

149
Q

Common causes of pre renal AKI

A

Hypovolaemia via dehydration or haemorrhage
Hypotension without hypovolaemia e.g sepsis or cirrhosis
Low cardiac output

150
Q

Biochemical diferential between pre and intra renal AKI

A

HIgh plasma Na+ and lower than 350 urine osmolality is intrinsic

151
Q

Biochemical abnormalities in AKI

A 
Hyperkalaemia 
Metabolic acidosis 
Hyponatraemia 
Hypoxalcaemia 
Hyperphosphateaemia
152
Q

Symptoms of uraemia

A

Weakness, fatigue, anorexia, nausea and vomiting, mental confusion, coma, seizures, pericarditis

153
Q

Investigations in AKI

A

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
Q

Bone diseases that develop following CDK

A

Osteomalacia, osteoporosis, secondary and tertiary hyperparathyroidism and osteosclerosis

155
Q

What nerve compression is common in dialysis?

A

Median nerve compression following dialysis due complicated things called amyloidosis

156
Q

What type of anaemia do you get in CKD?

A

Normochromic anaemia

157
Q

Gene for ADPKD

A

PKD1 in chromosome 16 or less common PDK2 on chromosome 4

158
Q

Sign if renal tumour obstructs the gonadal vein where it eners the renal vein?

A

Left-sided scrotal varicocele

159
Q

Symptoms of right sided heart failure

A

Raised JVP
Hepatomegaly
Ankle oedema

160
Q

Symptoms if left sided heart failure

A

bibasal crepitations

161
Q

Sudden onset of severe back pain in a lime dialysed patient

A

Discitis of intervertebral discs

162
Q

What is EPS in peritoneal dialysis?

A

Encapsulating peritoneal sclerosis

163
Q

If Hb is less than 70 in CKD what should you do?

A

Investigate for different causes of anaemia

164
Q

What is phimosis?

A

When the foreskin can’t retract

165
Q

What is Paraphimosis?

A

When the blood supply to the head of the penis is compromised

166
Q

If gram +ve cocci are seen in lumps?

A

Staph

167
Q

If gram possitive cocci are seen in a chain?

A

Strep

168
Q

What is granulomatosis with polyangitis also known as?

A

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
Q

WHat is another name for anti GBM disease?

A

Goodpasture’s

170
Q

What renal diesease do NSAIDS and PPIs increase the chance of ?

A

Interstitial nephritis

171
Q

If there is blood on a urine dip what should you do?

A

Test it for myoglobin and CK

172
Q

What can high K+ do to the heart?

A

Bradycardia and 3rd degree heart block

173
Q

What are the stages of CKD and how are they classified?

A 
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
Q

What should you check before giving erythropoietin?

A

Iron, B12, Folate

175
Q

If someones Na+ level is off what should you assess?

A

Asses their hydration level.

176
Q

What is potassium shift?

A

Acidosis brings K+ out of cells, treat underlying acidosis and K+ levels will fall to normal

177
Q

What is LDH and when does it go up?

A

Lactate dehydrogenase, goes up in rapid cell turnover

178
Q

If acute fall in Hb what should you think?

A

Bleeding, haemolysis which is probably autoimmune so do coombs test

179
Q

What drug increase MCv in sickle cell?

A

Hydroxycarbamide as it increase Hb F

Year 3 (26 decks)

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