Other Flashcards
What are most common causes of hypokalaemia and hyperkalaemia?
Hypokalaemia (BAD VCR)
- Bartter syndrome
- alkalosis
- diuretics (thiazide, furosemide loop), diarrhoea
- villous adenoma, vomiting
- cushing syndrome, conn’s disease (HTN+ hypoK)
- renal tubular failure
Hyperkalaemia (A CAP)
- Addison’s disease
- CKD
- ACEi
- Potassium sparing diuretics (spironolactone)
Which vitamin deficiency should be suspected in a patient using metforming and presenting with low moods?
Vitamin B12
What is the most common electrolyte disfunction related to TURP?
Hyponatremia.
TURP syndrome is rare but potentially life-threatening, it occurs when irrigation fluid enters the systemic circulation through prostatic veins exposed by breached in the prostatic capsule during TURPP. It’s caused by venous destruction and absorption of the irrigation fluid. Confusion, bradycardia, nausea, and vomiting associated with hyponatremia may be seen. The management involved fluid restriction to corret hypoNa.
TURP: transurethral resection of the prostate - treatment for benign prostatic hyperplasia, involved the insertion of a resectoscope via the penile urethra
What should be suspected in a patient presenting with progressive decrease of visual acuity and peripheral visual field loss?
Glaucoma
What are the normal lab value range of random glucose, fasting glucose and HbA1c and which values point to diabetes?
Random glucose
- normal < 11.1 mmol/l
- dabetes > 11.1
Fasting glucose
- normal < 5.5 mmol/l
- diabetes > 7.0
HbA1c
- normal < 6% or 42 mmol/mol
- diabetes > 6.5% or > 48
What is the blood glucose that defines hypoglycemia?
any blood glucose < 4.0 mmol/l
What are the diagnostic tests for cushing’s syndrome, DI, haemochromatosis, and Addison’s disease?
Cushing’s - dexa suppression test
DI - water deprivation test
Haemochromatosis - iron profile
Addison’s - ACTH stimulation test
What are the Light’s criteria?
Transudate
- P/S protein < 0.5
- P/S LDH < 0.6
Exsudate
- P/S protein > 0.5
- P/S protein > 0.6
Rule of thumb
fluid protein < 30 g/l = transudate
fluid protein > 30 g/l = exsudate
How to treat kidney stones bigger than 0.5 cm?
0.5 - 2cm = extracorporeal shockwave
> 2cm = percutaneous nephrolithotomy
How to differentiate hyperaldosteronism from Addison’s disease?
Hyperaldo
- hypertension
- hypokalaemia
- hypernatraemia
Addison’s
- low aldosterone = low Na = low BP
- low weight/energy
- hyperkalaemia
In Addison’s, everything is low but the potassium!
How to treat hyperthyroidism (thyrotoxicosis) and thyroid storm?
Hyperthyroidism
- propranolol for controlling adrenergic symptoms
- antithyroid drug
Choice of antithyroid drug
- carbimazole (most cases) - lower rate of side effects
- propylthiouracil (PTY) - pregnancy, thyroid storm
Only consider thyroidectomy if
- poor compliance with drugs
- manifestations of severe Grave’s ophthalmopathy
- relapsing Grave’s disease
- local compressive symptoms resulting in difficulty in breathing
Thyroid storm: rare, life-threatening condition that presents with altered mental status, high fever, vomiting, multisystem decompensation (cardiac failure, respiratory distress); pick PTU because it has the ability to quickly block T4 to T3 conversion in peripheral tissues
Which solution of short-acting (Actrapid) insulin and dextrose should be used in a patient with hyperkalaemia that has normal and high blood glucose?
Normal blood glucose
- 10 units of Actrapid + 50ml dextrose 50% over 5-15 minutes
- followed by 500ml dextrose 10% over 12h
High blood glucose
- 10 units of Actrapid + 50ml sodium chloride 0.9% over 5-15 minutes
- only once glucose normalise, give 500ml dextrose 10% over 12 hours
How to differentiate SIADH from DI?
SIADH - hyponatraemia due to excess ADH that causes decrease in urine
DI - hypernatraemia due to decrease in ADH that causes excess urine
