Other bits and pieces Flashcards
What are some common causes of hypernatraemia?
Drip arm effect
Dehydration - likely to be quite significant
HHS
Diabetes insipidus
How does the murmur for aortic stenosis and aortic sclerosis vary?
Both ejection systolic
Stenosis - absent S2 and radiate to carotids
Sclerosis - S2 present, doesn’t radiate
If needed, how much should you change insulin doses by?
Around 10-20%
What are some common causes of hyperkalaemia?
Haemolysed sample Drip arm effect AKI Drugs Rare stuff
What ECG changes are seen in intracranial bleeds?
Giant t wave inversion (cerebral t waves)
Prolonged QT
Bradycardia
Can see ST changes
What do PT and APTT tell you about clotting?
PT = extrinsic pathway APTT = intrinsic pathway
What blood results are seen with DIC?
Low platelets
Low fibrinogen
What bloods do you request to determine liver function?
Clotting - PT most important
Bilirubin
Glucose
Albumin
Why may you get deranged clotting with cholestatic jaundice due to blockage?
Vitamin K is a fat soluble vitamin
Bile is required for lipid absorption
Blockage of bile = reduced lipids = reduced vit K
Why may you get deranged clotting in pancreatic cancer?
May metastasise to liver affecting liver function
Upper GI cancers are known to cause DIC
What can an isolated rise in APTT indicate?
Lupus (antiphospholipid syndrome if also have miscarriage etc.)
What is a key worry with sickle cell patients with reduced saturations?
Acute chest syndrome - sickle cell crisis
How is acute chest syndrome investigated and what would imaging show?
Chest X-Ray - pulmonary infiltrates FBC ABG U&E LFT G&S and X match
How is acute chest syndrome managed?
Pain management is key - stress precipitate crisis
O2
Fluids - try oral if poss
Blood transfusion - if mild topup, if not exchange
Abx - PenV and pneumococcal vaccine
Hydroxycarbamide can be used preventatively
Which cancers metastasise to the bone?
Bilobe midline structures:
- Thyroid
- Lungs
- Breast
- Kidneys
- Prostate
How may patients with heparin induced thrombocytopenia present?
Recurrent clots and big ones
Refer to haem early!
What blood tests may indicate someone has myeloma? (Aside from CRAB)
Total protein - If raised, then it may indicate raised intact globulin
Globulin gap is a big indicator for myeloma:
Total protein - Albumin
How do dabigratran, rivaroxaban, heparin, warfarin and aspirin work?
Dabigatran - Direct thrombin inhibitor
Rivaroxaban and Apixaban - Factor Xa inhibitor
Heparin - antithrombin III
Warfarin - inhibit vitamin K dependent clotting factors
Aspirin - phosphodiesterase inhibitor - inhibit platelet aggregation
What could cause hyponatraemia with low urine osmolarity?
Primary polydipsia
Inappropriate fluid replacement
What could cause hyponatraemia with high urine osmolarity and high urine sodium?
SIADH
Addison’s
What could cause hyponatraemia with high urine osmolarity and normal urine sodium?
Hypervolaemia - 2o hyperaldosteronism:
- liver cirrhosis
- Heart failure
- Nephrotic syndrome
Dehydrated:
- Vomiting, diarrhoea, burns, pancreatitis, bleeding
Side effect of: Amoxicillin
Rash with infectious mononucleosis
Side effect of: Co-Amoxiclav
Cholestasis
Side effect of: Erythromycin/Clarithromycin
Prolong QT
GI upset
