passmed 27/12 Flashcards
Symptoms of lithium toxicity
coarse tremor (fine is therapeutic)
acute confusion
hyperreflexia
polyuria
seizure
coma
a non functioning pituitary adenoma can have numerous effects, what are they?
Headache from mass lesion + bitemporal heminaopia from compression of optic chiasm
stalk compression; mildly elevated prolactin levels, hypogonadism with low FSH and LH
secondary hypothyroidism; low t4, normal tsh
Vaccination schedule UK for children`
8 weeks; [dip,tet,pert] + polio + Hib + HBV + rotavirus + MenB
12 weeks; dip,tet,pert Hib, HBV, pneum, rotavirus
16 weeks; dip,tet, pert, polio, Hib HBV + menB
1 year; MMR, Hib, MenB + MenC, pneum
3 years + 4 months; MMR, dip, tet, polio, pert
12/13 yrs = HPV
14 yrs = dip, tet, polio
What is the classical presentation of vitreous detachment?
Flashes in the peripheral corners of vision, come and go but don’t obscure vision. May notice more if you go from light to dark environment, would continue on and off for weeks or months.
PVD presents a risk of retinal detachment.
Differences between central retinal vein and artery occlusion:
Vein; more common, causes include glaucoma, polycythaemia and hypertension. Severe retinal haemorrhages on fundoscopy.
Artery; thromboembolism due to atherosclerosis or arteritis. RAPD with cherry red spot on pale retina.
Causes of 3rd nerve palsy:
Uncal herniation
DM
Vasculitis e.g. temporal arteritis, SLE
PCA aneurysm; associated with dilated pupil and pain
Weber syndrome = 3rd nerve palsy + contralateral hemiplegia = midbrain stroke
Cavernous sinus thrombosis
?MS, amyloidosis
First line treatment for prolactinoma?
Dopamine agonist e.g. bromocriptine / cabergoline, which inhibit release of prolactin from the pituitary gland.
(dopamine secreted from hypothalamus among other areas)
MOA of thiazide diuretics and adverse effects:
Inhibits sodium resorption at the beginning of the DCT through blocking the thiazide sensitive Na/Cl symporter. Can lead to hypokalaemia due to more Na reaching the collecting ducts.
SEs:
dehydration
postural hypotension
hyponatraemia
hypercalcaemia, hypocalciuria
gout
impaired glucose tolerance
impotence
Severe but rare include thrombocytopenia, angranulocytosis, photosensitivity rash and pancreatitis.
Colon cancer resection operations by site:
caecum / asc / prox transverse = right hemi
distal trans / desc = left hemi
sigmoid = high anterior
upper rectum = anterior
lower rectum = anterior +/- defunctioning colostomy
anal verge = abdo / perineal resection of rectum
screening for DDH
newborn and 6 week barlow and ortolani test
if breech position delivery >36 weeks, regardless of mode of delivery then US screening at 6 weeks should be done.
RFs include breech, female, oligohydramnios, first borns, fhx, >5kg
in DKA what is the rate of insulin infusion?
0.1 unit / kg / hour
e.g. if 80kg, then 8 unit / hour
also resuscitate with isotonic saline, even if acidotic.
When blood glucose <14, add in dextrose solution 10% at 125 mls/hr
long acting insulin continue in DKA, short acting stopped
Treatment for diverticulitis
oral antibiotics at home
advise that if doesn’t improve within 3 days go to emergency department for admission for IV antibiotics ceftriaxone and metronidazole
Where is renin produced and in response to what?
Renin is produced in the juxtaglomerular / granular cells of the afferent arteriole.
Produced in response to low BP, low blood volume or low Na+.
as opposed to the macula densa which detects changes in NaCl concentration and modulates GFR. Macula densa is at the DCT.
contents of femoral triangle
lateral to medial
femoral nerve
femoral artery
great saphenous vein drains into the femoral vein within the triangle
femoral canal contains deep lymph nodes and vessels
NAVEL; nerve, artery, vein, empty space, lymph nodes
Life threatening features in adult tachycardia:
shock
syncope
severe heart failure
myocardial ischaemia (ecg changes)
