Passmed Learning Points Flashcards
hCG has a similar structure to LH, FSH, and TSH so…
This can stimulate the thyroid to produce excess T4/T3 and this can loop back to suppress TSH.
So, molar pregnancies can have
++hCG, ++T3/++T4, and –TSH.
TRALI
vs
TACO
Transfusion-Related Acute Lung Injury = Low BP, High HR, Low O2, fever. (Central Venous Pressure / CVP = 8-12mmHg) [Same as normal anion gap :)) but in mmol/L obvs )
TACO = High BP, Pulm oedema - Stop transfusion + Give furosemide + oxygen.
PMS; Mild/moderate/severe treatment:
Mild: Lifestyle; Lots of complex carbs
Moderate: COCP if not contraindicated
Severe: SSRIs like Fluoxetine.
Opioid Conversions
Increase in palliative care?
PRN dose?
30-50% increase in morphine if uncontrolled
1/6th - 1/10th daily dose
Follow RILE
Peripheral oedema: which side more likely?
Pansystolic
I really messed this question up:
RILE; Right side heard louder on inspiration
Peripheral oedema: More likely right side
Pansystolic: AV-Valve Regurgitation OR Outlet-Valve Stenosis.
What confused me was that it was heard at the left lower sternal edge:
Answer? Tricuspid Regurgitation.
Different bacterial pneumonia types and common signs:
Klebsiella
Legionella
Mycoplasma
Staph Aureus
Strep. Pneumo
Haem. Influ
Kleb: Lots of alcohol, redcurrent jelly sputum.
Legioenlla: Low sodium, holiday in spain / unventilated baths.
Mycoplasma: Erythema multiforme (target lesions)
Staph aureus: Cavities.
Strep. Pneumo: Literally no history of anything.
Haem influ: COPD / Bronchiectasis
Paget’s Disease: Bloods
Isolated rise in ALP
Warfarin and LMWH okay in breast feeding
Low K+ often leads to alkalosis; H+ drawn into cells so that K+ can be sent out.
GNRH agonist and the Anti-Androgen antagonist names:
Why are they both used in prostate cancer?
GNRH: Goserelin
Anti-Androgen: Cyproterone
GNRH agonist causes a small spike in LH before inhibiting it, this needs to be covered by the anti-androgen temporarily.
Dr C BraVADO!
Define Risk (E.g, pre-eclampsia, GD, etc)
Contractions (4-5 in 10 mins)
Base-RAte (>110 good)
Variability (5-25bpm good)
Accelerations (present = good)
Decelerations (None, or early, or variable without other characteristics = good)
Overall impression:
Sus = 1 non-reassuring
Path = 2 non-reassuring or 1 abnormal.
Iozoniazid to be taken with which vitamin to prevent peripheral neuropathy?
B6 - Pyridoxine.
PANCREAS for remembering acute pancreatitis
PO2 <8
Age >55
Neutrophillia (WCC > 15)
Calcium <2 (Phosphate release)
Renal function (Urea >16 )
Enzymes (AST / LDH)
Albumin (<32)
Sugar (>10 - Insulin dysfunction)
H.U.S
Cause?
Treatment to avoid?
Treatment you can give?
Shiga-Toxin, produced by E.Coli or Shigella- Attacks glomerular capillary bed.
Anything precipitating MORE shiga-toxin; Avoid antibiotics, avoid anti-gut-motility agents, avoid NSAIDs (AKI).
Mostly supportive; Fluids, assist high BP with CCBs. Potentially give shiga-binding drugs (Expensive).
ORBIT Mneumonic
O lder than 74
R ed blood cells (?Anaemic)
B leeding history
I nsufficient Kidneys (GFR < 60)
T hrombolytics (Antiplatelets?)
Syphilis Testing; What do these mean?
EIA
TPPA
RPR
Enzyme Immunoassay (IgM Levels; shows acute infection)
Trep-Pallidum Particle Agglutination (Specific to Syphillis; often remains positive)
Rapid Plasma Reagin (Number of syphilis particles in a liquid; 1 in 8 means that it needs to be diluted 8 times to make the syphilis undetectable; Gives an idea of how active current syphilis is).
CKD: Anaemia treatment:
Iron studies then EPO
Tranfusion if Hb < 70
Osteoporosis: Risk factors
Low BMI
Tamoxifen PROTECTS against it (Oestrogen agonist in bone and endometrium),
Letrozole IS A RISK.
Chronic Kidney Disease, eGFR <60.
Sickle-Cell; Vaso-occlusive crisis: How to diagnose?
Diagnose clinically; initiate treatment asap.
Post-op illeus; findings?
Tests?
-Absence of bowel sounds
-Abdo distention
-Post-op (duh)
-Nausea / vomiting
U&Es measured daily in ileus and any abnormalities should be corrected.
Sentinal Node Biopsy Before Surgery? Why even if the axillary ultrasound is negative?
If ultrasound was positive, a biopsy of the axillary nodes would be performed.
The sentinal biopsy is to rule out microscopic metastisis.
Haemorrhoids vs Anal Fissure surgical management:
Line which separates lower rectum from upper rectum?
All after laxatives and ++fibre diet:
Haemorrhoids: Band Ligation
Anal Fissure: Sphincetotomy.
Pectinate / dentate line (Remember like teeth in the mouth, the teeth of the anus.
JIA Diagnosis
No other cause
>6 weeks joint pain
<16 years old
+Joint pain
+Joint stiffness
+Joint swelling
TIA counts for 2 in CHADVASC
Yeah
Compartment syndrome: What features may make you suspect it, early?
-Parasthesia as a first neuro symptom
-Assessment of tone painful, compared to strength (Passive motion excessively painful)
Billary Collic: ALP, GGT, ALT, AST levels?
ALLL Normal
AAA : Endovascular repair when?
-Symptomatic (painful, expansatile)
-Asymptomatic but >4cm and grown 1cm in 1 year
-Asymptomatic but >5.5cm
Most common cause of viral meningitis?
Coxsackie B / Enterovirus
TV Ultrasound Scan for endometrial cancer is a test of:
Exclusion! <4mm has a very high negative predictive value for endometrial cancer.=
Chronic Kidney Disease Classification
Requires eGFR < 120 as expected
BUT
Also requires signs of actual kidney disease; Electrolyte imbalance, proteinuria, haematuria, urea. creatine issues.
Aortic Valve Replacement Criteria?
Symptomatic or
Valve gradient of >40mmHg
