passmed recall Flashcards
CUSHINGS
what are the urea and electrolytes most likely to show?
hypokalaemic metabolic alkalosis
excess of cortisol production from adrenal glands or exogenous glucocorticoid use.
Excess cortisol can lead to sodium and water retention –> HTN and hypokalaemic metablolic acidosis
Prolactinoma management
1st line - dopamine agonists (cabergoline or bromocriptine)
GH secreting adenoma:
Somatostatin analogues (octreotide)
ATH secretomg adenoma
–> ketoconazole (inhibit cortisol synthesis)
TRANSPHENOID SURGERY
Non-functioning adenoma - compressive symptoms or hormone deficiences therefore surgery if first line treatment
NECROTIZING FASCIITIS: A culture of the wound grows gram-positive cocci in chains.
Streptococcus pyogenes is the most common cause of type 2 necrotising fasciitis
STRIPTOCOCUS
Staph aureus - clusters
E.COLI - gram negative rod
P.aeruginosa - gram negative rod
C.perfringens - gram positive rod (T1 nec fasc)
Hypokalaemia causes
Hypokalaemia: DIRE
Drugs (loop and thiazide diuretics)
Intestinal loss or inadequate intake
Renal tubular acidosis
Endocrine (Conn’s, Cushings)
Hyperkalaemia causes
Drugs (K+ sparing anti-diuretics, ACEi)
Renal failure
Endocrine (Addison’s)
Artifact (clotted sample)
DKA
typical biochemical pattern for primary hyperparathyroidism.
- excessive autonomous secretion of PTH from parathyroid gland
- results in mild hypercalcaemia
- low serum phosphate
**corneal abrasion **
features
Investigation
management
Features
- eye pain
- lacrimation
- photophobia
- foreign body sensation and conjunctival injection
- decreased visual acuity in affected eye
Investigation
- fluorescein staining
Management
- topical ABx to prevent 2ndary bacterial infection (topical chloramphenicol)
Addison’s patient with intercurrent illness: dose increase
double the glucocorticoids, keep fludrocortisone dose the same
e.g. hydrocortisone
reversal agent for dabigatran
Idarucizumab
This is an agent used to reverse rivaroxaban and apixaban, two other direct oral anticoagulants which work as direct factor Xa inhibitors.
Andexanet alfa
Massive PE + hypotension MX
THROMBOLYSE
Thrombolysis indicated when there is haemodynamic instability.
PE 1st line
–> DOAC
or LMWH followed by another DOAC (dabigatran or edoxaban)
OR LMWH followed by vit k antagonist (warfarin)
Features of Guillain Barree syndrome
Features
- history of gastroenteritis
- respiratory muscle weakness
- cranial nerve involvement:
–> diplopia
–> bilateral facial nerve palsy
–> oropharyngeal weakness
- autonomic involvement
–> urinary retention
–> diarrhoea
Less common: papilloedema (2ndary to reduced CSF absorption)
Invetigations for Guillain Barre
- LP
–> rise in protein w/ normal WBC (ALBUMINOCYTOLOGIC DISSOCIATION) - Nerve conduction studies
–> decreased motor nerve conduction velocity
–> prolonged distal motor latency
Weakness typically ascending. Reflexes reduced or absent. Sensory symptoms mild
THIS should be co-administered with isoniazid to prevent peripheral neuropathy
VITAMIN B6 (PYRIDOXINE)
Helicobacter pylori infection can lead to what malignancy
GASTRIC LYMPHOMA (MALT)
–> antrum of stomach
–> systemic features (fever + night sweats)
Criteria to distinguish between exudate and transudate pleural effusion
LIGHTS CRITIERA
Exudates > 30g , transudate <30
if between 25-35 –> USE LIGHTS
pleural aspiration first then drainage
Send sample for pH, protein, lactate dehydrogenase, cytology and microbiology
8 MALE
pc: losing weight, lethargic, night sweats, RHS non tender lymphadenopathy and mild abdominal tenderness upon palpation.
Histology: starry sky pattern
What organism if indicated in patients condition:
BURKITT LYMPHOMA
EPSTEIN BARR VIRUS!
B-cell high grade neoplasm
Mx = chemo
Rapid response but may lead to tumour lysis syndrome. (RASBURICASE given before chemo to reduce risk of TLS)
paraesthesiae in limbs on neck flexion
Lhermitte’s syndrom
Dysphagia, aspiration pneumonia, halitosis →
pharyngeal pouch
IX - barium swallow combined with dynamic video fluroscopy
Management: surgery
Glasgow Coma Scale: adults
A 50-year-old man presents with right-sided ear pain and facial weakness. He had flu-like symptoms of fever and headache for three days before the rash appeared.
On examination, there is a right-sided facial nerve palsy. A vesicular rash is seen on otoscopy.
Treatment of Ramsay Hunt syndrome consists of
1. oral aciclovir
2. corticosteroids
herpes zoster oticus
Full recovery likely if antiviral tx started w/i 72 hours of onset of symptoms.
1st line = 800mg aciclovir 5 times daily for 7 days and prednisolone 60mg 5 days
acute management of DKA: insulin regime
START fixed rate insulin
Continue regular long acting insulin
STOP regular short acting insulin
0.1 unit/kg/hour
DKA mx
1. FLUID replacment - isotonic saline first
2. start fixed rate insulin infusion
3. once glucose >14 start 10% dextrose infusion 125mls/hr in addition to 0.9 NaCl regime
4. Correct electrolyte disturbances
DKA resolution is defined as:
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
Polymorphic ventricular tachycardia,
torsades de pointes
macrolides can prolong QT! e.g. azithromycin
When should a child presenting with glue ear be urgently referred to ENT
- DOWNS SYNDROME
- CLEFT PALATE
Tx usually:
- active observation for 3 months
- GROMMET INSERTION
- Adenoidectomy
TONSILLECTOMY
NICE recommend that surgery should be considered only if the person meets all of the following criteria
- sore throats are due to tonsillitis
- 5 or more episodes per year
- symptoms atleast year
- episodes are disabling
Complications of tonsillitis include:
otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely
suppressed TSH levels (below normal range) and normal serum thyroxine (T4) levels
indicate
Subclinical hyperthyroidism is associated with:
atrial fibrillation, osteoporosis and possibly dementia
dry AMD mx
High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss
An ECG shows absent T waves, large U waves and a prolonged PR interval
HYPOKALAEMIA
IV potassium infusion can be given at MAX **10mmol/hour **without cardiac monitoring!
Alcoholic ketoacidosis is managed
infusion of saline and thiamine
Rehydration - with IV fluids such as saline
Thiamine - to prevent the development of Wernicke’s encephalopathy
Pheochromocytoma investigation
Tests
24 hr urinary collection of metanephrines (sensitivity 97%*)
Management of phaeochromocytoma
- SURGERY
- alpha-blocker (e.g. phenoxybenzamine)
- beta-blocker (e.g. propranolol)
Features are typically episodic
hypertension (around 90% of cases, may be sustained)
headaches
palpitations
sweating
anxiety
Visual hallucinations with dementia :
Lewy body dementia
Mx: ACH i (Donepezil, rivastigimine) and memantine
Anterior uveitis management
URGENT OPTHAL REVIEW
- CYCLOPLEGICS (dilate the pupil to help relieve pain and photophobia) –> ATROPINE, CYCLOPENTOLATE
- Steroid eye drops
HLAB27 associated
**Features **
- blurred vision
- photophobia
- miosis (ciliary muscle spasm)
- pain (ciliary muscle spasm and raised IOP)
- CILIARY FLUSH
- IRREGULAR PUPIL!
Patient w/ pmh IHD & HTN pc: abdo pain , rectal bleeding and diarrhoea. after eating large meal.
CXR - no pneumoperitoneum or signs of obstruction
what is likely diagnosis and part of the colon affected:
ISHCAEMIC COLITIS
- bowel requires more blood flow for increased energy demands for digestion –> ischaemic colitis
SPLENIC FLEXURE
Thiazide diuretics can cause what biochemical picture
HYPERCALCAEMIA and hypocalciuria
65 MALE
PC: sudden onset painless vision loss in LEFT eye
FLASHES and floaters, reddish blurred vision in affected eye.
PMH: diabetics
Likely diagnosis
VIRTEOUS HAEMORRHAGE
Patient presents w/ rapid onset eye pain, watering of eye. photophobia, cotnact lens wearer , poor hygience, no fever headaches.
likely diagnosis
BACTERIAL KERATITIS
Acanthamoeba keratitis: associated with contact lens use
viral keratitis: herpes simplex, herpes zoster - may lead to a dendritic ulcer
notable decrease in systolic blood pressure during inspiration.
pulsus paradoxus
SEEN IN CARDIAC TAMPONADE
becks triad
- hypotension
- raised JVP
- muffled heart sounds
Flashes + floaters are most commonly caused by a
posterior vitreous detachment
conversely retinal detachement can be a complication of PVD and present with: sudden vision loss, veil covering visual field
Trick to remember complications of correcting sodium too fast:
Trick to remember complications of correcting sodium too fast:
‘if you go too high, the brain will die’ - central pontine myelinolysis
‘if you go too low, the brain will blow’ - cerebral oedema (hypernatraemia)
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
Progressive supranuclear palsy:
Management
poor response to L-dopa
