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#passmed 2023 > PASSPORT NAS TI7IT > Flashcards

PASSPORT NAS TI7IT Flashcards

1
Q

What order Adrenal Insufficiency is Addison’s?

A

Primary Adrenal Insufficiency

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2
Q

What is Addison’s Disease, aka what causes it?

A

When adrenal glands are damaged so don’t produce enough steroid hormones (cortisol + aldosterone)

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3
Q

What are the cause of primary adrenal insufficiency aka Addisons? (4 things)

A
  1. AI (90%)
  2. Infection (TB)
  3. Cancer (adrenal gland cancer)
  4. Trauma (from surgery)
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4
Q

Why should you investigate standing blood pressure for Addisons?

A

Bc with lack of cortisol, you will get orthostatic hypotension

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5
Q

Why is ACTH high in Primary Adrenal Insufficiency?

A

Because low cortisol –> -ve fdbk –> Pituitary releases more ACTH

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6
Q

What CF is caused by high ACTH in Primary Adrenal Insufficiency?

A

Bronze hyperpigmentation of skin

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7
Q

What does a Short Synacthen test tell you? (GOLD STANDARD)

A
  1. Primary = NO increase in cortisol* (bc adrenal glands r clarted)
  2. Secondary / Tertiary = increase in cortisol (bc its da pituitary / hypothalamus that r clarted)
    * = Cortisol should increase by more than double baseline if normal, if not = primary AI
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8
Q

What is are 3 Mx options for Adrenal Insufficiency? (3 things)

A

Steroid replacement
1. Hydrocortisone (to replace cortisol)
2. Fludrocortisone (to replace aldosterone)
(But remember in Addisonian crisis only replace hydrocortisone)
3. If in crisis, give fluids and dextrose as well

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9
Q

What are conservative Mx options for Addisons? (4 things)

A
  1. Avoid stress
  2. Healthy diet
  3. Stay hydrated
  4. No alcohol
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10
Q

How does High pH effect Hb?

A

High pH, Hb hugs (binds) oxygen
(Low pH, Lets go of oxygen) (Bohr effect)

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11
Q

How does Cold Temperature effect Hb?

A

Cold Temperature, Hb Clings to Oxygen
(hot temperature is the opposite obv)

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12
Q

What are the smoking cessation drugs? (4 things)

A
  1. Nicotine Replacement Therapy (NRT): Low dose nicotine in gum / patches
  2. Bupropion: antidepressant, causes anhedonia to smoking lol (aka less craving)
  3. Varenicline: fake nicotine
  4. Clonidine: anti-HTN
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13
Q

What are the CI for the smoking cessation meds?

A
  1. NRT: Recent MI / uncontrolled HTN
  2. Bupropion: pregnant / breastfeeding
  3. Varenicline: pregnant / breastfeeding
  4. Clonidine: recent MI
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14
Q

Why are MTX doses higher for Cancer than for RA? (3 things)

A
  1. Target of Tx: Cancer is killing cancer cells + shrinking tumours, while RA is just reducing inflamm + slow disease progression
  2. Route: Cancer is IV, so higher doses available, RA is oral so only smaller doses available
  3. Side fx: MTX has bad side fx such as liver damage, so benefits outweigh risk in cancer more than for RA for higher doses
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15
Q

What are some Extra articular features of RA?

A
  1. Eyes: scleritis / episcleritis / uveitis
  2. Vasculitis
  3. Pericarditis
  4. Interstitial Lung Disease (ILD)
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16
Q

What are the early XR findings of RA? (4 things)

A
  1. Could be normal
  2. Loss of joint space
  3. Juxta-articular osteopenia
  4. Soft-tissue swelling
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17
Q

What are the late XR findings of RA? (2 things)

A
  1. Bony erosions
  2. Subluxation (partial dislocation of joint)
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18
Q

What are the borders of Femoral triangle?

A

S-AL-IL (zay Khalil bs SALIL)

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19
Q

What are causes of lumps below inguinal ligaments? (6 things)

A
  1. Inguinal hernia
  2. Femoral hernia
  3. Lymphadenopathy
  4. Lipoma
  5. Cyst
  6. Abscess
20
Q

What are the complications of femoral hernias? (2 things)

A
  1. Strangulation (compromised vasc supply –> bowel ischaemia)
  2. Bowel obstruction
21
Q

What are the causes of SBO? (2 things)

A
  1. Adhesions
  2. Hernias
22
Q

What are the causes of LBO? (3 things)

A
  1. Malignancy
  2. Diverticular disease
  3. Volvulus (bowel twisting on itself)
23
Q

What does HIGHER up abd pain suggest in suspected BO?

A

SBO

24
Q

What does LOWER down abd pain suggest in suspected BO?

A

LBO
Lower pain = Large bowel

25
Q

What does EARLY vomiting suggest in suspected BO?

A

Proximal obstruction (SBO)
Remember: vomiting is from da mouth so da nearer obstruction is to da mouth da earlier it will present

26
Q

What does LATE vomiting suggest in suspected BO?

A

Distal obstruction (LBO)
Remember: vomiting is from da mouth so da nearer obstruction is to da mouth da earlier it will present

27
Q

What causes the abd pain in BO?

A

Peristalsis

28
Q

Which BO has MORE significant abd distension?

A

LBO

29
Q

What would a AXR show in SBO? (3 things)

A
  1. Changes in CENTRAL abdomen
  2. Dilated bowel (3+ cm)
  3. Valvulae conniventes (lines COMPLETELY crossing bowel)
30
Q

What would a AXR show in LBO? (3 things)

A
  1. Changes in PERIPHERAL abdomen
  2. Dilated bowel (6+ cm / 9+ cm @ caecum)
  3. Haustra (lines that only cross bowel Halfway)
31
Q

What are some other differentials that present similarly to BO?

A
  1. Pseudo-obstruction
  2. Paralytic ileus
  3. Constipation
32
Q

What is a pseudo-obstruction?

A

Resembles mech GI obstruction but NO real obstructing lesion

33
Q

What is the treatment for pseudo-obstruction? (2 things)

A
  1. Neostigmine (myasthenia gravis treatment)
  2. Colonoscopic decompression
34
Q

How do you differentiate between pseudo-obstruction VS BO? (2 things)

A

Pseudo-obstruction =
1. ABSENT bowel sounds
2. LESS pain

35
Q

What meds can you give to someone on dialysis? (3 things)

A
  1. EPO injection (bc kidney not making EPO)
  2. Phosphate binder (calcium carbonate) (bc high P levels)
  3. vit D (bc low levels)
36
Q

What are the indications for dialysis? (5 things)

A

Severe CKD / end stage renal disease (ESRD) with CF:
1. Hyperkalaemia
2. Metabolic acidosis
3. Uremic pericarditis
4. Uremic encephalopathy
5. Fluid overload

37
Q

What are the stages of CKD?

A
38
Q

What are the differences between Haemodialysis and peritoneal dialysis? (4 things)

A

Filter, fistula, frequency, fast / slow:
* Haem: External machine is FILTER
* Peritoneal: uses pt own peritoneal membrane is FILTER
.
* Haem: AV fistula
* Peritoneal: catheter into peritoneal cavity
.
* Haem: 3x a week @ centre
* Peritoneal: Daily @ home
.
* Haem: 3-4 hours per session during day
* Peritoneal: several hours overnight

39
Q

What are manoeuvres used to reduce Shoulder dislocation? (2 things)

A
  1. Stimsons manoeuvre: Sandbag on hand + Slowly allowing it to pull shoulder back (pt prone on table) (SSS)
  2. Hippocratic manoeuvre: pt lying on back, arm abd 90, elbow flexed 90, arm rotated in circular motion to push it back in
40
Q

Who can take a patient off of a MH section?

A

Responsible clinicial (RC)

41
Q

What are 4 forms of self harm?

A
  1. Cutting
  2. Substance abuse
  3. Restrictive eating / purging
  4. Suicidal behaviour (thoughts / plans of suicide)
42
Q

What should you not give in Panic disorder? (5 things)

A
  1. Stimulants (caffeine)
  2. Anticholingergics
  3. Antihistamines
  4. Antipsythotics
  5. Steroids
    (SAAAS)
43
Q

How is SA node affected in Panic attack? (6 steps)

A
  1. Stimulus
  2. Sympathetic NS activated
  3. Adrenaline + Noradrelaine released
  4. Adrenaline + Noradrelaine act on SA node
  5. SA node firing increased  HR increased
  6. CF: palpitations
44
Q

What are some Psychological complications of stress? (4 things)

A
  1. Anxiety
  2. Depression
  3. Insomnia
  4. PTSD
45
Q

What are some Psychosomatic complications of stress? (3 things) (incase that’s what they were asking)

A
  1. Headaches
  2. Muscle tension
  3. Digestive problems
46
Q

What cells produce TSH?

A

Thyrotrophs in Ant pituitary

#passmed 2023 (39 decks)

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