Pearls from Dr Hogan

Question 1

What are four possible causes of delirium after surgery?

Answer 1

PE

Side effect of opioid

Sepsis

Alcohol withdrawal

Question 2

What are the 3 major indications for dialysis?

Answer 2

Metabolite control

• acid/base
• urea

Fluid control

Control hyperkalaemia

Question 3

What is antiphospholipid syndrome?

Answer 3

Is haemostatic disorder that manifests with recurrent venous or arterial thrombotic event and/or fetal loss

Laboratory abnormalities found are persistently elevated levels of antibodies directed against membrane anionic phospholipids

Question 4

What are the words macular and papular used to describe?

Answer 4

Whether a skin lesion is risen (papular) or flat (macular)

Question 5

What do the words petechia, purpura and ecchymosis refer to?

Answer 5

All are descriptions of the size of macule of blood under the skin

Petechia - pin point sized

Purpura is larger

Ecchymosis even larger

None of them blanche

Question 6

How might Fe deficiency present in the hands?

Answer 6

Spooning of the fingers (Koilonychia)

Question 7

What is the underlying cause of leukonychia?

Answer 7

Hypoalbuminea

Question 8

What are some causes of hypoalbuminaemia?

Answer 8

Liver failure

Protein losing enteropathies (albumin lost through GIT)

Extensive thermal burns

Question 9

How might a protein losing enteropathy present and what are some causes?

Answer 9

Leukonychia, peripheral - only if loss can not be compensated for my increase production

Crohn’s disease

Tumours

Menetrier’s disease

Coeliac’s disease

Lymphatic disorders

Question 10

What should be done when examining a caput medusae?

Answer 10

Check for direction of blood flow by occluding each end

Question 11

What are the 4 sites of possible varices in portal hypertension?

Answer 11

Lower oesophagus

Rectum

Umbilicus

Question 12

What are the stigmata of chronic liver disease?

Answer 12

Jaundice

Hepatomegaly

Splenomegaly

Palmar erythema

Leukonychia

Dupuytrens contracture

Clubbing

Caput medusae

Spider naevi

Gynaecomastia

Testicular atropy

Ascites

Asterixis

Question 13

What are the 5 causes of a massive spleen?

Answer 13

Malaria

Visceral leishmaniasis aka Kalar Azar

Hairy cell leukaemia

CML

Mylofibrosis

Question 14

How would a right sided internuclear ophthalmoplegia (INO) present on eye examination? What condition would be the mostly likely cause?

Answer 14

On laze to the left;

R eye would fail to adduct

L eye would exhibit significant nystagmus

Question 15

What are 3 possible causes of anaemia in HIV?

Answer 15

Anaemia of chronic disease

Warm autoimmune anaemia

HART therapy suppression of RBC production

Question 16

What are some causes of warm autoimmune haemolytic anaemia?

Answer 16

Primary: Idiopathic

Secondary: SLE

Lymphoproliferative disorders (CLL, lymphomas)

Drugs

Infections - HIV, CMV, EBV

Question 17

How does B12 deficiency cause internuclear ophthalmoplegia?

Answer 17

Degradation of the mamilary bodies

Question 18

What is the difference

Question 19

What are two red flag questions to ask about for headache?

Answer 19

Is the headache present upon waking before moving

Is the headache associated with vomiting

Question 20

How might you be able to differentiate septic shock from cardiogenic shock clinically?

Answer 20

The hands will be warm in septic shock due to peripheral vasodilation

Question 21

What is protein-losing enteropathy? What are some causes?

Answer 21

Increased protein loss across an abnormal mucosa causing hypoalbuminaemia

Inflammatory or ulcerative lesions (eg Crohn’s), tumours, Menetrier’s, coeliac disease and lymphatic disorders

Question 22

What are some causes of hypoalbuminaemia?

Answer 22

Deficient production: liver disease

Increased loss: nephritic disease, protein loss enteropathy

Nutrient deficiency: Kwashiorkor’s