PM2 Flashcards
[] is the investigation of choice for suspected Boerhaave’s syndrome
CT contrast swallow is the investigation of choice for suspected Boerhaave’s syndrome
What is the difference in murmur between pulmonary and tricuspid stenosis? [2]
Pulmonary stenosis: ejection systolic
tricuspid stenosis: diastolic
Difference between Cushing disease and syndrome? [2]
Cushing’s syndrome is a collection of signs and symptoms due to prolonged exposure to cortisol and Cushing’s disease is a specific type of Cushing’s syndrome characterised by increased ACTH production of because of a pituitary adenoma (or sometimes due to excess production of hypothalamus CRH).
CI to diclofenac for kidney stones? [2]
CKD; recent upper GI bleeds
to
Describe how you alter paracetamol tx depending on time of ingestion of paracet.
If < 4hrs:
- Wait until 4 hrs and measure paracetamol levels
If > 4hrs:
- NAC immediately
If staggered:
- Give NAC immediately
Surgical emphysema, chest pain & vomiting blood indicates what pathology? [1]
Boerhaave’s syndrome
Which electrolyte disturbances are a RF for VT? [3]
Which is the most important? [1]
Hypokalemia, hypomagnesemia, and hypocalcemia may predispose patients to either monomorphic VT or torsade de pointes.
A deficiency in which immunoglobulin increases the risk of such blood transfusion reaction?
IgA
IgD
IgE
IgG
IgM
A deficiency in which immunoglobulin increases the risk of such blood transfusion reaction?
IgA
IgD
IgE
IgG
IgM
What is dialysis dysequilibrium syndrome? [1]
As urea doesn’t leave the BBB as quick so you have excess urea in the brain but lower in circulation so there is a shift of water into the brain causing cerebral oedema
What are the HbA1c targets for DMT2 patients? [2]
What HbA1c do you add a therapy after titrating up metformin to maximum dose? [1]
The standard HbA1c target in type 2 diabetes mellitus is 48 mmol/mol for those taking a signal drug not associated with hypoglycaemia (in this case metformin).
For those taking more than one medication or a single medication associated with hypoglycemia then the target would be 53 mmol/mol.
Only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
DVT investigation: if the scan is negative, but the D-dimer is positive → how do you manage? [1]
DVT investigation: if the scan is negative, but the D-dimer is positive → stop anticoagulation and repeat scan in 1 week
What MCV results are seen in SCA? [1]
Sickle cell disease causes a normocytic anaemia with raised reticulocyte count - due to haemolysis
What is the treatment of nephrogenic DI? [1]
Thiazide like diuretic:
- In simple terms DI leads to the production of vast amounts of dilute urine which is dehydrating and raises the plasma osmolarity, stimulating thirst. The effect of the thiazide causes more sodium to be released into the urine. This lowers the serum osmolarity which helps to break the polyuria-polydipsia cycl
Carcinoid syndrome can affect the [] side of the heart. The valvular effects are [] insufficiency and [] stenosis
Carcinoid syndrome can affect the right side of the heart. The valvular effects are tricuspid insufficiency and pulmonary stenosis
Which pathologies make up Men1, 2a & 3a [+]
What makes a AAA a high risk of rupture? 1[]
The presence of abdominal pain (1) indicates a symptomatic AAA which has a high risk of rupture, and these need surgical intervention rather than watching/medical treatment
How do you differentiate between rhabdomyolysis and other pathologies from blood results? [1]
rhabdomyolysis normally has CK elevations 5x greater than normal
elevations of CK that are ‘only’ 2-4 times that of normal are not supportive of a diagnosis and suggest another underlying pathophysiology
myoglobinuria: dark or reddish-brown colour
Acute limb ischaemia:
- Doppler or duplex? [1]
Doppler
The treatment of biliary colic is [] in the acute phase.
he treatment of biliary colic is analgesia in the acute phase.
Describe the DMT1 sick day rules with regards to:
- Fluid intake
- Checking glucose levels
- Checking ketone levels
- Meal contents
Describe the DMT1 sick day rules with regards to:
Fluid intake:
- Aim 3L water
Checking glucose levels:
- check blood glucose more frequently, for example, every 1-2 hours including through the night
Checking ketone levels:
- consider checking blood or urine ketone levels regularly
Meal contents
- if appetite is reduced meals could be replaced with carbohydrate-containing drinks (such as milk, milkshakes, fruit juices, and sugary drinks)
Describe the DMT2 sick day rules with regards to:
- Medication [1]
Consider stopping oral hypoglycaemics
WPW is associated with which cardiac disease? [1]
HOCM
What are the different stages of CKD? [5]
Investigation for ? colovesical fistula complication of diverticular disease? [1]
abdominal CT scan
? abscess of colon should be investigated by..
Acutely unwell surgical patients should be investigated in a systematic way. Plain abdominal films and an erect chest x-ray will identify perforation. An abdominal CT scan (not a CT cologram) with oral and intravenous contrast will help to identify whether acute inflammation is present but also the presence of local complications such as abscess formation.
Coagulase-negative, Gram-positive bacteria such as [] are the most common cause of neutropenic sepsis
Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis are the most common cause of neutropenic sepsis
A 52-year-old male presents with tearing central chest pain. On examination, he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF. What is the likely explanation? [1]
An inferior myocardial infarction and AR murmur should raise suspicions of an ascending aorta dissection rather than an inferior myocardial infarction alone. Also the history is more suggestive of a dissection.
Other features may include pericardial effusion, carotid dissection and absent subclavian pulse.
distal aorta → limb ischaemia
Complete heart block with broad complex QRS WITH bradycardia treatment? [1]
transvenous pacing
Describe the two types of hepatorenal syndrome [2]
What indicates a patient has HRS? [1]
How do you treat? [3]
functional kidney impairment that occurs in patients with advanced liver disease.
Treatment:
* vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation
* volume expansion with 20% albumin
* transjugular intrahepatic portosystemic shunt
A
A patient has acute tubular necrosis. How does their urine urine osmolality and urine sodium change? [2]
Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high
What change is seen in this kidney biopsy? [1]
Glomeruli are full of crescents.
NSTEMI management: unstable patients should have immediate []
NSTEMI management: unstable patients should have immediate coronary angiography
A patient has a UTI and CKD < 45. What is the treatment of choice for the UTI? [1]
Trimethoprim
What is the inheritance of CF? [1]
A woman presents to you for discussion of her recent genetic testing. She is pregnant with a new partner who has cystic fibrosis. Her results show that she is heterozygous for the disease.
What is the probability that their offspring will have this disease? [1]
Autosomal recessive
50
What does this CT show? [1]
Background of XS alcohol
Pancreatic pseudocyst
A mild jaundice, raised WCC and dense fluid-filled mass on CT are classic findings. Note fluid is less dense than the surrounding tissues and will therefore appear darker on CT
If symptomatic, one of the following results is sufficient for diagnosis for DMT2
Random blood glucose ≥ [] mmol/l
Fasting plasma glucose ≥ [] mmol/l
2-hour glucose tolerance ≥ [] mmol/l
HbA1C ≥ [] mmol/mol (6.5%)
If symptomatic, one of the following results is sufficient for diagnosis:
Random blood glucose ≥ 11.1mmol/l
Fasting plasma glucose ≥ 7mmol/l
2-hour glucose tolerance ≥ 11.1mmol/l
HbA1C ≥ 48mmol/mol (6.5%)
The BNF reports high doses or rapid intravenous administration of loop diuretics can cause []
The BNF reports high doses or rapid intravenous administration of loop diuretics can cause tinnitus and deafness.
In life-threatening bleeds what should you give a haemophiliac A patient? [1]
Haemophilia A affects factor VIII levels, and in major or life-threatening bleeds, recombinant factor VIII is the most appropriate treatment.
Desmopressin raises factor VIII levels and is used in minor bleeding in haemophilia A; it is not used in major bleeds.
Which biomarker should be used if you suspect an infarct, but the patient has had an infarct 3 days ago? [1]
Creatine Kinase-MB (CK-MB)
- Troponin levels can be elevated for up to 2 weeks after the initial infarct episode, whilst CK-MB usually clear by 72 hours. A CK-MB level of more than 3 times the upper limit of normal is generally considered to be indicative of one.
How do you treat hiatus hernias? [3]
all patients benefit from conservative management e.g. weight loss
medical management: proton pump inhibitor therapy
surgical management: only really has a role in symptomatic paraesophageal hernias
How do you differentiate between the most likely causes of primary and secondary aldosterinism? [1]
Explain your answer
Primary and secondary aldosteronism can be differentiated by looking at the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis:
- Because the blood flow through the renal arteries is slow, the kidney interpret the blood pressure to be low. This is sensed by macula densa. A low blood pressure in the renal artery means a lower glomerular filtration rate which means longer time to absorb salts. When salts are low when the tubular fluid reaches the macula densa, the kidneys know their blood pressure is low, and thus interpret that the systemic blood pressure must be low too. Thus they organize renine to fix the problem.
What are the 4 stages to testicular tumour spreaD? [4
A patient is fat and presents with this symptom. What does it specifically suggest? [1]
eruptive xanthomas - hypertriglyceridemia
Explain the change in JVP waveform you see in tricuspid regurgitation
Big v waves
- Tricuspid regurg happens during ATRIAL DIASTOLE, and means some blood moves from the ventricle to the atria filling it even more, and sending more of an equal and opposite force upwards to the internal jugular vein hence why we see prominent v waves.
Describe these changes seen in CXR [1]
What disease does this indicate? [1]
Ring shadows in the left lower zone are consistent with bronchiectasis.
Resp. causes of clubbing? [+]
Lung cancer
ILD / IPF
Bronchiectasis
CF
Lung abscess
Name what the arrow is pointing at [1]
What drug class might you expect to see them in? [1]
Hyaline casts may be seen in the urine of patients taking loop diuretics
