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Y3 Medicine > Random 13 > Flashcards

Random 13 Flashcards

1
Q

How do you manage an egfr <15?

A
  1. Treat underlying condition
  2. Manage BP
  3. Proteinuria
  4. Avoid NSAIDs
  5. Manage complications of the disease e.g (renal metabolic disease and anaemia)
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2
Q

What is the result of vitamin D toxicitiy?

A

AKI

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3
Q

What is the enzyme that activates vitamin D in the kidney?

A

1-alpha-hydroxylase

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4
Q

Why is stage 3 split into two groups?

A

3b has a increase in CHD by x 3

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5
Q

What are symptoms of pneumonia?

A

Fever
Malaise
Rigors
Cough
Purulent sputum
Pleuritic chest pain
Haemoptysis

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6
Q

What is the PSI?

A

Pneumonia severity index Estimates mortality for adult patients with community-acquired pneumonia.

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7
Q

Describe HAP

A

This is a lower respiratory tract infection that develops more than 48 hours after hospital admission. The most common organisms are Pseudomonas aeruginosa, Staphylococcal aureus, and Enterobacteria.

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8
Q

Describe aspiration pneumonia

A

This occurs in patients with an unsafe swallow. Risk factors include stroke, myasthenia gravis, bulbar palsy, alcoholism, and achalasia. On chest x-ray the right lung is most commonly affected, as the right bronchus is wider and more vertical than the left bronchus, making it more likely to facilitate the passage of aspirate.

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9
Q

Describe staphylococcal pneumonia

A

A bilateral cavitating bronchopneumonia due to staphylococcal aureus, a gram-positive cocci found in clusters.
It is found in intravenous drug users, elderly patients, or patients who already have an influenza infection

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10
Q

Describe Klebsiella pneumonia

A

Primarily affects the upper lobes resulting in a cavitating pneumonia, presenting with “red-currant” sputum.
It is caused by a gram-negative anaerobic rod.
Furthermore, there is an increased risk of developing complications including empyema, lung abscesses and pleural adhesions.
Patients at risk of Klebsiella pneumonia are those with weakened immune systems such as elderly, alcoholics, and diabetics.
Additional at-risk groups include patients with malignancy, chronic obstructive pulmonary disease, long term steroid use and renal failure.

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11
Q

Describe mycoplasma pneumonia

A

Presents with flu like symptoms consisting of flu, arthralgia, myalgia, dry cough and headache.
It primarily affects younger patients.
Additional features include auto-immune manifestation due to cold agglutinins causing an autoimmune haemolytic anaemia.
Complications that are associated with this pneumonia include: erythema multiforme; Stevens-Johnson Syndrome; Guillain-Barre Syndrome and meningoencephalitis.

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12
Q

Describe legionella pneumonia

A

Fever, myalgia and malaise followed by a dyspnoea and a dry cough. It is associated with Legionnaire’s disease, usually in patients who have been exposed to poor hotel air conditioning.

Look for hyponatraemia and deranged LFTs on blood tests. Legionella antigen may be present in the urine.

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13
Q

Describe chlamydia psitacci pneumonia

A

Chlamydophila psittaci is an intracellular bacteria that results in psittacosis. It is acquired from contact with infected birds such as parrots, cattle, horse and sheep.
Features include lethargy, arthralgia, headache, anorexia, dry cough and fever.
Additional features include: hepatitis; splenomegaly; nephritis; infective endocarditis; meningoencephalitis and a rash.

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14
Q

Describe pneumocystis pneumonia

A

This is associated with patients who are immunosuppressed (malignancy or chemotherapy) or HIV positive.
The causative organism is known as pneumocystis jiroveci and is a fungus. In patients who are HIV-positive the risk of PCP increases when the CD4+ <200 cells/uL.
Symptoms include exertional dyspnoea, dry cough, and fever.

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15
Q

Describe investigations for pneumonia

A

ABG
Bloods – FBC, U&E, LFT, ESR, CRP
Blood culture
Sputum for microscopy & culture
Polymerase chain reaction: for mycoplasma pneumonia
Urine antigen: for legionella and pneumococcal pneumonia
Chest X-ray: identify lobar, multi-lobar, cavitation and signs of pleural effusion

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16
Q

What are risk factors for pneumonia?

A
  • Age >65
  • COPD, Asthma, Bronchiectasis
  • Viral
  • Stroke, seizures, GORD
  • Smoking and alcohol (aspiration)
  • Prisons, homeless shelters
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17
Q

What are typical organisms for pneumonia?

A
  • Strep pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staph aureus
  • Group A streptococci
  • Klebsiella (alcoholics)
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18
Q

What are atypical organisms for pneumonia?

A

Legionella spp

*Mycoplasma pneumoniae

*Chlamydia pneumoniae

*Chlamydia psittaci

*Coxiella burnetii

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19
Q

Once heart failure is suspected, what are your next steps?

A
  1. Take a detailed history and perform a clinical examination
  2. Perform ECG, consider CXR, blood tests, urinalysis, peak flow or spirometry.
  3. Measure NT-proBNP
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20
Q

What NT-pro-BNP level warrants an urgent 2 week wait referral?

A

> 2,000ng/l.

Specialist clinical assessment including transthoracic echocardiography

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21
Q

What drug is given in heart failure first line for relief of congestive symptoms and fluid retention?

A

Diuretics (furosemide)

22
Q

Once starting an ACEi for heart failure, what must you make sure you do?

A

Measure serum sodium, potassium and assess renal function, before and 1-2 weeks after starting the ACEi and after each dose increment.

23
Q

What drugs do you start in heart failure with reduced ejection fraction?

A

Offer ACEi and BB

An MRA if symptoms continue (Spirononlactone, Eplerenone)

24
Q

In heart failure with reduced ejection fraction, what should you do if the patient is intolerant to an ACEi?

A

Start on ARB

25
Q

What is Beck’s triad?

A

Hypotension, muffled heart sounds and jugular venous distension that signifies cardiac tamponade.

26
Q

What is pulsus paradoxus?

A

Exaggerated drop in systolic blood pressure when the patient breathes in.

During inspiration, the negative intrathoracic pressure causes an increase in venous return to the right side of the heart. This leads to further compression of the left side of the heart due to the restricted filling, resulting in a decrease in the arterial pulse amplitude.

27
Q

What are examples of target organ damage in hypertensive emergencies?

A
  • The heart (IV glyceryl trinitrate)
  • Aortic dissection
  • Pulmonary oedema
  • Hypertensive encephalopathy
  • Acute renal failure
28
Q

What is p wave asystole?

A

The p waves are not conducted at all so you will see no electrical activity of the p waves on an ecg. Unlike in ventricular tachycardia where the atria may still be conducted but the signal does not reach the ventricles.

29
Q

What is the reversal/antidote for heparin?

A

Protamine

30
Q

What is Octaplex?

A

Octaplex is a medication used in the treatment of bleeding episodes and to reverse the effects of certain anticoagulant medications. It is a prothrombin complex concentrate (PCC) containing factors II, VII, IX, and X, as well as proteins C and S. These factors are essential for the normal clotting of blood.

31
Q

What is TACO?

A

Transfusion associated circulatory overload

  • Low body weight <50kg
  • > 60 years old
  • Cardiac failure
  • Renal impairment
  • Fluid balance
  • Peripheral oedema
32
Q

What is hypokinesia?

A

Hypokinesia of the heart refers to a condition where a part of the heart muscle exhibits reduced or weakened contraction during each heartbeat.

33
Q

What is stress induced cardiomyopathy?

A

Stress-induced cardiomyopathy, also known as takotsubo cardiomyopathy or broken heart syndrome, is a temporary heart condition where the heart muscle weakens and can’t pump blood effectively. This condition is often triggered by extreme emotional or physical stress, such as the death of a loved one, a serious illness, a sudden loss, or a significant accident.

In stress-induced cardiomyopathy, the heart’s left ventricle, which is the main pumping chamber, temporarily enlarges and weakens, causing symptoms similar to a heart attack, such as chest pain and shortness of breath

34
Q

What is milk of magnesia?

A

Antacid as-well as a laxative. It is a liquid suspension of magnesium hydroxide, a mineral that works by drawing water into the intestines, softening the stool and making it easier to pass.

35
Q

What is hemoglobin H disease and how is it related to gall stones?

A

Hemoglobin H disease (MEH) is where there are 3 alpha globin genes deleted. Moderately severe which results in microcytic anaemia.

In HbH disease, the excess bilirubin, a component of bile, can precipitate and form stones in the gallbladder, leading to the development of gallstones.

36
Q

What is a balloon trawl/sweep in ERCP?

A

Balloon sweep: It is useful for extracting stones from the bile duct. A cannula is inserted that has an inflatable ball at its tip. The ball passes while deflated and is placed distal to the stone, then it is inflated and with this the stone is pushed out.

37
Q

What is the most common primary adrenal insufficiency?

A

Autoimmune (Addison’s disease)

38
Q

What is the blood supply to the adrenal gland?

A

Renal arteries, aorta and inferior phrenic artery.

39
Q

What is the venous drainage of the adrenal gland?

A

Right into the inferior vena cava and left into the left renal vein.

40
Q

What are the hormones produced from the zona fasiculata?

A

Glucocorticoids

  • Prednisolone
  • Dexamethasone
  • Hydrocortisone
  • Fludrocortisone
41
Q

What hormones are produced from the zona reticularis?

A

Androgens

Dehydroepiandrosterone (DHEA): DHEA is a precursor hormone that can be converted into other androgens, including testosterone and estrogen.

42
Q

What hormones are released from the zona glomerulosa?

A

Mineralocorticoids

Aldosterone

43
Q

Does hyperpigmentation occur in ACTH dependent or ACTH independent adrenal insufficiency?

A

ACTH dependent. Nothing is wrong with the pituitary gland, low cortisol stimulates the production of ACTH.

44
Q

What are causes of primary adrenal insufficiency (problem with the adrenal gland)

A
  • Autoimmune
  • Malignancy
  • Infiltration (sarcoidosis)
  • Infection (TB, fungal)
  • Vascular (hemorrhage, sepsis)
45
Q

What are the causes of secondary adrenal insufficiency (problem with the pituitary gland)

A
  • Tumors
  • Infection
  • Inflammation
  • Infiltration
46
Q

What are sick day rules?

A

If you feel unwell, increase the dose of your cortisol for 48 hours.

47
Q

What are the three clinical features of an addisonian crisis?

A
  • Hypoglycemia
  • Hyponatremia
  • Hypotension that does not improve with fluids
48
Q

What are the two side effects of fludrocortisone?

A

Hypokalemia and fluid overload.

49
Q

What are some causes of primary hyperaldosteronism?

A

Conn’s (adenoma)
Bilateral hyperplasia
GRA

50
Q

What are some causes of secondary hyperaldosteronism?

A
  • RTA
  • Renovascular
  • Cirrhosis
  • CHF
  • Nephrotic syndrome
  • Renin secreting tumour

Y3 Medicine (17 decks)

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