Random 14 Flashcards
What does a high aldosterone/renin ratio indicate?
Hyperaldosteronism
How do you diagnose hyperaldosteronism?
To diagnose hyperaldosteronism, the following tests are commonly used:
First-line:
Aldosterone/Renin ratio: A high ratio is suggestive of hyperaldosteronism.
Second-line:
High-Resolution CT (HRCT) or MRI: To locate potential adrenal lesions.
Selective adrenal venous sampling: Considered the gold standard for localising the source of excess aldosterone, especially when distinguishing between Conn’s Syndrome and bilateral adrenal hyperplasia.
What are the three criteria that warrant immediate investigation into high blood pressure?
- <40 years old
- Hypokalaemia
- Resistant HT (not controlled by 3 agents)
What are some investigations for adrenal cushing’s syndrome?
- 2 x 24 hour (UFC)
- Overnight dexamethasone suppression test
- Salivary cortisol
- Midnight cortisol
- Low dose dexamethasone suppression test
- ACTH, serum K, High dose dexamethasone suppression test
- CT adrenal
How do you treat bilateral hyperplasia of the adrenal glands?
Bilateral adrenalectomy (lifelong steroid replacement) or medical treatment
What are features of phaecohromocytoma?
- Resistant HTN
- Palpitations
- Headaches
- Sweating
- Pallor
- Flushing
- Pyrexia
- Visual disturbance
- Livido reticularis
- Postural hypotension
How do you investigate phaeochromocytoma?
- 24 hour urine catecholamines/metanephrines
- Plasma metanephrines
- CT, MRI, FDG PET
When treating a phaeochromocytoma, why is it important to block the alpha receptors before the beta receptors?
Because alpha receptors control blood pressure and beta control the heart. You can’t drop the blood pressure once the heart rate has been decreased. This could trigger a crisis.
Examples of alpha blockers
Phenoxybenzamine and Prazosin
Why do you get immunosuppression in cushing’s even though you have neutrophila?
The neutrophils are unresponsive.
Explain dialysis
Dialysis is a medical procedure that serves to regulate electrolytes, remove excess water, acid and waste products from the body when the kidneys cannot perform this function.
What is the difference between haemodialysis and haemofiltration?
In haemodialysis, the patient’s own blood is cleansed outside the body and then returned to their circulation after the waste products and excess substances have been removed.
In hemofiltration, convective transport is used to push waste products and excess fluids out of the blood, and a replacement fluid is simultaneously given to the patient. This replacement fluid helps maintain the necessary fluid balance in the body.
What are common complications of dialysis in general?
Cramps, nausea, cardiovascular disease, infections, fistulas and dialysis disequilibrium syndrome
What is dialysis disequilibrium syndrome?
Dialysis disequilibrium syndrome (acute cerebral oedema due to rapid extraction of osmotically active substances; more common in severe uraemia)
What are complications of haemodialysis?
- Fistula-related complications- bleeding, stenosis, thrombosis, aneurysm, infection
- Dialyser reactions- air embolus
- Cramps, nausea and vomiting
What and why is the leading cause of death in dialysis patients?
Cardiovascular disease
CKD accelerates atherosclerosis
fluid and electrolyte imbalance= arrhythmias
HTN= strain on the heart and blood vessels
Calcification of arteries
What is a major complication of peritoneal dialysis?
Peritonitis.
Other complications are hernias, tunnel infections and peritoneal leaks.
What are the complications of fluid overload?
Excess fluid in the body can strain the heart, leading to hypertension, heart failure, and pulmonary edema.
What are the complications of dehydration?
Insufficient fluid can impair kidney function, lead to electrolyte imbalances, and cause weakness, dizziness, and confusion.
What changes are seen in an inferior STEMI?
ST elevation in leads II, III, aVF
Hyperacute T waves may precede these changes
Reciprocal ST depression in aVL
Progressive development of Q waves in II, III, aVF
