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Y3 Medicine > Random 17 > Flashcards

Random 17 Flashcards

1
Q

What are some causes of euvolemic hyponatremia?

A
  • Glucocorticoid deficiency, severe hypothyroidism and SIADH
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2
Q

What are some causes of hypovolemic hyponatremia?

A

Renal or extra-renal loss of sodium

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3
Q

Give 5 drug groups that cause hyponatremia

A
  • Thiazides
  • Loop diuretics
  • Potassium sparing diuretics
  • Tricyclic antidepressants
  • SSRIs
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4
Q

What are some examples of tricyclic antidepressants?

A
  • Amitptyline
  • Clomipramine
  • Dosulepin
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5
Q

What are some examples of SSRIs?

A
  • Citaloparm
  • Fluoxetine
  • Sertraline
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6
Q

What are some examples of MAO inhibitors?

A
  • Phenelzine
  • Isocarboxazid
  • Moclobemide
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7
Q

What is the criteria for diagnosing SIADH?

A
  • Serum osmolality <275msom/kg
  • Urine osmolality >100mosm/kg
  • Urine sodium >30mmol/L
    Absence of adrenal, thyroid, pituitary or renal insufficiency
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8
Q

What are some investigations for hyponatremia?

A
  • Paired serum and spot urine osmolality.
  • 9am serum cortisol
  • Thyroid function tests
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9
Q

What is the step by step management in treating hyponatremia?

A
  1. Within first hour- IV infusion 150mL 3% hypertonic saline or equivalent over 20 minutes
  2. Check Na- IV infusion 150mL 3% hypertonic saline or equivalent over 20 minutes
  3. Repeat twice or until 5mmol/L increase in Na
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10
Q

What are some causes of hyperandrogenism?

A
  • PCOS
  • CAH
  • Cushing’s
  • Acromegaly
  • Androgen secreting tumor
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11
Q

What are the characteristics of MEN (multiple endocrine neoplasia) 1?

A
  • Pituitary adenoma
  • Parathyroid hyperplasia
  • Pancreatic tumors
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12
Q

What are the characteristics of MEN 2A?

A
  • Parathyroid hyperplasia
  • Medullary thyroid carcinoma
  • Pheochromocytoma
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13
Q

What are the characteristics of MEN 2B?

A
  • Mucosal neuromas
  • Marfanoid body habitus
  • Medullary thyroid carcinoma
  • Pheochromocytoa
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14
Q

What 5 things should be taken into consideration with decisions/assessing about patients who may lack capacity?

A
  1. Presume capacity
  2. Support to make a decision
  3. Just because a decision is unwise, does not mean they lack capacity.
  4. Best interests
  5. Least restrictive
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15
Q

What is an exception to the best interests principle?

A

Advance decision to refuse treatment

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16
Q

What is the diagnostic part of the MC assessment?

A
  1. Is there a disorder of the mind
  2. Judgement needs to be made, how urgent is this decision? Can we wait until they are better
17
Q

What is the functional part of the MC assessment?

A
  • Understand
  • Retain
  • Weight up
  • Communicate their decision
18
Q

Does someone in a coma or in locked in syndrome have capacity?

A

No
They are unable to communicate their decision

19
Q

What two types of lasting power of attorneys are there?

A

For treatment and financial decisions

20
Q

What is the normal QRS complex duration?

A

0.06 and 0.10 seconds (60 to 100 milliseconds)

21
Q

What is the difference between Lambert-Eaton syndrome and Myasthenia Gravis?

A

Lambert-Eaton Myasthenic Syndrome (LEMS):

Response Pattern: LEMS is associated with an incremental response to repetitive nerve stimulation. This means that the muscle strength improves with repeated or sustained stimulation.
Explanation: LEMS is primarily characterized by impaired release of acetylcholine at the neuromuscular junction. With repetitive stimulation, the available acetylcholine accumulates, leading to an increase in muscle strength.
Myasthenia Gravis (MG):

Response Pattern: MG is characterized by a decremental response to repetitive nerve stimulation. This means that the muscle strength decreases with repeated or sustained stimulation.
Explanation: MG is an autoimmune disorder where the body produces antibodies that block or destroy acetylcholine receptors at the neuromuscular junction. With repetitive stimulation, the available acetylcholine becomes depleted, leading to a decrease in muscle strength.

22
Q

How do you define/work out a high urea:creatinine ratio and what does it signify?

A

Most importantly, their urea to creatinine ratio is increased. To calculate the urea to creatinine ratio you need to divide the urea by the creatinine divided by 1000. In this case, we need to do 16.1/(123/1000) which gives a result of 131.

Urea to creatinine ratio above 100 is a landmark characteristic of a pre-renal acute kidney injury. Urea and creatinine are both freely filtered at the glomerulus, but urea can be reabsorbed if the body’s homeostatic system perceives a decrease in fluids. Hence, an increased ratio equals a pre-renal cause of disease.

23
Q

Why should ACEi be stopped in AKI?

A

They cause a drop in perfusion to the kidneys.

Vasodilate the efferent arteriole which drops the blood pressure.

24
Q

What ages can you use the QRISK3 score?

A

25-84.

25
Q

In an NSTEMI, what does the GRACE score have to be to start PCI in 72 hours?

A

3

26
Q

What is the difference between a direct and indirect coombs test?

A

The direct Coombs test (DAT) detects antibodies attached to the surface of red blood cells, aiding in the diagnosis of autoimmune hemolytic anemia. The indirect Coombs test (IAT) identifies circulating antibodies in blood plasma, commonly utilized in blood typing and compatibility testing for blood transfusions and Rh factor incompatibility during pregnancy.

27
Q

What is defined as severe hypokalemia?

A

<2.5mmol/L

28
Q

What is the triad of HUS?

A

Presents with a triad of anaemia, thrombocytopenia and acute renal failure. This child has symptoms of all three - pallor, bruising, reduced urine output (despite good fluid intake) and peripheral oedema.

The majority of cases of HUS occur in children and the treatment is supportive. The most common cause of HUS is the Escherichia coliO157:H7

29
Q

What is the criteria for which patients are best managed on the coronary care unit?

A
  • Active cardiac ischamia or infarction
  • High risk features (dyspnea, hemodynamic instability
  • Complications of MI
  • Invasive hemodynamic monitoring
30
Q

A 78 year old male with chronic stable angina presents with chest discomfort that resolves with rest and nitroglycerin. What factors should be considered when deciding whether to manage him on the coronary care unit?

A

Overall clinical stability
Absence of ongoing ischemia
Patient’s functional status
Complications of MI like ventricular arrhythmias, high-degree heart block, ventricular septal rupture, papillary msucle dysfunction

31
Q

What are the 4 stages of diabetic nephropathy?

A

Hyperfiltration, microalbuminuria, macroalbuminuria, end stage renal failure

32
Q
A

Y3 Medicine (17 decks)

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