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1
Q

What is the first line investigation in heart failure?

A

NT-pro BNP. It has a longer half life than BNP and is stable in the bloodstream for longer. Therefore, a more accurate level.

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2
Q

What is orthopnoea?

A

It refers to the difficulty in breathing that occurs when an individual lies flat (supine) and is relieved when they sit up or assume an upright position.

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3
Q

How do you remember the drugs that should be stopped in an AKI?

A

DAMN AKI
Diuretics
Aminoglycosides and ACEi
Metformin
NSAIDs

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4
Q

What is the treatment for severe hyperkalaemia (greater than 6.5mmol/L) or with ECG changes?

A

IV calcium gluconate(30 mL, calcium gluconate 10%) and insulin/dextrose infusion

The calcium gluconate is for stabilising the myocardium and the insulin/dextrose is used to shift the potassium from the extracellular compartment to the intracellular compartment.

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5
Q

What is the normal anion gap range?

A

10-18mmol/L

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6
Q

What does a raised anion gap indicate?

A

If the anion gap is raised, this suggests that there is increased production, or reduced excretion, of fixed/ organic acids e.g.
Lactic acid (sepsis, tissue ischaemia)
Urate (renal failure)
Ketones (diabetic ketoacidosis)
Drugs/ toxins (salicylates, methanol, ethylene glycol)

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7
Q

What does a normal anion gap indicate?

A

If there is a metabolic acidosis with a normal anion gap, then this is either due to loss of bicarbonate, or accumulation of H+ ions. Causes include:
Renal tubular acidosis
Diarrhoea
Addison’s disease
Pancreatic fistula

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8
Q

How does fluid resuscitation cause hyperchloraemic metabolic acidosis?

A

A very high chloride in the blood causes bicarbonate to be pushed intra-cellularly.

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9
Q

What is azotemia?

A

Azotemia is a medical term used to describe a condition where there are elevated levels of nitrogen-containing compounds, such as urea and creatinine, in the blood.

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10
Q

What is brugada syndrome?

A

Genetic condition that causes faulty sodium channels, predisposes to fatal arrhythmias.

Right bundle branch block and raised ST segments in V1-V3

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11
Q

Teicoplanin

A

Part of the glycopeptide group of antibiotics, gram positive.

Effective against MRSA

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12
Q

What are some causes of hydronephrosis?

A
  • kidney stones
  • ureteral stricture
  • pregnancy
  • tumors
  • Urinary retention
  • blood clots
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13
Q

Treatment for HUS?

A

Normally resolves spontaneously.
Dialysis may be needed

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14
Q

What is railroading when inserting a catheter?

A

The physician inserts a guide wire through a vessel
The catheter is then ‘rail roaded’ over the guidewire, meaning it is advanced carefully along the wire, allowing it to navigate the challenging areas more easily.

Used for a PICC line
Peripherally inserted central catheter

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15
Q

What are some examples of organisms that cause atypical pneumonia?

A

Atypicals: so called because of the more gradual onset of symptoms, which may be non-specific initially (fever, myalgia, dry cough). The organisms are also intracellular;

  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophila
  • (Coxiella burnettii
  • Chlamydia psittaci)
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16
Q

What is achalasia?

A

Achalasia is a rare disorder of the esophagus, the muscular tube that connects the mouth to the stomach. In individuals with achalasia, the lower esophageal sphincter (LES), a ring of muscle at the bottom of the esophagus, fails to relax properly during swallowing. As a result, food and liquids have difficulty passing through the esophagus and into the stomach, causing symptoms and potential complications.

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17
Q

What are some complications of pneumonia?

A

Pleural effusion
Empyema (suspect if persistent, swinging fever with leucocytosis found after antibiotic therapy)
Abscess (can be caused by S. pneumoniae, Klebsiella, staph aureus). Can develop pyopneumothorax.
Pneumothorax
Septicemia
Atrial fibrillation
Post-infective bronchiectasis

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18
Q

What is Lambert-Eaton syndrome?

A

Lambert Eaton syndrome (LES) is a rare autoimmune disorder in which antibodies are formed against pre-synaptic voltage-gated calcium channels in the neuromuscular junction. A significant proportion of those affected have an underlying malignancy, most commonly small cell lung cancer. It is therefore regarded as a paraneoplastic syndrome.

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19
Q

What does methemoglobin mean?

A

Methemoglobin is a form of hemoglobin in which the iron atom within the heme group (the part of hemoglobin responsible for binding oxygen) is in the ferric (Fe³⁺) state rather than the normal ferrous (Fe²⁺) state. This altered state of hemoglobin cannot bind oxygen effectively and, therefore, cannot transport oxygen to body tissues.

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20
Q

Describe the NICE hypertension guidelines.

A

Look it up

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21
Q

Why is SBP more common in cirrhotic patients compared to patients with malignancy?

A

With a tumor, it will grow blood vessels around it and leak out immunoglobulins. This fights any infection, making SBP less likely.

22
Q

Give some examples of drugs used for Hep B

A

Entecavir, peginterferon alfa, tenofovir alafenamide, and tenofovir disoproxil are options for the treatment of chronic hepatitis B infection.

23
Q

What bacterial pneumonia is most common in alcoholics?

A

Klebsiella pneumonia

24
Q

What bacterial pneumonia is most common in the elderly?

A

Haemophilus influenzae

25
Q

What bacterial pneumonia is most common in children?

A

Mycoplasma pneumoniae

26
Q

What is catarrh?

A

Catarrh is a term used to describe the inflammation of the mucous membranes in the nose and throat, resulting in an excess production of mucus.

27
Q

What is uremic frost a cause of?

A

Uremic frost, also known as uremic frost or uremic crystals, is a rare and severe symptom of kidney failure (uremia).

28
Q

What is the most common nephrotic syndrome in a child?

A

Minimal change disease

29
Q

What does bigeminy refer to?

A

Bigeminy refers to a heartbeat marked by two beats close together with a pause following each pair of beats. The term comes from the Latin bigeminus, meaning double or paired (bi means two, geminus means twin). This rhythm arises from a minor misfire in the heart’s electrical system.

30
Q

What is the subacromial space?

A

located deep to the deltoid and acromion, and superficial to the supraspinatus tendon and joint capsule.
It reduces friction beneath the deltoid, promoting free motion of the rotator cuff tendons.

31
Q

What material is used in joint replacements?

A

Aluminium and cobalt

32
Q

What is allopurinol hypersensitivity syndrome?

A

Example is Steven-Johnson syndrome.

33
Q

What is coldizin?

A

The exact formulation of Coldizin may vary depending on the country and manufacturer, but it typically contains antihistamines (such as chlorpheniramine) to reduce allergy symptoms and nasal congestion, as well as sometimes decongestants (such as pseudoephedrine) to relieve nasal congestion.

34
Q

What crystals form in pseudogout?

A

Calcium dihydrate phosphate crystals

35
Q

Why are uric acid levels in acute gout flare ups low?

A

Because it precipitates

36
Q

What shape are urate crystals in urine microscopy?

A

Needle shaped

37
Q

What shape are calcium dihydrate phosphate crystals in urine microscopy?

A

Square

38
Q

What drug is allopurinol?

A

It is a xanthine oxidase inhibitor, which means it reduces the production of uric acid in the body.

39
Q

What is inter-critical gout?

A

Inter-critical gout refers to the symptom-free periods between acute gout attacks, which are characterized by sudden and severe pain, swelling, and tenderness in the joints, often the big toe. During inter-critical periods, individuals with gout do not experience any active symptoms, and their affected joints appear normal.

Inter-critical periods can vary in duration, ranging from days to months or even years. It’s essential to note that although there are no visible symptoms during these periods, uric acid crystals might still be present in the joints.

40
Q

What is metabolic syndrome?

A

Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes.

Metabolic syndrome, on the other hand, is a constellation of metabolic abnormalities, including central obesity, insulin resistance, high blood pressure, and dyslipidemia. While obesity is a component of metabolic syndrome, individuals with metabolic syndrome may not meet the BMI criteria for obesity.

41
Q

What is type 1 glycogen storage syndrome and what enzyme is deficient in this disease?

A

Type I glycogen storage disease is inherited as an autosomal recessive genetic disorder. Glycogen storage disease type I (GSDI) is characterized by accumulation of excessive glycogen and fat in the liver and kidneys that can result in an enlarged liver and kidneys and growth retardation leading to short stature.

In GSD Ia, there is a deficiency of enzyme glucose-6-phosphatase (G6Pase) which cleaves glycogen to glucose thus leading to hypoglycemia and lactic acidosis.

42
Q

What is sarcopenia?

A

Age related muscle mass loss

43
Q

What is the RASS assessment?

A

Richmond Agitation Sedation Scale (RASS)
Measures sedation level of patients

44
Q

What are some causes of sinus tachycardia?

A
  • Anaemia
  • Stress
  • Fever
  • Caffine, nicotine, stimulants
  • Hyperthyroidism
45
Q

What are monoamine oxidase inhibitors?

A

Monoamine oxidase inhibitors (MAOIs) are a class of medications primarily used to treat depression. They work by inhibiting the activity of the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. By inhibiting this enzyme, MAOIs increase the levels of these neurotransmitters, which can help improve mood and alleviate symptoms of depression.

Examples are Phenelzine and Tranylcypromine

46
Q

What are some examples of MOA’s?

A

Phenelzine (Nardil), Tranylcypromine (Parnate) and Isocarboxazid (Marplan)

47
Q

What is gilbert’s syndrome?

A

Gilbert’s syndrome is an inherited, autosomal recessive disorder where the liver does not properly process bilirubin. This is due to a mutation in the UGT1A1 gene, resulting in decreased activity of the enzyme that conjugates bilirubin with glucuronic acid.

Patients with Gilbert’s syndrome may often be asymptomatic. However, they may also experience Intermittent mild jaundice triggered by stress, fasting, infection or exercise

48
Q

What is a capture beat?

A

Occur when the sinoatrial node transiently “captures” the ventricles in the midst of AV dissociation, producing a QRS complex of normal duration

49
Q

What is unconjugated bilirubin?

A

Bilirubin is a breakdown product from hemoglobin. Before it is glycated with UGT it is insoluble in the blood, unconjugated.

50
Q

Cheilosis

A

Swelling and fissuring of the lips.

Y3 Medicine (17 decks)

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