Random questions Flashcards
Heparin mechanism of action
Antithrombin III inhibitor
Warfarin mechanism of action
Factor II, VII, IX and X
Dabigatran mechanism of action
Direct thrombin inhibitor
Rivaroxiban, apixoban mechanism of action
Factor Xa inhibitors
Reed-sternberg cells
HL
Biochem in addisonian crisis
High potassium
Low sodium
Low glucose
Beta-blockers antidote
Glucagon
Benzodiazepines antidote
Flumezanil
Heparin antidote
Protamine
Iron antidote
Desferroxamine
Narcotics antidote
N-acetylcysteine
Causes of hyponatraemia
Diuretics Water excess D&V Intestinal fistulae Renal failure SIADH Addison's Nephrotic Liver failure
Causes of hypernatraemia
Fluid loss without water replacement Saline excess Diabetes insipidus DKA Conn's
Causes of hyperkalaemia
Drugs - ACEIs, Spironolactone, suxamethonium Digoxin toxicity Excessive KCl Massive transfusion Burns Rhabdomyolysis Tumour lysis Renal failure Addison's Metabolic acidosis
Causes of hypokalaemia
Vomiting Diarrhoea Losses from intestinal fistulae Diuretics Cushing's, excess steroids/ACTH Metabolic alkalosis Conn's
Signs of hyponatraemia
Confusion Seizure HTN HF Muscle weakness Nausea Anorexia
Signs of hypernatraemia
Thirst Dehydration Confusion Coma Seizure
Signs of hyperkalaemia
Cardiac arrythmias - tall tented t waves, lengthened QRS, flatp waves, sloping up ST —> VT/VF
Sudden death
Signs of hypokalaemia
Arrythmia Weakness Hypotonia Cramps Tetany
Immediate management of hyperkalaemia
Calcium gluconate - stabilise myocardium
Insulin and glucose - get potassium temporarily into the cells (doesn’t affect metabolism)
Metabolic acidosis
Usually follows an episode of severe tissue hypoxia - hypovolaemic shock, MI, sepsis etc. Inadequate oxygenation leads to lactic acid build-up. In surgical patients may be an indicator of serious intra-abdominal problems such as anastomotic leak. Also seen in renal failure and uncontrolled DKA. Treat underlying cause
Signs of metabolic acidosis
Rapid deep breathing - Kussmaul respiration
ABG - low or normal pH, low pCO2 if compensated, very low bicarbonate
Plasma K elevated due to shift to extracellular space
Respiratory acidosis
Results from CO2 retention due to iatrogenic of pathological respiratory depression. Treat underlying cause
ABG respiratory acidosis
Low or normal pH
High pCO2
High bicarb if compensated
Metabolic alkalosis
Usually due to severe and prolonged vomiting, or nasogastric aspiration due to obstruction.
CO2 acidis or alkaline
CO2 makes things acidic
Bicarb makes things alkaline
Classical acid-base picture of a patient with gastric outlet obstruction - including pyloric stenosis
Hypochloraemic metabolic alkalosis
ROME ABG nmnemonic
Respiratory
Odd
Metabolic
Equal
So if the C02 and HCO3 values are abnormal, if they are both low -“equal” it’s likely metabolic, and if they’re nt
Achalasia management
Medical - only if surgery contraindicated or while waiting for treatment - CCBs, nitrates
Pneumatic dilation
Surgical: laparoscopic or open Heller myotomy
Follow up for varices
Follow up every 3-6 months, banding or sclerotherapy of any recurrent varices
4 types of benign colonic polyp
Adenomatous
Inflammatory
Metaplastic
Harmatomous
Bowel ischaemia ABG picture
metabolic acidosis
M rule in PBC
IgM
Middle aged women
Anti-Mitochondial antibodies
First line medical management in IBS
Loperamide
MEN 1
Pituitary
Parathyroid
Pancreas
Artery at risk with duodenal ulcers on the posterior wall
Gastroduodenal
Tongue and uvula deviation in hypoglassal nerve injury
Tongue goes t’same side
Uvula goes utha way
Treatments for hyperkalaemia
Calcium gluconate
Insulin and dextrose infusion
Salbutamol nebs
Calcium resonium
Pre-renal causes of ARF
Hypovolaemia
Multiple organ failure
Rhabdomyolysis
Renal causes of ARF
Vasculitis
Crescentic GN
Acute tubular necrosis
Post-renal causes of ARF
Blocked catheter
Prostatic hypertrophy
Extra-ureteric tumour
Retroperitoneal fibrosis
Common blood finding in interstitial nephritis
Eosinophil count elevated
Good marker in DM patients for assessing risk of future nephropathy
Microalbuminuria
Do you stop aspirin in AKI?
In low-dose for cardioprotection, no. Otherwise, yes
Most common renal AKI cause
Acute tubular necrosis
Diuretic for ascites
Spironolactone
Most common and important viral infection in solid organ transplant
CMV
Alternative to spironolactione if the patient develops gynaecomastia
Eplenerone
Diabetes Insipidus plasma and urine osmolality
high plasma osmolality and a low urine osmolality
Why is nephrotic syndrome associated with hypercoagulability?
Loss of antithrombin III
High or low urinary sodium in pre-renal vs ATN
Low in pre-renal as the kidney works to reabsorb because of the volume depletion and hold onto fluid
High in ATN
NB that a big difference in osmolality suggests pre-renal
In ATN the osmolality ratio is close to equal
Muddy brown casts suggestive of
ATN
4 eGFR variabilites
CAGE Creatinine Age Gender Ethnicity
Screening test for APKD
USS
1st line therapy in hyperparathyroidism requiring treatment
Vitamin D supplementation
Most common renal stones
Calcium oxalate
Gold standard for kidney stone
CT KUB - non-contrast
Staghorn composition
Struvium (magnesium ammonium phosphate)
6 functions of skin
Environmental barrier Vitamin D synthesis Cosmesis Immunosurveillance Sensation Temperature regulation
Mnemonic for describing a lesion
SCAM Size - widest diameter, Shape Colour Associated secondary change Morphology, Margin
Melanoma screen mnemonic
ABCD Asymmetry Border Colour Diameter - >6mm
4 cell types of the epithelium
Keratinocytes
Langerhans’ cells
Melanocytes
Merkel cells
Chondromalacia patellae vs osteochondritis dissecans
Chondromalacia patellae:
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Osteochondritis dissecans:
Pain after exercise
Intermittent swelling and locking
Electrolyte abnormality which predisposes to digoxin toxicity
Hypokalaemia
Most common side effect of isotretinoin
Dry skin
Severe side effect of hydroxychloroquine
Retinopathy
Metabolic acidosis with normal anion gap
Addisons
How long to wait after prostatitis to do PSA
1 month
Possible side effect of intubation and ventilation in a flail chest patient
Tension pneumothorax
First line treatment for severe C diff
Vancomycin
First and second line choices for MRSA treatment
Vancomycin
Linezolid
Causes of raised prolactin
pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metoclopramide, domperidone
3 key characteristics of HHS
- ) Severe hyperglycaemia
- ) Dehydration and renal failure
- ) Mild/absent ketonuria
Impetigo treatment
topical fusidic acid → oral flucloxacillin / topical retapamulin
3 key characteristics of HHS
- ) Severe hyperglycaemia
- ) Dehydration and renal failure
- ) Mild/absent ketonuria
Impetigo treatment
topical fusidic acid → oral flucloxacillin / topical retapamulin
ECG changes in hyperkalaemia
Tall tented t waves Loss of p waves Broad QRS complexes Sine wave VF
If a post menopausal woman has a fracture do you medicate, and if so with what
Yes, bisphosphonate and calcium
You don’t need to do a DEXA scan
Papillary and medullary thyroid cancer tumour markers
Medullary - Calcitonin - the MC
Papillary - Thyroglobulin - the PT
Things which falsely reduce HbA1c
SCD, G6PDD, HS
Things which falsely increase HbA1c
Splenectomy, iron-deficiency anaemia, B12 deficiency, alcoholism
Does Grave’s disease cause a tender goitre? What does?
No, De Quervain’s (subacute) does
Medication used in vestibular neuronitis and when
Prochlorperazine, only in the acute phase
Most common organism in acute bacterial tonsillitis
Strep pyogenes
Differential for tinnitus
Meniere's Acoustic neuroma Drugs - quinine, aspirin, loop diuretics Otosclerosis Hearing loss
Management of unilateral nasal polyp
Urgent ENT referral - usually bilateral so need to rule out malignancy
Otitis media abx, and in diabetics
Amoxicillin, DM - ciprofloxacin
How long to wait before ENT referral for tympanic membrane perforation
6 weeks
Causes of gingival hyperplasia
phenytoin, ciclosporin, calcium channel blockers, AML
Addison’s antibodies
21-hydroxylase
Reason for hyperpigmentation in Addison’s
Increased ACTH production
U&Es in Addison’s
Low sodium
High potassium
Test for addison’s other than antibody
Morning cortisol - low
Differentials for addison’s
Secondary hypoaldosteronism - Cushing’s or hypo-pit axis disease
Hyperthyroidism
Hameochromatosis
What are the three things a patient is short of in an Addisonian crisis
Steroid
Salt
Glucose
Management of an addisonian crisis
IV dexamethasone
IV 0.9 NaCl
IV glucose if hypoglycaemic
Regular monitoring and supportive Rx
2 key meds in stable Addison’s
Hydrocortisone and fludrocortisone
Hormone which reduces in response to surgery
Insulin
Test to differentiate between T1DM and T2
C-peptide
Causes of SIADH - mnemonic
SIADH S Surgery (24-48 hours post-op) I Idiopathic/Intracranial/Infection A Acute and chronic lung disease D Deficiency of cortisol/Drugs - opiates, cytotoxics, anti- psychotics, anti-epileptics H Hypothyroidism/Hyponatraemia
Myeloma screen
Total Protein
Albumin
Calculated Globulins
Serum Protein Electrophoresis (SPE) and free light chain measurement
Diagnostic criteria in myeloma
- Monoclonal plasma cells >10% on bone aspirate
- Monoclonal antibodies in blood or urine
- At least one of CRAB
Causes of increased INR (drugs)
Allopurinol Influenza Vaccine Tramadol Oxandrolone
H-2 Blockers
Macrolide Antibiotics Metronidazole
Protease Inhibitors Quinolone Antibiotics SSRI Antidepressants Statins and Fibrates Tricyclic Antidepressants
Ethanol
