Random stuff I should know

Question 1

Commonest causes of CAP (Community acquired pneumonia)

Answer 1

Typical:

1) Streptococcus (Strep Pneumoniae)
2) Haemophilus Influenzae

Atypical:

1) Mycoplasma
2) Legionella

Question 2

Commonest causes of HAP (Hospital acquired pneumonia)

Answer 2

1) E.coli
2) Pseudomonas
3) MRSA

Question 3

Main causes of splenomegaly

Answer 3

1) Portal hypertension
2) Haematological malignancies
3) Infections (TB, malaria, schistosomiasis)

Question 4

Differentials for unilateral swollen leg

Answer 4

1) DVT
2) Cellulitis
3) Ruptured baker’s cyst
4) Cardiac failure (Will typically be bilateral swelling)
5) Liver failure (Will typically be bilateral swelling)

Question 5

A 45 year old patient complains that they cough up a pot of purulent sputum every day. Examination reveals course crackles. What is the likely diagnosis

Answer 5

Bronchiectasis (Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.)

Can be caused by cystic fibrosis, or previous infections. or underlying problems with the immune system that make the bronchi more vulnerable to damage from an infection or allergic bronchopulmonary aspergillosis (ABPA) – an allergy to a certain type of fungi that can cause the bronchi to become inflamed if spores from the fungi are inhaled

Question 6

How to clinically diagnose a STEMI

Answer 6

STEMI is diagnosed clinically when there is new (or increased) and persistent ST-segment elevation in at least two contiguous leads of ≥1 mm in all leads other than leads V2-V3 where the following cut-off points apply:[1]

≥2.5 mm in men <40 years old
≥2 mm in men >40 years old
≥1.5 mm in women regardless of age
1 mm = 1 small square (at a standard ECG calibration of 10 mm/mV).

Question 7

A 40 year old man who drinks a bottle of vodka every night and is known to have chronic liver disease, developed severe abdominal pain with extreme tenderness. Examination revealed a rigid abdomen. What is the likely diagnosis?

Answer 7

This is the typical history with a risk factor for acute pancreatitis. The leakage of pancreatic enzymes into the peritoneum causes the rigidity and peritonitis

Question 8

Horner’s vs complete third nerve palsy

Answer 8

Horner’s- ptosis, miosis, anhydrosis
Complete/surgical 3NP- ptosis, mydriasis, pupil down and out. complete palsy caused mainly by PCOM aneurysm, non pupil sparing. Pupil sparing caused by Diabetic neuropathy. (Reason being is the parasympathetic fibres of CN3 run along the outer part of the neuron)

Question 9

Cerebellar signs (DANISH)

Answer 9

Dysdiadochokinesia
Ataxia
Nystagmus
Intention Tremor
Slurred Speech
Hypotonia

Question 10

Effects of NSAIDs and ACEi/ARB on kidney

Answer 10

NSAID- causes afferent arteriole constriction, CI in CKD
ACEi/ARB causes efferent arteriole vasodilation, typically protective in CKD caused by Diabetes (Where there is narrowing of efferent arteriole resulting in glomerular hyperfiltration and resultant glomerular sclerosis and reduced filtration). ACEi/ARB also reduce inflammation of glomerular vessels thus being protective. However CI in renal artery stenosis or end stage CKD, because dilation of e.arteriole will result in loss of pressure in glomerulus and lack of filtration and fall in egfr there.

Question 11

Common causes of metabolic alkalosis

Answer 11

1) Hypokalaemia
2) H+ losses (Eg vomiting, pyloric stenosis induced vomiting in kids)
3) Ingestion of bicarbonate

Question 12

Common causes of acidosis:

Metabolic:

Respiratory:

Answer 12

Metabolic:

1) Increased H+ production- DKA, Lactic acidosis
2) Decreased H+ excretion- Renal tubular acidosis, aspirin overdose
3) Bicarbonate loss - intestinal fistula

Respiratory:

1) COPD
2) Pulmonary embolism

Question 13

Red flags for urea cycle disorder

Answer 13

1) Vomiting without diarrhoea
2) Longstanding neurological problems/neurological encephalopathy
3) Change in diet (Sudden high protein diet)
4) High ammonia (Hyperammonaemia)
5) Respiratory alkalosis

Question 14

Causes of pediatric conjugated hyperbillirubinaemia

Answer 14

Pediatric CONJUGATED hyperbillirubinaemia is ALWAYS pathological:

Often caused by- biliary atresia, choledocal cyst

Question 15

How to pick up osteopenia of prematurity biochemically

Answer 15

Calcium will be normal so dont look at that
you will see a low phospate <1mmol/litre
alk phos >1200U/L (10X above normal adult limit)

Treatment: Calcium/phospate supplements, 1 alpha calcidol