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Met3b > random things you forget > Flashcards

random things you forget Flashcards

1
Q

Tx of prolactinoma

A

dopamine AGONISTS eg bromocriptine

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2
Q

Dx of cushings

A

overnight dexamethasone suppression test

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3
Q

how to determine location of problem in cushings

A

high dose dexa suprresion test. measure ACTH abd cortisol at 9am and midnight.

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4
Q

potassium problem in cushi gs

A

HYPOkalemia (alkalosis=¡)

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5
Q

diagnosis of addisons

A

short syncathen test. give ACTH 250mg IM, wait 30 mins and measure CORTISOL levels. if less than 100, problem. addisions.

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6
Q

cushings and glucose

A

impaired glucose tolerance

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7
Q

BP in cushings

A

high

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8
Q

BP ijn addisioms

A

low

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9
Q

glucoswe in addisons

A

low

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10
Q

calcium in addisons

A

high

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11
Q

which condition is associated with postual hypotension

A

addisons.

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12
Q

cushing TX

A

ketoconazole

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13
Q

what to do if sick with addisons

A

doubke gluco . hydrocortisone and keep fludrocortisone normla

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14
Q

Tx cushings

A

ketoconazole.

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15
Q

what are addisons patients given

A

hydrocortosone to self inject

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16
Q

addisons patiet who vomits

A

give hydrocortisone IM until stops vomiting

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17
Q

long qt cause

A

hypo0kalemia

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18
Q

what can trigger and adisons crisi

A

pregnnacy, sepsis, surgeyr, adrenal hemorrhage (waterhouse fried)

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19
Q

what metabolic disturbacne does addisons causse

A

normal anion gap metabolic acidosis.

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20
Q

conns potassium

A

low

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21
Q

conns serum bicarb

A

high

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22
Q

conns metabolic imablancxe

A

metabolic alkalosis

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23
Q

conns diagnosis

A

aldosterone renin plasma ratio

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24
Q

tx galatocorrhea

A

promocri`tine

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25
Q

MEN 1

A

pituitary parathryoid pacreas

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26
Q

MEN2

A

pheochromocytoma, parathryoid

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27
Q

MEN 3

A

pheocromocytome

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28
Q

trousseau sign is a sign of

A

hypocalcemia

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29
Q

tx subactue goitre

A

nsaids

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30
Q

overereplacement w thyroxine

A

osteoporosis

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31
Q

what can reduce levothryozine absorption

A

iron AND CALCIUM. os have 4 hrs apar.

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32
Q

pheochromocytoma diagbosis

A

urine metaneprhines

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33
Q

thrydoid sotrm tx

A

beta blockrs

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34
Q

what do you give to ower HR in gravecs

A

propranolol

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35
Q

what can cause osteonecrosis

A

steroids

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36
Q

what can impair glcoe tolerencce

A

ciclosphorin, thiazides, steroids

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37
Q

calcium in pancreatitis

A

low

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38
Q

diarrhea defined as

A

more than 4 BM in 24 hrs

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39
Q

signet ring cells

A

gastric adenocarcinoma

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40
Q

monotr corhns

A

WBB

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41
Q

cholangitis is raised

A

ALP

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42
Q

fecal protectin high suggests

A

IBD

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43
Q

size of colon small bowel etc

A

small bowel 3, cecum 9, large bowel 6, appendix 6

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44
Q

tumour bowel staging

A

Tis: in situ. only in the mucosa.

T1 : inner layer of the bowel.

T2 : muscle layer of the bowel wall.

T3 outer lining of the bowel wall but has not grown through it.

T4 is split into 2 stages, T4a and T4b:

T4a spread into the tissue layer (peritoneum) covering the organs in the tummy (abdomen)
T4b means the tumour has grown through the bowel wall into nearby organs

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45
Q

VWD inheritence

A

autosomal dominant

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46
Q

CF inheritence

A

autosomal reessive

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47
Q

DMD

A

x linked rcessive

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48
Q

hemoptysis asociated with

A

mitral stenosis.

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49
Q

pulsus paradoxus

A

cardiac tampoonade

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50
Q

elecrtical alternans

A

pericardial effusion and cardiac tamponade.

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51
Q

kussamaul sign

A

pericarditis.

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52
Q

hemophiola A ineheritecnce

A

x linked recessive

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53
Q

hemophila Bineheritecnce

A

x linked recessive

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54
Q

most hemophilias are a or b

A

hemophilia A

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55
Q

hemophilia a is a deficiency in factor

A

8

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56
Q

hemophilia B is a deficiency in factor

A

9

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57
Q

what drug causes ototoxicity

A

loop diuretics.

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58
Q

bisphosphaates work by

A

reducing bone resportion

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59
Q

myxodema coma presents with

A

hypothermia adn confusion

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60
Q

s3

A

mitral regurug

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61
Q

s4

A

aortic stenosis

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62
Q

inheritence HOCM

A

autosomal dominant

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63
Q

patent ductus arteriosus

A

continuous machine like murmur

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64
Q

rhumatic fever causes

A

mitral stenosis

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65
Q

cause of rheumatic fever

A

streptococcus A pyogenes

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66
Q

WPW

A

hypertrophic dilated cardiomypathy

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67
Q

isolated peri anal disease Tx

A

metrinidazole

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68
Q

methotrexate is an alternative to

A

azathroprine in crohns

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69
Q

probiotics is useful for

A

UC

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70
Q

what do you use infliximab for

A

refractory disease and fistulating crohns

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71
Q

1st line crohns to maintain remissio n

A

aza meto

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72
Q

when do you need to check tMPT

A

before giving aza or meto

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73
Q

what to do if you have stricuting terminal ileal disease

A

ileocecal resection or segmental small bowel resection or stricutorplasty.

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74
Q

diff entre simple and co,plex fistula

A

simple is low, complex is high (through muscle layer)

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75
Q

simpyotmatic perianal fistula tx

A

metronidazole

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76
Q

what kind of drug is infliximab

A

anti TNF

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77
Q

what drug helps close and keep closed perianal fistual

A

infliximab

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78
Q

what is draining seton used for

A

to keep ople fistual because premature closure leads to abcess

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79
Q

perianal abcess

A

drainange and incision and antibioitc

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80
Q

complications of crhons

A

small bowel cancer
colorectal cancer
ostoporosis.

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81
Q

HBeAg

A

marker of infectivity

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82
Q

HbsAg

A

surface antigen. acute if less than 6M chronic if more

also look at IgM not IgG to determine if acute or chornic

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83
Q

anti HBc

A

current or previous infection

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84
Q

anti HBs

A

immunised (throguh vaccination or previous exposure)

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85
Q

most common sx of chrons in kids

A

abdo pain

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86
Q

where do you see kantors string sing (LOOK UP PIC)

A

crohns

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87
Q

crpt abcess is linked with

A

UC

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88
Q

rectal bleeding in children casue

A

anal fissure

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89
Q

most common site affected by UC

A

rectum

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90
Q

Truelove and Witts’ severity index

A

severity of UC

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91
Q

what kind of. drug is loperamide? what does it cayse as a SE

A

anti motility drug. causes toxcic megacolon.

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92
Q

anaemia and low ferritin/folate levels,

A

all characteristic of coeliac disease!!!!!

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93
Q

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of

A

euvolemic hyponatremia

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94
Q

what s erious side effect of aminosalicylate

A

AGRANULOCYTOSIS. so do a FBC if they have an infection and are on mesalazine

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95
Q

what makes a c diff infection life threatening

A

hypotension, shock, or intestinal obstruction

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96
Q

other name for pseudomembranous colitis

A

c diff

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97
Q

what drugs are linked with c diff infection

A

ppi, Cephalosporins, clindamycin

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98
Q

SIBO diagnosis

A

hydrogen breath test

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99
Q

SIBO TX

A

RIFAXIMIN

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100
Q

What antibodies do you see in autoimmune hepatitis

A

anti-nuclear

and/or

anti-smooth muscle antibodies.

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101
Q

If SAAG - serum ascitic albumin gradietn is high (hihg protein)

A

so its portal hypertensino –> TRANSUDATE

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102
Q

If SAAG - serum ascitic albumin gradietn is low (low protein)

A

so its malignancy, infection, pacreatitis–> EXUDATE

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103
Q

Exudates are

A

fluids, CELLS, or other cellular substances that are slowly discharged from BLOOD VESSELS usually from inflamed tissues. examples include: malignancy, nifection, pancreatitis.

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104
Q

Transudates

A

are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES.

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105
Q

diagnosis of wilsons

A

Caeruloplasmin

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106
Q

diff entre wilsons and hemochromatosis

A

wilsons has neuropsychiatric symptoms while this one doesnt. like aggresiion, dysphagia…

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107
Q

link beteen hypoxia and liver

A

ischemic hepatitis

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108
Q

methotrexate can cause what bad side effect

A

pulmonary fibrosis

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109
Q

shoudl you give PPI before an endoscopy?

A

no. giove some AFTER if theres evidence of a non-variceal hemorrhage

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110
Q

how can you differentitate entre anemia of chronic disease and iron deficiency anemia

A

Total Iron Binding Capacity is low in ACD

high in IDA

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111
Q

what is h pylori associated with

A

gastric adenocarcinoma and atrophic gastritis but the strongest association is with duodenal ulceration.

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112
Q

what is a predisposition to gastric carcinoma

A

pernisious anemia (b12 def)

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113
Q

ESR levels in DE quervain

A

high ESR

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114
Q

de quesrvain lab values

A

high T4, low TSH eventually leading to hypo, high ESr, low iodine uptake

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115
Q

psoas sign positive indicates

A

appendicitis

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116
Q

what electroluyte change can enoxaparin (heparin( cause

A

hyperkalemia

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117
Q

how is b12 deficiency managed

A

intramuscular B12 replacement, a loading regime followed by 2-3 monthly injections

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118
Q

what to replace first b12 or folate

A

b12. because otherwise you night precipitate subacute combined degeneration of the cord.

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119
Q

hypercalcemia on ecg

A

short QT

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120
Q

low TSH and low free t4

A

secondary hypotheyoiridm. do MRI to confirm pituitary hypothryoidism

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121
Q

what to give before paracentesis

A

IV human albumin solution

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122
Q

potassium and long QT

A

hypokalemia

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123
Q

hyperkalemia

A

wide QRS

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124
Q

talk to me about renal tubular acidosis type 1

A

linked with stone formation
urine ph above 5.5
hematuria
hypokalemia and hyperchloremic metabolic acidosis

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125
Q

talk to me about renal tubular acidosis type 3

A

Extremely rare
Caused by carbonic anhydrase II deficiency.
Due to an impaired H+ secretion by the distal convoluted tubule and HCO3- wasting by the proximal convoluted tubule
Presents with a urine pH greater than 5.5, whilst this patient has a pH of 5.3.

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126
Q

talk to me about renal tubular acidosis type 4

A

Ccaused by a reduction in aldosterone that leads in turn to a reduction in proximal tubular ammonium excretion.
cuases hyperkalemia

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127
Q

talk to me about renal tubular acidosis type 2

A

Caused by a dysfunctional proximal convoluted tubule, that is unable to reabsorb HCO3-. BICARB
The defect can either be isolated, affecting only the reabsorption of HCO3- or, more commonly, the dysfunction is generalized in which case the condition is referred to as Fanconi syndrome.

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128
Q

talk to me about familial hypercalciuria

A

stones at an early age.
Generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone.

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129
Q

should you give allopurinol to prevent gout

A

no

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130
Q

to diagnose iron deficiency anemia during a concomittant disease what shoudl you use

A

NOT feritin, use trasnfersin saturation, iron, iron binding capacity.

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131
Q

hepatorenal sy drome management

A

terlispressin

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132
Q

cerebral pontine myelonlilsis is seen in treatment of

A

hyponatremia

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133
Q

cerebral edema is seen in the treatment of

A

hypernatremia

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134
Q

lemon tinge to skin is associated with

A

pernicisou anemia

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135
Q

what anemia has reduced vibration sense

A

pernicious

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136
Q

amitryptiline side effect

A

urinary retention

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137
Q

diabetic neuropathy management

A

duboxetine,

amitryptilline or pregabalin

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138
Q

how many ml in a pint

A

568

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139
Q

tx achalasia

A

Heller cardiomyotomy

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140
Q

simultaneous dilatation of the common bile duct and pancreatic ducts.

A

pancreatic cancer

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141
Q

hypothyroidism and sodium

A

Hypothyroidism causes a euvolaemic hyponatraemia

The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output.

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142
Q

Sister Mary Joseph node

A

palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

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143
Q

Tx wilson s disease

A

pennicillamine

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144
Q

s3 seen in

A

hf

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145
Q

gallop rythm seen in

A

hf

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146
Q

aortic stenosis

A

SAD- syncope, angina, dyspnoea

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147
Q

3rd heat sounds are soft or loud

A

soft

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148
Q

sound of mitral stenosis

A

loud first heart soubd

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149
Q

what can cause acute resp distress syn

A

pancreatitis

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150
Q

cause of pulm fibrosis

A

methotrexate, amiodarrone

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151
Q

posterior mi

A

tall r wave in v1 v3

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152
Q

calots triangle

A

inf border liver
cystic duct
common hepatic duct

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153
Q

hasselbachs triangle

A

Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.

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154
Q

hepB

A

hepatocellullar cancer

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155
Q

in wilsons is cerruplo`lasmin low or high

A

low

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156
Q

anti phosphlipid sydnrome tx

A

aspirin and lmwh

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157
Q

men who have sex with men should get what vaccine

A

hepA

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158
Q

Animal bite

A
  • co-amoxiclav
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159
Q

sudden anemia PLUS low reticulocytes indicates

A

parvovirus

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160
Q

explain asa grades 1-6

A
  1. moribounds

6. brain dead.

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161
Q

sepsis red flags

A

not passed urine in 18hrs

recent chemo

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162
Q

msot common esophageal cancer

A

adenocarcinoma

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163
Q

complicaiton of esophagectomy

A

anastomotic leak

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164
Q

gastric cancer is high where

A

korea

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165
Q

blood a group is linked to what cancer

A

gastric

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166
Q

surgery if gastric tumour is middle or distal

A

distal partial gastrectomy

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167
Q

surgery if gastric tumour is proximal

A

total gastrectomy

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168
Q

surgery if gastric tumour is at gastroesphageal junction

A

total or proximal gastrextomy nad distal esophagectomy

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169
Q

statistcal analysis for CCS

A

odds ratio

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170
Q

statistcal analysis for cohort studies

A

relative risk

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171
Q

legal prescribing must have

A 
practisinac name
signature
address
bleep
block capital letter
black or blue ineffacable ink
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172
Q

live attnuated vaccines

A

BCG
MMR
polio

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173
Q

live attnuated vaccines

A

BCG
MMR
polio
INFLUENZA

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174
Q

which vaccines have relatively low efficacy

A 
pertussis
pneumococcus
rotavirus
influenxa
BCG
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175
Q

vaccines for older poeple

A

shingles at 70 once.
influenxa at 65 eveyr year
pneumococcal at 65 every 5 years

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176
Q

rank studies in terms of credibililty

A 
meta analysis
RCT
cohort
CCS
cross sectional
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177
Q

advantage of cross sectional studies

A

gather data about exposure adn outcome simultaneously at a single point in time. netiher prospective nor retrospective.

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178
Q

is termimal sedation lawful

A

yes

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179
Q

parkes phases of grief

A

DADAR

  1. denial, shock
  2. anger
  3. depression
  4. acceptance
  5. resoluation and reorganisastion
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180
Q

clean hands with sopay water for how long

A

20s

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181
Q

gram stain of ecoli

A

negative

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182
Q

gram stain of c dfiff

A

positive

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183
Q

gram stain of MRSA

A

positive

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184
Q

gram stain pseudomonas

A

netgative

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185
Q

what are some carbapanem resistant enterobacteria

A

e coli klebsiella

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186
Q

enterobacteria are gram

A

negative

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187
Q

when to screen patients for MRSA

A

3 months before surgery

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188
Q

DNAR is a fr¡orm of—

A

passive euthanasia.

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189
Q

UC associated with what antibodies

A

p ANCA

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190
Q

skin complaints with UC and crohns

A

pyoderma gangernosum

eyrthema nodosum

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191
Q

peaks of UC and crohsn

A

20 70 UC

20 60 crohns

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192
Q

what vessel supplies ascending and trasnverse colon

A

sup mesenteric

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193
Q

what vessel supplies desceding colon

A

inf mesenteric

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194
Q

most common polyps in UCpatients

A

hyperpastic polyps

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195
Q

colon adenoma on what side

A

left

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196
Q

in loop stoma which one is spouted and which is flat

A

proximal is spouted, distal is flat

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197
Q

msot common cause of large bowel obstructin

A

bowel cancer

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198
Q

most colorectal cancer is in

A

rectum

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199
Q

what kind of stoma if you do an abdominoperineal resection

A

end colostomy

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200
Q

whats a gastrostomy

A

its a PEG. things in not out. food.

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201
Q

what stoma in hartmans

A

end ileostomy or colostony with no anastomosis.

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202
Q

higest rates of leak in

A

male rectal anastomoses

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203
Q

un emergency what stoma do you use

A

loop colostomy

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204
Q

what do you give for bites

A

co amox

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205
Q

when to give fluxocalicincn

A

s aureus infection other than MRSA

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206
Q

trimethorpimw orks on

A

tetrohydrofolate metabolosim (folic acid metabolisn)

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207
Q

sulfonamides works on

A

dihyfrofoalte metabolism (folci acod met)

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208
Q

DNA gyrase is worked on by

A

quinonlones

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209
Q

which antibiotic is ototoxic

A

gentamicini

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210
Q

which antibiotic is ototoxic

A

gentamicini, quinine

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211
Q

acyclovir is a

A

guanosine analogue

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212
Q

acyclovir is a

A

guanosine analogue. works by acting on viral DNA polymerase to inhibit it by causeig chain termination. . resistance via mutation of viral thymidine kinase and or DNA polymerase.

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213
Q

herpes keratitis Tx

A

idoxuridine. nucleoside analogue

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214
Q

CMV tx

A

gangiclovir and valgenciclovir,

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215
Q

metronidazole works on

A

dna replication

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216
Q

HIV proph

A

tenofovir and entrititabine

217
Q

post HIV rxposure

A

tenofovir and entritibine and dolutegraviror retrograve for 28 days

218
Q

what kind of drug is oseltamivir

A

neuraminidase inhibitor

219
Q

M2 inhibiotr used for what and what examople

A

influenxa, amantadine

220
Q

celiac antibodies

A

anti endomylin, DQ2 and DQ8

221
Q

cleiac associated with

A

anemia folate and iron and b12, aspelnism, SMALL BOWEL LYMPHOMA

222
Q

skin lesion in celiac

A

dermatitis hepatiformis

223
Q

type 1 hypersensitivity mediated by

A

Ige –> release of histamines

224
Q

type 2 hypersensitivity mediated by

A

IgM and IgG –> complement activation and phagocytosis

225
Q

type 3 hypersensitivity mediated by

A

immune complkexes causing pathology like vasculitis

226
Q

type 4 hypersensitivity mediated by

A

t cell lymphocyte. w granumolas CD4. wihtout CD8

227
Q

type 5 hypersensitivity mediated by

A

antibodies that stimulate target cells.

228
Q

cd20 is b cel and t cell is

A

cd3

229
Q

rouleaux cells seen in

A

multiple myeloma

230
Q

smear cells seen in

A

CLL

231
Q

pseudopelger seen in

A

CML

232
Q

rifampicin MOA

A

inhibits RNA polymerase

233
Q

isoniazid MOA

A

inhibits mycolic acid synthesis

234
Q

pyrazinimide MOA

A

converted into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I. can cause GOUT

235
Q

etham butol MOA

A

inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan

236
Q

heinz bodies seen in

A

g6pd

237
Q

fever on alternating days

A

malaria

238
Q

tx malaria SEVERE complicated FALCIPARUM

A

iv artesunate or IV quinine. blood films DAILY,

239
Q

precautions when you give quinine

A

cardiac and blood monitoring

240
Q

tx malaria uncomplicated FALCIPARUM

A 
oral malarone (atovaquone- proguanil)
riamet (artemeter, CACT not for preggos(
quinine et doxy/clinda
241
Q

nonfalciparum

A

chloroquine followed by primaquine

242
Q

for what drug do you need to check the g6pd sttaus

A

primquine.

243
Q

what level is good Hba1c control in dibaetic

A

53

244
Q

t1dm condordance in monozygotic twins

A

50%

245
Q

addisons is linked with what kind of diabetes

A

t1dm

246
Q

who to screen for t2dm

A 
family hx
south asians
afrocarribean
bmi over 30
pts on diabetes inducing drugs.
247
Q

at what glucose level do you get NEUROGENIC symptoms? and what are they

A

3.6,

tachycardia, nausea vomiting tremor

248
Q

at what glucose level do you get NEUROGLYCOPENIC symptoms? and what are they

A

2.7 coma, confusion

249
Q

does alcohol cause hyper or hypoglycemia

A

hypo

250
Q

how to reverse hypoglycemia awareness

A

go on hypo holiday. avoid hypo at all costs. use analogue of insuli, or insulin pump therapy.

251
Q

hypo if they can self administer

A

lucozade, sugar in water.

252
Q

hypo if conscious but cant self administer

A

buccogel

253
Q

hypo if unconcscious

A

recovery position and MI glucagon. 0-5-1mg or IV glucose if theres a cannula in already.

254
Q

when will dvla revoque liscence

A

if theres one or more hypo requiring assistanc.e

255
Q

LADA misdaignosed as

A

type 2 because patients present late

256
Q

MODY is bascially similar to

A

type 2

257
Q

LADA is bascially type

A

1

258
Q

which one is inherited in autosomal diminena tway mody or lada

A

mody

259
Q

positive coombes test seen in

A

autoimmune hemolytic anemia

260
Q

Intravenous immune globulin is used for

A

post-transfusion purpura

261
Q

Oral histamine (e.g. diphenhydramine) is used for (in trasnfusion)

A

urticarial/ allergic transfusion reactions.

262
Q

The isolated thrombocytopenia in a well patient points to

A

a diagnosis of ITP

263
Q

First-line treatment for ITP is

A

oral prednisolone

264
Q

Haemolytic transfusion reactions are usually the result of

A

IgM type antibodies, rather than IgG binding to red blood cells.

265
Q

The combination of low platelet counts and raised FDP

A

DIC

266
Q

The management of acute chest syndrome in sickle cell disease includes:

A

pain relief
oxygen therapy
antibiotics
transfusion

267
Q

features and blood test of hemophilia

A

Features
haemoarthroses
haematomas
prolonged bleeding after surgery or trauma

Blood tests
prolonged APTT
bleeding time, thrombin time, prothrombin time normal

268
Q

chirstams disease is

A

hemophilia b

269
Q

features and blood test of hemophilia

A

Features
haemoarthroses
haematomas
prolonged bleeding after surgery or trauma

Blood tests
LOOOOONG APTT
bleeding time, thrombin time, prothrombin time normal

270
Q

In sickle-cell, acute painful vaso-occlusive crises should be diagnosed

A

clinically

271
Q

This patient is suffering from post-thrombotic syndrome (PTS). This normally affects people 6 months to 2 years after they have had the initial DVT. It is caused by chronic venous hypertension. Symptoms of PTS include chronic pain, swelling, hyperpigmentation and venous ulcers.

A

give them compression socks

272
Q

Hirudoid cream is a heparinoid based cream that is useful in the treatment of

A

superficial thrombophlebitis

273
Q

Disproportionate microcytic anaemia -

A

think beta-thalassaemia trait

274
Q

DVT in preggo what do you use

A

LMWH

275
Q

imatinib is. a

A

tyrosine kinase inhibitor

276
Q

dx meloma

A

serum protein electrophoresis

277
Q

med while waiting for ctpa or dopller

A

doac

278
Q

A blood film shows large cells with a bilobed nucleus and prominent eosinophilic inclusion-like nucleoli.

A

reed stenberg cells
Patients with Hodgkin’s lymphoma are recommended to receive irradiated red cells lifelong to prevent the risk of developing transfusion-related graft-versus-host disease

279
Q

Piperacillin with tazobactam (Tazocin) is the empirical antibiotic of choice for neutropenic sepsis

A

genre after chemp

280
Q

glandular fever caused by

A

ebv

281
Q

Definitive diagnosis of sickle cell disease is by

A

haemoglobin electrophoresis

282
Q

cryoprecipitate is made ofwhat

A

factor 8, fibrinogen, von Willebrand factor and factor

13

283
Q

olanzapine SE

A

VTE

284
Q

parvovrius is associated w whta kind of crisis

A

aplastic

285
Q

some patients can get an “allergic type” infection in the kidneys. what is it called? what does it present as?

A

acute interstitial nephirtis
presents with high urea high creatinine, and WHITE CELL CASTS also raised IgE
can happen after peniclin.

286
Q

what do white cells casts on urinalysis show

A

acute interstitial nephritis

287
Q

how can you tell if its acute or chronic kidney disease

A

Hypocalcaemia means chronic and not acute

288
Q

sepsis causes what metabolic disturbance

A

metabolic acidosis with raised anion gap

289
Q

Hyaline casts may be seen in the urine of patients taking

A

loop diuretics

290
Q

Anti-GBM disease typically presents with

A

haemoptysis + AKI/proteinuria/haematuria

291
Q

Autosomal dominant polycistic kidney disease - most common extra renal manifestations

A

liver cysts

292
Q

Nrphrotic syndrome

A

Triad of:

  1. Proteinuria (> 3g/24hr) causing
  2. Hypoalbuminaemia (< 30g/L) and
  3. Oedema
293
Q

What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?

A

loss of antithrombin III

294
Q

is blood in nephirtic or nephrotiuc syndro,e

A

neprhitic

295
Q

thryoid and nephortic syndrome

A

Low total thyroxine T4 levels may be seen in nephrotic syndrome

296
Q

memerbaneous glomerulonephritis is associated with

A

SLE

297
Q

fluid theraoy for patient

A

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

Maintenance fluid in children is weight dependent: 100ml/kg for the first 10kg, 50ml/kg for the next 10kg and 20ml/kg for every subsequent kg.

298
Q

potassium delivery

A

The maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour, whereas rates above 20 mmol/hour require cardiac monitoring

299
Q

time for fistual to be ready for use

A

2 mohths

300
Q

What is the most likely outcome following the diagnosis of minimal change nephropathy in a 10-year-old male?

A

full recovery and no further episodes

301
Q

what bacteria cause hemolytic uremic syndrome

A

e coli

302
Q

what to do in patients with with a clinically raised ACR (>3mg/mmol) like in renal artery stenosis and co-existent diabetes mellitus.

A

give ACEi

303
Q

All patients with chronic kidney disease should be started on

A

a statin

304
Q

All diabetic patients require annual screening for

A

albumin:creatinine ratio (ACR) in early morning specimens

305
Q

neprhotic syndrome if caused by minimal change disease in childrne, how should it be managed

A

oral predniolone and reivew

306
Q

In a patient with suspected anaemia of chronic disease secondary to CKD, what to you do

A

iron status should be checked prior to commencing EPO

307
Q

do you automatically diagnose someone with CKD stages 1 and 2 or do you look at something else first

A

: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR. like high urea and high creatinine.

308
Q

dehydration lab values

A

urea that is proportionally higher than the rise in creatinine

309
Q

Most likely cause of death in someone with CKD on heamodialysis

A

IHD

310
Q

When should patients with chronic kidney disease be started on an ACE inhibitor

A

if they have an ACR > 30 mg/mmol

311
Q

typixal cause of acute interstitial nephritis

A

antibiotic use, NSAIDS

312
Q

Young female patients who develop AKI after the initiation of an ACE inhibitor

A

Consider fibromuscular dysplasia

313
Q

asthma on AF you give

A

diltiazem or veraàmil

314
Q

complete heart block

A

p waves marching through qrs

315
Q

most likely to die from stemi or nstemi

A

stemi

316
Q

biggest determinant of death in mi

A

infarct size

317
Q

how do you treat AF if there is coexistent heart failure, first onset AF or an obvious reversible cause

A

use rythm control so things like flecainide.

318
Q

if there is a structural heart disease, what drug can you NEVER USE and what should you use insteaad.

A

flecainide!!! isntead, use amiodarone.

319
Q

Anti GBM is also called

A

goodpastuer
Glomerulonephritis in Goodpasture’s syndrome is very commonly preceded by chest symptoms (coughing/chest pain/haemoptysis). It is a disease that affects type IV collagen that is found in both the lungs and the kidneys.

320
Q

high ACR suggests

A

microalbuminuria. This is a sign of early kidney damage and research has shown that using an ACE inhibitor or angiotensin-II receptor antagonist in these patients can be renoprotective, although the exact mechanism is still unclear. This is recommended by NICE regardless of the patient’s blood pressure.

321
Q

Primary and secondary aldosteronism can be differentiated by looking at

A

the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis. if low then probbalhy a primary.

322
Q

rhabdomyolysis Tx

A

saline

323
Q

Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:

A

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

324
Q

Anaemia in CKD which do you start with, correcting iron or correcting EPO

A

correct iron deficiency before starting erythropoiesis-stimulating agents

325
Q

Management of HUS

A

treatment is supportive e.g. Fluids, blood transfusion and dialysis if required

NO antibiotics, despite the preceding diarrhoeal illness in many patients

plasma exchange is reserved for severe cases of HUS not associated with diarrhoea

eculizumab (a C5 inhibitor monoclonal antibody) has evidence of greater efficiency than plasma exchange alone in the treatment of adult atypical HUS

326
Q

Calcium resonium results in

A

removal of potassium from the body, rather than shifting potassium between fluid compartments in the short-term

327
Q

Short-term shift in potassium from extracellular (ECF) to intracellular fluid (ICF)
compartment

A

combined insulin/dextrose infusion

nebulised salbutamol

328
Q

what is is an indication for dialysis

A

uremia (encephalopahy, pericarditis)

329
Q

is warfarin safe in AKI

A

yes

330
Q

heparin mode of action

A

inactivates thrombin and activated factor X (factor Xa)

through an antithrombin (AT)-dependent mechanism

331
Q

acute tubular necrosis findings

A

raised urine sodium

332
Q

causes of AKI

A

Pre-renal:
Caused by inadequate renal perfusion e.g. dehydration, haemorrhage, heart failure, sepsis
Kidneys act to concentrate urine and retain sodium - urine osmolality high, urine sodium low

Renal:
Most common = acute tubular necrosis
Damage to tubular cells due to prolonged ischaemia or toxins
Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high

Rarer causes = acute glomerulonephritis, acute interstitial nephritis

Post-renal:
Obstruction of urinary tract
Usually identified with hydronephrosis on renal ultrasound

333
Q

Low total thyroxine levels may be seen in

A

nephrotic syndrome

334
Q

Body builders often have an inappropriately high or low eGFR.

A

low

335
Q

Patients who are high-risk for contrast-induced nephropathy should

A

have metformin withheld for a minimum of 48 hours and until the renal function has been shown to be normal

336
Q

daily glucose requirement

A

50-100 g/day irrespective of the patient’s weight

337
Q

Sevelamer is a

A

non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease

338
Q

Acute tubular necrosis response to fluid challenge

A

poor

339
Q

Gentamicin causes

A

an intrinsic AKI

340
Q

HIV infection is a cause of

A

focal segmental glomerulosclerosis

341
Q

most common cause of nephrotic syndrome in adult

A

membranous nephropathy

342
Q

Alcohol bingeing can lead to

A

ADH suppression in the posterior pituitary gland subsequently leading to polyuria

343
Q

muddy brown casts

A

acute tubular necrosis (necrosis is dark - brown)

344
Q

main causes of AKI

A

Sepsis and Hypoperfusion

Toxicity (drugs&contrast)

Obstruction (in bladder, ureter, prostate)

Parenchymal disease

345
Q

how do you manage an AKI

A

Most important is to assess volume status!! If hypo –> give fluid

If >2L given and still hypoperfused –> circulatory support (vasopressin or ianotrophs)

346
Q

which fluid to give in AKI?

A

hartmanns. because NaCL and cause hyperchloremi metabolic acidosis and dextrose can worsen AKI

347
Q

complication of AKI

A

Hyperkalemia –> prolonged QRS –> cardiac arrest

348
Q

how do you deal with an AKI caused by an obstruction

A

neprhostomy, stenting

349
Q

CKD defined as

A

A GFR less than 60 for more than 3 months

350
Q

cuase od CKD

A

Diabetes

Glomerulonephritis

Hypertension

Polycystic kidney disease

Pyelonephritis

351
Q

What happens to calcium, phosphate if there is an CKD?

A

Hypocalcemia, hyperphosphatemia, hyperparathyroidism.

352
Q

What happens to RBC if there is an CKD?

A

anemia

353
Q

What happens to pH if there is CKD?

A

Metabolic acidosis

354
Q

What happens to potassium if there is an CKD?

A

Hyperkalemia

355
Q

treatment of CKD

A

Treatment of CKD

MAIN PRIORITY: control BP cause HTN makes it worse

SECOND PRIORITY: reduce protenuria. How? ACEi or ARB

THIRD PRIOIRTY: treat overload with salt restriction and diuretics

DIET: LOW sodium, LOW potassium, LOW phosphate

356
Q

what does dialysis do

A

Removes water, salt, toxins

MAKE EPO

357
Q

minimum hemodialysis schedule

A

Minimum of 4 hrs three times a week

358
Q

complication of dialysis

A

Thrombosis

Infection

Hypotension

359
Q

periteoneal dialysis is done how often

A

every day

360
Q

complications of periotenal dialysis

A

Infection (peritonitis)

Peritoneal leak

Encapsulating peritoneal sclerosis

361
Q

transplatnation drugs

Azathioprine

A

act on inhibit purine synthesis so no clonal expansion of t cell

362
Q

Rapamycin –

A

acts on motor upstream of clonal expansion

363
Q

Tacrolimus

A

act to reduce t cell signaling and stop production of IL2 that causse clonal expansion

364
Q

Cyclosporin

A

act to reduce t cell signaling and stop production of IL2 that causse clonal expansion

365
Q

MMF

A

act on inhibit purine synthesis so no clonal expansion of t cell

366
Q

transplantation complications

A

Infections

Viral CMV/wart

Fungal pneumocystis

INCREASED RISK OF TUMORS – skin!! Solid organs. PTLD often driven by EBV

367
Q

Tacrolimus

A

act to reduce t cell signaling and stop production of IL2 that causse clonal expansion

SE: diabetes AND alopecia

368
Q

Cyclosporin MOa nad SE

A

act to reduce t cell signaling and stop production of IL2 that causse clonal expansion

SE_ cause hirsuitism

369
Q

MMF

A

act on inhibit purine synthesis so no clonal expansion of t cell

SE: GI problems

370
Q

nephrotic syndrome criteria

A

Proteinuria >3g/day

Hypoalbuminemia <30g/dL

Oedema

Raised cholesterol

371
Q

nmephrotic syndrome diagnosis

A

ACR

If more than 3g protein per day –> nephrotic syndrome

372
Q

mechanism of edema in NS

A

underfill hypothesis: low albumin

overfill; high sidum retenion

373
Q

minimal change disaese biopsy

A

Fusion of podocytes on EM

374
Q

focal segmental glomerulosclerosis on biopsy

A

Focal (not all glomeruli are affected)

Segmental – part of the glomerulus is sclerosed

375
Q

membraneous nepohornpathy is secondary to

A

Secondary SLE/Lupus

376
Q

management of nephrotic syndrome

A

Non specific

Tx of edema,(salt and water reduction to 1L a day) reduction in proteinuria

Statins for dyslipidemia

Anticoagulation

377
Q

how do ACEi and ARB help in nephiotir c syndrtome

A

act by reducing intragloñmerular pressure

378
Q

hallmark of nephritic syndrome

A

URINE DIP HAS BLOOD AND PROTEIN .

red cell casts

379
Q

biopsy of glomerulonephirits

A

Red cell casts glomerulonephrotis

380
Q

common cuase of glomeroluopneprhitis

A

Small vessel vasculitis e.g. ANCA associated vasculitis
IgA nephrophaty
malignancy

381
Q

why do a neprhitic screen

A

to deter,ine what antibodies are causing a problem.

382
Q

crescent formation seen in

A

glomerulonephrotis

383
Q

what antibodies are commonly found in glomerulonephritis

A

ANCA

384
Q

breast pain

A

Evening primrose oil or soya milk (phytoestrogens) may be helpful

Reduce fat intake.

385
Q

breast pain

A

Evening primrose oil or soya milk (phytoestrogens) may be helpful

Reduce fat intake.

Tamoxifen

Danazol

Zoladex

Bromocriptine

386
Q

who are one stop breast clinics for

A

symptomatic patients

387
Q

what is done in one stop breast clinics

A

Mammography, ultrasound, cytology/histology Imaging, cytology, AND RESULTS all in one day.

388
Q

what are the two view on a mammogram

A

Craniocaudal

Mediolateral

389
Q

Extremely mobile, discrete, rubbery mass is msot likely

A

a fibroadenoma

390
Q

what are phyllodes tumour

A

can be confused with fibroadenoma, women usually older, rare (<1% of breast lumps), fibroepithelial tumour, needs wide local excision. They have a malignant potential. Spreads to adjacent structures.

391
Q

when do breasts cyst usually appear

A

Usually around perimenopause

392
Q

management of cysts

A

reassure, aspirate, occasionally operate.

393
Q

if there is a palpable mass with pain.

A

Sclerosing adenosis

394
Q

whatt is montgomerys gland

A

small periareolar glands around nipple which may develop a cyst

395
Q

mondors disease

A

hrombophlebitis of superficial veins of the breast

396
Q

what is meant by tripple assessment

A

three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNAC and core biopsy).

397
Q

malignancy rating

A

1 Normal (or Cytology Insufficient)

2 Benign (eg. Fibroadenoma or breats cysts)

3 Indeterminate probably benign

4 Suspicious of cancer

5 Cancer

P5 means on palpation it’s a score of 5

398
Q

commonest breast cnacer

A

Infiltrating ductal carcinoma

399
Q

Estrogen receptor not expressed on tumor cells- that is linked to

A

to poor prognosis.

400
Q

endocrine treatment of breast cancer

A

Tamoxifen

Aromatase Inhibitors

401
Q

risk factors for breast cancer

A
  • Family history of breast cancer
  • Prior personal history of breast cancer
  • Increased estrogen exposure – Early menarche – Late menopause – Hormone replacement therapy/oral contraceptives
  • Nulliparity • 1st pregnancy after age 30
  • Diet and lifestyle (obesity, excessive alcohol consumption)
  • Radiation exposure before age 40
  • Prior benign or premalignant breast changes – In situ cancer – Atypical hyperplasia – Radial scar
402
Q

National Breast Screening programme

A

mammography every three yeasr for women 50-70

investigation of MRI in premenopausal women

403
Q

types of breast cancer

A

• Non-invasive carcinoma in situ

– Ductal carcinoma in situ (DCIS)

– Lobular carcinoma in situ (LCIS)

• Invasive carcinoma

– Infiltrating ductal or lobular carcinoma

– Medullary, mucinous, and tubular carcinomas

• Uncommon tumors

– Inflammatory carcinoma

– Paget’s disease of the nipple where cancer invades skin of nipple.

404
Q

MOST INVASIVE BREAST CANCERs

A

MOST INVASIVE BREAST CANCERS ARE OF DUCTAL PATTERN

405
Q

breast cancer staging

A

TX Primary tumor cannot be assessed

  • T0 No evidence of primary tumor
  • TisCarcinoma in situ: Intraductal carcinoma, lobular carcinoma in situ, or Paget’s disease of the nipple with no tumor
  • T1 Tumor 2 cm or less in greatest dimension

T1mic Microinvasion less than 0.1 cm

T1a Tumor more than 0.1 cm but not more than 0.5 cm

T1b Tumor more than 0.5 cm but not more than 1 cm

T1c Tumor more than 1 cm but not more than 2 cm

-T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension

  • T3 Tumor more than 5 cm in greatest dimension
  • T4 Tumor of any size with direct extension to

(a) chest wall or
(b) skin only as described below

T4a Extension to chest wall

T4b Edema (including peau d’orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast

T4c Both (T4a and T4b) T4d Inflammatory carcinoma

406
Q

breats cancer mets where

A

bones, liver, lungs, and brain

407
Q

treatment of advanced disease

A
  • Endocrine treatment anti-oestrogen
  • Chemotherapy with one or two drug regimens
  • Targeted biologicals eg trastuzumab, pertuzumab, lapatinib
  • Radiotherapy eg bones
  • Surgery to chest wall
  • Supportive care eg bisphosphonates
  • Psychological support eg art therapy
408
Q

endocrine tx of breast cancer in premenauposal

A

Premenopausal

  • Oophorectomy
  • GnRH analogues eg goserilin , leuproprelin
  • SERMs eg Tamoxifen, Fulvestrant
  • Medroxy Progesterone acetate
409
Q

enndocrine tx of breast cancer in post menopausal

A
  • Aromatase inhibitors eg anastrozole, letrozole, exemestane
  • And all the above
410
Q

her2 positiev breast cancer is treated with

A

HErceptin (trastuzumabl ) for Her2 positive breast cacer

411
Q

halo sign radiology

A

breast cyst

412
Q

duct ectasia

A

common alteration in the breast that occurs with ageing. As the ducts shorten and dilate a degree of symmetrical slit like retraction occurs. A small amount of cheese like discharge may occur.

413
Q

who to refer for breast cancer

A

Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral

414
Q

Blood stained discharge is most likely to be associated with a

A

papiloma

415
Q

First-line management of mastitis is

A

to continue breastfeeding

416
Q

cause of mastitis and tx

A

staph aureaus, flucloxacillin

417
Q

cytotoxic theraoy

A

Cytotoxic therapy may be used either prior to surgery (‘neoadjuvanant’ chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.

418
Q

cancer premonopose you guve

A

tamoxifen

419
Q

cancer postmenaupose you guve

A

aromatase inhibiotr like anastrozole

420
Q

aromatase inhibitor /anastrozole) SE

A

osteoporosis

421
Q

Duct ectasia:

A

non-malignant breast disease with thick green nipple discharge, occurring with breast involution

422
Q

murphys sign positive in

A

cholecystitis

423
Q

Fibroadenosis64

A

symptoms are worse in premenstrual period

424
Q

mucisnus

A

acroscopically there is a grey, gelatinous surface.

425
Q

triple negative means

A

no re eoptors for
estrogen
progresterone
her2

426
Q

a women who is breast feeding presents with a very painful, red swelling above her areola

A

breast abscess

427
Q

p53 mutatio and breast cancer

A

increased risk

428
Q

a 40-year-old woman presents with a watery, blood-stained discharge from her nipple. There are no palpable lumps or skin changes

A

duct papilloma

429
Q

can aspirin be used while breast feeding

A

nooooooo

430
Q

can warfarin be used while breastfeeding

A

yes

431
Q

campylobacter tx

A

clarithromycin

432
Q

legionella tx

A

macrolides

433
Q

nutmeg liver associated with

A

right sided hf

434
Q

when does pci pr cabg have a prognostic benefit

A

in unstable angina, not in stavke angina

435
Q

tx to improve prognosis angina

A 
abas
aspirin
bb
acei
statims
436
Q

symptomatic relief in angina

A

bb

gtn

437
Q

ejection fraction grades

A

sever less than 35
moderate 36-45
mild 46-55

438
Q

core pulmonale causes what kind of heart fialure

A

right side

439
Q

right bbb with left axis deviation

A

left anterior fascicular block. impt i hf. indicates ischemic heart disease.

440
Q

management of acute pulm odema

A

high flow oxyge
gtn
fureosemide
morphine and antiemetic

441
Q

stenotic valves lead to hypertrophy or dilatation

A

hypertrophy

442
Q

regurigtnat valves lead to hypertrophy or dilatation

A

dilatatopm

443
Q

aortic stenosis on ecg

A

inverted t wave on v4 v5

444
Q

how to determine severity of arotic stenosis

A

doppler shows more velocity

445
Q

mitral faces seen in

A

mitral stenosis

446
Q

mitral regur cause

A

mitral valve prolapsem(genetic)

447
Q

when to intervene in valvular ehart disease

A

symptomatc, irreversible chanhge in cardiac functiom, improve progosis.

448
Q

medical tx of valvular heart dsiease

A

bb
acei
diuretics
calcium antagonists

449
Q

mainstay diagnosis of bacterial endocarditis is

A

presenc eof vegetations on echocardiography.

450
Q

duke criteria of definitive endocarditis criteria

A

2 majors
1 major and 3 minors
5 mniors

451
Q

minors duke criteria

A 
splinter hmorrhage
clubbing
prediposintion (knwn valvle abnormlaity=
splenomegaly
suggestive echo or microbiology
452
Q

major u¡duke criteria

A

typical blood culture
positive q fever serology
postivei echo: presence of abcess. desinhence of prostehtic valve, valvular regur. varying intracardiac amss on vale or supporting structure i te path of a regurgiantant ket

453
Q

what kind of valve require warfarin

A

mechanical

454
Q

how long do mechanical valves last

A

30 years

455
Q

how long do tissue valves last

A

12-15 years

456
Q

what part of neprhons do loop diuretics work on

A

ascending loop of H

457
Q

ACEi improve mortality in what

A

HfREdUCED EF

458
Q

ACEi side effects

A

hyperkalemia
angiodema
dry cough
first dose hypotension

459
Q

ARB

A

NO dry cough
no angiodema

yes hyperkalemia
yes first dose hypotension

460
Q

ARBimprove mortality in what

A

HfREdUCED EF

461
Q

spironolactone improve mortality in what

A

HfREdUCED EF

462
Q

contraindications to bb

A

asthma

verapamil therapy

463
Q

bb improve what funciton

A

diastolic

but can precipirate acute lvf

464
Q

does ivabradine improve morality

A

yes

465
Q

problem of digoxin

A

long half life so may need a loading dose.

466
Q

amiodarone problemd

A

can cause bradycardia
very long hafl life
pulm fibirsis, hepatitis

467
Q

ivarbradine porblem

A

acts o sinus noden so can cause bradycardia. It’s an interferon inhibitor

468
Q

side effect of amlodipine

A

ankle swelling

469
Q

side effect of verapamil

A

constipated

470
Q

stage 1 hypetension

A

140/90 and 135/85 ABPM

471
Q

stage 2 hypertension

A

160/100 and ABPM 150(95

472
Q

stage 3 hypertension

A

more than 180 more tha 110

473
Q

postural hypo

A

stand patient for one minute. drop systoly of more tha 20mmHg

474
Q

malignant hyyerptension

A

more than 180 over 110 /so stag 3( AND sign of papilloedema. or retunalk hemmorhage.

475
Q

if BP drops at night its a good prognosis or bad

A

good

476
Q

if BP increases at night its a good prognosis or bad

A

bad

477
Q

BP linked w sleep apnoea

A

high

478
Q

if coarctation of aorta which rading fo you consider

A

higher

479
Q

hypertension end organ damage examples

A

eye problems, protenuir,a

480
Q

bariatric surgery compliations

A

fat malabsoprtion so fat soluble vitmain deficiency

481
Q

whci type of hyperlipidemia is more common

A

secondary

482
Q

total serum cholesterol should be less than 5

A

more than 7.5 think about FH

483
Q

if serum LDL is more than 3

A

high. if more than 4.9 think about FH

484
Q

FH cause

A

mutation is LDL receptor. high secretion of VLDL

485
Q

FH inheritence

A

autosomal dominant. dx: simone broome critieria.

486
Q

dysbetalipoprotenemia cause

A

mutation of apoe to apoe2

487
Q

simone broome critera

A

cholesterol total more than 7.5 LDL more than 4.9 and tensdon zantohmanataor evidence of that in first or second degree relatives

488
Q

angular stomatitis sign of

A

iron def

489
Q

koilonychia sign of

A

iron def

490
Q

glossitis sign of

A

b12 def

491
Q

premature greying sign

A

iron def

492
Q

mean corpuscular hemoglobin definition

A

average mass of Hb per RBC

493
Q

NCH calculation

A

total mass of Hb/number of RBC

494
Q

MCH calculation

A

total mass of Hb/number of RBC

495
Q

if microcytic anemia with high RBC

A

thalassemia

496
Q

folic acid def leads to what type of anemia

A

macro

497
Q

lead poisening leads to what type of anemia

A

microcytic with normal RBC

498
Q

sideroblastic leads to what type of anemia

A

microcytic with normal RBC

499
Q

most caucasians are what blood group

A

o

500
Q

ABO mistmatch leads to what

A

complemetn activationm c’ - c3a c5a - cytokine release

501
Q

acute hemolytic reaction is undepined by what mechanism

A

complement mediated lysis due to ABO incompatible blood.

502
Q

tx acute hemolytic reaction

A

fluids, STOP trwssnfusion.

503
Q

when does delayed hemolytic transfusion occur

A

7-10 days after

504
Q

what causes delayed hemolytic tranfusion reaction

A

red cells Ab - IgG

505
Q

dx delayed hemolytic tranfion reaction

A

direct antiglobulin test

506
Q

whos most at risk of delayed hemolytic tranf react

A

SCD pts

507
Q

febrile non hemolytic

A

give paracteamo. temp rise by 1 degree. plus inus high pulse.

508
Q

if anaphylaxis durinf trasnufision

A

myabe IgA deficient

509
Q

post trasufusion purpura

A

7 10 days post strsunfusion. HPA1 negative patients form antibodies after transfuision or pregnancy. destruction of platelerts after further trsnfusion.

510
Q

transfusion associated graft vs host disease

A

rare but lawyas fatal.
mediated through viable lymphocytes in donors blood trasnfued to immunocompromised host
prevented by giving irradiated blood which makes donors lymphocytes unable to divide

511
Q

how to avoid graft vs host disease

A

irradiated blood.

512
Q

risk of infection Hep B HIV HepcC

A

most: HepB
HIV
HepC

513
Q

SO prion disease

A

leukodepletion

514
Q

tranexemic acid

A

reduces blood loss preop

515
Q

transfusion triggers

A

80 if ACS

70 if no ACS

516
Q

what causes pharingitis virus or bac

A

virus. but most common bac is group a

517
Q

scarlet fever tx

A

penicilion v for 10 days.

518
Q

antiobiotic or not? criteirs?

A

centor criteria. if 3/4 points then okau give.

  1. tonsilar exudate
    2- tender cervical ln
  2. abscence of cough
  3. ho fever
519
Q

pharyingitis tx

A

penicilin v

520
Q

amoxicilin can cause rash in who

A

pts with ebv. so give penicilin in sore thorat.

521
Q

otitis media tx

A

amox for 5.7 cays.

522
Q

sinusitis case

A

viral

523
Q

pneumoccoocal pneumo tx

A

amoc.

524
Q

mycoplasma pne tx

A

no cell wall so use macroilide.

525
Q

legionella is gram what? tx?

A

negative

quinolones

526
Q

CURB 65

A 
confusion
Urea more than 7
resp rate more than 30
BP less than 90s or less than 60 d
over 65 yo

if 0-1 low riks - OUTPATIENT- moral AMOX

2 moderate risk- ADMIT- IV benzylpenniclin and doxy

3-5 URGENT ADMISISON IV coamox and doxy or IV cefrtaicone and doxy if history of travel.

527
Q

HAP definition

A

more than 48hrs afte admission or within 2 weeks of amdissin.

rcoli. klebsiella, pseudomonas.

tx: mild moderate: doxy
severe: less than 5 days: co amox
more: piperacillin tazobactam

528
Q

whast the only thing that cover sfor pseudomonas

A

piperacillin tazobactam

529
Q

aspiration pneumonia tx

A

amoxicilin and mitronidazole which covers for anaerobles.

530
Q

COPD exacerbation tx

A

doxy or clarithro but only if more than two of high dyspnoea and high sputum purulence and high sputum volume.

531
Q

bronchiectasis tx

A

if pseudomonas: pipazobactma.

if not; clarithrymycin or doxyclicne or co amoc.

532
Q

prophylazis bronchiectasis

A

chest physio and postural drainage.

533
Q

empyema tx

A

drainage

prevention is vaccinatin.

534
Q

normal valve infective endocarditis cause

A

HIGH VIRULENCE staph auresu, strep pneumonia, yeast

535
Q

abnormla valve infective endocarditis cause

A

Low VIRULENCE viridans streptococcus, coxiella…

536
Q

prostehetic valve endocarditis cause

A

stap aureus

coagulase engative.

537
Q

prosthetic valve vs native vlavle IE therapy

A

prosthetic 6w

native 4w

538
Q

CURB 65

A 
confusion
Urea more than 7
resp rate more than 30
BP less than 90s or less than 60 d
over 65 yo

if 0-1 low riks - OUTPATIENT- oral AMOX

2 moderate risk- ADMIT- IV benzylpenniclin and doxy

3-5 URGENT ADMISISON IV coamox and doxy or IV cefrtaicone and doxy if history of travel.

Met3b (3 decks)

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