Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > SAQ book > Flashcards

SAQ book Flashcards

1
Q

CKD Stages: (Based on egfr)

A

Stage 1: Above 90 Egfr
Stage 2: 60-89
Stage 3a: 45-59
Stage 3b: 30-44
Stage 4: 15-29 (Usually only symptomatic from Stage 4 onwards)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Other than Diabetes, 4 common causes of CKD?

A
  • Hypertension
  • Glomerulonephritis
  • Pyelonephritis
  • Polycystic kidney disease
  • Obstructive uropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is a renal ultrasound arranged in CKD?

A
  • To assess renal size, exclude polycystic kidneys, and exclude obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Medication to add if diabetic and in CKD?

A

ACE-I (eg. Ramipril is protective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 common side effects of ACE-i?

A
  • Dry cough
  • AKI
  • Urticaria
  • hyperkalaemia
  • first dose hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 other blood tests that are important to check regularly in CKD?

A

PTH
FBC
Calcium
Alkaline Phosphatase
Phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of CKD?

A

-Anaemia
-Renal osteodystrophy

NB: CKD mx: often requires lowering dose of drug= Gentamicin and Digoxin
- CKD patients are prone to developing Hyperkalaemia= give low potassium diet for all patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 signs of CKD could find on examination?

A

-Pallor
- purpura
- uraemic tinge
- brown discolouration of nails
-peripheral oedema
Pericardial rub
- pleural effusion evidence
- Tenckhoff catheter (evidence of preparation for renal replacement therapy)
- Proximal Myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain basic principles of haemodialysis?

A
  1. Blood and dialysis fluid flow either side of a semipermeable membrane.
  2. Molecules diffuse DOWN their concentration gradient
  3. Plasma biochemistry changes to become more like the dialysis fluid.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 complications of Peritoneal Dialysis?

A
  • Bacterial/Sclerosing Peritonitis
  • Location infection at catheter site
  • Constipation
  • failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what time period determines if organ rejection after renal transplant is acute or chronic?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why is there a need to be seen by a dermatologist after a renal transplant?

A
  • increased risk of squamous cell carcinoma (due to the long-term immunosuppression)

-Renal replacement therapy: is started when egfr is less than 15+symptomatic. Options:
1)Haemodialysis (involves formation of AV fistula- blood and dialysis fluid flows in opposite directions)
2)Peritoneal Dialysis (tenckhoff catheter- dialysis fluid is introduced into peritoneal cavity
3) Renal transplant: can be from donors: brainstem dead, non-heart beating, living related, living unrelated. Patients must be ABO incompatible with donor. Lifetime immuno-suppression is needed after this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What form of Hyperparathyroidism has Low calcium and high PTH?

A

Secondary Hyperparathyroidism (high PTH and low Ca)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

give 2 actions of PTH

A

1) Increase osteoclast activity (results in increased calcium and phosphate released from bone)
2) Increase Calcium and Phosphate Reabsorption via kidney
3) increased hydroxylation of Vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At what 2 sites does Hydroxylation of Vit d occur?

A
  • Liver
  • Kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What term is given to bone disease in patients with renal failure

A

Renal Osteodystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 ways to manage Secondary Hyperparathyroidism

A
  • Calcium supplements
  • Vitamin D analogues (eg. calcipotriol)
  • Restrict dietary phosphates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tertiary Hyperparathyroidism: levels of calcium and PTH?

A

Calcium: high
PTH: High

NB: Both is high like Primary Hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Reason for why tertiary hyperparathyroidism can develop from secondary?

A
  • Prolonged Tertiary Hyperparathyroidism= causes parathyroid gland to act autonomously (causes hyperplastic change)
    NB: in CKD: there is reduced production of erythropoeitin= causing anaemia, therefore treat with Erythropoeitin injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how can AKI be subclassified?

A

3 types:
1) pre-renal
2) renal
3) post-renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 causes of each type of AKI?

A

Pre-renal: (dehydration)
1) Hypovolaemia
2) sepsis
3) congestive heart failure

Renal: (intrinsic)
1) Acute tubular necrosis
2)Glomerulonephritis
3) rhabdomyolysis
4) haemolytic uraemic syndrome
5) Pre-eclampsia
6) malignant hypertension

Post-renal: (obstruction)
1)renal calculi
2)ureteric tumours
3) BPH
4) Prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

triad of conditions in haemolytic uraemic syndrome?

A

1) AKI
2) haemolytic anaemia
3) thrombocytopenia (LOW platelets)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Other inv. to request in AKI except blood tests?

A
  • Renal USS: to rapidly rule out an obstruction
  • CXR
  • ECG
  • ABG
  • Urinalysis

NB: Mx of AKI= is by treatment of underlying cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

2 potentially life-threatening complications of AKI?

A
  • Pulmonary oedema
  • Hyperkalaemia
  • Haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

give 2 indications for dialysis in a patient with AKI?

A

1) Uraemic (either encephalopathy or pericarditis)- uraemia would present with confusion
2) Refractory: Pulmonary oedema/ Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Reason for AKI if urine is brown, collapsed on floor for ages?

A

Rhabdomyolysis= Following prolonged immobility
- Mechanism that causes this: Acute Tubular Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what blood test would be raised in Rhabdomyolysis?

A

Creatinine Kinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What urine test would you request to confirm the diagnosis?

A

Urinary Myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What may be seen on urine microscopy?

A

Muddy brown/granular casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which medications would you hold on admission in a person with Rhabdomyolysis?

A
  • metformin- as there is a risk of metabolic acidosis
  • lisinopril- is nephrotoxic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Other than prolonged immobility, give 3 causes of Rhabdomyolysis?

A
  • Excessive exercise
  • Crush injuries
  • Burns
  • Seizures
  • Neuroleptic malignant syndrome
  • Drugs: Heroin, Ecstasy, Statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

3 ECG changes seen in Hyperkalaemia?

A

(Everything big)
- Tall tented T waves
- Widening of QRS complex
- Flat P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Initial treatment for Hyperkalaemia?

A
  • IV Insulin+Dextrose
  • Salbutamol Nebulisers
  • 10% Calcium Gluconate 10mL over 5 mins (if K+ is more than 7= to protect the myocardium of the heart)
  • if hyperkalaemia still remains= Needs Dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What blood tests should you request urgently: for rapidly progressive Glomerulonephritis? (urine shows: positive for blood and protein)

A
  • ANCA
  • Anti-GBM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what medication should be started immediately in rapidly progressive Glomerulonephritis?

A

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Further inv. to confirm Wegener’s Granulomatosis (Granulomatosis with Polyangitis)

A

Renal biopsy

NB: about condition: is autoimmune affecting: upper and lower resp. tract+ Kidney
-cANCA
- Renal biopsy: will show Epithelial crescents in Bowman’s capsule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Define nephrotic syndrome

A

Triad:
1) Proteinuria (more than 3)
2) Hypoalbuminaemia (less than 30)
3) Oedema

Presentation could be: leg swelling that is worse when standing and walking, resolved when lying flat, + no SOB (as ddx: Heart failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Most common cause of nephrotic syndrome in - children - adults?

A
  • Children: Minimal Change Disease
  • Adults: Membranous Nephropathy/Glomerulonephritis (Mx: ACE-i/ ARB)
  • Elderly: Focal Segmental Glomerulosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What inv. will give definitive diagnosis for Nephrotic Syndrome?

A

Renal Biopsy (Almost always the definitive diagnosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

2 complications of nephrotic syndrome?

A
  • Increased susceptibility to infections
  • increased risk of thromboembolism
  • hyperlipidaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

One measure to manage complication of nephrotic syndrome?

A
  • infection: prompt abx. treatment, pneumococcal vaccination
  • thromboembolism: avoid prolonged bed rest, and consider anticoagulation
  • hyperlipidaemia: treat with statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

2 pieces of Dietary advice: for a patient with nephrotic syndrome?

A
  • Restrict salt intake
  • Normal protein intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

serum osmolality formula?

A

2*Na+urea+glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

clinical obs. and inv: to determine volume status and cause of hyponatraemia?

A
  • examine for peripheral oedema
  • examine jvp
  • postural blood pressure
  • measure urine output
  • cxr: signs of heart failure/pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the risk of correcting hyponatraemia too quickly?

A
  • Central pontine myelinolysis (another word for osmotic demyelination syndrome)
46
Q

Where is ADH (vasopressin) secreted?

A

Posterior pituitary gland

47
Q

How does ADH increase water reabsorption?

A

Recruits Aquaporin 2 channels: to apical membrane of principal cell of collecting ducts= making it water-permeable.

48
Q

Urine osmolality is high (relative to serum osmolality)+urinary sodium is high what diagnosis?

A
  • SIADH
49
Q

name a drug used to treat SIADH?

A
  • Demeclocycline
  • Vasopressin (ADH) receptor antagonists
50
Q

UTIs and Cystitis: classic presentation

A
  • In young female
  • Dysuria
  • Urinary frequency
51
Q

Which organism is commonly responsible for infections of the urinary tract?

A
  • e. coli
52
Q

4 risk factors for UTIs?

A
  • Female
  • Sexual intercourse
  • Pregnancy
  • renal calculi
  • long-term catheterisation
  • Diabetes
53
Q

which two things positive indicate UTI?

A
  • Nitrites
  • Leucocytes
54
Q

which abx. to prescribe in UTI and for how many days?

A

Trimethoprim
Nitrofurantoin
Amoxicillin
- 3 days
- If symptoms occurs despite abx= do a MSU

55
Q

Any advice to prevent recurrence of UTIs?

A
  • Keep well hydrated
  • Drink lots of cranberry juice
  • Post-coital voiding
  • Wipe front to back
  • Avoid spermicide
56
Q

Pyelonephritis classical presentation?

A
  • Young female
  • fever
  • RUQ pain
  • loin pain
  • rigors
  • vomiting
  • Urine dipstick: positive for= WCC+ Nitrites
57
Q

Pyelonephritis: steps you would do to see this patient?

A
  • assess ABC
  • full history and exam
  • IV access and give fluids IV
  • urine dip
  • request relevant inv.
  • start empirical abx.
  • start empirical abx if necessary
58
Q

4 investigations to request for pyelonephritis? (can treat with: IVco-amoxiclav)

A
  • FBCs
  • U and E’s
  • CRP
  • Urine MC and S
  • Blood cultures
  • Renal Ultrasound
59
Q

signs of anaphylaxis on patient?

A

-Airway: stridor, hoarse voice, obvious swelling of tongue/throat
-Breathing: Tachypnoea, cyanosis, wheeze
- Circulation: Tachycardia, Hypotension, pale appearance, may feel clammy

60
Q

Anaphylaxis: which route will you give adrenaline? What conc. and how much?

A
  • IM
  • Concentration: 1:1000
  • Volume: 0.5ml
61
Q

2 contraindications to renal biopsy?

A
  • single functioning kidney
  • systolic BP: more than 160
  • diastolic BP: more than 90
  • CKD with small kidneys
  • abnormal coagulation studies: therefore patients on anticoagulation should stop them well in advance of biopsy procedure
  • After biopsy: bed rest is advised+ pressure dressing applied. patients should avoid heavy lifting and strenuous activity for following 2 weeks
62
Q

2 complications to renal biopsy?

A
  • Macroscopic haematuria (bleeding)
  • pain
  • infection
  • formation of AV aneurysm
  • rare cases: death
63
Q

1 histological finding: in IgA nephropathy (NB: is associated with Henoch- Schloein Purpura- HSP)

A
  • IgA deposits
  • mesangial proliferation
64
Q

give 3 other causes of a purpuric rash (apart from HSP) ?

A
  • Meningococcal Septicaemia
  • DIC
  • TTP
  • ITP
65
Q

Rheumatoid Arthritis: immunological investigation to request?

A

Immunological= Antibody
1) Anti-CCP: specific
2) Rheumatoid Factor

66
Q

3 findings expected to see in hands of rheumatoid arthritis?

A
  • Swan neck deformity
  • ulnar deviation
  • Boutteneire’s
  • z shaped finger
67
Q

Rheumatoid Arthritis: 3 abnormalities seen on X-ray of hands?

A

LESS
- Loss of joint space
- bony Erosions
- Soft tissue swelling
- oSteopenia (juxta-articular)

68
Q

4 extra-articular features of Rheum arth?

A
  • Scleritis
  • rheumatoid nodules
  • anaemia
  • Raynaud’s
  • Pleural Effusion
  • carpal tunnel Syndrome
69
Q

What condition presents with: palpable spleen, neutrophil of 1.10(low), splenomegaly

A

Felty’s syndrome

70
Q

rheum arth classic px:

A
  • symmetrical polyarthritis
  • refer all suspected patients to rheum for further assessment
71
Q

what condition presents with: bone pain, tenderness, proximal myopathy+ waddling gait

A

Osteomalacia: most commonly secondary to vit d deficiency

72
Q

Neuro: Subarachnoid Haemorrhage classical presentation?

A
  • worst headache ever, ‘thunderclap’ ‘being hit by a baseball bat’
  • came on suddenly
  • neck stiffness+ coryzal symptoms
73
Q

Differentiating between: arterial and venous intracranial haemorrhage?

A

Subarachnoid haemorrhage= arterial
NB: Epidural= arterial
Subdural= venous

74
Q

what is type of aneurysm that commonly causes Subarachnoid haemorrhage?

A
  • Berry aneurysm
75
Q

name a condition associated with this aneurysm?

A

Polycystic Kidney disease
- also: coarctation of aorta, Ehlers-Danlos syndrome

76
Q

Name 4 other symptoms/signs other than headache, a patient with subarachnoid haemorrhage will present with?

A
  • Vomiting
  • Nausea
  • Seizures
  • Focal neuro signs eg. hemiplegia, dysphasia
  • photophobia
77
Q

what is Kernig’s sign and what does it demonstrate?

A
  • Demonstrates meningeal irritation
  • is + in meningitis
  • Hip and Knee is bent to 90 degrees and if +, there will be pain by straightening knee.
78
Q

Subarach: what imaging would you request and what would it classically show you?

A
  • CT Head
  • Blood appears white(haemorrhage), which will be mixed in with CSF
  • will lie within: interhemispheric fissure, basal cisterns and ventricles.
79
Q

What further test would you perform for subarachnoid haem. if CT was normal?

A
  • Lumbar puncture (only after 6 hours and if non contrast CT is normal.
  • NB: would ask the lab to analyse for: Xanthochromia
80
Q

What 4 bones meet at the Pterion?

A
  • Parietal
  • temporal
  • sphenoid
  • frontal
81
Q

What are the differences in the shape of haematoma on CT head scan: between extradural and subdural haematoma?

A
  • Extradural: lens shaped/bi-convex
  • Subdural: crescent-shaped
82
Q

Other CT changes seen in Extradural Haem. (trauma)

A
  • Midline shift
  • Compression of the ventricles
83
Q

4 risk factors of stroke?

A
  • diabetes
  • heart disease (eg. AF/valvular)
  • peripheral vascular disease
    -previous TIA
  • cocp
  • excess alcohol
84
Q

difference between TIA and stroke?

A

TIA: lasts for less than 24 hours
Stroke: lasts for more than 24 hours/or leads to death within the 24 hours

85
Q

signs of a stroke?

A
  • one sided sensory loss
  • dysphasia
  • homonymous hemianopia (vision)
86
Q

What is the most common cause of cerebral infarct and what surgical technique can be used to manage it?

A
  • Carotid artery Atherosclerosis
  • Mx: Carotid Endarterectomy= in cases of severe stenosis
87
Q

Ischaemic stroke, apart from medical mx, what else can be considered in managing this patient?

A
  • admission to stroke unit
  • swallow assessment
  • physio
  • skincare
88
Q

Primary prevention of stroke?

A
  • lowering BP
  • Stopping smoking
  • well-controlled diabetes
  • reducing cholesterol and lipids
  • improving diet and exercise.
89
Q

what is epilepsy?

A

Transient occurrence of intermittent, abnormal electrical activity of part of the brain.

90
Q

what is an aura?

A

is part of the seizure; often precedes other things.
- is a disturbance of a sensation- often a strange feeling/smell/taste/flashing light

91
Q

what is todd’s palsy?

A
  • is T emporary weakness, following a seizure.
92
Q

Different types of seizures?

A
  • Partial seizure: symptoms from 1 hemisphere (focal)
  • partial with secondary generalisation: seizure starts focally, then spreads= causing a generalised seizure.
  • absence seizure: generalised seizure, brief pauses (for eg. stops talking for a period, then continues from where they stopped)
93
Q

2 metabolic causes for seizures?

A
  • Hypoglycaemia
  • uraemia (also presents with confusion and seizures)
  • Hypo/hypernatraemia
  • Water intoxification
94
Q

airway adjunct to use in a fitting seizure patient- where they are not maintaining their airway?

A

Nasopharyngeal airway

95
Q

causes of epilepsy?

A
  • Structural brain abnormality
  • metabolic abnormalities
  • drugs
  • alcohol (or from withdrawal)
  • hypoxia
  • most are: idiopathic
96
Q

define status epilepticus timing:

A
  • If seizure lasts more than 5 mins, or has repeated seizure within 5 min period without person returning back to normal.
  • Aim: to stop seizure activity as soon as possible.
97
Q

Describe bitemporal Hemianopia visual loss?

A
  • loss of vision in the lateral half of both eyes
  • ’ Tunnel vision; - not as wide

NB: affects the optic chiasm

98
Q

most likely cause for: Bitemporal Hemianopia and the compression at the optic chiasm?

A

Pituitary gland adenoma- functioning or non-functioning depends on: if endocrine symptoms are present or not?

99
Q

Retinal field affected in bitemporal hemianopia?

A

Medial (is opposite to the actual vision loss that happens in the person= which is lateral- in bitemporal hemianopia)

100
Q

Info about Bitemporal hemianopia?

A
101
Q

HAEM: Young man presenting with rubbery lymph nodes, painless on palpation diagnosis?

A

Lymphoma (type of blood cancer)

102
Q

list 3 symptoms of lymphoma?

A

B symptoms:
- Night sweats
- Weight loss
- Fever
- Tiredness
- Alcohol induced pain at node sites

103
Q

2 signs on examination: Lymphoma?

A
  • Enlargement of lymph nodes
  • Splenomegaly
  • Hepatomegaly
104
Q

What is the name of the cell that suggests Hodgkin’s Lymphoma?

A
  • Reed Sternberg cell
105
Q

What staging system is used for Hodgkin’s Lymphoma?

A
  • Ann Arbor
106
Q

State 2 investigations to STAGE Hodgkin’s:

A
  • Bone marrow biopsy
  • CXR
  • CT chest/abdomen/pelvis
107
Q

Presentation: Dyspnoea, swelling of face+ congested veins in neck and chest (while being investigated for Hodgkin’s?

A
  • Superior vena cava obstruction: is an oncological emergency; headaches that are often worst in the morning
  • Mx: Endovascular stenting
108
Q

3 signs patient with Microcytic Anaemia will present with?

A
  • Pale Conjuctiva (of eye)
  • Tachypnoea
  • ## Tachycardia
109
Q

1 cause of iron-deficiency anaemia, other than heavy bleeding?

A
  • Poor diet
  • Malabsorption eg. coeliac disease
110
Q

Name 2 more specific signs: on examination of someone with: CHRONIC iron-deficiency anaemia?

A
  • Angular Cheilitis (Mouth ulcers)
  • Koilonychia (Spoon nails)
  • Atrophic Glossitis (smooth tongue with less filiform papillae
111
Q

2 common side effects of ferrous sulphate (oral iron)

A
  • black stools
  • constipation
  • nausea

Finals (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions