SAQ Learning Points Flashcards
Bone pain and low calcium due to kidneys:
Renal Osteodystrophy.
Low Ca, bone pain
Tx: Vit D, Calcium supplements, Low phosphate diet.
Vitamin D has it’s OH groups added in liver and kidneys.
Dialysis indications in AKI
- Volume expansion refractory to diuretics (e.g. pulm oedema)
- Hyperkalaemia refractory to therapy (insulin/dex, fluids, salbutamol)
- Acidosis refractory to medical therapy
- Uraemia
Gout; X-ray findings, start time for allopurinol?
Xray: No loss of joint space, Periarticular erosions
Start allopurinol 3 weeks after acute attack.
Pseudogout Risk Factors
- Hyperparathyroidism
- Hypothyroidism
- Wilson’s Disease
- Haemachromotosis.
Graves Disease; Treatments, and specific signs
Tx: Carbimazole and Propylthiouracil (pregnancy)
Specific Signs: Opthalmoplegia, Exopthalmos (and Proptosis), Thyroid acropachy, Pretibial myoedema.
Sickle-cell anaemia; Long-term treatment, management of sickle crisis?
Long-term: Hydroxycarbamide (Hydroxyurea), Folic Acid, Antibiotic prophylaxis, vaccines.
Sickle crisis: Analgesia, IV fluids, antibiotics, Oxygen, +-Transfusion.
Myeloma; What is it? Tests? Features + complications?
B-lymphocyte plasma-cell neoplasia; monoclonal antibodies (Mostly IgG).
Tests: Serum/Urine electrophoresis; monoclonal band. FBC/U&E. Bone marrow?
Features/Complications: CRAB; ++Calcium, Renal failure, Anaemia, Bone pain. Bacterial infection susceptibility due to monoclonal antibody dominance.
Gastritis; Bacterial causes, test for this, more features? Treatment of bacterial cause.
Gastritis caused by H.Pylori
Test: Urease breath test; give carbon-13/14 urea, H.P breaks it down to ammonia and CO2; measure C-13 CO2 for positive result.
More features; MALT lymphoma; management is to eradicate H.P
H.P eradication; PPI, Amoxicillin, Metronidazole (Clary instead of amox if needed).
Jaundice; types. Pancreatic cancer; Tumour marker? How is bilirubin formed?
Jaundice; choleostatic, intrahepatic, pre-hepatic. DON’T SAY CIRRHOSIS AS INTRAHEPATIC, say something like paracetemol overdose instead.
Pancreatic cancer; Ca19-9.
Bilirubin = Hb > Haem + iron > Porphyrins (e.g, biliverdin) > bilirubin.
What differentiates stroke from TIA?
Most common type of stroke and what is the most common cause of this? And what is the treatment for this?
> 24 hours symptoms or death = stroke. Otherwise TIA; This is now kinda been replaced with imaging as diagnosis; Diffusion weighted MRI best.
Most common (85%) = ischaemic
Cause of this most commonly = carotid stenosis/plaque.
Tx: Carotid endarterectomy
Epilepsy; definition:
A couple of types:
Ward treatment:
What is Todd’s palsy?
An idiopathic tendency to have seizures; transient abnormal electrical activity in the brain
Types (Where does it start, conciousness? Other features?) E.g; focal to general tonic-clonic seizure.
Nasopharyngeal airway, pillow, NOTHING IN MOUTH, Recovery position, IV loraz, O2, senior help.
Todd’s palsy; motor dysfunction for a while after seizure.
Hernia; Definition. Embryological cause of indirect hernia.
Obstructive hernia vs strangulated hernia.
Def: The protrusion of a structure through the wall that usually contains it.
Embry: Descent of testis through processus vaginalis; failure of this to close
Obstructive: Poo can’t go through
Strangulated: Blood can’t go through.
Haemorrhoids:
Internal vs external?
Investigations?
Symptoms?
Tx: Lifestyle and invasive.
Internal/external, above/below dentate line.
Ix: FBC, Sigmoidoscopy
Sx: itch, PR bleed, discomfort, mucous, soiling.
Tx: ++Fibre ++water, topical NSAIDS/steroids…. Then band ligation or haemorrhoidectomy
PSA; things that elevate it?
Grading for Prostatic cancer?
Intercourse, PR exam, UTI, prostatitis, catheter
Gleason grading–
<6 = not cancer
6+ = cancer
9/10 = High-grade cancer
Trauma X-rays;
Trauma further scans:
?C-spine injury… What would you avoid in initial ABCDE treatment.?
Trauma Xray Lateral Cervical spine, AP chest (ideally erect).
Further scans: CT head, CT Abdomen.
C-spine injury: Avoid head tilt (Jaw thrust instead); potentially avoid Naso-pharangeal airway (?Basal skull fracture).
Laryngeal Nerve: which side is more prone to injury?
Which laryngeal muscle does it not supply?
Sx unilateral palsy?
Left; longer course
Cricothyroid; supplied instead by superior thyroid.
Sx: quiet voice, cough, SOB, hoarsness.
Acute limb pain; no pulses, diagnosis?
6 symptoms
3 common causes
Why is tx needed quickly?
Tx?
Acute limb ischaemia
Pain, Pulseless, Paralysis, Pallor, Perishing cold, Parasthesia.
Thrombus (e.g from AF), arterial aneurism, iatrogenic damage, Trauma.
6h until irreversible damage
Oxygen, LMWH, IV fluids; THROMBOLYSIS or Arterial bypass.
Heparin Mechanism
DOAC Mechanism
Warfarin Mechanism
Heparin = Activates Antithrombin III (3 lines in an H) > This deactivates Xa to X.
DOAC: Direct Xa inhibitor.
Warfarin: Prevents vit K recycling; reducing II, VII, IX, and X (1972).
Difference between Critical Limb Ischaemia and Acute Limb Ischaemia?
CLI is an extension of peripheral vascular disease; when you have constant pain and have to hang leg over bed. ALI is it’s own diagnosis similar to Stroke, acute mesenteric ischaemia, etc; emoli in most cases.
Multiple large blisters; common populations this affects?
What causes this?
Investigations:
Sign in this disease?
Treatment?
Pemphigoid Vulgaris; Ashkanazi Jews + Indian
(Bullous Pemph is more in elderly).
Defunct desmosomes; autoimmune
Ix: Skin biopsy + autoantibodies
Nikolsky’s Sign; Separation when skin is rubbed.
Tx: Systemic steroids / immunosuppression.
Melanoma; risk factors
-Sun exposure
-Fare skin (Fitzpatrick skin type)
-Moles and lentigo
-Fam Hx, sunburn
Diabetic vs Hypertensive retinopathy: Stages
DR vs HTR: Haemorrhage type?
DR vs HTR? Cotton-wool spots?
Different stages signs?
DR: Non-Prolif and Prolif
HTR: 1,2,3,4
DR: Blot/spot haemorrhage
HTR: Flame haemorrhage
Both DR and HTR have cotton wool spots.
DR: Non-Prolif: Cotton + Blot Haem
Prolif: Retinal neovasc +- vitrious haem.
HR: 1. Arterial constrict 2. AV nipping 3. Cotten/Flame 4. Palliloedema
DR Mneumonic? Soak up the blood with cotton, then later replace the broken vessel.
HTR: Mneumonic: Constrict to stop blood flow, thickened walls compress on veins, arteries spur blood out in a flame, then pressure gets too much for the eye.
Pregnancy: Due date from last period?
Palpable uterus from what week?
Triple test vs Quad?
Quad in T21, T18, T13?
Just add 37 weeks to last period; 9 months + 7 days.
Week 12
Triple: Oestriol, hCG, AFP. Quad: Add Inhibin
T21: IBEA, Up,Up,Down,Down
T18: IBEA, Same,Down,Down,Same
T13: IBEA, Same,Same,Same,Up
Gestational Diabetes;
Mechanism of macrosomia?
Complications of GD?
Risks in future?
Macrosomia due to ++Glucose in blood > ++Insulin in blood > ++Fat deposition in foetus.
Shoulder dystocia (+-erbs palsy), sudden foetal death, commonly perinatal hypoglycaemia, polyhydramnios.
Future increased risk of both GD and T2DM.
Miscarriages:
Threatened
Inevitable
Incomplete
Complete
Missed
(Loss of pregnancy before 24 weeks)
Threatened: Os closed, foetus alive; Vaginal bleeding.
Inevitable: Os open; foetus still alive
Incomplete: Os open, foetus dead and most content expelled.
Complete: Os closed, all content expelled
Missed: Os closed, foetus dead inside uterus.
Stress Incontinence:
Causes
What worsens it?
What causes retention?
What tx for stress (And mechanism?)
Causes: pregnancy, vaginal birth, post-menopause (–Oestrogen), obesity, chronic constipation.
Worsens? Diuretics and sedatives.
Retention? Oxybutynin and NSAIDs.
Tx for stress incont? Duloxetine; SNRI; Noradrenaline builds up in synapse and this has sympathetic effect > ++Tone.
MMSE (Not recommended by NICE):
6CIT (Recommended by NICE):
MMSE: Time, place, following instructions, repetition, attention, recall.
6CIT: Year, month, Give address, Current time, 20-1, months of year in reverse, Repeat address.
Pyloric Stenosis
Base and electrolyte disturbance?
Palpation location?
–K+ –Cl- Metabolic alkalosis
RUQ, lateral border of rectus.
