Stuff Flashcards

1
Q

How to work out anion gap in metabolic acidosis?

A

Na - (Cl+HCO3), normal range = 4-12

OR

(Na+K) - (Cl+HCO3), normal range = 10-18

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2
Q

Causes of anion gap metabolic acidosis?

A

MUDPILES CAT

Methanol
Urea
DKA
Paraldehyde
Iron/Isoniazid
Lactate
Ethanol
Salicylates

Carbon monoxide
Aminoglycosides
Theophylline

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3
Q

Causes of normal anion gap metabolic acidosis?

A

HARDASS

Hyperalimentation (TPN feeds)
Addison's disease
Renal tubular acidosis
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
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4
Q

7 P450 enzyme inducers?

A
Phenytoin
Carbamazepine
Rifampicin
Phenobarbitone
St John's Wort
Chronic alcohol intake
Smoking (smokers need to take more aminophylline)
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5
Q

12 P450 inhibitors?

A
Ciprofloxacin and erythromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
Allopurinol
-azole antifungals
Fluoxetine and Sertraline
Valproate
Acute alcohol intake
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6
Q

Drugs which can cause SIADH?

A
Carbamazepine
Sulfonylureas
SSRI's
Tricyclics
Vincristine
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7
Q

Causes of hypernatraemia?

Management?

A

Dehydration
Osmotic diuresis (e.g. HHS)
Diabetes insipidus
Excessive saline

Correct hypernatraemia slowly and cautiously, can predispose cerebral oedema and seizures

General rate is no greater than 0.5mmol/hour

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8
Q

Raised ALP and raised Ca?

A

Bone mets

Hyperparathyroidism

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9
Q

Raised ALP and low Ca?

A

Osteomalacia

Renal failure

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10
Q

Generally, what is reabsorbed in kidney?

A
Na, Ca, Cl, Mg
H2O
HCO3
Glucose
AA
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11
Q

Generally, what is excreted in kidney?

A

K, H, urea

Creatinine

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12
Q

Hyponatraemia causes with urinary Na >20mmol/L?

A

Sodium depletion/renal loss (often hypovolaemic):

  • diuretics: thiazides, loops
  • Addison’s
  • renal failure

If patients euvolaemic:

  • SIADH (urine osmolality often >500mmol/kg)
  • Hypothyroidism
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13
Q

Hyponatraemia causes with urinary Na <20mmol/L?

A

Sodium depletion/extra-renal loss:

  • diarrhoea, vomiting, sweating
  • burns
  • rectal adenoma

Water excess (often hypervolaemic and oedematous):

  • secondary hyperaldosteronism (HF, cirrhosis)
  • nephrotic syndrome
  • IV dextrose
  • psychogenic polydipsia
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14
Q

Management of chronic (>48 hrs) hyponatraemia if:

  • hypovolaemic cause (renal failure, diuretics, addison’s)?
  • euvolaemic cause (SIADH)?
  • hypervolaemic cause (HF, liver failure, nephrotic syndrome)?
A

Hypovolaemic: 0.9% saline
Give as trial initially, if Na falls then likely alternative diagnosis such as SIADH

Euvolaemic: fluid restrict to 500ml/day. Consider demeclocycline/vaptans

Hypervolaemic: fluid restrict to 500ml/day. Consider loop diuretics/vaptans

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15
Q

When is a 150ml bolus of 3% NaCl typically given?

A

Acute hypovolaemia Na <120

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16
Q

Commonest causes of pyrexia <5 days post-op?

A
  • atelectasis
  • UTI
  • physiological response
  • Blood transfusion
  • cellulitis
17
Q

Commonest causes of pyrexia >5 days?

A

VTE
Pneumonia
Wound infection
Anastamotic leak

18
Q

What can occur with intra-abdominal sepsis causing deranged LFT’s?

A

Portal vein thrombosis

19
Q

Radicular pain with Cancer?

A

Spinal cord compression!!

20
Q

Initial Ix for SVCO?

A
  1. CXR
  2. Venogram
  3. CT chest
21
Q

Hypercalcaemia management?

A

IV fluids and pamidronate

22
Q

For intractable hiccups in palliative care?

A

Chlorpromazine

23
Q

1st and 2nd line for agitation in palliatiative care?

A
  1. haloperidol
  2. chlorpromazine

If syringe - midazolam

24
Q

If getting bowel colic in blockage from cancer if already receiving morphine?

25
Ramsay hunt Rx?
Aciclovir + pred
26
Argyll robertson?
Bilateral small pupils that constrict to accommodate but not to light Neurosyphilis
27
Holmes adie?
Dilated pupil unilateral, once it constricts it stays small for ages Slowly constricts to accommodate