Toms Top Tips Flashcards
eating worsens the pain of which ulcers
gastric or duodenal
gastric
eating improves the pain of which ulcers
gastric or duodenal
duodenal
why does urea rise in upper GI bleed
blood in the GI tract gets broken and one of the breakdown products is urea
what is group and save
where the lab simply checks the patients blood group and keeps a sample of their blood saved in case they need to match blood to it
what is crossmatch
the lab actually finds the blood, tests that it is compatible and keeps it ready in the fridge to be use if needed
we test all type 1 diabetics for which disease, even if they don’t have symptoms as the conditions are often linked
coeliac disease
anti-TTG and anti-EMA antibodies are which kind of immunoglobulin (IgA-E?)
IgA
remember to test for total IgA levels to exclude IgA deficiency
What can the causes of renal impairment be split into
pre renal
renal
post renal
if you come across a patient in the exam with a combination of acute renal failure and haemoptysis, what two conditions are you thinking of
good pasture syndrome
granulomatosis with polyangitis (aka wagerers granulomatosis
what is the difference between Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis)
good pastures is associated with anti-GBM antibodies
Wegeners is associated with ANCA
most common cause of nephrotic syndrome in
children
adults
minimal change in children
focal segmental glomerulosclerosis in adults
what is the most common cause of primary glomerulonephritis
IgA nephropathy aka burgers disease
muddy brown casts found on urinalysis is a pathognomonic finding specific to which kind of kidney disease
acute tubular necrosis
type 4 renal tubular acidosis
- most common caused by reduced aldosterone
name some reasons that this can be due to
adrenal insufficiency medications such as ACE inhibitors and sprionolactone SLE diabetes HIV
what is the management of type 4 tubular acidosis
fludrocortisone
sodium bicarbonate and treatment of the hyperkalaemia may also be required
what is the most common cause of haemolytic uraemia syndrome
toxin produced by the bacteria e coli called the shiva toxin
shigella also produces this toxin
the use of antibiotics and anti motility agents such as loperamide to treat gsatronteritits increases the risk of developing HUS too
you should suspect rhabdomyolysis in patients with
crush injury
trauma
prolonged immobilisation
excessive sweating
name the main medications that cause hyperkalaemia
Aldosterone antagonists (spironolactone and eplerenone) ACE inhibitors Angiotensin II receptor blockers NSAIDs Potassium supplements
name the main conditions that cause hyperkalaemia
Acute kidney injury Chronic kidney disease Rhabdomyolysis Adrenal insufficiency Tumour lysis syndrome
name the main treatments for hyperkalaemia
insulin and dextrose to drive potassium into the cells
calcium gluconate to stabilise the cardiac muscle cells
nebulised salbutamol
what is the most common cause of secondary hypertension
hyperaldosteronism (may also have low potassium but not always the case)
what is the most common cause of paraneoplastic Cushing’s.
Small Cell Lung Cancer
what are the 3 most dangerous aspects of DKA
dehydration
potassium imbalance
acidosis
what is the mnemonic for treating DKA
FIG-PICK
F – Fluids – IV fluid resuscitation with normal saline (e.g. 1 litre stat, then 4 litres with added potassium over the next 12 hours)
I – Insulin – Add an insulin infusion (e.g. Actrapid at 0.1 Unit/kg/hour)
G – Glucose – Closely monitor blood glucose and add a dextrose infusion if below a certain level (e.g. 14 mmol/l)
P – Potassium – Closely monitor serum potassium (e.g. 4 hourly) and correct as required
I – Infection – Treat underlying triggers such as infection
C – Chart fluid balance
K – Ketones – Monitor blood ketones (or bicarbonate if ketone monitoring is unavailable)
what are the main side effects of metformin
lactic acidosis
what are the main side effects of pioglitazone (thiazolidinedione)
weight gain
fluid retention
anaemia
heart failure
what is the most common side effect of Sulfonylureas
it is a gliclazide
weight gain
hypoglycaemia
increased risk of CVD and MI if used as montherapy
mnemonic for symptoms of hypercalcaemia
renal stones, painful bones, abdominal groans and psychiatric moans
what are the 2 main causes of secondary hyperparathyroidism
low vitamin D or CKD
what is used to diagnose pheochromocytoma
plasma free metanephrines as they are less prone to fluctuations compared to catecholamines
name the 2 most common causes of pneumonia
Streptococcus pneumoniae (50%) Haemophilus influenzae (20%)
which antibiotic can you not treat atypical pneumonia with
penicillins
name the 5 causes of atypical pneumonia “legions of psittacosis MCQs”
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
which of the following atypical pneumonia does the exam patient stay in cheap hotel holiday and presents with hyponatramia
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
legionella
which of the following atypical pneumonia does the exam patient present with erythema multiform “target lesions”
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
Mycoplasma pneumoniae
which of the following atypical pneumonia does the exam patient is a school aged child with a mild to moderate chronic pneumonia and wheeze
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
chlamoydophila pneumoniae
which of the following atypical pneumonia does the exam patient a farmer with flu like illness
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
Q fever aka Coxiella burnetii
which of the following atypical pneumonia does the exam patient a parrot owner
Legionella pneumophila Psittaci M – mycoplasma pneumoniae C – chlamydydophila pneumoniae Qs – Q fever (coxiella burnetii)
Chlamydia Psittaci
an exam patient who is a 20-40 year old black women presenting with a dry cough and SOB. they may have nodules on their shins suggesting erythema nodosum
what condition are you thinking about
sarcoidosis
what is the management for left ventricular failure
mnemonic ‘pour SOD’
Pour away (stop) their IV fluids
Sit up
Oxygen
Diuretics
what is the management of heart failure
ABAL
ACE inhibitor (e.g. ramipril titrated as tolerated up to 10mg once daily)
Beta Blocker (e.g. bisoprolol titrated as tolerated up to 10mg once daily)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
Loop diuretics improves symptoms (e.g. furosemide 40mg once daily)
what are the main secondary causes of HTN
ROPE
R – Renal disease. This is the most common cause of secondary hypertension. If the blood pressure is very high or does not respond to treatment consider renal artery stenosis.
O – Obesity
P – Pregnancy induced hypertension / pre-eclampsia
E – Endocrine. Most endocrine conditions can cause hypertension but primarily consider hyperaldosteronism (“Conns syndrome”) as this may represent 2.5% of new hypertension. A simple test for this is a renin:aldosterone ratio blood test.
what are the main causes of AF
SMITH
Sepsis Mitral valve pathology IHD Thyrotoxicosis Hypertension
