Year 3 Question Buzzwords/Learning points Flashcards
Stroke in which artery leads to lateral medullary syndrome?
(vertigo and vomiting, ataxia, nystagmus, dysphagia, ipsilateral facial sensory loss, and contralateral upper and lower limb sensory loss)
posterior inferior cerebellar artery
cerebellar signs, contralateral sensory loss in limbs & ipsilateral Horner’s
What does a stroke/lesion in right branches of posterior cerebral artery supplying the midbrain cause?
Weber’s syndrome affecting right CN III and left upper/lower limb weakness
Ipsilateral third cranial nerve palsy
Contralateral weakness of the upper and lower extremity
What does basilar artery thrombosis lead to?
It causes “locked-in” syndrome, a condition where the patient has complete loss of all voluntary muscles except for eye movements
Which type of kidney disease cause visible haematuria a few days after a URTI?
IgA nephropathy - more common in young people
Mind the time-frame of only DAYS following the URTI!
How would a haematuria in post-streptococcus glomerulonephritis present?
Haematuria usually occurs 1 to 3 WEEKS after the onset of streptococcal infection, and is not necessarily visible
Main symptom in this type of GN is proteinuria rather than haematuria
Elevated levels of antibodies to streptococcal antigens (anti-streptolysin O or anti-DNase B) are a good diagnostic clue, while C3 is usually low in the first couple weeks of infection
What is the diagnostic criteria for Multiple sclerosis?
two or more clinical episodes which are disseminated over time and affect anatomically different areas
If demyelinating disease is suspected, an MRI brain and spine WITH contrast should be done; an MRI without contrast cannot tell us if the lesion is acute or chronic
What kind of lesions is CT with contrast best for looking at?
Vascular lesions
What kind of presentation in the context of kidney disease is an indication for dialysis?
Uraemia that leads to/present as encephalopathy or pericarditis
What management is indicated when severe uraemia presents?
dialysis
Patients who have just left theatre would require fluids, what should be done when they are not able to drink fluids at a first instance?
Sodium chloride is a recommended fluid to be used for maintenance. Maintenance fluids should be prescribed at a rate of 25-30 ml/kg/24hr
Which pathogen is the most common cause of peritonitis secondary to peritoneal dialysis?
Coagulase -ve staphylococcus (eg staphylococcus epidermidis)
Which medications should be discontinued in the event of AKI?
ACE inhibitors
ARBs
NSAIDs (except low-dose aspirin)
Diuretics
Aminoglycosides
Metformin
Lithium
When would you want to measure FSH and LH in a male patient?
If there is a suspected secondary hypogonadism
They would present with a borderline or low testosterone - free testosterone is best taken during 9-11am
What are some universal managements for erectile dysfunction?
PDE-5 inhibitors can be prescribed regardless of aetiology
Anyone who cycles for above 3 hrs per week should be advised to stop
What is treatment of choice for overactive bladder?
Muscarinic antagonist (eg oxybutynin, tolterodine, solifenacin)
Beta-3 agonists can be used as alternatives
Alpha-1 adrenergic receptors and M3 muscarinic receptors are both responsible to some extent for smooth muscle contraction, where are they located respectively?
Alpha-1:
Vasculature
Iris dilator muscle
Prostate
Urethral sphincter
Pylorus
Anal sphincter
Skin
M3 muscarinic receptors:
Bronchus
Bladder
Also stimulates glandular secretion
What conditions do the following antibodies suggest?
Anti-centromere
Anti-Jo1
Anti-dsDNA
Anti-CCP
Anti-centromere: Systemic sclerosis
Anti-Jo1: Dermatomyositis/polymyositis
Anti-dsDNA: SLE
Anti-CCP: Rheumatoid arthritis
How to manage dermatomyositis/polymyositis?
- Give prednisolone (corticosteroids) and aim to eventually taper off
- Give immunosuppressants like azathioprine/methotrexate/cyclophosphamide
Rule out malignancies as these conditions could be paraneoplastic presentations
What is the first step to take when patient present with an obstructive urinary caliculi that has a signs of infection/sepsis?
This is considered a urological emergency
Insert a nephrostomy tube to relieve kidney pressure and drain fluids to prevent septic shock developing
After patient is stabilised, the suitable lithotripsy method can be used depending on stone size
What type of ureteric stones are suitable for extracorporeal shockwave lithotripsy?
stones that are < 10 mm and do not cause obstruction or infection
note: fragmented stones have a risk of causing obstruction themselves
What type of ureteric stones are suitable for ureteroscopy with laser lithotripsy?
It is the definitive measure for ureteric stones that are 10-20 mm in size and do not cause obstruction or infection
When would you consider expulsive therapy with tamsulosin to remove stones?
when it is a distal ureteric stones < 10 mm in size without features of obstruction or infection
How to calculate the anion gap and what is the normal range?
The simplest equation is:
AG = (sodium + potassium) - (chloride + bicarbonate)
Normal range is between 6 -18 mmol/l (can’t be sure of exact numbers)
What happens in metabolic acidosis with a high anion gap?
Usually when bicarbonate level is reduced, other anions (like chloride ions) are present ensuring balance of electric potential.
Looking at the equation it can be inferred that other types anions (like ketones and lactate) are present in the situation of metabolic acidosis with a high anion gap
What type of diuretic is acetazolamide and how does this type of diuretic act?
It is a carbonic anhydrase inhibitor and works by targeting these enzymes in PCT, resulting in reduced reabsorption of Na+, water and bicarbonate (likely inducing hyperchloraemic metabolic acidosis)
What are examples of metabolic acidosis with a normal anion gap?
- gastrointestinal bicarbonate loss:
prolonged diarrhoea: may also result in hypokalaemia
ureterosigmoidostomy
fistula - renal tubular acidosis
- drugs: e.g. acetazolamide
- ammonium chloride injection
- Addison’s disease
What are examples of metabolic acidosis with a high anion gap?
- lactate:
shock
sepsis
hypoxia - ketones:
diabetic ketoacidosis
alcohol - urate: renal failure
- acid poisoning: salicylates, methanol
What is the most likely renal outcome for an HSP patient presenting with mild renal function impairment?
Full recovery
For most patient this level of impairment is self-limiting especially when the damage done was mild
Even if there are relapse episodes they are likely to be even milder than the initial episode
Note: although there is a degree of overlap with IgA nephropathy, HSP renal involvement is by no means equal to that in IgA
What are the common side effects of tamsulosin and what is the mechanism?
Tamsulosin is an alpha receptor antagonist, and might lead to systemic vasodilation as a side effect
This would lead to symptoms like dizziness and postural hypotension
What are common side effects associated with 5-alpha reductase inhibitors?
Erectile dysfunction and reduced libido
What are medications that can reduce/prevent calcium stone formation?
Potassium citrate
Thiazide diuretics as they promote calcium reabsorption in DCT
What are medications that can reduce/prevent uric acid stone formation?
Allopurinol
Oral bicarbonate via urinary alkalisation
What are medications that can reduce/prevent oxalate stone formation?
Both cholestyramine and pyridoxine reduce urinary oxalate secretion
What drug reduces the rate of CKD progression in autosomal-dominant polycystic kidney disease?
Tolvaptan
Tolvaptan is approved by NICE to reduce the rate of CKD progression in autosomal dominant polycystic kidney disease with CKD stage 2 or 3 at the start of treatment and evidence of rapidly progressing disease
What is the most common causative agent of acute prostatitis and what are other causes to consider?
The most common causative agent is E. coli
In young men it is important to consider sexually-transmitted infective agents like Chlamydia trachomatis and Neisseria gonorrhoea
Which type of renal stone is associated with an inherited metabolic disorder?
Cystine
What does a soft, non-tender swelling on one side of the scrotum that transilluminates suggest?
Hydrocele
It is due to fluid accumulation in the tunica vaginalis surrounding the testicle
What does a taller or broader than usual T wave suggest?
They can be an early sign of ST-elevation myocardial infarction
What does a tall narrow T wave suggest?
This can be a sign of hyperkalaemia
What is the usual location of a hydrocele relative to the testis?
Anterior to and below
Soft non-tender
When is ultrasound required in the context of clincal suspicion of hydrocele?
When there is doubt/uncertainty or when the testis cannot be palpated
What type of presentation and history would cause you to think of a diagnosis of autonomic dysreflexia?
Symptoms of sympathetic overdrive like extreme hypertension (especially in patient context) and sweating, alongside bradycardia
Spinal cord injury of T6 level or above in the past year
How would a neurogenic shock present?
It is usually immediately after a spinal cord injury
Hypotensive and tachycardic
What is the management for autonomic dysreflexia?
Remove or control stimulus (commonly faecal impaction or urinary retention)
Treat or control life-threatening effects of extreme hypertension/bradycardia
What is the basic pathphysiology of NEPHROGENIC diabetes insipidus and what is the treatment of choice?
The body is unable to respond to vasopressins ie. ADH
Thiazide diuretics (like chlorothiazide) is given to decrease plasma osmolarity, hence break the polydipsia-polyuria pattern
Define myelopathy
Injury to spinal cord due to severe compression
What is the gold standard investigation for a suspected cervical myelopathy? and what condition does degenerative cervical myelopathy sometimes get misdiagnosed as?
Cervical spine MRI
Carpal tunnel syndrome
What is the location of inguinal hernia and femoral hernia relative to the pubic tubercle?
Inguinal hernia (direct/indirect) - medial and superior to pubic tubercle
Femoral hernia - laternal and inferior to pubic tubercle
What are the contents of the inguinal canal?
Spermatic cord (male)/Round ligament of uterus (female)
Lymph nodes and vessels
Ilioinguinal nerve
How to locate surface anatomy of inguinal ligament and inguinal canal?
Inguinal ligament forms a line between anterior superior iliac spine and pubic tubercle
The deep inguinal ring is located just superior to the half-way point of inguinal ligament, the superficial inguinal ring is just superior and lateral to the pubic tubercle
What is the Hesselbach triangle and what are its boundaries?
The Hesselbach triangle is a weak point in the abdominal wall where DIRECT inguinal hernias tend to penetrate
Medial boundary - lateral border of rectus abdominalis
Lateral boundary - inferior epigastric artery
Inferior boundary - inguinal ligament
How to distinguish between direct and indirect inguinal hernias?
Direct hernias protrudes medial to the inferior epigastric artery which forms the lateral border of Hesselbach triangle
Indirect hernias protrudes via the deep inguinal ring, hence lateral to the inferior epigastric artery
What are the contents of the femoral canal?
Deep inguinal lymph node chain and adipose tissue
It forms the most medial compartment of the femoral sheath
What are the boundaries of the femoral canal?
Medial - lacunar ligament
Anterior - inguinal ligament
Lateral - femoral vein
Posterior - Pectineus muscle, pectineal ligament and superior ramus of the pubic bone
What is the paediatric fluid requirement for non-neonates?
100ml/kg/24hr for 0-10kg
then 50ml/kg/24hr for any weight above 10kg
What analgesia is given for renal colic pain?
IM diclofenac is preferred
IV paracetamol is given when NSAIDs aren’t tolerated or is contraindicated (note: not oral!)
How does Guillain-Barre syndrome classically present?
Acute, symmetrical, progressive peripheral polyneuropathy with hyporeflexia
Usually start in the lower limbs but can rapidly progress to other parts
What is first-line management for Guillain-Barre syndrome?
IV immunoglobulin
