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YEAR 5 > YEAR 4 NOTES > Flashcards

YEAR 4 NOTES Flashcards

1
Q

ecoli

A

gram negative rod (haemolytic uraemic syndrome)

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2
Q

staph

A

gram positive coccus

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3
Q

strep

A

gram positive coccus

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4
Q

neisseria

A

gram negative coccus

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5
Q

moraxella

A

gram negative coccus

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6
Q

Actinomycetes

A

gram positive rod

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7
Q

bacillus cereus / anthrax

A

gram positive rod

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8
Q

clostridium

A

gram positive rod

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9
Q

diphtheria

A

gram positive rod

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10
Q

Listeria

A

gram positive rod

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11
Q

pseudomonas

A

gram negative rod

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12
Q

h/influenzae

A

gram negative rod

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13
Q

salmonella

A

gram negative rod

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14
Q

shigella

A

gram negative rod

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15
Q

campylobacter

A

gram negative rod

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16
Q

Ca125

A

Ovarian cancer

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17
Q

Ca 19-9

A

Pancreatic

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18
Q

Ca15-3

A

Breast cancer

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19
Q

PSA

A

prostate carcinoma

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20
Q

Alpha fetoprotein

A

HCC / teratoma

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21
Q

Carcinoembryonic antigen CEA

A

Colorectal

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22
Q

S100

A

Melanoma / schwannoma

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23
Q

Bombesin

A

SCLC / gastric cancer / neruoblastoma

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24
Q

Raised h-bCG + raised AFP

A

Nonseminomas testicular cancer

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25
Q

Raised b-hCG and normal AFP

A

Seminoma testicular cancer

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26
Q

things that can raise a Ca 125

A

○ Cervical adenocarcinoma ○ Endometrial carcinoma ○ Fallopian tube cancer ○ Heart failure ○ Hypothyroidism ○ Liver cirrhosis with severe necrosis ○ Non-Hodgkin’s lymphoma ○Pleural effusion

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27
Q

Conns syndrome

A

Low K+ and Normal/ high Na+

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28
Q

Addisons

A

Hyperkalaemia metabolic acidosis

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29
Q

Cushing’s disease

A

Hypokalaemic metabolic alkalosis

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30
Q

Ix findings in SIADH

A

U+E = hyponatraemiaUrinary sodium / osmolaltiy will be HIGHSerum osmolality = LOWBUT EUOVOLEMIC –> normal BP + skin turgor etc

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31
Q

How slow should you replace sodium in SIADH and why

A

10 mmol/l per 24 hoursto prevent central pontine myelinolysis

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32
Q

SIADH causes mnemonic

A

S - surgeryI - intracranial –> infection (meningitis) / CVAA - Alveolar –> malignancy / pus (atypical pneu or TB)D - Drugs –> thiazide diuretics, carbamazepine, vincristine, cyclophosphamide, antipsychotics, SSRIs, NSAIDSsH - Head injury

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33
Q

FLuid restriction in SIADH

A

500-1000ml

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34
Q

Oxycodone generally causes compared to morphine

A

less sedation / vomiting / pruitus than morphine BUT more constipation

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35
Q

oral codeine to oral morphine conversion

A

divide by 10

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36
Q

oral tramadol to oral morphine conversion

A

divide by 10

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37
Q

oral morphine to oral oxycodone conversion

A

divide by 1.5 (to 2 but bnf says 1.5)

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38
Q

transdermal fetanyl 12 mcg patch equals

A

approx 30mg oral morphine daily

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39
Q

transdermal buprenoprhine 10 mcg patch equals

A

approx 24mg oral morphine daily

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40
Q

when increasing dose of opiods - next dose should be increased by

A

30-50%

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41
Q

for metastatic bone pain strong opiods PLUS

A

bisphopshonates / radio / denosumab may be used

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42
Q

breakthrough dose of morphine is

A

1/6th the daily dose

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43
Q

all pts prescribe dopioid should be coprescribed a

A

laxative

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44
Q

opioids in CKD

A

use w caution:- oxycodone preferred in palliative pts with mild-mod pain- if renal impairment severe , alfentanil / buprenorphine / fentanyl preffered

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45
Q

when prescribed an opioid if they get nausea

A

advise it is often transient –> if persists offer an antiemetic

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46
Q

when prescribed an opioid if they get nausea

A

advise it is often transient –> if persists offer an antiemetic

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47
Q

CAP in alcoholics

A

klebsiella –> (klepSTELLA)

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48
Q

most common cause of CAP

A

strep pneumoniae

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49
Q

CAP assoc w erythema multiforme / haemolytic anaemia / ITP and diagnosed by serology

A

Mycoplasma pneumonia

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50
Q

CAP assoc w lymphopenia and hyponatraemia, recently holdica (or AC units) and diagnosed by urinary antigen

A

Legionella pneumophila

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51
Q

how to work out anion gap

A

(Na + K) - (Cl + HCO3)

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52
Q

normal anion gap

A

10-18 mmol/L

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53
Q

Causes of normal anion gap mneumonic

A

HARDASS

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54
Q

HARDASS stands for

A

H- hyperalimentationA - AddisonsR- Renal tubular acidosisD - diarrhoeaA - AcetazolamideS - SpirinolactoneS- saline infusion

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55
Q

Mnemonic for raised anion gap metabolic acidosis

A

A CAT MUDPILES

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56
Q

A CAT MUDPILES

A

A- AspirinC - Cyanide, carbon monoxideA - Alcoholic ketoacidosisT - TolueneM - Methanol, metforminU - UraemiaD - Diabetic ketoacidosisP - Phenformin, pyroglutamic acid, paraldehyde, propylene glycol, paracetamolI - Iron, isoniazidL - Lactate (numerous causes)E - Ethanol, ethylene glycolS - Salicylates

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57
Q

alpha 1 agonist

A

decongestant e.g. phenylephrine / oxymetazoline

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58
Q

alpha 2 agonist

A

glaucoma Tx e.g. topical brimonidine

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59
Q

alpha antagonist

A

BPH - tamsulosinHTN - doxazosin

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60
Q

beta 1 agonists

A

inotropes e.g. dobutamine

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61
Q

beta 1 blockers

A

non selective + selective bblockers e..g atenolol / bisoprolol

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62
Q

beta 2 agonists

A

bronchodilators e.g. salbutamol

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63
Q

b 2 antagonists

A

nonselective bblockers e.g. propanolol / labetalol

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64
Q

dopamine agonists

A

parkinsons disease - ropiniroleprolactinoma

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65
Q

dopamine antagonists

A

antipsychotics - haloperidolantiemetics - metoclopramide / domperidone

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66
Q

GABA agonist

A

benzodiapines baclofen

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67
Q

GABA antagonists

A

flumazenil - reversal of benzos

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68
Q

histamine 1 antagonists

A

antihistamines e.g. loratidine

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69
Q

histamine 2 antagonists

A

antacids - ranitidine

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70
Q

muscarininc agonist

A

glaucoma e.g. pilocarpine

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71
Q

muscarinic antagonist

A

atropine - bradycardiabronchodilator - ipatroprium bromide / tiotropiumurge incontinence - oxybutinin

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72
Q

nicotonic agonist

A

nicotinevareniciline - used for smoking cessationdepolarising muscle relaxant = suxamethonium

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73
Q

nicotonic antagonist

A

nondepolarising muscle relaxants - atracurium

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74
Q

oxycotin agonist

A

inducing labour - syntocinon

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75
Q

oxycotin antagonist

A

tocolysis e.g. atosiban

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76
Q

serotinin agonist

A

triptans e.g. zolmitriptan

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77
Q

serotinin antagonists

A

antiemetics - ondasteron

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78
Q

MEN1 syndrome

A

the 3 Ps- parathyroid ( hyper due to parathyroid hyperplasia)- pituitary - pancreas –> insulinoma / gastrinoma

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79
Q

MEN1 genetics

A

MEN1 gene

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80
Q

most common presentation of MEN1

A

hypercalcaemia

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81
Q

MEN2a syndrome

A

Medullary thyroid cancer AND the 2Ps- parathyroid- phaechromocytoma

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82
Q

Men2b syndrome

A

Medullary thyrpoid cancer and 1 P- phaechromocytomas(+ marfanoid body habitus and neuromas)

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83
Q

MEN2a genetic component

A

RET oncogene

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84
Q

MEN2b genetic component

A

RET oncogene

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85
Q

genetics in Lynch syndrome

A

Mismatch repair gene defect - MHS1/2

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86
Q

FAP genetics

A

APC mutation

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87
Q

liver mets usually come from

A

colorectal cancer

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88
Q

SCLC is a

A

central lung cancer (not in apices)

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89
Q

type of lung cancer seen more often in nonsmokers

A

adenocarcinoma

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90
Q

pernicious anaemia predisposes to

A

gastric cancer

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91
Q

right sided murmur heard best on

A

inspiration

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92
Q

Left sided murmur heard best on

A

expiration

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93
Q

holo/pansystolic

A

mitral / tricuspid regurg (high pitched and blowing)VSD (harsh)

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94
Q

aortic stenosis

A

ejection systoliclouder on expiration

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95
Q

pulmonary stenosis

A

ejection systoliclouder on inspiration

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96
Q

late systolic

A

mitral valve prolapse

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97
Q

aortic regurg

A

early diastolic high-pitched and ‘blowing’ in character)

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98
Q

mitral stenosis

A

mid-late diastolicrumbling in character

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99
Q

.

A

learn it bitch xoxox

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100
Q

head bobbing is a sign of

A

aortic regurg

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101
Q

Mitral stenosis is typically caused by

A

rheumatic fever

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102
Q

acute relapse Mx

A

high dose steroids for 5 days to shorten course(don’t affect degree of recovery just length of flare)

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103
Q

Indications for DMARDs

A
  • relapsing remitting disease + 2 relapses in past 2 years + ablte to walk 100m unaided- secondary progressive disease + 2 relapses in past 2 yrs + able to walk 10 (aided/unaided)
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104
Q

Natalizumab

A
  • monoclonal antibody –> antagonises integrin on surface of leukocytes- inhibit migration of leucocytes across endothelium into blood brain barrier- used first line (best evidence base) - given IV
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105
Q

Ocrelizumab

A
  • humanised antibody CD20 monoclonal antibody- often used first line too- given IV
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106
Q

fingolimod

A
  • S1P receptor modulator- prevents lymphocytes leaving lymph nodes- oral forms available
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107
Q

Mx of fatigue

A
  • amantadine- other options = mindfulness / CBT
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108
Q

Spaciticity Mx

A
  • baclofen and gabapentin first line- physio is important
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109
Q

Bladder dysfunction Mx

A
  • in form of urgency / incontinence / overflow- get USS to assess bladder emptying- if signic residual volume = intermittent self catheterization- if no signif residual volume = anticholinergics
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110
Q

HLA-B27

A

ankylosing spondylititsreactive arthritis

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111
Q

HLA-DQ2/8

A

coeliac disease

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112
Q

HLA-A3

A

haemochromatosiss

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113
Q

HLA-DR2

A

narcolepsygoodpastures syndrome

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114
Q

HLA-DR3

A

dermatitis herperitiformissjorgens syndromeprimary billiary cirrhosis

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115
Q

HLA-DR4

A

T1DMRA

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116
Q

Anti-Jo1

A

Polymyositis and dermatomyositis

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117
Q

Anti centromere

A

limited systemic sclerosis - aka CREST

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118
Q

Anti-Scl-70

A

diffuse systemic sclerosis

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119
Q

Anti-Ro

A

Sjorgens

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120
Q

Anti-RNA polymerase III

A

nonspecific for systemic sclerosis- more a marker of renal involvement

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121
Q

antihistone

A

drug induced lupus

122
Q

ANA

123
Q

ANCA

A

various vasculitises

124
Q

AMA

125
Q

Ank spond MX

A

DMARDs found not to be useful –> form NSAIDs skip straight to biologics like etanercept / infliximab

126
Q

etanercept and infliximab are Egs of

A

tnf alpha blockers

127
Q

cANCA

A

granulomatosis w polyangiitis

128
Q

granulomatosis w polyangiitis Fx

A

ent stuff (sinusitis etc) + resp + kidney

129
Q

amoxicillin

A

rash if have glandular fever

130
Q

Co-amoxiclav

A

cholestasis

131
Q

flucloxacillin

A

cholestasis –>wks after use

132
Q

Erythromycin

A

long QTGI upset

133
Q

Ciprofloxacin

A

Lowers seizure thresholdTendonitis

134
Q

Metronadizaole

A

Reaction following alcohol ingestion

135
Q

Doxycycline

A

photosensitivity and N+V

136
Q

Trimethoprim

A

Rashes, including photosensitivityPruritusSuppression of haematopoiesis

137
Q

gentamicin

A

ototoxicitiy and nephrotoxcitiy

138
Q

Hep A presents as

A
  • flu like Sx- RUQ pain- tender hepatomegaly- deranged LFTs
139
Q

Metoclopramide

A

Dopamine (D2) receptor antagonists should be used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis

140
Q

Levomepromazine

A

broad-spectrum anti-emetic useful for mechanical obstruction, and for persistent nausea and vomiting uncontrolled by other anti-emetics

141
Q

Ondanestron

A

serotonin antagonist anti-emetic which is used for nausea and vomiting related to chemotherapy and radiotherapy as well as for post-operative nausea and vomiting

142
Q

for migraine nausea

A

metoclopramide –> gastric stasis

143
Q

how to work out alcohol units

A

volume (ml) * ABV / 1,000

144
Q

Clarithromycin contrindicated w

A

STATINS –> increased risk of rhabdomyolysis

145
Q

CML causes

A

M -assive splenomegaly

146
Q

CLL causes

A

L - lymphadenopathy

147
Q

metformin titration

A

slowly! leave at least 1 wk between change of dose

148
Q

if someone bad GI SE w metformin

A

try MR before swapping

149
Q

osmotic laxatives MOA

A

increase amount of fluid in bowel –> therefore soften stool

150
Q

Osmotic laxatives e.g.

A

lactulose / movicol

151
Q

Stimulant laxatives MOA

A

stimulate bowel to contract –> thus expel faeces

152
Q

Stimulant laxatives e.g.

A

senna / picosulphate

153
Q

Bulk forming laxatives MOA

A

help stool retain water and thereby soften stool

154
Q

Bulk forming e.g.

A

Ispaghula husk

155
Q

Rectal meds e.g.

A

glycerin supppository (stimulant)phosphate enema (stimulant)

156
Q

Pts w chronic constipation will benefit from

A

stool softening laxative (movicol / lactulose) but may need glycerin suppositories initially n rectal stool

157
Q

Pts w post op ileus / opiod induced constipation / soft stool will benefit from

A

stimulant laxatives e.g. senna or picosulphate

158
Q

prophylactic laxatives should be given to

A

pts w opiod analgesia –> esp elderly (stimulant laxative)

159
Q

Used to determine the need to anticoagulate a patient in atrial fibrillation

A

CHA2DS2-VASc

160
Q

Prognostic score for risk stratifying patients who’ve had a suspected TIA

161
Q

HF severity score

162
Q

Measure of disease activity in rheumatoid arthritis

163
Q

A scoring system used to assess the severity of liver cirrhosis

A

Child-Pugh classification

164
Q

DVT Risk

A

Wells score

165
Q

cognitive impairment assessment

166
Q

MH scoring

A

HAD / PHQ9 / GAD7

167
Q

Alcohol screening tools

A

AUDIT / CAGE / FAST

168
Q

Prognosis of pneumonia

169
Q

assess of suspected OSA

A

Epworth sleepiness scale

170
Q

Prostate Sx scoring

171
Q

Prognositc indicator of prosate cancer

A

Gleason score

172
Q

Risk of pressure sore assessment

A

Waterloo score

173
Q

10 yr risk of osteoporotic related fracture

174
Q

Acute pancreatitis scoring

A

Ranson criteria

175
Q

Malnutrition screening

176
Q

Infective endocarditis

A

Modified dukes criteria

177
Q

ovarian cancer risk

A

Risk of malignancy index-Ca125 number + menopausal (1=pre/3= post) + USS score depending on number of Fx(0 = none , 1=1 , 3= 2+ features)

178
Q

ECOG status

A

deciedes how well pt is –> deciede between active and passive

179
Q

Grade mitotic rate of cancer cells (how quick it is growing)

A

Ki-67 index

180
Q

measures disability or dependence in activities of daily living in stroke patients

A

Barthel index

181
Q

Cyanide Mx

A

Hydroxycobalamin + sodium nitrite/thiosulphate

182
Q

Carbon monoxide Mx

183
Q

Iron overload

A

Desferrioxamine

184
Q

Digoxin tox Mx

A

DIgoxin specific antibody fragments ( digibind)

185
Q

Organophosphate (insecticide) poisoning

186
Q

Methanol poisoning

A

fomepizole / ethanol PLUS haemodialysis

187
Q

Ethylene glycol Mx

A

Fomepizole / haemodialysis

188
Q

BBlocker OD

A

bradycardia = atropineresistant cases = glucagon

189
Q

Lithium toxicity

A

mild mod = volume resus w salinesevere = haemodialysis?sometimes sodium bicarb?

190
Q

TCA OD Mx

A

IV bicarb = reduce risk of seizure / arrhythmias

191
Q

Benzo OD Mx

A

Flumenazil (risk of seizure w this so often managed supportively only)

192
Q

Opiod OD Mx

193
Q

Salicyate OD Mx

A

Urinary alkilization w IV bicarbhaemodialysis

194
Q

paracetamol OD presenting 8-24 hrs later taken more than _____ to treat w NAC, before plasma levels

195
Q

Dabigatran MOA

A

direct thrombin(factor IIa) inhibitor

196
Q

Dabigatran excretion + antidote

A

maj renal + idarucizumab

197
Q

RIvaroxaban MOA

A

Direct factor Xa inhibitor

198
Q

RIvaroxaban excretion + antidote

A

Maj liver + andexanet alpha (but it ain’t gr8)

199
Q

Apixaban MOA

A

Direct factor Xa inhibitor

200
Q

Apixaban excretion + antidote

A

Maj faecal + andexanet alpha (not gr8 tho)

201
Q

aplastic crisis has

A

low reticulocytes

202
Q

Sequestration crisis has

A

high reticulocytes

203
Q

FAB classification is for

A

AML –> shows what Fx seen on blood film

204
Q

JAK2 mutation

A

polycythaemia rubra vera

205
Q

Philadelphia chromosome

206
Q

ALL gentics

A

philadelphia chromosome

207
Q

Auer rods suggest

208
Q

APML genetics

209
Q

Down syndrome is assoc w

210
Q

smear / smudge cells indicative of

211
Q

RIchters transformatio

A

CLL to a high grade lymphoma

212
Q

ALL blood film shows

A

blast cells

213
Q

CML genetics

A

philadelphia chromosome t(9:22)

214
Q

AML blood film

A

blast cells and Auer rods

215
Q

Lymph node biopsy hodgkin lymphoma

A

Reed-sternburg cells

216
Q

Reed sternburg cells are

A

abnormally large B cells that have multiple nuclei that have nucleoli

217
Q

CML Tx

A

Imatinib = tyrosine kinase inhibitor

218
Q

Type 1 hypersensitivity

A

IgE mediated - mast cells

219
Q

Type 2 hypersensitivity

A

IgG and IgM antibodies

220
Q

Type 2 hypersensitivity e.g.

A

blood transfusion reaction / haemolytic disease of newborn / goodpastures syndrome

221
Q

Type 3 hypersensitivity e.g.

A

RA / farmers lung

222
Q

Type 3 hypersensitivity

A

Antibody-antigen complexes

223
Q

Type IV hypersensitivity

A

T cell mediated

224
Q

Type IV hypersensitivity

A

Nickel and gold / mantoux test / GVHD

225
Q

incubation period of malaria

226
Q

IV Tx of mod-severe malaria

A

artensuate + quinine

227
Q

How to get a diagnosis of malaria

A
  • malaria blood film (sent in EDTA bottle)3 samples over 3 days to catch in 48hr life cycle of the parasite
228
Q

whats the worst malaria

A

palmodium falciprum

229
Q

Malaria prophylaxis options

A

progunail and atovaquonemefloquinedoxycycline

230
Q

Proguanil and atovaquone as malaria prophylaxis

A

AKA MALARONE- Taken daily 2 days before, during and 1 week after being in endemic area- Most expensive (around £1 per tablet)- Best side effect profile

231
Q

Mefloquine as malaria prophylaxis

A
  • Taken once weekly 2 weeks before, during and 4 weeks after being in endemic area- Can cause bad dreams and rarely psychotic disorders or seizures
232
Q

Doxycycline as malaria prophylaxis

A
  • Taken daily 2 days before, during and 4 weeks after being in endemic area- Broad-spectrum antibiotic therefore it causes side effects like diarrhoea and thrush- Makes patients sensitive to the sun causing a rash and sunburn
233
Q

MRSA carrier Tx

A

nose: mupirocin 2% in white soft paraffin, tds for 5 daysskin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

234
Q

how to MRSA screening

A

charcoal swabsnasal swab and skin lesions or woundsthe swab should be wiped around the inside rim of a patient’s nose for 5 secondsthe microbiology form must be labelled ‘MRSA screen’

235
Q

who should be screened for MRSA

A

all elective and emergency admissions

236
Q

Ix for syphilis

A

(serological tests!!!)NON TREPONMONAL TESTS- not specific for syphilis, therefore may result in false positives- based upon the reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen- assesses the quantity of antibodies being produced- becomes negative after treatment- examples include: rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)TREPONMONAL SPEIFIC TESTS- more complex and expensive but specific for syphilis- qualitative only and are reported as ‘reactive’ or ‘non-reactive’- examples include: TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)

237
Q

confusion screen blood tests

A

Full blood countCRPU&EsBone profileB12 & FolateThyroid function testsGlucoseLFTsCoagulation/INR

238
Q

confusion screen imaging

239
Q

metformin SE

A

diarrhoea and abdo pain

240
Q

metformin class

241
Q

metformin MOA

A

increase insulin sensitivity and decrease liver glucose production

242
Q

pioglitazone class

A

thiazidiolines

243
Q

pioglitazone SE

A

weight gain , fluid retention, BLADDER CANCER

244
Q

pioglitazone MOA

A

increase insulin sensitivity and decrease liver glucose

245
Q

gliclazide class

A

sulphonurea

246
Q

gliclazide MOA

A

increase insulin release

247
Q

Gliclazide SE

A

weight gain, HYPOS

248
Q

sitagliptin class

A

DPP4 inhibitor

249
Q

Sitagliptin MOA

A

increases incretins (which inhibit glucagon storage)

250
Q

Sitagliptin SE

A

GI upset weight neutral

251
Q

empagliflozin MOA

A

makes you wee out glucose

252
Q

empagliflozin class

A

SGLT2 inhib

253
Q

Empagliflozin SE

A

UTI / thrush, wloss

254
Q

Exanatide MOA

A

incretin mimetic

255
Q

Exanatide class

A

GLP1 mimetic

256
Q

Exanatide SE

A

Wloss! but INJECTABLE

257
Q

causes of liver cirrhosis

A

-alcoholic liver disease-nonalcoholic liver disease-hep b -hep c

258
Q

monitoring of cirrhosis for HCC

A

6 monthly USS and AFP levels

259
Q

first line for assessing NAFLD

A

ELF –> enhanced liver fibrosismeasures 3 markers to grade severity of cirrhosis

260
Q

USS appearance in fibrosis

A
  • Nodularity of the surface of the liver- “corkscrew” appearance to the arteries with increased flow as they compensate for reduced portal flow- Enlarged portal vein with reduced flow- Ascites- Splenomegaly
261
Q

Screening for high risk of fibrosis

A

Fibro scan = transient elastography- measures elasticity using sound waves- retesting every 2 yrs in those w high risk

262
Q

Those considered high risk for liver fibrosis

A
  • Hepatitis C- Heavy alcohol drinkers (men drinking > 50 units or women drinking > 35 units per week)- Diagnosed alcoholic liver disease- Non alcoholic fatty liver disease and evidence of fibrosis on the ELF blood test- Chronic hepatitis B (although they suggest yearly for hep B)
263
Q

endoscopy use in liver cirrhosis

A

assess any varices w portal HTNshould be done every 3 yrs

264
Q

Whats in the child pugh score

A

BilirubinAlbumin INRAscitesencephalopathy

265
Q

WHat is the MELD score

A

to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality –> guides transplant refferal

266
Q

Mx of ascites

A

Low sodium dietspirinolactoneParacentesis (ascitic tap or ascitic drain)Prophylactic antibiotics against SBP (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluidConsider TIPS procedure in refractory ascitesConsider transplantation in refractory ascites

267
Q

Mx of hepatic encephalopathy

A
  • Laxatives (i.e. lactulose) promote the excretion of ammonia, aim is 2-3 soft motions daily, may require enemas initially- Abx reduce number of intestinal bacteria producing ammonia, Rifaximin is useful as it is poorly absorbed so stays in the GI tractNutritional support –>may need nasogastric feeding
268
Q

WHat is the MELD score

A

to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality –> guides transplant refferal

269
Q

Sx of hypercalcaemia

A
  • Renal stones- Painful bones- Abdominal groans refers to symptoms of constipation, nausea and vomiting- Psychiatric moans refers to symptoms of fatigue, depression and psychosis
270
Q

Primary hyperthyroidism is caused by

A

uncontrolled parathyroid hormone produced directly by a tumour of the parathyroid glands

271
Q

Mx of primary hyperparathyroid

A

surgical removal of tumour

272
Q

Secondary hyperparaythoid is caused by

A

CKD or vit D deficiencyparathyroid glands reacts to the low serum calcium by excreting more parathyroid hormone –> Over time the hyperplasia cos need to produce more PTH to keep calcium right

273
Q

Labs in secondary hyperparathyroid

A

-Ca = low/normal-PTH = high

274
Q

what causes tertiary parathyroid

A

secondary for long time –> permanent hyperplasiawhen initial cause of secondary fixed PTH remains highmeans hypercalcaemia

275
Q

The rule of Es is

A

Excessive PTH results in excessive phosphate excretion

276
Q

upper zone fibrosis

A

CHARTSC - Coal worker’s pneumoconiosisH - Histiocytosis/ hypersensitivity pneumonitisA - Ankylosing spondylitisR - RadiationT - TuberculosisS - Silicosis/sarcoidosis

277
Q

recommended weekly intake

278
Q

spread drinking over

A

3 days if going up to 14 units

279
Q

14 units is equal to

A

6 normal strength beersor 10 small glasses of low percentage wine

280
Q

steps of cxr

A

Airway: trachea, carina, bronchi and hilar structuresBreathing: lungs and pleuraCardiac: heart size and bordersDiaphragm: including assessment of costophrenic anglesEverything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas

281
Q

RIPE stands for

A

rotation –> spinous process in line w vertebral bodies AND clavicle equidistant from spinous processInspiration –> 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible.Projection –> AP or PA (if shoulderblades in chest = AP)Exposure –> vertebrae visible behind heart

282
Q

Sail sign

A

L Lower lobe collapse

283
Q

things to say in A of CXR

A

trachea –> central?carina + bronchi –> (does NG tube disect carina)hilar region –> any adenopathy / symmetrical / enlargement?

284
Q

things to say in B of CXR

A

lung fieldspleura

285
Q

things to say in C of CXR

A

size - cardiothoracici ratio of less than 0.5borders - reduction in definition suggests consolidation

286
Q

things to say in D of CXR

A

free gascostophrenic angles

287
Q

things to say in E of CXR

A

aortic knucle / aortopulmonary window bonessoft tissuestubes / valves / pacemakers

288
Q

Abdo xray approach

A

Exposure + projectionB - bowel and other organsb - bonesc - calcification

289
Q

B(ow) for AXR

A

small bowel –> valvulae conniventes obstruction = coiled spring appearancelarge bowel = haustradilated?sigmoid = coffee beancaecal = looks like foetus3/6/9 rule - small / large / caecumriglers sign = double walled = pneumopertioneum

290
Q

Fx of IBD on AXR

A

Thumbprinting: mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprints projecting into the lumen (wall of whiter bit looks poked in)Lead-pipe (featureless) colon: loss of normal haustral markings secondary to chronic colitisToxic megacolon: colonic dilatation without obstruction associated with colitis.

291
Q

B(on) Fx of AXR

A

RibsLumbar vertebraeSacrumCoccyxPelvisProximal femursSclerotic / lytic lesions!!!Fractures

292
Q

C Fx on AXR

A

Calcified gallstones in the right upper quadrantRenal stones/staghorn calculiPancreatic calcificationVascular calcificationCostochondral calcificationContrast (e.g. following a barium meal)Surgical clipsJewellery

293
Q

for ?NOF fracture imaging

A

XRAY AP pelvisXRAP R/L lateral hip

294
Q

confusion imaging clinical details

A

“to rule out reversible cause”

295
Q

Mx of pulmonary fibrosis

A

O2/rehab/morphinepirfinedone –> antifibrotic and antiinflammNintedanib –>monocolonal antibody targeting TKI nausea + photosensitivity

296
Q

OA Mx

A

up the pain ladderoral paracetamol + topical ibuprofenopioids arent effective against chronic pain + cause tolerancejoint replacement can be sought after

297
Q

angina baseline Mx

A

GTN aspirin statin

298
Q

Angina first line

A

either BBlocker or CCB (pt choice)

299
Q

if monotherapy don’t work add both together but

A

NEVER BBLOCKER W VERAPAMIL

300
Q

third line

A

long acting nitrate / nicorandil / ivabradine BUT ONLY whilst waiting for CABG or PCI

301
Q

calcineurin inhibitors

A

ciclosporin or tacrolimus

302
Q

antimetabolite immunospuresion

A

mycophenolate mofetil / azaithioprine

YEAR 5 (18 decks)

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