What urinary results would yo expect in ATN?
Sodium losses in excess of 60mmol/l
In a case of digital ischaemia, what is your role medically and what can you add?
80% are due to an embolus from the heart. They require an ECHO. but obviously surgical revasc is the emergency
Whats acanthosis nigracans and whats it assoc with?
Hyperpigmented velvety patches in axillae + groin + skin folds.
- Assoc Endocrine disease (acromegaly, cushings, insulin resistant diabetes)
- Paraneoplastic phenomenon due to gi tract tumors - usually adenocarc of stomach
Sudden onset headache + seizure + focal pyramidal signs in a patient with recent dehydration and demonstrable pulmonary hypertension with a prolonged APTT?
Dural venous sinus thrombosis secondary to anti-phospholipid syndrome.
CT will show infarct in non arterial distribution often with haemorrhage.
Which stroke patients qualify for decompressive hemicraniectomy?
- >50%MCA infarct
- NIHSS > 15
- A GCS that is anything less than alert and keenly responsive
How can radio-iodine dye help differentiate Amiodarone induced thyrotoxicosis?
- Type 1 is increase synthesis of thyroid hormone
- type 2 is destructive thyroiditis
What would you test for to diagnose Congenital adrenal hyperplasia?
Someone complaining of loss of conciousness preceeded by tremors and sweating, relieved by carb or sugar intake = ?
- Admit for prolonged fast and measure insulin + cpeptide + blood sugars
Schistosomiasis strains and their long term complications?
- Schistosoma Mansoni - Cerebral comps
- Schistosoma Japonica -
- Schistosoma Haematobium - Bladder comps
How do you manage granuloma annulare?
Whats the 5 year mortality of someone with HTN, previous TIAs and renal artery stenosis?
What are the grades of hepatic encephalopathy and what defines them?
- Grade 0 = minimal to none
- Grade 1 = Change in mood/behaviour and some sleep abnorms/inversion
- Grade 2 = Lethargy, apathy, drowsiness
- Grade 3 = Depressed GCS but rousable
- Grade 4 = Not responding to painful stimuli
Essentially what defines them is decreased consiousness levels.
What happens when you compress the cavernous sinus?
- 3rd nerve palsy
- 5th nerve palsy
Mononeuritis multiplex and a high ESR and neutrophilic leucocytosis?
- Its vasculitis
- Either Wegner's or PAN
Whats the legal bits and bobs surrounding brainstem death?
- The testing of brain stem death needs to be carried out by 2 medical practitioners. (this can be at the same time)
- Both need to have at least 5 years experience and one of them has to be a consultant
- Transplant teams cannot assess brain stem death.
- You have to have 2 tests with a sensible time difference but 1 week is too long.
- The legal time of death os when the first test showed brain stem death even though it is announced at the second test.
Mening gitis with brain stem involvment?
How does febuxostat work?
Xanthine oxidase inhibitor.
Differs from Allopurinol in that it is not a purine analogue.
How do probenacid and benobromadine work in gout?
They are uricosuric agents that block Urat-1 and Glut-9 receptors in the proximal tubule.
What is actinomycoses? Whats the treatment
Infection with actinomyces bacteria.
- Presents as:
- Cervicofacial actinomycoses - mass that discharges yellow granular material from a sinus
- Abdominal actinomycosis - usually a mass forming after surgery to abdomen introduces the bacteria.
- Also thoracic and CNS actinomycoses
High dose IV benpen and surgical resection are required
How does HHT present?
- Punctiform lesions in the mouth
- GI bleeding
- AVMs in lung and brain that go pop.
How does cetuximab work and what must the patient havein order for it to work at all?
Works by blocking the extracellular domain of EpiGrowthFactorReceptor.
Therefore you need a normal receptor to work So patients who have a KRAS mutation are not eligible as their EGFR is constitutively turned on.
What does heparin do to TFTs?
Mucks them up, interferes with the assay.
Who should be tested for Conns?
- Consider testing patients with:
- Stage 1 hypertension (>160-179/100-109 mmHg)
- Stage 2 hypertension (>180/110 mmHg)
- Drug resistant hypertension
- Hypertension and spontaneous or diuretic-induced hypokalaemia
- Hypertension with adrenal incidentaloma
- Hypertension and a family history of early onset hypertension or cerebrovascular accident at a young age (less than 40-years-old), and
- Hypertensive first-degree relatives of patients with primary hyperaldosteronism.
Test them with Renin/aldosterone ratios - Aldosterone will be sky high and renin very low
What do you do in a crdiac arrest if a patient is profoundly hypothermic?
- Warm them to atleast 32 degC
- The drugs and shocks wont work until they are warmed. Also continue the cardiac arrest for a lot longer than you otherwise would as good neuro outcomes very likely.
Whats the order of agents you can use for neuropathic pain in diabetes, what are their contra indications?
- Duloxetine - cannot use in patients with glaucoma
- Amitriptyline - cant use in glaucoma
- Pregabalin -
- Gabapentin - cannot use in renal impariment
First choice antiemetic in opioid induced nause in palli care setting?
Haloperidol - terrific deppressor of the CTZ - much better than the others.
A useful mnemonic for causes of angioid retinal streak?
- S - Sickle
- L - Lead poisoming
- A - Abetalipoproteinaemia/acromegaly
- P - Pagets/phacomatoses (tuberous, sclerosis, neurofibromatosis, Sturge-Weber)
- P - Pseudoxanthoma elasticum
- E - Ehlers-Danlos
- R - Raised calcium or phosphate
- S - Short people (dwarfism).
What is a Holmes tremor?
- Also called a rubral tremor - occurs when youve damaged the red nucleus.
- Characterised by a low frequency tremor that occurs at rest, intentionally and on action.
- Usually due to a stroke of the red nucelus - so vascular risk factors predispose to it
Chap comes in with barret's...watch guna do?
- If its less than 3cm - 3-5yearly OGD +biopsy
- If its more than 3cm - 2-3yearly OGD +biopsy
- If its low grade dysplasia - 6 monthly OGD
- If its high grade dysplasia - MDT ?EMR/surgery
Obviously everyone gets acid suppression
Whats the correct order to remove PPE?
Gloves and gown then eye protection in the room, followed by facemask removal outside of the room
What drugs interfere with Levothyroxine absorption?
- cholestyramine and sevelamer,
- iron sulphate
- proton pump inhibitors.
Symptoms of co-arctation of the aorta?
- Nose bleeds
- Cramping leg pains
What is Antiphospholipid syndrome?
- It is a non-inflammatory pro-thrombotic state in vivo.
- But the Lab tests suggest an anticoagulant state.
- The antiphospholipid antibodies (anticardiolipin and lupus anticoagulant) cause coagulation defect in-vitro (raised aPTT which fails to correct after the addition of normal human plasma).
- However, despite the coagulation defects, and thrombocytopenia, the lupus anticoagulant causes arterial and venous thromboses in vivo.
How do you manage hemiballismus?
- Will go away by itelf in 4-8weeks.
- Give tetrabenazine
If some one has bilateral ballismus what is the cause?
Usually metabolic - HONK
What are the types of cryoglobulinaemia?
- Type 1 - monoclonal - Assoc with haematological disease
- Type 2 - Mono and polyclonal mix - associated with many connective tissue disorders, chronic infections and most importantly, hepatitis C
Treatment for Cryoglobulinaemia?
- High dose steroids
Elevated plasma calcitonin levels...?
Medullary thyroid Ca
- Bilateral phaeos
- medullary thyroid ca
- parathyroid hyperplasia
Autosomal dominant and assoc with RETprotooncogene
- Same as men 2A but has
- marfanoid habitus
- Pappilary thyroid cancer
- pappilary ovarian
What do you worry about most when you see a raised IgM paraprotein titre?
- Waldenstroms Macroglobulinaemia
- Main concern in hyperviscosity syndrome. Test plasma viscosity - plasmaphorese and cytoreduce.
What factors predispose to post-extubation stridor/laryngeal oedema?
- Female gender
- cuff pressure
- large tube size
- Intubation for>36hrs
How does Fabry's present?
- Renal impairment
- Small vessel strokes
- Painful peripheral neuropathy
- Skin Angiokeratomas
What is Nelson's syndrome?
- When an ACTH secreting tumor is let loose because you've adrenalectomised the patient.
- They just present with cushings and lots of pigmentation
How does the care of bradycardia differ in the transplanted heart?
- Its denervated...so...
- Atropine and glycopyrrolate are useless.
You need to start a theophylline infusion to increase cAMP and try to increase the hearts own rate.
What percentage deterioration in renal function would you tolerate in a CCF/CKD patient that you start on an ACEi/ARB?
30% increase in Creat is fine. any more and you need to have a rethink.
What width is a widened mediastinum?
What is the primary abnormality in Bartter's syndrome?
- Thickening of the ascending limb of the LoH,
- This makes it difficult to reabsorb sodium, potassium and calcium.
- This causes hypokalemia and hyponatraemia
- Hypercalciuria and nephrocalcinosis
- Also causes Polyuria + weakness
- Usually fatal in childhood
Hyperplasia of the Juxtoglomerular apparatus
Painful red eye which is photophobic and has sluggish pupil responses..?
- Its Uveitis.
- Scleritis is a dusky blue discolouration and doesnt not have sluggish pupils or photophobia