Which drugs can cause a raised troponin I?
- Herceptin and
How do you differentiate between NMS and Serotonin syndrome?
Hz and Ex mainly.
- NMS develops over days to weeks, whereas serotonin syndrome develops over 24 hours.
- Serotonin syndrome is characterized by neuromuscular hyperreactivity (tremor, hyperreflexia, myoclonus),
- while NMS involves sluggish neuromuscular responses (rigidity, bradyreflexia). Hyperreflexia and myoclonus are rare in NMS.
Also, resolution of NMS typically requires an average of nine days, compared with less than 24 hours (usually) for resolution of serotonin syndrome
Whats the best investigation to monitor infections of the aortic valve/root?
Daily ECGs to look for PR prolongation which happens due to disruption of the AV node
Secondary haemochromatosis treatment in a patinet who has recieved blood transfusions for myelodysplasia/fibrosis?
- Oral iron chelation with Desferasirox.
- Phlebotomy not ideal as youll make them even more anemic. And subcut chelation has compliance issues
Differential diagnosis for large volume bronchorrhoea?
- Bronchoalveolar carcinoma
- Heart failure
- Alveolar protienosis
- Cryptogenic organising pneumonia
In a newly diagnosed Marfans patient what test do you need to do to risk stratify them?
ECHO to look at the aortic root and risk stratify for dissection
Commonest cause of travellers diarrhoea?
Enterotoxic E.Coli - 12-24 hr incubation.
Which anesthetic factors worsen Pulm HTN?
- High inspiratory pressures
What are your intra-operative management goals in a patient with Mitral Regurg.?
- Avoiding raised SVR - increases regurg
- Avoiding bradycardia - increases time of regurg
- and avoiding factors exacerbating pulmonary hypertension
Which Hep-C patients respond well long term to Interferon?
- Low hepatic iron
- No cirrhosis
What should you be wary of in patients who have had a Neobladder formation?
- Hyperchloraemic metabolic acidosis
- This is Accompanied by Hypokalemia, hypocalcaemia and hypomagnasaemia
Give Bicarb and K+ replacement
The first step in Bblocker overdose?
Atropine - give it when they have Sympotmatic bradycardia.
If present in the first hour, give activated charcoal.
What is the primary abnormality in Liddle's syndrome?
- Very sensitive epithelial sodium reuptake protein in the kidney.
- It retains more sodium than it should and therefore causes Secondary hypertension.
- This in turn causes your renin and aldosterone levels to go down and the lack of aldosterone causes you to become hypokalemic.
- It also causes a metabolic alkalosis, much like Bartters.
If someone says high grade lymphoma what should you be thinking?
- Burkitts lymphoma
- Refer as an emergency due to high cell turnover
Which live vaccine can you give safely to HIV Patients?
Which type of lung cancer predisposes to LEMS?
Small cell lung cancer
which type of lung cancer predisposes to SIADH?
Which opiates are safest in renal failure?
Fentanyl and Alfentanil
What do you do in PD induced peritonitis?
- Give intraperitoneal antibiotics
- DO NOT HANG ABOUT for cultures
- Give intra peri Vanc + Gent
At what level of PTH would you consider giving Alfacalcidiol to Renal failure patients? And whats the rationale?
- You actually want to maintain a slightly high PTH to protect against renal bone disease.
What medication could you give to a renal failure patient that is hypocalcaemic but very hyperphosphatemic?
Calcium acetate - replaces the calcium and binds the phosphate.
How do you treat TTP?
Plasmapheresis with FFP as the plasma substitute to replace ADAMTS-13
What are your treatment options in methaemoglobinaemia?
- Methylene blue
- Exchange transfusion of RBC transfusion
- Hyperbaric oxygen
- Add ascorbic acid if patient has G6PD
Causes of a SAAG>11?
- Alcoholic Hepatitis
- Cardiac Ascites
- "Mixed Ascites"
- Massive Liver Metastasis
- Fulminant Hepatic Failure
- Budd-Chiari Syndrome
- Portal Vein Thrombosis
- Veno-Occlusive Disease
- Fatty Liver of Pregnancy
- Nephrotic syndrome
Causes of an SAAG <11?
- Peritoneal Carcinomatosis
- Tuberculous Peritonitis
- Pancreatic Ascites
- Bowel Obstruction
- Biliary Ascites
- Nephrotic Syndrome
- Posteroperative Lymphatic Leak
- Serositis in Connective Tissue Disease
What does an unrecordable thyroglobulin indicate?
- The patient is taking thyroid meds.
- Thyroglobulin is the precursor to thyroid hormone and therefore if unrecordable with elevated thyroid hormones, they are taking thyroid meds.
What antimicrobial prophylaxis would you give to a patient about to have chemo with a purine analogue?
- Septrin for PCP.
- You can stop it once their CD4 is >200
What would you give to a close contact of a TB patient that has a strongly positive mantoux test?
- 3 months of Isoniazid + Rifampicin
- Or 6 months of Isniazid
Which ticks transmit Lyme in Europe and which in the US?
Europe = Ixodes ricinus
USA = Scapularis and Pacificus
If someone has scleroderma and they come in with malignant hypertension what do you do?
DO NOT GIVE LABETOLOL
Theyve gone into scleroderma renal crisis which requires ACEi and /or calcium channel blockers
Abrupt hypotension can worsen their kidney function so IV agents are a no no
What is the most specific biochemical picture of alcoholic liver disease?
AST more than twice the level of ALT
What should you counsel patients who are on Lenalidomide about?
EVEN if they are male!!
Whats the rough approximation of Bcell mass loss in t1dm and t2dm
- T1dm approx 90% mass loss
- t2dm approx 65% mass loss
How do you tackle a TCA overdose with evidence of Cardiotoxicity?
- Sodium Bicarb.
- Alkalinise the urine and get rid of the stuff.
- At low pH, TCAs uncouple from cadiac sodium channels.
How would you manage a second pneumothorax requiring chest drain in a young fit individual?
They need VATS for bullectomy and pleurectomy.
Pleurodesis is for old frail people.
Risk of hypothyroidism following Radioiodine therapy?
Risk of becoming hyperthyroid in the longterm if you're only using anti-thyroid meds?
Radioactive iodine - does it give you cancer?
Leading causes of ventilator assoc pneumonia?
- Stenotropherema maltophilia
Whats the main treatment for PBC?
What acid-base abnormality does Diamox cause?
Metabolic acidosis with normal anion gap due to bicarb loss via the kidneys.
treatment options for lewy body dementia?
If acei is not doing enough to reduce proteinuria whats the next option?
- Add in spiro but be very careful of their potassium
- They will have a drop in egfr for the first 12 weeks
A patient has just had a colonoscopy. What determines hen that patient will have their next colonoscopy, if at all?
All dependent on what is found during colonoscopy? (and a little bit on pre-existing risk factors)
- <2polyps, both <1cm - No F/U
- 3-4 adenomas or a single adenoma >1cm - Repeat colonoscopy in 3 years
- 5 or more adenomas or 3 or more where 1 is greater than 1cm - High risk, yearly colonoscopy
Which cardiac meds have no effect on your risk of cardiovascular events occuring?
- Calcium channel blockers
In post-menopausal women with metastatic breast Ca which is ER +ve, what is your management?
Aromatase inhibitors (anas, letrozole, exemestane)
Superior response rate, time to progression and overall survival compared to Tamoxifen.
Whats the best way to think about TLco and Kco?
- TLCO is the amount of CO you are transferring across the entire long
- KCO is the amount of CO you are transferring across a smaller unit volume.
- Whatever increases the amount of red blood cells coming into contact with alveoli will increase your Kco.
- Both should go up and down together.
- If they dont - you have a Extrapulmonary restriction. (Widespread pleural disease, thoracic cage deformities and resp muscle weakness)
- Pathognomic for Type 2a hyperlipidaemia.
- (Familial hypercholesterolaemia)
Risk factors for progression of CKD?
- Cardiovascular disease
- Urinary tract outflow obx
You're starting a patient on Amiodarone...what side effects are they most likely to get...in order of commonality?
- Corneal deposits - >90%
- Hypothyroidism - 30%
- Thyrotoxic 10%
- Abnormal LFTs 5%
- Chronic lung disease 5%