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If a patient with DKA comes in, youve started insulin infusion and rehydrated aggressively and you do bloods 2 hours later (which are better) but the patient has become unconcious...whats probably going on??
Do we screen for cerebral aneurysms in APCKD?
- Only 8% of ppl with APCKD have aneurysms.
- If they have had: a rupture before, FHx of rupture before or have concerning neuro symptoms then go ahead.
- The M&M assoc with curative procedures for aneurysms and the fact that most of them never pop means that screening everyone doesnt make sense.
A tender goitre with a temperature and a very raised ESR?
- Unknown aetiology.
- Give em steroids and Bblockers.
Chronic granulomatous disease?
- Inability of neutrophils to oxidative burst and kill phagocytes.
- 75% of patients present within first 5 years of life.
- Recurrent bacterial and fungal infections.
- DO NOT present with Pseudomonas because the neutrophils can kill them without Obursts.
- Present with recurrent URTIs and LRTIs.
- Most often with Encapsulated bacteris:
- Strep pneumo
- Strep pyogenes
- Staph aureus
Primary ciliary dyskinesia?
- Also called kartangeners
- Recurrent URTIs and LRTIs due to inability to effectively clear secetions.
- Also Infertile.
What do you do with meds for Adreno-deficient patients when they are sick?
Mineralocorticoid always stays the same.
If they are moderately unwell - DOUBLE THE PRED
If they are severely unwell - CONVERT TO IV HYDROCORT.
What are the main non-organic occupational agents that can cause lung disease?
What do you do in a patient with ascites and hyponatraemia on diuretics?
If creatinine is off - Stop diuretics
- If serum creatinie is normal then:
- If 126-135 - just observe
- If 121-125 - Decrease the dose of diuretic with a view to stopping
- if <121 - stop diuretic and give normal saline
What are the typical clinical feature of a drug-induced acute interstitial nephritis?
- Renal failure with fever
Who gets skin necrosis on warfarin?
Patients with underlying Protein C or S deficiencies.
How would yo investigate someone you suspect of having cushings?
24hr urinary free cortisol is a good screener
- Low dose dex suppression is the most reliable next step. If you suppress to <50. Thats your diagnosis.
- You can also do Overnight dex suppression
What are the relative contraindications for EPO agents?
- Previous ischaemic stroke
What are the most common clinical signs preceeding cardiac arrest?
- Increased Resp rate
- Altered mental status
If the base excess is <-4 what is the mortality?
What is the best measure of lactic acidosis on a ABG?
Its superior to pH.
What conditions predispose to hyperoxal uria?
- Ileal resection
- short bowel
essentially anything that will put bile salts into your colon.
treat by advising low oxalate diet.
How does extra cranial vertebral artery dissection present?
severe occipital pain on trivial trauma.
symptoms are in keeping with posterior ischaemia
When would you start liraglutide/exenatide on a type 2 diabetic?
if they are on maximal metformin and glicazide and are on the heavier side
the GLP1 analogues will cause a 2-3kg wt loss and give you a 11-22 mmol/mol improvement in hba1c
What is the gold standard to investigate renovascular disease?
Renal angiography +- angioplasty
it has less false negatives than Doppler
Name another disease in which you would see OcBs in CsF?
When does the urinary dysfunction present in NpH and how does this compare to binswangers
- NPH has urinary dysfunction as a late feature
- early in binswangers
How does vascular Parkinson's present?
lower body Parkinson's
What disease are caused by mutations in the dystrophin gene?
What is the best determinant of post treatment gait function in metastatic spinal cord compression?
Mobility at presentation is the best predictor.
What can you use to induce hypercalciuria in a hypercalcaemic patient?
How does Dengue present?
Break bone fever!
- Severe myalgia
- Retroorbital pain
- Swollen adenoids
- Palatal vesicles
- Back pain
- Scleral injection
- Maculopapular rash spreading from trunk to the extremities.
- Epistaxis and scattered petechiae
What is KCO with regards to PFTs?
Transfer factor per unit volume.
- Its elevated in extrapulmonary restriction:
- Pleural thickening
- Respiratory muscle weakness
- Chest wall disease (thoracoplasty)
What is Pulsus bisferiens?
A palpable double pulse which occurs in hypertrophic obstructive cardiomyopathy (HOCM) or mixed aortic valve disease.
The first beat is the percussion wave of normal systole and the second wave is formed by recoil of the vascular bed (dicrotic wave).
What is Pulsus Alternans?
Beats are regular in timing but alternating weak - strong in strength. This can be due to severe LVF or as a compensatory mechanism in tachycardia.
How does HOCM present clinically?
- Pulsus bisferiens
- Jerky carotid
- Double apex beat
- Prominent a wave in JVP
- Harsh ESM with possible MR
What does the ECG show in HOCM?
- Twave inversion and deep Q waves inferolaterally
What are the presenting features of HOCM?
Massive volume clear frothy sputum with weight loss and dyspnoea?
Which cancer happens to people with Graves? how does it look on iodine uptake scans?
- Shows up as a cold spot on radioactive iodine scans
Trastuzumab's main side effect that requires monitoring?
Causes cardiac dysfuction, need a regular echocardiogram.
ECG changes in Pulmonary artery hypertension?
- Right axis deviaton
- Tall Rs in the precordial leads
- High amplotutde P-waves in Lead 2 (sign of right heart strain.
How do you manage transient global amnesia?
Observe for 24hrs. If it doesnt improve after that then consider imaging.
Thought to be vascular but cause unknown. TGA resolves in most people by 24 hrs.
What are the tests for brain-stem death and what cranial nerves do they correspond to?
- Pupillary light response - CN II and III
- Corneal reflex, response to supraorbital pressure - CN V and VII
- Vestibulo-ocular reflex - CN III and VIII
- Gag reflex - CN IX
- Cough reflex - CN X
- Absence of respiratory effort
Features of a lesion affecting the dominant parietal lobe?
- Dyslexia, acalculia, agraphia
- Finger agnosia
- Right inferior quadrantanopia
- Right left disorientation
Dominant temporal lobe lesions cause?
- Right superior quadrantanopia
- Expressive dysphasia
Non-dom occipital lobe lesions cause?
Left homoymous hemianopia + visual agnosia
Non-dom parietal lesions cause?
- Left inferior quadrantanopia
- Dressing apraxia
Non-dom temporal lesions cause?
- Memory impairment
- Auditory agnosia
- Right superior quadrantanopia
What is Progressive Multifocal leucoencephalopathy?
- When the oligodendrocytes become infected with JC (john cunninghham) virus (papovavirus)
- Happens when your CD4 count goes less that 100
- PCR the CSF for JC virus
- Virus cant be treated. Treat the HIV.
For exams - how does CNS lymphoma present?
Solitary space occupying lesion with mass effect.
What is the Truelove and Witts criteria for severe flare of UC?
- bloody stool frequency ≥ 6/day
- Plus one of the following:
- a tachycardia (> 90 bpm),
- or temperature > 37.8 °C,
- or anaemia (haemoglobin < 10.5 g/dL),
- or an elevated ESR (> 30 mm/h)
Whats the most common residual problem after a repair of fallots Tet?
How does friedrichs ataxia present?
- Autosomal recessive Trinucleotide repeat disorder.
- Presents with spinocerebellar ataxia
- Limb ataxia + cerebellar signs
- Absent reflexes and upwards plantars
- Optic atrophy
- Pes cavus
What commonly used drug can cause B12 deficiency?
Metformin - inhibits B12 absorption by affecting the calcium dependent transporters in the ileum.