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34 Cards in this Set
- Front
- Back
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What are 3 reasons why Transaminases (LFTs) will go over 1000?
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Paracetamol overdose
hepatitis b Ischemia of the liver - will return to normal within a day or 2 Rare: autoimmune hepatic disease |
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T/f
In diabetes you can get atonia of the stomach. |
True - neuropathy
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What is octreotide?
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Somatostatin analogue
Used in acromegaly but also acutely in gastrointestinal bleeding - ie perforated esophageal varices |
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With respect to liver disease - what may propanalol be use to treat?
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Portal hypertension and hence can be used to reduce the chance of rupture of esophageal varices
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What is omeprazole?
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Weak PPI
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What are normal Hb values?
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> 130 for males
> 115 for females < 100 is a problem < 80 - usually transfuse |
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What are the most common causes of a macrocytic anaemia?
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Alcoholism
Also B12 or folate deficiency - hypersegmented neurophils |
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What is H pylori infection eradicated with usually?
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PPI
Clarithromycin Amoxicillin ...? Check |
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What are common signs and symptoms associated with anaemia?
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Dysnoea / SOB
palpitations Dizzy HA Pale / white Palmar crease pallor Conjunctival pallor - cardiac compensation - cardiomegaly, murmur... Angular stomatitis (iron deficiency) |
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What are alcohol associated causes of upper GI bleeding?
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Mallory weiss tear - esophageal tear
Alcoholic gastritis |
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What are the main biochemical investigations to assess liver function?
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Bilirubin levels
Albumin - ~20 days INR -- acute Half life ~1-2 days |
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What does a high AST and high ALT but
AST > ALT indicate? |
Hepatic liver disease rather than viral
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Explain IV cannulation.
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Introduction, wash hands, check patient (use name)
Explain pt why they need it (ie for antibiotics) Explain in detail the procedure Tell the common and rare complications - pain, swelling, haematoma, bruise, phlebitis, infection, death.. Any questions? Consent |
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Follow acute coronary syndrome what medications are usually started ?
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SAAB
Statin ACEI or AT2I anticoagulant - aspirin or clopidergrel Beta blocker - Reduced HR and arrhythmias Also REDUCE RFs DIABETES, CHOLESTEROL, HT, SMOKING |
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What are the 4 top RF for CVD?
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Diabetes
High cholesterol HT smoking |
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What are the main types of Diabetic complications?
And S&S to ask for ...? |
MACRO
CVA - stroke, TIA, hallucinations, loss of motor/sensory, LOC, HA, seizure CVD - angina, SOB, LOC, AMI PVD - renal, erectile, foot ulcers, claudication, sensation, motor, MICRO Retinopathy - Vision, diplopia, visual fields, movements, HA nephropathy - kidney, blood, freak urgency, incontinence neuropathy - sensation, motor |
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What are some side effects of long term steroid use?
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Cushingoid
Skin - fragile, bruises Infections - thrush, UTI Gastric erosions - ulcers (upper GI bleed) Osteoporosis, RA Immunosuppression - infection - deactivation of TB, shingles ADRENAL CRISIS (if steroids stopped) Normal dose - 5-50mg prednisone |
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What are the 3 divisions of acute renal failure ARF? And examples...
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PRE-RENAL
Hypovolaemia - vomitting, diarrhea, burns, shock, pancreatitis Shock - all types Hemorrhage - extreme drop in BP Renal hypoperfusion - drugs AT2I, ACEI, cardiac failure (cardiogenic shock), septic shock (DIC, thrombosis) RENAL Glomerulonephritis, interstitial nephritis, vasculitis (AI) DiabetesToxins - gentamicin (aminoglycosides) Acute tubular necrosis - SLE, Diabetes, Analgesic nephropathy CT dyes Rhabdomyolysis POST-RENAL Stone BPH Uterus compression of ureter Stricture - any back up of the system |
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What things can cause asterixis?
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Kidney, liver, respiratory failure, Drug OD - encephalopathy - brain nodding off
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What are the complications associated with uraemia ?
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Puritis
Uraemic fetor Uremic pericarditis - cardiac tamponade - reduction in BP - death Encephalopathy Urea - by product of protein metabolism |
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How do you assess volume status?
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JVP @ 45' - double flicker, check by feeling (no pulse), =5cm at base of neck
BP - postural Oedema - sacral, peripheral - pitting (acute) Skin turgor Pulse - tachycardia Urine output - anuria, oligouria (<400ml/day) mucous membranes WEIGHT LOSS or GAIN Pulmonary oedema Ascites |
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What group of the population are more likely to have intussusception of the bowel?
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Babies and children
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Is fever a symptom of intussusception?
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No
But it may cause the bowel to become ischaemic and necrotic --- this may lead to perforation and peritonitis and or sepsis |
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Where should bowel cancer screening start?
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By the age of 50
But if family Hx - 10 yrs prior to onset of Hx |
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What is acanthosis nigricans?
And what is it associated with? |
Brown or black (poorly defined) hyperpigmentation of the skin - commonly found in skin folds
Associated with hypo/hyperthyroidism, acromegaly, PCOS, T2D, Cushing's disease |
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What components of a family history could be important for a GIT history?
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IBS
Cholelithiasis Jaundice Splenectomy Anaemias GIT malignancy IBD Liver disease (hep B) |
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What is leukoplakia?
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A pre-malignant condition affecting the tongue
Appears as a whitening of edge of the tongue that doesnt move when touched (thrush will come off and bleed) |
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What symptom in the mouth can be associated with anti-epileptics?
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Gingivitis
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What does diaphoretic mean?
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Excessive sweating
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For a patient presenting with dysphagia - what are important questions to ask about the symptom??
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dysphagia implies oesophageal problem
Duration? - short or long (malignancy) Intermittent (motility) Solids or liquids or both - mainly liquids implies motility disorder Is there heartburn - GORD - benign stricture? Odontophagia (pain) - esophageal ulceration (due to infection or injected tablet) |
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What are Somme causes of macroglossia?
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= large tongue
Down syndrome (trisomy 21) Acromegaly Hypothyroidism Amyloidosis? |
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What vitamin deficiency is associated with a geographical tongue?
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Vit B
Also common in people with hypersensitivity diseases - eczema, asthma, allergies, and also in women |
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What is tenesmus?
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Painful, ineffective Straining --usually with Incomplete emptying - whether it be urinary or bowel
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A patient complaining of constipation, who has mixed blood inn their bowel motions has what until proven otherwise?
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Colorectal cancer (remember your demographic though)
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