naomi low beer
type 1 respiratory failure vs type 2 respiratory failure
type 1 respiratory failure - hypoxaemia with no hypercapnea
type 2 resp failure - hypoxaemia with hypercapnea
what do you see in abg results for dka
low ph, low paCO2, low bicarb,
what is beck's triad?
1) muffled, distant heart sounds
2) hypotension
3) distended neck veins
indicates cardiac tamponade
what are the most common secondary diseases you would expect in a patient with chronic kidney disease
1. honestly any cardiac
2. bones
3. anaemia
4. bone disorders
how are cirgler najar type 1 and type 2 different
crigler najar type 1 is an absense of the gene causing absence of UDP G transferase type 2 is less but not absent
what is cushings triad
1) bradycardia
2) low resp rate
3) hypertension
what is charcot's triad and what does it indicate
(bonus 50 if you know reynolds pentad )
1) right upper quadrant tenderness
2) fever
3) jaundice
4) AMS
5) hypotension
what investigations do you do to differentiate type 1 v type 2 diabetes ( name 2)
islet autoantibodih testing, c peptide measurement
what type of renal pathology would you NOT expect to see in a patient who comes in with significant proteinuria ?
a. diabetic nephropathy
b. renal artery stenosis
c. Iga nephropathy
d. focal segmental glomerulosclerosis
e. minimal change disease
b. renal artery stenosis
treating a patient with a severe ulcerative colitis flare up
corticosteroids ( prednisolone, budeosinede) and immunomodulators
what is the treatment for hypercholestraemia if the patient ahs statin allergies
PCSK9 inhibitors or Bempedoic acid
when managing a spesis patient, you are treating them for their low blood pressure (90/60). You have given IV fluids and see improvement but it is still low. What are your next steps of management?
1) vasopressors
2) inotropic agents
Patient ( Male, 15) comes in with itchy jaundice, tremor in both hands for 5 months along with mood changes and difficulty speaking. Upon ecamination, you note a golden ring around the ocrnea. What are your impressions?
wilson's
Patient ( male, 65y) presents with painless jaundice, dark urine, pale stools and unintenional weight loss. He complains of dull ache in epigastric area radiating to the back worse when lying flat. He denies gallstones and does not have any history of alcohol. Examination reveals Courvoiser's sign. INvestigations show raised LFTs and raised CA 19-9. What are your impressions and what further steps would you do?
biopsy to confirm adenocarcinoma and ultrasound/ CT abdomen
impression : pancreatic carcinoma
Patient ( male, 16) presents to the clinic because he is worried about being different from his peers. He has not had his puberty yet and has difficulty smelling things what does he have
Kallman's syndrome
1) 15L non-rebreather mask
2) 15L nasal cannulae
3) blue venturi mask ( 24% at 2-4L/min)
4) do nothing he is fine
Patient (male, 50) comes in with fever, abdominal pain, unintentional weight loss, diarrhoea, shortness of breath and chest pain that has been going on for 5 days. He has a background of high blood pressure and works as a farmer. You see non temder lumps in his axillary lymph nodes. He has raised inflammatory markers and low Hb with normal MCV. His LFTs, and U&Es show nothing too concerning. Chest X ray and Quantiferon was normal. US abdomen shows thickened small bowel and retroperitoneal lymphadenopathy. Micro has ruled out Brucellosis and E coli infection. Biopsy of the small bowel has shown PAS positive ma
1) coeliac's disease
2) sarcoidosis
3) Chron's disease
4) Whipple's disease
whipples
Patient ( male, 42) presents with mild epigastric pain, heartburn, and vomitting for the past 9 months with watery diarrhoea ( 5-6 times a day) ( nil blood or steatorrhea ). He was given a trial of omeprazole but the symptoms had minimal relief. He has a history of peptic ulcer disease and multiple stubborn gastric ulcers that did not heal. Micro rules out H pylori infection No history of NSAID use. Investigations showes a low gastric pH and endocscopy shows multiple duodenal ulcers in distal duodenum. He reports his father had similar presentations at a similar age. What are your impressions
Zollinger Ellison syndrome with a background of peptic ulcer disease
Patient presents with AKI, and is known to have alcoholic liver disease with cirrhosis. THe impression is hepatorenal sydrome. First line for treating this?
Terlipressin with IV albumin for 7 days to see renal improvement
( terlipressin is a synthetic vasopressin analogue)
MOA
acts on the vascular smooth muscle of splanchnic circulation -> leads to vasoconstriction -> decreased portal venous pressure -> increases renal perfusion
hereditary haemochromatosis