Hyponatraemia: A Working Approach — MCCQE Notes
Volume status plus urine sodium and osmolality gets you to the cause, and the rate of correction is what keeps the patient safe.
Structured the way you revise — mechanism, discriminators, first-line management, and the details that separate the right answer from the plausible one.
26 notes
Volume status plus urine sodium and osmolality gets you to the cause, and the rate of correction is what keeps the patient safe.
Diagnostic thresholds depend on how the pressure was measured, and the treatment target depends on the patient. Both are commonly examined.
The first decision is STEMI or not, because it changes the clock. Everything else follows from that fork.
Four drug classes change mortality and everything else treats symptoms. Knowing which is which answers most questions.
Diagnosis needs demonstrated variable airflow obstruction, and escalation decisions are driven by a short list of control questions.
Post-bronchodilator spirometry makes the diagnosis, and only three interventions change mortality.
Pretest probability comes first. Order a D-dimer without it and you have made the problem worse.
Non-contrast CT first, then the two time windows — thrombolysis and thrombectomy — and the secondary prevention that starts the same admission.
Four diagnostic tests, an individualised A1C target, and drug choice driven by cardiovascular and renal disease rather than by glucose alone.
Fluid first, then insulin, and never start insulin before you know the potassium.
TSH plus free T4 resolves nearly every stem — once you know the four patterns and the two traps.
Resuscitate, risk-stratify, scope within 24 hours — and know which patients get antibiotics and a vasoactive drug before the endoscope.
Ascites, SBP, encephalopathy, varices and hepatorenal syndrome — each with a treatment the exam expects verbatim.
Capacity is decision-specific, not a label on a patient — and in Canada a capable minor can consent for themselves. The two ideas the exam tests hardest.
Confidentiality is the rule; the exceptions are a short, memorisable list. Knowing which are mandatory and which are discretionary is the whole question.
The CTFPHC recommendations differ from the American ones in ways the exam deliberately targets — breast, cervical and prostate especially.
Pre-renal, renal, post-renal — and an ultrasound plus a urinalysis will usually tell you which.
A first unprovoked seizure does not automatically mean antiepileptic drugs; status is a timed protocol you should know by heart.
Acute onset with fluctuating attention is delirium until proven otherwise — and it is a medical emergency, not a behavioural problem.
Diagnosis by criteria, treatment by evidence, and a risk assessment that asks directly rather than inferring.
Preeclampsia no longer requires proteinuria, magnesium is for seizures rather than blood pressure, and delivery is the only cure.
Efficacy in typical use, the absolute contraindications to oestrogen, and emergency contraception — the three things reliably examined.
Under 28 days, fever means a full septic work-up and admission — no exceptions, however well the baby looks.
The nomogram, the eight-hour window, and the King's College criteria — and why a normal patient at four hours proves nothing.
The MCV splits the differential three ways, and the reticulocyte count tells you whether the marrow is trying.
Sensitivity and specificity, predictive values that move with prevalence, and the difference between relative and absolute risk.