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Internal medicine (eob) ECR > 2021 > Flashcards

2021 Flashcards

1
Q

1) presents with HIV + kaposi’s sarcoma
confirm splenomegaly (5)

A
  • enlarges inferomedially
  • moves early on inspiration
  • not ballotable
  • has a notch
  • can’t get above it
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2
Q

2) red flags of lower back pain (5)

rheuma

A
  • age < 20
  • trauma
  • unexplained fever/weight loss
  • neurological deficit
  • malignancy
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3
Q

3) signs of acute onset asthma (5)

pulmonology

A
  • cyanosis
  • dizzyness
  • dyspnoea
  • tachypnoea
  • tachycardia
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4
Q

4) symptoms of severe asthma attack (4)

pulmonology

A
  • cough
  • wheeze
  • shortness of breath
  • tight chest
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5
Q

5) signs of LVF (4)

cardio

A
  • pulsus alternans
  • s3
  • displaced dilated apex
  • bi-basal crackles
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6
Q

6) signs (3) + causes (4) of pre-renal failure

nephro

A

signs
- orthostatic hypotension
- thirst
- oliguria

causes
- dehydration
- shock
- sepsis
- drugs

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7
Q

7) test to confirm pre-renal failure (2)

nephro

A
  • urea:creatinine ratio
  • fractional excretion of Na
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8
Q

8) signs of TB on abdo exam (5)

infectious disease

A
  • weight loss
  • abdominal pain
  • abdominal mass
  • ascites
  • hepatomegaly
  • (fever)
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9
Q

9) confirm dx of TB abdomen (4)

infectious disease

A
  • saag < 11
  • lymphocytic with raised ada
  • para-aortic lymphnodes
  • micro-abscess
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10
Q

10) ischaemic cva risk factors (5)

neuro

A
  • dm
  • hpt
  • smoking
  • high cholesterol
  • alcohol use
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11
Q

11) lancunar stroke
a. definition
b. sign

neuro

A

a. a type of ischaemic stroke that occurs in the deep parts of the brain.

b. hemiparesis

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12
Q

12) signs of pericardial effusion (3)

cardio

A
  • absent apex beat
  • muffled heart sounds
  • increased cardiac dullness
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13
Q

13) pulsus paradoxus definition

A

decrease in BP of more than 10mmHg during inspiration

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14
Q

14) substance that causes jaundice

A

bilirubin

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15
Q

15) 3 main categories of jaundice causes + example

A

pre - hepatic
- excessive red cell breakdown
- eg. haemolytic anaemia

hepatic
- dysfunction of hepatic cells
- eg. alcoholic liver disease

post-hepatic
- obstruction of biliary drainage
- eg. gallstones

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16
Q

16) DMT1 microvascular complications

A
  • nephropathy
  • retinopathy
  • neuropathy
  • (gastroparesis)
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17
Q

17) signs of CCF on cxr (5)

cardio

A
  • peri-brochial cuffing
  • kerley b,c lines
  • small effusion
  • fluid in fissure
  • upper lobe diversion of blood
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18
Q

18) clinical features of severe hpt (5)

cardio

A
  • chest pain
  • dizziness
  • severe headache
  • SOB
  • nausea and vomiting
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19
Q

19) 3 anatomical structures that can have lesions leading to portal hpt
- condition affecting structures

liver linking signs

A
  • liver: cirrhosis
  • portal vein: portal vein thrombosis
  • heaptic veins: budd chiari
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20
Q

20) patient presents with an
enlarged lymph node…
Which characteristics of lymph nodes would you seek to aid you with a differential diagnosis and how would these findings influence your diagnosis and approach (6)

examination

A
  • site
  • size
  • consistency
  • duration
  • mobility
  • tenderness
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21
Q

21) chracteristics of different kinds of chest pain (5)

examination

A
  • type of pain
  • onset
  • radiation
  • exacerbating factors
  • alleviating factors
22
Q

22) presents with an irregularly irregular pulse
a. define irregular irregular pulse
b. dx of irregular irregular pulse
c. 2 additional signs

A

a. heart rate is irregular and no pattern can be found
b. AFib
c. pulse deficit and fatigue

23
Q

23) convulsions vs syncope (5)

A

seizure
- aura
- 1-2 min
- myoclonic jerks before LOC
- post ictal confusion
- eyes open

syncope
- no aura
- myoclonic jerks after LOC
- < 1 min
- rapid recovery
- eyes closed/rolled back

24
Q

24) difference between pneumothorax, pe, consolidation

A

inspection
- pneomo: trachea + apex shifted away
- pe: movement dec on affected side
- consolidation: movement dec on affected side

palpation
- pneomo: dec vocal fremitus
- pe: dec vocal fremitus
- consolidation: inc vocal fremitus

percussion
- pneomo: hyperresonant
- pe: stony dull
- consolidation: dull

auscultation
- pneomo: dec breath sounds, dec vocal resonance
- pe: dec breath sounds, dec vocal resonance
- consolidation: crackels, bronchial breathing, vocal resonance inc

25
Q

25) patient presents with hyperthyroidism…
which clinical signs and features would point towards Graves disease (4)

A
  • bruit
  • grave’s ophthalmopathy
  • grave’s dermopathy
  • acropachy
26
Q

26) man presents with a swollen right leg after travelling on a plane for a business trip
a. most likely diagnosis
b. Virchow’s triad (3)
c. differential diagnosis of a swollen leg besides the above diagnosis (4)

A

a. dvt

b. stasis of blood flow
hypercoagulability
endothelial injury

c. infection
lympoedema
trauma
soft tissue/bone malignancy

27
Q

27) clinical signs of pht (4)

cardio

A
  • big a wave on jvp
  • parasternal heave
  • loud s2
  • tricuspid regurg
28
Q

28) HIV positive, low CD4 presents with fever, depressed level of consciousness and progressive headache
a. differential diagnosis (4)
b. other associated signs (4)

A

a. tbm
cryptococcal meningitis
bacterial meningitis
opportunistic infections like toxoplamosis

b. raised icp
nausea and vomiting
papilloedema
headache worse on cough

29
Q

29) Which lymph nodes should be specifically examined if lung cancer is suspected

A
  • axillary
  • cervical
  • supraclavicular
30
Q

30) An elderly gentleman known with diabetes type 2 and hypertension presents with pain in the right knee.
a. What could be the possible diagnosis (5)
b. What special investigation could confirm the diagnosis

A

a. sepsis
gout
pseudogout
avascular necrosis
trauma

b. gram stain and culture synovial fluid

31
Q

31) clinical features of hypothyroidism (5)

A
  • skin cold, rough, dry
  • hoarse voice
  • yellow skin discolouration
  • bradycardia
  • puffy face
32
Q

32) mechanism of
a. S3
b. S4
c. List 2 conditions causing each of the above

A

a. rapid ventricular filling on opening of av valves

b. atrial contraction with non-compliant ventricle

c. s3: AR, MR
s4: AS, hpt

33
Q

33) nail signs and pathology (5)

A
  • blue: cyanosis
  • red: polycythaemia
  • clubbing: infective endocarditis
  • leuconychia: hypoalbuminaemia
  • koilonychia: fe defiency
34
Q

34) fe deficiency anaemia
a. dx (3)
b. investigation findings (3)

A

a. fbc
blood smear
serum ferritin

b. dec haemoglobin
microcytosis
hypochromia

35
Q

35) patient presents with liver failure due to paracetamol overdose
a. clinical signs (3)
b. investigations to confirm liver failure (4)

A

a. jaundice
bruising
encephalopathy

b. bilirubin
inr
albumin
cholesterol

36
Q

36) nephrotic syndrome
a. clinical features (5)
b. differential dx (4)
c. manage causes (4)

A

a. hpt
odema
proteinuria
inc cholesterol
hypoalbuminaemia

b. minimal change disease
fsgs
dibetes
hivan

c. fix cause
reduce proteinuria
anti-coagulate
repeat tests

37
Q

37) IHD
a. 3 acute coronary sydromes
b. difference between them

A

a. unstable angina
stemi
nstemi

b. unstable angina: non-occlusive thrombus
nstemi: incomplete thrombus occlusion
stemi: complete thrombus occlusion

38
Q

38) signs of aortic incompetence (regurg) (5)

A
  • decrescendo murmur
  • dilated displaced apex
  • waterhammer pulse
  • best heard sitting forward on exhalation
  • soft s2
39
Q

39) complications of TB spine (2)

A
  • paraplegia
  • cold abscess
  • (spinal deformity)
40
Q

40) UMN lesion (5)

A
  • hypertonia
  • hyperreflexia
  • clonus
  • babinski’s sign
  • regional weakness
41
Q

41) young Intravenous drug user presents with signs of tricuspid regurgitation
a. findings on exam
b. underlying cause

A

a. parasternal heave
pansystolic murmur
pulsatile liver
raised jvp

b. infective endocarditis

42
Q

42) respiratory examination
a. What is whispering pectoriloquy and what causes it?
b. What is amphoteric breathing and what causes it?
c. How would you demonstrate Pemberton’s sign and if it is positive, what does it
indicate

A

a. whispered words can be heard clearly during auscultation - consolidation

b. hollow breathing heard over cavity - cavitation, cyst

c. lift both arms above your head and if positive, you’ll start to see signs cyanosis or plethora after 1 - 2 minutes- sup vena cava obstruction

43
Q

43) headache red flags (5)

A
  • > 50 years
  • onset sudden
  • after recent trauma
  • neuro deficit
  • papilloedema
44
Q

44) an older woman has severe hypertension despite being on 3 antihypertensive drugs, what could be the cause of this?

A
  • adherance
  • chronic kidney disease causes resistant hpt
45
Q

45) HIV patient presents with renal disease
a. What is the differential diagnosis?(4)
b. What could confirm that it is HIVAN (3)

A

a. dm
hivan
pckd
myeloma

b. exclusion
- prerenal causes
- drug related
- usual causes like GN

46
Q

46) patient presents with a pleural effusion. the patient is a chronic smoker
a. clinical signs (4)
b. causes (2)
c. confirm diagnosis

A

a. trachea shifted away
stony dullness
absent breath sounds
dec expansion on affected side

b. tb and cancer

c. pleural tap

47
Q

47) rheumatoid arthritis vs osteoarthritis

A

rheumatoid (inflam)
- pain worse in morning
- swelling
- redness
- warmth
- morning stiffness > 1 hr

osteo (non-inflam)
- worse in evening or after a hard day’s work
- no swelling
- no redness
- rarely warm
- morning stiffness < 30 min

48
Q

48) lacunar stroke
a. common clinical presentations
b. important to distinguish

A

a.
- pure motor hemiparesis
- pure sensory stroke
- ataxic hemiparesis
- sensorimotor stroke

b. nb because you have to know if you need to look for associated embolic events

49
Q

49) causes of LVF (5)

A
  • hpt
  • ihd
  • inflammatory
  • idiopathic
  • metabolic (vit def)
  • (postpartum)
50
Q

51) clinical signs of ILD (5)

A
  • cyanosis
  • clubbing
  • dry cough
  • fine insp crackles
  • decreased expansion
51
Q

52) clinical signs of severe malaria

A
  • metabolic acidosis
  • pulmonary oedema
  • hypoglycaemia
  • severe anaemia
  • shock

Internal medicine (eob) ECR (3 decks)

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