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Internal medicine (eob) ECR > 2022 > Flashcards

2022 Flashcards

1
Q

52) Main complaint = SOCRATES

examination

A

site
onset
character
radiation
alleviating factors
timing
exacerbating factors
severity

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2
Q

53) Bronchus Ca, presents with sob and chest pain
a. Bronchus Ca: clinical features in early disease (3)
b. SOB reasons (2)
c. reason for chest pain (1)

pulmonology

A

a. bronchus ca
- chronic cough
- LOW
- blood stained sputum

b. SOB
- pleural effusion
- obstruction in main bronchus

c. chest pain
- metastasis to the pleura and ribs

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3
Q

54) patient present with oedema, raised jvp and has copd
a. cor pulmonale definition
b. signs of PHT (4)

cardio

A

a. right sided failure due to significant pulmonary hypertension

b. signs
- parasternal heave
- loud p2
- big a wave
- (pansystolic murmur)
- (hepatomegaly)
- (ascites)

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4
Q

55) patient presents with afib and dyspnoea
a. signs of Afib (2)
b. signs of LVF (3)

cardio

A

a. AF
- irregular irregular pulse
- pulse deficit

b. LVF
- pulsus alternans
- S3
- dilated displaced apex beat
- bi-basal crackles

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5
Q

56) young stroke
a. definition and importance to pick them up
b. potential causes (4)

neuro

A

a. under 50, with risk factors or unknown cause

b. cardio-embolic
hyper-coagulability state
autoimmune disease
mimickers (HIV, meningitis)

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6
Q

57) pathologies caused by excessive alcohol use (5)

?

A

cvs
- hpt
- cardiomyopathy

cns
- black-outs

git
- acute gastric erosions
- pancreatitis
- gastro-intestinal bleeing

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7
Q

58) patient presents with chronic cough. has smoked 10 cigarettes a day since 15 and is 65 now
a. clinical features of hyperinflation (4)
b. calculate pack years

pulmonology

A

a. barrel chest
resonant on percussion
liver dullness downwards
decreased cardiac dullness

b. 10/20 x 50 = 25 pack years

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8
Q

59) microvascular changes in DM (4)

endo

A
  • nephropathy
  • retinopathy
  • neuropathy
  • gastroparesis
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9
Q

60) back pain red flags (5)

rheuma

A
  • neuro deficit
  • unexplained fever/weight loss
  • malignancy
  • immnosuppression
  • age <20
  • trauma
  • osteoporosis
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10
Q

61) clinical features of pre-renal kidney injury (4)

nephro

A
  • thirst
  • sunken eyes
  • oliguria
  • orthostatic hypotension
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11
Q

62) chronc hep b
a. signs of liver failure (3)
b. shifting dullness definition
c. caput medusa definition

liver linking signs

A

a. jaundice
bruising
encephalopathy

b. sign of free peritoneal fluid wherein dullness of percussion shifts, from one side to the other when the patient turns from side to side

c. cluster of swollen veins in the abdomen

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12
Q

63) jvp pulse vs arterial pulse (4)

?

A

jvp
- not palpable
- double waveform pulse
- decreases on inspiration
- pulsation eliminated by light pressure

arterial pulse
- palpable
- single waveform pulse
- remains the same on inspiration
- pulsation not eliminated by light pressure

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13
Q

64) clinical signs of tricuspid regurg (4)

cardio

A
  • raised jvp
  • parsternal heave
  • pansystolic murmur
  • hepatomegaly
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14
Q

65) definition and causes
- whispering pectroriloque
- amphoric breathing
- pemberton sign

A

whispering pectroriloque
- whispered speech can be heard clearly upon auscultation
- consolidation (pneumonia)

amphoric breathing
- hollow sound heard over a cavity
- cyst

pemberton’s sign
- positive when patient lifts both arms above their head and start to show signs of cyanosis and plethora after 1-2 minutes
- superior vena cava syndrome

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15
Q

66) signs of HIVAN (3)
causes of renal impairment in HIV (2)

infectious disease

A

HIVAN
- large kidneys
- immunosuppression
- proteinuria without other features of nephrotic syndrome

renal impairment
- drug related
- pre-renal causes

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16
Q

67) LMN signs on motor exam (4)
spinal lesions signs on motor exam (2)

neuro

A

LMN
- hyopreflexia
- atrophy
- hypotonia
- fasiculations
- focal weakness

spinal lesion
- sphincter dysfunction
- flaccid paralysis

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17
Q

68) 3 secondary causes of HPT + clinical feature of each (6)

cardio

A
  • obstructive sleep apnoea: snoring
  • cushing’s syndrome :obesity
  • renal artery stenosis: abdominal bruit
  • (primary aldosteronism: hypokalaemia)
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18
Q

69) clinical signs of hypothyroidism (4)

endo

A
  • skin: cold, dry, rough
  • hoarse voice
  • puffy face
  • bradycardia
  • (yellow skin discolouration)
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19
Q

70) signs of cirrhosis in chronic alcohol user (5)

liver linking signs

A
  • palmar erythema
  • dupuytren’s contracture
  • gynecomastia
  • spider nevi
  • testicular atrophy
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20
Q

71) clinical signs of pleural effusion (4)
signs on CXR (2)

pulmonology

A

signs
- stony dull on percussion
- decreased/absent breath sounds
- decreased chest movement
- trachea shifted away

cxr
- mensicus sign
- pleural thickening

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21
Q

72) clinical signs of ILD (4)
confirm diagnosis (2)

pulmonology

A

ILD
- decreased expansion
- fine inspiratory crackles
- clubbing
- signs of connective tissue disease (rheumatoid arthritis)

dx
- cxr
- chest ct scan

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22
Q

73) lacunar stroke
common presentations (3)
clinical significance of lacunar vs mca stroke

neuro

A

presentation
- pure motor hemiparesis: unilat motor deficit, mild dysarthria, no higher cerebral dysfunction
- pure sensory stroke: unilt numbness, paresthesia, hemisensory deficit (face, arm, trunk,leg)
- ataxic hemiparesis: weakness more prominent in lower extremity with ipsilat arm and leg inco-ordination

lacunar vs mca
- mca you need to find the cause to see if it is ischaemic or haemorrhagic by doing a ct. no investigations needed for lacunar stroke

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23
Q

74) ecg features of pht (3)

cardio

A
  • p pulmonale
  • prominant r wave in v1
  • t wave inversion in v1-v3
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24
Q

75) types of shock (5)

?

A
  • spinal
  • septic
  • anaphylatic
  • hypovolaemic
  • cardiogenic
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25
Q

76) nail signs + associated conditions (5)

examination

A
  • blue: cyanosis
  • red: polycythaemia
  • clubbing: infective endocarditis
  • leuconychia: hypoalbuminaemia
  • koilonychia: fe deficiency
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26
Q

77) a. amphoric breathing + cause
b. pemberton sign + cause
c. kussmaul’s breathing + associated condition

pulmonology

A

a. hollow sound heard over a cavity
caused by cyst or cavitation

b. positive when patient lifts both arms above head and signs of cyanosis and plethora can be seen after 1-2 minutes
cause is sup vena cava syndrome

c. deep, rapid respiration due to stimulation of the respiratory centre.
metabolic acidosis

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27
Q

78) DMT1 microvascular complications (4)

endo

A
  • nephropathy
  • retinopathy
  • neuropathy
  • gastroparesis
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28
Q

79) hyperthyroidism
a. signs and features of grave’s disease (4)
b. test to confirm dx

A

a. bruit
grave’s ophthalmopathy
grave’s dermopathy
acropachy

b. antibody TSAb in blood

29
Q

80) mechanism of extra heart sounds
a. s3
b. s4
c. conditions causing above (2)

A

a. rapid ventricular filling on opening of av valves

b. atrial contraction with a non compliant ventricle

c. s3: AR, MR
s4: AS

30
Q

81) paracetamol overdose
a. liver failure clinical signs (3)
b. test to confirm liver failure

liver linking signs

A

a. jaundice
bruising
encephalopathy

b. bilirubin
inr
albumin
cholesterol

31
Q

82) clinical signs of aortic incompetence (5)

cardio

A
  • soft s2 (maybe s3)
  • dilated displaced apex
  • waterhammer pulse
  • decrscendo murmur
  • best heard on exhalation when sitting forward
32
Q

83) leg weakness
a. features of spinal cord lesion

neuro

A
  • loss of sphincter function
  • flaccid paralysis
33
Q

84) TB spine complications (2)

A
  • paraparesis
  • collapse of vertebrae pressure
34
Q

85) haemoptysis
a. life threatening haemoptysis
b. 3 causes

A

a. haemodynamically unstable
(> 400ml)

b. bronchiectasis
bronchus carcinoma
aspergiloma

35
Q

86) young person with liver failure after paracetamol OD
a. signs of liver failure (3)
b. tests to confirm liver failure (2)

A

a. brusing
jaundice
encephalopathy

b. liver function tests
bilirubin
INR
albumin

36
Q

87) stable vs unstable angina
a. pathogenesis
b. clinical presensation

A

a. stable
rupture of a small atheromatous plaque

unstable
obstruction of the coronary artery by a thrombus

b. stable
- tight chest
- chest pain during rest

unstable
- chest pain
- dyspnoea
- no enzyme leak

37
Q

88) patterns of weakness

A

look at diagram

38
Q

89) features that lead to diagnosis of diabetic nephropathy (4)

A
  • large kidneys
  • microalbuminaemia
  • proteinuria
  • microvascular damage (retinopathy, neuropathy)
39
Q

90) Kussmaul’s Sign and
Kussmaul’s Breathing

A

Kussmaul’s Sign
- paradoxical rise in right atrial pressure during inspiration

Kussmaul’s Breathing
- deep rapid breathing due to stimulation of the resp centre

40
Q

91) ecg features of pe (4)

A
  • sinus tachycardia
  • incomplete RBBB
  • right axis deviation
  • s1q3t3
  • (r ventricular strain: tall r wave in v1, inverted t waves in v1-v3)
41
Q

92) clinical signs of pht (4)

cardio

A
  • parasternal heave
  • loud p2
  • big a wave
  • pulsatile liver
  • (pansystolic murmur)
  • (hepatomegaly)
42
Q

93) chronic bilharzia infection
a. presenting features
b. clinical signs

A

a. rash
fever
bloody stool

b. hepatosplenomegaly
ruq tenderness
generalised lymphadenopathy

43
Q

94) chronic bilharzia vs liver cirrhosis
a. presentation (3)
b. clinical signs (3)

A

a. presentation
bilharzia
- rash
- fever
- bloody stool

liver cirrhosis
- jaundice
- low
- nausea and vomiting

b. signs
bilharzia
- hepatosplenomegaly
- ruq tenderness
- generalised lymphadenopathy

liver cirrhosis
- palmar erythema
- dupuytren’s contracture
- spider nevi

44
Q

95) ECG features of a Pericardial Effusion (2)

cardio

A
  • small complexes
  • electrical alternans
45
Q

96) clinical features which suggest pericardial tamponade (4)

cardio

A
  • distended neck veins
  • tachycardia
  • drop in bp
  • pulsus paradoxis
46
Q

97) typical features of TB on CXR (2)
2 types of TB CXR
presentations

infectious disease

A

a. pleural effusion
parenchymal infiltrates
(hilar adenopathy)

b miliary tb
upper lobe disease with cavitation

47
Q

98) main features on history and clinical signs of bronchiectasis (5)

pulmonology

A
  • sputum production
  • clubbing
  • coarse crackles
  • wheeze
  • maybe some dullness
  • severe: shifted towards
48
Q

99) features of Pre-Renal failure, with regard to
a. History
b. Signs (3)
c. Symptoms (3)
d. Investigations (2)

nephro

A

a.

b. oliguria
thrist
oedema

c. orthostatic hypotension
tachycardia
sunken eyes

d. urea:creatinine ratio
fractional excretion of Na

49
Q

100) definition of an Irregularly irregular pulse

cardio

A

heart beats with no pattern

50
Q

101) associated signs of irregularly irregular pulse (1)

cardio

A
  • pulse deficit
51
Q

102) ecg features of AF (2)

cardio

A
  • no clear p waves
  • irregular irregular pulse
52
Q

103) clinical signs of aortic stenosis (5)

cardio

A
  • ejection systolic murmur
  • heaving apex
  • plateau pulse
  • loud s2
  • radiating up carotid
53
Q

104) define + name the cause
a. radial femoral delay
b. corrigan’s sign
c. pulsus paradoxus

A

a. delay between the radial pulse and femoral pulse when palpated simultaneously

b. abrupt distension and quick collapse of the carotid arteries

c. drop in BP of more than 10mmHg during inspiration

54
Q

105) headache red flags (5)

A
  • sudden onset
  • papilloedema
  • > 50 years age
  • after recent trauma
  • neuro deficit
55
Q

106) reasons/causes for hypoglycaemia in a patient with diabetes (3)

A
  • not eating but still using meds
  • diabetic neuropathy
  • not adjusting meds after weight loss
56
Q

107) mechanism or techniques to obtain an accurate history other than Socrates (5)

A
  • comfortable eye contact
  • do not appear to be in a hurry
  • show empathy
  • no judgement
  • acknowledge patient’s feelings
57
Q

108) reasons hiv patients default arv tx (5)

A
  • depression
  • alcohol or substance use
  • work-related problems
  • non-disclosure
  • following pregnancy
58
Q

109) secondary causes of hpt in young patients (5)

A
  • cushing’s syndrome
  • renal artery stenosis
  • thyroid disease
  • primary aldosteronism
  • obstructive sleep apnoea
59
Q

110) diabetic
a. define charcot joint
b. define diabetic amyotrophy

A

a. destruction of a joint resulting from lysis and fragmentation of the bone in the setting of neuropathy

b. type of diabetic neuropathy characterised by nerve damage in hip, buttock or thigh typically on one side of the body

60
Q

111) clinical features of Guillain barre syndrome (5)

A
  • areflexia
  • progressive ascending weakness
  • minimal senosory features
  • resp failure
  • autonomic features
61
Q

112) signs of tension pneumothorax (5)

A
  • trachea shifted away from affected side
  • hyperresonant
  • absent breath sounds
  • absent vocal resonance
  • dec chest expansion on affected side
62
Q

113) renal failure
a. features of chronic renal failure (3)
b. classify renal failure and give 1 cause of each (3)

A

a. prev values
small kidneys
fibrosis

b. pre-renal: shock
renal: gn (glomerulonephritis)
post-renal: bph (benign prostatic hyperplasia)

63
Q

114) causes of haemoptysis (4)

A
  • bronchiectasis
  • aspergiloma
  • bronchus carcinoma
  • any pneumonia causing cavitation
64
Q

115) pleural effusion
a. cxr signs (2)
b. prove that effusion is d/t tb (4)

A

a. meniscus sign
pleural thickening

b. afb’s (acid fast bacilli) on microscopy
culture
genexpert

65
Q

116) signs of aortic stenosis (5)

A
  • ejection systolic murmur
  • loud s2, potential s4
  • heaving apex
  • plateau pulse
  • radiating up carotid
66
Q

117) signs of aortic regurg (5)

A
  • decrescendo murmur
  • soft s2, potential s3
  • dilated displaced apex
  • waterhammer pulse
  • best heard sitting forward in exhalation
67
Q

118) respiratory failure type 1 vs type 2

A

type 1
- resp system can’t adequately provide oxygen to the body. result = hypoxemia

type 2
- resp system can’t sufficiently remove carbon dioxide from the body. result = hypercapnia

68
Q

119) 5 ways to describe cardiac murmur

A
  • timing
  • radiation
  • loudness
  • pitch
  • area of greatest intensity

Internal medicine (eob) ECR (3 decks)

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