2022 Flashcards
52) Main complaint = SOCRATES
examination
site
onset
character
radiation
alleviating factors
timing
exacerbating factors
severity
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. 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
54) patient present with oedema, raised jvp and has copd
a. cor pulmonale definition
b. signs of PHT (4)
cardio
a. right sided failure due to significant pulmonary hypertension
b. signs
- parasternal heave
- loud p2
- big a wave
- (pansystolic murmur)
- (hepatomegaly)
- (ascites)
55) patient presents with afib and dyspnoea
a. signs of Afib (2)
b. signs of LVF (3)
cardio
a. AF
- irregular irregular pulse
- pulse deficit
b. LVF
- pulsus alternans
- S3
- dilated displaced apex beat
- bi-basal crackles
56) young stroke
a. definition and importance to pick them up
b. potential causes (4)
neuro
a. under 50, with risk factors or unknown cause
b. cardio-embolic
hyper-coagulability state
autoimmune disease
mimickers (HIV, meningitis)
57) pathologies caused by excessive alcohol use (5)
?
cvs
- hpt
- cardiomyopathy
cns
- black-outs
git
- acute gastric erosions
- pancreatitis
- gastro-intestinal bleeing
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. barrel chest
resonant on percussion
liver dullness downwards
decreased cardiac dullness
b. 10/20 x 50 = 25 pack years
59) microvascular changes in DM (4)
endo
- nephropathy
- retinopathy
- neuropathy
- gastroparesis
60) back pain red flags (5)
rheuma
- neuro deficit
- unexplained fever/weight loss
- malignancy
- immnosuppression
- age <20
- trauma
- osteoporosis
61) clinical features of pre-renal kidney injury (4)
nephro
- thirst
- sunken eyes
- oliguria
- orthostatic hypotension
62) chronc hep b
a. signs of liver failure (3)
b. shifting dullness definition
c. caput medusa definition
liver linking signs
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
63) jvp pulse vs arterial pulse (4)
?
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
64) clinical signs of tricuspid regurg (4)
cardio
- raised jvp
- parsternal heave
- pansystolic murmur
- hepatomegaly
65) definition and causes
- whispering pectroriloque
- amphoric breathing
- pemberton sign
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
66) signs of HIVAN (3)
causes of renal impairment in HIV (2)
infectious disease
HIVAN
- large kidneys
- immunosuppression
- proteinuria without other features of nephrotic syndrome
renal impairment
- drug related
- pre-renal causes
67) LMN signs on motor exam (4)
spinal lesions signs on motor exam (2)
neuro
LMN
- hyopreflexia
- atrophy
- hypotonia
- fasiculations
- focal weakness
spinal lesion
- sphincter dysfunction
- flaccid paralysis
68) 3 secondary causes of HPT + clinical feature of each (6)
cardio
- obstructive sleep apnoea: snoring
- cushing’s syndrome :obesity
- renal artery stenosis: abdominal bruit
- (primary aldosteronism: hypokalaemia)
69) clinical signs of hypothyroidism (4)
endo
- skin: cold, dry, rough
- hoarse voice
- puffy face
- bradycardia
- (yellow skin discolouration)
70) signs of cirrhosis in chronic alcohol user (5)
liver linking signs
- palmar erythema
- dupuytren’s contracture
- gynecomastia
- spider nevi
- testicular atrophy
71) clinical signs of pleural effusion (4)
signs on CXR (2)
pulmonology
signs
- stony dull on percussion
- decreased/absent breath sounds
- decreased chest movement
- trachea shifted away
cxr
- mensicus sign
- pleural thickening
72) clinical signs of ILD (4)
confirm diagnosis (2)
pulmonology
ILD
- decreased expansion
- fine inspiratory crackles
- clubbing
- signs of connective tissue disease (rheumatoid arthritis)
dx
- cxr
- chest ct scan
73) lacunar stroke
common presentations (3)
clinical significance of lacunar vs mca stroke
neuro
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
74) ecg features of pht (3)
cardio
- p pulmonale
- prominant r wave in v1
- t wave inversion in v1-v3
75) types of shock (5)
?
- spinal
- septic
- anaphylatic
- hypovolaemic
- cardiogenic
76) nail signs + associated conditions (5)
examination
- blue: cyanosis
- red: polycythaemia
- clubbing: infective endocarditis
- leuconychia: hypoalbuminaemia
- koilonychia: fe deficiency
77) a. amphoric breathing + cause
b. pemberton sign + cause
c. kussmaul’s breathing + associated condition
pulmonology
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
78) DMT1 microvascular complications (4)
endo
- nephropathy
- retinopathy
- neuropathy
- gastroparesis
79) hyperthyroidism
a. signs and features of grave’s disease (4)
b. test to confirm dx
a. bruit
grave’s ophthalmopathy
grave’s dermopathy
acropachy
b. antibody TSAb in blood
80) mechanism of extra heart sounds
a. s3
b. s4
c. conditions causing above (2)
a. rapid ventricular filling on opening of av valves
b. atrial contraction with a non compliant ventricle
c. s3: AR, MR
s4: AS
81) paracetamol overdose
a. liver failure clinical signs (3)
b. test to confirm liver failure
liver linking signs
a. jaundice
bruising
encephalopathy
b. bilirubin
inr
albumin
cholesterol
82) clinical signs of aortic incompetence (5)
cardio
- soft s2 (maybe s3)
- dilated displaced apex
- waterhammer pulse
- decrscendo murmur
- best heard on exhalation when sitting forward
83) leg weakness
a. features of spinal cord lesion
neuro
- loss of sphincter function
- flaccid paralysis
84) TB spine complications (2)
- paraparesis
- collapse of vertebrae pressure
85) haemoptysis
a. life threatening haemoptysis
b. 3 causes
a. haemodynamically unstable
(> 400ml)
b. bronchiectasis
bronchus carcinoma
aspergiloma
86) young person with liver failure after paracetamol OD
a. signs of liver failure (3)
b. tests to confirm liver failure (2)
a. brusing
jaundice
encephalopathy
b. liver function tests
bilirubin
INR
albumin
87) stable vs unstable angina
a. pathogenesis
b. clinical presensation
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
88) patterns of weakness
look at diagram
89) features that lead to diagnosis of diabetic nephropathy (4)
- large kidneys
- microalbuminaemia
- proteinuria
- microvascular damage (retinopathy, neuropathy)
90) Kussmaul’s Sign and
Kussmaul’s Breathing
Kussmaul’s Sign
- paradoxical rise in right atrial pressure during inspiration
Kussmaul’s Breathing
- deep rapid breathing due to stimulation of the resp centre
91) ecg features of pe (4)
- sinus tachycardia
- incomplete RBBB
- right axis deviation
- s1q3t3
- (r ventricular strain: tall r wave in v1, inverted t waves in v1-v3)
92) clinical signs of pht (4)
cardio
- parasternal heave
- loud p2
- big a wave
- pulsatile liver
- (pansystolic murmur)
- (hepatomegaly)
93) chronic bilharzia infection
a. presenting features
b. clinical signs
a. rash
fever
bloody stool
b. hepatosplenomegaly
ruq tenderness
generalised lymphadenopathy
94) chronic bilharzia vs liver cirrhosis
a. presentation (3)
b. clinical signs (3)
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
95) ECG features of a Pericardial Effusion (2)
cardio
- small complexes
- electrical alternans
96) clinical features which suggest pericardial tamponade (4)
cardio
- distended neck veins
- tachycardia
- drop in bp
- pulsus paradoxis
97) typical features of TB on CXR (2)
2 types of TB CXR
presentations
infectious disease
a. pleural effusion
parenchymal infiltrates
(hilar adenopathy)
b miliary tb
upper lobe disease with cavitation
98) main features on history and clinical signs of bronchiectasis (5)
pulmonology
- sputum production
- clubbing
- coarse crackles
- wheeze
- maybe some dullness
- severe: shifted towards
99) features of Pre-Renal failure, with regard to
a. History
b. Signs (3)
c. Symptoms (3)
d. Investigations (2)
nephro
a.
b. oliguria
thrist
oedema
c. orthostatic hypotension
tachycardia
sunken eyes
d. urea:creatinine ratio
fractional excretion of Na
100) definition of an Irregularly irregular pulse
cardio
heart beats with no pattern
101) associated signs of irregularly irregular pulse (1)
cardio
- pulse deficit
102) ecg features of AF (2)
cardio
- no clear p waves
- irregular irregular pulse
103) clinical signs of aortic stenosis (5)
cardio
- ejection systolic murmur
- heaving apex
- plateau pulse
- loud s2
- radiating up carotid
104) define + name the cause
a. radial femoral delay
b. corrigan’s sign
c. pulsus paradoxus
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
105) headache red flags (5)
- sudden onset
- papilloedema
- > 50 years age
- after recent trauma
- neuro deficit
106) reasons/causes for hypoglycaemia in a patient with diabetes (3)
- not eating but still using meds
- diabetic neuropathy
- not adjusting meds after weight loss
107) mechanism or techniques to obtain an accurate history other than Socrates (5)
- comfortable eye contact
- do not appear to be in a hurry
- show empathy
- no judgement
- acknowledge patient’s feelings
108) reasons hiv patients default arv tx (5)
- depression
- alcohol or substance use
- work-related problems
- non-disclosure
- following pregnancy
109) secondary causes of hpt in young patients (5)
- cushing’s syndrome
- renal artery stenosis
- thyroid disease
- primary aldosteronism
- obstructive sleep apnoea
110) diabetic
a. define charcot joint
b. define diabetic amyotrophy
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
111) clinical features of Guillain barre syndrome (5)
- areflexia
- progressive ascending weakness
- minimal senosory features
- resp failure
- autonomic features
112) signs of tension pneumothorax (5)
- trachea shifted away from affected side
- hyperresonant
- absent breath sounds
- absent vocal resonance
- dec chest expansion on affected side
113) renal failure
a. features of chronic renal failure (3)
b. classify renal failure and give 1 cause of each (3)
a. prev values
small kidneys
fibrosis
b. pre-renal: shock
renal: gn (glomerulonephritis)
post-renal: bph (benign prostatic hyperplasia)
114) causes of haemoptysis (4)
- bronchiectasis
- aspergiloma
- bronchus carcinoma
- any pneumonia causing cavitation
115) pleural effusion
a. cxr signs (2)
b. prove that effusion is d/t tb (4)
a. meniscus sign
pleural thickening
b. afb’s (acid fast bacilli) on microscopy
culture
genexpert
116) signs of aortic stenosis (5)
- ejection systolic murmur
- loud s2, potential s4
- heaving apex
- plateau pulse
- radiating up carotid
117) signs of aortic regurg (5)
- decrescendo murmur
- soft s2, potential s3
- dilated displaced apex
- waterhammer pulse
- best heard sitting forward in exhalation
118) respiratory failure type 1 vs type 2
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
119) 5 ways to describe cardiac murmur
- timing
- radiation
- loudness
- pitch
- area of greatest intensity
