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Medicine > 3rd Yr Med > Flashcards

3rd Yr Med Flashcards

1
Q

Stable Angina Features:

A

No pain at rest
No raised Trop
No ECG changes

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2
Q

Unstable Angina Features:

A

Pain at rest
No raised Trop
Transient ECG changes (ST Depress, T wave Invers)

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3
Q

nSTEMI Features:

A

Pain at rest
Raised Trop
ECG changes (ST Depress, T wave Invers)

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4
Q

STEMI Features:

A

Pain at rest
Raised Trop
ECG changes (ST Elev, LBBB)

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5
Q

Stable Angina Mx

A 
Aspirin 75mg
ACEi/ARB
SL GTN
Statin
(Rate control: Beta-blocker, CCB, Ivabradine)
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6
Q

Unstable Angina/nSTEMI Mx

A 
Morphine + Antiemetic
O2
Fondaparinux
SL GTN
Aspirin 300mg Stat (75mg OD)
Repeat ECG + Angiography
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7
Q

STEMI Mx + Tx

A 
Morphine + Antiemetic
O2
LMWHep
SL GTN
Aspirin 300mg Stat (75mg)
Repeat ECG + Angiography

Tx:
(w/ in 90mis): PPCI (w/ Prasugrel)
Thrombolysis (IV Alteplase)
(Aspirin continued indefinitely, Prasugrel/Clopidogrel continued for 12 months)

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8
Q

HF Class

A

NYHA:

1: No limitations
2: Mild limitations
3: Severe limitations
4: Sx at rest

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9
Q

HF Ix

A

BNP/ANP
Echo (Trans-oesophageal)
CXR
(ECG, Trop)

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10
Q

HF Meds

A

Cardiac meds:
Beta-blockers, CCB (Diltazem, Verapamil), Ivabradine (Slows HR w/out drop in BP)

Diuretics:
Furosemide, Thiazides, ACEi/ARB (If HT), Spironolactone (If Hypokalaemic)

Venodilators:
CCB (Amlodipine), GTN/Nitrates, Hydralazine

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11
Q

ECG Analysis

A 
Rate
Rhythm
Axis (LAD, RAD)
P waves
QRS
PRi (0.12-0.2s)
QRS (0.12s)
QT (0.2s)
R -> S Progress (L/RBBB)
ST Elev/Depress
T wave (Tall/Flat/Invers)
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12
Q

AF Mx

A

Rate control:
Beta-blocker, CCB, Digoxin

Rhythm control:
Beta-blocker, Amiodarone
(If < 48hrs: DC Cardioversion)

Anti-coag:
Rivaroxaban 15mg BD (21 days), 20mg OD

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13
Q

Bradyarrhythmia Mx

A

SAN ( + Sx): Pacemaker

AVN:
1/2T1 + Syncopal: Cardiac Monitor
2T2/3 + Sx: Permanent Cardiac Pacemaker

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14
Q

Tachyarrhythmia Mx:
SVT
VT

A

SVT:
Vasovagal manoeuvres
IV Adenosine 6mg (If NSR: Re-entry - Anti-arrhythmic, If no NSR: AF)
Cardioversion (DC, Amiodarone)

VT:
Amiodarone
DC Cardioversion

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15
Q

HT Mx

A

< 55yo, Diabetic:

ACEi/ARB (+/- CCB +/- Thiazide-like D)

> 55yo, Black:

CCB (+/- ARB/ACEi +/- Thiazide-like D)

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16
Q 
Features:
AS
AR
MR
MS
A

AS: (D, Carotids, Holding breath)
Eject-Syst, Cres-decres, Rad to Carotids

AR: (D, Leant forward, Exp)
Early Diast, Decres

MR: (D, L, Exp)
Pan-Syst, Blowing, Rad to Axillae

MS: (Bell, L, Exp)
Opening snap, Mid-Diast, Rumbling

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17
Q

Non-funct Pit Adenoma Mx

Prolactinoma Mx

A

Non-funct Pit Adenoma Mx:
Surg/RadioTx w/ HRT (GH, HC, Oestrog/Prog/Test, Thyroxine)

Prolactinoma Mx:
D2 (Dopamine) Agonists: Cabergoline, Bromocriptine

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18
Q

Acromegaly Ix

A 
Raised IGF-1, PRL (Co-secreted w/ GH)
Failed OGTT (Fails to Supp GH)
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19
Q

Acromegaly Mx

A

Surg
GHIH (Somatostatin)
GH Antag
Dopamine Agonists (Prevent Release of GH)

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20
Q

DI Features

A

Polydipsia
Polyuria (Large Vol, Diluted Urine: > 3L/day), Nocturia
Low Urine Osmolality (< 300)
High Serum Osmolality (> 295)

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21
Q

DI Mx

A

Cranial:
Vasopressin (Exogenous ADH)

Nephrogenic:
Reduced NaCl/Protein Intake +/- Diuretic
(Carbamazepine: Sensitises Renal Tubules)

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22
Q

SIADH Sx + Mx

A

Fluid Retention (Small Vol, Concentrated Urine)

Mx:
Fluid restrict (+/- Diuretic)
Demeclocycline/Tolvaptan (ADH Antag)

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23
Q

Cushings D Patho + Complications

A

Pit Adenoma secreting ACTH

+/- DM, HT, Osteoporosis

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24
Q

Cushings D Ix

A

Raised ACTH/Cortisol, Low CRH, (Raised Glu, BP)
Raised 24hr Urinary Cortisol
Failed Dexamethasone Supp Test (Low-dose does not Supp ACTH)

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25
Q

Cushings D Mx

A

Trans-sphenoidal Surg

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26
Q

Cause of Secondary Adrenal Insuff + Sx

A

LT Steroid use => Supp of ACTH => Low Cortisol

Hypoglycaemia, (Normal Aldosterone: Normal BP)
Weakness, Fatigue
Immunosupp

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27
Q

Secondary Adrenal Insuff Mx

A

Stop Steroids

HRT: Cortisol Supp (HC)

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28
Q

Addisons Patho, Features + Complication

A

Auto-Immune Adrenal Destruction (Ald Def):

Low Ald/Cortisol (HypoT/HypoGlyc)
Low Adrenals (Hair loss, Reduced Libido)
High ACTH (Hyperpigmentation)

Addisonian Crises during stress/illness

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29
Q

Addisons Ix

A

9am ACTH/Cortisol levels
(-) SynACTHen Stim Test (Low Cortisol)
U+Es (Hyponatraemia, Hypokalaemia, Raised Urea), HypoGlyc, Anaemia

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30
Q

Addisons Mx

A

HRT: Fludrocortisone, HC (Double dose when ill)
Steroid card
(Reg Fluids - IV Dextrose + HC when ill)

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31
Q

Bilat Adrenal Hyperplasia Patho + Features

A

Adrenal Enlargement => Excess Aldosterone/Cortisol

HT, Raised ICP
Cushings Synd

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32
Q

Bilat Adrenal Hyperplasia Mx

A

Spironolactone (Aldosterone Antag)

Bilateral Adrenalectomy

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33
Q

Klinefelters Features

A

(47, XXY):
Tall, feminised Man (Infertility, Gynaecomastia)
Small, male Ext Genitalia (Hypogonadism)

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34
Q

Turners Features

A

(45, XO)
Small, androgynous, Woman (w/ webbed neck)
Ambiguous Ext Genitalia

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35
Q

AIS Features

A

(Test Def/Insens):
Ambiguous Genitalia + Undescended testis
Amenorrhoea, Infertility

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36
Q

CAH Features

A

(21-Hydroxylase Def):
Ambiguous Genitalia
Excess Test (Male characteristics/Virilisation: Deep voice, Hair growth, Cliteromegaly, Acne, Amenorrhoea)
Cortisol/Aldosterone Def (Addisonian/Cushing Crisis)

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37
Q

Pheochromocytoma Sx

A

Headache
Palpitations/TachyC
Sweating
(Anxiety/Panic, HT, HyperGlyc)

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38
Q

Pheochromocytoma Ix + Mx

A 
24hr Urinary Metanephrines + Catecholamines
CT CAP (Mets)

Mx:
Alpha-block (Phenoxybenzamine, Doxazocin)
Beta-blocker
Surg

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39
Q

Causes of HypoTh

A

Hashimotos (Anti-Th AB’s)
Diet (I2 Def)
Med (Amiodarone, Lithium)
Post-partum Thyroiditis, Sheehans Synd

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40
Q

HypoTh Ix + Mx

A

T3/4, TSH
Th-Peroxidase AB’s

Mx:
Levothyroxine

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41
Q

Causes of HyperTh

A

Graves (Auto-AB’s Stim TSH-R)
Nodular D
Thyroiditis (Viral Inf, Amiodarone, Post-partum)

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42
Q

HyperTh Ix

A

T3/4, TSH
TSH-R AB’s
Thyroid USS (Confirm Nodules)
Nuclear Tc/I2 Uptake Scan (Assess Act): Uniform (Graves), Single (Nodule), None (Thyroiditis)

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43
Q

HyperTh Mx

A

Beta-blocker (Control Sx)
Carbimazole (Th Peroxidase Antag)
Radioactive I2
Thyroidectomy

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44
Q

HypoTh vs HyperTh Sx

A 
Weight changes
HR (Brady/Tachy)
GI (Constipation/Diarrhoea)
Cold/Heat Intolerance
Depression/Anxiety
Hypo/Hyper-reflexia
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45
Q

Specific Sx:
HypoTh
Graves

A

HypoTh:
Myxoedema (Puffy Eyes)

Graves:
Proptosis (Eyes protrude)
Pre-tibial Myxoedema

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46
Q

Hypercalcaemia Causes + Sx

A

Primary Hyper-PTH/Osteoporosis,
RCC/Squamous CLC (Secreting PTHrP) =>

Stones, Moans, Groans, Bones, Psych
ECG changes
Polyuria/Polydipsia (Nephrogenic DI)

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47
Q

Hypercalcaemia Ix + Interpretations

A

PTH (High: HyperPTH, Low: Malig)

(PTH => Bone Turnover): High ALP, Low Phosphate

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48
Q

Hypercalcaemia Mx

A

IV Fluids (w/ careful electrolyte monitoring)

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49
Q

Hypocalcaemia Causes + Sx

A

Diet/Hypo-Mg2+ (Low Ca2+),
Renal D/Lack of Sunlight (Low Vit D)
=>

ECG changes
Myalgia/Paraesthesia
Spasms (Laryngomalacia, Carpo-pedal)
Seizures

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50
Q

Hypocalcaemia Mx

A

Ca2+ Supp

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51
Q

DM Diagnosis Criteria

A

Fasting Glu: > 7mmol
Random: > 11mmol
HbA1c: > 6.5 (48mmol)

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52
Q

DKA Def/Criteria

A

HyperGlyc (> 11mmol)
Ketones (> 3mmol)
Acidosis (pH < 7.33)

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53
Q

DKA Ix + Mx

A

Hourly Glu + Ketones
FRII (IV Actrapid 0.1 Units/Kg/hr)
IV 0.9% NaCl (+/- Dextrose, K+)

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54
Q

HHS Def/Criteria

A

HyperGlyc (> 30mmol w/out Ketoacidosis)
HypoVol
Serum Osmolality > 320 (2Na + Glu+ Urea)

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55
Q

HHS Ix + Mx

A

Hourly Glu + Ketones
IV Fluids (1L/hr, 1L/4hr, 1L/4hr) +/- K+
LMWHep

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56
Q

DM Complications:
ST
LT

A

ST:
Lipodystrophy
Hyper/Hypo Episodes

LT:

Microvasc: 
Nephropathy, 
Retinopathy, 
Periph Neuropathy, 
Immunosupp (UTI, Pneumonia, Thrush)

Macrovasc:
Stroke/TIA,
CVS D/HT,
Ulcers/Gangrene (Periph Ischaemia - PVD)

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57
Q

Oesophageal Dysmotility Types + Features

A

Achalasia: (Non-distensible LOS):
Bird-beak (Ba Swallow)

Diffuse Oesophageal Spasm: (No control of Peristalsis):
Corkscrew (Ba Swallow)

Hypercontractile:
Nutcracker (Ba Swallow)

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58
Q

Oesophageal Dysmotility Ix + Mx

A

Ba Swallow
Endoscopy
Manometry

Mx:
SM Relaxants (CCB: Nifedipine, Nitrates)
Myotomy
Pneumatic Baloon Dilation

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59
Q

GORD Mx

A

PPi
H2 Antag (Ranitidine)
Alignates (Gaviscon)

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60
Q

Mallory-Weiss Tears Patho

A

Excess Vomiting => Tears w/in Endothelium of Oesophagus

=> Bleeding

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61
Q

UGIB Mx

A 
Variceal:
Fluid Resus
IV PPi
IV ABx + Terlipressin (ADH Antag)
OGD (Band/Stent)
Non-Variceal:
Fluid Resus
IV PPi
OGD (+/- Radioembolization/Surg)
Post-OGD PPi
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62
Q

SB vs LB Obstruct Ix

A

Erect CXR:
Air under Diaphragm

AXR:
SB:
> 3cm, 
Central, 
Valv Conniventes (All the way across)

LB:
> 6cm,
Periph,
Haustra (Part way across)

Contrast CT:
ID Level of Obstruct

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63
Q

SB/LB Obstruct Mx + Surg Indications

A

NBM (Bowel Rest)
IV Fluids (+ Electrolytes)
NGT (Bowel Decompress)
(Stop Opiates)

Surg (Strangulated Hernia/Reversible Cause, > 48hrs, Ischaemia, Perf)

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64
Q

Coeliacs D Patho, Ix + Mx

A

Auto-Immune React to Gluten w/in S Intestine
=> Lymphocytic Infiltration + Villous Atrophy

Ix: Raised Tissue Transglutaminase (tTG)

Mx:
Gluten-free Diet

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65
Q

Appendicitis Ix

A 
FBC, U+Es, LFTs, CRP
Amylase/Lipase (Excl Pancreatitis)
Urinalysis (Excl UTI)
ECG, Trop (Excl MI)
Preg test (Excl Preg)
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66
Q

Appendicitis Mx

A

Opiates + Antiemetic
Appendectomy
(If Perf: ABx)

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67
Q

PBC Eped + Features

A

Middle-aged Women
Early: Asymptomatic, Fatigue + Pruritus
Late: Cholangitis (Granulomatous Inflamm of Bile Ducts) => Cirrhosis

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68
Q

PBC Mx

A

Cholestyramine (Reduce Pruritus)
Ursodeoxycholic Acid (Improves Survival)
Liver Transplant

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69
Q

PSC Eped + Features

A

Younger men w/ Autoimmune D
Early: Progress Obstruct Jaundice
Late: Cirrhosis, Cholangiocarcinoma

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70
Q

PSC Mx

A

Cholestyramine (Reduce Pruritus)
Ursodeoxycholic Acid (Improves LFTs)
Liver Transplant

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71
Q

Biliary Colic vs Acute Cholecystitis vs Ascending Cholangitis

A 
Biliary Colic: 
RUQ Pain (1-5hrs after meal), N+V

Acute Cholecystitis:
RUQ Pain, N+V, Fever, TachyC

Ascending Cholangitis: 
Charcots Triad (RUQ Pain, Fever, Jaundice), 
Reynolds Pentad (+ Confusion, HypoT)
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72
Q

Biliary Colic/A Cholecystitis/Asc Cholangitis Ix + Mx

A

LFTs, ERCP

Mx:
Stone removal
Cholecystectomy (w/ Bile Salt replacement)
ERCP (w/ Biliary Decompress)
IV ABx (If Asc Cholangitis: Tazocin 4.5g TDS)

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73
Q

Pancreatic Ca Features:
Head
Tail

A

Head:
Painless, Obstruct Jaundice
Vague Epigastric Pain/Mass

Tail:
DM Sx
Loss of Enzymes (Malnutrition, Loose Stools)

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74
Q

Pancreatic Ca Ix

A

Amylase, Lipase, LFTs
ERCP/MRCP
AXR
CA19.9, CEA, aFP

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75
Q

Causes of Pancreatitis

A 
G: Gallstones
E: Ethanol
T: Trauma
S: Scorpion/Spider Venom
M: Mumps
A: Autoimmune
S: Steroids
H: Hyperlipidaemia, Hypercalcaemia, Hypothermia
E: ERCP
D: Drugs
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76
Q

Pancreatitis Ix

A

FBC, U+Es, LFTs
Raised Amylase/Lipase (More Sens)
AXR
ERCP/MRCP

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77
Q

Pancreatitis Mx

A 
Reduce Sx (Stop Alcohol, Remove Stones, Opiates)
Tx Cause (Electrolytes, ERCP, Steroids => Inflamm)
Exocrine Support (DM Insulin)
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78
Q

Colon Ca Features

A

L:
LIF
Constipation, Tenesmus, Late Diarrh
Anaemia (Blood of Surf + mixed)

R:
RIF
Diarrh, Late Constipation
Anaemia (Blood mixed)

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79
Q

Colon Ca Ix

A

AXR, CT

CEA, aFP, LDH

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80
Q

IBD Features (UC vs CD) - 5

A 
UC:
Rectum -> back (Continuous)
Submucosal Inflamm
No Granulomas
Cobblestone, friable mucosa
No Perianal D 
CD:
Ileum (LIF, Skip lesions)
Transmural Inflamm
Non-caseating Granulomas
Fissuring Ulcers, Crypt Abscesses
Perianal D (Fistulas , Fissures, Strictures)
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81
Q

IBD Ix - 5

A

Faecal Calprotectin, Stool Cult (Excl: C.Diff)
FBC, U+Es, LFTs, CRP/ESR
Coeliac Serology (Anti-tTG)
Serum Ferritin/B12/Folate/Vit.D (Malabsorption => Def)
Sigmoidoscopy/Colonoscopy (+/- Biopsy)

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82
Q

IBD Mx

A

Steroids, Azathioprine, Sulfasalazine
LMWHep

(Acute: IV HC 100mg QDS)

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83
Q

Haemorrhoids Features

A

Prominent Vessels (Vascular bundles)
Above (Painless)
Below (Painful)

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84
Q

Haemorrhoids Classification

A

1: No Prolapse
2: Reduce Spontaneously
3: Reduce Manually
4: Unable to Reduce

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85
Q

Haemorrhoids Mx

A

GTN/CCB Cream

Staples, Bands, Incision

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86
Q

TB Screening

A

Immigrants from highly Prevalent (Endemic) Countries
Healthcare workers
HIV (+) Pt’s
Pt’s beginning Immunosuppression

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87
Q

Latent TB Tx

A

Rifampicin + Isoniazid (with Pyridoxine) 3 months or
Isoniazid (with Pyridoxine) 6 months
(Avoid w/ Pt’s > 35yo or at risk of Hepatotoxicity)

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88
Q

Active TB Features

A

Non-resolving Cough
Unexplained Persistent Fever
Drenching Night Sweats
Unexplained Weight loss (Cachexia)

Other:
Clubbing
Lymphadenopathy
Hepatosplenomegaly
Erythema Nodosum
Pleural Effusion
Pericarditis
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89
Q

Active TB Ix + Findings

A

Sputum samples (3x AAFB + TB test), (If no Sputum: Bronchoscopy)
CXR (Cavitating Pneumonia, Pleural Effusion), CT/MRI
LN Biopsy + Histology (Caseating Granulomatous Inflamm)
LP (Raised Proteins, Reduced Glu, Lymphocytosis)

90
Q

Active TB Mx

A

2 months of RIFATER (RIPE)

4 months of RIFINAH (RI)

91
Q

Active TB Mx SE

A

RIP: Hepatotoxicity (Baseline LFT’s)
I: Periph Neuropathy (Pyridoxine)
E: Retrobulbar Neuritis (Visual Acuity)

92
Q

TB Paradoxical Reaction + Mx

A

Tx cause Bact to die => Inflamm

Mx:
Steroids (esp Pericardial + CNS): Prevent Inflamm

93
Q

HIV Tx:

ARVTx

A 
ARVTx:
2 Nucleoside Reverse Transcriptase Inhib
\+ 1: 
Non-nucleoside Reverse Transcriptase Inhib, 
Boosted Transcriptase/Protease Inhib, 
Integrase Inhib
94
Q

HIV Tx:
Prophylaxis
Vaccinations

A

Prophylaxis: (Falling CD4):
CD4 < 200: Cotrimoxazole (PCP)
CD4 < 50: Azithromycin (Mycobacterium)

Vaccinations:
Hep B
Pneumococcus
Annual Flu Vaccine

95
Q

Skin Inf Org + ABx

If MRSA:
If Penicillin Allergy:

A

Strep + Staph: Flucloxacillin

If MRSA: Vancomycin
(If Penicillin Allergy: Doxycycline, Meropenem)

96
Q

MSK Inf Org + ABx

A

Strep + Staph: Tazocin

97
Q

Resp Inf Org + ABx
Atypical
Viral

A

S Pneumoniae, H Influenzae: Amox, Co-amox, Doxy

Atypical (Legionella): Doxy, Fluoroquinolone

Viral (Rhino/Adeno/Entero): Oseltamivir

98
Q

GI Inf Org + ABx

A

Salmonella: Ceftriaxone, Azithromycin

C Diff: PO Vancomycin, Metronidazole (IV)

Enterobacteria (Campylobacter, E-coli, Shigella): Ciprofloxacin

99
Q

GUN Inf Org + Mx

A

Gonorrhoea: IM/IV Ceftriaxone

Chlamydia: Doxy

100
Q

CNS Inf Org + ABx

A

Meningitis (N. Men, S Pneum, H Influenzae): IV Ceftriaxone + Dexamethasone

Viral (HSV): Aciclovir

101
Q

CVS Inf Org + ABx
IE
Cult (-)

A

IE (S Viridans): Benzylpenicillin
IE (S Aureus - IVDU): Flucloxacillin
IE (Enterococci): Amox
(Cult - ): Ceftriaxone

102
Q 
Dementia Types + Features
Vascular D
D w/ Lewy Bodies
PD w/ D
FT D
A

Vascular:
Stepwise Progress w/ Risk Factors

D w/ Lewy bodies:
Gradually Progress (+/- PD Sx)
Persistent, Realistic A+V Hallucinations

PD w/ Dementia:
PD Sx (Bradykinesia, Rigidity, Tremor) precedes Dementia

FT Dementia:
Early-onset, Complex problems (Loss of Social Inhib)

103
Q

Delirium Mx

A 
Reverse Cause:
Hypoxia - O2, 
Electrolytes - Fluids, 
Inf - ABx, 
Obstruct/Retention - Laxatives/Catheter)

Orient to Time/Place
Family members
Avoid sedatives/anticonvulsants/Intoxicants

104
Q

Confirming Death

A

Pupils fixed + Dilated
No Resp to Pain
No Breath/Heart Sounds (> 1min)

105
Q

K+ Sparing and Non-K+ Sparing Diuretic Examples + SE

A

K+ Sparing:
ACEi/ARB, Spirnolactone => Hyper-K+

Non-K+ Sparing:
Thiazides (Inhib NCC in DCT)
Loop (Inhib NKCC in Loop of Henle)
=> Hypo-K+

106
Q

Causes of Hyper-K+

A 
CKD +/- K+-rich Diet
Drugs (K+-sparing, NSAIDs, Digoxin, Hep, Trimethoprim, Cyclosporin)
Intracellular Shift:
Decreased SNS (Beta-blockers)
Decreased Insulin
Decreased pH (Acidosis)
Decreased Aldosterone (Addisons)
Rhabdomyolysis/Haemolysis/Lysis
107
Q

Hyper-K+ ECG changes

A

Tall, Peaked T waves
Prolonged QRS
Loss of P waves (=> Asystole)

108
Q

Hyper-K+ Mx

A

Cardiac protection:
IV 10ml 10% Ca2+ Gluconate (10mins)

Shift K+ Intracellularly:
IV Actrapid 10 Units + 50ml 50% Dextrose
Neb Salbutamol 10mg
(If Acidotic: IV 500ml 1.4% NaHCO3)

Remove Excess:
PO/PR Ca2+ Resonium
IV 80mg Furosemide

109
Q

Causes of Hypo-K+

A

Losses (Renal: Diuretics, GI: Reduced Intake, Vom/Diarrh)
Intracellular Shift:
Increased SNS (Beta-agonists, Adren)
Increased Insulin
Increased pH (Alkalosis)
Increased Aldosterone (Hyperaldosteronism/Cushings, Hyper-RAAS)

110
Q

Hypo-K+ ECG changes

A

Small T waves
U wave (after T)
Increase in PRi

111
Q

Hypo-K+ Mx

A

(PO/IV) K+ and Mg2+ Supplements w/ IV Fluids

112
Q

Causes of Hyper-Na+

A

Hypervolaemic:
Hyperaldosteronism/Cushings

Euvolaemic:
DI, Hypodipsia

Hypovolaemic:
Diuretics, Diarrh, Sweating

113
Q

Hyper-Na+ Mx

A

Hypervolaemic: (Chronic): Fluid restrict +/- Furosemide, (Nutritional Support)
Euvolaemic: IV Dextrose
Hypovolaemic: (Acute): IV NaCl 0.9%

114
Q

Causes of Hypo-Na+

A

Hypervolaemic:
3rd Spacing (HF, Cirrhosis, Nephrotic Synd)
Polydipsia

Euvolaemic:
SIADH
HypoTh
Preg

Hypovolaemic:
Fluid loss (Vom/Diarrh, Bleeds, Diuretics, Burns)
Pancreatitis
Hypoaldosteronism (CAH/Addisons)

115
Q

Hypo-Na+ Mx

A

IV NaCl 0.9%

116
Q

AKI Classification

A

1: Serum Cr x 1.5-2
2: Serum Cr x 2-3
3: Serum Cr x > 3, UO < 0.5ml/Kg/hr

117
Q

Causes of Pre-renal AKI

A

Hypoperfusion:
Hypovolaemia
HF
Impaired Auto-regulation (ACEi/ARB, NSAIDs)

118
Q

Pre-renal AKI Ix + Mx

A

FBC, U+Es, BP, RAAS

Mx:
Stop meds
Tx Hypovolaemia/Sepsis/Anaemia

119
Q

Causes of Renal AKI

A

Drugs (Nephrotoxins)
Inflamm (GN, Vasculitis), Inf
Trauma (HT, Sepsis/Ischaemia)

120
Q

Renal AKI Ix + Mx

A

Urinalysis, Renal Biopsy, CRP/ESR, USS-KUB

Mx:
Stop Nephrotoxicity meds
Tx Cause
Assess Fluid balance
Steroids (Reduce Inflamm)
121
Q

Def ATN + Mx

A

Fluid-resistant AKI

Mx:
Stop IV Fluids (+/- => Pulmon Oedema)
Fluid restriction + Diuretics

122
Q

Cause of Post-renal AKI, Ix + Mx

A

Obstruction

USS-KUB

Mx: Surg

123
Q

RRTx Indications

A

Uraemic Pericarditis/Encephalopathy
Intoxicants (Antifreeze, Methanol, Lithium)
Fluid-overloaded despite Diuretics
Hyperkalaemia, Metabolic Acidosis despite Tx

124
Q

CKD Causes

A

Diabetic
HT
APCKD

125
Q

Diabetic CKD Ix

A

Raised Urin Albumin : Cr (Raised PCR): > 2.5 (Females)/ > 3.5 (Males)
Glu on Dipstick
(Evidence of poorly-controlled DM: Retinopathy, Nephropathy, Neuropathy)

126
Q

HT in CKD Ix

A 
Urin metanephrines (Phaeochromocytoma)
Aldosterone : Renin (Hyperaldosteronism)
Dexamethasone Supp test (Cushings)
T3/4, TSH (HyperTh)
MR Angiography (Renal A Stenosis)
127
Q

DM/HT CKD Mx

A

ACEi/ARBs (HT + Proteinuria)
Statin (Reduce CVS Risk Factors)
Screening (Microvascular Complications)

128
Q

APCKD Ix + Mx

A

(+) FHx
USS (Kidneys + Liver)

Mx:
ACEi/ARBs (HT + Proteinuria)
Tolvaptan (ADH Antag: Reduce Cysts)

129
Q

CKD Classification

A

eGFR

1: > 90
2: 60-90
3a: 45-60
3b: 30-45
4: < 30

130
Q

CKD Complications (Anaemia) Patho - 5

A 
Anaemia:
Reduced EPO
Blood loss + Reduced lifespan of RBC's
Uraemic Myelosuppression
Fe Def (Absolute: Reduced Absorption, Funct: Inflamm => Raised Hepcidin)
Vit B12/Folate Def
131
Q

CKD Complications (Min Bone D)

A

Min Bone D:
Increased Excretion of PO4-
Reduced Synthesis of Vit D (=> Reduced Absorption of Ca2+)
Hypocalcaemia => Rise in PTH
Hyper-PTH => Increase in ALP (Increase Bone Turnover + Osteoclast Act) => Rise in Serum Ca2+
(Tertiary Hyper-PTH: High PTH + Ca2+) =>
Vascular/Soft Tissue Calcification + Skeletal PTH Resistance (Osteodystrophy)

132
Q

Causes of Nephrotic Synd

A

Min change D (M Common in Children)
Focal Segmental Glomerulosclerosis
Membranous Nephropathy

133
Q

Nephrotic Synd Features

A

Proteinuria
Hypoalbuminaemia
Ascites, Oedema
(Hyperlipidaemia)

134
Q

Nephrotic Synd Mx

A 
Tx Cause
ACEi/ARB (HT, Proteinuria)
Diuretics (Reduce Oedema)
LMWHep
Statins (Hyperlipid)
135
Q

Causes of Nephritic Synd

A

Autoimmune/Inflamm (SLE, Vasculitis, IgA)

Inf (HIV, Hep B/C, IE, Post-strep)

136
Q

Nephritic Synd Features

A

Oliguria, AKI (Drop in eGFR)
Haematuria
Proteinuria
HT

137
Q

Nephritic Synd Mx

A 
Tx Cause
ACEi/ARB (HT, Proteinuria)
Diuretics (Reduce Oedema)
LMWHep
Steroids (Reduce Inflamm)
138
Q

Blood Gas Features:
Alkalosis
Acidosis

A

Alkalosis (pH > 7):
Resp (pCO2 Low)
Metabolic (BE High)

Acidosis (pH < 7):
Resp (pCO2 High)
Metabolic (BE Low)
- Anion Gap: Na - (HCO3 + Cl) = 8-12 (H+ added: AG > 12, HCO3- lost: AG < 8)

139
Q

Causes of Alkalosis + Acidosis

A

Resp Alkalosis: Hyperventilation

Metabolic Alkalosis: Loss of Acid (GI/Renal Loss)

Resp Acidosis: Poor Ventilation

Metabolic Acidosis: Gain of Acid (Toxins + Renal Fail, Lactic Acidosis, DKA), Loss of Base (GI/Renal Loss)

140
Q

Fluid Routine maintenance

A

H2O: 25-30ml/Kg/day

K+/Na+/Cl-: 1mmol/Kg/day

Glu: 100g/day

141
Q

Fluid Resus Indications + Mx

A 
Syst BP < 100
HR > 90
RR> 20
CRT> 2s
NEWS > 5

Mx:
IV 0.9% NaCl 500ml over 15mins

142
Q

Asthma Mx

A

1: SABA (Blue Reliever)
2: ICS (Brown Preventer)
3: + LTRA (Montelukast)
4: + LABA (w/ SABA, Remove LTRA)
5: LABA + ICS (MART) - Begin Increasing dose of ICS
6: MART + LTRA
7: + Aminophylline/LAMA (Ipratropium)

143
Q

Severe vs Life-threatening vs Near-fatal Asthma

A

Severe:
Cannot complete sentences
RR > 25, HR > 110, PEFR: 33-50%

Life-threatening:
Silent Chest, Cyanosis
RR < 12, HR < 60, PEFR: < 33%, SpO2 < 92%

Near-fatal:
Hypercapnia + Hypoxia (T2RF)
Req Mech Ventilation

144
Q

Acute Asthma Exacerbation Mx:

If Severe/Life-threatening/Near-fatal

A 
ABCDE
O2
Neb Salbutamol 5mg
PO Pred 40mg
(If Severe: Neb Ipratropium 500 micrograms)
(If Life-threatening: IV Aminophylline)
(If Near-fatal: Mech Ventilation)
145
Q

Asthma Safe Discharge

A 
Off Nebs > 24hrs
Peak Flow > 75%
Nurse R/v
PO Pred 40mg 5 days
GP f/up w/in 2 days
OTP Asthma Clinic w/in 4wks
Peak Flow Meter + Written Action Plan
146
Q

Inadequate Asthma Control Sx - 5

A 
Rescue meds > twice a week
Sx > twice a week
Awakening w/ Sx 
Excessive SE's or Sx => Activity limitation
FEV1: < 80%
147
Q

Acute COPD Exacerbation Mx - 6

A 
ABCDE
O2 (88-92%) via Venturi mask
Neb Salbutamol 5mg
Neb Ipratropium 500 micrograms
PO Pred 30mg STAT + OD (7 days)
(If Inf: CXR, IV Abx + f/up)
148
Q

COPD Mx:
Care bundle - 2
Med - 5
Surg - 1

A

Care bundle:
Pulmon Rehab
Smoking Cessation

Med:
Bronchodilators (Beta-Agonists)
Antimuscarinics (Ipratropium)
Steroids, 
Mucolytics
LTOT (Non-smokers w/ SpO2: < 7.3KPa, < 8KPa w/ CP)

Surg:
Lung Vol Reduction (Lobectomy)

149
Q

Bronchiectasis Sx

A

Large Vol of Clear Sputum
Chronic Cough/SOB
Obstruct LD

150
Q

Bronchiectasis Ix + Findings

A 
HR CT (Signet rings: Thickened Alveolar Walls)
CXR (Lobar Collapse/Atelectasis, Intercurrent Inf)
151
Q

Bronchiectasis Mx - 6

A

Physio (Improve Mucus Clearing)
(If MRC Dyspnoea Score > 3: Pulmon Rehab)
Bronchodilators
Flu Vaccine
Reg ABx (After 3 Exacerbations and + Cult)
(If Inf Exacerbation: ABx for 14 days, may need to change class if already taking Reg)

152
Q

MRC Dyspnoea Score - 5

A

1: No Sx
2: SOB walking up hill
3: SOB => Slower walking
4: SOB => Stop after 100m or 2mins
5: SOB => Immobility

153
Q

Pneumonia Scoring

A 
CURB-65:
Confusion
Urea > 7mmol
RR > 30
BP < 90 (Syst)
Age > 65yo
154
Q

Causes of Non-resolving Pneumonia Inf

A 
C: Complication (Abscess, Empyema)
H: Host (Immunosupp)
A: Abx (Inadequate)
O: Org (Atypical, Resistant)
S: Secondary Diagnosis (PE, Cancer)
155
Q

Haemoptysis Mx + Ix - 6

A 
ABCDE
O2
Lie Pt on side of Lesion
IV/PO Tranexamic Acid (Antifibrinolytic)
Stop Anticoags + NSAIDs

CT Aortogram

156
Q

Haemoptysis Ddx

A

Inf (TB, CF, Bronchiectasis, Fungal, Pneumonia)
Malig (Primary, Mets)
Bleeding D (Vasculitis, Coagulopathy, PE, Arterial Erosion)

157
Q

Tension Pneumothorax Criteria

A

Pleuritic Chest Pain
SOB
Silent Lung, Hyperresonance, Asymmetrical Chest Expansion
Shock (TachyC, HypoT)
(Deviated Trachea + Mediastinal Shift Away)

158
Q

Tension Pneumothorax Mx

A

Large Bore Cannula + Chest Drain (2nd IC Space MCL, Above Rib)

159
Q

Anaphylaxis Mx

A 
ABCDE
O2 + Secure Airway
Remove Trigger
IM Adren 0.5mg (Repeat every 5mins)
IV HC 200mg + Chlorpheniramine 10mg
160
Q

PE Sx + Signs

A

Sx:
Sudden, Constant, Severe Pleuritic Chest Pain
SOB, Cough (+/- Haemoptysis)

Signs:
(Recent DVT)
Shock (TachyC, HypoT)
Pulmon HT, RV Strain

161
Q

PE Mx + Ix

A 
ABCDE
O2
Anticoag
IV Alteplase (Thrombolysis)
(Confirm RV Strain: CT/Echo/ECG)
162
Q

Def FEV1 + FEVC

A

FEV1: Vol of Air expelled in 1s after Max Inspiration

FEVC: Total Vol of Air expelled after Max Inspiration

163
Q

Obstructive vs Restrictive Lung Function

A

Obstruct: (FEV1:FEVC 50%)
Normal/Low FEVC
Reduced FEV1

Restrict: (FEV1:FEVC 90%)
Reduced FEVC
Reduced FEV1

164
Q

TB Supp Mx - 4

A

Admit to SR
Specialist TB Nurse
Notify Public Health
Start ABx

165
Q

CF Advice - 8

A 
No Smoking
Annual Flu Vaccine
Avoid other CF Pt's or Pt's w/ Pneumonia
Avoid Smokers
Avoid Animals/Composts (Aspergillus)
Avoid Jacuzzis (Pseudomonas)
Clean + Dry Nebulisers Regularly
Frequent fluids + NaCl Tablets (esp during Illness/Exertion)
166
Q

Lung Ca Sx + Complications

A

Hoarse Voice, Dysphonia
SOB, Dry Cough, Haemoptysis
B Sx
Lymphadenopathy

SVCO (Facial Oedema, Engorged Neck Veins, Airway Compromise)
Horner’s Synd (Miosis, Anhidrosis, Ptosis, Enopthalmos)

167
Q

Lung Ca Paraneoplastic Syndromes

A

Anaemia, Clubbing
SIADH (Small Cell LC)
Cushings (Small Cell LC)
Hyper-PTH/Hypercalcaemia (Squamous Cell LC)

168
Q

Lung Ca Ix

A

CXR
Staging CT (Spiral Thorax + Abdo)
US-guided FNA of LN

169
Q

ILD Sx - 4

A

SOB
Dry Cough
Restrictive Lung Pattern (Reduced FEV1 + FEVC)
Weight loss

170
Q

Transudate vs Exudate

A

Transudate: (Prot < 30g/L):
HF
Cirrhosis
Hypo-Albumin

Exudate: (Prot > 30g/L):
Inf (HIV, TB)
Malig
Inflamm

171
Q

Pleural Effusion Ix

A

US-guided Pleural Aspiration:

Biochem (Protein, LDH, pH, Cytology)
Microbiology (Microscopy, Culture + Sensitivity)

172
Q 
Added Lung Sounds Features:
Crackles
Wheeze
Stridor
Pleural Rub
A

Crackles:
Inspiratory (Opening of Alveoli)
Fine (Fibrosis) + Coarse (Effusion, Consolidation)

Wheeze:
Continuous, Musical
High-pitch (Bronchospasm) + Low-pitch/Rhonchi (Secretions)

Stridor:
Inspiratory, High-pitch Whistle (Large Airway Obstruct)

Pleural Rub:
Inspiratory, Grating (Friction of Inflamm Pleura)

173
Q

OA Xray changes

A

Loss of Joint space
Osteophytes
Subchondral Sclerosis
Subchondral Cysts

174
Q

RA Xray changes

A

Loss of Joint Space
Erosions
Soft Tissue swelling
Soft Bones (Osteomalacia)

175
Q

OA Mx

A

OT/PT
Walking Aids
Analgesia (NSAIDs, Paracetamol, Opiates)
Surg (Joint Replacement/ Fusion)

176
Q

RA Mx:
Conservative
Med
Surg

A

OT/PT +/- Walking Aids
Analgesia (Opiates)

DMARDs
(After 2 Failed DMARDs: Monoclonal AB’s - Rituximab: CD20 Inhib)

Surg (Joint Replacement)

177
Q

Sero (-) Spondyloarthropathies Types + Features

A

(+) HLA-B27, (-) RhF

Psoriatic
Enteropathic
Reiters
Ankylosing Spondylitis

178
Q

Psoriatic Features

A 
R: Rheumatoid Arthritis (Hands + Wrists)
O: Oligo (2-4 Joints)
A: Arthritis Mutilans (Erosions => Deformities)
D: Dactylitis (Sausage-shaped fingers)
S: Sacroiliac Back Pain
(Psoriatic Plaques)
179
Q

Enteropathic Features + Mx

A

IBD
Asymmetrical Arthritis of Digits

Mx:
DMARDs + Anti-TNF
(Avoid NSAIDs - IBD)

180
Q

Reiters Synd Features, Ix, Mx

A

(Knee) Arthritis following Urethritis (STI) + Conjunctivitis
Severe, Unilat Pain (Unable to Flex/Ext Passively/Actively)
Fever, Raised WCC

Ix: Joint Asp

Mx:
IV ABx 6wks

181
Q

Ankylosing Spondylitis Features - 3

A

Back/Buttock Pain (Radiates Up)
Spinal Deformities (Kyphosis, Scoliosis) + Reduced/Asymmetrical Chest Wall Expansion
LL Weakness/Paraesthesia

182
Q

Sjogrens Sx + Ix

A 
M: Myalgia
A: Arthritis
D: Dry Eyes
F: Fatigue
R: Raynaud's
E: Enlarged Parotids
D: Dry Mouth

Ix:
Raised Anti-Ro/La, RhF

183
Q

Sjogrens Mx

A

Anti-Inflamm

Frequent fluids, Eye Lubricants

184
Q

SLE Sx

A

S: Serositis (Pericarditis, Pleurisy)
O: Oral Ulcers
A: Arthralgia
P: Photosensitive Rash

185
Q

SLE Ix

A

Normal CRP, Raised ESR/PV
Anti-Ro/La, Anti-dsDNA
Haem changes (Anaemia, Thrombocytopaenia, Leukopaenia + Low Complement Proteins)

186
Q

SLE Mx

A

Anti-Inflamm (DMARDs)

Sun Protection

187
Q

PMR Sx + Ix

A

Widespread Pain (Shoulders, Neck/Spine, Hips)
Fatigue, Fever, Weight Loss
Headache (Associated w/ GCA)

Ix:
Raised CRP/ESR
(+) ANA/ANCA

188
Q

PMR Mx

No Improvement

A

15mg Prednisolone, (Methotrexate: Steroid-sparing)

If no Improvement w/in 18 month: Reconsider Ddx - Cancer, RA

189
Q

GCA Sx

A 
Jaw Claudication
Scalp Tenderness
Unilat Throbbing/Pulsating Headache
Vision changes (Diplopia, Blindness)
(Associated w/ PMR)
190
Q

GCA Ix + Mx

A

Temple A Biopsy (Giant Cell Granulomas + Necrotising Vasculitis)

Mx:
Prednisolone 60mg 2wks
Aspirin (Prevent VTE)
(If Vision changes: IV Methylpred 1g)

191
Q

Osteopaenia/Osteoporosis Features + Ix

A

Rib/Vertebral #’s w/out Trauma

Ix:
Dexa scan (T: < -1)
192
Q

Vasculitis Sx - 6

A 
Fever
Fatigue
Weight loss
Rash
Haematuria
SOB
193
Q

Vasculitis Mx

A

ID Cause, Stop Drugs

Steroids/DMARDs (Excl Inf before starting)

194
Q

Gout vs Crystal Arthropathy

A

Gout: (-) Bifringent Crystals

Crystal Arthropathy: (+) Bifringent Crystals

195
Q

Gout Mx

A

Diet/Lifestyle changes (Reduce Meat/Alcohol, Avoid Dehydration)
Acute: NSAIDs, Colchicine
Prophylaxis: Allopurinol

196
Q

Crystal Arthropathy Mx

A

Acute: NSAIDs
Prophylaxis: Colchicine

197
Q

Fibromyalgia Triad + Sx

A

Pain, Poor sleep, Fatigue

Vague, Widespread Pain (Above + Below, Bilat)
Fibrofog (Diff Conc)
Diff Sleeping, Exercising
Fatigue, Fever, Weight loss

198
Q

Fibromyalgia Ix

A 
Normal Ix (No Raised CRP/ESR/PV)
Normal Exam
199
Q

Fibromyalgia Mx

A

Education
CBT
Amitriptyline

200
Q

Scleroderma Patho, Sx + Ix

A

Fibrosis of CT => Raynauds, Calcinosis, HT

Ix:
+) ANA
(Normal CRP/ESR/PV

201
Q

Scleroderma Synd

A 
C: Calcinosis Cutis
R: Raynauds
E: Oesophageal Dysmotility
S: Sclerodactyly
T: Telangiectasia
202
Q

Scleroderma Mx

A

Scleroderma: Methotrexate
(Flares: Prednisolone)
Calcinosis: Ca2+ Antagonist
HT: ACEi

203
Q

Dermamyositis/Polymyositis Sx + Ix

A

Acute + Symmetrical M Weakness (=> SOB)
Photosensitive Rash
Raynauds

Ix:
Raised CK, ALT
Normal CRP

204
Q

Bisphosphonates Indications, Info, SE

A

Indications: Osteoporosis, (Co-prescribed w/ Steroids)

(Ca2+, Vit D Co-prescribed)
Taken weekly, w/ water on empty stomach, whilst standing/sitting upright + for 30mins after

+/- Oesophagitis (Discontinue)

205
Q

Monoclonal AB’s Info

A

Require TB test

Increased risk of Intracellular Pathogens (Viral/Parasite)

206
Q

Sulfasalazine Contraindications

A

Aspirin Allergy

Do not take w/ NSAIDs => Kidney Fail, Peptic Ulcers

207
Q

Azathioprine Info

A

Assess TPMT Act (+/- => Myelosuppression)
Reg weekly FBC test for 8wks
+/- Skin sensitisation (Sunscreen)

208
Q

Methotrexate Info

A

Require Contraception + Preg test (Teratogenic)

Weekly doses w/ Folic Acid Supplements

209
Q

Inflamm vs Mech Pain

A

Inflamm:
Improves w/ Activity
Fatigue + Syst Sx

Mech:
Better w/ Rest (Shorter morning Stiffness)
No Fatigue/Syst Sx

210
Q

HF (w/ Reduced EF) Mx

A

ACEi
Beta-blocker
+/- Spironolactone

(Annual Flu Vaccine, One-off Pneumococcal Vaccine)

211
Q

HF CXR Signs

A 
A: Alveolar oedema (Bat wing opacities)
B: Kerley B lines (Horizontal lines)
C: Cardiomegaly
D: Dilated upper lobe vessels (Pulmonary Congestion)
E: Effusion (Pleural)
212
Q

BPH Mx

A

Alpha-1 Antag (Tamsulosin)
5a-Reductase Inhib (Finasteride)
TURP

213
Q

Post-MI Complications

A 
Death
Arrhythmia 
Rupture
Tamponade
HF
Valvular D
Aneurysm
Dressers (Pericarditis)
Embolus
Recurrence
214
Q

COPD Diagnosis + Ix

A

Post-bronchodilator FEV1 < 0.7

PEFR/Spirometry
CXR (Emphysema: Bullae, Hyperinflation: Flattened Diaphragm + Barrel-chest A-P on Lat)
FBC (Anaemia/Polycythaemia, Eosinophil Count)
BMI
(Serum alpha1 Anti-trypsin Def)

215
Q

Asthmatic/Steroid-Responsive Features

A

Diagnosis of Asthma/Atopy
Raised Eosinophil Count
Diurnal variation of PEFR
Variation of FEV1

216
Q

COPD Step-up Mx

A

1: SABA/SAMA

2: (If no Asthmatic/Steroid-Resp):
SABA + LABA + LAMA (Discontinue SAMA)
+/- ICS

2: (If Asthmatic/Steroid-Resp):
SABA + LABA + ICS
+/- LAMA (Discontinue SAMA)

(Prophylactic ABx: Azithromycin)

217
Q

COPD Staging

A

S1: (Mild): FEV1 > 80%
S2: (Mod): FEV1 50-70%
S3: (Sev): FEV1 30-50%
S4: (V.Sev): FEV1 < 30%

218
Q

GI Tract Blood Supply

A

Coeliac Trunk (Comm Hep, Splenic, L Gastric)

Sup Mesenteric (Middle Colic, Right Colic, Ileocolic, Jejunal + Ileal)

Inf Mesenteric (L Colic, Sigmoid, Sup Rectal)

219
Q

GI Anatomy affected by Ulcers

A

Post Gastric: Splenic A, Pancreas
L Curvature: L Gastric A
Duodenal: Gastroduodenal A

220
Q

Virchows Triad of Clotting

A 
Hypercoaguability (Surg/Trauma, Malig, Preg, Sepsis, Inflamm/Auto-Immune)
Endothelial Inj (Atherosclerosis, Vasculitis, Thrombophlebitis)
Haemostasis/Turbulent Blood flow (Immobility, AF/Arrhythmias, BradyC/HypoT, Venous Obstruct)
221
Q

Acute LVHF Mx

A 
(Sit Pt up)
Morphine + Antiemetic
O2
IV Furosemide 80mg
SL GTN
(+/- Isosorbide Nitrate +/- CPAP)
222
Q

Stroke Ix + Mx

A

Non-contrast CT Head:
- If Haem: Refer to Neurosurg (Do not give Aspirin/Thrombolysis), Reverse Anticoags
- If Ischaemic: Aspirin 300mg
(If < 80yo + Pc < 4.5hrs => Thrombolysis: IV Alteplase)

Medicine (13 decks)

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