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year 3 > Amir Sam DPD > Flashcards

Amir Sam DPD Flashcards

1
Q

60M, presenting with 4 hr Hx of tight chest pain, nausea, sweating, SOB, HTN, DH: Amlodipine

A

Myocardial infarction

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2
Q

Investigations on suspicion of MI?

A

ECG, Troponin (if positive, coronary angiography, if negative, exercise tolerance test - ETT), Echo

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3
Q

Cardio, resp, GI and musc Ddx of chest pain?

A

ACS, stable angina, aortic dissection, pericarditis, pneumonia, PE, pneumothorax, oesophageal spasm, oesophagitis, gastritis, costochondritis

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4
Q

Where is the ST elevation seen in a lateral MI and what artery is affected?

A

V5, V6, I, aVL, circumflex artery

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5
Q

Ddx of collapse?

A

Hypoglycaemia - ABCDEFG
Cardio - vasovagal, arrhythmia, outflow obstruction, postural hypotension
Neuro - seizure

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6
Q

How to investigate Ddx of collapse?

A 
Arrhythmias - ECG (see if there is long QT), cardiac monitor, 24 hour tape
Outflow obstruction (aortic stenosis, HOCM on the left, PE on the right) - low volume/slow rising pulse, ejection systolic murmur, Echo
Postural hypotension - lying/standing BP
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7
Q

What is long QT syndrome and what can cause it?

A

Abnormal ventricular repolarisation
Congenital: mutations in K+ channels, FHx of sudden death
Acquired: low K+/Mg2+ drugs

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8
Q

45M, fever, malaise, IV drug use, afebrile, Osler nodes, raised JVP, pansystolic murmur louder in inspiration, hepatomegaly

A

Infective endocarditis, mitral regurgitation

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9
Q

Ddx of raised JVP

A 
Right HF - secondary to LHF, pulmonary HTN (PE, COPD)
Tricuspid regurgitation (valve leaflets, R ventricle dilatation)
Constrictive pericarditis (infection e.g. TB, inflammation e.g. connective tissue disease, malignancy)
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10
Q

65M, SOB, palpitations, HTN, DH Bendroflumethiazide, afebrile, irregular and fast pulse, dull percussion and coarse crackles L base

A

Pleural effusion secondary to HF
Pneumonia
ECG will show sinus tachycardia

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11
Q

What does sinus tachycardia indicate on ECG?

A

Sepsis, hypovolaemia, endocrine (thyrotoxicosis, phaechromocytoma)

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12
Q

What does SVT indicate?

A

Re-entry circuit
AVRT - short PR, delta wave, accessory pathway
AVNRT - circuit within AVN

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13
Q

What does AF indicate?

A

Thyrotoxicosis, ischaemia (muscle, valve, pericardium), chest infection (pneumonia, PE, cancer), alcohol

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14
Q

What does VT indicate?

A

Ischaemia, electrolyte abnormality, long QT

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15
Q

What is the management for SVT?

A

Vagal manoeuvres, adénosine (cardiac monitor), DC cardio version if haemodynamically compromised

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16
Q

Management for AF

A

Rhythm control - if onset over 48 hours, anti-coagulate for 3-4 weeks before cardioversion
Rate control - beta blocker, digoxin

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17
Q

Management of VT

A

If no haemodynamic compromise: IV Amiodarone
Look and treat underlying cause
ICD
Pulseless VT: defibrillate

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18
Q

What does S3 indicate?

A

S3 = poor ventricular filling

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19
Q

What does S1 and S2 indicate?

A 
S1 = closure of mitral valve
S2 = closure of aortic valve
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20
Q

What is the fixed wide splitting of S2

A

Fixed wide splitting of S2.= atrial septal defect

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21
Q

What is S4?

A

Associated with ventricular hypertrophy

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22
Q

65F, SOB, few hours, orthopnoea, 2 MIs in past, DH: aspirin, simvastatin, ramipril, bisoprolol, raised JVP, S3 heart sound, fine crackles, peripheral oedema

A

Acute HF

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23
Q

Management of acute HF?

A

Sit up, oxygen, IV furosemide, treat underlying cause

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24
Q

78M, unconscious, not breathing, no carotid pulse, low temp, ECG shows VF, what is the management?

A

Shock, CPR (2min), assess rhythm, adrenaline every 3-5min, amiodarone after 3 shocks, treat reversible causes

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25
Q

What is the treatment for asystole/PEA

A

CPR (3min), adrenaline every 3-5min, correct reversible causes

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26
Q

Ddx of pleuritic chest pain?

A

Pericarditis, PE, pneumonia, pneumothorax, pleural pathology

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27
Q

60m, SOB, sudden onset, COPD, on Symbicort and tiotropium, high pulse, raised JVP, scattered wheeze and creps, peripheral oedema, low O2 stats, low Hb

A

Pneumothorax

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28
Q

SOB Ddx dependent on timing?

A

Seconds: pneumothorax, PE, foreign body
Mins/Hrs: airways (inflammation/obstruction), chest infection (pus), acute HF (fluid)
Days/weeks: chronic of the above, ILD, malignancy/large pleural effusion, neuromuscular, anaemia/thyrotoxicosis

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29
Q

Management of pneumothorax

A

Primary:
<2 cm: discharge, repeat CXR
>2 cm: aspiration, if unsuccessful, chest drain

Secondary:
<2 cm: aspiration
> 2cm: chest drain

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30
Q

How to determine axis deviation

A

Look at I and II: is either of them overall negative? If yes, axis deviation
Look at aVL, is it overall positive?
Yes: left axis deviation
No: right axis deviation

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31
Q

Ddx of progressive SOB, dry cough and clubbing with normal FEV1/FVC ratio

A

Idiopathic fibrosing alveolitis
Connective tissue disease, RA
Drugs
Asbestosis (ship builder)

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32
Q

How to interpret CXR?

A

PA/AP CXR of name, DOB, taken on (date/time), RIPE (rotation, inspiration, penetration, exposure)
Look at each zone
Follow the periphery - pneumothorax, pleural thickness, costophrenic angles, diaphragm, heart, mediastinum

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33
Q

Types of shadowing seen on CXR?

A

Interstitial/alveolar shadowing
Reticulo-nodular shadowing
Homogenous shadowing
Masses/cavitations

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34
Q

What should be looked for in the hands in an abdomen exam?

A 
Asterixis (liver flap)
Bruising 
Clubbing
Dupuytren's contracture
Erythema
Leuconychia
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35
Q

What can be seen on the chest in an abdo exam?

A

Gynaecosmastia, hair loss, excoriation marks, spider naevi

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36
Q

What can be seen on the abdomen in an abdo exam?

A

Abdo distention, caput medusae, scars

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37
Q

What does a right subcostal (Kocher’s) incision indicate?

A

Biliary surgery

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38
Q

What does a Mercedes-Benz incision indicate?

A

Liver transplant

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39
Q

What does a midline laparotomy incision indicate?

A

GI or any major abdo surgery

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40
Q

What does a McBurney’s (Gridiron) incision indicate?

A

Appendicectomy

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41
Q

What does a J-shaped (hockey stick) incision indicate?

A

Renal transplant

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42
Q

What does a low transverse (Pfannenstiel) incision indicate?

A

Gynaecological procedures?

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43
Q

What does an inguinal incision indicate?

A

hernia repair, vascular access

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44
Q

What does a loin incision indicate?

A

Nephrectomy

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45
Q

What can cause hepatomegaly?

A

Cancer (primary or secondary deposits)
Cirrhosis (early, usually alcoholic)
Cardiac: Congestive cardiac failure, constrictive pericarditis
Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

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46
Q

What are the causes of splenomegaly?

A

Portal hypertension, Haematological, Infection, inflammation

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47
Q

75M, epigastric and back pain, high pulse, low BP

A

Ruptured aortic aneurysms

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48
Q

What are the Ddx for epigastric pain?

A

Acute pancreatitis, good, Barrett’s oesophagus, peptic ulcer, gastritis (retrosternal, ETOH), malignancy
Above: MI
Below: ruptured AAA
Right: cholecystitis, hepatitis

49
Q

How do you tell the difference between acute and chronic pancreatitis?

A

Acute: pain, high amylase
Chronic: pain, wt loss, loss of exocrine and endocrine function, normal amylase, faecal elastase

50
Q

Ddx of RUQ pain

A 
Acute cholangitis, cholecystitis, biliary colic, hepatitis (alcoholic, AI, NASH, hep B/C), cirrhosis, liver abscess
Above: basal pnuemonia
Below: appendicitis
Left: peptic ulcer, pancreatitis
Right: pyelonephritis
51
Q

Ddx of RIF pain

A

Crohn’s, appendicitis, UC, Coeliac, ovarian, colon cancer, mesenteric adenitis

52
Q

Ddx of suprapubic pain

A

cystitis, urinary retention

53
Q

Ddx of LIF pain

A

Diverticulitis, malignancy, ovarian cyst/twist/rupture, IBD

54
Q

DDx of diffuse pain

A

Peritonitis, SBP, obstruction, IBD, mesenteric ischaemia

Medical: DKA, Addisons, hypercalaemia, porphyria, lead poisoning

55
Q

Causes of transudate ascites?

A

Cirrhosis, cardiac failure, nephrotic syndrome

56
Q

Causes of exudate ascites?

A

Malignancy (abdo, pelvic, peritoneal mesothelioma), infection (TB, pyogenic), Budd-Chiari syndrome (hepatic vein thrombosis), portal vein thrombosis

57
Q

Causes of pre-hepatic jaundice?

A

Haemolysis, Gilbert’s syndrome

58
Q

Causes of hepatic jaundice?

A

Alcohol, AI, Drugs, Viruses

Conjugated bilirubin enters duodenum and leaks out of hepatocytes - causes dark urine

59
Q

Causes of post-hepatic jaundice?

A

Gallstones in CBD, strictures, pancreatic cancer

Conjugated bilirubin cannot enter duodenum, causes dark urine and pale stool

60
Q

Causes of bloody diarrhoea?

A

Infective colitis (Campylobacter, Haemorrhagic E coli, Entamoeba histolytica, Salmonella, Shigella), Inflammatory colitis (young, extra-GI manifestations), Ischaemic colitis (elderly), diverticulitis, malignancy

61
Q

How do you manage in acute GI bleed?

A

ABC, IV access, fluids, G&S, X-match blood, OGD

Variceal bleed - Abx, Terlipressin

62
Q

How do you investigate and manage an acute abdomen?

A

Investigations: FBC, U&Es, LFTs, CRP, clotting, G&S, X-match
Erect CXR, CT
Management: NBM, fluids, analgesia, anti-emetics, Abx, monitor vitals and urine output

63
Q

Management for ascites

A

Ascitic drain, albumin solution, dietary sodium and fluid restriction, diuretics, monitor weight daily

64
Q

Appropriate drug for encephalopathy

A

Lactulose, phosphate enemias, avoid sedation, treat infections, exclude GI bleed

65
Q

What does a SAAG score of more than 11 g/L indicate?

A

Cirrhosis, cardiac failure

66
Q

What does a SAAG score of less than 11 g/L indicate?

A

TB, Cancer, nephrotic syndrome

67
Q

What is the presentation and treatment of a perianal abscess?

A

Tender, red swelling, incision and drainage

68
Q

What is the presentation and treatment of an anal fissure?

A

Rectal pain, stool coated with blood, advice re diet, GTN cream

69
Q

What are UMN signs?

A

Hypertonia, decreased power, hyperreflexia, positive plantar reflex

70
Q

What are LMN signs?

A

Hypotonia (flaccid), decreased power, hyporeflexia

71
Q

What are the cerebellar signs?

A

DANISH

Dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia

72
Q

What are the toxic/metabolic causes of peripheral neuropathy?

A

Drugs, alcohol, B12 deficiency, diabetes, hypothyroidism, uraemia, amyloidosis

73
Q

What are other causes of peripheral neuropathy?

A

Infection - HIV
Inflammation - Vasculitis, connective tissue disease, inflammatory demyelinating neuropathy
Tumour - paraneoplastic, paraproteinaemia
Hereditary - hereditary sensory motor neuropathy

74
Q

What is seen in optic neuritis?

A

Blurred optic disc margins, blurred vision, pain on eye movement

75
Q

What is meralgia paraesthetica and what is the treatment for it?

A

Compression of the lateral femoral cutaneous nerve
Reassure, avoid tight garments, lose weight
If persistent - carbamazepine, gabapentin

76
Q

What is radiculopathy?

A 
Disease of the nerve roots
e.g. lumbosacral - pain in the buttock, radiating down the leg below the knee
Compression by:
- Disc herniation
- Spinal canal stenosis
77
Q

What is the triad for Parkinsons?

A

Tremor, rigidity, bradykinesia

78
Q

What are the signs of progressive supranuclear palsy?

A

Parkinsonian features, upgaze abnormality

79
Q

What are the signs of Lewys body dementia?

A

Features of Alzheimers, Parkinsons and hallucinations

80
Q

What are the other causes of confusion apart from Parkinsons?

A

Post-ictal
Dysphasia - receptive or expressive, other features of stroke/TIA
Dementia - vascular, alcoholic

81
Q

What are the other causes of confusion apart from Parkinsons?

A

Post-ictal
Dysphasia - receptive or expressive, other features of stroke/TIA
Dementia - vascular, alcoholic, Alzheimers, Inherited (Huntington’s)
Depressive pseudo dementia - elderly, withdrawn, poor eye contract, precipitating factor

82
Q

What are the Ddx for confusion and LOC?

A

Hypoglycaemia
Vascular:
Bleed: headache, collapse
Subdural haematoma (fall, fluctuating consciousness)
Infection - temp, intracranial, extracranial
Inflammation
Malignancy
Metabolic/Toxic: drugs, U&Es, LFTs, vitamin deficiencies, endocrinopathies

83
Q

What are the differentials for headache in the ED?

A

Meningitis - fever, neck stiffness, Kernig’s sign
SAH - sudden onset, CT, LP
Giant cell arteritis - polymyalgia rheumatica (shoulder girdle pain, stiffness, constitutional upset), ESR, Steroids, over 50, Biopsy
Migraine - throbbing, vomiting, photophobia, FHx, aura

84
Q

What is the management for stroke?

A 
Less than 4.5 hours:
CT: no haemorrhage
Thrombolysis if not contraindications
More than 4.5 hours:
CT head (exclude haemorrhage)
Aspirin 300mg, swallow assessment
Maintain hydration, oxygen
85
Q

What is the management for a TIA?

A 
Aspirin
Don't treat BP acutely unless over 220/120 or other indication
ECG, Echo
Carotid Doppler
RF modification
86
Q

List 3 atypical organisms in CAP

A

Mycoplasma pneumoniae
Chlamydia pneumonia
Legionella pneumophilia

87
Q

What are the Ddx for bloody diarrhoea?

A

infective colitis, UC/Crohn’s, ischaemic colitis (older pts), malignancy, diverticulitis

88
Q

What are the complications of portal hypertension?

A

Encephalopathy
Ascites
SBP
Variceal bleed

89
Q

What do investigations show in DIC?

A

Reduced platelets and fibrinogen
Increased PT/APTT
Increased D-dimer/fibrin degradation products

90
Q

What do investigations show in Haemolytic Uraemia Syndrome?

A

Haemolysis (low Hb, high bilirubin)
Uraemia
Low platelets

91
Q

What do investigations show in TTP?

A

HUS + fever + neurological manifestations

92
Q

What are the types of hereditary haemolytic anaemia?

A

Red cell membrane (hereditary spherocytosis)
Enzyme deficiency (G6PDD)
Haemoglobinopathy (SCD, Thalassaemia)

93
Q

What are the types of acquired haemolytic anaemia?

A

AI, drugs, infection, microangiopathic haemolytic anaemia (DIC, HUS, TTP)

94
Q

What are the causes of hypovolaemic hyponatraemia?

A

Diarrhoea
Vomiting
Diuretics
Test: low urine sodium

95
Q

What are the causes of euvolaemic hyponatraemia?

A

Hypothyroidism
Adrenal insufficiency
SIADH
Test: TFTs, short synACTHen test, plasma and urine osmolality

96
Q

What are the causes of hypervolaemic hyponatraemia?

A

Cardiac failure
Cirrhosis
Nephrotic syndrome
Check: fluid overloaded, low urine sodium

97
Q

What are the causes of SIADH?

A

CNS pathology
Lung pathology
Drugs (SSRI, TCA, PPIs, carbamazepine)
Tumours

98
Q

What are the causes of onycholysis

A

Trauma
Thyrotoxicosis
Fungal infection
Psoriasis

99
Q

What are the complications of diabetes?

A

Microvascular:

  • Retinopathy
  • Neuropathy (foot ulcers)
  • Nephropathy

Macrovascular:
- MI/stroke/PVD

Metabolic:
- DKA/HHS/Hypoglycaemia

100
Q

Where is ALP made and what is it raised in?

A

Sources: liver and bone
High in obstructive liver disease and bone disease (malignancy, fracture, Paget’s disease)
normal in myeloma

101
Q

What are the 4 signs of multiple myeloma?

A 
Calcium (polyuria, polydipsia, constipation)
Renal impairment (urea, creatinine)
Anaemia (SOB, lethargy, FBC)
Bone (Fracture, bone pain, DXA)
Infection, cord compression
102
Q

What are the causes of a caveatting lung lesion?

A

Infection (TB, Staph, Klebsiella, e.g. alcoholics)
Inflammation (RA)
Infarction (PE)
Malignancy

103
Q

What are the signs of nephrotic syndrome?

A

Increased permeability of glomerular basement membrane to protein, proteinuria, hypoalbuminaemia, oedema

104
Q

What is hereditary haemorrhagic telangiectasia and how does it present?

A

Autosomal dominant
Recurrent GI and nose bleeds
Abnormal blood vessels in skin, mucous membranes, lungs, liver, brain

105
Q

What are the causes of microcytic anaemia?

A 
Iron deficiency (diet or blood loss, low ferritin)
Beta thalassaemia heterozygosity
106
Q

What are the causes of normocytic anaemia?

A

ACD (RA, normal/high ferritin)

107
Q

What are the causes of macrocytic anaemia?

A

Alcoholics May Have Liver Failure
Alcohol (Hx, GGT)
Myelodysplasia (pancytopenia, bone marrow)
Hypothyroidism (Hx, low T4, high TSH)
Liver disease (Hx/Exam)
Folate/B12 deficiency (Hx of small bowel disease, gastrectomy)

108
Q

What is the presentation for polycythaemia?

A 
Headache
Pruritus after hot bath
Blurred vision (hyperviscosity)
Tinnitus
Thrombosis (stroke, DVT)
Gangrene
Choreiform movements
109
Q

What does a sickle cell anaemia crisis present as?

A

Acute painful crises
Stroke
Sequestration crises (RBC pooling) - Lung (SOB, cough, fever), Spleen (exacerbation of anaemia)
Gallstones, chronic cholecystitis

110
Q

What is the management of a sickle cell anaemia crisis?

A

Analgesia, O2, IV fluids, antibiotics for acute painful crises
Stroke - exchange blood transfusion
Spleen - splenectomy for repeat episodes of splenic sequestration
Gallstones and chronic cholecystitis - cholecystectomy

111
Q

What does anaemia with a high reticulocyte count indicate?

A

Haemolytic crises

Ddx: haemorrhage

112
Q

What does anaemia with a low reticulocyte count indicate?

A

Parvovirus B19 infection
Aplastic crisis in pts with SCA
Blood transfusion

113
Q

How is a diagnosis of diabetes made?

A

Fasting > 7
Random > 11
IGTT - 75g OGTT, 2-hour glc: 7.8-11

114
Q

What is seen in a history and exam for thyroid cancer?

A

Lump
RFs: radiation, FHx, rapid enlargement, lymphadenopathy
Mets (lung, follicular thyroid cancer)

115
Q

What is the investigation and management for thyroid cancer?

A

USS, FNAC (uptake scan: cold nodules), MDT
Surgery: papillary, follicular, medullary, anaplastic
Thyroxine, radioiodine

116
Q

What are the discriminatory signs for Cushing’s syndrome?

A

Bruising, thin skin
Myopathy
Purple striae
DM, HTN, osteoporosis at a young age

117
Q

What are the causes of amenorrhoea/oligomenorrhoea and how do you investigate them?

A

Pregnancy (urine beta-hCG)
Hypothalamus (excessive exercise, low BMI)
Pituitary (excess prolactin, low LH/FSH)
Thyroid (hyper/hypo) - TFTs
Ovaries (PCOS, ovarian failure) - excess androgens, high FSH

118
Q

What is the presentation for hypokalaemia?

A

Weakness
Arrhythmia
Polyuria

119
Q

What is the Ddx for hypokalaemia?

A

GI: vomiting
Diuretics
Primary hyperaldosteronism (bilateral adrenal hyperplasia or Conn’s - aldosterone: renin ratio)

year 3 (11 decks)

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