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CASE Flashcards

1
Q

Lack of facial expression is indicative of?

A

Parkinson’s

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2
Q

Startled expresion indicative of?

A

Hyperthyroidism

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3
Q

Poor eye contact indicative of?

A

Depression

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4
Q

Apathy and pale puffy skin indicative of?

A

Hypothyroidism

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5
Q

Lugubrious expression and bilateral ptosis indicative of?

A

Myotonic dystrophy

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6
Q

Agitated demeanour indicative of?

A

Anxiety, hyperthyroidism, hypermania

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7
Q

Long, thin fingers a sign of?

A

Marfan’s syndrome (called arachnodactyly)

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8
Q

Spoon shaped nails?

A

Iron deficiency (koilonychia)

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9
Q

White nails?

A

hyperalbnuminaemia (leukonychia)

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10
Q

White transverse grooves on nails?

A

Beau’s lines (appear after severe illness)

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11
Q

Splinter haemorrhages?

A

Indicative of infective endocarditis

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12
Q

Distal nail separation?

A

Psoriasis (onycholysis)

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13
Q

What condition do you get dilated capillaries in proximal nail fold?

A

SLE

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14
Q

What joints affected in RA?

A

Metacarpophalangeal and proximal interphalangeal

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15
Q

What joints affected in OA and psoriatic arthropathy?

A

Distal interphalangeal

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16
Q

Signs of carpal tunnel syndrome?

A

Wasting of thenar muscles

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17
Q

Tremor in tongue due to?

A

Delirium tremens or Parkinson’s

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18
Q

Fasciculations in tongue due to?

A

Lower motor neurone disorders

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19
Q

Macroglossia sign of?

A

Acromegaly, amyloidosis or tumour

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20
Q

Red lines and rings on tongue that change over weeks and days?

A

B2 deficiency (called geographic tongue)

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21
Q

Smooth reddened tongue?

A

In alcoholics and coeliacs (called glossitis)

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22
Q

Rubbery lymph nodes indicative of?

A

Hodgkin’s

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23
Q

‘Matted’ lymph nodes indicative of?

A

TB

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24
Q

Hard lymph nodes indicative of?

A

Cancer

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25
Q

Tender lymph nodes indicative of?

A

Infection

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26
Q

Fixated lymph nodes indicative of?

A

Malignancy

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27
Q

Bruising under skin called?

A

Purpura

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28
Q

Large bruises called?

A

Ecchymosis

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29
Q

Pinpoint bruises called?

A

Petechiae

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30
Q

What waist size for health risk in men and women?

A

37” men and 32” women

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31
Q

Sign of scurvy?

A

Easy bruising, extensive bruising

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32
Q

Sign of vitamin A deficiency?

A

Xeropthalmia (night blindness), keratomalacia (eye disorder where cornea becomes opaque

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33
Q

Sign of vitamin D deficiency?

A

Rickets in children, osteomalacia in adults

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34
Q

Sign of vitamin K deficiency?

A

Bleeding disorder

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35
Q

Sign of vitamin B1 deficiency?

A

Beriberi (heart failure or neuropathy)

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36
Q

Sign of vitamin B2 deficiency?

A

Glossitis, stomatitis

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37
Q

Sign of vitamin B3 deficiency?

A

Pellagra (Dermatitis, diarrhoea, and dementia)

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38
Q

Sign of vitamin B6 deficiency?

A

Polyneuropathy

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39
Q

Sign of biotin deficiency?

A

Dermatitis, alopecia, parathesiae

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40
Q

Sign of folate deficiency ?

A

Megoblastic anaemia

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41
Q

Sign of B12 deficiency?

A

Megoblastic anaemia and neurological disorders

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42
Q

What is oedema a sign of?

A

Fluid overload or hypoalbuminaemia (can use JVP to distinguish as it will be elevated in overload)

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43
Q

Definition of postural hypotension?

A

Drop of 20mmHg systolic when standing

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44
Q

Yellow plaques on skin or tendons?

A

Xanthomata

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45
Q

Yellow plaques around eyelids?

A

Xanthelasma

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46
Q

Flame shaped haemorrhage with white centre on the retina a sign of?

A

Called Roth’s spots - bacterial endocarditis (also leukaemia, diabetes, pernicious anaemia)

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47
Q

What are the pulses?

A

Radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis

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48
Q

How does heart rate change with breathing?

A

Accelerates with inspiration, slows with expiration

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49
Q

How does blood pressure change with breathing?

A

Falls with inspiration, rises with expiration

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50
Q

How does the JVP change with breathing?

A

Falls with inspiration, rises with expiration

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51
Q

Signs of coarctation in children?

A

Pulses in arms normally normal, but leg pulses there is a delay and reduced volume

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52
Q

Signs of coarctation in adults?

A

Hypertension and heart failure

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53
Q

Beat to beat variation in pulse volume, with a normal rhythm?

A

Pulsus alternans (rare and happens in advanced heart failure)

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54
Q

Exaggeration of the normal variability pulse volume with the respiratory cycle?

A

Pulsus paradoxus (in tamponade and decreased intrathoracic pressure, ie severe asthma) - a decrease of 15mmHg on inspiration is pathological

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55
Q

What is a collapsing pulse? And what is is a sign of?

A

Peak of the pulse wave arrives early and followed by rapid descent. Is exaggerated with the arm raised.
Aortic regurgitation

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56
Q

What is a slow rising pulse? And what is is a sign of?

A

Gradual upstroke with a reduced peak occurring late in systole.
Severe aortic stenosis

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57
Q

What is a bisferiens pulse? And what is is a sign of?

A

2 systolic beats separated by a dip.

Mixed aortic regurgitation and stenosis

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58
Q

What is blood pressure monitored with?

A

Sphygmomanometer

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59
Q

Causes of secondary hypertension?

A

Pheochromocytoma (tumour of adrenal medulla)
Conn’s syndrome (tumour of adrenal cortex -aldosterone)
Cushing’s syndrome (microadenoma of pituitary -ACTH)
Coarctation of the aorta
Polycystic kidney disease

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60
Q

What are Korotkoff sounds?

A

Noises from under the distal half of the BP cuff between systole and diastole because the artery collapses completely and reopens with every heartbeat)

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61
Q

What pressure does JVP represent?

A

Central venous or right atrial pressure and indirectly right ventricle function

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62
Q

What do the points of the jugular pulse wave represent (draw it!)

A

a = atrial systole
c = closure of the tricuspid valve
v = peak pressure in the right atrium immediately prior to opening of the tricuspid
a to x = descent due to downward displacement of tricuspid ring during systole
v to y = descent at commencement of ventricular filling

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63
Q

Elevated JVP sign of?

A

Right sided heart failure (ventricular), acute PE, COPD with cor pulmonale, mechanical obstruction of vena cava

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64
Q

What is Kussmaul’s sign in the JVP and what is it a sign of?

A

A paradoxical rise of JVP on inspiration (normally falls).

Seen in tamponade, severe right ventricular failure, and restrictive cardiomyopathy

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65
Q

What is a prominent ‘a’ wave in the JVP a sign of?

A

Any condition with delayed or restricted right ventricular filling (eg pulmonary hypertension or tricuspid stenosis)

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66
Q

What are canon waves in the JVP and what is it a sign of?

A

Giant ‘A’ waves, occur when right atrium contracts against closed tricuspid (tricuspid stenosis)
Irregular canon waves seen in complete heart block
Regular canon waves seen during junctional bradycardias and some ventricular tachycardias

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67
Q

What is a ‘cv’ wave in the JVP a sign of?

A

Fusion of c and v resulting in increased wave and associated with a pulsatile liver. Seen in tricuspid regurgitation

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68
Q

What are absent ‘a’ waves in the JVP a sign of?

A

Atrial fibrillation

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69
Q

What heart sounds do you hear best at the cardiac apex?

A

1st heart sound
3rd and 4th heart sounds
Mid diastolic murmur of mitral stenosis

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70
Q

What heart sounds do you hear best at the lower left sternal border ?

A

Early diastolic murmur of aortic regurgitation

Pansystolic murmur of tricuspid regurgitation

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71
Q

What heart sounds do you hear best at the upper left sternal border ?

A

2nd heart sound
Pulmonary valve murmurs
Pansystolic murmur of ventricular septal defect

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72
Q

What heart sounds do you hear best at the upper right sternal border ?

A

Systolic ejection murmurs IE aortic stenosis

Hypertrophic obstructive cardiomyopathy

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73
Q

What heart sounds do you hear best at the left axilla ?

A

Radiation of pansystolic murmur of mitral regurgitation

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74
Q

What heart sounds do you hear best below left clavicle?

A

Patent ductus arteriosus

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75
Q

Common causes of pathological 3rd heart sound?

A

Left ventricular failure, mitral regurgitation

Can occur in heart failure with a tachycardia

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76
Q

What is a 4th heart sound?

A

Soft and low pitched, nest heard with bell of stethoscope.

Caused by forceful contraction of atrium against still ventricle

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77
Q

How best to hear pericardial rub?

A

Diaphragm of stethoscope and breath help on expiration

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78
Q

What is Cheyne-Stokes respiration?

A

Cyclical increasing rate and depth of breathing followed by diminishing effort ending in apnoea

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79
Q

What is Kussmaul respiration?

A

Deep sighing respirations in response to metabolic acidosis

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80
Q

Eryhthema nodosum on shins might indicate?

A

Sarcoidosis, IBD and pregnancy

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81
Q

Causes of clubbing?

A

Tumours, interstitial lung disease, bronchiectasis, CF, bacterial endocarditis, UC, CD

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82
Q

Tremor in hands could be a sign of?

A

Excessive use of B-agonist

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83
Q

Flapping tremor a sign of?

A

CO2 retention

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84
Q

Name lymph nodes in the neck

A

Supraclavicular, cervical (SCM), posterior (behind SCM), postauricular, preauricular, submental, submandibular, pretracheal

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85
Q

Prominence of the sternum (pigeon chest?) and the other sign that comes with this ?

A

Pectus carinatum

Harrison’s sulci- indrawing of ribs to form horizontal grooves

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86
Q

Depression of the sternum

A

Pectus excavatum

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87
Q

What is hyper resonant chest on percussion a sign of?

A

Pneumothorax

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88
Q

What is dull chest on percussion a sign of?

A

Consolidation, collapse, fibrosis

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89
Q

What is stony dull chest on percussion a sign of?

A

Effusion, haemothroax

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90
Q

What are crackles on the chest a sign of?

A

Early inspiration - small airway disease
Middle- pulmonary oedema
Late - pulmonary fibrosis, secretions in COPD, pneumonia
Biphasic, coarse - broniectasis

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91
Q

Causes of respiratory acidosis?

A

Severe acute asthma, severe pneumonia, COPD, kyphoscoliosis

CO2 and HCO3 are raised

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92
Q

Causes of respiratory alkalosis?

A

Hyperventilation due to anxiety, stroke, salicylate poisoning
(CO2 and HCO3 are decreased)

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93
Q

Causes of metabolic acidosis?

A

DKA, poisoning, renal failure (CO2 and HCO3 are decreased)

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94
Q

Causes of metabolic alkalosis?

A

Loss of acid from severe vomiting, excess diuretic therapy, hyperaldosteronism, Cushing’s syndrome
(CO2 and HCO3 are raised)

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95
Q

What is recorded in spirometry?

A

Forced vital capacity (FVC)- total exhaled (reaches residual volume)
Amount exhaled in one second (FEV1)

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96
Q

FEV1/FVC ratios useful for?

A

Usually above 75%
Decreased ratio indicative of obstructive disease
Preserved ratio but decreased FVC indicative of restrictive disease (fibrosis, sarcoidosis)

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97
Q

Night time wakening with coughing and wheeze a sign of?

A

This is characteristic of poorly controlled asthma

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98
Q

Causes of chronic cough with no X-ray changes?

A

Smoking, sinusitis, GORD, asthma or ACE inhibitors

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99
Q

Surface markings of the liver?

A

5th intercostal space on full inspiration (upper border)

Costal margin in mid-clavicular line on full inspiration (lower border)

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100
Q

Surface markings of spleen?

A

Underlies left ribs 9, 10 and 11 posterior to mid axillary line

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101
Q

Surface markings of gallbladder?

A

Intersection of right lateral vertical plane and costal margin (ie tip of 9th costal cartilage)

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102
Q

Surface markings of pancreas?

A

Neck lies at level of L1, head below and right, the tail above and left

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103
Q

Surface markings of kidneys?

A

Upper poles deep to the 12th rib posteriorly 7cm from midline - right is 2-3cm lower than the left

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104
Q

What is fancy word for dry mouth?

A

Xerostomia

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105
Q

What is fancy word for bad breath?

A

Halitosis due to gingival or pharyngeal infection

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106
Q

What is cacogeusia?

A

Foul taste in mouth

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107
Q

What is fancy word for altered tase sensation ?

A

Dysguesia

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108
Q

What is the Iliopsoas sign/test?

A

Flex thigh against resistance. Pain is a positive test- indicates inflammation involving the psoas muscle. (retroileal appendicitis, iliposoas abscess, perinephric accesses)

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109
Q

What is Murphy’s sign?

A

Pt takes a deep breath in while you gently palpate in right upper quadrant of abdomen - as the gallbladder comes into contact with fingers pain is elicited - sign of acute cholecystitis

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110
Q

What is Rovsing’s sign?

A

Palpation in left iliac fossa produces pain in right iliac fossa - sign of acute appendicitis

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111
Q

What are Grey-Turner’s and Cullen’s signs?

A

Bleeding into falciform ligament - bruising around umbilicus (Cullen’s) or in the loins (Grey-Turner’s).
Sign of haemorrhagic pancreatitis, aortic rupture, ectopic pregnancy

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112
Q

What is menarche?

A

When periods start

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113
Q

What is measured in pregnancy test?

A

B-HCG - useful for ectopic pregnancies

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114
Q

Ovarian cancer marker?

A

CA125

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115
Q

Gravidity?

A

Total no of pregnancies

116
Q

Parity

A

Live births and still births + no of miscarriages, terminations and ectopics

117
Q

Puerperium?

A

Post partum period - approx 6 weeks while uterus returns to how it was - involution of uterus is complete

118
Q

Lie of the foetus?

A

Spine axis compared to the mother.

Usually longitudinal but may be transverse or oblique

119
Q

Presentation of foetus?

A

Leading part of the foetus in the lower pole of the uterus

Normally cephalic, but can be breech or shoulder

120
Q

What is polyhydramnios?

A

Too much amniotic fluid resulting in tense uterus

121
Q

What are linea nigra?

A

Increased melanocyte activity results in dark midline

122
Q

Striae gravidarum?

A

Pink/red stretch marks caused by pregnancy

123
Q

Old striae gravidarum?

A

Striae albicans

124
Q

What should fundal height be equivalent to?

A

Gestation in weeks + or - 3cm

125
Q

How many fifths palpable if head fixed?

If engaged?

A

3 fifths

2 and 1 fifths

126
Q

What cells are testosterone produced from?

A

Leydig cells

127
Q

Two cylinders in penis?

A

Corpora cavernosa

128
Q

Muscles lining scrotum?

A

Dartos muscle- highly contractile to regulate temp

129
Q

What is hydadid of Morgani?

A

Appendix testis - vestigal of Mullerian duct

130
Q

Causes of epididymitis

A

STIs

E. coli infection

131
Q

Prevention of retraction of foreskin?

A

Phimosis - narrowing of preputial orifice

132
Q

Paraphimosis?

A

Inability to pull foreskin forward after retraction due to constriction in the prepuce

133
Q

Where are the cell bodies of the sensory nerves?

A

Dorsal root ganglia

134
Q

Where are the cell bodies of the motor nerves?

A

Anterior horns

135
Q

Signs of lower neurone lesions?

A

Weakness and wasting in the muscles, reduced tone and absent reflexes

136
Q

Signs of upper neurone lesions?

A

Increased tone and brisk reflexes

137
Q

Unsteadiness of standing with eyes open is a sign of?

A

Called Romberg’s test - cerebellar disorders

138
Q

Instability with eyes closed?

A

Proprioceptive sensory loss

139
Q

Hemiplegic gait sign of?

A

Unilateral upper motor neurone lesion

140
Q

What is dystonia?

A

Sustained muscle contractions leading to twisting, repetitive movements and tremor

141
Q

What is chroea and athetosis?

A

Writhing movements

142
Q

Ballism?

A

Violent flinging movements caused by contractions of proximal limb muscles.

143
Q

Fancy word for pain on swallowing?

A

Odynophagia

144
Q

What is water brash?

A

Excess saliva in the mouth

145
Q

Fancy word for rectal bleeding?

A

Haematochezia (fresh blood in stools)

146
Q

Fancy word for persistant urge to empty rectum?

A

Tenesmus

147
Q

Black tarry stools?

A

Melaena

148
Q

Achalasia?

A

Failure of smooth muscle fibres to contract which can cause oesophageal sphincter to remain closed

149
Q

Neuromuscular causes of dysphagia?

A

Achalasia, Myasthenia gravis, Pharyngeal pouch

150
Q

Mechanical causes of dysphagia?

A

Oesophageal cancer, peptic oesophagitis

151
Q

What is cause of vomiting blood after vomiting?

A

Mallory-Weiss syndrome lower mucosal osephageal tear due to vomiting

152
Q

Pain in the right hypochondrium and epigastric region and tip of scapula a sign of?

A

Gallbladder/biliary colic

153
Q

Inguinal canal pain a sign of?

A

Ureteric pain

154
Q

Epigastrium pain a sign of?

A

Peptic ulcer

155
Q

Epigastric/left hypochondrium pain eased by sitting upright?

A

Acute pancreatitis

156
Q

Fancy word for audible bowel sounds?

A

Borborygmi

157
Q

Fancy word for feeling of impending death?

A

Angor animi

158
Q

What kind of jaundice:

-urine normal, stool normal

A

Unconjugated

159
Q

What kind of jaundice:

-urine dark, stool normal

A

Hepatocellular

160
Q

What kind of jaundice:

-urine dark, stool pale

A

Obstructive

161
Q

What kind of jaundice:

Congenital disorder

A

Gilbert’s syndrome- impaired bilirubin excretion

162
Q

Painful hacks at the side of the mouth?

A

Angular cheilitis (iron deficiency)

163
Q

Troisier’s sign?

A

Gastric and pancreatic cancer may spread to left supraclavicular lymph nodes

164
Q

Distended veins on the tummy?

A

Caput medusae - portal vein hypertension

165
Q

What could cause an epigastric mass?

A

Gastric cancer, pancreatic cancer, aortic aneurysm

166
Q

Fetor hepaticus?

A

Sweet, musty smell on breath

167
Q

Chilaiditi’s sign?

A

Resonance below 5th intercostal space due to transverse colon getting between the diaphragm and the liver

168
Q

What is Courvoisier’s sign?

A

If gallbladder is palpable, and painless in jaundiced patient, not likely to be gallstones but cancer.

169
Q

Causes of enlarged spleen?

A

Lymphoma, glandular fever, endocarditis, RA, SLE.

Must be 3X as large to be palpable

170
Q

Cause of hydroceles?

A

Usually idiopathic, may be secondary to inflammatory conditions or tumour.

171
Q

MRC scale or power?

A

0 - none
1 - flicker of contraction, no movement
2 - joint movement when gravity is eliminated
3 - movement against gravity but not against resistance
4 - weak movement against resistance
5 - normal

172
Q

Dysdiadochokinesis?

A

Impairment of rapid alternating movements - sign of cerebellar disorders

173
Q

Where does dorsal column cross over and what type of sensory pathways?

A

Right up to the medulla - proprioception and vibration

174
Q

Where does spinothalamic column cross over and what type of sensory pathways?

A

Within one or two segments - pain and temperature

175
Q

Brown-Sequard syndrome?

A

Ipsilateral motor weakness and loss of vibration and proprioception with contralatereal loss od pain and temp

176
Q

What are the secretions in the eye and from what glands?

A

Mucin from goblet cells
Aqueous humour form accessory lacrimal glands
Oil from Meibomian glands

177
Q

Path of tears?

A

From the lacrimal glands on top of and lateral to the eye, across eye into lacrimal canaliculi into lacrimal sac, and from there into nasolacrimal duct which opens into nasal inferior meatus

178
Q

Where is the aqueous humour that fills the anterior chamber produced from?

A

Ciliary body in the posterior chamber

179
Q

Three layers of the eye?

A

Outer sclera
Choroid
Retina

180
Q

Loss of lateral vision in both eyes?

A

Bitemporal hemianopia caused by optic chiasm compression

181
Q

Loss of right side of vision in both eyes?

A

Right homonymous hemianopia - lesion of optic tract

182
Q

Top right quarter loss of vision in both eyes?

A

Upper right quadrantanopia from a lesion of the lower fibres of the optic radiation in the temporal lobe

183
Q

Lower right quarter loss of vision in both eyes?

A

Lower right quadrantanopia from a lesion of the upper fibres of the optic radiation in the anterior part of parietal lobe

184
Q

Loss of right side of vision in both eyes but macula spared?

A

Right homonymous hemianopia due to lesion of optic radiation in the posterior part of the parietal lobe

185
Q

Fancy name for inverted and everted eyelid?

A

Entropion and Ectropion

186
Q

Signs of acute angle-closure glaucoma?

A

Severe unilateral pain, cloudy cornea, oval non-reactive pupil

187
Q

Signs of acute iritis?

A

Small irregularly shaped pupil, and redness around the limbus (inflamed iris sticks to the underlying lens)
seen in . -ankylosing spondylitis, IBD or psoriasis

188
Q

Signs of scleritis?

A

Pain on moving a red eye

May be first sign of systemic vasculitis. Frequently bilateral

189
Q

Sign of conjunctivitis?

A

Feels uncomfortable, always associated discharge, inner eyelid inflamed

190
Q

Copper deposited around the cornea called?

A

Kayser-Fleischer rings, seen in Wilson’s disease

191
Q

Fancy word for long sighted?

A

Hypermetropia

192
Q

Fancy word for short sightedness?

A

Myopia

193
Q

Astigmatism?

A

When the cornea is irregularly curved - requires correction with cylindrical lenses.

194
Q

What is nystagmus?

A

Involuntary oscillations of the eyes that is often rhythmical

195
Q

One pupil bigger than the other and both behave normally?

A

Essential anisocoria - common normal variant

196
Q

Cotton wool spot formation on the retina a sign of?

A

Arteriolar occlusion

197
Q

Large rapidly progressing cotton wool retina spot?

A

Retinitis due to herpes infection

198
Q

Cherry red spot sign in the eye?

A

Central retinal artery occlusion - pallor in the rest of the eye, optic nerve head, the fovea and posterior retina is unaffected due to supply from the ophthalmic arteries

199
Q

Nodes on hands due to osteoarthritis?

A

Heberden’s and Bouchard’s

200
Q

Firm white irregular subcutaneous crystal collections?

A

Gouty tophi

201
Q

Gibbus?

A

Spinal deformity caused by anterior wedge deformity localised to a single vetrebrae

202
Q

Spondylolsis?

A

Degenerative change in the spine

203
Q

Spondylolysis?

A

Defect in the pars interarticularis of a vertebral arch

204
Q

Spondylolisthesis?

A

One vertebra slipping anteriorly on an inferior vertebra

205
Q

Retrolisthesis?

A

One vertebra slipping posteriorly on an inferior vertebra

206
Q

What spinous processes are level with pelvic brim?

A

L4/5

207
Q

Where does the spinal cord end?

A

L2

208
Q

Flexor of the DIP joint?

A

Flexor digitorum profundus

209
Q

Flexor of the PIP joint?

A

Need to eliminate action of the flexor digitorum profundus 9hold the other fingers back)
Flexor digitorum superficialis

210
Q

Flexor and extensor of the thumb IP joint?

A

Flexor and extensor pollicis longus

211
Q

Nerve roots and muscles in hip flexion?

A

ileopsoas. Femoral nerve/ branches of spinal nerves – L1,2

212
Q

Nerve roots and muscles in hip extension?

A

gluteus maximus : inf gluteal nerve – L5, S1

213
Q

Nerve roots and muscles in knee flexion?

A

hamstring muscles : Sciatic Nerve – L5/S1

214
Q

Nerve roots and muscles in knee extension?

A

quadriceps, femoral nerve – L2,3,4

215
Q

Nerve roots and muscles in foot dorsiflexion?

A

tibialis anterior : deep peroneal nerve – L4,5

216
Q

Nerve roots and muscles in foot plantarflexion?

A

gastrocnemius : tibial nerve – S1,2

217
Q

Nerve roots and muscles in great toe dorsiflexion ?

A

extensor halluces longus : deep peroneal nerve – L5,S

218
Q

Nerve root in knee reflex?

A

Knee – L4

219
Q

Nerve root in Ankle reflex?

A

Ankle – S1

220
Q

Temporary loss of vision in one or both eyes, might be like a black curtain?

A

amaurosis fugax

221
Q

Myotome for hip flexion?

A

L2

222
Q

Myotome for knee extension?

A

L3

223
Q

Myotome for dorsiflexion foot?

A

L4

224
Q

Myotome for big toe extension?

A

L5

225
Q

Myotome for plantarflexion foot?

A

S1

226
Q

Nerve root patella reflex?

A

L3/L4

227
Q

Nerve root tibialis anterior?

A

L4/L5

228
Q

Myotome for cervical extension?

A

C2

229
Q

Myotome for cervical flexion?

A

C1

230
Q

Myotome for cervical side flexion?

A

C3

231
Q

Myotome for shoulder elevation?

A

C4

232
Q

Myotome for shoulder abduction?

A

C5

233
Q

Myotome for elbow flexion?

A

C6

234
Q

Myotome for elbow extension?

A

C7

235
Q

Myotome for thumb extension?

A

C8

236
Q

Myotome for finger abduction?

A

T1

237
Q

Nerve root for biceps reflex?

A

C5/C6

238
Q

Nerve root for brachioradialis reflex?

A

C5/C6

239
Q

Nerve root for triceps replex?

A

C7/C8

240
Q

Myotome of the deltoid?

A

C5

241
Q

Myotome of the lat dorsi?

A

C6/C7/C8

242
Q

Myotome of the triceps?

A

C7/(C8)

243
Q

Myotome of the biceps?

A

(C5)/C6

244
Q

Myotome of the long finger extensors?

A

C7/(C8)

245
Q

Myotome of the finger flexors?

A

C8

246
Q

Myotome of the iterossei?

A

T1

247
Q

Test for median nerve?

A

Push thumb toward palm

248
Q

Test for ulnar nerve?

A

Resist fingers being pushed together

249
Q

Hypovalaemic patient, how much IV fluid?

A

Child - 20ml/kg

Adults 500ml-1L bolus, reasses

250
Q

Maintenance IV fluids?

A

Water - 35mls/kg
Glucose - 1g/kg
Sodium - 2mmols/kg
Potassium - 1mmol/kg

251
Q

What is osmolarity?

What is osmolality?

A

Osmoles per L

Osmoles per KG (independent of temp)

252
Q

What is human osmolality?

A

275- 296 mosm/kg

253
Q

Test for anxiety?

A

GAD-7

254
Q

Test for depression?

A

PHQ-9

255
Q

Large peaked T waves?

A

Hyperkalaemia

256
Q

Flattened T waves?

A

Hypokalaemia

257
Q

Leads looking at anterior of heart?

A

V1 V2 V3 (L ventricle)

258
Q

Leads looking at lateral heart?

A

V3 V4 V5 (L ventricle)

259
Q

Leads looking at inferior of heart?

A

II, III and aVF (r ventricle, right coronary artery)

260
Q

Leads to see a septal wall injury?

A

V1 V2

261
Q

Blood tubes?

A
  1. Blood culture
  2. BLUE - blood clotting/INR
  3. RED - Thyroglobulin, Serology and Abs
  4. GOLD - Thyroid function tests, hormones, B12, folate, tomour markers
  5. GREEN- amino acids, Insulin
  6. PURPLE - FBC
  7. PINK- cross matching
  8. GREY - glucose, alcohol, lactate
262
Q

DeMussett’s sign?

A

Head nodding in severe aortic regurgitation

263
Q

Gower’s sign?

A

Duchennes leads to difficulty standing- patient tolls over and walks hands and feet together, then claims their legs swinging from side to side

264
Q

What to measure baby length?

A

Neonatal stadiometer

265
Q

Link discolouration at nape of neck, eyelids, glabella?

A

Storks beak mark - not significant

266
Q

Collodion baby?

A

Varnished appearance, may be post mature

267
Q

Baby head descriptions?

A 
Microcephalic (small)
Megalen- (large)
Hydro- (large due to enlarged ventricles)
Brachy- (short headed)
Dolicho- (long headed)
Plagio- (asymmetrical)
268
Q

Eye size in neonates?

A

Small may suggest conventual abnormalities (microphthalmia)

Large, feel them, if firm suggests glaucoma (buphthalmos)

269
Q

Resp rate for sleeping baby

A

20-40/min.
May be above 60 if baby cold, Hungry or crying
30-50 in term neonate

270
Q

Heart rate for term neonate?

A

100-140

Preterm it’s 120-160

271
Q

Intestines protruding through umbilicus?

A

Exomphalos - covered in think layer of peritoneum

272
Q

Herniation of bowel in neonates?

A

Gastroschisis - not covered in membrane

273
Q

Tethering of foreskin?

A

Chordee, causes glans to curve

274
Q

Palsies in babies?

A

Erb’s - upper brachial root plexus (c5/c6), reduced movement of arm, medial rotation of the forearmand failure to extend wrist

Klumpke’s might be seen after breech delivery (c8and T1), weakness in forearm and hand

275
Q

Primary club foot?

A

Talipes equinovarus

276
Q

Test for developmental dysplasia of the hip?

A

Barlow manieuver and ortolani manoeuvre

277
Q

To measure testicular volume?

A

Prader orchidometer

278
Q

How to measure expected delivery date of baby?

A

Add 1 year and 7 days and subtract 3 months from 1st day of last period (if 28 day cycle, if eg, 35, add 7)

279
Q

Damage to Broca’s area?

A

(broca’s area is more anterior) reduction in words used , non fluent speech, with errors in grammar and syntax

280
Q

Damage to Wernicke’s area?

A

(wernicke’s areas more posterior) poor comprehension, speech my be fluent but non-sensical

281
Q

Damage to arcuate fasciculus?

A

(connection between Broca’s area and Werrnicke’s) patient unable to repeat phrases said by examiner

282
Q

What does Glossopharyngeal nerve do?

A

Sensation from pharynx and tonsils, sensation and taste from posterior third of the tongue

283
Q

What does Hypoglossal nerve do?

A

Innervates muscles of the tongue

284
Q

What nerve for taste from anterior two thirds of tongue?/

A

Facial nerve (via chordae tympani branch)

285
Q

Stages of GCS?

A

Eyes (4)
-normal -open to speech -open to pain - nothing
Verbal (5)
-normal -talks in sentences but disoriented -words not sentences -grunts not words - nothing
Motor (6)
- obeys commands -localises to pain, -flexes to pain -abnormal response to pain -extension to pain -nothing

CASE (2 decks)

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