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Lottie's Question Books > Cases Book > Flashcards

Cases Book Flashcards

1
Q

List triad of Sx in CCF

A

SOB, Na and water retention (oedema)

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2
Q

List signs O/E of CCF

A

S3 gallop rhythm
Cardiomegaly
Neck vein distention

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3
Q

List Ix for CCF

A

BNP, FBC, U&Es, BGC, LFTs

Echo, ECG, CXR

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4
Q

How is CCF categorised?

A

NYHA

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5
Q

List categories of NYHA classification

A 
I = mild 
II = Limited physical activity 
III = Moderate, gentle activity causes Sx 
IV = Severe, Sx at rest
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6
Q

List Mx of CCF

A

Diuretics, ACEi, B blockers, valsartan

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7
Q

Define PBC

A

Chronic disease of small intra hepatic ducts characterised by progressive bile duct damage and portal tract inflammation

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8
Q

List risks of developing PBC

A

Female, 45-60y/o
PMH or FH of AIDs
Sjorgens / scleroderma / coeliac / RA / thyroid problems

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9
Q

What AB is positive in PBC?

A

Anti mitochondrial antibodies

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10
Q

Sx of PBC?

A

Can be none

Jaundice, fatigue, pruritis, xs pigment, xanthelasma

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11
Q

Ix for PBC?

A

LFTs (ALP and GGT raised)
AB screen
USS abdo
Clotting and lipids

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12
Q

Describe pathophysiology of MG

A

Faulty ACh Rs causing auto antibodies to ACh R

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13
Q

What is defining feature of MG?

A

Fatiguability (worse on exertion, better with rest)

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14
Q

What is MG linked to?

A

Thyroid hyperplasia

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15
Q

What is pathophysiology of Lambert Easton?

A

ABs to VGCC causing weakness which is better with activity

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16
Q

List types of pneumoconiosis

A

Asbestosis, silicosis, coal workers lung

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17
Q

List Sx of pneumoconiosis

A

Nothing

Gradual SoB, dry cough, reduced exercise tolerance

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18
Q

List CXR findings of pneumoconiosis

A

Upper zone = egg shell calcification
Round opacities
Lower zone = interstitial fibrosis and pleural thickening

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19
Q

What causes MM?

A

Clonal proliferation of plasma cells in bone marrow

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20
Q

Sx of MM?

A

CRAB
C = hypercalcaemia Sx (stones, bones, throans, abdo moans, psychic groans)
R = renal failure - dark urine, recurrent UTI
A = anaemia (pale, SoB, fatigue)
B = bones (pain, fractures)

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21
Q

List Ix and results for MM

A

Blood film –> bence jones proteins
LFTs –> all normal inc NORMAL ALP
Serum/urine electrophoresis –> increased protein
Bone marrow biopsy –> >30% plasma cells

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22
Q

What is triad of anti-phospholipid syndrome?

A

Thromboses - DVT, PVD, stroke
Pregnancy loss - miscarriage, pre-eclampsia
Anti PL ABs - lupus anticoagulant, anti-cardiolipin

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23
Q

List Sx of SLE

A 
SOAP BRAIN MD 
Serositis (pleuritis, pericarditis) 
Oral ulcers 
Arthritis 
Photosensitivity 
Blood disorders (low platelets, haemolytic anaemia, low leukocytes) 
Renal problems (proteinuria, red cell casts) 
Anti-nuclear ABs 
Immunology (anti double stranded DNA, anti smooth muscle) 
Neuro Sx (psychosis, seizures)

Malar rash
Discoid rash

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24
Q

What is the key AB of SLE?

A

Anti nuclear ABs

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25
Q

Who is the typical SLE patient?

A

15-45y/o, Afro/Asian female

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26
Q

What is achalasia?

A

Motor disorder with loss of O peristalsis and failure of lower O sphincter to relax post swallow

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27
Q

What causes achalasia?

A

Loss of neurones in myenteric plexus

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28
Q

Sx /signs of achalasia?

A 
Dysphagia to solids and liquids 
Regurgitation 
Pain 
Weight loss 
Nausea and vomitting
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29
Q

Ix and result of achalasia?

A

Barium swallow - bird beak appearance

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30
Q

Define PSC

A

Inflammation and injury of medium/large bile ducts leading to fibrosis and strictures

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31
Q

Describe typical PSC patient

A

Male, 40-50y/o, with UC

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32
Q

Sx of PSC?

A

Abdo pain, pruritus, fatigue, weight loss, fever, jaundice

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33
Q

What AB is positive in PSC?

A

pANCA

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34
Q

What complication is linked to PSC?

A

Cholangiocarcinoma

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35
Q

Ejection systolic murmur

A

Aortic stenosis

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36
Q

Early diastolic murmur

A

Aortic regurg

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37
Q

Mid diastolic murmur with opening snap

A

Mitral stenosis

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38
Q

Pansystolic murmur

A

Mitral regurg

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39
Q

Collapsing pulse, wide pulse pressure

A

Aortic regurg

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40
Q

Quiet S1, split S2 in severe. Blowing sound.

A

MR

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41
Q

Loud S1, with S3 present and displaced apex beat. Rumble sound

A

MS

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42
Q

Soft S2. S4 present.

A

AS

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43
Q

Syncope, angina and dyspnoea.

A

AS

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44
Q

Quinckes and de MUssets?

A

AR

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45
Q

Causes include rheumatic fever, IE, Marfans, MV prolpase

A

MR

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46
Q

Graham Steel murmur

A

MS causing pulm HTN

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47
Q

Tapping apex beat

A

MS

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48
Q

Displaced apex beat

A

MR

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49
Q

S3 present

A

MR

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50
Q

S4 present

A

AS

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51
Q

Narrow pulse pressure and slow rising pulse

A

AS

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52
Q

Heaving apex beat

A

AS

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53
Q

Pistol shot over femorals

A

AR

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54
Q

Rheumatic heart disease, AF and malar rash

A

MS

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55
Q

The most common murmur

A

AS

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56
Q

What is carcinoid syndrome?

A

Tumour of ileum enterochromaffin cells (release serotonin) which metastasise to liver

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57
Q

What precipitates carcinoid syndrome?

A

Stress, alcohol, caffeine

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58
Q

Sx carcinoid syndrome?

A 
CARC
- cutaneous flushing 
- asthmatic wheeze 
- R murmur 
- cramps and diarrhoea 
Low BP
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59
Q

Ix for carcinoid syndrome?

A

Urinary 5-HIAA (serotonin)

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60
Q

Which IBD: has bloody diarrhoea and tenesmus?

A

UC

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61
Q

Which IBD: has diffuse pain ?

A

UC

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62
Q

Which IBD: has ulcers and perianal abcesses?

A

CD

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63
Q

Which IBD: has RIF pain?

A

CD

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64
Q

Which IBD: has risk of gallstones and fistula?

A

CD

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65
Q

Which IBD: PSC and colorectal cancer?

A

UC

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66
Q

Which IBD: has skip lesions?

A

CD

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67
Q

Which IBD: is continous?

A

UC

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68
Q

Where does UC effect?

A

Rectum to ileocaecal valve

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69
Q

Which layers does UC affect?

A

Mucosa and submucosa

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70
Q

Which IBD: affects all layers?

A

CD

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71
Q

What is histology of UC?

A

Depletion of goblet cells
Crypt abcesses
Pseudopolyps

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72
Q

What is histology of CD?

A

Goblet cell hyperplasia
Granulomas
Cobblestone on colonoscopy

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73
Q

What is AXR of CD?

A

Strictures

Rose thorn ulcers

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74
Q

What is AXR of UC?

A

Loss of haustra

Drainpipe colon

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75
Q

List 3 common extra GI features of IBD

A

Arthritis
Erythema nodosum
Pyoderma gangrenosum

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76
Q

How do you induce remission for UC?

A

Aminosalicylates +/- steroids

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77
Q

How do you induce remission for CD?

A

Glucocoticosteroids or budesonide

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78
Q

How do you maintain remission for UC?

A

Aminosalicylates & azothioprine

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79
Q

How do you maintain remission for CD?

A

Smoking cessation

Azothioprine or mercaptopurine

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80
Q

List types of SVT

A

AF, WPW, Atrial flutter, paroxysmal SVT

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81
Q

List Sx of SVT

A

Palpitations, SoB, chest pain, dizziness, syncope

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82
Q

What is the Mx of SVT?

A

Adenosine or flecainide

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83
Q

How do you Mx AF?

A

Rate control: beta blocker or CCB

Rhythm control: Dc cardiovert

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84
Q

What is WPW?

A

Re-entry circuit (bundle of kent)

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85
Q

What is seen on ECG of WPW?

A 
Delta wave (wide QRS with slurred upstroke) 
Short PR interval
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86
Q

What is WPW associated with?

A

Ebsteins anomaly

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87
Q

Describe pathophysiology of Alzheimers?

A

Cerebral atrophy
Type A beta amyloid plaque deposition
Tau protein tangles

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88
Q

List Sx of Alzheimers

A

Memory and language problems

Global deficits

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89
Q

List Sx of vascular dementia

A

CVD risk factors
Focal problems - visual / sensory /etc
Sudden, STEPWISE deterioration

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90
Q

Describe pathophysiology of Lewy Body dementia?

A

Lewy bodies in substantia nigra, paralimbic and neocortex

91
Q

List Sx of Lewy Body dementia

A 
Visual hallucinations 
Progressive cognitive impairments 
- attention and executive function are first to go 
- can be fluctuating 
PD Sx
92
Q

List Sx of fronto-temporal dementia

A

Disinhibition and change in personality

Hyperorality

93
Q

Vertigo, tinnitus and sensorineural hearing loss over minutes to hours in one ear only. Dx?

A

Menieres

94
Q

Sudden onset dizziness and vertigo due to changes in head position with nausea. Dx?

A

BPPV

95
Q

Ix for BPPV?

A

Dix-Hallpike manoeuvre

96
Q

What is positive sign in Dix Hallpike for BPPV?

A

Delayed onset (>2s) torsional nystagmus unilaterally

97
Q

Mx of BPPV?

A

Epley manouvre

98
Q

What is haemochromatosis?

A

Autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation

99
Q

Sx of haemochromatosis?

A

Bronze skin
DM
Fatigue, ED, arthralgia
Liver disease

100
Q

What does a target cell on blood film indicate?

A 
Sickle cell 
Thalassaemia 
Iron deficiency anaemia 
Hyposplenism 
Liver disease
101
Q

What does a tear drop cell / poikilocyte on blood film indicate?

A

Myelofibrosis

102
Q

What does a spherocyte cell on blood film indicate?

A

Hereditary spherocytosis

AI haemolytic anaemia

103
Q

What does a Howel Jolly body cell on blood film indicate?

A

Hyposplenism

104
Q

What does a Heinz body on blood film indicate?

A

G6PD deficiency

Alpha thalassaemia

105
Q

What does a schistocyte on blood film indicate?

A

Haemolysis
DIC
Mechanical heart valve

106
Q

What does a poikilocyte / pencil cell on blood film indicate?

A

Iron deficiency anaemia

107
Q

What does a burr cell on blood film indicate?

A

Uraemia

Pyruvate kinase deficiency

108
Q

What does a rouleaux on blood film indicate?

A

MM

109
Q

What does a smear / smudge cell on blood film indicate?

A

CLL

110
Q

What does an auer rod on blood film indicate?

A

AML

111
Q

What does hypersegmented neutrophil on blood film indicate?

A

Vit B12 deficiency

112
Q

What does a reed steenberg cell on blood film indicate?

A

Hodgkins lymphoma

113
Q

Which skin infection is in the dermis and sub cut fat?

A

Cellulitis

114
Q

Where does erysipelas effect?

A

Epidermis

115
Q

Which skin infection is well demarcated?

A

Erysipelas

116
Q

Which skin infection has systemic Sx such as fevers and rigors?

A

Erysipelas

117
Q

Which skin infection has a risk of sepsis?

A

Cellulitis

118
Q

List risks of cellulitis / erysipelas

A

Wounds, ulcers, bites, cannula, immunosuppression

119
Q

List complications of cellulitis

A

Abscess, sepsis, necrotising fasciitis, periorbital cellulitis

120
Q

Mx of cellultiis / erysipelas?

A

Draw a line around the border to monitor spread
Analgesia, fluids
Oral ABx - flucloxacillin

121
Q

List classical findings of TLS

A

High K
High PO43
High uric acid
LOW Ca

122
Q

List Sx of TLS

A 
Arrhythmias 
Gout 
Seizures 
Anorexia, N/V, diarrhoea  
Muscle cramps
123
Q

List risks of developing GN

A

Infection - Hep B/C, group A strep, IE, HIV, RTI, GIT infections
Connective tissue disorders eg SLE, vasculitides
Cancer - HL, lung, colorectal, blood
HUS
Drugs

124
Q

List Ix for GN

A

Urinalysis and MC&S
LFTs, FBC, lipids
Albumin, creatinine, GFR
Kidney USS

125
Q

List Sx of pilonidal sinus

A

Discharge / pain / swelling / sinus tract in sacrococcygeal areas

126
Q

What is a pilonidal sinus

A

Acquired disease in which a hair follicle becomes inserted in skin, creating chornic sinus tract in natal cleft

127
Q

Who gets pilonidal sinuses?

A

16-40y/o males with PMH natal cleft

128
Q

What is Mx of pilonidal sinus?

A

1st = hair removal and hygiene
If Sx - surgical closure
If abscess - surgical drainage

129
Q

What do erythema multiforme look like?

A

Target lesions which are symmetrical with a central blister

130
Q

Where do you get erythema multiforme?

A

Start on hands then spread to palms, soles of feet and limbs

131
Q

What is Stevens Johnson syndrome?

A

Erythema multiforme + fever + mucosal involvement

132
Q

List Sx of cerebral abscess

A

Fever, headache, seizures, raised ICP

133
Q

List risks of developing a cerebral abscess

A

Facial infections eg sinusitis or otitis media
Endocarditis
Fractures

134
Q

List Ix and Mx for cerebral abscess

A 
Ix = CT head, ESR, blood cultures 
Mx = IV ABx
135
Q

What ABx would you use for strep / anaerobes causing cerebral abscess ?

A

IV cef and met

136
Q

What ABx would you use for staph causing cerebral abscess ?

A

IV fluclox and cef

137
Q

What is sarcoidosis?

A

Multisystem granulomatous disorder of unknown causes

138
Q

Who is the typical sarcoid patient?

A

20-40y/o Afro Carribean woman with HLA DRB1

139
Q

List acute Sx of sarcoid

A 
Fever
Erythema nodosum
Polyarthralgia 
Dry cough
Progressive SoB
140
Q

What is seen on CXR of sarcoid?

A

Bilateral hilar lymphadenopathy

141
Q

List non resp Sx of sarcoid

A 
Lymphadenopathy 
Hepatosplenomegaly 
Conjunctivitis / glaucoma / uveitis 
Parotid enlargement --> Bells palsy 
Erythema nodosum
142
Q

List Ix for sarcoid

A

BLOODS: ESR, FBC, LFT, ACE, Ca
CXR
Tissue biopsy (transbronchial)

143
Q

What are the blood results for sarcoid?

A

Raised Ca and ACE

144
Q

What is the tissue biopsy result of sarcoid?

A

Non caseating granulomas

145
Q

What is the Tx for mild sarcoid?

A

Bed rest and NSAIDs

146
Q

What is the Tx for symptomatic sarcoid?

A

Prednisolone 40mg for 4-6weeks

147
Q

Name and describe 2 types of hiatus hernias

A 
Sliding = stomach pushes up oesophagus 
Rolling = stomach squishes up next to oesophagus
148
Q

Which type of hiatus hernia is more common?

A

Sliding (80%)

149
Q

List risks of developing a hiatus hernia

A

Obesity
Previous GI surgery
Raised intra-abdo pressure

150
Q

List a key sign of a hiatus hernia O/E ?

A

Bowel sounds in chest

151
Q

List Sx of hiatus hernia

A

Symptomatic GORD
Lower dysphagia
Painless regurg of food

152
Q

List gold standard Ix for haitus hernia

A

Barium swallow

153
Q

What condition is suggested by the auto antibody anti TPO?

A

Hashimotos

154
Q

What condition is suggested by the auto antibody Anti TSH R?

A

Graves

155
Q

What condition is suggested by the auto antibody anti soluble liver Ag?

A

AI hepatitis type III

156
Q

What condition is suggested by the auto antibody anti mitochondrial AB?

A

PBC

157
Q

What condition is suggested by the auto antibody anti smooth muscle?

A

AI hepatitis type I

158
Q

What condition is suggested by the auto antibody anti GBM?

A

Goodpastures

159
Q

What condition is suggested by the auto antibody anti cardolipin?

A

Anti phospholipid syndrome

160
Q

What condition is suggested by the auto antibody anti parietal cell?

A

pernicious anaemia

161
Q

What condition is suggested by the auto antibody anti CCP?

A

RA

162
Q

What condition is suggested by the auto antibody anti adrenocortical ?

A

Addisons

163
Q

What condition is suggested by the auto antibody cANCA?

A

Granulomatosis with polyangiitis

164
Q

What conditions are suggested by the auto antibody pANCA?

A

UC, PSC, eosinophilic granulomatosis with polyangiitis

165
Q

What condition is suggested by the auto antibody anti nuclear ABs?

A

systemic sclerosis

166
Q

What condition is suggested by the auto antibody anti centromere?

A

Systemic sclerosis

167
Q

What condition is suggested by the auto antibody anti-topoisomerase II?

A

DIffuse cutaneous sclerosis

168
Q

What condition is suggested by the auto antibody anti dsDNA?

A

SLE

169
Q

What condition is suggested by the auto antibody anti Lo and anti Ra?

A

Sjorgrens

170
Q

Name 3 types of cardiomyopathy

A

Dilated, restrictive and hypertrophic

171
Q

Describe aetiology of dilated cardiomyopathy

A

viral, alcoholic, cocaine, FHx, hyperthyroidism, haemochromatosis

172
Q

Describe aetiology of hypertrophic cardiomyopathy

A

Genetic (Beta myosin / troponin T / alpha tropomyosin)

173
Q

Describe aetiology of restrictive cardiomyopathy

A

Amyloidosis, sarcoidosis, haemochromatosis

174
Q

Describe Sx of dilated cardiomyopathy

A

Heart failure Sx, arrhythmia, embolus, FH sudden death

175
Q

Describe Sx of hypertrophic cardiomyopathy

A

None - sudden death

Syncope / angina / arrhythmia

176
Q

Describe Sx of restrictive cardiomyopathy

A

dyspnoea, fatigue, swelling

177
Q

Describe signs O/E of dilated cardiomyopathy

A

Raised JVP, displaced apex beat, S3, MR/TR

178
Q

Describe signs O/E of hypertrophic cardiomyopathy

A

Jerky carotid pulse

Double apex beat

179
Q

Describe signs O/E of restrcitive cardiomyopathy

A

Raised JVP
Kussmauls sign
S3
Swelling

180
Q

List Ix for cardiomyopathy

A

CXR
ECG
Echo

181
Q

What will hypertrophic cardiomyopathy show on ECG?

A

Left axis deviation
LVH
Q waves in inf/lat

182
Q

What will echo show for dilated cardiomyopthy?

A

Baggy ventricles

183
Q

What will echo show for hypertrophic cardiomyopthy?

A

Ventricular hypertrophy, esp septum

184
Q

What will echo show for restrictive cardiomyopthy?

A

Normal ventricles but large atria

185
Q

List risks of developing HL

A

20-30 or >50y/o
Male
EBV

186
Q

Describe Sx of HL

A

Painless enlarging neck mass in neck / axilla / groin
–> painful after alcohol
B Sx - FLAWS

187
Q

Describe signs O/E of HL

A

Splenomegaly

Non tender, firm lymphadenopathy

188
Q

List Ix for HL

A

FBC
Lymph node biopsy
Bone marrow aspirate

189
Q

What will FBC show for HL

A

Low Hb, Raised WCC, Raised ESR

190
Q

How do you stage HL?

A

Ann arbour staging

191
Q

What is diagnostic of HL?

A

Reed Sternberg cells on histology

192
Q

Name 2 types of focal seizures and differentiate between them

A

Simple partial (aware) and complex partial (impaired awareness)

193
Q

List localising features of focal seizures in the temporal lobe

A

Hallucinations, automatisms, deja vu

194
Q

List localising features of focal seizures in the frontal lobe

A

Head / leg movements, posturing

195
Q

List localising features of focal seizures in the parietal lobes

A

Parasthesia

196
Q

List localising features of focal seizures in the occipital lobes

A

Floaters / flashers

197
Q

What is Mx of focal seizures?

A

Lamotrigine or cabamazepine

198
Q

What is characteristic of generalised seizures?

A

LOC

199
Q

Name 4 types of generalised seizures?

A

Tonic clonic
Abscence
Non convulsive status epilepticus
Myoclonic

200
Q

List features of tonic clonic seizure

A 
Vague aura 
Muscle spasms 
Incontinence 
Tongue biting 
Post ictal conufsion
201
Q

List features of abscence seizures

A

LOC but retained posture
Blinking eyes / eyes roll up
No post ictal phase

202
Q

List features of myoclonic seizures

A

In clusters after waking up

203
Q

What is status epilepticus?

A

30+ mins of seizure

204
Q

What is Mx of status epilepticus ?

A

ABCDE
Check glucose
IV lorazepam / PR diazepam
Not working? Transfer to ITU and give IV phenytoin on ECG monitoring

205
Q

What causes ITP?

A

Anti platelet ABs from spleen attack GLP IIb - IIIa Ags

206
Q

Who gets ITP?

A

Kids after a viral infection

207
Q

Sx of ITP?

A

Easy bruising, mucosal bleeds, epistaxis

208
Q

Ix and results for ITP?

A 
FBC (low platelets) 
Clotting screen (normal)
209
Q

List Sx of TTP

A

Fever, renal failure, haemolytic anaemia, thyrombocytopenia, neuro Sx

210
Q

Who is the typical TTP patient?

A

39y/o black female

211
Q

List Ix and results for TTP

A 
FBC (anaemia, low platelets) 
Blood smear (schistocytes) 
LDH and BR (raised) 
Urinalysis (++ protein) 
U&Es (raised U & C)
212
Q

Where is the lesion in the following strokes:

contralateral hemiparesis and sensory loss. Lower limb > upper limb ?

A

ACA

213
Q

Where is the lesion in the following strokes:

contralateral hemiparesis and sensory loss. Upper limb > lower limb. Contralateral homoymous hemianopia and aphasia.

A

MCA

214
Q

Where is the lesion in the following strokes:

homonymous hemianopia with macular sparing. Visual agnosia ?

A

PCA

215
Q

Where is the lesion in the following strokes:

Ipsilateral CN 3 palsy. Contralateral limb weakness (webers syndrome) ?

A

Posterior branches to midbrain

216
Q

Where is the lesion in the following strokes:

ipsilateral facial pain/temp loss. Contralateral limb/torso pain/temp loss. Ataxia, nystagmus (LMS)?

A

Posterior inferior cerebellar

217
Q

Where is the lesion in the following strokes:

Ipsilateral facial paralysis and deafness. Similar Sx to Lateral Medullary Syndrome. (aka Lateral pontine syndrome) ?

A

Anterior inferior cerebellar

218
Q

Where is the lesion in the following strokes:

Amarosis fugax ?

A

Retinal / opthalmic artery

219
Q

Where is the lesion in the following strokes:

Locked in sydnrome ?

A

Basilar

220
Q

Where is the lesion in the following strokes:

isolated hemiparesis / sensory loss / ataxia ?

A

Lacunar infarct

221
Q

What type of inheritence is a1atd?

A

Autosomal recessive

222
Q

What does alpha 1AT protect against?

A

Neutrophil elastase

223
Q

Sx of A1AT deficiency?

A

Emphysema –> cough, SoB, freq URTI

Cirrhosis / HCC or cholestasis

224
Q

Ix for A1AT deficiency?

A

A1AT levels / plasma AAT
Spirometry - obstructive
Phenotyping

Lottie's Question Books (15 decks)

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