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Y2 Revision > CCE 2 Medicine revision > Flashcards

CCE 2 Medicine revision Flashcards

1
Q

DM

a) macrovascular complications
b) microvascular complications

A

a) CVA, IHD, PVD
b) Retinopathy, Neuropathy, Nephropathy

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2
Q

Genetic type associated with DMT1

A

HLA- DR3/4

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3
Q

3 things in DKA

A
  • Ketoacidosis
  • Osmotic diuresis
  • Potassium imbalance
    • Serum can be normal as balanced by kidneys
    • Total- insufficient K+ in cells
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4
Q

Management of DKA

A
  • Fluids
  • Insulin (once K+ reached 3.3mmol)
  • Glucose monitoring
  • Potassium- correct & monitor
  • Infection- treat
  • Chart fluid balance
  • Ketones
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5
Q

Atheroma pathophysiology

A
  • Exposure of endothelium to LDLs, adhesion molecules etc…
  • Adhesion molecules allow leukocytes to stick to arterial wall
  • Blood monocytes oxidise LDL –> Foam cells
  • Macrophage foam cells release cytokines –> smooth muscle cell migration (from media to intima) & smooth muscle proliferation
  • FIbroblasts form protective CT capsule
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6
Q

ECG changes in NSTEMI

A
  • ST depression
  • T wave inversion
  • Pathological Q wave
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7
Q

ECG leads, their territories and the artery

A
  • Anterior/ Septal = LAD
    • V1-V4,
  • Lateral = Circumflex
    • V5,V6, I, avL
  • Inferior = RCA
    • II, III, avF
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8
Q

Secondary prevention of ACS

A

​Antiplatlet x2, Statin, ACEi, Betablocker

  • Aspirin 75mg once daily
  • Another antiplatelet: e.g. clopidogrel or ticagrelor for up to 12 months
  • Atorvastatin 80mg once daily
  • ACE inhibitors (e.g. ramipril titrated as tolerated to 10mg once daily)
  • Atenolol (or other beta blocker titrated as high as tolerated)
  • Aldosterone antagonist for those with clinical heart failure (i.e. eplerenone titrated to 50mg once daily)
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9
Q

Layers of the heart

A
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10
Q

Finding of pericarditis on ECG

A

Wide spread saddle shape ST elevation

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11
Q

NYHA grading

A
  • Class 1: Ordinary physical activity doesn’t cause angina. Strenous activity does
  • Class 2: SLight limitation of ordinary acitivity eg- climbing stairs
  • Class 4: Marked limitiation of ordinary pysical activity eg: 100-200m on flat
  • Class 4: Inability to carry any physical activit without discomfort
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12
Q

If someone presented with a ‘sore throat’ what differentials would you be thinking off and what organisms/ aetiology? Also consider symptoms

A
  • Acute pharyngitis
    • Group A strep- lack of cough
    • Viral- cough
  • Acute tonsilitis
    • If bacterial- STREP A is common
  • Quinsy
    • Strep. pyrogens
  • Common cold
    • Rhinovirus common
  • Rhino-sinitus
    • Often viral, Strep. pneumoniae
  • Acute bronchitis
    • Viral (common)
  • Infectious mono
    • Splenomegaly, Spleen rupture (be aware!!)
    • Maculopapular rash
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13
Q

What is Beck’s Triad

A

Sign of cardiac tamponade

  • Hypotension
  • Distended neck veins/ elevated JVP
  • Muffled heart sounds
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14
Q

Management of acute HF

A

OMFG

  • Oxygen
  • Morphine
  • Frusimide
  • GTN- under cardio advice if BP stable
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15
Q

Classic triad of Aortic stenosis

A
  • Dysponea
  • Chest pain/ angina
  • Syncope
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16
Q

Pathophysiolgy of asthma

A
  • APC present to Th2 lymphocyte –> Activation of B cells to plasma cells producing IgE. Expression of IgE on mast cells
  • Antigen cross links on IgE on mast cells –> degranulation
  • Cytokines –> Inflammation
  • Proteases –> Tissue damage
  • Prostoglandins –> Vascular dilation
  • Leukotrienes –> SMC
  • Vasoactive amines –> SMC & vascular dilation

Eosinophils attracked to area

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17
Q

Treatment of asthma stepwise ladder

A
  1. Short acting beta agonist- Salbutamol
  2. Add low dose ICS
  3. Add LABA (salmeterol)
  4. Leukotriene receptor antagonist (motelukast) OR increase ICS to medium dose
    1. if no response to LABA consider stopping
  5. Specialist therapy
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18
Q

Treatment of acute asthma

A
  • Oxygen
  • Salbutamol nebs
  • Hydrocortisone (IV) or PO Pred
  • Ipatropium bromide (antimuscarinic) nebs
  • Theophyline IV

Consider intubation and Abx if necessary

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19
Q

ABG in asthma

a) Initially
b) If person is tiring- THIS IS CONCERNING and suggests life threatening asthma

A

a) Respiratory alkalosis (as tachypnoea)
b) Normal pCO2 or hypoxia

Resp acidosis is a bad sign in asthma

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20
Q

Most common cause of pneumonia bacterial

A

Strep. pneumoniae

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21
Q

ARDS

a) What is it?
b) How does it initially present?
c) Berlin’s criteria for ARDS
d) What is often shown on the CXR?

A

Severe inflammatory reaction to lung damage with bilateral pulmonary infiltrates not accounted for by HF or fluid overload

Initially presents as RFT1 (can progress)

Berlin’s criteria: Acute onset, Resp failure <1 week after a known/suspected trigger, Decreased FiO2/PO2, Should exclude CHF, other causes

  • Bilateral opacities (similar to pulmonary effusion)
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22
Q

Well’s score cut off

A

= 4

If low risk do D-dimer and if -ve –> go home

If D-dimer high then do CTPA

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23
Q

2 main divisions of lung cancer

A
  1. Non-small cell:
    1. SCC, Adenocarcinoma, Large cells
  2. Small cell:
    1. Contrains neurosecretory graunules –> neuroendocrine hormones
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24
Q

What type of inheritance is CF and where is the mutation?

What is the patho?

A

a) Autosomal recessive
b) CTFR gene deltaF508
c) ATP gated chloride channel absent/ defective on cell surface on epithelial cells –> thick & sticky secretions

Affects sweat glands- so excessive NaCl in sweat (here failure to reabsorb)

Exocrine glands- Hyperviscous mucus (reduced Cl- secretion –> increased Na reabsorption –> increased water absorption)

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25
Q

What happens histologically in Barrett’s?

A

Metaplasia from squamous to columnar epithelium

26
Q

What is Hodkim’s Lymphoma?

A
  • Proliferation of lymphocytes (mature B cells)
27
Q

In Hodgkin’s lymphoma what would you seen on the bx?

A
  • Reed- Sternbery cell
    • Abnormally large B cells
    • Multiple nuclei & nucleoli (owl face appearance)
28
Q

What is HIV and what is it’s pathophysiology?

A
  • RNA Retrovirus destryoing CD4 T helper cells
29
Q

What are the types of HIV testing?

A
  • Antibody test (usually hospital) may be negative for 3 months
  • P24 antigen in blood (screening test)
  • PCR testing- HIV RNA (viral load)
30
Q

Hypotonic hyponatraemia

A

Split into 3 different types to do with volaemia

  • Hypovolaemia
  • Euvolaemia
  • Hypervolaemia

Urine concentration of Na can help decide the cause

31
Q

Causes of Isotonic hyponatraemia

A

(Elevated concentration of serum proteins or lipids –> dilution of plasma sodium)

  • Hyperlipidaemia
  • Paraproteinaemia
32
Q

Causes of hypertonic hyponatraemia

A
  • Hyperglycaemia
  • Mannitol
  • ADH
33
Q

Types of hypernatraemia

A
  • Hypovoalaemic
  • Euvolaemia
  • Hypervolaemic
34
Q

Give some infections that haemoptysis may arise

A

Usually infection of medium sized airways

  • Acute bronchitis (viral or bacterial)
  • Exacerbation of chronic bronchitis
  • Pulmonary TB
35
Q

Classic triad of aortic stenosis

A
  • Dysponea
  • Chest pain
  • Syncope
36
Q

When is the physiology of S3 and S4 heart sounds

A

S3: overly compliant LV

S4: Non compliant LV

37
Q

What is rheumatic fever

A

Post/ not treated properly Strep A infeciton (throat or scarlet fever)

Symptoms of rheumatic fever can include:

  • Fever
  • Painful, tender joints (arthritis), most commonly in the knees, ankles, elbows, and wrists
  • Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
  • Fatigue
  • Jerky, uncontrollable body movements (called “chorea”)
  • Painless lumps (nodules) under the skin near joints (this is a rare symptom)
  • Rash that appears as pink rings with a clear center (this is a rare symptom)

In addition, someone with rheumatic fever can have:

A new heart murmur

An enlarged heart

Fluid around the heart

38
Q

How is calcium level

a) increased
b) decreased

A

a) PTH secretion from chief cells

  • Reabsorption from Kidney
  • Bone resorption
  • Increased Vit D production which stimulates 1-alpha hydrozylase in kidney causing 25(OH)D to 1,25 (OH)2D (–> increased Gut uptake)

b) Calcitonin from C cells (parafollicular cells) in thyroid

NB: Phosphate affects calcium. As calcium rises phosphate will fall.

39
Q

What is Sarcoidosis?

A

Granulomatous inflammatory condition

  • Mainly affects lungs- mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules
40
Q

Clinic readings of HTN

A
  1. >140/90
  2. >160/100
  3. >180/100
41
Q

Tx of HTN

A

1)

  • ACEi or ARB (<55yrs and non-black OR DMT2)
  • CCB (>55yrs and no DMT2 OR black with no DMT2)

2)

    • CCB or thiazide
  • +ACEi or ARB (preferred in black) or thiazide

3) ACEi or ARB + CCB + Thiazide
4) + consider low does Spironolactone + Specialist advice

42
Q

Nephrotic syndrome

A
  • Proteinuria
  • Hypoalbuminaemia
  • Peripheral oedema
43
Q

BNP- elevated or lower levels

A

Elevated BNP levels! Released when increased volume in ventricles

44
Q

Features of nephritic syndrome

A
  • Haematuria
  • Oliguria
  • Proteinuria
  • Fluid retention
45
Q

Give some causes of Nephrotic syndrome?

A
  • Minimal change disease
  • Focal segmental glomerulosclerosis
  • Membranoproliferative glomberulonephrits
46
Q

Give some causes of Nephritic syndrome

A
  • IgA nephropathy
  • Post-strep glomerulonephritis
  • Rapidly progressive glomerulonephritis
  • Goodpastures syndrome
    • Anti GBM antibodies attack glomerulus & pulmonary BM
47
Q

What is Amyloidosis

A

Amyloidosis is a collective term for the extracellular deposition of abnormal proteins, either in a single organ (localized amyloidosis) or throughout the body (systemic amyloidosis).

Types:

  • AL/ Light chain (eg- from plasma cell dyscrasia eg mutiple myeloma)
    • Increased production of light chains & depositions
  • AA/ Reactive (chronic inflammatory- SLE, IBD, RA or chronic infectious- TB
    • AA from inflammation
48
Q

TACS

A

need all 3

  • Unilateral weakness AND/OR sensory deficit
  • Homonymous hemianopia (due to pressure on optic tract)
  • Higher cerebreal dysfunction
49
Q

PACS

A

need 2 of:

Unilateral weakness AND/OR sensory deficit

Homonymous hemianopia (due to pressure on optic tract)

Higher cerebreal dysfunction

50
Q

POCS

A

Need 1 of:

  • Cerebellar/ brainstem (ataxia, nystagmus, vertigo)
  • LOC
  • Isolated homoymous hemianopia
51
Q

LACS

A

Need 1 of:

  • Unilateral weakness AND/OR sensory deficit
  • Pure sensory
  • Ataxic hemiparesis
52
Q

PICA syndrome

A

Acute vertigo & Cerebellar signs

  • Sensory nucleus CNV
  • Sympathetic nerves
  • Spinocerebellar tract
  • Spinothalamic tract
53
Q

6P’s of compartment syndrome

A
  • Pain
  • Pressure
  • Pulselessness
  • Paralysis
  • Paraesthesia
  • Pallor
54
Q

Normal axis deviation

A

-30 to +90

55
Q

LAD

A

-30 to -90

56
Q

RAD

A

+90 to +/-180

57
Q

Severe axis deviation

A

+/-180 to -90

58
Q

Lead I, II & III

A

I= 0

II= 60

III= 120

59
Q

aVL

A

-30

60
Q

aVF

A

+90

61
Q

aVR

A

+150

Y2 Revision (4 decks)

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