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Year 3 Medicine > Cheat Sheet > Flashcards

Cheat Sheet Flashcards

1
Q

What are the crescendo decrescendo murmurs/ ejection systolic?

A

Left sided

  • Aortic stenosis
  • HOCM

Right sided

  • Pulmonary stenosis
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2
Q

What are the holosystolic murmurs?

A

Left sided

  • Mitral regurgitation
  • Ventricular septal defects

Right sided

  • Tricuspid regurgitation
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3
Q

What are the decrescendo murmurs?

A

Left sided

  • Aortic regurgitation

Right sided

  • Pulmonary regurgitation
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4
Q

What are the decrescendo crescendo murmurs?

A

Left sided

  • Mitral stenosis

Right sided

  • Tricuspid stenosis
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5
Q

What is the manoeuvre to increase aortic stenosis?

A

Ask the patient to hold their breath and auscultate the carotids using the diaphragm

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6
Q

What is the manoeuvre to increase aortic regurgitation?

A

Ask the patient to sit forward and fully exhale and auscultate over the right sternal boarder 2nd ICS

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7
Q

What is the manoeuvre to increase mitral regurgitation?

A

Ask the patient to lean on their left side and fully exhale, auscultate at the apex using the diaphragm and at the axilla for radiation

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8
Q

What is the manoeuvre to increase mitral stenosis?

A

Ask the patient to lean on their left side and full exhale and auscultate over the apex with the bell

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9
Q

Which drugs can cause pre-renal AKI?

A
  • Vasoconstrictors
  • Antihypertensives
  • NSAIDs
  • Cyclosporins (occasionally used in Crohn’s)
  • Diuretics
  • Laxatives
  • Tacrolimus
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10
Q

What is tacrolimus?

A

An immunosuppresant drug commonly prescribed to patients after organ transplant

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11
Q

What is osteopetrosis?

A

Increased bone density which can make bones brittle and liable to break

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12
Q

How does hypothyroidism lead to arthritis?

A

Hypothyroidism increases TSH levels and TSH increases deposition of proteins in the joints

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13
Q

What would blood results for osteopetrosis show?

A
  • Normal/ low serum Ca2+
  • Normal serum PO43-
  • Normal ALP
  • Normal PTH

Dense and brittle bones

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14
Q

What is Paget’s disease of the bone?

A

Pathological remodelling of the bones leading to abnormal bone formation

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15
Q

What would bloods for Paget’s disease of the bone show?

A
  • Normal Ca2+
  • Normal PO43-
  • Increased ALP
  • Normal PTH
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16
Q

What is osteitis fibrosa cystica?

A

It results due to hyperparathyroidism and is abnormal breakdown of bone with bone tissue replaced with fibrous tissue

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17
Q

What are the blood results for osteomalacia/ rickets?

A
  • Low Ca2+
  • Low PO43-
  • High ALP
  • High PTH
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18
Q

What is the mechanism of tertiary hyperparathyroidism?

A

Chronic secondary hyperparathyroidism that leads to hyperplasia of the PTH glands with very high levels of PTH and normal-high calcium

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19
Q

How is GCS calculated?

A

Motor
6- movement on command
5- localises to pain
4- withdraws from pain
3- abnormal flexion
2- abnormal extension
1- no movement

Verbal
5- fully orientated
4- confused
3- inappropriate words/ sentences
2- incomprehensible sounds
1- no speech

Eyes
4- opens eyes spontaneously
3- opens eyes on command
2- opens eyes to pain
1- does not open eyes

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20
Q

What GCS would indicate minor brain injury?

A

15-13

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21
Q

What GCS would indicate moderate brain injury?

A

13-8

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22
Q

What GCS would indicate severe brain injury?

A

8-3

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23
Q

What GCS would require airway support?

A

8

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24
Q

What is AFP a tumour marker for?

A
  • Testicular teratomas
  • Hepatocellular carcinoma
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25
Q

What is beta-hCG a tumour marker for?

A
  • Testicular cancers
  • Choriocarcinoma
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26
Q

What is Ca 15-3 a tumour marker for?

A

Breast cancer

(As well as BRCA-1 chromosome 17, BRCA-2 chromosome 13)

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27
Q

What is Ca 19-9 a tumour marker for?

A

Pancreatic cancer

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28
Q

What is calcitonin a tumour marker for?

A

Medullary thyroid cancer, due to the follicular cells in the medulla producing calcitonin

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29
Q

What is CEA a tumour marker for?

A

Colorectal cancer

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30
Q

What is monoclonal Ig a tumour marker for?

A

Multiple myeloma

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31
Q

What is neurone-specific enolase a tumour marker for?

A

Small cell lung cancer

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32
Q

What is placental ALP a tumour marker for?

A
  • Ovarian carcinomas
  • Testicular carcinomas
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33
Q

What is PSA a tumour marker for?

A

Prostate carcinoma

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34
Q

What is S-100 a tumour marker for?

A

Malignant melanoma

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35
Q

What is thyroglobulin a tumour marker for?

A

Thyroid cancer

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36
Q

What is a choriocarcinoma?

A

Carcinoma of the cells left of the placenta post delivery

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37
Q

What is neurogenic shock?

A

Loss of control of the blood pressure and heart rate due to damage to the spinal cord/ nerves

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38
Q

What is the managment of meningitis?

A

IV benzylpenicillin followed by Ceftriaxone

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39
Q

What is the Glasgow score for acute pancreatitis?

A

PaO2 < 7.9mmol/L

Age > 55

Neutrophils >15x10^9

Calcium < 2mmol/L

Renal function (urea >16mmol/L)

Enzymes (LDH >600, AST >200)

Albumin <32 mmol/L

Sugar >10 mmol/L

Score of >3 indicates acute severe pancreatitis

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40
Q

What is the extrinsic vs intrinsic clotting pathway?

A
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41
Q

What is the pathophysiology of haemophilia A vs B?

A

X-linked recessive

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42
Q

What is the inheritance pattern of haemophilia A and B?

A

X-linked recessive

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43
Q

What are the absolute contra-indications for fibrinolysis in ischaemic stroke patients?

A
  • Bleeding disorder
  • Age >75
  • Any previous intracranial haemorrhage
  • Any head trauma
  • Recent surgery
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44
Q

What is seen on blood smear for ALL?

A

Blast cells (as well as on bone marrow aspirate)

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45
Q

Which is the only leukaemia that doesn’t tend to present with hepatomegaly?

A

Chronic myeloid leukaemia although it does present with splenomegaly

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46
Q

What is seen on blood smear of acute myeloid leukaemia?

A

Auer rods

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47
Q

What is seen on blood smear of chronic lymphocytic leukaemia?

A

Smear cells

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48
Q

What is CML associated with?

A

Philadelphia chromosome

Translocation between 9 and 22 involving the BCR-ABL1 gene

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49
Q

What is a common side effect of co-amoxiclav?

A

Cholestatic hepatitis

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50
Q

What is a common side effect of erythromycin?

A

Diarrhoea

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51
Q

What is a common side effect of gentamicin?

A

Nephrotoxicity

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52
Q

What is a common side effect of nitrofurantoin?

A

Pulmonary fibrosis

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53
Q

What does malaria cause on blood smear?

A

Schistocytes

54
Q

Which condition are Heinz bodies commonly observed in?

A

G6PD deficiency

55
Q

What is haemolyric uraemic syndrome?

A

A post E.coli 0157h7 diarrhoea infection that commonly occurs in children with the traid:

  • Renal failure
  • Thrombocytopaenia
  • Microangiopathic haemolytic anaemia
56
Q

What is Henoch Schonlein Purpura?

A

An IgA nephropathy that commonly occurs in children post upper respiratory tract infection consisting of the traid:

  • Purpura
  • Abdominal pain
  • Arthritis
57
Q

What are the blood results for iron deficiency anaemia?

A
  • Decreased Fe2+
  • Decreased Hb
  • Decreased Ferritin
  • Increased Transferrin
  • Decreased Transferrin saturation
  • Increased TIBC
58
Q

What are the blood results for anaemia of chronic disease?

A
  • Decreased serum iron
  • Decreased Hb
  • Increased ferritin
  • Normal/ low transferrin
  • Decreased transferrin
  • Normal/ high TIBC
59
Q

What is thalassaemia trait confirmed by?

A

Hb electrophoresis

60
Q

What is the pathophysiology of anaemia of chronic disease?

A

Increased hepcidin activation leading to increased iron sequestration in the tissues and decreased Fe2+ in the plasma

61
Q

Which HLA is involved in Rheumatoid arthritis?

62
Q

What are the seronegative spondyloarthropathies?

A
  • Psoriatic arthritis
  • Enteropathic arthritis
  • Ankylosing spondylitis
  • Reactive arthritis
63
Q

What are the three small vessel vasculidities?

A
  • Microscopic polyangiitis
  • Granulomatosis with polyangiitis
  • Eosinophilic granulomatosis with polyangiitis
64
Q

Which is the only Hepatitis virus to have DNA rather than RNA?

65
Q

Which hepatitis is most commonly chronic?

A

C is most commonly chronic, however B, C, D and E can all become chronic

66
Q

Which is the only hepatitis virus that will not become chronic?

67
Q

Which antibodies are associated with UC vs Crohn’s?

A
  • Ulcerative colitis- pANCA
  • Crohn’s- ASCA (IgG/IgA)
68
Q

Where are arterial ulcers commonly found?

A
  • Lateral malleolus
  • In between the toes
  • Soles of the feet
69
Q

What is the appearance of arterial ulcers?

A
  • Punched out
  • Rough edges
  • Necrotising tissue
70
Q

What is the skin around an arterial ulcer like?

A
  • Tight and shiny
  • Hairless
  • Pale
  • Pulseless
  • Prolonged cap refill
71
Q

What is the management of an arterial ulcer?

A
  • Anti-platelets
  • Revascularisation
  • Reduction of risk factors
72
Q

Where do pressure ulcers form?

A

On sights of high pressure loading such as bony prominences

73
Q

What is the best initial investigation for arterial ulcer?

74
Q

What is the best initial investigation for venous ulcer?

A

Duplex ultrasound

75
Q

What are the best investigations for neuropathic ulcers?

A
  • Pain
    • Neurofilaments
  • Fine touch
  • Vibration sensation
76
Q

What is the hypertension management algorithm?

A

Black and/ or >55

  1. CCB
  2. ACEi or ARB
  3. Thiazide diuretic
  4. If K+ >4.5 beta blockers, if K+ <4.5 spironolactone

T2DM and/ or <55

  1. ACEi or ARB
  2. CCB
  3. Thiazide diuretic
  4. If K+ >4.5 beta blockers, if K+ <4.5 spironolactone
77
Q

What is the management of T2DM?

A
  1. Monotherapy with metformin or sulphonylurea (gliclazide, glimeperide)
  2. Dual therapy with M/S and DPP-4 inhibitor (-gliptin), SGLT-2 inhibitor (-flozin) or GLP-1 agonist (-tide)
  3. Insulin
78
Q

What is needed on the Duke’s criterion to make a diagnosis of infective endocarditis?

A
  • 2 majors
  • 1 major, 3 minors
  • 5 minors
79
Q

What are the stages of heart failure?

A
  • Class 1- no change to daily activities
  • Class 2- difficulty performing activities on exertion, but comfortable at rest
  • Class 3- marked limitation in physical activites, but comfortable at rest
  • Class 4- unable to complete physcial activites, cardiac pain even at rest
80
Q

What are the symptoms of a middle cerebral artery stroke?

A
  • Contralateral hemisensory deficits face>arm>leg
  • Contalateral weakness
  • Contralateral homonymous hemianopia
  • Aphasia if on the left side
81
Q

What is the difference in hemiparesis between anterior and middle cerebral artery occlusions?

A

Anterior tends to affect the lower extremities, whereas middle tends to affect the upper extremities

82
Q

What temperature should red blood cells be stored at prior to infusion?

83
Q

What is the timeframe of blood transfusion for non-urgent scenarios?

A

Blood should be transfused over 90-120 minutes

84
Q

What is the red blood cell transfusion threashold and haemoglobin aim after transfusion for patients without ACS?

A
  • Threshold- 70g/L
  • Haemoglobin aim- 70-90g/L

Patients with ACS

  • Threshold- 80g/L
  • Haemoglobin aim- 80-100g/L
85
Q

What does fresh frozen plasma contain?

A
  • All the clotting factors
  • Platelets
  • VWB factor
  • Complement
86
Q

What does cryopercipitate contain?

A

It’s a more concentrated version of fresh frozen plasma, therefore the doseage is lower

  • Lots of fibrinogen (usually given to fibrinogen deficient patients)
  • Factor VIII
  • Factor XIII
  • ADAMTS-13
87
Q

When would cryopercipitate be used over fresh frozen plasma?

A

If the patient was fibrinogen (factor I) deficient or has VWB disease

88
Q

What is primary immune thrombocytopaenic purpura?

A

Thrombocytopaenia and petichiae occurring in children approximately 3 weeks after a viral prodrome

It’s often self limiting and is a diagnosis of exclusion, however severe cases can be managed with IVIG/ steroids for active bleeding and

89
Q

What is the management of TTP?

A
  • Consult haematologist
  • Plasma exchange with FFP
90
Q

What is the management algorithm for chronic asthma?

A
  1. SABA
  2. SABA + low dose inhaled ICS
  3. LTRA + low dose inhaled ICS
  4. (+- LTRA) LABA + low dose inhaled ICS
  5. (+- LTRA) LABA as a MART + low dose inhaled ICS
  6. (+- LTRA) LABA as a MART + medium dose inhaled ICS
91
Q

When would you consider reducing maintenance therapy for asthma?

A

If the patient has been on effective asthma therapy for at least 3 months and asthma is well controlled

92
Q

What are the indications of moderate asthma?

A
  • PEFR 50-75% of targeted peak flow or previous best
  • Speech normal
  • Resp rate <25
  • Pulse <110
93
Q

What are the indications of severe asthma?

A
  • PEFR 33-50% of predicted or previous best
  • Unable to speak in full sentences
  • Resp rate >25
  • Heart rate >110
94
Q

What are the indications of life-threatening asthma?

A
  • PEFR <33% previous best or predicted
  • Unable to speak
  • O2 <92%
  • Silent chest
  • CO2 normal is a very bad sign as it indicates fatigue
  • Cyanosis
95
Q

What is the class of theophylline?

A

Bronchodilator

96
Q

What is the management of a life threatening asthma exacerbation?

A
  • A-E assessment
  • High flow O2
  • High dose inhaled SABA
  • Oral prednisolone
97
Q

What is the management of moderate and severe asthma exacerbations?

A

All SABAs in acute asthama should be given via oxygen-driven nebuliser or IV if the patient can’t take via nebuliser

Moderate

  • A-E assessment
  • SABA
  • Oral prednisolone

Severe

  • A-E assessment
  • SABA
  • Oral prednisolone
98
Q

What is the asthma diagnostic pathway for adults over 17 who are symptomatic?

A

Reversible airway obstruction on spirometry with FeNO >40ppb or variability in peak flow readings

99
Q

What investigations should be ordered in suspicion of asthma?

A

Bedside

  • Spirometry with bronchodilator therapy
    • FEV1/FVC
  • PEFR
  • FeNO

Bloods

  • FBC
    • Eosinophils
  • CRP/ ESR

Imaging

  • Chest x-ray
100
Q

What is the Well’s Score for PE?

A
  • Signs of DVT- 3
  • Alternative diagnosis to PE unlikely- 3
  • Surgery within the past 4 weeks, or immobile for 3 or more days- 1.5
  • Previous PE/ DVT- 1.5
  • Tachycardic- 1.5
  • Haemoptysis- 1
  • Malignancy- 1

>4 CTPA, <4 D-dimer

101
Q

What is the management algorithm of COPD?

A
  1. SABA or SAMA

Asthmatic features

  1. LABA + ICS
  2. LAMA (if poorly controlled)

No asthmatic features

  1. LABA + LAMA
  2. ICS (if poorly controlled)
102
Q

What are some examples of SABAs?

A
  • Salbutamol
  • Terbutaline
103
Q

What are some examples of SAMAs?

A

Ipratropium

104
Q

What are some examples of LABAs?

A
  • Formeterol
  • Salmeterol
105
Q

What are some examples of LAMAs?

A

Tiotropium

106
Q

What is the management of acute exacerbation of COPD?

A
  • Inhaled SABA
  • Oral corticosteroid
  • O2 via venturi mask
107
Q

How should O2 be administered to COPD patients in acute respiratory failure?

A

Via venturi mask, as it can be tightly titrated to ensure their sats are 88-92%

108
Q

What is the HAS-BLED score?

A

The score used to calculate a patients one year risk of bleeding when taking anticoagulents in AF

109
Q

What are the thresholds for CHAD-VASc score?

A
  • 1= aspirin or warfarin
  • 2= warfarin
110
Q

Which antibiotic should be given if pneumonia is severe (CURB-65 >=3)?

A

Co-amoxiclav

111
Q

What is the first line antibiotic for hospital acquired pneumonias?

A

Co-amoxiclav

112
Q

Does cardiac tamponade cause Kussmaul’s sign?

A

No, only constrictive pericarditis

113
Q

Which organisms are most commonly associated with infection in bronchiectasis patients?

A
  • Pseudomonas aeruginosa
  • Streptococcus pneumoniae
  • Staph aureus
114
Q

What is the surgical managment of renal stones?

A
  • 5-7mm stones usually pass on their own
  • 10mm offer SWL and consider ureteroscopy if unsuccessful
  • 10-20mm offer ureteroscopy (consider SWL if contraindicated) and consider PCNL
  • >20mm offer PCNL or if the stone is a staghorn
115
Q

What medications can be offered for renal calculi less than 10mm?

A

Alpha blockers such as Tamsulosin

116
Q

What are the first choice oral antibiotics for pyelonephritis?

A
  • Cefalexin
  • Co-amoxiclav
  • Trimethoprim
  • Ciprofloxacin
117
Q

What is the classification of Parkinson’s disease vs dementia with Lewy bodies?

A
  • If dementia symptoms come on within one year of motor symptoms–> dementia with Lewy bodies
  • If motor symptoms are more than 1 year before the dementia symptoms–> Parkinson’s dementia
118
Q

What is the pathophysiology of Lewy body dementia?

A

Lewy bodies building up in the cortex and midbrain leading to generalised atrophy

119
Q

What is the pathophysiology of Frontotemporal dementia?

A

Pick’s bodies accumulating in the cortex leading to frontal and temporal atrophy

120
Q

What is the criteria for Rheumatic fever?

A

The Jones criteria, two majors or one major and two minors are needed for a diagnosis

Major

  • Joint involvement
  • O looks like a heart - myocarditis/ valve involvement
  • Nodules (subcutaneous)
  • Erythema marginatum
  • Sydenham’s chorea

Minor

  • Previous rheumatic fever
  • ECG prolonged PR interval
  • Arthralgia
  • CRP and ESR raised
  • Elevated temperature
121
Q

What is the anaesthetic pre-operative ASA criteria?

A
  • ASA 1- normal healthy patient
  • ASA 2- mild systemic illness
  • ASA 3- severe systemic illness that is not life threatening
  • ASA 4- severe systemic illness that is life threatening
  • ASA 5- moribund patient that will die without surgery
122
Q

What is the management of heart failure?

A

Heart failure with reduced ejection fraction diagnosed via specialist (ejection fraction <40%):

  1. ACEi and beta blockers
  2. Spironolactone
123
Q

What are the signs and symptoms present with MEN1 vs MEN2a vs MEN2b?

A

MEN 1

  • Pituitary adenoma
  • Parathyroid hyperplasia
  • Pancreatic tumours

MEN 2a

  • Parathyroid hyperplasia
  • Medullary carcinoma
  • Phaeochromocytoma

MEN 2b

  • Mucosal neuromas (neurofibromatosis)
  • Marfanoid body habitus
  • Medullary carcinoma
  • Phaeochromocytoma
124
Q

What is an essential tremor?

A

A benign tremor that usually affects the hands bilaterally and is alleviated by alcohol

  • Usually of the hands (rarely with leg involvement)
  • No other neurological symptoms
  • Can be isolated in the head
125
Q

What is dystonia?

A

Abnormal muscle movements

126
Q

What is a Parkinsonian tremor?

A

Pill rolling tremor alleviated by movement, usually in the legs and hands

127
Q

What is a cerebellar tremor?

A

A tremor exacerbated by reaching (intention tremor) often accompanied with limb ataxia and dysmetria

128
Q

What is a physiologic tremor?

A

A tremor exacerbated by sympathetic stimulants such as caffiene and exacerbated by movement, it can involve the face and extremities

129
Q

What are the investigations to confirm a T1DM diagnosis?

A

Symptomatic patients need one positive test, asymptomatic patients need two positive tests

  1. Random glucose >= 11.1mmol/L
  2. Fasting glucose >= 7 mmol/L
  3. Two hour post prandial glucose >= 11.1 mmol/L
  4. Urine glucose and ketones
  5. HbA1c
130
Q

What are the investigations to confirm a T2DM diagnosis?

A
  1. HbA1c >= 48mmol/L
  2. Fasting glucose >=7 mmol/L
  3. Random glucose >= 11.1 mmol/L
  4. Two hour post prandial glucose >= 11.1 mmol/L

Year 3 Medicine (22 decks)

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