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FRACP > Clinical > Flashcards

Clinical Flashcards

1
Q

Macro and micro vascular complications of diabetes?

A

Macro vascular:
Heart attack, angina
Stroke
Peripheral vascular disease

Micro vascular:
Retinopathy
Diabetic nephrology
Neuropathy

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2
Q

Cardiovascular risk history points

A

CHOKLEDDS

Coronaries
Hypertension
Obesity
Kidneys
Lipids
Exercise
Diabetes
Diet
Smoking

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3
Q

Decompensated liver disease signs

A

JEAVS C

Jaundice
Encephalopathy
Ascites
Variceal bleeds
SBP
Coagulopathy

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4
Q

Signs of portal hypertension

A

S CARS

Splenomegaly

Caput Medusa
Ascites
Rectal/oesophageal varices
Spider naevi

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5
Q

Differential list for:

Pansystolic murmur

A

Mitral regurgitation
Tricuspid regurgitation
VSD
HOCM (though usually ESM)

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6
Q

Differential list for:

Ejection systolic murmur

A

Aortic stenosis
Aortic sclerosis
HOCM
ASD
Pulmonary stenosis

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7
Q

Mitral regurgitation signs of severity

A

PLEDS S123

Pulmonary hypertension

Left heart failure

Early diastolic rumble (due to increased flow in diastole)

Displaced volume loaded apex beat

Small pulse volume (very severe)

Soft S1

Split S2

S3

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8
Q

Aortic stenosis signs of severity

A

SLAPS

Slow rising, low volume carotid pulse

Left heart failure

Aortic thrill

Paradoxical splitting of S2

S4

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9
Q

Echo criteria for severe aortic stenosis

A

Mean gradient: >40

Vmax >4

Aortic valve area <1

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10
Q

Acromegaly features

A

Hands:
Large
Thick skin
Median nerve entrapment/Carpal tunnel
Hyperhydrosis

Feet:
Wide
Thick heel pad

Upper limb:
Proximal myopathy
Axilliary skin tags
Blood pressure

Face:
Visual fields with pin
Fundoscopy
Macroglossia
Frontal bossing
Enlarged mandible
Teeth splaying
Acne
Hirsutism

Chest:
Gynaecomastia
Galactorrhoea
Heart

Abdomen:
Organomegaly
Testicular atrophy

Lower limbs:
Osteoarthritis
Pseudogout

Ask for urine looking for glycosuria

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11
Q

Acromegaly features

A

Hands:
Large
Thick skin
Median nerve entrapment/Carpal tunnel
Hyperhydrosis

Feet:
Wide
Thick heel pad

Upper limb:
Proximal myopathy
Axilliary skin tags
Blood pressure

Face:
Visual fields with pin
Fundoscopy
Macroglossia
Frontal bossing
Enlarged mandible
Teeth splaying
Acne
Hirsutism

Chest:
Gynaecomastia
Galactorrhoea
Heart

Abdomen:
Organomegaly
Testicular atrophy

Lower limbs:
Osteoarthritis
Pseudogout

Ask for urine looking for glycosuria

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12
Q

Causes of isolated Splenomegaly?

A

HAEM RIP

Haematological

Infection: CMV EBV

Portal hypertension with cirrhotic liver

Rheum: feltys syndrome

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13
Q

Causes of isolated Splenomegaly?

A

HAEM RIP

Haematological

Rheum: feltys syndrome

Infection: CMV EBV

Portal hypertension with cirrhotic liver

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14
Q

Haem exam: where to next

A

Inguinal nodes
Hands
Elbow nodes
Face: eyes and mouth
Neck nodes
Spine
Shoulder bones
Hips bones
Legs

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15
Q

Long case history screen
(MOCCHHASS)

A

Mental health
OSA
CKD
Chronic pain
Haem (clots/bleeding/anaemia)
Heart
Attacks
Strokes
Surgeries

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16
Q

SHX
A-J

A

Accomodation
ADLs
Business
Coping?
Drives?
Every day is like…
Finances
GP
Home help
Insight
Judgement

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17
Q

What does calcitriol indicate on a drug chart in CKD?

A

Secondary hyperparathyroidism

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18
Q

Differential list:
- peripheral sensory neuropathy with reduced vibration and pinprick sense
- absent reflexes
- unsteady gait with Romberg positive

A

Peripheral sensory neuropathy without motor component:

Insults:
- Diabetes
- EtOH
- B12
- Chemo

Immune:
- Sensory variant CIDP
- Paraneoplastic

Hereditary:
- CMT

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19
Q

Peripheral sensorimotor neuropathy
Absent reflexes
Dorsal columns affected, anterior spared

A

CIDP
Paraneoplastic

Diabetes
EtOH
B12

Hereditary eg CMT

20
Q

Upper motor neuron pyramidal weakness
Spastic gait
Hyperreflexia

A

Hereditary spastic paraparesis
Cerebral Palsy

Cervical myelopathy

Bilateral lacunar infarcts

21
Q

Ataxia
Nystagmus
Normal reflexes
Peripheral sensory neuropathy

A

INSULTS EtOH

IMMUNE Paraneoplastic

HEREDITARY SCA

Dual pathology

22
Q

Distal myopathy or LMN weakness

A

Myotonic dystrophy
Critical illness myopathy
Inclusion body myositis
MND LMN variant

23
Q

Macroalbuminuria:

Urine ACR over?

24h urine albumin?

Urine PCR over?

24hr urine protein?

A

Urine ACR
Men >25
Women > 35

24 hr albumin >300

Urine PCR
Men >40
Women > 60

24hr protein > 500

24
Q

Microalbuminuria

ACR cut off

PCR

Albumin

Protein

A

ACR:
Men 2.5-25
Women 3.5-25

PCR:
Men 4-40
Women 6-60

Albumin
30-300

24h protein
50-500

25
Q

Anaemia of CKD targets

A

Hb 100-115

Ferritin >200
Transferrin saturation >20%

Manage hyper PTH or chronic inflammation

26
Q

Management of renal bone disease and targets?

A

Manage hyperparathyroidism:
Target 2-9x ULN
Calcitriol for secondary hyperparathyroidism
Vitamin D replacement (only if calcium and phosphate within targets)
Cinacalcet in dialysis pts
Parathyroidectomy for tertiary hyperparathyroidism

Manage phosphate:
Target to high end of normal range
Phosphate binders with meals
Low phosphate diet

Keep in mind often get osteomalacia, DEXA not helpful as architectural problem rather than density problem

27
Q

When to treat lipids in CKD?

A

Age >50 with any stage CKD should have statin
Add ezetimibe below eGFR 60

Age < 50, statin if other risk factor (eg. Coronary disease)

28
Q

Management renal acidosis?

A

Aim bicarb in low 20s
Can give sodibic
Keep in mind salt load can worsen fluid overload

29
Q

Indications for dialysis

A

Acidosis
Electrolytes
Intoxication (drug build up)
Overload
Ureaemia

30
Q

Management hyperkalaemia in CKD

A

Stop offending agents:
Spiro
ACE

Lifestyle:
Low K diet

Drugs:
SGLT2 or thiazide
Resonium

Dialysis

31
Q

Management of OSA

A

Weight loss
Avoid CNS depressants eg alcohol
CPAP

32
Q

Management restless legs

A

Iron replacement and replace if deficient

Non pharm therapies
Warm/cool compress

Dopaminergic agents (eg pramipexole)

33
Q

COPDX

A

Confirm diagnosis

Optimise function
- non pharm: pulm rehab
- pharm: stepwise inhaler introduction

Prevent deterioration
- cease smoking, vaccines, mucolytics

Develop plan of care
- action plans, ACD

Manage exacerbations
- steroids
- inhaled bronchodilators
- antibiotics
- oxygen
- NIV for T2RF

34
Q

Foot drop:
Dorsiflexion weak
Eversion weak
All else in tact

A

Peroneal nerve

35
Q

Foot drop:
Inversion weak
Eversion weak
Dorsiflexion weak
Hip abduction weak
Internal rotation hip weak

A

L5

36
Q

Foot drop:
Sciatic nerve

A

Inversion weak
Eversion weak
Dorsiflexion weak
Plantar flexion weak
Knee flexion weak
Ankle jerk absent

37
Q

Causes of upper lobe fibrosis?

A

SCHAART

Sarcoidosis, silicosis
CF
Histiocytosis
Ankylosis spondylitis
Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis

38
Q

Transplant issues

A

Immunosuppression side effects:
- infection
- malignancy
- drug specifics

Graft function

Rejection (need surveillance)

Psychosocial

39
Q

Massive hepatomegaly
Cm cut off?
Differentials?

A

> 20cm

Myelofibrosis
Myelodysplasia

Cancer: Mets or hepatoma

Chronic liver disease with fatty infiltration

TR/severe RHF

40
Q

Moderate hepatomegaly
Cm cut off?
Differentials?

A

15-20cm

Haemochromatosis
CML
Lymphoma
Fatty liver disease

As for massive

41
Q

Mild hepatomegaly
Cm cut off
Differentials

A

12-15cm

NAFLD

Haematological causes:
CLL, myelofibrosis

Chronic liver disease early stages

42
Q

Massive Splenomegaly
CM cut off
Differentials

A

> 7cm

Myelofibrosis
CML
Myelodysplasia

43
Q

Moderate splenomegaly
Cm cut off
Differentials

A

3-7cm

Lymphoma
CLL
Polycythaemia rubra Vera

Portal hypertension

44
Q

Difference between NYHA III and IV

A

III comfortable at rest

IV not comfortable at rest

45
Q

Difference NYHA II and III

A

II = Slight limitation, symptoms with ordinary activity

III = marked limitation, symptoms with less than ordinary activity

46
Q

Difference between NYHA class I and II

A

Class I no symptoms

Class II symptoms with ordinary activity

FRACP (11 decks)

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