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Semester 4 (NME) > Clinical Info > Flashcards

Clinical Info Flashcards

1
Q

Where is pain from the forgut organs often referred to?

A

Epigastric region

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2
Q

Where is pain from the midgut organs often referred to?

A

Umbilical region

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3
Q

Where is pain from the hindgut organs often referred to?

A

Flank/ Hypogastric region

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4
Q

Where is pain from the kidney often referred to?

A

‘Loin to groin’

With some pain in hypogastric

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5
Q

A patient presents with pain in the epigastric region, what are your main differentials?

A 
MI
Pancreatitis
Peptic ulcer disease (duodenal) 
Cholecystitis 
GORD or perforated oesophagus
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6
Q

A patient presents with pain in the RUQ, what are your main differentials?

A

Hepatitis/ hepatomegaly
Billary colic (a type of gallstones)
Pleurisy (from pneumonia)
Pylonephritis (kidney infection)

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7
Q

A patient presents with pain in the LUQ, what are your main differentials?

A

Gastric ulcer
Ruptured spleen
Pleurisy (from pneumonia)
Pylonephritis (kidney infection)

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8
Q

A patient presents with pain in the RLQ, what are your main differentials?

A 
Appendicitis 
Diverticulitis 
Renal stones
Crohns 
Hernia
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9
Q

A 60yo patient presents with pain in the flank and back pain, what is the first thing which must be checked for?

A

AAA

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10
Q

A patient presents with pain in the LLQ, what are your main differentials?

A

Diverticulitis
Left femoral/ inguinal hernia
Renal stone
Ectopic pregnancy

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11
Q

Rebound tenderness is a classic sign of…?

A

Appendicitis

Press down and let go, pain increases when you let

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12
Q

What IV antibiotics would you give to a patient who presented with an acute GI infective problem (e.g. appendicitis)

A

IV cephalosporin + metronidazole

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13
Q

A patient comes in with suspected appendicitis/ pancreatitis/ similar what do you do for and in what order?

A

ABCD examination- NIL BY MOUTH
Give O2 and fluids if needed (ie if beginning to shock)
Give painkillers (mophine) and antiemtic (cyclizine)
ABCD again/ Take history/ Do examination
NG tube if needed to aspirate stomach/ bowel contents

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14
Q

What IV antibiotics would you give to a patient who presented with an acute GI infective problem (e.g. appendicitis)

A

IV cephalosporin + metronidazole

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15
Q

What extra thing would you check for in F of childbearing age who presented with abdo pain?
Why?

A

Pregnancy test

Concern for ectopic pregnancy

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16
Q

What are the 4 types of kidney stones?

A

Calcium oxylate
Urease
Magnesium phosphate
Cystine

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17
Q

How do you distinguish between primary and secondary hyperparathyroidism using PTH/Ca2+ levels?

A

Primary: HIGH PTH, HIGH Ca2+
Secondary: HIGH PTH, LOW/NORM Ca2+
(In secondary the high PTH is due to trying to correct for the low Ca2+)

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18
Q

What is pseudohypoparathyroidism?

A

Where PTH levels are normal and the gland is fully functional but the target cells are insensitive to PTH

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19
Q

What are the symptoms of hyperparathyroidism?

A

Bone pain/ tenderness. Dehydration associated with hypercalcemia

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20
Q

What are the symptoms of hypoparathyroidism?

A

Based around Hypocalcaemia
Muscle cramps, parathesia (especially oral), insomnia, fatigue, tetany (cramps of hand muscles)
Cardio: Increased HR/ decreased contractility/ QT prolongation

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21
Q

Long QT syndrome can often be associated with hypoparathyroidism because…

A

Hypocalcaemia

electrolyte imbalances causes disturbance

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22
Q

What are the NICE guidlines for treating hyperthyroidism?

A 
Start carbimazole (10mg, 2/3x daily, weight dependant)
- If pregnant use propylthiouracil instead 
Monitor T4 levels and tritrate dose according to this (not TSH)
Add propanalol (or if can't - Diltiazem (CCB))
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23
Q

Propylthiouracil should never be used first line for hyperthyroidism, because of the risk of ?X?, except in the following circumstances (list 3)

A

X= Severe liver injury

Exceptions: 1st trimester pregnancy/ thyroid storm and if can’t use carbimazole/ radioiodide

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24
Q

What are the advantages/ disadvantages of radioiodide treatment vs. thionamide treatment?

A

RI Advantage: Usually v. successful
RI Disadvantage: High hypo risk/ precautions needed
T Advantage: Easy/ less hypo risk
T Disadvantage: Not as successful/ more SE’s

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25
When is surgical thyroidectomy treatment indicated?
If there is suboptimal response to anti-thyroid medication or radio-iodine, especially in P who are pregnant or who have Graves' orbitopathy Toxic adenoma or toxic multinodular goitre = SURGERY
26
When is treatment for hyperthyroidism with radioactive iodine indicated?
I(131) used in younger age groups as first line | NB: No additional cancer risk
27
What precautions must be taken when taking I(131)?
Single dose with precautions upto 2wks after | Little contact with people/ especially pregnant or children!
28
What are the NICE guidelines for treating hypothyroidism?
Treat with levothyroxine. P who are stable on levothyroxine require at least annual measurement of serum TSH (To check adherence + to ensure that the dosage is still correct)
29
What is Hashimoto's thyroiditis?
Chronic lymphocytic thyroiditis (T-cell infiltration and destruction leading to hypothyroidism) Autoantibodies to thyroperoxidase/ thyroglobulin
30
What scan can test for Graves disease (as a cause) in a patient with hyperthyroidism?
Isotope thyroid scan Swallow (technetium isotope)- scan to measure how much thyroid absorbs High absorbtion= Graves/ nodules Low= Thyroiditis/ iodine deficiency/ thyroid cancer
31
How do you test for Graves disease (as a cause) in a patient with hyperthyroidism? (2)
TSI Blood test and Isotope thyroid scan
32
What factors can give a pseudo T4 result which can show hypo/hyperthyroidism when there is none?
Pregnancy/ oral contraceptive = Increased protein binding so gives higher than true T4 level Severe illness/ corticosteroid use = Decreased protein binding so gives lower than true T4 level
33
When are serum T3 levels useful as a measurement?
In diagnosing hyperthyroidism (when T4 is normal but disease is suspected) Not useful for hypothyroidism as levels only drop when disease is severe
34
How is an isotope thyroid scan carried out and what can it's results show?
Swallow (technetium isotope)- scan to measure how much thyroid absorbs (scintillation counter used 6hours post drink)- Normal uptake (15-25%)- Use I(131) or I(123) High absorbtion= Graves/ nodules Low= Thyroiditis/ iodine deficiency/ thyroid cancer
35
if a patient is in a critical condition what type of O2 do you start them on? When would you consider to adjust
100% high flow (15L/min) | *Until sats of 94-98%, then can lower
36
What tests need to be reguarlly done on patients taking methotrexate?
LFT's | - SE is causing hepatitis
37
What are some of the ‘alarm symptoms’ related to dyspepsia that suggest serious disease?
Dysphagia/ weight loss/ protracted vomiting/ anorexia/ melaena/ haematemesis
38
What are the guidelines for investigation of suspected PUD?
P under 55 with suspected PUD and H.Pylori +ve start eradication therapy P over 55 requires endoscopy, GU’s always require biopsy Endoscopy required if alarm symptoms present
39
What key symptoms based around eating allow one to distinguish between DU’s and GU’s?
DU’s: Pain 2-3 hours after meals and pain is relieved with food GU’s: Pain as eating food and immediately after
40
What is the most common way of presentation in peritonitis?
Sudden, severe pain which initially develops in upper abdomen and rapidly becomes generalised. Pain in shoulder tip due to irritation of diaphragm/ phrenic nerve. Accompanied by shallow respiration and abdo guarding.
41
What is the most common complication of PUD and how does it present?
GI bleeding | Presents as melena or hematemesis
42
What is the NICE recommended treatment for PUD?
4-8wks of PPI (omeprazole) If H.Pylori (Metronidazole + clarithromycin/ tetracycline) If NSAIDS- Stop NSAID
43
A patient with a newly diagnosed DU is also found to be anemic, what complication is suspected?
Slow internal bleed (DU gone down to BV)
44
How do you treat diverticulitis?
High fibre diet + paracetamol AB's if diverticulitis Surgery if serious complications
45
How does pain from appendicitis present?
Generalised (whilst pressing on viscera), once it presses on the peritoneum it presents as a sharp localised pain in the right iliac fossa
46
A 45-year-old female with nephrotic syndrome develops renal vein thrombosis. What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?
Loss of antithrombin III
47
Which one of the following may be used to monitor patients with colorectal cancer? A) CA-125 B) Carcinoembryonic antigen C) Alpha-fetoprotein D) CA 19-9 E) CA 15-3
``` B (Carcinoembryonic antigen for colorectal) CA-125: ovarian cancer, AFP: Hepatocellular cancer CA 19-9: Pancreatic cancer Ca-15-3: Breast Cancer ```
48
What blood tests could be done to diagnose coeliac disease?
Anti-endomyseal/ anti-reticulin/ anti-gliadin | Antibodies in blood
49
What is the treatment for Crohns disease?
Mesalazine | Steroids for flare ups
50
What is Telangiectasia?
Small dilated blood vessels[1] near the surface of the skin or mucous membranes,
51
Name two signs that a Px is dehydrated:
Sunken eyes | Reduced tissue turgor
52
What is achalasia?
A disorder of motility of the lower oesophageal sphincter. The smooth muscle layer of the oesophagus has impaired peristalsis and the LES fails to relax causing stenosis
53
What symptoms characterise achalasia?
Dysphagia (mainly solids) Regurgitation Chest pain/ heartburn Weight loss
54
How could you distingusih achalasia from benign oesophageal strictures?
Achalasia- No reflux | BOS- Caused (commonly) by GORD
55
What is the diagnostic criteria for impaired fasting glucose?
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
56
What is the diagnostic criteria for impaired glucose tolerance?
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT (oral glucose tolerance test) 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
57
What is the clinical name for death rattle and what causes it?
Terminal respiratory secretions | - Where bronchial secretions and saliva etc increased an unable to be cleared (strong indicator of impending death)
58
What drugs would be given in palliative care to ease the symptoms of death rattle?
Glycopyrronium, glycopyrolate, hyoscine hydrobromide (scopolamine) or atropine - All have anti-cholinergic effects to reduce secretions
59
What marker may be used to monitor patients with colorectal cancer?
Carcinoembryonic antigen (CE)
60
What marker may be used to monitor patients with ovarian cancer?
CA-125
61
What marker may be used to monitor for hepatocellular cancer?
AFP
62
What marker may be used to monitor for breast cancer?
CA-15-3
63
What marker may be used to monitor for pancreatic cancer?
CA-19-9
64
Wheeze heard on auscultation indicates what?
Forced airflow through narrowed airways
65
Coarse crackles heard on auscultation indicates what?
Fluid in the lungs
66
Fine crackles heard on auscultation indicates what?
Small airway collapse
67
Dark urine or pale stool can indicate what in relation to bilirubin?
High levels of conjugated bilirubin (soluble) | - Shows post hepatic jaundice (caused by something such as cholestasis- which would also give an itch)
68
What is cholestasis?
Impaired flow of bile (i.e. due to blocked canaliculi) | - Note dark urine/ pale stools/ itch/ jaundice
69
A Px presents with dark urine, pale stools and jaundice. What type of jaundice is this likely to be?
Post hepatic
70
Name 3 causes of post hepatic jaundice?
Pancreatitis, cholestasis, gallstones
71
Why do patients with renal failure experience high blood pressure?
Renal failure = hyperkalaemia | Hyperkalaemia = increased aldosterone release
72
Pain from appendicitis typically presents with pain where?
From periumbilical region to right iliac fossa

Semester 4 (NME) (24 decks)

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