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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
Q

When is surgical thyroidectomy treatment indicated?

A

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

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26
Q

When is treatment for hyperthyroidism with radioactive iodine indicated?

A

I(131) used in younger age groups as first line

NB: No additional cancer risk

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27
Q

What precautions must be taken when taking I(131)?

A

Single dose with precautions upto 2wks after

Little contact with people/ especially pregnant or children!

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28
Q

What are the NICE guidelines for treating hypothyroidism?

A

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)

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29
Q

What is Hashimoto’s thyroiditis?

A

Chronic lymphocytic thyroiditis
(T-cell infiltration and destruction leading to hypothyroidism)
Autoantibodies to thyroperoxidase/ thyroglobulin

30
Q

What scan can test for Graves disease (as a cause) in a patient with hyperthyroidism?

A

Isotope thyroid scan
Swallow (technetium isotope)- scan to measure how much thyroid absorbs
High absorbtion= Graves/ nodules
Low= Thyroiditis/ iodine deficiency/ thyroid cancer

31
Q

How do you test for Graves disease (as a cause) in a patient with hyperthyroidism? (2)

A

TSI Blood test and Isotope thyroid scan

32
Q

What factors can give a pseudo T4 result which can show hypo/hyperthyroidism when there is none?

A

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
Q

When are serum T3 levels useful as a measurement?

A

In diagnosing hyperthyroidism (when T4 is normal but disease is suspected)
Not useful for hypothyroidism as levels only drop when disease is severe

34
Q

How is an isotope thyroid scan carried out and what can it’s results show?

A

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
Q

if a patient is in a critical condition what type of O2 do you start them on?
When would you consider to adjust

A

100% high flow (15L/min)

*Until sats of 94-98%, then can lower

36
Q

What tests need to be reguarlly done on patients taking methotrexate?

A

LFT’s

- SE is causing hepatitis

37
Q

What are some of the ‘alarm symptoms’ related to dyspepsia that suggest serious disease?

A

Dysphagia/ weight loss/ protracted vomiting/ anorexia/ melaena/ haematemesis

38
Q

What are the guidelines for investigation of suspected PUD?

A

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
Q

What key symptoms based around eating allow one to distinguish between DU’s and GU’s?

A

DU’s: Pain 2-3 hours after meals and pain is relieved with food
GU’s: Pain as eating food and immediately after

40
Q

What is the most common way of presentation in peritonitis?

A

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
Q

What is the most common complication of PUD and how does it present?

A

GI bleeding

Presents as melena or hematemesis

42
Q

What is the NICE recommended treatment for PUD?

A

4-8wks of PPI (omeprazole)
If H.Pylori (Metronidazole + clarithromycin/ tetracycline)
If NSAIDS- Stop NSAID

43
Q

A patient with a newly diagnosed DU is also found to be anemic, what complication is suspected?

A

Slow internal bleed (DU gone down to BV)

44
Q

How do you treat diverticulitis?

A

High fibre diet + paracetamol
AB’s if diverticulitis
Surgery if serious complications

45
Q

How does pain from appendicitis present?

A

Generalised (whilst pressing on viscera), once it presses on the peritoneum it presents as a sharp localised pain in the right iliac fossa

46
Q

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?

A

Loss of antithrombin III

47
Q

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

A 
B (Carcinoembryonic antigen for colorectal)
CA-125: ovarian cancer, 
AFP: Hepatocellular cancer
CA 19-9: Pancreatic cancer 
Ca-15-3: Breast Cancer
48
Q

What blood tests could be done to diagnose coeliac disease?

A

Anti-endomyseal/ anti-reticulin/ anti-gliadin

Antibodies in blood

49
Q

What is the treatment for Crohns disease?

A

Mesalazine

Steroids for flare ups

50
Q

What is Telangiectasia?

A

Small dilated blood vessels[1] near the surface of the skin or mucous membranes,

51
Q

Name two signs that a Px is dehydrated:

A

Sunken eyes

Reduced tissue turgor

52
Q

What is achalasia?

A

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
Q

What symptoms characterise achalasia?

A

Dysphagia (mainly solids)
Regurgitation
Chest pain/ heartburn
Weight loss

54
Q

How could you distingusih achalasia from benign oesophageal strictures?

A

Achalasia- No reflux

BOS- Caused (commonly) by GORD

55
Q

What is the diagnostic criteria for impaired fasting glucose?

A

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

56
Q

What is the diagnostic criteria for impaired glucose tolerance?

A

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
Q

What is the clinical name for death rattle and what causes it?

A

Terminal respiratory secretions

- Where bronchial secretions and saliva etc increased an unable to be cleared (strong indicator of impending death)

58
Q

What drugs would be given in palliative care to ease the symptoms of death rattle?

A

Glycopyrronium, glycopyrolate, hyoscine hydrobromide (scopolamine) or atropine
- All have anti-cholinergic effects to reduce secretions

59
Q

What marker may be used to monitor patients with colorectal cancer?

A

Carcinoembryonic antigen (CE)

60
Q

What marker may be used to monitor patients with ovarian cancer?

A

CA-125

61
Q

What marker may be used to monitor for hepatocellular cancer?

A

AFP

62
Q

What marker may be used to monitor for breast cancer?

A

CA-15-3

63
Q

What marker may be used to monitor for pancreatic cancer?

A

CA-19-9

64
Q

Wheeze heard on auscultation indicates what?

A

Forced airflow through narrowed airways

65
Q

Coarse crackles heard on auscultation indicates what?

A

Fluid in the lungs

66
Q

Fine crackles heard on auscultation indicates what?

A

Small airway collapse

67
Q

Dark urine or pale stool can indicate what in relation to bilirubin?

A

High levels of conjugated bilirubin (soluble)

- Shows post hepatic jaundice (caused by something such as cholestasis- which would also give an itch)

68
Q

What is cholestasis?

A

Impaired flow of bile (i.e. due to blocked canaliculi)

- Note dark urine/ pale stools/ itch/ jaundice

69
Q

A Px presents with dark urine, pale stools and jaundice. What type of jaundice is this likely to be?

A

Post hepatic

70
Q

Name 3 causes of post hepatic jaundice?

A

Pancreatitis, cholestasis, gallstones

71
Q

Why do patients with renal failure experience high blood pressure?

A

Renal failure = hyperkalaemia

Hyperkalaemia = increased aldosterone release

72
Q

Pain from appendicitis typically presents with pain where?

A

From periumbilical region to right iliac fossa

Semester 4 (NME) (24 decks)

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