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Clinical Knowledge > Clinical Knowledge > Flashcards

Clinical Knowledge Flashcards

1
Q

Temporal lobe

A

Auditory processing
Language comprehension (Wernicke’s area)
Memory/information retrieval

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2
Q

Cerebellum

A

Balance and co-ordination

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3
Q

Frontal lobe

A

Motor control
Problem solving
Speech production (Broca’s area)

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4
Q

Parietal lobe

A

Touch perception

Body orientation and sensory discrimination

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5
Q

Spinothalamic tract

A

Transmission of:
Pain
Temperature
Crude touch

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6
Q

Brain stem

A

Involuntary responses

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7
Q

Dorsal column-medial Lemniscus

A

Fine touch
Vibration
Pressure
Proprioception

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8
Q

Occipital lobe

A

Sight

Visual reception and interpretation

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9
Q

Corticospinal tract

A

Voluntary movements

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10
Q

Corticobulbar

A

Muscles of the head face and neck

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11
Q

Corticospinal tract path

A

Contralateral motor cortex - Midbrain - Medulla - decussates - Synapse with LMN at anterior horn - muscle

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12
Q

Rubrospinal tract

A

Red nucleus of midbrain responsible for muscle flexion

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13
Q

Babinski sign UMN lesion

A

Positive

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14
Q

At what level is the superior and inferior mediastinum divided

A

Sternal angle

T4/T5 intervertebral disk

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15
Q

Hypoglossal CN XII

A

Motor - tongue movement

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16
Q

Lateral border of mediastinum

A

Mediastinal pleura

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17
Q

Main mediastinal contents

A 
Heart
Oesophagus
Trachea 
Thoracic nerves 
Systemic blood vessels
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18
Q

Babinski sign LMN lesion

A

Negative

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19
Q

Inferior border of the mediastinum

A

Diaphragm

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20
Q

Facial CN VII

A

Sensory - Taste of anterior 2/3 of tongue

Motor - Facial expression, lacrimation, salivation

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21
Q

Anterior border of mediastinum

A

Sternum

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22
Q

Vagus CN X

A

Sensory - Taste to epiglottis

Motor - swallowing, talking, coughing

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23
Q

Superior border of mediastinum

A

Superior thoracic aperture

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24
Q

The internal thoracic artery is a branch of which artery

A

Subclavian

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25
Q

The phrenic nerve is most associated with what structure?

A

Pericardium

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26
Q

Glossopharyngeal CN IX

A

Sensory - Somatosensation of posterior 1/3 of tongue

Motor - swallowing

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27
Q

Oculomotor CN III

A

Motor- Eye movement, eyelid opening, pupillary constriction, lens accommodation

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28
Q

The recurrent laryngeal nerve is a branch of what nerve?

A

Vagus

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29
Q

Trigeminal CN V

A

Sensory - facial sensation, somatosensation of anterior 2/3 of tongue

Motor - open/close jaw

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30
Q

Accessory CN XI

A

Motor - Traps, SCM,

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31
Q

Vestibulocochlear CN VIII

A

Sensory - hearing and balance

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32
Q

Abducens CN VI

A

Motor - eye movement

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33
Q

Negative to positive

A

Depolarisation

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34
Q

Trochlear IIII

A

Motor - eye movement

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35
Q

What vertebral level is the iliac crest

A

L4

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36
Q

Olfactory CN I

A

Sensory - Smell

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37
Q

Which hormone regulates blood volume

A

Aldosterone

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38
Q

Two lateral ventricles drain in the third ventricle through the

A

Interventricular foramina

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39
Q

Function of brain ventricles

A

To house CSF

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40
Q

Where is CSF produced

A

Choroid plexus of ventricles

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41
Q

Branches of Aorta

A 
Inferior Phrenic
Celiac trunk
SMA
Supra renal artery 
Renal artery 
Testicular artery 
Lumbar arteries 
IMA
Middle sacral 
Common iliac
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42
Q

At what level does the common iliac vein become the inferior vena cava

A

L5

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43
Q

What vertebral level does the DA become the AA

A

T12

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44
Q

Optic CN II

A

Sensory - Vision

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45
Q

Two lateral ventricles drain in the third ventricle through the

A

Interventricular foramina

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46
Q

Function of brain ventricles

A

To house CSF

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47
Q

At what level does the common iliac vein become the inferior vena cava

A

L5

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48
Q

Where is CSF produced

A

Choroid plexus of ventricles

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49
Q

Where are baroreceptors found?

A

Carotid sinus

Aortic arch

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50
Q

What vertebral level does the DA become the AA

A

T12

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51
Q

Branches of Aorta

A 
Inferior Phrenic
Celiac trunk
SMA
Supra renal artery 
Renal artery 
Testicular artery 
Lumbar arteries 
IMA
Middle sacral 
Common iliac
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52
Q

Where are baroreceptors located?

A

Carotid sinus, Aortic arch

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53
Q

What hormones are released from the medulla of the adrenal gland by sympathetic stimulation?

A

Adrenaline
Noradrenaline
Dopamine

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54
Q

Cardiac output =

A

HR x SV

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55
Q

What is stroke volume

A

Amount of blood left ventricle pumps in one beat

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56
Q

Beta blocker suffix

A

Lol

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57
Q

Stroke volume depends on?

A

Preload = increase in stretch
Contractility = increased force
After load decrease

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59
Q

ACE inhibitor suffix

A

PRIL

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60
Q

ARB suffix

A

Sartan

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61
Q

Coronary arteries

A

Anterior
RCA - RMA
LCA - LAD - LCFA

Posterior
RCA- RIVA
LCA

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62
Q

Coronary venous supply

A

Small cardiac vein
Middle cardiac vein
Great cardiac vein
Posterior vein

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63
Q

CHF treatment

A 
Ace inhibitors 
ARB’s
Aldosterone antagonists 
Beta blockers 
Diuretics
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64
Q

Consistent prolonged PRI

A

First degree heart block

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65
Q

PRI getting progressively longer until dropped QRS (Long long drop)

A

Second degree heart block type 1

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66
Q

Normal PRI until dropped QRS

A

Second degree type 2

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67
Q

P wave and QRS complex are in sync to themselves but no correlation between each other. Super Brady

A

Third degree heart block

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68
Q

Prazole

A

PPI’S

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69
Q

Which cells are Responsible for production and release of stomach acid?

A

Parietal cells

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70
Q

B cells are responsible for

A

Antibody production

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71
Q

Mast cells are responsible for

A

Releasing inflammatory mediators

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72
Q

Dendritic cells

A

Antigen presentation to aid recruitment of white cells

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73
Q

Goblet cells

A

Mucus producing cells

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74
Q

Sympathetic innervation of the bladder

A

Thoracic and lumbar spine

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75
Q

Parasympathetic innervation of the bladder

A

Sacral spinal cord

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76
Q

Most common organism in dog bites

A

Pasteurella multocida

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77
Q

Innate immune system consists of

A

Physical barrier (skin, mucus membrane)
Chemical signals
Inflammation

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78
Q

Phagocytes are part of the

A

Innate immune system

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79
Q

Lymphocytes are part of the

A

Adaptive immune system

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80
Q

Cytokines

A

Molecules that are used for cell signalling

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81
Q

Cell responsible for inflammation

A

Mast cells

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82
Q

Hypokalaemia symptoms

A

Muscle weakness, muscle cramps, constipation, neurological symptoms

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83
Q

Hemiballismus

A

Damage to the subthalmic nucleus of basal ganglia. Characterised by violent involuntary movements of the limbs on one side of the body

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84
Q

Butterfly rash on face

A

Lupus

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85
Q

Adrenaline is produced in the

A

Medulla of the adrenal gland

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86
Q

Most common cause of meningitis in adolescents

A

Neisseria meningitis

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87
Q

U waves on ECG can be caused by

A

Hypokalaemia

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88
Q

Mycin

A

Macrolides

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89
Q

What antibiotic and cause torsades de pointes

A

Macrolides

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90
Q

EF=

A

SV/EDV X 100

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91
Q

Most common cause of ottitis media infection

A

Strep pneumoiae

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92
Q

Causes of AFIB

A 
Age 
Inflammation 
Enlarged atria 
Lung disease 
Hormonal abnormalities 
Alcohol abuse
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93
Q

Drugs ending in lactone

A

Potassium sparing diuretics

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94
Q

Resting phase in cardiac action potential

A

Phase 4

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95
Q

Vaughan Williams class 3 drugs act on

A

Potassium transporters in cardiac conduction

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96
Q

Auto antibodies found in thyroid autoimmune diseases

A

Anti thyroid peroxidase (Anti-tpo)

Anti thyroglobulin antibodies

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97
Q

Most common cause of hypothyroidism in developing world

A

Iodine deficiency

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98
Q

Primary hypothyroidism causes and TSH, T3 and T4 levels

A

Autoimmune - TSH high T3 and T4 low

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99
Q

Secondary hypothyroidism causes and TFT levels

A

Pituitary pathology - Low TSH low T3,T4

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100
Q

Hypothyroidism treatment

A

Levothyroxine

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101
Q

Pretibial myxoedema

A

Found in hyperthyroidism discoloured waxy, oedematous on shins

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102
Q

Common cardiac symptoms

A 
.Pain or pressure in the chest 
.pain or discomfort in the arms, left shoulder, elbows, jaw or back
. SOB
.Nausea 
.Fatigue 
.Lightheadedness or dizziness 
.cold sweats
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103
Q

Stable angina symptoms, investigations and treatment

A

Pain on exertion that goes away when resting

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104
Q

Bronchiectasis

A

Dilation of the bronchioles caused by an infection it is irreversible and is an obstructive respiratory condition. Most common cause CF and TB

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105
Q

Bronchiectasis symptoms

A

A lot of Foul smelling sputum
Hemoptysis
Nail clubbing

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106
Q

Empyema

A

Pus in the pleural cavity

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107
Q

Three types of extra systole

A

Atrial, Nodal (Junctional), ventricular

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108
Q

Glasgow blatchford score that can be treated as an outpatient

A

1 and under

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109
Q

Variceal management of AUGIB

A

Endoscopy trelipressin and ligation

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110
Q

Non-variceal bleeding

A

Endoscopy, Epinephrine, Clips, Thermal probe

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111
Q

V3-V4 artery

A

LAD

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112
Q

V5-V6 artery

A

Distal LAD, LC or RCA

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113
Q

1, AVL artery

A

LC

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114
Q

2, AVF, 3 artery

A

RCA, LC

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115
Q

V1-V3 artery

A

RCA or LC

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116
Q

Cholinergic receptors

A

Nicotinic, muscarinic

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117
Q

Types of Nicotinic receptors

A

NN, NM

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118
Q

Types of muscarinic receptors

A

M1 M2 M3 M4 M5

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119
Q

Main causes of pancreatitis

A

Gaul stones, alcohol

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120
Q

Symptoms of pancreatitis

A 
Epigastric pain
Nausea and vomiting
Tachycardia 
Jaundice
Fever
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121
Q

Pancreatitis investigations

A

Serum amylase and lipase
Ultrasound
ABG

122
Q

How does pancreatitis cause ABG changes

A

Pancreatitis causes the epithelial cells in the pancreas to stop producing Bicarbonate. Bicarbonate is used to neutralise the acid in the stomach.

123
Q

Teratogens

A

Substances that can cause birth defects

124
Q

Rovsings sign

A

Palpitation in the left lower quadrant causes pain in the right lower quadrant and is suggestive of appendicitis

125
Q

Peristalsis

A

Involuntary movements of longitudinal and circular muscles. Oesophagus, stomach, intestines

126
Q

Heparin MOA

A

Activates antithrombin 3

127
Q

Thromboxane a2

A

Produced by activated platelets to stimulate activation of platelet aggregation.

128
Q

Which antibodies are developed in Graves’ disease on the thyroid gland?

A

IgG

129
Q

Grave’s disease TSH and T3/T4

A

Low TSH high T3/T4

130
Q

Guillain-Barré syndrome

A

Immune mediated demyelination of the peripheral nervous system following an infection.

131
Q

What does the ST segment represent?

A

The period when the entire ventricle is depolarised

132
Q

QRS complex represents?

A

Ventricular depolarisation

133
Q

P wave represents?

A

The wave of depolarisation that spreads from the SA node throughout the Atria

134
Q

P-R interval

A

Onset of P wave to beginning of QRS complex usually 0.12-0.20

135
Q

Causes of varicose veins?

A

Incompetent venous valves

136
Q

What level does the AA bifurcate?

A

L4

137
Q

SOB when lying flat?

A

Orthopnea

138
Q

The left and right atria are connected by what in foetal life?

A

Foramen ovale

139
Q

What vertebral level does the left renal artery lie?

A

L1

140
Q

Ebstein’s anomaly

A

A congenital heart defect leading to a large right atrium and a small right ventricle. Typically accompanied by tricuspid regurgitation

141
Q

What drugs can cause sexual dysfunction?

A

Thiazide-like diuretics

142
Q

Phase 2 of cardiac action potential

A

Slow influx of calcium which relates to the ST segment

143
Q

Sudden onset of SOB and a wedge shaped opacification on chest x-ray

A

Highly suggestive of PE

144
Q

Warfarin MOA

A

Inhibits epoxide reductase preventing vitamin K from being converted to its activated form

145
Q

Hep B vaccine protects against what other virus?

A

Hep D

146
Q

What can calcium glauconate be used for?

A

Protection of cardiac membrane increasing depolarisation threshold. Possibly caused by hyperkalaemia

147
Q

Tinea corporis AKA ringworm

A

Enlarging raised red rings with a central area of clearing

148
Q

Rheumatoid arthritis clinical findings

A

Radiographic changes that show erosion
Symmetrical
Small joints are often affected
Morning stiffness for at least one hour

149
Q

Dermatomyositis

A

Inflammatory connective tissue disorder affecting skeletal muscle and the skin.

Presentation - progressive proximal muscle weakness with facial rash and raised Creatinine Kinase.

150
Q

Iron deficiency anaemia

A

Low hb
Low MCV
Low ferritin
Hypochromic RBC

151
Q

Macrocytic anaemia symptoms

A 
LOA
Brittle nails 
Tachycardia 
Diarrhoea 
Fatigue
Pale skin 
SOB 
Poor concentration and confusion
152
Q

SEPSIS 6

A

Give - High flow oxygen, Broad spectrum ABx, fluids

Take - Blood cultures, Lactate, urine output.

153
Q

Snout and Spin

A

Sensitivity rule out and specificity rule in

154
Q

What artery supplies blood to Broca’s and wernicke’s area

A

Middle cerebral artery (MCA)

155
Q

Speech and language will be affected by a stroke in which artery?

A

MCA

156
Q

Stroke symptoms

A

1) Weakness of an arm leg or both.
2) Weakness or twisting to one side of the face causing drooling or slurred speech.
3) problems with balance, co-ordination, vision, speech
4) numbness in part of the body
5) headache
6) confusion
7) LOC in severe cases

157
Q

Stroke risk factors

A

AF
MI
Atherosclerosis build up caused by smoking, diabetes

158
Q

What artery supplies the primary somatosensory cortex?

A

MCA

159
Q

What arteries supply the motor cortex?

A

MCA and ACA

160
Q

Investigations for stroke

A 
CT
MRI
ECG
Carotid artery US looking for arethoma 
Blood test looking at glucose and Cholesterol
161
Q

Stroke treatment

A

Ischaemic

1) Anti platelet (Aspirin)
2) Thrombolysis (Alteplase)

Haemorrhagic

1) find the artery bleeding
2) reduce BP, sit patient up and use anti hypertensives

162
Q

ROSIER score

A

Recognition of stroke in the emergency room
If score >0 stroke likely
If score <0 stroke unlikely but still possible

163
Q

Immediate aspirin dose in suspected Ischaemic stroke

A

300mg

164
Q

ALT and AST

A

Enzymes made in the liver to break down amino acids. Raised in liver disease.

165
Q

GGT

A

GGT is a transport molecule, helping to move other molecules around the body.
It also helps the liver metabolise drugs and other toxins.

166
Q

ALP

A

ALP is found in the liver and bones and helps break down proteins. A raised ALP does not necessarily mean liver disease however, if other liver markers are raised then it is likely liver disease.

167
Q

Guillain-barre

A

An autoimmune disease where your body attacks your nerves. The causes of the disease is unknown but most patients report symptoms within six weeks of having an infection.

168
Q

CSF ranges in bacterial infection

A 
Appearance: cloudy and turbid 
Opening pressure: elevated 
WBC: elevated 
Glucose: low 
Protein: elevated
169
Q

CSF ranges in viral infection

A 
Appearance: clear 
Opening pressure: normal or elevated 
WBC: elevated 
Glucose: normal 
Protein: elevated
170
Q

Most common viral causes of encephalitis

A

HSV
Varicella zoster virus
Enterovirus

171
Q

Romberg’s test

A

Positive when a patient is unable to maintain balance with their eyes closed.

172
Q

Seborrheic keratosis

A

Common non cancerous skin growth

173
Q

Zosin

A

Alpha blockers

174
Q

Antidote for opioid overdose

A

Naloxone

175
Q

Antidote for paracetamol overdose

A

Acetylcysteine

176
Q

Crohn’s disease RF and Presentation

A

Risk factors - smoking, genetic, infections

Symptoms - weight loss, diarrhoea, malaise, anorexia, fever

177
Q

Murphy’s sign

A

Press down on subcostal margin and ask patient to inspire. During inspiration if patient has pain Murphy’s sign is positive. Positive sign is indicative of acute cholecystitis.

178
Q

RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In Biliary colic

A

RUQ

179
Q

RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In acute cholecystitis

A

RUQ pain

Fever/WCC

180
Q

RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In Cholangitis

A

RUQ pain
Fever/WCC
Jaundice

181
Q

Charcots triad

A

RUQ pain
Fever/WCC
Jaundice

Found in Cholangitis

182
Q

What liver tests are most reflective of liver synthetic function?

A

Pro-thrombin - The liver normally produces Vitamin K if the synthetic function of the liver is damaged pro thrombin time will be increased.

Albumin - Gives an indication of synthetic liver function over longer period.

183
Q

Hyperkalaemia ECG changes

A

Tall tented T waves
Increased PR interval
Wide QRS complex

184
Q

Hyperkalaemia treatment

A

Give calcium glauconate 10% 10ml by slow IV injection.

Secondly give 10 units Actrapid min 100ml of 20% glucose.

185
Q

Paget’s disease

A

Chronic disease of the skeleton with symptoms of
Bone pain
Joint pain
Headache
Physical signs show bowing of the femur, lower leg and enlargement of the forehead.

ALP will be raised as a marker of osteoblasts activity

Treatment - bisophosphonates

186
Q

Most common primary liver tumour?
risk factors
Features

A

Hepatocellular carcinoma

Hep B 
Infection 
Cirrhosis 
Male 
Age

Raised alpha - fetoprotein

187
Q

Rash in response to amoxicillin
Severe pharyngitis
Slightly increased ALT
Positive mono spot

A

Epstein Barr virus

188
Q

Ankylosing spondylitis

A

Is a seronegative arthropathy. It is an autoimmune disorder, most common amongst men. It is associated with back stiffness that gets better over the cause of a day and a bamboo spine on radiography.
Ankylosing spondylitis is associated with HLA-B27 positivity

189
Q

How can an ectopic pregnancy cause shoulder tip pain?

A

Bleeding into the peritoneum can cause irritation to the diaphragm and cause referred pain at the tip of the shoulder.

190
Q

Ectopic pregnancy symptoms

A 
Sever, sudden onset RIF pain 
Vaginal bleeding but not always. 
Shoulder tip pain 
Syncopal episodes 
Shock
191
Q

Chronic reflux nephropathy signs and symptoms

A 
Burning sensation whilst urinating 
Strong, persistent urge to urinate 
Fever 
Cloudy urine 
Flank and abdo pain
192
Q

Posterior duodenal ulcers can cause haemorrhage from which artery?

A

Gastroduodenal artery

193
Q

What dermatological condition is diagnostic of chronic sarcoidosis?

A

Lupus pernio - a specific complex involvement of the skin of the bridge of the nose and the area beneath the eyes and cheeks. The lesions are typically large, bluish-red and dusky purple, infiltrated, plaque-like nodules.

194
Q

Autonomic dysreflexia

A

Is caused by excessive sympathetic activity in the absence of parasympathetic supply in high spinal cord lesions.

Tachycardia
Hypertension
Sweating
Flushing

195
Q

Blood supply to the stomach

A

Coeliac trunk which originates from vertebral level T12 supplies the stomach.

196
Q

Patients presenting with first episode of psychosis should be offered

A

Oral antipsychotics

Psychological interventions

197
Q

Reed-stern berg cells are pathognomic in

A

Hodgkin’s lymphoma

198
Q

Aspiration of what cyst in the anterior neck triangle usually in the third decade contains cholesterol?

A

Branchial cyst

199
Q

Intussusception

A

Is a paediatric emergency where a bowel segment invaginates into a neighbouring part of the bowel. Mostly in patients under 1.

Three s’s
Screaming and pallor
Stool has red currant jelly appearance
Sausage-shaped mass palpable in right hypochondrium

200
Q

Symptoms of lithium toxicity

A

Nausea, diarrhoea, coarse tremor, unsteadiness

Happens at 1.5mmol/l or above

201
Q

Coeliac disease

A

Coeliac is a disease whereby there is an abnormal jejunal mucosa
That improves with the withdrawal of gluten. The typical onset is in early infancy when gluten is introduced and the 4th decade.

Vague abdominal pain
Bloating
Diarrhoea particularly after gluten containing meals.
Macrocyclic anaemia (due to folate deficiency)

Blood tests reveal anti-EMA and anti-TTG antibodies.

202
Q

Sarcoidosis risk factors

A

Age - adults under 40
Female
Afro-Caribbean populations

203
Q

Most common finding in sarcoidosis

A

Bilateral hilar lymphadenopathy

Erythema nodosum

204
Q

Candida albicans symptoms

A

Thick cottage cheese like discharge
Pain on urination

It is a fugal infection

205
Q

Myasthenia gravis? Symptoms?

A

MG is an autoimmune disorder typified by autoantibodies raised against the acetylcholine receptors, causing decreased efficacy of transmission at the neuromuscular junction. MG can be precipitated by stresses on the body such as pregnancy.

Bulbar weakness
Ptosis 
Double vision 
Dysphagia 
Easy fatiguability of neck flexion
206
Q

Treatment for pre-eclampsia seizures?

A

Magnesium sulphate

207
Q

Initial Treatment of anaphylaxis from penicillin

A

Adrenaline 0.5mg, 1 in 1000 IM

208
Q

Clozapine

A

Clozapine is an alpha1-adrenoreceptor antagonist usually given in schizophrenia.

209
Q

What drug can cause priapism

A

Trazadone

210
Q

Tumour marker for ovarian cancer

A

Ca-125

211
Q

Signs of ovarian cancer

A 
Abdo distension 
Feeling bloated 
Abdo pain 
Early satiety 
Loss of appetite 
Urinary frequency and urgency 
Unexplained weight loss 
Fatigue 
Change in bowel habit
212
Q

Sacroiliitis is a feature of which bowel disease

A

UC

IBD is commonly associated with arthalgia and arthritis hence why the sacro iliac joints become inflamed.

213
Q

Type 1 respiratory failure

A

Low o2 with normal or low Co2

214
Q

Type 2 respiratory failure

A

Hypoxia

Hypercapnia

215
Q

Salbutamol MOA

A

Beta2 adrenergic receptor agonist which works by causing relaxation of airway smooth muscle.

216
Q

Agonist

A

Something that binds to a receptor and activates it

217
Q

Antagonist

A

Something that binds to a receptor and deactivates it

218
Q

Acute Asthma exacerbation stages

A

Moderate:
O2 > 92%
PEF >
No severe features

Severe: 
O2 <92%
PEF 
Not able to talk/complete sentences in one breath
HR>125
RR>30
Accessory muscle use 
Life threatening:
O2<92%
PEF 
Silent chest 
Poor resp effort 
Altered consciousness 
Cyanosis
219
Q

Bronchiolitis causes and presentation

A

RSV most common cause - very common in winter and in infants under 1 years age.

Presentation:
Coryzal symptoms 
Signs of respiratory distress 
Dyspnoea 
Tachypnoea
Poor feeding 
Mild fever 
Wheezes 
Crackles
220
Q

Signs of respiratory distress

A 
Increased RR
Use of accessory muscles 
Intercostal recessions 
Subcostal recessions 
Nasal flaring 
Head bobbing 
Tracheal tug 
Cyanosis 
Abnormal airway noises
221
Q

Abnormal airway noises

A

Wheezing - whistling sound due to narrow airways on expiration

Grunting - exhaling with glottis partially closed - increase positive end-expiration pressure

Stridor - Hight pitched inspiratory - obstruction upper airway - E.G. Croup

222
Q

Criteria for admission in babies with bronchiolitis

A 
Aged 3 months and under 
Pre-existing condition 
<50-75% of normal intake 
Clinically dehydrated 
RR >70
O2 sats <92%
Moderate to severe respiratory distress 
Apnoea
223
Q

Kawasaki disease

A

Vasculitis disease

Risk factors
Children of Asian descent

Presentation 
Fever > 5 days 
Rash - mouth, Eyes, palms and soles, body rash.
Swelling of cervical lymph nodes
Strawberry tongue
224
Q

Kawasaki treatment/ investigations

A

Bloods - CRP
ALT, platelets, WBC, Albumin
Echo cardio gram

Treatment:
Aspirin

225
Q

Causes of Jaundice

A

Blood problems: Extravascular haemolytic anaemia, ineffective hematopoesis.

Physiologic jaundice of the newborn: due to low levels of UGT enzyme.

Genetic defects: Gilbert’s syndrome due to low levels of UGT enzyme, Dubin - Johnson syndrome due to deficient MRP2 transporter protein.

Obstructive jaundice: Gallstones, pancreatic carcinoma, liver fluke.

Viral hepatitis:

226
Q

Apoptosis

A

Programmed cell death

227
Q

Viral hepatitis symptoms and blood markers

A 
Fever
Malaise 
Nausea 
Hepatomegaly 
Inflamed liver 
Pain 
Jaundice 
Dark urine 
Bloods:
\++ ALT 
\+ AST
\+ Atypical lymphocytes 
\+ CB and UCB
228
Q

5 types of Hepatitis and how they’re transmitted

A

Hep A: orally through contaminated food or drink. Always acute never chronic. IgM antibodies = active infection IgG = recovery/vaccinated
Hep E: similar to Hep A, Hep E no vaccination, very serious in pregnant women.
Hep C: Blood transmitted, Acute + chronic, HCV RNA (with PCR).
Hep B: blood transmitted, Acute + chronic (20%), Chronic HBV linked to liver cancer.
Hep D: can only infect people with Hep B

229
Q

Osteoarthritis

A

Progressive destruction of a joint surface and remodelling of underlying bone

230
Q

Osteoarthritis risk factors

A 
Age > 50
Trauma 
Obesity 
Family history 
Gender 
Consider occupation
231
Q

Osteoarthritis presentation

A

Gradual onset of joint pain, better with rest, worsens throughout the day. Not usually present at night.

Morning stiffness usually less than 30 minutes. Longer could indicate RA
Joint swelling
Locking/giving away
Mostly weight bearing joints
Unilateral vs bilateral
Joint pain, stiffness, functional limitation

Take holistic approach in history

232
Q

Osteoarthritis findings on the hand

A 
Bouchard’s nodes (PIP)
Heberden’s nodes (DIP)
Squaring of the base of the thumb 
Ulnar/radial deviation 
Wasting of the the area muscle
233
Q

Osteoarthritis XR changes acronym

A

L - loss of joint space
O - osteophytes
S - subchrondral cysts
S - subchrondral sclerosis

234
Q

Normal pressure hydrocephalus presentation and MRI findings

A

Shuffling gait
Incontinence
Memory loss

MRI findings:
Ventricular enlargement
Increased signal intensity around the ventricles

235
Q

Side effect of clozapine

A

Reducing WBC

236
Q

Reactive arthritis

A

Usually happens 1-3 weeks after an initiating infection.

Triad of symptom:
Urethritis
Arthritis
Conjunctivitis

237
Q

Opioid that has the longest analgesic effect?

A

Fentanyl transdermal 48-72 hrs

238
Q

Most common type of renal cancer and symptoms

A

Renal cell carcinoma most common being clear cell.

Haematuria, loin pain, fatigue, weight loss

239
Q

Phlebitis

A

Phlebitis is inflammation of the veins. It is caused by clotting inside of the veins.

Symptoms:
Pain, swelling and tenderness
Red, itchy skin that feels warm to touch

Diagnosed with USS

Treatment: NSAIDs or paracetamol

240
Q

DVT

A

Clots forming in the deep veins or the legs.

Risk factors:
Pregnancy 
Post surgery 
Obesity 
Malignancy

Symptoms:
Asymmetrical oedema
Asymmetrical calf swelling
Pain the in calf

Investigations:
FBC - D-dimer 
LFT’s
EUC
INR 
Venous USS

Treatment:
LMWH - suffix = Parin or Parinux

241
Q

Virchow’s triad

A

Vessel injury
Venous stasis
Hyper-coagulability

242
Q

Pulmonary embolism

A

Caused when a clot travels from the systemic venous circulation to

Signs and symptoms:
Dyspnoea
Pleuritic chest pain 
Increased RR
Hypotension  
Investigations:
C-X-ray but will be normal usually 
CT scan 
D-dimer 
ECG - used to exclude MI, however might show Sinus tachycardia, right ventricular strain
243
Q

Tonic and clonic seizures

A 
Tonic = stiffening of muscles 
Clonic = jerking of muscles
244
Q

Heyde’s syndrome

A

Is a triad of aortic stenosis, anaemia from an intestinal angiodysplasia and an acquired coagulopathy.

245
Q

Angiodysplasia

A

Swelling of the vascular in the GI tract can cause lesions and bleeding in the colon

246
Q

Obstructive and restrictive lung disease

A

Obstructive is characterised by a reduction in airflow because the lungs can not expel gas.

Restrictive is difficulty in taking in air due to stiffness in lung tissue or chest wall cavity.

247
Q

4 types of shock and classification

A

Obstructive shock - e.g. PE, cardiac tamponade
Shock is a circulatory failure with inadequate tissue perfusion

Cardiogenic shock - where your heart can’t supply the body adequately.

Distributive - septic, anaphylactic, neurogenic

Hypovolemic shock - due to volume of blood inadequacy

248
Q

Peripheral vascular disease

A

When the peripheral blood vessels become narrowed which reduced blood flow and affects limbs.

Symptoms:
Hair loss
Numbness or weakness
Brittle, slow growing toe nails 
Ulcers 
Shiny skin

Investigations:
Ankle-brachial index
USS
Angiography

Treatment:
Medications to treat underlying causes
Parins
Aspirin 
Bypass surgery
249
Q

Ruptured AA

A

Presents with pain and collapse, MI symptoms, Heamoptysis, cardiac tamponade.

AAA presents with triad of pain in the flank or back, hypotension and a pulsating abdomen, may feel cold sweaty and faint on standing

Syncope or vomiting

OE they will be cold, pale and sweaty with a weak and thready pulse. They will be tachycardic.

250
Q

Trifascicular block

A

Is a combination of RBBB, LAFB or LPFB, and Heart block.

Does not need treatment on its own but can lead to complete heart block. Avoid high doses of AV blocking agents.

251
Q

Dilated cardiomyopathy

A

DCM is a disease where your heart becomes stretched and thin. This means it is unable to pump blood efficiently. EF <40%

Symptoms: 
SOB 
SOB when lying flat 
Fatigue 
Swelling 
Fainting

Invx: Echocardiogram, exercise stress test, chest x-ray

Treatment: ACE, BB’s, Diuretics,

252
Q

Coarctation of aorta

A

Left ventricular hypertrophy due to a narrowed aorta.

Invx: ECG, echo, CT angiogram.

Treatment: surgery, balloon angioplasty, stenting

253
Q

Tetralogy of falot

A

VSD, pulmonary stenosis, displace aorta, blood flow from both sides of heart into aorta.

254
Q

Glomerulonrphritis

A

GN is when damage to the glomerular has been caused. This can be from infection, auto immune and more.

Due to the damage blood and proteins can leak into the urine. Can cause low GFR.

Usually adults in 50-60s 
Blood,protein in urine
Peripheral oedema 
Frequent nighttime urination 
Very bubbly/foamy urine

Diagnosed using urine dipstick

Treatment involves dietary changes, ACE and pred

255
Q

Nephrotic syndrome

A

Damage to podocytes Causing loss of up to 3.5G/day of protein. Frothy urine due to protein. Nephrotic syndrome causes oedema. Main protein lost is Albumin so liver compensates and causes hyperlipidimia.

-Albumin
+Lipids
Hyper-coagulability

256
Q

Nephritic

A

Response to immune proliferation caused RBC, WBC and protein to leak into urine.

Hematuria
Oliguria = low urine output
Hypertension

257
Q

Drugs that contribute to reduced renal excretion

A 
ACEi
ARB
NSAIDS
Beta blockers 
Antibiotics
258
Q

Two cause of hyperkalaemia

A

Reduced kidney excretion

Damage to cells causing potassium to leak into blood

259
Q

Hypercalcemia

A

Bones - abnormal bone remodelling, fracture risk
Stones - increased risk of kidney stones
Groans - abdo cramping, nausea, ileus, constipation
Psychiatric overtones - lethargy, depressed mood, psychosis, cognitive dysfunction

260
Q

Wernickes encephalopathy

A

Triad of encephalopathy, ocular motor dysfunction and gait ataxia caused by vitamin b1 deficiency often found in alcohol abusers.

Give thiamine repletion before treatment to offset complications of wernickes

261
Q

ESM

A

Of aortic valve origin

262
Q

Pan systolic murmur

A

Mitral regurgitation

263
Q

Horner syndrome

A

Horner syndrome is a combination of signs and symptoms caused by disruption of a nerve pathway to the brain or face. Common signs are pupil reduction, drooping eyelid, decreased sweating.

264
Q

Lesions to the optic chiasm cause what symptom

A

Bitemporal hemianopia

265
Q

VF and VT, presentation, investigation, treatment

A

VF and VT are both shockable rhythms and emergencies. Chest pain, fatigue, palpitations and other non-specific complaints.

Causes: Electrolyte disturbances e.g Hyperkalaemia, hypocalcaemia, hypomagnesaemia, drug levels e.g antidepressants, digoxin, Thyroid, cocaine

Treatment: Defibrillator

ECG: VT will show as broad QRS fast rate and regular on ECG. VF will show similar to VT except if will be irregular.

266
Q

Cardiac tamponade

A

Cardiac tamponade is caused by an accumulation of blood,pus, fluid, clots or gas in the pericardial space, resulting in reduced ventricular filling and subsequent haemodynamic instability.

Can be caused by malignancy, MI, Infection, aortic dissection

Presentation: anxiety, fatigue, altered mental state, oedema, dyspnoea, tachycardia, tachypnoea, cold and clammy extremities.

Signs: Distended neck veins, hypotension, tachycardia, muffled heart sounds, pericardial friction rub, becks triad

Management: Should be done in ICU, Inotrope therapy e.g dobutamine, Echo-guided pericardiocentesis.

267
Q

Acute bronchitis

A

Acute bronchitis is an infection of the bronchi - large airways. It is common and usually due to a viral infection. Most common virus being Rhinovirus, adenovirus and influenza a and b.

Symptoms: Cough, fever, headache, cold and aches and pains. Symptoms typically peak after 2-3 days and 2-3 weeks for the symptoms to be completely gone.

Treatment: OTC meds, drink lots, quit smoking.

268
Q

10 classes of Antibiotics

Antibiotics can terminate protein synthesis for microbial cells like germs

A 
Aminoglycosides 
Cephalosporins 
Tetracyclines 
Penicillins 
Sulfonamides 
Fluoroquinolones 
Macrolides 
Carbapenems
Lincosamides 
Glycopeptides
269
Q

Aminoglycosides: examples, coverage, MOA, uses

A

generally end in Mycin
Streptomycin
Gentamicin

Covers against Gram negative

Inhibits protein synthesis

Some uses abdominal or blood infections

270
Q

Cephalosporins: examples, coverage, MOA, uses

A

Drugs usually start with cef examples include ceftriaxone and cefepime.

Cover against gram negative and gram positive

Inhibit cell wall synthesis

Skin, urinary, resp infections

271
Q

Tetracyclines: examples, coverage, MOA, uses

A

Usually end in cycline, examples tetracycline, doxycycline

Gram + and -

Inhibit protein synthesis

Lyme disease, PID, STI’s

272
Q

Penicillins: examples, coverage, MOA, uses

A

Typically end in cillin examples, ampicillin, amoxicillin

Gram + and -

Inhibits cell wall synthesis

ENT, skin, urinary infections

273
Q

Sulfonamides: examples, coverage, MOA, uses

A

Typically start with sulfa examples, sulfasalazine, sulfamethoxazole

Gram + and -

Inhibits folate synthesis

UTI’s, burns, eye infections

274
Q

Fluoroquinaones: examples, coverage, MOA, uses

A

Typically end in floxacin examples, ciprofloxacin, levofloxacin

Gram + and -

Inhibit DNA replication

Respiratory and urinary infections

275
Q

Macrolides: examples, coverage, MOA, uses

A

Typically end in thromycin examples, azithromycin, erythromycin

Gram +

Inhibit protein synthesis

Pneumonia, sinus, ENT, STI’s

276
Q

Carbapenems: examples, coverage, MOA, uses

A

Typically end in penem examples, Meropenem, ertapenem

Gram + and -

Inhibit cell wall synthesis

Urinary, abdo infections

277
Q

Lincosamides: examples, coverage, MOA, uses

A

Clindamycin

Gram +

Inhibit protein synthesis

Skin, bone, lung infections

278
Q

Glycopeptides: examples, coverage, MOA, uses

A

Vancomycin

Gram +

Inhibits cell wall synthesis

MRSA, skin, endocarditis

279
Q

Croup

A

Self-limiting upper airway viral infection of the larynx and trachea

Symptoms: Hoarse voice, barking cough, inspiratory stridor, increased work of breathing.

Causes: Parainfluenza virus 1 and 2, RSV

Moderate presentation requires steroid therapy with dexamethasone
Severe presentation requires nebulised adrenaline

280
Q

Child-pugh score

A

Criteria for assessing chronic liver disease looks at the levels of total bilirubin, serum albumin, ascites, INR and the grade of hepatic encephalopathy.

281
Q

How does liver failure causes hepatic encephalopathy

A

The liver is too diseased or damaged to properly process ammonia. Ammonia travels to the brain and causes confusion, disorientation and even death.

282
Q

Bronchiolitis

A

Inflammation of the small airways of the lung most commonly caused by RSV.

Mainly affects young children.

Symptoms:
Coryza 
Increased work of breathing 
Wheezing 
Fever

Treatment:
Oxygen
Supplemental fluids
Steroid nebs in severe cases

283
Q

Bacterial pneumonia

A

Infection and inflammation of the lungs usually by streptococcus pneumonia or HIB.

CAP or HAP

Symptoms: 
SOB
Chest pain 
Productive cough 
Systemic symptoms

Diagnosis:
CXR showing consolidation
Dullness to percussion
Crackles

Treatment:
Antibiotics - macrolides usually end in Mycin

284
Q

Pertussis (whooping cough)

A

Contagious infection caused by bordetella pertussis characterised by a whooping cough.

Gram negative

Symptoms:
Whooping cough
Vomiting 
Collapsed lung 
Petechiae

Treatment is usually prophylactic in the form of a vaccine. DTAP
Diphtheria, Tetanus, Acellular pertusis

Or macrolide antibiotics, which end in Mycin

285
Q

Sickle cell disease

A

Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells.

Risk factors:
Afro-Caribbean family background

Symptoms:
Painful episodes called sickle cell crisis, can be very severe and last up to a week
Increased risk of serious infection
Anaemia

Treatment 
Definitive treatment is bone marrow transplant 
Prophylactic antibiotics 
Blood transfusion 
OTC analgesia
286
Q

Bisphosphonates

A

A group of drugs that slow down or prevent bone loss by inhibiting osteoclasts.

Example: denosumab

Most common side effects bowel irritation and heartburn

287
Q

Best test to see if a woman is ovulating

A

Day 21 progesterone level

288
Q

Toxic shock syndrome

A

Happens around the time of a woman’s period due to a retained tampon. A patient will present with an infective picture. Removal of tampon and broad spectrum antibiotics.

289
Q 
COPD 
Pathophysiology 
Symptoms 
Investigations 
Management
A

COPD is caused by excessive damage caused mainly by smoking to the lining of the lungs and airways.

Symptoms:
Increasing breathlessness 
Persistent cough
Frequent chest infections 
Persistent wheeze 
Weight loss
Tiredness 
Chest pain 
Swollen ankles

Investigations:
Spirometry
Chest x-ray to rule out other causes

Treatment:
Quit smoking
Inhalers - short acting bronchodilators
Pulmonary rehabilitation

290
Q

What is body temperature regulated by?

A

Hypothalamus

291
Q

Fever is a physiological response to what 4 things?

A

Infection
Autoimmune
Inflammation
Malignancy

292
Q

Fever causes the release of what Pyrogenic cytokines?

A

IL-1, IL-6, TNF

293
Q

Pyrogenic cytokines induce the synthesis of what?

A

Prostaglandin E2 in the pre-optic area of the hypothalamus it is responsible for increasing the core body temperature

294
Q

Prostaglandin E2 triggers what?

A

Vasoconstriction

295
Q

Antipyretic drugs and what they target in fever

A

Aspirin

Target prostaglandin E2

296
Q

What do corticosteroids target in fever?

A

Target the production of Pyrogenic cytokines
IL-1
IL-6
TNF

297
Q

Most common Hepatic tumour?

A

Hepatocellular carcinoma (HCC)

298
Q

Most common leukaemia in adults?

A

Chronic lymphocytic leukaemia B-CLL

299
Q

Child-Pugh score

A

The Child-Pugh score determines the severity of cirrhosis and is useful for determining prognosis. It is based on five parameters:

Ascites 
Hepatic encephalopathy
Serum bilirubin
Albumin
INR/PT.
300
Q

Collapsing pulse is associated with what valve defect

A

Aortic regurgitation

Clinical Knowledge (14 decks)

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