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Medicine - Year 2 > Clinical Skills and Reasoning > Flashcards

Clinical Skills and Reasoning Flashcards

1
Q

Normal and abnormal cause of palmar erythema

A

Normal in pregnancy

Also found in liver disease

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2
Q

Symptoms of clubbing

A

nail hard, nail bed spongy, nail curvature and angle change

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3
Q

Causes of clubbing

A

CV: Congenital heart disease, Infective endocarditis, Atrial myxoma (tumour in atrium)
RS: Lung carcinoma, Pulmonary fibrosis, Cystic fibrosis, Bronchiectasis, Abscess, Empyema

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4
Q

What are osler’s nodes?

A

Red dots on the fingertips

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5
Q

What order do you examine the lymph nodes in? (11)

A

submental > submandibular > tonsillar > parotid > periauricular > postierior auricular > superficial cervical > deep cervical > supraclavicular > posterior cervical > occipital

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6
Q

What is the difference between marked and moderate hydration status?

A

Marked: loss of skin tension
Moderate: Tongue and eyes should be wet and glistening (fontanelle in babies)

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7
Q

Which 2 CAM therapies are statutory regulated?

A

Osteopathy and Chiropractice

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8
Q

Define the effectiveness gap

A

Clinical area where available treatments are not fully effective or satisfactory

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9
Q

3 main reasons for CAM use

A

Musculoskeletal/neuromuscular
Arthritis
Headaches

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10
Q

4 methods of chiropractic therapy

A

Mobilisation and manipulation (moving joints, relaxing muscles and modifying the pain gate)
Soft tissue therapies and massage
Guided movement
Rehabilitation exercises

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11
Q

What affects how well a treatment works? (5)

A 
Relationship between patient and physician
Treatment is patient centered
Healthcare setting
Patient education (complaince)
Patient expectations
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12
Q

Why is acupuncture not in NICE guiedlines?

A

There is no significant difference between actual and sham acupuncture

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13
Q

What does NICE state about CAM therapies?

A

Used alongside other treatments such as drugs, psychological and exercise

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14
Q

Define dysponea

Is it a sign or a symptom

A

Breathlessness

Symptom

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15
Q

Why does giving oxygen not sure dysponea?

A

Not caused by reduced oxygen or poor respiratory rate

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16
Q

9 causes of cough hypersensitivity

A

Interstitial lung disease, Left heart failure, Lung cancer, Reflux
ACEi, Asthma, Aspiration, Infection, Pulmonary fibrosis

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17
Q

Define mucoid

A

Excess secretion of mucus

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18
Q

Define purulent

A

Green or yellow sputum from inflammation

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19
Q

When does mucus have a bad smell/taste? (3)

A

Anaerobic infection
Abscess
Cancer

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20
Q

What cardiac disease do you get haemoptysis in? (2)

A

PE or mitral stenosis

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21
Q

Define rhonchi

A

Wheeze: A musical noise produced by air moving through narrowed airways louder in expiration

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22
Q

Why does salbutamol not cure a severe asthma attack?

A

It does not cure every symptom of asthma

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23
Q

3 characteristics of pleuritic pain
Where does the pain come from?
3 causes

A

Sharp, stabbing and worse on inspiration
Parietal pleura
e.g. pneumonia, PE, pneumothorax

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24
Q

5 things which mimic pleuritic pain

What differentiates them from the lungs?

A 
Reterosternal pain (trachea/mediastinum)
Bony pain (e.g. metastases)
Chest wall pain (trauma)
Spinal root pain
Shingles 
(often unrelated to exercise)
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25
Q

Define astrexis

A

Flapping tremor

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26
Q

Define intercostal indrawing

A

Skin between ribs pulled in

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27
Q

2 accessory muscles of respirtion

A

Pectoral

Sternomastoid

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28
Q

What causes mediastinal shift towards the affected side and away from the affected side?

A

Towards = reduced volume e.g. collapsed lung (penumothorax)

Away from = tumour, pleural effusion (fluid in pleural cavity)

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29
Q

What happens to the cricosternal distance when the patient is hyperinflated?

A

Reduces

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30
Q

Explain what causes the 4 noises on percussion

A

Stony dull = pleural effusion
Dull = pneumonia
Resonant = normal
Hyperresonant = pneumothorax

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31
Q

What is the technical term for normal breath sounds?

A

Vesicular

32
Q

3 causes of diminished/absent breath sounds

A

Collapse, Effusion, Pneumothorax

33
Q

Cause of bronchial breath sounds
What do they sound like
Why are they loud?

A

Consolidation
Harsh sounds with prolonged expiratory phase
Solidified alveoli transmits sound better than airy

34
Q

Define crepitations

A

Crackles

Discontinuous non-musical sounds on inspiration due to explosive opening of occluded small airways

35
Q

What does it mean if crackles clear with coughing

A

Secretions are in large airways rather than small ones

36
Q

2 causes of coarse crackles

2 causes of fine crackles

A

Coarse: pneumonia, bronchiectasis
Fine: oedema, pulmonary fibrosis

37
Q

Define whispering pectoriloquy

A

Whispered sounds are heard more clearly in consolidation

38
Q

What does it mean if syllables are transmitted more/less clearly when testing vocal resonance?

A

More clear = consolidation

Less clear = collapse, pneumothorax, effusion

39
Q

What are most deaths from CVD due to?

A

Smoking

40
Q

9 symptoms of heart failure

A

SOB, Peripheral oedema, Cough with pink sputum, Reduced sleep, Reduced energy, Swollen abdomen,
Nocturia, Confusion, Memory loss

41
Q

Difference between angina and MI?

A

Angina: worse on exertion and cold; relieved by rest and GTN, 2-10 mins

MI: worse at rest, no relief, breathless, sweaty, nausea, fear, 30 mins +

42
Q

What are the 4 classifications of angina

A
  1. Angina with prolonged exertion
  2. Slight limitation of normal activity (stairs, hill, cold)
  3. Marked limitation or normal physical activity
  4. Angina at rest / can’t do any physical activity
43
Q

2 characteristics of pericarditis pain

2 things that make it worse
1 thing which makes it better
Duration
Cause
2 ECG changes
A

Sharp, stabbing

Worse with inspiration and lying flat
Eased by sitting
Hours > Days
Viral illness
ST elevation and PR depression
44
Q

4 characteristics of aortic dissection pain

2 places it radiates to

A

Sudden, tearing, knifetlike, excrutiating

Radiates to back/abdomen

45
Q

2 characteristics of pulmonary embolism pain

What is it associated with?

A

Pain over infarcted area
Pleuritic rub
SOB

46
Q

Define tachypnoea

A

More than 20bpm

47
Q

What is it called when patients have to sleep on more pillows?

A

Orthopnoea

48
Q

What is PND?
Explain what happens during an episode and how long it lasts
2 causes

A

Paroxysmal Nocturnal Dysponea
Wake up and have to sit up and go to the window
Cough and wheeze for 20 mins
Frightening

Reduced respiratory drive, Reduced heart adrenergic activity at night

49
Q

Define palpitation

A

Unpleasant awareness of heart beat

50
Q

Define syncope

A

Brief transient loss of consciousness and postural tone with rapid spontaneous recovery

51
Q

6 characteristics of a cardiac syncope

A 
Sudden onset
No aura
No jerks/incontinence
Injury common
Immediate recovery
Very pale
52
Q

4 characteristics of a neurological syncope

A

Convulsive movement
Confusion after
Incontinence
Tongue biting

53
Q

Explain vasodepressor syndrome

A

Faint after prolonged standing
Gradual faintness and greying vision
Response to stress

54
Q

Explain carotid sinus hypersensitivity

Diagnosis and treatment

A

Syncope when pressure is put in the carotid artery
Diagnosed by rubbing carotid with ECG
Fitted with a pacemaker

55
Q

3 drugs which cause peripheral oedema

A

NSAIDs, Fluorocortisone (retain Na)

Amlodipine (increased capillary permeability)

56
Q

5 causes of fatigue in cardiac patients

A

Reduced cardiac output or blood pressure
Excessive diuresis (causing reduced K)
Drugs e.g. beta blockers

57
Q

3 causes of splinter haemorrhages

A

SLE, gardening, rheumatoid

58
Q

What causes clubbing of the toes?

A

Patent ductus artriosus

59
Q

What are the 2 lipid signs around the eye?

A

Orbital xanthelasma

Corneal arcus

60
Q

What is the cause of a slow rising pulse and collapsing pulse?

A

Slow rising = Aortic stenosis

Collapsing = Aortic regurgitation

61
Q

Where do you measure the JVP from?

A

Manubrum-sternal joint

62
Q

What are the 5 parts of the JVP wave?

A

A: atrial systole
X decent: after atrial contraaction
C: rapid increase in R ventricle pressure before tricuspid valve closes
V wave: venous return fills RA during ventricle systole
Y decent: Tricuspid valve opens

63
Q

6 causes of an elevated JVP

A 
Cardiac tamponade
Constrictive pericarditis 
Heart failure
Increased arterial pressure
Renal disease
SVC obstruction (cancer or mediastinal mass)
64
Q

3 causes of large A waves on the JVP

A

Pulmonary hypertension, Tricuspid stenosis, Cannon waves

65
Q

1 cause of giant V waves

A

Tricuspid regurgetation

66
Q

1 cause of a steep Y descent

What sign is also seen?

A

Constrictive pericarditis

Freidreict’s sign - rapid increase and slow decrease in JVP

67
Q

What causes the 1st and 2nd heart sound?

A

1st: Tricuspid and mitral valve CLOSE
2nd: Aortic and pulmonary valve CLOSE

68
Q

What does it mean if the apex beat is:

  • Normal bit shifted
  • Impalpable
  • Tapping
  • Heaving
  • Volume loaded
  • Double impulse
  • Dyskinetic
A
  • Normal bit shifted: Pneumothorax
  • Impalpable: High BMI, COPD, Cardiac tamponade
  • Tapping: Mitral stenosis
  • Heaving: Increased bp, Aortic stenosis
  • Volume loaded: Aortic regurgitation, Bigger LV
  • Double impulse: Hypertrophy cardiomyopathy
  • Dyskinetic: Previous MI/LV aneurysm
69
Q

What does splitting of the 2nd heart sound indicate?

What does reverse splitting indicate?

A

Atrial septal defect

Pulmonary heard before atrial in severe aortic stenosis

70
Q

3rd heart sound:

What does it sound like?
When is it?
How can you hear it?
3 causes

A 
Ken-tuc-KY
After S2 (start of diastole)
Low pitch (bell)

Normal in young adults and athletes
Failing LV/ Movement of blood between atrial walls

71
Q

4th heart sound:

What does it sound like?
When is it?
1 cause

A 
TENN-es-see
Before S1 (end of diastole)

Failing LV

72
Q

What increases the sound of a cardiac hypertrophy murmur and a mitral stenosis murmur?

A

Cardiac hypertrophy = squatting

Mitral stenosis = rolling to the left

73
Q

When are heart murmurs not important? (4)

A

Short systolic murmurs around the left sternum (pregnancy/anaemia)
Normal heart sounds, normal ECG, asymptomatic

74
Q

What murmurs are found with prosthetic valves?

A

Aortic valve prosthesis = systolic ejection murmur

Mitral valve prosthesis = diastolic flow murmur

75
Q

What happens to the heart sounds in stenosis?

What changes to the pulse and ECG?

A

2nd heart sound is soft (calcified valve)
Slow rising carotid pulse
ECG = left ventricular hypertrophy

76
Q

What happens to the heart sounds in sclerosis?

What changes to the pulse and ECG?

A

Normal/loud 2nd sound
Carotid pulse is brisk/normal
No LVH on ECG unless severely hypertensive

Medicine - Year 2 (19 decks)

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