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CP1 as you go > Cp1 as you go > Flashcards

Cp1 as you go Flashcards

1
Q

angina treatment

A

Nitrates
Beta Blockers
Calcium chall

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2
Q

Subdural haemorhage

A
  • Headache
  • drowsiness
  • confusion

Maybe

  • focal deficits
  • epilepsy
  • stupor coma and death
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3
Q

meningo-encephalitis

A
  • meningism
  • fever

common

  • malaise
  • rigors
  • vomitng
  • progressive drowsiness
  • lateralising signs
  • cranial nerve lesions
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4
Q

Hypothroidisms causes

A

Primary

  • atriophic thyroiditis
  • hashimoto’s thyroiditis
  • infective (TB, Waterhouse Friedrichson syndrome)
  • iodine deficiency
  • congenital

Secondary

  • hypopituitarism
  • peripheral resistance to thyroid hormone
  • drug induced hypothyroidism (amiodarone, carbimazole).
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5
Q

Addison’s

A
  • hyperpigmentation
  • weakness and fatigue
  • N and V
  • Dizziness and postural hypertension
  • severe hypotension
  • dehydration
  • hyperkalaemia
  • hyponatraemia
  • hypoglycaemia
  • hypercalcaemia
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6
Q

Causes of hypercalcaemia

A
  • primary hyperparathyroidism/malignancy
  • thyrotoxicosis
  • addison’s
  • thiazides
  • lithium
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7
Q

secondary caues of diabetes

A

Pancreatic failure

  • chronic pancreatitis
  • cystic fibroiss
  • haemochromatosis

Insulin resistance

  • polycystic ovarian syndrome
  • cushing’s syndrome
  • acromegaly

drugs

  • glucocoricoids
  • thyroid hormon
  • thiazides
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8
Q

diabetic neuropathy

A

v-Symmetrical distal sensorimotor polyneuropathy

  • acute painful neuropathy
  • mononeuropathy and mononeuritis
  • diabetic amotrophy
  • autonomic neuropathy.
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9
Q

hyperthyroidism causes

A

Causes include;

  • Grave’s disease (80%)
  • solitary toxic adenomas (5%)
  • toxic multinodal goitres (15%)
  • de Quervain’s thyroiditis (5%)
  • postpartum thyroiditis
  • amiodarone-induced thyrotoxicosis
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10
Q

hyperthyroidism symptoms

A

SWEATING

  • Sweating
  • Weight loss
  • Emotional lability
  • Appetite increased
  • Tremor/ tachycardia
  • Intolerance of heat/ Irregular menstruation/ Irritability
  • Nervousness
  • Goitre and GI problems (diarrhoea)
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11
Q

Growth hormone tumour

A

-joint pain
-heart problems
-hyperglycaemia
-swating
enlarged hands and feet
-coarsened facial eatures
-increased hair
-misaligned teath

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12
Q

prolactin secreting tumour

A

women

  • milky discharge from breasts
  • lack of menstrual periods
  • irregular menstrual cycles

men

  • gynaemastia
  • lower sperm count
  • erectile dysfunction
  • excessive sweating
  • frequent bowel movements
  • nervousness
  • palpitations
  • weight loss
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13
Q

step four hypertension

A
  • alpha blocker
  • spironolactone
  • other diuretic
  • beta blocker
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14
Q

pancreatitis causes

A

Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP (Endoscopic retrograde cholangio-pancreatography)
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

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15
Q

anion gap

A 
causes of increased anion gap:
lactic acidosis
diabetic ketoacidosis
methanol poisoning
ethylene glycol poisening
Phosphates (renal failure)
negative base excess

normal? - hyperchloraemic acidosis (vomiting and diahorhea?)
high output stoma
(normal is 12-16 if you include potassium)
positive base excess
Addison’s

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16
Q

thyroid cancers

A

1) Papillary - 65%, generally young females. Metastasis to cervical lymph nodes. Thyroglobulin can be used as a tumour marker. Characteristic Orphan Annie eyes on light microscopy. Good prognosis
2) Follicular - 20%, generally women >50 years old. Metastasis to lung and bones. Thyroglobulin can be used as a tumour marker. Moderate prognosis
3) Medullary - 5%, sporadic or part of MEN2 syndrome. It originates from the parafollicular cells which produce calcitonin - can be used as a tumour marker.
4) Anaplastic - very rare. Elderly patient. Very poor prognosis
5) Lymphoma - 5%, might present with dysphagia or stridor

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17
Q

kidney damage drugs

A

DAAMN

Diuretics
ACE inhibitors/ARBs/antibiotics (penicillin)
Metformin
NSAIDs

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18
Q

acute diarrhoea

A
  • gastroenteritis
  • diverticulitis
  • antibiotic therapy
  • constipation causing overflow
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19
Q

chronic diarrhoea

A
  • irritable bowel syndrome
  • ulcerative colitis
  • crohn’s disease
  • colorectal cancer
  • coeliac disease
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20
Q

causes of hypoglycaemia

A

EXPLAIN mneumonic

Exogenous drugs (typically sulfonylureas or insulin)
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours (insulinomas)
Non-pancreatic neoplasms
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21
Q

BP classification

A

stage1

  • 140/90 clinic bp and subsequent ABPM
  • HBPM average 135/85

stage 2

  • 160/100 clinic bp and subsequent ABPM
  • HBPM average 150/95

severe
-clinic 180/110

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22
Q

Lung cancer paraneoplasic features

A

Small cell
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

Squamous cell
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

Adenocarcinoma
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

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23
Q

Sirs

A

temp <36 >38
heart rate > 90
TCHPNEA >20
wbc <4000 or >12000

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24
Q

anaemia

A

Symptoms;

  • Fatigue
  • headaches
  • faintness
  • SOB
  • angina
  • intermittent claudication
  • palpitations.

Anaemia exacerbates existing cardiopulmonary problems, such as angina, claudication and SOB.

Signs include;

  • pallor
  • tachycardia
  • systolic flow murmur
  • cardiac failure (oedema, hypotension).

Specific anaemias may produce;

-koilonychia
-jaundice
-bone deformities
-leg ulcers
-angular
stomatitis
-brittle hair and nails
-Plummer-Vinson syndrome (dysphagia and glossitis).

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25
Q

Neutrophilia

A

Neutrophilia (>10):
Bacterial infection,
Tissue damage (MI, PE, Burn),
Physiological (Pregnancy, during exercise),
Corticosteroids and Inflammation (Gout, RA, UC, Crohn’s),
Malignancy (CML, solid tumour).

26
Q

neutropenia

A

Neutropenia (<1.5):
Viral infection & Severe bacterial infection (typhoid),
Autoimmunity,
Felty’s syndrome (RA, splenomegaly, neutropenia),
Ethnicity (common in black races),
Alcohol and other Drugs,
ELA2 gene mutation (may cause cyclical or complete lack).

27
Q

lymphocytosis

A

Lymphocytosis (>5):
Viral infections (particularly EBV, CMV and early HIV),
Chronic infections (TB, toxoplasmosis),
CLL(chronic lymphocytic leukemia)i and some lymphomas,
Post-splenectomy.

28
Q

lymphopenia

A 
Lymphopenia:
HIV, autoimmunity,
Corticosteroids and Inflammation (conn tiss disease),
Chemotherapy and lymphoma,
Renal failure,
Transient following recent infection.
29
Q

Lab clotting tests

A

Things to take away;

  • INR = prothrombin time = raised by warfarin = Extrinsic pathway
  • APTT = raised by heparin = intrinsic pathway (also prolonged with warfarin)
30
Q

liver and clotting

A
  • liver produces factors 1 (fibronogen), 2(prothrombin) 4, 5, 6 and 7.
  • decreases lead to increased PT (INR)
  • Portal hypertension >splenomegaly> thrombocytopenia
  • cholestasis > reduced bile salts > reduced vit K absorbtion
  • Vit K needed for factor 2, 7, 9, 10 glutamate residue carboxylation
31
Q

BP targets age

A

<80
140/90 clinic or 135/85 home

> 80
150/90 clinic
145/85 home

32
Q

cerebellar damage

A

DANISH

  • dysdiadochokinesis
  • ataxia
  • nystagmus
  • intention tremor
  • slurred speech (scanning dysarthria - HI PO POT A MUS)
  • hypotonia
33
Q

parkinson’s

A

TRAP

  • Tremor
  • rigidity
  • akinesia
  • postural instability.
34
Q

differentiate acute and chronic renal failure

A

Best way to differentiate is renal ultrasound - most patients with CRF have bilateral small kidneys

Exceptions
autosomal dominant polycystic kidney disease
diabetic nephropathy
amyloidosis
HIV-associated nephropathy

Other features suggesting CRF rather than ARF
hypocalcaemia (due to lack of vitamin D)

35
Q

nephrotic syndrome

A

Triad of:

  1. Proteinuria (> 3g/24hr) causing
  2. Hypoalbuminaemia (< 30g/L) and
  3. Oedema

Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels predispose to thrombosis. Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels.

36
Q

cushings test

A

not suppressed by low dose dexamethasone = cushings syndrome probs secondary to corticosteroid therapy

suppressed by high dose = cushing disease

not suppressed by either = ectopic acth syndrome

37
Q

Endocrine parameters reduced in stress response

A

Insulin
Testosterone
Oestrogen

38
Q

suspect asthma

A
  • may be triggered by viral infection
  • allergen exposure
  • NSAIDs/beta-blockers
  • exacerbated by exercise
  • cold air
  • emotion/laughter in children
  • worse at night and early morning
  • atopy
  • absence if COPD, dysfunctional breathing or obesity
39
Q

Complete heart block

A 
syncope
heart failure
regular bradycardia (30-50 bpm)
wide pulse pressure
JVP: cannon waves in neck
variable intensity of S1
40
Q

Chest pain differentials

A 
MI
pneumothorax
PE
Pericarditis
Dissecting aortic aneurysm
GORD
Musculoskeletal
41
Q

T1 respiratory failure

A

T1 <8Kpa o2 and <6.7Kpa co2 -mismatch

  • high altitude
  • PE
  • pneumonia
  • left right shunt
42
Q

T2 respiratory failure

A

T2 <8kpa o2 and >6.7kpa CO2 - hypoinflation

  • copd
  • asthma
  • extreme obesity
  • suphocation
  • chronic bronchitis
  • neuromuscular problems
  • deformity
43
Q

copd investigations

A

CAT - COPD assessment test

  • blood counts
  • spirometry
  • CXR - flattened diaphram and hyperinflation
  • HRCT to evaluate bullae
  • Alpha 1 anti-trypsin deficiency
44
Q

Pneumonia organisms

A

CAP:

  • Strep pneumo
  • Myco pneumo
  • Hib
  • Chlamydia pneumo
  • Legionella

HAP:

  • Gram -ve bacteria (E Coli, Pseudomonas, klebsiella)
  • Staph Aureus
45
Q

DIC

A

complication of septicaema

  • low platlet count
  • low fibrinogen
  • long APTT
46
Q

RA autoantibody

A

Anti-cyclic citrullinated peptide

47
Q

Fibrosis symptoms

A
  • reduced global expansion
  • inrcreased vocal respnance
  • fine crackles
  • finger clubbing
48
Q

types of fibrosis

A

Localised fibrosis may be caused by;

  • systemic sclerosis
  • sarcoidosis
  • tuberculosis
  • asbestosis
  • berylliosis.
Diffuse fibrosis may be caused by;
IPF (Idiopathic pulmonary fibrosis)
-rhematoid lung
-tuberous sclerosis
-nerofibromatosis
-lagnerhan's cell histiocytosis.
49
Q

Acute renal failure symptoms

A
  • uraemia
  • oliguria
  • anorexia
  • N+V
  • pruritis
  • intellectual clouding
  • haemorrhage (endothelial damage).
50
Q

acute renal failure biochemical markers

A
  • raised serum creatinine
  • loss of urinary output.
  • hyperkalaemia
  • acidosis
  • hyponatraemia (via overdrinking)
  • hypocalcaemia (less vit D)
  • hyperphosphataemia.
51
Q

AKI causes

A 
Renal artery thrombosis
massive hypotension/haemorrhage
burns
D+V
pancreatitis
diuretics
MI
CCF
endotoxic shock
snake bite
globinaemias
liver failure
radiological contrasts
drugs
pregnancy
(pre-eclampsia, eclampsia, abruption placentae)
acute-on-chronic disease.
52
Q

CRF

A

-uraemia
(a) Decreased GFR and tubular resorption lead to retention of Na, K and H2O, leading to hypertension ( leads to cardiac failure leads to reduced renal perfusion) and hyperkalaemia.
(b) Reduced bicarbonate resorption and decreased H+ excretion lead to metabolic acidosis.
(c) Reduced renal mass leads to reduced EPO and resulting anaemia (normochromic/cytic).
(d) Retention of phosphate and loss of renal mass lead to less vit D production, and a
hypocalcaemia, causing secondary hyperparathyroidism and renal osteodystrophy.
(e) Fibrinous and Uraemic exudates develop and may cause pericarditis or pneumonitis with exudate development.
(f) Haemorrhagic ulcers in the GI tract, immunological depression, and other system alteration may occur.

53
Q

uraemia

A
  • symptoms from 50mM
  • malaise and lethargy
  • anorexia
  • N+V
  • insomnia progressing to confusion
  • convulsions
  • coma.
54
Q

CRF investigation

A
  • urinalysis
  • urine microscopy
  • urine biochemistry
  • serum biochemistry (U&Es, vit D, Ca+PO4-+albumin, ABG, glucose+lipids)
  • haematology (FBC and haematinics)
  • immunology tests (HIV, Hep, G&S)

Secondary investigations include;

  • ultrasound
  • CT and MRI (every patient should receive an ultrasound).
55
Q

body temperature

A

36.1 - 37.2

56
Q

heart failure x ray

A 
Alveolar oedema (bat's wings) 
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
57
Q

Hypercalcaemia symptoms

A

69/76
x ray findings in heart failure

Alveolar oedema (bat's wings) 
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)

hypercalcaemia symptoms

Stones (renal)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria)
Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)

58
Q

Pulmonary oedema typical features

A

Discuss the main pathological classification of tumours of the testis and give a brief outline of their biological behaviour

Tumours of the testis may be germ cell, or non-germ cell.

Non germ-cell tumours are much rarer and include Lymphoma, Sertoli and Leydig cell tumours, which are often functional - increased levels of testosterone may result in increased secondary sexual characteristics and aggression.

Germ cell tumours may be Seminomas, or non-seminomas.

Non-seminoma germ cell tumours (35%) include;

  • mature teratomas (well differentiated -recognisable structures)
  • teratocarcinomas (intermediately well differentiated - recognisable structures alongside malignant material)
  • choriocarcinomas & yolk sac carcinomas (alpha-FP and beta-HCG secreting)
  • embryonal carcinomas (totally undifferentiated) - in order of increasing
    malignancy.

These tumours are irregular in shape and show focal haemorrhage. Spread is via
lymphatics to para-aortic nodes, and through the blood to lungs, bone and liver.

Seminomas (50%) have a peak incidence in patients’ 30s. The testis is uniformly enlarged and on section looks well circumscribed and uniformly grey/white. Spread is principally along the spermatic cord through lymphatics and blood vessels. 15% of tumours show both seminomatous and teratomatous change.

Describe the typical clinical features of acute pulmonary oedema

Main three;

  • Tachycardia/Dyspnoae
  • gallop rhythm
  • bilateral basal crackles
distressed
pale 
sweaty
increased RR
wheeze

Other signs present may indicate a cause - ie
JVP in heart failure, jaundice in liver failure.

59
Q

ARDS

A

73/76
Describe the typical clinical features of acute pulmonary oedema

Main three;

  • Tachycardia/Dyspnoae
  • gallop rhythm
  • bilateral basal crackles
distressed
pale 
sweaty
increased RR
wheeze

Other signs present may indicate a cause - ie
JVP in heart failure, jaundice in liver failure.

acute respiratory distress syndrome

symptoms;

  • Severe shortness of breath
  • Labored and unusually rapid breathing
  • Low blood pressure
  • Confusion and extreme tiredness

Causes:

  • Sepsis. The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream.
  • Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS, as can inhaling (aspirating) vomit or near-drowning episodes.
  • Severe pneumonia. Severe cases of pneumonia usually affect all five lobes of the lungs.
  • Head, chest or other major injury. Accidents, such as falls or car crashes, can directly damage the lungs or the portion of the brain that controls breathing.
  • Others. Pancreatitis (inflammation of the pancreas), massive blood transfusions and burns.
60
Q

Obstructive lung disease

A

asthma
COPD
bronchiectasis
bronchoilitis obliterns

61
Q

restrictive lung disease

A
  • pulmonary fibrosis
  • asbestosis
  • sarcoidosis
  • ARDS
  • Infant respiratory diseress syndrome
  • kyphoscoliosis
  • neuromuscular disorders
62
Q

glucose values

A

normal

  • random <11.1
  • fasting <5.5
  • tolerance <7.8

prediabetes

  • random - na
  • fasting 5.5-6.9
  • tolerance 7.8-11

diabetes

  • radom >11.1
  • fasting >7
  • rolerance >11.1

Hypoglycaemic <4

CP1 as you go (3 decks)

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