1
Q
What is a depression in the centre of the nail and what is associated with?
A
- Koilonychia or spoon nails. It can be as a result of issueswith the CVS, CRS, GI
- It is caused by Iron deficient - anaemia
2
Q
What are white marks on the nail called and what are they associated with?
A
• Leukonychia – whitened nail bed – hypoalbuminemia – liver failure / enteropathy
3
Q
What are 4 GI pathologies associated with clubbing?
A
- Malabsorption - Crohn’s disease and ulcerative colitis
- Cirrhosis, especially in primary biliary cirrhosis
- Cancer
4
Q
What are 4 CVS pathologies associated with clubbing?
A
Any disease featuring chronic hypoxiaCongenital →
- cyanotic heart disease (most common cardiac cause)-
- Subacute bacterial endocarditis
- Atrial myxoma (benign tumor)
- Tetralogy of Fallot
5
Q
What are 4 Lung pathologies associated with clubbing?
A
- Lung cancer, mainly non-small-cell (54% of all cases), not seen frequently in small-cell lung cancer
- BCFM → Bronchiectasis, cystic fibrosis, fibrosing alveolitis, mesothelioma
6
Q
What is an autoimunne disease of the thyroid associated with clubbing and exopthalmos?
A
Graves disease.
- it is the most common cause of hyperthyroidism :
- irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and weight loss.
7
Q
what is exopthalmos?
A
Bulging eyes.
8
Q
what is enopthalmos and name 2 conditions it is associated with?
A
- Sunken eyes. It may be a congenital anomaly, or be acquired as a result of trauma (such as in a blowout fracture of the orbit),
- Horner’s syndrome (apparent enophthalmos due to ptosis),
- Marfan Syndrome, silent sinus syndrome, or phthisis bulbi.
9
Q
What is Anisocoria?
A
different sized pupils.
10
Q
What is mydriasis?
A
Dilated pupils.
11
Q
What is myosis?
A
constriction of the pupils.
12
Q
What are the red line-like marks of the nail called, and what are they associated with?
A
Splinter haemorrhages -infective endocarditis is the main one but also:
- scleroderma
- trichinosis
- systemic lupus erythematosus (SLE)
- rheumatoid arthritis
- psoriatic nails
- haematological malignancy
- trauma.
13
Q
What and where are hederden’s nodes and what are they associated with?
A
Osteoarthritis – nodes on the distal interphalangeal joints
14
Q
What and where are bouchard’s nodes and what are they associated with?
A
Osteoarthritis – nodes on the proximal interphalangeal joints
15
Q
What is palmar erythema?
A
Palmar erythema is reddening of the palms at the thenar and hypothenar eminences.
It is associated with the CVS, CRS, GI
- Peripheral vasodilation–Sepsis
- Chronic liver disease
- Portal hypertension
16
Q
What are Janeway’s lesions?
A
Small red non-raised, non-painful lesions on the palms and fingers. Associated with cardio vascular system.
- Infective endocarditis
- Can come from previous Rheumatic fever
17
Q
What are Orslers Nodes?
A
Small red nodes on the fingers. they are raised (nodular) and painful.
Associated with CVS.
• Infective endocarditis
18
Q
What does a single transverse palmar crease signify in child development?
A
Downs syndrome.
19
Q
In which fluid compartment is the majority of water in the body and what is its primary composition?
A
- Intracellular
- majority of our total body water is locked within our cells in the intracellular compartment.
- Composed of high potassium and low sodium. The gradient is maintained by Na-K ATPase.
20
Q
Which is the second largest fluid compartment in the body and what is its primary composition?
A
- Interstitial
- bathes the cells and occupies spaces such as pleural cavity and joint spaces. It absorbs and loses fluid to intracellular and intravascular compartments.
- Composed of high sodium (135 – 145 mmol/L and low potassium (3.5 – 5 mmol/L) identical to blood, but with a lower protein content.
21
Q
What are the basic requirements for sodium, potassium and fluid per day?
A
Basic requirements:
Sodium → 2mmols/kg/day
Potassium → 1mmol/kg/day
Fluid→ 1-1.5 mls/Kg/hour (for adults approx. 1.5-2.5 L/day)
22
Q
Where can the body lose fluid?
A
- GI - vomiting and diarrhoea. can also loose ↑↑Na + K
- Insensible - can be as much as 500mls/day but can double in sepsis, burns, skin loss or pyrexia.
- Urine- 1ml/kg/hr
- Trauma - haemorrhage, drain, dialysis
23
Q
What is a crystaloid?
A
Crystalloid solutions contain low molecular weight salts or sugars which dissolve completely in water and pass freely between the intravascular and interstitial compartments.
- Normal
- Saline
- Dextrose 5%
24
Q
what is a colloid?
A
- Colloids contain larger molecular weight substances that do not dissolve completely and depending on their molecular size, structure and capillary permeability of he patient, remain for a longer period in the intravascular compartment than crystalloid solutions.
- You may need 2 – 3 times the volume of crystalloid to colloid to achieve the same vascular filling. they act as “a plasma expander in place of blood”.
- Albumin
- Hetastarch
- Dextran
25
What are signs that a patient has too little fluid in them?
* Look ‘dry’
* Peripherally shut down
* Tachycardic
* Low BP
* Poor or absent urine output (
26
What are signs that a patient is overloaded? (too much fluid)
* Oedematous
* Tachycardic
* Hypertension
* Fluid in various cavities – pleural effusions, ascites,
* pulmonary oedema
27
What tests and monitoring are there to assess a patients fluid situation?
* Fluid balance charts – monitor in theory everything that goes into and out of a patient
* Blood investigations – should be performed daily on anyone receiving IV fluids, in particular electrolytes
* Urine biochemistry
28
If someone is bleeding, what would I give them as a quickfix?
Blood or Blood products.
29
If someone is has a very low blood pressure, what would I give them as a quickfix?
Crystalloid/colloid.
30
If someone is has a very low blood pressure, what would I give them to maintain?
crystalloid → bearing in mind electrolyte balance
31
What are purple blood bottles used for?
FBCs!!!!
* FBC
* ESR
* blood film for abnormal cells or malaria parasites
* reticulocytes
* red cell folate
* Monospot test for EBV
* HbA1C for diabetic control
* parathyroid hormone (PTH)*
32
What is the pink blood bottle used for?
* Group and save
| * crossmatch
33
What is the blue blood bottle for?
The blue bottle is used for haematology tests involving the clotting system, which require inactivated whole
blood for analysis.
* coagulation screen including bleeding time for platelet function, prothrombin time
* D-dimer for thrombosis
* INR for WARFARIN
* activated partial thromboplastin ratio (APTR) for monitoring patients on IV heparin infusions
* anti-Xa assay for monitoring patients on high-dose low molecular weight heparins like tinzaparin
34
what is the yellow/gold blood bottle used to test for?
These bottles are used for a huge variety of tests LFTs, U+Es, CRP, troponin.
* U+E's
* LFT's
* CRP
* amylase assay
* bone profile – this includes calcium, phosphate, ALP and albumin
* magnesium assay
* iron studies – this includes serum iron, ferritin, •transferrin saturation and total iron binding capacity
* lipid profile – this includes cholesterol, LDL, HDL and •triglycerides
* thyroid function tests (TFTs) – this includes TSH, free T4 +/- free T3
* vitamins e.g. vitamin B12
* troponins – this requires 2 samples to be taken at different times to assess the acute trend
* creatine kinase (CK)
* urate
* serum osmolality
35
What is the grey blood tube used for?
* Glucose
| * Lactate
36
What are the 2 shockable ECG paterns?
* Ventricular fibrillation → crazy jaggedy line
| * Ventricular tachycardia → look like a childs drawing of pointy teeth
37
What are 2 Non-shockable ECG patterns?
* Asystole → flatlining
| * Pulsless electrical activity→ normal QRS complex, no pulse.
38
What are Dupuytrens?
* Normally idiopathic
* Genetic component → celtic or norse finger
* Can be related to Alcoholic liver disease
39
What is a bluing of the fingers?
Peripheral cyanosis → hypoxia
40
what is a test of liver disease or CO2 retention?
* Asterixis→ Looking for hand flap.
| * Arms out infront of you and hands extended.
41
What is a white opaque deposit around the outside of the iris called and what is indicative of?
Corneal arcus/arcus senilis → High cholesterol
42
When a patient pulls down their eye lids What are you looking for?
Conjunctival pallor → anaemia.
43
What is a orange/brown deposit around the outside of the iris called and what is indicitive of?
kaiser-fleischer → indicitive of liver dysfunction GI issues
44
What is a yellow sclera and yellow skin tone symptomatic of?
Jaundice. CV/GI issues
45
What are pale skintag like deposits around the eye called and what are they symptomatic of?
Xantholasma → high cholesterol
46
What is a bluing around the lips and under the tongue called and what is it symptomatic of?
Central cyanosis → Cardiac issues
47
What is a white blotchy rash the occurs in the mouth?
Thrush (oropharyngeal candidiasis) is a medical condition in which a fungus called Candida albicans overgrows in the mouth and throat.
48
If you have a fiery red swollen tongue, what is this symptomatic of?
Glositis → Vit b12 (folate) deficiency
49
What is an inflammation of the corners of the mouth called?
Angular stomatitis or chelitis
• Caused by Infections such as fungi: Candida albicans and bacteria such as Staph
50
When doing a GI exam, what node should be looked for?
Virchows node/ pancost tumour →. Left supraclavicular lymph node enlargement – symptomatic of gastric cancer
51
What are small red clusters of veins that appear on the skin radiating out from a central point called and what is the associated pathology?
Spider neavi
* Chronic liver disease
* Normally occur in the drainage above the SVC (think chest).
* Blanch on compression
52
What do you call massive fluid on the stomach?
Ascites → due to:
* Cirrhosis
* Heart failure
53
What is a patchy, red, raised inflammation of the skin on the legs and what is it symptomatic of?
Erythema nodosum →
* Throat infections
* Sarcoidosis → known as Löfgren syndrome.
* Tuberculosis (TB)
* Pregnancy or the oral contraceptive pill
* EN may occur in pregnancy, clear after delivery, then recur in subsequent pregnancies.
* Drugs → sulphonamides
* Inflammatory bowel disease (ulcerative colitis or Crohn disease)
54
What is pitting oedema a sign of?
Heart failure
55
What are skin coloured raised nodules around the elbows called?
Xanthoma → high cholesterol
56
What is a red inflamed pimply tongue symptomatic of? It may be accompanied by a rash, swollen glands in the neck, dry, cracked lips, red fingers or toes and red eyes?
Kawasaki disease is a disease in which blood vessels throughout the body become inflamed
• strawberry red, inflamed tongue with cracked bleeding lips
57
what is a heart murmur heard on the first heart sound called? (contraction of the ventricles)
systolic murmur
58
what is a murmur heard as the heart muscles relax called?
diastolic murmur
59
what can systolic murmurs indicate?
AS MR AR MS
* Aortic Stenosis
* mitral valve prolapse
* Mitral valve Regurgetation
60
what can diastolic murmurs indicate?
AS MR AR MS
* Aortic or pulmonary regurgitation
* Mitral or tricuspid Stenosis
* other conditions such as growths or tumours in the heart chambers.
61
What are the 5 F's associated with the GI exam?
Flatus, foetus, fluid, faeces, fat. (+malignant tumour)
62
What are heaves?
Right ventricular hypertrophy
63
What are thrills?
Palpable murmurs
64
What does a collapsing pulse signify?
Aortic regurgitation
65
What are you testing for if you feel both pulses at the smae time?
Coarctation of the aorta
66
What are red cheeks?
Malar flush → Mitral problems
67
What would you do at the end of a cardiac exam?
ECG, CXR, fundoscopy, cardiac markers.
68
what are petechiae?
small bruise
69
What gives a high arched palate?
Marfans
70
describe a regular pulse?
evenly spaced beats that may vary with respiration
71
What is a scar on the back?
Pneumonectomy
72
What is bronchial breathing?
Sounds like darth vader → consolidation
73
What is a high pitched nasal bleating atop a pleural effusion?
Aegophony
74
What is purelent sputum
bronchial of pneumonic infection
75
What is serous or frothy or pink sputum a sign of?
Pulmonary oedema
76
What is blood stained sputum a sign of?
* Cancer
* Tb
* brochiectasis
* PE
77
What are venous stars?
Superficial veins
78
Wheeze is when? inspiration or expiration?
Expiration
79
What is atelectasis?
When there is an obstructed communication between the alveoli and the trachea the alveoli reabsorb the air in them and flatten marking the lungs unable to fully expand
differentiated from collapse becauseit is only a segment of a lobe
80
What causes wheeze?
* Obstruction of the airway
* Asthma
* COPD
* Foreign body
* Tumour
81
What causes crackles
* Fibrosis
* Oedema
* Infection
* Secretions
82
What causes Pleural rub?
Inflamation → they occur where the pleural layers are inflamed and have lost their lubrication
83
Vasicular breathing
Commonly heard over lung peripheries
84
What is dysuria?
Painful urination
85
What is High Co2 in blood called?
Hypercapnia
86
What is low O2 in the blood called?
Hypoxaemia
87
What is cachexia?
A very thin patient where calorie consuption will not help.
88
What are the 4 signs of horners syndrome?
* ptosis
* miosis
* anhydrosis
* enopthalmus
89
What are 4 repiratory causes of clubbing?
BCFM
* Bronchiectasis
* Cystic fibrosis
* Fibrosing alveolits
* Mesothelioma
90
An inferior heart attack would show in which ECG leads and would affect which coronary artery?
II, III, AVF → RCA
91
An anterior heart attack would show in which ECG leads and would affect which coronary artery?
V1, V2, V3, V4 → LAD
92
A lateral heart attack would show in which ECG leads and would affect which coronary artery?
I, aVL, V5, V6 → Circumflex
93
Which valves open during trial systole?
Pulmonary + aortic
94
Which valves close during aortic diastole?
tricuspid, mitral
95
What are the 4 H's of ALS (advanced life support)?
* Hypothermia
* Hypoxia
* Hyperkalaemia → and all other metabolic derangment
* Hypovolaemia
96
What are the 4 T's of ALS (advanced life support)?
* Tamponade
* Toxins
* Tension pneumothorax
* Thromboembolism
97
What is the time limit for giving red cells, and over what period of time are they given?
* 4 hour time limit
| * Given over 2-3 hours
98
What is the time limit for giving red Fresh frozen plasma (FFP), and over what period of time is it given?
* 4 hours time limit
| * Given over 30 mins
99
What is the time limit for giving platelets, and over what period of time are they given?
* 1 hour time limit
| * given over 30 mins
100
What is the time limit for giving cryoprecipitate, and over what period of time is it given?
* 4 hour time limit
| * Given over 30-60 mins
101
What are the 4 blood types?
A,B,AB,O
102
If a patient is blood type A, what antibodies will he have in his blood plasma?
Anti B antibodies
103
If a patient is blood type B, what antibodies will he have in his blood plasma?
Anti A antibodies
104
If a patient is blood type AB, what antibodies will he have in his blood plasma?
None. no antibodies.
105
If a patient is blood type O, what antibodies will he have in his blood plasma?
Anti-A + anit-B antibodies
106
Which blood type is the universal donor?
Type O
107
Which blood type is the universal receiver?
Type AB
108
What does the direct Coombs test detect?
Haemolytic anaemia
109
What does the indirect Coombs test detect?
antibodies in donated blood and Rhesus status of pregnant mothers
110
What are 4 causes of innocent murmurs?
* Pregnancy
* Fever
* Thyrotoxicosis
* Anaemia
111
In Obs and gynae, what does CTG stand for?
• Cardiotocograph
112
What does this▼ mean in the BNF?
report all suspected adverse reactions
113
In a 70kg adult, approximately how many litres of intracellular fluid will the be comprised of?
~ 30 L → 60% fluid + 12L extracellular
114
In a 70kg adult, approximately how many litres of Extracellular fluid will the be comprised of?
~12 L → 9L interstitial fluid + 3L intravenous
115
How much urine does the average adult excrete per day?
1ml/KG/hr or ~1.5-2.5 L/day
116
What are the first rank symptoms of schizophrenia?
• Auditory hallucinations:
→hearing thoughts spoken aloud
→hearing voices made in the third person
→auditory hallucinations as commentary
* Thought withdrawal, insertion and interruption
* Thought broadcasting
* Somatic hallucinations
* Delusional perception
* Feelings or actions experienced as made or influenced by external agents
117
What are the key symptoms in Bipolar?
* Manic episodes (feeling high)
* Hypomanic episodes (feeling high)
* Depressive episodes (feeling low)
* Mixed episodes (feeling high and low at the same time)
* psychotic symptoms
118
What are the 3 key symptoms of depression?
* Anhedonia → Low mood, feeling depressed
* Loss of joy → no interest or pleasure
* Fatigue → Sleeping all the time
119
What are the 7 other depressive symptoms?
* Suicidal ideation
* Loss of concentration
* Loss of appetite
* Feelings of guilt
* Agitation
* Low self confidence
* Poor sleep
120
What are the criteria for not depressed, mild, moderate and severe depression?
* > than 4 symptoms
* 4 symptoms including 2 of the key symptoms
* 5-7 symptoms including 2 of the key symptoms
* > 7 symptoms including all 3 key symptoms
121
What is section 2 of the mental health act?
Detainment for assessment → max. 28 days
122
What is section 3 of the mental health act?
Treatment → detainment for up to 6 months
• Renewable
123
What is section 4 of the mental health act?
Emergency → 72 hours. just 1 doctor needed.
• Non renewable
124
What is section 5 of the mental health act?
Detention in hospital → by a doctor for 72 hours, by a nurse for 6
125
What does PTH do?
Increases calcium reabsorbtion from bone
Increases renal calcium absorption
Increases renal phosphate excretion
Increases calcium absorption from the gut
126
What would you expect in calcium, phosphate and ALP in osteoporosis?
Normal across the board!
Normal calcium
Normal phos
Normal alp
127
What would you expect in calcium, phosphate and ALP in osteomalacia?
Calcium down
Phosphate down
Alp up
128
What is ALP a marker of in bone disease?
Increased osteoblastic activity
129
In pagets disease, what bone profile would you expect?
* Normal Calcium
* Normal phosphate
* ↑ ALP
130
What bone profile would you expect in Boney Mets?
* ↑/N Calcium
* N/↑ Phosphate
* ↑ ALP
131
What bone profile would you expect in primary hyperparathyroidism?
* ↑ Calcium
* ↓ Phosphate
* ↑ ALP
132
What bone profile would you expect in secondary hyperparathyroidism?
* ↓ Calcium
* ↑ Phosphate
* ↑ ALP
133
What bone profile would you expect in multiple myeloma?
* ↑ Calcium
* Normal Phosphate
* Normal ALP
134
What is CRP?
* C-reactive protein
| * Acute phase reactant that is raised in inflammation and infection
135
Name 2 conditions where ESR is raised but CRP is not?
* SLE
| * Multiple myeloma
136
What cancers are B-hCG associated with?
Testicular Seminomas and teratomas
137
What cancers are a fetoprotein associated with?
* Hepatocellular cancer
| * Testicular teratoma
138
What cancer is Ca-125 marker associated with?
Ovarian cancer
139
What cancer is Ca-19-9 marker associated with?
Pancreatic cancer
140
What cancer is Carcinoembryonic antigen (CEA) marker associated with?
Colorectal cancer
141
Name 4 causes of a raised PSA?
* Prostate cancer
* Recent ejaculation
* instrumentation of prostate
* Urinary tract infection
142
What procedure is used to assess liver cirrhosis?
transient elastogrophy
143
What does TACO stand for?
Transfusion Associated Circulatory Overload
144
What does TRALI stand for?
Transfusion Reaction Associated Lung Injury
145
Waht are the two exam signs for meningitis called?
Kernig and brudzinski signs
146
what is the kernig sign?
when you raise the leg it will not straighter indicating meningism
147
what is the brudzinski sign?
when you raise the head the knees flex.
148
What are the 2 commonest reason for poor Absorbtion of Vit B12?
* Absence of intrinsic factor
| * disease of the ileum
149
What is the commonest disease causing Vit B12 deficiency?
Pernicious anaemia
150
What is Pernisious anaemia?
Autoimmune attack of the parietal cells that produce intrinsic facctor
151
What are 3 signs of blood haemolysis?
* A rise in unconjugated bilirubin
* Increased urine urobiligen
* increase lactate dehydrogenase
152
Name 3 common causes of neutrophillia?
raised neutrophils >7.5
* Bacterial infection
* Inflammation
* Malignancy
* cortico steroid treatment
* Necrosis eg after an MI
153
Name 3 common causes Neutropaenia?
Neutrophils <2.0
* Post chemotherapy
* post radiotherapy
* Drugs carbimazole, clozapine
* viral infection
* Feltys syndrome
154
Name 3 common causes of lymphocytosis?
Lymphocytes >3.5
* Viral infection
* Chronic infection
* Chronic lymphocytic leukamia
* Lymphomas
155
name 3 common causes of eaosinophilia?
* Allergic disorder
* parasite infection
* Hypereosinophilic disorder
* skin disease - eczema
* allergic bronchopulmonary aspergillosis
* Malignancy - hodgkins lymphoma
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