DPD Flashcards
4 causes of splenomegaly
infection
inflammation
haematological
portal hypertension
Gastritis
retrosternal
ETOH
markers chronic pancreatitis
normal amylase
faecal elastase
loss of exocrine/endocrine function
RUQ pain in appendicitis
- retrocaecal appendix
- pregnancy
suprapubic pain ddx
cystitis
urinary retention
diffuse abdo pain ddx
- obstruction
- peritonitis/gastroenteritis
- IBD
- mesenteric ischaemia (angina post-prandially)
medical-
- DKA
- Addison’s
- Hypercalcaemia
- Porphyria
- Lead poisoning
what may be high in any cause of acute abdo?
amylase
what ascitic tap would you see in SBP?
ascites neut >250 cells/mm3
Transudate ascites (less protein)
Failures:
cirrhosis
cardiac failure
nephrotic syndrome
Exudate ascites
malignancy (abdo, pelvic, mesothelioma)
infection (TB, pyogenic)
Budd chiari, portal vein thrombosis
cause of pale stool in obstructive jaundice
low stercobilogen
Bloody diarrhoea ddx
- Infective- CHESS
- IBD (young)
- Elderly (ischaemic)
CEA marker
colon cancer
Mx acute abdo
NBM IV fluid analgesics antibiotics anti-emetics
GI bleeds
ABC
IV access
Fluids
OGD
if variceal- broad spectrum Abx + terlipressin (splanchnic vasoconstriction)
Ix acute abdo
Bloods
Erect CXR
CT
jaundice primary Ix
Bloods
USS (post fast)
Dysphagia Wt loss primary Ix
OGD biopsy
Ascites Mx
Diretics spironolactone +/-furosemide sodium restriction fluid restriction if hyponatraemia monitor daily weight therapetuic paracentesis with IV human albumin
serum:ascites albumin gradient
>11 = cirrhosis/HF <11 = TB, cancer, nephrotic
features of wound infection
erythematosus
discharge
features of anastomotic leak
diffuse abdo tenderness
guarding, rigidity
shock
features pelvic abscess
pain
fever, sweats
mucus diarrhoea
peripheral neuropathy causes
infection
- HIV
inflammation
- GBS
- amyloidosis
metabolic/toxic
- diabetes
- ETOH
- B12
- drugs
- hypothyroidism
Tumour
- paraneoplastic syndrome
optic neuritis
aka papillitis
blurred optic disc + blurred vision
different to papilloedema = painless
sign of MS
Reduced PP sensation Al thigh
T2DM
Obese
what Mx + diagnosis?
= meralgia paraesthetica compression of lateral femoral nerve reasure, avoid tight garments lose weight carabezapine/gabapentin if persists
causes of radiculopathy
disc herniation
spinal canal stenosis
osteophytes
describe the abnormal sensation for pathology at:
- cortex
- SC
- nerve roots
- mononeurpathy
- polyneuropathy
- cortex = hemisensory
- SC = level eg umbilicus
- nerve roots = dermatomes
- mononeurpathy = specific area eg radial
- polyneuropathy = glove + stocking
lewy body dementia
alzheimers + PD + hallucinations
limited upgaze
supranuclear palsy
DDx of raised JVP
- RHF (2/2 LHF or pulmonary HTN- PE, COPD etc)
- TR (valve damage eg IE, R ventricular dilation)
constrictive pericarditis (TB, CTD, malignancy)
causes of palpitaitons
sinus tachy- SVT
AF
ventricular tachy
causes of sinus tachy
- sepsis
- hypovolaemia
- endocrine (thyrotoxicosis, phaeo)
causes of SVT
re-entry circuit (WPW)
Causes of AF
- thyrotoxicosis
- ischaemia
- chest infection/PE/cancer
- alcohol
Causes of VT
- ischaemia
- electrolyte abnormality
- long QT (hypo K/Mg, congenital)
sinus tachycardia on ECG
p before every QRS
normal just fast
VT on ECG
NO p waves before QRS
regular
BROAD COMPLEX
SVT on ECG
short PR delta wave (slurred upstroke)
Af principles
RHYTHM CONTROL
- <48h DC
- > 48h 3-4 weeks anticoagulate
RATE
- BB (bisoprolol)
- Digoxin
- anticoagulate (CHADSVASC)
Pulseless VT Tx?
defibrillate
LVH (hypertension) ECG signs
Deep S in V1/2
Tall R in V5/6
> 7 LARGE SQUARES
Heart sounds- for each, state the association
S1 = closure of mitral
S2 = closure of aortic
Fixed splitting of S2 = atrial septal defect
S3 = rapid ventricular filling
S4 = atrial contraction against stiffened ventricles (hypertophy)
AHF failure management
sit up
oxygen 60-100%
Diuretics (furosemide)
GTN if pain
treat underlying cause
Symptomatic level for anaemia
Hb <80
Primary pneumothorax management
<2cm - discharge, repeat CXR
>2cm/SOB- aspirate + chest drain if unsuccessful
Secondary pneumothorax management
<2cm - aspiration
>2cm - chest drain
what might you see in PE
RBBB + RAD
why do you give clarithromycin in pneumonia
cover atypicals
AF started 4 hours ago how to treat
<48h so DC cardioversion
3 causes/types of MAHA
- DIC
- HUS
- TTP
Features of DIC
low plt + fibrinogen
high PT/APTT
high D-dimer/FDP
Features of HUS
haemolysis- low Hb, high Br
uraemia
low plt
Features of TTP
HUS + fever + neurological signs
why does MAHA occur?
some coagulation occurs, fibrin slices RBCs
Hereditary causes of haemolytic anaemia
- hereditary spherocytosis
- G6PD deficiency
- Hb-opathy - SCD, thalassaemia
Acquired causes of haemolytic anaemia
- Autoimmune
- Drugs
- Infection
- MAHA
small bowel lines
valvulae conniventes
causes of hypovolaemic hyponatraemia
D + V
Diuretics
Would have low urine sodium
causes of euvolaemic hyponatraemia
Hypothyroidism
Adrenal insufficiency
SIADH
normal/high urine sodium
causes of hypervolaemic hyponatraemia
CF
Cirrhosis
Nephrotic syndrome
Would have low urine sodium
tests for euvolaemic hyponatraemia
TFTs
Short synacthen
Plasma/urine osmolality
What is the cause of the majority of hyponatraemia
high ADH
Causes of SIADH
- CNS/lung pathology
- drugs- SSRI, TCA, opiates, carbamezapine)
- Tumours
oncholysis causes
trauma
thyrotoxicosis
nail bed infection
Psoriasis
How can PTH determine whether someone has malignancy in the context of hypercalcaemia?
low PTH = supressed so mailgnancy
High = hyperPTH
high ALP causes
Paget’s
obstructive jaundice
Bony mets
Causes of cavitating lung lesions
- Infection- TB, staph, klebsiella (alcoholics)
- Inflammation- RA
- PE
- Malignancy- SCC
nephrotic syndrome
high GBM permiability- so protein leaks out
proteinuria >3g/day
hypoalbuminaemia
oedema (oncotic pressure)
What is hereditary haemorrhagic telangiectasia?
AD condition
abnormal blood vessels in:
- skin
- Mucous membranes
- lungs
- liver
- brain
low sodium + high potassium endocrine cause
Adrenal insufficiency
in what type of thyroid condition would TFTs be normal?
multinodular goitre
