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IK6 - Exams > DPD > Flashcards

DPD Flashcards

1
Q

What are the risk factors for ischaemic heart disease?

A

smoking
diabetes mellitus
hypertension
hyperlipidaemia
previous episode of IHD
FHx of IHD

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2
Q

Differentials for chest pain

A

cardiac: IHD/ACS, aortic dissection, pericarditis
resp: PE, pneumonia, pneumothorax

GI: oesophageal spasm, oesophagitis, gastritis

Musculoskeletal: costochondritis

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3
Q

Risk factors for PE

A

clots in legs (DVT), previous PE, recent fracture, malignancy, recent surgery, recent immobility, oral contraceptive pill

long haul flight (immobility)

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4
Q

ECG pattern for left ventricular hypertrophy

A

deep S in V1/V2
tall R wave in V5/V6

largest S and largest R in chest leads > 45mm when added together

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5
Q

ECG features of ischaemia

A

ST change (elevation or depression)
T wave inversion (MI)
pathological Q waves (old MI)

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6
Q

Which leads on an ECG represent a lateral view of the heart?

A

I, aVL, V5, V6

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7
Q

what coronary artery supplies the lateral territory of the heart?

A

circumflex artery

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8
Q

what ECG leads present the anterior aspect of the heart?

A

V3, V4 and V2 to some extent

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9
Q

what coronary artery supplies the anterior territory of the heart?

A

LAD

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10
Q

what coronary artery supplies areas of the heart matching to V3, V4 and V2 (to an extent)?

A

Left anterior descending

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11
Q

what coronary artery supplies areas of the heart matching to I, aVL, V5 and V6?

A

circumflex artery

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12
Q

what ECG leads represent the septal region of the heart?

A

V1 and V2

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13
Q

What coronary artery supplies the septal region of the heart?

A

left anterior descending

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14
Q

what coronary artery supplies the region corresponding to V1 and V2 on ECG?

A

left anterior descending

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15
Q

what ECG leads correspond to the inferior aspect of the heart?

A

II, III and aVF

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16
Q

what coronary artery supplies the inferior region of the heart?

A

right coronary artery

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17
Q

what coronary artery supplies the area of the heart corresponding to II, III and AvF?

A

right coronary artery

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18
Q

differentials for collapse

A

hypoglycaemia

cardiac: postural hypotension,
arrhythmias, outflow obstruction [HOCM, severe AS, massive PE], vasovagal syncope

seizure

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19
Q

what does a long QT on ECG mean?

A

abnormal ventricular repolarisation which predisposes patients to ventricular tachycardias

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20
Q

differentials for a raised JVP

A

right heart failure - secondary to LHF or pulmonary HTN

tricuspid regurgitation

constrictive pericarditis (infection, CTD, malignancy)

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21
Q

what causes a systolic murmur?

A

aortic stenosis
mitral regurgitation
tricuspid regurgitation
ventricular septal defect

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22
Q

Causes of sinus tachycardia

A

sepsis
hypovolaemia
thyrotoxicosis
phaeochromocytoma
anxiety

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23
Q

causes of atrial fibrillation

A

thyrotoxicosis
ischaemic damage to heart muscle
chest infection
alcohol

pathology affecting the heart or lungs

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24
Q

causes of ventricular tachycardia

A 
ischaemia 
electrolyte abnormality (K+, Mg+) 
long QT
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25
Q

Robert attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 125/85 mmHg.

How would you manage this patient?

A

he is HAEMODYNAMICALLY STABLE

  1. Vagal manoeuvres (e.g. carotid sinus massage)
  2. Adenosine (IV) x 3
  3. if unable to return to sinus may DC cardiovert

adenosine is CI in asthmatics

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26
Q

what are the 2 common types of supra-ventricular tachycardia?

A

AV nodal reentrant tachycardia [AVNRT]

atrioventricular reciprocating tachycardia [AVRT} - accessory pathway present

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27
Q

Alex attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 80/60mmHg.

How would you manage this patient?

A

he is haemodynamically unstable

the arrhythmia is compromising his CO.

DC cardioverstion

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28
Q

Jo attends GP for a health check. The GP feels her pulse and finds it to be irregularly irregular. An ECG confirms AF.

How would you manage Jo?

A

as don’t know onset….

Rhythm control:
anti-coagulate for 3-4 weeks if suitable candidate for cardioversion. use NOAC or warfarin

Rate control: beta blocker, digoxin

prophylaxis: CHADs VASC vs HASBLED. anti-coagulate with NOAC or warfarin e.g. riveroxaban

investigate possible underlying causes and treat

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29
Q

Lucy attends A&E with palpitations. Her ECG shows a ventricular tachycardia. She has a palpable radial pulse. her BP is 120/80mmHg

A

as she is haemodynamically stable do not shock immediately

  1. IV amiodarone

if pulseless VT -> start ALS and cardioversion as soon as possible

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30
Q

what is S3 associated with?

A

rapid ventricular filling

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31
Q

what is S4 associated with?

A

ventricular hypertrophy and the atria trying to contract against the stiff ventricle

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32
Q

Max is a 65yr old man who attends A&E with an acute deterioration of his heart failure.

How do you manage him in A&E?

A
  1. sit him up
  2. oxygen if saturations are low
  3. GTN infusion (venodilates reducing preload)
  4. diaMorphine (venodilates)
  5. Furosemide IV - diuretic and venodilates

treat any underlying cause e.g. infection

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33
Q

What are ECG features of pericarditis?

A

saddle-shaped ST elevation across all leads or most of them (not belonging to a specific heart territory)

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34
Q

differentials of pleuritic chest pain

A

5 Ps
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology

sub-diaphragmatic pathology may cause it too e.g. hepatic abscess

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35
Q

Max has been admitted after an acute episode of heart failure. How will you manage his heart failure in the long term?

A
  1. ACEi -> prevent cardiac remodelling
  2. beta-blocker - reduce work
  3. spironolactone - prevents chronic RAAS activity
  4. diuretic (furosemide)
  5. digoxin

ABDDS

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36
Q

differentials for breathlessness

A

seconds: pneumothorax, PE, foreign body

mins/hours: airway inflammation/obstruction, chest infection, acute heart failure

days/weeks: interstitial lung disease, malignancy, large pleural effusion, neuromuscular, anaemia, thyrotoxicosis, any of the above as chronic process

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37
Q

what is the management of a PE?

A

give LMWH
start warfarin

continue LMWH until INR within therapeutic levels.

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38
Q

If the FEV1/FVC ratio is > 70% what sort of lung disease might a patient have?

A

restrictive

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39
Q

If the FEV1/FVC ratio is < 70% what sort of lung disease might a patient have?

A

obstructive

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40
Q

what might cause interstitial/alveolar shadowing on a CXR ?

A

fluid - pulmonary oedema
pus - pneumonia
blood - pulmonary haemorrhage

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41
Q

what can cause reticulo-nodular shadowing on a CXR?

A

lung fibrosis

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42
Q

what can cause a homogenous shadow on a CXR?

A

pleural effusion
lung or lobar collapse

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43
Q

what are the signs of chronic liver disease?

A

ABCDEFGHIJ+S

asterixis
bruising
clubbing
dupuytren’s contracture
palmar erythema
fetor hepaticus

gynaecomastia
hair loss
icterus/jaundice

spider naevi
leukonychia (due to hypoalbuminaemia)

44
Q

causes of hepatomegaly

A

3 C’s and 1 I

cancer - primary or mets
cirrhosis - early on
cardiac - CCF, constrictive pericarditis

Infiltrative: fatty infiltrate, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

45
Q

causes of jaundice

A

AADVM

alcohol
autoimmune
drugs
viral
biliary disease

46
Q

causes of splenomegaly

A

HI HI

H- portal HTN
Haematological - lymphoproliferative diseases, myeloproliferative diseases or haemolytic anaemia

Infection: TB, brucellosis
infiltration: chronic inflammatory conditions (sarcoidosis)

47
Q

differentials of epigastric pain:

A

stomach - peptic ulcer, GORD, gastritis, malignancy

acute pancreatitis
MI
ruptured aortic aneurysm
cholecystitis
hepatitis

48
Q

differentials for RUQ pain

A

cholecystitis, cholangitis, gallstones (biliary colic)

hepatitis, abscess

basal pneumonia
appendicitis (retro-caecal or pregnancy more likely)

peptic ulcer
pancreatitis
pyelonephritis

49
Q

differentials for right iliac fossa pain

A

appendicitis
mesenteric adenitis
colitis (IBD)
malignancy

ovarian cyst rupture
ovarian cyst twist
ovarian cyst bleed
Ectopic Pregnancy

50
Q

differentials of suprapubic pain

A

cystitis
urinary retention

51
Q

differentials for left iliac fossa pain

A

diverticulitis
colitis (IBD)
malignancy

ovarian cysts rupture/twist/bleed
Ectopic Pregnancy

52
Q

diffuse abdominal pain

A

Bowel obstruction
peritonitis
gastroenteritis
IBD
mesenteric ischaemia

DKA, Addison’s, hypercalcaemia

porphyria, lead poisoning

53
Q

causes of an ascitic transudate?

A

low protein level

cirrhosis
cardiac failure

54
Q

causes of an ascitic exudate

A

high protein level

malignancy in the abdomen, pelvis or peritoneum
infection = TB, pyogenic (cause formation of pus)

nephrotic syndrome (this is only because overall albumin is low)

budd-chiari syndrome
portal vein thrombosis

55
Q

What does the celiac artery supply?

A

stomach
spleen
liver
gallbladder
part of the duodenum

56
Q

what does the superior mesenteric artery supply?

A

small intestine
right colon

57
Q

what does the inferior mesenteric artery supply?

A

left colon

rectum is supplied by a branch of the iliac artery

58
Q

differentials for abdomial distention

A

THE 5 F’S

fluid (ascites)
flatus
fat
faeces
foetus

59
Q

causes of bloody diarrhoea

A

infective colitis (campylobacter, E.coli, entaemoeba histolytica, salmonella, shigella)

inflammatory colitis (young)
ischaemic colitis (older)
diverticulitis
malignancy

60
Q

What might cause a pre-hepatic jaundice?

A 
increased haemolysis (e.g. haemolytic anaemia) 
Gilbert's syndrome (reduced glucuronidation)
61
Q

what might cause a hepatic jaundice?

A

hepatitis (autoimmune, alcohol, drugs, viruses)

62
Q

what might cause a post-hepatic jaundice?

A

gallstones in the common bile duct
stricture
cancer of pancreas head

63
Q

What does thumb-printing on an AXR suggest?

A

mucosal oedema

64
Q

What does featureless colon on an AXR suggest?

65
Q

What medications should be given to patients presenting with variceal bleeding due to portal HTN?

A

terlipressin - induces splanchnic vasoconstriction reducing pressure in the portal system

Antibiotics -> taxosin

66
Q

How would you manage a patient with an acute abdomen?

A

INVESTIGATIONS
bloods: FBC, U&Es, LFTs, CRP, G&S, clotting, x-match
erect CXR
may need CT

MANAGEMENT PLAN

  1. monitor vitals and urine output
  2. NBM and fluids
  3. analgesia
  4. anti-emetics
  5. Abx - cephalosporins, metronidazole
67
Q

how would you manage a patient with ascites?

A

diuretics (spironolactone +/- furosemide)
dietary sodium restrictioni
fluid restrict if hyponatraemic
monitor weight daily

therapeutic paracentesis (drainage) with IV human albumin

68
Q

How would you manage a patient present with hepatic encephalopathy?

A

lactulose (reduce gut transit time)
phosphate enemas
avoid sedation

treat any infection and exclude a GI bleed

69
Q

what is the presenting complaint for an anal fissure/

A

severe pain on defecating
stool coated with small amount of bright red blood

70
Q

What would you tell a patient with anal fissure and what might you prescribe?

A

increase fibre and fluid in their diet
GTN cream to vasodilate vessels improving blood flow to promote healing

71
Q

what are signs of an UMN lesion?

A

increase tone (spasticity)
reduced power
hyperreflexia
upgoing plantar reflex

72
Q

what are the signs of a LMN lesion?

A

reduced tone (flaccid)
reduced power
hyporeflexia

73
Q

What are signs of cerebellar pathology?

A

DANISH

Dysdiadochokinesia (tested with rapid alternating movements)
Ataxia
Nystagmus
Intention tremor
Speech - slurred, scanning
Hypotonia

74
Q

How would you manage a stroke?

A

< 4.5 hours - CT if no haemorrhage THROMBOLYSIS

> 4.5hrs - CT head to exclude haemorrhage, aspirin, swallow assessment, maintain hydration + oxygenation + monitor glucose

75
Q

How would you manage a TIA?

A

aspirin
ECG, echocardiogram
Carotid doppler
Risk factor modification

76
Q

Lucy attends A&E finding it hard to breath. her lips are swollen and she has a diffuse rash. Her friend says she had just eaten a snack and then suddenly couldn’t breathe.

How would you manage lucy?

A

ANAPHYLAXIS

  1. IM adrenaline 1mg
  2. 10mg chlorphenamine (anti-histamine)
  3. 100mg hydrocortisone
77
Q

What are organisms that cause an atypical pneumonia?

A

mycoplasma pneumoniae
chlamydia pnuemoniae
legionella pneumoniae

78
Q

What antibiotic is given to patients diagnosed with a hospital acquired pneumonia?

79
Q

How would you further investigate a microcytic anaemia?

A

haematinics (iron studies, B12 and folate)
coeliac screen - TTG antibodies

80
Q

what results of blood tests would you expect a patient suffering from DIC to have?

A

low platelets
low fibrinogen
high PT and APTT
high D-dimer and fibrin degradation products

81
Q

what are hereditary causes of haemolytic anaemia?

A

hereditary spherocytosis
hereditary elliptocytosis

G6PD deficiency, pyruvate kinase deficiency

sickle cell disease, thalassaemia

82
Q

what are acquired causes of a haemolytic anaemia?

A

autoimmune (SLE)
some drugs
infection
MAHA

83
Q

what are the complications of diabetes?

A

microvascular = retinopathy, neuropathy, nephropathy

macrovascular = MI, stroke, PVD

metabolic = DKA, HHS, hypoglycaemia

84
Q

What would be the differential for a patient present with backache with hypercalcaemia, low PT and normal ALP ?

A

multiple myeloma

85
Q

What features do patients with multiple myeloma have?

A

CRAB

Calcium is high
Renal impairment
Anaemia
Bone (pain/ache or fracture)

86
Q

What might cause a cavitating lung lesion?

A

infection = Tb, staph, klebsiella

RA, PE, squamous cell carcinoma

87
Q

What might patients with polycythaemia present with?

A

headache
pruritis post hot bath
blurred vision
tinnitus
thombosis
grangrene
choreiform movements

88
Q

what causes a low reticulocyte count?

A

parvovirus B19 infection (-> aplastic crisis)

aplastic crisis 2nd to sickle cell
blood transfusion

89
Q

What drug is used to treat prolactinoma?

A

cabergoline

90
Q

CN I

  • function
  • S, M, B
  • clinical
A

CN I - olfactory

  • S
  • function - smell (sensory
91
Q

CN II

  • function
  • S, M, B
  • clinical
A

CN II - optic

  • S
  • function - sight (S)
  • via optic canal
92
Q

CN III

  • S, M, B
  • function
  • clinical
A

CN III - oculomotor

  • M
  • function
    • eye movement (MOTOR)
      • medial rectus, inferior oblique, superior rectus, inferior rectus
      • pupil constriction
      • accomodation
      • eyelid opening
  • clinical
    • palsy - ptosis + down & out + dilated fixed pupil
93
Q

CN IV

  • S, M, B
  • function
  • clinical
A

CN IV - trochlear

  • M
  • function
    • eye movement superior oblique
  • clinical
    • palsy - vertical diplopia, defective down gaze
94
Q

CN V

  • S, M, B
  • function
  • clinical
A

CN V - trigeminal

  • B
  • function
    • S - facial sensation
    • M - muscles of mastication
    • corneal reflex (afferent)
    • jaw jerk (efferent and afferent, mandibular branch)
  • clinical
    • loss of corneal reflex, loss of facial sensation, paralysis of muscles of mastication
    • deviation of jaw towards weak side
95
Q

CN VI

  • S, M, B
  • function
  • clinical
A

CN VI - abducens

  • M
  • function
    • eye movement - lateral rectus
  • clinical
    • defective abduction, horizontal diplopia
96
Q

CN VII

  • S, M, B
  • function
  • clinical
A

CN VII - facial

  • B
  • function
    • S - taste anterior ⅔ tongue
    • M - facial movement
    • stapedius of the ear
    • lacrimation, salivation
  • clinical
    • flaccid paralysis (forehead sparing UMN)
    • loss of corneal reflex efferent arm
    • loss of taste
    • hyperacusis
97
Q

CN VIII

  • S, M, B
  • function
  • clinical
A

CN VIII - vesticulocochlear

  • S
  • function
    • hearing
    • balance
  • clinical
    • hearing loss
    • vertigo, nystagmus
      • acoustic neuroma, schwannoma
98
Q

CN IX

  • S, M, B
  • function
  • clinical
A

CN IX - glossopharyngeal

  • B
  • function
    • S - taste posterior ⅓ tongue
    • M - swallowing, mediates input from carotid body + sinus
    • salivation
  • clinical
    • hypersensitive carotid sinus reflex
    • loss of gag reflex
99
Q

CN X

  • S, M, B
  • function
  • clinical
A

CN X - vagus

  • B
  • function
    • phonation
    • swallowing - muscles of pharynx, soft palate and larynx
    • innervates viscera
  • clinical
    • uvula deviation - away from site of lesion
    • loss of gag reflex (efferent)
100
Q

CN XI

  • S, M, B
  • function
  • clinical
A

CN XI - accessory

  • M
  • function
    • head and shoulder movement
    • trapezius and sternocleidomastoid
  • clinical
    • weakness in turning head to contralateral side
101
Q

CN XII

  • S, M, B
  • function
  • clinical
A

CN XII

  • M
  • function
    • tongue movement
  • clinical
    • tongue deviations to side of lesion
102
Q

what are the ascending spinal tracts?

afferent

A
  • dorsal column
  • spinocerebellar tract
  • anterolateral system
103
Q

what are the descending spinal tracts?

descending

A
  • pyramidal tracts (lateral and anterior corticospinal)
  • extrapyramidal tracts
104
Q

what is transmitted along dorsal columns?

A

deep touch

proprioception

vibration

105
Q

what is transmitted along ventral spinothalamic

A

light touch

106
Q

what is transmitted along the spinothalamic tract?

A

pain and temperatute

107
Q

what are the cranial nerves?

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear nerve
  5. trigeminal
  6. abducens
  7. facial nerve
  8. vestibulocochlear
  9. glossopharyngeal
  10. vagus
  11. accessory
  12. hypoglossal

IK6 - Exams (24 decks)

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