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MBBS Year 3 notes > DPD > Flashcards

DPD Flashcards

1
Q

3 macrovascular complications of diabetes

A
  1. Ischaemic heart disease
  2. Cerebrovascular disease
  3. Peripheral vascular disease
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2
Q

3 microvascular complications of diabetes

A
  1. Diabetic neuropathy
  2. Diabetic retinopathy
  3. Diabetic nephropathy
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3
Q

State the 4 types of diabetic retinopathy and their treatment

A
  1. Background diabetic retinopathy: blood glucose control
  2. Pre-proliferative: pan-retinal photocoagulation
  3. Proliferative: pan-retinal photocoagulation
  4. Maculopathy: grid photocoagulation
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4
Q

Side effects of metformin

A

GI upset

Lactic acidosis in unwell patients

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5
Q

Side effects of sulfonylureas

A

Hypoglycaemia

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6
Q

Side effects of thiazolidinediones

A

Fluid retention

MI, osteoporosis

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7
Q

3 clinical features of diabetic nephropathy

A
  1. Progressive proteinuria (microalbuminuria)
  2. Hypertension
  3. Deranged renal function (creatinine, eGFR)
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8
Q

Definition of diabetes

A

Fasting blood glucose >7.0 mmol/L

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9
Q

Management of diabetic nephropathy

A

Inhibit RAAS: ACEi, ATII blockers
Diabetic control
Blood pressure control
Stop smoking

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10
Q

3 top investigations for chest pain

A
  1. ECG
  2. Troponin
    - Positive –> coronary angiography
    - Negative –> exercise tolerance test
  3. Echocardiography
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11
Q

Three things to think about when deciding ddx

A

Symptoms
Associated features
Risk factors

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12
Q

Chest pain: top three causes

A

Ischaemic heart disease
Aortic dissection
Pericarditis

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13
Q

LoC important to know

A

Before: Prodrome?
During: Tongue biting? Epilepsy
After: Confusion? None in cardiac causes

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14
Q

Collapse ddx (3 main types of causes)

A

Metabolic: Hypoglycaemia
Neurological: seizures
Cardiac: Vasovagal. arrhythmias, outflow obstruction, postural hypotension

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15
Q

Cardiac causes of collapse

A

Arrhythmias
Outflow obstruction: Aortic stenosis, hypertrophic obstructive cardiomyopathy, PE
Postural hypotension

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16
Q

Causes of long QT syndrome

A

Congenital

Acquired: low K+, low Mg2+, drugs

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17
Q

3 causes of pansystolic murmur

A

Mitral regurg
Tricuspid regurg
Ventricular septal defect

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18
Q

3 causes of raised JVP

A

R heart failure
Tricuspid regurg
Constrictive pericarditis

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19
Q

3 causes of constrictive pericarditis

A

Infection e.g. TB
Inflammation e.g. connective tissue disease
Malignancy

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20
Q

Both are regular narrow-complex tachycardias with no P waves.
How to distinguish AVNRT and AVRT on ECG?

A

AV nodal reentry: circuit includes the AV node; no delta wave
AV reentry: goes through accessory pathway (bundle of Kent); delta wave present when not in tachycardia

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21
Q

Causes of sinus tachy

A

Shock (septic, hypovolaemic)
PE
Endocrine (thyrotoxicosis, phaeo)
Anxiety

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22
Q

Causes of AF

A

Thyrotoxicosis, alcohol
Heart: myocarditis, valvular disease, pericarditis
Lungs: Pneumonia, PE, cancer

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23
Q

Causes of VT

A

Ischaemia
Electrolyte abnormality
Long QT

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24
Q

SVT management

A

Vagal maneuvers
IV adenosine for cardioversion
DC cardioversion if haemodynamically compromised

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25
Q

AF acute management

A

Rate control with beta-blockers / digoxin
Anticoagulation

Can also do rhythm control - but If onset >48h, need to anticoagulate for 2-3weeks before cardioversion.

26
Q

Management of VT

A

With pulse: IV amiodarone
Pulseless: defibrillation

Treat underlying cause!

27
Q

ECG signs of ischaemia

A

ST elevation / depression
T wave inversion?
Q waves?

28
Q

ECG signs of arrhythmia or conduction defects

A

Rate
Rhythm
PR: first
QRS: broad? LBBB, RBBB

29
Q

Ventricular strain / hypertrophy

A

Axis deviation

QRS morphology

30
Q

Cause of S3

A

Ventricular filling

31
Q

Cause of S4

A

Ventricular hypertrophy and stiffening

32
Q

S3 vs fixed split S2?

A

S3 heard better with bell

33
Q

Management of acute pulmonary oedema

A

Sit up
O2
IV GTN
IV furosemide

34
Q

Management of acute pulmonary oedema

A

Sit up
O2
IV GTN
IV furosemide

35
Q

VF / pulseless VT management

A 
Shock (defib)
CPR
Reassess rhythm
IV 1mg adrenaline every 2 - 3 min
Treat underlying cause
36
Q

5Ps: causes of pleuritic chest pain

A 
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology

…and referred pain sub-diaphragmatic problems e.g. hepatic abscess

37
Q

Causes of pleural effusion transudates

A

Organ failure: heart, liver, kidney

38
Q

Causes of pleural effusion exudates

A

Parapneumonic, cancer, pulmonary embolism

39
Q

Buerger’s sign

A

Reactive hyperemia after elevation of foot to 45 deg (sign of arterial insufficiency)

40
Q

6 Ps of acute limb ischaemia

A 
Pain
Pallor
Perishingly cold
Pulseless
Paraesthesia
Paralysis
41
Q

Classification of aortic dissection, and treatment

A

Stanford Type A: proximal to L subclavian
Stanford Type B: distal to L subclavian

Emergency open surgery for Type A
Surgery for complicated Type B (visceral ischaemia)
Conservative, BP control and surveillance for uncomplicated Type B

42
Q

Diagnosis of Gilbert’s Syndrome

A

Normal LFTs with elevated unconjugated bilirubin

Worsened by fasting

43
Q

Gilbert’s syndrome pathophysio

A

UDP-glucuronyltransferase activity reduced to 30%
Autosomal recessive
Fairly common, 6-10% of Western populations affected

44
Q

4 grades of hypertensive retinopathy

A

Grade 1: “silver wiring”
Grade 2: AV nipping
Grade 3: flame haemorrhage, cotton-wool spots
Grade 4: All 3 + papilloedema

45
Q

Definition of LVH on ECG

A

S wave in V1 + R wave in V5/6 >35mm

46
Q

Management of essential hypertension

A

Intensive lifestyle modification
Aggressive management of blood pressure and lipids
Aspirin
Assess for T2DM

47
Q

Electrolyte imbalances causing fits

A
  1. Hypercalcaemia
  2. Hyponatraemia
  3. Hypoglycaemia
  4. Hypokalaemia
48
Q

Antimitochondrial antibodies are the hallmark of…

A

Primary biliary cirrhosis

49
Q

Triad of symptoms for Wernicke’s encephalopathy

A

Confusion
Ataxia
Opthalmoplegia

(Note: Wernicke’s is acute or subacute in presentation)

50
Q

Korsakoff’s encephalopathy is associated with what type of amnesia?

A

Anterograde amnesia

Note: Korsakoff’s is chronic in presentation

51
Q

Internuclear opthalmoplegia is indicative of…

A

Demyelinating disease / MS

52
Q

Management of variceal bleed

A

Antibiotics (prophylactic for bacterial translocation)
IV terlipressin
Endoscopy with variceal band ligation

53
Q

Investigations for jaundice

A

Bloods: FBC, LFTs, CRP

Abdominal USS

54
Q

2 investigations for dysphagia and wt loss

A

OGD and biopsy

55
Q

Main investigation for PR bleed and wt loss

A

Colonoscopy

56
Q

3 common post-op complications in GI ops

A

Wound infection
Anastomotic leak
Pelvic abscess

57
Q

Management of acute hyperkalaemia

A

IV calcium gluconate (10ml of 10%)

Insulin and dextrose

58
Q

Definition of MS

A

At least 2 neurological lesions separated in time and space

59
Q

Meralgia paraesthetica

A

Compression of lateral femoral cutaneous nerve causing burning anterolateral thigh pain

Management: lose weight, wear loose clothing

60
Q

AV block Type 2: Mobitz II

A

Usually haemodynamic compromise, more likely to progress to complete heart block

MBBS Year 3 notes (3 decks)

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