Name 5 features of endocarditis. - 2 in hand - 1 in heart - 2 in abdomen

- splinter haem and clubbing - changing murmurs - splenomegaly and haematuria (due to GN)

Dr Clarke revision Flashcards by M H

Name 5 features of endocarditis.

2 in hand
1 in heart
2 in abdomen

splinter haem and clubbing
changing murmurs
splenomegaly and haematuria (due to GN)

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Name the 4 stages of clubbing.

inc fluctuancy of nail bed
loss of angle
inc curvature of nail
expansion of terminal phalanx

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What is corrigans sign and corrigans/waterhammer pulse and which condition is it seen in?

C sign-distension and collapse of carotids (appear as if they are dancing)

WH pulse-bounding forceful then collapse of pulse when arm lifted
Seen in AR

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Name 5 causes of AF.

IHD
rheumatic heart disease
thyrotoxicosis
HTN
Alcohol

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In AF, why might there be a difference between the pulse at the wrist and heart rate timed at apex?

Pulse deficit-As rate inc, filling time decreases. Enough filling for valves to close but not enough to maintain a CO

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What 2 situations is warfarin preferred over a DOAC?

mitral stenosis

metal valve

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Name 4 causes of pressure overload in LV.

HTN
AS
H(O)CM
CoA

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Name 3 sx of AS. Name 2 rx and which situations they are used.

Syncope
Angina
breathlessness

Valve replacement-healthy
TAVI-unfit for surgery

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In one sentence, what is the diff between aortic stenosis and sclerosis?

sclerosis-no pulse signs, normal apex, no carotid radiation…just MURMUR

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Name 3 causes of MR.

congenital valve
endocarditis
degenerative change
marfans
rupture of papillary muscle with MI

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What 2 diseases can mitral stenosis cause and how?

RHF due to back pressure

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What 2 things can make a murmur louder?

holding inspiration/expiration (RILE)

exercise patient

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Name 3 complications of valve replacement.

Valvular leakage
Endocarditis
Obstruction (thrombus)
Valve failure

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Name the 6 qualities of pericardial pain.

2x lung- sharp and worse on inspiration
2x heart- central, retrosternal and radiates to left shoulder
2x other- worse on lying flat, eased with sitting forward

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State the 4 radiological changes seen in heart failure.

Alveolar oedema
B lines (kerley)
Cardiomegaly
Dilated upper lobe vessels
Effusions (pleural)

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Name 3 comps of MI. Use mnemonic sudden death on PRAED st.

Sudden death!
Pump failure
Rupture of muscle papillae
Arrhythmia, aneurysm
Embolism
Dresslers (pericarditis post MI)

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Name the ABCDE management of STEMI for long term.

ACE-i
B blockers
Cholesterol lowering
Dual antiplatelet (aspirin+clop/ticag)
Echo to assess LV

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Name some causes of LVF/HF. Use mnemonic CHAMP.

Coronary syndrome
Hypertension 
Arrhythmia
Mechanical (valve, heart defect)
Pulm embolism

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Name the treatment for HF. Use LMNOP

Loop duiretic (furosemide)
Morphine
Nitrates
Oxygen
Position (sit up)/CPAP

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Name some causes of LVF/HF. Use mnemonic CHAMP.

Coronary syndrome
Hypertension 
Arrhythmia
Mechanical (valve, heart defect)
Pulm embolism

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Name the treatment for HF. Use LMNOP

Loop duiretic (furosemide)
Morphine
Nitrates
Oxygen
Position (sit up)/CPAP

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Name 4 indications of pacemaker. Use SCAR

Sick sinus syndrome
Complete heart block
AV node ablation
Resynchronisation therapy for HF

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What is the most common causative organism of inf endocarditis? Name the 2 abx used to treat.

strep viridans

penicillin+gentamicin IV

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Name 2 imaging techniques when inf endocarditis is suspected.

transthoracic echo

trans oesophageal echo

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Name 4 nephrotoxic drug classes. ' Stop the DAMN drugs'

Duiretics Ace-i/ARB Metformin NSAIDS

Name 5 indications of dialysis in AKI. Use AEIOU

Acidosis Electrolyte disturbance (e.g. hyperkalaemia) Intoxication wit drugs (aspirin, lithium) Overload of fluid Uraemic symptoms (encephalopathy)

What are some causes of CKD. Mnemonic: HIDDEN

``` Hypertension Infection Diabetes Drugs Exotica (SLE. vasculitis) Nephritis (GN) ```

If a pt experiences pain, pallor, parasthesia and diminished pulses distal to fistula, what syndrome has occured?

steal syndrome | Ischaemia due to thrombosis/narrowing distal to fistula

Name 3 features of peritoneal dialysis peritonitis.

fever cloudy fluid in bag port site infection abdo pain

Name the triad of symptoms in nephrotic syndrome.

odema hypoalbuminaemia proteinuria

Name 4 symptoms of nephritic syndrome. abnormal HOST response

HTN Oliguria Smoky brown haematuria Traces of oedema

Name 3 causes of nephritic syndrome.

Post strep infection IgA nephropathy Vasculitis

Name the 3 functions of the DCML pathway. 'Find Vivians Pathway'. Where does it decussate?

Fine touch Vibration Proprioception MEDULLA (dcMl)

Where does the second order neurone meet the third order neurone in DCML and spinothalamic pathways?

thalamus

Nam 4 functions of the spinothalamic tracts. Where does it decussate?

crude touch pain temperature pressure spinal cord

What is the name of the tracts that supply the cerebellum, provide unconscious info and assist with co-ordination and motor movements?

spinocerebellar tracts

Name 2 causes of DCML pathway destruction. What sensory functions are lost and which side?

``` Vit B12 deficiency Tabes dorsalis (consequence of syphylis causing demyelination of DCML) ``` Fine touch, vibration and proprioception lost Ipsilateral due to decussation in medulla

What loss of function is seen in brown sequarde syndrome?

DCML-loss of fine touch, vibration and proprioception on ipsilateral side Spinothalamic-loss of crude touch, pain and temp on contralateral side Descending motor-hemiparesis on ipsilateral side

Which tract supplies the musculature of the: - body - head and neck

Body-corticospinal | H&N-corticobulbar

Name 5 UMN signs.

``` Hypertonia Hyperreflexia Clonus Babinski +ve muscle weakness ```

Which 2 cranial nerves receive only unilateral innervation from corticobulbar tracts?

hypoglossal | facial

Name 5 causes of a positive prayer sign.

``` Diabetes RA Scleroderma Ulna nerve palsy Dupuytren's contracture ```

What is scleroderma/systemis sclerosis (can be divided into limited and diffuse)? sclero-hard derma-skin

AI connective tissue disorder characterised by overproduction of collagen depositing into organs causing failure: - breathing difficulty - swallowing difficulty - digestive dysfunction - raynauds phenomenon - arthritis & stiffening in joints of hand

What is another word for limited systemic sclerosis and explain what each letter stands for. How is diffuse systemic sclerosis different?

``` CREST syndrome Calcinosis Raynauds Esophageal webs Sclerodactyly Telangiectasia ``` Diffuse-CREST+internal organ involvement

Name an antibody measured in systemic sclerosis.

anti-centromere

Which muscle in the thenar eminence is innervated by a different nerve that isn't median nerve?

adductor pollicis | ulna nerve

What is froment's sign?

Flexion of thumb at IP joint on attempting pincer grip to compensate in ulna nerve palsy (when adductor pollicis is compromised)

Name the ABCDE causes of peripheral neuropathy. Name the 3 extras that do not fit in this acronym.

``` Alcohol B12 deficiency Chronic kidney disease Diabetes and drugs Every vasculitis ``` Cancer, Lyme disease and Charcot Marie Tooth

Name the antibody detected in rheumatic fever

ASTO titre (anti streptolysin O titre)

Name 5 major criteria in jones criteria.

``` Sydenhams chorea Inflammatory arthritis Carditis Nodules Erythema marginatum ```

What is sydenhams chorea?

unco-ordinated voluntary movement of face, hands and feet after infection of group A beta haemolytic strep

What does erythema marginatum look like and which condition is it seen in?

pale red macules or papules on trunk or proximal limbs | rheumatic fever

Name a virus that causes erythema multiforme (target lesions). What else can cause this rash?

herpes simplex | drug reaction

Which rash does lyme disease cause? How would you describe the rash?

erythema migrans | Bulls eye lesions

What is charcot marie tooth disease?

hereditary sensorimotor neuropathy

Name the cerebellar signs using DANISH.

``` Dysdiadokokinesia Ataxia Nystagmus Intention tremor Scanning (staccato)/slurred speech Hypotonia ```

Rupture of which artery can cause an extradural/epidural haemorrhage?

middle meningeal artery

Give 3 examples of when you shouldn't thrombolyse a patient after an ischaemic stroke. Use High BROWS

High BP ``` Bleeding tendency Recent surgery/head injury Over 80 years old Woke with symptoms Stroke in last 3 months ```

What scan must be done after thrombolysing a patient who has had an ischaemic stroke and why?

CT scan to exclude haemorrhagic transformation

What should be given to a patient who has been on alteplase for ischaemic stroke?

aspirin daily thereafter

What treatment method can be done up to 6 hours after ischaemic stroke occured?

mechanical thrombectomy

Name some causes of carpel tunnel syndrome using acronym RAPID TTT.

``` RA Acromegaly Pregnancy Idiopathic Diabetes ``` Trauma Tendons Thyroid