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Finals Toolkit Mushkies Flashcards

1
Q

What are the cardio paces stations likely to be?

A 
Murmur/additional sounds
Operations/scars
Arrhythmia 
HF
EI
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2
Q

What are the 7 hand signs in a cardio exam?

A 
Perfusion 
Temperature
Clubbing
Koilonychia 
Splinter haemorrhages
Oslers Nodes
Tendon xanthomata
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3
Q

What are you feeling for in the pulse?

A

Rate
Rhythm
Volume
Character

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4
Q

What are the 5 face signs in a cardio exam?

A 
Malar flush = mitral stenosis
Corneal arcus = high cholesterol 
Conjunctival pallor = anaemia 
Central cyanosis = lung disease/cardiac shunt
Poor dentition = IE
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5
Q

What are the 3 cardiac causes of clubbing?

A
  1. Atrial myxoma
  2. Bacterial endocarditis
  3. Cyanotic CHD
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6
Q

What are the 2 causes of an irregular pulse?

A

AF

Ventricular ectopics

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7
Q

What is a leg scar indicative of in a cardio exam?

A

CABG

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8
Q

What are femoral scars indicative of in a cardio exam?

A

TAVI
Angioplasty
Other vascular surgery (EVAR)

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9
Q

What is a submammary scar indicative of?

A

Mitral valve replacement

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10
Q

What is a subclavicular scar indicative of?

A

Pacemaker

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11
Q

What are midline sternotomies most likely indicative of?

A

Valve replacement
CABG
Congenital cardiac condition

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12
Q

What are the 3 most common causes of a systolic murmur?

A

Aortic stenosis
Mitral regurgitation
Ventricular septal defect

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13
Q

What are the 2 most common causes of a diastolic murmur?

A

Aortic regurgitation

Mitral stenosis

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14
Q

How can you differentiate between the causes of a metallic click?

A

1st HS = mitral valve
2nd HS = aortic valve
No scar –> look for femorals (TAVI)

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15
Q

How can you classify the causes of aortic stenosis?

A

Congenital and acquired

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16
Q

What are the acquired causes of aortic stenosis?

A

Senile calcification

Rheumatic fever

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17
Q

What are the congenital causes of aortic stenosis?

A
  1. Subvalvular = HOCM, other malformations
  2. Valvular = bicuspid
  3. Supravalvular = Williams syndrome
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18
Q

What is aortic sclerosis?

A

Valve thickening with no narrowing, and is characterised by an end systolic murmur with no radiation, normal pulse, normal apex, and normal ECG

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19
Q

What are the causes of mitral regurgitation?

A

PAL
Papillary = MV prolapse, ACS, Marfans+ED
Annular = Cardiomyopathy, IHD with HF
Leaflet (primary) = Endocarditis, Rhematic, Degenerative, Congenital

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20
Q

What is the triad of presentation of aortic stenosis?

A

Syncope, angina and dyspnoea (SAD)

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21
Q

What is the triad of presentation of mitral regurgitation?

A

SOB, Fatigue, LVF

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22
Q

What are 4 causes of pressure overload?

A

AS
HTN
Coarctation of aorta
Hypertrophic cardiomegaly

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23
Q

What kind of hypertrophy happens with pressure overload?

A

Concentric hypertrophy –> heaving non-displaced apex

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24
Q

What are 3 causes of volume overload?

A

Mitral regurgitation
Aortic Regurgitation
IHD (low EF)

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25
Q

What kind of hypertrophy happens with volume overload?

A

Eccentric hypertrophy –> thrusting, displaced apex

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26
Q

What is S3 also called?

A

Ventricular gallop

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27
Q

What is S4 also called?

A

Atrial gallop

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28
Q

What are 5 causes of S3?

A
  1. Normal <30y/o
  2. Mitral regurgitation
  3. Aortic regurgitation
  4. Constrictive pericarditis
  5. S4 pathologies
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29
Q

What are 4 causes of S4?

A
  1. HF
  2. MI
  3. CM
  4. HTN
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30
Q

What two groups of people typically get a tissue valve replacement?

A

Women of childbearing age and older pts

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31
Q

Why do young pts normally get a mechanical valve?

A

They have a longer lifespan

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32
Q

What are the complications of a heart prosthesis?

A 
POSH Valve
Paravalvular leak
Obstruction (by thrombus)
Subacute bacterial endocarditis
Haemolysis due to turbulence
Valve failure
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33
Q

What 3 things should you ask for after examining a pacemaker and why?

A
  1. ECG (look for pacing spikes)
  2. CXR (no. leads, ICD wire)
  3. Echo (valvular pathology, LV function)
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34
Q

What are the indications for pacemakers?

A

Nodal disease = symptomatic bradycardia (SSS), drug-resistant tachyarrhythmia
Conduction problems = complete AV block, Mobitz II, symptomatic Mobitz I
Assistance = BVP in chronic HF

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35
Q

How can you distinguish between AF and ventricular ectopics as a cause of an irregular pulse?

A

Exercise the patient - AF will remain irregularly irregular, VE –> increased HR –> normal HR (diastole time reduces, reducing window for ectopics)

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36
Q

What are 3 causes of atrial fibrillation?

A

IHD
RHD
Thyrotoxicosis

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37
Q

How can you classify the causes of bilateral leg oedema?

A

Systemic cause

Non-systemic cause

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38
Q

What are the systemic causes of bilateral leg oedema?

A

Cardiac = RHF
Renal
Hepatic

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39
Q

What are the non-systemic causes of bilateral leg oedema?

A

Chronic venous insufficiency

Lymphoedema

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40
Q

What are 4 causes of left sided HF?

A

IHD, HTN, Mitral/aortic valve disease, Idiopathic DCM

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41
Q

What are 3 causes of right sided HF?

A

LVF, Cor pulmonale, Tricuspid/pulmonary valve disease

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42
Q

What are 2 abdominal signs of IE?

A

Splenomegaly, microscopic haematuria

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43
Q

What are abdo paces station most likely to be?

A 
SSHORL
Scars
Stomas
Hernias
Organomegaly
Renal Disease
Liver Disease
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44
Q

How do you describe a surgical scar?

A 
Location 
Size
Age
Healthy 
Name
Likely Operation 
Likely Cause for operation
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45
Q

What is a Rooftop (chevron) incision used for?

A 
Oesophageal surgery e.g. oesophaegectomy 
Gastric surgery e.g. gastrectomy 
Bilateral Adrenalectomy 
Liver Resection
Liver Transplant
Whipple's
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46
Q

When is a Kocher’s (subcostal) incision used?

A
  1. Open cholecystectomy

2. A L Kocher’s is used for a splenectomy

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47
Q

When is a Mercedes Benz incision used?

A

Liver transplant

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48
Q

What are common indications for a liver transplant?

A
  1. Acute liver failure
  2. HCC
  3. Cirrhosis
  4. PSC/PBC
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49
Q

When is a loin incision made?

A

Nephrectomy

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50
Q

What are common indications for a nephrectomy?

A

PCKD and Malignancy

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51
Q

When is a Rutherford Morrison incision used?

A

Kidney Transplant

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52
Q

What are common indications for a kidney transplant?

A
  1. Diabetic nephropathy
  2. PCKD
  3. Glomerulonephritis
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53
Q

When is a Pfannenstiel incision used?

A
  1. Gynae surgery = LSCS, hysterectomy, oopherectomy

2. Lower Urinary Tract surgery

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54
Q

What is the spiel for examining a stoma?

A

I would like to thoroughly examine the stoma by removing the bag, checking its contents, inspecting the lumen and the surrounding skin

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55
Q

What is the description for a normal colostomy?

A

There is a stoma in the LIF, with a single lumen which is flushed with the skin. It appears healthy with no associated surrounding skin changes. There is a concurrent midline laparotomy scar. This is most likely an end colostomy which may be a result of a Hartmanns.

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56
Q

How do you describe a hernia?

A 
Location 
Size
Reducibility 
Pain
Signs of Obstruction 
Signs of Strangulation
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57
Q

What are the positions you must examine a hernia at?

A

Standing
Lying
Coughing

58
Q

What are the risk factors for developing hernias?

A
  1. Abdominal wall weakness x 3 = age, surgery (itself –> preop, intraop, postop), systemic disease
  2. Increased intra-abdominal pressure x 5 = obesity, pregnancy, chronic cough, constipation, occupation
59
Q

What is the management of hernias?

A
  1. Conservative x 4 = manual reduction, belt, lifestyle changes, watchful waiting
  2. Surgical = open mesh repair, open suture repair, laparoscopic (TEP/TAPP)
60
Q

How does one describe organomegaly?

A 
Location
Size
Smooth/irregular
Tenderness
Movement with respiration
Percussive/ballotable
Associated systemic signs
61
Q

What are the causes of hepatomegaly?

A

3Cs, 2Is, 2Bs

  1. Cancer = primary or secondary
  2. Cirrhosis = early, usually alcoholic
  3. Cardiac = CCF, congestive pericarditis
  4. Infiltration = fatty, haemochromatosis, amyloidosis, sarcoidosis
  5. Infection = Viral, Malaria, Abscess
  6. Blood = leukaemia, lymphoma, myeloproliferative, haemolytic
  7. Biliary = PBC, PSC
62
Q

What are the 3 causes of massive splenomegaly (>8cm tip)?

A

Malaria
Myelofibrosis
CML

63
Q

What are the indications for splenectomy?

A
  1. Rupture = trauma/EBV

2. Haematological = ITP/hereditary spherocytosis

64
Q

What do pts require post-splenectomy?

A
  1. Vaccination against encapsulated bacteria
  2. Prophylactic penicillin
  3. MedicAlert bracelet
65
Q

What are 4 causes of renal failure?

A
  1. Diabetes
  2. HTN
  3. Glomerulonephritis
  4. PCKD
66
Q

What are the 3 treatment modalities for renal failure?

A
  1. Haemodialysis
  2. Peritoneal dialysis
  3. Renal transplant
67
Q

What are side effects of tacrolimus?

A

Fine Tremor and HTN

68
Q

What are side effects of ciclosporine?

A

Gum hypertrophy and HTN

69
Q

What are 2 metabolic causes of liver disease?

A

NAFLD and Haemochromatosis

70
Q

What are 2 drugs that cause liver disease?

A

Methotrexate and amiodarone

71
Q

How can one classify the approach to managing liver disease?

A
  1. I would like to use an MDT approach to
  2. Specific to the cause
  3. Specific to the complications
  4. Ascitic drains
  5. Liver transplant
72
Q

What is an ophthalmology paces station most likely to be?

A
  1. Blindness
  2. Visual field defect
  3. Ocular muscle palsy
  4. Fundus pathology
73
Q

What are the 5 key parts of an eye examination?

A 
Inspection
Acuity
Fields
Movements 
Fundoscopy
74
Q

What are you looking for upon inspection of the eyes?

A

Eyelids
Alignment
Prosthesis

75
Q

How does one present a normal eye exam?

A
  1. On inspection there appears to be no obvious abnormalities of the eyes or surrounding structures. There does not appear to be a squint.
  2. The patient’s visual acuity is 6/6 in both eyes, with and without glasses.
  3. There are no visual field defects.
  4. Ocular movements were normal and did not cause any pain or blurring of vision.
  5. On fundoscopy the optic disc was visualised with a clear border and normal disc to cup ratio. No papilloedema was seen.
76
Q

What are 3 common visual field defects?

A

Bitemporal hemianopia
Homonymous hemianopia
Monocular blindness

77
Q

What are 4 features of diabetic retinopathy on fundoscopy?

A
  1. Cotton wool spots
  2. Haemorrhages
  3. Microaneurysms
  4. Hard exudates
78
Q

What are 4 features of hypertensive retinopathy on fundoscopy?

A
  1. Cotton wool spots
  2. Flame haemorrhages
  3. Optic disc swelling
  4. AV nicking
79
Q

What are the 3 main causes of hand problems in a hand examination?

A
  1. Rheumatological = RA, osteoarthritis, scleroderma
  2. Neurological = nerve palsy, carpal tunnel syndrome
  3. Vascular = surgery, Raynaud’s
80
Q

What are the 5 components of a hand examination?

A
  1. Inspection
  2. Palpation
  3. Movement
  4. Neurovascular
  5. Additional
81
Q

What are you inspecting for in a hand examination?

A

Skin, muscles and joints

82
Q

What are you trying to palpate in a hand examination?

A

Temperature and every joint individually

83
Q

What are you assessing during movement in a hand examination?

A

Active and passive movement

84
Q

What are you assessing in the neurovascular component of a hand examination?

A

PSP

Power, Sensation, Pulses

85
Q

What are you assessing during the ‘additional’ component of a hand examination?

A
  1. Ears/neck/scalp
  2. Forearms
  3. Visual fields
86
Q

What do you do to complete a hand examination?

A

Examine the elbows and shoulders
Assess limb function
Take an X-ray of the joints

87
Q

What is the DAS28 score?

A

The DAS28 is a measure of disease activity in rheumatoid arthritis (RA). DAS stands for ‘disease activity score’ and the number 28 refers to the 28 joints that are examined in this assessment.

88
Q

What are 5 signs and symptoms of rheumatoid arthritis?

A
  1. Symmetrical, stiff, swollen
  2. Small joints (MCP, PCP, Wrist)
  3. Subluxation, ulnar deviation
  4. Boutonniere, Swan-neck deformities
  5. Pain in the morning
89
Q

What are 6 extra-articular features of rheumatoid arthritis?

A
  1. Subcutaneous nodules
  2. Raynauds
  3. Carpal Tunnel Syndrome
  4. Peripheral Neuropathy
  5. Lung disease
  6. Pleural/pericardial effusions
90
Q

What are 4 radiological features of rheumatoid arthritis?

A
  1. Juxta-articular osteopenia
  2. Soft-tissue swelling
  3. Joint deformity
  4. Loss of joint space
91
Q

What are 4 signs and symptoms of osteoarthritis?

A
  1. Localised disease
  2. Pain on movement
  3. Worse at end of the day
  4. Heberden’s and Bouchard’s notes
92
Q

What are the radiological features of osteoarthritis?

A 
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
93
Q

What parts of the body must you specifically examine in pts with acromegaly?

A

Neck
Face
Eyes

94
Q

What investigations must you order in pts with acromegaly?

A

OGTT
ECG
MRI

95
Q

What is the management of acromegaly?

A
  1. Conservative = watch and wait
  2. Medical = Somatostatin analogue
  3. Surgical = Transsphenoidal resection
96
Q

What might be wrong with the pt in a PACES leg examination?

A
  1. Vascular = PVD, varicose veins, amputation
  2. Orthopaedics = arthritis, joint replacement
  3. Neurology = nerve palsy
97
Q

What are the components of a leg examination?

A
  1. Inspection = standing and lying, skin, muscles and joints
  2. Palpation = temp, tenderness, valvular incompetence
  3. Pulses = proximal to distal
  4. Function = walking
  5. Additional = Buerger’s, Trendelenburg’s
98
Q

What are 4 key features of chronic venous insufficiency?

A
  1. Varicose veins
  2. Oedema
  3. Lipodermatosclerosis
  4. Ulcers
99
Q

What are 3 features of chronic limb ischaemia?

A

Amputation, ulceration, surgical scars

100
Q

What 4 investigations would you order for chronic limb ischaemia?

A

Buerger’s Test
ABPI
Duplex USS
CT/MR angiogram

101
Q

What are some possible bedside clues during a resp exam?

A

Inhalers
LTOT
Sputum pot

102
Q

What are the 4 grades of clubbing?

A
  1. Fluctuant nail bed
  2. Obliteration of the Lovibond angle
  3. Parrot beaking
  4. Hypertrophic osteoarthropathy
103
Q

How can you describe breath sounds?

A 
Vesicular
Bronchial breathing
Crackles/crepitations
Wheeze
Pleural rub
104
Q

What is increased vocal fremitus a sign of?

A

Increased lung density e.g. consolidation

105
Q

What is decreased vocal fremitus a sign of?

A

Decreased lung density e.g. emphysematous bullae, pneumothorax

106
Q

What are the investigations to order as part of a resp exam?

A 
Bedside = PEFR, spirometry, sputum sample 
Bloods = FBC, CRP, ABG
Imaging = CXR
107
Q

What are causes of pulmonary fibrosis?

A 
DASHII
Drugs 
Asbestosis/Silicosis
Systemic Disease
Hypersensitivity (EAA)
Infection
Idiopathic (IPF)
108
Q

What drugs can cause pulmonary fibrosis?

A

BAM
Bleomycin
Adriamycin
Methotrexate

109
Q

What are holly leaf opacifications a sign of?

A

Pleural plaques

110
Q

What is the most common cause of interstitial lung disease?

A

Idiopathic Pulmonary Fibrosis, 2M:1F

111
Q

How is IPF diagnosed?

A

HRCT (High Resolution CT)

112
Q

What is the mean life expectancy of IPF?

113
Q

What are the treatment strategies for IPF?

A
  1. Supportive

2. Anti-fibrotics e.g. Pirfenidone/Nintedanib

114
Q

How can LTOT be helpful for pts with ILD?

A

PaO2>8 for 15h per day improves survival rate by 50%

115
Q

What ILD pts qualify for LTOT?

A
  1. PaO2 < 7.3kPa or

2. PaO2 7.3-8kPa + pulmonary HTN/peripheral oedema/polycythaemia

116
Q

What COPD pts qualify for LTOT?

A
  1. Clinically stable non smokers AND
  2. PaO2 < 7.3kPa or
  3. PaO2 7.3-8kPa + pulmonary HTN/peripheral oedema/polycythaemia
117
Q

What is bronchiectasis?

A

Irreversible, abnormal dilation of the biliary tree.

118
Q

What are 3 causes of bronchiectasis?

A
  1. Severe childhood infections
  2. CF
  3. Kartagener’s syndrome
119
Q

What investigations would you order for bronchiectasis and what would they show?

A
  1. Spirometry = obstructive picture
  2. CXR = tramlines, ring shadows
  3. HRCT = signet ring sign
120
Q

What is the management of bronchiectasis?

A
  1. Conservative = MDT, physio

2. Medical = Abx, Bronchodilators, vaccination

121
Q

What are 3 ways you can tell clinically if a scar is due to a pneumonectomy or a lobectomy?

A
  1. Breath sounds = absent vs reduced
  2. Chest rise = absent vs. reduced
  3. Trachea and apex deviation to abnormal side vs. trachea deviation to abnormal side
122
Q

Where do lung metastases commonly come from?

A

BBCPKNS

  1. Bladder
  2. Breast
  3. Colon
  4. Prostate
  5. Kidney
  6. Neuroblastoma
  7. Sarcoma
123
Q

What 7 things may you see on inspection of a pt with COPD?

A
  1. Tripod position
  2. Pursed lip breathing
  3. Flushed appearance (plethora)
  4. Hyperinflated chest
  5. Muscle wasting
  6. Use of accessory muscles
  7. Inhalers/nebulisers
124
Q

What might you hear upon auscultation of a pt with COPD?

A

Bilateral wheeze and crackles with a prolonged expiratory phase

125
Q

What 2 conditions are COPD composed of?

A

Emphysema

Chronic bronchitis

126
Q

What is emphysema?

A

Alveolar wall destruction with airway collapse and air trapping

127
Q

What is chronic bronchitis?

A

Cough productive of sputum on most days for at least 3m in 2 consecutive years

128
Q

What investigations can you order for COPD?

A

Bedside = peak flow, sputum sample, BMI, spirometry
Bloods = polycythaemia, high WCC
Imaging (CXR) = bullae, hyperinflation, flattened diaphragms

129
Q

What spirometry result do you usually get in pts with COPD?

A

FEV1 < 80%

130
Q

What is the management of COPD?

A
  1. Conservative = MDT, smoking cessation, pulmonary rehabilitation
  2. Medical x 6 = Antimuscarinics, beta agonists, inhaled steroids, mucolytics, emergency packs, vaccination
  3. Surgical = lung reduction/bullectomies
131
Q

What is CF?

A

An autosomal recessive mutation of chloride ion channels leading to excessive mucus production, distortion of the airways, premature bronchiectasis, and non-respiratory signs

132
Q

How can you classify the causes of an UMN lesion?

A 
VINITD
Vascular = thrombotic or haemorrhagic 
Inflammatory = demyelinating or vasculitic
Neoplastic = primary or secondary 
Infective = bacterial/viral/fungal
Traumatic
Degenerative
133
Q

What investigations can be ordered to be done on an LP?

A

Microbiology = MC&S
Cytology
Biochemistry = electrophoresis

134
Q

What 2 questions must one consider when considering a LMN lesion?

A
  1. Is the lesion motor, sensory or mixed?

2. Is it a mono or polyneuropathy?

135
Q

What are possible locations for a LMN lesion?

A

‘Anywhere from origin to termination of the nerve’

  1. Anterior horn cell = MND
  2. Peripheral nerve = inherited (porphyria) or acquired (lead toxicitiy/GBS)
  3. NMJ = MG or LEMS
  4. Muscle = inherited myopathies and acquired trauma
136
Q

What investigations can you order for a LMN lesion?

A
  1. Bloods = B12, folate, TFTs, lead
  2. Nerve Conduction Studies
  3. Electromyogram
137
Q

Parkinsonian symptoms + failure of upgaze?

A

Progressive Supranuclear Palsy

138
Q

Parkinsonian symptoms + autonomic instability?

A

Multisystem Atrophy

139
Q

Parkinsonian symptoms + Cognitive impairment?

A

Dementia with Lewy bodies

140
Q

Parkinsonian symptoms + Cerebellar involvement?

A

Corticobasal degeneration

141
Q

What are the core features of Parkinson’s Disease

A 
TRAP
Tremor 
Rigidity 
Akinesia/Bradykinesia 
Postural Instability
142
Q

What are the DDx for Parkinson’s Disease?

A
  1. Idiopathic
  2. Vascular (infarcts of substantia nigra)
  3. Organic/drug-induced (metoclopramide + neuroleptics)
  4. Wilson’s disease
  5. Parkinsons Plus Syndromes

Medicine and Surgery Mushkies (52 decks)

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