Finals Toolkit Mushkies Flashcards
1
Q
What are the cardio paces stations likely to be?
A
Murmur/additional sounds Operations/scars Arrhythmia HF EI
2
Q
What are the 7 hand signs in a cardio exam?
A
Perfusion Temperature Clubbing Koilonychia Splinter haemorrhages Oslers Nodes Tendon xanthomata
3
Q
What are you feeling for in the pulse?
A
Rate
Rhythm
Volume
Character
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
5
Q
What are the 3 cardiac causes of clubbing?
A
- Atrial myxoma
- Bacterial endocarditis
- Cyanotic CHD
6
Q
What are the 2 causes of an irregular pulse?
A
AF
Ventricular ectopics
7
Q
What is a leg scar indicative of in a cardio exam?
A
CABG
8
Q
What are femoral scars indicative of in a cardio exam?
A
TAVI
Angioplasty
Other vascular surgery (EVAR)
9
Q
What is a submammary scar indicative of?
A
Mitral valve replacement
10
Q
What is a subclavicular scar indicative of?
A
Pacemaker
11
Q
What are midline sternotomies most likely indicative of?
A
Valve replacement
CABG
Congenital cardiac condition
12
Q
What are the 3 most common causes of a systolic murmur?
A
Aortic stenosis
Mitral regurgitation
Ventricular septal defect
13
Q
What are the 2 most common causes of a diastolic murmur?
A
Aortic regurgitation
Mitral stenosis
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)
15
Q
How can you classify the causes of aortic stenosis?
A
Congenital and acquired
16
Q
What are the acquired causes of aortic stenosis?
A
Senile calcification
Rheumatic fever
17
Q
What are the congenital causes of aortic stenosis?
A
- Subvalvular = HOCM, other malformations
- Valvular = bicuspid
- Supravalvular = Williams syndrome
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
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
20
Q
What is the triad of presentation of aortic stenosis?
A
Syncope, angina and dyspnoea (SAD)
21
Q
What is the triad of presentation of mitral regurgitation?
A
SOB, Fatigue, LVF
22
Q
What are 4 causes of pressure overload?
A
AS
HTN
Coarctation of aorta
Hypertrophic cardiomegaly
23
Q
What kind of hypertrophy happens with pressure overload?
A
Concentric hypertrophy –> heaving non-displaced apex
24
Q
What are 3 causes of volume overload?
A
Mitral regurgitation
Aortic Regurgitation
IHD (low EF)
25
What kind of hypertrophy happens with volume overload?
Eccentric hypertrophy --> thrusting, displaced apex
26
What is S3 also called?
Ventricular gallop
27
What is S4 also called?
Atrial gallop
28
What are 5 causes of S3?
1. Normal <30y/o
2. Mitral regurgitation
3. Aortic regurgitation
4. Constrictive pericarditis
5. S4 pathologies
29
What are 4 causes of S4?
1. HF
2. MI
3. CM
4. HTN
30
What two groups of people typically get a tissue valve replacement?
Women of childbearing age and older pts
31
Why do young pts normally get a mechanical valve?
They have a longer lifespan
32
What are the complications of a heart prosthesis?
```
POSH Valve
Paravalvular leak
Obstruction (by thrombus)
Subacute bacterial endocarditis
Haemolysis due to turbulence
Valve failure
```
33
What 3 things should you ask for after examining a pacemaker and why?
1. ECG (look for pacing spikes)
2. CXR (no. leads, ICD wire)
3. Echo (valvular pathology, LV function)
34
What are the indications for pacemakers?
Nodal disease = symptomatic bradycardia (SSS), drug-resistant tachyarrhythmia
Conduction problems = complete AV block, Mobitz II, symptomatic Mobitz I
Assistance = BVP in chronic HF
35
How can you distinguish between AF and ventricular ectopics as a cause of an irregular pulse?
Exercise the patient - AF will remain irregularly irregular, VE --> increased HR --> normal HR (diastole time reduces, reducing window for ectopics)
36
What are 3 causes of atrial fibrillation?
IHD
RHD
Thyrotoxicosis
37
How can you classify the causes of bilateral leg oedema?
Systemic cause
| Non-systemic cause
38
What are the systemic causes of bilateral leg oedema?
Cardiac = RHF
Renal
Hepatic
39
What are the non-systemic causes of bilateral leg oedema?
Chronic venous insufficiency
| Lymphoedema
40
What are 4 causes of left sided HF?
IHD, HTN, Mitral/aortic valve disease, Idiopathic DCM
41
What are 3 causes of right sided HF?
LVF, Cor pulmonale, Tricuspid/pulmonary valve disease
42
What are 2 abdominal signs of IE?
Splenomegaly, microscopic haematuria
43
What are abdo paces station most likely to be?
```
SSHORL
Scars
Stomas
Hernias
Organomegaly
Renal Disease
Liver Disease
```
44
How do you describe a surgical scar?
```
Location
Size
Age
Healthy
Name
Likely Operation
Likely Cause for operation
```
45
What is a Rooftop (chevron) incision used for?
```
Oesophageal surgery e.g. oesophaegectomy
Gastric surgery e.g. gastrectomy
Bilateral Adrenalectomy
Liver Resection
Liver Transplant
Whipple's
```
46
When is a Kocher's (subcostal) incision used?
1. Open cholecystectomy
| 2. A L Kocher's is used for a splenectomy
47
When is a Mercedes Benz incision used?
Liver transplant
48
What are common indications for a liver transplant?
1. Acute liver failure
2. HCC
3. Cirrhosis
4. PSC/PBC
49
When is a loin incision made?
Nephrectomy
50
What are common indications for a nephrectomy?
PCKD and Malignancy
51
When is a Rutherford Morrison incision used?
Kidney Transplant
52
What are common indications for a kidney transplant?
1. Diabetic nephropathy
2. PCKD
3. Glomerulonephritis
53
When is a Pfannenstiel incision used?
1. Gynae surgery = LSCS, hysterectomy, oopherectomy
| 2. Lower Urinary Tract surgery
54
What is the spiel for examining a stoma?
I would like to thoroughly examine the stoma by removing the bag, checking its contents, inspecting the lumen and the surrounding skin
55
What is the description for a normal colostomy?
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.
56
How do you describe a hernia?
```
Location
Size
Reducibility
Pain
Signs of Obstruction
Signs of Strangulation
```
57
What are the positions you must examine a hernia at?
Standing
Lying
Coughing
58
What are the risk factors for developing hernias?
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
What is the management of hernias?
1. Conservative x 4 = manual reduction, belt, lifestyle changes, watchful waiting
2. Surgical = open mesh repair, open suture repair, laparoscopic (TEP/TAPP)
60
How does one describe organomegaly?
```
Location
Size
Smooth/irregular
Tenderness
Movement with respiration
Percussive/ballotable
Associated systemic signs
```
61
What are the causes of hepatomegaly?
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
What are the 3 causes of massive splenomegaly (>8cm tip)?
Malaria
Myelofibrosis
CML
63
What are the indications for splenectomy?
1. Rupture = trauma/EBV
| 2. Haematological = ITP/hereditary spherocytosis
64
What do pts require post-splenectomy?
1. Vaccination against encapsulated bacteria
2. Prophylactic penicillin
3. MedicAlert bracelet
65
What are 4 causes of renal failure?
1. Diabetes
2. HTN
3. Glomerulonephritis
4. PCKD
66
What are the 3 treatment modalities for renal failure?
1. Haemodialysis
2. Peritoneal dialysis
3. Renal transplant
67
What are side effects of tacrolimus?
Fine Tremor and HTN
68
What are side effects of ciclosporine?
Gum hypertrophy and HTN
69
What are 2 metabolic causes of liver disease?
NAFLD and Haemochromatosis
70
What are 2 drugs that cause liver disease?
Methotrexate and amiodarone
71
How can one classify the approach to managing liver disease?
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
What is an ophthalmology paces station most likely to be?
1. Blindness
2. Visual field defect
3. Ocular muscle palsy
4. Fundus pathology
73
What are the 5 key parts of an eye examination?
```
Inspection
Acuity
Fields
Movements
Fundoscopy
```
74
What are you looking for upon inspection of the eyes?
Eyelids
Alignment
Prosthesis
75
How does one present a normal eye exam?
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
What are 3 common visual field defects?
Bitemporal hemianopia
Homonymous hemianopia
Monocular blindness
77
What are 4 features of diabetic retinopathy on fundoscopy?
1. Cotton wool spots
2. Haemorrhages
3. Microaneurysms
4. Hard exudates
78
What are 4 features of hypertensive retinopathy on fundoscopy?
1. Cotton wool spots
2. Flame haemorrhages
3. Optic disc swelling
4. AV nicking
79
What are the 3 main causes of hand problems in a hand examination?
1. Rheumatological = RA, osteoarthritis, scleroderma
2. Neurological = nerve palsy, carpal tunnel syndrome
3. Vascular = surgery, Raynaud's
80
What are the 5 components of a hand examination?
1. Inspection
2. Palpation
3. Movement
4. Neurovascular
5. Additional
81
What are you inspecting for in a hand examination?
Skin, muscles and joints
82
What are you trying to palpate in a hand examination?
Temperature and every joint individually
83
What are you assessing during movement in a hand examination?
Active and passive movement
84
What are you assessing in the neurovascular component of a hand examination?
PSP
| Power, Sensation, Pulses
85
What are you assessing during the 'additional' component of a hand examination?
1. Ears/neck/scalp
2. Forearms
3. Visual fields
86
What do you do to complete a hand examination?
Examine the elbows and shoulders
Assess limb function
Take an X-ray of the joints
87
What is the DAS28 score?
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
What are 5 signs and symptoms of rheumatoid arthritis?
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
What are 6 extra-articular features of rheumatoid arthritis?
1. Subcutaneous nodules
2. Raynauds
3. Carpal Tunnel Syndrome
4. Peripheral Neuropathy
5. Lung disease
6. Pleural/pericardial effusions
90
What are 4 radiological features of rheumatoid arthritis?
1. Juxta-articular osteopenia
2. Soft-tissue swelling
3. Joint deformity
4. Loss of joint space
91
What are 4 signs and symptoms of osteoarthritis?
1. Localised disease
2. Pain on movement
3. Worse at end of the day
4. Heberden's and Bouchard's notes
92
What are the radiological features of osteoarthritis?
```
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
```
93
What parts of the body must you specifically examine in pts with acromegaly?
Neck
Face
Eyes
94
What investigations must you order in pts with acromegaly?
OGTT
ECG
MRI
95
What is the management of acromegaly?
1. Conservative = watch and wait
2. Medical = Somatostatin analogue
3. Surgical = Transsphenoidal resection
96
What might be wrong with the pt in a PACES leg examination?
1. Vascular = PVD, varicose veins, amputation
2. Orthopaedics = arthritis, joint replacement
3. Neurology = nerve palsy
97
What are the components of a leg examination?
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
What are 4 key features of chronic venous insufficiency?
1. Varicose veins
2. Oedema
3. Lipodermatosclerosis
4. Ulcers
99
What are 3 features of chronic limb ischaemia?
Amputation, ulceration, surgical scars
100
What 4 investigations would you order for chronic limb ischaemia?
Buerger's Test
ABPI
Duplex USS
CT/MR angiogram
101
What are some possible bedside clues during a resp exam?
Inhalers
LTOT
Sputum pot
102
What are the 4 grades of clubbing?
1. Fluctuant nail bed
2. Obliteration of the Lovibond angle
3. Parrot beaking
4. Hypertrophic osteoarthropathy
103
How can you describe breath sounds?
```
Vesicular
Bronchial breathing
Crackles/crepitations
Wheeze
Pleural rub
```
104
What is increased vocal fremitus a sign of?
Increased lung density e.g. consolidation
105
What is decreased vocal fremitus a sign of?
Decreased lung density e.g. emphysematous bullae, pneumothorax
106
What are the investigations to order as part of a resp exam?
```
Bedside = PEFR, spirometry, sputum sample
Bloods = FBC, CRP, ABG
Imaging = CXR
```
107
What are causes of pulmonary fibrosis?
```
DASHII
Drugs
Asbestosis/Silicosis
Systemic Disease
Hypersensitivity (EAA)
Infection
Idiopathic (IPF)
```
108
What drugs can cause pulmonary fibrosis?
BAM
Bleomycin
Adriamycin
Methotrexate
109
What are holly leaf opacifications a sign of?
Pleural plaques
110
What is the most common cause of interstitial lung disease?
Idiopathic Pulmonary Fibrosis, 2M:1F
111
How is IPF diagnosed?
HRCT (High Resolution CT)
112
What is the mean life expectancy of IPF?
2 years
113
What are the treatment strategies for IPF?
1. Supportive
| 2. Anti-fibrotics e.g. Pirfenidone/Nintedanib
114
How can LTOT be helpful for pts with ILD?
PaO2>8 for 15h per day improves survival rate by 50%
115
What ILD pts qualify for LTOT?
1. PaO2 < 7.3kPa or
| 2. PaO2 7.3-8kPa + pulmonary HTN/peripheral oedema/polycythaemia
116
What COPD pts qualify for LTOT?
1. Clinically stable non smokers AND
2. PaO2 < 7.3kPa or
3. PaO2 7.3-8kPa + pulmonary HTN/peripheral oedema/polycythaemia
117
What is bronchiectasis?
Irreversible, abnormal dilation of the biliary tree.
118
What are 3 causes of bronchiectasis?
1. Severe childhood infections
2. CF
3. Kartagener's syndrome
119
What investigations would you order for bronchiectasis and what would they show?
1. Spirometry = obstructive picture
2. CXR = tramlines, ring shadows
3. HRCT = signet ring sign
120
What is the management of bronchiectasis?
1. Conservative = MDT, physio
| 2. Medical = Abx, Bronchodilators, vaccination
121
What are 3 ways you can tell clinically if a scar is due to a pneumonectomy or a lobectomy?
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
Where do lung metastases commonly come from?
BBCPKNS
1. Bladder
2. Breast
3. Colon
4. Prostate
5. Kidney
6. Neuroblastoma
7. Sarcoma
123
What 7 things may you see on inspection of a pt with COPD?
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
What might you hear upon auscultation of a pt with COPD?
Bilateral wheeze and crackles with a prolonged expiratory phase
125
What 2 conditions are COPD composed of?
Emphysema
| Chronic bronchitis
126
What is emphysema?
Alveolar wall destruction with airway collapse and air trapping
127
What is chronic bronchitis?
Cough productive of sputum on most days for at least 3m in 2 consecutive years
128
What investigations can you order for COPD?
Bedside = peak flow, sputum sample, BMI, spirometry
Bloods = polycythaemia, high WCC
Imaging (CXR) = bullae, hyperinflation, flattened diaphragms
129
What spirometry result do you usually get in pts with COPD?
FEV1 < 80%
130
What is the management of COPD?
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
What is CF?
An autosomal recessive mutation of chloride ion channels leading to excessive mucus production, distortion of the airways, premature bronchiectasis, and non-respiratory signs
132
How can you classify the causes of an UMN lesion?
```
VINITD
Vascular = thrombotic or haemorrhagic
Inflammatory = demyelinating or vasculitic
Neoplastic = primary or secondary
Infective = bacterial/viral/fungal
Traumatic
Degenerative
```
133
What investigations can be ordered to be done on an LP?
Microbiology = MC&S
Cytology
Biochemistry = electrophoresis
134
What 2 questions must one consider when considering a LMN lesion?
1. Is the lesion motor, sensory or mixed?
| 2. Is it a mono or polyneuropathy?
135
What are possible locations for a LMN lesion?
'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
What investigations can you order for a LMN lesion?
1. Bloods = B12, folate, TFTs, lead
2. Nerve Conduction Studies
3. Electromyogram
137
Parkinsonian symptoms + failure of upgaze?
Progressive Supranuclear Palsy
138
Parkinsonian symptoms + autonomic instability?
Multisystem Atrophy
139
Parkinsonian symptoms + Cognitive impairment?
Dementia with Lewy bodies
140
Parkinsonian symptoms + Cerebellar involvement?
Corticobasal degeneration
141
What are the core features of Parkinson's Disease
```
TRAP
Tremor
Rigidity
Akinesia/Bradykinesia
Postural Instability
```
142
What are the DDx for Parkinson's Disease?
1. Idiopathic
2. Vascular (infarcts of substantia nigra)
3. Organic/drug-induced (metoclopramide + neuroleptics)
4. Wilson's disease
5. Parkinsons Plus Syndromes
