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General Bits Flashcards

1
Q

COPD key things increasing survival

A

stopping smoking most important!!

salbutamol
tiotropium also

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2
Q

mortality predictor PE

A

PESI score

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3
Q

anticipatory medications palliative

A

anti secretions drugs
morphine
midazolam
antiemetic

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4
Q

significant ST elevation

A

1mm in 2 consecutive non chest leads

2mm in 2 chest leads

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5
Q

inflammatory / septic bloods

A

raised platelets
low albumin
raised CRP
raised ferritin

and the usual

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6
Q

obstructive jaundice

A

ALP up and BR too

usually a stone
can be tumour etc

do USS then if not clear do MRCP

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7
Q

anaphylaxis treatmnet

A 
remove cause 
1 in 1000 0.5ml IM adrenaline
200mg IV hydrocortisone
500ml-1000ml saline 
10mg chlorphenamine

can repeat adrenaline every 5 mins

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8
Q

hypoglycaemia, DKA, HHS

A

HHS - they are very very dehydrated with much higher sugars

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9
Q

DVT examination

A 
colour changes
swelling
signs of venous insufficiency
temp
tenderness
pitting oedema
measure circumference 10cm below tibial top
palpate pulses
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10
Q

when to do D dimer

A

if Well’s score <2

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11
Q

signs of venous insuffiency

A

venous eczema
haemosiderin deposits
lipodermatosclerosis (inverted champagne bottle leg)
venous ulcers

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12
Q

describe # xray

A 
Describing a fracture: PAID • Radiographs must be orthogonal: request AP and lat. films.
• Need images of joint above and joint below #.
• Demographics
§ Pt. details
§ Date radiograph taken
§ Orientation and content of image
• Pattern
• Transverse
• Oblique
• Spiral
• Multifragmentary
• Crush
• Greenstick
• Avulsion
• Anatomical Location
• Intra- / extra-articular
• Dislocation or subluxation
• Deformity (distal relative to proximal)
§ Translation
§ Angulation or tilt
§ Rotation
§ Impaction (→shortening)
• Soft Tissues
§ Open or closed
§ Neurovascular status
§ Compartment syndrome
• ? Specific # classification/type
§ Salter-Harris
§ Garden
§ Colles’, Smith’s, Galeazzi, Monteggia
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13
Q

hyperthyroid o/e

A

– hyper -> hot, sweaty, palmar erythema, tachy, anxious, flushed hypo, fine tremor, oncholysis, fast reflexes +/- (pretib myx, thyroid acropachy, exopth, proptosis, lid lag, H test pain) thyroid swelling, AF

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14
Q

hypothyroid o/e

A

cold, muscle wasting, dry hair/waxy skin, lateral third of eyebrows gone, myxoedema, slow reflexes, +/- thyroid swelling,

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15
Q

extra thyroid exam bits

A

thyroglossal cyst moves on swallowing, proximal myopathy in hypo+hyper

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16
Q

diabetic foot exam

A

Charcot joints, clawed toes, dystrophic nails, hairless+pallor (vasc insuff), LPS, eczema HS deposits-> complete with ABPI, Doppler, blood gluc, HbA1c

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17
Q

venous ulcer

A

gaiter region, superficial, sloping edge, pink, some pain, diabetic skin changes

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18
Q

arterial ulcer

A

pressure areas, deep, punched out, sloughy, pale, painful, no pulses

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19
Q

neuropathc ulcer

A

pressure areas, depp, punched out, bloody, painless, neuropathy

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20
Q

Cushing’s syndrome o/e

A

NB ‘examine endocrine status’ can be hypoT, Cush or acromegaly. Central adiposity, intrascapular fat pad, hirsutism, osteoporosis, pigmented (Disease), thin skin, bruising, poor healing, moon face, acne, thrush, hoarse voice, striae, prox myopathy, signs of cause (complete with BP, urine dip, visual fields, hx, 24 hr cortisol, dex suppression test)

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21
Q

acromegaly o/e

A

large hands, osteoarthritis, boggy soft tissue, carpal tunnel scar, coarse features, enlarged nose/ears, macrognathia, bitemp hemianopia, frontal bossing, splayed teeth, macroglossia, goitre, +/- cardiomyopathy and rolling gait + prox myopathy

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22
Q

acromegay hx Qs

A 
headaches
vision
pins and needles
back ache
muscle weakness
change in shoe size
change in appearnce
what did you notice first?
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23
Q

Qs to differentiate Cushing’s and hypothyroid

A

taking any steroids?

changes in appearance?

mood?
heat/cold intolerance?
change in periods?

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24
Q

varicose veins

A

tortuous dilated superficial. Retrograde flow from deep to surface veins. May get pains, cramps, restless legs. Skin changes like diabetic ones. Colour flow duplex to assess.
Peripheral arterial disease – acute limb ischaemia (6Ps), critical ischaemia (rest pain at night,

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25
Q

PVD

A

Peripheral arterial disease – acute limb ischaemia (6Ps), critical ischaemia (rest pain at night, gangrene, 0.3), intermittent claudication (rest stops, 0.9), rest pain 0.6. ABPI. Manage as CVD +/- revascularisation or amputation. Bypasses incl fem-pop, aortofemoral, femoral – femoral.

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26
Q

pregnant skin changes

A

pregnant skin changes – linea nigra, striae gravidarum (purplish-current preg), striae albicans (prev pregnancy), excoriations (OC), distended veins, umbilicus eversion

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27
Q

uterus enlarged

A

Uterus enlarged o/e pregnant, fibroids, malignancy, endometrial fluid collection

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28
Q

cervical excitation

A

cervical excitation o/e – PID or ectopic

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29
Q

adnexal tenderness

A

adnexal tenderness o/e – salpingitis, ovarian torsion, ectopic

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30
Q

fundal height excesssive

A

fundal height bigger than expected – macrosomia, polyhydramnios, multiples, dates wrong, fibroids

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31
Q

fundal height small

A

fundal height small IUGR, oligohydramnios, small baby

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32
Q

presentation of baby

A

presentation of baby round hardish presenting part – cephalic, broader and softer = breech bottom

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33
Q

baby head engaged

A

baby head engaged >50% in pelvis

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34
Q

normal foetal HR

A

120-160

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35
Q

normal fundal height

A

should match weeks in cm approx

12 weeks - feel uterus

20-22 fundus near umbilicus

36 weeks fundus near xiphi

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36
Q

forceps trauma

A

cephalhaematoma

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37
Q

Down’s

A

dysmorphia, cleft lip, low set ears and epicanthic folds

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38
Q

fontanelles

A

bulging raised ICP sunken dehyrdated

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39
Q

red relfex baby

A

red reflex baby absent – congenital cataracts, white – retinoblastoma

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40
Q

scaphoid abdo

A

diaphragmatic baby hernia

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41
Q

kidney large kid

A

kidney mass kid Wilm’s tumour

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42
Q

coarctation baby exma

A

lack of femoral pulese

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43
Q

Barlow Ortolani hip tests

A

Barlow + Ortalani test Barlow dislocates, O replaces

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44
Q

talipes

A

is club foot

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45
Q

spina bifida o/e

A

spina bifida lipomas, tufts of hair on back

spine abnormal on palpatoon

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46
Q

baby exam reflexes

A

grasp Moro

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47
Q

sats uneqaul in baby arms

A

congen heart disease

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48
Q

examining kids - tips

A

keep talking and asking Qs and using their name!!

make it a game

if child upset, talk to their family calmly first

always invovle them to the max

use simple words

undress in small stages

keep rechecking they are okay

distract

reassure

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49
Q

newborn baby hx Qs

A

Newborn hx Qs – how long since born, problems in labour incl mum/ROM time, drugs in labour, mother – any temps, overall preg health/ complics, any hip dysplasia hx baby – pre/post term baby, weight, breast/bottle feeding, any urine within first 12 hours, meconium, breathing well?

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50
Q

unwell child assessment

A

ABCDE approach. A – stridor (croup, foreign body), grunting (bronchiolitis, pneumo, asthma) B – rate, recessions/flaring/trach tug, sats 97+ C – pallor / mottling / blue, brachial pulse, hydration signs (nappies, skin, central CRT, temp), ausc, palpate L D – alert/ reactive, inconsolable, fontanelle, GCS, pupils, rash, tone, glucose E – ENT exam, abdo

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51
Q

child red flags

A

stridor, resp distress RR 60+, grunting, chest indrawing, pale/mottled / ashen/blue, turgor reduced, no response to cues/can’t stay awake, non blanching rash, seizures, neuro signs, bulging fontanelles, fever < 3months

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52
Q

paeds normal obs

<1 year
1-2
5-12
older

A

Paeds obs <1 year (RR 30-40, HR 110-160), 1-2 years (RR 25-35, HR100-150), 5-12 years (RR 20-25, HR 80-120), 12+ normalises to adult obs

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53
Q

stridor in baby / child

A

never look in throat!!

croup
foreign body

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54
Q

grunting in baby / child

A

bronchioloitis pneumonia asthma

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55
Q

wheeze in baby/child

A

asthma/viral induced / bronch

56
Q

sluggish baby/child pupils

A

post ictal or drug toxic

unequal sizes of pupils = SOL

57
Q

paeds resp o/e signs

A

wheezing - bronchiolitis, astham, VIW

stridor - croup, FB
grunting - bronch, pneumo, asthama

cough - barking = croup, dry = URTI, cough with insp whooping = whooping cough

clubbing - CF or bronchiect

barrel chest - asthma

crackles - bronchioloitis, infection

58
Q

paeds cardiac o/e

A

dysmorphic features - Down’s, Williams, DiGeorge

Turner - AS

Noonan - PS

continuous machinery like murmur = PDA

systolic murmur left interscarpular zone - coarctation

preductal/postductal sats

59
Q

paeds abdo exam

A

PR never routine or really needed in a child!

liver may be 2cm below rib margin and be normal

60
Q

key developmental milestones in a child

A

smiles 6 weeks,

head control / eye following / laughing 3 months,

rolling/ babbling/eating solids, sits/crawls/pincer grip 9 months,

stands/mama/socially responsive 12 months,

walks/words 18 months,

runs/phrases 2 years

61
Q

o/e dev assess a child

A
  • 4 areas (gross motor, fine motor and vision, hearing/lang, social). GM – look for rolling, head control, sitting, standing, walking, crawling FMV – transferring betweenhands, grips used, building towers, drawing, fixing and following HL – startles to sound, turns to name/noise, babbling/phrases/words, follows commands S – smiling, laughing, stranger
62
Q

global developmental delay

A

Global dev delay – prenatal (chromosomal, alc/drugs/infection in pregnancy), perinatal (IVentricular bleed, hypoxia, hypoglyc), postnatal (meningitis, anoxic events, head injury)

63
Q

isolated developmental delay

A

– motor (cerebral palsy, visual impairment, spotted 1st yr), language (hearing, cleft palate, neglect, 2nd yr), social (autism, hyperactivity, attention deficit, 3rd yr life)

64
Q

categorise the skin lesion descriptors

A

skin lesions define <0.5cm flat = macule, raised = papule, vesicle (fluid), pustule (pus // >0.5cm flat = patch, plaque (palpable) raised = nodule, bulla (fluid)

65
Q

central scotoma

A

can’t see red pin in middle of vision

66
Q

large blind spot

A

papilloedema

67
Q

lost adult red reflex

A

cataract, retinoblastoma, bleed

68
Q

examine optic disc , abnormalities

A 
check optic disc o/e  - cup, colour, contours
enlarged cup (>0.3 of total diameter) – glaucoma, colour grey = optic atrophy, swollen = papoed
69
Q

hypertesnive retinopathy

A

silver wiring, AV nipping, cotton wool spots, papilloedema

check each quadrant following vessels from optic disc

70
Q

diabetic retinopaty

A

dot/blot haemorrhages, cotton wool spots, neovasc, retinal fibrosis

71
Q

drusen

A

macular degeneation

macula dark when they focus on the light (should be pink)

72
Q

periperhal pigmentation of retina

A

retinitis pigmentosa

73
Q

non CN3 eye muscles

A

superior oblique CN4 lateral rectus CN6

74
Q

systemic sclerosis define and categorise incl key features

A

– AI condition due to excess collagen deposition by fibroblasts. Limited cutaneous – only skin signs below elbows vs diffuse cutaneous (organ involvement more likely). Features CREST – calcinosis, Raynaud’s, oEsophageal dysfunction, Sclerodactyly, Telengiectasia. i.e. thick, tight, itchy skin + calcium deposits + heartburn. Mask like face, microstomia, beaked nose.

75
Q

systemic sclerosis inv and management

A

Organ involvement = lung fibrosis, arrhythmias, kidney injury, dysphagia, incontinence. Limited – anti centromere Abs, diffuse – anti Scl 70 Abs. assess organs on imaging and XR hands. Treat – CCBs for Raynaud’s, PPIs, cyclophosphamide Isupp.

76
Q

Paget’s disease summarise features

A

Paget’s disease increasing and disorganised bone remodelling. White >55 yrs. Bony pain, kyphosis, OA, frontal bossing, nerve deafness/tinnitus enlarged maxilla, raised JVP, bowed femur, sabre tibia, path #.

77
Q

Paget’s inv and treat

A

Inv – XR = cotton wool lesions, ALP raised with normal electrolytes. Bone radioscan. Treat – NSAIDs, alendronate, vitD/cal, physio.

key complicationsn = nerve compression, secondary osteosarcoma

78
Q

summarise Marfan’s and complications

A

conn tissue disease. Auto dominant fibrillin mutation. Tall/thin, scoliosis, wide arm span, hyperextension, myopia, high arched palate, chest deformity, AR murmur, flat feet. Inv – genetic testing. Treat – no cure, MDT + annual echo, 5 yearly MR aorta, beta blockers, eye exams, screen family. Complic – ½ lens dislocates, AR/MR, aneurysms.

79
Q

neurofibromatosis summary

A

Neurofibromatosis – auto dominant nerve tumour condition. Generalised brown circular nodules, SNT with button hole sign. Flat brown patches+café au lait spots. Axiallary, inguinal freckling, Lisch nodules. 2+ neurofibromas + 6+ CaL spots = NF. Inv BP, spine, eyes. type 1 NFomas type 2 schwannomas. MRI + monitoring

80
Q

type 1 vs type 2 NF

A

type 1 - peripheral, neurofibromas, cafe au lait, axillary freckling, optic nerve gliomas (visual loss), Lisch nodules, spinal cord tumours

type 2 - central schwannomas, bilateral acoustic neuromas causing 20-30 yr old person hearing loss
also get gliomas, meningiomas, tinnitus SKIN signs uncommon

81
Q

NF1 complications

A

malignant nerve sheath tumours, HTN, phaeo,rrneal artery stensosi, GI neurofibromas (bloat, dyspepsia, bleed , constipation)

82
Q

psoriasis define and types

A

erythematous extensor plaques with scaling, nail pitting, oncholysis. +/- symmetrical polyarthropathy of DIPs. Guttate = raindrop lesions chronic plaque type = most common seborrheic = nose and ears pustular = palms/soles erythrodermic = 90%+ of all skin affected

83
Q

treat psoriasis

A

emollients, vit D analogues/steroid cream, phototherapy, methotrexate/infliximab.

84
Q

psoriasis complications

A

erythroderma

nail changes

p arthritis

85
Q

atopic eczema

A

Atopic eczema flexor papules/vesicles with lichenification/scaling. Atopic hx Qs x3. Exacerb by allergens, infection, heat, sweat. Treat – emollients, topical steroids, tacrolimus, avoid trigger.

beware secondary infection or eczema herpeticum

86
Q

basal cell carciomas

A

BCC – pearly rolled edge with surface telangiectasia. Sun exposed areas. Mohs surgery. Mets v rare.

87
Q

seborrhoeic keratosis

A

Seb keratosis stuck on appearance, dark brown warty papule. Reassure, remove if uncertain dx

88
Q

vitiligo

A

melanocyte AI destruction, patchy depigmentation. Assoc other AI. Avoid sun, use strong suncream. Screen thyroid/diabetes/pernicious a/addison’s. topical steroids, topical tacrolimus.

89
Q

compare foot ulcer histories

A

arterial - tips of toes, pretibial zone, nocturnal pain, worse on elevating the leg

venous - gaiters, mild pain, worse standing, assoc varicose

neuro - pressure points (soles/heels), painless, loss of sensation too

INV - fasting glucose,ABPI, duplex US, x ray to exclude OM, swab and culture

90
Q

diabetic retinopathy

A

no signs unless bleeds. Non prolif mild = microaneurysms mod – blot haemorrhages, venous beading, hard exudates, cotton wool spots prolif any neovascularisation! Optimise diabetes +/- photocoagulationfor neovasc.

CHECK PICS!

91
Q

hypertensive retinopathy grading

A

Hypertensive retinopathy grade 1 – arteriolar narrowing 2 - + AV nipping, silver wiring 3 - + flame haemorrhages, hard exudates, cotton wool spots 4- ++ papilloedema. Treat HTN.

CHECK PICS

92
Q

retinal artery / vein occlusion

A

both same hx - sudden painless loss of vision

central = all vision lost

branch occlusion = partial vsion loss

difference seen on opthalmoscopy

93
Q

retinal artery occlusion on picture + treta

A

Retinal artery occlusion swollen pale macula with cherry red spot. Urgently reduce IOP

CHECK PIC

94
Q

retinal vein occlusion on eye look

A

Retinal vein occ tortuous dilated vessels, stormy sunset, disc oedema

95
Q

retinitis pigmentosa

A

Ret pigmentosa deteriorating night vision + getting tunnel vision. Bone spicule peripheral pigmentation, waxy disc. No cure, genetic.

96
Q

wet vs dry macular degeneration

A

central vision loss dry mac degen = drusen, no treatment, don’t smoke. Wet mac degen = subret haems, localised retinal oedema. Intravit anti VEGF, laser photocoag

97
Q

optic neuritis vs optic atrophy

A

reduced acuity, loss of red colour vision, central scotoma, afferent pupillary defect

Optic neuritis unilat swollen optic disc – give methylpred if MS. Optic atrophy pale setting sun disc, no treatment, treat cause.

98
Q

optic neuritis vs optic atrophy

A

reduced acuity, loss of red colour vision, central scotoma, afferent pupillary defect

Optic neuritis unilat swollen optic disc – give methylpred if MS. Optic atrophy pale setting sun disc, no treatment, treat cause.

99
Q

bilateral swollen optic discs with blurred margins

A

papilloedema

raisd ICP

treat cause

100
Q

chronic open angle glaucoma

A

chronic open angle glaucoma asympto until sev impaired vision. Optic disc cupping + atrophy. BB eye drops, prostaglandin eye drops, c anhydrase eye drops, laser trabeculoplasty

101
Q

acute closed angle glaucoma

A

Acute closed angle glaucoma eye pain, red eye, headache, halos, blurring. Ciliary flush, mid dilated irreg pupil. Optic cupping. IV/PO acetazolamide, alpha / beta blocker drops. Laser periph iridectomy

102
Q

vitreous haemorrhage

A

sudden painful vision loss or haze. No red reflex, can’t visualise retina. Treat cause (detachment/diabetic R).

103
Q

digital clubbing causes

A

digital clubbing resp = idio PF, lung ca, bronchiect, TB, CF, sarcoid CVS = cyanotic congenital, inf endocarditis abdo – IBD, liver cirrhosis others – preg, acro, thyroid

104
Q

stages of labour

A

Stages of Labour 1 – ROM, bloody show, 3-4 contractions/10 mins. 15hrs prima/7.5 multiparous. Foetal head descends into pelvis. May be induced by prostaglandin pessary or given IV oxytocin. Left OA most common lie. 2 – 90 mins primp/45 mins multip. Expulsion of foetus in this stage. Descent, internal rotation until facing to mum’s spine, extension of head, restitution (rotates to face sideways, shoulders out A,P. 3 – delivery of placenta, 30-60mins. Give IM syndometrine to speed. Controlled cord traction

105
Q

postpartum haemorrhage

A

Postpartum bleed – primary = within 24 hrs of birth (tone, tissue, trauma, thrombin). Secondary – retained placenta or clots

106
Q

female pelvis diffs

A

Female pelvis – wider, round inlet, curved sacrum.

107
Q

major LN areas

A

Major lymph node areas cervical, supraclavicular fossa (gastric mal), axillary, epitrochlear (elbow), inguinal, popliteal, palpate hep/spleen. Hard/tethered/irregular = mal, rubbery = lymphoma.

108
Q

neck exam

A

Neck o/e – feel anterior LNs, feel thyroid lobes + stay there on swallow+sticking tongue out, feel posterior LNs, feel supraclav (esp Virchow Left), percuss sternum, ausc thyroid/carotid.

109
Q

midline neck path

A

thyroid, thyroglossal cyst, dermoid cyst

110
Q

ant triangle pathology

A

branchial cyst, laryngocoele, carotid body tumour (v rare

111
Q

posterior triangle path

A

cystic hygroma (since childhood, lights up), pharyngeal pouch

112
Q

breast exam

A

breast o/e chaperone, inspect relaxed, hands on hips/above head, spiral palpation, pt massages nipple d/c, axillary/sc LNs. 2WW triple assess exam/imaging/FNA if cystic, core biopsy if solid. If <35 do US, if older do mammogram.

113
Q

mental state examintion

A

A+B, SMT, PCI

appearnce - appropriate, dress, clean

behaviour - eye contact, manner

speech - rate, volume, fluency

mood/affect - facial expressions and general vibe

thoughts - delusions, coherency, content

perceptions - hallucinations

cognition - concentration/attention, memory, MMST

insight - understanding of illness / need for treatment

RISK

finish with rest of psych hx

114
Q

hydration status exam

A

Hydration status exam – general vibe, fluid in / out + chart, obs (temp, HR, BP), eyes, mucus membranes, JVP, carotid volume, central CRT, apex, ausc, ascites, oedema. Follow up – daily wt, catheter and monitor UO, UEs, ABG+lactate

115
Q

refeeding bloods

A

refeeding bloods UE, cal, mag, phosphate

116
Q

vitamin A def

A

night blindness, dry eyes

117
Q

vit E def

A

haemolysis, neuro deficits, retinopathy

118
Q

Wernicke’s encephalopathy

A

ophthalamoplegia ataxia confusion

119
Q

Korsakoff syndrom

A

prolonged Wernicke’s b1 thiamine def

amnesia, confabulation, apathy

120
Q

B3 niacin def

A

Pellagra (diarrhoea, dermatitis, dementia, death)

121
Q

B6 pyridoxine def

A

dermatitis, glossitis, neuropathy, conjuncitvitsi

122
Q

B12 def

A

macro anaemia, polyneuropathy, subacute combined degen of the cord, glossitis, pancytopaneia

123
Q

vit C def

A

scurvy )listless bleeding gums, gingitivits, rough dry skin, anorexia brusiing

124
Q

fat malabsoprtion vits

A

ADEK (liver stored)

125
Q

512hz

A

cranial nerves

126
Q

128hz

A

legs arms neuro

127
Q

tender pinna

A

and mastoid = mastoiditis

128
Q

examining ear

A

pull pinna up and back in adults, down and back in kids

hold otoscope in the same hand as eaer youre examining e..g right hand right ear

rest ulnar border of hand on cheek to stabilise

look at - canal, tympanum+light cone reflect, behind membrane

check hearing if necc

129
Q

otitis externa

A

otitis externa inflamed swollen narrow canal with d/c + flaking. Acute – Sofradex (Abx/steroid) or antifungal if chronic e.g. swimmers. Be careful not perf- ototoxicity.

130
Q

otitis media

A

Otitis media swollen red tympanum, bulging behind, oral abx

131
Q

otitis media with effusion / glue ear

A

Ot media with effusion/glue ear fluid level seen behind tympanic memb, observe for 3 months, may resolve. If not tympanostomy/grommet.

132
Q

choleastoma

A

slowly expanding thick white canal growth, can invade. Excise

133
Q

perf and wax ear

A

Perf – most heal spontaneously. Wax never syringe, give olive oil and bicarb. Can use otoscope to look in nose

134
Q

quinsy appearacne

A

obliterates posterior arch, uv dev

Scarred tympanum tympanosclerosis

135
Q

DVLA guidelines

A

check 3 Ps provocation, prodrome, postural -> if present, okay to drive

solitary+unknown cause -6 month ban
solitary + treated cause - 1 month ban

recurrent seizures - must be seizure-free for 1 year

AS / OS Paces RT (11 decks)

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