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Final Year Defintions > General Medicine > Flashcards

General Medicine Flashcards

1
Q

Purple urine bag syndrome

A

occurs when there is an indwelling catheter with concurrent bacterial infection. Bacteria produce indoxyl phosphatase which converts certain urinalysis substances purple

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2
Q

Fine inspiratory dry crackles (cause)

A

fibrosis (idiopathic most common)

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3
Q

Causes of delirium

A

DELIRIUM: drugs, electrolyte imbalance, lack of drugs (withdrawal), infection, reduced sensory input (deaf, blind), intercranial (bleeds, infection, tumours), urinary retention (and constipation), myocardial (MI)

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4
Q

4AT (what is it and what are the conditions?)

A

rapid assessment for delirium:

* Alertness /4
* Age, DOB, place (name hospital), current year /2
* Attention (months of the year backwards) /2
* Acute change or fluctuation (yes / no assessment by doctor) /4

Score of >4 strongly suggests delirium

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5
Q

Haematocrit

A

number of RBC in blood. If Hb is stable and haematocrit drops, consider dilution effect (i.e. large amounts of fluids have been given)

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6
Q

Osmolarity (units)

A

Osm/L

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7
Q

Osmolality (units)

A

Osm/kg

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8
Q

Tonicity

A

The relative solute concentrations of 2 solutions separated by a semi permeable membrane

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9
Q

Osmotic pressure

A

The pressure needed to stop net movement

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10
Q

Oncotic pressure

A

The pressure exerted by proteins to draw water

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11
Q

Starling forces (name the 4 forces)

A

Hydrostatic pressure in capillary
Hydrostatic pressure in interstitial
Oncotic pressure in capillary
Oncotic pressure in interstitial

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12
Q

Sensible losses of water (what are they?)

A

urine, GI

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13
Q

Insensible losses of water (what are they? how much is it in ml?)

A

skin, respiratory tract (in a healthy person this is 500ml. It this can change dramatically during illness)

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14
Q

Crystalloids (give examples and MOA)

A

Simple solutions (e.g. Saline, dextrose, Hartmann’s)

Increases oncotic pressure in both plasma and interstitial compartments therefore there is net movement from the cells into both the interstitial and intravascular compartments.

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15
Q

Colloids (give examples and MOA)

A

Suspensions of large macromolecules (e.g. Blood, plasma, albumin)

Increases oncotic pressure in compartment (plasma) causing an increase in net movement out of the cells into the plasma thereby increasing fluid in intravascular compartment.

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16
Q

Reflex sympathetic dystrophy

A

when there is a nerve injury and then there is reflex pain, swelling and vasomotor dysfunction of the area

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17
Q

What are the matching tumour markers:

  • Pancreas
  • Breast
  • Ovarian
  • Hepatocellular carcinoma
  • Seminoma
  • Colorectal cancer
A 
Pancreas CA19-9
Breast CA15-3
Ovarian CA12-5
Hepatocellular carcinoma BHCG
Seminoma AFP
Colorectal cancer CEA
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18
Q

What cancers most common metastasise to the bones?

A 
Thyroid
Breast
Lung 
Kidney (renal)
Prostate

THINK 1 222 1 - single organ (thyroid), paired organs (breast, lung, kidney), single organ (prostate)

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19
Q

Which is the most common type of thyroid cancer?

A

Papillary

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20
Q

Which thyroid cancer has the worst prognosis?

A

Anaplastic - rapid progressing, common in elderly

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21
Q

Which thyroid cancer is associated with MEN2A

A

Medullary

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22
Q

Which thyroid cancer can you not tell the difference between benign or malignant on FNA?

A

Follicular

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23
Q

If an adult patient has reduced urine output, how depleted are they?

A

500 ml

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24
Q

If a patient has reduced urine output and tachycardia, how depleted are they?

A

1L

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25
Q

If a patient has reduced urine output, tachycardia and is shocked, how depleted are they?

A

> 2L

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26
Q

Causes of microcytic anaemia

A

IDA
Thalassaemia
Sideroblastic anaemia

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27
Q

Causes of normocytic anaemia

A

ACD
Blood loss
Haemolytic anaemia
Renal failure

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28
Q

Causes of macrocyclic anaemia

A 
B12/folate 
Pernicious anaemia (B12)
Alcohol XS
Liver disease
Hypothyroid 
Haematological malignancies - myrloproliferative, myelodysplastic, MM
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29
Q

Causes of hypovolaemkd hyponatraemia

A

Vomiting
Diarrhoea
Addison’s
Drugs - diuretics

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30
Q

Causes of euvolaemic hyponatraemia

A

SIADH
Polydipsia
Hypothyroidism

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31
Q

Causes of hypervolaemic hyponatraemia

A

Heart failure
Renal failure
Liver failure

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32
Q

Causes of hypokalaemia (HINT: think DIRE)

A

Drugs - loop diuretics, thiazides
Intestinal loss - vomiting, diarrhoea
Renal tubular necrosis
Endocrine - cushings, conns

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33
Q

Causes of hyperkalaemia (HINT: think DREAD)

A 
Drugs - K sparing diuretics, ACEi
Renal failure
Endocrine - Addison’s 
Artefact - clotted sample 
DKA
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34
Q

Causes of raised ALP (HINT: think ALK PHOS)

A

Any fracture
Liver damage
Kancer (cancer)

Paget’s disease / Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery

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35
Q

List the main signs of pulmonary oedema on CXR (HINT:think ABCDE)

A 
Alveolar oedema (bat wings sign)
kerley B lines (interstitial oedema)
Cardiomegaly 
Diversion of blood to upper love’s 
pleural Effusions
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36
Q

Causes of clubbing

A

Respiratory

  • Carcinoma
  • Bronchiectasis
  • CF
  • Empyema
  • Fibrosis (inc. TB)

Cardiac

  • Congenital cyanotic heart disease
  • Infective endocarditis

GI

  • Crohn’s / UC
  • Cirrhosis
  • Cancer
  • Coeliac disease

Other

  • Thyroid acropatchy
  • Familial
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37
Q

List the differentials for coin lesions on CXR (HINT: think FANGS)

A 
Foreign body
Abscess
Neoplasm
Granuloma
Structural (eg: AVM)
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38
Q

List the causes of lung fibrosis -

  • Upper (HINT: think APENT)
  • Lower (HINT: think STAIR)
  • Drugs (HINT: think BANS ME)
A

Upper:

  • Aspergillosis (APBA)
  • Pneumoconiosis
  • EAA (extrinsic allergic alveolitis)
  • Negative seroarthropathy
  • TB

Lower:

  • Sarcoidosis
  • Toxins - drugs
  • Asbestosis
  • IPF (idiopathic pulmonary fibrosis)
  • Rheumatological disease (SLE, RA, Sjogren’s)

Drugs:

  • Busulfan
  • Amiodarone
  • Nitrofurantoin
  • Sulfasalazine
  • MEthotrexate
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39
Q

List the risk factors for DVT/PE (HINT: think SPASMODICAL)

A 
Sex - female
Pregnancy
Age - increased
Surgery
Malignancy
Oestrogen - OCP, HRT
DVT/PE - PMH
Immobility 
Colossal size
Anti-phospholipid Abs
Lupus
40
Q

Define: surgical emphysema

A

Air trapped in pleural spaces secondary to surgery or a procedure

41
Q

List some of the affected systems and features of sarcoidosis (HINT: think GRANULOMAS)

A

General - fever, malaise, weight loss

Respiratory - restrictive/fibrotic disease (SOB, dry cough), BHL, pulmonary infiltrates, fibrosis

Arthralgia

Neurological - polyneuropathy (Bell’s palsy common)

Urinary - hypercalcaemia causing renal stones

Low hormones - pituitary dysfunction

Ophthalmology - uveitis, sjogrens (dry eyes, skin, mouth)

Myocardial - constrictive pericarditis

Abdominal - hepatosplenomegaly

Skin - erythema nodosum, lupus pernio

42
Q

Define colitis

A

Inflammation of the colon - presents with diarrhoea plus evidence of colonic inflammation

43
Q

Outline the management of C diff / paeudomembranous colitis

A
  1. Side room + enteric precautions
  2. Metronidazole P.O. for 14 days / Vancomycin if severe
  3. Hydrate and manage complications

DO NOT GIVE ANTIDIAHORREALS

44
Q

What is AFP a tumour marker for?

A

Hepatocellular carcinoma

Teratoma

45
Q

What is Ca 125 a tumour marker for?

A 
Ovarian cancer
(uterine, breast ca also)
46
Q

What is Ca 15-3 a tumour marker for?

A

Breast

47
Q

What is Ca 19-9 a tumour marker for?

A

Pancreatic cancer

cholangiocarcinoma

48
Q

What is Ca 27-29 a tumour marker for?

A

Breast

49
Q

What is CEA a tumour marker for?

A

Colorectal cancer

50
Q

What is b-HCG a tumour marker for?

A

Germ cell tumour (eg: testicular cancer in males)

51
Q

What is PSA a tumour marker for?

A

Prostate cancer

52
Q

What is mono-Ig a tumour marker for?

A

Multiple myeloma

53
Q

What is thyroglobulin tumour marker for?

A

Thyroid cancer

54
Q

List some causes of haematemesis (HINT: think VINTAGE)

A 
Varices
Inflammation - PUD, gastritis, duodenitis, oesophagitis
Neoplasia - oesophageal, gastric
Trauma - mallory-weiss
Angiondysplasia (vascular abdnomalities)
Generalised bleeding - eg: warfarin
Epistaxis
55
Q

Which artery is most commonly involved in haematemesis secondary to PUD?

A

Gastroduodenal artery - runs between D1 and D1 and is most commonly eroded through by PUD

56
Q

List some of the causes of PR bleeding (HINT: think DRIPING)

A 
Diverticulae
Rectal pathology - haemorrhoids, fissure
Infection
Polyps - painless
Inflammation - Crohn's
Neoplasia 
Gastric (i.e. upper GI bleed)
57
Q

What are the red flag symptoms with a presentation of dyspepsia? (HINT: think ALARMS)

A 
Anaemia
Loss of weight
Anorexia (loss of appetite) 
Recent onset OR progressive symptoms 
Malena OR haematemesis
Swallowing difficulty
58
Q

List some things that can aggravate dyspepsia

A

Drugs - NSAIDs
Smoking
EtOH
Obesity

59
Q

What is the treatment for H pylori?

A

Eradication therapy - 2x Abx + PPI (BD for 7 days)

  • Amoxicillin 1 g BD for 7 days
  • Clarithromycin 500 mg BD for 7 days
  • PPI lansoprazole 30 mg / omeprazole 40 mg BD for 7 days
60
Q

List some of the risk factors for GORD

A 
Hiatus hernia
Smoking
EtOH
Obesity
Pregnancy
Drgus
61
Q

List the risk factors for pancreatic cancer

A 
Smoking
Inflammation
Nutrition - high fat diet
EtOH
DM
62
Q

List some causes of acute pancreatitis (HINT: I GET SMASHED)

A 
Iatrogenic
Gallstones
EtOH
Trauma
Steroids
Mumps
Autoimmune 
Scorpion venom
Hyperlipidaemia, hypercalcaemia
ERCP
Drugs (eg: azathioprine)
63
Q

List some causes of chronic pancreatitis (HINT: A GIT)

A

Alcohol
Genetic
Immune
Triglycerides

64
Q

Which type of infection causes neutrophilia?

A

Bacterial

65
Q

Which type of infection causes lymphocytosis?

A

Viral

66
Q

Which type of infection causes monocytosis?

A

Chronic

67
Q

Which type of infection causes eosinophilia?

A

Parasitic

68
Q

Which pathologies cause neutropenia?

A

Viral infection
Drugs - esp chemotherapy
Severe sepsis (neutropenic sepsis)
Hypersplenism - eg: Felty’s syndrome

69
Q

Which pathologies cause neutrophilia?

A 
Bacterial infection
Stress
Steroids
Inflammatory disorders
Myeloproliferative disorders
70
Q

Which pathologies cause eosinophilia?

A

Parasitic infection
Drug reactions
Allergies
Skin disease

71
Q

Which pathologies cause basophilia?

A

Parasitic infection

IgE mediated hypersensitivity

72
Q

What does the following finding on blood film suggest?

- Blasts

A

Leukaemia

73
Q

What does the following finding on blood film suggest?

- Dimorphic picture

A

Myelodysplasia

74
Q

What does the following finding on blood film suggest?

- Howell-Jolly Bodies

A

Hyposplenism

75
Q

What does the following finding on blood film suggest?

- Leukoerythroblastic film

A

BM infiltration

76
Q

What does the following finding on blood film suggest?

- Pappenheimer bodies

A

Hyposplenism

77
Q

What does the following finding on blood film suggest?

- Reticulocytes

A

Haemolysis

Massive haemorrhage

78
Q

What does the following finding on blood film suggest?

- Spherocytes

A

Autoimune haemolytic anaemia (AIHA)

Hereditary spherocytosis

79
Q

What does the following finding on blood film suggest?

- Schistocytes

A

Microangiopathic haemolytic anaemia (MAHA)

Prosthetic valves

80
Q

What does the following finding on blood film suggest?

- Target cells

A

Hyposplenism
Thalassaemia
Liver disease

81
Q

What does the following finding on blood film suggest?

- Tear drop cells

A

BM infiltration

82
Q

List the main causes of microcytic anaemia (HINT: think FAST)

A

Fe deficiency
ACD
Sideroblastic anaemia
Thalassaemia

83
Q

List the main causes of normocytic anaemia

A

Blood loss
Failures
Haemolysis - intra- and extravascular

84
Q

List the main causes of macrocytic anaemia (HINT: think FAT RBC)

A 
Foetus
Alcohol
Thyroid (hypothyroid)
Reticulocytosis
B12 and folate deficiency 
Cirrhosis
85
Q

List the triad of signs/symptoms that make up MAHA

A

Jaundice
Anaemia
Evidence of haemolysis on blood films

86
Q

List the triad of signs/symptoms that make up HUS

A

MAHA
AKI - oligouria
Thrombocytopenia

87
Q

List the pentad of signs/symptoms that make up TTP

A 
MAHA
AKI - oligouria
Thrombocytopenia
CNS signs - confusion, seizures
Fever
88
Q

Is warm AIHA IgG or IgM mediated?

A

IgG

89
Q

Is cold AIHA IgG or IgM mediated?

A

IgM

90
Q

In patients with G6PD what are some triggers for haemolysis?

A

Fava (broad) beans
Mothballs
Infection
Drugs - esp antimalarials

91
Q

List the 3 features of sickle cell disease Hb when exposed to low oxygen states

A

1) sickling (HbS insoluble when deoxygenated)
2) haemolysis (sickled cells have shorter life span)
3) thrombosis (sickled cells become trapped in the microvasculature)

92
Q

List the signs of sickle cell disease (HINT: think SICKLED)

A 
Splenomegaly
Infarction
Crises - pulmonary
Kidney disease
Liver disease
Erectile dysfunction (or priapism due to thrombosis) 
Dactylitis
93
Q

List the features of anti-phospholipid syndrome (HINT: think CLOT)

A

Coagulation defect - increased APTT
Livido reticularis (rash)
Obstetric complications - recurrent 1st trimester miscarriage
Thrombocytopenia

94
Q

List some drugs which can cause pancyopenia

A 
Cytotoxic - eg: azathioprine, methotrexate
Antibiotics - eg: cholamphenicol
Diuretics - eg: thiazides 
Anti-thyroid - eg: carbimazole
Anti-psychotics - eg: clozapine 
Anti-epileptics - eg: phenytoin
95
Q

What are Auer rods pathomnemonic of?

A

AML

96
Q

What signs on XR would you expect to find in MM patients?

A

Pepper pot skull
Punched out lesions
Vertebral collapse
Pathological fractures

97
Q

List the signs of MM (HINT: think CRAB)

A

Calcium - high: >2.6 mM
Renal insufficiency
Anaemia
Bone lesions

Final Year Defintions (13 decks)

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