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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
If a patient has reduced urine output, tachycardia and is shocked, how depleted are they?
>2L
26
Causes of microcytic anaemia
IDA Thalassaemia Sideroblastic anaemia
27
Causes of normocytic anaemia
ACD Blood loss Haemolytic anaemia Renal failure
28
Causes of macrocyclic anaemia
``` B12/folate Pernicious anaemia (B12) Alcohol XS Liver disease Hypothyroid Haematological malignancies - myrloproliferative, myelodysplastic, MM ```
29
Causes of hypovolaemkd hyponatraemia
Vomiting Diarrhoea Addison’s Drugs - diuretics
30
Causes of euvolaemic hyponatraemia
SIADH Polydipsia Hypothyroidism
31
Causes of hypervolaemic hyponatraemia
Heart failure Renal failure Liver failure
32
Causes of hypokalaemia (HINT: think DIRE)
Drugs - loop diuretics, thiazides Intestinal loss - vomiting, diarrhoea Renal tubular necrosis Endocrine - cushings, conns
33
Causes of hyperkalaemia (HINT: think DREAD)
``` Drugs - K sparing diuretics, ACEi Renal failure Endocrine - Addison’s Artefact - clotted sample DKA ```
34
Causes of raised ALP (HINT: think ALK PHOS)
Any fracture Liver damage Kancer (cancer) Paget’s disease / Pregnancy Hyperparathyroidism Osteomalacia Surgery
35
List the main signs of pulmonary oedema on CXR (HINT:think ABCDE)
``` Alveolar oedema (bat wings sign) kerley B lines (interstitial oedema) Cardiomegaly Diversion of blood to upper love’s pleural Effusions ```
36
Causes of clubbing
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
37
List the differentials for coin lesions on CXR (HINT: think FANGS)
``` Foreign body Abscess Neoplasm Granuloma Structural (eg: AVM) ```
38
List the causes of lung fibrosis - - Upper (HINT: think APENT) - Lower (HINT: think STAIR) - Drugs (HINT: think BANS ME)
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
39
List the risk factors for DVT/PE (HINT: think SPASMODICAL)
``` Sex - female Pregnancy Age - increased Surgery Malignancy Oestrogen - OCP, HRT DVT/PE - PMH Immobility Colossal size Anti-phospholipid Abs Lupus ```
40
Define: surgical emphysema
Air trapped in pleural spaces secondary to surgery or a procedure
41
List some of the affected systems and features of sarcoidosis (HINT: think GRANULOMAS)
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
Define colitis
Inflammation of the colon - presents with diarrhoea plus evidence of colonic inflammation
43
Outline the management of C diff / paeudomembranous colitis
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
What is AFP a tumour marker for?
Hepatocellular carcinoma | Teratoma
45
What is Ca 125 a tumour marker for?
``` Ovarian cancer (uterine, breast ca also) ```
46
What is Ca 15-3 a tumour marker for?
Breast
47
What is Ca 19-9 a tumour marker for?
Pancreatic cancer | cholangiocarcinoma
48
What is Ca 27-29 a tumour marker for?
Breast
49
What is CEA a tumour marker for?
Colorectal cancer
50
What is b-HCG a tumour marker for?
Germ cell tumour (eg: testicular cancer in males)
51
What is PSA a tumour marker for?
Prostate cancer
52
What is mono-Ig a tumour marker for?
Multiple myeloma
53
What is thyroglobulin tumour marker for?
Thyroid cancer
54
List some causes of haematemesis (HINT: think VINTAGE)
``` Varices Inflammation - PUD, gastritis, duodenitis, oesophagitis Neoplasia - oesophageal, gastric Trauma - mallory-weiss Angiondysplasia (vascular abdnomalities) Generalised bleeding - eg: warfarin Epistaxis ```
55
Which artery is most commonly involved in haematemesis secondary to PUD?
Gastroduodenal artery - runs between D1 and D1 and is most commonly eroded through by PUD
56
List some of the causes of PR bleeding (HINT: think DRIPING)
``` Diverticulae Rectal pathology - haemorrhoids, fissure Infection Polyps - painless Inflammation - Crohn's Neoplasia Gastric (i.e. upper GI bleed) ```
57
What are the red flag symptoms with a presentation of dyspepsia? (HINT: think ALARMS)
``` Anaemia Loss of weight Anorexia (loss of appetite) Recent onset OR progressive symptoms Malena OR haematemesis Swallowing difficulty ```
58
List some things that can aggravate dyspepsia
Drugs - NSAIDs Smoking EtOH Obesity
59
What is the treatment for H pylori?
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
List some of the risk factors for GORD
``` Hiatus hernia Smoking EtOH Obesity Pregnancy Drgus ```
61
List the risk factors for pancreatic cancer
``` Smoking Inflammation Nutrition - high fat diet EtOH DM ```
62
List some causes of acute pancreatitis (HINT: I GET SMASHED)
``` Iatrogenic Gallstones EtOH Trauma Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia, hypercalcaemia ERCP Drugs (eg: azathioprine) ```
63
List some causes of chronic pancreatitis (HINT: A GIT)
Alcohol Genetic Immune Triglycerides
64
Which type of infection causes neutrophilia?
Bacterial
65
Which type of infection causes lymphocytosis?
Viral
66
Which type of infection causes monocytosis?
Chronic
67
Which type of infection causes eosinophilia?
Parasitic
68
Which pathologies cause neutropenia?
Viral infection Drugs - esp chemotherapy Severe sepsis (neutropenic sepsis) Hypersplenism - eg: Felty's syndrome
69
Which pathologies cause neutrophilia?
``` Bacterial infection Stress Steroids Inflammatory disorders Myeloproliferative disorders ```
70
Which pathologies cause eosinophilia?
Parasitic infection Drug reactions Allergies Skin disease
71
Which pathologies cause basophilia?
Parasitic infection | IgE mediated hypersensitivity
72
What does the following finding on blood film suggest? | - Blasts
Leukaemia
73
What does the following finding on blood film suggest? | - Dimorphic picture
Myelodysplasia
74
What does the following finding on blood film suggest? | - Howell-Jolly Bodies
Hyposplenism
75
What does the following finding on blood film suggest? | - Leukoerythroblastic film
BM infiltration
76
What does the following finding on blood film suggest? | - Pappenheimer bodies
Hyposplenism
77
What does the following finding on blood film suggest? | - Reticulocytes
Haemolysis | Massive haemorrhage
78
What does the following finding on blood film suggest? | - Spherocytes
Autoimune haemolytic anaemia (AIHA) | Hereditary spherocytosis
79
What does the following finding on blood film suggest? | - Schistocytes
Microangiopathic haemolytic anaemia (MAHA) | Prosthetic valves
80
What does the following finding on blood film suggest? | - Target cells
Hyposplenism Thalassaemia Liver disease
81
What does the following finding on blood film suggest? | - Tear drop cells
BM infiltration
82
List the main causes of microcytic anaemia (HINT: think FAST)
Fe deficiency ACD Sideroblastic anaemia Thalassaemia
83
List the main causes of normocytic anaemia
Blood loss Failures Haemolysis - intra- and extravascular
84
List the main causes of macrocytic anaemia (HINT: think FAT RBC)
``` Foetus Alcohol Thyroid (hypothyroid) Reticulocytosis B12 and folate deficiency Cirrhosis ```
85
List the triad of signs/symptoms that make up MAHA
Jaundice Anaemia Evidence of haemolysis on blood films
86
List the triad of signs/symptoms that make up HUS
MAHA AKI - oligouria Thrombocytopenia
87
List the pentad of signs/symptoms that make up TTP
``` MAHA AKI - oligouria Thrombocytopenia CNS signs - confusion, seizures Fever ```
88
Is warm AIHA IgG or IgM mediated?
IgG
89
Is cold AIHA IgG or IgM mediated?
IgM
90
In patients with G6PD what are some triggers for haemolysis?
Fava (broad) beans Mothballs Infection Drugs - esp antimalarials
91
List the 3 features of sickle cell disease Hb when exposed to low oxygen states
1) sickling (HbS insoluble when deoxygenated) 2) haemolysis (sickled cells have shorter life span) 3) thrombosis (sickled cells become trapped in the microvasculature)
92
List the signs of sickle cell disease (HINT: think SICKLED)
``` Splenomegaly Infarction Crises - pulmonary Kidney disease Liver disease Erectile dysfunction (or priapism due to thrombosis) Dactylitis ```
93
List the features of anti-phospholipid syndrome (HINT: think CLOT)
Coagulation defect - increased APTT Livido reticularis (rash) Obstetric complications - recurrent 1st trimester miscarriage Thrombocytopenia
94
List some drugs which can cause pancyopenia
``` Cytotoxic - eg: azathioprine, methotrexate Antibiotics - eg: cholamphenicol Diuretics - eg: thiazides Anti-thyroid - eg: carbimazole Anti-psychotics - eg: clozapine Anti-epileptics - eg: phenytoin ```
95
What are Auer rods pathomnemonic of?
AML
96
What signs on XR would you expect to find in MM patients?
Pepper pot skull Punched out lesions Vertebral collapse Pathological fractures
97
List the signs of MM (HINT: think CRAB)
Calcium - high: >2.6 mM Renal insufficiency Anaemia Bone lesions

Final Year Defintions (13 decks)

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