get to know Flashcards
4 causes of oedema
raised capillary hydrostatic pressure
reduced plasma oncotic pressure (<65)
lymphatic insufficiency - lymph node damage
changes in capillary permeability - inflammation, histamine
winged scapula
due to paralysis of long thoracic nerve (supplies serratus anterior)
what does vagus nerve pass through diaphragm with?
oesophagus (T10)
what nerve hooks under the ligamentum ateriosum?
the recurrent laryngeal branch of the left vagus nerve - does enter chest
(right recurrent laryngeal nerve hooks under the arch of the aorta - does NOT enter chest)
pulseless, unconscious, shockable arrhythmia
ventricular fibrillation
what is sodium nitroprusside used for?
rapid bp lowering (parenteral medication)
management post 2nd PE that had unknown causes
thrombophilia screen
initial therapy for hypertrophic obstructive cardiomyopathy
beta blocker
increased jugular distension on inspiration + reduced S1 + S2
constrictive pericarditis
29 y/o presents with fatigue + palpitations, ECG shows irregularly irregular pulse + no added cardiac sounds
most useful next investigation?
thyroid function test
–> thyrotoxicosis is most common cause of AF in young + in absence of valvular disease
what can a small ventricular septal defect cause?
endocarditis
atropine side effects
pupil dilatation, urinary retention, dry eyes, constipation
(antimuscarinic - inhibits parasympathetic)
treatment of bradycardias / AV node blocks
conditions to suspect in plumbers
asbestosis
legionella
pH, LDH + glucose levels in pleural aspirate analysis of emyema
pH < 7.2
increase LDH
decrease glucose
most likely causative organism of chronic pneumonia in patient with long standing cystic fibrosis
pseudomonas aeruginosa
treatment of aspergillosis
Itraconazole with corticosteroids (prednisolone)
Bronchodilators for asthma
** NOT antibacterials (amoxicillin, erythromycin etc) **
asthma exacerbation, as you feel the peripheral pulse, the volume falls as the patient inspires, explain this clinical sign
decreased left atrial filling pressures on inspiration
–> high RR + air flow obstruction > increase in negative intrathoracic pressure > pulmonary vasodilation > pooling blood in lungs > reduced pulmonary venous return to LA
what type of hypersensitivity reaction is hypersensitivity pneumonitis? what are the different types?
type III
bird fanciers
farmers
mushroom workers
malt workers
** NOT coal workers**
what can regular nebulised doses of salbutamol cause?
hypOkalaemia
lung cancer related to hyponatraemia
small (ADH secretion)
lung cancer related to hypercalcaemia
squamous - PTHrP
next step in COPD exacerbation post drug admin + CXR request
ABG - needed for decision if invasive/non invasive ventilation + for monitoring
what drug do u give first line in someone with hypertension + type 2 diabetes?
ACEi
** regardless of age **
raised bilirubin, raised AST + ALT, what other parameter would support a diagnosis of alcoholic liver disease?
raised MCV
+ deranged LFTs - alcoholic liver disease
commonest cause of duodenal ulcers
H pylori
what is budd-chiari? clinical features?
hepatic vein obstruction causing congestive ischaemia + hepatocyte damage
triad = abdo pain, hepatomegaly, ascites
raised ALT, jaundice
potentially treat with TIPSS
investigation + treatment for hiatus hernia
barium meal/swallows
endoscopy - view mucosa not too reliable (cheese+onion)
lose weight
treat associated GORD
scoring system for severity of UC
truelove & Witts
criteria for moderate + severe UC
moderate - opening bowels 4-6 times a day, moderate amounts of blood
severe - more than 6, large amounts of blood
** Truelove & Witts **
which part of the small bowel is responsible for the absorption of vitamin B12?
terminal ileum
jejunum - vit D, folic acid
proximal ileum - vit B2, vit C
causes of hepatomegaly
malignancy fatty liver early cirrhosis hepatic conjestion secondary to - right HF, Budd-Chiari infection - hepatitis, malaria
sickle-cell, leukaemia
drugs that can cause cholestasis
co-amoxiclav
penicillins
oestrogens
erythromycin
an osmotic laxative
lactulose
constipation rapid relief - magnesium/sulphate salts
GI conditions that cause clubbing
IBD !!
liver cirrhosis
PBC
coeliac
achlasia
commonest cause of upper GI bleeds
peptic ulcers
what is the difference between koilonychia + leuconychia?
associated conditions?
koilonychia = spooning of nails -> iron deficiency anaemia
leuconychia = whitening of nails due to hypoalbuminaemia -> chronic liver disease, malnutrition
band ligation post oesophageal varice bleed, what drug acts as prophylaxis in preventing rebleed?
propranolol - non-selective BB
management of upper GI bleed post ABCDE resuscitation
blood stuff - tests + crossmatch/group+save
ACESS = 2 large bore cannula - for fluids, blood etc
Transfuse- blood, platelets + clotting factors (fresh frozen plasma), prothrombin complex concentrate
Endoscopy
drugs - stop anticoag, nsaids
which vessel connects iliac arteries to placenta?
umbilical artery
opening of this valve causes biphasic waveform in jugular venous pressure
pulmonary
tricuspid = closing causes
serum potassium + spironolactone
spironolactone = potassium sparing diuretic, retains K - risk of hyperkalaemia
serum K must be <4.5 before commencing + monitored throughout treatment
a positive test in AAA screening
> 3cm
–> <3cm discharge from programmee
left sided rib fracture, what complication must urgently be investigated?
rupture to spleen
goblet cells
secrete mucins to immobilise pathogens + foreign bodies in the resp tract
tenecteplase. streptokinase, alteplase
thrombolytic agents
for massive PEs with haemodynamic compromise
marks division between superior + inferior mediastinum
sternal angle
where is fluid drained in pericardiocentesis
infrasternal angle
where does azygous vein ascend to SVC?
along right side of vertebral column
a sign of unsalvageable limb ischaemia
non-blanching region
–>potential amputation
where is angiotensinogen produced?
in the liver
-> is found continuously circulating in the plasma
what stimulates the release of aldosterone from the adrenal cortex?
angiotensin II
what chamber covers most of heart base?
LA
difference between thiazide + loop diuretics
thiazide - acts on distal tubule, inhibits NaCl co-transporter - inhibiting reabsorption of Na + Cl in distal tubule - so sodium leaves + water follows
loop - acts on ascending loop of henle, inhibits NaK2Cl co-transporter reabsorption in ascending loop of henle - water is absorbed in ascending tubule via osmosis
6 week old, not been feeding well + losing weight. low pan systolic murmur on auscultation. what condition?
ventricular septal defect
at what potassium level would you switch to spironolactone?
if K level drops below 3.5
spironolactone = potassium sparing
** seek expert advise before giving in resitant hypertension
commonest site of aneurysm formation due to atheroma
abdominal aorta
atheroma in renal arteries - hypertension, renal failure
fever, fatigue, breathlessness + confused. developed symptoms over past 2 days + IV drug user
first line investigation?
trans-thoracic echo
–> vegetation seen on valve
review time for hypertension
year
murmur associated with hypertrophic cardiomyopathy
ejection systolic
jerky pulse
double apex beat
commonest type of inheritance in hypertrophic cardiomyopathy
autosomal dominant
management option (HOCM) pre cardiac arrest if presented with recurrent syncope or sustained VT
ICD implantation + avoidance of competitive sports
scoring in DVT investigation
Wells
if low = d-dimers
when is thrombolysis considered as a DVT treatment option
if DVT symptoms are less than 14 days
difference in duct damage between PBC + PSC
PBC = destruction of INTRAhepatic bile ducts ONLY
PSC = autoimmune destruction of INTRA AND EXTRAhepatic ducts
murphys sign positive
cholecystitis - gall bladder inflammation, probs gall stones
mechanism of cirrhosis
hepatic stellate cells found in the space of Disse are activated + transformed into myofibroblasts under the influence of cytokines
–> these activated cells synthesise collagen leading to fibrosis
which amino acid is neither D nor L in configuration?
glycine - side chain is H so no long has 4 different groups (already a H)
D + L = stereoisomers
bone which possesses the odontoid process
axis (C2)
bone has tuberosity
tibia
tuberosity = A moderate prominence where muscles and connective tissues attach
47 XY + 14
miscarriage - not a viable chromosome complement
47XY + 18
edwards (trisomy 18) - early death or miscarriage
what occurs in G1 phase of cell cycle?
chromosomes are ready to be replicated
which is NOT included in the 4C antibiotics: co-amoxiclav clindamycin ciprofloxacin clarithromycin cefuroxime
clarithromycin
cefuroxime = cephalosporin
whats released from kidneys in response to low blood pressure?
renin
also released in response to low sodium
when can statins not be taken?
with macrolide antibiotics - erythromycin, clarithromycin
pregnancy
arterial vs venous thrombi
arterial - stroke, MI
venous - DVT, PE
atherosclerosis pathophysio
Endothelial dysfunction/damage
Lipids (LDL) get oxidised in the intima
Macrophages consume oxidised lipids resulting in foam cells
Foam cells accumulate into fatty streaks
Smooth muscle cells from media migrate and proliferate in intima
Collagen synthesis and continued accumulation result in atheroma/plaque formation
Fibrous cap and a necrotic core develops in the plaque
Plaque can rupture - platelet agregation/adhesion- thrombus
ABPI that = calf claudication
0.4-0.85
mode of inheritance of HCOM
autosomal dominant - condition affecting myosin chain protein
high risk patients - ICD
low - amiodarone
dilated cardiomyopathy
HF like symptoms
S3 present
ALCOHOL
WPW definitive treatment
radiofrequency ablation of accessory pathway
-> reentrant SVT due to accessory pathway called bundle of kent
endocarditis diagnostic criteria
dukes
2/3 +ve cultures = major
pericarditis treatment
treat underlying cause
NSAIDS or aspirin - may require PPI
colchicine 3 months - reduce risk of recurrence
why are serial troponins done
serial = baseline + 6hrs
troponin doesnt instantly spill into blood stream - serial increase = highly likely cardiac ischaemia
GTN effect of preload + afterload
decreases
vasodilates increasing collateral supply
betablockers in angina
reduce adrenergic signalling on heart
reduce heart oxygen demand
work by improving contractility of heart
grace score
6 month risk of death or repeat MI post NSTEMI
high = angiography within 96hr +/- PCI low = aspirin + ticagrelor
