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first year med > get to know > Flashcards

get to know Flashcards

1
Q

4 causes of oedema

A

raised capillary hydrostatic pressure

reduced plasma oncotic pressure (<65)

lymphatic insufficiency - lymph node damage

changes in capillary permeability - inflammation, histamine

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2
Q

winged scapula

A

due to paralysis of long thoracic nerve (supplies serratus anterior)

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3
Q

what does vagus nerve pass through diaphragm with?

A

oesophagus (T10)

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4
Q

what nerve hooks under the ligamentum ateriosum?

A

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)

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5
Q

pulseless, unconscious, shockable arrhythmia

A

ventricular fibrillation

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6
Q

what is sodium nitroprusside used for?

A

rapid bp lowering (parenteral medication)

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7
Q

management post 2nd PE that had unknown causes

A

thrombophilia screen

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8
Q

initial therapy for hypertrophic obstructive cardiomyopathy

A

beta blocker

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9
Q

increased jugular distension on inspiration + reduced S1 + S2

A

constrictive pericarditis

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10
Q

29 y/o presents with fatigue + palpitations, ECG shows irregularly irregular pulse + no added cardiac sounds

most useful next investigation?

A

thyroid function test

–> thyrotoxicosis is most common cause of AF in young + in absence of valvular disease

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11
Q

what can a small ventricular septal defect cause?

A

endocarditis

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12
Q

atropine side effects

A

pupil dilatation, urinary retention, dry eyes, constipation

(antimuscarinic - inhibits parasympathetic)

treatment of bradycardias / AV node blocks

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13
Q

conditions to suspect in plumbers

A

asbestosis

legionella

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14
Q

pH, LDH + glucose levels in pleural aspirate analysis of emyema

A

pH < 7.2

increase LDH
decrease glucose

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15
Q

most likely causative organism of chronic pneumonia in patient with long standing cystic fibrosis

A

pseudomonas aeruginosa

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16
Q

treatment of aspergillosis

A

Itraconazole with corticosteroids (prednisolone)

Bronchodilators for asthma

** NOT antibacterials (amoxicillin, erythromycin etc) **

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17
Q

asthma exacerbation, as you feel the peripheral pulse, the volume falls as the patient inspires, explain this clinical sign

A

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

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18
Q

what type of hypersensitivity reaction is hypersensitivity pneumonitis? what are the different types?

A

type III

bird fanciers
farmers
mushroom workers
malt workers

** NOT coal workers**

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19
Q

what can regular nebulised doses of salbutamol cause?

A

hypOkalaemia

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20
Q

lung cancer related to hyponatraemia

A

small (ADH secretion)

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21
Q

lung cancer related to hypercalcaemia

A

squamous - PTHrP

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22
Q

next step in COPD exacerbation post drug admin + CXR request

A

ABG - needed for decision if invasive/non invasive ventilation + for monitoring

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23
Q

what drug do u give first line in someone with hypertension + type 2 diabetes?

A

ACEi

** regardless of age **

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24
Q

raised bilirubin, raised AST + ALT, what other parameter would support a diagnosis of alcoholic liver disease?

A

raised MCV

+ deranged LFTs - alcoholic liver disease

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25
Q

commonest cause of duodenal ulcers

A

H pylori

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26
Q

what is budd-chiari? clinical features?

A

hepatic vein obstruction causing congestive ischaemia + hepatocyte damage

triad = abdo pain, hepatomegaly, ascites
raised ALT, jaundice

potentially treat with TIPSS

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27
Q

investigation + treatment for hiatus hernia

A

barium meal/swallows
endoscopy - view mucosa not too reliable (cheese+onion)

lose weight
treat associated GORD

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28
Q

scoring system for severity of UC

A

truelove & Witts

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29
Q

criteria for moderate + severe UC

A

moderate - opening bowels 4-6 times a day, moderate amounts of blood

severe - more than 6, large amounts of blood

** Truelove & Witts **

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30
Q

which part of the small bowel is responsible for the absorption of vitamin B12?

A

terminal ileum

jejunum - vit D, folic acid
proximal ileum - vit B2, vit C

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31
Q

causes of hepatomegaly

A 
malignancy
fatty liver
early cirrhosis
hepatic conjestion secondary to - right HF, Budd-Chiari
infection - hepatitis, malaria

sickle-cell, leukaemia

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32
Q

drugs that can cause cholestasis

A

co-amoxiclav
penicillins
oestrogens
erythromycin

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33
Q

an osmotic laxative

A

lactulose

constipation rapid relief - magnesium/sulphate salts

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34
Q

GI conditions that cause clubbing

A

IBD !!

liver cirrhosis
PBC
coeliac
achlasia

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35
Q

commonest cause of upper GI bleeds

A

peptic ulcers

36
Q

what is the difference between koilonychia + leuconychia?

associated conditions?

A

koilonychia = spooning of nails -> iron deficiency anaemia

leuconychia = whitening of nails due to hypoalbuminaemia -> chronic liver disease, malnutrition

37
Q

band ligation post oesophageal varice bleed, what drug acts as prophylaxis in preventing rebleed?

A

propranolol - non-selective BB

38
Q

management of upper GI bleed post ABCDE resuscitation

A

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

39
Q

which vessel connects iliac arteries to placenta?

A

umbilical artery

40
Q

opening of this valve causes biphasic waveform in jugular venous pressure

A

pulmonary

tricuspid = closing causes

41
Q

serum potassium + spironolactone

A

spironolactone = potassium sparing diuretic, retains K - risk of hyperkalaemia

serum K must be <4.5 before commencing + monitored throughout treatment

42
Q

a positive test in AAA screening

A

> 3cm

–> <3cm discharge from programmee

43
Q

left sided rib fracture, what complication must urgently be investigated?

A

rupture to spleen

44
Q

goblet cells

A

secrete mucins to immobilise pathogens + foreign bodies in the resp tract

45
Q

tenecteplase. streptokinase, alteplase

A

thrombolytic agents

for massive PEs with haemodynamic compromise

46
Q

marks division between superior + inferior mediastinum

A

sternal angle

47
Q

where is fluid drained in pericardiocentesis

A

infrasternal angle

48
Q

where does azygous vein ascend to SVC?

A

along right side of vertebral column

49
Q

a sign of unsalvageable limb ischaemia

A

non-blanching region

–>potential amputation

50
Q

where is angiotensinogen produced?

A

in the liver

-> is found continuously circulating in the plasma

51
Q

what stimulates the release of aldosterone from the adrenal cortex?

A

angiotensin II

52
Q

what chamber covers most of heart base?

A

LA

53
Q

difference between thiazide + loop diuretics

A

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

54
Q

6 week old, not been feeding well + losing weight. low pan systolic murmur on auscultation. what condition?

A

ventricular septal defect

55
Q

at what potassium level would you switch to spironolactone?

A

if K level drops below 3.5

spironolactone = potassium sparing

** seek expert advise before giving in resitant hypertension

56
Q

commonest site of aneurysm formation due to atheroma

A

abdominal aorta

atheroma in renal arteries - hypertension, renal failure

57
Q

fever, fatigue, breathlessness + confused. developed symptoms over past 2 days + IV drug user

first line investigation?

A

trans-thoracic echo

–> vegetation seen on valve

58
Q

review time for hypertension

A

year

59
Q

murmur associated with hypertrophic cardiomyopathy

A

ejection systolic
jerky pulse
double apex beat

60
Q

commonest type of inheritance in hypertrophic cardiomyopathy

A

autosomal dominant

61
Q

management option (HOCM) pre cardiac arrest if presented with recurrent syncope or sustained VT

A

ICD implantation + avoidance of competitive sports

62
Q

scoring in DVT investigation

A

Wells

if low = d-dimers

63
Q

when is thrombolysis considered as a DVT treatment option

A

if DVT symptoms are less than 14 days

64
Q

difference in duct damage between PBC + PSC

A

PBC = destruction of INTRAhepatic bile ducts ONLY

PSC = autoimmune destruction of INTRA AND EXTRAhepatic ducts

65
Q

murphys sign positive

A

cholecystitis - gall bladder inflammation, probs gall stones

66
Q

mechanism of cirrhosis

A

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

67
Q

which amino acid is neither D nor L in configuration?

A

glycine - side chain is H so no long has 4 different groups (already a H)

D + L = stereoisomers

68
Q

bone which possesses the odontoid process

A

axis (C2)

69
Q

bone has tuberosity

A

tibia

tuberosity = A moderate prominence where muscles and connective tissues attach

70
Q

47 XY + 14

A

miscarriage - not a viable chromosome complement

71
Q

47XY + 18

A

edwards (trisomy 18) - early death or miscarriage

72
Q

what occurs in G1 phase of cell cycle?

A

chromosomes are ready to be replicated

73
Q 
which is NOT included in the 4C antibiotics:
co-amoxiclav
clindamycin
ciprofloxacin
clarithromycin
cefuroxime
A

clarithromycin

cefuroxime = cephalosporin

74
Q

whats released from kidneys in response to low blood pressure?

A

renin

also released in response to low sodium

75
Q

when can statins not be taken?

A

with macrolide antibiotics - erythromycin, clarithromycin

pregnancy

76
Q

arterial vs venous thrombi

A

arterial - stroke, MI

venous - DVT, PE

77
Q

atherosclerosis pathophysio

A

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

78
Q

ABPI that = calf claudication

A

0.4-0.85

79
Q

mode of inheritance of HCOM

A

autosomal dominant - condition affecting myosin chain protein

high risk patients - ICD
low - amiodarone

80
Q

dilated cardiomyopathy

A

HF like symptoms
S3 present
ALCOHOL

81
Q

WPW definitive treatment

A

radiofrequency ablation of accessory pathway

-> reentrant SVT due to accessory pathway called bundle of kent

82
Q

endocarditis diagnostic criteria

A

dukes

2/3 +ve cultures = major

83
Q

pericarditis treatment

A

treat underlying cause
NSAIDS or aspirin - may require PPI

colchicine 3 months - reduce risk of recurrence

84
Q

why are serial troponins done

A

serial = baseline + 6hrs

troponin doesnt instantly spill into blood stream - serial increase = highly likely cardiac ischaemia

85
Q

GTN effect of preload + afterload

A

decreases

vasodilates increasing collateral supply

86
Q

betablockers in angina

A

reduce adrenergic signalling on heart
reduce heart oxygen demand
work by improving contractility of heart

87
Q

grace score

A

6 month risk of death or repeat MI post NSTEMI

high = angiography within 96hr +/- PCI
low = aspirin + ticagrelor

first year med (15 decks)

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