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ICM Flashcards

1
Q

List causes of Microcytic anaemia

A

Iron deficiency anaemia (most common); Thalassaemia; Sideroblastic (rare), aneamia of chronic disease (may be normocytic)

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2
Q

List causes of Normocytic anaemia

A

Pregnancy; Acute blood loss; Haemolysis (can be macro); Hypothyroidism (can be macro); Bone marrow failure; Renal failure; Chronic disease

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3
Q

List causes of Macrocytic anaemia

A

B12 or folate deficiency; Myelodysplastic sydromes; Alcohol excess; Reticulocytosis; Cytotoxic drugs (e.g. chemo, hydrocarbamide); Marrow infiltration; Antifolate drugs; Hypothyroidism

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4
Q

Interpret these ABG results
pH: 7.29 (7.35-7.45)
PaCO2: 25 mmHg (35-45 mmHg)
HCO3-: 12 mEq/L (22-26 mEq/L)

A

Metabolic acidosis with partial respiratory alkalotic compensation

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5
Q

Interpret these ABG results
pH: 7.45 (7.35-7.45)
PaCO2: 63 mmHg (35-45 mmHg)
HCO3-: 30 mEq/L (22-26 mEq/L)

A

Metabolic alkalosis will full respiratory compensation

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6
Q

Interpret these ABG results
pH: 7.21 (7.35-7.45)
PaCO2: 56 mmHg (35-45 mmHg)
HCO3-: 22 mEq/L (22-26 mEq/L)

A

Respiratory acidosis without compensation

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7
Q

Interpret these ABG results
pH: 7.35 (7.35-7.45)
PaCO2: 41 mmHg (35-45 mmHg)
HCO3-: 22 mEq/L (22-26 mEq/L)

A

Normal ABG

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8
Q

Interpret these ABG results
pH: 7.52 (7.35-7.45)
PaCO2: 16 mmHg (35-45 mmHg)
HCO3-: 13 mEq/L (22-26 mEq/L)

A

Respiratory alkalosis with partial metabolic acidotic compensation

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9
Q

Interpret these ABG results
pH: 7.22 (7.35-7.45)
PaCO2: 58 mmHg (35-45 mmHg)
HCO3-: 23 mEq/L (22-26 mEq/L)

A

uncompensated respiratory acidosis

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10
Q

What is a melanocytic naevus?

A

A mole.

Made from a collection of melanocytes - dark pigmentation which gives them their colour.

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11
Q

What features distinguish a malignant melanoma from a mole (melanocytic naevus)?

A

Asymmetrical
Irregular border and colour
Increasing size

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12
Q

What are the features of a BCC?

A 
Pearly lesion 
Central ulceration on with rolled edges
Telengectasia (dilated spidery venules)
(Bleed > ulcerate > heal again)
Almost never mets, commonest skin cancer, sunlight exposure
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13
Q

What are the characteristics of a Squamous Cell Carcinoma?

A 
Rapidly expanding
Painless (though often loo painful!)
Ulcerated nodule, rolled margin
Commonly ulcerate and bleed
Potential to metastasize!
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14
Q

What does psoriasis look like?

A

Scaly, thickened, red patches with silvery-white accumulations
Frequently appear around elbows and knees

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15
Q

What does erythema multiforme look like?

A

Target lesions typically on arms and hands but anywhere

Heals in 3 weeks

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16
Q

What causes erythema multiforme?

A

Barbiturates, aspirin, sulphonamides, herpes simplex, TB, mycoplasma, typhoid, pregnancy, Vit C def, collagen vascular disease, IBD

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17
Q

What features may help you diagnose a shingles rash?

A

Unilateral
Follows dermatome
Pustular

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18
Q

How do you treat shingles and what causes it?

A

Caused by varicella zoster

Treated with aciclovir (800mg five times a day for 7 days)

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19
Q

How do you diagnose a neck swelling as a thyroglossal cyst?

A

By asking the patient to stick their tongue out. If it is it will move up with the tongue.

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20
Q

When would surgical resection be indicated for a thyroglossal cyst?

A 
Dyspnoea
Dysphagia
Cyst infection
To prevent malignant change
Cosmesis
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21
Q

How does the appearance of ringworm differ to erythema multiforme?

A

The lesions are not target-like although they are circular, tend to have a wider inner radius than EM and often isolated lesions rather than clusters of lesions

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22
Q

How would you treat ringworm?

A

Topical anti fungal therapy

Oral terbinafine/itraconazole

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23
Q

What does erythema nodosum look like?

A

Red painful nodules originally then on healing become bruise-like patches on the skin (typically front of legs below knee)

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24
Q

What is Erythema Nodosum and what causes it?

A

Reactive process of unknown pathogenesis
Strept infectin, sarcoidosis, pregnancy, oral contraceptive pill, IBD, TB
(In 50% of cases no cause identified)
Do bloods and CXR

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25
What does pretibial myxoedema look like and what causes it?
``` Graves Disease (rare complication) Sore, swollen, cracked skin down shins ```
26
What is the 'Butterfly Rash' associated with?
SLE Pellagra Dermatomyositis
27
What would you feel on palpation of an arteriovenous fistula?
``` A thrill (buzzing sensation) Also audible bruit ```
28
What does impetigo look like and what is the most common cause?
It has honey coloured scabs on an erythematous background Staph aureus is the most common cause It's highly contagious!
29
Where is eczema most common and what conditions is it commonly associated with?
Head, neck and creases (flexure areas) | Asthma and hayfever
30
List 4 ways in which venous disease presents
1) varicose veins 2) superficial thrombosis 3) deep vein thrombosis 4) chronic venous insufficiency and ulceration
31
Name the 4 Cardinal symptoms of lower limb venous disease
Pain Swelling Discolouration Ulceration
32
Describe the 4 different presentations of pain for the 4 presentations of venous disease
1) varicose veins - aching, itchy, feeling of swelling - worse on standing and end of the day 2) DVT - deep-seated with assoc swelling below point of obstruction 3) sup. venous thrombophlebitis - red painful area overlying vein involved 4) varicose ulceration - may be painless, if pain elevation may help
33
Which venous disease presentations may present with swelling (oedema)?
DVT and varicose veins
34
In chronic venous insufficiency what causes the discolouration of the skin (blue/black, purple or red)?
Deposition of haemosiderin (from breakdown of extravasated blood) in the skin leading to lipodermatosclerosis
35
Which area of the leg is generally affected by colour changes associate with chronic venous insufficiency?
Medial lower third of leg | occasionally lateral if superficial reflux predominates in short saphenous vein
36
Where does venous ulceration occur and with what is it always associated?
Usually above medial malleolus | Lipodermatosclerosis / severe venous disease
37
List causes of chronic leg ulceration
``` Venous and / or arterial disease(1in 5 with venous ulcer will have significant arterial disease) Pyoderma gangrenosum Syphilis Sickle cell TB Leprosy ```
38
List the 4 major ways in which peripheral arterial disease presents
Limb symptoms Neurological symptoms Abdominal symptoms Vasospastic symptoms
39
Which limbs are 8x more commonly affected by peripheral arterial disease than the other?
Legs
40
What is the main reason for PAD?
Underlying atherosclerosis
41
What are the 4 classifications of lower limb ischaemia?
I) asymptomatic II) intermittent claudication III) night / rest pain IV) tissue loss (ulceration / gangrene)
42
What ankle:brachial pressure index (ABPI) figure defines haemodynamically significant lower limb ischaemia?
<0.8 at rest
43
Name 5 types of oxygen delivery system?
``` Nasal cannula Hudson mask (rebreather) Venturi non-rebreather Laryngeal mask airway AMBU bag / bag valve mask - ```
44
List 4 ways I which venous disease presents
1) varicose veins 2) superficial thrombosis 3) deep vein thrombosis 4) chronic venous insufficiency and ulceration
45
Name the 4 Cardinal symptoms of lower limb venous disease
Pain Swelling Discolouration Ulceration
46
Describe the 4 different presentations of pain for the 4 presentations of venous disease
1) varicose veins - aching, itchy, feeling of swelling - worse on standing and end of the day 2) DVT - deep-seated with assoc swelling below point of obstruction 3) sup. venous thrombophlebitis - red painful area overlying vein involved 4) varicose ulceration - may be painless, if pain elevation may help
47
Which venous disease presentations may present with swelling (oedema)?
DVT and varicose veins
48
In chronic venous insufficiency what causes the discolouration of the skin (blue/black, purple or red)?
Deposition of haemosiderin (from breakdown of extravasated blood) in the skin leading to lipodermatosclerosis
49
Which area of the leg is generally affected by colour changes associate with chronic venous insufficiency?
Medial lower third of leg | occasionally lateral if superficial reflux predominates in short saphenous vein
50
Where does venous ulceration occur and with what is it always associated?
Usually above medial malleolus | Lipodermatosclerosis / severe venous disease
51
List causes of chronic leg ulceration
``` Venous and / or arterial disease(1in 5 with venous ulcer will have significant arterial disease) Pyoderma gangrenosum Syphilis Sickle cell TB Leprosy ```
52
List the 4 major ways in which peripheral arterial disease presents
Limb symptoms Neurological symptoms Abdominal symptoms Vasospastic symptoms
53
Which limbs are 8x more commonly affected by peripheral arterial disease than the other?
Legs
54
What is the main reason for PAD?
Underlying atherosclerosis
55
What are the 4 classifications of lower limb ischaemia?
I) asymptomatic II) intermittent claudication III) night / rest pain IV) tissue loss (ulceration / gangrene)
56
What ankle:brachial pressure index (ABPI) figure defines haemodynamically significant lower limb ischaemia?
<0.8 at rest
57
Name 5 types of oxygen delivery apparatus
- nasal cannula - Hudson mask (rebreather) - Venturi non-rebreather - laryngeal mask airway - AMBU bag (artificial mechanical breathing ...)
58
What % of oxygen can you deliver via a nasal cannula?
24-40% (closer to 38% max)
59
What % of oxygen can you deliver via a simple face mask (Hudson rebreather)?
40-60% (some say 35-50%)
60
What % of oxygen can you deliver via a Venturi non-rebreather mask?
60-90% (Venturi 24-60; non-rebreather 80-95%)
61
What are the advantages and disadvantages to nasal cannula oxygen delivery?
D: Cannot control precisely how much oxygen is reaching the lungs Can be uncomfortable Can dry out nasal mucosa A: Allow pt to eat and speak with ease; well tolerated
62
How would you treat a pt having a severe asthma attack?
High percentage, high flow oxygen Include a salbutamol nebuliser Oral or IV steroids IV magnesium to relax smooth muscle (sometimes theophylline)
63
What increases the risk of cardiac arrest in the treatment of the previous patient (severe asthma)?
Arrhythmia risk associated with B agonists (salbutamol) Hypoxia if oxygen therapy inadequate Electrolyte imbalance may prevail as salbutamol can reduce potassium
64
If a known COPD patient is admitted with 86% O2 sats, RR 26, HR 109 and a temp of 35.5 and ABG showing pH normal with slightly raised CO2 how should you treat?
~28% oxygen via Venturi mask Repeat ABG 20mins after oxygen therapy started and cont to monitor WHY: hypoxia kills quicker than hypercapnoea so if in doubt give oxygen. When monitoring look for O2 sats to increase and pH to remain normal. CO2 can remain the same but do not want to increase
65
List at least 3 causes of hypercalcaemia
Kidney failure; hyperparathyroidism; cancer; increased calcium intake
66
List at least 3 causes of hypocalcaemia
Vit D deficiency; kidney failure; thyroid disorders; drugs such as heparin
67
List at least 3 causes of hyperkalaemia
MI; GI bleed; kidney failure; drugs such as lithium, beta-blockers and diuretics
68
List at least 3 causes of hypokalaemia
Eating disorders; severe D&V (severe dehydration); drugs such as laxatives, diuretics and penicillin; adrenal gland problems
69
List at least 3 causes of hypernatraemia
Dehydration; excessive sodium intake; decreased water intake
70
List at least 3 causes of hyponatraemia
Excessive sweating; water intoxication; kidney disease; illicit drugs
71
List at least 3 causes of hypomagnesaemia
Chronic alcoholism; malnutrition; malabsorption; Drugs such as some ABx, diuretics and cyclosporin
72
List at least 3 causes of hyperphosphataemia
Bone breaks; intestinal obstruction; kidney disease
73
List at least 3 causes of hypophosphataemia
Trauma (severe burns / injuries); alcoholism; malnutrition
74
Define a hernia
Condition in which part of or entire viscera protrudes thought the wall of the cavity ordinarily containing it (often involving intestine at a weak point in the abdominal wall)
75
Which type of hernia is most common?
Indirect inguinal hernias (85%)
76
In which group of patients are femoral hernias more common?
Women
77
In which group of patients are direct inguinal hernias more common?
Older patients (men and women)
78
Describe the root of an indirect inguinal hernia
An indirect inguinal hernia leaves the abdominal cavity via the deep inguinal ring, travels down the inguinal canal and can reach the scrotum
79
Describe the root of a direct inguinal hernia and explain where you would expect to find the hernia
A direct hernia protrudes "directly" out of the abdominal cavity (not down the inguinal canal) via the weak posterior wall of the inguinal canal in "Hesselbach's Triangle" - medial to the inferior epigastric vessels and lateral to the Rectus Abdominis muscle
80
What anatomical landmarks would you use to define a hernia as femoral?
The inguinal canal and pubic tubercle. Femoral hernias will be inferior to the inguinal canal and lateral to the pubic tubercle (As opposed to a direct hernia which will be found superior and medial to the pubic tubercle) note fem. can be above inguinal ligament but will take course laterally not medially as inguinal would
81
After reducing an inguinal hernia, you put your fingers over the deep inguinal ring and ask the patient to cough. The hernia is NOT controlled? What sort of hernia is most likely?
A direct inguinal hernia
82
Where will you locate the deep inguinal ring?
a) halfway between the pubic tubercle and ASIS b) ~2cm above inguinal ligament c) halfway between b) and pubic tubercle (Other sources simply say 2cm above mid-inguinal point!)
83
What characteristics of a hernia make it a surgical emergency?
An irreducible one as it is at risk of strangulation, ischaemia and necrosis. (The strangulation is what makes it the surgical emergency but irreducibility puts it at greater risk of strangulation so worth a referral)
84
What examination findings might be indicative of strangulation or obstruction of a hernia?
Reduced or absent bowel sounds are likely with both | Obstruction of small bowel likely to illicit high-pitched tinkling on auscultation
85
Where is the superficial inguinal ring located?
1cm above and medial to pubic tubercle
86
Ŵhere would you expect to feel the femoral pulse?
~2cm below mid inguinal point
87
What are the common causes of small bowel obstruction?
Post surgical adhesions Hernias Less common = tumours and volvulus
88
What are the common causes of large bowel obstruction?
Tumours (particularly at splenic flexures or caecum) Strictures Diverticular disease Less common = adhesions
89
Why do Venturi masks tend to be preferable to Simple face masks (Hudson)?
More control over amount of oxygen delivery to patient | Particularly useful in COPD patients where adjustment is so important
90
Describe the main features of a non-rebreathing mask and in which types of patient this form of oxygen mask is usually indicated?
Has an oxygen reservoir which must be filled before applied to patient and does not collapse with inspiration. A one-way valve prevents patient berthing expired air - can achieve flow rates of 15L/min Indicated in seriously ill patients who can still self-ventilate (e.g. Severely hypoxaemic WITHOUT risk factors for hypercapnic respitatory failure)
91
What does a bag valve mask entail and when should it be used?
A self-refilling bag, jam-proof valve which prevents rebreathing that can be used to provide artificial ventilation. Designed to either deliver air directly from atmosphere or pure oxygen from supplemental system Indicated in respiratory arrest or respiratory failure (where breathing I'd inadequate to support life)

Medicine Year 2 (28 decks)

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