Internal Medicine Flashcards
M/C CAUZE OF HEOMOPTYSIS INDIA
TB
M/C CAUZE HEMOPTYSIS IN WORLD
Bronchogenic carcinoma
FEV1/FVC RATIO
Is the measurements of amount of air you can forcefully exhale from your lungs
ie,,-fev1 or forced expiratory volume in one second— is the volume of breath exhaled with effort
FVC— forced vital capacity —full amount of air that can be exhaled with effort in a complete breath
FEV1/FVC decreases in OBSTRUCTIVE LUNG DISEASE
FEV/FVC increases in RESTRICTIVE LUNG DISEASE
ABPA
Allergic bronchopulmonary aspergilosis
Condition charrectrised by exagerrated response of immune system to fungus aspergilus
Most commonly occurs in patients of BROCHIAL ASTHMA ,CYSTIC FIBROSIS
ASPERGILLOMA MOST ASSOCIATED WITH
Tuberculosis
Aspergilloma typically occurs in cavities of post primary pulmonary tuberculosis
KARTAGENER SYNDROME
Is a genetic ciliary disorder consisting of a triad of
Bronchiectasis, chronic sinusitis, situs inversus
Basic promblem lies in the defective movement of cilia leading to reccurent chest infection ,ear throat nose symptoms
LANDOLFIS SIGN
In severe aortic valve regurgitation ,landalofis sign refers to systolic contraction and diastolic dilation of pupils results from large stroke volume present
Patients pupil dilate and constrict synchronized with his heart beat
MULLERS SIGN
Pulsation or bobbing of uvula that occurs during systole
Seen in severe or sudden aortic insufficiency
HILLS SIGN
Popliteal systolic preasure exceeding bracheal systolic preasure by 60 mm hg
MOST SEVERE OR SENSITIVE SIGN FOR SEVERE AORTIC REGURGITATION OF ALL PERIPHERAL SIGNS
Hills sign
PERIPHERAL SIGNS OF AORTIC REGURGITATION
1)corrigan pulse(water hammer pulse) De mussete sign Mullers sign Quinke sign Traubes sign Duroziezes sign Hills sign Shelly sign Rosenbach sign Beckers sign Gerhards sign( aka sailors sign) Maynes sign Landolfis sign
CORRIGAN PULSE(water hammer pulse)
A rapid and forcefull distensionn of arteriel pulse with quick collapse
DE MUSSETE SIGN
Bobbing of head with each heart beat like bird walking
MULLERS SIGN
Visible pulsation of uvula
QUINKES SIGN
Capillary pulsation seen on compresion of nail bed
TRAUBES SIGN
Seen in severe aortic regurgitation
Refers to systolic and diastolic pistol shot heard while auscultating femoral artery
DUROZIEZES SIGN
Sign of aortic insufficiency
Consist of audible diastolic murmer which can be heard over femoral artery when it is compresed with bell of sthethescope
Systolic and diastolic murmer heard when pressing femoral artery
HILLS SIGN
In HILL SIGN blood preasure is meseured in leg(popleatal artery)
Blood preasure measured in arms(inner bracheal artery)
We will have systolic blood preasure more than bracheal artery in arms
SHELLY SIGN
Pulsation of cervix
Seen in severe aortic valve regurgitation
ROSENBACH SIGN
In severe aortic valve regurgitation , rosenbach sign is a pulsation of liver during systole caused by high stroke volume
BECKERS SIGN
Presence of visible pulsation of retinal arteries
Found in patients of aortic insufficiency or Graves’ disease
GERHARDTS SIGN
Also known as sailers sign
In severe aortic valve regurgitation ,gerhardts sign is present when pulsation of spleen are detected in presence of splenomegally
MAYNES SIGN
Is a clinical sign that indicates that there is a drop of atleast 15 mm hg in the diastolic blood preasure on raising the arm
Occurs in patients of aortic regurgitation
LANDOLFIS SIGN
Pupil dilated and constriction that were synchronized with his heart beat
Seen in severe aortic regurgitation
Results from large stroke volume
TRAUBES SPACE PRODUCE DULL TONE ON PERCUSSION IN
Splenomegally Left sided pleural effusion Full stomach Fundus mass Enlarged left lobe of liver Massive pericardial edfusion
AGATSTON SCORE
Coronary calcium scan
X ray test of heart to detect and measure calcium containing plaque in the artery
This plaques insude the artery of heart can restrict blood flow to muscle of heart
Measuring calcified plaque with heart scan we can identify possible coronary artery disease
Done by multislice computed tomography
DRUG OF CHOICE FOR ACUTE ADRENAL INSUFFICIENCY
Hydrocortisone
Also called adison disease
Is a life threatening diseases caused by insufficient levels of cortisol
ADRENAL GLAND
The two adrenal gland are located on top of the kidneys
They consist of an outer portion called cortex, and inner portion called medulla
The cortex produces 3 type of hormones:—all of which are corticosteroids
Cortisol
Aldosterone
DHEA and androgenic steroids
Epinephrine and norepinephrine
CORTISOL
Cortisol produced by adrenal gland is gloucocorticoid that maintains blood sugar ,suppress the immune response ,and is released as a response to bodys stress
Cortisol production regulated by small gland just below the brain called pitutory gland
ALDOSTERONE
Hormone produced by adrenal gland
It plays an important role in regulation of blood preasure mainly by acting on kidneys and colon to increase amount of salt (sodium) reabsorbed into blood stream and to increase amount of pottasium excreted in urine
Aldosterone also causes water to be reabsorbed along with sodium causing increased blood volume thus blood preasure
ALDOSTERONE MECHANISM
Aldosterone is a part of group of linked hormones such as RENIN,ANGIOTENSIN,ALDOSTERONE SYSTEM
Activation of this occurs when there is decreased blood flow to kidneys following loss of blood volume or drop of blood preasure
Renin leads to production of angiotensin 2,which in turn stimulates aldosterone release
Aldosterone causes increase in salt and water reabsorbtion from the kidneys to blood stream
FEATURES OF HYPER AND HYPO ALDOSTERONISM
HYPERALDOSTERONISM SYMPTOMS::-high blood preasure Low blood level of pottasium Abnormal increase in blood volume Increased hydrogen ion excretion(alkalosis) Headache HYPOALDOSTERONISM::- Symptoms:—low blood preasure Lethargy Increase in pottasium level in blood
WATER DEPRIVATION TESTING
Used to defferntiate between diabetes inspidus and paychogenic polydipsia(moothramoyikkal)
JOD BASEDOW EFFECT
Iodine supplement to patient with low iodine exposure for long time will show hyperthyroidism
DOC FOR HYPER PROLACTINEMIA
CABERGOLINE
HYPERPROLACTINEMIA
Higher level of prolactin in blood Main funtions of prolactin is milk production and development of mammary alveoli Symptoms::—infertility Irregular periods Change in menstural flow Loss of libido Galactorhea Pain in breasts Vaginal drynes Treatment::—- Dopamine agonist such as bromicriptine(parlodel,cycloset) used
M/C CAUZE OF ANEMIA IN CKD
Epo enzyme defeciency
EARLY AND SENSITIVE MARKER FOR DIABETIC RETINOPATHY
Microalbuminuria(proteinuria)::-
Earliest clinical evidence of diabetic nephropathy
It occurs when kidney leaks albumin in urine
GROSS HEAMTURIA SEEN IN
Iga nephropathy
NOVEL MARKERS FOR ACUTE KIDNEY INJURY ARE
Kim 1(kidney injury molecule)
Ngal(neutrophin gelatinase asociated lipocalin)
Cystatin c
IL 18
TRIAD OF ALPORT SYNDROME
Renal failure
Sensirineural hearing loss
Lenticonus(
ALPORT SYNDROME
Genetic disorder charrectrized by progressive kidney disease and abnormalities of inner ear and eye
Mutatuons of genes coL4A3 andCOL4A4
PULMONARY RENAL SYNDROME SEEN IN
Good pasteurs syndrome
GOOD PASTEURES SYNDROME
Anti glomerular basement membrane disorder
Rare autoimmune diseases in which antibodies attack the basement membrane of lungs,kidneys leading to bleeding from lung ,glomerulonephritis,kidney failure
Disease occurs when body’s immune system mistakenly produces antibodies against collagen in the lung and kidneys
ADPKD type1 is (autosomal dominant on chromosome
16
ADPKD TYPE 2 IS
Autosomal recessive on chromosome 4
PKD::-POLY CYSTIC KIDNEY DISEASE
Disorder that effect kidney and other organs
Clusters of fluid filled sacs called cysts develops in the kidney and interfere within theirs ability to filter waste products From blood
Growth of cyst causes kidney to become enlarged and can lead to kidney failure
COMPLICATIONS OF PKD
High blood preasure Pain in the back or sides Hematuria Reccurent uti Kidney stones Heart valve abnormalities High risk of anuerysm(bulging of aorta)
POLY ARTHRITIS NODOSA A/W
Hep B
CRYOGLOBULINEMIA A/W
Hep C
IT is the condition in which blood contain large amounts pathological cold sensitive antibodies called cryoglobulins
CLITCHY CRITERIA
Criteria to find out survival of individual with acute liver failure
Can be used as a criteria in emergency liver transplantation
According to clitchy criteria::-in acute viral hepatitis liver transplantation decided in patient with coma or confusion and FACTOR 5
SMOKING A/W DECREASED RISK OF
Developing primary sclerosing cholengitis, and ulcerative colitis
SCREENING TEST OF CHOICE FOR WILSON DISEASE
Urinary free copper level
DUBIN JHONSON SYNDROME
Disorder that causes isolated increase of conjugated bilrubin in the serum
Classically condition causes black liver due to deposition of pigment similarly to melanin
Build up bilrubin seen
BEST DRUG FOR PRIMARY PULMONARY HTN
Bosentan
M/C CAUSE OF PULMONARY THROMBO EMBOLISM
Lower limb dvt
THROMBOLYTIC WINDOW PERIOD FOR MYOCARDIAL INFARCTION
6hrs-24 hrs
ASCENDING TYPE OF SENSORY/MOTOR LOSS OCCURS IN
Extra medullary lesions
DESCENDING TYPE OF SENSORY/MOTOR LOSS OCCURS IN
Intra medullary lesions
HEMIPARESIS MAINLY CAUSED BY
Weakness or paralysis of one side of body
Is due to middle cerebral artery lesions
M/C SITE OF HYPERTENSIVE INTRACRANIAL HEOMHARAGE
Basal ganglia
NEUROFIBRILLARY TANGLES IN ALZHEMEIRS DISEASE
Intracellular
ATROPHY OF CAUDATE NUCLEUS SEEN IN
Huntingtons disease
DEJA VU STRONGLY A/W
Meisal temporal lobe epilepsy
CHARLIE CHAPLIN GAIT SEEN IN
Tibial torsion
CAPLAN SYNDROME
Is a combination of reumatoid arthritis,pneumoconiosis that manifest as intrapulmonary nodules
It is swelling(inflamation) and scaring of lungs
It occurs in people with rheumatoid arthritis who have breathed in dust such as coal or silica
FELTYS SYNDROME TRIAD
Rheumatoid arthritis,splenomegally,neutropenia
APLA SYNDROME
It is A/W thrombo cytopenia
It occurs when your inmune system mistakenly creates antibodies that make your blood more likely to clot ,this can cause dangerous clot in legs kidneys,lungs
Can cause miscarriage and still birth
WIRE LOOP LESIONS CHARRECTRISTICLY SEEN IN
Class 4 lupus nephritis
CARRY COMBS MURMER SEEN IN
Rheumatic fever
Is aShort diastolic murmer caused by active reumatic carditis and mitral valve inflammation
AUSTIN FINT MURMER
Severe aortic regurgitation
It is a low pitched rumbling heart murmer which is best heard at cardiac apex
FESTINATING GAIT SEEN
Parkinsons disease
It is the type of gait exhibited by patients suffering from parkinsons disease
It is often described as feeling like being stuck in a place when initiating a step or turning and increse risk of falling
Caused by defeciency of dopamine in basal ganglia leading to motor deficits
FIRST SENSATION TO LOSS IN DIABETIC PATIENTS
Vibration
TUMOUR LYSIS SYNDROME INVOLVES
Hyperurecimia
Hyperkalemia
Hypocalcemia
TUMOUR lysis syndrome is a group of metabolic abnormalities that can occur as a complication during treatment of cancer , where large amounts of tumor cells are killed off at the same time leading to releasing their content into bloodstream
IST HORMONE TO REPLACE IN SHEEHAN SYNDROME
Cortisol
SHEEHAN SYNDROME
Condition that effect women who lose a life threatening anount of blood in childbirths or who have severe low blood preasure during or after childbirth which can deprive oxygen in the body, this lack of oxygen causes damage to pitutory gland
SHEEHAN SYNDROME TREATMENT
Treatment is lifelong hormone replacement therappy
Corticosteroids::-hydrocortisone,prednisone::for replacing adrenal hormones that are not being produced due to ACTH defeciency
LEVOTHYROXINE::-this boosts defecient thyroid hormone level caused by low tsh
ESTROGEN::-
GROWTH HORMONE::-
M/C CAUZE OF CUSHING DISEASE IS
Pitutory adenoma
M/C CAUZE OF CONN SYNDROME
Adrenal adenoma
PRIMARY ALDOSTERONISM OR CONN SYNDROME
Excessive aldosterone secondary to adrenal tumour Retain sodium and excrete pottasium Results in alkalosis Hypertension::- universal sign of hyperaldosteronism Inability of kidney to concentrate urine Serum become concentrated Exessive thirst Hypokalemia interferes with insulin secretion Symptoms:: frequent urinating Incresed thirst Head ache Muscle cramps Tingling in fingers Temporary paralysis Heart palpitations
GRAHM STEEL MURMER SEEN IN
Pulmonary regurgitation
CARVALLO SIGN
Occurs when murmer of tricuspid valve regurgitation gets louder with deep inspiration
This louder sign distinguish it from mitral valve regurgitation
WHY C REACTIVE PROTEIN IS A BETTER PREDICTOR OF CORONARY ARTERY DISEASE
Your levels of c reactive protein can be indicator of how at risk you are developing cardiovascular promblems
This is because development of atherosclerosis (laying down of cholestrol in blood vessel) is a/w inflammation within blood vessels
MARTELS G SIGN
Gouty tophis are masses resulting from soft tissue deposition of urate crystals
The erosions of gouty arthritis are outlined with sclerotic margins
As the tophus erodes bones ,it produces overhanging c shaped edge of bone charrectrstic of gouty arthritis
M/C IMPLICATED AGENT IN REACTIVE ARTHRITIS
Clamydia
