Laz n Oli Flashcards
Inguinal Canal contents
Males - Spermatic cord
Females - Round ligament
Inguinal canal anatomy
ASIS to pubic tubercle
Begins at deep inguinal ring (just above midpoint of inguinal ligament)
Ends at superficial inguinal ring (Superior and medial to pubic tubercle)
Direct inguinal hernia
Weakness in posterior wall of inguinal canal
Abdo viscera protrude directly through back of inguinal canal
Indirect inguinal hernia
Abdo contents pass through deep inguinal ring and along inguinal canal
Differentiating direct vs indirect inguinal hernia on exam
Place finger on deep ring and ask pt to cough. Only direct hernia will protrude
Spigelian hernia
Abdo contents herniate through linea semilunaris
Inferior and lateral to umbilicus
Obturator hernai
Abdo contents herniate through obturator canal and present with inner thigh pain when his internally rotated
Austin Flint murmur
Severe AR
Regurgitated blood apply pressure mitral valve = physiological MS
Low pitched, rumbling mid-diastolic murmur
Graham Steel murmur
High pitched early diastolic murmur at left sternal edge
Assoicated with PR
Gibson murmur
Machinery murmur associated with patent ductus arteriosus
Carey-Coombs murmur
Mid-diastolic murmur causede by turbulent blood flow over thickened mitral valve
Associated with acute rheumatic fever
Barlow murmur
Mid-systolic click + end systolic murmur heard best at apex
Associated with mitral valve prolapse
GCS Points breakdown
Eyes - 4
Verbal - 5
Motor - 6
Minimum = 3; Maximum = 15
GCS Eyes
1 – No eye opening
2 – Eyes open in response to pain
3 – Eyes open to verbal command
4 – Eyes open spontaneously
GCS Verbal
1 – No verbal response 2 – Incomprehensible sounds 3 – Inappropriate responses 4 – Confused conversation 5 – Oriented
GCS Motor
1 – No motor response
2 – Abnormal extension in response to pain (decerebrate posture)
3 – Abnormal flexion in response to pain (decorticate posture)
4 – Withdraws from pain
5 – Purposeful movement towards painful stimulus
6 – Obeys commands for movement
Minimal change glomeruonephritis
Non-proliferative glomerulonephritis which causes nephrotic syndrome in young children
Light microscopy shows no visible changes to the glomerulus (hence, minimal change), but electron microscopy shows diffuse loss of the processes of the podocytes in the Bowman’s capsule.
Membranous gloerunephritis
Non-proliferative glomerulonephritis and is a cause of nephrotic syndrome in adults
IgA nephropathy
Most common cause of glomerulonephritis and tends to occur a few days after upper respiratory tract infections.
Cause nephritic syndrome - haematuria more prominent than proteinuria
Henoch-Schonlein purpura
Type of IgA nephropathy that tends to affect older children and presents with a triad of abdominal pain, arthritis and a purpuric rash
Rapidly progressive glomeuronephritis
acute nephritic syndrome characterised by rapid loss of kidney function within weeks to months.
Anterior MI
LAD
V1-V4
Laterla MI
L circumflex
aVL, I and V5-V6
Inferior MI
Right coronary artery
II, III, aVF
Posterior MI
Posterior descending artery
ST depression in V1-V4
Rheumatoid arthritis
Chronic AI inflammatory disease
Symmetrical polyarthritis, joint deformity, extra-articular manifestations (eg. subcutaneous nodules, pulmonary fibrosis & episcleritis)
O/E: tenderness and warmth or MCP and PIP.
Radial ddeviation of wrist, ulnar deviation of fingers
Z deformity of thumb
Swan neck deformity
Boutonniere deformity
Trigger finger
Reactive arthritis q
Sterile arthritis
Tends to occur days/weeks post GI/urogenital infection
Traid of arthritis, uveitis and urethritis
Osteoarthritis
Degenerative disease of cartilage, occuring in weight bearing joints eg kness, hips
Often assymetrical and stiffness worse with activity
Psoriatic arthritis
presence of arthritis in pts with psoriasis
Chronic pancreatitis
Weight loss, steatorrhoea, alcholic
Acute vs chronic pancreatitis blood tests
Acute - high aylase
Chronic - normal serum amylase
Investigation to aid diagnosis of chronic pancreatitis
Faecal elastase is usually low in chronic pancreatitis, indicative of pancreatic exocrine insufficiency
Peptic ulcer disease gold investigation
OGD
Ca19-9
Pancreatic cancer marker
Pancreatic cancer signs
Painless jaundice and palpable gallbladder (Courvoisier’s Law)
Subtle causes of SoB
Anaemia
Hereditary haemochromatosis
Autosomal recessive
Excessive intestinal absorption of iron
Bronze skin, diabetes, hepatomegaly (iron deposition in skin, pancreas & liver respectively)
Haemochromatosis Iron sudies
Serum iron Ferritin Trasnferring Transferring sats TIBC
High serum iron
High ferritin - inc iron = inc ferritin in compensatory atttempt to increase intracellular iron storage
Low transferrin - inc iron = dec trasnferring to prevent more iron from plasma protein bound in blood
High trasnferring sat - high iron and low trasnferrin
Low total iron binding capacity - measure of blood’s capacity to bind iron to transferring. As trasnferring low, inc diff for iron to bind
Hepcidin
Protein that inhibits ferroportin –> thereby regulating amount of iron entering blood `
Secondary causes of osteoporosis
Cushing’s syndrome
Hyperthyroidism
Hypogonadism
Gold standard diagnosing osteoprosis
DEXA
T scores for osteoporosis
T-scores are interpreted as follows:
0 to -1 = Normal
-1 to -2.5 = Osteopaenia (at risk of developing into osteoporosis)
-2.5 or worse = Osteoporosis
Score used to assess risk of stroke in AF pts
CHA2DS2-VASc
Congestive heart failure
Hypertension
Age > 75 yrs (2 points)
Diabetes mellitus
Stroke/TIA symptoms previously (2 points)
Vascular disease (e.g. peripheral artery disease) Age 65-74 yrs (1 point)
Sex category (Female = 1 point)
Score >2 = anticoag with warfarin or NOAC
Score to predict risk of cardiovascular disease
Qrisk2
Used to decide whether to give statins
Predict patients risk of stroke in days following TIA
ABCD2
Allows triaging of TIA patient s
GRACE score
Risk assessment and triaging of patients with ACS
CURB-65
Score used to assess severity of community acquired pneumonia
> 2 hospital admission
3 or more sever and therefore ITU
Diabetic retinopathy sequence
background retinopathy –> pre-proliferative retinopathy –> proliferative retinopathy
BAckground retinopathy features
hard exudates (leaked lipid contents from blood vessels creating a cheesy yellow appearance)
Microaneurysms
Blot haemorrhages
Pre-proliferative features
Soft exudates - regions of retinal ischaemia
Proliferative retinopathy
New blood vessels begin to form in regions of retinal ischaemia
Guillain Barre syndrome
Acute demyelinating polyneuropathy that often occurs a few weeks or months after an infection (e.g. Campylobacter jejuni).
MONITOR FVC as can cause resp muscle weakness
Causes of CKD
Diabetes mellitus (most common), hypertension, idiopathic, glomerulonephritis, pyelonephritis, vasculitides, polycystic kidney disease, reflux nephropathy and obstructive nephropathy.
Polycythaemia Sx
Headaches, tinnitus, blurred vision, history of thromboses, angina, pruritus after a hot bath
Polycythaemia vera
Rare type of bone neoplasm resulting in clonal proliferation of myeloid cells
Secondary polycythaemia
Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes
Secondary polycythaemia
Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes
Myelofibrosis
Disorder characterised by progressive bone marrow fibrosis
Dec bone marrow output, extramedullary haematopoiesis and massive splenomegaly
Psoas sign
Lying the patient on their left-hand side, straightening their right leg and then passively extending their right hip. If pain is elicited, this suggests that the appendix is retrocaecal.
Rovsing’s sign
Palpation of the left iliac fossa causes pain in the right iliac fossa
Cope’s sign
Pain on flexion and internal rotation of the hip and indicates that the appendix lies close to the obturator internus
Aaron’s sign
Referred epigastric pain when pressure is applied over McBurney’s point
Murphy’s Sign
Cessation of inspiration when two fingers are placed below the right costal margin in the midclavicular line and the patient is asked to take a deep breath in. This is suggestive of cholecystitis.
Squamous cell carcnioma
Arise in sun- exposed areas and have raised, everted edges with an ulcerated centre and a keratotic core
Keratoacanthoma
Variant of SCC which grows rapidly but does not metastasise.
Basal cell carcinoma
Skin lesion with raised pearly edges and fine telangiectasia on the surface. It grows across the skin but rarely metastasises.
Melanoma
Asymmetrical pigmented skin lesion with an irregular border.
Actinic keratosis
Thick crusty surface
AAA surgery indiciations
Diameter >5.5cm or rapidly expanding AAA
Diabetes insipidus
Production of large volumes of dilute urine and is caused by insufficient production of vasopressin (central DI) or the inability of the kidneys to respond to vasopressin (nephrogenic DI)
Water deprivation test
Pt not allowed to drink for 8hrs
Urine osmolality measured every 2 hrs and weight every hr
Inc in osmolality (>600 mOsm/kg) is normal response
Failure to concentrate indicates DI
When desmopressin administered, should cause increase with central DI
Kaposi’s sarcoma
systemic disease caused by infection with human herpesvirus 8 (HHV-8), presenting as cutaneous tumours
First AIDS related complication in HIV
Paracetamol overdose complications
Hepatic necrosis
Paracetamol overdose antidote
IV n-acetylcysteine
Opiate overdose antidote
Naloxone
Benzodiazepine overdose antidote
Flumenzanil
Organophosphate overdose antidote
Atropine
Aspirin overdose antidote
Sodum Bicarb
Haemolytic uraemic syndrome
Triad of:
- microangiopathic haemolytic anaemia (MAHA)
- acute renal failure
- thrombocytopaenia
WIll followed diarrhoeal infection by E.coli 0157 in children
Atypical pneumonia
Present with vague symptoms such as malaise, headache and diarrhoea.
Legionella pneumophila - bodies of water at temp below 60, associated with confision. produces antigens excreted in urine
Mycoplasma pneumoniae - red cell agglutination, associated with transveerse myelitis
Chlamydia psittaci - found in birds
Prostate cancer scoring system
Gleason
Breslow thickness
Prognostic indicator for melanoma based on depth to which tumour cells invade surround tissues
Grace score
Risk stratify people suffered ACS
Wells score
PE probability
Dukes staging
Colorectal cancer
UTI treatment
trimethoprim or nitrofurantoin
Haemorrhoid grades
Grade 1: no prolapse
Grade 2: prolapse on defecation but reduces spontaneously
Grade 3: prolapse requires manual reduction
Grade 4: remain persistently prolapsed and cannot be reduced
Type 1 rectal prolapse
only the rectal mucosa protrudes through the anus
Tpe 2 rectal prolapse
All layers of the rectum protrude through the anus, creating a mass which has palpable, concentric muscular rings
Dresslers vs post MI pericarditis
Dresslers 2-10 weeks post MI, wheres post Mi pericarditis is 2-4days psot
Intermitten claudication
Cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest
Critical limb ischaemia
cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest
Leriche syndrome
Type of intermittent claudication resulting in buttock claudication, erectile dysfunction and weak distal pulses, due to aortoiliac stenosis.
HSV
dsDNA virus that is transmitted via close contact with an individual shedding the virus in oral secretions.
Tietze’s syndrome
form of costochondritis characterised by painful swelling of costal cartilage
Causes of pleuritic chest pain
PE Pneumothorax Pericarditis Pleurisy Pneumonia
Subphrenic pathology
Rib fractures
Costochondritis
Molluscum contagiosum
Skin condition caused by pox virus
Occurs in children, spread via skin-to-skin contact
In adults, via sex
Lesions dome shaped, firm and smooth with umbilicated centre. Will last for around 8 months
Varicella zoster virus
Chicken pox (children) --> suddent appearance of extremely itchy rash. Vesicles appear, weep and crust over. Accomanied by prodromal flu-like symtoms
Shingles (adults) –> reactivation of VZV, which lies in dorsal root ganglia
Causes painful and tingling sensation in dermatone
Syphilis
Sexually transmitted disease caused by Treponema pallidum
Begins as single painless genital ulcer, followed by generalised lymphadenopathy and widespread skin lesions
Tertiary syphilis = infection spreads to brain and causes neuro complications
Gonorrhoea
Sexually-transmitted infection, caused by N.gonorrhoeae
Presents vaginal or urethral discharge, dysuria and dyspareunia (in women)
Sebaceous cyst
Keratinous, epithelium line cyst arising from blocked hair follicle
Very common, and appear as smooth lumps with overlying punctum that may discharge creamy substance
1st step management with temporal arteritis
Oral prednisolone
Delaying treatment = loss of vision
Temporal arteritis Sx
Unilateral headache
Scalp tenderness
Jaw claudication
Malise
Fever
Weight loss
Hep B
Prevalent in Sub-Saharan Afria and SE asia
Sexual contact, blood and vertical transmission from mum to child
Hep B antigen location
Surface antigen on outer envelope (HBsAg)
Inside is nucelocaspid, with the viral DNA
Nucleocaspid carries core antigen (HBcAg), involved in viral replication
e antigen (HbeAg) also closed associated with nucloecaspid
What antigen is administered in Hep B vaccine
HBsAg administered in HB vaccine
Antibody generated by immune system in response to HBsAg
HBsAb
Individuals with vaccination for Hep B serology presentation
HBsAb+
Serology in previously infected Hep B who have cleared the virus
HBsAb+ & HBcAb IgG+
Hep B progression of serology
Early marker of infection = inc HBsAg
Then rise HbcAb IgM (only present for acute phase) and HBcAb IgG (will persist if virus is cleared or if infection chronic)
HBeAg present both acute and chronic
Summary Hep B serology in acute infeciton
HBsAg+ HBsAb- HBcAb IgM+ HBcAb IgG+ HBeAg +/-.
Summary Hep B serology in chronic infection
HBsAg+ HBsAb- HBcAb IgM- HBcAb IgG+ HBeAg +/-
Blood groups A/B
Group A – has A antigens, produces anti-B antibodies
Group B – has B antigens, produces anti-A antibodies
Group AB – has A & B antigens, produces no antibodies against A or B antigens
Group O – has no antigens, produces anti-A and anti-B antibodies
Rhesus antigen
If rhesus positive, you have antigen on your RBC, therefore can accept any blood.
Ankylosing spondylitis
Seronegative spondyloarthropathy that presents with lower back pain and stiffness that is worst in the morning and improves with activity.
Test to diagnose ankylosing spondylitis
Schober’s
During this clinical test, a mark is made on the skin overlying the 5th lumbar spinous process (usually at the level of the posterior superior iliac spine) and a second mark is made 10 cm above the first. The patient is then asked to bend over, which flexes the spine. In normal subjects, the distance between the two marks will increase to > 15 cm. If the distance is less than 15 cm, this indicates a reduction in spinal flexion, which supports a diagnosis of ankylosing spondylitis.
Schirmer’s test
Assesses teat production in pts with Sjogren’s
Tensilon test
Diagnose Myasthenia gravis
Admin short acting AChest inhibitor –> see rapid improvement in muscle weakness
Hypertension NICE guidelines
STEP 1: Patients < 55 years old should be offered an ACE inhibitor (ACEI e.g. enalapril) or angiotensin receptor blocker (ARB e.g. losartan). Patients > 55 years old and patients of Afro-Caribbean origin should be offered a calcium channel blocker (CCB e.g. amlodipine) or, if there is any evidence (or high risk) of heart failure, a thiazide-like diuretic (e.g. bendroflumethiazide).
STEP 2: Offer a CCB with an ACEI or ARB. If CCBs are not suitable, a thiazide-like diuretic can be used instead.
STEP 3: Offer a combination of an ACEI or ARB with a CCB and a thiazide- like diuretic.
STEP 4: If these three steps are unsuccessful in gaining control of blood pressure, it is considered ‘resistant hypertension’. Expert help should be sought and a 4th antihypertensive may be added e.g. spironolactone.
Symptoms of storage (renal)
FUN
Frequency
Urgency
Nocturia
Symtpoms of voiding
WISE
Weak stream
Intermittency
Straining
incomplete Emptying
Prostate cancer secondary symtpoms
Back pain (mets) Paraneoplastic syndromes (hypercalcaemia) Constitutional upset (weight loss, malaise)
Major features of Lewy Body dementia
HALLUCINATIONS
Fluctuating levels of confusion
Resting tremor
Symtpoms of Alzheimers disease
Anterograde amnesia
confusion
Changes in personality and mood and difficulty planning
Frontotemporal dementia
First present with change in personality or behaviour
Vascular dementia
Multipe small cerebral infarcts = loss brain function
Diagnostic criteria for diabetes
• One fasting blood glucose measurement > 7 mmol/L in a symptomatic patient
• Two fasting blood glucose measurements > 7 mmol/L in an asymptomatic
patient
• One random blood glucose measurement > 11.1 mmol/L in a symptomatic
patient
• Two random blood glucose measurements > 11.1 mmol/L in an asymptomatic
patient
- Oral glucose tolerance test – 2 hr blood glucose > 11.1 mmol/L
- HbA1c > 48 mmol/mol or > 6.5%
Lack of red reflex
Sth obscurring retina = no red reflection
Cataracts (opacification of lens)
Retinoblastoma
Herpes simplex keratitis
Infection of cornea
Dendritic ulcer
Often in adults due to reactivation of HSV lying dormant in trigeminal nerve
Long HX of abdo pain, increased freq and PR bleeding in young person
IBD
Red ring around cornea
Anterior uveitis
Villous atrophy and crypt hyperplasia
Coeliac disease
High grade dysplasia and metaplastic columnar epithelium
Barrett’s oesophagus
Features of hyperviscosity
Blurred vision & headaches
Others: Vertigo Seizures HEaring loss Ataxia Increased bleeding tendency
Relative vs absolute polycythaemia
relative (normal red cell mass but reduced plasma volume)
Absolute (increased red cell mass)
Primary vs secondary polycythaemia
Polycythaemia rubra vera is a primary polycythaemia caused by clonal proliferation of myeloid stem cells.
Secondary polycythaemia is caused by natural or artificial increases in erythropoietin (EPO) production. This increase in EPO production may be appropriate (e.g. in response to chronic hypoxia in COPD) or inappropriate (e.g. EPO abuse amongst athletes).
Subclavian steal syndrome
Stenosis of the subclavian artery proximal to the origin of the vertebral artery results in blood being ‘stolen’ from the brain by retrograde blood flow down the vertebral artery and into the arm. This tends to occur when there is an increased demand for blood in the arm
Retrograde flow = dec blood to brain = blackout
Guillain Barre occurs often following waht
Infection
30% of these are gastroenteritis caused by C. jejuni
Treatment of CAP
co-amoxiclav (effective against S. pneumoniae) and clarithromycin (provides cover against atypical organisms).
Co-trimoxazole indications
combination of trimethoprim and sulfamethoxazole, is used to treat
Pneumocystis jiroveci pneumonia in HIV patients.
Can also be used for UTIs and resp tract infections
Metronidazole indicaitons
effective against anaerobes, and, so, is used to treat several GI infections (e.g. C. difficile colitis), pelvic inflammatory disease and aspiration pneumonia.
Flucloxacilin
enicillin that is effective against Gram-positive bacteria (mainly S. aureus). It is often used to treat skin and soft tissue infections
Side effects of morphine
Constipation, respiratory depression, nausea and drowsiness
Anti-muscarinic side effects
Blurred vision
ACEi side effect
Cough
B-adrenergic receptor agonists
Tremor
Ampicillin and amoxicillin in glandular fever side effects
RAsh
Gout most common location
Metatarsophalangeal joint of great toe
Microscopy of synovial fluid in gout
Negatively birefringent, needle-shaped crystals
Pseudogout microscopy of synovial fluid
Positively birefringent, rhomboid-shaped crystals
Turbid synovial fluid with high WCC
Septic arthritis
Causes of adrenal insufficiency
AI attack
TB
WHy vitiligo in adrenal insufficiency
AI attack of melanocytes leading to skin depigmentation patches
Short synacthen test
Adrenal insuffiency diagnosis
Change in bowel habit, PR bleeding and weight loss in elderly person
Suspicion of colorectal cancer
Left vs R sided colorectal cancer
L: present earlier with a change in bowel habit and PR bleeding
R: tends to present later with abdominal pain and symptoms of anaemia
Tenesmus
SoL in rectum
Tumour marker for colorectal cancer
CEA
Virchow’s node
Indicative of all abdominal malignancies, but most often gastric cancer
Courvoirsier’s law
painless jaundice in the presence of a palpable gallbladder is unlikely to be due to gallstones
More likely due to cancer
Anterior cerebral artery (location and infarct presentation)
Medial aspect of the frontal and parietal lobes
Behavioural changes
Weakness of contralateral leg > arm
Mild sensory deficit
Middle cerebral artery (location and infarct presentation)
Lateral aspect of the frontal, temporal and parietal lobes
Subcortical structures e.g. basal ganglia, internal capsule
Contralateral hemiparesis of face > arm > leg
Aphasia
Hemisensory deficits
Loss of contralateral half of visual field
Posterior cerebral artery (location and infarct presentation)
Occipital lobes
Inferior and medial portion of temporal lobes
Loss of contralateral half of visual field
Sensory deficit
Visual agnosia
Prosopagnosia
Mild hyponatraemia
130-135 mmol/L
Asymptomatic
Moderate hyponatraemia
125-130 mmol/L Nonspecific Sx (headaches, nausea, lethary, muscle cramps)
Severe hyponatraemia
< 120 mmol/L and is associated with neurological symptoms such as seizures, hallucinations, confusion and memory loss
Sail sign appearance on CXR
Left lower lobe collapse
= left tracheal deviation and edge of collapsed lower lobe forms what looks like 2nd heart border
Contrast between collapsed left lower border and heart shadow = sail shape
Framingham criteria
Congestive cardiac failure = 2 major criteria or 1 major & 2 minor
Major Criteria • Paroxysmal nocturnal dyspnea • Crepitations • S3 gallop • Cardiomegaly • Increased central venous pressure • Weight loss > 4.5 kg in 5 days in response to treatment • Neck vein distention • Acute pulmonary oedema • Hepatojugular reflex
Minor Criteria • Bilateral ankle oedema • Dyspnoea on ordinary exertion • Tachycardia (> 120 bpm) • Decrease in vital capacity by 1/3 from maximum recorded • Nocturnal cough • Hepatomegaly • Pleural effusion
Meralgia paraesthetica
Numbness, pain or paraesthesia affecting an area of skin on the outside of the thigh caused by injury to the lateral femoral cutaneous nerve.
Often caused by weight gain
PBC
T cell mediated AI inflammation and destruction of intrahepatic ducts
Persistently elevated ALP, GGT
ANTI-MITOCHONDRIAL ABs
Trigeminal neuragia
Caused by compression of trigeminal nerve
Associated with MS
Shingles
Reactivation of varicella zoster virus
Ramsey hunt syndrome
Type of shingles caused by reactivation of varicella zoster in geniculate ganglio of facial nerve
Facial nerve palsy
Altered taste
Dry eyes/mouth
Vesicular rash in ear canal
Cluster headaches
Recurrent, severe unilateral headaches
Located around eye
Eye Sx:
Lacrimation
Conjunctival injection
Eyelid swelling
Ischaemic colitis occurs in
elderly patients
Dermatitis herpetiformis
Blistering, papulovesicular rash
Extra-GI manifestation of coeliac disease
Coeliac disease
Inflamm condition due to gluten intolerance
Coeliac pathophysiology
Gluten = immunological reaction in SB by T cells = disruption of S+F of mucosal lining
Leads to malabsorption, malnutrition & anaemia (due to iron deficiency)
First line investigation for coeliacs
Tissue transglutaminase antibodies
Anti-endomysial antibodies
Anti-gladin antibodies
Definitive diagnosis: OGD and biopsy
Histological appearance due to coeliacs
Subtotal villous atrophy with crypt hyperplasia
Chest Xray of HF
ABCDE
Alveolar oedema Kerley B lines Cardiomegaly Upper lobe Diversion Pleural Effusion
Hypercalcaemia Sx
Stones bones abdominal groans thrones (urinary freq, commode = throne?!) psychiatric overtones
Multiple myeloma
Haem malignancy
Excessive proliferation of plasma cells
Multiple myeloma Sx
CRAB
hyperCalcaemia
Renal failure
Anaemia
Bone Pain
Blood cells seen in multiple myeloma
Rouleaux
Stacks of red cells seen on blood film, form due to high conc of plasma proteins
Schistocytes
Red cell fragments –> indicator of intravascular haemolysis
Granulocytes with absent granulation and hyposegmented nuclei
Myelodysplastic syndrome
Dacrocytes
Teardrop shaped cells in myelofibrosis §
Smear cels
Chronic Lymphocytic leukaemia
TB
Haemoptysis Weight loss Night sweats Cervical lymphadenopathy Erythema nodosum
TB Xray
Tends to affect upper lobes
May show hilar lymphadenopathy
Best investigation for TB
Sputum sample, tested for presence of acid-fast bacilli using Ziehl-Neelsen stain
Mantoux test
Intradermal injection of tuberculin protein derivative
Reaction producing raised, hardened area 72 hrs post injection = previous exposure to TB
Urinary tract stone prevalance
Calcium oxalate – 75%
Magnesium ammonium phosphate (struvite) – 15% Urate – 5%
Hydroxyapatite – 5% Cysteine – 1%
First line investigation for pancreatitis
Transabdominal USS
Cushing’s reflex
Physiological response to raised ICP
Triad of high BP, bradycardia and irregular breathing
Kussmaul sign
parafoxical rise in JVP on inspiration, occuring in pts with imparied right ventricular filling
Beck’s triad
Raised JVP, muffled heart sounds and low BP
Cardiac tamponade