Laz n Oli Flashcards
1
Q
Inguinal Canal contents
A
Males - Spermatic cord
Females - Round ligament
2
Q
Inguinal canal anatomy
A
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)
3
Q
Direct inguinal hernia
A
Weakness in posterior wall of inguinal canal
Abdo viscera protrude directly through back of inguinal canal
4
Q
Indirect inguinal hernia
A
Abdo contents pass through deep inguinal ring and along inguinal canal
5
Q
Differentiating direct vs indirect inguinal hernia on exam
A
Place finger on deep ring and ask pt to cough. Only direct hernia will protrude
6
Q
Spigelian hernia
A
Abdo contents herniate through linea semilunaris
Inferior and lateral to umbilicus
7
Q
Obturator hernai
A
Abdo contents herniate through obturator canal and present with inner thigh pain when his internally rotated
8
Q
Austin Flint murmur
A
Severe AR
Regurgitated blood apply pressure mitral valve = physiological MS
Low pitched, rumbling mid-diastolic murmur
9
Q
Graham Steel murmur
A
High pitched early diastolic murmur at left sternal edge
Assoicated with PR
10
Q
Gibson murmur
A
Machinery murmur associated with patent ductus arteriosus
11
Q
Carey-Coombs murmur
A
Mid-diastolic murmur causede by turbulent blood flow over thickened mitral valve
Associated with acute rheumatic fever
12
Q
Barlow murmur
A
Mid-systolic click + end systolic murmur heard best at apex
Associated with mitral valve prolapse
13
Q
GCS Points breakdown
A
Eyes - 4
Verbal - 5
Motor - 6
Minimum = 3; Maximum = 15
14
Q
GCS Eyes
A
1 – No eye opening
2 – Eyes open in response to pain
3 – Eyes open to verbal command
4 – Eyes open spontaneously
15
Q
GCS Verbal
A
1 – No verbal response 2 – Incomprehensible sounds 3 – Inappropriate responses 4 – Confused conversation 5 – Oriented
16
Q
GCS Motor
A
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
17
Q
Minimal change glomeruonephritis
A
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.
18
Q
Membranous gloerunephritis
A
Non-proliferative glomerulonephritis and is a cause of nephrotic syndrome in adults
19
Q
IgA nephropathy
A
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
20
Q
Henoch-Schonlein purpura
A
Type of IgA nephropathy that tends to affect older children and presents with a triad of abdominal pain, arthritis and a purpuric rash
21
Q
Rapidly progressive glomeuronephritis
A
acute nephritic syndrome characterised by rapid loss of kidney function within weeks to months.
22
Q
Anterior MI
A
LAD
V1-V4
23
Q
Laterla MI
A
L circumflex
aVL, I and V5-V6
24
Q
Inferior MI
A
Right coronary artery
II, III, aVF
25
Posterior MI
Posterior descending artery
| ST depression in V1-V4
26
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
27
Reactive arthritis q
Sterile arthritis
Tends to occur days/weeks post GI/urogenital infection
Traid of arthritis, uveitis and urethritis
28
Osteoarthritis
Degenerative disease of cartilage, occuring in weight bearing joints eg kness, hips
Often assymetrical and stiffness worse with activity
29
Psoriatic arthritis
presence of arthritis in pts with psoriasis
30
Chronic pancreatitis
Weight loss, steatorrhoea, alcholic
31
Acute vs chronic pancreatitis blood tests
Acute - high aylase
| Chronic - normal serum amylase
32
Investigation to aid diagnosis of chronic pancreatitis
Faecal elastase is usually low in chronic pancreatitis, indicative of pancreatic exocrine insufficiency
33
Peptic ulcer disease gold investigation
OGD
34
Ca19-9
Pancreatic cancer marker
35
Pancreatic cancer signs
Painless jaundice and palpable gallbladder (Courvoisier's Law)
36
Subtle causes of SoB
Anaemia
37
Hereditary haemochromatosis
Autosomal recessive
Excessive intestinal absorption of iron
Bronze skin, diabetes, hepatomegaly (iron deposition in skin, pancreas & liver respectively)
38
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
39
Hepcidin
Protein that inhibits ferroportin --> thereby regulating amount of iron entering blood `
40
Secondary causes of osteoporosis
Cushing's syndrome
Hyperthyroidism
Hypogonadism
41
Gold standard diagnosing osteoprosis
DEXA
42
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
43
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
44
Score to predict risk of cardiovascular disease
Qrisk2
| Used to decide whether to give statins
45
Predict patients risk of stroke in days following TIA
ABCD2
Allows triaging of TIA patient s
46
GRACE score
Risk assessment and triaging of patients with ACS
47
CURB-65
Score used to assess severity of community acquired pneumonia
>2 hospital admission
3 or more sever and therefore ITU
48
Diabetic retinopathy sequence
background retinopathy --> pre-proliferative retinopathy --> proliferative retinopathy
49
BAckground retinopathy features
hard exudates (leaked lipid contents from blood vessels creating a cheesy yellow appearance)
Microaneurysms
Blot haemorrhages
50
Pre-proliferative features
Soft exudates - regions of retinal ischaemia
51
Proliferative retinopathy
New blood vessels begin to form in regions of retinal ischaemia
52
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
53
Causes of CKD
Diabetes mellitus (most common), hypertension, idiopathic, glomerulonephritis, pyelonephritis, vasculitides, polycystic kidney disease, reflux nephropathy and obstructive nephropathy.
54
Polycythaemia Sx
Headaches, tinnitus, blurred vision, history of thromboses, angina, pruritus after a hot bath
55
Polycythaemia vera
Rare type of bone neoplasm resulting in clonal proliferation of myeloid cells
56
Secondary polycythaemia
Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes
57
Secondary polycythaemia
Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes
58
Myelofibrosis
Disorder characterised by progressive bone marrow fibrosis
Dec bone marrow output, extramedullary haematopoiesis and massive splenomegaly
59
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.
60
Rovsing's sign
Palpation of the left iliac fossa causes pain in the right iliac fossa
61
Cope's sign
Pain on flexion and internal rotation of the hip and indicates that the appendix lies close to the obturator internus
62
Aaron's sign
Referred epigastric pain when pressure is applied over McBurney’s point
63
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.
64
Squamous cell carcnioma
Arise in sun- exposed areas and have raised, everted edges with an ulcerated centre and a keratotic core
65
Keratoacanthoma
Variant of SCC which grows rapidly but does not metastasise.
66
Basal cell carcinoma
Skin lesion with raised pearly edges and fine telangiectasia on the surface. It grows across the skin but rarely metastasises.
67
Melanoma
Asymmetrical pigmented skin lesion with an irregular border.
68
Actinic keratosis
Thick crusty surface
69
AAA surgery indiciations
Diameter >5.5cm or rapidly expanding AAA
70
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)
71
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
72
Kaposi's sarcoma
systemic disease caused by infection with human herpesvirus 8 (HHV-8), presenting as cutaneous tumours
First AIDS related complication in HIV
73
Paracetamol overdose complications
Hepatic necrosis
74
Paracetamol overdose antidote
IV n-acetylcysteine
75
Opiate overdose antidote
Naloxone
76
Benzodiazepine overdose antidote
Flumenzanil
77
Organophosphate overdose antidote
Atropine
78
Aspirin overdose antidote
Sodum Bicarb
79
Haemolytic uraemic syndrome
Triad of:
- microangiopathic haemolytic anaemia (MAHA)
- acute renal failure
- thrombocytopaenia
WIll followed diarrhoeal infection by E.coli 0157 in children
80
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
81
Prostate cancer scoring system
Gleason
82
Breslow thickness
Prognostic indicator for melanoma based on depth to which tumour cells invade surround tissues
83
Grace score
Risk stratify people suffered ACS
84
Wells score
PE probability
85
Dukes staging
Colorectal cancer
86
UTI treatment
trimethoprim or nitrofurantoin
87
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
88
Type 1 rectal prolapse
only the rectal mucosa protrudes through the anus
89
Tpe 2 rectal prolapse
All layers of the rectum protrude through the anus, creating a mass which has palpable, concentric muscular rings
90
Dresslers vs post MI pericarditis
Dresslers 2-10 weeks post MI, wheres post Mi pericarditis is 2-4days psot
91
Intermitten claudication
Cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest
92
Critical limb ischaemia
cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest
93
Leriche syndrome
Type of intermittent claudication resulting in buttock claudication, erectile dysfunction and weak distal pulses, due to aortoiliac stenosis.
94
HSV
dsDNA virus that is transmitted via close contact with an individual shedding the virus in oral secretions.
95
Tietze's syndrome
form of costochondritis characterised by painful swelling of costal cartilage
96
Causes of pleuritic chest pain
```
PE
Pneumothorax
Pericarditis
Pleurisy
Pneumonia
```
Subphrenic pathology
Rib fractures
Costochondritis
97
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
98
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
99
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
100
Gonorrhoea
Sexually-transmitted infection, caused by N.gonorrhoeae
Presents vaginal or urethral discharge, dysuria and dyspareunia (in women)
101
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
102
1st step management with temporal arteritis
Oral prednisolone
Delaying treatment = loss of vision
103
Temporal arteritis Sx
Unilateral headache
Scalp tenderness
Jaw claudication
Malise
Fever
Weight loss
104
Hep B
Prevalent in Sub-Saharan Afria and SE asia
Sexual contact, blood and vertical transmission from mum to child
105
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
106
What antigen is administered in Hep B vaccine
HBsAg administered in HB vaccine
107
Antibody generated by immune system in response to HBsAg
HBsAb
108
Individuals with vaccination for Hep B serology presentation
HBsAb+
109
Serology in previously infected Hep B who have cleared the virus
HBsAb+ & HBcAb IgG+
110
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
111
Summary Hep B serology in acute infeciton
```
HBsAg+
HBsAb-
HBcAb IgM+
HBcAb IgG+
HBeAg +/-.
```
112
Summary Hep B serology in chronic infection
```
HBsAg+
HBsAb-
HBcAb IgM-
HBcAb IgG+
HBeAg +/-
```
113
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
114
Rhesus antigen
If rhesus positive, you have antigen on your RBC, therefore can accept any blood.
115
Ankylosing spondylitis
Seronegative spondyloarthropathy that presents with lower back pain and stiffness that is worst in the morning and improves with activity.
116
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.
117
Schirmer's test
Assesses teat production in pts with Sjogren's
118
Tensilon test
Diagnose Myasthenia gravis
Admin short acting AChest inhibitor --> see rapid improvement in muscle weakness
119
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.
120
Symptoms of storage (renal)
FUN
Frequency
Urgency
Nocturia
121
Symtpoms of voiding
WISE
Weak stream
Intermittency
Straining
incomplete Emptying
122
Prostate cancer secondary symtpoms
```
Back pain (mets)
Paraneoplastic syndromes (hypercalcaemia)
Constitutional upset (weight loss, malaise)
```
123
Major features of Lewy Body dementia
HALLUCINATIONS
Fluctuating levels of confusion
Resting tremor
124
Symtpoms of Alzheimers disease
Anterograde amnesia
confusion
Changes in personality and mood and difficulty planning
125
Frontotemporal dementia
First present with change in personality or behaviour
126
Vascular dementia
Multipe small cerebral infarcts = loss brain function
127
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%
128
Lack of red reflex
Sth obscurring retina = no red reflection
Cataracts (opacification of lens)
Retinoblastoma
129
Herpes simplex keratitis
Infection of cornea
Dendritic ulcer
Often in adults due to reactivation of HSV lying dormant in trigeminal nerve
130
Long HX of abdo pain, increased freq and PR bleeding in young person
IBD
131
Red ring around cornea
Anterior uveitis
132
Villous atrophy and crypt hyperplasia
Coeliac disease
133
High grade dysplasia and metaplastic columnar epithelium
Barrett's oesophagus
134
Features of hyperviscosity
Blurred vision & headaches
```
Others:
Vertigo
Seizures
HEaring loss
Ataxia
Increased bleeding tendency
```
135
Relative vs absolute polycythaemia
relative (normal red cell mass but reduced plasma volume)
Absolute (increased red cell mass)
136
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).
137
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
138
Guillain Barre occurs often following waht
Infection
30% of these are gastroenteritis caused by C. jejuni
139
Treatment of CAP
co-amoxiclav (effective against S. pneumoniae) and clarithromycin (provides cover against atypical organisms).
140
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
141
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.
142
Flucloxacilin
enicillin that is effective against Gram-positive bacteria (mainly S. aureus). It is often used to treat skin and soft tissue infections
143
Side effects of morphine
Constipation, respiratory depression, nausea and drowsiness
144
Anti-muscarinic side effects
Blurred vision
145
ACEi side effect
Cough
146
B-adrenergic receptor agonists
Tremor
147
Ampicillin and amoxicillin in glandular fever side effects
RAsh
148
Gout most common location
Metatarsophalangeal joint of great toe
149
Microscopy of synovial fluid in gout
Negatively birefringent, needle-shaped crystals
150
Pseudogout microscopy of synovial fluid
Positively birefringent, rhomboid-shaped crystals
151
Turbid synovial fluid with high WCC
Septic arthritis
152
Causes of adrenal insufficiency
AI attack
| TB
153
WHy vitiligo in adrenal insufficiency
AI attack of melanocytes leading to skin depigmentation patches
154
Short synacthen test
Adrenal insuffiency diagnosis
155
Change in bowel habit, PR bleeding and weight loss in elderly person
Suspicion of colorectal cancer
156
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
157
Tenesmus
SoL in rectum
158
Tumour marker for colorectal cancer
CEA
159
Virchow's node
Indicative of all abdominal malignancies, but most often gastric cancer
160
Courvoirsier's law
painless jaundice in the presence of a palpable gallbladder is unlikely to be due to gallstones
More likely due to cancer
161
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
162
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
163
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
164
Mild hyponatraemia
130-135 mmol/L
| Asymptomatic
165
Moderate hyponatraemia
```
125-130 mmol/L
Nonspecific Sx (headaches, nausea, lethary, muscle cramps)
```
166
Severe hyponatraemia
< 120 mmol/L and is associated with neurological symptoms such as seizures, hallucinations, confusion and memory loss
167
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
168
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
```
169
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
170
PBC
T cell mediated AI inflammation and destruction of intrahepatic ducts
Persistently elevated ALP, GGT
ANTI-MITOCHONDRIAL ABs
171
Trigeminal neuragia
Caused by compression of trigeminal nerve
Associated with MS
172
Shingles
Reactivation of varicella zoster virus
173
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
174
Cluster headaches
Recurrent, severe unilateral headaches
Located around eye
Eye Sx:
Lacrimation
Conjunctival injection
Eyelid swelling
175
Ischaemic colitis occurs in
elderly patients
176
Dermatitis herpetiformis
Blistering, papulovesicular rash
Extra-GI manifestation of coeliac disease
177
Coeliac disease
Inflamm condition due to gluten intolerance
178
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)
179
First line investigation for coeliacs
Tissue transglutaminase antibodies
Anti-endomysial antibodies
Anti-gladin antibodies
Definitive diagnosis: OGD and biopsy
180
Histological appearance due to coeliacs
Subtotal villous atrophy with crypt hyperplasia
181
Chest Xray of HF
ABCDE
```
Alveolar oedema
Kerley B lines
Cardiomegaly
Upper lobe Diversion
Pleural Effusion
```
182
Hypercalcaemia Sx
```
Stones
bones
abdominal groans
thrones (urinary freq, commode = throne?!)
psychiatric overtones
```
183
Multiple myeloma
Haem malignancy
| Excessive proliferation of plasma cells
184
Multiple myeloma Sx
CRAB
hyperCalcaemia
Renal failure
Anaemia
Bone Pain
185
Blood cells seen in multiple myeloma
Rouleaux
Stacks of red cells seen on blood film, form due to high conc of plasma proteins
186
Schistocytes
Red cell fragments --> indicator of intravascular haemolysis
187
Granulocytes with absent granulation and hyposegmented nuclei
Myelodysplastic syndrome
188
Dacrocytes
Teardrop shaped cells in myelofibrosis §
189
Smear cels
Chronic Lymphocytic leukaemia
190
TB
```
Haemoptysis
Weight loss
Night sweats
Cervical lymphadenopathy
Erythema nodosum
```
191
TB Xray
Tends to affect upper lobes
May show hilar lymphadenopathy
192
Best investigation for TB
Sputum sample, tested for presence of acid-fast bacilli using Ziehl-Neelsen stain
193
Mantoux test
Intradermal injection of tuberculin protein derivative
Reaction producing raised, hardened area 72 hrs post injection = previous exposure to TB
194
Urinary tract stone prevalance
Calcium oxalate – 75%
Magnesium ammonium phosphate (struvite) – 15% Urate – 5%
Hydroxyapatite – 5% Cysteine – 1%
195
First line investigation for pancreatitis
Transabdominal USS
196
Cushing's reflex
Physiological response to raised ICP
Triad of high BP, bradycardia and irregular breathing
197
Kussmaul sign
parafoxical rise in JVP on inspiration, occuring in pts with imparied right ventricular filling
198
Beck's triad
Raised JVP, muffled heart sounds and low BP
Cardiac tamponade
199
Charcot's traid
RUQ pain
Jaundice
Fever with rigors
Ascending cholangitis
200
5 malaria species
```
P. falciparum,
P. vivax,
P. malariae,
P. ovale
P. knowlesi
```
201
Diagnosis of malaria
Microscopic analysis of blood films
Thin films preserve the appearance of the parasites allowing species identification.
Thick films screen a larger volume of blood allowing higher sensitivity when picking up low level infections.
202
Two hormones responsible for inc serum Ca2+
PTH
| Calcitriol
203
Hypercalcaemia of malignancy
Condition - Release of calcium from bone metastases or from the paraneoplastic effect of PTH-related peptides, which can be released by cancer cells and mimic the action of PTH.
Ca2+ level will be raised but the PTH feedback loop will be intact, so the PTH level will be low
204
Milk-Alkali syndrome
Rare condition caused by the ingestion of too much calcium and alkali (e.g. from dietary supplements used to prevent osteoporosis).
205
Causes of VT
Coronary artery disease, valvular disease, electrolyte imbalances (e.g. low Mg2+) and long QT syndrome
206
Varicocoele
Scrotal mass formed by the dilation of the veins of the pampiniform plexus
207
Varicocoele L or R?
90% L
Angle at which testicular vein meets renal vein and inc reflux from compression of vein
208
Common causes of bowel obstruction
Tumours
Adhesions
Volvuli
Hernias
209
Embryo sign on AXR
Caecal volvulus
210
Coffee bean sign
Sigmoid volvulus
211
Onycholysis
Painless separation of fingernail or toenail from nailbed
212
Causes of onycholysis
DR PITHS
* Drugs (e.g. tetracyclines, oral contraceptive and diabetes drugs)
* Reactive arthritis, Reiter’s syndrome
* Psoriais
* Infection (especially fungal)
* Trauma
* Hyper- and Hypothyroidism
* Sarcoidosis, Scleroderma
213
Wernicke's area damage
Inability to understand language, but pts can produce fluent but nonsensical speech
214
Broca's area damage
Inability to produce fluent speech, despite intact undestanding of language
215
Arcuate fasciculus damage
Intact language comprehension and fluent speech production; however, speech repetition is poor
216
Hippocampus function
Memory and learning
217
Amygdala function
Flight or fight response
218
Drawing blood too fast =
Hyperkalaemia
Fast blood withdrawal = red cell lysis, releasing all intracellular potassium into sample
219
B symtpoms of lymphoma
Fever, night sweats and weight loss
220
Malar flush
Mitral stenosis
Occurs due to CO2 retention leading to vasodilation of vascular beds of cheeks
221
4 ways to detect H.pylori
1) Urea breath test
- If Co2 containing labelled carbon detected in breath 30 mins after, suggests urea has been cleaved by urease produced by H.pylori
2) Blood antibody test
3) Stool antigen test
4) Rapid urease test/Campylobacter-like organism test
222
Appropriate management of H.pylori negative peptic ulcer disease
Stop NSAIDs and start omeprazole
223
Appropriate manaagement of H.pylori positive peptic ulcer disease
triple therapy
PPI & 2 ABs
224
De Quervain's thyroiditis
Viral thyroiditis
Halts thyroxine production
Initially = hyperthyroid as stored thyroid hormone release
After few weeks = hypothyroid
Initially damaged thyroid gland doesnt take up iodine .>. gland doesnt show up on scan
225
Graves' disease thyroid scan
Diffuse uptake throughout an enlarged gland
226
Toxic multinodular goiter (Plummer's disease) thyroid scan
Multinodular gland with single hot nodule
227
Thyroid cancer uptake scan
Diffuse uptake with single cold nodule
228
Fibroadenoma
A firm, smooth, mobile breast lump without axillary lymphadenopathy, skin changes or nipple discharge in a young woman
229
Pt presents with acute neurological Sx (eakness, slurring of speech, facial droop, amaurosis fugax) resolving within 24 hrs
What should be done?
Administer 300mg aspirin
230
Henoch-Schonlein purpura triad of signs
```
Arthritis
Abdo pain
Purpuric rash (often buttocks and lower legs)
```
231
Causes of LIF pain
```
Diverticulitis,
Constipation
Irritable bowel syndrome
Ulcerative colitis (UC),
Colorectal cancer and gynaecological causes
```
232
Whooping cough
Bordatella pertussis
233
Syphilis
Treponema pallidum
234
Diarrhoeal illness in immunocompromised patients
Cryptosporidium
235
Atypical pneumonia
Mycoplasma pneumoniae
236
The plague
Yersinia pestis
237
JVP A wave
Atrial contraction causing some blood to flow back up the superior vena cava
238
JVP C wave
ventricular contraction causes the tricuspid valve to bulge into the right atrium resulting in a pressure wave passing up the superior vena cava
239
JVP X descent
Atrial relaxation and filling
240
JVP V wave
Caused by increased venous return to the right atrium occurring in late
systole
241
JVP Y descent
Flow of blood from the right atrium into the right ventricle through an open tricuspid valve
242
Cannon A waves
Atrai and ventricles contract simultaneously
Complete heart block
243
Larve V waves
Tricuspid regurg
244
Raised JVP with absent pulsation
SVC obstruction
245
Slow Y descent
Tricuspid stenosis
246
Ankylosing spondylitis
Seronegative inflammatory arthropathy
Mainly affects axial skeleton & large joints.
Seronegative cos significant level of serum antibodies.
Strong association HLA-B27 allele
247
Ankylosing spondylitis presentation
Males more common
Lower back and sacroiliac pain worst in morning and better with activity
Reduced range of spinal motion
248
Lumbar disc herniation
Acute back pain with shooting pains in the lower limbs. The location of pain depends on the nerves affected
249
Vocal resonance increased
Consolidation (tumour, pneumonia)
SOund conducts better through solids
250
Bronchial breath sounds
Consolidation in between surface of sthethoscope and bronchi
Normally arent meant to hear air in bronchi as too small and far away
If consolidation, sound conducts better through solid, therefore will be able to hear bronchial breath sounds better
251
Poylmyalgia rheumatic
Inflamm condition
Pain and stiffness (withouth weakness) of shoulder and pelvic girldle which is worst in the morning
252
Bladder cancer types
Transitional cell carcinoma
Squamous cell carcinoma
Strong association with exposure to dye stuffs
253
Romano-Ward Syndrome
Hereditary condition causing long QT syndrome
254
Seborrhoeic eczema
Affects areas rich in sebaceous glands ie scalp, eyebrows and nasolabial folds
255
Discoid eczema
Distinc coin-shaped lesions seen on shins, forearms and trunk
256
Contact eczema
Type iV delayed hypersensitivity to allergen
Affects part of body exposed to allergen
257
Atopic excema
Froms atopic triad
258
Pompholyx eczema
Fluid-filled blisters restricted to palms of hands and soles of feet
259
Long term oxygen therapy for COPD
• Patients with PaO2 < 7.3 kPa despite maximal treatment
• Patients with PaO2 7.3-8.0 kPa and one of: pulmonary hypertension,
polycythaemia, peripheral oedema or nocturnal hypoxia
• Terminally ill patients
260
Acute mesenteric ischaemia triad
Severe abdo pain
Normal abdo examination
Shock
261
Acute mesenteric ischaemia
```
Arterial thrombosis (atherosclerosis)
Embolism (AF)
```
```
Venous thrombosis (hypercoagulable states)
Non-occlusive disease (hypotension)
```
262
CHronic mesenteric ischaemia
Combination of low-flow state, ie heart failure & atherosclerotic disease
Presents with gut claudication:
Poorly localised, colicky, post-prandial abdo pain
PR bleeding
Weight loss
263
Signs of perforation in bowel
Pneumoperitoneum
| Rigler's sign
264
Toxic multinodular goitre
Plummer's Disease
Very high T3/T4
Low TSH & TRH
265
Features of acute limb ischaemia
6Ps
```
Pale
Pulseless
Paraesthesia
Paralysis
Perishingly Cold
Painful
```
266
Most common causes of viral meningitis
Enteroviruses (e.g. poliovirus,
Coxsackie A)
Herpes viruses (e.g. HSV, VZV, EBV)
267
Bacterial LP
Cloudy/turbid
High neutrophils
High protein
Low glucose
268
Viral LP
Clear
Lymphocytes high
High protein
Normal glucose
269
TB LP
Fibrinous
High Lymphocytes
High protein
Low glucose
270
Ruddy/red complexion
Feautre of polycythaemia
271
Granulomatosis with polyangiitis (Wegener's granulomatosis)
Systemic vasculitis
Characterised by triad of upper and lower respiratory tract involvement (nosebleeds and haemoptysis) & glomerulonephritis (haematuria and proteinuria)
Saddle nose
272
Test for granulomatosis with polyangitis
cytoplasmic anti-neutrophil cytoplasmic antibdoies (cANCA)
273
Goodpasture's syndrome
autoimmune
condition attacking the basement membrane in the kidneys and lungs leading to
renal failure and haemoptysis.
274
Goodpasture's test
Anti-GBM antibodies
275
pANCA
UC
PSC
Microscopic polyangiitis
Churg-Strauss syndrome
276
Anti-liver/kidney microsomal (anti-LKM)
| ASMA
autoimmune hepatitis
277
Systemic inflammatory response syndrome (SIRS)
```
• Heart Rate > 90 bpm
• Respiratory Rate > 20/min or PaCO2 < 4.3 kPa
• Temperature > 38°C or < 36°C
• White Cell Count < 4 x 109
/L or > 12 x 109
/L
```
Sepsis = SIRS & septicaemia (organism in the blood)
278
Psoriatic arthritis presentation
1) DIP joint disease
2) Psoriatic spondylopathy
3) Symmetrical polyarthritis
4) Asymmetrical oligoarthritis
5) Arthritis mutilans
279
Epilepsy faint
Before, during, after
Before:
Aura (partial seizure)
No warning (generalised seizure)
```
During:
Mins
Tongue biting
Limb jerking
Incontinence
```
After:
Slow recovery
Confusion
280
Vasovagal faint
Before, during,after
Before:
Vagal symptoms (nausea, pallor, sweating)
Precipitants (hot weather etc)
During:
Secs
Rarely twitching and incontinence
After:
Rapid recovery on sitting or lying
281
Arrhythmia fainting
Before:
Chest pain
Palpitations
No warnings
During:
Secs
After:
Rapid spontaneous recovery
282
Light detection
Light is detected by rods and cones in the retina, which then generate an electrical
signal that passes along the optic nerve. The optic nerve contains two main bundles
of nerves, one will carry signals from the medial half of the retina (responsible for the
temporal half of the visual field) and the other will carry signals from the lateral half of
the retina (responsible for the nasal half of the visual field). The two optic nerves will
meet at a point called the optic chiasma. At the chiasm, the neurons from the lateral
half of the retina will continue to the optic tract on the ipsilateral side. Whereas the
neurons from the medial half of the retina will decussate at the chiasm and join the
optic tract on the contralateral side. Therefore, the optic tract in the left hemisphere is
responsible for the right half of the visual field and the optic tract in the right
hemisphere is responsible for the left half of the visual field. The optic tract ends at
the lateral geniculate nucleus (LGN) in the thalamus. Optic radiations link the LGN to
the visual cortex. The optic radiations have an upper division (passing through the
parietal lobe) and a lower division (passing through the temporal lobe). The upper
division is responsible for the inferior quadrant of the visual field (e.g. the upper
division of the optic radiation in the right hemisphere, is responsible for the left
inferior quadrant) and the lower division is responsible for the superior quadrant. The
primary visual cortex will then integrate the information from these inputs.
Damage to the optic nerve will lead to complete loss of vision in one eye, with intact
vision in the other eye. Disruption of the optic chiasm (e.g. by pituitary tumours)
mainly affects the neurons from the medial half of the retina, which decussates at the
chiasm. This leads to bitemporal hemianopia. The optic tract carries information from
one half of the visual field – i.e. right half of the visual field in the left optic tract and
vice versa. Disruption of this tract leads to homonymous hemianopia (loss of one half
of the visual field). Disruption of the upper and lower divisions of the optic radiations
will lead to superior or inferior homonymous quadrantopia.
This patient has left homonymous hemianopia, meaning that his right optic tract has
been damaged.
283
Constipation features
Lower abdo pain
Bloating
Abdo distention
Palpable mass in LIF
284
Common side effect of codein (and other opioids)
Constipation
285
Faecal impaciton in distal colon =
Liquid stools in little space left in lumen
286
Rectocoele
Herniation of rectum into vagina due to tear
May experinece constipation, tensemus, faecal incontinence and dyspareunia
287
PCOS
Characterised by oligomenorrhoea/amenorrhoea and features of hyperandrogenism
Menstrual irregularities, hirsuitism
288
Turner syndrome
Females born with only 1 X chromosome
Short stature
Lower posterior hair line
Primary amenorrhoea
Webbed neck
289
Asterixis
hepatic encephalopathy, azotaemia due
to renal failure, carbon dioxide retention, Wilson’s disease and drugs-induced (e.g.
phenytoin)
290
Bacterial conjunctivits
Yellow crust
291
Hypopyon
Yellow exudate in lower part of anterior chamber of eye
292
Hyphaema
Collection of blood in anterior chamber, usually by injury to eye
293
HOCM distinguising features
Jerky carotid pulse
Ejection SM
Double apex beat
294
Phenobarbital
Barbiturate
Used in epilepsy treatment
295
Loperamide
Weak opiod used as anti-diarrhoeal
296
Risperiodne
Antipsychotic used in shizophrenia and bipola treatment
297
AML special signs
Auer rods
| Sudan black stain
298
CML special signs
Philadelphia Chromosome
| Massive splenomegaly
299
CLL special signs
```
Smear/smudge cells
Warm agglutinins (AIHA)
```
300
Hodgkin's lymphoma special signs
Panful lymph nodes after alcohol digestion
| Reed-Sternberg cells
301
Myelodysplasia special signs
Ringed sideroblasts
| NO splenomegaly
302
Myelofibrosis
MASSIVE splenomegaly
Dry tap (no aspirate)
Dacrocytes (tear drop cells)
Associated with polycythaemia rubra vera
303
Infectious mononucleosis (glandular fever)§
non-specific flu-like symptoms (fever, malaise, sore throat) along with cervical
lymphadenopathy and splenomegaly
304
What shouldnt be givent to person with glandular fever
Ampicillin and amoxicilin
causes maculopapular rash
305
TB treatment
Rifampicin and Isoniazid – 6 months
Pyrazinamide and Ethambutol – 2 months
Pyridoxine (vit B6) given as well as isoniazid = B6 deficiency = peripheral neuropathy
306
Normal pressure hydrocephalus
Confusion/dementia
Gait disturbance
Urinary incontinence
307
Systemic sclerosis
Scleroderma
Small blood vessel damge & fibrosis in skin & organs
308
Limited cutaneous systemic sclerosis
CREST sydnrome
```
Calcinosis
Raynaud's phenomenon
oEsophageal dysmotility
Sclerodactlyl
Telangiectasia
```
309
Brudzinski's sign
Passive flexion of neck causes pt to involuntarily flex their hip
If passive extension of knee causes pain --> kernig's positive
Caused by meningeal irriation
310
Uhthoff's sign
Worsening of neuro symptoms when body is overheated
Sign of Multiple Scleorisis
311
Lhermitte's sign
Flexion of neck = shooting pain down spine
Sign of Multiple sclerosis
312
Tinel's sign
Carple tunnel syndrome
Tapping the wrist at the point at which the median nerve runs under the flexor retinaculum causes pain and a tingling sensation in the area of the hand supplied by the median nerve
313
Courvoisier's Law
Palpably enlarged and non-tender gallbladder in presence of painless jaundice is unlikely to be due to gallstones - its cancer
314
Flecanide CI
IHD
315
Recurrent epsiodes of sweating, palpitations and anxiety in young people =
Phaeochromocytoma
316
Multiple endocrine neoplasia Type 2A
Associated with parathyroid adenomas, medullary thyroid cancer and phaeochromocytomas
317
IX phaeochromocytoma
24hr urine vanillymendelic acid (VMA)
By product of adrenaline synth
318
Serum 17-hydroxyprogresterone elevation
Congenital adrenal hyperlasia
319
24 hr urine 5- hydroxyindoleacetic acid (5-HIAA)
Main metabolite of serotonin
Released in excess in carcinoid sydrome
320
Carcinoid syndrome buzzword
Facial flushing
321
SAAG
Serum albumin - ascities albumin
322
SAAG <11 g/L
Ascitic fluid is exudative (high protein)
323
Nephrotic syndrome with SAAG
Causes low SAAG as albumin freeely filtered
324
Causes of low SAAG
Malignancy
Pancreatitis
Infeciton
bowel obstruction
325
SAAG >11 g/L
Transudative (low protein)
OFten due to portal hypertension
326
Causes of high SAAG
```
Cirrhosis,
Constrictive pericarditis
CCF
Budd-Chiari sydnrome
Hepatic venous obstruction
```
327
Prothrombin time
Funciton of extrinsic pathway
328
Prolonged pT
Pt deficienct in 1 or more componenet of extrinsic and common pathways
Causes:
Warfarin
Liver disease
329
Activated partial thromboplastic time
Function of intrinsic and common pathways
330
Haemophilia
Deficiency in factor 8 or 9
Both part of intrinsic pathways .>. prolonged APTT
Pt normal
331
Trying to find PE in pregnant woman
V/Q scan
332
CXR rare abnormalities in PE
Hampton’s Hump (peripheral wedge of opacity), Westermark sign (regional oligaemia) and Fleischner sign (enlarged pulmonary artery)
333
CA 15-3
Breast cancer
334
CA125
Ovraian Cancer
335
CEA
Colorectal cancer
336
aFP
Liver Cancer, Testiculaar Cancer
337
b-hCG
Choriocarcinoma, Germ Cell Tumours
338
S100
melanoma
339
Calcitonin
Medullary thyroid cancer
340
PSA p
prostate cancer
341
Thyroglobulin
Thyroid cancer
342
Spinalal cord stenosis & causes
Narrowing of spinal canal
Caused by osteophytes, disk herniation, ligamentum flavum hypertrophy
343
SPinal cord stenosis Sx
Sciatica-like pain experience when walking downhill
Stooped posture
344
Acute vs gradular cord compression
```
Acute = LMN
Gradual = UMN
```
345
Rheumatic fever major criteria
JONES
Joints (arthritis),
O – looks like a heart (carditis e.g. tachycardia, murmurs)
subcutaneous Nodules,
Erythema marginatum (a rash with red, raised edges and a clear centre)
Sydenham’s chorea (involuntary semi-purposeful movements).
346
RHEUMATIC Fever minor criteria
Fever, raised ESR/CRP, arthralgia, prolonged PR interval and previous rheumatic fever
347
Kussmaul breathing
Deep sighing breaths
| Comprensatoruy response to met acidosis
348
Cheyne-Stokes breathing
Cyclic breathing patter where breathing gets progressively deeper then progressively shallowed then apnoea
Causes: Brainstem damage or herniation
349
Main risk factors for testicular cancer
Maldescended or ectopic testes
350
Testicular cancer spreads to which lymph node
Para-aortic
351
Rectal bleeding in young people causes
Haemorrhoids
Anal fissures
Coeliac disease
IBD
352
Anal fissure
Painful tear in squamous lining of lower anal canal
Pain on defecation & bright red blood streaked on toilet paper/stoosl
353
Anal fissure people diet
Low fibre and poor fluid intake --> have to strain
354
Haemorrhoids blood in stool
Bright red
| Separate to stool and may drip into pan post defecation
355
Felty's syndrome
Triad of rheumatoid arthritis, splenomegaly and neutropenia
356
Giemsa stain
Malaria
357
India Ink Stain
Cryptococcus spp.
358
Sudan Black stain
AML
359
First thing to do in a stroke
See if ischaemic or haemorrhagic by doing CT head
360
Stroke with Sx onset <4.5 hrs
Thrombolysis with alteplase and aspiring within 24 hrs
361
Stroke with Sx onset >4.5 hrs
Antiplatelet therapy and undergo swallw assessment and GCS monitoring
362
Prognostic indicator of melanoma
Dept of penetraiton of melanoma - Breslow thickness
363
Central pontine myelinolysis
Neuro condition caused by damage to myelin sheath of neurones that makes up pons
364
Central pontine myelinolysis SX
Acute paralysis
Dysarthria
Dysphagia
365
Consequence of rainsing plasma sodium conc too quickly
Osmotic gradient between myeling cells and extracellular environment = water out of myeling cells, resulting in central pontine myelinolysis
366
Signs of liver failure
A to J
```
Asterixis
Bruising
Clubbing
Dupuytren's contracture
Erythema
Fetor hepaticus
Gynaecomastia
Hepatomegaly
Itching
Jaundice
```
Other findings are:
spider naevi, leukonychia, testicular atrophy and signs of portal hypertension, such as splenomegaly, GI bleeds, caput medusae, haemorrhoids and ascites
367
Koilonychia sign of
Chronic iron deficiency
368
5 organisms causing bloody diarrhoea
CHESS
```
Campylobacter jejune
Haemorrhagic E.coli (0157)
Entamoeba histolytica
Salmonella
Shigella
```
369
Giardia
Parasite causing giardiasis
```
Presents with:
- non bloody diarrhoea
Abdo cramps
Fould smelling flatulence
Belching
```
370
Polycystic kidney disease
Autosomal dominant
Bilaterally enlarged kidneys
Hypertension
Haematuria
(strongly associated with subarachnoid haemorrhage)
371
Secondary cause of hypertension that's common
Renal artery stenosis
372
Hyperkalaemia Sx
```
General muscle weakness
Flaccid paralysis
Paraesthesia of hands & feet
Lethargy
Confusion
Palpitations
```
373
Adverse effect of spironolactone
Hyperkalaemia
as its a potassium sparking diuretic
374
ECG changes of hyperkalemia
* Tented T waves - K+ > 5.5 mmol/L
* Flattening of P waves - K+ > 6.5 mmol/L
* Widening of the QRS complex and bradycardia - K+ > 7.5 mmol/L
375
Hyperkalaemia management
1. 10ml 10%calcium gluconate - stabilises the myocardium and protects against arrhythmias but does not lower serum potassium levels
2. 50ml of 50%dextrose with 10U insulin - insulin drives potassium into cells and dextrose is also given to prevent hypoglycaemia
376
Generalised seizure
Occur in both hemispheres of brain
377
Portal HTN signs
Ascites
Splenomegaly
Caput medusa
378
Hepatopulmonary sydrome
Rare complication of cirrhosis
Hypoxaemia in its with portal HTN
Results from microscopic pul vasodilation due to dec hepatic clearance of vasodilators
Vasodilation = hyperperfusion of lungs and hypoxaemia
379
Multiple myeloma
Haem malignancy
Proliferation of plasma cells
Lytic bone lesions and excess Ig production
380
Multiple myeloma Sx
Bone pain
Pathological fractures
Recurrent infections
Hypercalcaemia features
Raised ESR and Ca2+
381
Multiple myeloma special protein
Bence-Jones
382
COPD treatment
1. Short-acting muscarinic antagonist (SAMA e.g. ipratropium) or short-acting beta-agonist (SABA e.g. salbutamol) PRN
2. Add long-acting muscarinic antagonist (LAMA e.g.tiotropium) or long-acting beta-agonist (LABA e.g. salmeterol)
3. Consider using a LAMA + LABA or LABA with an inhaled corticosteroid(ICS)
• Symbicort = Budesonide (ICS) + Formoterol (LABA)
383
UMN lesion tone
First flaccid paralysis
| Then spastic paralysis
384
LMN features
Hypotonia
Hyporeflexia
Muscle atrophy
Fasciculations
Fibrillations - not visible to naked eye
385
Granulomatosis with polyangitis
Small and medium vessel vasculitis.
Classic triad of organ involvement:
Upper respiratory tract (nosebleeds)
Lungs (haemoptysis)
Kidneys (glomerulonephritis)
Rhinitis
Saddle nose deformity
Purpura
Increased cANCA
386
Microscopic polyangitits
SKin, lung and kidney involvement, but no granulomatous disease
387
Goodpastures syndrome characterised by
anti-GBM antibodies
388
Churg-Strauss syndrome
Triphasic vasculitis
1) allergic phase
2) eosinophilic has
3) vasculitis phase
389
Behcet's disease
Small vessel vasculitis characterised by triad of oral ulcers, genital ulcers and uveitis
390
Gas gangrene
Clostridium perfringens
391
Necrotising fasciitis organisms
S. progenies & S.aureus
392
Most common organisms for cellulitits
S.pyogenes & S.aureus
393
What diabetes drug could cause hypoglycaemia
Sulfonylurea
394
Cancer of lung associated with cavitating lesions
Squamous cell carcinoma
395
Best investigation for ureteric colic
Non-contrast CT-KUB
396
Tricuspid regurg JVP
Giant V waves
397
Tension test
Administer edrophonium brome (short acting anticholinergic) & observe pt response
Improvement in muscle movement = myasthenia gravis
398
Dix-Hallpike test
Identify BPPV
399
Schirmer's teset
Assess tear production
Sjogren's syndorme
400
Romberg's test
Balance
401
Trendelenburg test
Abductor muscles of hip
402
Anaphylaxis first step management
IM adrenaline
| IV used in cardiac arrest but not here
403
Microcytic anaemia causes
TAILS
Thalassaemia, Anaemia of chronic disease, Iron deficiency, Lead poisoning and Sideroblastic anaemia (an abnormality of haem synthesis resulting in the inability to incorporate iron into haemoglobin)
404
Normocytic anaemia causes
MR I CALM
Marrow failure, Renal failure, Iron deficiency (early), anaemia of Chronic disease (early), Aplastic anaemia (and acute blood loss), Leukaemia and Myelofibrosis
405
Acanthosis nigricans
Dark, velvety skin found in body folds
Associated with:
T2DM
Cushing's
PCOS
Paraneoplastic due to gastric cancer
406
Diabetic dermopathy
Slight depressed red-brown patch occurring on shins
407
Granuloma annulare
peculiar skin condition that looks like a ring of pink-purple skin lumps most often found on the backs of the hands and feet.
T2DM
Thyroid
408
Intrinsic causes of gynaecomastia
Hypogonadism
Cirrhosis
Oestrogen-producing tumours
409
Gynaecomastia as drug side effect
Oestrogen
Spironolactone
Digoxin
Cimetidine
410
BPH which zone
Transitional zone
411
Prostate cancer zone
Peripheral zone
412
Leriche Syndrome
aortoiliac occlusive disease
Intermittent claudication of buttocks
Erectile dysfunciton
Reduced/absent distal pulses
413
Chronic compartment syndrome
when the pressure within a fascial compartment increases during exercise, causing pain
414
Spinal stenosis
Narrowing of spinal canal, applying pressure on spinal cord.
415
Lumbar spinal stenosis
Pain in lower limbs when walking or standing for long periods of time
Pain eased by bending forwards
416
Behcet's disease
Systemic inflammatory disease
TRIAD:
Mouth ulcers
Genital ulcers
Uveitis
417
Most common ECG finding in PE pts
sinus tachy
418
Long term PE ECG finding
S1Q3T3
419
Riverse tick sign
Digoxin toxicity
420
Characteristic Parkinson's disease
```
Pill-rolling resting tremor
Lead pipe muscle rigidity
Bradykinesia
Narrow gait
Postural instability
```
```
Hypomimia (dec facial expression)
Hypophonia (soft voice)
Micrographia (progressively smaller handwriting)
Up-gaze impairment
Drooling tendency
Furrowed eyebrows
```
421
Polycystic kidney disease inheritance
AD
422
Huntingdon's inheritance
AD
423
Marfan's inheritance
AD
424
MEN inhertance
AD
425
Cystic fibrosis inheritance
AR
426
Sickle Cell inheritane
AR
427
Thalassemia inheritance
AR
428
Colour blindness inheritance (red green)
X-linked
429
Haemophilia inheritance
X-linked
430
G6PD deficiency inheritance
X-linked
431
Aspirin overdose
```
Fever
Sweating
Hyperventilation
Tinnitus
Deafness
```
432
Paracetamol overdose
Asymptomatic for first 24 hrs then features of liver failure
433
TCA overdose
```
Tachycardia
Drowsiness
Dry mouth
N&V
Confusion
```
434
Painless lymphadenopathy that becomes painful after alcohol ingestion
Hodgkin's lymphoma
435
Cough - large vols purulent sputum
Recurrent rest infections
Bronchiectasis
436
Tumour lysis sundrome
Group of metabolic abnormalities that results from cancer treatment
Most commonly occurs in treatment of leukaemia and lymphoma
High K+
High PO4 3-
High uric acid
Low ca2+
437
Portal hypertension problems
Problems in Butt (haemorrhoids), ‘gut’ (oesophageal varices) and ‘caput’ (caput medusae)
438
Variceal bleed first thing to do
Terlipressin - vasopressin analogue causes splanchnic vasoconstriction, thereby reducing mesenteric blood flow and portal pressure
439
Duct ectasia buzzword
Cheesy yellow/green discharge
440
SLE features (>4 of these =SLE)
SOAP BRAIN MD
Serositis (pleuritis, pericarditis)
Oral ulcer
Arthritis (non-erosive)
Photosensitivity
Blood disorders (haemolytic anaemia, leukopaenia, thrombocytopaenia)
Renal disorders (e.g. proteinuria, red cell casts)
Anti-nuclear antibodies (ANA)
Immunological disorders (presence of anti-dsDNA/anti-Sm/anti-phospholipid antibodies)
Neurological disease (psychosis, seizures) Malar rash (butterfly rash)
Discoid rash
441
Hashimoto's thyroiditis
Hypothyroidism
442
Ridel's thyroiditis
Normal thyroid tissue replaced by dense fibrous tissue
Thyroid is described as woody
443
Cavitating lesion with air fluid level
Infectious causes:
- S. aureus
- Klebsiella
- pneumonia
- TB
Squamous cell carcinoma
Rheumatoid arthritis
Granulomatosis with polyangitis
444
Legionella pneumophila distinctive feature
Air conditioning units
445
4 main components of AKI management
- Protecting from hyperkalaemia
- Optimising fluid balance
- Stopping nephrotoxic drugs
- Assessing need for dialysis
446
Spontaneous bacterial peritonitis
Neutrophil count > 250 cells/mm^3
Most commonly E.coli & K. pneumonia
447
Hypertensive retinopathy changes order
Grade 1 = Silver Wiring
Grade 2 = AV Nipping
Grade 3 = Flame Haemorrhages and Cotton Wool Exudates
Grade 4 = Papilloedema
448
Carpal tunnel syndrome
sensory impairment in the distribution of the median nerve (lateral half of the palm and the first three digits) leading to a tingling pain and weakness of the affected hand
Idiopathic
Obesity
Infiltrative disease
449
Why low Hb in haemolytic anaemia
Microangiopathy haemolytic anaemia component of DIC
450
Immediate management of PE
High flow O2 & SC LMWH
451
GOld standard diagnostic test for acromegaly
Oral glucose tolerance test
452
Insulin suppression test
To investigate hypopituitarism
453
Why elevated MCV in alcoholic pts?
Harmful effect of alcohol on erythroblast development
454
AST:AKT >2
Liver damage secondary to alcohol abuse
455
Treating MRSA
Vancomycin
456
Tazocin indication
HAPs
457
Three causes of raised JVP
Constrictive pericarditis
Right heart failure
Tricuspid regurgitation
458
Peaked P waves on ECG
P pulmonale
| Due to right atrial enlargement
459
4 histopathological sybtypes of melanoma
Superficial spreading - from pre-existing naves --> slowly changing mole
Nodular melanoma --> rapidly out of area of skin with no pre-existing navi. Grow vertically as blue-black or blue-red nodules
Acral lentiginous melanomas - soles & palms. Brown black mace with irregular borders
Lentigo maligna
460
Bowen's disease
Squamous cell carcinoma in situ
461
MRC scale
Grade 0 = no muscle movement
Grade 1 = flicker of movement
Grade 2 = active movement with gravity eliminated
Grade 3 = active movement against gravity (but not against resistance)
Grade 4 = active movement against gravity and resistance Grade 5 = normal power
462
Best Ix to confirm sliding hiatus hernia
Barium Swallow
463
Diagnosis of AKI criteria
• Rise in urea > 26 micromol/L in in 48 hrs
• Rise in creatinine > 1.5 x baseline (baseline measured in the last 3
months)
• Urine output < 0.5 mL/kg/h for > 6 hrs (i.e. your urine production in mL
over 2 hours should match your body weight in kg)
464
Indications for Aki dialysis
• Refractory pulmonary oedema
• Persistent hyperkalaemia
• Severe metabolic acidosis
• Uraemic complications (e.g. encephalopathy, pericarditis)
• Drug overdose by the BLAST drugs: Barbiturates, Lithium, Alcohol,
Salicylates and Theophyline
465
Causes of HAP
```
Gram-ve enterobacteriaee (eg. E.coli)
S.aureus
Pseudomonas
Klebsiella
Bacteriodies
Clostridia
```
466
Causes of CAP
```
S. pneumoniae
H. infleunzae
M. pneumoniae
Moraxella
Chalmydia
Legionella
```
467
Neurofibromatosis
Autosomal dominant
Tumour development in nervous system
468
Type 1 neurofibromatosis
Peripheral manifestations
```
Cafe-au-lait macules
Axiallry ferckling
Neurocutaneous fibromas
Phaeos
Renal artery stenosis
```
469
Type 2 neurofibromatosis
Central features
Bilateral vestibular schwannomas
Meningiomas
Gliomas
470
Xeroderma pigmentosum
Genetic disorder of DNa repair
.>. pts susceptible to DNA damange by UV radiation = multiple skin cancers
471
Dercum disease
Presence of several painful lipomas across body
472
Extra articular features of ankylosing spondylitis
5 A's
```
Apical lung fibrosis
Amyloidosis
Anterior uveitis
Achilles tendinitis
Aortic regurgitation
```
473
Erythema ab igne
Reticulated rash caused by long term exposure to heat
Sometimes seen in chronic pancreatitis, hypothyroidism and lymphedema
474
Subcut nodules
Seen in rheumatoid arthritis
475
Tophi
Deposits of monosodium urate crystsal in joints
Occur in gout
476
Cardiac tamponade
Beck's triad
Muffled heart sounds
Raised JVP
Hypotension
477
Causes of erythema nodusum
LOST BUSH
```
Leprosy, Lymphoma, Leukaemia
OCP
Sarcoidosis, Sulphonamides
TB, Toxoplasmosis
Behcet's disease
Ulcerative Colitis (& Chron's)
Salmonella, Strep
Histoplasmosis
```
478
Hypervolaemic causes of hyponatraemia
Congestive cardiac failure
Cirrhosis
Nephrotic syndrome
479
Euvolaemia causes of hyponatraemia
Adrenal insufficiency
SIADH
Hypothyroidism
480
Hypovolaemic causes of hyponatraemia
Diarrhoea
Vomitting
Diuretics
481
Sharp chest pain
Pleuritic pain
482
Chronic dry cough and SoB in Afro-Caribbean origin person
Think Sarcoidosis
483
Bilateral hilar lymphadenopathy
Radiological hallmark of sarcoidosis, although it can be caused by TB and lymphoma
484
Sarcoid what parameter would be raised
Ca2+
485
Extra-GI feature of coeliac disease
Dermatitis herpetiformis
Papulovesicular rash
486
Anti-tTG antibodies
Diagnostic test for Coeliac
487
Most common causes of septic arthritis
S.aureus,
Streptococci
Neisseria gonorrhoeae
488
CKD definition
GFR < 60 mL/min/1.73m2 for more than 3 months
489
Heart failure management
1. Sit the patient upright
2. Administeroxygen
3. Gain IV access and monitor ECG (treat arrhythmias)
4. IV Diamorphine
5. IV Furosemide
6. GTN spray or infusion
7. Consider CPAP if the patient’s condition worsens
490
Microcytic anaemia causes
Iron deficiencyy
ACD
Thalassemia
Sideroblastic anaemia
491
Normocytic anaemia cuases
```
Aplastic anaemia
Haemolysis
Post haemorrhage
Pregnancy
Fluid overload
```
492
Macrocytic anaemia causes
```
B12 defieicny
Folate deficiency
Drugs (methotrexate)
Alcohol excess
Liver disease
Myelodysplasia
Hypothyroidism
Multiple myeloma
```
493
SVC syndrome
COmpression of SVC often by lung tumours
```
Dyspnoea
Orthopnoea
Swollen face & arms
Plethora
Cough
Engorged neck & facial veins (raised and non pulsatile)
```
494
Pulsus alternans
Seens in left ventricular systolic failure
EF low = low SV, .>. high end diastolic vol --> Starling's law --> stronger subsequent contraction
Alternating pattern of strong and weak pulses
495
Pulsus paradoxus
Abnormally large dec in BP and pulse amplitude during inspiration
Constrcitve pericarditis
Cardiac tamponade
496
Pulsus bisferiens
Biphasic pulse that has two peaks per cardiac cycle
Detected in HOCM
497
IgA nephropathy vs post-strep glomerulonephritis
Post-strep 4-6 weeks after strep infeciton
IgA nephropathy 5-7 days after pharyngitis
