Laz Paper 1 Flashcards
What is an Austin Flint murmur?
A murmur heard in severe aortic regurgitation due to the regurg leading to mitral stenosis, therefore the murmur is mid-diastolic
What is a Graham-Steell murmur?
A murmur that indicates pulmonary regurgitation, therefore is early-diastolic
What is minimal changes disease?
Minimal changes disease is the most common type of non-proliferative glomerulonephritis in children and is visualised as reduced podocytes on electron microscopy
It causes nephrotic syndrome
What is membranous glomerulonephritis?
A non-proliferative glomerulonephritis in adults that leads to nephrotic syndrome
What is IgA nephropathy?
Glomerulonephritis that presents days after upper respiratory tract infection and leads to nephritic syndrome
What is Henoch-Schonlein purpura?
A type of IgA nephropathy that affects children and leads to nephritic syndrome
Triad:
- Purpura
- Arthritis
- Abdominal pain
What is rapidly progressive glomerulonephritis?
A nephritic syndrome causing condition that presents as renal failure over weeks to months
What is the marker of acute pancreatitis?
Raised amylase levels
What is the marker of chronic pancreatitis?
Decreased fecal elastase due to chronic pancreatic insufficiency
What is Courvoisier’s law?
Painless jaundice in the presence of a palpable painless gallbladder is likely to be pancreatic cancer
What is the inheritance pattern of hereditory haemochromatosis?
Autosomal recessive
What is the pathphysiology of hereditory haemochromatosis?
There is a mutation in hepcidin therefore there is unregulated absorption of iron from the duodenum, leading to deposition in the liver, pancreas and skin
What is the clinical presentation of hereditory haemochromatosis?
- Diabetes due to deposition in the pancreas
- Hepatomegaly due to deposition in the liver
- Bronze skin
What are the iron study blood results for hereditory haemochromatosis?
- Increased serum iron
- Increased ferritin
- Increased transferrin saturation
- Decreased transferrin
- Decreased total iron binding capacity (due to the decreased transferrin levels overall)
What is the CHA2DS2-VASc score?
- Congestive heart failure
- Hypertension
- Age (>65 1, >75 2)
- Diabetes
- Previous stroke/ tia (2)
- Vascular disease (eg. peripheral vascular disease)
- Sex (female = 1)
When is a CHA2DS2-VASc score clinically significant?
If the score is above or = 2, patients should be started on warfarin to reduce their stroke risk
What is a QRISK2 score used for?
QRISK2 score is used to predict the cardiovascular risk based on traditional parameters (eg. blood pressure etc) and to assess the need for primary intervention eg. statins
What are the features of background retinopathy on fundoscopy?
- Hard exudates (lipid leakage)
- Blot haemorrhages
- Microaneurysms
What are the features of pre-proliferative retinopathy?
- Soft exudates (ischaemia)
What are the features of proliferative retinopathy?
- Angiogenesis (if obstructing the macula, can affect vision)
What are the features of maculopathy?
Hard exudates found near the macula
What is Guillian-Barre syndrome?
An acute polyneuronal demyelinating condition that occurs weeks or months following infection, commonly Campylobacter
What is the most common cause of CKD?
Diabetes, followed by hypertension
What are the two types of polycythaemia?
- Polycythaemia rubra vera, a neoplastic condition characterised by proliferation of myeloid cells in the bone marrow
- Polycythaemia secondary to anther condition
What is the clinical presentation of polycythaemia?
- Headache
- Facial plethora
- Blurred vision
- Pruritis after a hot bath
What is myelofibrosis?
A myelodysplasic disorder that leads to bone fibrosis which reduces bone marrow output leading to anaemia and extramedullary haematopoiesis
What is the psoas sign?
A positive sign for appendicitis if the doctor passively extends the leg at the hip joint
What is Cope’s sign?
When the examiner passively flexes the hip and rotates the knee inwards and elicits pain in the patient
This indicates appendicitis
What are the characteristics of squamous cell carcinomas?
- Everted edges
- Ulcerated centre
- Keratotic core
- Sun exposed areas
What is a keratoacanthoma?
A type of squamous cell carcinoma that developes rapidly but does not metastasise
What is the most common type of skin cancer?
Basal cell carcinoma
What are the characteristics of basal cell carcinomas?
- Pearly white and waxy
- Rolled edges
- Telangectasia
What are the characteristics of melanoma?
- Macular
- Pigmented
- Irregular boarders
What is an actinic keratosis?
An actinic keratosis is a common skin lesion that occurs secondary to sun damage, it has a crusty surface
What is the diameter of a normal aorta?
2cm
Which AAA patients should surgical repair be considered in?
Patients with diameters >5.5cm or who have AAAs growing >1cm per year
What is the required surveillance for AAAs 3-4.5cm?
Patients should be surveilled every year via ultrasound
What is the recommended surveillance for AAAs 4.5-5.5cm?
Every 3 months via ultrasound
What is Kaposi’s sarcoma?
Kaposi’s sarcoma is an AIDS defining illness caused by infection with HHV-8 virus presenting as cutaneous tumours
What is haemolytic uraemic syndrome?
Haemolytic uraemic syndrome commonly occurs in children after haemorrhagic E.coli 0157 infection and presents with microangiopathic haemolytic anaemia, thrombocytopaenia and renal failure
What is microangiopathic haemolytic anaemia?
Haemolytic anameia due to red blood cell damage secondary to fibrin deposition in the vasculature resulting in schistocytes on blood film
What commonly predisposes haemolytic uraemic syndrome in children?
Infection with E.coli 0157h7
What is the pathophysiology of haemolytic uraemic syndrome?
Infection leads to endothelial damage (the glomerulus is particulary susceptible) which leads to activation of the clotting cascade and thrombus formation (thrombocytopaenia) leading to damage of the red blood cells via microangiopathic haemolytic anaemia
What is the difference in presentation between haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura?
Haemolytic uraemic syndrome (kids)
- Renal failure
- Thrombocytopaenia
- Microangiopathic haemolytic anaemia
Thrombotic thrombocytopaenic purpura (adults)
- HUS symptoms +
- Fevers
- Neurological symptoms
How are legionella pneumophila antibodies detected?
Via urine sample
What is mycoplasma pneumonia associated with?
Red blood cell agglutination and transverse myelitis (inflammation of the spinal cord)
Which atypical pneumonia is associated with birds?
Chlymidia psittaci
What is the Breslow thickness scale used for?
To indicate the prognosis of melanoma based on the depth of the tumour
Which antibiotics are used for uncomplicated UTI in non-pregnant women?
Nitrofuratoin and trimethoprim
They’ve given before the MC&S results come back as they’re effective against E.coli (the most common UTI causing organism)
How long after MI does Dressler’s syndrome arise?
2-10 weeks later, thought to be due to an inflammatory reaction prompted by the tissue damaged during the MI
Can lead to pericardial effusion
When would a simple post MI pericarditis occur?
2-4 days after
What is peripheral vascular disease?
Narrowing of the peripheral arteries due to atherosclerosis formation
What is critical limb ischaemia?
A more severe form of PVD characterised by:
- Night pain
- Pain at rest
- Tissue loss (gangrene etc)
What is Leriche syndrome?
Narrowing of the aortic-iliac arteries leading to:
- Buttock claudication
- Erectile dysfunction
- Weak distal pulses
What are the measurements for ankle brachial pressure index?
- >=1 normal
- 0.9-0.5 intermittent claudication/ mild-moderate PVD
- <0.5 critical limb ischaemia
How is ABPI calculated?
Ankle pulse pressure/ radial pulse pressure
Which variant of herpes is sexually transmitted?
HSV2
Why is trimethoprim avoided in pregnancy?
Trimethoprim is a folic acid antagonist therefore can lead to foetal spinal cord defects
Which strain of herpes is assoicated with childhood infection?
HSV1
