Medicine 10 Flashcards
List some causes of a fixed dilated pupil.
3rd nerve palsy
Mydriatics (e.g. tropicamide)
Iris trauma
Acute glaucoma
List some causes of optic atrophy.
MS
Glaucoma
Congenital (LHON, CMT, Friedreich ataxia)
Toxins (ethambutol, B12 deficiency)
How can acute glaucoma be distinguished from anterior uveitis?
Cloudy cornea
Large pupil
Increased IOP
NOTE: both are painful
How can episcleritis and scleritis be distinguished?
Scleritis: vasculitis of the sclera, PAINFUL, worse on eye movement
Episcleritis: painless, acuity preserved, redness can be moved over sclera
Which imaging tool is used to give a 3D representation of the retina?
Optical coherence tomography
Outline the management options for wet ARMD.
Photodynamic therapy
Intravitreal VEGF injections (bevacizumab)
Anti-oxidants and zinc may help early ARMD
List some classes of medications that are used to reduced IOP in open angle glaucoma.
Beta-blockers (reduce production) - timolol
Prostaglandin analogue (increase uveoscleral outflow) - latanoprost
Alpha-agonists (reduce product and increase outflow) - brimonidine
Carbonic anhydrase inhibitors - acetazolamide
Miotics - pilocarpine
List some causes of cataracts.
Age
DM
Steroids
Congenital (Rubella, Wilson’s, myotonic dystrophy)
What is the normal duration of the following parts of an ECG?
PR interval
QRS complex
QTc
PR interval: 120-200 ms (3-5 small squares)
QRS complex: < 120 ms (3 small squares)
QTc: 380-420 ms (~2 big squares)
NOTE: normal ECG calibration is 25 mm/s
What is the difference between bifascicular and trifascicular block?
Bifascicular: RBBB + left anterior or posterior fascicular block
Trifascicular: RBBB + left anterior or posterior fascicular block + prolonged PR (1st degree)
What are escape rhythms?
Appear after an anticipated beat
Atrial Escape: SAN fails to depolarise leading to failed sinus beat, followed by atrial escape (narrow complex)
Ventricular Escape: atrial wave fails to conduct due to AV block, followed by ventricular escape (broad complex - weird and wide)
List some differentials for broad complex tachycardia.
VT
VF
Torsades de pointes
SVT with BBB
List some causes of VT.
Infarction Myocarditis Long QT syndrome Cardiomyopathy Iatrogenic (antiarrhythmics)
List some contraindications for thrombolysis.
GI bleeding
Recent haemorrhagic stroke
Severe hypertension
Trauma
List some differentials for chest pain.
ACS Angina Aortic dissection Aortic aneurysm GORD Oesophageal spasm Musculoskeletal
List some causes of heart failure.
SYSTOLIC: ischaemia, DCM, hypertension, myocarditis
DIASTOLIC: pericardial effusion, restrictive cardiomyopathy
ARRHYTHMIA: brady/tachy
Valve disease
HIGH OUTPUT: anaemia, thyrotoxicosis, pregnancy, Paget’s disease
List the main CXR features of heart failure.
Alveolar shaddowing Kerley B lines Cardiomegaly Upper lobe diversion Effusions
What are the main indications for pharmacological management of hypertension?
< 80 yrs, stage 1 hypertension (140/90-160/100) and one of:
- target organ damage (retinopathy, LVH)
- 10 yr CVD > 10% (QRISK)
- established CVD
- diabetes mellitus
- renal disease
Anyone with stage 2 hypertension and above
NOTE: statin should also be offered if QRISK > 10%
List some echocardiography features of severe mitral stenosis.
Valve orifice < 1 cm^2
Pressure gradient > 10 mm Hg
Pulmonary artery systolic pressure > 50 mm Hg
Which investigations should be requested insuspected infective endocarditis?
Bloods: ESR, blood cultures (3 x 12 hours apart), serology for unusual organisms
Urine: microscopic haematuria
ECG: AV block
Echo: vegetations
Which investigations should you request in a patient with suspected rheumatic fever?
Bloods: ASO titre, streptococcal antigen, FBC, ESR
Throat swab (if strep throat)
ECG
Echocardiogram (MR/AR)
List some causes of restrictive cardiomyopathy.
Amyloidosis
Haemochromatosis
Sarcoidosis
Primary endomyocardial fibrosis
List some causes of dilated cardiomyopathy.
Muscular dystrophy Myocarditis Alcoholism SLE Drugs (doxorubicin) Thyrotoxicosis
List some complications of congenital heart disease.
Infective endocarditis
Pulmonary hypertension
Paradoxical emboli
Eisenmenger syndrome
List some features of Marfan syndrome.
Cardiac: aortic aneurysm, aortic dissection, aortic regurgitation, mitral valve prolapse Lens dislocation High-arched palate Arm span > height Pectus excavatum Scoliosis Hypermobility
List some features of Ehlers-Danlos syndrome.
Hyperelastic skin
Hypermobility (Beighton)
Cardiac (mitral prolapse, MR, AR, aneurysms)
Easy bruising (fragile blood vessels)
NOTE: cutis laxa is loose skin and hypermobile joints
List some complications of pneumonia.
Respiratory failure Sepsis AF Pleural effusion Empyema
List the different diseases that can be caused by aspergillosis.
Asthma ABPA Aspergilloma Invasive aspergillosis Extrinsic allergic alveolitis
List some causes of ARDS.
Pulmonary: pneumonia, aspiration, inhalational, contusion
Systemic: sepsis, pancreatitis, DIC, acute liver failure
List some causes of pulmonary oedema.
Heart failure Renal failure Liver failure Iatrogenic fluid overload Nephrotic syndrome Lymphatic obstruction ARDS (exudative)
What concentration of oxygen should be used in acutely unwell COPD patients?
80-90% 15 L/min through non-rebreathe mask initially and perform ABG
If PCO2 < 6 kPa: aim for target SaO2 94-98%
If PCO2 > 6 kPa: maintain target SaO2 88-92%
Outline the management of primary and secondary pneumothorax.
PRIMARY
- < 2 cm rim and not SOB - consider discharge
- otherwise: aspiration –> chest drain
SECONDARY
- > 2 cm rim OR SOB OR > 55 years –> chest drain
- otherwise: aspiration –> chest drain
- ALL patents should be admitted for at least 24 hours
List some features of sarcoidosis.
Constitutional upset Respiratory (fibrosis, bilateral hilar lymphadenopathy) Arthralgia Peripheral/cranial neuropathy (e.g. Bell's palsy) Uveitis/keratoconjunctivitis Restrictive cardiomyopathy Hepatosplenomegaly Lupus pernio Erythema nodosum
What pulmonary artery pressure counts as pulmonary hypertension?
> 25 mm Hg
NOTE: normal is 8-20 mm Hg
Outline the management of pulmonary hypertension.
Treat underlying condition LTOT CCB Sildenafil Prostacyclin analogues Heart failure treatment Heart-lung transplant
List some secondary causes of diabetes mellitus.
Drugs (steroids, tacrolimus, ciclosporin)
Pancreatic (chronic pancreatitis, cystic fibrosis, hereditary haemochromatosis)
Endocrinology (phaeo, Cushing’s, phaeo)
What is usually checked at a routine diabetes check up?
Control (glycaemic) - HbA1c, BP, lipids, capillary blood glucose
Complications - BP, cardiac auscultation, fundoscopy, ACR, sensory testing
Competency - with treatment regime
Coping - psychosocial
What are the two main types of insulin regime in diabetes?
Biphasic - 30 mins before breakfast and dinner, good for patients with regular lifestyle (e.g. children, elderly)
Basal-Bolus - bedtime long-acting insulin + short-acting insulin before meals, good for patients with flexible lifestyle
NOTE: once-daily long-acting before bed is initially used in patients switching from tablets in T2DM
List some side-effects of insulin therapy.
Hypoglycamia (careful with alcohol and beta-blockers)
Lipohypertrophy
Weight gain
What should patients with diabetes be informed about regarding diabetes management when they are ill?
Insulin requirements usually increase
Check BMs more frequently than every 4 hours (and check urine for ketonuria)
Increase insulin dose if glucose is rising
Maintain calories as much as possible
Which investigation is used to check for proliferative diabetic nephropathy and wet ARMD?
Fluorescein angiography
List some complications of DKA.
Cerebral oedema (excess fluid administration)
Aspiration
Hypokalaemia
Hypophosphataemia (resp and skeletal muscle weakness)
VTE
List some causes of hypoglycaemia.
Inappropriate insulin Drugs (sulphonylureas) Pituitary insufficiency Addison's disease Liver failure Insulinoma
List some causes of hypothyroidism.
Atrophic hypothyroidism Hashimoto's hypothyroidism Iodine deficiency De Quervain's thyroiditis Drugs (thionamides, lithium) Thyroidectomy
What are the main features of multiple endocrine neoplasia (MEN)?
MEN1: pituitary adenoma (prolactin, GH) + parathyroid adenoma/hyperplasia + pancreatic islet cell (gastrinoma, insulinoma)
MEN2: medullary thyroid cancer + phaeochromocytoma + parathyroid hyperplasia (2B - marfanoid body habitus)
Which diseases fall under the autoimmune polyendocrine syndromes?
Type 1 (recessive): Addison's, candidiasis, hypoparathyroidism Type 2 (polygenic): Addison's, thyroid disease, T1DM
List some clinical features of acromegaly.
Prominent supraorbital ridges Coarse facial features Prognathism Macroglossia Wide-spaced teeth Thenar wasting (and CTS symptoms) Sweaty spade-like hands
What are the initial steps in the management of a patient with suspected coeliac disease and a high TTG?
Refer for gastroscopy and duodenal biopsies
Referral for bone density scan
Screening of first-degree relatives
Referral to dieticians for gluten-free diet advice
Which extra-GI manifestations of UC are related to the activity of colitis?
Erythema nodosum Aphthous ulcers Episcleritis Acute arthropathy Pyoderma gangrenosum Anterior uveitis
List some medical treaments used for multiple sclerosis.
Steroids (IV methylprednisolone for optic neuritis)
1st line: Beta-interferon, glatiramer acetate
2nd line: natalizumab
Symptomatic: baclofen (spasticity)
