Medicine Flashcards
What is May-Thurner’s syndrome?
a rare vascular disorder in which an artery compresses a vein in your pelvis. This compression can cause symptoms in your left or right leg and foot and may lead to blood clots.
what is an unprovoked DVT?
no major risk factor in history
what are the 3 questions to ask someone you suspect may have a PE?
SoB, chest pain signs of DVT
which heart valve is most commonly affected in IV drug users in infective endocarditis?
tricuspid
which valve is usually affected in infective endocarditis?
mitral
what is the most common abnormality in ECG in PE?
sinus tachycardia
define massive PE
Large or extensive
thrombus; saddle; bilateral
Acute PE with sustained hypotension
define sub-massive PE
Larger thrombus or embolus than low risk; right heart strained
Acute PE without hypotension, signs of RV dysfunction or myocardial necrosis- ECG changes, elevated troponin
define small risk emboli in PE
- Acute PE without the clinical markers that define massive or sub-massive pulmonary embolism
Mortality estimated at 15% at 90 days
what are the ECG changes found in sub-massive PE?
RV strain, ischemic changes, S1 Q3 T3 pattern,
define barretts oesophagus
pre-malignant, Metaplasia in the mucosal cells lining the lower portion of the oesophagus, from normal stratified squamous epithelium to simple columnar epithelium
define peptic ulcer
Peptic ulcers are defects in the gastric or duodenal mucosa that extend through the muscularis mucosa.
what is the pathophysiology of coeliac disease
Gluten triggers production of IgA antibodies and t-cell mediated inflammatory response that targets bowel. Small bowel most affected
-> chronic inflammation
-> villous atrophy (damage to lining of small intestine) -> decrease SA for absorption
what are the features of celiac disease on histology?
Increase in intraepithelial Lymphocytes(IELs)
Villous atrophy
Crypt hyperplasia
Chronic inflammatory cells (lymphocytes) in lamina propria
what are the human leukocyte antigens for celiac disease
HLA DQ2 (90%), remaining are HLA DQ8
what type of rash is ass with celiac disease?
dermatitis herpetiforms- Uncommon blistering subepidermal eruption of the skin, itchy
what are the investigations for someone with suspected celiac disease?
Blood tests: FBCs, LFTs, U&Es, bone profile, vitamin D, vitamin B12, haematinics and albumin- to check for nutritional deficiencies
Serological blood sample
1st line: total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG)
2nd line: IgA endomysial antibody (EMA) can be used if IgA tTGA is unavailable, or in cases where it is weakly positive
Definitive diagnosis is made via upper GI endoscopy and biopsy of small bowel tissue
when is bariatric surgery indicated?
BMI>40 or BMI>35 with complications (T2DM) after non surgical approaches tried ONLY if pt commits to long term and fit for surgery. otherwise BMI >50 option for choice
define achalasia
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus (innervates smooth muscle) i.e. LOS contracted, oesophagus above dilated.
is bloating a feature of GORD?
NO- need urgent referral if reflux and bloating
which spinal tract decussates near level of entry?
spinothalamic tract (pain and temp)
which muscles of the thumb are innervated by the median nerve?
thenar muscles (opponens, abductor brevis, flexor pollicis brevis)
lumbircals of digit 1 and 2 (flexor)
what are the signs of LMN lesions
weakness
wasting
reduced tone
reflex loss
fasciculation
define Bell’s Palsy
acute, unilateral, idiopathic facial nerve palsy
