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YEAR 6: PACES > Medicine 8 > Flashcards

Medicine 8 Flashcards

1
Q

List some causes of palmar erythema.

A 
Cirrhosis 
Hyperthyroidism
Rheumatoid arthritis 
Pregnancy 
Polycythaemia
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2
Q

List some causes of gynaecomastia.

A 
Physiological (puberty)
Drugs (spironolactone, digoxin, cimetidine, finasteride)
Cirrhosis 
Testicular tumour/orchidectomy 
Kleinfelter's and Kallman syndrome
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3
Q

List some clinical features of haemochromatosis.

A 
Testicular atrophy 
Diabetes mellitus (injection sites)
Congestive cardiac failure 
Arthropathy 
Chronic liver disease
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4
Q

What are the main indications for splenectomy?

A

Rupture (trauma)

Haematological (ITP, hereditary spherocytosis, sickle cell disease)

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5
Q

How do patients with polycystic kidney disease tend to present?

A 
Hypertension 
Recurrent UTI
Abdominal pain (bleeding into cyst or cyst infection)
Haematuria 
End-stage renal failure

NOTE: may present with extra-renal manifestations such as subarachnoid haemorrhage, mitral valve prolapse and hepatic cysts

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6
Q

List some signs of interstitial lung disease.

A 
Clubbing 
Central cyanosis 
Fine end-inspiratory crackles 
Signs of autoimmune disease (e.g. rheumatoid arthritis, SLE, SS)
Grey skin (amiodarone)
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7
Q

List some causes of apical fibrosis.

A 
TB 
Radiation 
Ankylosing spondylitis 
ABPA
Sarcoidosis 
Histoplasmosis 
EAA
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8
Q

List some clinical signs of COPD.

A 
Central cyanosis 
Pursed lip breathing 
CO2 retention flap/bounding pulse 
Tar stained fingers 
Expiratory polyphonic wheeze 
Cor pulmonale (raised JVP, ankle oedema, RV heave, loud P2)
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9
Q

Outline the management of COPD.

A 
Smoking cessation 
Beta-agonists (salbutamol)
Tiotropium bromide 
Inhaled corticosteroids 
Vaccinations (influenza, pneumococcus) 
Pulmonary rehabilitation 
LTOT
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10
Q

List some surgical treatment options for COPD patients.

A

Bullectomy
Endobronchial valve placement
Lung reduction surgery (if heterogenous distribution of emphysema)
Single lung transplant

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11
Q

List some differentials for a wheezy chest.

A 
COPD 
Asthma 
Bronchiectasis 
Granulomatosis with polyangiitis (obliterative bronchiolitis) 
Rheumatoid arthritis
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12
Q

List the criteria for starting long-term oxygne therapy.

A

Non-smoker
PaO2 < 7.3 kPa on air
PaO2 7.3-8 with secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertension

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13
Q

List some clinical signs of a pleural effusion.

A 
Asymmetrically reduced expansion 
Trachea deviated away from effusion 
Stony dull percussion 
Absence tactile vocal fremitus 
Reduced breath sounds 
Bronchial breathing above fluid level
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14
Q

List some complications of lung cancer.

A 
Superior vena cava obstruction 
Recurrent laryngeal nerve palsy 
Horner's syndrome 
Wasting of small muscles of hand 
Endocrine (gynaecomastia)
Neurological (Lambert-Eaton)
Dermatomyositis
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15
Q

List some differentials for systolic murmurs.

A 
Aortic stenosis 
Aortic sclerosis
Mitral regurgitation 
HOCM 
VSD 
Aortic flow murmur
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16
Q

List some clinical signs of aortic stenosis.

A

Slow rising pulse
Narrow pulse pressure
Ejection systolic murmur
Thrill over aortic area

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17
Q

What is the EuroSCORE?

A

A risk model that calculates the risk of death after a cardiac operation

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18
Q

List some clinical signs of tricuspid regurgitation.

A

Raised JVP (giant V waves)
Pansystolic murmur loudest in tricuspid area
Thrill at left sternal edge
Pulsatile liver, ascites and peripheral oedema
Endocarditis signs (IVDU)
Pulmonary hypertension (loud P2)

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19
Q

List some indications for having an ICD.

A

Familial conditions with high risk of sudden cardiac death (long QT, ARVD, brugada, HCM)
Cardiac arrest due to VT/VF
Haemodynamically compromising VT
VT with LVEF < 35%

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20
Q

List some clinical signs of constrictive pericarditis.

A

Raised JVP
Right heart failure
Kussmaul sign (paradoxical increase in JVP on inspiration)
Pulsus paradoxus (>10 mm Hg drop in SBP on inspiration)
Hepatomegaly, ascites and peripheral oedema

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21
Q

List some causes of constrictive pericarditis.

A

TB
Trauma (or surgery)
Radiotherapy
Connective tissue disease (rheumatoid, SLE)

22
Q

What murmur is caused by ASD?

A

Ejection systolic murmur with fixed split-second heart sounds

23
Q

What murmur is caused by VSD?

A

Systolic murmur loudest at the left sternal edge (no radiation)

24
Q

List some clinical signs of myotonic dystrophy.

A 
Myopathic facies (long, thin, expressionless)
Wasting of facial muscles and SCM 
Bilateral ptosis 
Frontal balding 
Dysarthria (myotonia of tongue and pharynx)
Test grip (wont be able to let go) 
Cataracts 
Cardiomyopathy 
Testicular atrophy
25
What are dominant and non-dominant parietal lobe signs?
Dominant: dysphasia (receptive, expressive, global) | Non-Dominant: dressing/constructional apraxia, spatial neglect
26
List some causes of mononeuritis multiplex.
``` Diabetes mellitus Connective tissue disease (SLE, rheumatoid) Vasculitis (e.g. PAN) Infection (e.g. HIV) Malignancy ``` Mononeuritis multiplex: painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas
27
Outline the management of Bell's palsy.
``` Prednisolone if within 72 hours of onset of symptoms Eye protection (artificial tears, tape eyes closed at night) ```
28
Outline the treatment of myasthenia gravis.
Acute: IVIG and plasmapheresis Chronic: acetylcholinesterase inhibitor (e.g. pyridostigmine), steroids, thymectomy
29
List some signs of tuberous sclerosis.
Angiofibromata on the face Periungual fibromas Shagreen patch (roughened, leathery skin in lumbar region) Ash leaf hypopigmentation Other: cystic lung disease, renal enlargement due to angiomyolipoma/PKD (and features of renal replacement), seizures, developmental delay, signs of antiepileptic treatment
30
List some medical and surgical causes of 3rd nerve palsy.
Medical: mononeuritis multiplex (DM), midbrain infarction, MS, migraine Surgical: posterior communicating arter aneurysm, cavernous sinus thrombosis, uncal herniation
31
List some causes of tunnel vision.
``` Papilloedema Glaucoma Choroidoretinitis Migraine Retinitis pigmentosa ```
32
Describe the appearance of retinal artery occlusion on fundoscopy.
Pale, milky fundus with thread-like arterioles | Cherry red macula
33
Describe the appearance of retinal vein occlusion on fundoscopy.
Flame haemorrhages (radiating out from swollen disc) Engorged tortuous veins Cotton wool spots Look for diabetic or hypertensive changes NOTE: causes include hypertension, diabetes, hyperviscocity and high IOP
34
List some differentials for Parkinson's disease.
``` Parkinson's plus (PSP, CBD, MSA, LBD) Basal ganglia infarct Encephalitis Traumatic encephalopathy Metabolic (Wilson's) Drugs (antipsychotics, metoclopramide) ```
35
List some causes of unilatearl spastic paraparesis.
Hemisphere: stroke, MS, SOL, cerebral palsy Hemicord: MS, compression
36
What are the main clinical features of de Quervain's tenosynovitis and what is it caused by?
Pain on radial side of wrist Tender radial styloid process Abduction of thumb against resistance is painful Finkelstein test - examiner pulls thumb in ulnar deviation and longitudinal traction. It causes pain over radial styloid process Tendons involved: extensor pollicis brevis + abductor pollicis longus
37
What is a major indication for NIV in a patient with an infective exacerbation of COPD?
Respiratory acidosis despite maximum medical treatment (PaCO2 > 6 kPa and pH < 7.35)
38
List some indications for non-invasive ventilation.
``` COPD with respiratory acidosis Type 2 respiratory failure (e.g. due to neuromuscular disease) Cardiogenic pulmonary oedema Obstructive sleep apnoea Weaning from endotracheal intubation ```
39
List some causes of spider naevi.
Chronic liver disease Pregnancy COCP
40
List some indications for CABG.
Left main stem disease Triple vessel disease Refractory angina Unsuccessful angioplasty NOTE: complications include MI, cardiac tamponade, haemothorax, post-op AF, graft stenosis
41
List some causes of high-output cardiac failure.
Thyrotoxicosis Anaemia Paget's disease Pregnancy
42
List some secondary causes of hypertension.
Renal artery stenosis Coarctation of the aorta Polycystic kidney disese Conn's, Cushing's, Phaeochromocytoma, acromegaly, thyrotoxicosis
43
What are the indications for surgical valve replacement in aortic stenosis?
Symptomatic AS Severe asymptomatic AS with reduced EF Severe AS undergoing other operation (e.g. CABG)
44
List some causes of an S4 heart sound.
Thickened ventricular wall due to hypertension or aortic stenosis Coronary artery disease Cardiomyopathy
45
List some conditions that display Koebner phenomenon.
Psoriasis Vitiligo Lichen planus
46
Describe some symptoms and signs of subacute combined degeneration of the spinal cord.
``` Weakness (e.g. legs, arms, trunk) Tingling and numbness Bilateral spastic paresis Impaired find touch and vibration Upgoing plantars ```
47
Describe the classical features of lumbar spinal stenosis.
Back pain extending to buttocks and backs of thighs Pain is worse when standing or walking Pain relieved by sitting down and leaning forward Lower limb weakness
48
Which investigations would you request in a patient with suspected thyroid disease?
TFTs (TSH, T3/4, antibodies) Thyroid uptake scan (technetium 99m pertechnetate) FBC, Calcium, ESR
49
List some differentials for thyroid enlargement.
Graves Thyroiditis (Hashimoto's, De Quervain's, Riedel) Multinodular goitre Follicular adenoma Thyroid cancer (papillary, follicular, medullar, anaplastic) Iodine deficiency
50
What are the two different types of Charcot-Marie-Tooth disease?
HSMN1 - more common, demyelinating, autosomal dominant (PMP22 gene) HMSN2 - axonal degeneration, autosomal dominant NOTE: CMT can also be recessive

YEAR 6: PACES (22 decks)

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