Medicine 8 Flashcards
List some causes of palmar erythema.
Cirrhosis Hyperthyroidism Rheumatoid arthritis Pregnancy Polycythaemia
List some causes of gynaecomastia.
Physiological (puberty) Drugs (spironolactone, digoxin, cimetidine, finasteride) Cirrhosis Testicular tumour/orchidectomy Kleinfelter's and Kallman syndrome
List some clinical features of haemochromatosis.
Testicular atrophy Diabetes mellitus (injection sites) Congestive cardiac failure Arthropathy Chronic liver disease
What are the main indications for splenectomy?
Rupture (trauma)
Haematological (ITP, hereditary spherocytosis, sickle cell disease)
How do patients with polycystic kidney disease tend to present?
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
List some signs of interstitial lung disease.
Clubbing Central cyanosis Fine end-inspiratory crackles Signs of autoimmune disease (e.g. rheumatoid arthritis, SLE, SS) Grey skin (amiodarone)
List some causes of apical fibrosis.
TB Radiation Ankylosing spondylitis ABPA Sarcoidosis Histoplasmosis EAA
List some clinical signs of COPD.
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)
Outline the management of COPD.
Smoking cessation Beta-agonists (salbutamol) Tiotropium bromide Inhaled corticosteroids Vaccinations (influenza, pneumococcus) Pulmonary rehabilitation LTOT
List some surgical treatment options for COPD patients.
Bullectomy
Endobronchial valve placement
Lung reduction surgery (if heterogenous distribution of emphysema)
Single lung transplant
List some differentials for a wheezy chest.
COPD Asthma Bronchiectasis Granulomatosis with polyangiitis (obliterative bronchiolitis) Rheumatoid arthritis
List the criteria for starting long-term oxygne therapy.
Non-smoker
PaO2 < 7.3 kPa on air
PaO2 7.3-8 with secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertension
List some clinical signs of a pleural effusion.
Asymmetrically reduced expansion Trachea deviated away from effusion Stony dull percussion Absence tactile vocal fremitus Reduced breath sounds Bronchial breathing above fluid level
List some complications of lung cancer.
Superior vena cava obstruction Recurrent laryngeal nerve palsy Horner's syndrome Wasting of small muscles of hand Endocrine (gynaecomastia) Neurological (Lambert-Eaton) Dermatomyositis
List some differentials for systolic murmurs.
Aortic stenosis Aortic sclerosis Mitral regurgitation HOCM VSD Aortic flow murmur
List some clinical signs of aortic stenosis.
Slow rising pulse
Narrow pulse pressure
Ejection systolic murmur
Thrill over aortic area
What is the EuroSCORE?
A risk model that calculates the risk of death after a cardiac operation
List some clinical signs of tricuspid regurgitation.
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)
List some indications for having an ICD.
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%
List some clinical signs of constrictive pericarditis.
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
List some causes of constrictive pericarditis.
TB
Trauma (or surgery)
Radiotherapy
Connective tissue disease (rheumatoid, SLE)
What murmur is caused by ASD?
Ejection systolic murmur with fixed split-second heart sounds
What murmur is caused by VSD?
Systolic murmur loudest at the left sternal edge (no radiation)
List some clinical signs of myotonic dystrophy.
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
What are dominant and non-dominant parietal lobe signs?
Dominant: dysphasia (receptive, expressive, global)
Non-Dominant: dressing/constructional apraxia, spatial neglect
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
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)
Outline the treatment of myasthenia gravis.
Acute: IVIG and plasmapheresis
Chronic: acetylcholinesterase inhibitor (e.g. pyridostigmine), steroids, thymectomy
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
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
List some causes of tunnel vision.
Papilloedema Glaucoma Choroidoretinitis Migraine Retinitis pigmentosa
Describe the appearance of retinal artery occlusion on fundoscopy.
Pale, milky fundus with thread-like arterioles
Cherry red macula
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
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)
List some causes of unilatearl spastic paraparesis.
Hemisphere: stroke, MS, SOL, cerebral palsy
Hemicord: MS, compression
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
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)
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
List some causes of spider naevi.
Chronic liver disease
Pregnancy
COCP
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
List some causes of high-output cardiac failure.
Thyrotoxicosis
Anaemia
Paget’s disease
Pregnancy
List some secondary causes of hypertension.
Renal artery stenosis
Coarctation of the aorta
Polycystic kidney disese
Conn’s, Cushing’s, Phaeochromocytoma, acromegaly, thyrotoxicosis
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)
List some causes of an S4 heart sound.
Thickened ventricular wall due to hypertension or aortic stenosis
Coronary artery disease
Cardiomyopathy
List some conditions that display Koebner phenomenon.
Psoriasis
Vitiligo
Lichen planus
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
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
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
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
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
