Medicine Flashcards
Reed sternberg cells
Hodgkins Lymphoma
Histological triad of hypersensitivity pneumonitis
Interstitial inflammation, chronic bronchiolitis and non necrotising granuloma
Always consider with occupation exposure to mould, hay, fungus, pigeons, popcorn, hot tubs etc
Post MI Care
Secondary prevention - stop smoking, cardiac rehab, lose weight, reduce salt and improve diet
Dual antiplatelet - 75mg aspirin and 75mg clopidogrel/ticagregel
B- blocker - bisoprolol
ACEi - ramipril
80mg atorvastatin OD
Temporal lobe eye lesion
Homonymous upper quadrantanopia
Parietal lobe eye lesion
Homonymous lower quadrantanopia
Conditions associated with pyoderma gangrenosum
IBD, RA, myelocytic leukemia and hairy cell leukemia
SE of bisphosphonates
Gastritis/ oesophagitis
Osteonecrosis of the jaw
Digoxin toxicity
Can be precipitated by hypokalemia and hypercalcemia. Causes bradycardia, yellow visual disturbance. Careful in AKI as renally excreted
Antibodies raised in SLE
Anti ds-DNA 60% sensitive, 90% ANA +ve
Less specific - anti SM and anti phospholipid
SLE PC
Relapsing remitting illness where autoantibodies form immune complexes which deposit throughout the body
4/11 to diagnose:
Malar rash sparing of nasolabial folds
Discoid rash - Erythematous patches with adherent keratotic scales
Photosensitivity
Non erosive arthritis 2+ joints
Oral/nasopharnygeal ulceration
Serositis
Renal disorders - red cell casts or persistent proteinuria
CNS - seziures/psychosis in absence of neurological cause
Haematological - haemolytic anameia, leucopenia or thrombocytopenia
+ve ANA
+ve immune markers ie anti dsDNA, anti SM
Testicular cancer tumour markers
aFP and Bhcg. 90% = germ cell tumours
Pyloric stensosis PC
Typically forceful non bilous projectile vomiting often with a palpable sausage shaped mass in the abdomen
Duodenal atresia
Congential constriction of the duodenum leading to bilous vomitng after first feed. Double bubble sign on xray indiciated of proximal duodenal dilation
MOA bisphosphanates
Inhibit bone reabsorption by inhibting osteoclasts and binding to calcium phosphate crystals
Erythema nodosum
Associated with TB, sarcoidosis
Glucagon stimulation test
GH, cortisol and C-peptide
Frontotemporal dementia
disinhibition, aggression, anxiety and emotional behaviour. Usually symptoms including stealing/obsession precede memory loss
CT in FTD
Collection of tau bodies and degeneration of the frontotemporal lobe
Paraaortic lymph node in cancer
Often first site of metasasis in testicular, ovarian and endometrial cancer
Insulin perioperatively
Continue long acting
Stop short acting commence on variable rate (sliding scale ) insulin infusion
Life threatening asthma
Normal/high PaCO2
Cyanosis, silent chest
Peak flow <33% of best
PaO2 <8 or sats <92
Severe asthma
Peak flow 33- 50%
RR > 25, HR > 110
Unable to speak in full sentences
Hyperprolactinoma
Amenorrhoea, reduced libido and glacatorrhoea
Invx of GH defiency
Insulin tolerance test used to induced hypoglycemia ACTH and GH are released as a stress response
ACEi acceptable creatinine rise
30%. Care of underlying renal artery stenosis
Plummer Vinson syndrome
Dysphagia, upper oesophageal web and iron defiency anaemia
Periductal mastitis
Infection of the ducts within the nipple. PC = pain, periareolar mass and green/yellow discharge. Needs USS in clinic +/- FNA if suspicious
Mx - oral fluxcloxacillin +/- drainage
Fibroadenoma
Benigin breast tumour mobile small well defined breast mouse. Rarely painful doesn’t = erythema or discharge
Fibrocystic disease
Benign breast tissue disease commonly seen in females 30-50 y/o. PC breast swelling, multiple tender lumps and nipple discharge. Varies with menstrual cycle
Cryptococcal meningitis + CSF
Fungal meningitis commonly seen in immunocomprimised . Stained with india ink encapsulated organisms
CSF = high opening pressure, lymphocytic, high protein, glucose normal/low
Clarithromycin and warfarin
Enzyme inhibitor reduces metabolism of warfarin increasing INR
Hyperkalemia on ECG
Tall tented T waves, widened QRS, short PR
Hypothermia ECG
Bradycardia, J wave at end of QRS, 1st degree HB and long QT interval
SUFE Mx
In screw fixation
Supracondylar fracture risks of injury
Common fracture in children risk of damage to the brachial artery which runs posterior to the condyle. May present with cool pulseless hand
Mid shaft humeral fractures
Radial nerve. Loss of sensation over dorsum of hand and extensor muscles of the arm
Pneumocystis jirovecii pneumoniae
Fungal pneumonia AIDS defining illness classically presenting with desaturation on exertion
Anti-TB drug side effects
Rifampacin - orange coloured tears/urine, rashes, hepatotoxicity
Ethambutol - optic neuritis, red/green colour blindness
Isonazid - peripheral neuropathy
Normal urine output
0.5ml/kg/hr
Molluscum contagiosum
Viral diease caused by HSV - flesh colour umbilicated semi-spherical papules. Conservative management may take up to 2 years to resolve completely
Drug induced Parkinsons
Usually dopamine antagonists such as metaclopramide and anti-psychotics
Acute management of pneumothorax
Only if >2cm on CXR or breathless. Needle decompression at 2nd ICS only for tension pneumothorax.
Protcol = 2x aspirate then chest drain
Essential thrombocytosis Mx
Hydroxyurea
Essential thrombocytosis
Platelets >450x109. +/- splenomegaly, bleeding/thrombosis Linked to JAK2 mutations
Indications for dialysis
K+ refractory to treatment/ >6.5, acidosis <7.2, uremic encehalopathy, toxins, refractory pul oedema
Meniere’s triad
Episodic hearing loss, tinnitus and vertigo
Sheehan’s syndrome
Hypopituitarism secondary to infarction of the anterior pituitary due to postpartum haemorraghic shock
Masquerades as primary hyperparathyroidism
Familial hypocalcuric hypercalcaemia, urinary calcium is raised in 1 hyperparathyroid
Budd Chiari syndrome
Venous thrombosis within the hepatic venous system leading to venous outflow obstruction hence sinusoidal congestion and hepatocyte dysfunction. Clinically new-onset ascites secondary to portal HTN
Invx Budd-Chiari
Portal USS looking for caudate lobe swelling and evidence of hepatic vein obstruction
HSV 1
Oral herpes
HSV 2
Genital herpes
Mx chlamydia
Stat dose of azithromycin
Renal stones unlikely to pass
> 0.5 cm. Needs admitting diclofenac, IV fluids and antiemetic. Either lithotripsy or nephrolithotomy if >2cm
Beurger’s disease
Thromboangitis obliterans - segmental thrombosis + acute/chronic inflammation of medium/small arteries often in tibial/radial arteries. Heavily linked to smoking. Rest pain and ulceration. Presents in <35y/o
Coarctation of aorta
Narrowing of aorta often at ducuts arterious. Presents with eak femoral pulse or radiofemoral delay. Prostaglandin infusion to maintain patency of PDA. Lifetime risk of CVA and CVD
Renal stone cause
75% due to hypercalcaemia
AI hepatitis antibodies
80% specific anti smooth muscle. ANA also +ve
T2 AIH = anti-LMK
Di-George syndrome
Cardiac - TOF, VSD etc Abnormal facies Thymic hypoplasia - increased infection risk Cleft palate Hypoparathyroid - low Ca2+
Neural crest defects
Pre-patellar bursitis
Housemaids Knee - warm swollen knee + effusion. No raised inflammatory markers
Arteries occluded in testicular torsion
Testicular arteries - branches of aorta @ L2. Surgery within 6hrs to prevent ischemia
Diagnosis of COPD
FEV1 < 80%, FEV1/FVC <0.7
Bechets syndrome
Multisystem disease characteristed by oral and genital ulceration. Systemic perivasculitis - increased VTE risk
Anti-saccharomyces cerevisea
Turners syndrome
45X. Short webbed neck, low hairline, high arched palate. Cardiac abnormalities CoA/ bicuspid aortic valve. Short stature, widely spaced nipples, sparse axillary/pubix hair. Ovarian agenesis - premature ovarian failure
Acute radiation dermatitis
Often erythematous and sharply demarcated +/- weeping bullae and ulceration. Supportive usually resolves with treatment cessation
Tear of supraspinatus
Initiates abduction for 15o
Post partum hemorrhage definition
1 - s 24hrs of delivery
2- After 24hrs - 6 week
Major >1000mls
Cause of 2nd trimester miscarriage
Antiphospholipid
Septate/bicornate uterus
Cervical incompetence
Legionella pnuemonia
Harboured in air conditioning systems
Dry cough
+/- hyponatremia, deranged LFTS
Mycoplasma pneumonia
Erythema multiforma and cold hameolytic anaemia.
Medical termination
Before 14 weeks = oral mifepristone and outpatient vaginal misprostol
Expect crampy abdo pain and bleeding
Mifepristone - progesterone antagonist promoting degradation of endometrium and ripening of the cervix
Misoprostol - prostaglandin analogue promoting contraction of uterus hence expulsion
ADPKD Genetics
PKD1 gene cr16 = 85%, PKD2 gene cr4
Dermatitis herpatiformis
Linked to coeliac disease symmetrical clusters of blisters at shoulder/buttocks/knees/elbows
Isograft
Tissue transplant between two genetically identical induviduals ie monozygotic
Allograft
Genetically different induviduals
Accreta > Increta > percreta
Alphabetical order!
Accreta - superficial layer of myometrium
Increta - infiltrates myometrium
Percreta - transmural myometrial infiltration breaching through the serosa outside the uterus
Risk factors for placental infiltration
PMHx C-section, myomectomy
Uterine abnormality
Placenta praevia
What binds to vit D for exertional effects
calcitriol - 1,25-hydroxycholecalciferol
Prognosis of successful pregnancy after miscarriage
After single = 85%, after 2 miscarriages = 75%
Threatened miscarriage
Vaginal bleeding, current pregnancy = Os closed
Complete miscarriage
Os closed, no fetal heart beat or uterine contents
Inevitable miscarriage
Os open, active bleeding, may have fetal activity however irreversible
Missed miscarriage
No bleeding, no expulsion of contents, Os closed
Stillbirth
Absence of fetal movements/ heart beat
Uses of misoprostol
Combined with mifepristone for termination of pregnancy
Stand alone - induction of labour, medical management of miscarriage
1st line miscarriage
Expectant management for 14 days
Hypokalemia ECG signs
Increased amplitude/width of P wave, increased PR interval
T wave flattening/inversion
ST depression
U waves
Pre-diabetes
Hba1c 42-47
Impaired fasting glucose and impaired glucose tolerance
IFG - fasting glucose 6.1 -6.9 mmol
IGT - Serum glucose 7.8 - 11.0 2hrs following OGTT
Fibroproliferative disorders
Duyptren’s, Peyronie’s
AD with variable penetrance
Duyptren’s contracture incidence and managements
6x increased in males, a fibroproliferative disorder leading to forward flexion contracture of a finger due to thickening of cords
RF - FHx, alcohol, diabetes
Red flag of developmental delay
Unable to walk at 18 months
Indications for urgent AAA repair
Size > 5.5 or increasing > 1cm per year
Most common AIDS defining illness
Pneumocystis jiovecii pneumonia
Inheritence of haemophilias
X-linked recessive
Sensitivity
Identification of those with the diease ie the true postive rate
TP/ (TP + FN)
Specificity
Identifying those without the disease TN/ (TN + FP)
SCID
Severe combined immunodefiency - impaired B/T cell immunity increasing risk of all bacterial, viral and fungal infections usually presents at young age!
X-linked recessive or AR
T cells in di George
Thymic hypoplasia due to 3rd/4th pharyngeal arch defects leading to T-cell defiency
Increased risk of viral and fungal. Not bacterial due to intact humoral component
Parkland formula
BSA x 4ml x weight = fluid volume
50% over 8hrs, 50% over 16hrs
Septic arthritis Mx
Surgical emergency due to risk of joint destruction and irrversible damage.
FBC, CRP, joint aspiration prior to joint aspiration/washout with 2 weeks IV Abx - flucloxacillin/ tazocin
Infections common in complement defiency
Encapsulated organism - neisseria meningitides, streptococcus pneumoniae, HiB
Due to C5-C9 needed to form the MAC
FAST scan
Focused assessment with sonography in trauma
- subxiphoid pericardial effusion
- periheptic space (Morrison’s pouch)
- perisplenic
- Pouch of douglas
Pericardial tamponade
Beck’s triad - muffled heart sounds, rasied JVP, reduced arterial pressure
TB drug regime
2 months - rifampacin, isonazid, ethanbutol, pyrazinamide
4 months - rifampacin + isonazid
Right-left shunt
Blood bypasses lungs flowing from RV - LV.
Aveolar pa02 normal, arterial pa02 - reduced
Increasing inspired 02 = no effect on pa02
A-gradient
Difference inbetween aveolar and arterial pa02.
Normal = 1.3 kPa
A-gradient
Difference inbetween aveolar and arterial pa02.
Normal = 1.3 kPa
Antibiotics inhibiting cell wall synthesis
Penicillin, cephalsporins, vancomycin
Antibiotics inhibting protein synthesis
Macrolides, tetrecyclines, aminoglycosides, chloramphenicol, clindamycin
Antibiotics affecting DNA synthesis
Trimethoprim, quinolones, metronidazole, rifampacin
Narrow complex tachycardia management
Vagal manouvres
Adensoine bolus 6mg, 6mg, 12mg
If haemodynamically unstable - DC cardioversion
Radial nerve anatomy
Arises in axilla, lies posterior to axillary artery, descends tightly wrapped around humerus in the radial groove.
Function of radial nerve
Innervates all muscles in posterior muscles of the forearm essential for wrist extension. Hence wrist drop due to unopposed flexion
Sensory loss to dorsal lateral 3 1/2 fingers
Heriditary haemorraghic telengestasia
AD condition 1/5000
PC - recurrent epistaxis often presents in teenagers
Multiple mucocutaneous telengectasia in nasal mucosa, lips, tongue. They can occur in the GI tract, conjunctiva, bladder, vagina, respiratory tract, brain and liver.
FHx, epistaxis, telengectasia and visceral lesions.
NB telengectasia blanch with pressure
AVM’s in HHT
Cerebral - stroke
Gastrointestinal - chronic slow bleeding leading to Fe2+ defiency anaemia
Risk factors Cervical cancer
HPV 11 + 18
Smoking
Early sexual activity, low socioeconomic status
HIV , immunosupression
Neonatal congential heart block + SLE
anti-Ro autoantibodies cross react with antigens in cardiac conducting tissue. IgG autoantibodies cross the placenta hence passivly acquired
Require permenant pacing, rash/leucopenia resolve within 6 months
Drug induced lupus antibodies
Isonazid, hydralazine, procainmide, chloropromazine and anticonvulsants
Cutanenous/pulmonary > renal
Homogenous staining on ANA
SLE autoantibodies
ds-DNA, anti-smith, ANA
anti ro/ anti la - photosensitivity syndrome
anti cardiolipin - anti phospholipid syndrome
PBC autoantibodies
AMA
Limited systemic sclerosis
anti-centromere autoantibodies
Fanconi syndrome PC
Polyuria, hypokalemia, hypophosphotaemia, acidosis
Catherisation with #pelvic rami
Exclusion of urethral injury prior to catherisation
- reterograde urterography
Proteinurea
> 300mg in 24hrs
Smouldering myeloma
Transition from MGUS to myeloma
Monoclonal serum protein > 30g/l
Plasma cells >10% in BM / tissue biopsy
Crucially no evidence of end-organ damage!
Drugs causing Stevens Johnson syndrome
NSAIDs, allopurinol
Anti-epileptics - phenytonin, carbamezipine, lamotrigine
Antibiotics
Calcium gluconate hyperkalemia
10ml 10% calcium gluconate
First line Mx of ankylosing spondylitis
Regular exercise, physio and NSAIDs
Local anaestheitic overdose
20% intralipid injection.
Perimortem C-section timings
Within 5 mins of arrest
Primary closed angle glaucoma Mx
Acetazolamide 500mg stat
Pilocarpine
Urgent referral to opthalmologist
Growth scans for diabetics pregnancy
Fetal growth scans 4 weekly from 28 weeks - 28,32,36
Dating scan
From 10 weeks to 13+6
Confirms presence of viable interuterine pregnancy
Gestational age + singleton vs twins
Anamoly scan
17 to 20+6 weeks detailed interrogation of organ development, placenta positioning.
Low lying placental at dating scan
Extra scan at 36wks to assess for placenta praevia effecting delivery
Antiepileptics safe in pregnancy
Lamotrigine + carbamazepine
Malaria stats
Spread by female anolephes mosquito, four strains plasmodium falciparum, vivax, malariae and ovale
Definition of venous sinus thrombosis
Thrombotic occlusion of one of the dural venous sinuses commonly presents with sub acute onset of headache with nausea/vomiting.
Difficult to diagnose on CT scan
Gold standard investigation for painless haematuria
Cystoscopy + biopsy
B2 adrenoreceptors
Relaxation of SM found in bronchial SM - salbutamol/salmeterol B2 agonists
A1 adrenoreceptors
SM contraction in blood vessels, skin, GI and GU systems
B1 adrenoreceptors
Cardiac muscle stimulation by B1 agonist ie adrenaline = increased HR + contractility
Breastfeeding and fertility
Prolactin inhibits the release of FSH/LH hence suppression of ovulation
Interuterine system for contraception post partum
Very effective as a long acting reversible contraceptive. Inserted at delivery or within 48hrs post partum
If not within 48hrs delay until 4 weeks due to increased risk of uterine perforation
Safe contraception post partum
POP, progesterone implant, barrier methods
Contraception > 6 weeks postpartum
All offered!
Side effects of SSRIs
Restlessness, insomnia + agitation
Sexual dysfunction
GI upset - N/V, dyspepsia, diarrhoea
Levothyroxine in pregnancy
Increase dose 25-50 ug + referral to endocrinologist
Chronic diarrhoea in HIV
Cryptosporidium - severe debilitating diarrhoea, wt loss, malabsorption. Mx - IV fluids, HAART, ORT
Gold standard investigation for DDH
Hip ultrasound
Barlow’s manouvre
Identifies dislocated hip
Adduct and applying force posteriorally
Ortalani’s manouvre
Attempts to relocated a posterior dislocated hip.
Abduct to 90o and press over greater trochanter
Laxitive abuse
Melanosis coli - brown/black pigmentation of colonic mucosa. Apoptosis of colonic mucosa leads to macrophage recruitment and stained with lipofuscin
Asymptomatic - incidental finding on colonoscopy
Trisomy 13
Patau’s syndrome - nearly exclusively die in utero or are stillborn often have holoprosencephaly, cleft defects, neural tube defects, renal abnormalities, cardiac defects, polydactyl
When to suspect Potter’s syndrome
IUGR + severe oligohydramnios
Centor criteria
Fever >38
Absence of cough
Tonsillar exudate
Tender ant cervical lymphadenopathy
Precipitant of SCD aplastic crisis
Parovirus B19 triad of reticulocytopenia, symptomatic anaemia, parovirus IgM antibodies
Blood supply to posterior heart
Right dominant - RCA branches to marginal (ant/post RV) and posterior interventricular (inferior) = 90%
Left dominant - LCA - left anterior interventricular branch to supply inferior = 10%
Enzyme inducers
Carbamazepine Rifampacin C Phenytoin Grisufovine Phenobarbitone Sulphonylureas
Enzyme inhibitors
Sulphonamides Isonazid Cimitidine Ketoconazole Fluconazole Alcohol (acute) Ciprofloxacin Erythromycin Sodium valproate Chlorampenicol Omeprazole Metronidazole
BCR:ABL
9:22 translocation of tyrosine kinase receptor = CML
Iron chemistry in haemochromatosis
Increased ferritin, serum iron and transferrin
Decreased total iron binding capacity (TIBC)
Total iron binding capacity
Measure of the capacity of transferrin to bind iron hence in iron defiency anaemia increased
Platelets in von Willebrand disease
Normal platelets, prolonged APTT, normal PT
Follicular lymphoma
Most common non-Hodgkin lymphoma. 14:18 translocation forming bcl-2
Chromosomal abnormality in Burkitt’s lymphoma
cr 14:18 c-myc
Fanconi’s anaemia
Defective DNA repair increased risk of chromsomal rearrangments and breakages
High frequency in Ashkanazi Jews (1/90 carrier)
Inherited aplastic anaemia, abnormal thumbs, renal malformations, microcephaly and hypogonadism
Howell Jolly bodies
DNA remenants usually removed by the spleen however perist in those post-splenectomy or with functional hypersplenism
Schistocytes
Red blood cell fragments from RBC which have been sliced by fibrin bands - seen with intravascular haemolysis
Triad in haemolytic anaemia
Reticulocytosis - increased RBC production
Unconjugated bilirubinaemia - increased RBC destruction
Unexplained microcytic anaemia with low ferritin
Urgent upper and lower GI endoscopy
Transfusion haemosiderosis
Repeated blood transfusion lead to iron depostion in the heart and endocrine organs - irrerversible heart failure
MRI for diagnosis
Triad seen in DIC
Thrombocytopenia
Prolonged PT/APTT
Low fibrinogen
+/- elevated d-dimer
ADAMTS13 defiency
TTP
Signs of iron defiency
Glossitis, angular stomatitis, kolinochyia (spoon shaped nails)
Plummer Vinson syndrome - dysphagia, oesophageal webs and iron defiency
Tardive dyskinesia
Tetrebenzaine
Causes of haemolytic anaemia
Inherited - SCD, thalassemia, G6PD, herediatry spherocytosis
Acquired - AI warm/cold haemolytic anaemia
Investigation of choice for vesocuteric reflux in children
MCUG - micturating cystography
Haemolysis in conjunction with pneumonia
AI cold haemogluttin disease secondary to mycoplasma pneumonia
Complete remission in leukemia
No need for blood transfusion
< 5% blasts on BM biopsy
Neutrophils > 1 and platelets >100
Partial remission in leukemia
Blasts 5% - 25%
>50 % remission
Antiphospholipid syndrome
Hypercoaguable state with auto antibodies against phospholipid components causing recurrent miscarriages
Acute haemolytic anaemia
Early transfusion complication occur within 24hrs commonly ABO/rh incompatability leads to agitation, pyrexia, hypotension, flushing, abdo/chest pain + DIC
MAP
Average BP during a cardiac cycle
2 x diastolic + systolic/3
MAP > 65 = organ perfusion
Normoglycemia
4-7 mmol/l
Normal urine production
1ml/kg/hr = 70ml/hr = 1500 ml per day !
