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Medicine Year 3 > Meeran Lecture 29/03/2017 > Flashcards

Meeran Lecture 29/03/2017 Flashcards

1
Q

Major criteria for Rheumatic Fever

A
  1. carditis
  2. Arthritis
  3. Chorea
  4. Erythema marginatum
  5. Subcutaneous nodules
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2
Q

ECG

A

This is a 12 lead ECG on …
It was taken on …
rate
rhythm (usually sinus or fast or slow may be regular or irregular)
axis (usually normal - look at lead 2 st segment positive -> axis is normal)
PR

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3
Q

Causes of AF

A
  1. IHD
  2. Hyperthyroidism
  3. Old Rheumatic fever
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4
Q

AF Management

A
  1. Rate control
    Beta blocker (propranolol, atenolol) - younger people
    Digoxin (older people)
  2. Rhythm control
  3. Thromboembolism prophylaxis
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5
Q

AF when to anti coagulate?

A

CHADS2

CHADS2VASc

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6
Q

Aspirin

A

Prefer recurrent MIs or stroke

anti-platelet

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7
Q

HASBLED scoring

A

Risk of bleeding on anticoagulation

Hypertension
Abnormal liver and renal function 
Stroke
Bleeding 
Labile INR 
Elderly (>65)
Drugs or alcohol

Score greater than 3 -> increased risk of bleeding on anticoagulation -> caution and regular review

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8
Q

High circulating level of thyroxine

A

Tremor
Palpitations
Tachycardia
Proptosis

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9
Q

lid lag

A

Seen in graves disease

not controlled by high levels of thyroxine

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10
Q

ptosis

A

drooping of eye lid

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11
Q

Horners syndrome

A

ptosis
myosis
anhydrosis
(opposite of lid lag)

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12
Q

Graves Disease

A

Autoimmune (at least 4 antibodies)

Antibodies bind to and stimulate the TSH receptors in the thyroid

Antibodies cause goitre and hyperthyroidism and exophalmos

Hyperthyroidism causes lid lag

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13
Q

Exophthalmos

A

Antibodies bind to muscle behind the eye and cause exophthalmos.

Other antibodies cause pretibial myxoedema

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14
Q

Infective endocarditis

A

Caused by a bacterial infection of the heart

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15
Q

Acute rheumatic fever causes

A

Infection (sore throat) -> antibodies cause the problem

Carditis
Erythema Marginatum 
Subcutaneous nodules
chorea
arthritis

Autoimmune disease

Non existing in the UK (rural world)

But a lot of 70year olds whom had it in the past

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16
Q

Asthma management

A
  1. Beta agonist and inhaled steroid
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17
Q

Microcytic anaemia

A

Iron deficiency

18
Q

Macrocytic anaemia

A

b12 deficiency

folate deficiency

19
Q

Microcytic anaemia - iron deficiency

A

Slow GI blood loss (colonic carcinoma)

Iron stores run out as blood contains iron -> once iron stores are zero, smaller red cells appear -> microcytic anaemia typical of iron deficiency -> high platelet count because of bleeding

20
Q

Pernicious anaemia

A

Big RBCs

21
Q

Red Cell Distribution Width

RDW

A

standard deviation of the MCV

If there are a lot of big and small ones ->wide -> anisocytosis -> different sizes

If you have a lot of small ones -> low

if you only have larger ones -> low

22
Q

High Red Cell Distribution WIdth (RDW)

A

Mixed picture

23
Q

Pernicious anaemia

A 
Lack on intrinsic factor
Stop absorbing B12
DNA replicates poorly
Thus cell grows but fails to divide 
Macrocytosis results from B12 or folate deficiency 
Hyper-segmented neutrophils
24
Q

Anaemia of chronic disease

A

MCV normal
anemia
not mixed picture

25
Q

How to distinguish chronic disease anaemia from mixed picture?

A

RDW

26
Q

Chronic myeloid leukaemia

A

very high malignant white count (79) normal range 4-11

in severe sepsis 25

27
Q

MALARIA

A 
Very pyrexial patient
come back of some part of asia 
WCC low (3)
haemoglobin low 
Platelet count very low
28
Q

Spider Naevus

A

Touch the centre makes it blanch

Found only in the distribution of the SVC
It can only be found above the nipple line.

Chronic stable liver disease

29
Q

Portal hypertension

A

large visible veins
ascites
splenomegaly

30
Q

Campbell de Morgan spot

A

No pathology known.

Incidence increases with age

31
Q

Infective endocarditis

A

definitely causes splenomegaly

32
Q

Causes of large spleens

A
  1. CML
  2. Infective endocarditis
  3. Alcohol
33
Q

Obstructive jaundice

A

Puts up alkphos the most!

SO if very high -> pancreatic cancer

34
Q

Viral Hepatitis

A

Higher ALT with AST high too but ALT higher

35
Q

Cirhhosis

A

AST higher then ALT but both are high

36
Q

Patient with both asthma and heart failure. drug that can be used for both

A

aminophylline (phosphodiesterase inhibitor)

Beta blocker contraindicated in asthmatics

37
Q

Metabolic acidosis

A

DKA

38
Q

Respiratory acidosis

A

acute overdose of drugs that stops breathing (opioid)

COPD: chronic. compensation (bicarbonate will be high)

39
Q

ACE Inhibitors

A

cause an (increase) worsening of the creatinine within days of starting

hyperkaemaemia

DO not use ace inhibitor in renal artery stenosis (If they get acidotic, pulmonary oedema, hyperkalaemia) -> emergency
dialysis

less albuminuria (albuminuria causes renal failure in diabetic patients)

Prevent end-stage renal failure

40
Q

Diabetes drugs

A
  1. Metformin (biguanide)
    - Dont give in renal failure, helps loose weight
    - causes a bit of diarrhea
  2. Sulphonylurea (Gliclazide)
  3. Thiozolidinediones (Pioglitazone)
  4. Incretins (exanatide)
  5. Dipeptidyl peptidase IV inhibitors (gliptins)
  6. Insulin
41
Q

Diabetes type 2

A

First diet and exercise

Medicine Year 3 (13 decks)

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