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Year 5 Core Conditions > Miscellaneous Points > Flashcards

Miscellaneous Points Flashcards

1
Q

Which leads are supplied to LAD artery of heart?

A

V1, V2, V3, V4

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2
Q

Which leads are supplied to Left circumflex artery of heart?

A

I, aVL, V5, V6

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3
Q

Which leads are supplied to right coronary artery of heart?

A

II, III, aVF

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4
Q

Leads corresponding to anterior part of heart?

A

V3, V4

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5
Q

Leads corresponding to septal part of heart?

A

V1, V2

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6
Q

Leads corresponding to inferior part of heart?

A

II, III, aVF

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7
Q

Leads corresponding to lateral part of heart?

A

I, aVL, V5, V6

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8
Q

Leads corresponding to posterior part of heart?

A

Pathological R waves in V1, V2, V3

Reciprocal horizontal ST depression in V1-V3

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9
Q

Features of MEN1?

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell insulinomas

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10
Q

Features of MEN2A?

A

Hyperparathyroidism
Medullary thyroid cancer
Phaeochromocytoma

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11
Q

Features of MEN2B?

A 
Marfanoid body
Mucosal neuromas
Medullary thyroid cancers
Phaeochromocytoma
Intestinal ganglioneuromas
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12
Q

Features of BRCA 1&2?

A

Breast, ovary and prostate cancers

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13
Q

Features of VHL?

A 
Angiomatosis
Haemangioblastoma
Phaeochromocytoma
Papillary cystadenoma of epidydimis
RCC
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14
Q

Features of FAP?

A 
Polyposis
Thyroid cancer
Congenital hypertrophy of retinal pigment epithelium (CHRPE)
Supernumery teeth
Epidermoid cysts
Osteoma
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15
Q

Features of HNPCC?

A

Colorectal, endometrial, ovary and gastric cancers

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16
Q

Features of Peutz Jeghers’ syndrome?

A

Small intestine haemartomatous polyps, hyperpigmented mucocutaneous sites

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17
Q

Epilepsy medications - tonic clonic seizures?

A

Sodium Valproate//Lamotrigine

Carbamazepine

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18
Q

Epilepsy medications - absence seizures?

A

Sodium Valproate/Ethosuximide

Lamotrigine

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19
Q

Epilepsy medications - tonic/atonic seizures?

A

Sodium Valproate

Lamotrigine

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20
Q

Epilepsy medications - myotonic seizures?

A

Sodium Valproate/Topiramate/Levetiracetam

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21
Q

Epilepsy medications - partial seizures?

A

Carbamazepine/Lamotrigine

Sodium Valproate/Levetiracetam

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22
Q

Canadian C-spine rule - high risk factor?

A

> 65
Dangerous mechanism
Paraesthesia in extremities

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23
Q

Canadian C-spine rule - low risk factor?

A 
Simple rear end collision
Sitting in ED
Ambulatory at any time
Delayed neck pain
No midline C-spine tenderness
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24
Q

Canadian C-spine rule - other factor?

A

Able to rotate neck actively left and right 45 degrees

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25
Q

Criteria for imaging in Canadian C Spine rule? What imaging?

A

1 or more high risk factor
No low risk factors
Not able to rotate neck 45 degrees left and right

CT adult
MRI child

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26
Q

Criteria for CT head <1 hour in children?

PICANSS F RF

A

PICANSS F Risk F

Post-traumatic seizure
Initial GCS <14 (<15 in <1 year olds)
Child <1 - bruise/swelling/laceration >5cm on head
After 2 hours GCS <15
Non-accidental injury suspected
Suspected open/depressed skull fracture or tense fontanelle
Sign of basal skull fracture (haemotypanum, panda eyes, CSF from nose, Battle’s sign)
Focal neurological deficit
More than 1 RF of:
- LoC>5 mins, abnormal drowsiness, 3 or more vomiting, dangerous mechanism (RTA, fall >3m, high-speed projectile), amnesia>5 minutes

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27
Q

Criteria for CT head <1 hour in adults?

FSG GPS Vom

A

FSG GPS Vom

Focal neurological deficit
Suspected open/depressed skull fracture
GCS <13 initial

GCS <15 at 2 hours
Post-traumatic seizure
Sign of basal skull fracture (haemotypanum, panda eyes, CSF from nose, Battle’s sign)

> 1 episode of vomiting

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28
Q

Criteria for CT head <8 hours in adults?

A

If loss of consciousness or
amnesia since the head injury &:

Age >65

History of bleeding or clotting disorder

Dangerous mechanism (paedestrian/motor cyclist hit by vehicle, occupant ejected from car, fall >1m or 5 stairs)

> 30 minutes retrograde amnesia of events immediately before head injury

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29
Q

Stroke - indications for CT within 1 hour?

A

Indications for thrombolysis (<4.5 hour) or thrombectomy

GCS <13

Anticoagulation or bleeding tendency

Progressive or fluctuating symptoms

Papilloedema, neck stiffness, fever, severe headache at onset

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30
Q

Contraindications for LP?

A

Signs of raised ICP, relative bradycardia and hypertension, papilloedema
GCS<9 or drop of 3 or more
Focal neurological signs
Abnormal posturing or doll eyes
Unequal, dilated or poorly responsive pupils
Shock
Extensive purpura
After convulsions until stable
Abnormal coagulation/Platelets <100/Anticoagulation therapy
Superficial LP site infection
Respiratory insufficiency

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31
Q

Blood results - Primary hyperparathyroidism?

A

ALP - high
PTH - high
Ca - high
PO4 - low

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32
Q

Blood results - Secondary hyperparathyroidism?

A

ALP - high
PTH - high
Ca - low/normal
PO4 - high/normal

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33
Q

Blood results - Tertiary hyperparathyroidism?

A

ALP - high
PTH - high
Ca - high
PO4 - high

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34
Q

Blood results - Hypoparathyroidism?

A

ALP - no change
PTH - low
Ca - low
PO4 - high

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35
Q

Blood results - Paget’s Disease of Bone?

A

ALP - high
PTH - normal
Ca - normal
PO4 - normal

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36
Q

Blood results - Osteomalacia?

A

ALP - high
PTH - normal/high
Ca - low
PO4 - normal/high

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37
Q

Blood results - Osteoporosis?

A

ALP - normal
PTH - normal
Ca - normal
PO4 - normal

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38
Q

Blood results - normal/euthyroid?

A

TSH - normal

T3 & T4 - normal

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39
Q

Blood results - hyperthyroidism?

A

TSH - low

T3 & T4 - high

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40
Q

Blood results - Primary hypothyroidism??

A

TSH - high

T3 & T4 - low

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41
Q

Blood results - Secondary hypothyroidism?

A

TSH - low

T3 & T4 - low

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42
Q

Blood results - TSH producing adenoma?

A

TSH - high

T3 & T4 - high

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43
Q

Blood results - Levothyroxine overtreatment?

A

TSH - low

T3 & T4 - high (can be normal)

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44
Q

Heart murmurs - aortic stenosis?

A

Ejection systolic murmur, radiates to carotids

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45
Q

Heart murmurs - aortic regurgitation?

A

Early diastolic murmur, forward in expiration

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46
Q

Heart murmurs - mitral stenosis?

A

Mid-diastolic murmur, loudest at apex, opening snap

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47
Q

Heart murmurs - mitral regurgitation?

A

Pan systolic murmur, radiates to axilla

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48
Q

Heart murmurs - mitral valve prolapse?

A

Mid systolic click

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49
Q

Heart murmurs - VSD?

A

Pan-systolic murmur at LLSE

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50
Q

Heart murmurs - PDA?

A

Continuous murmur

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51
Q

What is S3 heart sound?

A

KEN-TUCK-Y

Ventricular filling rapidly, normal in children/athletes/high output states

Pathology - CHF, chronic MR/TR, Dilated cardiomyopathy

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52
Q

What is S4 heart sound?

A

TEN-ES- SEE

Atrial contraction in non-compliant ventricle - abnormal

Hypertension, AS, HOCM

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53
Q

What is Corrigan’s Pulse?

A

Waterhammer pulse

Pulse forceful and suddenly collapses, sign of aortic regurgitation

54
Q

What is Beck’s Triad?

A

Hypotension

Rising JVP

Muffled heart sounds

Seen in cardiac tamponade

55
Q

What is Kussmaul’s Sign?

A

JVP increases during respiration

56
Q

What is Austin Flint Murmur?

A

Low-pitched mid-diastolic murmur, sign of severe aortic stenosis due to blood striking anterior leaflet of mitral valve

57
Q

What is De Musset’s Sign?

A

Nodding of head in synchrony of beating heart due to aortic regurgitation

58
Q

What is Muller’s Sign?

A

Bobbing of uvula occurring during systole, in aortic regurgitation

59
Q

What is Quinke’s Sign?

A

Capillary pulsations seen on light compression of nail bed, sign of aortic regurgitation

60
Q

What is Traube’s sign?

A

Pistol shot - systolic and diastolic murmurs heard over femoral arteries , aortic regurgitation

61
Q

What is Ewart’s sign?

A

Dullness on percussion at inferior angle of left scapula when effusion large enough to compress LLL of lung

62
Q

Wells PE Score - DA PITCH? And interpretation?

A 
DVT symptoms and signs (3) 
Alternative diagnosis less likely (3)
Previous VTE (1.5)
Immobilisation (Bed Ridden >3 days/Surgery <4 weeks) (1.5)
Tachycardia >100bpm (1.5)
Cancer Hx (1)
Haemoptysis (1)

PE likely - >4
PE unlikely - 4 or less

63
Q

Wells DVT Score - PEARL CPCP A? And interpretation?

A

Paralysis, paresis or plaster immobilization of leg
Entire leg symptoms
Active Cancer (Rx ongoing or within 6 months or palliative)
Recently bedridden 3 or more days or major surgery <12 weeks (GA/RA)
Localised tenderness along deep venous system
Calf Swelling (>3cm)
Pitting oedema in symptomatic leg
Collateral superficial veins
Previous VTE
Alternative diagnosis at least as likely as DVT

DVT likely - 2 or more
DVT unlikely - <2

64
Q

Asthma severity assessment - moderate?

A

Increasing symptoms
PEFR 50-75% best or predicted
No features of acute severe asthma

65
Q

Asthma severity assessment - severe?

A

Inability to complete sentences in one breath
PEFR 50-33% best or predicted
RR 25 or over
HR 110 or over

66
Q

Asthma severity assessment - life-threatening?

A 
Altered conscious level
Cyanosis
Hypotension
Exhaustion
Silent Chest
Threatening (1) PEFR <33%, (2) SpO2 <92%, (3) PaO2 <8kPa
Normal CO2
67
Q

Asthma severity assessment - Near fatal?

A

Raised PaCO2 and/or need for ventilation with raised inflation pressures

68
Q

CURB 65 score in pneumonia?

A 
Confusion (AMTS 8 or less)
Urea >7mmol/L
RR 30 or more
BP 90 or less SBP, 60 or less DBP
Age >65

0-1 home
2 inpatient
3-5 inpatient ICU

69
Q

CRB 65 score in pneumonia in GP?

A

Confusion (AMTS 8 or less)
RR 30 or more
BP 90 or less SBP, 60 or less DBP
Age >65

0 home
1 or more - consider admission

70
Q

Causes of clubbing - cardiovascular?

A

ACE

Atrial myoxoma
Congenital cyanotic heart disease
Infective endocarditis

71
Q

Causes of clubbing - respiratory?

A

SLAM

Supporative lung disease (bronchiectasis, empyema, lung abscess)
Lung cancer
Alveolitis (fibrosing)
Mesothelioma
TB
CF
72
Q

Causes of clubbing - gastrointestinal?

A

5 C’s

Cirrhosis
Crohn's &amp; UC
Coeliacs disease
Cancer
CF
73
Q

Causes of clubbing - endocrine?

A

thyroid acropatchy in thyrotoxicosis

74
Q

Causes of erythema nodosum?

A

SLIMEST

Sarcoidosis
Leprosy
IBD
Meds (Trimethoprim)
Streptococcal infection
TB
75
Q

Which cancers cause rise in CEA?

A

Colorectal cancer

76
Q

Which cancers cause rise in Ca19.9?

A

Pancreatic cancer

77
Q

Which cancers cause rise in AFP?

A

Hepatocellular cancer

Non-seminomatous germ cell tumour

78
Q

Which cancers cause rise in B-hCG?

A

Non-seminomatous germ cell tumour

Gestational trophoblastic disease

79
Q

Which cancers cause rise in Ca125?

A

Ovarian Cancer

80
Q

Which cancers cause rise in PSA?

A

Prostate Cancer

81
Q

Which cancers cause rise in Thyroglobulin?

A

Follicular/Papillary thyroid cancer

82
Q

Which cancers cause rise in M protein/Bence Jones Protein?

A

Multiple myeloma

83
Q

Which cancers cause rise in Catecholamines?

A

Phaeochromocytoma

84
Q

Which cancers cause rise in calcitonin?

A

Medullary thyroid cancer

85
Q

Which cancers cause rise in LDH?

A

Lymphoma

Ewing’s sarcoma

86
Q

What diseases is the antibody RF present in?

A 
RA
Sjogren's Syndrome
Felty's Syndrome
Infection
SLE
Sclerosis
87
Q

What disease is the antibody anti-CCP present in?

A

RA

88
Q

What diseases is the antibody ANA present in?

A 
SLE
Autoimmune hepatitis
Sjogren's syndrome
RA
Sclerosis
89
Q

What disease is the antibody anti-dsDNA, anti-Sm, anti-RNP present in?

A

SLE

90
Q

What disease is the antibody anti-histone present in?

A

Drug induced lupus

91
Q

What disease is the antibody anti-cardiolipin present in?

A

APS

SLE

92
Q

What disease is the antibody anti-Ro & anti-La present in?

A

Sjogren’s syndrome

SLE

93
Q

What disease is the antibody anti-Jo1 & anti-Mi2 present in?

A

Polymyositis

Dermatomyositis

94
Q

What disease is the antibody anti-Scl70 present in?

A

Diffuse Systemic Sclerosis

95
Q

What disease is the antibody anti-mitochondrial present in?

A

Primary biliary cirrhosis

96
Q

What disease is the antibody anti-smooth muscle present in?

A

Autoimmune hepatitis

97
Q

What disease is the antibody anti-gastric parietal & anti-intrinsic factor present in?

A

Pernicious anaemia

98
Q

What disease is the antibody anti-TTG & anti-endomysial present in?

A

Coeliac Disease

99
Q

What disease is the antibody anti-islet cell & anti-GAD present in?

A

T1DM

100
Q

What disease is the antibody anti-GBM present in?

A

Goodpasture’s Syndrome

101
Q

What disease is the antibody cANCA present in?

A

Wegener’s granulomatosis
Polyarteritis Nodosa
Microscopic arteritis

102
Q

What disease is the antibody pANCA present in?

A

Churg Strauss disease

Microscopic Polyarteritis

103
Q

What disease is the antibody ANCA present in?

A 
IBD
Sclerosing cholangitis
Felty's syndrome
SLE
RA
Drug
104
Q

What disease is the antibody anti-acetylcholine receptor present in?

A

Myasthenia gravis

105
Q

What disease is the antibody anti-voltage gated Ca channel present in?

A

Lambert Eaton Syndrome

106
Q

What disease is the antibody anti-TSH receptor present in?

A

Graves disease

107
Q

What disease is the antibody anti-thyroid peroxidase & anti-thyroglobulin present in?

A

Hashimoto’s disease

108
Q

What are the San Francisco Syncope Rules?

A

CHESS - high risk for serious complications

Congestive HF history
Haematocrit <30%
ECG abnormal
SOB history
Systolic BP <90
109
Q

What is the Oesil Syncope Rule?

A

Predictor of 12 month mortality

Age >65
Hx of CVD
Syncope without prodrome
Abnormal ECG

110
Q

What is NIHSS score?

A

Quantifies severity of acute stroke

111
Q

Indications of surgical management in infective endocarditis?

A

o severe valvular incompetence
o aortic abscess (often indicated by a lengthening PR interval)
o infections resistant to antibiotics/fungal infections
o cardiac failure refractory to standard medical treatment
o recurrent emboli after antibiotic therapy

112
Q

When to get CCU in management of DKA?

A 
o	Pregnant
o	Heart Failure
o	Oliguria or Anuria
o	Sat <92% on air
o	Systolic BP <90mmHg after 2L of fluid
o	Venous bicarbonate <5mmol/L or pH<7.1
o	GCS<12
o	K<3.5 on admission
113
Q

What is the CHA2DS2VASC score and interpretation?

A 
CHF (LVrEF or recent hospitalised)
Hypertension (>140/90)
Age (<65=0, 65-74=1, >75=2)
Diabetes
Stroke/TIA/VTE Hx (+2)
Vascular disease (prior MI, PVD, aortic plaque)
Sex (female=1, male=0)

Women 2 or more
Men 1 or more

114
Q

What is HASBLED Score?

A

Hypertension (uncontrolled, >160 mmHg systolic)
Abnormal liver function (cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal)
Abnormal renal function (dialysis, transplant, Cr >2.26mg/dl or >200)
Stroke
Bleeding (bleeding history or predisposition)
Labile INR (high INRs, therapeutic time in range <60%)
Elderly (aged over 65 years)
Drugs (antiplatelet agents or nonsteroidal anti-inflammatory drugs)
Harmful alcohol consumption

If score - weigh up benefits and negatives of anticoagulation

115
Q

Criteria of severity in acute pancreatitis?

A

Glasgow Criteria

PaO2 <8kPa
Age >55
Neutrophils >15x109/L
Ca >2mmol/L
Renal (urea >16)
Enzymes (LDH>600, AST>2000)
Albumin <32
Sugar (glucose >10)

3 or more indicates severe attack - ICU? HDU?

116
Q

What is involved in confusion screen of ‘confused patient’?

A

Observations (NEWS, BP, pulse, temperature, RR, oxygen sats)

Bloods (FBC, LFTs, U&Es, TFTs, INR, Ca, B12, folate, glucose)

Blood Cultures

Urinalysis & cultures

Imaging (CXR?, CT?)

117
Q

Risk factors for osteoporosis? Over 50?

A

All women>65 years, all men >75 years

All women aged 50–64 years and all men aged 50–74 years who have any of the following risk factors:
o A previous osteoporotic fragility fracture.
o Current use or frequent recent use of oral corticosteroids.
o History of falls.
o Low body mass index (less than 18.5 kg/m2
o Smoker.
o Alcohol intake of more than 14 units per week.
o A secondary cause of osteoporosis, including:
o Hypogonadism, including untreated premature menopause (menopause before 40 years of age), treatment with aromatase inhibitors (such as exemastane) or gonadotrophin-releasing hormone agonists (such as goserelin).
o Endocrine conditions, including diabetes mellitus, Cushing’s disease, hyperthyroidism, hyperparathyroidism, and hyperprolactinaemia.
o Conditions associated with malabsorption including inflammatory bowel disease, coeliac disease, and chronic pancreatitis.
o Rheumatoid arthritis and other inflammatory arthropathies.
o Haematological conditions such as multiple myeloma and haemoglobinopathies.
o Chronic obstructive pulmonary disease.
o Chronic liver failure.
o Chronic kidney disease.
o Immobility.

118
Q

Contents of 0.9% saline 1L?

A

Sodium - 150 mmol/litre

Chloride - 150 mmol/litre

119
Q

Contents of Hartmann’s fluid 1L?

A 
Sodium - 131 mmol/litre
Potassium - 5 mmol/litre
Bicarbonate - 29 mmol/litre
Chloride - 111 mmol/litre
Calcium - 2 mmol/litre
120
Q

Amount of potassium in 0.15%?

A

20mmol/L

121
Q

Amount of potassium in 0.3%?

A

40mmol/L

122
Q

Normal requirements of water/day?

A

25–30 ml/kg/day of water

123
Q

Normal requirements of potassium/chloride/sodium/day?

A

1 mmol/kg/day of potassium, sodium and chloride

124
Q

Normal requirements of glucose/day?

A

50–100 g/day of glucose

125
Q

What parameters make up the Glasgow Pancreas score for pancreatitis?

A 
PaO2 <8kPa
Age >55
Neutrophils (>15x109/L)
Calcium (<2mmol/L)
Renal Function (Urea >16mmol/L)
Enzymes (LDH >600, AST >2000)
Albumin <32
Sugar (glucose >10mmol/L
126
Q

What parameters are in the Truelove & Witts UC criteria?

A 
Bowel Movements per day
Blood in Stools
Pyrexia (>37.8)
Pulse Rate >90
Anaemia
ESR
127
Q

Mild UC attack - Truelove & Witts?

A 
Bowel Movements per day - <4
Blood in Stools - no more than small amounts
Pyrexia (>37.8) - no
Pulse Rate >90 - no
Anaemia - no
ESR <30
128
Q

Moderate UC attack - Truelove & Witts?

A 
Bowel Movements per day - 4-6
Blood in Stools - between mild and severe
Pyrexia (>37.8) - No
Pulse Rate >90 - No
Anaemia - No
ESR <30
129
Q

Severe UC attack - Truelove & Witts?

A 
Bowel Movements per day >6
Blood in Stools - Visible blood
Pyrexia (>37.8) - Yes
Pulse Rate >90 - Yes
Anaemia - Yes
ESR >30
130
Q

When and what antibiotics to give in ascites?

A

Ascites with protein <15g/L, until resolved

Prophylactic oral ciprofloxacin/norfloxacin

131
Q

What tests are needed before azathioprine/mercaptopurine drug given?

A

Pre-treatment - Thiopurine methyltransferase (TPMT)

FBC weekly for first 4 weeks, then every 3 months

Year 5 Core Conditions (55 decks)

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