Miscellaneous Points Flashcards
Which leads are supplied to LAD artery of heart?
V1, V2, V3, V4
Which leads are supplied to Left circumflex artery of heart?
I, aVL, V5, V6
Which leads are supplied to right coronary artery of heart?
II, III, aVF
Leads corresponding to anterior part of heart?
V3, V4
Leads corresponding to septal part of heart?
V1, V2
Leads corresponding to inferior part of heart?
II, III, aVF
Leads corresponding to lateral part of heart?
I, aVL, V5, V6
Leads corresponding to posterior part of heart?
Pathological R waves in V1, V2, V3
Reciprocal horizontal ST depression in V1-V3
Features of MEN1?
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell insulinomas
Features of MEN2A?
Hyperparathyroidism
Medullary thyroid cancer
Phaeochromocytoma
Features of MEN2B?
Marfanoid body Mucosal neuromas Medullary thyroid cancers Phaeochromocytoma Intestinal ganglioneuromas
Features of BRCA 1&2?
Breast, ovary and prostate cancers
Features of VHL?
Angiomatosis Haemangioblastoma Phaeochromocytoma Papillary cystadenoma of epidydimis RCC
Features of FAP?
Polyposis Thyroid cancer Congenital hypertrophy of retinal pigment epithelium (CHRPE) Supernumery teeth Epidermoid cysts Osteoma
Features of HNPCC?
Colorectal, endometrial, ovary and gastric cancers
Features of Peutz Jeghers’ syndrome?
Small intestine haemartomatous polyps, hyperpigmented mucocutaneous sites
Epilepsy medications - tonic clonic seizures?
Sodium Valproate//Lamotrigine
Carbamazepine
Epilepsy medications - absence seizures?
Sodium Valproate/Ethosuximide
Lamotrigine
Epilepsy medications - tonic/atonic seizures?
Sodium Valproate
Lamotrigine
Epilepsy medications - myotonic seizures?
Sodium Valproate/Topiramate/Levetiracetam
Epilepsy medications - partial seizures?
Carbamazepine/Lamotrigine
Sodium Valproate/Levetiracetam
Canadian C-spine rule - high risk factor?
> 65
Dangerous mechanism
Paraesthesia in extremities
Canadian C-spine rule - low risk factor?
Simple rear end collision Sitting in ED Ambulatory at any time Delayed neck pain No midline C-spine tenderness
Canadian C-spine rule - other factor?
Able to rotate neck actively left and right 45 degrees
Criteria for imaging in Canadian C Spine rule? What imaging?
1 or more high risk factor
No low risk factors
Not able to rotate neck 45 degrees left and right
CT adult
MRI child
Criteria for CT head <1 hour in children?
PICANSS F RF
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
Criteria for CT head <1 hour in adults?
FSG GPS Vom
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
Criteria for CT head <8 hours in adults?
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
Stroke - indications for CT within 1 hour?
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
Contraindications for LP?
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
Blood results - Primary hyperparathyroidism?
ALP - high
PTH - high
Ca - high
PO4 - low
Blood results - Secondary hyperparathyroidism?
ALP - high
PTH - high
Ca - low/normal
PO4 - high/normal
Blood results - Tertiary hyperparathyroidism?
ALP - high
PTH - high
Ca - high
PO4 - high
Blood results - Hypoparathyroidism?
ALP - no change
PTH - low
Ca - low
PO4 - high
Blood results - Paget’s Disease of Bone?
ALP - high
PTH - normal
Ca - normal
PO4 - normal
Blood results - Osteomalacia?
ALP - high
PTH - normal/high
Ca - low
PO4 - normal/high
Blood results - Osteoporosis?
ALP - normal
PTH - normal
Ca - normal
PO4 - normal
Blood results - normal/euthyroid?
TSH - normal
T3 & T4 - normal
Blood results - hyperthyroidism?
TSH - low
T3 & T4 - high
Blood results - Primary hypothyroidism??
TSH - high
T3 & T4 - low
Blood results - Secondary hypothyroidism?
TSH - low
T3 & T4 - low
Blood results - TSH producing adenoma?
TSH - high
T3 & T4 - high
Blood results - Levothyroxine overtreatment?
TSH - low
T3 & T4 - high (can be normal)
Heart murmurs - aortic stenosis?
Ejection systolic murmur, radiates to carotids
Heart murmurs - aortic regurgitation?
Early diastolic murmur, forward in expiration
Heart murmurs - mitral stenosis?
Mid-diastolic murmur, loudest at apex, opening snap
Heart murmurs - mitral regurgitation?
Pan systolic murmur, radiates to axilla
Heart murmurs - mitral valve prolapse?
Mid systolic click
Heart murmurs - VSD?
Pan-systolic murmur at LLSE
Heart murmurs - PDA?
Continuous murmur
What is S3 heart sound?
KEN-TUCK-Y
Ventricular filling rapidly, normal in children/athletes/high output states
Pathology - CHF, chronic MR/TR, Dilated cardiomyopathy
What is S4 heart sound?
TEN-ES- SEE
Atrial contraction in non-compliant ventricle - abnormal
Hypertension, AS, HOCM
What is Corrigan’s Pulse?
Waterhammer pulse
Pulse forceful and suddenly collapses, sign of aortic regurgitation
What is Beck’s Triad?
Hypotension
Rising JVP
Muffled heart sounds
Seen in cardiac tamponade
What is Kussmaul’s Sign?
JVP increases during respiration
What is Austin Flint Murmur?
Low-pitched mid-diastolic murmur, sign of severe aortic stenosis due to blood striking anterior leaflet of mitral valve
What is De Musset’s Sign?
Nodding of head in synchrony of beating heart due to aortic regurgitation
What is Muller’s Sign?
Bobbing of uvula occurring during systole, in aortic regurgitation
What is Quinke’s Sign?
Capillary pulsations seen on light compression of nail bed, sign of aortic regurgitation
What is Traube’s sign?
Pistol shot - systolic and diastolic murmurs heard over femoral arteries , aortic regurgitation
What is Ewart’s sign?
Dullness on percussion at inferior angle of left scapula when effusion large enough to compress LLL of lung
Wells PE Score - DA PITCH? And interpretation?
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
Wells DVT Score - PEARL CPCP A? And interpretation?
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
Asthma severity assessment - moderate?
Increasing symptoms
PEFR 50-75% best or predicted
No features of acute severe asthma
Asthma severity assessment - severe?
Inability to complete sentences in one breath
PEFR 50-33% best or predicted
RR 25 or over
HR 110 or over
Asthma severity assessment - life-threatening?
Altered conscious level Cyanosis Hypotension Exhaustion Silent Chest Threatening (1) PEFR <33%, (2) SpO2 <92%, (3) PaO2 <8kPa Normal CO2
Asthma severity assessment - Near fatal?
Raised PaCO2 and/or need for ventilation with raised inflation pressures
CURB 65 score in pneumonia?
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
CRB 65 score in pneumonia in GP?
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
Causes of clubbing - cardiovascular?
ACE
Atrial myoxoma
Congenital cyanotic heart disease
Infective endocarditis
Causes of clubbing - respiratory?
SLAM
Supporative lung disease (bronchiectasis, empyema, lung abscess) Lung cancer Alveolitis (fibrosing) Mesothelioma TB CF
Causes of clubbing - gastrointestinal?
5 C’s
Cirrhosis Crohn's & UC Coeliacs disease Cancer CF
Causes of clubbing - endocrine?
thyroid acropatchy in thyrotoxicosis
Causes of erythema nodosum?
SLIMEST
Sarcoidosis Leprosy IBD Meds (Trimethoprim) Streptococcal infection TB
Which cancers cause rise in CEA?
Colorectal cancer
Which cancers cause rise in Ca19.9?
Pancreatic cancer
Which cancers cause rise in AFP?
Hepatocellular cancer
Non-seminomatous germ cell tumour
Which cancers cause rise in B-hCG?
Non-seminomatous germ cell tumour
Gestational trophoblastic disease
Which cancers cause rise in Ca125?
Ovarian Cancer
Which cancers cause rise in PSA?
Prostate Cancer
Which cancers cause rise in Thyroglobulin?
Follicular/Papillary thyroid cancer
Which cancers cause rise in M protein/Bence Jones Protein?
Multiple myeloma
Which cancers cause rise in Catecholamines?
Phaeochromocytoma
Which cancers cause rise in calcitonin?
Medullary thyroid cancer
Which cancers cause rise in LDH?
Lymphoma
Ewing’s sarcoma
What diseases is the antibody RF present in?
RA Sjogren's Syndrome Felty's Syndrome Infection SLE Sclerosis
What disease is the antibody anti-CCP present in?
RA
What diseases is the antibody ANA present in?
SLE Autoimmune hepatitis Sjogren's syndrome RA Sclerosis
What disease is the antibody anti-dsDNA, anti-Sm, anti-RNP present in?
SLE
What disease is the antibody anti-histone present in?
Drug induced lupus
What disease is the antibody anti-cardiolipin present in?
APS
SLE
What disease is the antibody anti-Ro & anti-La present in?
Sjogren’s syndrome
SLE
What disease is the antibody anti-Jo1 & anti-Mi2 present in?
Polymyositis
Dermatomyositis
What disease is the antibody anti-Scl70 present in?
Diffuse Systemic Sclerosis
What disease is the antibody anti-mitochondrial present in?
Primary biliary cirrhosis
What disease is the antibody anti-smooth muscle present in?
Autoimmune hepatitis
What disease is the antibody anti-gastric parietal & anti-intrinsic factor present in?
Pernicious anaemia
What disease is the antibody anti-TTG & anti-endomysial present in?
Coeliac Disease
What disease is the antibody anti-islet cell & anti-GAD present in?
T1DM
What disease is the antibody anti-GBM present in?
Goodpasture’s Syndrome
What disease is the antibody cANCA present in?
Wegener’s granulomatosis
Polyarteritis Nodosa
Microscopic arteritis
What disease is the antibody pANCA present in?
Churg Strauss disease
Microscopic Polyarteritis
What disease is the antibody ANCA present in?
IBD Sclerosing cholangitis Felty's syndrome SLE RA Drug
What disease is the antibody anti-acetylcholine receptor present in?
Myasthenia gravis
What disease is the antibody anti-voltage gated Ca channel present in?
Lambert Eaton Syndrome
What disease is the antibody anti-TSH receptor present in?
Graves disease
What disease is the antibody anti-thyroid peroxidase & anti-thyroglobulin present in?
Hashimoto’s disease
What are the San Francisco Syncope Rules?
CHESS - high risk for serious complications
Congestive HF history Haematocrit <30% ECG abnormal SOB history Systolic BP <90
What is the Oesil Syncope Rule?
Predictor of 12 month mortality
Age >65
Hx of CVD
Syncope without prodrome
Abnormal ECG
What is NIHSS score?
Quantifies severity of acute stroke
Indications of surgical management in infective endocarditis?
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
When to get CCU in management of DKA?
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
What is the CHA2DS2VASC score and interpretation?
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
What is HASBLED Score?
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
Criteria of severity in acute pancreatitis?
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?
What is involved in confusion screen of ‘confused patient’?
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?)
Risk factors for osteoporosis? Over 50?
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.
Contents of 0.9% saline 1L?
Sodium - 150 mmol/litre
Chloride - 150 mmol/litre
Contents of Hartmann’s fluid 1L?
Sodium - 131 mmol/litre Potassium - 5 mmol/litre Bicarbonate - 29 mmol/litre Chloride - 111 mmol/litre Calcium - 2 mmol/litre
Amount of potassium in 0.15%?
20mmol/L
Amount of potassium in 0.3%?
40mmol/L
Normal requirements of water/day?
25–30 ml/kg/day of water
Normal requirements of potassium/chloride/sodium/day?
1 mmol/kg/day of potassium, sodium and chloride
Normal requirements of glucose/day?
50–100 g/day of glucose
What parameters make up the Glasgow Pancreas score for pancreatitis?
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
What parameters are in the Truelove & Witts UC criteria?
Bowel Movements per day Blood in Stools Pyrexia (>37.8) Pulse Rate >90 Anaemia ESR
Mild UC attack - Truelove & Witts?
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
Moderate UC attack - Truelove & Witts?
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
Severe UC attack - Truelove & Witts?
Bowel Movements per day >6 Blood in Stools - Visible blood Pyrexia (>37.8) - Yes Pulse Rate >90 - Yes Anaemia - Yes ESR >30
When and what antibiotics to give in ascites?
Ascites with protein <15g/L, until resolved
Prophylactic oral ciprofloxacin/norfloxacin
What tests are needed before azathioprine/mercaptopurine drug given?
Pre-treatment - Thiopurine methyltransferase (TPMT)
FBC weekly for first 4 weeks, then every 3 months
