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Nat 5 Physics > More bits and bobs > Flashcards

More bits and bobs Flashcards

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1
Q

What is the definition of high blood pressure?

A

Over 140/90

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2
Q

What are secondary causes of hypertension?

A

Endocrine disorders (cushings disease, phaeochromocytoma, acromegaly, conn’s syndrome, thyrotoxicosis)

Renal disease (chronic renal failure, renal artery stenosis)

Coarctation of the aorta

Drugs (isotretinoin, corticosteroids, ciclosporin)

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3
Q

How do you check for end organ damage in hypertension?

A

fundoscopy: to check for hypertensive retinopathy

urine dipstick: to check for renal disease, either as a cause or consequence of hypertension

ECG: to check for left ventricular hypertrophy or ischaemic heart disease (Left bundle branch block)

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4
Q

What are potential drugs you can take for high blood pressure?

A

Ace I (first line if you are under 55)

Calcium channel blocker if you are over 55 (or are under 55 but afrocarribean)

Thiazide like diuretic

Angiotensin 2 receptor blocker

Beta blocker

Spironolactone (this is generally when there is low potassium)

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5
Q

What are the side effects of cacium channel blockers?

A

Flushing

Headache

Swelling of legs

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6
Q

What are the side effects of ace inhibitors?

A

Hyperkalaemia

Angiodema

Cough

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7
Q

What are the side effects of thiazide like diuretics?

A

Hyponatraemia

Hypokalaemia

Dehydration

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8
Q

What are non-pharma ways to control blood pressure?

A

Reduce salt intake

Stop smoking

Reduce alcohol intake

Optimise glycaemic control

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9
Q

What are the symptoms of high blood pressure?

A

Syncope

Headache

Blurred vision

Epistaxis

Angina

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10
Q

What are the causes of atrial fibrillation?

A

Ischaemic heart disease

Lung disease

Hypoxia

Hypertension

Rheumatic heart disease

Sepsis

Hypercapnea

Alcohol

Mitral stenosis

Atrial septal defect

Metabolic abnormalities

Thyrotoxicosis

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11
Q

What are symptoms of AF?

A

Palpitations

Dizziness

SOB

HF

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12
Q

What are the signs of AF?

A

Irregularly irregular pulse

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13
Q

What would you see on ECG for AF?

A

Absent P waves

Ireg ireg rhythm

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14
Q

What is the treatment in AF that controls rhythm?

A

Digoxin, beta blockers, diltiazem

DC cardioversion

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15
Q

What are the drugs used to prevent coagulation in AF?

A

Warfarin / heparin

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16
Q

What are the complications of AF?

A

Systemic embolisation

Rapid ventricular rate leading to hypotensin, angina and heart failure

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17
Q

What are the boundaries of the anterior border of the neck?

A

Anterior border of the Sternocleidomastoid
Lower border of mandible
Anterior midline

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18
Q

What are the contents of the anterior triangle of the neck?

A

Digastric triangle:

Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve

Muscular triangle:

Strap muscles
External jugular vein

Carotid triangle:

Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis

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19
Q

What are causes of neck swelings?

A

Reactive lymphadenopathy

Thyroid swelling - moves upward on swallowing

Thyroglossal cyst - More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

Cystic hygroma

Branchial cyst - failure of obliteration of second branchial cleft in embryonic development

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20
Q

How does a thyroglossal cyst form?

A

Remnant of the thyroglossal duct

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21
Q

What are causes of hypothyroidism?

A

Hashimotos - autoimmune condition

Subacute thyroiditis (later stages)
Insufficient dietary iodine

Drugs (lithium, amiodarone)

Down’s, turners, coeliacs

Post - surgery

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22
Q

What is the presentation of hypothyroidism?

A

Fatigue

Lethargy

Cold intolerance

Constipation

Weight gain

Carpal tunnel syndrome

Menorrhagia

Low mood

Dry skin

Hair loss

Slow reflexes

Peri-orbital puffiness

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23
Q

What are the levels of thyroid hormones in hypothyroidism?

A

TSH is high

T4 is low

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24
Q

What are the causes of acute pancreatitis?

A

GETSMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps (other viruses include Coxsackie B)

Autoimmune (e.g. polyarteritis nodosa), Ascaris infection

Scorpion venom

Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia

ERCP

Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

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25
Q

What are the features of acute pancreatitis?

A

Severe epigastric pain that may radiate through to the back

Vomiting is common

Examination may reveal tenderness, ileus and low-grade fever

Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

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26
Q

What are the necessary investigation for acute pancreatitis?

A

ERCP

Bloods - amylase / lipase

Abdominal X-Ray (ileus)

Chest X-Ray (pleural effusion)

Abdominal ultrasound (pancreatic oedema, gallstones, pseudocyst)

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27
Q

What are markers of severe pancreatitis?

A

High white cell count

High blood glucose

High blood urea

High AST

Low serum albumin

Low serum calcium

Low arterial partial pressure oxygen

High CRP

28
Q

What is the managment of acute pancreatitis?

A

Analgesia

FLuids

Blood transfusion

NG tube - rest the gland

Oxygen

May require insulin

If pancreatic necrosis - CT guided aspiration - antibiotics and surgery

If gallstones - EUS/MRCP/ERCP - cholecystectomy

Lifestyle modifications - lower alcohol, diet and lipid lowering drugs

29
Q

What are complications of acute pancreatitis?

A

Pancreatic necrosis

Abscess

Pseudocyst

30
Q

What are the different causes of cushings syndrome?

A

Exogenous vs endogenous

ACTH dependant

ACTH independant

Pseudocushings

31
Q

What are the ACTH dependant causes of cushings disease?

A

Pituitary tumour secreting too much ACTH - adrenal hyperplasia

Ectopic ACTH secretion i.e from a small cell lung cancer

32
Q

What are the ACTH independant causes of cushing’s syndrome?

A

Steroids

Adrenal Adenoma/carcinoma

Carney complex

I think this also includes alcohol excess and depression

(since there is no excretion of ACTH by a tumour then this is called cushings syndrome not disease)

33
Q

What are the causes of pseudocushing’s?

A

Pseudo-Cushing’s

mimics Cushing’s

often due to alcohol excess or severe depression

causes false positive dexamethasone suppression test or 24 hr urinary free cortisol

insulin stress test may be used to differentiate

34
Q

What are the signs and symptoms of cushings?

A

Increase weight gain

Poor wound healing

Recurrent infections

Depression

Menstrual disturbances

Low libido

Hirsuitism

Headache

Osteoporosis

Signs:

Moonface

Abdominal striae

Centripetal obesity

Proximal myopathy

Hirsuitism

Thin skin

Easy bruising

Hypertension

Acne

35
Q

What are the investigations for cushings?

A

24 hour urinary collection: free cortisol

Random blood cortisol - loss of circadian rhythm (normally secreted in the morning)

Low dose - dexamethasone suppression test - confirm wether ACTH can be suppressed

High dose dexamethasone supression test - differentiate between pituitary and ectopic ACTH secretion

36
Q

Probably worth having a wee gander

A
37
Q

What are the treatments for cushings syndrome?

A

Medical:

  • Metyrapone
  • Ketoconazole

Surgery - adrenalectomy

38
Q

What are the treatments for cushings disease?

A

Surgery = trans-sphenoidal surgery (this is if there is an ACTH secreting tumour in the pituitary)

39
Q

What percentage of strokes are TACS?

A

15%

40
Q

Which arteries does the total anterior circulation stroke affect?

A

Involves the middle and anterior cerebral arteries

41
Q

What are the criteria for TACs?

A

All 3 of:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
42
Q

What portion of strokes are partial anterior circulation infarcts

A

25%

43
Q

What arteries are involved in the partial anterior circulation?

A

Smaller arteries of anterior circulation e.g upper or lower division of middle cerebral artery

44
Q

What are the criteria for a PACS?

A

2 of the following criteria:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
45
Q

What percentage of strokes are lacunar infarcts?

A

25%

46
Q

Which arteries are involved in a lacunar stroke?

A

Perforating arteries around the internal capsule, thalamus and basal ganglia

47
Q

How does a lacunar stroke present?

A

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
48
Q

What percentage of strokes are posterior circulation infarcts?

A

25%

49
Q

Which arteries are involved in posterior circulation infarcts?

A

25%

50
Q

What are the signs of posterior circulation infarct?

A

Presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
51
Q

What are the features of haemorrhagic stroke?

A

Decreased level of consciousness likely

Headache

Nausea and vomitting

Seizures

52
Q

What are risk factors for AAA?

A

Hypertension

Diabetes

Smokers

Marfan’s or other connective tissue diseases

53
Q

When is surgery usually offered to AAA?

A

Between 5.5 cm and 6 cm

3-4.4 = annual USS scans

4.5-5.5 = 3 monthly USS scans

54
Q

What are the clinical features of aortic stenosis?

A

Chest pain

DYspnoea

Syncope

55
Q

What are features of severe aortic stenosis?

A

Narrow pulse pressure

Slow rising pulse

Delayed ESM

Soft/absent S2

S4

Thrill

Duration of murmur

Left ventricular hypertrophy or failure

56
Q

What are the causes of aortic stenosis?

A

degenerative calcification (most common cause in older patients > 65 years)

bicuspid aortic valve (most common cause in younger patients < 65 years)

William’s syndrome (supravalvular aortic stenosis)

post-rheumatic disease

subvalvular: HOCM

57
Q

What are the potential managements available for aortic stenosis?

A

Valve replacement

Balloon valvuloplasty for those that are unfit for surgery

58
Q

What is the ECG finding of aortic stenosis?

A

LBBB

59
Q

What are organisms that cause cellulitis?

A

Strep pyogenes

Staph aureus

60
Q

What are the symptoms of celulitis?

A

commonly occurs on the shins

erythema, pain, swelling

there may be some associated systemic upset such as fever

61
Q

What is the treatment of cellulitis?

A

Flucloxicillin

Clairithromycin or clindamycin is recommended in patients allergic to penicillin

Severe cellulitis = iv benzylpenicillin and flucloxicillin

62
Q

What is meant by an outbreak?

A

Sudden increase in occurences of a disease in a particular time and place.

63
Q

What are potential organisms for hospital outbreak?

A

Group A beta-haemolytic streptococcus

MRSA

influenza A

C.diff

Measles

Meningococcal infections

Parainfluenza

Pertussis

RSV
Varicela

64
Q

What type of bacteria are gut pathogens?

A

Gram Negative

Large aeorobic bacilli

65
Q

What type of orgnism is campylobacter?

A

Gram negative

Small, curved, microaerophilic bacilli

66
Q

What type of bacteria are neisseria?

A

Gram negative Aerobic cocci

67
Q

When should you suspect a hereditary cancer syndrome?

A

Cancer in 2 or more close relatives (on same side of family)

Early age at diagnosis

Multiple primary tumors

Bilateral or multiple rare cancers

Characteristic pattern of tumours (e.g. breast and ovary)

Evidence of autosomal dominant transmission

Nat 5 Physics (3 decks)

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