Progress Test Questions: Flashcards
What is Murphy’s sign?
Indicates cholecysitis: right subcostal area is palpated- pain isn’t felt on inspiration as the inflamed gallbladder comes into contact with the hand
What is Horner’s syndrome?
A combination of syndromes that arise when the sympathetic trunk is damaged- ptosis (drooping of upper eyelid- anhidrosis (decreases sweating) -miosis (constriction of pupil) are all observed
Relevant to respiratory examination as a pancoast tumour may be pressing on the sympathetic chain of nerves in the chest
What is a pancoast tumour?
A tumour of the pulmonary apex- it typically spreads to nearby tissues such as the ribs and vertebrae
The tumour May cause horner’s syndrome by pressing the nerves of the sympathetic ganglion
How is giant cell arteritis diagnosed?
Blood test for ESR and CRP- a raised ESR and CRP will be seen in GCA as it is an inflammatory condition
- 10% of people will not have these raised
- temporal artery biopsy is the gold standard for diagnosis- the others would be used as they are less invasive and this can also take a long time to give results
What are ESR and CRP?
Inflammatory markers detected on blood tests
How would you treat GCA?
corticosteroids- begin prednisolone immediately if suspected- 60-100mg daily (high dose)
What is the Rockall scoring system used for?
Assessing the severity of upper GI bleeding- includes BP and HR, comorbidities and any stigmata of recent haemorrhage
What can lactic acidosis be a sign of?
It is a form of metabolic acidosis that occurs during ischaemia- may be seen in ischaemic bowel
What is a strangulated hernia?
A hernia in which the blood supply has been compromised- the hernia contents are ischaemic and the patient should undergo emergency surgery
When are ESR and CRP raised?
In any chronic inflammatory conditions (e.g. rheumatoid arthritis, GCA), infections and accesses.
Which is the most common type of hernia?
Inguinal hernia
What is the difference between a direct and indirect inguinal hernia?
An indirect hernia passes through the inguinal canal- enters laterally to the deep inguinal ring and exiting via the superficial ring; a direct hernia the contents merge into the inguinal canal medially to the deep inguinal ring
Where does Chron’s disease commonly present?
the terminal ileum- this is often associated with right iliac pain
What is a central line and where are they typically placed?
A central line or central venous catheter (CVC) is a catheter placed into a large vein- if there is risk of significant blood loss in surgery they may be placed
Internal Jugular Vein
Subclavian/axillary vein
Femoral vein
post pituitary gland hormones?
ADH and oxytocin
ant pituitary gland hormones?
growth hormone, ACTH (adrencorticotropic hormone), TSH, FSH and LH, prolactin
What is Sheehan’s syndrome?
if during childbirth a woman loses a lot of blood or has severely low blood pressure there is damage to the pituitary gland due to lack of oxygen- this affects the hormones produced by the pituitary gland and may result in being unable to breastfeed and amenorrhea
What are the two most common heart valve deformities in the UK?
Atrial stenosis, mitral regurgitation
What are some drugs that require careful monitoring?
gentamycin, vancomycin, digoxin, warfarin (INR)
What is pernicious anaemia?
An autoimmune disorder affecting the gastric mucosa- it results in vitamin B12 deficiency
What are causes of vitamin b12 deficiency?
pernicious anaemia, atrophic gastritis (H. pylori infection), gastrectomy, malnutrition
What is vitamin b12 used for and as a result what are the symptoms of deficiency?
myelenation of nerves- symptoms may include paraesthesia and muscle weakness as well as symptoms of anaemia
What autoimmune conditions does pernicious anaemia tend to occur alongside?
type 1 diabetes
Grave’s disease
What is Courvoisier’s sign?
a palpable gallbladder with painless jaundice- this is likely to be cholangiocarcinoma
What is primary sclerosing cholangitis?
a long-term progressive disease of the gallbladder and pancreas characterised by inflammation and scarring of the bile ducts
What does palpable Virchow’s node indicate?
As Virchow’s node receives lymph from the abdomen- if it is palpable it indicates metastatic malignancy from somewhere in the abdomen e.g. cholangiocarcinoma, gastric cancer, kidney cancer
What is Gilbert’s syndrome?
An autosomal recessive condition characterised by defective bilirubin conjugation (caused by a deficiency of UDP glucuronosyltransferase)
What are ACE inhibitors used for, example and a common side effect?
hypertension, given after a heart attack, example: ramirpril, common side effect: dry cough
What is the QRISK3 score?
an algorithm which calculates someones risk of developing a heart attack or stroke in the next 10 years
Example of a thiazide diuretic and a common side effect?
hydrochlorothiazide, indapamide, chlorothiazide- common side effect is hyponatraemia as sodium is moved into the DCT to increase diuresis
What are the differentials for headaches?
migraine, cluster headache, tension headache, temporal arteritis, sub-arachnoid headache
Which type of headache presents with a ‘thunderclap’ onset?
sub-arachnoid
What are some clinical signs of meningitis?
Pyrexia, unblanching rash (meningococcal), Kernig’s sign (hamstring stiffness) and nuchal rigidity
Which investigation should be carried out if meningitis is suspected and what are you looking for?
lumbar puncture- opening pressure measured, consistency, glucose and protein contents and WCC of the CSF is considered
Protein + glucose content in bacterial meningitis
very low glucose and very high protein
Protein + glucose content in viral meningitis
normal glucose and raised protein
How does temporal arteritis present?
localised pain in the temporal region- may be painful to brush hair, jaw claudication due to cramping and loss of blood supply
What is vasculitis?
an inflammatory disorder of the blood vessels- it can affect the vessels in any organ- presentation will depend on which organs are involved
Whats should you consider protecting if you are prescribing a high dose of corticosteroids?
gastric and bone protection- e.g. a PPI and alendronate
Why is hyperkalaemia dangerous?
it may cause arrythmias or cardiac arrest
What is achondroplasia?
a disorder of bone growth that prevents the changing of cartilage- characterised by dwarfism
Which group of drugs are contra-indicated in Parkinson’s and why?
anti-psychotics; this is because they usually function using dopamine
What bacteria are aminoglycosides used against?
aerobic gram negative bacteria
