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Internal Med > Random facts > Flashcards

Random facts Flashcards

1
Q

CXR of pulmonary edema shows?

A

Perihilar opacities
Costophrenic angle blunting
Upper lobe diversion
Kerley B lines
Cardiomegaly

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2
Q

When is Pro-BNP raised?

A

It is released in atrial stretch.
Hence high in cardiac failure

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3
Q

How does CKD cause hypertension?

A

Through impaired autoregulation and hypervolemia.
HTN itself accelerates progression of renal disease

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4
Q

How to test for Conn’s?

A

Aldosterone-to-Renin ratio for screening.
Oral sodium loading test / Saline suppression test for confirmation.

Adrenal CT or Adrenal Venous sampling for Invasive/imaging

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5
Q

Which type of Local Anaes has longer half life?

A

Amide type (lidocaine, bupivacaine) has longer T-half. Metabolized by liver.

Ester type LA (PRocaine) has shorter T-half.

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6
Q

What is Xerophthalmia?

A

Spectrum of ocular disorder due to Vit A deficiency.
Causes dry eyes

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7
Q

Features worrisome for secondary bacterial peritonitis?

Instead of Spontaneous bacterial peritonitis

A
  1. Focal abdo symptoms suggestive of surgical causes
  2. Sudden symptom onset
  3. Polymicrobial gram stain / culture
  4. Very low glucose or high protein in ascitic fluid
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8
Q

What is Tenckhoff catheter for?

A

This catheter is commonly used for peritoneal dialysis. Peritoneal dialysis uses the peritoneal membranes as the dialyser. Dialysate solution is introduced into the peritoneal cavity via a Tenckhoff catheter.

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9
Q

What is pneumatosis intestinalis?

A

Radiographic finding of gas within intestinal wall.
Suggests transmural ischemia or infarct

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10
Q

How to detect WBCs in urine in urinalysis?

A

Positive leukocyte esterase on dipstick

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11
Q

Characteristics of myopathies on biochemical tests?

A

Elevated muscle enzymes e.g. Creatinine kinase and aldolase
Myopathic pattern on EMG.

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12
Q

What is myalgia?

A

Muscle aches and pain

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13
Q

What is myotonia?

A

Slowed relaxatioon after muscle contraction

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13
Q

How to monitor for respiratory insufficiency?

A

Measure forced vital capacity or negative inspiratory force everyday.

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14
Q

How does EEG work?

A

Measures fluctuation of electric potential at different regions of cortex.

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15
Q

What is EEG used for?

A

Often for epilepsy and sleep disorders.

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16
Q

What is EMG used for?

A

To differentiate neuropathies from myopathies

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17
Q

How do Nerve Conduction Studies work?

A

Divided into Sensory NCS and Motor NCS.
It assesses nerve impulse conduction through peripheral nerves an are used to specify type of nerve damage e.g. compression or transection of nerves

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18
Q

What does FBC test for?

A

RBC
WBC
Hemoglobin
Hematocrit
Platelets
Mean Corpuscular Volume

MCV measures average size of RBCs

Hematocrit measures how much of blood is made of RBCs

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19
Q

Name some Abx that cause idiosyncratic platelet destruction

A

Linezolid
Cotrimoxazole
Beta lactams

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20
Q

Initial septic workup?

A

FBC - neutrophilia, lymphocytosis, eosinophilia etc may be found
Inflammatory markers = WBC, CRP, procalcitonin
Blood cultures
Localizing investigations = e.g. CXR, urine microscopy + culture

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21
Q

What do the different types of leukocytosis indicate?

A

Neutrophilia with left shift = bacterial
Lymphocytosis = viral
Eosinophilia = parasitic / other IgE-related AI pathology

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22
Q

Common central causes of fever?

A

Heat Stroke
Thyrotoxicosis
Phaeochromocytoma
Drugs - NMS, Serotonin syndrome, malignant hyperthermia
Toxins - cocaine etc etc

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23
Q

What is neuroleptic Malignant Syndrome (NMS)?

A

Seen in patients with anti-psychotics and dopmine antagonists.
Present with fever, altered mental state and autonomic dysfunction, usu over 1-3 days

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24
Q

What is Serotonin syndrome?

A

Increased CNS serotoninergic activity due to serotonin agonists
Fever, tachycardia, altered mental state

Resembles NMS, but has more acute onset within 24hr

25
Q

what is Raynaud phenomenon?

A

Recurrent vasospasm of fingers and toes, usually in response to stress or cold exposure.
Vasospasm is paroxysmal, bilateral and a/w normal capillaroscopy findings.

Can occur as primary condition (Raynaud disease) or secondary (usu AI)

26
Q

What is Discoid rash / Discoid lupus erythematosus?

A

Erythematous scaly plaques that often result in inflammation, scarring, and atrophy on face, ears and scalp.

Chronic autoimmune skin condition

27
Q

Difference between Rheumatoid vs SLE arthritis?

Hint: deformities

A

Both Rheumatoid and SLE arthritis affect MCP and PIP joints, but SLE does not usually lead to deformities.

28
Q

What is pulsus paradoxus?

A

Large fall in systolic BP on inspiration

>10 mmHg fall

29
Q

What is Kussmaul breathing?

A

Type of hyperventilation in response to acidosis.

Look for DKA, uremic acidosis etc.

30
Q

5 Ts of anterior mediastinal mass?

5 most common ant medistinal mass

A

Thymus
Teratoma
“Terrible” lymphoma
Thoracic aorta
Thyroid

31
Q

Old stroke prediposes to what infection?

A

Aspiration pneumonia

32
Q

Neutrophilia with left shift suggests?

A

Bacterial infection

33
Q

Lymphocytosis suggests?

A

Viral infection

34
Q

Eosinophilia suggests?

A

Parasitic infection or other IgE-associated autoimmune pathology

35
Q

Criteria for oliguria?

A

Less than 20ml per hour

36
Q

What body state causes hypercoagulable state?

A

Pregnancy
Oral contraceptives

37
Q

Criteria for postural hypotension?

A

Sustained fall in systolic BP >20mmHg, or diastolic BP >10mmHg

38
Q

Criteria for significant LOW?

A
  1. unintentional
  2. Lost 5-10% over 6-12 months
39
Q

Causes of primary and secondary lymphedema?

Primary is rare. SEcondary more common

A

Primary = Congenitally poorly developed lymphatic vessels, characteristic in Turner syndrome
Sec = Tumours, surgeries, inflammation, trauma, radiation, infections

40
Q

Presentation of lymphedema?

A

Unilateral LL swelling. Characteristic non-pitting edema.
Toes and feet swelling with deep flexion creases
Stemmer’s sign - cannot lift a skin fold on base of 2nd toe

41
Q

Causes of unilateral non pitting edema?

A

Myxedema
Lymphedema
DVT
Lipedema

42
Q

What vaccines are contraindicated in HIV patients?

A

Live influenza vax.
Live smallpox vax
BCG (for TB) live typhoid vax

43
Q

How does septic arthritis usually spread?

A

Haematogenously!

44
Q

OA usually affects?

A

Knee, shoulders, MCPJ, PIPJ

45
Q

Sepsis six bundle?

A

6 tasks to be done in 1 hr.
Oxygen
Abx
Fluids
Culture
Lactate measurement
Urine Output monitoring

3 things to measure, 3 things to give.
Put in catheter for strict UO monitoring

46
Q

quick SOFA score for sepsis?

A

1 point each!
RR ≥ 22
altered mental status
Systolic BP ≤ 100

47
Q

Causes of tiredness?

A

Chronic infection
Any major organ failure
DM
Malabsorption
HypoT
Hypogonadism
Adrenal insufficiency
Anemia
OSA
Malignancy
Naproxen
Uncontrolled inflammatory state

48
Q

Common drugs that cause LL swelling?

A

Amlodipine
NSAIDs
Prednisolone

49
Q

Why are there cold and clammy peripheries in shock?

A

Due to baroreceptor reflex causing peripheral vasoconstriction to redirect blood for central perfusion.

50
Q

Locations of internal bleeding?

A

BGIT is top cause by far.
Others include hemothorax, retroperitoneum

51
Q

Why cannot feel ridges of MCPJ in synovitis?

A

The inflammation in synovitis causes joint effusion.
Subclinical synovitis can be detected with US

52
Q

How does hyperglycemia damage vessels?

A

Oxidative stress

53
Q

In hypotension, how is sympathetic system activated to raise BP?

A

Hypoperfusion at carotid sinus causes baroreceptors to activate sympathetic reflex, which activates chronotropic and inotropic effects on, raising both Contractility and HR to raise CO.

54
Q

Can adenoCA and post-infection cause pro-thrombotic state?

A

Yes

55
Q

Pain that improves towards end of day points to?

A

Inflammatory pain

56
Q

How to test for OSA?

A

Polysomnography

57
Q

Albumin abnormality points to acute or chronic problem?

A

Albumin abnormality points to chronic issue.

58
Q

How to manage localized vs mets cancer?

A

Localized = surgery + immunomodulator therapy
Mets = Immunomodulator first, then surgery

very broad principles!!!

59
Q
A
60
Q

Primary vs Secondary amenorrhea?

A

Primary = never had menses before
Secondary = had menses before

61
Q

Pathophysiology of uremia?

A

Defective ion transport across cell membranes, resulting in intracellular sodium and water accumulation.

Uremia is indications for dialysis and sign of ESRD!

Internal Med (18 decks)

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