Random facts Flashcards
CXR of pulmonary edema shows?
Perihilar opacities
Costophrenic angle blunting
Upper lobe diversion
Kerley B lines
Cardiomegaly
When is Pro-BNP raised?
It is released in atrial stretch.
Hence high in cardiac failure
How does CKD cause hypertension?
Through impaired autoregulation and hypervolemia.
HTN itself accelerates progression of renal disease
How to test for Conn’s?
Aldosterone-to-Renin ratio for screening.
Oral sodium loading test / Saline suppression test for confirmation.
Adrenal CT or Adrenal Venous sampling for Invasive/imaging
Which type of Local Anaes has longer half life?
Amide type (lidocaine, bupivacaine) has longer T-half. Metabolized by liver.
Ester type LA (PRocaine) has shorter T-half.
What is Xerophthalmia?
Spectrum of ocular disorder due to Vit A deficiency.
Causes dry eyes
Features worrisome for secondary bacterial peritonitis?
Instead of Spontaneous bacterial peritonitis
- Focal abdo symptoms suggestive of surgical causes
- Sudden symptom onset
- Polymicrobial gram stain / culture
- Very low glucose or high protein in ascitic fluid
What is Tenckhoff catheter for?
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.
What is pneumatosis intestinalis?
Radiographic finding of gas within intestinal wall.
Suggests transmural ischemia or infarct
How to detect WBCs in urine in urinalysis?
Positive leukocyte esterase on dipstick
Characteristics of myopathies on biochemical tests?
Elevated muscle enzymes e.g. Creatinine kinase and aldolase
Myopathic pattern on EMG.
What is myalgia?
Muscle aches and pain
What is myotonia?
Slowed relaxatioon after muscle contraction
How to monitor for respiratory insufficiency?
Measure forced vital capacity or negative inspiratory force everyday.
How does EEG work?
Measures fluctuation of electric potential at different regions of cortex.
What is EEG used for?
Often for epilepsy and sleep disorders.
What is EMG used for?
To differentiate neuropathies from myopathies
How do Nerve Conduction Studies work?
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
What does FBC test for?
RBC
WBC
Hemoglobin
Hematocrit
Platelets
Mean Corpuscular Volume
MCV measures average size of RBCs
Hematocrit measures how much of blood is made of RBCs
Name some Abx that cause idiosyncratic platelet destruction
Linezolid
Cotrimoxazole
Beta lactams
Initial septic workup?
FBC - neutrophilia, lymphocytosis, eosinophilia etc may be found
Inflammatory markers = WBC, CRP, procalcitonin
Blood cultures
Localizing investigations = e.g. CXR, urine microscopy + culture
What do the different types of leukocytosis indicate?
Neutrophilia with left shift = bacterial
Lymphocytosis = viral
Eosinophilia = parasitic / other IgE-related AI pathology
Common central causes of fever?
Heat Stroke
Thyrotoxicosis
Phaeochromocytoma
Drugs - NMS, Serotonin syndrome, malignant hyperthermia
Toxins - cocaine etc etc
What is neuroleptic Malignant Syndrome (NMS)?
Seen in patients with anti-psychotics and dopmine antagonists.
Present with fever, altered mental state and autonomic dysfunction, usu over 1-3 days
What is Serotonin syndrome?
Increased CNS serotoninergic activity due to serotonin agonists
Fever, tachycardia, altered mental state
Resembles NMS, but has more acute onset within 24hr
what is Raynaud phenomenon?
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)
What is Discoid rash / Discoid lupus erythematosus?
Erythematous scaly plaques that often result in inflammation, scarring, and atrophy on face, ears and scalp.
Chronic autoimmune skin condition
Difference between Rheumatoid vs SLE arthritis?
Hint: deformities
Both Rheumatoid and SLE arthritis affect MCP and PIP joints, but SLE does not usually lead to deformities.
What is pulsus paradoxus?
Large fall in systolic BP on inspiration
>10 mmHg fall
What is Kussmaul breathing?
Type of hyperventilation in response to acidosis.
Look for DKA, uremic acidosis etc.
5 Ts of anterior mediastinal mass?
5 most common ant medistinal mass
Thymus
Teratoma
“Terrible” lymphoma
Thoracic aorta
Thyroid
Old stroke prediposes to what infection?
Aspiration pneumonia
Neutrophilia with left shift suggests?
Bacterial infection
Lymphocytosis suggests?
Viral infection
Eosinophilia suggests?
Parasitic infection or other IgE-associated autoimmune pathology
Criteria for oliguria?
Less than 20ml per hour
What body state causes hypercoagulable state?
Pregnancy
Oral contraceptives
Criteria for postural hypotension?
Sustained fall in systolic BP >20mmHg, or diastolic BP >10mmHg
Criteria for significant LOW?
- unintentional
- Lost 5-10% over 6-12 months
Causes of primary and secondary lymphedema?
Primary is rare. SEcondary more common
Primary = Congenitally poorly developed lymphatic vessels, characteristic in Turner syndrome
Sec = Tumours, surgeries, inflammation, trauma, radiation, infections
Presentation of lymphedema?
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
Causes of unilateral non pitting edema?
Myxedema
Lymphedema
DVT
Lipedema
What vaccines are contraindicated in HIV patients?
Live influenza vax.
Live smallpox vax
BCG (for TB) live typhoid vax
How does septic arthritis usually spread?
Haematogenously!
OA usually affects?
Knee, shoulders, MCPJ, PIPJ
Sepsis six bundle?
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
quick SOFA score for sepsis?
1 point each!
RR ≥ 22
altered mental status
Systolic BP ≤ 100
Causes of tiredness?
Chronic infection
Any major organ failure
DM
Malabsorption
HypoT
Hypogonadism
Adrenal insufficiency
Anemia
OSA
Malignancy
Naproxen
Uncontrolled inflammatory state
Common drugs that cause LL swelling?
Amlodipine
NSAIDs
Prednisolone
Why are there cold and clammy peripheries in shock?
Due to baroreceptor reflex causing peripheral vasoconstriction to redirect blood for central perfusion.
Locations of internal bleeding?
BGIT is top cause by far.
Others include hemothorax, retroperitoneum
Why cannot feel ridges of MCPJ in synovitis?
The inflammation in synovitis causes joint effusion.
Subclinical synovitis can be detected with US
How does hyperglycemia damage vessels?
Oxidative stress
In hypotension, how is sympathetic system activated to raise BP?
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.
Can adenoCA and post-infection cause pro-thrombotic state?
Yes
Pain that improves towards end of day points to?
Inflammatory pain
How to test for OSA?
Polysomnography
Albumin abnormality points to acute or chronic problem?
Albumin abnormality points to chronic issue.
How to manage localized vs mets cancer?
Localized = surgery + immunomodulator therapy
Mets = Immunomodulator first, then surgery
very broad principles!!!
Primary vs Secondary amenorrhea?
Primary = never had menses before
Secondary = had menses before
Pathophysiology of uremia?
Defective ion transport across cell membranes, resulting in intracellular sodium and water accumulation.
Uremia is indications for dialysis and sign of ESRD!
