Random facts

Question 1

CXR of pulmonary edema shows?

Answer 1

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

Question 2

When is Pro-BNP raised?

Answer 2

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

Question 3

How does CKD cause hypertension?

Answer 3

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

Question 4

How to test for Conn’s?

Answer 4

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

Adrenal CT or Adrenal Venous sampling for Invasive/imaging

Question 5

Which type of Local Anaes has longer half life?

Answer 5

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

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

Question 6

What is Xerophthalmia?

Answer 6

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

Question 7

Features worrisome for secondary bacterial peritonitis?

Instead of Spontaneous bacterial peritonitis

Answer 7

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

Question 8

What is Tenckhoff catheter for?

Answer 8

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.

Question 9

What is pneumatosis intestinalis?

Answer 9

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

Question 10

How to detect WBCs in urine in urinalysis?

Answer 10

Positive leukocyte esterase on dipstick

Question 11

Characteristics of myopathies on biochemical tests?

Answer 11

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

Question 12

What is myalgia?

Answer 12

Muscle aches and pain

Question 13

What is myotonia?

Answer 13

Slowed relaxatioon after muscle contraction

Question 13

How to monitor for respiratory insufficiency?

Answer 13

Measure forced vital capacity or negative inspiratory force everyday.

Question 14

How does EEG work?

Answer 14

Measures fluctuation of electric potential at different regions of cortex.

Question 15

What is EEG used for?

Answer 15

Often for epilepsy and sleep disorders.

Question 16

What is EMG used for?

Answer 16

To differentiate neuropathies from myopathies

Question 17

How do Nerve Conduction Studies work?

Answer 17

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

Question 18

What does FBC test for?

Answer 18

RBC
WBC
Hemoglobin
Hematocrit
Platelets
Mean Corpuscular Volume

MCV measures average size of RBCs

Hematocrit measures how much of blood is made of RBCs

Question 19

Name some Abx that cause idiosyncratic platelet destruction

Answer 19

Linezolid
Cotrimoxazole
Beta lactams

Question 20

Initial septic workup?

Answer 20

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

Question 21

What do the different types of leukocytosis indicate?

Answer 21

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

Question 22

Common central causes of fever?

Answer 22

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

Question 23

What is neuroleptic Malignant Syndrome (NMS)?

Answer 23

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

Question 24

What is Serotonin syndrome?

Answer 24

Increased CNS serotoninergic activity due to serotonin agonists Fever, tachycardia, altered mental state | Resembles NMS, but has more acute onset within 24hr

Question 25

what is Raynaud phenomenon?

Answer 25

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)

Question 26

What is Discoid rash / Discoid lupus erythematosus?

Answer 26

Erythematous scaly plaques that often result in inflammation, scarring, and atrophy on face, ears and scalp. | Chronic autoimmune skin condition

Question 27

Difference between Rheumatoid vs SLE arthritis? ## Footnote Hint: deformities

Answer 27

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

Question 28

What is pulsus paradoxus?

Answer 28

Large fall in systolic BP on inspiration | >10 mmHg fall

Question 29

What is Kussmaul breathing?

Answer 29

Type of hyperventilation in response to acidosis. | Look for DKA, uremic acidosis etc.

Question 30

5 Ts of anterior mediastinal mass? | 5 most common ant medistinal mass

Answer 30

Thymus Teratoma "Terrible" lymphoma Thoracic aorta Thyroid

Question 31

Old stroke prediposes to what infection?

Answer 31

Aspiration pneumonia

Question 32

Neutrophilia with left shift suggests?

Answer 32

Bacterial infection

Question 33

Lymphocytosis suggests?

Answer 33

Viral infection

Question 34

Eosinophilia suggests?

Answer 34

Parasitic infection or other IgE-associated autoimmune pathology

Question 35

Criteria for oliguria?

Answer 35

Less than 20ml per hour

Question 36

What body state causes hypercoagulable state?

Answer 36

Pregnancy Oral contraceptives

Question 37

Criteria for postural hypotension?

Answer 37

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

Question 38

Criteria for significant LOW?

Answer 38

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

Question 39

Causes of primary and secondary lymphedema? | Primary is rare. SEcondary more common

Answer 39

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

Question 40

Presentation of lymphedema?

Answer 40

**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

Question 41

Causes of unilateral non pitting edema?

Answer 41

Myxedema Lymphedema DVT Lipedema

Question 42

What vaccines are contraindicated in HIV patients?

Answer 42

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

Question 43

How does septic arthritis usually spread?

Answer 43

Haematogenously!

Question 44

OA usually affects?

Answer 44

Knee, shoulders, MCPJ, PIPJ

Question 45

Sepsis six bundle?

Answer 45

6 tasks to be done in 1 hr. Oxygen Abx Fluids Culture Lactate measurement Urine Output monitoring ## Footnote 3 things to measure, 3 things to give. Put in catheter for strict UO monitoring

Question 46

quick SOFA score for sepsis?

Answer 46

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

Question 47

Causes of tiredness?

Answer 47

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

Question 48

Common drugs that cause LL swelling?

Answer 48

Amlodipine NSAIDs Prednisolone

Question 49

Why are there cold and clammy peripheries in shock?

Answer 49

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

Question 50

Locations of internal bleeding?

Answer 50

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

Question 51

Why cannot feel ridges of MCPJ in synovitis?

Answer 51

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

Question 52

How does hyperglycemia damage vessels?

Answer 52

Oxidative stress

Question 53

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

Answer 53

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.

Question 54

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

Answer 54

Yes

Question 55

Pain that improves towards end of day points to?

Answer 55

Inflammatory pain

Question 56

How to test for OSA?

Answer 56

Polysomnography

Question 57

Albumin abnormality points to acute or chronic problem?

Answer 57

Albumin abnormality points to chronic issue.

Question 58

How to manage localized vs mets cancer?

Answer 58

Localized = surgery + immunomodulator therapy Mets = Immunomodulator first, then surgery | very broad principles!!!

Question 60

Primary vs Secondary amenorrhea?

Answer 60

Primary = never had menses before Secondary = had menses before

Question 61

Pathophysiology of uremia?

Answer 61

Defective ion transport across cell membranes, resulting in intracellular sodium and water accumulation. | Uremia is indications for dialysis and sign of ESRD!