Random Facts Flashcards
Side Effects of Steroids
Weight gain Osteoporosis Avascular necrosis (AVN) Cataracts, glaucoma Peptic ulcer disease (PUD) Susceptibility to infection Easy bruising Acne Hypertension Hyperlipidemia Hypokalemia Hyperglycemia Mood swings
Bornholm disease/pleurodynia
Uncommon infection of intercostal muscles by Coxsackie B virus.
Causes severe stabbing chest pain. Pleuritic and worse with movement.
Associated with fever, malaise, and headaches.
Causes of Mononeuritis Multiplex
1) diabetes
2) vasculitis
2 diameters of NGT - their purpose
Smaller - for giving
Larger - for sucking
Steroid use in premature babies
Help to grow
Matures type 2 pneumocytes to reduce surface tension and aid breathing
What is the Ross procedure?
Diseasedaortic valveis replaced with the person’s ownpulmonary valve.
A pulmonaryallograft(valve taken from acadaver) is then used to replace the patient’s own pulmonary valve.
For common in children.
Chiari malformation
Structural defect where cerebellum +/- brain stem tissue extends into the foramen magnum
2 things to ask before interpreting ECG
1 - pain?
2 - HTN?
Most common cause of LVH is HTN.
Shows upas high voltages
When can you have ectopic rupture or D/C?
7-9 weeks.
Need the mass to be big enough either to cause rupture or to scrape.
Bacterial vs viral illness
Bacterial - constitutional symptoms
Viral - coryzal symptoms, esp sore throat, runny nose
What investigations to rule out SAH?
CT brain and then LP - rules out 99%
If still suspicious, do MRI.
LP preferably done within 24hrs .
Expect blood in all tubes.
4th tube looking for xanthochromia. Must be wrapped in foil.
Dimples of Venus correlate to?
Sacroiliac joints.
They directly overlie them.
How long can viral cough last for?
2-3 months
Therapeutic dose of clexane
for DVT
1.5mg/kg daily
or
1mg/kg bd
How can we clinically assess for jaw dislocation or #?
Look at alignment of teeth
Look for any hematomas in/under the gum
Iron tablets - what can they cause?
Black stools without the offensive smell
Intra-uterine hematoma
what are we worried about besides the baby?
Rh -ve mother
Rh +ve baby
Creation of Abs that attack the next baby
Iliac crest correlates to
L4-5 interspinal space
How to treat panadol OD?
N-Acetylcysteine as IV infusion or oral.
NAPQI (metabolite) accumulates within the body in OD.
NAPQI is conjugated by glutathione, but in excess, glutathione reserves are not sufficient. NAPQI interact with hepatic enzymes and damage liver.
Acetylcysteine acts to maintain or replenish depleted glutathione reserves in the liver and enhance non-toxic metabolism of acetaminophen.
Levels of Hb we can tolerate
before transfusion
70 - young
100 - old/other co-morbidities
Accessory pathway in wPw
Bundle of Kent
Why do we ask about amphetamine use in seizures?
Can cause arrhythmias and spasms
DVT, PE in young person
Think:
- Prothrombotic state/coagulopathies
- Left to Right heart shunts
Otolith catastrophe
Sudden ‘drop attacks’ in the context of Meniere’s disease.
During attacks, the patient falls to the ground in the absence of vertigo, loss of consciousness or malaise.
Late in the stage of Meniere’s.
What raises Lactate levels?
Anaerobic rest
Adrenaline - causes increases metabolic rate.
Diverts blood away from non essential organs. Anaerobic rest for those organs.
Investigations when suspecting SBO
CT Abdo
With IV and oral contrast
Looking for transition point in oral contrast
Causes of ascites in a CLD patient
- further decompensation
- non compliance with medications
- hepatic vein thrombus
- malignancy causing a resistant ascites
Which murmurs become louder with Valsaver?
HOCM and click of MVP
all other murmurs become softer
Causes of low voltages on ECG?
Pericardial effusion Dilated cardiomyopathy (walls are thinner)
How long do you have with testicular torsion to act?
Adult - 6hrs
Child - 12 hrs
(want to preserve function: spermatogenesis and hormone production)
Common causes of raised Aa gradient
V/Q mismatch
Right to left shunt (intrapulmonary or cardiac)
Which is more sensitive V/Q scan or CTPA?
CTPA will only tell you about PE’s that are proximal.
Need V/Q scan to look for more distal PE’s
Long term overdose of Insulin
Can have hypo-unawareness
Body gets use to stress response (adrenaline release).
Then get a blunted response to hypos
Side effects of Rifampicin
Red urine
Tears
Interacts with NOAC and warfarin (up regulates hepatic metabolism - CYP3A4 )
Relationship between rifampicin and flucloxacillin
Adding Rifampicin can lower the dose of flucloxacillin used.
Avoiding intra-hepatic cholestasis and allergies.
Vasopressors used commonly in anaesthetics
Ephedrine
Metaraminol
Rare cases: NA
Empirical one-off Rx for gonococcal urethritis
Ceftriaxone 500mg IM
Azithromycin 1g PO
Painless ulcer on penis?
Syphilis
Primary Chancre
What test can we do to determine pancreatic exocrine insufficiency?
Low levels of faecal pancreatic elastase
CREON?
Pancreatic Enzyme Replacement Therapy
Which part of duodenum do you get PUD?
1st part of duodenum
Test in Autoimmune pancreatitis
IgG4 - RAISED
accumulation of IgG4 in pancreas causing a mass –> blockage
Common causes of pancreatitis (clinically)
GET Autoimmune ERCP Methotrexate Prednisolone
Lipase levels in pancreatitis
> 1000
Below that, think:
renal colic, renal failure, gastritis, ovarian pathology
Contrast the pain location in Cholangitis and Biliary colic
Cholangitis - RUQ
Biliary colic - Epigastric
What does a drop >0.1 in PCV mean in someone receiving fluid resus?
Quite dehydrated as the pt is requiring lots of fluid resuscitation.
Why do Xray in Pancreatitis?
Looking for fat saponification and effusion around the pancreas
Diagnostic features of someone who does not clinically fit the picture of pancreatitis?
Epigastric pain and fat stranding around the pancreas.
How does ERCP cause pancreatitis?
- Backwash of contrast or pressure into the pancreatic duct
2. Repeat cannulation causing trauma
Management of someone with Pancreatitis
IVT
ADC
PPI
Analgesia
Normal wall thickness of gallbladder
Level of bilirubin at which you cannot perform CT IVC
Bilirubin >30
As the contrast, biliscopin will not be excreted.
Indications for CT IVC
Visualising bile leaks
Looking for stones
2 types of AAA
Suprarenal or Infrarenal.
Difficult to operate on suprarenal AAA as cannot reattach the arteries back onto the aorta. Will electively perform EVAR.
In emergency situations, tend to palliate.
RUQ USS
What do you look for?
Liver Gallbladder Biliary tree Kidneys Pancreas
What do check in exam of #?
- tenderness
- deformity
- swelling
- temperature
- abnormal mobility and crepitus
- loss of function
- neurovascular status
How to calculate the the eGFR
Cockcroft-Gault equation
Dose of suxemethonium
1-2mg/kg of TBW
Why might you get a derm consult in setting of ablative therapy (chemo)
Skin cancers may transform.
Any dormant malignancies may activate.
Thus should get a skin check for things like SCCs etc.
Which type of leukaemia are more likely to cause splenomegaly?
Monocytic/monoblastic
Acute erythroid
Why might you inspect skin in acute leukaemia?
Looking for skin infiltrates (leukaemic deposits in skin which look like papules)
Also known as chloromas
More common in myeloid > lymphoid
Valganciclovir used for?
CMV prophylaxis
Do serology to check status.
Why check CMV serology status?
When giving blood products - do they need CMV-ve products?
Do they have dormant CMV? Must check before we immunosupress for fear of activation.
What can be used to treat oral thrush?
Amphotericin B mouth lozenges
Why worry about oral mucosa in leukaemic pts?
Because of the combo of neutropenia + chemo:
high risk of candida infections
mouth pain
nutrition also affected
Therefore do regular inspection of the mouth.
Why start allopurinol in someone with Leukaemia?
Large tumour burden –> hyperuricemia –> may precipitate gout
Also help prevent tumour lysis syndrome
What parameters do you look at for tumour lysis monitoring?
LDH
Urate
Potassium
eGFR
What type derangement can thiazide diuretics cause?
increase BSL
hyperuricaemia
Who do we need to dose adjust Clexane in?
Renal impairment
Obese or small ppl
In who do we need to monitor clexane?
with anti-factor Xa levels
renal impairment
someone who has a propensity to bleed from a site (PUD)
Difference in Mx in someone with proximal or distal DVT
Proximal - greater risk of PE
Distal - may not treat medically if small and not really symptomatic but are close to hospital and sensible.
3 type of Myeloproliferative disorders
- Polycythemia Rubra Vera
- Myelofibrosis
- Essential thrombocythemia
Commonly associated with JAK2 mutation
1 cause of acquired anti-thrombin deficiency
Nephrotic syndrome
The MW of the protein is such that it can leak.
Why might morphine be used in APO?
Dilates the abdominal great veins and decreases preload.
What is entorox used for?
Analgesic gas - used commonly in paeds
Someone bleeding profusely?
Direct pressure on bleeding vessel
What predisposes a Pathological #?
Osteoporosis
Bone tumours
Paget disease
Osteogenesis imperfecta
Which Ca’s most commonly go to bone?
Breast
Prostate
Bowel
Contraindication in tranexamic acid use
Lowers seizure threshold.
Avoid in epilepsy
What 2 drugs when given too quickly can cause ototoxity?
Frusemide IV
Gentamicin IV
Side effects of morphine in anaesthetics
Broncho-constriction
Vasodilation (via histamine release)
Time for IV morphine to take effect?
10 mins
Anti-emetic options
Metoclopramide
Ondansetron
Dexamethasone (prophylaxis)
Droperidol 1mg
Side effect of Panadol IV
Drops blood pressure
What can be used for Analgesia?
Mg Local anaesthetic Panadol NSAID Opiate TCAs Gabapentin Pregabalin Tramadol clonidine
What are the 3 actions of Tramadol
- Partial agonist at mu receptors
- alpha agonist
- 5HT3 receptor
(last 2 actions are in the descending pathways)
What would monitors show if there was a large fat embolus?
Drop in CO2 that is expired
Lung Primaries metastasise to?
Other parts of lung
Adrenals
Bone
Sometimes liver
Which Cancers metastasise to bone?
Breast Prostate Lung Melanoma Thyroid Kidney
1st line therapy for TB
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Regimen for HAART
2 NRTI + PI
2 NRTI + NNRTI
Where does breast Ca metastasise to?
Bone
Liver
Lung
Which diuretics precipitate gout?
Loop
Thiazides
Reduce urate excretion by both directly and indirectly increasing urate reabsorption and decreasing urate secretion
Most common cause of LLQ pain?
Diverticulitis
Midgut ends where?
2/3 along transverse colon
Ligamentous injury or fracture?
Test vibration - hurts bad in fracture. Not so much in ligament injury.
Change in position also does not change fracture pain.
What sign may you see radiologically with pneumoperitoneum?
Rigler’s sign
When air is present on both sides of the intestine –> get a double wall sign.
Femoral hernias more common in…
little old ladies
Toxic megacolon
dilated bowel with translocation of material
Differentiate LB and SB radiologically
Location
Diameter
Haustra vs Valvulae Conniventes (plicae circulares)
Lower abdo pain in female.
DDx
Appendicitis Diverticulitis Cyst rupture Retrograde menstruation Ectopic PID
Location of pain for fore/mid/hind gut?
Foregut - epigastric
Midgut -periumbilical
Hindgut - lower abdomen
Describe Shenton’s line
Shenton’s line is formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus.
Help to pick NOFs
Bechets triad
Apthous ulcers
Genital ulcers
Uveitis
Dark urine DDx
Myoglobinuria (rhabdo)
Haemoglobinuria (Hemolysis)
Hyperbilirubinemia
How would hemolysis show in blood?
haptoglobin low
Primaries that metastasise to lung
breast
pancreas
kidney
skin
Expected CO2 formula for compensation for metabolic acidosis
HC03 x 1.5 + 8 +/- 2
Do the following causes alkalosis or acidosis?
Liver failure
Renal failure
Sepsis
Liver failure - alkalosis (loop diuretics, aldosterone)
Renal failure - acidotic
Sepsis - acidotic (shock, lactic acid build up)
Normal Anion gap?
For every drop of 0.1 in pH, how much does K go up by?
0.5 increase
Rigors imply?
Sepsis
Think bacteria, influenza, HIV, vasculitis
Would you expect to see radiological changes in septic arthritis
Not in acute setting.
If after several weeks, may see osteopenia
What does decreased haptoglobin suggest?
- intravascular hemolysis: with increased reticulocyte count and a decreased haemoglobin and hematocrit.
- extravascular hemolysis: haptoglobin can be normal and the reticulocyte count is increased
Prophylaxis for vatical bleeding
- propranolol
2. band ligation
2 benefits if ascitic fluid analysis
- diagnose Spont Bact. Peritonitis (pmn count > 250)
2. diagnose portal hypertension (SAAG > 11 g/L)
how does portal hypertension manifest?
- ascites +/- SBP
2. vatical +/- bleeding
Ddx for upper GI bleed
– Peptic ulcer disease – Varices – Esophagitis – Mallor-Weiss tear – Other: cancer, angiodysplasia/AVM
Causes of Cushing’s syndrome
- anterior pituitary adenoma (cushion’s disease)
- paraneoplastic (SCC of lung)
- primary adenoma/carcinoma of adrenals
- iatrogenic
3 antidotes to know?
- NAC - for paracetamol OD
- Flumazenil - benzodiazepine GABA receptor antagonist
- Naloxone - opioid antagonist
Back pain and fever?
Epidural abcess until proven otherwise
Can cause paralysis if ignored
Treatment for toxoplasmosis
sulphadiazine + pyremethamine
Cushing reflex
Impending herniation
Increased BP
Bradycardia
Cheyne stokes breathing
Wernicke’s encephalopathy
Vitamin B1 deficiency (thiamine)
ataxic gait
encephalopathy (confusion)
oculomotor deficiency
Normal pressure hydrocephalus triad
urinary incontinence
gait disturbance
dementia
Side effect of tetracycline in breastfeeding
Stains teeth
Insulin use post MI
Improves survival in hyperglycaemia setting.
Sliding scale 24hrs post
3months insulin subcut
Delirium tremens
Most severe form of ethanol withdrawal
Confusion, hallucinations
high mortality
Neuropathy distinctions
Diabetic: peripheral sensory
B12: Vibration and proprioception
CIDP: large fibre and areflexia
Syringomyelia: pain and temp in UL
Anti-endomysial Abs
Coeliac disease
Sign of hyperventilation
Carpal spasm
hypogonadotrophic hypogonadism and anosmia
Kallman’s syndrome
Failure of migration of the olfactory neurones and GnRh neurones during development.
Phenytoin side effects
peripheral sensory neuropathy
cerebellar ataxia
hirsutism
gum hypertrophy
Neural tube defects
Valproate
Supplement with folate!
CLL and immunodeficiency
CLL is commonly complicated by panhypogammaglobulinaemia
Seroconversion illness HIV
widespread macular rash
pharyngitis
generalised lymphadenopathy
Amoidarone induced hypothyroidism
amiodarone induced hypothyroidism which inhibits the peripheral conversion of T4 to T3.
Hypercalcemia seen in…
multiple myeloma, hyperparathyroidism and hyperthyroidism
Upper lobe fibrosis
Ankylosing spondylitis
How to differentiate Myasthenia from Lamber Eaton?
Weakness tends to improve after a few minutes of muscular contraction, and absent reflexes return in Lambert eaton whereas in MG, muscles fatigue with use.
Valsava
First ask if you can do one - pt may be unstable
- breath in and push against my hand that’s flat ons stomach
- squat
- reinforcement
- syringe
- blow out of nose that’s squeezed closed
What should you do in a pt with AF on examination?
take radial pulse and auscultate heart at the same time.
Not all contractions may be transmitted into a pulse
Major side effect of verapamil
constipation
Amiodarone effect on warfarin
increases effective dose
2 antibodies to look for in scleroderma
anti-centromere
anti-topoisomerase (Scl 70)
Fluorinated Steroid
Also has prefix beta
Avoid on face
Can cause steroid rosacea
methotrexate crepitations
coarse creps in mid zone
MLH1 and MSH mutations are important in which syndrome?
Lynch
Hereditary nonpolyposis colorectal cancer
Alcohol binge LFT pic
AST and GGT rise
Oxygen saturation 90
PaO2 = 60mmHg
Von Willebrand features
autosomal dominant
affects APTT
Haemophilia inheritance
X linked recessive
MRSA
Healthcare workers
Courvoisier’s Sign
enlarged, palpable gallbladder in patients with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors
Pneumocystis features
symptoms progress over month
cough is optional
Sigmoid volvulus
RIF pain
Sign of portal hypertension in cirrhosis
splenomegaly
Skin reactions in radiotherapy last for?
up to 3 weeks
basal keratinocytes takes 3 weeks to generate new skin
Low DLCO
Interstitial pulmonary fibrosis (restrictive)
Emphysema (obstructive)
Anaemia, pulmonary vasc disease (normal)
Metacholine challenge test
diagnose asthma
Normal DLCO
Chest wall disease
Neuromuscular disease
Optic neuritis
RAPD
Central scotoma
More often normal fundus (otherwise can be pale or swollen optic disc)
Can have colour defects - but only if acuity also affected
Fulminant Hepatitis
Hep B not Hep C
Chylothorax
One of the rare complications of CABG
Nick the thoracic duct.
Get chyle in drainage once you begin to eat fatty foods
ECG pattern in PE
SI QIII TIII pattern – deep S wave in lead I, Q wave in III, inverted T wave in III.
What might you see on CXR of aortic dissection?
widened mediastinum
irregular aortic contour
Riddle’s lobe
Anatomical variant of the right lobe of the liver
Tongue like projection - may look like hepatomegaly
Dentate line
Divides the upper two thirds and lower third of the anal canal. Developmentally, this line represents the hindgut-proctodeum junction.
Superior rectal artery vs inferior rectal artery
Superior rectal vein vs inferior rectal vein
Visceral (inferior hypogastric plexus) vs. somatic (pudendal)
Chilaiditi sign
Large bowel btw the liver and diaphragm
Appears as free gas with rugae underneath the diaphragm
Portal venous gas
Accumulation of gas in the portal vein and its branches.
Harbinger of death
Gas found more peripherally
Pneumobilia
Gas in biliary tree.
Gas found more centrally in liver
4 types of calcification
Rim like - in wall of hollow viscus - e.g. cysts
Linear - in wall of tubular structures
Lamellar - stones
Amorphous - in solid organ
SBO
Dilated loops of bowel
> 2.5-3cm
> 5 air fluid levels on erect film
Proximal to obstruction - first to dilate
Overtime, all parts dilate
In ileus, what happens to the bowel?
Both small and large bowel are dilated
Where is the largest diameter in bowel?
Caecum - 9cm but thinnest. >15cm: impending perforation
Small bowel 3cm
Colon - 6cm
Imaging in LBO?
CT with rectal contrast
Apple core lesion
Stenosing annular colorectal carcinoma
Side effects of metronidazole
Severe nausea
Massive vomiting with alcohol consumption
Metallic taste in mouth
Difference in Prinzmetal and normal angina on ECG?
ST elevation and more leads affected.
cf.
ST depression usually limited to one vascular territory.
Considerations for MRI and previous SAH
Certain aneurysmal clips may be CI
Things to consider in a splenectomy pt
Left shift in neutrophils and thrombocytosis
Increased risk of thrombosis
low dose Abs for prophylaxis
Side effect go mycophenolate
Microangiopathic haemolytic anaemia
Where else can you get cysts in PKD?
liver spleen pancreas ovaries lung
Preop anaesthetic assessment of RA pt
Must image C-spine
Instability from RA
Reiter’s triad for reactive arthritis
arthritis
uveitis
urethritis
Behcet’s triad
mouth ulcers
genital ulcers
uveitis
Most common cause of pneumoperitoneum
perforated peptic ulcer
Dengue symptoms
Fever, violent headache, and severe pains in the muscles and joints following an incubation period of 5-8 days, and lasts about 4-7 days
Troisier’s sign
Clinical finding of a hard and enlarged left supraclavicular node (Virchow’s node)
Virchow’s node: where the lymphatic drainage of most of the body (from the thoracic duct) enters the venous circulation via the left subclavian vein.
Why does CKD increase CVD risk?
High PO4 leads to increased PTH levels.
Ca released binds to PO4 and together they deposit in vessel walls
What do we use to treat Meniere’s?
Betahistadine
Increases bloodflow to vestibule
