Random things from posters Flashcards
When shouldnt you give beta blockers
asthma, heart block/failure, hypotension, bradyarrythmias
What does hereditary spherocytosis cause
RBC membrane defects in haemolytic anaemia
What does Glucose-6-phosphate dehydrogenase deficiency cause
Enzyme defects in haemolytic anaemia
What do thalassaemias and sickle cell cause
Haemoglobinopathies in haemolytic anaemia
What is poikilocytosis
Variation in RBC shape
What is anisocytosis
Variation in RBC size
What mutation is present in polycythaemia rubra vera
JAK 2
What are the signs of Mobitz type 1 heart block and what is it
PR interval increasing with QRS dropped. It is second degree AV block AKA Wenckebach
What is charcots triad and what does it suggest
worsening right upper quadrant pain, jaundice and fever. Cholangitis
What do these symptoms suggest in children and how would you confirm a diagnosis: failure to thrive, recurrent respiratory tract infections, diarrhoea
Cystic fibrosis. Sweat test.
Which murmurs are loudest on expiration
Mitral Regurgitation, Aortic Stenosis and Mitral Valve Prolapse
What are the features of mitral regurg murmur
low pitched, pan-systolic murmur, loudest in expiration, radiates to the axilla
Which type of anaemia is peripheral neuropathy associated with
B12 deficiency (macro)
What do these features suggest Koilonychia (spoon-shaped nails – both fingers and toes)
Angular stomatitis and glossitis
Dysphagia, tongue atrophy
Iron deficiency anaemia (micro)
Whats the MI sign where the patient has their hand over their chest called
Levines sign
What is Beck’s triad
Signs of cardiac tamponade. Hypotension, muffled heart sounds and increased jugular venous distension (JVD)
What does this suggest and what is the investigation: progressive dysphagia, regurgitation of undigested food debris, chronic cough, chronic aspiration, halitosis, a sensation of a lump in the throat, hoarseness, whistling and cervical borborygmi
Zenkers diverticulum. Outpouching of hypopharynx. Do a barium swallow.
What are the signs and symptoms of pneumonia
productive cough, progressive shortness of breath and the clinical findings of left basal coarse crackles, tachypnoea and hypoxia.
For what disease is Pirfenidone used
IPF, it is an antifibrotic which inhibits TGF-B
What is the pulse like in aortic stenosis
Slow rising pulse
Signs of aortic stenosis
A murmur typically loudest in the aortic region (2nd intercostal space right sternal edge)
Sitting forward and expiring accentuates the murmur
Slow-rising pulse
Narrow pulse pressure
Heaving apex beat
What is the first investigation in PE
CT pulmonary angiogram
Investigation if suspect angina
Exercise stress test
What does this suggest: worsening fatigue, dizziness and dark stools (malaena)
Upper GI bleed
What is the pulse like in sepsis and hypercapnia
bounding
What is the pulse like in aortic regurgitation
collapsing
What is the pulse like in AF
Irregularly irregular
What is pulsus paradoxus
a large decrease in pulse pressure (>10mmHg drop) during inspiration: is a sign of various conditions, including: cardiac tamponade, constrictive pericarditis, pulmonary embolism and acute asthma
What is grey turners sign
The bruising on the flanks which occurs due to retroperitoneal haemorrhage in acute pancreatitis
What does brugada show on ECG
Coved ST in V1-V3 followed by inverted T
What channel is affected in brugada
Sodium
What features make a brugada diagnosis more likely
Young male, family early death, nocturnal agonal respiration
What causes superior vena cava syndrome
Small cell carcinoma
Most common presenting complaint in lung cancer
Cough
Name a tyrosine kinase inhibitor and what is it used for
Imatinib, used for CML
What are the signs of normal cardiac axis
Lead II has the most positive deflection compared to Leads I and III
What are the signs of left axis deviation
Lead I has the most positive deflection
Leads II and III are negative
Left axis deviation is seen in individuals with heart conduction defects
What are the signs of right axis deviation
Lead III has the most positive deflection and Lead I should be negative
This is commonly seen in individuals with right ventricular hypertrophy
What causes osteogenesis imperfecta
an autosomal dominant mutation that impairs the synthesis of type 1 collagen
When is the LH surge in the menstrual cycle
Day 12
What is vitiligo
localised loss of skin pigmentation due to the autoimmune destruction of melanocytes
Signs of IgA neuropathy
upper respiratory tract infection, gross haematuria, flank pain and red blood cells casts
Drugs which cause hyperkalaemia
ACE-I, NSAIDs, BB, Warfarin
Which drugs should you stop in AKI
ACE-I
What the signs of idiopathic premature ventricular contractions
extra-beats or palpitations, often exacerbated by caffeine or alcohol and are more evident during the nigh
First line african/ over 55
CCB; Amlodipine
Which leads provide a lateral view of the heart
I, aVL, V5 and V6
Describe vasovagal syncope
The event occurred after a postural change, was preceded by nausea and resolved rapidly with no intervention or residual neurological deficits
What is the distinctive sign of Myasthenia Gravis
Muscle fatigueability
What condition is associated with VSD
Foetal alcohol syndrome
What condition is associated with PDA
Congenital rubella
What condition is associated with ASD
Downs
What condition is associated with transposition of the great vessels
Maternal diabetes
Most common left axis deviation cause
Left anterior fasciculator block
Most common right axis deviation cause
Right ventricular hypertrophy
Where does pulmomary stenosis murmur radiate
Shoulder
Where does mitral regurg murmur radiate
Axilla
Loudest on inspiration murmurs
RHS; Pulmonary and tricuspid
Loudest on expiration murmurs
LHS; Aortic and mitral
Criteria for long term oxygen therapy
<55 when clinically stable or <60 and evidence of organ failure eg pulmonary HTN, RH Failure and polycythaemia
Which region of the heart is looked at with II, III and aVF
Inferior
Hypokalaemia ECG changes
tall/peaked P waves, T-wave flattening, supraventricular/ventricular ectopics and supraventricular tachyarrhythmias.
Hypercalcaemia ECG changes
typically features shortening of the QT interval and Osborn (J) waves on the ECG
Hyperkalaemia ECG changes
tall tented T waves, flattened P waves and broad QRS complexes
Hypocalcaemia ECG changes
Prolonged QT interval
Who gets SLE
Young girls
Osteopetrosis
Poor osteoclast function due to a carbonic anhydrase II mutation
Reactive arthritis skin sign
Keratoderma blennorrhagica on the feet
Which medications increase the change of gout
Loop and thiazide diuretics
What type of diuretic is Indapamide
Thiazide like diuretic
insidious onset of bleeding and bruising, in addition to the low platelet count and normal coagulation screen suggests
Immune thrombocytopenia, requires corticosteroids
Pulseless electrical activity management
Chest compressions and adrenaline
What condition is horners syndrome associated with
Coarctation of the aorta
What are the symptoms of horners syndrome
Short stature Ovarian dysgenesis Lymphatic defects Cystic hygroma Webbed neck Lymphoedema
What is duloxetine
Antidepressant, serotonin and noradrenaline reuptake inhibitor
Factors which activate RAAS
Reduced renal Na, low blood pressure, hypovolaemia, sympathetic stimulation
In which days of the uterine cycle is the menstrual phase with bleeding
1-5
Polycythaemia rubra vera mutation
JAK2
Signs of cystic fibrosis in children
failure to thrive, recurrent respiratory tract infections, diarrhoea
Minimal change disease triad
oedema, hypoalbuminaemia and proteinuria
Which condition is suggested by normal O2 sats which fall very dramatically on walking
Pneumocystis pneumonia, HIV related condition
Which two conditions should you suspect HIV in
Reccurent shingles and candidiasis
Which coreceptor which HIV binds to is on the surface of Tcells, macrophages, monocytes and dendritic cells
CCR5
Which coreceptor is only present on the surface of Tcells and is often targetted during the chronic HIV stage
CXCR4
How does a hiatus hernia appear on CXR
retrocardiac air-fluid level.
What is used to assess the severity of pancreatitis
Abbreviated glasgow scoring system, PANCREAS
What does PANCREAS stand for for the assessment of pancreatitis
PaO2 (low), Age, Neutrophilia, Calcium, Renal function, Enzymes, Albumin, Sugar
Vommiting fresh bright red blood suggests
Mallory Weiss tear
Bruising on the flanks and abdominal region suggests
Acute pancreatitis
Most common cause of drug induced jaundice
Coamoxiclav and flucoxacillin
Which blood marker classically rises with upper GI bleeding
Urea due to blood breakdown
Primary sclerosing cholangitis investigations
Ultrasound at first, then MRCP to confirm. Magnetic resonance cholangiopancreatography
How does hyperventilation lead to perioral and peripheral paresthesia?
Hypocalcaemia
Why does hypokalaemia happen with alkalosis
H+ dissociates from albumin so calcium binds and free calcium drops
Which antiviral is used for Herpes Zoster and encephalitis
Aciclovir
Neuro problem which is sudden
Vascular
Neuro problem which is episodic
Relaxing, remitting MS
Neuro problem with diurnal fatigueability
Myasthenia gravis
Focal neuro problem which progressively worsens
MND
What is the antibiotic for Group A B-haemolytic streptococci
Benzylpenicillin or clindamycin
What is Cryptorchidism
Cryptorchidism is the absence of one or both testes from the scrotum
What is the most common consequence of the macrophage stage, 4-7days after an MI
Myocardial rupture, and therefore. Cardiac tamponade / Shunt through the ventricular wall / Mitral insufficiency
RUQ mass
mass in the right upper quadrant is likely to represent a distended gallbladder secondary to bile flow obstruction from a malignant pancreatic mass
Minimial change disease is nephritic or nephrotic
Nephrotic
IgA nephropathy is nephritic or nephrotic
Nephritic
What is asterixis and what is it associated with
Flapping tremor, hypercapnia
Agar for bordatella pertussis
Bordet gengou
What is murphys sign and what does it mean
When you put hand on bile duct and they breathe in and it hurts. If positive it means acute cholecystitis
Radial nerve supplies muscles of flexion or extension
Extension (R-ex)
Ulnar nerve supplies muscles of flexion or extention
Flexion (U-Flex)
What is graves disease
An autoimmune disease of the thyroid
What does bloody diarrhoea + india suggest
Entamoeba histolytica
What is charcots foot
Loss of sensation
If there is a peptic ulcer in the pylorus of the stomach which artery will it perforate
Gastroduodenal
Paracetamol antedote
N-acetyl-cysteine
What is Kussmauls sign
Deep and laboured breaths, a sign of sever diabetic ketoacidosis
How does amoxicillin work
It inhibits peptidoglycan crosslinking in cell wall formation
If you suspect cirrhosis what would be the next step
CT abdo
If there is a glossopharyngeal nerve lesion which way does the tongue go
Towards the problem, lick the lesion
Which cancers metastasise to bone
Breast, bronchus, bridney, bryroid, brostate
3 signs of chronic liver disease
Bruising, clubbing, dupuytrens contracture
Signs of left ventricular failure
Pulmonary crackles, extra heart sounds, displaced apex beat, tachycardia
3 endocrine causes of HTN
Conns (hyperaldosteronism), Cushings (prolonged cortisol) and Phaeochromocytoma (Nad+Ad)
First line treatment for bradycardia with adverse features like syncope and shock
IV atropine
Superior vena cava syndrome, major cause and treatment
SSC of the lung. Elevate the head, corticosteroids and diuretics
Ventricular tachycardia and adverse effects
Synchronised DC shocks, further treatment would incluse IV amiodarone
Where are colostomies positioned
Left illiac fossa
Where are ileostomies positioned
Right illiac fossa
Cause of aortic regurg in young children
VSD
Sign of complete heart block on ECG
Complete dissociation between P waves and QRS complexes
Recent chemo and fever=
Neutropenic sepsis. Give broad spectrum antibiotics
What classically rises in upper GI bleeds
Urea
Describe the pericarditis pain
retrosternal, pleuritic (exacerbated on inspiration) and worse when lying flat
tall tented T waves, flattened P waves and broad QRS complexes
Hyperkalaemia
Skin abscess organism
Staph aureus
Pneumonia organsims
S.aureus, klebsiella pneumonia, anaerobic bacteria, mycobacterium tuberculosis
Liver abscess organisms
Gram negative (E.Coli), strep milleri, anaerobes (bacteriodes fragilis), entamoeba histolytica in tropics
Kidney abscess organisms
E coli, klebsiella
Bowel abscess organisms
Gram negative (Ecoli), strep milleri and anaerobes (bacteriodes fragilis)
Target BP in people under 80
140/90
Target BP in people over 80
150/90
Side effects of CCB
-ve chronotrope: bradycardia, AV block -ve ionotrope: worsening CF
What is doxazosin
Alpha one antagonist
Two major causes of regurgitiation
Rheumatic fever and infective endocarditis
Cause of mitral regurg
Myoxomatous degeneration, ischaemia, rheumatic heart disease and infective endocarditis
aortic stenosis triad of symptoms
Exertional syncope, exertional dyspnoea and angina
Aortic stenosis initial investigation
Echocardiography
Pulse in aortic stenosis
Slow rising carotid pulse, reduced pulse amplitude
What shape is the ejection murmur in aortic stenosis
Rhomboid
Indications for valve replacement in aortic stenosis
Symptomatic, LVEF decreasing
Signs of mitral regurg
Soft 1st HS, 3rd HS, pansystolic murmur
Investigations for suspected mitral regurg
Echo, ECG, Cxr
Treatment for mitral regurg
Rate control and anticoagulation for AF, diuretics for fluid, IE prophylaxis, surgery if symptomatic
When should you suspect Spondyloarthropathies
Inflammatory back pain, assymetrical large joint arthritis, skin psoriasis, IBD and inflammatory eye disease
What is enteropathic arthritis
Episodic peripheral synovitis which can occur with IBD, lower limb, assymetrical and usually gets worse and better as IBD does. Management similar to RA
Signs of Mobitz type 1, second degree heart block
PR increasing the QRS dropped.
Mutation in Polycythaemic rubra vera
JAK2
Which part of the HIV virus binds to receptors
GP160
Which enzyme converts viral RNA into DNA
Reverse transcriptase
Which enzyme encorporates Viral DNA into the Cellular DNA
Integrase
Complication of having a pacemaker fitted
Pneumothorax
Organism causing croup
Parainfluenza Virus 1
Most common cause of right sided heart failure
Left sided heart failure
What is quinckes sign
Pulsations visible in the nail bed with each heartbeat upon light compression of the nail bed
Collapsing pulse
a sudden, abrupt drop in the pressure on the arterial wall after systole
Corrigan’s sign
visible distention and collapse of the carotid arteries in the neck
De Musset’s sign:
Head bobbing with each heartbeat
Most common mitral regurg cause
Rheumatic fever
Cullens sign
periumbilical oedema and bruising suggestive of retroperitoneal bleeding
Grey-turners sign
bruising on the flanks bilaterally suggestive of retroperitoneal bleeding.
Mcburneys sign
deep tenderness over McBurney’s point (1/3 between the anterior superior iliac spine to the umbilicus) suggestive of acute appendicitis
Rovsings sign
palpation of the left lower quadrant causes pain in the right lower quadrant, suggestive of acute appendicitis
Sudden death of young athletes, heart cause
Hereditary hypertrophic cardiomyopathy is due to autosomal dominant mutations in the beta-myosin heavy chain. It causes massive hypertrophy of the left ventricle which results in diastolic dysfunction and subaortic stenosis
How does hypertension lead to paraesthesia
Alkalosis leads to hypocalcaemia
Charcots triad for cholangitis
worsening right upper quadrant pain, jaundice and fever
Paraneoplastic syndrome from lung SCC
Parathyroid hormone related peptide is high and phosphorus is low
Rockall risk scoring system
attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding
Minimal change syndrome
oedema, hypoalbuminaemia and proteinuria
What does a short PR interval suggest
Wolff-parkinson-white syndrome. An abnormal pathway between the atria and ventricles
CHA2DS2–VASc Score
is used to predict the probability of a stroke or thromboembolic event with atrial fibrillation
ABCD² Score
Estimates the chance of a stroke following a suspected TIA
Wells score
Predicts the probability of a patient suffering a DVT or PE
TIMI
Estimates the probability of mortality in a patient with unstable angina or an NSTEM
QRISK2 score
Predicts the chance of having a cardiovascular event (myocardial infarction or stroke). Used for primary prevention of cardiovascular disease to identify patients at high risk, and patients who would benefit from primary prevention treatments
The ECG shows a slurred upstroke of the QRS complex (known as a Delta wave).
Wolff parkinson white syndrome
Turner’s syndrome
sex chromosome disorder of female sexual development commonly associated with preductal coarctation of the aorta which causes hypertension in the upper extremities and weak pulses in the lower extremities
PR interval is fixed but there are dropped beats
MOBITZ TYPE 2 SECOND DEGREE HEART BLOCK
Bradycardia and adverse effects treatment
IV Atropine
Takotsubu cardiomyopathy
Stress cardiomyopathy
