SAQ Flashcards
1
Q
Charcot’s neurological triad + associated disease
A
- Dysarthria (Slurred/ slowed speech due to impaired muscles)
- Nystagmus (Involuntary side to side, up-down, rhythmic movement of eyes)
- Intention tremor (Tremor during intentional, visually guided movement)
Associated with Multiple Sclerosis
2
Q
Risk factors for infective endocarditis
A
- Rheumatic fever
- Sepsis
- Poor oral hygiene
- Regurgitative valve
- Prosthetic valves
- IV drug use
3
Q
Signs of infective endocarditis on hands
A
Janeway lesions
Oslers nodes
Splinter haemorrhage
4
Q
Scoring system for Infective Endocarditis
A
Duke’s criteria.
2 major, 1 minor. 1 major, 3 minor. 5 minor.
Major - blood culture for endocarditis. Positive evidence ie echocardiogram for IE, abscess, new valve regurgitation.
Minor - Predisposing heart condition, IV drug use, fever, vascular signs (Janeway lesion, aneurysm etc), immunological signs (Oslers nodes, roths spots, rheumatoid factor)
5
Q
PVD in leg. Site of pain and artery
A
Buttocks - iliac or lower aorta
Thigh - iliac or femoral
Calf - popliteal
Foot - tibial or peritoneal
6
Q
6 signs of limb ischaemia (6 Ps)
A
Perishingly Cold Pain Pulseless Pale Paralysis Paraesthesia
7
Q
Investigations for PVD
A
- Ankle-brachial pressure index: systolic BP recorded with appropriately sized cuff in both arms and posterior tibial, dorsalis pedis and peroneal arteries. 0.5-0.9 claudication (mild-moderate)
<0.5 critical limb ischaemia.
Absence on lower extremity - acute limb ischaemia. - Duplex ultrasound
8
Q
Beck’s triad
A
- Hypotension
- Distended jugular veins (and raised JVP in heart failure)
- Muffled heart sounds
Associated with Cardiac Tamponade
9
Q
Charcot’s triad
And what can it progress to
A
- Fever
- Jaundice (raised bilirubin)
- RUQ Pain
Associated with acute biliary obstruction (cholangitis)
Can progress to Reynold’s Pentad
- Charcot’s triad +
- Confusion
- Hypotension
Associated with Obstructive ascending cholangitis
10
Q
Virchows Triad
A
- Hypercoagulability (cancer, surgery, oestrogen, sepsis)
- Venous stasis (Recent surgery, long-haul travel)
- Endothelial damage
Factors that contribute to venous thrombosis
11
Q
Kidney cancer (all types) triad
A
Haematuria, flank pain, abdominal mass
12
Q
How might you differentiate an arterial ulcer from a venous ulcer?
A
Arterial: Distal extremities. absence of hair, pale/ necrotic wound tissue, skin shiny pale taut, minimally exudative
Venous: Gaiter area, lower calf to medial malleolus. Irregular shape, granular appearance, more exudative, firm odoema, thick skin.
13
Q
What symptoms might be experienced by a patient with chronic limb ischaemia?
A
Hair loss, ulcers, foot numbness, absent distal pulses, atrophic skin, brittle/slow growing nails, intermittent claudication.
14
Q
Name 2 investigations used to diagnose Cystic Fibrosis
A
- Guthrie heel prick - check for serum immunoreactive trypsinogen in foetuses
- Sweat test. >60mmol/L diagnostic
- Genetic testing
15
Q
Lifestyle advices to patients with Cystic Fibrosis
A
- No smoking
- High calorie high fat diet
- Regular flu vaccination
- Exercise regularly
- Do chest physiotherapy
16
Q
ECG changes for atrial fibrillation
A
Absent P waves Irregularly irregular rhythm Absent isoelectric baseline Fibrilatory waves QRS <120ms
17
Q
What is BNP and when would it be raised
A
BNP (B- type Natriuretic Peptide) is raised when cardiac muscles are stretched beyond normal range. High means heart overloaded with blood beyond normal capacity to pump properly.
Raised in: Heart failure Tachycardia Sepsis Pulmonary embolism Renal impairment COPD
18
Q
What is Sepsis 6
A
- Administer oxygen
- Give IV fluids
- Give IV antibiotics (ceftriaxone)
- Take blood culture
- Check serum lactates
- Measure urine output
19
Q
Red flags for sepsis 6
A
Confusion Unresponsive Hypotension Tachycardia High respiratory rate Hypoxic Not passing urine High lactate Recent chemotherapy
20
Q
Exudate vs Transudate
A
Exudate - Inflammatory fluid release, due to changes in capillary permeability
- High protein
- Coagulates
- Contains inflammatory cells
Transudate - Non inflammatory (pressure gradients)
- Low protein
- Doesnt coagulate
- No inflammatory cells
21
Q
What microbes cause CAP and what causes HAP
A
CAP - Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus Influenzae
HAP - Pseudomonas aeruginosa
22
Q
Nephritic vs Nephrotic
A
Nephritic - Haematuria, Hypertension, Oedema.
Nephrotic - Proteinuria (>3.5g/24h), Hypoalbuminaemia, Oedema, with or without hypertension
(Nephrotic has >3.5g protein, nephritic has <3.5g protein)
23
Q
Histology of Coeliac
A
Endoscopy and duodenal biopsy
Villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, lamina propria infiltration with lymphocytes
24
Q
Histology of Crohns
A
Transmural inflammation, granulomas, goblet cells present
25
Histology of Ulcerative Colitis (4)
Psuedopolyps, crypt abscesses, goblet cell depletion. Inflammation limited to mucosa + submucosa
26
Crohns vs Colitis vs Coeliac Histology
Crohns - Transmural inflammation, granulomas, goblet cells present
Colitis - pseudopolyps, goblet cell depletion, crypt abscesses. Inflammation is mucosa/sub only
Coeliac - Villous atrophy, crypt hyperplasia, intraepithelial lymphocytes, lamina propria infiltration with lymphocytes
27
Coeliac investigations
IgA- Anti tTG (tissue transglutaminase)
- Anti EMA (East mids airport (but also Endomysial))
IgG- Anti DGP (Deaminated gliadin peptide)
28
Supportive treatments with examples
IV fluids
Analgesia (Paracetamol)
Antiemetics
Preoperative antibiotics (ceftriaxone)
29
GORD vs Achalasia
```
Achalasia has:
Regurgitation rather than reflux
Dysphagia affects solids more than liquids
No apparent underlying cause
Trialled PPIs dont help
Achalasia has dilated oesophagus
```
30
1 pathogenic, 1 non infectious cause, 1 not related to disease. Causes of diarrhoea
Pathogenic - norovirus, rotavirus, staph aureus, e coli
Non pathogenic - IBS, IBD, Bowel cancer
Not related to disease - stress, medication side effect, toxin ingestion
31
Action of penicillin and clarithromycin
Penicillin - inhibits bacterial cell wall synthesis
Clarithromycin - Inhibits protein synthesis by bacteria
32
ECG in hyper/hypokaleaemia
Hyperkalaemia - Tall T waves, broad QRS, flat P waves, short QT
Hypokalaemia - flat T wave, U wave present, prolonged PR
33
Which cancers metastasise to bone
```
Breast
Prostate
Lung
Kidney
Thyroid
```
34
Complications of CKD
- Hyperkalaemia
- Hypocalcaemia (less vit D activation by kidney) -> secondary hyperparathyroidism -> - - Bone osteodystrophy
- Hypertension (renin secretion)
- Anaemia (Erythropoietin release decreases)
35
Primary vs secondary vs tertiary hyperparathyroidism
Primary hyperparathyroidism - Uncontrolled PTH due to tumour
Secondary hyperparathyroidism - Insufficient vit D or chronic renal failure so low absorption of calcium from intestines and kidneys.
Tertiary - Hyperparathyroidism continues for long time leading to hyperplasia of parathyroid glands.
36
Hyperparathyroid treatment
Primary - Avoid thiazide diuretic, high Ca2+ intake.
- Surgical removal of tumour
Secondary - Correct vit D or transplant kidney.
Phosphate binder
Tertiary - Remove parathyroid tissue
37
How do you know if a UTI is complicated?
If it affects:
- a man
- a pregnant lady
- baby
- the immunocompromised
- it is recurrent
38
First line for an uncomplicated UTI
Trimethoprim (TERATOGENIC) and nitrofurantoin for 3 days
39
Pre Renal, Intrinsic and post renal causes of AKI
Pre renal: inadequate supply
Dehydration, Hypotension, Heart failure
Intrinsic: Disease causes reduced filtration
glomerulonephritis
acute tubular necrosis
interstitial nephritis
Post renal: Obstruction to outflow of kidney
Kidney stones, ureteral stricture, cancer in abdomen or pelvis, enlarged prostate or prostate cancer
40
Lower Urinary Tract symptoms
- Storage (frequency, urgency, nocturia)
| - Voiding (straining, hesitancy, incomplete emptying, poor flow)
41
lower urinary tract symptoms - investigations
1) Urine dipstick and culture
2) PSA
3) Assess symptoms International Prostate Symptom Score
42
Treatments for moderate-severe lower urinary tract symptoms
1) Alpha-1-blockers (tamsulosin) - relaxes muscles in bladder to reduce resistance to bladder flow
2) 5-alpha-reductase-inhibitors (finasteride) - inhibit conversion of testosterone to dihydrotestosterone to reduce prostate size.
43
Tamsulosin side effects
hypotension, retrograde ejaculation
44
Stages of CKD
eGFR used to stage CKD
1. >90
2. 60-89
3a. 45-59
3b. 30-44
4. 15 to 29
5. <15
45
Microbial causes of UTI
```
KEEPS
K-klebsiella
E- E Coli
E- Enterococci
P-proteus spp
S-staphylococcus
```
46
Gold Standard investigation for Cystitis
midstream urine dipstick sample showing nitrates, leukocyte and haematuria
47
4 types of nephritic syndromes
IgA nephropathy, post strep glomerulonephritis, Good Pasture's, SLE
48
3 types of nephrotic syndrome
minimal change, amyloidosis, diabetic nephropathy
49
TB drugs and their side effects
R- rifampicin --> red urine/sweat
I- isoniazid --> peripheral neuropathy
P- pyrazanamide --> gout
E- ethambutol --> optic neuritis
50
Hidden places where psoriasis can be found on the body
soles of the feet and the scalp
51
common cancers that can metastasis to the bone
breast, lung, prostate, kidney, thyroid
52
antibodies found in SLE and how sensitive/specific they are
ANA antibodies - sensitive
| double stranded DNA antibodies- specific
53
treatment and drug class for osteoporosis
drug class- bisphosphonates
| example- alendronate/alendronic acid 70mg once weekly taken on an empty stomach
54
two signs of osteoarthritis
Heberden's Nodes- small bony nodules on DIP joints
| Bouchard's Nodes- swelling in PIP join
55
two investigations for giant cell arteritis
temporal artery biopsy- showing multinucleated giant cells present and granulomatous inflammation
FBC- ESR and CRP raised. WBC normal. may show anaemia
56
treatment for GCA
high dose prednisolone, methylprednisolone if visual problems. aspirin daily
57
Diagnostic criteria for GCA
1. new onset headache
2. temporal artery biopsy
3. elevated ESR
58
Symptoms and Signs of GCA
+association
unilateral and severe headaches, vision loss if ophthalmic artery affected, scalp pain when brushing hair, jaw pain, fever, symptoms of polymyalgia rheumatica- shoulder/joint pain
59
von willebrand
is a cunt
60
Name three inflammatory arthropathies
Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis
61
Name the three HLA-B27 positive arthropathies
psoriatic arthritis, ankylosing spondylitis, reactive arthritis
62
ACS complications
Heart failure
| Thrombocytopenia due to anticoagulation treatment
63
X ray changes in heart failure
```
A - Alveolar oedema (bat wing opacities)
B - Kerley B lines
C - Cardiomegaly
D - Dilated upper lobe vessels
E - Pleural effusion
```
64
Left vs right sided heart failure
Left - Tachypnoea, tachycardia. Third heart sound (S3). Peripheral cyanosis, Displaced apex sound
Right - Raised JVP, Pitting Oedema, Hepatosplenomegaly, Ascites
65
Well's score
Predicts DVT
Highly sensitive but not very specific
DVT likely 2 points
DVT unlikely 1 point or less
Some point factors include:
- pitting oedema
- active cancer
- calf swelling
- previous DVT
- localised tenderness
- recent bedriddenness
If alternative diagnosis equally likely take 2 from points
66
Sensitivity vs specificity
Sensitivity - number of true positives
| Specificity - number of true negatives
67
Alcohol units equation
(alcohol % by volume * volume of liquid in ml)/1000
68
Systolic vs diastolic heart failure
Systolic - ejection fraction reduced (ventricles dont contract properly)
Diastolic - ejection fraction preserved (ventricles do not relax properly)
69
What do raised ALT and ALP mean?
Raised ALT - hepatocellular injury
Raised ALP - Cholestasis (when raised with GGT - without GGT can suggest pathology that causes bone breakdown)
If ALT raised less than 10 fold and ALP raised more than 3 fold, it still suggests cholestasis, and vice versa for hepatocellular injury
70
Normal ALT and ALP but raised bilirubin. Diagnosis:
Gilbert's syndrome OR haemolysis
71
AST/ALT ratio
ALT>AST - Chronic liver disease
| AST>ALT - Cirrhosis and acute alcoholic hepatitis
72
HTN staging
```
Normal: 120/80
Stage 1: 140/90
Stage 2: 160/100
Stage 3: 180/120
(On clinical readings - slightly less for ambulatory)
```
73
PVD Treatment
Conservative - exercise, weight loss
Antiplatelet - clopidogrel
Statin - atorvastatin
surgical - stent/endovascular angioplasty
74
4 short term effects of chemotherapy
Alopecia, nausea, vomiting, sexual dysfunction, fatigue, neutropenia, immunosuppression, anaemia
75
2 long term effects of chemotherapy
Hearing loss, infertility, heart failure
76
Signs of ascites on physical examination
Abdominal distension, shifting dullness, fluid in flanks
77
What is the buergers test
Test for PVD.
Raise patient's legs 45 degrees. Pallor after 1-2 mins suggests PVD. Next, have them sit over the edge of a bed with their legs hanging. In normal patient legs will remain pink. In PVD patient, legs will go blue (as ischaemic tissue deoxygenates blood) and then dark red (due to vasodilation in response to waste products of anaerobic respiration)
78
Graves disease.
Pathology, signs/symptoms, investigations, management
Pathology: Hyperthyroidism when TSH receptor stimulating antibodies bind to TSH receptors in thyroid, causing release of T3/T4, resulting in hyperthyroidism.
Signs/symptoms: Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]
- (specific to graves) Thyroid bruit, pretibial myxoedema, opthalmoplegia (muscle paralysis around eyes)
Investigations: TFT: Raised T3/T4, reduced TSH
Management: Carbimazole (1st line) in mild
Radioiodine if severe
79
Give the risk factors for osteomyelitis and septic arthritis
>80years old, DM, recent penetrating trauma, prosthetic joints, recent surgery
80
Treatment for ankylosing spondylitis
1. NSAIDs
2. steroids during flares
3. Anti TNF eg infliximab
81
The antibodies found in SLE
ANA antibodies
| double stranded DNA antibodies
82
```
State the class of drugs which is the first line medication for osteoporosis
Give an example
Give brief instructions for how this class of drug should be taken
```
- bisphosphonates
- alendronic acid/alendronate
- 70mg once weekly, taken orally with a large glass of water and to remain upright for half an hour after consuming
83
Name 3 characteristic deformities of the hands in rheumatoid arthritis.
Swan neck deformity, boutonniere deformity and z thumb deformity
84
Pharmacological treatment and prevention of gout
treatment- colchicine plus NSAIDs
| prevention- allopurinol
85
what are the X-Ray changes in Rheumatoid Arthritis
```
LESP
loss of joint space
erosion of bone
soft tissue swelling
pariarticular osteopenia
```
86
Graves disease.
Pathology, signs/symptoms, investigations, management
Pathology: Hyperthyroidism due to TSH receptor stimulating antibodies bind to TSH receptors in thyroid, causing release of T3/T4, resulting in hyperthyroidism.
Signs/symptoms: Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Diarrhoea, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]
- (specific to graves) Thyroid bruit, pretibial myxoedema, opthalmoplegia.
Investigations: TFT: Raised T3/T4, reduced TSH
Management: Carbimazole (1st line) in mild
Radioiodine if severe
87
What is De Quervains Thyroiditis
Transient hyperthyroidism from acute inflammation of the gland after an infection. To be treated with only aspirin.
88
ECG changes in pericarditis
```
PeRicariTiS
- Saddle shaped ST elevation
- PR depression
followed by T wave flattening and eventual inversion.
- low QRS if effusion
```
89
ECG in pericardial effusion
low QRS complex voltage
90
What is dressler's
Pericarditis following MI
91
Causes of peritonitis
```
AEIOU
A- Appendicitis
E- Ectopic pregnancy
I- Infection
O- Obstruction
U- Ulcers
```
92
Ascites - fluid investigations
- Ascitic tap
- Serum ascites-albumin gradient
High SAAG - tranudate (high portal pressure)
Low SAAG - exudate (low portal pressure)
93
Describe first degree AV heart block
occurs where there is delayed atrioventricular conduction through the AV node but every atrial impulse leads to a ventricular contraction
94
Describe second degree type 1 AV heart block
atrial input becomes gradually weaker until it does not pass through the AV node. After failing to stimulate a ventricular contraction the atrial impulse returns to being strong
95
Describe second degree type 2 AV heart block
Disease of the His-Purkinje system. Results in missing QRS complexes
96
Describe third degree AV heart block
complete heart block. There is no observable relationship between P waves and QRS complexes
97
Major Dukes criteria
```
Two positive blood cultures
Or enodcardial involvement on echocardiogram
- Endocardial vegetation
- Perialvular abscess
- New prosthetic valve
- New valve regurgitation
```
98
Why does cardiac tamponade lead to hypotension?
Compression of heart causes decrease in stroke volume and cardiac output, leading to hypotension and tachycardia
99
Mitral stenosis sounds
Loud S1 snap w/ mid diastolic murmur
100
Mitral regurgitation sounds
Pansystolic murmur w/ mid systolic click and additional S3 sound
101
Aortic stenosis
Ejection systolic murmur w/ ejection click and S4 sound
102
Aortic regurgitation
Early decrescendo murmur, water hammer pulse, soft S1 and S2
103
Mitral stenosis and regurgitation and
| Aortic stenosis and regurgitation sounds
Mitral stenosis: Loud S1 snap w/ mid diastolic murmur
Mitral regurgitation: Pansystolic murmur w/ mid systolic click and additional S3 sound
Aortic stenosis: Ejection systolic murmur w/ ejection click and S4 sound
Aortic regurgitation: Early decrescendo murmur, water hammer pulse, soft S1 and S2
104
In ACS,
| Aspirin + what?
Aspirin + clopidogrel if undergoing PCI
| Aspirin + Ticagrelor if not
105
Symptoms of Hypercalcaemia
Painful bones
Renal stones
Abdominal groans (nausea,vomiting,constipation,indigestion)
Psychiatric moan (lethargy, fatigue, memory loss, depression)
106
Signs of osteoarthritis
Joint pain, effusion, stiffness, mechanical locking
Herbeden's and Bouchard's nodes.
No morning pain, pain worse with activity
107
Signs of rheumatoid arthritis
Boutonniere: PIP flexion and DIP hyperextension
Swan neck: DIP flexion and PIP hyperextension.
Rheumatoid nodules, popliteal cysts.
Starts small joints and progresses larger.
108
Pain in hands worse in morning and improves through day. Osteo or rheumatoid?
Rheumatoid. Osteo gets worse throughout day.
109
Lifestyle advice in gout
Low purine foods, lose weight, avoid alcohol
110
Risk score for stroke after Atrial fibrillation
CHADS VASc
```
Congestive heart failure
Hypertension
Age>75 (2pts)
Diabetes Mellitus
Stroke/TIA/Thromboembolism (2pts)
Vascular disease
Age 65-74
Sex (female)
```
111
What is Reiter's Syndrome?
Reactive arthritis
"Cant pee, see climb up a tree"
Conjunctivitis, urethritis and arthritis
112
What is Behcet's syndrome
oral ulcers, genital ulcers, eye inflammation
113
Benign vs malignant neoplasm of glandular tissue
Adenoma vs adenocarcinoma
114
Benign vs malignant neoplasm of squamous epithelium
papilloma vs squamous cell carcinoma
115
Benign vs malignant neoplasm of fat
lipoma vs liposarcoma
116
Benign vs malignant of smooth muscle
leiomyoma vs leiomyosarcoma
117
small bowel obstruction vs large bowel obstruction
X ray first for both
Large bowel has slower onset of symptoms
Pain lower higher in SBO (periumbilical)
Nausea and vomiting early in SBO late in LBO
Pain intermittent in SBO, constant in LBO
X ray first line investigation for both
118
Salbutamol side effects
```
fine tremor
headache
dry mouth
palpitations
nervousness
```
119
Duodenal vs gastric ulcer
Duodenal is relieved by eating, worse a few hours later
Gastric made worse by eating
120
What does P-ANCA suggest
Vasculitis or PSC
121
Signs of chronic liver disease on hands
Spider angioma, palmar erythema, leukonychia (white nails), Dupuytren's contractures (thickening of palm skin)
122
Signs of decompensated liver disease
Encephalopathy, ascites, jaundice, splenomegaly, variceal bleeding
123
Liver biopsy in chronic hepatitis
Mallory bodies, large mitochondria, fibrosis, extracellular matrix proteins
124
Primary sclerosing cholangitis vs primary biliary cholangitis
PSC is P ANCA positive
PSC associated with UC
PBC has anti mitochondrial and anti nuclear antibodies
125
What does aldosterone to do kidneys?
Increases sodium reabsorption and potassium and H+ secretion by kidney. Causes hypokalaemia and metabolic alkalosis
126
Primary biliary cholangitis antibodies
Anti mitochondrial antibodies
| Anti nuclear antibodies
127
Murphy's sign
Palpate gallbladder and ask patient to exhale then inhale. On inhalation, patient will feel a sharp shooting pain.
```
Positive = cholecystitis
Negative = biliary colic (or like normal life too i guess)
```
128
Risk factors for gallstones
4Fs
| Female, fat, fourties, fertile (pregnancy)
129
Jaundice types and urine/stool presentation
Prehepatic - unconjugated bilirubin - normal urine/stool
Hepatic - Both conjugated and unconjugated - Dark urine/ normal stools
Post hepatic - Conjugated bilirubin - dark urine pale stools
130
What drug given in alcohol withdrawal?
Chlordiazepoxide
131
Murphy's sign
Palpate gallbladder and ask patient to exhale then inhale. On inhalation, patient will feel a sharp shooting pain.
```
Positive = cholecystitis
Negative = biliary colic (or like normal life too i guess)
```
132
Risk factors for gallstones
4Fs
| Female, fat, fourties, fertile (pregnancy)
133
Jaundice types and urine/stool presentation
Prehepatic - unconjugated bilirubin - normal urine/stool
Hepatic - Both conjugated and unconjugated - Dark urine/ normal stools
Post hepatic - Conjugated bilirubin - dark urine pale stools
134
What drug given in alcohol withdrawal?
Chlordiazepoxide
135
Antibodies in autoimmune hepatitis
- Antinuclear antibody (ANA),
- Anti smooth muscle antibody (ASMA),
- Anti-soluble liver antigen/liver-pancreas antibody (anti-SLA/LP)
- Anti-liver cytosol 1 antibody (anti-LC1)
136
Symptoms of hypoglycaemia
Blood sugar below 70mg/dL
- sweating, tired, dizziness, shaking, mood swings, anxiety, pallor, palpitations,
- can progress to weakness, confusion, blurred vision, fits, collapsing
137
Scoring system for stroke after TIA
ABCD2
```
Age>60
BP > 140/90
Clinical features (Speech +1, w weakness +2)
Duration (10-59 mins +1, 60+ mins +2)
Diabetes history (+1)
```
138
Where are renal stones most likely to get stuck?
ureteropelvic junction, ureterovesical junction, ureteral crossing of the iliac vessels
139
What are the risk factors for osteoporosis
```
SHATTERED.
S- steroids
H- hyperthyroidism
A- alcohol and tobacco
T- thin
T- testosterone
E- early menopause
R- renal failure
E- erosive bone disease
D- dietary calcium low
```
140
What is the potentially life threatening complication of rheumatoid arthritis? And how does it present?
Felty's Syndrome
- rheumatoid arthritis
- splenomegaly
- neutropenia
141
What is the main cause of pneumonia in HIV patients?
pneumocystis jirovecii
142
Common cause of pneumonia if you have been abroad eg to Spain
Legionella pneumophilia
143
Cauda Equina causes, S+S, Management and treatment
Cauda Equina Syndrome=
S+S- bilateral lower limb weakness, reduced sensation, reduced perianal sensation/tone, lower back pain, saddle anaesthesia, bladder and bowel dysfunction, leg weakness + difficulty walk
Investigations- urgent spine MRI (gold standard)
management
Management- emergency spinal cord decompression
144
Calcium channel blocker MOA
Dihydropyridines (amlodipine) are more vascular selective (decrease vascular resistance and BP)
Non-dihydropyridines (Verapamil) are more myocardial selective and tend to reduce the heart rate
145
How does calcium gluconate protect heart?
stabilizing the cardiac cell membrane against undesirable depolarization
146
Ankylosing spondylitis extra articular manifestations
```
5 A's:
Anterior uveitis,
Autoimmune bowel disease,
Apical lung fibrosis,
Aortic regurgitation,
Amyloidosis.
```
147
Test for spine mobility
Schober's test:
Have patient stand. Locate L5 vertebrae. Mark 10cm above and 5cm below. Ask patient to bend forward as far as possible and measure distance between 2 points. <20cm distance = reduced lumbar movement.
148
Asthma exacerbation scale
Moderate - PEFR 50-75% w/normal speech
Acute severe - 33-50% or inability to complete sentences in one breath, oxygen saturation>92%.
Life threatening - <33% or oxygen<92% or altered consciousness
Treatment: SABA, SAMA nebuliser and Steroid
(Salbutamol, Ipratropium Bromide nebuliser, Oral prednisolone or IV hydrocortisone)
149
Raise in ALP, but other LFT normal
Paget's
150
Adrenaline MOA
Beta adrenergic receptor agonist
151
Restrictive vs obstructive pulmonary disease
With examples
```
Obstructive: COPD/Asthma etc
Reduced FEV1 (<80%) and lesser reduced FVC
FEV1:FVC <0.7
```
Restrictive: Pulmonary fibrosis, bronchiectasis, other causes of decreased breath
Reduced FEV1 (<80%) reduced FVC (<80%)
FEV1:FVC >0.7
152
GCA what arteries affected
- Headache, scalp pain - Superficial temporal artery
- Jaw claudication - Mandibular artery
- Eye problems - Retinal ischaemia
153
Histology of Alzheimers
Senile plaques and neurofibrillary tangles.
154
Epilepsy vs Syncope
Syncope caused by emotional distress or from getting up too quick. No post ictal symptoms
155
Kernigs sign
Inability to straighten leg when hip flexed to 90 degrees
Suggests Meningitis
156
Teratology of Fallot
Ventricular septal defect
Overriding aorta
RV hypertrophy
Pulmonary stenosis
157
Treatment of Cluster headache and Migraine
Sumatriptan (triptan)
158
COPD x ray
hyperinflation,
flat hemidiaphragm,
bullae,
barrel chest
159
Causes of microcytic anaemia <80 fL
```
TAILS
Thalassaemia
Anaemia of chronic disease
Lead poisoning
Sideroblastic
```
160
Causes of normocytic anaemia 80-95 fL
```
3A 2H
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic (sickle cell, G6PD, spherocytosis)
Hypothyroidism
```
161
Macrocytic anaemia >95 fL
B12 and folate defficiency
162
Alcohol withdrawal drug
Chlordiazepoxide
side effects: Drowsy, diarrhoea, weakness, tiredness
163
Bisphosphonates. Example, how to take, side effects.
Alendronic acid. Given in osteoporosis. To be given on empty stomach, first thing in the morning with a full glass of water. Stay upright for 30 mins after taking and dont eat or drink for 30 mins after.
Side effects: Oesophagitis, oesophageal ulcers, osteonecrosis of jaw
164
Multiple myeloma cells
Rouleaux formation
165
G6PD Blood film
Heinz bodies and bite cells
166
How to take infective endocarditis culture
3 different sites 3 different times (1 hour apart each)
167
Gout vs Pseudogout crystals
- Gout: Needle shaped, negative birefringence
| - Pseudogout: Rhomboid shaped, positive birefringence
168
2 causes of reactive arthritis
STI (chlamydia)
Gastroenteritis (gram negative (e.g. salmonella, e.coli, shigella, campylobacter))
tissues of synovium, urethra, conjunctiva affected 2-3 weeks after initial infection
169
HLA B27 associated diseases
Reactive arthritis,
psoriasis/psoriatic arthritis,
ankylosing spondylitis
ulcerative colitis
170
Reiter's syndrome triad
Inflammation of synovium, urethra, conjunctiva (eyes)
171
What is meant by seronegative spondyloarthropathy
Rheumatoid factor negative, HLA-B27 associated, can affect axial skeleton
172
Conn's triad
Hypokalaemia, refractory hypertension, metabolic alkalosis, hypernatraemia.
Due to effect of aldosterone on kidney
173
Signs in osteoarthritis
```
Herbeden's nodes (DIP)
Bouchard's nodes (PIP)
Squaring at base of thump at carpo-metacarpal joint
Weak grip
Reduced range of motion
```
174
Signs in rheumatoid arthritis
```
Z shaped thumb deformity
Swan neck deformity (hyperextended PIP, flexed DIP)
Boutonnieres deformity (hyperextended DIP, flexed PIP)
Ulnar deviation of fingers at MCP joints
```
175
Biochemistry of Paget's
Raised ALP (other LFT normal)
Normal calcium
Normal phosphate
176
X ray in Paget's
```
Bone enlargement and deformity
Osteolytic lesions (osteoporosis circumscripta)
Cotton wool appearance of skull
V shaped defects of long bones
```
177
Risk factors for osteoporosis
```
Women > 65
Men > 75
Low BMI (<18.5kg/m^2)
Long term corticosteroids
Reduced mobility
```
178
What is the FRAX tool?
Prediction of fragility fracture (hip or major osteoporotic) over next 10 years.
Age, sex, weight, height, previous fracture, smoking, glucocorticoids, alcohol >3 units/day, femoral neck BMD.
179
Giant cell arteritis diagnostic criteria
- Age>50
- New onset headache
- Temporal artery abnormality (tender on palpitation, decreased pulsation)
- Elevated ESR
- Abnormal temporal artery biopsy
180
Sjogren's. Tell me what it is, test for it and how to treat it
Autoimmune condition affecting exocrine glands, leads to dry mucous membranes (dry mouth, eyes, vagina)
Can be primary or secondary (SLE, rheumatoid arthritis)
Schirmer test - strip of filter paper left under eyelid for 6 mins, moisture distance measured. Tears should travel 15mm in healthy young adult, less than 10 significant.
Anti-Ro, anti-La antibodies
hydroxychloroquine
181
What blood tests done for vasculitis
CRP/ESR
ANCA (Anti neutrophil cytoplasmic antibodies)
p-ANCA (aka anti-PR3) - Wegener's granulomatosis
c-ANCA (aka anti-MPO) - microscopic polyangiitis
182
antibodies in SLE
```
ANA - Sensitive
Anti-dsDNA - Specific
Anti-Smith - most specific but low sensitivity
Anti histone - Drug induced
Anti-Ro, Anti-La - Sjogrens
```
183
What is Schirmer test
strip of filter paper left under eyelid for 6 mins, moisture distance measured. Tears should travel 15mm in healthy young adult, less than 10 significant.
Check for sjorgrens
184
Causes of peripheral neuropathy
```
A - Alcohol
B - B12 deficiency
C - Cancer/CKD
D - Diabetes and Drugs (isonazid, cisplatin)
E - Every vasculitis
```
185
What antibodies in hashimoto's
Anti TPO (thyroid peroxidase) - degeneration of thyroid gland
186
Antibodies in graves
Anti TSH receptor - causes release of T4
187
Bronchiectasis CT
signet ring
188
Typical Multiple Myeloma symptoms
```
CRAB
C - hypercalcaemic >2.75mmol/L
R - renal impairment (creatinine)
A - Anaemia
B - Bone lesions
```
189
Bone signs in multiple myeloma
Pepper pot skull, cord compression, back pain
190
Malaria causing bacteria
P. falciparum - most common and severe and highest mortality rate. Africa
P. Vivax - Also causes severe disease, less contribution to global burden. Asia and South America
191
Signs of malaria
"warm and cold"
recent travel
diarrhoea
abdominal pain
192
Treatments alongside chemo for Leukaemia
CML - Imatinib (tyrosine kinase inhibitor)
CLL - Ibrutinib (bruton kinase inhibitor)
- Rituximab (monoclonal antibody)
193
Immune thrombocytopenia purpura (ITP) signs
Easy bruising
Epistaxis (nose bleeds)
Menorrhagia (abnormally heavy bleeding)
Purpura (Purple spots caused by bleeding under skin)
194
Diagnostic criteria for Multiple Myeloma
Bench jones protein in urine
Lytic bone lesions
Excess plasma cells in bone marrow (>10% infiltration)
195
Multiple Myeloma investigations (5)
Urine electrophoresis: Bence jones proteins in urine (immunoglobulin light chains)
Serum electrophoresis: Monoclonal paraprotein band, IgG or IgA
Bone marrow aspiration: >10% plasma cell infiltration
Blood film: Rouleaux formations
X ray: Raindrop skull due to lytic lesions
196
Multiple myeloma treatment
Bortezomib, dexamethasone, thalidomide
If under 70, or poor performance status
Bortezomib, prednisolone, melphalan
Stem cell transplant.
Blood tests repeated every few months and bortezomib monotherapy following relapse
197
Poor prognostic factors for Myeloma
Raised LDH, raised beta 2 microglobulin
198
Alzheimers biopsy findings
Biopsy performed after death
- Senile plaques (beta amyloid) outside of neurones
- Neurofibrillary tangles (hyperphosphorylated tau protein aggregations) Inside neurones
199
Hyperthyroidism Symptoms
Tremor, Heart rate increase, Yawning, Restless, Oligomenorrhea, Irritability, Diarrhoea, Intolerance to heat, Sweating, Muscle wasting (weight loss) [THYROIDISM]
200
Hyperparathyroid signs
Bones, stone, (abdominal) groans, (psychiatric) moans.
Bone pain
Renal stones
Constipation etc
Mood/behaviour changes
201
Hyperparathyroid biochemistry
Primary - Raised PTH, raised Ca, low phosphate
Secondary - Raised PTH, low calcium and phosphate
Tertiary - Raised PTH, calcium and phosphate
202
Microcytic anaemias (TAILS)
```
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficient
Lead poisoning
Sideroblastic anaemia
```
203
Normocytic anaemia (AAAHH)
```
AAAHH
Acute blood loss
Anaemia of chronic disease
Aplastic
Hypothyroidism
Haemolytic (spherocytosis, G6PD deficiency, Sickle cell)
```
204
Macrocytic anaemia
B12 deficiency
| Folate deficiency
205
Brown Sequard vs cauda equina
BS: Ipsilateral loss of position, light touch and vibration sessions at level of lesion.
Ipsilateral muscle weakness
Contralateral loss 0of pain and temperature below lesion
Cauda equina: Bilateral leg weakness, flaccid, areflexic (LMN signs)
206
Causes of pancreatitis
```
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune conditions
Scorpion venom
Hyperlipidaemia/calcaemia
ERCP
Drugs (Furosemide, NSAIDs)
```
207
Vitamin K dependent clotting factors
10,9,7,2 (1972)
208
Warfarin MOA
Vit K antagonist (clotting factors 10,9,7,2)
209
Signs of pneumothorax
| Spontaneous and Tension
Spontaneous: Ipsilateral Hyperresonance, ipsilateral reduced breath sounds, cyanosis, tachycardia.
Tension: Ipsilateral hyperextension, ipsilateral reduced breath sounds, contralateral tracheal deviation, hypotension
210
Heparin MOA
Binds to antithrombin, increasing its activity.
Inactivates thrombin and factor 10a
211
What can rapid correction of sodium cause?
Central pontine myelinolysis - demyelination of nerve cells. When Na+ raised by >10mmol/L in 24 hours.
212
Hypothyroidism signs and symptoms
goitre, bradycadia, myoedema, hair loss, weight gain, cold intolerance, lethargy, menorrhagia, oligomenorrhoea
213
Action of PTH
Calcium absorption from bone
Kidneys reabsorb more calcium
Kidneys synthesise vit D which causes calcium absorption in GI tract
214
Complications of Acromegaly
Cardiomyopathy, heart failure, type 2 diabetes, obstructive sleep apnoea, carpal tunnel syndrome.
Hyperprolactinaemia.
215
Signs/symptoms of acromegaly
Bitemporal hemianopia, spade like hands, sweaty palms, large tongue, protruded jaw
216
Prolactinoma S+S
Men: Gynaecomastia, erectile dysfunction
Women: Galactorrhoea, amenorrhoea, vaginal dryness, brittle bones (RISK OF FRACTURE)
General: Loss of libido, infertility,
217
RAAS system explained
Juxtaglomerular cells in afferent arteriole of kidney sense low BP and release renin. which converts liver secreted angiotensin to angiotensin I which is converted to angiotensin II in lungs using ACE. Angiotensin II causes release of aldosterone which causes sodium reabsorption and potassium and hydrogen excretion, raising BP.
218
What causes secondary hyperaldosteronism
When BP is lower in kidneys than in rest of body (renal artery stenosis, obstruction or heart failure), resulting in renin secretion
219
What causes primary hyperaldosteronism
Conn's
Caused by adrenal adenoma releasing aldosterone from zona glomerulosa.
220
Hyperaldosteronism S+S
Refractory hypotension, hypokalaemia, hypernatraemia, metabolic alkalosis
Polyuria, nocturia, lethargy, mood disturbance
221
Causes of SIADH
```
Small cell carcinoma
brain injury
infection
Prostate cancer
pancreatic cancer
lymphoma
```
222
What does cutting off corticosteroid therapy cause
Secondary adrenal insufficiency
223
Hyperkalaemia symptoms
```
Tachycardia
Paresthesia
Light headedness
Muscle weakness
Diarrhoea/constipation (muscle cramps - e.g. GI)
```
224
Hypokalaemia symptoms
```
Hypotonia
Hyporeflexia
Fatigue
Generalised weakness
Light headedness
Palpitations
Constipation
```
225
Addison's investigations
```
SynACTHen test (ACTH stimulation test)
Give ACTH and see if cortisol goes up in 30 then 60 mins. If not, addisons.
```
Check serum ACTH, if high - addisons
If low, secondary hypoadrenalism
226
Addison's signs and symptoms
Postural hypotension, hyperpigmentation, vitiligo, hair loss.
Tanned, tired, tearful, toned
Hyperpigmentation, fatigue, depression, weight loss
227
Lofgren's triad
Erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia/pain in more than one joint
Suggest specific type of sarcoidosis
228
AKI Criteria
Rise in creatinine > 26 mmol/L in 48 hours
Rise in creatinine >1.5x baseline
Urine output <0.5ml/kg/hour
229
Antibiotics in gonococcal arthritis or gram negative infection
Cefotaxime or ceftriaxone
230
Subarachnoid haemorrhage S+S
```
Thunderclap headache
Nuchal rigidity (neck stiffness)
Face droop
Arm weakness
Speech difficulty
Time
```
231
Extra articular manifestations of RA
Felty's syndrome (arthritis, neutropenia, splenomegaly)
Anaemia
Secondary amyloidosis
232
Meningitis CSF
Bacterial - Cloudy, neutrophils, with proteins and reduced glucose
Viral - Clear, lymphocytes, proteins in CSF
Fungal - cloudy/fibrin web, protein elevated
233
Treatments for Meningitis
IM or IV benzylpenicillin if suspected meningococcal
Ciprofloxacin prophylaxis for contacts
Dexamethasone to reduce inflammation
Antiviral - aciclovir
Supportive
234
Investigations for Meningitis
lumbar puncture and CSF analysis
Blood culture
Glasgow consciousness scale - intubate if <8
CT head to check for damage, haemorrhage or tumor
235
Side effects of Epilepsy treatment
Focal Carbamazepine - Agranulocytosis, aplastic anaemia
Sodium valproate - Teratogen, liver damage, hair loss
Ethosuximide - Night terrors, rash
236
Triggers of migraine
```
CHeese
Oral contraceptive pill
Caffeine
Alcohol
Anxiety
Travel
Exercise
```
