SBA revision Flashcards
Hernias
•Direct inguinal
hernias arise from a weakness in the posterior wall of the inguinal canal,
allowing abdominal viscera to protrude ‘directly’ through the back of the
inguinal canal.
•In indirect inguinal hernias, the abdominal contents pass
through the deep inguinal ring and along the inguinal canal. The hernial
sacs in both conditions will protrude through the superficial ring and
produce a swelling in the groin. These two types of hernia are differentiated
on examination by reducing the hernia, placing a finger on the deep inguinal
ring and asking the patient to cough. As you are blocking the deep inguinal
ring with your finger, an indirect inguinal hernia should not reappear as a
groin lump when the patient is asked to cough. Therefore, if the hernia
appears again when the patient increases their intra-abdominal pressure (by
coughing), it suggests that it is a direct inguinal hernia. This test is very
crude and error prone — definitive diagnoses are often made in theatre.
•Spigelian hernias occur when
abdominal contents herniate through the linea semilunaris, typically
occurring inferior and lateral to the umbilicus.
•Obturator hernias occur
through the obturator canal and they present with inner thigh pain when the
hip is internally rotated (Howship–Romberg sign).
Extra murmurs
•Austin-Flint murmur- AR •Graham-Steell murmur -PR •Gibson murmur - PAD •Carey-Coombs murmur - thickened mitral valve •Barlow murmur -MVP
GCS
Glasgow coma scale (GCS) criteria: Eyes 1— No eye opening 2— Eyes open in response to pain 3— Eyes open to verbal command 4— Eyes open spontaneously Verbal 1— No verbal response 2— Incomprehensible sounds 3— Inappropriate responses 4— Confused conversation 5— Oriented
Motor
1— No motor response
2— Abnormal extension in response to pain (decerebrate posture)
3— Abnormal flexion in response to pain (decorticate posture)
4— Withdraws from pain
5— Purposeful movement towards painful stimulus
6— Obeys commands for movement
Minimum = 3; Maximum = 15
Glomerulonephritis
Minimal change disease is - youngkids
Membranous glomerulonephritis - adults
Nephritic syndrome : hematuria more prominent than proteinuria
IgA nephropathy - most common cause of glomerulonephritis, after URTI
Henoch–
Schönlein purpura (IgA in older kids) - triad ; Abd pain, arthritis, purpuric rash
MI locations
Anterior MI — left anterior descending coronary artery — V1–4
Lateral MI — left circumflex coronary artery — aVL, I and V5–6
Inferior MI — right coronary artery — II, III and aVF
Posterior MI — posterior descending artery — ST depression in V1–4
Pancreatitis serum
Acute - serum amylase/lipase
Chronic - Faecal elastase
Pancreatic cancer - CA19-9
CHA2DS2-VASc
used to assess the risk of stroke in patients
with atrial fibrillation, and, hence, determine the benefit of long-term
anticoagulation.
Congestive heart failure
Hypertension
Age >75 yrs (2 points)
Diabetes mellitus
Stroke/TIA symptoms previously (2 points)
Vascular disease (e.g. peripheral artery disease)
Age 65–74 yrs (1 point)
Sex category (Female = 1 point)
2 or more- offer DOAC
QRISK2
predict the risk of cardiovascular disease based on
traditional risk factors such as blood pressure and smoking status. It is used
to decide whether to give primary prevention (e.g. statins).
ABCD2
predicts
a patient’s risk of stroke in the days following a TIA.
GRACE
is used for risk
assessment and triaging of patients with ACS.
CURB-65
(Creatinine, Urea,
Respiratory rate, Blood pressure, >65 yrs) is used to assess severity of
community-acquired pneumonia. A score of 2 warrants hospital admission.
A score of 3 or more is considered ‘severe’ pneumonia and should be
considered for ITU admission.
Causes of CKD
diabetes mellitus (most common), hypertension, idiopathic, glomerulonephritis, pyelonephritis, vasculitides, polycystic kidney disease, reflux nephropathy and obstructive nephropathy.
Examination signs
○psoas sign — achieved by
lying the patient on their left-hand side, straightening their right leg and
then passively extending their right hip. If pain is elicited, this suggests that
the appendix is retrocaecal.
○Rovsing’s sign - when palpation of the left iliac fossa causes pain in the
right iliac fossa.
○Obturator sign - is pain on flexion and internal rotation of
the hip and indicates that the appendix lies close to the obturator internus.
○Aaron’s sign is referred as epigastric pain when pressure is applied over
McBurney’s point.
○ Murphy’s sign is the cessation of inspiration when two
fingers are placed below the right costal margin in the midclavicular line
and the patient is asked to take a deep breath in. This is suggestive of
cholecystitis.
Skin cancers
○squamous cell carcinoma (SCC) is one of most common - SCCs
typically arise in sun-exposed areas and have raised, everted edges with an
ulcerated centre and a keratotic core.
○A keratoacanthoma is a variant of
SCC which grows rapidly but does not metastasise.
○Basal cell carcinomas -most common type of skin cancer. A skin lesion with
raised pearly edges and fine telangiectasia on the surface. It grows across
the skin but never metastasises.
○Melanoma - worst. an asymmetrical pigmented skin
lesion with an irregular border. rapid growth and metastasis
○actinic keratosis - is a very common, non-
malignant skin lesion that occurs due to sun damage. It has a thick, crusty
surface.
AAA surveilance
3–4.5 cm (every year)
4.5–5.4 cm (every 3 months).
>5.5 cm open repair or endovascular aneurysm repair (EVAR),
AIDS defining disease
○Kaposi’s sarcoma ○candidiasis (of the oesophagus, trachea, bronchi or lungs), ○cervical cancer ○Burkitt’s lymphoma ○cytomegalovirus retinitis, ○mycobacterium avium complex ○Pneumocystis jiroveci ○pneumonia and ○toxoplasmosis.
Treating overdose
○Paracetamol - IV n-acetylcysteine ○Opiate Overdose — Naloxone ○Benzodiazepine Overdose — Flumezanil ○Organophosphate Poisoning — Atropine ○Aspirin Overdose — Sodium Bicarbonate
Anaemias
○Haemolytic uraemic syndrome (HUS) is a triad of microangiopathic
haemolytic anaemia (MAHA), acute renal failure and thrombocytopaenia. It
most often occurs following a diarrhoeal infection by E. coli O157 in
children. N.B. The clotting screen is normal in HUS.
○ Thrombotic thrombocytopaenic purpura (TTP) has the same features as
HUS with the addition of fever and fluctuating neurological signs.
○ Disseminated intravascular coagulation (DIC) is widespread activation of
the clotting cascade resulting in low platelets, low Hb and low fibrinogen
with a high APTT/PT.
Cancer staging
TMN - most cancers
Gleason staging - prostate cancer
Breaslow thickness - melanoma
Dukes staging - Colorectal cancer
Rectal masses
A
lump that protrudes with defecation and requires manual reduction suggests
haemorrhoids or rectal prolapse.
Grades of haemorrhoids:
Grade 1: no prolapse
Grade 2: prolapse on defecation but reduces spontaneously
Grade 3: prolapse requires manual reduction
Grade 4: remain persistently prolapsed and cannot be reduced
Type 1
rectal prolapse occurs when only the rectal mucosa protrudes through the
anus and type 2 occurs when all layers of the rectum protrude through the
anus, creating a mass which has palpable, concentric muscular rings.
Lax anal tone
MI complications
○Dressler’s syndrome is a type of pericarditis that arises 2–10 weeks after an
MI.
○presents in the same
way as viral pericarditis — pleuritic chest pain that is relieved by sitting
forward, fever and a pericardial rub.
○ simple post-MI pericarditis which occurs within 2–4 days of an MI.
