Semester 1 Theory Flashcards
Definition of palpitations:
Abnormal awareness of heart beat.
Definition of palpitations:
Abnormal awareness of heart beat.
Appropriate cuff size for BP:
80% the circumference of the arm, and 40% the width.
If the BP cuff is too small, the measure BP will be artificially ___.
Elevated (and if too big, artificially diminished).
Normal location of brachial pulse:
Medial aspect of the antecubital fossa.
Formula for BMI:
Weight/height^2.
Weight in kg, and height in m.
Normal BMI is between ___ and ___
18.5 and 24.9
BMI does not differentiate between ___ and ___ mass.
Muscle and fat.
Formula for WHR:
Waist circumference/hip circumference.
The normal BMI if Asian background is:
18.5-23.
For WHR, the waist is measured at:
Narrowest point of abdomen when viewed from front.(Or halfway between 12th rib and top of iliac crest).
For WHR, the hip is measured at:
Most protuberant part of the buttock region.
Normal WHR:
Normal waist circumference:
Cardiac syncope can be caused by:
Arrhythmias (tachy or brady), or organic heart disease e.g. aortic stenosis or MI.
Cardiac syncope can be caused by:
Arrythmias (tachy or brady), or organic heart disease e.g. aortic stenosis or MI.
Appropriate cuff size for BP:
80% the circumference of the arm, and 40% the width.
If the BP cuff is too small, the measure BP will be artificially ___.
Elevated (and if too big, artificially diminished).
Normal location of brachial pulse:
Medial aspect of the antecubital fossa.
Formula for BMI:
Weight/height^2.
Weight in kg, and height in m.
Normal BMI is between ___ and ___
18.5 and 24.9
The most common cause of myocardial ischaemia is narrowing or coronary arteries due to ___.
Atherosclerosis.
Formula for WHR:
Waist circumference/hip circumference.
The normal BMI if Asian background is:
18.5-23.
For WHR, the waist is measured at:
Narrowest point of abdomen when viewed from front.(Or halfway between 12th rib and top of iliac crest).
For WHR, the hip is measured at:
Most protuberant part of the buttock region.
Normal WHR:
Left border of the heart on a line joining ___ ___ costal cartilage, ___ cm from the sternal edge, to the ___ intercostal space in the ___-___ line.
2nd left costal cartilage, 2 cm from the sternal edge, to the 5th intercostal space in the mid-clavicular line.
Definition of syncope:
Sudden loss of consciousness and postural tone due to insufficient blood supply to the brain.
Cardiac syncope can be caused by:
Arrhythmias (tachy or brady), or organic heart disease e.g. aortic stenosis or MI.
Vasovagal syncope is due to overwhelming ___ drive.
Overwhelming parasympathetic drive.
Cardiac syncope usually has ___ precipitating factors, but precipitating factors for vasovagal syncope include:
Cardiac syncope - usually NO precipitating factors/triggers!
Vasovagal syncope - fasting, pain, emotion, standing.
There is usually no prodrome in ___ syncope, but there is in ___ syncope.
Usually no prodrome in cardiac syncope.
But there usually is prodrome in vasovagal syncope - light-headedness, “wobbly” legs, dim vision, distant noises.
In ___ syncope, lying down usually helps, but not in ___ syncope!
In vasovagal syncope - lying down usually helps recovery.
Not in cardiac syncope!
If suspect cardiac syncope, ask about past/family history of ___ disease.
Heart/cardiac.
Normal pulse rate:
60-100.
Oedema due to volume overload (as in HF) is first noticed in the ___ ___.
Lower limbs.
Definition of angina:
Reversible myocardial ischaemia (both stable and unstable).
Wheezing is usually associated with diseases that mainly affect the ___, but can be due to fluid in the lungs or aspiration from GORD.
Lungs
Typical symptoms of asthma are (3):
Cough, dyspnoea and wheeze.
Superior border of the heart on a line joining ___ ___ and ___ ___ costal cartilages, ___ cm from the sternal edge.
2nd left and 3rd right, 2 cm from the sternal edge.
Right border of the heart on a line joining ___ and ___ right costal cartilage, ___ cm from the sternal edge.
3rd and 6th right costal cartilages, 2 cm from the sternal edge.
Left border of the heart on a line joining ___ ___ costal cartilage, ___ cm from the sternal edge, to the ___ intercostal space in the ___-___ line.
6th costal cartilage, 2 cm from the sternal edge, to the 5th intercostal space in the mid-clavicular line.
Inferior border of the heart on a line joining ___ intercostal space in the ___-___ line, to the ___ ___ costal cartilage, ___ cm from the sternal edge.
5th intercostal space in the mid-clavicular line, to the 6th right costal cartilage, 2 cm from the sternal edge.
Location of heart valves:
In an oblique line behind the sternum from 2nd left costal cartilage to 6th right costal cartilage.
From superior to inferior: PAMT.
Auscultation of mitral valve at:
Apex
Surface anatomy of pleura:
Same as lung but apss further inferiorly to reach the level of the 8th rib in MC line, 10th rib in MA line, 12th rib in paravertebral line.
Auscultation of aortic valve at:
Right of sternum in second intercostal space.
Auscultation of pulmonary valve at:
Left of sternum in second intercostal space.
Causes of oedema (4 causes):
1 - high capillary hydrostatic pressure - due to high volume or reduced venous return (e.g. in congestive HF).
2 - decreased oncotic pressure e.g. if decreased production of proteins due to cirrhosis.
3 - if increased permeability e.g. in some systemic infections, or anaphylaxis.
4 - obstruction of lymphatic drainage (i.e. lymphoedema).
Unilateral leg swelling raises possibility of:
DVT
Definition of massive haemoptysis:
More than 200 - 600 mL in 24 hours.
Dyspnoea is often associated with diseases including:
HF, COPD or asthma.
Wheezing is usually associated with diseases that mainly affect the ___, but can be due to fluid in the lungs or aspiration from GORD.
Lungs
Typical symptoms of asthma are (3):
Cough, dyspnoea and wheeze.
Surface anatomy of trachea:
Behind the manubrium and bifurcates at the level of the manubriosternal junction.
Surface anatomy of apex of lung:
2.5 cm above the medial 3rd of the clavicles.
Surface anatomy of borders of the lungs:
Line from sternoclavicular joint and continues along the lateral border of the sternum to the 4th costal cartilage.
Border of right lung arcs down to 6th rib in MC line, the 8th rib in MA line, and 10th rib adjacent to vertebral column posteriorly.
Border of the left lung similar, but deviate laterally (beyond the lateral marging of the sternum) at the 4th costal cartilage to form the cardiac notch.
Posterior border of the lung:
Extends from C7 to T10, about 4cm from the midline.
Oblique fissure:
Joins spinous process of T2 to the 6th costal cartilage anteriorly.
Normal liver span:
12-13 cm.
Surface anatomy of pleura:
Same as lung but apss further inferiorly to reach the level of the 8th rib in MC line, 10th rib in MA line, 12th rib in paravertebral line.
Acute cough is up to ___ weeks in duration.
Up to 3 weeks for acute!
Causes of acute cough:
Viral infections such as common cold, or bronchitis, or bacterial pneumonia.
Chronic cough is greater than ___ weeks in duration.
> 8 weeks for chronic cough.
Chronic diarrhoea:
> 4 weeks.
Causes include many different medical conditions.
Definition of massive haemoptysis:
More than 200 - 600 mL in 24 hours.
Definition of dysphagia:
Difficulty with swallowing.
Definition of odynophagia:
Pain with swallowing.
Types of dysphagia:
Oropharyngeal - difficulty with initiation of swallowing.
Oesophageal - when food (and some times liquid) gets stuck after swallowing.
Causes of oropharyngeal dysphagia:
Disease affecting pharynx and upper oesophagus e.g. stroke, Parkinson’s, multiple sclerosis.
Causes of oesophageal dysphagia:
Mechanical obstruction - e.g. cancer of oesophagus.
Motility disorder - difficulty with solids AND liquids e.g. achalasia where there is loss of peristalsis in distal oesophagus.
Cause of metabolic flap:
Due to hepatic encephalopathy due to accumulation of ammonia and its effects on brain cell function.
9 divisions of the abdomen:
Right and left hypochondrium, epigastrium, right and left lumbar region, umbilical region, right and left inguinal region, and suprapubic region.
The upper level of of the liver is usually at the level of the ___ rib or ___ intercostal space.
6th rib or 5th intercostal space.
Normal liver span:
12-13 cm.
Spleen is between ribs ___ and ___
9 and 11
Kidneys are between the ___ rib and the ___ ___
12th rib and iliac crest.
Acute diarrhoea:
Persistent diarrhoea:
2-4 weeks.
Chronic diarrhoea:
> 4 weeks.
Causes include many different medical conditions.
If there is enough rectal bleeding it can lead to ___
Anaemia
Anal fissures are ___ but haemorrhoids are not.
Painful.
The spleen is situated posteriorly along the line of the left ___ and ___ rib.
9th and 11th.
If bleeding in upper GI tract, stools may look ___ and ___, this is called ___
Black and tarry.
Melaena
If blood is dark and mixed into stools, it is probably from the ___
Early parts of large intestine.
The transumbilical plane is between L_ and L_
3 and 4
The ___ and ___ are in the RUQ of abdomen.
Liver and gall bladder.
The gall bladder projects just below the liver at the point where the ___-___ line crosses the ___ ___
Mid-clavicular line crosses the costal margin.
The ___ is in the LUQ
Stomach
CAGE stands for:
C - have you ever felt you should CUT down?
A - have people ever ANNOYED you by criticising your drinking?
G - have you ever felt bad or GUILTY about your drinking?
E - do you ever need a drink first thing in the morning (EYE OPENER).
The ___ ___ and ___ ___ are in the LLQ
Descending and sigmoid colon
Where is McBurney’s point?
1/3 of the way along a line from the right ASIS to the umbilicus.
What structure does McBurney’s point mark?
The base of the appendix and site of incision for appendicectomy.
The superior pole of the left kidney reaches as high as ___ rib
11th rib
The superior pole of the right kidney reaches as high as the ___ rib
12th
The inferior pole of left kidney reaches approx. L___
3
If jaundice occurs intermittently, likely due to ___
Gallstones or Gilbert’s syndrome
The spleen is situated posteriorly along the line of the left ___ and ___ rib.
9th and 11th.
For healthy men and women, drinking no more than ___ standard drinks on ANY DAY reduces the lifetime risk of harm from alcohol-related disease or injury.
2!
For healthy men and women, drinking no more than ___ standard drinks on A SINGLE OCCASION reduces the lifetime risk of harm from alcohol-related disease or injury.
4!
___ and ___ questionnaires are used to assess patient’s alcohol use and dependence.
AUDIT and CAGE
AUDIT stands for
Alcohol use disorders identification test.
AUDIT assesses ___, ___ and ___-___ ___.
Consumption
Dependence
Alcohol-related harm
CAGE questionnaire assesses ___
Dependence
CAGE stands for:
C - have you ever felt you should CUT down?
A - have people ever ANNOYED you by criticising your drinking?
G - have you ever felt bad or GUILTY about your drinking?
E - do you ever need a drink first thing in the morning (EYE OPENER).
Disorders causing mainly unconjugated hyperbilirubinaemia:
Overproduction of bilirubin (prehepatic, like haemolysis).
Impaired uptake or conjugation (medication, Gilbert’s syndrome).
Disorders causing mixed unconjugated and conjugated hyperbilirubinaemia:
Impaired bilirubin secretion into canaliculi (e.g. Dubin Johnson syndrome, primary biliary cirrhosis).
Liver disease (e.g. viral causes,alcohol or drugs, or vascular causes like portal vein thrombosis).
Obstruction of bile ducts (i.e. post hepatic) e.g. due to gallstones or cancer of head of pancreas.
When bile duct obstruction occurs, stools may appear ___ coloured
Pale or clay coloured due to lack of pigmentation.
Dark urine in jaundice is due to increased excretion of ___ bilirubin
Conjugated!
Unconjugated bilirubin is not water soluble so is not excreted by kidneys.
Jaundice becomes apparent when concentration of bilirubin is > ___ umol/L
50 umol/L
Normal bilirubin concentration is
If jaundice occurs intermittently, likely due to ___
Gallstones or Gilbert’s syndrome
Acute onset of jaundice suggests:
Acute hepatitis or gall stones.
Onset of jaundice over weeks or months suggests:
Chronic malignancy or cirrhosis.
