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Medicine and Surgery Mushkies > Talley and O'Connor Mushkies > Flashcards

Talley and O'Connor Mushkies Flashcards

1
Q

What are the CAGE questions?

A

Cut down
Annoyed
Guilty
Eye opener

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2
Q

What are the AUDIT-C questions?

A
  1. How often do you have a drink containing alcohol?
  2. How many drinks containing alcohol do you have on a typical day when you are drinking alcohol?
  3. How often do you have 6 or more alcoholic drinks on one occasion
    Each question is scored from 0-4, and unhealthy drinking is >2 for women and >3 for men
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3
Q

How can you classify the complications of alcohol abuse?

A
  1. GI = gastric, pancreatic, hepatic
  2. Cardio = hypertension, arrhythmias, CM
  3. Neuro = Wernickes, Korsakoff, dementia
  4. Haem = anaemia, thrombocytopenia
  5. GU = ED, amenorrhoea
  6. Other = fractures
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4
Q

What are the cardio red flags?

A
  1. Blackouts without warning (Stokes-Adams)

2. Felt dizzy/blacked out whilst exercising (severe AS/HCM)

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5
Q

What is the resp red flag?

A

Coughing up blood

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6
Q

What are the GI red flags?

A
  1. Difficulty swallowing (oesophageal cancer)
  2. Vomited blood (GI bleeding)
  3. Blood in stools/black stools (GI bleeding)
  4. Unexplained weight loss (Colorectal cancer)
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7
Q

What is the GU red flag?

A

Blood in urine (UT malignancy)

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8
Q

What are the haem red flags?

A
  1. Lots of bleeding from small cut (bleeding disorder)

2. Lumps under arm/neck/groin (malignancy)

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9
Q

What are 4 good disease mimickers?

A

TB
HIV
Syphilis
Sarcoidosis

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10
Q

How do you deal with an emotional response?

A 
NURS
Name the emotion 
Show Understanding
Deal with issue with respect
Show support
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11
Q

What are common side effects of psychotropics?

A

Sedation and falls

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12
Q

What are common side effects of diuretics?

A

Hypokalaemia
Renal dysfunction
Gout

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13
Q

What are common side effects of NSAIDS?

A
  1. Exacerbation of HTN
  2. of HF
  3. of CKD
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14
Q

What are common side effects of anti-hypertensives?

A

Postural hypotension and falls

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15
Q

How do you start a clinical examination?

A 
WIPER
Wash hands
Introduce yourself
Position the patient
Expose the patient
Right side of bed
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16
Q

What are the 6 vital signs?

A
  1. HR
  2. RR
  3. BP
  4. Sats
  5. Temperature
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17
Q

Why is the term scleral icterus misleading?

A

Bilirubin is actually deposited in the vascular conjunctiva rather than in the avascular sclera

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18
Q

What is a cause of yellow discoloration of the skin, with normal sclerae?

A

Carotenaemia from eating too many carrots and/or mangoes

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19
Q

What causes deep blue discoloration of the face?

A

Amiodarone

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20
Q

When is a lipodystrophic facies seen?

A

Anti-retroviral therapy

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21
Q

When do you see risus sardonicus?

A

Tetanus

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22
Q

What are 2 features of an acromegalic facies?

A

Supraorbital ridge and prognathism

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23
Q

What is cyanosis?

A

Blue discoloration of the skin and mucous membranes due to presence of deoxygenated haemoglobin in superficial blood vessels (approx >50g/L deoxygenated Hb present in capillaries)

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24
Q

Why does cyanosis not occur in anaemic hypoxia?

A

Because the total Hb content is low

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25
Q

What is central cyanosis?

A

There is an abnormal amount of deoxygenated blood in the arteries

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26
Q

How can you classify the causes of cyanosis?

A

Central vs. peripheral

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27
Q

What are the causes of central cyanosis?

A
  1. Decreased arterial oxygen saturation
  2. Polycythaemia
  3. Hb abnormalities
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28
Q

What are causes of decreased arterial oxygen saturation?

A
  1. High altitude
  2. Hypoventilation
  3. Lung disease
  4. R to L cardiac shunt
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29
Q

What is an Hb abnormality that can lead to central cyanosis?

A

Methaemoglobinaemia, often due to drugs such as dapsone or topical anaesthetics, can be fatal if not recognised and treated

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30
Q

What are causes of peripheral cyanosis?

A
  1. All causes of central cyanosis
  2. Exposure to cold
  3. Reduced CO (LV Failure/shock)
  4. Arterial or venous obstruction
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31
Q

What causes pallor?

A

A deficiency of haemoglobin (anaemia)

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32
Q

At what point does subconjunctival pallor appear?

A

Hb <70g/L

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33
Q

How can you classify the causes of shock?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Distributive
  4. Obstructive
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34
Q

What are the causes of hypovolaemic shock? x2

A
  1. External fluid loss = haemorrhage, vomit, diarrhoea, urine, burns, sweating
  2. Internal fluid loss = ascites, haemothorax, fracture
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35
Q

What are the causes of cardiogenic shock? x6

A
  1. Arrhythmia
  2. Valve failure
  3. Cardiomyopathy
  4. MI
  5. Dissection
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36
Q

What are the causes of distributive shock? x5

A
  1. Anaphylactic
  2. Neurogenic
  3. Septic
  4. Drug-induced
  5. Addisonian
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37
Q

What are the causes of obstructive shock?

A
  1. Tension pnuemothorax
  2. Tamponade
  3. PE
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38
Q

How can you classify the complications of obesity? x6

A
  1. Endocrine
  2. Cardio
  3. Resp
  4. Gut
  5. Musk
  6. Skin
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39
Q

What are some endo complications of obesity?

A
  1. T2DM
  2. Dyslipidaemia
  3. Amenorrhoea
  4. Infertility
  5. PCOS
  6. Hypogonadism
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40
Q

What are some resp complications of obesity?

A
  1. Sleep apnoea

2. Dyspnoea

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41
Q

What are come cardiac complications of obesity?

A
  1. HTN
  2. HF
  3. IHD
  4. PE
  5. Cor pulmonale
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42
Q

What are some musk complications of obesity?

A
  1. Arthritis

2. Immobility

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43
Q

What are some skin complications of obesity?

A
  1. Abscesses, cellulitis, fungal infections

2. Venous stasis

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44
Q

What are some gut complications of obesity?

A
  1. GORD
  2. NASH
  3. Hernias
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45
Q

What causes perifollicular haemorrhages?

A

Vitamin C deficiency

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46
Q

How can you classify dehydration?

A
  1. Mild (<5%) = 2.5L deficit
  2. Moderate (5-8%) = 4L deficit
  3. Severe (9-12%) = 6L deficit
  4. Very severe (>12%) = >6L deficit
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47
Q

What are signs of mild dehydration?

A
  1. Mild thirst
  2. Dry mucous membranes
  3. Concentrated urine
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48
Q

What are signs of moderate dehydration?

A

+

  1. Reduced skin turgor
  2. Tachycardia
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49
Q

What are signs of severe dehydration?

A

+

  1. Gaunt face with sunken eyes
  2. Postural hypotension
  3. Oliguria (<400ml/24hr)
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50
Q

What are the signs of very severe dehydration?

A

+

  1. Comatose
  2. Moribund
  3. Signs of shock
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51
Q

What might a pt have if when you shake their hand they are unable to let go?

A

Dystrophia myotonica

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52
Q

What are 3 causes of blue nails?

A
  1. Cyanosis
  2. Wilson’s disease
  3. Ochronosis
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53
Q

What is ochronosis?

A

A syndrome caused by the accumulation of homogentisic acid in connective tissues

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54
Q

What are 2 causes of red nails?

A
  1. Polycythaemia (reddish-blue)

2. Carbon monoxide poisoning (cherry-red)

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55
Q

What causes yellow nails?

A

Yellow nail syndrome

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56
Q

What is yellow nail syndrome?

A

A rare syndrome also known as “primary lymphedema associated with yellow nails and pleural effusion”

57
Q

What are causes of splinter haemorrhages?

A
  1. Trauma (particularly in manual workers)
  2. IE
  3. Vasculitis
58
Q

What are 3 causes of koilonychia?

A
  1. IDA
  2. Fungal infection
  3. Raynaud’s disease
59
Q

What are 3 causes of onycholysis?

A
  1. Over-enthusiastic cleaning under the nails
  2. Thyrotoxicosis
  3. Psoriasis
60
Q

What are 3 causes of Beau’s lines?

A
  1. Fever
  2. Cachexia
  3. Malnutrition
61
Q

What are Beau’s lines?

A

Non-pigmented transverse lines in the nail bed, caused by a temporary cessation of cell division in the nail matrix.

62
Q

What causes leukonychia?

A
  1. Hypoalbuminaemia
63
Q

What are 3 causes of Muehrcke’s lines?

A
  1. Trauma
  2. Hypoalbuminaemia
  3. Acute illness
64
Q

What is the difference between Beau’s and Muehrcke’s lines?

A

Beau’s lines are grooved

65
Q

What do you call a single transverse white band?

A

Mees’ lines

66
Q

What are 2 causes of Mees’ lines?

A
  1. Arsenic poisoning
  2. Renal failure
  3. Chemotherapy patients
67
Q

What causes nail fold erythema and telangiectasia?

68
Q

What causes Terry’s nails?

A
  1. CKD

2. Cirrhosis

69
Q

What are Terry’s nails?

A

Also known as ‘half-and-half’ nails, it is when the proximal portion of the nails are white and the distal portion is red-brown

70
Q

What is onychogryphosis?

A

Finger or toe nails shaped like a talon

71
Q

What causes onychogryphosis?

A

Repeated trauma or fungal infections

72
Q

How much will very hot weather cause a pts temperature to increase by?

73
Q

How does body temperature change throughout the day?

A

There is diurnal variation, coldest in the morning and reaches a peak between 6pm and 10pm, and thus the febrile pattern of most diseases follows this variation

74
Q

What is hyperpyrexia?

A

Temp >41.6 C

75
Q

What is hypothermia?

A

Temp <35 C

76
Q

What are 5 causes of hyperpyrexia?

A
  1. Heat stroke form exposure
  2. Excessive exertion e.g. marathon runners
  3. Malignant hyperthermia
  4. Neuroleptic malignant syndrome
  5. Hypothalamic disease
77
Q

What may cause sweet smelling breath?

A
  1. Ketoacidosis

2. Liver failure

78
Q

What may cause fishy breath?

A
  1. Eating fish

2. Uraemic foetor of kidney failure

79
Q

What are 3 causes of ‘bad breath?’

A
  1. Poor dentition
  2. Gingivitis
  3. Nasopharyngeal tumours
80
Q

How can you classify fevers?

A
  1. Continued
  2. Intermittent
  3. Remittent
  4. Relapsing
81
Q

What is a continued fever?

A

Does not remit e.g. Typhoid, drug

82
Q

What is an intermittent fever?

A

Temperature falls to normal each day e.g. pyogenic, lymphoma, miliary TB

83
Q

What is a remittent fever?

A

Daily fluctuations >2 C, temperature does not return to normal (not characteristic of any specific disease)

84
Q

What is a relapsing fever?

A

Temperature returns to normal for days before rising again

85
Q

What are 5 causes of a relapsing fever?

A
  1. Malaria (tertian = vivax/ovale, quartan = malaria)
  2. Lymphoma
  3. Pel-Ebstein of Hodgkin’s lymphoma
  4. Pyogenic infection
86
Q

What is meant by a tertian fever?

A

Fever peaks every other day

87
Q

What is meant by a quartan fever?

A

Fever peaks every 3rd day

88
Q

What is the likelihood ratio?

A

A useful way to summarise sensitivity and specificity

89
Q

What is the kappa statistic?

A

A way of expressing the intra-observer variation for a sign or test

90
Q

What is the ESC classification for typical angina?

A

Meets all 3 of

  1. Characteristic retrosternal chest discomfort
  2. Provoked by exertion or emotion
  3. Relieved by rest or GTN or both
91
Q

What is the ESC classification for atypical angina?

A

Meets 2 of:

  1. Characteristic retrosternal chest discomfort
  2. Provoked by exertion or emotion
  3. Relieved by rest or GTN or both
92
Q

What is the ESC classification for non-cardiac chest pain?

A

Meets 1 or none of:

  1. Characteristic retrosternal chest discomfort
  2. Provoked by exertion or emotion
  3. Relieved by rest or GTN or both
93
Q

Where would you feel the pain in a proximal aortic dissection?

A

Anterior chest pain

94
Q

Where would you feel the pain in a descending aortic dissection?

A

Interscapular pain

95
Q

How can you classify the causes of orthopnoea?

A

Common and uncommon

96
Q

What is a common cause of orthopnoea?

A

Cardiac failure

97
Q

What are the 5 uncommon causes of orthopnoea?

A
  1. Massive ascites
  2. Pregnancy
  3. Bilateral diaphragmatic paralysis
  4. Large pleural effusion
  5. Severe pneumonia
98
Q

What is oedema that affects the face most likely to be caused by?

A

Nephrotic syndrome

99
Q

What is syncope?

A

Transient loss of consciousness due to cerebral anoxia, usually due to inadequate blood flow

100
Q

What is presyncope?

A

Transient sensation of weakness without loss of consciousness

101
Q

What are two examples of situational syncope?

A

Micturation and tussive syncope

102
Q

What are two causes of an exertional syncope?

A

AS and HOCM

103
Q

What is a Stokes-Adams attack?

A

Transient loss of consciousness due to reduced cardiac output

104
Q

What is a cause of Stokes-Adams attacks?

A

Complete heart block

105
Q

What drugs are associated with bradycardias?

A
  1. BBs
  2. Rate limiting CCBs (verapamil, diltiazem)
  3. DIgoxin
106
Q

What drugs are associated with QT prolongation?

A
  1. Antiarrhythmics = flecainide, amiodarone
  2. Antibiotics = clarithromycin/erythromycin
  3. Antipsychotics = chlorpromazine, haloperidol
107
Q

What drugs are associated with postural hypotension?

A
  1. Most anti-HTNs but especially prazosin and CCBs

2. Anti-parkinsonian drugs

108
Q

What are the 6Ps of acute limb ischaemia?

A 
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysed
109
Q

What could cause intermittent claudication in young men/athletes when walking but not with running?

A

Popliteal artery entrapment syndrome (PAES)

110
Q

How do you differentiate between lumber canal stenosis (pseudo-claudication) and vascular claudication?

A

In pseudo-claudication, the pain is not relieved by standing but is relieved by sitting (flexing the spine) and may be exacerbated by extending the spine (e.g. walking downhill)

111
Q

What are 2 recreational drugs that can cause MI in young people?

A

Cocaine and amphetamines

112
Q

What is Thomas Sydenham once say about arteries?

A

‘A man is as old as his arteries’

113
Q

Where does the LMS originate from and what are its branches?

A
  1. Originates from the left coronary sinus of Valsalva
  2. LAD supplies anterior wall of heart
  3. LCX supplies back of heart
114
Q

Where does the RCA originate from and what are its branches?

A
  1. Originates from the right coronary sinus of Valsalva

2. Supplies RV and inferior wall of LV

115
Q

What is the origin of the word coronary?

A

From the latin corona, which means garland or crown, as the coronaries look like a garland draped over the heart

116
Q

What are the 9 common palpable arteries?

A
  1. Superficial temporal
  2. Common carotid
  3. Brachial
  4. Radial
  5. Ulnar
  6. Femoral
  7. Popliteal
  8. Posterior tibial
  9. Dorsalis pedis
117
Q

What is a theory explaining clubbing?

A

PDGF release from megakaryocyte and platelet emboli in the nail beds causes fibrovacular proliferation, thus only occurs in conditions where megakaryocytes and platelets are able to clump in the arterial circulation or bypass the pulmonary circulation

118
Q

What is the diamond window clubbing sign called?

A

Schamroth’s sign

119
Q

What is a way of measuring clubbing?

A

Interphalangeal depth ratio, ratio >1 = clubbing.

1. AP dimension of finger is measured at DIP and compared with AP dimension where skin joins nail

120
Q

What are 7 features of Marfans?

A
  1. Tall stature
  2. High arched palate
  3. Thoracic kyphosis
  4. Pectus excavatum
  5. Aortic regurgitation
  6. Long arms and legs
  7. Arachnodactyly
121
Q

What are the cardio causes of clubbing?

A

Atrial myxoma
Subacute bacterial endocarditis
Cyanotic congenital heart disease

122
Q

What are the respiratory causes of clubbing?

A
  1. Lung caner
  2. IPF
  3. CF
  4. Chronic pulmonary suppuration = bronchiectasis, abscess, empyema.
  5. Asbestosis, Mesothelioma
123
Q

What are the GI causes of clubbing?

A
  1. Coeliac disease
  2. IBD
  3. Cirrhosis
124
Q

What endo disorder can cause clubbing?

A

Thyrotoxicosis

125
Q

What are 2 causes of unilateral clubbing?

A
  1. Bronchial AV aneurysm

2. Axillary artery aneurysm

126
Q

What are tendon xanthomata?

A

Yellow/orange lipid deposits in the tendons that occur in Type II hyperlipidaemia

127
Q

What are 2 features of Type III hyperlipidaemia?

A

Palmar and tuboeruptive (on elbows and knees) xanthomata

128
Q

What is a pulse deficit?

A

HR when listening with stethoscope at the heart is greater than pulse felt at the wrist

129
Q

Does pulse increase or decrease with inspiration?

130
Q

Does pulse increase or decrease with expiration?

131
Q

What do you call it when every second heart beat is an ectopic?

132
Q

What do you call it when every third heart beat is an ectopic?

133
Q

What do you call it when 2 ectopics occur in a row?

134
Q

What is coarctation of the aorta?

A

A congenital narrowing in the aortic isthmus at the level where the ductus arteriosus joins the descending aorta

135
Q

What are 4 causes of a radio-radial delay?

A
  1. Coarctation of the aorta
  2. Subclavian artery stenosis
  3. Dissecting thoracic aneurysm
  4. Takayasu’s arteritis
136
Q

What is pulsus alternans?

A

Alternating strong and weak pulse of advanced LV failure

137
Q

How many Korotkoff sounds are there?

138
Q

Does BP normally increase or decrease during inspiration?

Medicine and Surgery Mushkies (52 decks)

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