Talley and O'Connor Mushkies Flashcards
1
Q
What are the CAGE questions?
A
Cut down
Annoyed
Guilty
Eye opener
2
Q
What are the AUDIT-C questions?
A
- How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking alcohol?
- 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
3
Q
How can you classify the complications of alcohol abuse?
A
- GI = gastric, pancreatic, hepatic
- Cardio = hypertension, arrhythmias, CM
- Neuro = Wernickes, Korsakoff, dementia
- Haem = anaemia, thrombocytopenia
- GU = ED, amenorrhoea
- Other = fractures
4
Q
What are the cardio red flags?
A
- Blackouts without warning (Stokes-Adams)
2. Felt dizzy/blacked out whilst exercising (severe AS/HCM)
5
Q
What is the resp red flag?
A
Coughing up blood
6
Q
What are the GI red flags?
A
- Difficulty swallowing (oesophageal cancer)
- Vomited blood (GI bleeding)
- Blood in stools/black stools (GI bleeding)
- Unexplained weight loss (Colorectal cancer)
7
Q
What is the GU red flag?
A
Blood in urine (UT malignancy)
8
Q
What are the haem red flags?
A
- Lots of bleeding from small cut (bleeding disorder)
2. Lumps under arm/neck/groin (malignancy)
9
Q
What are 4 good disease mimickers?
A
TB
HIV
Syphilis
Sarcoidosis
10
Q
How do you deal with an emotional response?
A
NURS Name the emotion Show Understanding Deal with issue with respect Show support
11
Q
What are common side effects of psychotropics?
A
Sedation and falls
12
Q
What are common side effects of diuretics?
A
Hypokalaemia
Renal dysfunction
Gout
13
Q
What are common side effects of NSAIDS?
A
- Exacerbation of HTN
- of HF
- of CKD
14
Q
What are common side effects of anti-hypertensives?
A
Postural hypotension and falls
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
16
Q
What are the 6 vital signs?
A
- HR
- RR
- BP
- Sats
- Temperature
17
Q
Why is the term scleral icterus misleading?
A
Bilirubin is actually deposited in the vascular conjunctiva rather than in the avascular sclera
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
19
Q
What causes deep blue discoloration of the face?
A
Amiodarone
20
Q
When is a lipodystrophic facies seen?
A
Anti-retroviral therapy
21
Q
When do you see risus sardonicus?
A
Tetanus
22
Q
What are 2 features of an acromegalic facies?
A
Supraorbital ridge and prognathism
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)
24
Q
Why does cyanosis not occur in anaemic hypoxia?
A
Because the total Hb content is low
25
What is central cyanosis?
There is an abnormal amount of deoxygenated blood in the arteries
26
How can you classify the causes of cyanosis?
Central vs. peripheral
27
What are the causes of central cyanosis?
1. Decreased arterial oxygen saturation
2. Polycythaemia
3. Hb abnormalities
28
What are causes of decreased arterial oxygen saturation?
1. High altitude
2. Hypoventilation
3. Lung disease
4. R to L cardiac shunt
29
What is an Hb abnormality that can lead to central cyanosis?
Methaemoglobinaemia, often due to drugs such as dapsone or topical anaesthetics, can be fatal if not recognised and treated
30
What are causes of peripheral cyanosis?
1. All causes of central cyanosis
2. Exposure to cold
3. Reduced CO (LV Failure/shock)
4. Arterial or venous obstruction
31
What causes pallor?
A deficiency of haemoglobin (anaemia)
32
At what point does subconjunctival pallor appear?
Hb <70g/L
33
How can you classify the causes of shock?
1. Hypovolaemic
2. Cardiogenic
3. Distributive
4. Obstructive
34
What are the causes of hypovolaemic shock? x2
1. External fluid loss = haemorrhage, vomit, diarrhoea, urine, burns, sweating
2. Internal fluid loss = ascites, haemothorax, fracture
35
What are the causes of cardiogenic shock? x6
1. Arrhythmia
2. Valve failure
3. Cardiomyopathy
4. MI
5. Dissection
36
What are the causes of distributive shock? x5
1. Anaphylactic
2. Neurogenic
3. Septic
4. Drug-induced
5. Addisonian
37
What are the causes of obstructive shock?
1. Tension pnuemothorax
2. Tamponade
3. PE
38
How can you classify the complications of obesity? x6
1. Endocrine
2. Cardio
3. Resp
4. Gut
5. Musk
6. Skin
39
What are some endo complications of obesity?
1. T2DM
2. Dyslipidaemia
3. Amenorrhoea
4. Infertility
5. PCOS
5. Hypogonadism
40
What are some resp complications of obesity?
1. Sleep apnoea
| 2. Dyspnoea
41
What are come cardiac complications of obesity?
1. HTN
2. HF
3. IHD
4. PE
5. Cor pulmonale
42
What are some musk complications of obesity?
1. Arthritis
| 2. Immobility
43
What are some skin complications of obesity?
1. Abscesses, cellulitis, fungal infections
| 2. Venous stasis
44
What are some gut complications of obesity?
1. GORD
2. NASH
3. Hernias
45
What causes perifollicular haemorrhages?
Vitamin C deficiency
46
How can you classify dehydration?
1. Mild (<5%) = 2.5L deficit
2. Moderate (5-8%) = 4L deficit
3. Severe (9-12%) = 6L deficit
4. Very severe (>12%) = >6L deficit
47
What are signs of mild dehydration?
1. Mild thirst
2. Dry mucous membranes
3. Concentrated urine
48
What are signs of moderate dehydration?
+
1. Reduced skin turgor
2. Tachycardia
49
What are signs of severe dehydration?
+
1. Gaunt face with sunken eyes
2. Postural hypotension
3. Oliguria (<400ml/24hr)
50
What are the signs of very severe dehydration?
+
1. Comatose
2. Moribund
3. Signs of shock
51
What might a pt have if when you shake their hand they are unable to let go?
Dystrophia myotonica
52
What are 3 causes of blue nails?
1. Cyanosis
2. Wilson's disease
3. Ochronosis
53
What is ochronosis?
A syndrome caused by the accumulation of homogentisic acid in connective tissues
54
What are 2 causes of red nails?
1. Polycythaemia (reddish-blue)
| 2. Carbon monoxide poisoning (cherry-red)
55
What causes yellow nails?
Yellow nail syndrome
56
What is yellow nail syndrome?
A rare syndrome also known as "primary lymphedema associated with yellow nails and pleural effusion"
57
What are causes of splinter haemorrhages?
1. Trauma (particularly in manual workers)
2. IE
3. Vasculitis
58
What are 3 causes of koilonychia?
1. IDA
2. Fungal infection
3. Raynaud's disease
59
What are 3 causes of onycholysis?
1. Over-enthusiastic cleaning under the nails
2. Thyrotoxicosis
3. Psoriasis
60
What are 3 causes of Beau's lines?
1. Fever
2. Cachexia
3. Malnutrition
61
What are Beau's lines?
Non-pigmented transverse lines in the nail bed, caused by a temporary cessation of cell division in the nail matrix.
62
What causes leukonychia?
1. Hypoalbuminaemia
63
What are 3 causes of Muehrcke's lines?
1. Trauma
2. Hypoalbuminaemia
3. Acute illness
64
What is the difference between Beau's and Muehrcke's lines?
Beau's lines are grooved
65
What do you call a single transverse white band?
Mees' lines
66
What are 2 causes of Mees' lines?
1. Arsenic poisoning
2. Renal failure
3. Chemotherapy patients
67
What causes nail fold erythema and telangiectasia?
SLE
68
What causes Terry's nails?
1. CKD
| 2. Cirrhosis
69
What are Terry's nails?
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
What is onychogryphosis?
Finger or toe nails shaped like a talon
71
What causes onychogryphosis?
Repeated trauma or fungal infections
72
How much will very hot weather cause a pts temperature to increase by?
0.5 C
73
How does body temperature change throughout the day?
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
What is hyperpyrexia?
Temp >41.6 C
75
What is hypothermia?
Temp <35 C
76
What are 5 causes of hyperpyrexia?
1. Heat stroke form exposure
2. Excessive exertion e.g. marathon runners
3. Malignant hyperthermia
4. Neuroleptic malignant syndrome
5. Hypothalamic disease
77
What may cause sweet smelling breath?
1. Ketoacidosis
| 2. Liver failure
78
What may cause fishy breath?
1. Eating fish
| 2. Uraemic foetor of kidney failure
79
What are 3 causes of 'bad breath?'
1. Poor dentition
2. Gingivitis
3. Nasopharyngeal tumours
80
How can you classify fevers?
1. Continued
2. Intermittent
3. Remittent
4. Relapsing
81
What is a continued fever?
Does not remit e.g. Typhoid, drug
82
What is an intermittent fever?
Temperature falls to normal each day e.g. pyogenic, lymphoma, miliary TB
83
What is a remittent fever?
Daily fluctuations >2 C, temperature does not return to normal (not characteristic of any specific disease)
84
What is a relapsing fever?
Temperature returns to normal for days before rising again
85
What are 5 causes of a relapsing fever?
1. Malaria (tertian = vivax/ovale, quartan = malaria)
2. Lymphoma
3. Pel-Ebstein of Hodgkin's lymphoma
4. Pyogenic infection
86
What is meant by a tertian fever?
Fever peaks every other day
87
What is meant by a quartan fever?
Fever peaks every 3rd day
88
What is the likelihood ratio?
A useful way to summarise sensitivity and specificity
89
What is the kappa statistic?
A way of expressing the intra-observer variation for a sign or test
90
What is the ESC classification for typical angina?
Meets all 3 of
1. Characteristic retrosternal chest discomfort
2. Provoked by exertion or emotion
3. Relieved by rest or GTN or both
91
What is the ESC classification for atypical angina?
Meets 2 of:
1. Characteristic retrosternal chest discomfort
2. Provoked by exertion or emotion
3. Relieved by rest or GTN or both
92
What is the ESC classification for non-cardiac chest pain?
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
Where would you feel the pain in a proximal aortic dissection?
Anterior chest pain
94
Where would you feel the pain in a descending aortic dissection?
Interscapular pain
95
How can you classify the causes of orthopnoea?
Common and uncommon
96
What is a common cause of orthopnoea?
Cardiac failure
97
What are the 5 uncommon causes of orthopnoea?
1. Massive ascites
2. Pregnancy
3. Bilateral diaphragmatic paralysis
4. Large pleural effusion
5. Severe pneumonia
98
What is oedema that affects the face most likely to be caused by?
Nephrotic syndrome
99
What is syncope?
Transient loss of consciousness due to cerebral anoxia, usually due to inadequate blood flow
100
What is presyncope?
Transient sensation of weakness without loss of consciousness
101
What are two examples of situational syncope?
Micturation and tussive syncope
102
What are two causes of an exertional syncope?
AS and HOCM
103
What is a Stokes-Adams attack?
Transient loss of consciousness due to reduced cardiac output
104
What is a cause of Stokes-Adams attacks?
Complete heart block
105
What drugs are associated with bradycardias?
1. BBs
2. Rate limiting CCBs (verapamil, diltiazem)
3. DIgoxin
106
What drugs are associated with QT prolongation?
1. Antiarrhythmics = flecainide, amiodarone
2. Antibiotics = clarithromycin/erythromycin
3. Antipsychotics = chlorpromazine, haloperidol
107
What drugs are associated with postural hypotension?
1. Most anti-HTNs but especially prazosin and CCBs
| 2. Anti-parkinsonian drugs
108
What are the 6Ps of acute limb ischaemia?
```
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysed
```
109
What could cause intermittent claudication in young men/athletes when walking but not with running?
Popliteal artery entrapment syndrome (PAES)
110
How do you differentiate between lumber canal stenosis (pseudo-claudication) and vascular claudication?
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
What are 2 recreational drugs that can cause MI in young people?
Cocaine and amphetamines
112
What is Thomas Sydenham once say about arteries?
'A man is as old as his arteries'
113
Where does the LMS originate from and what are its branches?
1. Originates from the left coronary sinus of Valsalva
2. LAD supplies anterior wall of heart
3. LCX supplies back of heart
114
Where does the RCA originate from and what are its branches?
1. Originates from the right coronary sinus of Valsalva
| 2. Supplies RV and inferior wall of LV
115
What is the origin of the word coronary?
From the latin corona, which means garland or crown, as the coronaries look like a garland draped over the heart
116
What are the 9 common palpable arteries?
1. Superficial temporal
2. Common carotid
3. Brachial
4. Radial
5. Ulnar
6. Femoral
7. Popliteal
8. Posterior tibial
9. Dorsalis pedis
117
What is a theory explaining clubbing?
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
What is the diamond window clubbing sign called?
Schamroth's sign
119
What is a way of measuring clubbing?
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
What are 7 features of Marfans?
1. Tall stature
2. High arched palate
3. Thoracic kyphosis
4. Pectus excavatum
5. Aortic regurgitation
6. Long arms and legs
7. Arachnodactyly
121
What are the cardio causes of clubbing?
Atrial myxoma
Subacute bacterial endocarditis
Cyanotic congenital heart disease
122
What are the respiratory causes of clubbing?
1. Lung caner
2. IPF
3. CF
4. Chronic pulmonary suppuration = bronchiectasis, abscess, empyema.
5. Asbestosis, Mesothelioma
123
What are the GI causes of clubbing?
1. Coeliac disease
2. IBD
3. Cirrhosis
124
What endo disorder can cause clubbing?
Thyrotoxicosis
125
What are 2 causes of unilateral clubbing?
1. Bronchial AV aneurysm
| 2. Axillary artery aneurysm
126
What are tendon xanthomata?
Yellow/orange lipid deposits in the tendons that occur in Type II hyperlipidaemia
127
What are 2 features of Type III hyperlipidaemia?
Palmar and tuboeruptive (on elbows and knees) xanthomata
128
What is a pulse deficit?
HR when listening with stethoscope at the heart is greater than pulse felt at the wrist
129
Does pulse increase or decrease with inspiration?
Increases
130
Does pulse increase or decrease with expiration?
Decreases
131
What do you call it when every second heart beat is an ectopic?
Bigeminy
132
What do you call it when every third heart beat is an ectopic?
Trigeminy
133
What do you call it when 2 ectopics occur in a row?
Couplet
134
What is coarctation of the aorta?
A congenital narrowing in the aortic isthmus at the level where the ductus arteriosus joins the descending aorta
135
What are 4 causes of a radio-radial delay?
1. Coarctation of the aorta
2. Subclavian artery stenosis
3. Dissecting thoracic aneurysm
4. Takayasu's arteritis
136
What is pulsus alternans?
Alternating strong and weak pulse of advanced LV failure
137
How many Korotkoff sounds are there?
5
138
Does BP normally increase or decrease during inspiration?
Decreases
