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Jack Teh Cheat Sheet Flashcards > Things I don't know from med ed > Flashcards

Things I don't know from med ed Flashcards

1
Q

Causes of myocarditis

A 
metal
drugs- cocaine etc
Idiopathic
Inflammation- viral
Radiation
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2
Q

Causes of constrictive pericarditis

A

Inflammation
Acute pericarditis
Cardiac surgery/radiation

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3
Q

Causes of dilated cardiomyopathy

A 
Alcohol
Post viral
Genetic
Autoimmune 
Haemochromatosis
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4
Q

Haemochromatosis causes what type of cardiomyopathy?

A

Dilated

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5
Q

Amyloidosis causes what type of cardiomyopathy?

A

Restrictive

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6
Q

What heart sound is heard in hypertrophic cardiomyopathy?

A

S4

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7
Q

Arrythmogenic right ventricular cardiomyopathy

Definition

Aetiology

Presentation

A

Fat and fibrosis in pericardium

Genetic- autosomal dominant

Asymptomatic or arrhythmia during exercise

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8
Q

Dilated cardiomyopathy on CXR?

A

Globular heart

[Also pericardial effusion]

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9
Q

Glaucoma investigations?

A

Fundoscopy- optic cupping
Tonometry- high pressure
Gonioscope- angle [iris and trabecular meshwork]

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10
Q

Glaucoma investigations?

A

Fundoscopy- optic cupping
Tonometry- high pressure
Gonioscope- angle [iris and trabecular meshwork]
Slit lamp

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11
Q

Ototoxic drugs

What type of deafness do they cause?

A
  • Aminoglycoside antibiotics
  • Aspirin (overdose)
  • Loop diuretics

Sensorineural

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12
Q

When is radiotherapy used in Cushings tx?

A

after surgery if doesn’t respond

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13
Q

What can bilateral adrenalectomy cause?

A

Nelson syndrome- locally aggressive pituitary tumour causing skin pigmentation due to ACTH secretion

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14
Q

Complications of Cushing’s surgery- transphenoidal?

A

CSF leakage
Meningitis
Sphenoid sinusitis
Hypopituitarism

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15
Q

Complications of Cushing’s radiotherapy?

A

Hypopituitarism
Radionecrosis
Second intracranial tumour/stroke

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16
Q

Signs of phaeochromocytoma

A 
Hypertension 
Postural hypotension 
Pallor 
Tachycardia
Fever 
Weight loss
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17
Q

Causes of adrenal insufficiency

A 
Autoimmune
Infections
Tuberculosis: developing countries
Infiltration
Infarction
Inherited
Adrenoleukodystrophy
ACTH receptor mutation 
Iatrogenic
Sudden cessation of long-term steroid therapy 
After bilateral adrenalectomy
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18
Q

Causes of adrenal insufficiency

A

Autoimmune
Infections
Tuberculosis: developing countries, Meningococcal septicaemia (Waterhouse-Friderichsen Syndrome); CMV ; Histoplasmosis

Infiltration - mets, amyloidosis

Infarction

Inherited-Adrenoleukodystrophy, ACTH receptor mutation

Iatrogenic- Sudden cessation of long-term steroid therapy, After bilateral adrenalectomy

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19
Q

Treatment when both hypothyroidism and addisons?

A

if pt has hypothyroidism, give hydrocortisone BEFORE thyroxine to prevent precipitating Addisonian crisis

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20
Q

Advise for addisons patients

A

Advise
Medic alert bracelet
Carry steroid warning card
Carry emergency hydrocortisone

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21
Q

Autoimmune polyendocrinopathy syndrome

A

AIPES – T1: autosomal rec mutation in AIRE gene

- Both T1 + T2 involve Addison’s disease

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22
Q

Causes of hyperkalemia?

A 
Renal disease – HTN, DM
Low RAAS activity – ACE-Is, ARBs, aldosterone antagonists, adrenal failure
Systemic K+ release - rhabdomyolysis, metabolic acidosis (e.g DKA)
Damage to the DCT - type 4 renal tubular acidosis, NSAID toxicity
Spurious sample (recheck)
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23
Q

Rhabdomyolysis and K+?

A

Hyperkalaemia

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24
Q

Causes of hypokalemia?

A

High RAAS- primary hypoaldosteronism
Excess cortisol [mineralocorticoid effects]
Renal- natriuresis

Decreased intake- anorexia nervosa

GI loss- vomiting, diarrhea
Diuretics

Redistribution into cells- insulin, beta agonists, metabolic alkalosis

Only causes problems if <3.0 mmol/L

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25
Q

Management of hypokalemia?

A

Management – always correct magnesium

K+ 3.0-3.5 mmol/L
Oral potassium chloride (SandoK)
Recheck in 48 hours

K+ <3.0 mmol/L
IV potassium chloride
Max infusion rate 10 mmol/hr (peripheral irritant)

Treat underlying cause

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26
Q

Management of hypokalemia?

A

Always correct magnesium

K+ 3.0-3.5 mmol/L
Oral potassium chloride (SandoK)
Recheck in 48 hours

K+ <3.0 mmol/L
IV potassium chloride
Max infusion rate 10 mmol/hr (peripheral irritant)

Treat underlying cause

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27
Q

PCOS

A

Low sex hormone binding globulin [less production in liver]

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28
Q

Feature of arterial ulcers?

A

Grey tissue+ pale base

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29
Q

Arterial ulcers more distal

A

Venous ulcers more proximal

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30
Q

Most common type of AAA

A

Ninety %= infra renal

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31
Q

Risk factors for aortic dissection?

A

HYPERTENSION
Smoking
Atherosclerosis

Coarctation of aorta- congenital cardiac
CTD
Cocaine/amphetamine
Heavy lifting

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32
Q

Timing of aortic dissection

A

Considered acute if <14 days

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33
Q

Symptoms of aortic dissection

due to obstruction of other aortic branches

A

Abdominal pain (coeliac axis)
Loss of consciousness (subclavian artery)
Anuria (renal artery)

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34
Q

Signs of aortic dissection

A

Difference in blood pressure between arms of more than twentymmHg

Diastolic murmur

Hypertension

Or hypotension if tamponade

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35
Q

Ix of aortic dissection?

A

Gold standard- CT angiogram

FBC, U+E, LFTs
Cross match
Lactate
Cardiac enzymes= exclude ACS
ECG- ischemia
CXR- loss of aortic knuckle
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36
Q

Varicose veins definition

A

Subcutaneous, permanently dilated veins of >3 mm diameter when standing

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37
Q

Causes of varicose veins

A

Valve insufficiency

Primary- idiopathic

Secondary-
DVT
Pelvic masses-fibroids, ovarian mass, pregnancy
AV malformation

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38
Q

Symptoms of varicose veins

Investigations of varicose veins

A 
Visible dilated veins- on standing
Aching- BETTER WHEN ELEVATED
Swelling
Itching
BLEEDING

Tender/hard veins
Bruits

Tap test- transmitted impulse over saphenofemoral junction
Tredelenburg test - using tourniquet
Duplex USS

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39
Q

Management of varicose veins?

A

Compression stockings, Lifestyle changes= conservative

Endovascular- Radiofrequency ablation
OR microinjection sclerotherapy

Surgical:
Stripping [long saphenous]
Avulsion of varicosities- remove small section through skin
Saphenofemoral ligation- tying vein

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40
Q

Reticular veins:

A

permanently dilated intradermal veins which may be tortuous. Usually asymptomatic.

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41
Q

Reticular veins:

A

permanently dilated intradermal veins which may be tortuous. Usually asymptomatic.

bigger than telangiectasias, smaller than VVs, flatter and less twisted

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42
Q

Complications of varicose veins

A 
Venous ulcers
Venous eczema
Lipodermatosclerosis
Pigmentation
SUPERFICIAL THROMBOPHLEBITIS- warm and red
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43
Q

Complications of sclerotherapy to treat varicose veins

A

Local scarring

Skin staining

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44
Q

Complications of surgery to treat varicose

A

Haemorrhage
Infection
Parasthesia + peroneal nerve injury

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45
Q

pseudomonas Abx?

A

levofloxacin

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46
Q

Most common lung cancer

A

Adenocarcinoma

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47
Q

Asbestos- lung cancer risk?

A

Squamous cell carcinoma

Mesothelioma

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48
Q

Which cancer has cavitating lesions?

A

SqCC- squamous cell carcinoma

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49
Q

What organs apart from the lung can mesothelioma affect?

A

Heart - pericardium

Abdo- peritoneum

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50
Q

What is heard on auscultation of mesothelioma?

A

Pleural friction rub

51
Q

Gold standard Ix for mesothelioma?

A

Pleural fluid cytology and pleural biopsy

52
Q

Gold standard Ix for mesothelioma?

A

Pleural fluid cytology and pleural biopsy

Other Ix
CXR
CT chest

53
Q

Staging of lung cancer?

A

CT

PET

MRI

54
Q

Breast conditions that smoking predisposes you towards?

A

Mastitis [non lactational/periductal?]

Ductal ectasia

55
Q

Neck lump epidemiology

A

Children: >75% lateral neck lumps are benign
Adults (>40): >75% lateral neck lumps are malignant
Lump: SCTF

56
Q

Breast cysts discharge?

A

Clear

Only occurs sometimes

57
Q

Fibroadenoma definition?

A

Benign neoplasm of a lobule

58
Q

Epidemiology of intraductal papilloma?

A

Peri/post menopausal women

59
Q

Organism that causes mastitis and breast abscess?

A

Staph aureus

60
Q

Nipple in mastitis?

A

May be cracked

61
Q

What does PMH in non lactional/periductal mastitis look like?

A

Non-lactational: tend to present with
a history of previous infections with
less pronounced systemic upset

62
Q

Breastfeeding and mastitis?

A

ENCOURAGE BREAST FEEDING

63
Q

Mx of breast abscess

A

Antibiotics [IV or oral]

FNA [therapeutic and diagnostic]

64
Q

Ix/Mx of breast abscess

A

Antibiotics [IV or oral]
FNA [therapeutic and diagnostic]
FBC + blood cultures- if systemic infection
Surgical drainage

65
Q

Complications of breast abscess?

A

Fistula

Rarely: necrosis

66
Q

What staging system is used in breast cancer?

A

Nottingham staging system

67
Q

Risk factors for breast cancer?

A

Age
FHx

Oestrogen exposure:
Nulliparty
Early menarche
Late menopause
HRT
OCP

BRCA gene

ALCOHOL
RADIATION TO CHEST
FATTY DIET
OBESITY

68
Q

Signs of breast cancer

A 
Peau d'orange
Skin dimpling
Inverted nipple
[Bloody] nipple discharge
Eczema- Paget's disease

ARMPIT SKIN THICKENING

69
Q

Does breast cancer often metastasise?

A

No

Bone, lungs when it does

70
Q

What breast cancer is Paget’s disease associated with?

A

DCIS

[Ductal carcinoma in situ]

71
Q

Lung cancer medication

A

Aromatase inhibitors e.g letrozole

ER receptor antagonist - tamoxifen

72
Q

Autoimmune hepatitis risk factors?

A

Fat young women, cushingoid symptoms post tx

73
Q

Low urea- reasons

A

severe liver disease, (synthesised in liver), malnutrition, pregnancy

74
Q

NASH symptoms

A

often asymptomatic

Dull or aching RUQ pain
Fatigue
Unexplained weight loss
Weakness

75
Q

Histopathological features of alcohol hepatitis:

A 
Centrilobular ballooning
Degeneration and necrosis of hepatocytes
Steatosis
Neutrophilic inflammation
Cholestasis
Mallory-hyaline inclusions(eosinophilic intracytoplasmic aggregates of cytokeratin intermediate filaments)
Giant mitochondria
76
Q

U and E in alcoholic hepatitis

A

Urea and K+ tend to be low

77
Q

Mx of alcoholic hepatitis

A

Mx:
Acute
Thiamine
Vitamin C and other multivitamins (can be given asPabrinex)
Monitor and correct K+, Mg2+ and glucose
Ensure adequate urine output
Treat encephalopathy with oral lactulose or phosphate enemas
Ascites - manage with diuretics(spironolactone with/without furosemide) Therapeutic paracentesis
Glypressin and N-acetylcysteine for hepatorenal syndrome
• Nutrition
Via oral or NG feeding is important
Protein restrictionshould be avoided unless the patient is encephalopathic
Nutritional supplementation and vitamins (B group, thiamine and folic acid) should be started parenterally initially, and continued orally
Steroid Therapy - reduce short-term mortality for severe alcoholic hepatitis

78
Q

pANCREATIC CANCER- most common type

A

90% adenocarcinoma

79
Q

Complications of epidural

A 
Complications:
Dural puncture
Vessel puncture
Hypoventilation
Epidural haematoma or abscess
80
Q

Complications of blood transfusion

A 
Early complications (<24 hours):
Anaphylaxis
Bacterial infection
Acute haemolytic reaction
Febrile non-haemolytic reaction
Transfusion associated circulatory overload (TACO) or transfusion associated lung injury (TRALI)
Late complications (>24 hours):
Delayed haemolytic reaction
Infection
Transfusion associated graft vs host disease
Iron overload
81
Q

indications of blood transfusion

A 
Packed red cells:
Indicated if Hb <70g/l or >30% loss of blood volume
1 unit increases Hb by 10-15g/l
Platelets
If platelets <20*109/L
FFP
To correct clotting defects e.g DIC
82
Q

Treatment of cellulitis and erysipelas?

A

Vancomycin

83
Q

Mx of appendicitis?

A

Appendicetomy

+ antibiotics- cefotaxime + metronidazole

84
Q

Conditions with positive RhF

A 
Wegener's/Granulomatosis with polyangitis
Infective endocarditis
Sjogren syndrome
SLE
Rheumatoid arthritis
85
Q

Appendicitis complications

A

Perforation
Mass
Abscess

86
Q

What do femoral hernias contain?

A

Omentum

87
Q

What do inguinal hernia contain?

A

Bowel

88
Q

Signs of hernia strangulation

A

tender, red, colicky abdominal pain, distension, vomiting

89
Q

Investigation of hernia?

A

Clinical diagnosis

Ultrasound first line

90
Q

Anal fissure management steps?

A

Paracetamol/ibuprofen and topical lidocaine

Topical diltiazem + GTN if more than one week

Constipation alleviation- laxative, fibre

Botox

Internal sphincterotomy

91
Q

Haemorrhoid investigation?

A

Proctoscopy

Anaemia

92
Q

Complications of haemorrhoids

A

@ Thrombosis of external haemorrhoids

Severe pain + purplish oedematous
perianal mass

If <72 hours, surgical incision

@ Strangulation of internal haemorrhoids

Severe pain

Urgent haemorrhoidectomy

93
Q

Albumin in IBD?

A

Low albumin

94
Q

Gold standard for fibrosis/interstitial lung disease?

A

Biopsy

But usually CT is done

95
Q

HLA for coeliac disease?

A

HLA DQ2/8 alleles

96
Q

Is smoking a risk factor for rheumatoid arthritis?

A

Yes

97
Q

Gold standard for fibrosis/interstitial lung disease?

A

No

98
Q

Which leukaemia is Down’s related to?

A

AML

Acute myeloid leukaemia

99
Q

Acute promyelocytic leukaemia chromosome?

A

t(15;17)

100
Q

CLL extra facts

A

Can be associated with autoimmune thrombocytopenia + anaemia = Evan’s syndrome

Can transform to aggressive NHL = Richter’s syndrome

101
Q

Weird symptoms of CML?

A

Hyperviscosity symptoms: visual disturbance, headaches, thrombotic event
Gout

MASSIVE splenomegaly in 90%

102
Q

Eighty five percent B cells in which lymphoma?

A

non hodgkins

103
Q

What conditions associated with non hodgkins?

A

EBV, HIV, SLE, Sjogren’s

104
Q

Sickle cell blood film

A

Sickle cells

HOWELL JOLLY BODIES

105
Q

Additional features of nephrotic syndrome?

A

Hyperlipidaemia

Hypercoagulable state

106
Q

HBV/HCV - hepatitis can cause which type of kidney disease?

A

Nephrotic syndrome

107
Q

Investigations in glomerulonephritis?

A

Bloods – FBC, U&Es, CRP, Complement, Autoantibodies
Urine
Imaging – RENAL USS +/- RENAL BIOPSY

108
Q

Management of sarcoidosis?

A

Steroids

NSAIDS

109
Q

Diffuse cutaneous systemic sclerosis symptoms

A 
Skin changes involving the trunk
Raynaud’s phenomenon
Tendon friction 
Early lung disease
Heart, GI and renal disease
110
Q

Symptoms of polyarteritis nodosa?

A

Skin changes
Peripheral neuropathy

Renal failure

Abdo pain
Rectal bleeding

Hypertension

Rosary sign on angiogram

Hep B

111
Q

WHAT IS SEEN ON CXR WITH WEGENER’S/ GRANULOMATOSIS WITH POLYANGITIS?

A

Cavitating lesion

112
Q

Other symptoms of churg strauss?

A

Haemoptysis
Rash
Kidney/renal damage
Focal neurology

113
Q

Which HLA is Behcet’s associated with?

A

HLA-B51

114
Q

Symptoms of Behcet’s disease?

A

TRIAD:
Recurrent oral ulcers
Genital ulcers
Uveitis

Rash (e.g. erythema nodosum)
Arthritis
Pericarditis
Colitis

115
Q

Consequences of CKD

A
  1. Progressive failure of homeostatic function
    • Acidosis
    • Hyperkalaemia
  2. Progressive failure of hormonal function
    • Anaemia
    • Renal Bone Disease - Osteomalacia
  3. Cardiovascular disease
    • Vascular calcification
    • Uraemic cardiomyopathy
  4. Uraemia and Death
116
Q

Investigations for CKD

A

Bloods: ↓Hb (normocytic anaemia); U&Es (↑urea/Cr), glucose (DM), eGFR, ↓Ca2+, ↑PO43−, ↑ALP (in renal osteodystrophy) ↑PTH if severe CKD

Urine: dipstick, MC&S, Protein:Cr ratio

Imaging: USS to check size/anatomy/cortico-medullarly differentiation and eliminate obstruction – in CKD kidneys are small (<9cm) but may be enlarged in infiltrative disorders

CXR: Pericardial effusion or pulmonary oedema

Histology: consisted renal biopsy if rapidly progressing or unclear cause (C/I for small kidneys)

117
Q

Other names for renal cell carcinoma

A

von Grawitz tumour, hypernephroma

118
Q

Risk factors for renal cell carcinoma?

A 
Age
Smoking
Genetic- von Hippel Lindau, tuberous sclerosis, familial papillary renal cell carcinoma
Obesity
HTN/hypertension
Dialysis
119
Q

Epidemiology of renal cell carcinoma?

A

Males > female

2:1

120
Q

Gold standard Ix/investigation for renal cell carcinoma?

A

CT

[Could consider using IV urogram- CT/MRI]

121
Q

Causes of renal artery stenosis?

A

Atherosclerosis
Fibromuscular dysplasia- in young females

May be associated with collagen disorders, neurofibromatosis and Takayasu’s arteritis
Micro-aneurysms in the mid and distal renal arteries (resembling a string of beads on angiography)
Antiphospholipid syndrome
Post renal transplant

122
Q

What kidney condition is related to flash pulmonary oedema?

A

Renal artery stenosis

123
Q

What can cause sterile pyuria?

A

TB

Jack Teh Cheat Sheet Flashcards (13 decks)

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