Things I don't know from med ed Flashcards
1
Q
Causes of myocarditis
A
metal drugs- cocaine etc Idiopathic Inflammation- viral Radiation
2
Q
Causes of constrictive pericarditis
A
Inflammation
Acute pericarditis
Cardiac surgery/radiation
3
Q
Causes of dilated cardiomyopathy
A
Alcohol Post viral Genetic Autoimmune Haemochromatosis
4
Q
Haemochromatosis causes what type of cardiomyopathy?
A
Dilated
5
Q
Amyloidosis causes what type of cardiomyopathy?
A
Restrictive
6
Q
What heart sound is heard in hypertrophic cardiomyopathy?
A
S4
7
Q
Arrythmogenic right ventricular cardiomyopathy
Definition
Aetiology
Presentation
A
Fat and fibrosis in pericardium
Genetic- autosomal dominant
Asymptomatic or arrhythmia during exercise
8
Q
Dilated cardiomyopathy on CXR?
A
Globular heart
[Also pericardial effusion]
9
Q
Glaucoma investigations?
A
Fundoscopy- optic cupping
Tonometry- high pressure
Gonioscope- angle [iris and trabecular meshwork]
10
Q
Glaucoma investigations?
A
Fundoscopy- optic cupping
Tonometry- high pressure
Gonioscope- angle [iris and trabecular meshwork]
Slit lamp
11
Q
Ototoxic drugs
What type of deafness do they cause?
A
- Aminoglycoside antibiotics
- Aspirin (overdose)
- Loop diuretics
Sensorineural
12
Q
When is radiotherapy used in Cushings tx?
A
after surgery if doesn’t respond
13
Q
What can bilateral adrenalectomy cause?
A
Nelson syndrome- locally aggressive pituitary tumour causing skin pigmentation due to ACTH secretion
14
Q
Complications of Cushing’s surgery- transphenoidal?
A
CSF leakage
Meningitis
Sphenoid sinusitis
Hypopituitarism
15
Q
Complications of Cushing’s radiotherapy?
A
Hypopituitarism
Radionecrosis
Second intracranial tumour/stroke
16
Q
Signs of phaeochromocytoma
A
Hypertension Postural hypotension Pallor Tachycardia Fever Weight loss
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
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
19
Q
Treatment when both hypothyroidism and addisons?
A
if pt has hypothyroidism, give hydrocortisone BEFORE thyroxine to prevent precipitating Addisonian crisis
20
Q
Advise for addisons patients
A
Advise
Medic alert bracelet
Carry steroid warning card
Carry emergency hydrocortisone
21
Q
Autoimmune polyendocrinopathy syndrome
A
AIPES – T1: autosomal rec mutation in AIRE gene
- Both T1 + T2 involve Addison’s disease
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)
23
Q
Rhabdomyolysis and K+?
A
Hyperkalaemia
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
25
Management of hypokalemia?
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
26
Management of hypokalemia?
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
27
PCOS
Low sex hormone binding globulin [less production in liver]
28
Feature of arterial ulcers?
Grey tissue+ pale base
29
Arterial ulcers more distal
Venous ulcers more proximal
30
Most common type of AAA
Ninety %= infra renal
31
Risk factors for aortic dissection?
HYPERTENSION
Smoking
Atherosclerosis
Coarctation of aorta- congenital cardiac
CTD
Cocaine/amphetamine
Heavy lifting
32
Timing of aortic dissection
Considered acute if <14 days
33
Symptoms of aortic dissection
| due to obstruction of other aortic branches
Abdominal pain (coeliac axis)
Loss of consciousness (subclavian artery)
Anuria (renal artery)
34
Signs of aortic dissection
Difference in blood pressure between arms of more than twentymmHg
Diastolic murmur
Hypertension
Or hypotension if tamponade
35
Ix of aortic dissection?
Gold standard- CT angiogram
```
FBC, U+E, LFTs
Cross match
Lactate
Cardiac enzymes= exclude ACS
ECG- ischemia
CXR- loss of aortic knuckle
```
36
Varicose veins definition
Subcutaneous, permanently dilated veins of >3 mm diameter when standing
37
Causes of varicose veins
Valve insufficiency
Primary- idiopathic
Secondary-
DVT
Pelvic masses-fibroids, ovarian mass, pregnancy
AV malformation
38
Symptoms of varicose veins
Investigations of varicose veins
```
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
39
Management of varicose veins?
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
40
Reticular veins:
permanently dilated intradermal veins which may be tortuous. Usually asymptomatic.
41
Reticular veins:
permanently dilated intradermal veins which may be tortuous. Usually asymptomatic.
bigger than telangiectasias, smaller than VVs, flatter and less twisted
42
Complications of varicose veins
```
Venous ulcers
Venous eczema
Lipodermatosclerosis
Pigmentation
SUPERFICIAL THROMBOPHLEBITIS- warm and red
```
43
Complications of sclerotherapy to treat varicose veins
Local scarring
| Skin staining
44
Complications of surgery to treat varicose
Haemorrhage
Infection
Parasthesia + peroneal nerve injury
45
pseudomonas Abx?
levofloxacin
46
Most common lung cancer
Adenocarcinoma
47
Asbestos- lung cancer risk?
Squamous cell carcinoma
| Mesothelioma
48
Which cancer has cavitating lesions?
SqCC- squamous cell carcinoma
49
What organs apart from the lung can mesothelioma affect?
Heart - pericardium
| Abdo- peritoneum
50
What is heard on auscultation of mesothelioma?
Pleural friction rub
51
Gold standard Ix for mesothelioma?
Pleural fluid cytology and pleural biopsy
52
Gold standard Ix for mesothelioma?
Pleural fluid cytology and pleural biopsy
Other Ix
CXR
CT chest
53
Staging of lung cancer?
CT
PET
MRI
54
Breast conditions that smoking predisposes you towards?
Mastitis [non lactational/periductal?]
| Ductal ectasia
55
Neck lump epidemiology
Children: >75% lateral neck lumps are benign
Adults (>40): >75% lateral neck lumps are malignant
Lump: SCTF
56
Breast cysts discharge?
Clear
| Only occurs sometimes
57
Fibroadenoma definition?
Benign neoplasm of a lobule
58
Epidemiology of intraductal papilloma?
Peri/post menopausal women
59
Organism that causes mastitis and breast abscess?
Staph aureus
60
Nipple in mastitis?
May be cracked
61
What does PMH in non lactional/periductal mastitis look like?
Non-lactational: tend to present with
a history of previous infections with
less pronounced systemic upset
62
Breastfeeding and mastitis?
ENCOURAGE BREAST FEEDING
63
Mx of breast abscess
Antibiotics [IV or oral]
| FNA [therapeutic and diagnostic]
64
Ix/Mx of breast abscess
Antibiotics [IV or oral]
FNA [therapeutic and diagnostic]
FBC + blood cultures- if systemic infection
Surgical drainage
65
Complications of breast abscess?
Fistula
| Rarely: necrosis
66
What staging system is used in breast cancer?
Nottingham staging system
67
Risk factors for breast cancer?
Age
FHx
```
Oestrogen exposure:
Nulliparty
Early menarche
Late menopause
HRT
OCP
```
BRCA gene
ALCOHOL
RADIATION TO CHEST
FATTY DIET
OBESITY
68
Signs of breast cancer
```
Peau d'orange
Skin dimpling
Inverted nipple
[Bloody] nipple discharge
Eczema- Paget's disease
```
ARMPIT SKIN THICKENING
69
Does breast cancer often metastasise?
No
Bone, lungs when it does
70
What breast cancer is Paget's disease associated with?
DCIS
| [Ductal carcinoma in situ]
71
Lung cancer medication
Aromatase inhibitors e.g letrozole
| ER receptor antagonist - tamoxifen
72
Autoimmune hepatitis risk factors?
Fat young women, cushingoid symptoms post tx
73
Low urea- reasons
severe liver disease, (synthesised in liver), malnutrition, pregnancy
74
NASH symptoms
often asymptomatic
Dull or aching RUQ pain
Fatigue
Unexplained weight loss
Weakness
75
Histopathological features of alcohol hepatitis:
```
Centrilobular ballooning
Degeneration and necrosis of hepatocytes
Steatosis
Neutrophilic inflammation
Cholestasis
Mallory-hyaline inclusions (eosinophilic intracytoplasmic aggregates of cytokeratin intermediate filaments)
Giant mitochondria
```
76
U and E in alcoholic hepatitis
Urea and K+ tend to be low
77
Mx of alcoholic hepatitis
Mx:
Acute
Thiamine
Vitamin C and other multivitamins (can be given as Pabrinex)
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 restriction should 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
pANCREATIC CANCER- most common type
90% adenocarcinoma
79
Complications of epidural
```
Complications:
Dural puncture
Vessel puncture
Hypoventilation
Epidural haematoma or abscess
```
80
Complications of blood transfusion
```
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
indications of blood transfusion
```
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
Treatment of cellulitis and erysipelas?
Vancomycin
83
Mx of appendicitis?
Appendicetomy
| + antibiotics- cefotaxime + metronidazole
84
Conditions with positive RhF
```
Wegener's/Granulomatosis with polyangitis
Infective endocarditis
Sjogren syndrome
SLE
Rheumatoid arthritis
```
85
Appendicitis complications
Perforation
Mass
Abscess
86
What do femoral hernias contain?
Omentum
87
What do inguinal hernia contain?
Bowel
88
Signs of hernia strangulation
tender, red, colicky abdominal pain, distension, vomiting
89
Investigation of hernia?
Clinical diagnosis
| Ultrasound first line
90
Anal fissure management steps?
Paracetamol/ibuprofen and topical lidocaine
Topical diltiazem + GTN if more than one week
Constipation alleviation- laxative, fibre
Botox
Internal sphincterotomy
91
Haemorrhoid investigation?
Proctoscopy
Anaemia
92
Complications of haemorrhoids
@ Thrombosis of external haemorrhoids
Severe pain + purplish oedematous
perianal mass
If <72 hours, surgical incision
@ Strangulation of internal haemorrhoids
Severe pain
Urgent haemorrhoidectomy
93
Albumin in IBD?
Low albumin
94
Gold standard for fibrosis/interstitial lung disease?
Biopsy
| But usually CT is done
95
HLA for coeliac disease?
HLA DQ2/8 alleles
96
Is smoking a risk factor for rheumatoid arthritis?
Yes
97
Gold standard for fibrosis/interstitial lung disease?
No
98
Which leukaemia is Down's related to?
AML
| Acute myeloid leukaemia
99
Acute promyelocytic leukaemia chromosome?
t(15;17)
100
CLL extra facts
Can be associated with autoimmune thrombocytopenia + anaemia = Evan’s syndrome
Can transform to aggressive NHL = Richter’s syndrome
101
Weird symptoms of CML?
Hyperviscosity symptoms: visual disturbance, headaches, thrombotic event
Gout
MASSIVE splenomegaly in 90%
102
Eighty five percent B cells in which lymphoma?
non hodgkins
103
What conditions associated with non hodgkins?
EBV, HIV, SLE, Sjogren’s
104
Sickle cell blood film
Sickle cells
HOWELL JOLLY BODIES
105
Additional features of nephrotic syndrome?
Hyperlipidaemia
| Hypercoagulable state
106
HBV/HCV - hepatitis can cause which type of kidney disease?
Nephrotic syndrome
107
Investigations in glomerulonephritis?
Bloods – FBC, U&Es, CRP, Complement, Autoantibodies
Urine
Imaging – RENAL USS +/- RENAL BIOPSY
108
Management of sarcoidosis?
Steroids
| NSAIDS
109
Diffuse cutaneous systemic sclerosis symptoms
```
Skin changes involving the trunk
Raynaud’s phenomenon
Tendon friction
Early lung disease
Heart, GI and renal disease
```
110
Symptoms of polyarteritis nodosa?
Skin changes
Peripheral neuropathy
Renal failure
Abdo pain
Rectal bleeding
Hypertension
Rosary sign on angiogram
Hep B
111
WHAT IS SEEN ON CXR WITH WEGENER'S/ GRANULOMATOSIS WITH POLYANGITIS?
Cavitating lesion
112
Other symptoms of churg strauss?
Haemoptysis
Rash
Kidney/renal damage
Focal neurology
113
Which HLA is Behcet's associated with?
HLA-B51
114
Symptoms of Behcet's disease?
TRIAD:
Recurrent oral ulcers
Genital ulcers
Uveitis
Rash (e.g. erythema nodosum)
Arthritis
Pericarditis
Colitis
115
Consequences of CKD
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
Investigations for CKD
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
Other names for renal cell carcinoma
von Grawitz tumour, hypernephroma
118
Risk factors for renal cell carcinoma?
```
Age
Smoking
Genetic- von Hippel Lindau, tuberous sclerosis, familial papillary renal cell carcinoma
Obesity
HTN/hypertension
Dialysis
```
119
Epidemiology of renal cell carcinoma?
Males > female
| 2:1
120
Gold standard Ix/investigation for renal cell carcinoma?
CT
[Could consider using IV urogram- CT/MRI]
121
Causes of renal artery stenosis?
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
What kidney condition is related to flash pulmonary oedema?
Renal artery stenosis
123
What can cause sterile pyuria?
TB
