Things I get wrong a lot Flashcards
How to treat IHD?
Immediate = 300mg aspirin and GTN
Hospital = Morphine, Oxygen, Nitrates, Aspirin/Clopidogrel
Long term = Beta-blockers, ACEis, Clopidogrel, Aspirin, Statins
Causes of left sided HF?
IHD, MI, Cardiomyopathy, Ventricular hypertrophy, Constrictive pericarditis, Cardiac tamponade
S&S of left sided HF?
Dysponea, poor exercise tolerance, fatigue, orthoponea, nocturnal dysponea/cough, wheeze, nocturia and cold peripheries
Causes of right sided HF?
LV HF, pulmonary stenosis, lung disease e.g. cor pulmonale
S&S of right sided HF?
peripheral oedema, ascites, nausea, anorexia and epistaxis
What causes Marfans and Ehlers-Danlos Syndromes?
Inherited Autosomal Dominant conditions
What is Ehlers-Danlos syndrome?
A defective type 1 and type 2 collagen production
What may trigger gout onset?
Red meat/alcohol binge, trauma/surgery to the joint, starvation, infection and diuretics
What may trigger pseudo-gout onset?
Ilness, direct joint trauma or surgery
Name some risk factors for pseudo-gout?
Old age, being female, hyperparathyroidism, hypophospataemia and haemochromatosis
Name some common extra-articular manifestations of RA?
Rheumatoid nodules, vasculitis, pulmonary fibrosis and pericarditis
What is scleroderma?
An autoimmune disease of the connective tissue leading to scarring and thickening of tissues
How may scleroderma present?
Weight loss, fatigue, Reynauds phenomenom, Sclerodactyly and thickened skin on the face
Red flag signs in diarrhoea?
Severe dehydration, electrolyte imbalance, renal decline/failure, severe abominal pain and immunocompromised patients
What is the main cause of travellers diarrhoea? How does it present?
Enterotoxigenic E.coli.
Watery diarrhoea precceded by cramps and nausea
Which antibiotics most commonly cause C.difficile infection?
clindamycin, cephalosporins, carbapenems, co‑amoxiclav and quinolones
How is C.difficile treated?
Metronidazole, Vancomycin (main) and foecal transplant
How do you treat cholera?
Oral rehydration salts/IV fluids and doxycycline/tetracycline
Name 3 parasites commonly affecting the GI tract
Cryptosporidium, Entomeba histolytica and Giardia
Non GI symptoms of Coeliac’s disease?
Osteomalacia, weight loss, fatigue, iron deficiency anaemia and weakness
GI symptoms of Coeliac’s disease?
Steatorrhoea, diarrhoea, abdominal pain/cramps, abdominal bloating, nausea/vomiting
Diseases associtated with Coeliac’s disease?
Dermatitis herpetiformis, Sjorgen’s sydrome, T1DM etc. (autoimmune diseases)
What is gastritis?
Inflammation of the stomach mucosa following damage
Treating gastritis?
Antacids, H2-receptor antagonists e.g. cimetidine, PPIs and treat H.pylorio infection (lansoprazole, clarithromycin and amoxicillin)
What are some consequences of hypoglycaemia?
Autonomic = sweating, anxiety, hunger, tremour, palpatations and dizziness Neuroglycopenic = confusion, drowsiness, visual disturbances, seizures and coma
How does metformin work and what are its side effects?
Inscreases sensitivity to insulin, increases glucose absorption by the skeletal muscles, decreases liver glucose secretion and decreases glucose uptake at the intestines.
S/Es = GI disturbances e.g. diarrhoea, nausea and vomiting
How can you treat PVD?
Angioplasty/stenting, encourage patient to walk through pain (to assist new vessel formation) and smoking cessation
What causes psuedohypoparathyroidism?
Genetic abnormalities - there will be PTH resistance.
Short stature, short fingers, round face and a short neck are also seen
Describe 1st line hypertension treatment?
55 + and any age in black patients = CCBs
<55 and white = ACEis
Which condition is most likely to cause thoracic aortic aneurysm?
Marfans syndrome - defective fibrillin 1 production
1st line treatment for PE
LMW Heparin
What is the staging for lymphoma?
Ann Arbor Staging
I = one area of lymph node involvment
II = 2+ lymph nodes involved but on the SAME side of the diaphragm
III = 2+ lymph nodes involved but on DIFFERENT sides of the diaphragm
IV = Extranodal involvment
What drug is used in disollution therapy and for which gall stones?
Ursodeoxycholic acid for cholesterol gall stones
Which disease matches these 3 classic symptoms:
Urethritis, Conjunctivitis and arthritis
Reactive arthritis
Which disease causes bony growths (may lead to hearing loss, enlarged head etc.)
Pagets disease of bone - causes bones to become fragile and misshapen, usually affects pelvis, skull, spine and legs
First line BPH treatment?
Alpha-blockers e.g. tamulosin
Which cancer gives painless heamaturia?
Bladder (transitional cell bladder cancer)
Signs of meningitis?
neck stiffness, photophobia, Kernig’s sign, non-blanching petechial rash, seizures and decreased GCS score
What are the two signs seen in hypocalcaemia?
Chvostek’s (twitch in response to tapping of the facial nerve) and Trousseau’s (spasm of hand when tightening blood pressure cuff) signs
Patient has UMN signs plus muscle wasting and fasiculation, what do they have?
Motor neruone disease
What is the syndrome of innapropriate aldosterone secretion called?
Conn’s syndrome
What are the antibodies found in Graves and Hashimotos?
Thyroid Stimulating Receptor hormone antibodies in graves, anti-TPO in hashimotos
What may cause increased testosterone in a woman?
Polycystic ovary disease
What condition may present with periodic sweating, headaches, snoring and insomnia?
acromegaly
A fault with which protein is associated with eczema?
Filaggrin
How do you treat an arterial thrombus?
LMW heparin, aspirin and thrombolytic therapy
What imaging methods assess PE?
CT angiography and V/Q scan
How do you treat a PE?
LMW heparin, then thrombolysis (if haemodynamically unstable).
Long term = DOAC or warfarin (3 months if provoked and up to 6 months if unprovoked)
Define Myeloma?
Early malignant proliferation of bone marrow cells
What increases the risk of both types of lymphoma?
EBV, being male and immunosuppression
Treatments for non-hodgkin’s lymphoma?
Low grade = Radiotherapy in local disease or palliative care
High grade = R-CHOP chemotherapy
Clinical features of platelet dysfunction?
Epistaxis, Gum bleeding, Easy bruising, Petechiae/purpura, Traumatic haematoma
Tests for thalassaemia?
FBC, MCV, blood film, iron/Hb levels
Treatment for thalassaemia?
Life long transfusions, splenectomy, bone marrow transplant/stem cell transplant
What are the most commonly used antibiotics in UTIs?
Nitrofurantoin and Trimethoprin
What is Fanconi syndrome?
Damage to the PCT causing changes in the urinary content
How does membranoproliferative glomerulonephritis present?
Nephrotic and nephritic syndrome
What two organs does Goodpasture’s syndrome affect and how?
Kidneys - oedema and hypertension
Lungs - dysponea, chest pain and haemoptysis
Risk factors for urinary stones?
Obesity, diuretics, IBD, PKD, structural abnormalities of the urinary tract and past occurance
How does renal colic present?
Unilateral flank pain which radiates to the groin associated with nausea/vomiting
How do uriany stones present?
Dysuria, Urinary urgency, Urinary frequency and Haematuria
Complications of urianry stones?
Chronic renal damage, Recurrent stones, Renal abscess and Renal fistula
Medical treatment for CKD?
EPO/Iron supplementation, Frusemide, Losartan/Ramipril and Atorvastatin/simvastatin
What is Beck’s triad?
Hypotension, jugular venous distention (raised JVP) and muffled heart sounds
This is a sign of cardiac tamponade
What is pheochromocytoma?
An endocrine tumour, this in an important differential in hyperthyroidism
What is Charcot’s triad?
Jaundice, fever and right upper quadrant pain indicating ascending cholangitis
How do loop diuretics work?
Inhibition of the sodium/potassium/chloride symporter in the loop of Henle
How do thiazide diuretics work?
Inhibition of the sodium chloride transporter in the distal convoluted tubule
How do potassium sparring diuretics work?
Inhibition of aldosterone receptor in the distal tubules
What is the ABCD2 score used to calculate?
Risk of stroke after TIA
Age 60+ - 1 point
BP >/= 140/90 - 1 point
Clinical features: unilateral weakness - 2 points, slurred speach no weakness - 1 point
Duration: >/= 1 hour - 2 points, 10-59mins - 1 point
Diabetes - 1 point
What is the QRISK2 score used to calculate?
Risk of heart attack
How does sarcoidosis affect 1,25-dihydroxyvitamin D production?
It becomes uncontrolled so will eventually lead to hypercalcaemia
How does hyperthyroidism affect calcium levels?
It causes hypercalcaemia
How do you identify suspected coeliac’s diseases cases which should be sent for biopsy?
IgA tissue transglutaminase (tTg) and IgA endomysial (EMA) antibodies present in the blood
How can you tell between IBS and IBD?
Faecal Calprotectin is raised in IBD but not in IBS
What is the most common composition of renal stones?
Calcium oxalate
What are the stages in CKD grading?
Stage 1 > 90 ml/min with evidence of renal damage
Stage 2 60-89 ml/min with evidence of renal damage
Stage 3a 45-59 ml/min with or without renal damage
Stage 3b 30-44 ml/min with or without renal damage
Stage 4 15-29 ml/min with or without renal damage
Stage 5 <15 ml/min, established renal failure
ml/min is in refference to eGFR
A patient in their twenties presents with b syptoms and an asymmetrical painless lymphadenopathy worse on drinking alcohol what is the likely diagnosis?
Hodgkin’s lymphoma
Where are auer rods found?
AML
How does multiple myeloma present?
C - calcium increse
R - renal impairment
A - anaemia (and pancytopenia)
B - bone lesions/pain/fractures
What is leukocytosis?
An increased number of WBCs e.g. in CML
Name some side effects of amitriptyline?
It is anticholinergic so causes blurred vision, confusion, dry mouth and urinary retention
What are the TB drugs? Give SEs of each?
Rifampicin - Red/orange discolouration of urine/tears
Isoniazid - Peripheral neuropathy
Pyrazinamide - High uric acid levels → gout
Ethambutol - Colour blindness/reduced visual acuity
What are the known casues of tension headaches?
Depression, lack of sleep, missed meals and stress
What is the initial treatment for PE/DVT?
LMW Heparin, you perform thrombolysis in haemodynamically unstable patients
Patient (25-40) presents with long term dry cough, SOB and erythma nodosum. X-ray shows bilateral hilar lymphadenopathy and biopsy shows non-caseating granulomas with epithelioid cells. What is the likely diagnosis?
Sarcoidosis
What are the cardinal signs of carcinoid syndrome?
Cardiac involvment, bronchoconstriction, diarrhoea and flushing
What are the common causative orgnaisms of UTIs?
Klebsiella, E. Coli, Enterococcus, Proteus/pseudomonas and Staphylococcus saprophyticus
What are the causes of megaloblastic anaemia? How do you tell betweeen them?
B-12/folate defficiency
B-12 is found in fish, meat and pultory products so is often deficient in vegans. It is absorbed at the terminal ileum and deffiency also leads to neurological signs
What are teh beta-lactams?
Penicillins, Cephalosporins (e.g. ceftriaxone and cefotaxime) and Carbapenems (e.g. Ertapenem and Biapenem)
What are the red flags in bone pain and what do they signify?
Pain at rest/night - cancer, infection or fracture
Name some clinical features seen in spondlyarthropathies?
Sausage fingers, Psoriasis, Inflammatory back pain, NSAIDs response, Enthesitis, Arthritis, CRP elevation, HLAB27, Eye issues
What is fibromyalgia?
Widespread pain > 3 months in >11 of the 18 tender spots when no other cause can be identified
Give some extra-articular manifestations of RA?
Nodule formation, lymphadenopathy, vasculitis, interstital fibrosis, IHDs, pericarditis, pericardial effusion, carple tunnel syndrome
What makes up the crystals in gout and pseudogout?
Urate in gout, calcium phosphate in pseudo gout
Pink puffers vs blue bloaters?
PP - Exhilation issues due to emphysema, perfusion is maintained - weight loss and breathlessness
BB - reduced perfusion causing cyanosis and chest expansion (take large breaths) - due to chronic bronchitis so there will be a productive cough and respiratory failure may occur
S&S of acute asthma attack?
Dysponea, coughing, chest pain/tightness, tachyponea, tachycardia, cyanosis, drowsiness/confusion
What are the two steroids you can use in acute asthma attack and how do you deliver them?
Hydrocortiosne - IV
Prednisolone - PO
How does pneumonia occur?
Bacterial infection of the alveolar space leads to neutrophils and fluid moving into the lungs
How much fluid is neded to diagnose pleural effusion?
Clinically - 500ml
CXR - 350ml
Transudate vs exudate?
Transudate <25g/L of proteins due to CHF/liver cirrhosis/nephrotic syndrome
Exudate >35g/L protein due to infection e.g. TB or pneumonia/inflammation/malignancy
What are the tests used to diagnose TB?
Latent disease = mantoux skin test
Active disease = ziehl-neelson stain/acid fast bascilli
What is miliary TB and how do you test for it?
TB infection which has spread to the CNS - test using lumbar puncture
What is polycythemia?
Relative polycythaemia = decreased plasma volume but normal RBC mass
Absolute polycythaemia = increase in RBC mass
Name a thrombolysis drug?
Streptokinase and Alteplase
What causes huntington’s disease?
CAG repetes on chromosome 4
What is a Jacksonian March?
Where a seizure spreads from the distal part of the limb towards the ipsilateral face - seen in frontal lobe seizures
What is the defining freature of a trigeminal neuraliga?
Sudden severe shooting facial pain lasting only for a few seconds
What are the triggers of migraine?
Chocolate, Hangovers, Orgasms, Cheese/Caffine, Oral-contraceptives, Lie-ins, Alcohol, Travel, Exercise, Stress
Where in the nervous system does demyelination NOT occur in MS
Cerebellum
Name the causes of macrocytic anaemia?
B-12 deficiency, alcohol excess/liver damage, hypothyroidism, haemolysis, BM failure and pernicious anaemia
Name the causes of iron deficieny anaemia?
Blood loss, poor diet, malabsorption and hook worm
What medications prevent an angina attack and what medications reduce complications?
Angina attack prevention =Beta-blockers and CCBs
Complications prevention = Aspirin, statins and ACEis
How does acute pericarditis appear on ECG?
Saddle shaped ST elevation and PR depression
What criteria is used to diagnose IE?
Duke criteria
What are common SEs of CCBs?
Oedema, flushing and palpatations
What are common SEs of amioderone?
Sun sensitivity, Hyperthyroidism, Corneal deposits, Interstitial pneumonitis, Hepatic disorders and Nausea
How do you manage acute AF?
Rate control = Bisoprolol or Diltiazem
Anticoagulation = LMW Heparin (until emboli risk is assed) then if high risk DOAC (e.g. apixaban) or warfarin
What are the steps in chronic asthma management?
Step 1 = Short acting Beta-2 agonists (if >1 daily/night time symptoms go to step 2)
Step 2 = Add standard dose inhaled steroids
Step 3 = Add long acting Beta-2 agonists
What is Virchow’s triad?
Factors which contribute to thrombosis:
Hypercoagulability
Haemodynamic Changes (stasis/turbulence)
Endothelial injury/dysfunction
Define chronic bronchitits?
A cough with sputum production for >3 months for over 2 years
Type 1 vs 2 respiratory failure?
Type 1 = Low PaO2, Normal/low PaCO2
Type 2 = High PaCO2, Normal/low PaO2
What is the most common microorganism to cause osteomyelitis?
Staph. aureus
What is the mode of action of gliclazide?
Stimulates beta cells to secrete insulin
What visual disturbance occurs in acromegaly?
Bitemporal hemianopia
What is the first treatment in DKA?
Replace volume with fluids - then give insulin
What is the most common cause of primary hyperthyroidism?
Graves disease
What is the first line treatment for thyroid storm?
Propanolol (consider diltiazem if contraindicated) - to slow heart
Then give carbimazole
What can gram -ve bacteria release?
Endotoxins
How do viruses cause diesease?
Direct destruction of host cells, Cell proliferation and cell immortalisation, Inducing immune system mediated damage and Modification of host cell structure or function
What is a protazoa?
A single celled eukaryotic organism, causes malaria
Where do viruses replicate?
DNA viruses = nucleus, RNA viruses = cytoplasm
What is the best way to identify gall stones?
Abdominal US
What are adenomas?
Benign tumours - may become cancerous
What is Reynold’s pentad?
Charcot’s triad (Jaundice, RUQ pain and fever in ascending cholangitis) PLUS hypotension and decreased consiousness - this indicates sepsis onset
What causes severe abdominal pain radiating to the back, nausea and vomiting?
Acute pancreatitis
What is cobalamin deficiency?
B-12 deficiency - caused by disorders of the stomach, small bowel, pancreas and seen in strict vegitarians
What is Choledocholithiasis?
Bile duct stones/gall stones, will cause intermittent pain which is worse after eating
What is a lentivirus?
A genus of retroviruses which casue severe diseases with long incubation periods e.g. HIV
What dies innate immunity depend on?
Leukocytes e.g. natural killer cells, mast cells, eosinophills and basophils
What is a malignant neoplasm of glandular epithelium called?
Adenocarcinoma
What does Emax describe?
The potency of a drug
Describe the types of hypersensitivity reactions?
T1 = IgE mediated in allergic response/anaphylaxis T2 = IgG and IgM mediated in autoimmune disease e.g. Rheumatic fever/Grave's/Good Pastures T3 = immune complex mediated in IgA nephropathy and SLE T4 = pre-sensitized T lymphocytes coming into contact with antigens in contact dermatitis and Gullain-Barre syndrome
How does Botox work?
Inhibits the release of acetylcholine from the pre-synaptic neurones at the neuromuscular junction leading to muscle paralysis
What antibiotics are used in diverticulitis?
Ciprofloxacin and metronidazole
Where are NSAIDs most likely to cause ulceration?
The duodenum
What is the first line investigation in appendicitis?
Abdo US
What does bloody diarrhoea and a recent trip to hospital suggest is the causative organism?
Bloody = bacerial Hoptial = C. difficile
What is C.difficile?
A gram positive, spore forming, obligate anaerobe
What is deontology?
Acts are right or wrong and people have a duty to act accordingly
Where are tamulosin and finasteride used?
Symptomatic BPH
What are the treatments for prostate cancer?
Radical prostectomy, orchidectomy, antigonadotrophins e.g. goserelin/buserelin, androgen receptor blockers e.g. bicalutamide/futamide
What stimulates the external urethral sphincter to contract?
The pudendal nerve
Where are calcium levels monitored?
The parathyroid gland
What causes syphyllis?
Treponema pallidum
What causes a rise in PSA?
Benign prostate enlargement, Urinary tract infection, Prostatitis and Prostate cancer
What is teh Rome III criteria for IBS?
Abdo pain for at least 3 days a month for the last 3 months + two or more of:
Change in frequency
Change in form of stools
Pain improves upon defecation
What drugs can treat IBS?
Anti-spasmodics e.g. dicyclomine for cramps
Loperamide for diarrhoea
Laxatives for constipation
Tricyclic antidepressants
What are the initial treatments for UC and Chron’s?
UC = 5 ASAs e.g. mesalazine Chron's = prednisolone
What can be seen on ECG in hyperkalaemia?
Absent P waves, long PR interval, wide QRS and tall tented T waves
What can be seen on ECG in hypokalaemia?
U waves
S&S of sepsis?
Shiver/fever/cold, Extreme pain, Pale/discoloured skin, Sleepy/difficult to wake, Impending doom, Shortness of breath
Septic shock = warm peripheries and bounding pulse
Main symptom of pericarditits?
Sharp pleuritic chest pain worse when lying flat
What is the most common cause of secondary hypoadrenalism?
Long term corticosteroid use
What is seen in Barret’s oesophagus?
change from stratified squamous to simple colunmar
What is angular stomatitis?
Sores in the corner of the lips, seen in coeliac’s disease alongside apthous ulcers
What is Trosier’s sign?
Englarged Virchow’s nodes seen in gastric cancer
What are the most common leukaemias?
Adults = AML Children = ALL
Symptoms of Polycythaemia Vera?
Headaches, dizziness, tinnitus, visual disturbances, itching after a hot bath and erythromelagia. It can also cause haemorrhage and thrombosis.
It this is the primary cause for polycythemia
How will RBCs appear in iron defficiency anaemia?
Abnormally shaped (polikilocytosis), pale (hypochromic), vary in size (anisocytosis) and small (microcytosis)
When does asterixis occur?
Type 2 respiratory failure or liver failure
How does liver failure affect oestrogen levels and what does this lead to?
Increased oestrogen (as the liver can no longer break it down), this causes spider navaei and gynaecomastia
What is Kussmaul breathing?
A deep breathing done in DKA (it is a form of hyperventilation to remove excess CO2)
What are the definitions of liver failure?
INR > 1.5, onset duration of <26 weeks, mental alteration without cirrhosis, no previous liver disease
What is painless jaundice a red flag for in teh UK?
Cancer of the pancreatic head (could also be cholangiocarcinoma howevere this is rare in the Western World)
S&S and test for addisons?
Hyperpigmentation, fatigue, tearfulness, weakness and anorexia
ACTH stimulation test/Synacthen test
Test for Wilson’s disease?
24hr urinary copper secretion
Liver biopsy - DIAGNOSTIC
S&S of haemachromatosis?
Skin bronzing/goes slate grey, joints pain, erectile dysfunctions/amenorrhoea, liver failure and kidney issues
Which antibiotics inhibit nucleic acid synthesis?
Ciprofloxacin, Metronidazole, Rifampicicin and Trimethoprim
What is a common cause of neonate meningitis?
Strep. agalactiae
How do you differentiate between teh non-lactose fermenting (pale on MacConkey) aerobic bacilli?
Oxidase test
Positive = pseudomonas
Negative = proteus, salmonella and shigella
What are the two types of alpha-haemolytic strep?
Optochin resisitant e.g. strep. viridans
Optochin sensitive e.g. strep pneumoniae
What are the two types of beta-haemolytic strep?
Lancefield A = strep. pyogenes
Lancefield B = strep. agalactiae
What is teh first line test for lung cancer?
CXR
What is seen in pleural effusions?
Stony dull percussion
What is the immediate management for a TIA?
300mg aspirin
What is the duke’s staging of colonc cancer?
A = The cancer is in the inner lining of the bowel or it is slightly growing into the muscle layer. B = The cancer has grown through the muscle layer of the bowel. C = The cancer has spread to at least 1 lymph node close to the bowel. D = The cancer has spread to another part of the body
S&S of Conn’s syndrome?
Weakness, cramps, polyuria, polydypsia, parasthesia and increased BP
How do you serologically differentiate between UC and Chron’s?
UC = pANCA positive Chrons = ASCA positive
What are owls eyes inclusions?
A radiological/histological pattern that is highly specific to cytomegalovirus
What is the most common cause of foot drop?
Compression of the peroneal nerve
Which types of leukaemia have blast cells?
AML and ALL
What are candersartan and amlodipine?
Candasartan = ARB Amlodipie = CCB
Risk factors for GORD?
Lower oesophageal hypotension, hiatus hernia, oesophageal dysmotility, obesity, gastric acid hypersecretion, delayed gastric emptying, smoking, alcohol, pregnancy and drugs e.g. tricyclics
What is the first line test for a bowel obstruction?
X-ray
Describe duodenal ulcers?
Worse several hours after eating and relieved by eating
What is the dignostic test for bowel cancer?
Colonoscopy
Where do the majority of colon cancers occur?
Distal colon
Name the complications of PKD?
Liver cyst formation, Increased blood pressure => CVD, berry aneurysm and kidney stones
How do you treat malaira?
Uncomplicated = oral chloroquine Complicated/severe = IV artesunate
What is seen in acute inflammation?
Rubour (redness), Dolor (pain), Calor (heat), Tumour (swelling) and loss of function
There will be neutrophil polymorph infiltration
What is amaurosis fugax?
Unilateral painless progressive vison loss ‘like a curtain descending’ typically seen in TIA due to retinal artery occlusion
Risk factors for peripheral neruopathies?
Diabetes, alcohol abuse, vitamin B deficiencies, autoimmune diseases e.g. sjorgens and SLE, immunocompromised patients (due to increased risk of infection e.g. lyme disease, shingles, EBV, HBV/HCV and HIV)
What are the most common bacterial and viral causes for COPD exacerbation? Which is the most common?
Bacterial - H.influenzae
Viral - rhinovirus
Bacterial exacerbations are more common
What is seen in RBBB and LBBB?
WILLIAM MARROW
LBBB = slurred S wave in V1, R wave in V6
RBBB = R wave in V1, slurred S wave in V6
S&S of IE?
Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anaemia, Nail bed (splinter) haemorrhages, Emboli (FROM JANE)
What is xanthelasma?
Build up of yellow plaques on the eyelid seen in hyperlipidaemia
RFs for oesophageal cancer?
poor diet, alcohol, smoking, oesophagitis, barretts oesophagus, obesity, hot drinks and reflux
Causes of diverticular disease?
Low fibre diet, Obesity, NSAIDs and Smoking
What is Thrombotic Thrombocytopenic Purpura and how do you treat it?
Blood condition presenting with low platelets, RBC fragmentation, renal failure, neurological deficit and fever as blood clots occur in the small vessels throught the body
Treat first line with urgent plasma exchange
What is hydroxycarabimide?
A bone marrow suppressive drug used to treat polycythaemia rubra vera and sickle cell disease
What is cytopenia?
Whe one or more of your blood cell types are low
What is leukonychia?
White discolouration of the nails due to injury of the nail base
PBC vs PSC?
PBC = autoimmune (affects small interlobular ducts), more common in women and associated with AMA PSC = associated with UC (affects intra/extra-hepatic ducts), more common in men and associated with ANCA and ANA
How do you treat myasthenia gravis?
Neostigmine/pyridostigmine - block the action of actelycholinesterase so increase the amount of ACh in the synapse
Define the thresholds for life-threatening asthma attack?
PEF <33%, silent ches/cyanosis, arrythmia/hypotension, exhaustion/confusion/coma, PaCO2 >4.6kPa, SaO2 <92%/PaO2 <8kPa
Define the thresholds for a severe asthma attack?
Inability to complete scentences in one breath, RR >/= 25, pulse >/= 110, PEF 33-50%
S/Es of salbutamol?
Headaches, restlessness, fine tremour, palpatations and sore throat
S&S of aortic vs mitral stenosis?
Aortic = ejection systolic murumr, non-displaced apex beat, slow rising narrow pressure pulse Mitral = mid-diastolic murmur, non-displaced apex beat, low volume pulse, malar flush
S&S of aortic vs mitral regurgitation?
Aortic = early diastolic murumr, displaced hyperdynamic apex beat, colapsing wide pressure pulse Mitral = pansystolic murmur, displaced hyperdynamic apex beat, AF
How does HF appear on CXR?
Alveoar oedema, kerley B lines, Cardiomegaly, Dilated promient upper lobe veins, pleural Effusions (ABCDE)
S&S/test of Addison’s ?
Lean, tanned, tired, tearful, dizziness, postural hypotension, generally feeling unwell
Short ACTH stimulation test (Synacthen test)
Causes of SIADH?
Malignacy, CNS issues, Chest disease, Drugs e.g. opiates, trauma, alcohol withdrawal and major abdo/chest surgery
Treatment of carcinoid syndome?
Somatostatin anologue e.g. octerotide
What are the two types of buising seen in pancreatitis?
Cullen’s sign = periumbillical bruising
Grey Turner’s sign = flank bruising
Bacteria vs viral on a lumbar puncture?
Bacterial = raised nutrophils, turbid, high protein, low glucose Viral = raised lymphocytes, clear, normal glucose/protein
Main causative organisms of bronchiectasis?
H. influenzae, Strep. pneumoniae, Staph. aureus and Psuedomonas aeruginosa
Treatment of COPD?
1) SAMA/SABA
2) LAMA/LABA
3) Inhaled corticosteroids
How can you localise focal seizures (frontal vs parietal)?
Frontal = Motor features (retained awarness), Jacksonian march, dysphasia and post-ictal weakness Parietal = sensory disturbances and parasthesia
How can you localise focal seizures (temporal vs occipital)?
Temporal = Motor features e.g. lip smacking/grabbing (impaired awareness), dysphasia, deja vu, emotional disturbances/hallucinations Occipital = visual phenomona
S&S of a PCA stroke?
Contralateral homonomous hemianopia/cortical blindness, visual agnosia/prospagnosia, dyslexia and unilateral headache
S&S of an ACA stroke?
Les weakness/sensory disturbances, gait apraxia/truncal ataxia, akinetic mutism and incontinence
