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Internal Medicine > TUT > Flashcards

TUT Flashcards

1
Q

Splenomegaly

A

Has a notch
Non-ballotable
Can’t get above it
Moves inferior-medially
Enlarge towards umbilicus
Moves early on inspiration

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2
Q

Lower back pain (Red flags)

A

Neurological defect
Trauma
Previous surgery
Osteoporosis
Unexplained fever/weight-loss
Malignancy
Immunosuppression
Inflammatory nature of pain
Age (<20)
Prolonged use of corticosteroids

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3
Q

Acute onset or asthma

A

Cough
Wheeze
Increased Work of breathing
Restlessness
Anxiety
Hypoxia
Dyspnea
Tachycardia
Tachypnoea
Pulsus Paradoxs

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4
Q

Severe asthma

A

Exhaustion and fear
Inability to speak (Breathlessness)
Drowsiness (hypercapnia)
Cyanosis
Tachycardia (Hypoxemia)
Pulsus Paradoxs
‘Silent’ Chest

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5
Q

Left Ventricular Failure

A

Pulsus Alternans
Displaced, Dilated apex
S3
Bi-basal crackles

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6
Q

Pre-Renal failure (causes)

A

Dehydration
Shock
Sepsis
Drugs (NSAIDs, ACEi)

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7
Q

Pre-Renal failure (Dx/Signs)

A

Dehydration
History of [prev]
Mucosal membrane
Orthostatic HPT
Tachycardia
Urea: Creatinine ratio (7) (1:10)
Oliguria (improve with fluids)
Fraction excretion of Na (7)
Urine Na (<20 mm/mol)

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8
Q

TB on Abdo exam (Signs)

A

Weight-loss
Fever
Abdominal pain
Ascites
Hepatomegaly
Bowel obstruction
Diarrhea
Abdominal mass
‘Doughy’ abdomen

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9
Q

TB Abdo (Dx)

A

Ascites present = TB pleural effusion
SAAG <11
Lymphocytic with raised ADA
Ultrasound
Para-aortic lymph nodes
Micro-abscesses

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10
Q

Risk factors of Ischemic CVA

A

2nd(ary) = DM, HPT
Atherosclerosis (Angina, Claudification, Erectile dysfunction)
Previous Vascular event
Systemic (fever, arthritis, constitutional symptoms)

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11
Q

Lacunar stroke (Definition)

A

Lacunar infarcts are mostly caused by lipohyalinosis or microatheroma of a small penetrating endartery in basal ganglia or pons. Less than 25% of lacunar strokes are caused by large vessel artheroembolism.

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12
Q

Pericardial Effusion (Signs)

A

Absent apex beat
Muffled heart sound
Enlarged cardiac dullness

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13
Q

hypothyroidism

A

Face puffy
Skin (Cold, dry, rough) & Yellow discoloration
Hoarse voice
Bradycardia
Slow mentation
Slow reflexes
Concentration difficulties

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14
Q

S3

A

Rapid ventricular filling on opening of AV valves
Due to reduced ventricular compliance/diastolic overload
MI
TI
AI
VSD & PDA
Constrictive Pericarditis

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15
Q

S4

A

Due to high-pressure atrial wave reflected back from a poorly compliant ventricle
Atrial contraction with a “non-compliant” ventricle
Systolic overload/decreased compliance
AS
HPT & pulmonary HPT
HOCM (Hypertrophic Obstructive Cardiomyopathy)
Infarction/Ischemia
Acute AI/MI

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16
Q

3 Complications of TB on spine

A

Pott’s disease
Arachnoiditis
Transverse Myelitis

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17
Q

JVP vs Arterial

A

visible but not palpable
More prominent inward movement
Complex wave form
Moves on respiration (decreases on inspiration)
first obliterated than fills from above when light pressure is applied on the base of the neck

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18
Q

Bronchus carcinoma (Early disease detection)

A

Chronic cough
Blood stained sputum
LOW

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19
Q

Bronchus CA (direct invasion)

A

Chest pain
SOB
Hoarseness
SVC syndrome
Pathological fracture
Brain mets

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20
Q

Bronchus CA (paraneoplastic syndrome)

A

SIADH
HyperCa
Cushing’s
Hypoglycaemia
Acanthosis
Dermatomyositis

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21
Q

A good screening test

A

Cheap
Safe
Prevalence of the disease NB
Able to pick up pathology early (pre-symptomatic)
Treatable disease
Treatable with high mortality - sensitivity NB
Non-treatable - specificity NB

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22
Q

Paraneoplastic syndromes

A

not caused by direct infiltration of the malignancy. Effect is produced by hormones, cytokines or proteins secreted into circulation.
Weight loss, Fever (Unexpected)
First symptom of malignancy (when the primary is still to small to cause symptoms itself)
Signs of reccurrence

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23
Q

TMN Staging (Tumor)

A

T1 – <3cm
T2 – >3 cm
T3 – onto structures which can be surgically remove (ribbes)
T4 – less than 2cm from carina OR nodules in another lobe (same lung) OR onto structures that can not be surgically remove (aorta, pericardial, phrenicus)

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24
Q

TMN Staging (Nodes)

A

N1 – Hilar same side
N2 – hilar contralateral side / para-aortic
N3 - supraclavicular

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25
Q

TMN Staging (Metastasis)

A

M0 – none
M1a – malignant pleural effusion OR nodule in other lung
M1b – distal mets (Brain, Adrenals, Bone)

26
Q

possible explanations for SOB

A

Pleural effusion
Pneumonia
COPD

27
Q

5 signs of cirrhosis in chronic alcohol user.

A

Palmar erythema
Duputreyn’s
Spider Nevi
Gynecomastia
Testicular atrophy

28
Q

Features other than seen on motor exam which will indicate spinal lesion.

A

Flaccid paralysis
sphincter impairment (bowel and bladder dysfunction)
Sensory level

29
Q

Secondary causes of HPT and a clinical feature of each

A

Coarctation of aorta = HBP
Obstructive sleep apnea = Snoring
Cushing’s = central obesity
Pheochromocytoma = headaches
Renal parenchymal disease = familial hx of CKD
Primary Aldosteronism = hypokalemia

30
Q

Pleural effusion (CXR)

A

Typical effusion with Meniscus sign (concave shape)
Pleural thickening (no typical meniscus sx, sharp angle), post TB

31
Q

Signs of ILD

A

Cough (Dry)
Clubbing
Crackles (fine-insp. -> coarse)
Progressive dyspnoea
Decr. expansion
Underlying connective tissue dx (SLE, RA etc.)

32
Q

Confirm ILD

A

Bronchoscope
Lung biopsy
CXR
PFT’s

33
Q

Lacunar Presentations

A

Pure motor Hemiparesis
Pure sensory stroke
Ataxic-hemiparesis
Dysarthria-clumsy hand syndrome

34
Q

Cinical significance of being
diagnosed with lacunar v MCA stroke

A

LCA (small disease atherosclerosis) you don’t have to look for an embolic event whereas in MCA it could be an embolic event/phenomenon.

35
Q

3 ECG features of pulmonary HPT

A

P. Pulmonale
Dominant R-wave in V1
T-wave inversion V1-V3

36
Q

Besides signs of bilateral UMN weakness, hyperreflexia, clonus and
hypertonia, what other 2 features indicate a spinal cord lesion

A

Incompetence (bladder) UMN bladder
Lhermitte’s sign

37
Q

Spinal TB (Potts Dx)

A

Infect vertebrae
Collapse = pressure in spine + paraperisis
X-ray = Disc body, Endplate, Adjacent vertebrae
Malignancy: Vertebrae body (mostly)
Final Dx: MRI
UMN pattern

38
Q

Arachnoiditis

A

TBM
Exudate around spinal cord at lumbar & sacral
Cause: dysfunction of nerve roots
LMN pattern

39
Q

Transverse Myelitis

A

Not true infection of chord
Immunological reaction (Rheumatoid Fever)
Antibodies -> demyelination of cord with Multiple Sclerosis like lesion = paraparesis
Associated with inflammation of optic neuron & blindness ( Devic’s Disease)

40
Q

Stable angina

A

Clinical dx
Typical hx
Patient with risk fx.
Plaque but no rupture

41
Q

Unstable angina

A

Typical Hx
ECG change
No enzyme leak
Rupture of atheromatous plaque

42
Q

What are the important aspects/features on History, Signs and Investigations
which could lead to a diagnosis of Diabetic Nephropathy?

A

Foamy urine
Chronic Hyperglycemia
Chronic kidney dx features (HPT)
Nephrotic syndrome
rapid progressive albuminuria
Urine studies (Urine: Albumin: Creatinine ratio = ≥ 30mg/g)

43
Q

Kassmaul’s sign

A

Increase in JVP with inspiration
Constrictive pericarditis, Restrive cardiomyopathy, right HF, massive PE,

44
Q

Pulmonary embolism (ECG)

A

Sinus tachycardia
Rt Axis
RV strain
Tall R wave in V1
Inverted T waves in V1-V3
Incomplete RBBB
S1Q3T3 pattern (15% cases)

45
Q

Presenting features and clinical signs of Chronic Bilharzia Infection

A

Portal HPT, Intestinal polyposis, seizures, anemia, Cor pulmonale,

Liver disease
Bloody stool
Abdominal (RUQ) tenderness
Rash
Hepatosplenomegaly
Fever
Jaundice (prehepatic) signs

46
Q

What are the differences in presentation and clinical signs between Chronic
Bilharzia and Liver Cirrhosis?

A

Bilharzia (PRE-HEPATIC)= Portal HPT (Varices, Ascites, Splenomegaly)
Liver Cirrhosis (HEPATIC) = Chronic liver disease (5)

47
Q

Pericardial effusion (ecg) TB pericarditis

A

Small complexes
Pulsus alternans

48
Q

Pericardial Tamponade

A

Distended neck veins
Tachycardia
Drop in BP
Pulsus Paradoxis

49
Q

Irregularly irregular pulse

signs of an irregularly irregular pulse

A

A pulse with an irregular rhythm, completely irregular with no pattern.

Pulse deficit

50
Q

Radial-femoral delay

A

Radius pulse + Femoral pulse = delay
Young pt (HPT)
Coarctattion of aorta

51
Q

Corrigan’s sign

A

Radial pulse compressed until it disappears, lift 90° to body pulse returns but same pressure maintained in Radial artery.
Prominent carotid pulsations.

Aortic Incompetence/Regurge

52
Q

mechanism or techniques to obtain an accurate history other than Socrates

A

Open questions
Eye contact
Allow patient to tell story in their own words
Empathy
No judgement

53
Q

reasons HIV patients may default ARV treatment

A

Depression
Alcohol-substance abuse
Non-disclosure
Inadequate treatment literacy
Stockouts
Inaccessible clinics
High pill burden
Adverse effects
Frequent dosing

54
Q

Charcot’s joint

A

Deformed, disorganized joints due to loss of proprioception or pain (or both) this leads to recurrent unnoticed injury to joint.

55
Q

Diabetic AMYOTROPHY

A

DM pt = proximal neuropathy of lower limbs (weakness of hip flexors/adductors & knee extensors associated with inguinal and thigh pain.)
depressed deep tendon reflexes (quadriceps)
Uni/Bilateral
Onset abrupt/ more gradual (days to weeks)

56
Q

Guillain barre syndrome (clinical features)

A

Progressive ascending weakness
Areflexia
Paresthesis
Autonomic features
Resp. failure

57
Q

Prove that an effusion is due to TB

A

AFB’s on microscopy
Gene-Xpert
Culture positive
Predominantly lymphocytic effusion with raised ADA
Typical symptoms

58
Q

Type 1 Respiratory failure

A

Resp system cannot adequately provide O2 to body leading to hypoxemia.

59
Q

Type 2 Respiratory failure

A

Resp system cannot sufficiently remove CO2 from body leading to hypercapnia.

60
Q

Murmur

A

Timing
Area of greatest intensity
Radiation
Loudness
Pitch

61
Q

Transudates

A

Membrane intact
Incr. hydrostatic power
Decr. Oncotic
Decr. Concentration
HF, Renal Dx (nephro)
Decr. albumin
Prot: Serum prot <0.5
LDH:Serum LDH <0.6

62
Q

Subarachnoid haemorrhage

A

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Internal Medicine (11 decks)

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