Vol 1 Flashcards by Jack Wildman

What will a LAD blockage cause in terms of MI location?

Anterior/septal + lateral

How well did you know this?

Not at all

Perfectly

4 signs of MI visible on ECG?

T wave elevation (ischaemia)
ST elevation or change (infarct)
T wave inversion
Q wave change (infarct + non functional cells)

How well did you know this?

Not at all

Perfectly

What will a LCA blockage cause?

(Antero)Lateral MI

How well did you know this?

Not at all

Perfectly

Blockage of what artery causes a posteroinferior MI?

RAD

How well did you know this?

Not at all

Perfectly

What other conductive problem arises from RAD territory infarct?

Heart block due to av node infarct

How well did you know this?

Not at all

Perfectly

What is eplenerone?

Aldosterone antagonist (K+ sparing)

How well did you know this?

Not at all

Perfectly

What are the criteria for CURB65?

Confusion (7mmol/L)
Respiratory rate (>30/min)
BP (<90/60)
Over 65 age

How well did you know this?

Not at all

Perfectly

What ratio defines an obstructive deficit on spirometry?

FEV1/FVC <0.7 (70%)

How well did you know this?

Not at all

Perfectly

Bands of FEV1 % of expected when defining severity of obstructive airway disease?

50-80% = mild
30-50% = moderate
< 0.7

How well did you know this?

Not at all

Perfectly

Discuss medullary thyroid cancer

Has family link
Spreads faster than the well-differentiated types, requires removal of local lymph nodes and thyroid gland
‘Middle ground’ for survival

How well did you know this?

Not at all

Perfectly

4 stages of shock?

Initial (lactate production due to underperfusion and anaerobic metabolism)
Compensatory (tachycardia, tachypnoea and reduced urine output)
Progressive (failure of compensatory mechanisms)
Refractory (irreversible -> death)

How well did you know this?

Not at all

Perfectly

5 types of shock?

Hypovolaemic
Distributive (incl anaphylaxis, burns etc.)
Obstructive (tension pneumo, tamponade)
Cardiogenic
Dissociative (cyanide poisoning)

How well did you know this?

Not at all

Perfectly

4 criteria for SIRS?

Temp (>38 or 90)

RR (>20) or PaCO2 (12000 or <4000)

How well did you know this?

Not at all

Perfectly

Discuss basal cell carcinomas BCC

Most common skin cancer
Pearly papules with telangiectasia, raised edge/eroded centre (?rodent ulcer)
Most commonly head or neck
Excision (Mohs micrographic) or radio/cryotherapy, cautery

How well did you know this?

Not at all

Perfectly

Discuss squamous cell carcinomas SCC

Risk increased massively by xeroderma pigmentosa (NER dysfunction) - big sunlight exposure link
Scaly, crusty kereatotic mess
Ill defined nodule, often painful, firm
Can ulcerate
Needs excision/Mohs

How well did you know this?

Not at all

Perfectly

How to tell the difference between gastric and duodenal ulcers?

Gastric tend to be more painful and are NOT relieved by food - pain a couple of hours after
Duodenal ulcers are relieved by eating, may get melena -> pain comes 3 or 4 hours later

How well did you know this?

Not at all

Perfectly

How to manage SAH?

Nimodipine (Ca blocker to prevent vasospasm)
Anti-epileptics e.g. Phenytoin if seizing
ABCDE resus + support BP
Ultimately endovascular coil/clip

How well did you know this?

Not at all

Perfectly

3 causes of a macrocytic anaemia?

B12/folate deficiency
Alcohol
Reticulocytosis (due to haemolysis)

How well did you know this?

Not at all

Perfectly

When analysing urine, what to comment on pH?

Usually slightly acidic
If alkaline, could be infection (UTI)
If very acidic, could be renal calculi or uric acid

How well did you know this?

Not at all

Perfectly

Presence of glucose in urine can indicate what?

Pregnancy

How well did you know this?

Not at all

Perfectly

What is the mainstay of secondary urine investigation for UTI?

Microscopy, culture and sensitivities (MCS)

How well did you know this?

Not at all

Perfectly

What can a raised specific gravity in urine indicate?

Low blood volume ->

Dehydration, heart or liver failure, SIADH

How well did you know this?

Not at all

Perfectly

What can a lowered specific gravity of urine indicate?

Diabetes insipidus, increased fluid intake

What are the diagnostic criteria for toxic megacolon?

Signs of large bowel dilatation (>6cm) and mucosal oedema
And 3 of the following:
-fever
-tachycardia
-leukocytosis
-anaemia

What can hyperexpansion indicate and how can yo visualise it on CXR?

>7 anterior ribs on inspiration, flattened diaphragm | Obstructive lung disease

What is lantus/glargine?

Long acting insulin

What is Novorapid and how long does it take to work/last for?

15mins -> 3hrs

What is novomix30?

30% short acting insulin | 70% intermediate acting insulin

2 things ketones in urine can indicate?

Starvation | DKA

3 drugs that can mimic haematuria?

Rifampicin Phenytoin Sulfonamides

What specifically do nitrites present in urine indicate?

Gram negative bacterial infection

Discuss malignant melanoma

Worst skin cancer | Most common on back or trunk in men, legs in women

ABCDES for malignant melanoma?

``` Asymmetry Border irregular Colours multipigmented Diameter increased Evolution (change) Symptoms - bleed, itch ```

How to calculate units of alcohol?

Volume in mls x ABV (%) ---------------------------- = units 1000

What is a normal ABPI?

0.9-1.3 (ankle shouldn't be significantly different to brachial)

What does an ABPI of >1.3 signify?

Significant PVD - abnormally hard (calcified) arteries

What type of ulcers does a higher ABPI suggest?

Venous ulcers

What should be given for venous ulcer management?

Full compression bandages

What does a ABPI of 0.5-0.9 suggest?

Moderate arterial disease - modify risk factors and specialist referral Mixed ulcers - reduced compression bandages

What does ABPI of <0.5 suggest?

Severe arterial disease - urgent specialist referral

What pains are people likely to experience with a ABPI of 0.5-0.9 and then <0.5?

Intermittent claudication | Rest pain

What pattern will a restricted flow-volume curve show?

Normal shape but absolute reduction in volume

What pattern will an obstructive flow-volume curve show?

Concave decline in the curve and reduced volume (PEFR)

What is Budd-Chiari syndrome?

``` Hepatic vein thrombosis causing: Painful hepatomegaly Portal hypertension Ascites Can be caused by polycythaemia Vera, COCP use ```

What are the transaminases (ALT/AST) useful for?

Markers of liver necrosis ALT is more liver specific, AST is a mitochondrial enzyme and hence raised markedly in alcoholic liver disease GGT is also markedly raised in ALD

What enzymes are most markedly raised in alcoholic liver disease?

GGT + AST

What does a rise in AP need to be associated with to suggest liver pathology, and what does an isolated rise suggest?

Should be associated w/GGT | Isolated = non-liver pathology (also produced by placenta)

What is frank haematochezia and what does it suggest?

Frank blood in stool More commonly diverticulae, angiodysplasia, haemorrhoids Bowel cancer

Which IBD is more likely to feature bloody stools?

5 common causes of bowel obstruction and 2CCs?

``` Adhesions Herniae (particularly indirect inguinal) Intussusception Volvulus Gallstone ileus (meconium for CF) + colorectal cancer, crohns ```

What is Whipple's Disease?

A male dominant, systemic disease causing jejunal/ileal vilous blunting and therefore fat malabsorption Causes fever, diarrhoea/steatorrhoea, arthralgias, grey-brown skin, lymphadenopathy

What cures Whipple's Disease?

Antibiotics - trophyeryma whippelii

What does solid-only dysphagia suggest?

Obstruction - esophageal cancer (?SCC), neck or thyroid lumps, GORD, Plummer-Vinson syndrome

What does solid/liquid dysphagia suggest?

Motor dysfunction - stroke, achalasia, PSS/scleroderma (CREST)

2 shockable rhythms and voltage?

VF and pulseless VT | 150J