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Junior IM Posting > Week 1 > Flashcards

Week 1 Flashcards

1
Q

myocardial ischaemia is classically felt in the ___________ radiating to the _______

Pain from a hollow organ is classically __________ (such as biliary or renal colic).

A

centre of the chest

left arm

colicky

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2
Q

The pain of a subarachnoid haemorrhage is classically very ____________, ‘like a __________ to the head’.

A

sudden

hammer blow

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3
Q

peptic ulcer pain is classically worse when _______ and better ___________ ).

A

hungry

after food

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4
Q

a headache accompanied by ______________ suggests migraine

A

preceding flashing lights

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5
Q

The UK Government now recommends that to minimize alcohol-related health effects, both men and women should keep to less than ________ of alcohol per week.

A

14 units

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6
Q

The units of alcohol can be determined by __________________ by its _________________ and ______________.

A

multiplying the volume of the drink (in ml)

% alcohol by volume (abv)

dividing this by 1000

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7
Q

The CAGE assessment for alcohol dependency
■ C – Have you ever felt the need to ___________________ ?
■ A – Have you ever felt ___________________?
■ G – Do you ever feel ___________________ ?
■ E – Do you ever drink in the ___________________?

—————— positive answers could indicate a problem of dependency.

A

Cut down your alcohol consumption

Angry at others criticizing your drinking

Guilty about excess drinking

mornings (Eye-opener)

Two or more

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8
Q

Pneumaturia: almost always due to a _____________

Fortification spectra: if associated with ___________, strongly suggests classical migraine

A

colovesical fistula

unilateral headache

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9
Q

Rigors: strongly suggests _________,_______, or __________

A bitten tongue: if associated with a seizure, strongly suggests a __________

A

bacteraemia, viraemia or malaria

grand mal fit

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10
Q

The examination should be conducted in a warm, private, quiet area. Daylight is preferable to artificial light, which may make the recognition of —————————————— difficult

A

subtle changes in skin colour (e.g. mild jaundice)

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11
Q

For most patients, start the examination on the right of the bed/couch with the patient __________ (approximately ______).

A

semi- recumbent

45°

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12
Q

Patients with left heart failure typically find that lying ___________ worsens their sense of ___________(______)

A

horizontally

breathlessness (orthopnoea

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13
Q

A persistent fever is one that ___________________________________

; a remittent fever ______________________ ; and an intermittent or spiking fever is present for only ___________ at a time before returning to normal. None has great sensitivity or specificity for any particular diagnosis, but changes may provide useful information about the course of a disease.

A

does not fluctuate by more than 1°C during 24 hours

oscillates by 2°C during the course of a day

several hours

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14
Q

fine tremor of _______ or recent _____________ therapy

rhythmical ‘pill rolling’ tremor of ____________

coarse jerky tremor of ___________ or __________

intention tremor of _______________.

A

thyro- toxicosis; beta-adrenergic

Parkinsonism

hepatic or uraemic failure

cerebellar disease

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15
Q

Feel for Dupuytren’s contracture in both hands, the first sign of which is usually a ___________ of tissue over the _________ of the __________ at the level of the ____________.

A

thickening

flexor tendon

ring finger

distal palmar crease.

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16
Q

____________ angle refers to the angulation between the nail plate and the skin below the nail, when viewed laterally.

A

Lovibond’s

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17
Q

Lovibond’s angle refers to the angulation between the _________ and ___________, when viewed laterally.

A

nail plate and the skin below the nail

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18
Q

Lovibond’s angle

Normally it is ______________. When clubbing is present, the angle is at least _______________________

A

less than 180°

180°, or more.

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19
Q

Raynaud’s syndrome, in which __________ of the __________ causes the fingers to become __________ and __________, followed by __________ __________ and then __________ due to __________ and __________

A

vasospasm; digital arterioles

white and numb

blue/purple cyanosis

redness; arteriolar dilatation

reactive hyperaemia

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20
Q

In koilonychia the nails are (soft or hard?), (thin or thick?) and _______ and the normal _______ity replaced by a _________-shaped _______ity .

It is a rare feature of longstanding ____________.

A

soft, thin and brittle

convex ; spoon

concav; iron-deficiency

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21
Q

Leuconychia ( __________ nails) may occur in _________ disease and other conditions associated with __________ , but are not particularly useful for making a clinical diagnosis of chronic liver disease.

A

opaque white

chronic liver

hypoalbuminaemia

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22
Q

The odour of diabetic ketoacidosis resembles __________

The odour of hepatic failure and uraemia have been described as ‘ __________ ’ or ‘ ________’, respectively, but such terms are rather subjec- tive and their use is limited.

Halitosis (bad breath) is common in patients with __________ diseases and those with gingivitis due to poor dental hygiene.

A

acetone

ammonia-like; mousy

suppurative lung

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23
Q

Causes of secondary HT???

A

Alcohol
Obesity
Pregnancy
RENAL
Endocrine
• - NEUROGENIC
Vascular
Aortic coarctation

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24
Q

Systemic hypertension is defined as persistently elevated systolic and diastolic blood pressure above _________ mmHg

A

140/90

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25
Q

Hypertension can only be diagnosed when elevated BP levels are measured on ______________ occasions

A

Two different

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26
Q

Optimal BP =
Normal BP=
High normal BP=

A

<120/80

120-129/80-84

130-139/85-89

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27
Q

You can rule out white coat hypertension by using _______ and ________ BP readings

A

Home

Ambulatory

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28
Q

Target organ damages in hypertension

BLOOD VESSELS:

_________ of the arterial wall

Widespread _________ ,causing _____,____, etc, especially if there’s a positive history of smoking, DM, or Hyperlipidemia

Aortic _________ and aortic __________

A

Thickening

Atheroma; CAD;CVD

Aneurysm; dissection

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29
Q

Target organ damages in hypertension

CNS:

________,________ atheroma, ________,________

A

Stroke; carotid; transient ischemic attack; subarachnoid Haemorrhage; hypertensive encephalopathy

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30
Q

hypertensive encephalopathy = _______+ _________ such as _____,____,______

A

High BP
Neurological symptoms

Speech and vision disturbance

Paresthesia

Papilloedema

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31
Q

Target organ damages in hypertension

RETINA:

GRADE1: arterial walls are ________, and ________ and there’s ______ phenomenon

Grade 2:grade 1+ _________

Grade 3: grade 2+ ___________

Grade 4: grade 3+ ____________

A

Thickening ; tortuous; silver wiring

Arteriovenous nipping

Evidence of retina ischemia

Papilloedema

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32
Q

silver wiring : increased __________ of the retinal vessels

Evidence of retina ischemia : eg _______ Haemorrhage and ________ exudates

A

Reflectiveness

Flame /blot

Cotton wool/soft

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33
Q

What grades of hypertensive Retinopathy are diagnostic of malignant hypertension

A

3 and 4

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34
Q

Target organ damages in hypertension

HEART:

________
__________
_____________

A

Coronary artery disease
Left ventricular hypertrophy
Atrial fibrillation
Heart failure

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35
Q

Target organ damages in hypertension

KIDNEY:

_________,__________

A

Proteinemia

Progressive renal failure

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36
Q

Malignant hypertension

A (common or rare?) complication of hypertension characterized by ________ and rapidly progressive ___________

A

Rare; raised BP

End organ damage

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37
Q

Pulsating abdominal mass= ???

A

Aortic aneurysm

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38
Q

Chest pain on exertion suggests ______________

A

angina pectoris

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39
Q

Severe prolonged cardiac chest pain may be due to ____________ or to __________ – known collectively as ______________

A

acute myocardial infarction

unstable angina

acute coronary syndrome.

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40
Q

Acute coronary syndrome is suggested by a previous history of ___________ but an episode of __________________________ can also be the first presentation of coronary artery disease.

A

stable angina

acute severe chest pain at rest

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41
Q

The term ‘syncope’ refers to _______________ due to _______________.

A

loss of consciousness

reduced cerebral perfusion

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42
Q

Cardiac arrest describes the sudden and complete _____________ due to ______, ventricular ___________ or ventricular ___________

A

loss of cardiac output

asystole; tachycardia

fibrillation

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43
Q

Acute coronary syndrome includes ———-,———,————

A

Unstable angina
NSTEMI
STEMI

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44
Q

Polyuria + cardiac arres

This is usually a symptom of ???

A

Supraventricular tachycardia

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45
Q

Additional heart sounds and murmurs demonstrate a consistent relationship to the ____________, whereas extracardiac sounds, such as a pleural rub or venous hum, do not.

A

cardiac cycle

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46
Q

Pathological sounds and murmurs are the product of _________ or _________ due to abnormal loading conditions.

A

turbulent blood flow

rapid ventricular filling

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47
Q

Some added heart sounds are physiological but may also occur in pathological conditions; for example, a third sound is common in ______ people and in _________ but is also a feature of __________.

A

young; pregnancy

Heart failure

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48
Q

Similarly, a systolic murmur due to turbulence across the right ventricular outflow tract may occur in hyperdynamic states such as _______ or __________, but may also be due to pulmonary stenosis or an intracardial heart lead

A

anaemia or pregnancy

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49
Q

Heart sounds: Timing

First heart sound : ________
Second heart sound : ___________
Third heart sound: __________
Fourth heart sound: ___________

A

Onset of systole
End of systole
Early in diastole, just after S2
End of diastole, just before S1

50
Q

Heart sounds: Mechanisms

First heart sound : ________
Second heart sound : ___________
Third heart sound: __________
Fourth heart sound: ___________

A

Closure of mitral and tricuspid valves

Closure of aortic and pulmonary valves

From ventricular wall due to rapid cessation of filling

From ventricular origin related to atrial filling

51
Q

Features of a benign or innocent heart murmur

(Soft or hard?)
Occurs at __________
No __________
No __________

A

Soft
Mid-systole
Radiation
Other cardiac abnormalities

52
Q

Heart failure describes the clinical syndrome that develops when the heart cannot ___________, or can do so only at the expense of __________________.

A

maintain adequate output

elevated ventricular filling pressure

53
Q

In mild to moderate forms of heart failure, symptoms occur only when the ___________________ increases during _______ or some other form of ________.

A

metabolic demand

exercise

stress

54
Q

______________ is the commonest cause of angina and acute coronary syndrome and the leading cause of death worldwide.

A

Coronary artery disease (CAD)

55
Q

Stable angina : ________ due to ___________ of one or more coronary arteries

A

Ischaemia ; fixed atheromatous stenosis

56
Q

Unstable angina: _________ caused by _______ complete or partial _______ of a coronary artery due to ________ or ______ with superimposed ___________

A

Ischaemia ; dynamic

obstruction ; plaque rupture

erosion ;thrombosis

57
Q

Myocardial infarction (type 1): ________ caused by _________ of a coronary artery due to plaque rupture or erosion with superimposed thrombosis

Myocardial infarction (type 2): ______________ where blood flow cannot meet the needs of the myocardium.

A

Myocardial necrosis; acute occlusion

Supply demand imbalance

58
Q

Heart failure: ____________ due to ________ or _______

A

Myocardial dysfunction

infarction or ischaemia

59
Q

Arrhythmia : __________ due to ischaemia or infarction

A

Altered conduction

60
Q

Sudden death

Can be caused by : Ventricular __________ , _________ or ____________

A

arrhythmia

asystole

massive myocardial infarction

61
Q

________ is the most impor- tant modiable risk factor for CAD

A

Smoking

62
Q

Diabetes mellitus
This is a potent risk factor for all forms of atherosclerosis, especially type ______ diabetes mellitus.

A

2

63
Q

Classification of angina pectoris and chestpain

Three characteristic features of angina
1. Constricting discomfort in the _________, or in the ______, ________, _______ or _______
2. Precipitated by _______________
3. Relieved by _______ (or GTN) within _________

A

centre of the chest

neck; shoulders

jaw or arms

physical exertion

rest; 5 minutes

64
Q

coronary artery spasm may rarely occur as an isolated phenomenon in patients with normal coronary arteries on angiography. This is sometimes known as ________ angina; when it is accompanied by ___________ on the ECG, it is termed _______ angina.

A

variant

transient ST elevation

Prinzmetal’s

65
Q

Some patients find the discomfort comes when they start walking and that later it does not return despite greater effort (‘ _______ angina’).

A

warm-up

66
Q

The term acute myocardial infarction (MI) should be used when there is ______________ with clinical evidence of __________________ and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th centile upper reference li

A

acute myocardial injury

acute myocardial ischaemia

67
Q

For the diagnosis of type 2 MI, there needs to be clinical evidence of ischaemia, such as __________ or __________ .

A

ECG changes or symptoms of chest pain

68
Q

Buerger’s disease or __________________ is an inflammatory disease of the arteries that is distinct from atherosclerosis and usually presents in (young or old?) ( ________ years) _______________.

A

thromboangiitis obliterans

Young 20–30 years male smokers

69
Q

Buerger’s disease

_______ and _______ pulses are absent but _______ and ______ pulses are present.

It may also affect the veins, giving rise to superficial ___________. It often remits if the patient stops smoking.

A

Wrist and ankle

brachial and popliteal

thrombophlebitis

70
Q

Buerger’s disease

____________ is the most frequent outcome if patients continue to smoke.

A

Major limb amputation

71
Q

Raynaud’s syndrome
This common disorder affects 5%–10% of ___________ aged ______ years in temperate climates. It does not progress to ________ or ________, and _________ is unusual.

A

young women; 15–30

ulceration or infarction

significant pain

72
Q

Raynaud’s syndrome

The patient should be reassured and advised to avoid __________. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are trou- blesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective tissue disease.

A

exposure to cold

73
Q

a BP check is advisable every _______ in adults over 40 years of age to pick up occult hypertension.

A

5 years

74
Q

Signs in hypertension

radio-femoral delay can be found in patients with ________________

enlarged kidneys in patients with ____________ disease

A

coarctation of the aorta

polycystic kidney

75
Q

Dilated Cardiomyopathy is characterised by ________ and impaired ________ of the LV and often the RV.

A

dilatation; contraction

76
Q

In DCM

Left ventricular _____ is increased but ___________ is normal or reduced .

A

mass; wall thickness

77
Q

In DCM

__________ may be an important cause in some patients.

At least 25% of cases are inherited as an ______________ trait and a variety of single-gene mutations have been identified

A

Alcohol; autosomal dominant

78
Q

Spondylosis

A general term for _____-related __________ of the _______

A

age

wear and tear

spinal discs

79
Q

Brachial plexus

It begins in the _____________, passes through the _______, and runs through the entire ____________.

A

root of the neck

axilla

upper extremity

80
Q

The brachial plexus is formed by the anterior rami (divisions) of cervical spinal nerves _______________ and the ___________

A

C5, C6, C7 and C8,

first thoracic spinal nerve, T1.

81
Q

The brachial plexus is divided into five parts; ______,________,________,_______, and _________

A

roots, trunks, divisions, cords and branches

82
Q

Branches of brachial plexus

________ Nerve
___________ nerve
________ nerve
________ Ulnar
________ nerve

A

Musculocutaneous

Axillary

Radial

Median

Ulnar

83
Q

When dissecting the upper limb, it can be difficult to recognise what part of the brachial plexus you are at – it can just look like a mass of nerves.

The important structure to look for is an ‘ ____ ’ shape. This is formed by the _________,________, and _______ nerves, usually superficial to the axillary artery.

This shape is usually consistent between cadavers. It can help you get your bearings, and you can work backwards to identify the cords, divisions and branches

A

M

musculocutaneous, median, and ulnar

84
Q

Erb’s palsy refers to an injury to the ___________ of the brachial plexus (typically ______). It most commonly occurs as a result of a ______ injury during a difficult __________-.

A

upper roots; C5-6

stretching

vaginal delivery.

85
Q

Klumpke’s palsy is an injury of the ________ of the brachial plexus (_______). It is also most commonly associated with a ____________ but has a much (lower or higher?) incidence than Erb’s palsy.

A

lower roots

C8-T1

difficult vaginal delivery

Lower

86
Q

In the neck, the internal jugular vein descends within the ___________ , (superficial or deep?) to the ___________ and (medial or lateral?) to the common carotid artery.

At the base of the neck, posteriorly to the ___________________ , the IJV combines with the ________ to form the _________ vein.

A

carotid sheath; deep

sternocleidomastoid muscle

lateral

sternal end of the clavicle

subclavian vein; brachiocephalic

87
Q

The external jugular vein courses (superficial or deep?) to and obliquely across the _____________ in the ______ fascia. Part of its descent in the neck is also along the ________ border of the sternocleidomastoid muscle in its lower third.

A

superficial

sternocleidomastoid muscle

Superficial

posterior

88
Q

The external jugular vein most commonly drains into the __________ vein near the _______ third of the _______.

A

subclavian

middle

clavicle

89
Q

Kussmaul’s sign is a paradoxical ___________________ on inspiration, or a failure in the appropriate _________ with inspiration. It can be seen in some forms of heart disease and is usually indicative of __________________________ due to _________

A

rise in jugular venous pressure (JVP)

fall of the JVP

limited right ventricular filling

right heart dysfunction.

90
Q

Most women experience menopause between the ages of ______ and ______ years as a natural part of biological ageing.

A

45 and 55

91
Q

CRANIAL NERVES

____________ nerve (CN I)
____________ nerve (CN II)
____________ nerve (CN III)
____________ nerve (CN IV)
____________ nerve (CN V)
____________ nerve (CN VI)
____________ nerve (CN VII)
____________ nerve (CN VIII)
____________ nerve (CN IX)
____________ nerve (CN X)
____________ nerve (CN XI)
____________ nerve (CN XII).

A

Olfactory nerve (CN I)
optic nerve (CN II)
oculomotor nerve (CN III)
trochlear nerve (CN IV)
trigeminal nerve (CN V)
abducens nerve (CN VI)
facial nerve (CN VII)
vestibulocochlear nerve (CN VIII)
glossopharyngeal nerve (CN IX)
vagus nerve (CN X)
accessory nerve (CN XI)
hypoglossal nerve (CN XII).

92
Q

Locomotor brachii is a prominent __________ of ——————- usually seen in patients with severe _________________ and elderly patients with ______________

A

pulsation of tortuous brachial artery

aortic regurgitation

arteriosclerosis

93
Q

How to different between pulsation from the jugular vein and pulsation from the carotid artery

A

IJV’s is more of a wave like motion

Palpate the right subcoastal region deeply, If the pulsation gets more prominent, then it’s IJV

94
Q

Echocardiography, also known as ________________, is the use of ultrasound to examine the heart, ____________. It is a type of medical imaging, using __________ or ___________ .

A

cardiac ultrasound

Non-invasively

95
Q

An echocardiogram can also give physicians other estimates of heart function, such as a calculation of the _________,________, and _______

A

cardiac output, ejection fraction, and diastolic function

96
Q

Uses of echocardiogram

_________ of Heart Conditions:
______________ of Heart Function:
____________________
Detection of _______________
It has. _________ , as well as ________ value

A

Diagnosis

Assessment

Monitoring Treatment Effectiveness

Blood Flow Irregularities
Prognostic; therapeutic

97
Q

The Mercedes-Benz sign can be seen in aortic __________ on ______ 1. It is seen as _______________ that have a ________ configuration similar to the Mercedes-Benz logo

A

dissection ; CT

three distinct intimal flaps

triradiate

98
Q

Reverse mercedenz Benz sign

Two of the three lumens outlined by these intimal flaps belong to the ________________

A

false lumen of aortic dissection.

99
Q

Tissue Doppler echocardiography (TDE) is a medical ultrasound technology, specifically a form of echocardiography that measures the _________________ through the phases of one or more heartbeats by the Doppler effect ( _____________ ) of the reflected ultrasound.

A

velocity of the heart muscle (myocardium)

frequency shift

100
Q

Doppler echocardiography

It is based on the Doppler principle that _______________________ from moving objects, such as _________, undergo a _____________.

A

sound waves reflected

red blood cells

frequency shift

101
Q

The aorta can be divided into four sections:???

A

the ascending aorta, the aortic arch, the thoracic (descending) aorta and the abdominal aorta.

102
Q

Aorta terminates at the level of _____ by bifurcating into the _______________________ arteries.

A

L4

left and right common iliac

103
Q

Ascending Aorta: Branches

They give rise to the ____________________ arteries

A

left and right coronary

104
Q

There are three major branches arising from the aortic arch. Proximal to distal:

List them

A

Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

105
Q

Coarctation of the aorta refers to _________ of the vessel, usually at the ___________________ (former ___________). It is a congenital condition.

A

narrowing

insertion of the ligamentum arteriosum

ductus arteriosus

106
Q

Coarctation of aorta

The narrow vessel has an increased ————-1 to blood flow, which increases the _______ for the left ventricle – leading to _______________

A

resistance

after-load

left ventricular hypertrophy.

107
Q

Branches of thoracic aorta

In descending order:

List them!

A

Bronchial arteries
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phrenic arteries
Intercostal and subcostal arteries:

108
Q

Aortic dissection

A ——— in the __________ of the aorta

It’s most common in (men or women?) in their ______ and ______

A

tear; inner layer

Men; 60s and 70s.

109
Q

ABCDE of chest X-ray features of heart failure ??

A
B
C
D
E

A

Alveolar edema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusion

110
Q

Kerley B lines are ???

A

Interstitial edema

111
Q

Causes of heart failure?

List 8

A

High blood pressure
Valvular diseases
Cardiomyopathy
Congenital heart disease
Arrythmia
Diabetes
Coronary heart disease
Alcohol
Obesity

112
Q

Precipitants of heart failure

List 8

A

Infections
Anaemia
Unaccustomed exercise
Electrolyte derangement
Endocrine dysfunction
Poor medical adherence
Renal failure
MI

113
Q

Peripartum cardiomyopathy is a rare disorder in which a pregnant woman’s heart becomes _________ and ________ .

It develops during the _______________, or within __________________________.

A

weakened and enlarged

last month of pregnancy

5 months after the baby is born

114
Q

Gallop rhythm is a mechanical event associated with a relatively _____ rate of _____________ and characterized by a ventricular ______ and a __________ sound

A

rapid

ventricular filling

bulge; low-frequency

115
Q

A _________ rhythm in diastole is called a gallop and results from the presence of a ____________[__.

A

triple

S3, S4 or both

116
Q

Gallop rhythm

Both sounds are _____ frequency and thus best heard with the _____ of the stethoscope.

A

Low

bell

117
Q

A gallop rhythm contains another sound, called S3 or S4, dependent upon where in the cycle this added sound comes. It can also contain _______________ forming a ________ gallop, and in situations of very fast heart rate can produce a summation gallop where __________________.

A

both of these sounds ; quadruple

S3 and S4 occur so close as to be indistinguishable

118
Q

Known as the “four pillars” of heart failure therapy, these medications are ____________,____________________ , ___________________ and __________________.

A

beta blockers

angiotensin receptor-neprilysin inhibitors (ARNIs)

mineralcorticoid receptor antagonists (MRAs)

sodium-glucose co-transporter 2 Inhibitors (SGLT2i)

119
Q

Heart failure based on ejection fraction
??

A

Preserved: 50% and above of the ejection fraction

Mildly reduced: 40-40%

Reduced: less than 40%

120
Q

Symptoms of left sided heart failure

Mention 7

A

Dyspnea
Orthopnea
Cough
Cyanosis
Fatigue
Tachycardia
Paroxysmal nocturnal dyspnea

121
Q

Symptoms of right sided heart failure

List 7

A

Ascites
Pedal edema
Hepatomegaly
Distended jugular veins
Splenomegaly
Wright gain
Anorexia and GI distress

Junior IM Posting (20 decks)

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