wrong Qs 2.0 Flashcards
what heart murmur is corrigans sign associated with?
aortic regurgitation - heard best upright leaning forward
corrigans sign = collapsing pulse, visible carotid pulsation
what cardiovascular problem can syphilis cause?
arterial aneurysm - ascending/arch of aorta common
complication of AAA surgery
trash foot
surgeries - laparotomy / endovascular repair (EVAR, less invasive)
prolong QT interval is a feature of what
hypocalcaemia
what can conns syndrome cause?
secondary hypertension
conns syndrome = hyperaldosteronism
IVC filter
for recurrent PEs
respiratory cause of AF
pneumonia
pathophysio of exercise in intermittent claudication
exercise encourages collateral artery development
critical limb ischaemia
rest pain for 2 weeks
ankle pressire <50 mmHG
amputation may be required to prevent gangrene spread
3rd heart sound characteristics
after S2 in early diastole
a sign of heart failure
what time of day is peripheral vascular rest pain worse?
@ night
what effect does constrictive pericarditis have on JVP?
raised JVP
murmur in ventricular septal defect
pan-systolic murmur
JVP in complete heart block
cannon waves
JVP paradoxically rising on inspiration
constrictive pericarditis
Kussmaul’s sign - impaired RV filling
risk factors of ischaemic HD
decreases HDL
hypothyroidism
major cause of cardiomyopathy
alcohol
a cause of high output heart failure
thyrotoxicosis
complications of MI
LV aneurysm (late) cardiogenic shock - rupture of heart septum or papillary muscles oedema - heart failure AF pericarditis (dresslers)
hyper resonant percussion note + decreased expansion
pneumothorax
young patient, ST elevation in all leads (concave), radiates to neck + arm
acute pericarditis - angina/MI vibes but NOT !!
** relieved by sitting forward **
ECG of someone on digoxin
concave ST depression in ALL leads with T wave inversion
radio-femoral delay
coarctation of aorta
myxoma
tumour of primitive tissue in heart atrium
“plop” sound early diastole
haphazard electrical activity, no recognizable complexes + no coordination
ventricular fibrillation
drugs that can cause gynaecomastia
spironolactone
digoxin
cimetidine - H2 blocker (stomach acid)
liver cirrhosis
atrial septal defect on auscultation
wide fixed splitting of S2
normal = split on inspiration, single on expiration
FIXED splitting = when respiration makes no difference to the interval between aortic + pulmonary components of S2
difference between osler nodes + janeway lesions
both signs of infective endocarditis
osler - tips of fingers/toes + painful/tender
janeway - palms/soles + NON-tender
what are roth spots
retinal haemorrhages - sign of infective endocarditis
which cardiac drug can cause pulmonary fibrosis + liver cirrhosis as a side effect
amiodarone
most common cause of ejection systolic murmur + S4 in U30s
hypertrophic cardiomyopathy
cheyne-strokes
alternating hyper/hypoventilation
–> sign of severe heart failure
side effect of adenosine
hyper/hypothyroidism
–> weight loss, tremor, weakness, palpitations, heat intolerance
test for orthostatic syncope
tilt table testing
“fainting after standing behind fish counter for 2hrs” lol
diagnosis of paroxysmal SVT
holter monitoring - 24hr ECG
signs of HOCM
jerky pulse
double apical impulse
S3 + S4
late systolic murmur
drug that can cause gout
bendroflumethiazide > thiazide diuretic > hyperuricaemia
gout symptoms -
sudden severe pain in a joint – usually your big toe, but it can be in other joints in your feet, hands, wrists, elbows or knees
hot, swollen, red skin over the affected joint
angina investigation for patient who can’t exercise (non-invasive cardiac evaluation)
thallium scanning
stress echo - dobutamine used to stimulate heart + US used to look for wall motion abnormalities
non-metastatic extrapulmonary manifestation of bronchial carcinoma
cushings syndrome
–> due to ectopic adrenocorticotrophic hormone (ACTH) secretion
kartangeners syndrome
ciliary dysfunction (autosomal recessive)
causes bronchiectasis, situs inversus, chronic sinusitis,
reduced chest wall movement + increased vocal resonance
lung consolidation
ECG + respiratory failure type in PE
type 1 resp failure
ECG - RBBB
meningioma
benign
liver failure cause trans or exudative pleural effusion
transudative
–> hypoalbuminaemia - decrease in hydrostatic pressure
a cause of hypertrophic pulmonary osteoarthropathy
bronchial carcinoma - NSCLC
common causes of clubbing
bronchiectasis, empyema, bronchial carcinoma, mesothelioma, pulmonary fibrosis
if u say COPD ur a gimp
goodpastures syndrome
vasculitic disorder featuring proliferative glomerulonephritis + pulmonary haemorrhage
–>autoimmune
causes haemoptysis
anti-GBM antibodies are characteristic
pneumonia after influenza
staph aureus
smoker, 6 month gradual SOB, CXR = hyperexpanded lung fields + no focal lesions
COPD
rusty sputum
pneumococcal / strep pneumoniae
terbutaline
SABA
fluticasone
ICS - beclometasone
impotent + buttock claudication
peripheral vascular disease
23 y/o, SOB, just returned from africa, o2 sats 92%, CXR normal
PE from long haul - CTPA
68 y/o, pancreatic cancer, 5hr history of haemoptysis + SOB, 92 o2 sats, high RR, CXR = small triangular area of increased density in right lung field
PE
wedged shaped lesion = infarct
COPD patients, bone fractures/issues due to medication
steroids - prednisolone
dry mouth caused by inhaler
ipratropium bromide - blocks parasympathetic bodily functions such as salivation (LAMA)
bronchial carcinoma, swollen face, dilated veins over thorax
SVC obstruction - complication of lung cancer
lethargy, constipation, abdo pain, nocturia, low mood, doesnt enjoy activities she once did, what type of cancer?
squamous - ectopic parathyroid hormone related peptide (PTHrP) causing hypercalcaemia
bronchial carcinoma, drooping eyelids, after repeated attempts to open eyes fully, droopiness disappears
eaton-lambert syndrome - small cell
characteristically weakness improves with repeated activity
suspected PE, CT pulmonary angiogram requested, what is the most important consideration before the test can go ahead?
normal renal function
name of proteins which catalyse phosphorylation reactions
kinases
gram positive rods
c diff
bacillus cereus
glossitis
smooth red sore tongue
caused by iron, folate or b12 deficiency
treatment of mallory-weiss tear
usually heals spontaneously
symptoms of cholera gastroenteritis
watery diarrhoea - rice water
what kind of diet can cause diverticular disease
low fibre
small intestine valvulae conniventes on AXR
cross entire lumen
risk factors for squamous cell carcinoma
achlasia
alcohol
coeliac disease
painless jaundice, palpable mass in RUQ, weight loss, dark urine + pale stools
carcinoma of head of pancreas
acute bloody diarrhoea in children
medical emergency
A 43-year-old businessman presents to his general practitioner with fever, headache, and diarrhoea. He has not had any coughs, nausea, or vomiting. He is normally fit and well. The only history of note is that he returned from a business trip in India 3 weeks ago. He has been eating and drinking the same things as his family since his return, and they are all well. On examination, the man appears dehydrated and has right upper quadrant tenderness.
What is the most likely diagnosis?
hep A
Hepatitis A has an incubation period of 2-4 weeks, meaning that patients in the UK often present after returning home from travelling to at-risk countries
Traveller’s diarrhoea is when there are at least 3 episodes of diarrhoea in a 24 hour period, either during or shortly after foreign travel. 3 weeks after travel is too late.
18 y/o, 1 week history of lethargy, headaches, painful sore throat, not travelled abroad
no rash until GP gave antibiotics
sore abdomen when examined over liver, spleen + lymphadenopathy, yellow eyes
most appropriate test to perform?
monospot test
diagnosis = infectious mononucleosis (glandular fever, epstein-barr virus)
12 y/o, decreased pigmentation of skin + eyes, history of severe bacterial + viral infections + bleeding abnormalities
Chediak-Higashi (auto recessive)
–> decreased phagocytosis resulting in pyogenic infection, partial albinism + peripheral neuropathy
1 y/o, well until 6 months - developed recurrent otitis media
severe pneumonia @ 8 months
now presents with seizure, reduced GCS, high fever, globally reduced tone
Bruton’s agammaglobulinemia
X-linked primary immunodeficiency disease with absence of IgG
condition presents in young children with sino/pulmonary infections
drug that HIV patient with pneumocystis pneumonia responds to
co-trimoxazole
22 y/o backpacker, travelled trough southern russia for months. presents with iron deficiency anaemia
most appropriate test?
distal duodenal biopsy
differentials = Giarda or coeliac
distal duodenal = gold standard for both
** (not sure about that luv but its what the q says) **
most common malignant tumour in colon? where does it metastases first?
adenocarcinoma
metastases in liver first
what stage of lung maturation does branching of the terminal bronchioles occure?
pseudoglandular
reducing agent in conversion of pyruvate to lactate
NADH
very low infectious dose, effects mediated by toxin, most common cause of renal failure in under 5s
E coli 0157
units of alcohol in litre of 40% proof spirits
40 units
30 y/o, RIF pain, previous gynae surgery
investigations?
laparoscopy
differentials = appendix or ovarian pathology
would exclude both
what does increased pulmonary arterial vasoconstriction result in?
increased pulmonary vascular resistance - associated pulmonary hypertension
–> this in turn leads to increased RV afterload + initially RV hypertrophy, eventually followed by RV dilation + failure (Cor pulmonale)
medication used for rapid relief of thyrotoxic symptoms including atrial fibrillation
bisoprolol - selective beta blocker
20 y/o, lethargy, headaches, fever, nausea, abdo pain for 4 days. no rash. returned from backpacking india 28 days ago, yellow eyes
hep A
dengue fever typically has rash
pathology seen in person not attending barretts review sessions with worsening symptoms
uncontrolled proliferation of MUCOUS GLAND cells in lover 1/3 of oesophagus
–> adenocarcinoma = GLAND cells
62 y/o man w alcohol related cirrhosis + alcoholic hepatitis who is anuric + CVP = 12
most appropriate initial management?
terlipressin
–> has developed hepato-renal syndrome = has been adequately fluid resuscitated - terlipressin will improve renal flow
(anuria = failure of kidneys to produce urine)
55 y/o with know PBC, bilirubin rose to 110 over 6 months, abdominal US show normal bile ducts
most appropriate initial management?
liver transplant
–> raised bilirubin in absence of biliary disease shows deteriorating liver function + liver failure requiring transplantation
artery located inferior to retroinguinal space
femoral
–> retroinguinal space lies deep to inguinal ligament through which structures pass between abdominopelvic cavity + lower limb
(external iliac artery becomes femoral as it passes under inguinal ligament)
healthy start vitamins are provided to low-income pregnant woman
this is most likely to reduce the prevalence of which deficiency disease?
rickets/osteomalacia (vit D)
–> the vitamins contain folic acid + vitamins C+D
what acts on membrane bound beta2 adrenoceptor on airway smooth muscle to mediate relaxation?
adrenaline
confidentiality
confidentiality is about the importance of keeping medical info private + secure
50 y/o alcoholic with history of recurrent abdominal pain + central abdominal calcification on AXR
Ix to confirm diagnosis?
faecal elastase
–> recurrent abdo pain makes chronic pancreatitis likely, this is supported by calcification on AXR, also alcohol is big cause
> best test of pancreatic function = faecal elastase
severe aspiration pneumonia treatment
IV amoxicillin, gentamicin + metronidazole
most appropriate treatment for grade C oesophagitis
PPI
tight benign peptic stricture seen on endoscopy - most appropriate management?
balloon oesophageal dilatation
–> rapid relief of symptoms, safer that bougie
choosing between hellers cardiomyotomy + balloon oesophageal dilatation for achlasia
myotomy - young, fit, has advantage of not requiring repeat procedures
causes of of Beri-Beri + Pellagra
Beri-Beri - thiamine deficiency (vit B1)
Pellagra - niacin deficiency (vit B3)
