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Y3- TO LEARN > Y1 + Y2 > Flashcards

Y1 + Y2 Flashcards

1
Q

A superior homonymous quadrantanopia is due to a lesion in the …?

A

Temporal lobe

PITS (Parietal-Inferior, Temporal-Superior)

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2
Q

An inferior homonymous quadrantanopia is due to a lesion in the …?

A

Parietal lobe

PITS (Parietal-Inferior, Temporal-Superior)

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3
Q

Duration of PR interval?

A

<0.20 secs

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4
Q

How many boxes make up 1 second on an ECG?

A

5 big boxes

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5
Q

How long does each big box represent on an ECG?

A

0.2 seconds

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6
Q

How to calculate HR on ECG if regular?

A

300/number of large squares between beats

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7
Q

How to calculate HR on ECG if IRregular?

A

Number of QRS COMPLEXES in 30 big boxes x 10

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8
Q

How many cords are used in a 12 lead ECG?

A

10

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9
Q

Where does lead 1 go to/from on an ECG?

A

Right arm to left arm

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10
Q

Where does lead 2 go to/from on an ECG?

A

Right arm to left leg

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11
Q

Where does lead 3 go to/from on an ECG?

A

Left arm to left leg

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12
Q

If both leads 1 and aVF are upstrokes, the cardiac axis is?

A

Normal (90 to -30)

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13
Q

If lead 1 is upstroke and aVF is downstroke, the cardiac axis is?

A

Left axis deviation (-30 to -90)

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14
Q

If lead 1 is downstroke and aVF is upstroke, the cardiac axis is?

A

Right axis deviation (90 to 180)

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15
Q

4 steps to ECG interpretation before looking at rhythm strip?

A
  1. Patient details
  2. Date/time of ECG
  3. Calibration of paper
  4. Determine axis
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16
Q

Which is the only part of the eye with lymphatic drainage?

A

Conjunctiva

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17
Q

Layers of the skin?

A 
Keratin layer
Granular layer
Prickle cell layer
Basal layer
Dermis

(Kerry Grafts People Buying Drinks)

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18
Q

Cells in the keratin layer of skin?

A

Corneocytes (no nucleus)

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19
Q

Cells present in prickle cell layer of skin + function?

A

Langerhans cells

Sample surface antigens + present

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20
Q

Cells present in basal cell layer of skin + function?

A

Merkel cells

For mechanoreception

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21
Q

How do topical/transdermal creams work?

A

By passive diffusion

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22
Q

Investigations of allergic skin reactions?

A

Serum IgE
Skin prick test
Challenge testing

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23
Q

Type of hypersensitivity and investigations of allergen contact dermatitis?

A

Type 4

Patch testing

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24
Q

How to diagnoses fungal skin infections?

A 
Wood lamp (fluorescence)
Skin scrapings
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25
Q

What is post-herpatic neuralgia?

A

Pain 4+ weeks after shingles

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26
Q

What causes gingiostomatitis?

A

Herpes simplex

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27
Q

Cause of blistering rash at back of throat?

A

Herpangina

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28
Q

Presentation of erythema multiforme and associations?

A

Target lesions

HSV, drugs

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29
Q

What is erythema infectiosum caused by and features?

A

Parovirus B19

Slapped cheek

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30
Q

Pathology of eczema?

A

Spongiosis (oedema) and inflammatory infiltrates

Due to mutation in fillagrin gene

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31
Q

What causes sawtooth acanthosis in skin?

A

Lichen Planus

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32
Q

Which skin cancer can present as a painless plaque or raised shiny lesion- pearly white/rolled edge?

A

BCC

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33
Q

Which skin cancer can present as an ulcer/painful or bleeding lesion?

A

SCC

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34
Q

Features of venous ulcer?

A

Shins + ankles
Varicose veins
Brown iron rich
Blue

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35
Q

Features of arterial ulcer?

A

Feet + toes
Deep, punched out
Dry and scabbed
Pale cool shiny hairless

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36
Q

ABPI of 0.8-1.3?

A

Compress stockings

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37
Q

ABPI of <0.8?

A

Vascular disease

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38
Q

ABPI of >0.8?

A

Calcification

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39
Q

Effect of sympathetics on the eye? (3)

A

Emotional lacrimation
Pupil dilation
Focus on far objects

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40
Q

Central corneal ulcers are more likely to be caused by?

A

Infection

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41
Q

Peripheral corneal ulcers are more likely to be caused by?

A

Autoimmune

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42
Q

Rice-grain follicles on eyelids?

A

Chlamydial conjuncitivis

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43
Q

Contact lens wearer with unilateral eye pain, redness and photophobia?

A

Keratitis

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44
Q

Drusen is a sign of?

A

Dry MD

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45
Q

Which nerve palsy causes difficulty in walking down stairs or reading?

A

4th nerve palsy

Struggle to focus down and in

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46
Q

Painless loss of vision and cherry red spot?

A

CRAO

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47
Q

How often are taste buds replaced?

A

10 days

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48
Q

How often are olfactory receptor cells replaced?

A

2 months

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49
Q

Membrane in ear that vibrates?

A

Basilar membrane

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50
Q

Treatment of candida sore throat?

A

Nystatin

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51
Q

Causes of nasal polyps?

A

Allergies
Infection
Asthma
CF!

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52
Q

Cause of nasopharyngeal carcinoma?

A

EBV

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53
Q

Most common salivary gland tumour?

A

Pleomorphic adenoma

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54
Q

Where does most epistaxis arise from?

A

Little’s area

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55
Q

What is longitudinal temporal bone fracture associated with?

A

Lateral blows

CONDUCTIVE hearing loss

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56
Q

What is transverse temporal bone fracture associated with?

A

Frontal blows

SENSORINEURAL hearing loss

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57
Q

Symptom and test of BPPV?

A

Brief vertigo, mostly on looking up

Ix: Dix-Hallpike

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58
Q

Features of vestibular neuronitis?

A

Vertigo days-wks
Day 1 worst, gets better
No hearing loss/tinnitus
? Viral cause

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59
Q

Features of labyrinthitis?

A

Vertigo days-wks
TINNITUS/HEARING LOSS
?Viral cause

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60
Q

Features of Meniere’s disease?

A

Recurrent spontaneous rotational vertigo (>20 mins)
TINNITUS/HEARING LOSS
AURAL FULLNESS

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61
Q

Treatment of Meniere’s disease? (4)

A

Supportive (buccastem)
Tinnitus therapy
Hearing aids
Grommet/Meniette

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62
Q

6 Ds of ear disease?

A 
Deafness
Discomfort (pain)
DinDin (tinnitus)
Discharge
Dizziness
Defective facial movement (CN VII)
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63
Q

Treatment of otitis externa? (4)

A

Topical aural toilet
Avoid water/hearing aids
Topical clotrimazole (fung.)
Gentamicin (bact.)

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64
Q

Features of bacterial tonsillitis (CENTOR criteria)?

A 
Fever
Exudates
NO cough
Tender lymph nodes (~1 wk)
Often can't work/school
<15 or >44
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65
Q

What not to give in glandular fever?

A

Amoxicillin

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66
Q

What causes epiglottitis?

A

Haemophilus influenza B

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67
Q

MRI features of rheumatoid arthritis?

A

Periarticular osteopenia + erosions

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68
Q

Scoring used for rheumatoid arthritis?

A 
DAS28 score (disease activity score)
>5.1= active
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69
Q

Treatment of rheumatoid arthritis?

A 
Steroids (before DMARDs)
Methotrexate 15mg/week
Sulphasalazine
Hydroxychloroquine
Analgesia
Physio
Biologics- anti-TNF (infliximab)
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70
Q

X ray features of OA?

A

LOSS

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

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71
Q

Which drugs are gout associated with?

A

DIURETICS

lisinopril

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72
Q

What does joint aspirate show in gout?

A

Negative birefringence needle crystals

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73
Q

What does joint aspirate show in pseudogout?

A

Positive birefringence calcium pyrophosphate crystals

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74
Q

Symptoms of SLE?

A 
Fatigue
Weight loss
Malar rash
Reynaulds
Alopecia
Arthritis
Pericarditis
Nephritis
etc.
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75
Q

Markers of SLE?

A

ANA
Anti-dsDNA
Low complement

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76
Q

Treatment of SLE?

A

Hydroxychloroquine
Steroids/NSAIDs
+/- methotrexate/azathioprine
Rituximab

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77
Q

Diagnosis of Sjogren’s?

A

Anti-Ro
Anti-LA
Schirmer’s test

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78
Q

Treatment of Sjogren’s?

A

Tear/saliva supplement
PILOCARPINE
Hydroxychloroquine

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79
Q

Which bullous disorder is more superficial?

A

Bullous pemphiguS

pemphigoiD= Deep, through DEJ

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80
Q

Which bullous disorder is painful?

A

Bullous pemphigus

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81
Q

What is Nikolsky’s sign, and when is it positive?

A

Top layer of the skin slips away from lower layer when slightly rubbed
in Bullous pemphigus

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82
Q

Which conditions are associated with pANCA?

A

EGPA (+anti-MPO antibody)

MPA

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83
Q

cANCA and PR3 are associated with?

A

GPA

84
Q

What does GPA commonly cause?

A

ENT features- nasal crusting, epistaxis, ‘saddle nose’ deformity and ulcers
Lung features

85
Q

Bone affected by nightstick fracture?

A

Ulnar

86
Q

Bone affected by pilon fracture?

A

Tibia

87
Q

Galeazzi fracture dislocation?

A

Fracture of the distal third of the radius +

Dislocation of the distal radioulnar joint

88
Q

Monteggia fracture dislocation

A

Fracture of the proximal third of the ulna +

Dislocation of the proximal head of the radius

89
Q

RHEUM: Symmetrical muscle weakness affecting big muscles (pelvic girdle, shoulder)?

A

Polymyositis

90
Q

RHEUM: Perivascular inflammation and muscle necrosis

A

Polymyositis

91
Q

Is polymyalgia rheumatica autoimmune?

A

NO

92
Q

Features of limited systemic sclerosis?

A

CREST

Clacinosis
Raynaulds
Esophageal dysmotility
Sclerodactyly
Telangectasia
93
Q

Features of diffuse systemic sclerosis?

A

CREST
Thickened skin on torso/forearms
Lung/renal involvement

94
Q

Anti-centromere?

A

limited systemic sclerosis

95
Q

Anti-Scl-70?

A

diffuse systemic sclerosis

96
Q

Anti-Jo-1?

A

Polymyositis

97
Q

Pain + stiffness of shoulder/pelvic girdle, no weakness?

A

Polymyalgia rheumatica

98
Q

Treatment of simple polymyalgia rheumatica?

A

15mg pred

99
Q

Treatment of headache (arteritis) with polymyalgia rheumatica?

A

40mg pred

100
Q

Treatment of visual loss with polymyalgia rheumatica?

A

60mg pred

101
Q

Anti-smooth muscle antibody?

A

Autoimmune hepatitis

102
Q

Anti-mitochondrial antibody?

A

Primary biliary cirrhosis

103
Q

Pain in ankylosing spondylitis?

A

Better with exercise

Worse at night

104
Q

Xray- pencil in cup?

A

Psoriatic arthritis

105
Q

Aspiration results in reactive arthritis?

A

No viable organisms

106
Q

What to avoid in enteropathic arthritis?

A

NSAIDs

107
Q

t11:22 translocation?

A

Ewing’s sarcoma

108
Q

Bloods in osteomalacia?

A

Low Ca
Low phosphate
High alk phos

109
Q

Osteogenesis imperfecta defect in which type of collagen?

A

Type 1

AD inheritance

110
Q

Knee alignment at age 2-3 years?

A

Knock-kneed

111
Q

Causes of fixed flat feet in children?

A

Tarsal coalition

112
Q

DDH?

A

Developmenal Dysplasia of Hip
In girls, breech, LEFT hip
+ Barlow/Ortolani

113
Q

Cause of Perthes?

A

Idiopathic avascular necrosis of femoral head

114
Q

Typical presentation of SUFE?

A

Male, puberty, overweight:

Pain, limp, loss of internal rotation

115
Q

Investigation of meniscal tear?

A

MRI

116
Q

Conn’s syndrome?

A

Excess aldosterone

117
Q

Triad of phaeochromocytoma?

A

Headache
Palpitations
Sweating

118
Q

Cause of negative straight leg raise?

A

Knee extensor mechanism rupture

119
Q

What is pes cavus?

A

High arches

120
Q

What does loss of medial arch of foot suggest?

A

Tibialis posterior tendon dysfunction

121
Q

Tennis elbow?

A

Lateral epicondyle (extensor origin)

122
Q

Golfer’s elbow?

A

Medial epicondyle (Flexor origin)

123
Q

Investigation of scaphoid fracture?

A

4 Xrays! (AP, lateral, 2 obliques)

124
Q

Management of femoral shaft fracture?

A

Thomas’ splint

Closed reductions + IM nail

125
Q

Amine hormones?

A

Adrenaline

T3, T4

126
Q

Steroid hormones?

A

Cortisol
Progesterone
Testosterone

127
Q

Diagnosis of T1DM?

A

Fasting gluc >7mmol/l

Random gluc >11mmol/l

128
Q

Target BG in T1DM insulin therapy?

A

4-8 mmol/l

129
Q

How do diabetes complications occur?

A

Poyol pathway- try to lower glucose by converting to sorbitol then fructose

130
Q

Examples of sulphonylureas?

A

Gliclazide

Tolbutamide

131
Q

How are ketones produced?

A

Through lipolysis

132
Q

Hypothyroidism with Goitre?

A

Hashimoto’s thyroiditis

133
Q

Antibodies in Hashimoto’s thyroiditis?

A

TPO antibodies

134
Q

Blood T3/4, TSH, Ca, Alk phos in Grave’s?

A

High T3/4
Low TSH
High Ca
High Alk phos

135
Q

Eye and skin features of Grave’s?

A

Eyes- exophthalamus + lid lag

Skin- pretibial myxoedema

136
Q

Treatment of hyperthyroidism? (4)

A

Carbimazole
PTU
Radioiodine 131
Thyroidectomy

137
Q

Cause of myxoedema coma and symptoms?

A

Severe hypothyroidism

T2 resp failure + acidosis, bradycardia, heart block, t wave inversion

138
Q

Cause of thyroid storm?

A

Severe hyperthyroidism

139
Q

Most common thyroid cancer causing goitre and what is it associated with?

A

Papillary carcinoma

Associated with Hashimoto’s

140
Q

Investigation of goitre? (3)

A

Thyroid screen (bloods)
US FNA
Thyroid isotope scan

141
Q

Which thyroid cancer is part of MEN2?

A

Medullary

142
Q

Ketones and BG in DKA?

A

Ketones >3mmol/l

BG > 11mmol/l

143
Q

Features of hyperglycaemic hyperosmolar state? (4)

A

Hypovolaemia
Hyperglycaemia
Hyperosmolar
+ renal impairment

144
Q

Size of pituitary micro vs macro-adenoma?

A

<1cm microadenoma

>1cm macroadenoma

145
Q

Investigation of acromegaly?

A

Glucose tolerance test (no suppression of GH)

Brain MRI

146
Q

Treatment of acromegaly?

A

Surgery
Cabergoline
GH antagonists

147
Q

Cushing’s disease?

A

Cushing’s syndrome due to pituitary tumour

148
Q

Diagnosis of Cushing’s?

A

Low dose dexamethasone test (no cortisol suppression)
then
High dose dexamethasone test (50% suppression= pituitary)

149
Q

Which drug can normalise cortisol in Cushing’s?

A

Metyrapone

150
Q

What does congenital adrenal hyperplasia cause?

A

No cortisol/aldosterone production- become TESTOSTERONE

Leads to Addison’s + masculine features

151
Q

Effect of aldosterone?

A

When low BP- causes vasoconstriction (through angiotensin II)

152
Q

Where is adrenaline produced?

A

Adrenal medulla

153
Q

2 causes of secondary adrenal insufficiency?

A

Excess steroid use

Pituitary/hypothalamic cause

154
Q

Symptoms of Addison’s?

A 
Dehydration
Hyperpigmentation
Weight loss
Hyponatraemia
Amenorrhea
Fatigue
Abdo pain
155
Q

Investigation of Addison’s?

A

Short synACTHen test (no increase in cortisol= addison’s)

MRI brain

156
Q

Treatment of Addison’s?

A

Hydrocortisone + Fludrocortisone

157
Q

What is Conn’s Syndrome + causes?

A

High aldosterone

Adrenal adenoma
Bilateral hyperplasia
Genetics

158
Q

Symptoms of Conn’s Syndrome?

A

HYPERTENSION
hypokalaemia
metabolic acidosis

159
Q

Investigation of Conn’s Syndrome?

A

Aldosterone:Renin ratio (high)

Saline suppression test (no suppression of aldosterone seen)

160
Q

Treatment of Conn’s Syndrome?

A

Remove tumour

Spironolactone

161
Q

Diagnosis of phaeochromocytoma?

A

24 hour urinary catecholamines

162
Q

Treatment of phaeochromocytoma?

A

Phenoxybenzamine

Propranalol

163
Q

3Ps of cancer associated with MEN1?

A

Parathyroid
Pituitary
Pancreas

164
Q

3 things associated with MEN2?

A

Parathyroid cancer
Medullary thyroid cancer
Phaeochromocytoma

165
Q

PTH is released in response to..?

A

Hypocalcaemia

166
Q

Hyperparathyroidism scan?

A

Sestamibi scan

167
Q

Symptoms of hypocalcaemia?

A 
Pins + needles
Numbness
Muscle cramps
Weakness/fatigue
Prolonged QT
168
Q

Juxtamedullary nephrons make more.. urine?

A

Concentrated

169
Q

Glomerulus is within the?

A

Bowman’s capsule

170
Q

Plasma moves into the proximal convoluted tubule as..?

A

Tubular fluid

171
Q

Function of granular cells AKA juxtaglomerular cells?

A

Produce and secrete renin (part of RAAS)

172
Q

Function of macula densa?

A

Monitor how much salt is present in tubular fluid as it passes through

173
Q

3 layers to glomerular filtration?

A
  1. Glomerular Capillary Endothelium (barrier to RBC- too big)
  2. Basement Membrane (basal lamina) (plasma protein barrier)
  3. Slit processes of podocytes (plasma protein barrier)
174
Q

Constriction of arterioles occurs in response to..?

A

Low BP

  • less blood to glomeruli- low GRF + urine output (increase BP)
175
Q

What substances can be used to estimate GFR?

A

Inulin

Creatinine

176
Q

How much urea is reabsorbed?

A

50%

177
Q

How much creatinine is reabsorbed?

A

0%

178
Q

What absorption occurs at the proximal tubule?

A

67% of SALT + WATER
100% glucose + amino acids
Reabsorbed

179
Q

Which part of the nephron has extensive cilia surface?

A

Proximal tubule

180
Q

What secretion occurs at the proximal tubule? (5)

A 
H+ ions
Neurotransmitters (adrenaline, acetylcholine etc.)
Bile pigments
Uric acid
Drugs and toxins
181
Q

In the loop of Henle, which limb is highly permeable to water?

A

Descending limb (via aquaporins)

182
Q

In the loop of Henle, which limb reabsorbs NaCl?

A

Ascending limb (via. triple co-transporter)

183
Q

Where is H+ secreted into the urine?

A

Distal tubule

184
Q

Fluid entering the distal tubule is …. to plasma?

A

Hypo-osmotic

185
Q

Endocrine hormones only act on the … of the kidneys?

A

Distal tubules and collecting ducts

186
Q

How does ADH increase water reabsorption?

A

Increase the expression of water channels (aquaporin) on basolateral membrane

187
Q

How does ANP regulate BP?

A

Released when cells are mechanically stretched due to an increase in the circulating plasma volume
–> promote Na excretion + diuresis

188
Q

How do carbonic anhydrase inhibitors work as diuretics?

A

In proximal convoluted tubules

Block Na+/H+ exchange (increase HCO3 excretion)

189
Q

How do loop diuretics work?

A

In thick ascending limb

Block Na+/K+/2Cl- co-transporter

190
Q

How do thiazide diuretics work?

A

In distal convoluted tubule

Block Na+/Cl- co-transporter

191
Q

What can loop and thiazide diuretics lead to? (2)

A

Hypokalaemia

Metabolic alkalosis

192
Q

Pre-renal causes of AKI?

A

Anything involving:
Hypovolaemia
Hypotension
Hypoperfusion

193
Q

What can untreated pre renal AKI cause?

A

Acute tubular necrosis

194
Q

Renal causes of AKI?

A

Glomerulonephritis
Vasculitis
Interstitial nephritis
Haemolysis/Rhabdomylolysis

195
Q

Post-renal causes of AKI?

A

Obstruction:
renal stones
enlarged prostate
tumour compression

196
Q

Non-proliferative glomerulonephritis presents with …. and includes (3)?

A

Nephrotic syndrome

Minimal change GN
Focal segmental GN
Membranous GN

197
Q

Proliferative glomerulonephritis presents with …. and includes (4)?

A

Nephritic syndrome

IgA nephropathy
Membranoproliferative GN
Post Infectious GN
Rapidly Progressive GN

198
Q

Most common glomerulonephritis in adults?

A

IgA GN

199
Q

What does IgA nephropathy often occur after?

A

URTI

200
Q

What is nephrotic syndrome?

A

Proteinuria > 3 g/day (mostly albumin)
Hypoalbuminaemia
Oedema
(Hypercholesterolaemia)

201
Q

What is nephritic syndrome?

A 
Acute Kidney Injury
Oliguria
Oedema/ Fluid retention
Hypertension
Active urinary sediment (casts, RBCs)
202
Q

Woman with RUQ pain that radiated to shoulder tip?

A

Cholecystitis

203
Q

First degree heart block?

A

Prolonged PR interval >0.2s

204
Q

Mobitz I Second Degree Heart Block?

A

Increasing PR interval then dropped beat

205
Q

Mobitz II Second Degree Heart Block?

A

Some missing P waves
QRS complex dropped
(Can be 2:1, 3:1, 4:1)

206
Q

Complete (Third Degree) Heart Block?

A

No relationship between P waves and QRS complex

Y3- TO LEARN (13 decks)

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