General medicine: CL Lai Session 4 Flashcards
1
Q
Where is JVP?
How to differentiate IJV from ECA?
A
- between heads of SCM
- Easily occludible
- Changes with pressure on abdomen, respiration (inspiration it goes down), posture
- Usually has upper border (unless goes to jaw)
- Biphasic (a wave = atrial contraction, v= ventricular contraction)
2
Q
TR features
A
- Giant V wave
- Pulsatile liver
- Pansystolic murmur
- Murmur increases on inspiration (right sided lesion causes increased venous return)
- Parasternal heave
- P2 increased due to pulmonary hypertension (must happen before TR)
- Systolic ejection murmur at pulmonary area due to pulmonary hypertension
3
Q
How to differentiate small bowel vs large bowel diarrhea
A
- Small bowel is watery diarrhea, no blood, no mucus. Periumbilical pain.
- Large bowel is semi solid diarrhea, bloody mucus. Suprapubic pain. Subsides with defaecation. Colicky pain: cycles of 3-5 minutes pain returning to baseline due to peristasis.
4
Q
Cause of colicky pain?
A
Contraction of smooth muscle of hollow viscus
* Gut
* Uterus (in menstruation or labor)
* Urinary tract (ureteric colic in urolithiasis)
Normal cycles of 3-5 mins pain and return to baseline
Biliary colic: pain rises to max at 30 min to 1hour, fluctuates about the plateaum and subsides after about 6 hours
5
Q
Approach to diarrhea
A
- Acute (<2 weeks) or chronic (>2 weeks or recurrent)
- Large bowel or small bowel. Small bowel diarrhea: usually water (because it ix toxigenic. No damage to intestinal mucosa –> no blood, no mucus). Pain= periumbilical. Large bowel diarrhea = usally more solid –> blood and mucus may be possible –> pain in flanks or hypogastrium
- if chronic diarrhea: is it organic or functional
Functional (IBS): patient never woken up by the urge to defaecate. Stress related: typically occurs in the morning. Blood is never present, unless there are hemorrhoids (easily excluded)
Organic: DM can cause nocturnal diarrhea, hyperthyroidism, autonomic neuropathy, drugs
Chlorea: V. cholera toxin
Oral rehydration solution: mixture of saline and glucose. Facilitates substrate dependent uptake of sodium ions and water
6
Q
Signs of AR
A
- Corrigan pulse: rapid and forceful distension of arterial pulse with quick collapse
- Traube sign: systolic and diastolic sounds (pistol shots) over the femoral artery
- Quincke sign: capillary pulsation on light compression (half white) on nail bed
- De Musset sign: to and fro head bobbing