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)
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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
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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.
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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

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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

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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
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