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Lottie's Question Books > Cases Book > Flashcards

Cases Book Flashcards

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1
Q

List triad of Sx in CCF

A

SOB, Na and water retention (oedema)

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2
Q

List signs O/E of CCF

A

S3 gallop rhythm
Cardiomegaly
Neck vein distention

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3
Q

List Ix for CCF

A

BNP, FBC, U&Es, BGC, LFTs

Echo, ECG, CXR

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4
Q

How is CCF categorised?

A

NYHA

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5
Q

List categories of NYHA classification

A 
I = mild 
II = Limited physical activity 
III = Moderate, gentle activity causes Sx 
IV = Severe, Sx at rest
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6
Q

List Mx of CCF

A

Diuretics, ACEi, B blockers, valsartan

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7
Q

Define PBC

A

Chronic disease of small intra hepatic ducts characterised by progressive bile duct damage and portal tract inflammation

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8
Q

List risks of developing PBC

A

Female, 45-60y/o
PMH or FH of AIDs
Sjorgens / scleroderma / coeliac / RA / thyroid problems

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9
Q

What AB is positive in PBC?

A

Anti mitochondrial antibodies

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10
Q

Sx of PBC?

A

Can be none

Jaundice, fatigue, pruritis, xs pigment, xanthelasma

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11
Q

Ix for PBC?

A

LFTs (ALP and GGT raised)
AB screen
USS abdo
Clotting and lipids

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12
Q

Describe pathophysiology of MG

A

Faulty ACh Rs causing auto antibodies to ACh R

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13
Q

What is defining feature of MG?

A

Fatiguability (worse on exertion, better with rest)

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14
Q

What is MG linked to?

A

Thyroid hyperplasia

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15
Q

What is pathophysiology of Lambert Easton?

A

ABs to VGCC causing weakness which is better with activity

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16
Q

List types of pneumoconiosis

A

Asbestosis, silicosis, coal workers lung

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17
Q

List Sx of pneumoconiosis

A

Nothing

Gradual SoB, dry cough, reduced exercise tolerance

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18
Q

List CXR findings of pneumoconiosis

A

Upper zone = egg shell calcification
Round opacities
Lower zone = interstitial fibrosis and pleural thickening

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19
Q

What causes MM?

A

Clonal proliferation of plasma cells in bone marrow

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20
Q

Sx of MM?

A

CRAB
C = hypercalcaemia Sx (stones, bones, throans, abdo moans, psychic groans)
R = renal failure - dark urine, recurrent UTI
A = anaemia (pale, SoB, fatigue)
B = bones (pain, fractures)

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21
Q

List Ix and results for MM

A

Blood film –> bence jones proteins
LFTs –> all normal inc NORMAL ALP
Serum/urine electrophoresis –> increased protein
Bone marrow biopsy –> >30% plasma cells

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22
Q

What is triad of anti-phospholipid syndrome?

A

Thromboses - DVT, PVD, stroke
Pregnancy loss - miscarriage, pre-eclampsia
Anti PL ABs - lupus anticoagulant, anti-cardiolipin

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23
Q

List Sx of SLE

A 
SOAP BRAIN MD 
Serositis (pleuritis, pericarditis) 
Oral ulcers 
Arthritis 
Photosensitivity 
Blood disorders (low platelets, haemolytic anaemia, low leukocytes) 
Renal problems (proteinuria, red cell casts) 
Anti-nuclear ABs 
Immunology (anti double stranded DNA, anti smooth muscle) 
Neuro Sx (psychosis, seizures)

Malar rash
Discoid rash

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24
Q

What is the key AB of SLE?

A

Anti nuclear ABs

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25
Who is the typical SLE patient?
15-45y/o, Afro/Asian female
26
What is achalasia?
Motor disorder with loss of O peristalsis and failure of lower O sphincter to relax post swallow
27
What causes achalasia?
Loss of neurones in myenteric plexus
28
Sx /signs of achalasia?
``` Dysphagia to solids and liquids Regurgitation Pain Weight loss Nausea and vomitting ```
29
Ix and result of achalasia?
Barium swallow - bird beak appearance
30
Define PSC
Inflammation and injury of medium/large bile ducts leading to fibrosis and strictures
31
Describe typical PSC patient
Male, 40-50y/o, with UC
32
Sx of PSC?
Abdo pain, pruritus, fatigue, weight loss, fever, jaundice
33
What AB is positive in PSC?
pANCA
34
What complication is linked to PSC?
Cholangiocarcinoma
35
Ejection systolic murmur
Aortic stenosis
36
Early diastolic murmur
Aortic regurg
37
Mid diastolic murmur with opening snap
Mitral stenosis
38
Pansystolic murmur
Mitral regurg
39
Collapsing pulse, wide pulse pressure
Aortic regurg
40
Quiet S1, split S2 in severe. Blowing sound.
MR
41
Loud S1, with S3 present and displaced apex beat. Rumble sound
MS
42
Soft S2. S4 present.
AS
43
Syncope, angina and dyspnoea.
AS
44
Quinckes and de MUssets?
AR
45
Causes include rheumatic fever, IE, Marfans, MV prolpase
MR
46
Graham Steel murmur
MS causing pulm HTN
47
Tapping apex beat
MS
48
Displaced apex beat
MR
49
S3 present
MR
50
S4 present
AS
51
Narrow pulse pressure and slow rising pulse
AS
52
Heaving apex beat
AS
53
Pistol shot over femorals
AR
54
Rheumatic heart disease, AF and malar rash
MS
55
The most common murmur
AS
56
What is carcinoid syndrome?
Tumour of ileum enterochromaffin cells (release serotonin) which metastasise to liver
57
What precipitates carcinoid syndrome?
Stress, alcohol, caffeine
58
Sx carcinoid syndrome?
``` CARC - cutaneous flushing - asthmatic wheeze - R murmur - cramps and diarrhoea Low BP ```
59
Ix for carcinoid syndrome?
Urinary 5-HIAA (serotonin)
60
Which IBD: has bloody diarrhoea and tenesmus?
UC
61
Which IBD: has diffuse pain ?
UC
62
Which IBD: has ulcers and perianal abcesses?
CD
63
Which IBD: has RIF pain?
CD
64
Which IBD: has risk of gallstones and fistula?
CD
65
Which IBD: PSC and colorectal cancer?
UC
66
Which IBD: has skip lesions?
CD
67
Which IBD: is continous?
UC
68
Where does UC effect?
Rectum to ileocaecal valve
69
Which layers does UC affect?
Mucosa and submucosa
70
Which IBD: affects all layers?
CD
71
What is histology of UC?
Depletion of goblet cells Crypt abcesses Pseudopolyps
72
What is histology of CD?
Goblet cell hyperplasia Granulomas Cobblestone on colonoscopy
73
What is AXR of CD?
Strictures | Rose thorn ulcers
74
What is AXR of UC?
Loss of haustra | Drainpipe colon
75
List 3 common extra GI features of IBD
Arthritis Erythema nodosum Pyoderma gangrenosum
76
How do you induce remission for UC?
Aminosalicylates +/- steroids
77
How do you induce remission for CD?
Glucocoticosteroids or budesonide
78
How do you maintain remission for UC?
Aminosalicylates & azothioprine
79
How do you maintain remission for CD?
Smoking cessation | Azothioprine or mercaptopurine
80
List types of SVT
AF, WPW, Atrial flutter, paroxysmal SVT
81
List Sx of SVT
Palpitations, SoB, chest pain, dizziness, syncope
82
What is the Mx of SVT?
Adenosine or flecainide
83
How do you Mx AF?
Rate control: beta blocker or CCB | Rhythm control: Dc cardiovert
84
What is WPW?
Re-entry circuit (bundle of kent)
85
What is seen on ECG of WPW?
``` Delta wave (wide QRS with slurred upstroke) Short PR interval ```
86
What is WPW associated with?
Ebsteins anomaly
87
Describe pathophysiology of Alzheimers?
Cerebral atrophy Type A beta amyloid plaque deposition Tau protein tangles
88
List Sx of Alzheimers
Memory and language problems | Global deficits
89
List Sx of vascular dementia
CVD risk factors Focal problems - visual / sensory /etc Sudden, STEPWISE deterioration
90
Describe pathophysiology of Lewy Body dementia?
Lewy bodies in substantia nigra, paralimbic and neocortex
91
List Sx of Lewy Body dementia
``` Visual hallucinations Progressive cognitive impairments - attention and executive function are first to go - can be fluctuating PD Sx ```
92
List Sx of fronto-temporal dementia
Disinhibition and change in personality | Hyperorality
93
Vertigo, tinnitus and sensorineural hearing loss over minutes to hours in one ear only. Dx?
Menieres
94
Sudden onset dizziness and vertigo due to changes in head position with nausea. Dx?
BPPV
95
Ix for BPPV?
Dix-Hallpike manoeuvre
96
What is positive sign in Dix Hallpike for BPPV?
Delayed onset (>2s) torsional nystagmus unilaterally
97
Mx of BPPV?
Epley manouvre
98
What is haemochromatosis?
Autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation
99
Sx of haemochromatosis?
Bronze skin DM Fatigue, ED, arthralgia Liver disease
100
What does a target cell on blood film indicate?
``` Sickle cell Thalassaemia Iron deficiency anaemia Hyposplenism Liver disease ```
101
What does a tear drop cell / poikilocyte on blood film indicate?
Myelofibrosis
102
What does a spherocyte cell on blood film indicate?
Hereditary spherocytosis | AI haemolytic anaemia
103
What does a Howel Jolly body cell on blood film indicate?
Hyposplenism
104
What does a Heinz body on blood film indicate?
G6PD deficiency | Alpha thalassaemia
105
What does a schistocyte on blood film indicate?
Haemolysis DIC Mechanical heart valve
106
What does a poikilocyte / pencil cell on blood film indicate?
Iron deficiency anaemia
107
What does a burr cell on blood film indicate?
Uraemia | Pyruvate kinase deficiency
108
What does a rouleaux on blood film indicate?
MM
109
What does a smear / smudge cell on blood film indicate?
CLL
110
What does an auer rod on blood film indicate?
AML
111
What does hypersegmented neutrophil on blood film indicate?
Vit B12 deficiency
112
What does a reed steenberg cell on blood film indicate?
Hodgkins lymphoma
113
Which skin infection is in the dermis and sub cut fat?
Cellulitis
114
Where does erysipelas effect?
Epidermis
115
Which skin infection is well demarcated?
Erysipelas
116
Which skin infection has systemic Sx such as fevers and rigors?
Erysipelas
117
Which skin infection has a risk of sepsis?
Cellulitis
118
List risks of cellulitis / erysipelas
Wounds, ulcers, bites, cannula, immunosuppression
119
List complications of cellulitis
Abscess, sepsis, necrotising fasciitis, periorbital cellulitis
120
Mx of cellultiis / erysipelas?
Draw a line around the border to monitor spread Analgesia, fluids Oral ABx - flucloxacillin
121
List classical findings of TLS
High K High PO43 High uric acid LOW Ca
122
List Sx of TLS
``` Arrhythmias Gout Seizures Anorexia, N/V, diarrhoea Muscle cramps ```
123
List risks of developing GN
Infection - Hep B/C, group A strep, IE, HIV, RTI, GIT infections Connective tissue disorders eg SLE, vasculitides Cancer - HL, lung, colorectal, blood HUS Drugs
124
List Ix for GN
Urinalysis and MC&S LFTs, FBC, lipids Albumin, creatinine, GFR Kidney USS
125
List Sx of pilonidal sinus
Discharge / pain / swelling / sinus tract in sacrococcygeal areas
126
What is a pilonidal sinus
Acquired disease in which a hair follicle becomes inserted in skin, creating chornic sinus tract in natal cleft
127
Who gets pilonidal sinuses?
16-40y/o males with PMH natal cleft
128
What is Mx of pilonidal sinus?
1st = hair removal and hygiene If Sx - surgical closure If abscess - surgical drainage
129
What do erythema multiforme look like?
Target lesions which are symmetrical with a central blister
130
Where do you get erythema multiforme?
Start on hands then spread to palms, soles of feet and limbs
131
What is Stevens Johnson syndrome?
Erythema multiforme + fever + mucosal involvement
132
List Sx of cerebral abscess
Fever, headache, seizures, raised ICP
133
List risks of developing a cerebral abscess
Facial infections eg sinusitis or otitis media Endocarditis Fractures
134
List Ix and Mx for cerebral abscess
``` Ix = CT head, ESR, blood cultures Mx = IV ABx ```
135
What ABx would you use for strep / anaerobes causing cerebral abscess ?
IV cef and met
136
What ABx would you use for staph causing cerebral abscess ?
IV fluclox and cef
137
What is sarcoidosis?
Multisystem granulomatous disorder of unknown causes
138
Who is the typical sarcoid patient?
20-40y/o Afro Carribean woman with HLA DRB1
139
List acute Sx of sarcoid
``` Fever Erythema nodosum Polyarthralgia Dry cough Progressive SoB ```
140
What is seen on CXR of sarcoid?
Bilateral hilar lymphadenopathy
141
List non resp Sx of sarcoid
``` Lymphadenopathy Hepatosplenomegaly Conjunctivitis / glaucoma / uveitis Parotid enlargement --> Bells palsy Erythema nodosum ```
142
List Ix for sarcoid
BLOODS: ESR, FBC, LFT, ACE, Ca CXR Tissue biopsy (transbronchial)
143
What are the blood results for sarcoid?
Raised Ca and ACE
144
What is the tissue biopsy result of sarcoid?
Non caseating granulomas
145
What is the Tx for mild sarcoid?
Bed rest and NSAIDs
146
What is the Tx for symptomatic sarcoid?
Prednisolone 40mg for 4-6weeks
147
Name and describe 2 types of hiatus hernias
``` Sliding = stomach pushes up oesophagus Rolling = stomach squishes up next to oesophagus ```
148
Which type of hiatus hernia is more common?
Sliding (80%)
149
List risks of developing a hiatus hernia
Obesity Previous GI surgery Raised intra-abdo pressure
150
List a key sign of a hiatus hernia O/E ?
Bowel sounds in chest
151
List Sx of hiatus hernia
Symptomatic GORD Lower dysphagia Painless regurg of food
152
List gold standard Ix for haitus hernia
Barium swallow
153
What condition is suggested by the auto antibody anti TPO?
Hashimotos
154
What condition is suggested by the auto antibody Anti TSH R?
Graves
155
What condition is suggested by the auto antibody anti soluble liver Ag?
AI hepatitis type III
156
What condition is suggested by the auto antibody anti mitochondrial AB?
PBC
157
What condition is suggested by the auto antibody anti smooth muscle?
AI hepatitis type I
158
What condition is suggested by the auto antibody anti GBM?
Goodpastures
159
What condition is suggested by the auto antibody anti cardolipin?
Anti phospholipid syndrome
160
What condition is suggested by the auto antibody anti parietal cell?
pernicious anaemia
161
What condition is suggested by the auto antibody anti CCP?
RA
162
What condition is suggested by the auto antibody anti adrenocortical ?
Addisons
163
What condition is suggested by the auto antibody cANCA?
Granulomatosis with polyangiitis
164
What conditions are suggested by the auto antibody pANCA?
UC, PSC, eosinophilic granulomatosis with polyangiitis
165
What condition is suggested by the auto antibody anti nuclear ABs?
systemic sclerosis
166
What condition is suggested by the auto antibody anti centromere?
Systemic sclerosis
167
What condition is suggested by the auto antibody anti-topoisomerase II?
DIffuse cutaneous sclerosis
168
What condition is suggested by the auto antibody anti dsDNA?
SLE
169
What condition is suggested by the auto antibody anti Lo and anti Ra?
Sjorgrens
170
Name 3 types of cardiomyopathy
Dilated, restrictive and hypertrophic
171
Describe aetiology of dilated cardiomyopathy
viral, alcoholic, cocaine, FHx, hyperthyroidism, haemochromatosis
172
Describe aetiology of hypertrophic cardiomyopathy
Genetic (Beta myosin / troponin T / alpha tropomyosin)
173
Describe aetiology of restrictive cardiomyopathy
Amyloidosis, sarcoidosis, haemochromatosis
174
Describe Sx of dilated cardiomyopathy
Heart failure Sx, arrhythmia, embolus, FH sudden death
175
Describe Sx of hypertrophic cardiomyopathy
None - sudden death | Syncope / angina / arrhythmia
176
Describe Sx of restrictive cardiomyopathy
dyspnoea, fatigue, swelling
177
Describe signs O/E of dilated cardiomyopathy
Raised JVP, displaced apex beat, S3, MR/TR
178
Describe signs O/E of hypertrophic cardiomyopathy
Jerky carotid pulse | Double apex beat
179
Describe signs O/E of restrcitive cardiomyopathy
Raised JVP Kussmauls sign S3 Swelling
180
List Ix for cardiomyopathy
CXR ECG Echo
181
What will hypertrophic cardiomyopathy show on ECG?
Left axis deviation LVH Q waves in inf/lat
182
What will echo show for dilated cardiomyopthy?
Baggy ventricles
183
What will echo show for hypertrophic cardiomyopthy?
Ventricular hypertrophy, esp septum
184
What will echo show for restrictive cardiomyopthy?
Normal ventricles but large atria
185
List risks of developing HL
20-30 or >50y/o Male EBV
186
Describe Sx of HL
Painless enlarging neck mass in neck / axilla / groin --> painful after alcohol B Sx - FLAWS
187
Describe signs O/E of HL
Splenomegaly | Non tender, firm lymphadenopathy
188
List Ix for HL
FBC Lymph node biopsy Bone marrow aspirate
189
What will FBC show for HL
Low Hb, Raised WCC, Raised ESR
190
How do you stage HL?
Ann arbour staging
191
What is diagnostic of HL?
Reed Sternberg cells on histology
192
Name 2 types of focal seizures and differentiate between them
Simple partial (aware) and complex partial (impaired awareness)
193
List localising features of focal seizures in the temporal lobe
Hallucinations, automatisms, deja vu
194
List localising features of focal seizures in the frontal lobe
Head / leg movements, posturing
195
List localising features of focal seizures in the parietal lobes
Parasthesia
196
List localising features of focal seizures in the occipital lobes
Floaters / flashers
197
What is Mx of focal seizures?
Lamotrigine or cabamazepine
198
What is characteristic of generalised seizures?
LOC
199
Name 4 types of generalised seizures?
Tonic clonic Abscence Non convulsive status epilepticus Myoclonic
200
List features of tonic clonic seizure
``` Vague aura Muscle spasms Incontinence Tongue biting Post ictal conufsion ```
201
List features of abscence seizures
LOC but retained posture Blinking eyes / eyes roll up No post ictal phase
202
List features of myoclonic seizures
In clusters after waking up
203
What is status epilepticus?
30+ mins of seizure
204
What is Mx of status epilepticus ?
ABCDE Check glucose IV lorazepam / PR diazepam Not working? Transfer to ITU and give IV phenytoin on ECG monitoring
205
What causes ITP?
Anti platelet ABs from spleen attack GLP IIb - IIIa Ags
206
Who gets ITP?
Kids after a viral infection
207
Sx of ITP?
Easy bruising, mucosal bleeds, epistaxis
208
Ix and results for ITP?
``` FBC (low platelets) Clotting screen (normal) ```
209
List Sx of TTP
Fever, renal failure, haemolytic anaemia, thyrombocytopenia, neuro Sx
210
Who is the typical TTP patient?
39y/o black female
211
List Ix and results for TTP
``` FBC (anaemia, low platelets) Blood smear (schistocytes) LDH and BR (raised) Urinalysis (++ protein) U&Es (raised U & C) ```
212
Where is the lesion in the following strokes: | contralateral hemiparesis and sensory loss. Lower limb > upper limb ?
ACA
213
Where is the lesion in the following strokes: | contralateral hemiparesis and sensory loss. Upper limb > lower limb. Contralateral homoymous hemianopia and aphasia.
MCA
214
Where is the lesion in the following strokes: | homonymous hemianopia with macular sparing. Visual agnosia ?
PCA
215
Where is the lesion in the following strokes: | Ipsilateral CN 3 palsy. Contralateral limb weakness (webers syndrome) ?
Posterior branches to midbrain
216
Where is the lesion in the following strokes: | ipsilateral facial pain/temp loss. Contralateral limb/torso pain/temp loss. Ataxia, nystagmus (LMS)?
Posterior inferior cerebellar
217
Where is the lesion in the following strokes: | Ipsilateral facial paralysis and deafness. Similar Sx to Lateral Medullary Syndrome. (aka Lateral pontine syndrome) ?
Anterior inferior cerebellar
218
Where is the lesion in the following strokes: | Amarosis fugax ?
Retinal / opthalmic artery
219
Where is the lesion in the following strokes: | Locked in sydnrome ?
Basilar
220
Where is the lesion in the following strokes: | isolated hemiparesis / sensory loss / ataxia ?
Lacunar infarct
221
What type of inheritence is a1atd?
Autosomal recessive
222
What does alpha 1AT protect against?
Neutrophil elastase
223
Sx of A1AT deficiency?
Emphysema --> cough, SoB, freq URTI | Cirrhosis / HCC or cholestasis
224
Ix for A1AT deficiency?
A1AT levels / plasma AAT Spirometry - obstructive Phenotyping

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