Cheat Sheet Flashcards
(130 cards)
1
Q
What are the crescendo decrescendo murmurs/ ejection systolic?
A
Left sided
- Aortic stenosis
- HOCM
Right sided
- Pulmonary stenosis
2
Q
What are the holosystolic murmurs?
A
Left sided
- Mitral regurgitation
- Ventricular septal defects
Right sided
- Tricuspid regurgitation
3
Q
What are the decrescendo murmurs?
A
Left sided
- Aortic regurgitation
Right sided
- Pulmonary regurgitation
4
Q
What are the decrescendo crescendo murmurs?
A
Left sided
- Mitral stenosis
Right sided
- Tricuspid stenosis
5
Q
What is the manoeuvre to increase aortic stenosis?
A
Ask the patient to hold their breath and auscultate the carotids using the diaphragm
6
Q
What is the manoeuvre to increase aortic regurgitation?
A
Ask the patient to sit forward and fully exhale and auscultate over the right sternal boarder 2nd ICS
7
Q
What is the manoeuvre to increase mitral regurgitation?
A
Ask the patient to lean on their left side and fully exhale, auscultate at the apex using the diaphragm and at the axilla for radiation
8
Q
What is the manoeuvre to increase mitral stenosis?
A
Ask the patient to lean on their left side and full exhale and auscultate over the apex with the bell
9
Q
Which drugs can cause pre-renal AKI?
A
- Vasoconstrictors
- Antihypertensives
- NSAIDs
- Cyclosporins (occasionally used in Crohn’s)
- Diuretics
- Laxatives
- Tacrolimus
10
Q
What is tacrolimus?
A
An immunosuppresant drug commonly prescribed to patients after organ transplant
11
Q
What is osteopetrosis?
A
Increased bone density which can make bones brittle and liable to break
12
Q
How does hypothyroidism lead to arthritis?
A
Hypothyroidism increases TSH levels and TSH increases deposition of proteins in the joints
13
Q
What would blood results for osteopetrosis show?
A
- Normal/ low serum Ca2+
- Normal serum PO43-
- Normal ALP
- Normal PTH
Dense and brittle bones
14
Q
What is Paget’s disease of the bone?
A
Pathological remodelling of the bones leading to abnormal bone formation
15
Q
What would bloods for Paget’s disease of the bone show?
A
- Normal Ca2+
- Normal PO43-
- Increased ALP
- Normal PTH
16
Q
What is osteitis fibrosa cystica?
A
It results due to hyperparathyroidism and is abnormal breakdown of bone with bone tissue replaced with fibrous tissue
17
Q
What are the blood results for osteomalacia/ rickets?
A
- Low Ca2+
- Low PO43-
- High ALP
- High PTH
18
Q
What is the mechanism of tertiary hyperparathyroidism?
A
Chronic secondary hyperparathyroidism that leads to hyperplasia of the PTH glands with very high levels of PTH and normal-high calcium
19
Q
How is GCS calculated?
A
Motor
6- movement on command
5- localises to pain
4- withdraws from pain
3- abnormal flexion
2- abnormal extension
1- no movement
Verbal
5- fully orientated
4- confused
3- inappropriate words/ sentences
2- incomprehensible sounds
1- no speech
Eyes
4- opens eyes spontaneously
3- opens eyes on command
2- opens eyes to pain
1- does not open eyes
20
Q
What GCS would indicate minor brain injury?
A
15-13
21
Q
What GCS would indicate moderate brain injury?
A
13-8
22
Q
What GCS would indicate severe brain injury?
A
8-3
23
Q
What GCS would require airway support?
A
8
24
Q
What is AFP a tumour marker for?
A
- Testicular teratomas
- Hepatocellular carcinoma
25
What is beta-hCG a tumour marker for?
- Testicular cancers
- Choriocarcinoma
26
What is Ca 15-3 a tumour marker for?
Breast cancer
(As well as BRCA-1 chromosome 17, BRCA-2 chromosome 13)
27
What is Ca 19-9 a tumour marker for?
Pancreatic cancer
28
What is calcitonin a tumour marker for?
Medullary thyroid cancer, due to the follicular cells in the medulla producing calcitonin
29
What is CEA a tumour marker for?
Colorectal cancer
30
What is monoclonal Ig a tumour marker for?
Multiple myeloma
31
What is neurone-specific enolase a tumour marker for?
Small cell lung cancer
32
What is placental ALP a tumour marker for?
- Ovarian carcinomas
- Testicular carcinomas
33
What is PSA a tumour marker for?
Prostate carcinoma
34
What is S-100 a tumour marker for?
Malignant melanoma
35
What is thyroglobulin a tumour marker for?
Thyroid cancer
36
What is a choriocarcinoma?
Carcinoma of the cells left of the placenta post delivery
37
What is neurogenic shock?
Loss of control of the blood pressure and heart rate due to damage to the spinal cord/ nerves
38
What is the managment of meningitis?
IV benzylpenicillin followed by Ceftriaxone
39
What is the Glasgow score for acute pancreatitis?
PaO2 \< 7.9mmol/L
Age \> 55
Neutrophils \>15x10^9
Calcium \< 2mmol/L
Renal function (urea \>16mmol/L)
Enzymes (LDH \>600, AST \>200)
Albumin \<32 mmol/L
Sugar \>10 mmol/L
Score of \>3 indicates acute severe pancreatitis
40
What is the extrinsic vs intrinsic clotting pathway?
41
What is the pathophysiology of haemophilia A vs B?
X-linked recessive
42
What is the inheritance pattern of haemophilia A and B?
X-linked recessive
43
What are the absolute contra-indications for fibrinolysis in ischaemic stroke patients?
- Bleeding disorder
- Age \>75
- Any previous intracranial haemorrhage
- Any head trauma
- Recent surgery
44
What is seen on blood smear for ALL?
Blast cells (as well as on bone marrow aspirate)
45
Which is the only leukaemia that doesn't tend to present with hepatomegaly?
Chronic myeloid leukaemia although it does present with splenomegaly
46
What is seen on blood smear of acute myeloid leukaemia?
Auer rods
47
What is seen on blood smear of chronic lymphocytic leukaemia?
Smear cells
48
What is CML associated with?
Philadelphia chromosome
Translocation between 9 and 22 involving the BCR-ABL1 gene
49
What is a common side effect of co-amoxiclav?
Cholestatic hepatitis
50
What is a common side effect of erythromycin?
Diarrhoea
51
What is a common side effect of gentamicin?
Nephrotoxicity
52
What is a common side effect of nitrofurantoin?
Pulmonary fibrosis
53
What does malaria cause on blood smear?
Schistocytes
54
Which condition are Heinz bodies commonly observed in?
G6PD deficiency
55
What is haemolyric uraemic syndrome?
A post E.coli 0157h7 diarrhoea infection that commonly occurs in children with the traid:
- Renal failure
- Thrombocytopaenia
- Microangiopathic haemolytic anaemia
56
What is Henoch Schonlein Purpura?
An IgA nephropathy that commonly occurs in children post upper respiratory tract infection consisting of the traid:
- Purpura
- Abdominal pain
- Arthritis
57
What are the blood results for iron deficiency anaemia?
- Decreased Fe2+
- Decreased Hb
- Decreased Ferritin
- Increased Transferrin
- Decreased Transferrin saturation
- Increased TIBC
58
What are the blood results for anaemia of chronic disease?
- Decreased serum iron
- Decreased Hb
- Increased ferritin
- Normal/ low transferrin
- Decreased transferrin
- Normal/ high TIBC
59
What is thalassaemia trait confirmed by?
Hb electrophoresis
60
What is the pathophysiology of anaemia of chronic disease?
Increased hepcidin activation leading to increased iron sequestration in the tissues and decreased Fe2+ in the plasma
61
Which HLA is involved in Rheumatoid arthritis?
HLA-DR4`
62
What are the seronegative spondyloarthropathies?
* Psoriatic arthritis
* Enteropathic arthritis
* Ankylosing spondylitis
* Reactive arthritis
63
What are the three small vessel vasculidities?
* Microscopic polyangiitis
* Granulomatosis with polyangiitis
* Eosinophilic granulomatosis with polyangiitis
64
Which is the only Hepatitis virus to have DNA rather than RNA?
B
65
Which hepatitis is most commonly chronic?
C is most commonly chronic, however B, C, D and E can all become chronic
66
Which is the only hepatitis virus that will not become chronic?
A
67
Which antibodies are associated with UC vs Crohn's?
* Ulcerative colitis- pANCA
* Crohn's- ASCA (IgG/IgA)
68
Where are arterial ulcers commonly found?
* Lateral malleolus
* In between the toes
* Soles of the feet
69
What is the appearance of arterial ulcers?
* Punched out
* Rough edges
* Necrotising tissue
70
What is the skin around an arterial ulcer like?
* Tight and shiny
* Hairless
* Pale
* Pulseless
* Prolonged cap refill
71
What is the management of an arterial ulcer?
* Anti-platelets
* Revascularisation
* Reduction of risk factors
72
Where do pressure ulcers form?
On sights of high pressure loading such as bony prominences
73
What is the best initial investigation for arterial ulcer?
ABPI
74
What is the best initial investigation for venous ulcer?
Duplex ultrasound
75
What are the best investigations for neuropathic ulcers?
* Pain
* Neurofilaments
* Fine touch
* Vibration sensation
76
What is the hypertension management algorithm?
Black and/ or \>55
1. CCB
2. ACEi or ARB
3. Thiazide diuretic
4. If K+ \>4.5 beta blockers, if K+ \<4.5 spironolactone
T2DM and/ or \<55
1. ACEi or ARB
2. CCB
3. Thiazide diuretic
4. If K+ \>4.5 beta blockers, if K+ \<4.5 spironolactone
77
What is the management of T2DM?
1. Monotherapy with metformin or sulphonylurea (gliclazide, glimeperide)
2. Dual therapy with M/S and DPP-4 inhibitor (-gliptin), SGLT-2 inhibitor (-flozin) or GLP-1 agonist (-tide)
3. Insulin
78
What is needed on the Duke's criterion to make a diagnosis of infective endocarditis?
* 2 majors
* 1 major, 3 minors
* 5 minors
79
What are the stages of heart failure?
* Class 1- no change to daily activities
* Class 2- difficulty performing activities on exertion, but comfortable at rest
* Class 3- marked limitation in physical activites, but comfortable at rest
* Class 4- unable to complete physcial activites, cardiac pain even at rest
80
What are the symptoms of a middle cerebral artery stroke?
* Contralateral hemisensory deficits face\>arm\>leg
* Contalateral weakness
* Contralateral homonymous hemianopia
* Aphasia if on the left side
81
What is the difference in hemiparesis between anterior and middle cerebral artery occlusions?
Anterior tends to affect the lower extremities, whereas middle tends to affect the upper extremities
82
What temperature should red blood cells be stored at prior to infusion?
4 degrees
83
What is the timeframe of blood transfusion for non-urgent scenarios?
Blood should be transfused over 90-120 minutes
84
What is the red blood cell transfusion threashold and haemoglobin aim after transfusion for patients without ACS?
* Threshold- 70g/L
* Haemoglobin aim- 70-90g/L
Patients with ACS
* Threshold- 80g/L
* Haemoglobin aim- 80-100g/L
85
What does fresh frozen plasma contain?
* All the clotting factors
* Platelets
* VWB factor
* Complement
86
What does cryopercipitate contain?
It's a more concentrated version of fresh frozen plasma, therefore the doseage is lower
* Lots of fibrinogen (usually given to fibrinogen deficient patients)
* Factor VIII
* Factor XIII
* ADAMTS-13
87
When would cryopercipitate be used over fresh frozen plasma?
If the patient was fibrinogen (factor I) deficient or has VWB disease
88
What is primary immune thrombocytopaenic purpura?
Thrombocytopaenia and petichiae occurring in children approximately 3 weeks after a viral prodrome
It's often self limiting and is a diagnosis of exclusion, however severe cases can be managed with IVIG/ steroids for active bleeding and
89
What is the management of TTP?
* Consult haematologist
* Plasma exchange with FFP
90
What is the management algorithm for chronic asthma?
1. SABA
2. SABA + low dose inhaled ICS
3. LTRA + low dose inhaled ICS
4. (+- LTRA) LABA + low dose inhaled ICS
5. (+- LTRA) LABA as a MART + low dose inhaled ICS
6. (+- LTRA) LABA as a MART + medium dose inhaled ICS
91
When would you consider reducing maintenance therapy for asthma?
If the patient has been on effective asthma therapy for at least 3 months and asthma is well controlled
92
What are the indications of moderate asthma?
* PEFR 50-75% of targeted peak flow or previous best
* Speech normal
* Resp rate \<25
* Pulse \<110
93
What are the indications of severe asthma?
* PEFR 33-50% of predicted or previous best
* Unable to speak in full sentences
* Resp rate \>25
* Heart rate \>110
94
What are the indications of life-threatening asthma?
* PEFR \<33% previous best or predicted
* Unable to speak
* O2 \<92%
* Silent chest
* CO2 normal is a very bad sign as it indicates fatigue
* Cyanosis
95
What is the class of theophylline?
Bronchodilator
96
What is the management of a life threatening asthma exacerbation?
* A-E assessment
* High flow O2
* High dose inhaled SABA
* Oral prednisolone
97
What is the management of moderate and severe asthma exacerbations?
All SABAs in acute asthama should be given via oxygen-driven nebuliser or IV if the patient can't take via nebuliser
Moderate
* A-E assessment
* SABA
* Oral prednisolone
Severe
* A-E assessment
* SABA
* Oral prednisolone
98
What is the asthma diagnostic pathway for adults over 17 who are symptomatic?
Reversible airway obstruction on spirometry with FeNO \>40ppb or variability in peak flow readings
99
What investigations should be ordered in suspicion of asthma?
Bedside
* Spirometry with bronchodilator therapy
* FEV1/FVC
* PEFR
* FeNO
Bloods
* FBC
* Eosinophils
* CRP/ ESR
Imaging
* Chest x-ray
100
What is the Well's Score for PE?
* Signs of DVT- 3
* Alternative diagnosis to PE unlikely- 3
* Surgery within the past 4 weeks, or immobile for 3 or more days- 1.5
* Previous PE/ DVT- 1.5
* Tachycardic- 1.5
* Haemoptysis- 1
* Malignancy- 1
\>4 CTPA, \<4 D-dimer
101
What is the management algorithm of COPD?
1. SABA or SAMA
Asthmatic features
1. LABA + ICS
2. LAMA (if poorly controlled)
No asthmatic features
1. LABA + LAMA
2. ICS (if poorly controlled)
102
What are some examples of SABAs?
* Salbutamol
* Terbutaline
103
What are some examples of SAMAs?
Ipratropium
104
What are some examples of LABAs?
* Formeterol
* Salmeterol
105
What are some examples of LAMAs?
Tiotropium
106
What is the management of acute exacerbation of COPD?
* Inhaled SABA
* Oral corticosteroid
* O2 via venturi mask
107
How should O2 be administered to COPD patients in acute respiratory failure?
Via venturi mask, as it can be tightly titrated to ensure their sats are 88-92%
108
What is the HAS-BLED score?
The score used to calculate a patients one year risk of bleeding when taking anticoagulents in AF
109
What are the thresholds for CHAD-VASc score?
* 1= aspirin or warfarin
* 2= warfarin
110
Which antibiotic should be given if pneumonia is severe (CURB-65 \>=3)?
Co-amoxiclav
111
What is the first line antibiotic for hospital acquired pneumonias?
Co-amoxiclav
112
Does cardiac tamponade cause Kussmaul's sign?
No, only constrictive pericarditis
113
Which organisms are most commonly associated with infection in bronchiectasis patients?
* Pseudomonas aeruginosa
* Streptococcus pneumoniae
* Staph aureus
114
What is the surgical managment of renal stones?
* 5-7mm stones usually pass on their own
* 10mm offer SWL and consider ureteroscopy if unsuccessful
* 10-20mm offer ureteroscopy (consider SWL if contraindicated) and consider PCNL
* \>20mm offer PCNL or if the stone is a staghorn
115
What medications can be offered for renal calculi less than 10mm?
Alpha blockers such as Tamsulosin
116
What are the first choice oral antibiotics for pyelonephritis?
* Cefalexin
* Co-amoxiclav
* Trimethoprim
* Ciprofloxacin
117
What is the classification of Parkinson's disease vs dementia with Lewy bodies?
* If dementia symptoms come on within one year of motor symptoms--\> dementia with Lewy bodies
* If motor symptoms are more than 1 year before the dementia symptoms--\> Parkinson's dementia
118
What is the pathophysiology of Lewy body dementia?
Lewy bodies building up in the cortex and midbrain leading to generalised atrophy
119
What is the pathophysiology of Frontotemporal dementia?
Pick's bodies accumulating in the cortex leading to frontal and temporal atrophy
120
What is the criteria for Rheumatic fever?
The Jones criteria, two majors or one major and two minors are needed for a diagnosis
**Major**
* **J**oint involvement
* **O** looks like a heart - myocarditis/ valve involvement
* **N**odules (subcutaneous)
* **E**rythema marginatum
* **S**ydenham's chorea
**Minor**
* **P**revious rheumatic fever
* **E**CG prolonged PR interval
* **A**rthralgia
* **C**RP and ESR raised
* **E**levated temperature
121
What is the anaesthetic pre-operative ASA criteria?
* ASA 1- normal healthy patient
* ASA 2- mild systemic illness
* ASA 3- severe systemic illness that is not life threatening
* ASA 4- severe systemic illness that is life threatening
* ASA 5- moribund patient that will die without surgery
122
What is the management of heart failure?
Heart failure with reduced ejection fraction diagnosed via specialist (ejection fraction \<40%):
1. ACEi and beta blockers
2. Spironolactone
123
What are the signs and symptoms present with MEN1 vs MEN2a vs MEN2b?
**MEN 1**
* Pituitary adenoma
* Parathyroid hyperplasia
* Pancreatic tumours
**MEN 2a**
* Parathyroid hyperplasia
* Medullary carcinoma
* Phaeochromocytoma
**MEN 2b**
* Mucosal neuromas (neurofibromatosis)
* Marfanoid body habitus
* Medullary carcinoma
* Phaeochromocytoma
124
What is an essential tremor?
A benign tremor that usually affects the hands bilaterally and is alleviated by alcohol
* Usually of the hands (rarely with leg involvement)
* No other neurological symptoms
* Can be isolated in the head
125
What is dystonia?
Abnormal muscle movements
126
What is a Parkinsonian tremor?
Pill rolling tremor alleviated by movement, usually in the legs and hands
127
What is a cerebellar tremor?
A tremor exacerbated by reaching (intention tremor) often accompanied with limb ataxia and dysmetria
128
What is a physiologic tremor?
A tremor exacerbated by sympathetic stimulants such as caffiene and exacerbated by movement, it can involve the face and extremities
129
What are the investigations to confirm a T1DM diagnosis?
Symptomatic patients need one positive test, asymptomatic patients need two positive tests
1. Random glucose \>= 11.1mmol/L
2. Fasting glucose \>= 7 mmol/L
3. Two hour post prandial glucose \>= 11.1 mmol/L
4. Urine glucose and ketones
5. HbA1c
130
What are the investigations to confirm a T2DM diagnosis?
1. HbA1c \>= 48mmol/L
2. Fasting glucose \>=7 mmol/L
3. Random glucose \>= 11.1 mmol/L
4. Two hour post prandial glucose \>= 11.1 mmol/L
