Clinical Flashcards by Sarah McArthur

Macro and micro vascular complications of diabetes?

Macro vascular:
Heart attack, angina
Stroke
Peripheral vascular disease

Micro vascular:
Retinopathy
Diabetic nephrology
Neuropathy

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Cardiovascular risk history points

CHOKLEDDS

Coronaries
Hypertension
Obesity
Kidneys
Lipids
Exercise
Diabetes
Diet
Smoking

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Decompensated liver disease signs

JEAVS C

Jaundice
Encephalopathy
Ascites
Variceal bleeds
SBP
Coagulopathy

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Signs of portal hypertension

S CARS

Splenomegaly

Caput Medusa
Ascites
Rectal/oesophageal varices
Spider naevi

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Differential list for:

Pansystolic murmur

Mitral regurgitation
Tricuspid regurgitation
VSD
HOCM (though usually ESM)

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Differential list for:

Ejection systolic murmur

Aortic stenosis
Aortic sclerosis
HOCM
ASD
Pulmonary stenosis

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Mitral regurgitation signs of severity

PLEDS S123

Pulmonary hypertension

Left heart failure

Early diastolic rumble (due to increased flow in diastole)

Displaced volume loaded apex beat

Small pulse volume (very severe)

Soft S1

Split S2

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Aortic stenosis signs of severity

SLAPS

Slow rising, low volume carotid pulse

Left heart failure

Aortic thrill

Paradoxical splitting of S2

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Echo criteria for severe aortic stenosis

Mean gradient: >40

Vmax >4

Aortic valve area <1

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Acromegaly features

Hands:
Large
Thick skin
Median nerve entrapment/Carpal tunnel
Hyperhydrosis

Feet:
Wide
Thick heel pad

Upper limb:
Proximal myopathy
Axilliary skin tags
Blood pressure

Face:
Visual fields with pin
Fundoscopy
Macroglossia
Frontal bossing
Enlarged mandible
Teeth splaying
Acne
Hirsutism

Chest:
Gynaecomastia
Galactorrhoea
Heart

Abdomen:
Organomegaly
Testicular atrophy

Lower limbs:
Osteoarthritis
Pseudogout

Ask for urine looking for glycosuria

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Acromegaly features

Hands:
Large
Thick skin
Median nerve entrapment/Carpal tunnel
Hyperhydrosis

Feet:
Wide
Thick heel pad

Upper limb:
Proximal myopathy
Axilliary skin tags
Blood pressure

Face:
Visual fields with pin
Fundoscopy
Macroglossia
Frontal bossing
Enlarged mandible
Teeth splaying
Acne
Hirsutism

Chest:
Gynaecomastia
Galactorrhoea
Heart

Abdomen:
Organomegaly
Testicular atrophy

Lower limbs:
Osteoarthritis
Pseudogout

Ask for urine looking for glycosuria

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Causes of isolated Splenomegaly?

HAEM RIP

Haematological

Infection: CMV EBV

Portal hypertension with cirrhotic liver

Rheum: feltys syndrome

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Causes of isolated Splenomegaly?

HAEM RIP

Haematological

Rheum: feltys syndrome

Infection: CMV EBV

Portal hypertension with cirrhotic liver

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Haem exam: where to next

Inguinal nodes
Hands
Elbow nodes
Face: eyes and mouth
Neck nodes
Spine
Shoulder bones
Hips bones
Legs

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Long case history screen
(MOCCHHASS)

Mental health
OSA
CKD
Chronic pain
Haem (clots/bleeding/anaemia)
Heart
Attacks
Strokes
Surgeries

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SHX
A-J

Accomodation
ADLs
Business
Coping?
Drives?
Every day is like…
Finances
GP
Home help
Insight
Judgement

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What does calcitriol indicate on a drug chart in CKD?

Secondary hyperparathyroidism

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Differential list:
- peripheral sensory neuropathy with reduced vibration and pinprick sense
- absent reflexes
- unsteady gait with Romberg positive

Peripheral sensory neuropathy without motor component:

Insults:
- Diabetes
- EtOH
- B12
- Chemo

Immune:
- Sensory variant CIDP
- Paraneoplastic

Hereditary:
- CMT

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Peripheral sensorimotor neuropathy
Absent reflexes
Dorsal columns affected, anterior spared

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CIDP
Paraneoplastic

Diabetes
EtOH
B12

Hereditary eg CMT

Upper motor neuron pyramidal weakness
Spastic gait
Hyperreflexia

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Hereditary spastic paraparesis
Cerebral Palsy

Cervical myelopathy

Bilateral lacunar infarcts

Ataxia
Nystagmus
Normal reflexes
Peripheral sensory neuropathy

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INSULTS EtOH

IMMUNE Paraneoplastic

HEREDITARY SCA

Dual pathology

Distal myopathy or LMN weakness

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Myotonic dystrophy
Critical illness myopathy
Inclusion body myositis
MND LMN variant

Macroalbuminuria:

Urine ACR over?

24h urine albumin?

Urine PCR over?

24hr urine protein?

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Urine ACR
Men >25
Women > 35

24 hr albumin >300

Urine PCR
Men >40
Women > 60

24hr protein > 500

Microalbuminuria

ACR cut off

PCR

Albumin

Protein

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ACR:
Men 2.5-25
Women 3.5-25

PCR:
Men 4-40
Women 6-60

Albumin
30-300

24h protein
50-500

Anaemia of CKD targets

Hb 100-115 Ferritin >200 Transferrin saturation >20% Manage hyper PTH or chronic inflammation

Management of renal bone disease and targets?

Manage hyperparathyroidism: Target 2-9x ULN Calcitriol for secondary hyperparathyroidism Vitamin D replacement (only if calcium and phosphate within targets) Cinacalcet in dialysis pts Parathyroidectomy for tertiary hyperparathyroidism Manage phosphate: Target to high end of normal range Phosphate binders with meals Low phosphate diet Keep in mind often get osteomalacia, DEXA not helpful as architectural problem rather than density problem

When to treat lipids in CKD?

Age >50 with any stage CKD should have statin Add ezetimibe below eGFR 60 Age < 50, statin if other risk factor (eg. Coronary disease)

Management renal acidosis?

Aim bicarb in low 20s Can give sodibic Keep in mind salt load can worsen fluid overload

Indications for dialysis

Acidosis Electrolytes Intoxication (drug build up) Overload Ureaemia

Management hyperkalaemia in CKD

Stop offending agents: Spiro ACE Lifestyle: Low K diet Drugs: SGLT2 or thiazide Resonium Dialysis

Management of OSA

Weight loss Avoid CNS depressants eg alcohol CPAP

Management restless legs

Iron replacement and replace if deficient Non pharm therapies Warm/cool compress Dopaminergic agents (eg pramipexole)

COPDX

Confirm diagnosis Optimise function - non pharm: pulm rehab - pharm: stepwise inhaler introduction Prevent deterioration - cease smoking, vaccines, mucolytics Develop plan of care - action plans, ACD Manage exacerbations - steroids - inhaled bronchodilators - antibiotics - oxygen - NIV for T2RF

Foot drop: Dorsiflexion weak Eversion weak All else in tact

Peroneal nerve

Foot drop: Inversion weak Eversion weak Dorsiflexion weak Hip abduction weak Internal rotation hip weak

Foot drop: Sciatic nerve

Inversion weak Eversion weak Dorsiflexion weak Plantar flexion weak Knee flexion weak Ankle jerk absent

Causes of upper lobe fibrosis?

SCHAART Sarcoidosis, silicosis CF Histiocytosis Ankylosis spondylitis Allergic bronchopulmonary aspergillosis Radiation Tuberculosis

Transplant issues

Immunosuppression side effects: - infection - malignancy - drug specifics Graft function Rejection (need surveillance) Psychosocial

Massive hepatomegaly Cm cut off? Differentials?

>20cm Myelofibrosis Myelodysplasia Cancer: Mets or hepatoma Chronic liver disease with fatty infiltration TR/severe RHF

Moderate hepatomegaly Cm cut off? Differentials?

15-20cm Haemochromatosis CML Lymphoma Fatty liver disease As for massive

Mild hepatomegaly Cm cut off Differentials

12-15cm NAFLD Haematological causes: CLL, myelofibrosis Chronic liver disease early stages

Massive Splenomegaly CM cut off Differentials

>7cm Myelofibrosis CML Myelodysplasia

Moderate splenomegaly Cm cut off Differentials

3-7cm Lymphoma CLL Polycythaemia rubra Vera Portal hypertension

Difference between NYHA III and IV

III comfortable at rest IV not comfortable at rest

Difference NYHA II and III

II = Slight limitation, symptoms with ordinary activity III = marked limitation, symptoms with less than ordinary activity

Difference between NYHA class I and II

Class I no symptoms Class II symptoms with ordinary activity

Clinical Flashcards

(46 cards)