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Semester 4 (NME) > Clinical Info > Flashcards

Flashcards in Clinical Info Deck (72):
1

Where is pain from the forgut organs often referred to?

Epigastric region

2

Where is pain from the midgut organs often referred to?

Umbilical region

3

Where is pain from the hindgut organs often referred to?

Flank/ Hypogastric region

4

Where is pain from the kidney often referred to?

'Loin to groin'
(With some pain in hypogastric)

5

A patient presents with pain in the epigastric region, what are your main differentials?

MI
Pancreatitis
Peptic ulcer disease (duodenal)
Cholecystitis
GORD or perforated oesophagus

6

A patient presents with pain in the RUQ, what are your main differentials?

Hepatitis/ hepatomegaly
Billary colic (a type of gallstones)
Pleurisy (from pneumonia)
Pylonephritis (kidney infection)

7

A patient presents with pain in the LUQ, what are your main differentials?

Gastric ulcer
Ruptured spleen
Pleurisy (from pneumonia)
Pylonephritis (kidney infection)

8

A patient presents with pain in the RLQ, what are your main differentials?

Appendicitis
Diverticulitis
Renal stones
Crohns
Hernia

9

A 60yo patient presents with pain in the flank and back pain, what is the first thing which must be checked for?

AAA

10

A patient presents with pain in the LLQ, what are your main differentials?

Diverticulitis
Left femoral/ inguinal hernia
Renal stone
Ectopic pregnancy

11

Rebound tenderness is a classic sign of...?

Appendicitis
(Press down and let go, pain increases when you let)

12

What IV antibiotics would you give to a patient who presented with an acute GI infective problem (e.g. appendicitis)

IV cephalosporin + metronidazole

13

A patient comes in with suspected appendicitis/ pancreatitis/ similar what do you do for and in what order?

ABCD examination- NIL BY MOUTH
Give O2 and fluids if needed (ie if beginning to shock)
Give painkillers (mophine) and antiemtic (cyclizine)
ABCD again/ Take history/ Do examination
NG tube if needed to aspirate stomach/ bowel contents

14

What IV antibiotics would you give to a patient who presented with an acute GI infective problem (e.g. appendicitis)

IV cephalosporin + metronidazole

15

What extra thing would you check for in F of childbearing age who presented with abdo pain?
Why?

Pregnancy test
Concern for ectopic pregnancy

16

What are the 4 types of kidney stones?

Calcium oxylate
Urease
Magnesium phosphate
Cystine

17

How do you distinguish between primary and secondary hyperparathyroidism using PTH/Ca2+ levels?

Primary: HIGH PTH, HIGH Ca2+
Secondary: HIGH PTH, LOW/NORM Ca2+
(In secondary the high PTH is due to trying to correct for the low Ca2+)

18

What is pseudohypoparathyroidism?

Where PTH levels are normal and the gland is fully functional but the target cells are insensitive to PTH

19

What are the symptoms of hyperparathyroidism?

Bone pain/ tenderness. Dehydration associated with hypercalcemia

20

What are the symptoms of hypoparathyroidism?

Based around Hypocalcaemia
Muscle cramps, parathesia (especially oral), insomnia, fatigue, tetany (cramps of hand muscles)
Cardio: Increased HR/ decreased contractility/ QT prolongation

21

Long QT syndrome can often be associated with hypoparathyroidism because...

Hypocalcaemia
(electrolyte imbalances causes disturbance)

22

What are the NICE guidlines for treating hyperthyroidism?

Start carbimazole (10mg, 2/3x daily, weight dependant)
- If pregnant use propylthiouracil instead
Monitor T4 levels and tritrate dose according to this (not TSH)
Add propanalol (or if can't - Diltiazem (CCB))

23

Propylthiouracil should never be used first line for hyperthyroidism, because of the risk of ?X?, except in the following circumstances (list 3)

X= Severe liver injury
Exceptions: 1st trimester pregnancy/ thyroid storm and if can't use carbimazole/ radioiodide

24

What are the advantages/ disadvantages of radioiodide treatment vs. thionamide treatment?

RI Advantage: Usually v. successful
RI Disadvantage: High hypo risk/ precautions needed
T Advantage: Easy/ less hypo risk
T Disadvantage: Not as successful/ more SE's

25

When is surgical thyroidectomy treatment indicated?

If there is suboptimal response to anti-thyroid medication or radio-iodine, especially in P who are pregnant or who have Graves' orbitopathy
Toxic adenoma or toxic multinodular goitre = SURGERY

26

When is treatment for hyperthyroidism with radioactive iodine indicated?

I(131) used in younger age groups as first line
NB: No additional cancer risk

27

What precautions must be taken when taking I(131)?

Single dose with precautions upto 2wks after
Little contact with people/ especially pregnant or children!

28

What are the NICE guidelines for treating hypothyroidism?

Treat with levothyroxine.
P who are stable on levothyroxine require at least annual measurement of serum TSH (To check adherence + to ensure that the dosage is still correct)

29

What is Hashimoto's thyroiditis?

Chronic lymphocytic thyroiditis
(T-cell infiltration and destruction leading to hypothyroidism)
Autoantibodies to thyroperoxidase/ thyroglobulin

30

What scan can test for Graves disease (as a cause) in a patient with hyperthyroidism?

Isotope thyroid scan
Swallow (technetium isotope)- scan to measure how much thyroid absorbs
High absorbtion= Graves/ nodules
Low= Thyroiditis/ iodine deficiency/ thyroid cancer

31

How do you test for Graves disease (as a cause) in a patient with hyperthyroidism? (2)

TSI Blood test and Isotope thyroid scan

32

What factors can give a pseudo T4 result which can show hypo/hyperthyroidism when there is none?

Pregnancy/ oral contraceptive = Increased protein binding so gives higher than true T4 level
Severe illness/ corticosteroid use = Decreased protein binding so gives lower than true T4 level

33

When are serum T3 levels useful as a measurement?

In diagnosing hyperthyroidism (when T4 is normal but disease is suspected)
Not useful for hypothyroidism as levels only drop when disease is severe

34

How is an isotope thyroid scan carried out and what can it's results show?

Swallow (technetium isotope)- scan to measure how much thyroid absorbs (scintillation counter used 6hours post drink)- Normal uptake (15-25%)- Use I(131) or I(123)
High absorbtion= Graves/ nodules
Low= Thyroiditis/ iodine deficiency/ thyroid cancer

35

if a patient is in a critical condition what type of O2 do you start them on?
When would you consider to adjust

100% high flow (15L/min)
*Until sats of 94-98%, then can lower

36

What tests need to be reguarlly done on patients taking methotrexate?

LFT's
- SE is causing hepatitis

37

What are some of the ‘alarm symptoms’ related to dyspepsia that suggest serious disease?

Dysphagia/ weight loss/ protracted vomiting/ anorexia/ melaena/ haematemesis

38

What are the guidelines for investigation of suspected PUD?

P under 55 with suspected PUD and H.Pylori +ve start eradication therapy
P over 55 requires endoscopy, GU’s always require biopsy
Endoscopy required if alarm symptoms present

39

What key symptoms based around eating allow one to distinguish between DU’s and GU’s?

DU’s: Pain 2-3 hours after meals and pain is relieved with food
GU’s: Pain as eating food and immediately after

40

What is the most common way of presentation in peritonitis?

Sudden, severe pain which initially develops in upper abdomen and rapidly becomes generalised. Pain in shoulder tip due to irritation of diaphragm/ phrenic nerve. Accompanied by shallow respiration and abdo guarding.

41

What is the most common complication of PUD and how does it present?

GI bleeding
Presents as melena or hematemesis

42

What is the NICE recommended treatment for PUD?

4-8wks of PPI (omeprazole)
If H.Pylori (Metronidazole + clarithromycin/ tetracycline)
If NSAIDS- Stop NSAID

43

A patient with a newly diagnosed DU is also found to be anemic, what complication is suspected?

Slow internal bleed (DU gone down to BV)

44

How do you treat diverticulitis?

High fibre diet + paracetamol
AB's if diverticulitis
Surgery if serious complications

45

How does pain from appendicitis present?

Generalised (whilst pressing on viscera), once it presses on the peritoneum it presents as a sharp localised pain in the right iliac fossa

46

A 45-year-old female with nephrotic syndrome develops renal vein thrombosis. What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?

Loss of antithrombin III

47

Which one of the following may be used to monitor patients with colorectal cancer?
A) CA-125 B) Carcinoembryonic antigen
C) Alpha-fetoprotein D) CA 19-9 E) CA 15-3

B (Carcinoembryonic antigen for colorectal)
CA-125: ovarian cancer,
AFP: Hepatocellular cancer
CA 19-9: Pancreatic cancer
Ca-15-3: Breast Cancer

48

What blood tests could be done to diagnose coeliac disease?

Anti-endomyseal/ anti-reticulin/ anti-gliadin
(Antibodies in blood)

49

What is the treatment for Crohns disease?

Mesalazine
Steroids for flare ups

50

What is Telangiectasia?

Small dilated blood vessels[1] near the surface of the skin or mucous membranes,

51

Name two signs that a Px is dehydrated:

Sunken eyes
Reduced tissue turgor

52

What is achalasia?

A disorder of motility of the lower oesophageal sphincter. The smooth muscle layer of the oesophagus has impaired peristalsis and the LES fails to relax causing stenosis

53

What symptoms characterise achalasia?

Dysphagia (mainly solids)
Regurgitation
Chest pain/ heartburn
Weight loss

54

How could you distingusih achalasia from benign oesophageal strictures?

Achalasia- No reflux
BOS- Caused (commonly) by GORD

55

What is the diagnostic criteria for impaired fasting glucose?

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

56

What is the diagnostic criteria for impaired glucose tolerance?

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT (oral glucose tolerance test) 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

57

What is the clinical name for death rattle and what causes it?

Terminal respiratory secretions
- Where bronchial secretions and saliva etc increased an unable to be cleared (strong indicator of impending death)

58

What drugs would be given in palliative care to ease the symptoms of death rattle?

Glycopyrronium, glycopyrolate, hyoscine hydrobromide (scopolamine) or atropine
- All have anti-cholinergic effects to reduce secretions

59

What marker may be used to monitor patients with colorectal cancer?

Carcinoembryonic antigen (CE)

60

What marker may be used to monitor patients with ovarian cancer?

CA-125

61

What marker may be used to monitor for hepatocellular cancer?

AFP

62

What marker may be used to monitor for breast cancer?

CA-15-3

63

What marker may be used to monitor for pancreatic cancer?

CA-19-9

64

Wheeze heard on auscultation indicates what?

Forced airflow through narrowed airways

65

Coarse crackles heard on auscultation indicates what?

Fluid in the lungs

66

Fine crackles heard on auscultation indicates what?

Small airway collapse

67

Dark urine or pale stool can indicate what in relation to bilirubin?

High levels of conjugated bilirubin (soluble)
- Shows post hepatic jaundice (caused by something such as cholestasis- which would also give an itch)

68

What is cholestasis?

Impaired flow of bile (i.e. due to blocked canaliculi)
- Note dark urine/ pale stools/ itch/ jaundice

69

A Px presents with dark urine, pale stools and jaundice. What type of jaundice is this likely to be?

Post hepatic

70

Name 3 causes of post hepatic jaundice?

Pancreatitis, cholestasis, gallstones

71

Why do patients with renal failure experience high blood pressure?

Renal failure = hyperkalaemia
Hyperkalaemia = increased aldosterone release

72

Pain from appendicitis typically presents with pain where?

From periumbilical region to right iliac fossa