Clinical Knowledge Flashcards
(299 cards)
1
Q
Temporal lobe
A
Auditory processing
Language comprehension (Wernicke’s area)
Memory/information retrieval
2
Q
Cerebellum
A
Balance and co-ordination
3
Q
Frontal lobe
A
Motor control
Problem solving
Speech production (Broca’s area)
4
Q
Parietal lobe
A
Touch perception
Body orientation and sensory discrimination
5
Q
Spinothalamic tract
A
Transmission of:
Pain
Temperature
Crude touch
6
Q
Brain stem
A
Involuntary responses
7
Q
Dorsal column-medial Lemniscus
A
Fine touch
Vibration
Pressure
Proprioception
8
Q
Occipital lobe
A
Sight
Visual reception and interpretation
9
Q
Corticospinal tract
A
Voluntary movements
10
Q
Corticobulbar
A
Muscles of the head face and neck
11
Q
Corticospinal tract path
A
Contralateral motor cortex - Midbrain - Medulla - decussates - Synapse with LMN at anterior horn - muscle
12
Q
Rubrospinal tract
A
Red nucleus of midbrain responsible for muscle flexion
13
Q
Babinski sign UMN lesion
A
Positive
14
Q
At what level is the superior and inferior mediastinum divided
A
Sternal angle
T4/T5 intervertebral disk
15
Q
Hypoglossal CN XII
A
Motor - tongue movement
16
Q
Lateral border of mediastinum
A
Mediastinal pleura
17
Q
Main mediastinal contents
A
Heart Oesophagus Trachea Thoracic nerves Systemic blood vessels
18
Q
Babinski sign LMN lesion
A
Negative
19
Q
Inferior border of the mediastinum
A
Diaphragm
20
Q
Facial CN VII
A
Sensory - Taste of anterior 2/3 of tongue
Motor - Facial expression, lacrimation, salivation
21
Q
Anterior border of mediastinum
A
Sternum
22
Q
Vagus CN X
A
Sensory - Taste to epiglottis
Motor - swallowing, talking, coughing
23
Q
Superior border of mediastinum
A
Superior thoracic aperture
24
Q
The internal thoracic artery is a branch of which artery
A
Subclavian
25
The phrenic nerve is most associated with what structure?
Pericardium
26
Glossopharyngeal CN IX
Sensory - Somatosensation of posterior 1/3 of tongue
Motor - swallowing
27
Oculomotor CN III
Motor- Eye movement, eyelid opening, pupillary constriction, lens accommodation
28
The recurrent laryngeal nerve is a branch of what nerve?
Vagus
29
Trigeminal CN V
Sensory - facial sensation, somatosensation of anterior 2/3 of tongue
Motor - open/close jaw
30
Accessory CN XI
Motor - Traps, SCM,
31
Vestibulocochlear CN VIII
Sensory - hearing and balance
32
Abducens CN VI
Motor - eye movement
33
Negative to positive
Depolarisation
34
Trochlear IIII
Motor - eye movement
35
What vertebral level is the iliac crest
L4
36
Olfactory CN I
Sensory - Smell
37
Which hormone regulates blood volume
Aldosterone
38
Two lateral ventricles drain in the third ventricle through the
Interventricular foramina
39
Function of brain ventricles
To house CSF
40
Where is CSF produced
Choroid plexus of ventricles
41
Branches of Aorta
```
Inferior Phrenic
Celiac trunk
SMA
Supra renal artery
Renal artery
Testicular artery
Lumbar arteries
IMA
Middle sacral
Common iliac
```
42
At what level does the common iliac vein become the inferior vena cava
L5
43
What vertebral level does the DA become the AA
T12
44
Optic CN II
Sensory - Vision
45
Two lateral ventricles drain in the third ventricle through the
Interventricular foramina
46
Function of brain ventricles
To house CSF
47
At what level does the common iliac vein become the inferior vena cava
L5
48
Where is CSF produced
Choroid plexus of ventricles
49
Where are baroreceptors found?
Carotid sinus
| Aortic arch
50
What vertebral level does the DA become the AA
T12
51
Branches of Aorta
```
Inferior Phrenic
Celiac trunk
SMA
Supra renal artery
Renal artery
Testicular artery
Lumbar arteries
IMA
Middle sacral
Common iliac
```
52
Where are baroreceptors located?
Carotid sinus, Aortic arch
53
What hormones are released from the medulla of the adrenal gland by sympathetic stimulation?
Adrenaline
Noradrenaline
Dopamine
54
Cardiac output =
HR x SV
55
What is stroke volume
Amount of blood left ventricle pumps in one beat
56
Beta blocker suffix
Lol
57
Stroke volume depends on?
Preload = increase in stretch
Contractility = increased force
After load decrease
59
ACE inhibitor suffix
PRIL
60
ARB suffix
Sartan
61
Coronary arteries
Anterior
RCA - RMA
LCA - LAD - LCFA
Posterior
RCA- RIVA
LCA
62
Coronary venous supply
Small cardiac vein
Middle cardiac vein
Great cardiac vein
Posterior vein
63
CHF treatment
```
Ace inhibitors
ARB’s
Aldosterone antagonists
Beta blockers
Diuretics
```
64
Consistent prolonged PRI
First degree heart block
65
PRI getting progressively longer until dropped QRS (Long long drop)
Second degree heart block type 1
66
Normal PRI until dropped QRS
Second degree type 2
67
P wave and QRS complex are in sync to themselves but no correlation between each other. Super Brady
Third degree heart block
68
Prazole
PPI’S
69
Which cells are Responsible for production and release of stomach acid?
Parietal cells
70
B cells are responsible for
Antibody production
71
Mast cells are responsible for
Releasing inflammatory mediators
72
Dendritic cells
Antigen presentation to aid recruitment of white cells
73
Goblet cells
Mucus producing cells
74
Sympathetic innervation of the bladder
Thoracic and lumbar spine
75
Parasympathetic innervation of the bladder
Sacral spinal cord
76
Most common organism in dog bites
Pasteurella multocida
77
Innate immune system consists of
Physical barrier (skin, mucus membrane)
Chemical signals
Inflammation
78
Phagocytes are part of the
Innate immune system
79
Lymphocytes are part of the
Adaptive immune system
80
Cytokines
Molecules that are used for cell signalling
81
Cell responsible for inflammation
Mast cells
82
Hypokalaemia symptoms
Muscle weakness, muscle cramps, constipation, neurological symptoms
83
Hemiballismus
Damage to the subthalmic nucleus of basal ganglia. Characterised by violent involuntary movements of the limbs on one side of the body
84
Butterfly rash on face
Lupus
85
Adrenaline is produced in the
Medulla of the adrenal gland
86
Most common cause of meningitis in adolescents
Neisseria meningitis
87
U waves on ECG can be caused by
Hypokalaemia
88
Mycin
Macrolides
89
What antibiotic and cause torsades de pointes
Macrolides
90
EF=
SV/EDV X 100
91
Most common cause of ottitis media infection
Strep pneumoiae
92
Causes of AFIB
```
Age
Inflammation
Enlarged atria
Lung disease
Hormonal abnormalities
Alcohol abuse
```
93
Drugs ending in lactone
Potassium sparing diuretics
94
Resting phase in cardiac action potential
Phase 4
95
Vaughan Williams class 3 drugs act on
Potassium transporters in cardiac conduction
96
Auto antibodies found in thyroid autoimmune diseases
Anti thyroid peroxidase (Anti-tpo)
| Anti thyroglobulin antibodies
97
Most common cause of hypothyroidism in developing world
Iodine deficiency
98
Primary hypothyroidism causes and TSH, T3 and T4 levels
Autoimmune - TSH high T3 and T4 low
99
Secondary hypothyroidism causes and TFT levels
Pituitary pathology - Low TSH low T3,T4
100
Hypothyroidism treatment
Levothyroxine
101
Pretibial myxoedema
Found in hyperthyroidism discoloured waxy, oedematous on shins
102
Common cardiac symptoms
```
.Pain or pressure in the chest
.pain or discomfort in the arms, left shoulder, elbows, jaw or back
. SOB
.Nausea
.Fatigue
.Lightheadedness or dizziness
.cold sweats
```
103
Stable angina symptoms, investigations and treatment
Pain on exertion that goes away when resting
104
Bronchiectasis
Dilation of the bronchioles caused by an infection it is irreversible and is an obstructive respiratory condition. Most common cause CF and TB
105
Bronchiectasis symptoms
A lot of Foul smelling sputum
Hemoptysis
Nail clubbing
106
Empyema
Pus in the pleural cavity
107
Three types of extra systole
Atrial, Nodal (Junctional), ventricular
108
Glasgow blatchford score that can be treated as an outpatient
1 and under
109
Variceal management of AUGIB
Endoscopy trelipressin and ligation
110
Non-variceal bleeding
Endoscopy, Epinephrine, Clips, Thermal probe
111
V3-V4 artery
LAD
112
V5-V6 artery
Distal LAD, LC or RCA
113
1, AVL artery
LC
114
2, AVF, 3 artery
RCA, LC
115
V1-V3 artery
RCA or LC
116
Cholinergic receptors
Nicotinic, muscarinic
117
Types of Nicotinic receptors
NN, NM
118
Types of muscarinic receptors
M1 M2 M3 M4 M5
119
Main causes of pancreatitis
Gaul stones, alcohol
120
Symptoms of pancreatitis
```
Epigastric pain
Nausea and vomiting
Tachycardia
Jaundice
Fever
```
121
Pancreatitis investigations
Serum amylase and lipase
Ultrasound
ABG
122
How does pancreatitis cause ABG changes
Pancreatitis causes the epithelial cells in the pancreas to stop producing Bicarbonate. Bicarbonate is used to neutralise the acid in the stomach.
123
Teratogens
Substances that can cause birth defects
124
Rovsings sign
Palpitation in the left lower quadrant causes pain in the right lower quadrant and is suggestive of appendicitis
125
Peristalsis
Involuntary movements of longitudinal and circular muscles. Oesophagus, stomach, intestines
126
Heparin MOA
Activates antithrombin 3
127
Thromboxane a2
Produced by activated platelets to stimulate activation of platelet aggregation.
128
Which antibodies are developed in Graves’ disease on the thyroid gland?
IgG
129
Grave’s disease TSH and T3/T4
Low TSH high T3/T4
130
Guillain-Barré syndrome
Immune mediated demyelination of the peripheral nervous system following an infection.
131
What does the ST segment represent?
The period when the entire ventricle is depolarised
132
QRS complex represents?
Ventricular depolarisation
133
P wave represents?
The wave of depolarisation that spreads from the SA node throughout the Atria
134
P-R interval
Onset of P wave to beginning of QRS complex usually 0.12-0.20
135
Causes of varicose veins?
Incompetent venous valves
136
What level does the AA bifurcate?
L4
137
SOB when lying flat?
Orthopnea
138
The left and right atria are connected by what in foetal life?
Foramen ovale
139
What vertebral level does the left renal artery lie?
L1
140
Ebstein’s anomaly
A congenital heart defect leading to a large right atrium and a small right ventricle. Typically accompanied by tricuspid regurgitation
141
What drugs can cause sexual dysfunction?
Thiazide-like diuretics
142
Phase 2 of cardiac action potential
Slow influx of calcium which relates to the ST segment
143
Sudden onset of SOB and a wedge shaped opacification on chest x-ray
Highly suggestive of PE
144
Warfarin MOA
Inhibits epoxide reductase preventing vitamin K from being converted to its activated form
145
Hep B vaccine protects against what other virus?
Hep D
146
What can calcium glauconate be used for?
Protection of cardiac membrane increasing depolarisation threshold. Possibly caused by hyperkalaemia
147
Tinea corporis AKA ringworm
Enlarging raised red rings with a central area of clearing
148
Rheumatoid arthritis clinical findings
Radiographic changes that show erosion
Symmetrical
Small joints are often affected
Morning stiffness for at least one hour
149
Dermatomyositis
Inflammatory connective tissue disorder affecting skeletal muscle and the skin.
Presentation - progressive proximal muscle weakness with facial rash and raised Creatinine Kinase.
150
Iron deficiency anaemia
Low hb
Low MCV
Low ferritin
Hypochromic RBC
151
Macrocytic anaemia symptoms
```
LOA
Brittle nails
Tachycardia
Diarrhoea
Fatigue
Pale skin
SOB
Poor concentration and confusion
```
152
SEPSIS 6
Give - High flow oxygen, Broad spectrum ABx, fluids
| Take - Blood cultures, Lactate, urine output.
153
Snout and Spin
Sensitivity rule out and specificity rule in
154
What artery supplies blood to Broca’s and wernicke’s area
Middle cerebral artery (MCA)
155
Speech and language will be affected by a stroke in which artery?
MCA
156
Stroke symptoms
1) Weakness of an arm leg or both.
2) Weakness or twisting to one side of the face causing drooling or slurred speech.
3) problems with balance, co-ordination, vision, speech
4) numbness in part of the body
5) headache
6) confusion
7) LOC in severe cases
157
Stroke risk factors
AF
MI
Atherosclerosis build up caused by smoking, diabetes
158
What artery supplies the primary somatosensory cortex?
MCA
159
What arteries supply the motor cortex?
MCA and ACA
160
Investigations for stroke
```
CT
MRI
ECG
Carotid artery US looking for arethoma
Blood test looking at glucose and Cholesterol
```
161
Stroke treatment
Ischaemic
1) Anti platelet (Aspirin)
2) Thrombolysis (Alteplase)
Haemorrhagic
1) find the artery bleeding
2) reduce BP, sit patient up and use anti hypertensives
162
ROSIER score
Recognition of stroke in the emergency room
If score >0 stroke likely
If score <0 stroke unlikely but still possible
163
Immediate aspirin dose in suspected Ischaemic stroke
300mg
164
ALT and AST
Enzymes made in the liver to break down amino acids. Raised in liver disease.
165
GGT
GGT is a transport molecule, helping to move other molecules around the body.
It also helps the liver metabolise drugs and other toxins.
166
ALP
ALP is found in the liver and bones and helps break down proteins. A raised ALP does not necessarily mean liver disease however, if other liver markers are raised then it is likely liver disease.
167
Guillain-barre
An autoimmune disease where your body attacks your nerves. The causes of the disease is unknown but most patients report symptoms within six weeks of having an infection.
168
CSF ranges in bacterial infection
```
Appearance: cloudy and turbid
Opening pressure: elevated
WBC: elevated
Glucose: low
Protein: elevated
```
169
CSF ranges in viral infection
```
Appearance: clear
Opening pressure: normal or elevated
WBC: elevated
Glucose: normal
Protein: elevated
```
170
Most common viral causes of encephalitis
HSV
Varicella zoster virus
Enterovirus
171
Romberg’s test
Positive when a patient is unable to maintain balance with their eyes closed.
172
Seborrheic keratosis
Common non cancerous skin growth
173
Zosin
Alpha blockers
174
Antidote for opioid overdose
Naloxone
175
Antidote for paracetamol overdose
Acetylcysteine
176
Crohn’s disease RF and Presentation
Risk factors - smoking, genetic, infections
| Symptoms - weight loss, diarrhoea, malaise, anorexia, fever
177
Murphy’s sign
Press down on subcostal margin and ask patient to inspire. During inspiration if patient has pain Murphy’s sign is positive. Positive sign is indicative of acute cholecystitis.
178
RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In Biliary colic
RUQ
179
RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In acute cholecystitis
RUQ pain
| Fever/WCC
180
RUQ pain
Fever/ increased WCC
Jaundice
Which are positive In Cholangitis
RUQ pain
Fever/WCC
Jaundice
181
Charcots triad
RUQ pain
Fever/WCC
Jaundice
Found in Cholangitis
182
What liver tests are most reflective of liver synthetic function?
Pro-thrombin - The liver normally produces Vitamin K if the synthetic function of the liver is damaged pro thrombin time will be increased.
Albumin - Gives an indication of synthetic liver function over longer period.
183
Hyperkalaemia ECG changes
Tall tented T waves
Increased PR interval
Wide QRS complex
184
Hyperkalaemia treatment
Give calcium glauconate 10% 10ml by slow IV injection.
Secondly give 10 units Actrapid min 100ml of 20% glucose.
185
Paget’s disease
Chronic disease of the skeleton with symptoms of
Bone pain
Joint pain
Headache
Physical signs show bowing of the femur, lower leg and enlargement of the forehead.
ALP will be raised as a marker of osteoblasts activity
Treatment - bisophosphonates
186
Most common primary liver tumour?
risk factors
Features
Hepatocellular carcinoma
```
Hep B
Infection
Cirrhosis
Male
Age
```
Raised alpha - fetoprotein
187
Rash in response to amoxicillin
Severe pharyngitis
Slightly increased ALT
Positive mono spot
Epstein Barr virus
188
Ankylosing spondylitis
Is a seronegative arthropathy. It is an autoimmune disorder, most common amongst men. It is associated with back stiffness that gets better over the cause of a day and a bamboo spine on radiography.
Ankylosing spondylitis is associated with HLA-B27 positivity
189
How can an ectopic pregnancy cause shoulder tip pain?
Bleeding into the peritoneum can cause irritation to the diaphragm and cause referred pain at the tip of the shoulder.
190
Ectopic pregnancy symptoms
```
Sever, sudden onset RIF pain
Vaginal bleeding but not always.
Shoulder tip pain
Syncopal episodes
Shock
```
191
Chronic reflux nephropathy signs and symptoms
```
Burning sensation whilst urinating
Strong, persistent urge to urinate
Fever
Cloudy urine
Flank and abdo pain
```
192
Posterior duodenal ulcers can cause haemorrhage from which artery?
Gastroduodenal artery
193
What dermatological condition is diagnostic of chronic sarcoidosis?
Lupus pernio - a specific complex involvement of the skin of the bridge of the nose and the area beneath the eyes and cheeks. The lesions are typically large, bluish-red and dusky purple, infiltrated, plaque-like nodules.
194
Autonomic dysreflexia
Is caused by excessive sympathetic activity in the absence of parasympathetic supply in high spinal cord lesions.
Tachycardia
Hypertension
Sweating
Flushing
195
Blood supply to the stomach
Coeliac trunk which originates from vertebral level T12 supplies the stomach.
196
Patients presenting with first episode of psychosis should be offered
Oral antipsychotics
| Psychological interventions
197
Reed-stern berg cells are pathognomic in
Hodgkin’s lymphoma
198
Aspiration of what cyst in the anterior neck triangle usually in the third decade contains cholesterol?
Branchial cyst
199
Intussusception
Is a paediatric emergency where a bowel segment invaginates into a neighbouring part of the bowel. Mostly in patients under 1.
Three s’s
Screaming and pallor
Stool has red currant jelly appearance
Sausage-shaped mass palpable in right hypochondrium
200
Symptoms of lithium toxicity
Nausea, diarrhoea, coarse tremor, unsteadiness
Happens at 1.5mmol/l or above
201
Coeliac disease
Coeliac is a disease whereby there is an abnormal jejunal mucosa
That improves with the withdrawal of gluten. The typical onset is in early infancy when gluten is introduced and the 4th decade.
Vague abdominal pain
Bloating
Diarrhoea particularly after gluten containing meals.
Macrocyclic anaemia (due to folate deficiency)
Blood tests reveal anti-EMA and anti-TTG antibodies.
202
Sarcoidosis risk factors
Age - adults under 40
Female
Afro-Caribbean populations
203
Most common finding in sarcoidosis
Bilateral hilar lymphadenopathy
| Erythema nodosum
204
Candida albicans symptoms
Thick cottage cheese like discharge
Pain on urination
It is a fugal infection
205
Myasthenia gravis? Symptoms?
MG is an autoimmune disorder typified by autoantibodies raised against the acetylcholine receptors, causing decreased efficacy of transmission at the neuromuscular junction. MG can be precipitated by stresses on the body such as pregnancy.
```
Bulbar weakness
Ptosis
Double vision
Dysphagia
Easy fatiguability of neck flexion
```
206
Treatment for pre-eclampsia seizures?
Magnesium sulphate
207
Initial Treatment of anaphylaxis from penicillin
Adrenaline 0.5mg, 1 in 1000 IM
208
Clozapine
Clozapine is an alpha1-adrenoreceptor antagonist usually given in schizophrenia.
209
What drug can cause priapism
Trazadone
210
Tumour marker for ovarian cancer
Ca-125
211
Signs of ovarian cancer
```
Abdo distension
Feeling bloated
Abdo pain
Early satiety
Loss of appetite
Urinary frequency and urgency
Unexplained weight loss
Fatigue
Change in bowel habit
```
212
Sacroiliitis is a feature of which bowel disease
UC
| IBD is commonly associated with arthalgia and arthritis hence why the sacro iliac joints become inflamed.
213
Type 1 respiratory failure
Low o2 with normal or low Co2
214
Type 2 respiratory failure
Hypoxia
| Hypercapnia
215
Salbutamol MOA
Beta2 adrenergic receptor agonist which works by causing relaxation of airway smooth muscle.
216
Agonist
Something that binds to a receptor and activates it
217
Antagonist
Something that binds to a receptor and deactivates it
218
Acute Asthma exacerbation stages
Moderate:
O2 > 92%
PEF >
No severe features
```
Severe:
O2 <92%
PEF
Not able to talk/complete sentences in one breath
HR>125
RR>30
Accessory muscle use
```
```
Life threatening:
O2<92%
PEF
Silent chest
Poor resp effort
Altered consciousness
Cyanosis
```
219
Bronchiolitis causes and presentation
RSV most common cause - very common in winter and in infants under 1 years age.
```
Presentation:
Coryzal symptoms
Signs of respiratory distress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Wheezes
Crackles
```
220
Signs of respiratory distress
```
Increased RR
Use of accessory muscles
Intercostal recessions
Subcostal recessions
Nasal flaring
Head bobbing
Tracheal tug
Cyanosis
Abnormal airway noises
```
221
Abnormal airway noises
Wheezing - whistling sound due to narrow airways on expiration
Grunting - exhaling with glottis partially closed - increase positive end-expiration pressure
Stridor - Hight pitched inspiratory - obstruction upper airway - E.G. Croup
222
Criteria for admission in babies with bronchiolitis
```
Aged 3 months and under
Pre-existing condition
<50-75% of normal intake
Clinically dehydrated
RR >70
O2 sats <92%
Moderate to severe respiratory distress
Apnoea
```
223
Kawasaki disease
Vasculitis disease
Risk factors
Children of Asian descent
```
Presentation
Fever > 5 days
Rash - mouth, Eyes, palms and soles, body rash.
Swelling of cervical lymph nodes
Strawberry tongue
```
224
Kawasaki treatment/ investigations
Bloods - CRP
ALT, platelets, WBC, Albumin
Echo cardio gram
Treatment:
Aspirin
225
Causes of Jaundice
Blood problems: Extravascular haemolytic anaemia, ineffective hematopoesis.
Physiologic jaundice of the newborn: due to low levels of UGT enzyme.
Genetic defects: Gilbert’s syndrome due to low levels of UGT enzyme, Dubin - Johnson syndrome due to deficient MRP2 transporter protein.
Obstructive jaundice: Gallstones, pancreatic carcinoma, liver fluke.
Viral hepatitis:
226
Apoptosis
Programmed cell death
227
Viral hepatitis symptoms and blood markers
```
Fever
Malaise
Nausea
Hepatomegaly
Inflamed liver
Pain
Jaundice
Dark urine
```
```
Bloods:
++ ALT
+ AST
+ Atypical lymphocytes
+ CB and UCB
```
228
5 types of Hepatitis and how they’re transmitted
Hep A: orally through contaminated food or drink. Always acute never chronic. IgM antibodies = active infection IgG = recovery/vaccinated
Hep E: similar to Hep A, Hep E no vaccination, very serious in pregnant women.
Hep C: Blood transmitted, Acute + chronic, HCV RNA (with PCR).
Hep B: blood transmitted, Acute + chronic (20%), Chronic HBV linked to liver cancer.
Hep D: can only infect people with Hep B
229
Osteoarthritis
Progressive destruction of a joint surface and remodelling of underlying bone
230
Osteoarthritis risk factors
```
Age > 50
Trauma
Obesity
Family history
Gender
Consider occupation
```
231
Osteoarthritis presentation
Gradual onset of joint pain, better with rest, worsens throughout the day. Not usually present at night.
Morning stiffness usually less than 30 minutes. Longer could indicate RA
Joint swelling
Locking/giving away
Mostly weight bearing joints
Unilateral vs bilateral
Joint pain, stiffness, functional limitation
Take holistic approach in history
232
Osteoarthritis findings on the hand
```
Bouchard’s nodes (PIP)
Heberden’s nodes (DIP)
Squaring of the base of the thumb
Ulnar/radial deviation
Wasting of the the area muscle
```
233
Osteoarthritis XR changes acronym
L - loss of joint space
O - osteophytes
S - subchrondral cysts
S - subchrondral sclerosis
234
Normal pressure hydrocephalus presentation and MRI findings
Shuffling gait
Incontinence
Memory loss
MRI findings:
Ventricular enlargement
Increased signal intensity around the ventricles
235
Side effect of clozapine
Reducing WBC
236
Reactive arthritis
Usually happens 1-3 weeks after an initiating infection.
Triad of symptom:
Urethritis
Arthritis
Conjunctivitis
237
Opioid that has the longest analgesic effect?
Fentanyl transdermal 48-72 hrs
238
Most common type of renal cancer and symptoms
Renal cell carcinoma most common being clear cell.
Haematuria, loin pain, fatigue, weight loss
239
Phlebitis
Phlebitis is inflammation of the veins. It is caused by clotting inside of the veins.
Symptoms:
Pain, swelling and tenderness
Red, itchy skin that feels warm to touch
Diagnosed with USS
Treatment: NSAIDs or paracetamol
240
DVT
Clots forming in the deep veins or the legs.
```
Risk factors:
Pregnancy
Post surgery
Obesity
Malignancy
```
Symptoms:
Asymmetrical oedema
Asymmetrical calf swelling
Pain the in calf
```
Investigations:
FBC - D-dimer
LFT’s
EUC
INR
Venous USS
```
Treatment:
LMWH - suffix = Parin or Parinux
241
Virchow’s triad
Vessel injury
Venous stasis
Hyper-coagulability
242
Pulmonary embolism
Caused when a clot travels from the systemic venous circulation to
```
Signs and symptoms:
Dyspnoea
Pleuritic chest pain
Increased RR
Hypotension
```
```
Investigations:
C-X-ray but will be normal usually
CT scan
D-dimer
ECG - used to exclude MI, however might show Sinus tachycardia, right ventricular strain
```
243
Tonic and clonic seizures
```
Tonic = stiffening of muscles
Clonic = jerking of muscles
```
244
Heyde’s syndrome
Is a triad of aortic stenosis, anaemia from an intestinal angiodysplasia and an acquired coagulopathy.
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Angiodysplasia
Swelling of the vascular in the GI tract can cause lesions and bleeding in the colon
246
Obstructive and restrictive lung disease
Obstructive is characterised by a reduction in airflow because the lungs can not expel gas.
Restrictive is difficulty in taking in air due to stiffness in lung tissue or chest wall cavity.
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4 types of shock and classification
Obstructive shock - e.g. PE, cardiac tamponade
Shock is a circulatory failure with inadequate tissue perfusion
Cardiogenic shock - where your heart can’t supply the body adequately.
Distributive - septic, anaphylactic, neurogenic
Hypovolemic shock - due to volume of blood inadequacy
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Peripheral vascular disease
When the peripheral blood vessels become narrowed which reduced blood flow and affects limbs.
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Symptoms:
Hair loss
Numbness or weakness
Brittle, slow growing toe nails
Ulcers
Shiny skin
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Investigations:
Ankle-brachial index
USS
Angiography
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Treatment:
Medications to treat underlying causes
Parins
Aspirin
Bypass surgery
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Ruptured AA
Presents with pain and collapse, MI symptoms, Heamoptysis, cardiac tamponade.
AAA presents with triad of pain in the flank or back, hypotension and a pulsating abdomen, may feel cold sweaty and faint on standing
Syncope or vomiting
OE they will be cold, pale and sweaty with a weak and thready pulse. They will be tachycardic.
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Trifascicular block
Is a combination of RBBB, LAFB or LPFB, and Heart block.
Does not need treatment on its own but can lead to complete heart block. Avoid high doses of AV blocking agents.
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Dilated cardiomyopathy
DCM is a disease where your heart becomes stretched and thin. This means it is unable to pump blood efficiently. EF <40%
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Symptoms:
SOB
SOB when lying flat
Fatigue
Swelling
Fainting
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Invx: Echocardiogram, exercise stress test, chest x-ray
Treatment: ACE, BB’s, Diuretics,
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Coarctation of aorta
Left ventricular hypertrophy due to a narrowed aorta.
Invx: ECG, echo, CT angiogram.
Treatment: surgery, balloon angioplasty, stenting
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Tetralogy of falot
VSD, pulmonary stenosis, displace aorta, blood flow from both sides of heart into aorta.
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Glomerulonrphritis
GN is when damage to the glomerular has been caused. This can be from infection, auto immune and more.
Due to the damage blood and proteins can leak into the urine. Can cause low GFR.
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Usually adults in 50-60s
Blood,protein in urine
Peripheral oedema
Frequent nighttime urination
Very bubbly/foamy urine
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Diagnosed using urine dipstick
Treatment involves dietary changes, ACE and pred
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Nephrotic syndrome
Damage to podocytes Causing loss of up to 3.5G/day of protein. Frothy urine due to protein. Nephrotic syndrome causes oedema. Main protein lost is Albumin so liver compensates and causes hyperlipidimia.
-Albumin
+Lipids
Hyper-coagulability
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Nephritic
Response to immune proliferation caused RBC, WBC and protein to leak into urine.
Hematuria
Oliguria = low urine output
Hypertension
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Drugs that contribute to reduced renal excretion
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ACEi
ARB
NSAIDS
Beta blockers
Antibiotics
```
258
Two cause of hyperkalaemia
Reduced kidney excretion
| Damage to cells causing potassium to leak into blood
259
Hypercalcemia
Bones - abnormal bone remodelling, fracture risk
Stones - increased risk of kidney stones
Groans - abdo cramping, nausea, ileus, constipation
Psychiatric overtones - lethargy, depressed mood, psychosis, cognitive dysfunction
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Wernickes encephalopathy
Triad of encephalopathy, ocular motor dysfunction and gait ataxia caused by vitamin b1 deficiency often found in alcohol abusers.
Give thiamine repletion before treatment to offset complications of wernickes
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ESM
Of aortic valve origin
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Pan systolic murmur
Mitral regurgitation
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Horner syndrome
Horner syndrome is a combination of signs and symptoms caused by disruption of a nerve pathway to the brain or face. Common signs are pupil reduction, drooping eyelid, decreased sweating.
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Lesions to the optic chiasm cause what symptom
Bitemporal hemianopia
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VF and VT, presentation, investigation, treatment
VF and VT are both shockable rhythms and emergencies. Chest pain, fatigue, palpitations and other non-specific complaints.
Causes: Electrolyte disturbances e.g Hyperkalaemia, hypocalcaemia, hypomagnesaemia, drug levels e.g antidepressants, digoxin, Thyroid, cocaine
Treatment: Defibrillator
ECG: VT will show as broad QRS fast rate and regular on ECG. VF will show similar to VT except if will be irregular.
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Cardiac tamponade
Cardiac tamponade is caused by an accumulation of blood,pus, fluid, clots or gas in the pericardial space, resulting in reduced ventricular filling and subsequent haemodynamic instability.
Can be caused by malignancy, MI, Infection, aortic dissection
Presentation: anxiety, fatigue, altered mental state, oedema, dyspnoea, tachycardia, tachypnoea, cold and clammy extremities.
Signs: Distended neck veins, hypotension, tachycardia, muffled heart sounds, pericardial friction rub, becks triad
Management: Should be done in ICU, Inotrope therapy e.g dobutamine, Echo-guided pericardiocentesis.
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Acute bronchitis
Acute bronchitis is an infection of the bronchi - large airways. It is common and usually due to a viral infection. Most common virus being Rhinovirus, adenovirus and influenza a and b.
Symptoms: Cough, fever, headache, cold and aches and pains. Symptoms typically peak after 2-3 days and 2-3 weeks for the symptoms to be completely gone.
Treatment: OTC meds, drink lots, quit smoking.
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10 classes of Antibiotics
Antibiotics can terminate protein synthesis for microbial cells like germs
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Aminoglycosides
Cephalosporins
Tetracyclines
Penicillins
Sulfonamides
Fluoroquinolones
Macrolides
Carbapenems
Lincosamides
Glycopeptides
```
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Aminoglycosides: examples, coverage, MOA, uses
generally end in Mycin
Streptomycin
Gentamicin
Covers against Gram negative
Inhibits protein synthesis
Some uses abdominal or blood infections
270
Cephalosporins: examples, coverage, MOA, uses
Drugs usually start with cef examples include ceftriaxone and cefepime.
Cover against gram negative and gram positive
Inhibit cell wall synthesis
Skin, urinary, resp infections
271
Tetracyclines: examples, coverage, MOA, uses
Usually end in cycline, examples tetracycline, doxycycline
Gram + and -
Inhibit protein synthesis
Lyme disease, PID, STI’s
272
Penicillins: examples, coverage, MOA, uses
Typically end in cillin examples, ampicillin, amoxicillin
Gram + and -
Inhibits cell wall synthesis
ENT, skin, urinary infections
273
Sulfonamides: examples, coverage, MOA, uses
Typically start with sulfa examples, sulfasalazine, sulfamethoxazole
Gram + and -
Inhibits folate synthesis
UTI’s, burns, eye infections
274
Fluoroquinaones: examples, coverage, MOA, uses
Typically end in floxacin examples, ciprofloxacin, levofloxacin
Gram + and -
Inhibit DNA replication
Respiratory and urinary infections
275
Macrolides: examples, coverage, MOA, uses
Typically end in thromycin examples, azithromycin, erythromycin
Gram +
Inhibit protein synthesis
Pneumonia, sinus, ENT, STI’s
276
Carbapenems: examples, coverage, MOA, uses
Typically end in penem examples, Meropenem, ertapenem
Gram + and -
Inhibit cell wall synthesis
Urinary, abdo infections
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Lincosamides: examples, coverage, MOA, uses
Clindamycin
Gram +
Inhibit protein synthesis
Skin, bone, lung infections
278
Glycopeptides: examples, coverage, MOA, uses
Vancomycin
Gram +
Inhibits cell wall synthesis
MRSA, skin, endocarditis
279
Croup
Self-limiting upper airway viral infection of the larynx and trachea
Symptoms: Hoarse voice, barking cough, inspiratory stridor, increased work of breathing.
Causes: Parainfluenza virus 1 and 2, RSV
Moderate presentation requires steroid therapy with dexamethasone
Severe presentation requires nebulised adrenaline
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Child-pugh score
Criteria for assessing chronic liver disease looks at the levels of total bilirubin, serum albumin, ascites, INR and the grade of hepatic encephalopathy.
281
How does liver failure causes hepatic encephalopathy
The liver is too diseased or damaged to properly process ammonia. Ammonia travels to the brain and causes confusion, disorientation and even death.
282
Bronchiolitis
Inflammation of the small airways of the lung most commonly caused by RSV.
Mainly affects young children.
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Symptoms:
Coryza
Increased work of breathing
Wheezing
Fever
```
Treatment:
Oxygen
Supplemental fluids
Steroid nebs in severe cases
283
Bacterial pneumonia
Infection and inflammation of the lungs usually by streptococcus pneumonia or HIB.
CAP or HAP
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Symptoms:
SOB
Chest pain
Productive cough
Systemic symptoms
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Diagnosis:
CXR showing consolidation
Dullness to percussion
Crackles
Treatment:
Antibiotics - macrolides usually end in Mycin
284
Pertussis (whooping cough)
Contagious infection caused by bordetella pertussis characterised by a whooping cough.
Gram negative
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Symptoms:
Whooping cough
Vomiting
Collapsed lung
Petechiae
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Treatment is usually prophylactic in the form of a vaccine. DTAP
Diphtheria, Tetanus, Acellular pertusis
Or macrolide antibiotics, which end in Mycin
285
Sickle cell disease
Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells.
Risk factors:
Afro-Caribbean family background
Symptoms:
Painful episodes called sickle cell crisis, can be very severe and last up to a week
Increased risk of serious infection
Anaemia
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Treatment
Definitive treatment is bone marrow transplant
Prophylactic antibiotics
Blood transfusion
OTC analgesia
```
286
Bisphosphonates
A group of drugs that slow down or prevent bone loss by inhibiting osteoclasts.
Example: denosumab
Most common side effects bowel irritation and heartburn
287
Best test to see if a woman is ovulating
Day 21 progesterone level
288
Toxic shock syndrome
Happens around the time of a woman’s period due to a retained tampon. A patient will present with an infective picture. Removal of tampon and broad spectrum antibiotics.
289
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COPD
Pathophysiology
Symptoms
Investigations
Management
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COPD is caused by excessive damage caused mainly by smoking to the lining of the lungs and airways.
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Symptoms:
Increasing breathlessness
Persistent cough
Frequent chest infections
Persistent wheeze
Weight loss
Tiredness
Chest pain
Swollen ankles
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Investigations:
Spirometry
Chest x-ray to rule out other causes
Treatment:
Quit smoking
Inhalers - short acting bronchodilators
Pulmonary rehabilitation
290
What is body temperature regulated by?
Hypothalamus
291
Fever is a physiological response to what 4 things?
Infection
Autoimmune
Inflammation
Malignancy
292
Fever causes the release of what Pyrogenic cytokines?
IL-1, IL-6, TNF
293
Pyrogenic cytokines induce the synthesis of what?
Prostaglandin E2 in the pre-optic area of the hypothalamus it is responsible for increasing the core body temperature
294
Prostaglandin E2 triggers what?
Vasoconstriction
295
Antipyretic drugs and what they target in fever
Aspirin
| Target prostaglandin E2
296
What do corticosteroids target in fever?
Target the production of Pyrogenic cytokines
IL-1
IL-6
TNF
297
Most common Hepatic tumour?
Hepatocellular carcinoma (HCC)
298
Most common leukaemia in adults?
Chronic lymphocytic leukaemia B-CLL
299
Child-Pugh score
The Child-Pugh score determines the severity of cirrhosis and is useful for determining prognosis. It is based on five parameters:
```
Ascites
Hepatic encephalopathy
Serum bilirubin
Albumin
INR/PT.
```
300
Collapsing pulse is associated with what valve defect
Aortic regurgitation
