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Medicine - Year 2 > Clinical Skills and Reasoning > Flashcards

Clinical Skills and Reasoning Flashcards

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1
Q

Normal and abnormal cause of palmar erythema

A

Normal in pregnancy

Also found in liver disease

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2
Q

Symptoms of clubbing

A

nail hard, nail bed spongy, nail curvature and angle change

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3
Q

Causes of clubbing

A

CV: Congenital heart disease, Infective endocarditis, Atrial myxoma (tumour in atrium)
RS: Lung carcinoma, Pulmonary fibrosis, Cystic fibrosis, Bronchiectasis, Abscess, Empyema

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4
Q

What are osler’s nodes?

A

Red dots on the fingertips

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5
Q

What order do you examine the lymph nodes in? (11)

A

submental > submandibular > tonsillar > parotid > periauricular > postierior auricular > superficial cervical > deep cervical > supraclavicular > posterior cervical > occipital

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6
Q

What is the difference between marked and moderate hydration status?

A

Marked: loss of skin tension
Moderate: Tongue and eyes should be wet and glistening (fontanelle in babies)

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7
Q

Which 2 CAM therapies are statutory regulated?

A

Osteopathy and Chiropractice

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8
Q

Define the effectiveness gap

A

Clinical area where available treatments are not fully effective or satisfactory

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9
Q

3 main reasons for CAM use

A

Musculoskeletal/neuromuscular
Arthritis
Headaches

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10
Q

4 methods of chiropractic therapy

A

Mobilisation and manipulation (moving joints, relaxing muscles and modifying the pain gate)
Soft tissue therapies and massage
Guided movement
Rehabilitation exercises

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11
Q

What affects how well a treatment works? (5)

A 
Relationship between patient and physician
Treatment is patient centered
Healthcare setting
Patient education (complaince)
Patient expectations
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12
Q

Why is acupuncture not in NICE guiedlines?

A

There is no significant difference between actual and sham acupuncture

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13
Q

What does NICE state about CAM therapies?

A

Used alongside other treatments such as drugs, psychological and exercise

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14
Q

Define dysponea

Is it a sign or a symptom

A

Breathlessness

Symptom

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15
Q

Why does giving oxygen not sure dysponea?

A

Not caused by reduced oxygen or poor respiratory rate

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16
Q

9 causes of cough hypersensitivity

A

Interstitial lung disease, Left heart failure, Lung cancer, Reflux
ACEi, Asthma, Aspiration, Infection, Pulmonary fibrosis

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17
Q

Define mucoid

A

Excess secretion of mucus

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18
Q

Define purulent

A

Green or yellow sputum from inflammation

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19
Q

When does mucus have a bad smell/taste? (3)

A

Anaerobic infection
Abscess
Cancer

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20
Q

What cardiac disease do you get haemoptysis in? (2)

A

PE or mitral stenosis

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21
Q

Define rhonchi

A

Wheeze: A musical noise produced by air moving through narrowed airways louder in expiration

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22
Q

Why does salbutamol not cure a severe asthma attack?

A

It does not cure every symptom of asthma

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23
Q

3 characteristics of pleuritic pain
Where does the pain come from?
3 causes

A

Sharp, stabbing and worse on inspiration
Parietal pleura
e.g. pneumonia, PE, pneumothorax

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24
Q

5 things which mimic pleuritic pain

What differentiates them from the lungs?

A 
Reterosternal pain (trachea/mediastinum)
Bony pain (e.g. metastases)
Chest wall pain (trauma)
Spinal root pain
Shingles 
(often unrelated to exercise)
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25
Define astrexis
Flapping tremor
26
Define intercostal indrawing
Skin between ribs pulled in
27
2 accessory muscles of respirtion
Pectoral | Sternomastoid
28
What causes mediastinal shift towards the affected side and away from the affected side?
Towards = reduced volume e.g. collapsed lung (penumothorax) | Away from = tumour, pleural effusion (fluid in pleural cavity)
29
What happens to the cricosternal distance when the patient is hyperinflated?
Reduces
30
Explain what causes the 4 noises on percussion
Stony dull = pleural effusion Dull = pneumonia Resonant = normal Hyperresonant = pneumothorax
31
What is the technical term for normal breath sounds?
Vesicular
32
3 causes of diminished/absent breath sounds
Collapse, Effusion, Pneumothorax
33
Cause of bronchial breath sounds What do they sound like Why are they loud?
Consolidation Harsh sounds with prolonged expiratory phase Solidified alveoli transmits sound better than airy
34
Define crepitations
Crackles | Discontinuous non-musical sounds on inspiration due to explosive opening of occluded small airways
35
What does it mean if crackles clear with coughing
Secretions are in large airways rather than small ones
36
2 causes of coarse crackles | 2 causes of fine crackles
Coarse: pneumonia, bronchiectasis Fine: oedema, pulmonary fibrosis
37
Define whispering pectoriloquy
Whispered sounds are heard more clearly in consolidation
38
What does it mean if syllables are transmitted more/less clearly when testing vocal resonance?
More clear = consolidation | Less clear = collapse, pneumothorax, effusion
39
What are most deaths from CVD due to?
Smoking
40
9 symptoms of heart failure
SOB, Peripheral oedema, Cough with pink sputum, Reduced sleep, Reduced energy, Swollen abdomen, Nocturia, Confusion, Memory loss
41
Difference between angina and MI?
Angina: worse on exertion and cold; relieved by rest and GTN, 2-10 mins MI: worse at rest, no relief, breathless, sweaty, nausea, fear, 30 mins +
42
What are the 4 classifications of angina
1. Angina with prolonged exertion 2. Slight limitation of normal activity (stairs, hill, cold) 3. Marked limitation or normal physical activity 4. Angina at rest / can't do any physical activity
43
2 characteristics of pericarditis pain ``` 2 things that make it worse 1 thing which makes it better Duration Cause 2 ECG changes ```
Sharp, stabbing ``` Worse with inspiration and lying flat Eased by sitting Hours > Days Viral illness ST elevation and PR depression ```
44
4 characteristics of aortic dissection pain | 2 places it radiates to
Sudden, tearing, knifetlike, excrutiating | Radiates to back/abdomen
45
2 characteristics of pulmonary embolism pain | What is it associated with?
Pain over infarcted area Pleuritic rub SOB
46
Define tachypnoea
More than 20bpm
47
What is it called when patients have to sleep on more pillows?
Orthopnoea
48
What is PND? Explain what happens during an episode and how long it lasts 2 causes
Paroxysmal Nocturnal Dysponea Wake up and have to sit up and go to the window Cough and wheeze for 20 mins Frightening Reduced respiratory drive, Reduced heart adrenergic activity at night
49
Define palpitation
Unpleasant awareness of heart beat
50
Define syncope
Brief transient loss of consciousness and postural tone with rapid spontaneous recovery
51
6 characteristics of a cardiac syncope
``` Sudden onset No aura No jerks/incontinence Injury common Immediate recovery Very pale ```
52
4 characteristics of a neurological syncope
Convulsive movement Confusion after Incontinence Tongue biting
53
Explain vasodepressor syndrome
Faint after prolonged standing Gradual faintness and greying vision Response to stress
54
Explain carotid sinus hypersensitivity | Diagnosis and treatment
Syncope when pressure is put in the carotid artery Diagnosed by rubbing carotid with ECG Fitted with a pacemaker
55
3 drugs which cause peripheral oedema
NSAIDs, Fluorocortisone (retain Na) | Amlodipine (increased capillary permeability)
56
5 causes of fatigue in cardiac patients
Reduced cardiac output or blood pressure Excessive diuresis (causing reduced K) Drugs e.g. beta blockers
57
3 causes of splinter haemorrhages
SLE, gardening, rheumatoid
58
What causes clubbing of the toes?
Patent ductus artriosus
59
What are the 2 lipid signs around the eye?
Orbital xanthelasma | Corneal arcus
60
What is the cause of a slow rising pulse and collapsing pulse?
Slow rising = Aortic stenosis | Collapsing = Aortic regurgitation
61
Where do you measure the JVP from?
Manubrum-sternal joint
62
What are the 5 parts of the JVP wave?
A: atrial systole X decent: after atrial contraaction C: rapid increase in R ventricle pressure before tricuspid valve closes V wave: venous return fills RA during ventricle systole Y decent: Tricuspid valve opens
63
6 causes of an elevated JVP
``` Cardiac tamponade Constrictive pericarditis Heart failure Increased arterial pressure Renal disease SVC obstruction (cancer or mediastinal mass) ```
64
3 causes of large A waves on the JVP
Pulmonary hypertension, Tricuspid stenosis, Cannon waves
65
1 cause of giant V waves
Tricuspid regurgetation
66
1 cause of a steep Y descent | What sign is also seen?
Constrictive pericarditis | Freidreict's sign - rapid increase and slow decrease in JVP
67
What causes the 1st and 2nd heart sound?
1st: Tricuspid and mitral valve CLOSE 2nd: Aortic and pulmonary valve CLOSE
68
What does it mean if the apex beat is: - Normal bit shifted - Impalpable - Tapping - Heaving - Volume loaded - Double impulse - Dyskinetic
- Normal bit shifted: Pneumothorax - Impalpable: High BMI, COPD, Cardiac tamponade - Tapping: Mitral stenosis - Heaving: Increased bp, Aortic stenosis - Volume loaded: Aortic regurgitation, Bigger LV - Double impulse: Hypertrophy cardiomyopathy - Dyskinetic: Previous MI/LV aneurysm
69
What does splitting of the 2nd heart sound indicate? | What does reverse splitting indicate?
Atrial septal defect | Pulmonary heard before atrial in severe aortic stenosis
70
3rd heart sound: What does it sound like? When is it? How can you hear it? 3 causes
``` Ken-tuc-KY After S2 (start of diastole) Low pitch (bell) ``` Normal in young adults and athletes Failing LV/ Movement of blood between atrial walls
71
4th heart sound: What does it sound like? When is it? 1 cause
``` TENN-es-see Before S1 (end of diastole) ``` Failing LV
72
What increases the sound of a cardiac hypertrophy murmur and a mitral stenosis murmur?
Cardiac hypertrophy = squatting | Mitral stenosis = rolling to the left
73
When are heart murmurs not important? (4)
Short systolic murmurs around the left sternum (pregnancy/anaemia) Normal heart sounds, normal ECG, asymptomatic
74
What murmurs are found with prosthetic valves?
Aortic valve prosthesis = systolic ejection murmur | Mitral valve prosthesis = diastolic flow murmur
75
What happens to the heart sounds in stenosis? | What changes to the pulse and ECG?
2nd heart sound is soft (calcified valve) Slow rising carotid pulse ECG = left ventricular hypertrophy
76
What happens to the heart sounds in sclerosis? | What changes to the pulse and ECG?
Normal/loud 2nd sound Carotid pulse is brisk/normal No LVH on ECG unless severely hypertensive

Medicine - Year 2 (19 decks)

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