Data revision notes Flashcards
(148 cards)
1
Q
Name the structures that pass through the femoral triangle
A
Femoral nerve
Femoral artery
Femoral vein
Lymphatics
2
Q
What nerve innervates the medial compartment of the thigh?
A
Obturator
3
Q
What nerve innervates the anterior compartment of the thigh?
A
Femoral
4
Q
What nerve innervates the posterior compartment of the thigh?
A
Sciatic
5
Q
What nerve innervates the lateral compartment of the leg?
A
Superficial branch of common fibular nerve
6
Q
What nerve innervates the anterior compartment of the leg?
A
Deep branch of the common fibular nerve
7
Q
Name 2 screening questionnaires that can be used for alcoholism
A
CAGE and AUDIT
8
Q
What symptoms can occur 6-12 hours after alcohol withdrawal in an alcoholic?
A
Shaking, sweating, nausea, vomiting, headache, insomnia
9
Q
What symptoms can occur 12-24 hours after alcohol withdrawal in an alcoholic?
A
Visual, auditory and tactile hallucinations (can usually be distinguished from reality)
10
Q
What symptoms can occur 24-48 hours after alcohol withdrawal in an alcoholic?
A
Withdrawal seizures
11
Q
What symptoms can occur 48-72 hours after alcohol withdrawal in an alcoholic?
A
Delirium tremens -> usually peak at 5 days. Patient suffers confusion, disorientation, hallucinations and seizures
12
Q
What are the triad of symptoms in Wernicke’s encephalopathy?
A
Confusion, ataxia, ophthalmoplegia (paralysis of muscles surrounding eye)
13
Q
Name some hand signs seen in patients with chronic liver disease
A
- Clubbing
- Terry’s nails (proximal 2/3 white, distal 1/3 red)
- Meuhrcke’s lines
- Palmar erythema
- Asterixis
- Dupuytren’s contracture
14
Q
What is the most common cause of acute pancreatitis?
A
Gallstones
15
Q
What does the mnemonic PANCREAS stand for in acute pancreatitis?
A
PaO2 Age Neutrophilia Calcium Renal - urea Enzymes Albumin Sugar
16
Q
Name some drugs that can cause acute pancreatitis
A
Azothiaprine Thiazides Trimethoprim Tetracyclines Metronidazole
17
Q
What is Grey Turner’s sign?
A
Bruising of the flanks - due to retroperitoneal haemorrhage. Causes = acute pancreatitis, pancreatic haemorrhage, ruptured aaa, ruptured ectopic
18
Q
What is Cullen’s sign?
A
Umbilical bruising and superficial oedema. Causes = acute pancreatitis, blunt trauma, ruptured aaa, ruptured ectopic
19
Q
What are 4 causes of large bowel obstruction?
A
1) Diverticulitis
2) Malignancy
3) Sigmoid volvulus
4) IBD -> UC, toxic megacolon
20
Q
What are 3 causes of small bowel obstruction?
A
1) Adhesions
2) Hernias
3) Malignancy
21
Q
How big do both small and large bowel have to be on AXR to be classed as dilated?
A
Small >3cm
Large >6cm
22
Q
What is a Phlebolith?
A
A small calcification within a vein - common finding on AXR in the pelvis
23
Q
What is an ileus?
A
An intestinal blockage caused by a lack of peristalsis. It can happen after surgery, due to electrolyte imbalance or acid-base abnormalities. Most resolve with ‘watchful waiting’
24
Q
If both the small and large bowel are dilated, what does this suggest?
A
Ileocaecal incompetence
25
When might you see thumb printing on AXR?
In UC - caused by bowel wall thickening as a result of actor inflammation
26
If you see bilateral hilar lymphadenopathy and right paratracheal lymphadenopathy what should your differential include?
Sarcoidosis!
27
A double shadows over the right heart border on CXR suggests what?
A posterior mediastinal mass. CT needed to evaluate
28
What can air bronchograms signify on CXR?
Pulmonary consolidation, pulmonary oedema, interstitial lung disease, malignancy, pulmonary infarct, pulmonary haemorrhage.
29
If someone has fractured a long bone and then develops a petechial rash, neurological problems and respiratory problems, what might of happened?
Fat embolism
30
What malignancies can metastasise to bone?
```
Breast
Bronchus
Prostate
Kidney
Thyroid
```
31
Name 2 different types of fracture commonly seen in children
Greenstick
| Buckle
32
What are the haematinics and where are they absorbed?
Iron - duodenum and jejunum
B12 - terminal ileum
Folate - SI
33
What is the best test for iron deficiency?
Serum ferritin
34
Describe the: 1) location of the apex, 2) first heart sound and 3) third heart sound in mitral regurgitation.
Apex - thrusting and displaced
First heart sound - soft
Third heart sound - present
35
Describe the: 1) location of the apex, 2) first heart sound and 3) third heart sound in mitral stenosis.
Apex - tapping, undisplaced
First sound - loud
Third sound - absent
36
Describe the: 1) pulse, 2) location of the apex, 3) systolic thrill, 4) Ejection systolic murmur and 5) BP pulse pressure in aortic stenosis.
```
Pulse - slow rising
Apex - Undisplaced, heaving
Systolic thrill - Present
Ejection systolic murmur - harsh and loud
Pulse pressure - narrow
```
37
Describe the: 1) pulse, 2) location of the apex, 3) systolic thrill, 4) Ejection systolic murmur and 5) BP pulse pressure in aortic regurgitation.
```
Pulse - collapsing
Apex - 6th IC space, ant. axillary line, thrusting
Systolic thrill - absent
Ejection systolic murmur - softer
Pulse pressure - wide
```
38
What criteria is used for helping confirm a diagnosis of infective endocarditis?
Duke's
39
Name 5 examination findings you might see in a patient with infective endocarditis
Osler's nodes - painful, raised red lesions on fingers or toes
Janeway lesions - non-tender flat red lesions on palms and soles
Splinter haemorrhages
Signs of emboli (peripheral or central)
Pyrexia
Petechial rash
Cotton wool spots
40
Before prescribing a statin what blood test must you do and and why?
LFTs as they are hepatotoxic. Must be checked as a baseline, at 3 months and then again at 1 year
41
What hormone is significantly raised in heart failure?
BNP - brain natriuretic peptide
42
What 2 drugs are the first line treatment for heart failure?
ACEI and B-blocker (maybe ARB and B blocker)
43
What electrolyte abnormalities can thiazide diuretics cause?
```
Hyponatraemia
Hypokalaemia
Hyperuricaemia (can cause gout)
Hypercalcaemia
Hyperglycaemia
```
44
What 2 blood tests can be done to check synthetic liver function?
- INR/PT
| - Albumin -> hypoalbuminaemia is seen in chronic liver disease, it is this that results in ascites and peripheral oedema
45
List 3 abdominal signs of chronic liver disease
- Ascites
- Hepatomegaly
- Splenomegaly
- Caput medusae
46
Where in the GI tract does Crohn's disease most typically affect?
Terminal ileum and ascending colon
47
What layers of the bowel does UC affect?
Just the bowel mucosa
48
What layers of the bowel does Crohn's affect?
All layers - it is transmural which can lead to fistulas.
49
Give 4 extra intestinal manifestations of IBD
- Mouth ulcers (aphthous)
- Skin - erythema nodosum, pyoderma gangrenosum
- Eyes - conjunctivitis, uveitis
- Joints - acute arthritis
- Finger clubbing
50
Give 6 contraindications to the OCP
- History of DVT/PE
- Breast cancer
- Currently breastfeeding
- Previous stroke
- Migraine with aura
- Liver disease
- IHD
51
Name a drug that is used to treat infertility in women
Clomifene
52
Give some signs and symptoms of hyponatraemia
```
Anorexia
Malaise
Nausea and vomiting
Muscle cramps
Confusion, seizures
Coma
```
53
What does it suggest about the cause of hyponatraemia if urinary sodium is high? Give some examples of causes
That sodium and water are being lost from the kidneys.
- Diuretic overuse
- Renal failure
- Addison's disease
- Osmotic diuresis
54
Give some non-renal causes of hyponatraemia
- D+V
- Burns
- Small bowel obstruction
- Heat exposure
- Iatrogenic
55
Why must you not correct hyponatraemia too quickly?
Can cause cerebral oedema and central pontine myelinolysis
56
How do you manage hyponatraemia?
IV 0.9% saline, gradually. Furosemide if v. severe to reduce risk of heart failure
57
Give some signs and symptoms of hypernatraemia
- Thirst
- Lethargy
- Irritability
- Weakness
- Confusion
- Reduced consciousness, seizures, coma
58
Give 4 potential causes of hypernatraemia
- D+V
- Burns
- Osmotic diuresis (hyperosmolar hyperglycaemia state)
- Diabetes insipidus
59
How do you manage a patient with hypernatraemia due to diabetes insidious?
Desmopressin
60
How do you treat hypernatraemia?
Slowly! Oral water but if not tolerated 5% dextrose.
61
Give 4 signs/symptoms of hypokalaemia
- weakness / fatigue
- constipation / ileus
- paraesthesia, tetany, muscle weakness
- paralysis (starting distally)
62
Give 3 drugs that can cause hypokalaemia
- Salbutamol
- Insulin (drives it intracellularly)
- Thiazide diuretics and loop diuretics
- High dose corticosteroids
63
What other electrolyte often needs replacing with K+?
Mg as depletion makes it difficult to replace K+
64
Give some signs/symptoms of hyperkalaemia
Muscle weakness, oliguria, respiratory distress, ECG changes, areflexia
65
What are 4 potential causes of hyperkalaemia?
Addison's disease
Renal damage and renal failure
RBC transfusion nearing expiry
Drugs
66
Give 4 examples of drugs that can cause hyperkalaemia
```
B blockers
ACEI
ARBs
Digoxin
NSAIDS
Aldosterone antagonists
```
67
What can you give to protect the heart in emergency hyperkalaemia?
Calcium gluconate
68
How do you treat hyperkalaemia as an emergency?
Insulin in dextrose
Salbutamol
Calcium resonium
Dialysis
69
What autoantibody screen would you do in someone you expect has Coeliac disease?
Anti-transglutaminase
70
What is the most common cause of a benign breast lump?
Fibroadenoma
71
Describe how breast cancer can spread nodally
- Axillary nodes (75%)
- Deep cervical nodes
- Parasternal nodes
- Infraclavicular nodes
72
How might a surgeon distinguish between an indirect and a direct hernia in surgery?
An indirect inguinal hernia will be lateral to the inferior epigastric artery
73
What veins are dilated in a varicocele?
Veins of the Pampiniform plexus
74
What structure is ligated when sterilising a man?
The ductus deferens
75
How might you distinguish between a gastric and duodenal ulcer based on the history?
- Duodenal ulcers -> pain is better with food and then returns a few hours after eating. Nocturnal pain
- Gastric ulcers -> pain worse on eating
76
What is the most common cause of portal hypertension?
Liver cirrhosis
77
Which muscle is most likely to be torn in childbirth?
Pubococcygeus
78
Which nerve is most commonly involved in foot drop?
Common fibular (peroneal) nerve
79
Name 5 causes of peripheral neuropathy
- Diabetes - most common
- Charcot Marie Tooth
- Guillain Barre
- Vasculitis
- Hypothyroidism
- Excess alcohol intake
- Shingles
80
Give 4 potential causes of high opening CSF pressure
- Meningitis
- Tumour/space occupying lesion
- Intracranial haemorrhage
- IIH
81
What does the presence of xanthochromia in CSF (with the absence of jaundice) indicate?
Subarachnoid haemorrhage -> must be done 12hours later
82
What can you look for in the CSF to help confirm a diagnosis of MS?
Oligo-clonal bands
83
What antibiotics can be used to treat bacterial meningitis in hospital?
IV cefotaxime
| IV amoxicillin
84
Give 4 clinical signs suggestive of venous insufficiency
- Venous eczema
- Haemosiderin deposits
- Venous ulceration
- Varicose veins
- Lipodermatosclerosis (inverted champagne bottle sign)
85
Give 4 retinal signs in a patient with hypertensive retinopathy
- Silver wiring
- AV nipping
- Cotton wool spots
- Flame haemorrhages
- Papilloedema
86
Give 4 retinal signs in a patient with diabetic retinopathy
- Cotton wool spots
- Neovascularisation
- Dot and blot haemorrhages
- Hard exudates
87
What mnemonic can be used to ascertain the cause of metabolic acidosis?
```
MUDPILES
Methanol/metformin
Uremia
DKA
Paracetamol
Iron
Lactic acidosis
Ethylene glycol
Salicylates
```
88
What are the sepsis 6?
1) High flow O2
2) Blood cultures
3) IV Abx
4) Lactate (and FBC)
5) IV fluids
6) Urine output -> catheterise
89
Why do pudendal nerve blocks not completely abolish sensation during childbirth?
The ilio-inguinal nerve provides sensation to the anterior part of the perineum and is not blocked
90
Fractures to the epiphyseal plate during childhood are called what type of fracture?
Salter-Harris
91
What nerve damage does a positive trendelenburg test suggest? Which muscle is involved?
Superior gluteal nerve
| Gluteus medius
92
What nerve roots are responsible for the babinski reflex?
L4, L5, S1, S2
93
Ankle sprains are almost always due to which kind of injury and what ligament is commonly affected?
Inversion injury
| Anterior talofibular ligament
94
If Weber's lateralises to the left and Rinne's is negative in the left what does this suggest?
Conductive hearing loss in the left ear
95
If Weber's lateralises to the left and Rinne's is positive in the left what does this suggest?
Sensorineural hearing loss in the right ear
96
If an asthmatic requires a salbutamol inhaler, steroid inhaler and still isn't well controlled what is the next step?
Add a LABA (e.g. salmeterol)
97
What is step 4 in asthma management?
- Leukotriene receptor antagonist
- Theophylline
- Increasing steroid dose
98
What is the normal respiratory rate and heart rate in a newborn?
RR - 30-60
| HR - 110-150
99
How much feed do babies require/day?
150ml/kg/day
100
What is the FEV1:FVC ratio in obstructive lung disease? (e.g. COPD, asthma, bronchiectasis?
Reduced,
101
What histological/pathological findings might be seen in the neural tissue of a patient with Alzheimer's disease?
Neurofibrillary tangles and amyloid plaques
102
Describe 2 changes that can be seen in the histological slices of a Parkinson's brain
1) Lewy bodies - these look like purple circles within neurones
2) Loss of pigmentation in the substantial nigra in the midbrain
103
In what disease might Reed-Sternberg cells be found in the blood?
Hodgkins Lymphoma
104
What is a Signet ring cell and when might it be seen?
A cell with a large vacuole. Seen in carcinomas, most commonly gastric and colorectal.
105
Describe some histological and pathological changes seen in UC
Superficial ulcers
| Crypt abscesses
106
Describe some histological and pathological changes seen in Crohn's disease
Cobblestone appearance
Skip lesions
Granulomas
107
Where are plaques most commonly seen in psoriasis? What other manifestations (non-skin) might be apparent?
Extensor surfaces
- Pitting of the nails
- Oncholysis
- RA
108
What is the causative agent of Pityriasis versicolor, what does the condition look like and how is it treated?
M. fur fur
Flat depigmented lesions
Ketoconazole shampoo
109
How might erythema multiform be easily recognised? What is the most common trigger?
Target lesions.
| Herpes simplex virus is most common trigger
110
How is Steven's Johnson Syndrome often recognised?
Affects the lips and mucus membranes - necrosis
111
What is the most likely cause of rhinophyma? (and what is it?)
Bulbous looking nose
| Untreated rosacea
112
What type of hypersensitivity reaction is urticaria due to?
Type 1 (IgE)
113
What is Henoch-Schonlein purpura?
Small vessel vasculitis, IgA.
A triad of: purpura, arthritis and abdominal pain.
Mostly affects children, usually resolves on its own
114
How is scabies treated?
Permethrin cream from head down.
115
What cream can be used to treat Tinea infections?
Terbinafine
116
What other signs/symptoms might a patient with scleroderma have?
Raynauds -> treat w/ Ca channel blockers
Facial telangiectasia
Sclerodactyly
Dilated nail fold capillaries
117
Name the 2 muscles that supinate the hand and what innervates them
- The supinator -> radial nerve
| - Biceps brachii -> musculocutaneous nerve
118
What nerve injury can cause a winged scapula and what muscle is involved?
Injury to the long thoracic nerve
| Serratus anterior
119
What nerve roots for the superior part of the brachial plexus and what problems can damage to this cause?
C5 and C6
| - Erb's palsy. Limb hangs in medial rotation
120
What nerve roots for the inferior part of the brachial plexus and what problems can damage to this cause?
C8 and T1
| - Klumpke's palsy -> claw hand (ulnar nerve)
121
What injury results in a popeye deformity?
Rupture to the tendon of the long head of biceps brachii
122
What sodium and potassium abnormalities will be seen in a patient with Addison's disease?
High K+
| Low Na+
123
In which vein is a central line usually placed?
The right or left subclavian
124
Horner's syndrome is caused by a lesion in the parasympathetic or sympathetic trunk in the neck?
Sympathetic
125
Loss of the corneal reflex can occur if either of 2 nerves are damaged. Which nerves?
CNV1 -> ophthalmic nerve
| CNVII -> facial nerve
126
Which nerves can be involved in an acoustic neuroma?
CNVIII
CNVII
CNV
127
A lesion in what nerve will result in palatal deviation to the unaffected side (uvula off centre), absence of taste to the posterior third of the tongue, changes in swallowing and an absent gag reflex?
Glossopharyngeal nerve
128
What is the skyline test in a knee exam looking for?
PCL rupture
129
What is the Lachman test for?
ACL damage
130
How should hypertension managed medically according to NICE guidelines?
It differs for people over 55 and those under 55
131
What medical treatment is recommended for people <55 years with htn?
ACEI or a low cost ARB (candesartan)
132
What medical treatment is recommended for people >55 years with hypertension? (Step 1)
Ca channel blocker (amlodipine)
133
What drug can be added in for step 3 of hypertension treatment?
Thiazide like diuretic
134
What drug us most commonly used for treating hypertension in pregnancy?
Labetalol
135
What does the CHA2DS2VAS score stand for and what is it used for?
```
It is used to evaluate the stroke risk of patients with AF
C - congestive heart failure
H - hypertension
A - Age (>75yrs) +2
D - diabetes
S - stroke or TIA +2
V - vascular disease
A - Age (65-74 +1)
S - sex - female +1
```
136
If the CHADVASC score is +1 in a man and women, what is the appropriate action?
In a man a score of 1 would usually mean anticoagulation
| In a women a score of 1 is usually managed conservatively
137
Name 6 risk factors for endometrial cancer
- Obesity
- Nulliparity
- Late menopause
- FH of ovarian, breast or colon ca
- Unopposed oestrogen therapy
- Diabetes
- PCOS
- Tamoxifen
138
Name 5 risk factors for ovarian cancer
- BRCA1 or BRCA2 genes
- Jewish
- Nulliparity
- Age >45
- Oestrogen only HRT
- Endometriosis
- Obesity
139
Name some protective factors for ovarian cancer
- Multiparty
- Young age at first child and late age at last child
- Breast feeding
- COCP use
- Tube ligation
140
What is the most common cause of cushion's syndrome?
Steroid use - glucocorticoids.
141
Give some methods used to diagnose Cushing's
- Measuring cortisol in 24 hour urine collection -> if Cushings then cortisol high
- Measure cortisol in late night salivary sample -> if Cushings cortisol high
- Dexamethasone supperssion test -> high cortisol = cushings
142
How can Addison's disease be diagnosed?
- Short synacthen test. Poor rise in cortisol if Addison's
- Insulin tolerance test -> induces hypoglycaemia which should stimulate GH and cortisol. Poor cortisol response in Addison's
143
What is sick euthyroid syndrome?
In an acutely unwell patient TFTs can become abnormal -> normal/low TSH with low T3+T4. This resolves when recovered
144
What autoantibodies might be seen in someone with SLE?
anti - dsDNA, lupus anticoagulant, anti-Ro, ANA
145
What autoantibodies are often seen in Sjogren's?
Anti-Ro, anti-La
146
What autoantibodies are best for diagnosing RA?
Anti - CCP and rheumatoid factor
147
c-ANCA and p-ANCA are often found in what autoimmune condition?
Wegner's granulomatosis
148
Other than myocardial injury - name some potential causes of a raised Troponin T
- PE
- Sepsis
- AF
- Renal failure
- Myocarditis
- Heart failure
