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Flashcards in Day 2 Deck (74):
1

General SE?

Weight loss, change in appetite, fever/night sweats, fatigue, pain

2

Cardiac SE?

Chest pain, palpitations, orthopnoea, peripheral oedema, claudication

3

Resp SE?

Breathlessness, wheeze, cough, hoarseness, haemoptysis

4

Chest pain kay details of the history?

SOCRATES (chest pain, palpitations, orthopnia, peripheral odema, claudication, breathlessness, wheeze, cough, hoarseness, haemoptysis, fever, sweats, fatigue, pain elsewhere)
ICE and summary
PMH: Cardiac, GORD
DH and allergies
FH
SH
SE: Urinary symptoms, bone/joint/muscle pain, headaches/confusion, rashes or skin changes

5

MI prescribing?

Morphine 1-10mg IV + Metoclopramide 10mg IV
Oxygen if <94%
Nitrates: Glyceryl trinitrate 1tab/3puffs every 5 mins
Aspirin 300mg PO/450mg PR
Ticagrelor 180mg PO
<120mins PCI
>120 mins thrombolysis (alteplase)

6

Secondary prevention of cardiac events post ACS?

Aspirin + clopidogrel
Bblocker
ACEi
Statin

7

Types of MI?

II, III, aVF: inferior RCA
I, aVL, V5, V6: anterolateral circumflex
V1-V4: anterolateral LAD
STD in V1-3: posterior RCA

8

ECG interpretation?

Details (name, dofb, date and time of ECG, calibration speed 25mm/s)
Rate: this is a regular rhythm at (300/R-R), this is an irregular rhythm at (QRSx6). Tachy or brady
Rhythm: P waves, P waves before every QRS and every QRS proceeded by P wave = sinus rhythm
Axis: I and aVF
PR: 3-5 (0.12-0.2)
QRS: <3 (<0.12)
ST: STE, STD
T wave: inversion outwith V1 and III

9

Cardiac enzymes and timing of rise/decreases?

Troponin 2-4hrs, 7 days
CK 4-6hrs, 72hrs

10

GI SE?

Dysphagia, reflux, N&V, change in bowel habit, blood/mucous in stool

11

GU SE?

Dysuria, frequency, urgency, nocturia, haematuria

12

CNS SE?

Fits/faints/falls/funny turns, numbness/tingling, weakness, headaches, visual changes

13

MSK SE?

Joint pain, muscle pain, swelling, stiffness, rashes

14

Ophthalmology SE?

Dry eyes, red eyes, visual changes

15

Obstetric SE?

Miscarriages

16

Haem SE?

VTE, bruising/bleeding

17

Skin lesion describing?

Areas affected
Body part
Count the lesions
Description (macule, patch, papule, nodule, plaque, vesicle, bulla, pustule, erosion, ulcer, fissure, wheals/hives)
Diameter & definition (mm, well defined, poorly defined)
Configiration (discrete, confluent, linear, annular)
Blush (erythematous, purpuric, hyper/hypopigmented)
Additional features (scale, excoriation, lichenification, crusting)

18

Gynae history taking?

PC
HPC (Pain: abdo, pelvis, during sex, will moving bowels. Bleeding: intermenstrual, post coital. Urinary symptoms. STI symptoms: discharge, skin changes or itching)
ICE and summary
Menstrual history: Age, LMP, typical cycle, menorhagia, dysmenorhia, contraception, menopause
Obstetric history
Sexual history: LSI, consensual, demographics, type, contraception, LSI in 3 months, HIV risk
Smears and procedures
PMH: migraine, VTE, breast Ca, bleeding disorders
DH and allergies
FH
SH
SE: Ca: WL, change in bowel habit, bloating. Infection: fever. Anaemia: SOB/tiredness. Hypothyroid: cold/weight gain/reduced sex drive

19

What are fibroids?

Benign tumours in the uterus, not cancerous

20

What are the signs of fibroids on abdo exam?

Palpable masses

21

What are the typical symptoms of symptomatic fibroids?

Heavy and long periods
Fe deficiency anaemia
Abdo pain, urinary and bowel symptoms (mass effect)

22

How to diagnose fibroids and other useful tests?

Abdo exam, TVUSS
FBC (Fe def anaemia), TFTs

23

What do fibroids look like on TVUSS?

Hypochoic mass

24

What is the main difference between endometriosis presentation and fibroid presentation?

Endometriosis is classically painful heavy periods with fixed retroverted uterus and deep dyspareunia

25

How to manage fibroids?

Mirena, COCP
Tranexamic acid
Mefanamic acid
Myomectomy, uterine artery embolisation, hyterectomy

26

What are the CI for COCP?

BMI >30
Smoker >35yrs
FH/PMH of breast Ca
Migraines with aura

27

What is seen in Fe deficient anaemia?

Hb <120
MCV <80 (microcytic)
Low ferritin

28

SLE key questions to ask?

General: fever, weight loss, night sweats
CNS: change in thoughts, change in mood, stroke
MSK: joint pain, rashes or skin changes
Cardio and resp: SOB, chest pain, PE
GU: blood in urine, frothy urine, urinary symptoms
Skin: malar rash, photo-sensitivity, mucosal ulcers
Haem: bruising, fatigue, recurrent infections
Obstetric: problems during pregnancies, miscarriages
Ophthalmology: Dry eyes, red eye, visual changes

29

Investigations in SLE?

AutoAbs: ANAs, antidsDNA, antismith, antiphospholipid
Xrays of affected joints
FBC (anaemia, thrombocytopenia, leukopenia)
Prothrombin time (prolonged)
Urinalysis (If proteinuria and haematuria: urinalysis to rule out infection, microscopy to look for casts, renal biopsy for immune deposits)

30

Management of SLE?

Refer to rheumatology
If evidence of kidney involvement refer to nephrology Lifestyle (avoid sun, stop smoking)
Steroids
DMARDs: hydroxychloroquine

31

Differentiating between RA and SLE joint pain?

RA is more deforming, XRAYs show erosions. ABS RF, antiCCP

32

Differentials of SLE?

RA, antiphospholipid syndrome, vasculitis

33

Differentials for haematuria?

Infection, stones, BPH, cancer, glomerulonephritis

34

Key questions in haematuria history?

Infection: dysuria, frequency, urgency, lumbar pain, fever/rigors
Stones: lumbar pain, colicky pain radiating to groin, N&V
BPH: hesitancy, poor flow, dribbling, incontinance
Cancer: WL
Glomerulonephritis: frothy, quantity

35

SE in haematuria history?

Rash, joint pain, fatigue, odema/swelling

36

Key features of PMH in haematuria hx?

Recent catheter, bleeding disorders, prostate problems

37

Key to ask in DH?

Anticoagulation

38

Initial investigations of haematuria?

Urinalysis (rule out infection - positive nitrites and leukocytes)
Urine microscopy (dysmorphic RBCs and casts indicated glomerular damage)
FBC, U&Es (kidney function), LFTs (albumin), GFR, lipid profile (raised in nephrotic)

39

If proteins are +++ what do you suspect and what are investigations?

Glomerularnephritis
Referal to nephrology
KUB USS
Renal biopsy

40

Investigation of choice if suspecting stones?

KUB non contract CT detects 99% of stones

41

What are the investigations for all macroscopic haematuria and why?

1- flexible cystoscopy
2- <50years: KUB USS
>50years: CT urogram with contrast
(look for cancer)

42

What is the most common type of cancer in bladder and kidneys?

Bladder: TCC
Kidneys: Adenocarcinoma

43

Key difference between nephritic and nephrotic syndrome?

Nephritic: Proliferative damage allowing protein and RBCs to escape (Haematuria, red cell casts, protein ++, hypertension, decreased UO)
Nephrotic: Only allows protein to be filtered (protein +++, frothy urine, hypoalbuminaemia, odema, hyperlipidema

44

What is key difference between post strep glomerulopnephritis and igA nephropathy?

Post strep is 2-3 weeks after bacterial infection
IgA nephropathy can occur without infection or 1 or 2 days post

45

What is post strep glomerulonephritis and how does it present?

T3HS deposition of immune complexes in the kidneys causing local inflammation
Nephritic syndrome pattern

46

What are the differentials for post strep glomerulonephritis?

Vasculitidies involving kidneys (wegners, churg straus), Good pastures, IgA nephropathy, SLE

47

Management of glomerulonephritis?

Reduce proteinuria (ACEi)
Diuretics
Preserve renal function
Control HTN

48

Acute cholecystitis presentation?

Murpheys +ve, RUQ pain, fever, raised CRP, may or may not be jaundiced

49

What is acute cholecystitis?

Inflammation of the gall bladder most commonly due to gall stones

50

What are the fat soluble vitamins?

A, D, E, K

51

What happens to stools when bile flow is blocked?

Pale, smelly - steatorrhoea
(bile isnt available to breakdown fat so it is excreted unabsorbed)

52

What are the ducts in the biliary tree?

Cystic duct from gall bladder
Hepatic duct from liver joins cystic duct to form common bile duct

53

What is ascending cholangitis and the key symptoms?

inflammation of the bile duct usually due to stone there
Charcots triad: RUQ pain, jaundice, fever

54

What are the investigations in acute cholecystitis?

LFTs
Abdo USS

55

When does dark urin arise and what does it indicate?

CB in the blood as it is water soluble passes out in urine
Damage to hepatocytes allowing it to leak out (hepatitis, obstruction)

56

Investigations in query obstructive jaundice?

LFTs
USS
If not confirmed MRCP

57

Management of acute cholecystitis?

Laparoscopic cholecytectomy

58

Management of ascending cholangitis?

IV abx, ERCP

59

Management of gall stones?

Assymptomatic: if in gall bladder no treatment, if in bile duct ERCP
Symptomatic (colicky biliary pain): cholecystectomy or ERCP

60

Presentation of pancreatic Ca?

Painless jaundice often palpable gall bladder

61

Investigations in suspected pancreatic Ca?

USS, CT

62

Investigations in suspected cholangioCa?

USS, MRCP or ERCP

63

Management of pancreatic Ca?

Whipples procedure

64

CAGE screening?

Cut down
Annoyed
Guilt
Eye opener

65

What are the signs of liver cirrhosis?

Portal hypertension (forces fluid out: hepatomegaly, RUQ pain, ascites, splenomegaly, portosystemic shunt causing renal vasoconstriction, osophageal varices in lower 1/3rd, caput medusae)
Decreased liver function (detox: toxins to brain causing hepatic encepalopathy - asteryxix, confusion, coma, high oestrogen causing gynaecomastia, palmar erythema and spider naevi. Decreased CFs. Decreased Albumin)
Leakage of CB into blood through damaged hepatocytes (jaundice)

66

Investigating liver problems?

LFTs
USS of liver (hepatomegaly, fatty liver, cirrhosis, mass, ascites, portal htn)
Biopsy

67

Process of ALD?

increased fat production and deposition - steatosis, inflammation and damge to cells - alcoholic hepatitis, fibrosis and cirrhosis

68

LFTs in ALD?

ALT +
AST ++
ALT:AST >2
GGT high
Albumin low

69

Main marker for obstructive jaundice in LFTs?

ALP high high high

70

LFTs in NASH?

ALT++ >AST+

71

LFTS in acute hepatitis?

albumin normal indicating not a chronic process

72

Differentials for hypoechoic enlarged liver with no ductal pathology?

ALD with cirrhosis
Hepatocellular Ca
Pancreatic Ca (CT)
Cholangio Ca (MRCP)

73

key feature NASH?

No history of alcohol consumption

74

Key questions in jaundice history?

Dysphagia, N&V, haematemesis, change in apetite, WL, GORD, abdo pain, abdo distension, altered bowel habit, change in stool colour, fever, malaise, urine colour
Alcohol consumption
Fatty foods consumption, obesity, T2DM, HTN, hyperlipidemia