Firms: General Flashcards
(135 cards)
1
Q
SOB DDx
A
Asthma (reversible), AECOPD (irreversible), pulmonary oedema (HF), pleural effusion (malignancy), pneumonia, pneumothorax, PE, ILD, TB
Also: anaemia, anxiety, DKA
2
Q
List common causes of HF (6)
A
IHD, valve disease, myocarditis, HTN, dilated cardiomyopathy, arrhythmias
3
Q
Why do you get pulm oedema w HF?
A
When the pressure of venous blood > oncotic pressure
4
Q
The acute mx of pulm oedema
A
Sit up, oxygen, diuretics, cardio review, monitor daily weights and UO
5
Q
Furosemide: dose and route
A
40mg oral OD
6
Q
What can you give for acute pulm oedema if furosemide fails?
A
Diamorphine
7
Q
Which antiemetic works well w morphine?
A
Metoclopramide
8
Q
Tx for chronic HF
A
Conserv: exercise, red alcohol, stop smoking, dietary, red salt
Medical: ACEi, beta blocker, aldosterone antag, digoxin
Surg: implantable cardioverter defib and cardiac resynchronisation therapy
9
Q
Ramipril: dose and route
A
1.25mg oral OD
10
Q
What are the top three causative organisms of pneumonia?
A
- Pneumococcus
- Haemophilus
- Mycoplasma
11
Q
At which hb do you transfuse?
A
Usually 70 but threshold inc to 80 in ACS pts
12
Q
When bleeding what is the order of bottles by draw?
A
Cultures
Blue
Yellow
Purple
Pink
Grey
13
Q
Which blood culture bottle do you take first?
A
Aerobic -> Anaerobic
NB: clean the tops w a different wipe before use and collect at least 3ml per bottle
14
Q
What is the blue bottle for?
Mix 3-4
A
Coag, INR, D-dimer
15
Q
What is the yellow bottle for?
Mix 5-6
A
CRP
U+Es
LFTs
TFTs
Iron Studies
Bone Profile
Lipid Profile
Troponin
Amylase
Hormones
Toxicology
Complement
Immunoglobulins
Tumour Markers
16
Q
What is the purple bottle for?
Mix 8-10
A
FBC
ESR
PTH
HbA1c
Film
17
Q
What is the pink bottle for?
Mix 8-10
A
G+S, XM, DAT
18
Q
What is the grey bottle for?
Mix 8-10
A
Glucose + Lactate
19
Q
What happens if you leave the tourniquet on? (3)
A
Bruising, nerve palsies, ALI
20
Q
List the seven types of glomerulonephritis
A
Nephrotic Syndrome: minimal change, membranous, focal segmental
Nephritic Syndrome: post streptococcal, berger disease, crescentic, alport syndrome
21
Q
What is a/w nephrotic syndrome? (3)
A
Hypercholesterolaemia, hypoalbuminaemia, peripheral oedema
22
Q
What are the end of life PRNs? (4)
A
Analgesic
Anti-Emetic
Anti-Secretion
Relaxant
Morphine
Levomepromazine
Glycopyrronium
Haloperidol/Midazolam
23
Q
What are the causes of crackles during insp?
A
Fine - Fibrosis + HF
Coarse - Pneumonia + Bronchiectasis
24
Q
Resp Failure: Type 1 vs Type 2
A
Type 1 - Hypoxaemic (V/Q Mismatch): pneumonia, pulm oedema, pulm fibrosis, pulm HTN, pneumothorax, PE, ARDS, obesity
Low O2 + N CO2 = Give CPAP
Type 2 - Hypercapnic (Hypoventilation): severe asthma, COPD, drug OD, CNS injury, primary muscle disorders, NMJ disorders, chest wall deformities, Pickwickian syndrome
Low O2 + High CO2 = Give BiPAP
25
What is low PaO2 and high PaCO2?
PaO2 <8kPa (60mmHg)
PaCO2 >6kPa (50mmHg)
26
What is Westermark’s sign?
Focal area of reduced vasc markings due to oligaemia from a massive PE
27
What is COPD?
Chronic Bronchitis (clinical dx - productive cough for 3m/yr for two consecutive yrs) + Emphysema (histological dx - permanent airspace dilatation)
28
What are the spirometry results in COPD?
FEV1 <0.8, FEV1/FVC ratio <0.7, not fully reversible
29
What are the values of FEV1 for COPD severity set by NICE?
Mild >80%, Mod 50-80 and Sev 30-50, V Sev <30%
30
What are the causes of COPD? (3)
Smoking, A1AT-D, Environmental/Occupational
31
What ca are A1AT-D pts at risk of?
Hepatocellular Carcinoma
32
Rx of COPD
Bronchodilators, ICS, FLORES: FluOxygenREhabSmoking
Flu and Pneumococcal Vaccines
LTOT if PaO2 <7.3 twice at least 3wks apart in stable pts OR <8 w secondary polycythaemia, pulm HTN, cor pulmonale, nocturnal hypoxaemia
Pulmonary Rehab + Stop Smoking
33
Mx of AECOPD
It’s a medical emerg therefore A-E plus three main issues: RF, infection, chronic mx
RF: controlled O2 therapy w venturi, air driven bronchodilators, BiPAP to improve V/Q mismatch
Infection: steroids + abx
Chronic Mx: FLORES
34
Comps of COPD + Lung Fibrosis (4)
Chest infection, resp failure, cor pulmonale, cancer
35
What cardiac drug can lead to fibrotic lung disease?
Amiodarone
?Skin Pigmentation ?AF
36
What is ILD?
Umbrella term for a group of conditions related to different pathologies that all cause a restrictive defect, hypoxia and breathlessness
37
The five broad cats of ILD
Idiopathic, IPF, NSIP, EAA, Pneumoconiosis
38
What are the causes of APICAL fibrosis?
Any environmental cause except asbestosis
PLUS sarcoidosis + ank spond
39
What are the causes of BASAL fibrosis?
Asbestosis
PLUS idiopathic, connective tissue diseases, drugs
40
What is Hamman-Rich syndrome?
Rapidly progressive fibrosis w very poor prognosis
41
What can be seen on HRCT for ILD?
IPF - honeycombing
NSIP - ground glass appearance
42
What imaging is required for upper lobe fibrosis?
MRI
43
What does lymphocytosis on a BAL predict?
Steroid responsiveness and therefore better prognosis
44
Mx of ILD
C: stop smoking + look for reversible causes
M: steroids guided by a specialist + PPIs if any sx of reflux disease
S: consider if focal disease to improve V/Q mismatch
45
What can ILD pts be switched onto if steroids aren’t working? (2)
Azathioprine
Cyclophosphamide
46
How does RA affect the lungs?
Lung fibrosis directly as autoimmune or secondary to methotrexate tx
Pleural effusions usually asx, small, self remitting
Intrapulmonary nodules inc Caplan’s syndrome
Obliterative bronchiolitis presenting w breathlessness + high pitched wheeze
47
What is bronchiectasis?
Permanent dilatation of terminal bronchioles
48
What are the causes of bronchiectasis?
Bronchial obstrc - foreign body + tumour
Childhood infections - measles, pertussis, TB
Defect of mucociliary clearance - CF + ciliary dyskinesia
PLUS ig immunodeficiency + yellow nail syndrome
49
What is the chromosomal error in CF?
Ch7 deletion of F508
50
What tests can you perform for suspected ciliary dysfunction?
Saccharin test OR cilial electron microscopy
51
What immunodeficiency classically causes bronchiectasis?
IgA
52
What can you see on CXR in pts w bronchiectasis?
Tramline shadows due to bronchial thickening
53
What is pathognomonic of bronchiectasis on HRCT?
Signet ring sign
54
Mx of Bronchiectasis
C: stop smoking, chest physiotherapy, psychological support
M: oxygen, rotating abx, carbocysteine
S: consider lobectomy if sx uncontrolled
Tx w MDT approach - chest PT for mucous clearance, O2 therapy assessment, meds to aid chest clearance and prevent infections - important to immunise these pts and take serial sputum samples looking for pseudomonas colonisation
55
What abx do you give in the acute setting for bronchiectasis?
Standard tx for pneumonia PLUS cover for pseudomonas
NB: always check local trust guidelines
56
What are the indications for a lobectomy? (3)
Main Points: bronchiectasis, TB, malignancy
Small Print: CF, abscess, single pulm nodule
57
What paraneoplastic syndromes are a/w small cell lung ca? (3)
SIADH, Cushings, Lambert-Eaton
58
What paraneoplastic syndromes are a/w squamous cell lung ca? (2)
HyperCa (PTHrP) + Hyperthyroidism (TSH)
59
What paraneoplastic syndromes are a/w adeno lung ca? (3)
Clubbing, HPOA, Gynaecomastia
60
How does pancoast syndrome cause shoulder/ant chest wall pain, arm weakness, ipsilateral horners?
It invades the brachial plexus and cervical sympathetic nerves
61
Typical ABPA pt
Chronic asthma, new copious mucopurulent sputum, high IgE
It’s a hyperactive response to aspergillus fumigatus NOT an infection
Rx w 16wks of antifungals
62
ABG: acidosis + low CO2
Met Acidosis w pt breathing heavily to compensate
63
ABG: alkalosis + low CO2
Resp Alkalosis w pt breathing heavily due to asthma or panicking etc
64
What does a raised lactate make you worried about?
End organ hypoperfusion
65
How can you tell an AV fistula is working? (2)
A thrill can be felt and a bruit can be heard
66
Comps of AV fistula (3)
If it’s large enough you get elements of high output cardiac failure
PLUS thrombosis and infection
67
Indications for RRT (5)
Uraemia w comps, refractory hyperK/pulm oedema/met acidosis, drug OD
68
What are the different RRT options? (4)
1. Haemofiltration: used for emergencies in ITU
2. Haemodialysis: via tunnelled line or fistula
3. Peritoneal Dialysis: via continuous ambulatory or automated
4. Renal Transplant
69
HF vs HD
HF - 24hrs; uses convection; fluid volume IS replaced; prevents intravasc depletion, BP swings, dec risk of cerebral oedema
HD - 4hrs; uses diffusion; fluid is NOT replaced; haemodynamically stable but catabolic, hyperK, fluid overloaded
70
What is the risk w haemodialysis?
Endocarditis of the tricuspid valve
71
What are the comps of peritoneal dialysis? (2)
Sclerosing peritonitis and hyperglycaemia
72
Typical PBC pt
40+ F w liver failure and signs of autoimmune conditions complaining of itching that started BEFORE the jaundice, fatigue, xanthelasma
73
What is a/w PBC? (3)
RA, Sjogrens, hypothyroidism
74
Bloods for PBC (2)
Anti mitochondrial ab subtype M2
Raised bilirubin, alk phos, gamma gt
75
Tx for PBC (3)
Fat soluble vitamin supplementation, cholestyramine for the pruritis, ultimately a liver transplant
76
What are the consequences of deficiencies in the fat soluble vitamins?
A - night blindness
D - tiredness, bones, schizophrenia
E - generalised weakness, myopathy, dysarthria
K - elevated INR
NB: the impact on vitamin D deficiency on bones is compounded by the chronic inflammation
77
What is a/w APCKD? (3)
Berry aneurysms, HTN, family screening
78
What is a/w Wilsons? (2)
Dysarthria + Tremor
79
What are the causes of hepatomegaly? (6)
3C’s: cirrhosis, cancer, congestion
3I’s: infiltrative (sarcoidosis, amyloidosis, haemochromatosis), inflam (alcoholic, viral, AI hepatitis), Riedel’s lobe structural variant
80
What is pathognomonic for cirrhosis?
Hepatic venous hum
81
What are the neuro comps of alcohol XS? (3)
Wernicke encephalopathy, cerebellar syndrome, delirium tremens on withdrawal
82
Triad of Wernicke encephalopathy
Ophthalmoparesis w nystagmus, ataxia, confusion
83
Consequences of an impaired synthetic function of the liver
Coagulopathy + Hypoalbuminaemia
84
At what neutrophil count following an ascitic tap would you start abx?
>250/ml
85
How much does one unit of Novorapid reduce BMs by as a rule of thumb?
3mmol/L
86
What should you be wary of when giving insulin to newly diagnosed type 1s?
Hypos as they’ll be insulin sensitive
87
What should you check if a pt has low hb post op?
The pre op hb + estimated blood loss
88
When would it be urgent to receive NG tube confirmation?
For Parkinson pts so they can have their meds on time
89
Typical PSC pt
Mostly men with UC presenting w obstructive jaundice
90
What does ‘beads on a string’ on ERCP indicate?
PSC
91
Which ca do pts w PSC get?
1 in 5 get cholangiocarcinoma
92
Why do pts w PSC receive ursodeoxycholic acid when it doesn’t improve sx?
It improves the LFTs and increases the time until a transplant is required
93
IBD: UC vs CD
UC: continuous mucosal inflam w main sx of urgency, tenesmus, wt loss, bloody diarrhoea
CD: non-continuous transmural inflam w cobblestoning, skip lesions, ulcers, strictures, fistulae, perforation
NB: extra-intestinal manifestations in both inc large joint arthritis, erythema nodosum, pyoderma gangrenosum, uveitis, episcleritis
94
A/w UC
Greater ca risk, PSC, uveitis
95
A/w CD
Worse in smokers, gallstones and oxalate renal stones, episcleritis
96
Can you get a terminal ileitis w UC?
Despite not affecting the small bowel you can get backwash ileitis, less common than w CD, but can also have B12 def w UC
97
What infective disease can also cause a terminal ileitis?
Yersinia Enterocolitica
98
RIF pain ddx
GI: appendicitis, terminal ileitis, yersinia infection, mesenteric adenitis, meckels diverticulitis
Gynae: ectopic, ovarian/testicular torsion, PID
Uro: UTI + stone
99
LIF pain ddx
GI: diverticulitis, IBD, IBS, constipation, hernia
Gynae: ectopic, ovarian/testicular torsion, PID
Uro: UTI + stone
100
Ix for IBD (3)
Bloods - anaemia, B12, vit D
Stool - inc faecal calprotectin + occult blood
AXR - obstruction, UC: toxic megacolon, CD: perforation
101
Ddx for increased faecal calprotectin (5)
IBD, coeliac disease, infective colitis, colon cancer, NSAID use
102
What is a toxic megacolon?
Colonic diameter >6cm on clear abdominal film PLUS signs of systemic inflam: tachycardia, febrile, leukocytosis, low albumin count
103
Mx for IBD
Medical - 5-ASA PO/PR, steroid foams PR, budesonide PO, biologics
Surgical - UC: panproctocolectomy + CD: elective terminal ileum resection
104
The three types of chronic AI hepatitis
Type 1: ANA, anti-SM, IgG hyperglobulinaemia
Type 2: anti LKM1 + responds to interferon
Type 3: SLA + liver-pancreas antigen
105
Hep B Abs/Ags
HBsAb - cleared or vaccinated
HBcAb - cleared
HBsAg - active or chronic
HBeAg - active
106
Tx for Hep B
Peg-IFNα + an antiviral agent such as entecavir or tenofovir
107
Hep B vs Hep C: DNA vs RNA? Which is more likely to become chronic?
Hep B - DNA
Hep C - RNA
NB: it’s Hep C that’s much more likely to become chronic
108
Associate features of Hep C
Mixed cryoglobulinaemia causing a vasculitic rash and Raynaud’s phenomenon
109
Ix for Hep C
Rheumatoid Factor + complement screen for normal C3 and low C4
110
Tx for Hep C
Peg-IFNα + antiviral or ribavirin
111
What is the most common Hep C genotype in the UK?
1
112
What causes your ALT to go above 1000? (2)
Ischaemia + Paracetamol OD
113
List three other non-hepatic causes of an elevated ALT
Addisons, coeliac, anorexia
114
What comes to mind for sudden onset severe abdo pain in elderly pt w AF?
Mesenteric Infarction
115
Outline the associated sx to ask for a neck and throat hx
Voice
Dysphagia
Odynophagia
Dyspnoea
Haemoptysis
Neck Lumps
Referred Ear Pain
Thyroid Sx
FLAWS
116
Outline the examination of the neck
Inspect: asymmetry, oral cavity, w tongue out, sipping water
Palpate: tender, lumps, temp, trachea, LNs
Percuss: thyroid borders
Auscultate: bruits + stridor
SRV: tremor, pulse, eye signs
117
What does specificity equal?
True Neg / (True Neg + False Pos)
Therefore high specificity means the test has few false positives
118
What does sensitivity equal?
True Pos / (True Pos + False Neg)
Therefore high sensitivity means the test has few false negatives
119
Specificity vs Sensitivity
SPIN + SNOUT
SPecific tests are good at ruling things IN - low false pos
SeNsitive tests are good at ruling things OUT - low false neg
120
What features suggest activity in Graves disease? (2)
Lid Lag + Tachycardia
121
What features suggest activity in acromegaly? (2)
HTN + Glycosuria
122
What features suggest activity in Cushing’s syndrome? (3)
HTN, Glycosuria, Proximal Myopathy
123
Dx DKA
CBG >11mmol/L or know diabetes mellitus
Ketones >3mmol/L or significant ketonuria
Venous pH <7.3 or HCO3 <15mmol/L
124
Priorities of DKA Mx
1. Fluids
2. Insulin
3. Potassium
4. Anticoag
125
Why do you give fixed rate insulin in DKA?
Ketones > Glucose
126
Dx HHS
CBG >30mmol/L w/o sig hyperketonaemia or acidosis
Hypovolaemia + OsmolaLity >320mosmol/kg
127
Priorities of HHS Mx
1. Fluids
2. Potassium
3. Anticoag
4. Insulin
128
Why might the plasma sodium show as falsely low in HHS?
The hyperglycaemia results in water shift from IC -> EC
129
What are the precipitating factors leading to DKA/HHS?
The 6I’s
Infection
Ischaemia
Iatrogenic
Intoxication
Ignorance
Infant
130
How would you explain DKA/HHS to the pt?
Check pt understanding
Explain comp of their diabetes causing high blood sugars +/- acidic blood
Tx will require admission for fluids insulin monitoring + sx control w analgesia and anti sickness
Explore ICE eg length of stay and amount of needles
131
What is the calculation to work out an IV infusion drip rate?
Volume/Time(mls/mins) x Drop Factor
132
What is acanthosis nigricans a/w?
Insulin resistance, obesity, GI malignancy
133
HyperNa Causes
Hypotonic:
Dehydration
Diabetes Insipidus
Hypertonic:
Conn’s Syndrome
Inappropriate Saline
XS Salt Ingestion
134
What biopsy features are suggestive of carcinoma in any site of the body?
Nuclear enlargement, hyperchromasia and pleomorphism
135
How can you tell if the T2RF is acute or chronic?
If the pt is acidotic it’s acute
