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Flashcards in Gastro/Endocrine/Renal/Haem Deck (33)
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1

What are some specific symptoms you should ask about in a GI history?

Dysphagia/odynophagia, nausea/vomiting/haematemasis, abdominal pain/bloating, altered bowel habit/PR bleeding, jaundice

2

If a female patient presents with abdominal pain, what other things must you remember to ask them?

Is there any chance they could be pregnant? - remember to screen for gynae/obstetric problems

3

If a patient presents with jaundice, what are some extra things to ask about?

Have they travelled abroad recently? Have they had any tattoos/piercings recently? Have they had unprotected sex recently? (particularly new partner/high risk activity)

4

What gastrointestinal conditions can finger clubbing be a sign of?

IBD, cirrhosis, coeliac disease

5

What is leuconychia a sign of?

Hypoalbuminaemia

6

Scleral icterus implies a serum level of bilirubin greater than what?

35

7

Where is Virchow's node and what is the significance of it?

Left supraclavicular area - suggestive of gastric cancer

8

The presence of how many spider naevi is suggestive of chronic liver disease?

5 or more

9

In addition to oedema, what are some extra skin changes to look for on the calves of someone with potential gastrointestinal disease?

Erythema nodosum or pyoderma gangrenosum

10

How do you assess for shifting dullness?

Percuss from the umbilicus to the opposite flank- if dullness is detected, ask the patient to roll towards you, wait 10 seconds and the re-percuss

11

The presence of shifting dullness suggests what?

Ascites

12

Where should you auscultate for bowel sounds?

Just below the umbilicus

13

Where should you auscultate for renal bruit?

Superior and lateral to the umbilicus

14

Where should you auscultate for aortic bruit?

Superior to the umbilicus

15

After finishing an abdominal examination, you may wish to mention that you would perform which further examinations?

Hernial orifices, PR, male/female genitalia

16

Where will a transplanted kidney be found?

Right or left iliac fossa

17

If you suspect fluid overload in an individual with gastrointestinal/renal disease, what is a useful thing to examine out with these systems?

Lung bases for pulmonary oedema

18

What is the ideal position for a patient to be in when you examine for hernias?

Standing upright

19

What should you always ask patients to do when examining a possible hernia?

Cough

20

What are the main symptoms you should ask about during a urological history?

Dysuria, haematuria, frequency/nocturia, incontinence, urgency, hesitancy/poor stream/terminal dribbling

21

What are the main symptoms you should ask about if you suspect haematological disease?

Shortness of breath/dizziness/pallor, bleeding/bruising, recurrent infections and systemic symptoms

22

If you are asked to do a warfarin review, what are the first things you should clarify?

Why are they on warfarin and what is their INR

23

When should warfarin be taken?

At the same time every day

24

What should you advise patients to do if they miss one dose of warfarin?

Take it as soon as they remember, unless it is the next day in which case the dose should be omitted and they should contact their doctor

25

When patients start warfarin, you should inform them to seek help if they experience what skin changes?

Jaundice or painful, swollen areas of skin

26

What are some examples of foods that decrease the effect of warfarin (increased risk of clotting)?

Kale, broccoli, spinach

27

What are some examples of foods that increase the effect of warfarin (increased risk of bleeding)?

Cranberry and grapefruit juice, alcohol

28

What should you do if a patient on warfarin has an INR of 5-8 but is not actively bleeding?

Withhold 1 or 2 doses of warfarin and reduce the maintenance dose

29

What should you do if a patient on warfarin has an INR of 5-8 with minor bleeding?

Withhold warfarin, give an IV injection of vitamin K, restart warfarin when INR is < 5

30

What should you do if a patient on warfarin has an INR > 8 but is not actively bleeding?

Withhold warfarin, give oral vitamin K, restart when INR is < 5