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get to know Flashcards

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1
Q

4 causes of oedema

A

raised capillary hydrostatic pressure

reduced plasma oncotic pressure (<65)

lymphatic insufficiency - lymph node damage

changes in capillary permeability - inflammation, histamine

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2
Q

winged scapula

A

due to paralysis of long thoracic nerve (supplies serratus anterior)

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3
Q

what does vagus nerve pass through diaphragm with?

A

oesophagus (T10)

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4
Q

what nerve hooks under the ligamentum ateriosum?

A

the recurrent laryngeal branch of the left vagus nerve - does enter chest

(right recurrent laryngeal nerve hooks under the arch of the aorta - does NOT enter chest)

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5
Q

pulseless, unconscious, shockable arrhythmia

A

ventricular fibrillation

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6
Q

what is sodium nitroprusside used for?

A

rapid bp lowering (parenteral medication)

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7
Q

management post 2nd PE that had unknown causes

A

thrombophilia screen

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8
Q

initial therapy for hypertrophic obstructive cardiomyopathy

A

beta blocker

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9
Q

increased jugular distension on inspiration + reduced S1 + S2

A

constrictive pericarditis

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10
Q

29 y/o presents with fatigue + palpitations, ECG shows irregularly irregular pulse + no added cardiac sounds

most useful next investigation?

A

thyroid function test

–> thyrotoxicosis is most common cause of AF in young + in absence of valvular disease

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11
Q

what can a small ventricular septal defect cause?

A

endocarditis

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12
Q

atropine side effects

A

pupil dilatation, urinary retention, dry eyes, constipation

(antimuscarinic - inhibits parasympathetic)

treatment of bradycardias / AV node blocks

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13
Q

conditions to suspect in plumbers

A

asbestosis

legionella

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14
Q

pH, LDH + glucose levels in pleural aspirate analysis of emyema

A

pH < 7.2

increase LDH
decrease glucose

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15
Q

most likely causative organism of chronic pneumonia in patient with long standing cystic fibrosis

A

pseudomonas aeruginosa

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16
Q

treatment of aspergillosis

A

Itraconazole with corticosteroids (prednisolone)

Bronchodilators for asthma

** NOT antibacterials (amoxicillin, erythromycin etc) **

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17
Q

asthma exacerbation, as you feel the peripheral pulse, the volume falls as the patient inspires, explain this clinical sign

A

decreased left atrial filling pressures on inspiration

–> high RR + air flow obstruction > increase in negative intrathoracic pressure > pulmonary vasodilation > pooling blood in lungs > reduced pulmonary venous return to LA

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18
Q

what type of hypersensitivity reaction is hypersensitivity pneumonitis? what are the different types?

A

type III

bird fanciers
farmers
mushroom workers
malt workers

** NOT coal workers**

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19
Q

what can regular nebulised doses of salbutamol cause?

A

hypOkalaemia

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20
Q

lung cancer related to hyponatraemia

A

small (ADH secretion)

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21
Q

lung cancer related to hypercalcaemia

A

squamous - PTHrP

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22
Q

next step in COPD exacerbation post drug admin + CXR request

A

ABG - needed for decision if invasive/non invasive ventilation + for monitoring

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23
Q

what drug do u give first line in someone with hypertension + type 2 diabetes?

A

ACEi

** regardless of age **

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24
Q

raised bilirubin, raised AST + ALT, what other parameter would support a diagnosis of alcoholic liver disease?

A

raised MCV

+ deranged LFTs - alcoholic liver disease

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25
commonest cause of duodenal ulcers
H pylori
26
what is budd-chiari? clinical features?
hepatic vein obstruction causing congestive ischaemia + hepatocyte damage triad = abdo pain, hepatomegaly, ascites raised ALT, jaundice potentially treat with TIPSS
27
investigation + treatment for hiatus hernia
barium meal/swallows endoscopy - view mucosa not too reliable (cheese+onion) lose weight treat associated GORD
28
scoring system for severity of UC
truelove & Witts
29
criteria for moderate + severe UC
moderate - opening bowels 4-6 times a day, moderate amounts of blood severe - more than 6, large amounts of blood ** Truelove & Witts **
30
which part of the small bowel is responsible for the absorption of vitamin B12?
terminal ileum jejunum - vit D, folic acid proximal ileum - vit B2, vit C
31
causes of hepatomegaly
``` malignancy fatty liver early cirrhosis hepatic conjestion secondary to - right HF, Budd-Chiari infection - hepatitis, malaria ``` sickle-cell, leukaemia
32
drugs that can cause cholestasis
co-amoxiclav penicillins oestrogens erythromycin
33
an osmotic laxative
lactulose constipation rapid relief - magnesium/sulphate salts
34
GI conditions that cause clubbing
IBD !! liver cirrhosis PBC coeliac achlasia
35
commonest cause of upper GI bleeds
peptic ulcers
36
what is the difference between koilonychia + leuconychia? associated conditions?
koilonychia = spooning of nails -> iron deficiency anaemia leuconychia = whitening of nails due to hypoalbuminaemia -> chronic liver disease, malnutrition
37
band ligation post oesophageal varice bleed, what drug acts as prophylaxis in preventing rebleed?
propranolol - non-selective BB
38
management of upper GI bleed post ABCDE resuscitation
blood stuff - tests + crossmatch/group+save ACESS = 2 large bore cannula - for fluids, blood etc Transfuse- blood, platelets + clotting factors (fresh frozen plasma), prothrombin complex concentrate Endoscopy drugs - stop anticoag, nsaids
39
which vessel connects iliac arteries to placenta?
umbilical artery
40
opening of this valve causes biphasic waveform in jugular venous pressure
pulmonary tricuspid = closing causes
41
serum potassium + spironolactone
spironolactone = potassium sparing diuretic, retains K - risk of hyperkalaemia serum K must be <4.5 before commencing + monitored throughout treatment
42
a positive test in AAA screening
>3cm --> <3cm discharge from programmee
43
left sided rib fracture, what complication must urgently be investigated?
rupture to spleen
44
goblet cells
secrete mucins to immobilise pathogens + foreign bodies in the resp tract
45
tenecteplase. streptokinase, alteplase
thrombolytic agents for massive PEs with haemodynamic compromise
46
marks division between superior + inferior mediastinum
sternal angle
47
where is fluid drained in pericardiocentesis
infrasternal angle
48
where does azygous vein ascend to SVC?
along right side of vertebral column
49
a sign of unsalvageable limb ischaemia
non-blanching region -->potential amputation
50
where is angiotensinogen produced?
in the liver -> is found continuously circulating in the plasma
51
what stimulates the release of aldosterone from the adrenal cortex?
angiotensin II
52
what chamber covers most of heart base?
LA
53
difference between thiazide + loop diuretics
thiazide - acts on distal tubule, inhibits NaCl co-transporter - inhibiting reabsorption of Na + Cl in distal tubule - so sodium leaves + water follows loop - acts on ascending loop of henle, inhibits NaK2Cl co-transporter reabsorption in ascending loop of henle - water is absorbed in ascending tubule via osmosis
54
6 week old, not been feeding well + losing weight. low pan systolic murmur on auscultation. what condition?
ventricular septal defect
55
at what potassium level would you switch to spironolactone?
if K level drops below 3.5 spironolactone = potassium sparing ** seek expert advise before giving in resitant hypertension
56
commonest site of aneurysm formation due to atheroma
abdominal aorta atheroma in renal arteries - hypertension, renal failure
57
fever, fatigue, breathlessness + confused. developed symptoms over past 2 days + IV drug user first line investigation?
trans-thoracic echo --> vegetation seen on valve
58
review time for hypertension
year
59
murmur associated with hypertrophic cardiomyopathy
ejection systolic jerky pulse double apex beat
60
commonest type of inheritance in hypertrophic cardiomyopathy
autosomal dominant
61
management option (HOCM) pre cardiac arrest if presented with recurrent syncope or sustained VT
ICD implantation + avoidance of competitive sports
62
scoring in DVT investigation
Wells if low = d-dimers
63
when is thrombolysis considered as a DVT treatment option
if DVT symptoms are less than 14 days
64
difference in duct damage between PBC + PSC
PBC = destruction of INTRAhepatic bile ducts ONLY PSC = autoimmune destruction of INTRA *AND* EXTRAhepatic ducts
65
murphys sign positive
cholecystitis - gall bladder inflammation, probs gall stones
66
mechanism of cirrhosis
hepatic stellate cells found in the space of Disse are activated + transformed into myofibroblasts under the influence of cytokines --> these activated cells synthesise collagen leading to fibrosis
67
which amino acid is neither D nor L in configuration?
glycine - side chain is H so no long has 4 different groups (already a H) D + L = stereoisomers
68
bone which possesses the odontoid process
axis (C2)
69
bone has tuberosity
tibia tuberosity = A moderate prominence where muscles and connective tissues attach
70
47 XY + 14
miscarriage - not a viable chromosome complement
71
47XY + 18
edwards (trisomy 18) - early death or miscarriage
72
what occurs in G1 phase of cell cycle?
chromosomes are ready to be replicated
73
``` which is NOT included in the 4C antibiotics: co-amoxiclav clindamycin ciprofloxacin clarithromycin cefuroxime ```
clarithromycin cefuroxime = cephalosporin
74
whats released from kidneys in response to low blood pressure?
renin also released in response to low sodium
75
when can statins not be taken?
with macrolide antibiotics - erythromycin, clarithromycin pregnancy
76
arterial vs venous thrombi
arterial - stroke, MI venous - DVT, PE
77
atherosclerosis pathophysio
Endothelial dysfunction/damage Lipids (LDL) get oxidised in the intima Macrophages consume oxidised lipids resulting in foam cells Foam cells accumulate into fatty streaks Smooth muscle cells from media migrate and proliferate in intima Collagen synthesis and continued accumulation result in atheroma/plaque formation Fibrous cap and a necrotic core develops in the plaque Plaque can rupture - platelet agregation/adhesion- thrombus
78
ABPI that = calf claudication
0.4-0.85
79
mode of inheritance of HCOM
autosomal dominant - condition affecting myosin chain protein high risk patients - ICD low - amiodarone
80
dilated cardiomyopathy
HF like symptoms S3 present ALCOHOL
81
WPW definitive treatment
radiofrequency ablation of accessory pathway -> reentrant SVT due to accessory pathway called bundle of kent
82
endocarditis diagnostic criteria
dukes 2/3 +ve cultures = major
83
pericarditis treatment
treat underlying cause NSAIDS or aspirin - may require PPI colchicine 3 months - reduce risk of recurrence
84
why are serial troponins done
serial = baseline + 6hrs troponin doesnt instantly spill into blood stream - serial increase = highly likely cardiac ischaemia
85
GTN effect of preload + afterload
decreases vasodilates increasing collateral supply
86
betablockers in angina
reduce adrenergic signalling on heart reduce heart oxygen demand work by improving contractility of heart
87
grace score
6 month risk of death or repeat MI post NSTEMI ``` high = angiography within 96hr +/- PCI low = aspirin + ticagrelor ```

first year med (15 decks)

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