Cellulitis - antibiotic
- clarithromycin for penicillin allergy
Dermatome to dorsum of foot
What does ART stand for (with HIV topic)
and associated problems?
- resistance to drugs
- side effects, drug intolerance
- adherence problems from complex regime
- drug interactions
What's a cause of loud borborygmi?
(movement of fluid and gas)
small-bowel obstruction/ dysmotility if associated with colicky discomfort.
What conditions can cause upper motor neurone symptoms?
- traumatic brain injury
- cerebral palsy
Important things that affect vit D absorption (except for the obvious)
- absorption is in first part of SI, therefore digestive disorders
- condition of the Kidneys
Reasons to do a lumbar puncture
- investigating bacterial meningitis
what is a cardinal feature of bronchitis?
a productive cough.
(usually self resolving and viral)
- an infection of the main airways (bronchi)
Chronic bronchitis features in COPD
What is the ROME III criteria?
Criteria for diagnosing IBS
Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:
- Improvement with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in appearance of stool.
What type of headache is common first thing in the morning?
The hallux dorsiflexes, and the other toes fan out; this is Babinski's sign;
damage to the central nervous system.
Stimulate from heel upwards.
ACNE - antibiotic
doxycycline - tetracyclines
if not responding; erythromycin
Dermatome to Upper inner arm
Suspected subarachnoid haemorrhage headache diagnosis
CT scan (reliability 90% only)
If CT negative, LP > 12 hours following onset of symptoms.
LP: uniform RBC in bottles suggests SAH
Presence of bilirubin suggests bleed (and not trauma)
What is bioavailability?
A subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs.
By definition, when a medication is administered intravenously, its bioavailability is 100%.
UTI - antibiotic
Characteristics of cluster headaches
severe, unilateral, retro-orbital
clustered over time
variable duration (10-60 mins)
autonomic symptoms; tearing, red eye, nasal congestion.
attacks often at night
much more commen in MEN (9:1)
Pathophysiology of pleural effusion due to LVF
back up of fluids increases pulmonary pressure resulting in pulmonary oedema in the alveoli, fluid in the interstitial fluid, and finally into the pleural cavity.
What's the common cause of esophageal varices?
cirrhosis and consequences of portal hypertension
What is cor pulmonale?
Pulmonary heart disease.
Occurs in 25% of patients with COPD.
Caused by pulmonary hypertension causing enlargement of the right ventricle.
Occurs in young men who smoke
This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you're at rest
Inflammation along a vein just below the skin's surface (due to a blood clot in the vein)
Possible antibiotics for meningitis
How is HIV infection diagnosed?
Detection of anti-HIV antibodies by ELISA (enyme-linked immunosorbent assay).
Felty's syndrome (important)
Rare autoimmune disease
C. diff - antibiotic
or vancomycin (glycopeptide) . Nephrotoxic
Characteristics of tension headaches
- mild to moderate (fuzzy head); dull generalized headache
- exert bandlike pressure
- no nausea
poor response to over the counter analgesia
What is the TIMI score?
Estimates mortality for patients with unstable angina and non-ST elevation MI.
What is Boerhaave syndrome?
10% of esophageal perforations which occur due to vomiting.
full-thickness tear in the esophageal wall
high morbidity and mortality and is fatal without treatment
What are the clinical features of a PE?
sudden and unexplained dyspnoea. This maybe the only symptom, especially in the elderly.
- IMP> pleuritic chest pain and haemoptyosis are present only when infarction has occured. PE can be silent!
What is Proctitis?
Proctitis is an inflammation of the lining of the rectum.
Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement
RhA diagnostic criteria
morning stiffness >> 60 mins
stiffness after rest
>> six weeks duration
DIP joints spared
Swan neck/ boutonniere, guttering between bones
RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension
Dermatome to Toes 1-3
Central upper abdominal radiating through to the back and partially relieved by sitting forwards is...
What is found here?
- lymph nodes, cervical rib
- cystic hygroma (lymphangioma)
- Pharyngeal pouch
- Subclavian aneurysm
What is achalasia?
What is a dange of this?
- Oesophageal aperistalsis
- Impaired relaxation of the lower oesophageal sphincter.
Progressive overflow of secretions and food, esp. at night and can cause aspiratory pneumonia.
Upper motor neurone signs
Increase in muscular tone (spasticity)
Increase in reflexes (hyperflexia)
++ Babinski sign
Takayasu's disease (rare)
Takayasu arteritis is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology; affects women of childbearing age.
Gradual stenosis of arteries dues to inflammatory attacks.
- Pain with use of an arm or leg (called “claudication”),
- high BP
distinguish between narrowing due to vasculitis and due to atherosclerosis
Diagnosis; angiogram (X-ray with dye), CT angiography
Tx: steroids, immune suppresants
Upper motor neurone lesion, upper....
What are the two types of leukaemia?
acute lymphoblastic leukaemia (ALL) - lymphoid cell line
myeloid cell line - Acute Myeloid Leukaemia (AML)
What happens to Functional Residual Capacity with emphysema?
REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.
Which part of the GI tract is Crohn's disease?
(abdominal cramping + diarrhoea)
Sudden onset headache could be:
Typically symptoms of intestinal obstruction
- abdominal colic
- constipation WITHOUT the passing of wind
- increased bowel sounds
- Marked tenderness
What is bacterial vaginosis?
•Commonest cause of vaginal discharge (often recurrent)
•Overgrowth of commensals - anaerobes, mycoplasmas & Gardnerella vaginalis
•NOT sexually transmitted though may exacerbate
What is a common cause of melaena.
NB> melaena is due to an upper GI bleed
Testing the median nerve
NB. Thumb opposition; C8, T1 nerve roots
- test; altered sensation over thumb, index, middle fingers
- any thenar eminence wasting?
hand palm up on flat surface. Px moves thumb vertically against resistance (abductor pollicis brevis)
opponens pollicis; try and pull thumb and ring finger apart
Common AIDS-defining illnesses in the West
- Pneumocystis jirovecii
- oesophageal candidiasis
- herpes simplex/ zoster - repeated infections
- + others
ALONG WITH; systemic features weight loss, persistent fever or persistent diarrhoea.
What is the GRACE score?
A scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality
CAP - antibiotic
or doxycycline/ clarithromycin
How does PCP present? - pneumocystis carinii (jirovecii) pneumonia
- non-productive cough
- subacute, symptoms last 3-4 weeks.
CXR normal in 90% of cases.
Name some lower motor neurone conditions
cauda equina syndrome
amyotrophic lateral sclerosis
Epigastric pain that is not tender on palpation and has autonomic symptoms could be....
Syphilis - antibiotic
Dermatome to medial malleolus
Diagram of Lung Volumes
Dermatome to the thumb
Dermatome to Toes 4 and 5; lateral malleolus
Dermatome to Inner Forearm
Small bony nodules (osteophytes) at the DIP and PIP joints are characteristic of what?
DIP - Herberden's nodes
PIP - Bouchard's nodes
Characteristics of migraines
- often unilateral. Recurrent
- usually pulsatile
- builds up over minutes to hours
- occurs with or with aura
associations include; nausea & vomiting, photophobia, sound sensitivity, family history
- exacerbation with physical activity
- triggers; cheese, chocolate, etc.
NB. neurological exam should be negative
What are the signs and symptoms of peritonitis?
severe abdominal pain, tenderness and guarding.
(rigidity - invol contraction of abdo muscles)
Worse for movement as the inflammed peritoneum moves.
REBOUND pain (Blumberg sign) as the peritoneum snaps back into place after palpation.
fever, weight loss
Endocarditis - antibiotic
Gentamicin and Penicillin G
Another name for Broca's aphasia?
Acute asthma attack
add ipratropium bromide if not working well.
Give steroids (orally, IM, IV)
Name some cystic lumps
- Branchial cyst
- Cystic degeneration of tumour
What are typical signs and symptoms of acute leukaemia?
Bone marrow failure symptoms; anemia, leukopenia, thrombocytopenia. Therefore; SOB, fatigue, bacterial infections, bleeding, bruises. Possibly DIC.
- Systemic; malaise, weight loss, sweats are common
What is pseudomembranous colitis?
Also called antibiotic-associated colitis or C. difficile colitis, is inflammation of the colon associated with an overgrowth Clostridium difficile.
This overgrowth of C. difficile is most often related to recent antibiotic use.
What's the story?
Zollinger–Ellison syndrome (ZES) is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers.
Symptoms include abdominal pain and diarrhea.
The syndrome is caused by a neuroendocrine tumor that secretes a gastrin. The tumor causes excessive production of gastric acid.
Dermatome to knee
What symptoms could indicate a median nerve pathology?
the thumb and lateral two and a half fingers affected (numbness)
wasting of thenar eminence
weakness of thumb abduction
Immediate management of acute leukaemia
- often very ill px vulnerable to infections and/or bleeding.
- IV antibiotics
platelets and fresh frozen plasma for bleeding
blood transfusion for anaemia
* even if fever is caused by disease and not infection, treat with antibiotics because b.
Deformities of the finger in RhA
Dermatome to middle finger
Symptoms of meningitis
- high temperature of 38C or more
- blotchy rash that doesn't fade when a glass is rolled over - septicaemia (
- often not present)
- stiff neck
- photophobia, drowsiness, seizures, confusion,
- aching muscles & joints,
- cold hands & feet, tachypnoea
Name opportunistic HIV infections
- PCP - pneumocystis jirovecii
cytomegalovirus (CMV) in late-stage infection (CD4 <50) - main problem progressive retinitis (85%)
toxoplasmosis - protozoa infection. Causes encephalitis (80%) in late HIV
- Kaposi's sarcoma (herpes virus 8)
- + others
What are the tests for Coeliac disease?
Total immunoglobulin A (IgA)
IgA Tissue transglutaminase antibody (shortened to tTG)
+ eat gluten in more than one meal every day for six weeks prior to testing.
GOLD standard; duodenal biopsies with IEL ( increased number of intraepithelial lymphocytes is typical of active celiac disease)
Parotid tail lump - Solid
What other solid lumps are there?
- lymph node
- vagal schwannoma
What is seroconversion?
- Period of time during which HIV antibodies develop and become detectable.
- takes place within a few weeks of initial infection.
- It is often accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes. These symptoms are not a reliable way to identify seroconversion or to diagnose HIV infection.
Lung volumes diagram
What is a pharyneal pouch?
A diverticulum of the mucosa of the pharynx.
Dysphagia, and sense of a lump in the throat
Regurgitation, reappearance of ingested food in the mouth
Cough, due to food regurgitated into the airway
Halitosis, smelly breath, as stagnant food is digested by microorganisms
Neisseria Gonorrhoea - antibiotic
What is the important of lactate in ABG?
by-product of anaerobic respiration.
Good indicator of poor tissue perfusion.
What could CTS be associated with?
What does raised PSA indicate?
Prostate cancer/ benign hypertrophy
other examination; PR, biopsy
Name for rectal bleeding
Investigations for acute leukaemia
FBC; anaemia and thrombocytopenia, << WBCs (or normal , or raised). If raised then cells are mainly primitive white cells (blasts).
Coagulation profile; prolonged clotting times
Blood cultures; infection risk
CXR; mediastinal mass on ALL of T-cell lineage.
GOLD standards to differentiate ALL from AML; bone marrow aspirations, trephine biopsy.
protozoan parasite that causes malaria
Coeliac disease and gluten... what's the story?
gluten > villous atrophy > malabsorption
- Familial component
- T Cell mediated autoimmune inflammation of the small bowel.
What is the definitive examination for a PE?
CT pulmonary angiogram (CTPA) computed tomography using a contrast dye to obtain an image of the pulmonary arteries.
Lower motor neurone signs
- absence of reflexes
- muscle fasciculations
- atrophy of muscles
- decrease muscular tone
HIV is caused by what type of virus?
blood-borne RNA retrovirus
- intercourse, drug use
- maternal-child transmission
- transfusion of blood products
What's this? And info
BCC is a non-melanoma skin cancer, and is the most common type (> 80%) of all skin cancer.
BCC are sometimes referred to as ‘rodent ulcers’.
Common on areas that are exposed to the sun, such as your face, head, neck and ears
Kussmaul breathing is a deep sighing pattern to decrease CO2 levels and is commonly seen with....
Which part of the GI tract is ulcerative colitis?
colon and rectum only
(abdominal cramping + diarrhoea)
What is FNAC?
Fine Needle Aspiration for Cytology
- may be used for neck lumps
Define acute leukaemia
Clonal haematopoietic stem cell/ progenitor disorder characterized by the rapid accumulation of immature progenitor cells (blasts) and impaired normal marrow function.
alcoholic ‘dry heaves’, retching, severe coughing.
tears at the oesophagogastric junction by a sudden increase in intra-abdominal pressure
RhA nodules characteristics
Made from fibroblasts.
Blood supply on the outside only; can become necrotic.
Locations; extensor surfaces of elbows, forearms and hands
What's this? + info.
asymptomatic midline neck mass at or below the level of the hyoid bone, above the thyroid cartilage.
Most often in the midline
They may present in childhood (less than 50%) or, usually as a young adult
Move up when the tongue is protruded & with swallowing- cysts attached to the base of the tongue by the thyroglossal tract.
Symptoms of temporal arteritis
visual loss; blood supply to retina is affected.
One-sided headache, very tender scalp; tender brushing hair
Typically new and continuous headache with those over 50 yrs. Gradual onset (wks-mtns)
Pain in jaw with chewing; jaw claudication
Can cause clots leading to stroke.
- ESR often raised (>100)
What is respiratory acidosis?
Acidosis due to an inability of the lungs to excrete CO2 adequately.
What is a pannus?
containing inflammatory cells that release collagenolytic enzymes
causing loss of bone and cartilage (chronic RhA)
What's the common cause of this?
the consequences of portal hypertension.
Commonly these bleed.
lower 1/3 of the oesophagus
Which shoulder dislocation is most common?
Anterior - 95%
Usually caused by a direct blow to, or fall on, an outstretched arm.
The patient typically holds his/her arm externally rotated and slightly abducted.
Management of Benign prostatic hypertrophy
alpha-adrenergic blockers; prazosin
alpha adrenoceptor antagonists; tamsulosin
or finasteride (inhibitor of testosterone, reduces prostatic hypertrophy)
TURP: TransUrethral Resection of the Prostate.
- 4-72 hOurs duration
Nausea or vomiting
Some characteristics of CTS
- more common in women
- tingling in hand
- symptoms often occur at night
- px may hand hand and arm out of bed for relief
- associated with.... (3)
- thenar muscle wasting
What is the ankle-brachial pressure index (ABPI)
The ratio of the blood pressure at the ankle to the blood pressure in the upper arm.
Lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD)
Unreliable with calcification of arteries (e.g. diabetes)
Which type of leukaemia has a peak age of onset of four years?
ALL - acute lymphoblastic leukaemia
70-80% cure rate for children.
Immediate Stroke/ TIA management
- CT scan to rule out haemorrhagic cause
- thrombolysis (3 hr window from onset of symptoms?)
- antiplatelet therapy
What is tenesmus?
Sensation of needing to defaecate although the rectum is empty.
(could be rectal inflammation of tumour)
What is pharmacokinetics?
Pharmacokinetics is the study of how an organism affects a drug.
Absorption is part of pharmacokinetics.
IV - max bioavailability.
HIV/ cancer patients
Characteristics of essential/ benign/ idiopathic tremor.
- cause unknown
- symmetrical (Parkinson's is asymmetric)
- happens on movement or postural (due to sustained muscular tone). EG. Rattling of a teacup.
DOESN'T HAPPEN AT REST (unlike PARKINSON'S)
Some possible red flags for neck lumps
Dark colour suggestive of malignant melanoma,
RhA on XR - characteristics
White sclerotic changes - spongy bone looks whiter.
Subluxation of MCP
Wrist/ hand displacement
Thumb - Z deformity
Dermatome to little finger?
meningitis - antibiotic
Headache; red flags
- new onset or changes in headache in px over 50 years old
- focal neurological symptoms
- abnormal neurological examination
- headache that changes with posture
- wakes up px during night
- worse for valsalva manoeuvre
- thrombosis risks
- jaw claudication
- neck stiffness with fever
- new onset with cancer/ HIV px
Emphysema and Lung volumes - what's the story
Emphysema, functional respiratory capacity is increased, because the lungs are more compliant. Total lung capacity also increases, largely as a result of increased functional residual capacity.
Chlamydia - antibiotic
What lumps move with swallowing?
definitive tx of acute leukaemia and side effects?
- hair loss, nausea & vomiting, sore mouth, bone marrow failure.
- severe infection
radiotherapy, & some cases; stem cell transplantation. Destroy stem cells and reinfuse.
What and where and how?
melanoma - cutaneous malignant melanoma is a cancer of the pigment cells of the skin
common backs (men), legs (women)
Usual skin type suspects. Sunbeds and sudden intense sun exposure BAD.
What could cause wrist drop?
Radial nerve compression
Where does pain radiate with acute cholecystitis?
from right hypochondrial region to shoulder/ interscapular region.
Nerve involved with CTS?
Which type of cells does HIV virus infect?
CD4-bearing T lymphocytes and monocytes/ macrophages
What is the age group for AML (acute myeloid leukaemia)?
more common with increasing age, with peak age onset of 70 years.
Causes of purpura
Platelet disorders (thrombocytopenic purpura)
Vascular disorders (nonthrombocytopenic purpura)
Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
Vasculitis, as in the case of Henoch–Schönlein purpura
Disseminated intravascular coagulation (DIC)
Scurvy (vitamin C deficiency) - defect in collagen synthesis results in weakened capillary walls and cells
Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities. Levamisole is purportedly a common cutting agent.
Referred pain (diagram)