GIM exam Easter 2018 Flashcards Preview

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Flashcards in GIM exam Easter 2018 Deck (136):
1

Cellulitis - antibiotic

Flucloxacillin

- clarithromycin for penicillin allergy

2

Dermatome to dorsum of foot

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3

What does ART stand for (with HIV topic)

and associated problems?

anti-retroviral therapy

  • resistance to drugs
  • side effects, drug intolerance
  • adherence problems from complex regime
  • drug interactions
  • cost

4

What's a cause of loud borborygmi? 

(movement of fluid and gas)

small-bowel obstruction/ dysmotility if associated with colicky discomfort.

5

What conditions can cause upper motor neurone symptoms?

  • stroke
  • MS
  • traumatic brain injury
  • cerebral palsy

6

Important things that affect vit D absorption (except for the obvious)

  • age
  • absorption is in first part of SI, therefore digestive disorders
  • condition of the Kidneys

7

Reasons to do a lumbar puncture

  • investigating bacterial meningitis
  •  

8

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

9

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.

10

What type of headache is common first thing in the morning?

migraine

11

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The hallux dorsiflexes, and the other toes fan out; this is Babinski's sign; 

damage to the central nervous system.

Stimulate from heel upwards. 

12

ACNE - antibiotic

doxycycline - tetracyclines

if not responding; erythromycin

13

Dermatome to Upper inner arm

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14

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)

15

What is bioavailability?

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%.

16

UTI - antibiotic

nitrofurantoin

trimethoprim

17

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)

 

18

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.

19

What's the common cause of esophageal varices?

cirrhosis and consequences of portal hypertension

20

What is cor pulmonale?

Pulmonary heart disease.

Occurs in 25% of patients with COPD.

Caused by pulmonary hypertension causing enlargement of the right ventricle.

21

Buerger's disease

(thomboangiitis obliterans)

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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)

Gangrene

22

Possible antibiotics for meningitis

Cefolaxime

Benzylpenicillin

Chloramphenicol

23

How is HIV infection diagnosed?

Detection of anti-HIV antibodies by ELISA (enyme-linked immunosorbent assay).

24

Felty's syndrome (important)

Rare autoimmune disease

Splenomegaly

neutropenia

RhA

25

C. diff - antibiotic

metronidazole

or vancomycin (glycopeptide) . Nephrotoxic

26

Characteristics of tension headaches

  • mild to moderate (fuzzy head); dull generalized headache
  • bilateral
  • non-pulsatile
  • exert bandlike pressure
  • no nausea

poor response to over the counter analgesia

27

28

What is the TIMI score?

Estimates mortality for patients with unstable angina and non-ST elevation MI.

29

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

30

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!

31

32

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

33

RhA diagnostic criteria

morning stiffness >> 60 mins

stiffness after rest

>> six weeks duration

DIP joints spared

Volar subluxation

Swan neck/ boutonniere, guttering between bones

RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension

34

Dermatome to Toes 1-3

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35

Central upper abdominal radiating through to the back and partially relieved by sitting forwards is...

pancreatitis

36

What is found here?

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  • SOLID:
  • lymph nodes, cervical rib
  •  
  • CYSTIC:
  • cystic hygroma (lymphangioma)
  • Pharyngeal pouch
  • Subclavian aneurysm
  •  

37

What is achalasia?

 

What is a dange of this?

  1. Oesophageal aperistalsis
  2. Impaired relaxation of the lower oesophageal sphincter.

Progressive overflow of secretions and food, esp. at night and can cause aspiratory pneumonia.

38

Upper motor neurone signs

Increase in muscular tone (spasticity)

Increase in reflexes (hyperflexia)

++ Babinski sign

 

39

Takayasu's disease (rare)

 

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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

40

Upper motor neurone lesion, upper....

face sparing.

41

What are the two types of leukaemia?

acute lymphoblastic leukaemia (ALL) - lymphoid cell line

 

myeloid cell line - Acute Myeloid Leukaemia (AML)

42

What happens to Functional Residual Capacity with emphysema?

Increased because

REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.

43

Which part of the GI tract is Crohn's disease?

anywhere

(abdominal cramping + diarrhoea)

44

Sudden onset headache could be:

meningitis

subarachnoid haemorrhage

migraine

45

Typically symptoms of intestinal obstruction

  • abdominal colic
  • vomiting
  • constipation WITHOUT the passing of wind
  • distension
  • increased bowel sounds
  • Marked tenderness

46

What is bacterial vaginosis?

•Commonest cause of vaginal discharge (often recurrent)

•Overgrowth of commensals - anaerobes, mycoplasmas & Gardnerella vaginalis

•NOT sexually transmitted though may exacerbate

METRONIDAZOLE

47

What is a common cause of melaena.

NB> melaena is due to an upper GI bleed

peptic ulceration

48

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

49

Common AIDS-defining illnesses in the West

  • Pneumocystis jirovecii
  • oesophageal candidiasis
  • tuberculosis
  • herpes simplex/ zoster - repeated infections
  • + others

ALONG WITH; systemic features weight loss, persistent fever or persistent diarrhoea. 

 

50

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

51

CAP - antibiotic

amoxicillin

or doxycycline/ clarithromycin

52

How does PCP present? - pneumocystis carinii (jirovecii) pneumonia

  • non-productive cough
  • fever
  • dyspnoea

- subacute, symptoms last 3-4 weeks.

CXR normal in 90% of cases.

53

Name some lower motor neurone conditions

Guillain-Barre syndrome

C. botulism

polio

cauda equina syndrome

amyotrophic lateral sclerosis

54

Epigastric pain that is not tender on palpation and has autonomic symptoms could be....

MI

55

Syphilis - antibiotic

Benzylpenicillin

or

Doxycycline

56

Dermatome to medial malleolus

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57

Diagram of Lung Volumes

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58

Dermatome to the thumb

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59

Dermatome to Toes 4 and 5; lateral malleolus

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60

Dermatome to Inner Forearm

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61

Small bony nodules (osteophytes) at the DIP and PIP joints are characteristic of what?

OA

DIP - Herberden's nodes

PIP - Bouchard's nodes

62

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

63

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

 

64

Endocarditis - antibiotic

Gentamicin and Penicillin G

65

Another name for Broca's aphasia?

Expressive aphasia

66

Acute asthma attack

Salbutamol nebs

add ipratropium bromide if not working well.

Give steroids (orally, IM, IV) 

67

Name some cystic lumps

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  • Branchial cyst
  • Cystic degeneration of tumour
  • Larynogocoele

68

NYHA

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69

70

What are typical signs and symptoms of acute leukaemia?

  1. Bone marrow failure symptoms; anemia, leukopenia, thrombocytopenia. Therefore; SOB, fatigue, bacterial infections, bleeding, bruises. Possibly DIC.
  2. Systemic; malaise, weight loss, sweats are common

71

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.

72

What's the story?

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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.

73

Dermatome to knee

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74

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

75

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.

76

Deformities of the finger in RhA

(diagram)

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77

Dermatome to middle finger

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78

Symptoms of meningitis

  • high temperature of 38C or more
  • headache
  • 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

79

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 

80

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)

81

Parotid tail lump - Solid

What other solid lumps are there?

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  • lymph node
  • tumours
  • vagal schwannoma

82

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.

83

Lung volumes diagram

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84

What is a pharyneal pouch?

diverticulum of the mucosa of the pharynx.

Dysphagia, and sense of a lump in the throat

Trapped food:

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

Infection

85

Neisseria Gonorrhoea - antibiotic

Ceftriaxone

86

What is the important of lactate in ABG?

by-product of anaerobic respiration. 

Good indicator of poor tissue perfusion.

87

What could CTS be associated with?

pregnancy

diabetes

hypothyroidism

88

What does raised PSA indicate?

Prostate cancer/ benign hypertrophy

other examination; PR, biopsy

89

Name for rectal bleeding

haematochezia

90

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.

+ others 

GOLD standards to differentiate ALL from AML; bone marrow aspirations, trephine biopsy.

91

 protozoan parasite that causes malaria

Plasmodium falciparum

92

Coeliac disease and gluten... what's the story?

gluten > villous atrophy > malabsorption

 

  • Familial component 
  • T Cell mediated autoimmune inflammation of the small bowel.

93

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. 

94

Lower motor neurone signs 

  • absence of reflexes
  • muscle fasciculations
  • atrophy of muscles
  • decrease muscular tone

95

HIV is caused by what type of virus?

blood-borne RNA retrovirus

  • intercourse, drug use
  • maternal-child transmission
  • transfusion of blood products

96

What's this? And info

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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

97

Kussmaul breathing is a deep sighing pattern to decrease COlevels and is commonly seen with....

Diabetic ketoacidosis

98

Which part of the GI tract is ulcerative colitis?

colon and rectum only

 

(abdominal cramping + diarrhoea)

99

What is FNAC?

Fine Needle Aspiration for Cytology

 

- may be used for neck lumps

100

Define acute leukaemia

Clonal haematopoietic stem cell/ progenitor disorder characterized by the rapid accumulation of immature progenitor cells (blasts) and impaired normal marrow function.

101

Mallory-Weiss tears

- when?

 

 alcoholic ‘dry heaves’, retching, severe coughing.

 tears at the oesophagogastric junction by a sudden increase in intra-abdominal pressure

102

RhA nodules characteristics

Made from fibroblasts.

Pinky colour.

Blood supply on the outside only; can become necrotic.

Locations; extensor surfaces of elbows, forearms and hands

103

What's this? + info.

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Thyroglossal cysts

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

104

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)

105

What is respiratory acidosis?

Acidosis due to an inability of the lungs to excrete COadequately.

 

106

What is a pannus?

hypertrophied synovium,

containing inflammatory cells that release collagenolytic enzymes

causing loss of bone and cartilage (chronic RhA)

107

What's the common cause of this?

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cirrhosis,

the consequences of portal hypertension.

Commonly these bleed.

lower 1/3 of the oesophagus

108

109

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.

110

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.

111

POUND mneumonic

  • Pulsatile
  • 4-72 hOurs duration
  • Unilateral
  • Nausea or vomiting
  • Disabling intensity

112

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

113

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)

114

Which type of leukaemia has a peak age of onset of four years?

ALL - acute lymphoblastic leukaemia

 

70-80% cure rate for children.

115

Immediate Stroke/ TIA management

  • CT scan to rule out haemorrhagic cause
  • thrombolysis (3 hr window from onset of symptoms?)
  • antiplatelet therapy

 

116

What is tenesmus?

Sensation of needing to defaecate although the rectum is empty.

 

(could be rectal inflammation of tumour)

117

What is pharmacokinetics?

Pharmacokinetics is the study of how an organism affects a drug. 

Absorption is part of pharmacokinetics.

IV - max bioavailability.

118

 

infectious esophagitis.

 

Common cause?

Candida albicans

HIV/ cancer patients

119

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)

120

Some possible red flags for neck lumps

Dark colour suggestive of malignant melanoma,

ulceration,

skin fixation,

bleeding, or

hard texture

121

RhA on XR - characteristics

White sclerotic changes - spongy bone looks whiter.

Subluxation of MCP

Wrist/ hand displacement

Thumb - Z deformity

 

122

Dermatome to little finger?

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123

meningitis - antibiotic

benzylpenicillin

124

Headache; red flags

  • new onset or changes in headache in px over 50 years old
  • thunderclap
  • 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

125

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.

126

Chlamydia - antibiotic

Azithromycin

127

What lumps move with swallowing?

SOLID:

Goitre

lymph node

CYSTIC:

Thyroid cyst

128

definitive tx of acute leukaemia and side effects?

cytotoxic drugs

  • hair loss, nausea & vomiting, sore mouth, bone marrow failure.
  • severe infection

 

radiotherapy, & some cases; stem cell transplantation. Destroy stem cells and reinfuse.

129

What and where and how?

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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. 

 

130

What could cause wrist drop?

Radial nerve compression

131

Where does pain radiate with acute cholecystitis?

from right hypochondrial region to shoulder/ interscapular region.

132

Nerve involved with CTS?

median

133

Which type of cells does HIV virus infect?

CD4-bearing T lymphocytes and monocytes/ macrophages

 

134

What is the age group for AML (acute myeloid leukaemia)?

more common with increasing age, with peak age onset of 70 years.

135

Causes of purpura

(pathophysiology)

Platelet disorders (thrombocytopenic purpura)

 

Vascular disorders (nonthrombocytopenic purpura)

Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged

Hypertensive states

Vasculitis, as in the case of Henoch–Schönlein purpura

Coagulation disorders

Disseminated intravascular coagulation (DIC)

Scurvy (vitamin C deficiency) - defect in collagen synthesis results in weakened capillary walls and cells

Meningococcemia

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.

136

Referred pain (diagram)

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