Medicine Flashcards
(120 cards)
1
Q
Diastolic murmur + AF
A
?mitral stenosis
2
Q
what kind of murmur is mitral stenosis
A
mid-diastolic murmur
3
Q
where is mitral stenosis heard loudest
A
over the apex in expiration
4
Q
what position is mitral stenosis accentuated by
A
patient in a left lateral position.
5
Q
what arrythmia does mitral stenosis and regurg cause and why
A
atrial fibrillation (secondary to left atrial enlargement) which may result in embolic sequelae (e.g. stroke, TIA, mesenteric ischaemia).
6
Q
what kind of murmur is Atrial regurgitation
A
early diastolic murmur
7
Q
where is Aortic regurgitation heard loudest
A
loudest over the aortic area
8
Q
what kind of murmur is Mitral regurgitation
A
pansystolic murmur
9
Q
where is mitral regurgitation heard loudest
A
apex radiating to the axilla.
10
Q
what kind of murmur is tricuspid regurgitation
A
systolic murmur over the tricuspid area.
11
Q
causes of mitral stenosis
A
RHEUMATIC FEVER
Rarer causes that may be seen in the exam include mucopolysaccharidoses
12
Q
why do u get SOB in mitral stenosis
A
↑ left atrial pressure → pulmonary venous hypertension
13
Q
what murmur causes malar flush
A
mitral stenosis
14
Q
management for mitral stenosis - asymptomatic and symptomati
A
asymptomatic patients:
* monitored with regular echocardiograms
symptomatic patients:
* percutaneous mitral balloon valvotomy, mitral valve surgery (commissurotomy, or valve replacement)
15
Q
examples of loop diuretics
A
furosemide and bumetanide
16
Q
how do loop diuretics work
A
inhibiting the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl.
17
Q
6 side effects of loop diuretics
A
- hypotension
- electrolyte impairement: hyponatraemia, hypokalaemia, hypomagnaesmia, hypocalcaemia
- ototoxicity
- hyperglycaemia
- renal impairement
- gout
18
Q
first line treatment for prolactinomas
A
dopamine agonists - cabergoline, bromocriptine
inhibits release of prolactin from the pituitary gland
19
Q
4 features of excess prolactin in women
A
- amenorrhoea
- infertility
- galactorrhoea,
- osteoporosis
20
Q
3 features of excess prolactin in men
A
impotence
loss of libido
galactorrhoea
21
Q
symptoms of macroadenomas besides prolactin related things
A
headache.
visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia)
symptoms and signs of hypopituitarism
22
Q
Respiratory syncytial virus -? Associated condition
A
Bronchiolitis
23
Q
Parainfluenza virus - Associated condition
A
croup
24
Q
rhinovirus - Associated condition
A
common cold
25
influenza virus - Associated condition
flu
26
streptococcus pneumoniae - Associated condition
most common cause of community-acquired pneumonia
27
Haemophilus influenzae -?Associated condition
* Community-acquired pneumonia
* Most common cause of bronchiectasis exacerbations
* Acute epiglottitis
28
Staphylococcus aureus - ?associated condition
pneumonia, particularly following influenza
29
Mycoplasma pneumoniae - ?associated condition
* Atypical pneumonia
flu like symptoms followed by a dry cough
* complications: haemolytic anaemia and erythema multiforme
30
Legionella pneumophilia - ?associated condition
Atypical pneumonia
Classically spread by air-conditioning systems, causes dry cough. Lymphopenia, deranged liver function tests and hyponatraemia may be seen
31
Pneumocystis jiroveci -?associated condition
Common cause of pneumonia in HIV patients.
Typically patients have few chest signs and develop exertional dyspnoea
32
Anthracyclines (e.g doxorubicin) - adverse effects
Cardiomyopathy
- can manifests as CHF --> SOB, s3, displaced apex beat
| dose-dependent cardiotoxicity
33
Causes of AR due to valve disease
ACUTELY: INFECTIVE ENDOCARDITIS
CHRONICALLY:
* rheumatic fever
* calcific valve disease
* connective tissue diseases e.g. rheumatoid arthritis/SLE
* bicuspid aortic valve (affects both the valves and the aortic root)
34
Causes of AR due to aortic root disease
ACUTELY: AORTIC DISSECTION
CHRONICALLY:
* bicuspid aortic valve
* spondylarthropathies (e.g. ankylosing spondylitis)
* hypertension
* syphilis
* Marfan's, Ehler-Danlos syndrome
35
what is refractory anaphylaxis?
* respiratory (tachypnoea, hypoxia, wheeze, dyspnoea, swelling of the throat and tongue --> hoarse voice and stridor)
and/or
* cardiovascular problems (tachycardia, hypotension) persisting despite 2 doses of IM adrenaline
36
how to treat refractory anaphylaxis
expert help should be sought for consideration of an IV adrenaline infusion
37
how often can IM adrenaline be repeatdd
every 5 minutes
38
best site for IM injection of adrenaline?
anterolateral aspect of the middle third of the thigh.
39
adrenaline dose for anaphylaxis in a < 6 month old
100-150 mcg (0.1-0.15 ml 1 in 1000)
40
adrenaline dose for anaphylaxis in a 6 month to 6 year old
150 mcg (0.15 ml 1 in 1000)
41
adrenaline dose for anaphylaxis in a 6 - 12 year old
300 mcg (0.3ml 1 in 1000)
42
adrenaline dose for anaphylaxis in a adult and child > 12 year old
500 mcg (0.5ml 1 in 1000)
43
when should serum tryptase levels be taken?
when it is difficult to establish whether a patient had a true episode of anaphylaxis.
Serum tryptase levels are sometimes taken in such patients as **they remain elevated for up to 12 hours following an acute episode of anaphylaxis**
44
side effect of Pioglitazone
weight gain and fluid retention, potentially exacerbating heart failure in susceptible patients
| **pioglitazone makes you look like a PIG (weight gain)**
45
what kind of drug is Pioglitazone and how does it work
Pioglitazone is a thiazolidinedione, which works by increasing insulin sensitivity.
46
# ****
what do you do if in TD2M a triple combination of drugs has failed to reduce HbA1
switch one of the drugs for a GLP-1 mimetic, particularly if the BMI > 35
47
what is Weber's syndrome
lesion affecting (branches of the posterior cerebral artery that supply the midbrain)
48
associated features of weber's syndrome
Ipsilateral CN III palsy (down and out)
Contralateral weakness of upper and lower extremity
| DOC
D - down and out (ipsilateral CN 3 palsy)
O - oculomotor nerve pals
49
associated effects of a stroke in Anterior cerebral artery
Contralateral hemiparesis and sensory loss, lower extremity > upper
| ACA feeds the feet
ACA --> supplies medial surface of brain
50
associated effects of a stroke in Middle cerebral artery
* Contralateral hemiparesis and sensory loss, upper extremity > lower
* Contralateral homonymous hemianopia
* Aphasia
| MAP
Motor n sensory loss
Aphasia
Partial visual field loss
51
associated effects of a stroke in posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
| Pictures Cant Appear
PCA
Contrala
Agnosia
52
associated effects of a stroke in Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
(lateral medullary syndrome, Wallenberg syndrome) Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
53
associated effects of a stroke in Anterior inferior cerebellar artery (lateral pontine syndrome)
Symptoms are similar to Wallenberg's , but:
Ipsilateral: facial paralysis and deafness
54
associted effects of a stroke in Retinal/ophthalmic artery
amaurosis fugax
55
associated effects of a stroke in basilar artery
locked in syndrome
56
what condition are lacunar strokes associated with
hyoertension
57
how do lacunar strokes present
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
58
common sites of lacunar strokes
basal ganglia, thalamus and internal capsule
59
what does Lhermitte's sign indicate?
disease near the dorsal column nuclei of the cervical cord
60
describe Lhermitte's sign
paraesthesia in limbs when you flex your neck
| tingling in your hands when you flex your neck
61
visual signs of Multiple sclerosis
* optic neuritis
* optic atrophy
* Uhthoff's phenomenon
* internuclear ophthalmoplegia
62
what is Uhthoff's phenomenon?
worsening of vision following rise in body temperature
63
what is internuclear ophthalmoplegia?
one or both eyes have difficulty turning inward (adduction) when looking to the side.
## Footnote
the lesion is in the medial longitudinal fasciculu
64
sensory signs of multiple sclerosis
Sensory
pins/needles
numbness
trigeminal neuralgia
Lhermitte's syndrome: paraesthesiae in limbs on neck flexion
65
DANISH mneumonic
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria
Hypotonia
66
what is ataxia
lack of coordination and balance --> unsteady gait and difficulty with fine motor tasks
67
what is nystagmus?
involuntary rhythmic eyemovements
68
what is Intention tremor?
Tremor that worsens during voluntary movements, particularly when the patient is close to their target
69
what is scanning dysarthria
Speech that is slurred, staccato, or has difficulty with rhythm and articulation.
70
motor symptoms of multiple sclerosis?
spastic weakness - most commonly seen in legs
71
what is bullous myringitis
painful vesicles on the tympanic membrane
72
why is pregnancy a hypercoagulable state?
* increase in factors VII, VIII, X and fibrinogen
* decrease in protein S
* uterus presses on IVC causing venous stasis in legs
73
After having gladular fever, how long should you avoid playing contact sports for?
| and why
4 weeks to reduce the risk of splenic rupture
74
what is infectious mononucleosis (glandula fever) commonly caused by
Epstein-Barr virus (EBV)
| aka HHV-4 (human herpesvirus 4)
75
infectious mononucleosis (glandular fever) classic triad
sore throat, fever, lymphadenopathy
76
4 more features of infectious mononucleosis
* palatal petechia
* splenomegaly
* hepatitis
* haemolytic anaemia (cold agglutiinins IgM
77
what happens in 99% of people who take ampicillin/amoxicillin when the have infectious mononucleosis
they develop a maculopapular, pruritic rash
78
diagnosis for gladular fever
heterophil antibody test (monospot)
## Footnote
NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.
79
signs of a PE
* tachypnoea
* crackles
* tachycardia
* fever
80
ECG signs of PE
* sinus tachycardia
* RBBB
* RAD
* S1Q3T3
81
# ```
5 causes of acute pericarditis
1. coxsackie virus
2. tuberculosis
3. uraemia
4. post myocardial infarction
5. radiotherapy
82
5 features of acute pericarditis
1. pleuritic chest pain
relieved by sitting forward
2. non productive cough
3. dyspnoea
4. flu like symptoms
5. pericardial rub
83
first-line tx for acute idiopathic or viral pericarditis (2)
NSAIDS and colchicine
## Footnote
therapy is continued until symptom resolution and normalisation of inflammatory markers (usually 1–2 weeks), followed by a taper of the dose over a further 2–4 weeks
84
5 endocrine glucocorticoid steroid side effects
1. impaired glucose regulation
2. increased appetite --> weight gain
3. hirsuitism
4. hyperlipidaemia
5. cushing's syndrome
85
3 MSK side effects of glucocorticoid steroids
1. osteoporosis
2. proximal myopathy
3. avascular necrosis of the femoral head
86
psychiatric side effects of glucocorticoid steroids
insomnia
mania
depression
psychosis
87
2 GI side effects of glucocorticoid steroids
peptic ulcers
acute pancreatitis
88
2 side effects of mineralcorticoide steroids
fluid retention
hypertension
89
3 situations you need to wean steroids
1. received more than 40mg prednisolone daily for more than one week
2. received more than 3 weeks of treatment
3. recently received repeated courses
90
4 ecg features of hyperkalaemia
1. tall tented t waves
2. no p waves
3. broad QRS
4. sinusoidal wave pattern
91
if an < 80 pt has ABPM 135/85 - 150/90. start tx if they have any of the following (5)
target organ damage
cardiovascular diseaase
renal disease
diabetes
Qrisk >= 10
92
how does a RBC transfusion affect potassium?
Can cause **hyperkalaemia**
stored blood has high potassium levels due to leakage from RBC during storage
93
Non-haemolytic febrile reaction pathophysiology
WBC HLA antibodies reacting with WBC fragments in the blood product
often the result of sensitization by previous pregnancies or transfusions
94
features of non haemolytic febrile reaction
fever
chills
95
how to tx non haemolytic febrile reaction
1. stop the transfusion
2. paracetamol
3. monitor
96
acute haemolytic reaction pathophysiology
ABO incompatible blood --> massive intravascular hemolysis
| e.g secondary to human error.
RBC destruction by IgM type antibodies
97
pathophysiology of Transfusion related acute lung injury (TRALI)
* non cardiogenic pulmonary oedema
* host neutrophils become activated in substances in donated blood --> increased vascular permeability
98
signs of TRALI
fever
hypoxia
hypotension
infiltrates on chest x ray
99
acute haemolytic anaemia signs and symptoms
fever
hypotension
abdominal pain
chest pain
agitation
100
main difference between TACO and TRALI
hypertension in TACO
hypotension in TRALI
101
how does terlipressin help variceal bleeding
causes splanchnic vasoconscriction --> portal venous pressure reduced
## Footnote
network of blood vessels supplying the digestive organs like the stomach, intestines, liver, and pancrea
102
# ```
what meds to give in variceal bleed and when?
terlipressin and prophylactic IV antibiotics PRIOR to endoscopy
103
preventative tx for variceal haemorrhage?
propranolol
EVL (endoscopic variceal band ligation)
104
# ```
```
5 signs/symptoms of degenerative cervical myelopathy
1. Pain (neck, U+L limbs)
2. loss of motor function
3. loss of sensory function
4. loss of autonomic function
5. Hoffman's sign
105
what is Hoffman's sign
reflex test - gently flick one finger on patient's hand --> positive test if they twitch the other fingers on the same hand
106
6 complications of coeliac disease
1. Anaemia (folate > b12)
2. Hyposplenism
3. Osteoporosis, osteomalacia
4. Lactose intolerance
5. Enteropathy associated T cell lymphooma
6. Subfertility
| A HOLEs
107
first line treatment of mild-moderate ulcerative colitis
topical (rectal) aminosalicylate: mesalazine
108
what to do if remission is not achieved in mild -mod UC with rectal aminosalicylate
| q
add oral aminosalicylate (mesalazine)
109
if remission is not achieved in mild- mod UC after rectal and oral aminosalicylate
add oral steroids
110
treatment for mild-mod UC with extensive disease
topical AND oral aminosalicylate
111
if remission is not achieved after 4 weeks in mild-mod UC with extensive disease
stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid
112
how to maintain remission in left-sided and extensive ulcerative coliti
low maintenance dose of an oral aminosalicylate
113
how to maintain remission following a severe relapse or >=2 exacerbations in the past year of UC
oral azathioprine or oral mercaptopurine
114
4 side effects of rifampicin
potent liver enzyme inducer
hepatitis
orange secretions
flu-like symptoms
115
4 side effects of isoniazid
peripheral neuropathy
hepatitis
agranulocytosis
liver enzyme inhibitor
| IsoNERVEazid
116
how to prevent peripheral neuropathy when taking isoniazid
pyridoxine (Vitamin B6)
117
4 side effects of pyrazinamide
hyperuricaemia causing gout
arthralgia
myalgia
hepatitis
| PYROzinamide (firey - gout)
118
1 side effect of ethambutol
optic neuritis: check visual acuity before and during treatment
| EYEthambutol
119
4 causes of transient or spurious non-visible haematuria
1. UTI
2. exercise
3. sex
4. being on your period
120
6 Causes of persistent non-visible haematuria
1. Bladder cancer
2. stones (bladder,kidney, prostate)
3. BPH
4. Prostatitis
5. Urethritis
6. renal causes: IgA nephropathy, thin basement membrane disease
