Miscellaneous Points Flashcards
1
Q
Which leads are supplied to LAD artery of heart?
A
V1, V2, V3, V4
2
Q
Which leads are supplied to Left circumflex artery of heart?
A
I, aVL, V5, V6
3
Q
Which leads are supplied to right coronary artery of heart?
A
II, III, aVF
4
Q
Leads corresponding to anterior part of heart?
A
V3, V4
5
Q
Leads corresponding to septal part of heart?
A
V1, V2
6
Q
Leads corresponding to inferior part of heart?
A
II, III, aVF
7
Q
Leads corresponding to lateral part of heart?
A
I, aVL, V5, V6
8
Q
Leads corresponding to posterior part of heart?
A
Pathological R waves in V1, V2, V3
Reciprocal horizontal ST depression in V1-V3
9
Q
Features of MEN1?
A
Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell insulinomas
10
Q
Features of MEN2A?
A
Hyperparathyroidism
Medullary thyroid cancer
Phaeochromocytoma
11
Q
Features of MEN2B?
A
Marfanoid body Mucosal neuromas Medullary thyroid cancers Phaeochromocytoma Intestinal ganglioneuromas
12
Q
Features of BRCA 1&2?
A
Breast, ovary and prostate cancers
13
Q
Features of VHL?
A
Angiomatosis Haemangioblastoma Phaeochromocytoma Papillary cystadenoma of epidydimis RCC
14
Q
Features of FAP?
A
Polyposis Thyroid cancer Congenital hypertrophy of retinal pigment epithelium (CHRPE) Supernumery teeth Epidermoid cysts Osteoma
15
Q
Features of HNPCC?
A
Colorectal, endometrial, ovary and gastric cancers
16
Q
Features of Peutz Jeghers’ syndrome?
A
Small intestine haemartomatous polyps, hyperpigmented mucocutaneous sites
17
Q
Epilepsy medications - tonic clonic seizures?
A
Sodium Valproate//Lamotrigine
Carbamazepine
18
Q
Epilepsy medications - absence seizures?
A
Sodium Valproate/Ethosuximide
Lamotrigine
19
Q
Epilepsy medications - tonic/atonic seizures?
A
Sodium Valproate
Lamotrigine
20
Q
Epilepsy medications - myotonic seizures?
A
Sodium Valproate/Topiramate/Levetiracetam
21
Q
Epilepsy medications - partial seizures?
A
Carbamazepine/Lamotrigine
Sodium Valproate/Levetiracetam
22
Q
Canadian C-spine rule - high risk factor?
A
> 65
Dangerous mechanism
Paraesthesia in extremities
23
Q
Canadian C-spine rule - low risk factor?
A
Simple rear end collision Sitting in ED Ambulatory at any time Delayed neck pain No midline C-spine tenderness
24
Q
Canadian C-spine rule - other factor?
A
Able to rotate neck actively left and right 45 degrees
25
Criteria for imaging in Canadian C Spine rule? What imaging?
1 or more high risk factor
No low risk factors
Not able to rotate neck 45 degrees left and right
CT adult
MRI child
26
Criteria for CT head <1 hour in children?
| PICANSS F RF
PICANSS F Risk F
Post-traumatic seizure
Initial GCS <14 (<15 in <1 year olds)
Child <1 - bruise/swelling/laceration >5cm on head
After 2 hours GCS <15
Non-accidental injury suspected
Suspected open/depressed skull fracture or tense fontanelle
Sign of basal skull fracture (haemotypanum, panda eyes, CSF from nose, Battle's sign)
Focal neurological deficit
More than 1 RF of:
- LoC>5 mins, abnormal drowsiness, 3 or more vomiting, dangerous mechanism (RTA, fall >3m, high-speed projectile), amnesia>5 minutes
27
Criteria for CT head <1 hour in adults?
FSG GPS Vom
FSG GPS Vom
Focal neurological deficit
Suspected open/depressed skull fracture
GCS <13 initial
GCS <15 at 2 hours
Post-traumatic seizure
Sign of basal skull fracture (haemotypanum, panda eyes, CSF from nose, Battle's sign)
>1 episode of vomiting
28
Criteria for CT head <8 hours in adults?
If loss of consciousness or
amnesia since the head injury &:
Age >65
History of bleeding or clotting disorder
Dangerous mechanism (paedestrian/motor cyclist hit by vehicle, occupant ejected from car, fall >1m or 5 stairs)
>30 minutes retrograde amnesia of events immediately before head injury
29
Stroke - indications for CT within 1 hour?
Indications for thrombolysis (<4.5 hour) or thrombectomy
GCS <13
Anticoagulation or bleeding tendency
Progressive or fluctuating symptoms
Papilloedema, neck stiffness, fever, severe headache at onset
30
Contraindications for LP?
Signs of raised ICP, relative bradycardia and hypertension, papilloedema
GCS<9 or drop of 3 or more
Focal neurological signs
Abnormal posturing or doll eyes
Unequal, dilated or poorly responsive pupils
Shock
Extensive purpura
After convulsions until stable
Abnormal coagulation/Platelets <100/Anticoagulation therapy
Superficial LP site infection
Respiratory insufficiency
31
Blood results - Primary hyperparathyroidism?
ALP - high
PTH - high
Ca - high
PO4 - low
32
Blood results - Secondary hyperparathyroidism?
ALP - high
PTH - high
Ca - low/normal
PO4 - high/normal
33
Blood results - Tertiary hyperparathyroidism?
ALP - high
PTH - high
Ca - high
PO4 - high
34
Blood results - Hypoparathyroidism?
ALP - no change
PTH - low
Ca - low
PO4 - high
35
Blood results - Paget's Disease of Bone?
ALP - high
PTH - normal
Ca - normal
PO4 - normal
36
Blood results - Osteomalacia?
ALP - high
PTH - normal/high
Ca - low
PO4 - normal/high
37
Blood results - Osteoporosis?
ALP - normal
PTH - normal
Ca - normal
PO4 - normal
38
Blood results - normal/euthyroid?
TSH - normal
| T3 & T4 - normal
39
Blood results - hyperthyroidism?
TSH - low
| T3 & T4 - high
40
Blood results - Primary hypothyroidism??
TSH - high
| T3 & T4 - low
41
Blood results - Secondary hypothyroidism?
TSH - low
| T3 & T4 - low
42
Blood results - TSH producing adenoma?
TSH - high
| T3 & T4 - high
43
Blood results - Levothyroxine overtreatment?
TSH - low
| T3 & T4 - high (can be normal)
44
Heart murmurs - aortic stenosis?
Ejection systolic murmur, radiates to carotids
45
Heart murmurs - aortic regurgitation?
Early diastolic murmur, forward in expiration
46
Heart murmurs - mitral stenosis?
Mid-diastolic murmur, loudest at apex, opening snap
47
Heart murmurs - mitral regurgitation?
Pan systolic murmur, radiates to axilla
48
Heart murmurs - mitral valve prolapse?
Mid systolic click
49
Heart murmurs - VSD?
Pan-systolic murmur at LLSE
50
Heart murmurs - PDA?
Continuous murmur
51
What is S3 heart sound?
KEN-TUCK-Y
Ventricular filling rapidly, normal in children/athletes/high output states
Pathology - CHF, chronic MR/TR, Dilated cardiomyopathy
52
What is S4 heart sound?
TEN-ES- SEE
Atrial contraction in non-compliant ventricle - abnormal
Hypertension, AS, HOCM
53
What is Corrigan's Pulse?
Waterhammer pulse
Pulse forceful and suddenly collapses, sign of aortic regurgitation
54
What is Beck's Triad?
Hypotension
Rising JVP
Muffled heart sounds
Seen in cardiac tamponade
55
What is Kussmaul's Sign?
JVP increases during respiration
56
What is Austin Flint Murmur?
Low-pitched mid-diastolic murmur, sign of severe aortic stenosis due to blood striking anterior leaflet of mitral valve
57
What is De Musset's Sign?
Nodding of head in synchrony of beating heart due to aortic regurgitation
58
What is Muller's Sign?
Bobbing of uvula occurring during systole, in aortic regurgitation
59
What is Quinke's Sign?
Capillary pulsations seen on light compression of nail bed, sign of aortic regurgitation
60
What is Traube's sign?
Pistol shot - systolic and diastolic murmurs heard over femoral arteries , aortic regurgitation
61
What is Ewart's sign?
Dullness on percussion at inferior angle of left scapula when effusion large enough to compress LLL of lung
62
Wells PE Score - DA PITCH? And interpretation?
```
DVT symptoms and signs (3)
Alternative diagnosis less likely (3)
Previous VTE (1.5)
Immobilisation (Bed Ridden >3 days/Surgery <4 weeks) (1.5)
Tachycardia >100bpm (1.5)
Cancer Hx (1)
Haemoptysis (1)
```
PE likely - >4
PE unlikely - 4 or less
63
Wells DVT Score - PEARL CPCP A? And interpretation?
Paralysis, paresis or plaster immobilization of leg
Entire leg symptoms
Active Cancer (Rx ongoing or within 6 months or palliative)
Recently bedridden 3 or more days or major surgery <12 weeks (GA/RA)
Localised tenderness along deep venous system
Calf Swelling (>3cm)
Pitting oedema in symptomatic leg
Collateral superficial veins
Previous VTE
Alternative diagnosis at least as likely as DVT
DVT likely - 2 or more
DVT unlikely - <2
64
Asthma severity assessment - moderate?
Increasing symptoms
PEFR 50-75% best or predicted
No features of acute severe asthma
65
Asthma severity assessment - severe?
Inability to complete sentences in one breath
PEFR 50-33% best or predicted
RR 25 or over
HR 110 or over
66
Asthma severity assessment - life-threatening?
```
Altered conscious level
Cyanosis
Hypotension
Exhaustion
Silent Chest
Threatening (1) PEFR <33%, (2) SpO2 <92%, (3) PaO2 <8kPa
Normal CO2
```
67
Asthma severity assessment - Near fatal?
Raised PaCO2 and/or need for ventilation with raised inflation pressures
68
CURB 65 score in pneumonia?
```
Confusion (AMTS 8 or less)
Urea >7mmol/L
RR 30 or more
BP 90 or less SBP, 60 or less DBP
Age >65
```
0-1 home
2 inpatient
3-5 inpatient ICU
69
CRB 65 score in pneumonia in GP?
Confusion (AMTS 8 or less)
RR 30 or more
BP 90 or less SBP, 60 or less DBP
Age >65
0 home
1 or more - consider admission
70
Causes of clubbing - cardiovascular?
ACE
Atrial myoxoma
Congenital cyanotic heart disease
Infective endocarditis
71
Causes of clubbing - respiratory?
SLAM
```
Supporative lung disease (bronchiectasis, empyema, lung abscess)
Lung cancer
Alveolitis (fibrosing)
Mesothelioma
TB
CF
```
72
Causes of clubbing - gastrointestinal?
5 C's
```
Cirrhosis
Crohn's & UC
Coeliacs disease
Cancer
CF
```
73
Causes of clubbing - endocrine?
thyroid acropatchy in thyrotoxicosis
74
Causes of erythema nodosum?
SLIMEST
```
Sarcoidosis
Leprosy
IBD
Meds (Trimethoprim)
Streptococcal infection
TB
```
75
Which cancers cause rise in CEA?
Colorectal cancer
76
Which cancers cause rise in Ca19.9?
Pancreatic cancer
77
Which cancers cause rise in AFP?
Hepatocellular cancer
| Non-seminomatous germ cell tumour
78
Which cancers cause rise in B-hCG?
Non-seminomatous germ cell tumour
| Gestational trophoblastic disease
79
Which cancers cause rise in Ca125?
Ovarian Cancer
80
Which cancers cause rise in PSA?
Prostate Cancer
81
Which cancers cause rise in Thyroglobulin?
Follicular/Papillary thyroid cancer
82
Which cancers cause rise in M protein/Bence Jones Protein?
Multiple myeloma
83
Which cancers cause rise in Catecholamines?
Phaeochromocytoma
84
Which cancers cause rise in calcitonin?
Medullary thyroid cancer
85
Which cancers cause rise in LDH?
Lymphoma
| Ewing's sarcoma
86
What diseases is the antibody RF present in?
```
RA
Sjogren's Syndrome
Felty's Syndrome
Infection
SLE
Sclerosis
```
87
What disease is the antibody anti-CCP present in?
RA
88
What diseases is the antibody ANA present in?
```
SLE
Autoimmune hepatitis
Sjogren's syndrome
RA
Sclerosis
```
89
What disease is the antibody anti-dsDNA, anti-Sm, anti-RNP present in?
SLE
90
What disease is the antibody anti-histone present in?
Drug induced lupus
91
What disease is the antibody anti-cardiolipin present in?
APS
| SLE
92
What disease is the antibody anti-Ro & anti-La present in?
Sjogren's syndrome
| SLE
93
What disease is the antibody anti-Jo1 & anti-Mi2 present in?
Polymyositis
| Dermatomyositis
94
What disease is the antibody anti-Scl70 present in?
Diffuse Systemic Sclerosis
95
What disease is the antibody anti-mitochondrial present in?
Primary biliary cirrhosis
96
What disease is the antibody anti-smooth muscle present in?
Autoimmune hepatitis
97
What disease is the antibody anti-gastric parietal & anti-intrinsic factor present in?
Pernicious anaemia
98
What disease is the antibody anti-TTG & anti-endomysial present in?
Coeliac Disease
99
What disease is the antibody anti-islet cell & anti-GAD present in?
T1DM
100
What disease is the antibody anti-GBM present in?
Goodpasture's Syndrome
101
What disease is the antibody cANCA present in?
Wegener's granulomatosis
Polyarteritis Nodosa
Microscopic arteritis
102
What disease is the antibody pANCA present in?
Churg Strauss disease
| Microscopic Polyarteritis
103
What disease is the antibody ANCA present in?
```
IBD
Sclerosing cholangitis
Felty's syndrome
SLE
RA
Drug
```
104
What disease is the antibody anti-acetylcholine receptor present in?
Myasthenia gravis
105
What disease is the antibody anti-voltage gated Ca channel present in?
Lambert Eaton Syndrome
106
What disease is the antibody anti-TSH receptor present in?
Graves disease
107
What disease is the antibody anti-thyroid peroxidase & anti-thyroglobulin present in?
Hashimoto's disease
108
What are the San Francisco Syncope Rules?
CHESS - high risk for serious complications
```
Congestive HF history
Haematocrit <30%
ECG abnormal
SOB history
Systolic BP <90
```
109
What is the Oesil Syncope Rule?
Predictor of 12 month mortality
Age >65
Hx of CVD
Syncope without prodrome
Abnormal ECG
110
What is NIHSS score?
Quantifies severity of acute stroke
111
Indications of surgical management in infective endocarditis?
o severe valvular incompetence
o aortic abscess (often indicated by a lengthening PR interval)
o infections resistant to antibiotics/fungal infections
o cardiac failure refractory to standard medical treatment
o recurrent emboli after antibiotic therapy
112
When to get CCU in management of DKA?
```
o Pregnant
o Heart Failure
o Oliguria or Anuria
o Sat <92% on air
o Systolic BP <90mmHg after 2L of fluid
o Venous bicarbonate <5mmol/L or pH<7.1
o GCS<12
o K<3.5 on admission
```
113
What is the CHA2DS2VASC score and interpretation?
```
CHF (LVrEF or recent hospitalised)
Hypertension (>140/90)
Age (<65=0, 65-74=1, >75=2)
Diabetes
Stroke/TIA/VTE Hx (+2)
Vascular disease (prior MI, PVD, aortic plaque)
Sex (female=1, male=0)
```
Women 2 or more
Men 1 or more
114
What is HASBLED Score?
Hypertension (uncontrolled, >160 mmHg systolic)
Abnormal liver function (cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal)
Abnormal renal function (dialysis, transplant, Cr >2.26mg/dl or >200)
Stroke
Bleeding (bleeding history or predisposition)
Labile INR (high INRs, therapeutic time in range <60%)
Elderly (aged over 65 years)
Drugs (antiplatelet agents or nonsteroidal anti-inflammatory drugs)
Harmful alcohol consumption
If score - weigh up benefits and negatives of anticoagulation
115
Criteria of severity in acute pancreatitis?
Glasgow Criteria
```
PaO2 <8kPa
Age >55
Neutrophils >15x109/L
Ca >2mmol/L
Renal (urea >16)
Enzymes (LDH>600, AST>2000)
Albumin <32
Sugar (glucose >10)
```
3 or more indicates severe attack - ICU? HDU?
116
What is involved in confusion screen of 'confused patient'?
Observations (NEWS, BP, pulse, temperature, RR, oxygen sats)
Bloods (FBC, LFTs, U&Es, TFTs, INR, Ca, B12, folate, glucose)
Blood Cultures
Urinalysis & cultures
Imaging (CXR?, CT?)
117
Risk factors for osteoporosis? Over 50?
All women>65 years, all men >75 years
All women aged 50–64 years and all men aged 50–74 years who have any of the following risk factors:
o A previous osteoporotic fragility fracture.
o Current use or frequent recent use of oral corticosteroids.
o History of falls.
o Low body mass index (less than 18.5 kg/m2
o Smoker.
o Alcohol intake of more than 14 units per week.
o A secondary cause of osteoporosis, including:
o Hypogonadism, including untreated premature menopause (menopause before 40 years of age), treatment with aromatase inhibitors (such as exemastane) or gonadotrophin-releasing hormone agonists (such as goserelin).
o Endocrine conditions, including diabetes mellitus, Cushing's disease, hyperthyroidism, hyperparathyroidism, and hyperprolactinaemia.
o Conditions associated with malabsorption including inflammatory bowel disease, coeliac disease, and chronic pancreatitis.
o Rheumatoid arthritis and other inflammatory arthropathies.
o Haematological conditions such as multiple myeloma and haemoglobinopathies.
o Chronic obstructive pulmonary disease.
o Chronic liver failure.
o Chronic kidney disease.
o Immobility.
118
Contents of 0.9% saline 1L?
Sodium - 150 mmol/litre
| Chloride - 150 mmol/litre
119
Contents of Hartmann's fluid 1L?
```
Sodium - 131 mmol/litre
Potassium - 5 mmol/litre
Bicarbonate - 29 mmol/litre
Chloride - 111 mmol/litre
Calcium - 2 mmol/litre
```
120
Amount of potassium in 0.15%?
20mmol/L
121
Amount of potassium in 0.3%?
40mmol/L
122
Normal requirements of water/day?
25–30 ml/kg/day of water
123
Normal requirements of potassium/chloride/sodium/day?
1 mmol/kg/day of potassium, sodium and chloride
124
Normal requirements of glucose/day?
50–100 g/day of glucose
125
What parameters make up the Glasgow Pancreas score for pancreatitis?
```
PaO2 <8kPa
Age >55
Neutrophils (>15x109/L)
Calcium (<2mmol/L)
Renal Function (Urea >16mmol/L)
Enzymes (LDH >600, AST >2000)
Albumin <32
Sugar (glucose >10mmol/L
```
126
What parameters are in the Truelove & Witts UC criteria?
```
Bowel Movements per day
Blood in Stools
Pyrexia (>37.8)
Pulse Rate >90
Anaemia
ESR
```
127
Mild UC attack - Truelove & Witts?
```
Bowel Movements per day - <4
Blood in Stools - no more than small amounts
Pyrexia (>37.8) - no
Pulse Rate >90 - no
Anaemia - no
ESR <30
```
128
Moderate UC attack - Truelove & Witts?
```
Bowel Movements per day - 4-6
Blood in Stools - between mild and severe
Pyrexia (>37.8) - No
Pulse Rate >90 - No
Anaemia - No
ESR <30
```
129
Severe UC attack - Truelove & Witts?
```
Bowel Movements per day >6
Blood in Stools - Visible blood
Pyrexia (>37.8) - Yes
Pulse Rate >90 - Yes
Anaemia - Yes
ESR >30
```
130
When and what antibiotics to give in ascites?
Ascites with protein <15g/L, until resolved
Prophylactic oral ciprofloxacin/norfloxacin
131
What tests are needed before azathioprine/mercaptopurine drug given?
Pre-treatment - Thiopurine methyltransferase (TPMT)
FBC weekly for first 4 weeks, then every 3 months
