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Nat 5 Physics > More bits and bobs > Flashcards

More bits and bobs Flashcards

1
Q

What is the definition of high blood pressure?

A

Over 140/90

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2
Q

What are secondary causes of hypertension?

A

Endocrine disorders (cushings disease, phaeochromocytoma, acromegaly, conn’s syndrome, thyrotoxicosis)

Renal disease (chronic renal failure, renal artery stenosis)

Coarctation of the aorta

Drugs (isotretinoin, corticosteroids, ciclosporin)

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3
Q

How do you check for end organ damage in hypertension?

A

fundoscopy: to check for hypertensive retinopathy

urine dipstick: to check for renal disease, either as a cause or consequence of hypertension

ECG: to check for left ventricular hypertrophy or ischaemic heart disease (Left bundle branch block)

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4
Q

What are potential drugs you can take for high blood pressure?

A

Ace I (first line if you are under 55)

Calcium channel blocker if you are over 55 (or are under 55 but afrocarribean)

Thiazide like diuretic

Angiotensin 2 receptor blocker

Beta blocker

Spironolactone (this is generally when there is low potassium)

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5
Q

What are the side effects of cacium channel blockers?

A

Flushing

Headache

Swelling of legs

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6
Q

What are the side effects of ace inhibitors?

A

Hyperkalaemia

Angiodema

Cough

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7
Q

What are the side effects of thiazide like diuretics?

A

Hyponatraemia

Hypokalaemia

Dehydration

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8
Q

What are non-pharma ways to control blood pressure?

A

Reduce salt intake

Stop smoking

Reduce alcohol intake

Optimise glycaemic control

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9
Q

What are the symptoms of high blood pressure?

A

Syncope

Headache

Blurred vision

Epistaxis

Angina

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10
Q

What are the causes of atrial fibrillation?

A

Ischaemic heart disease

Lung disease

Hypoxia

Hypertension

Rheumatic heart disease

Sepsis

Hypercapnea

Alcohol

Mitral stenosis

Atrial septal defect

Metabolic abnormalities

Thyrotoxicosis

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11
Q

What are symptoms of AF?

A

Palpitations

Dizziness

SOB

HF

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12
Q

What are the signs of AF?

A

Irregularly irregular pulse

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13
Q

What would you see on ECG for AF?

A

Absent P waves

Ireg ireg rhythm

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14
Q

What is the treatment in AF that controls rhythm?

A

Digoxin, beta blockers, diltiazem

DC cardioversion

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15
Q

What are the drugs used to prevent coagulation in AF?

A

Warfarin / heparin

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16
Q

What are the complications of AF?

A

Systemic embolisation

Rapid ventricular rate leading to hypotensin, angina and heart failure

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17
Q

What are the boundaries of the anterior border of the neck?

A

Anterior border of the Sternocleidomastoid
Lower border of mandible
Anterior midline

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18
Q

What are the contents of the anterior triangle of the neck?

A

Digastric triangle:

Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve

Muscular triangle:

Strap muscles
External jugular vein

Carotid triangle:

Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis

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19
Q

What are causes of neck swelings?

A

Reactive lymphadenopathy

Thyroid swelling - moves upward on swallowing

Thyroglossal cyst - More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

Cystic hygroma

Branchial cyst - failure of obliteration of second branchial cleft in embryonic development

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20
Q

How does a thyroglossal cyst form?

A

Remnant of the thyroglossal duct

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21
Q

What are causes of hypothyroidism?

A

Hashimotos - autoimmune condition

Subacute thyroiditis (later stages)
Insufficient dietary iodine

Drugs (lithium, amiodarone)

Down’s, turners, coeliacs

Post - surgery

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22
Q

What is the presentation of hypothyroidism?

A

Fatigue

Lethargy

Cold intolerance

Constipation

Weight gain

Carpal tunnel syndrome

Menorrhagia

Low mood

Dry skin

Hair loss

Slow reflexes

Peri-orbital puffiness

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23
Q

What are the levels of thyroid hormones in hypothyroidism?

A

TSH is high

T4 is low

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24
Q

What are the causes of acute pancreatitis?

A

GETSMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps (other viruses include Coxsackie B)

Autoimmune (e.g. polyarteritis nodosa), Ascaris infection

Scorpion venom

Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia

ERCP

Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

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25
What are the features of acute pancreatitis?
Severe epigastric pain that may radiate through to the back Vomiting is common Examination may reveal tenderness, ileus and low-grade fever Periumbilical discolouration (Cullen's sign) and flank discolouration (Grey-Turner's sign) is described but rare
26
What are the necessary investigation for acute pancreatitis?
ERCP Bloods - amylase / lipase Abdominal X-Ray (ileus) Chest X-Ray (pleural effusion) Abdominal ultrasound (pancreatic oedema, gallstones, pseudocyst)
27
What are markers of severe pancreatitis?
High white cell count High blood glucose High blood urea High AST Low serum albumin Low serum calcium Low arterial partial pressure oxygen High CRP
28
What is the managment of acute pancreatitis?
Analgesia FLuids Blood transfusion NG tube - rest the gland Oxygen May require insulin If pancreatic necrosis - CT guided aspiration - antibiotics and surgery If gallstones - EUS/MRCP/ERCP - cholecystectomy Lifestyle modifications - lower alcohol, diet and lipid lowering drugs
29
What are complications of acute pancreatitis?
Pancreatic necrosis Abscess Pseudocyst
30
What are the different causes of cushings syndrome?
Exogenous vs endogenous ACTH dependant ACTH independant Pseudocushings
31
What are the ACTH dependant causes of cushings disease?
Pituitary tumour secreting too much ACTH - adrenal hyperplasia Ectopic ACTH secretion i.e from a small cell lung cancer
32
What are the ACTH independant causes of cushing's syndrome?
Steroids Adrenal Adenoma/carcinoma Carney complex I think this also includes alcohol excess and depression (since there is no excretion of ACTH by a tumour then this is called cushings syndrome not disease)
33
What are the causes of pseudocushing's?
Pseudo-Cushing's ## Footnote mimics Cushing's often due to alcohol excess or severe depression causes false positive dexamethasone suppression test or 24 hr urinary free cortisol insulin stress test may be used to differentiate
34
What are the signs and symptoms of cushings?
Increase weight gain Poor wound healing Recurrent infections **Depression** Menstrual disturbances Low **libido** **Hirsuitism** **Headache** **Osteoporosis** Signs: **Moonface** **Abdominal striae** Centripetal **obesity** **Proximal myopathy** **Hirsuitism** **Thin skin** **Easy bruising** **Hypertension** **Acne**
35
What are the investigations for cushings?
24 hour urinary collection: free cortisol Random blood cortisol - loss of circadian rhythm (normally secreted in the morning) Low dose - dexamethasone suppression test - confirm wether ACTH can be suppressed High dose dexamethasone supression test - differentiate between pituitary and ectopic ACTH secretion
36
Probably worth having a wee gander
37
What are the treatments for cushings syndrome?
Medical: - Metyrapone - Ketoconazole Surgery - adrenalectomy
38
What are the treatments for cushings disease?
Surgery = trans-sphenoidal surgery (this is if there is an ACTH secreting tumour in the pituitary)
39
What percentage of strokes are TACS?
15%
40
Which arteries does the total anterior circulation stroke affect?
Involves the middle and anterior cerebral arteries
41
What are the criteria for TACs?
All 3 of: ## Footnote 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia
42
What portion of strokes are partial anterior circulation infarcts
25%
43
What arteries are involved in the partial anterior circulation?
Smaller arteries of anterior circulation e.g upper or lower division of middle cerebral artery
44
What are the criteria for a PACS?
2 of the following criteria: ## Footnote 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia
45
What percentage of strokes are lacunar infarcts?
25%
46
Which arteries are involved in a lacunar stroke?
Perforating arteries around the internal capsule, thalamus and basal ganglia
47
How does a lacunar stroke present?
presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis
48
What percentage of strokes are posterior circulation infarcts?
25%
49
Which arteries are involved in posterior circulation infarcts?
25%
50
What are the signs of posterior circulation infarct?
Presents with 1 of the following: 1. cerebellar or brainstem syndromes 2. Loss of consciousness 3. Isolated homonymous hemianopia
51
What are the features of haemorrhagic stroke?
Decreased level of consciousness likely Headache Nausea and vomitting Seizures
52
What are risk factors for AAA?
Hypertension Diabetes Smokers Marfan's or other connective tissue diseases
53
When is surgery usually offered to AAA?
Between 5.5 cm and 6 cm 3-4.4 = annual USS scans 4.5-5.5 = 3 monthly USS scans
54
What are the clinical features of aortic stenosis?
Chest pain DYspnoea Syncope
55
What are features of severe aortic stenosis?
**Narrow pulse pressure** **Slow rising pulse** Delayed ESM **Soft/absent S2** S4 **Thrill** Duration of murmur **Left ventricular hypertrophy or failure**
56
What are the causes of aortic stenosis?
degenerative calcification (most common cause in older patients \> 65 years) bicuspid aortic valve (most common cause in younger patients \< 65 years) William's syndrome (supravalvular aortic stenosis) post-rheumatic disease subvalvular: HOCM
57
What are the potential managements available for aortic stenosis?
Valve replacement Balloon valvuloplasty for those that are unfit for surgery
58
What is the ECG finding of aortic stenosis?
LBBB
59
What are organisms that cause cellulitis?
Strep pyogenes Staph aureus
60
What are the symptoms of celulitis?
commonly occurs on the shins erythema, pain, swelling there may be some associated systemic upset such as fever
61
What is the treatment of cellulitis?
Flucloxicillin Clairithromycin or clindamycin is recommended in patients allergic to penicillin Severe cellulitis = iv benzylpenicillin and flucloxicillin
62
What is meant by an outbreak?
Sudden increase in occurences of a disease in a particular time and place.
63
What are potential organisms for hospital outbreak?
Group A beta-haemolytic streptococcus MRSA influenza A C.diff Measles Meningococcal infections Parainfluenza Pertussis RSV Varicela
64
What type of bacteria are gut pathogens?
Gram Negative Large aeorobic bacilli
65
What type of orgnism is campylobacter?
Gram negative Small, curved, microaerophilic bacilli
66
What type of bacteria are neisseria?
Gram negative Aerobic cocci
67
When should you suspect a hereditary cancer syndrome?
Cancer in 2 or more close relatives (on same side of family) Early age at diagnosis Multiple primary tumors Bilateral or multiple rare cancers Characteristic pattern of tumours (e.g. breast and ovary) Evidence of autosomal dominant transmission

Nat 5 Physics (3 decks)

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