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Year 3 Conditions > OSCE nuggets > Flashcards

OSCE nuggets Flashcards

1
Q

What is third HS heard in

A

HF

Young athletes

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2
Q

When is gallop rythm heard

A

HF on history of HTN

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3
Q

LVH vs HF on ECG and CXR

A

LVH- tall r waves and normal on X-ray cos heart grows in

HF- cardiomégalie and normal ECG

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4
Q

BMI levels

A 
Overweight -25 30
Obese- 30 35
Severe obesity 35 40
Morbid obesity 40 50
Severe morbid 50+
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5
Q

How does obesity levels change with ethnicity

A

Over 23 is overweight in South Asians

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6
Q

What are you gonna do if BP over 140 diastolic

A

Check multiple times and and examine patient for signs of HTN

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7
Q

On examination what would be signs of HTN

A

Carotid bruits
S4
Fundoscopy
Heave

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8
Q

What is seen in grade 1 HTN fundoscopy

A

Silver wiring

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9
Q

What is silver wiring

A

Line in artery coming off the disc

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10
Q

What is grade 2 HTN fundoscopy finding

A

AV nipping

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11
Q

What is AV nipping

A

Crossing between artery and vein

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12
Q

What is grade 3 HTN of fundoscopy

A

Flame haemorrhages

Cotten wool spots showing ischaemia

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13
Q

What is grade 4 HTN fundoscopy finding

A

Papilloedema

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14
Q

What are secondary causes of HTN

A 
Acromegaly 
Nephritis
Renal artery stenosis 
Coarctation of aorta
Cushing 
Cons
Phaeos
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15
Q

What is primary HTN called

A

Essential HTN

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16
Q

Why do FBC HTN

A

Polycythaemia

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17
Q

Why do U&Es HTN

A

Low K is Conns or Cushing

See if kidney function affected in nephritis or renal artery stenosis

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18
Q

ECG finding HTN

A

LVH

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19
Q

What to look for urinalysis HTN

A

Nephritis

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20
Q

Investigations would do for HTN

A 
FBC
U&Es
Glucose 
Lipids
ECG
Urinalysis
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21
Q

Most important investigation for secondary HTN investigations

A

U&Es

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22
Q

If suspected Renal artery causing HTN what is first line investigation for this

A

MR Angio as can see aortic coarctation too

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23
Q

What are 3 steps to diabetic retinopathy

A

Background
Pre-proliferative
Proliferative

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24
Q

What are signs of background retinopathy

A

Hard exudates
Microaneurysms
Blot haemorrhages

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25
What are signs of pre proliferative diabetic retinopathy
Cotton wool spots
26
What are signs of proliferative retinopathy
New blood vessels formed due to ischaemia
27
What is maculopathy
When macula is damaged by retinopathy
28
What are signs of maculopathy
Hard exudates over macula
29
Antibiotics used in appendicitis
Cefoxamine and metronidazole
30
Who does appendicular mass occur in
People who wait to present
31
What are appendix perfs more common in
When faecolith involved- children
32
What in any abdo pain in young women is first line
Pregnancy
33
What does a positive psoas sign suggest about appendix position
Retrocaecal
34
What does a positive copes sign suggest about appendix position
Near to obturator externus
35
What non bowel symptoms are common in diverticulitis
Urinary ones | Especially when fistula- brown urine
36
What surgical procedure is done in diverticulitis
Hartmanns
37
What is a hartmanns procedure
Form colostomy bag leaving anorectal stump- once inflammation has died down will do promary anastomosis
38
Why cant you do primary anastomosis in diverticulitis
Oedema will mean when close the bowel there will be holes
39
What is first line investigation for diverticular disease
Barium swallow through
40
OPeration done in severe diverticular disease
Primary anastomosis
41
Complications of diverticular disease
``` Perf Diverticulitis Peri-colic abscess LBO Faecal peritonitis Fistulas ```
42
Risk factors to ask about in hernia history
Constipation Chronic cough Heavy lifting
43
Hernia presentation
Lump in groin Groin pain Scrotal swelling Vomiting
44
Who does femoral hernias occur in
Elder females
45
Who does inguinal hernias occur in
Younger males
46
What do inguinal hernias contain
Bowel
47
What do femoral hernias contain
Omentum
48
In what position do hernias often reduce
Supinated
49
Signs of strangulated hernias
``` Tender Red Colicky pain Distension Vomiting ```
50
Difference in management of femoral and inguinal hernias
Will do surgery much more often in femoral as risk of strangulation
51
Which drugs cause pancreatitis
Thiazides | Azathioprine
52
Signs on examination of pancreatitis
Epigastric tenderness Reduced bowel sounds Fever Shock
53
What does a normal Ca in glasgow score suggest about pancreatitis cause
Hypercalcaemia
54
What does very low Ca suggest about prognosis
Not good
55
How long after eating does chronic pancreatitis pain present
15-30mins
56
What is often new diagnosis in chronic pancreatitis
T2DM
57
1st line investigation for chronic pancreatitis
CT abdo- see calcified pancreas
58
Management of sigmoid volvulus
Rigid sigmoidoscope decompression
59
What is the other name for watershed zone
Griffiths
60
If ischaemia at griffiths point what is most likely cause of
Hypovolaemia ( water shed zone is griffiths point)
61
Which areas are susceptible to ischaemic colitis
Sudeks point Griffiths point Right colon
62
Where is sudeks point
Rectosigmoid junction
63
What are most likely causes of ischaemic colitis
Hypoperfusion
64
What are most likely causes of acute mesenteric ischaemia
VTE
65
Managment of ischaemic colitis vs mesenteric ischaemia
Mesenteric immediate surgery | Ischaemic conservative- fluids and bowel rest
66
What is presentation of mesenteric ischaemia
Vomiting Diarrorhoea Sudden onset diffuse pain
67
Risk factors mesenteric ischaemia
AF Cocaine Smoking
68
Triad for mesenteric ischaemia
Sudden diffuse pain Normal exam Shock signs
69
Investigations for acute mesenteric ischaemia
ECG ABG AXR CT
70
Signs seen on imaging mesenteric ischaemia
Perforated Megacolon Dilated
71
Managment of occlusive mesenteric ischaemia no gangrene
Thrombectomy | Thrombolysis
72
Management of non-occlusive mesenteric ischaemia with no gangrene
Fluid resus
73
Presentation of ischaemic colitis
Post prandial gut pain history PR bleeding Weigjht loss
74
Causes of non occlusive ischaemia in bowels
SEPSIS Shock Trauma
75
Complication of iscahemic colitis
Ileus
76
Management of iscahemic colitis causing ileus
Drip and suck
77
Management of ischaemic colitis
IV fluids
78
Diet lifestyle management in diabetes
Low sugars and complex carbs | Snack less regularly
79
After metformin what are 3 drugs can choose from
Sulphonylureas Gliptins SGLT2i
80
How does metformin work
Reduces liver production of glucose and improves sensitisation to insulin
81
Pros of metformin
Shown to easily reduce Hb1ac | Improves reduced CVA events, life expectancy and cancer risk
82
Cons of metformin
Diarrorhoea | Metabolic acidosis risk
83
Symptoms for metformin acidosis
stomach pain, nausea, irregular heart rate, anxiety, hypotension (low blood pressure), rapid heart rate.
84
How do sulphonylureas work
Increase insulin production at level of pancreas
85
How can metformin does be delivered to help with diarrorhoea
Titre up slowly
86
What impact does sulphonylureas have on weight
Makes you gain weight
87
What is main risk of sulphonylureas
Can have hypoglycaemic episode
88
Who isnt sulphonylureas appropriate for
Overweight people | People who drive regularly or are truck drivers as risk of hypo
89
Cons of sulphonylureas
Weight gain No benefit longer term in terms of mortality Risk of hypos
90
What do gliptins do
GLP 1 enzyme inhibitor thus increases insulin production
91
Benefits of gliptins
Help reduce appetitie and lose weight | Good at lowering Hb1ac
92
Cons of gliptin
Risk of pancreatitis | Can have diarrorhoea
93
How do SGL2Ti work
Block a channel in kidney allowing glucose to pass out
94
Side effects of SGL2Ti
Polyuria and polydipsia | Genital infections
95
Positives of SGL2Ti
Especially helpful for kidney and heart failure patients- improved mortality Help lose weight
96
Names of sulphonylureas
Glibenclamide | Glipizide
97
Names of gliptins
Vildagliptin | Saxagliptin
98
Names of SGLT2i
empagliflozin
99
If troponin and ECG neg what is next investigation
Exercise tolerance test
100
Gastro causes of chest pain
Oesophagitis Gastritis Oesophageal spasm
101
What is major risk factor for boerhaves perforation
Recent endoscopy
102
How high can JVP go
Up to ear can even appear pulsatile
103
Causes of tricuspid regurg
RV dilation | Leaflet damage- RF, endocarditis
104
What infection can commonly lead to pericarditis
TB
105
Rfs for pericarditis
TB Recent URTI infection CTD
106
What questions ascertains in syncope if LOC
Can you remember
107
What does sinus mean in reference to rythm
Present P waves
108
Causes of sinus tachycardia
``` Hypovolaemia Sepsis Pain Caffeine PE Endo- thyrotoxicosis, phaeochromocytoma ```
109
How to determine if AVRT or AVNRT
Return to normal rate and rythm
110
Amir sam causes of Afib
``` Thyrotoxicosis Alcohol Heart: - pericarditis - muscle. cardiomyopathy, IHD - Valvular Lung - PE - cancer - pneumonia ```
111
Causes of VT
Electrolyte abnormalities Ischaemia Long QT
112
Management of SVT haem stable
Valsalva and vagal manouevres Adenosine Treat cause
113
Management of SVT haem unstable
DC cardioversion
114
What can cause fixed splitting of S2
Atrial septal defect
115
If patient is hypothermic needing defib what must do
Warm up
116
Management of haem stable VT
IV amiodarone Treat underlying cause ICD
117
How to work out if LVH
Add deep S in V1 to tall R in V5/6 and if greater than 35 small squares
118
What scores are used to work out if anticoagulate in Afib
CHAD VASC | HASBLED
119
How to work out if long QT
Draw 2 lines between R waves and work out midpoint | If t wave here or further then long QT
120
Which type of stroke will normally lead to collapse
Haemorrhagic
121
Why do we feel carotid pulses
Hypovolaemia will be weak | Slow rising pulse for aortic stenosis
122
What does carotid feel like in aortic stenosis
Like a thrill Slow rising Weak
123
What is pulsus tardus and parvus seen in
Aortic stenosis
124
What is bifid carotid pulse seen in
Aortic regurg
125
What is the anion gap
Sodium and potassium - chloride and bicarbonate however chloride and bicarrbonate dont account for all of the negative ions so the anion gap is all those left that allow electroneutrality
126
What is a normal anion gap
Should be small
127
What is an abnormal anion gap
Very high- due to extra anions normally due to dissociated acid part
128
What causes a high anion gap
``` Lactate Uraemia Ketones Toxins KULT ```
129
What does hypoalbuminaemia indicate about liver disease
Chronic
130
What does isolated elevated PT suggest about liver disease
Acute liver disease
131
Causes of hyperkalaemia
``` Addisons Renal failure ACE Spironolactone Rhabdomyolysis Metabolic acidosis ```
132
Main ECG findings of hyperkalaemia
``` Bradycardia Absent or small p waves Long PR Broad QRS Tented T waves ```
133
Management of hyperkalaemia
``` ECG Calcium Gluconate 10% 10ml Salbutamol nebs.10mg Insulin 5-10 units + Glucose 50% 50mmol Regular VBGs ```
134
Symptoms of hypokalaemia
Weakness Arrythmia Hypokalaemia
135
Causes of hypokalaemia
``` Vomiting Diarrorhoea Loop diuretics Thiazide diuretics Conns Cushing ```
136
Arrythmia hypokalaemia can lead to
Torsades de pointes
137
What does RAAS do to k and na
Excretes K | Reabsorb Na
138
Keys to managment of hypo Na and K
Do it slowly Na fast leads to central pontine myelinolysis K is an irritant to veins so either cheset drain or slowly in cannula
139
Mild hyponatraemia presentation
Confusion
140
Severe hyponatraemia presentation
Vomiting Seizures Death
141
What causes ADH release
Low volume at carotid sinus | Low Na concentration
142
Why does ADH release cause hyponatraemia
It only retains water not Na like aldosterone as acts on collecting duct
143
Hypovolaemia signs on examination
``` Dry membranes Reduced skin turgor Postural hypotension HR up Reduced urine output Confused ```
144
What happens to urine sodium in hypovolaemia
Its low
145
Signs on examination of hypervolaemia
JVP up Bibasal creps Peripheral oedema
146
Why do you get hyponatraemia in hypovolaemia
Lose sodium and fluid however ADH only fixes water so volume goes up but sodium remains the same
147
Why do you get hyponatreamia in hypothyroidism
Reduced thyroxine reduces CO thus reducing apparent volume causing ADH release
148
How does addisons lead to hypovolaemic then euvolaemic hyponatraemia
Aldosterone production is reduced causing sodium loss and so also water loss leading to hypovolaemia. Then as reudced volume ADH increase water up to euvolaemic
149
Why dont you become hypervolaemic in SIADH
Initially you release too much ADH causing retention of water however this hypervolaemia triggers ANP and BNP release which gets rid of water and sodium
150
Causes of SIADH
CNS pathology such as meningitis, enchepahlitis and SAH Surgery Drugs- SSRIs, TCAs, opiates, PPIs, carbamezapines Lung pathology
151
Investigation for euvolaemic hyponatraemia
Short SynACThen TFTs Urine osmolaltiy
152
Causes of hypernatraemia
Diabetes insipidus Conns Cushings
153
What is defined as HTN
BP over 140/90mmHg
154
If in OSCE take BP what do you offer to do
Take in both arms and if is difference of over 15 then recheck in the arm with highest BP
155
If you notice that BP is over 140/90 on first go what do you do
Ideally take 3 readings and take the lower of last 2
156
Once a clinic reading of 140/90 is made what is next step
Offer ambulatory BP measurement
157
What are 3 cut offs for ABPM
If under 135/85 then not hypertensive If over 150/95 then stage 2 HTN If over 135/85 then stage 1 HTN
158
What does stage 1 HTN mean for treatment plan
If under the age of 80 and has one of these then treat; - established CVD - renal disease - diabetes - organ damage - 10 year risk of CVA over 10%
159
Way to remember HTN stage 1 reasons for treatment
CORD 10
160
What does it mean for stage 2 HTN
Treat all patients regardless of age
161
What is metformin contraindicated in
Renal failure due to lactica acidosis risk
162
What would be suspected in MI at young age
HOCM Long QT Familial hypercholesterolaemia
163
What can cause elevated lipids non lifestyle
Liver failure Renal problems Hypothyroidism High glucose
164
Management plan for hypercholesterolaemia
Lifestyle Statin Ezetimibe Bezafibrate
165
SEs of statins
Headache Proximal myopathy Flatulence Tired
166
What is problem of nifedipine in malignant HTN management
Done too quickly- want to manage slowly down in around 24hrs
167
What is target BP for diabetics
130:80
168
What offer if BP less than 140:90
To check every 5 years maybe less if close to target
169
What must be measured when giving apixaban
Renal function
170
Investigations for stable angina
``` Bedside - ECG - Obs- BP to see if hypertensive Bloods - FBC - troponin - lipid profile - glucose or hba1c Imaging - ETT with ECG - ETT with echo - stress echo - cardac CT angiography - invasive coronary angiography ```
171
Management plan for stable angina
``` Lifestyle advice - lipid, diabetes and HTN management Aspirin 75mg or clopidogrel or both GTN spray for when in pain First line anti anginal of either CCB or beta blocker depending on SEs of patietns choice Then both if tolerated Second line ivabradine or long acting nitrate Third line PCI with stent or CABG ```
172
Why is FBC important in stable angina
Anaemia can exacerbate symptoms
173
In cardiac CT angio and invasive coronary angio what is defined as coronary obstruction
Stenosis of 50-70%
174
Management plan for acute UAP
Aspirin and clopidogrel Nitrates- if not toleralted morphine Fondaparinaux Sent for ETT/stress echo then potential PCI
175
Investigations for UAP
``` Bedside - obs - ECG Bloods - troponin - FBC - U&Es - LFTSs - lipids - glucose/Hba1c Investigations - stress echo - echo - ETT - myoview of heart - cardiac CT angio - invasive angio with potential PCI ```
176
Why are LFTs important in ACS
Check clotting for anticoagulation
177
Why are U&Es important ACS
Baseline
178
Why do an Echo UAP
See if any regional wall abnormaliites | Check LVF
179
What is seen in myocardial perfusion scan of heart UAP
Unmatched perfusion between rest and stress
180
Long term management of UAP
Continue on aspirin for life and clopidogrel for one year Statin Beta blockers or verapmil or carvedilol (mainly beta blocker) ACEi/ARB Spironolactone DM/HTN management
181
What is verapamil MOA
CCB
182
What class of drug is clopidogrel
P2Y12 inhibitor
183
What are 2 P2Y12 inhibitors
Clopidogrel | Ticagrelor
184
What is MOA of flecainide
Sodium channel blocker
185
What are 2 examples of ARBs
Losartan | Candesartan
186
MOA of thiazides
Inhibits Na/Cl channel DCT
187
2 examples of thiazide diuretics
Bendroflumethazide | Indapamide
188
MOA of spironolactone
Aldosterone inhibitor
189
What does ARB stand for
Angiotensin 2 receptor blocker
190
MOA of digoxin
Reduces HR and also improves contractility
191
Management plan of Type B aortic dissection
If no end organ ischaemia - beta blockade using labetalol - aiming for HR under 60 and systolic under 120 so if beta blockade fails use vasodilator therapy - first line vasodilator therapy is nitropusside - second line diltiazem If end organ failure open surgery or endovascular graft
192
BP managemet in any aortic dissection
Beta blockade using labetalol Aim for HR under 60 and sys under 120 If beta blockade fails use 1st line nitropusside, 2nd line diltiazem
193
Investigations ordered for aortic dissection
``` Bedside - BP in both arms - ECG Bloods - FBC - U&Es - LFTs - G&S - troponin - VBG Imaging - CXR - CT angio - echo ```
194
What can be seen aortic dissection on ECG
St depression or ST elevation
195
CXR findings aortic dissection
Widened mediastinum with blunted aortic knuckle | Can get pleural effusion
196
Risk factors for pericarditis
``` TB CTD Recent MI URTI- viral Cancer Uraemia ```
197
Where can pericarditis pain also be
Trapezius ridge
198
O/E constrictive pericarditis
Pericardial friction rub Raised JVP HF signs possible
199
Management plan for pericarditis
NSAIDS(aspirin or ibuprofen) with PPI! Colchicine Exercise restriction Second line steroids if unresponsive
200
Investigations for pericarditis and findings
``` ECG- widespread concave ST elevation Throat swab Bloods - FBC- lymphocytosis - U&Es- uraemia is cause - troponin Echo- pericardial effusion or helps distinguish from MI and pericardial thickening helps distinguish from restrictive cardiomyopathy Pericardiocentesis helps identify cause ```
201
Examples of target organ failure in HTN
LVH Retinopathy Increased albumin to creatinine ratio CKD
202
In stage 2 HTN when is a statin given
If q risk over 10%
203
What is as significant contraindications for CCB
HF
204
What is main side effect of thiazides
Sexual dysfunction
205
Complications of pneumothorax
Bronchopleural fistula | Recurrent pneumothoraces are common- 20% chance of repeat
206
Management of recurrent pneumothoraces
PLeuroidesis using sclerosants like tetracycline
207
Diffuse abdo pain with nausea and vomiting
Obstruction | Mesenteric ischaemia
208
How does acute mesenteric ischaemia present
Acute diffuse abdo pain Nausea and vomiting Haematochezia Complains of post prandial pain
209
What is small meal syndrome
When due to chronic mesenteric ischaemia you start eating smaller meals due to pain caused by eating larger ones
210
Risk factors for liver abscess
``` intrahepatic processes/surgery DM Biliary disease GI infection Recent travel ```
211
Difference in pain of SBO vs LBO
SBO pain higher up due to somatic supply | LBO lower and spasms last for longer
212
What is PT in obstructive causes of jaundice
High as reduced absorption of VIT K
213
US finding of cholangiocarcinoma
Mass | Dilated bile ducts
214
What are 2 cancer markers raised in cholangiocarcinoma
CA19-9 CEA Ratio of CA19-9>40xCEA
215
What non cancerous disease is CEA raised in
IBD
216
Why isnt measuring CEA to screen adenocarcinoma in UC a good idea
Also elevated in UC
217
Why do U&Es plus LTFs in sarcoidosis
Can get liver and renal involvement
218
Management of diverticular disease
Improved diet and hydration If bacterial overgrowth suggested give abx If symptoms persist for a while can consider surgery
219
Management plan for diverticulitis
Analgesia Fluids Abx Consider surgery if perforation, abscess, fistula or excessive bleeding
220
What should be done if excessive bleeding that cant be stopped in acute diverticulitis
Consider transfusions | CT angio or isotope labelled red blood cell nuclear scan
221
Complications of diverticulitis
``` Abscess Fistula Perforation Sepsis Excessive bleeding ```
222
Investigatons for acute diverticulitis
``` Bloods FBC- neutrophillia, CRP up, anaemia U&Es for baseline Blood cultures G&S CT eCXR or AXR to look for pneumoperitoneum ```
223
What is seen on CT diverticulitis
Abscess Fistula Thickened bowel walls Outpouchings inflammed
224
What can be done for patients who have regular COPD exacerbations
Arithomycin thrice weekly
225
Who does constipation cause confusion in
The elderly especially post op
226
What causes ischaemic colitis in younger people
Cocaine use
227
What happens to Hba1c in hereditary spherocytosis
It decreases and is so underestimated
228
What causes PSM heard loudest at left sternal edge lower down and with louder P2
VSD
229
If variceal haemorrhage is uncontrolled with terlipressin what must be done prior to endoscopy
Insertion of sengstaken blakemore tube
230
If patient has atelectasis what is best immediate management
Sit patient up | Then refer for chet physio
231
What can cause ischaemic hepatitis
Sepsis leading to hypoperfusion | Clot
232
What artery most commonly affects the trigeminal nerve in TN
Superior cerebellar artery
233
What can be secondary causes of cluster headaches
Pituitary adenoma or hypothalamic dysregulation
234
Pathophysiology of cluster headaches
hypothalamic activation with secondary trigeminal and autonomic activation
235
What can trigger a cluster headache
Alcohol Stress Sleep Volatile smells
236
Investigations for cluster headache
ESR to rule out GCA MRI to rule out secondary pituitary or hypothalamic cause Pituitary function tests can rule out secondary cause
237
What is seen on head CT of extradural
Lemon shaped bleed | Midline shift and cerebral oedema
238
What is alternative cause of extradural and how would be investigated
AV malformation | CT angio
239
Major criteria for rheumatic fever
``` JONES pnemonic Arthritis Carditis Nodules sub cut Erytherma marginatum Sydenhams chorea ```
240
Minor criteria for rheumatic fever
Raised CRP Raised ESR Fever over 38.5 Prolonged PR
241
Investigations for rheumatic fever
``` Bloods -ESR -CRP -WCC ECG - can show elongated PR Echo - valve damage PCR or throat culture for strep Anti-streptolysin titres ```
242
How does erythema marginatum appear
Ring like appearance on torso and legs
243
What is management of gallstones
If symptomatic give NSAIDS like diclofenac and offered laparoscopic cholecystectomy If asymptomatic from being found incidentally dont offer cholecystectomy unless signs of porcelain gall bladder, high risk of GB cancer and chronic risk like SCD
244
When would you offer cholecystectomy in asymptomatic biliary colic
Signs of porcelain GB High risk of GB cancer Chronic risk from diseases like SCD
245
What are main complications of biliary colic
``` Cholecystitis Cholangitis Pancreatitis Mirrizi syndrome Gallstone ileus ```
246
Investigations ordered for bilairy colic
``` Bloods - FBC looking for WCC - CRP as inflammation - LFTs see if liver function deranged - amylase - lipid profile Imaging - US showing gallstones, dilated ducts and sludge - MRCP and CT also showing this Only really would do this if stones unidentifiable or signs of complications ```
247
What is most common viral cause of subacute thyroiditis
Cocksackie virus
248
Investigations for subacute thyroiditis
Bloods - ESR and CRP up - TFTs depends on the stage of disease - antithyroid peroxidase abs can be present Imaging - scintigraphy will show global reduced uptake - FNA will show granulomas and WCC infiltration
249
How long cant you drive for following a first unprovoked seizure
6 months
250
O/E idiopathic pulmonary fibrosis
Clubbing | Fine late inspiratory crackles
251
What should be ruled out in initial idiopathic pulmonary fibrosis screen
RA | Myositis
252
What is positive BPPV finding
Delayed onset torsional unilateral nystagmus
253
What is podagra
Gout
254
What are smudge/smear cells
Remnants of cells
255
RFs for saccular aneurysms
Marfans Ehlers PCKD NF1
256
What is lupus vernio seen in
Sarcoid
257
What are risk factors for burkitts lymphoma
Immunosuppression- HIV | EBV
258
Investigations for SIADH
TFTs | Short Synacten to rule out these as causes of euvolaemic hyponatraemia
259
What is difference in pupil between anterior uveitis and closed angle glaucoma
Dilated in glaucoma | Constricted in anterior uveitis
260
what is finding of CSF in GBS
High protein | Albumin cytological dissociation
261
What indicates severity of mitral stenosis
Length of murmur
262
How to diagnose zollinger ellison syndrome
Fasting gastrin level
263
How is nephrogenic diabetes insipidus treated
Thiazide diuretics
264
How is cranial diabetes insipidus treated
Intranasal desmopressin
265
What virus predisposes to MS
EBV
266
What 2 lifestyle changes will help improve BP
Lose weight | Eat less salt
267
What cardiac abnormailities are seen in carcinoid syndrome
Pulmonary stenosis | Tricuspid insufficiency
268
O/E myocarditis
HF signs Sinus tachycardia Arrythmias common
269
Investigations for myoarditis
``` Bloods - WCC up - CK MB up - troponin very up ECG - non specific ST elevation and depression - some T wave inversion CXR - bibasal crackles if in HF Echo - global dyskinesia - LV dilation Endomyocardial biopsy - infiltration and necrosis ```
270
Management plan for bronchiectasis
``` All patients - improve diet and exercise - physio Some patients - inhaled bronchodilator - mucolytic (hypertonic saline) ```
271
What is example of mucolytic used in bronchiectasis
Hypertonic saline
272
What is done for patients with bronchiectasis who have over 3 exacerbations a year
Inhaled abx
273
When are patients with bronchiectasis given inhaled abx
If have over 3 exacerbations a year
274
What causes systolic HF
Arrythmia Cardiomyopathy MI
275
What causes diastolic HF
Constrictive pericarditis Valve regurg HTN
276
Why in stroke do you stop anticoagulants
Is risk of haemorrhagic transformation
277
Immediate treatment for stroke
Aspirin 300mg and stop anticoags
278
Anticoagulation for stroke first 2 weeks
Aspirin 300mg and stop anticoags
279
Anticoagulation for stroke after first 2 weeks
Stop aspirin Clopidogrel 75mg OD Specialist consideration for anticoags depending on cause etc
280
What is given to someone just before going to PCI regardless of if NSTEMI or STEMI
Unfractionated heparin
281
Immediate antplatelet therapy in ACS
Aspirin 300mg | Clopidogrel 300mg or ticagrelor 180mg
282
Long term ACS dual antiplatelet
Aspirin 75mg for life | Clopidogrel 75mg or ticagrelor 90mg BD
283
What is only long term ACS antiplatelet take BD
Ticagrelor
284
What is myelodysplasia
A precancerous state where mutations leads to bone marrow production of immature cells in all myeloid strains leading to pancytopenia
285
What does myelodysplasia lead to in 1/3 of cases
AML
286
What happens initially in myelofibrosis
Produce loads of every cell but bone marrow then decompensates leading to fibrous deposits
287
Causes of TTP
Cancer Pregnancy Idiopathic
288
What are nerve comlpications of amyloid
Carpal tunnel | Neuropathies
289
What causes dry eyes in sarcoid
Keratoconjunctivitis sicca
290
What is skin change seen in amyloid
Purpuric rash
291
What is main difference between PBC and PSC
PBC only affects intrahepatic bile ducts
292
What is condition linked to polyarteritis nodosa
Hep B- most sufferers will have Hep B
293
What is rosary sign seen in
Polyarteritis nodosa
294
What is rosary sign
Aneurysms formation polyarteritis nodosa
295
What is pathergy test used for
Behcets
296
What happens in pathergy test
Skin prick made into skin and in behcets get small red lump
297
What are 3 types of amyloid
AL- myeloma AA- inflammatory conditions ATTR- elderly and familial
298
What does Amyloid ATTR stand for
Amyloid trans thyretin
299
What is only vasculitis that causes cavitating lesion
Wegners
300
What is common to all COPD categories
FEV1/FVC ratio less than 0.7
301
COPD categories are based on what
Percentage of expected FEV1
302
COPD categories
Mild above 80% expected FEV1 Moderate 50-80% expected FEV1 Severe 30-50% of expected FEV1 Very severe less than 30% of expected FEV1
303
What are main complications of COPD
Cor pulmonale Pneumothorax Recurrent infection leading to exacerbations Polycythaemia vera
304
What are 3 treatmetns known to improve mortality in COPD
Stop smoking Lung reduction surgery Long term O2
305
4 factors that determine if COPD patient goes down asthma pathway
Raised eosinophil count Diurnal variation of PEF greater than 20% FEV1 variation in time Diagnosis of asthma or atopy
306
Simple COPD management
Stop smoking Annual flu vaccine Pneumococcal vaccination
307
Drug management COPD
SABA or SAMA If asthmatic LABA and ICS If not LABA and LAMA Finally LABA, LAMA, ICS
308
Further long term management of COPD
Lung reduction surgery Long term O2 if meet criteria 1 of either - terminally ill - PaO2 less than 7.3 - PaO2 7.3-8 with pulmonary HTN, PCV or nocturnal hypoxaemia
309
What is difference in hydrocrotisone dose between asthma and COPD infective exacerbation
100mg in asthma | 200mg in COPD
310
How does Hep C present typically
Asymptomatically- most people will be able to clear but sometimes can progress to cirrhosis
311
What is main risk factor for progression of Hep C to cirrhosis
Alcohol intake | Hep C
312
Most common cause of CKD
Diabetes
313
What antibiotic should be avoided in pregnancy
Trimethoprin
314
Which is more common FAP or HNPCC
HNPCC
315
What is target Hba1c for T1DM
48
316
What does ST elevation alone in AVR and widespread ST depression imply
Left main or LAD ischaemia
317
What is definition of TIA based on now
The definition of a TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
318
General management of atypical pneumonia
Amoxicillin and clarithomycin
319
If want to DCcardiovert someone in AF who has been symptomatic for longer than 48 hours what are 2 options
TEE to look for clots if clear can do it | Anticoagulate for 3 weeks
320
Metabolic compications of DM
DKA HHS Hypoglycaemia
321
Cavitating lesion causes
``` Wegners SqCC Klebsiella TB Staph aureus Mycetoma Rheumatoid arthritis ```
322
Cause of bleed if malaena and recurrent nose bleeds
Hereditary telengiectasia
323
Cancer causes of parasthesia
Myeloma | Paraneoplastic syndrome
324
Hereditary causes of parasthesia
Hereditary sensory motor neuropathy
325
Common symptom of MS often overlooked by clinicians
Fatigue
326
What is L'hermites sign most commonly seen in
MS from transverse myelitis
327
Which countries are MS sufferers normally seen in
Scandinavia
328
How can you tell if a lesion in MS is new or old
Gadolinium contrast will show what lesions are new as acute inflammation leads to increased uptake
329
Which types of people does MG most commonly occur in
Women under 40 | Men over 60
330
What happens to reflexes in MG
Normal
331
What mainly happens to thymus in MG
Majority of time get thymic hyperplasia but can sometimes get thymomas
332
What is picks disease
A type of frontotemporal dementia
333
How is diagnosis of MND made
Clincal but other diagnoses must be excluded
334
Differential diagnoses to rule out in MND
``` B12 deficiency MS Cervical myelopathy HIV Metastatic brain cancer ```
335
Investigations done in MND work up
Bloods- B12, HIV and lyme disease serology | CT/MRI
336
EMG finding of MND
Fasiculations and fibrillations
337
Main wasting sites of MND
Thenar | Tongue
338
Sign on examination of MND causing dysphagia
Tongue wasting
339
What is typical initial presentation of ALS
Foot drop | Clumsy weak hand
340
Signs on examination of initial ALS
Some wasting | Mix of initial UMN and LMN
341
Proportions of types of MND
ALS- 60% Bulbar- 30% Progressive lateral sclerosis- 5% Progressive muscular atropy-5%
342
4 types of MS
Relapsing remitting Primary progressive Secondary progressive Clinically isolated syndrome
343
What is presentation of bulbar MND
Dysarthria and dysphagia
344
Signs on examination of bulbar MND
Dysarthria Brisk jaw jerk Tongue fasiculations and wasting
345
What is difference in prognosis between bulbar MND and ALS
Bulbar much worse
346
What MND gives pure UMN onset
Primary lateral sclerosis
347
What MND gives purely LMN onset
Progressive muscular atrophy
348
What does pseudobulbar MND mean
Purely UMN findings
349
What is difference between pseudobulbar and bulbar MND
Pseudobulbar is purely UMN whereas bulbar is a mix
350
What are UMN bulbar signs
Exaggerated gag reflex Brisk jaw jerk Spastic tongue
351
What are LMN bulbar signs
Tongue wasting Tongue fasicullations and fibrillations Absent jaw jerk and gag reflex
352
Main risk factors for parkinsons
Male Age Living in countryside Fhx
353
What rigidity is seen on examination on parkinsons
Initially is lead pipe but with tremor superimposed becomes cog wheel
354
What comes under umbrella of parkinsonism
Parkinsons disease Drug induced parkinsons Atypical parkinsons diseases
355
What drugs can causes drug induced parkinsonism
Anti-epileptics Anti-emetics Anti-psychotics
356
What are some atypical parkinsons diseases
Multi infarct parkinsons | Parkinsons diseae dementia
357
What is main difference between parkinsons disease dementia and LBD
With LBD motor and cognitive sx come on at same time | In parkinons disease dementia the cognitive decline comes on way after
358
What is main pathognomic symptom for parkinsons disease dementia
Visuospatial disturbances
359
What is best test for parkinsons
Responsiveness to L dopa
360
What does lead pipe rigidity mean on examination
Increased smooth hypertonia in both directions
361
Hypomimia sign on face
Blinking
362
What is needed for parkinsons diagnosis
3 of triad | 2 is just parkinsonims
363
What are 2 degenerations of parkinsons
Progressive supranuclear palsy | Multiple system atropy
364
Defining features of progressive supranuclear palsy
Dysarthria Instability Fail to look downwards
365
Defining features of multiple system atrophy
Early autonomic features- incontinence, orthostatic hypotension
366
What is degeneration of parkinsons that leads to autonomic symptoms
Multiple system atrophy
367
What is degeneration of parkinsons that leads to postural instability and impaired gaze
Progressive supranuclear palsy
368
What are features that distinguish parkinsons from parkinsonism
Asymmetrical features Response to L dopa No atypical features No history of parkinsonism assocaited drugs
369
Common drugs causing parkinsonism
Haloperidol Metoclopramide Risperidone
370
What is defining feature on imaging of pseudogout
Chondrocalcinosis
371
What is main cause of renal artery stenosis in younger women
Fibromuscular dysplasia
372
What is normal appearance of arthrocentesis
Cloudy yellow
373
What is appearance of arthrocentesis in septic arthritis
Turbid grey
374
What is appearance of crystal arthritis on arthrocentesis
Cloudy yellow
375
What is appearance of crystal arthritis on arthrocentestis
Cloudy yellow
376
Dementia differentials
``` Alzheimers LBD PDD Frontotemporal dementia Depression Syphillis Hydrocephalus ```
377
What typically comes first in alzheimers
Amnesia
378
What is later progression of alzheimers
``` Language problems Failure to recognise people Poor calculation Loss of executive thinking Poor with names ```
379
What is episodic memory
Remembering specific dates and days you did something
380
What part of brain is affected in episodic memory loss
Hippocampus
381
On MRI of brain what is seen in huntingtons
Atrophy of medial temporal lobe mainly | Whole brain atrophy
382
What is needed to definitively diagnose dementia
Brain biopsy
383
What is seen on biopsy of dementia brain
Amyloid deposits Fibrillatory tangles Loss of synapses and neurones
384
What are fibrillatory tangles
Hyperphosphate tau proteins
385
Investigations for dementia
Clinical diagnosis using various mental tests LP will show high tau protein and low amyloid CT/MRI in later disease progression will show atrophy
386
Cognitive tests that can be done assess dementia
MOCA MMSE Addenbrookes cognitive assessment
387
Features of vascular dementia
``` Focal neurology Stepwise decline Emotional and personality changes Stepwise decline Cardiovascular rfx ```
388
Imaging finding of vascular dementia
Multiple hypodense lesions showing haemosederin deposites
389
What is picks disease a type of
Frontotemporal dementia
390
What are features of frontotemporal dementia
Poor hygiene Loss of inhibition Personality changes
391
Which ages does picks disease tend to affect
Younger than other dementias- 40-60
392
What is different about brain biopsy finding of picks disease to alzheimers
Picks is purely tau proteins
393
What is athetosis
Writhing movements of hands
394
Presentation of huntingtons
``` Chorea Athetosis Ataxia Dysphagia Cognitive symptoms ```
395
What is disease course progression of huntingtons
To begin with twitching of hands then get full motor symptoms Later on progresses to cognitive dysfunction
396
Cognitive dysfunctioning of huntingtons
Poor concentration Depression Dementia Personality changes- aggression
397
What is inheritance of huntingtons
Autosomal dominant
398
What is mutation in huntingtons
CAG repeat in HTT gene
399
What is early MRI finding of huntingtons
Basal gangial atrophy | Mainly striatum
400
What is late MRI finding of huntingtons
Global brain atrophy
401
What are investigations for huntingtons
Genetic testing for HTT | MRI showing striatal atrophy
402
In which disease cant you stick out tongue
Huntingtons
403
How does alcoholism lead to wernickes
Alcoholics have poor diet | Alcohol impairs ability to absorb B1
404
Investigations done for wernickes
Bloods - B1 and albumin as marker of liver disease ECG CT scan Neuropsycology
405
Differences between werkickes and korsakoffs
W patient is confused but in korsakoffs alert Signs of W are cerebellar whereas K is confabulation and amnesia W reversible whereas korsakoffs irreversible W acute but K chronic
406
3 mechanisms leading to iscahemic stroke
Thrombous AF Watershed stroke
407
What are watershed strokes
In hypotension reduced blood flow to areas on borders between artery territories
408
What HAS BLED score would contraindicate against CHAD VASC
HASBLED of 3
409
What in history would suggest haemorrhagic stroke
Headache Meningism Nausea and vomiting LOC
410
Causes of haemorrhagic stroke
HTN Microaneurysms AV malformations Vasculitis
411
In stroke what are eye abnormalities at in each territory for ACA, MCA and PCA
ACA- homonymous hemianopia MCA- quadrantopias PCA- macula sparing homonymous hemianopia
412
What are eye deficits in MCA strokes
Quadrantopias
413
What are eye deficits in PCA strokes
Macula sparing homonymous hemianopias | Visual agnosia
414
Where is damage in visual agnosia
Occipital lobe
415
Where are strokes in LOC or reduced consciousness
Posterior CA
416
MCA stroke symptoms
``` Contralateral hemiparesis upper limb/face > lower limb Contralateral hemisensory loss Apraxia Aphasia Quadrantopias ```
417
What is apraxia
Disorder of skilled movement
418
Where is stroke in pure motor loss
Internal capsule
419
Patient comes into A&E with suspected stroke what do
A-E make sure hydrated, saturated Send for CT scan non contrast Take bloods ECG is possible
420
What bloods are ordered in stroke
``` Glucose FBC- thrombophlia, polycythaemia U&Es- electrolyte imbalances could be cause of sx LFTs- clotting and INR Cardiac enzymes ```
421
Is aspirin given before or after alteplase
After
422
Management of stroke when on ward
A-E Swallow screen GCS monitoring DVT prophylaxis
423
Subsequent tests for stroke
Doppler Echo MR angiography
424
What does secondary prevention of stroke depends on
Whether stroke AF in origin or not If AF anticoagulate based on chadvasc and hasbled If not clopidogrel for life after 2 weeks
425
What is done to assess risk of stroke progression in TIA
ABCD2
426
What are criteria for carotid endarterectomy
Over 70% stenosed 50-69% stenosed and symptomatic Fully recovered from stroke
427
Complications of stroke
``` Aspiration pneumonia Cerebral oedema (↑ ICP) Immobility Depression DVT Seizures Death ```
428
Management of haemorrhagic stroke
ITU place and refer to neurosurgery | BP and ICP management
429
Causes of reflex syncope
Carotid sinus hypersensitivity Vasovagal Situational
430
Define epilepsy, seizure and convulsion
Seizure- abnormal paroxysmal discharge of cerebral neurones Convulsion- motor seizure Epilepsy- increased tendancy to have unprovoked seizures
431
What are triggers for epilepsy
``` Poor sleep Alcohol Increased flashing lights Stress Poor adherance to medications ```
432
Feelings of epilepsy before seizure
Deja vu Flashing lights Strange smells Feeling in the gut
433
What happens during epileptic seizure
Lasts for less than 3 mins Incontinence Tongue biting Convulsions
434
What happens after seizure
Slow time to recover Confused Weakness in arm
435
What happens in focal parietal seizure
Sensory loss or tingling in body
436
What happens in focal frontal seizure
Spasms Todds paresis after Involuntary actions Jacksonian march
437
What happens in jacksonian march
Spasms spread from distal to proximal muscles
438
Investigations for epilepsy
EEG Bloods CT
439
Bloods ordered after seizure
Glucose FBC to look if infection as cause U&Es as can cause seizure
440
Main problems of epilepsy drugs
Weight gain | Depression
441
Management of focal epilepsy
First line carbamezapine | Second line lmaotrigine
442
Management of generalised epilepsy
Sodium valproate is first line | Second line carbamezapine
443
Which antiepileptic should be strictly avoided in pregnancy
Sodium valproate
444
Complications of epilepsy
SUDEP (sudden death in epilepsy) Behavioural problems Fractures (from seizures) Complications from drugs
445
First line management of status elipticus
ABC- secure airway | THEN LORAZEPAM
446
What antibody can be found in GBS
Anti ganglioside
447
Investigations for GBS
Spirometry to check FVC LP- high protein, albumincytological dissociation Nerve conduction studies showing decreased velocity
448
What is pathophysiology of normal pressure hydrocephalus
Increase in size of ventricles without increase in CSF volume
449
What can cause non communicating/obstructive hydrocephalus
Stenosis of cerebral aqueduct | Lesions of posterior fossa
450
Wha causes white matter damage in hydrocephalus
Seapage out through ventricle walls
451
What are sunset eyes seen in
Hydrocephalus
452
What are sunset eyes
Eyes permenantly looking downwards
453
What are investigations for hydrocephalus
CT/MRI | Intraventricular drain
454
Where is lesion in radiculopathy, CES and spinal chord compression
CES- below L2 over cauda equina Spinal chord compression- above cauda euina in spinal chord Radiculopathy the spinal nerve root is affected
455
Causes of spinal chord compression
``` Pagets Osteoporosis Steroid use Cancer Osteoarthritis Intervertebral disease Trauma ```
456
What are signs below and at level of chord compression
LMN at site | UMN below
457
Investigations for chord compression
Bloods- FBC, U&Es, LFTs, calcium, ESR, immunoglobulins MRI Urinalysis for bence jones proteins
458
What causes dissociative seizures
Hx of abuse, psychological or emotional precipitants
459
What are features of dissociative seizures
NO biological correlate Prolonged duration Hx of abuse, psychological or emotional precipitants
460
How does a radiculopathy present
Sensory loss in a dermatome Pain and numbness in that area Weakness in those muscles supplied
461
Where is weakness in sciatica
The calfs
462
Where is pain in sciatica
Back of thigh and buttock
463
What is nerve affected in sciatica
Lumbosacral
464
Causes of radiculpathies
``` Degenerative disc disease Spondylolisthesis Osteoarthritis Cancer Abscess ```
465
What is spondylolisthesis
Forward protrusion of vertebral disc impinging on nerve
466
How is sciatica diagnosed
Clinically using straight leg test
467
What is done in straight leg test
Someone flexes the hip with straight leg and if pain of sciatica is replicated then is positive- lesagues sign
468
What is a positive lesagues sign
Pain replicated on passive flexion of straight hip
469
What is a positive lesague test indicative of
Sciatica
470
Investigations for sciatica
Straight leg test | MRI/CT to visualise the cause
471
What happens to liver in acute phase of drinking alcohol
Steatosis with no symptoms
472
What tends to cause alcoholic hepatitis
Not necessarily binge drinking but after drinking heavily for a substantial amount of time
473
How does mild alcoholic hepatitis present
N&V Anorexia Weight loss
474
Sign on examination of mild alcoholic hepatitis
Hepatomegaly
475
Presentation of severe alcoholic hepatitis
Jaundice Fever Ascites
476
Signs on examination of severe alcoholic hepatitis
Jaundice Bruising Ascites RUQ tenderness
477
Investigations for alcoholic hepatitis
Bloods - FBC macrocytic anaemia, WCC up - LFTs AST, ALT and GGT all up mainly AST and GGT - Clotting PT very high Liver USS rule out cancer, clots and see if cirrhosis Biopsy will show mallory denk bodies and ballooning
478
What are mallory denk bodies a sign of
Liver inflammation not specific to any condition
479
What is management in hospital of alcoholic hepatitis
``` Mainly supportive Fluids and hydration Feeding enterally with vitamins etc Alcohol abstinence Treat complications- ascites, SBP, alcohol withdrawal ```
480
Longer term management of alcoholic hepatitis
Lose weight Stop smoking and drinking Refer to therapy groups to help with this
481
Management of alcoholic hepatitis if severe in hospital
Can give steroids
482
What are 3 parts to progression of NAFLD
Steatosis NASH Cirrhosis
483
What are rfs for NAFLD
Hyperlipidaemia HTN Diabetes Obesity
484
Management of NAFLD
Exercise Improve diet RF management- statin for cholesterol, metformin for DM, HTN drugs
485
Investigations for NAFLSD
LFTs- high ALT and AST | Measure Hba1c and cholesterol
486
What can be sign on examination of insulin resistance
Acanthosis nigricans
487
Why cant metfromin be given in liver failure
Risk of metabolic acidosis
488
How do hep a and e present
Acutely with jaundice
489
What is presentation of Hep A
Prodrome of fever, malaise and vomiting | Then get jaundice, RUQ pain, dark urine and pale stools
490
What is only hepatic cause of jaundice that gives you pale stools
hep A
491
Transmission of Hep A
Faeco oral- Gay sex Contaminated water
492
Management of Hep A and E
Supportive | Avoid alcohol and
493
Management of acute Hep B
Supportive as 90% of people will self recover
494
Management of acute Hep C
Antiviral- sofosbuvir or ledipasvir | Same for chronic
495
Management of chronic Hep C
Antiviral- sofosbuvir or ledipasvir | Same for acute
496
What is role of anti virals in chronic Hep B
Suppress viral replication but isnt curative
497
Management of Hep B if compensated liver disease
If liver working well then give peg interferon
498
Management of Hep B if decompensated liver disease
Tenofovir or entecavir
499
Management of Hep D superimposed on Hep B
Tenofovir and peg interferon
500
How can Hep E affect pregnant women differently
Strong chance will progress to liver failure
501
How does Hep E affect immunocompromised individuals differently
More likely to become chronic
502
Difference on serology of Hep D chronic vs acute
``` Acute IgM HepD RNA Chronic IgG HepD RNA Will always be RNA no matter if acute or not ```
503
What is main difference between transmission of Hep B vs C
Hep B more likely to be form sex | Hep C more likely to be from poor medical products
504
What is Hep C serology findings infection vs cleared
Firstly do HCV IgG- present in all forms Then check for HCV RNA If cleared will be absent If acute or chronic will have
505
Serology findings of chronic Hep C
HCV IgG | HCV RNA positive for over 6 months
506
Serology findings of cleared Hep C infection
HCV IgG | RNA negative
507
Serology findings of acute Hep C infection
HCV IgG | RNA positive for less than 6 months
508
Secondary causes of haemochromatosis
Iron overload from transfusions
509
Causes of haemochromatosis
Hereditary haemochromatosis | Iron overload
510
What can haemochromatosis progress to
CIrrhosis | Cancer
511
What is differnce between macronodular and micronodular cirrhosis
Size of nodules <3cm is micro >3cm is macro
512
What tends to be difference in cause of micro and macro nodular cirrhosis
Macro is viral | Micro alcohol
513
Common causes of liver cirrhosis
``` Alcohol Hep B/C NASH Haemochromatosis Autoimmune hepatitis PSC and PBC ```
514
Definition of NAFLD
Fatty damage to liver having not drank the alcohol to cause damage such damage
515
Define liver cirrhosis
Replacement of healthy liver tissue with fibrosis and nodules of regenerating hepatocytes
516
Long term management of liver cirrhosis
Avoid hepatotoxic drugs Work out MELD score 6 monthly USS Endoscopy on diagnosis and 3 yearly one to look for varcies
517
What is MELD score
Model for end stage liver disease
518
4 main complications of liver cirrhosis
Ascites SBP Encephalopathy Varices
519
Management of ascites
``` Ascitic tap and sample Sodium and fluid restrict Spironolactone and or furosemide Therapeutic paracentesis Albumin supplementation ```
520
Management of SBP
Broad spectrum Abx- cefuroxamine and metronidazole
521
Most common cause of SBP
E coli
522
Management of encephalopathy (4 points)
``` Lactulose and phosphate enemas Protein restrict short term Treat cause (infection, GI bleed) Avoid sedation ```
523
What are common tirggers for encephalopathy
Infection GI bleed High protein diet
524
Primary prevention of oesophageal varices if small if picked up on endoscopy
Non selective beta blocker- pindolol or propanolol
525
Acute management of oesophageal varices
ABCDE IV access- fluids or blood if Hb beloe 70 Terlipressin and abx If this doesnt work sengstaken blakemore tube After resus and haemoodynamically stable do endoscopic band ligation
526
Primary prevention of oesophageal varices if large if picked up on endoscopy
Endoscopic band ligation
527
Secondary prevention of oesophageal varices
Pindolol or propanolol started after 2-5 days | If propanolol or endoscopic band ligation fails do TIPS
528
Definition of liver failure
Dysfunction of liver leading to jaundice, encephalopathy and coagulopathy
529
How is liver failure classified
Based on onset of encephalopathy following jaundice Hyperacute- within 7 days Acute- 1-4 weeks Subacute- 4-12 weeks
530
What is most common cause of acute liver failure
Paracetamol
531
Investigations for liver failure acute
Viral serology | Paracetamol mesurements
532
Management of liver failure
Treat cause ie paracetamol OD Suportive Treat complications Transplant ideally
533
RUQ pain that radiates to shoulder with jaundice
Liver abscess
534
RUQ pain with jaundice, travel history and diarrorhoea
Entamoeba histolytica abscess
535
Most common cause of liver abscess in child
S.aureus
536
Most common cause of liver abscess in adults
E coli
537
What is major risk factor for hydatid cyst
Contact with sheep
538
What organism causes hydatid cyst
Tapework echinoccus granulosis
539
4 causes of liver cyst/abscess according to amir sam
Pyogenic Amoebic abscess Hydatid cyst TB
540
What is blood finding for hydatid cyst
Eosinophilia | Serology positive
541
Aspiration finding for amoebic abscess in liver
Anchovy sauce with necrotic hepatocytes and trophozoites
542
What is a trophozoite
Early stage of life parasite
543
How is amoebic abscess best diagnosed
Stool sample
544
How is hydatid cyst best diagnosed
Stool sample
545
What is cholelithisasis vs biliary colic
Cholelithiasis is gallstones in the gall bladder whereas biliary colic is with this with pain
546
Management of biliary colic vs cholelithiasis vs cholecystitis
Bilairy colic- analgesia and elective cholecystectomy Cholelithiasis- no management Cholecystitis- clear fluids, fluid resus, analgesia, IV abx, lap chole within a week
547
What is difference between asymptomatic stone in CBD, stone in CBD with pain and cholangitis
Asymptomatic stone in CBD- choledocholithiasis Painful stone in CBD- biliary colic Painful stone in CBD with infection- cholangitis
548
Management of choledocholitiasis
ERCP and lap chole
549
Management of biliary colic in CBD
Analgesia ERCP Lap chole
550
Managemnet of biliary colic in CBD vs cystic duct
Have to do ERCP if in common bilde duct
551
When is percutaneous cholecystostomy only indicated in acute cholecystitis
If complicated ie empyema
552
Complications of choledocholithiasis
Pancreatitis Asceding cholangitis Obstructive jaundice
553
Complications of cholecystitis long term
Porcelain gall bladder | Increased GB cancer risk
554
What is florid duct lesion on histology seen in
PBC
555
What is concentric onion skin fibrosis seen in
PSC
556
Risk factors for pancreatic cancer
``` Obesity T2DM Chronic pancreatitis Smoking MEN ```
557
Signs on examination of pancreatic cancer
``` Corvoursiers law Trousseas sign Hepatomegaly if met Scleral icterus Cachexia ```
558
Gold standard for diagnosing pancreatic cancer
ERCP with biopsy
559
Most common source of mets to liver
``` Oesophagus Bowel Breast Pancreas Stomach ```
560
Risk factors for primary liver cancer
``` Viral hepatitis, Hep C and B most common Alcoholic cirrhosis PSC and PBC Haemochromatosis AIH NAFLD ```
561
Symptoms of liver cancer
``` Anorexia RUQ pain Weight loss Malaise Jaundice ```
562
Investigations for liver cancer
Bloods- LFTS, AFP CT Biopsy
563
Gold standard for liver cancer
Biopsy
564
Risk factors for cholangiocarcinoma
PSC Cirrhosis Worms
565
Stroke territory if cant name an item they can see in front of them
Posterior- visual agnosia
566
What is abx given in variceal bleed management
Tazocin
567
Why is tazocin given in variceal bleed
Portal HTN increases risk of SBP
568
What causes palpable kidneys
PCKD Cancer Hydronephrosis
569
Causes of suprapubic mass
Bladder cancer | Bladder retention
570
Causes of pain in suprapubic
Bladder cancer Urinary retention Torsion
571
RIF in elderly
Caecal- volvulus, cancer | Aorta
572
Diarrhoea in young person
``` IBD Gastroenteritis Coeliac Hyperthyroid IBS ```
573
What causes pain on eating 4 things
Chronic mesenteric ischaemia GORD Peptic ulcers Gallstones
574
What endocarditis causing organism is associated with colorectal cancer
Strep bovis
575
First sign of hyperkalaemia on ECG
Tented T waves
576
Blood abnormalities in hypothyroidism
Macrocytic non megaloblastic anaemia
577
Risk factors for endocarditis
``` Damaged valves Artifical valves IVDU Dental stuff Immunocompromised ```
578
Difference between pulmonary HTN and Cor pulmonale
Pulmonary HTN- heart hypertrophies due to having to work harder In cor pulmonale there is failure of RH and so dilates
579
How much post bronchodilator change must there be in asthma
Over 12 %
580
Mouth ulcers differentials
``` SLE Behcets Crohns Coeliac Anaemia ```
581
Pathophysiological causes of anal fissure
Hard stools tearing mucosal lining of distal anal canal | Poor blood supply
582
Risk factors for anal fissure
Constipation (anything that causes constipation like opiates) Pregnancy
583
How do you examine an anal fissure
You cant do DRE- mainly clinical diagnosis | Must be under anaesthetic
584
First line management of anal fissure
Manage constipation- more fibre and water Sitz baths Topical GTN or diltiazem
585
How long do anal fissure normally take to heal
6-8 weeks
586
Management of anal fissures if persist
Botulinim injection | Surgical sphincterectomy
587
What is a sitz bath
Use warm water on buttocks
588
What causes frequent abscesses around the anus
Anal fistula
589
What are rfx for anal fistula
Crohns Trauma Radiation Clogged anal glands
590
How do anal fistulas present
Frequent anal abscesses Pain and abscesses around the anus Bloody foul smelling drainage inuinderwear
591
What presents with pus in underwear thats foul smelling
Anal fistula
592
How does an anal fistula appear on examination
Opening of skin around the anus | Swelling
593
What is an anal fistula
Connection between anal canal and skin surrounding the anus
594
How do you examine an anal fistula
Rectoscope | If doesnt work consider MRI or examination under anaesthetic
595
How to manage anal fistulas
Fistulotomy | Seton
596
Risk factors for anal abscesses
Crohns Anal fistulas Constipation
597
How do anal abscesses present
Perianal pain not related to defaecation Perianal swelling and tenderness LOOK OUT for fever and tachycardia if shock
598
Diagnosis for anal abscess
Visualise abscess or EUA then MRI if internal pelvic abscess
599
Management of anal abscess
Surgical drainage of abscess Fistulotomy IF SYSTEMIC give ABX
600
What are 2 types of anal haemorrhoid
Internal or external | Depends if above or below the dentate line
601
What is boundary between internal and external haemorrhoids
Dentate line
602
What are rfx for haemorrhoids
Constipation Pregnancy SOL in pelvis
603
Presentation of haemorrhoids
Painlesss bleeding with defacation Can be painful and cause discomfort Anal pruritus Palpable mass
604
How to diagnose a haemorrhoid
Anoscope | Can consider colonoscopy to rule out other diagnoses and FBC
605
Conservative management of haemorrhoids
Lifestyle- fibre and water | Discourage straining
606
What is management of grade 1 haemorrhoids
Topical corticosteroids to alleviate itching
607
What is management of grade 2 haemorrhoids
Rubber band ligation
608
What is management of grade 3 haemorrhoids
Rubber band ligation
609
What is management of grade 4 haemorrhoids
Surgical haemorrhoidectomy
610
Complication of haemorrhoids
Thrombosed haemorrhoid
611
How to manage thrombosed haemorrhoid
Conservative - stool softeners, ice packs, warm baths, analgesia If very severe or early on in presentation can consider excision
612
How does a thrombosed haemorrhoid present
Significant pain and tender lump
613
How does a thrombosed haemorrhoid appear on examination
Purple Oedematous Sub cut mass
614
What causes pilonidal sinus
Caused by forceful insertion of hairs into skin of natal cleft
615
Rfx for pilonidal sinus
Young males Stiff hair Hirsutism
616
Presentaion of pilonidal sinus
Pain when sitting down Swelling Discharge that can be offensive and stains underwear
617
Investigation for pilonidal sinus
Clinincal diagnosis
618
How to manage pilonidal sinus if symptomatic
Surgical management to excise it Antibiotics Laser hair removal Local hygiene advice
619
Management of asymptomatic pilonidal sinus
Laser hair removal and local hygiene advice
620
What is lynch syndrome
HNPCC
621
Rfx for colonic cancer
``` Age Obesity UC Acromegaly Poor fibre intake HNPCC FAP ```
622
Signs on examinatin of colon cancer
``` Koilonychia Cachexia Lymphadenopathy Mass Ascites ```
623
How old do you have to be to be investigated urgently for IDA
60
624
What imaging is used for colon cancer
Colonoscopy with biopsy Double contrast barium enema CTAP for staging
625
What imaging is apple core sign seen on
Double contrast barium swallow
626
Risk factors for crohns
FHx Smoking OCP High sugar diet
627
What condition is seen frequnetly in the ashkenazi jews
Crohns
628
Where can pain be in crohns
RIF and periumbilical
629
Signs on examination of crohns
``` Oral ulcers RIF tenderness Fistulae Abscesses Erythema nodosum, pyoderma gangrenosum Episcleritis ```
630
CT findings of crohns
Bowel wall thickening | Skip lesions
631
Barium findings of crohns
Rose thorn ulcers | String sign of kantor
632
What do rose thorn ulcers refer to
Deep ulcerations
633
What does string sign of kantor suggest
Fibrosis and strictures
634
What is seen on colonoscopy of crohns
Ulcers | Cobblestoning
635
How is crohns confirmed
Histology
636
How is crohns treated in relapse
IV steroids and azathioprine/mercatopurine/methotrexate
637
What further therapy can be given to crohns patients to induce remission
Biologics- adalimumab or infliximab
638
What is severe management stricture in crohns management
Surgery
639
What is further adjunct management of crohns
Nutritional management Perianal disease mx Smoking cessation
640
How are extra intestinal manifestatoins of crohns and UC managed
MDT
641
Maintaining remission in crohns
Infliximab | Azathioprine or any other immunomodulator
642
What immunomodulators are given in crohns
Azathioprine Mercatopurine Methotrexate
643
Risk factors for UC
FHx HLAB27 Not smoking
644
Examination finding of UC
Skin Episcleritis Anaemia DRE see blood
645
Investigations for UC bloods
FBC -anaemia LFTs- PSC and albumin CRP and ESR pANCA
646
Histology signs of UC
Crypt abscesses Goblet cell depletion Mucosal ulceration
647
What is seen on UC plain AXR
Severe dilation of large bowel Leadpipe Thumbprinting Ank Spond
648
What is a double contrast barium swallow
Use negative and psoitive contrasts to increase sensitivity
649
Double contrast barium swallow findings UC
Thickened haustra | Leadpiping
650
Treatment of aute UC
Oral betclamethasone | Mesalazine
651
Maintaining remission UC
Azathioprine Infliximab Niche ciclosporin and vedolizumab
652
How to cure UC
Total colectomy
653
4 comlications of UC
``` Toxic megacolon PSC Adenocarcinoma Strictures Obstruction and perforation ```
654
Histology finding of coeliac
Subvillous atropy Crypt hyperplasia Lymphocyte infiltrates
655
RFs coeliac
T1DM Autoimmune thyroid FHx IgA deficiency
656
Management of coeliac
Gluten free diet | Vitamin supplements
657
Investigations for IBS
Exclude coeliac, IBD Bloods- anaemia, CRP TTG, IgA FIT and calprotectin
658
Main difference between IBS and coeliac
Pain relieved by defacation in IBS
659
What is R in CURB 65
30
660
What are absent a waves seen in
A fib
661
What is preferred as method of cardioversion in early AF treatment
Electrical
662
What can PSM heard best at left sternal edge be
VSD | Tricuspid regurg
663
In acute COPD what comes first ABG or peak flow
ABG
664
When is only time permitted to DC cardiovert earlier than 3 weeks AF
TTE
665
What is fleischner sign seen in
PE on CXR | Will show enlarged pulmonary arteries
666
What is atelectasis to percussion
Dull
667
In DVT what is normally the most major risk factor
Smoking
668
If a young person is in dilated cardiomyopathy HF what think of as cause
Myocarditis
669
What type of heparin is given in acute limb ischaemia
UFH
670
What is most common site for ablation in atrial flutter
Tricuspid valve isthmus
671
What is main difference in treatment of atrial flutter vs AF
Atrial flutter responds much better to DC cardioversion, is quite poor to chemical
672
What are 2 types of V tach
Monomorphic | Polymorphic
673
What is only type of polymorphic v tach need to know
Torsades des pointes
674
What ACS gives you permenant ST elevation that isnt STEMI
Prinzmetal angina
675
What is screening method for abdominal aorta
One off surveillance for all men over 65 | Then depending on size plan from there is determined
676
What does susceptible mean with regards to serology
Never any exposure
677
What gives granulocytes with absent granulation and hyposegmented nuclei
Myelodysplasia
678
What are 2 tpyes of bladder cancer
Transitional | Squamous
679
What to think of as differentials for lower abdo pain
``` Diverticular pain Cancer Constipation UC Pseudomembranous ```
680
What are causes of viral meningitis
HSV Polio Cocksackie
681
What type of pericarditis are steroids containdicated in
Viral
682
What does rheumatic fever cause in heart
Endocarditis
683
Which drugs shouldnt be given in HF with reduced EF
CCBs
684
Common arrythmia causing acute HF
Palpitations
685
Acute HF causes
MI | Atrial flutter or any arrythmia
686
What typically is type of gangrene in gut
Wet
687
What causes dry vs wet gangrene
Dry typically arterial | Wet typically venous insufficiency
688
If cardiac arrest is witnessed by someone how many shocks are given
3
689
Causes of dilated cardiomyopathy
Myocarditis Alcohol Haemochromatosis Sarcoid
690
Why would sarcoid cause chest pain
Dilated cardiomyopathy
691
What WELLS score suggests DVT likely or not
2 or more
692
What do if WELLS score 2 or more
US of leg within 4 hours | If not available do D-dimer and anticoagulate with US within 24 hours
693
What do if WELLS score 1
Do dimer with result in 1 hour
694
If WELLS score 1 and d dimer positive what do
Same as if WELLS was 2
695
What counts as high grace score risk
3% or above
696
What does GRACE score do
Work out 6 month mortality
697
What is difference between primary and secondary dose statin
Primary is 20mg | Secondary is 80mg
698
What is done if 80mg statin not tolerated
Lower dose or switch to different drug
699
Before doing CTPA what is one investigation must do
CXR
700
What is difference in kussmals sign between cardiac tamponade and constrictive pericarditis
Kussmals positive in constrictive pericarditis | Negative in tamponade
701
Which lung cancer is assocaited with gynaecomastia
Adenocarcinoma
702
Leg pain on walking differentials
Ischaemia Buergers disease Spinal canal stenosis
703
Vertigo lasting around an hour
Vestibular migraine TIA MS Vestibular neuronitis
704
Vertigo lasting a few seconds
Menieres BPPV Vestibular neuronitis

Year 3 Conditions (33 decks)

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