What is Subclavian Steal syndrome?
Stenosis of subclavian artery proximal to origin of vertebral artery results in blood being “stolen” from the brain by retrograde flow down the vertebral artery + into the arm (usually when increased demand in arm)
List 3 causes of Subclavian steal syndrome
Cervical rib (compresses subclavian artery, less blood flows to brain)
Atherosclerosis
Takayasus arteritis
List 3 symptoms of subclavian steal syndrome
Syncope
Arm claudication
Vertigo
List 5 side effects of opioids
Constipation (can lead to confusion) Respiratory depression Nausea Drowsiness Pupillary constriction (MIOSIS)
What are the side effects of anti-muscarinic agents e.g. atropine?
Hot as a hare (Hyperthermia) Dry as a bone (Dry Skin) Red as a beet (Flushed) Blind as bat (Mydriasis) Mad as a hatter (Delirium)
What class of drugs may cause a dry cough?
ACEi
What side effect may result from use of B2 adrenergic receptor agonists?
Tremor
What drugs may cause a rash in glandular fever?
Amoxicillin Ampicillin Cephalosporins Macrolides Tetracyclines
What parameter defines severe hyponatraemia? What would this result in?
<120
Neuro symptoms: Seizures, Hallucinations, Confusion
What pathology produces the “sail sign” on CXR?
Left lower lobe collapse
What pathology produces the “golden S sign” on CXR?
Right upper lobe collapse
What is the immediate management approach for those with bowel obstruction?
Drip + suck
Where is the pathology in PBC? What antibody is associated with this?
Intrahepatic biliary ducts
Anti MITOCHONDRIAL antibody
Where is the pathology in PSC? What antibody is associated with this?
Intrahepatic + extrahepatic biliary ducts
pANCA
What skin manifestation arises in coeliac disease?
Dermatitis Herpetiformis
Symmetrical blistering, papulovesicular rash
What 3 antibodies may be present in coeliac disease?
Anti-TTG
Anti-endomysial
Anti-gliadin
What is the classic histological description of bowel affected by coeliac disease?
Subtotal villous atrophy with crypt hyperplasia
What is found on CXR in heart failure?
Alveolar oedema kerley B lines Cardiomegaly upper lobe Diversion pleural Effusion
List 3 causes of air bronchograms
Pus in pneumonia
Fluid in pulmonary oedema
Fibrosed tissue in interstitial lung disease
What may be seen on blood film in multiple myeloma?
Rouleaux
Form due to high conc. plasma proteins (immunoglobulins) + lead to high ESR
In which disease would you find Granulocytes with absent granulation and hyposegmented nuclei?
Myelodysplastic syndrome
What would you find on a blood film in myelofibrosis?
Dacrocytes are teardrop-shaped cells
What is the best test to establish a diagnosis of TB?
Sputum sample for acid fast bacilli with Ziehl-Neelsen stain
What test determines exposure to TB?
Mantoux test (does not distinguish active + latent)
What is the most common type of urinary tract stone?
Calcium oxalate
What is the most appropriate
investigation to order when suspecting pancreatitis due to raised amylase?
Transabdominal ultrasound
What causes the Cushings reflex?
Raised ICP
What is the Cushings reflex?
High BP
Bradycardia
Irregular breathing
What is Beck’s triad seen in?
Cardiac tamponade
What is Beck’s triad?
Raised JVP
Muffled heart sounds
Low BP
What investigation is diagnostic of malaria?
Thick + thin blood smear
What would you give to a haemodynamically stable patient in VT?
IV Amiodarone
What cardiovascular pathology is treated with Adenosine?
Supraventricular tachycardia
What scrotal mass feels like “a bag of worms”?
Varicocele
List the most common causes of onycholysis
DR PITHS Drugs: Tetracyclines, OCP, diabetes drugs Reactive arthritis Psoriasis Infection esp. fungal Trauma Hyper + Hypothyroidism Sarcoidosis, Scleroderma
What is Wernicke’s dysphasia?
Inability to understand language
Speak fluent nonsensical speech
What is Broca’s dysphasia?
Inability to produce fluent speech
Intact understanding of language
What must you remember about an extreme hyperkalaemia with a normal ECG?
Poor blood taking technique leads to red cell lysis, releasing intracellular K+
What are the B symptoms of lymphoma ?
Fever
Night sweats
Weight loss
What are the different results on thyroid uptake scan caused by?
Diffuse uptake= Graves
Multinodular gland + single hot nodule= Toxic multi nodular goitre
Diffuse uptake + single cold nodule = Thyroid cancer
No uptake = Viral thyroiditis (de Quervains)
LIst 3 causes of pulmonary fibrosis
Exposure to toxins e.g. Asbestos
Systemic inflammatory conditions e.g. RA
Drugs e.g. Methotrexate
What should a patient presenting with acute neurological symptoms that resolve completely within 24 hours be given?
300mg Aspirin
What is the triad of symptoms seen in Henoch-Schonlein purpura?
Arthritis Abdominal pain Purpurin rash (usually Buttocks + lower legs)
What other organ is often involved in HSP, and what symptoms does this cause?
Kidney Haematuria Proteinuria HTN Oedema
What causes a raised JVP with absent pulsation?
Superoir vena cava obstruction
What is and what causes Kussmaul sign?
Paradoxical rise in JVP on inspiration
Conditions that impair ventricular filling e.g. constrictive pericarditis
What causes a slow Y descent in JVP?
Tricuspid stenosis
What causes large V waves in the JVP?
Tricuspid regurgitation
Ventricular contraction causes blood to surge through incompetent valve through RA to JV
