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Finals Revision Lectures > Prof Meerans Lectures > Flashcards

Prof Meerans Lectures Flashcards

1
Q

Infective Endocarditis causative organism?

A

Strep Viridians

S. Aureus after IVDU

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2
Q

Infective Endocarditis signs?

Hand, eyes, chest, abdomen

A

Hand = Clubbing, petichiae, splinter haemorrhages, Jane ways lesions and Olsen nodes

Eyes = Roth spots

Chest = changing murmur

Abdomen = microscopic haematuria and splenomegaly.

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3
Q

What is acute rheumatic fever?

A

An immunological response to to strep pyogenes.

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4
Q

Major criteria for acute rheumatic fever?

A 
Carditis
Arthritis
Sydenham chorea 
Erythema marginatum 
Subcutaneous nodules
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5
Q

Minor criteria for acute rheumatic fever?

A 
Fever
Arthralgia
Raised ESR
Leuocytosis
Prolonged PR on ECG
Hx of rheumatic fever
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6
Q

Mitral stenosis murmur?

A

Blowing mid diastolic murmur with presystolic accentuation

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7
Q

Clinical features of mitral stenosis?

A 
Middle aged female
Malar flush 
AF
Tapping, non-displaced apex
Right ventricular heave
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8
Q

What murmur is mitral regurgitation?

A

Pansystolic murmur, radiating to the axilla

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9
Q

Examination findings of mitral regurgitation?

A

Displaced apex
Apical thrill
Quiet S1, but S3 present

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10
Q

Why is S1 loud in mitral stenosis?

A

Mitral valve can’t close properly, so force of the ventricles closes it loudly.

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11
Q

What murmur is aortic regurgitation?

A

Early diastolic murmur at left sternal edge

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12
Q

What are the clinical features of aortic regurgitation?

A 
Collapsing pulse
Corrigans sign = visible neck pulses
De Mussets = head bobbing 
Dynamic apex
Quinckes = capillary pulsation in the nail bed
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13
Q

Causes of AF?

A

IHD
Thyrotoxicosis
Rheumatic Heart Disease

Also alcohol, PE, cardiomyopathy or lone AF.

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14
Q

What are the different MI leads, and the artery supplying them?

A

II, III, aVF - inferior MI = right coronary

V1-V4 - anterior MI = LAD

I, V5 and V6 - lateral = circumflex artery

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15
Q

Management of an acute MI?

A 
Sit up and give oxygen if <94%
GTN
Aspirin 300mg and Clopidogrel 
Diamorphine IV 2.5-5mg
If no PCI = Streptokinase 1.5MU over 1 hour (tPA has clear mortality benefits)
If PCI = LMWH
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16
Q

Complications if MI?

A

Arrhythmia
Cardiac failure
Embolism
Rupture / aneurysmal dilation
Pericarditis: early = full thickness anterior MI
Late = Dressler’s at 6 weeks

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17
Q

What would left ventricular aneurysm look like on CXR and ECG?

A

Like a bubble, vs the uniform enlargement of cardiomegaly

ST elevation

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18
Q

Pulmonary embolism ECG?

A

Most common is normal or sinus tachycardia

S1Q3T3 = deep S and Q, with t wave inversion (in V1-V4).

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19
Q

Signs of heart failure?

A

Tachycardia and tachypnoea
Wheeze and bilateral crepitations
3rd heart sound
Raised JVP and peripheral oedema

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20
Q

Causes of S3?

A

Rapid ventricular filling
Can be normal in <35
Heart failure, MR and constrictive pericarditis

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21
Q

Causes of S4?

A

Atrial contraction against a stiff ventricle

Hypertension and aortic stenosis

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22
Q

Heart failure vs cardiogenic shock ?

A

Heart failure is where CO is insufficient to meet tissue demands.

Cardiogenic shock is where heart failure is so severe that there is not enough pressure to perfume even the heart/brain

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23
Q

Management of cardiogenic shock?

A

Dobutamine or dopamine

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24
Q

Is apex beat displaced by dilatation or hypertrophy?

A

Dilatation

Caused by volume overload;

Aortic regurgitation
Mitral regurgitation
ASD/VSD

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25
Q

What causes hypertrophy?

A

Pressure overload:

Aortic stenosis
HTN
Coarctation of the aorta.

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26
Q

What to look for an an exercise ECG?

A

Enlarged V4/V5 = angina

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27
Q

Management of SVT?

A

Vasovagal manoeuvres

Then IV adenosine 6mg then 12 then 12.

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28
Q

What are the clinical examination findings in consolidation?

A

Decreased expansion ipsilaterally
Dull to percuss
Increased tactile vocal fremitus
Bronchial breathing

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29
Q

Management of pneumonia?

A

Amoxicillin and clarithromycin

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30
Q

Are hand warm or cold in septic shock?

A

Warm

Due to severe endotoxins release = vasodilation

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31
Q

Treatment of septic shock?

A

Fluids

Noradrenaline to cause vasoconstriction.

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32
Q

Causes of respiratory clubbing?

A 
Bronchogenic carcinoma
Cystic fibrosis
Bronchiectasis 
Empyema 
Fibrosis alveolitis
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33
Q

Signs of hypercapnoea?

A 
Retention flap
Bounding pulse
Vasodilation = warm hands 
Papilloedema 
Mental changes 
Drowsiness
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34
Q

Types of obstructive airway disease?

A

Asthma = reversible

Emphysema = irreversible, destruction of lung distal to terminal bronchiole

Chronic bronchitis

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35
Q

Signs of acute severe asthma?

A 
Not talking
Peak flow <150
Cyanosis
Tachycardia
Silent chest
Normal carbon dioxide 
Pulsus paradoxus = inspiratory systolic pressure fall >20mmHg.
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36
Q

Management of acute severe asthma?

A

High flow oxygen
Nebulised salbutamol 5mg driven by oxygen
Ipratropium bromide 0.5mg
Steroids 100mg IV hydrocortisone and 40mg prednisolone

If bad ITU and aminophylline 100-200mg IV bolus

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37
Q

Blood gases in asthma?

A

Oxygen and carbon stay normal until it hits severe

Severe = low Oxygen and high carbon

38
Q

Features of pancoasts tumour?

A

Horners syndrome = ptosis, mitosis and anhydrosis

Thenar wasting

39
Q

Endocrine manifestations of lung cancer?

A

Cushings = cortisol from oat cell carcinoma

SIADH = ADH from oat cell carcinoma

         - high urine osmolality, low serum osmolality 
         - low sodium

PTH from squamous cell carcinoma = hypercalcaemic

40
Q

Signs of obstructive airway disease?

A 
Hyperexpansion 
Barrel chest = reduced cricosternal distance 
Tracheal tug 
Decreased expansion 
Resonant 
Expiration you wheeze
41
Q

Signs of pleural effusion?

A

Decreases expansion
Normal trachea
Reduced air entry and vocal fremitus
Stony dull to percuss

42
Q

Signs of stable chronic liver disease?

A

Spider naevi >5, in distribution of SVC
Palmar erythema
Gyanecomastia
Dupuytren’s

43
Q

Signs of liver cell failure?

A 
Jaundice 
Leuconychia = low protein 
Brushing = clotting deranged 
Ascites and oedema = hypoalbuminaemia 
Encephalopathy
44
Q

Signs of portal HTN?

A 
SAVE
Splenomegaly
Ascites
Varices- oesophageal or caput medusa 
               - blood goes away from the umbillicus 
Encephalopathy
45
Q

Causes of ascites?

A 
Portal HTN
IVC / hepatic vein obstruction 
Constrictive pericarditis 
Malignancy / TB
Meigs syndrome = ascites, pleural effusion and benign ovarian tumour
46
Q

How do you clinically distinguish obstructive jaundice from hepatic?

A 
Pale stool, dark urine and pruritic 
Urine negative for urobilinogen 
LFT’s cholestatic = ALP very high 
PBC = AMA+ve, with high IgM
CAH = ANF+ve, high IgG
47
Q

Distinguishing kidney mass vs spleen in LUQ?

A

Spleen:

  • moves across not just down like kidney
  • find a notch
  • dull to percuss
  • can’t get above the spleen
  • not ballotable
48
Q

Cardiogenic vs Septic vs Hypovolaemic shock?

A

Blood pressure low in all of them
JVP will be raised in cardiogenic, low in other two.
Peripheries warm in septic shock, cold in other two

Management:
Cardiogenic = dobutamine
Septic = noradrenaline
Hypovolaemic = Blood

49
Q

Erythema nodusum - what is it and causes?

A

Painful red lesions on shins

Sarcoid
Sulphonamides 
Salicylates
Streptococcal infection 
IBD
50
Q

Erythema multiforme - what is it and what causes it?

A

Typical target lesion

Usually in children or young adults, 7-14 days after herpes simplex virus
Mycoplasma
Drugs e.g. sulphonamides and sulphonylureas

If severe = Stevens Johnson’s syndrome

      - associated mucosal ulceration 
      - liver failure
51
Q

Erythema ab igne - what is it and causes?

A

Brown pigment art discolouration caused by chronic heat over skin

Often seen in cases with chronic pain.

52
Q

Erythema marginatum - what is it and causes?

A

Annular eruption with well defined erythematous borders and central clearing

Rheumatic fever

53
Q

Diabetic ketoacidosis features?

A

No insulin = glucose cannot enter cells
Blood glucose high as cannot enter cells

Body makes ketones to fuel brain = high blood ketones

Severe dehydration and air hunger

54
Q

Diabetes glucose definitions?

A

Fasting > 7.0
- impaired 6.0 - 7.0

OGTT > 11.1

55
Q

Is HONKC more likely to occur in type 1 or type 2?

A

Type 2

Significant hyperglycaemia in the absence of ketosis, as insulin is sufficient to suppress ketogenesis but not hyperglycaemia.

Management: rehydrate slowly with normal saline

56
Q

DKA management?

A

Rehydrate with normal saline and IV insulin infusion
Replace total body potassium

If pH falls below 7.0 May try small amount of bicarbonate 1.26%

57
Q

Stages of diabetic retinopathy?

What you see in each stage….

A

Background = venodilation, microaneurysms and hard exudates

Pre-proliferative = soft exudates (cotton wool spots)

Proliferative = new vessels

58
Q

Hypertensive retinopathy stages ?

A

Grade 1 = arteriolar narrowing and silver wiring

Grade 2 = AV nipping

Grade 3 = Flame shaped haemorrhages and cotton wool spots

Grade 4 = papilloedema

59
Q

What is Graves ?

A

Systemic autoimmune disease involving several autoantibodies:

  • TSH
  • growth factor receptors in extra ocular muscles
  • one that stimulates growth in the pretibial region
60
Q

Features of Graves?

A

Hyperthyroidism
Exophthalmos
Pretibial myxoedema
Smooth goitre

61
Q

Features of thyrotoxicosis

A 
Weight loss with increased appetite 
SOB, palpitations 
Sweating
Heat intolerance 
Diarrhoea 
Lid lag
62
Q

Why does lid lag occur?

A

Sympathetic innervation to the eyelid is over activated by thyroxine = open eye lid

63
Q

Management of hyperthyroidism?

A

Medical = beta blockers, carbimazole and propyluracil

Radioiodine

Surgical

64
Q

Acromegaly instant things on walking in?

Good acromegaly question for growth?

A

Shake hand = sweaty and doughy, large person

Any change in hat size, ring size , shoe size.

65
Q

Complications of acromegaly?

A

Bitemporal hemianopia

Pituitary macroadenoma secreting GH
- perform OGTT and measure GH, it should be suppressed.

66
Q

Acromegaly management?

A

Transphenoidal hypophysectomy

Pituitary irradiation

Medical = octreotide 100-200mcg every 8 Hours, cabergoline

67
Q

Cushing’s syndrome causes?

A

Pituitary dependant Disease = 85%

Ectopic ACTH = 5%

Adrenal adenoma secreting cortisol = 10%

68
Q

Complications of cushings?

A

Proximal myopathy and centripetal obesity
HTN
Diabetes
Osteoporosis

69
Q

What is pagets?

A

Overactive osteoclasts.

70
Q

Pagets clinical features?

A

Warmth and tenderness over bones
Hearing loss
- pagets of ossicles = conductive deafness
- pagets of 8th nerve canal = neurosensory deafness
Bowed legs
Frontal bossing

71
Q

Management of pagets?

A

None may be needed

Simple analgesia
Calcitonin injections can suppress osteoclasts
IV pamindronate every 3 months
Regular bisphosphonates .

72
Q

Meningitis causative organisms?

A

Neonate = e.coli, GBS

Adults = streptococcal

Old = pneumococcal

73
Q

What does blood in the CSF indicate?

A

Subarachnoid

Can manage with nimodipine to maintain brain perfusion.

74
Q

Someone hit on the head by cricket ball?

A

Extradural
Has to have a skull fracture, which will tear middle meningeal vessels
Clinically = lucid interval for an hour, then deteriorates.

Lens shape on CT

75
Q

Features of Parkinson’s disease?

A

Bradykinesia
Cogwheel rigidity
Pill rolling tremor

76
Q

What is synkinesis?

A

In parkinsons, tone will increase on distraction

77
Q

Features of carpal tunnel syndrome?

A

Thenar wasting
Sensory loss over median distribution
Pain at night, relieve by hanging hand out of bed
Tinels tap test

78
Q

Clinical signs of a cerebellar lesion?

A 
Dysdiadokinesia
Ataxia
Nystagmus 
Intention tremor 
Staccato speech 
Hypotonia
79
Q

Neurofibromatosis 1 features?

A

Autosomal dominant inheritance

Axillary and inguinal freckling
Optic glioma and brain tumours
Iris hamartoma
Small risk of phaeochromocytoma

80
Q

INO: where is the pathology?

A

Lesion to the medial longitudinal fasiculus, a collection of neuronal fibres which co-ordinates occulomotor, trochlear and abducens.

81
Q

INO: what are the clinical features?

A

Dissociated eye movements
Impaired adduction ipsilaterally
And nystagmus in the contralateral eye on abduction.

I ADore NYC DUCks

82
Q

INO: causes ?

A

MS
Vascular brainstem lesions
Encephalitis

83
Q

Argyll Robertson clinical features?

A

Like a prostitute = accommodates but doesn’t react.

So small irregular pupils that do not constrict to bright light

84
Q

Where’s the lesion of Argyll Robertson pupil.

A

Lesion in the pretectal region

85
Q

What is Argyll Robertson a classic sign of?

A

Neurosyphilis

Also diabetes and MS.

86
Q

What are the clinical features of Holmes Adie pupil?

A

Sudden onset blurred vision in a female.

Pupils are large
React very slowly to light and accommodation
Dilation also slow

Slow deep tendon reflexes

87
Q

Is MS UMN or LMN?

A

Always UMN!!!

88
Q

What are the clinical features of Marcus Gunn pupil?

A

RAPD

Pupil will constrict consensually when light shone on good eye

Pupil will dilate when light removes from other eye and moved to the blind eye.

89
Q

Cause of Marcus Gunn pupil?

A

Multiple sclerosis

90
Q

APTT, PT and bleeding time in:
Haemophilia
Vitamin K deficiency
Von Willebrands

A

Haemophilia:
APTT raised. Normal rest.

Vit K = APTT, PT raised. Normal bleeding

VWD = Prolonged bleeding, APTT raised. Normal PT

Finals Revision Lectures (2 decks)

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