What is pan systolic murmur vs ejection systolic murmur? What valves do they respectively involve and which side are they each heard best (YES there are two different valves involved) - Description of the murmur - What valve/condition? - Which side heard best? (Edited 29th March 2024: this is more for CVS Clinical Skills!) What are the things we have learnt in CVS bedside tutorial from Dr Kalpee?

Pan systolic murmur - Whooshing sound THROUGHOUT the interval between s1 - s2 and same level throughout systole - Mitral regurgitation - Heard best at apex and radiating to axilla Ejection systolic murmur - Incresendo and then decrease, bascially increase in sound and then a decrease sorta thing through systole - Aortic stenosis - The aortic stenosis murmur is actually heard best on the left sternal border (where the pulomonary valve is usually ascultated) From the CVS beside teaching - heart sounds Abbormal heart sounds = 3 and 4 But do not even hear 4th heart sound in atrial fibrillation

PT33 Flashcards by Cara Wang

If the tongue can’t move, which main nerve is probably involved? Which side does tongue deviate to?

Hypoglossal n. (CN VII)

Neuro exam = tongue deviates to weak side

How well did you know this?

Not at all

Perfectly

Cause of nappy rash and therefore why bb powder

Candida albicans

How well did you know this?

Not at all

Perfectly

Why no beta blockers in asthma

If block Beta2 receptors in airways causes bronchoconstriction in patients w asthma which is bad

How well did you know this?

Not at all

Perfectly

What is pan systolic murmur vs ejection systolic murmur? What valves do they respectively involve and which side are they each heard best (YES there are two different valves involved)

Description of the murmur
What valve/condition?
Which side heard best?

(Edited 29th March 2024: this is more for CVS Clinical Skills!)

What are the things we have learnt in CVS bedside tutorial from Dr Kalpee?

Pan systolic murmur

Whooshing sound THROUGHOUT the interval between s1 - s2 and same level throughout systole
Mitral regurgitation
Heard best at apex and radiating to axilla

Ejection systolic murmur

Incresendo and then decrease, bascially increase in sound and then a decrease sorta thing through systole
Aortic stenosis
The aortic stenosis murmur is actually heard best on the left sternal border (where the pulomonary valve is usually ascultated)

From the CVS beside teaching
- heart sounds
Abbormal heart sounds = 3 and 4
But do not even hear 4th heart sound in atrial fibrillation

How well did you know this?

Not at all

Perfectly

An adverse effect of beta blocker

Beta blocker can cause Hypotension

How well did you know this?

Not at all

Perfectly

Chronic vs acute subdural bleed

Acute - crescent shape after trauma
Chronic - arteries rupture then bleed into subdural space over time see progressive confusion or less of consciousness

How well did you know this?

Not at all

Perfectly

Brain meninges and their bleeds

Epidural - around dura mater, so a round shape on ct, between bone and dura, so enforced by the bone to push out on the dura

Subdural - crescent moon shape because between meninges and nothing hard to push off on, under dura, between dura and arachnoid

Subarachnoid - between arachnoid and pia mater, which is the space where blood vessels are, see more squiggly lines as pia mater lines all the folds of the brain

How well did you know this?

Not at all

Perfectly

Why is difference between glomerular filtration rate and renal clearance? And what are normal values?

GFR = measure by amount of inulin as body get rid of inulin only by filtration ie by GFR = vol of blood/time that blood go thru glomerular capillaries thru bowmans corpuscle = how fast glo capillaries get blood thru bowman corpuscle
Need to be 60 or higher

Renal clearance = vol of plasma or blood for a substance to be removed / the time it takes = how fast it takes to remove that substance from plasma or blood
Blood Plasma = liquid that has no blood cells
90-130mL/min

So GFR is purely on speed and blood flow
Clearance is how fast to remove somethjng

How well did you know this?

Not at all

Perfectly

Graves and Goitre hyper or hypothyroidism?

Hyper

How well did you know this?

Not at all

Perfectly

Why are thyroid antibodies relevant?

Majority thyroid disorder is autoimmune which is primary thyroid disorders
Anti TPO antibodies
TSH receptor antibodies
Thyroglobulin antibodies

How well did you know this?

Not at all

Perfectly

What is common cause of chronic liver damage and how can we tell it’s chronic damage?

Chronic alc use

Cirrhosis from fibrotic scan imaging and six months history of symptoms

How well did you know this?

Not at all

Perfectly

How to diagnose Hep A (HAV)?

Detection of anti HAV IgM in blood
HAV is acute

How well did you know this?

Not at all

Perfectly

What is normal GFR?

> = 120 mL/ min

How well did you know this?

Not at all

Perfectly

What is borderline GFR?

60 ml / min

How well did you know this?

Not at all

Perfectly

AKI vs CKI timeframe

Acute kidney injury is hours to days whereas chronic kidney injury is wks mnths yrs

How well did you know this?

Not at all

Perfectly

What release renin in response to what

Juxtaglomerular apparatus releases renin
In response to decreased renal perfusion

How well did you know this?

Not at all

Perfectly

RAAS stand for

Renin angiotensin ii and aldosterone system

How well did you know this?

Not at all

Perfectly

What is renin what does it do

Renin is an enzyme
It incr pd of angiotensin and angiotensin ii

How well did you know this?

Not at all

Perfectly

What does angiotensin ii do

Systemic vasoconstriction
Incr Na absorption in proximal tubule PT
Reduced GFR by contracting Mesangial cells and efferent arteriole

Therefore incr BP

Induces thirst
Stimulate inc pd of aldosterone

How well did you know this?

Not at all

Perfectly

What does aldosterone do: why what how

Stimulated by:
- angiotensin ii
- potassium

Action
- on distal convoluted tubule DCT and collecting duct to increase sodium and therefore water reabsorption

How
- upregulating Na/K ATPase and ENaC

How well did you know this?

Not at all

Perfectly

Gentamicin for what gram?

Gram neg eg e coli

How well did you know this?

Not at all

Perfectly

Movement in Hand Median N

Thumb abduction

How well did you know this?

Not at all

Perfectly

Movement radial nerve in hand

Finger joint extension so holding fingers straight

How well did you know this?

Not at all

Perfectly

Movement ulnar nerve in hand

Finger abducation

How well did you know this?

Not at all

Perfectly

Movement of C5

Shoulder Abduction, lifting up chicken wings movement

Movement of C6 and 7

Adduction of shoulders, going down of the chicken wings Test by resistance against adduction so examiner pushes up and get patient to adduct shoulders

Movement C7

Elbow extension

Movement C5,6

Elbow extension

Movement C6 in hand

Wrist extension Cock wrist up against resistance

C6, 7 in hand

Wrist flexion

Sacral plexus roots range and major branches

L4-S4 Superior gluteal Inferior gluteal Sciatic: fibula then tibial Posterior femoral Pudendal

Femoral nerve in relation to sacral plexus

Femoral nerve most anterior and sacral plexus is posterior

Path musculocutaneous n

Lateral, thumb, radius side, axilla to forarm

Path Median n from axilla to in the hand

Upper arm: travel medially Elbow: middle Forearm: between radius and ulna since called Median n Carpal bones / wrist: main n stops In the Hand: - palmar - thumb - index - middle - later side of 4th digit

Path of Radial n to in the hand

Upper arm: goes posterior of arm through medial and lateral heads of triceps Elbow: comes anterior at radial groove on humerus, lateral Forearm: down radius, the lateral bone in thumb side In the hand: - posterior = the back of hand - thumb - Index - Lateral half of middle

Path ulnar

Arm: Runs medial posteriorly Elbow: posteriorly to medial epicondyle Forearm: medial, digiti minimi side In the hand: - Anteriorly = medial one and a half fingers - Posteriorly = medial two and a half fingers

Hip flexion nerve roots

L1,2

Hip extension

L5 S1

Leg adduction

L2,3

Leg Abduction

L4,5

Femoral n roots

L2-4

Knee flexion

Knee extension

S3-4

Ankle dorsiflexion

Bring ankle upwards, flexing back of foot - dorsi L4

Ankle plantarflexion

Plantar = pointing toes S1-2

Big toe

L5, Arises from branches from both deep and superficial fibular

Ankle inversion

Ankle eversion

L5 S1

Nervous system ganglion versus nucleus

Collection of cell bodies - Somas In the CNS = nucleus In the PNS = ganglion - ie throughout the body

CN III

Oculomotor - Eyelids dilated - Eyes down and out - Pupil dilated and fixed

CN IV

Trochlear Superior oblique that when contracts moves eyes down snd out - Eyes vertical diplopia, unable to look down and out, so eyes shift upwards

CN V

Trigeminal V1 - Eyes: no corneal reflex (afferent) V - Face: no sensation V3 - Muscles and mastication: can’t move - Jaw: deviates to weak side

CN VI

Abducens Lateral rectus - Eyes can’t abduct - horizontal diplopia so eyes can look laterally

CN VII

Facial - Face: can’t move - Eyes: no corneal reflex (efferent) - Taste anterior 2/3: no taste - Auditory: sounds appear super loud hyperacusis

CN VIII

Vestibulocochlear - Auditory: hearing loss, acoustic neuroma - Eyes: nystagmus - General: vertigo - feeling of spinning and diszziness

CN IX

Glossopharyngeal - No gag reflex (afferent)

CN X

Vagus - Uvula deviating away from lesion side - No gag reflex (efferent)

CN XI

Accessory - Head and shoulder: weakness turning to contralateral side, so the side can’t turn is opposite to the side with the week nerve Ie if can’t turn right, then nerve lesion is on the left

CN XII

Hypoglossal - Tongue deviates to weak side

Long QT and electrolyte associations

Hypo K Ca and Mg