Questions Flashcards
What genes are associated with Crohn’s? What other risk factors are there?
NOD2 (chromosome 16) & HLA-B27.
Smoking, refined sugar intake, autoimmune disease, female.
Describe the pathology seen in the GI tract of a Crohns patient.
Skip lesions anywhere along the GI tract. Cobblestone mucosa: mucosal oedema and ulceration with ‘rose-thorn’ fissures. Transmucosal. Granulomatous.
What extraintestinal complications can occur in IBD?
Uveitis, episcleritis, gallstones, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, amyloidosis.
How do you treat an acute exacerbation of Crohns?
Fluid resus, IV corticosteroids, high dose 5-ASA analogues, analgesia, parenteral nutrition if required.
What are the risk factors of UC?
FHx, increased serum pANCA, primary sclerosing cholangitis, autoimmune diseases.
Treatment for Acute Cholecystitis?
analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (Cephalosporin). Cholecystectomy
Treatment for Acute ascending cholangitis?
Analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (cefuroxime & Metronidazole). Urgent biliary drainage if obstruction is present. Cholecystectomy
Causes of pancreatitis?
Gall stones, Ethanol, Trauma, Steroids, Mumps, Autoimmune conditions, Scorpion Venom, Hyperlipidaemia, Hypercalcaemia, ERCP, Drugs Pregnancy
Assessment of Pancreatitis Severity
PaO2 55y, Neutrophils >15x10/L, Calcium 16 mmol/L, Enzymes(LDH) >600 units, Albumin 10g/L 3 positive factors within 48h of onset, should be transferred to ITU
What is the treatment of Pancreatitis?
NBM, analgesia, IV fluids, hourly monitoring
What are the causes of Liver Failure?
HALTED: Hepatitis Viral, Autoimmune Hepatitis, Leptospirosis (infection), Toxins, Enzyme deficiency (antitrypsin deficiency), Drugs (Paracetamol, isoniazid, halothane)
What are the signs of Chronic Liver Disease?
Ascites/Asterixis/ankle oedema, Bruising, Clubbing, Dupuytren’s Contracture, Erythema (palmar)/Encephalopathy, hepatic Foetor, Gynaecomastia, Hepatosplenomegaly/Hair loss, Increase in parotid sice, Jaundice
Signs of severe alcohol withdrawal
“When Sergy halts his habit madness runs amok” Wernickes encephalopathy, Seizures, Hypoglycaemia, Hypokalaemia, Hypocalcaemia, Malnutrition, Respiratory Alkalosis
What is the treatment of severe alcohol withdrawal?
Chlordiasepoxide (po), Pabrinex (IV)
DDx of Hepatomegaly
Cancer, Cirrhosis, Congestive cardiac failure, Constrictive pericarditis, Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases
DDx of Splenomegaly
Portal Hypertension, Haematological, Infection (Malaria, TB, Infective Endocarditis, Infectious mononucleosis, Brucellosis), Inflammation (Sarcoidosis)
DDx of Abdominal Distension
Fat, Faeces, Fluid, Flatus (obstruction), Foetus, Full-sized tumour, Full bladder, Fibroids
DDX of Haematemesis
Peptic Ulcer Disease, Gastroduodenal erosions/ulcers, Mallory-Weiss tear, Varices, Upper GI bleed, Vascular malformation, Hereditary telengectasia
Hair loss on the scalp with a characteristic margin of exclamation mark hair shifts.
Alopecia Areata
Benign overgrowth of fibroblastic tissue following skin injury, causing an excessively large scar. More common in Afro-Carribeans.
Keloid Scarring
Fleeting erythematous rash, associated with fever cracked lips, red tongue, swollen hands, and swollen neck glands.
Kawasaki Disease (can lead to development of coronary artery aneurysms if not treated)
Itchy lesion with an irregular edge, raised surface and variable pigmentation. Changing shape and size and can bleed.
Melanoma
Slow growing ulcerated lesion with rolled pearly edges and telengiectasia. Normally on sun exposed area.
Basal Cell Carcinoma
What is Koilonychia and what does it indicate?
Spoon shaped nails, Iron deficiency Anaemia
What are the cardiac causes of clubbing?
Atrial myxoma, aneurysms, congenital CHF, infective endocarditis
What nerve is damaged? Wrist drop and loss of sensation in the anatomical snuff box.
Radial nerve injury
Loss of sensation in thumb, index, middle and lateral half of ring finger. What nerve is damaged?
Median nerve injury
Claw hand deformity and loss of sensation in little finger and medial half of ring finger. What nerve is injured?
Ulnar Nerve
What is Grad 1, 2 and 3 HTN? (Diastlic, Systolic)
Grade 1 = 140-159/90-99
Grade 2 = 160-179/100-109
Grade 3 >180/110
What are the 2 types of HTN, and how are they different?
V-hypertension = predominantly Na-volume mediated; direct renin 5uU/ml
How are V-hypertension and R-hypertension treated differently?
V-HTN = diuretics and vasodilators (CCBs, alpha blockers) R-HTN = ACEI, ARB, B-blockers
What is the immediate treatment for an MI? What other intervention can be offered for a STEMI
Morphine, Metaclopramide, Oxygen, Nitrates, Antiplatelets (Aspirin, Clopidogrel, Fondaparinux), B-blocker (unless CI)
PCI (percutaneuous coronary intervention) for STEMI
What is considered a normal and a high normal blood pressure?
120-129/80-84
130-139/85-89
AFTER AN ECG, what is the next investigation you should do on someone with a suspected MI?
Blood Test: Troponin (highest 8 hours after MI), serum cholesterol, FBC, U&Es (K), CRP, Glucose, CKMB
What is the most important biomarker to check for a patient with chest pain and a previous heart attack in last 2 weeks?
CK-MB, less specific than troponin but is only raised for 3 days after an MI (troponin raised for 10 days)
MI complications
Death, Arrhythmia, Rupture (of septum or outer walls), Tamponade, Heart Failure, Valve disease, Aneursym, Dressler’s Syndrome (autoimmune pericarditis 2-10 weeks after), Embolism, Re-infarction
Causes of ST elevation?
Normal variant, Electrolyte imbalance, LBBB, Early Repolarization, Ventricular Hypertrophy, Aneurysm, Treatments, Injury (MI), Osbourne waves (hypothermia), Non-Occlusive vasospasm (Prinzmetal’s angina)
What is the normal QRS duration?
What are the causes of RAD?
RVH, Pulmonary Embolism, Anterolateral MI, WPW syndrome, Left posterior hemiblock
ST depression in leads II, III, and aVF during exertion indicates what? What is the most likely pathology behind this finding?
Inferior myocardial ischaemia, most likely due to a ricght coronary artery occlusion
How do you present an ECG?
This is a 12 lead ECG of Mr/Mrs… presenting with… taken on…
Rate… Rhythm… Axis…
P wave, QRS complex, PR interval, QT interval
ST segment, T wave.
In conclusion this is a 12 lead ECG of Mr.. Presenting with… showing… which is consistent with..
Causes of LAD on ECG?
Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome
Causes of LAD on ECG?
Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome
What are the main symptoms of digoxin toxicity?
confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, palpitations, vision changes
ST depression in leads V1-V3 with a dominant R wave in V2 indicates what? What is this patient also likely to be suffering from?
Posterior MI, rarely occur alone, so likely to accompany an inferior or lateral infarction.
23yo F, 24h RIF pain. Tenderness and guarding in RIF. No menstrual symptoms. Abdominal and Pelvic US are normal. Initial DDx and managment?
Ectopic Pregnancy, Acute appendicitis.
Should do a FBC and urine sample (hCG), if this is not an option the next best investigation is a diagnostic laparoscopy.
30yo M, severe colicky left loin pain, radiated to left groin. Initial ddx and investigation?
Renal colic. Unless, pregnant, CT scan is best option, otherwise would do renal US. Haematuria will also be present in 90% of cases.
45yo man, sudden onset epigastric pain, constant. Had several previous episode. Drinks half a bottle of whisky a day. Initial DDx and Investigation?
Acute Pancreatitis.
Serum amylase is key to diagnosis. CT may help show more specific complications.
What are the causes of ST depression?
Mitral Valve Prolapse, LV Hypertrophy, Hypokalaemia, Reciprocal ST depression, PE, Subendocardial Ischaemia, Subendocardial Infarct, Encephalon Haemorrhage, Dilated Cardiomyopathy, Shock, Toxicity (Digoxin, Quinidine)
What is Salpingitis and what are the most common causes?
Infection and inflammation of the fallopian tubes, can be split into acute and chronic.
Bacteria: N.gonorrhoea, chlamydia trachomatis, Mycoplasma, Staphylococcus, Streptococcus.
Abnormal smelling vaginal discharge, abdominal pain on having sex, fever, vomiting and nausea. Diagnosis? Investigations?
Salpingitis
Pelvic Exam, vaginal swab and blood tests.
ECG changes after a STEMI
Tented T waves in the affected leads within mins (due to localised hyperkalaemia following myocyte ischemia)
ST elevation lasting 24-48 hours
T wave inversion develops in 1-2 days
Q waves, develop within days and remain permanently
Causes of Pericarditis
Collagen Vascular disease, Aortic aneurysm, Radiation, Drugs (eg Hydralazine), Infections, Acute Renal Failure, Cardac Infarction, Rheumatic Fever, Injury, Neoplasms, Dresslers Syndrome
Jones Criteria of Rheumatic Fever (Major)
Major: Carditis, Arthiritis, Subcutaneous Nodules, Chorea (Sydenhams), Erythema Marginatum, Required = evidence of Strep/recent scarlet fever
Jones criteria of Rheumatic Fever (Minor)
Fever, Rheumatic Fever Hx, Arthralgia, Inflammatory cells, Long PR interval
Main 3 Ddx of raised JVP
Right Heart Failure (or strain due to pulmonary hypertension), Tricuspid regurgitation, Constrictive Pericarditis
Loud systolic murmur, radiates to carotids, ejection click heard at apex
Aortic stenosis (no ejection click if stenosis is due to calcification)
Pan-Systolic murmur, radiates to axilla, SOB, left ventricular hypertrophy
Mitral Regurgitation
Low pitched mid-diastolic murmur radiating to apex, best heard if patient rolled onto left side, tapping apex beat.
Commonest cause?
Mitral Stenosis, Rheumatic Fever
Rumbling murmur increases with inspiration, best heard at lower left sternal edge, little radiation.
Tricuspid Stenosis
High pitched puffing quality, best heard at left 2nd IS with patient leaning forward, radiates down left sternal border.
Aortic Regurgitation
What are the classic triad of symptoms for aortic stenosis?
Angina, exertional syncope, exertion SOB
Ddx of Sinus tachycardia
Sepsis, hypovolaemia, thyrotoxicosis, phaeochromocytoma
SVT Management
1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise
SVT Management
1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise
ABCDE Criteria for worrying mole signs
Asymmetry, Border irregularity, colour variegation, diameter >6mm, elevation or enlargement of mole
How do you measure Breslow thickness? At what depth does 5 year survival drop to only 50%?
Granular layer of epidermis to the deepest layer of tumour invasion.
>4mm
Syndrome X?
angina and positive exercised ECG test but normal coronary arteries on angiogram. Possibly caused by structural or functional abnormalities of coronary microvasculature
Prinzmetal Angina
AKA Variant angina: angina at rest that occurs in cycles, caused by vasospasm rather than atherosclerosis. Associated with ST elevation during an attack
Decubitus Angina
Angina on lying down at night, possibly precipitated by cold sheet or increased HR during a dream
Murmur on the back below the left scapula, descending to the abdomen + wide pulse pressure
Aortic Dissection
Risk factors of Aortic Dissection
HTN (90%), aortic atherosclerosis, Connective tissue disease, Congenital cardiovascular abnormalities, Aortitis, Iatrogenic, Trauma
What is aortitis and what are the 5 main causes?
Inflammation of the aorta; Tertiary syphilis, autoimmune vasculitis, giant cell arteritis, Takayasu’s arteritis, RA
Signs of aortic insufficiency?
collapsing ‘water-hammer’ pulse, wide pulse pressure, displaces thrusting apex beat, early diastolic murmur at lower left sternal edge (expiration, sitting forward)
Where/how is Aortic regurgitation best heard?
Lower left sternal border; Patient sitting forward in expiration