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Flashcards in Real Patient Deck (43):
1

What is charcot marie tooth sydrome?

Hereditary neuropathy affecting motor and sensory nerves of the PNS

2

Typical presentation of charcot marie tooth syndrome?

Early childhood
Foot drop, wasting of muscles in lower leg (inverted champagne bottle)
Weakness in hands and forearms
High arched or flat arched feet

3

How is charcot marie tooth syndrome diagnosed?

Nerve conduction studies
DNA testing

4

Diagnosis of restrictive lung disease?

FEV1 and FVC decrease
FEV1:FVC ratio >80% (FEV1 decreases less than FVC)

5

Diagnosis of obstructive lung disease?

FEV1 and FVC decrease
FEV1:FVC ratio <70%

6

What are the two main causes of restrictive lung disease?

Interstitial lung disease (fibrosis of the interstitium, thickening the barrier for gas exchange)
Chest wall abnormalities (obesity)

7

What are the common interstitial lung diseases?

Idiopathic pulmonary fibrosis
Pneumoconosies

8

Features of IPF?

Progressive breathlessness, malaise, WL, decreased chest expansion, fine end inspiratory crackles

9

Investigations for IPF?

Spirometry, CXR (lower zone fibrosis), CT (honeycombing)

10

What are the most common pneumoonosies and offending particles?

Asbestosis: insulation material
Berylliosis: miners, aerospace workers
Silicosis: sand blasters
Coal workers

11

What are main symptoms of digoxin toxicity?

Vomiting, loss of appetite, blurry vision
Arrhythmias (commonly frequent premature beats)

12

Valve replacement on patient with midsternal scar and pacemaker implant on LHS?

Mechanical mitral valve

13

What is the INR target for mechanical heart valve?

3-4

14

What kind of hypersensitivity is MS?

T4HS

15

What is the pathophysiology of MS?

Demyelinating disorder of the CNS

16

What are the main types of MS?

Relapsing remitting
Secondary progressive
Primary progressive
Progressive relapsing remitting

17

What can worsen the symptoms of MS?

heat: holidays, hot baths

18

What is internuclear ophthalmoplagia?

Difficulty adducting one eye and nystagmus in the abducting eye

19

What are some of the common symptoms of MS?

Dysarthia
Internuclear ophthalmoplagia
Intention tremor
RAPD
Ataxia
UMN signs (muscle weakness, increased tone, hyperreflexia, babinski positive)
Numbness and parasthesia
Bowel and bladder symptoms

20

What is ataxia?

Group of conditions affecting coordination, balance and speech

21

What is key for the diagnosis in MS?

Multiple neurological symptoms separated in time and space

22

Investigations for MS?

MRI (shows white plaques)
CSF (high levels of ABs)

23

How to treat MS?

Steroids, cyclophosphamide
IV IG
Plasmaphoresis
Immunosuppresants

24

OA knee with pain and sometimes giving way?

Degenerative meniscal injury
MRI, knee Xray

25

What autoantibodies are associated with RA?

Anti RF, Anti CCP (these are negative in psoriatic arthritis)

26

Xray findings in psoriatic arthritis?

Pencil in cup

27

Treatment of psoriatic arthritis?

DMARDs: methotrexate, sulfasalazine
Biologics (TNF inhibitors)

28

GALS screening questions?

Problems getting dressed
Problems walking up stairs
Pain or stiffness in muscles and joints

29

GALS examination?

Screening Qs
Gait
Inspect from side, front and back
Modified schobers
Lateral flexion of neck
TMJ
Hands behind head
Hand: inspect, power grip, thumb to finger, pincer grip, squeeze MCPJs
Knee flexion, internal rotation of the hip

30

Where is a transplanted kidney placed?

RIF (soft round palpable mass with hockey stick scar)

31

Findings in hand RA?

Ulnar deviation at MCPJs
Swan neck hyperextended PIP, flexed DIP
Boutonniere flexed PIP, hyperextended DIP
Z shaped thumb fixed flexion and subluxation of MCPJ, hyperextions of IPJ

32

RA hand exam?

Expose to elbow
Inspect for deformity (dorsum and palm)
Feel temperature
Squeeze MCPs for tenderness
Bimanually palpate swollen joints
Bimanually palpate wrist
Run hand up forearm (plaques, nodules)
Prayer sign, upside down prayer sign
Make fist
Thumb to each finger
Grip power
Pincer power
Pick up small object
Hold pen

33

Mitral regurge

Systolic
Pan systolic, best heard at apex
Radiates to the axilla

34

Diabetic foot exam?

Inspect
Palpate: temp, cap refill, pulses (p.tibial, d.pedis)
Sensation: monofilament, 128hz fork
Ankle jerk
Gait

35

What is charcot foot?

Progressive degeneration of joint due to loss of sensation

36

NF1 vs NF2?

1: chromosome 17, multiple neurofibromatomas near skin (mobile lumps under skin and cafe au lait) lisch nodules in iris
2: chromosome 22, brain, spinal cord and CNs commonly affected (bilateral aucoustic neuromas), meningiomas (seizures, visual changes)
CT or MRI to detect fibromas

37

Why does thyroid eye disease occur?

TSH receptors near eyes

38

Features of graves eye disease?

Lid lag
Lid retraction
Lid swelling
Exopthalmos (bulging)

39

Treatment of graves?

Radioiodine
BBlockers, carbimazole
Surgery

40

What is retinitis pigmentosa?

Genetic disorders that result in break down of retina
Tunnel vision, FH
Dark pigment deposits on ophthalmoscopy

41

Aortic stenosis?

Systolic cresendo decresendo
Radiates to carotid
Best heard in aortic area
Slow rising pulse

42

What is de musset sign?

Bobbing of the head seen in aortic regurge due to wide pulse pressure seen in aortic regurge

43

PD signs?

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability