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Year 6 - MBBS COPY > Sen Med PACES Misc > Flashcards

Sen Med PACES Misc Flashcards

(70 cards)

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1
Q

Wording Tips

A

Acute situ keep tasks closed loop ie lmk when it’s done

Make sure inspection is done at the END of the bed

On insp well and not tachypnoeic > calm and comfortable at rest

I feel > I think + I would > You can

If running low on time: whilst I always start w routine initial ix the gold standard is _ and mainstay tx is _

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2
Q

My usual things to forget in examinations (5)

A

Core Three: cap refill, flap, JVP, lymph nodes, sacral/peripheral oedema

AS - narrow PP | AR - wide PP

CN: insp + reflexes | UL: pronator drift | LL: rombergs + gait

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3
Q

Examining a skin lesion

A

Intro: chaperone, full exposure, any pain

General insp: number, location, distribution, objects, equipment

Closer insp: size, outline, discrete/confluent, colour, shape

Palpate: surface (texture, elevation, crust, temp) + deep (consistency, fluctuance, mobility, tenderness)

Systemic: hands and elbows, hair and scalp, mucous membranes

Complete: swab/scrap, dermatoscopy, biopsy

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4
Q

What are the different distributions of skin lesions?

A

Acral - hands and feet

Extensor - elbows and knees

Flexural - axillae, cubital fossae, genitals

Follicular - face, chest, axillae

Dermatomal - confined and don’t cross the midline

Seborrhoeic - face and scalp

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5
Q

What is the different morphology of skin lesions?

A

Macule - flat <1.5cm diameter

Patch - flat >1.5cm diameter

Papule - raised <0.5cm diameter

Nodule - raised >0.5cm diameter

Vesicle - clear fluid filled <0.5cm diameter

Bulla - clear fluid filled >0.5cm diameter

Pustule - pus contained lesion <0.5cm diameter

Abscess - pus contained lesion >0.5cm diameter

Furuncle - staph infection around or within a hair follicle

Carbuncle - above plus adjacent hair follicles

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6
Q

How do you assess a pigmented lesion?

A

ABCDEF

Asymmetry

Border

Colour

Diameter

Elevation + Evolution

Finally look for other suspicious lesions and examine the regional lymph nodes

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7
Q

What do you look for next after identifying a midline sternotomy scar? Why?

A

Ddx: CABG, valve repair, congenital heart disease, pacemakers, ICD

Leg scars for vein harvest

Arm scars for arterial harvest

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8
Q

Pacemaker vs ICD

A

An ICD will have thick coils on CXR

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9
Q

What do relatively small scars on the top, bottom and left side of the chest indicate?

A

S/C ICD

No leads within the heart

Smaller risk of infection and vasc comps

But cannot place in thin individuals nor do advanced pacing

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10
Q

Ddx for splinter haemorrhages and nail fold infarcts (3)

A

Infective endocarditis, Rheumatoid vasculitis, systemic sclerosis

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11
Q

What can you do if you’re struggling to feel the apex beat?

A

Try in held expiration and in left lateral decubitus position

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12
Q

How would you finish your cardiac exam?

A

Full hx PLUS check temp (endocarditis), dipstick urine (diabetes, HTN, glomerulonephritis), ECG (rhythm disturbance)

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13
Q

What should you do if a young woman presents cyanotic?

A

O/E: clubbing, scars underneath the breasts, signs of right heart strain

Ix: bloods (polycythaemia, IDA, liver function, uric acid levels), ECG (AF, p pulmonale, RVH), echo (right heart catheterisation)

Rx: oxygen, diuretics, consider referral to PH centre for vasodilators, avoid pregnancy

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14
Q

What are the signs of right heart strain? (5)

A

Loud and palpable P2, systolic V waves in an elevated JVP (raised venous pressure), parasternal heave (RV hypertrophy), pulm regurg, tricuspid regurg +/- pulsatile liver

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15
Q

What is the sign called when a murmur is louder in inspiration?

A

Carvallo’s Sign

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16
Q

If you hear a murmur on the left sternal edge what is it most likely going to be?

A

VSD > Tricuspid Regurg

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17
Q

Why do cyanotic pts get IDA?

A

Chronic hypoxaemia, activation of hepcidin, same mechanism as ACD

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18
Q

What is the gold standard to look at right heart pressures?

A

Right heart catheterisation

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19
Q

What are the possible cardiac causes to consider in the cyanotic pt? (2)

A

Shunt + Pulmonary HTN

NB: they are linked as you could get PH secondary to an old shunt

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20
Q

What is Eisenmenger’s syndrome?

A

L-R shunt -> R-L shunt

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21
Q

What are the three most common causes of Eisenmenger’s in order?

A

VSD
ASD
PDA

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22
Q

What ix do you perform in pts w chronic cyanotic cardiac disease?

A

CT chest for ILD causing the pulm HTN + V/Q scan for thromboembolic disease in lungs

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23
Q

What rx should you give pulm HTN pts? (2)

A

Warfarin + Digoxin

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24
Q

What is the most common cause of pulm HTN?

A

Systemic HTN

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25
COPD O/E
Obstructive Picture Inspection: big chest, breathless at rest, leaning forward, use of accessory muscles, cough Key Signs: plethoric, CO2 retention, tar staining, hyperinflation, prolonged maximal exhalation, pursed lip breathing, cor pulmonale
26
What does a pt w COPD who gets clubbing suggest?
Developed bronchogenic carcinoma
27
What is a/w secondary polycythaemia?
Gout .’. If a pt presents w gout check their haemoglobin
28
What are the signs of CO2 retention? (3)
Bounding pulse, flapping tremor, red palms
29
What’s a reduced cricoid-sternal distance?
Less than three fingers
30
How long does a maximal exhale that is suggestive of an obstructive defect take?
>6s
31
Fibrosis O/E
Restrictive Picture Inspection: clubbing, cyanosis, on oxygen, steroid signs, Rheumatic hands, CREST, ank spond, thoracotomy scars, cachexia Key Signs: dull percussion note + fine end resp creps that DON’T shift w coughing
32
What bloods do you want to do for ILD?
FBC - secondary polycythaemia + raised eosinophil count Inflam Markers - ESR, RF, cANCA, pANCA, anti-GBM PLUS: ACE and Ca (sarcoidosis), precipitins (hypersensitivity pneumonitis), CK (polymyositis)
33
Bronchiectasis O/E
Obstructive Picture Inspection: clubbing, lots of sputum, cachexia Key Signs: insp click, early to mid insp creps that DO shift w coughing, yellow curved nails and lymphoedema in legs
34
What does the sputum look like during a pseudomonas infection?
Blackish Green
35
Why are pts w bronchiectasis cachexic?
The recurrent chest infections put the pt in a hyperinflammatory state throughout the year
36
What bloods do you want to do for bronchiectasis?
Serum immunoglobulin levels + Aspergillus serology
37
What are the relevant resp negatives? (5)
Breathless at rest, clubbing, tar staining, LNs, pulm HTN/RHF
38
How would you finish your resp exam?
- Full hx PLUS check temp, sputum, peak flow/bedside spirometry, bloods, ABG, CXR/CT - Any evidence the pt is on tx such as oxygen therapy - Closing statement regarding associations and causation
39
What does PESTO stand for in resp histories?
Pets Exercise Smoking Travel Occupation
40
Ddx RIF Masses (3)
Caecal malignancy, crohns, adenopathy
41
What do you look for next after identifying a Rutherford-Morrison scar? Why?
Look to the neck for a parathyroidectomy scar hidden in the neck crease
42
Px of CKD
On general insp: well, not tachypnoeic, also notably not Cushingoid O/e of hands: AV fistula in the left arm w signs of recent use + BP was elevated at 150/90 in keeping w renal impairment O/e of H+N and chest: nad On insp of abdo: scar in LIF w a firm underlying mass which was smooth and non-tender w/o overlying erythema consistent w a kidney transplant The rest of abdo was SNT, no organomegaly, BS were present The current mode of RRT is likely to be adequate as the pt is euvolemic w/o signs of pedal oedema The cause of the pts ESRF is not readily apparent and I would like to enquire about RFs for chronic kidney disease such as diabetes and HTN I would also like to dipstick the urine to look for glucosuria and blood or protein which may indicate an underlying glomerulonephritis
43
Signs of immunosuppression
Violacious striae, other steroid signs, inc risk of chronic infection, reactivation of herpes, ca esp skin Cyclosporin - gum hypertrophy + tremor Tacrolimus - diabetes mellitus + tremor Azathioprine - anaemia + liver fibrosis
44
How do you assess graft function?
Failure: anaemic, fluid overload, uraemic, active RRT methods Rejection: tenderness and heat over the graft
45
Signs of fluid overload
Unable to lie flat, breathless, on oxygen Raised JVP + pedal oedema
46
Signs of uraemia
1st Sign: hiccups -> pruritus PLUS loss of appetite, malaise, pericarditis w pericardial rub
47
What bloods do you do for pts w CKD?
Assuming chronic: bicarbonate, potassium, urea, Cr, Hb, PTH, calcium, phosphate PLUS urine PCR
48
Px of CLD
On general insp: cachectic O/e of hands: clubbing + palmar erythema O/e of H+N: conjunctival pallor + elevated JVP On insp of chest: multiple spider naevi in the distribution of the SVC On insp of abdo: distended with dilated veins which fill away from the umbilicus suggestive of caput medusae On palpation: I noted eight finger breadths of smooth non-tender hepatomegaly extending below the right costal margin w no associated splenomegaly On percussion: I noted a distended abdomen with shifting dullness in keeping w ascites which is non-tense On auscultation: BS were present There was peripheral oedema likely from hypoalbuminaemia These findings would be most consistent w a dx of cirrhotic liver disease w some evidence of decompensation Valuable ix would inc a liver US to confirm the cirrhosis and blood screen looking for causes and signs of liver dysfunction
49
Why do liver pts get palmar erythema, spider naevi, gynaecomastia, lack of body hair, testicular atrophy?
Inc in relative oestradiol:testosterone ratio as a result of dec production of albumin and sex hormone binding globulin
50
How long do you need to check for liver flap?
30secs
51
Why would you check for parotid swelling in an abdomen exam?
A/w alcoholic liver disease
52
What is key to accurately stating the pt has hepatomegaly?
Percuss for the top edge as well
53
How do you px hepatomegaly?
Describe: size, smooth, irregular, tender, pulsatile Causes: cirrhosis, cancer, congestion, infiltrative, inflam, riedel’s lobe
54
How is decompensation defined?
It describes the comps of advanced liver disease: any of ascites, jaundice, encephalopathy
55
What are the causes of decompensation? (3)
Infection, Constipation, Alcohol PLUS meds (sedatives, NSAIDs, XS diruetics), any source of inc protein/nitrogen (GI bleed + renal failure), HCC
56
How does XS diuretics lead to decompensation?
The hypoK results in dec renal ammonia clearance
57
What bloods would you do for a CLD pt?
Gen: Hb, MCV, Pl, LFTs, U+Es, coag screen, albumin Viral: Hep A IgM, Hep B sAg, Hep C Ab AI: serum Igs, anti smooth muscle, ANA
58
What are the signs of portal HTN? (4)
SAVE Splenomegaly Ascites Varices Encephalopathy
59
What is the consequence of splenomegaly?
Hypersplenism - sequestration of the platelets - thrombocytopenia
60
Why are varices in liver pts so catastrophic?
They’re already thrombocytopenic and have an elevated INR
61
How many of all pts w portal HTN have gastric varices?
20%
62
What is the mortality of a varices haemorrhage?
20%
63
What are the signs of hepatic encephalopathy?
1st Sign: diurnal sleeping pattern disturbance Asterixis -> Bradykinesia -> Areflexia -> Decerebrate -> Coma
64
Tx to relieve pressure on the portal vein
TIPSS
65
How would you finish your abdo exam?
Full hx +/-: - Urine dip to look for nitrites and leucocytes which may indicate infection as a cause of decompensation AND glucosuria as diabetes is a RF for NASH - Perform a DRE to look for melaena as a cause of decompensation - Examine external genitalia looking for signs of loss of secondary sexual characteristics - Examine CVS to look for underlying valvular heart disease - Examine neuro to look for signs of chronic alcohol use such as cerebellar ataxia and peripheral neuropathy
66
What should you always think about adding to your conservative mx?
MDT, Referrals, Pt Education
67
CVS RFs
HTN Diabetes Cholesterol Strokes Smoker
68
What are you inspecting for in neuro examinations?
DWARFS: deformity, wasting, asymmetry, rashes, fasciculations, swelling and scars
69
What may small scars inferiorly to a midline sternotomy represent?
Drains
70
What are the cardinal signs of hyperinflation?
1. Red Cricosternal Distance 2. Loss of Cardiac Dullness 3. Displaced Liver Edge

Year 6 - MBBS COPY (35 decks)

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