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test - Split (1) Flashcards

1
Q

abdoPainDDX

A

can be by region or by organ. GASTRO: i) Gastroduodenal (PUD, gastritis, malignancy, gastric volvulus. ii) Intestinal (appendicitis, obstruction, diverticulitis, gastroentereitis, mesenteric adenitis, strangulated hernia, IBD, inutssusception, volvulus, TB) iii) Hepatobiliary (acute/chronic cholecystitis, cholangitis, hepatitis) iv) Pancreatic (acute/chronic pancreatitis, malignancy) v) Spleen (infarct, spontaneous rupture). URINARY: cystitis, acute urinary retention, acute pyelonephritis, ureteric colic, hydronephrosis, tumour, pyonephrosis, PCK. GYNAE: ruptured ectopic, torsion of ovarian cyst, ruptured ovarian cyst, salpingitis, severe dysmenorrhoea, mittelschmerz, endometriosis, red degeneration of a fibroid. VASCULAR aortic aneurysm, mesenteric embolus, mesenteric angina, mesenteric venous thrombosis, ischaemic colitis, dAA. PERITONEUM secondary peritonitis, primary (rare). ABDO WALL: strangualted hernia, rectus sheath haematoma, cellulitis. RETROPERITONEUM: retroperitoneal haemorrhage (eg anticogaulants). REFERRED PAIN: AMI, pericarditis, test torsion, pleurisy, herpes zoster, lobar pneumonia, thoracic spin disease (eg disc, tumour). MEDICAL (all rare): hypercalcaemia, uraemia, DKA, sickle cell disease, addisons, acute intermittent porphyria, Henoch-Schonlein purpura, tabes dorsalis

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2
Q

acuteAngleClosureGlaucomaEx

A

hazy, semi-dilated pupil

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3
Q

acuteAngleClosureGlaucomaHx

A

photophobia, visual disturbances, seeing haloes, painful red eye

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4
Q

acuteAorticDissection(AAA)Epi

A

elderly males with HTN, or younger pts with CTD (Marfan or Ehlers-Danlos or fam hx)

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5
Q

acuteArterialOcclusionEx

A

6Ps: pain, pallor, pulseless, paraesthesia, paralysis, perishingly cold

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6
Q

acuteArterialOcclusionHx

A

sudden, pain, can’t move, feels cold

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7
Q

acuteCoronarySyndrome(ACS)-STEMIEx

A

clammy, sweaty, sob, pale, alternatively: cardiac arrhytmias, heart failure, severe hypotension w cardiogenic shock, ventricular septal rupture/papillary muscle rupture, systemic embolism or pericarditis

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8
Q

acuteCoronarySyndrome(ACS)-STEMIHx

A

central, heavy, burning, crushing, tight retrosternal, lasting for several minutes, not relieved by SL GTN, anxiety, SOB, N/V, pain rad to neck/jaw/arms/back occasionally epigastrium (or may present at these sites alone) ** atypical presentations in elderly, diabetics, and females

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9
Q

acuteCoronarySyndrome(ACS)-STEMIIx

A

ECG: TWI or STEMI in contigious leads. Posterior infarcts = tall R and STDep in V1-4

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10
Q

acuteCoronarySyndrome(ACS)-STEMIRf

A

cig, htn, age, dm, hyperchol, male, fam hx, previous angina/heart failure

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11
Q

acuteKidneyInjury(AKI)DDX

A
  1. Prerenal (low BP, hypovol, renal artery occlusion from mass or emboli), 2. Renal (intrinsic pathology eg GN, vasculitis, drugs), 3. Post renal (outflow obstruction, ureter, bladder, urethra, due to enlarge prostate, single functioning kidney with calculi, pelvic mass/surgery)
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12
Q

acuteKidneyInjury(AKI)Dx

A

acute rise in baseline urea and cr +/- oliguria

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13
Q

acuteKidneyInjury(AKI)Ex

A

volume status, BP, HR, JVP, basal creps, gallop rhyth,, oedma, palpable bladder

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14
Q

acuteKidneyInjury(AKI)Hx

A

previous renal problems, comorbidities, UO, fluid intake, nephrotoxic medication? (eg NSAIDS, gentamicin, IV contrast)

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15
Q

acuteKidneyInjury(AKI)Ix

A

urine (colour, hourly volume, dipstick, MCS, osmolality and sodium osmolality), Bloods: FBE (hyperK), UEC, LFT, CK, CRP, osmolality, ESR, Clotting. ABG to look for acidosis, ECG, CXR, urinary tract USS

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16
Q

acuteKidneyInjury(AKI)Rx

A

IDC (to monitor UO), cause dependent (ie IDC, or fluids if shocked, or frusemide and O2 if overloaded, ins/gluc, cagluc, salbutamol if hyperK associated)

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17
Q

ankleInjuryHx

A

immediate swelling and inability to WB = serious and suspicious for lig tear/fracture

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18
Q

ankleSprain/Dislocation/FractureScore

A

Ottawa Foot Rule: 98% sensitive: Request foot x-ray if there is PAIN in mid-foot AND one of these: 1) tender over the base of fifth metatarsal, 2) tender over navicular, 3) unable to WB (ie 4 steps) after injury AND in ED. Ottawa Ankle Rule: Request ankle AP and LAT xray if, Malleolar pain (ie bwn medial and lateral malleolus) AND on of these: 1) bone tenderness over the post edge or tip of distal 6cm of medial OR lateral malleolus, 2) inability to WB within 1st hour and in ED.

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19
Q

anorectalPainDDX

A

ACUTE: fissure-in-ano, perianal haematoma, thrombosed haemorrhoids, perianal abscess, intersphincteric abscess, ischiorectal abscess, trauma, anorectal gonorrhoea, herpes. CHRONIC: fistula-in-ano, malignancy, chronic perianal sepsis (eg crohns disease, TB), proctalgia fugax, solitary rectal ulcer, cauda equina lesions

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20
Q

aorticStenosis(AS)Aetiology

A
  1. stenosis 2ndary to rheumatic heart disease, 2. calcification of bicuspid aortic valve. 3. calcification of tricuspid aortic valve in the elderly
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21
Q

aorticStenosis(AS)Complications

A

arrhytmias, Stokes-Adams attacks (sudden death), MI, LVF. Only years to live, correlates with symptom severity

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22
Q

aorticStenosis(AS)Epi

A

M>F. old. bicuspid aorta leads to presentation earlier

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23
Q

aorticStenosis(AS)Ex

A

narrow pulse pressure, slow-rising pulse, thrill in aortic area, forceful sustained thrusting undisplaced apex beat, harsh ESM, rad to carotids and apex, S2 softened, bicuspid valve may produce an ejection click

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24
Q

aorticStenosis(AS)Hx

A

SAD (syncope/dizzy on exertion, angina, dyspnoea and other signs of heart failure)

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25
Q

aorticStenosis(AS)Ix

A

ECG: LVH, LBBB, CXR showing post-stenotic enlargement. ECHO. Angio

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26
Q

aorticStenosis(AS)Rx

A

Surgery (replacement, balloon dilation (valvoplasty), management of LVF medically, ABX prophylaxis against infective endocarditis

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27
Q

ascitesDDX

A

HEPATIC: cirrhosis, hepatic tumors, MALIGNANCY: carcinomatosis, abdominal/pelvic ca (primary/secondary), pseudomyxoma peritonei, primary mesothelioma. CARDIAC: card failure, constrictive pericarditis, tricuspid incompetence. RENAL: nephrotic syndrome. PERITONITIS: TB, Spont bacterial. VENOUS OBSTRCUTION: Budd-Chiari syndrome, veno-occlusive disease, hepatic portal vein obstruction, inferior vena cava obstruction. GI: pancreatitis, malabsorption, bile ascites.

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28
Q

backPainAetiology

A

Most pts in primary care (>85%) have nonspecific low back pain, meaning that the patient has back pain in the absence of a specific underlying condition that can be reliably identified

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29
Q

backPainDisp

A

HOME: Home care in simple lower back pain: Address the factors that contribute (ie bad work practices and lifting techniques, poor posture, being overweight, lack of exercise, pregnancy, stress, smoking). In the first two to three days patient should aim to minimise pain and assist healing. Ice to back wrapped in towel for 20 minutes, every one to two hours when awake. Avoid ‘HARM” – Heat, Alcohol, Re-injury and Massage for the first few days. Avoid activities you do not really need to do. Sit as little as possible until the pain settles. Avoid extended car travel unless absolutely necessary. When resting, lie in a comfortable position, supported by pillows if necessary. Keep moving as much as possible. Take painkillers when necessary. Physiotherapy as soon as possible.

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30
Q

backPainEx

A

scoliosis, kyphosis, bony tendereness, paraspinal tenderness, reduced range of movement (especailly flexion), pain on straight leg raise, lower limb neurology in motor, sensory, reflexes, expansile abdo mass. PR exam for decreased tone or sensation

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31
Q

backPainHx

A

trauma/lifiting, location of pain, duration, aggrevating/relieving factors, radiation, pain in joints, pain or tingling in legs, leg weakness, bladder retention or incontinence, faecal incontinence, altered sensation on passing stool, LOW. PMH: previous, neurological problems, osteoporosis, anaemia. DH: steroids, analgesia. FH: joint or back problems. SH: occupation involves lifting or prolonged sitting

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32
Q

backPainScore

A

RED FLAGS: Age of onset 55 years? First presentation? Ill health or presence of other medical illnesses? Urinary/bowel incontinence? Saddle anaesthesia? Progressive neurological deficits? Disturbed gait? Malignancy? Current or history of? Fevers/night sweats? Unexplained weight loss? History of trauma? IVDU? Immune suppresed? (ie. HIV, Steroids) Symptoms worse at night? YELLOW FLAGS (psychosocial factors shown to be indicative of long term chronicity and disability) i) Negative attitude that back pain is harmful or potentially severely disabling? ii) Fear avoidance behaviour and reduced activity levels? iii) An expectation that passive, rather than active, treatment will be beneficial iv) A tendency to depression, low morale, and social withdrawal v) Social or financial problems

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33
Q

bronchialCarcinomaHx

A

low, smoking,

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34
Q

bronchiectasisHx

A

purulent long-standing sputum production

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35
Q

brugadaSyndromeDisp

A

Cardio for further evaluation and risk stratification

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36
Q

brugadaSyndromeHx

A

Fam hx of sudden death? Fever? Anti-arrhytmic? (bc ECG pattern sometimes only seen in fever or after taking anti-arrhytmic drugs (particularly 1C - flecainide, propafenone)

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37
Q

brugadaSyndromeIx

A

ECG: RBBB morphology, coved ST segment elevation in V1-2 with terminal TWI.

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38
Q

budd-ChiariSyndromeIx

A

LFT for inc transaminases. FBE, UEC, clotting, thrombophillia screen. Doppler US for flow in hepatic vein. Hepatic venogram.

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39
Q

budd-ChiariSyndromePatho

A

obstruction to hepatic venous outflow (from hypercoagulable state) resulting in abdo pain, ascites, jaundice, encephalopathy, variceal bleeding and hepatosplenomegaly (due to portal hypertension)

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40
Q

cardiacTamponadeEx

A

tachycardia, hypotension, pulsus paradoxus, raised JVP which rises on inspiration (ie Kussmaul’s sign)

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41
Q

cardiovascularHx

A

chest pain, palpitations, soboe, PND, orthopnoea, ankle swelling, claudication

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42
Q

caudaEquinaSyndrome(CES)Aetiology

A

Sun et al. SR found that cauda equina syndrome was caused by prolapse of the intervertebral disc in 22.7 percent of cases, ankylosing spondylitis in 15.9 percent, lumbar puncture in 15.9 percent, trauma in 7.6 percent, malignant tumor in 7.2 percent, benign tumor in 5.7 percent, and infection in 5.3 percent

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43
Q

cellulitisAetiology

A

beta-haemolytic strep, S.Aureus, MRSA, Gram-Neg aerobic bacilli (minor number of cases)

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44
Q

cellulitisEx

A

Clinical symptoms: Erythema, oedema, warm, Entry source: toe web intertrigo, injection sites

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45
Q

cellulitisHx

A

slow onset (days cf erysipelas which is more accute), swelling, warmth, +/- purulent drainage. most often on lower limbs, but may also be eyes, abdo (in morbid obese)

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46
Q

cellulitisPatho

A

DDX is erysipelas. E involves upper dermis and superficial lymphatics, whilst C involves deeper dermis and subcut fat. Therefore in E, there is a sign (milian sign) behind the ear, as this are does not have any deeper dermis. E in young and old. C in mid-age-group

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47
Q

cellulitisRf

A

skin disruption, preexisting skin infection, inflammation (eg eczema / radiotheraphy), odema due to venous congestion, lymp obstruction post surgery. Most important entry is perhaps the skin bwn toes (toe web intertrigo)

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48
Q

cellulitisRx

A

mark the area w a pen, elevation, hydrate the area to avoid cracks, treat the underlying condition if one found (tinea pedis, lymphoedema, chronic venous insufficiency), diuretics, compressive stockings, ANTIBIOTICS: empirical eTG tba

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49
Q

chestPainDDX

A

Life-threats: ACS, PE, Aortic dissection, TPT. Complete list: CV (angina, AMI, acute aortic dissection, pericarditis) GI (reflux oesophagitis, PUD, oesophageal spasm, oesophageal rupture, hiatus hernia, biliary colic/cholecystitis, subdiaphragmatic irritation), Pulmonary (Pneumonia, Ptx, PE, pneumomediastinum, pleurisy), MSK (fractured ribs, chest wall injuries, herpes zoster, costocohonditis, secondary tumors to rib) Emotional (Depression) Pleuritic chest pain = Ptx, PE, pericarditis, PE, pneumonia, pleurisy, rib #, costochondritis

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50
Q

chestPainDo

A

IV, cardiac monitor, sats, O2>94%, FBE, UEC, LFT, Troponin, ECG, repeat in 10min if 1st ECG is non-diagnostic. CXR mainly looking for APO, cardiomegaly, atelectasis. Aspirin 150-300mg, gtn SL (0.6mg tab or 0.4mg spray)

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51
Q

chestPainEx

A

end-of-bed-quick-look-test, vital signs, appearance (marfanoid - predisposing to aortic dissection), HEENT: xanthelasma = hyperchol, thrush associated with oesophageal candidiasis. RESP:

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52
Q

chestPainHx

A

site, onset, character, radiation, association, time course, exacerbating/relieving factors, severity, pleuritic, hx of heart disease, similar to previous episodes, PMH: card/respiratory problems, DM, GORD. Drugs: cardiac/resp meds. antacids. FamHx: IHD, premature cardiac death. SHx: smoking, exercise tolerance.

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53
Q

chronicBronchitisEx

A

hyperexpanded chest, decrased inspiratory movement

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54
Q

chronicBronchitisHx

A

purulent long-standing sputum production

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55
Q

clavicle#Anatomy

A

Clavicle = 1st bone to ossify. The only bony connection between arm and the trunk. Articulated distally with acromion and prox with sternum by Atypical synovial joints, because (fibrocartilage not hyaline cartilage). “S” shape. The proximal half curves outward (convex) providing space for the neurovascular bundle of the upper limb. The distal half = concave. # at the junction (midshaft) between these two curves, most likely because this area i) lacks ligamentous attachments to adjacent bones and is the bone’s ii) thinnest segment. Displacement = Proximal fragment superiorly (cephalad) by the pull of the SCM. Distal = inferiorly (caudad) by the weight of the arm. Shortening often occurs (because subscapularis and pectoralis muscles, which internally rotate and pull the arm towards the chest). Even though the clavicle is subcutaneous, with only a thin layer of overlying soft tissue, open fractures are uncommon. However, tenting (ie, taught stretching) of the overlying skin is relatively common. If left uncorrected, tenting may lead to necrosis of the overlying skin and conversion to an open fracture. Tenting is therefore an indication for closed reduction or surgical repair.

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56
Q

clavicle#Anticipate

A

scapula #, rib #, hemothorax, pneumothorax, brachial plexus injury

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57
Q

clavicle#Dx

A

Fall on shoulder. direct violence, or FOOSH. Fractures bwn middle and outer third in adults. greenstick in kids. c/o pain. Ex: local deformity. tenderness. Look for tenting! as this is a sign of potential evolving necrosis/needing operative mx. AP X-ray shows the #

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58
Q

clavicle#Ex

A

crepitus, tenderness, neurovascular exam: lung exam:

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59
Q

clavicle#Hx

A

fall on shoulder, pain, snapping, cracking, swelling

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60
Q

clavicle#Ix

A

AP Xray. Sometimes need a 45-degree cephalic tilt view to see midshaft clav fracture

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61
Q

clavicle#Note

A

69% middle 3rd, 28% distal, 3% proximal /// 87% of clav # are from fall on shoulder, 7% direct blow, 6% FOOSH.

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62
Q

clavicle#Rx

A

SUPPORT: triangular sling, PAIN: analgesia. SWELLING: ice. OPERATIVE: if nerves/vessels compromised. F/U: Refer to next # clinic. Note: NO longer use of figure of 8 bandage as uncomfortbale and ineffective.

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63
Q

clusterHeadachesHx

A

retro-orbital pain

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64
Q

coffeeGroundVomitingAnticipate

A

melena

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65
Q

coffeeGroundVomitingDDX

A

upper GI bleeding

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66
Q

coffeeGroundVomitingPatho

A

iron exposed to gastric acid –> oxidization

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67
Q

commonFibular/PeronealNerveAnatomy

A

MOTOR: Innervates the short head of the biceps femoris directly. Also supplies (via branches) the muscles in the lateral and anterior compartments of the leg. SENSORY: Innervates the skin over the upper lateral and lower posterolateral leg. Also supplies (via branches) cutaneous innervation to the skin of the anterolateral leg, and the dorsum of the foot. Clinical EFFECT of damage: Foot drop, Sensory loss to the dorsal surface of the foot and portions of the anterior, lower-lateral leg. NOTE: A common yoga kneeling exercise, the Varjrasana, has been linked to a variant called yoga foot drop.

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68
Q

commonFibular/PeronealNerveRf

A

damaged by: fibula fracture, too tight cast

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69
Q

conn’sSyndromeHx

A

few sx. but HTN, may give headache and poor vision. muscle weakness, spasms, tingling sensation, xs urination. Complications with stroke, AMI, kidney fail, arrhytmia

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70
Q

conn’sSyndromePatho

A

too much aldosterone –> low renin.

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71
Q

conn’sSyndromeSyn

A

eponym for primary hyperaldosterism.

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72
Q

constipationDDX

A

i) Obstruction (diverticular disease, colonic carcinoma, extrinsic compression), ii) Painful anus (fissure-in-ano, perianal abscess, strangulated haemorrhoids, post-haemorrhoidectomy), Adynamic bowel (paralytic ileus, spinal cord injury), Endocrine (diabetes, autonomic neuropathy, myxoedema, hyperparathyroid), Drugs (codeine, morph, TCA, atropine, laxative abuse), Other(dietary changes, anxiety, depression, irritable bowel syndrome, generalised disease, starvation) Congential (Hirschsprungs)

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73
Q

constipationHx

A

what does the pt mean? abdo pain, distension, N/V, haemodynamic status, absent/tinkling bowel sounds, LOW, PR bleeding

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74
Q

costochondritisAetiology

A

3 I’s. Idio, infection (direct or haem), inflammation (microtrauma, cough, unaccustomed upper limb movement)

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75
Q

costochondritisEpi

A

common. females >40y.

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76
Q

costochondritisRx

A

ABx not effective because cartilage has poor blood supply

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77
Q

diabeticKetoAcidosis(DKA)Hx

A

4 situations equal incidence. 1. precipitant (infection, stress), 2. treatment non-compliance, 3. new diagnosis, 4. no known precipitant event

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78
Q

diabeticKetoAcidosis(DKA)Patho

A

xs stress hormones antagonises actions of insulin, the pathogenesis requires two events: (i) increased mobilisation of FFA and, (ii) a switch of hepatic lipid metabolism to ketogenesis.

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79
Q

dvtEx

A

pain, tenderness, swelling, heat, oedema, Homans signs (on dorsiflexion) - to do or not do?

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80
Q

dvtRf

A

Malignancy, Presence of a central venous catheter, Surgery, especially orthopedic, Trauma, Pregnancy, OCP, HRT, Tamoxifen, Thalidomide, Lenalidomide, Immobilization, Congestive failure, Antiphospholipid antibody syndrome, Myeloproliferative disorders (eg Polycythemia vera, Essential thrombocythemia/thrombocytosis), Paroxysmal nocturnal hemoglobinuria, Inflammatory bowel disease, Nephrotic syndrome, Inherited thrombophilia (ie Factor V Leiden mutation, Prothrombin gene mutation, Protein S or C deficiency, Antithrombin (AT) deficiency, Dysfibrinogenemia)

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81
Q

dyspepsia(Indigestion)Hx

A

epig pain related to hunger, eating, specific foods, time of day, bloating, fullness, heartburn. alarms symptoms = anaemia (IDA), LOW, anorexia, recent onset of progressive sx, melaena/haematemesis, swallowing difficulty

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82
Q

dysphagiaHx

A
  1. difficulties swallowing solids AND liquids from the start (yes = motility, no = stricture benign or malignant) 2. difficult to make the swallowing movement (yes = ?bulbar palsy especially if coughing on swallowing) 3. odynophagia (yes = ca, ulcer, spasm) 4. intermittent or constant and getting worse (intermittent = oesophageal spasm, latter = malignant stricture) 5. does the neck bulge or gurgle on drinking (yes = pharyngeal pouch)
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83
Q

dyspnoea(SOB)DDX

A

Sudden (ptx, chest trauma, aspiration, anxiety, APO, PE, anaphylaxis) Acute (asthma, resp tract infection, pleural effusion, lung tumours, metabolic acidosis) Chronic (COPD, anaemia, valvular heart disease, cardiac failure, CF, idiopathic pulmonary fibrosis, chest wall deformities, neuromuscular disorders, pulm HT)

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84
Q

dyspnoea(SOB)Ex

A

cyanosis (peripheral and or central), kyphosis, conscious state, barrel-chest, pursed-lip breathing, accessory muscle use, clubbing, pulse rhythm, JVP, temperature, traceha, expansion, percussion (dull or resonant. note ptx presents initially with ‘relative dullness’ on unaffected side), murmurs, third heart sound, quiet heart sound in COPD, breath sound volume, wheezing, crepitations, fine inspiratory creps (IPF)

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85
Q

dyspnoea(SOB)Hx

A

onset, precipitants, relieving factors, associated with cough, sputum, blood stained, haemoptysis, wheezing

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86
Q

earpainDDX

A

Primary (OM, OE, other infections) Secondary (referred, eg neuralgia, neoplasma, odontogenic)

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87
Q

earpainEx

A

Otoscopy

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88
Q

earpainHx

A

pain, pruritus, discharge, hearing loss, any known tympanic membrane perforation, previous ear infections, any prior ear surgery, recent ear instrumentation, and water exposure

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89
Q

enoxaparinRx

A

DVT/PE prophylaxis 20-40mg/24h depending on renal function. DVT/PE treatment: 1.5mg/kg/24h. ACS treatment: 1mg/kg/12h. CONTRAINDICATIONS: bleeding disorders, thrombocytopenia, severe HTN, recent trauma. CAUTION: hyperK, hepatic/renal impairment. SIDE EFFECT: haemorrhage, thrombocytopenia, hyperK. INTERACTIONS: NSAIDS increases bleeding risk. effect increased by GTN

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90
Q

epiduralHaemorrhage(EDH)Anatomy

A

1) usually from temporal bone fracture, across the groove of the middle meningeal artery. 2) biconvex shape due to intimnate attachement of dura to inner table, which therefore inhibits soread of blood

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91
Q

epiduralHaemorrhage(EDH)Hx

A

lucid interval bwn trauma and appearance of symptoms

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92
Q

epiduralHaemorrhage(EDH)Ix

A

CTB: footbal (biconvex)

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93
Q

erysipelasEx

A

Miian ear sign (because there is now deeper dermis there!), butterfly involvement of the face

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94
Q

essentialHTNDDX

A

Renal (GN, DMNephropathy, renal art stenosis, chronic pyelo, PCKD, CTD (eg systemic sclerosis)), Endocrine(cushings, conn’s, pcc, acromegaly), Drugs (Oestrogen-OCP, Corticoids (eg corticosteroids, liquorice), MAOIs and thiamine, sympathomimetics ()), CV, Pregnancy (pre-eclampsia)

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95
Q

essentialHTNEpi

A

> 90% of HTN are essential

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96
Q

fibula#(Isolated)Ex

A

neurovascular. focus on common peroneal nerve (ie foot drop, lost sensation to dorsum and lateral leg)

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97
Q

fibula#(Isolated)Hx

A

direct blow to lateral leg, local pain, swelling, walking-difficulties

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98
Q

fibula#(Isolated)Ix

A

full length AP and lateral X-ray of tib and fib + ankel and knee joints

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99
Q

fibula#(Isolated)Rx

A

Support: firm crepe bandage with cotton-wool padding OR below-knee walking plaster, Refer: to fracture clinic

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100
Q

fissure-in-anoHx

A

constipation, pain on defecation, blood on paper.

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101
Q

gaitEx

A

initiation, festination, hesitancy, stride length, base (narrow or wide)

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102
Q

gastrointestinalHx

A

Symptoms: top-to-bottom. Appetite, taste, vomiting, dysphagia, reflux, abdo pain, nausea, opening of bowels, change in stool habit, bowel movement frequency, consistency, colour, pain on passing, recurrent urge, blood (bowl or paper), offensive smell, mucus. Allergies: MEDs: NSAIDs, anticoagulants, hepatotoxics drugs, opioids, laxatives. PHx: GI bleeds, gord, varices, gallstones, liver problems, jaundice, IBD, haemorrhoids, polyps. FamHx: IBD, liver disease, cancer. SHX: foreign travel, illicit drug use, IVDU, etoh.

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103
Q

gcsScore

A

eye (spontaneous, voice, pain, none), verbal (oriented, confused, inappropriate, incomprehensible sounds, none), motor (command-following, localises, withdrawal, decort, decerebrate, none)

104
Q

goodpasturesSyndromeHx

A

haemoptysis, haematuria, renal disease

105
Q

haemoptysisDDX

A

Resp (bronchial carcinoma, pneumonia, TB, chronic bronchitis, bronchiectasis, pulmonary oedema, Goodpasture’s, Wegners), Vascular (PE, pulmonary HTN (mitral stenosis), hereditary haemorrhagic telangiectasia), Systemic (coagulation disorders)

106
Q

haemoptysisDx

A

sob, sudden (PE, resp infection) or chronic (rest of ddx), pink stained = APO, long-standing sputum = bronchiectasis/chronic bronchitis, flecks of blood = TB, lung ca, mitral stenosis, LOW, other sites of bleeding (haematuria = Goodpastures, epistaxis = wegners and HHT), rheumatic fever, co-existing renal disease

107
Q

haemoptysisEx

A

clubbing, cachexia, malar flush, small dilated blood vessels on mucus membranes, JVP, hyperexpanded chest, decrased inspiratory movement, supraclavicular lymphadenopathy, calves for dvt

108
Q

haemoptysisIx

A

sputum, ecg, fbe, uec, clotting scree, cxr, bronchoscopy. Specifics (mantoux, urin analysis for red cell casts with GN due to goodpastures or wegners), antiglomerualr basement antibodies, c-ANCA, renal biopsy, tissue biopsy of lung, ct PA, tte

109
Q

headacheAlternatives

A

Primary (migraine, tension, cluster, miscellaneous benign types) 2. Secondary (head injury, vascular (bleed, thrombous, malformation), non-vasc intracranial (inc CSF pressure, SOL), substance abuse or withdrawal, infection (meningitis, encephalitis), metabolic (hypoxia, hypercapnoea, hypogly, CO poisoning, dialysis), craniofacial disorder (eg referred pain), neuralgias (trigeminal, occipital, other cranial nerves)

110
Q

headacheDDX

A
  1. Acute (trauma, cerebrovascular (SAH, intracranial bleed/infarction), systemic infection, meningitis, acute angle-closure glaucoma). 2. Chronic or recurrent (tension, migraine, cluster, drugs (eg GTN, nifedipine, substance withdrawal (etoh), psych (inc anxiety and depression). raised ICP (from tumour, hydrocephalus, abscess, benign), temporal arteritis, pre-eclampsia, paget’s disease of bone, severe HTN, CO poisoning
111
Q

headacheDx

A

associated worrying features? severe and/or first? chronic unresponsive to treatment? Onset over minutes (primary headaches), hours/days (meningitis), days/weeks (raised ICP) sudden/gradual, severity, altered LOC, fever, vomiting, phonophobia, photophobia, recent LP

112
Q

headacheEx

A

Vitals, Head for injury/tenderness, Eyes: VA, conjunctival infection (occurs with acute attacks of cluster headaches and angle-closure glaucoma), pupil reactions, eye movements, papilloedema. Sinuses: palpate for infection/tenderness, Ear: haemotympanum, infection. Oral cavity: infection. Skin: rash, purpura, petechial haemorrhages.

113
Q

headacheIx

A

temp

114
Q

hereditaryHaemorrhagicTelangiectasiaEx

A

small dilated blood vessels on mucus membranes

115
Q

hereditaryHaemorrhagicTelangiectasiaHx

A

haemoptysis, epistaxis

116
Q

herpesZosterDisp

A

postherpatic neuralgia occurs after the acute episode and is difficult to treat. get expert help

117
Q

herpesZosterHx

A

unilateral dermatomal distribution of chest pain for 2-3days, then rash. Rash = redening, maculopapular evolving into vesicular lesions. How long since vesicle eruption

118
Q

herpesZosterRx

A

opioids and steroids for pain releif. Aciclovir 800mg PO five times per day for 7days (or famciclovir 250mg PO TDS for 7days if seen within 72 hours of vesivle eruption)

119
Q

hyperKalaemiaDDX

A

1) Pseudo (Delay in separating red cells, haemolysis, Severe leucocytosis/thrombocytosis), 2) Excessive intake (Exogenous: IV or oral KCl, massive blood transfusion, Endogenous/Tissue necrosis Burns, Ischaemia, Trauma, rhabdo, Tumour lysis) , 3) Decrease renal excretion (Drugs interferring w excretion (ie K-sparing diuretics (spirnolactone, amiloride), ACEi/ARBs, NSAIDs, Calcineurin inhibitors, trimethoprim, pentamidine), Renal failure, Addison’s, Hyporeninaemic hypoaldosteronism, 4) Compartmental shift (acidosis, insulin deficiency, digoxin OD, Succinylcholine, Fluoride poisoning, Hyperkalaemic periodic paralysis)

120
Q

hyperKalaemiaDx

A

Conscious state, chest pain, palpitations, dizzy, abnormal ECG, breathlessness (due to acidosis), paraesthesia, areflexia, wekaness, abdo pain, hypoglycaemia, hyperpigmentation (ie addisons)

121
Q

hyperKalaemiaEx

A

haemodynamic unstable, pulse irregular, stigmata of renal failure

122
Q

hyperKalaemiaIx

A

Repeat UEC, dig levels (bc dig toxicity will worsen hyperK), ABG for acidosis if renal fail, ECG (Peaked T, prolonged PRI, broad QRS, flat P, VF), FBE for haemolysis, CK for crush, cortisol (which will be down in addisons)

123
Q

hyperKalaemiaPhys

A

K is excreted main (95%) by kidney, rest by gut. excretion is slow. hormonal and acid-base systems shifts K into cell.

124
Q

hyperKalaemiaRx

A

1) Stop the cause and nephrotoxics, 2) CaGluconate 10% IV 5-10ml or 15g PO (protects), 3) Salb nebulized 10-20mg, Insulin20U with Dextrose 50g, or IV Sodium Bicarb 50-200mmol (move into cells), 4) Frusemide+resonium, refractory or acidosis –> dialysis (inc excretion)

125
Q

hyperTensionEx

A

comfortable/distressed/critical, BP bilat, HR? (brady+htn = increased ICP, tachy+htn = catecholamine), Lungs (Crackles = APO) Note: atheroscleosis/obese measured with small cuff may read facticously too high,

126
Q

hyperTensionHx

A
  1. An emergency? (Aortic dissection, chest pain, arrhytmia, SOB (APO, AMI), sudden headache, vomiting, confusion, seizure) 2. MAOI antidepressant (Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), Tranylcypromine (Parnate)) 3. AntiHTN meds normally taking
127
Q

hyperTensionRx

A

O2>94%,

128
Q

hypoCalcaemiaDDX

A

1) Major cause is hypoPTH (form surgery, thyroid dis, autoimm, developmental abn of PTH gland.

129
Q

hypoCalcaemiaDisp

A

Calcium-vitD tablet, Complications: seizures, arrhytmias, cataracts, bone #

130
Q

hypoCalcaemiaDx

A

dec GCS, chest pain, palpitations, dec BP, abn ECG

131
Q

hypoCalcaemiaEx

A

hyperreflexia, tetany, Trousseau’s (ie spasm of hand from inflated BP cuff for 3-5min), Chovstek’s (uni and ipsilat twitch of face from tapping the facial nerve 2cm anterior to audiory meatus), dec BP, bradycardia, arrhytmia, concern is tetany –> laryngospasm

132
Q

hypoCalcaemiaHx

A

carpopdeal spasm, twitching of muscle, tingling around mouth, distal paraesthesia, fatigue, depression, dry skin, coarse hair,

133
Q

hypoCalcaemiaIx

A

UEC, CMP, Albumin, ALP, PTH, VitD, ECG: prolonged QT, ST abn, arrhytmias

134
Q

hypoCalcaemiaPatho

A

loss from ECF is greater than replacement from intestines and bones. Concern is laryngospasm!

135
Q

hypoCalcaemiaPhys

A

albumin binds 40% of ecf Ca, so need to correct. Levels controlled by vitD and PTH

136
Q

hypoCalcaemiaRx

A

if severe tetany: 10ml 10% ca gluc over 10min. correct other elec deficiencies, if mild/asymp - monitor. **Need to correct hypoCa before acidosis if that is present, bc correcting acidosis w bicarb will make the ca fall even further

137
Q

hypoKalaemiaDDX

A

Decreased intake (K-free IV fluids, reduced oral intake). Excessive loss from Renal, GI, Endocrine. Renal (diuretics, renal tubular disorders). GI (diarrhoea, vomiting, fistulas, laxatives, villous adenoma). Endocrine (cushing’s syndrome, steroids, hyperaldosteronism, alkalosis)

138
Q

hypoKalaemiaHx

A

chest pain, palpitations, muscle weakness, myalgia, constipation, paralytic ileus, cardiac arrhytmia (ranging from ectopics to serious arrhytmias), hypotonia

139
Q

hypoKalaemiaIx

A

UEC, BSL for DKA. ABG for metabolic alkalosis. ECG (flattened T, ST dep, U waves, prolonged QT). CMP (look for decrease, as magneisum is required for adequate processing of K+). Plasma aldosterone (raised in Conn’s syndrome). Plasma renin (low in Conn’s). Cortisol (diurnal cariation lost in cushings). Urinary free cortisol (elevated in cushings). ACTH

140
Q

ketoacidosisAetiology

A

starvation, alcoholic, diabetic

141
Q

ketoacidosisHx

A

starvation, chronic alcoholic has binge then stops dirnking AND eating, GI sx (NV, abdo pain, haematemesis, melaena), magnesium low

142
Q

ketoacidosisPatho

A

ketoacidosis = high anion gap metabolic acidosis due to xs keton bodies (ie keto-anions) in the blood. these ketone bodies (acetiacetatem beta-hydroxybutyrate, acetone) are released into blood from liver when hepatic lipid metabolism has changed to increasing ketogenesis. Always either relative or absolute insulin deficiency

143
Q

leftAnteriorFascicularBlock(LAFB)Dx

A

LAD, ‘qR complexes’ in leads I and aVL, ‘rS complexes’ in leads II, III, aVF, QRS duration normal or slightly prolonged (80-110 ms), Prolonged R wave peak time in aVL > 45 ms, Increased QRS voltage in the limb leads

144
Q

legPainDDX

A

trauma (#, disloacations, crush injuries), inflammatory (RA, Reiter’s, ank spond), Infective (cellulitis, septic arthritis, myositis, osteomyelitis), degenerative (OA, meniscal lesions, baker’s cyst), vascular (intermittent claudication, DVT, acute arterial occlusion), Neurological (sciatica, peripheral neuropathy, neurogenic claudication), Metabolic (Gout), Neoplastic (osteogenic sarcoma, secondary deposits), Other (cramp, PMR, strenous exercise)

145
Q

legSwellingDDX

A
  1. Local swelling. 1a) Acute (trauma, DVT, cellulitis, RA, Allergy) 1b) Chronic. Varicose veins, venous obstruction (eg pregnancy, pelvic tumor, post-phlebitic limb), Dependency, lymphoedema, congential malformation (eg AVfistulae), paralysis (failure of muscle pump) 2. General swelling (CCF, hypoprotein(eg liver fail, nephrotic syndrome, malnutrition), renal failure, fluid overload, myxoedema)
146
Q

legSwellingDx

A

pain, trauma, recent pregnancy, abdominal or pelvic malignancy, prev surgery, radiotheraphy to lymph nodes, thyroid disease, failures (heart, liver, renal), malnutrition, poliomyelitis in childhood, nerve lesions

147
Q

liverFunctionTests(LFTs)DDX

A
  1. AST/ALT 2:1, normal ALP, inc GGT, macrocytosis = alcoholic liver disease. 2. AST inc +++, ALT + = acute viral hepatitis 3. AST, ALT LDH increase = ischaemic hepatitis 4. ALP and GGT ++ = cholestasis
148
Q

maisonneuveFractureAnatomy

A

This is a combination of spiral fracture of the proximal fibula and ankle injury which could manifest by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism.

149
Q

malignancyHx

A

b-symptoms (night sweats, fevers, LOW), LOA, fatigue, malaise, TBA

150
Q

meningitisEx

A

petechial haemorrhages, kernig’s sign (pain on extending knee whilst hips flexed)

151
Q

meningitisHx

A

photophobia, neck stiffness

152
Q

meningitisIx

A

CT urgent and prior to LP if suspicion of inc ICP

153
Q

metastaticCancerToBoneNote

A

The bone is one of the most common sites of metastasis. A history of cancer (excluding nonmelanoma skin cancers) is the strongest risk factor for back pain from bone metastasis. Among solid cancers, metastatic disease from breast, prostate, lung, thyroid, and kidney (BPLTK) cancers account for 80 percent of skeletal metastases

154
Q

migraineHx

A

preceeding aura, unilateral, throbbing headache, photophobia, precipitants (cheese, red wine, chocolate), flashing lights, NV,

155
Q

mitralStenosisEx

A

malar flush, arrhytmia, mitral area reveals loud first heart sound, mid-diastolic rumbling, accentuated by expiration in left lateral position

156
Q

mitralStenosisHx

A

sob

157
Q

mitralStenosisRf

A

rheumatic fever

158
Q

nephroticSyndromeDx

A

Def: proteinuria (>3g/24h), hypoalb (

159
Q

nephroticSyndromeEpi

A

Oedema (periorbital, peripheral, genital). Ascites (Fluid thrill, shofting dullness)

160
Q

nephroticSyndromeHx

A

SWELLING face, abdo, limbs, genital. Symptoms of UNDERLYING disease (eg SLE). Symptoms of COMPLICATIONS (renal vein thrombosis, loin pain, haematuria)

161
Q

nephroticSyndromeRf

A

fam hx of renal disease / atophy

162
Q

nephroticSyndromeRx

A

Oedema (FR 1L/day, Na restriction, diuretics, oral/IV). Cause (minimal change GN = steroids, immunosup). Monitor (BP, UEC, FBalance). VTE prophylaxis (Heparin/Clexane)

163
Q

nephrotoxicDrugsNote

A

tba

164
Q

neuroCNEx

A

1 - not tested. no subjectively reported anosmia / decreased taste sense, 2-

165
Q

normalRangeOfMovement(ROM)Note

A

tba

166
Q

oesophagealSpasmHx

A

pain worse with swallowing

167
Q

opioidConversionRx

A

tba

168
Q

OSAHx

A

day-time sleepy, morning headache, snoring, breath-gasping during night / nocturnal choking, disturbing partner during sleep, silence followed by loud snoring

169
Q

OSARf

A

age, male, obese, craniofacial/upper airway soft tissue abnormalities, OTHER (smoking, nasal congestion, menopause, fam hx, comorbs(pregnancy, end-stage renal dis, CHF, chronic lung disease, stroke)

170
Q

otitisExternaDisp

A

ENT clinic for formal Aural toilet. Direct ENT referral if severe and painful occlusion.

171
Q

otitisExternaEpi

A

Any age group. 10% in lifetime. 5-14years commonest. More likely in summer.

172
Q

otitisExternaEx

A

pinna pulling worsens pain, erythema, oedema, debris and drainage in the canal, desquamation. Otosocpe: The tympanic membrane may be erythematous in external otitis and only partially visible due to canal edema.

173
Q

otitisExternaHx

A

pain, pruritus, discharge, oedema, hearing loss

174
Q

otitisExternaIx

A

clinical dx, consider malignancy only if persistent case or otalgia out of proportion (CT/MR)

175
Q

otitisExternaPatho

A

Infectious (commonest), allergic, dermatologic. P. aeruginosa (38 percent), S. epidermidis (9 percent), and S. aureus (8 percent). Swimming RF because excess moisture –> skin maceration and breakdown of the skin-cerumen barrier, changing the microflora of the ear canal to predominantly gram-neg bacteria.

176
Q

otitisExternaRf

A

Recent water exposure, Instrumentation of the auditory canal (eg cotton buds), trauma, canal occluding devices (hearing aids, earphones, or diving caps), allergic contact dermatitis, psoriasis, atopic dermatitis, prior radiation therapy (as it may have cause ischaemic ear canal), any known tympanic membrane perforation, previous ear infections, any prior ear surgery.

177
Q

otitisExternaRx

A

1) Clean thoroughly (eg remove debris) 2) Treat inflammation and infection (eg abx ear drops, and wick to ensure in the canal, +/- steroids) - fluoroquinolones ofloxacin and ciprofloxacin good cover of both pathogens P.aeruginosa and S.Aureus 3) Analgesia, 4) Avoid promoting factors, 5) Follow-up and culture recalcitrant cases / consider DDX

178
Q

otitisExternaSyn

A

Swimmer’s ear / external otitis

179
Q

otitisMediaEx

A

Otoscope: Air-fluid level along the tympanic membrane is indicative of a middle ear effusion and underlying otitis media

180
Q

paget’sDiseaseOfBoneIx

A

ALP increased

181
Q

painDx

A

site, onset, character, radiation, association, time course, exacerbating/relieving factors, severity

182
Q

palpitationsDDX

A

Sinus Tachycardia (anxiety, emotional stress, caffeine, nicotine, etoh), Cardiac Arrhytmias (ectopic beats, PVCs or PACs, AF, SVT, VT)

183
Q

palpitationsEx

A

ideally done during attack, listen for HR - not just palpate radially, BP, screen for underlying cardiac disease (eg MVP which is assoc w SVT and Afib)

184
Q

palpitationsHx

A

what was felt (pounding, galloping or fluttering), frequency, regular or irregular (think ectopics or afib), precipitants, onset and offset (abrupt = SVT. Arrhythmia upon standing up straight after bending over and ending when lying down = AVNRT. Terminating post carotid sinus massage or other vagal maneuvers (eg Valsalva) = SVT, AVNT), tap out the rhythm on table/bed, light-headedness, dizzy, syncope (assoc w serious arrhytmias), chest pain, sweating, sob, age of first onset,

185
Q

palpitationsIx

A

Bloods: rule out anemia and hyperthyroidism. ECG: for conduction defects or enlargement or ischaemic changes, ambulant ECG monitoring if high risk

186
Q

palpitationsNote

A

DEF: Palpitations are a sensory symptom. They are defined as an unpleasant awareness of the forceful, rapid, or irregular beating of the heart

187
Q

pancreatitisScore

A

Ranson: On admission WBV>16, age>55, BGL>10, AST>250, LDH>350 48hours into admission: Hct drop>10% from admission +++

188
Q

pericarditisAetiology

A

Assocxiated with AMI, 2-6weeks post AMI = dressler syndrome, viral (coxsackie B virus, HIV), bacterial (pneumonia and/or septicaemia), TB (especially in HIV pts), locally invasive carcinoma, rheumatic fever, uraemia, collagen vascular disease (SLE, polyarteritis nodosa, RA), after cardiac surgery or radiotheraphy, drugs (hydralazine, procainamide, methyldopa, minoxidil)

189
Q

pericarditisAnticipate

A

pericarditis and myocarditis goes together often. Determine the cause of the pericarditis

190
Q

pericarditisDx

A

chest pain, low grade fever, pericardial friction rub

191
Q

pericarditisHx

A

sharp, retrosternal, radiating to the back, worse on inspiration, pain can be worse with swallowing, pain worse on deep inspiration/lying flat/raising both legs (ie inc venous return), releaved by sitting up, but may be transient

192
Q

pericarditisIx

A

cardiac monitor, bloods, card enzymes, viral serology, ECG (tachy, concave ST elevation, PRi depression, later: T wave flattens, becomes symmertrical inverted. Decreased voltage = effusion. electrical alternans suggests pericardial effusion), CXR (but need >250mls of effusion to see card enlargment)

193
Q

pericarditisRx

A

NSAIDs (colchicine 1mg BD +/- Pred 50mg PO or Dexamethasone4mg PO/IV for pain control)

194
Q

pneumoniaAetiology

A
  1. CAP (s.pneum, h.inf, mycoplasma.pneumonia. remainder = s.aureua, legioneela, moraxella catarrhalis, chlamydia). viruses = 15%. 2. HAP (gram Neg enterobacteria ro s.aureus. Also consider pseudomonas, klebsiella, bacteroides, clostridia) 3. aspiration (stroke, myasthenia, bulbar palsies, dec GCS, oesophageal disease, poor dental hygiene can aspirate oropharyngeal anaerobes 4. immunocompromised pts ( s.pneumo, h.inf, s.aureus, m.catarrhalis, M.pneumo. G Neg bacilli, pneumocystis jiroveci. Others = fungi, viruses, mycobacteria
195
Q

pneumoniaDx

A

acute LRTI + fever + chest symptoms + abn CXR

196
Q

pneumoniaHx

A

Where and who (as determines pathogen) - cap, hap, aspiration, immunocompromised

197
Q

pneumoniaScore

A

SMART-COP (age cutoff at 50 alters scoring slightly): SBP25 in young and >30 in old = 1, HR>125 = 1, acute confusion = 1, oxygen low sats or PaO2 or PaO2/FiO2, 93 or 90% = 2, pH 7mmol/l, RR >30, Low BP (

198
Q

pneumoThorax(PTx)Disp

A

advice as per BTS guidelines, which consists of i) Patients should be advised to return to hospital if increasing breathlessness develops, ii) Follow up by respiratory physicians until full resolution, iii) Air travel should be avoided until full resolution or 6weeks, and iv)Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.

199
Q

porphyriaHx

A

Acute attacks precipitated by drugs (barbituates, oestrogens, progesterones, etc). Other precipitants = etoh, smoking, sudden dieting, stress, abuse, pregnancy. Abdo pain. Peripheral neuropathy (predominanetly motor). Tachycardia, HTN, Postural hypotension. Hyponatraemia, psychiatric manifestations (eg agitation, depression, mania, hallucinations)

200
Q

porphyriaIx

A

hyponatraemia, fresh urine sample protected from light to test for amino laevulinic acid and porphobilinogen concentrations. In acute attack, the urine goes dark red/brown, if exposed to light

201
Q

porphyriaPatho

A

haem biosynthesis disorders in which enzyme deficiencues > porphyrin accumulation and their precursors.

202
Q

porphyriaRx

A

supportive. CHO intake. careful attention to antiseizure mx as many drugs as CIed in acute attacks

203
Q

pulmonaryEmbolismEx

A

inc JVP, tachypnoea,cardia, hypotension, RV heave. pleural rub

204
Q

pulmonaryEmbolismHx

A

sob, pleuritic chest pain, haemoptysis, dizzy, leg pain

205
Q

pulmonaryEmbolismIx

A

ECG (tachy, RBBB, TWI in V1-4, S1Q3T3). D-dimer Wells=

206
Q

pulmonaryEmbolismScore

A

Wells score (DVT signs - ie leg swelling and pain on deep vein palpation = 3, PE most likely dx = 3, HR>100 =1.5, >3d immob/surgery in last 4/52 = 1.5, prev DVT/PE = 1.5, Haemoptysis = 1, malignancy (current rx, palliated) = 1.

207
Q

pulmonaryOedemaHx

A

pink sputum, sob recumbent,

208
Q

radiculopathyDx

A

Radiculopathy = Sx or impairments related to a spinal nerve root. May be due to degenerative changes in the vertebrae, disc protrusion, and other causes. As the root varies, the sx varies, but >90% are L5 and S1 radiculopathies

209
Q

raisedIntraCranialPressure(ICP)Aetiology

A

tumoru, hydrocepahlus, cerebral abscess, benign intracranial HTN

210
Q

raisedIntraCranialPressure(ICP)Ex

A

papilloedema (on fundoscope), loss of retinal nerve pulsation

211
Q

raisedIntraCranialPressure(ICP)Hx

A

bursting pain, worst in morning, changes with position/cough/sneeze

212
Q

RBBBIx

A

M in V1, W in V6

213
Q

refeedingSyndromePatho

A

biochemical dysfunction aw the reinstitution of calorific intake in malnourished pts. may present in numerous ways. decreased electrolyes (mg, ca, glucose, thiamine), usually within 4days of startin refeeding. shift from fat to CHO metabolism –> inc insulin secretion. ins leads to cell uptake of phosphate and K cauing the serum levels of these to drop. decreased ATP in the metabolic pathway and decreased 2,3DPG in erythrocytes = tissue hypoxia and impairement of myocardial contractility

214
Q

refeedingSyndromeRx

A

prevent, measure K, phos, mg, ca, replace electrolytes, thiamine, multivitamine, calories gradually

215
Q

refluxOesophagitisDisp

A

endoscopy for H.Pylori testing

216
Q

refluxOesophagitisHx

A

pain worse with swallowing

217
Q

reitersDiseaseHx

A

conjunctivits, urethritis

218
Q

salicylatePoisoningHx

A

V, tinnitus, deafness, sweating, vasodilation, hyperventilation, dehydration. Severe=coma, convulsions. Rare features=non-card APOD, cerebral oedema, renal failure

219
Q

salicylatePoisoningIx

A

hypokalaemia. hyperpyrexia and hypoglycaemia (particularly in children)

220
Q

salicylatePoisoningPatho

A

aspirin = 300mg acetylsalicylic acid. 150mg/kg =mild toxicity. 500mg/kg = severe/possible fatal toxicity. Can get poisoning from absorption through the skin

221
Q

sickleCellCrisisHx

A

preceeded by hypoxia/ischaemia situations (eg infection, dehydration, etc) or de novo.

222
Q

sickleCellDiseasePatho

A

mutation > Hgb abnormality. deoxygenation and acidosis > sickling > increased blood viscosity > sludging > stasis (stasis is again the basis)

223
Q

socialHxHx

A

home: who live with, kind of house, any help, own ADLs (eg cooking, dressing, washing), mobility: walking aids, exercise tolerance, climb stairs, lifestyle: occupation, etoh, smoking, rec drugs

224
Q

spinalEpiduralAbscessHx

A

Initial symptoms (eg, fever and malaise) are often nonspecific. over time, localized back pain may be followed by radicular pain and, left untreated, neurologic deficits

225
Q

spinalEpiduralAbscessRf

A

Risk factors include recent spinal injection or epidural catheter placement, injection drug use, and other infections (eg, contiguous bony or soft tissue infection or bacteremia). Immunocompromised patients may also be at higher risk.

226
Q

spleenAnatomy

A

1×3×5×7×9×11 rule. The spleen is 1” by 3” by 5”, weighs approximately 7 oz, and lies between the 9th and 11th ribs on the left hand side

227
Q

spleenPhys

A

large lymph node, blood filter, red blood cells (removes old ones and holds reserve), immune system, recycles iron

228
Q

spleenRuptureEx

A

tachycardia, hypotension, abdo tenderness, pain referred to Left shoulder/shoulder tip

229
Q

spleenRuptureHx

A

rib fractures recently, enlarge spleen recently (eg EBV, malaria, leukaemia) + trauma to the area. Acute rupture versus Delayed (up to 2/52 post trma)

230
Q

spleenRuptureIx

A

CXR (for ?fractured ribs ?basal pleural effusion). Abdo US and/or CT. AXR is not helpful. (although if done, may see displaced stomach bubble to the right, and enlarge soft-tissue shadow in splenic area)

231
Q

spleenRuptureRf

A

left lower rib injuries following trauma (associated with splenic damage in 20% of cases). Occasionally there can be injury to an already enlarged spleen (ie from glandular fever, malaria, leukaemia, etc)

232
Q

subarachnoidHaemorrhage(SAH)Hx

A

neck stiffness

233
Q

subarachnoidHaemorrhage(SAH)Rf

A

berry aneurysm

234
Q

subduralHaemorrhage(SDH)Ix

A

CTB: most common in parietal region. crescent along the inner table of the skull, effacement of ipsilateral ventricle, midline shift

235
Q

subduralHaemorrhage(SDH)Rf

A

elderly (given decreased resilence of bridging veins), cerebral atrophy (ie elderly and alcoholics - given the increased tension on veins)

236
Q

syncopeDisp

A

SFSS: (San Francisco Syncope Score) to determine risk of serious adverse outcomes. CHF, Haematocrit

237
Q

syncopeEx

A

postural BP

238
Q

syncopeHx

A

presyncopal sx (palpitations, )

239
Q

systemsReviewHx

A

CVS: CP, palp, SOB, ankle swelling, orthopnoea. RESP: Cough, sputum, wheeze, SOB. ABDO: pain, NV, bowel habits, stool colour and consistency, distension, dysuria, frequency, urgency, haematuria. NEURO: headache, photophobia, neck stiffness, weakness, change in sensation, balance, fits, falls, speech, changes in vision/hearing. SYSTEMIC: appetite, weight loss / gain, fever/night sweats, malaise, stiff/swollen joints, fatigue, rashes/itch, sleep pattern

240
Q

temporalArteritisEx

A

tender along course of superficial temporal artery, absent pulsation

241
Q

temporalArteritisHx

A

localised pain over artery, jaw claudication, throbbing headache

242
Q

temporalArteritisIx

A

ESR raised

243
Q

tensionHeadacheHx

A

tight band

244
Q

transientIschaemicAttack(TIA)Rf

A

ABCD2 score (admit if 5 or more) to predict risk of stroke in short-term. Age > 65 (1 point) BP >140/90 (1 point) C symptoms = Hemi = 2 points, Dysphasia (2 points) Duration - >1hour (1 point) Diabetes (1 point)

245
Q

tuberculosisEx

A

nail clubbing,

246
Q

tuberculosisHx

A

LOW, LOA, flecks of blood on sputum, night sweats, cough, fever, chills,

247
Q

tuberculosisPatho

A

infection (pulm or extrapulm), usually caused by mycobacterium tuberculosis, latent and active stages

248
Q

urinaryTractInfection(UTI)Aetiology

A

75-90% E.Coli. Next is Staphylococcus saprophyticus… klebsiella…proteus mirabilis CLASSIFICATION: Simple (typically young and not pregnant with normal urinary tract) vs complicated (abn anatomy, urinary obstruction or incomplete emptying (eg due to instrumentation/catheter/pregnancy/underlying disease eg diabetes)

249
Q

urinaryTractInfection(UTI)DDX

A

CYSTITIS (lower tract) = dysuria, freq, suprapub discomfort, +-/ macro haematuria, no vag discharge. PYELONEPHRITIS: loin pain, fever, chills, urinary symptoms. URETERIC CALCULUS + INFECTION: severe pain++. Be suspiscious as this could lead to sepsis + permanent injury to the kidneys.

250
Q

urinaryTractInfection(UTI)Epi

A

Femals: by 32 years of age, 50% of women will report at least one UTI. Males: bacteruria beyond infancy = 0.1%. increases to around 3.5% with prostatic disease. 15% in hospitalised men >70yo. Homosexual at increased risk

251
Q

urinaryTractInfection(UTI)Hx

A

dysuria, frequency, haematuria, suprapubic tenderness, discharge. IN ELDERLY:, institutionalised pts, non-specific sx + decline correlates POORLY with UTI despite pyuria and bacteriuria –> find another cause. IN MEN: the most common cause of recurrent lower tract UTI = prostatitis, so look for evidence like chills, dysuria, prostaic tenderness.

252
Q

urinaryTractInfection(UTI)Ix

A

for most outpatient women with typical symptomatology, cultures not needed

253
Q

urinaryTractInfection(UTI)Rf

A

sexual activity is the most important RF in young women, previous UTIs, cathether, homosexual men

254
Q

urinaryTractInfection(UTI)Rx

A

ONLY treat asymptomatic bacteriuria in pregnant women and those about to have significant urological procedures

255
Q

wegnersGranulomatosisEx

A

loss of nasal bridge, saddling of nose

256
Q

wegnersGranulomatosisHx

A

haemoptysis, epistaxis, renal disease

257
Q

wegnersGranulomatosisIx

A

c-ANCA

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