The forgotten facts Flashcards
(195 cards)
1
Q
Paracetamol OD defined as:
A
> 4g // 0.75mg/kg
PER HOUR
2
Q
Aspirin OD defined as:
A
> 6.5g // 150mg/kg
PER HOUR
3
Q
Epidural nerve orders
A
Usually 3rd first
Then 6th when bad
Cushings triad if posterior fossa
4
Q
What is cushings triad?
A
Bradycardia
Irregular RR
Hypertension
5
Q
What do you see on an epidural CT?
A
Bright
Lentiform spreading
Think Epidural = extradural = EXTRABRIGHT
6
Q
Classification AKI
A
Creatinine >26.5mmol / 1.5x baseline
<0.5ml/kg/hr UO
7
Q
What does it imply if Urea:creatinine ratio >20 in AKI?
A
Pre renal cause
8
Q
What happens to K+ in AKI?
A
GOES UP
Less excreted
9
Q
Causes of Heart Block
A
BBs, CCBs, adenosine, anti-arrythmias
Purkinje disease
50% age related
10
Q
What ABPI signifies PVD?
A
<90
11
Q
What is DCM?
A
Cardiomyopathy with LV dilation and systolic dysfunction in the absence of CAD
12
Q
What is RCM?
A
Restrictive physiology but normal wall thickness - impaired filling
13
Q
HCM
A
Inherited, sudden death, systolic dysfunction with a hypertrophic physiology. NON dilated
14
Q
What are the causes of constrictive pericarditis?
A
Infectious - Viruses = coxsackie, mumps, rubella, varicella, CMV, EBV
Inflammation = RhA, SLE
Post transmural MI
20s-40s often
15
Q
Name the IE culture negative bacteria?
A
HACEK
Haemophillus, Actinobacter, Cardiobacter, Eschenella, Kigella
16
Q
What is phlegmonas cerulae dolens?
A
Impingement of arterial supply of limb by malignancy
17
Q
What are the causes of MR?
A
IE, Rheumatic fever, deg dysfunction, MVP, HOCM, LV dilation, papilliary muscle dysfunction
18
Q
Causes of MS
A
Primary cause Rheumatic fever - streptococcal
19
Q
How is myocarditis diagnosed?
A
Picture may often resemble ACS - ST el, raised troponins, CKCKMB
Normal coronary angiograms -> absence evidence CAD
20
Q
What is VT caused by low K+/MG2+ called?
A
Torsaides de points
21
Q
What is IPHPT defined as?
A
> 25mmg at rest or wedge pressure >1.5
22
Q
Mutation in IPHTN
A
BMPR2
23
Q
What do you see on CXR with IPHTN
A
Inc pulmonary artery shadowing
Vascular “pruning”
24
Q
What diameter varicose vein
A
4-5mm
25
Arrest what do yea do
CPR and adrenaline
Shockable = magnesium sulfate + amiodarone - defib
Non shock = atropine 1mg IV 3-5 mins (3x max)
26
Amyloidosis forgotten Ix
Think "immuno"
Serum/urine immunofixation = presence of monoclonal proteins
Serum free light chain assay + BM biopsy = abnormal kappa:lambda
27
What are the Ix for dermatomyositis?
Muscle biopsy = atrophy
In CK and aldolase
EMG - dec
28
Antiphospholipid symptoms aside from thrombosis
| CPOT
Clots, Proteinura, Oedema, Thrombocytopenia
29
behcets
PATHERGY
30
Spondylosis. When UMN signs, when LMN?
Affecting S/C = UMN - ie compression/narrowing of foramina - herniation
LMN = affecting roots - radiculopathy
31
What is fever more likely in, gout or pseudo
Pseudo
32
Bloody aspirate, gout or pseudo
Pseudo
33
What is laseage sign?
Sciatica = straight leg rise causes nerve pain = nerve root affected
34
What is the main bacteria - osteomyelitis
Staph a
35
What do you see on a plain radiograph with osteomyelitis?
DARK
36
Precipitating cause for reactive
Chalmidyal GU/ GI infections
37
Reactive A, large or small Joints
Big joints
38
Stiffness > 1hr
Inflammatory
39
What are the abs in Rheum A?
Anti CCP / RF
40
Sarcoid granulomas
Non caseating
41
ACE and ca up
Sarcoid
42
Sjorgens
lymphocytic infiltration of the lacrimal and salivary glands
43
What is the paper eye test called?
Shirmers test
44
Antibodies in sjorgens
Anti 60 KD ro and anti LA
45
Prostate >80g
Prostectomy
46
Prostate <80g
TURP
47
CKD creatinine levels Men vs Women
Men >97mmol = 1.1mg/dl
| Women >105mmol = 1.2 mg/dl
48
CKD features
Microalbuminuria 30-300mg
Creatinine >97/105mmol // 1.1/1.2mg/dl
3 months <60mls/min
49
PKD inheritance
AD OR AR
| AD more common
50
What are the 4 Hs of PKD?
HTN, Haematura, Headaches, Hepatosplenomegaly
+ flank pain
+ increased UTI - LUT symptoms
Inc SAH risk
51
Hyper or hypo K+ in RAS?
Hypokalaemia - INC Ang2 to meet GFR -> inc aldo
52
What does aldosterone : renin ratio >20:1 mean
Connor
53
What does aldosterone:renin ratio <20:1 mean
RAS
54
What are the UTI Rx steps?
Levo/ciprofloxacin -> trimethoprim -> nitrofurantin
55
What abx is commonly used in renal stones?
Trimethoprim
56
What is glomerulonephritis?
Inflammation of BM + capillaries
| Most common cause ESRD
57
What do you see in urinalysis of glomerulonephritis
Haematuria, schistocyes, proteinuria (typically <3.5g/day), leucocytes
58
What goes bad glomerulonephritis result in
Nephrotic/nephritic
59
Dec Mg and citrate predisposes to what?
Kidney stones
60
Non contrast helical CT doesn't pick up what stones?
Urate indonavir
61
HUUUUUGE unbreakable stone
Percutaneous nephrolithotomy
62
<10mm stone
Let it pass
63
Advice for recurrent stones
Increase water, citrus fruits
Dec protein, sodium, oxalate
Many respond to alkalinisation with potassium citrate
64
5 common stones
Citrate, calcium, urate, oxalate, struvite
65
Nephrotic syndrome
>3.5 g day, peripheral oedema, hypoalbuminaemia
66
Nephritic syndrome RAH
Renal dysfunction (acute), Active urinary sediment, HTN
67
Nephrotic causes
Minimal change nephropathy (kids)
FSGS, diabetic nephropathy
Ass with thrombosis + hyperlipidaemia
68
Cellulitis presumptive treatment
Vancomycin
69
Most common causes of cellulitis
Staph A
| B haemolytic
70
What is erysipelas?
Cellulitis + LNs
71
What are the EBV antibodies?
EBVEBNA, VCA-IgG, VCA-IgM, Heterophile antibodies
72
What are the symptoms of falciparum?
SAJ
| Seizures, Anuria, Jaundice
73
Rx VCZ
Paracetamol + diphenhydramine -> acyclovir
74
Main cause of Rheumatic fever
Group A streptococcus
75
Red Flags headaches:
```
Onset of new sensation headache >50yo
Thunderclap
Worse upon awakening (ICP)
Headaches with exertion
Positional Headaches
Constant headache in same region
Substantial change in headache
Systemic symptoms
Focal Neurological signs
Headache in morning with vomiting
```
IF associated vertigo = possibility of tumour - mimic BPV
76
Carcinoid investigations
Serum chromogranin A/B
Urine hydroxyindolacetic acid
Pet/CT
inc U+C in dehydration
77
Cushings Ix
Dex sup >50nmol
| Morning ACTH >0.4 (dis)
78
DI investigations
3L 24hr urine
Urine osmolairty <300
Water dep testing
79
NR for urine osmolarity
300-900
80
T1DM HLA
DR/DQ
81
What levels HbA1c and BG required for polyuria and dipsia
>16.6mmol BG
| HbA1c >95
82
Diffuse uptake
Graves
83
Pagets Ix
Bone scan - inc uptake
X-ray - lyric early, sclerotic late
ALP inc (bone >40)
Serum procollagen 1 N terminal peptide - INC
Serum C terminal propeptide of type 1 collagen
Biopsy - osteoclasts = multinucleated
84
LH/FSH ratio PCOS
>3 (in 2/3rds)
85
USS signs PCOS
>12 follicles + inc endometrial thickness
86
Conns fludro sup test
Fails to suppress to <6ng
87
A:R ratio CONNS
>100 typically, but >20 confirms conns>RAS
88
SIADH serum osmolarity
<280
89
Rx of dec GCS SIADH
Furosemide, hypertonic saline (2hrly Na checks)
| 2nd = tolvaptans
90
Abdo pain
| Common in stomach cancer YAY or NAY
YAY
91
Cholangiocarcinoma - ob J or hep J?
Either. Can arise in CBD or intrahepatic BDs
92
What is a Klatskin tumour?
Tumour arising from bifurcation of ducts in liver
93
Cholangiocarcinoma tumour markers?
CEA CA19-9 CA125
94
Painless jaundice cancer
Cholangio>panc
95
Gastric carcinoma symptoms
WL, LN, Pain
96
Endoscopic USS helps with what in Gastric carcinoma?
Tumour and Node staging
97
HPC RFs
Any inflammation
98
AFP increased in
HPC + testicular
99
LFTs in HPC?
ALL UP inc biliary
100
Tumour lysis symptoms
Hypocalcaemia - tetany, paraesthesias, spasms, weakness, chvosteks/trousseaus
HyperUric/Phos - NV diarrhoea
Hyperkalaemia - arrhythmias - syncope, chest pain, dyspnoeam seizures
101
Sides % testicular cancer
55% RS, 2% bilateral, 43% LSr
102
Mesothelioma RFs
BAP1 + simian virus 40
103
Pancreatic carcinoma precursor
IPMN intraductal papilliary mucinous neoplasm
104
S+S of pancreatic
Causes OB J @ head
WL, anorexia, abdo discomfort
COURVOUSIERS = PALPABLE PAINLESS GALLBLADDER
105
What is the 1st imagery Ix for pancreatic carcinoma
USS abdo
106
RCC paraneoplastic syndrome
Dec HB, Inc RBCs
107
S+S of RCC
Flank pain, FLAWs, Haematuria, lower limb oedema, VARICOCELE (Rsided often)
108
What is def of febrile neutropenia
>38 fever
ANC <500
or ANC <1000 pred NADIR <500
109
Tumour markers for colon cancer
CEA Ca19-9
110
Papillary thyroid carcinoma mutation
BRAF for the ppl
111
FolliculAR thyroid carcinoma mutation
PPAR
112
mEdullary carcinoma mutation
RET
113
Hep DNA virus
B
114
Hep RNA virus
C
115
Most useful investigation chronic pancreatitis
ERCP
116
What does ERCP show with chronic pancreatitis
beading of the main pancreatic duct as well as irregularities in the side branches
117
Huge testicles and ears, trinucleotide expansion, congenital
"Fragile Balls" - Fragile X
118
Small testicles, gynaecomastia, congenital
Kleinfelters - think klein = small and he had tits
119
Polydactyl trisomy 18
Edwards
120
Cardiac silhouette
Pericardial effusion
121
Rusty sputum
Strep pneumoniae
122
Preferred initial therapy generalised seizure
IV lorazepam
123
1st line status epilepticus
IV lorazepam
124
Purpuric rash meningitis
Meningiococcal
125
HRT RF for
Breast and endometrial cancer
126
What is dressler's?
A/i process with myocardial neoantigens 2-3weeks post MI, inc ESR sharp pain fever
127
What grows on MacConkey in Qs
Pseudomonas
128
G-ve motile spiral shaped rods
Campylobacter
| Spiral = straight as a corkscrew = CAMPylobacter
129
Felty's
RA, splenomegaly, pancytopenia
130
What is Beri beri (short)?
B1 def
131
What occurs in wet beri beri?
High output HF, peripheral oedema, vasodilation and orthopnoea
132
What is shosin beri beri?
Also a wet beri beri
| Low output HF, lactic acidosis, peripheral cyanosis
133
What is neurogenic shock?
distributive shock due to spinal or brain stem injury
134
What is spinal shock?
Hypotonia and flaccidity that resolves in 24 hours
135
Dermatomes L2
Front of thigh
136
Dermatomes L3
Knee
137
Dermatomes L4
Inner calf
138
Dermatomes L5
Outer calf
139
Dermatomes S1
Little toe
140
Dermatomes S2
Bottom of heel
141
Dermatomes C4
Shoulder
142
Dermatomes C5
Bicep c5 keeps the guns alive
143
Dermatomes c6
Thumb
144
Dermatomes C7
Middle finger
145
Dermatomes c8
Little finger
146
List all arm Dermatomes
```
C4 = shoulder
C5 = bicep
C6 = thumb
C7 = middle finger
C8 = little finger
```
147
list all leg dermatomes
```
Thigh L2
Knee L3
Medial calf L4
Lateral calf l5
Little toe s1
Bottom of heel s2
```
148
Gilbert's inheritance pattern
95% recessive
| 50% carriers
149
Hep B antigens sAG only
Immunisation
150
Hep B surface antigen + anti HBs
Low infectivity carrier
151
Hep B eAG positive and anti HBe
High infectivity
152
Mallory denck bodies
Alcoholic liver disease
153
IV B1
Panbrinex
154
What is necrobiosis lipoidica?
Waxy yellow patches in diabetic pts
155
What percentage of asthma patients get ABPA?
1-2%
156
Where are the infiltrates in ABPA
Upper and middle
157
Hypersensitivity pneumonitis drugs
Methrotrexate, nitrofurantoin, rituximab
158
Morning headache in OSA
DDx for ICP potent
159
What is S1Q3T3?
Deep s v1, deep q v3, inverted T waves v3
160
Purpura, abdo pain, arthritis
Henoch-schonlein
161
Facial weakness, ear pain, vertigo, deafness, vesicles around ear and soft palate
Ramsey hunt
162
Herpes, measles a/i, idiopathic
| What can all these cause?
Achalasia
163
What percentage of acute cholangitis results from ERCP
1-3%
164
What percentage of acute cholangitis results from PSC
24%
165
Rx steps ALD
Pred 40mg > ascites Rx > TIPS > pentoxyfylline > transplant
| Lifestyle + immunisations + cessation
166
IMMA PBC
AMA PBC
167
Asthma anna has an a/i condition
ASMA ANA a/i hep
168
Most common causes appendicitis
E coli + b fragalis
169
Cheeky signs appendicitis
Obturator sign: The person being evaluated lies on her or his back with the hip and knee both flexed at ninety degrees. The examiner holds the person's ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the person's ankle away from his or her body while allowing the knee to move only inward. A positive test is pain with internal rotation of the hip.
Psoas sign, also known as "Obraztsova's sign", is right lower-quadrant pain that is produced with either the passive extension of the right hip or by the active flexion of the person's right hip while supine.
Rovsing's sign: Pain in the lower right abdominal quadrant with continuous deep palpation starting from the left iliac fossa upwards (counterclockwise along the colon).
Dunphy's sign: Increased pain in the right lower quadrant with coughing
170
Nod 1 / CARD 1
Crohns
171
RLQ pain IBD
Crohns
Affects
Ileum + colon > ileum > colon
172
Granuloma and ulcers
Crohns
173
Exclude what in bells?
B burgdorfi
174
Myesthenia gravis A/bs
ACHr, Striational, Muscle spec TK,
175
Mysethenia nerve stim
>10% decline in APs between 1+4th in a run of 10 at 2-3hz
176
NF inheritance
AD
177
Baby signs meningitis
Bulging fontanelle, high pitched crying, restlessness, extreme agitation
178
Empirical meningitis
Vanc and ceftriaxome
179
What CAG repeat is definite Huntingtons?
>40
180
Wernickes triad
gait ataxia, opthalmoplegia, mental state changes (seemingly rare for all 3)
181
TN causes
Abhorrent vascular loop
| MS
182
Classification Haemorrhagic stroke?
```
Prim = spontaneous - no precipitating disease/vascular malformation
Secondary = secondary to anatomical defect/disease ie tumour/cocaine/impaired coagulation
```
183
Differing symptoms in haemorrhagic stroke (as opposed to ischaemic)
Inc ICP signs seen - N+V. Also the progression worsens as the haematoma grows
184
What BP drug in haemorrhagic
Nifedipine
185
Non infused CT haemorrhagic appearance
Hyperdense lesion
186
Ct ischaemic stroke appearance
DARKNESS of brain parenchyma, BRIGHT vessel = thrombus
187
<4.5hrs isch
0.9mg/kg 10% bolus 90% infusion 1hr +/- stent/thrombectomy
188
SCC compression below L1/2
Gives LMN signs too
189
Chronic subdural - what ruptures?
Rupture of. Bridging cortical vein usually
190
+ve TdT staining
Lymphoblastic leukaemia
191
+ve myelperoxidase staining
Myeloblastic leukaemia
192
translocation in AML
15:17
193
Sickle cell what changes to what
Glut-Valine codon 6
194
Haptoglobin L/H in sickle?
LOW - used up. Binds to free Hb released in haemolysis
195
What is new vessel formation in the brain from occlusions called? (In sickle)
MOYAMOYA
