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TUT Flashcards

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1
Q

Splenomegaly

A

Has a notch
Non-ballotable
Can’t get above it
Moves inferior-medially
Enlarge towards umbilicus
Moves early on inspiration

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2
Q

Lower back pain (Red flags)

A

Neurological defect
Trauma
Previous surgery
Osteoporosis
Unexplained fever/weight-loss
Malignancy
Immunosuppression
Inflammatory nature of pain
Age (<20)
Prolonged use of corticosteroids

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3
Q

Acute onset or asthma

A

Cough
Wheeze
Increased Work of breathing
Restlessness
Anxiety
Hypoxia
Dyspnea
Tachycardia
Tachypnoea
Pulsus Paradoxs

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4
Q

Severe asthma

A

Exhaustion and fear
Inability to speak (Breathlessness)
Drowsiness (hypercapnia)
Cyanosis
Tachycardia (Hypoxemia)
Pulsus Paradoxs
‘Silent’ Chest

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5
Q

Left Ventricular Failure

A

Pulsus Alternans
Displaced, Dilated apex
S3
Bi-basal crackles

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6
Q

Pre-Renal failure (causes)

A

Dehydration
Shock
Sepsis
Drugs (NSAIDs, ACEi)

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7
Q

Pre-Renal failure (Dx/Signs)

A

Dehydration
History of [prev]
Mucosal membrane
Orthostatic HPT
Tachycardia
Urea: Creatinine ratio (7) (1:10)
Oliguria (improve with fluids)
Fraction excretion of Na (7)
Urine Na (<20 mm/mol)

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8
Q

TB on Abdo exam (Signs)

A

Weight-loss
Fever
Abdominal pain
Ascites
Hepatomegaly
Bowel obstruction
Diarrhea
Abdominal mass
‘Doughy’ abdomen

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9
Q

TB Abdo (Dx)

A

Ascites present = TB pleural effusion
SAAG <11
Lymphocytic with raised ADA
Ultrasound
Para-aortic lymph nodes
Micro-abscesses

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10
Q

Risk factors of Ischemic CVA

A

2nd(ary) = DM, HPT
Atherosclerosis (Angina, Claudification, Erectile dysfunction)
Previous Vascular event
Systemic (fever, arthritis, constitutional symptoms)

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11
Q

Lacunar stroke (Definition)

A

Lacunar infarcts are mostly caused by lipohyalinosis or microatheroma of a small penetrating endartery in basal ganglia or pons. Less than 25% of lacunar strokes are caused by large vessel artheroembolism.

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12
Q

Pericardial Effusion (Signs)

A

Absent apex beat
Muffled heart sound
Enlarged cardiac dullness

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13
Q

hypothyroidism

A

Face puffy
Skin (Cold, dry, rough) & Yellow discoloration
Hoarse voice
Bradycardia
Slow mentation
Slow reflexes
Concentration difficulties

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14
Q

S3

A

Rapid ventricular filling on opening of AV valves
Due to reduced ventricular compliance/diastolic overload
MI
TI
AI
VSD & PDA
Constrictive Pericarditis

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15
Q

S4

A

Due to high-pressure atrial wave reflected back from a poorly compliant ventricle
Atrial contraction with a “non-compliant” ventricle
Systolic overload/decreased compliance
AS
HPT & pulmonary HPT
HOCM (Hypertrophic Obstructive Cardiomyopathy)
Infarction/Ischemia
Acute AI/MI

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16
Q

3 Complications of TB on spine

A

Pott’s disease
Arachnoiditis
Transverse Myelitis

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17
Q

JVP vs Arterial

A

visible but not palpable
More prominent inward movement
Complex wave form
Moves on respiration (decreases on inspiration)
first obliterated than fills from above when light pressure is applied on the base of the neck

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18
Q

Bronchus carcinoma (Early disease detection)

A

Chronic cough
Blood stained sputum
LOW

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19
Q

Bronchus CA (direct invasion)

A

Chest pain
SOB
Hoarseness
SVC syndrome
Pathological fracture
Brain mets

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20
Q

Bronchus CA (paraneoplastic syndrome)

A

SIADH
HyperCa
Cushing’s
Hypoglycaemia
Acanthosis
Dermatomyositis

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21
Q

A good screening test

A

Cheap
Safe
Prevalence of the disease NB
Able to pick up pathology early (pre-symptomatic)
Treatable disease
Treatable with high mortality - sensitivity NB
Non-treatable - specificity NB

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22
Q

Paraneoplastic syndromes

A

not caused by direct infiltration of the malignancy. Effect is produced by hormones, cytokines or proteins secreted into circulation.
Weight loss, Fever (Unexpected)
First symptom of malignancy (when the primary is still to small to cause symptoms itself)
Signs of reccurrence

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23
Q

TMN Staging (Tumor)

A

T1 – <3cm
T2 – >3 cm
T3 – onto structures which can be surgically remove (ribbes)
T4 – less than 2cm from carina OR nodules in another lobe (same lung) OR onto structures that can not be surgically remove (aorta, pericardial, phrenicus)

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24
Q

TMN Staging (Nodes)

A

N1 – Hilar same side
N2 – hilar contralateral side / para-aortic
N3 - supraclavicular

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25
TMN Staging (Metastasis)
M0 – none M1a – malignant pleural effusion OR nodule in other lung M1b – distal mets (Brain, Adrenals, Bone)
26
possible explanations for SOB
Pleural effusion Pneumonia COPD
27
5 signs of cirrhosis in chronic alcohol user.
Palmar erythema Duputreyn’s Spider Nevi Gynecomastia Testicular atrophy
28
Features other than seen on motor exam which will indicate spinal lesion.
Flaccid paralysis sphincter impairment (bowel and bladder dysfunction) Sensory level
29
Secondary causes of HPT and a clinical feature of each
Coarctation of aorta = HBP Obstructive sleep apnea = Snoring Cushing's = central obesity Pheochromocytoma = headaches Renal parenchymal disease = familial hx of CKD Primary Aldosteronism = hypokalemia
30
Pleural effusion (CXR)
Typical effusion with Meniscus sign (concave shape) Pleural thickening (no typical meniscus sx, sharp angle), post TB
31
Signs of ILD
Cough (Dry) Clubbing Crackles (fine-insp. -> coarse) Progressive dyspnoea Decr. expansion Underlying connective tissue dx (SLE, RA etc.)
32
Confirm ILD
Bronchoscope Lung biopsy CXR PFT’s
33
Lacunar Presentations
Pure motor Hemiparesis Pure sensory stroke Ataxic-hemiparesis Dysarthria-clumsy hand syndrome
34
Cinical significance of being diagnosed with lacunar v MCA stroke
LCA (small disease atherosclerosis) you don't have to look for an embolic event whereas in MCA it could be an embolic event/phenomenon.
35
3 ECG features of pulmonary HPT
P. Pulmonale Dominant R-wave in V1 T-wave inversion V1-V3
36
Besides signs of bilateral UMN weakness, hyperreflexia, clonus and hypertonia, what other 2 features indicate a spinal cord lesion
Incompetence (bladder) UMN bladder Lhermitte's sign
37
Spinal TB (Potts Dx)
Infect vertebrae Collapse = pressure in spine + paraperisis X-ray = Disc body, Endplate, Adjacent vertebrae Malignancy: Vertebrae body (mostly) Final Dx: MRI UMN pattern
38
Arachnoiditis
TBM Exudate around spinal cord at lumbar & sacral Cause: dysfunction of nerve roots LMN pattern
39
Transverse Myelitis
Not true infection of chord Immunological reaction (Rheumatoid Fever) Antibodies -> demyelination of cord with Multiple Sclerosis like lesion = paraparesis Associated with inflammation of optic neuron & blindness ( Devic’s Disease)
40
Stable angina
Clinical dx Typical hx Patient with risk fx. Plaque but no rupture
41
Unstable angina
Typical Hx ECG change No enzyme leak Rupture of atheromatous plaque
42
What are the important aspects/features on History, Signs and Investigations which could lead to a diagnosis of Diabetic Nephropathy?
Foamy urine Chronic Hyperglycemia Chronic kidney dx features (HPT) Nephrotic syndrome rapid progressive albuminuria Urine studies (Urine: Albumin: Creatinine ratio = ≥ 30mg/g)
43
Kassmaul's sign
Increase in JVP with inspiration Constrictive pericarditis, Restrive cardiomyopathy, right HF, massive PE,
44
Pulmonary embolism (ECG)
Sinus tachycardia Rt Axis RV strain Tall R wave in V1 Inverted T waves in V1-V3 Incomplete RBBB S1Q3T3 pattern (15% cases)
45
Presenting features and clinical signs of Chronic Bilharzia Infection
Portal HPT, Intestinal polyposis, seizures, anemia, Cor pulmonale, Liver disease Bloody stool Abdominal (RUQ) tenderness Rash Hepatosplenomegaly Fever Jaundice (prehepatic) signs
46
What are the differences in presentation and clinical signs between Chronic Bilharzia and Liver Cirrhosis?
Bilharzia (PRE-HEPATIC)= Portal HPT (Varices, Ascites, Splenomegaly) Liver Cirrhosis (HEPATIC) = Chronic liver disease (5)
47
Pericardial effusion (ecg) TB pericarditis
Small complexes Pulsus alternans
48
Pericardial Tamponade
Distended neck veins Tachycardia Drop in BP Pulsus Paradoxis
49
Irregularly irregular pulse signs of an irregularly irregular pulse
A pulse with an irregular rhythm, completely irregular with no pattern. Pulse deficit
50
Radial-femoral delay
Radius pulse + Femoral pulse = delay Young pt (HPT) Coarctattion of aorta
51
Corrigan’s sign
Radial pulse compressed until it disappears, lift 90° to body pulse returns but same pressure maintained in Radial artery. Prominent carotid pulsations. Aortic Incompetence/Regurge
52
mechanism or techniques to obtain an accurate history other than Socrates
Open questions Eye contact Allow patient to tell story in their own words Empathy No judgement
53
reasons HIV patients may default ARV treatment
Depression Alcohol-substance abuse Non-disclosure Inadequate treatment literacy Stockouts Inaccessible clinics High pill burden Adverse effects Frequent dosing
54
Charcot's joint
Deformed, disorganized joints due to loss of proprioception or pain (or both) this leads to recurrent unnoticed injury to joint.
55
Diabetic AMYOTROPHY
DM pt = proximal neuropathy of lower limbs (weakness of hip flexors/adductors & knee extensors associated with inguinal and thigh pain.) depressed deep tendon reflexes (quadriceps) Uni/Bilateral Onset abrupt/ more gradual (days to weeks)
56
Guillain barre syndrome (clinical features)
Progressive ascending weakness Areflexia Paresthesis Autonomic features Resp. failure
57
Prove that an effusion is due to TB
AFB's on microscopy Gene-Xpert Culture positive Predominantly lymphocytic effusion with raised ADA Typical symptoms
58
Type 1 Respiratory failure
Resp system cannot adequately provide O2 to body leading to hypoxemia.
59
Type 2 Respiratory failure
Resp system cannot sufficiently remove CO2 from body leading to hypercapnia.
60
Murmur
Timing Area of greatest intensity Radiation Loudness Pitch
61
Transudates
Membrane intact Incr. hydrostatic power Decr. Oncotic Decr. Concentration HF, Renal Dx (nephro) Decr. albumin Prot: Serum prot <0.5 LDH:Serum LDH <0.6
62
Subarachnoid haemorrhage
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Internal Medicine (11 decks)

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