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What is a stepping or stamping gait?
What is it a sign of?
Sensory deficitt in the legs, particularly the dorsal column.
What do you do for anterior dislocation of the shoulder?
Milch's technique - Arm in abduction and externally rotated, use thumd to push the humeral head back into acromioclavicular joint.
What are the stages of the cardiac action potential and which electrolyte changes account for each phase?
- Phase 0 (the depolarisation phase) is mediated by fast Na channels opening and an influx of Na ions into the cell.
- Phase 1 (initial repolarisation) is caused by those channels closing.
- Phase 2 (plateau) is caused by K and Ca channels opening, with the calcium entering the cell being balanced by potassium leaving the cell.
- Phase 3 (repolarisation) is caused by Ca channel closure, causing a net negative current as K+ ions continue to leave the cell.
Name all the drugs you can use for hypertension and their mode of action.
- Ace inhibs\ace receptor antags
- Diuretics (loop or thiazide)
- B blockers
- Calcium channel blockers
- Imidazolene agonist - e.g. monoxidine, acts on medulla to reduce sympathetic outflow
A 58-year-old Tibetan man is seen in the clinic with a painless mass on the left side of his neck, lying just anterior to the sternocleidomastoid. He is asymptomatic and no other masses are palpable.
Mass in the anterior triangle of a person from high altitude = Carotid body tumor\chemodectoma.
- Usually assymptomatic but can press on vagus or hypoglossal nerves and cause hoarseness stridor dysphagia.
- Rx = surgical excision.
A 53-year-old woman is seen in the clinic reporting pain in her left hand on exertion such as when she brushes her hair. At rest her pulses are palpable but they disappear after repeatedly elevating her arm. An x ray is performed that confirms the diagnosis. which is...?
Thoricic outlet obx, usually due to:
- Compression or thrombosis of the subclavian artery and vein, and compression of the brachial plexus as they pass over the first rib.
- Cervical ribs - abnormalities arising from the 7th cervical
- vertebra - are amongst the most common causes.
- Can confirm diagnosis with Adsons test:
- Patient breathes deeply
- Neck extended
- Chin turned toward affected side
- Repeat test with chin to opposite side
What is holmes-adie's SYNDROME?
=Pupil + loss of deep tendon reflexes.
Pupil - Large and irregular, reacts poorly to light and accommadation and remains small after torching (tonic pupil)
Complications of blood transfusions (early and late)
- Early -
- Acute febrile haemolytic reaction
- Non-haemolytic febrile reaction
- Fluid overload
- Contamination rcn (bacterial, prion etc.)
- Contamination (bacterial, viral, prion etc)
What symptoms constitute a diagnosis of IBS?
What are your differentials?
Abdo pain and distention, Looser and more frequent stools assco with the pain, mucus with stool, pain relief with bowel action.
- IBD (rule out by asking bout nocturnal pain and diarrhoea, blood, wt loss fevers. FBC, ESR, CRP))
- Hyperthyroid (TFT)
- Laxative abuse
- Lactose intolerance
- Psychosocial stuff eg Panic disorders and depression.
Rx for IBS?
- Dependent on dominant symptoms
- Pain - Antispasmodics or TCS
- Constipation - Fibre
- Diarrhoea - Cholestyramine, Loperamide
- Anxiety\panic - BDZ
A patient deteriorates and you discover the blood glucose is 1.0. Whats your next step?
50ml of 20% dextrose stat.
Extra intestinal features of Crohn's?
- Apthous ulcers
- Anaemia due to chronic disease or malabsorption or bleeding
- Ank Spond
- Erythema Nodosum and Pyoderma Gangrenosum
Which micronutrient deficiency are patients with carcinoid syndrome at risk of getting?
- Excess serotonin has to be synthesized from tryptophan a precursor also necessary to make niacin.
- Divert the tryptophan for serotonin purposes and youll end up with the 3 D's of Pellagra: Dermatitis, Diarrhoea, Dementia.
What combination of Fasting glucose and GTT would lead to a diagnosis of:
b) Impaired glucose tolerance
c) Impaired fasting glucose
- A) Fasting >7.0 2hr GTT >11.1
- B) Fasting <7 2hr GTT 7.8-11.0
- C) Fasting 6.1-7.9 2hr GTT <7.8
Eponymous lower legs...
- May-thurner - Left sided Iliofemoral DVT, 2nd to compression of left common iliac vein by right common iliac artery.
- Klippel-Trenaueney - Unilateral Varicosity and swelling, soft tissue hypertrophy, naevus flammeus. All because they dont have a deep venous system in that leg.
- Milroy's - Congenital aplasia\hypoplasia of lymphatic system which leads to swelling in legs.
- Buerger's - Throboangitis Obliterans.
What to do when warfirin goes wrong..
If a patients INR comes back between 6-8 and they are assymptom?
If a patients INR comes back between 6-8 and they are symptomatic?
If a patient starts bleeding out of an ulcer and you think theyre INR is high?
An AF patients INR comes back as 1.9
- Omit + Vit K oral
- Omit + Vit K IV + Prothrombin complex (better than FFP)
- Do nothing, small fluctuations are normal. Just recheck INR in a week.
Which Auto antibodies do you look for if you suspect Hashimoto's?
Anti thyroid peroxidase and Anti microsomal.
Neurological conditions assoc with Hashi\Hypothyroid?
- Carpal Tunnel and other entrapment neuropathies
- Cerebellar ataxia
- Myxoedema madness
What is Boerhaave's syndrome?
What must you NEVER!! do if you suspect the patient has this?
- Perforation of oesophagus due to excessive vomitting.
- NEVER order a barium swallow. Gastrograffin is fine.
An 85 yrold diabetic complains of wild flinging movements of the left arm which disappered during sleep...what happened?
Ischaemia\Infarction of contralateral Subthalamic nucleus. At risk of CVA due to diabetes.
Two possible IV therapies for status epilepticus?
First line treatment in anaphylaxis?
500 mcg Adrenaline 1:1000
A IV drug abuser just contracted Hep b from sharing a needle, what are the possible scenarios from here on out?
- Acutely infected, Clears it in 3 months. Job done (95% cases)
- Acutely infected, converts to chronic infection, slowly progesses to cirrhosis.
- Sever acute infection, requires Alpha-interferon, converts to chronic, slowly progresses to cirrhosis
List some aids defining illnesses, at least 6.
- Oral\oesophageal candidiasis
- Kaposis sarcoma
- Cervical cancer
- CMV disease or CMV retinitis
- Mycobacterium Avium
- the Cryptos - sporidium, coccus
What infectious diseases are spread by:
Which cancers commonly metastasize to bones?
- Poor bones keep loving tumors.
7 C's of post-operative pyrexia?
Cannula, Catheter, Chest, Cut, Central line, Calves, Collection.
5 causes of a RIF mass?
- Caecal cancer
- Ovarian cyst
- Appendix mass
- Enlarged iliac nodes
- Aneurysm of the external or common iliac artery.
Causes of mitral stenosis?
- Age related calcification
- Rheumatic heart disease.
What does fixed splitting of the second heart sound imply?
What would lead you to think that a murmur is innocent?
- Short duration
- Vary with posture
Which antibodies are strongly assoc with CREST syndrome?
What is Electrical alternans?
Is a type of ECG showing wavering amplitude of QRS complexes and possibly a changing axis.
This occurs with Cardiac tamponade or severe pleural effusions and is thought to reflect the heart wobbling around in a fluid environment.
Most common cause of cardiac tamponade?
Malignancy - so think Lung.
What is Duke's clasification of CRC?
- A: Extention into bowel wall
- B: Reaches Serosa
- C: Nodes involved
- D: Mets
Which stucture is involved if a patient presents with Left sided hemiplegia and contralateral opthalmoplegia?
- Midbrain cuz thats where the third nerve nucleus is innit!
- This is called Weber's syndrome.
P.S. dont forget the 2,3,4 rule
Causes of erythema nodosum?
- Infections due to mycobacterium (TB, Leprosy, pneumonia)
What did Gorbachoff have on his bald pate?
Port-wine stain or Naevus Flammeus
What are the Chest xray changes in LVF?
- A - Alveolar bat wings
- B - Kerly B lines
- C - Cardiomegaly
- D - Upper lobe diversion of blood flow
- E - Effusions
Warfirin duration for...
Due to temporary risk factors
What are the thresholds to distinguish...
Moderate - PEFR 50-75%, Sats >92
Severe - Cant complete sentences, PEFR <50, RR>25, sats>92
Life threatening - PEFR<33, Silent chest, exhausted, poor resp effort
Whats the difference between a primary and secondary pneumothorax?
- Primary - idiopathic, happens in tall young males
- Secondary - Due to underlying lung disease, usually emphysema
For secondary pneumothoracies, how wud you decide whether to aspirate or stick in a chest drain?
- Are they:
- >50 years old
- And the pneumothorax is >2cm air ring?
- If yes then chest drain
- If no the stab them in their second intercostal space mid clavicular line.
New york classification of HF?
- i. Got it, not symptomatic
- ii. Symptoms bought on by exertion (normal exertion)
- iii. SYmptoms bought on by mild exertion
- iv. Symptoms at rest.
Which kind of ulcer pain is worsened by eating and which is made worse?
- Gastric made WORSE
- Duodenal made better