Internal Med

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candywithak
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93568
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Internal Med
Updated:
2011-07-14 09:04:45
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MBBSIII UQ medicine
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For PCH medicine, based on tuts and reading.
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  1. Name 4 conditions that can cause hepatosplenomegaly.
    • Polycythaemia ruba vera
    • Chronic myeloid leukaemia
    • Essential thrombocytosis
    • Myelofibrosis
  2. What are the 6 conditions that can cause clubbing of the fingers?
    • Interstitial fibrosis
    • Lung cancer
    • Suppurative lung disease
    • Cirrhosis of the liver (pulmonary AV shunt)
    • Infective endocarditis
    • Cyanotic heart disease of the newborn
  3. What are the signs of mitral stenosis?
    • Opening snap
    • Mid-diastolic murmur (rumbling)
    • Tapping apex beat
  4. What are possible causes of pneumothorax?
    • Malignancy
    • Trauma
    • Low albumin
    • Bullou emphysema
  5. How can you clear mucus out of the lungs?
    • Nebulised hypotonic saline
    • Mannitol
    • Positive expiratory pressure exercises (i.e. bubble PEP)
    • Mucolytics (carbacysteine, bromhexine)
    • Erythromicin (to reduce neutrophil cytokinesis)
  6. How do you treat a pseudomonas lung infection?
    • Beta lactam (ben pen, ceph)
    • Aminoglycosides (gentamicin)
    • Mucus clearance
  7. List 5 intrinsic risk factors for falls.
    • Dementia
    • Parkinsons disease
    • MND
    • Visual/auditory/vestiular impairment
    • CVD - syncope, hypotension
    • Deconditioning
    • Peripheral neuropathy
    • Medications (polypharmacy, psychoactives, antihypertensives, hypoglycaemics)
  8. List 3 extrinsic risk factors for falls
    • Lighting
    • Obstacles (cats, rugs)
    • Grab rails
    • Walking aids
    • Footwear
  9. What are the stages of chronic kidney disease?
    • 1. eGFR >90 but with evidence of kidney damage (scars on US, Hx of renal colic/stones)
    • 2. 60-90 + evidence of kidney damage
    • 3. 30-60 +/- evidence
    • 4. 15-30 +/- evidence
    • 5. <15
  10. Horner's syndrome constitutes...
    • Partial ptosis
    • Anhidrosis
    • Miosis
    • Enopthalmos
  11. List 4 possible causes of Horner's Syndrome.
    • Usually compression of the cervical/thoracic sypathetic chain, e.g.
    • Lung tumour (Pancoast tumour, SCC)
    • Neck malignancy/trauma
    • Carotid artery lesion (aneurysm, dissection, tumour)
    • Brainstem lesions (lateral medullary syndrome)
    • Syringomyelia
  12. List 4 causes of transient loss of consciousness.
    • Epilepsy
    • Trauma
    • Hypoglycaemia
    • Syncope
    • - cardiogenic (arrhythmia)
    • - non-cardiogenic (postural hypotension, vasovagal)
  13. Define postural hypotension.
    • Systolic BP drop of >=20mmHg or
    • Diastolic BP drop of >= 10mmHg within 3 minutes of standing
  14. What is the CURB65 score for?
    • Prediction of death from CAP at 30 days:
    • - Confusion
    • - Urea >=7mmol/L
    • - Respiratory rate >=30bpm
    • - BP <90 sys or 60 diastolic
    • - >= 65yo
  15. List 5 possible causes of decreased consciousness.
    • Hypotension/hypovolaemia
    • Hypoxia
    • Hypoglycaemia
    • Hypernatraemia
    • Hypocalcaemia
    • Drugs
    • Brain damage
    • Severe hypothyroidism (myxoedema coma)
  16. List 5 causes of oliguria.
    • 1. Pre-renal:
    • - Decreased fluid intake
    • - Increased fluid loss
    • - Third spacing
    • - Vasodilation
    • - Heart failure
    • 2. Renal:
    • - Glomerulonephritis
    • - Acute tubular necrosis (eg. IV contrast)
    • - Interstitial nephritis (eg. penicillin)
    • 3. Post-renal
    • - calculi
    • - blood clot
    • - catheter obstruction
    • - BPH etc.
  17. What is the most common cause of hip pain?
    Trochanteric bursitis
  18. List 5 signs of severe mitral regurgitation.
    • Lateral displacement of apex beat
    • Apical heave
    • S3
    • Forceful, unsustained apex beat
    • Bibasal crackles
  19. List 3 ECG finding in longtanding mitral regurgitation.
    • LVH as indicated by Rs in V1/V2 (-ve) + V5/V6 (+ve) summing >= 35mm
    • P mitrale (P wave > 2mm wide)
    • AF
  20. What CXR findings do you expect in severe MR?
    • Splaying of carina (LA and LV enlargement)
    • Increased cardiothoracic ratio
    • Signs of HF (ABCDE)
  21. What sign indicate severe aortic stenosis?
    • Forceful, sustained thrill
    • Late peaking of cresc/decresc murmur
    • Low volume, slow rising pulse
    • S4
  22. What ECG and CXR findings would you expect in severe aortic stenosis?
    • LVH (tall R)
    • Calcified aortic valve
    • Later - enlarged LV, and LA
  23. What are the cardinal symptoms of aortic stenosis?
    • Syncope
    • Dyspnoea
    • Chest pain
  24. How do you treat AF?
    • Rate control (non-dihydropyridine CCB e.g. diltiazem, verapamil; beta-blockers; +/- digoxin)
    • Rhythm control (amiodarone, sotalol, flecanide or DC cardioversion)
    • Warfarinise according to CHADS2
  25. A patient presents with AF for the first time. You want to pursue a strategy of rhythm control. Detail your options.
    • Amiodarone/flecainide
    • DC cardioversion
    • - associated with increased risk of stroke (1st 2 weeks)
    • - if <48h, cardioversion okay
    • - if >48h:
    • -- Heparinised and TOE cardioversion, then immediate warfarin for 1m
    • -- 1m of warfarin, TOE and then another 1m warfarin
  26. What tool do you use to determine whether an AF patient requires warfarin?
    • CHADS2 score of 2 or more
    • C - CCF
    • H - Hypertension
    • A - Age > 75
    • D - Diabetes Mellitus
    • S2 - Stroke/TIA previously
  27. What are the 4 different types of regular SVTs?
    • A flutter
    • A tachycardia
    • AVNRT
    • AVRT
  28. What is atrial flutter?
    Atrial flutter occurs when there is a re-entry circuit around the tricuspid valve resulting in a very fast atrial depolarisation rate, every 2-3 of which is conducted through the AV node to the ventricles.
  29. What do you expect to see on an ECG with atrial flutter?
    Sawtooth baseline (PPP), followed by QRS. Increased sawtooth baseline between QRSs when vagal manouvre performed.
  30. What is atrial tachycardia?
    Increased atrial depolarisation rate due to ectopic atrial source or micro-reentry circuit.
  31. What do you see on an ECG with atrial tachycardia?
    Abnormal P followed by normal QRS, increased HR.
  32. What is AV nodal reentry tachycardia? ECG?
    This is when there is an accessory pathway in or near the AV node. As a result, the slow pathway conducts anterogradely, depolarising the ventricles, but by then the fast pathway has retrogradedly depolarised the atria again --> P wave hidden in QRS complex.
  33. How do you treat AVNRT?
    • Vagal manouvres
    • Drugs - verapamil, adenosine, beta blocers
    • Radioablation of slow pathway.
  34. What is AV reentry tachycardia? 2 types? ECGs?
    • This is where there is an accessory pathway between the atria and ventricles.
    • 1. Orthodromic AVRT - AV node carries impulse down to ventricles, accessory pathway carries it retrogradely back: P1, QRS, P2
    • 2. Antidromic AVRT - impulse down accessory path, back up through AV node: wide QRS (+ delta wave)
  35. What is wolff parinson white syndrome? When is it dangerous?
    Pre-excitation through Bundle of Kent --> delta wave. Dangerous in AF or if it becomes an AVRT circuit
  36. What are the classes of haert failure according to the New York Heart Association?
    • 1. Asymptomatic
    • 2. Mild SOB and/or angina with slight limitation of activity
    • 3. Marked limitation in activity (<100m)
    • 4. Severe limitation, symptoms at rest.
  37. What are the 4 different types of coronary artery disease?
    • Chronic stable angina
    • STEMI
    • NSTEMI
    • Unstable angina pectoris
  38. What is the definition of ST elevation?
    • ST elevation of >2mm in the anterior leads (V3 and V4)
    • ST elevation of >1mm in the limb leads
  39. How do you manage a STEMI?
    • 1. Reperfuse (PCI or thrombolysis
    • 2. Drugs: aspirin, clopidogrel, beta-blocker, ACEI, statin, epleronone
    • 3. Symptomatic GTN
  40. A patient presents with chest pain at rest but no ischaemic ECG changes or troponin rise. What is your next step?
    Repeat ECG at 6-8h.
  41. What puts a patient in the category of high risk NSTEACS?
    • Increased troponins
    • Ischaemic ECG changes (ST depression, T wave inversion)
    • Clinical LVF
    • VT/VF
    • Established CAD
  42. How do you manage high risk NSTEACS?
    • Double antiplatelet (aspirin and clopidogrel)
    • Heparin
    • Statins
    • Beta-blockers
    • ACEI
    • Coronary angiogram --> PCI/CABG
  43. How do you manage intermediate risk NSTEACS?
    Investigate with stress test, stress echo (dobutamine), CT coronary angiogram or myocardial perfussion scan (adenosine).
  44. List 3 causes of pulmonary oedema
    • cardiac failure
    • overhydration
    • increased capillary permeability (ARDS)
  45. What are the two types of CCF? How do you distinguish the two?
    • Echocardiogram - EF 55% as cut off
    • LV systolic dyfunction
    • Heart failure with normal ejection fraction
  46. List 8 causes of LV dysfunction
    • CAD
    • Valvular abnormalities (MR esp)
    • Hypertension
    • Thyrotoxicosis
    • Myocarditis (e.g. Chaga's)
    • Haemochromatosis
    • Vascular/connective tissu (RHD, SLE)
    • Hereditary cardiomyopathy
    • Idiopathic (primary DCM)
    • Long term SVT
    • Infiltrative (sarcoidosis, amyloidosis)
  47. What signs of HF can you see on CXR?
    • Alveolar oedema (batwing)
    • Kerley B lines
    • Cardiothoracic ratio increased
    • Dilation of upper lobe vessels
    • Effusion at pleura
  48. How do you treat LV dyfunction heart failure?
    • Medications that improve outcome: ACEI, B-blocker, eplenerone
    • Medications that manage symptoms: frusemide, GTN
    • Devices: automated implanatable cardioverter-defibrillator (EF<30); biventricular pacemaker (HF with LBBB)
    • Treat underlying cause (e.g. CAD and CABG)
  49. How do you treat HFNEF?
    Diuretics to reduce symptoms only.
  50. A patient presents with symptoms consistent with stroke. What are your next steps?
    • Head CT to exclude haemorrhage
    • tPA otherwise (in first 4.5h)
    • Long term secondary prevention with aspirin/clopidogrel/warfarin and addressing of risk factors
  51. What is the treatment for aortic stenosis and when is it indicated?
    Aortic valve replacement - onset of any of the 3 symptoms (chest pain, dyspnoea, syncope)
  52. What is the main cause of mitral stenosis?
    Rheumatic heart disease
  53. How do you treat mitral stenosis?
    Balloon valvotomy (so long as it is not MS and MR)
  54. How do you treat aortic regurgitation and when is it indicated?
    Aortic valve replacement - when end diastolic diameter >55mm or EF <55%. LV has already decompensated by the time symptoms of HF occur.
  55. What can cause aortic regurgitation?
    • Infective endocarditis
    • Syphillis
    • Rheumatic heart disease
  56. Mitral valve regurgitation can be caused by...
    • Mitral valve prolapse
    • Infective endocarditis
    • RHD
    • Connective tissue disease
  57. How do you treat mitral regurgitation and when is it indicated?
    Mitral valve repair (us. posterior leaflet) - decompensation occurs before symptos (EF <65% or ESD <55mm)
  58. On examination of a patient with bronchiectasis, what findings do you expect to see (list 5)?
    • Sputum cup
    • Clubbing
    • Coughing
    • Reduced chest expansion
    • Normal vocal resonance
    • Coarse, bibasal crackles
    • Wheeze
  59. List 5 causes of apical fibrosis.
    • (allergic) Bronchopulmonary aspergillis
    • RA
    • Extrinsic allergic alveolitis (e.g. bird fanciers)
    • Ankylosing spondylitis
    • Sarcoidosis
    • TB
    • Silicosis
    • Histiocytosis X
  60. List 4 causes of interstitial lung disease.
    • Idiopathic
    • Connective tissue disease (RA, SLE, scleroderma)
    • Drugs (amiodarone, sulfasalazine)
    • Occupation (silicosis, asbestosis)
  61. What 2 signs are present in hypocalcaemia?
    • Chovstek sign: stimulation of facial nerve --> twiching of ipsilateral nose/lips.
    • Trousseau sign: inflation of cuff above systolic BP for 3 minutes --> spasm of hand and forearm muscles.
  62. What conditions are associated with Cheyne-Stokes respiration?
    • HF
    • Stroke
    • Traumatic brain injury
    • Brain tumours
    • CO poisoning
  63. What are the complications of diabetes mellitus?
    • Autonomic: postserol hypotension, urinary retention, nocturnal diarrhoea
    • Macrovascular: CAD, PVD, CVD
    • Microvascular: retinopathy, nephropathy, neuropathy
  64. List 5 risk factors for VTE.
    • HF
    • Previous VTEs
    • Oestrogen
    • Obesity
    • Active cancer
    • Lung disease
    • Inflammatory disease
  65. VTE prophylaxis consists of...
    • Enoxaparin (LMWH)
    • Mechanical prophylaxis (eg. TED stockings)
  66. How do you treat VTE?
    • IV heparin or SC enoxaparin from day 1, for >5d
    • Warfarin from day 2 (for 3-6m)
    • Thrombectomyebolectomy as last resort
  67. List 3 causes of SOB.
    • Cardiac: CCF
    • Respiratory: aspiration, PE, pneumonia, pneumothorax, collapse, COPD, URT obstruction
    • Sepsis: from joint, cellulitis, IV line, diverticulitis etc.
  68. An elderly patient was found on the floor 2 days after a fall. You suspect rhabdomyolysis. What investigations and management do you employ?
    • Ix: Creatine kinase (5x ULN), LDH, transaminases (AST)
    • Tx: generous IV isotonic saline
  69. What are the symptoms of vertebral artery dissection? How would you diagnose it and treat it?
    • Sx: head and neck pain, intermittent stroke symptoms
    • Dx: CT cerebral angiography
    • Tx: reduce stroke risk with anticoagulation and antiplatelet; if obstructed - thrombolyse, angioplasty and stenting.
  70. What are the 4 cardinal signs of Parkinsons Disease?
    • Rigidity
    • Resting tremor
    • Bradykinesia/hypokinesia
    • Postural instability
  71. What are the early manifestations of Parkinsons Disease?
    Fatigue and non-specific discomfort (e.g. shoulder pain).
  72. List 3 symptoms of Parkinson's Disease.
    • Craniofacial: blurred vision, anosmia
    • Autonomic: postural hypotension, nocturnal diarrhoea, urinary incontinence
    • Psych: depression, anxiety, sleep disturbance
  73. On general inspection of a patient with advanced Parkinsons Disease, what do you expect to see (list 5)?
    • Asymmetric resting tremor
    • Pill-rolling tremor
    • Dystonia (writhing, flexing with medication)
    • Lack of spontaneous movement
    • Mask-life facies
    • Decreased blink rate
    • Sialorrhea
    • Stooped posture
  74. What gait abnormalities might you see in a patient with Parkinson's disease (list 5)?
    • Shuffling (small steps, reduced swing)
    • Difficulty starting
    • Festinating (hurrying progressively)
    • Difficulty stopping
    • Lack of normal arm swing
    • Difficulty with heel-toe walking
  75. What tests (list 4) may help you ellicit signs of Parkinson's Disease?
    • Finger tapping
    • Twiddling of hands
    • Finger nose test - decreased tremor on intention
    • Decreased tremor with mental stimulation (serial 7s)
    • Glabellar tap
    • Speech - palilalia, monotonous, soft and faint
    • Ocular movemennts - weakness of upward gaze
    • Writing - micrographia
  76. What are other causes (besides PD) for Parkinsonism (list 4)?
    • Drugs: MPTP, antipsychotics, metoclompramide, stemetil
    • Vascular Parkinsons (more symmetrical)
    • Lewy Body disease
    • Toxicity with CO, Hg
    • Wilsons disease
  77. How is a diagnosis of osteoporosis made?
    • T score <2.5 SD; or
    • Fragility fracture
  78. What test is a good indicator of intravascular haemolysis?
    Reduced haptoglobin
  79. Haemolytic anaemia may be associated with changes in what particular parameters?
    • Bilirubin (increased)
    • LDH (increased)
    • Potassium (increased)
    • Haptoglobin (decreased, if intravascular)
  80. List 5 different causes of peripheral neuropathy
    • Drugs: phenytoin, amiodarone
    • EtOH: with or without B12 deficiency
    • Metabolic: DM, chronic renal failure
    • Guillain-Barre syndrome: acute <4/52
    • Chronic inflammatory demyelinating polyneuropathy: >8/52
    • Vitamins: deficit in B12, excess of B6
    • Malignancy: paraneoplastic neuropathy
    • CT/vasculitis: SLE
    • Idiopathic
  81. What is the ABCD2 score for?
    • Calculating risk of stroke within 2 days of a TIA.
    • Age: >60
    • BP: >140/90
    • Clinical signs: unilateral weakness/speech disturbance only
    • Duration: >60/10-59/<10
    • Diabetes
  82. What is a TACI?
    • New, higher cerebral dysfunction;
    • Homonymous visual defect; AND
    • Ipsilateral motorsensory deficit of 2 or more of face, arms and legs
    • (assume latter 2 if drowsy)
  83. What is a PACI?
    • 2 out of 3 features of the TACI criteria; OR
    • Homonymous hemianopia; OR
    • Motor/sensory defeciti of 2 or more of face, arms and legs
  84. What is a LACI?
    • Pure motor (weakness of 2 or more of face, arms or legs)
    • Pure sensory loss;
    • Sensorimotor loss; or
    • Ataxic hemiparesis
  85. POCI can be any of... (list 5)
    • Brainstem, cerebellar or occipital signs
    • Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
    • Bilateral motor and/or sensory deficit
    • Disorder of conjugate eye movement
    • Cerebellar dysfunction
    • Isolated homonymous visual field defect
  86. What are the primary reflexes (list 4) and when do you see them?
    • Snout and pout reflex
    • Grasp reflex
    • Palmomental reflex
    • Glabellar tap
    • Child <2 or frontal lobe dysfunction is when you see these.
  87. Causes of proximal muyopathy (4)
    • EtOH
    • Steroids
    • Cushings Syndrome
    • Osteoarthritis
  88. What are the characteristic findings of OA on an x-ray?
    • Subchondral cysts
    • Subchondral sclerosis
    • Osteophytes
    • Joint space narrowing
  89. What are the 10 questions on an MSQ?
    • 1. Name of place
    • 2. Suburb
    • 3. Date today
    • 4. Month
    • 5. Year
    • 6. Date and month of birth
    • 7. Year or birth
    • 8. Age now
    • 9. PM current
    • 10. Last PM
  90. What is the triple whammy and what can it cause?
    • ACEI, diuretic and NSAID.
    • Renal failure
  91. A patient presents with diabetic ketoacidosis - what symptoms are you expecting?
    • Vomiting,
    • Dehydration,
    • Kussmaul breathing,
    • Confusion
    • Coma
  92. What investigations should you run with a DKA patient, and what findings do you expect?
    • ABG: decreased pH, decreased CO, reduced bicarb
    • Urine dipstick: glycosuria, ketosuria
    • U&E: urea, creatinine (renal function), increased electrolytes from dehydration (e.g. Na and K)
  93. In a GIT exam, what signs are you looking for in the hands and wrists? Why are they significant?
    • Leukonychia: hypoalbuminaemia
    • Clubbing: cirrhosis
    • Dupuytren's contracture: alcohol
    • Palmar erythema: oestrogen (preg, thyrotoxicosis, RA, polycythaemia)
    • Palmar creases pallor: GIT bleed, malnutrition
    • Asterixis: hepatic encephalopathy
    • Tremor: Wilson's, alcoholism
  94. Why is bruising significant in a GIT exam?
    • Hepatocellular: decreased clotting factor production
    • Obstructive jaundice: dec bile --> dec vit K --> dec II, VII, IX, X
    • EtOH: BM depn --> thrombocytopenia
    • Splenomegaly: destruction of platelets
    • Severe liver disease: DIC using up platelets
  95. What skin findings are important in a GIT exam and why?
    • Jaundice: hyperbilirubinaemia
    • Bronzing: haemochromatosis
    • Bruising: see Q94
    • Scratch marks: obstructive/cholestatic jaundice
    • Spider naevi over SVC: cirrhosis (EtOH/viral hep), pregnancy
    • Telangectasias: hereditary haemorrhagic telangectasia (GI bleeds)
  96. In a GIT exam, what significant signs are you looking for around the eyes?
    • Scleral jaundice: hyperbilirubinaemia
    • Conjunctival pallor: anaemia
    • Kayser-Flischer rings: Wilsons disease (cirrhosis)
    • Xanthelasma: hypercholesterolaemia, cholestasis
  97. Why would you palpate the cheeks in a GIT exam?
    • Parotidomegaly (bilateral) = alcoholism or parotid tumour
    • Submandibular gland enlargement: calculus, chronic liver disease
  98. List 5 significant fetor findings.
    • Fetor hepaticus: hepatocellular disease with methylmercaptans; sweet
    • Ketosis: DKA; sickly sweet
    • Uraemia
    • Alcohol
    • Putrid: chest infection
    • Cigarettes
  99. What are you looking for around and in the mouth in a GIT exam?
    • Leucoplakia: smoking, spirits, sepsis, syphilis
    • Glossitis: Fe, folate and vit B deficiencies
    • Candidiasis: oesophageal involvement; DM; Fe deficiency
    • Aphthous ulcers: Crohns disease, coeliac disease
    • Angular stomatosis: Fe, vit B or folate deficiencies
  100. What is Troisier's sign?
    Enlarged supraclavicular node and stomach carcinoma
  101. Gynaecomastia is seen in liver disease Why?
    • Alcoholic cirrhosis or chronic active hepatitis --> decreased oestrogen breakdown
    • Treatment of ascites with spironolactone
  102. What is Courvoisier's law?
    If a gallblaer is enlarged, obstructive jaundice is more likely to be due to carcinoma or the pancreas or lower biliary tree (gallbladder fibroses chronically)
  103. How do you distinguish the spleen from the left kidney on palpation? (list 4)
    • Cannot get above spleen
    • Spleen moves inferomedially with inspiration, kidney only inferiorly
    • Splenic notch
    • Spleen only ballotable if grossly ascitic, but kidney is because it is retroperitoneal
  104. List 7 causes of ascites and classify them as high or low serum:ascites albumin concentration
    • High:
    • Cirrhosis
    • Alcoholic hepatitis
    • Fulminant hepatic failure
    • CCF
    • Budd-Chiari syndrome
    • Myxoedema
    • Massive liver mets
    • Low:
    • Peritoneal carcinomatous
    • TB
    • Pnacreatic ascieties
    • Nephrotic syndrome
  105. List 10 causes of hepatomegaly.
    • Metastases
    • Alcoholic liver disease
    • Myeloproliferative disease
    • RHF
    • HCC
    • Haemochromatosis
    • Haematological cancers
    • Fatty liver
    • Infiltration (e.g. amyloid)
    • Hepatitis
    • Biliary obstruction
    • Hydatid disease
    • HIV infection
  106. When would your liver be pulsatile (3?
    • Tricuspid regurg
    • HCC
    • Vascular abnormalities
  107. What is Murphy's sign?
    Hand on R. costal margin and inhalation --> pain as inflamed gallbladder catches
  108. What 2 signs, when positive, are associated with appendicits?
    • McBurney's point (2/3:1/3 umbilicus:ASIS) tenderness
    • Rovsing's sign
  109. List 4 conditions associated with pulmonary crackles, and describe the type of crackles you would hear.
    COPD - early inspiratory, medium coarsenessPulmonary fibrosis - fine, late/pan-inspiratoryLeft ventricular failure - medium coarseness, late/pan-inspiratoryBronchiectasis - coarse, gurgling, late/pan-inspiratory
  110. Empirical treatment for infective endocarditis?
    Benzyl penicillin, flucloxacillin, gentamicin.
  111. Empirical treatment for CAP?
    • Benzyl penicillin + roxithromycin if moderate.
    • Benzyl penicillinn + gentamicin if severe.
  112. Empirical treatment for HAP
    • Amoxicillin and clavulanic acid if mild.
    • Ticarcillin and clavulanic acid and gentamicin if severe.
  113. Uncomplicated UTI Tx?
    Trimethoprim.
  114. Complicated UTI Tx?
    Ampicillin and gentamicin.
  115. Febrile neutropenia Tx?
    Merepenam.
  116. Sepsis from an intrabdominal source Tx?
    Metronidazole and cefataziime.
  117. Meningitis Tx?
    Ceftriaxone.
  118. Skin/joint/bone infection?
    Flucloxacillin.
  119. What types of pharmacological treatment can you give for osteoporosis?
    • Bisphosphonates (alendronate)
    • Strontium
    • Raloxifene (SERM)
    • Vit D and calcium
  120. DDx for a lung lesion on CXR (list 6)?
    • Cancer
    • TB or mycobacterium avium complex
    • Cryptococcus
    • Aspergilloma
    • Wegeners Granulomatosis
    • Sarcoidosis (usually multiple)
    • Abscess (fluid level)
  121. List 6 causes of pulmonary fibrosis in the upper lobes.
    • Silicosis
    • Sarcoidosis
    • Coal workers pneumoconiosis
    • Histiocytosis
    • Ankylosing spondylitis
    • Allergic bronchopulmonary aspergillosis
    • Radiation
    • Tuberculosis
  122. List 5 causes of lower lobe pulmonary fibrosis.
    • RA
    • Asbestosis
    • Scleroderma
    • Cryptogenic fibrosing alveolitis
    • Other (drugs eg. amiodarone, methotrexate).
  123. What are you looking for in the hands and wrists in a respiratory exam (7)?
    • Clubbing
    • Cyanosis peripherally
    • Tar stains
    • Wasting/weakness of hand muscles (brachial plexus)
    • HPOA
    • Pulse (tachycardia, pulsus paradoxus)
    • Flatting tremor (CO2 narcosis)
  124. What do you look for in the face in a respiratory exam?
    • Horners
    • Conjunctival pallor
    • Central cyanosis
    • Oral candidiasis from inhaled steroids
    • Hoarse voice
    • Facial plethora (smoker, SVC obstruction)
  125. Why is ankylosing spondylitis important in a cardiovascular exam?
    Aortic regurgitation
  126. What do you look for in the hands/wrists in a cardiovascular exam (7)?
    • Clubbing
    • Cyanosis
    • Capillary refill
    • IE signs
    • Xanthomata
    • Radial pulse
    • Radio-radial delay
  127. Sitting forward and deep expiration makes which pathological heart sounds clearer?
    • Aortic regurgitation
    • Pericardia friction rub
  128. Which two heart pathological heart sounds become louder with the valsalva manouvre (phase 2 - straining)?
    • HCM
    • Mitral valve prolapse - sytolic click and murmujr occur earlier and become loude
  129. What significant findings in the hands and wrists may you find in rheumatoid arthritis (list 11 of 13)?
    • Vasculitic changes at base of nail (active)
    • Splinter haemorrhages
    • Z deformity of the thumb\
    • Swan neck
    • Boutonniere
    • Ulnar deviation of fingers
    • Symmetrial deformity
    • Subluxation of MCP joints
    • Wasting of small muscles of hand
    • Palmar erythema
    • Median nerve palsy (Phalens)
    • Ulnar nerve palsy (clawing of 4th and 5th fingers)
    • Palmar tendon crepitus
  130. What are 2 significant findings you may see on a general inspection of a patient with rheumatoid arthritis?
    • Wasting - active disease
    • Cushingoid appearance - steroid treatment
  131. What signs may you see around the face of a patient with RA (list 8 of 10)?
    • Episcleritis
    • Scleritis
    • Scleromalacia
    • Dry eyes (Sjogrens)
    • Anaemia
    • Cataracts (steroids)
    • Parotid enlargement (Sjogrens)
    • Dry mouth and dental caries (Sjogrens)
    • Ulcers (gold Tx)
    • Temporamandibular joint crepitus
  132. What blood tests could you run in suspected RA?
    • Rheumatoid factor
    • ANti-citrullinated protein antibodies
  133. What pharmacological treatments are available for RA?
    • Methotrexate (hepatomegaly)
    • Sulfasalazine
    • Steroids (Cushings)
  134. What eponymous syndromes is RA associated with?
    • Felty's: RA, neutropenia and splenomegaly
    • Caplan's: RA and pneumoconiosis
    • Sjogrens: autoimmune destruction of exocrine (tears and saliva) glands
  135. List 4 rheumatological diseases that are associated with pulmonary fibrosis.
    • RA
    • Ankylosing spondylitis
    • Scleroderma
    • SLE
  136. List 5 rheumatological diseases that are associated with heart disease and specify what.
    • RA (AR, pericarditis)
    • Ankylosing Spondylitis (AR)
    • SLE (pericarditis)
    • Scleroderma (pericarditis, cor pulmonale 2ndary to pulm fibrosis, LVF)
    • Rheumatic fever (pericarditis, myocarditis, MR, AR due to acute endocarditis)

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