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139 Cards in this Set
- Front
- Back
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FBCs |
General, Anaemia, Infection (WCC) |
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LFTs |
General, Jaundice, Alcohol, Protein loss |
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Brain Natriuretic Peptide (BNP) |
Heart Failure. Can also be raised in left ventricular hypertrophy, ischaemia, tachycardia, etc. |
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TFT |
Hypothyroidism, Hyperthyroidism |
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U & Es |
General, AKI, dehydration, ion imbalance (e.g. hyponatraemia), hyper/hypoglycaemia |
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CRP |
General, inflammation, sepsis, rheumatoid, IBD etc. |
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D-Dimer |
Increased clotting, DVT, PE, DIC |
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ESR |
Inflammation, mainly GCA and Polymyalgia rheumatica |
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Calcium Blood test |
Kidney disease or stones, bone diseases, cancer, thyroid diseases |
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Cardiac Enzymes |
Heart attack |
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HbA1C |
Type 2 diabetes |
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PT |
Bleeding conditions, measure medication efficacy (e.g. warfarin), liver function |
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Magnesium test |
Calcium/Magnesium homeostasis problems, Kidney disease |
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Troponin
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Heart muscle damage (e.g. MI)
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eGFR
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To assess kidney function, through measuring creatinine to calculate eGFR.
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Coronary/Ischaemic Heart Disease Types
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1.) Stable angina 2.) Unstable angina 3.) NSTEMI 4.) STEMI 5.) Sudden cardiac death. |
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Coronary/Ischaemic Heart Disease Symptoms
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1.) Chest pain - central crushing, worse on exertion 2.) Radiating pain - arm and/or back 3.) Breathlessness and tiredness 4.) May cause dizziness. |
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Coronary/Ischaemic Heart Disease Investigations
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1.) Observation - BP, HR, RR etc. 2.) Cardio examination 3.) Bedside tests - Troponin, Cardiac enzymes, BNP, FBCs, U&Es, LFTs, CRP etc. 4.) ECG 5.) Imaging - Coronary angiogram |
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Coronary/Ischaemic Heart Disease Treatment
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If angina - GTN If MI - 1) PCI if possible 2) Fibrinolytic drugs (e.g. alteplase and streptokinase) 3) Antiplatelet agent (e.g. clopidogrel or aspirin) =3) Beta-blockers, ACE inhibitors, statins, =3) Heparin can be used adjunctively too |
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Valvular Heart Disease Symptoms
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1.) SOB 2.) Syncope 3.) Chest pain 4.) Palpitations 5.) Oedema (e.g. ankles) 6) Tiredness |
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Valvular Heart Disease Investigations
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1.) Observations - BP, HR, RR, etc. 2.) Cardio exam AS/PS - Ejection systolic MR/TR - Pan systolic AR - Early diastolic MS - Mid diastolic 3.) Echocardiogram 4) CXray |
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Valvular Heart Disease Treatment
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AS: 1) Modification of atherosclerotic risk factors and avoidance of heavy exertion 2) Surgery 3) Digoxin, diuretics, ACEI if heart failure symptoms 4) Treatment of any hypertension MR: Similar to above |
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Heart Failure Symptoms
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1.) SOB and orthopnoea (LHF) 2.) Ankle and leg oedema (RHF) 3.) Tiredness 4.) Nocturnal cough (+/- pink frothy sputum) 4.) Pre-syncope |
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Heart Failure Investigations
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1) Observations 2) Exam 3) Bedside - BNP. general 4) ECG and Echocardiogram 5) CXray - cardiomegaly, pulmonary oedema 6) Other bloods - e.g. TFTs. HbA1c, lipids |
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Heart Failure Treatment
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Depends on if the ejection fraction is reduced or not but generally:
1) Patient Education (e.g. risk factors) 2)ACE inhibitors (or ARB if preferred) 3)Diuretics (symptomatic relief) 4)Beta-Blockers 5)Mineralocorticoid/aldosterone receptor antagonists |
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Atrial Fibrillation Symptoms
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2) Palpitations 3) Syncope/Pre-syncope 4) Chest discomfort 5) Stroke/TIA |
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Atrial Fibrillation Investigations
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1) Obs - HR - Irregularly irregular 2) Blood tests - TFTs, general, coagulation screen (pre-warfarin) 3)ECG - Diagnostic apart from paroxysmal AF 4) CXray and Echocardiogram if indicated |
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Atrial Fibrillation Treatment |
1)Rate control - beta-blocker 2)Anticoagulation - e.g. apixaban, dabigatran, warfarin etc. |
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Chest pain causes |
Cardiac - Angina, MI, Pericarditis, Dissection
Pulmonary - PE, Pleurisy, pneumothorax Gastro - Ulcer/reflux, gallstones, pancreatitis MSK - Chostochondritis Non-organic - Anxiety |
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SOB causes |
Cardiac - Angina, MI, valvular heart disease, arrhythmias, HF, cardiac tamponade Pulmonary - PE, pneumothorax, asthma, COPD, fibrosis Gastro - pancreatitis Non-organic - Anxiety |
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Angina Key Features |
Central crushing chest pain Constricting discomfort Worse on exertion Relieved by rest or GTN |
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MI Key features |
More severe than angina usually Can include breathlessness, sweating, nausea GTN and rest dont help Last longer than 20 mins |
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Acute pericarditis features |
Pleuritic, retrosternal chest pain Pain relieved by sitting and leaning forward Pain increases with coughing, inspiration, swallowing and lying supine Presence of pericardial rub on examination |
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Aortic dissection key features |
Tearing chest pain Unequal BP in both arms Patient often presents in a collapsed state |
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Pneumonia defintion |
Acute illness with: -Cough -Another LRT symptom -New focal signs upon examination (e.g. crackles) -Fever -No other diagnosis |
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Common Pneumonia organisms |
S pneumonia H influenzae |
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Pneumonia Management |
Treat sepsis. -Give o2 -Bed rest and lots of fluids -Take sputum and blood cultures to sample -LMWH prophylaxis - Antibiotics (depends on CURB-65 and if organism is known) CURB Score: 1=Oral amoxi - 5 days 2=Oral amoxi and oral clarith 3-5=IV co-amoxiclav and oral/iv clarithromycin |
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PE signs & symptoms |
Sudden onset SOB Pain - central or pleuritis Haemoptysis Hypotension/collapse Raised RR Signs of DVT Pleural Rub |
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Pleural Rub |
Can be found in pneumonia, PE, pleuritis Appear on inspiration and expiration Sounds like treading on fresh snow - Low pitched rumble |
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PE Tests |
Blood - General, D-Dimer ECG - Tachycardia, Anterior T waves inverted. S1Q3T3 (Large S wave in lead 1, large q in lead 3, and inverted t waves in lead 3) CXR CTPA |
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PE Treatment |
Anticoagulation (e.g. LMWH) |
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Pneumothorax signs and symptoms |
Pain - pleuritic Sudden onset SOB Swelling in face and neck Raised RR 'Crackling' under skin Hyperresonant upon percussion Reduced breath sounds and vocal resonance. |
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Pneumothorax Investigations |
CXRAY CT (often not necessary) Ultrasound can be used too |
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Pneumothorax Treatment |
Small pneumothoraxes sometimes dont need treatment Needle or chest tube to relieve the air |
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Asthma Symptoms |
Often diurnal variation of symptoms Combinations of wheeze/breathlessness/chest tightness/cough - Episodic Symptoms can be triggered by allergen |
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Asthma investigations |
Bloods - check for eosinophils, IgE, and atopy Skin-prick test Spirometry & Peak flow |
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Asthma treatment |
Inhaled corticosteroids - Long term preventer B-agonist - Short acting bronchodilator for relief. Asthma attack 'O **** ME' |
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COPD symptoms and signs |
SOB, cough, sputum Use of accessory muscles, raised JVP, barrel chest, reduced expansion, expiratory wheeze, |
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COPD diagnosis |
Spirometry CXray - rules out complications. Looks hyperinflated with flattened diaphragms FBC PEFR - Rules out asthma alpha 1 antitrypsin ECG and Echocardiogram sputum culture CT Thorax |
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COPD Treatment |
Smoking cessation Pulmonary rehab Inhaled bronchodilators corticosteroids (oral/inhaled) oxygen therapy xanthines - theophylline mucolytics - carbocysteine |
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Lung Cancer Symptoms |
Cough - Haemoptysis Dyspnoea Wheeze and/or Stridor Chest pain Weight loss Tiredness Pain Confusion |
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Lung cancer signs |
Finger clubbing Lymphadenopathy SVC Obstruction Horner's syndrome Stridor Paraneoplastic syndrome (e.g. ACTH leads to cushings) |
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Lung cancer investigations |
CT CXray MRI Bloods - FBCs, U&Es, LFTs, LDH |
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Lung Cancer Treatment |
Surgery Chemotherapy Radiotherapy Combinations Palliative Care Newer therapies (TKI; immunotherapy) |
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Acute Abdomen Definition |
Sudden severe abdominal pain, often requiring surgery. Acute abdomen can be erroneously used as a synonymn for peritonitis, but acute abdomen can be caused by peritonitis |
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Peritonitis Symptoms and signs |
Abdomen pain Abdomen swelling Fever Nausea and vomiting Diarrhoea or constipation Rebound pain Abdominal guarding Sinus tachycardia |
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Peritonitis Treatment |
Usually IV antibiotics Surgery if indicated |
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GORD vs PUD symptoms |
GORD: Retrosternal Pain after meals Reflux Extra-oesophageal features (e.g. chronic cough) PUD (Peptic ulcer disease): Fullness after meals NSAID steroid history Epigastric tenderness |
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GORD vs PUD investigations |
Gord: only do endoscopy if a/w dysphagia, red flag, or not responsive to treatment PUD: H.pylori breath test Stool antigen test Endoscopy to exclude malignancy |
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GORD vs PUD Treatment |
GORD: Anatacids PPI fundoplication PUD: PPI H.pylori eradication Stop NSAIDs if possible |
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Crohn's Vs UC Symptoms |
Crohn's: Diarrhoea Weight loss Peri-anal disease More chronic disease Can have erythema nodosum, arthropathy too UC: Diarrhoea - w/ blood and mucus lower abdominal discomfort tenesmus Can have erythema nodosum, arthropathy too |
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Crohn's vs UC Endoscopy and Histology |
Crohn's: Cobblestone Ulceration Fistulas Granulomas UC: Friable pseudopolyps Continuous, mucosal, crypt abscesses |
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Crohn's vs UC Management |
Crohn's : Polymeric diet azathioprine anti-TNF alpha antibodies UC: Mesalazine azathioprine anti-TNF alpha antibodies |
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IBS symptoms |
Recurrent pain/discomfort relieved by defecation Bloating and constipation Diarrhoea No extra-intestinal symptoms |
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Acute abdomen causes |
Liver - Acute hepatitis, abscess Gallbladder - Cholecystitis, ascending cholangitis Pancreas - pancreatitis Stomach - Perforated ulcer Duodenum - Perforated ulcer Spleen - Rupture Kidneys - Pyelonephritis, stones Aorta - AAA rupture Bowel - Appendicitis, Diverticulitis, UC/crohn's flare, strangulated hernia, perforated colon, ischaemic bowel, peritonitis, intestinal obstruction Bladder - Urinary retention Gynae - ectopic pregnancy |
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GI Cancer symptoms |
Weight loss Anorexia Fatigue Night sweats Symptoms and signs of anaemia Malaena/haematemesis |
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Region Specific GI cancer symptoms |
Oesophageal - dysphagia, hoarse voice, coffee ground vomit Gastric - can be non-specific, coffee ground vomit, anaemia (due to occult bleeding) Pancreatic - Painless obstructive jaundice, weight loss. Colon - Blood in stool, tenesmus, diarrhoea/constipation. |
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GI Cancer investigations |
Bloods - FBCs, U&Es, LFT Biopsy via endoscopy CT/MRI for staging Tumour markers (indicator of primary cancer): CA19-9 - pancreatic, CEA - colon |
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Diverticulitis |
Pain in LLQ is white patients or RLQ in asian patients. Fever Tachycardia Rectal bleeding - causes large volume of red blood abruptly Altered bowel habit, nausea, vomiting, anorexia |
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Specific LFTs |
ALT - Marker of hepatocyte cell death ALP - Biliary side of hepatocytes GGT - Liver, ignore if raised in isolation Albumin Bilirubin |
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Hepatitic pattern - LFTs |
Elevated ALT/AST Elevated GGT In end stage liver failure, ALT/AST will be low due to hepatocyte death. Alcoholic hepatitis and liver cirrhosis actually cause anOBSTRUCTIVE pattern of LFTs |
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Obstructive pattern - LFTs |
High ALP High GGT Alcoholic hepatitis and liver cirrhosis can cause obstructive pattern of LFTs too |
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Pre-hepatic jaundice causes and investigations |
Malaria Metallic heart valves (trauma) Sickle cell anaemia Blood film - will show Haemolysis LFTs - will show raised unconjugated bilirubin Urine dipstick - will show raised urobilinogen |
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Hepatic jaundice causes |
Hepatitis (e.g. viral, alcohol, Wilson's disease, drugs, haeomachromatosis, NAFLD) Gilbert's syndrome |
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Post-hepatic jaundice causes |
Intra-luminal - gall stones, Luminal - cholangiocarcinoma Extra-luminal pancreatic cancer |
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Post-hepatic jaundice symptoms and investigations |
dark urine Pale stool/steatorrhoea LFTs - raised conjugated bilirubin urine - conjugated bilirubin in urine but urobilinogen is not raised |
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Courvoisier's law |
Painless jaundice + palpable gall bladder = Usually malignancy (pancreatic or biliary) |
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Acute Hepatitis Causes |
Viruses (Mainly Hep A,E, CMV, and EBV) Poisons - Alcohol, paracetamol, drugs Metabolic - Wilson's disease Autoimmune Ischaemic |
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Fulminant Liver Failure Definition |
A form of acute liver failure, in which encephalopathy develops within 8 weeks after the onset of symptoms (basically, severe acute liver failure). |
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Fulminant liver failure causes and signs |
Paracetamol overdose Severe alcoholic hepatitis Hep E (if pregnant) Encephalopathy Coagulopathy - increased PT Kidney failure Inflammation and infection (SIRS and sepsis) |
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Fulminant Liver Failure LFTs |
ALT - Raised ALP - Raised/no change Albumin - no change Bilirubin - no change/ raised PT - raised |
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Compensated vs Decompensated Liver disease |
Compensated refers to when there are no symptoms because despite cirrhosis of some regions, there are enough healthy cells to maintain liver function. Decompensated refers to when there aren't enough healthy cells, so signs of decompensation become apparent (e.g. jaundice, ascites, coagulopathy, and encephalopathy) |
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Chronic Hepatitis causes |
Virus - Hep B, C, D Poison - alcohol Metabolic - Wilson's disease, haemachromatosis, fat Autoimmune - autoimmune hep. Primary biliary cirrhosis |
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Autoimmune hepatitis types |
Chronic active autoimmune hep - leads to fatigue, muscle aches, jaundice, fever, RUQ pain PBC - Destruction of bile ducts in liver, causing cholestasis and eventually fibrosis and cirrhosis. IgM raised Primary sclerosing cholangitis - Inflammation and scarring of bile ducts - linked with IBD. |
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Haemochromatosis symptoms and investigations |
Caused by genetic disorder of iron metabolism. Arthralgia, signs of chronic liver disease, 'bronze diabetes' (due to iron deposition in pancreas) Investigations - Raised LFTs, raised ferritin and transferrin. Genotype for HFE gene |
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Wilson's disease symptoms and investigations |
Disorder of copper excretion Liver symptoms, CNS problems (e.g. poor memory, depression etc.), copper in iris Investigations - High urinary copper, low serum copper, liver biopsy |
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Spontaneous bacterial peritonitis symptoms, investigations, and treatment |
Infection of ascitic fluid Symptoms - Fever, abdo pain Investigations - Ascitic fluid: PMN cells >250 mm3 Treatment = antibiotics |
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Constipation investigation |
Digital Rectal Exam |
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Liver Malignancies Types |
Mostly metastases Primary - Hepatocellular Due to cirrhosis, most often Hep B and C. Alcohol too. |
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Liver malignancies investigations |
Ultrasound Serum alpha-fetoprotein |
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Gallstones and their pathology |
Biliary colic - Gall stone intermittently impacts upon cystic duct. Results in colicky pain Cholecystitis - Same as biliary colic with inflammation. More constant pain and fever. Cholangitis - Gallstone is in bile duct so occludes liver output too + inflammation. Pain, fever, and jaundice - Charcot's triad |
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Murphy's sign |
•Painon palpation during inspiration on right side•Notpresent on the left side |
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Gallstone pathology investigations |
LFTs Abdominal USS MRCP - Special type of MI |
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Migraine symptoms |
Unilateral pain Pulsatile Aura - focal neurology |
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Cluster headache symptoms |
Unilateral - retro-orbital pain Stabbing V1 primarily affected |
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Trigeminal neuralgia symptoms |
Unilateral - facial pain Stabbing V2/3 affected primarily |
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Tension headache symptoms |
Bilateral, forehead pain Non-pulsatile Can have scalp tenderness associated |
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Meningitis symptoms |
Headache Fever Neck stiffness Confusion Non-blanching rash |
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Meningitis investigationsl |
Ct to check for raised intracranial pressure LP - Low glucose, high WBC, and high protein indicates bacterial meningitis
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GCA symptoms |
Temporal headache scalp tenderness and jaw claudication Associated with PMR Visual changes are an emergency, indicate amaurosis fugax |
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GCA investigations and management |
Bloods - ESR Temporal artery doppler Temporal artery biopsy Oral prednisolone |
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Headache Red flags |
Focal neurology - ?Migraine Nausea and vomiting - ?migraine or meningitis Raised ICP - ?tumour Progressively worse - ?Tumour Tender scalp or jaw claudication - ?GCA Fever or recent illness - ?meningitis |
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Pituitary adenoma symptoms |
Raised ICP signs (e.g. headache worse on coughing or sneezing) Worse as tumour grows |
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Pituitary adenoma investigations |
Prolactin levels IGF-1 ACTH and cortisol, short synacthen TFTs LH/FSH MRI pituitary - best |
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Subarachnoid haemorrhage symptoms |
Sudden severe headache Stiff neck Photophobia Blurred/double vision Nausea and vomiting Stroke-like symptoms |
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Subarachnoid haemorrhage investigations |
CT scan w/o contrast then CT angiography to identify aneurysms.
LP can be used if history is suggestive of SH but CT is negative - Xanthochromia (yellow) |
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Subarachnoid treatment |
Prevent further bleeding via occlusion of aneurysm Endovascular obliteration or direct neurosurgical approach (clipping) Pain relief too |
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Back Pain Red Flags |
TUNA FISH Trauma Unexplained weight loss Neurological symptoms Age (<20, >55) Fever IVDU Steroid use History of cancer |
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Stroke classification |
Hemiparesis/sensory deficit Visual changes cortical dysfunction (e.g. speech) TACS - 3 of the above PACS - 2/3 of the about LACS - just the motor/sensory changes POCS - Cerebellar, brainstem, occipital lobe affected |
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UMN Lesions symptoms |
Spastic paralysis hypertonic and hyperreflexic up going plantarsa ankle clonus |
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LMN Lesions symptoms |
flaccid paralysis hypotonic hyporeflexic muscle wasting fasciculations |
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Stroke treatment |
Ischaemic - thrombolysis within 4.5. hours if possible (alteplase) Thrombectomy can be used in some ischaemic strokes Antiplatelets - e.g. aspirin Anticoagulants - e.g. warfarin, apixaban |
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Dementia criteria |
Decline in memory Decline in other cognitive abilities (e.g. judgement and thinking) |
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Dementia symptoms |
Memory loss difficulty performing familiar tasks Problems with language Disorientation Poor or decreased judgement Changes in mood or behaviour |
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Dementia types |
Alzheimer's Vascular - classical stepwise following vascular events Lewy body - parkinsonism/hallucinations/cognitive impairment Others: e.g. CJD, wernicket's, fronto-temporal |
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Delirium definition |
Acute confused state characterised by -rapid onset -fluctuating state -inattention -impaired level of consciousness -disturbed cognition -secondary to underlying physical cause |
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Delirium clinical features |
Rapid onset and fluctuating throughout day -Disturbance of cognition -clouding of consciousness -Disturbance of sleep-wake cycle, symptoms may be worse at night. Can be hyperactive, hypoactive, or mixed |
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Delirium causes |
Drugs Electrolytes Lack of drugs Infection Reduced sensory input Intracranial Urinary or bowels Myocardial or pulmoanry |
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mental test scores |
AMTS - out of 10 MMSE - out of 30 ACE-R - out of 100 |
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Delirium/dementia investigations |
MRI DAT - direct antibody test SPECT - Single Photon Emission Computed Tomography |
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Delirium treament |
Treat underlying condition careful attention to nutrition and hydration |
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Dementia treatment |
Alzheimers/lewy/parkinson's: Address risk factors for vascular dementia |
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Depression symptoms and treatment |
Low mood anhedonia withdrawal Antidepressants, e.g. SSRIs, SNRI, NARIs |
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Benign breast lumps |
Firm or rubbery Often painful regular or smooth margins Mobile Bilateral discharge - no blood no nipple retraction |
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Malignant breast lumps |
hard often painless irregular margins Fixation to skin or chest wall Skin contour changes Nipple discharge (can be w/ blood) Nipple changes e.g. inversion Axillary lumps - lymph nodes |
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Fibroadenoma |
Common in young women (20s) Form, non-tender highly mobile palpable lumps Benign |
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Breast cyst |
Common between 35-50 y.o. Palpable discrete lumps Benign |
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Breast cancer types |
Intraductal - 85% lobular - 9% unspecified - 6% Can be positive or negative for HER-2 (human epidermal growth factor receptor) or HR (hormone receptor) |
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Breast lump investigations and management |
Triple assessment -clinical exam -imaging - US/mammography -biopsy - core biopsy or fine needle aspiration Management -surgery - wide local excision or masectomy -chemo/radio -hormonal if indicated |
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5 features regarding skin lesions |
A-asymmetry B- border C- colour D - diameter E - evolution |
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Osteoarthritis signs and symptoms |
Symptoms -pain stiffness exacerbated by exercise relieved by rest signs -reduced range of motion -swelling/synovitis -crepitus -weakness |
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Osteoarthritis diagnosis |
can be clinical is -age over 45 -activity related -no morning stiffness/less than 30 mins xray - LOSS Blood tests and joint aspiration should be normal |
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Osteoarthritis management |
Weight loss exercise thermotherapy paracetamol NSAIDS codeine |
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Inflammatory vs. non-inflammatory arthritis features |
Inflammatory -swelling -redness -heat non-inflammatory -mechanically related -locking |
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Septic arthritis symptoms and signs |
Pain fever swelling erythema |
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Septic arthritis tests and treatment |
lactate blood culture aspirate for culture high WCC, CRP, ESR Xray Sepsis 6 antibiotics |
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Rheumatoid arthritis symptoms |
pain better with movement morning stiffness more than 30 mins red warm joint often fingers |
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rheumatoid investigations |
Bloods: -rheumatoid factor -Anti-CCP -General bloods Xray - LESS |
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RA management |
DMARDs - e.g. methotrexate, sulfasalzide NSAIDS - symptomatic relief Steroids - acute exacerbations |
