Terms in this set (162)
Causes of macrocytic anaemia
Drugs (e.g. methotrexate)
Causes of normocytic anaemia
Anaemia of chronic disease
Acute blood loss
Causes of microcytic anaemia
Anaemia of chronic disease (if also iron deficient)
Cause of type 1 MI
Causes of type 2 MI
Immediate management of suspected MI
Aspirin 300mg soluble
Oxygen (if sats <95%)
Management of NSTEMI
Management of STEMI
What medications would a patient be discharged with following an MI?
GTN spray (angina patients)
What is the target normal BP in clinic for patients under 80?
What is the target normal BP in clinic for patients over 80?
What % is defined as high risk using QRISK and would warrant starting therapy?
What does QRISK measure?
The risk of a coronary event over the next 10 years
What is stage 1 hypertension?
BP >135/08 but <150/95
What is stage 2 hypertension?
What is malignant hypertension?
BP > 180/110 with potentially life-threatening symptoms and signs indicative of acute impairment of one or more organ systems
What are signs of malignant hypertension
What is atrial fibrillation?
abnormal heart rhythm characterised by rapid, irregular and chaotic contraction of the atria
What is the appearance of atrial fibrillation on ECG?
Absence of P waves
What is the appearance of atrial flutter on ECG?
What causes atrial fibrillation?
- mitral stenosis
- previous MIs (scarring)
What drugs can be used for chemical cardioversion?
(pre-existing heart disease)
(no known heart disease)
What is the mechanism of action of NOACs?
Factor Xa inhibitors
What is the mechanism of action of warfarin?
Inhibits the vitamin K-dependent synthesis of clotting factors II, VII, IX and X
What is the mechanism of action of Clopidogrel?
ADP receptor antagonist, important in activation of platelets and eventual fibrin cross-linking
What spirometry would you expect for obstructive disease?
FEV1/FVC ration <0.7
What spirometry would you expect for restrictive disease?
FEV1/FVC ratio ≥0.7
What does the bronchodilator administration indicate
reversible = likely asthma
irreversible = likely COPD
Examples of obstructive lung disease
Examples of restrictive lung disease
Idiopathic pulmonary fibrosis
Idiopathic interstitial pneumonia
Adverse effect of certain drugs (e.g. amiodarone, methotrexate) Chest deformities
Signs of obstructive disease
reduced chest expansion
wheeze (polyphonic, bilateral)
chest X ray signs of COPD
hyper inflated lungs
flattening of diaphragm
may show bullae
What are the 2 main components of the pathophysiology of COPD
emphysema + chronic bronchitis
definition of chronic bronchitis
cough with sputum production for at least 3 months in 2 consecutive years
definition of emphysema
permanently dilated airways distal to terminal bronchioles with alveolar destruction and bullae formation
what protein deficiency is linked to development of emphysema (and thus COPD)
What cells are responsible for inflammation in COPD?
causes of COPD
smoking (including secondhand exposure)
alpha-1 antitrypsin deficiency
Symptoms of COPD
shortness of breath
(worse early morning)
what are 'pink puffers' in the context of COPD?
dominant pathology= emphysema
(hyperventilation + maintenance of blood oxygenation)
what are 'blue bloaters' in the context of COPD?
dominant pathology= chronic bronchitis
(peripheral oedema + cyanosis)
GOLD scale for assessment of severity of COPD
Stage I - mild
Stage II - moderate
Stage III - severe
Stage IV - very severe
Management of COPD
short acting beta agonist
long acting muscarinic antagonist (titotropium)
OR long acting beta agonist (salmeterol)
complications of COPD
Pathophysiology of asthma
What cells are responsible for inflammation in asthma?
Symptoms of asthma
dry cough (nocturnal)
breathlessness (worse at night/early morning)
Management of asthma
short acting beta agonist (salbutamol)
Respiratory causes of finger clubbing
interstitial lung disease
Cardiovascular causes of finger clubbing
congenital cyanotic heart disease
tetralogy of Fallot
Gastrointestinal and hepatobiliary causes of finger clubbing
IBD (Crohns and UC)
Cirrhosis (especially PBC)
Pathophysiology of bronchiectasis
abnormal chronic dilatation of bronchi + poor mucous clearance
Symptoms of bronchiectasis
- large volume
- daily purulent sputum
- worst early morning
signs of bronchiectasis
coarse, inspiratory crackles
Treatment of bronchiectasis
Antibiotics (if infection present)
Causes of infective exacerbations of asthma and COPD
- rhinovirus, influenza, RSV
- H. influenzae
- Step. pneumoniae
- M. pneumoniae
Treatment of infective exacerbations of asthma and COPD
Pathophysiology of idiopathic pulmonary fibrosis
Injury to endothelial cells, inflammation and repairably cellular reorganisation
Signs of pulmonary fibrosis
reduced chest expansion
fine, end-inspiratory crackles (bilateral)
Ovarian cancer marker
Test for IBD
Tests for coeliac disease
Endomysial antibodies (EMA)
Tissue transglutaminase (TTG)
Colorectal cancer red flags
Rectal bleeding >3 weeks
Change of bowel habit >3 weeks
Abdominal or rectal mass
Iron deficiency anaemia
What is non-alcoholic fatty liver disease?
Excess fatty infiltration of hepatocytes
What is non-alcoholic steatohepatitis?
inflammation of hepatocytes due to fatty deposits
What is liver cirrhosis?
replacement of normal liver parenchyma with scar tissue
What is the main pathophysiology of NAFLD?
insulin resistance and metabolic syndrome
Treatment of NAFLD
weight loss >5% of body mass
What blood results would you expect in alcoholic liver disease?
Serology for Hepatitis A
Serology for Hepatitis B
Serology for Hepatitis C
Diagnostic test for haemochromatosis?
HFE gene mutation
Diagnostic tests for autoimmune hepatitis?
antinuclear antibody (ANA)
smooth muscle antibody (SMA)
Causes of prehepatic jaundice
haemolytic uraemia syndrome
Causes of hepatic jaundice
alcoholic liver disease
Primary biliary cholangitis
Causes of post hepatic jaundice
primary sclerosing cholangitis
Which vitamins does bile assist the absorption of?
A, D, E, K
What pattern of liver function tests would indicate a prehepatic pathology?
What pattern of liver function tests would indicate an acute hepatitic picture?
AST/ALT very raised (>1000)
ALP mildly raised
What pattern of liver function tests would indicate a chronic hepatitic picture?
ALT/AST raised (>100)
What pattern of liver function tests would indicate a cholestatic picture?
ALT/AST mildly raised
raised ALP (~1000)
Gallstone causing temporary blockage of cystic duct
Gallstone causing prolonged blockage of cystic duct
What is Murphy's sign?
Pain on deep palpation of RUQ on inspiration. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed
What does a positive Murphy's sign likely signify?
Gallstone obstructing common bile duct
Associated symptoms of obstructive jaundice
Gallstone at ampulla of Vater
What does abdominal guarding signify?
Bruising in flanks
What does Grey-Turner's sign indicate?
retroperitoneal haemorrhage (acute severe pancreatitis)
Bruising around the umbilicus
What does Cullen's sign indicate
Pancreatic enzymes that have tracked along the falciform ligament and digested subcutaneous tissues around the umbilicus
What causes a 'coffee bean sign' on abdominal X Ray?
What microorganisms can cause cellulitis?
What microorganisms cause necrotising fasciitis?
Group A beta-haemolytic Streptococcus
What is the definition of prolonged QT interval?
>440 in men
>460 in women
What is long QT a risk for progression to?
Torsades de pointes
(can itself progress to ventricular fibrillation)
Hand features of rheumatoid arthritis
Swan neck deformity
Which immunoglobulin indicates acute events
Which immunoglobulin indicates chronic events
Which joints are most commonly affected in rheumatoid arthritis?
Peripheral joints (fingers)
Which joints are most commonly affected in osteoarthritis?
Weight bearing joints (hips, knees, spine)
Which joints are usuallyaffected in polymyalgia rheumatica?
shoulder girdle and pelvic girdle
Likely cause of anaemia in a patient with a low MCV and normal RDW
Likely cause of anaemia with low MCV + high RDW
Likely cause of anaemia with high MCV + high RDW
Likely cause of anaemia with normal MCV + high RDW
Where is iron absorbed in the body?
What is necessary for the absorption of iron?
reduction by stomach acid
Where is vitamin B12 absorbed?
What is necessary for the absorption of vitamin B12?
Where is intrinsic factor produced?
parietal cells in the stomach
What is pernicious anaemia
B12 deficiency anaemia caused by an autoimmune destruction of the parietal cells in the gastric mucosa
Causes of iron deficiency anaemia
chronic blood loss (e.g. menorrhagia)
Where is iron stored in the body?
Majority in circulating red blood cells, rest in the liver
What is the problem with a ferritin blood test?
Ferritin is an acute phase reactant
What is the main feature that distinguishes thalassaemia on FBC?
disproportionately low MCV for Hb
Possible causes of vitamin B12 anaemia
lack of intrinsic factor
treatment of vitamin B12 deficiency
Consequences of B12 deficiency
alteration in bowel motility
neurological symptoms (including dementia)
what cells does a common lymphoid progenitor give rise to?
what cells does a common myeloid progenitor give rise to?
what is the function of erythropoietin?
stimulates erythrocyte production
what is the function of thrombopoietin?
stimulates platelet production
risk factors for acute myeloid leukaemia
symptoms of acute leukaemia
low RBCs (anaemia)
pathophysiology of acute leukaemia
accumulation of immature 'blast' cells in bone marrow at the expense of normal haemopoiesis
management of acute myeloid leukaemia
high dose combination chemotherapy
haematopoietic stem cell transplant
what is the key feature of ALL on blood film?
hand mirror cells
symptoms of ALL
management of ALL
stem cell transplant
Imatinib (if Philadelphia +ve)
what is the commonest leukaemia?
chronic lymphocytic leukaemia
pathophysiology of CLL
cancer of naive T/B cells,
slow accumulation of CLL cells causes failure of normal immune system
clinical features of CLL
can be asymptomatic
treatment of CLL
allogeneic stem-cell transplant
What chromosome is associated with CML?
What is the Philadelphia chromosome?
translocation between chromosomes 9 and 22
clinical features of CML
How can we test for the Philadelphia chromosome
BCR-AbL fusion gene
what does the BCR-AbL fusion gene signify?
ABL1 gene of chromosome juxtaposed onto BCR gene of chromosome 22
what does the Philadelphia chromosome code for?
a hybrid tyrosine kinase signalling protein that is permanently switched on, causing uncontrollable cell division
treatment of CML
Imatinib (or other TK inhibitors)
What are the complications of CML?
can progress to ALL or AML (blast crisis)
what is myeloma?
accumulation of malignant plasma cells in bone marrow
what types of myeloma are there?
features of myeloma (CRAB)
what is the protein found in urine that is suggestive of myeloma?
Bence Jones protein
what is an autologous stem cell transplant?
from patient's own stem cells
what is an allogeneic stem cell transplant?
from a donor
causes of normocytic anaemia
anaemia of chronic disease
acute blood loss
causes of iron deficiency anaemia
chronic GI blood loss
clinical features of a tension pneumothorax
severe respiratory distress
tracheal deviation away from affected side
decreased/absent breath sounds
immediate management of a tension pneumothorax
insertion of a large bore (14 or 16 gauge) needle into the 2nd intercostal space, mid clavicular line
Framingham criteria - Major criteria
Crepitations in lungs
S3 heart sound (Gallop rhythm)
Framingham criteria - Minor criteria
dyspnoea on exertion
vital capacity reduced by 1/3
how many hours a day does oxygen therapy need to be used to be effective?
What ejection fraction is needed to make a diagnosis of heart failure?
drugs causing hyponatraemia
SSRIs, thiazide diuretics, proton pump inhibitors, ACE-inhibitors and loop diuretics.
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