-
Name 4 conditions that can cause hepatosplenomegaly.
- Polycythaemia ruba vera
- Chronic myeloid leukaemia
- Essential thrombocytosis
- Myelofibrosis
-
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
-
What are the signs of mitral stenosis?
- Opening snap
- Mid-diastolic murmur (rumbling)
- Tapping apex beat
-
What are possible causes of pneumothorax?
- Malignancy
- Trauma
- Low albumin
- Bullou emphysema
-
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)
-
How do you treat a pseudomonas lung infection?
- Beta lactam (ben pen, ceph)
- Aminoglycosides (gentamicin)
- Mucus clearance
-
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)
-
List 3 extrinsic risk factors for falls
- Lighting
- Obstacles (cats, rugs)
- Grab rails
- Walking aids
- Footwear
-
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
-
Horner's syndrome constitutes...
- Partial ptosis
- Anhidrosis
- Miosis
- Enopthalmos
-
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
-
List 4 causes of transient loss of consciousness.
- Epilepsy
- Trauma
- Hypoglycaemia
- Syncope
- - cardiogenic (arrhythmia)
- - non-cardiogenic (postural hypotension, vasovagal)
-
Define postural hypotension.
- Systolic BP drop of >=20mmHg or
- Diastolic BP drop of >= 10mmHg within 3 minutes of standing
-
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
-
List 5 possible causes of decreased consciousness.
- Hypotension/hypovolaemia
- Hypoxia
- Hypoglycaemia
- Hypernatraemia
- Hypocalcaemia
- Drugs
- Brain damage
- Severe hypothyroidism (myxoedema coma)
-
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.
-
What is the most common cause of hip pain?
Trochanteric bursitis
-
List 5 signs of severe mitral regurgitation.
- Lateral displacement of apex beat
- Apical heave
- S3
- Forceful, unsustained apex beat
- Bibasal crackles
-
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
-
What CXR findings do you expect in severe MR?
- Splaying of carina (LA and LV enlargement)
- Increased cardiothoracic ratio
- Signs of HF (ABCDE)
-
What sign indicate severe aortic stenosis?
- Forceful, sustained thrill
- Late peaking of cresc/decresc murmur
- Low volume, slow rising pulse
- S4
-
What ECG and CXR findings would you expect in severe aortic stenosis?
- LVH (tall R)
- Calcified aortic valve
- Later - enlarged LV, and LA
-
What are the cardinal symptoms of aortic stenosis?
- Syncope
- Dyspnoea
- Chest pain
-
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
-
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
-
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
-
What are the 4 different types of regular SVTs?
- A flutter
- A tachycardia
- AVNRT
- AVRT
-
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.
-
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.
-
What is atrial tachycardia?
Increased atrial depolarisation rate due to ectopic atrial source or micro-reentry circuit.
-
What do you see on an ECG with atrial tachycardia?
Abnormal P followed by normal QRS, increased HR.
-
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.
-
How do you treat AVNRT?
- Vagal manouvres
- Drugs - verapamil, adenosine, beta blocers
- Radioablation of slow pathway.
-
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)
-
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
-
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.
-
What are the 4 different types of coronary artery disease?
- Chronic stable angina
- STEMI
- NSTEMI
- Unstable angina pectoris
-
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
-
How do you manage a STEMI?
- 1. Reperfuse (PCI or thrombolysis
- 2. Drugs: aspirin, clopidogrel, beta-blocker, ACEI, statin, epleronone
- 3. Symptomatic GTN
-
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.
-
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
-
How do you manage high risk NSTEACS?
- Double antiplatelet (aspirin and clopidogrel)
- Heparin
- Statins
- Beta-blockers
- ACEI
- Coronary angiogram --> PCI/CABG
-
How do you manage intermediate risk NSTEACS?
Investigate with stress test, stress echo (dobutamine), CT coronary angiogram or myocardial perfussion scan (adenosine).
-
List 3 causes of pulmonary oedema
- cardiac failure
- overhydration
- increased capillary permeability (ARDS)
-
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
-
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)
-
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
-
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)
-
How do you treat HFNEF?
Diuretics to reduce symptoms only.
-
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
-
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)
-
What is the main cause of mitral stenosis?
Rheumatic heart disease
-
How do you treat mitral stenosis?
Balloon valvotomy (so long as it is not MS and MR)
-
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.
-
What can cause aortic regurgitation?
- Infective endocarditis
- Syphillis
- Rheumatic heart disease
-
Mitral valve regurgitation can be caused by...
- Mitral valve prolapse
- Infective endocarditis
- RHD
- Connective tissue disease
-
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)
-
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
-
List 5 causes of apical fibrosis.
- (allergic) Bronchopulmonary aspergillis
- RA
- Extrinsic allergic alveolitis (e.g. bird fanciers)
- Ankylosing spondylitis
- Sarcoidosis
- TB
- Silicosis
- Histiocytosis X
-
List 4 causes of interstitial lung disease.
- Idiopathic
- Connective tissue disease (RA, SLE, scleroderma)
- Drugs (amiodarone, sulfasalazine)
- Occupation (silicosis, asbestosis)
-
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.
-
What conditions are associated with Cheyne-Stokes respiration?
- HF
- Stroke
- Traumatic brain injury
- Brain tumours
- CO poisoning
-
What are the complications of diabetes mellitus?
- Autonomic: postserol hypotension, urinary retention, nocturnal diarrhoea
- Macrovascular: CAD, PVD, CVD
- Microvascular: retinopathy, nephropathy, neuropathy
-
List 5 risk factors for VTE.
- HF
- Previous VTEs
- Oestrogen
- Obesity
- Active cancer
- Lung disease
- Inflammatory disease
-
VTE prophylaxis consists of...
- Enoxaparin (LMWH)
- Mechanical prophylaxis (eg. TED stockings)
-
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
-
List 3 causes of SOB.
- Cardiac: CCF
- Respiratory: aspiration, PE, pneumonia, pneumothorax, collapse, COPD, URT obstruction
- Sepsis: from joint, cellulitis, IV line, diverticulitis etc.
-
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
-
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.
-
What are the 4 cardinal signs of Parkinsons Disease?
- Rigidity
- Resting tremor
- Bradykinesia/hypokinesia
- Postural instability
-
What are the early manifestations of Parkinsons Disease?
Fatigue and non-specific discomfort (e.g. shoulder pain).
-
List 3 symptoms of Parkinson's Disease.
- Craniofacial: blurred vision, anosmia
- Autonomic: postural hypotension, nocturnal diarrhoea, urinary incontinence
- Psych: depression, anxiety, sleep disturbance
-
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
-
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
-
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
-
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
-
How is a diagnosis of osteoporosis made?
- T score <2.5 SD; or
- Fragility fracture
-
What test is a good indicator of intravascular haemolysis?
Reduced haptoglobin
-
Haemolytic anaemia may be associated with changes in what particular parameters?
- Bilirubin (increased)
- LDH (increased)
- Potassium (increased)
- Haptoglobin (decreased, if intravascular)
-
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
-
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
-
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)
-
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
-
What is a LACI?
- Pure motor (weakness of 2 or more of face, arms or legs)
- Pure sensory loss;
- Sensorimotor loss; or
- Ataxic hemiparesis
-
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
-
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.
-
Causes of proximal muyopathy (4)
- EtOH
- Steroids
- Cushings Syndrome
- Osteoarthritis
-
What are the characteristic findings of OA on an x-ray?
- Subchondral cysts
- Subchondral sclerosis
- Osteophytes
- Joint space narrowing
-
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
-
What is the triple whammy and what can it cause?
- ACEI, diuretic and NSAID.
- Renal failure
-
A patient presents with diabetic ketoacidosis - what symptoms are you expecting?
- Vomiting,
- Dehydration,
- Kussmaul breathing,
- Confusion
- Coma
-
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)
-
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
-
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
-
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)
-
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
-
Why would you palpate the cheeks in a GIT exam?
- Parotidomegaly (bilateral) = alcoholism or parotid tumour
- Submandibular gland enlargement: calculus, chronic liver disease
-
List 5 significant fetor findings.
- Fetor hepaticus: hepatocellular disease with methylmercaptans; sweet
- Ketosis: DKA; sickly sweet
- Uraemia
- Alcohol
- Putrid: chest infection
- Cigarettes
-
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
-
What is Troisier's sign?
Enlarged supraclavicular node and stomach carcinoma
-
Gynaecomastia is seen in liver disease Why?
- Alcoholic cirrhosis or chronic active hepatitis --> decreased oestrogen breakdown
- Treatment of ascites with spironolactone
-
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)
-
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
-
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
-
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
-
When would your liver be pulsatile (3?
- Tricuspid regurg
- HCC
- Vascular abnormalities
-
What is Murphy's sign?
Hand on R. costal margin and inhalation --> pain as inflamed gallbladder catches
-
What 2 signs, when positive, are associated with appendicits?
- McBurney's point (2/3:1/3 umbilicus:ASIS) tenderness
- Rovsing's sign
-
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
-
Empirical treatment for infective endocarditis?
Benzyl penicillin, flucloxacillin, gentamicin.
-
Empirical treatment for CAP?
- Benzyl penicillin + roxithromycin if moderate.
- Benzyl penicillinn + gentamicin if severe.
-
Empirical treatment for HAP
- Amoxicillin and clavulanic acid if mild.
- Ticarcillin and clavulanic acid and gentamicin if severe.
-
Uncomplicated UTI Tx?
Trimethoprim.
-
Complicated UTI Tx?
Ampicillin and gentamicin.
-
Febrile neutropenia Tx?
Merepenam.
-
Sepsis from an intrabdominal source Tx?
Metronidazole and cefataziime.
-
Meningitis Tx?
Ceftriaxone.
-
Skin/joint/bone infection?
Flucloxacillin.
-
What types of pharmacological treatment can you give for osteoporosis?
- Bisphosphonates (alendronate)
- Strontium
- Raloxifene (SERM)
- Vit D and calcium
-
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)
-
List 6 causes of pulmonary fibrosis in the upper lobes.
- Silicosis
- Sarcoidosis
- Coal workers pneumoconiosis
- Histiocytosis
- Ankylosing spondylitis
- Allergic bronchopulmonary aspergillosis
- Radiation
- Tuberculosis
-
List 5 causes of lower lobe pulmonary fibrosis.
- RA
- Asbestosis
- Scleroderma
- Cryptogenic fibrosing alveolitis
- Other (drugs eg. amiodarone, methotrexate).
-
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)
-
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)
-
Why is ankylosing spondylitis important in a cardiovascular exam?
Aortic regurgitation
-
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
-
Sitting forward and deep expiration makes which pathological heart sounds clearer?
- Aortic regurgitation
- Pericardia friction rub
-
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
-
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
-
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
-
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
-
What blood tests could you run in suspected RA?
- Rheumatoid factor
- ANti-citrullinated protein antibodies
-
What pharmacological treatments are available for RA?
- Methotrexate (hepatomegaly)
- Sulfasalazine
- Steroids (Cushings)
-
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
-
List 4 rheumatological diseases that are associated with pulmonary fibrosis.
- RA
- Ankylosing spondylitis
- Scleroderma
- SLE
-
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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