PASTEST RANDOM INFO

Supraventricular, regular tachycardia vagotonic manoeuvres

LCA:
Anterior interventricular/LAD anterior interventricular groove > supplies
septum and anterior LV wall
Circumflex branches
RCA:
Posterior interventricular/Posterior Descending > inferior/RV
* expected to produce arrhythmias since dominant supply to SA and AV nodes
DIC moribund patients, ICU, sepsis/malignancy.
Triad: thrombocytopenia, rise in PT, APTT and TT, low fibrinogen,
Also: rise in D dimers, fragmented blood cells/schistocytes
Acutely swollen, tender, red hot joint = septic arthritis until proven otherwise!
(Commonest cause: Staph aureus). Abx treatment for at least 6 weeks, min 2
weeks iv abx.
SCC lung ca = most commonly cavitates
Features of SCC: cavitating lung lesion, central location, hypercalcaemia
Tetralogy of Fallot:
- Interventricular septal defect
- Hypertrophy (right ventricular)
- Overriding aorta
- Pulmonary stenosis
Osteogenesis imperfecta, achondroplasia, Marfans, dystrophia myotonica = AD
Haemochromatosis (AR) clinical manifestations due to iron deposition:
- Liver : Chronic liver disease/cirrhosis
- Heart: Cardiomyopathy
- Pancreas: Secondary DM
- Joints: Arthropathy (commonly pseudo-gout)
- Pituitary: Hypopituitarism
DDx for acute, red hot swollen joint:
Septic arthritis, gout, pseudogout, inflammatory monoarthritis, post-traumatic
Causes of gout:
- Primary hyperuricaemia
- Secondary hyperuricaemia
- Overproduction alcohol excess, high purine diet, leukaemia, obesity,
metabolic diseases
- Decreased renal excretion
Rx for acute gout NSAIDs, colchicine (second line), short course of pred

Crohns

UC

Inflammation
Crypt abscesses
Rose thorn (deep)
ulcers
Lesions
Lymphoid
aggregates

Transmural
Unusual
Yes

Mucosal
Yes
No

Skip
Yes

Continuous
No

First line method to confirm safe placement of NG tube BEFORE feeding:

Aspirate 10ml and check pH. (pH < 5.5 = safe)
Two indications for NG tube:
- Enteral feeding or medication administration
- Decompression of the stomach
*Most common location of renal tract calculi: vesioureteric junction
Three most common: pelvicoureteric junction (PUJ), within ureter at pelvic brim,
VUJ
Commonest site for mesenteric ischaemia: splenic fixture.
Blood supply of gut:
Foregut coeliac axis, jejunum
Midgut SMA,
Hindgut inferior mesenteric artery
Bag of worms, scrotal pain = varicocele
*Ultrasound of kidneys = left varicocele associated with left renal malignancy
Right testicular vein > IVC
Left testicular vein > left renal vein
Large ecchymosis around umbilicus = Cullens sign
Discolouration of flanks = Grey-Turners sign
Trosiers sign = Virchows lymph node
Anaphylaxis: 1:1000 IM adrenaline/ 0.5mg. Repeat every 5 min.
Cardiac arrest 1:10,000 IV adrenaline
DUKES:
A confined to bowel wall
B extends across bowel wall
C involvement of regional nodes
C1: only few nodes near primary growth, distal nodes free
C2: distal nodes involved
D distant metastases
Phaeochromocytoma 10% rule.
10% extramedullary, 10% familial, 10% bilateral
24 hr urinary catecholamines and repeat. (three measurements optimal due to
paroxysmal nature of catecholamine secretion)
ECG, echo, CT, MIBG

Pericarditis third heart sound, relieved by sitting forwards, worsened by

coughing and lying flat
Concave ST segment (saddle-shaped) persists for a few days
Causes of pericarditis:
- Viral (most common), bacterial, fungal infection
- Neoplastic
- MI
- Autoimmune
- Uraemia
- Inflammatory
MS- loud first heart sound, tapping undisplaced apex beat, opening snap after
second heart sound
Rx: medical management beta blockers and for AF, digoxin. Surgery for mitral
valve 1 cm2 mitral valvuloplasty, open or closed valvotomy, mitral valve
replacement
Left ventricular failure:
1. Sit patient upright (reduces venous return to heart)
2. Administer 100% O2 through trauma mask
3. Establish venous access
(if opiates indicated because patient is distressed, admin IV diamorphine and
IV metoclopramide)
4. Administer IV furosemide 80-100mg
5. Insert urinary catheter
(If patient SBP>110 with pulmonary oedema and no Hx of mitral/aortic
stenosis, administer IV nitrates.)
6. Continuous positive airway pressure drives fluid from alveoli back into
circulation
MRC grading of dyspnoea:
0 none
1 when hurrying on the level or walking up a slight hill
2 walks slower than contempories on level ground, or has to stop to catch
breath
3 stops for breath after walking 100m/few minutes on level ground
4 too breathless to leave house, normal daily activities affected
Sarcoidosis:
- Adults <40 yrs, peak incidence 20-30 yrs
- F>M
- Afro-Caribbean > Caucasians
- Bilateral hilar lymphadenopathy, ocular and skin presentations erythema
nodosum (blue-red nodules on anterior shins), anterior uveitis; weight loss,
fatigue, fever
- Management: acute usually resolves spontaneously over 2 years without
treatment. Chronic steroids, monitoring of lung function, ESR, CRP,
serum ACE elvels
Pulmonary fibrosis causes: BREAST CA
Bleomycin
Radiation
Extrinsic allergic alveolitis

Ankylosing spondylitis
Sarcoidosis
TB
Cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis)
Asbestosis
Other causes: azathioprine, pneumoconiosis, occupational lung diseases
Treatment of Crohns:
- Anti-diarrhoeal meds eg loperamide and ferrous sulphate for anaemia
- Mild flareup 30mg/d prednisolone for 1 week, then 20mg/d for 1 month
- Severe attacks admit for IV steroid and hydration, then hydrocortisone
100mg/6h IV and metronidazole 400mg/8h IV.
- Additional therapies: azathioprine, sulfasalazine, MTX, infliximab, surgery
Symptoms resembling ulcer? DUODENAL more likely than gastric ulcer!
Acute cholangitis bacterial infection + obstruction in biliary tree (most
commonly caused by gallstones)
Symptoms: continuous epigastric or RUQ pain, vomiting, fever, peritonism,
gallbladder mass.
Charcots triad fever, jaundice, abdominal pain
Risk factors: choledocholithiasis, biliary strictures, tumours, ERCP.
CTKUB gold standard for renal colic
Risk groups for developing Alzheimers:
- Family history
- Head injury
- Down syndrome
Carbuncle subcutaneous collection of pus that discharges to the surface via
multiple sinuses. Usually caused by staphylococcal infection.
Furuncle perifollicular (around a hair root) abscess, typically staph infection
S2(4): A person under the age of 16 shall have legal capacity to consent on his
own behalf where in the opinion of a qualified medical practitioner attending him,
he is capable of understanding the nature and possible consequences of the
procedure or treatment.
All >16 y/o presumed in law to have capacity to consent to treatment unless
there is evidence to contrary: Age of Legal Capacity (Scotland) Act 1991 s1.
If person does not have capacity to consent, Adults with Incapacity (Scotland) Act
2000.
Mental Health (Scotland) Act = any GMC fully registered doctor can detain a
patient on Emergency Detention Certificate (EDC).
In Scotland, father has parental responsibility if he was married to the mother
when the child is conceived, or marries her at any point afterwards.
Certificate under section 47 of the Adults With Incapacity Act 2000.
PBC
Autoimmune hepatitis

Anti-mitochondrial abs
Anti-smooth muscle

SLE
Wegeners
granulomatosis
Microscopic polyangiitis,
Churg-Strauss
syndrome; PSC

(ASMA), anti-liver kidney

microsonal (anti-LKM)
Anti-dsDNA
cANCA; (Proteinase 3
ANCA)
pANCA; (Myeloperoxidase
ANCA)

ERCP before CT!

OCP can increase risk of gallstones
AXR features of small bowel obstruction:
Multiple loops of dilated small bowl (>3cm)
Loops located in center
Paucity of gas in distal large bowel
Valvulae connivantes markings across whole width of bowel
Commonest cause of SBO: surgical adhesions
Direct inguinal hernia always acquired: straining, heavy lifting, chronic
coughing, elderly
Sudden onset abdo pain, AF, tender abdo without guarding = mesenteric
ischaemia
Pericarditis:
- Coxsackie virus
- Uraemia
- Dressler syndrome
- Thoracic trauma
- Malignant infiltration of pericardium
- Hypothyroidism
- Rheumatic fever
- Bacterial pericarditis
- Miliary TB
- Vasculitis
Flumazenil antidote for: benzodiazepines
Glucagon antidote for: B-blockers
Penicillamine for: acute and chronic arsenic and mercury poisoning
Guillain-Barre secondary to respiratory tract infection
URTI, low grade fever, reduced power, reduced sensory, downgoing plantars
Post-op AF = marker of underlying physiological insult
Common causes of post op AF:
- Electrolyte imbalance
- MI
- Dehydration and urinary retention
- Anastomotic leakage subtle markers of physiological compromise eg
tachy, AF, tachypnoea

Pyoderma gangrenosum: IBD, RA, myelocytic leukaemia, hairy cell leukaemia

Dermatitis herpetiformis coeliac disease
CTKUB gold standard for renal colic.
USS for haematuria and assessment of complication of stone disease limite
duse in diagnosis of renal calculi
SMALL CELL = SIADH!
Gilberts syndrome Autosomal recessive: deficiency of glucoronyl transferase
activity and rise in levels of unconjugated bilirubin. Rise marked when fasting/ill.
Phenobarbitone, a liver enzyme inducer leads to elevated glucoronyl transferase
activity and reduces Bil levels
Autoimmune haemolysis: LDH increased
DKA hyperkalaemia (due to polyuria and GI losses)
Balloon valvuloplasty preferred option for symptomatic mitral stenosis patients
with valve area < 1.5cm2 as long as the valve is mobile and non-calcified.
P.jirovecii fungal infection: fever, progressive SOB, dry cough. 90% of patients
have abnormal CXR. Cannot be cultured. Diagnosis: microscopy from induced
sputum, BAL. Treatment: co-trimoxazole or pentamidine
Non-healing gingival lesions with exposure of mandible or maxilla bone
osteonecrosis of jaw: pain secondary infection
Citalopram SE: hyponatremia
Donepezil reversible acetylcholinesterase inhibitors used to slow progression of
Alzheimers
Otgers: rivastigmine, galantamine
Pyridostigmine reversible Ach-esterase inhibiot