MBBS Year 3 notes > DPD > Flashcards

DPD Flashcards

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1
Q

3 macrovascular complications of diabetes

A
  1. Ischaemic heart disease
  2. Cerebrovascular disease
  3. Peripheral vascular disease
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2
Q

3 microvascular complications of diabetes

A
  1. Diabetic neuropathy
  2. Diabetic retinopathy
  3. Diabetic nephropathy
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3
Q

State the 4 types of diabetic retinopathy and their treatment

A
  1. Background diabetic retinopathy: blood glucose control
  2. Pre-proliferative: pan-retinal photocoagulation
  3. Proliferative: pan-retinal photocoagulation
  4. Maculopathy: grid photocoagulation
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4
Q

Side effects of metformin

A

GI upset

Lactic acidosis in unwell patients

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5
Q

Side effects of sulfonylureas

A

Hypoglycaemia

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6
Q

Side effects of thiazolidinediones

A

Fluid retention

MI, osteoporosis

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7
Q

3 clinical features of diabetic nephropathy

A
  1. Progressive proteinuria (microalbuminuria)
  2. Hypertension
  3. Deranged renal function (creatinine, eGFR)
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8
Q

Definition of diabetes

A

Fasting blood glucose >7.0 mmol/L

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9
Q

Management of diabetic nephropathy

A

Inhibit RAAS: ACEi, ATII blockers
Diabetic control
Blood pressure control
Stop smoking

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10
Q

3 top investigations for chest pain

A
  1. ECG
  2. Troponin
    - Positive –> coronary angiography
    - Negative –> exercise tolerance test
  3. Echocardiography
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11
Q

Three things to think about when deciding ddx

A

Symptoms
Associated features
Risk factors

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12
Q

Chest pain: top three causes

A

Ischaemic heart disease
Aortic dissection
Pericarditis

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13
Q

LoC important to know

A

Before: Prodrome?
During: Tongue biting? Epilepsy
After: Confusion? None in cardiac causes

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14
Q

Collapse ddx (3 main types of causes)

A

Metabolic: Hypoglycaemia
Neurological: seizures
Cardiac: Vasovagal. arrhythmias, outflow obstruction, postural hypotension

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15
Q

Cardiac causes of collapse

A

Arrhythmias
Outflow obstruction: Aortic stenosis, hypertrophic obstructive cardiomyopathy, PE
Postural hypotension

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16
Q

Causes of long QT syndrome

A

Congenital

Acquired: low K+, low Mg2+, drugs

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17
Q

3 causes of pansystolic murmur

A

Mitral regurg
Tricuspid regurg
Ventricular septal defect

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18
Q

3 causes of raised JVP

A

R heart failure
Tricuspid regurg
Constrictive pericarditis

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19
Q

3 causes of constrictive pericarditis

A

Infection e.g. TB
Inflammation e.g. connective tissue disease
Malignancy

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20
Q

Both are regular narrow-complex tachycardias with no P waves.
How to distinguish AVNRT and AVRT on ECG?

A

AV nodal reentry: circuit includes the AV node; no delta wave
AV reentry: goes through accessory pathway (bundle of Kent); delta wave present when not in tachycardia

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21
Q

Causes of sinus tachy

A

Shock (septic, hypovolaemic)
PE
Endocrine (thyrotoxicosis, phaeo)
Anxiety

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22
Q

Causes of AF

A

Thyrotoxicosis, alcohol
Heart: myocarditis, valvular disease, pericarditis
Lungs: Pneumonia, PE, cancer

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23
Q

Causes of VT

A

Ischaemia
Electrolyte abnormality
Long QT

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24
Q

SVT management

A

Vagal maneuvers
IV adenosine for cardioversion
DC cardioversion if haemodynamically compromised

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25
AF acute management
Rate control with beta-blockers / digoxin Anticoagulation Can also do rhythm control - but If onset >48h, need to anticoagulate for 2-3weeks before cardioversion.
26
Management of VT
With pulse: IV amiodarone Pulseless: defibrillation Treat underlying cause!
27
ECG signs of ischaemia
ST elevation / depression T wave inversion? Q waves?
28
ECG signs of arrhythmia or conduction defects
Rate Rhythm PR: first QRS: broad? LBBB, RBBB
29
Ventricular strain / hypertrophy
Axis deviation | QRS morphology
30
Cause of S3
Ventricular filling
31
Cause of S4
Ventricular hypertrophy and stiffening
32
S3 vs fixed split S2?
S3 heard better with bell
33
Management of acute pulmonary oedema
Sit up O2 IV GTN IV furosemide
34
Management of acute pulmonary oedema
Sit up O2 IV GTN IV furosemide
35
VF / pulseless VT management
``` Shock (defib) CPR Reassess rhythm IV 1mg adrenaline every 2 - 3 min Treat underlying cause ```
36
5Ps: causes of pleuritic chest pain
``` Pericarditis PE Pneumonia Pneumothorax Pleural pathology ``` ...and referred pain sub-diaphragmatic problems e.g. hepatic abscess
37
Causes of pleural effusion transudates
Organ failure: heart, liver, kidney
38
Causes of pleural effusion exudates
Parapneumonic, cancer, pulmonary embolism
39
Buerger's sign
Reactive hyperemia after elevation of foot to 45 deg (sign of arterial insufficiency)
40
6 Ps of acute limb ischaemia
``` Pain Pallor Perishingly cold Pulseless Paraesthesia Paralysis ```
41
Classification of aortic dissection, and treatment
Stanford Type A: proximal to L subclavian Stanford Type B: distal to L subclavian Emergency open surgery for Type A Surgery for complicated Type B (visceral ischaemia) Conservative, BP control and surveillance for uncomplicated Type B
42
Diagnosis of Gilbert's Syndrome
Normal LFTs with elevated unconjugated bilirubin | Worsened by fasting
43
Gilbert's syndrome pathophysio
UDP-glucuronyltransferase activity reduced to 30% Autosomal recessive Fairly common, 6-10% of Western populations affected
44
4 grades of hypertensive retinopathy
Grade 1: "silver wiring" Grade 2: AV nipping Grade 3: flame haemorrhage, cotton-wool spots Grade 4: All 3 + papilloedema
45
Definition of LVH on ECG
S wave in V1 + R wave in V5/6 >35mm
46
Management of essential hypertension
Intensive lifestyle modification Aggressive management of blood pressure and lipids Aspirin Assess for T2DM
47
Electrolyte imbalances causing fits
1. Hypercalcaemia 2. Hyponatraemia 3. Hypoglycaemia 4. Hypokalaemia
48
Antimitochondrial antibodies are the hallmark of...
Primary biliary cirrhosis
49
Triad of symptoms for Wernicke's encephalopathy
Confusion Ataxia Opthalmoplegia (Note: Wernicke's is acute or subacute in presentation)
50
Korsakoff's encephalopathy is associated with what type of amnesia?
Anterograde amnesia | Note: Korsakoff's is chronic in presentation
51
Internuclear opthalmoplegia is indicative of...
Demyelinating disease / MS
52
Management of variceal bleed
Antibiotics (prophylactic for bacterial translocation) IV terlipressin Endoscopy with variceal band ligation
53
Investigations for jaundice
Bloods: FBC, LFTs, CRP | Abdominal USS
54
2 investigations for dysphagia and wt loss
OGD and biopsy
55
Main investigation for PR bleed and wt loss
Colonoscopy
56
3 common post-op complications in GI ops
Wound infection Anastomotic leak Pelvic abscess
57
Management of acute hyperkalaemia
IV calcium gluconate (10ml of 10%) | Insulin and dextrose
58
Definition of MS
At least 2 neurological lesions separated in time and space
59
Meralgia paraesthetica
Compression of lateral femoral cutaneous nerve causing burning anterolateral thigh pain Management: lose weight, wear loose clothing
60
AV block Type 2: Mobitz II
Usually haemodynamic compromise, more likely to progress to complete heart block
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