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Practice Exams > 17/10/21 > Flashcards

17/10/21 Flashcards

1
Q

Evaluation of osteoporosis is based on what measurement?

A
  • The evaluation of osteoporosis is based on the lower T-score of either the lumbar spine, femoral neck or total hip
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2
Q

Relationship between thyroid disease and lithium?

A
  • lithium can cause goitre and hypothyroidism
  • TSH and AntiTPO antibody titres should be conducted prior to lithium treatment commencement
  • TFTs shold be reevaluated every 6-12 months for several years.
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3
Q

Investigations in EBV (3 points + 1 bonus)

A
  • Infectious mononucleosis (IM) test → heterophile antibody test or monospot test)
    • if negative → repeat as test can be negative early in illness
  • Epstein-Barr Virus Serology to confirm diagnosis
  • FBE → lymphocytosis
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4
Q

Antibiotics in EBV? What happens?

A
  • DO NOT prescribe antibiotics for EBV as if rash can result from ABx given to patient with EBV infection. Note that this is not a penicillin hypersensitivity.
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5
Q

Clinical Features of EBV? (8 points)

A

Presents with severe sore throat → purulent or exudative

Other clinical features:
- fever, nausea, lymphadenopathy, splenomegaly, hepatomegaly, rash and fatigue

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6
Q

Random complication of EBV. What practical implications does this have?

A
  • Splenic Rupture → care when palpating the spleen and contact sports should be avoided in first 3 weeks.
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7
Q

Investigations in the context of Hereditary Haemochromatosis. (2 points)

A
  • Recommended in individuals with suspected iron overload (ferritin >200 in females and >300 in males) and a transferrin saturation >45%
    Cascade testing → all first degree relatives with HHC who are C282Y homozygous or C282Y/H63D compound heterozygous
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8
Q

Multi-organ consequences of Fe Overload secondary to Hereditary Haemochromatosis.

A
  • Liver Fibrosis + Liver Cirrhosis
  • Hepatocellular Carcinoma
  • Cardiac Arrhythmias + Cardiomyopathy
  • Diabetes
  • Arthropathy
  • Hypogonadism
  • Skin Hyperpigmentation
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9
Q

Signs and Symptoms of Testicular Torsion (5,3 points

A

Symptoms

  • Sudden Onset
  • Severe Pain
  • Associated Nausea and Vomiting
  • Associated Trauma
  • Possible Abdominal Pain

Signs

  • Asymmetric, high-riding testes
  • Negative Prehn’s Sign
  • Absent Cremasteric Reflex
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10
Q

Investigations and Management of Testicular Torsion

A

Investigations

Bloods, U/S + Doppler U/s → NOT USEFUL IN ACUTE SETTING

U/S should only be considered after surgical assessment → only if a testicular torsion or irreducible hernia have been excluded then consider U/S.

Management

Immediate surgical exploration with detorsion (or orchidectomy) and fixation of both testes

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11
Q

Causes of Hyperkalaemia (6 categories)

A
  • Pseudohyperkalaemia → haemolysis, blood sample handling error, thrombocytosis, extreme leucocytosis
  • Kidney Failure → reduced potassium excretion
  • Fluid Volume Depletion → reduced potassium excretion (secondary to reduced distal tubular water and sodium delivery)
  • Hypoaldosteronism → hyporeninaemia (diabetes, interstitial kidney disease), primary adrenal insufficiency, adrenal enzyme defects, heparin, HIV, resistance to aldosterone action
  • Drug-Induced - potassium-sparing diuretics, NSAIDs, potassium supplements, trimethoprim, ACEi, ARBs, pentamidine, cyclosporin
  • Increased K+ release from cells → metabolic acidosis, insulin deficiency, tissue damage, rhabdomyolysis
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12
Q

Red Flags with Haematospermia (4 points)

A
  • Patients Age ≥40yo
  • Recurrent or Persistent Haematospermia
  • Prostate Cancer Risk
  • Constitutional Symptoms - weight loss, anorexia, bone pain
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13
Q

Causes of Haematospermia (7 points, give 4)

A
  • Urinary Tract infection
  • Sexually Transmitted Infection
  • Prostatitis → pain on ejaculation
  • Recent urological procedure
  • Prolonged sexual intercourse or masturbation
  • History of TB or schistosomiasis
  • Anticoagulation or presence of bleeding disorders
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14
Q

Baseline investigations of haematosptermia (4 poitns)

A

Urine MCS
Urine Cytology
FBE
Coagulation Studies

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15
Q

Risk Factors for B12 Deficiency (3 points)

A
  • autoimmune gastritis aka pernicious anaemia
  • gastrectomy or significant small bowel resection or bariatic surgery
  • vegan diet
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16
Q

Discuss relationship between Transcobalamin and B12.

A

Transcobalamin II → binds Vit B12 to form a complex called Holotranscobalamin (HoloTC) aka Active-B12

  • HoloTC fall in B12 deficiency → therefore HoloTC can identify low Vit B12 status before total serum Vitamin B12 levels drop
17
Q

What is pernicious anaemia?

A

Pernicious Anaemia → B12 deficiency caused by autoantibodies that interfere with Vitamin B12 absorption by targeting intrinsic factor (IF), gastric parietal cells or both.

18
Q

Clinical Manifestation of B12 Defiency (4 categories, 12 individual points, give 4)

A

Haeamatologic

  • Megaloblastic Anaemia
  • Pancytopenia → leukopenia, thrombocytopenia
  • Pernicious Anaemia → large immature RBC

Neurologic

  • Parasthesias
  • Peripheral Neuropathy
  • Combined Systems Disease

Psychiatric

  • Irritability + Personality Change
  • Mild Memory Impairment + Dementia
  • Depression
  • Psychosis
  • Alzheimer’s Disease

Cardiovascular
- Possible Increased Risk of MI

19
Q

Treatment of B12 Deficiency

A

Hydorxycobalamin 1mg IM on alternate days for 2 weeks for severe anaemia or neurological symptoms

  • can use less intesive therapy for patients without severe anaemia

Maintenance Therapy

  • Hydroxycobalamin 1mg IM once every 2-3 minths
20
Q

Causes of Salivary Gland Swelling (5 categories)

A

Inflammatory Causes → acute bacterial or viral (mumps, coxsackievirus, EBV) illnesses, Chronic infections, Sjögren Syndrome

Obstructive Causes → stones, trauma, mucus retention

Metabolic Causes → obesity, hypothyroidism, alcoholic liver disease, malnutrition

Tumours → Benign or Malignant

Drug or Food Hypersensitivity

21
Q

Risk Factors for formation of salivary gland stones. (4 points)

A
  • Dehydration
  • Diuretics
  • Anti-cholinergic Medication
  • Trauma
22
Q

Diagnosis of Sialalithiasis. DDx and clinical features.

A

DIagnosis

  • characteristic history of swelling and pain associated with eating or anticipation of eating
  • small rock hard mass palpable in the salivary gland or duct or visible at the os

DDx

  • Acute Bacterial Sialadenitis → purulent discharge and systemic symptoms
23
Q

Management of sialadenitis. (4 steps)

A
  1. Conservative Management → well hydrated, apply moist heat to area, massage the gland + milk the duct, suck on tart, hand candy to promote salivary flow
    - Manage pain with NSAIDs
  2. If concerned re: secondary infection → treat with antistaphylococcal ABx → dicloxacillin 500mg QID or cefalexin 500mg QID for 7-10/7
  3. if no improvement with conservative measures → for referral to ENT for sialoendoscopy (minimally invasive)
  4. if recurrent stones → consider sialadenectomy
24
Q

Causative pathogens for Postpartum Endometritis

A

Usually a polymicrobial infection

  • if late-onset endometritis (occuring more than 7 days after delivery) → suggests chlamydia trachomatis infection
25
Q

Clinical Presentation of Postpartum Endometritis (4 points)

A
  • Fever (>38)
  • Lower Abdominal Pain
  • Uterine Tenderness
  • +/- purulent vaginal discharge
26
Q

Severe vs Nonsevere Postpartum Endometritis. Management of Non-Severe Endometritis and Severe Endometritis.

A
  • *Nonsevere Postpartum Endometritis** - no fever or other systemic features, localised infection
  • amoxicillin + clavulanate 875+125mg BD for 7/7
  • if hypersensitivity to penicillins → trimethoprim + sulfamethoxazole 160+800 PO BD for 7/7 + metronidazole 400mg BD for 7/7

Severe Postpartum Endometritis - systemic features, sepsis or septic shock
Start ABx within 1/24 of presentation to medical care

For uncomplicated infections:
- continue IV ABx for at least 24-48 hours after resolution of leucocytosis and resolution of clinical signs and symptoms (fever, uterine tenderness, purulent vaginal discharge)
For complicated infections → may require longer course of IV therapy with switch to oral therapy as needed once patient is stable.

Practice Exams (45 decks)

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