17/4

Question 1

How do you tell the difference between ectopic and intrinsic causes of Cushing’s?

Answer 1

Low dose overnight dexamethasone test used initially to diagnose Cushing’s (no supression in morning cortisol spike)

HIGH DOSE Dexamethasone suppression test
- this works to suppress ACTH (exogenous steroid to suppress endogenous production)

If suppresses cortisol - pituitary cause
If not suppressed - adrenal cause (but ACTH will be suppresesd)
If ACTH not suppressed - ectopic ACTH syndrome

Question 2

What PPI is contradicted with clopidogrel and why?

Answer 2

Omeprazole - reduces clopidrogrel efficency

Question 3

How does antibiotic treatment change for exacerbation of COPD if pt has brochiestasis on invx

Answer 3

Get whatever AB they have best responded to in the past rather than amox. straight away

2 wk course rather than 1wk

Question 4

What kind of AC do pts with AF get started on?

Answer 4

DOAC

Question 5

Majority of abdominal pain in children is not pathological - what are red flags for it being?

Answer 5

• Bilious or bloody vomiting
• Failure to thrive
• Bloody diarrhoea or IBD symptoms

Question 6

1st line invx in suspected GI ulcer perforation

Answer 6

CXR check for pneumoperitoneum

Question 7

8 month old boy presents with vomiting and severe abdominal pain following a URTI 2 weeks ago. They have recurrent jelly stools.

What is your diagnosis?
What do you expect to find on abdominal exam?
What is the invx and management?

Answer 7

Intussception - where large bowel telescopes back into the small bowel

Sausage shaped mass in RUQ

USS
Theraputic eneama - surgical reduction or resection if perforation/gangerous has occured

Question 8

Target sign on USS in child with abdominal pain

Answer 8

Intusecption

Question 9

What is mesenteric adenititis?

Answer 9

Inflamed lymph nodes within the mesentery following viral infection

Can present similar to appendicitis but no treatment required

Question 10

How does bowel obstruction present in children?

How will bowels sound?

What is the invx

What management should be done until correcting the underlying cause?

Answer 10

Persistent vomiting ~bilious
ABSOLUTE constipation
abdo pain

Whistling and high-pitched tinkling -> absent

AXR
- dilated bowel loops
- step-ladder like air-fluid levels on upright XR

Drip and suck (NG tube and IV fluids)

Question 11

What is Hirschsprung’s disease?

How is diagnosis confirmed?

How is it managed longterm?

Answer 11

Genetic condition that causes loss of parasympathetic ganglion in the distal colon = aganglionic region
- leads to bowel obstruction as aganglionic region constricts

Rectal biopsy

Surgical removal of anglionic segment