2017 Flashcards
40-year-old farmer has wheeze for a few weeks. Normal CXR. Diagnosis?
Aspergillosis (normal and eventually bronchiectasis)
Transfusion reaction - fever, other obs normal, transfusion stopped. What next?
Check bag against patient details
Mid-diastolic murmur
Mitral stenosis
Patient on warfarin for AF has INR of 3.3, falls and found on CT to have intracerebral haematoma - warfarin stopped and been given Vit K, what next?
Prothrombin Complex
Lady with palmar erythema, raised ALT, raised bilirubin, strongly positive ANA?
AI Hepatitis
Haematemesis and abdo pain, BP 120/80, HR >100 (what was the actual HR?) What do you give IV whilst waiting for endoscopy?
IV crystalloid
- IV terlipressin (in variceal bleeding – can do that first)
- IV PPI (in upper GI bleed) – NO do endoscopy FIRST
Small cell lung ca, hilar LN, no distant mets - what treatment?
Chemo
SCLC
Usually disseminated @ presentation
Some benefit c¯ chemo
Palliative Care
Analgesia: opiates for pain and cough
Radiotherapy: haemoptysis, bone or CNS mets
SVCO: dex + radio or intravascular stent
Persistent effusions: chemical pleurodesis
Public health question: 200 pts in 2 month period out of 10,000 people get influenza. They ask how many people out of 100,000 in one month period get infection?
1000
Patient has bad claudication and can only walk 10m. Distal aorta and both iliac vessels occluded. What do you do?
Aorto-Bifemoral
Indications for bypass:
- V. short claudication distance (e.g. <100 m)
- Affecting QoL
- Rest Pain develops
Lady has surgery 4 days ago, after she was given multiple bags of 5% dextrose. Now she is drowsy. What’s the mechanism?
Cerebral Oedema
Guy gets claudication in calf. Where is the block?
Calf = superior femoral
Buttock = iliac
Lady with RA and purple nodule on shin ulcerating with raised edges. Dx?
Pyoderma Gangrenosum
Guy with prostate ca has back pain and bone scan shows increased uptake in spine, how to help with pain?
Radiotherapy
Some woman with folate and iron deficiency. Some unstated bowel symptoms following bouts of gastroenteritis as a child. What ix do you do?
Anti TTG abs
Post partum breast feeding lady with red tender breast, no mass. What do you do?
Flucloxicillin
What does a triple assessment consist of?
Clinical exam + imaging + core biopsy. (Imaging in <35 is USS, >35 is mammogram)
Old guy with bacteruria grown from catheter. What do you do?
Treat if symptomatic
Smoker has lung cancer near right bronchus removed with raised calcium, what will histology show?
SCC
- Non-Small Cell Lung Cancer*
- ·* SCC: 35%
- § Highly related to smoking
- § Centrally located
- § PTHrP → ↑ Ca2+
What is a feature of reactive arthritis other than arthritis, urethritis etc?
Keratoderma blenhorrhagicum (yellow lesions on soles of feet)
Idiopathic Intracranial Hypertension
- headache, blurred vision, papilloedema, blind spot, 6th nerve palsy
- RFs = obese, female, pregnant, OCP, tetracycline, vitamin A, lithium
- Mx = WEIGHT LOSS, acetazolamide (diuretic - inactivates carbonic anhydrase), topiramate (weight loss too), repeated LP, surgery
40 year old banker has headaches which have led to taking ibuprofen and paracetamol daily. No neuro or eye signs. No weight loss.
Advise to stop taking meds and reassess in a month
Someone has hearing changes, haemoptysis, nasal discharge, renal problems. CXR shows 3 cavitated lesions?
Wegener’s Granulomatosis
49 yo lady with 2 month history of diffuse thyroid swelling and intense sweating at night
Graves
Test for gestational diabetes
Oral glucose tolerance test at 28 weeks
Thyroid function low TSH, High T4- post URTI, reduced iodine uptake, hyperthyroid. Cause?
Viral thyroiditis (de quervains)
Patient has bowel operation 4 days ago, has not opened bowels for 24 hours. Distended with scant bowel sounds. Cause?
Small bowel obstruction (tinkling bowel sounds = high pitched)
Patient with symptoms of guarding, peritonism, what test?
Erect CXR
Patient with symptoms of bowel obstruction - what test?
Supine AXR
Patient has been generally unwell for a week. Now has dysuria and is going frequently. Later on, she gets more unwell and has really bad loin pain. What’s wrong?
Pyelonephritis
80 year old with essential hypertension and peripheral vascular disease. What meds?
Nifedipine, Amlodipine, Felodipine
(dihydropyridine CCBs) = affects peripheral vascular smooth muscle > myocardium
Testicular pain in a sexually active 18 year old. Management?
Take to theatre
Someone has AF and has a cold pale leg. It’s been 6 hours. Mx?
Amputate (> 6 hours – but otherwise embolectomy w fogarty catheter)
Lady with flushing, pustular rash, telangectasia on her face?
lupus pernio (sarcoidosis)
Gentlemen with bald head, lumpy hyperkeratotic lesions on scalp. What is he at risk of?
SCC
Guy with pale stools, abdo pain. Xray shows area of calcification.
Dx - decrease in exocrine pancreatic function. Chronic Pancreatitis.
Guy who was lifting heavy things. Now just lumbar pain. Mx?
Symptom control with NSAID
Patient with 3 weeks of fevers, cough, feeling unwell. On exam: dull percussion, absent Vocal Resonance, reduced expansion?
Empyema
(vocal resonance increases in consolidation and decreases in effusion)
What vitamin you have to give somebody when starting TB treatment?
Pyridoxine (B6)
Somebody comes in to A&E with drug resistant TB, where do you keep them?
Negative pressure room + respiratory measures for staff (allows air into room but not out)
Somebody with features of UC - how do you investigate?
flexible sigmoidoscopy
Pt with known renal cell cancer now gets swollen legs and distended veins below umbilicus what’s the diagnosis?
Obstruction of IVC
Some guy with obstructive features, long term smoker. Dx?
Chronic Bronchitis
20 year old female, walks in, has 2yr history of intermittent diarrhoea, IDA, aphthous ulcers, raised ESR. Dx?
Coeliac
A man with stab injury to the back - hemisection of the cord. Where would he lose pain sensation from?
. Contralateral spinothalamic
An ECG shows STEMI in leads V4-V6 and I, AvL - where is the infarct?
Antero-lateral (circumflex)
