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Question corrections > 25/04 > Flashcards

25/04 Flashcards

1
Q

tb meds

A

I eat perfect rice

Isoniazid.
Rifampin
Ethambutol
Pyrazinamide.

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2
Q

tertiary hyperparathyroidism signs

A

Raised alkaline phosphatase levels
This is due to increased bone turnover (osteoblastic activity in particular) as a result of raised parathyroid levels. It is likely this patient has progressed from secondary to tertiary hyperparathyroidism, as persistent secondary hyperparathyroidism leads to autonomous production of parathyroid hormone, regardless of negative feedback from calcium levels.

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3
Q

prolonged PR interval

A

1st-degree heart block is caused by a delay in conduction from the SA node into the ventricles. As the AV node is supplied by the right coronary artery in 85% of individuals, disease in this artery may lead to first-degree heart block.

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4
Q

Acute Kidney Injury(AKI) and treatment

A

increase in serum creatinine of 26 μmol/L within 48 hours or an increase in serum creatinine ≥1.5 times above baseline value within 1 week or urine output of <0.5 ml/kg/hr for > 6 consecutive hours.

dialysis

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5
Q

signs of asthma

A

Tachypnoea- fast breathing
Hyperinflated chest
Hyper-resonance on chest percussion

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6
Q

Investigations in chronic asthma

A

Spirometry: FEV1/FVC <0.7 (obstructive spirometry)

Bronchodilator reversibility tests: Improvement of FEV1 >12% after bronchodilator therapy is diagnostic

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7
Q

Investigations in acute asthma

A

ABG: type 2 respiratory failure (low PaO2 and high PaCO2) is a sign of a life-threatening attack.
Routine blood tests (including FBC, CRP): to look for precipitating causes of an asthma attack, such as an infection.
Chest x-ray: to exclude differentials and possibly identify a precipitating infection.

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8
Q

asthma drugs

A

SABA

+ICS- beclometasone, Prednisolone, hydrocortisone
+LABA- salmeterol
+ Trial oral leukotriene receptor antagonist,/monelukast high-dose steroid, oral B2-agonist

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9
Q

tumours of the caecum and ascending colon

A

right hemicolectomy

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10
Q

tumours of the distal transverse colon and descending colon

A

left hemicolectomy

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11
Q

tumours of the sigmoid colon.

A

sigmoid colectomy

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12
Q

tumours >8 cm from the anal canal or involving the proximal 2/3 of the rectum

A

Anterior resection

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13
Q

tumours <8 cm from the anal canal or involving the distal 1/3 of the rectum.

A

Abdomino-perineal (AP) resection

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14
Q

Hepatic Adenoma surgery

A

<5cm or reducing in size - annual MRI

>5cm or increase in size - for surgical excision

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15
Q

HCC surgery

A

<2cm

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16
Q

peripheral lesions adenocarcinoma of the lung diagnosis

A

CT chest abdomen pelvis

then

biopsy would be the next investigation to carry out after a CT CAP to provide a definitive diagnosis. As this is a peripheral lesion it will most likely be obtained via transthoracic needle aspiration.

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17
Q

falls and elderly

A

Use the Fracture Risk Assessment Tool (FRAX)

This patient is elderly and clearly has a high falls risk, making her liable to have an osteoporotic fracture in the future. The FRAX score offers a formal way to quantify this risk, and if it is above a certain threshold, bisphosphonates should be given. If the risk is low, bisphosphonates do not need to be given, but if the risk is between the two extremes, a DEXA scan should be carried out to guide the need for bisphosphonates.

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18
Q

ramipril side effects

A

Ramipril causes hyperkalaemia by blocking the aldosterone pathway thereby leading to a retention of potassium.

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19
Q

2 week worsening SoB, stiffness and pain in wrists and fingers, particularly in the morning

dullness to percussion at the right lung base with associated reduced breath sounds
tenderness and boggy swelling at the metacarpo-phalangeal joints bilaterally.

A

Pleural fluid glucose <3.3 mmol/L

This is the correct answer. The patient presents with a pleural effusion, most likely an extra-articular manifestation of underlying rheumatoid arthritis. Almost 100% of effusions due to rheumatoid arthritis have low glucose levels.

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20
Q

absolute contraindication for diagnostic laparoscopy?

A

On warfarin with an INR of 2.8

An abdominal aortic aneurysm risks vascular rupture if not directly visualized. However, it is a relative contraindication rather than absolute.

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21
Q

MI and can’t get PCI till 2h and intracranial haemorrhage history
treatment

A

However, they have a previous intracranial haemorrhage which is an absolute contra-indication for fibrinolysis so PCI is the best option even if outside of the typical window.

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22
Q

diarrhoea after Bangladesh . He describes it as rice water looking and has also been vomiting.

and treatment

A

lassical description of a cholera infection. It is a Gram-negative aerobic bacterium. It is very rare or extinct in the western world, however in developing nations still exists. It is found in faecally contaminated water. It causes profuse watery diarrhoea and is treated with oral rehydration salts and fluids. Antibiotics can be given if the infection is severe, which lessens the severity and shortens the disease lifespan.- Doxycycline or co-trimoxazole)

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23
Q

Salmonella enterocolitis symptoms

A

t presents with diarrhoea, fever and cramps (usually within 12-36 hours of exposure). It can cause sepsis or meningitis, as well as septic arthritis.

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24
Q

fatigue, easy bruising, and tooth loss

multiple ecchmoses at non-traumatic sites, perifollicular haemorrhages, coiled hairs, and gingival swelling.

A

vitamin C deficiency. Refugee populations are at particular risk. There is a risk of intracerebral and endocardial haemorrhage,

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25
Q

5kg weight loss over the last 5 weeks and malaise
He also reports dark-coloured urine. He has a past medical history of familial adenomatous polyposis, for which he had a proctocolectomy 8 years ago.

On physical examination he is cachectic and there is scleral icterus.

A

Duodenal cancer

This is the correct answer. Patients with familial adenomatous polyposis (FAP) not only have a high risk of colorectal cancer, but are also at increased risk of duodenal cancer. Duodenal cancer is the 2nd highest cause of cancer death in FAP. Duodenal cancer can present with weight loss, nausea/vomiting, abdominal pain, and obstructive jaundice.

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26
Q

Mitral regurgitation

A

produces a pansystolic murmur that is heard best over the apex.

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27
Q

aortic stenosis

A

presents with syncope, shortness of breath and angina. It also produces an ejection systolic murmur heard best over the upper right sternal edge.

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28
Q

how to calc units

A

Units = strength % x volume (ml) ÷ 1000

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29
Q

Plummer Vinson Syndrome

A

triad of dysphagia, iron deficiency anaemia and glossitis/ inflamed tongue

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30
Q

Peutz-Jeghers syndrome

A

autosomal dominant
hamartomatous polyps in the GIT
pigmented lesions on the lips, face, palms and soles.

GI bleeding secondary to these polyps, and have an increased risk of developing gastric cancer. Management tends to be conservative, unless complications arise.

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31
Q

Hypothermia ecg sign

A

J waves

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32
Q

Hyperkalaemia ecg sign

A

tall tented T waves and flattened P waves.

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33
Q

Ventricular fibrillation ecg

A

chaotic with no discernible P waves or QRS complexes.

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34
Q

one week history of fevers, myalgia and cough productive of white sputum.
recently abroad in Crete and returned home a week before his symptoms began. A chest X-ray shows diffuse bilateral infiltrates.

A

Legionella pneumophila

inhalation or aspiration of unsanitary water such as in showers supplied by poorly maintained water tanks. It causes atypical pneumonia, sometimes with bilateral signs of infection on a chest X-ray. It can also cause deranged liver function tests and electrolytes

35
Q

Congestive cardiac failure

A

no chest pain

36
Q

ascities causes

A

liver disease, however in most cases it results from a combination of portal hypertension and hypoalbuminaemia. It is not related to hyperbilirubinaemia.

37
Q

raised serum bilirubin,

fatigue, weakness and loss of appetite for the past year as well as abdominal swelling which he says started around a month ago. He is known to abuse alcohol and has been drinking around 70 units a week for the last 10 years.

palmar erythema, Dupuytren’s contracture, multiple spider naevi, and a distended abdomen with shifting dullness on percussion. He also has leuconychia and excoriations on his arms and stomach.

A

Raised serum bilirubin as seen in chronic liver disease is associated with pruritus and this often results in excoriations where patients scratch themselves with their nails. Itching frequently precedes jaundice in these patients. Although there is some debate in the literature as to the precise cause of pruritus associated with raised serum bilirubin, colestyramine (a bile acid sequestrant) is effective at reducing it.

38
Q

Barrett’s oesophagus

A

oesophagal epithelium from squamous to columnar owing to long term acid reflux. Typical symptoms of oesophageal reflux would be heartburn-like pain worsened on lying flat or eating acidic foods. Patients can, however, be asymptomatic

39
Q

Functional dyspepsia

A

This is the cause of 60% of dyspepsia cases. It may be caused by gut hypersensitivity, non-erosive reflux disease, motility problems, post infectious bowel upset or psychological factors.

abdominal discomfort, nausea and belching

40
Q

Peptic ulcer disease

A

abnormal upper GI endoscopy
Epigastric tenderness would also be likely on examination

duodenal and gastric ulcers; duodenal ulcers most common. The stomach lining protects itself with mucin and bicarbonate secretion and mucosal blood flow; however, damage can occur if these barriers are not sufficient, or if external factors such as Helicobacter pylori (H. Pylori) are present.

mostly due to H. pylori

can be due to NSAIDS - ibuprofen, aspirin

41
Q

aortic stenosis treatment and symptoms

A

worsening dyspnoea and an ejection systolic murmur radiating to carotids.

transcatheter aortic valve implantation (TAVI) or open valve replacement, depending on the patient’s fitness.

Medical therapy only as a treatment option should be reserved for patients unsuitable for the above.

42
Q

63 year old man is admitted to hospital having been found collapsed. His past medical history includes type 2 diabetes and hypertension

partially compensated metabolic acidosis and a high lactate.

A

lactic acidosis. Sepsis is a well known cause of this and comes about via local tissue hypoxia (secondary to increased metabolic requirement and poor perfusion because of vasodilation).

43
Q

which hernias are surgically treated

A

symptomatic ones

44
Q

CSF predominantly polymorphs, with a cell count of 90-1000+; CSF glucose is less than half of plasma glucose; over 1.5g/L of protein is present

A

bacterial meningitis

45
Q

severe UC flare up

A

> 6 bloody stools per day, a temperature > 37.8, Hb < 108, CRP > 30

46
Q

Gastro-oesophageal reflux disease (GORD)

A

retrosternal pain that is associated with meals, belching and regurgitation. Chronic untreated GORD may develop into Barrett’s oesophagus, with potential to transform into oesophageal adenocarcinoma.

47
Q

Cachexia

A

a “wasting” disorder that causes extreme weight loss and muscle wasting, and can include loss of body fat

48
Q

Ecchymosis

A

bruise

49
Q

diffuse consolidation

A

spread out

50
Q

Pruritus

A

itchy skin

51
Q

Leukonychia

A

white discoloration appearing on nails

mostly at base of nails

52
Q

excoriations

A

skin picking

red parts on skin

53
Q

Aortic regurgitation

A

left parasternal edge murmur

54
Q

sudden onset crushing chest pain and diaphoresis/ excess sweating
The pain has persisted for around 25 minutes and an ECG reveals ST depression in the inferior leads.

blood pressure is noted to be 210/90.

medication for lowering BP

A

Hypertensive emergencies should be treated with IV medication.

Oral amlodipine can be used in the management of hypertensive urgencies
Amlodipine takes longer to work than nifedipine due to a larger volume of distribution. Therefore, both can be given initially and nifedipine discontinued after 3 days by which time amlodipine should start to work.

55
Q

step 1 hypertension management

A

ACE-inhibitor (e.g. Ramipril) if <=55 years old
CCB (e.g. Nefedipine) if >55 y OR African or Caribbean ethnicity
If unable to tolerate ACE-inhibitor then switch to Angiotensin Receptor Blocker (e.g. Candesartan)

56
Q

Step 2 of hypertension management

A

(If maximal dose of Step 1 has failed or not tolerated)

Combine CCB and ACE-I/ARB

57
Q

Step 3 of hypertension management

A

(If maximal doses of Step 2 has failed or not tolerated):

Add thiazide-like diuretic (e.g. Indapamide)

58
Q

Step 4 of hypertention management

A

if blood potassium <4.5mmol/L then add Spironolactone
If >4.5mmol/L increase thiazide-like diuretic dose/
Alpha blocker (e.g. Doxacosin)
Beta blocker (e.g. Atenolol)
Referral to cardiology for further advice

59
Q

sudden onset shortness of breath and pleuritic chest pain. She is currently receiving chemotherapy for metastatic ovarian cancer and is bedbound. Vital signs are: temperature 36.5’C, heart rate 90 beats per minute, respiratory rate 24/minute, oxygen saturation 92% on room air, blood pressure 100/75 mmHg. Chest x-ray and ECG are normal

what sign will be expected

A

PE!!

In a sub-massive PE there may be signs of right heart strain (such as a raised JVP, parasternal heave, and loud P2).

60
Q

STEMI diagnosis criteria

A

men under 40-years-old (≥ 2.5 mm in leads V2-3) and for women (≥ 2.5 mm in leads V2-3).

apart from ST-segment elevation, a new-onset LBBB or hyperacute T-waves are also indicative of a STEMI.

61
Q

most important direct consequence of refeeding syndrome?

A

Hypophosphataemia is caused by an increase in insulin production when carbohydrates are re-introduced to the body. This then leads to many of the complications of tumour lysis syndrome such as rhabdomyolysis, fluids shifts, other electrolyte imbalances and arrhythmias.

62
Q

tension pneumothorax

A

2nd intercostal space, mid clavicular line!!!
not mid axillary !!

needle decompression with a 14-16 gauge cannula into the right second intercostal space, mid-clavicular line THEN chest drain

63
Q

Type 1 Diabetes is found collapsed on the floor at a bus stop

treatment

A

100ml of 20% glucose IV

64
Q

past medical history of Wolff-Parkinson-White syndrome and waiting for definitive treatment, develops sudden-onset palpitations. She also reported chest pain and momentarily lost consciousness and was brought to A&E by ambulance.
regular rhythm with narrow QRS complexes with a heart rate of 140 beats per minute. P-waves are not seen.
blood pressure is 125/85 mmHg, her JVP is not raised and no pedal oedema was noted.

first step for management

A

urgent Synchronised electrical cardioversion

This patient has supraventricular tachycardia with adverse features such as syncope and chest pain.

65
Q

fever. Her symptoms began three weeks ago with a swollen red tongue and a fine rash across her trunk. Her rash has now resolved, but her fever is persistent. On examination, there is an audible pan-systolic murmur, loudest at the apex. Her blood tests reveal a C-reactive protein (CRP) of 124 mg/L.

first step management

A

IV Benzylpenicillin

. Rheumatic fever is precipitated by Group A beta-haemolytic streptococcal infection,

66
Q

Rheumatic fever symtoms

A

recent streptococcal infection

Arthritis

Pancarditis

Affects all layers of the myocardium, endocardial inflammation may predominate causing valvulitis. tachycardia, new murmur or new conduction defect.

Sydenham’s chorea

abrupt, non-rhythmic, involuntary movements along with muscular weakness and emotional disturbance. They are most frequently marked on one side and cease during sleep.

Arthralgia- joint stiffness

Raised acute phase proteins (ESR and CRP)
Prolonged PR interval on ECG
fever

Erythema marginatum

pink/red, nonpruritic rash involving mainly the trunk, thighs and arms.

Subcutaneous nodules- Firm, mobile painless lesions

67
Q

rheumatic fever management

A

Eradication of group-A beta-haemolytic streptococcal infection

IV Benzylpenicillin, with a ten day course of Phenoxymethylpenicillin to follow

Analgesia/painkillerts for arthritic symptoms

Aspirin/ (NSAIDs) such as ibuprofen or naproxen.
Aspirin should be used with caution in young children

If carditis is complicated by heart failure
Glucocorticoids (e.g. Prednisolone) can provide benefit (NSAIDs should be stopped concurrently).
Diuretic treatment may also be necessary, and valve surgery if severe.

Sydenham’s chorea for distressing symptoms or risk of harm.

Erythema marginatum is associated with rheumatic fever is temporary and doesn’t require treatment, although antihistamines can help with pruritus.

68
Q

Management of a Simple Primary Pneumothorax

A

short of breath OR the pneumothorax is >2 cm the pneumothorax should be aspirated with a 16-18G cannula under local anaesthetic. If this is successful the patient can be discharged. If this fails an intercostal drain is necessary (and the patient must be admitted).

69
Q

2 month history of constipation, blood in the stool, weight loss

A

colorectal cancer

so colonoscopy first line not CT!!

CT for staging

70
Q

sarcoidosis symptoms

A

Pulmonary (most common manifestation): dry cough, dyspnoea, reduced exercise tolerance, crepitations.

Constitutional: fatigue, weight loss, arthralgia/joint stiffness, and low-grade fever. General signs include lymphadenopathy and ENLARGED PAROTID GLANDS

Neurological: meningitis, peripheral neuropathy, bilateral Bell’s palsy.

Ocular: uveitis, keratoconjunctivitis sicca.

Cardiac: arrhythmias, restrictive cardiomyopathy.

Abdominal: hepatomegaly, splenomegaly, renal stones.

Dermatological: erythema nodosum, lupus pernio.

71
Q

10-month old baby boy rapid onset abdominal pain.
off his food and not his usual temperament for 3 days prior
regular wet nappies and there are no rashes or vomit
redcurrent jelly stools
pale and his abdomen there is a sausage shaped mass in the right upper quadrant and the boy draws ups his legs and screams uncontrollably on palpation.

A

Intussusception

most common in 3 months - 12-month-old children and 75% are ileocaecal in location. If the child is relatively well, pneumatic reduction under fluoroscopic guidance can be attempted. If the child is unwell or perforation is suspected laparotomy

72
Q

Viral gastroenteritis cause, symptoms and treatment

A

diarrhoea/ vomiting + fever

Rotavirus
Norovirus: common cause of viral
Adenoviruses: resp system and children

management-
fluid replacement

severe-
Salmonella and shigella- ciprofloxacin.
Campylobacter - macrolide, erythromycin.
Cholera - tetracycline

73
Q

long PR interval and infective endocarditis

A

Perivavlular or aortic root abscesses are a potential complication of infective endocarditis. They manifest through prolongation of the PR interval on the ECG, which can be followed by higher degrees of heart block. Patients with infective endocarditis are monitored for this complication through daily ECGs.

74
Q

Risedronate side effect

A

dyspepsia and acid reflux. Patients should be advised to take the tablet half an hour before breakfast with plenty of water and to remain upright to reduce the risk of mucosal irritation.

75
Q

dyspepsia

A

indigestion, refers to discomfort or pain that occurs in the upper abdomen, often after eating or drinking
symptom

76
Q

Wolff-Parkinson-White syndrome symptoms and management

A 
supraventricular tachycardias.
often asymptomatic
Palpitations
Dizziness
Syncope
short PR interval 
Broad QRS
Radiofrequency ablation of the accessory pathway
Drug treatment (such as amiodarone or sotalol) to avoid further tachyarrhthmias. These are contraindicate din structural heart disease.
77
Q

CXR sign for pulmonary oedema

A

patchy perihilar shadowing

78
Q

squamous cell carcinoma of tongue

A

smoking
side of tongue and floor of mouth
>2 week, should be biopsied

79
Q

linchen planus

A

itchy rash affecting wrists and shins and sore mouth

white striae and buccul mucosa

80
Q

smooth, sore, red tongue, cracking at corners

A

iron deficiency

81
Q

sore mouth, inflamed palette with white patches that rub off

A

oral candidiasis
associated with corticosteroids so like people with asthma

treatment- topical miconazole gel
oral fluconazole for severe

82
Q

pancreatic carcinoma related to

A

diabetes

83
Q

acute pancreatitis, worsening SoB, resp acidosis so resp failure , cyanosis around lips, bilateral crackles

A

acute resp distress syndrome

Question corrections (17 decks)

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