Abdomen and Surgery (random) Flashcards by Yama Baheer

Abdominal film of an elderly constipated woman shows an ‘inverted U’ loop of bowel

Volvulus

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Chronic liver disease associated with:

Early onset emphysema

α1-antitrypsin deficiency

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Signs on examination

Angular stomatitis

Iron deficiency anaemia

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Constipation and bright-red blood coating her stools

Two bluish tender spongy masses are found protruding from the anus

They prolapse through the rectum on defecation but spontaneously reduce

Second-degree haemorrhoids

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Hereditary nephritis, sensorineural deafness, ocular abnormalities

Alport’s

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Early oliguria followed by recovery of renal function with an increase in renal output

Acute tubular necrosis

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Signs on examination

Asterixis (liver flap)

Hepatic encephalopathy

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21-year-old man presents with a history of constipation and rectal bleeding

On examination there are numerous dark freckles on the palm, lips and oral mucosa

Peutz-Jeghers syndrome

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Pruritis, jaundice, pigmentation, Anti-mitochondrial antibodies (AMA) positive, middle-aged woman

Associated with: RA, Sjorgen’s syndrome, thyroid disease, renal tubular acidosis

Primary biliary cirrhosis (primary biliary cholangitis)

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Testicular swelling that has increased in size over the last couple of months

The swelling is fluctuant and the underlying testis impalpable

Hydrocoele

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Treatment of GI conditions

IBS patient complains of colicky pain and bloating

Mebeverine

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Worsening eczema-like rash overlying the areola and nipple

Palpable mass can be felt under the rash

Paget’s disease of the breast

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Chronic liver disease associated with:

Dysarthria, dyskinesia, dementia, Kayser-Fleishcer ring

Wilson’s disease

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Vitamin D, folate and nicotinic acid (Vit B3) are absorbed in the…

jejunum

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Classical presentation

Severe epigastric pain radiating to back associated with vomiting

Acute pancreatitis

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Signs on examination

Glossitis

Vitamin B12 deficiency

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Caused by occlusion of the hepatic veins that drain the liver

Classical triad of abdominal pain, ascites and liver enlargement

Budd-Chiari syndrome

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Glomerulonephritis, pulmonary damage, anti-GBM antibody

Goodpasture’s

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Treatment of GI conditions

Severe oesophagitis confirmed on endoscopy

High-dose PPI

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Splenomegaly

Neutropenia

Rheumatoid arthritis

Felty’s syndrome

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Tanned man with an ulcer on nose with rolled edge, due to necrosis of centre

Basal cell carcinoma

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Most common cause of glomerulonephritis

IgA nephropathy / Berger’s disease

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A 35-year-old woman is worried about an abdominal mass that has grown over the last six months and a similar length history of very heavy menstrual bleeding with no intermenstrual bleeding

On examination a knobbly mass can be felt in the middle lower quadrant that is dull to percussion

The lower edge is not palpable

Fibroids

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Week history of fever and sore throat

Macular rash after ampicillin

Enlarged posterior cervical nodes

Palatal petechiae

Splenomegaly

Infectious mononucleosis (glandular fever)

Results from primary infection with EBV

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**Signs on examination** Expansile pulsatile mass

Aneurysm

**Signs on examination** Buccal pigmentation

Peutz-Jeghers syndrome Addison's disease

**Treatment of GI conditions** Cirrhosis, with haematemesis

Upper GI endoscopy (suspected oesophageal varices)

**Classical presentation** Jaundice and constant right upper quadrant pain

Biliary colic

Hepatosplenomegaly Anaemia Bone involvement Increased pigmentation on forehead and hands

Gaucher's disease

Fever and bloody diarrhoea Tachycardic and Hb of 10g/dL Abdominal film shows loss of haustral pattern and a colonic dilatation of 8cm

Toxic megacolon - presentation of severe UC

Crohn's patient complains of watery discharge from a puckered area 2cm from the anal canal

Anal fistula

Patient treated with broad-spectrum antibiotics presents a few days later with bloody diarrhoea

Pseudomembranous colitis

Soft lump in left groin Expansile cough impulse Fluid thrill felt when percussing lower down the legs

Saphena varix (A saphena varix, or a saphenous varix is a dilation of the saphenous vein at its junction with the femoral vein in the groin. Saphena varix is a common surgical problem)

Thirst, tiredness, depression, bone pain, constipation

Hypercalcaemia

Lump behind the anterior border of sternocleidomastoid on the upper left side of the neck

Branchial cyst

19-year-old man complains of severe pain and swelling of sudden onset in his right scrotum Testes and epididymis are very tender Has had unprotected sex recently

Acute epididymo-orchitis

Constipation and bright-red blood coating her stools Two bluish tender spongy masses are found protruding from the anus These do not reduce spontaneously and require digital reduction

Third-degree haemorrhoids

Chronic liver disease associated with: Pigmentation, diabetes

Haemochromatosis

Man presenting with scrotal swelling is worried that he is growing a third testicle On examination there is a smooth fluctuant swelling within the scrotum Both left and right testes are palpable

Epididymal cyst

Woman who has recently given birth complains of excruciating pain on defecation, which persists for hours afterwards Examination reveals a defect posterior to the anal canal

Anal fissure

62-year-old man presents with rectal bleeding and a year's history of left iliac fossa pain and change in bowel habit There is no weight loss

Diverticular disease

Vitamins B12 and C are absorbed in the...

terminal ileum

Transmural, non-caseating granulomatous inflammation, skip lesions

Crohn's

65-year-old woman presents with constipation and colicky left-sided abdominal pain relieved by defecation

Diverticular disease

**Treatment of GI conditions** Perforated gastric ulcer

Laparotomy

GET SMASHED causes of pancreatitis

* *G**all stones * *E**thanol * *T**rauma * *S**teroids * *M**umps * *A**utoimmune * *S**corpion stings/spider bites * *H**yperlipidaemia/hypercalcaemia (metabolic) * *E**RCP * *D**rugs

**Classical presentation** Iliac fossa pain, positive pregnancy test

Ectopic pregnancy

Feeling of a lump in throat that causes discomfort on swallowing, but examination and imaging of the pharynx and oesophagus reveal no abnormality

Globus hystericus

**Signs on examination** Craggy hepatomegaly

Liver malignancy

**Signs on examination** Leuconychia

Hypoalbuminaemia

Irreducible lump in the left groin that is positioned below and lateral to the pubic tubercle

Femoral hernia

**Signs on examination** Koilonychia

Iron deficiency anaemia

4-year-old presents with large swelling at the posterior triangle Swelling is soft and fluctuant and transilluminates brilliantly

Cystic hygroma

Constipation and bright-red blood coating her stools Two bluish tender spongy masses are found in the rectum

First-degree haemorrhoids

**Signs on examination** Aphthous ulceration

IBD Coeliac disease

55-year-old woman presents with abdominal pain, weight loss and fatty stools She also complains of extremely uncomfortable itchy blisters on her knees and elbows Particularly strong association with HLA-DR3 and -DQ2 Can develop iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)

Coeliac disease

6-year-old boy presents with a 2-week history of non-blanching rash over the buttocks and macroscopic haematuria Complains of pain in both knees

Henoch-Schönlein purpura

Anaemia + mild jaundice Reticulocytosis Elevated serum unconjugated bilirubin Reduced plasma haptoglobin Raised LDH Increased urinary urobilinogen

Haemolytic anaemia

Abdominal pain, vomiting and jaundice Tender hepatomegaly and ascites History of recurrent miscarriages

Budd-Chiari syndrome

Bleeding ulcer on upper region of left cheek Everted edge Palpable cervical lymph nodes

Squamous cell carcinoma

Calcium and iron are absorbed in the...

duodenum

UC patient presents with jaundice, pruritus and abdo pain Raised ALP Negative anti-mitochondrial antibodies Association with HLA-B8 and HLA-DR3

Primary sclerosing cholangitis

**Classical presentation** Colicky pain radiating to the groin

Ureteric colic

Crypt abscesses, goblet cell depletion, mucosal ulcers, continous

Ulcerative colitis

Barrett's oesophagus is metaplasia from...

squamous to columnar

Presence of red cell casts in urine are strongly suggestive of...

glomerular pathology

Treatment of H. pylori

**Triple therapy (PPI + 2 Abx)** * Abx:* amoxicillin + clarithromycin * (for penicllin allergic):* clarithomycin + metronidazole

Pruritis, jaundice, abdominal pain, elevated ALP, AMA negative Associated with IBD

Primary sclerosing cholangitis

At what plasma bilirubin level is jaundice usually visible at?

\>35µmol/L

Double stranded DNA virus with the cytoplasm of hepatocytes

Hepatitis B

RNA virus in a patient with signs of hepatic inflammation

Hepatitis C