Acute + Breast + Chest + ENT + Infection Flashcards
1
Q
Treatment of nosebleeds that do not stop after 10-15min
A
If bleeding point can be seen
–> NASAL CAUTERY
If bleeding point cannot be seen
–> NASAL PACKING
2
Q
MSM (Anal sex)
Painless genital ulcer
Proctitis (Pain when opening his bowels)
Tender inguinal lymphadenopathy
Diagnosis?
A
Lymphogranuloma venerum (LGV)
3
Q
Tx of bone mets
A
If frail –> External beam radiotherapy
If fit for surgery –> Surgery
4
Q
Terminal restless (palliative)
A
After a diagnosis of dying has been made
First, exclude reversible causes of deterioration
Then: Midazolam PRN (s.c.)
5
Q
Sx of Delirium tremens
A
MATCH
- Mood changes (extreme fear, hilarity, aggression)
-
Autonomic symptoms
- ↑ HR, ↑ BP, Sweating, Fever, Dilated pupils
- Tremors (coarse) (‘tremens’)
-
Confusion / Altered mental state (‘delirium’)
- Fluctuates in severity throughout the day
-
Hallucinations
- Lilliputian (small people)
- Seeing insects crawling on skin
6
Q
Sx of Delirium tremens
A
MATCH
- Mood changes (extreme fear, hilarity, aggression)
-
Autonomic symptoms
- ↑ HR, ↑ BP, Sweating, Fever, Dilated pupils
- Tremors (coarse) (‘tremens’)
-
Confusion / Altered mental state (‘delirium’)
- Fluctuates in severity throughout the day
-
Hallucinations
- Lilliputian (small people)
- Seeing insects crawling on skin
7
Q
Choice of analgesia for AP resection of low rectal carcinoma
in patient with severe COPD
A
Epidural anaesthesia
Avoid opioids in major surgery in patients with respiratory disease
Epidural can be titrated up
Spinal cannot
8
Q
Ix and Tx for ARDS
A
Ix: White out lung
Tx
- ABCDE
- Oxygen
- Intubation and Ventilation
- Low tidal volume ventilation
- Fluid management
- Treat the cause
9
Q
Sepsis
Pink, frothy sputum (pulmonary oedema)
Bilateral inspiratory fine crackles (mid-late)
Tachypnoea
Hypoxia / Cyanosis
SOB
A
Acute respiratory distress syndrome (ARDS)
==> non-cardiogenic pulmonary oedema
10
Q
Ix and Tx for Anaphylaxis
A
Serial mast cell tryptase
Oxygen
IV Fluids
IM Adreanline (0.5mg, 1:1000)
IV Hydrocortisone (100mg) - prevent rebound anaphylaxis
IV Chlorpheniramine (10mg) - reduce itching and hives
11
Q
Types of Burns
A
12
Q
Sx, Ix and Tx of Compartment Syndrome
A
-
Pain, Pain, Pain, Pain, Pain, Pain
- Pain out of proportion
- Pain on passive stretching of compartment
- Pallor
- Pulseless
- Paralysis
- Paraesthesia
- Poikilothermia = limb is colder than surrounding areas
- Ix: Compartment pressure monitor
- Tx: Fasciotomy
13
Q
Sepsis Six
A
- Give 3
- Give IV ABx
- Give IV Fluid resuscitation
- Give high-flow oxygen (keep SaO2 > 94%)
- Take 3
- Take blood culture
- Measure lactate
- Measure urine output (catheterise)
14
Q
Tx for NMS
A
Sx (oh FRAC)
- Fever
- Rigidity
- Autonomic instability
- Confusion
Tx
- Stop antipsychotics immediately
- IV fluids
- Benzodiazepines (Lorazepam)
- Dopamine agonist
15
Q
Tx for opiate overdose
A
100% oxygen
IV Nalaxone
16
Q
Fever
Sweating
Vomiting
Hyperventilation
Deafness
Respiratory depression
Mixed Metabolic acidosis AND Respiratory alkalosis
Diagnosis? Ix? Tx?
A
Aspirin overdose
- Salicyclate levels ==> HIGH
- Mixed metabolic acidosis and respiratory alkalosis
- Hypokalaemia ==> small T waves, U waves
- Prolonged PT
Tx
- ABCDE
- IV Fluids
- Hypokalaemia ==> IV KCl
- Coagulopathy ==> Vitamin K
- IV Sodium Bicarbonate +/- Haemodialysis
- If < 12 hour ==> Activated Charcol +/- Gastric lavage
17
Q
“Cherry red” lips and skin
Pulmonary oedema
N&V
Dizziness
Dull headache
House fire
Diagnosis? Ix?
A
CO poisoning
Ix: Carboxyhaemoglobin
Tx: High flow + Hyperbaric Oxygen
18
Q
Tx of Bendodiazepine overdose
A
Flumazenil
19
Q
Tx of TCA (Amitripyline) overdose
A
IV sodium bicarbonate (treat acidosis)
Within 1 hour –> Activated charcoal
20
Q
SOB
Headache, Abdo pain
Renal failure (Calcium oxalate crystals)
Metabolic acidosis with anion gap
Diagnosis? Tx?
A
Methanol & Ethylene glycol poisoning
Tx: Fomepizole
21
Q
Tx of Digoxin poisoning
A
Digibind (anti-digoxin antibodies)
22
Q
Tx of Lithium toxicity
A
IV Saline
+/- Haemodialysis
23
Q
Anticholinesterase inhibitors / Organophosphate poisoning
A
Atropine
+ Pralidoxime
24
Q
Atropine (anticholinergic) poisoning
A
Physostigmine
25
Tx of Heparin overdose
Protamine sulphate
26
Tx of Verapamil poisoning
(1) IV Ca2+
(1) IV Fluids
(1) Atropine (to treat bradycardia)
27
Lead poisoning
Dimercaprol
28
**Breast mouse**
**Painless**
**Well circumscribed**
**Highly mobile**
**Women \< 30 years old**
Dx? Tx?
**Fibroadenoma**
Observation and Reassurance
29
**Lumpy breasts**
**Associated with menstrual cycle**
**Worse prior to menstruation**
Dx? Tx?
**Fibroadenosis**
Reassure and Discharge
30
**Hard, irregular lump**
**Nipple inversion**
**Skin tethering**
**+/- Eczematous changes**
Dx?
Breast cancer
Paget's disease of the breast
31
**Tender lump around areola**
**Green nipple discharge (cheesy)**
**Slit like nipple**
Dx? Tx?
**Duct ectasia**
Reasurre and discharge
32
Hx of trauma
Hard, irregular lump
Painless
Non-mobile
**Fat necrosis**
Ix: FNA
Reassure and Discharge
33
**Lactating women**
**Red, warm, _painful lump_**
**_Fever_**
Diagnosis? Tx?
Breast abscess
FNA
Surgical drainage
Antibiotics
34
**Smoker**
**Peri-areolar inflammation**
**Pain**
**Red, peri-areolar mass**
Dx? Tx?
**Periductal mastitis**
Antibiotics
35
**Difficulty breastfeeding**
**Warm, red, painful breasts**
**Hot to touch**
**No fever**
Dx? Tx?
**Acute mastitis**
**Analgesia**
**Continue breastfeeding**
**+/- Flucloxacillin** (if systemically unwell)
36
**_Breast lump_**
**Well defined**
**Fluctant**
**Round**
**Mobile**
**_Associated with menstrual cycle_**
Dx? Tx?
**Fibrocystic disease**
Reassure and discharge
37
**Blood nipple discharge**
**Subaerolar mass**
**Ductal carcinoma in situ**
or **Lobular carcinoma in situ**
or **Breast cancer**
38
**Rapidly growing breast lump**
**Tear drop appearance of breast**
**Shiny, red skin**
Dx? Tx?
**Phyllodes tumour**
Complete surgical excision + Radiotherapy + Chemotherapy
39
Tx of DCIS
**Surgical excision + Radiotherapy**
or **Breast conserving surgery**
40
Tx of LCIS
**Observation** or **Bilateral prophylactic mastectomy**
41
Ix for bladder cancer
Tx
Urine cytology
**Flexible cystoscopy + Biopsy**
In non-invasive --\> TURBT
In invasive --\> Cystectomy + Ileal conduit
42
UK Breast Cancer Screening
47-73 year olds
Every 3 years
Mammogram X-ray
43
Tx for breast cancer
* **Surgery**
* Wide local excision
* Segmental mastectomy
* **Radiotherapy**
* **Chemothearpy**
* **Hormone therapy**
* If ER +ve
* **Tamoxifen**
* **Aromatase inhibitiors** (Letrozole)
* **LHRH analogue** (ovarian ablation)
* **Biologics**
* If HER2 +ve --\> **Herceptin** (mAb)
44
**Cholangiocarcinoma**
Cause
Tumour markers
Ix
Tx
**Cholangiocarcinoma**
* Cause
* PSC/UC
* Markers
* Ca19-9
* Ca-125
* CEA
* Management
* Surgical resection of liver
* +/- Chemotherapy
* +/- Radiotherapy
* or Liver transplant
45
Most common locations for colorectal cancer
Left / Rectosigmoid
46
Marker for colorectal cancer
CEA
47
Double-contrast Barium enema --\> **apple core lesion**
Diagnosis?
Colorectal cancer
48
NHS Screening for Colorectal cancer
49
Duke's staging
A Tumour confined to mucosa | nodes -ve
B1 Tumour growth into muscularis propria | nodes -ve
B2 Tumour growth through muscularis propria and serosa | nodes -ve
C1 Tumour spread to 1-4 regional lymph nodes | apical -ve
C2 Tumour spread to \>4 regional lymph nodes | apical +ve
D Distant metastases (Liver, Lung, Bones)
50
Indications for 2WW for colorectal cancer
* Unexplained rectal or abdominal mass
* Unexpected anal mass or anal ulceration
* \> 40 and unexplained weight loss and abdo pain
* \< 50 and **rectal bleeding** AND **1 of the following**
* **Abdo pain**
* **Change in bowel habit**
* **Weight loss**
* **Iron deficiency anaemia**
* \> 50 and **unexplained PR bleeding**
* \> 60 and **IDA**
* \> 60 and **changes in bowel habit**
51
**Familial adenomatous polyposis**
Cause
Tx
**Familial adenomatous polyposis**
Mutation in **APC tumour supressor gene**
**Prophylactic colectomy** \< 20 years old
(Total colectomy + Ileorectal anastomosis) ==\> rectal stump surveillance
Panproctocolectomy + Ileal pouch anal anastomosis (IPAA)
However, they will still remain at risk of stomach and duodenum cancers
∴ Regular endoscopic screening
52
Hereditary non-polyposis colorectal cancer = Lynch syndrome
Cause
Cancers
Mutation in DNA mismatch repair gene
Colorectal cancer
Gastric cancer
Endometrial cancer
Prostate cancer
Breast cancer
53
**Small bowel obstruction**
**Mucocutaneous pigmentation**
**Colonic polyps --\> GI bleeding**
**PR blood**
**Iron deficiency anaemia**
**Change in bowel habit**
**Weight loss**
Diagnosis? Ix? Tx?
Peutz-Jegher's syndrome
* Ix
* OGD + Colonoscopy ==\> Polyps
* Biopsy of Polyp + Histology ==\> Hamartomatous polyp
* Tx
* Surveillance endoscopy
* +/- Polyp excision
* Surveillance for extra-GI malignancy
54
**Epigastric pain**
**Weight loss**
**Virchow's node +ve**
**Sister Mary Joseph nodule +ve**
**Dysphagia**
Diagnosi? Ix? Tx?
**Gastric cancer**
## Footnote
Ix: **OGD + Biopsy**
Tx: **Surgical resection** (total gastrectomy or endoscopic mucosal resection)
**+/- Chemotherapy**
55
**Smoking**
**Alcohol**
**HPV infection**
**Oral pain**
**Neck lump**
**Lymphadenopathy**
**Weight loss**
Diagnosis? Ix? Tx?
**Oral cavity cancer** (SCC)
Biopsy
Tx: Radiotherapy (preferred)
56
**EBV**
**Neck mass**
**Nasal obstruction with epistaxis**
**Otitis media**
**Cranial nerve involvement (3, 4, 5, 6)**
Diagnosis? Tx?
**Nasopharyngeal cancer**
Tx: Radiotherapy
57
**Painless mass or swelling of parotid gland**
**Facial nerve involvement**
**Lymphadenopathy**
Diagnosis? Tx?
**Salivary gland cancer**
Surgical resection
58
Types of lung cancer
* **Small-cell** lung cancer (SCLC) – 15%
* **Non-small cell** lung cancer (NSCLC) – 85%
* **Adenocarcinoma** (40%) – peripherally
* **Squamous cell carcinoma** (30%) – central airways
* **Large cell carcinoma** (15%) – centrally, undifferentiated tumours
59
**Neutrophil count ≤ 0.5 x 109/L**
**Fever**
**Sepsis**
Tx?
**Neutropenic sepsis**
**Sepsis Six**
**IV Tazocin + IV Gentamicin**
60
**Abdominal mass**
**Painless haematuria**
**Hypertension in a child**
Diagnosis? Tx?
**Wilm's tumour**
Nephrectomy +/- Chemotherapy
61
Types of oesophageal cancer and location
**Adenocarcinoma** (lower 1/3) = arises from from Barrett's oesophagus
**SCC** (middle 1/3)
62
_Progressive_ dysphagia
Odynophagia (pain on swallowing)
Weight loss
Hoarsenss
GORD
Diagnosis? Ix? Tx?
**Oesophageal cancer**
OGD + Bioipsy
**Endoscopic resection** or **Oesophagectomy**
**+/- Chemotherapy**
**+/- Radiotherapy**
63
**Painless jaundice**
**Pale stools**
**Dark urine**
**Weight oss**
**Steatorrhoea**
**Migratory thrombophlebitis**
**(Trosseau's sign of malignancy)**
Diagnosis? Ix? Tx?
Pancreatic cancer
## Footnote
**Abdominal USS**: Pancreatic mass, dilated bile ducts
**Ca 19-9**
**Surgical resection + Pancreatic enzyme replacement**
64
Tx for Prostate cancer
65
**Haematuria**
**Flank pain**
**Palpable abdominal mass**
**Polycythaemia**
**Hypertension**
**Scrotal varicocele**
Diagnosis? Ix? Tx?
**Renal cell carcinoma**
**CT Abdo Pelvis**
\< 3cm --\> **Active surveillance** (scan every 6 months)
**or Surgical resection**
Resistant to chemotherapy and radiotherapy
66
Tyeps of testicular cancer and markers
* Seminoma
* Normal AFP
* Normal B-hCG
* Teratoma
* ↑ AFP
* ↑ β-hCG
67
Types of Thyroid cancer
68
**Start Chemotherapy**
**Uric acid: ↑**
**Phosphate: ↑**
**Potassium: ↑**
**Calcium: ↓**
* **IV Fluids**
* Treat Hyperkalaemia
* **IV Calcium gluconate**
* Treat high urate
* **IV Rasburicase**
* Treat high phosphate
* **Aluminium hydroxide** (phosphate binder)
* **+/- Dialysis**
69
Borders of anterior / posterior triangle
Anterior trianage
* Mandible
* Midline
* SCM
Posterior triangle
* SCM
* Clavicle
* Trapezius
70
Neck lumps in anterior, midline and posterior triangle
* **Midline**
* Dermoid cyst
* Thyroglossal cyst
* **Anterior triangle**
* Lymph node
* Brachial cyst
* Salivary gland pathology
* Carotid artery aneurysm
* Carotid body tumour
* **Posterior triangle**
* Lymph node
* Cervical rib
* Cystic hygroma
* Pharyngeal pouch
71
**Swelling**
**Loss of radial pulse on abduction and external rotation of shoulders**
**Arm claudication**
**Radiculopathy**
Diagnosis? Tx?
**Thoracic outlet syndrome**
Remove 1st rib
72
**Neck lump in posterior triangle**
**Regurgitation**
**Halitosis**
**Gurgling sounds**
Diagnosis? Ix? Tx?
**Pharyngeal pouch / Zenker diverticulum**
Barium swallow
Surgical excision
73
**Unilateral sensorineural hearing los**
**Tinnitus**
**Facial palsy**
**Absent corneal reflex**
Diagnosis?
**Acoustic neuroma**
Cerebellopontine angle tumour of CN8 nerve
Audiogram
GAD-enhanced MRI
Stereotactic radiosurgery
74
**_Recurrent_ episodes of vertigo**
**Worse with specific movements**
Diagnosis? Ix? Tx?
**BPPV**
Benign Paroxysmal Positional Vertigo
due to loose otoconia
Ix: **Dix Hallpike manoeuvre** ==\> confirms diagnosis (vertigo and upbeat torsional nystagmus)
Tx: **Epley manoeuvre**
75
**Episodic vertigo**
**Sensorineural hearing loss**
**Tinnitus** (roaring)
**Sensation of fullness** (in affected ear)
Diagnosis? Tx?
**Meniere's disease**
* **Vestibular supressants**
* **Antiemetics**
* **Corticosteroids**
76
**Recent viral illness**
**Vertigo** (room spinning)
**Nystagmus**
**+ve head impulse**
**_Normal hearing_**
**_Single episode_**
Diagnosis? Tx?
**Vestibular neuritis**
Inflammation of CN8 nerve
Self-resolves after few weeks
Anti-emetics
Single episode
DDx from BPPV and Vestibular migraine which require recurrent episodes for diagnosis
77
**Recent viral illness**
**Vertigo (room spinning)**
**_Sensorineural hearing loss_**
**Otorrhoea**
Diagnosis?
**Labyrinthitis** = inflammation of inner ear (cochlea + vestibular system)
Treat underlying cause
78
**Chronic purulent ear discharge**
**Facial nerve palsy**
**Crusting of TM**
**Conductive hearing loss**
Diagnosis? Tx?
**Cholesteatoma**
Tx: Micro-suctioning
79
**Tonsillar exudate**
**Tender anterior cervical lymphadenopathy/ lymphadenitis**
**History of fever (\>38°C)**
**Absence of cough**
Scoring system? Diagnosis?
**Centor score**
Likelihood of **Strep throat infection ==\> Tonsillitis**
80
Herpes viruses
81
University
**Generalised lymphadenopathy**
**Pharyngitis**
**Tonsillitis with exudate**
**Fever**
**Splenomegaly**
**Atypical lymphocytes**
**Monospot test for Heterophile antibodies +ve**
Diagnosis? Tx?
**Infectious mononucleosis** (EBV)
**Supportive** (IV fluids, anti-pyretics, analgesia)
**+/- Corticosteroids**
82
DDx
Hypopigmented skin
With sensory loss
Without sensory loss
* Hypopigmented skin with sensory loss
* **Leprosy**
* Hypopigmented skin without sensory loss
* **Vitiligo**
* **Pityriasis versicolour**
83
**Travel to Africa, Asia or Pakistan**
**Periodic fever every 48 hours**
**Anaemia**
**Hepatosplenomeagly**
**Jaundice**
Diagnosis? Ix? Tx?
**Malaria**
Thick and Thin blood smears
**Choloroquine or Hydroxychloroquine**
84
Types of malaria
***Plasmodium falciparum*** —most life threatening
***Plasmodium vivax*** - most common
***Plasmodium ovale*** —‘relapses’ of malaria months or years after initial infection.
***Plasmodium malariae***
***Plasmodium knowlesi*** — monkeys
85
**Trauma**
**Cellulitis + Loss of sensation** over that area
**Crepitus**
**Bullae**
Diagnosis? Tx?
**Necrotising fasciitis**
Surgical debridement + IV ABx
86
**Purulent urethral discharge**
**Dysuria**
**Prostatitis**
Diagnosis? Ix? Tx?
Gonorrhoea
Culture: intracellular Gram -ve diplococci
Ceftriaxone IM
87
Painless indurated ulcer on genitals
Maculopapular rash (soles, palms)
Aortic aneurysm
Tabes dorsalis
Jarisch-Herxheimer reaction
Diagnosis? Tx?
**Syphillis**
VDRL
TPHA/FTA
Benzathine Pen
88
**Argyll-Robertson pupil**
Sx
**Syphillis**
**Accommodates**
**But doesn't react!**
Prostitute's pupil
89
**Cardiac arrest**
Tx for Shockable rhythm
* Cycle
* **Deliver the shock**
* **Re-start CPR immediately**
* **After 2 min** *_or_* signs of life--\> **Rhyhmn check**
* If VF or pVT persists ==\> **continue above cycle**
* After 3rd shock
* **_IV_ Adrenaline (1mg)**
* GIven after 3rd shock and then on alternate cycles
* **IV Amiodarone (300mg)**
* GIven after 3rd shock and then on alternate cycles
* If electrical activity compatible with pulse ==\> **Feel for pulse**
* If no pulse ==\> switch to **non-shockable Tx**
* If pulse ==\> **post resuscitation care**
90
Cardiac arrest
Tx for Non-shockable rhythm
* **Check for a pulse**
* _If no pulse_ (asystole or pulseless electrical activity)
* **IV Adrenaline** (1mg) - given ASAP
* Continue CPR
* After 2min ==\> Rhythm check
* If VF/pVT --\> swtich to shockable side of alogorithm
91
4Hs and 4Ts of Cardiac arrest
* Hypoxia
* Hypovolaemia
* Hypo- or Hyperkalaemia
* Hypothermia
* Thrombosis
* Tension pneumothorax
* Tamponade (cardiac)
* Toxins
92
Pre-operative fasting
2 hours for clear liquids
6 hours for solids
93
**Chronic onset**
**Abdo pain**
**Neuropsychiatric Sx**
**Burton's line** (on teeth)
Blood film: **basophilic stippling** and **ringed sideroblasts**
Diagnosis? Ix? Tx?
**Lead poisonining**
Total body lead
Dimercaprol
