ALL CORRECTIONS Flashcards
Investigations for sarcoidosis
Increased ESR
Hypercalcaemia
Raised ACE
Diagnostic CXR- bilateral hilar lymphadenopathy
Staging for sarcoidosis
stage 1 - BHL
stage 2 - BHL and parenchymal disease
stage 3 - parenchymal disease only
stage 4 - end stage lung - pulmonary fibrosis
Treatment for sarcoidosis
stage 2 and above
Corticosteroids
Henoch schonlein purpura
IgA deposits on blood
Iga nephropathy ( nephritis) arthralgia, abdo pain and purpura
Childhood
What drugs cause SLE
Sulfalazine
Hydralazine
Isoniazid
Procainamide
Penicillamine
Symptoms of SLE
malar rash
discoid rash
worse on sun exposure
antibodies for SLE
ANA– sensitive
Anti-dsDNA- more specific
Anti-smith - more specific
Wegeners granulomatosis -
cANCA
saddle shaped nose
epistaxis
cough
haemoptysis
NEPHRITIC SYNDROME
Involvement in microscopic polyangiitis
lower resp tract involvement and glomerulonephritis
What is churg strauss and antibodies
pANCA
Eosinophilic and autoimmune
Accompanied by asthma
What is amyloidosis
starch like deposits in the tissue
Cause nephrotic syndrome
Can cause hyperlipidaemia
Where can amyloidosis cause abnormalities in the body
restrictive cardiomyopathy
arrhythmia
Intestines- splenomegaly , hepatomegaly
Diagnostic for amyloidosis
Renal biopsy and congo red stain- pink
under polarised light - apple green
Sjogrens syndrome antibody ?
Anti - Ro and Anti-La
Systemic sclerosis antibodies
Limited - anti centromere
CREST SYNDROME - hands, face and feet
Systemic - anti-Scl-70
Anti-RNA polymerase
WIDESPREAD ORGAN INVOLVEMENT
Polyarteritis nodosa cause
after Hep B
necrotising inflammation
Diagnosis of polyarteritis nodosa
MRA- string of pearls appearance
Polyarteritis nodosa presentation
systemic features
LIVEDO RETICULARIS
Triad of behcets disease
recurrent aphthous ulcers
genital ulcerations
erythema nodosum
Polymyositis T cells involvement
CD8 T+
Dermatomyositis T cells involvement
CD4 T+
Antibodies in poly/dermatomyositis
Anti -jo1 , Anti-Mi2
Polymyalgia rheumatica- symptoms?
Bilateral pain and stiffness
NO WEAKNESS
What extrapulmonary feature is seen in sarcoidosis
LUPUS PERNIO
Management for psoriasis
potent corticosteroid and vit D analogue ( Calcipotriol)
Nail changes seen in psoriasis
subungal hyperkeratosis
pitting nails
nail thickening
onycholysis
How to treat dermatitis herpetiformis
dapsone
Treatment for pyoderma gangrenosum
high dose prednisolone and dressings
What patients is lupus vulgaris found in
TB
brown,firm, translucent nodules
Full RIPE for a year
Rash seen in lyme disease
erythema chronicum migrans
Treatment for shingles
oral antivirals within 72 hrs
Hypercalcaemia of malignancy treatment vs hypercalcaemia treatment
Malignancy - IV rehydration and pamidronate
Hypercalcaemia - IV rehydrations
Small cell lung carcinoma treatment
chemo - very sensitive to chemo
What is carcinoid syndrome
carcinoid tumours w liver mets - PATIENTS ARE SYMPTOMATIC
What can lung adenocarcinomas cause
HPOA-
hypertrophic pulmonary osteoarthropathy
causes inflammation of bones and joints
What is toxoplasmosis
HIV patients presents as encephalitis - multiple ring enhancing lesions( hallmark)
Copper poisoning presentation
profuse emesis , diarrhoea, abdo pain
Metallic taste in mouth and green discolouration in gums
Copper poisoning treatment
D-penicillamine
Risk factor for gastric ulcers
Use of NSAIDS
Amitriptyline toxicity presentation and ECG changes
pupil dilation
skin flushing
seizures
Prolonged QRS and tachyarrythmias
What will cause bilateral adrenal atrophy
exogenous steroid use
What will be heard in a patient with atrial myxoma
LOUD S3
Choice of antihypertensive in pregnant woman
CCB
LVH ECG changes
increased amplitude of QRS complexes
non-specific T wave inversion
Antibody for Type 1 autoimmune hepatitis
ANA
What sign is consistent with acute liver pathology
tender smooth hepatomegaly
What electrolyte side effect can SSRIs cause
hyponatremia
What is charcot’s joint
destruction of weight bearing joint secondary to sensory neuropathy
affects ankles and knees
How does charcot marie tooth disease present-
nerve biopsy diagnosis
AUTOSOMAL DOMINANT
-symmetrical distal slowly progressive muscle wasting
CHAMPAGNE BOTTLE APPEARANCE
motor and sensory neuropathy
What is enteropathic arthritis
associated with IBD
asymmetrical oligoarthritis - larger joints of lower limbs
Papillary carcinoma of thyroid presentations
younger females
moves with swallowing
spreads to lymph nodes
Anaplastic carcinoma of thyroid presentation
older people
acute
most aggressive
Hard symmetrical rapidly enlarging
Pulmonary hypertension management drugs
Prostacyclin analogues - eroprestenol
endothelin analogues- bosentan
phosphodiesterase type 5 inhibitors- sildenafil
PMR vs fibromyalgia bloods
PMR - Raised ESR
Fibromyalgia - normal ESR
Choice of antibiotic for severe campylobacter
clarithromycin
Primary biliary cirrhosis treatment
Ursodeoxycholic acid
What vaccine should you offer men who sleep with other men
Hep A
Anterior uveitis treatment
Steroid and cycloplegic /mydriatic( dilates pupil which relieves pain )eye drops-
Anal fissure management if conservative fails
sphincterectomy
Guillian barre syndrome diagnostic investigation
Lumbar puncture
high protein
normal WCC
Acute angle glaucoma treatment
Pilocarpine and beta blocker eye drops
What medications should be avoided in a patient with MG
Beta blockers - worsens MG - leads to decreased FVC
What part of brain is damaged in alzheimer’s
widespread cerebral atrophy
cortex and hippocampus
most common causative organism of bullous impetigo
S.aureus
Choice of management for neuropathic bladder
intermittent self catheterisation
What kind of liver pathology can co-amoxiclav cause
cholestatic picture
What can a large PE cause on an ECG
RBBB
What is the cause of a painful 3rd nerve palsy
posterior communicating artery
Pupil dilation
How does a phyllodes breast tumour look on histology
mixed epithelial and connective tissue
RARE
Description of peau d’orange
cutaneous lymphoedema w/ dimpling
Basal atelectasis presentation
Respiratory alkalosis
pO2 much lower than expected
decreased breath sounds on auscultation post operatively -
CHEST PHYSIO
Treatment for superficial thrombophlebitis
compression stockings and NSAIDs can be used
In BPH where in the prostate is affected
hyperplasia in transitional zone
Myelofibrosis - hallmark features on investigations
dry tap
dacrocytes/ tear drop cells
CK level in rhabdomyolisis
CK > 10,000
Most common organism that causes cellulitis
strep pyogenes
Meningeal signs
Kernig’s sign – pain on passive extension of knee
Brudzinski sign - flexion of neck causes flexion of hips
Conjunctiva presentations depending on causative organisms
Viral - most common
Allergic - bilateral
Bacterial - unilateral
Orbital cellulitis management
Hospital admission for IV cefotaximine
What treatment can be used for chronic Hep C
interferon alpha
Treatment for aspiration pneumonia
metronidazole
What is boutonneire deformity
flexed at PIJ
hyperextended at DIPJ
What is swan neck deformity
hyperextended at PIPJ
flexed at DIPJ
RBBB changes on ECG
RSR1 pattern in V1 and V2
large S waves in V6
wide QRS complexes
Skin changes that can be seen in reactive arthritis
keratoderma blenorrhagicum - pustular crusty yellow brown seen on soles of feet
Circinate balanitis - annular lesions on penis
Most common eye symptoms in RA
dry eye syndrome
Mode of inheritance for alpha 1- antitrypsin deficiency
autosomal recessive
What is brugada syndrome
Young males history fo sudden death
COVED ST ELEVATION ON ECG
What does bacterial keratitis cause
entropion ( in turning of lower eyelid)
How do you treat a benzodiazepine overdose
Flumazenil
Initial management of rhabdomyolysis
administer IV fluids
Most common organism that causes acute bacterial prostatitis
e.coli
dysuria, urinary frequency , tender prostate gland
Treatment for acute bacterial prostatitis
oral ciprofloxacin
What is a side effect of sodium valproate
hepatic dysfunction -
deranged LFTs
What virus is mollacusum contagiosum associted with
poxvirus
Treatment for giardia lamblia infection
metronidazole
Conditions associated with erythema multiforme
HSV
Mycoplasma pneumonia
strep
TB
Choice of imaging for TIA
MRI brain with diffusion weighted imaging
Posterior MI ECG changes
ST depression
Tall R waves in V1-V2
What is Charles bonnet syndrome
Intact cognition , ocular pathology , visual hallucinations
INSIGHT IS PRESERVED
What JVP changes are seen in tricuspid stenosis
GIANT A WAVES
How does a pontine haemorrhage present
low GCS
quadriplegia
miosis
absent horizontal eye movement
How does a lacunar infarct present
ISOLATED HEMISENSORY LOSS
First line for focal seizures
lamotrigine/ levetiracetam
Most common causative organism of infective exacerbations of COPD
H. influenzae
3rd degree heart block JVP signs
Canon A wave
AF JVP signs
Absent A wave
What will lead poisoning lead to
microcytic anaemia and motor neuropathy
HSV in pregnancy management
Oral acyclovir and plan C section for delivery
What is post exposure prophylaxis for HIV
oral anti-retroviral therapy for 4 weeks and then retest at 12 weeks
Thyroid eye disease treatment
smoking cessation
1st line - oral steroids
2nd line - rituximab
3rd line - radiotherapy
Hyperparathyroidism common X ray finding
pepperpot skull
Most common organism that causes peritoneal dialysis associated peritonitis
S. epidermidis
What kind of signs does cerebellar syndrome cause
unilateral lesions that cause ipsilateral signs
Dysdiachokinesia, dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia
What is the management of an acute anal fissure
Dietary advice
bulk forming laxatives- first line - isphagula husk
Mitral valve prolapse signs
characteristic mid systolic click and systolic murmur
Management of chronic anal fissure
topical GTN
not effective after 8 weeks - sphincterectomy
What is the diagnostic imaging for diverticular disease
CT abdo with oral and IV contrast
When do you admit patients for IV antibiotics in diverticulitis
if symptoms do not settle within 72hrs or patient initially presents with more severe symptoms
How do thrombosed haemorrhoids present
significant pain
purplish, oedematous tender subcutaneous perianal mass
How should thrombosed haemorrhoids be managed
patient presents within 72 hrs
referral for excision
otherwise can use stool softeners, ice packs and analgesia
What is the grading of internal haemorrhoids
Grade 1- do not prolapse out of anal canal
Grade 2- prolapse on defecation but reduce spontaneously
Grade 3- can be manually reduced
Grade 4 - cannot be reduced
Where is ischaemic colitis most likely to occur
splenic flexure
What may be seen on AXR in ischaemic colitis
thumbprinting
What are some indications for surgery in a Crohn’s patient
complications such as fistulae, abscess formation and strictures
What blood marker can be used in patients with medullary carcinoma
Calcitonin
What marker can be used generally as thyroid cancer follow up
Thyroglobulin antibodies
Hyperkalaemia ECG findings
peaked/tall tented T waves
loss of P waves
broad QRS complexes
sinusoidal wave pattern
What patients are identified as being malnourished
BMI <18.5
unintentional weight loss >10% 3-6 months
BMI<20 and >5% unintentional weight loss 3-6 month
Osteosarcoma key points
most common primary malignant bone tumour
sunburst pattern
Ewings sarcoma key points
onion skin appearance
seen in children and adolescents
Chondrosarcoma key points
malignant tumour of cartilage
affects axial skeleton
more common in middle age
What is mirizzi syndrome
RUQ, fever and signs of systemic upset
alongside deranged LFTs
gallstone impacted in distal cystic duct
Features of severe pancreatitis
age>55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
Diagnosis of Boerhaaves syndrome
CT contrast swallow
Treatment for Boerhaave’s syndrome
Thoracotomy and lavage
What tumour marker is raised in cholangiocarcinoma
CA19-9
What is seen in acute tubular necrosis
features of AKI - raised urea, creatinine, potassium
MUDDY BROWN CASTS IN URINE
Most common cause of acute urinary retention in men
secondary to BPH- prostate presses on urethra
2 main symptoms of chronic urinary retention
painless and insidious
What is meant by high pressure retention
impaired renal function and bilateral hydronephrosis
– due to bladder outflow obstruction
What is meant by low pressure retention
normal renal function and no hydronephrosis
Describe epididymal cysts
seperate from body of testicle
found posterior to testicle
Describe hydrocele
communicating – newborns
soft non tender swelling of hemi-scrotum
you can get above the mass
transilluminates
What is Marjolins ulcer
squamous cell carcinoma
occurs at sites of chronic inflammation - burns, osteomyelitis etc
lower limb
