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1
Q

Gastric tumors, unusual findings

A

dysphagia
acnathosis nigarans
black velvety rash

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2
Q

RFs for gastric cancer

A

pernicious anaemia
H pylori
consumption of N nitroso compounds

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3
Q

Ranson’s criteria or modified Glasgow coma scale

A

prognostic criteria for pancreatitis

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4
Q

perianal pain

A

abcess–> usually pain so bad that DRE is impossible

CT or MRI may be needed to get full diagnosis

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5
Q

RFs for abcess

A

Chron’s and anal fistulae

Complication of abcess is fistula

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6
Q

puritis ani

A

abcess

hameorrhoids

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7
Q

Tx of abcess

A

involves drainage of abcess +/- adjunct Abx

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8
Q

Hemorrhoids

A

Grade 1 is limited to within the anal canal.
Grade 2 protrudes but spontaneously reduces when the patient stops straining.
Grade 3 protrudes and reduces fully on manual pressure.
Grade 4 is irreducible.

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9
Q

Tx for hemorrhoids and fissures:

A

-Hemorrhoids: fibre, ligation, photocoagulation, sclerotherapy or surgical haemorrhoidectomy

-Fissure: topical GTN or diltiazem
reccurrent fissures –> botulinum toxin

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10
Q

Fissure risk factors

A

opiates and third trimester of pregnancy

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11
Q

Tenesmus

A

Tenesmus is the constant feeling of needing to pass stools, even if there is nothing to pass. It may also be a symptom of rectal carcinoma, and is caused by a SOL.

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12
Q

Pancreatic cancer procedure

A

Whipples

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13
Q

Hepatitis spread by IVDU

A

Hep B and C

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14
Q

70 year old woman has seen her GP for depression on several occasions. She now complains of abdominal pain, constipation & thirst –> what is the cause?

A

Hypercalcaemia

Causes hyperparathyroidism or malignancy. The serum PTH level is elevated in primary hyperparathyroidism whereas it may be very low in malignancy due to negative feedback.

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15
Q

HIV and diarrhea

A

Cryptosporidium –> diagnosis is made in the lab by detection of oocysts or antigens in stool.

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16
Q

When vomiting is the main presenting symptom

A

Staphylococcus aureus, bacillus cereus or norovirus

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17
Q

Complications of chronic pancreatitis

A

pseudo cysts
calcification
DM
malabsorption

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18
Q

secrete large amounts of mucus and result in hypokalaemia

A

villous adenomas

villous adenoma, which is a type of polyp in the GIT with a malignant potential. Most colorectal cancers arise from an adenoma and polypectomy reduces the incidence of colorectal cancer. The non-neoplastic polyps include hyperplastic ones, hamartomas, inflammatory and lymphoid polyps

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19
Q

Yersinia enterocolitis

A

Yersinia enterocolitis can mimic Crohn’s RLQ pain

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20
Q

Osler-Weber-Rendu syndrome

A

aka hereditary haemorrhagic telangiectasia
This causes abnormal blod vessels pretty much everywhere which are prone to bleed. It is an autosomal dominant condition so a positive FH can often be found.

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21
Q

pancreatic psuedocyst

A

most common finding is pain followed by a palpable mass

complication of pancreatitis

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22
Q

fever and CT of abdo shows a ring-enhancing fluid collection with gas

A

pancreatic abcess –> drainage and Abx

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23
Q

EBV

A

infectious mononulceous
causes splenomegaly
meaning more prone to rupture

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24
Q

viral gastroenteritis

A

N&V more so than diarrhoea

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25
Q

condition that is associated with Budd-Chiari syndrome

A

polycythemia vera –> Around 30% will go on to develop myelofibrosis.

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26
Q

Coombs’ test is positive

A

CLL –> warm type AIHA accounting for her pallor and fatigue

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27
Q

info

A

Retrosternal pressure experienced can be precipitated by drinking liquids but is eased by continuing to drink, and the pain may be relieved by cold water. This may wake the individual from sleep.

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28
Q

myasthenia gravis is associated with what?

A

associated with thymic hyperplasia in 70% or thymoma in 10%

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29
Q

elevated serum AChR receptor antibody titres or MuSK antibodies

A

myasthenia gravis

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30
Q

PBC is also associated with

A

srojens, rhA

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31
Q

Positive heterophile antibody test and serological testing

A

EBV

EBV and characterised by fever, pharyngitis and lymphadenopathy with atypical lymphocytosis.

IM is commonly named the ‘kissing’ disease as EBV is most commonly transmitted by saliva. Penetrative sex and general promiscuity in young women also increases the risk.

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32
Q

Leucoerythroblastosis and splenomegaly

A

myelofibrosis
Strong risk factors include exposure to radiation and industrial solvents. BM biopsy is essential for diagnosis. Extramedullary haematopoiesis leads to dacrocytes in the peripheral blood smear. Those without symptoms can be managed with folate and pyridoxine supplements. Otherwise options such as a BM transplant and hydroxycarbamide can be considered.

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33
Q

myalgia may indicate what infectious disease

A

influenza or typhoid

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34
Q

non-caseating granulomas

A

sarcoidosis

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35
Q

jaundice in malaria suggests what

and thrombocytopenia and mild anaemia

A

falciparum infection

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36
Q

pain in lymph nodes after alcohol consumption

A

Hodgkins lymphoma

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37
Q

Typhoid / enteric fever

A
  • fever increases incrementally until a persistent fever with temperature 39-41 is established.
  • flu like symptoms after onset of fever and cough. -characteristic findings such as bradycardia and rose spots
  • Rose spots are blanching red lesions reported in 5-30% of cases usually occuring on the chest or abdomen.
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38
Q

Brudzinski’s sign .

A

meningitis

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39
Q

and a petechial/purpuric rash, typically associated with …

A

meningococcal meningitis

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40
Q

Dengue fever Px

A
  • headache
  • retrobulbar pain worsening with eye movement
  • rash
  • leukopenia and thrombocytopenia are common.
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41
Q

Two weeks after a holiday in the Far East, a 30 year old lady presented with anorexia, fever and joint pains. Jaundice appeared a week later and on examination her liver and spleen were both enlarged and very tender

A

5) This is likely hepatitis A which is primarily transmitted via the faecal-oral route. After the virus is consumed and absorbed, it replicates in the liver and is excreted in the bile (to be re-transmitted). Transmission usually precedes symptoms by about 2 weeks and patients are non-infectious one week after onset of jaundice. The history can reveal risk factors such as living in an endemic area, contact with an infected person, homosexual sex or a known food-borne outbreak. This is classically, in EMQs, associated with shellfish which is harvested from sewage contaminated water.

The clinical course of HAV consists of a pre-icteric phase, lasting 5-7 days, consisting characteristically of N&V, abdominal pain, fever, malaise and headache. Rarer symptoms may be present such as arthralgias and even severe thrombocytopenia and signs that may be found include splenomegaly, RUQ tenderness and tender hepatomegaly as well as bradycardia. The icteric phase is characterised by dark urine, pale stools, jaundice and pruritis. When jaundice comes on, the pre-icteric phase symptoms usually diminish, and jaundice typically peaks at 2 weeks. However, a fulminant course runs in <1% of patients with worsenining jaundice and encephalopathy. Serum transaminases may reach in excess of 10,000 units, although there is little correlation between the level and disease severity. ALT is typically higher than AST.

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42
Q

characteristics of EBV

A

fever
pharyngitis
lymphadenopathy
EBV causes a maculopapular pattern after ampicillin

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43
Q

Unexplained diarrhoea of >1 month duration with no pathogen diagnosed

A

HIV

The oral candidiasis is also indicative of HIV and is an opportunitistic infection in an immunocompromised host.

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44
Q

you get rheumatic fever following infection with what?

A

group A streptococci

nb rheumatic fever is an autoimmune process
–> carditis, polyarthritis, chorea, erythema marginatum and SC nodules

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45
Q

painless white plaque found along the lateral tongue borders

A

oral hairy leukoplakia

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46
Q

Dengue fever Ix

A

Viral antigen or nucleic acid detection and serology are confirmatory tests to perform

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47
Q

CMV disease in AIDS

A

retinitis

However do remember that virtually any organ can be affected by CMV and it can cause a range of conditions from encephalitis to pneumonitis. In CMV retinitis, fundoscopy will reveal areas of infarction, haemorrhage, perivascular sheathing and retinal opacification. These findings here are of chorioretinitis.

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48
Q

friable cervix

A

chlamydia

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49
Q

green pigment = pyoverdine

A

Pseudomonas

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50
Q

gram negative bacilli causing hospital acquired pneumonia and UTI.

A

Pseudomonas

green pigment = pyoverdine

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51
Q

organisms with the disease:

Mycobacterium tuberculosis

A

Pott’s disease

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52
Q

organisms with the disease:

Plasmodium falciparum

A

Blackwater fever
Blackwater fever is a complication of malaria infection caused by haemolysis, which releases haemoglobin into the bloodstream. This passes into the urine and it is the presence of haemoglobinuria which defines this condition (seen with dark red or black urine, hence the name). It can often lead to renal failure.

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53
Q

organisms with the disease:

Clostridium difficile

A

Pseudomembranous colitis –> tissue culture assay

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54
Q

organisms with the disease:

Borrelia bugdorferi

A

Lyme disease

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55
Q

organisms with the disease:

Salmonella enterica

A

Enteric fever / typhoid

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56
Q

gram staining:

Gram positive cocci:

A

Streptococcus, Staphylococcus, Enterococcus

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57
Q

gram staining

•Gram positive bacilli:

A

Clostridium, Listeria

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58
Q

gram staining

•Gram negative cocci:

A

Neisseria, Haemophilus

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59
Q

gram staining

•Gram negative bacilli:

A

Most EMQ bacteria not already mentioned (Salmonella, Shigella, Pseudomonas, Legionella, Vibrio, ESBL, Proteus…)

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60
Q

organism causing scarlet fever or Kaywaskai

A

Streptococcus pyogenes

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61
Q

VRE stands for vancomycin resistent enterococci

A

Enterococcus faecium not facecialis

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62
Q

brown freckles (GI syndrome)

A

Peutz Jeghers

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63
Q

Abdominal pain:
constant -?
colicky-?

A 
constant = inflammation 
colicky = obstruction
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64
Q

Hepatomegaly causes

A 
Cancer
Cirrhosis
Cardiac: 
-congestive cardiac failure
-constrictive pericarditis 
Infiltration:
-amyloidosis, sarcoidosis, lymphoproliferative disease
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65
Q

Splenomegaly causes

A

Portal HTN
Haemiatological: lymphomas, leukeamia
Infection: malaria, schistomasis, TB, glandular fever
Inflammation

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66
Q

fecal elastase

fecal calprotectin

A

fecal elastase - chronic pancreatitis

fecal calprotectin - IBD

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67
Q

suprapubic pain Dx

A

cystitis

urinary retention

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68
Q

Mesenteric adenitis – where is the pain?

A

RLQ

inflammation of lymph nodes in the abdomen, caused by the bacteriym Yersinia enterolitica, Occures in the RLQ and can be mistaken for appendicitis.

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69
Q

Diverticulitis - pain, where?

A

LIF

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70
Q

Medical causes of generalized abdominal pain

A

DKA, porphyria, addisons, hypercalacemia, ledpoisontin, phaeo.

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71
Q

Post hepatic causes of jaundice

Px: dark urine, pale stool

A

Gallstones
Stricture
Ca of head of pancreas

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72
Q

Hepatic cause of jaundice

Px: JUST DARK URiNE

A 
Hepatits
AI
Alcohol 
Drugs 
Viruses
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73
Q

Thumb printing in abdo X ray

A

UC

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74
Q

Lead piping

A

UC

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75
Q

Serum albumin-ascities albumin cut off

A 
>11g = cirrhosis and cardiac failure 
<11g = TB, cancer, nephrotic syndrome
76
Q

Ascities Tx

A
  • Diuretics (spiro +/- frusemide)
  • Dietary sodium restriction
  • Fluid restriction in pts with hyponatemia
  • Daily wts
  • Theraputic paracentesis with IV human albumin
77
Q

Encephalopathy Tx

A 
Lactulose 
Phosphate enemas 
Avoid sedation 
Tx infections 
Exclude a GI bleed
78
Q

Alcoholics usually have a urea of approx 1, if an alcoholic has a urea of 7/8 suggests a protein mean, which means what?

A

GI bleed

79
Q

J waves on an ECG

A

Characteristically seen in hypothermia (typically T<30C), but they are not pathognomonic.
J waves may be seen in a number of other conditions:
Normal variant
Hypercalcaemia
Medications
Neurological insults such as intracranial hypertension, severe head injury and subarachnoid haemorrhage
Le syndrome d’Haïssaguerre (idiopathic VF)

80
Q

Vesicular rash patterns are seen in ,

A

VZV, HSV and enteroviruses

81
Q

maculopapular pattern

A

EBV causes a after ampicillin,

82
Q

Lyme disease skin change

A

erythema migrans

83
Q

erythema nodosum

A

TB

84
Q

Porphyria Px

A

abdominal pain, peripheral motor neuropathy, mental symptoms like confusion

…trigger by the use of certain drugs which are known to provoke AIP attacks. In reality, the list of drugs is pretty vast and include most CYP450 inducers, but in EMQs, alcohol and the OCP are common

85
Q

inflammed bulging tympanic membrane with decreased mobility. The membrane may be pink, red, yellow or white.

A

otitis media

Complications can include the facial weakness CNVII palsy, and perforation of the eardrum, mastoiditis and sigmoid sinus thrombosis.

86
Q

Ramsay Hunt syndrome

A

reactivation of VZV in geniculate gaglion –> CNVII palsy due to herpes zoster

87
Q

ear pain and an erythematous vesicular rash in the ear canal and on the hard palate

A

VZV causing Ramsy Hunt Syndrome

88
Q

Conditions which predispose to aneurysm formation and SAH include

A

adult PKD, Marfan’s, NF1 and Ehlers-Danlos

Cerebral angiography can confirm the presence of aneurysms. The patient should be stabilised and this followed by surgical clipping or endovascular coil embolisation, the choice is subject to much current controversy sparked by relatively recent research. Complications can commonly occur and include rebleeding, hydrocephalus and vasospasm.

89
Q

Trigeminal neuralgia is common in what?

What is its treatment?

A

Common in MS

antiepileptics such as carbamazepine

90
Q

Acute glaucoma px

A

change in vision with other severe acute symptoms such as eye pain, headache and N&V

Ix: large optic disc cup

91
Q

Seizures Ix

A

EEG

92
Q

Hypos in unconcious pts

A
  • IV dextrose

- only do IM glucagon if IV access cannot be established

93
Q

maculopapular rash and the parotitis

A

mumps

children not vaccinated against mumps and measles are at risk of mumps or measles encephalitis, and there is also a risk of subacute sclerosing panencephalitis from measles.

94
Q
  • Unilateral field loss (blindness due to trauma to eye, bloody supply or optic nerve)
  • Central scotoma (macular degeneration, vascular lesion, bilateral -toxins
  • Bitemporal hemianopia (damage to centre of optic chiasm - pituitary tumour, craniopharyngioma, suprasellar meningioma)
  • Binasal hemianopia (rare)
  • Homonymous hemianopia (stroke, macular sparing - optic radiation lesion, no macular sparing optic tract lesion)
  • Homonymous quadrantanopia (upper - temporal lobe lesion, lower- parietal lobe lesion)
  • Tunnel vision (glaucoma, retinal damage, papilloedema)
A

xxx

95
Q

• Unilateral field loss

A

(blindness due to trauma to eye, bloody supply or optic nerve)

96
Q

• Bitemporal hemianopia

A

(damage to centre of optic chiasm - pituitary tumour, craniopharyngioma, suprasellar meningioma)

97
Q

• Homonymous hemianopia

A

(stroke, macular sparing - optic radiation lesion, no macular sparing optic tract lesion)

98
Q

• Homonymous hemianopia

A

stroke
macular sparing - optic radiation lesion
no macular sparing optic tract lesion)

99
Q

•Tunnel vision

A

(glaucoma, retinal damage, papilloedema)

100
Q

Antistreptolysin O Titer

A

The ASO test is primarily used to help determine whether a recent strep infection with group A Streptococcus:
•Is the cause of a person’s or glomerulonephritis, a form of kidney disease
•Caused rheumatic fever in a person with signs and symptoms

101
Q

Complication of mumps parotitis

A

epidydimo orchitis

Mumps can also cause an aseptic meningitis, oophoritis in women and uncommonly, mastitis, encephalitis and SN deafness.

102
Q

RFs for testicular cancer

A

cryptorchidism and FH

103
Q

Beta-hCG is raised in

A

seminomas and teratomas

104
Q

AFP is raised in

A

teratomas only (more common in 20-30s wherease seminomas are more common 30 plus)

105
Q

cannot be differentiated from the testicle

A

hydrocele -The mass can also increase in size with increased intra-abdominal pressure (such as coughing, crying or raising the arms) which causes peritoneal fluid to move into the scrotal sac. This causes the mass to vary in size during the day (smaller after lying down).

106
Q

A history of undescended testes is a major risk factor as is the bell clapper deformit

A

RF for torsion

107
Q
  • Painless swelling of testes
  • Differentiated from testicle
  • transilluminates
A

Epididymal cyst

108
Q

Urinalysis: pigmented, muddy brown granular casts

A

ATN - urinalysis centrifuge is diagnostic

109
Q

Gleason score

A

Prostate cancer grading

110
Q

Testicular mass which varies in size over the day (smaller after lying down)

A

Hydrocele–> Surgery is only performed if the hydrocele is problematic

111
Q

Abx in UTIs

A

co-trimoxazole or nitrofurantoin. If there is resistance, a quinolone can be considered such as ciprofloxacin.

112
Q

Blood at end of the stream

A

bladder calculus

113
Q

Bladder calculus Px

A
  • pain on standing and difficulty urinating –> calculus blocks the bladder outflow.
  • Blood at the end of the stream
  • suprapubic pain, haematuria and obstructive symptoms.
  • Ix urinalysis. A non-contrast CT abdomen is also indicated to look for the stone.
114
Q

large painless bladder and overflow incontinence at night and a raised creatinine level

A

hydronephrosis (due to bph )

115
Q

-blood at the start of voiding and then the urine became clearer as continue to void.
-hypertensive.
DRE: reveals a smooth enlarged prostate gland.

A

Prostatic varices

A varix is an abnormally dilated vein which is prone to rupture and haemorrhage.

116
Q

Causes of urinary retention

A
  • renal failure
  • UTI
  • mets, spinal chord compression
  • obstruction
  • constipation
117
Q

Hormonal Tx for Prostate cancer

A
  1. anti androgens (start with this to block peripheral receptors)
  2. LHRH agonist
118
Q

Causes of hypothyroidism

A
  1. Iodine deficiency
  2. Hashimotos
  3. secondary or tertiary hypothyroidism
  4. viral
119
Q

Wound refusing to heal

A

high cortisol

120
Q

small cell lung cancer on cortisol and ACTH

A

increased ACTH

increased cortisol

121
Q

steroids on ACTH and cortisol

A

steroids supress ACTH and hence also decrease cortisol

122
Q

peripheral neuropathy pain management

A

pregabalin and gabapentin

123
Q

Non DM causes of hypoglycaemia include

A

insulinomas, alcohol, liver failure and Addison’s disease

124
Q

carpal tunnel symptoms

A

Symptoms include numbness/tingling of the thumb and radial fingers, an aching wrist and clumsiness (especially with fine motor tasks). The symptoms are of gradual onset and often wake the patient up at night, and is relieved by shaking the wrist.

125
Q

carpal tunnel Ix

A

EMG

126
Q

carpal tunnel tests

A

Tinel’s test

phalen’s test

127
Q

carpal tunnel causes

A

inflammation, arthriris, tensonsynovtis, old fractures

128
Q

Zenker’s diverticulum

A

pharengeal pouch

A pharyngeal pouch can cause symptoms of dysphagia and the sensation of a lump in the neck. There may also be regurgitation of food, cough, halitosis and gurgling noises and the condition is associated with webs. Additionally, it may be asymptomatic. A barium swallow will confirm the dagnosis. Surgical intervetion may be necessary.

129
Q

parotitis and epidymo-orchitis togeather

A

mumps

130
Q

dexamethasone suppression test

A

Cushings

131
Q

Cushings Test

A

Dexamethasone suppression test

132
Q 
Addisons - levels of: 
Aldosterone 
ACTH 
NA 
K
A 
Addisons - levels of: 
Aldosterone - low
ACTH - high 
NA - low 
K - high
133
Q

Addisons Test

A

ACTH stimulation test (synacthen test)
serum cortisol remains low despite the administration of synthetic ACTH. In an emergency, treatment should not be delayed by diagnostic testing.

134
Q

Amiodarone can cause both hyperthyroidism (Jod-Basedow effect) and hypothyroidism (Wolff-Chaikoff effect). Amiodarone is 37.3% iodine by weight and is structurally similar to thyroxine.

A

xx

135
Q

TrOusseau’s sign

ChvOstek’s sign

A

hypOcalcaemia

136
Q

Orphan Annie’ eyes and psammoma bodies.

A

Papillary thyroid cancer

137
Q

Pernicious Anaemia Tests

A

Serum B12 levels are useful and APC (anti-parietal cell antibody) can determine whether pernicious anaemia is the cause (but note APC can also be elevated in atrophic gastritis). IF antibody is highly specific for PA but lacks sensitivity compared to APC. Treatment involves supplementation.
-Dont forget Schillings Test

138
Q

fever, pharyngitis and lymphadenopathy.

A

EBV, infectious mononucleosis –> Kissing disease

139
Q

heterophile antibodies using the Paul Bunnell monospot.

atypical lymphocytes

A

infectious mononucleosis

140
Q

pituitary adenoma secreting ACTH (i.e. Cushing’s disease) first line Tx

A

Surgery

141
Q

Nephrogenic diabetes insipidus

A

fluids, salt restriction and thaizide diuretics (paradoxically).

142
Q

RF for nephrogenic diabetes insipidus

A

FH
lithium use
CKD
chronic hypercalcaemia or hypokalaemia.

143
Q

green nipple discharge

A

duct ectasia

144
Q

fast growing fibroepithelial mass in the breast

A

Phylloids Tumor

145
Q

gynaecomastia inducing drugs

A
  • reduce testosterone synthesis (GnRH agonists, cancer drugs, ketoconazole, metronidazole, spironolactone),
  • impair the action of testosterone (spironolactone again, finasteride, H2 blockers, PPIs)
  • act via oestrogen (digoxin, PHT, anabolic steroids).
146
Q

cold abscess with skin changes

A

TB

147
Q

activated charcoal does not adsorb what

A

lithium

148
Q

aspirin overdose Tx

A

The mainstay of treatment is alkaline diuresis induced by an infusion of sodium bicarbonate. In cases of severe poisoning, it is still started as a bridge to haemodialysis.

149
Q

Vitamin B12 deficency not corrected by intrinsic factor

A

Coeliac

150
Q

JAK2V617 mutation

A

polycythemia rubera vera
There is a clear link between Budd-Chiari syndrome and subsequent PRV. Treatment is with venesection. Around 30% will go on to develop myelofibrosis.

151
Q

monoclonal plasma cells in the bone marrow

A

myeloma

152
Q

Acute myeloid leukaemia

A

Auer rods

153
Q

‘owl’s eye’

orphan annie eyes

A

Hodgkin’s lymphoma

Papillary thyroid cancer

154
Q

warm-type AIHA and there is peripheral blood lymphocytosis.

A

CLL

155
Q

Leukaemia associated with Downs

A

ALL

156
Q

he most common cause of a hypovolaemic hyponatraemia.

A

thiazide diuretics these are NOT potassium sparing

157
Q

potassium sparing diuretics

A

aldosterone antagonists

158
Q

beta blocker’s effect on potassium

A

cause hyperkalaemia

159
Q

new onset osteopenia

A

hypercalacemia

160
Q
  • skull deformities, resulting from increased bone resorption, formation and remodelling which characterise this chronic disorder
  • most patients are asymptomatic but features such as deafness can occur due to skull remodelling. This affects CNVIII, and can be accompanied by facial pain.
  • The patient here also has high-output heart failure, due to the high blood flow to metabolically active bone sites.
A

Paget’s disease

161
Q

Low calcium, Low phosphate, High PTH, High ALP

A

Osteomalacia

162
Q

High calcium, Low phosphate, Normal PTH, High ALP

A

primary hyper PTH

163
Q

Normal calcium, Normal phosphate, High PTH, Very high ALP

A

pagets disease

164
Q

High calcium, Normal phosphate, Slightly low PTH , High ALP

A

hypercalcaemia of malignancy

165
Q

Normal calcium, Normal phosphate, Normal PTH, Normal ALP

A

osteoporosis

166
Q

What confirms diagnosis is Paget’s disease?

A

Bone biopsy (but this is rarely done)

167
Q

blue colour of the sclera

A

type I osteogenesis imperfecta which is characterised by the blue colour of the sclera which is due to the choroidal veins showing through as the sclera is thinner than normal. The cause of this is defective type I collagen formation. The bones fracture easily without any major trauma. It is a genetic disorder which is classically autosomal dominant and warrants referral to a geneticist as a result.

168
Q

seronegative HLA-B27

A

ankylosing spondlytis
psoriatic arthritis
enteropathic arthritis
reactive arthritis

169
Q

erythromycin side effect

A

Nausea and vomiting

170
Q

Tricyclic antidepressants e.g amitriptyline, imipramine side effect

A

constipation and dry mouth

171
Q

Criteria for CHF

A

Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.

Major criteria:
· Paroxysmal nocturnal dyspnea
· Neck vein distention
· Rales
· Radiographic cardiomegaly (increasing heart size on chest radiography)
· Acute pulmonary edema
· S3 gallop
· Increased central venous pressure (>16 cm H2O at right atrium)
· Hepatojugular reflux
· Weight loss >4.5 kg in 5 days in response to treatment

Minor criteria:
· Bilateral ankle edema
· Nocturnal cough
· Dyspnea on ordinary exertion
· Hepatomegaly
· Pleural effusion
· Decrease in vital capacity by one third from maximum recorded
· Tachycardia (heart rate>120 beats/min.)
Minor criteria are acceptable only if they can not be attributed to another medical condition (such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).

The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.

172
Q

SAH immediate management

A

CCB nimodipine, reduces spasm of cerebral artery

173
Q

thumb printing in barium enema

A

ischemic colitis

174
Q

CREST symptoms in scleroderma

A 
calcinosis 
raynauds 
oesophageal dismotility 
sclerodactyly 
telangactasia
175
Q

Common cause of bowel obstruction:

  • small bowel
  • large bowel
A
  • small bowel: adhesions and hernias –> pain is more colicky in nature
  • large bowel: hernias, fecal impaction and tumors
  • paralytic ileum usually occurs after surgery
176
Q

Nelsons syndrome

A

A rare disorder and occurs in patients who have had both adrenal glands removed owing to Cushing’s disease.[1] During the disorder the patient develops macroadenomas that secrete adrenocoticotropic hormone (ACTH).[2]

177
Q

pleomorphic adenoma

A

benign tutor of salivary glands

178
Q

cafe un lait spots

autosomal dominant

A

neuroofibroma

179
Q

cough impulse on examination of hernias

A

reducible

180
Q

incarenated hernia

A

not reducible

181
Q

hernia more commonly to be strangulated

A

femoral

182
Q

Multiple ulcers in different sites

A

gastrinoma

zollinger ellison syndrome

183
Q

villous adenomas can cause

A

diarrhoea and hypokalaemia (muscle weakness, myalgia and arrhythmia)

184
Q

Boerhave syndrome triad

A

subcutaenous emphysema
lower thoracic pain
vomiting

185
Q

trimethoprim

A

UTIs ABx

186
Q

Abdominal Aorta Aneurysm

  • diagnosis limit
  • follow up every 3 months
  • elective intervention
A
  • diagnosis limit = >3cm
  • follow up every 3 months = 4-5.5cm
  • elective intervention = >5.5cm

Resp (13 decks)

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