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Lottie's Question Books > Cases Book 2 > Flashcards

Cases Book 2 Flashcards

1
Q

RUQ pain post eating. No other Sx. Dx?

A

Symptomatic cholelithiasis

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2
Q

RUQ pain and jaundice. Dx?

A

Choledocholithiasis

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3
Q

RUQ pain, fever and Murphy’s sign positive. Dx?

A

Acute cholecystitis

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4
Q

RUQ pain, jaundice, fever. Dx?

A

Ascending cholangitis

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5
Q

RUQ pain, jaundice, fever. Name of triad?

A

Charcot’s triad

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6
Q

Which conditions have raised WCC and LFTs?

A

Acute cholecytitis

Acute cholangitis

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7
Q

What is the imaging and results for cholethiliasis?

A

USS - stone in GB

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8
Q

What is the imaging and results for choledocholithiasis?

A

USS - stones +/- dilated CBD

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9
Q

What is the imaging and results for acute cholecystitis?

A

USS - stones in GB, thick wall and dilated lumen of GB

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10
Q

What is the imaging and results for acute cholangitis?

A

USS + ERCP

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11
Q

What is the initial and definitive Mx for acute cholecystitis?

A 
1st = NBM, analgesia, fluids, IV ABx 
Def = Lap chole in a week
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12
Q

What is the initial and definitive Mx for acute cholangitis?

A 
1st = NBM, analgesia, IV ABx, IV fluid, ERCP 
Def = elective lap chole
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13
Q

List complications of acute cholecystitis

A

Empyema
Porcelain GB
GB cancer
GB ileus

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14
Q

List complications of acute cholangitis

A

CBD perforation

Sepsis

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15
Q

Name the borders of Hesselbach’s triangle

A 
Medial = lateral rectus abdominis 
Lateral = Inferior epigastric artery
Inferior = inguinal ligament
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16
Q

Where is the inguinal ligament?

A

ASIS to pubic tubercle

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17
Q

List the walls of the inguinal canal

A 
Ant = external oblique aponeurosis 
Post = transversalis fascia 
Floor = inguinal ligament 
Roof = TF, internal oblique, transversus abdominus
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18
Q

Where is the deep ring?

A

Midpoint of inguinal ligament

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19
Q

Where is superficial ring?

A

Superior to pubic tubercle

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20
Q

What is the course of an indirect inguinal hernia?

A

Deep ring –> inguinal canal –> superficial ring

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21
Q

What is the course of a direct inguinal hernia?

A

Weak posterior wall –> canal –> superficial ring

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22
Q

Which type of hernia has a cough impulse?

A

Direct

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23
Q

Name the stages of diabetic retinopathy

A
  1. Background retinopathy
  2. Preproliferative
  3. Proliferative
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24
Q

Name the features of background retinopathy

A

Hard exudates
Microaneurysms
Blot haemorrhages

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25
Q

What are hard exudates?

A

Leaked lipid from BV

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26
Q

Name the features of pre-proliferative retinopathy

A

Cotton wool spots

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27
Q

What are cotton wool spots?

A

Retinal ischaemia

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28
Q

Name the features of proliferative retinopathy

A

Formation of new BVs

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29
Q

Name the features of HTN retinopathy

A 
SAFE 
Silver wiring 
AV nipping 
Flame haemorrhages 
pailloEdema
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30
Q

Raised pearly edges, telangiectasia and central rodent ulcer. Dx?

A

BCC

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31
Q

Raised, everted edges with hyperkeratotic, ulcerating core. Sun exposed area. Dx?

A

SCC

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32
Q

What is the difference in formation of BCC and SCC?

A

BCC is in stratum basal in epidermis, SCC is in epidermis

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33
Q

What is the key prognostic difference between BCC and SCC?

A 
BCC = slow growing, no mets 
SCC = faster growing, mets
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34
Q

What is Marjolin’s ulcer?

A

SCC in chornic inflammaed area

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35
Q

Name 4 types of melanoma

A

Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous

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36
Q

What is a key feature of nodular melanoma?

A

Aggressive, not from existing naevi

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37
Q

What is a key feature of lentigo maligna?

A

Elderly, on face

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38
Q

What is a key feature of acral lentiginous?

A

In darker skinned people, on palms and soles

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39
Q

List Sx of HUS

A

TRIAD
Microangiopathic haemolytic anaemia
Acute renal failure
Thrombocytopenia

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40
Q

List causes of HUS

A 
E Coli (kids) 
OCP
Cancer 
Malignant HTN 
SLE
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41
Q

What is TTP?

A

HUS + neuro Sx + fever

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42
Q

Fever, headache, diarrhoea, dry cough, confusion. Dx?

A

atypical pneumonia

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43
Q

List 3 causes of atypical pneumonia

A

Legionella
Mycoplasma pneumoniae
Chlamydia psittaci

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44
Q

Pneumonia w birds. Dx?

A

Chlamydia psittaci

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45
Q

Pneumonia with air con and AGs in urine. Low Na. Dx?

A

Legionella

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46
Q

What is mycoplasma pneumoniae associated with?

A

Transverse myelitis
Red cell agglutination
Epidemics

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47
Q

Pneumonia in IVDU. Had flu a few weeks before. Cavitating lesion on CXR. Dx>

A

Staph aureus

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48
Q

Pneumonia in COPD patient?

A

Moraxella cattarhalis

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49
Q

1st line Tx of HTN in under 55 y/o?

A

ACEi or ARB

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50
Q

1st line Tx of HTN in black / over 55 y/o?

A

CCB

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51
Q

1st line Tx of HTN in someone with heart failure?

A

Thiazide

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52
Q

Name an ACEi

A

Ramipril

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53
Q

Name an ARB

A

Losartan

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54
Q

Name a CCB

A

Amlodipine

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55
Q

2nd line Tx of HTN ?

A

CCB + ACEi or ARB

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56
Q

What can be given if CCB not tolerated?

A

Thiazide

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57
Q

3rd line Tx of HTN ?

A

CCB + thiazide + ACEi / ARB

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58
Q

4th line Tx of HTN ?

A

Refer to specialist

Spironolactone

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59
Q

1st line Tx of HTN in DM patient?

A

ACEi

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60
Q

2nd line Tx of HTN in DM patient?

A

CCB

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61
Q

1st line Tx of HTN in preg?

A

CCB

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62
Q

What is ABx for CAP?

A

Amoxicillin & clarithromycin

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63
Q

ABx for aspiration pneumonia?

A

Metronidazole

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64
Q

ABx for C.diff infection?

A

Metronidazole

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65
Q

ABx for skin infection?

A

Flucloxacillin

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66
Q

ABx for MRSA?

A

Vancomycin

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67
Q

ABx for UTI?

A

Nitrofurentoin or trimethroprim

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68
Q

ABx for COPD exacerbation or malaria?

A

Tetracycline

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69
Q

ABx for pseudomonas?

A

Gentamicin

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70
Q

ABx for meningococcus?

A

Ceftriaxone

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71
Q

What is Addisons?

A

Primary adrenal insufficiency (AI attack of adrenals)

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72
Q

What is the blood result of Addisons?

A

LOW cortisol / aldosterone

Low Na, High K

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73
Q

Describe typical Addisons pt

A

Female, blood thinners, adrenal haemorrage

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74
Q

What AB is associated with Addisons?

A

Anti adrenocortical AB

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75
Q

PC of Addisons?

A

Fatigue, anorexia, weight loss, N&V, hyperpigmentation in palmar creases and mucosa

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76
Q

Ix for Addisons + results?

A

U&Es - low Na, high K
9am cortisol - LOW
Short synthacten test - VERY low
Serum ACTH - high

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77
Q

What is Mx of acute Addisonian crisis?

A

Fluid resus

Glucocorticoid

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78
Q

What is Mx of chronic Addisons?

A

Glucocorticoid + mineralocorticoid

79
Q

Give an example of a Glucocorticoid

A

Hydrocortisone

80
Q

Give an example of a mineralocorticoid

A

Fludrocortisone

81
Q

High HR, low BP, confused, weak. Dx?

A

Addisonian crisis

82
Q

List causes of Addisonian crises

A

Infection, trauma, surgery, missed medications

83
Q

Dome shaped, smooth firm lump with umbillicated centre. Dx?

A

Molluscum contagiosum

84
Q

How is molluscum contagiosum spread?

A

Skin or sex

85
Q

What causes molluscum contagiosum ?

86
Q

What does HBsAg show?

A

Infection with Hep B

87
Q

HBsAg +
HBcAb IgM +
HBcAb IgG +
Dx?

A

Acute infection

88
Q

HBsAg +
HBcAb IgM -
HBcAb IgG +
Dx?

A

Chronic infection

89
Q

What does HBcAb IgM + indicate?

90
Q

What does HBcAb IgG + indicate?

A

Chronic infection

91
Q

What does HBeAg + indicate?

A

Infective disease

92
Q 
HBsAg - 
HBcAb IgM -
HBcAb IgG + 
HBsAb +
Dx?
93
Q

HBsAb +

Dx?

A

Vaccinated

94
Q

Which hepatitis is DNA?

95
Q

Which hepatitis are faecal oral?

96
Q

How are hep B, C, D spread?

A

Sexual, paraenteral

97
Q

Which hepatitis is chronic?

98
Q

Which hepatitis needs another infection?

A

D (needs B)

99
Q

Which hepatitis is severe in preg?

100
Q

Which hepatitis doesn’t present with the classic Sx?

101
Q

What is the classic hepatitis presentation?

A

Jaundice, fever, malaise, anorexia, N&V, abdo pain, dark urine, pale stool

102
Q

Which hepatitis can have carriers?

103
Q

Which hepatitis can cause cirrhosis and liver cancer?

104
Q

Which hepatitis have vaccines?

105
Q

What is Mx for hep B?

A

Peginterferon a2a

106
Q

What is Mx for hep C?

A

antiviral (sufusbovir)

107
Q

What causes Conns?

A

Excess aldosterone production from adrenal glands due to ADENOMA

108
Q

Sx of Conns?

A

HTN in young person

LOW K - polyuria, polydipsia, muscle weakness, arrhytmia

109
Q

What other condition does Conns cause?

A

Diabetes insipidous

110
Q

Ix for Conns & results ?

A 
Serum K (low) 
Plasma aldosterone : renin ratio (high)
111
Q

Mx for Conns?

A

Laparascopic adrenalectomy

Spironolactone

112
Q

What are ECG features of low K?

A

U waves
ST depression
Flat T waves
Prolonged PR interval

113
Q

Name causes of CAP

A

Strep pneumoniae

H influenzae

114
Q

Name causes of HAP

A

Pseudomonas
Klebsiella
Aspiration pneumoniae

115
Q

What colour is sputum in pneumonia?

A

Yellow or green

116
Q

O/E of pneumoniae?

A 
Fever, high RR, high HR, low BP 
Decreased chest expansion on side 
Increased vocal resonance on side 
Dull to percussion on side 
Crackles / bronchial breathing
117
Q

What does CXR of pneumonia look like?

A

Lobar / patchy shadowing

118
Q

Flushed, fever, sweaty, increased RR, tinnitus, deafness. Dx?

A

Aspirin OD

119
Q

Mild N&V, fatigue –> RUQ pain and vomitting –> encephalopathy and jaundice. Dx?

A

Paracetamol OD

120
Q

Tx for paracetamol OD?

A

N acetyl cysteine

121
Q

Constricted pin point pupils, low RR, drowsy, constipated. Dx?

122
Q

Tx for opioid OD?

123
Q

Back pain, worse in morning and better with exercise. Insidious onset in <40s. Dx?

124
Q

What are extra articular features of ank spon?

A 
5As 
apical lung fibrosis 
amyloidosis 
anterior uveitis 
achilles tendinitis
aortic regurg
125
Q

What is seen O/E of ank spon?

A

Loss of lumbar lordosis

Kyphosis

126
Q

What is the test for ank spon?

A

Schobers test

127
Q

What will XR of ank spon show?

A

Bamboo spine

128
Q

Cannon A wave in JVP?

A

Complete heart block

129
Q

Large V wave in JVP?

A

Tricuspid regurg

130
Q

Cause of Kussmaul’s sign in JVP?

A

Constrictive pericarditis

131
Q

What is Kussmaul’s sign?

A

paradoxical rise in JVP on inspiration

132
Q

Absent pulsation in raised JVP?

A

SVC obstruction

133
Q

Slow Y descent in JVP?

A

Tricuspid stenosis

134
Q

3 causes of raised JVP?

A

Constrictive pericarditis
TR
Right heart failure

135
Q

Which type of leukaemia has smear / smudge cells?

136
Q

Which type of leukaemia has auer rods?

137
Q

Which type of leukaemia has massive splenomegaly?

138
Q

Which type of leukaemia affects children mainly?

139
Q

Which type of leukaemia has philadelphia chromosome?

140
Q

What is the philadelphia chromosome?

141
Q

Which type of leukaemia has faggot cells?

A

Acute promyeoltic leukaemia

142
Q

Which type of leukaemia is most common in adults?

143
Q

List risk of AML

A

Old age, Downs, chemo, radio

144
Q

List risks of ALL

A

Young age, genetics, radiation, influenza

145
Q

Is chronic leukaemia more common in men or women?

146
Q

List BM failure Sx

A

Pallor, bleeds, infection

147
Q

List raised BMR Sx

A

Weight loss, sweating, malaise

148
Q

List hyper-viscosity Sx

A

Thromboses, headache

149
Q

Which leukaemia stain with Sudan black?

150
Q

Which leukaemia often has no Sx?

151
Q

What causes oesophageal varices?

A

Portal HTN

152
Q

List the biggest risk of oesophageal varices in Europe vs world

A 
Europe = alcoholic liver disease 
World = Hep B/C
153
Q

Immediate Mx of oesophageal varices?

A

Blood transfusion if Hb <6
IV terlipressin and ABx
Emergency OGD
+/- Sengstaken-Blakemore tube

154
Q

What is long term Mx of varices?

A

Band ligation and beta blockers

155
Q

What is myelodysplasia?

A

Clonal stem cell disorder characteristed by ineffective haematopoeisis resulting in cytopenias

156
Q

Who does myelodysplasia effect?

157
Q

Sx of myelodysplasia?

A

None

Fatigue, reduced ETT, pallor, petechiae, infections

158
Q

What is blood film result of myelodysplasia?

A

Ringed sideroblasts

Low or normal reticulocyte count

159
Q

Why is myelodysplasia so worrying?

A

Can develop into AML

160
Q

Does myelodysplasia have splenomegaly?

161
Q

Is sickle recessive or dominant?

162
Q

WHat is the defect in sickle?

A

Defective beta Hb resulting in HbS

163
Q

Acute chest syndrome, pripiasm in known sickle. Dx?

A

Sequestration crisis

164
Q

Myalgia, painful hands and feet in known sickle. Dx?

A

Painful crisis

165
Q

When does sickle present?

A

> 4 months old

166
Q

Why does sickle present after 4 months old?

A

This is when HbF is swapped to normal Hb

167
Q

Ix for sickle?

A

FBC, U&Es
Blood film
Sickle solubility test
Hb electrophoresis

168
Q

What would blood film show in sickle?

A

Sickled cells

Howell Jolly bodies (hyposplenism)

169
Q

Mx of sickle crisis?

A

O2, fluids, opiates, ABx

170
Q

Prophylaxis of sickle?

A

Penecillin and folic acid
Hydroyurea
Maybe transfusion

171
Q

List complications of sickle

A 
Avascular necrosis 
Aplastic crisis 
Gallstones, cholecystitis 
Leg ulcers 
Cardiomyopathy
172
Q

What causes aplastic crisis in sickle?

A

B19 Parvovirus

173
Q

Shoulder and pelvic girdle pain and stiffness.

Worse in morning and when brushing hair or standing from sitting. Dx?

A

Polymyalgia rheumatica

174
Q

Associations / risks of developing PMR?

A

GCA, female, over 50

175
Q

Ix for PMR and results?

A

ESR and CRP - raised

USS - bursitis

176
Q

Mx of PMR?

A

Oral pred within 72hrs
Ca, Vit D, bisphosphonate supplements
NSAIDs

177
Q

What is heart block?

A

Impairment of AVN impulse conduction, represented by PR interval

178
Q

What is type 1 HB?

A

Prolonged PR

179
Q

What is type 2.1 HB?

A

Progressive prolongation of PR until 1 dropped then cycle repeats

180
Q

What is type 2.2 HB?

A

P often not followed by QRS

181
Q

What is type 3 HB?

A

No relationship between p and QRS

182
Q

List causes of HB

A 
MI or IHD !!
Infection - IE, rheumatic fever 
Drugs - CCB, beta blockers 
Metabolic - hyperkalaemia, hypothermia 
Sarcoid, amyloid
183
Q

What are the Sx of 1st and 2.1 HB ?

184
Q

What are Sx of 2.2 and 3rd HB?

A

Chest pain, dizziness, palpitations

185
Q

What is Stokes Adams attack?

A

Syncope due to ventricular asystole

186
Q

What will you find O/E peripherally in HB?

A

Slow, large volume pulse

JVP cannon A waves

187
Q

Ix for HB?

A

ECG !!

CXR, cardiac enzymes, echo

188
Q

Mx for acute HB?

A

IV atropine +/- external pacemaker

189
Q

Mx for chronic HB?

A

Permenant pacemaker

190
Q

List causes of microcytic anaemia (5)

A 
Iron deficiency 
Thalassaemia 
Lead poisoning 
Anaemia of chronic disease 
Sideroblastic (X linked / drugs / alcohol / myelodysplasia)
191
Q

List causes of normocytic anaemia (6)

A 
Anaemia of chronic disease 
Haemolytic anaemia 
Hypothyroidism 
Pregnancy 
Renal failure 
Bone marrow failure
192
Q

List causes of macrocytic anaemia (8)

A 
Alcohol 
Low B12 
Low folate 
Hypothyroid 
Myelodysplasia 
Liver disease 
Haemolytic anaemia 
Drugs
193
Q

List causes of hereditary haemolytic anaemia (6)

A 
Sickle cell 
Thalassaemia 
Spherocytosis 
Elliptocytosis 
Pyruvate kinase deficiecny 
G6PD deficiency
194
Q

List causes of acquired haemolytic anaemia (9)

A 
AI
Transfusion reaction 
Penecillin 
TTP, HUS, DIC
Artificial heart valve 
Liver /renal disease

Lottie's Question Books (15 decks)

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