Clinical Cases

Question 1

how do you define an aneurysm?

Answer 1

• bulging of artery that causes it to enlarge
• 1.5x

Question 2

what causes an aneurysm? (4)

Answer 2

• cardiovascular disease
• atherosclerosis
• smoking
• trauma

Question 3

why do AAAs normally appear at the bottom of the aorta and not higher up?

Answer 3

find it coincidentally

Question 4

at which vertebral level would you palpate to examine the aortic pulse?

Answer 4

• L1-L5 but it bifurcates at L2

Question 5

what is atherosclerosis?

Answer 5

narrowing of artery due to plaque

Question 6

what are the main risk factors of atherosclerosis? (2)

Answer 6

• smoking
• high fat diet

Question 7

what causes chest pain in atherosclerosis?

Answer 7

angina caused by reduced blood flow to the heart

Question 8

what are healthy levels of cholesterol?

Answer 8

• 5mmol/L or less
• under 200mg

Question 9

how might a myocardial infarction occur?

Answer 9

when blood can’t flow to the heart

Question 10

what is the most common method of coronary artery bypass?

Answer 10

• coronary artery bypass graft (CABG)
• then stent

Question 11

it is harder to diagnose pneumonia in elderly individuals compared to those under 65, why is this?

Answer 11

symptoms may differ

Question 12

why is pneumonia particularly concerning in older adults?

Answer 12

comorbidities lead to weakened immune systems

Question 13

how does covid-19 develop in a patient?

Answer 13

• immune system attacks an infection of the SARS-CoV-2 virus in lungs
• alveoli swell
• leaks fluids

Question 14

how is pneumonia treated?

Answer 14

• antibiotics, oxygen

Question 15

what is a pneumothorax?

Answer 15

• collapsed lung
• air fulls pleural space

Question 16

what is the difference between a tension pneumothorax and a spontaneous pneumothorax?

Answer 16

• tension - caused from penetrating chest trauma, more you breathe the worse it gets, can cause mediastinal shift
• spontaneous - no real cause, blebs just ruptur

Question 17

what are the common causes of a pneumothorax? (5)

Answer 17

• chest pain
• tachycardia
• history of trauma
• cyanosis
• low BP

Question 18

which lifestyle choices lead to gastric ulceration? (5)

Answer 18

• smoking
• medication
• spicy food
• stress
• alcohol

Question 19

which symptoms would be experienced after eating with a gastric ulcer vs duodenal ulcer?

Answer 19

• eating improves pain of duodenal ulcer but worsens pain of gastric ulcers

Question 20

what causes blood and ‘grit’ in vomit?

Answer 20

• ulcer bleeding
• digested blood that looks like coffee grounds

Question 21

why does a patient with gastric ulcers have to attend regular endoscopies?

Answer 21

to check the ulcer has healed

Question 22

how is a colonoscopy performed?

Answer 22

• long, thin tube with a camera on the end inserted up rectum and into stomach
• allows doctors to clearly see the inside of your colon

Question 23

what anatomical feature has been lost with a patient demonstrating a ‘lead pipe colon’?

Answer 23

Haustre

Question 24

what impact might have UC have on a patient’s life? (3)

Answer 24

• pain
• toilet more frequently
• j-pouch can lead to fertility problems

Question 25

what is a J-pouch? What else can be offered for UC?

Answer 25

- colon and rectum removed and small intestine attached to form passage and rectum - medications

Question 26

what might cause swelling in the abdomen and feet/ankles?

Answer 26

- body attempts to compensate for this pressure by diverting blood flow into other veins

Question 27

why does the skin and eyes appear yellow in cirrhosis & portal hypertension?

Answer 27

- excess bilirubin in blood

Question 28

what can portal hypertension result in?

Answer 28

- splenomegaly - caput medusae

Question 29

what is splenomegaly and caput medusae?

Answer 29

- splenomegaly- enlarged spleen - caput medusae- distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen

Question 30

what would happen if a patient continued drinking alcohol with liver cirrhosis?

Answer 30

- need a liver transplant

Question 31

what is the difference between a rectocele, cystocele and uterine prolapse?

Answer 31

- all caused by weakening of the pelvic floor muscles - rectocele - rectum protrudes into vaginal wall - cystocele - bladder drops from normal position into vaginal wall - uterine prolapse - uterus drops from normal position to vaginal wall

Question 32

what are the risks and benefits involved with a midline episiotomy? (3)

Answer 32

- less bleeding - less pain - increased risk of perineal body damage

Question 33

how does a midline episiotomy compare to a mediolateral episiotomy?

Answer 33

- medio-lateral is at a 45 angle - less risk of damage to perineal body - more painful and bleeding

Question 34

how are pelvic organ prolapses prevented and treated? (5)

Answer 34

- lifestyle changes - pelvic floor exercises - hormonal treatment - vaginal pessaries - surgery

Question 35

what is epididymitis?

Answer 35

- a tube (epididymis) at the back of the testicles become swollen and painful - caused by infection - treated with antibiotics

Question 36

what is the route of infection from the tip of the penis to the epididymis? (6)

Answer 36

- spongy urethra - membranous uretha - prostatic urethane - through hole into ejactulatory duct - vas deferent - epididymis

Question 37

why are UTI's less common in men compared to women?

Answer 37

- men have longer, thinner urethra that is further from the rectum

Question 38

what is a differential diagnosis?

Answer 38

- when symptoms match more than one condition and additional tests are necessary before making an accurate diagnosis

Question 39

how would you determine if a patient has epididymitis and not testicular torsion? (3)

Answer 39

- blood tests - bacterial culture of urine - testicular torsion is more acute onset

Question 40

what is cancer?

Answer 40

- disease caused when cells divide uncontrollably and spread into surrounding tissues

Question 41

what is the difference between radiotherapy and chemotherapy?

Answer 41

- radiotherapy is a treatment where radiation is used to kill cancer cells - chemotherapy is a cancer treatment where medicine is used to kill cancer cells

Question 42

explain why difficulty urinating is a symptom of prostate pathology

Answer 42

- you might get urinary problems if the cancer is pressing on your urethra or has spread around the prostate eg. urethra & bladder

Question 43

what is locally advanced prostate cancer?

Answer 43

- cancer that has started to break out of the prostate, or spread to the area just outside the prostate

Question 44

how does locally advanced prostate cancer differ from 'normal' prostate cancer and advanced prostate cancer?

Answer 44

- advanced cancer has spread outside the prostate to other parts eg. lymph nodes, bones, liver, lungs - normal hasn't spread yet

Question 45

what is a prostatectomy and what are the consequences?

Answer 45

- surgical procedure for the partial or complete removal of the prostate - may cause erectile dysfunction or incontinence