Core Presentations

Question 1

What are your differentials for Chest pain:

Answer 1

M.I

• central chest pain
• radiates to left arm
• crushing

Pleuritic chest pain

• sharp
• localised
• pneumonia

Pericarditis
- Central pain worse on breathing in and leaning back

GORD

• Burning
• dyspepsia

Cholecystitis

Question 2

What will the Central ScvO2 be during cardio/ hypovolemic shock and how does this differ to sepsis or anaphylaxis?

Answer 2

Much lower than normal, due to increased extraction of oxygen as flow is impeded.
- oxygen extraction exceeds delivery

Sepsis may be reduced as oxygen simply can’t extracted as easily.

Question 3

Differentials for cough:

Answer 3

URTI 
COPD 
Bronchiectasis 
Lung cancer 
Interstitial disease 
GORD 
LEft ventricular heart failure

Question 4

Common causes of haemoptysis:

Answer 4

Bronchitis 
Pneumonia 
Bronchial carcinoma 
Pneumonia 
Bronchiectasis 
Left heart failure

Question 5

List some causes of acute and chronic breathlessness:

Answer 5

Acute:

• P.E
• Pneumothorax
• Asthma attack
• Metabolic acidosis
• Pneumonia
• Anxiety

Chronic:

• COPD
• Lung cancer
• Interstitial lung disease
• Anaemia
• Chronic heat failure

Question 6

What investigations do you want into a chronic cough? >6 weeks

Answer 6

CXR
Spirometry
CT
24 hour pH monitoring

Question 7

What are some differentials for weight loss:

Answer 7

Malignancy

G.I disease:

• Crohn’s
• Coeliac

Biliary tract disease

• Chronic pancreatitis
• chronic obstruction

Endocrine disease:

• Thyrotoxicosis
• Diabetes

Chronic inflammation

• vasculitis
• RA

Alcohol abuse

Question 8

What are some causes of constipation:

Answer 8

Low fibre

In activity

Drugs
- Opioids

Colorectal cancer

Hypercalcaemia

Hypothyroidism

Question 9

What are your immediate investigation into acute diarrhea:

Answer 9

Bloods:

• FBC
• CRP

Orifices:

• Stool Culture
• C.Diff toxin

X-ray:
- Abdominal x-ray

Question 10

What investigations are wanted into chronic diarrhea?

Answer 10

Bloods:

• FBC
• ESR
• LFTs - albumin level
• TFTs
• Coeliac screen

Orifices:

• stool cultures, microscopy
• Ova eggs and parasites
• Faecal elastase

X-rays:

• AXR
• Endoscopy
• Colonoscopy

Question 11

What investigations do you want in a large PR bleed?

Answer 11

Bloods:

• FBC
• U&Es - urea level
• Coagulation studies
• Cross match

Orifices:
- flexible sigmoidoscope

X-rays:

• Mesenteric Angiography
• Abdominal x-ray - may show inflammation

Question 12

Investigations into dyspepsia:

Answer 12

Bloods:

• FBC
• ESR
• U&Es

Orifices:

• Endoscopy
• 24 hour pH monitoring

X-rays:
- barium swallow

Special tests:
- H.Pylori testing

Question 13

In transudate causes of ascites, what other signs may be seen?

Answer 13

Peripheral oedema
Raised JVP
Pleural effusions

Question 14

What is the definition of polyuria?

Answer 14

> 3L a day

Question 15

Causes for polyuria:

Answer 15

Diabetes mellitus

Polydipsia

Hypercalcaemia

Diabetes insipidus

Diuretic use

Question 16

What are some differentials for sweating and anxiety state:

Answer 16

Anxiety

Thyrotoxicosis

Pheochromocytoma

Tachyarrhythmias

Lymphoma
- night sweats

Question 17

What are the most common causes of a fever of unknown origin?

Answer 17

Abscess
Endocarditis

Lymphoma
Solid tumours

Vasculitis

Question 18

Key question to ask in a fever of returning traveler?

Answer 18

Duration and nature of symptoms?

Countries visited?

When were they visited?

Activities?
- water contact

Sexual contact?

Anti-malarial prophylaxis?

Question 19

What are some causes of a fever in a returning traveler?

Answer 19

Malaria 
Hepatitis 
Leptospirosis 
Typhoid 
Dengue fever

Question 20

What key investigations should be done in a patient with a fever that has recently returned from traveling?

Answer 20

Malarial thick films

Blood cultures

FBC
- look for eosinophilia - schistosomiasis, liver flukes

HIV test

Serology

Question 21

In new onset back pain in a >55 year old or <20 year old what investigations do you want to do?

Answer 21

Bloods:

• FBC - WCC?
• ERS/ CRP
• Bone profile - Ca2+/ Alk phos
• Protein electrophoresis
• Blood cultures

Orifices:
- electrophoresis

X-rays

• spinal x-ray
• MRI

Question 22

What are some causes of pruritus:

Answer 22

Primary skin conditions:

• Eczema
• Dermatitis herpetiformis
• Angioedema

Drugs:

• Opioids
• ACE inhibitors

Systemic disease:

• Anaemia
• Leukemia
• Polycythemia vera `

Question 23

What are some causes for constipation:

Answer 23

Medical:
- Opioids

Low fibre diet

Hypercalcemia

Hypokalemia

Autonomic dysfunction

Poor mobility