Corrections 4 Flashcards
Impact of dopamine on the kidneys?
Dopamine is a renal artery vasodilator –> increased renal blood flow.
What are the 4 cardinal signs of suppurative flexor tenosynovitis?
1) flexed posture
2) fusiform swelling
3) pain on passive extension
4) flexor sheath tenderness
Why can newborns not produce their own vitamin K?
Due to a lack of GI bacteria flora –> most vit K is produced from metabolism by intestinal bacteria that colonise after birth.
What ist he diagnostic criteria for nephrotic syndrome?
1) Proteinuria: >3g/24h
2) Hypoalbuminaemia: <25g/L
3) Oedema
What is a pseudofracture?
A diagnostic finding in osteomalacia.
It is a band of decreased bone density that appears on an X-ray as if it were a fracture
Which artery supplies the sigmoid colon?
IMA
Foregut, midgut & hindgut?
Foregut: from the oral cavity to the first part of the duodenum
Midgut: from the mid-duodenum to the first two-thirds of the transverse colon
Hindgut: distal one-third transverse colon to the upper portion of the anus.
2 key causes of hypogonadism and delayed pubertal development in males?
1) Klinefelter’s
2) Kallman’s
How to differentiate between Klinefelter’s & Kallman’s?
Karyotyping:
Klinefelter’s –> 47 XXY
Kallman’s –> 46 XY (assess smell)
Karyotype of a normal male?
46 XY
Karyotype of a normal female?
46 XX
In a patient with hypoglycaemia, which test would help to differentiate between insulinoma and exogenous insulin administration?
Serum C peptide
Levels will be LOW in exogenous insulin (this is because synthetic insulin usually doesn’t contain C-peptide).
Levles will be HIGH in an insulinoma.
What level doesthe carotid artery bifurcate?
C4
Mx of patients with suspected renal artery stenosis?
Refer to renal services for further investigation
In the pancreas, what is the role of the delta cells?
Produce somatostatin
What is pulsus alterans?
a physical finding characterised by a regular alternation of the force of the arterial pulse.
What does pulsus alterans indicate?
The presence of severe LV systolic dysfunction
What is the mechanism of resistance for penicillin resistant Streptococcus pneumoniae?
Alteration of penicillin binding proteins –> these enzymes are required for cell wall synthesis
Mechanism of penicillin?
Acts by inhibiting cell wall synthesis.
Gardner’s syndrome is a hereditary dominant condition that comprises what?
Colonic polyposis, multiple osteomas, cutaneous and soft tissue tumours
CKD?Why is alfacalcidol (vit D) indicated in CKD?
Does not require activation by the kidneys
Mx of pre-tibial lacerations:
a) in young patients
b) in elderly patients with thin skin, or those on warfarin or steroids the skin
a) suture
b) clean & steri-stip (skin is often too fragile to suture)
What is myxoedema?
A term that can refer to a severe thyroid hormone deficiency or a skin condition that can occur in hypothyroidism.
Results in myxoedematous facies (coarse facial features and periorbital puffiness), and congestive cardiac failure.
In patients on dialysis who get muscle cramps, what can this indicate?
Too much fluid is being removed –> hypoperfusion of muscles
What is the most effective measure at reduce CVS risk?
Smoking cessation
What does thumbprinting on AXR indicate?
Large bowel wall thickening, usually caused by inflammation or infection.
The normal haustra of the bowel thicken at regular intervals, appearing like thumbprints in the bowel lumen.
Causes of thumbprinting?
- UC
- Crohn’s
- Pseudomembranous colitis
- Ischaemic colitis
- Diverticulitis
What does 1 fingertip unit of steroid cream cover?
Covers the area of two adult hands.
Define 1 fingertip unit
The distance from the tip of the adult index finger to the first crease
esophoria vs esotropia?
Esotropia and esophoria are both conditions that cause the eye to drift inward, but they differ in the following ways:
- Esotropia is usually constantly present, while esophoria only happens to an eye when you cover it.
- Esotropia is a visible inward deviation of one or both eyes, while esophoria is only visible when testing eye position and breaking fusion.
What is a key predisposing factor for a solitary rectal ulcer?
Chronic constipation & straining
What investigation is required in a solitary rectal ulcer?
Biopsy –> need to exclude malignancy
TFTs in sick euthyroid?
Low T3/T4 with normal TSH
PR interval in HYPOkalaemia?
Prolonged
QT interval in HYPOkalaemia?
Long
In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT
Where are inhaled foreign obejcts most likely to be found?
R main bronchus
From there, they usually pass into the inferior or middle lobe bronchi
Features of avascular necrosis of the femoral head?
- longstanding hip pain
- pain exacerbated by weight-bearing
- limited active and passive range of movement
- pain upon adbuction and internal rotation
What XR sign is pathognomonic of avascular necrosis of the femoral head?
Crescent sign
This is due to the subchondral bone, which is the layer of bone just beneath the cartilage that covers the femoral head, collapses or erodes.
Mx of a witnessed cardiac arrest whilst on a monitor?
Give up to 3 successive shocks before CPR
Which NSAID can be continued in an AKI?
Low dose asirin (cardioprotective)
What is the major complication of carbimazole?
Agranulocytosis
What is seen on a fundoscopy in temporal arteritis with visual involvement?
Anterior ischemic optic neuropathy - fundoscopy typically shows a swollen pale disc and blurred margins
Stature in children with Turner’s syndrome?
Typically have short stature –> may require GH therapy
Give 4 indications for GH therapy
1) proven GH deficiency
2) Turner’s syndrome
3) Prader-Willi syndrome
4) chronic renal insufficiency before puberty
What is the most common complication of mumps in post-pubertal males?
Orchitis
Complications of mumps?
1) orchitis (post-pubertal)
2) hearing loss: usually unilateral and transient
3) meningoencephalitis
4) pancreatitis
Contraception in women who menopause:
a) <50 y/o
b) >50 y/o
a) require contraception for at least 2 years after their last LMP
b) require contraception for at least 1 year after their LMP
Features of myocarditis?
Patients are often <50 y/o and have a history of a recent viral illness.
- chest pain
- acute pulmonary oedema (can manifest as new onset congestive heart failure)
- ST elevation
- raised troponin
raised inflammatory markers
5 examples of live attenuated vaccines?
- oral polio
- BCG
- MMR
- yellow fever
- oral typhoid
Role of urodynamic studies?
Can help ascertain whether the patient’s incontinence is due to stress, urge, or mixed incontinence.
Whilst using an inhaler, how long should you ideally hold your breath for after pressing down on the canister?
10 seconds
Filling of telangiectasia vs spider naevi?
Spider naevi fill rapidly from the center, while telangiectasia fill slowly and lack a central vessel.
Role of cholestyramine?
Binds to bile acids in the small intestine and promotes their reabsorption into the cycle of bile aacid production.
How can a cholecysectomy lead to diarrhoea?
This disturbs the usual cycle of bile release and bile acid reabsorption.
This results in too much bile progressing to the large intestine, where it causes more water and salts to be lost in the stool and a faster transit time of stool through the intestines.
What is the most common type of Salter-Harris fracture?
Type II
What is the correct dose of 1 in 1,000 intramuscular adrenaline to treat a 5 y/o?
150mcg (0.15ml; 1:1000)
In ALS, what can be used instead of amiodarone?
Lidocaine
What are syndesmophytes?
Ossification of outer fibres of annulus fibrosus –> a feature of ankylosing spondylitis.
Location of lung fibrosis in AS?
Upper zone
What is the most common type of distal radius fracture?
Colle’s fracture
Describe a Colle’s fracture
A fracture of the distal radius along the metaphysis with no articular involvement.
There is dorsal displacement of fragments.
What nerve may be injured in a Colle’s fracture?
Median nerve
Presentation of median nerve injury in Colle’s fracture?
Acute carpal tunnel syndrome presenting with weakness or loss of thumb or index finger flexion
Dinner fork deformity
Early complications of Colle’s fracture?
1) median nerve injury
2) compartment syndrome
3) vascular compromise
4) malunion
5) rupture of the extensor pollicis longus tendon
Mx of inguinal hernias in children?
Surgical reduction:
< 6 weeks old = correct within 2 days
< 6 months = correct within 2 weeks
< 6 years = correct within 2 months
What movement is weak in carpal tunnel syndrome?
Thumb abduction (abductor pollicis brevis)
What is there wasting of in carpal tunnel?
wasting of thenar eminence (NOT hypothenar)
What is Phalen’s sign?
Flexion of the wrist causes symptoms
When can Lyme disease be diagnosed clinically?
If erythema migrans is present –> give abx (doxycycline)
What can be used to monitor flares in SLE?
Complement levels
Usually low during active disease (formation of complexes leads to consumption of complement)
What antibody is seenin SLE?
ANA
ESR vs CRP in SLE?
ESR is generally used
What is the gold standard for investigation for identifying the cause of contact dermatitis?
Skin patch test
Key risk factor for invasive aspergillosis?
Immunocompromised
In the investigation of acromegaly, if a patient is shown to have raised IGF-1 levels, what test is then recommended to confirm the diagnosis?
OGTT with serial GH measurements
Give some causes of gingival hyperplasia
1) phenytoin
2) ciclosporin
3) CCBs
4) AML
In a pneumothorax with a persistent air leak, or recurrent episodes of a pneumothorax, what should you consider?
Consider referral for video-assisted thoracoscopic surgery (VATS) to allow for mechanical/chemical pleurodesis +/- bullectomy
Mx of temporal arteritis if biopsy is negative?
Continue steroids regardless oof biopsy result (skip lesions can occur which show up as a negative result).
Within how long of starting steroids should a temporal biopsy be done in temporal arteritis?
Within 7 days of starting steroids
What is the mx of choice for patients with an indisplaced intracapsular hip fracture?
Fit –> internal fixation (cannulated hip screw)
Unfit –> hemiarthroplasty
1st line mx of lichen planus?
Potent topical steroids e.g. betamethasone
What is seen in the mouth in lichen planus?
Wickham’s striae
Mx of prostatitis?
14 day course of ciprofloxacin (quinolone)
What is the most common organism causing acute bacterial prostatitis?
E. coli
How is SBP confirmed?
Paracentesis -> neutrophil count >250 cells/ul
What organism causing Lyme disease?
the spirochaete Borrelia burgdorferi
