Derm/ Endo / Gastro Flashcards by Hamish Reed-Embleton

Ulcerative colitis
Now hepatosplenmegaly and ALP 600 = ? Ix?

Primary sclerosing cholangitiss
ERCP/MRCP
[pANCA often positive]

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Anti-mictochondrial antibodies in ? Which subtype

Primary billiary cirrhosis
M2 subtype most specific

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Primary sclerosing cholangitis
[stricturing of bile ducts or ‘beading’

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HRT and
colon Ca?
Diabetes?
osteoperosis?
Gallbladder disease?
Dementia?
CAD?

colon Ca - decreased risk [but more advanced disease hen found]

Diabetes - decreases risk

osteoporosis - decreases risk

Gallbladder disease - increases risk

Dementia - no change

CAD - no change

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PCOS and hirtuism rx? Ovulation?

co-cyprindiol

Clomifine for ovulation

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Thyrotoxicosis in preg rx?

Propylthiouracil in first trimester
Carbamazepine 2-3rd

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Bacillus cereus onset of Sx?

1-4hrs

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Chest tightness, palpitations, SOB and HTN?

Phaeo

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Swan neck of oesopahagus =? rx? if medical ineffective?

Achalasia
CCB or nitrates

Botox/balloon dilation

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Sore throat / cough. Now oedematous papules some with vesicles in middle forming a target lesion =?

HSV-1 most likely

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Regurgitation of undigested food + halitosis = ? key Ix? Rx?

Zenckers diverticulum
Barium swallow
Surgical

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Diffuse symmetrical triphasic sharp waves on EEG = ?

Hepatic encephalopathy

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Can you get eye signs in post partium thyroiditis?

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DKA - given fluids and insulin what is next most important

LMWH - high risk of thrombosis

IV sodiumbicarb if severe acidosis + circulatory collapse

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Girl - rasied testosterone/progesterone, hirtuism, irregular periods and

non classical CAH
[as raised progesterone not in PCOS]

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Diagnosis of haemochromatosis

Genetic testing
[then liver biopsy to determine cirrhosis level]

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Best drug for long term rx of portal HTN

propanolol

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Which laxative causes melanosis coli

Senna

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Small hyperpigmented macules on wrists, arms, neck

Lichen plannus

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Keloid scar Rx if causing issues Eg depression

triamcinolone

2nd line 5-FU

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Describe this

Annular rash

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Derm what does it mean?
Annular
serpiginous
Nummular
reticulated

Annular - Ring shaped erythema with central clearing

serpiginous - Curved

Nummular - circular without central clearing

reticulated - Lace or network pattern

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dyspepsia with no red flags rx?

PPI
-> if sx persist stop for 2 weeks then H pylori
-> If ongoing endoscopy

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Viral infection then tender thyroiditis

De Quiervans

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Fibrosis of thyroid sometimes leading to tracheal compression?

Riedel's thyroiditis

Cranial DI presents with

Hypernatraemia and hypotension

Bleeding DU what medication has positive impact on prognosis? Variceal?

Omeprazole Terlipressin for variceal

Delayed puberty with low FSH/LH ix?

GnRH testing

Pigmented oral lesions

peutz-jeghers syndrome

Hx of nose bleeds + fam Hx

Heredatory haemorrhagic telangectasia [olser weber rendu]

middle eastern - repeated abdo pain, fever and arthralgia

familial Mediterranean fever

Daily fevers, arthritis, Salmon coloured rash raised ferritin and splenomegaly

Adult onset stills

Acute abdo symptoms and neuropsych? Common triggers?

Acute intermittent porphyria Alcohol, oestrogen

Low BMI with urinary K <1 =

Laxative abuse - as lose lots through bowels, kidneys try to conserve

SAAG for portal HTN

>11g/L

given vanc - > red man sydrome rx?

Chlorphenamine -then add steroids topical/PO if needed

diarrhoea, wheeze abdo pain weight loss? ix?

carcinoid urinary 5-haii

phaeo initial Ix 2 options

urinary metanephrines urinary vanillylmandelic acid

Small undescended testis and gynecomastia often learning difficulties ? genetics? rx?

Kleinfelter XXY Androgen replacement

Diabetes, diarrhoea, gallstones

Somatostatinoma

CAH caused by

21-hydroxylase deficiency 95% 17-hydroxylase deficiency in others

best Ix for charcots vs infective

indium-labelled white cell scan

middle ages woman with itching fatigue and raised ALP key ix?

PBC = Anti-mitochondrial Abs

Lesions in armpit and neck pictured = ? What would be seen on opthalmology?

Pseudoxanthoma elastum angioid streaks in iris

risk of transmisstion / When test baby for hep c with a positive mum ? breast feeding risk?

2% risk test after 2 months No risk breastfeeding

coeliac disease malignany

enteropathic associated T cell lymphoma

Uncontrolled bleeding DU with poor lung function rx

Angiography and embolisation unfit for surg

Name 3 causes of carpal tunnel

Hypothyroid Cushing Obesity Raised oestrogen

Best drugs for maintaining remission in corhns

Thiopurines - azathioprine or 6-mercaptopurine

1st line Ix visceral leish

Direct agglutination testing + rk39 antigen test

AIDs + ++ALP key Ix

MRCP - likely strictures due to infection eg cryptosporridium or CMV or microsporidium -> Stenting

general flu like sx with oral ulcers and a patch of alopecia

Secondary syphilis

Surgery for BCC vs melanoma

BCC - mohs micrographic surgery melanoma - wide excision 2 cm

psoriasis + what -> erythroderma

propranolol

2 main causes of erythroderma

eczema - 40% psoriasis - 25%

Barrets with low grade dysplasia Rx

High dose PPI

pemphigoid of preg rx

Topical corticosteroids => oral if not improving

Watery diarrhoea, weight loss Colonoscopy - normal macroscopic, but cellular infiltrate in lamina propria? rx?

Microscopic colitis Stop NSAID / PPI

Serum osmolality after deprivation? Urine osmolality after deprivation? Urine osmolality after desmopressin?

Serum osmolality after deprivation - 278-300 Urine osmolality after deprivation - >300 Urine osmolality after desmopressin- >750

Most common cause of acute dysentry in UK

Campylobacter [then salmonella]

Chronic history abdo pain, loose stool and depression Eye movement disorder with jaw twitching on eye movement? ix?

Whipple Jejunal biopsy -> PAS positive macrophages

Lesion on achillies ix?

Xanthomata Needs fasting lipids

Why not start thyroxine with other concurrent autoimmune disease eg vitiligo?

Need to rule out autoimmune adrenitis -> otherwise thyroxine can precipitate an adrenal crisis

Examine nutritional status in anorexia

Mid arm circumference and skin-fold thickness

Test for chronic pancreatic insufficiency? bile acid malabsorbtion?

Pancreatic - fecal lipase Bile acid - seHCAT test

Lupus vulgaris

HHS K5.5 Na146, glucose 35 Which fluid

0.9% saline

36 weeks preg deranged LFTs + jaundice When would you think cholestasis of preg and when acute fatty liver

Cholestasis - more common -less Sx Acute fatty liver - vomiting -abnormalities of synthetic function eg low albumin

Chronic alcohol, obese, buffalo hump, raised 0900 cortisol midnight cortisol <50% dx?

Pseudo Cushings Cushings would not have significant drop in cortisol

Pain in cheeks and gums ? rx?

Lichen plannus (wickhams straiae) Topical corticosteroids

Thyrotoxicosis in pregnancy with smooth small goitre =

Graves (85% thyrotoxicosis of preg)

symmetrical dark pink lesions on shins + new AF = ? finding on hand exam?

Graves Lesions are pretibial myxoedema Acropachy - soft-tissue swelling of the hands and clubbing of the fingers.

hypertension, HypoK, Alkalosis

Conns

Differentiate liddle and conns

Both HTN, hypoK and alkalosis Conns - raised aldosterone Liddle - low

Previous acne now these itch red lesions? Rx?

Keloid scars secondary to acne Intralesional steroids

Ectopic gastric mucosa in diverticulum? Key Ix? rx?

Meckles Tc-99m pertechnetate scintigraphy Surgery if bleeds

itchy rash on the elbows? on biopsy?

Dermatitis herpetiformis IgA deposits on biopsy

Raised prolactin in CKD due to?

Uraemia -> hypothalamus -> reduces dopamine Also impaired metabolism of prolactin by kidney

insulinoma vs insulin abuse

C -peptide high in insulinoma [also raised pro-insulin]

How does test for pernicious anaemia work?

Schilling - check labled b12 in urine Then add intrinsic factor -> if positive the % of b12 in urine will significantly increase

Weight loss, foul smelling stool Macrocytic anaemia with raised folate and low B12

Small bowel bacterial overgrowth

Memory loss, ataxia, weight loss, loose stools

Whipples

CKD what does K need to be before surgery

<5.5

dextrocardia

What electrolyte abnormality

HypoK Prominent U wave (small deflection following t wave)

Which vit deficiency

naicin b3

What is needed for synthesis of naicin?

Pyridoxine (B6) -> B6 deficiency may also cause pellagra

microcytic anaemia , epistaxis =? ix?

Telangiectasia of lips + above = olser weber rendu (HHT) CT angiogram bowel

phaeo, hyperPTH =

MEN2a

Rash on scalp ? cause? rx?

Seborrheic dermatitis - likely malassezia Ketoconaozole

kantor string sign on barium meal

crohns

Subacute thyroiditis rx?

propranolol

Kid with cold

impetigo

CKD5 Tightening of skin and joint contractures indurated woody plaques on trunk and limbs

nephrogenic systemic fibrosis

pregnant with this striae caused by?

cortisol

IBD rx options in order

topical pred topical tacrolimus oral pred

nail pitting psoriasis

primary HyperPTH surgical indications Cr T score Age Ca urinary ca

Cr >30% increase T score >-2.5 Age <50 Ca >2.85 urinary ca >10mmol/24hrs

Hx of coeliac with negative endomysial antibodies why?

IgA deficiency -> causes false negative Need to do immunoglobulin electrophoresis

Non bowel parts of FAP

Hypertrophy of retinal epithelium dental issues osteomas

Itchy = ? rx?

malassezia - ptyriasis versiculor Ketoconazole

Travellers diarrhoea when Abx

>3 days >6 episodes per day bloody

How much pred in breast feeding is safe

<40mg/day

Long standing T1DM not great control now joint pains in wrist and ankle and these lesions on the shins Cause of joint pains?

raised red plaques - necrobiosis lipoidca diabeticorium Rheum A - HLADR4 associated with above lesions and joint pains

Epilepsiy now pancreatitis = which med

valproate

How to calculate plasma osmolarity? value for HHS

2(Na + K) + urea + glucose >320 for HHS (Glucose likely >30)

Hosepipe appearnce of UC

RX of pain in thyroiditis

NSAIDs

Rectal bleeding, mum has it too multiple polyps ? how often endocopy

peutz jehger endoscopy 3 yearly

Long distance run now this rash

capilliritis

Cafe au lait skin precocious puberty Hyper thyroid

mcune albright syndrome

1st line Rx PCOS

weight loss if raised BMI

65F with hairloss and itching in patch on scalp

Cicatricial Alopecia

Hairloss 2-3months after stressfull times

telegen effluvium

Psychogenic pulling out of own hair

trichotilomania [MANIA]

Ulcerative colitis with colon diameter 5.5 on IV hydrocortisone next step

IV cyclosporin [not infliximab] Surg ref if colon >6cm after 72hrs therapy

Polyglandular syndrome type 1 and 2 features

Type 1 2 of: HypoPTH 90% Adrenal insufficiency chronic mucocutaenous candida gonadal failure hypothyroid type 2 Adrenal insufficiency and T1DM [vitiligo, gonadal failure and pernicious anaemia]

Normal TSH and free t4 low total t4 (and mebe t3) =?

Thryroid binding globulin deficiency

Alcoholic hepatitis Igs

++ IgA +IgG / M

How long washout for aldosterone levels if on ACE/ARB etc

2 weeks

Melanoma biopsy margin

1cm

toxic epidermal necrolysis mediated by

Cytotoxic T cells

Recently started antihypertenive now acute abdo

ACEi -> angiodema of bowel

IBD then on sertraline now colitits what type?

Lyphocytic colitis

What transferrin saturation in Haemochromatosis

>55% Venesection to aim <50%

Cholangiocarcinoma secondary to PSC rx

Liver transplant If invasion of lymph then stenting and palliative

Amiodarone thyrotoxicosis rx

Stop ami steroids

bleeding varicies -> banding but still ooze what next

TIPS Balloon tamponade only for catatrophic bleeding

Tall, small testis and no pubic hair =

Klinefelters 47XXY

Blue-black skin pigmentation seen with

Minocycline

Really itchy rash following a stress trigger

Lichen simplex et chronicus

Anaemia

HHT

Low Na in boozer with normal CT chest

Beer potomania

Groin perianal and axilla lesions with discharge. Not STI

Hidradenitis suppurativa Doxy / tetracyclines

Slow growing painless

Subungual fibromas

Prev TB

Discoid lupus [Lupus vulgaris is a single slow growing plaque]

24 Altered bowel habit and passing air bubbles in urine

Crohns with fistula

Thyroidectomy Hyper PTH Impaired glucose tolerance

Men2a [Impaired glucose tolerance due to phaeo]

Which drug for deranged LFTs if cholestatic? If ALT higher than ALP

Co-amox Statins

Young, Abdo pain, weight loss, postural hypotension

Addison's [often low glucose]

Amiodarone thyrotoxicosis most commonly treated with antithyroid drugs incombnation with what ?

potassium percholrate

No prev issues

Tinea corporis (ring worm topical antifungal

Weight loss raised glucose

glucagonoma

Alcoholic with low Ca - what needs replaced 1st

Glargline insulin as changes in?

Glycine and Arginine [GlArginine]

Itchy rash after running - some areas of blistering where he's rubbed it

mastocytosis [Dariers sign is the blistering where rubbed]

Crohns on azathioprine wants to get preg plan?

Continue same dose Start folic acid

Kallman best rx

Pulsed GnRH

Pancreatitis LDL 4.5, triglycer 11.2 rx?

Statin + fibrate

Diarrhoea

UC - continuous thickening of bowel

Primary amenorrhoea raised FSH/LH small and fat No breast development

turner

UC and PSC how often colonoscopy if asymptomatic

every year

palpable red nodules on penis and scrotum

scabies

erythema nodosum HLA

HLA B27

Actual thyroid adenoma in preg rx?

Antithyroid drugs til delivery

ASCA antibodies in

cROHNS

Dysphagia

Pharyngeal pouch

65M IDA with no change in bowel habit 1st line ix

Urineanaysis

Which glutide is best

Liraglutide

Recurrent pneumonia caused by

bronchiectasis [yellow nail syndrome]

Alcoholic with multiple episodes of pancreatitis. How to manage diabetes?

Likely type 3 diabetes -> lack of insulin Insulin replacement

Addisons and Thyroid disease

Polyglandular type 2

74 widespread itch rash

Scabies

Itchy - biopsy shows cuffing in coat sleeve

Erythema annular centrifugum

Liver failure related hydrothorax definitive management

Transplant

Perductal concentric onion skin fibrosis =

PSC

Growth next to nose

BCC

Itchy, comes and goes

Lichen plannus

Severe psoriasis not responding to rx rx?

Anti-TNFa Ustekinumab - ant IL-12/23

Area of skin that becomes waxy and hyper/hypo pigmented Trigger of trauma or infection?

Morphoea

History of funny turns whcih improve after sugary tea and raised Ca on bloods

MEN1 [insulinoma -> funny turns]

Peristomal pyoderma gangrenosum not responding to oral steroids

Infliximab