DPD Amir Sam 5 Flashcards by Chang Kim

24M
Breathless, facial swelling
Had a chinese takeaway

A. IM adrenaline
B. IV adrenaline
C. IM hydrocortisone
D. IV hydrocortisone
E. IV fluids

A. IM adrenaline

1:1000 dose
This Pt has had an anaphylactic reaction to peanuts

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45M
Cough, breathless, recent travel
Hyponatraemia, deranged LFTs
Coarse crepitations and bronchial breathing
What would you give with amoxicillin?

A. Cefuroxime
B. Clarithromycin
C. Co-amoxiclav
D. Tazocin
E. Vancomycin

B. Clarithromycin

This Pt has an atypical pneumonia caused by Legionella pneumophila (Pt has recently travelled, and is hyponatraemic).

Cefuroxime- not given in pneumonia
Co-amoxiclav- replaces amoxicillin
Tazocin- for G-ve HAP
Vancomycin- MRSA

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What are the atypical causes of pneumonia?

Legionella pneumophila
Chlamydia pneumoniae
Mycoplasma pneumoniae

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50M
Dyspepsia
Wt loss
Hb 70, MCV 70

A. Abdo CT
B. Abdo US
C. Erect CXR
D. Colonoscopy
E. OGD

E. OGD

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What investigations should you do when a Pt has microcytic anaemia?

Haematinics
Coeliac antibody (anti-TTG)
Top and tail (OGD and colonoscopy)

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What are the duodenal biopsy findings indicative of Coeliac disease?

Villous atrophy

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70M
Bloody diarrhoea
Stool MC+S: -ve
Stool C Diff toxin:-ve

A. Infective colitis
B. Ischaemic colitis
C. Ulcerative colitis
D. Appendicitis
E. Gastroenteritis

B. Ischaemic colitis

No infection
Old for a new presentation of UC
Appendicitis doesn’t give bloody diarrhoea
Could be GE but more likely to be ischaemic colitis with said Hx

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What are the causes of bloody diarrhoea?

Infection- infective colitis
Inflammation- UC/CD (younger)
Ischaemia- ischaemic colitis (older)
Malignancy
Diverticulutus

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40M
Palpitations 4 hrs ago
ECG- AF
How would you treat him?

A. Adenosine
B. Amiodarone
C. Digoxin
D. Metoprolol
E. DC cardioversion

E. DC cardioversion

Give to someone if they present <48 hrs

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When can you do cardioversion?

If a Pt is arrhythmic with haemodynamic instability

A Pt with AF <48 hrs

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What would you do if a Pt has presented with AF >48 hrs and you want to cardiovert them?

TOE to assess for an embolus

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What are caput medusae?

Distended superficial veins with the flow of the veins below the umbilicus towards the legs

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What is Trousseau’s sign of malignancy?

Thrombophlebitis secondary to cancer

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What is Troisier’s sign?

Palpable Virchow’s node secondary to cancer

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What is Grey Turner’s sign?

Bruising of the flanks due to retroperitoneal bleeding

eg. acute pancreatitis, trauma

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What are the complications of portal hypertension?

Encephalopathy
Ascites
SBP
Variceal bleeds

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What two things are given to Pts with variceal bleeds?

ABx

Terlipressin/octreotide

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20M
Recent diarrhoea + malaise
Hb 70 Creatinine 300
Blood film- schistocytes
Diagnosis?

Haemolytic uraemic syndrome

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What are the three types of microangiopathic haemolytic anaemia?

DIC (disseminated intravascular coagulation)
HUS (haemolytic uraemic syndrome)
TTP (thrombocytic thrombocytopaenic purpura)

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What is the triad seen in DIC?

Dec Plt
Inc PT/APTT
Inc D-dimer

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What is the triad seen in HUS?

Dec Hb/inc BR
Uraemia
Dec Plt

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What is the pentad seen in TTP?

HUS
Fever
Neurological manifestations

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What are the two subtypes of haemolytic anaemia?

Hereditary OR acquired

What are the causes of hereditary haemolytic anaemia?

Hereditary spherocytosis
Hereditary elliptocytosis
G6PD deficiency
Sickle cell
Thalassaemia

What are the causes of acquired haemolytic anaemia?

MAHA (DIC, HUS, TTP) Autoimmune Drugs Infection

What are the names of the small circular fold seen in the small and large bowel?

SI: valvulae conniventes LI: haustrae

What are the diameters which indicate SBO/LBO?

SI >3cm | LI >5cm

What are the causes of hypovolaemic hyponatraemia?

Diarrhoea Vomiting Diuretics

What are the causes of euvolaemic hyponatraemia?

SIADH Hypothyroidism Adrenal insufficiency

What are the causes of hypervolaemic hyponatraemia?

CHF Liver cirrhosis Nephrotic syndrome

``` 60M Confused, cough, no postural hypotension Na 120 K 4 Normal TFTs + synACTHen Urine Na 40 (40-220) Urine osmolality 400 (500-800) ``` ``` A. Brain MRI B. CXR C. CT Abdo D. PFTs G. OGD ```

B. CXR Pt has SIADH secondary to a small cell carcinoma

20F Abdo pain + vomiting T1DM CBG 20, venous pH 7.2 ``` A. Capillary ketone B. FBC C. HbA1c D. LFTs E. CRP ```

A. Capillary ketone Pt has DKA

What are the microvascular complications of diabetes?

Retinopathy Neuropathy (ulcers) Nephropathy

What are the macrovascular complications of diabetes?

MI/stroke/PVD

What is the general treatment for microvascular complications of diabetes?

Fluids K Insulin

What are the metabolic complications of diabetes?

DKA (diabetic ketoacidosis) HHS (hyperosmolar hyperglycaemic state) Hypoglycaemia

``` 26M Chest pain Smokes 5/day Auscultation: scratching sounds ECG: widespread ST elevation ```

Pericarditis

``` 60F Collapse 120/70mmHg No postural drop HS S1+S2+ESM ``` Deep S waves in V1 Tall R waves in V6

LVH by voltage criteria | Secondary to aortic stenosis

40M Loin pain Normal CRP Urinalysis: blood ++

CT KUB

``` 50M Hypercalcaemia Low PTH Backache Normal ALP ``` ``` A. Bone metastases B. Multiple myeloma C. Osteoporosis D. Primary hyperparathyroidism E. Secondary hyperparathyroidism ```

B. Multiple myeloma Bone mets would have a raised ALP. Osteoporosis would have normal values for everything. Hyperparathyroidism would have high PTH Osteoblasts make ALP Plasma cells suppress osteoblasts ALP is normal in myeloma

What causes a raised ALP?

Bone/liver disease Liver- obstruction Bone- malignancy, fracture, Paget's Osteoblasts make ALP

What are the clinical features of multiple myeloma?

hyperCalcaemia Renal impairment Anaemia Bone lytic lesions

What is multiple myeloma?

Plasma cells secreting serum immunoglobulins

What is the ideal investigation for multiple myeloma?

Serum electrophoresis

What do urine Bence Jones protein indicate?

Multiple myeloma

23F 1cm breast lump Smooth non-tender mobile ``` A. basal cell carcinoma B. ductal carcinoma C. fat necrosis D. fibroadenoma E. galactocele ```

D. fibroadenoma

What are the causes of cavitating lesions in a CXR?

Infection: TB, staph, Klebsiella (alcoholics) Inflammation: RhA Malignancy Infarction: PE

``` 35F Ankle oedema Recent echo- NAD Normal U+E, ALP, AST, ALT Albumin 15 ``` ``` A. Coronary angiogram B. Renal USS C. Troponin D. Urinalysis E.Repeat LFTs ```

D. Urinalysis Likely nephrotic syndrome

30M Recurrent GI bleeds + nose bleeds Telangectasia on lips and tongue ``` A. Acromegaly B.Cirrhosis C. Hereditary haemorrhagic telangectasia D. Peutz-Jehger syndrome E. Systemic sclerosis ```

C. Hereditary haemorrhagic telangectasia PJS- hamartomatous GI polyps + hyperpigmented macules on lips/oral mucosa

What is hereditary haemorrhagic telangectasia?

Autosomal dominant condition Abnormal vessels in: -skin, mucous membranes, lungs, liver, brain

``` Na: 120 K: 5 Short synACTHen test: 0 min cortisol: 100 30 min cortisol: 200 ``` ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Adrenal insuficiency

Prolactin: 10,000 (high) Testosterone: 6 (low) LH <1 (low) FSH <1 (low) ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Prolactinoma | Prolactin suppresses gonadotrophins High prolactin when breastfeeding, don't want high gonadotrophins

Prolactin: 1000 (high) IGF1: 100 (high) OGTT: failure of GH suppression ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Acromegaly Raised IGF1 GH normally suppresses when given glucose Prolactin is raised either due to co-secretion or dopamine suppression is inhibited due to compression of the stalk

Oestradiol: 50 FSH: 40 (high) LH: 35 (high) Prolactin: 200 ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Premature ovarian failure Lack of oestradiol Lack of negative feedback Increased gonadotrophin secretion

Free T4: 5 (10-20) TSH: 60 (0.5-5.0) Prolactin: 700 ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Myxoedema TRH stimulates prolactin release hence high prolactin

``` Free T4: 12 (10-20) TSH 1.0 (0.5-5.0) LH: 1 Prolactin: 300 Cortisol: 500 (All levels are normal) ``` ``` Acromegaly Adrenal insuficiency Cushing's syndrome Graves' disease Myxoedema Premature ovarian failure Primary hyperaldosteronism Prolactinoma Multinodular goitre Thyroiditis ```

Multinodular goitre Can have multinodular goitre with normal levels

DPD Amir Sam 5 Flashcards

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