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Year 3 DPD > DPD Amir Sam 5 > Flashcards

DPD Amir Sam 5 Flashcards

Random cases

1
Q

24M
Breathless, facial swelling
Had a chinese takeaway

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

A. IM adrenaline

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

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2
Q 
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
A

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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3
Q

What are the atypical causes of pneumonia?

A

Legionella pneumophila
Chlamydia pneumoniae
Mycoplasma pneumoniae

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4
Q

50M
Dyspepsia
Wt loss
Hb 70, MCV 70

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

E. OGD

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5
Q

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

A

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

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6
Q

What are the duodenal biopsy findings indicative of Coeliac disease?

A

Villous atrophy

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7
Q

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
A

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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8
Q

What are the causes of bloody diarrhoea?

A 
Infection- infective colitis
Inflammation- UC/CD (younger)
Ischaemia- ischaemic colitis (older)
Malignancy
Diverticulutus
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9
Q

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

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

E. DC cardioversion

Give to someone if they present <48 hrs

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10
Q

When can you do cardioversion?

A

If a Pt is arrhythmic with haemodynamic instability

A Pt with AF <48 hrs

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11
Q

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

A

TOE to assess for an embolus

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12
Q

What are caput medusae?

A

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

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13
Q

What is Trousseau’s sign of malignancy?

A

Thrombophlebitis secondary to cancer

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14
Q

What is Troisier’s sign?

A

Palpable Virchow’s node secondary to cancer

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15
Q

What is Grey Turner’s sign?

A

Bruising of the flanks due to retroperitoneal bleeding

eg. acute pancreatitis, trauma

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16
Q

What are the complications of portal hypertension?

A

Encephalopathy
Ascites
SBP
Variceal bleeds

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17
Q

What two things are given to Pts with variceal bleeds?

A

ABx

Terlipressin/octreotide

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18
Q 
20M
Recent diarrhoea + malaise
Hb 70 Creatinine 300
Blood film- schistocytes
Diagnosis?
A

Haemolytic uraemic syndrome

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19
Q

What are the three types of microangiopathic haemolytic anaemia?

A

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

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20
Q

What is the triad seen in DIC?

A

Dec Plt
Inc PT/APTT
Inc D-dimer

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21
Q

What is the triad seen in HUS?

A

Dec Hb/inc BR
Uraemia
Dec Plt

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22
Q

What is the pentad seen in TTP?

A

HUS
Fever
Neurological manifestations

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23
Q

What are the two subtypes of haemolytic anaemia?

A

Hereditary OR acquired

24
Q

What are the causes of hereditary haemolytic anaemia?

A 
Hereditary spherocytosis
Hereditary elliptocytosis
G6PD deficiency
Sickle cell
Thalassaemia
25
Q

What are the causes of acquired haemolytic anaemia?

A

MAHA (DIC, HUS, TTP)
Autoimmune
Drugs
Infection

26
Q

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

A

SI: valvulae conniventes
LI: haustrae

27
Q

What are the diameters which indicate SBO/LBO?

A

SI >3cm

LI >5cm

28
Q

What are the causes of hypovolaemic hyponatraemia?

A

Diarrhoea
Vomiting
Diuretics

29
Q

What are the causes of euvolaemic hyponatraemia?

A

SIADH
Hypothyroidism
Adrenal insufficiency

30
Q

What are the causes of hypervolaemic hyponatraemia?

A

CHF
Liver cirrhosis
Nephrotic syndrome

31
Q 
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
A

B. CXR

Pt has SIADH secondary to a small cell carcinoma

32
Q

20F
Abdo pain + vomiting
T1DM
CBG 20, venous pH 7.2

A. Capillary ketone
B. FBC
C. HbA1c
D. LFTs
E. CRP
A

A. Capillary ketone

Pt has DKA

33
Q

What are the microvascular complications of diabetes?

A

Retinopathy
Neuropathy (ulcers)
Nephropathy

34
Q

What are the macrovascular complications of diabetes?

A

MI/stroke/PVD

35
Q

What is the general treatment for microvascular complications of diabetes?

A

Fluids
K
Insulin

36
Q

What are the metabolic complications of diabetes?

A

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

37
Q 
26M
Chest pain
Smokes 5/day
Auscultation: scratching sounds
ECG: widespread ST elevation
A

Pericarditis

38
Q 
60F
Collapse
120/70mmHg
No postural drop
HS S1+S2+ESM

Deep S waves in V1
Tall R waves in V6

A

LVH by voltage criteria

Secondary to aortic stenosis

39
Q

40M
Loin pain
Normal CRP
Urinalysis: blood ++

A

CT KUB

40
Q 
50M
Hypercalcaemia
Low PTH
Backache
Normal ALP
A. Bone metastases
B. Multiple myeloma
C. Osteoporosis
D. Primary hyperparathyroidism
E. Secondary hyperparathyroidism
A

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

41
Q

What causes a raised ALP?

A

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

42
Q

What are the clinical features of multiple myeloma?

A

hyperCalcaemia
Renal impairment
Anaemia
Bone lytic lesions

43
Q

What is multiple myeloma?

A

Plasma cells secreting serum immunoglobulins

44
Q

What is the ideal investigation for multiple myeloma?

A

Serum electrophoresis

45
Q

What do urine Bence Jones protein indicate?

A

Multiple myeloma

46
Q

23F
1cm breast lump
Smooth non-tender mobile

A. basal cell carcinoma
B. ductal carcinoma
C. fat necrosis
D. fibroadenoma
E. galactocele
A

D. fibroadenoma

47
Q

What are the causes of cavitating lesions in a CXR?

A

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

48
Q 
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
A

D. Urinalysis

Likely nephrotic syndrome

49
Q

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
A

C. Hereditary haemorrhagic telangectasia

PJS- hamartomatous GI polyps + hyperpigmented macules on lips/oral mucosa

50
Q

What is hereditary haemorrhagic telangectasia?

A

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

51
Q 
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
A

Adrenal insuficiency

52
Q

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
A

Prolactinoma

Prolactin suppresses gonadotrophins
High prolactin when breastfeeding, don’t want high gonadotrophins

53
Q

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
A

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

54
Q

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
A

Premature ovarian failure

Lack of oestradiol
Lack of negative feedback
Increased gonadotrophin secretion

55
Q

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
A

Myxoedema

TRH stimulates prolactin release hence high prolactin

56
Q 
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
A

Multinodular goitre

Can have multinodular goitre with normal levels

Year 3 DPD (5 decks)

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