DPD Amir Sam 5 Flashcards
Random cases
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
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
What are the atypical causes of pneumonia?
Legionella pneumophila
Chlamydia pneumoniae
Mycoplasma pneumoniae
50M
Dyspepsia
Wt loss
Hb 70, MCV 70
A. Abdo CT B. Abdo US C. Erect CXR D. Colonoscopy E. OGD
E. OGD
What investigations should you do when a Pt has microcytic anaemia?
Haematinics
Coeliac antibody (anti-TTG)
Top and tail (OGD and colonoscopy)
What are the duodenal biopsy findings indicative of Coeliac disease?
Villous atrophy
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
What are the causes of bloody diarrhoea?
Infection- infective colitis Inflammation- UC/CD (younger) Ischaemia- ischaemic colitis (older) Malignancy Diverticulutus
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
When can you do cardioversion?
If a Pt is arrhythmic with haemodynamic instability
A Pt with AF <48 hrs
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
What are caput medusae?
Distended superficial veins with the flow of the veins below the umbilicus towards the legs
What is Trousseau’s sign of malignancy?
Thrombophlebitis secondary to cancer
What is Troisier’s sign?
Palpable Virchow’s node secondary to cancer
What is Grey Turner’s sign?
Bruising of the flanks due to retroperitoneal bleeding
eg. acute pancreatitis, trauma
What are the complications of portal hypertension?
Encephalopathy
Ascites
SBP
Variceal bleeds
What two things are given to Pts with variceal bleeds?
ABx
Terlipressin/octreotide
20M Recent diarrhoea + malaise Hb 70 Creatinine 300 Blood film- schistocytes Diagnosis?
Haemolytic uraemic syndrome
What are the three types of microangiopathic haemolytic anaemia?
DIC (disseminated intravascular coagulation)
HUS (haemolytic uraemic syndrome)
TTP (thrombocytic thrombocytopaenic purpura)
What is the triad seen in DIC?
Dec Plt
Inc PT/APTT
Inc D-dimer
What is the triad seen in HUS?
Dec Hb/inc BR
Uraemia
Dec Plt
What is the pentad seen in TTP?
HUS
Fever
Neurological manifestations
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
