exam cram MD2 2014 answers Flashcards
(107 cards)
Features of melanoma
1) Asymmetrical
2) Pushing, irregular border
3) Non- homogenous
4) Greater than 6mm
5) Any changing lesion/ new lesion
Features of SCC
1) Grows rapidly (weeks- months)
2) Occur commonly on chronically sun exposed skin
3) Think, red/ pink nodule
4) tender on palpation
5) Bleeds easily/ ulcerates
RF for developing SCC
1) Smoking
2) Sun exposure
Features of BCC
1) Pearly nodule
2) Telangiectasia
3) Commonly found on head and neck, inner canthus of eye
4) Central depression
5) Raised edges/ margins
6) Central necrosis
7) Bleeding/ ulceration (nodular BCC)
8) Red plaque not responding to topical Rx (superficial BCC)
Metastatic potential of SCC and BCC
- SCC more likely to mets
- BCC less likely to mets, locally invasive
Features on Hx for peptic ulcer disease
1) Epigastric pain especially after meals
2) NSAID use
3) Previous incidences of PUD
4) N & V
5) Dyspepsia
Features on Hx for oesophageal variceal rupture
1) Painless bleeding
2) Sudden onset, without warning (i.e. no symptoms beforehand)
3) Previous Dx of CLD
4) Hx of EtOH abuse, current EtOH intake
Features on Hx for MW tear
1) Epigastric pain
2) Episodes of vomiting preceding haematemesis- e.g. a/w heavy EtOH intake
3) preceded by straining e.g. heavy coughing, defacation
Features on Hx of acute gastritis
1) ‘Gnawing’ epigastric pain
2) Previous mucosal injury -e.g. gastritis, PUD
3) Exposure to noxious/ toxic compounds (NSAIDs, EtOH)
Features on Hx of oesophagitis
Reflux oesophagitis: 1) heartburn, dyspepsia 2) water brash 3) regurgitation Infective oesophagitis: 1) Dysphagia, odonophagia 2) Heart burn 3) N & V 4) Fever, anorexia, fatigue etc
Features on Hx of neoplasm (oesophagus or stomach)
Oesophageal: 1) Positive smoking Hx (SCC) 2) GORD (adenocarcinoma) 3) Dysphagia 4) Weight loss, anorexia, fatigue Stomach: 1) Indigestion, post- prandial fullness 2) N & V 3) Dysphagia 4) Weight loss, anorexia, fatigue
3 predisposing factors for MW tears
1) Hiatus hernia
2) EtOH (especially when a/w vomiting)
3) Any other condition that causes repeated retching/ vomiting (e.g. morning sickness)
How can MW tears be repaired endoscopically?
1) Contact thermal therapy
2) Epinephrine injection
3) Sclerotherapy
4) Band ligation
5) Haemoclip
2 classes of drugs which may prevent re-exacerbation of MW tears and potential SE
1) PPI: headache, N + V + D, abdo pain, constipation
2) Anti-emetics:
a) 5-HT3 R antagonist: constipation, headache, dizziness
b) corticosteroids (dexamethasone): adrenal suppression, immunosuppresion, Na+ and water retention, HTN, hypokalaemia, hyperglycaemia/ DM, dyslipidaemia, OsteoP, increased appetite, delayed wound healing, skin atrophy, bruising, acne, facial flushing, hirsuitism, myopathy, fat distribution, weight gain, amorrhoea, cataracts, pysch effects (disturbances of mood, cognition, sleep and behaviour)
c) DA antagonist: drowsiness/ sedation, dry mouth
Causes of SBO
1) Adhesions
2) hernia
3) Malignancy
4) Stricture
5) Foreign body
6) Volvulus
7) Intussusception
8) Gallstone ileus
Causes of LBO
1) Malignancy
2) Diverticulitis
3) Sigmoid volvulus
4) Faecal impaction
5) Stricture
6) Intussusception
What complications of an SBO might a pt display?
1) Bowel ischaemia
2) TachyC
3) Febrile
4) Leucocytosis
5) Tenderness
6) Guarding
Causes of post-op confusion
1) Hypoxia: atelectasis, chest infection, over-sedation, CCF, MI, PE
2) Sepsis/ infection: chest, urine, wound, abdo
3) Medication: opiates, sedatives
4) Metabolic: ureamia, hyponatraemia, hypoglycaemia, hyperglycaemia
Name some factors that could contribute to a pt developing post- op confusion
1) Stroke
2) Pain
3) Anaemia
4) Hypotension
5) Dementia
What are some Ix you would order for a pt with post op confusion?
1) ABGs
2) U&Es
3) Random BSLs
4) FBE
5) Blood culture
6) MSU
7) CXR
8) ECG
DDx of palpitations, feature on Hx and feature on Ix
1) SVT (e.g. AFlut, WPW, atrial tachy). On Hx: abrupt onset, sweats, dizziness. ECG: normal QRS, abnormal or absent P waves, >140bpm
2) Sinus tachy (caffeine, anxiety, febrile illness, hypovolaemia, exercise). On Hx: gradual onset over minutes of regular palpitations, clear precipitant. ECG: normal ECG, resolution with stopping precipitating factors
3) AF. Hx: irregularly irregular pulse. ECG: no p waves, irregularly irregular, normal QRS complexes
4) Ventricular ectopics. Hx: palpitations noted over hrs-days, a/w anxiety. ECG: Premature, wide QRS complexes
Features of hypothyroidism
1) Weight gain
2) Cold intolerance
3) Fatigue, depression, difficulty concentrating, poor memory
4) BradyC
5) Dry, coarse, itchy skin. Loss of outer 3rd of eyebrow
6) No tremor
7) Slow relaxing reflexes
8) Heavy, irregular periods
9) Brittle nails
Features of hyperthyroidism
1) Weight loss
2) Heat intolerance
3) Nervousness, anxiety, irritability, restlessness, panic, insomnia
4) TachyC
5) Thin skin, warm moist palms
6) Tremor
7) Brisk reflexes
8) Scant, less frequent periods
9) Soft nails
An eye sign unique to Grave’s
Exopthalmos
