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Pass Med finals pack > extra passmed questions 3 > Flashcards

extra passmed questions 3 Flashcards

1
Q

what is meckels diverituclum?

A
  • pouch
  • may be lined with ectopic gastric mucosal tissue
  • produce bleeding
  • congenital
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2
Q

what type of shock most commonly occurs following a spinal cord transection?

A
  • neurogenic shock
  • vasolidation –> decreased preload –> decreased cardiac output –> hypotension
  • patient will need vasopressors !
  • to reverse profound v.dilation
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3
Q

which pancreatic enzyme would you use to diagnose acute pancreatitis?

A
  • serum lipase has longer half life than amylase

- may be useful in late presenting patients

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4
Q

3 - 4.4cm

small aneurysm

action

A

rescan every 12 months

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5
Q

4.5 - 5.4cm

medium aneurysm

action:

A

rescan every 3 months

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6
Q

> 5.5cm

large aneurysm

action:

A

refer within 2 weeks to vascular surgery

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7
Q

next appropriate step in management of patient with long saphenous vein superficial thrombophlebitis?

A

USS

to exclude underlying DVT

TX: bed red and analgesia

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8
Q

absent T waves

A

hypokalaemia

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9
Q

Reynold’s pentad is

A

charcots triad

  • RUQ pain
  • jaundice
  • fever

and

  • hypotension
  • confusion
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10
Q

Beck’s triad

A
  1. hypotension
  2. raised JVP
  3. muffled heart sounds

CARDIAC TAMPONADE

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11
Q

Cushing’s triad

A
  1. irregular and decreased resp rate
  2. bradycardia
  3. hypertension

RAISED INTRACRANIAL PRESSURE

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12
Q

45 y/o female

pc: 3cm breast lump

ER+, HER2- tumour, confined to breast

describe this case and next stage of management:

A

HER2-

  • hormone receptor positive cancers
  • grow faster than HER2+ cancers

ER+
- increased aggressiveness

this patient has a fast growing aggressive cancer.

management depends on size of tumour.

If < 4cm ——> WIDE LOCAL EXCISION

if > 4cm ——> MASTECTOMY

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13
Q

abdominal pain

  • presents post meal
  • nausea vomiting
  • pain radiates to shoulder

indicative of:

A

biliary colic

- esp if obs are normal

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14
Q

investigation for suspected bowel perforation

A

erect chest x-ray

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15
Q

28 y/o male

pc: locally advanced mucinous carcinoma of the caecum
oe: scanty polyps in remaining colon
fhx: father died from colorectal cancer aged 34

likely diagnosis:

A

Lynch syndrome

aka HNPCC

Amsterdam criteria used to identify families at risk

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16
Q

mode of inheritance of BRCA gene

A

autosomal dominant

so 50% chance of passing this on

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17
Q

management for anal fissures not responding to conservative management:

A

sphincterotomy

anal fissures
- longitudinal or elliptical tears at squamous lining of distal anal canal

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18
Q

in management of ER +ve beast cancer what drugs are used:

A

ER+ = aggressive

Either:

  1. aromatose inhibitors
    - anastrozole
    - side effect: osteoporosis
  2. anti-oestrogen medications is Selective oEstrogen Receptor Modulators (SERM)
    - tamoxifen
    - side effect: VTE, endometrial cancer
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19
Q

causes of unilateral hydronephrosis:

A

PACT

Pelvic-ureteric obstruction (congenital or acquired)

Aberrant renal vessels

Calculi

Tumours of renal pelvis

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20
Q

causes of bilateral hydronephrosis:

A

SUPER

Stenosis of the urethra

Urethral valve

Prostatic enlargement

Extensive bladder tumour

Retro-peritoneal fibrosis

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21
Q

Investigations and management for hydronephrosis

A
  1. USS first line
  2. IVU (intravenous urogrpahy) assess position of obstruction
  3. Antegrade or retrograde pyelography- allows treatment
  4. if you suspect stones: CT scan

management

  1. remove obstruction
  2. acute: nephrostomy
  3. chronic: ureteric stent
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22
Q

What is the mechanism of action of goserelin in prostate cancer?

A

GnRH agonist

- provides negative feedback to the AP

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23
Q

28 y/o hypertension + haematurua + polycytheaemia, CT shows L renal mass

A

renal adenocarcinoma

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24
Q

68 y/o recurrent episodes of LHS ureteric colic + haematuria + dilatation of renal pelvis

A

transitional cell carcinoma

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25
Q

A 4-year-old boy presents with haematuria and on examination is found to have a right sided renal mass.

A

Wilms tumour (nephroblastoma)

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26
Q

Which one of the following may be used to monitor patients with colorectal cancer?

A

Carcinoembryonic antigen (CEA)

27
Q

analgesia recommended for acute management of renal colic

A

IM diclofenac

28
Q

what is an indicator of severe illness in pancreatitis:

A

hypocalcaemia

P - PaO2 (< 7.9 kPa).

A - age (>55).

N - neutrophils (white cell count > 15x 109/L).

C - calcium (calcium < 2 mmol/L).

R - renal function (urea > 16 mmol/L).

E - enzymes (lactate dehydrogenase > 600 IU/L).

A - albumin (albumin < 32 g/L).

S - sugar (blood glucose > 10 mmol/L).

3 points and above suggests a high risk for severe pancreatitis.

29
Q

summarise the causative organisms in epididymitis

A

E Coli
- older adults esp with prior BPH dx

Chlamydia and N. Gonnorrhoea
- younger men

30
Q

30 y/o female

pc: 3 week hx worsening erythema over left breast. not breast feeding. not painful.
oe: swollen breast, no discharge, nipple changes and no palpable mass.

Ca 15-3 elevated, normal WCC and CRP

indicative of:

A

inflammatory breast cancer

differential diagnoses:

if fever + elevated WCC, CRP
- mastitis or cellulitis

fibroadenoma
- firm mobile lump

pagets disease of breast
- involves nipple, spreads to areola and breast

31
Q

what is an emergency Hartmann’s procedure?

A
  • resection of rectosigmoid colon
  • end colostomy formed
  • indicated by perforation of rectosigmoid bowel leading to subsequent peritonitis
32
Q

87 y/o female

pc: right nipple very itchy
oe: erythematous, blood stained discharge on inside of bra

indicative of:

A

paget’s disease of nipple

  • skin changes
  • associated with breast malignancy
  • weeping crusty lesion
  • areolar lesion spared ?

mx
- imaging and biopsy

33
Q

mention of bubbly urine may indciate:

A

fistula between bowel and bladder

e.g enterovesicual fistula

34
Q

31 y/o male

pc: trouble concieving
oe: diffuse lumpy swelling on LHS scrotum, not painful, testicle can be felt separately and it normal

indicative of:

A

varicocele

35
Q

management of epididymal cyst:

A

usually supportive

surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts

36
Q

management of varicocele:

A

usually conservative

surgery if patient troubled by pain

37
Q

first-line investigation in suspected prostate cancer

A

refer for multiparametric MRI

38
Q

common complication of radical prostatectomy?

A
  • incontinence

- erectile dysfunction

39
Q

common complication of TURP

A

retrograde ejaculation

40
Q

most common organism causing cholangitis

A

E .COLI

41
Q

Acute upper urinary tract obstruction is managed with

A

nephrostomy

42
Q

tumour marker for hepatocellular carcinoma

A

AFP

43
Q

This man’s tumour is in the rectum and sigmoid colon.

what is the most appropriate operation?

A

anterior resection

44
Q

32 y/o male with Crohns

pc: intermittent jaundice, obstructive. usually resolves spontaneously.

diagnosis:

A

Bile duct stones

  • bile salts are absorbed in terminal ileum
  • impaired in Crohn’s
  • patient may develop gallstones
  • if they pass into CBD —> obstructive jaundice
45
Q

A 22-year-old man returns to the UK from holiday in India. He presents with painless jaundice. On examination he is not deeply jaundiced and there is no organomegaly.

A

hepatitis A

46
Q

this is spouted!

A

ileostomy

47
Q

this is flat against the skin!

A

colostomies

48
Q

A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

A

fibroadenoma

49
Q

A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.

A

fibroadenosis

50
Q

what kind of drugs are useful in patients with overactive bladder?

A

anti-muscarinic drugs

51
Q

A 17-year-old man presents with a 2 week history of significant pain on defecation accompanied by the presence of a small amount of blood which is noticed on toilet paper.

A

fissure in ano

young patients + painful rectal bleeding –> fissure

tx

  • stool softener
  • either GTN or diltiazem
52
Q

24 y/o long hx obstructed defecation and chronic constipation and straining.

OE: indurated area located anteriorly approx 3cm prox to anal verge

A

solitary rectal ulcer syndrome

53
Q

42 y/o male

pc: painless lump left testicle, firm nodulse. USS shows irregular mas lesion. normal AFP and HCG levels.

likely diagnosis:

A

seminoma

- typically have normal AFP and HCG

54
Q

A 40-year-old female presents to the GP with unusual discharge from her breast. She has no children and is not breastfeeding but is complaining of blood stained discharge from her nipple.

A

duct papilloma

- may present with blood stained discharge

55
Q

A 34-year-old female presents with a 1-month history of a breast lump. She first noticed it after she tripped and fell over. It was initially firm. On examination, there is a hard irregular lump.

A

fat necrosis

- typically firm initially and then may develop into a hard irregular lump

56
Q

management for anal fissures not responding to conservative measures:

A

anal fissures

57
Q

A 65-year-old man with carcinoma of the caecum management

A

right hemicoloectomy

58
Q

Struvite is…

A

magnesium ammonium phosphate

59
Q

15 y/o male

pc: patch of hair growing over lower lumbar spine, birth mark in same location.

lower limb neuro exam normal

known as:

A

spina bifida occulta

60
Q

double wall sign on abdominal x-ray indicates

A

RIGLERS sign

free air in abdomen

61
Q

this is:

  • common in males
  • between 10-20 years
  • onion type periosteal reaction on x-ray
A

Ewing’s sarcoma

62
Q

this has a ‘soap bubble appearance’ on x-ray?

A

giant cell tumour

63
Q

22-year-old woman presents with macroscopic haematuria. She is sexually active. She is known to have renal calculi and had a berry aneurysm clipped.

A

Adult polycystic kidney disease

APKD is associated with liver cysts (70%), berry aneurysms (25%) and pancreatic cysts (10%). Patients may have a renal mass, hypertension, renal calculi and macroscopic haematuria.

Pass Med finals pack (40 decks)

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