extra passmed questions 3 Flashcards
what is meckels diverituclum?
- pouch
- may be lined with ectopic gastric mucosal tissue
- produce bleeding
- congenital
what type of shock most commonly occurs following a spinal cord transection?
- neurogenic shock
- vasolidation –> decreased preload –> decreased cardiac output –> hypotension
- patient will need vasopressors !
- to reverse profound v.dilation
which pancreatic enzyme would you use to diagnose acute pancreatitis?
- serum lipase has longer half life than amylase
- may be useful in late presenting patients
3 - 4.4cm
small aneurysm
action
rescan every 12 months
4.5 - 5.4cm
medium aneurysm
action:
rescan every 3 months
> 5.5cm
large aneurysm
action:
refer within 2 weeks to vascular surgery
next appropriate step in management of patient with long saphenous vein superficial thrombophlebitis?
USS
to exclude underlying DVT
TX: bed red and analgesia
absent T waves
hypokalaemia
Reynold’s pentad is
charcots triad
- RUQ pain
- jaundice
- fever
and
- hypotension
- confusion
Beck’s triad
- hypotension
- raised JVP
- muffled heart sounds
CARDIAC TAMPONADE
Cushing’s triad
- irregular and decreased resp rate
- bradycardia
- hypertension
RAISED INTRACRANIAL PRESSURE
45 y/o female
pc: 3cm breast lump
ER+, HER2- tumour, confined to breast
describe this case and next stage of management:
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
abdominal pain
- presents post meal
- nausea vomiting
- pain radiates to shoulder
indicative of:
biliary colic
- esp if obs are normal
investigation for suspected bowel perforation
erect chest x-ray
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:
Lynch syndrome
aka HNPCC
Amsterdam criteria used to identify families at risk
mode of inheritance of BRCA gene
autosomal dominant
so 50% chance of passing this on
management for anal fissures not responding to conservative management:
sphincterotomy
anal fissures
- longitudinal or elliptical tears at squamous lining of distal anal canal
in management of ER +ve beast cancer what drugs are used:
ER+ = aggressive
Either:
- aromatose inhibitors
- anastrozole
- side effect: osteoporosis - anti-oestrogen medications is Selective oEstrogen Receptor Modulators (SERM)
- tamoxifen
- side effect: VTE, endometrial cancer
causes of unilateral hydronephrosis:
PACT
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
causes of bilateral hydronephrosis:
SUPER
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
Investigations and management for hydronephrosis
- USS first line
- IVU (intravenous urogrpahy) assess position of obstruction
- Antegrade or retrograde pyelography- allows treatment
- if you suspect stones: CT scan
management
- remove obstruction
- acute: nephrostomy
- chronic: ureteric stent
What is the mechanism of action of goserelin in prostate cancer?
GnRH agonist
- provides negative feedback to the AP
28 y/o hypertension + haematurua + polycytheaemia, CT shows L renal mass
renal adenocarcinoma
68 y/o recurrent episodes of LHS ureteric colic + haematuria + dilatation of renal pelvis
transitional cell carcinoma
A 4-year-old boy presents with haematuria and on examination is found to have a right sided renal mass.
Wilms tumour (nephroblastoma)
Which one of the following may be used to monitor patients with colorectal cancer?
Carcinoembryonic antigen (CEA)
analgesia recommended for acute management of renal colic
IM diclofenac
what is an indicator of severe illness in pancreatitis:
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.
summarise the causative organisms in epididymitis
E Coli
- older adults esp with prior BPH dx
Chlamydia and N. Gonnorrhoea
- younger men
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:
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
what is an emergency Hartmann’s procedure?
- resection of rectosigmoid colon
- end colostomy formed
- indicated by perforation of rectosigmoid bowel leading to subsequent peritonitis
87 y/o female
pc: right nipple very itchy
oe: erythematous, blood stained discharge on inside of bra
indicative of:
paget’s disease of nipple
- skin changes
- associated with breast malignancy
- weeping crusty lesion
- areolar lesion spared ?
mx
- imaging and biopsy
mention of bubbly urine may indciate:
fistula between bowel and bladder
e.g enterovesicual fistula
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:
varicocele
management of epididymal cyst:
usually supportive
surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts
management of varicocele:
usually conservative
surgery if patient troubled by pain
first-line investigation in suspected prostate cancer
refer for multiparametric MRI
common complication of radical prostatectomy?
- incontinence
- erectile dysfunction
common complication of TURP
retrograde ejaculation
most common organism causing cholangitis
E .COLI
Acute upper urinary tract obstruction is managed with
nephrostomy
tumour marker for hepatocellular carcinoma
AFP
This man’s tumour is in the rectum and sigmoid colon.
what is the most appropriate operation?
anterior resection
32 y/o male with Crohns
pc: intermittent jaundice, obstructive. usually resolves spontaneously.
diagnosis:
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
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.
hepatitis A
this is spouted!
ileostomy
this is flat against the skin!
colostomies
A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.
fibroadenoma
A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.
fibroadenosis
what kind of drugs are useful in patients with overactive bladder?
anti-muscarinic drugs
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.
fissure in ano
young patients + painful rectal bleeding –> fissure
tx
- stool softener
- either GTN or diltiazem
24 y/o long hx obstructed defecation and chronic constipation and straining.
OE: indurated area located anteriorly approx 3cm prox to anal verge
solitary rectal ulcer syndrome
42 y/o male
pc: painless lump left testicle, firm nodulse. USS shows irregular mas lesion. normal AFP and HCG levels.
likely diagnosis:
seminoma
- typically have normal AFP and HCG
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.
duct papilloma
- may present with blood stained discharge
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.
fat necrosis
- typically firm initially and then may develop into a hard irregular lump
management for anal fissures not responding to conservative measures:
anal fissures
A 65-year-old man with carcinoma of the caecum management
right hemicoloectomy
Struvite is…
magnesium ammonium phosphate
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:
spina bifida occulta
double wall sign on abdominal x-ray indicates
RIGLERS sign
free air in abdomen
this is:
- common in males
- between 10-20 years
- onion type periosteal reaction on x-ray
Ewing’s sarcoma
this has a ‘soap bubble appearance’ on x-ray?
giant cell tumour
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.
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.
