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Meded Flashcards 2020 > Extra questions > Flashcards

Extra questions Flashcards

1
Q

Narrow pulse pressure, Heaving/thrusting undisplaced apex beat
Soft 2nd heart sound (due to calcification)
Ejection systolic murmur heard in aortic area radiating to carotids and apex

A

Aortic stenosis (Triad of
exertional syncope,
dyspnoea, angina)

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2
Q

Displaced, volume overloaded apex beat (thrusting)
Soft 1st heart sounds
Blowing Pansystolic murmur at apex radiating to axilla (louder in expiration)
Atypical chest pain = mitral valve prolapse

A

Mitral regurgitation (pink
frothy sputum; MI –
rupture of papillary
muscle)

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3
Q

Wide pulse pressure (158/61)
Displaced, volume overloaded apex beat
Early diastolic murmur at lower sternal edge (best heard leaning forward at expiration)
Soft, low pitched rumbling mid-diastolic murmur -Austin flint murmur (severe AR)

A

Aortic regurgitation

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4
Q

Tapping apex beat + Malar flush
Loud 1st heart sound (opening snap)
Rumbling mid-diastolic murmur at apex (louder in left lateral position at expiration)

A

Mitral stenosis

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5
Q

Graham Steel murmur (pulmonary regurgitation 2° to pulmonary hypertension
resulting from mitral stenosis)
High pitched early diastolic murmur heard best at the left sternal edge 2
nd ICS

A

Mitral stenosis (common
cause: Rheumatic heart
disease)

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6
Q

Mid-systolic click+ late systolic murmur (Barlow syndrome)

A

Mitral valve prolapse

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7
Q

Large systolic V waves
Pansystolic murmur lower left sternal edge (best heard in inspiration) (Carvallo’s sign)
L parasternal heave, pulsatile liver
Increased JVP to ear lobe + hepatomegaly + IVDU

A

Tricuspid regurgitation

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8
Q

Harsh pansytolic murmur lower left sternal edge

Left parasternal thirll

A

Ventricular septal defect

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9
Q

Continous machine like murmur heard inferior to left clavicle, left subclavicular thrill
Bounding pulse, widened PP

A

Patent ductus arteriosus

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10
Q

Wide, fixed split second heart sound
Ejection systolic murmur, 2nd 3
rd intercostal space (RBBB)

A

Atrial septal defect

maybe Down’s

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11
Q

MIdsystollic murmur, louder with Valsalva (worsened ventricular outflow tract
obstruction); does not radiated

A

HOCM (AS: quieter with

Valsalva)

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12
Q

3
rd Heart sound (S3/ventricular gallop) – early diastole (low frequency) due to rapid
ventricular filling

A

Heart failure, MI,
cardiomyopathy, HTN,
mitral/aortic regurge

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13
Q

4
th Heart sound – due to atrial contraction which cause rapid flow of blood from atria
to non-compliant stiffened ventricle and vibration in blood

A

HTN, aortic stenosis,
hypertrophic
cardiomyopathy

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14
Q

Malar (cheek) flush + pulmonary oedema (frothy sputum) + mid-diastolic
murmur

A

Mitral stenosis

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15
Q

Pulsatile hepatomegaly + Jaundice

Left Lower Sternal Edge pan-systolic murmur in inspiration

A

Tricuspid regurgitation

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16
Q

Carotid pulsation (Corrigan’s sign)
Head nodding (De Musset’s sign)
Capillary pulsations in nail bed (Quincke’s sign)
Pistol-shot heard over femorals (Traube’s sign)

A

Aortic regurgitation

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17
Q 
Roth’s spots (boat-shaped retinal haemorrhage with a white centre)
Osler nodes (painful hard swellings on finger/toes)
Janeway lesions (painless blanching macules seen on palmar surfaces
A 
Infective endocarditis (abdo signs:
splenomegaly, microscopic haematuria)
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18
Q

Beck’s triad (Low BP + Increased JVP + Muffled heart sounds)

A

Cardiac tamponade – can get PEA

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19
Q

Pancarditis; Arthritis; Subcutaneous nodules (small, painless nodules on
extensors);Erythema marginatum (Red, raised edges with central clearing)
Syndenham’s Chorea

A

Rheumatic Fever

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20
Q

Absent p wave

A

Atrial fibrillation

Sinoatrial block

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21
Q

Saw tooth pattern with normal complexes

A

Atrial flutter

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22
Q

Bifid p wave (P mitrale)

A

Left atrial hypertrophy (mitral

stenosis)

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23
Q

Peaked p wave (P pulmonale)

A

Right atrial hypertrophy (pulmonary

hypertension, tricuspid stenosis)

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24
Q

ST depression

A

Myocardial ischaemia

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25
Q

ST elevation

A

Acute myocardial infarction

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26
Q

Hyperacute T waves (inverts later in V5,6) + Q wave formation
ST elevation in Leads 2, 3, aVF

A

Inferior infarct (Right coronary artery)

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27
Q

ST elevation in Leads 1, aVL. V2-V6

A

Anterolateral infarct (left main
stem/left coronary artery as both LAD
and LCX come off from them)

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28
Q

ST elevation in V1-V4

A

Anterior infarct (LAD)

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29
Q

Reciprocal changes V1, V2 (tall R wave., ST depression in V1-V3, tall
upright T waves)

A 
Posterior infarct (posterior descending,
usually a branch of R coronary 70%
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30
Q

ST depression, T wave inversion

A

NSTEMI

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31
Q

‘Saddle’ shaped ST elevation + PR depression (most sensitive marker)

A

Acute pericarditis

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32
Q

S1, T3, Q3 pattern (Deep S waves in I, Q waves in III, T waves in III)
RBBB + RAD (dominant R in V1 rS), inverted T in V1-3, Deep wide S wave
in V6 qRs

A

Pulmonary embolus (rare), also see
Peaked p wave in lead 2 – p
pulmonale

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33
Q

Tall tented T waves, wide QRS complex (sine wave), P wave flattening,
Long PR

A

Hyperkalaemia

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34
Q

Flattened T wave, Prominent U waves, Depressed ST, Long PR and Long
QT weakness, cramps, tetany)

A

Hypokalaemia (Weakness, arrhythmia,

polyuria → increase ADH resistance

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35
Q

Long QT interval, tetany perioral paraesthesia, carpopedal spasm

A

Hypocalcaemia

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36
Q

Upward deflection following R wave of QRS complex (J wave) (Osborn)

A

Hypothermia

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37
Q

M pattern in V6 and inverted T waves in lateral leads (I, aVL and V5. 6)

A

Left bundle branch block (IHD, HTN,
aortic stenosis, cardiomyopathy,
idiopathic Fibrosis, digoxin toxicity

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38
Q

Dominant R in V1 (rSR pattern), Inverted T waves in V1-V3, Deep wide S
waves in V6 (qRs

A

Right bundle branch block (atrial

septal defect, inferior MI, RVH

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39
Q

PR > 200ms

A

1

st Degree Heart Block

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40
Q

Progressive lengthening of PR interval + one non-conducted P wave

A

2
nd Degree Heart Block
(Wenckebach/Mobitz I)

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41
Q

Constant PR + occasional non-conducted P wave, wide QRS

A

2

nd Degree Heart Block (Mobitz II)

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42
Q

P waves and QRS at different rates - dissociation

A

3

rd Degree Heart Block

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43
Q

Absent P wave or immediately before/after QRS

Normal QRS

A

AV Nodal Re-entrant Tachycardia

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44
Q

Short PR interval + Slurred upstroke of QRS in V3/4

(if LAD –ve AvF → Type B right sided accessory pathway

A

Wolff-Parkinson’s White syndrome

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45
Q

RBBB + Coved ST elevation in V1-3

A

Brugada syndrome

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46
Q

Down-slopping ST depression + T wave inversion (Reverse tick)

A

Digoxin

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47
Q

Disorganised broad complex, irregular rhythm with fluctuating base time

A

Ventricular fibrillation

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48
Q

Broad complex tachycardia with rate of 210 beats/min on variable axis
Hx of schizophrenia (polymorphic ventricular tachycardia)

A

Torsades de pointes

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49
Q

Inverted P wave

A

Dextrocardia

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50
Q

R1 tall, S6 deep

A

Right ventricular hypertrophy

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51
Q

S+ R >= 7 large square by voltage criteria

A

Left ventricular hypertrophy

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52
Q

63M, HTN, sudden tearing chest pain radiating to back

+/- Tall, high arched palate

A

Aortic dissection, Type A requires surgery, Type B

requires aggressive reduction of BP

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53
Q

40F, sudden onset SOB following hip surgery, tachypnoea,

RAD

A

PE

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54
Q

60M, central crushing chest pain, radiating both arm after

running, relieved by rest, ECG normal after 1 h

A

Angina

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55
Q

21M, tall, acute onset SOB, right side pleuritic chest pain,

increased resonance, reduced expansion on right

A

Pneumothorax

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56
Q

23M, left sided chest pain, worsen by cough, painful on

light pressure, normal ECG, pain relieved aspirin

A

Constipation, tiredness fatigue, flushing, headache

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57
Q

Acute lower chest pain, upper abdo pain following
vomiting; marked tenderness in epigastrium, presence of
sc emphysema, ECG: sinus tachycardia, no ST segment
changes, chest-Xray: mediastinal air

A

Boerhaave syndrome = transmural rupture of the
oesophagus
Mackler’s triad of vomit, lower thoracic pain, sc
emphysema =; Dx confirmed with gastrografin
swallow; Mallory-Weiss Tear: haematemesis after vomit

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58
Q

Intermittent attack of sharp pain over lower left side of
chest, feverish over 2 days
Exacerbated by movmenet of rib cage, difficult to breath

A

Bornholm disease (caused by Coxsackie B virus)

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59
Q

Pain in ribs/tenderness +/- swelling

A

Costochondritis/Tietze’s syndrome

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60
Q

1 month post MI, pain on inspiration, low grade fever,

central sharp chest pain, better leaning forwards

A

Dressler’s syndrome

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61
Q

Chest pain, ST segment depression, coronary angiogram

Normal

A

Cardiac syndrome X (microvascular angina) – Tx: CCB

nifedipine

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62
Q

Chest pain, ST elevation, angiogram: exaggerated spasm

Tx: CCB

A

Prinzmetal’s/variable angina (vasospasm of coronary a)

Gold Ix: coronary angiography + injection of agent

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63
Q

Chest pain while lying down

A

Decubitus angina

64
Q

Young footballer collapse and die

PMHx: 2 episodes of syncope at gym

A

HOCM (AD, hypertrophy of interventricular septum –

cardiac pacing, internal cardiac defibrillator

65
Q

SOB on exertion + lying down
Multiple spider naevi + face, apex beat displaced laterally
Pansystolic murmur + heartbeat irregularly irregular

A

Dilated cardiomyopathy

66
Q

64F weight loss, low grade fever, nonspecific chest pain,

palpitations

A

Atrial myxoma – loud 1st HS

ECG: polypoid mass attached to septal wall on LA

67
Q

Central chest pain stabbing in nature, worse lying down

High K, Urea, Creatinine, sodium

A

Uraemic pericarditis

68
Q

46F, Hx of worsening SOB + low exercise tolerance
Lethargy, muscle aches, fever, palpitations 2 weeks
Raised WCC, CRP

A

Myocarditis (due to Coxsackie B virus), troponin,
cardiac enzyme elevated. Endomyocardial biopsy aid
Dx

69
Q

24 ECG tape: Period of sinus bradycardia + episodes of

sinus tachycardia

A

Sick sinus syndrome (dysfunctional sinoatrial node, 2°

to age realted fibrosis)

70
Q

Key management to know in pneumothorax

A

<2cm in 1° pneumothorax: Discharge, >2cm aspiration: large bore cannula inserted into 2nd CIS MCL, up to 2.5L can be
aspirated, f/up CXR just after, 2h, 2 weeks later, avoid diving
2° pneumothorax: Chest drain with water seal if >2cm, insert into 4th
-6
th ICS MAL

71
Q

Mx of Acute MI

A

Morphine; Oxygen; Nitrates ;Antiplatelets (aspirin + clopidogrel); Beta-blockers (limit size of MI, reduce subsequent
mortality); ACE inhibitors ; Statins ; IV unfractionated Heparin (if undergoing PCI)
Patient presenting < 12 hours from onset of symptoms
•Send to cathlab for PCI if it can happen within 120 mins of the time that fibrinolysis could have been administered
Patient presenting > 12 hours from onset of symptoms
•Coronary angiography followed by PCI if indicated
Year 3 Cheat Sheet Prepared by J.J Teh
Page 9 of 67
Cyclizine contraindicated – (antihistamine that can precipitate tachycardia and increased ventricular filling pressure

72
Q

What is polymorphic VT

A

Asubtype of polymorphic VT is torsades de pointes; precipitated by long QT interval

73
Q

What are causes of Dilated cardiomyopathy and signs on examination

A

Cause of Dilated: Cosackie B virus, Wet Beri-beri, doxorubicin, Alcohol (+ cause Mitral regurgitation)
o Increased JVP, displaced apex beat, functional MR, TR, 3rd heart sound

74
Q

What are causes of restrictive cardiomyopathy and signs on examination

A

Cause of Restrictive: Amyloidosis, Sarcoidosis. Loeffler’s endocarditis, haemochromatosis
o Kussmaul’s sign (raised JVP on inspiration), 3rd heart sound, ascites, ankle oedema

75
Q

What are causes of hypertrophic cardiomyopathy and signs on examination

A

Jerky carotid pulse, double apex beat, ejection systolic murmur

76
Q

65M HF, need rate control to treat coexisting AF

A

Digoxin

77
Q

65F, with large doses of loop diuretics requires additional

therapy for oedema

A

Metolazone – (thiazides: remains effective in presence

of renal impairment)

78
Q

69F, asthmatic, treated with loop diuretics, ACEi, long

acting nitrate + need one more drug

A

Spironolactone – if not asthmatic, then beta-blocker

carvedilol

79
Q

60F, severe pulmonary oedema

A

100% O2, IV diamorphine, IV furosemide, sublingual

GTN

80
Q

Tx of mild Sx of SOB and ankle oedema in 65M with LV

dysfunction, on ACEi already

A

Oral furosemide

81
Q

65M with AF >48 hours before DC cardioversion

A

Digoxin rate control+ warfarin for a month

82
Q

60F, severely compromised with acute persistent AF

A

DC shock (synchronised) + heparin

83
Q

55M, acute MI, develop short run of symptomatic
ventricular tachycardia despite bisoprolol 10mg, need Tx
for prophylaxis against recurrent VT

A

IV amiodarone

84
Q

50M unidentifiable, regular narrow complex tachycardia,

need a drug to aid Dx

A

IV adenosine, can terminate tachycardia involving AV

re-entry circuit (avoid asthmatic, use verapamil)

85
Q

50M unidentifiable, regular narrow complex tachycardia,

need a drug to aid Dx

A

IV adenosine, can terminate tachycardia involving AV

re-entry circuit (avoid asthmatic, use verapamil)

86
Q

57M, 4hrs of crushing chest pain, ST elevation Lead 2,3,

aVF (refuse surgery?)

A

Aspirin + Streptokinase (develop anti-streptokinase

immunoglobulin G antibody; have other tPMA instead

87
Q

65M, chest pain, unresponsive, VF

A 
DC shock (unsychronised)+ adrenaline
Initial shock: 200J bisphasic or 360K uniphasic and CPR
88
Q

40F, collapse after flight, breathlessness, R-sided pleuritic chest pain

A

100% O2, SC LMWH, IV fluids

89
Q

Acutely painful L calf after flight, US: DVT extending above

popliteal veins

A

SC LMWH (enoxaparin, dalteparin, tinzaparin), if they
have heparin induced thrombocytopenia, give Factor
Xa antagonist (Foundaparinux), give for at least 5 days
until INR between 2-3, then warfarin

90
Q

45M, chronic glomerulonephritis, severe headache,

papilloedema, bilateral retinal haemorrhages, 240/132

A

Labetalol

91
Q

What is the score used for Heart failure?

A

Framingham

92
Q

On a chest x ray what does a tram line shadowing indicate

A

Bronchiectasis

93
Q

On a chest x ray what does Miliary shadowing indicate

A

Miliary TB

94
Q

On a chest x ray what does Wedge-shaped infarct indicate

A

Pulmonary embolus

95
Q

On a chest x ray what does Ground-glass appearance

Honeycomb appearance

A

Fibrosis

Fibrosis (late)

96
Q

On a chest x ray what does Pleural mass with lobulated margin

A

Mesothelioma

97
Q

Early-onset emphysema plus liver disease

A

Alpha-1 antitrypsin deficiency

98
Q

Fever, cough, SOB hours after exposure to antigen

A

Extrinsic allergic alveolitis

99
Q

Asymptomatic with bilateral hilar lymphadenopathy
(BHL)/progressive SOB/dry cough, non-caseatinag granuloma
Non-pulmonary manifestations (erythema nodosum)
Increased serum ACE or hypercalcaemia

A

Sarcoidosis (lupus pernio: raised violaceous
(red/blue) lesion with papules centrally in
nose,cheek, ears; can get uveitis -red pain eye)

100
Q

Hx of recurrent chest infection
Steatorrhea (pancreatic insufficiency)
Positive sweat test >60mmol/l

A

CF (common organism: Pseudonomas

aeruginosa)

101
Q

Progressive dyspnoea and cyanosis
Gross clubbing, fine end-inspiratory crackles +
Groundglass/honeycomb lung

A

Fibrosing alveolitis (IPF)

102
Q

Non-specific e.g. fever, night sweats, anorexia, haemoptysis

Ziehl-Neelsen staining- acid fast bacilli

A

TB (culture: Lowenstein-Jensen media),

homeless, crowding, endemic areas

103
Q

Extra-pulmonary infection of TB
cervical LN – abscesses/sinuses – discharge pus, spread to sin
(scrofuloderma), lupus vulgaris (brown coloured nodular lesion
on anterior neck, apple jelly appearance on diascopy)
Screening: Mantoux test: intradermal injection of tuberculin

A

TB meningitis, Pott’s disease (vertebral),
disseminated military TB, Addison’s, Renal (2nd
most common = sterile urine)
purified protein derivative; 72hrs; cannot
distinguish between latent and active TB

104
Q

Swinging fever, copious foul smelling sputum

Persistent, worsening pneumonia

A

Lung abscess

105
Q

Builder, left side chest discomfort progressive over 2 weeks

Left lower lobe dull to percuss, pleural tap = blood stained fluid

A

Mesothelioma

106
Q

Weight loss, loss of appetite, SOB
Reduced air entry, dullness to percussion in Right lung
Pleural tap: Protein content of >30g (exudative)

A 
Bronchogenic carcinoma (met to liver, brain,
bone) – bronchoscopy to diagnose, CT to stage
107
Q

Never smoked, weight loss, decreased appetite
Finger clubbing, X-ray opacity in hilar region, awaiting
bronchoscopy and CT chest

A

Adenocarcinoma (one of the non-small cell,
arise in peripheral lung, pleural involvement,
female)

108
Q

Male smoker, product PTHrp, hypercalcaemia of malignancy

Bone pain, renal stones, abdo pain, high Ca, dehydrated

A 
Squamous cell (non-small cell carcinoma) –
found in central airways, clubbing
109
Q

Ex-smoker, hyponatramic, 110/78, well hydrated, shipyard

A

Small cell carcinoma (ADH/ACTH production,

Lambert-Eaton); Central lung, smoking

110
Q

Features associated with Pancoast tumour

A

Hoarseness, anhidrosis, ptosis, miosis, weakness

of small muscles of hand

111
Q

Early morning headache, facial congestion, oedema in arms,

distended veins on chest and neck, blackouts

A

SVC Obstruction (elicited by Pemberton’s sign)

112
Q

CXR = white lesions over both lungs that cross lobar boundaries
Bilateral lower zone reticulonodular shadowing, pleural
plaques, white line in diaphragmatic pleura – holly leaf

A

Asbestos related lung disease

113
Q

Multiple large, round, well-circumscribed masses in both lungs

A

Cannon-ball metastasis (most likely from RCC)

114
Q

6/12 Hx of worsening SOB
Bilateral end inspiratory crackles + clubbing
CXR = reticulonodular shadowing in Lower zones

A

Cryptogenic fibrosing alveolitis = idiopathic
pulmonary fibrosis
FEV1: FVC ratio > 70% = restrictive

115
Q

4/12 Hx Hx of worsening SOB
Bilatral end inspiratory crackles + clubbing
CXR = reticulonodular shadowing in upper zones

A

Extrinsic allergic alveolitis (inhalation of
organic dusts – immune complex mediated
reaction + formation of granulomas, e.g.
Farmer’s lung, bird fancier’s lung, malt worker’s
lung)

116
Q

Massive haemoptysis + 2 similar episodes last months
Often feel SOB + finished course of Tx for TB
CXR: Cavitating lesions with opaque mass in it

A

Aspergillosis (Caused by aspergillus fumigatus),
when spores lodge in pulmonary tissue, usually
lungs that have been damaged previously

117
Q

What causes consolidation in the upper zone

A 
A PENT
Aspergillosis (Aspergilloma: round opacity with a crescent of air around it)
o Pneumoconiosis (beryliosis)
o Extrinsic allergic alveolitis
o Negative, sero-arthropathy
o TB
118
Q

What causes consolidation in the lower zones

A

STAIRS
Sarcoidosis (mid zone)
o Toxins (Methotrexate MTX, amiodarone nitrofurantoin, bleomycin
o Asbestosis
o Idiopathic pulmonary fibrosis
o CTD: Rheumatoid arthritis (sarcoid, SLE) → Look for velcroe fine bibasal crackles

119
Q

What causes T1RF

A

Pneumonia, pulmonary embolism, asthma, emphysema, fibrosing

alveolitis, ARDS (PO2 <8.0, PCO2 Normal or low)

120
Q

What causes T2RF

A

(alveolar hypoventilation), with or without V/Q mismatch): COPD, asthma, pneumonia, Obstructive
sleep apnoeal, reduced respiratory drive (sedative drugs, CNS tumour, trauma), neuromuscular lesions (cervical cord
lesions, GB, MS, diaphragmatic paralysis), thoracic wall disease (flail chest, kyphosis) (PO2<8, PCO2 > 6.0kPa)

121
Q

What causes ARDS

A

Pulmonary (Pneumonia, gastric aspiration, vasculitis), extrapulmonary (septic/haemorrhagic shock,
DIC, pancreatitis, multiple transfusion)

122
Q

Contact with birds
Dry cough, fever, arthralgia, hepatosplenomegaly
Patchy lower lobe consolidation

A

Chlamydia Psittaci

Mx: Tetracycline

123
Q

HIV+ve, bilateral hilar shadowing
Dry cough, fever, SOB, weight loss, night sweats
O2 sat low, boat shaped organism with silver stain

A

Pneumocystis jiroveci pneumonia (Mx: Cotrimaxazole)

124
Q

Cavitating lungs (+ air fluid levels/abscesses)

A

Staphylococcal/klebsiella infection
Other DDx of cavitating lesion: Squamous
cell carcinoma, Wegner’s

125
Q

Occupation involving water systems, deranged LFTs
Dry cough, myalgia, malaise, GI Sx, confusion, low sodium, albumin
Ix: Urinary Legionella antigen detection

A

Legionella (IV ciprofloxacin (fluroquinolone),
clarithromycin (macrolide)
Non-pneumatic legionella = Pontiac fever

126
Q

Frequent admission to hospital for chest infection since younger *CF
background, green biofilm

A

Pseudomonas Aeruginosum Mx: Tazocin

Piperacillin/tazobactam

127
Q

Positive cold agglutinins, low grade fever
Eyrthema nodosum. Younger adolescents and adults
Headache, malaise which preceded chest Sx, dry cough

A 
Mycoplasma pnuemoniae (IXR: PCR)
Mx: Erythromycin/clarithromycin
128
Q

Cough + expectorating rusty sputum + consolidation of right lower
lobe (herpes labialis – cold sore)

A

Streptococcus pneumoniae

129
Q

IVDU, central venous catheters, patches like abscess, post-influenza

A

Staph aureus

130
Q

Hospital acquired infection, aspiration pneumonia
Cough productive of purulent dark sputum. Widespread
consolidation (upper lobes)

A

Klebsiella pneumonia

131
Q

Known COPD, amoxicillin + prednisolone little effect

Cough up thick yellow sputum, fever, breathlessness

A

Haemophilus influenzae

132
Q

Mx of aspiration pneumonia

A

IV cefuroxime and metronidazole (need to

cover anaerobic bacteria)

133
Q

X rays:
Multiple bilateral nodules (0.5-5cm) former miner + Rheumatoid
arthritis

A

Caplan’s syndrome (presence of pulmonary

nodules in rheumatoid arthritis)

134
Q

X rays:
Kerley B lines, bat-wing shadowing, prominent upper lobe
vessels, cardiomegaly

A

Left ventricular failure

135
Q

X rays:
Trachea deviated to right, horizontal fissure and right hilum
displaced upwards + Golden S Sign

A

Right upper lobe collapse

136
Q

X rays:
Hazy white appearance over a large part of left lung field +
tracheal deviation to side of lesion, elevation of hilum +
preservation of costophrenic angle

A

Left upper lobe collapse

137
Q

Sail sign

A

Left lower lobe collapse (form a 2nd heart

borde

138
Q

Numerous calcified nodules <5mm located lower zones of

lungs

A

Previous varicella pneumonitis

139
Q

Double shadow right heart border, prominent left atrial

appendage, left main bronchus elevation

A

Mitral stenosis (left atrial enlargement)

140
Q

Dry cough + progressive SOB + bilateral hilar lymphadenopathy

A

Sarcoidosis

141
Q

CF + tramline + ring shadows

A

Bronchiectasis (causes: Kartagener’s, pertussis)

142
Q

Calcified pleural thickening (holly leaves)

A

Asbestos-related lung disease

143
Q

Clubbing + progressive SOB + fine end-inspiratory crackles,

ground glass appearance of lung

A

Idiopathic pulmonary fibrosis

144
Q

Smoker, 8 ribs anteriorly above diaphragm on each side of the
chest in MCL

A

COPD

145
Q

Worsening SOB + sputum, X-ray: air-fluid level behind heart, no
consolidation

A 
Hiatus hernia (Nissen’s fundoplication) =
Definitive Ix: Barium swallow
146
Q

Free gas under the diaphragm

Epigastric discomfort of several months

A

Perforated ulcer

147
Q

Elderly constipated woman + nausea, inverted U loop of bowel

X-ray: a single loop of dilated bowel that turns back on itself

A

Sigmoid volvulus, coffee bean sign, Mx: passing
flatus tube into sigmoid colon via rectum,
laparotomy

148
Q

Fever and bloody diarrhoea
Tachycardic, HB of 10.0, loss of haustral pattern, colonic dilation
of 8cm

A 
Ulcerative colitis (pseudopolyps)
Haustra = feature of large bowel (do not
transverse, peripherally placed
149
Q

Bloody diarrhoea, abdominal pain, weight loss

Barium enema: Cobble stoning and colonic strictures

A

Crohn’s disease – ulceration and fissuring give

rise to rose thorn ulcer

150
Q

12cm dilation of transverse colon with colonic wall thickening

A

Toxic megacolon (linked with UC)

151
Q

Severe epigastric pain and vomiting

AXR: Psoas shadow and sentinel loop of proximal jejunum

A

Build of retroperitoneal fluid
Sentinel loop: Segment of gas-filled proximal
jejunum → Pancreatitis

152
Q

AXR: Multiple loops of dilated small bowel and gas in biliary tree

A 
Gallstone ileus (cholecyo-duodenal fistula allows
air into biliary tree; rare cause of SB obstruction)
153
Q

Widened mediastinum and double right heart border (dilated
oesophagus), air-fluid level in upper chest, absence of normal
gastric air bubble

A

Achalasia

154
Q

Psychiatric problem, young female, 12 month Hx of indigestion,
nausea, stomach upsets
Barium swallow: irregular, round filling defect in duodenum

A

Bezoar: Indigestible mass of material, usually

hair or fibres in stomach or intestine

155
Q

Chronic liver disease + Dysarthria + Dyskinesia (clumpsy)+
dementia + Kayser-Fleischer ring (brown ring around iris)
+/- Parkinsonian (rigidity+ tremor + bradykinesia)

A

Wilson’s disease (Chr13, AR) – basal ganglia deposits
Ix: Low serum caeruloplasmin, low serum free copper;
high urinary copper (Mx: Penicillamine)
Acute: Haemolytic anaemia; T2 RTA

Meded Flashcards 2020 (36 decks)

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