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)
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)
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
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
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)
6
Q
Mid-systolic click+ late systolic murmur (Barlow syndrome)
A
Mitral valve prolapse
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
8
Q
Harsh pansytolic murmur lower left sternal edge
Left parasternal thirll
A
Ventricular septal defect
9
Q
Continous machine like murmur heard inferior to left clavicle, left subclavicular thrill
Bounding pulse, widened PP
A
Patent ductus arteriosus
10
Q
Wide, fixed split second heart sound
Ejection systolic murmur, 2nd 3
rd intercostal space (RBBB)
A
Atrial septal defect
maybe Down’s
11
Q
MIdsystollic murmur, louder with Valsalva (worsened ventricular outflow tract
obstruction); does not radiated
A
HOCM (AS: quieter with
Valsalva)
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
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
14
Q
Malar (cheek) flush + pulmonary oedema (frothy sputum) + mid-diastolic
murmur
A
Mitral stenosis
15
Q
Pulsatile hepatomegaly + Jaundice
Left Lower Sternal Edge pan-systolic murmur in inspiration
A
Tricuspid regurgitation
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
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)
18
Q
Beck’s triad (Low BP + Increased JVP + Muffled heart sounds)
A
Cardiac tamponade – can get PEA
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
20
Q
Absent p wave
A
Atrial fibrillation
Sinoatrial block
21
Q
Saw tooth pattern with normal complexes
A
Atrial flutter
22
Q
Bifid p wave (P mitrale)
A
Left atrial hypertrophy (mitral
stenosis)
23
Q
Peaked p wave (P pulmonale)
A
Right atrial hypertrophy (pulmonary
hypertension, tricuspid stenosis)
24
Q
ST depression
A
Myocardial ischaemia
25
ST elevation
Acute myocardial infarction
26
Hyperacute T waves (inverts later in V5,6) + Q wave formation
ST elevation in Leads 2, 3, aVF
Inferior infarct (Right coronary artery)
27
ST elevation in Leads 1, aVL. V2-V6
Anterolateral infarct (left main
stem/left coronary artery as both LAD
and LCX come off from them)
28
ST elevation in V1-V4
Anterior infarct (LAD)
29
Reciprocal changes V1, V2 (tall R wave., ST depression in V1-V3, tall
upright T waves)
```
Posterior infarct (posterior descending,
usually a branch of R coronary 70%
```
30
ST depression, T wave inversion
NSTEMI
31
‘Saddle’ shaped ST elevation + PR depression (most sensitive marker)
Acute pericarditis
32
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
Pulmonary embolus (rare), also see
Peaked p wave in lead 2 – p
pulmonale
33
Tall tented T waves, wide QRS complex (sine wave), P wave flattening,
Long PR
Hyperkalaemia
34
Flattened T wave, Prominent U waves, Depressed ST, Long PR and Long
QT weakness, cramps, tetany)
Hypokalaemia (Weakness, arrhythmia,
| polyuria → increase ADH resistance
35
Long QT interval, tetany perioral paraesthesia, carpopedal spasm
Hypocalcaemia
36
Upward deflection following R wave of QRS complex (J wave) (Osborn)
Hypothermia
37
M pattern in V6 and inverted T waves in lateral leads (I, aVL and V5. 6)
Left bundle branch block (IHD, HTN,
aortic stenosis, cardiomyopathy,
idiopathic Fibrosis, digoxin toxicity
38
Dominant R in V1 (rSR pattern), Inverted T waves in V1-V3, Deep wide S
waves in V6 (qRs
Right bundle branch block (atrial
| septal defect, inferior MI, RVH
39
PR > 200ms
1
| st Degree Heart Block
40
Progressive lengthening of PR interval + one non-conducted P wave
2
nd Degree Heart Block
(Wenckebach/Mobitz I)
41
Constant PR + occasional non-conducted P wave, wide QRS
2
| nd Degree Heart Block (Mobitz II)
42
P waves and QRS at different rates - dissociation
3
| rd Degree Heart Block
43
Absent P wave or immediately before/after QRS
| Normal QRS
AV Nodal Re-entrant Tachycardia
44
Short PR interval + Slurred upstroke of QRS in V3/4
| (if LAD –ve AvF → Type B right sided accessory pathway
Wolff-Parkinson’s White syndrome
45
RBBB + Coved ST elevation in V1-3
Brugada syndrome
46
Down-slopping ST depression + T wave inversion (Reverse tick)
Digoxin
47
Disorganised broad complex, irregular rhythm with fluctuating base time
Ventricular fibrillation
48
Broad complex tachycardia with rate of 210 beats/min on variable axis
Hx of schizophrenia (polymorphic ventricular tachycardia)
Torsades de pointes
49
Inverted P wave
Dextrocardia
50
R1 tall, S6 deep
Right ventricular hypertrophy
51
S+ R >= 7 large square by voltage criteria
Left ventricular hypertrophy
52
63M, HTN, sudden tearing chest pain radiating to back
| +/- Tall, high arched palate
Aortic dissection, Type A requires surgery, Type B
| requires aggressive reduction of BP
53
40F, sudden onset SOB following hip surgery, tachypnoea,
| RAD
PE
54
60M, central crushing chest pain, radiating both arm after
| running, relieved by rest, ECG normal after 1 h
Angina
55
21M, tall, acute onset SOB, right side pleuritic chest pain,
| increased resonance, reduced expansion on right
Pneumothorax
56
23M, left sided chest pain, worsen by cough, painful on
| light pressure, normal ECG, pain relieved aspirin
Constipation, tiredness fatigue, flushing, headache
57
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
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
58
Intermittent attack of sharp pain over lower left side of
chest, feverish over 2 days
Exacerbated by movmenet of rib cage, difficult to breath
Bornholm disease (caused by Coxsackie B virus)
59
Pain in ribs/tenderness +/- swelling
Costochondritis/Tietze’s syndrome
60
1 month post MI, pain on inspiration, low grade fever,
| central sharp chest pain, better leaning forwards
Dressler’s syndrome
61
Chest pain, ST segment depression, coronary angiogram
| Normal
Cardiac syndrome X (microvascular angina) – Tx: CCB
| nifedipine
62
Chest pain, ST elevation, angiogram: exaggerated spasm
| Tx: CCB
Prinzmetal’s/variable angina (vasospasm of coronary a)
| Gold Ix: coronary angiography + injection of agent
63
Chest pain while lying down
Decubitus angina
64
Young footballer collapse and die
| PMHx: 2 episodes of syncope at gym
HOCM (AD, hypertrophy of interventricular septum –
| cardiac pacing, internal cardiac defibrillator
65
SOB on exertion + lying down
Multiple spider naevi + face, apex beat displaced laterally
Pansystolic murmur + heartbeat irregularly irregular
Dilated cardiomyopathy
66
64F weight loss, low grade fever, nonspecific chest pain,
| palpitations
Atrial myxoma – loud 1st HS
| ECG: polypoid mass attached to septal wall on LA
67
Central chest pain stabbing in nature, worse lying down
| High K, Urea, Creatinine, sodium
Uraemic pericarditis
68
46F, Hx of worsening SOB + low exercise tolerance
Lethargy, muscle aches, fever, palpitations 2 weeks
Raised WCC, CRP
Myocarditis (due to Coxsackie B virus), troponin,
cardiac enzyme elevated. Endomyocardial biopsy aid
Dx
69
24 ECG tape: Period of sinus bradycardia + episodes of
| sinus tachycardia
Sick sinus syndrome (dysfunctional sinoatrial node, 2°
| to age realted fibrosis)
70
Key management to know in pneumothorax
<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
Mx of Acute MI
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
What is polymorphic VT
Asubtype of polymorphic VT is torsades de pointes; precipitated by long QT interval
73
What are causes of Dilated cardiomyopathy and signs on examination
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
What are causes of restrictive cardiomyopathy and signs on examination
Cause of Restrictive: Amyloidosis, Sarcoidosis. Loeffler’s endocarditis, haemochromatosis
o Kussmaul’s sign (raised JVP on inspiration), 3rd heart sound, ascites, ankle oedema
75
What are causes of hypertrophic cardiomyopathy and signs on examination
Jerky carotid pulse, double apex beat, ejection systolic murmur
76
65M HF, need rate control to treat coexisting AF
Digoxin
77
65F, with large doses of loop diuretics requires additional
| therapy for oedema
Metolazone – (thiazides: remains effective in presence
| of renal impairment)
78
69F, asthmatic, treated with loop diuretics, ACEi, long
| acting nitrate + need one more drug
Spironolactone – if not asthmatic, then beta-blocker
| carvedilol
79
60F, severe pulmonary oedema
100% O2, IV diamorphine, IV furosemide, sublingual
| GTN
80
Tx of mild Sx of SOB and ankle oedema in 65M with LV
| dysfunction, on ACEi already
Oral furosemide
81
65M with AF >48 hours before DC cardioversion
Digoxin rate control+ warfarin for a month
82
60F, severely compromised with acute persistent AF
DC shock (synchronised) + heparin
83
55M, acute MI, develop short run of symptomatic
ventricular tachycardia despite bisoprolol 10mg, need Tx
for prophylaxis against recurrent VT
IV amiodarone
84
50M unidentifiable, regular narrow complex tachycardia,
| need a drug to aid Dx
IV adenosine, can terminate tachycardia involving AV
| re-entry circuit (avoid asthmatic, use verapamil)
85
50M unidentifiable, regular narrow complex tachycardia,
| need a drug to aid Dx
IV adenosine, can terminate tachycardia involving AV
| re-entry circuit (avoid asthmatic, use verapamil)
86
57M, 4hrs of crushing chest pain, ST elevation Lead 2,3,
| aVF (refuse surgery?)
Aspirin + Streptokinase (develop anti-streptokinase
| immunoglobulin G antibody; have other tPMA instead
87
65M, chest pain, unresponsive, VF
```
DC shock (unsychronised)+ adrenaline
Initial shock: 200J bisphasic or 360K uniphasic and CPR
```
88
40F, collapse after flight, breathlessness, R-sided pleuritic chest pain
100% O2, SC LMWH, IV fluids
89
Acutely painful L calf after flight, US: DVT extending above
| popliteal veins
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
45M, chronic glomerulonephritis, severe headache,
| papilloedema, bilateral retinal haemorrhages, 240/132
Labetalol
91
What is the score used for Heart failure?
Framingham
92
On a chest x ray what does a tram line shadowing indicate
Bronchiectasis
93
On a chest x ray what does Miliary shadowing indicate
Miliary TB
94
On a chest x ray what does Wedge-shaped infarct indicate
Pulmonary embolus
95
On a chest x ray what does Ground-glass appearance
| Honeycomb appearance
Fibrosis
| Fibrosis (late)
96
On a chest x ray what does Pleural mass with lobulated margin
Mesothelioma
97
Early-onset emphysema plus liver disease
Alpha-1 antitrypsin deficiency
98
Fever, cough, SOB hours after exposure to antigen
Extrinsic allergic alveolitis
99
Asymptomatic with bilateral hilar lymphadenopathy
(BHL)/progressive SOB/dry cough, non-caseatinag granuloma
Non-pulmonary manifestations (erythema nodosum)
Increased serum ACE or hypercalcaemia
Sarcoidosis (lupus pernio: raised violaceous
(red/blue) lesion with papules centrally in
nose,cheek, ears; can get uveitis -red pain eye)
100
Hx of recurrent chest infection
Steatorrhea (pancreatic insufficiency)
Positive sweat test >60mmol/l
CF (common organism: Pseudonomas
| aeruginosa)
101
Progressive dyspnoea and cyanosis
Gross clubbing, fine end-inspiratory crackles +
Groundglass/honeycomb lung
Fibrosing alveolitis (IPF)
102
Non-specific e.g. fever, night sweats, anorexia, haemoptysis
| Ziehl-Neelsen staining- acid fast bacilli
TB (culture: Lowenstein-Jensen media),
| homeless, crowding, endemic areas
103
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
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
Swinging fever, copious foul smelling sputum
| Persistent, worsening pneumonia
Lung abscess
105
Builder, left side chest discomfort progressive over 2 weeks
| Left lower lobe dull to percuss, pleural tap = blood stained fluid
Mesothelioma
106
Weight loss, loss of appetite, SOB
Reduced air entry, dullness to percussion in Right lung
Pleural tap: Protein content of >30g (exudative)
```
Bronchogenic carcinoma (met to liver, brain,
bone) – bronchoscopy to diagnose, CT to stage
```
107
Never smoked, weight loss, decreased appetite
Finger clubbing, X-ray opacity in hilar region, awaiting
bronchoscopy and CT chest
Adenocarcinoma (one of the non-small cell,
arise in peripheral lung, pleural involvement,
female)
108
Male smoker, product PTHrp, hypercalcaemia of malignancy
| Bone pain, renal stones, abdo pain, high Ca, dehydrated
```
Squamous cell (non-small cell carcinoma) –
found in central airways, clubbing
```
109
Ex-smoker, hyponatramic, 110/78, well hydrated, shipyard
Small cell carcinoma (ADH/ACTH production,
| Lambert-Eaton); Central lung, smoking
110
Features associated with Pancoast tumour
Hoarseness, anhidrosis, ptosis, miosis, weakness
| of small muscles of hand
111
Early morning headache, facial congestion, oedema in arms,
| distended veins on chest and neck, blackouts
SVC Obstruction (elicited by Pemberton’s sign)
112
CXR = white lesions over both lungs that cross lobar boundaries
Bilateral lower zone reticulonodular shadowing, pleural
plaques, white line in diaphragmatic pleura – holly leaf
Asbestos related lung disease
113
Multiple large, round, well-circumscribed masses in both lungs
Cannon-ball metastasis (most likely from RCC)
114
6/12 Hx of worsening SOB
Bilateral end inspiratory crackles + clubbing
CXR = reticulonodular shadowing in Lower zones
Cryptogenic fibrosing alveolitis = idiopathic
pulmonary fibrosis
FEV1: FVC ratio > 70% = restrictive
115
4/12 Hx Hx of worsening SOB
Bilatral end inspiratory crackles + clubbing
CXR = reticulonodular shadowing in upper zones
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
Massive haemoptysis + 2 similar episodes last months
Often feel SOB + finished course of Tx for TB
CXR: Cavitating lesions with opaque mass in it
Aspergillosis (Caused by aspergillus fumigatus),
when spores lodge in pulmonary tissue, usually
lungs that have been damaged previously
117
What causes consolidation in the upper zone
```
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
What causes consolidation in the lower zones
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
What causes T1RF
Pneumonia, pulmonary embolism, asthma, emphysema, fibrosing
| alveolitis, ARDS (PO2 <8.0, PCO2 Normal or low)
120
What causes T2RF
(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
What causes ARDS
Pulmonary (Pneumonia, gastric aspiration, vasculitis), extrapulmonary (septic/haemorrhagic shock,
DIC, pancreatitis, multiple transfusion)
122
Contact with birds
Dry cough, fever, arthralgia, hepatosplenomegaly
Patchy lower lobe consolidation
Chlamydia Psittaci
| Mx: Tetracycline
123
HIV+ve, bilateral hilar shadowing
Dry cough, fever, SOB, weight loss, night sweats
O2 sat low, boat shaped organism with silver stain
Pneumocystis jiroveci pneumonia (Mx: Cotrimaxazole)
124
Cavitating lungs (+ air fluid levels/abscesses)
Staphylococcal/klebsiella infection
Other DDx of cavitating lesion: Squamous
cell carcinoma, Wegner’s
125
Occupation involving water systems, deranged LFTs
Dry cough, myalgia, malaise, GI Sx, confusion, low sodium, albumin
Ix: Urinary Legionella antigen detection
Legionella (IV ciprofloxacin (fluroquinolone),
clarithromycin (macrolide)
Non-pneumatic legionella = Pontiac fever
126
Frequent admission to hospital for chest infection since younger *CF
background, green biofilm
Pseudomonas Aeruginosum Mx: Tazocin
| Piperacillin/tazobactam
127
Positive cold agglutinins, low grade fever
Eyrthema nodosum. Younger adolescents and adults
Headache, malaise which preceded chest Sx, dry cough
```
Mycoplasma pnuemoniae (IXR: PCR)
Mx: Erythromycin/clarithromycin
```
128
Cough + expectorating rusty sputum + consolidation of right lower
lobe (herpes labialis – cold sore)
Streptococcus pneumoniae
129
IVDU, central venous catheters, patches like abscess, post-influenza
Staph aureus
130
Hospital acquired infection, aspiration pneumonia
Cough productive of purulent dark sputum. Widespread
consolidation (upper lobes)
Klebsiella pneumonia
131
Known COPD, amoxicillin + prednisolone little effect
| Cough up thick yellow sputum, fever, breathlessness
Haemophilus influenzae
132
Mx of aspiration pneumonia
IV cefuroxime and metronidazole (need to
| cover anaerobic bacteria)
133
X rays:
Multiple bilateral nodules (0.5-5cm) former miner + Rheumatoid
arthritis
Caplan’s syndrome (presence of pulmonary
| nodules in rheumatoid arthritis)
134
X rays:
Kerley B lines, bat-wing shadowing, prominent upper lobe
vessels, cardiomegaly
Left ventricular failure
135
X rays:
Trachea deviated to right, horizontal fissure and right hilum
displaced upwards + Golden S Sign
Right upper lobe collapse
136
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
Left upper lobe collapse
137
Sail sign
Left lower lobe collapse (form a 2nd heart
| borde
138
Numerous calcified nodules <5mm located lower zones of
| lungs
Previous varicella pneumonitis
139
Double shadow right heart border, prominent left atrial
| appendage, left main bronchus elevation
Mitral stenosis (left atrial enlargement)
140
Dry cough + progressive SOB + bilateral hilar lymphadenopathy
Sarcoidosis
141
CF + tramline + ring shadows
Bronchiectasis (causes: Kartagener’s, pertussis)
142
Calcified pleural thickening (holly leaves)
Asbestos-related lung disease
143
Clubbing + progressive SOB + fine end-inspiratory crackles,
| ground glass appearance of lung
Idiopathic pulmonary fibrosis
144
Smoker, 8 ribs anteriorly above diaphragm on each side of the
chest in MCL
COPD
145
Worsening SOB + sputum, X-ray: air-fluid level behind heart, no
consolidation
```
Hiatus hernia (Nissen’s fundoplication) =
Definitive Ix: Barium swallow
```
146
Free gas under the diaphragm
| Epigastric discomfort of several months
Perforated ulcer
147
Elderly constipated woman + nausea, inverted U loop of bowel
| X-ray: a single loop of dilated bowel that turns back on itself
Sigmoid volvulus, coffee bean sign, Mx: passing
flatus tube into sigmoid colon via rectum,
laparotomy
148
Fever and bloody diarrhoea
Tachycardic, HB of 10.0, loss of haustral pattern, colonic dilation
of 8cm
```
Ulcerative colitis (pseudopolyps)
Haustra = feature of large bowel (do not
transverse, peripherally placed
```
149
Bloody diarrhoea, abdominal pain, weight loss
| Barium enema: Cobble stoning and colonic strictures
Crohn’s disease – ulceration and fissuring give
| rise to rose thorn ulcer
150
12cm dilation of transverse colon with colonic wall thickening
Toxic megacolon (linked with UC)
151
Severe epigastric pain and vomiting
| AXR: Psoas shadow and sentinel loop of proximal jejunum
Build of retroperitoneal fluid
Sentinel loop: Segment of gas-filled proximal
jejunum → Pancreatitis
152
AXR: Multiple loops of dilated small bowel and gas in biliary tree
```
Gallstone ileus (cholecyo-duodenal fistula allows
air into biliary tree; rare cause of SB obstruction)
```
153
Widened mediastinum and double right heart border (dilated
oesophagus), air-fluid level in upper chest, absence of normal
gastric air bubble
Achalasia
154
Psychiatric problem, young female, 12 month Hx of indigestion,
nausea, stomach upsets
Barium swallow: irregular, round filling defect in duodenum
Bezoar: Indigestible mass of material, usually
| hair or fibres in stomach or intestine
155
Chronic liver disease + Dysarthria + Dyskinesia (clumpsy)+
dementia + Kayser-Fleischer ring (brown ring around iris)
+/- Parkinsonian (rigidity+ tremor + bradykinesia)
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
