Formative 2 2020 Flashcards
What is the gold standard investigation for hepatocellular carcinoma?
CT abdomen
What is the presentation of acute cholecystitis?
- Right upper quadrant pain
- Fevers/ rigors
- Nausea/ vomiting- no jaundice
- No jaundice
What is charcot’s triad?
- Right upper quadrant pain
- Fevers
- Jaundice
What is the gold standard investigation of acute cholecystitis?
Abdominal ultrasound, however if sepsis is suspected CT/MRI to screen for perforated gallbladder/ gallbladder necrosis
What is the management of acute cholecystitis?
- IV fluids
- Analgesia
- Broad spectrum antibiotics
What is the cut off for a TIA?
Presentation can be classified as a TIA if the symptoms resolve within 24 hours
What is the prognosis for Bell’s palsy?
Patients tend to improve within 3-4 months
What is the managment of Bell’s Palsy?
- Patients presenting within 24 hours should be offered supportive management and reassured that they will fully recover
- Patients presenting within 72 hours should be considered for prednisolone management
- Acyclovir is generally not recommended
What is conjunctivitis?
Inflammation of the convunctiva, presenting as a unilateral red eye with no visual disturbance and usually no eye pain
Viral and bacterial are both common after an ear or upper respiratory tract infection
- Bacterial will yield yellow prurulent discharge
- Viral will yeild watery discharge
What is Blepharitis?
Inflammation of the eyelid
What is uveitis?
Inflammation of the middle layer of the eye (as opposed to conjunctivitis- inflammation of the external layer of the eye)
- Patients may have blurred vision
- Photophobia
- Pupil changes
- Eye pain
What would urinalysis of pyelonephritis show?
- Leukocytes
- Nitrates
- Blood
What are the organisms that commonly cause hospital acquired pneumonia?
ESC(K)APE
- Enterococcus faecium
- Staphylococcus aureus
- C. diff, Klebsiella
- Acinetobacter baumannii
- Pseudomonas aeruginosa
- Enterbacter species
What skin changes may be present in sarcoidosis?
- Lupus pernio
- Erythema nodosum
What biochemical markers may be raised in sarcoidosis?
- Ca2+
- ACE
Why is ACE raised in sarcoidosis?
Because the cells surrounding the granulomas produce ACE
What colour would synovial fluid be in gout?
Yellow/ staw coloured
Which crystals are present in gout?
Negatively birefringent monosodium urate rod shaped crystals
Which crystals are present in pseudogout?
Postively birefringent rhomboid shaped calcium pyrophosphate dihydrate crystals
What is Rovsing’s sign?
A sign indicating appendicitis, putting pressure on the left side which indices pain in the right side
What is the obturator sign?
A sign indicating appendicitis, passively flexing the knee while the patient is supine and rotating the leg inwards induces pain
What is the purpose of the Alvarado score?
To diagnose accute appendicitis
What is the gold standard investigation for renal colic?
CT KUB
What are the most common compositions of renal stones?
In order of commonality
- Calcium oxalate
- Calcium phosphate
- Urate (radiolucent)
- Struvate
- Cystine (partially radiolucent)
What investigation can be done for radiolucent kidney stones?
MRI, to demonstrate the filling defect caused by stone obstruction, but the stone itself cannot be identified
How does hypothyroidism present?
- Cold
- Dry skin
- Hair loss/ course hair
- Weight gain
- Reduced appetite
- Fatigue
- Bradycardia
- Facial oedema
- Constipation
What is the most common cause of hypothyroidism in the UK?
Autoimmune thyroiditis (Hashimoto’s thyroiditis)
What is the complication patients with acute pancreatitis and a CRP >200 are at risk of?
Pancreatic necrosis
What investigation should be done if a patient is a risk of pancreatic necrosis?
CT to detect complications
What are the causes of acute pancreatitis?
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpian venom
- Hyperlipidaemia, hyperparathyroidism, hypothyroidism
- ERCP
- Drugs- azathioprine, sodium valproate
Structured answer of the causes:
- Iatrogenic
- Azathioprine, sodium valproate
- Steroids
- ERCP
- Metabolic
- Hyperlipidaemia
- Hyperparathyroidism
- Ethanol
- Pathological
- Mumps
- Gallstones
- Autoimmune
- Other
- Scorpian venom
- Hypothermia
- Trauma
Which investigation is crucial to order in female patients presenting with appendicitis?
Beta HCG to exclude ectopic pregnancy
What are the characteristics of psoriatic arthritis?
Nail signs
- Oncholysis
- Subungal hyperkeratosis
- Pitting
Skin signs
- Psoriasis
Finger signs
- Dactylitis
What is the gold standard investigation for heart failure with raised BNP?
Echocardiogram
How does cellulitis present?
Inflammation of the dermis and subcutaneous tissue with indistinct boarders, commonly occurring in an extremity
- Redness
- Inflammation
- Tenderness
What is the first line management of patients with cellulitis who are not systemically ill?
- Topical antibacterial cream
- Oral flucloxacillin
What is the suffix of sulphonylureas?
-ide
What are the investigations for prolactinoma?
- Serum prolactin levels
- If breasts have been examined, prolactin levels should be taken 48 hours after
- Prolactin may be falsely raised due to stress, therefore minimal venepuncture stress should be aimed for
- Pituitary MRI
- Computerised visual field examination
What are the biochemical results of a patient with PCOS?
- LH:FSH ratio 2:1
- Raised testosterone
What is the overnight dexamethosone suppression test?
A test for diagnosing Cushings syndrome/ disease, ACTH is given before the patient goes to sleep and 9am cortisol levels are measured in the morning. If the patient has high Cortisol levels in the morning, a diagnosis of Cushings is likely
What is the function of the high dose dexamethosone suppression test?
A test used to distinguish whether the hypercortisol is primary or secondary
- Secondary will show reduced cortisol levels
- Primary will show sustained cortisol levels (negative feedback on the pituitary will not have an effect)
What is the presentation of BPPV?
Transient episodes of vertigo brought on by movement of the head that last less than 1 minute at a time
- No tinnitus
Which maneuvre triggers BPPV?
Dix-Hallpike
What maneuvre is used to manage BPPV?
Epley maneuvre
