From end of placements Y4 Flashcards
Colposcopy
- name the position of the patient
- name 2 dyes used
- Lithotomy position
- Acetic acid and iodine dyes
The paramedic transfers patient’scare to the doctor and states that his capillary glucose was 2.4mmol/L when he first arrived at the scene of the collapse. He administered 250mls of 10% glucose by intravenous drip and his capillary glucose shortly afterwards in the emergency department is 2.6mol/L
Give reasons why the capillary sugar may still be low?
- Addisons disease primary or secondary to long-term steroid therapy
- Oral hypoglycaemic medication
- Insulin
- Starvation
Antibiotics that we need to stop atorvastatin with
Clarithromycin or erythromycin
A 60 year old previously fit man man attends the emergency department with severe right-sided abdominal pain which radiates into his right groin and scrotum. He woke in the night with it and is finding it difficult to lie still due the pain. There are no other symptoms. The surgeon suspects renal colic
Give 2 other differential diagnoses for this pain
- scrotal torsion
- pyelonephritis
- aortic aneurysm dissection or rupture
- cholecystitis
- strangulated Rt sided hernia
- diverticulitis
- early bowel obstruction
- appendicitis
Name 2 other than pain symptoms or signs that he might demonstrate consistent with renal colic
- visible haematuria or positive blood on stick testing,
- loin tenderness
- nausea and vomiting
- frequency
- dysuria
- strangury
- occasionally retention with palpable tender bladder
What imaging to perform if suspected renal colic?
- KUB X-Ray (kidneys, ureters, bladder)
- USS
- non- contrast CT scan (contrast makes stones hard to see) so would be second line
Surgical options for stone removal
- Stent
- percutaneous nephrostomy
- extracorporeal shock wave lithotripsy (ESWL)
- uteroscopy (URS)
- percutaneous nephrostolithotomy
- open nephrostomy
- anatrophic nephrolithotomy
A 22 year old attends the doctor with a painful Rt eye which is irritating.
She is wearing dark glasses because of the irritation and also has minor irritation in the left eye, though it is not as severe. The eyes had been “stuck down” when she awoke in the morning and there has been some green eye discharge.
Visual acuity is 6/6 in both eyes and there is redness of the eye which lessens towards the iris.
What is the most likely diagnosis?
Conjunctivitis
The bilateral nature suggests blepharitis or conjunctivitis but it is the conjunctiva rather than the eyelids which are irritated. The peripheral redness and associated discharge also suggest conjunctivitis.
Visual acuity would be reduced in uveitis and acute glaucoma.
A 43-year old man presents to his GP with a 4 week history of balanitis. During the consultation, he mentions that he also has symptoms of polyuria, polydipsia, and a weight loss of about a stone during this period.
What is the most likely cause for balanitis?
Candida species
A 50 year old has a colonic polyp removed. Histology is reported as a harmatomous polyp
Harmatomus polyps are typically associated with which condition?
Peutz - Jeghers
A previously well 14 year old girl attends with a 2 week history of stumbling when walking
She she has weakness of Right foot dorsiflexion at the ankle and a Right upgoing plantar reflex (positive Babinski sign). All other neurological signs are normal.
What is the most likely diagnosis?
Astrocytoma
A father brings his 15 year old son into the GP clinic saying, “he’s always hunched up, doctor, I’ve told him to straighten up, can you look at him?”
Which of one of the following symptoms or signs is most helpful?
One scapula more prominent than another
A baby born to recent immigrants has had no neonatal screening or baby checks.
The parents via an interpreter report that he had prolonged jaundice. The doctor notes a protruding tongue and umbilical hernia.
What is the most likely diagnosis?
Untreated congenital hypothyroidism
Kocher’s rules for septic arthritis
Each score a point:
- Temp.>38.5oC
- non-weight bearing or/and pain on passive joint movement
- ESR>40mm/hr
- WCC>12 x 109
Ix (apart from blood tests) to diagnose osteosarcoma
- Bone biopsy
- XRay
- MRI scan
