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DPD Stuff > Gen Med 5 > Flashcards

Gen Med 5 Flashcards

1
Q 
• 24 yr old man
• Breathlessness 
• Facial swelling
• After having a Chinese take‐
away

What treatment do you give?

A

IM adrenaline

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2
Q

What are the atypical organisms in pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophila
  • Implicated in up to 40% of CAP
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3
Q
  • 50 yr old man
  • Dyspepsia
  • Wt loss
  • Hb: 70
  • MCV: 70

What test would you request?

A

[OGD- check]

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4
Q

How would you identify a GI cause of microcytic anaemia?

A
  • Haematinics
  • Coeliac screen* (TTG Ab)
  • Remember red flags
  • Top & Tail
  • Order depends on upper/lower GI symptoms
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5
Q
  • 70 year old man
  • Bloody diarrhoea
  • Stool micro & culture: ‐ve
  • Stool C. diff toxin: ‐ve

Most likely diagnosis?

A

Ischaemic colitis

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6
Q

What are the causes of bloody diarrhoea?

A
  • Infection: infective colitis
  • Inflammation: ulcerative/Crohn’s colitis (younger pts)
  • Ischaemia: ischaemic colitis (older pts)
  • Malignancy
  • Diverticulitis
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7
Q

What is associated with portal hypertension?

A
  • Encephalopathy
  • Ascites
  • Spontaneous bacterial peritonitis
  • Variceal bleed
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8
Q
  • 20 year old boy
  • Recent diarrhoea
  • Malaise
  • Hb: 70
  • Cr: 300

Blood film shows schistocytes

Diagnosis?

A

Microangiopathic haemolytic anaemia

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9
Q

What can Microangiopathic haemolytic anaemia be caused by?

A

• DIC (Disseminated Intravascular Coagulation)
–low platelets & fibrinogen
–high PT/APTT
–high D‐dimer/ fibrin degradation products

• HUS (Haemolytic Uraemic Syndrome)
– Haemolysis ( low Hb, high bilirubin)
– Uraemia
– low plts

• TTP (Thrombotic Thrombocytopenic Purpura)
– HUS + fever + neurological manifestations

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10
Q

What are the hereditary causes of haemolytic anaemia?

A

– Red cell membrane (hereditary spherocytosis)
– Enzyme deficiency (G6PD deficiency)
– Haemoglobinopathy (Sickle cell disease, Thalassaemias)

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11
Q

What are the hereditary causes of haemolytic anaemia?

A

– Red cell membrane (hereditary spherocytosis)
– Enzyme deficiency (G6PD deficiency)
– Haemoglobinopathy (Sickle cell disease, Thalassaemias)

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12
Q

What are the acquired causes of haemolytic anaemia?

A

– Autoimmune
– Drugs
– Infection
– MAHA

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13
Q

What are valvulae conniventes?

A

The circular folds (valves of Kerckring) (also, plicae circulares, or valvulae conniventes) are large valvular flaps projecting into the lumen of the small intestine.

They arise as regular closely spaced rings/ lines on an AXR

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14
Q
  • 60 yr old man
  • Confused
  • Cough
  • No postural hypotension
  • Na+: 120
  • K+: 4.0
  • TFTs: normal
  • SST: normal
  • Urine Na+: 40
  • Urine osmolality: 400

What test would you request next?

A

CXR

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15
Q

What are the hypovolaemic causes of hyponatraemia?

A

Diarrhoea
Vomiting
Diuretics

Test:
Clinically
Low urine sodium
Measure off diuretics

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16
Q

What are the euvolaemic causes of hyponatraemia?

A

Hypothyroid
Adrenal insufficiency
SIADH

Test:
TFTs
Short synACTHen test
Plasma and urine osmolality

17
Q

What are the hypervolaemic causes of hyponatraemia?

A

Cardiac failure
Cirrhosis
Nephrotic syndrome

Test:
Fluid overload
Low urine sodium

18
Q

What are the hypervolaemic causes of hyponatraemia?

A

Cardiac failure
Cirrhosis
Nephrotic syndrome

Test:
Fluid overload
Low urine sodium

19
Q

What are the causes of SIADH?

A

CNS pathology
Lung pathology
Drugs (SSRIs/ TCAs/ Opiates/ PPIs/ Carbemazepine)
Tumours

20
Q

What are the causes of onycholysis?

A
  • Trauma
  • Thyrotoxicosis
  • Fungal infection
  • Psoriasis
21
Q
  • 20 year old woman
  • Abdominal pain
  • Vomiting
  • Type 1 diabetes
  • CBG: 20
  • Venous pH: 7.20

• What is the most
appropriate next step?

A

Cap ketones

22
Q

What are the complications of diabetes?

A 
• Microvascular
– Retinopathy
– Nephropathy
– Neuropathy (foot ulcers)
• Macrovascular
– MI/Stroke/PVD
• Metabolic
– DKA/HHS/Hypoglycaemia
23
Q 
• 26 year old man
• Chest pain
• Smokes 5/day
• Auscultation: ‘scratching 
sound’

ECG shows widespread ST elevation

What is the diagnosis?

A

Pericarditis

24
Q
  • 60 yr old woman
  • Collapse
  • BP: 120/70 mmHg
  • No postural drop
  • HS: S1+S2+ ESM

ECG shows tall QRS complexes

What is the pathology?

A

Left ventricular hypertrophy

25
Q 
• 40 year old man
• Loin pain
• CRP: normal
• Urinalysis: blood ++
What investigation would you do?
A

CT KUB to investigate calculi (colic pain)

26
Q

What might a CT KUB find?

A
  • Pelvi‐ureteric junction obstruction

* Calculus within the dilated renal pelvis

27
Q
  • 50 year old man
  • Hypercalcaemia
  • Low PTH
  • Backache
  • Normal ALP

Diagnosis?

A

Multiple myeloma

[Explanation:
PTH and Ca not both high so not hyperparathyroid
ALP is raised in bone or liver disease (osteoblasts make ALP)
ALP is normal in myeloma

> > > • Calcium is high
• Renal impairment
• Anaemia]

28
Q
  • 23 yr old woman
  • Breast lump
  • 1cm
  • Smooth mobile

Most likely diagnosis?

A

Fibroadenoma

29
Q

What does a cavitating lesion on a CXR suggest?

A 
• Infection 
– TB
– Staph
– Klebsiella (e.g. alcoholics)
• Inflammation (RA)
• Infarction (PE)
• Malignancy
30
Q
  • 35 yr old woman
  • Ankle oedema
  • Recent Echocardiogram: NAD
  • U&Es: normal
  • ALT, AST & ALP: normal
  • Albumin: 15

What test would you order
next and why?

A

Urinalysis to see if protein is being lost in the urine

31
Q

What is nephrotic syndrome?

A
  • increased permeability of GBM to protein
  • Proteinura> 3g/day
  • Hypoalbuminaemia
  • Oedema
32
Q
  • 30 year old man
  • Recurrent GI & nose bleeds

Facial exam shows small red spots on mouth and tongue

What is the diagnosis?

A

Hereditary telengectasia

33
Q

What is Hereditary telengectasia?

A 
• Autosomal dominant
• Abnormal blood vessels in 
– Skin
– Mucous membranes
– lungs
– Liver
– brain

DPD Stuff (23 decks)

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