General Flashcards

Question

Best imaging modality to assessing bone metastasis?

Answer 1

CT followed by MRI

Answer 2

Adjuvant 'mops' up any cancer cells after the main treatment (e.g. radiation post mastectomy). This decreases the rate of local recurrence and micro-metastasis Neoadjuvant is aimed to reduce tumour size prior to main treatment (e.g. chemotherapy to reduce breast cancer size prior to mastectomy).

Answer 3

internal thoracic, axillary, and intercostal arteries

Answer 4

internal thoracic, axillary and intercostal veins

Answer 5

lymph fluid drains into the axillary nodes (75%), parasternal nodes (20%), and posterior intercostal nodes (5%)

Answer 6

occurs through haematogenous and lymphatic spread -> into the lymph nodes, bone, liver, lungs, and brain (LBLBL)

Answer 7

Signs: - breast asymmetry - nipple retraction/inversion - colour/skin changes e.g. erythema, peau d'orange - lymphadenopathy - swollen lymph nodes (esp. of the axilla) - lymphedema of the arm - signs of metastasis such as bone pain Symptoms: - painless lumps (hard, uneven borders) - bloody discharge from the nipples

Answer 8

Core needle biopsy allows for moledular typing, fine needle does not

Answer 9

Radioactive substance or blue dye is injected into the tumour and will travel to affected lymphnodes. Lymph node with metastatic disease can then be identified and assessed whether lymph node dissection is required.

Answer 10

FEC Fluorouracil, epirubicin, and cyclophosphamide Add docetaxel if there is lymph node involvement. Can be given before (neoadjuvant) or after surgery (adjuvant).

Answer 11

If ER positive: - Premenopausal: use tamoxifen (an estrogen receptor antagonist in the breast, and estrogen receptor agonist in bone and uterus). This means it will prevent osteoporosis but it increases the risk of endometrial cancer (and VTE). Tamoxifen is effective in reducing local recurrence, mortality and contraletal breast cancer - Postmenopausal: use aromatase inhibitors to reduce the production of oestrogen which decreases cancer growth, but also causes menopausal symptoms. May consider ovarian function suppression via radiotherapy, oophorectomy or medical (triptorelin)

Answer 12

Trastuzumab (aka Herceptin) is a monoclonal antibody that targets HER2 Can cause gastrointestinal upset and is cardiotoxic

Answer 13

Damage to the long thoracic nerve -> winging of the scapula Damage to the thoracodorsal nerve Lymphodema Shoulder stiffness, pain, numbness Risk of infection to the surgical area

Answer 14

Human epidermal growth factor receptor

Answer 15

- age (more common in younger patients) - race - more common in African-American - being premenopausal - young age of first pregnancy - obesity - BRCA1 mutation

Answer 16

Every two years for people aged 50-74yrs

Answer 17

Prevention = enoxaparin 40mg subcut Treatment = enoxaparin 1.5mg/kg subcut daily. Can also start oral anticoagulant such as warfarin. Use IV heparin is kidney impairment.

Answer 18

hyperparathyroidism, Paget disease, osteoblastic bone tumours, osteomalacia, rickets, healfing fractures, liver disease, hyperthyroidism

Answer 19

Head and neck of the pancreas wraps around the duodenum -> get gastric distention and vomiting

Answer 20

Abnormaility in pancreatic duct/drainage -> leads to chronic pancreatitis

Answer 21

Alcohol use Biliary tract disease Obstruction due to neoplasms Iatrogenic (ERCP_ Drugs (frusemide) Trauma

Answer 22

Alcohol use Biliary tract disease Obstruction due to neoplasms Iatrogenic (ERCP_ Drugs (frusemide) Trauma

Answer 23

Acina cell injury via multiple mechanisms (obstruction, inflammation, drugs, ischemia, premature activation of enzymes) -> premature activation of pancreatic enzymes -> autodigestion of the pancreas (proteases, lipases, and elastases).

Answer 24

Cullens is around the umbillicus and grey turner is the flanks (bruising in pancreatitis due to internal retroperitoneal haemorrhage)

Answer 25

- severe abdominal pain - elevated serum lipase - bloody abdominal fluid (due to small vessel haemorrhage due to elastase) - ARDS - electrolyte disturbances and renal failure - Shock

Answer 26

Usually pancreatic rest and supportive treatment is all that is required. Very severe cases where infective necrosis is present will require surgery and empiric ABx. Give pain relief NBM until pain free and has bowel sounds Give IV fluids/resusc

Answer 27

Recurrent mild pancreatitis leads to chronic injury and scarring of the pancreas. Leads to loss of function and acini. Ressults in pancreatic insufficiency (weight losss, malnutrition, diarrhea/steatorrhea, diabetes mellitis)

Answer 28

I = idiopathic G = gallstones E = ethanol T = trauma S = steroids M = mumps or malignancy A = autoimmune S = scorpion sting H = hypertrigliceridemia or hypercalcemia E = ERCP D = drugs (diuretics, NSAIDs)

Answer 29

Abdominal pain suggestive of acute pancreatitis Raised serum lipase -> 3 times the upper limit (can also do amylase but not as specific) characteristic findings of acute pancreatitis on CT

Answer 30

- pancreatic enlargement - oedema - fat stranding - free fluid - complications including necrosis, pseudocyst, abscess

Answer 31

Pancreatic rest Fluid administration (normal saline) Pain relief (morphine or fentanyl) ABs have limited role unless pancreatic necrosis (occurs due to haemmaorhage and damage to the blood vessels) or an abscess is present. Recommence food when patient is pain free and tolerating food. Also consider the underlying cause and treat. e.g ERCP if gallstone obstruction

Answer 32

The pancreatic lipase breask down peripancreatic and mesenteric fat. Get release of fatty acids that bind calcium which results in hypocalcemia.

Answer 33

excessive alcohol consumption idiopathic pancreatitis ductal obstruction other causes include CF, AI, hereditary conditions.

Answer 34

They are usually normal due to fibrosis and atrophy of the pancreas

Answer 35

Identifies pancreatic exocrine insufficiency in chronic pancreatitis. Faecal elastase will be low in pancreatic insufficiency

Answer 36

Lifestyle: - reduce risk factors such as excessive alcohol use, smoking Identify diabetes and manage Pain management using analgesia Pancreatic enzyme replacement therapy

Answer 37

- symptomatic cholelithiasis with or without complications - asymptomatic cholelithiasis in patients who are at an increased risk of gallbladder cancer or gallstone complications - cholecystitis - gallbladder polyps >0.5 cm - porcelain gallbladder

Answer 38

Presenting feautres of acute cholangitis (NOT CHOLECYSTITIS) including fever, abdominal pain, and jaundice.

Answer 39

Occurs in suppurative cholangitis where patients have fever, abdominal pain, jaundice, confusion, and hypotension.

Answer 40

Monitor for sepsis and treat with empiric ABs (gent, amp, met) before commencing targeted therapy once cultures are returned. Establish biliary draining (usually via ERCP) Supportive therapy (e.g pain, nausea, fluids) Cholecystectomy if gangrenous

Answer 41

Mild = no organ damage, no local or systemic complication Moderate = transient organ failure that resolves within 48hr and/or local or systemic complication without persistent organ failure Severe = persistent organ failure that may involve one or more organs.

Answer 42

Cholangitis = inflammation of the bile duct Cholecystitis = inflammation of the gallbladder. Murphy's sign will be positive

Answer 43

Usually cholesterol, calcium, and bilirubin. Usually radiopaque. Will create an acoustic shadow behind it.

Answer 44

Cholelithiasis = gallstone in the gallbladder Choledocholithiasis = gallstones within the bile duct

Answer 45

Six F's = female, fat, forty, fertile, fair skinned, family hx Modifiable: - physical inactivity - low fibre intake - hypercholesterolemia - rapid weight loss (bariatric surgery patients) Non-modifiable: - liver cirrhosis - Crohn's disease (inflamed terminal ileum impairs bile acid recirculation) - presence of gallstones - comorbidities such as T2DM, cirrhosis, jaundice

Answer 46

Gentamicin + ampicillin If chronic biliary obstruction then add metronidazole

Answer 47

Withhold oral feeds if going for surgery (then low fat diet) Empiric ABs gent + amp +/- met Cholecystectomy -> laparoscopic vs open Percutaneous cholecystostomy or ERCP to remove gallstone in bile duct. Cholecystectomy better to prevent recurrence. Supportive care -> fluids, analgesia (morphine), lifestyle modification post surgery such as low fat diet 1 week following surgery.

Answer 48

gallstone located in the Hartmann's pouch causing compression of the adjacent hepatic structures. Can result in obstructive jaundice.

Answer 49

advanced age genetic risk factors smoking elevated BMI cheotherapy high red meat consumption connective tissue diseases such as Marfan Syndrome or Ehlers-Danlos syndrome chronic constipation low fibre diet

Answer 50

Formation of diverticulosis (most commonly in the sigmoid colon) due to weakening of the diverticular wall (age, vascular penetration) and increase in intraluminal pressure -> bacteria or faecal matter enters the diverticular -> results in inflammation/infection -> can form complications such as abscess or perforation.

Answer 51

Essentials of diagnosis: - fever - left lower abdominal pain - leukocytosis Clinical features: - low grade fever - left lower quadrant pain - altered bowel habits (usually contipation) - acute abdomen would possibly indicate perforation or peritonitis.

Answer 52

E.coli enterococcus bacteroides fragilis

Answer 53

Perforation Abscess formation intestinal obstruction due to inflammatory related narrowing Fistula formation (usually rectovesical fistula

Answer 54

I - pericolic abscess formation II - pelvic, intra-abdominal, or retroperitoneal abscess III- generalised purulent peritonitis IV - generalised fecal peritonitis

Answer 55

Complicated diverticulitis: - in patient management with broad spectrum IV antibiotic - gentamicin, metronizadole, ampicillin IV - CT guided percutaneous drainage for abscesses of more than 4cm (Hirchey 1 or 2) - emergency colectomy in patients with generalised peritonitis → Hartmann’s procedure where part of the descending or sigmoid colon is removed and a stoma bag is attached (can be connected to the sigmoid colon later on). Performed in Hirchey 3 or 4 (purulent or faecal peritonitis) - patients should be nil by mouth and receive IV fluids

Answer 56

Herniation of the mucosa and submucosa through the muscular layer of the colon wall

Answer 57

Abdominal and pelvic contrast CT Use MRI or US if CT is contraindicated

Answer 58

Anterior = arteries not impacted, more likely to result in free intra-peritoneal gas under the diaphragm. Posterior = gastroduodenal artery likely to be perforated. Causes bleeding into the intra-peritoneal cavity.

Answer 59

Visceral pain = c-fibres Parietal/somatic pain = A and c-fibres (more localised)

Answer 60

GIT: appendicitis, large or small bowel obstruction, perforated peptic ulcer, diverticulitis, IBD, mesenteric adenitis Liver, spleen, biliary: - acute cholecystitis, acute cholangitis, acute hepatitis, spontaneous rupture of the spleen Pancreatic: - acute pancreatitis Urinary: - renal or ureteral colic, acute pyelonephritis, acute cystitis Gynae: - acute salpingitis, ruptured ovarian cyst, ruptured ectopic pregnancy

Answer 61

Non-neoplastic polyps include: hyperplastic polyps, inflammatory polyps, haemartomatous polyps. These polyps have a low potential to become malignant. Neoplastic polyps include adenomas (e.g. tubular, tubulovillous, and villous adenomas) and serrated types. These polyps have moderate to high potential to become malignant if given enough time to grow. Most CRC arise from dysplastic adenomatous polyps.

Answer 62

**Staging:** TNM staging: T part - T1 → invaded the submucosa - T2 → invaded the muscularis propria - T3 → invaded to the serosa/adventia or perirectal tissues - T4 → invaded into the peritoneum and surrounding tissues N part - 0 → no lymph node involvement - 1 → invaded 1-3 local lymph nodes - 2 → invaded 4 or more local lymph nodes - 3 → distant lymph node metastasis M part - 0 → no metastsis - 1 → metastasis

Answer 63

Lynch syndrome: accounts for 2-10% of CRC and is caused by a mutation of a MMR genes (esp MLH, MSH, PMS2). This leads to microsatellite instability and an increased risk of CRC. Condition is autosomal dominant. Familial adenomatous polyposis: accounts for 1% of CRC. Affected patients have multiple precancerous adenomatous polyps with the onset of polyps at a mean age of 16. They have a 95% lifetime risk of developing CRC. Also autosomal dominant. Management includes polyp removal but will eventually require a protocholectomy and ileostomy.

Answer 64

Colon: - colectomy (hemi, sigmoid, subtotal, total) with lymph node dissection indicated in all resectable tumours - chemotherapy including FOLFOX (usually used as an adjuvant therapy) - radiation is typically not used due to risk of radiation enteritis - preoperative chemotherapy or immunotherapy considered for stage IV CRC Rectal: - surgical resection if possible - neoadjuvant radiation may be used to decrease tumour size - adjuvant chemotherapy considered

Answer 65

- Chromosomal instability - Most common pathway - Abnormality to chromosomal segregation (M phase) - Mutation to APC, p53, DCC, K-Ras, B-Raf, C-Myc - Seen in most cases of CRC (FAP) - Microsatellite instability - Typically associated with mutations in mismatch repair enzymes including MSH2 and MLH1 - Seen in Lynch Syndrome - Aberrant methylation - Abnormal patterns in epigenetic methylation. Usually hypermethylation which causes DNA to wrap tightly, leading to the silencing of genes.

Answer 66

paroxysmal = less than 1 week persistent = >1week to 12mth longstanding = 1yr new onset permanent = decision for no more control strategies valvular = mitral stenosis or mechanical HV

Answer 67

atrial dilatation -> HTN, valve dysfunction sepsis electrolytes abnormalities thyroid - thyroidoxicosis or hyperthyroidism alcohol drugs - cocaine

Answer 68

anti-thyroid medications radioactive iodine therapy -> thyroid takes up the radioactive iodine which progressively kills the thyroid cells to decrease its function beta blockers - symptom control surgery (partial or full thyroidectomy) corticosteroids for poptosis

Answer 69

Early prostate cancer is typically asymptomatic and detected by early screening. Lower urinary tract symptoms include: - frequency - urinary retention - haematuria - incontinence - nocturia - dribbling Metastatic: - bone pain, pathological fractures - lymphadema

Answer 70

Urinary stasis -> recurrent UTIs and bladder calculi Bladder wall hypertrophy and pseudodiverticula Renal impairment -> pyelonephritis, hydroureteronephrosis

Answer 71

increasing age Fx genetics (BRCA1/2, lynch syndrome) high BMI smoking chemical exposure (firefighters at greater risk)

Answer 72

Prostate cancer: - hard, enlarged, asymmetrical/bumpy nodular mass, loss of median sulcus BPH: - enlarged, non-tender smooth, can still feel median sulcus

Answer 73

- DRE - prostate specific antigen (PSA) levels. PSA is a serine protease produced only by the prostate gland. Therefore it is an organ specific marker. It is elevated in benign and malignant conditions. - multiparametric MRI (mpMR)I of the prostate - transrectal US of the prostate (also used to guide a prostate biopsy) - perform prostate biopsy if there is clinical suspicion of prostate cancer. Need to give prophylactic ABx to prevent prostatitis.

Answer 74

True -> therefore needs to be taken into account if screening patient for prostate cancer in they are on 5-alpha reductase inhibitors for BPH

Answer 75

Grading cell differentiation in prostate cancer.

Answer 76

TNM staging

Answer 77

Watchful waiting - if a slow growing tumour, limited life expectancy. Still check PSA and perform DRE regularly. Active surveillance - regular monitoring with DRE, PSA, biopsies, mpMRI Radiotherpay Radical prostatectomy Androgen deprivation therapy (aims to decrease testosterone levels via medical or surgical castration. Chemotherapy - usually an adjunct to androgen deprivation therapy. Docetaxel most commonly used.

Answer 78

BPH UTI/cystitis overactive detrusor muscle Prostatitis

Answer 79

usually adenocarcinoma arising from gland cells. Other types include small cell carcinomas.

Answer 80

bone liver lungs lymph nodes

Answer 81

no recommendations. Controversial as to whether PSA screening and DRE are beneficial. Informed patient decision making is encouraged.

Answer 82

non-pharm: - medication reconcilliation, reduced fluid intake, reduced caffeine intake, reduced alcohol intake, bladder emptying techniques. Pharm: - a-blockers relax SM of the neck of bladder and internal urethral sphincter -> this improves urine outflow e.g tamsulosin, doxazosin - 5a-reductase inhibitors decrease conversion of testosterone to DHT -> this decreases prostate growth. e.g. finasteride - antimuscarinics to inhibit the PSns muscarinic receptors in the detrusor smooth muscle. Causes a decrease in muscle tone. Phosphodiesterase type 5 inhibitors reduces tone in the detrusor muscle, prostate, and urethra. Surgical: TURP (transurethral resection of the prostate) is gold standard therapy. Indicated when pharmacology is insufficient or contraindicated. It is resection of the hyperplastic tissue around the urethra. Can causes sexual dysfunction, retention, stricture and the BPH may be recurrent.

Answer 83

cortisol glucagon growth hormone epinephrine Remember all of these hormones will oppose insulin

Answer 84

A temperature of > 38.3°C recorded on multiple occasions that lasts for > 3 weeks with no clear etiology despite appropriate diagnostics on 3 outpatient visits, 3 days in the hospital, or 1 week of invasive ambulatory investigation.

Answer 85

autosomal dominant inheritance -> mutation to the APC gene

Answer 86

carcinoembryonic antigen -> found in increased amounts in blood in people who have colon cancer

Answer 87

mouth to ampulla coeliac artery coeliac plexua

Answer 88

ampulla to distal third of the transverse colon SMA superior mesenteric plexus

Answer 89

distal transverse colon to rectum IMA inferior mesenteric plexua

Answer 90

foregut = epigastrium midgut = periumbilical hindgut = suprapubic

Answer 91

murphy's = cholecystitis tender over mcburney's = appendicitis roving's sign (RIF tenderness on palpation of the LIF) = suggests free fluid in pelvis Grey-turner's sign = retroperitoneal bleeding (occurs in pancreatitis)

Answer 92

raised lipase (3 x upper limit of normal) epigastric pain CT proven pancreatic stranding Need 2/3

Answer 93

mild = no organ failure and no local or systemic complications moderate = transient organ failure that last less than 48 hours severe = persistent organ failure for more than 48hrs

Answer 94

Acinar cells (also produces other enzymes)

Answer 95

Seminoma Non-seminoma: - choriocarcinoma - terotoma - yolk sac carcinoma - embyronal carcinoma - mixed

Answer 96

Loading: Aspirin = 300mg Clopidogrel = 300mg Therapeutic/prophylactic: Aspirin = 100mg Clopidogrel = 75mg

Answer 97

- hypotension - sudden onset of severe abdominal and/or back pain - tender pulsatile abdominal mass

Answer 98

Telmestartan

Answer 99

endovascular aneurysm repair - risk of a persistent endoleak or open surgical repair.

Answer 100

male smoking (biggest one) advanced age HTN hyperlipidemia atherosclerosis FHx

Answer 101

Decreased blood flow to kidneys -> hypovolemia, dehydration, blood loss, vasodilation due to anaesthetic, blood being directed away from kidneys and the the areas of surgical trauma/intervention. Clamping of the aorta -> decreases blood flow to the kidneys iatrogenic -> trauma during surgery, nephrotoxin agents, contrasts, Inflammation within the body

Answer 102

because pancreatic carcinomas cause an increase expression of tissue factor.

Answer 103

antibiotics potassium insulin narcotics chemotherapy heparin

Answer 104

warfarin erythromycin verapamil warfarin st johns wort statins

Answer 105

Positive sonographic murphy's sing Increased density/opacity of stone with posterior acoustic shadowing Gallbladder wall thickening

Answer 106

gastric outlet obstruction caused by large gallstones that reach the duodenal bulb and get lodged there through a biliodigestive fistula.

Answer 107

trisomy 21, 18, 13

Answer 108

hepatocellular carcinoma and testicular cancer

Answer 109

a painless and enlarged gallbladder (palpable). Can occur in pancreatitc cancer.

Answer 110

SCC and adenocarcinoma (associated with Barrett's oesophagus)

Answer 111

transhiatal trans thoracic three field minimally invasive

Answer 112

because tumour embolisation travels via the thoracic duct which drains in the left supraclavicular node. This indicated stage 4 disease (advanced disease). Also enlarged in lymphma, breast, oesophageal, pelvic, and testicular cancers.

Answer 113

Gastric lymphomas -> arise from mucosa associated lymphoid tissue (MALT)

Answer 114

- progressive dysphagia - retrosternal discomfort - systemic symptoms: - weight loss, fatigue, fever, night sweats - signs of anemia → fatigue, SoB - persistent cough - Horner’s syndrome → infiltrates local nerves/fibres

Answer 115

hemoptysis = blood from the respiratory system Hematemesis = blood from the GIT

Answer 116

- smoking - GORD → barrett’s → adenocarcinoma - high alcohol consumption - male - advanced age - consumption of hot foods/liquids - achalasia - obesity - poor diet

Answer 117

Reflux esophagitis → stomach acid damages mucosa of distal esophagus → nonkeratinized stratified squamous epithelium is replaced by nonciliated columnar epithelium and goblet cells (intestinal metaplasia, Barrett metaplasia)

Answer 118

Adult: oral 0.5-1g every 4-6hrs. Maximum 4g daily Children: oral 15mg/kg every 4-6hrs

Answer 119

- predominately central dilated bowel loops (peripheral in LBO). Dilation >3cm - Air-fluid levels noted in erect position (>2.5cm width) - dilation of small bowel loops present -> small bowel anatomical folds of the small bowel become more apparent - minimal air distal to site of obstruction

Answer 120

bowel adhesions incarcerated hernia volvulus Crohn's disease (strictures)

Answer 121

When there is a functional inability of bowel contraction to cause propulsion of food through the GIT. Can occur post operatively.

Answer 122

CRC Diverticulitis Volvulus Adhesions from previous surgery IBD -> strictures foreign body

Answer 123

15ml/min Use heparin -> 5000 units Can use 20mg subcut enoxaparin if CrCl is between 15-30ml/min

Answer 124

between 2-3

Answer 125

For patients who require reversal of anticoagulation therapy and the the prevention/treatment of bleeding patients with low levels of factor II, IX, or X. Can be used prophylactically in surgery for patients who are on warfarin and require immediate surgery. Obviously increases risk of VTE

Answer 126

Helps to replace coagulation factors in bleeding patients. i.e. helps to replenish what is lost. Not as potent as prothrombinex.

Answer 127

100mg IV infusion over two hours

Answer 128

0.9mg/kg over 60mins

Answer 129

Hemodynamically unstable: - DCCV (direct current cardioversion) Stable: - treat cause (infection, hyperthyroid) - AV nodal blockers - rate vs rhythm control (rate = BBlockers, CCBs, digoxin - not in HF) (rhythm = amiodarone, cardioversion)

Answer 130

Aim for rhythm control

Answer 131

Every CN that does NOT divide into 12 (except 11) i.e. 5, 7, 8, 9, 10. So 5, 7, 8 for lateral pontine strokes And 9, 10 for lateral medulla (hoarse voice and dysarthria)

Answer 132

spinocerebellar tracts (ataxia) spinothalamic tract (pain and temperature) Spinotrigeminal tract (pain and temp in the face) Sympathetic pathway (Horner's syndrome)

Answer 133

Motor tracts (corticospinal) Medial lemniscus Cranial nerves that divide evenly into 12 PLUS CN11 (3, 4, 6, 12)

Answer 134

Benedict = lesion to CN3, medial lemniscus, red nucleus - occulomotor nerve palsy contralateral loss of proprioreceptoion and vibration, involuntary movements (ataxia and tremor) Webers = CN3, corticospinal and corticobulbar - occulomotor nerve palsy, contralateral hemiparesis

Answer 135

Ectoderm: skin and nervous system Mesoderm: bone, muscle and connective tissue Endoderm: linings of the digestive and respiratory system, as well as organs including the pancreas

Answer 136

Adenocarcinoma (most common) Mucinous adenocarcinoma Signet ring cell carcinoma

Answer 137

Hypokalemia Hypochloremia Hyponatremia

Answer 138

Apixaban 10mg oral twice daily for 7 days, then 5mg twice daily for the treatment of a VTE. Use 2.5mg daily in the prevention of a VTE. If post hip surgery then don't use apixaban. Instead, use dabigatran 150mg oral twice daily.

Answer 139

Uncomplicated = biliary colic in the absence of complications Complication = gallstone related complications - cholecystitis, cholangitits, gallstone pancreatitis, gallstone ileus (gallstone causes obstruction of the small bowel), Mirizzi syndrome

Answer 140

Viscus perforation Severe rectal bleeding  uncontrollable and causing hemodynamic compromise Toxic megacolon

Answer 141

Where the small bowel is not able to adequately absorb nutrients, fluids, and electrolytes. Common post-surgery.

Answer 142

PRERENAL: Physiological response to surgery including release of cytokines and increased stress response -> increases ACTH release from the AP -> increase cortisol and aldosterone release -> increased Na+ and H2O reabsorption in the distal convoluted tubule -> decreased urine output. Also, Post-op hypotension (decreased CO, vasodilatation and hypovalemia) causes baroreceptor stimulation to increase ADH release -> increased H2O reabsorption in collecting ducts -> decreased urine output Hypovolemia post-surgery: dehydration -> decreased renal perfusion causes decreased GFR and urine output RENAL: Nephrotoxic substances (e.g. contrast, ABx, NSAIDs) or direct renal damage during surgery POST-RENAL: e.g. catheter obstruction, BPH **Also UTI post-surgery likely due to catheter

Answer 143

Screening is intended for a target population where they do not have symptoms of the disease

Answer 144

Disease: - must target a disease and look at a particular population group - disease has an early latent period - justify early detection of disease through its health burden Test: (good screening test) - high sensitivity and specificity - detects disease while asymptomatic - simple to perform and cost affective - safe to perform - reproducible in a variety of settings - Treatment: - there must be an effective treatment for the disease - improved survival if treated early -> i.e. treatment via screening better than treatment via clinical diagnosis

Answer 145

Monitoring and recurrence of CRC

Answer 146

Pancreatic cancer and CRC

Answer 147

Multiple myeloma -> highly sensitive and specific. Found in urine. Also called M-protein (monoclonal protein)

Answer 148

Prevalence = TOTAL number of cases of a disease during a particular period of time Incidence = number of NEW cases of a disease during a particular period of time

Answer 149

Number of deaths caused by a disease over a period of time / the number of people at risk of dying in the same period

Answer 150

Hyperechoic circular mass with posterior acoustic shadowing. May have gallbladder wall thickening in cholecystitis

Answer 151

Acute confusional state with an organic cause -> dehydration, sepsis, toxins. Characterised by a cognitive disturbance of attention and awareness. Delirium is the most common surgical complication among older patients.

Answer 152

Predisposing: - change of environment (noise, cold, sleep deprived, hungry, thirsty) - pre-existing conditions (co-morbidities, substance abuse - withdrawal, dementia, polypharmacy Precipitating: - full bladder - pain - hypoxia (big one to remember) - alcohol or drug withdrawal - sepsis - metabolic -> electrolyte disturbance, BSL (high, low), acidotic - endocrine -> thyroid conditions

Answer 153

* Prostate cancer * UTI * Neurogenic bladder * Urethral stricture

Answer 154

— Bleeding — Urethral stricture or bladder neck contracture — Perforation of the prostate capsule with extravasation — Retrograde ejaculation (75%) — Erectile dys unction (5%–10%) — Urinary incontinence (< 1%)

Answer 155

* Urinary obstruction, eg, urethral stricture, stone, bladder neck contracture * Prostatitis * Benign prostatic hyperplasia * Prostatic stones * Bladder cancer

Answer 156

4ng/ml (greater then 10 is suggestive of metastatic disease)

Answer 157

yes - osteoblastic cancer

Answer 158

BRCA1 BRCA2 involved in prostate cancer

Answer 159

benign paroxysmal positional vertigo (dix hallpikes) labyrinthitis (vestibular neuritis) meniere's disease (impaired endolymph absorption)

Answer 160

- frequent exacerbations (more than 3 times a year) - cachexia - signs of pulmonary hypertension

Answer 161

- oral ABx (amox and docy) - steroids (prednisolone 3-5 days)

Answer 162

H. influenzae Pseudomonas aeruginosa Moraxella catarrhalis

Answer 163

coagulopathy + acidosis + hypothermia = increased bleeding

Answer 164

20ml/kg of IV fluid bolus

Answer 165

To correct coagulopathy in bleeding patients

Answer 166

25-30ml/kg/day

Answer 167

ABG - hypoxia D-dimer Imaging -> TTE, V/Q scan, CTPA

Answer 168

3rd cycle if shockable rhythm and 300mg

Answer 169

TTTW Tachycardia >90 Tachypnoea >20 or partial pressure of CO2 <32mmHg Temperature >38 or <36 WCC >12,000 or <4,000

Answer 170

Blood test investigation for suspected anaphylaxis. Will be elevated.

Answer 171

Cardiac tamponade

Answer 172

chemo - minimal benefit radiotherapy - local regional disease such as brain met surgical excision - only curative some immunotherapies available

Answer 173

Elevated testicle Horizontal lie of the testis (bell clapper deformity Absence of the cremasteric reflex A negative Prehn sign (positive in epididymitis Blue dot sign

Answer 174

Non-contrast CT of kidneys, ureter, and bladder

Answer 175

BPH, prostatitis, UTU, urinary retention, catheterisation, or by prostate cancer

Answer 176

Hypoaldosteronism - hyponatremia, hyperkalemia, hypertension

Answer 177

Increased risk of re-narrowing and clot formation. Leads to need of revascularisation due to increased risk of MI. Patients should be put on DAPT (aspirin and clopidogrel) to reduce the risk of stent thrombosis.

Answer 178

antiproliferative drugs including paclitaxel or sirolimus

Answer 179

Half life is about 6hrs but it irreversibly inactivates platelets to prevent the synthesis of thromboxane A2. Platelet lifespan ~10days. Works for the lifetime of a platelet, therefore needs to be stopped 5-7 days prior to surgery.

Answer 180

To measure risk of arterial clot formation?

Answer 181

Adhesion - release of ADP, TXA, 5HT Activation - change shape, secrete vWF, fibrinogen Aggregation - to form platelet plug, and stimulation of the clotting cascade

Answer 182

150-300 x10^9

Answer 183

<10 >50 is usually ok for most operations

Answer 184

AF + CHADS 5-6, or AF + CHADS-VASC7-8, or VTE in last 3mths, or recent embolic event, or a mechanical heart valve.

Answer 185

Therapeutic: treatment of VTE or bridging 1-1.5mg/kg daily Prophylactic: 40mg subcut daily 20mg if CrCl between 15-30 ml/min

Answer 186

Inhibitor of factor Xa Used in AF absolute CrCl for its use is <15

Answer 187

Factor Xa inhibitor VTE treatment 10mg twice daily for 7 days then 5mg twice daily (oral) VTE prophylaxis is 2.5mg daily (oral)

Answer 188

Colorectal -> gram -ves (E.coli, anaerobes)

Answer 189

Patient factors: - age - diabetes - smoking - obesity - immunosuppression - malnutrition - length of hospital stay Types of surgery: - wound classification -> clean, clean contaminated, contaminated, dirty - abscess - foreign body - open bowel - should only be covered for 24hrs Perioperative care factors: - hair removal increases risk - inadequate skin prep - preop BSL control in diabetes - inadequate or inappropriate prophylactic antibiotics (1hr before the first cut) Intraoperative: - open vs close theatre - pressure in the OT (should be positive pressure) - operation time

Answer 190

Metronidazole 500mg IV + cefazolin 2g IV

Answer 191

Cefazolin 2g IV

Answer 192

NEXUS c-spine rules, and canadian c-spine rules

Answer 193

get answers to question. Some things include increased nucleus to cytoplasmic ratio, coarse chromatin, variable cell shapes and sizes.

Answer 194

microbiology, biochemistry,

Answer 195

Hb: is the measure of concentration of protein hemoglobin within RBCs. Requires the lysis of RBCs to release the hemoglobin. It is a concentration. Males are 14-18 g/dl, and females are 12-18 g/dl. Hct: measures the % of RBC in total blood. It is a percentage. Male is about 45% and females are about 40%.

Answer 196

including baroreceptors, chemoreceptors, SNS stimulation, osmoreceptors, RAAS, transcapillary fill *look at the trauma tutorial

Answer 197

anaphylaxis, fever, urticaria, ABO incompatibility (human error), infection (HIV, hep B) TACO: transfusion related acute cardiac overload (BAD) TRALI: transfusion related acute lung injury (immunological)

Answer 198

if the contrast in in the kidneys then been givenIV. If the contrast is in the stomach then likely given an oral contrast. Mention if a coronal or sagittal plane. May be in the osce (Watt)

Answer 199

low energy, volarly (palmer side) displaced, extra-articular fracture

Answer 200

low energy, dorsally displaced, extra-articular

Answer 201

pain out of proportion swelling cool limb distally redness/erythema tingling/change in sensation motor weakness weak or absent pulse (bad)

Answer 202

Superficial haematoma on the left side of the head Biconvex haemorrhage Midline shift to the right Diagnosis: extradural haematoma (aka epidural haematoma)

Answer 203

The middle meningeal artery (involved in 75% of extradural haematomas)

Answer 204

Subdural haematoma (between the dura mater and the arachnoid mater). Salient feature: crescentric shape of haemorrhage. Some midline shift.

Answer 205

subarachnoid (10% of all strokes) (bleeding between the arachnoid mater and the pia mater) intracerebral haemorrhage

Answer 206

ruptures of a saccular "berry" aneurysm

Answer 207

hypercoagulability blood stasis enodthelial injury

Answer 208

unfractionated heparin

Answer 209

Hodgkin's lymphoma

Answer 210

Impairs enzymatic activation of coagulation factors, therefore get impaired coagulation.

Answer 211

Yes (it acts as a co-factor)

Answer 212

Yes, depleted during the storage process of the blood. Therefore should replace calcium in patients

Answer 213

Inhibits plasminogen from converting to plasmin. Plasmin is then not able to break down fibrin.

Answer 214

TACO: - transfusion associated circulatory overload TRALI: - transfusion related acute lung injury Usually within 6hrs of transfusion and has a high mortality. Not related to poor crossmatching. Patients with co-morbidities. Cannot treat - can only give supportive management

Answer 215

fibrinogen, vWF, fibrinnectin, factor 8, factor 13. Takes the insoluble proteins from FFP

Answer 216

factors II, IX, X used in the reversal of warfarin and in haemophilia B (IX) **Works quickly, is short acting

Answer 217

Only 5% of breast cancer is familial Increased risk: - FDR <40 = 2x risk - 2 FDR or SDR <60yr - close relative bilateral breast cancer - close male relative with breast cancer

Answer 218

85% breast and 40% ovarian. Increases the risk of triple negative cancer

Answer 219

pancreatic cancer, melanoma, sarcoma, prostate cancer. Also ovarian cancer

Answer 220

autosomal dominant

Answer 221

phenylketonuria primary congenital hypothyroidism cystic fibrosis galactosaemia

Answer 222

The disease/condition: - needs to have a 'burden of disease' - there is a recognisable latent or early symptomatic stage - the natural history of the condition should be adequately understood The features of a good screening test: - accurately detects the target condition while it is still asymptomatic - cost effective - sensitive and specific - reproducible in a variety of setting - safe to perform The treatment: - effective treatment is available - early detective with treatment improves surviival - benefits of screening outweights any harm

Answer 223

chorioembryonic antigen

Answer 224

screen fir malignancy prognosis determine the success of treatment monitor recurrence

Answer 225

Consent needs to be: - specific to the treatment - patient must be competent - patient must be informed - must be freely given Patient requires: - Benefits - Risks - Information - Alternative treatments - Natural progression of the disease

Answer 226

renal clearance > 25ml/min

Answer 227

2.5mg oral daily

Answer 228

5mg twice daily. If valvular AF, then use warfarin and adjust to INR of 2-3

Answer 229

low molecular weight heparin

Answer 230

a new word or expression

Answer 231

clean wounds clean contaminated wound contaminated wounds dirty wounds

Answer 232

cephazolin = gram +ve and skin flora ampicillin = gram positive metronidazole = anaerobes gentamicin = wide spectrum but gram -ve in particular (does not cover an +ve)

Answer 233

Predisposing factors: - change in environment - pre-existing health conditions including dementia, polypharmacy, malnutrition, visual/hearing impairment Precipitating: - full bladder - pain - sepsis/infection - hypoxia - endocrine changes - metabolic

Answer 234

check operation notes - includes information about blood loss, fluid replacement during surgery patient history - any medical conditions ask patient about symptoms - SoB, full bladder, thirsty check fluid chart - know input vs output examination - assess fluid overload or dehydration

Answer 235

- stress response and release of cytokines: increase in SNS which causes vasoconstriction and reduced GFR. Also get increased cortisol which increases aldosterone release. Aldosterone causes increased sodium and water reabsorption in the DCT and CD. - decreased blood volume: baroreceptor response also increases SNS response, and activates the RAAS, which leads to increased aldosterone release - Will also have loss of serum H2O, which increases osmolality. This causes an increase in ADH which increasees H2O reabsorption in the CD.

Answer 236

bare metal stents and drug eluting stents. ideally required to be on DAPT for at least 6 weeks for BMS and 6mths of DES.

Answer 237

tissue damage leading to endothelial and collagen exposure --> platelet adheres --> release of receptor stimulants including thrombin, ADP --> get platelet activation --> secreting of vWF and other activating agents --> platelet aggregation --> formation of platelet plug. Also further activation of the clotting cascade.

Answer 238

5-alpha reductase, and tamsulosin (alpha-1 inhibitor for urinary retention)

Answer 239

when the patient is a high srgical risk of bleeding and also a high risk of TE event

Answer 240

commence when INR is

Answer 241

take last dose 6 days prior to surgery so there are 5 days of not taking warfarin prior to the surgery.

Answer 242

Advantages of warfarin: well known/studied anticoagulant Disadvantages of warfarin: requires monitoring drug interactions crosses the placenta (teratogenic) high bleeding risk Advantages of DOACs: no monitoring minimal drug interactions fixed dosage decreased risk of major bleeding compared with warfarin Disadvantages: short half-life -> therefore, even a single missed dose will impair anticoagulatory effect not effective if mechanical heart valve

Answer 243

Prothrombinex®-VF contains the concentrated human coagulation factors II, IX and X and low levels of the factors V and VII

Answer 244

Risk of bleeding in a patient with AF

Answer 245

middle meningeal artery

Answer 246

cutaneous lupus

Answer 247

It is a diagnosis of exclusion -> will have completely normal investigations but patient will present as jaundice. It is an autosomal recessive condition where the liver is not able to metabolise billirubin at an adequate rate during times of physical stress (illness, drugs, alcohol). As a result, there is a build up of unconjugated billirubin in the blood, resulting in jaundice.

Answer 248

know the gallstone image. This is choledocoliathesis

Answer 249

Cutaneous larva migrans Cutaneous larva migrans is the correct answer. It is most commonly caused by cat or dog hookworm larvae. The parasite is typically confined to the epidermis as it lacks the collagenase necessary to break through the basement membrane. Most infections are localized in the lower extremity as it is a common site of larval penetration. The eruption appears to migrate as the larvae move up to a few centimeters daily.

Answer 250

no - usually detected on biopsy

Answer 251

CONTACT DERMATITIS ATOPIC DERMATITIS INFECTION – bacterial, fungal PSORIASIS MALIGNANCY – SCC, Paget’s disease

Answer 252

FEC = fluorouracil, epirubicin and cyclophosphamide

Answer 253

used in ER positive breast cancer. Competitive ER antagonist in the breast, but it increased oestrogen sensitivity in other tissues. Increases the risk of endometrial cancer.

Answer 254

results from 2+ ribs being fracture in 2 or more places. Impairs movement during inspiration and expiration

Answer 255

A-E assessment thoraccentesis 2nd intercostal space mid-clavicular line

Answer 256

MLH1, MSH2, MSH6, PMS2, EPCAM

Answer 257

Causes a left shift as the RBCs lose 2,3 DPG and O2, meaning the transfused blood cell want to hold onto the O2. Therefore, does not improve oxygen delivery to tissues.

Answer 258

Potentiates the actions of anti-thrombin to prevent the convervsion of prothombin to thrombin.

Answer 259

Non-pharm: Medication review - e.g. anti-histamines can contribute to urinary retention Lifestyle: no caffeine or large amounts of fluid before bed Bladder retraining and double voiding Pharm: alpha blockers including tamsulosin (increases risk of patient falls) 5-alpha reductase inhibitor e.g. finasteride antimuscarinics Surgical: TURP (transurethral resection of the prostate)

Answer 260

History and exam (ask about intermittent claudication, Buerger's) ABI Angiography Dublex US - if angiogram is contraindicated (e.g. contrast allergy)

Answer 261

7 acuity eye fields blind spot fundus accommodation eye movement light - direct and consensual response

Answer 262

- anti-hypertensive medication non-adherence - MAOIs (especially if eating cheese) - pre-eclampsia - hyperthyroidism - pheochromocytoma (catecholamine secreting tumour of the adrenal medulla)

Answer 263

Well's criteria

Answer 264

Above-knee (proximal) DVT if present in the popliteal, superficial femoral (despite the name, still a deep vein), deep femoral, common femoral or external iliac veins Below knee (distal) DVT if present in the soleal or peroneal veins

Answer 265

Doppler US UEC to assess which choice of treatment D-dimer

Answer 266

Positive in DVT - pain on dorsiflexion of the foot of the affected leg?

Answer 267

general features: non-compressible venous segment loss of phasic flow on Valsalva manoeuvre absent colour flow if completely occlusive lack of flow augmentation with calf squeeze increased flow in superficial veins acute thrombus: increased venous diameter soft/deformable intraluminal material smooth surface free-floating edge (uncommon) chronic post-thrombotic change: normal or decreased venous diameter rigid intraluminal material irregular surface synechiae or bands calcifications (rare) +/- acute thrombus

Answer 268

the use of iFOBT as the screening test provision of iFOBT screening at no cost to participants distribution of invitations and screening tests by mail analysis of screening in a central laboratory follow-up of positive test results, mostly by colonoscopy, through the usual care pathway backed up by a central reminder service central collation of data and reporting of NBCSP outcomes via regular reports

Answer 269

Signet ring cell carcinoma (SRCC) is an aggressive and poorly differentiated gastric adenocarcinoma that occurs in the stomach in 90% of cases

Answer 270

anti-nuclear antibodies (ANA), anti-dsDNA antibodies, and anti-Sm antibodies

Answer 271

lupus anticoagulant, anti-cardiolipin, anti-β2-glycoprotein

Answer 272

TSH receptor antibodies (Graves disease) Thyroid peroxidase antibodies (Hashimotos) Thyroglobulin antibodies (can be both but not always)