General Pass Med

Question 1

Acute hepatorenal failure

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 1

1. Cirrhosis, POD, hypovolaemia due to lack of albumin etc.
2. Ascites + AKI
3. U&E, LFT, paracentesis of ascetic fluid.
4. Liver Tx or Vasopressin analogues (terlipressin) + albumin

Question 2

Coeliac First line screening

Answer 2

Anti TTG

Question 3

Oesophageal varices

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 3

1. Hepatic failure - and portal HTN. Causes increase usage of collaterals.
2. Nil. Until haemorrhage.
3. Ix - Endoscopy
4. Prophylaxis of bleeding = non-cardioselective BB such as propranolol, ligation.
5. Acute Rx =
   - ABCDE
   - Correct clotting; FFP, vit K
   - Terlipressin
   - Ligation

Question 4

Carcinoid syndrome.

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 4

1. Occurs when mets are present in the liver and lung and release serotonin into the circulation.
2. Facial flushing, diarrhoea, bronchospasm, hypotension.
3. Urinary 5-HIAA, Plasma chromogranin A
4. Somatostatin analogues - ocreotide

Question 5

Spontaneous Bacterial Peritonitis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 5

1. Ascitic fluid infection w/o evident source. Often occurs in those w/ cirrhosis, ascites, ALD, hep B/C.
2. Patient w/ liver pathology presenting w/ ascites, abdo pain and fever.
3. Paracentesis - high neutrophil count. Often E.coli
4. IV cefotaxime

Question 6

Delirium Tremens

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 6

1. Alcohol withdrawal - increased NMDA glutamate and decreased GABA suddenly
2. 6-12hrs; tremor, sweating, tachycardia, anxiety
   36 hrs peak incidence of seizure
   72hrs; DT (coarse tremor, confusion, delusions, hallucinations)
3. Ix clinically
4. Chlordiazepoxide for DT
   Pabrinex to stop encephalopathy
   Phenytoin can help w/ seizures.

Question 7

Charles Bonnet - DDX in new onset hallucinations in the elderly

Answer 7

• Visual impairment
• Hallucinations of animal and children.
• Social isolation, sensory deprivation and RF’s

Question 8

SSRI Stopping

Answer 8

• Gradually over 4 weeks to prevent discontinuation symptoms; increased mood change, Flu like Sx, restlessness, difficulty sleeping, unsteadiness, GI Sx.

Question 9

Tardive Dyskinesia

Answer 9

• Develops when on long-term anti-psychotic meds.
• Excessive blinking, chewing, pouting, lip smacking
• Rx w/ tetrabenazine

Question 10

Acanthosis nigricans

Answer 10

• Symmetrical brown, velvety plaques often seen on the neck, axilla or groin
• Caused by; GI cancer, DM, Obesity, PCOS, Acromegaly, cushings, hypothyroidism, OCP.

Question 11

Bullous Pemphigoid

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 11

1. Autoimmune due to the development of antibodies against hemidesmosomal proteins BP180 and BP230
2. Elderly patients, itchy, tense blisters around the flexures. Mouth spared.
3. Skin biopsy - IgG and C3 at the dermoepidermal junction
4. Derm referral + Oral steds, topical steds, ABx and immunosuppressants also used.

Question 12

Seborrhoeic Keratoses

Answer 12

• Benign
• Light brown - black. STcuk on appearance.
• Rx - leave it alone or remove w/ cryo or curette

Question 13

Pityriasis Versicolour

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 13

1. Fungal infection w/ Malassezia furfur
2. Trunk, patches may be hypopigmented, pink or brown. More noticeable with a tan. Scaly and itchy.
3. Clinical
4. Topical antifungal - ketoconazole shampoo