geris

Question 1

small bowel ischaemia presentation by anatomy

Answer 1

SMA:
severe abdo pain
vomiting, sweating, bloody diarrhoea
CVS collapse

mesenteric vein thrombosis:
non specific, vague abdo pain
more insidious onset, may take weeks

chronic:
postprandial abdo pain (mesenteric angina)
weight loss, fear of eating

Question 2

large bowel ischaemia presentation

Answer 2

subacute:
transient episodes of abdo pain

acute:
severe abdo pain usually LIF
may be PR bleed

Question 3

diagnosing bowel ischaemia

Answer 3

SMA- lactic acidosis, CT angio
mesenteric non occlusive- mesenteric angio
mesenteric v thrombosis- thickened bowel wall on AXR, clot on CT
chronic- CT or mesenteric angio

subacute large bowel- colonoscopy or barium enema
acute large- thickened wall on CTAP, inflammation in watershed area around splenic flexure

Question 4

surgical management of bowel ischaemia

Answer 4

SMA embolus- arteriotomy and embolectomy
thrombosis- aortomesenteric bypass
resect necrotic bowel
non occlusive- resect if necrotic
mesenteric thrombosis- anticoag

subacute large- surgery if obstructed
acute large- conservative unless peritonitic

Question 5

structural brain changes associated with increased risk of depression

Answer 5

hippocampus atrophy
reduction of glial cells in prefrontal cortex
focal lesions of subcortical white matter on MRI

Question 6

dermatitis herpetiformis treatment

Answer 6

GF diet
dapsone PO
steroids PO or topical

Question 7

dermatitis herpetiformis biopsy

Answer 7

histology: microabscesses in dermal papillae containing neutrophils and eosinophils

immunofluorescence: granular IgA deposits in upper dermis

Question 8

conditions increasing risk of digoxin toxicity

Answer 8

renal impairment
hypokalaemia
hypomagnesaemia
hypercalcaemia

p glycoprotein inhib- verapamil, diltiazem, amiodarone, ketoconazole, erythromycin

Question 9

digoxin action

Answer 9

inhibits NaKATPase pump
increases intracellular Na, reduces K
reduces NaCa exchanger action
> increased contractility
increases vagal tone
> decreases SAN and AVN conduction

Question 10

features of dig toxicity

Answer 10

SA and AV block
premature ventricular contractions
PR prolongation
ST depression

GI symptoms
blurry/yellow vision
CNS symptoms
thrombocytopenia, agranulocytosis
gynaecomastia

Question 11

managing dig toxicity

Answer 11

ix: levels 4-6h post dose
therapeutic range 0.5-0.9
ECG: AV blockage, premature ventricular contractions, slowed ventricular response
K reflects severity

Fab fragments if:
life threatening/unstable arrythmia
hyperkalaemia
end organ dysfunction

calcium gluconate for hyperkalaemia in dig toxicity can be fatal

Question 12

dystonia anatomy

Answer 12

torticollis and hand- caudate nucleus and thalamus
cervical- basal ganglia and vestibulo ocular reflex
drug induced- striatal dopamine receptors

Question 13

managing dystonia and dyskinesia

Answer 13

trial L dopa
anticholinergic e.g. trihexyphenidyl
baclofen or benzos
botox
deep brain stimulation

tardive:
withdraw antipsychotics, wait 6/12
tetrabenazine

tics:
clonazepam or clonidine

surgery:
selective denervation for cervical dystonia
myectomy for cervical or blepharospasm