Go Through Flashcards
1
Q
How do we treat anaemia in pregnancy?
A
NICE advises that haemoglobin levels outside the normal UK range for pregnancy (that is, 110g/| at first contact and
105g/d at 28 weeks) should be investigated and iron supplementation considered if indicated.
2
Q
How does Goodpasture syndrome present on XR?
A
characterized by parenchymal consolidations from autoantibody induced inflammatory lesions that are most often present bilaterally in both lungs, the perihilar, & bibasilar regions. When pulmonary haemorrhage is recurrent an interstitial pattern is observed.
3
Q
How does Wegener’s present?
A
Wegener’s granulomatosis: Symptoms include sinusitis, nasal ulcers, alveolar capilaritis, cavitary pulmonary lesions, and pulmonary hemorrhage.
Goodpasture’s syndrome: Symptoms include cough, hemoptysis, dyspnea, and fatigue.
4
Q
Which vitamin is likely to be low in carcinoid syndrome?
A
B3 (niacin)
5
Q
How does AKPKD present
A
haematuria - from cyst rupture
* flank pain - from cyst enlargement
* hypertension
* stroke - from subarachnoid haemorrhage from intracranial aneurysms
* renal failure
* palpable masses in the flanks
* increased incidence of UTIs
Supportive mx
6
Q
If a CCB is not tolerated for first-line for HTN due to SEs, what should we start?
A
Thiazide-like diuretic
7
Q
Where do you see +ve Murphy’s sign?
A
Acute cholecystitis
8
Q
When should babies be delivered?
A
40w
Pre-37 = premature
42+ = postterm
9
Q
Where is the rash in measles?
A
Face
10
Q
How does genitu-urinary tract TB present?
A
GUTB often manifests as repeated urinary tract infections that do not respond to the usual antibiotics.
* The most common symptoms of GUTB, in descending order of frequency, is
* 1 frequency of urination
* dysuria
* suprapubic pain
* blood or pus in the urine (hallmark of genitourinary tract TB is sterile pyuria)
* fever
* There may also be a painful testicular swelling, perianal sinus, or a genital ulcer.
* Fertility maybe diminished & may be a cause of unexplained infertility.
11
Q
How do we treat bowel colic pain in colorectal cancer?
A
Buscopan - hyoscine butylbromide
12
Q
Give RFs for endometrial carcinoma
A
- obesity
- nulliparity
- late menopause
- family history of ovary, breast, colon cancer
- tamoxifen
- unopposed oestrogen therapy (HRT)
- pelvic irradiation
- diabetes
- polycystic ovary syndrome
13
Q
A very raised platelet count due to essential thrombocythaemia can be a risk factor for bleeding.
A
A very raised platelet count due to essential thrombocythaemia can be a risk factor for bleeding.
14
Q
What is Caplan’s syndrome?
A
Caplan’s Syndrome is pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis.
* CXR shows multiple, round, well-defined nodules, usually 0.5-2.0 cm in diameter, which may cavitate and resemble tuberculosis.
Tx = steroids
15
Q
What is goserelin used for/
A
Endometriosis
* Precocious puberty
* Infertility
* Uterine fibroids
* Breast cancer
* Prostate cancer
16
Q
What is co-cyprindiol?
A
Dianette® (co-cyprindiol) contains two active ingredients, cyproterone acetate (synthetic progestogen) & ethinylestradiol. Cyproterone acetate suppresses the actions of testosterone by blocking androgen receptors.
* Indications
* Moderate to severe acne in females of child-bearing age refractory to topical therapy or oral antibacterials
* Moderately severe hirsutism
17
Q
Give RFs for cervical ca
A
Early age of first sexual intercourse.
- Infection with at least one type of HPV occurs soon after the start of sexual activity, with nearly 40% of women infected within 2 years.
- Multiple sexual partners or a high-risk sexual partner.
- History of sexually transmitted infection (STI).
- Lack of use of barrier methods of contraception, such as condoms.
- History of HPV-related vaginal or vulval dysplasia.
- Conditions causing immunocompromise or immunosuppression, such as solid organ transplant or HIV infection.
18
Q
What causes viral warts?
A
HPV, a papovavirus
19
Q
How does pharyngeal pouch present?
A
Usually presents in elderly men as dysphagia which is characterised by the first mouthful being swallowed easily but as the pouch becomes filled with food, obstruction of the upper oesophagus occurs.
* Further swallowing is prevented and the contents of the pouch are regurgitated.
There is usually a palpable swelling in the neck in two-thirds of cases which may gurgle and there may also be fits of coughing & episodes of pulmonary infection, especially at night, due to the inhalation of regurgitated food.
20
Q
How do we detect neural tube defects if US unable?
A
Amniocentesis is only used when unable to obtain adequate ultrasound images and is used to measure alpha-fetoprotein and
neuronal acetylcholinesterase.
* Amniotic fluid a-fetoprotein obtained via amniocentesis at 16 weeks (1% risk of fetal loss) is more accurate than maternal serum
a-fetoprotein for detecting neural tube defects.
21
Q
What is round ligament pain?
A
Round ligament pain generally refers to a brief, sharp, stabbing pain or a longer-lasting dull ache that pregnant women commonly feel in the lower abdomen or groin, starting in the second trimester. This is due to the uterus pulling on the round ligament.
22
Q
What is rectus muscle haematoma?
A
Rectus muscle haematoma is due to rupture of inferior epigastric vessels in late pregnancy and presents with sudden severe
abdominal pain, often after coughing or trauma.
23
Q
What is Munchausen’s syndrome?
A
Münchhausen’s syndrome (named after the legendary Baron von Münchhausen who was renowned for his wide travels and dramatic and untruthful stories) is the most well-known but extreme form of factitious disorder characterised by three features:
(1) Simulated illness - either physical or psychiatric
(2) Pathological lying (pseudologia fantastica)
(3) Wandering from place to place (peregrination) - the patient typically presents to numerous different hospitals using different names.
24
Q
How do anti-muscarinics impact pupils?
A
Dilation
25
How do we treat AACG?
Eye drops reduce intra-ocular pressure by reducing production of aqueous humour
* beta-blockers
* sympathomimetics
* carbonic anhydrase inhibitors
* or increasing the drainage of aqueous humour
* prostaglandin analogues
* sympathomimetics
* miotics
26
When can children dress themselves?
4y
27
What is an ectopic pregnancy?
Ectopic pregnancy is defined as a fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube.
28
A 26-year-old woman is out on a Friday night with her friend when she twists her ankle on her high heel shoes. X-ray shows a medial malleolar fracture and a proximal fibula fracture.
Maisonneuve
29
How does syringomyelia present?
Syringomyelia describes a fluid-filled tubular cavitation (syrinx) within the (usually cervical) spinal cord.
* Commoner in men than in women and most commonly presents in the 20s and 30s.
* Pain & temperature sensation are lost due to spinothalamic tract damage.
* One side may be affected more than the other.
* Classically, the sensation loss is experienced in a shawl or cape like distribution over the arms, shoulders and upper body.
There is muscle wasting & weakness that begins in the hands and then affects the forearms and shoulders which reflect
involvement of cervical anterior horn cells.
* Condition is progressive and there is no cure.
30
A 40-year-old woman presents with fatigue, pruritus, steatorrhoea, dry eyes and mouth. On examination, she is jaundiced with xanthelasma and an enlarged liver & spleen are palpable. Which one of the following investigations would be the MOST appropriate to order?
Primary biliary cirrhosis is an autoimmune disease of the liver with destruction of the bile canaliculi within the liver.
Antimitochondrial antibodies
Tx - liver transplant
31
How do we monitor for colorectal ca in a pt with longstanding, extensive UC?
is colonoscopy and multiple biopsies.
32
How do we dx menopause?
For most women, menopause is a clinical diagnosis and it is rarely necessary to arrange any specific tests.
Serum FSH should generally only be measured in women with menopausal symptoms who are aged 45 years and under.
33
How does COCP inhibit ovulation?
CHC acts on the hypothalamo-pituitary-ovarian axis to suppress luteinising hormone (LH) & follicle-stimulating
hormone (FSH) and thus inhibit ovulation.
34
What may undertreated hypothyroidism lead to?
Untreated or undertreated HYPOthyroidism is associated with a decrease in insulin sensitivity, including direct effects on insulin secretion and clearance, leading to potential insulin resistance and increased risk of developing metabolic syndrome.
35
What may untreated hyperthyroidism lead to?
Untreated or undertreated HYPERthyroidism may cause atrial fibrillation, osteoporosis, Graves orbitopathy and thyrotoxic periodic paralysis (rare complication characterized by muscle paralysis and hypokalaemia, which is more prevalent in Asian people with hyperthyroidism).
36
What is typhoid fever?
Classic typhoid fever syndrome begins 7-14 days after ingestion of Salmonella typhi.
* The fever pattern is characterized by a rising temperature over the course of each day that drops by the subsequent morning.
* During the first week of illness
* The notorious gastrointestinal manifestations of the disease develop which include diffuse abdominal pain and constipation from inflamed Peyer patches that narrow the bowel lumen.
* The patient develops blanching, truncal, maculopapules which represent bacterial emboli to the dermis.
* During the second week
* A soft splenomegaly is common and a relative bradycardia may develop.
37
How do we dx typhoid fever?
Bone marrow aspirate
Bloods cultures
38
How do we dx dengue fever?
Patients present with fever as high as 41°C. The fever begins on the third day and lasts 5-7 days.
Dengue fever is a viral infection spread by mosquitoes that causes fever, headache, muscle and joint pain, and sometimes a rash.
Dx - serology
39
What is Bornholm disease?
Bornholm disease (also called pleurodynia) is an uncommon condition due to a viral infection with Coxsackie B virus. It mainly affects children and young adults.
It causes pain in the chest or upper abdomen with flu-like symptoms. The pain is severe, stabbing and pleuritic in nature, worse with breathing deeply, coughing or movements. In very severe cases, the pain can make it difficult to breathe and the affected area may be tender. The pain tends to come and go, with episodes lasting 15 to 30 minutes. There may be variable symptoms of fever and sometimes sore throat, cough, headache and aching muscles.
40
How do we treat toxoplasmosis?
Spiramycin
41
How do we treat listeria?
Amox + gent
42
How do we treat syphilis?
Penicillin
43
When do we give MMR?
1y, 3y4m
44
What type of wave is seen in WPW?
Delta wave
45
1. A 5-year-old boy presents with recurrent sinusitis, upper respiratory tract infections and chronic diarrhoea. His parents have been advised to warn doctors if he is to have a blood transfusion or intravenous. Dx?
IgA deficiency
46
How does hereditary angioedema present? Cause?
A 13-year-old girl presents with rapid swelling of the face, lips and hands.
C1 inhibitor deficiency
47
Why do we not give glucose to alcoholic pts?
Infusion of glucose without thiamine in a patient with chronic thiamine deficiency can precipitate Wernicke's encephalopathy - a triad of acute mental confusion, ataxia, and ophthalmoplegia. In the West, thiamine deficiency is characteristically associated with chronic alcoholism, because it affects thiamine uptake and utilization.
48
What is PSC associated with?
UC
49
What is often associated with Friedrich's ataxia?
Cardiomyopathy and diabetes
50
Anti-emetic for metabolic vomiting?
Haloperidol
51
Anti-emetic for mechanical bowel obstruction?
Cyclizine
52
A 23-year-old African man presents with severe back pain. Tests show a normocytic, normochromic anaemia, high reticulocyte count and jaundice. ESR is lOW. Dx?
Sickle cell
53
What is coronaritis?
Inflammation of coronary arteries - seen with H pylori infection
54
What are anaplastic thyroid carcinoma?
Anaplastic thyroid carcinoma are aggressive rare thyroid carcinomas (2% of all thyroid cancers).
* Usually affects women in their 6th-7th decades of life.
* It presents as a rapidly growing thyroid mass and patients complain of symptoms due to local invasion.
* Hoarseness and dyspnoea resulting from the involvement of the recurrent laryngeal nerve and airway occur in as many
as 50% of patients.
* Examination reveals a firm thyroid mass(es) that are usually >5 cm at presentation.
- 30% have vocal cord paralysis, 40% have cervical lymphadenopathy and 50% already have distant metastases (usually lungs, bones, and brain) at the time of diagnosis.
- The progression of disease is rapid, and most patients die from local airway obstruction or complications of pulmonary metastases within 1 year despite all treatment efforts.
55
How does medullary thyroid carcinoma present?
The major clinical symptoms of metastatic medullary thyroid carcinoma are diarrhoea and facial flushing due to excessive calcitonin.
* Calcitonin levels tend to be elevated & diagnostic.
* Levels of serum serotonin, ACTH and other peptides may also be raised.
56
How does papillary carcinoma present?
Papillary carcinoma is the most common thyroid malignancy, representing approximately 80% of thyroid carcinomas.
* It occurs more frequently in women and presents in the 30-40 year age group.
* It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck (tumours typically appear after a latency period of about 10-20 years).
* Papillary carcinoma is a slow-growing tumour that arises from the thyroxine (T4)- and thyroglobulin-producing follicular cells of
the thyroid.
* The cells are TSH sensitive and take up iodine. This feature has both diagnostic and therapeutic value for managing residual disease and recurrences after surgical excision.
* Papillary carcinoma typically arises as an irregular, solid or cystic mass that arises from otherwise normal thyroid tissue.
* The most common presentation of thyroid cancer is an asymptomatic thyroid mass or a nodule that can be felt in the neck but some patients have persistent cough, difficulty breathing, or difficulty swallowing.
* Another common feature of papillary carcinoma is its propensity to spread to the cervical lymph nodes.
57
When can we only give simvastatin 20mg?
If given in conjunction with amlodipine - means it is in effect 40mg
58
Which laxative can stain urine red?
Co-danthramer
59
A previously healthy 61-year-old woman presents with a 3-month history of sinusitis and nasal discharge. She has noted only marginal, temporary improvement despite multiple courses of antibiotics. The nasal discharge is purulent and frequently bloody. She also has a 2-week history of migratory joint pain, mainly affecting wrists, knees, and ankles. She does not describe joint swelling. She reports having less energy and has lost 5kg in weight over the past 2 months. She has no respiratory, urinary, neurological, or other symptoms.
Urinalysis reveals 3+ microscopic haematuria and 2+ proteinuria. Dx?
Wegener's granulomatosis
60
How does scaphoid fracture present?
Clinically patients present with snuff box tenderness.
* In addition, look for tenderness over the palmar & dorsal aspect of the scaphoid, pain on compressing the thumb longitudinally and pain on gentle flexion & ulnar deviation of the wrist.
61
Where are femoral hernias?
Inferiolateral to the pubic tubercle
62
Where is livedo reticularis seen?
Livedo reticularis is a red net-like discolouration of venules typically on the legs and can be triggered by cold.
Caused by pregnancy, RA, SLE, PAN, lymphoma, TB, polymyositis, and Raynaud's.
63
How does glucagonoma present?
diabetes, dermatosis, deep vein thrombosis,
depression, (as well as diarrhoea & decreased weight - so could also be known as the 6Ds).
64
What is pulsus paradoxus?
exaggerated drop in a patient's blood pressure >10 mmHg during inspiration
65
What is Kussmaul's sign?
paradoxical increase in jugular venous pressure (JVP) during inspiration, often seen in conditions like constrictive pericarditis or severe heart failure.
66
How does campylobacter present?
Campylobacter is one of the two most commonly documented foodborne diseases in the UK (the other being salmonella).
* Diarrhoea can be watery or bloody and is frequently associated with crampy abdominal pain.
* It has been linked to serious complications such as reactive arthritis & Guillain-Barre syndrome.
67
What is the mode of action of nicotinic acid?
Nicotinic acid lowers both cholesterol and triglyceride concentrations by inhibiting synthesis & it also increases HDL-cholesterol.
68
What is the most common cause of lower GI bleeding?
Diverticulitis
69
What is Fregoli syndrome?
where a familiar person (his wife) is falsely identified in strangers.
70
How does cervicitis present?
The cervix appears inflamed and friable with a thick, purulent discharge coming out of the external os.
71
How do we calculate alcohol intake?
[volume(ml) x %ABV] /1000.
72
A 40-year-old woman complains of a mobile subcutaneous lump which fluctuates in size on her face and has discharged in the past as well as becoming infected needing antibiotics from her GP. On close examination a punctum is visible. Dx?
Sebaceous cyst
73
How does vitamin B2 deficiency (riboflavin) present?
* Riboflavin deficiency results in cracked red lips, inflammation of the lining of mouth & tongue, mouth ulcers, cracks at the corners of the mouth (angular cheilitis), & sore throat.
74
A 42-year-old woman presents with a 5 month history of amenorrhoea. An abdominal mass is palpable on examination. Which of the following is the MOST likely diagnosis?
Pregnancy
75
Red urine first thing in the morning...
Out of the options available, the features of dark urine first thing in the morning and anaemia is most suggestive of paroxysmal nocturnal haemoglobinuria (PNH). There are three features of PNH that are most uncommon together but the finding of them all is pathognomonic:
* Acquired haemolytic anaemia due to the susceptibility of the erythrocyte membrane to the haemolytic action of complement.
* Thromboses in large vessels, such as hepatic, abdominal, cerebral and subdermal veins.
* Deficient haematopoiesis that may be mild or severe and cause a pancytopenia with aplastic anaemia.
76
What is first-line in alkalosing spondylitis?
Physio
77
Who does haemophilia B impact?
Only men - x-linked recessive
78
How does pseudohypoparathroidism present?
Pseudohypoparathyroidism is caused by resistance to parathyroid hormone (PTH).
* It is characterised by hypocalcaemia, hyperphosphataemia, raised PTH levels, and an unusual collection of developmental and skeletal defects including short stature, rounded face, shortened fourth metacarpals and other bones of the hand and feet,
obesity, dental hypoplasia, and soft tissue calcifications/ossifications.
79
How does meconium aspiration present?
Faecally amniotic fluid with RDS
80
What is precordial catch syndrome?
Precordial catch syndrome (Texidor's Twinge) is an idiopathic, benign condition in which there are sharp stabbing pains in the chest that usually occur while the patient is at rest, but never occurs during sleep. It is a common, but underrecognized cause of chest pain in children and adolescents.
81
What is Gower's sign?
Gower's sign - 'climbing up legs' using the hands when rising from the floor.
* Characteristic pseudohypertrophy of the calves.
Seen in Duchennes
82
Bilateral hilar lymphadenopathy
Sarcoidosis
83
A 25-year-old woman presents to her GP with multiple symptoms. She was recently seen in A&E with renal colic but now complains of new-onset headaches, fatigue, and constipation. Her menstrual cycle is regular and she has not experienced episodes of flushing. Her weight is unchanged and her peripheral vision is normal. Family history reveals that her father had kidney stones and died of a 'stomach problem' in his 60s. Examination is unremarkable with visual fields full to confrontation. Dx?
Multiple endocrine neoplasia type 1
84
WPW ECG sign?
Delta wave
85
ACEi + azathioprine (immunosuppressant)
Severe leukopenia
86
What usually causes secondary hyperparathyroidism?
Low vitD or chronic renal failure
87
How does cholestyramine work?
Cholestyramine is a bile acid sequestrant, which binds bile in the gastrointestinal tract to prevent its reabsorption which are then excreted in the faeces.
88
What is PEDSS
"PEDSS"
* Position of cervix
* Effacement (or length) of cervix
* Dilation of cervix
* Softness (or consistency) of cervix
* Station of the foetus
The maximum score is 10.
* A score of ≤5 suggests that labour is unlikely to start without induction.
* A score of ≥9 indicates that labour will most likely commence spontaneously.
* A low Bishop's score often indicates that induction is unlikely to be successful.
89
Persistent change in bowel habit =
FIT test
90
Most common cause of portal htn?
Liver cirrhosis
91
What is round ligament pain?
Round ligament pain generally refers to a brief, sharp, stabbing pain or a longer-lasting dull ache that pregnant women commonly feel in the lower abdomen or groin, starting in the second trimester. This is due to the uterus pulling on the round ligament.
92
What are Braxton-Hicks contractions?
Braxton-Hicks contractions are usually felt as 'tightening' rather than pain after 20 weeks.
93
Renal ca presentation?
Haematuria, left flank mass and Lt varicocele
94
ECG in hypothermia
J wave
95
Perforated peptic ulcer first line ix =
Erect CXR
96
Who does haemophilia impact?
Mostly males - X linked recessive
MSK bleeding is most common (unlike VWD)
97
A 40-year-old woman with a long history of ulcerative colitis presents with
pruritus and fatigue. Her LFTs are abnormal.
Primary sclerosing cholangitis
The diagnosis of primary sclerosing cholangitis should be suspected in a patient with ulcerative colitis who has
abnormal LFTs, especially a raised alkaline phosphatase.
98
A 50-year-old woman with rheumatoid arthritis complains of pruritus, xanthelasmatic lesions around the eye and hepatosplenomegaly. Her family thinks she looks yellow.
Primary biliary cirrhosis
99
Amiodarone eye SE?
Corneal deposits
100
Hypercalcaemia bowel SE?
Constipation
101
What is aplastic anaemia?
anaemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia.
102
BCG can tx which ca?
Bladder
103
Pre-ecl vs ecl
Ecl = seizures
104
Most common shoulder dislocation?
Anterior 95% of the time
105
Hyphaemia =
Blood in the anterior chamber
106
Phaeochromocytoma
Headache, palpns and htn
107
High arched palate =
Marfans
108
Which lung ca causes hyperca
Squamous cell --> PTH
109
For how long are babies immune to chickenpox
New born babies have passive immunity to chickenpox for 7/7 post birth
110
Myotonic dystrophy =
Cataracts, muscle weakness and frontal balding
111
MOA inhibitor + sertraline =
Serotonin sy drome
112
Inevitable miscarriage =
Inevitable miscarriage is a diagnosed non-viable pregnancy in which bleeding has begun and the cervical os is open, but pregnancy tissue remains in the uterus. The pregnancy will proceed to incomplete or complete miscarriage.
* Complete miscarriage is when all the products of conception have been expelled from the uterus and bleeding has stopped.
* Incomplete miscarriage is a diagnosed non-viable pregnancy in which bleeding has begun but pregnancy tissue remains in the uterus.
Missed miscarriage (also known as delayed or silent miscarriage) is diagnosed when a non-viable pregnancy is identified on ultrasound scan, without associated pain and bleeding.
gestation.
Threatened miscarriage
113
Wernicke's =
Wernicke's encephalopathy is caused by a deficiency of thiamine (vitamin B1). It presents with a triad of acute mental confusion, ataxia, and ophthalmoplegia. Korsakoff's psychosis, a late manifestation of Wernicke's encephalopathy, presents with confabulation and memory loss, or psychosis.
114
scleral icterus
Yellowing of whites of eyes
115
1st line stable angina?
Ca channel blocker or beta blocker
116
ACEi in pregnancy?
Switch to labetalol
117
Budd-Chiari syndrome
is an uncommon condition caused by obstruction to hepatic venous outflow.
118
A 13-year-old girl presents with rapid swelling of the face, lips and hands.
hereditary angiooedema
119
The bumper fracture is
Tibial plateau fracture
120
A 20-year-old woman presents with mouth ulcers. She has suffered with this problem intermittently for years and the ulcers tend to occur during periods of anxiety or stress and eventually self-resolve. She usually uses over-the-counter lozenges and a local anaesthetic oral spray, but this latest crop is proving more painful and longer lasting than usual. She is otherwise fit and well with no significant medical history. Oral examination reveals three 5mm aphthous ulcers in her buccal mucosa. Which is the SINGLE
MOST appropriate treatment option?
Recurrent aphthous stomatitis
Oral steroids
121
What is pseudo-obstruction
Pseudo-obstruction presents as colonic obstruction but a mechanical cause cannot be found.
* The patient is often elderly & bedridden.
* The abdomen gradually distends and bowel actions cease.
* Note bowel sounds may still remain & even sound obstructive.
* There is usually little or no abdominal pain and no tenderness.
* Abdominal X-ray shows a similar picture to mechanical obstruction but gas may be seen in the rectum.
* Once mechanical obstruction is excluded, management is conservative.
122
Sigmoid volvulus on XR?
A volvulus is a complete twisting of a loop of intestine around its mesenteric attachment site.
* This can occur at various locations of the GI tract, including stomach, small intestine, caecum, transverse colon, & sigmoid colon.
* Sigmoid volvulus is the most common form of gI tract volvulus.
* Torsion is usually anti-clockwise ranging from 180 - 540 degrees.
* It is most common in elderly persons (often neurologically impaired) and patients almost always have a history of chronic constipation.
* Predisposing factors
* chronic constipation
* high-roughage diet (may cause a long, redundant sigmoid colon)
* roundworm infestation
* megacolon (often due to Chagas disease)
* Presentation
* Usually with an acutely distended abdomen, colicky pain (often LLQ), & failure to pass flatus or stool (constipation is prevailing feature).
* The abdominal plain film is usually diagnostic which shows an inverted U-shaped appearance of distended sigmoid loop.
123
Posterior pituitary =
oxytocin and ADH
124
How does typhoid present?
Classic typhoid fever syndrome begins 7-14 days after ingestion of Salmonella typhi.
* The fever pattern is characterized by a rising temperature over the course of each day that drops by the subsequent morning.
* During the first week of illness
* The notorious gastrointestinal manifestations of the disease develop which include diffuse abdominal pain and constipation from inflamed Peyer patches that narrow the bowel lumen.
* The patient develops blanching, truncal, maculopapules which represent bacterial emboli to the dermis.
* During the second week
* A soft splenomegaly is common and a relative bradycardia may develop.
125
Anti-muscarinics on eye?
Dilate pupil
126
Pharyngeal pouch presentation
Usually presents in elderly men as dysphagia which is characterised by the first mouthful being swallowed easily but as the pouch becomes filled with food, obstruction of the upper oesophagus occurs.
* Further swallowing is prevented and the contents of the pouch are regurgitated.
* There is usually a palpable swelling in the neck in two-thirds of cases which may gurgle and there may also be fits of coughing & episodes of pulmonary infection, especially at night, due to the inhalation of regurgitated food.
127
First-line HAP?
Co-amox
128
Ix pneumaturia?
CT - ? colovesical fistula
129
Multiple erythematous macular lesions on the forehead, eyelids and upper lip that blanch with pressure.
Stork mark
130
What is milk-alkali syndrome?
Triad of hypercalcaemia, renal failure and metabolic alkalosis secondary to ingestion of large amounts of calcium and absorbable alkali (e.g. OTC antacids)
131
Tx acute uncomplicated diverticulitis?
Co-amox
132
GH deficiency presentation
Standing height and growth velocity are reduced and there is often increased subcutaneous fat around the trunk.
* The face is immature, with a prominent forehead and depressed midfacial development and dentition is often delayed.
* Pubertal onset is delayed and in males the phallus may be small.
133
Electrolyte abn in rhabomyolysis
Treating clinicians should be aware that electrolyte abnormalities are prominent features of rhabdomyolysis.
Hyperphosphataemia, hyperkalaemia, hypocalcaemia (early), hypercalcaemia (late), hypoalbuminaemia and hyperuricaemia have been described.
