important basics

Question 1

normal body temperature range

Answer 1

36.5–37.5 °C

Question 2

what are haemorrhoids

Answer 2

Haemorrhoids are disrupted and dilated anal cushions. The anus is lined mainly by discontinuous masses of spongy vascular tissue—the anal cushions, which contribute to anal closure. Viewed from the lithotomy position, the 3 anal cushions are at 3, 7, and 11 o’clock (where the 3 major arteries that feed the vascular plexuses enter the anal canal). They are attached by smooth muscle and elastic tissue, but are prone to displacement and disruption, either singly or together. The effects of gravity (our erect posture), increased anal tone (?stress), and the effects of straining at stool may make them become both bulky and loose, and so to protrude to form piles (Latin pila, meaning a ball). They are vulnerable to trauma (eg from hard stools) and bleed readily from the capillaries of the underlying lamina propria, hence their other name, haemorrhoids (≈running blood in Greek). Because loss is from capillaries, it is bright red. NB: piles are not varicose veins.

Question 3

what are the sepsis 6?

Answer 3

6 basic interventions that can be done rapidly to reduce the risk of death in a patient believed to have sepsis

The Sepsis Six are:

1 - Administer high flow oxygen.

2 - Take blood cultures

3 - Give broad spectrum antibiotics

4 - Give intravenous fluid challenges

5 - Measure serum lactate and haemoglobin

6 - Measure accurate hourly urine output

Question 4

uk gov guidelines on calorie consumption

Answer 4

men 2600

women 2000

Question 5

what is orlistat

Answer 5

lowers fat absorption
used in obesity
SE oily incontinence

Question 6

normal BMI range

Answer 6

18.5-25

weight in kg/height in m^2

Question 7

what is angular stomatitis

Answer 7

fissuring of the mouth’s corners caused by iron or B2 deficiency or candidiasis

Question 8

white fur on an erythematous tounge

Answer 8

oral candidiasis. white patches and erythema. patches are hard to remove and bleed if scraped.

Question 9

oral pigmentation

Answer 9

addison’s disease
drugs
Peutz-Jeghers syndrome, also known as hereditary intestinal polyposis syndrome

Question 10

what is glossitis

Answer 10

a smooth, red sore tounge. iron, folate or B12 deficiency.

Question 11

dysphagia - 5 key questions to ask

Answer 11

1- solids AND liquids from the start? yes = motility. no and progressive = stricture, both benign and malignant.

2 - difficult to make the swallowing movement? bulbar palsy

3- odynophagia? cancer, ulcer, candida, spasm.

4 - intermittent or constant and progressive - intermittent = oesophageal spasm. constant = malignant stricture

5 - neck bulges or gurgles on drinking? phyrangeal pouch.

Question 12

overview of causes of dysphagia

Answer 12

1 - mechanical block 
a - malignant stricture 
b - benign stricture
c - extrinsic pressure (AAA, lung ca, LA enlargement)
d - phyrangeal pouch

2 - motility disorders
a - achalasia, spasm
b - neurological - myasthenia gravis, PD,

3 - other
a - oesophagitis, globus

Question 13

how to classify antiemetics

Answer 13

1 - H1R antag
- cyclizine

2 - D2 antag

• metclopramide
• domperidone
• haloperidol

3- 5ht3 antag
- ondansentron

4 - other
- dexamethasone (unknown MOA)

Question 14

what is cushing’s

Answer 14

Cushing’s syndrome describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol. This can be caused by taking glucocorticoid drugs, or diseases that result in excess cortisol, adrenocorticotropic hormone (ACTH), or CRH levels.[1]

Cushing’s disease refers to a pituitary-dependent cause of Cushing’s syndrome: a tumor (adenoma) in the pituitary gland produces large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol. It is the most common non-iatrogenic cause of Cushing’s syndrome, responsible for 70% of cases excluding glucocorticoid related cases.[2][3] An easy way to distinguish Cushing’s syndrome (primary hypercortisolism, specifically) from Cushing’s disease is that the measured ACTH levels are lower in the former. The decrease in ACTH is due to increased negative feedback of cortisol on the hypothalamus and anterior pituitary.

Question 15

H pylori eradication

Answer 15

triple therapy eg amoxicillin clarithromycin and PPI

-prazoles

Question 16

dyspepsia DD

Answer 16

duodenal/gastric ulcer
NSAIDS
duodeo/gastr/oesophag-itis
malignancy

Question 17

etymology of dyspepsia

Answer 17

Dyspepsia (from the Greek δυσ- dys-, “bad” or “difficult”, and πέψις pepsis “digestion”), also known as indigestion,

Question 18

whats a hiatus hernia

Answer 18

common.

2 types

1- sliding hiatus hernia - 80% - GOJ slides up into chest. acid reflux is common

2 - rolling hiatus hernia - 20% - GOJ remains in abdomen but a bulge of stomach herniates into the chest alongside the oesophagus.

do a barium swallow. lose weight, treat symptoms. surgery if intractable symptoms or if a rolling hernia as these can strangulate.

Question 19

common causes of diarrhoea

Answer 19

• gastroenteritis
• parasites
• IBS
• colorectal cancer - do a PR
• crohn’s, UC, coeliac

less common

• chronic pancreatitis
• laxative abuse
• overflow diarrhoea - do a PR
• c. diff
• thyrotoxicosis
• drugs

Question 20

what is thyrotoxicosis

Answer 20

Thyrotoxicosis is a common condition associated with excess circulating thyroid hormones that may present in myriad ways and thus will be encountered by practitioners in all medical disciplines. In Europe, it affects around 1 in 2000 people annually.1 Although thyrotoxicosis typically presents with weight loss, heat intolerance, and palpitations, there are a large variety of additional features, which manifest more variably with advancing age and in people with milder disease. It is important to determine the cause of the thyrotoxicosis, as this determines treatment. Some experts distinguish between thyrotoxicosis and hyperthyroidism by restricting the latter term to describe the conditions associated with excess synthesis and secretion of thyroid hormones from the thyroid gland

Question 21

treatment of C Diff

Answer 21

metronidazole or vancomycin

probiotics may help prevent recurrences

Question 22

constipation - questions

Answer 22

freq, nature, consistency
blood or mucus
alternating diarrhoea (IBS)
recent change in bowel habit
pain
diet and drugs

PR exam

idiopathic can be improved by drinking more, diet and exercise advice.

Question 23

constipation medication

Answer 23

1- bulking agents
- methylcellulose

2- stimulant laxatives - SE stomach cramping

• senna
• glycerol

3 - stool softeners
- arachis oil enemas

4 - osmotic laxatives
-lactulose

Question 24

definition of constipation

Answer 24

lots of different colloquial definitions relating to frequency, difficulty or incompleteness.

the Rome criteria to formalise:
greater than or 2 of the following in 25% of BMs. 
- straining
- hard
- incomplete sensation
- blockage sensation
- manual facilitation needed
- less than 3 BM pw

Question 25

overview of causes of constipation

Answer 25

1- general

• poor diet and exercise
• low fluid intake
• IBS
• old age

2 - anorectal disease

• cancer
• fissures
• prolapse

3- intestinal obstruction

• cancer
• strictures - crohn’s
• pelvic mass - foetus, fibroids
• diverticulosis

4 - drugs

• opiates
• anticholinergics eg TCAs
• others

5 - metabolic/endo

• hypercalcaemia
• hypokalaemia

6- neuromuscular

7- other
idiopathic
psychological

Question 26

best indicators of hepatic synthetic function

Answer 26

clotting factors and albumin.

Question 27

cause of dark urine with jaundice

Answer 27

cholestatic - urine conjugated bilirubin. whisky.

Question 28

good written patient notes should be and include what?

Answer 28

should be succinct and legible.

and contain:

1 - Hx of PC, HPC, DH, FH, allergies, social.
2 - PT ICE
3 - legible and ordered details of examination
4 - documented risk factors and the aspects of social Hx that are relevant to care of the PT
5 - a summary including a DD and problem list.