interactive cases in general internal medicine 5 Flashcards
24 yr old man • Breathlessness • Facial swelling • After having a Chinese takeaway
What is the first step in management?
A. IM adrenaline
B. IV adrenaline
C. IM hydrocortisone
D. IV hydrocortisone
E. IV fluids
• 45 yr old man • Cough • Breathlessness • Recent travel • O/E: coarse crepitations & bronchial breathing • Hyponatraemia • Deranged LFTs
What antibiotic would you prescribe in addition to amoxicillin?
A. Cefuroxime
B. Clarithromycin
C. Co-amoxiclav
D. Tazocin
E. Vancomycin
What atypical organisms that cause pneumonia?
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
50 yr old man • Dyspepsia • Wt loss • Hb: 70 • MCV: 70
What test would you request?
A. Abdominal CT
B. Abdominal USS
C. Erect CXR
D. Colonoscopy
E. OGD (gastroscopy)
What investigations do you do in someone that presents with microcytic anaemia?
Haematinics
Coeliac screen* (TTG Ab) and diagnosis confirmed with duodenal atrophy
- Remember red flags
- Top & Tail
- Order depends on upper/lower GI symptoms
What would you see on a duodenal biopsy?
villous atrophy
70 year old man • Bloody diarrhoea • Stool micro & culture: -ve • Stool C. diff toxin: -ve
What is the most likely diagnosis?
A. Infective colitis
B. Ischaemic colitis
C. Ulcerative colitis
D. Appendicitis
E. Gastroenteritis
40 yr old man • Palpitations • Started 4 hours ago • ECG: AF
How would you treat him?
A. Adenosine
B. Amiodarone
C. Digoxin
D. Metoprolol
E. DC cardioversion
Direction of flow in the veins below the umbilicus is towards the legs
What is the name of this clinical sign?
A. Trousseau’s sign
B. Virchow’s node
C. Caput medusae
D. Troisier’s sign
E. Grey Turner
What are complications of portal hypertension?
Encephalopathy
Ascites
Spontaneous bacterial peritonitis
Variceal bleed
20 year old boy • Recent diarrhoea • Malaise • Hb: 70 • Cr: 300
What do the arrows show?
A. Codocytes (target cell) B
. Eliptocytes
C. Lymphocytes
D. Schistocyte (red cell fragment)
E. Spherocytes
What are the 3 MAHA?
What do they present with?
DIC: low platelet and fibrinogen, high PT and APPT and D-Dimer
HUS: Haemolysis (low HB, high bilirubin), Uraemia, low platelets
TTP: HUS+ fever+ neurological manifestations
What are the presenting features of DIC?
DIC:
- low platelet and fibrinogen
- high PT and APPT
- high D-Dimer/ fibrin degradation product
What are the presenting features of HUS?
HUS:
- Haemolysis (low HB, high bilirubin)
- Uraemia
- low platelets
What are presenting feature of TTP (Thrombotic Thrombocytopenic Purpura)
HUS + fever + neurological manifestations
What are causes of haemolytic anaemia?
Hereditary
- Red cell membrane (hereditary spherocytosis)
- Enzyme deficiency (G6PD deficiency)
- Haemoglobinopathy (Sickle cell disease, Thalassaemias)
Acquired
- Autoimmune
- Drugs
- Infection
- MAHA (DIC, TTB, HUS)
What does the arrow show?
A. Adhesions
B. Haustra
C. Large bowel
D. Stomach
E. Valvulae conniventes
What part of the bowel i this?
small bowel