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DPD 2020 > interactive cases in general internal medicine 5 > Flashcards

interactive cases in general internal medicine 5 Flashcards

1
Q

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

A

IM adrenaline

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2
Q

• 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

A

Clarithromycin

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3
Q

What atypical organisms that cause pneumonia?

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophila

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4
Q

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)

A

OGD

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5
Q

What investigations do you do in someone that presents with microcytic anaemia?

A

Haematinics

Coeliac screen* (TTG Ab) and diagnosis confirmed with duodenal atrophy

  • Remember red flags
  • Top & Tail
  • Order depends on upper/lower GI symptoms
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6
Q

What would you see on a duodenal biopsy?

A

villous atrophy

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7
Q

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

A

B. Ischaemic colitis

since he is old

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8
Q

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

A

amiodarone

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9
Q

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

A

caput medusea

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10
Q

What are complications of portal hypertension?

A

Encephalopathy

Ascites

Spontaneous bacterial peritonitis

Variceal bleed

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11
Q

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

A

schistocytes

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12
Q

What are the 3 MAHA?

What do they present with?

A

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

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13
Q

What are the presenting features of DIC?

A

DIC:

  • low platelet and fibrinogen
  • high PT and APPT
  • high D-Dimer/ fibrin degradation product
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14
Q

What are the presenting features of HUS?

A

HUS:

  • Haemolysis (low HB, high bilirubin)
  • Uraemia
  • low platelets
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15
Q

What are presenting feature of TTP (Thrombotic Thrombocytopenic Purpura)

A

HUS + fever + neurological manifestations

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16
Q

What are causes of haemolytic anaemia?

A

Hereditary

  • Red cell membrane (hereditary spherocytosis)
  • Enzyme deficiency (G6PD deficiency)
  • Haemoglobinopathy (Sickle cell disease, Thalassaemias)

Acquired

  • Autoimmune
  • Drugs
  • Infection
  • MAHA (DIC, TTB, HUS)
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17
Q

What does the arrow show?

A. Adhesions

B. Haustra

C. Large bowel

D. Stomach

E. Valvulae conniventes

A

E. Valvulae conniventes

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18
Q

What part of the bowel i this?

A

small bowel

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19
Q

What part of the bowel is this?

A

large bowel

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20
Q

60 yr old man • Confused • Cough • No postural hypotension • Na+ : 120 • K + : 4.0 • TFTs: normal • SST: normal • Urine Na+ : 40 • Urine osmolality: 400

What test would you request next?

A. Brain MRI

B. CT Abdomen

C. CXR

D. Lung function tests

E. OGD

A

hyponatraemia

CXR- cough (lung cancer)

21
Q

What is the algorythm you go through to identify the cause of hyponatraemia?

What are the individual causes?

What would be the investigations you want to do?

A
22
Q

WHat are rare causes of hyponatraemia that are not due to high ADH?

A

Excess water intake

Sodium-free irrigation solutions (e.g. used in TURP)

23
Q

What are causes of SIADH?

A

CNS pathology

Lung pathology

Drugs (SSRI, TCA, opiates, PPIs, carbamazepine)

Tumours

24
Q

35 yr old man • Sweating • Weight loss

What is the name of this sign?

A. Beau’s lines

B. Nail pitting

C. Koilonychia

D. Onycholysis

E. Leukonychia

A

onycholysis

25
Q

What are causes of onycholysis?

A

Trauma

Thyrotoxicosis

Fungal infection

Psoriasis

26
Q

20 year old woman • Abdominal pain • Vomiting • Type 1 diabetes • CBG: 20 • Venous pH: 7.20

What is the most appropriate next step?

A. Capillary ketone

B. FBC

C. HbA1c

D. LFTs

E. CRP

A

A. Capillary ketone

27
Q

What are the complications of Diabetes?

A
  • Microvascular
    • Retinopathy
    • Nephropathy
    • Neuropathy (foot ulcers)
  • Macrovascular
    • MI/Stroke/PVD
  • Metabolic
    • DKA/HHS/Hypoglycaemia
28
Q

26 year old man • Chest pain • Smokes 5/day • Auscultation: ‘scratching sound’

What diagnosis is supported by his ECG?

A. Anteriolateral MI

B. Inferior MI

C. NSTEMI

D. Pericarditis

E. Posterior MI

A

D. Pericarditis

29
Q

60 yr old woman • Collapse • BP: 120/70 mmHg • No postural drop • HS: S1+S2+ ESM

What does her ECG suggest?

A. Left atrial hypertrophy

B. Left ventricular hypertrophy

C. Right atrial hypertrophy

D. Right ventricular hypertrophy

E. NAD

A

B. Left ventricular hypertrophy

aortic stenosis- left ventricle needs to work harder

30
Q

40 year old man • Loin pain • CRP: normal • Urinalysis: blood ++

What investigation would you request?

A. Abdominal X-ray

B. Abdominal USS

C. CT KUB

D. CT with contrast

E. MR Angiogram

A

C. CT KUB

31
Q

What does this show?

A

CT KUB

Pelvi-ureteric junction obstruction

Calculus within the dilated renal pelvis

32
Q

50 year old man • Hypercalcaemia • Low PTH • Backache • Normal ALP

What is the most likely diagnosis?

A. Bone metastases

B. Multiple myeloma

C. Osteoporosis

D. Primary hyperparathyroidism

E. Secondary hyperparathyroidism

A

B. Multiple myeloma

33
Q

Where is ALP produced and in which pathologies is it elevated?

A

Sources: liver & bone (osteoblasts)

High in obstructive liver disease & bone disease (malignancy, fracture, Paget’s disease)

34
Q

What is the ALP level in myeloma?

A

normal

becuase Plasma cells suppress osteoblasts

35
Q

What are the clinical features of multiple myeloma’s?

A

CRAB

  • Calcium
  • Renal impairment
  • Anaemia
  • Bone
36
Q

23 yr old woman • Breast lump • 1cm • Smooth mobile

What is the most likely diagnosis?

A. Basal cell carcinoma

B. Ductal carcinoma

C. Fat necrosis

D. Fibroadenoma

E. Galactocele

A

D. Fibroadenoma

37
Q

60-year-old man • Cough • Haemoptysis

What does his chest X-ray show?

A. Cavitating lesion

B. Interstitial shadowing

C. Pleural effusion

D. Reticulonodular shadowing

E. Bilateral hilar lymphadenopathy

A

A. Cavitating lesion

38
Q

What are causes for this?

A

CAVITATING LESION

  • Infection
    • TB
    • Staph
    • Klebsiella (e.g. alcoholics)
  • Inflammation (RA)
  • Infarction (PE)
  • Malignancy
39
Q

35 yr old woman • Ankle oedema • Recent Echocardiogram: NAD • U&Es: normal • ALT, AST & ALP: normal • Albumin: 15

What test would you order next?

A. Coronary angiogram

B. Renal USS

C. Troponin

D. Urinalysis

E. Repeat LFTs

A

D. Urinalysis

40
Q

What is the triad of nephrotic syndrome?

What is the pathophysiology?

A

Proteinura> 3g/day • Hypoalbuminaemia • Oedema

increased permeability of GBM to protein

41
Q

30 year old man • Recurrent GI & nose bleeds • Facial examination shows:

What is the diagnosis?

A. Acromegaly

B. Cirrhosis

C. Hereditary telangiecstasia

D. Peutz-Jegher syndrome

E. Systemic sclerosis

A

C. Hereditary telangiecstasia

42
Q

What are features of Hereditary Haemorrhagic Telangiecstasia?

What is the inheritance pattern?

A

Autosomal dominant

Abnormal blood vessels in

  • Skin
  • Mucous membranes
  • lungs
  • Liver
  • brain
43
Q

Na+ : 120

K + : 5

Short Synacthen test

0 min cortisol: 100

30 min cortisol: 200

select the single most likely diagnosis from the list.

A. Adrenal insufficiency

B. Cushing’s syndrome

C. Graves’ disease

D. Myxoedema (hypothyroidism)

E. Premature ovarian failure

F. Primary hyperaldosteronism

G. Prolactinoma

H. Multinodular goitre

I. Thyroiditis

A

adrenal insufficiency

44
Q

PRL: 1000 (high)

IGF-1: 100 (high)

OGTT: failure of GH suppression

select the single most likely diagnosis from the list

A. Acromegaly

B. Adrenal insufficiency

C. Cushing’s syndrome

D. Graves’ disease

E. Myxoedema (hypothyroidism)

F. Premature ovarian failure

G. Primary hyperaldosteronism

H. Prolactinoma

I. Multinodular goitre

J. Thyroiditis

A

acromegaly

45
Q

Oestradiol: 50

FSH: 40 (high)

LH: 35 (high)

PRL: 200

select the single most likely diagnosis from the list

A. Acromegaly

B. Adrenal insufficiency

C. Cushing’s syndrome

D. Graves’ disease

E. Myxoedema (hypothyroidism)

F. Premature ovarian insufficiency

G. Primary hyperaldosteronism

H. Prolactinoma

I. Multinodular goitre

J. Thyroiditis

A

premature ovarian insufficiency

46
Q

Free T4: 5

TSH: 60

PRL: 700

select the single most likely diagnosis from the list

A. Acromegaly

B. Adrenal insufficiency

C. Cushing’s syndrome

D. Graves’ disease

E. Myxoedema (hypothyroidism)

F. Premature ovarian failure

G. Primary hyperaldosteronism

H. Prolactinoma

I. Multinodular goitre

J. Thyroiditis

A

hypothyroidsim

47
Q

Free T4: 12

TSH: 1.0

LH: 1

PRL: 300

Cortisol: 500

select the single most likely diagnosis from the list.

A. Acromegaly

B. Adrenal insufficiency

C. Cushing’s syndrome

D. Graves’ disease

E. Myxoedema (hypothyroidism)

F. Premature ovarian failure

G. Primary hyperaldosteronism

H. Prolactinoma

I. Multinodular goitre

J. Thyroiditis

A

multinodular goitre

normal endocrine

48
Q

PRL: 10,000 (high)

Testosterone: 6 (low)

LH <1 (low)

FSH <1 (low)

select the single most likely diagnosis from the list

A. Acromegaly

B. Adrenal insufficiency

C. Cushing’s syndrome

D. Graves’ disease

E. Myxoedema (hypothyroidism)

F. Premature ovarian failure

G. Primary hyperaldosteronism

H. Prolactinoma

I. Multinodular goitre

J. Thyroiditis

A

prolactinoma

DPD 2020 (48 decks)

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