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Finals random > January > Flashcards

January Flashcards

1
Q

What score do we use to assess need for anticoagulant medication?

A 
CHADVASC
HASBLED
CHADVASC gives risk of stroke
HASBLED risk of bleeding
If risk of bleeding higher do not start anticoagulant
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2
Q

What’s the carina?

A

Bifurcation into right and left bronchus

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3
Q

Side effects of prolonged steroid use

A 
Cushingoid
Bones - osteoporosis
Skin - thinning and bruising
Weight gain
Glucose - diabetes
Hypertension
Psychosis
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4
Q

Atrial fibrillation increases the risk of what condition

A

Stroke

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5
Q

Causes of loss of consciousness

A 
Arrhythmias
Head injury
Hypercapnia
Hypoglycaemia
Hypotension
Stroke
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6
Q

Symptoms of Hypoglycaemia

A 
Anxious
Tired
Hunger
Sweating
Headache 
Nausea
Coma
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7
Q

Which vessel is damaged if patient has following symptoms - Contralateral hemiplegia, hemisensory loss, homonymous hemianopia, aphasia?

A

Middle Cerebral artery

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8
Q

Which vessel is damaged if patient displays following symptoms - Contralateral weakness and sensory loss in the leg more than in the arm.

Urinary incontinence, confusion and behavioural disturbances are common.?

A

Anterior cerebral artery

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9
Q

Which vessel is damaged if patient displays following symptoms - Contralateral homonymous hemianopia, agnosia?

A

Posterior cerebral artery

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10
Q

What symptoms are caused by a lacunar stroke?

A

Pure motor
Pure sensory
Ataxia
Dysarthria clumsy hand syndrome

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11
Q

What investigations required for stroke?

A 
Non-contrast CT head
MRI head
Carotid doppler
ECHO
ECG
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12
Q

TPA is given under 4.5 hours when which condition has been excluded in stroke?

A

Haemorrhagic stroke

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13
Q

Risk factors for stroke?

A 
Hypertension
Diabetes
Smoking
Lipids
Alcohol excess
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14
Q

What is the term given when someone is unable to recognise and interpret visual information?

A

Visual agnosia

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15
Q

What is the term given when someone is unable to recognise objects, smells, shapes and sounds?

A

Sensory agnosia

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16
Q

What term is given to the denial of hemiplegia?

A

Anosagnosia

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17
Q

What term is given to the inability to recognise your own and others faces?

A

Prosopagnosia

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18
Q

Signs and symptoms of subarachnoid haemorrhage?

A 
Thunderclap headache
Loss of consciousness
Photophobia
Phonophobia
Neck stiffness - nuchal rigidity
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19
Q

3 causes of aneurysmal subarachnoid haemorrhage

A

Trauma
Ehler Danlos
Polycystic kidney disease

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20
Q

Investigations for SAH?

A

CT head

Spinal tap - if CT head negative

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21
Q

Cause of SAH

A

Rupture of berry aneurysm
Rupture of arteriovenous malformation
Head injury

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22
Q

Where do intracranial aneurysms usually occur?

A

In circle of willis where arteries connect

40% - at junction of anterior cerebral and anterior communicating

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23
Q

Complications of subarachnoid haemorrhage

A 
Cardiogenic shock
Vasospasm
Hydrocephalus
Rebleeding
Seizure
Infection
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24
Q

How are SAH graded?

A

World Federation of Neurological Societies (WFNS) scale which uses GCS and motor deficits to grade the severity of the sub arachnoid haemorrhage

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25
Q

What is included in the WFNS scale to grade severity of SAH?

A

GCS

Motor deficits

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26
Q

3 points of HHS

A

Hypovolaemia
Hyperglycaemia
Hyperosmolality

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27
Q

How is SAH treated?

A 
Treatment of aneurysm
Coiling of aneurysm
Craniotomy and clipping of aneurysm
Nimodipine - for vasospasm
HHH therapy - used to prevent or treat cerebral vasospasm after SAH
Hypervolaemia
Haemodilution
Hypertension
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28
Q

What is meckel’s diverticulum?

A

Congenital diverticulum of small intestine

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29
Q

What type of cells are found in meckel’s diverticulum?

A

Ectopic ileal, gastric or pancreatic mucosa

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30
Q

Where does meckel’s diverticulum occur?

A

2 feet (60cm) from ileocaecal valve

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31
Q

What percentage of the population have meckel’s diverticulum?

A

2%

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32
Q

What is meckel’s diverticulum a remnant of?

A

omphalomesenteric duct (vitellomesenteric duct) - vitelline duct: joins yolk sac to midgut in foetus

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33
Q

Presenting symptoms of meckel’s diverticulum?

A

Abdominal pain; mimics appendicitis
Rectal bleeding
Intestinal obstruction

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34
Q

How does intestinal obstruction occur in meckel’s diverticulum?

A

Secondary to volvulus, omphalomesenteric band and intussusception

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35
Q

What is the most common cause of painless massive GI bleeding in children between ages 1 and 2?

A

Meckel’s diverticulum

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36
Q

When does the attachment between the vitellointestinal duct and yolk sac disappear?

A

6 weeks

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37
Q

Management of meckel’s diverticulum

A

Surgery - wedge excision or formal small bowel resection and anastomosis

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38
Q

Which plexuses fail to develop in Hirschspung’s disease?

A

Auerbach and Meissner parasympathetic

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39
Q

Risk factors for hirschsprung’s disease

A

Male
Down’s Syndrome
Family history

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40
Q

A defect in the anterior abdominal wall leading to protruding bowel is known as

A

Gastroschisis

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41
Q

Hypertrophy of the pyloric muscle leads to

A

Pyloric stenosis

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42
Q

Telescoping of the ileocolic junction occurs in which disease

A

Intussusception

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43
Q

Symptoms of intussusception

A

Bilious vomiting

Red currant jelly like stool

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44
Q

Treatment for intussusception

A

Air enema

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45
Q

What is Grey Turner’s sign?

A

Retroperitoneal haemorrhage leading to blue discolouration of the flanks.

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46
Q

Name the organs which are retroperitoneal

A

S: suprarenal (adrenal) gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: oesophagus

R: rectum

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47
Q

Which part of the pancreas is intraperitoneal?

A

Tail

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48
Q

Barrett’s oesophagus increases the risk of what disease?

A

Oesophageal adenocarcinoma

49
Q

Which type of cell present in a histological sample taken from the lower oesophagus is diagnostic of barrett’s?

A

Goblet cell

50
Q

Risk factors for barrett’s

A

Male
GORD
Smoker
Centra obesity

51
Q

Management for barrett’s oesophagus

A

Endoscopy for surveillance and biopsies every 3-5 years

Proton pump inhibitors

52
Q

Endoscopic intervention used to treat Barrett’s oesophagus?

A

endoscopic mucosal resection

radiofrequency ablation

53
Q

Which monoclonal antibody targets Toxin b of C difficile?

A

Bezlotoxumab

54
Q

Which type of organism is Clostridium difficile?

A

Gram poositive bacillus

55
Q

Which syndrome is caused by exotoxin released by C difficile?

A

Pseudomembranous colitis

56
Q

How does c difficile infection tend to occur?

A

Normal gut flora suppressed by antibiotics

57
Q

Which antibiotic is associated in causing c difficile?

A

Clindamycin

58
Q

Which drugs other than clindamycin are associated with c diff?

A

Second and third gen cephalosporins

PPIs

59
Q

Signs and symptoms of c difficile

A

Diarrhoea
Abdominal pain
Raised WCC
Toxic megacolon if severe

60
Q

How is c difficile diagnosed?

A

Presenting signs and symptoms with history

Detection of CD toxin in the stool

61
Q

First line treatment for c difficile

A

Metronidazole

62
Q

Second line treatment for c difficile

A

Vancomycin

63
Q

Life threatening c difficile is treated with which drug combination?

A

Oral vancomycin and IV metronidazole

64
Q

Complications of diverticular disease

A 
Diverticular stricture leading to obstruction
Colovesical fistula
Colovaginal fistula
Haemorrhage 
Peritonitis
Perforation and abscess
65
Q

Risk factors for formation of diverticulum

A 
Age
Low dietary fibre intake
Smoking
Obesity
Family history
NSAIDS
66
Q

Features of diverticular disease

A

Intermittent lower abdominal pain, colicky, relieved by defecation
Change in bowel habit
Nausea
Flatulence

67
Q

Features of acute diverticulitis

A 
Sharp left iliac fossa pain
Worse on movement
Decreased appetite
Pyrexia
Nausea
68
Q

General causes of lower abdominal pain

A 
Diverticular disease
Bowel cancer
Inflammatory bowel disease
Gynaecological
Renal stones
Mesenteric ischaemia
69
Q

Investigations for Diverticular disease

A

Bloods
CT abdopelvis
Barium enema

70
Q

How does gastroschisis differ from exomphalos?

A

Both abdominal wall defects leading to protusion of contents
Contents held in amniotic sac in exomphalos
Exomphalos also associated with cardiac (cardiomegaly) and kidney (cysts) conditions
Exomphalos occurs at base of insertion of umbilical cord
Gastroschisis occurs lateral to umbilical cord

71
Q

When do abdominal contents normally protrude in development?

A

Six weeks

Return by the twelth week

72
Q

Foetal anomaly scan showing exomphalos and enlarged liver is indicative of which condition?

A

Beckwith-wiedemann syndrome

73
Q

Features of Beckwith-wiedemann syndrome?

A

Overgrowth symptoms - large for gestational age, macrosomia, macroglossia, organomegaly and abdominal wall defects (exomphalos, umbilical hernia).
Blood sugar issues - neonatal hypoglycaemia, hyperinsulinism
Increased risk of childhood cancers - Wilm’s tumour, hepatoblastoma

74
Q

What is Behcet’s disease?

A

Inflammatory disorder causing genital sores, uveitis and arthritis
Can’t pee, can’t see, can’t climb a tree

75
Q

What is Dandy-walker syndrome?

A

Failure of growth or abscence of central part of cerebellum

76
Q

Which mutation is a risk factor for a desmoid tumour?

A

APC

77
Q

In which group of patients do desmoid tumours most commonly occur?

A

Women in the rectus abdominis after childbirth

78
Q

How are desmoid tumours treated?

A

Surgical resection

79
Q

Which 2 structures are most likely to be penetrated in peptic ulcer disease?

A

Posterior medial wall of second part of the duodenum

Into the gastroduodenal artery

80
Q

What is a complication of peptic ulcer disease?

A

GI Bleed leading to Shock

81
Q

How does a patient present with shock?

A

Low blood pressure
Sweating
Collapse

82
Q

What is the most common cause of peptic ulcer disease?

A

Bleeding

83
Q

Most common presenting symptoms of peptic ulcer disease?

A

Haematemesis
Melaena
Hypotension
Tachycardia

84
Q

Management of peptic ulcer disease

A 
ABCDE approach
PPIs via IV
Endoscopic intervention
FAILURE OF FIRST LINE
urgent interventional angiography with transarterial embolization or
surgery
85
Q

What is the method of inheritance of Gilbert’s syndrome?

A

Autosomal recessive

86
Q

Which deficiency is present in Gilbert’s syndrome?

A

UDP glucoronosyltransferase

87
Q

What is the prevalence of Gilbert’s syndrome>

A

1-2%

88
Q

What are the features of Gilbert’s syndrome?

A

Unconjugated Hyperbilirubinaemia

Jaundice

89
Q

What does unconjugated hyperbilirubinaemia indicate?

A

Bilirubin not present in the urine

90
Q

When might someone experience jaundice if they have Gilbert’s syndrome?

A

In illness
Exercise
Fasting

91
Q

What is the treatment for Gilbert’s?

A

No management

92
Q

What type of epithelium lines the oesophagus?

A

Stratified squamous epithelium

93
Q

Define metaplasia

A

Reversible change of differentiated cells to another ccell type

94
Q

What type of metaplasia can smoking cause and what is the name given to this?

A

Ciliated columnar to simple squamous - Schistosomiasis

95
Q

What is the acute treatment of variceal haemorrhage?

A

ABC
Clotting - FFP, Vitamin K
Vasoactive reagents - terlipressin, octreotide
Endoscopic variceal band ligation
Endoscopic sclerotherapy
If both methods fail - TIPP - Transjugular Intrahepatic Portosystemic Shunt

96
Q

Which drug should be given to a patient with cirrhosis in acute variceal bleeding to reduce mortality?

A

Antibiotics - quinolones

97
Q

What is the prophylactic treatment of variceal bleeding?

A

Endoscopic band ligation - particularly to patient with cirrhosis
Propanolol

98
Q

What kind of drug is propanolol and why is it used in the prophylaxis of variceal bleeds?

A

Non-cardioselective B blocker

Causes splanchnic vasoconstriction - reduces portal flow

99
Q

Which drug can cause oligospermia in men?

A

Sulfasalzine

100
Q

What are the indications for sulfasalazine?

A

Crohns
Ulcerative colitis
Rheumatoid arthritis

101
Q

Which vein is commonly harvested for CABG?

A

Great saphenous vein

102
Q

Which nerve is prone to damage when harvesting vessel for CABG?

A

Saphenous nerve

103
Q

What is carcinoid syndrome?

A

Occurs when metastases present in the liver - release serotonin
Also can occur in lung carcinoid

104
Q

Features of a carcinoid tumour

A 
Flushing
Diarrhoea
Bronchospasm
Hypotension
Right vavular stenosis
ACTH and GHRH secretion
Pellagra - inflamed skin, diarrhea, dementia, and sores in the mouth
105
Q

ACTH and GHRH secretion as seen in carcinoid syndrome can result in what condition?

A

Cushing’s syndrome

106
Q

investigations for carcinoid syndrome?

A

Urinary 5 HIAA

Plasma chromogranin A

107
Q

Management of carcinoid syndrome

A

somatostatin analogues e.g. octreotide

diarrhoea: cyproheptadine may help

108
Q

Which type of drug is metoclopramide and what is its action?

A

Antiemetic - D2 receptor antagonist

Metoclopramide functions both at the chemoreceptor trigger zone and on 5-HT receptors in the GI tract

109
Q

Indications of metoclopramide

A

Nausea
Migraine
GORD

110
Q

Adverse effects of metoclopramide

A

extrapyramidal effects: oculogyric crisis. This is particularly a problem in children and young adults
hyperprolactinaemia
tardive dyskinesia
parkinsonism

111
Q

Symptoms of small bowel obstruction

A

Vomiting, severe abdominal pain and abdominal distension

112
Q

Sign on Abdominal X ray in cholecystoenteric fistula

A

Air in the gallbladder and biliary tree on AXR is most likely due to cholecystoenteric fistula
Pneumobilia

113
Q

What needs to be checked before prescribing a biologic - eg infliximab for Crohns?

A

Interferon gamma release assay - TB

114
Q

What is the most common site affected in ischaemic colitis?

A

The splenic flexure is a watershed area for arterial supply from the superior and inferior mesenteric artery, and is the location most susceptible to ischaemic colitis.
Sigmoid - 2nd most affected

115
Q

What is the typical presentation of acute mesenteric ischaemia?

A

Severe, sudden onset, constant abdominal pain
Diarrhoea
Out of keeping with physical examination findings

116
Q

What condition is a risk factor for acute mesenteric ischaemia?

A

Atrial fibrillation

117
Q

Which other conditions can result in raised troponin?

A 
Pulmonary embolism
Myocarditis
Arrhythmia
Heart failure
Sepsis
Renal failure
Aortic dissection
118
Q

Mechanism of methotrexate

A

Folic acid antagonist - deprives cells of functional folic acid

119
Q

What monitoring is required with methotrexate?

A

Lowers the blood count

Remedy with fullinic acid????

Finals random (5 decks)

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