Laz Paper 2 Flashcards
What is the difference in presentation between right and left sided colorectal cancer?
Right sided
- More insideous onset
- Anaemia symptoms
- Abdominal pain
Left sided
- PR bleeding
- Change in bowel habit
- Tenesmus
- Earlier onset
What is tenesmus?
The feeling of incomplete defecation due to a space occupying lesion in the rectum
What are the most common sites of colorectal cancers?
- Rectum
- Sigmoid
*
How does gastric cancer present?
- Bloating
- Premature fullness
- Melaena
- Dyspepsia
- Vomiting
What are the investigations for colorectal cancer?
- DRE
- Serum CEA
- Colonoscopy and biopsy
What does the anterior cerebral artery supply?
The medial aspects of the frontal and parietal lobes
- Change in behaviour
- Weakness leg>arm
- Some hemisensory loss
What does the middle cerebral artery supply?
Lateral aspects of the frontal, temporal and parietal lobes
- Weakness face>arm>leg
- Hemisensory loss
- Visual field defects
What does the posterior cerebral artery supply?
The occipital and temporal lobes
- Contralateral homonymous hemianopia
- Sensory deficit
What is subclavian steal syndrome?
A stenosis of the subclavian artery leading to reduced blood flow down the arm from the aorta, this leads to retrograde flow from the vertebral arteries when the arm is in use leading to syncope
What are the primary renal conditions that can lead to nephrotic syndrome?
- Minimal change disease (most common cause of nephrotic syndrome in children)
- Membranous nephropathy
SLE is a secondary cause
Which organism commonly causes Guillan Barre Syndrome?
Campylobacter jejuni
What is used to treat Pneumocystis Jerovecii?
Co-trimoxazole
What is the management for C.diff?
- Oral vancomycin
- Oral metronidazole
When would flucloxacillin be used?
For gram positive bacteria, commonly staph aureus
Usually used in skin conditions such as cellulitis
What are the side effects of opioids?
- Constipation
- Respiratory depression
- Nausea
- Drowsiness
What is podagra?
Inflammation of the first metatarsal joint (commonly found in gout)
What is the most common cause of adrenal insufficiency worldwide?
TB
Which investigation is gold standard for diagnosing adrenal insufficiency?
Short synacthen test, it should increase levels of cortisol
Adrenal insufficiency can be diagnosed if cortisol is <550nmol/L after 30 mins
How can hyponatraemia be fatal?
If Na+ falls rapidly within 24-28 hours, it can lead to cerebral oedema, coning and respiratory depression
What are the severity levels and symptoms of hyponatraemia?
- 135-130
- Usually asymptomatic
- 130-125
- Non-specific symptoms
- Nausea
- Vomiting
- Headache
- <120 very severe
- Seizures
- Hallucinations
- Loss of consciousness
- Memory loss
What is the golden S sign on x-ray?
Right lower lobe collapse
What is the 3, 6, 9 rule on x-ray?
- Small bowel should be 3cm
- Colon should be 6cm
- Sigmoid colon should be 9cm
What is the management of bowel obstruction?
- NG tube for aspirating stomach contents and IV fluids (drip and suck)
- Correction of the underlying cause
Surgery= exploratory laparotomy
When would surgery be considered in bowel obstruction?
- Obstruction has not resolved within 72 hours of conservative treatment
- Patient is showing signs of peritonitis
- Patient is showing signs of bowel ischaemia
- Patient appears to have a strangulation hernia
Which criteria is used for congestive heart failure?
Framingham criteria
What is meralgia paraesthetica?
Damage to the lateral femoral nerve causing a pain and burning sensation to the lateral aspect of the thigh, commonly caused by weight gain and increasingly tight belts putting strain on the femoral nerve
What is the management of meralgia paraesthetica?
Commonly weight loss as tighter belts and clothing puts strain on the femoral nerve, NSAIDs can also be used
What is PBC associated with?
Autoimmune conditions
- Rheumatoid arthritis
- Sjorgen’s syndrome
- Coeliac disease
- Scleroderma
What is the presentation of primary biliary cirrhosis?
- Jaundice
- Xanthelasma
- Pruritis
- Hepatomegaly (late stage)
Which antibodies are present in PBC?
Anti-mitochondrial
