Live Lecture - Cases.

Question 1

40. Beautician, Tiredness for the last three months. Adrenal mass found upon ultrasound.
    What is the differential diagnosis.

Answer 1

Cushing’s syndrome.
Conn’s syndrome.
Phaechromocytoma.

Question 2

What three hormones could be produced by an adrenal mass.

Answer 2

Cortisol (Cushing’s).
Adrenaline (Phaeochromocytoma).
Aldosterone (Conn’s).

Question 3

Where do phaeochromocytomas occur in the adrenals.

Answer 3

Medulla.

Question 4

Where do cortisol producing tumours occur.

Answer 4

Cortex fasciculata.

Question 5

What do cortisol producing tumours cause.

Answer 5

Cushing’s syndrome.

Question 6

Where do aldosterone producing tumours occur.

Answer 6

Cortex glomerulosa.

Question 7

What do aldosterone producing tumours cause.

Answer 7

Conn’s syndrome.

Question 8

What drugs do you use to treat phaeochromocytomas.

Answer 8

Alpha blockers (Phenoxybenzamine). 
Beta blockers (Propanolol).

Question 9

When treating a phaeochromocytoma, what do you give first.

Answer 9

Alpha blocker.

Then add a beta blocker.

Question 10

When treating Cushing’s, what drugs do you use to treat.

Answer 10

Ketoconazole.

Metyrapone.

Question 11

When treating Conn’s, what drugs do you use to treat.

Answer 11

Spironolactone.

Question 12

What are the biggest adrenal tumours.

Answer 12

Phaeochromocytoma.

Question 13

What do you use to treat Graves disease.

Answer 13

Propanolol.

Carbimazole.

Question 14

What are the two biggest complaints in a patient with Conn’s syndrome.

Answer 14

Hypokalaemia.

Hypertension.

Question 15

Patient presents with breathlessness that is worse on lying flat.

Answer 15

Pulmonary oedema (orthopnoea).

Question 16

Patient has a continuous productive cough for 3 months each year, starting in December, and is always coughing over Christmas.

Answer 16

Chronic bronchitis (COPD).

Question 17

33 Year old pregnant female presents with breathlessness and a tender swelling in her right leg.

Answer 17

Pulmonary embolus secondary to DVT.

Question 18

70 year old smoker. Examination reveals dullness and increased tactile vocal fremitus on the right.

Answer 18

Pneumonia.

Question 19

69 year old smoker. Examination revealed dullness and reduced tactile vocal fremitus on the right.

Answer 19

Pleural Effusion.

Question 20

What does consolidation indicate.

Answer 20

Pneumonia.

Question 21

What is the causes of pleural effusions in smokers.

Answer 21

Usually due to malignancy.

Question 22

Where is the fluid present in pulmonary oedema.

Answer 22

Within the vasculature.

Question 23

Where is the fluid present in pleural effusion.

Answer 23

Outside the vasculature.

Question 24

What do you hear upon percussion of a patient with pulmonary oedema.

Answer 24

No change in percussion or tactile vocal fremitus.

Question 25

Is pulmonary oedema unilateral or bilateral.

Answer 25

Bilateral crackles.

Question 26

14 year old schoolboy who presents with breathlessness, deep sighing respiration and has started bedwetting again.

Answer 26

Diabetic Ketoacidosis.

Question 27

What age is the peak onset for T1DM.

Answer 27

14.

Question 28

What type of breathing do you get in DKA.

Answer 28

Deep sighing respiration.

Question 29

Why do you get deep sighing respiration in DKA.

Answer 29

To clear CO2.

Question 30

What is the most common cause of DKA.

Answer 30

Non-compliance of insulin. Due to various causes (eg, poor control, illness, etc…)

Question 31

25 year old tall thin and. On examination, there were absent breath sounds and hyper resonance on the right side.

Answer 31

Tension pneumothorax.

Question 32

On what type of CXR can you not comment on heart size.

Answer 32

AP film.

Question 33

Who are AP films usually done in.

Answer 33

Very sick people who are unable to stand for the CXR for any reason.

Question 34

What murmur will you hear if the mitral valve leaks.

Answer 34

Pansystolic murmur.

Question 35

What is the condition called when the mitral valve leaks.

Answer 35

Mitral regurgitation.

Question 36

What murmur do you hear with atrial stenosis.

Answer 36

An ejection systolic murmur.

Question 37

What type of murmur is it if you hear the murmur in type with the pulse in the carotid.

Answer 37

Systolic murmur.

Question 38

What are the two conditions causing systolic murmurs.

Answer 38

Atrial stenosis.

Mitral regurgitation.

Question 39

What are the two systolic murmurs.

Answer 39

Pansystolic murmurs.

Ejection systolic murmurs.

Question 40

What is the characteristic of an ejection systolic murmur.

Answer 40

Crescendo decrescendo between S1 and S2.

Question 41

What is the characteristic of a pansystolic murmur.

Answer 41

Constant turbulent sound between S1 and S2.