Medicine Tips 4

Question 1

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

Answer 1

Arterial pH < 7.3, 24 hours after ingestion
OR
All of the following - prothrombin time > 100 seconds, creatinine > 300 µmol/l, grade III or IV encephalopathy

Question 2

Plummer-Vinson syndrome

Answer 2

Triad of dysphagia, glossitis and iron-deficiency anaemia

Mx - iron supplementation and dilation of the webs

Question 3

Mallory-Weiss syndrome

Answer 3

Severe vomiting -> painful mucousal lacerations at the gastroesophageal junction -> haematemesis
Common in alcoholics

Question 4

Boerhaave syndrome

Answer 4

Severe vomiting -> oesophageal rupture

Question 5

Iron-deficiency anaemia

Answer 5

Usually an incidental finding
Fatigue, SOB on exertion, palpitations, sore tongue and taste disturbance, changes in the hair/hair loss, pruritus, headache, tinnitus, angina
Causes - poor iron intake, impaired absorption (coeliac disease), NSAIDs, SSRIs, clopidogrel, steroids, bleeding, blood donation, thalassaemia
Pallor, koilonychia, angular cheilitis, atrophic glossitis
Severe anaemia - tachycardia, flow murmur, cardiomegaly, heart failure
Ix - FBC (hypochromic microcytic anaemia), serum ferritin (low), blood film (anisocytosis, poikilocytosis), urine dipstick, eosopheogastroduodenoscopy (if no gastric ulcer or coeliac disease -> lower GI endoscopy)
Mx - ferrous sulphate PO, treat underlying cause

Question 6

Sister Mary Joseph node

Answer 6

Palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

Question 7

Pancreatitis

Answer 7

Causes - gallstones, ethanol, trauma, steroids, mumps, autoimmune, ascaris infection, scorpion venom, hypertriclyceridaemia, hypercalacemia, hypothermia, ERCP, drugs (azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
Risk factors - fair, female, forty, fertile, fat

Question 8

Raised alpha fetoprotein

Answer 8

Hepatocellular carcinoma, hepatoblastoma, neuroblastoma, endodermal sinus (yolk sac) tumour

Question 9

Bulbar palsy

Answer 9

Drooling, weak and wasted tongue, dysphonia and problems articulating

Question 10

Oesophageal spasm

Answer 10

Pain when swallowing

Question 11

Achalasia

Answer 11

Trouble swallowing solids and liquids equally that starts intermittently, regurgitation of food

Question 12

Squamous Cell Carinoma of the oesophagus

Answer 12

Tumour in first 2/3 of oesophagus

Associated with achalasia

Question 13

Adenocarcinoma of the oesophagus

Answer 13

Tumour in the last 1/3 of oesophagus

Associated with GORD and Barrett’s oesophagus

Question 14

Wilson’s Disease

Answer 14

Autosomal recessive
Hepatitis, cirrhosis, basal ganglia degneration (Parkinsonism), speech and behaviuoral problems, Kayser-Fleischer rings, renal tubular acidosis, haemolysis, blue nails
Ix - serum caeruloplasmin (reduced), serum copper (reduced), 24 hr urinary copper (increased)
Mx - penicillamine or trientine hydrochloride

Question 15

Melanosis Coli

Answer 15

Disorder of pigmentation of the bowel
Causes - laxative abuse
Histology - pigment laden macrophages

Question 16

Helicobacter Pylori

Answer 16

Gram -ve bacteria
Associated with PUD, gastric cancer, B cell lymphoma of MALT tissue, atrophic gastritis
Mx - PPI + clarithromycin + amoxicillin/metronidazole

Question 17

Carcinoid syndrome

Answer 17

Liver metastases releasing serotonin into the circulation
Flushing, diarrhoea, bronchospasm, hypotension, right heart valvular stenosis, Cushing’s syndrome
Ix - urinary 5-hydroxyindoleacetic acid (5-HIAA), plasma chromagramim A y
Mx - somatostatin analogues (octreotide), cyprohepatidine (for diarrhoea)

Question 18

Achalasia

Answer 18

Dysphagia of both liquids and solids from the onset of symptoms, heartburn, regurgitation of food (may lead to cough, aspiration pneumonia)