MISC Flashcards
Write out (from memory) the GCS scale
Eye opening 4 - Spontaneous 3 - To speech 2 - To pain 1 - No response
Verbal response 5 - Oriented 4 - Confused sentences 3 - Inappropriate words 2 - Sounds that are incomprehensible 1 - No response
Motor response 6 - Obeys commands 5 - Localises pain 4 - Withdraws to pain 3 - Flexion to pain 2 - Extension to pain 1 - No response
A man attends A&E via paramedics due to a fall. He has a decreased GCS of 6, and has a history of alcohol access. What is your initial first step and why?
Initial first step - Urgent CT scan of the head
Why - could have a bleed in the brain, specifically a subdural heamatoma as a fall, reduced GCS and alcohol excess are all risk factors
A woman with a BMI of 35 attends your breast clinic due to a lump in her left breast. On examination, it is irregular and hard. She mentions it was initially firm, round and painful after trauma to the breast last week. She has a PMH of T2DM, IHD, OA and Hyperlipidaemia.
- What is your diagnosis?
- What investigations would you like to do and why?
- Diagnosis is fat necrosis of the breast. This is a classic history.
- Investigations - Mammogram and biopsy - to rule out malignancy as presentation of breast cancer is similar.
Name features of biliary colic
Colicky RUQ pain
Worse after eating
No fever
Murphy sign -ve
What is the complication of biliary colic?
Obstructive jaundice = jaundice, dark urine and pale stools
What can ascending cholangitis be caused by?
Biliary calculi, benign biliary stricture, malignancy
Name three risk factors of cholangiocarcinoma
Hx of gallstones, smoking, obesity, porcelain gallbladder, primary sclerosing cholangitis, UC, Chrons, Oestrogens, Occupational exposure
A man had a radical prostatectomy 5 months ago due to prostate cancer. He now returns to you as he has a week stream and post micturition dribble. Why might he have these symptoms now?
Developed a urethral stricture
A patient attends ED as she has anxiety. She has SOB and feels her heart is beating too quickly. You carry out an ABG.What would this show?
Respiratory alkalosis.
WHY? Pt has anxiety —> panic attacks due to hyperventilation —> breathing off too much CO2 so reduces pp of CO2 —> = resp alkalosis
When do we invite women to breast screening?
ages 50-70yrs, every 3 years
How is an active seizure treated in the hospital setting?
IV 4mg lorazepam
Which organism causes Staghorn calculus in abdominal XR
Proteus species infection- causes alkalisation of urine leading to staghorn calculus e.g Proteus mirabilis. Note: E.coli causes UTIs but does not cause stones to form
What does having a glucose-6-phosphate dehydrogenase (G6PD) deficiency mean for red blood cells?
G6pd keep red blood cells working properly and live a normal ~ 120 day cycle. Without this, red cells lyse early (haemolysis) - get haemolytic anaemia
In achalasia, how is pain/discomfort described clinically?
Retrosternal discomfort.
How does Pharyngeal pouch present?
Dysphagia, regurgitation of undigested food, aspiration, chronic cough, weight loss
A history of dysphagia, regurgitation of food and aspiration can bring about what differentials?
Achalasia
GORD
Pharyngeal pouch
Name treatment used for HER2 receptor positive breast cancer
Trastuzumab aka Herceptin
Which hormone receptor must a breast lesion be positive for to be treated with Tamoxifen?
ER (oestrogen receptor) positive
Which antibiotic would be an appropriate choice for the treatment of a food borne enteric infection acquired in the UK?
Ciprofloxacin - good activity against many salmonellae and campylobacter.
What particular food borne infection is metronidazole effective in treating?
Giardia
Quinolone antibiotics need to be used with caution in the following groups: Patients with e\_\_\_\_\_\_ Patients over \_\_ years old C\_\_\_\_\_\_ Patients who are p\_\_\_\_
Patients with epilepsy
Patients over 60 years old
Children
Patients who are pregnant
Name three contraindications to using loperamide
Hints - medication causing gut problem, stool abnormality, hot hot hot!
Antibiotic associated colitis, bloody diarrhoea, high temperature
What should you advise a patient about before taking metronidazole?
Metronidazole has a disulfram-like effect web drinking alcohol along side metronidazole. Symptoms of this include flushing, abdominal pain and hypotension.
If the colon is dilated more than 10cm on an abdominal x ray, what is your top differential?
Toxic megacolon
Amlodipine, Ramipril, Atorvastatin, Beclometasone and Salbutamol inhaler all have side effects. Which two from this list cause GI symptoms such as heartburn/dyspepsia, belching, occasional vomiting?
Amlodipine - causes dyspepsia. Atorvastatin - cause upper GI symptoms
A 30 year old woman attends ED as she has an acutely red swollen leg. You confirm a DVT. Bloods are significant for thrombocytopenia and a prolonged activated partial thromboplastin time (APTT). These findings prompt an antibody screen, and the patient is subsequently diagnosed with antiphospholipid syndrome.
What should her long term treatment be (i.e. once discharged)?
Lifelong warfarin - After the first VTE, patients with antiphospholipid syndrome should be on lifelong warfarin
Which lung cancer can present with moon face and purple striae on the abdomen?
Small cell lung cancer - secretes ACTH - leads to Cushing’s syndrome
What is mesothelioma
Mesothelioma is a cancer of the pleura due to asbestos exposure.
What is the lymphatic drainage of the bladder?
External and internal iliac nodes, so if cancer in bladder, these will be the first nodes affected
What metabolic disturbance are you most worried about when prescribing salbutamol?
Hypokalaemia
How does hyperkalaemia show on ECG?
Tall tented T waved
What do you give if you see tall tented t waves on ECG and why?
IV calcium gluconate, to stabilise the myocardium and prevent cardiac arrest
Characteristics of hypodelirum?
Withdrawal and sleepiness
How does levy body dementia commonly present?
Dementia w Parkinsonism
Fluctuating cognition - compared to other dementia
What are the 5D’s of charcot’s foot found on Xray? (Capsule clinical investigation case 142)
Density change (areas of lucency and sclerosis)
Destruction
Debris (loose bodies and bone fragments)
Distension (joint effusion)
Dislocation (e.g. metacarpophalangeal joints).
What to do with warfarin if a pt has an IC haemorrhage?
give IV vitamin K 5mg + prothrombin complex concentrate
