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Finals PACES > Misc > Flashcards

Misc Flashcards

1
Q

Causes of Cushing’s syndrome

A

High ACTH = Pituitary adenoma (Cushing’s disease) OR Ectopic ACTH
Low ACTH = adenoma of adrenal cortex; carcinoma of adrenal cortex; iatrogenic

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2
Q

Cushing’s syndrome Ix

A
  1. Preliminary: overnight dexamethosone suppression test OR 24 hour urinary free cortisol
  2. Confirmation: 48 hour dexamethasone suppression test
  3. Localise lesion: Plasma ACTH + high dose dexamethasone (Cushing’s disease shows response) + imaging (CT chest and adrenals or MRI pituitary)
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3
Q

Claudication with normal pulses

A
  1. Neurogenic
  2. Anaemia
  3. B-blockers
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4
Q

Critical limb ischaemia O/E

A 
6 Ps
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysis (best indicator of danger to limb)
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5
Q

ABPI measurements

A

> 1 normal
0.5-1 intermittent claudication
0.3-0.5 rest pain/critical limb ischaemia
<0.3 gangrene + ulceration

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6
Q

Leriche’s syndrome

A

bilateral buttock pain and erectile impotence due to common iliac disease

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7
Q

A red foot!

A

May have chronic arterial disease with pooling, feel temperature and raise leg to see if fast exsanguination (means it is chronic)

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8
Q

Venous ulcer features

A 
Site = Medial gaiter region of leg
Sloped edges
Lots of exudate
Usually associated with limb oedema
Extra features of venous insufficiency
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9
Q

Extra features of venous insufficiency

A

Varicose veins
DVT
Venous eczema
Haemosiderosis (cayenne pepper petechiae)
Lipodermatosclerosis (scarring of subcutaneous fat)
Atrophie blanche (angular scarring after injury)
Inverted champagne bottle leg

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10
Q

Arterial ulcer feature

A

Site = Feet/toes/ankle
Punched out edges
Painful
with trophic changes and gangrene

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11
Q

Venous ulcer Rx

A

Graduated compression dressing

Antibiotics for any infection

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12
Q

Arterial ulcer Rx

A 
Conservative
Endovascular revascularisation (angioplasty)
Surgical revascularisation eg fem-pop bypass, fem-distal bypass etc
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13
Q

Trendelenburg Tourniquet test

A

Raise leg vertical (if no pain) and empty varicose veins; once empty place tourniquet on upper thigh, ask to stand and see whether veins refill:
If doesn’t fill then sapheno-femoral incompetence
If fills slowly then mix of sapheno-femoral incompetence and perforating veins (that bridge deep and superficial) incompetence
NB can also have sapheno-popliteal incompetence which typically affect short saphenous vein

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14
Q

Sapheno-femoral incompetence test

A

Place finger at SFJ (2cm infero-lateral to pubic tubercle) and get patient to cough, if can feel then positive

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15
Q

Varicose veins warm and tender

A

= superificial phlebitis

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16
Q

Varicose veins Rx

A

Conservative = elastic support hose; weight loss; regular exercise
Injection sclerotherapy = suitable for small varices from perforating veins (not for SFJ incompetence)
Surgery = SFJ ligated or Long saphenous vein stripped; for sapheno-popliteal can ligate the junction (do not strip short saphenous vein as can damage sural nerve)

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17
Q

Post-thrombotic syndrome

A

Chronic venous insufficiency secondary to DVT

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18
Q

Intradermal lump (impossible to slide skin over)

A

Sebaceous cyst (punctum)
Abscess
Dermoid cyst
Granuloma

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19
Q

Subcutaneous lumps (skin can slide over)

A

Lipoma (smooth and fluctuant)
Ganglion (moves with tendon)
Neurofibroma
Lymph node

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20
Q

Neurofibromatosis Type 1 (AD)

A 
aka von Recklinghausen's disease: CATCHES
Cafe au lait (>6)
Axillary freckling
Tumours of nervous system
Cutaneous neurofibromata
HTN
Eye features (lisch nodules)
Scoliosis
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21
Q

Neurofibromatosis Type 2 (AD)

A

Bilateral acoustic neuromas (key)
Other tumours of nervous system
Fewer cutaneous features

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22
Q

Sloping edge

A

Venous ulcer

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23
Q

Punched out edge

A

Arterial ulcer

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24
Q

Undetermined edge

A

TB, pressure necrosis

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25
Q

Rolling edge

A

BCC

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26
Q

Everted edge

A

SCC

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27
Q

Erythema nodosum DDx

A 
Painful, purple raised lesion on shins
Idiopathic
Sarcoidosis
Infection (strep, TB)
IBD
Drugs (Sulphonamides)
Malignancy (lymphoma, leukaemia)
Pregnancy
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28
Q

Melanoma

A 
ABCDE
Asymmetry of shape
Border irregular
Colour variation
Diameter >6mm or increasing
Elevation
29
Q

Hernia

A

Protusion of whole or part of viscus through an opening in the wall of its containing cavity into a place where it is not normally found

30
Q

Direct inguinal hernia

A

Through weak point in posterior wall of inguinal canal (Hesselbach’s triangle)

31
Q

Indirect inguinal hernia

A

Through internal inguinal ring down inguinal canal and out of external inguinal ring

32
Q

Femoral vs inguinal

A

Femoral inferior to pubic tubercle and usually not reducible as usually incarcerated with high likelihood to strangulate; direct moderate risk of incarceration and indirect = low risk
Femoral needs urgent surgery

33
Q

Borders of Hesselbach’s triangle

A

Inferior epigastric artery
Inguinal ligament
Linea semilunaris (lateral border of rectus muscle)
Within = direct hernia (so inferior to inferior epigastric artery)

34
Q

Hernia Repair

A 
Open mesh repair
Open suture repair
Laparoscopic:
1. Total extraperitoneal procedure (TEP)
2. Trans-abdominal procedure (TAP)
35
Q

Richter’s hernia

A

Only part of bowel herniates meaning strangulation can occur without obstruction. More common in femoral hernia

36
Q

Deep ring

A

Opens at midpoint of inguinal ligament into transversalis fascia

37
Q

Superficial ring

A

In aponeurosis of external oblique superior to pubic tubercle

38
Q

Inguinal canal

A

Roof = internal oblique
Floor = inguinal ligament
Back wall = transversalis fascia
Front wall = external oblique

39
Q

Mid-inguinal point

A

Midpoint of ASIS and pubic symphysis

Where femoral artery crosses

40
Q

Midpoint of inguinal ligament

A

MIdpoint of ASIS and pubic tubercle

41
Q

Pulsation in neck lump

A

Carotid body tumour

42
Q

Neck cysts (transilluminate)

A

Thyroglossal, branchial, cystic hygroma

43
Q

Pembreton’s test

A

Raise hands slowly and watch for facial plethora (venous compression, SVCO) and ask to take a deep breath in to see if stridor (tracheal compression)

44
Q

Classic Grave’s features

A 
Goitre
Specific to Graves:
Exopthalmos
Ophthalmaplegia
Pretibial myxoedema
Thyroid acropathy
45
Q

Signs of active disease

A

AF
Tremor
Lid lag
Thyroid bruit

46
Q

End colostomy

A

Usually left with 1 lumen, doesn’t spout and hard stool
Can be from Abdomino-peroneal (AP) resection for low rectal tumour (no back passage) or Hartmann’s procedure for higher tumour (have back passage)

47
Q

End ileostomy

A

Usually right, 1 lumen, spouting and soft/liquid stool

For UC or FAP, panproctocolectomy

48
Q

Loop ileostomy (temporary stoma)

A

Usually right, 2 lumens, spout and soft/liquid stool

To defunction obstruction or anus is bad Crohn’s

49
Q

Loop colostomy (temporary stoma)

A

Upper abdomen, 2 lumens, not spouting and hard stool

50
Q

Stoma complications

A 
Haemorrhage
Necrosis
Prolapse
Retraction
Obstruction
Parastoma hernia
High output
51
Q

Spigelian hernia

A

Through semilunaris at upper border of rectus sheath

High risk of incarceration so always repaired

52
Q

Epigastric hernia

A

Through linea alba at epigastric region

53
Q

True umbilical herna (congenital)

A

In neonates

Through umbilicus and usually resolves in early life

54
Q

Paraumbilical hernia (acquired)

A

Through linea alba usually above umbilicus, often irreducible and always repaired as high chance of incarceration

55
Q

Surgical emphysema on X-Ray of anterior chest wall

A

If the anterior chest wall is affected air can outline the pectoralis major muscle, giving rise to the ‘ginkgo leaf’ sign

56
Q

Goodsall’s rule

A

States that if the perianal skin opening is posterior to the transverse anal line, the fistulous tract will open into the anal canal in the midline posteriorly, sometimes taking a curvilinear course.

A perianal skin opening anterior to the transverse anal line is usually associated with a radial fistulous tract

Rule not applicable to fistulas >2.5cm from anal verge

57
Q

Haemorrhoids seen at

A

3, 7 and 11 o’clock

58
Q

Proctitis causes

A

Crohn’s, UC and C. diff

59
Q

Anal fissure seen at

A

Location: midline 6 (posterior midline 90%) & 12 o’clock position. Distal to the dentate line
Chronic fissure > 6/52: triad: Ulcer, sentinel pile, enlarged anal papillae

60
Q

Dentate (pectinate) line significance

A

Divides upper 2/3 (columnar) and lower 1/3 (squamous) of anus which distinguishes:

[] iliac and superficial inguinal lymph drainage
[] superior and middle + inferior rectal arteries
[] internal and external haemorrhoids (makes sense if you think about arteries)

61
Q

Medication for PAD

A

naftidrofuryl oxalate OR cilostazol

Remember to prescribe clopidogrel (1st line now) and statin

62
Q

Cavernous sinus syndrome

A

Most commonly caused by cavernous sinus tumours (like nasopharyngeal).
Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner’s syndrome.

63
Q

Co-presciption with goserelin for prostate cancer

A

Cyproterone acetate as this avoids the flare up of prostate symptoms

64
Q

Homonymous quadrantanopias

A

PITS:
Parietal=Inferior
Temporal=Superior

Left pathology ==> right sided lesion and vice versa
In practice though most homonymous quadrantanopias are caused by occipital lesions

65
Q

Bitemporal hemianopia

A

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

66
Q

Tumour markers: S-100

A

Melanoma

Schwannoma

67
Q

Tumour markers: bombesin

A

Small Cell lung cancer
gastric cancer
neuroblastoma

68
Q

Gingival hyperplasia causes

A

phenytoin, ciclosporin, calcium channel blockers and AML

Finals PACES (12 decks)

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