Miscellaneous Flashcards
Images + tables from all specialities
fill in the table
fill in the table provided with cause of peripheral neuropathy
How would you manage a pneumothorax?
fill in table with causes of hyponatraemia with assocaited fluid status
What acute events might a patient with sickle cell anaemia present with?
- acute painful crisis
- stroke
- sequestration crises where RBC pool in the lungs of the spleen
- lungs -> SOB, cough, fever
- spleen -> exacerbated anaemia
- gallstones, chronic cholecystitis
differentials for amenorrhoea
- Pregnancy
- Hypothalamus
- Pituitary
- Thyroid disorder (hypo or hyper)
- PCOS
- Ovarian failure
Fill in the table with the appropriate management for each sickle cell disease crisis
What visual field deficit would lesions in the corresponding areas cause?
fill in the table
fill in the table
Fill in the table with the conditions associated with these signs
Fill in the table with the conditions associated with these signs
Fill in the table with the conditions associated with these signs
What does this investigation show?
what is the sign called?
what kind of investigation is this?
Barium follow through
apple core lesion
colon adenocarcinoma (apple core suggests malignancy of the bowel)
What is this sign and what is the pathology?
foetus sign
caecal volvulus
what is this?
Large bowel obstruction
line across bowel are the haustra
what does this AXR show?
small bowel obstruction
the lines across the bowel are valvulae conniventes
What is this sign and what is the pathology?
coffee bean sign
sigmoid volvulus
What is the abnormality?
staghorn calculus
What is the sign? what pathologies might cause this sign?
thumbprinting
seen in colitis and mesenteric ischaemic due to mucosal thickening
what does this AXR show?
toxic mega colon
what are the clinical features of meniere’s disease?
recurrent episodes of tinnitus, paroxysmal vertigo and unilateral fluctuating hearing loss
what is the diagnostic test for BPPV?
Hallpikes test
what conditions are associated with PCOS?
obesity
dyslipidaemia
insulin resistance
type 2 diabetes
what is the presentation of renal cell carcinoma?
haematuria + flank pain + abdominal mass
+ FLAWS symptoms
how do you investigate renal artery stenosis
bloods: U&Es, aldosterone:renin ratio (>20)
duplex USS -> blood flow
renal USS to look at kidneys
gold standard = digital subtraction angiography
what is the presentation of a hydrocele?
painless scrotal swellling
fluid filled lump which may feel cystic, fluctuant, seperate from testes and can palpate above
transilluminates
what is the presentation of bladder cancer?
painless haematuria + FLAWs
what are the main causes of AKI?
acute tubular necrosis
sepsis (causes hypotension and therefore ischaemia)
what are the risk factors for bladder cancer?
smoking, aromatic amines, dye stuff, chrnoic cystitis, pelvic irritation, schistosomiasis
what stain on a kidney biopsy confirms amyloidosis?
positive congo red stain
what is the treatment of epididymitis and orchitis?
rest, analgesia, scrotal support, abstain from sex
if STD -> test partner
NSAIDs and empirical tx -> doxycycline for chlamydia, ceftraxiaxone for gonorrhoea
if severe admit the patient for IV therapy
what is the presentation of epididymitis/orchitis?
unilateral scrotal swelling with pain
+ dysuria
+ pain on walking
+ fevers
what organisms are commonly implicated in epididymitis/orchitis?
< 35 years -> STD chlamydia or gonorrhoea
> 35 years -> gram -ve such as e.coli or pseudomonas
most common viral is mumps
what are the clinical features and signs of PCOS?
- mestrual irregularities (oligomenorrhoea or amenorrhoea)
- dysfunctional uterine bleeding
- infertility
- hirsutism
- male-pattern hair loss
- acne
what is benign paroxysmal positional vertigo and what are the signs?
vertigo lasting for a seconds-minutes in response to changing head position.
dizziness, vertigo, loss of balance, nausea/vomiting
what are cataracts?
opacification of lens of the eye
what is the presentation of cataracts?
gradual-onset painless loss of vision, glare when looking at bright light
vision may worsen in light
some may no longer need their reading glassess
- loss of red reflex
- hazy lens appearance
- reduced visual acuity
what is glaucoma?
it is an optic neuropathy with a dield deficit which is usually associated with ocular hypertension (>21 mmHg)
what are signs of glaucoma?
redness of eye + dilated pupil + cloudy cornea
what are the features of acute closed angle glaucoma?
red eye
hazy cornea
loss of red reflex
fixed and dilated pupil
eye is tender and hard on palpation
cupped optic disc
visual field deficit
moderate raised intra ocular pressure
How does primary open angle glaucoma present?
slow progressive loss of peripheral fields.
few signs. the optic disc may be cupped on fundoscopy
What are the characteristics of alcohol dependence?
3 or more of:
- withdrawal when they stop drinking
- tolerance
- compulsion to drink, difficulty controlling termination or levels of use
- persistant desire to cut down or control use
- time spent obtaining, using or recovering from alcohol
- negect of other interests
- continued use despite physical and psychological problems
What is the maximum recommended alcohol intake?
in units
14 units a week
What is the pathophysiology of alcohol withdrawal?
alcohol enhances inhibitory GABA and inhibits exictatoy glutamate neurotransmission
the body adapts by: reducing GABA receptors and upregulating glutamate receptors
stop drinking = overactivation of excitatory receptors
What questions might you ask to initially screen for alcohol dependence?
CAGE questions
- have you felt like you should cut down on drinking?
- have you felt annoyed by people telling you to stop drinking:
- have you ever felt guilty about how much you drink?
- do you feel like you need a drink to way you up in the morning? (eye opener)
What are the features of alcohol withdrawal?
nausea, sweating, tremor, restlessness, agitation, visual hallucinations, confusion, seizures
What is the diagnostic criteria for anxiety?
- excessive anxiety + worry occuring more days than not for at least 6 months
- difficult to control worry
- associated with:
- restlessness
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
What is the diagnostic criteria for depression?
at least 1 of the following:
- persistent sadness or low mood nearly every day
- loss of interests or pleasure in most activities
plus some of the following:
- fatigue or loss of energy
- worthlessness, excessive/inappropriate guilt
- suicidal thoughts
- diminished ability to think or concentrate
- psychomotor agitation or retardation
- insomnia
- changes in appetite and/or weight loss
symptoms must have persisted for at least 2 weeks
What assessment tools can be used to assess depression?
patient health questionnaire (PHQ-9)
hospital anxiety and depression scale (HAD)
Beck’s depression inventory
What is pseudohyponatraemia?
a mildly low sodium due to hyperlipidaemia or hyperproteinaemia
What is necrobiosis lipoidica?
shiny yellow skin patches usually over shins
DM complication
What are the stages of HTN retinopathy?
stage I = silver wiring
stage II = silver wiring + arteriovenous nipping
stage III = silver wiring + arteriovenous nipping + flame haemorrhages + cotton wool exudates
stage IV = silver wiring + AV nipping + flame haemorrhages + cotton wool exudates + PAPILLOEDEMA
what is stage I of HTN retinopathy?
silver wiring
what is stage II of HTN retinopathy?
silver wiring + AV nipping
what is stage III of HTN retinopathy?
silver wiring + AV nipping + flame haemorrhages + cotton wool exudates
what is stage IV of HTN retinopathy?
silver wiring + AV nipping + flame haemorrhages + cotton wool exudates + papilloedema
what are the stages of diabetic retinopathy?
- background = hard exudates + blot haemorrhages
- pre-proliferative = cotton wool spots, pre-retinal haemorrhages
- proliferative = new vessels forming
- maculopathy = any of the above occuring closer or on the macular threatening sight
higher risk for glaucoma, cataracts and transient visual loss
What are causes of haemolytic anaemia?
what are the causes of a true polycythaemia?
What are the benign breast conditions?
- fibroadenomas
- fibrocystic changes
- breast cyst
- sclerosing adnosis
- intraductal papilloma
- duct ectasia
- fat necrosis
- periductal mastitis
What are the features of duct ectasia?
yellow/green discharge
occurs due to central ducts become dilated with ductal secretions due to lactiferous duct blockage
describe the triple assessment at the breast clinic
- examination
- imaging (< 35 USS, >35 mammogram 2 views
- cytology/histology of lump - FNA or excision biopsy
what is the common causative organism of breast abscesses?
staphylococcus aureus
what kind of breast abscesses tend to recur?
non-lactational
what is the treatment for the 2 types of breast abscess?
lactational abcess = flucloxacillin
non-lactational abcess = flucloxacillin + metronidazole
- only fluclox for lactation as mainly s. aureus
- non-lactitional tx needs to cover s.aureus and anaerobes
what are the direct consequences of HIV on the following organ systems ?
what is the management of VZV infection?
what is the test for BPPV?
hallpike manouevre
which row shows results indicative of primary, secondary or tertiary hyperparathyroidism?
describe the motor component of the GCS score.
gram stain of streptococcus pneumoniae
gram +ve cocci chains
gram stain of S. aureus
gram +ve cocci clusters
gram stain of N. meningitides
gram -ve cocci
life threatening differentials of syncope
- PE
- Ectopic pregnancy
- AAA
- Aortic dissection
- MI
- SAH
- Aortic stenosis
- Arrhythmias - SVT/VF/VT or bradycardia or heart-block
differentials for purpuric rash
- infection - meningococcal septicaemia
- IgA vasculitis (HSP)
- small vessel vasculitis
- lower platelet - ITP, etc
what are the retroperitoneal organs?
SAD PUCKER
Suprarenal (adrenal) gland
Aorta/IVC
Duodenum (2nd and 3rd part)
Pancreas (except the tail)
Ureters
Colon (ascending and descending)
Kidneys
Oesophagus
Rectum
what are the features of excess acetylcholine?
e.g. organophosphate poisoning
SLUD
- salivation
- lacrimation
- urinary
- defecation/diarrhoea
- CVD - hypotension, bradycardia
- small pupils
- muscle fasciculation
management with atropine
describe the cervical screening
- every 3 years from 25-49
- every 5 years from 50-64
describe the breast screening program
- invited from 50 - 70
- every 3 years
describe the bowel cancer screening program
- home test screening kit every 2 years from 60-74
- faecal immunochemistry test
describe the AAA screening
1 off USS to men > 65
can refer women > 70 with RF (COPD, cerebrovascular/coronary/peripheral arterial disease, FHx, hyperlipidaemia, HTN, current or ex-smoker)
causes of normal anion gap or hyperchloraemic metabolic acidosis
- GI bicarb loss - diarrhoea, fistula
- renal tubular acidosis
- drugs - acetazolamide
- ammonium chloride injection
- addison’s disease
