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Resp > Mock 2003 and 2004 > Flashcards

Mock 2003 and 2004 Flashcards

1
Q

crypt abcesses

A

UC

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2
Q

spindle shaped cells

A

sarcoma

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3
Q

most common presenting symptom in gastric cancer

A
  • weight loss

- 80% may also complain of epigastric pain that may reflect or be similar to peptic ulcers

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4
Q

a periumbilical nodule (Sister Mary Joseph’s nodule) or a left axillary nodule (Irish node).

A

gastric cancer

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5
Q

multiple ulcers or ulcers refractory to treatment

A

Zollinger-Ellison syndrome

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6
Q

HIV associated pulmonary conditions

A
  • pneumonia
  • HIV is a risk factor for pulmonary TB

NB all patients with TB should be tested for HIV within 2 months

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7
Q

can also get erythema nodosum in TB along with..

A

..sarcoidosis

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8
Q

CLL is warm time cause its

A

CLLoser

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9
Q

lupus pernio

A

sarcoidosis

main stay treatment of sarcoidosis is steroids

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10
Q

if anyone has dysphagia

A

GI endoscopy!

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11
Q

Paul Bunnell monospot

A

shows heterophile antibodies –> EBV, infectious mononucleosis (glandular fever)

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12
Q

First line Abx for salmonella

A

ciprofloxacin
Given for young children/>50yrs/immunocompromised
Also consider antiemetics and fluids

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13
Q

swinging fever post op, indicated what? What Ix is indicated?

A

Post-surgical patients are at risk of developing an abscess. An abscess is a collection of pus or infected material. A swinging fever is strongly indicative of an abscess and a blood culture is required to identify the pathogenic organism. Percutaneous or surgical drainage will usually be required with appropriate antimicrobial therapy

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14
Q

rusty coloured phlemgh

A

pneumococcus pneumonia

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15
Q

Paraneoplastic syndrome to do with lunch cancer

A

Lambert Eaton Syndrome

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16
Q

62 year old man with enlarging pulsatile mass in left groin. 3 days previously he had had a coronary angiogram.

A

This is a false or pseudoaneurysm as it does not involve all layers of the arterial wall. This has resulted from arterial trauma during the angiogram. Most cases of false aneuryms are as a result of iatrogenic trauma. A haematoma has formed between the breached layers and the remaining intact artery, causing the lump, which is pulsatile as blood rushes through the artery.

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17
Q

Right sided colorectal cancer tends to present with

A

anaemic symptoms

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18
Q

normal range for potassium

A

3.5-5mmol/l

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19
Q

phaeoctochromas may be inherited in

A

MEN2, von Hippel-Lindau syndrome and NF1.

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20
Q

BP lifestyle measures

A

(reducing salt intake to <2g/day, weight loss, fruit and vegetables as outlined in the DASH diet (Dietary Approaches to Stop Hypertension), increased physical activity and limiting alcohol) stoping smoking

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21
Q

PBC nail signs

A

clubbing

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22
Q

common oesophageal cancers

A

The two main types are squamous cell carcinoma and adenocarcinoma. Tumours in the upper 2/3 of the oesophagus are SCC whereas those that lie in the lower 1/3 are adenocarcinomas.

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23
Q

PKD

A

A renal ultrasound is the first test to order when the diagnosis is suspected. If the ultrasound is equivocal, a CT scan can be done of the abdomen and pelvis.

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24
Q

oropharyngeal airway

A

gudel

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25
Q

definitive airway

A

Single-lumen cuffed ET tube

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26
Q

cyclical breast disease

fibrocystic disease

A

cyclical breast disease - pain only - mastaglgia, NSAIDs help?
fibrocystic disease - pain and tender lumps

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27
Q

breast abbess

A

mastalgia and fever

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28
Q

stroke-like symptoms in nature but with slow onset point towards..

A

… SOL

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29
Q

positive coombs test

A

CLL (warm type AIHA)

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30
Q

Heavy alcohol consumption increases a persons risk of what?

A

Hypoglycaemia (glucose<3mmol/L)

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31
Q

Aplastic anaemia

A
  • pancytopenia
  • infections (neutropenia)
  • anaemia (anaemia)
  • bruising (thrombocytopenia)
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32
Q

common electrolyte imbalance found with ascities

A

hyponatreamia

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33
Q

NSAIDs are contraindicated in

A
  • peptic ulcer disease
  • renal failure
  • asthmatics (build up of leukotrienes can cause bronchospasm)
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34
Q

Delerium Tremens Tx

A

First line treatment is with chlordiazepoxide (or lorazepam if the patient has liver failure).Vitamin supplementation will also be indicated.

Check this

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35
Q

Wernicke’s is due to

A

acute thiamine deficiency
Others at risk include those with AIDS, cancer and treatment with chemotherapy, malnutrition and GIT surgery, especially bariatric procedures.

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36
Q

Wernicke’s triad

A
  1. mental change
  2. opthalmoplegia
  3. gait dysfunction

Note that thiamine should be given before dextrose! Magnesium deficiency also needs to be corrected as it is a co-factor in the functioning of thiamine dependent enzymes.

37
Q

Korsakoff’s psychosis,

A

is irreversible

38
Q

poultry, dairy items and undercooked eggs

A

salmonella –> gram negative bacilli

39
Q

testis cannot be felt separately

A

hydrocele

The mass can also increase in size with increased intra-abdominal pressure (such as coughing, crying or raising the arms) which causes peritoneal fluid to move into the scrotal sac. This causes the mass to vary in size during the day (smaller after lying down).

40
Q

AFP is raised in

A

teratomas (AFP is your territory)

41
Q

An 80-year-old woman is admitted from a residential home with a two week history of purulent sputum and pyrexia (38ºC). Examination reveals a constant wheezing in inspiration and expiration localised over the right lung base.

A

This is aspiration pneumonia. There are symptoms of pneumoia with pyrexia and purulent sputum, along with risk factors for aspiration in this elderly person who may have difficulties swallowing or altered mental status from, for example, dementia. The location of the wheeze is also consistent with this diagnosis as the RLL is the most common site due to the anatomy of the bronchial tree. Complications include abscess and empyema. Treatment is predominantly with antibiotics and supportive car

42
Q

Chronic IDA with retrosternal dysphagia

A

Plummer Vison Syndrome

43
Q

amoebiasis caused by E. histolytica

A

hepatic abcess
CNS signs
Additional risk factors include being male and male-male sex, both oral and anal. Diagnosis would be confirmed by the detection of antigen in stool samples, serology or PCR.

44
Q

DKA Tx

A

Initial treatment of DKA aims at correcting severe volume depletion (the main problem), again with IV saline infusion at a rate of 1-1.5L for the first hour. When glucose reaches 11.1mmol, fluid should be changed to 5% dextrose to prevent hypoglycaemia.

45
Q

over warfarinization Tx

A

‘over-warfarinised’. The guidelines are as follows:

  1. If there is no bleeding and INR is <6 then you should stop the warfarin.
  2. If the INR is >6 you need to give PO vitamin K as well.
  3. If there is severe bleeding and the INR is high, then you need to stop warfarin and give parenteral vitamin K and PCC (octreotide/octaplex). PCC (prothrombin complex concentrate) is better than FFP in these situations. Remember that warfarin prevents the activation of vitamin K which is a cofactor in the synthesis of factors 2, 7, 9 and 10.
46
Q

When are MRIs contraindicated

A

MRI is contra-indictaed in some cases such as those with a permanent pacemaker or those with ESRF on dialysis –

47
Q
  • difficulty drawing up blood

- raised potassium

A

This is pseudohyperkalaemia caused by haemolysis of the sample. The medical student who has had some difficulty drawing the blood has haemolysed the sample. Potassium in serum will in this case exceed the plasma value by >0.5 mmol/L and the pink tinge when centrifuging the sample will also give this away

48
Q

Blood being brought up at a fixed time everyday and pt has no signs of anaemia makes you think the cause is what?

A

Respiratory

Hence a CXR is indicated

49
Q

Warafrin and ABx can cause interactions resulting in…

A

.. enhanced action of warfarin. Coughing up bloods etc…

50
Q

Is suspect polycystic kidney disease what Ix?

A

Renal US

51
Q

cervical carcinoma is at risk of what renal things?

A

ureteric obstruction and then hydronephrosis

Renal US is indicated

52
Q

when cause of renal failure is nephrotic syndrome, diagnostic Ix

A
  • renal biopsy

- should be done urgently so immunospressants can be given

53
Q

Coeliac Disease Ix

A
  • diagnostic- biopsy BUT
  • The test of choice before performing such an invasive confirmatory test is to look for elevated anti-gliadin antibodies. Anti-tissue transglutaminase is less accurate and endomysial antibody is more expensive and has lower sensitivity.
54
Q

Acute interstitial nephritis classically presents with

A
  1. acute renal failure associated with oliguria
  2. ‘hypersensitivity triad’ triggered by a drug.
    -rash
    -fever
    -eosinophilia
    (This can commonly be Abx, especially beta-lactams, and NSAIDs) Oliguria can be present in more severe cases

NB. Can also be due to something chronic rather than acute hypersensitivity too

55
Q

new onset hypertension and proteinuria in pregnant women after 20 weeks gestation

A

pre eclampsia

56
Q

Half of patients with pancreatitis can get

A

pleural effusions

57
Q

SAH Ix

A

-CT scan..

.. if unrevealing –> LP

58
Q

complications of GORD

A
  • stricures (dysphagia to solids)
  • oesophageal ulcer
  • haemorrhage or perforation
  • Barrett’s oesophagus
  • oesophageal adenocarcinoma.
59
Q

fluids>solids dysphagia

A
  • Neuromuscular

- achalasia

60
Q

A child with moderate learning difficulties, round face, small head, slanting eyes and a single palmar crease.

A

down’s

61
Q

Mitral Regurgitation is associated with what

A

Chronic MR is associated with a laterally displaced apex beat with LV dilatation.
Acute MR in the setting of an acute MI is very serious can lead to high LA pressure and pulmonary oedema secondary to reduced LA compliance.

62
Q

VSD

A

has no axillary radiation
SD also gives a pansystolic murmur, which is generally easily heard, and is loudest at the left parasternal region, with no axillary radiation.

63
Q

sarcoidosis diagnosis Ix

A

transbronchial biopsy

64
Q

TB diagnosis

A

ACID FAST BACILLI (3 sputum cultures needed)

65
Q

Bronchiectasis Ix (diagnostic)

A

CT

66
Q

Laryngeal cancer RFs

A

smoking and alcohol

67
Q

Biopsy changes in IBD:

A

CD: transmural granulomatous inflammation. macroscopically characterised by skip lesions.

UC: crypt abscesses, which is pathognomic

68
Q

Anti-mitochondrial antibodies

A

Primary biliary cirrhosis

69
Q

DNA hepatits virus

A

HepB

70
Q

RNA hepatitis virus

A

HepC

71
Q

Hepatitis B is a DNA virus which is transmitted

A

percutaneously and permucosally. It is also a STI.

72
Q

hepatitis B markers: HBsAb

A

resolved infection and life-long immunity (it is also detectable and titres are measured in those immunised with the HBV vaccine).

73
Q

HBsAg

A

appears 2-10 weeks after exposure to HBV and usually, in self-limiting acute cases, becomes undetectable after 4-6 months of infection. Persistence for >6 months implies chronic infection.

74
Q

Chronic infection in HepB

A

IgG core antibody

75
Q

Acute infection HepB

A

Core antibody IgM

76
Q

anticholinergic effect on bladder

A

urinary retention

77
Q

Bladder cancer –> RF: Schistosomiasis resulting in SCC (related to chronic inflammation – so other risks also include UTI, stones etc). Bladder cancer is the most common cancer in Egypt, for the

A

xx

78
Q

dyspareunia

A

painful sexual intercourse –> endometeriosis (with null parity)

79
Q

Pelvic inflammatory disease is an acute ascending infection of the female tract that is often associated with .

A

Neisseria gonorrhoeae or Chlamydia trachomatis

Key RF:

  • prior infection with chlamydia or gonorrhoea or PID, -young age of onset of sexual activity
  • unprotected sex with multiple partners
  • IUD use.
80
Q

Gilberts

A

autosomal recessive

81
Q

IBD

ANCA positive

A

Primary sclerosing cholangitis

82
Q

Murmur seen in Aortic Dissection

A

diastolic murmur of AR

83
Q
  • Prior viral infection
  • male gender
  • post-MI (both ‘early’ and Dressler’s)
  • post-pericardiotomy syndrome
  • neoplasm from local tumour invasion, uraemia and
  • autoimmune conditions such as RA and SLE.
A

Pericarditis RF

84
Q

non lung disease legionella

A

Pontiac fever

85
Q

MacConkey agar grows what

A

gram negative bacteria:

Pseudomonas, E. coli, Klebsiella and Salmonella, to Proteus, Shigella and Enterobacter will all grow on i

86
Q

gram negative bacilli causing hospital acquired pneumonia and UTI

A

pseudomonas

87
Q

macroscopic haematuria after a URTI or gastroenteritis.

A

IgA nephropathy
Definitive diagnosis is made on renal biopsy. Light microscopy shows focal or diffuse mesangial proliferation and extracellular expansion, and IF shows diffuse mesangial IgA deposition in a granular pattern.

88
Q

Note that MPO-ANCA is also known as pANCA and ANCA stands for anti-neutrophil cystoplasmic antibodies.

A

x

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