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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
definitive airway
Single-lumen cuffed ET tube
26
cyclical breast disease | fibrocystic disease
cyclical breast disease - pain only - mastaglgia, NSAIDs help? fibrocystic disease - pain and tender lumps
27
breast abbess
mastalgia and fever
28
stroke-like symptoms in nature but with slow onset point towards..
... SOL
29
positive coombs test
CLL (warm type AIHA)
30
Heavy alcohol consumption increases a persons risk of what?
Hypoglycaemia (glucose<3mmol/L)
31
Aplastic anaemia
- pancytopenia - infections (neutropenia) - anaemia (anaemia) - bruising (thrombocytopenia)
32
common electrolyte imbalance found with ascities
hyponatreamia
33
NSAIDs are contraindicated in
- peptic ulcer disease - renal failure - asthmatics (build up of leukotrienes can cause bronchospasm)
34
Delerium Tremens Tx
First line treatment is with chlordiazepoxide (or lorazepam if the patient has liver failure).Vitamin supplementation will also be indicated. Check this
35
Wernicke’s is due to
acute thiamine deficiency Others at risk include those with AIDS, cancer and treatment with chemotherapy, malnutrition and GIT surgery, especially bariatric procedures.
36
Wernicke’s triad
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
Korsakoff’s psychosis,
is irreversible
38
poultry, dairy items and undercooked eggs
salmonella --> gram negative bacilli
39
testis cannot be felt separately
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
AFP is raised in
teratomas (AFP is your territory)
41
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.
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
Chronic IDA with retrosternal dysphagia
Plummer Vison Syndrome
43
amoebiasis caused by E. histolytica
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
DKA Tx
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
over warfarinization Tx
‘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
When are MRIs contraindicated
MRI is contra-indictaed in some cases such as those with a permanent pacemaker or those with ESRF on dialysis –
47
- difficulty drawing up blood | - raised potassium
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
Blood being brought up at a fixed time everyday and pt has no signs of anaemia makes you think the cause is what?
Respiratory | Hence a CXR is indicated
49
Warafrin and ABx can cause interactions resulting in...
.. enhanced action of warfarin. Coughing up bloods etc...
50
Is suspect polycystic kidney disease what Ix?
Renal US
51
cervical carcinoma is at risk of what renal things?
ureteric obstruction and then hydronephrosis | Renal US is indicated
52
when cause of renal failure is nephrotic syndrome, diagnostic Ix
- renal biopsy | - should be done urgently so immunospressants can be given
53
Coeliac Disease Ix
- 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
Acute interstitial nephritis classically presents with
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
new onset hypertension and proteinuria in pregnant women after 20 weeks gestation
pre eclampsia
56
Half of patients with pancreatitis can get
pleural effusions
57
SAH Ix
-CT scan.. | .. if unrevealing --> LP
58
complications of GORD
- stricures (dysphagia to solids) - oesophageal ulcer - haemorrhage or perforation - Barrett’s oesophagus - oesophageal adenocarcinoma.
59
fluids>solids dysphagia
- Neuromuscular | - achalasia
60
A child with moderate learning difficulties, round face, small head, slanting eyes and a single palmar crease.
down's
61
Mitral Regurgitation is associated with what
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
VSD
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
sarcoidosis diagnosis Ix
transbronchial biopsy
64
TB diagnosis
ACID FAST BACILLI (3 sputum cultures needed)
65
Bronchiectasis Ix (diagnostic)
CT
66
Laryngeal cancer RFs
smoking and alcohol
67
Biopsy changes in IBD:
CD: transmural granulomatous inflammation. macroscopically characterised by skip lesions. UC: crypt abscesses, which is pathognomic
68
Anti-mitochondrial antibodies
Primary biliary cirrhosis
69
DNA hepatits virus
HepB
70
RNA hepatitis virus
HepC
71
Hepatitis B is a DNA virus which is transmitted
percutaneously and permucosally. It is also a STI.
72
hepatitis B markers: HBsAb
resolved infection and life-long immunity (it is also detectable and titres are measured in those immunised with the HBV vaccine).
73
HBsAg
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
Chronic infection in HepB
IgG core antibody
75
Acute infection HepB
Core antibody IgM
76
anticholinergic effect on bladder
urinary retention
77
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
xx
78
dyspareunia
painful sexual intercourse --> endometeriosis (with null parity)
79
Pelvic inflammatory disease is an acute ascending infection of the female tract that is often associated with .
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
Gilberts
autosomal recessive
81
IBD | ANCA positive
Primary sclerosing cholangitis
82
Murmur seen in Aortic Dissection
diastolic murmur of AR
83
- 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.
Pericarditis RF
84
non lung disease legionella
Pontiac fever
85
MacConkey agar grows what
gram negative bacteria: | Pseudomonas, E. coli, Klebsiella and Salmonella, to Proteus, Shigella and Enterobacter will all grow on i
86
gram negative bacilli causing hospital acquired pneumonia and UTI
pseudomonas
87
macroscopic haematuria after a URTI or gastroenteritis.
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
Note that MPO-ANCA is also known as pANCA and ANCA stands for anti-neutrophil cystoplasmic antibodies.
x

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