October AFT Flashcards
Deficiency when knee reflexes are brisk and ankle absent. Reduced pinprick sensation up to mid calf.
Bloods:
- Low Hb
-Low WBC
-Low platelets
-High MCV
Vitamin B12 deficiency
Most common neurologic findings:
- Symettric paraesthesias or numbness and gait problems
55 Y/o man, lower back pain, fatigue foe 3 months.
Hb: low
WCC: Normal
Platelets: low
Corrected Ca: High
Albumin: low
Serum electrophoresis: monoclonal Ig Kappa peak
Bone marrow biopsy: foci of plasma cells, 18% of all haemopoietic cells
Multiple Myeloma
Women with reduced UO 24 hours post admission for CAP. Treated with IV amoxi and clarithro.
Creatine: normal on admission
High temp, HR: 106, BP: 102/50, Sats: 95% on O2.
Urinalysis: protein 1+
WCC: High
Platelets: Low
Urea: High
Creatinine: High
Cause of AKI?
A)Drug induced interstitial nephritis
B)HUS
C)Infection related glomerulonephritis
D) Renal hypoperfusion
E) Systematic vasculitis
D) RENAL HYPOPERFUSION
-Ptnt has ongoing sepsis with hypotension leading to pre-renal AKI
-This might lead to acute Tubular necrosis
-Not A: wouldn’t appear until 4-7 days of ABs
-Not B: Would present differently: marked anaemia, low platelet count
-Not C: Uncommon with pneumonia no evidence of haematuria
Not E: No evidence of non-visible haematuria
What type of ulcer:
-70 y/o woman
-Above left medial malleolus
-T2DM
-Smokes 10 PD
BMI: 34
Ulcer: 10 x 5cm and superficial
-Brown leg discolouration of both legs and thickened waxy feel.
Venous Ulcer
-Site and presence of hyperpigmentation are venous suggestive,
Plus not assoc with pain
What is the combination of hypoalbuminaemia, proteinuria, oedema, hypercholesteraemia characteristic of?
Nephrotic syndrome
Causes of nephrotic syndrome in 67 year old, non-diabetic, age group?
Membranous nephropathy
Minimal change
FSGS (Focal segmental glomerulosclerosis)
Myeloma can also be considered
What drugs are prescribed to reduce risk of future falls and fracture?
Calcium
Vitamin D
Alendronic acid
2nd line treatment of osteoporosis? And what is given if intolerant of oral bisphosphonate?
Denosumab (RANKL inhibitor)
Zoledronate IV
8 weeks of back pain, wakes at night, increasing tiredness, no history of problems/recent trauma.
Tenderness over L3/4
Hb: normal
ESR: High
Serum electrophoresis: no paraprotein
Investigation?
-CT scan+ abdomen
-DEXA
-HLA-B27
-Isotope bone
-X-ray lumbar spine
X-ray lumbar spine
-Spinal tenderness and elevated ESR = red flags espesh being woken from sleep
-If negative MRI would be next
17 y/o with florid 24hr skin rash, unwell for past week + intermittent abdo pain.
Rash: palpable, purpuric on lower limbs and buttocks
Temp: 37.2 PR: 70, BP:122/80
Urinalysis: Blood 3+, Protein 2+. nitrates -ve. leucocytes -ve
Bloods: normal Hb, WCC, platelets, Urea, Creatinine.
What is it?
A)IgA vasculitis
B) Meninococcal septicaemia
C) Microscopic polyangitis
D) Postinfectious glomerulonephritis
E) SLE
IgA Vascultis (Henoch-Schlonen Purpura)
-Classic presentation with vasculitic rash, and active urinary sediment
-Renal function usually normal
NOT:
B) Patient would be more unwell
C)Less common in this age, longer history
D) Follows clear infection, strep throat usually
E) Longer history, no vasculitic rash, othe features of SLE would be present
Other features of SLE?
Alopecia
Arthralgia
Skin rash
Cytopenias
Mouth ulcers
Glucose when a person is hypoglycaemic?
If they are alert enough to swallow: Oral tablets
Confused, aggresive, but able to swallow: Gluco gel 2 tubes, if post 15 mins still not fixed, repeat 3 times
If still not fixed: IV Glucose 20%
Unconcious: IV glucose 20% 100ml or IV glucose 10% 200mls
If no IV access IM Glucagon
Hypo Guidelines?
https://abcd.care/sites/default/files/site_uploads/JBDS_Guidelines_Current/JBDS_01_Hypo_Guideline_with_QR_code_January_2023.pdf
Which of these drugs causes constipation?
-Amlodipine
-Doxazosin
-Gliclazide
-Metformin
-Oxybutynin
OXYBUTYNIN
Anticholinergic
65 y/o man sudden visual change, flashing lights, floaters, loss of vision in upper quadrant of right eye.
PMHx: HT
Options:
Acute glaucoma
CRAO
CRVO
Retinal detachment
Vitreous haemorrhage
RETINAL DETACHMENT
-Typically ptnts complains of increasing floaters in one eye, as detachment progresses the separating vitreous will tug on surface of retina and create mechanical depolarisation of axons running through the nerve and fibre layer of retina= flashing lights
70 y/o pyrexia, recued OX sars 2 days post gastercomy.
Post op pain control: difficult, so no chest physio/mobilisation
Temp: 37.8, PR: 84. O2 sats: 92% on 02.
BMI: 36
Reduced breath sounds at both lung bases, soft abdo, wound tenderness
Serous output from drain
ATELECTASIS
-Development of fever in early post-op + reduced 02 sats: bibasal atelectasis particularly in abdominal surgeries
6 months intermittent weakness and numbness bilaterally in legs upon walking 100m which settles with rest, Leaning forwards helps, can bike ride without provoking symptoms.
Diet controlled T2DM, Ex-smoker, BP: 178/95, Bilateral hip flexion weakness.
Lumbar spinal stenosis
Typical history of neurogenic claudication
Comes on with walking and better leaning forwards (including bike riding)
If a mass is found on chest x-ray, what is next most appropriate investigation?
CT scan of chest
Single most important diagnostic factor of localised melanoma?
Breslow thickness
42 y/o with colicky Central abdo pain, vomitingm abdo distension, increased bowel sounds.
Ruptured appendix 20 years ago.
Diagnosis and management?
Bowel obstruction
Conservative:
-Fluid resus
-Nasogastric decompression of gut
-Aspirate stomach contents with syringe then bag placed on free drainage
Surgical is for patients who do not improve with this as dividing adhesions creates opportunity for more to grow
Thrombocytopenia?
Deficiency of platelets in blood
Patients with thrombocytopenia, prolonged PT and aPTT, low plasma fibrinogen and elevated plasma D dimer.
What is usual diagnosis?
Disseminated Intravascular Coagulation
(DIC)
This can be due to complicated urosepsis
22 y/o went to sleep after party, woken at 3 to urinate, felt faint+nauseous while bearing down, lost consciousness and fell.
Diagnosis?
-Alcohol related seizure
-Cardiac dysrhythmia
-Ecstasy Toxcity
-Hypoglycaemia
-Vasovagal syncope
VASOVAGAL SYNCOPE
Purpose of cricoid pressure?
Prevents passage of gastric contents into airway
25 y/o LHS chest pain, worse upon lying back, and deep breaths.
Recent RTI.
Troponin: 0.025 (<0.01)
ECG changes: widespread PR depression and ST elevation
Pericarditis
18 y/o female, 6 hrs of severe dizziness + nausea
-Room constantly spinning, several vomits, dizziness worse upon opening eyes
Nystagmus with fast phase to left, doesn’t fatigure
Vestibular neuronitis
-Single episode in 18 y/o girl,
-If recurrent: vestibular migraine, BPPV
One episode of visible haematuria, 75 y/o man, BP: 142/80, temp:36.2, Urinalysis: 2+, leucocytes -ve, protein -ve, nitrate -ve.
MSUS: RBCs and epithelial, no microbes
Investigation?
-US Scan of renal tract
-CT urography
-Serum prostate Specific ANtigen
-Urology opinion
-Repeat MSUS for culture and sensitivity
Urology Opinion
-Possibility of transitional cell carcinoma of bladder
-Thorough invgX of haematuria is required
73 y/o male, 3 months of increasing weakness in RH with reduced forearm sensation.
Wasting of all intrinsic muscles of RH, weakness of finger abduction & adduction and thumb adduction.
Finger flexion normal, mild light touch altered sensation along ulnar aspect of forearm,
Reflexes normal
Whats the most likely site of issue?
T1 nerve root
Normal reflexes and normal other arm: no cord lesion
Sensory loss on forearm: no median and ulnar nerve lesions
What does intrinsic hand muscle wasting suggest?
T1 root lesion
Mixed growth on urine specimen indicates what?
Contaminated Urine sample
What does this ptnt have? and what should treatment be?
70 y/o female, 6 weeks generalised shoulder and hip pain and stiffness, excessive tiredness
Temp: 37.5, reduced ROM at shoulders, no muscle tenderness
Synovial thickening and tenderness at wrist
ESR: High
CK: Normal
Polymyalgia rheumatica
Based on age, pattern of msucle weakness and raised ESR
-Prednisolone (corticosteroids)
Man, increasing abdo pain, 1-2 bottles of vodka per day.
Jaundice, spider naevi, prominent veins on abdo walls
Diffusely tender abdo
Temp: 37.6
INR: High
ALT: HIgh
Bilirubs: High
US: ascites with mild hepatosplenomegaly
What do you suspect and what invgX do you do?
Spontaneous bacterial peritonitis (SBP) should be sus in patients with ascites due to to cirrhosis who develop fever, abdo pain, tenderness adn confusion
Therefore an Ascitic tap should be done
65 y/o woman, painful watery left eye 3 days
Reduced visual acuity on left. Fundoscopy normal.
You’re in GP what do you do?
Refer to ophthalmology as emergency
PAINFUL EYE WITH ACUITY LOSS= EMERGENCY
Triple assessment of breast includes?
Clinical examination
Breast imaging
Core biopsy
1st line HT treatment in afro-carribean peoples?
CCB
-pines
What is a prospective cohort?
Longitudinal cohort study that follows a group over time of similar individuals who differ with respect to certain factors to determine how factors affect rates of certain outcomes
Classic features of lithium toxicity?
Confusion
Coarse tremor
Jerking leg movements
Likely underlying pathology for 42 y/o female with 3 months of wt loss, insomnia, palpitations.
Fine resting tremor, bilateral proptosis.
GRAVES
-Autoantibodies to TSH receptors
Clinical picture of Primary Biliary Cirrhosis?
Raised ALP
AMA +ve
No evidence of obstruction
Treatment of PBC?
Ursodeoxycholic acid
Commonest endocrine cause of HT?
Conn’s syndrome
Classic presenting signs of conns?
HT
Hypokalaemia
aswell consider in
-Severe HT (150/100)
-HT with sleep apnoea
-HT with FHx of early inset HT
Fat emboli classic presentation?
Multiple fractures
Early onset hypoxia, dyspnea, tachypnea
-Acute confusion, altered level of conciousness, seizures/focal deficits
Petechial rash (last component to appear,only in 1/3 of cases)
PE presents similarly minus the neurological beef
Cardiac arrest in ED following chest pain, ventricular fib after 3 DC shocks, treated with bolus of IV adrenaline.
What do next with drugs?
-Altepase
-Amiodarone hydrochloride
-Atropine sulfate
-Lidocaine
-Magnesium sulfate
Amiodarone hydrochloride
-After 3rd shock if condition persists, resume chest compressions then give adrenaline 1mg IV and amiodarone 300mg IV will performing firther 2 mins CPR.
What is the likely cause and what investigation should he have?
18 y/o male, 3 weeks malaise, fever, headaches, 1 week sore throat
Large tonsils with exudate, petechial rash on palate, axillary/inguinal lymphadenopathy
Temp: 37.6, PR:84, BP: 120/82, RR: 12
WCC: High
Lymphocytes: High
AST: High
ALT: High
Alkaline phosphatase: normal
Bilirubin: Normal
Glandular Fever
EBV serology
This is a common presentation of EBV induced mononucleosis
-YA sore throat, fever, malaise, lymphadenopathy, pharyngitis
Palatal petechiae
Lymphocytosis
Most appropriate first step management for man in ED after fall, history of Afib and takes apixaban. No pain, signif bruising o to LHS face and arm.
PR: 80, Irregular
BP: 150/95
O2 sats: 96%
GCS 14
Cervical Spine Immobilisation
Repeated episodes of racing sensation in abdomen, followed by loss of awareness.
Vacant stare, waves left arm around in writhing manner.
What do we think it is? What is the most likely site of origin?
Focal onset impaired awareness seizures
-The aura implicates it is one of the temporal lobes
-The waving of his left arm implicates a spread to the R frontal lobe however this is not the origin
Risk with clozapine?
AGRANULOCYTOSIS
34 y/o man, 3 day fever, sweat, productive cough, brown sputum.
Temp: 38.8, bronchial breathing over right mid-zone.
Likely pathogen?
Strep pneumoniae
38 y/o man, blood stained sputum 3 months.
+ve for mycobacterium tuberculosis
Treated with quadruple therapy, 2 weeks later passing orange urine.
Whats going on?
Rifampicin
This typically casues orange discolouration
(Rifam-pissing: orange urine)
46 y/o
Fevere, headache, confusion over several hours
Impossible to life head and resists attempts to feel neck
Temp: 38.1, PR: 105, BP: 110/60, GCS:14
Whats happening, what investigation do you want, and what result will it have?
Bacterial meningitis
Lumbar puncture
High pressure, raised protein, XS neutrophils
Treatment of chlamydia trachomatis infection?
Doxycycline orally
Difference between croup and bronchiolitis?
Croup: URT illness, inflammation of larynx resulting in inspiratory stridor and harsh barky cough
Bronchiolitis: LRT ilness with inflammation of bronchioles resulting in expiratory wheezing and wet cough
Ronchi: weird low noise when breathing indicative of secretions
What do you give a pregnant woman who is seizing?
Magnesium sulfate
5 y/o girl
Smooth indistinct philtrum, thin upper lip, small eyes with epicanthal folds, flat midface, short nose
What is likely diagnosis?
Fetal alcohol syndrome
Presentation of turners syndrome?
Neck webbing
Low set ears
HIgh palate
Retro or micrognathia
Posterior low hairline
Physical presentation of DS?
Microcephaly
Low set ears
Protruding tongue
Small nose with flattened nasal bridge
Old person in home with bloody diarrhoea. No urine output in past 24 hours. Other patients had similar episodes?
Ecoli
HUS: Reason for low UO
Prominent hilar lymphadenopathy + scattered non-caeseating granuloma?
Sarcoidosis
57 y/o woman, intermittent fresh vaginal bleeding for 3 weeks.
LMP: 6 yers ago
Left mastectomy for breast carcinoma, currently on tamoxifen?
Likely diagnosis:
A) Cervical carcinoma
B) Cervical ectropion
C) Endometrial carcinoma
D) Endometrial hyperplasia
E) Uterine leiomyoma
D ENDOMETRIAL HYPERPLASIA
A) Typical presentation: post-coital bleed
B) Typically doesn’t cause symptoms
C) This is possible due to tamoxifen, however benign hyperplasia is more likely
D) This is CORRECT as more likely given her use of tamoxifen
E) These tend to regress after menopause
14 day old baby vomiting. Born at 28 weeks, still on resp support.
Lethargic and abdominally distended.
Whats going on?
Necrotising enterocolitis
Presentation: Vomiting, lethargy, bloody diarrhoea on deterioration
Who is most commonly going to get NEC?
Sick preterm babas
Particularly with progression on enteral nutrition
When would jaundice due to haemolysis present in a baby?
24 hours of birth
Breast feeding jaundice occurs when?
Between 1-2 weeks of life
Physiological jaundice when?
Within first week of life
What type of epilepsy do tonic-clonic seizures suggest?
Generalised epilepsy
First line generalised epilepsy treatment for non-child bearing age people?
Sodium valproate
Then
Lamotrigine
Examples of Enzyme inducing AEDs?
Carbamazepine
Phenytoin
Topiramate
What is an important POI with Enzyme inducing AEDs?
CANNOT BE USED WITH HORMONAL CONTRACEPTION
Kernigs sign?
MENINGITIS
Unilateral tremor of gradual onset?
PARKINSONIAN TREMOR
-Unilateral rules out essential + alcohol dependence
-Cerebellar lesion would cause coordination problems not tremor
What is seen in meconium aspiration syndrome?
Meconium stained liquor
Prolonged ROM increases likelihood of what?
Infection
16 y/o painful, irregular periods: contraception?
COCP
-Irregularity + pain= COCP
Mirena: won’t help with pain
POP: Won’t provide hormonal balance
Intra-uterine device and depo-povera: breakthrough bleeding
Diagnostic procedure for primary infertility where 36 y/o female has PID and normal ovulatory cycle, partner is fit and healthy?
Diagnostic laparoscopy
4 y/o with fever for 7 days, erythematous rash 4 days across body.
Fully immunised, temp: 38.1, lips crackedm numerous palpable lympmhnodes
Bilateral conjunctivitis
Kawasaki disease
Fever duration: diagnostic
What to do when a child vomits green?
THIS IS BILLIOUS VOMITING = EMERGENCY
Suggestive of obstruction
37 y/o planning pregnancy soon, essential HT severe.
Treatment?
Labetalol, nifidepine, Methyldopa
Progressive confusion over 2 weeks, slight slurring of speech, history of alcoholism and fall 2 weeks previously.
Diagnosis?
Chronic subdural bleed
Overweight, 13 y/o male, limp for 3 weeks, antalgic gait, pain on passive and active movement of Left hip. Temp 37.1.
Diagnosis?
Slipped Upper Femoral Epiphysis
DDH: normally picked up in infancy
Perthes: Between 4-12 years old
13 y/o girl, short for ages, mild LD, no signs of puberty?
Turners syndrome
Allodynia?
Pain due to stimulus that wouldn’t normally provoke pain
19 y/o male, post sore throat haematuria, feels well.
2 weeks later hands in urine sample, blood pressure 160/96, blood 3+, protein 2+.
Diagnosis?
IgA Nephropathy
External rotation and groin pain in 72 y/o lady?
Intracapsular hip fracture (? dodgy explanation so maybe don’t take this at it’s word)
1st line preventative treatment of migraines?
Topiramate
or
Propanolol (Just be careful of asthma)
Little boy, sudden onset dyspnoea, fatigure, pink urine. Began shortly after eating lunch.
Biological father has genetic blood condition
Visibly pale, HR: 130
Hb: Low border of normal
MCV: Normal
Haptoglobin: low
G6PD deficiency
Treatment for OCD?
SSRIs
Medication for PTSD?
SSRIs (Sertraline)
Change in memory, urinary incontinenece, unsteady gait.
DIganose?
Normal pressure hydrocephalus
What is given in hard to control bleeding, when patient is on anti-platelet meds?
Platelets
