PAPER 2 (76%) Flashcards
Most likely causative organisms for cellulitis?
Strep pyogenes
(Less commonly staph aureus)
Which regional lymph nodes is an ovarian tumour most likely to initially spread to?
Para-aortic lymph nodes
What is the most appropriate test to monitor respiratory function in myasthenia gravis?
FVC monitoring - this directly assesses the maximum amount of air a person can forcefully exhales after a full inhalation = this reflects the strength of resp muscles, particularly the diaphragm
Outline the 2-level Wells score for PE?
Clinical signs and Sx of DVT - 3
Alternative diagnosis is < likely than a PE - 3
Tachycardia - 1.5
Immobilisation for >3 days or surgery in past 4 weeks - 1.5
Previous DVT/PE - 1.5
Haemoptysis - 1
Malignancy - 1
Most appropriate management of gallstone pancreatitis?
Early cholecystectomy - if obstructed biliary system due to stone they need an early ERCP
Management of a prolactinoma?
First line - dopamine agonists e.g. cabergoline or bromocriptine
Second line - transphenoidal surgery
Presentation of Fibrocystic breast disease (aka fibroadenosis)?
Cyclical breast pain often worse prior to menstruation & lumpiness B/L
Fine needle aspiration may just show cellular debris and the mass may disappear
After water deprivation what woild you expect the final urine osmolality to be in diabetes insipidus?
<300
(Think after no water you should be reabsorbing more water in the collecting ducts which should increase the urine osmolality as its more concentrated so if there is a dysfunction in this it will remain low)
After giving desmopressin what woild you expect the final urine osmolality to be in nephrogenic diabetes insipidus?
<300 (kidneys can’t respond to desmopressin to reabsorb more water so urine osmolality stays low)
After giving desmopressin what woild you expect the final urine osmolality to be in psychogenic diabetes insipidus?
> 600 (you’ve essentially fixed the problem so now there is vasopressin available for the kidneys to respond to and reabsorb more water, leading to a very concentrated urine with a high final urine osmolality)
Psychogenic diabetes insipidus:
What would you expect for starting plasma osmolality, final urine osmolality after water deprivation and final urine osmolality after desmopressin?
Starting plasma - low (lots of water in urine)
Final urine after water deprivation >400 (when you remove the issue, more water is rebsorbed as normal)
Fine urine after desmopressin >400 (no change as there was always desmopressin available)
What further investigations should you do after superficial thrombophlebitis?
USS to rule out an underlying DVT!
Management of superficial thrombophlebitis
Simple analgesia
Self care - warm, moist towel. Keep leg elevated when sitting to improve venous blood. Remain active to reduce DVT!
Consider compression stockings as long as arterial insufficiency has been excluded!
Management of venous ulcers?
Clean & dress the ulcer
Compression bandaging - usually 4 layers *provided ABPI has been done)
Consider prescribing oral pentoxyifylline - it is a peripheral vasodilator which improves healing rate
Manage infection with ABx if present
Simple analgesics for pain
Hydrocele vs epididymal cyst?
Hydrocele usually anterior to & below testicle
Epididymial cyst - MC cause of scrotal swelling. Found posterior to the testicle and separate from the body of the testicle
Management of metformin for surgery?
Take as normal the day before
Take as normal on the day of (unless take it TDS then omit lunch dose) - regardless of time of surgery!
Management of sulfonylureas for surgery?
Take as normal the day before
Omit morning dose on day of surgery. If surgery is in the afternoon then also omit the afternoon dose (if taken BD)
In diabetes insipidus:
What would you expect the starting plasma osmolality to be for cranial and nephrogenic?
Should be high - cannot reabsorb water as vasopressin not present or kidneys can’t respond to it!!
How do you carry out the water deprivation test?
Prevent pt drinking water
Ask pt to empty their bladder
Take hourly urine and plasma osmolalities
8 hourly later if urine osmolality remains low then do desmopressin test:
Give DDAVP. Pt can eat and drink freely
Take hourly urine volumes and osmolalities
What cause a avaricocele?
Abnormal dilatation of the pampiniform venous plexus within the spermatic cord
Why are varicoceles associated with infertility?
As they increase the intra-scrotal temperature - men will need a semen analysis if they have a varicocele and fertility issues
How are varicoceles diagnosed?
USS with Doppler studies
