Passmed corrections 26/02/24 Flashcards
What CT findings suggest stroke du to carotid artery stenosis and what is the invstigation?
- A shower of infarcts confined to one hemisphere of the brain (suggests cause after the heart but before the brain)
- Investigation is carotid artery doppler
What are the signs of carcinoid syndrome, what’s the aetiology, what’s initial investigation, and what’s the management?
- Signs: abdominal pain, diarrhoea, flushing, wheezing and pulmonary stenosis
- Caused by serotonin secreting tumour (commonly in appendix, small intestine or liver)
- Initial investigation is 5HIAA levels
- Management is with octreotide for symptoms and surgical excision
What is he most common mechanism of distal metastasis?
Haemotagenous spread
Signs and causes of pseudohyponatraemia?
- Signs: hyponatraemia with normal serum osmolality
- Most common causes are hyperlipidaemia, hyperglycaemia and presence of paraproteins in the blood (myeloma)
Signs, investigation and treatment of lymphogranuloma venereum?
- Signs: painless genital ulcers, inguinal lymphadenopathy, proctitis, fever, malaise, common in MSM
- Investigation is PCR
- Management it doxycycline first line (caused by chlamydia), tetracycline 2nd line,erythromycin 3rd line
Signs and initial management of delirium tremens?
- Signs: confusion & disorientation, hallucinations (visual or tactile), autonomic hyperactivity (sweating and hypertension), seizures (rare)
- Initial management is IV lorazepam
Signs, investigations and treatment of SIADH?
- Signs: headache, fatigue, myalgia, muscle cramps and confusion (non-specific), euvolaemic hyponatraemia
- Investigations: no diagnostic investigation (diagnosis of exclusion), short synacthen test (rule out adrenal insufficiency), check history of diuretics, excessive water loss excessive fluid loss (diarrhoea, vomiting, burns, fistula or excessive sweating) + excessive water intake, U&Es + GFR (exclude AKI and CKD)
- Treatment is with vaptans
Signs, investigations, and treatment of diabetes insipidus?
- Signs: polyuria, polydipsia, dehydration, postural hypotension, hypernatraemia (sign of serve disease, medical emergency)
- Investigation: water deprivation test
- Treatment: Cranial = desmopressin, nephrogenic = maintaining fluid intake, thiazides diuretics, low salt and protein diet, can give high dose desmopressin but requires monitoring
Interpretation of water deprivation test?
- Low then high = cranial DI
- Low then low = nephrogenic DI
- High then high = primary polydipsia
Signs, investigations and treatment/diagnosis of polymyalgia rheumatica?
- Signs: bilateral shoulder and pelvic girdle pain that’s worse on movement and interferes with sleep, stiffness for at least 45 minutes in a morning, WEAKNESS IS NOT A SIGN OF PMR
- Investigations: CRP, ESR, and plasma viscosity all raised, normal CK
- Treatment/diagnosis: symptoms present for at least 2 weeks and improvement of symptoms and inflammatory markers in 3-4 weeks with prednisolone treatment (dramatic response, if non then consider alternative diagnosis)
Signs, investigation, and treatment of osteomalacia?
- Signs: pain in low back, hips and pelvis, pseudofractures, bone tenderness, muscle weakness
- Investigation: Blood tests (low vitamin D, calcium and phosphate; high ALP and PTH), bon biopsy gold standard, X-ray can identify pseudofractures and other bone abnormalities
- Treatment: replacement vitamin D, calcium and phosphate with dietary changes or supplementation + treat underlying cause
What must be ruled out before doing a water deprivation test?
Hyprcalcaemia
What lobe does Alzheimer’s affect most?
Temporal lobe
What histological findings suggest carcinoma?
Nuclear enlargement, hyperchromasia and pleomorphism
What CSF signs can elicit between bacterial and tubercular meningitis?
- Bacterial will have cell count >10,000, tubrcular is much less
- Bacterial has mainly pleomorphs, tubercular has mainly lymphocytes
