Passmed questions Flashcards
Antibiotic which is also a recognised cause of cholestasis
Co-amoxiclav
Most likely oesophageal cancer likely to develop in patients with history of GORD or Barrett’s oesophagus
Adenocarcinoma.
Squamous cell carcinoma more commonly find in upper 2/3rd of oesophagus
Incarcerated vs strangulated hernia
Incarcerated - irreducible but no pain
Strangulated - blood supply compromised, risking ishcaemia and necrosis leading to pain
Case: 65 y/o Male, ED, pc: severe abdo pain + vomiting + fever.
PMH - peptic ulcer disease.
OE: generalised tenderness, guarding and rebound tenderness
Most appropriate next step investigation:
Erect CXR –> bowel perforation?
Pneumoperitoneum
Young adult with sore throat, fever, lethargy, cervical lymphadenopathy persisting over 1 week may hint to diagnosis of what:
Infectious Mononucleosis (Kissing disease)
- self limiting viral condition
- seen in adolescents or young adults
Mx: rest , plentiful hydration and simple analgesia
Rhesus status notes
Rhesus system is most important antigen found on red blood cells.
The D antigen is most important antigen of Rhesus system.
If Rhesus NEGATIVE mother delivers a Rhesus POSITIVE child - a leak of foetal RBC may occur.
This causes anti-D IgG antibodies to form in mother.
In later pregnancies these can cross placenta and cause haemolysis in foetus.
Prevention
- test for D antibodies in all Rhesus negative mothers at booking.
- give anti-D to non-sensitised Rhesus NEGATIVE mothers at 28 and 34 weeks.
Important tests for checking anti-D status of a mother
If baby born to RHESUS POSITIVE MOTHER then cord blood should be taken at delivery for FBC, blood group and direct Coombs test.
Coombs test : direct antiglobulin, will demonstrate antibodies on RBC of baby.
Kleihauer test: add acid to materna blood, foetal cells are resistant.
A pregnant patient with candida infection will be given
Clotrimazole pessary
Oral fluconazole is contraindicated in pregnant women
- risk of congenital malformation
Renal complications of systemic sclerosis are managed how?
ACE inhibitors
A patient presents with nausea, dehydration, confusion and reduced urine output following a viral infection.
This is a classic presentation of what:
AKI
Key drugs to stop in AKI
C - Contrast media.
A - ACE inhibitors.
N - NSAIDs.
A - Aminoglycosides.
D - Diuretics.
A - Angiotensin receptor blockers (ARBs)
Most common causative mastoiditis is:
strep pneunomiae
risk factors
- young children
- immunocompromised
- diabetes mellitis
A 36-year-old man presents with recurrent episodes of right-sided tinnitus, hearing loss and vertigo. These episodes typically last between 10-30 minutes. He also describes a ‘full’ sensation in his right ear. Otoscopy is unremarkable and the cranial nerve examination is normal.
likely diagnosis
Meniere’s disease
Recurrent epsiodes of
- vertigo
- tinnitus
- hearing loss (sensorineural)
aural fullness
other features
- nystagmus and positive Rhomberg test
A 31-year-old man presents with bilateral hearing loss and tinnitus. There is a family history of similar problems. Examination of the tympanic membranes is unremarkable. Audiometry shows bilateral conductive hearing loss.
likely diagnosis
otosclerosis
- autosomal dominant
- conductive deafness
- tinnitus
- tympanic membrane
A 2-year-old boy is brought in by his mother due to concerns about his hearing and delayed speech. She has noticed problems for the past three months. You can see from the notes that he has had frequent courses of amoxicillin for otitis media in the past. There is no evidence of excessive ear wax on examination.
Glue
- peaks at 2 years of age
- hearing loss is usually the presenting feature
- may have speech and language delay
Glue ear = otitis media with effusion
most common inherited bleeding disorder
Von Willebrands disease
- autosomal domiannt
VWF promotes platelet adhesion to damaged endothelium.
Ix = prolonged bleeding time
Mx =
- tranexamic acid for mild bleeding
- desmopressin
suspect what condition in a patient with back pain, low grade fever, elevated WBC and CRP and past history of IVDU.
Discitis
- contrast enhancement of disc and adjacent bone marrow
most common causative organism is : staph aureus
A 32-year-old female presents to the GP due to changes in her vision. She explains that she was experiencing double vision, especially during the evenings, which has been occurring over the past 6 months. She explains that her face feels flushed and warm. There is nil past medical history of note.
On examination, there is left-sided ptosis and distension of the veins in the neck and head.
Given the likely diagnosis, which of the following would offer a definitive diagnosis?
Likely diagnosis - **myasthenia gravis **
- antibodies against ACH receptors
Characterised by
-** fatigue of eyes which can cause diplopia and ptosis **
distended neck veins and flushed face are likely to be caused by superior vena cava obstruction which can be a compliation of thymomas
most common cause of nephrotic syndrome in a child
minimal change disease
- nephrotic syndrome
- oedema with proteinuria
- bibasal crackles are suggestive of pulmonary oedema
Important features of Myeloma
Use the mnemonic CRABBI:
Calcium
hypercalcaemia
primary factor: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells
much less common contributing factors: impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels
this leads to constipation, nausea, anorexia and confusion
Renal
monoclonal production of immunoglobulins results in light chain deposition within the renal tubules
this causes renal damage which presents as dehydration and increasing thirst
other causes of renal impairment in myeloma include amyloidosis, nephrocalcinosis, nephrolithiasis
Anaemia
bone marrow crowding suppresses erythropoiesis leading to anaemia
this causes fatigue and pallor
Bleeding
bone marrow crowding also results in thrombocytopenia which puts patients at increased risk of bleeding and bruising
Bones
bone marrow infiltration by plasma cells and cytokine-mediated osteoclast overactivity creates lytic bone lesions
this may present as pain (especially in the back) and increases the risk of pathological fractures
Infection
a reduction in the production of normal immunoglobulins results in increased susceptibility to infection
