Passmed Questions Flashcards
What is the most common cause of large bowel obstruction?
colorectal cancer
tumours cause 60% of LBOs
particularly the case in more distal colonic and rectal tumours, as these tend to obstruct earlier due to the smaller lumen diameter
How does large bowel obstruction present?
absence of passing flatus or stool
abdominal pain
abdominal distention
nausea and vomiting are late symptoms that may suggest a more proximal lesion
peritonism may be present if there is associated bowel perforation
How can LBO be investigated?
Abdominal x-ray:
commonly used first-line
upper limits of normal diameter: 3cm for the small bowel, 6cm for the large bowel and 9cm for the caecum (3/6/9 rule)
presence of free intra-peritoneal gas indicates colonic perforation
CT scan
How can LBO be managed?
‘drip and suck’
NBM
IV fluids
nasogastric tube with free drainage
IV abx if perf
consider surgery
Subacute productive cough, foul-smelling sputum, night sweats →
?lung abscess
How can confined RCC be managed?
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
otherwise radical nephrectomy
Give 4 key features of myeloma
C - calcium raised
R - renal failure
A - anaemia (technically a pancytopenia)
B - bone pain
What is a ‘rouleaux formation’?
a stacking of red blood cells seen in a blood film. It is characteristic of a myeloma.
raised ESR + osteoporosis = what until proven otherwise?
multiple myeloma
Hypercalcaemia, renal failure, high total protein suggests what dx?
multiple myeloma
Impaired renal function is typical. Lower back pain is classical, a symptom of osteolytic lesions in the lower spine.
Rectal cancer on the anal verge can be managed with →
Abdomino-perineal excision of rectum
diagnostic investigation of choice for pancreatic cancer?
High resolution CT of pancreas
What side effects should the patient be warned about regarding prostate brachytherapy?
proctitis- inflammation of the rectum resulting in bloody diarrhoea
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →
end colostomy
High-dose dexamethasone suppression test results with an adrenal adenoma?
Cortisol: not suppressed
ACTH: suppressed
High-dose dexamethasone suppression test results with a pituitary adenoma?
Cortisol: suppressed
ACTH: suppressed
When is pleural fluid considered exudative?
> 30g/L protein
What type of pleural effusion is caused by lung cancer?
exudative
Myasthenia gravis is associated with what tumours?
thymomas
How can myasthenia gravis be differentiated from Lambert- Eaton syndrome?
In myasthenia gravis key feature is muscle fatigability - muscles become progressively weaker during periods of activity and slowly improve after periods of rest
What can cause a raised serum amylase other than pancreatitis?
small bowel obstruction - due to pressure on the pancreatic duct
old man, bone pain, raised ALP =
Paget’s disease!!
What is the preferred management option for patients with low-grade prostate cancer and significant co-morbidities?
watchful waiting
What pain relief is availale to palliative patients with varying renal function?
first line = morphine sulphate
moderate renal impairment =oxycodone
end-stage renal failure = buprenorphine
Options for mx of metastatic bone pain?
analgesia, bisphosphonates or radiotherapy
What is the mechanism of action of hycosine hydrobromide?
Muscarinic receptor antagonist
What may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life?
Benzydamine hydrochloride
Bence Jones proteins in the urine suggest what?
multiple myeloma
What is the prognosis like for polycythaemia rubra vera?
around 5-15% progress to myelofibrosis or AML
thrombotic events cause significant mortality
The main components for managing sickle cell crisis are what?
analgesia, oxygen, and IV fluids
consider antibiotics if you suspect an infection, and transfusion if the Hb is low
If investigating a suspected DVT, and either the D-dimer or scan cannot be done within 4 hours …
start a DOAC
What may be seen on blood film in coeliac disease?
Target cells and Howell-Jolly bodies may be seen in coeliac disease → hyposplenism
A sudden anemia and a low reticulocyte count in a patient with sickle cell =
aplastic crisis, may be due to parvovirus
Sickle cell patient with new pulmonary infiltrates on chest x-ray, fever, cough and SOB =
Acute sickle chest syndrome
Most common causes of massive splenomegaly in UK =
CML/myelofibrosis
Which is the most common type of Hodgkin’s lymphoma?
nodular sclerosing
Which types of Hodgkin’s lymphoma have the best and worst prognosis?
Lymphocyte predominant = Best prognosis
Lymphocyte depleted = Worst prognosis
Positive clinical Tumour Lysis Syndrome requires any one of:
increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure
How can you definitively diagnose sickle cell disease?
haemoglobin electrophoresis
A sudden decrease in haptoglobins suggests what?
intravascular haemolysis
Pancytopaenia 5 years post-chemotherapy/radiotherapy →
?myelodysplastic syndrome
What increases the risk of anaphylactic blood transfusion reactions?
IgA deficiency
If neutropenic sepsis is suspected (i.e. recent chemo + fever) …
Immediately prescribe IV piperacillin/tazobactam- do not wait for blood results
What is used in the prophylactic management of sickle cell anemia to prevent painful episodes?
Hydroxyurea - increases the HbF levels
DVT investigation: if the scan is negative, but the D-dimer is positive →
stop anticoagulation and repeat scan in 1 week
How often should sickle cell patients receive the pneumococcal polysaccharide vaccine?
every 5 years
What can precipitate renal failure in patients with multiple myeloma?
NSAIDs
Give some common drugs that can cause thrombocytopenia
NSAIDs
furosemide
penicillins, sulphonamides, rifampicin
carbamazepine, valproate
heparin
A patient’s cytogenetic analysis shows the presence of the following translocation: t(9;22)(q34;q11).
Which haematological malignancy is most strongly associated with this translocation?
CML - Philadelphia chromosome - t(9:22)
What common drugs can induce neutrophilia?
corticosteroids
What blood results would be seen in sickle cell patients?
Low haemoglobin, normal MCV and raised reticulocytes
What would you see on bone marrow aspirate of multiple myeloma?
plasma cells
Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension →
?polycythaemia vera
Describe the bone profile of a patient with myeloma without metastasis
high calcium, normal/high phosphate and normal alkaline phosphate
