Passmed stuff 2 Flashcards
A 33-year-old female presents with pain and stiffness in her right knee, which she’s had for the last 3 months. On further questioning, she also has pain and stiffness in her left wrist and the distal interphalangeal joint of her right index finger. Her symptoms are worse in the morning and seem to improve throughout the day. She reports that her late mother also had joint problems; but does not know the diagnosis, although she recalls that her fingers were completely swollen before she started treatment.
What is the most likely diagnosis?
Psoriatic arthritis
A 57-year-old man, with a background history of acromegaly, presents with a red, hot, painful and swollen right knee. He says this occurred over the last 3 days, he is apyrexial. He was fit and well before this occurred. His past medical history includes acromegaly which he takes octreotide monthly. He does not take any diuretics. A joint aspirate is performed and an x-ray is taken. The X-ray shows chondrocalcinosis. What would you expect to find on joint fluid microscopy?
Weakly positive birefringent rhomboid shaped crystals
Pseudogout can occur in acromegaly
Bronchiectasis most common organism
Haemophilus influenzae
What causes upper zone pulmonary fibrosis?
Tuberculosis
What causes lower zone pulmonary fibrosis?
Idiopathic pulmonary fibrosis
Exposure to asbestos
A 58-year-old man presents to the emergency department with sudden onset chest pain and shortness of breath following a prolonged episode of vomiting. He describes the pain as severe and central, he is also complaining of pain when swallowing.
He has a history of alcohol abuse and drinks around 50 units a week.
On examination, he looks unwell, his heart rate is 126 bpm, blood pressure 85/62 mmHg, respiratory rate 30 breaths per minute, oxygen saturation 94% on air, temperature 36.7 ºC. Subcutaneous emphysema is present over his chest, his breath sounds are normal. Abdominal exam is unremarkable.
Given the most likely diagnosis, which of the following is the most appropriate investigation?
CT contrast swallow is the investigation of choice for suspected Boerhaave’s syndrome
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.
Diagnosis?
Investigations?
Management?
The most likely diagnosis is myasthenia gravis which is characterised by muscle fatigue of the eyes, which can cause diplopia and ptosis, typically at the end of the day. The distended neck veins and flushed face are likely to be caused by superior vena cava obstruction, which can be a complication of thymomas. Thymomas are associated with myasthenia gravis.
Autoantibodies to acetylcholine receptors
Pyridostigmine; thymectomy; prednisolone followed by azathioprine
(Pyridostigmine is a long acting acetylcholinesterase inhibitor)
A 21-year-old lady who has just started her second year at medical school presented to the emergency department with a temperature of 38°C, severe headache, and aversion to bright light. Upon physical examination, the junior doctor on call notices that the lady has difficulty bending her neck forward and also notice a non-blanching rash on the lady’s arm. The junior doctor is worried about the lady’s condition and after finding a raised white cell count on an initial blood test, he decides to start the lady on some treatment without delay. Which of these is the recommended treatment to start the lady on?
IV cefotaxime or ceftriaxone
A 6-year-old boy is brought for review. You can see from his records that he has been treated for constipation in the past but is otherwise fit and well. His mother reports that he is currently passing only one hard stool every 4-5 days. The stool is described as being like ‘rabbit droppings’. There is no history of overflow soiling or diarrhoea. Examination of the abdomen is unremarkable. What is the most appropriate first-line intervention?
Advice on diet and fluid intake; Movicol paediatric plain
Ben is a 15-year-old who is brought to the emergency department following a fall by his mother. An X-ray of his right ankle demonstrates a Weber A fracture.
What is the most appropriate management for his injury?
CAM boot, remain weight bearing as tolerated
Weber A fractures occur below the syndesmosis of the ankle and so are stable. As such they should be immobilised in a CAM boot for 6 weeks and the patient should be encouraged to weight bear as tolerated.
A 68-year-old woman presents to her GP with a 2-month history of a non-productive cough. She denies any haemoptysis, weight loss, chest pain, or breathlessness.
Her past medical history includes type 2 diabetes and hypertension which has been well controlled for the past 5 years with metformin and ramipril. The patient was treated for tuberculosis when she was in her 20’s whilst living abroad and smoked a small number of cigarettes when she was a teenager.
What is the most likely cause of her cough?
Aspergilloma
An aspergilloma may arise in a lung cavity that developed secondary to previous tuberculosis
MODY: which anti diabetic agent is most effective in the most common type?
Sulfonylureas
Which hormonal treatment can be used to treat women who are HER 2 positive?
Herceptin (trastuzumab)
(can’t be used in women with a history of heart disorders)
Which hormone therapies can be used in breast cancer for pre and post menopausal women?
Tamoxifen is still used in pre- and peri-menopausal women.
In post-menopausal women, aromatase inhibitors such as anastrozole are used.
A 21-year-old man attends the emergency department after being involved in a fight. He tells you that he thinks he may have been bitten by the other male involved.
On examination, you find an area of broken skin on the left forearm consistent with a human bite. It is not currently bleeding, but blood has been drawn. The patient is normally fit and well, and has no known drug allergies.
What is the most appropriate treatment?
Co-amoxiclav
