PassMedicine Flashcards
1
Q
what are the features of a surgical sieve
A
infective inflammatory vascular traumatic metabolic
2
Q
what sort of pain does biliary colic present as
A
RUQ pain
3
Q
features of biliary colic
A
gallstone lodged in bile duct
provoked after a fatty meal
4
Q
how is acute cholecystitis as biliary colic differentiated
A
biliary colic - no fever and inflammatory markers are normal
5
Q
what sort of pain does acute cholecystitis present as
A
RUQ pain
6
Q
features of acute cholecystitis
A
inflammation/infection of gallbladder secondary to impacted gallstones
murphys sign positive
7
Q
what is murphys sign
A
tests for gallbladder inflammation
arrest of inspiration on palpation of RUQ
8
Q
what sort of pain does ascending cholangitis present as
A
RUQ pain
9
Q
features of ascending cholangitis
A
bacterial infection of biliary tree
charcots triad
10
Q
what is the most common predisposing factor in ascending cholangitis
A
gallstones
11
Q
what is charcots triad
A
associated with ascending cholangitis
1 RUQ pain
2 fever
3 jaundice
12
Q
acute pancreatitis presenting pain
A
epigastric pain
can radiate to the back
13
Q
what is commonly associated with acute pancreatitis
A
1 alcohol
2 gallstones
14
Q
peptic ulcer disease presenting pain
A
epigastric pain
15
Q
history of peptic ulcer disease
A
history of NSAID use or alcohol excess
16
Q
features of duodenal and gastric ulcers
A
duodenal>gastric
duodenal ulcers - pain relieved with eating
gastric ulcers - pain worsened with eating
17
Q
what are common lower Gi problems of acute abdominal pain
A
1 appendicits
2 acute diverticulitis
3 intestinal obstruction
18
Q
appendicitis presenting pain
A
RIF pain
19
Q
features of RIF pain - appendicitis
A
pain initially in central abdomen before localising to RIF
anorexia common
rovsings sign
20
Q
what is rosvings sign
A
sign of appendicitis
pain in RIF when LIF pressed
21
Q
acute diverticulitis presenting pain
A
LLQ pain (colicky)
22
Q
features of acute diverticulitis
A
diarrhoea (sometimes bloody)
fever, raised inflammatory markers, raised WCC
23
Q
intestinal obstruction presenting pain
A
central pain
24
Q
features of intestinal obstruction
A
history of malignancy (intraluminal obstruction) or operations (adhesions)
‘tinkling’ bowel sounds
25
common urological causes od acute abdominal pain
1 renal colic
2 acute pyelonephritis
3 urinary retention
26
renal colic presenting pain
loin pain radiating to groin
27
features of renal colic
visible or non-visible haematuria
28
acute pylonephritis presenting pain
loin pain
29
urinary retention presenting pain
suprapubic pain
30
features of urinary retention
obstruction of bladder outflow
men>women
history of benign prostatic hyperplasia in men
31
ectopic pregnancy pain
right or left iliac fossa pain
32
features of ectopic pregnancy
history of amenorrhoea
33
common vascular causes of abdominal pain
1 ruptured AAA
| 2 mesenteric ischaemia
34
rupture AAA pain
central abdominal pain radiating to back
35
features of ruptured AAA
if severe, sudden collapse
| patients may go into shock (hypotension, tachycardia)
36
mesenteric ischaemia pain
central abdominal pain
37
features of mesenteric ischaemia
history of AF
diarrhoea/rectal bleeding
metabolic acidosis is often seen due to 'dying' tissue
38
what is the difference in pain between renal colic and acute pylonephritis
renal colic is colicky
| acute pylonephritis is constant pain
39
coeliac disease is associated with what
anaemia
40
type 1 renal tubular acidosis is associated with what
renal stones
41
what causes coeliacs disease
sensitivity to gluten
| repeated exposure leads to villous atrophy and results in malabsorption
42
what conditions are coeliacs disease associated with
```
dermatitis herpetiformis
autoimmune disorders (T1DM, autoimmune hepatitis)
```
43
what HLA are associated with coeliacs
HLA-DQ2
| HLA-B8
44
signs and symptoms in coeliacs
chronic/intermittant diarrhoea
persistant/unexplained GI symptoms (N+V)
fatigue
weight loss
45
a 70y/o man presents with anorexia, weight loss, painless jaundice
pancreatic cancer
46
a 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ
Cholangiocarcinoma
47
a 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings
Irritable bowel syndrome
48
a 20-year-old man presents with a 3 week history of bloody diarrhoea associated with tenesmus
Ulcerative colitis
49
what antibodies are looked for in coeliac screen
tissue transglutaminase antibodies
50
a 40y/o man presents with severe pain on the right side of his back. this comes in waves. on examination he is restless with blood on the urine dipstick
renal colic
51
renal colic - presenting pain
loin pain radiating to groin
| -colicky
52
what would be found in the urine with renal colic
visible or non-visible haematuria may be present
53
what are the two types of IBD
UC
| CD
54
what are commonly found in both UC and CD
diarrhoea
arthritis
erythema nodosum
pyoderma gangrenosum (ulcers)
55
is blood diarrhoea associated with UC or CD
UC
56
PSC associated with UC or CD
UC
57
where does UC affect in the bowel
continuous disease
affects from rectum to ileocaecal valve
no inflammation beyond submucosa
58
where does CD affect in the bowel
skip lesions
anywhere from mouth to anus
inflammation in all layers
59
crypt abscesses - UC/CD
goblet cells - UC/CD
bowel obstruction - UC/CD
UC
CD
CD
60
which IBD is associated with loss of haustrations
UC
61
a 70/yo male presents with anorexia, weight loss, painless jaundice
pancreatic cancer
62
give two examples of PPIs
omeprazole
| lansoprazole
63
what is the MOA for PPIs
reduce acid secretion in the stomach
| irreversibly block H+/K+ ATPase of the gastric parietal cell
64
a 65y/o woman presents with jaundice, weight loss, passing of clay-coloured stools, she describes bouts of colicky RUQ pain, OE a mass is palpable in the RUQ
cholangiocarcinoma
65
what are the common features of a history of viral hepatitis
question may indicate foreign travel or IV drug use
nausea+vomiting
myalgia
RUQ pain
66
what are the common features of a history of biliary colic
RUQ pain
- colicky
- usually begins suddenly and subsides gradually
- often occurs after eating
67
who does biliary colic commonly affect
"female, forties, fat"
68
what are common features of a history of acute cholecystitis
RUQ pain
- constant
- more severe than biliary colic
69
what condition is murphys sign associated with
acute cholecystitis
70
what is charcots triad and what condition is it associated with
ascending cholangitis
1 fevers
2 RUQ pain
3 jaundice
71
what is reynolds pentad
associated with ascending cholangitits
```
1 fevers
2 RUQ pain
3 jaundice
4 hypotension
5 confusion
```
72
what are common features of a history of cholangiocarcinoma
```
persistant biliary colic symptoms
weight loss
courvoisiers sign
sister mary joseph nodes
virchows node
```
73
what is courvoisers sign
palpable mass in RUQ
74
what is sister mary joseph nodes
periumbilical lyphadenopathy
75
what are common features of a history of acute pancreatitis
severe epigastric pain
vomiting
tenderness
76
what is cullens sign
sign of acute pancreatitis
| periumbilical discolouration
77
what is grey-turners sign
sign of acute pancreatitis
| flank discolouration
78
what are common features of a history of pancreatic cancer
painless jaundice
| weight loss
79
an overweight 45y/o woman presents with recurrent episodes of RUQ pain that is made worse by eating a fatty meal
biliary colic
80
a 50y/o man presents with epigastric pain relieved by eating
duodenal ulcer
81
painless jaundice
| steatorrhoea
pancreatic cancer
82
common pancreatic tumours
adenoncarcinoma (head of pancreas) - 80%
83
risk factors for pancreatic cancer
age
smoking
diabetes
chronic pancreatitis
84
features of pancreatic caner
painless jaundice
patients usually present in a non-specific way (weight loss, epigastric pain)
loss of exocrine function (steatorrhoea)
85
A 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings
IBS
86
a 45y/o woman presents with fatigue and pruritus, blood tests show raised bilirubin, ALP, IgM
primary biliary cirrhosis/cholangitis
87
who is PBC commonly seen in
females
| middle-aged
88
classic presentation of PBC
pruritus/itching
| in a middle aged woman
89
clinical features of PBC
```
early:
-asymptomatic
-raised ALP
later:
-jaundice
-hyperpigmentation (over pressure points)
-xanthalasma/xanthamata
```
90
An obese 50-year-old woman presents with pain in the RUQ which radiates to the interscapular region. She is apyrexial and not jaundiced
biliary colic
91
what is metoclopramide
antiemetic
| D2 receptor antagonist
92
side effects of metoclopramide
hyperprolactinaemia
| parkinsonism
93
gallstones is common in which IBD
CD
94
A patient with a history of heartburn presents with odynophagia. There no weight loss, vomiting or anorexia
oesophagitis
95
what are 4 common causes of dysphagia
oesophageal cancer
oesophagitis
achalasia
myasthenia gravis
96
features of oesophageal cancer
dysphagia
- associated with weight loss, vomiting during eating
- PMH of barrett's oesophagus, GORD, alcohol, smoking
97
features of oesophagitis
dysphagia
odynophagia
history of heart burn
98
features of achalasia
dysphagia of both liquids and solids from the start
heartburn
regurgitation
99
features of myasthenia gravis
dysphagia
| extraocular muscles weakness/ptosis
100
A 70-year-old man with a history of benign prostatic hyperplasia presents with constant, severe suprapubic pai
urinary retention
101
a 40-year-old man presents with severe pain on the right side of his back. This comes in waves. On examination he is restless with blood+ on the urine dipstick
renal colic
102
a 35-year-old woman presents with pain on the right side of her back. This is constant and associated with fever and rigors
Acute pyelonephritis
103
what is common in acute pylonephritis
loin pain
fevers + rigors
vomiting
104
what is leukoplakia
oral mucosa white patches which do not run off
| a premalignant lesions
105
what are aphthous ulcers
small shallow ulcers in the mouth
| associated with CD, coeliacs
106
what is cheilitis (angular stomatitis)
inflammation and redness of the corners of the mouth
| due to iron or riboflavin (B2) deficiency
107
what is gingivitis
gum hypertrophy and inflammation
| associated with AML
108
what is glossitis
smooth, red, sore tongue
| iron/b12/folate deficiency
109
what is macroglossia
tongue enlargement
| associated with myxoedema (hypothyroidism) and acromegaly
110
how are causes of dysphagia classified
mechanical or obstructive
motility disorders
others
111
what are mechanical or obstructive causes of dysphagia
```
malignant strictures (oesophageal, gastric, pharyngeal cancer)
benign strictures (oesophageal web, peptic stricture)
extrinsic pressure (lung cancer, retrosternal goitre, LA enlargement)
pharyngeal pouch
```
112
what are motility disorders which cause dysphagia
achalasia
diffuse oesophageal spasm
systemic sclerosis
bulbar palsy
113
what are other causes of dysphagia
oesophagitis
114
what questions must be asked in a dysphagia history and why
1 difficulty swallowing solids AND liquids from the start?
YES - motility disorder
NO - mechanical or obstructive (solids THEN liquids)
2 difficulty making swallowing movement?
YES - bulbar palsy
3 painful swallowing?
YES - malignancy or oesophageal ulcer
4 intermittant dysphagia or constant and worsening?
INTERMITTANT - oesophageal spasm
CONSTANT AND WORSENING - malignant strictures
5 neck bulge or gurgling on swallowing water?
YES - pharyngeal pouch
115
what is achalasia
failure of relaxation of LOS due to degeneration of myenteric plexus
116
what are features of achalasia
dysphagia (solids and liquids from the start)
| regurgitation
117
what does "coffee grounds" when vomiting indicate
GI bleeding
118
what does food when vomiting indicate
gastric stasis or gastroenteritis
119
what does feculant (containing fecal matter) indicate
small BO
120
what does morning vomiting suggest
pregnancy
| raised ICP
121
what does vomiting 1hr post food suggest
gastric stasis
122
what does vomiting which relieves pain suggest
peptic ulcer
123
what are the "attackers" in PUD
gastric acid
| H pylori
124
what are the "defenders" in PUD
mucin secretion
| bicarbonate secretion
125
what are the GI red flag symptoms
ALARM Symptoms
```
Anaemia (iron deficiency which suggests GI bleeding)
Loss of weight
Anorexia
Recent onset or progressive symptoms
Meleana or haematemesis
Swallowing difficulty
```
126
which ulcers are more common duodenal or gastric ulcers
duodenal
127
what are the risk factors for duodenal ulcers
h. pylori
NSAIDs
steroids
128
what are the risk factors for gastric ulcers
h. pylori
NSAIDs
smoking
129
what are the symptoms in duodenal ulcers
epigastric pain
| relieved by eating
130
what are the symptoms in gastric ulcers
epigastric pain
| worsened by eating
131
how is diagnosis of duodenal ulcer made
upper GI endoscopy
132
what is triple therapy
for eradication of h. pylori
one week of a full does PPI, amoxicillin (1g) and clarithromycin (500mg)
133
complications of PUD
bleeding
perforation
malignancy
134
what are the DDx for dyspepsia
```
infection (h. pylori)
-gastric or duodenal uclers
inflammation
-oesphagitis
-gastritis
-duodenitis
malignancy (gastric)
```
135
when should someone with dyspepsia be referred for endoscopy
>55yrs
| or ALARM Symptoms
136
what is GORD
gastro-oesophageal reflux disease
| reflux of acid with or without bile
137
what are the types of hiatus hernia
1 sliding HH (80%)
-GOJ moves in to the chest and LOS becomes incompetent leading to reflux of acid with or without bile (GORD)
2 rolling HH (20%)
-part of stomach herniates into the chest while the GOJ remains in the same position, as the GOJ remains intact, the LOS is not affected so there is no reflux
138
what is the first line investigation for a suspected hiatus hernia
barium swallow
