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Year 5 Core Conditions > PassMedicine learning > Flashcards

PassMedicine learning Flashcards

1
Q

If a patient has a reduced AMTS (7/10) and low blood pressure a day post-operatively (hemicolectomy), what is the most common cause?

A

Hyponatraemia (U&Es will show low sodium levels)

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2
Q

What are the risk factors for surgical patients for DVT? (10)

A
  1. Surgery greater than 90 minutes at any site or greater than 60 minutes if the procedure involves the lower limbs or pelvis
  2. Acute admissions with inflammatory process involving the abdominal cavity
  3. Expected significant reduction in mobility
  4. Age over 60 years
  5. Known malignancy
  6. Thrombophilia
  7. Previous thrombosis
  8. BMI >30
  9. Taking HRT or COCP
  10. Varicose veins with phlebitis
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3
Q

What is classed as mechanical thromboprophylaxis? (4)

A
  1. Early ambulation after surgery is cheap and is effective
  2. Compression stockings (TED)
  3. Intermittent pneumatic compression devices
  4. Foot impulse devices
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4
Q

For prophylaxis VTE treatment pre-surgery, when is dabigatran used?

A

Used prohylactically in hip and knee surgery. It does not require therapeutic monitoring. It has no known antidote and should not be used in any patient in whom there is a risk of active bleeding

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5
Q

Why is unfractionated heparin sometimes used prophylactically?

A

It has a rapid onset and its therapeutic effects decline quickly on stopping and infusion. Its activity is measured using the APTT. If need be it can be reversed using protamine sulphate.

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6
Q

Which type of kidney stone is associated with an inherited metabolic disorder?

A

Cystine stones (inherited recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestinal and renal tubule)

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7
Q

What type of kidney stone is often a staghorn calculus with an alkaline urine?

A

Struvite (chronic infection with urease producing enzymes can produce an alkaline urine and formation of struvite stones)

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8
Q

What are struvite stones formed from? (3)

A
  1. Magnesium
  2. Ammonium
  3. Phopshate
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9
Q

What is the management for a patient who has been treated for acute pancreatitis, found to have a cystic lesion on the head of the pancreas, but is clinically stable?

A

Conservative management - it is a pancreatic pseudocyst. A raised amylase and a cystic lesion following pancreatitis is most likely to represent a pseudocyst. If a procedure would be required, then a radiological fine needle aspiration would be best suited.

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10
Q

What are the indications for draining a pancreatic pseudocyst? (3)

A
  1. Signs of infection
  2. Mass effect on abdominal organs
  3. Persistent pseudocyst 12 weeks beyond it developing
    (often even when there are symptoms associated with the pseudocyst, it is still managed conservatively due to the procedural risks)
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11
Q

How may an anal or interspincteric abscess present?

A

A 24-48 hour history of increasingly severe ano-rectal pain. Patient may be febrile and the skin surrounding the anus may look normal if it is intersphincteric or red/show an abscess. They may not be able to tolerate a PR examination.

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12
Q

How may someone with a fistula in ano present?

A

With a history of offensive discharge from the anus, but otherwise well. There may be a defect visible. The discharge may be foul and patients should be listed for examination under anaesthesia

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13
Q

What is the most likely diagnosis for a 37 year old man presenting to A&E with severe central abdominal pain radiating to the back, vomiting on several occasions and guarding on examination.

A

Acute pancreatitis

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14
Q

What are the top characteristic exam features (conditions) for abdominal pain?

A
  1. Peptic ulcer disease
  2. Appendicitis
  3. Acute pancreatitis
  4. Biliary colic
  5. Acute cholecystitis
  6. Diverticulitis
  7. Abdominal aortic aneurysm
  8. Intestinal obstruction
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15
Q

What are the ‘unusual’ causes of abdominal pain that are important to remember?

A
  1. MI
  2. DKA
  3. Pneumonia
  4. Acute intermittent porphyria
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16
Q

What is the most common cause of bladder cancers in the developed world?

A

90% of bladder cancers in the developed world are due to transitional cell carcinomas

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17
Q

What is the most common cause of bladder cancer in the developing world and why?

A

Squamous cell carcinoma is the most common cause due to schistosomiasis

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18
Q

A 31 year old man with a diffuse lumpy swelling on the left side of his scrotum presents to clinic. There is no pain and testicle is normal. What is the most likely diagnosis?

A

A varicocele

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19
Q

What is the most likely diagnosis for a 44 year old man with a lump on his right testicle, it is discrete, soft and can be felt posterior to the right testicle.

A

Epididymal cyst

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20
Q

What is the most likely cause for a 75 year old man to have a swelling in his right scrotum that cannot be palpated above and is large and non-tender?

A

Inguinal hernia

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21
Q

What can be given IV to a patient with evidence of oedema on a head CT with the beginnings of mass effect, following a head trauma?

A

IV mannitol

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22
Q

What first line investigation is important to perform in someone presenting with priaprism not associated with sexual stimulation?

A

A cavernosal blood gas analysis

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23
Q

What does cavernosal blood gas analysis differentiate?

A

Differentiates an ischaemic and non-ischaemic priapism

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24
Q

What are the causes of priapism? (5)

A
  1. Idiopathic
  2. Sickle cell disease
  3. Erectile dysfunction medication (e.g. Sildenafil)
  4. Iatrogenic - antihypertensives, anticoagulants, antidepressants, recreational
  5. Trauma
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25
Q

Which type of priapism is a medical emergency?

A

Ischaemic priapism - aspiration of blood and infection of saline flush is first line management

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26
Q

Which anaesthetic muscle relaxant is contraindicated in patients with penetrating eye injuries or acute narrow angle glaucoma and why?

A

Suxamethonium - because it increases intra-ocular pressure

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27
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

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28
Q

Which nerve is affected if a patient has a blown/dilated pupil and a head trauma?

A

Third cranial nerve

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29
Q

Why does a third cranial nerve palsy occur with some head injuries?

A

If the head injury results in an uncal herniation - the uncus of the temporal lobe herniates under the free edge of the tentorium cerebelli. The herniated uncus compresses the third cranial nerve causing a surgical third nerve palsy, presenting as a dilated and unreactive pupil

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30
Q

What is the other name for an uncal herniation?

A

Transtentorial herniation

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31
Q

Which anaesthetic agent has anti emetic properties?

A

Propofol

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32
Q

Which agent reverses the action of midazolam?

A

Flumenazil

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33
Q

Which biologic therapy is used to treat patients with crohns disease?

A

Infliximab

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34
Q

Which biologic therapy is used to treat an unresectable GI stromal tumour if it is KIT positive?

A

Imatinib

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35
Q

Which organism most commonly causes cholangitis?

A

E.coli

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36
Q

What are the features of Charcot’s triad, associated with cholangitis?

A
  1. RUQ pain
  2. Fever
  3. Jaundice
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37
Q

What is the first line investigation for a testicular mass?

A

USS

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38
Q

If there is a suspicion of bowel perforation, what is the best investigation to perform?

A

An erect CXR

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39
Q

Which formula is used to calculate fluid resuscitation in a burns patient?

A

Parkland formula for 24 hours (4ml X TBSA X body weight kg) - 50% is given in the first 8 hours and 50% given in the next 16 hours.

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40
Q

When should an LP be performed to detect a SAH?

A

12 hours from the start of the headache

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41
Q

In a patient with an upper GI bleed and melaena, why would urea levels be raised?

A

An increased urea level occurs due to the breakdown of red blood cells in the stomach. - it is usually indicative of an upper GI bleed

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42
Q

What is hereditary haemorrhagic telangiectasia also known as?

A

Osler-Weber-Rendu syndrome

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43
Q

Although hereditary haemorrhage telangiectasia is an autosomal dominant condition, what % of cases can occur spontaneously without prior family history?

A

20%

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44
Q

What are the 4 main diagnostic criteria for HHT? (2 or more = possible diagnosis, 3 or more = definite)

A
  1. Epistaxis
  2. Telangiectasis
  3. Visceral lesions
  4. Family history
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45
Q

The telangiectasis associated with HHT affects certain sites on the body, where are they? (4)

A
  1. Lips
  2. Oral cavity
  3. Fingers
  4. Nose
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46
Q

What are the complications of hepatitis B infection? (4)

A
  1. Fulminant liver failure
  2. Hepatocellular carcinoma
  3. Glomerulonephritis
  4. Polyarteritis nodosa
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47
Q

How does tricuspid atresia present?

A

Systolic ejection murmur at the left upper sternal border with a prominent apical pulse

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48
Q

What are the side effects of rifampicin? (4)

A
  1. Discolouration of urine and tears - red/orange colour.
  2. Abdominal discomfort
  3. Hepatotoxicity
  4. Flu-like symptoms
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49
Q

What is the serious adverse effect associated with ethambutol?

A

Optic neuritis

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50
Q

What are the adverse effects associated with isoniazid? (3)

A
  1. Hepatits
  2. Peripheral neuropathy
  3. Agranulocytosis
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51
Q

What are the adverse effects associated with pyrazinamide? (4)

A
  1. Myalgia
  2. Arthralgia
  3. Hepatitis
  4. Hyperuricaemia
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52
Q

What is the first line medication for patients with glaucomas associated with raise intraocular pressure?

A

Prostaglandin analogue eyedrops = latanoprost

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53
Q

What is the aim of eye drops in treating open angle glaucoma?

A

To reduce intra-ocular pressure which in turn has been shown to prevent progressive loss of visual fields

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54
Q

What type of surgery may be performed for people with open angle glaucoma with refractory?

A

Trabeculectomy

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55
Q

What are the causes of erythema nodosum? (9)

A
  1. Strep infection - scarlet fever and rheumatic fever
  2. TB
  3. Lymphogranuloma venereum
  4. Mycoplasmia pneumonia
  5. Sulfonamides
  6. Crohn’s/UC
  7. Hodgkin’s and non-Hodgkins
  8. Pregnancy
  9. EBV, hep B, hep C and HIV
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56
Q

What is the most likely diagnosis for a 40 year old woman presenting with erythema nodosum, non-productive cough, joint pains and bilateral hilar lymphadenopathy on CXR?

A

Sarcoidosis

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57
Q

What electrolyte abnormality is often seen with sarcoidosis?

A

Hypercalcaemia

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58
Q

What is the most common cause of heel pain in adults?

A

Plantar fasciitis

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59
Q

How can mesenteric infarction present?

A

Sudden onset pain with vomiting and occasionally passage of bloody diarrhoea - the pain present is usually out of proportion to the physical signs

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60
Q

How is the anion gap calculated?

A

([Na+] + [K+] - [Cl] + [HCO3])

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61
Q

What is the anion gap used for?

A

To classify metabolic acidosis into either:
1. Raised anion gap (seen in DKA)
or
2. Normal anion gap seen in patients with diarrhoea due to GI bicarbonate loss

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62
Q

What medication is contraindicated if a patient requires GTN spray?

A

PDE 5 inhibitors e.g. sildenafil - concomitant use of both a nitrate and phosphodiesterase inhibitor may lead to significant hypotension and the potential to precipitate an MI.

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63
Q

What is seen on an ECG of someone with hypothermia?

A

Bradycardia with J waves, and sometimes prolonged PR, QT and QRS intervals.
Could also lead to VT, VF and asystole (temp <16 degrees)

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64
Q

What is the most likely treatment that has been given to a patient with CKD stage 5, suffering from new side effects including abdominal pain, back pain, muscle weakness and anxiety?

A

Calcium acetate - will have been given to treat hyperphosphataemia. The calcium acetate is a calcium-based binder which can lead to hypercalcaemia - hence the symptoms.

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65
Q

What is sarcoidosis?

A

A multisystem chronic inflammatory condition characterised by formation of non-caveating epithelioid granulomata at various sites of the body. It often affects the lungs and thoracic cavity.

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66
Q

At what age range is peak onset of sarcoidosis?

A

20s-40s

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67
Q

What are the systemic/constitutional upset symptoms associated with sarcoidosis?

A
  1. Fever
  2. Night sweats
  3. Malaise/fatigue
  4. Weight loss
  5. Heerfodr’s syndrome
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68
Q

What is Heerfodt’s syndrome?

A

Inflammation of the submaxillary/parotid glands with uveitis and facial nerve palsy

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69
Q

What % of people with sarcoidosis have lung involvement?

A

90%

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70
Q

What happens to the lungs in people with sarcoidosis?

A

There is usually a restrictive pattern seen with diffuse parenchymal lung disease, however airflow obstruction is also found and patients can present with:

  1. Dry cough
  2. Fever
  3. Dyspnoea
  4. Chest discomfort/pain
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71
Q

How can sarcoidosis affect the skin?

A
  1. Papules - brownish/red infiltrative plaques on the extremities and trunk
  2. Erythema nodosum
  3. Lupus pernio on the nose and cheeks (this is uncommon but pathognomonic)
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72
Q

What is Lofgren’s syndrome?

A

It is a combination of erythema nodosum with arthritis

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73
Q

What are the differentials for sarcoidosis? (9)

A
  1. RA
  2. Lymphoma
  3. Metastatic malignancy
  4. TB
  5. MS
  6. Lung cancer
  7. SLE
  8. Multiple myeloma
  9. Churg-Strauss syndrome
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74
Q

What is the treatment for a patient with known sarcoidosis who is experiencing headaches and a burning sensation in their eyes?

A

Corticosteroids e.g. oral prednisolone

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75
Q

What blood test can be used to determine if a seizure has occurred/differenitate between a pseudo-seizure?

A

Prolactin - elevated serum prolactin 10-20 minutes after an episode can be used to differentiate a general tonic-clonic/partial seizure from a non-epileptic pseudo seizure

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76
Q

What factors about a seizure may indicate it is in fact a pseudo seizure?

A
  1. Pelvis thrusting
  2. Crying after seizure
  3. Don’t occur when alone
  4. Gradual onset
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77
Q

In a male with a pelvic fracture and a high displaced prostate, with perineal oedema and a urine dipstick showing blood, what is the top differential?

A

A membranous urethral rupture

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78
Q

In someone with a pelvic fracture with abdominal pain, peritonism and not passing any urine, what is the top differential?

A

Ruptured bladder

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79
Q

What is the assessment tool used to differentiate between stroke and stroke mimics?

A

ROSIER - recognition of stroke in the emergency room scale

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80
Q

What is the Bamford classification? (3)

A

A way of classifying stroke using the following criteria:

  1. Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
  2. Homonymous hemianopia
  3. Higher cognitive dysfunction e.g. dysphasia
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81
Q

What are the 4 different types of ischaemic stroke?

A
  1. Total anterior circulation infarct - TACI 15%
  2. Partial anterior circulation infarct - PACI 25%
  3. Lacunar infarcts - LACI 25%
  4. Posterior circulation infarcts - POCI 25%
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82
Q

Which type of ischaemic stroke involves the middle and anterior cerebral arteries and involves all 3 of the Bamford criteria?

A

TACI

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83
Q

What symptoms, although cannot alone be used to differentiate, are more common in patients who have had a haemorrhagic stroke? (4)

A
  1. Decrease in level of consciousness
  2. Headache
  3. Nausea and vomiting
  4. Seizure
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84
Q

In pemphigus - which structure do antibodies target?

A

Desmosomes

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85
Q

What is pemphigus?

A

An autoimmune disease caused by antibodies directed against desmosomes. The antibodies target desmoglein 3, a cadherin-type epithelial cell adhesion molecule.

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86
Q

How does pemphigus present?

A

Generally in younger people with flaccid, easily ruptured vesicles and bullae and mucosal ulceration.

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87
Q

Why can placenta percreta lead to frank haematuria?

A

The invasive placental implantation into the myometrium can rarely extend into the bladder and cause severe bleeding

88
Q

What is adult polycystic kidney disease associated with in terms of symptoms and problems in other organs?

A 
Patients may have a renal mass, hypertension, renal calculi and macroscopic haematuria. 
They can also have:
1. Liver cysts (70%)
2. Berry aneurysms (25%)
3. Pancreatic cysts (10%)
89
Q

What autoantibody is almost diagnostic of Graves’ disease?

A

TSH receptor stimulating autoantibodies (90%)

90
Q

In addition to TSH receptor stimulating autoantibodies, which other autoantibody is present 75% of the time in Graves’ disease?

A

Anti-thyroid peroxidase antibodies

91
Q

Which auto-antibody is found 90% of the time in Hashimoto’s ?

A

Anti-thyroid peroxidase autoantibodies

92
Q

What is night blindness and tunnel vision associated with?

A

Retinitis pigmentosa

93
Q

What is retinitis pigmentosa?

A

It primarily affects the peripheral retina resulting in tunnel vision.

94
Q

Which of the TB treatments can cause gout?

A

Pyrazinamide - hyperuricaemia causing gout

95
Q

What is the most likely diagnosis for someone with acute onset joint pain with effusions, and RF and anti-CCP are negative, but serum ACE levels are raised?

A

Sarcoidosis - treatment with steroids

96
Q

What are the complications of DKA? (6)

A
  1. Gastric stasis
  2. Thromboembolism
  3. Arrythmias due to hyperkalaemia
  4. Iatrogenic cerebral oedema
  5. Acute respiratory distress syndrome
  6. AKI
97
Q

Rovsing sign positive is a clinical marker for what?

A

Appendicitis

98
Q

If someone presents with symptoms of Sjogrens syndrome e.g. dry eyes, dry mouth, Schirmer’s test positive, what is the most appropriate antibody blood test to perform?

A

Anti-Ro/Anti-La antibodies

99
Q

In addition to anti-Ro and anti-La, which other blood test will be 100% positive for people with Sjogrens (but is less useful as it is not specific)?

A

Rheumatoid factor

100
Q

What condition is associated with hypermetropia?

A

Acute closed angle glaucoma

101
Q

What is primary open angle glaucoma associated with in the eye?

102
Q

What are the risk factors for open angle glaucoma? (6)

A
  1. Genetics - family history
  2. Afro-caribbean ethnicity
  3. Myopia
  4. Hypertension
  5. Diabetes
  6. Corticosteroids
103
Q

How can open angle glaucoma present?

A
  1. Peripheral visual field loss
  2. Decreased visual acuity
  3. Optic disc cupping
104
Q

What is the most common malignancy associated with acanthosis nigricans?

A

GI adenocarcinoma

105
Q

A patient presents with lethargy and back pain and has raised ALP in the presence of normal LFTs. What should this raise suspicion of?

A

Boney metastases

106
Q

What is the triad of symptoms for reactive arthritis?

A

Urethritis + arthritis + conjunctivitis

can’t see, can’t pee, can’t climb a tree

107
Q

Of the malaria prophylaxis medications, which one is taken weekly but should be avoided in the patient has a history of depression?

A

Mefloquine

108
Q

Which antimalarial is associated with photosensitivity?

A

Doxycycline

109
Q

If a patient is being tested for coeliac disease, what must they do for 6 weeks prior to the test?

A

Eat gluten

110
Q

What two tests are carried out when suspected coeliac disease?

A

Tissue transglutaminase antibodies and IgA

111
Q

Is Bell’s palsy an upper or lower motor neurone condition?

A

Lower motor neurone - meaning the entire side of the face is affected.

112
Q

Why are upper motor neurone defects forehead sparing?

A

Because the ganglia are innervated bilaterally

113
Q

What is Plummer-Vinson syndrome a triad of?

A
  1. Dysphagia
  2. Glossitis
  3. Iron deficiency anaemia
114
Q

Which two drugs can caused drug-induced lupus?

A
  1. Procainamide (antiarrhythmia)

2. Hydralazine

115
Q

What are the features of lupus? (4)

A
  1. Arthralgia
  2. Myalgia
  3. Malar rash
  4. Pleurisy
116
Q

Which antibody is positive in 100% of people with SLE?

117
Q

How does adhesive capsulitis present?

A

It presents as a painful stiff shoulder with restriction of active and passive range of motion in abduction, interval and external rotation.
The classic impairment is external rotation.

118
Q

What is the more common name for adhesive capsulitis?

A

Frozen shoulder

119
Q

Which condition is frozen shoulder associated with?

120
Q

How long does frozen shoulder aka adhesive capsulitis last for?

A

Typically between 6 months and 2 years

121
Q

What is the management for frozen shoulder? (4)

A

No single intervention - treatment options include:

  1. NSAIDs
  2. Physiotherapy
  3. Oral corticosteroids
  4. Intra-articular corticosteroids.
122
Q

A 54 year old female presents with fatigue and xerostomia (dry mouth). Her blood tests reveal no infection, raised bilirubin and raised ALP, but normal ALT. What is the most likely diagnosis?

A

Primary biliary cirrhosis

123
Q

In carpel turner syndrome, what is found on examination? (4)

A
  1. Weakness of thumb abduction (abductor pollicis bravis)
  2. Wasting of thenar eminence
  3. Tinnel’s sign (tapping causes paraesthesia)
  4. Phalen’s sign (flexion of the wrist causes symptoms)
124
Q

Why do people with coeliac disease have to be ‘up to date’ with immunisations?

A

Because they have functional hyposplenism - for this reason all patients with coeliac are offered the pneumococcal vaccine

125
Q

What is haemochromatosis?

A

It is an autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation.

126
Q

Which genes and chromosome are involved in haemochromatosis?

A

The gene mutation is in the HFE gene and both copies are on chromosome 6

127
Q

Which blood marker is considered the most useful when investigating people for haemochromatosis?

A

Transferrin saturation

128
Q

What is the typical iron study profile for men and women with haemochromatosis? (3)

A
  1. Transferrin saturation >55% in men and >50% in women
  2. Raised ferritin >500ug/l
  3. Low total iron binding capacity
129
Q

What is the first-line treatment for haemochromatosis?

A

Venesection

130
Q

What is Peutz-Jeghers syndrome?

A

An autosomal dominant condition characterised by numerous hamartomatous polyps in the GI tract, but also pigmented freckles on the lips, face, palms and soles.

131
Q

In Wilson’s disease, what is the treatment?

A

Penicilamine (chelates copper)

132
Q

How do children present in Wilson’s disease?

A

Generally they tend to present with liver disease e.g. hepatitis/cirrhosis

133
Q

How does young adults tend to present with Wilsons disease?

A

Neurological symptoms e.g. speech, behavioural and psychiatric problems

134
Q

What is the most common causative agent of ascending cholangitis?

135
Q

What is the first line treatment for ocular myasthenia gravis?

A

Pyridostigmine

136
Q

What is the treatment for Pneumocystis jiroveci pneumonia (PJP)?

A

Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole

137
Q

What is Felty’s syndrome?

A

It is a condition characterised by splenomegaly and neutropenia in a patient with rheumatoid arthritis.

138
Q

What is the most common extra-renal complications associated with autosomal dominant polycystic kidney disease?

A

Liver cysts

139
Q

What is the most common organism to cause gas gangrene?

A

Clostridium perfringens

140
Q

Which renal stones are radio-lucent? (2)

A

Urate and xanthine

141
Q

What is Beck’s triad, and what is it characteristic of?

A 
It is a triad of:
- Falling BP
- Rising JVP
- Muffled heart sounds
...characteristic of cardiac tamponade
142
Q

What are the classic signs of right sided heart failure? (3)

A
  1. Raised JVP
  2. Ankle oedema
  3. Hepatomegaly
143
Q

What is the first line treatment for restless leg syndrome?

A

Ropinirole - or another dopamine agonist

144
Q

What is the surgical treatment for late stage alpha-1-antitrypsin deficiency?

A

Lung volume reduction surgery

145
Q

What are the characteristics of testicular torsion? (3)

A
  1. Acute testicular pain
  2. Unilateral swollen
  3. Retracted testicle with loss of cremasteric reflex
146
Q

What are the eGFR variables? (CAGE)

A

C - creatinine
A - age
G - gender
E - ethnicity

147
Q

What is Plummer-Vinson syndrome? (it is a triad)

A

A triad of:

  1. Dysphagia
  2. Glossitis
  3. Iron-deficiency anaemia
148
Q

What causes the dysphagia in Plummer-Vinson syndrome?

A

Oesophageal webs AKA post-cricoid webs.

149
Q

What are the features of autonomic dysfunction secondary to type 2 diabetes? (3)

A
  1. Postural hypotension
  2. Loss of respiratory arrhythmia
  3. Erectile dysfunction
150
Q

What is Reynold’s pentad?

A

It is charcots triad (fever, RUQ pain and jaundice) with hypotension and confusion

151
Q

In what condition is Reynold’s pentad seen?

A

Severe cases of ascending cholangitis

152
Q

What is Becks triad indicative of?

A

Cardiac tamponade (hypotension, raised JVP and muffled heart sounds)

153
Q

What is Cushing’s triad?

A

It is triad of decreased respiratory rate, bradycardia and hypertension, seen in patients with raised intracranial pressure

154
Q

What is the management for sigmoid volvulus?

A

Decompression by sigmoidoscope and insertion of a flatus tube

155
Q

What is the management for malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biliary stenting

156
Q

What does Hartmanns procedure entail?

A

Often performed in an emergency if there is a perforated bowel, the procedure involves resecting the appropriate part and then forming an ileostomy/colostomy

157
Q

Why is an ileostomy spouted?

A

Because the contents that is produces are alkaline and can damage the skin - alkaline due to the pancreatic enzymes being produced

158
Q

What prophylactic antibiotics are given to people with animal bites - and what is given if they are penicillin allergic?

A

Co-amoxiclav = first-line

Penicillin allergy = doxycycline + metronidazole

159
Q

When can you elicit lateral epicondylitis pain?

A

When the elbow is extended and wrist extension/suppination is resisted

160
Q

Which organism is most likely to develop in an emphysematous cavity, which is resistant to broad spectrum antibiotics?

A

Aspergillus fumigatus

161
Q

Which organism is the most common cause of malaria?

A

Plasmodium falciparum

162
Q

What is subacute thyroiditis also known as?

A

De Quervain’s thyroiditis

163
Q

What are the 4 phases of De Quervain’s thyroiditis?

A 
Phase 1 (typically lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
Phase 2 (1-3 weeks): euthyroid 
Phase 3 (weeks-months): hypothyroidism 
Phase 4: thyroid structure and function goes back to normal
164
Q

On investigation of De Quervians thyroiditis - thyroid scintigraphy, what is found?

A

Globally reduced uptake of iodine-131

165
Q

How is the Q-T interval measured on an ECG?

A

It is the time between the start of the Q wave and the end of the T wave

166
Q

Which drug is used to treat patients who develop neuroleptic malignant syndrome?

A

Bromocriptine - it is a dopamine agonist

167
Q

Which organism is the most common cause of fungal toe infection?

A

Trichophyton rubrum

168
Q

What does the direct Coombs test for?

A

Autoimmune haemolytic anaemia

169
Q

What type of hearing loss is seen in presbycusis?

A

Bilateral high frequency, sensourinal hearing loss - so air conduction is better than bone conduction

170
Q

What are the first-line investigations for a patient with suspected vestibular schwannoma? (2)

A
  1. Audiogram

2. Gadolinium-enhanced MRI head scan

171
Q

Kaposki’s sarcoma is caused by which virus?

A

Human herpesvirus 8 - HHV8

172
Q

What treatment is first line for hyperhidrosis (excessive sweating)?

A

20% aluminium chloride hexahydrate in alcohol solution

173
Q

Why should metformin be suspended when a patient has diarrhoea and vomiting illness?

A

Increases the risk of lactic acidosis

174
Q

What are the common side effects of amiodarone? (10)

A
  1. Bradycardia
  2. Hyper/hypothyroidism
  3. Pulmonary fibrosis/pneumonitis
  4. Liver fibrosis/hepatitis
  5. Jaundice
  6. Taste disturbance
  7. Persistent slate grey skin discolouration
  8. Raised serum transaminases
  9. Nausea
  10. Constipation (particularly at the start of treatment)
175
Q

What is polyarteritis nodosa?

A

PAN is a vasculitis affecting medium-sized arteries with necrotising inflammation leading to aneurysm formation.
PAN is more common in middle-aged men and is associated with hepatitis B infection.

176
Q

What are the clinical features of PAN? (8)

A
  1. Fever
  2. Weight loss
  3. Hypertension
  4. Livedo reticularis (like sixes and sevens on back of legs)
  5. ANCA are found in 20% of patients with polyarteritis nodosa
  6. Testicular pain
  7. Malaise
  8. Arthralgia
177
Q

What is the optimal treatment for someone with maturity onset diabetes of the young (MODY) type hepatic nuclear factor 1 alpha (HNF1A)?

A

Sulfonylureas - gliclazide are the optimal treatment

178
Q

Tonsilar squamous cell carcinoma is associated with which viral infection?

179
Q

What is myxoedema coma?

A

It is a serious and extreme complication of hypothyroidism, resulting in multi-organ abnormalities and mental deterioration - confusion and hypothermia.

180
Q

What is the treatment for myxoedema coma? (4)

A

It is a medical emergency and requires:

  1. IV thyroid replacement therapy (levothyroxine i presume)
  2. IV fluid
  3. IV corticosteroids
  4. Electrolyte imbalance correction
181
Q

In the treatment of hypertension - after the standard ACEi, CCB and thiazide-like diuretic are used, what is the next step in management if it is still poorly controlled?

A

This depends on the patients potassium levels:
K+ <4.5 = low dose spironolactone
K+ >4.5 = add an alpha or beta-blocker

182
Q

What are the new drugs that are being trialled for hypertension?

A

Direct renin inhibitors - Aliskiren

183
Q

What are the differences in presentation between IgA nephropathy and post-strep glomerulonephritis?

A

IgA - develops 1-2 days after URTI whereas post-strep is 1-2 weeks after URTI.
Post-strep is associated with proteinuria.

184
Q

Which corticosteroid has high glucocorticoid activity and low mineralcorticoid activity?

A

Dexamethasone

185
Q

What is the treatment for patients with a pituitary tumour causing acromegaly?

A

Trans-sphenoidal surgery

186
Q

What is the most likely diagnosis for someone with symptoms of obstructed defecation - passing mucous and experiencing pelvic pain. PR exam is normal and barium enema is normal.

A

Rectal intussusception

187
Q

The mnemonic PANCREAS is useful for remembering what investigations offer a prognostic valve in pancreatitis, what are they?

A 
P - PaO2 <8
A - age >55 
N - neutrophilic WCC >15
C - calcium <2
R - renal function - urea >16
E - enzymes LDH>600
A - albumin <32
S - sugar - blood glucose >10
188
Q

What is Courvoisier’s law?

A

Carcinoma of the pancreas - the development of jaundice in association with a smooth RUQ mass.

189
Q

P-ANCA antibodies will be positive in which conditions? (3)

A
  1. UC
  2. Primary sclerosing cholangitis
  3. Churg-Strauss syndrome
190
Q

ANA ..antibodies are positive in which conditions? (4)

A
  1. SLE
  2. Sjogren’s syndrome
  3. Diffuse cutaneous systemic sclerosis
  4. Limited cutaneous systemic sclerosis
191
Q

What does the term scleroderma mean?

192
Q

What is scleroderma also known as?

A

Systemic sclerosis or SSc

193
Q

What type of problems with skin do people have with systemic sclerosis? (4)

A
  1. Excessive scarring
  2. Swollen
  3. Tight
  4. Hard skin
    (generally on hands/fingers, but can also be on face and arms)
194
Q

In addition to skin changes, what other problems can occur with sclerosis or scleroderma?

A 
As fibrosis (scarring) is the main problem, it can lead to scarring in:
1. Skin
2. GI tract
3. Heart
4. Lungs
It can also cause vascular problems:
5. Raynauds 
6. Ischaemia of the extremities 
7. Pulmonary arterial hypertension 
8. Renal disease
195
Q

Why do people with sclerosis experience skin thickening?

A

Protein collagen deposits in higher amounts in the skin of people with sclerosis - the excess collagen can deposit in the fingers, face and hands. It is due to increased fibroblast activity resulting in abnormal growth of connective tissue.

196
Q

What are the two subgroups of sclerosis?

A

Diffuse and limited cutaneous

197
Q

Which type of sclerosis is most common?

A

Limited cutaneous

198
Q

In limited cutaneous scleroderma, what is affected? What is the mnemonic used to remember the symptoms?

A 
Areas of the skin include face, forearms and lower legs up to the knee.
CREST
C - calcinosis
R - raynaud's
E - oesphageal dysmotility
S - sclerodactyly
T - telangiectasia
199
Q

How is diffuse scleroderma different to limited?

A

The skin areas involved are more extensive, including the upper arms, thighs and trunk

200
Q

What are the ‘cardinal features’ of SSc (systemic sclerosis)?

A
  1. Excessive collagen production and deposition
  2. Vascular damage
  3. Immune systemic activation via autoantibody production and cell-mediate autoimmune mechanisms
201
Q

What are the risk factors for developing SSc?

A

Cause unknown, but RFs:

  1. Genetic predisposition
  2. Infectious agents - cytomegalovirus, parvovirus B19, H.pylori, hep B, EBV, chlamydia
  3. Chemicals - pesticids, organic solvents, hair dyes
  4. Drugs e.g. cocaine, bleomycin, vitamin K
  5. Radiation therapy
  6. Physical trauma?!
  7. Vit D deficiency (strong association apparently)
202
Q

How can systemic sclerosis present?

A
  1. Raynaud’s phenomenon
  2. Skin hardening in hands or face
  3. Non-specific MSK pain, fatigue
203
Q

Which subtype of SSc has a quicker onset?

204
Q

What may be the signs in the hands of SSc?

A
  1. Swelling (non-pitting oedema) of fingers and toes
  2. Skin thickening
  3. Swelling of hands - unable to make fist or make ‘the prayer sign’
  4. Loss of bulk from finger pads
  5. Raynaud’s phenomenon
205
Q

What can be the signs on the face of SSc?

A
  1. Tightening of facial skin
  2. Tight lips (microstomia) - can make dental hygiene difficult
  3. Telangiectasia
  4. Salt and pepper appearance of the skin
  5. Dry or itchy skin
206
Q

What are the MSK features of SSc?

A
  1. Joint pain and swelling
  2. Myalgia
  3. Restriction of joint movement, contractures, muscle atrophy
207
Q

What are the GI symptoms associated with SSc? (7)

A
  1. Heartburn and GORD
  2. Oesophageal scarring and dysphagia
  3. Delayed gastric emptying
  4. ‘Watermelon stomach’
  5. Reduced small bowel motility (malnutrition)
  6. Constipation
  7. Obstruction/pseudo-obstruction
208
Q

What are the two main pulmonary problems associated with SSc?

A
  1. Pulmonary fibrosis (interstitial lung disease) - occurs in up to 80% of people, causes restrictive lung disease (cough, dyspnoea, coarse basal crackles)
  2. Pulmonary arterial hypertension
209
Q

Which autoantibodies are positive in SSc?

A
  1. Anti-Scl 70 (strongly associated with lung fibrosis and a poor prognosis)
  2. ACA
  3. Anti-RNA polymerase III antibody
210
Q

Which anti-TB drug can cause optic neuritis?

A

Ethambutol

211
Q

Which drugs are known to cause hepatotoxicity? (10)

A
  1. Methotrexate
  2. Ciclosporin
  3. Rifampicin
  4. Sulphonlyureas
  5. Isoniazid
  6. Sodium valproate
  7. Amiodarone
  8. Phenytoin
  9. Pioglitazone
  10. Pyrazinamide
212
Q

SLE is associated with which antibodies? (3)

A
  1. ANA
  2. Anti-dsDNA
  3. Anti-histone (drug induced lupus)
213
Q

Bamboo spine is associated with which condition?

A

Ankylosing spondylitis

214
Q

What is the treatment for salicylate overdose?

A

Supportive, IV bicarbonate

215
Q

What is the most common cause of pneumonia after flu?

A

Staph. aureus

216
Q

A 30-year-old woman presents with weight gain and irregular menstruation. Her blood pressure is elevated at 170/100 mmHg and there is evidence of proximal muscle weakness. What is the most likely diagnosis?

A

Cushing’s syndrome

217
Q

Anti-TPO antibodies are seen in which thyroid disease?

A

Hashimoto’s

Year 5 Core Conditions (25 decks)

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