Past paper pop quiz 4 Flashcards
How do the 2 forms of systemic sclerosis differ?
Limited: face + limbs distal to knees + elbows ‘CREST’
Diffuse: entire body
What are the features of limited systemic sclerosis?
Calcinosis Raynaud’s phenomenon oEsophageal dysmotility Sclerodactyly Telangiectasia
How does a tension pneumothorax arise?
When damaged area of pleura forms a 1-way valve resulting in the progressive accumulation of air in the pleural space
What is a positive Brudzinskis sign?
Passive flexion of neck causes involuntarily flexion of hip.
What is a positive Kernigs sign?
Lying supine, with hip flexed + knee flexed at 90 degrees to the hip joint.
Passive extension of knee causes pain
What 2 signs may be seen in MS?
Uhthoff’s sign: Worsening of neuro symptoms when body is overheated
Lhermitte’s sign: flexion of the neck causes a shooting pain running down the spine.
How are haemodynamically unstable patients in AF treated, irrespective of the time of onset?
DC cardioversion.
How are stable patients with AF presenting within 48 hours of onset treated?
DC cardioversion or chemical cardioversion
How are stable patients with AF presenting >48 hours since onset be treated?
Anticoagulation, using LMWH followed by warfarin, for > 3 weeks before elective cardioversion.
Name 2 drugs that can be used for chemical cardioversion
Flecainide- contraindicated in those with hx of IHD
Amiodarone.
Describe the pattern of features in MEN2a. What acronym can be used for this?
Thyroid: Medullary thyroid cancer
Adrenal: Phaeochromocytomas
Parathyroid hyperplasia
TAP
What could you investigate if you suspected a Phaeochromocytoma?
24 hr urine metanephrines
Which virus is implicated in ~50% of cases of Hodgkin’s lymphoma
EBV
List 6 causes of a high SAAG
Portal HTN Cirrhosis Constrictive pericarditis Congestive cardiac failure Budd-Chiari syndrome Hepatic venous obstruction
List 5 causes of a low SAAG
Nephrotic syndrome Malignancy Pancreatitis Infection Bowel obstruction
What are the lower urinary tract symptoms?
FUN (storage/ irritative) WISE (Voiding/ obstructive) Frequency Urgency Nocturia Weak stream Intermittency Straining incomplete Emptying
Name 2 causes of a prolonged PT
Warfarin (depletion of factors II, VII, IX + X)
Liver disease
Name 3 causes of a prolonged APTT
Heparin Haemophilia A (factor VIII) Haemophilia B (factor IX)
What clotting results are seen in haemophilia A and B?
Prolonged APTT
Normal PT
Give 2 indications of a ruptured abdominal aortic aneurysm
Sudden-onset flank pain
Features of circulatory collapse (e.g. tachycardia + hypotension)
In a patient with perforated diverticulitis what is the most appropriate procedure?
Hartmann’s procedure
Removal of sigmoid colon with formation of a rectal stump + end colostomy.
Allows time for inflammatory process to resolve + can be reversed, forming an anastomosis.
What condition may present with paresis, weakness, sensory loss, sphincter dysfunction and erectile problems?
Spinal cord compression
How can you distinguish between acute cord compression (Cauda equina) and gradual cord compression (spinal stenosis)?
Acute: LMN signs
Gradual: UMN signs
What mnemonic can be used to remember the major criteria for rheumatic fever?
JONES:
Joints (arthritis)
O – looks like a heart (carditis e.g. tachycardia, murmurs)
Subcutaneous Nodules
Erythema marginatum (a rash with red, raised edges + clear centre)
Sydenham’s chorea (involuntary semi-purposeful movements)
What is rheumatic fever usually caused by?
Streptococcus pyogenes
Where do testicular tumours spread? What symptom may this occasionally cause?
Para-aortic lymph nodes
may cause backache
Define the parameters for type 1 and type 2 respiratory failure?
Type 1: PaO2 < 8 kPa, PaCO2 = normal
Type 2 = PaO2 < 8 kPa + PaCO2 > 6 kPa
What is an anal fissure?
Painful tear in squamous lining of lower anal canal
Give 4 features of an anal fissure?
Pain on defecation
Bright red blood streaked on toilet paper/ stools but not mixed in with the stools.
Low fibre diet
Poor fluid intake
(May be constipated + strain at the stool)
What triad characterises Felty’s syndrome?
Rheumatoid arthritis
Splenomegaly
Neutropenia
In a hyponatraemic patient, what is a major consequence of raising plasma sodium concentration too rapidly?
Central pontine myelinolysis
Myelin cells dont have enough time to adapt to increasing extracellular osmolality, draws water out of the myelin cells
What acronym can be used to remember the drugs indicating need for dialysis in the “intoxication” part of AEIOU?
BLAST Barbituates Lithium Alcohol Salicylates Theophyline
