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Final Prep > PasTest > Flashcards

PasTest Flashcards

1
Q

What is the main determinant of fasting plasma phosphate concentration?

A

Rate of renal tubular absorption.
Therefore 1* hyperparathyroid, hypercalcaemia of malignancy, inherited hypophosphatemic rickets, prolonged IV nutrition = low PO4

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2
Q

What is the main site for the tumour in Zollinger Ellison?

A

Proximal wall of duodenum (90% located there or tail of pancreas)

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3
Q

Where does the ampulla of vater enter the bowel?

A

Descending (2nd) part of duodenum

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4
Q

Viral Causes of Pancreatitis

A

mumps
Coxsackie B
Hepatitis B

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5
Q

Posterior hip dislocation

A

Internal rotation, adduction, flexion at the hip

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6
Q

Anterior hip dislocation

A

Leg extended and externally rotataed at the hip

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7
Q

Therapeutic management of thromboembolic stroke

A

Thrombolysis - tPa
Aspirin 300 mg OD
Warfarin - AF, LV thrombus, enlarged L atrium
MDT rehab

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8
Q

Kussmaul’s Sign

A

Paradoxical rise in JVP in acute tamponade.

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9
Q

Supranuclear Palsy

A

Symmetrical Parkinsonism, initially slow saccades (esp vertical), progressing to limitation of eye movements.

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10
Q

Corticobasal syndrome

A

Asymmetrical cortical syndrome, prominent gait unsteadiness, falls, parkinsonism, apraxia, alien limb syndrome

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11
Q

Potencies of steroid creams

A

Help EVERY BUDDING DERMATOLOGIST

Hydrocortisone Eumovate Betnovate Dermovate

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12
Q

Causes of Carpal Tunnel - mnemonic

A 
CARPAL
C - cardiac failure / COCP
A - acromegaly
R - renal (nephrotic, DM)
A - arthritis of wrist (RA, OA)
L - large size (obesity)
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13
Q

What is the correct B12 replacing regimen?

A

Hydroxycolbalamin 1mg IM 3 times a week for 2 weeks, monthly for 3 months, once every 3 months

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14
Q

Risk factors for cataracts + mneumonic

A 
DEHYDRATION
DM / dehydration
Eye disease - glaucoma, uveitis
Hypertension, hypocalcaemia
dYstophia myotonica
Diet - low in carotene and antioxidants
Race and FH
Alcohol
Toxicity - steroids, tobacco
Ionising radiation
Old age
No protection (prophylactic aspirin, osetrogens)
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15
Q

Pemphigus vulgaris - what is it caused by?

A

IgG autoAb to desmoglein 3 leading to intra-epidermal splitting

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16
Q

Which carpal bone dislocates most frequently?

A

Lunate

Typically disloctes anteriorly into carpal tunnel, compressing median nerve

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17
Q

Meckel’s Diverticulum rule

A

Rule of 2s

2 inches in length, 2 feet from ileocaecal junction, 2% of population, 2 types of tissue - gastric and pancreatic

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18
Q

Which main vessels exit the abdominal aorta?

A

T12 - coeliac plexus (stomach, spleen, liver)
L1 - SMA (D2 - right 2/3 transverse colon)
L3 - IMA (transverse colon L to dentate line)
Gonadal Arteries
4 paired lumbar arteries
Birucation into CI arteries

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19
Q

Triad of Pellagre

A

3 D

Diarrhoea, dermatitis, dementia

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20
Q

Yellow Nail Syndrome

A

yellow deformed nails, lymph oedema, exudative pleural effusion. Maldevelopment of lymphatic system.

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21
Q

Branches of the abdominal aorta

A 
T12 - coeliac trunk
L1 - SMA
L3 - IMA
Paired gonadal arteries (from which ureteric arise)
4 paired lumbar arteries
Common iliac
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22
Q

Cerebello-pontine angle tumour

A

V, VI, VII, VIII palsy

Likely acoustic neuroma in NF-1

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23
Q

Causes of pellagra - primary and secondary

A

Presents with diarrhoea, dementia and dermatitis (B3 niacin def)
Primary due to dietary insufficiency
Secondary due to decreased absorption in chronic alcohol, carcinoid tumour or GI disease (e.g. IBD)

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24
Q

Which MODY associated with hepatic neoplasm?

A

MODY3

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25
Q

Classifying severity of eczema

A

Clear - no signs
Mild - areas of dry skin, infrequent itching ± small erythematous patches
Moderate - dry skin, frequent itching, erythematous patches + excoriations
Severe - widespread, continous itching, redness, excoriations, bleeding, oozing, skin thickening or altered pigmentation

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26
Q

Smudge cell?

A

CLL

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27
Q

Clonal population of immature cels with intracytoplasmic dark pink rods?

A

APML (auer rods)

Note can cause DIC, treated with all-trans retinoic acid

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28
Q

Lymphocytes with thin projections of cytoplasm?

A

Hairy cell leukaemia

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29
Q

What is indapamide? What are its advantages?

A

Thiazide diuretic, less propensity for hyponatreamia and no effect on insulin resistance vs bendroflumathazide

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30
Q

Why must sodium nitroprusside infusions be covered?

A

Degrades in sunlight to form cyanide. If poison - sodium thiosulphate

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31
Q

Cat scratch disease?

A

Bartonella henselae - brownish red papules around inoculation site after 3-10 days. Can take 6-12 months to resolve completely. Also fever, malaise, anorexia.
Azithromycin 5 days

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32
Q

Post herpatic neuralgia?

A

TCA

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33
Q

What can increase T1/2 of morphine?

A

Imparied renal and/or liver function

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34
Q

Gilbert’s mutation?

A

UDP glucuronyl transferase

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35
Q

SE - cisplatin

A

Tinnitus, metallic taste in mouth

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36
Q

SE - bleomycin

A

Lung injury

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37
Q

SE - imatinib

A

Fluid retention, esp peri orbital

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38
Q

SE - vincristine

A

Peripheral neuropathy

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39
Q

SE - capecitabine

A

Loose stool and severe diarrhoea

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40
Q

SLE symptoms - pneumonic

A 
DOPAMINE RASH
Discoid Lupus
Oral Ulcers
Photosensitivity
Arthritis
Malar Rash
Immunological (dsDNA, Ro, La, Smith)
Neuroloical
ESR
Renal
ANA
Serositis (pleurisy, pericarditis)
Haematological (HA, leukopenia, thrombocytopenia)
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41
Q

What is the mechanism of osteoporosis in cushings?

A

Elevated cortisol reduced intestinal Ca absorption, leading to secondary hyperPTH which favours PO4 loss. Results in increased osteoclast activity and bone turnover. Also causes less osteoid matrix synthesis

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42
Q

Rose spots, salmon pink spots

A

Typhoid fever

Ciprofloxacin

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43
Q

Anion gap

A

Na+K-Cl-HCO3

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44
Q

P450 inducers

A

Qunidine Barbiturates Phenytoin Rifampin Griseofulvin Carbamazepine Chronic Alcohol intake

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45
Q

P450 inhibitors

A

Protease inhibitors, isionizid, cimetidine, ketoconazole, erythromycin, grapefruit juice, sulfonamide

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46
Q

Lhermitte’s phenomenon

A

test for intrinsic lesion of the cervical cord usually seen in multiple sclerosis but can occur in SACD. Passive flexion of the neck gives an electric shock like sensation down the back.

Ddx diabetes with cord compression, tabes dorsalis, friedichs ataxia

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47
Q

Lesions of the temporal lobe classically produce which visual field loss?

A

Superior quadrantinopias

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48
Q

Lesion of the parietal lobe classically produce which visual field loss?

A

Inferior quadrantinopias

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49
Q

what is another name for Wallenbergs syndrome?

A

Lateral medullary syndrome (PICA)

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50
Q

Lateral Medullary Syndrome (Wallenbergs)

A

Loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face.

Dysphagia (IX and X) slurred speech, ataxia (broad based gait), facial pain, vertigo, nystagmus, Horner’s (ipsilateral), diplopia, and possibly palatal myoclonus.

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51
Q

Anoscoria - def

A

difference in size between pupils

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52
Q

What suppresses gastrin? Name of drug in this group?

A

Somatostatin - octreotide e.g. for ZE syndrome

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53
Q

Treatment of dermatitis herpetiformis?

A

Dapsone

Papulovesicular rash caused by IgA complex deposition in papillary dermis

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54
Q

Which is the only laryngeal muscle not supplied by recurrent laryngeal?

A

Cricothyroid muscle - external laryngeal branches of superior laryngeal nerve

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55
Q

Turner’s and heart problems

A

Coarctation, dissection, congenital bicuspid valve, mitral prolapse

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56
Q

Anatomical boundaries of the inguinal canal

A

MALT - muscles, aponeuroses, ligaments, tendon/transversalis
Superior - Muscles (internal oblique and transversus abdominis
Anterior - Aponeurosis (internal and external oblique)
Inferior - Ligments (Inguinal and lacunar)
Posterior - Tendon (conjoint) and Transversalis fascia

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57
Q

Which lymph nodes drain testes?

A

Para-aortic

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58
Q

Measuring burns areas

A

9% head, arm
18% leg (9% anterior/posterior)
36% torso (18% front, 18% back)
1% genitals/perineum

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59
Q

Warfarin - which juice to avoid

A

Grapefruit and cranberry

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60
Q

Symptoms of Paget’s disease of bone - mnemonic

A 
PANICS
Pain
Arthritis
Nerve Compression
Increased bone size
Cardiac Failure
osteoSarcoma (1-2% of cases)
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61
Q

What iron chelator is given in both B Thalassaemia major and haemochormatosis

A

Desferrioxamine

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62
Q

Which infection commonly precedes Guillan Barre’ syndrome?

A

Campylobacter gastroenteritis

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63
Q

Lithium poisoning

A

Diarrhoea, hypokalaemia, hypotension, arrythmias, seizures, coma, metallic taste, fine tremor

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64
Q

Treating septic arthritis

A

Irrigation and drainage of joint (open or arthroscopic approach), + targeted IV Abx 2/52 + PO 4/52

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65
Q

Boxer’s Fracture - presentation and management

A

Fracture of 5th MCP after punching. Usually wool + crepe bandage but i angulated/rotated may need manipulation + K-wire

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66
Q

MM pt with neck pain + focal neurological deficit?

A

Plasmacytoma (malignant plasma cell tumour, occur in axial skeleton/soft tissue and may cause compression/fracture)
MRI spine
Rx needed

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67
Q

What anatomical landmark key to fistula in ano?

A

Pectinate (detonate) line. Junction of columnar (above line) with SC epithelium (below line). Low fistula = not lie across sphincter = lie it open. High fistula = crosses sphincter above line = seton (thread woven into fistula then tightened over several weeks to cut through surface

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68
Q

Managing fractures - mneumonic

A 
6 Rs
Resuscitate
Radiology (XR)
Reduce
Restrict (fixate, internal vs external)
Remain
Rehabilitate
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69
Q

Causes of erythema nodosum - mnemonic

A 
NODOSUM
NOne (idiopathic0
Drugs (sulphonamides, penicillin)
Oral contraceptive pill
Sarcoidosis
UC (IBD)
Microbiology (strep throat, TB)
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70
Q

Causes of alveolar haemorrhage

A

SLE, Goodpasture, GPA

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71
Q

Traumatic splenic injury grades

A

I - sub scapular haematoma <10% surface area; laceration <1cm depth
II - haematoma 10-50% SA or intraparenchymal <5cm; laceration 1-3cm w/o involving vessel
III - haematoma >50% SA or expanding, or ruptured or intraparenchymal >5cm; laceration >3cm involving vessel
IV - major devascularisation (>25% spleen(
V - completely shattered spleen, hilar vascular injury

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72
Q

RF for cataracts - mnemonic

A 
DEHYDRATION
DM, dehydration
Eye disease - glaucoma, uveitis
HTN, hypo Ca
dYstrophia myotonica
Diet low in fit A and antioxidants
Race and FH
Accidents, Alcohol excess
Toxicity - roids, tobacco, toxoplasmosis
Ionising radiation
Old Age
No protection - oestrogens, aspirin use
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73
Q

Normal presure hydrocephalus triad

A

Unsteady gait dementia with psychomotor retardation and urinary incontinence.
Typically gait broad based and small stepping with difficulty on initiation.

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74
Q

Risk factors for different renal stones

A

CaPO4 - idiopathic, hypercalcuria, hyperparathyroidism
Struvite (MgNH3PO4) - chronic UTI
Uric acid - hypercalcuria
Cysteine - intrinsic metabolic defects
Drug precipitation - Acyclovir, Indinavir, Mg Silicate, Sulfasalazine

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75
Q

Site of bronchiectasis can point to underlying disease. Which?

A

Upper lobe: CF, TB
Middle lobe: mycobacterium avium complex infection
Lower lobe: congenital immunodeficiency, recurrent aspiration
Central: allergic bronchopulmonary aspergillosis

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76
Q

Was is a common cause of paraphimosis?

A

The foreskin retracted during catheterisation has not been replaced leading to glans swelling. Urological emergency.
Attempt gradual manual reduction. If fails, inform urologist.

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77
Q

What is the distribution of myasthenia gravis?

A

Bimodal - in 30s and 60/70s

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78
Q

What scan is performed in varcioceles and why?

A

Kidney US, L sided varicocele associated with L renal malignancy. Anatomy of gonadal veins asymmetrical, R drains into IVC, L drains into L renal vein (and the fore may be compressed by tumour to cause L varicocele)

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79
Q

RF for avascular necrosis of femoral head

A

Chronic corticosteroids, excessive alcohol consumption

MRI is investigation of choice

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80
Q

Tropical sprue - presentation, biopsy and treatment

A

Chronic diarrhoea, weight loss, B12 & B9 deficiency, positive travel Hx
SI biopsy - mononuclear infiltration and villous atrophy
Broad spectrum Abx - tetracyclines and B9 supplements

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81
Q

Whipple’s disease - biopsy and treatment

A

PAS-positive macrophage in lamina propria

Double strength trimethoprim and sulfamethaxozole

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82
Q

Causes of dilated cardiomyopathy

A 
Dilation of all 4 chambers of the heart 
Viral - Coxsackie, Parvovirus B19, HIV
Alcohol
Methamphetamines
Chaga's disease
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83
Q

Carcinoid syndrome

A

Neuroendocrine GI tumour producing serotonin. Does not manifest until liver mets - as liver metabolises serotonin
Facial flushing, diarrhoea, right sided valvular disease (does not cause L sided as lungs metabolise serotonin)

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84
Q

Tinea versicolour

A 
Malassezia furfur  (fungus)
Pale, velvety, hypo pigmented macule which does not tan and is non scaly
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85
Q

Causes of TEN

A

NSAIDS, steroids, methotrexate, allopurinol, penicillins

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86
Q

Sutures: Silk

A

Non absorbable natural multifilament suture

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87
Q

Sutures: Prolene

A

Non absorbable, synthetic monofilament suture

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88
Q

Sutures: Polyester

A

Non absorbable synthetic multifilament suture

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89
Q

Sutures: Vicryl

A

Absorbable, synthetic, multifilament suture

90
Q

Polyarteritis nodosa spares which arteries?

A

Associated with hep B

Spares pulmonary arteries

91
Q

Humeral fractures and neuro deficits

A

Mid-humeral shaft fracture - Radial
Medial humeral epicondyle - Ulnar
Supracondylar humeral fractures - Median

92
Q

What is a classical examination finding in P. jirovecii infection?

A

Destauration on exercise

Pulse oximetry before and after walking up and down on ward

93
Q

What is transient hypocalcaemia?

A

Common complication of partial thyroidectomy, usually resolves.
If Ca <1.9 or frank tetany, OV calcium glucuronate bolus
Usually patients preloaded with 1alphacalcidol pre-op

94
Q

Behcet’s antibodies

A

Anti saccharomyces cervisiae

95
Q

Penicillamine is associated with which type of GN?

A

Membranous

96
Q

Protein Deposition: Alzheimer’s

A

Amyloid precursor protein (APP) and Tau hyperphosphorylated protein

97
Q

Protein Deposition: Lewy Body dementia

A

Alpha synuclein

98
Q

Protein Deposition: PD

A

Alpha synuclein

99
Q

Protein Deposition: Fronto-temporal dementia and ALS

A

TAR DNA binding protein 43 (TARDBP43)

100
Q

Protein Deposition: Pick’s disease

A

Tau protein, Pick bodies (large ballooned neuronal cells)

101
Q

Branches of the facial nerve - mnemonic

A 
Ten Zulus Baked My Cat
Temporal
Zygomatic
Buccal
Mandibular
Cervical
102
Q

Steroid regimens for surgery

A

Pre-op requirement <10mg and minor surgery - none
Pre-op >10mg daily and minor surgery - 25mg IV hydro + normal post op
>10mg and intermediate - 25mg IV + 25mg TDS 24h
>10mg and major - 50mg IV + 50mg TDS 72h

103
Q

SIRS criteria

A

T >38 / <36
RR >20 / PaCO2 <4.25
HR >90
WCC >12 / <4

104
Q

Pre-op management of pt with IDDM

A

Two common regimens - 1:1 (50u insulin in 50ml saline) or PIG (potassium insulin glucose)
Continue normal SC insulin until NBM before surgery

105
Q

Mount Vernon formula for fluid replacement in burns

A

Use rule of 9s
(weight x % burn)/2 = Volume of colloid (mL)
First 3 sets every 4h, 2 sets every 6 hours, final set over 12h

106
Q

Classes of shock

A

I - <15% blood loss (750ml), Obs within range
II - <30% (1500ml), tachycardia, tachypnoea, anxiety
III - <40% (2000ml), tachycardia, low BP, RR 30-40, low UO, confusion
IV- >40% (2500ml), Obs fucked, confused/drowsy

107
Q

On which grade od splenic injury do we operate?

A

IV only

I-III conservative

108
Q

GCS in intubated patients

A

Discount vocal entirely, out of 10 points, rest normal

109
Q

Monroe-Kellie concept

A

In cranial bleeding (fixed space), initial compensation (volume sacrificing) is provided by loss of CSF and venous volume. However when overwhelmed (150ml), exponential increase in ICP

110
Q

Foramen of Winslow

A

Only communication between greater and lesser sac

IVC, D1, hepatoduodenal ligament (contains portal triad), caudate lobe of liver

111
Q

What runs in hepatoduodenal ligament?

A

Portal triad (HA, PV, CBD)

112
Q

The anorectal ring is made up of?

A

Combined fibres of the puborectal muscle and external sphincter

113
Q

Carcinoma of the anal canal presents with:

A

RF: Gay man (HPV)
Bleeding and incontinence
70% have sphincter involvement at resentation
25% have palpable mass

114
Q

Peri-anal abscesses - different presentations

A

Majority of abscesses originate from infection within gland between internal and external sphincters.
65% will track down - perianal abscess (discrete red swelling close to anal verge)
15% track through external sphincter into ischiorectal fossae (systemic illness, extreme pain on palpation/DRE)
15% remain within muscle layers - intersphincteric abscess (chronic anal pain)
5% upwards through levitator ani - supralevator abscess (next to bladder - braider irritation)

115
Q

Most CRC occur in the:

A 
Rectum (33%)
Sigmoid (25%)
Caecum and ascending colon (18%)
Transverse (9%)
Descending
116
Q

Inguinal Canal anatomy: MALT

A

Superior: M (internal oblique and transversus abdominis)
Anterior: A (aponeurosis of EO and IO)
Floor: L (Inguinal and Lacunar ligaments)
Posterior: T (transversalis fascia and conjoint tendon)

117
Q

MoA colchicine for gout

A

Inhibits activation of neutrophils by irate crystal through inhibiting polymerisation of B tubulin

118
Q

Breast imaging - cut off for US vs mammogram

A

35 years

119
Q

Triple assessment

A

Examination + Hx
Imaging (mammogram / USS)
FNA ± core biopsy

120
Q

Abx for acute mastitis

A

Flucloxacillin

Pathogens likely skin commensals - majority Staph

121
Q

Suitability for carotid endarterectomy - who?

A

Pts with symptomatic (TIA) carotid artery stenosis >70-80% good candidates
Symptomatic pts with stenosis 50-70% - optimise medical therapy and review regularly - if continue to be symptomatic operate
If asymptomatic but stenosis >80% consider endarterectomy but may be controversial

122
Q

AAA - indications for surgery

A

> 5.5 cm (at this size will increase 4-6mm per annum)
<5.5 but growing at rate of 1cm per annum or more
Symptomatic - back pain, distal embolisation

123
Q

AAA repair principles

A

Either lapatotomy with dacron artificial graft or EVAR (endovascular aneurysm repair)
EVAR - femoral approach, radio guidance, endoluminal stunting. Better for patients less fit for surgery, shorter inpatient stay with less blood transfusions

124
Q

Varicose veins - treatment options

A

Conservative - compression stockings, weight loss, avoiding standing, frequent periods of walking
Medical - injection sclerotherapy (e.g. Na tetradecyl) increases amount of granulation tissue (injection followed by compression bandage for few weeks). Foam sclerotherapy also done. SE: long term pigmentation changes at site.
Surgery - best option, if QoL severely impaired. Ligation of saphenopopliteal or saphenofemoal junctional endoluminal RF ablation
High recurrence rates all methods

125
Q

Complications of carotid endarterectomy

A

Post-op HTN (66% pts) - close eye on BP for 72h
Stroke (5-8%)
Cranial nerve injury (5%)
Wound infection / patch rupture

126
Q

Causes of necrotising fasciitis

A

Group A strep, vibrio vulnificus, clostridium perfringens, bacteroides fragilis

127
Q

Indications for amputation

A

Useless limb - fixed flexion deformity, vestigial fingers
Dead limb - unsalvageable trauma, necrosis, PVD
Lethal limb - malignancy

128
Q

Causes of Raynauds phenomenon

A

Primary - idiopathic
Scleroderma, SLE, polyarteritis nodosa, RA, cervical rib, polycythaemia, cryoglobulinaemia, B blockers,
Ix –> FBC, TFT, LFTs, ANA, RF, cold provocation tests, cryoglobulins

129
Q

Popliteal aneurysms are associated with?

A

AAA - always look

50% B/L, 40% with AAA

130
Q

What is the anatomy of the femoral artery?

A

As the external iliac passes under the inguinal ligament, it becomes the common femoral and gives of the profunda femurs artery before continuing down as the superficial femoral artery

131
Q

Broadly, when would you use synthetic grafts, when organic?

A

Reversed (remember valves) autologous vein grafts indicated for below inguinal ligament, above use dacron / PTFE

132
Q

How do you classify bypass procedures

A

Anatomical (e.g. femoropopiteal) vs Extra-anatomical (e.g. axillofemoral, axillo-bifemoral)

133
Q

Branches of the external carotid

A 
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
134
Q

Renal arteries - anatomical relation

A

L1/L2 (right below SMA at L1)

135
Q

At rest how much blood do kidneys receive?

A

20% via renal arteries

R renal artery lives posterior to IVC and is the longer one

136
Q

Which muscle is posteromedial to kidneys?

A

Psoas. Also separates ureters from lumber vertebrae.

137
Q

Widest and narrowest part of male urethra

A

Widest - prostatic, approx 3cm in length, vas deference and prostatic duct open here.
Narrowest - membranous urethra - where pierces the urogenital diaphragm

138
Q

Frequency of stone composition

A 
60% Ca oxalate
30% triple (Mg, Ca, PO4)
5% Uric acid
2% Cysteine
1% Xanthine
139
Q

What size stones can a person pass?

A

Usually <5mm

140
Q

Which scan can estimate renal function?

A

DMSA scan

141
Q

Which organisms predispose to renal calculi?

A 
Proteus
Pseudomonas
Staphylococcus
Mycoplasma
Klebsiella
These are urease splitting organisms which hydrolyse urea to ammonia causing alkylotic urine and precipitation
142
Q

Fournier’s gangrene

A

Rare necrotising fascists of the perineum and genitals
Middle aged - elderly men
Co-morbidities include DM

143
Q

ADPKD genes

A

PKD1 chr 16 (85%)

PKD2 chr 4 (15%)

144
Q

ECG hypokalaemia

A 
Small/inverted T waves
Prominent U waves
Prolonged PR
ST depression
Prolonged QT
145
Q

ECG hyperkalaemia

A

Tented T waves
Small P waves
Wide QRS

146
Q

RF RCC

A 
Dialysis (causes acquired cystic disease in 90%)
Smoking
Lead
Asbetos
Polycarbons
FH: VHL
147
Q

Treatment of bladder cancer - medical

A

BCG for 6wks can be tried

148
Q

Testicular tumours

A
  1. Stromal. Leydig cells (secrete androgens); Sertoli cells (secrete androgens and can present with testicular feminisation)
  2. Lymphoma. <10%, elderly, poor prognosis
  3. Germ cell. Seminomas - 20 to 40 years, solid, slow growing, very Rx (5yr 90%), AFP. Teratomas - 15 to 35 years, solid or cystic, bHCG + AFP
    ALL Drain to para-aortic LN
149
Q

Peyronie’s disease - associations and treatment

A

Dupuytren’s and palmar fascitis
1 year conservative - allow disease to stabilise
Surgical –> Nesbit’s (cut opposite side, shortens penis)

150
Q

Prostate anatomy

A

Transition zone - innermost, surrounds urethra, enlarged in BPH
Central zone - surrounds ejaculatory ducts, projects beneath bladder to seminal vesicles
Peripheral zone - most Ca here (causes bulky irregular palpable prostate)
Anterior fibromuscular stroma

151
Q

BPH treatment

A

Medical - alpha blockers (tamsulosin, alfuzosin); 5 alpha reductase inhibitors (finasteride, dudasteride)
Surgical - TURP

152
Q

A partial radial nerve injury causing weakness in finger and wrist extension but no wrist drop or sensory loss is associated with?

A

Radial nerve winds around shaft of humerus, enters the forearm laterally, runs adjacent to head of radius.
Head of radius fracture
Proximal to this gives off superficial radial (sensory), posterior interosseus, superficial radial

153
Q

RA and OA - valgus or varus?

A

RA causes valgus (more commonly affects lateral compartment)
OA causes varus (moe commonly affects medial compartment)
However since OA&raquo_space;> RA, overall valgus more likely to be caused by OA

154
Q

What is the most common cause of traumatic haemarthrosis?

A

ACL injury

155
Q

What disease is associated with Baker cyst rupture

A

Both OA and RA, rupture with active RA

156
Q

Papillary thyroid Ca histology

A

Ground glass “Orphan Annie” nuclei with psammoma bodies (calcified spherical bodies)

157
Q

Early non-invasive bladder tumours and treatment

A

CaIS (confined to epithelial layer)
Ta (papillary neoplasm confined to bladder epithelium)
T1 (invasion into subepithelial layer but not muscle layer)
Tx = TUR of bladder tumour (TURBT) + intravesical chemo (e.g. doxorubicin) or BCG intravesical depending on grade:
Low grade (single dose chemo)
Medium (6/52 weekly chemo)
High (5/52 BCG)
5yr survival 80-90%§

158
Q

Lower parietal lesion

A

Lower quadrantanopia

159
Q

Temporal lobe lesion

A

Upper quadrantanopia

160
Q

Delayed gastric emptying in DM

A

Stop GLP-1 agonists

Add pro kinetic agent (metoclopramide / domperidone)

161
Q

Comedocarcinoma

A

High grade malignant ductal epithelial cells with dark staining nuclei and mitotic figures under high powered field
Necrosis and central calcification + intact BM
High grade ductal carcinoma in situ

162
Q

Axillary nerve injury

A

C5, C6. Commonly anterior dislocation with flattening of deltoid muscle after injury.
Loss of lateral rotation and abduction of affected shoulder, loss of sensation over lateral arm

163
Q

Median nerve injury

A

C5 - T1
Supracondylar fracture of humorous.
Loss of flexion of digits, thenar muscle and lumbricals 1&2, loss of pronation and sensory loss on lateral palm and 3 half digits

164
Q

Meniere’s disease

A

Episodic vertigo, tinnitus, hearing loss, fullness/pressure in ear before attack

165
Q

Smith’s fracture

A

Reverse colle’s
Distal radius fractues with velar angulation of distal bony fragment.
Fall on flexed wrist

166
Q

Monteggia’s fracture

A

Proximal ulna with dislocation of radial head

167
Q

Galleazii’s fracture

A

Fracture of radius with dislocation of radio ulnar joint

168
Q

Hangman’s fracture

A

C2 vertebrae due to hyperextension of neck

169
Q

Jefferson’s fracture

A

C1 vertebrae caused by axial loading to head - diving in shallow water and hitting bottom

170
Q

Air crescent sign

A

Invasive aspergillosis

Sign of recovering from infection

171
Q

ASD

A

Prominent RV cardiac impulse, ESM in pulmonary area & along left sternal border, fixed splitting of S2

172
Q

HHT

A

Epistaxis, telangectasia, visceral lesions and FDR with OWR

173
Q

Penicillamine

A

Membranous nephropathy

174
Q

Salter Harris Fracture classification of physeal fractures

A

SALTR
Physeal = involving the growth plate
I - Slipped (5-7%, though growth plate, cannot occur if gp fused)
II - Above (75%, passes across gp and up through metaphysis)
III - Lower (7-10%, passes some distance along gp and down through epiphysis
IV - Through/Transvers/Together
IV - Ruined (crush injury of growth plate)

175
Q

Kruckenberg tumours

A

Gastric Ca mets to ovary - contains signet ring cells

176
Q

Vaughan & Williams classification

A 
I - Na channel blocker (flecanide)
II - Beta blocker (atenolol)
III - K channel blocker (amiodarone)
IV - Ca channel blocker (diltiazem)
V - Other (digoxin)
Note amiodarone has I, II, III and IV activity
177
Q

Epistaxic point?

A

Little’s area

178
Q

Surgical neck of humerus fracture

A

Posterior and or anterior humeral circumflex artery

Axillary nerve

179
Q

Complications of blood transfusion

A

Hyperacute: allergic, haemolytic, non haemolytic fever, pulmonary oedema
Acute: haemolytic, TRALI, bacterial infection
Late: viral infection, GVHD, Fe overload, immune sensitisation

180
Q

Subcostal, transpyloric, supracristal and intertubercular planes

A

Transpyloric - L1
Subcostal - L3
Supracristal - L4
Intertubercular - L5

181
Q

Skier’s thumb

A

Ulnar collateral ligament tear

Pain on ulnar side on MCP, weakness of grasp & pinch

182
Q

HA - warm or cold

A

Warm –> Idiopathic, SLE

Cold –> infectious mononucleosis, idiopathic cold haemagglutinin syndrome

183
Q

Popcorn wool calcification XR

A

Chondrosarcoma

Paget’s

184
Q

Codman’s triangle

A 
Ewings sarcoma (+ Onion skin periostitis)
Osteosarcoma (+sun ray speculation
185
Q

Structures passing behind medial malleolus

A 
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial vein
Posterior tibial artery
Tibial nerve
Flexor hallucis longus
186
Q

Anaesthetic muscle relaxants

A
  1. Non depolarising (pancuronium, atracurium). Reversible competitive antagonists of acetylcholine at nicotinic receptor. Terminated by anticholinesterase (neostigmine)
  2. Depolarising (suxamethonium, succinylcholine). Irreversible, initially stimulating.
187
Q

In which pts suxamethonium dangerous as fuck?

A

Normally metabolised by pseudocholinesterase

Some pts familial deficiency of this enzyme

188
Q

PNH

A

Phosphatidylinositol glycan A defect in RBC
Increased binding of complement to RBC, makes cells susceptible to lysis in mildly acidotic environment (e.g. relative hypoventilation at night)
Thrombosis of major veins common

189
Q

BRCA1

A

Breast prostate pancreas ovarian melanoma

190
Q

Complications of acromegaly

A 
ABCDEFGH
Acromegaly
BP / Bowel Ca
Cardiomyopathy / Carpal tunnel
DM
Enlarged viscera
Field defects
Galactorrhoea
HF / HTN
191
Q

Old guy, acute onset dizziness / R hearing loss?

A

Anterior inferior cerebellar artery stroke

Supplies lateral inferior pons (vestibular and cochlear nuclei

192
Q

Parkland formula burns

A

4ml/kg x % burn = 24 hour requirement

1/2 in first 8h, remainder over 16 hours

193
Q

Otosclerosis

A

AD, conductive heraing loss, classically worse in pregnancy.
Incomplete penetrance
Fixation of stapes bone in ear
Hearing aids, stapedectomy/stapedotomy

194
Q

Open angle glaucoma

A

OPEN
Optic disc pales (atrophy)
Pressure >21mmHg (disk cupping + capillary closure = nerve damage)
Emerging blood vessels have breaks
Nasal and superior fields lost first (last to go temporal)

195
Q

Acute closed angle glaucoma

A

CLOSED
Cornea hazy
Lights have haloes and blurred
Occurs due to blocked drainage of aqueous humour from anterior chamber via canal of Schlemm
Shallow anterior chamber is RF
Dilatation of pupil at night worsens condition

196
Q

Retinal detachment

A 
FFFF
Floaters
Flashes (migraine)
Field loss (dark cloud)
Falling acuity
197
Q

Carpal Bones

A

Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate

198
Q

Silicosis

A

Small numerous opacities in upper lung zones with hilar lymphadenopathy

199
Q

Blood supply to NoF

A

Medial circumflex femoral

200
Q

Hand of benediction

A

In median nerve injury, inability to flex MCP of index and middle finger (loss of innervation to lateral 2 lumbricals

201
Q

Rapid sequence induction

A

Thiopentona and Suxamethonium

202
Q

Whipple’s disease

A

Infection by tropheryma whopplei (actinomycete)

Malabsorption + Intestinal LN ± cognitive decline / arthritis / hyperpigmentation / retinitis / endocarditis

203
Q

Surface anatomy: R lung

A

Oblique fissure = rib 6 (inf vs sup & middle lobe)

Horizontal fissure = R 4th costal cartilage (mid vs sup)

204
Q

Coagulation disease: Vit K def / Warf

A

PT +
APTT =
PLT =
BT =

205
Q

Coagulation disease: DIC

A

PT +
APTT +
PLT -
BT +

206
Q

Coagulation disease: Thrombocytopenia

A

PT =
APTT =
PLT -
BT +

207
Q

Coagulation disease: Bernard Soulier

A 
Giant platelet syndrome, defectin in GP1b. Megakaryocytes on film
PT =
APTT =
PLT -
BT +
208
Q

Coagulation disease: Haemophilia

A

PT =
APTT +
PLT =
BT =

209
Q

Coagulation disease: vWD

A

PT =
APTT +
PLT =
BT +

210
Q

Coagulation disease: Glanzmann’s

A 
Defect in GP IIb/IIIa
PT =
APTT =
PLT =
BT +
211
Q

Tennis elbow

A

Extensor carpi radialis brevis
Also known as lateral epicondylitis
Overuse condition
RICE + NSAID + Physio may take a year to fully effect

212
Q

C1 inhibitor deficiency

A

Hereditary angiodema

213
Q

C3 deficiency

A

Inpaired response to encapsulated bacteria

214
Q

Terminal compliment deficiency

A

Neisseria infections

215
Q

Congenital neutrophil deficiency

A

Pyogenic bacteira and fungi

Chronic granulomatous disease / Hyper IgE syndrome

216
Q

Congenital B cell deficiency

A

Hypogammaglobulinaemia, bacterial and fungal infections

Common variable deficiency

217
Q

Congenital T cell deficiency

A

Imparied cell mediated immunity - viral, mycobacterial, fungal infections
DiGeorge

218
Q

Congenital B and T cell deficiency

A

Viral, bacterial, mycobacterial and fungal

SCID, Wiskot-Aldrich

219
Q

t14:18 translocation

A

BCL2 gene, Follicular lymphoma

220
Q

t8:14 translocation

A

cMyc - Burkitt’s

Final Prep (19 decks)

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