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Phase 2 Exam Content Flashcards

1
Q

What is the natural progression of colorectal cancer?

A

AK53

Loss of function of APC tumour suppressor leading to early adenoma, gain of function of KRAS causing unregulated cell growth and proliferation, loss of function of TP53 tumour suppressor causing progression from adenoma to adenocarcinoma.

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2
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

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3
Q

What are modifiable and non-modifiable risk factors for colorectal cancer?

A

Modifiable:

  • smoking
  • low-fibre diet
  • obesity
  • processed meats

Non-modifiable:

  • age
  • hereditary polyposis syndromes
  • positive family history
  • IBD
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4
Q

What is the TNM staging of CRC?

A

T1- through submucosa
T2- through muscularis propria
T3- pericolorectal tissues
T4- into peritoneum

N1- 1-3 regional lymph nodes
N2- 4-6 regional lymph nodes

M0- nothing
M1- 1 site
M2- 2 sites

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5
Q

What is the prognosis for CRC?

A 
Duke's A: T1N0M0: 95%
Duke's B1: T2N0M0: 85%
Duke's B2: T3N0M0: 70-80%
Duke's C: TxN1M0: 35-65%
Duke's D: TxNxMx: 5%
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6
Q

What is prevalence?

A

The number of prevalent cases is the total number of cases of disease existing in a population.

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7
Q

What is incidence?

A

Incidence is the number of newly diagnosed cases of a disease.

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8
Q

What is mortality rate?

A

The number of deaths in a given area or period, or from a particular cause.

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9
Q

What epithelium are the majority of anal cancers?

A

Squamous cell cancers

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10
Q

What are the classic findings of small bowel obstructions?

A

Dilated, air-filled, small loops of bowel with relatively little gas in bowel.

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11
Q

What are the most common causes of small bowel obstructions in adults?

A

Adhesions (60%), hernias (10-20%), neoplasms (10-20%), intussusception, gallstone, ileus, stricture secondary to IBD, volvulus

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12
Q

What if the most common cause of small bowel obstruction in children?

A

Hernia

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13
Q

What is the initial management of small bowel obstruction?

A
  • Fluid resuscitation
  • NPO status
  • pain management (avoid opioids and anticholinergics)
  • IV hydration
  • Foley catheterisation
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14
Q

What on history suggests infective diarrhoea?

A

Acute onset
Duration less than two weeks
Self-limiting
Exposure (travel, food, etc)

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15
Q

What are conditions that mimic diarrhoea?

A
  • overflow incontinence
  • laxative use
  • incontinence
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16
Q

What are the risk factors and treatment for salmonella?

A

Risk factors: consumption of contaminated poultry or eggs, affects young or old more frequently

Treatment: Fluids or oral quinalone in high risk patients

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17
Q

What are risk factors and treatment for C.Diff?

A

Risk factors: recent antibiotic treatment, hospitalisation

Treatment: stop antibiotics, PO metronidazole for mild, PO vancomycin for moderate

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18
Q

What are risk factors and treatment for Norovirus?

A

Risk factors: childcare, contaminated food, travel

Treatment: Fluids

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19
Q

What are risk factors and treatment for Cryptosporidium?

A

Risk factors: contaminated water, childcare, travel

Treatment: supportive

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20
Q

What are non-infective causes of diarrhoea?

A
  • IBS
  • IBD (ulcerative colitis or Crohn’s)
  • Diverticulitis
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21
Q

What are four functions of the GI tract?

A

Motility, digestion, absorption and secretion.

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22
Q

Questions for paeds history of constipation?

A 
When did it start?
Initially pooing or suddenly stopped?
Passing gas? 
Fever?
Feeding? 
Unsettled? 
Vomiting?
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23
Q

What are signs of congenital hypothyroidism?

A
  • Constipation
  • Fatigue and lethargy
  • Poor appetite
  • Prolonged jaundice
  • Poor growth
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24
Q

What does the Guthrie test look for and how?

A

CF- immunoreactive trypsinogen
Congenital hypothyroidism- TSH or T4
CAH- 17OHP
PKU- Phenylalanine

25
Major Depressive Disorder Features
5/9 symptoms for greater than 2 weeks- one of first two 2 - low mood - anhedonia 3 - suicidal ideation - poor concentration - guilt 4 SAME - sleep disturbance - appetite - motor - energy
26
BPD Features
5 symptoms since adolescence, inflexible across multiple environments ``` Abandonment Mood instability Suicidal ideation Unstable relationships Impulsivity Control of anger (poor) Identity disturbances Dissociation Empty feelings ```
27
BPAD Features
Symptoms of mania ``` Distractibility Insomnia Grandiosity Flight of ideas Activities/Agitation Sexual disinhibition Talkativeness ``` BPAD 1: manic episode BPAD 2: hypomanic, more than one MDD episode Cyclothymic: does not meet criteria for hypomania or MDD but alternating symptoms for two years
28
PTSD Features
Symptoms for > 1 month Intrusive symptoms: nightmares and flashbacks Avoidance: stimuli associated with trauma Negative alterations in mood and cognition: numb Changes in arousal and reactivity: hypervigilance, sleep disturbances
29
Substance Use Disorder Features
2/11 criteria for 1 year Social impairment - work/school/home - continued despite problems - isolation Impaired control - more consumption than intended - failed reduction - increased time spent acquiring - craving Risky use - hazardous situations - continued despite issues Pharmacologic - tolerance - withdrawal
30
Schizophrenia Features
>6 months symptoms Delusions Hallucinations Speech (disorganised) ``` Behaviour (disorganised) Negative symptoms (affect, avolition, asociality, anhedonia, apathy) ```
31
Presentation of RPOC
uterine bleeding, pelvic pain, fever, uterine tenderness
32
Complication of RPOC
``` Sepsis Haemorrhage Cervical stenosis Cervical incompetence Adhesions Vaginal bleeding ```
33
Medical management of RPOC
Vaginal misoprostol SE: Abdominal cramping, diarrhoea, vaginal bleeding, nausea, vomiting
34
Antiphospholipid syndrome effects
``` Coagulation defect Livedo reticularis Obstetric Thrombocytopaenia SLE ```
35
Antiphospholipid syndrome diagnostic criteria
Clinical (one needed) - vascular thrombosis - pregnancy morbidity Labs (one needed) 12 weeks apart - anticardiolipin antibody - lupus antibody
36
Antiphospholipid syndrome and pregnancy
- increased risk of developing a thrombosis and miscarriage -at risk for preeclampsia and decreased blood flow to the foetus resulting in intrauterine growth restriction -manage with: low dose aspirin heparin stop warfarin when trying to conceive no COCP because oestrogen and increased risk of clots
37
Causes of recurrent miscarriages
Chromosomal abnormalities (early before 12 weeks) Anatomical abnormalities of the uterus Endocrine disorders (DM, hypothyroidism) Other inherited thrombophilia (Factor V leiden, protein C and S) Antiphospholipid syndrome Late spontaneous miscarriage (12-20 weeks) due to hypercoagulable state
38
Cough history
``` When did it start? Can you cough for me? Are you producing any sputum? Have you coughed up blood? Has it gotten better or worse? Anything that helps or makes worse? Smoke? Fevers, night sweats, weight loss? Occupational exposure? Travel? Pets? ```
39
Examination findings pleural effusion
Dullness to percussion Decreased tactile fremitus Asymmetrical chest expansion
40
SIADH Causes
Central or nephrogenic - pulmonary disease - paraneoplastic syndrome - tumour - drugs: antipsychotics, NSAIDs
41
Multiple myeloma features
Hypercalcaemia Renal involvement Anemia Bone lesions
42
Differential diagnosis for jaundice
Pre hepatic - increased haemolysis (malaria, HUS, etc) - decreased conjugation (crigler najaar, gilberts, etc) Intrahepatic Hepatitis Cirrhosis Post hepatic Choledocolithiasis Pancreatic malignancy
43
What are the clinical signs of liver failure?
``` Jaundice Ascites Coagulopathy Disorientation or confusion Pruritis Dark urine Pale stools ```
44
Functions of the liver and how dysfunction results in symptoms
Synthetic function: Clotting factors --> coagulopathy Proteins--> ascites Clearance of toxins: Ammonia --> hepatic encephalopathy Bilirubin --> jaundice
45
What are the components of child pugh classification for liver failure?
``` Bilirubin Albumin PT INR Ascites Hepatic encephalopathy ``` -lower score means higher chance of one year survival, there are classes A, B, and C
46
What are the consequences of chronic hepatitis?
Cirrhosis, portal hypertension, liver failure, and hepatocellular carcinoma
47
What is the goal for treatment of cirhosis?
Stop progression and prevent complications
48
What is cirrhosis?
Fibrosis and nodular regeneration resulting from chronic hepatic injury. Most commonly caused by alcohol, chronic viral infection (HCV), and non alcoholic steatohepatitis
49
What are the complications of cirrhosis?
Ascites: increased portal hypertension causes transudative effusion, manage with sodium restriction and diuretics SBP: paracentesis >250 PMNs/mL, IV Abx acutely, I albumin Hepatorenal syndrome: "healthy kidneys in an unhealthy environment" Hepatic encephalopathy: decreased clearance of ammonia, lactulose Oesophageal varices: portal hypertension leads to increased flow through porto-systemic anastamoses, acute bleeding > endoscopy with band ligation or sclerotherapy, TIPS in refractory cases but associated with poor outcome, beta blockers can be used prophylactically Coagulopathy: impaired synthesis of all clotting factors except VIII, for acute bleeding fresh frozen plasma
50
Cholelithiasis (DIASG)
Definition: stones in gallbladder causing temporary occlusion Presentation: Asymptomatic or biliary colic, transient RUQ pain after eating fatty meals Labs: normal bilirubin, ALP, amylase Dx: US Mx: observation if asymptomatic, laparoscopic cholecystectomy if symptomatic
51
Kawasaki disease
1. fever for more than 5 consecutive days 2. palmar erythema 3. head and neck rash 4. cervical lymphadenopathy 5. conjunctival congestion 6. strawberry tongue ``` Conjunctival Rash Edema Adenopathy Mucosal involvement ```
52
Kawasaki treatment
IV immunoglobulins
53
Diagnostic criteria PCOS
-oligo/anovulation -hyperandrogenism clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) -polycystic ovaries on ultrasound
54
Ddx PCOS
``` Congenital adrenal hyperplasia Androgen secreting tumours Cushing syndrome Thyroid dysfunction Hyperprolactinaemia ```
55
Investigations for PCOS
``` Testosterone FSH/LH OH-17 for CAH BSL HbA1C TFTs Prolactin ```
56
Management of PCOS
Not trying to conceive: COCP or Progestin + metformin Trying: Clomiphene (SERM) plus metformin Symptoms:
57
Simple versus complex ovarian cysts on ultrasound
Simple cysts: anechoic, thin wall, smooth, reduced or no blood flow Complex: Vascular, echoic, septate, thick wall irregular walls
58
Types of ovarian cysts
Functionals: follicular and corpus luteal Non-functional: Dermoid Chocolate cysts (endometriosis) Haemorrhagic Neoplasms: epithelial (90%) CA-125
59
Ovarian torsion
Aetiology: hypermobile ovary (50%) or adnexal mass Presentation: severe non-specific lower abdominal and pelvic pain, either intermittent or sustained, nausea, and vomiting. There is an adnexal tenderness. A raised white cell count is common. Imaging: The main feature of torsion is ovarian enlargement due to venous/lymphatic engorgement, oedema, and haemorrhage. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle.

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