Postits Flashcards
Colonic angiodysplasia is…
What does it cause?
Who gets it?
Vascular malformation
Causes PR bleeding
Often in elderly
Usually asymptomatic
Prerequisites for good bone healing (3)
Patient condition (nutrients, age, comorbidities) Minimal fracture gap Minimal movement in the break
Wolffs law regarding bone
Bone will adapt to forces applied to it (remodel)
How long until a fracture fully heals?
6 months typically
Dependent on other factors may take less time or more time
Which bones tend to heal faster?
Generally upper limbs heal faster
Fracture management
ABCDE
Reduce = bring the bone back together in an acceptable alignment Rest = hold the fracture in that position to prevent distortion of movement Rehabilitate = get function back and avoid stiffness
What are the 4 Rs of fracture?
Resuscitate
Reduce
Rest
Rehabilitate
What’s the big risk of immobility?
VTE
Need VTE prophylaxis!
Conservative fracture management
Conservative (for minor fractures)
- Rest, ice, elevation
- Plaster cast/fibreglass or splint
- Traction (weights to keep them in a particular position)
Surgical fracture management
Intramedullary nail
ORIF
External fixation = mono/biplanar, multiplanar
Arthroplasty = hemiarthroplasty, or total
Bronchopneumonia shows what on X-ray?
WIDESPREAD consolidation
Peripheral consolidation on X-ray =>
COVID
Line along femur that should cross femoral epiphysis =
Klein’s line
Relevant in SUFE
Line that should be smooth in pelvis, regarding hip fracture
Shenton’s line
X-ray view for SUFE
Frogs legs view
Features of Perthe’s disease on X-ray
Avascular necrosis of the femoral head
Flattening of the femoral head
Widening or reduction in joint space
Appearance of fragmentation
Difference between golfer’s elbow and tennis elbow
Golfer’s elbow is inside elbow pain (medial)
Tennis elbow is outside (lateral)
Management of tennis and golfers elbow
Rest
Ice
Brace
Reduce activity
Symptoms of tennis and golfers elbow
Stabbing, burning pain
Structure for presentation
HERID History Examination Recommended tests Investigations Differential diagnoses
DDx of abdominal pain, think in categories
Viscera = appendicitis, renal colic, pyelonephritis, testicular torsion
Vascular = mesenteric ischaemia, AAA
Gynae = ectopic, ovarian cyst, saplingitis, PID
Other causes = DKA, referred pain from pneumonia
Neonatal cause of abdominal pain and red current stool, very upset
Intussception
Presentation of obstruction
Colicky pain
Not passed any stool or flatus
Pain may become constant
Presentation of inflammatory abdominal pain
More constant pain than an obstruction
More likely going to pick it up elsewhere
How do you screen for IBD?
Faecal calprotectin
Sign of inflammation in the bowel
If it isn’t present, can pretty much rule out IBD
Signs of peritonism
Rigid abdomen
Lying very still
Where does foregut pain refer to?
Epigastric/upper abdomen
Where does midgut pain refer to?
Umbilicus/central abdomen
Where might the pain from salpingitis present?
LIF, RIF
Supra pubic/ LIF pain in elderly most likely
Diverticulitis
Sign of appendicitis on urine dip
Raised leukocytes
Normal lactate level
Less than 1
Immediate manage of bowel perforation
Escalate to senior NBM Sepsis 6 Analgesia Theatre
What can increase risk of bowel obstruction?
Previous surgery -> adhesions
Immediate management of volvulus
Escalate NBM Drip and suck Consider sliding scale CT abdomen
PEARL in ABCDE is?
Pupils even and responsive to light
Haustra of small bowel are called
Valvulae conniventes
What separates intracellular and extra cellular fluid components?
Cell membrane
Examples of crystalloid fluid
Sodium chloride
Hartmanns
Dextrose
Signs of fluid overload
Raised JVP
Oedema (peripheral or pulmonary)
Signs of dehydration
Dry mucous membranes
Reduced skin turgor
Urine output
Tachycardia
Loss of fluid can be due to
Vomiting Urine Diuretics Stoma Bleeding 3rd spacing
How much potassium can you prescribe /hr
10mmol
How much glucose / hr?
50-100g / 24hr
Jobes test is also known as the …. test
Empty can test
Which muscle does the Jobes test assess?
Supra-spinatous
If Jobe’s test is positive, what does this indicate?
Shoulder impingement
Erythasma is…
Rash under the armpits and in the groin
Lichun planus is…
Superficial infection
See Wickham’s striae
Purple
Pityriasis versicolour is caused by…
Fungus
Pempholyx is…
Rash in the family of eczema
Tiny pustules along fingers and on feet
Resolves after a few weeks
Hidradenitis suppurativa is…
Issue with sebaceous glands
Results in chronic, recurring abscesses in armpit
Follicular pyoderma is…
Staph infection
Small yellow pustules
Bullous pemphigoid is
AI condition involving deep skin
Get tense blisters
What does insulin do to ketone production?
Switches it off!
If osteopaenia in CKD, which drug might you give?
Alfacalcidol
Active vit D
Cant activate with shit kidneys so can’t give cholecalferol
Patients reliant on steroids, what should you do with their dose when admitted with infection?
Double the dose
Hyperkalaemia management
C BIG K DROP Calcium gluconate Beta agonist Insulin Glucose Dialysis/diuretics
Signs of aortic dissection
Widened mediastinum on x-ray
Severe, tearing pain
Low BP
Cold and clammy
Causes of radio-radial delay
Coarctation of the aorta
Cervical rib interrupting blood flow
What do we use to screen for colorectal cancer?
FIT test
Faecal immuno testing
Risk factors of colorectal cancer
Diet Neoplasticism polyps Alcohol Smoking Genetic predisposition = FAP
Presentation of colorectal cancer
Left sided => bleeding and altered bowel habit and mass
Right sided => weight loss, anaemia (iron deficiency microcytic), abdominal pain
Complications = haemorrhage, fistula, perforation
Bowel cancer markers
CEA (used to monitor after operation)
Where do colorectal cancers often spread to?
The liver
Make sure to do a CT abdo pelvis
Dukes stage A
Tumour confined to the bowel but not extending beyond it
Dukes D is …
Invasion of the bowel wall
Dukes C is…
Lymph node involvement
When do you do a right hemicolectomy?
Caecal tumours
Ascending tumours
You then attach the small intestine to the remaining colon
Left hemicolectomy procedure
Remove bit of bowel and then connect colon to colon
Anastomoses isn’t very good
What is Hartmanns procedure?
Removal of some colon with the formation of a stoma and end anorectal stump that can be joined up later
Indications for drain insertion
To eliminate dead space
Stop build up of fluid, pus, blood, bile, serous exudate
Seen decision making in gynae surgery, try to avoid by making sure there is no internal bleeding
Types of drains
Open
Closed
Active
Passive
Passive drainage post op most likely uses which drain?
Robinsons drain
Drain for drainage of bile, sits in the hepatobiliary tree
Pigtail drain
Assessment of drain involves…
Drain site, any ooze or erythema
Fluid output, what’s coming out of it
Any blockages
Assess infection risk and when it needs to be removed
Symptoms of anterior uveitis
Blurred vision Small pupil Red eye Lacrimation Photophobia Eye pain
Remember HLA-B27
Management of hepatic encephalopathy
Oral lactulose (helps reduce ammonia load by affecting gut absorption) Rifiximin is another choice if refractory to lactulose
Signs of hepatic encephalopathy
Confusion Coma Disruption of sleep cycle Liver flap Altered GCS
RUQ pain radiating to shoulder tip
Cholecystitis
Subphrenic collection
Perforated duodenal ulcer
RUQ -> back
Biliary colic/cholecystitis
Central -> back pain
Pancreatitis/aorta
Any woman of childbearing age is having an X before proven otherwise?
Ectopic
3 categories of jaundice
Pre hepatic
Hepatic
Post hepatic
Which drug do you give alongside aspirin in NSTEMI?
Ticagrelor
First line treatment for Dresser’s syndrome
Aspirin
Symptoms of poly myalgia rheumatica
Stiffness in morning around shoulders
Treatment of polymyalgia rheumatica
Prednisolone
CO poisoning causes a rise in what?
Carboxyhaemoglobin
Unprovoked DVT, what do you need to do after acute management?
CT to check for malignancy
Scaling skin over wounds =>
Psoriasis
What improves cranial diabetes insipidus?
Desmopressin
Symptoms of prolactinoma
Irregular period
Galactorrhoea
Decreased libido
First-line medical management of prolactinoma
Cabergoline
Which tube protects from aspiration?
Tracheal tube
Causes of hepatomegaly
Heart failure
Haemochromatosis
Liver abscess
Hepatocellular carcinoma
Hepatomegaly, what levels do you want to check?
LFTs
Ferritin
Hepatomegaly and raised ferritin =>
Haemochromatosis
What type of headache can spinal anaesthetic cause?
Low-pressure headache
How long do you need to fast for before surgery?
6hr solids
2hr fluids
The antibody in rheumatoid arthritis
Anti-CCP
Cocaine-induced ACS =>
Coronary artery spasm
Drug to give in coronary artery spasm? Think ruptured berry aneurysm
Nifedipine
Malaria blood test
Thick and thin blood films
Symptoms of malaria
Confusion
Drowsiness
High fever
Cause of malaria
Plasmodium falciparum
4 Hs of hepatomegaly
Heart failure
Hepatic abscess
Hepatocellular carcinoma
Haemochromatosis
What is the treatment for severe hydronephrosis (say, due to a stone)
Nephrostomy
What does a nephrostomy do?
Drains the fluid from the kidney
What do you give in severe, sinus bradycardia?
Atropine
It poisons the vagus nerve, reducing parasympathetic activity and raising heart rate
Way to remember that atropine speeds up heart rate
Atro is agro
It poisons the vagus nerve
Treatment for acute gout
Naproxen = NSAID
Conductive hearing loss, Rinne test will show what
Louder on the pinna, because lost ability to conduct sound through air
Most likely, spreading cellulitis
Strep pyogenes
Can spread because it breaks down the cell matrix using streptokinase
Symptoms of superficial thrombophlebitis
Swollen, hard cord in the distribution of the long saphenous vein
How do you check if a superficial thrombophlebitis is a DVT?
USS
What drug can you give for superficial thrombophlebitis?
Naproxen
How long does it take for a superficial thrombophlebitis to settle?
6 weeks
Diabetic undergoing surgery, what do you do before?
Stop sulphonyureas and gliciazide
Make them 1st on the list to minimise fasting times (in case there are delays!)
Which part of the leg does the common fibular nerve innervate?
Anterior leg
Damage to the common peroneal nerve results in what sign?
Foot drop
Twitching in the arm for approx 2 mins then weak after => what type of seizure?
Partial seizure
Which lymph nodes do the abdominal organs drain to?
Para-aortic lymph nodes
Treatment of symptomatic cholecystitis
Laparoscopic cholecystectomy
The drug you can give in obstetric cholestasis (the main Sx of which is itching)
Ursodeoxycholic acid
Signs of cerebellar stroke
Prominent headache
Ataxia (because balance centre)
N+V (because balance centre!)
ABPI >0.5
Venous ulcer Mx
Compression stockings
Localise to pain = what GCS scoring
5/6
Symptoms of acute, closed angle glaucoma
Hazy cornea
Blurred vision
Halos around lights
Sudden, red painful eye
Red-eye, small pupil, painful =>
Anterior uveitis
Recurrent candida can be seen in which endocrine condition?
Diabetes mellitus (because pissing out sugar)
Time cut off for alteplase in ischaemic stroke
<4.5hr
DIC platelet level on FBC
LOW
Which drug can you give to reduce tumour size?
Dexamethasone
How can you reverse warfarin?
Vitamin K IV and prothrombin complex concentrate
Features of nephrotic syndrome
Ankle oedema
Low albumin
Ix for nephrotic syndrome
Renal biopsy
Which vasopressor can be given peripherally
Metraminol
Complications of chest drain
Insertion related = damage to nearby structures, pneumothorax, subcutaneous emphysema
Infection
Placement, e.g. it’s got kinked
When do you do hemiarthroplasty?
Poor baseline
May be demented or unable to walk
When might you use an intramedulary nail?
Good baseline, young, Garden 1/2
When might you do a total hip replacement?
Good functional baseline
Young
Displaced fracture, can’t fix it with a nail
Example of an inotrope
Digoxin
Dopamine
Examples of vasopressors
Metraminol
Adrenaline
2 medications for a medical abortion
Mifepristine (clinic) + Misoprostal (home)
Which oesophageal condition can cause dysphagia and can be visualised and removed via endoscope
Oesophageal candidiasis
Mx of anterior uveitis
Topical steroids
Cyst that moves with the tongue
Thyroglossal cyst
What does the Lachmann test test for
Pull the knee forwads, see if there is an ACL injury
Features to classify and present a fracture
Which bone Which part Type of fracture Simple/open Displacement (relative to PROXIMAL fragment) Rotation Shortening Bone quality
Questions to ask if you are thinking of hepatitis
Sexual history
Abdominal Sx
Cirrhosis
Typical pabrinex prescription
2 pairs
3x daily
Markers for acute pancreatitis
Amylase
Lipase!
Pancreatic cancer, red lines on legs, what’s the condition?
Migratory thrombophlebitis
What does cholestyramine do?
Bings to bile acids
Reduces itching
What can overdose of aspirin cause?
Reyes syndrome
Why do you do an echocardiogram in Kawasaki?
Coronary artery aneursym
Features of Scarlet fever
Group A strep
Sandpaper rash
Fever
Kawasaki disease Mx
High dose aspirin
IV Ig
Cut off for abortion (not due to risk to mother)
24 weeks
Mx of acute flare in UC
IV hydrocortisone
Long standing rash
Lymphadenopathy
Peeling hands and feet
Kawasaki
Additional questions to ask in abortion Hx
Contraception Normal Hx aswell Sexual Hx Ectopic stuff SH
Mx of acute- severe asthma
Nebulised salbutamol
Ipratropium bromide
Oral prednisolone
(IV if refractory)
When might you use amiodarone?
Anti-arrhythmic drug
How does eclampsia cause seizures?
You are leaky everywhere
The abdominal pain is fluid causing the liver capsule to stretch
Cerebral oedema causes the seizures
What neurological assessment should you do in eclampsia?
Clonus
Looking for UMN signs
Reflexes
Drug for pre-eclampsia
Labetalol
Blood pressure cut off for pre-eclampsia
140
Urinary tests for pre-eclampsia
Protein
PCR 30< (confirms pre-eclampsia)
Mx of large pneumothorax or secondary
Chest drain
Which types of jaundice cause itching?
Hepatic and post hepatic
In a woman, what test should you always consider doing?
Pregnancy test
When should you not use a nasopharyngeal tube?
Basal skull fracture
Features of Colles fracture
FOOSH
Osteoporosis RF
Dorsal displacement of the distal radius
Important things to check with arm fractures
Neurovascular involvement
Which bone is the radius?
Thumb side forearm bone
Mneumonic for suicide risk
HIRMS Hope Intention Risk MSE Support network
Whats an important place to ask about regarding paediatrics?
How school is going
Causes of epigastric pain in categories
Gastric = ulcer, gastritis Pancreas = pancreatitis Intestinal = appendicitis, obstruction, colitis Biliary = gallstones, cholecystitis, ascending cholangitis
Drug to treat oesophageal candidiasis
Nystatin
Risk factors of breast cancer
2 first degree relatives or 1 young close relative with breast cancer or if they had bilateral cancer or a male affected in the family Ovarian cancer Jewish ancestry Increased age BRCA mutation
Things that decrease breast cancer risk
Pregnancy
Breastfeeding
Use of oral contraceptives
Chance of detecting a cancer with screening and follow up tests
1%
Which radiograph do you use for younger people for screening for breast cancer?
USS
Popcorn calcification is a feature of which breast mass?
Calcified fibroadenoma
Micro calcifications in the ducts on breast mammogram =>
Breast carcinoma
Causes of high stoma output
New stoma
Short bowel syndrome
Sepsis
Prokinetics
Risk factors of AAA surgery (categorise)
Immediate = blood loss, anaesthetic issues
Intermediate = sepsis
Long term = DVT
Which diagnosis do you always have to remember when reporting flank pain?
AAA!
What is shock?
Inability to perfuse body’s tissues
Hypovolaemic shock, which 4 compartments do you need to check for loss of blood?
Chest
Abdo
Long bones
On the floor
Type of scan you can do quickly to determine if there is free fluid/bleeding?
FAST scan
Signs of hypovolaemic shock
Hypotension Tachycardia Pallor Weak thready pulse Pallor Reduced urine output
What medications can you give to improve hypovolaemic shock?
Fluids
Vasopressors (but can cause peripheral tissue ischaemia because pushing all the fluid centrally)
Average age of menopause
51
Drug for breast cancer, oestrogen sensitive in post-menopausal women
Anastrozole
FNA or core needle biopsy for histology sample?
Core needle biopsy
Fast growing, smooth lump in breast in elderly
Phyllodes tumour
Painful breast in lactating woman, no mass just tenderness. Fever.
Peuperal mastitis
Local inflammation due to ascending infection through crack in nipple
HER2 positive drug treatment for breast cancer
Trastuzumab (herceptin)
Pulmonary oedema, tense swelling in legs, breathless, having chemotherapy for breast cancer, what’s the likely drug culprit?
Herceptin
Cardiotoxic
Triad of acute liver failure
New onset jaundice
Coagulopathy (INR >1.5)
Encephalopathy
Causes of vitamin B12 deficiency
Pernicious anaemia
Zollinger Ellison syndrome
Terminal ileum resection
Chronic severe gastritis
Long term management of pernicious anaemia
Cobalamin
What is Whipple’s disease?
Rare, systemic disease caused by tropheryma whipplei
Diarrhoea
Abdo pain
Joint pain
Diagnosed with bowel biopsy -> presence of acid-schifff macrophages
Treatment of hepatic encephalopathy
Oral lactulose
Reduced ammonia production
Painful ascites and unwell implies
Spontaneous bacterial peritonitis
Treatment of cholera
Effective rehydration
Potentially doxycycline
Long term UC management (distal rectal disease)
Mesalazine suppository
Triad of nephrotic syndrome, with values
Hypoalbuminaemia (<30g)
Proteinuria (3.5g25hr)
Oedema
Mx of child with nephrotic syndrome
Refer to renal
Prednisolone treatment
What is the only acceptable form of contraception in women with active breast cancer?
IUD
Woman doing lots of planks at the gym, now got a painful lump on her elbow, not tender to touch
Olecranon bursitis
Mx of olecranon bursitis
Ice
Rest
Anti-inflammatories
At what time in the cycle does ovulation occur
Halfway
Say day 14 of 28
Symptoms of coeliac disease
Loose smelly stools Bloating Abdo pain Hx/FH of autoimmune disease Failure to thrive
Gene linked with coeliac disease
HLA DQ2
Complications of coeliac disease
Osteoporosis
MALT
Why shouldn’t you use an IUD in active chlamydia infection?
Can result in an ascending infection (PID)
Drug treatment for benign prostatic hyperplasia
Tamsulosin
Antibiotic for cellulitis in penicillin allergic
Cephalosporin e.g. clindamycin
48 years old, last period 12 months ago, contraception advice
IUD for 1 year
Need 2 years of no periods if under 50yo
Hx of breast cancer, which contraceptive to prescribe
IUD
Someone has forgotten to take their POP for 4 hours, what do you advise?
Take the pill, continue as normal, condoms for 2 days
Patient on methotrexate, encountered patient with chickenpox 2 days ago, what do you do?
Give VZIG
Key differences between GPA, Churg-strauss and Goodpastures disease
GPA: URT involvement (epistaxis)
Churg-Strauss: More of an asthma picture with sinusitis
Good pastures: More respiratory (pulmonary haemorrhage + haematuria)
Causes of proximal myopathy
PEACH PODS Polymyositis Endocrine Alcohol Carcinoma HIV
Osteomalacia
Drugs (statins)
Steroids and sarcoidosis
Features of polymyositis
Proximal muscle weakness with no pain or stiffness or skin involvement
Which marker is raised in polymyositis
CK
Dermatomyositis and polymyositis turn your muscles to CLAA mneumonic for blood tests to order stands for…
CK
Lactate dehydrogenase
ALT
AST
Best NSAID to use in GI bleed (should be avoiding, but in case they really need it)
Celocoxib
These are COX-2 inhibitors
DONT use in IHD
Which medication, used in rheumatoid arthritis alongside methotrexate can cause loss of colour vision
Hydroxychlorquine
Stop it immediately at the first signs of damage
Mx of temporal arteritis
1mg/kg oral prednisolone for 4 weeks then slowly taper off for 6 months
Why do you taper steroids very slowly in temporal arteritis?
High risk of recurrence
What type of vaccine is contraindicated in methotrexate Mx?
Live vaccines
e.g. yellow fever
Features of chronic fatigue syndrome
Persistent disabling fatigue
May have on and off flu symptoms
Tired all the time, lots of naps
May have muscle aches (difficult to determine between this and fibromyalgia often)
Pyoderma gangrenosum is associated with…
IBD (usually UC)
Complications of septic arthritis
Immediate: Sepsis, loss of limb, osteomyelitis
Long term: Arthritis, removal of replacement joint
Triad of Felty’s syndrome
Rheumatoid arthritis
Enlarged spleen
Neutropaenia (can lead to infection!)
SANTA features of Felty’s syndrome
Splenomegaly Arthritis Neutropaenia Thrombocytopaenia Anaemia
Scoring system for hypermobility
Beighton
X-ray features of psoriatic arthritis
Loss of joint space
Pencil in cup deformity
Bone erosions
Arthritis mutilans
Mx of psoriatic arthritis
Treatment is conservative at first with local steroid injections and NSAIDs, but most require regular immunosuppression with methotrexate, and increasingly novel biologics
Pain in ankle
Recent chemotherapy
Chronic kidney disease
DDx?
GOUT
Septic arthritis
Trauma
Pseudogout
What is an obturator hernia?
Abdominal contents herniate through the obturator canal (the hole in the pelvis)
On PR may feel a mass in the upper lateral region
Symptoms of bowel obstruction
Parasthesia down the medial thigh because the obturator nerve is impacted
Most common site of occlusion in mesenteric ischaemia
Superior mesenteric artery
Acute rectal bleeding, with no pain DDx
Meckel's Ischaemic colitis (due to tissue necrosis)
Alcohol is a risk factor to developing which type of oesophageal cancer?
SCC?
What is malignant hyperthermia?
Hyperthermia triggered by anaesthetics
Often caused by an autosomal dominant mutation in ryanodine receptor 1
Patient may have a very rigid abdomen
How much of the bodies surface area does each leg count for?
18%
Complications of venous ulcers
Immobility
Osteomyelitis
Infection and sepsis
Mx of venous ulcers
Lifestyle advice Keep ulcer clean Encourage mobility Weight reduction Leg elevation at rest Emollient treatment of the leg
Compression bandaging - aimed at improving venous return from the leg
Patients must have an ABPI to exclude co-commitment arterial disease as bandaging will worsen arterial supply to the leg.
Surgery – not usually necessary
Debridement
Skin grafting
Flatulence related to fatty meals
Indigestion
Abdominal pain
Long-standing
Chronic cholecystitis
How long do you give nitrofurantoin for in pregnancy?
7 days
Management of intussception
Rectal air insufflation or contrast enema (only to be performed if child is stable)
Operative reduction indicated if:
Failure of non-operative management
Peritonitis or perforation is present
Haemodynamically unstable
Painless scrotal lump, can still palpate testis, transilluminates
Epididymal cyst
Fluid requirement in cardiac disease
25ml/kg/day
Drug treatment of delirium
Low dose haloperidol
Myasthenic crisis, what do you want to measure?
FVC with spirometry
What might the PR interval being prolonged indicate in infective endocarditis?
It’s a poor prognostic marker
Indicates greater mortality
This is because it’s associated with an aortic root abscess
What is Waterhouse-Freidrichson syndrome?
Waterhouse-Friderichsen’s syndrome is caused by a severe bacterial infection which results in disseminated intravascular coagulation and subsequent adrenal haemorrhage and failure.
Investigations for bladder cancer
Urine dip
Flexible cytoscopy
Histological sampling
CT urogram
Features of pseudobulbar palsy
UMN signs Dysphagia Difficulty with speech Small stuff tongue Exaggerated gag reflex
Features of bulbar palsy
LMN signs
Absent gag reflex
Floppy tongue because hypotonia
Features of femoral nerve damage
Loss of sensation to front of thigh and medial leg
Absent knee jerk
Operation for a Achalasia
Heller myotomy
Whenever the patient doesn’t eat for a while they get dizzy and agitated. Gained a lot of weight recently. Ix and Dx
C peptide levels
Insulinoma
What is a myxoedema coma?
Extremely low levels of thyroxine
Low BP low HR and temperature
Jaundiced gentleman with distended abdomen and prominent abdominal veins. Most likely cause =
Alcoholic liver disease
Rx for hypospadias
Surgical correction
Features of a Monteggia fracture
Ulna fracture
Radial displacement
Features of Galazzi fracture
Radial fracture
Ulna displacement
Features of bowel obstruction
Abdominal pain Vomiting Not passing stool Tinkly bowel sounds Distended abdomen
What is proctalgia fugax?
Stabbing anal pain
Features of a pantaloon hernia
2 parts
Straddles the inferior epigastric artery
If unconscious what type of breathing tube is needed?
Endotracheal tube
The others are for partially conscious/impaired consciousness.
If unconscious they will not be able to maintain their airway!
Get an endotracheal tube down
What Ix for a psoas abscess?
Abdominal MRI
Ix for ectopic
B-Hcg
TVUSS
Sx of ectopic
Amennorhoea
Abdominal pain
Spotting
Shoulder tip pain
Sudden onset knee pain and swelling
Pt complains of the knee ‘locking’
Dx & Mx
Osteochondritis dissecans
A fragment of bone is stuck in the knee, ouch
Need key hole surgery to remove it
What is the pathophysiology of Osgood Schlatter disease?
Repeated rubbing of the patella tendon across the knee growth plate
That’s why you see it in young athletes!
What is chondromalacia patellae?
Chronic overuse of knee leads to damage and inflammation to the underside of the patella (the cartilage)
It becomes rough and painful to move across the cartilage
In short, damage to the cartilage underneath the patella
Which 3 components to breast lump triple assessment
Examination Scan (USS in young women, mammography for older) FNA/core biopsy Core biopsy for histology FNA for cytology
What is Cushing’s disease?
ACTH secreting tumour in the pituitary
Pt up who had Cushing’s syndrome had their adrenals removed, but now they have darkening skin and high BP
Dx?
Nelsons syndrome
The original cause for their Cushing’s was an ACTH secreting tumour
Now that the negative feedback is gone, it has grown loads and is making loads of ACTH hence the tanning (like Addison’s disease)
Symptoms of Conn’s syndrome
Excessive thirst. Fatigue. Frequent urination. Headache. Muscle cramps. Visual disturbances. Weakness or tingling
All caused by excess aldosterone
Surgical procedure for rectal tumours
Abdominoperineal resection
Mx of colorectal cancer
MDT Staging Radiotherapy Chemotherapy Surgery and potential stoma
Features of an incarcerated hernia
Painless and persistent
Features of a strangulated hernia
Twisted around blood supply
Painful
May have signs of bowel obstruction
Fleshy, rubbery lesions, often on torso
When you touch them they tingle
Neurofibromas
Which type of neurofibromatosis is more related to cutaneous issues?
1
Treeman is number 1!
Which movements are performed by each of the arm nerves
Radial = extend at wrist Median = scout sign Ulna = abduct fingers
Which nerve does a humeral fracture often damage?
Radial nerve
What is the difference between a radial nerve injury and a posterior interosseous nerve injury?
Both cause wrist drop
No sensation loss in posterior interosseous injury
Still have sensation on back of thumb and scaphoid. Wouldn’t in radial injury.
What is a pleomorphic adenoma?
Hard lump on jaw angle
Painless
NO FACIAL NERVE INVOLVEMENT
What is the pathology and presentation of an acoustic neuroma?
Benign tumour of the Schwann cells of the vestibular cochlear nerve
May have facial nerve involvement
Sensorineural hearing loss and facial tingling
Which type of hearing loss do you get in otosclerosis?
Conductive hearing loss
Because the stapes (middle ear) is fixed
Features of splenic injury
Elevated left diaphragm
LUQP
Guarding
Which bacteria are encapsulated?
Meningococcus
Pneumococcus
Symptoms of salivary gland calculus
Swelling and pain on eating
Management of SUFE
Surgery with screw, potentially the other side as well
Features of incisional hernia
Late complication of abdominal surgery
Usually managed conservatively if stable
What Ix should you consider for ulcers?
USS Doppler
Need a skilled operator but can determine if there is a deep vein issue that may benefit from surgery (can often really benefit)
What is erysipelas?
Superficial streptococcal infection
Mx of erysipelas
IV antibiotics to avoid cellulitis and sepsis
What is paronychia?
Infection of the nail
Mx of paronychia
Antiseptic cream
If gets big, need to cut and drain it (seen in A&E)
What should you do for a Dupytrens that is interrupting function?
Operate
Causes of Dupytrens contracture
Liver disease
Anti epileptics
Peyronie disease
How long do upper limb fractures take to heal?
6-8weeks
Factors that affect healing
Body habitus Blood supply Drugs Diabetes Steroid use
