Practice Paper 3 Flashcards
What is the treatment for acute coronary syndrome?
300mg aspirin Clopidogrel Treatment dose heparin b-blocker stat GTN spray Morphine
From LAZ:
o Admit to coronary care unit
o Oxygen, IV access, monitor vital signs and serial ECG
o GTN
o Morphine
o Metoclopramide (to counteract the nausea caused by morphine)
o Aspirin - 300 mg initially, followed by 75 mg indefinitely.
o Clopidogrel (300 mg initially, followed by 75 mg for at least 1 year if troponin positive or high risk)
o LMWH (e.g. enoxaparin)
o Beta-blocker (e.g. metoprolol)
Pt presents to gp with painless haematuria Has a recent history of a sore throat He is producing less urine and the urine is brown There are no other symptoms BP is 155/90 \+++ blood on urine dip High creatinine What do you suspect?
Nephritic syndrome triad:
- Hypertension
- Proteinuria
- Haematuria
What is nephritic syndrome?
Nephritic syndrome is a syndrome comprising signs of nephritis, which is kidney disease involving inflammation.
It often occurs in glomerulonephritis, which is characterized by a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins and red blood cells to pass into the urine
Whats the difference between nephritic syndrome and nephrotic syndrome?
Nephritic = both blood and protein move into urine Nephrotic = ONLY protein
Tell me about digoxin
Its used for the treatment of chronic heart failure
Its an inotrope
it does NOT improve survival
It works by blocking the na/k pump causing a rise in iIC na which via na/ca exchange increases the IC conc of ca and hence contractility (inotrope).
It hence increases the AV delay and the HR is indirectly slowed.
Define hodgkins lymphoma
Lymphomas are neoplasms of lymphoid cells, originating in the lymph nodes or other
lymphoid tissues.
Hodgkin’s lymphoma (15% of all lymphomas) is diagnosed histopathologically by the PRESENCE OF REED-STERNBERG CELLS (BINUCLEATE LYMPHOCYTES)
Whats the aetiology of Hodgkins lymphoma?
Unknown
EBV trigger in 50% (“glandular fever”)
Epidemiology of hodgkin’s lymphoma
MALES
bimodal: peaks at 20-30 and >50
What are the PC of hodgkins?
• Painless enlarging mass (unilateral)
o Most commonly in the neck
o Can also be in the axilla or groin
• The mass may become painful after ALCOHOL INGESTION
• B symptoms of Lymphoma
o Fever > 38 degrees - If this is cyclical it is referred to as Pel-Ebstein fever
o Night sweats
o Weight loss > 10% body weight in the past 6 months
- these are associated with a worst prognosis.
• Other symptoms
o Pruritis
o Cough
o Dyspnoea
Recognise the signs of Hodgkin’s lymphoma on physical examination
• Non-tender firm rubbery lymphadenopathy***
(may be cervical, axillary or inguinal)
• Splenomegaly (or sometimes, hepatosplenomegaly)
• Skin excoriations
• Signs of intrathoracic disease (e.g. pleural effusion, superior vena cava obstruction)
What is the staging for hdgkin
• Ann Arbor Staging
o I = single lymph node region
o II = 2+ lymph node regions on one side of the diaphragm
o III = lymph node regions on both sides of the diaphragm
o IV = extranodal involvement
o A = absence of B symptoms
o B = presence of B symptoms
o E = localised extranodal extension
o S = involvement of spleen
Define psoriasis
• A chronic inflammatory skin disease, which has characteristic lesions and may be complicated by arthritis
Recognise the PC of psoriasis
Recognise the presenting symptoms of psoriasis
• Itching and occasionally tender skin
• Pinpoint bleeding with removing scales (Auspitz phenomenon)
• Skin lesions may develop at sites of trauma/scars (Koebner phenomenon)
Recognise the sings OE for psoriasis
Recognise the signs of psoriasis on physical examination
• Discoid/Nummular psoriasis - symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces (knee, elbows, scalp, sacrum)
- Flexural psoriasis - less scaly plaques in axilla, groins, perianal and genital skin
- Guttate psoriasis - small drop-like lesions over trunk and limbs
- Palmoplantar psoriasis - erythematous plaques with pustules on palms and soles
- Generalised pustular psoriasis - pustules distributed over limbs and torso
- Nail Signs
How does psoriatic arthritis present
• Joint Signs M FIVE presentations of psoriatic arthritis
o Asymmetrical oligoarthritis
o Symmetrical polyarthritis
o Distal interphalangeal joint predominance
o Arthritis mutilans
o Psoriatic spondylitis
What are the main causes of subarachnoid haemorrhages?
- 85% - rupture of a saccular aneurysm at the base of the brain (Berry aneurysms)
- 10% - perimesencephalic haemorrhage
- 5% - arteriovenous malformations, bleeding diathesis, vertebral artery dissection
What are the main RF for subarachnoid haemorrhages?
• Risk Factors
o Hypertension
o Smoking
o Excess alcohol intake
o Saccular aneurysms are associated with:
• Polycystic kidney disease
• Marfan’s syndrome
• Ehlers-Danlos syndrome
What are the presenting symptoms of subarachnoid haemorrhage?
- Sudden-onset worst headache ever THUNDERCLAP
- Nausea/vomiting
- Neck stiffness
- Photophobia
- Reduced level of consciousness
Recognise the signs of subarachnoid haemorrhage on physical examination
Meningism :
o Neck stiffness
o Kernig’s sign
o Pyrexia
What do you expect to find on a LP of a sub. haem?
Xanthochromia = straw-coloured CSF due to breakdown of red blood cells
requires at least 6hrs to show up though - until the rbc break down.
What do you expect to find on a CT scan of sub. haem?
• CT Scan
Hyperdense areas in the basal regions of the skull (due to blood)
What investigations do you do for sub. haem?
• Bloods o FBC o U&Es o ESR/CRP o Clotting
• CT Scan
o Hyperdense areas in the basal regions of the skull (due to blood)
• Angiography - detect source of bleeding
• Lumbar Puncture
o Increased opening pressure
o Increased red cells
o Xanthochromia - straw-coloured CSF due to breakdown of red blood cells
What’s the antidote for paracetamol overdose?
N-acetylcysteine
Whats’s the antidote for opiate overdose?
Naloxone
What is the CURB65 score and what is it used for?
Used to asses severity/management of pneumonia Confusion Urea >7 RR>30 BP low 65< yrs old
On examining a patient with a weak regular pulse, ejection systolic murmur.
When they lean forward so you can palpate their apex beat in expiration they get flustered and complains of a sore back and SOB.
What are you thinking?
Aortic stenosis
Ejection systolic murmur is classic of aortic stenosis
Rheumatic fever is a rf - most comon cause wordlwide.
What is the most common cause of aortic stenosis?
Age related calcification
What are aortic stenosis complications?
Heart failure
Angina
Heyde syndrome (colonic angiodysplasia and lower GI bleed)
Explain the aetiology and risk factors of aortic stenosis
- Stenosis can be secondary to rheumatic heart disease (MOST COMMON WORLDWIDE)
- Calcification of a congenital bicuspid aortic valve
- Calcification/degeneration of a tricuspid aortic valve in the elderly
Recognise the presenting symptoms of aortic stenosis
• May be ASYMPTOMATIC initially
• Angina (due to increased oxygen demand of the hypertrophied left ventricle)
• SYNCOPE or dizziness on exercise (due to outflow obstruction)
–> classic elderly patient falls for no reason and comes to a&e then you discover aortic murmur.
• Symptoms of heart failure (e.g. dyspnoea, orthopnoea)
Recognise the signs of aortic stenosis on examination
Recognise the signs of aortic stenosis on examination
• Narrow pulse pressure
• Slow-rising pulse
• Thrill in the aortic area (only if severe)
• Forceful sustained thrusting undisplaced apex beat
• EJECTION SYSTOLIC MURMUR** at the aortic area, radiating to the carotid artery
• Second heart sound may be softened or absent (due to calcification)
• A bicuspid valve may produce an ejection click
What are the signs you expect to find for aortic stenosis on ECG?
• ECG Signs of left ventricular hypertrophy • Deep S in V1/2 • Tall R in V5/6 • Inverted T waves in I, aVL and V5/6 • Left axis deviation
LBBB signs
WilliaM v1,v6
Common AB and their side effects
Co-amoxiclav = cholestatic jaundice Erythromycin = diarrhoea Gentamicin = nephrotoxicity
What scoring system is used to predict risk of pressure sores in patients?
Waterlow
Define obstructive sleep apnoea
A disease characterised by recurrent prolapse of the pharyngeal airway and apnoea (cessation of airflow for > 10 s) during sleep, followed by arousal from sleep.
Also known as Pickwickian Syndrome
What’s obstructive sleep apnoea associated with?
Associated with: Weight gain - OBESE Smoking Alcohol Sedative use Enlarged tonsils and adenoids in children Macroglossia Marfan's syndrome Craniofacial abnormalities
How does obstructive sleep apnoea occur?
Occurs due to narrowing of the upper airways because of the collapse of soft tissues of the pharynx
This is due to decreased tone of the pharyngeal dilators during sleep
Recognise the presenting symptoms of obstructive sleep apnoea
TIREDNESS Excessive daytime sleepiness Unrefreshing or restless sleep Morning headaches Dry mouth Difficulty concentration Irritability and mood changes Partner reporting snoring, nocturnal apnoeic episodes or nocturnal choking
In an SBA what does “work in a shipyard” indicate?
Asbestos exposure
Define mesothelioma
Aggressive tumour of the mesothelial cells, which
usually occurs in the pleura (90%) but can also occur in other sites, such as the peritoneum, pericardium and testes.
Whats the RF of mesothelioma
ASBESTOS ** (shipyard exposure)
has a latent period of 50years
Summarise the epidemiology of mesothelioma
- RARE
- More common in ELDERLY (> 75 yrs)
- Asbestos exposure is documented in 70M80% of cases
- Latent period between asbestos exposure and mesothelioma may be up to 50 yrs
Recognise the presenting symptoms and signs of mesothelioma
• MOST COMMON symptoms:
o SOB
o Chest pain (dull, diffuse and progressive)
WORST ON INHALATION = pleural chest pain
o Weight loss
• Occasionally palpable chest wall mass
• Fatigue
• Fever
• Night sweats
• Clubbing (due to underlying asbestosis (pulmonary fibrosis))
• Signs of metastases (e.g. hepatomegaly, bone pain and tenderness)
What ix will you do for mesothelioma?
• CXR/CT
o Shows pleural effusion
o May show a pleural mass and rib destruction
- MRI and PET
- Pleural fluid - can be sent for cytological analysis and may be blood-stained
- Pleural biopsy
What would help distinguish between angina and myocardial infarction?
raised troponin levels = MI
What’s the classic presentation for colonic carcinoma on CT or barium enema?
apple core lesion
Whats the classic px of crohns on barium enema of the colon?
“cobble stoning” PATCHY throughout colon
rosy thorne ulcer
colonic strictures
Whats the classic px of UC on barium enema of the colon?
CONTINUOUS changes from recturm proximally
loss of haustra on plain film
colon appears shorter
Which sign would you NOT expect to see on a cauda equina pt?
Upgoing plantars- They should be normal
Upgoing plantars would indicate a lesion higher up.
Which nerve roots are compressed in saddle anesthesi
s3-s5
Whats coeliac disease?
An inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption.
Which component of gluten specifically irritates the bowel?
gliadin
Recognise the presenting symptoms of coeliac disease
- May be asymptomatic
- Abdominal discomfort, pain and distention
- Steatorrhoea (pale bulky stool, with offensive smell and difficult to flush away)
- Diarrhoea
- Tiredness, malaise, weight loss (despite normal diet)
- Failure to ‘thrive’ in children
- Amenorrhoea in young adults
Recognise the signs of coeliac disease on physical examination
• Signs of anaemia: pallor
• Signs of malnutrition:
o Short stature
o Abdominal distension
o Wasted buttocks in children
o Triceps skinfold thickness gives indication of fat stores
• Signs of vitamin/mineral deficiencies: osteomalacia, easy bruising
• Intense, itchy blisters on elbows, knees or buttocks (dermatitis herpetiformis)
Identify appropriate investigations for coeliac disease
Identify appropriate investigations for coeliac disease • Blood: o FBC (low Hb, iron and folate) o U&E o Albumin o Calcium o Phosphate
• Serology:
o IgG anti-gliadin antibodies***, IgA and IgG anti-endomysial tranglutaminase antibodies can be diagnostic
o NOTE: IgA deficiency is quite COMMON (1/50 with coeliac) so Ig levels should be measured to avoid false negatives
- Stool: culture to exclude infection, faecal fat tests for steatorrhoea
- D-xylose test: reduced urinary excretion after oral xylose indicates small bowel malabsorption
• Endoscopy: allows direct visualisation of villous atrophy in the small intestine (mucosa appears flat and smooth)
o Biopsy will show villous atrophy and crypt
hyperplasia in the duodenum
o The epithelium adopts a cuboidal appearance - there is an inflammatory infiltrate of lymphocytes and plasma cells in the lamina propria
What exactly happens in coeliac disease with gliadin ingestion?
Exposure to gliadin triggers and immunological reaction in the small intestine leading to mucosal damage and loss of villi
Generate a management plan for coeliac disease
- Advice: avoid gluten (wheat, rye and barley products)
* Medical: vitamin and mineral supplements. Oral corticosteroids if disease does not subside with avoidance of gluten
Identify the possible complications of coeliac disease
- Iron, folate and B12 deficiency
- Osteomalacia
- Ulcerative jejunoileitis
- GI lymphoma (particularly T cell) *
- Bacterial overgrowth
- Cerebellar ataxia (rarely)
What is delirium tremens?
What are the complications?
What is the treatment?
A syndrome of delirium, autonomic activation and agitation brought on by acute detoxification from alcohol
It is a terrifying and life threatening confusional state
35% mortality if untreated
It can progress to seizures and heart arrhythmias
Its important tot keep monitoring vital signs in these pts - bp drops.
Treatment is with benzodiazepines.
What should you suspect in a pt with known cancer and vague abdominal symptoms?
Hypercalcaemia
Explanation: metastasis from primary cancer to the bone causing hypercalcaemia. Hypercalcaemia symtpoms are “bones, abdominal groans, mones, stones”
Which explain these vague unspecific abdominal symptoms
Which cancers are prone to met to the bones?
Breast Bronchus Kidney Prostate Thyroid Myeloma
What diseases and things can cause Disseminated Intravascular Coagulation? And how.
Meningococcal septicaemia E Coli Strep pneumonia Malaria Lung cancer Pancreatic caner
Diffuse endothelial damage leads to widespread tissue factor expression thus activating intravascular coagulation and consuming platelets, factors 5 and 8 and fibrinogen. This causes the pt to enter a haemorrhagic state.
Recognise the symptoms OE of DIC pt
o Petechiae, purpura, ecchymoses o Epistaxis o Mucosal bleeding o Overt haemorrhage o Signs of end organ damage o Respiratory distress o Oliguria due to renal failure
What does a full blood count of a DIC pt show
- Low platelets
- Low Hb
- High APTT/PT
- Low fibrinogen
- High fibrin degradation products
- High D-dimers
What confirms the diagnosis of gout?
Needle shaped rystals showing negative birefringence under polarised light
What crystals cause pseudogout?
Calcium pyrophosphate crystals
How is pseudogout seen under polarised light?
Brick shaped positive birefringence crystals and under polarised light
Why does gout occur
It occurs secondary to the deposition of uric acid crystals in the joint
Who is a classic gout pt
Older Male Obese Drinker - PUBLICAN **** With Htn, ischaemia, diabetes
How does gout usually present?
Sudden onset sharp pain, swelling, redness in the first metataatrsophalangeal joint (PODAGRA)
25% of cases occur in the knee
How is gout treated?
NSAID’s
Allopurinol (xanthine oxidase inhibitor that slows the production of uric acid) - in recurrent pt’s
Where does chronic tophaceous gout often present at
In cartilage
Usually ear and Achilles tendon.
Post op pt presents with SOB what do you suspect
PE
What criteria is used to stratify PE risk
Well’s criteria
4 or less = low probability - use D-dimer
above 4 = high probability - required imaging (CTPA)
What is a PE
a blood clut in the lung vasculature
LAZ:
Occlusion of pulmonary vessels, most commonly by a thrombus that has travelled to the pulmonary vascular system from another site
What are the features of a PE?
acute onset pleuritic chest pain
SOB
fever
tachycardia
What are d-dimers?
Breakdown product of clots
a low d dimer excludes a PE
a high level does NOT confirm a PE though.
Whats a CTPA?
Computer tomography pulmonary angiography is the best investigation
if its -ve its not pe for sure - no further investigations required .
Treatment of PE
Heparin or LMWH and then Wargarin for 6 months
What level of INR are you aiming for?
2-3
the normal range
If haemodynamically UNSTABLE - massive pe - how do you manage
Resuscitate
O2
IV fluids
*Thrombolysis with tPA may be considered if cardiac arrest is imminent
Is there sensory loss in parkinsons disease?
no
Why is colour and central vision most commonly affected in MS?
because the axons conducting messages from the cone cells (colour vision and high acuity central vision) are myelinated
Unlike the ones conducting messages from the rod cells (dark vision and peripheral vision).
Define multiple sclerosis
• Inflammatory demyelinating disease of the CNS
What are the 3 main types of MS?
Relapsing-Remitting –> COMMONEST form
• Clinical attacks of demyelination with complete recovery in between attacks
Clinically Isolated Syndrome
• Single clinical attack of demyelination
• The attack in itself does NOT count as MS
• 10-50% progress to develop MS
Primary Progressive MS
• Steady accumulation of disability with NO relapsing-remitting pattern
Marburg Variant
• Severe fulminant variant of MS leading to advanced disability or death within weeks
What’s the aetiology of MS?
UNKOWN
possible connection to EBV
Summarise the epidemiology of multiple sclerosis
- UK prevalence: 1/1000
- 2 x as common in FEMALES
- Age of presentation: 20M40 yrs
Recognise the presenting symptoms of multiple sclerosis
Recognise the presenting symptoms of multiple sclerosis
• Varies depending on the site of inflammation
Optic Neuritis (COMMONEST)
o Unilateral deterioration of visual acuity and colour perception
o Pain on eye movement
o Common first symptoms of multiple sclerosis
Sensory
o Pins and needles
o Numbness
o Burning
Motor o Limb weakness o Spasms o Stiffness o Heaviness
Autonomic o Urinary urgency o Hesitancy o Incontinence o Impotence
Psychological
o Depression
o Psychosis
Whats Uhthoff’s Sign
• Uhthoff’s Sign - worsening of neurological symptoms as the body gets overheated from hot weather, exercise, saunas, hot tubs etc.
What’s Lhermitte’s Sign
• Lhermitte’s Sign - an electrical sensation that runs down the back and into the limbs
when the neck is flexed
What’s the McDonald criteria
Diagnosis is based on the finding of two or more CNS lesions with corresponding symptoms, SEPERATED IN TIME AND SPACE.
eg: presents now with weakness in arm and 1 year ago had an episode of loss of vision (optic neuritis)
What are the expected results of MS on LP?
unmatched oligoclonal bands
What enchancement is used for scans in MS diagnosis?
Gadolinium
Pt presents with left sided weakness of sudden onsett
L arm power = 0
left leg power = 3/4
Reduced reflexes throughout
Sensation absent in the arm and reducecd in the leg
CN exam = can’t see left hand side
Lower half of her left face is weak (she can raise her eyebrow)
Which vacular territory is affected?
Middle cerebral artery
What sort of symptoms do you expect to see in an ANTERIOR cerebral artery stroke?
Lower limb weakness
Confusion
What sort of symptoms do you expect to see in an MIDDLE cerebral artery stroke?
HEMI - …
! Facial weakness ! Hemiparesis (motor cortex) ! Hemisensory loss (sensory cortex) ! Apraxia ! Hemineglect (parietal lobe) ! Receptive or expressive dysphasia (due to involvement of Wernicke's and Broca's areas) ! Quadrantopia (if superior or inferior optic radiations are affected)
What sort of symptoms do you expect to see in an POSTERIOR cerebral artery stroke?
More cerebellar like symptoms:
- Posterior Cerebral M hemianopia
- Anterior Inferior Cerebellar - vertigo, ipsilateral ataxia, ipsilateral deafness, ipsilateral facial weakness
- Posterior Inferior Cerebellar (affected in lateral medullary syndrome) - vertigo, ipsilateral ataxia, ipsilateral Horner’s syndrome, ipsilateral hemisensory loss, dysarthria, contralateral spinothalamic sensory loss
- Basilar Artery - cranial nerve pathology and impaired consciousness
- Multiple Lacunar Infarcts - vascular dementia, urinary incontinence, gait apraxia, shuffling gait, normal or excessive arm-swing
- Intracerebral - headache, meningism, focal neurological signs, nausea/vomiting, signs of raised ICP, seizures
45yo male smoker with 4month history of productive cough and exertional breathlesness. What are you thinking?
COPD
define COPD
Cough with sputum for most days of a 3month period on two consecutive years
Define emphysema
Pathological destructive enlargement of the alveoli
Whats cor pulmonale
Abnormal enlargement of the right side of the heart as a result of disease of the lungs (COPD) or the pulmonary blood vessels.
What are the features of COPD on examination
INSPECTION Respiratory distress Use of accessory muscles Barrel-shaped over-inflated chest * Decreased cricosternal distance Cyanosis
PERCUSSION
Hyper-resonant chest
Loss of liver and cardiac dullness
AUSCULTATION Quiet breath sounds Prolonged expiration Wheeze Rhonchi - rattling, continuous and lowMpitched breath sounds that sounds a bit like snoring. They are often caused by secretions in larger airways or obstructions Sometimes crepitations
SIGNS OF CO2 RETENTION
Bounding pulse
Warm peripheries
Asterixis
LATE STAGES: signs of right heart failure (cor pulmonale)
Right ventricular heave
Raised JVP
Ankle oedema
What does PEFR and spirometry look like in a COPD pt?
Shows obstructive picture: Reduced PEFR Reduced FEV1/FVC Increased lung volumes Decreased carbon monoxide gas transfer coefficient
Generate a management plan for COPD
STOP SMOKING
Bronchodilators
SABA (e.g. salbutamol)
Anticholinergics (e.g. ipratropium bromide)
LABA (if > 2 exacerbations per year)
Steroids
Inhaled beclamethasone - considered in all patients with FEV1 < 50% of predicted OR > 2 exacerbations per year
Regular oral steroids should be avoided if possible
Pulmonary rehabilitation
Oxygen therapy
Only for those who stop smoking
Indicated if:
PaO2 < 7.3 kPa on air during a period of clinical stability
Identify the possible complications of COPD
Acute respiratory failure Infections Pulmonary hypertension Right heart failure Pneumothorax (secondary to bullae rupture) Secondary polycythaemia
What sort of AB do you expect a patient to be on who has recently developed c diff diarrhoea?
Co-amoxiclav
Clarithromycin
What’s the best treatment plan for C diff?
Oral vancomycin
What are classic features of GORD?
Obese pt
Intermittent burning central chest pain
Occurs on lying down
Smoker
Alcoholic
Pregnant woman
Hiatal hernia history
What’s the mx of GORD?
CONSERVATIVE FIRST: o Weight loss o Elevating head of bed o Avoid provoking factors o Stop smoking o Lower fat meals o Avoid large meals late in the evening
MEDICAL: o Antacids o Alginates o H2 antagonists (e.g. ranitidine) o Proton pump inhibitors (e.g. lansoprazole,
ENDOSCOPY:
o Annual endoscopic surveillance - looking for Barrett’s Oesophagus
o May be necessary for stricture dilation or
SURGERY:
o Antireflux surgery if refractory to medical treatment
NISSEN FUNDOPLICATION:
o Fundus of the stomach is wrapped around the lower oesophagus - helps reduce the risk of hiatus hernia and reduce reflux
Identify the possible complications of GORD
- Oesophageal ulceration
- Peptic stricture
- Anaemia
- Barrett’s oesophagus
- Oesophageal adenocarcinoma
- Associated with asthma and chronic laryngitis
What would you suspect with a hr of 300bpm
Atrial flutter
What would you suspect with a hr of 140-220 bpm
AVN re-entry tachycardia.
What’s moloscum contagiosum?
A common skin infection caused by a pox virus that affects children and adults.
Transmission is usually by direct skin contact.
What are the risk factors of moloscum contagiosum?
o Mainly in CHILDREN
o Immunocompromised * (AIDS)
o Atopic eczema
Recognise the signs of molluscum contagiosum on physical examination
• Firm, smooth, UMBILICATED* papules
• Usually 2-5 mm in diameter
• In children - tends to occur on the trunk
and the extremities
• In adults - tends to occur on the lower abdomen, genital area and inner thighs (suggesting sexual contact)
How does pneumothorax present?
Acute onset pleuritic (unilateral) chest pain ** SOB No associated trauma Could or could not have a pmh of lung disease (COPD) No temperature High RR
What does a CXR show with pneumothorax?
Small rim of air between the lung edge and chest wall
How would a tension pneumothorax present?
Distress with rapid shallow breathing in te
How do you treat a pneumothorax?
Chest Drain with Underwater Seal
Inserted in the 4th-6th intercostal space midaxillary line
Performed if:
Aspiration fails
Fluid in the pleural cavity
After decompression of a tension pneumothorax
52yo pt with history of alcoholism presents: can’t fully extend his ring finger on his R hand. Its permanently partially flexed
What is this
Dupuytren contracture
Define SLE
• Multi-system inflammatory autoimmune disorder
What is the mnemonic for SLE?
SOAP BRAIN MD
o Serositis
o Oral ulcers
o Arthritis (non-erosive)
o Photosensitivity
o Bloods (haemolytic anaemia/ leukopaenia /thrombocytopaenia)
o Renal disease (urine casts/proteinuria)
o ANA
o Immunological disorder (antidsDNA /anti-Sm/ anti-phospholipid)
o Neurological disease (psychosis/seizures)
o Malar rash
o Discoid rash
Summarise the epidemiology of SLE
Summarise the epidemiology of SLE • COMMON • 1-2/1000 • More common in the YOUNG * • More common in AFRO-CARIBBEAN and CHINESE * • 9 x more common in FEMALES *
What autoantibodies are present in SLE?
o Anti-dsDNA (60%) o Rheumatoid factor (30-50%) o Anti-ENA o Anti-RNP o Anti-SM o Anti-Ro o Anti-La o Anti-histone o Anti-cardiolipin (anti-phospholipid)
What is spironolactone MOA?
Is an aldosterone antagonist which will increase serum K
Which 4 symptoms BEST describe parkinsons?
Bradikynesia
Postural inability
Rigidity
Tremor (10-12Hz)
