Random Flashcards
In the management of a patient with DKA, what is the most important factor:
give vigorous IV fluids
Patient with chest pain history and ECG finding ST elevation all leads
Pericarditis
Patient has upper abdominal pain, in which one of the following conditions will the pain not radiate to the back:
a. PUD
b. perforated appendicitis
c. acute pancreatitis
d. AAA (rupture?)
e. biliary colic
Which are retroperitoneal
S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)esophagus
R: rectum
THerefore biliary colic
70 y/o male patient presents with weight loss, anorexia and constipation. Bloods show a microcytic anaemia. Which diagnosis is likely:
a. carcinoma of sigmoid colon
b. small bowel tumour
c. angiodysplasia of caecum
d. PUD
e. rectal polyp
A
Anorexia - cancer
Age - cancer
Constipation - obstruction
Microcytic anaemia - Iron deficient
Footballer injures shin during game, thereafter has painful toes, bandaging and analgesia do not relieve pain which is getting worser. What would you do next
Compartment syndrome
Decompress with fasciotomy
Patient has left homonymous hemi-anopia. Where is the lesion
Right Occipital Lobe
35 y/o female presents spitting blood 1 week post-tonsillectomy. What type of bleed is this
secondary
Patient presents with midline swelling that moves on tongue protrusion
thyroglossal cyst
Patient present with chronic suppurative chronic external otitis media. Which is most common symptom
conductive hearing loss
Middle-aged male eats fruit & nut chocolate bar. 15 minutes later he becomes short of breath and has stridor. How would you treat him
IM adrenaline
Patient is a slow eater, chest x-ray shows… , barium swallow shows tapering of the oesophagus distally. Diagnosis is
achalasia
DM fundoscopy. Proliferative retinopathy involves
neovascularization
50 y/o patient present s with headache, protruding L eye with a droop and dilated pupil. What is diagnosis
cavernous sinus aneurysm
?
20 y/o female, presents with painless irregular lump in L breast. Skin dimpling and tethering are present. No nodes on L are palpable. What is the diagnosis
GO OVER BREAST CANCER
Iron deficiency anaemia associated with MCV
Microcytic Anaemia
Anaemic patient with leg ulcers and priapism suffers from
Sickle Cell
Mid-diastolic murmur in a patient who has atrial fibrillation controlled by digoxin
Mitral Stenosis
Which ECG leads would suggest an inferior MI:
Ii III aVF
Male patient presents with history of shaft of femur fracture 1-2 weeks post-op. He has bilirubin of 80 and is jaundiced. There are no other symptoms and all other LFTs are normal. What is the likely cause
Gilberts
26 y/o builder, 3 hour history of R colic which radiates into genitalia and lasts ½ hour at a time. He also vomits and has microscopic haematuria:
a. UTI
b .ureteric colic
c. testicular torsion
d. bladder cancer
e. renal tuberculosis
Ureteric Colic
65 y/o female, 10 days post-THR, has chest pain, HR: 110 bpm, BP: 110/80, JVP: +15cm. The investigation of choice is
CTPA for PE
13 y/o female, has argument with grandmother and takes 12 tablets of 10mg diazepam. How will you treat her
flumazenil
80 y/o male with hypertension and atrial fibrillation. How would you reduce the risk of “embolic stroke”:
Warfarin
Male with alcoholic cirrhosis. On examination percussion dullness and fluid suggest ascites. USS shows fluid and diagnostic ascetic tap show sterile transudate with no malignant cells. He is not SOB. First line treatment
Sprio
70 y/o female with SOB on exertion has ejection systolic murmur, diagnosis
Aortic stenosis
26 y/o male homosexual footballer has fever, SOB and cough. He is admitted for 2 weeks and treated for pneumonia. He is very ill, however decides to self-discharge, what advice would you give him
IF TB then notifiable disease and keep in by force
Otherwise - to advise to stay
50 y/o male smoker has a cough, hoarseness and a “breathy” voice. There are no findings on examination. Nasoendoscopy reveals a vocal cord palsy. What investigation would you do next
Chest X ray for lung mets
Patient presents with hepatosplenomegaly, but no lymphadenopathy. Bloods show ↑ plt ,↑ wbc, ↓ hb. Blood film shows Philadelphia
CML
Patient with increased BP has coarctation of aorta, which of the following sign
radio femoral
Patient 5 days post-anterior resection operation. The fluid balance chart shows
-1370 ml/24 hr. What is the likely cause
third space losses
Old male presents in A&E with 1 day history of acute L eye pain. The cornea was cloudy and the pupils mid-dilated. What is the diagnosis
acute closed angle glaucoma
Hypernatraemia is associated with:
a. Cirrhosis of the liver
b heart failure
c. SIADH
d. diabetic coma
diabetic coma
others cause hypo
A patient and his family present with history of itching. Likely diagnosis
scabies
An old male with diabetes present complaining of hand pain at night relieved by shaking etc. What is the likely cause
CTS
An old lady with rheumatoid arthritis presents with gradual reduction in visual acuity. What is the likely cause
Steroid induced glaucoma
A patients blood film shows rouleaux formation and his bloods show
↓ hb, ↓ plt, ↓ wcc, ↑Ca2+. What is the likely diagnosis
Myeloma
A patient presents with haematuria 1 week post-URTI. What is the likely cause:
IgA nephropathy (Berger’s Disease)
An alcoholic patient vomits blood. He has surgical emphysema etc. etc. What is the likely cause
lower oesophageal rupture
Patient has cellulitis of leg. You need to prescribe an antibiotic. Which organism would you ensure you covered
Haemolytic streptoccoi
treat trichomonas
Metronidazole
AMitriptaline overdose
IV bicarb
How do you treat HIV encecphalitis
(toxoplasma gondii)
pyrimethamine plus sulfadiazine or clindamycin
Pneumovax indications
all over 65
defunctioning spleen
chronic resp conditions
chronic heart, kideny, liver conditions
immunosupressed
cochlear implants
CSF leak
occupational hazard
TB meningitis treatment
rifampicin + isonoazid + pyrazinamide + ethambutol
An old male presents with a unilateral swelling of the parotid gland. On
examination cranial nerve VII function has not been affected
Pleopmorphic adenoma
- 80% of tumours in the parotid are benign pleopmorphic adenomas
- Typically: middle age, slow growth
- Removed by superficial parotidectomy or enucleation. Radiotherapy has a role eg in residual disease or recurrence (recurrence rate of 1-2% at 12 years)
VII nerve paresis suggests malignancy
- Rapid growth, hard fixed mass, pain and VII nerve palsy
Non-necrotising granulomas found in
- Chron’s: non-necrostising granulomas are found within the inflammation in the gut wall.
- Sarcoidosis: get graulomas in multiple organs. Most do not contain necrosis and are surrounded by concentric scar tissue (fibrosis).
caseating granulomas found in
- TB: Said to be caseating – grossly visible cheese like appearance
- Wegeners granulomatosis
A lady presents with constipation, abdominal pain and vomiting. She has
other symptoms suggestive of malignancy. most important/first line investigation
Calcium
ABCDEFGHI
of vomiting
- Acute renal failure/Addisons, brain (eg raised ICP), cardiac (MI), DKA, ears (labyrinthitis, Menieres), foreign substances (alcohol, drugs), gravidy (eh hyperemesis gravidarum), hypercalcamia/hyponatraemia, infection (eg UTI, meningitis)
Isosorbide mononitrate
- postural hypotension, fast/fluttering heart beat, flushing
Frusemide
postural hypotension, ringing in the ears, increased sensitivity to sunlight
Phenytoin
increased hair growth, acne, numbness/tingling, sore/swollen gums
Simvastatin
muscle/joint pain, numb/pins+needles, nightmares, mood change, sexual probs
Bisoprolol
postural hypotension, coldness of the extremities, disturbed sleep, nightmares
Enalapril
dry cough, low mood, taste disturbance
Verapamil/diltiazem
postural hypotension, flushing, muscle/joint pain, , swollen ankles, rash
B2-agonist (maybe salbutamol)
tremor, palpitations
achondroplasia is what type of inheritance
85% sporadic mutation
auto dominant
when to suspect ampyema
if resolving pneumonia but swinging fevers and lower lobe effusion
lung cancer histological finding of increased keratinisation
SCC
- 20 y/o male who is otherwise fit and healthy develops typical community acquired pneumonia:
Streptococcus pneumoniae
75 y/o male with COPD has an acute exacerbation
- viral- influenza/ rhinovirus/ adenovirus streptococcus or haemophilus
20 y/o male with cystic fibrosis
pseudomonas
male with SOB. worse on week days, better on weekends. works in zoo
psittaci
40 y/o male develops life-threatening community acquired pneumonia
after returning from sprain/brazil
legionella
young male presents with 19 day history of gradual SOB and low fever. His
chest x-ray reveals “diffuse perihilar shadowing
PCP
if a patient has random bits of palpitations what the best ivx
Holter monitor
in A.fib how do you manage?
Rate vs rhythm
Rhythm first in young - amioderone
Rate in old or ICH - bb or digoxin
