Random viva Qs Flashcards

Question

Spot Dx describe what you see and state the diagnosis? What other deformities might you look for in the hands?

Answer 1

***symmetrical deforming polyarthropathy*** ulnar deviation at the MCPs Z thumb bilaterally MCP volar subluxation These features are in keeping with RA involving the hands look for; boutonniere's deformity, swan neck deformity, rheumatoid nodules

Answer 2

PIP flexion, DIP hyperextension button hole deformity as there is a pipj prolapse through a 'button hole' created by 2 lateral slips

Answer 3

Nodules Tenosynovitis: de Quervains and atlanto-axial subluxation Immune: vasculitis, amyloidosis Cardiac: pericarditis ± effusion Carpal tunnel Pulmonary: fibrosis, effusions Ophthalmic: episcleritis, scleritis, Sjogren’s Raynaud’s Felty’s: RA + ↓PMN + splenomegaly

Answer 4

**L**oss of joint space Periarticular **E**rosions Soft tissue **S**wellings **S**oft bones i.e. periarticular osteopenia

Answer 5

**Conservative:** MDT approach, physiotherapy + OT (aids and splints) monitor disease + annual review (DAS 28) **Medical:** * analgesia; paracetamol or NSAIDs (+PPI) -\> codeine -\> opiods (non-pharma TENS & behavioural approaches * Steroids: IM, PO (short term treatment) or intra-articular * DMARDs: methotrexate + sulfasalazine 1st line (DM suppression therefore SE and monitoring) * Biologicals: anti TNF e.g. infliximab, etanercept, adalimumab * Biological: anti CD20 e.g. rituximab (failure of anti TNF treatment) **Surgical:** CT decompression, tendon repairs and transfers, ulna stylectomy and arthroplasty

Answer 6

*Closer inspection of the chest and back revealed a left sided well healed scar starting laterally at the _5th/6th ICS which curves posteriorly and upwards, ending midway between the spine of the scapula and the thoracic vertebral spaces_/ This is in keeping with a lobectomy scar*

Answer 7

a surgical procedure where a lobe of lung is removed

Answer 8

90% are for non-disseminated lung cancers (**NSCLC**) Others: * bronchiectasis with uncontrolled symptoms * lung abscess * COPD- lung reduction surgery * Historically TB pre ABx (usually upper lobe)

Answer 9

classified histologically in order to determine management and prognosis Non-small cell lung cancer (85%) Small cell lung cancer (15%)

Answer 10

Squamous cell carcinoma - highly related to smoking, centrally located, often secrete PTHrP leading to high calcium levels adenocarcinomas- femal non-smokers, peripherally located, 80% present with extrathoracic metastases Large cell carcinoma

Answer 11

highly related to smoking central location 80% present with advanced disease often associated with ectopic hormone secretion -\> endocrine/paraneoplastic syndrome associaton as cells contain neurosecretory cells

Answer 12

**Group and save (G&S)** – *this simply means the patient’s blood is typed and tested for antibodies, then saved in the lab in case it is required; it DOES NOT get you blood products for transfusion. If you need blood products you have to request a crossmatch.* **Crossmatch (XM)** – *this means that the patient’s blood is typed and tested as above, then matched to specific units of blood, platelets or other products for transfusion. You need to specify on the form how many units you need, why you need them and when they are required. A full crossmatch takes about 45-60 minutes in the lab – if you have an unstable bleeding patient and think you’ll need blood products sooner than this, you still need to send a crossmatch sample, but you can ask the lab for units of type-specific blood (which take 10-20 minutes), or in a genuine emergency you can use their stocks of O negative blood from the fridge.*

Answer 13

CXR- heart located on RHS ECG- electrodes placed on RHS

Answer 14

a rare congenital defect in which the apex of the heart is located on the R side of the body

Answer 15

* Isolated D;* dextrocardia of embryonic arrest where the heart is simply placed further right in the thorax then normal- it is commonly associated with severe defects of the heart and related abnormalities including pulmonary hypoplasia * dextrocardia situs inversus totalis* all the visceral organs are mirrored

Answer 16

Ejection systolic murmur best heard in the left parasternal 2nd ICS increased splitting of the second HS

Answer 17

A condition in which a portion of the heart becomes thickened, hypertrophies, without an obvious cause Obstructive variant is where the distortion of the normal heart anatomy causes an obstruction of blood from the left ventricle of the heart

Answer 18

some asymptomatic with no clinically detectable disease some present with AS like sympotoms due to outflow obstruction e.g. dyspnoesa, angina and palpitations, syncopal episodes sudden cardiac death

Answer 19

Hx- especially FHx of HOCM or unexplained sudden death in otherwise healthy individuals genetic testing- although not primarily used for Dx ECG- = LA enlargement gives P mitrale, LV enlargement gives large R waves (Sokolov-Lyon criteria greater than 35mm total R in V5 + S in V1) Echocardiography, Cardiac catheterisation, Cardiac MRI

Answer 20

Pulsus bisferiens - biphasic pulse, is a cardiac cycle with two peaks, a small one followed by a strong and broad one. It is a sign of problems with the aortic valve, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.

Answer 21

***Aqcuired;*** age related calcification is the commonest cause, rheumatic heart disease ***Congenital*** bicuspid aortic valve, williams syndrome

Answer 22

Angina Syncope dyspnoea

Answer 23

Gen comp; anaesthetic SE, damage to structures, NAVY, infection (wound), DVT, post op pneumonia COmplications of open heart surgery; 5% operative mortality Complications of the valve: * acute failure of the bvalve e.g. dehiscence, breakage * chronic failue of the valce e.g. stenosis, incompetence * Infective endocarditis e.g. early (\<2/12 post op) likely staph epidermis/late likely strep viridans * bleeding * anaemia (haemolysis, warfarin and endocarditis) * arrhythmia (AF) * Thromboembolism (1-2% risk per annum, despite warfarin therapy)

Answer 24

Heyde's syndrome - GI bleed angiodysplasia in the presence of AS occurs due to depletion of vWF flowing through narrowed valvular stenosis

Answer 25

Hepatobiliary surgery such as liver transplant/gall bladder other; segmental resection, whipple's procedure (pancreaticoduodenectomy)

Answer 26

Cirrhosis acute liver failure (hepatitis A + B, paracetamol OD) Malignancy (Hepatocellular carcinoma)

Answer 27

Severe infection/sepsis Extra-hepatic malignancy severe cardio-respiratory disease ongoing alcohol or drug abuse AIDS Non-complicance with drug therapy

Answer 28

progressive destruction and degreneration of liver parenchyma leading to cirrhosis... ...which lasts over a period of 6 months

Answer 29

Defined histologically as a diffuse heatic process characterised by fibrosis and conversion of normal liver architecture into structurally abnormal nodules

Answer 30

alcohol excess chronic hepatitis C and hepatitis B Non-alcoholic fatte liver disease AI e.g. hepatitis, PBC, PSC drugs; methotrexate, amiodarone neoplastic e.g. HCC metastases congenital e.g. haemochromatosis, wilsons and cystic fibrosis

Answer 31

* LFTs e.g. AST/ALT ration (\>2) + raised GGT (EtOH excess acutely) * FBC e.g. MCV (EtOH excess) * Clotting e.g. raised INR * Bone profile e.g. albumin * Us&Es e..g. hepatorenal syndrome * ESR/CRP e.g inflammatory process * Viral serology e.g. hep B and C * Metabolic profile e.g. lipids and glucose * AI screen SMA LKM1 + ANA (AIH) AMA (PBC) ANA + SMA PSC) * Genetic e.g. caeruloplasmin, ferritin + TIBC, alpha1 AT * Cancer- AFP Ca19-9

Answer 32

cirrhosis CCF carcinomatosis

Answer 33

according to Serum ascites albumin gradient (SAAG) SAAG= **serum** albumin - **ascites** albumin SAAG \> 1.1g/dL (due to portal hypertension) = transudate e.g. cirrhosis, cardiac, renal SAAG \< 1.1 (not due to portal hypertension,) = exudate e.g. cancer, venous obstruction e.g. budd-chiari, infection TB/SBP, nephrotic syndrome **nb vise versa to fluid protein/ serum protein in assessment of pleural effusion!!**

Answer 34

MDT approach fluid restriction \<1.5 L/day and daily weights low Na diet diuretics e.g. spironolactone and furosemine (if poor response) EtOH liason team (if relevant)

Answer 35

Is there anyone available to look after you post surgery?

Answer 36

* RNA virus * Affects anterior horn cells * Fever, sore throat, myalgia * 0.1% develop paralytic polio * **Asymmetric LMN paralysis** * No sensory involvement * May be confined to upper or lower limbs or both * Respiratory muscle paralysis can → death * Polio was eradicated by the 1988 WHO global polio eradication initiative; 37 cases in 2016, VACCINATION PROGRAM -\> Herd immunity