Review of SBA books Flashcards
Ix for CO poisoning?
Carboxyhaemoglobin levels
MEdication for polymyalgia rheumatica, think about side effects
Prednisolone
What Ix should you do for unprovoked DVT?
CT abdo pelvis looking for malignancy
Scaling skin over wounds =>
Psoriasis
First line medical management of prolactinoma
Cabergoline
Haemochromatosis features
HEPATOMEGALY
Tanned
Erectile dysfunction
Diabetes
How long do you need to stop eating/drinking before surgery
6hr no food
2hr no clear fluids
What can cocaine induce (ACS?)
Coronary artery spasm
Mx of coronary artery spasm
Nimodipin
Like SAH helping with spasm
Most common organism for malaria
Plasmodium falciparum
Painless scrotal lump
Well defined
Transilluminates
Epididymal cyst
Features of osteoarthritis
Assymetrical joint pain
Often base of thumb
X-ray shows LOSS
Treated with NSAIDs
How does atropine work?
It poisons the vagus nerve
Used in bradycardia to increase HR because reduces parasympathetic stimulation
Most likely causative organism in leg cellulitis
Streptococcus pyogenes
Swollen hard cord in the leg on background of varicose veins
Superficial thrombophlebitis
Treatment of superficial thrombophlebitis
Naproxen
Ix to consider in superficial thrombophlebitis
USS to exclude DVT
Which nerve, when damaged results in foot drop
Common peroneal nerve
Which nerve supplies sensation to the sole of the foot
Tibial nerve
Twitching in arm for 2 minutes, then stopped, felt weak for 1hr afterwards =>
Partial seizure
Can be precipitated by previous stroke -> damage
3 branches of the inferior mesenteric artery
Left colic
Sigmoid
Superior rectal artery
MEdical management of obstetric cholestasis (itching in pregnancy)
Ursodeoxycholic acid
Also the management for PBC
Prominent headache Nystagmus N+V Can't walk straight Dx?
Cerebellar stroke
Treatment of venous ulcer ABPI >0.5
Compression stockings
SMALL PUPIL Lacrimation Red eye Painful Hazy
Anterior uveitis
DILATED PUPIL Lacrimation Red-eye Painful Haloes Headache
Acute glaucoma
4H and 4Ts of MI
Hypoxia
Hypothermia
Hyper/hypokalaemia
HYPOVOLAEMIA
Tension pneumothorax
Tamponade
Toxins
Thrombosis
Differential for acutely painful scrotum in children
Testicular torsion
Hydatid of Morgani (embryological remnant, presents a bit more insidiously)
Fever
Epididymitis
+ve Prehn’s sign
Epidido-orchitis
What is Prehn’s sign
Pain relieved on elevation of the scrotum
Features of ALL
Easy bruising Fatigue Anaemia SOB Recurrent infections Splenomegaly Pallor
What is benign rolandic epilepsy?
Usually nocturnal twitching
Activity is in the rolandic fissure = motor
What might the EEG show in absence seizures
3 spike-wave cycles
Symptoms of a ventricular septal defect in infants
Poor feeding
Breathlessness
Chromosome 18 congenital disorder with features
Edwards
Rockerbottom feet
Small jaw
Bad at boxing
DDx for collapse in young child
Reflex anoxic seizure Breath-holding spells Febrile convulsion Epilepsy Arrhythmia Head injury
Prolonged jaundice in infant, past 2 weeks probably indicates…
Biliary atresia
Features of Henoch Scholein Purpura
Abdominal pain
Joint pain
Rash on buttocks
Can get renal failure so make sure to check up on them
UTi <3mo what do you do?
Refer to paediatrician
What is first line Mx of constipation in kids?
Movicol
How do you confirm coarctation of the aorta?
MRI
What happens in pulsus alternans?
In congestive HF there is often blood left over in the ventricle from bad pumping
The heart has to work harder with the next pump
So you get an alternating strong and weak pulse
Why do you get hepatomegaly in RHF?
Vena cava isn’t cleared so backs up into the liver
Signs of LHF
Pulmonary oedema
Signs of RHF
Raised JVP
Peripheral oedema
Symptoms of hypercalcaemia
Abdominal pains
Depression
Polyuria and polydypsia
Constipation
Management of hypercalcaemia
Urgent fluid rescucitation
Causes of hypercalcaemia
Malignant
Hyperparathyroidism
Translocation in CML
BCR ABL
9:22
Which drug can target 9:22 translocation
Imatinib
What is the pathophysiology of thalassaemia major?
No B globin
Presents int he first year
May see frontal bossing
Which nodes might you see in osteoarthritis
Osler’s and Heberden’s
They are basically osteophytes
Ulcer for more than 3w, what should you do?
Biopsy it to make sure it isn’t carcinoma
Antibody associated with dermatomyositis
Anti-Jo1
Features of dermatomyositis
Raised CK
Weakness
Heliotrope rash
Long QT can predispose to which ventricular tachycardia?
Torsade de Pointes
Ix for cauda equina
Spinal MRI
Mx of shingles
Oral acyclovir
Features of coarctation of the aorta
Pulsus alternans
Radio-femoral delay
Management of chronic asthma
SILLI! SABA ICS Leukotriene LABA Increase doses
When is a retrograde urethrogram used?
To look for urethral injury or stricture
It may be useful in pt with repeated catheterization -> stricture formation
Symptoms of cholesteatoma
Constant sound inside your ear (tinnitus) Dizziness (or vertigo) Ear infection. Earache. Feeling of "fullness" in one ear. Fluid that smells bad and leaks from your ears. Trouble hearing in one ear. Weakness in half your face.
Features of glue ear
Peaks at 2yo
May have developmental (speech and language) delay
Also known as otitis media with effusion
Hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
What is Bowen’s disease?
Early skin cancer
Red patch on the skin
Scaly
Easily treatable
7day old infant with grossly distended abdomen, vomiting, bloody diarrhoea, fever, bile stained vomiting
Necrotising enterocolitis
What is a keratoacanthoma
Its a benign lesion that pops up like a little eruption on sun exposed areas
Can progress to SCC so best to excise
Test for Addisons’s disease
Short SynACTHen test
Cortisol should rise
Cause of recurrent UTIs in children
Vesicauteric reflux (urine travelling the wrong way) Can get dilation of the urethra on retrograde urogram
Mx of vesica-uteriric reflux
Prophylactic antibiotics if young and getting repeated UTI If older (>5yo) can consider surgery to fix the problem
Mx of acute cholecystitis
IV antibiotics, let it settle, then operate selectively 6w later to remove the gallbladder
Difference between biliary colic and acute cholecystitis
Signs of infection = fever and raised inflammatory markers
Surgical Mx of BPH (very symptomatic)
Transurethral resection of the prostate
Drugs for BPH
Tamsulosin (a blocker, reduce smooth muscle tone and decrease bladder outflow resistance)
Finasteride inhibits conversion to active testosterone
Cut off for abdominal aortic aneurysm Dx
3cm
Cut off for surgery for AAA
5.5.cm
Monitoring for AAA 3cm
Yearly
Monitoring for AAA 4.7cm
3 monthly
Signs of infective tenosinovitis
A finger that’s red and inflamed
Difficult to move
Often after penetrating trauma (e.g. cut)
It’s the infection of the tendon sheath
The thumb and little finger share a union of tendon sheaths so you can get a horseshoe shaped pattern of inflammation
What are Kanavel signs?
Tenderness over the flexor sheath
Pain on passive extension
Flexed posture of the digit
Uniform swelling of the digit
Mx of infective tenosinovitis
IV antibiotics
Consider drainage
How many compartments of the hand
4
What is paronychia?
Infection of the nail
What is whitlow?
Herpes infection of the finger
Back pain improved by sitting =>
Spinal stenosis
Ix for spinal stenosis
Spinal MRI
X-ray changes of ankylosing spondylitis
Bamboo spine
HLA association for ankylosing spondylitis
HLA-B27
Features of Beurger’s disease
Young patient with features of intermittent claudication
Pulses are not palpable but the legs are nice and warm
Its a vasculitis
What is Volkmann’s contracture and what causes it?
Brachial artery injury leads to a fixed flexion deformity and shortening on the forearm
Often after use of a plaster cast
Antibody associated with PBC
AMA
Cancer associated with PSC
Cholangiocarcinoma
What is gastroschisis?
Intestines out of the abdomen in a baby
No covering
Where is a Morton neuroma most common?
Between the 3rd and 4th metatarsals
Where is the pain typically in plantar fasciitis?
The heels
What type of polyp is seen in IBD?
Pseudopolyp
Continuos waves of inflammation lead to lots of benign growths in the bowel
What South American disease can cause dysphagia?
Chagas disease
How does neurogenic shock cause low BP?
Loss of sympathetic tone
Blood pools in the peripheries
Most aggressive type of thyroid cancer
Anaplastic
Most common thyroid cancer
Papillary cancer
Bloody nipple discharge =>
Intraductal papilloma
1st line management of open fracture after splinting
IV antibiotics and debridement
Which nerve should you assess after shoulder dislocation/relocation?
Axillary nerve (badge area)
Which type of melanoma occurs on the palms/soles?
Acral letiginous melanoma
Can also occur under the nail!
Most common form of melanoma and typical presentation
Superficial spreading
Usually from a pre-existing mole
Do cystic hygromas transilluminate?
Yes
Do branchial cysts transilluminate?
No
Test for myasthenia gravis
Tensilon test
Initial management of acute glaucoma
Topical pilocarpine
Bone cancer that shows periosteal elevation in Codman’s triange. Usually around the knee
Osteosarcoma
Ix for bone cancer
BIOPSY
Features of a psoas abscess
Fever
Flank pain
Pain on straight leg raise
Raised inflammatory markers
Mx of psoas abscess
Incision and drainage
IV antibiotics
Nerve damaged in carpal tunnel syndrome
Median nerve
Congenital peripheral oedema (non-pitting) most likely is…
Milroy disease
Dysfunctional lymphatic system (failure of lymph nodes to develop)
What type of aneurysm can angioplasty cause in the femoral artery?
A false aneurysm
Tumour marker in ovarian carcinoma
CA125
Which type of bone cancer shows ‘onion skin’ periosteal reaction?
Ewing sarcoma
What is Rigler’s triad?
Gas in the biliary tree
Gallstones
Bowel obstruction
Triad for gallstone ileus
Which skin lesion has a ‘stuck on’ appearance?
Seborrhoiec keratoses
How do you Ix carcinoid syndrome?
24hr urinary 5-HIAA
Hernia above the inguinal ligament that on covering the midpoint, still appears, most likely Dx
Direct inguinal hernia
Ix and Mx of hydrocele
Transilluminates
Cant palpate the testis
Ix = USS
Mx = rule out sinister then give scrotal support or surgery if required
Features of De Quervain’s thyroiditis
Viral infection
Initial hyperthyroid phase followed by a hypothyroid phase
Smooth enlarged thyroid
Young woman
Which syndrome is associated with a port wine stain?
Sturge Weber syndrome
Purulent vaginal discharge
Suprapubic and LIF pain
Dx?
PID
Patient has cast removed and hand is very red, swollen and tender as well as sweating over the area
Dx??
Sudeck atrophy
Sympathetic stimulation is the cause
Mx of sudeck atrophy
Physiotherapy
Which test will be positive in an ACL tear?
Lachman’s test
Symptoms of a flail chest
Breathless
Part of the chest is not moving how it should
Management of a flail chest
Analgesia and ventilatory support
Fluorescein and blue light reveals a dendritic ulcer on the eye, Dx?
Herpes keratitis
Green discharge from the nipple =>
Duct ectasia
RF for duct ectasia
Smoking
Cause of lots of bilious vomiting in 1 day old infant
Mother had polyhydramnios while pregnant
Duodenal atresia
Signs of a sciatic nerve injury
Weakness of the whole leg
Loss of sensation throughout, only spared areas are the medial leg and upper thigh
Ix for ?urethral stricture
Cystoscopy
Urethrogram
RF for urethral stricture
Recurrent STI
Surgery
Recurrent catheterisation
Infant, unwell with jaw pain
Now has unilateral generalised swelling of the testis
Dx?
Mumps orchitis
Mx of small pilonidal sinus
Antibiotics
Mx of large pilonidal sinus
Excised
Features of pilonidal sinus
Perianal pain at lower natal cleft
Contains hair
Press and get some discharge
Mx of ?TIA
Aspirin and specialist review in <24hr
What causes popeye muscle?
Proximal rupture of the biceps
Where does the bicep join in the arm?
The radial tuberosity
Features of impingement syndrome
Painful arc
Positive Neer’s test
Features of a March fracture
Neck of the 2nd or 3rd metarsal
Often in runners/soldiers (marching)
Name of slow growing ulcer in previously damaged skin
Marjolin ulcer
Dx and Mx of a Marjolin ulcer
Biopsy and excision
DDx for retrosternal pain on eating
GORD
Oesophageal spasm
Cancer (if other features like dysphagia and FLAWS)
What is lymphoedema praecox?
Idiopathic lymphoedema (non-pitting!)
Features of ulnar nerve damage
Wasting of the hand (except the thenar eminence)
Clawing of ring and little finger
Loss of power to splay the fingers
What is Erb’s palsy?
Upper brachial plexus injury
Often after traumatic injury
Upper = C5 and C6 injury! (because brachial plexus is C5-T1, makes sense)
You lose sensation over the lateral forearm and arm
What is Klumpke’s palsy?
Lower brachial plexus injury
C8-T1!
Present with a clawed hand and sensory loss of ulnar border of forearm and the hand
Which incision for ?abdominal internal bleeding?
Midline laparotomy
What are Langer’s lines?
Lines on the body that if you cross you get worse scarring, just makes sense
Which class of shock do you first have a drop in blood pressure?
Class 3
Where do you find neuropathic ulcers?
Glove and stocking distribution
Areas that get regular minor trauma (e.g. around edge of shoes)
What is necrobiosis lipoidica?
Like pyoderma gangrenosum of diabetes
Pyoderma gangrenosum = shin ulcer in IBD
Diagnosis of Meckel diverticulum
99Technetium scan
What is a pharyngeal pouch also known as?
Zenker diverticulum
What is a laryngocele?
A pocket of air in the trachea
Like a pharyngeal pouch in the trachea instead
What is a fistula?
Abnormal connection between 2 epithelial surfaces
How do you Ix a fistula
MRI scan
Mx of anal fistulae
Depends on its relationship to puborectalis
If below, it can be laid open
If it passes through it, laying it open would be too higher risk of faecal incontinence, so these have a seton inserted
What is a haematocele?
Trauma to testis -> swelling
Takes a while to go away but Mx should be supportive usually
Painful, swollen testicle with a bit of a fever =>
Orchitis
Most common cause of orchitis
Viral
Most common cause of epididymo-orchitis
STI
Give antibiotics
Signs thats +ve in epididymo-orchitis
+vs Prehn’s sign
Eczema over nipple with lump underneath =>
Paget’s disease
1st line Ix for swallowed object
Chest, neck and abdominal x-rays
Polyuria
Polydipsia
High sodium
Low glucose
Dx?
Conn’s syndrome
The physiology behind Conn’s syndrome
Excess aldosterone
Swapping out potassium for more sodium
Dx of Conn’s syndrome
Renin: aldosterone
Aldosterone should be raised compared to renin
Initial management of Conn’s syndrome
Spironolactone
Key Ix for melaena
OGD
What delineates the upper GI tract from the lower?
Ligament of Treitz
Which rash appears as bumps in a circle, usually in diabetics and clears up after around a year
Granuloma annulare
How do you Dx congenital adrenal hyperplasia?
Levels of 17-hydroxyprogesterone
ACTH stimulation test
Presentation of CAH
Precocious puberty
Tall
Pubertal features
Presentation of impetigo
Blisters that itch and bleed
Superficial golden-yellow crust
Mx of impetigo
Start with hydrogen peroxide if very limited infection
Can progress to fusidic acid
What type of tumour in the neck that can be moved left and right but not up and down?
Chemodectoma
Reiter’s syndrome other name and Sx
Reactive arthritis
Can’t see (conjunctivitis)
Can’t pee (urethritis)
Can’t climb a tree (arthritis
What is Kussmaul’s sign?
Rise in JVP on inspiration
Which type of hernia might you get post-surgery
Incisional hernia
Most common type of hiatus hernia
Sliding (95%)
Sx of hiatus hernia
Dysphagia
Night cough
Acid reflux
Tests for developmental dysplasia of the hip
Ortolani (posterior pressure)
Barlow (anterior pressure)
Mx of DDH
Pavlik harness
Catheter to use when passing clots
3 way catheter
Mx of ascending cholangitis
ERCP
Complications of ERCP
Pancreatitis
Perforation of the bile duct
Ix for ?ichaemic colitis/mesenteric angina
Mesenteric angiography
Scoring system for prostatic carcinoma
Gleason scoring
Rest pain, ABPI = ?
<0.5
Bowel obstruction with Hx of Crohn’s =>
Stricture formation
Which side is classically associated with Crohn’s
RIF
Swinging fever
Jaundice
Just been abroad
Dysentry
Dx?
Amoebic liver abscess
Management of acute limb ischaemia
Analgesia Call vascular surgeons Oxygen IV fluids IV heparin
Surgical options = embolectomy (if say from A fib)
Thrombolysis if acute on chronic
Management of an anal fissure
Topical GTN (improve blood supply)
Analgesia
Stool softener
Analgesia of choice in back pain
NSAID
1st line Mx of UC to induce remission
Mesalazine
Drug for acute attacks of UC
Steroids
At what level does the spinal cord end?
L2
What drug do you give post-menopausal women with breast cancer?
Anastrazole = aromatase inhibitor
Ex and Ix for achilles tendon rupture
Ex = Simmonds test (feet of the bed)
Ix = MRI
Symptoms of hyperthyroid with a thyroid bruit =>
Graves disease
SALTER HARRIS criteria are…
Straight along the growth plate = I Above = II Lower = III Through the growth plate = IV Rammed (compressed) = V
What does the tibial nerve supply?
The sole of the foot
Flexion of the toes
Ankle jerk
Analgesia to use for digits
Nerve block using lidocaine only
Max dose of lidocaine
3mg/kg
Management of a young patient with a NOF fracture intracapsular
Cannulated screw or dynamic hip screw
Mx of myxoedema coma
IV thyroxine
What to measure if ?insulinoma? Sx of dizziness when they don’t eat, may be putting on weight
C-peptide levels
Hernia that straddles the inferior epigastric vessles
Pantaloon
Imaging for young patient with a breast lump
USS
Lump on the leg that disappears when lying down
Non-pulsatile
Bluish
Saphena varix
Pain in knee, feels like its locking, young patient
Osteochondritis dissecans
Mx of osteochondritis dissecans
Arthroscopic removal
Surgery for tumours close to the anal verge (<8cm)
Abdominoperineal resection (think of research!)
Surgery for achalasia
Heller myotomy
How long for upper limb fractures to heal?
6 weeks
How long for lower limb fractures to heal?
12 weeks
Treatment for a well-demarcated, red hot area on the face
IV antibiotics for erysipelas
Difference between erysipelas and cellulitis
Erysipelas is well demarcated
