Revision Flashcards
Normal oeseophageal histology
Non-keratinised squamous epithelium, lots of mucous glands
Definition of reflux oesophagitis
Inflammation of oesophagus due to refluxed low pH gastric content
Microscopic findings in reflux oesophagitis
Basal zone epithelial expansion
Intraepithelial neutrophils, lymphocytes and eosinophils
Infections with what virus causes squamous papilloma?
Infection with HPV
What is a Kruckenberg tumour?
A tumour in the ovary that has metastasised from a primary site (usually GI e.g. stomach)
The most metabolically active part of the bowel wall
The mucosa - therefore most sensitive to infarction
Amyloidosis is a rare but serious complication which may occur in which disease?
In Crohn’s
(basically protein is deposited and ruins organs- most commonly the kidneys and patients present with nephrotic syndrome/impaired renal function/renal failure)
Rare features of pancreatitis
Ischaemic (Purtscher) retinopathy
-may cause temporary or permanent blindness
Two potentially life-threatening causes of epigastric pain in young people?
- appendicitis
- peptic ulcer disease
Preferred diagnostic test for pancreatitis?
CT pancreas WITH contrast - look for calcification
(with contrast gives clearer resolution than non-contrast)
(MRI poor at picking up calcifications)
When is pain worse in pancreatitis?
Typically worse 15-30 minutes after a meal
Gradual onset obstructive jaundice without a palpable gallbladder
Think cholangiocarcinoma
Typically painless jaundice WITH palpable gallbladder
Pancreatic cancer
Why do you need to manage jaundice?
Patients with unrelieved jaundice have a much higher incidence of septic complications, bleeding and death
What type of suture should be used for vascular anastamoses?
Non-absorbable monofilament suture
What are retractile testis?
A testis that appears in warm conditions, or which can be brought down on clinical examination and does not immediately retract
What is Boas’ sign
This is when you get pain under the right scapula in acute cholecystitis
What is Rovsing’s sign?
This is when you press on the left lower quadrant and get pain in the right lower quadrant (appendicitis)
When do you see Cullen’s sign?
Seen in pancreatitis and in other causes of intra-abdominal haemorrhage (e.g. ectopic pregnancy rupture)
When would you see Grey-Turner’s sign?
In pancreatitis, or other retroperitoneal haemorrhage
A thyroidectomy may damage which nerve?
The laryngeal nerve
Inguinal hernia surgery may damage which nerve?
The ilioinguinal nerve
A carotid endarterectomy may damage which nerve?
The hypoglossal nerve
A 34-year-old lady presents with a long standing offensive discharge from the ear and on examination is noted to have a reduction in her hearing of 40 decibels compared to the opposite side
Cholesteatoma
combination of offensive discharge and hearing loss is strongly suggestive of cholesteatoma
Treatment for C.diff
Vancomycin
Where would you find peyers patches?
Small intestine
Mucosal defence of large intestine
Enterocytes do defence
What do paneth cells release and where would you find them?
Release defensins
Found in small intestine
What could cause dry mouth?
Lack of saliva (e.g. infection, dehydration)
Salivary gland disease (sjogrens syndrome, radiotherapy)
Diabeties (diuretics!)
What might raise PSA levels?
benign prostatic hyperplasia (BPH)
prostatitis and
urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract
What might cause orofacial granulomatosis?
Allergy
Crohn’s disease
Sarcoidosis
H. pylori can either increase acid secretion and cause ulceration, or decrease acid secretion and predispose to gastric cancer, how does the latter occur?
IL-1 beta production in stimulated by H. pylori infection
IL-1 beta is a powerful inhibitor of acid secretion
Imaging studies for oesophageal cancer?
Upper GI endoscopy
Barium meal
CT (MRI) scan of chest and abdomen
Bronchoscopy
Treatment of oesophageal cancer
Surgery is only chance of “cure”
(not suitable for T4/M1)
Radiotherapy
Gastric cancer treatment
Total gastrectomy for proximal lesions
Partial gastrectomy for distal lesions
Radiotherapy
Chemotherapy
Treatment of typhoid
Chloramphenicol and ciprofloxacin
How would you diagnose typhoid?
Blood culture is key to diagnosis
Which strains of hepatitis may cause fever and jaundice?
Hep A and Hep E (occasionally hep B)
Side effects of steroids
MSK - avascular necrosis, osteoporosis GI Cutaneous - acne, thinning of the skin Metabolic - weight gain, diabetes, hypertension Neuropsychiatric Cataracts Growth failure
Treatment of rectal gonorrhoea
Cephalosporin e.g. ceftriaxone
IM in the bum stat
Treatment of rectal chlamydia
Azithromycin (STAT dose)
Doxycycline (7/7 course)
Test of cure at 6 weeks
What is the nutcracker angle?
Angle between the abdominal aorta and superior mesenteric vein (renal vein may become compressed here in renal cancer –> varicocele)
Treatment of lymphogranuloma venerum
Doxycycline
Triad of Budd-Chiari syndrome
Abdominal pain
Ascites
Enlarged liver
What is Fitz-High curtis syndrome?
This is when pelvic inflammatory disease (usually chlamydia) causes adhesions between the abdominal wall and the liver
Usually recent upper respiratory tract infection.
High grade fever.
Generalised abdominal discomfort
Mesenteric adenitis
You think someone might have appendicitis, what other test must you do?
Pregnancy test
What is mittelschmerz?
Only seen in females - midcycle pain
Usually occurs two weeks after last menstrual period
Pain is usually suprapubic location.
Usually subsides over a 24-48 hour period
Only seen in females - midcycle pain
Usually occurs two weeks after last menstrual period
Pain is usually suprapubic location.
Usually subsides over a 24-48 hour period
Mittelschmerz
US findings of Fitz-Hugh Curtis syndrome?
Abdominal ultrasound may show free0flui
Management of Fitz-Hugh Curtis syndrome
Usually managed medically - doxycylcine or azithromycin
Most common type of renal carcinoma?
Renal cell carcinoma (adenocarcinoma)
Is vasectomy effective immediately?
No, need to perform semen analysis at 16 and 20 weeks
Complications of vasectomy
Bruising, haematoma, sperm granuloma
Chronic testicular pain (affects between 5 and 30% of men)
“Someone is taking analgesia for a sore hip what do they have”
Perforated peptic ulcer (LOL MOST VAGUE PASSMEDICINE Q ever)
Which type of transplants are at risk of hyperacute rejection?
Renal transplants at greater risk, liver transplants least risk
Name a class of drugs that are nephrotoxic
NSAIDS
e.g. diclofenac
What type of cells are responsible for acute organ transplant rejection?
T cells
Someone has bubbly urine and frequent UTI, what causes this and what should you investigate for?
Enterovesical fistula - must investigate for underlying colorectal malignancy
Acute management of renal colic
IM diclofenac
Kidney stone treatment:
1) 0.7cm stone associated with hydronephrosis
2) A 1cm left sided ureteric caculus with no associated hydronephrosis
3) large staghorn calculus that measures 2.3cm in diameter
1) nephrostomy/uteroscopy and IV antibiotics
2) Extracorpeal shock wave lithotripsy
3) Percutaneous nephrolithotomy (nephrolithotomy for large unusual shaped stones)
Thiazide diuretics may cause which type of stone?
Calcium stones
Cholestyramine may cause which type of stone?
Oxalate stones
Allopurinol may cause which type of stone?
Uric acid stone
What might raise PSA levels?
benign prostatic hyperplasia (BPH)
prostatitis and
urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract
Anti-muscarinic for overactive bladder
NICE recommend oxybutynin, tolterodine or darifenacin
Management of nocturia
- advise about moderating fluid intake at night
- furosemide 40mg in late afternoon may be considered helpful
- desmopressin may also be helpful
Diagnosis of pagets disease of the nipple
Punch biopsy, mammography and ultrasound of the breast
Where would you find Cloquet’s lymph node?
In the inguinal canal
Borders of the femoral canal
Laterally - femoral vein
Medially - lacunar ligament
Anteriorly- inguinal ligament
Posteriorly - pectineal ligament
Differences between hyperacute, acute and chronic organ rejection
Hyperacute - occurs immediately through presence of preformed antigens (e.g. HLA, ABO, complement)
Acute - T cell mediated, occurs within first 6 months, MONONUCLEAR CELLS PREDOMINATE
Chronic - occurs after 6 months, vascular changes predominate
Who is most likely to get intussception and KEY BUZZWORD?
Most likely to occur in children
Symptoms include rectal bleeding and RED JELLY STOOL
If Meckel’s diverticulum were to present how might it?
Usually asymptomatic, but if it does present then usually before age 2
Symptoms include rectal bleeding, bowel obstruction, intusussception, volvulus or a picture similar to acute appendicitis
What is the lowest Gleason score for prostate cancer?
6
(the gleason score is comprised of the sum of the two most common histological patterns seen, the first number reflects the most common grading seen in all the samples, the second number is the highest grade of remaining tissue
As such, the score can range from 2 to 10, however grades 1 and2 not usually used so lowest score is 3+3 = 6)
What side are varicoceles most likely to present?
Left side
What is the most sensitive test of acute pancreatitis?
Lipase
What is the nutcracker angle?
Angle between the abdominal aorta and superior mesenteric vein (renal vein may become compressed here in renal cancer –> varicocele)
Investigation of suspected renal stone
FIRST do ultrasound and then if you think there is a stone, do non-contrast CT (NON-CONTRAST)
- if you use contrast then it basically becomes invisible
A 73 year old lady is admitted with a brisk rectal bleed. She is otherwise well and the bleed settles. On examination her abdomen is soft and non-tender. Elective colonoscopy shows a small erythematous lesion in the right colon, but no other abnormality
Angiodysplasia
(can be difficult to identify and treat because might be missed if poor bowel preparation)
Bleeding may be massive however may cause few symptoms
The right side of the colon is more commonly affected
