SAQ exam 2 corrections- usually forget Flashcards
Features of lung cancer:
- pleuritic chest pain
- dyspnoea
-haemoptysis
1st line tx: for CAP (+dose)
500mg oral amoxicillin TDS
3 ways to INCREASE sputum production?
- Nebulised salbutamol
- physiotherapy
- postural drainage (sitting in certain positions to allow)
3 causes of low platelets in pneumonia patient? (Thrombocytopenia)
- chemo/radiotherapy side effects
- spleen/bone metastases
- platelet clumping
what differential diagnosis: elderly woman with 2 week of obstructive jaundice, pale stools, dark urine, weight loss?
Pancreatic carcinoma
Gallstones
3 complications of ERCP procedure?
- acute pancreatitis
- perforation
- infection (eg. acute cholangitis)
- bleeding
- aspiration pneumonia
management options of Pancreatic cancer?
- Whipple’s procedure: Surgery
- chemotherapy, radiotherapy
- palliative care: symptom control, eg. decompression of biliary tree via ERCP, analgesia, nutritional supplementation.
2 abx. given in GP for meningitis septicaemia?
IM Benzylpenicillin
IV Ceftriaxone
4 investigations: positive microbiology meningitis diagnosis can be made?
- blood cultures
- lumbar puncture
- gram stain
- microscopy
- PCR
- throat swab
- skin swab
3 prophylactic measures: to prevent DVT after hip surgery?
- Compression stockings
- LWMH propylactic SC (half the dose if renal impairment)
- Early mobilisation
Clinical features that may suggest: Breast cancer?
- Lump: non tender
- Peau d’orange, dimpling ulceration
- NEW nipple inversion
- bloody discharge
- cervical and axillary lymphadenopathy
- general features: weight loss, malaise, anorexia
3 things to take into consideration: before writing A DNAR order?
- does patient have capacity
- would CPR be successful and beneficial for the patient
- DNR order: has it been discussed with the patient and family?
4 causes of rectal bleeding in 70 yr old man (elderly) ?
- Anal fissure/haemorrhoids
- Diverticular disease
- infective colitis eg. campylobacter, shigella
- colonic angiodysplasia (could get fresh PR bleeding)
Investigation to confirm: Colorectal Carcinoma?
- Sigmoidoscopy +/- Biopsy
Definition of stroke:
- Rapidly developing focal neurological deficit of vascular origin lasting over 24 hours/ resulting in death.
Significant NON-neurological complications of Stroke?
- bed sores due to immobility
- communication difficulties
- DVT/PE due to immobility
- aspiration pneumonia: food/liquid is breathed instead of air.
- depression
Nerve root (ortho) and what area they correspond with?
L4: knee
L5: toe and foot
S1: ankle
Sign and symptoms of cauda equina (Central Disc Prolapse)?
- bilateral leg pain/weakness
- urinary retention/incontinence
- perianal sensory loss
- reduced anal tone
investigation to confirm diagnosis: prolapsed intervertebral disc/cauda equina?
MRI (of specifically lumbosacral spine)
NB: paramedics can offer= behavioural therapy, occupational therapy, physiotherapy
- Surgical treatment to consider: Discectomy
4 signs on examination: Hyperthyroidism?
- Fine tremor
- tachycardia
- goitre
- exophthalmos
- lid lag and lid retraction
- palmar erythema (warm, sweaty hands)
- sweating
-palpitations - weight loss
Most serious side effect: from anti-thyroid drugs eg. Carbimazole, Propylthiouracil
- Agranulocytosis (bone marrow suppression= may lead to pancytopenia)
- look for signs of: bruising, mouth ulcers, sore throat, fever, malaise/non-specific illness= indicates: Agranulocytosis.
4 possible causes of seizures? (apart from infection)
- Epilepsy
- hypoglycaemia
- substance abuse
- hypoxia
Others:
- stroke, syncope, trauma (head injury), alcohol
bacterial meningitis: apart from IV abx (cefotaxime). what else will be in your management plan?
- Blood cultures and PCR: to check for Neisseria
- IV fluids
- Antipyretics
- contact senior/HDU/ITU
- CT brain: NO Lumbar puncture due to possible raised ICP= which is indicated by seizure.
4 complications of bacterial meningitis?
- coma
- death
- sepsis
- seizures
- intellectual impairment
3 common causes of 1 week history of diarrhoea + blood through the stool?
IBD:
- Ulcerative Colitis
- Crohn’s
Also:
- Infectious Colitis: infectious cause for diarrhoea eg: C.Difficile.
what condition has crypt abscesses+ mucosal inflammation?
- Ulcerative Colitis
class of drugs to treat UC:
oral steroid therapy
5-ASA eg. sulfasalazine/mesalazine
what inv. can help clarify UC/diarrhoea diagnosis and underlying causes?
ABC;
- A bdominal Xray: to rule out any masses or faecal loading
- Biopsy and histology: Determines presence of colitis
- C olonoscopy: investigation of lower GI tract.
If UC patient deteriorates despite drug treatment: what urgent operation might be needed?
Colectomy
Complications in ortho?
- osteoarthritis
avascular necrosis of the femoral head - chondrolysis
- leg length discrepancy
Tricuspid regurgitation
Signs?
- pan-systolic murmur
- prominent/giant V waves in JVP
- pulsatile hepatomegaly
- left parasternal heave
2 drugs to manage acute heart failure?
- Furosemide
- GTN
Causes for clinical deterioration and resulting in heart failure?
- MI
- PE
- AF
- VSD rupture
- Cardiac tamponade
pansystolic murmur heard loudest at apex?
mitral regurgitation
Painless loss of vision, with AF, comes and resolves in 30 minutes.
Retinal artery occlusion
- other ddx: retinal vein occlusion, retinal detachment, optic neuropathy, vitreous haemorrhage
on examination signs: cherry red spot at macula, afferent pupil defect, threadlike arterioles
Inv: CT angiogram: to look for signs of= Atherosclerotic plaques, stenosis
Prostate cancer investigation:
- first line to investigate prostate enlargement
- to investigate degree of metastasis
- PSA, MRI multimetric, TRUS guided biopsy, Digital Rectal Examination
- Staging: CT chest/abdo and Bone scan: look specifically for other bony metastases.
most common histological type of prostate cancer?
adenocarcinoma
if cant do surgery for prostate cancer: mx?
- palliative chemotherapy
- pallative radiotherapy
- androgen ablation: hormonal= (GnRH antagonist)
ORTHO: 2 common causes of avascular necrosis of femoral head?
- Trauma
- Idiopathic: especially middle aged men affecting hips and knees.
Difference between: Stage and Grade: of malignant tumours?
Stage: reflects number of PROGNOSTIC risk factors that reflect patient outcomes; in terms of morbidity and mortality
Grade: reflects degree of mitotic abnormalities detected within cancerous cells
3 investigations in diagnosis of avascular necrosis of femoral head?
- X ray (AP and lateral= both views)
- Bone scan
- MRI
2 other areas that avascular necrosis could affect (apart from hip)?
- scaphoid bone
- talus
(foot and hand)
Early and late radiological sign of hip avascular necrosis?
Early: less common= generally no changes trabeculae with sclerosis, subchrondral sclerosis
Late: crescent sign, flattening of femoral head, osteochondral fracture, joint space narrowing
Surgical procedure: recommended to treat avascular necrosis late stage?
- Arthroplasty: surgical procedure to restore function of joint.
Pleural effusion (presents with: weight loss, R sided area of dullness)
breathlessness features on a plain CXR?
- blunting of costophrenic angles
- opaque (solid) consolidation in right hemithorax + concave meniscus sign
INV: - would do a pleural USS before doing diagnostic aspiration
Free air: Intraperitoneum suggests?
Perforation of some sort: either bowel or peptic ulcer
Emergency treatments that patients will require:
- IV 0.9% saline
- High flow oxygen and IV fluid support
- monitor urine output
Haem: what might you detect in urine: Acute Haemolytic Transfusion reaction
Haemoglobin
Aim of cervical cancer screening program:
- To screen for HPV
- to screen for abnormal cells indicative of pre-invasive (dyskaryosis) ‘CIN’: cervical intraepithelial neoplasia
coarctation of aorta clinical signs:
- radio-femoral delay
- ejection systolic murmur
- left ventricular heave
- weak peripheral pulses in legs
Investigation of Trigeminal neuralgia:
MRI head
Mx: carbamazepine, trigeminal nerve block
2 investigations to confirm coarctation of aorta:
- Echocardiography
- CT aorta
- cardiac catheterisation
2 tests to rule out renal cause for hypertension?
- U and E’s
- Renal Ultrasound
long term treatment: coarctation of aorta
- Conventional (open) surgery/ balloon angioplasty and stent insertion.
- if already resistant to anti-hypertensive drugs= medical therapy is not long-term option.
Good medical practice:
Good medical practice sets out the standards of care and behaviour expected of all medical professionals.
It covers areas that include:
- making the care of patients the first concern
- providing a good standard of practice and care
- working within competence
- working in partnership with patients and supporting them to make informed decisions about their care
treating colleagues with respect and help to create an environment that is compassionate, supportive and fair - acting with honesty and integrity and being open if things go wrong
- protecting and promoting the health of patients and the public
peripheral vascular disease Mx:
- Angioplasty
- Stent
Bedside investigation: Angioplasty, Stent
Differences between Graft being occluded OR compartment syndrome?
Compartment syndrome:
- swollen, tense, tender calf with: pain on dorsiflexion. (more hot)
Occluded graft:
- cool, pale foot, absent pulse in graft. (more cool symptoms)
Initial management of sickle cell crisis: apart from A to E assessment?
- IV fluid resus
- Analgesia
- Oxygen therapy
- keep warm
- contact haematologist
- CXR
NB: think emergency treatment.
3 examples of simple non-pharmaceutical measures that can reduce rate of painful crises? (pharma mx: is normally= regular blood transfusions).
- Avoid dehydration/cold/
exhaustion - Avoid alcohol
- Avoid smoking
2 clinical signs of ascites?
- Shifting dullness
- **Fluid thrill (usually forget)
Name 3 or more causes of chronic liver disease:
- Alcohol
- Viral hepatitis (B,C,D)
- NAFLD (non-alcoholic fatty liver disease)
- Autoimmune (PBC, PSC, Autoimmune hepatitis)
- Genetic: Wilson’s disease, haemochromatosis.
- Drugs
what investigation to order for ear? (bilateral hearing loss)
MRI Internal Auditory Meatus
most likely cause diagnosis for bilateral hearing loss?
- Noise induced hearing loss (+/- asymmetry)
- Tx to offer: Hearing aid
Features of Osteoarthritis?
- less than 30 minutes of morning stiffness
- pain is worse at the end of the day
- manual occupation higher risk
-activity-related pain
Resp (lung tumour): what investigations will you require to give all the information to plan treatment? (think STAGING)
Staging CT chest and abdomen
or
Transthoracic aspiration under CT
Two possible (direct) causes of hyponatraemia (low sodium)?
- SIADH
- Dehydration
Treatment for hyponatraemia
- Fluid restriction (immediate mx.)
-oral medication to achieve and maintain normal sodium? Tolvaptan
