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Capsule > Schofield medicine SAQs > Flashcards

Schofield medicine SAQs Flashcards

1
Q

2 later ECG changes post MI?

A

Pathological Q waves and inverted T waves

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2
Q

How long until you can drive post-MI?

A

Can’t drive for 4 weeks, no need to inform DVLA

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3
Q

Complications of coronary angiography?

A

Bleeding
Infx
MI
Stroke
Death

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4
Q

Symptoms apart from pain during episode of angina?

A

SOB
Sweating
Feeling faint/lightheaded

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5
Q

Blood tests for angina?

A

FBC for anaemia
TFTs for thyrotoxicosis
Glucose for diabetes

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6
Q

Investigations for angina?

A

ECG
ECHO
Coronary angiography

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7
Q

How does aspirin reduce the risk of coronary events?

A

Aspirin irreversibly binds to COX, preventing further production of TXA2, which then inhibits platelet aggregation.

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8
Q

Signs of acute pulmonary oedema?

A

Tachypnoea
Tachycardia
Raised JVP
Wheeze
Cyanosis
Fine lung crepitations

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9
Q

Drugs to treat pulmonary oedema?

A

Furosemide
GTN
Morphine
Oxygen

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10
Q

Give two ways to increase someone’s potassium medically?

A

Orally (e.g. sando-K)
IV (Add KCl to IV fluids)

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11
Q

Normal QRS interval?

A

<0.12s (<3 small squares)

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12
Q

ECG shows regular rhythm, rate 140bpm, broad QRS complex and occasional capture beat?

A

Ventricular tachycardia

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13
Q

What is a capture beat?

A

Normal QRS complex between VT complexes

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14
Q

Two drugs that may be used during V tacky?

A

Amiodarone
Lidocaine
Oxygen
Adrenaline

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15
Q

What system is used to classify the severity of heart failure?

A

New York Heart Association Classification

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16
Q

Symptoms of left ventricular failure?

A

Dyspnoea
Fatigue
Paroxysmal nocturnal dyspnoea
Orthopnoea
Wheeze
Cough
Pink, frothy sputum

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17
Q

Signs of heart failure on CXR?

A

Kerley B lines
Cardiomegaly
Pleural effusions
Alveolar/interstitial oedema in ‘bat wings’ distribution

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18
Q

How and where does furosemide act?

A

Competitively inhibits the Na-K-2Cl cotransporter in the thick ascending limb of the LoH, diminishing the osmotic gradient for water reabsorption.

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19
Q

Side effects of ACEi?

A

Dry cough
Hyperkalaemia
Renal impairment
Angioedema/urticaria
Hypotension

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20
Q

Signs that may be visible on fundoscopy of someone with hypertensive retinopathy?

A

Cotton wool spots
Flame haemorrhages
A-V nipping
Papilloedema

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21
Q

Complications of hypertension?

A

Heart failure
Stroke
IHD
CKD
Hypertensive retinopathy
Peripheral vascular disease

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22
Q

Mechanism of action of statins?

A

Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis

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23
Q

Signs of hypercholesterolaemia?

A

Xanthelasma
Xanthoma
Corneal arcus

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24
Q

Causes of AF?

A

IHD
HTN
Hyperthyroidism
Heart failure
Endocarditis

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25
Q

Symptoms of AF?

A

SOB
Light-headed
Dizzy

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26
Q

Methods of cardioversion?

A

Electrical - DC cardioversion

Pharmacological - Amiodarone and flecainide

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27
Q

Long term meds in AF patients?

A

Beta-blocker
CCB
Digoxin
DOAC

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28
Q

Target INR on warfarin?

A

2-3

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29
Q

Complications of atrial fibrillation?

A

Stroke
TIA
Heart failure

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30
Q

Most common cause of infective endocarditis?

A

Staphylococcus aureus

If prosthetic valve - staphylococcus epidermis

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31
Q

Why do urine dip in infective endocarditis?

A

Microscopic haematuria

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32
Q

Infective endocarditis fundoscopy: boat-shaped retinal haemorrhage with a pale centre?

A

Roth spots

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33
Q

Criteria used to diagnose infective endocarditis?

A

Modified Duke criteria

1 major and 3 minor
OR
5 minor

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34
Q

Examination findings infective endocarditis?

A

New heart murmur
Splinter haemorrhages
Petechiae on the trunk, limbs, oral mucosa or conjunctiva
Janeway lesions (painless red flat macules on the palms of the hands and soles of the feet)
Osler’s nodes (tender red/purple nodules on the pads of the fingers and toes)
Roth spots

Splenomegaly (in longstanding disease)
Finger clubbing (in longstanding disease)

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35
Q

Pansystolic murmur heard loudest on inspiration?

A

Tricuspid regurgitation

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36
Q

How should blood cultures be taken for infective endocarditis?

A

3 sets, from 3 diff sites at 3 diff times

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37
Q

What increases the risk of infective endocarditis?

A

IVDU
Prosthetic valves
PDA
VSD
Mitral valve disease
Bicuspid aortic valve

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38
Q

What pattern on spirometry is seen in asthma?

A

Obstructive (FEV1/FVC <0.7)

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39
Q

How does salbutamol work?

A

SABA
Stimulates B2 receptors of resp tract, increases sympathetic activity and relaxes bronchial smooth muscle

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40
Q

Oxygen therapy for Type 2 respiratory failure (low O2, high CO2)

A

Controlled oxygen therapy via venturi mask as at risk of losing hypoxic drive

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41
Q

Management of acute infective exacerbation of COPD?

A

Abx
Steroids
Salbutamol/ipratropium NEB
Resp physiotherapy

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42
Q

CURB-65?

A

C - confusion
U - urea >7
R - RR >30
B - BP <90 systolic or <= 60 diastolic
65 - >65

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43
Q

Most common causes of community acquired pneumonia

A

Streptococcus pneumonia
Haemophilus influenzae
Staphylococcus aureus

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44
Q

Why may cases of TB be on the rise?

A

HIV/AIDs prevalence
Use of immunosuppressive drugs
Increased immigration from areas of high prevalence of TB
Poor socio-economic conditions and overcrowding

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45
Q

Why multi-drug therapy for TB?

A

To combat multidrug resistance

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46
Q

Causes of erythema nodosum?

A

Idiopathic
Crohns
TB
Ulcerative colitis
Sarcoidosis

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47
Q

Incidence of Cystic Fibrosis?

A

One in 2500 births

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48
Q

Organisms that colonise the lungs of those with cystic fibrosis?

A

Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa

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49
Q

Causes of bronchiectasis?

A

Idiopathic
Post-infective
Post-obstructive (foreign body, tumour)
Congenital (Young’s, Kartagener’s)
RA
Alpha-1-antitrypsin deficiency

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50
Q

Complications of bronchiectasis?

A

Pneumonia
Sepsis
Recurrent LRTIs
Resp failure
Cor pulmonale
Pneumothorax

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51
Q

Lung cancer commonly metastases sites?

A

Brain
bone
Liver
Lung
Adrenals

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52
Q

Causes of finger clubbing?

A

Idiopathic pulmonary fibrosis
Bronchial carcinoma
Mesothelioma
Bronchiectasis

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53
Q

Other than obesity give risk factors for OSA?

A

Acromegaly
Enlarged tonsils
Enlarged adenoids
Nasal polyps
Alcohol

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54
Q

What is cor pulmonale?

A

Right sided heart failure secondary to chronic pulmonary hypertension

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55
Q

ECG changes in cor pulmonale?

A

Right axis deviation
Inverted T waves in chest leads
P pulmonale
Dominant R wave in VI

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56
Q

Causes of bilateral hilarity lymphadenopathy?

A

Sarcoidosis
Lymphoma
Bronchial carcinoma
TB

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57
Q

Sarcoidosis biopsy?

A

Non-caseating granuloma

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58
Q

Extrapulmonary manifestations of sarcoidosis?

A

Erythema nodosum
Lymphadenopathy
Arthralgia
Anterior uveitis
Cardiomyopathy
Hepatosplenomegaly

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59
Q

Advice for patient before starting long-term steroids?

A

Do not stop taking steroids abruptly
Carry ‘steroid card’ at all times
Doses need to be increased during illness

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60
Q

Side effects of long-term steroids?

A

Adrenal suppression
Hyperglycaemia
Central obesity
Moon face
Skin thinning
Cataracts
Muscle wasting
Osteoporosis

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61
Q

Signs of pleural effusion on examination?

A

Reduced chest expansion on affected side
Dull percussion
Absent breath sounds
Reduced vocal resonance
Tracheal deviation away from effusion if large

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62
Q

Where to insert needle in pleural tap?

A

Above the rib to avoid the neuromuscular bundle which sit directly inferior each rib.

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63
Q

Causes of CKD?

A

Diabetes
Hypertension
Glomerulonephritis
Polycystic kidney disease

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64
Q

Signs of CKD on examination?

A

Peripheral oedema
Pallor
Purpura
Bruising
Evidence of excoriation

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65
Q

Basic principles of haemodialysis?

A

Blood and dialysis fluid flow either side of a semipermeable membrane, molecules diffuse down their concentration gradient.

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66
Q

Complications of peritoneal dialysis?

A

Bacterial peritonitis
Infx at catheter site
Weight gain (due to dextrose solution)

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67
Q

What sites does hydroxylation of Vitamin D take place?

A

Liver
Kidney

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68
Q

Causes of post-renal AKI

A

renal calculi
renal tumour
ureteric tumour
BPH
prostate cancer

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69
Q

Other than blood tests, investigations for AKI?

A

US KUB
Urinalysis
ABG

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70
Q

Life-threatening complications of AKI?

A

Pulmonary oedema
Hyperkalaemia
Haemorrhage

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71
Q

Indications for dialysis for patients with AKI?

A

Refractory pulmonary oedema
Refractory hyperkalaemia
Severe metabolic acidosis
Uraemic encephalopathy
Uraemic pericarditis

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72
Q

By what mechanism does rhabdomyolysis cause AKI?

A

Acute tubular necrosis

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73
Q

What would you see on urine microscopy with rhabdomyolysis

A

Muddy brown/ granular casts (due to myoglobinuria)

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74
Q

Why withhold metformin and lisinopril during AKI?

A

Metformin - risk of metabolic acidosis

Lisinopril - nephrotoxic

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75
Q

Hyperkalaemia ECG changes?

A

Tall tented T waves
Widening of QRS complex
Flat P waves
Prolonged PR interval

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76
Q

If suspected rapidly progressive glomerulonephritis what blood tests should be requested urgently?

A

ANCA, anti - GBM

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77
Q

What should be started immediately with rapidly progressive Glomerulonephritis?

A

steroids

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78
Q

Most common cause of nephrotic syndrome in kids and adults?

A

Kids - minimal change disease

Adults - membranous nephropathy

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79
Q

Complications of nephrotic syndrome?

A

Increased susceptibility to infections
Increased risk of thromboembolism
Hyperlipidaemia

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80
Q

Dietary advice for those with nephrotic syndrome?

A

Low salt diet
Normal protein diet

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81
Q

How to calculate serum osmolality?

A

Serum osmolality = 2(Na + K) + urea + glucose

Normal range = 275-295mOsm/kg

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82
Q

How to examine for someone’s volume status?

A

Postural blood pressures
Serial weights
Examine for peripheral oedema
Measure urine output

83
Q

Where is ADH secreted?

A

Posterior pituitary

84
Q

How to treat SIADH pharmacologically?

85
Q

Risk factors for UTI?

A

Female
Pregnancy
Diabetes
Immunosuppressed
Sexual intercourse

86
Q

Contraindications for renal biopsy?

A

Abnormal coagulation studies
Single functioning kidney
CKD with small kidneys

87
Q

Complications of renal biopsy?

A

Macroscopic haematuria
Pain
Haematoma
Infection
Death

88
Q

Histological finding in patient with IgA nephropathy?

A

Mesangial proliferation
IgA deposits
C3 deposits

89
Q

Causes of purpuric rash?

A

Henoch-Schonlien purpura
Immune thrombocytopenic purpura
Thrombotic thrombocytopenic Purpura
DIC

90
Q

Hand findings in RA?

A

Swan-neck deformity
Boutonnieres deformity
Z-shaped deformity of the thumb
Ulnar deviation of the fingers

91
Q

X ray findings in RA

A

Loss of joint space
Juxta-articular osteopenia
Subluxation
Soft tissue swelling

92
Q

Extra-articular features of RA?

A

Sjogren’s syndrome
Carpal tunnel syndrome
Pulmonary fibrosis
Lymphadenopathy
Raynaud’s phenomenon

93
Q

RA with palpable spleen and neutropenia?

A

Felty’s syndrome

94
Q

Causes of poly arthritis?

A

RA
Osteoarthritis
Psoriatic arthritis
SLE

95
Q

Mechanism of NSAIDS

A

COX inhibition
Reduces prostaglandin synthesis
Reduces inflammation

96
Q

How is methotrexate administered and how often in RA?

A

Orally/IM once a week - take with folic acid

97
Q

Other than GP and rheumatologist - who else will be involved in RA patient’s care?

A

Rheumatology specialist nurse
Physiotherapist
Occupational therapist

98
Q

Common precipitants to gout?

A

Starting bendroflumethiazide
High purine diet
Alcohol
Trauma
Infection

99
Q

X ray findings in gout?

A

Normal joint space
Soft tissue swelling

100
Q

Commonly affected joints in pseudo gout?

A

Knee
Hips
Wrist

101
Q

Risk factors for pseudo gout?

A

Hypothyroidism
Hyperparathyroidism
Wilson’s disease
OA
Increasing age

102
Q

Investigation for gout/pseudogout?

A

Polarised light microscopy of synovial fluid

103
Q

Treatment options for OA?

A

Conservative (weight loss, exercise)
Physiotherapy
Topical NSAIDs
Intra-articular steroid injections
Joint replacement

104
Q

Positive blood tests in antiphospolipid syndrome?

A

ANA and anti-cardiolipin antibodies

105
Q

Skin effects of SLE

A

Malar rash
Photosensitive rash
Discoid rash

106
Q

Features of anti phospholipid syndrome?

A

Recurrent miscarriages
Coagulation defects
Livedo reticularis
Thrombocytopenia

107
Q

Drugs to treat anti phospholipid syndrome?

A

Aspirin
Clopidogrel
Heparin

108
Q

Dermatomyositis autoantibodies?

A

Anti-Jo1
ANA
Anti-Mi2
RF

109
Q

What is Raynaud’s phenomenon?

A

Peripheral digital Ischaemia due to vasospasm precipitated by cold or emotion.

110
Q

Causes of Raynaud’s phenomenon?

A

Raynaud’s disease
SLE
RA
Dermatomyositis/polymyositis
B-blockers

111
Q

Features of limited cutaneous scleroderma? (CREST)

A

Calcinosis
Raynaud’s phenomenon
Oesophageal dysfunction
Sclerodactyly (thick and tight skin over fingers/hands)
Telangiectasia

112
Q

X ray findings in ankylosing spondylitis?

A

Calcification of intervertebral ligaments
Bamboo spine

113
Q

Ank spond with ant. uveitis - what may you hear on heart and lungs?

A

Early diastolic murmur (Aortic regurgitation)
Fine inspiratory crepitations at apices

114
Q

Forms of psoriasis?

A

Chronic plaque psoriasis
Flexural psoriasis
Guttate psoriasis

115
Q

Commonly affected sites of skin lesions of chronic plaque psoriasis?

A

Extensor surface of arms
Extensor surface of legs
Scalp
Lower back

116
Q

Some patients with psoriatic arthritis develop periarticular osteolysis and shortening of the bones. What is this form of psoriatic arthritis called?

A

Arthritis mutilans

117
Q

Organisms that may trigger reactive arthritis?

A

Chlamydia
Campylobacter
Salmonella
Shigella

118
Q

Name ANCA positive and ANCA negative small vessel vasculitis:

A

p-ANCA : eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome)

p-ANCA: Microscopic polyangitis

ANCA negative: Goodpasture’s, Henoch-Schonlein purpura

119
Q

Large and medium vessel vasculitis?

A

Large - Takayasu arteritis, temporal arteritis

Medium - Kawasaki’s disease, polyarteritis nodosa

120
Q

Systemic conditions in which vasculitis is a feature of the disease?

A

Infective endocarditis
RA
Behcet’s
SLE
IBD
Hep B & C
Dermatomyositis

121
Q

What is mononeuritis multiplex?

A

Type of peripheral neuropathy
Used to describe inflammation or damage to >= 2 peripheral nerves

122
Q

Causes of mononeuritis multiplex?

A

Granulomatosis with polyangiitis
HIV
RA
Diabetes
Sarcoidosis
Leprosy
Polyarteritis nodosa

123
Q

What is acromegaly?

A

Hypersecretion of GH by a tumour in the ant pituitary gland

124
Q

Signs and symptoms of acromegaly?

A

Macroglossia
Bitemporal hemianopia
Voice changes
Carpal tunnel syndrome
OSA
Frontal bossing
Increased blood pressure
Prognathism (jaw protrusion)

125
Q

How does oral glucose tolerance test aid in acromegaly diagnosis?

A

Rapid increase in blood glucose should suppress GH secretion - this will not happen in acromegaly.

126
Q

If acromegaly is confirmed, what other endo disorder do you screen for?

A

Diabetes mellitus as GH is anti-insulin leading to insulin resistance and eventually diabetes.

127
Q

Main complication and cause of death in acromegaly patients?

A

Cardiovascular disease

128
Q

Signs of hypothyroidism?

A

Fatigue
Weight gain
Cold intolerance
Dry/thinning hair
Bradycardia
Dry skin
Ataxia
Goitre
CTS
Loss of lateral 1/3rd of eyebrows

129
Q

Causes of hypothyroidism

A

Amiodarone
Radiotherapy
Iodine deficiency
Autoimmune (Hashimoto’s)
Cancer
Hypopituitarism

130
Q

What will FBC show in hypothyroidism?

A

Macrocytic anaemia

131
Q

What anatomical structure represents the site at which the thyroid gland originated before embryological descent?

A

Foramen caecum

132
Q

What is Grave’s disease

A

Autoimmune disease caused by TSH receptor antibodies

133
Q

Sign’s specific to Grave’s disease

A

Pretibial myxoedema
Exophthalmos

134
Q

Excessive thirst, polyuria, and weight loss - urine dip is negative for glucose.

Most likely diagnosis?

A

Diabetes insipidus

135
Q

In diabetes insipidus describe the urine osmolality and plasma osmolality?

A

Urine osmolality will be low

Plasma osmolality will be high

136
Q

How does water deprivation test used to diagnose diabetes insipidus?

A

Patient is starved of any fluid intake.

Normal response = concentrate urine and decrease urine output.

Diabetes insipidus = continued production of large vol of urine with low osmolality

137
Q

How to treat cranial diabetes insipidus?

A

Desmopressin

138
Q

Advice for patient and family to prevent hypoglycaemic episodes?

A

Regular glucose monitoring
Never miss a meal
Keep ‘emergency supply’ of glucose in pocket

139
Q

Causes of hypoglycaemia in non-diabetic patients?

A

Liver failure
Addison’s
Insulin-secreting tumours
Alcohol binging
Pituitary insufficiency

140
Q

Explain the OGTT?

A

Patient fasts overnight prior to test.

Drink containing 75g of glucose in 300ml water is given.

Blood glucose is measured before drink and then at 120 mins.

Diabetes = >11.1mmol/L at 2 hours

141
Q

T2DM macrovascular and microvascular complications?

A

Macrovascular:
Cerebrovascular disease
MI
IHD
Peripheral vascular disease

Microvascular:
nephropathy
neuropathy
retinopathy

142
Q

Confirm DKA bedside test?

A

Urine dip - presence of ketonuria

143
Q

Pathophysiology of DKA?

A

Insulin deficiency = more glucose production in the liver and lipolysis.
Fatty acids get broken down to form ketone bodies = metabolic acidosis.

144
Q

Investigations for Addison’s?

A

U&Es
SynACTHen test

145
Q

What would you expect serum sodium and potassium to be in Addison’s?

A

Hyponatraemia
Hyperkalaemia

146
Q

Advice for patients starting on steroid therapy for Addison’s?

A

Carry steroid card
Medic alert bracelet
Know how to alter dosage in illness

147
Q

Signs and symptoms of prolactinoma in women?

A

Amenorrhea
Galactorrhea
Decreased libido
Subfertility
Headache
Visual field defect

148
Q

Drug/apart from surgery treatment for prolactinoma?

A

Dopamine agonist:
Cabergoline/ bromocriptine

Radiotherapy

149
Q

Investigations for primary hyperparathyroidism?

A

DEXA scan
USS Abdo
CT/MRI neck (look at parathyroid gland)

150
Q

Complications of surgical resection of parathyroid adenoma?

A

Hypoparathyroidism
Laryngeal nerve palsy

151
Q

Relationship between calcium and Vitamin D?

A

Vitamin D is needed to absorb calcium in the gut

152
Q

Name of distribution of sensory loss in diabetes - (hands and feet)

A

Glove and stocking distribution

153
Q

In neuropathy secondary to diabetes, what is the first type of sense to be lost?

A

Vibration sense

154
Q

Feet findings in diabetes?

A

Loss of sensation
Charcot’s foot
Painless ulcer
Diminished reflexes

155
Q

In light of finding neuropathy (microvascular complication of diabetes), what two other area must now be investigated?

A

Eyes
Kidneys

156
Q

Diabetic with intractable vomiting?

A

Autonomic gastroparesis

157
Q

Histological features of Crohn’s?

A

Granuloma formation
Transmural inflammation
Lymphocytic infiltration

158
Q

Extraintestinal features of Crohn’s?

A

Erythema nodosum
Pyoderma gangrenosum
Conjunctivitis
Ankylosing spondylitis
Apthous ulcers

159
Q

Long term complications of Crohn’s?

A

Perianal abscess and fistulae
Bowel perforation
SBO
Colon carcinoma
Malnutrition

160
Q

MOA of infliximab?

A

Infliximab is TNFalpha inhibitor.

Antibody is directed against tumour necrosis factor - important in establishing inflammation and granuloma formation.

161
Q

What meds can contribute to upper GI bleed?

A

NSAIDS
Aspirin
Steroids
Anticoagulants
Thrombolytics

162
Q

What will blood results be in upper GI bleed?

A

Urea raised out of proportion to creatinine indicated upper GI bleed.

163
Q

How doe liver cirrhosis lead to oesophageal varices?

A

Venous portal hypertension

164
Q

Site of portosystemic anastomoses and the symptom it would cause.

A

Superior rectal vein shunts cause haemorrhoids

165
Q

Risk factors for peptic ulcer disease?

A

H. Pylori infx
NSAIDs/steroids
Smoking
Alcohol
Stress
Spicy foods

166
Q

Investigation for peptic ulcer perforation?

A

Erect chest X-ray

167
Q

What would you see on Xray with peptic ulcer perforation

A

Pneumoperitoneum is seen as free air under the diaphragm

168
Q

Define GORD

A

Excessive entry of gastric contents into the oesophagus through the gastro-oesophageal junction

169
Q

Exacerbating factors of GORD?

A

Lying flat
Alcohol
Obesity
Food
Hiatus hernia

170
Q

Patient suffers with GORD also suffers from night-time wheeze but no asthma - what is causing this?

A

Inhalation of small amounts of gastric contents.

171
Q

Causes of dysphagia of someone with GORD?

A

Benign stricture secondary to GORD
Malignant stricture
Pharyngeal pouch
Oesophagitis
Myasthenia gravis

172
Q

Gold standard for proving GORD?

A

Oesophageal manometry

173
Q

Complication of Nissens fundoplication

A

Dysphagia from compression of the GOJ
Dumping syndrome
Achalasia

174
Q

Pre-hepatic causes of jaundice?

A

Malaria
Sickle cell
Thalassemia
G6PD deficiency
Gilbert’s syndrome

175
Q

Intra-hepatic causes of jaundice?

A

Viral hepatitis
Paracetamol overdose
Alcoholic hepatitis
Haemochromatosis

176
Q

Post-hepatic causes of jaundice?

A

CBD bile stones
Pancreatic caner
PBS
PSC

177
Q

Why does conjugated bilirubin appear in the urine and unconjugated doesn’t?

A

Conjugated bilirubin is water-soluble, so dissolves in the urine, making it dark.

178
Q

What investigation do you do for obstructive jaundice?

179
Q

At risk groups for Hepatitis B?

A

IVDU
Sex workers
Healthcare workers

180
Q

What does anti-HBC indicate?

A

Past infection

181
Q

Long term complications of Hepatitis B?

A

Cholestasis
Hepatocellular cancer
Cirrhosis
Chronic hepatitis

182
Q

Viruses that may be co-infected post needle stick injury with Hep B?

183
Q

Inherited vs acquired causes of cirrhosis?

A

Inherited:
Haemochromatosis
Wilson’s disease
Alpha-1-antitrypsin deficiency

Acquired:
Chronic alcohol abuse
Chronic viral hepatitis
Autoimmune hepatitis
PBC
Idiopathic

184
Q

Investigations for synthetic function of the liver?

A

Albumin or INR/PT

185
Q

Complications of cirrhosis?

A

Coagulopathy
Encephalopathy
Hypoalbuminaemia
Sepsis
SBP
Hypoglycaemia
Ascites
Oesophageal varices

186
Q

Investigations for ascitic fluid?

A

WCC
MC&S
Cytology
LDH
Glucose

187
Q

How does lactulose work in hepatic encephalopathy?

A

Lactulose increases bowel transit which will reduce the number of nitrogen producing bacteria in the gut which contributes to hepatic encephalopathy.

188
Q

Causes of GI malabsorption?

A

Coeliac’s
Crohn’s
Chronic pancreatitis
Cystic Fibrosis

189
Q

Coeliac’s disease signs and symptoms?

A

Abdo pain
Weight loss
Diarrhoea
N+V
Fatigue
Iron deficiency anaemia
Osteomalacia
Dermatitis herpetiformis

190
Q

Commonest source of gluten?

191
Q

Blood test for Coeliac’s?

A

Anti-TTG antibodies and IgA

192
Q

Histological findings on Coeliac’s biopsy?

A

Crypt hyperplasia and villous atrophy

193
Q

Autoimmune diseases that Coeliac’s is associated with?

A

T1DM
Thyroid disease

194
Q

Drugs that cause constipation?

A

Opioids
Iron
Anticholinergics

195
Q

Mechanical causes of constipation?

A

Colorectal cancer
Stricture (e.g. Crohn’s)
Pelvic mass

196
Q

Lifestyle causes of constipation?

A

Dehydration
Immobility
Poor diet

197
Q

Psychological disorders related to IBS?

A

Depression
Stress disorder
Anxiety

198
Q

IBS patient with weight loss, fatigue, increasing abdo pain and new iron-deficiency anaemia.

What investigation and why?

A

Colonoscopy

Investigate for right sided colonic tumour as may present as unexplained iron-deficiency anaemia.

199
Q

Predisposing factors to colonic carcinoma?

A

Ulcerative colitis
Crohn’s disease
FAP (familial adenomatous polyps)
HNPCC
Low-fibre diet

200
Q

Colorectal cancer metastases sites?

A

Liver
Lung
Bone
Lymph

201
Q

Viral cause of gastroenteritis?

A

Rotavirus
Norovirus
Adenovirus
Astrovirus

202
Q

Drugs that increase risk of C.diff infection?

A

Fluoroquinolones
Clindamycin
Cephalosporins
Penicillins

203
Q

Infection control measures used when treating acute diarrhoea?

A

Isolation of patient
Hand-washing
PPE
Reduce number of contacts with patient

Capsule (5 decks)

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