September 2016 Flashcards
Neonate with weak urinary stream -
posterior urethral valves
lightheadedness following gastric surgery what is the diagnosis -
dumping syndrome
Transmission of MRSA?
Direct skin-to-skin contact with shared items
Transmission of clostridium difficile?
faecal oral route
Gastroenteritis in developing country -
Amoebiasis, faeocal oral, bloody diarrhoea, liver abscess
Causes of osteomyelitis in a child with sickle cell anaemia
Salmonella
Injury with a sewing needle, what’s an organism?
?Staph
Which of the following is true regarding the vertebral artery? Tell me everything
Originates from subclavian, to transverse process of C6, through each transverse foramen. once through transverse foramen of C1/ Atlas, they cross posterior arch of C1 and through the suboccipital Triangle, before entering foramen Magnum, forming midline basilar artery.
A patient has recurrent pulmonary embolism due to DVT. What is the best management?
IVC filter.
A question on the differential diagnosis of left iliac fossa pain
Gastroenteritis: Constipation Diverticulitis Volvulus: sigmoid volvulus Left inguinal/femoral hernia Appendicitis Ectopic Miscarriage Placental abruption Uterine Rupture
gallbladder mucocele
The term gallbladder mucocele refers to an overdistended gallbladder filled with mucoid or clear and watery content. Usually noninflammatory, it results from outlet obstruction of the gallbladder and is commonly caused by an impacted stone in the neck of the gallbladder or in the cystic duct.
Pancreatic cancer
Adenocarcinoma
Mainly occur in the head of the pancreas (70%)
Weight loss
Painless jaundice
Epigastric discomfort (pain usually due to invasion of the coeliac plexus is a late feature)
Pancreatitis
Trousseau’s sign: migratory superficial thrombophlebitis
Investigations
USS: May miss small lesions
CT Scanning (pancreatic protocol). If unresectable on CT then no further staging needed
PET/CT for those with operable disease on CT alone
ERCP/ MRI for bile duct assessment
Staging laparoscopy to exclude peritoneal disease
Management
Head of pancreas: Whipple’s resection (SE dumping and ulcers). Newer techniques include pylorus preservation and SMA/ SMV resection
Carcinoma body and tail: poor prognosis, distal pancreatectomy, if operable
Usually adjuvent chemotherapy for resectable disease
ERCP and stent for jaundice and palliation
Surgical bypass may be needed for duodenal obstruction
Oesophageal CA
Upper GI endoscopy is the first line test
Contrast swallow may be of benefit in classifying benign motility disorders
If CT does not show metastatic disease, then local stage may be more accurately assessed by use of endoscopic ultrasound.
If CT does not show metastatic disease, then local stage may be more accurately assessed by use of endoscopic ultrasound.
Treatment
Operable disease is best managed by surgical resection. The most standard procedure is an Ivor- Lewis type oesophagectomy. mobilisation of the stomach and division of the oesophageal hiatus. The abdomen is closed and a right sided thoracotomy performed. The stomach is brought into the chest and the oesophagus mobilised further. An intrathoracic oesophagogastric anastomosis is constructed. Alternative a- transhiatal resection (for distal lesions), a left thoraco-abdominal resection (difficult access due to thoracic aorta) and a total oesophagectomy (McKeown) with a cervical oesophagogastric anastomosis.
The biggest surgical challenge is that of anastomotic leak, with an intrathoracic anastomosis this will result in mediastinitis. With high mortality. The McKeown technique has an intrinsically lower systemic insult in the event of anastomotic leakage.
In addition to surgical resection many patients will be treated with adjuvant chemotherapy.
A patient on multiple antibiotics and immunosuppressive drugs is complaining of dysphagia. What is the diagnosis?
A patient on multiple antibiotics and immunosuppressive drugs is complaining of dysphagia. What is the diagnosis? Candida.
A patient presented with breast cancer. What is the defective gene?
BRCA 1 (17q21) > BRCA 2 (13)
A patient with known lung cancer presented with nausea and headache. What is the best treatment?
Dexamethasone.
A patient presented with ischemic colitis. What is the most likely cause?
Thromboembolism in AAA repair as well Vs Hypoperfusion SIRS
A patient with esophageal varices. What are the involved veins?
Left gastric vein.
What forms the medial wall of the femoral canal?
Lacunar Ligament (LMAP/FLIP)
A infant with retractile testes. What is the abnormality?
Patent processus vaginalis.
A mediastinal lesion was biopsied and this shows Hassal bodies. What it is the lesion?
Thymus tumor (Hassall’s corpuscles (or thymic corpuscles (bodies)) are structures found in the medulla of the human thymus, formed from eosinophilic type VI epithelial reticular cells arranged concentrically.)
A man presented with abdominal pain. Abdominal radiograph shows multiple air-fluid levels small and large bowel. What is the most likely cause?
Paralytic ileus (?or adhesions)
A woman underwent short saphenous vein surgery for varicose veins. What is the most likely nerve to be damaged?
Sural nerve.
A man presented with flexion deformity affecting mainly the ring finger. What is the diagnosis?
Dupytrens contracture. (The ring finger followed by the little and middle fingers are most commonly affected)
A woman underwent surgery for Dupytrens contracture.
A nerve lying to the head of the fourth metacarpal was injured. What was this nerve? Communicating branch between ulna and median nerve or digital nerve
What part of the humerus articulates with the radius?
Capitalum
What is the investigation of choice for fracture in the face?
CT scan
A patient presented with episodes of fainting. She has a history of parathyroid disease. What is the diagnosis?
Insulinoma (MEN1)
A patient presented with newly onset diabetes mellitus and skin rash.
Glucagonoma (typically associated with a rash called necrolytic migratory erythema, weight loss, and mild diabetes mellitus, can be as part of MEN1 or sporadic)
Stimulant for gastric acid release?
histamine, acetylcholine and gastrin
Parietal cells - in the fundus and cardia
he enzyme hydrogen potassium ATPase (H+/K+ ATPase)
A patient develops sudden anuria post-operatively. There’s no hypotension or his temperature is normal. What is the cause? Catheter obstruction
Catheter obstruction.
Transplantation: iso, allo, auto, xeno
isograft (genetically identical twins), allograft (same species), autograft (same body) and xenograft (from different species).
Which type of bacteria develop in clean wounds?
Normal Flora - Staph
A patient has fistula between the vagina and rectum. What is the developmental anomaly?
urorectal septum reaches the cloacal membrane and divides it into anal and urogenital membranes.
What is the test that confirms carcinoid tumor?
Investigation 5-HIAA in a 24-hour urine collection Somatostatin receptor scintigraphy CT scan Blood testing for chromogranin A
Treatment
Octreotide
Surgical removal
Carcinoid tumours secrete serotonin
Originate in neuroendocrine cells mainly in the intestine (midgut-distal ileum/appendix)
Can occur in the rectum, bronchi
Hormonal symptoms mainly occur when disease spreads outside the bowel
Clinical features
Onset: insidious over many years
Flushing face
Palpitations
Pulmonary valve stenosis and tricuspid regurgitation causing dyspnoea
Asthma
Severe diarrhoea (secretory, persists despite fasting)
A patient has rectal adenoma. What is the likely electrolyte abnormality?
Hypokalemia?Hyponatraemia
What is the drug of choice for septic shock?
Noradrenaline
A patient has an urgency to pass urine while in a car. He was involved in an RTA. Upon waking up in the hospital he no longer has the urgency to void?
Bladder rupture
A patient with a lesion on his penis. There is inguinal lymph nodes involvement. I think they said it bleeds easily.
Squamous cell carcinoma.