Spotter Flashcards
What is this complication of UC? [1]
Iritis
What is this complication of UC? [1]
Erythema nodosum
What is this complication of UC? [1]
Erythema nodosum
What is this complication of UC? [1]
Pyoderma gangrenosum
What is this IBD complication? [1]
Figure 6. Erythematous papulonodular lesions involving the face of a patient with Sweet’s syndrome associated with Crohn’s disease.
What is this complication in a patient with UC? [1]
Figure 7. Vegetating plaques localized on the beard region of a patient with ulcerative colitis-associated pyodermatitis vegetans.
- “Pyostomatitis vegetans” is the mucosal counterpart of “pyodermatitis vegetans”, and mainly involves the oral cavity. The typical presentation includes multiple small pustules with a characteristic “snail track-appearance”
What is this complication in a patient with UC? [1]
Figure 9. Psoriasiform eruption involving the abdomen and the pubic area of a patient undergoing adalimumab treatment.
Patient has UC and:
Episcleritis
Iritis
Conjunctivitis
Uveitis
Patient has UC and:
Episcleritis
Iritis
Conjunctivitis
Uveitis
Patient has UC and:
Episcleritis
Iritis
Conjunctivitis
Uveitis
Patient has UC and:
Episcleritis
Iritis
Conjunctivitis
Uveitis
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Mastitis
Pagets
P’eau d’orange
Areola dermatitis
Breast infection
Staph. aureus
Treatment is with Abx and US guided aspiration
Overlying skin necrosis is an indication for surgical debridement
Continue breast feeding and monitor
12-24hrs
What is this
due to a duct papilloma
A patient is breast feeding.
What is this presentation? [1]
Periductal mastitis
This is a relatively uncommon condition where by patients present with recurrent episodes of inflammation and infection within the breast tissue – normally behind the nipple or at the margin of the areola itself.
This condition is almost exclusively seen in women who smoke although the exact cause of the condition is not known.
Label A-C
Caused by hypercholesterolaemia
What spefically causes this? [1]
High triglyceride levels
BMI 35 ++
What is the name for this sign? [1]
Striae palmaris
Patient with sarcoid.
What is this? [1]
Lupus pernio
A patient has DMT2.
What is this complication? [1]
bullous diabeticorum
What is this skin complication of DMT2? [1]
Necrobiosis lipoidica diabeticorum
Granuloma annulare
This patient has DM.
What is depicted? [1]
Diabetic cheiroarthropathy is also called diabetic hand syndrome or stiff hand syndrome
This patient has DM.
What is depicted? [1]
Dx and tx? [2]
Pharyngitis -> Group A strep
Rx – penicillin V x10 days (or clarithromycin/erythromycin if allergic)
A patient has infective mononucleosis.
What drug has been given to cause this complication?
Amoxicillin
Ciprofloxacin
Azithromycin
Doxycycline
Cephalexin
A patient has infective mononucleosis.
What drug has been given to cause this complication?
Amoxicillin
Ciprofloxacin
Azithromycin
Doxycycline
Cephalexin
Name this nail change and three causes [3]
Oncholysis
- Hyperthyroidism, fungal infections, psoriasis
Label A & B
What is the name for the nail changes seen? [1]
What causes them? [+]
Beaus lines
Mees lines
Muehrckes lines
Terrys nails
Chronic paronychia
Beaus lines
- temporary arrest of nail growth at times of biological stress
Severe infection eg malaria, typhus, rheumatic fever, Kawasaki disease, MI, chemo, trauma, high altitude climbing, deep sea diving
What is the name for the nail changes seen? [1]
What causes them? [+]
Beaus lines
Mees lines
Muehrckes lines
Terrys nails
Chronic paronychia
Terrys nails
- Cirrhosis, CKD, congestive cardiac failure
What is the name for the nail changes seen? [1]
What causes them? [+]
Beaus lines
Mees lines
Muehrckes lines
Terrys nails
Chronic paronychia
** Mees lines:**
- **single white transverse bands classically seen in arsenic poisoning, CKD, carbon monoxide poisoning **
What is the name for the nail changes seen? [1]
What causes them? [+]
Beaus lines
Mees lines
Muehrckes lines
Terrys nails
Chronic paronychia
Chronic paronychia – chronic infxn of nail fold, painful swollen nail + intermittent discharge
Nail fungal infection
What is the name for the nail changes seen? [1]
What causes them? [+]
Beaus lines
Mees lines
Muehrckes lines
Terrys nails
Chronic paronychia
Muehrcke’s lines – paired white parallel transverse bands without furrowing of the nail seen in chronic hypoalbuminemia, hodgkins, pallegra (niacin/B3 deficiency), CKD
A patient is treated with antibiotics.
What has caused this? [1]
Red man syndrome – vancomycin
APML
AML
Person with AIDS.
What infection has caused this KS? [1]
HPV 2
HPV 4
HPV 6
HPV 8
HPV 10
Person with AIDS.
What infection has caused this KS? [1]
HPV 2
HPV 4
HPV 6
HPV 8
HPV 10
AIDS patient.
Which infective pathogen has caused this retinitis? [1]
CMV
AIDS patient.
Which infective pathogen has caused this oral leukoplakia? [1]
EBV
C. diff (pseudomembrane colitis)
A patient has pneumonia. A MCS reveals the following.
What is the treatment? [1]
Diplococci bacteria -> strep pneumoniae
Rx – amoxicillin, ciprafloxicin if not available/allergic
Otitis media
Sign? [1]
Cause? [1]
Roth spots
Infective endocarditis
Papilloedema
Disc cupping
Optic atrophy
Central retinal artery occlusion
Central retinal vein occlusion
Hypertensive retinopathy
Central retinal vein occlusion
- ‘Stormy sunset’ appearance
Papilloedema
Disc cupping
Optic atrophy
Central retinal artery occlusion
Central retinal vein occlusion
Hypertensive retinopathy
Papilloedema
Disc cupping
Optic atrophy
Central retinal artery occlusion
Central retinal vein occlusion
Hypertensive retinopathy
Hypertensive retinopathy.
The retinal arteries have become narrow and tortuous.
Papilloedema
Disc cupping
Optic atrophy
Central retinal artery occlusion
Central retinal vein occlusion
Hypertensive retinopathy
Papilloedema
Disc cupping
Optic atrophy
Central retinal artery occlusion
Central retinal vein occlusion
Hypertensive retinopathy
Exudative (Wet) macula degeneration
- characterized by the formation of pathological choroidal neovascular membranes (CNM) under the retina, which can leak fluid and blood.
IgA nephropathy
Membranous nephropathy
Focal segmental glomerulosclerosis (FSGS)
Membranoproliferative glomerulonephritis (MPGN)
Rapidly progressive glomerulonephritis (RPGN)
IgA nephropathy
Membranous nephropathy
Focal segmental glomerulosclerosis (FSGS)
Membranoproliferative glomerulonephritis (MPGN)
Rapidly progressive glomerulonephritis (RPGN)
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie
Patient has malaria - which type?
P. vivax - signet ring; ameboid shape
P. ovale
P. falciparum
P. malaraie
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie
P. falciparum
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie - bands
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie
Patient has malaria - which type?
P. vivax
P. ovale
P. falciparum
P. malaraie
Patient with BHL and this histological slide.
What type of HS?
1
2
3
4
Patient with BHL and this histological slide.
What type of HS?
1
2
3
4 - TB
Bronchiectasis
Hiatus hernia
How do you calculate:
1. Anion gap
2. Osmolarity
Anion gap = Na + K – (Cl+HCO3)
Osmolarity = 2(Na+K) + urea + glucose
Describe the findings of this fundoscopy [1]
Describe the findings of this fundoscopy [1]
Describe the findings of this fundoscopy [1]
Post-MI complication [1]
LV aneurysm
Describe the cardiac abnormality [1]
LA enlargement
Clinical presentation:
- SOB; weight loss & fevers
Dx? [1]
Pulmonary mets
Clinical presentation:
- Known inoperable lung cancer
- Rapid worsening SOB
Dx? [1]
Phrenic nerve palsy
Dx? [1]
Pneumothorax
Feel like rice crispies or bubble wrap on palpitation [1]
Surgical emphysema
What treatment has been given in this CXR? [1]
Chest drain
Dx? [1]
Dx? [3]
arrow pointing to what specifically? [1]
Clinical presentation:
- COPD
Cor pulmonale - RVH
Dx? [1]
Finding? [1]
What are the two arrows pointing to in this breast ultrasound? [2]
What is the name for this sign? [1]
What pathology does it indicate? [1]
Kantors string sign - Crohns
Dx? [1]
The abdominal x-ray is consistent a diagnosis of ulcerative colitis showing lead pipe appearance of the colon (red arrows). Ankylosis of the left sacroiliac joint and partial ankylosis on the right (yellow arrow), reinforcing the link with sacroilitis.
What is this form of IBD? [1]
What is the arrow pointing at? [1]
Cobblestoning - Crohns
Crohns
Which one is UC or Crohns? [2]
Describe the histological changes of each form of IBD [2]
What is this histology suggestive of? [1]
Signet ring cells -> gastric cancer
What is this histology suggestive of? [1]
Signet ring cells -> gastric cancer
Dx? [1]
Dx? [1]
Peptic ulcer
A & B are histological changes seen in kidneys. What are they? [2]
A: acute tubular necrosis
B” acute interstitial nephritis
Dx? [1]
Troponin raised
Myocarditis
Name for this sign? [1]
Dx? [1]
What are they spefically pointing at? [2]
Double duct sign - main pancreatic duct (short arrow) and common bile duct (long arrow).
Caused by pancreatic cancer
Name this sign seen in an US of a breast [1]
What is it caused by? [1]
Snowstorm - breast implant rupture
Which is the cause of her sudden loss of vision?
A. Branch retinal artery occlusion
B. Branch retinal vein occlusion
C. Central retinal artery occlusion
D. Central retinal vein occlusion
E. Cilioretinal vein occlusion
B. Branch retinal vein occlusion
Which is the cause of her sudden loss of vision?
A. Branch retinal artery occlusion
B. Branch retinal vein occlusion
C. Central retinal artery occlusion
D. Central retinal vein occlusion
E. Cilioretinal vein occlusion
Which is the cause of her sudden loss of vision?
A. Branch retinal artery occlusion
B. Branch retinal vein occlusion
C. Central retinal artery occlusion
D. Central retinal vein occlusion
E. Cilioretinal vein occlusion
Which is the cause of her sudden loss of vision?
A. Branch retinal artery occlusion
B. Branch retinal vein occlusion
C. Central retinal artery occlusion
D. Central retinal vein occlusion
E. Cilioretinal vein occlusion
C. Central retinal artery occlusion
Which is the most likely cause of his acute deterioration?
A. Acute myocardial infarction
B. Diaphragmatic hernia
C. Lobar pneumonia
D. Pneumothorax
E. Pulmonary embolus
D. Pneumothorax
Dx? [1]
Lipodermatosclerosis
Label the arrows [2]
A male patient is a heavy smoker.
He has angiography of his hands.
What is the dx? [1]
Buerger’s syndrome; corkscrew collaterals
This patient is likely infected with which organism? [1]
green wound = pseudomnas aerugonisa.
Patient with infective endocarditis - what can you see? [1]
Extensive Osler’s nodes on the hand of a patient with infective endocarditis.
What form of IBD does this patient have? [1]
What specific finding can be seen on this image? [1]
Endoscopic Image of Ulcerative Colitis with Pseudopolyps
What form of IBD does this patient have? [1]
What specific finding can be seen on this image? [1]
Cobblestone appearance of Crohn’s with skip lesions
A patient presents with these changes to their nails.
You find they are suffering from micocytic anaemia.
What is the most likely cause?
Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.
A patient presents with these changes to their nails.
You find they are suffering from micocytic anaemia.
What is the most likely cause?
Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.
A patient presents with this nail change. What systemic condition is likely to have caused this? [1]
Psoriasis
A patient presents with these nail changes. You find out that they have normal iron levels.
What infective organism might cause this? [1]
Koilonychia refers to spoon-shaped nails. Can be caused by:
* Iron deficiency anaemia (e.g. Crohn’s disease)
* Lichen planus
* Rheumatic fever: therefore Streptococcus pyogenes
A patient has these hands. Alongside cardio-resp diseases, what might a gastro differential be? [1]
IBD
A 24 year old female with a known history of Crohn’s disease presents with a painful, bilateral rash on her shins. There are numerous red-purple nodules approximately 2-6 cm in size scattered on both shins that are painful to touch.
What is the most appropriate treatment? [1]
Erythema nodosum is a self-limiting disease that can be treated with NSAIDs (e.g. naproxen). Steroids may be prescribed in some setting (e.g. sarcoidosis).
State the name of this symptom of Crohn’s [1]
Pyostomatitis vegetans: an inflammatory stomatitis
What sign of Crohn’s Disease are the arrows pointing to? [1]
Rosehorn ulcer
Name this EIM symptom of CD [1]
Aphthous ulcers
Name this EIM symptom of CD [1]
pyoderma gangrenosum
Describe the histopathological features of CD [1]
Non-caseating granuloma (w/ Langhan giant cells)
Name this symptom of CD [1]
Erythema Nodosum
Name this symptom of CD [1]
Pyoderma gangrenosum: large, painful sores (ulcers) to develop on your skin, most often on your legs.
Warts
Dx? [1]
Superficial thrombophlebitis
Dx? [1]
Superficial thrombophlebitis
47-year-old Edward Munch presents to his
GP complaining of dysphagia. He states that
it feels like food gets stuck in his throat
easily, so he’s changed his diet to consume
only liquid foods.
Mr. Munch has a long history of
postprandial heartburn, but only feels
partial relief from over-the-counter
antacids.
A thoracic CT image near the level of the
aortic arch is shown below. Mr. Munch’s
symptoms are most likely related to
pathology involving which of the following
structures?
Label the signs shown in A & B [2]
What pathology does these signs indicate? [1]
A: Cullens sign
B: Grey-Turners sign
Cullen’s and Grey-Turner’s signs are associated with severe necrotising pancreatitis
What does this yellow arrow depict in non-proliferative diabetic retinopathy? [1]
Hard exudates
What does the yellow arrow on the image of non-proliferative retinopathy depict? [1]
Lipid exudates
Describe what the arrows & circle depict on this image of non proliferative diabetic retinopathy [3]
intraretinal microvascular abnormality (IRMA; green arrow)
venous beading and segmentation (blue arrow)
cluster haemorrhage (red circle)
featureless retina suggestive of capillary non-perfusion (white ellipse)
What is the arrow pointing to on this NPDR? [1]
Cotton wool spots (severe NPDR
Which pathology is depicted? [1]
Diabetic maculopathy: hard exudates near to the macula
What is depicted in this image? [1]
Proliferative diabetic retinopathy:
extensive vitreous haemorrhage obscuring most of fundus (white circle)}
What is the arrow pointing to? [1]
Cotton wool spot
What is depicted in this image? [1]
Non-proliferative diabetic retinopathy: blot haemorrhage (white circle)}
Describe what is happening in this image [1]
Proliferative diabetic retinopathy: NVD new vessels on the optic disc
What does the green arrows point to? [1]
Kimmelstein-Wilson lesion
What is this skin condition associated with diabetes? [1]
Necrobiosis Lipoidica Diabeticorum
What is the name of this skin complication of diabetes? [1]
Granuloma annulare
What is the name for this diabetic skin complication? [1]
Bullosis Diabeticorum
Name this complication of diabetes
Charcot neuroarthropathy
Name this sign [1] and disease [1] that is a complication of diabetes
Prayer sign; diabetic cheiroarthropathy
What is the name of this treatment for diabetic retinopathy? [1]
Pan-retinal photocoagulation (PRP)
Patient with severe abdominal pain. What does the image show?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Patient with severe abdominal pain. What does the image show?
Rigler’s/ double wall sign
Free gas (pneumoperitoneum) can be seen on both sides of the bowel wall. This is Rigler’s sign or the double wall sign.
Whenever sharp points or triangles of low density are seen adjacent to loops of bowel, pneumoperitoneum should be suspected.
Note: In patients with an acute abdomen an erect chest X-ray is more sensitive for small volumes of free gas.
Patient with severe abdominal pain. What does the image show?
What is the likely pathology?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Patient with severe abdominal pain. What does the image show?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Inflammation of the bowel wall leads to thickening of the haustral folds. This results in the radiological sign of thumbprinting, a characteristic finding in patients with active ulcerative colitis.
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Staghorn renal calculus
24-year-old patient with suspected appendicitis. What does the image show?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
24-year-old patient with suspected appendicitis. What does the image show?
Small bowel obstruction
Dilated loops of bowel with valvulae conniventes – lines crossing the full width of the bowel – indicates small bowel obstruction.
Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
What is the artifact shown in this image?
Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent
What is the artifact shown in this image?
Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent
Patient with abdominal pain and vomiting. What is the radiological diagnosis?
Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal
Patient with abdominal pain and vomiting. What is the radiological diagnosis?
Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal
What is the radiological diagnosis?
Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum
What is the radiological diagnosis?
Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum
What is the cause of the abnormal calcification in this image?
Calcified gallstones
Calcified mesenteric lymph nodes
Pancreatic calcification
Malignant calcification
Calcified uterine fibroid
What is the cause of the abnormal calcification in this image?
Calcified gallstones
Calcified mesenteric lymph nodes
Pancreatic calcification
Malignant calcification
Calcified uterine fibroid
Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?
Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal
Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?
Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal
What is the cause of the area of increased density in the pelvis?
Calcified pelvic kidney
Calcified abdominal lymph node
Calcified uterine fibroid
Ingested barium
Calcified adrenal gland
What is the cause of the area of increased density in the pelvis?
Calcified pelvic kidney
Calcified abdominal lymph node
Calcified uterine fibroid
Ingested barium
Calcified adrenal gland
History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis?
Small bowel obstruction
Post-operative ileus
Normal
Perforation
Sigmoid volvulus
History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis?
Small bowel obstruction
Post-operative ileus
Normal
Perforation
Sigmoid volvulus
If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action?
Place an abdominal drain
Request abdominal ultrasound
Request abdominal MRI
Resuscitate the patient and inform the surgeons
Take a break
If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action?
Place an abdominal drain
Request abdominal ultrasound
Request abdominal MRI
Resuscitate the patient and inform the surgeons
Take a break
A large volume of free gas is present under the diaphragm. In the context of acute abdominal pain this finding indicates perforation. Emergency resuscitation and informing the surgeons would be the most appropriate action.
Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?
Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal
Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?
Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal
Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances?
Large bowel obstruction
Sigmoid volvulus
Caecal volvulus
Perforation
Small bowel obstruction
Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances?
Large bowel obstruction
Sigmoid volvulus
Caecal volvulus
Perforation
Small bowel obstruction
Describe what Rigler’s double wall sign appears like [1]
What does this indicate?
Normally only the inner wall of the bowel is visible
If there is pneumoperitoneum both sides of the bowel wall may be visible
What may a liver edge silhouette indicate on an AXR? [1]
When perforation of a duodenal ulcer occurs, and
results in a pneumoperitoneum:
Gas collects in Morison’s pouch (the hepato-renal space), and rise on the supine film to the anterior abdominal wall outlining the edge of the liver
diagnostic of duodenal
perforation.
What pathology is indicated in this AXR? [1]
False Rigler’s/double wall sign
* Be careful not to mistake the gas within two adjacent bowel segments for Rigler’s sign.
* Gas seen on both sides of the bowel wall is contained within adjacent bowel
* There are no black triangles or sharp angles on the outside of the bowel wall
Describe what is seen in this AXR [3]
Small bowel obstruction - features
Centrally located multiple dilated loops of gas filled bowel (arrowheads)
Valvulae conniventes (arrow) are visible - confirming this is small bowel
Describe what is depicted in this AXR [1]
Large bowel obstruction
- Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon.
- Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow).
- An obstructing colon carcinoma was confirmed on CT and at surgery.
Which of the following is a caecal and sigmoid volvulus? [2]
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Mucosal thickening - ‘thumbprinting’
This patient presented with an exacerbation of symptoms of ulcerative colitis.
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Lead pipe colon
This patient with ulcerative colitis has a featureless segment of transverse colon with loss of the normal haustral markings.
This ‘lead pipe’ appearance is associated with longstanding ulcerative colitis.
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Toxic megacolon
The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of ulcerative colitis. The clinical features and X-ray appearances are consistent with toxic megacolon.
Where is the ureteric stone in this AXR? [1]
What is depicted here? [1]
State a cause of this [1]
Bladder stones form in the bladder as a result of urinary stasis, e.g. bladder outflow obstruction (enlarged prostate) or in patients with a neurogenic bladder (loss of bladder function due to spinal cord injury/disease)
What is depicted in this AXR? [1]
What does this indicate? [1]
Vascular calcification
There is striking calcification of the aorta and iliac vessels
This is a sign of generalised atherosclerosis elsewhere in the body
What is depicted in this AXR? [1]
What does this indicate? [1]
Abdominal aortic aneurysm - AAA
There is calcification of the dilated aortic wall
Frequently only one side of the aneurysm is visible - as in this image - the other being projected over the spine
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is depicted in this AXR? [1]
What does this indicate? [1]
Appendicolith
Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain
Appendicoliths are calcific masses in the appendix, formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix
What is the artifact shown in this image?
What pathology does it reduce the risk of?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Inferior vena cava (IVC) filter
An IVC filter may be used to reduce the risk of large pulmonary emboli
What is the artifact shown in this image?
What pathology does it reduce the risk of?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Colonic stent
Large bowel obstruction can be treated with placement of a metallic colonic stent
This is often used as a temporary measure allowing a patient to recover from the effects of obstruction prior to definitive colonic resection
What is the artifact shown in this image?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Pig-tail (JJ) stent
A ureteric stent has been placed to relieve ureteric obstruction
The catheter has loops (pig-tails) at both ends which hold it in place
What is the artifact shown in this image?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Naso-jejunal tube
Placed for the purpose of enteral feeding
The tube passes through the stomach and forms a C-shape as it navigates the 4 parts of the duodenum (D1-4)
The tube tip lies beyond the duodenojejunal flexure which lies on the left
What is depicted in this AXR? [1]
What does this indicate? [1]
Ascites
There is generalised hazy density of the entire abdomen
In the presence of ascites gas within bowel is located centrally
A 73-year-old male presents with a 2-hour history of sudden-onset abdominal pain, accompanied by a bowel motion and vomiting. He has a history of non-specific heart problems and takes antihypertensive medication. He also had a previous appendicectomy performed 45 years ago.
Examination of the abdomen reveals a distended and generally tender abdomen with no guarding. There is a scar present in the right iliac fossa and bowel sounds are absent. Rectal examination is unremarkable. An ECG performed is shown below:
What is the most likely diagnosis?
Small bowel obstruction
Large bowel obstruction
Caecal volvulus
Mesenteric ischaemia
Ileus
A 73-year-old male presents with a 2-hour history of sudden-onset abdominal pain, accompanied by a bowel motion and vomiting. He has a history of non-specific heart problems and takes antihypertensive medication. He also had a previous appendicectomy performed 45 years ago.
Examination of the abdomen reveals a distended and generally tender abdomen with no guarding. There is a scar present in the right iliac fossa and bowel sounds are absent. Rectal examination is unremarkable. An ECG performed is shown below:
What is the most likely diagnosis?
Small bowel obstruction
Large bowel obstruction
Caecal volvulus
Mesenteric ischaemia
Ileus
What does this chest CT depict? [1]
Figure 4 – CT Chest of Stanford Type B Aortic Dissection
What is the DeBakey classification this aortic dissection?
Type I
Type II
Type IIIa
Type IIIB
What is DeBakey classification for aortic dissection is this?
Type I
Type II
Type IIIa
Type IIIB
The Aortic dissection classified as involving the aorta proximal to the left subclavian artery and requires further surgical intervention to avoid coronary artery occlusion or cardiac tamponade.
What is the most likely aetiology of the vascular abnormality shown?
atherosclerosis
hypertension
trauma
vasculitis
This is a case of aortic dissection: hypertension is the most likely etiology for a dissection.
What is the DeBakey classification this aortic dissection?
Type I
Type II
Type IIIa
Type IIIB
This aortic dissection is essentially limited to the ascending aorta making it a Stanford type A / DeBakey type 2.
What is the DeBakey classification this aortic dissection?
Type I
Type II
Type IIIa
Type IIIB
DeBakey type 2.
What is the DeBakey classification this aortic dissection?
Type I
Type II
Type IIIa
Type IIIB
Type IIIa
What is the DeBakey classification this aortic dissection?
Type I
Type II
Type IIIa
Type IIIB
Type IIIa
What is this complication of varicose veins?
Lipodermatosclerosis
Thrombophlebitis
Haemosiderin
Varicose eczema
What is this complication of varicose veins?
Lipodermatosclerosis
Thrombophlebitis
Haemosiderin
Varicose eczema
What is this complication of varicose veins?
Lipodermatosclerosis
Thrombophlebitis
Haemosiderin
Varicose eczema
What is this complication of varicose veins?
Lipodermatosclerosis
Thrombophlebitis
Haemosiderin
Varicose eczema
What is this complication of varicose veins?
Lipodermatosclerosis
Thrombophlebitis
Haemosiderin
Varicose eczema
Lipodermatosclerosis
What treatment is suggested for this pathology? [1]
Laser photocoagulation therapy is performed to stop the growth of new blood vessels.
The white circular lesions represent focal laser surgery for proliferative diabetic retinopathy.
Cotton wool spots, microhaemorrhages and neovascularisation can be seen across the remaining retina.
Describe your findings of this fundoscopy [3]
Extensive new vessel proliferation / neovascularisation
Cotton wool spots
Microhaemorrhages
What is the exacct name for this sign? [1]
Icteric sclera
What is this most likely a diagnosis of? [1]
Pseudomembrane colitis: inflammation of the colon associated with an overgrowth of the bacterium Clostridioides difficile
A patient undergoes a barium swallow of their oesophagus after presenting with dysphagia. What is the most likely diagnosis? [1]
Achalasia
- bird beak sign
- esophageal dilatation
Presentation
History of chronic alcohol abuse with long time chest pain, dysphagia and nocturnal cough.
Patient Data
Age: 60 years
Gender: Male
What is the most likely diagnosis? [1]
Findings are most suggestive of achalasia. There is a classic bird beak sign at the gastro-esophageal junction.
A 40-year-old female presents with dysphagia and barium swallow is performed. What is the most likely diagnosis?
achalasia
diffuse oesophageal spasm
gastro-oesophageal reflux disease
non-specific oesophageal motility disorder
presbyoesophagus
scleroderma
achalasia
What pathology does this drawing imitate? [1]
eosinophilic oesophagitis
What pathology is likely shown? [1]
eosinophilic oesophagitis
Sometimes, multiple rings may occur in the esophagus, leading to the term “corrugated esophagus”
What pathology is likely shown? [1]
eosinophilic oesophagitis
Sometimes, multiple rings may occur in the esophagus, leading to the term “corrugated esophagus”
Dx? [1]
nodular mesangial expansion = kimmelstell-wilson lesions (pathognomonic)
sclerosis isolated to a specific region (arrow) i.e. focal sclerosis: focal segmental GS
causes GS and CKD in young patients, presenting with nephrotic picture
idiopathic or secondary to IgA nephropathy, HIV, Alport’s, SCA
Steroids ± immuonsuppression
howell-jolly body - nuclear remnant in RBC. RBCs usually expell their nuclei, and those that don’t are destroyed in the spleen. HJBs therefore suggest a/hyposplenism
normal light microscopy with podocyte fusion and foot process effacement on EM - minimal change disease
What IF is +Ve here? [2]
IgA nephropathy (Berger’s)
most common GN worldwide
- - mesangial hypercellularity (top) with +ve immunofluorescence for IgA and C3
17 y/o boy; IDA
Dx? [1]
What other scan would you use to confirm? [1]
Meckel diverticulum
- detection and localization of a symptomatic Meckel’s diverticulum are based on accumulation of technetium-99m
glomeruli are full of cresents therefore it’s likely to be rapidly progressive GN
Dx? [1]
glomeruli are full of cresents therefore it’s likely to be rapidly progressive GN
Immunofluorescence for IgG
Dx? [1]
Goodpastures
stacks of aggregated RBCs - rouleaux formation
- suggestive of MM
inclusions of denatured Hb attached to RBC - heinz bodies
Cataract
CML
AML: usually more symptoms of BM failure, leucostasis with neuropenia
CLL: usually with thrombocytopenia
Myelodyslpasia: older patients, full BM failure
myeloma: usually bony/renal involvement
A to B is associated with which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
A to B is associated with which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
patient x comes into contact with posion ivy and has the following reaction. This is which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
patient x comes into contact with posion ivy and has the following reaction. This is which type of hypersensitivity reaction?
Type 1
Type 2
Type 3
Type 4
How do you treat? [4]
How do you treat if severe? [2]
top: trophozoite infecting a reticulocyte
bottom: trophozoite infecting an RBC with Schuffner’s dots (eosinophilic) with preserved cell morphology
suggestive of plasmodium vivax - similar to ovale but without RBC shape change
- treated with oral artemeter + lumefantrine or quinine sulphate or doxycyline
- consider artesunate + quinine dihydrochloride IV if severe infection
commence IV ABx and admit
Label A & B
A - potency
B - efficacy
congo red staining revealing characteristic apple-green birefringence - amyloid deposition
congo red staining revealing characteristic apple-green birefringence - amyloid deposition
BHL
dark dots in RBC: infected RBC. Note presence of ring trophozoites (almost like signet-ring cells in RBC) and crescent-shaped gameocytes - pathognomonic of falciparum malaria
Treat with IV artesunate and quinine dihydrochloride
i
aspirin
bisoprolol
digoxin
furosemide
spironolactone
spironolactone - tall tented T waves with abnormal QRS suggests hyperkalaemia
label A
Ligament of treitz
Label the borders of Calot’s triangle [3]
cystic duct (lateral)
liver (superior)
CBD (medial)
decompression sigmoidoscopy
emergency laparotomy
high dose laxatives
metoclopramide
drip and suck
decompression sigmoidoscopy
Hx of bloody diarrhoea
Crypt abscesses
How would you treat this? [1]
ABVD - HL
A 30 year old man is brought into the Emergency Department after falling from his horse. His spleen is ruptured and an urgent blood transfusion is started. A few minutes later a rash appears on his arm. He is otherwise well.
What is the most appropriate initial management step?
give antihistamine and continue transfusion
give IM adrenaline
give IV adrenaline
stop transfusion, give prednisolone
stop transfusion, reasses
stop transfusion, reasses
clerosis isolated to a specific region (arrow) i.e. focal sclerosis: focal segmental GS
causes GS and CKD in young patients, presenting with nephrotic picture
idiopathic or secondary to IgA nephropathy, HIV, Alport’s, SCA
Steroids ± immuonsuppression
Note neutrophil infiltrate on biopsy, in contrast to Berger’s (IgA) which has no neutrophil infiltration
nephritic syndrome with headache, malaise, low serum C3 and raised ASO
starry sky appearance on immunofluorescence = post-strep!!
You treat a 20 year old who came in to the GP with vague infective symptoms.
The next day she comes back and presents with this rash.
Investigations reveal she has EBV.
Which abx was initially given?
Metronidazole
Flucoxacillin
Rifampicin
Fluroquinolone
Amoxicillin
You treat a 20 year old who came in to the GP with vague infective symptoms.
The next day she comes back and presents with this rash.
Investigations reveal she has EBV.
Which abx was initially given?
Amoxicillin
- causes a reaction with EBV infection
A patient comes in with the following.
Dx? [1]
Tx? [1]
What is the most likely prescription?
Ciprofloxacin
Doxycycline
Erythromycin
Flucloxacillin
Metronidazole
Erysipelas - flucloxacillin
Acute mesenteric ischaemia
Pacemaker spikes
Oral vancomycin
Hyperkalaemia
A 74-year-old man has had increasingly severe, throbbing headaches for several months, centred on the right. There is a palpable tender cord-like area over his right temple.
His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities, BP is 110/85 mmHg. A biopsy of this lesion is obtained, and histologic examination reveals a muscular artery with lumenal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy.
Which of the following laboratory test findings is most likely to be present with this disease?
pANCA titre of 1:160
Anti-double stranded DNA titre of 1:1024
HDL cholesterol of 0.6 mmol/L
Rheumatoid factor titre of 80 IU/mL
Erythrocyte sedimentation rate of 50 mm/hr
Erythrocyte sedimentation rate of 50 mm/hr
L-thyroxine
ANA
Vitamin B12
No immediate investigation required
BO
Administer IV fluids and insert NG tube
Myocarditis
Pyoderma gangrenosum
Lupus nephropathy
Loop ileostomy
This blood film is most associated with which clotting disorder? [1]
DIC - microangiopathic haemolytic anaemia
```
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Label prosethetic heart valves A&B [2]
- Which is preffered? [1]
St Judes valve is the best
What is a cause of this ECG?? [1]
Sick sinus syndrome
Runs of tachycardia interspersed with long sinus pauses (up to 6 seconds).
The sinus rate is extremely slow, varying from 40 bpm down to around 10 bpm in places.
Young patient presents with recurrent syncope.
ECG changes are shown below.
Dx? [1]
Brugada syndrome
What type of stoma is this? [1]
Loop stoma
What type of stoma is this? [1]
Label which of A & B is the proximal and distal part [2]
Double barrel stoma
A: Proximal
B: Distal
Label E & F
What type of surgeries would they be used for? [1]
E: Battle
F: Lanz
Both for open appendicectomy
Label B [1]
What is the indication for B? [1]
Rooftop scar: Liver transplant
Label A [1]
What would indicate A? [1]
Kocher scar: open cholecystectomy
What is the scar called? [1]
Whats the indication? [1]
Rutherford Morison
Label A-C
The gridiron and lanz incisions are muscle-splitting incisions which are the incisions of choice for open appendicectomy.
They differ in the orientation of the skin incision alone. The gridiron incision can be more readily extended laterally into an oblique, curvilinear muscle-cutting incision: the Rutherford Morison.
This type of scar is A
Rutherford Morrison
Lanz
Kocher
Hockey-Stick
Chevron
Gridiron
Pfannenstiel
This type of scar is A
Rutherford Morrison
Lanz
Kocher
Hockey-Stick
Chevron
Gridiron
Pfannenstiel
Dx? [1]
IPF
A patient has this anal fissure.
Which is the most likely cause?
Constipation
Malignancy
Anal intercourse
Diarrhoea
Trauma
A patient has this anal fissure.
Which is the most likely cause?
Malignancy
Also Crohns
Which stain would you use to confirm diagnosis? [1]
What renal manifestation might occur? [1]
Congo red stain
Amyloidosis can cause nephrotic syndrome
This ECG would be caused toxicity from
Amiodarone
Digoxin
Adenosine
Flecainide
Digoxin
