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Triads Flashcards

1
Q

Vertigo,

Tinnitus,

Hearing Loss

A

Menieres Disease

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2
Q

Pale child

Severe colic

Vomiting

A

Acute intussusception

Features:

Sausage shaped mass in RUQ

Bowel sounds alternating high pitched to absent

Emptiness in RIF (signe de dance)

PR exam +/- PR blood - red currant jelly stool

Check for hernias

Ix: USS Abdo

Mment: barium enema, hydrostatic reduction, surgical referral

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3
Q

Intense pain

Pale and shocked

Back pain

A

Ruptured AAA

Normal diameter 3cm

Significant diameter 5cm

Dangerous >6cm

Mment: Oxygen, Ambulance, Iv fluids (large bore ivc), Urgent surgical referral.

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4
Q

Localised RIF pain

Anorexia,

Nausea + vomiting

Guarding

A

Acute Appendicitis

Esp 20-30yo

Pain oft central then progressing to RIF over 6 hours Tenderness - McBurney’s

Rovsing sign - RIF tenderness while palpating LIF.

Psoas sign - pain on right hip resisted flexion or passive leg elevation

Obturator sign - pain on right hip and knee flexion with internal hip rotation.

Mment:

Investigations are generally not helpful

Urgent surgical referral

If perforation: Start Iv fluids, Ceftriaxone + Metronidazole

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5
Q

Colicky central pain

1min duration every 3-10 mins

Vomiting

Distension

Nil flatus

A

Small Bowel Obstruction

Signs: Tinkling bowel sounds, Dehydration/hypovolemia, PR: empty rectum.

Check all hernial orifices

Ix: Abdo X-ray >4 air fluid levels in step ladder

CT scan

Urgent surgical referral

IV Fluids

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6
Q

Colicky pain (non central)

Distension

+/- Vomiting

A

Large bowel obstruction

Exam: Abdominal distension, Rigidity, Increased bowel sounds.

PR exam: empty rectum

Ix: Abdo X-ray - separation of haustra, coffee bean sign (sigmoid volvulus)

Mment:

Ng tube drip and suck

Surgical referral

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7
Q

Severe pain

Sudden onset

Anxious, grey, sweaty,

Deceptive improvement 2-6 hrs post onset.

A

Perforated Peptic Ulcer

Ix: BP, PR CXR (erect), CT abdomen.

Mment: Pain relief

NG tube - drip and suction

IV Fluids

Broad spectrum Abs

Hospital

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8
Q

Intense pain

Radiates to the groin

Restlessness

Microscopic haematuria.

A

Ureteric colic

Ix: Urine dipstick, Urine MCS, UEC, LFT, CMP,

Abdo-pelvic X-ray, USS KUB, CT Non - contrast KUB is most diagnostic (Sn 97%, Sp 96%), IVP if recurrent.

Mment: ketoralac 10 - 30mg im

Morphine 5-10mg im/Iv And metoclopramide,

10mg Iv Diclofenac 50mg TDS 7 days

Stone for analysis

Dietary advice: 2L water daily, avoid caffeinated foods and beverages, rhubarb, beer, red wine, processed/organ meats (high oxalates), increase citrate in diet, eat high fibre.

Referral for intervention if:

Stone > 5mm, High grade obstruction, Gross hydronephrosis,

Fever/UTI, Unremitting pain, Stone fails to progress, T2DM, Staghorn calculus, Solitary kidney.

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9
Q

Severe pain esp post prandial

Vomiting

Pain radiating esp right shoulder

Murphy’s sign (RUQ tenderness)

A

Biliary colic

Ix: USS abdo, LFTs, Helical CT,

If prev. Cholecystectomy then Iv colangiography

Complications: cholecystitis, perforation, obstructive jaundice, acute pancreatitis.

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10
Q

Anxiety

Prostration

Intense central pain

Profuse vomiting

+/- bloody diarrhoea

A

Mesenteric artery occlusion

Watery diarrhoea initially

Progress to confusion

Absent bowel sounds, Tachycardia or AF

Ix: CRP, ALP, X-ray shows thumb printing (bowel wall thickening) - also seen in other types of colitis. CT abdo

Surgical referral.

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11
Q

Severe Pain

Nausea and vomiting

Lack of Abdo signs

+/- Fever

A

Acute pancreatitis

Ix: WCC -leeukocytosis

Serum lipase elevated

CRP, BSL elevated

Hypocalcaemia

Blood gas PaO2

LFTs

Plain X-ray

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12
Q

Acute Abdo pain (LIF)

Left sided radiation

Fever

+/- tenderness, guarding, rigidity in LIF.

A

Acute diverticulitis

Ix: FBC (leukocytosis), ESR elevated, Faecal m/c/s Pus in stools,

CT Abdo - If ct not available erect CXR for perforation (air under diaphragm) and erect + supine Abdo X-ray

Mment: Admit to hospital, Rest gut, Ng tube - suction, Analgesia, Broad spectrum Abs, (Mild: amoxycillin + clavulanate 500mg TDS for 7 days Severe: Ceftriaxone 1gm daily + Metronidazole 500mg TDS)

Surgery if complications

Screening colonoscopy when settles.

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13
Q

Diarrhoea

Abdominal pain

Weight loss

Joint pain (migratory)

A

Whipple’s disease

Also: malabsorption ( inc steatorrhoea and hypoalbuminaemia), Abdominal lymphadenopathy, Skin changes (darkening, Nodules, Uveitis, Endocarditis, Dementia, Memory loss, Confusion, Weakness, Ataxia, Ocular myorhythmia (eye twitches)

Dx by duodenal biopsy Very rare 1:1,000,000

Due to a genetic failure in immunofunction and subsequent internal colonisation of T. whipplei

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14
Q

Malaise

URTI symptoms (rhinitis, sinusitis, etc)

LRTI symptoms (wheeze, cough)

+/- Febrile illness

A

Wegner’s granulomatosis

75% of patients develop glomerulonephritis

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17
Q

Malaise

Cough

Fever

+/- erythema nodosum

A

Sarcoidosis

Multi system involvement

Lungs: granulomas, fibrosis, perihilar lymphadenopathy

Skin: EN, plaques, maculopapular eruptions

Cardiac: conduction abnormalities inc complete HB and ventricular arrhythmias, pericarditis.

Eyes: uveitis, facial nerve palsy/ptosis Hyperprolactinemia, hypercalcaemia

Diagnosis is by exclusion

Treatment: NSAIDs, prednisolone 15mg daily for 4 weeks, methotrexate 5-10mg Po, weekly + folic acid 5mg weekly on an alternate day.

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18
Q

Less than 16 YO

Limping or Reduced physical activity

Morning joint pain and stiffness

Joint swelling

Lethargy

Poor appetite

A

Juvenile Idiopathic Arthritis

Mangement: Referral to Paediatric Rheumatologist

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19
Q

Child, esp < 5 YO

Joint pain or stifness esp morning.

High remittent fever

Coppery red (Salmon Pink) rash

lymphadenopathy

A

Systemic Onset Juvenile Idiopathic Arthritis (Still Syndrome)

Adult version is Adult-onset Still disease.

Referral to Specialist

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20
Q

Young esp 5 - 15 YO

Acute onset fever

Joint pains

Malaise

Migratory (flitting) arthritis

+/- History of sore throat

A

Rheumatic Fever

Diagnosis requires either

2 + major criteria, or 1 major & 2 + minor criteria

Major criteria: Polyarthritis, carditis, chorea, subcutaneous nodules, Erythema marginatum

Minor criteria: Fever + 38 degC, previous RF or RHD, arthralgia, Raised ESR > 30 or CRP > 30, prolonged PR interval on ECG.

Ix: FBC, ESR/CRP, throat swab streptococcal ASOT, Streptococcal anti-DNase B, ECG (Echocardiogram if inc. PR interval), chest xray.

Tx: Bed rest, 900mg Benzathine penicillin IM (450mg if < 20Kg)

Paracetamol 15mg/kg QID

If carditis ACEI + Corticosteroid

Note: if diagnosed with acute rheumatic fever or rheumatic heart disease, then will need 4 weekly IMI of Benzathine Penicillin.

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21
Q

Advancing age

Joint pain worse at end of day

Pain relieved by rest and non weight bearing.

Joint deformity (Bouchard’s nodes at PIP and Heberden’s nodes at DIP)

No systemic manifestations

A

Osteoarthritis

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22
Q

Arthritis

Conjuctivitis

+/- iritis

Following urethritis or gastroenteritis

A

Reactive arthritis

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23
Q

Oedema,

Increased urine albumin,

Dereased serum albumin,

Hyperlipidemia

A

Nephrotic syndrome

Causes: Nonproliferative:

Focalsegmental glomerulosclerosis

Membranous glomerulonephritis

Minimal Change disease

Thin basement membrane disease

24
Q

Hypertension,

Haematuria,

Oligouria

A

Nephritic Syndrome (Glomerulonephritis)

Types:

(Proliferative)

IgA Nephropathy (Most common cause)

Post infectious

Membranoproliferative

Rapidly progressive

Dx: Proteinuria 1 - 3gm/day, Red cell casts,

25
Q

Tiredness,

Husky voice,

Cold intollerance

A

Myxoedema (Hypothyroidism)

Also: Constipation, Mental slowing, Depression, Puffiness, Pallor, Hair loss, Weight gain.

26
Q

Anxiety,

Weight loss,

Weakness,

A

Thyrotoxicosis.

Also: Heat intollerance, Tremor, Goitre, Proximal myopathy, Hyper reflexia, AF, Lid lag, Lid retraction, Exopthalmos, Opthalmaplegia.

Ix: TSH, T3, T4, Radioisotope thyroid scan, Antithyroid peroxidase

Uniform uptake on scan = Graves

Irregular uptake = toxic multinodual goitre

Tx: Radioactive iodine, Antithyroid drugs (eg carbimazole), Surgery, Adjuncts (propanalol 40mg TDS)

Refer to specialist.

27
Q

Reduced libido,

Subfertility,

Amenorrhoea,

Erectile dysfunction

Galactorrhoea

A

Hyperprolactinemia

Causes: Pituitary adenoma, Pituitary stalk damage, Drugs (MJ, Opiates), Metoclopramide, Oestrogens, Pregnancy, Breast feeding.

28
Q

Acute vertigo,

Nausea,

Vomiting

A

Acute Vestibular Neuronitis

Tx

Bed rest

Gaze in direction that reduces symptoms

Antiemetic: Prochlorperazine 12.5mg IM

Diazepam 5 - 10mg IM then 5mg TDS PO for 2-3 days

Prednisolone 25mg daily PO, taper over 9 days

29
Q

Vertigo,

Nausea,

Vomiting,

Hearing loss,

+/- Tinnitus

A

Acute Labarynthitis

Tx:

Bed rest

Gaze in direction that reduces symptoms

Antiemetic: Prochlorperazine 12.5mg IM

Diazepam 5 - 10mg IM then 5mg TDS PO for 2-3 days

Prednisolone 25mg daily PO, taper over 9 days

30
Q

Malaise

Weight Loss

Cough

A

Lung Ca

31
Q

Haematuria

Loin Pain

Palpable Kidney Mass

A

Renal Cell Carcinoma

32
Q

Child esp 2 - 3 YO

Palpable abdominal mass

Haematuria

Malaise

A

Wilm’s Tumour

33
Q

Female esp > 40 yo

Abdominal Discomfort

Anorexia

Abdominal bloating/Distension

A

Ovarian Ca

Ix: Pelvic USS, CA-125,

50 YO is average age of diagnosis

34
Q

Anemia +/- Haematochezia

Abdominal Discomfort

Change in Bowel habit

A

Colon Cancer

35
Q

Jaundice

Anorexia

Abdominal Pain or Discomfort

A

Pancreatic Cancer (usual ductal adenocarcinoma)

(Until proven otherwise)

Pain presentation depends on location:

Head: Painless

Body or Tail: Epigastric, radiating to back, relived by leaning forward.

36
Q

Malaise

Pallor

Bone Pain and or Joint pain

esp Age < 45

A

Acute lymphatic leukemia

37
Q

Malaise

Pallor

Oral Problems (eg Gingival hypertrophy)

esp Age > 45

A

Acute Myeloid Leukaemia

Symptoms / Haemotology change has rapid onset

Ix: Bone marrow : Blasts > 20%

If anemia, hypercellular marrow and blasts:

BM blasts 10 - 19 % then RAEB 2

BM blasts 5 - 9% then RAEB 1

RAEB = Refractory anemia with excess blasts

38
Q

Malaise

Fever or Night Sweats

Pruritis

Painless rubbery lymphadenopathy

+/- splenomegally

A

Hodgkin Lymphoma

Dx on lymph node biopsy

Ann Arbor system for staging

39
Q

Fatigue

Fever or Night sweats

Abdominal fullness (Splenomegaly)

esp 40 - 60 yo

A

Chronic Myeloid Leukaemia

Associated with Philadelphia chromosome

Features

Leukocytosis with left shift

Normocytic anemia

Thrombocytosis (50%)

Eosinophilia

Basophilia

40
Q

Fatigue

Weight loss

Fever or Night sweats

Lymphadenopathy

Esp > 55 YO

A

Chronic Lympocytic Leukaemia

Lymph adenopathy 80% (neck, axilla, groin)

Can also have splenomegally (50%)

Mild anemia

Lymphocytosis usually > 15 x 109. Some times greater than 100 x 109

41
Q

Malaise

Fever or Night sweats

Painless Lymphadenopathy

Older age.

A

Non Hodgkin Lymphoma

Pruritis is rare

42
Q

Weakness

Back pain

Recurrent Infection

A

Multiple myeloma

Ix: Serum protein electrophoresis = paraproteins

Urine Bence Jones Proteins

Bone scan = lytic lesions

43
Q

Advanced Age

Fatigue

Headache

Epistaxis

Pruritis after hot shower

A

Polycythemia vera

Malignant prolifeartion of red cells

Also: Splenomegaly, thrombosis

Ix: Increased haematocrit and Hb

Bone marrow biopsy to confirm.

44
Q

Angina

Dyspnoea

Blackouts or Fainting

A

Aortic Stenosis

Findings: Low BP, Displaced Apex, ES Murmur (Aortic)

Ix: ECG shows Left ventriclar hypertrophy

S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm

Increased R wave peak time > 50 ms in leads V5 or V6

ST depression and T wave inversion in the left-sided leads (V5,V6, I, AVL

45
Q

Perineal Pain

Ejaculatory discomfort

A

Prostatitis

46
Q

Epigastric pain

Sudden onset

Constant

Radiates to back

Relieved by leaning forward

A

Acute pancreatitis

47
Q

Infant

Abdominal distension

Constipation

Occaisional vomiting

Irritable

Anorexia

A

Hirschsprung Disease

Disorder of innervation of the bowel

48
Q

Young child

Unilateral Nasal discharge

Often smelly

A

Inhaled foreign body

49
Q

Returned traveller

Headache

Fever

Malaise

A

Malaria

50
Q

Foreigner

Cough

Fatigue

A

Tuberculosis

51
Q

Anaemia, weight loss, dysphagia and older age

A

Gastric Cancer

Refer for endoscopy

52
Q
A

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