vsa Flashcards
A 50 yearoldman with a history of type 2 diabetes presents with left sided weakness and a headache. Examination reveals brisk reflexes in the left arm.
A.mgraine B. GBS c. brain tumour D. stroke E. MS
STROKE
A 50yearold male presents with severe epigastric pain. He has had a similar episode in the past and he admits to drinking an excess of alcohol, and smoking a pack per day.
Cholecystitis Acute inferior MI Peptic ulcer disease basal pneumonia acute pancreatitis
Acute pancreatitis
A 40yearold man presents with collapse and loss of consciousness witnessed by his wife. The episode lasted 3 minutes. He felt dizzy for a few seconds prior to the event and had some jerky movements during the event. He recovered spontaneously and was not confused afterwards. He had no previous cardiac history and in fact had never seen a doctor
Arrhythmia seizure TIA hypoglycaemia vasovagal attack
Vasovagal attack
A 24 year old female presents with severe right sided back and abdominal pain and a
fever. She has no other previous medical or travel history.
Hepatitis Campylobacter inf actue pyelonephritis Acute cholecystitis Peptic Ulcer
Acute pyelonephritis
A 50year old woman presents with a severe headache and photophobia. Examination reveals brisk reflexes.
Extrdural haemorrhage subdural haemorrhage SAH Encephalitis Meningitis
SAH
A 50yearold smoker presents with lobar pneumonia. Examination reveals dullness at the right base with increased tactile vocal fremitus
Ecoli Mycoplasma Legionella Strep Haemophilius
Strep pneumoniae
Abdominal examination of a 70year old breathless man of no fixed abode reveals a palpable spleen. He is known to drink heavily and has had an anterior myocardial infarction previously.
Malaria
TB
Portal hypertensionSchistosomiasis
CCF
Portal HTN
A 50yearold woman presents with left calf swelling and tenderness. She has had a recent fracture and has been immobile. Her past medical history includes osteoarthritis. She has smoked 30/day for the last 30 years, but does not drink alcohol.
Baker's cyst rupture Liver failure DVT Cardiac failure Cellulitis
DVT
A 45yearold woman presents with a 1 day history of dizziness on standing up and vomiting. She had been started on a tricyclic antidepressant by her GP two weeks ago. Her past medical history includes type 2 diabetes diagnosed 4 years ago and treated with metformin.
Diabetic neuropathy side effect of TCA side effectof metformin Amyloidosis Hypovolaemia secondary to gastroenteritis
Side effect to TCA
A 35yearold male intravenous drug abuser is admitted to Casualty with a 3 day history of yellow discolouration of his skin, flulike symptoms and nausea. On examination, he is cachectic and jaundiced, with smooth, tender hepatomegaly.
Paracetamol Alcoholic liver disease Gilberts Hep C HIV
Hep c
Loud pansystolic murmur at the apex
mitral regurg
ejection systolic murmur
aortic stenosis
irregularly ireg pulse
AF
slow rising pulse
Aortic stenosis
collapsin pulse
Aortic regurgitation
Very loud S1
Mitral stenosis
early diastolic murmur at left sternal edge
Aortic regugitation
Tapping apex beat
Mitral stenosis
A 60 year old man complains of breathlessness, and has a third heart sound. What is the cause of a third heart sound?
A third heart sound is caused by rapid ventricular filling during normal diastole BEFORE the atrium contracts (which would cause a fourth heart sound if there is any stiffness). This occurs when the ventricle is dilated due to cardiac failure
Cannon waves @neck
Complete heart block
only condition where the atrium can contract when the tricuspid valve is closed (randomly) because the atria and ventricles are contracting at different rates. When they both contract together, the tricuspid valve will be closed and if the atria contract at the same time, the blood of the atrium can only rush upwards. This is much more intense than the v-wave of tricuspid regurgitation
Low pitched rumbling mid diastolic
mitral stenosis
Examination reveals reduced expansion on the left side with dullness to percussion and increased tactile vocal resonance (when he says “99”)
pneumonia (consolidation)
- A 25 year old comes to casualty with Expiratory wheezes. What is the likely diagnosis?
acute severe asthma
- A 45 year old patient complains of a cough that lasts for 3 months every winter for the last three years. What is the likely diagnosis?
chronic bronchitis, exacerbation of COPD
A 30 year old is on the oral contraceptive pill and becomes suddenly breathless. Examination of the respiratory system is normal.
PE
Examination reveals reduced expansion on the left side with dullness to percussion and reduced tactile vocal resonance (when he says “99”).
left sided pleural effusion
A 45 year old patient complains that they cough up a pot of purulent sputum every day. Examination reveals course crackles.
Bronchiectasis caused by CF
- A 65 year old complains of breathlessness and has fine crepitations at both bases.
Pulmonary oedema or pulmonary fibrosis
- A tall 19 year old suddenly complains of breathlessness and left sided chest pain
.
Pneumothorax
- A 55 year old with known lung cancer complains of a swollen leg and then suddenly becomes breathless.
PE
- A 30 year old complains of weight loss and coughs up blood. He has a fever of 38 degrees centigrade and complains of night sweats
pulmonary TB
Examination reveals a palpable mass in the right hypochondrium
Hepatomegaly
- Examination reveals a palpable mass in the left hypochondrium
splenomegaly
- A forty year old mother of five complains of abdominal pain after eating fish and chips. What is the likely diagnosis?
Gal stones
- A 40 year old man who drinks a bottle of vodka every night and is known to have chronic liver disease, developed severe abdominal pain with extreme tenderness. Examination revealed a rigid abdomen. What is the likely diagnosis?
- What single diagnostic confirmatory blood investigation is required for the patient in question 39?
Acute pancreatitis
Amylase
- A 50 year old complains of slowly worsening weakness in his left leg. This started gradually three months ago, and is now making him limp. Examination reveals increased tone, brisk reflexes and weakness in the left leg.
brain tumour
- A 50 year old complains that he has developed weakness in his left leg when he woke up this morning. He has great difficulty walking. Examination reveals increased tone, brisk reflexes and weakness in the left leg.
Stroke
- A 60 year old man complains of drooping of his left eyelid. Examination of his eyes reveals normal eye movements, but his left pupil is smaller than his right pupil.
Horner’s syndrome
- A 50 year old man complains of drooping of his left eyelid, so that his left eye is almost closed. When you hold his left eye open, he complains of double vision, and the left pupil is larger than the right one.
complete 3rd nerve palsy
- Examination of the lower limbs reveals wasting of the muscles of the left calf with absent reflexes on that side.
Lower motor neurone
A patient develops cerebellar atrophy due to alcohol abuse. The mnemonic “DANISH” is often used by students to list the six features of cerebellar disease.
D: dysdiadokinesia A: ataxia N: nystagmus I: intention tremor S: scanning/ staccato or slurred speech H: hypotonia
A patient complains of a tremor when he smokes cigarettes. What is the likely cause if the tremor gets worse when he puts the cigarette into his mouth.
Ataxia w/ cerebellar disease
- What is the diagnosis when a patient complains of a tremor of one hand at rest?
Parkinsons, symtoms start one sided
- A 40 year old patient has brisk reflexes on the right hand side. What do you expect to find when you examine the tone on the same side?
Increased Tone, UMN
- Examination of the plantar responses reveals that the right plantar is upgoing and the left plantar is downgoing. What do these findings suggest?
Upgoing plantar suggests UMN in right leg
Caused by: brain tumour or stroke in LEFT side
A 35-year old woman complains of weight loss, tremor of her outstretched hands and palpitations.
Hyperthyroidism graves
- A 40 year old woman complains of weight gain, thin skin and is noted to have stretch marks on the abdomen
Cushings syndtome
- A 40 year old woman complains of palpitations, and is noted to have a blood pressure of 190/120.
Phaemochromocytoma
could also be conns
- A patient with type 2 diabetes is advised on a healthy diet, and to exercise regularly. Three months later, he has an HbA1c of 60 mmol/mol. What drug will you start him on according to NICE guidelines.
Metformin
- Three months after that, the patient still does not have adequate glucose control. What class of drug should you add?
- Name one such drug.
Sulphonylurea: Gliclazide, Glibenclamide and Tolbutamide
What CLASS of drug should be prescribed for a patient with diabetes and hypertension who is found to have microalbuminuria?
63. Name one such drug:
ACE inhibitor
Enalapril, Lisinopril, Ramipril
What effect will ACEi have on the plasma potassium levels?
Increase
- What effect will ACEi have on plasma creatinine levels?
INCREASE
- What effect will ACEi drug have on the urinary albumin excretion?
DECREASE
A patient has a lymph node biopsy which is sent for histology, Caseating granulomata are seen
TB
A patient has a lymph node biopsy which is sent for histology, non-caseating granulomata are seen
Sarcoidosis
NSAID
Ibuprofen
corticosteroid
Prednisolone
ACEi
Ramipril
Ang-2 receptor antag
Lorsatan
Beta block
Propanolol
beta agonist
Salbutamol
calcium antagonist for HTN
Amlodipine nifedipine
Alpha block in HTN
Tamsulosin
Aldosterone receptor antag for HTN
Spironolactone
Dopamine agonist for prolactinoma
Cabergoline and bromocriptine
dopamine antagonist for psychotic disorders/nausea
Metaclopramide
Macrolide ABx
Clarythromycin
A 70 year old lady is found to have low albumin on a routine blood test at her GP. A consequent urine dipstick is +++ for protein. The patient is otherwise well apart from a nasty chest infection 2 months ago and difficulty getting out of bed in the morning, which she attributes to old age. On examination the GP notices swellings in both the PIP and MCP joints of the hands, and oedema in the patients legs. What is the most likely diagnosis? A.Diabetic nephropathy B. Post-streptococcal glomerulonephritis C. IgA nephropathy D. SLE E. Amyloidosis
E: Amyloidosis
The patient has presented with nephrotic syndrome most likely (would want to quantify the proteinuria) as there is no blood. Options B, C and D are more likely to give nephritic syndrome. There is no recent URTI to suggest IgA nephropathy and post-strep is normally 2-3 weeks after a infection. There is no suggestion of diabetes. SLE can lead to arthritis, but symmetrical arthritis in these joints typically suggests rheumatoid arthritis, and amyloidosis is a complication of this. Amyloidosis involves accumulation of misfolded proteins, here leading to structural damage of the glomerulus and so nephrotic syndrome.
A 30 year old lady presents to A&E with severe pain in her left flank that started this morning. Upon further questioning, she reveals she hasn’t urinated in the last 12 hours, but had increased urgency and frequency for the last 3 days. She is febrile, but otherwise her observations are normal. Her urine is positive for protein, leucocytes and nitrites, and an ultrasound of her abdomen was normal. What is the most likely reason for her reduced urine output? A.Pre-renal AKI B.Post-renal AKI C. Acute tubular necrosis D. Acute interstitial nephritis E. Glomerulonephritis
D. Acute interstitial nephritis
This patient has presented with AKI secondary to pyelonephritis. Her history suggests an initial UTI (increased frequency and urgency) that has progressed up the ureter to her kidney giving her flank pain and pyrexia. Pre-renal AKI would likely show haemodynamic compromise, post-renal is unlikely given the normal ultrasound. ATN would give brown cell casts in the urine, glomerulonephritis would likely give blood in the urine.
Acute interstitial nephritis is a complication of pyelonephritis – the inflammatory cells get into the interstitial tissue of the kidney
A 70 year old smoker presents to his GP with episodes of facial flushing. On further questioning, he reports his clothes have been looser lately but attributes this to his reduced appetite. The GP refers the patient to an oncologist who arranges a CTCAP. This demonstrates a lesion adjacent to the right main bronchus. What is the most likely diagnosis?
A.Squamous cell carcinoma B. Adenocarcinoma C. Small cell carcinoma D. Pancoast tumour E. Large cell carcinoma
C: small cell carcinoma
The flushing here represents carcinoid syndrome, due to ectopic serotonin secretion. This is most commonly associated with small cell carcinoma, further supported by the fact the patient is male and a smoker, and the lesion is found proximally.
Large cell and adeno are normally found distally, and adeno more in females who don’t smoke. Squamous is perhaps second most likely but less likely to give carcinoid.
In wrong place to be Pancoast tumour.
A 53 year old woman presents to her GP after an episode of haemoptysis, on a background of occasional jaundice and weight loss. She was a social smoker in her 20’s but hasn’t smoked for over 20 years. An X-ray arranged by the GP demonstrates a mass in the left lower lobe. What is the most likely diagnosis?
A. Squamous cell carcinoma B. Adenocarcinoma C. Small cell carcinoma D. Pancoast tumour E. Large cell carcinoma
B: adenocarcinoma
The factors that point to adenocarcinoma include that the patient is a woman and non-smoker – she did socially smoke, but lung cancer is more associated with high levels of smoking.
The jaundice suggests liver mets – adeno spreads earlier. Adeno is also found peripherally in keeping with the X ray
A 4-year-old boy is brought to see A&E after his mother noticed some bruises along his legs. The child does not recall injuring his legs. On examination, he is pale with several bruises on his legs. What is the most likely diagnosis? A Non-accidental injury B Immune thrombocytopaenic purpura C Acute lymphoblastic leukaemia D Acute myeloid leukaemia E Haemophilia A
C: ALL
A 73-year-old man presents to the gastroenterology outpatient clinic as he has as he has been suffering from constipation. He has also been feeling unwell for the past year. On examination, he is pale and has a grossly enlarged spleen. FBC reveals pancytopaenia. Given the most likely diagnosis, what would you expect to see on examination of the bone marrow? A More than 20% blast cells B Infiltration by mature lymphocytes C Dry tap D Band cells E Ringed sideroblasts
C: dry Tap
Myelofibrosis: Clonal bone marrow disease characterised by excessive fibrosis and extramedullary haemopoiesis
FBC initially variable (later pancytopaenia)
Tear drop cells (blood film)
Dry tap (bone marrow aspirate)
MASSIVE splenomegaly
A 74-year-old man presents to A&E with a fractured humerus with no history of trauma. An X-ray reveals a comminuted fracture with surrounding lytic bone lesions. FBC and U&Es are performed on admission, which showed the following significant results: Hb: 78 g/L (135-180) Ca2+: 2.89 mmol/L (2.2-2.6) Urea: 12 mmol/L (2-7) Creatinine: 289 µmol/L (55-120) Which investigation is most likely to offer a definitive diagnosis? A Serum protein electrophoresis B Bone marrow aspirate C Skull X-ray D Lymph node biopsy E Blood film
A: serum protein electrophoresis
Multiple Myeloma: CRAB C: hypercalcaemia Renal failure Anaemia Bone lesions/back pain
Blood film will show rouleaux formation
Serum + urine electrophoresis: Bence-jones protein (monoclonal immunoglobulin light chain found in urine) + serum paraprotein
Bone marrow aspirate: High plasma cells
Osteolytic lesions without surrounding sclerosis
