VSAS and feedback Flashcards
A 12 year old boy develops widespread urticarial rash, facial and lip swelling, and wheeze after being stung by a bee. He has eczema and asthma. What medication should be administered as a first step?
0.5mg IM adrenaline
*An 81 year old man with type 2 diabetes is admitted following a fall at home.
His renal function was previously normal.
Investigations:
Sodium 142 mmol/L (135–146)
Potassium 5.9 mmol/L (3.4–5.0)
Creatinine 267 µmol/L (50–95)
Urea 19.7 mmol/L (2.5–7.8)
Creatine Kinase 8,000 U/L (<350)
Glucose 14 mmol/L (3–6)
Urinalysis:
Nitrite negative
Leukocytes negative
Blood 2+
Protein negative
What is the most likely cause of his renal failure?
Rhabdomyolysis [due to trauma]
Rhabdomyolysis: High CK, High serum lactate, High potassium, Myoglobinurea
Urine dipstick cannot distinguish between myoglobinurea and haematuria
A 63 year old man has palpitations but feels otherwise well.
His temperature is 37.1˚C, pulse rate 120 bpm, BP is 134/95mmHg, respiratory rate 18 breaths per minute and oxygen saturation 98% breathing air.
His ECG shows runs of polymorphic ventricular tachycardia.
What treatment should be given?
Amiodarone IV [if normal QT interval] or Magnesium IV [if long QT interval- torsades de pointes- b/c magnesium deficiency]
A 65 year old man has three weeks of painless haematuria. His renal function is normal.
Investigations:
Urinalysis:
Nitrites negative
Leukocytes negative
Blood 3+
Protein negative.
What is the next most appropriate investigation?
Cystoscopy [with biopsy]
A 45 year old woman with rheumatoid arthritis has weakness in her arms, worse in the evening. She has trouble keeping her eyes open when reading long reports. She has a bilateral ptosis which develops after staring upwards for some time.
What is the most likely diagnosis?
Myasthenia gravis
A 24 year old man has a two week history of cramping abdominal pain, mouth ulcers and weight loss. He has a rapidly enlarging painful ulcer with violaceous margins on his left lower limb.
What is the most likely cause of his abdominal pain?
Crohn’s [more likely] or UC/IBD
A 24 year old woman has two months of lethargy, dizziness, weight loss and nausea. She has type 1 diabetes and reports erratic blood sugars and one episode of loss of consciousness. She has hyperpigmentation in her palmar creases and her oral mucosa. Her temperature is 36.8˚C, pulse rate 101 bpm, BP is 78/61mmHg (standing), respiratory rate 16 breaths per minute and oxygen saturation 99% in air. Her blood sugar is 3.2 mmol/litre.
Investigations:
Sodium 129 mmol/L (135–146)
Potassium 5.4 mmol/L (3.4–5.0)
Creatinine 67 µmol/L (50–95)
Urea 7.7 mmol/L (2.5–7.8)
What is the most likely diagnosis?
Addison’s disease/crisis
A 75 year old man with known Benign Prostatic Hyperplasia (BPH) has a two day history of oliguria and lower abdominal pain.
A bladder scan shows a residual volume of 1.1L.
He is found to have an Acute Kidney Injury (AKI) with a Creatinine of 590.
Which immediate intervention is most likely to relieve his symptoms?
Catheter
A 40 year old woman with bipolar disease is found to be hyponatraemic. She is diagnosed with nephrogenic diabetes insipidus secondary to lithium use.
Which hormone is implicated in the pathophysiology of diabetes insipidus?
Vasopressin/ADH
*A 61 year old female has a lower respiratory tract infection. She then develops target-shaped erythematous macules and papules over her arms, legs, chest and back.
What is the most likely diagnosis of the rash?
Erythema multiforme [mycoplasma pneumonia]
A 23 year old female has burning on urination for three days. She develops fevers, rigors and loin pain. Urinalysis: Nitrite 3+ Leukocytes 2+ Blood 1+ Protein 1+ What is the most likely diagnosis?
Pyelonephritis [due to UTI]
A 62 year old male has a new diastolic murmur, a fever of 39˚C and splinter haemorrhages on his fingernails. Fundoscopy shows retinal haemorrhages with a white centre. What is the name of clinical sign seen on fundoscopy?
Roth spot
A 41 year old woman has three months of increasing anxiety, weight loss and palpitations. She has bilateral erythematous palms, periorbital oedema and proptosis. Her BMI is 19.8 kg/m². An ECG shows a sinus tachycardia at 120 beats per minute.
What would be the next most appropriate investigation for this patient?
TSH/T3/T4
A 67 year old man has gradual onset of worsening breathlessness over a year. He has a dry irritating cough.
He does not take any medications.
He has no fevers, sputum production or haemoptysis.
He has a 30 pack-year smoking history.
He has finger clubbing and a raised JVP and bi-basal fine late inspiratory crepitations with no wheeze. His spirometry results show a restrictive defect.
What is the likely diagnosis?
Idiopathic pulmonary fibrosis Interstitial lung disease
A 31 year old woman has recently returned from holiday. She has a four day history of headache, myalgia and fevers.
Over the past two days she has had a cough and confusion.
Her sodium level is 121 mmol/L (Reference range: 135–146).
Her chest X-ray shows left lower lobe consolidation and diagnosis of Legionella pneumonia is suspected.
What investigation will be most appropriate to confirm this diagnosis?
Urinary antigen
*A 71 year old woman has severe central chest pain. Her troponin is raised and she is diagnosed with an acute myocardial infarction. Her ECG is as shown.
Which coronary artery has been affected?
Tombstone - V3-6
A 65 year old woman has not opened her bowels in three days. She now has nausea and vomiting. An abdominal Xray is as shown. What is the most common cause of this presentation?
Adhesions-post surgery [leading to small bowel obstruction]
