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Clinical Skills > Written Exam Y3 S1 > Flashcards

Written Exam Y3 S1 Flashcards

1
Q

Acute Abdomen:

A

rapid onset of severe symptoms that may indicate a potentially life threatening abdo/pelvic pathology, requiring urgent referral

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2
Q

Red flags for AA

A
  • over 65
  • immunocompromised
  • previous abdo surgery
  • multiple comorbidities
    cardiac disease
    alcoholism
    pregnancy
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3
Q

Typical signs of acute abdomen:

A 
fever
tachycardia (^ HR)
signs of shock
rigid abdomen
involuntary guarding
peritonitis
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4
Q

3 factors determining whether AA requires GP or urgent hospital referral

A
  • severity of presentaton
  • presence of red flags
  • DD’s
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5
Q

Typical imaging for acute abdomen:

A
  • CT for generalised abdomen pain or when patients over 50, or LIF pain over 40
  • ultrasound: epigastric or RUQ pain, under 50 in females only or when patients pregnant
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6
Q

Typical other acute abdomen investigations:

A

blood tests
urinalysis
pregnancy test in women of childbearing age

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7
Q

Typical blood test types:

A

LFT - liver function test
BSL - Blood sugar level
EUC - electrolytes, urea and creatinine
FBC - full blood count

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8
Q

AAA definition:

A

AA >3.0cm

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9
Q

AAA risk factors:

A 
smoker
males
old age
caucasion
atherosclerosis
HTN
family history of AAA
other peripheral artery aneurysm
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10
Q

AAA classic triad:

A

severe acute pain, pulsatile abdominal mass and hypotension

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11
Q

symptoms of ruptured aneurysm may mimic that of:

A

renal colic
diverticulitis
GI haemorrhage
other intra abdominal conditions

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12
Q

acute appendicitis:

A

inflam of the lining of the vermiform appendix.

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13
Q

typical causes of appendicitis?

A

bacterial infection precipitated by an obstruction of the lumen via a fecalith

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14
Q

Alvardo score for appendicitis?

A 
MANTRELS
M: migration of pain to RLQ
A: anorexia
N: nausea/vomiting
T: tenderness in RLQ
R: rebound tenderness
E: elevated temperature
L: leukocytosis
S: shift of WBC to the left (high amount of immature  WBCs)
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15
Q

Scoring of ALvardo (MANTRELS)

A

> 7 - probable append
4-6: further imaging required
<4: unlikely append

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16
Q

common age of onset for diverticulosis:

A

40 years

seen in ~50% of people over 70

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17
Q

common presentation of diverticulitis:

A 
sharp LIF pain
fever
bloating
change in bowel habits
nausea/vomiting
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18
Q

how will an abscess present in diverticulitis patients:

A

palpable abdo mass

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19
Q

How will peritonitis typically present:

A
  • general tenderness with rebound and guarding
  • distended and tympanic abdomen
  • diminished abdo sounds
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20
Q

preferred diverticulitis imaging?

A 
CT abdomen:
will usually find:
- colonic diverticula
bowel wall thickening
soft tissue inflam masses
abscess
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21
Q

typical changes in blood test results for patients with diverticulitis:

A
  • leukocytosis and left shift

other tests are used to rule out other DD’s

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22
Q

PID covers spectrum of inflam disorders of the female genital tract

A
  • endometritis
  • salpingitis
  • pelvic peritonitis
  • tubo-ovarian abscess
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23
Q

common organisms of PID:

A

chlamydia, gonorrhoea, mycoplasma

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24
Q

pyelonephritis:

A

infection of the renal parenchyma and calyces system

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25
Q

typical questions to ask in patients presenting with PID ssx?

A
  • early coitarche
  • high number of sexual partners
  • recent UID
  • operative procedures? abortion
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26
Q

Symptoms of PID:

A

abdo pain
pelvic pain with sex
abnormal bleeding
urinary symptoms

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27
Q

signs of PID:

A
  • tenderness during cervical, uterine or adnexal movement
  • cervicitis
  • adnexal swelling
  • increased or decrease in temperature
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28
Q

PID diagnostic interventions:

A

preg test
STI check
urinalysis
blood tests

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29
Q

acute cholecystitis?

A

inflammation of the GB, typically presents with RUQ pain, fever and leucocytosis

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30
Q

gall stones/cholelithiasis common people with:

A 
- obesity
female gender
increasing age
rapid weight loss
sedentary lifestyle
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31
Q

common DDS for acute cholecystitis:

A

acute pancreatitis
Rt sided pneumonia
cardiac ischaemia
perforated viscus (peptic ulcer/ectopic pregnancy)

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32
Q

Common blood test changes in cholecystitis:

A
  • increased neutrophils especially immature

- ECG to rule out AMI

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33
Q

Imaging for acute cholecystitis?

A

Ultrasound often most used

CT useful to exclude differentials

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34
Q

acute pancreatitis definition?

A

acute inflam of the pancreas which can range from mild to severe with extensive necrosis and multiple organ failure

35
Q

risk factors for pancreatitis:

A 
gall stones
ethanol (alcohol)
endoscopic procedures
trauma
infections
metabolic conditions
36
Q

SSX of pancreatitis:

A
  • abdominal pain in upper quadrants that is typically severe and may radiate to the back
  • nausea, diaphoresis: abnormal sweating)
37
Q

blood test changes in acute pancreatitis

A

serum lipase 3 times higher than normal

38
Q

Bowel obstruction:

A

when normal flow of the bowel is interrupted.

can be mechanical or functional, as well as complete or partial

39
Q

where does bowel obstruction usually occur?

A

small intestine

40
Q

risk factors for bowel obstruction

A
  • previous abdo/pelvic surgery
  • hernias (groin, inguinal)
  • intestinal inflammation
  • intestinal malignancy
41
Q

high pitched bowel sounds may indicate:

A

bowel obstruction

42
Q

common imaging findings of small bowel obstruction

A

XRAY: dilated loops of bowel with air fluid levels
proximal bowel dilation >2.5cm

gasless abdomen

CT abdomen: better to indicate site and severity

43
Q

Gastroscopy definition:

A

inspection of the interior stomach with a flexible, lighted, optical instrument that is passed through the mouth and esophagus to the stomach

44
Q

Wwhat is the only test that confims Barrett’s esophagus?

A

Gastroscopy

45
Q

when is a gastroscopy indicated?

A
  • if treatment/therapy for suspected benign digestive disorder was unsuccessful
  • initial method of evaluation as an alternative to radiographic studies
  • if change in management is probable based on results of endoscopy
46
Q

What pathologies can a gastroscopy detect:

A 
tumours
varices (enlarged veins)
mucosal inflam
hiatal hernia
polyps (projecting growth from mucosal membrane)
ulcers
obstructions
47
Q

invasive H. pylori investigations:

A
  • biopsy with urea and pH measure

- H.pylori is positive when the measurement is more alkaline

48
Q

what does H.pylori do?

A

converts urea to ammonia and CO2

49
Q

Non-invasive H.pylori investigations

A

test for presence of H.pylori in blood serum:

presence of H.pylori-specific IgG antibodies

50
Q

bowel cancer screening program test for?

A

blood in the feces

51
Q

what ages is the bowel cancer screening program offered free

A

ages 50-74 years

52
Q

Colonoscopy definition:

A

visual inspection of the interior aspect of the colon with a flexible tube inserted through the rectum

53
Q

Indications for colonoscopy?

A
  • abnormal results on other tests or unexplained SSX
positive iFOBT
unexplained weight loss  or abdo pain
        OR
investigate suspected colorectal cancer in relatively high risk patients such as:
- family history
rectal bleeding
change of bowel habit
significant/unexplained weight loss
54
Q

therapeutic use of colonoscopy:

A

ulceration,
vascular malformation,
balloon dilation of stenotic lesions

55
Q

LFT:

A

liver function test:

- group of tests performed together to detect, evaluate and monitor liver disease or damage

56
Q

What does a LFT evaluate?

A

synthetic capability of the liver
or
evidence of hepatocellular disease

57
Q

LFT that asses the Synthetic capability of liver include:

A

(bilirubin, albumin, total protein)

an abnormal level of these may indicate an in ability of hepatocytes to function normally

58
Q

LFT that assess hepatocellular damage evaluate:

A

AST: Aspartate aminotransferase
ALT: alanine aminotransferase
Both are enzymes found in hepatocyte. And are released into the blood stream when hepatocytes are damaged

59
Q

raised ALT levels usually indicates:

A

hepatitis

60
Q

LFT indications?

A

jaundice
history of alcohol abuse
signs of chronic liver disease
family history of haemochromatosis

61
Q

Cholestasis?

A

reduced bile flow due to impaired secretion by hepatocytes or due to obstruction of intra/extrahepatic bile ducts

62
Q

in cholestasis, substances normally secreted into bile by hepatocytes will build up in their cytoplasm and eventually diffuse back into?

A

blood stream

63
Q

What usually result in increased plasma levels of alkaline phosphatase?

A

high pressures in the biliary pathways and subsequent obstruction. which cause damage to canalicular surface of hepatocytes and cause an increase in alkaline phosphatase

64
Q

what would a LFT show in a patient with cholestasis?

A

ALP>200IU/L

ALP 3 times greater than ALT

65
Q

What is ALP?

A

Alkaline phosphatase:
an enzyme found in hepatocytes.
it originates from the canicular surface of hepatocytes, thus anything causing cholestasis will damage these cells and cause their release into the blood stream

66
Q

suspected pancreatic tumour what test?

A

abdominal CT or US

67
Q

suspected diabetes what test?

A

BSL and insulin levels

68
Q

suspected acute pancreatitis what test?

A

pancreatic enzyme tests

69
Q

why wouldnt an increase in lipase (associated with damaged pancreas) be seen in a urinalysis?

A

kidneys reabsorb lipase, therefore it would be seen only in a blood test

70
Q

serum amylase and serum lipase increase for how long and by how much when acute pancreatitis is present?

A

lipase: 2 weeks & x3-5
amylase: 2 days & >5x

71
Q

Urinalysis is a group of chemical, physical and microscopic tests on urine used to detect and measure:

A
  • byproducts of normal/abnormal metabolism
  • drugs
  • preg-related hormones
  • cells/cellular fragments
  • bacteria
72
Q

different types of urine samples:

A
  • first morning sample
  • midstream sample
  • first pass (any time of day but first part)
73
Q

common uses of urinalysis?

A
  • check renal function
  • diagnose UTI’s
  • look for blood in urine
  • confirm pregnancy
  • diagnose and monitor diseases such as diabetes, bladder cancer or STIs
  • monitor recreational or performance enhancing drug use
74
Q

Urine SG measures?

A

specific gravity: assesses the ability of the kidney to concentrate or dilute urine

75
Q

decreased SG:

A

inability of kidney to concentrate urine

76
Q

increased SG:

A

indicates concentrated urine with large volume of dissolved solutes: eg - dehydration, adrenal insufficiency

also can indicate glycosuria

77
Q

what may cause acidic urine?

A

high protein diet
systemic acidosis
diabetes
diarrhoea

78
Q

what may cause alkaline urine?

A

vegetarian diet
systemic alkalosis
UTIs with urea splitting organisms
drugs (carbonic anhydrase inhibitors - a diuretic)

79
Q

what condition can cause excess protein in the urine?

A
  • nephrotic syndrome
  • glomerular disease
  • congestive heart failure
  • NSAIDs
80
Q

How do nitrates form nitrites?

A

nitrates are converted to nitrites in the urine in the presence of bacteria

81
Q

causes of haematuria?

A 
trauma
infection
inflammation
infarction
calculi
neoplasia
coagulation disorders
82
Q

Normal bilirubin metabolism:

A
  • unconjugated bilirubin is formed when RBC are broken down (predominantly by the spleen)
  • hepatocytes (liver) conjugate bilirubin with glucouronic acid to make it water soluble
  • hepatocytes excrete conjugated bilirubin in bile which enters the small intestine and is converted to stercobilin and urobilinogen
83
Q

bilirubin is converted to urobilinogen by bacteria in the duodenum, 90% is excreted in faeces and the other 10% is?

A

transported back to the liver and converted into bile

the remaining <1% is excreted in the urine

84
Q

Typical level of RBC, WBC and epithelial cells in a microscopic & culture examination

A

RBC - very low (higher - inflamm, urinary tract disease)
WBC - low (higher - UTI and inflamm)
Epithelial cells - less than 15-20 per hpf (higher - infections, malignancies)

Clinical Skills (2 decks)

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