24/02/24 (morning) Flashcards
What malignancies are patients with coeliac disease at risk of if left untreated?
Lymphoma (EATL) and small bowel adenocarcinomas
What skin condition is seen in coeliac disease and what is seen in IBD?
- Coeliac disease - dermatitis herpetiformis (itchy, painful blistering or papular rash commonly on the trunk, buttocks, and elbows)
- IBD - erythema nodosum (red, raised nodules over shins) and pyoderma gangrenosum (blistering over shins)
What is Prehn’s sign and how do you interpret it?
- Testicular pain relieved on elevation of testicles
- Positive suggests epididymitis over torsion
What are the signs of necrotising enterocolitis and what is the treatment?
- Signs: Bile-streaked vomit, blood streaked stool, abdominal distension and intramural air on X-ray (distended loops of bowl with thin black lines across the bowel wall)
- Treatment is with broad spectrum antibiotics and parenteral nutrition
What are the sings of Meckel’s diverticulum, what’s the investigation and what’s the treatment?
- Signs are painless rectal bleeding, possible mass in RLQ, generally well
- Investigation is Tec-99 scan (shows reduced uptake at lesion)
- Treatment is managing any obstruction (NG tube) and surgery (wedge excision or small bowel resection with anastomosis)
What needs to be done in a woman presenting with possible appendicitis before surgery and why?
Abdominal US to rule out any ovarian cause of pain and confirm appendicitis
Signs, associations, investigation, and treatment for oesophageal atresia?
- Newborn constantly drooling and coughing up milk
- Associated with Down’s and polyhydramnios
- Investigation is NG tube insertion with X-ray (see how far it goes, may show bird beak sign)
- Treatment is surgical
Signs, investigation and treatment mesenteric adenitis?
- Signs: diffuse acute abdominal pain following recent URTI
- Investigation: abdominal ultrasound (shows enlarged mesenteric lymph nodes and mesenteric thickening, can also distinguish between mesenteric adenitis and appendicitis)
- Treatment is supportive as condition is usually self limiting, surgery may be warranted if appendicitis can’t be ruled out
Which out of ramipril or furosemide is likely to cause hyperkalaemia?
- Ramipril by blocking aldosterone
- Furosemide is a loop diuretic so more likely to waste potassium
Signs of haemolytic uraemia syndrome and the moist common organism?
- Signs of AKI, microangiopathic haemolysis and thrombocytopaenia
- Most cases secondary to underlying infectious or inflammatory pathology (e.g. after GI infection)
- 90% of cases in children caused by shiga-like toxin from E.coli
What do you give in severe colitis not responsive steroids and fluids?
IV ciclosporin to cover infection
What antibiotic causes urine and tear discolouration?
- Rifampicin
- Goes orange, patient may think it’s blood
Most serious adverse effect of rapid correction of chronic hyponatraemia and how to avoid it?
- Central pontine demyelinosis (leading to locked in syndrome)
- Avoid by not exceeding correction of 10mmol/L in 24 hours
Most common adverse effect of induction of labour?
- Failure of induction requiring C-section
- Warn patients C-section may be required
What test needs to be done before starting lithium and why?
- TFTs
- Lithium can cause hypothyroidism
