Cases Book 2 Flashcards
(194 cards)
1
Q
RUQ pain post eating. No other Sx. Dx?
A
Symptomatic cholelithiasis
2
Q
RUQ pain and jaundice. Dx?
A
Choledocholithiasis
3
Q
RUQ pain, fever and Murphy’s sign positive. Dx?
A
Acute cholecystitis
4
Q
RUQ pain, jaundice, fever. Dx?
A
Ascending cholangitis
5
Q
RUQ pain, jaundice, fever. Name of triad?
A
Charcot’s triad
6
Q
Which conditions have raised WCC and LFTs?
A
Acute cholecytitis
Acute cholangitis
7
Q
What is the imaging and results for cholethiliasis?
A
USS - stone in GB
8
Q
What is the imaging and results for choledocholithiasis?
A
USS - stones +/- dilated CBD
9
Q
What is the imaging and results for acute cholecystitis?
A
USS - stones in GB, thick wall and dilated lumen of GB
10
Q
What is the imaging and results for acute cholangitis?
A
USS + ERCP
11
Q
What is the initial and definitive Mx for acute cholecystitis?
A
1st = NBM, analgesia, fluids, IV ABx Def = Lap chole in a week
12
Q
What is the initial and definitive Mx for acute cholangitis?
A
1st = NBM, analgesia, IV ABx, IV fluid, ERCP Def = elective lap chole
13
Q
List complications of acute cholecystitis
A
Empyema
Porcelain GB
GB cancer
GB ileus
14
Q
List complications of acute cholangitis
A
CBD perforation
Sepsis
15
Q
Name the borders of Hesselbach’s triangle
A
Medial = lateral rectus abdominis Lateral = Inferior epigastric artery Inferior = inguinal ligament
16
Q
Where is the inguinal ligament?
A
ASIS to pubic tubercle
17
Q
List the walls of the inguinal canal
A
Ant = external oblique aponeurosis Post = transversalis fascia Floor = inguinal ligament Roof = TF, internal oblique, transversus abdominus
18
Q
Where is the deep ring?
A
Midpoint of inguinal ligament
19
Q
Where is superficial ring?
A
Superior to pubic tubercle
20
Q
What is the course of an indirect inguinal hernia?
A
Deep ring –> inguinal canal –> superficial ring
21
Q
What is the course of a direct inguinal hernia?
A
Weak posterior wall –> canal –> superficial ring
22
Q
Which type of hernia has a cough impulse?
A
Direct
23
Q
Name the stages of diabetic retinopathy
A
- Background retinopathy
- Preproliferative
- Proliferative
24
Q
Name the features of background retinopathy
A
Hard exudates
Microaneurysms
Blot haemorrhages
25
What are hard exudates?
Leaked lipid from BV
26
Name the features of pre-proliferative retinopathy
Cotton wool spots
27
What are cotton wool spots?
Retinal ischaemia
28
Name the features of proliferative retinopathy
Formation of new BVs
29
Name the features of HTN retinopathy
```
SAFE
Silver wiring
AV nipping
Flame haemorrhages
pailloEdema
```
30
Raised pearly edges, telangiectasia and central rodent ulcer. Dx?
BCC
31
Raised, everted edges with hyperkeratotic, ulcerating core. Sun exposed area. Dx?
SCC
32
What is the difference in formation of BCC and SCC?
BCC is in stratum basal in epidermis, SCC is in epidermis
33
What is the key prognostic difference between BCC and SCC?
```
BCC = slow growing, no mets
SCC = faster growing, mets
```
34
What is Marjolin's ulcer?
SCC in chornic inflammaed area
35
Name 4 types of melanoma
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
36
What is a key feature of nodular melanoma?
Aggressive, not from existing naevi
37
What is a key feature of lentigo maligna?
Elderly, on face
38
What is a key feature of acral lentiginous?
In darker skinned people, on palms and soles
39
List Sx of HUS
TRIAD
Microangiopathic haemolytic anaemia
Acute renal failure
Thrombocytopenia
40
List causes of HUS
```
E Coli (kids)
OCP
Cancer
Malignant HTN
SLE
```
41
What is TTP?
HUS + neuro Sx + fever
42
Fever, headache, diarrhoea, dry cough, confusion. Dx?
atypical pneumonia
43
List 3 causes of atypical pneumonia
Legionella
Mycoplasma pneumoniae
Chlamydia psittaci
44
Pneumonia w birds. Dx?
Chlamydia psittaci
45
Pneumonia with air con and AGs in urine. Low Na. Dx?
Legionella
46
What is mycoplasma pneumoniae associated with?
Transverse myelitis
Red cell agglutination
Epidemics
47
Pneumonia in IVDU. Had flu a few weeks before. Cavitating lesion on CXR. Dx>
Staph aureus
48
Pneumonia in COPD patient?
Moraxella cattarhalis
49
1st line Tx of HTN in under 55 y/o?
ACEi or ARB
50
1st line Tx of HTN in black / over 55 y/o?
CCB
51
1st line Tx of HTN in someone with heart failure?
Thiazide
52
Name an ACEi
Ramipril
53
Name an ARB
Losartan
54
Name a CCB
Amlodipine
55
2nd line Tx of HTN ?
CCB + ACEi or ARB
56
What can be given if CCB not tolerated?
Thiazide
57
3rd line Tx of HTN ?
CCB + thiazide + ACEi / ARB
58
4th line Tx of HTN ?
Refer to specialist
| Spironolactone
59
1st line Tx of HTN in DM patient?
ACEi
60
2nd line Tx of HTN in DM patient?
CCB
61
1st line Tx of HTN in preg?
CCB
62
What is ABx for CAP?
Amoxicillin & clarithromycin
63
ABx for aspiration pneumonia?
Metronidazole
64
ABx for C.diff infection?
Metronidazole
65
ABx for skin infection?
Flucloxacillin
66
ABx for MRSA?
Vancomycin
67
ABx for UTI?
Nitrofurentoin or trimethroprim
68
ABx for COPD exacerbation or malaria?
Tetracycline
69
ABx for pseudomonas?
Gentamicin
70
ABx for meningococcus?
Ceftriaxone
71
What is Addisons?
Primary adrenal insufficiency (AI attack of adrenals)
72
What is the blood result of Addisons?
LOW cortisol / aldosterone
| Low Na, High K
73
Describe typical Addisons pt
Female, blood thinners, adrenal haemorrage
74
What AB is associated with Addisons?
Anti adrenocortical AB
75
PC of Addisons?
Fatigue, anorexia, weight loss, N&V, hyperpigmentation in palmar creases and mucosa
76
Ix for Addisons + results?
U&Es - low Na, high K
9am cortisol - LOW
Short synthacten test - VERY low
Serum ACTH - high
77
What is Mx of acute Addisonian crisis?
Fluid resus
| Glucocorticoid
78
What is Mx of chronic Addisons?
Glucocorticoid + mineralocorticoid
79
Give an example of a Glucocorticoid
Hydrocortisone
80
Give an example of a mineralocorticoid
Fludrocortisone
81
High HR, low BP, confused, weak. Dx?
Addisonian crisis
82
List causes of Addisonian crises
Infection, trauma, surgery, missed medications
83
Dome shaped, smooth firm lump with umbillicated centre. Dx?
Molluscum contagiosum
84
How is molluscum contagiosum spread?
Skin or sex
85
What causes molluscum contagiosum ?
Pox virus
86
What does HBsAg show?
Infection with Hep B
87
HBsAg +
HBcAb IgM +
HBcAb IgG +
Dx?
Acute infection
88
HBsAg +
HBcAb IgM -
HBcAb IgG +
Dx?
Chronic infection
89
What does HBcAb IgM + indicate?
Acute
90
What does HBcAb IgG + indicate?
Chronic infection
91
What does HBeAg + indicate?
Infective disease
92
```
HBsAg -
HBcAb IgM -
HBcAb IgG +
HBsAb +
Dx?
```
Cleared
93
HBsAb +
| Dx?
Vaccinated
94
Which hepatitis is DNA?
B
95
Which hepatitis are faecal oral?
A & E
96
How are hep B, C, D spread?
Sexual, paraenteral
97
Which hepatitis is chronic?
C
98
Which hepatitis needs another infection?
D (needs B)
99
Which hepatitis is severe in preg?
E
100
Which hepatitis doesn't present with the classic Sx?
C
101
What is the classic hepatitis presentation?
Jaundice, fever, malaise, anorexia, N&V, abdo pain, dark urine, pale stool
102
Which hepatitis can have carriers?
B, C, D
103
Which hepatitis can cause cirrhosis and liver cancer?
B, C, D
104
Which hepatitis have vaccines?
A, B, D
105
What is Mx for hep B?
Peginterferon a2a
106
What is Mx for hep C?
antiviral (sufusbovir)
107
What causes Conns?
Excess aldosterone production from adrenal glands due to ADENOMA
108
Sx of Conns?
HTN in young person
| LOW K - polyuria, polydipsia, muscle weakness, arrhytmia
109
What other condition does Conns cause?
Diabetes insipidous
110
Ix for Conns & results ?
```
Serum K (low)
Plasma aldosterone : renin ratio (high)
```
111
Mx for Conns?
Laparascopic adrenalectomy
| Spironolactone
112
What are ECG features of low K?
U waves
ST depression
Flat T waves
Prolonged PR interval
113
Name causes of CAP
Strep pneumoniae
| H influenzae
114
Name causes of HAP
Pseudomonas
Klebsiella
Aspiration pneumoniae
115
What colour is sputum in pneumonia?
Yellow or green
116
O/E of pneumoniae?
```
Fever, high RR, high HR, low BP
Decreased chest expansion on side
Increased vocal resonance on side
Dull to percussion on side
Crackles / bronchial breathing
```
117
What does CXR of pneumonia look like?
Lobar / patchy shadowing
118
Flushed, fever, sweaty, increased RR, tinnitus, deafness. Dx?
Aspirin OD
119
Mild N&V, fatigue --> RUQ pain and vomitting --> encephalopathy and jaundice. Dx?
Paracetamol OD
120
Tx for paracetamol OD?
N acetyl cysteine
121
Constricted pin point pupils, low RR, drowsy, constipated. Dx?
Opioid OD
122
Tx for opioid OD?
Naloxone
123
Back pain, worse in morning and better with exercise. Insidious onset in <40s. Dx?
Ank spon
124
What are extra articular features of ank spon?
```
5As
apical lung fibrosis
amyloidosis
anterior uveitis
achilles tendinitis
aortic regurg
```
125
What is seen O/E of ank spon?
Loss of lumbar lordosis
| Kyphosis
126
What is the test for ank spon?
Schobers test
127
What will XR of ank spon show?
Bamboo spine
128
Cannon A wave in JVP?
Complete heart block
129
Large V wave in JVP?
Tricuspid regurg
130
Cause of Kussmaul's sign in JVP?
Constrictive pericarditis
131
What is Kussmaul's sign?
paradoxical rise in JVP on inspiration
132
Absent pulsation in raised JVP?
SVC obstruction
133
Slow Y descent in JVP?
Tricuspid stenosis
134
3 causes of raised JVP?
Constrictive pericarditis
TR
Right heart failure
135
Which type of leukaemia has smear / smudge cells?
CLL
136
Which type of leukaemia has auer rods?
AML
137
Which type of leukaemia has massive splenomegaly?
CML
138
Which type of leukaemia affects children mainly?
ALL
139
Which type of leukaemia has philadelphia chromosome?
CML
140
What is the philadelphia chromosome?
t(9:22)
141
Which type of leukaemia has faggot cells?
Acute promyeoltic leukaemia
142
Which type of leukaemia is most common in adults?
CLL
143
List risk of AML
Old age, Downs, chemo, radio
144
List risks of ALL
Young age, genetics, radiation, influenza
145
Is chronic leukaemia more common in men or women?
Men
146
List BM failure Sx
Pallor, bleeds, infection
147
List raised BMR Sx
Weight loss, sweating, malaise
148
List hyper-viscosity Sx
Thromboses, headache
149
Which leukaemia stain with Sudan black?
AML
150
Which leukaemia often has no Sx?
CLL
151
What causes oesophageal varices?
Portal HTN
152
List the biggest risk of oesophageal varices in Europe vs world
```
Europe = alcoholic liver disease
World = Hep B/C
```
153
Immediate Mx of oesophageal varices?
Blood transfusion if Hb <6
IV terlipressin and ABx
Emergency OGD
+/- Sengstaken-Blakemore tube
154
What is long term Mx of varices?
Band ligation and beta blockers
155
What is myelodysplasia?
Clonal stem cell disorder characteristed by ineffective haematopoeisis resulting in cytopenias
156
Who does myelodysplasia effect?
>70s
157
Sx of myelodysplasia?
None
| Fatigue, reduced ETT, pallor, petechiae, infections
158
What is blood film result of myelodysplasia?
Ringed sideroblasts
| Low or normal reticulocyte count
159
Why is myelodysplasia so worrying?
Can develop into AML
160
Does myelodysplasia have splenomegaly?
NO
161
Is sickle recessive or dominant?
Recessive
162
WHat is the defect in sickle?
Defective beta Hb resulting in HbS
163
Acute chest syndrome, pripiasm in known sickle. Dx?
Sequestration crisis
164
Myalgia, painful hands and feet in known sickle. Dx?
Painful crisis
165
When does sickle present?
> 4 months old
166
Why does sickle present after 4 months old?
This is when HbF is swapped to normal Hb
167
Ix for sickle?
FBC, U&Es
Blood film
Sickle solubility test
Hb electrophoresis
168
What would blood film show in sickle?
Sickled cells
| Howell Jolly bodies (hyposplenism)
169
Mx of sickle crisis?
O2, fluids, opiates, ABx
170
Prophylaxis of sickle?
Penecillin and folic acid
Hydroyurea
Maybe transfusion
171
List complications of sickle
```
Avascular necrosis
Aplastic crisis
Gallstones, cholecystitis
Leg ulcers
Cardiomyopathy
```
172
What causes aplastic crisis in sickle?
B19 Parvovirus
173
Shoulder and pelvic girdle pain and stiffness.
| Worse in morning and when brushing hair or standing from sitting. Dx?
Polymyalgia rheumatica
174
Associations / risks of developing PMR?
GCA, female, over 50
175
Ix for PMR and results?
ESR and CRP - raised
| USS - bursitis
176
Mx of PMR?
Oral pred within 72hrs
Ca, Vit D, bisphosphonate supplements
NSAIDs
177
What is heart block?
Impairment of AVN impulse conduction, represented by PR interval
178
What is type 1 HB?
Prolonged PR
179
What is type 2.1 HB?
Progressive prolongation of PR until 1 dropped then cycle repeats
180
What is type 2.2 HB?
P often not followed by QRS
181
What is type 3 HB?
No relationship between p and QRS
182
List causes of HB
```
MI or IHD !!
Infection - IE, rheumatic fever
Drugs - CCB, beta blockers
Metabolic - hyperkalaemia, hypothermia
Sarcoid, amyloid
```
183
What are the Sx of 1st and 2.1 HB ?
None
184
What are Sx of 2.2 and 3rd HB?
Chest pain, dizziness, palpitations
185
What is Stokes Adams attack?
Syncope due to ventricular asystole
186
What will you find O/E peripherally in HB?
Slow, large volume pulse
| JVP cannon A waves
187
Ix for HB?
ECG !!
| CXR, cardiac enzymes, echo
188
Mx for acute HB?
IV atropine +/- external pacemaker
189
Mx for chronic HB?
Permenant pacemaker
190
List causes of microcytic anaemia (5)
```
Iron deficiency
Thalassaemia
Lead poisoning
Anaemia of chronic disease
Sideroblastic (X linked / drugs / alcohol / myelodysplasia)
```
191
List causes of normocytic anaemia (6)
```
Anaemia of chronic disease
Haemolytic anaemia
Hypothyroidism
Pregnancy
Renal failure
Bone marrow failure
```
192
List causes of macrocytic anaemia (8)
```
Alcohol
Low B12
Low folate
Hypothyroid
Myelodysplasia
Liver disease
Haemolytic anaemia
Drugs
```
193
List causes of hereditary haemolytic anaemia (6)
```
Sickle cell
Thalassaemia
Spherocytosis
Elliptocytosis
Pyruvate kinase deficiecny
G6PD deficiency
```
194
List causes of acquired haemolytic anaemia (9)
```
AI
Transfusion reaction
Penecillin
TTP, HUS, DIC
Artificial heart valve
Liver /renal disease
```
