DPD 5 - Acute, Endo, Breast + Haem Flashcards Preview

Amir Sam DPD 2018 > DPD 5 - Acute, Endo, Breast + Haem > Flashcards

Flashcards in DPD 5 - Acute, Endo, Breast + Haem Deck (94)
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1

A 24 y/o man presents w/ short onset breathlessness + facial swelling after a Chinese takeaway. What is the Dx?

Anaphylaxis

2

A 24 y/o man presents w/ short onset breathlessness + facial swelling after a Chinese takeaway. A Dx of anaphylaxis is made. What is the first step in management?
1. IM adrenaline
2. IV adrenaline
3. IM hydrocortisone
4. IV hydrocortinsone
5. IV fluids

IM adrenaline
Hydrocortisone + fluids are part of Mx but not first step

3

A 45 y/o man presents w/ cough, breathlessness + recent travel. O/E: Coarse crepitations + bronchial breathing. He has hyponatraemia + deranged LFTs. What is the most likely Dx?

Community acquired pneumonia

4

What is the Tx for CAP?

Amoxicillin - covers Strep. pneumonia
Macrolide - e.g. Clarithromycin to cover for atypical pneumonia

5

A 45 y/o man presents w/ cough, breathlessness + recent travel. O/E: Coarse crepitations + bronchial breathing. He has hyponatraemia + deranged LFTs. A Dx of CAP has been made and he is given amoxicillin. What antibiotics would you prescribe in addition to amoxicillin?
1. Cefuorxime
2. Clarithromycin
3. Co-amoxiclav
4. Tazocin
5. Vancomycin

Clarithromycin - macrolide to cover for atypical pneumonia. It has good bioavailability so given orally 250 mg twice daily usually for 1-2 weeks

6

What antibiotic would you use to treat HAP?

Tazocin - Gram negative organisms e.g. Klebsiella. 4.5g every 8 hours

7

What antibiotic would you use to treat MRSA?

Vancomycin

8

Name 3 atypical organisms in pneumonia

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumoniae - assoc. w/ bodies of water e.g. AC conditioning, plumbers etc

9

A 50 y/o man presents w/ dyspepsia + weight loss. Ix: Hb 70; MCV 70. What test would you request?
1. Abdominal CT
2. Abdominal USS
3. Erect CXR
4. Colonoscopy
5. OGD (Gastroscopy)

OGD as the symptoms suggest upper GI due to microcytic anaemia + dyspepsia (impaired digestion) + weight loss (red flag). If NAD then do colonoscopy.
Erect CXR done if there is perforation - pt will present w/ diffused abdo pain, rigidity, guarding, same w/ abdo CT
Abdo USS - next Ix in patients w/ deranged LFTs (common bile ducts to look for obstruction)

10

What Ix would you do if you found microcytic anaemia? (x 3)

OGD + Colonscopy: investigate top + tail; when to do which depends on upper/lower GI symptoms
Haematinics: iron studies, ferritin, folate/B12
Coeliac screen (TTG ab + duodenal biopsy - this is diagnostic)

11

What kind of protein is ferritin and when will it be raised?

Ferritin is an acute phase protein and will be raised in infection, inflammation + malignancy therefore iron deficiency anaemia + pneumonia may have normal ferritin as it is induced by infection.

12

What kind of protein is folate and when will it be raised?

Folate is an acute phase protein. Infection + malignancy will cause increased folate.

13

What confirms diagnosis of coeliac disease + what will be seen?

Duodenal biopsy
Villous atrophy, crypt hyperplasia

14

What is coeliac disease?

Systemic AI disease triggered by dietary gluten peptides found in wheat, rye, barley + related grains. Presentation: diarrhoea, bloating, abdo pain/discomfort, failure to thrive, iron deficiency microcytic anaemia, osteoporosis, dermatitis herpetiformis

15

What is the Tx for coeliac disease?

Strict, lifelong gluten-free diet
Vit D supplements for vit D deficiency

16

A 70 y/o man presents w/ bloody diarrhoea. Stool micro + culture -ve. Stool C. diff toxin: -ve. What is the most likely diagnosis?
1. Infective colitis
2. Ischaemic colitis
3. UC
4. Appendicitis
5. Gastroenteritis

Ischaemic colitis - typically older patients affecting smaller vessels as opposed to mesenteric ischaemia
Unlikely to be infective colitis due to -ve stool culture + -ve toxin. UC typically younger patients (30-40s).

17

What are the 5 organisms that most commonly cause infective colitis therefore bloody diarrhoea?

CHESS organisms
Campylobacter
Haemorrhagic E. coli (0157) - assoc. w/ haemolytic uraemic syndrome
Entomoaeba histolytica
Salmonella
Shigella

18

A 40 y/o man presents w/ palpitations that started 4 hours ago. ECG: AF. How would you treat him?
1. Adenosine
2. Amiodarone
3. Digoxin
4. Metoprolol
5. DC cardioversion

DC cardioversion as he is presenting < 48 hours
Adenosine is for SVT; Amiodarone is for broad complex tachycardia (VT) but works on all arrhythmias (often 2nd/3rd line); digoxin + metoprolol is for rate control

19

What is the management of AF that is <48 hours onset?

DC cardioversion to revert back to sinus rhythm or chemical cardioversion with flecainide

20

What is the management of AF that is >48 hours onset?

Anticoagulate w/ LMWH + rate control with BB/digoxin
After 3-4 weeks, DC cardioversion to prevent clot dislodging

21

A sign is seen on a pt's abdomen - the direction of flow in the veins below the umbilicus is towards the legs. What is the name of this clinical sign?
1. Trousseau's sign
2. Virchow's node
3. Caput medusa
4. Troisier's sign
5. Grey Turner sign

Caput medusa - sign of portal hypertension

22

What does Trousseau's sign indicate?

Hypercalcaemia - carpopedal spasm w/ BP cuff
OR
Sign of thrombophlebitis in Pancreatic cancer

23

What does Virchow's node indicate?

Supraclavicular lymph node indicated gastric cancer

24

What does Troisier's sign indicate?

Enlargement of left supraclavicular lymph node due to secondary involvement

25

What does Grey Turner's sign indicate?

Bruising assoc. w/ pancreatitis (retroperitoneal haemorrhage)

26

A 20 y/o boy presents w/ recent diarrhoea + malaise. Hb 70; Cr 300. Arrows on blood film point to fragmented cells. What does this indicate?
1. Codocytes
2. Eliptocytes
3. Lymphocytes
4. Schistocyte
5. Spherocyte

Schistocyte - red cell fragment
Not codocyte (target cell) seen in hyposplenism

27

What are the signs of portal hypertension?

Presents w/ signs of decompensated liver disease:
Encephalopathy
Ascites
SBP
Variceal bleed

28

What is the pathophysiology in MAHA?

Lots of tiny clots in small vessels (microangiopathic) which narrow small vessels. As RBCs pass through these narrow vessels they break up - haemolysis. This is why you see schistocytes in MAHA + low Hb

29

What is the pathophysiology in DIC?

Widespread intravascular coagulation - constant making and breaking of clots. Paradoxically prone to bleeding as clotting factors being used up

30

What are the levels of (1) platelets + fibrinogen (2) PT/APTT (3) D-Dimer/fibrin degradation products in DIC?

1. Decreased platelets + fibrinogen as they used up to make tiny clots + fibrinogen is turned into fibrin as RBC trapped in fibrin strands
2. Increased PT/APTT as clotting factors used up
3. Increased D-dimer/fibrin degradation products due to fibrinolysis