charcots triad - RUQ pain - jaundice - fever and - hypotension - confusion

1. hypotension 2. raised JVP 3. muffled heart sounds CARDIAC TAMPONADE

1. irregular and decreased resp rate 2. bradycardia 3. hypertension RAISED INTRACRANIAL PRESSURE

extra passmed questions 3 Flashcards by Andrea Jayawardena

what is meckels diverituclum?

pouch
may be lined with ectopic gastric mucosal tissue
produce bleeding
congenital

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what type of shock most commonly occurs following a spinal cord transection?

neurogenic shock
vasolidation –> decreased preload –> decreased cardiac output –> hypotension
patient will need vasopressors !
to reverse profound v.dilation

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which pancreatic enzyme would you use to diagnose acute pancreatitis?

serum lipase has longer half life than amylase

- may be useful in late presenting patients

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3 - 4.4cm

small aneurysm

action

rescan every 12 months

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4.5 - 5.4cm

medium aneurysm

action:

rescan every 3 months

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> 5.5cm

large aneurysm

action:

refer within 2 weeks to vascular surgery

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next appropriate step in management of patient with long saphenous vein superficial thrombophlebitis?

USS

to exclude underlying DVT

TX: bed red and analgesia

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absent T waves

hypokalaemia

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Reynold’s pentad is

charcots triad

RUQ pain
jaundice
fever

and

hypotension
confusion

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Beck’s triad

hypotension
raised JVP
muffled heart sounds

CARDIAC TAMPONADE

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Cushing’s triad

irregular and decreased resp rate
bradycardia
hypertension

RAISED INTRACRANIAL PRESSURE

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45 y/o female

pc: 3cm breast lump

ER+, HER2- tumour, confined to breast

describe this case and next stage of management:

HER2-

hormone receptor positive cancers
grow faster than HER2+ cancers

ER+
- increased aggressiveness

this patient has a fast growing aggressive cancer.

management depends on size of tumour.

If < 4cm ——> WIDE LOCAL EXCISION

if > 4cm ——> MASTECTOMY

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abdominal pain

presents post meal
nausea vomiting
pain radiates to shoulder

indicative of:

biliary colic

- esp if obs are normal

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investigation for suspected bowel perforation

erect chest x-ray

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28 y/o male

pc: locally advanced mucinous carcinoma of the caecum
oe: scanty polyps in remaining colon
fhx: father died from colorectal cancer aged 34

likely diagnosis:

Lynch syndrome

aka HNPCC

Amsterdam criteria used to identify families at risk

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mode of inheritance of BRCA gene

autosomal dominant

so 50% chance of passing this on

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management for anal fissures not responding to conservative management:

sphincterotomy

anal fissures
- longitudinal or elliptical tears at squamous lining of distal anal canal

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in management of ER +ve beast cancer what drugs are used:

ER+ = aggressive

Either:

aromatose inhibitors
- anastrozole
- side effect: osteoporosis
anti-oestrogen medications is Selective oEstrogen Receptor Modulators (SERM)
- tamoxifen
- side effect: VTE, endometrial cancer

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causes of unilateral hydronephrosis:

PACT

Pelvic-ureteric obstruction (congenital or acquired)

Aberrant renal vessels

Calculi

Tumours of renal pelvis

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causes of bilateral hydronephrosis:

SUPER

Stenosis of the urethra

Urethral valve

Prostatic enlargement

Extensive bladder tumour

Retro-peritoneal fibrosis

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Investigations and management for hydronephrosis

USS first line
IVU (intravenous urogrpahy) assess position of obstruction
Antegrade or retrograde pyelography- allows treatment
if you suspect stones: CT scan

management

remove obstruction
acute: nephrostomy
chronic: ureteric stent

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What is the mechanism of action of goserelin in prostate cancer?

GnRH agonist

- provides negative feedback to the AP

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28 y/o hypertension + haematurua + polycytheaemia, CT shows L renal mass

renal adenocarcinoma

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68 y/o recurrent episodes of LHS ureteric colic + haematuria + dilatation of renal pelvis

transitional cell carcinoma

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A 4-year-old boy presents with haematuria and on examination is found to have a right sided renal mass.

Wilms tumour (nephroblastoma)

Which one of the following may be used to monitor patients with colorectal cancer?

Carcinoembryonic antigen (CEA)

analgesia recommended for acute management of renal colic

IM diclofenac

what is an indicator of severe illness in pancreatitis:

hypocalcaemia P - PaO2 (< 7.9 kPa). A - age (>55). N - neutrophils (white cell count > 15x 109/L). C - calcium (calcium < 2 mmol/L). R - renal function (urea > 16 mmol/L). E - enzymes (lactate dehydrogenase > 600 IU/L). A - albumin (albumin < 32 g/L). S - sugar (blood glucose > 10 mmol/L). 3 points and above suggests a high risk for severe pancreatitis.

summarise the causative organisms in epididymitis

E Coli - older adults esp with prior BPH dx Chlamydia and N. Gonnorrhoea - younger men

30 y/o female pc: 3 week hx worsening erythema over left breast. not breast feeding. not painful. oe: swollen breast, no discharge, nipple changes and no palpable mass. Ca 15-3 elevated, normal WCC and CRP indicative of:

inflammatory breast cancer differential diagnoses: if fever + elevated WCC, CRP - mastitis or cellulitis fibroadenoma - firm mobile lump pagets disease of breast - involves nipple, spreads to areola and breast

what is an emergency Hartmann's procedure?

- resection of rectosigmoid colon - end colostomy formed - indicated by perforation of rectosigmoid bowel leading to subsequent peritonitis

87 y/o female pc: right nipple very itchy oe: erythematous, blood stained discharge on inside of bra indicative of:

paget's disease of nipple - skin changes - associated with breast malignancy - weeping crusty lesion - areolar lesion spared ? mx - imaging and biopsy

mention of bubbly urine may indciate:

fistula between bowel and bladder e.g enterovesicual fistula

31 y/o male pc: trouble concieving oe: diffuse lumpy swelling on LHS scrotum, not painful, testicle can be felt separately and it normal indicative of:

varicocele

management of epididymal cyst:

usually supportive surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts

management of varicocele:

usually conservative surgery if patient troubled by pain

first-line investigation in suspected prostate cancer

refer for multiparametric MRI

common complication of radical prostatectomy?

- incontinence | - erectile dysfunction

common complication of TURP

retrograde ejaculation

most common organism causing cholangitis

E .COLI

Acute upper urinary tract obstruction is managed with

nephrostomy

tumour marker for hepatocellular carcinoma

AFP

This man's tumour is in the rectum and sigmoid colon. what is the most appropriate operation?

anterior resection

32 y/o male with Crohns pc: intermittent jaundice, obstructive. usually resolves spontaneously. diagnosis:

Bile duct stones - bile salts are absorbed in terminal ileum - impaired in Crohn's - patient may develop gallstones - if they pass into CBD ---> obstructive jaundice

A 22-year-old man returns to the UK from holiday in India. He presents with painless jaundice. On examination he is not deeply jaundiced and there is no organomegaly.

hepatitis A

this is spouted!

ileostomy

this is flat against the skin!

colostomies

A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

fibroadenoma

A 35-year-old woman complains of 'lumpy' breasts. Her symptoms are worse in the premenstrual period.

fibroadenosis

what kind of drugs are useful in patients with overactive bladder?

anti-muscarinic drugs

A 17-year-old man presents with a 2 week history of significant pain on defecation accompanied by the presence of a small amount of blood which is noticed on toilet paper.

fissure in ano young patients + painful rectal bleeding --> fissure tx - stool softener - either GTN or diltiazem

24 y/o long hx obstructed defecation and chronic constipation and straining. OE: indurated area located anteriorly approx 3cm prox to anal verge

solitary rectal ulcer syndrome

42 y/o male pc: painless lump left testicle, firm nodulse. USS shows irregular mas lesion. normal AFP and HCG levels. likely diagnosis:

seminoma | - typically have normal AFP and HCG

A 40-year-old female presents to the GP with unusual discharge from her breast. She has no children and is not breastfeeding but is complaining of blood stained discharge from her nipple.

duct papilloma | - may present with blood stained discharge

A 34-year-old female presents with a 1-month history of a breast lump. She first noticed it after she tripped and fell over. It was initially firm. On examination, there is a hard irregular lump.

fat necrosis | - typically firm initially and then may develop into a hard irregular lump

management for anal fissures not responding to conservative measures:

anal fissures

A 65-year-old man with carcinoma of the caecum management

right hemicoloectomy

Struvite is...

magnesium ammonium phosphate

15 y/o male pc: patch of hair growing over lower lumbar spine, birth mark in same location. lower limb neuro exam normal known as:

spina bifida occulta

double wall sign on abdominal x-ray indicates

RIGLERS sign free air in abdomen

this is: - common in males - between 10-20 years - onion type periosteal reaction on x-ray

Ewing's sarcoma

this has a 'soap bubble appearance' on x-ray?

giant cell tumour

22-year-old woman presents with macroscopic haematuria. She is sexually active. She is known to have renal calculi and had a berry aneurysm clipped.

Adult polycystic kidney disease APKD is associated with liver cysts (70%), berry aneurysms (25%) and pancreatic cysts (10%). Patients may have a renal mass, hypertension, renal calculi and macroscopic haematuria.