High Yield Stuff - FRC Flashcards

Question

Briefly describe how a L/R BBB gives rise to its ECG changes?

Answer 1

The L/R branch is damaged Conduction is blocked through this damaged area. The signal from the other side activates the damaged side. Results in 2 R waves

Answer 2

Inferior - RCA

Answer 3

Anterior - LAD

Answer 4

Arrythmias - RCA supplies the SA and AVN

Answer 5

Rapid ventricular filling KENTUCKY HF, MR, constrictive pericarditis

Answer 6

Atrial contraction against stiff ventricle. TENESSEE

Answer 7

•Condition where cardiac output is insufficient to meet tissue demands

Answer 8

•Severe life threatening hypotension

Answer 9

Definition of shock

Answer 10

•Heart failure is so severe, that there is not enough pressure to perfuse even the heart muscle and brain alone * Severe heart failure * Pressure inadequate to perfuse heart muscle itself * 100% untreated mortality * 90% mortality if treated with dobutamine or dopamine * Raised JVP, cold clammy peripheries and hypotention. DOPAMINE •At low (“renal” doses), improves renal perfusion by binding to beta 1 receptors in the kidney. •At medium doses, a cardiac stimulant (beta 1 agonist) useful in cardiogenic shock •At very high doses (never used now), has alpha 1 agonist activity ad causes peripheral vasocontriction (danger)

Answer 11

* ST elevation in first 4 – 12 hours. •Potentially reversible * Q waves after about 6 hours. •Indicate irreversible damage * T wave inversion appears as STs normalise * Non Q wave infarct = subendocardial * Prolonged ST elevation in several leads without Q waves may be acute pericarditis

Answer 12

•Most lateral and inferior position palpable •Displaced by dilatation not hypertrophy

Answer 13

Dilatation caused by volume overload: •aortic regurgitation •mitral regurgitation •ASD / VSD

Answer 14

Concentric hypertrophy caused by pressure overload: •aortic stenosis •hypertension •coarctation of the aorta

Answer 15

Stress ECG

Answer 16

``` Narrow complex tachycardia •Treatment is to activate vagal nerve to slow down heart rate •Try carotid sinus massage •Valsalva manoevre •Adenosine 3-12 mg IV to block AV node ```

Answer 17

* Potently stimulates alpha and beta-1 receptors * Main effect is peripheral vasoconstriction and hence shuts off non essential organs such as gut * Useful in septic shock to maintain Blood pressure.

Answer 18

1. Bronchogenic carcinoma 2. Cystic fibrosis 3. Bronchiectasis 4. Empyema 5. Fibrosing alveolitis

Answer 19

* flap * bounding pulse •vasodilatation (warm hands) •papilloedema * mental changes •drowsiness (narcosis)

Answer 20

* not talking * PF < 150 lpm •cyanosed * tachycardia (>120 bpm) •paradox > 20 mmHg •silent chest * "normal" CO2

Answer 21

•hyperexpansion •barrel chest •tracheal tug •decreased expansion •hyperresonant •expiratory wheeze

Answer 22

* Jaundice * Leuconychia (low protein) •bruising (clotting / fibrinogen) •ascites * encephalopathy (?nitrogenous)

Answer 23

* splenomegaly * ascites * dilated veins on abdomen (blood goes away from umbilicus) •(haematemesis / melaena)

Answer 24

•ascites •dilated veins on abdomen (blood travels upwards) To differentiate IVCO from portal hypertension, look at vein below umbilicus

Answer 25

•portal hypertension / thrombosis •IVC / hepatic vein obstruction •constrictive pericarditis •peritoneal secondaries / tuberculosis •ovarian malignancy •hypoproteinaemic states: nephrotic syndrome liver failure malabsorption

Answer 26

•excoriations (itching) •pale stools (PR) •dark urine negative for urobilinogen •jaundice •xanthelasmata

Answer 27

•Spleen has a notch •cannot get above a spleen •spleen dull to percussion (kidney resonant due to overlying bowel) •kidney ballotable •spleen moves to RIF; kidney moves down

Answer 28

* Painful red lesions on shins • Sarcoid * Sulphonamides * Salicylates * Streptococcal infection * TB / leprosy * Inflammatory bowel disease

Answer 29

* Children or young adults * 7-14 days after herpes simplex in 30 % of cases * Mycoplasma * Several other unusual infections * (Strep, TB, Orf, Yersinia, histoplasmosis, vaccinia) * Drugs; Sulphonamides, sulphonylureas * When severe called Stevens-Johnson syndrome. * Associated with severe mucosal ulceration * Liver failure

Answer 30

erythema marginatum

Answer 31

chronicum migrans

Answer 32

LV failure

Answer 33

Full thickness LCA occlusion

Answer 34

Inferior infarction with true posterior extension

Answer 35

Acts via Glut-4 receptors •Insulin signals the fed state •Stimulates uptake of glucose from blood into tissues and conversion into storage molecules •Stimulates fat generation •Suppresses ketone (acid) production

Answer 36

deficiency of insulin T1 = absolute deficiency T2 = relative deficiency

Answer 37

•Blood glucose high as it cannot enter cells • Liver produces ketones (acidosis) •Severe dehydration Deep RR to blow off CO2 (respiratory compensation)

Answer 38

* Prone to ketoacidosis * Acute onset * Non obese * Usually young * HLA DR3 and DR4 * Islet cell antibodies * 30-50% concordance * Always need Insulin

Answer 39

* Resistance to insulin action * Secondary rise in glucose * The pancreas makes lots of insulin to try and counteract this * Eventually (after several years) the pancreas becomes exhausted and type 2 diabetes ensues * Not prone to ketoacidosis •Insidious onset * Patients usually overweight •Usually older (maturity onset) •No HLA associations * No islet cell antibodies •Nearly 100% concordance •Can usually manage with diet or oral hypoglycaemic agents but insulin can be used.

Answer 40

•Rehydrate with normal saline SLOWLY

Answer 41

* Fasting glucose > 7.0 mM * Glucose tolerance test (75 grams glucose given at time 0) * Plasma glucose > 11.1 mM at 2 hours * (2h value 7.8 – 11.1 = impaired glucose tolerance).

Answer 42

Numerical definitions of T2DM

Answer 43

* Normal fasting plasma glucose < 6.0 * Impaired Fasting glucose 6.0 - 7.0 mM * Diabetes : fasting glucose >7.0 mM * IFG Correlates well with IGT (impaired glucose tolerance) * (2h value 7.8 – 11.1 = impaired glucose tolerance).

Answer 44

•(2h value 7.8 – 11.1 = impaired glucose tolerance).

Answer 45

•Rehydrate with normal saline for first bag, then add potassium •insulin: an intravenous infusion should be started at 0.1 unit/kg/hour. Once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started Please note that slower infusion may be indicated in young adults (aged 18-25 years) as they are at greater risk of cerebral oedema. •Restore normal pH but try and avoid bicarb. •Investigate cause: Glucose, electrolytes, ABG, FBC, CXR, ECG, cultures. children/young adults are particularly vulnerable to cerebral oedema following fluid resuscitation in DKA and often need 1:1 nursing to monitor neuro-observations, headache, irritability, visual disturbance, focal neurology etc. It usually occurs 4-12 hours following commencement of treatment but can present at any time. If there is any suspicion a CT head and senior review should be sought * Give dilute (1.26%) bicarbonate to bring pH up to but no higher than 7.0 * Once pH > 7.0 further improvement occurs spontaneously.

Answer 46

Microaneurysms Venodilation Hard exudates

Answer 47

Microaneurysms Venodilation Hard exudates + SOFT exudates

Answer 48

``` Microaneurysms Venodilation Hard exudates Soft exudates + NEOVASCULARISATION ```

Answer 49

Proliferative

Answer 50

Pre-proliferative

Answer 51

Background

Answer 52

• Grade 1: arteriolar narrowing and silver wiring

Answer 53

• Grade 2: AV nipping

Answer 54

• Grade 3: Flame shaped haemorrhages | and cotton wool spots

Answer 55

• Grade 4: papilloedema

Answer 56

• Grade 1: arteriolar narrowing and silver wiring • Grade 2: AV nipping • Grade 3: Flame shaped haemorrhages and cotton wool spots • Grade 4: papilloedema

Answer 57

``` • Systemic autoimmune disease • Several different antibodies • Antibody to TSH receptor = results in hyperthyroidism Sx • Antibody to growth factor receptors in extraocular muscles • Antibody that stimulates growth in pretibial region ```

Answer 58

``` Weight loss despite increased appetite • Breathlessness, palpitations, tachycardia • Sweating • Heat intolerance • Diarrhoea • Lid lag and other sympathetic features ```

Answer 59

* Hyperthyroidism * Exophthalmos * Pretibial myxoedema • Smooth goitre

Answer 60

Plummers disease = toxic multinodular goitre

Answer 61

* Beta blockers (propranolol) * Anti thyroid drugs * Carbimazole or propyl thio uracil • Radioiodine * Surgery

Answer 62

* Bitemporal hemianopia : check each eye individually * Look at tongue and teeth * Ask for old photographs, and whether patients ring size and shoe size have changed. * Examine cardiovascular system if time.

Answer 63

* Pituitary macroadenoma secreting GH * Perform a glucose tolerence test and measure GH levels. In normal people, GH is suppressed to undetectable levels. * In acromegaly, GH levels paradoxically rise * Lateral SXR / CT / MRI

Answer 64

Serum IGF-1 and GH levels have overtaken OGTT Perform OGTT if high GH/IGF1 * Perform a glucose tolerence test and measure GH levels. In normal people, GH is suppressed to undetectable levels (< 2 mu/L) * In acromegaly, GH levels paradoxically rise * Lateral SXR / CT / MRI

Answer 65

•Transphenoidal hypophysectomy •Pituitary irradiation •Medical therapy Octreotide 100-200 mcg every 8h Bromocriptine initially in divided doses Cabergoline twice weekly •Dopamine agonists do not cause tumour shrinkage

Answer 66

•Effects of exposure to steroids •Proximal myopathy •Centripetal obesity (lemon on sticks) •Hypertension •Diabetes •Osteoporosis •Immunosuppression (reactivation of TB) - Interscapular fat pad, moon like-facies, "lemon on sticks" - proximal myopathy and central adiposity, purple striae, thin skin, easy bruising, May have irregular periods, ED<

Answer 67

•(excluding taking steroids by mouth) * Pituitary dependent Cushing's disease 85% * ectopic ACTH 5% * adrenal adenoma secreting cortisol 10%

Answer 68

``` •Common amongst the elderly •99% asymptomatic raised (bone) alkaline phosphatase •1% of cases present with bone pain •Overactive osteoclasts •Normal calcium and PTH ```

Answer 69

``` Clinical features - only 5% of patients are symptomatic the stereotypical presentation is an older male with bone pain and an isolated raised ALP bone pain (e.g. pelvis, lumbar spine, femur) classical, untreated features: bowing of tibia, bossing of skull ``` - deafness (cranial nerve entrapment) - bone sarcoma (1% if affected for > 10 years) - fractures - skull thickening - high-output cardiac failure

Answer 70

* None may be needed. * Simple analgesia * intravenous pamidronate every 3 months * regular oral alendronate •calcitonin injections can suppress osteoclast activity

Answer 71

Raised alkaline phosphatase (ALP) - calcium* and phosphate are typically normal other markers of bone turnover include: procollagen type I N-terminal propeptide (PINP), serum C-telopeptide (CTx), urinary N-telopeptide (NTx), and urinary hydroxyproline skull x-ray: thickened vault, osteoporosis circumscripta Can do isotope scan to assess areas of involvement

Answer 72

Clear 0-5 lymphocytes Glucose 2.8-4.4 Protein 0.15-0.35

Answer 73

Cloudy HIGH - 10-100,000 POLYMORPHS (NORMAL = 0-5) Glucose <2.8 = LOW Protein 0.5-5.0 = (NORMAL = 0.15-0.35)

Answer 74

Usually clear 15-2000 leukocytes (NOT AS HIGH AS BACTERIAL, which is also neutrophils) Glucose NORMAL 2.8-4.4 PROTEIN = normal or slightly high, not as high as bacterial

Answer 75

Opalescent 250-500 lymphocytes VERY LOW GLUCOSE Protein 0.45-5.0

Answer 76

``` • Meningococcus: Gram negative intracellular diplococci • Pneumococcus: Gram positive diplococci (streptococci). •Haemophilus: Gram negative rods • E-coli : Gram negative rods ```

Answer 77

* Age usually > 40 y * Sudden onset SEVERE headache * LP if no blood on CT scan * CSF uniformly blood stained (3 bottles) •Berry Aneurysm found in 85% •Ischaemia days 5-14 (vasospasm) •Risk reduced with Nimodipine * Risk of rebleeding peaks at 10 days

Answer 78

Nimodipine

Answer 79

``` •Following trauma or skull fracture where middle meningeal vessals torn - normally trauma at pterion •Acute concussion •Recovery: "Lucid interval" •As haematoma expands, pressure causes coning and coma ``` PTERION = where the frontal, parietal, temporal, and sphenoid bones join together

Answer 80

* Elderly * Alcoholic * Apparent dementia * Headache * Bradycardia * Can occur acutely following trauma

Answer 81

``` Increased tone Brisk reflexes Weakness Pronator drift Extensor plantar Pyramidal posture - spastic + in flexion ```

Answer 82

Decreased tone Absent / decreased weakness with wasting no response flaccid/fasciculation

Answer 83

``` •Lack of dopamine in the substantia nigra •Akinesia (bradykinesia), Rigidity : lead pipe •Tremor at rest : 4-7 Hz : pill rolling •Synkinesis •Stoop with festinant shuffling gait. •Narrow based causing falls •Lack of arm swinging •Monotonous speech •Depression and dementia •Stroke •Multiple sclerosis •Brain tumour •Damage to spinal cord ``` TREMOR: The resting tremor is present in approx. 75% of cases [3-6Hz] ‘Pill-rolling' tremor of the opposed thumb and fingers is characteristic but rare Postural ‘emergent’ tremor (70%) Tremor brought out by mental activity (e.g. counting down) May be associated with Parkinson's + syndromes

Answer 84

* In diabetes, vasa nervorum supplying thick fibres affected causing ischaemia to middle of large fibres parasympathetic fibres main trunk of third nerve = ONLY PTOSIS + DIPLOPIA USUALLY, NO PUPILLARY DYSFUNCTION * In a space occupuying lesion, pressure on the parasympathetic fibres occurs early, causing pupillary dilatation

Answer 85

* Dysdiadochokinesia * Ataxia * Nystagmus * Intention tremor * Scanning Speech * Hypotonia

Answer 86

• UMN Lesions discontinuous in time and place • Episodic optic neuritits • Upper motor neurone lesions due to plaques in spinal cord • Cerebellar signs with lesions in cerebellum

Answer 87

* Nystagmus due to cerebellar lesions * Internuclear ophthalmoplegia (INO) * Lesion of the medial longitudinal fasciculus * On looking right, left eye fails to adduct * Right eye exhibits ataxic nystagmus

Answer 88

* Relative afferent pupillary defect * Internuclear ophthalmoplegia (INO) * Lesion of the medial longitudinal fasciculus * On looking right, left eye fails to adduct * Right eye exhibits ataxic nystagmus

Answer 89

- MRI head | •CSF: raised protein with oligoclonal bands

Answer 90

* Brainstem or cerebellar disease at onset •Onset after age 40 * Primary progressive MS (ie. no resolution)

Answer 91

* Autosomal dominant (chromosome 17) * Multiple (>5) café au lait spots * Axillary or inguinal freckling * Optic glioma * Lisch nodules (Iris Hamartomas) * Small risk of phaeochromocytoma

Answer 92

•Relative afferent pupillary defect (RAPD) •i.e. Blind in that eye •Pupil will constrict consensually when light shone in other eye •Pupil will dilate when light removed from other eye and moved to this blind eye. •Multiple sclerosis

Answer 93

* Accommodation Reaction Present: Reaction to Light Lost | * Lesion in pretectal region

Answer 94

Argyll Robertson pupil

Answer 95

Holmes Adie (myotonic) pupil

Answer 96

•Sudden onset with blurred vision •Usually female •Large pupil which reacts only sluggishly to light and accommodation •Dilatation also slow to occur •Knee and ankle jerks may be absent on the same side

Answer 97

* Previous polio which destroys anterior horn cell. NO sensory signs * Guillain Barre syndrome: peripheral motor and sensory. * Peripheral nerve lesion (eg trauma around fibula causing footdrop) * Motor neurone disease (NB this also causes upper motor neurone signs)

Answer 98

* Stroke * Multiple sclerosis * Brain tumour * Damage to spinal cord

Answer 99

The resting tremor is present in approx. 75% of cases [3-6Hz] ‘Pill-rolling' tremor of the opposed thumb and fingers is characteristic but rare Postural ‘emergent’ tremor (70%) Tremor brought out by mental activity (e.g. counting down)

Answer 100

The resting tremor is present in approx. 75% of cases [3-6Hz] ‘Pill-rolling' tremor of the opposed thumb and fingers is characteristic but rare Postural ‘emergent’ tremor (70%) Tremor brought out by mental activity (e.g. counting down)

Answer 101

``` Initially: reduced arm swing Gradually: Slower Stooped Small steps Shuffle Gait ignition difficulties Freezing Falls ```

Answer 102

Festination ``` Stand up Walk Tandem walk Passive shoulder shrug Romberg’s sign Hop (each leg) Squat & rise Heels (L4&5) & toes (S1&2) ```

Answer 103

Drags leg(s), Circumducts or scissors (bilateral)

Answer 104

Foot drop (high step)

Answer 105

Waddling, difficulty standing/squatting

Answer 106

Broad based, variable cadence

Answer 107

Broad based, Stamping (Romberg’s sign +ve)

Answer 108

Only absent when not present with reinforcement show patient how to hold hands “when I say pull - try to pull hands apart” “Pull!” tap reflex immediately “Relax” alternative methods (clenching)

Answer 109

Finger jerks Hoffman’s Crossed adductors Absent abdominal reflexes

Answer 110

``` Peripheral neuropathy (i.e. peripheral) Single nerve (e.g. ulnar) Single root (e.g. S1) Mononeuritis multiplex Brachial plexopathy or cauda equina ```

Answer 111

``` Nystagmus Ocular dysmetria Slurred speech (scanning dysarthria) Incoordination (clumsiness) Dysdiadokinesis Dysmetria Intention tremor Reduced tone Pendular reflexes (underdamped) Heel-shin ataxia Truncal ataxia (unsteadiness) – Vermis ``` INTERESTING TEST = REBOUND

Answer 112

LMN Signs in legs If lesion below L1 UMN Signs in legs If lesion above L1

Answer 113

Left lower lobe collapse

Answer 114

``` TOPICAL ABX Drops include abx and steroid Eg Sofradex (soframycin and dexamethasone) ANALGESIA SWAB AURAL TOILET POPE WICK (ORAL ABX) ```

Answer 115

Necrotising (MALIGNANT) OTITIS EXTERNA

Answer 116

Streptococci (adults) Pneumococci (children) Haemophillus, staph, coliforms Broad spec abx (amoxycillin) 7-10 days

Answer 117

Mastoiditis REFER IMMEDIATELY CT Surgical Decompression (Cortical mastoidectomy) ``` Complications: Meningitis VII palsy Sigmoid sinus thrombosis brain abscess death ```

Answer 118

``` Blocked Eustachian tube Common in children due to underdeveloped ET and large adenoids Hearing tests and tympanogram Watchful waiting 3 months Grommets ```

Answer 119

Ramsey hunt = painful ear + rash - Caused by herpes zoster Vesicles in concha or EAM Facial palsy and ? hearing loss, tinnitus or vertigo, nystagmus or other cranial nerve deficit. Acyclovir within 5 days + Steroids

Answer 120

High dose oral steroids (40-60mg)- beware diabetics, PUD Acyclovir 800mg 5x day Prognosis good if improves early

Answer 121

Epley (lying down, need someone else) | Semont (self administered- flopping to each side)

Answer 122

Infection Trauma Barotrauma

Answer 123

Acoustic neuroma Rare tumours 8th Nerve schwannoma

Answer 124

Cholesteatoma

Answer 125

Frontal, ethmoidal, sphenoidal, maxillary

Answer 126

If seen very early reduce immediately before swelling Otherwise: Review at 7 days to assess alignment If compound clean thoroughly and close primarily - broad spectrum antibiotics. If septal haematoma refer for drainage

Answer 127

Little's area Keisselbach’s Plexus Internal and External Carotid ``` Rx - Calm. Reassure, fluids, bloods Protection – apron, mask, goggles Assistant LA spray – cophenylcaine Suction AgNO3 Merocel/ Rapid Rhino BIPP Foley, Brighton Balloon ```

Answer 128

Papillary 80% 80% of all thyroid cancer, 30 to 50 years old, More common in females than males (3:1 ratio), 10-year survival rates >90%. Follicular – 15% older age (40-60 years) Nodes (10%), Haematogenous spread to Lung & Bone (20-30%). Age important in prognosis Hurthle Cell – variant of Follicular Medullary – 4% Anaplastic – 2% Lymphoma – often related to Hashimotos Others - Sarcoma, SCC, Secondaries (breast, lung & kidney)

Answer 129

``` 3 pairs major glands Parotid Submandibular Sublingual Multiple minor salivary glands ```

Answer 130

ILD/fibrosis | Thoracic restriction or muscle weakness

Answer 131

Obstruction

Answer 132

Gas transfer: measured uptake of CO – TLCO/ DLCO: not adjusted for volume – Kco adjusted for ventilated volume (using helium dilution) – disease that causes a decrease in lung surface area: decrease in transfer factor but normal Kco. • Fibrosis/emphysema damage to the lung parenchyma : reduction in both TLCO and Kco. – inability to expand the thorax (neuromuscular): • TLCOislowbutKconormalorincreased.

Answer 133

– PEF (>20%) | – FEV1 (>12%/ 200ml)

Answer 134

``` – Idiopathic – Post-infective • Measles,Pertussis,TB – Immunodeficiency • Hypogammaglobulinaemia/CVID – (CF) – PCD, Young’s, Kartagener’s – ABPA – Obstruction/foreignbody/tumour – Rheumatoid, IBD ```

Answer 135

``` – FBC: polycythaemia (secondary) – A1AT – Lung function • Fixed, Obstructive; decreased transfer factor (TLCO) if emphysema – Blood gas – HRCT – Echo assess Pul HT ```

Answer 136

No of exacerbations Dyspnoea scale Degree of airflow limitation - FEV1

Answer 137

``` – Bronchodilators • Short / Long acting COPD – ICS (low dose) – Pulmonary rehabilitation – Dietician – Smoking cessation – Steroids/ antibiotics for exacerbation – OxygenifpO2≤7.3(or8ifpulmHT) – Controversy re inhaled steroids: pneumonia – Pall care? – LVRS/valves / transplant ```

Answer 138

The ABPI = ankle pressure / brachial pressure

Answer 139

Greater than two weeks duration Ankle pressure of less than 40mmHg Rest pain or tissue loss Greater than two weeks duration Less than this is considered acute ischaemia Ankle pressure of less than 40mmHg In diabetic patients the calf vessels are commonly calcified and incompressible, so that the pressure in the ankle is unrecordible. A toe pressure may be measured to make the diagnosis although commonly the prescence of significant arterial disease on duplex is used. Rest pain or tissue loss Constant pain in the distal portion of the lower extremity worse on raising feet. Night pain is a lesser degree of rest pain occuring at night, necessitating feet to be hung out of the side of the bed or sleeping in a chair. Tissue loss is any ulceration or necrosis

Answer 140

Painful Pulseless Perishingly cold Pale Paralysis Paraesthesia - If these are present 0 immediate revascularisation is needed

Answer 141

Examination Venous – Upper limb DVT and long term swelling Arterial – Raynauds, Claudication, Embolisation Neurological – Pain, Radiculopathy Investigation MRI, MRA, MRV Duplex – in abduction Nerve conduction studies

Answer 142

PVD Small vessel disease Neuropathy Infection

Answer 143

Venous malformations

Answer 144

``` Stroke Nerve damage: XII X VII (marginal mandibular) Greater auricular VIII ```

Answer 145

damaged in catorid artery surgery

Answer 146

``` Stroke Nerve damage: XII X VII (marginal mandibular) Greater auricular VIII ```

Answer 147

• Flexible Cystoscopy – Inspection of the urethra and bladder under LA

Answer 148

• Rigid Cystoscopy – Inspection of the urethra and bladder under GA

Answer 149

• Cystoscopy and retrograde pyelogram ( contrast examination of the ureter)

Answer 150

• Cystoscopy and Insertion of JJ Stent – GA- obstructed ureter

Answer 151

• Insertion of Nephrostomy for obstructed kidney ( Tube directly into the kidney )

Answer 152

Percutaneous Nephrolithotomy ( Insertion of a scope directly into the kidney to laser stones in the kidney – GA

Answer 153

• Simple Nephrectomy

Answer 154

• Radical Nephrectomy –

Answer 155

• Partial Nephrectomy – removal of a part of a kidney for cancer small renal lesion

Answer 156

Nephroureterectomy – Removal of Kidney and ureter ( for TCC of the renal pelvis or ureter) • Laparoscopic or open

Answer 157

Radical Cystectomy – Removal of bladder and prostate and pelvic LN in the male, and bladder uterus, ovaries and cervix and anterior vagina and pelvic LN in females

Answer 158

Simple / Millans prostatectomy – removal of prostate adenoma | for BPH – when the gland is too big for resection by TURP

Answer 159

• Trans rectal Bx of the Prostate TRUS Bx Done in the OPA to diagnose Prostate cancer

Answer 160

• Radical Prostatectomy – Removal of prostate and pelvic LN for cancer • Can be done open, Laparoscopically , Robotically

Answer 161

• Testes exploration – through the median raphe of the scrotum and bilateral fixation of the testes – an emergency

Answer 162

Radical Orchidectomy – Removal of testes for suspected cancer -Always through an inguinal incision -Never through the scrotum

Answer 163

The modified Ranson's criteria are used to assess gallstone pancreatitis.

Answer 164

The modified Ranson's criteria are used to assess gallstone pancreatitis.

Answer 165

Diverticulitis ``` 0 = subclinical 1 = pericolic 2 = Pelvic / intra-abdominal / Intraperitoneal abscess 3 = generalised purulent peritonitis 4 = faecal peritonitis ```

Answer 166

Modified hinchey ``` 0 = subclinical 1 = pericolic 2 = Pelvic / intra-abdominal / Intraperitoneal abscess 3 = generalised purulent peritonitis 4 = faecal peritonitis ```

Answer 167

``` 1 = Rectum = 27% 2 = sigmoid = 20% 3 = caecum = 14% ```

Answer 168

Most common 3 sites for colorectal cancer

Answer 169

``` A = submucosa / mucosa B = into muscle wall C = nodes involved D = distant mets ```

Answer 170

Area between SMA and IMA supply SMA feeds R colon + traverse IMA feeds L colon + sigmoid

Answer 171

SMA feeds R colon + traverse | IMA feeds L colon + sigmoid

Answer 172

NONE | Iliocolic anastomosis

Answer 173

NONE | Colo-colic anastomosis

Answer 174

``` Sigmoidectomy = primary anastamosis Hartmans = end colostomy + rectum sewn up = anastomosis attempted ELECTIVELY ```

Answer 175

End colostomy + perineum closed

Answer 176

end colostomy

Answer 177

11,7,3 o clock

Answer 178

Posterior in 90% men 70% women

Answer 179

Posterior fistulae open up in the midline | Anterior fistulae open up directly

Answer 180

``` 4 = cannot be retracted 3 = can be retracted with pressure 2 = retract spontaneously 1 = no prolapse ```

Answer 181

Supra / trans / inter sphincteric | Superficial

Answer 182

Encephalopathy Asterixis Ascites Bleeding

Answer 183

Cirrhosis CCF Carcinomatosis

Answer 184

Take a full history | Assess hernial orifices + genitalia playing close attention to TESTICLES (atrophy)

Answer 185

``` Physiological - puberty Kleinfelters Cirrhosis Digoxin + spironolactone Testicular tumours or orchidectomy Hyper/hypothyroidism Addisons ```

Answer 186

``` Albumin Bilirubin Clotting Distension - ascites Encephalopathy ```

Answer 187

Sitgmata CLD Splinter haemorrhages / murmur - endocarditis Rheumatoid hands - felty syndrome Evidence haematological malignancy

Answer 188

RhA / SLE / SS / crohns Sx of Rx - cushingoid Amiodarone - grey skin, may be in AF HIGH RES CT!!

Answer 189

Raised JVP, ankle oedema, P2, RV heave

Answer 190

PaO2 <7.3 OR PaO2 <8 with evidence of oedema, polycythaemia or cor pulmonale NB CONTRAINDICATION = SMOKING -> EXPLOOOOSION

Answer 191

Age related progression of aortic sclerosis Rheumatic heart disease Bicuspid Endocarditis

Answer 192

MAJ 2x +ve blood cultures Echo with abscess or vegetation ``` MINOR >38deg Suggestive echo 1x culture ESR + CRP Embolic phenomena (janeway/ostlers) Prosthetic valve - predisposition ```

Answer 193

``` HTN RhF AD IE Aortitis Marfans Age ```

Answer 194

``` Thyroxicosis Pregnancy PDA Anaemia Pagets ```

Answer 195

``` Angina = 50% dead at 5 yrs Syncope = 50% dead at 3 yrs SOB = 50% dead at 2 yrs ```

Answer 196

EF >50% = 1% mortality at 5 yrs | EF <50% = 2/3rds dead at 3 yrs

Answer 197

RhF Senile degeneration Endocarditis Congenital cleft mitral valve

Answer 198

LEAFLET - IE, RhF, connective tissue disorder, prolapse post MI ANNULUS - dilated LV, calcification Chordae - rupture, amyloid, fibrosis

Answer 199

NYHA >2 = 50% mortality at 5yrs untreated

Answer 200

25% mortality at 5 years

Answer 201

PS VSD overarching aorta, RVH

Answer 202

``` MAJ = 3% risk MIN = 7% risk ```

Answer 203

Prevents tachyarrythmias - used post MI - long QT, HCM, Brugada Also 2ndary prevention of cardiac arrest / VT

Answer 204

Brady arrhythmia - eg complete HB, mobitz T2 Also used in HF if: NYHA 3/4 LVEF < 35%

Answer 205

Also used in HF if: NYHA 3/4 LVEF < 35%

Answer 206

``` TB, coxsackie, influenza Trauma Tumour therapy - radio ConnecTive Tissue - RhA, SLE PosT MI - dresslers ```

Answer 207

Bilateral - Myotonic dystrophy - Myasthenia gratis - Congenital Unilateral - 3rd nerve palsy - Horners syndrome

Answer 208

``` DANISH Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech / scanning dysarthria Hypotonia hyporeflexia ``` Also check for "rebound" Sx

Answer 209

Direction of FAST phase of the nystagmus is TOWARDS the side of the lesion and MAXIMAL on looking towards the lesion UNLESS a CN8 lesion = the opposite

Answer 210

``` Alcoholic degeneration MS Tumour in posterior fossae Iatrogenic - phenytoin toxicity Endocrine - hypothyroidism Stroke - involving brainstem Rare - freidrichs ataxia ```

Answer 211

MS worsens after hot bath or exercise

Answer 212

Lhermittes - lightning pains down c-spine on flexion due to cervical cord lesions

Answer 213

Hip flexion

Answer 214

Knee extension

Answer 215

dorsiflexion of ankle

Answer 216

Hip extension

Answer 217

foot plantar flexion | Tip toe

Answer 218

degeneration of the dopamine producing neurones between the substantia nigra and basal ganglia

Answer 219

L dopa and peripheral decarboxylase inhibitor eg madopar Dopamine agonists eg pergolide Mao-B - selegine - inhibit breakdown of dopamine Anticholiergics - aid tremor COMT - inhibit peripheral breakdown of Ldopa Amantadine - increases dopamine release Surgery, thalidotomy, deep brain stimulation

Answer 220

``` Resting - parkinsons Intention - cerebellar Postural (worse with outstretched arms): Benign essential Anxiety Thyrotoxicosis Alcohol withdrawal Hepatic encephalopathy ```

Answer 221

SENSORY PREDMONINANT - DM, alcohol, isoniazid, b12/b1 deficiency MOTOR PRED - GBS, Botulism, Lead toxicity, charcoat marie Mononeuritis multiplex: is a painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas. Seen in DM, SLE, RhA, HIV, Malignancy

Answer 222

Spinal cord degeneration Motor neurone disease Friedrichs ataxia

Answer 223

Eyeballs roll upwards with closure of eyes

Answer 224

Bells / DM / herpes zoster - isolated CN 7 palsy Stroke / MS in PONS - 6th nerve palsy usually (stroke affecting hemisphere would SPARE THE EYEBROWs) Acoustic neuroma at the - Cerebellar pontine angle - CN 5/6/8 + cerebellar involvement TOO Auditory canal - cholesteatoma Parotid tumour / trauma to face or neck

Answer 225

Anti-ACH-R post synaptic membrane Anti-muscle specific kinase if ACH -ve On EMG - decremental response to evoked potentials

Answer 226

Antibodies against presynaptic calcium channels at the NMJ On EMG - second wind phenomena on repetitive stimulation

Answer 227

``` PODS Pitting Onycholysis Discolouration Subungual hyperkeratosis ```

Answer 228

``` DIP involvement - similar to OA Large joint mono/oligoarticular involvement Seronegative - similar to RhA Sacroiliac ARTHRITIS MUTILANS ```

Answer 229

Arterial - check for AF, bruits, murmurs, CKD Venous - Check for intra-abdominal or perineal masses Neuropathic - DM/control, charcots joint

Answer 230

Cheiroarthropathy - seen in DM

Answer 231

Granuloma annulare

Answer 232

Necrobiotica lipoidica

Answer 233

``` Asymmetry Border irregularity Colour irregularity Diameter >6mm Evolution ``` Excision Mohs Surgery

Answer 234

``` >1.5mm = 90% at 5 years >3.5mm = 40% at 5 years ```

Answer 235

AD condition causing growth of multiple benign tumours of different organs Periungal fibromas Ash leaf macules Shagreen patches Adenoma sebaceum - looks like acne

Answer 236

Gum hypertrophy | Hirsituism

Answer 237

A syndrome characterised by multiple cutaneous neurofibromas, cafe au lait spots, axilliary freckling and lisch nodules (iris melanocytic hamartomas of the eye) Often have epilepsy

Answer 238

Infection eg strep throat / TB Sarcoid IBD

Answer 239

An autoimmune symmetrical and deforming polyarthropathy

Answer 240

Pulmonary - fibrosing alveolitis, effusions Eyes - dry eyes, scleritis Neuro - carpal tunnel, peripheral neuropathy Haem - FELTY = RhA, splenomegaly, anaemia, neutropenia, thrombocytopenia, arthritis Cardiac - pericarditis Renal - nephrotic syndrome secondary to amyloidosis

Answer 241

Neutropenia, pulmonary fibrosis, hepatitis

Answer 242

Retinopathy

Answer 243

Rash, BM suppression

Answer 244

Osteoporosis, DM, HTN, Cushings

Answer 245

Proteinuria, thrombocytopenia

Answer 246

1. Morning stiffness 2. 3+ joints 3. Arthritis of the hands 4. Symmetrical arthritis 5. Rheumatoid nodules 6. RhF +ve 7. Erosions on the radiograph

Answer 247

Seen in SLE Looks like RhA But due to tendon contractures

Answer 248

A rare AI disease caused by excessive production and accumulation of collagen Limited = below elbows + knees Diffuse = widespread cutaneous and visceral involvement that progresses in months

Answer 249

anti-scl-70 and topoisomerase + ANA | Limited = ana and centromere

Answer 250

``` AAAAAA Aortitis Aortic regurg Apical lung fibrosis AVN heart block Arthritis Anterior uveitis ```

Answer 251

Marfans syndrome Arachnodactylyl = fingers ca span their wrist Monitor aortic root size with annual TTE BB + ARB Screen family

Answer 252

< 40 = every 2 years > 40 = annual Tested on acuity, fundoscopy, retinal photography and florescin angiography

Answer 253

Maculopathy | Pre or proliferative diabetic retinopathy

Answer 254

AR inherited form of retinal degeneration characterised by loss of photoreceptors due to a rhodopsin pigment mutation. Bone-spicule pigmentation seen

Answer 255

``` Papilloedema Glaucoma Migraine Hysteria Chondroretinitis ```

Answer 256

Phacoemulsification with prosthetic lens implant. NB cataracts may have RAPD Marcus gunn pupil

Answer 257

One side has: Poor response to light Slow accommodation (constriction occurs with accommodation) Benign condition in females - may have diminished or absent knee/ankle reflexes

Answer 258

Small irregular pupil that doesn't react to light May have atrophied and depigmented iris - DM or neyrosyphillis

Answer 259

``` Mononeuritis multiplex MS Migraine Midbrain infarction Communicating artery aneurysm Cavernous sinus thrombus Cerebral uncalled herniation ```

Answer 260

Consensual reflex preserved but dilated pupil on testing the afferent Pale disc on fundoscopy

Answer 261

Pressure - tumour or glaucoma Ataxia (Friedrichs) LEbers ``` Dietary - B12 or Degenerative - retinitis pigmentosa Ischaemic - CRA occlusion Syphilis Cyanide Sclerosis ```

Answer 262

``` Optic neuritis is CRAP Central scotoma Acuity (deteriorated in hr/d) Rapd Pain on movement ``` Loss of red colours

Answer 263

Graves De quervains Toxic multi nodular goitre Potential solitary adenoma

Answer 264

``` Hashimotos AI Iatrogenic - removal, lithium, amiodarone, anti-thyroid meds Iodiine deficiency Post-partum - sheehans Genetic - pendreds syndrome ```

Answer 265

80% due to AI process Adrenal mets Adrenal TB Waterhouse friedrichsons = SEPSIS -> ADRENAL INFARCTION

Answer 266

Increased ACTH and MSH due to lack of negative feedback on POMC MSH stimulates pigmentation

Answer 267

Cushings disease = pituitary adenoma secreting ACTH Syndrome = constellation of symptoms seen due to the corticosteroid excess THUS Defining features include: Bitemporal, potential increased pigment

Answer 268

Bilateral adrenalectomy for cushings Leads to increased ACTH production and MSH Thus gives the pt hyperpigmentation + pituitary overgrowth due to lack of negative feedback

Answer 269

Inherited - muscular dystrophy Endocrine - bushings, HPTism, thyrotoxicosis, diabetic amyotrophy Inflammatory - polymyositis / RhA / myasthenia Metabolic - Lambert eaton Drugs - steroids or alcohol

Answer 270

HBA1c >58mmol | -Check every 3-6 months until stable for 6m

Answer 271

When 3 drugs fail

Answer 272

BMI >35 or insulin contraindicated (occupational)

Answer 273

Increases insulin sensitivity Decreases hepatic gluconeogenesis GI upset, lactic acidosis

Answer 274

Stimulate Beta cells to produce insulin Hypoglycaemia Weight gain Hyponatraemia

Answer 275

sulphonylureas | Glipizide + glibenclamide

Answer 276

Activate PPAR gamma receptors in adipocytes to promote adipogenesis and fatty uptake Weigh gain, fluid retention

Answer 277

Thiazolidinediones eg pioglitazone

Answer 278

Increase incretin levels inhibiting glucagon secretion Increased risk pancreatitis

Answer 279

DPP4 eg seragliptin, liragliptin

Answer 280

Inhibit reabsorption of glucose in the kidney Increased UTIs WL

Answer 281

SGLT-2 inhibitors - glifazones

Answer 282

Incretin mimetic - inhibits glucagon secretion | N+V, pancreatitis, WL

Answer 283

GLP1 agonists eg exenetide

Answer 284

``` Vascular - CCF, budd chiari Infection - Hepatitis CMV Toxic - ALF, NAFLD AI - PBC / PSC Metabolic - Wilsons or haemochromatosis Neoplastic - metastases, pancreatic, hepatocellular ```

Answer 285

Pre hepatic = haemolysis eg haemorrhagic fever - increased conjugated Hepatic = Impaired conjugation of bilirubin due to dysfunctional hepatocytes - mixed conj+un conj Post hepatic = due to obstruction of intra/extra hepatic bile ducts - conjugated hyperbilirubinaemia

Answer 286

Walk with prosthesis Assess with doppler ABPI

Answer 287

Dead - PVD Dangerous - eg sepsis, malignancy Damaged - extreme trauma or burn Damned nuisance - extreme neurological damage

Answer 288

Poor stump shape -> difficult prosthesis | Scar contractures + phantom limb pain

Answer 289

2 blue stents, bag drains urine, bag has valve to empty urine / connect to a catheter overnight On scar you will see a pfannelstein or low midline incision with multiple port sites

Answer 290

Relapsing-remitting - periods of resolution + Sx Primary progressive - symptoms develop and worsen with no resolution Secondary progressive - relapsing/remitting cause but symptoms worsen gradually 50% of R-R become secondary progressive

Answer 291

T cell mediated demyelination of sensory and motor neurones at multiple CNS sites Diagnosis scored using the McDonald criteria

Answer 292

``` Whipples Oesophagectomy Gastrectomy Hepatic resection Liver transplant ```

Answer 293

Throbophlebitis migrant

Answer 294

Endoscopic US

Answer 295

Only if tumour confined to the periampullar region

Answer 296

Removal of the C of duodenum, the head of the pancreas and a partial gastrectomy +/- gallbladder

Answer 297

Scarring after skin damage seen in venous insufficiency

Answer 298

Extravasation of fibrin and RBCs Poor oxygenation leads to ulceration and fat necrosis the inflammation leads to distal shrinkage Proximal leg swelling occurs due to obstruction

Answer 299

Pooling of blood leads to immune activation and inflammation

Answer 300

Dilated superficial veins

Answer 301

Contralateral saphenous or an axillary vein

Answer 302

Primary - idiopathic - related to obesity, standing, OCP, pregnancy Secondary - valve destruction by DVT or obstruction eg by pelvic mass

Answer 303

>70% CN 7,8,10,12, can be damaged alongside sympathetic tract

Answer 304

CN 7,8,10,12, can be damaged alongside sympathetic tract

Answer 305

50% bilateral 50% have an AAA <10% rupture May have ischaemic patches on feet

Answer 306

HLA-B27+ve seronegative spondyloarthropathy leading to inflammation and progressive stiffening of the spine. There are a rang of extra-articular manifestations of the disease ``` Apical fibrosis Aortitis AVN block Aortic regurg Amyloidosis Anterior uveitis ```

Answer 307

Poorly understood AI condition presenting with oral and genital ulcers, anterior uveitis, and erythema nodosum, usually affecting Turkish or Japanese individuals Pathergy - minor skin trauma leads to inflammatory papule

Answer 308

``` Uraemia Acidosis Hyperkalaemia Hypernatraemia Anaemia Protein loss Vit D deficiency Hyperphosphataemia ```

Answer 309

Clamshell incision = double heart + lung transplant

Answer 310

2ndary to a proximal stenosing lesion or occlusion in the SC artery typically on the left. In order to compensate for the increased O2 demands in the arm blood is drawn from the collateral circulation - reverse blood flow is in the ipsilateral vertebral artery or less commonly the internal thoracic artery.

Answer 311

Pre-Hepatic - portal or splenic vein thrombosis, SVC occlusion Hepatic - PBC, cirrhosis, polycystic liver, Post-hepatic - CCF, Budd–Chiari, IVC thrombosis

Answer 312

Transudate <30g protein Exudate >30g protein Transudate CCC CCF, CHF, CLD Exudate Neoplasia, infection, inflammation (eg RhA, SLE)

Answer 313

3 criteria" 1. Unilateral hemiparesis or hemisensory loss 2. Homonymous hemianopia 3. Higher cognitive function eg dysphasia Total anterior cerebral infarct = 3/3 Parial = 2/3 Lacunar = 1 of: hemiparesis, hemisensory, ataxia Posterior cerebral infarct = cerebella Sx or isolated homonymous hemianopia Webers = ipsilateral 3rd nerve paralysis + weakness contra Lateral medullary syndrome = cerebellar Sx, CN palsy + limb sensory loss - contra pain + temp, ipsilateral light touch+vib, HORNERS [posterior inferior cerebellar artery or vertebral artery]

Answer 314

Webers = ipsilateral 3rd nerve paralysis + weakness contra

Answer 315

Lateral medullary syndrome = cerebellar Sx, CN palsy + limb sensory loss - contra pain + temp, ipsilateral light touch+vib, HORNERS [posterior inferior cerebellar artery or vertebral artery]

Answer 316

Webers = ipsilateral 3rd nerve paralysis + weakness contra

Answer 317

Impaired flexion at elbow Impaired supination ARM HELD in EXTENSION AND PRONATION Sensory loss of LATERAL forearm

Answer 318

Seargents patch numb Paralysis of deltoid + teres minor Shoulder adducted and internally rotated

Answer 319

Impaired extension of arm, forearm, wrists + finger Numbness of posterior arm + forearm Wrist drop

Answer 320

Weak flexion of fingers (innervates all of the flexors aside from FCU and medial FDP) Thenar eminence wasting + flexion of thumb

Answer 321

Numbness on hypothenar eminence and medial third of the hand Weak abduction of fingers Ulnar claw

Answer 322

``` 6 = obeys command 5 = localises to pain (above clavicle) 4 = withdraw from pain (above clavicle) 3 = abnormal flexion 2 = abnormal extension 1 = no response ```

Answer 323

``` 5 = Oriented 4 = Confused 3 = Words but not making sense 2 = Sounds 1 = no response ```

Answer 324

``` 4 = spontaneously open 3 = open on command 2 = open to pain 1 = do not open ```

Answer 325

``` MOTOR 6 = obeys command 5 = localises to pain (above clavicle) 4 = withdraw from pain (above clavicle) 3 = abnormal flexion 2 = abnormal extension 1 = no response ``` ``` VOICE 5 = Oriented 4 = Confused 3 = Words but not making sense 2 = Sounds 1 = no response ``` ``` EYES 4 = spontaneously open 3 = open on command 2 = open to pain 1 = do not open ```

Answer 326

``` MAJOR Chorea Erythema marginatum Subcutaneous nodules Polyarteritis Carditis ``` ``` MINOR Raised ESR/CRP Raised WCC Arthralgia RhF Fever >38 Prolonged PR ```

Answer 327

Dot + blot haemorrhages Microaneurysms Hard exudates Venodilation

Answer 328

Soft exudates ``` AND Dot + blot haemorrhages Microaneurysms Hard exudates Venodilation ```

Answer 329

New vessel formation ``` AND Soft exudates Dot + blot haemorrhages Microaneurysms Hard exudates Venodilation ```

Answer 330

Arteriolar narrowing | Silver wiring

Answer 331

AV nipping

Answer 332

Soft exudates - cotton wool spots Blot haemorrhages Flame shaped haemorrhages

Answer 333

Papilloedema - loss of optic disc margin Patons lines might be seen May be dual ringed Haemorrhages adjacent to disc FRISEN STAGING

Answer 334

11/9/8 THEN common pathway = 10, 5, 2 Heparin activates antithrombin 3

Answer 335

7 Then common pathway 10,5,2 Warfarin decreases production of 2,7,9,10

Answer 336

25-30ml/kg water 1mmol per day Na, K, Cl 50-100g glucose to avoid ketosis

Answer 337

``` 5/5 = normal 4/5 = reduced power against resistance 3/5 = moves against gravity 2/5 = moves with gravity neutralised 1/5 = flicker 0/5 = none ```

Answer 338

Anatomy of where a direct inguinal hernia passes through ``` LATERAL = inferiorepigastric artery MEDIAL = lateral border of rectus abdominis INFERIOR = inguinal ligament ```

Answer 339

Resuscate Reduce Restrict Rehabilitate

Answer 340

``` None of: Neurological deficits Spinal tenderness in midline Altered consciousness Intoxication Distracting injury ```

Answer 341

SLTP TTCH Scaphoid, lunate, triquetrium, pisoform Trapezium, trapezoid, capitate, hamate

Answer 342

Flexor retinactulum overarches: | TTCH

Answer 343

1. Normal healthy person 2. Mild systemic disease / smoker / drinker / controlled DM 3. Severe systemic disease eg uncontrolled DM 4. Severe systemic disease that is a constant threat to life 5. Moribund pt who will not survive without operation - eg AAA 6. Dead PT for organ salvage

Answer 344

Non opioid + adjuvant -> weak opioid -> strong opioid

Answer 345

Score for calculating stroke risk in AF patients + subsequent need for anticoagulation ``` CHF HTN Age >75 = 2, >64 =1 DM Stroke Vasc = MI, PVD, aortic plaque ``` 0 - none needed 1 - consider 2 - suggest

Answer 346

Estimated the risk of major bleeding for PTs on anticoagulation to assess risk-benefit in AF care ``` HTN Abnormal LFTs, RFTs Stroke Hx Bleeding Hx Labile INRs Elderly >65 Drugs that predispose to bleeding OR alcohol >8 units per week ``` NO FORMAL RULES Score >3 believed to be high risk for bleeding

Answer 347

Transpyloric plane = L1 | Midpoint of the suprasternal notch and symphysis pubis

Answer 348

Ribs 9-11 posteriorly

Answer 349

1/3 between ASIS and the umbilicus

Answer 350

I+E obliques, traverses abdominus, lien alba

Answer 351

Dilated veins in the pampniform plexus

Answer 352

Accumulation of fluid in the processes vaginalis

Answer 353

S - inguinal ligament I - pectineus L - Femoral vein M - Lacunar ligament SILM IPF L

Answer 354

Roof - formed by Muscles: internal oblique, transversus abdominis (M) Anterior - formed by Aponeuroses: internal oblique, external oblique (A) Floor - formed by Ligaments: inguinal ligament, lacunar ligament (L) Posterior - formed by Tendon and transversalis fascia (T) Mnemonic: MALT Roof - IO + traverses abdominus Anterior - aponeurosis of I+E oblique Lateral - lacunar ligament + inguinal ligament Posterior - traversals fascia + conjoint tendon

Answer 355

4 reasons: L Testicular vein = more vertical where it joins the renal vein Left is more compressed by the colon Left vein is larger Left vein may lack a terminal valve to prevent back flow

Answer 356

``` 0-4 = ward response (3+ = urgent response by ward) 5-6 = urgent response 7+ = emergency response ```

Answer 357

``` Skin Campers fascia Scarpers fascia External oblique Internal oblique Transversus abdominis Transversals fascia Peritoneal fat + peritoneum ```

Answer 358

Diverticulitis with: 1. Pericolic or mesenteric abscess 2. Walled off pelvic abscess 3. purulent peritonitis 4. faecal peritonitis

Answer 359

``` Intramural = faecal impaction, intussusception, gallstones mural = strictures, diverticulum, rarely neoplasia extramural = adhesions, herniation, volvulus, ```

Answer 360

``` A = confined to muscularis mucosal B = extension through muscularis mucosa C = involvement of regional LNs D = Distant metastases ```

Answer 361

No stomas needed for R/L hemicolectomies - LOW pressure areas are removed (IE sigmoid left) - Anasatmosis can occur in low pressure areas as there is reduced risk of perforation or leak - Exception = anterior resection

Answer 362

Emergency removal of the rectosigmoid

Answer 363

Anterior resection IF - >5cm from anus | AP if <5cm from anus

Answer 364

SMA - iliocolic, right colic + R branch of middle colic

Answer 365

IMA, left colic, left branch of middle colic

Answer 366

Haemodynamic instability Intestinal obstruction Raised ICP

Answer 367

CCF Preganncy AAA Profuse adhesions

Answer 368

Sacral promontery to anal verge

Answer 369

levator ani to anal verge Upper 2/3 is columnar + insensate Lower 1/3 is squamous and sensate

Answer 370

Squamocolumnar junction of the anus

Answer 371

Where anal canal becomes skin

Answer 372

External sphincter is 3 rings of skeletal muscle | Internal sphincter is rectal smooth muscle = involuntary

Answer 373

3,7,11 o clock

Answer 374

1. Remains in rectum 2. Prolapses on defacation, spontaneously retracts 3. Must be manually retracted 4. Cannot be retracted 5% need haemorrhoidectomy - must be grade 3/4

Answer 375

UO <0.5ml/kg/hr | Creatinine rise >26.5mmol

Answer 376

1. Creatinine rise >26.5mmol or <100% rise 2. UO <0.5ml/kg/hr or 100-200% creatinine rise 3. UO <0.3ml/kg/hr or >200% creatinine rise

Answer 377

Refractory hyperkalaemia Refractory pulmonary oedema Uraemic complications Severe metabolic acidosis

Answer 378

``` 75% - calcium oxalate 15% - struvite (aka triple), magnesium ammonia phosphate 5% urate <5% hydroxyapatitie <1% cystein Rare stones eg Indinavir ```

Answer 379

Urate Indinavir Cystein = semi opaque

Answer 380

Diclofenac

Answer 381

Stomach + ampulla of vater

Answer 382

Duodenum + 2/3 traverse colon

Answer 383

Rest of the large intestine

Answer 384

Coeliac axis

Answer 385

Loss of peristalsis Loss of normal sheen Green/black colour Loss of arterial pulsation

Answer 386

Metabolic - hypokalaemia, uraemia, DKA Toxic - anticholinergics, antiparkinsonium Post op Secondary to peritonitis

Answer 387

Paralytic ileus of the large bowel due to disruption of the autonomic supply of the gut - caused by retroperitoneal bleeding or surgery

Answer 388

Inflammatory - crohns, UC Infection - C.dif Ischaemic - embolus, thrombus, atheroma, HF

Answer 389

<1-2cm small bowel | Causes steatorrhoea and fatigue

Answer 390

Common hepatic, left gastric, splenic artery

Answer 391

Left + right hepatic | Gastroduodenal artery

Answer 392

Luminal - foreign body Mural - stricture, tumour, Plummer vinson, achalasia, pouch Extramural - Aortic aneurysm, LN, mediastinal enlargement, bronchial carcinoma Systemic - sarcoid, MS, diphtheria

Answer 393

Hellers myomotomy Ballon dilation Botox

Answer 394

Between thyropharyngeus and cricopharyngeus muscles

Answer 395

ADENOCARCINOMA + STROMAL CANCER

Answer 396

Roux en Y - gastroplasty and diversion to small bowel Gastric sleeve - partial gastrectomy - removal of the greater curve Gastric band (band placed 1-2cm below gastrooesophageal junction

Answer 397

``` Acute = painful palpable bladder, usually less is drained than in chronic Chronic = often painless, >1.5L drainage usually ```

Answer 398

Obstructive causes: luminal/mural/extramural Neurological: MS, DM, spinal surgery Myogenic: post anaesthesia, bladder overdistention

Answer 399

Luminal - stones, clots Mural - strictures, tumours Extramural - BPH, abdominal mass, retroperitoneal fibrosis

Answer 400

Conservative - privacy + analgesia Medical - catheterisation, tamsulosin, TWOC after 24-72 hrs Surgical - suprapubic catheter under US guidance

Answer 401

``` Creation of a false tract Haematuria Paraphimosis Infection Blockage ``` Contraindications - pelvic fracture, urethral trauma

Answer 402

``` <5mm = conservative, analgesia +/- sieve for urine 5-10mm = medical with tamsulosin or nifedipine, prednisolone can be given >10mm = surgical = extracorporeal shockwave lithotripsy, laser lithotripsy ``` If stag horn / hydronephosis - may need to do percutenous nephrolithotomy If febrile - nephrostomy or ureteric stent JJ Stent insertion for recurrent

Answer 403

LHRH antagonists eg goserelin Anti-androgens Brach-radiotherpay Radical prostectomy

Answer 404

Where fluid enters the systemic circulation | Dilutional hyponatraemia, fluid overload, glycine toxicity

Answer 405

``` Episcleritis Pneumonitis, Pericarditis Carpal tunnel De Q thumb Atlanto-axial subluxation ```

Answer 406

Loss of joint space and subluxation Soft tissue swelling Periarticular osteopenia May see Z thumb, ulnar deviation f fingers, radial deviation of wrist - marked deformities

Answer 407

Swelling of the great toe

Answer 408

Firm deposits of urate

Answer 409

Seen in pseudoG. Calcification of joint space

Answer 410

Thumb to little finger (opponens pollicis) | Oppose

Answer 411

Finger abduction

Answer 412

Finger extension

Answer 413

95% anterior 5% posterior - usually seen in epilepsy patients Main cause = trauma Arm usually in fixed rotation and abduction Complications = axillary nerve/artery damage, fracture, reoccurrence, bank hart or hill-sacks lesion

Answer 414

anterolateral tear to glenoid labrum

Answer 415

bank-hart lesion

Answer 416

Posterolateral humeral head depression due to impaction against glenoid rim

Answer 417

hill-sachs lesion

Answer 418

Entrapment of the supraspinatus tendon + subacromial bursae Causes = supraspinatus tendonitis +ve hawkins, scarf, painful arc

Answer 419

Compression of the caudal equine, most commonly due to herniation of discs l4/5 or l5/S1

Answer 420

saddle anasthesia Back pain Sexual dysfunction Loss of continence

Answer 421

``` Herniation Mets Tumours Abscess Post op haematoma ```

Answer 422

Urgent surgical referral | NSAIDs and Steroids

Answer 423

0.8-1 = normal 0.6-0.8 = claudication <0.6 = critical ischaemia NB DM + CKD ABPI is RAISED due to calcification of the vessels

Answer 424

aortic access

Answer 425

Common femoral artery access

Answer 426

Aortofemoral bypass graft

Answer 427

retroperitoneal plane for iliac artery access

Answer 428

axial-bifemoral artery bypass graft

Answer 429

Femora-Distal bypass

Answer 430

All patients receive aspirin and statin unless CI All patients receive GTN reliever 1. BB or CCB (verapamil/diltiazem) 2. Increase to maximum tolerated dose 3. Long acting nitrate eg nicorandil, ivabradine Nitrate tolerance develops - MOD release isosorbide mononitrate

Answer 431

Impacted fracture of the radial epiphysis with dorsal displacement and shortening Caution re median nerve injury

Answer 432

mMRC dyspnoea scale Airfow limitation - FEV1 No exacerbations per year

Answer 433

``` BODE BMI Obstruction - FEV1 Dyspnoea mMRC Exercise capacity ```

Answer 434

PAO2<7.3 Or PaO2 < 8 with cor pulmonale or polycythaemia

Answer 435

ACTH Prolactin FSH/LSH GH 50% of pituitary tumours are prolactinomas

Answer 436

ADH | Oxytocin

Answer 437

Macro >1cm Micro < 1cm Functioning or non-functioning

Answer 438

``` Hypotension Hyponatraemia Hypokalameia Dehydration Pigmentation ``` May be concurrent infection, trauma or infarction

Answer 439

Synthetic tract runs from hypothalamus to T1 - back up to eye via carotid

Answer 440

Aspergillosis Pneumoconiosis Extrinsic allergic alveolitis TB

Answer 441

Sarcoid Asbestosis IPF RhA

Answer 442

``` Infarction of the medulla leading to: Ipsilateral Nystagmus Ipsilateral facial numbness Ipsilateral horners Contralateral loss of pain sensation Absent corneal reflex Vertigo and ataxia ```

Answer 443

laterally medullary syndrome Infarction of the medulla

Answer 444

Cardiac - LVH, ischaemia, tachycardia Systemic - hyperaemia, sepsis, DM Other - GRF <60, Cirrhosis, COPD

Answer 445

Whereby the stomach rapidly empties its contents into the intestine Hypoglycaemia and hypovolaemia Dizziness, NV, crampy, sweaty, diarrhoea RF = high sugar foods

Answer 446

Truelove and witt BF FATE Bloody stool Frequency Fever Anaemia Tachycardia ESR

Answer 447

BF FATE Bloody stool Frequency Fever Anaemia Tachycardia ESR

Answer 448

High fever, joint pain, salmon pink rash Can have increased ferritin

Answer 449

Adiposis dolorosa Multiple encapsulated lipomas. Associated with women 35-50, emtotional upset

Answer 450

-1 for: Seizure or LOC ``` +1 for: asymmetric facial weakness • asymmetric arm weakness • asymmetric leg weakness • speech disturbance • visual field defect ``` Score >0 stroke likely

Answer 451

SMA = supplies R colon and Traverse | IMA supplies Left colon and Sigmoid

Answer 452

Indications for loop ileostomy include the necessity to protect multiple or complicated anastomoses, the protection of ileorectal anastomoses in patients with inflammatory disease, and the necessity of diverting the flow of intestinal contents in patients with fulminant inflammatory bowel disease. ``` Protect anastomosis Ilioanal pouch for UC/FAP Reversal of Hartmans Anterior resection Complicated rectovaginal fistulas ```

Answer 453

Loop ileostomy

Answer 454

Acquired oculomotor palsy: Vascular disorders such as diabetes, heart disease, atherosclerosis and aneurysm, particularly of the posterior communicating artery Space occupying lesions or tumours, both malignant and non-malignant Inflammation and infection Trauma Demyelinating disease (multiple sclerosis) Autoimmune disorders such as myasthenia gravis Post-operatively as a complication of neurosurgery Cavernous sinus thrombosis

Answer 455

Ischemic stroke selectively affects somatic fibers over parasympathetic fibers, while traumatic stroke affects both types more equally. Pupillary abnormalities are more commonly associated with trauma and the 'surgical third' than with ischemia, ie the 'medical third'. The sparing of the pupil is thought to be associated with the microfasciculation of the fibers which control the pupillomotor function located on the outmost aspect of the occulomotor nerve fibres; these fibres are spared because they are outermost and so less prone to ischaemic damage than the innermost fibres

Answer 456

Subacute combined degeneration of the cord involves degeneration of the posterior and lateral columns of the spinal cord, often due to vitamin B12 deficiency. Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg's test). Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs). Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).

Answer 457

Papers Don't Contribute To A Good Specialist Level P: pampiniform plexus D: ductus deferens C: cremasteric artery T: testicular artery A: artery of the ductus deferens (deferential artery) G: genital branch of the genitofemoral nerve S: sympathetic nerve fibres L: lymphatic vessels 3 arteries, 3 nerves, 3 fascias, 3 other things 3 arteries: testicular, deferential, cremasteric 3 nerves: genital branch of the genitofemoral, cremasteric nerve*, sympathetic nerve fibres 3 fascias: external spermatic fascia, cremasteric fascia, internal spermatic fascia 3 other things: ductus deferens, pampiniform plexus, lymphatic vessels

Answer 458

Volkmann's ischaemic contracture

Answer 459

Normally, air conduction is better than bone conduction and this is referred to as a positive Rinne test (AC>BC) Normally conduction of sound through the air via the external canal, tympanic membrane and middle ear is about twice as efficient as conduction through bone. The Rinne test is designed to see if this is the case. The tuning fork is held over the mastoid process and then in front of the external canal and the patient asked which is louder. Alternatively, it may be held over the mastoid until it fades and then moved to in front of the meatus to see if the sound is still audible.

Answer 460

Who should receive a statin? all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease) following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10% patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Answer 461

NICE currently recommends the following for the prevention of cardiovascular disease:: atorvastatin 20mg for primary prevention increase the dose if non-HDL has not reduced for >= 40% atorvastatin 80mg for secondary prevention

Answer 462

Heart failure

Answer 463

NHL - AKA DLBCL

Answer 464

Toxoplasmosis

Answer 465

Sulfadiazine and pyrimethamine

Answer 466

Infection Complications of tonsillectomy primary (< 24 hours): haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain secondary (24 hours to 10 days): haemorrhage (most commonly due to infection), pain

Answer 467

Asbestosis

Answer 468

Midbrain lesion

Answer 469

Haemolysed sample

Answer 470

S pneumonia = encapsulated cocci | S aureas = cocci in clusters

Answer 471

B12 - megaloblastic

Answer 472

Lat lums | Also opponens pollicis, APB, FPB

Answer 473

Small cell lung carcinoma

Answer 474

Hypochloraemic metabolic alkalosis

Answer 475

Infectious mononucleosis | Glandular fever

Answer 476

HSV encephalitis

Answer 477

Navicular fracture (the scaphoid of the foot)

Answer 478

Potassium chloride 0.3% contains 40 mmol each of K+ and Cl-/litre or 0.15% contains 20 mmol each of K+ and Cl-/litre with 5% of anhydrous glucose. Therefore 0.15% = 20mmol

Answer 479

Panproctocolectomy and ilioanal pouch Ilioanal pouch = better

Answer 480

Amoebiasis - long incubation period

Answer 481

Sciatic nerve injury

Answer 482

Doxorubicin

Answer 483

Both have red eye + may have blurring SCLERITIS IS PAINFUL EPI = NOT - no pain receptors

Answer 484

The signs of globe rupture include subconjunctival hemorrhage, hyphema, irregular or peaked pupil, corneal lacerations, shallow anterior chamber, low intraocular pressure, or intraocular contents being noted outside of the globe.

Answer 485

Refer to gynaecologist under 2WW

Answer 486

1. Pregabalin, gabapentin or duloxetine | 2. Amitryptiline

Answer 487

MRI | Hyperprolactinaemia occurs with the drug only, therefore as normally you won't have a bitemporal -> an MRI is indicated

Answer 488

Management IV bicarbonate first-line therapy for hypotension or arrhythmias indications include widening of the QRS interval >100 msec or a ventricular arrhythmia other drugs for arrhythmias

Answer 489

Admit patient two days pre-op and start heparin,

Answer 490

clarithromycin

Answer 491

Prothrombin complex | (if not available, then FFP),

Answer 492

Cefotaxime

Answer 493

Co-trimoxazole

Answer 494

Cerebral oedema

Answer 495

Posterior hip dislocation

Answer 496

Antibiotics are indicated for patients with acute pain, severe symptoms, or symptoms lasting more than 12-24 hours; fever or any other signs of systemic infection; or positive microbiology studies. Fluclox 250-500qds

Answer 497

amputate Must be <6 hours

Answer 498

Pneumococcus more common than H influenza

Answer 499

Misoprostol

Answer 500

Muscle biopsy Dermatomyositis is associated with autoantibodies, especially antinuclear antibodies (ANA).[9] Around 80% of people with DM test positive for ANA and around 30% of people have myositis-specific autoantibodies which include antibodies to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including antibodies against histidine—tRNA ligase (also called Jo-1); antibodies to signal recognition particle (SRP); and anti-Mi-2 antibodies.

Answer 501

a) 15L 02 by non rebreathe mask

Answer 502

Flexion of inter joints of pinky

Answer 503

Previous infection

Answer 504

Lymecycline

Answer 505

2100x40 = 84000, divided by 1000 = 84 To calculate the number of units in a drink multiply the number of millilitres by the ABV and divide by 1,000.

Answer 506

hypromellose artificial tears

Answer 507

IgA nephropathy,

Answer 508

constrictive pericarditis,

Answer 509

Thiazide like diuretic | Hypokalaemia

Answer 510

Clear cell

Answer 511

Surgical 3rd

Answer 512

The adverse prognostic factors identified in the international study are: ``` Age ≥ 45 years Stage IV disease Hemoglobin < 10.5 g/dl Lymphocyte count < 600/µl or < 8% Male Albumin < 4.0 g/dl White blood count ≥ 15,000/µl ```

Answer 513

First pass hep metabolism

Answer 514

Unblinding has occurred

Answer 515

Stop nsaid ie has IDA

Answer 516

Answr Tri – cause of | isolated high Cr and K

Answer 517

Domperidone

Answer 518

TIPS predisposes to hepatic encephalopathy because ammonia can reach brain and cause osmotic change, damaging astrocytes

Answer 519

PR depression MOST sensitive sign of pericarditis Or atrial infarction

Answer 520

PDE5 inhibition -> postural hypotension

Answer 521

Aspergillus

Answer 522

Looked this up night before, only treat thrombocytosis if reaches 1500 x 10^9 and not before

Answer 523

Plant fasc

Answer 524

Do nothing and observe Only Rx when resp depression

Answer 525

-TB/sarcoid/rheum

Answer 526

Pseudogout affects knee more commonly

Answer 527

Plasma cells

Answer 528

delta waves

Answer 529

-In the presence of jaundice a palpable gallbladder means gallstones are unlikely

Answer 530

hypovolaemia

Answer 531

Answer: A Justification: The immediate clinical problem is agitation in someone with psychosis. This requires active treatment (i.e. intramuscular haloperidol) with an onset of action of 1-2 hours. Risperidone depot will not take effect for several days; if he continues to refuse medication a depot may be a good option but there is a chance that after he settles down he will accept oral medication (olanzapine or aripiprazole). Clozapine is not indicated unless he is shown to fail to respond to at least two antipsychotics.

Answer 532

Which is the most appropriate next investigation? A) Catheter (invasive) angiography B) CT coronary angiography C) CT scan of the chest D) Exercise ECG E) MRI scan of the heart Answer: B Justification: In (young) patients with a low-to-moderate risk of coronary artery disease and atypical chest pain, CT coronary angiography is now considered, by many cardiologists, to be the investigation of first choice. When coupled with a low pre-test probability, a negative CT coronary angiogram has a very high (>95%) negative predictive value. Invasive angiography is not indicated in this patient with non-typical cardiac pain. A CT scan of the chest may show some coronary calcification and/or other pathology which might explain the clinical presentation. However, a non-gated CT scan of the chest will not provide sufficient anatomical detail to confirm or exclude the presence of significant coronary plaque. An exercise ECG will not permit a morphological diagnosis of significant coronary disease to be made. Similarly, an MRI scan of the heart is usually requested for the evaluation of cardiac muscle or valvular disease; MRI of the coronary arteries is generally considered inferior to CT examination of the coronary circulation.

Answer 533

Justification: This is the typical clinical presentation of acute promyelocytic leukaemia – this is a haematological emergency as patient can die of catastrophic bleeding. Patients develop disseminated intravascular coagulation and the chromosomal defect [t(15; 17)] confirms the diagnosis. Treatment with the vitamin A derivative, ATRA, and correction of coagulation should begin immediately once the diagnosis of acute promyelocytic leukaemia is suspected.

Answer 534

Answer: E Justification: The management of claudication is supportive, not interventional, unless symptoms are severe and debilitating. Smoking cessation is essential to achieve long-term improvement. Drug treatment (e.g. cilostazol) is expensive and of questionable value unless symptoms are severe and no interventional treatment is possible. The most cost effective management is a supervised exercise programme. Angioplasty and stenting or by-pass surgery are not appropriate in this patients. The results of all interventions are worse in those who continue to smoke. There is no point in performing undertaking CT angiography alone unless it will alter the management. Those who smoke have an increased risk of developing an aortic aneurysm. The National Aneurysm Screening programme is for those aged >65; this patient is too young for screening.

Answer 535

Answer: B Justification: The clinical features of progressive LMN distal weakness with preservation of sensation, occuring after an episode of diarrhoea (often Campylobacter) are indicative of Guillain-Barre Syndrome. This is confirmed by the CSF findings of a low cell count in the presence of markedly raised protein. The nerve dysfunction in Guillain–Barré syndrome is caused by an immune attack on the nerve cells of the peripheral nervous system and their support structures. The 2 potential immunotherapy treatments for Guillain-Barre Syndrome are intravenous immunoglobulin (the preferred treatment - answer B), and plasmapheresis (not included in

Answer 536

Answer: A Justification: An ABCDE approach should be used. Immediately reversible and/or life threatening causes should be identified and corrected first. A capillary glucose can be performed rapidly at the bedside and if hypoglycaemia is confirmed this can be managed promptly. A CT brain may be indicated but would not be performed prior to checking the glucose. An EEG is unlikely to be of value at this stage and will take time to organise. A lumbar puncture would only be performed once a structural cause of the reduced level of consciousness had been excluded following a CT. Urine toxicology would be useful in this situation to detect alcohol/ drug use but a urine sample is required and the results may not be available immediately.

Answer 537

Answer: A Justification: Amitriptyline - these features are typical of tricyclic antidepressant poisoning; the significant QRS prolongation is a risk factor for both convulsions and arrhythmias after tricyclic antidepressant overdose. Amphetamine can cause dilated pupils and tachycardia; however the drowsiness, hypotension and ECG changes are not typical of amphetamine toxicity. Aspirin does not cause ECG changes or dilated pupils. Atenolol is a selective beta-1 blocker with poor CNS penetration and causes bradycardia and hypotension; it would not cause CNS depression or the ECG changes seen in this case. Fluoxetine and other serotonin specific reuptake inhibitors rarely cause severe toxicity and are not associated with QRS prolongation.

Answer 538

A) Clostridium perfringens

Answer 539

Answer: E Justification: Vitiligo is an autoimmune skin condition and as such may be found in conjunction with Hashimoto’s thyroiditis. There are reports that acne may be associated with autoimmune thyroid disease. Granuloma annulare is a common condition of unknown cause which affects the skin of children, teenagers or young adults. It only affects the skin and is considered harmless. Necrobiosis lipoidica is a rare skin disorder which can affect the shins of patients with insulin dependent diabetes. Pretibial myxoedema is associated with Grave’s thyroid disease.

Answer 540

Answer: E Justification: Recurrent episodes of acute large bowel obstruction is the typical presentation of a recurrent sigmoid volvulus. This is usually treated by a flatus tube or decompression by flexible sigmoidoscopy. Surgery (resection) is reserved for those patients who are seen late and have developed ischaemia. Acute malignant large bowel obstruction, toxic megacolon and perforated diverticular disease develop over a much longer timescale. These conditions would not be recurrent. Perforated diverticulitis would not result in gross abdominal distension. Small bowel obstruction due to adhesions may be recurrent but is associated with early vomiting. Gross abdominal distention would not develop over four hours.

Answer 541

Answer: D Justification: A perforated peptic ulcer causes sudden onset of pain with generalised peritonitis. Acute cholecystitis usually has right upper quadrant tenderness but not peritonitis. Acute mesenteric ischaemia presents with more gradual onset of very severe abdominal pain but few abdominal signs. Acute pancreatitis usually presents with back pain but not generalised peritonitis. This patient is probably too young for to have a ruptured aortic aneurysm. A patient with a ruptured aneurysm may also have back pain and a tender mass but not generalised peritonitis.

Answer 542

Answer: A Justification: Interstitial nephritis is a common drug reaction to NSAIDS and causes an eosinophilia in 25% of patients and results in proteinuria and haematuria. Haemorrhagic cystitis does not result in a rash or eosinophilia. Nephritic syndrome does not result in a rash or eosinophilia. Nephrotic syndrome does not result in haematuria. SLE does not result in eosinophilia and is unusual at age 72.

Answer 543

Answer: D Justification: Primary hyperparathyroidism is a common cause of hypercalcaemia. It is more prevalent in postmenopausal women. Most cases are caused by a single adenoma which is not controlled by the normal feedback mechanism, and continues to produce parathyroid hormone despite normal or high calcium. This results in increased release of calcium from the bones and increased calcium resorption in the kidneys. Familial hypocalciuric hypercalcaemia is a rare genetic condition, which can be associated with elevated levels of parathyroid hormone, however it usually presents in childhood. Milk- alkali syndrome and sarcoidosis are associated with reduced levels of parathyroid hormone and frequently with elevated serum phosphate.

Answer 544

Answer: C Justification: An MRCP will show if the common bile duct (CBD) contains stones and is more reliable than ultrasound. A stone may already have passed but the CBD may remain dilated. ERCP has an overall mortality of 1-2% so should only be carried out if stones are proven to still be in the CBD. Laparoscopic cholecystectomy (early or delayed) should not be carried out until after the CBD is cleared of any stones that are present. There is no benefit in drainage of the gallbladder or percutaneous drainage of the biliary system for this patient.

Answer 545

erythromycin

Answer 546

Omit gliclazide and keep metformin Metformin - take as normal if BD, if TDS omit lunch dose Sulphonylurea - take PM dose if BD but omit if OD Stat VRII if: T1 - missing a meal T2 - poor control (HBA1c if >69), missing >1 meal and BM >12, emergency surgery If BM >12: SC insulin for T1 - 1 unit drops by 3mmol T2 - 0.1units /kg rapid

Answer 547

Vertebral or PICA

Answer 548

50% chance for both

Answer 549

thickened palmar | fascia

Answer 550

Mod: Sat >92 HR <125 PEFR >50 ``` Acute severe: SP<92 Too breathless to talk HR >125 PEFR 33-50 ``` Life threatening: Sx of respiratory failure SP<92 PEFR <33%

Answer 551

repeat LFT in 2 weeks

Answer 552

Offer surveillance with aortic ultrasound to people with an asymptomatic AAA:  every 3 months if the AAA is 4.5–5.4 cm  every 2 years if the AAA is 3.0–4.4 cm. 521 The committee recommended ultrasound surveillance every 2 years for people with 522 asymptomatic AAAs of 3–4.4 cm in diameter because: 527  528 How the recommendations might affect practice monitoring every 2 years offers the best balance between benefits and costs

Answer 553

Carbimazole

Answer 554

Anastamotic leak

Answer 555

Procyclidine

Answer 556

Hold simvastatin, classic scenario of statin-induced rhabdomyolysis after taking an inhibitor

Answer 557

Stress hyperglycaemia

Answer 558

Osteomalacia

Answer 559

doxorubicin

Answer 560

hookworm most common cause ida ww

Answer 561

medial meniscus tear

Answer 562

Subluxation of radial head (links to pic)

Answer 563

Flexion of inter joints of pinky

Answer 564

Hx infection

Answer 565

Both amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by AD

Answer 566

No treatment or chest physiotherapy

Answer 567

infer-nasal artery | occlusion

Answer 568

Temporal petrous

Answer 569

Only Rx if maj bleed If maj bleed: 1: pred 2. IVIG Although platelets are likely to be rapidly destroyed during transfusion, there is evidence to suggest that patients with active bleeding respond transiently to transfusion. IVIG can prolong platelet survival; therefore, platelet transfusion may be more effective if given after IVIG infusion.

Answer 570

delayed distended testicles

Answer 571

Wide local excision

Answer 572

Cavernous sinus syndrome

Answer 573

vesicovaginal fistula

Answer 574

Chest compressions

Answer 575

MRI best, but XR first

Answer 576

Haloperidol

Answer 577

Cavernous sinus

Answer 578

Complete HB

Answer 579

Parietal - hemisensory neglect

Answer 580

cerebello pontine angle thrombosis OR lateral sinus thrombosis

Answer 581

Half it -> 30

Answer 582

PSC | ANCA

Answer 583

Loadsa fluids | Low salt diet

Answer 584

Which is the most appropriate next investigation? A. CT scan abdomen and pelvis B. DEXA scan C. HLA-B27 antigen D. Isotope bone scan E. X-ray lumbar spine Correct Answer(s): E Justification for correct answer(s) Being woken from sleep is a red flag symptom, as is the duration. At this age and with the persistence of symptoms, spinal tenderness and an elevated ESR it is reasonable to perform imaging. Plain X-rays are appropriate initially, although if negative an MR scan would be indicated.

Answer 585

CT would be the most appropriate investigation for a suspected lung cancer.

Answer 586

Correct Answer(s): B Justification for correct answer(s) The cricoid cartilage is a complete ring; pressure on the front is transmitted to the back, and this seals the oesophagus, preventing gastric contents in a patient who is not fasted or has abdominal problems from passing higher up and possibly entering the airway. None of the others are true - in fact, it can make intubation more difficult.

Answer 587

``` Correct Answer(s): E Justification for correct answer(s) The breakthrough dose should be one-sixth of the total daily dose. The current daily morphine dose is 180 mg, hence MST continues at 90 mg 12 hourly and the breakthrough at morphine 30 mg. ```

Answer 588

Correct Answer(s): E Justification for correct answer(s) The most likely diagnosis is vestibular neuronitis as this is a single episode in an 18- year-old. The diagnoses of vestibular migraine and benign positional vertigo would not be considered unless the attacks were recurrent.

Answer 589

Justification for correct answer(s) The intrinsic hand muscle wasting suggests T1. The normal reflexes and normal other arm are against a cord lesion. The sensory loss on the forearm excludes median and ulnar nerve lesions. T1 dermatome is often thought to be higher in the arm medially.

Answer 590

Correct Answer(s): E Justification for correct answer(s) Painful eye with loss of acuity needs urgent ophthalmology assessment.

Answer 591

Correct Answer(s): E Justification for correct answer(s) The clinical picture fits a diagnosis of primary biliary cirrhosis (raised ALP, AMA positive with no evidence of obstruction. There is good evidence that Ursodeoxycholic acid should be prescribed for all patients with this diagnosis. A biopsy is not required to make the diagnosis.

Answer 592

Correct Answer(s): B Justification for correct answer(s) If VF/VT persists after a third shock, resume chest compressions immediately and then give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2 min CPR. As per ALS guidelines 2015.

Answer 593

Correct Answer(s): E Justification for correct answer(s) He has focal onset impaired awareness seizures, the aura implicates one of the temporal lobes.

Answer 594

Rifampicin

High Yield Stuff - FRC Flashcards

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