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DPD 2020 > interactive cases in general internal medicine 5 > Flashcards

interactive cases in general internal medicine 5 Flashcards

1
Q

24 yr old man • Breathlessness • Facial swelling • After having a Chinese takeaway

What is the first step in management?

A. IM adrenaline

B. IV adrenaline

C. IM hydrocortisone

D. IV hydrocortisone

E. IV fluids

A

IM adrenaline

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2
Q

• 45 yr old man • Cough • Breathlessness • Recent travel • O/E: coarse crepitations & bronchial breathing • Hyponatraemia • Deranged LFTs

What antibiotic would you prescribe in addition to amoxicillin?

A. Cefuroxime

B. Clarithromycin

C. Co-amoxiclav

D. Tazocin

E. Vancomycin

A

Clarithromycin

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3
Q

What atypical organisms that cause pneumonia?

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophila

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4
Q

50 yr old man • Dyspepsia • Wt loss • Hb: 70 • MCV: 70

What test would you request?

A. Abdominal CT

B. Abdominal USS

C. Erect CXR

D. Colonoscopy

E. OGD (gastroscopy)

A

OGD

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5
Q

What investigations do you do in someone that presents with microcytic anaemia?

A

Haematinics

Coeliac screen* (TTG Ab) and diagnosis confirmed with duodenal atrophy

  • Remember red flags
  • Top & Tail
  • Order depends on upper/lower GI symptoms
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6
Q

What would you see on a duodenal biopsy?

A

villous atrophy

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7
Q

70 year old man • Bloody diarrhoea • Stool micro & culture: -ve • Stool C. diff toxin: -ve

What is the most likely diagnosis?

A. Infective colitis

B. Ischaemic colitis

C. Ulcerative colitis

D. Appendicitis

E. Gastroenteritis

A

B. Ischaemic colitis

since he is old

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8
Q

40 yr old man • Palpitations • Started 4 hours ago • ECG: AF

How would you treat him?

A. Adenosine

B. Amiodarone

C. Digoxin

D. Metoprolol

E. DC cardioversion

A

amiodarone

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9
Q

Direction of flow in the veins below the umbilicus is towards the legs

What is the name of this clinical sign?

A. Trousseau’s sign

B. Virchow’s node

C. Caput medusae

D. Troisier’s sign

E. Grey Turner

A

caput medusea

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10
Q

What are complications of portal hypertension?

A

Encephalopathy

Ascites

Spontaneous bacterial peritonitis

Variceal bleed

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11
Q

20 year old boy • Recent diarrhoea • Malaise • Hb: 70 • Cr: 300

What do the arrows show?

A. Codocytes (target cell) B

. Eliptocytes

C. Lymphocytes

D. Schistocyte (red cell fragment)

E. Spherocytes

A

schistocytes

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12
Q

What are the 3 MAHA?

What do they present with?

A

DIC: low platelet and fibrinogen, high PT and APPT and D-Dimer

HUS: Haemolysis (low HB, high bilirubin), Uraemia, low platelets

TTP: HUS+ fever+ neurological manifestations

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13
Q

What are the presenting features of DIC?

A

DIC:

  • low platelet and fibrinogen
  • high PT and APPT
  • high D-Dimer/ fibrin degradation product
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14
Q

What are the presenting features of HUS?

A

HUS:

  • Haemolysis (low HB, high bilirubin)
  • Uraemia
  • low platelets
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15
Q

What are presenting feature of TTP (Thrombotic Thrombocytopenic Purpura)

A

HUS + fever + neurological manifestations

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16
Q

What are causes of haemolytic anaemia?

A

Hereditary

  • Red cell membrane (hereditary spherocytosis)
  • Enzyme deficiency (G6PD deficiency)
  • Haemoglobinopathy (Sickle cell disease, Thalassaemias)

Acquired

  • Autoimmune
  • Drugs
  • Infection
  • MAHA (DIC, TTB, HUS)
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17
Q

What does the arrow show?

A. Adhesions

B. Haustra

C. Large bowel

D. Stomach

E. Valvulae conniventes

A

E. Valvulae conniventes

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18
Q

What part of the bowel i this?

A

small bowel

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19
Q

What part of the bowel is this?

A

large bowel

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20
Q

60 yr old man • Confused • Cough • No postural hypotension • Na+ : 120 • K + : 4.0 • TFTs: normal • SST: normal • Urine Na+ : 40 • Urine osmolality: 400

What test would you request next?

A. Brain MRI

B. CT Abdomen

C. CXR

D. Lung function tests

E. OGD

A

hyponatraemia

CXR- cough (lung cancer)

21
Q

What is the algorythm you go through to identify the cause of hyponatraemia?

What are the individual causes?

What would be the investigations you want to do?

22
Q

WHat are rare causes of hyponatraemia that are not due to high ADH?

A

Excess water intake

Sodium-free irrigation solutions (e.g. used in TURP)

23
Q

What are causes of SIADH?

A

CNS pathology

Lung pathology

Drugs (SSRI, TCA, opiates, PPIs, carbamazepine)

Tumours

24
Q

35 yr old man • Sweating • Weight loss

What is the name of this sign?

A. Beau’s lines

B. Nail pitting

C. Koilonychia

D. Onycholysis

E. Leukonychia

A

onycholysis

25
What are causes of onycholysis?
Trauma Thyrotoxicosis Fungal infection Psoriasis
26
20 year old woman • Abdominal pain • Vomiting • Type 1 diabetes • CBG: 20 • Venous pH: 7.20 What is the most appropriate next step? A. Capillary ketone B. FBC C. HbA1c D. LFTs E. CRP
A. Capillary ketone
27
What are the complications of Diabetes?
* **Microvascular** * Retinopathy * Nephropathy * Neuropathy (foot ulcers) * **Macrovascular** * MI/Stroke/PVD * **Metabolic** * DKA/HHS/Hypoglycaemia
28
26 year old man • Chest pain • Smokes 5/day • Auscultation: ‘scratching sound’ What diagnosis is supported by his ECG? A. Anteriolateral MI B. Inferior MI C. NSTEMI D. Pericarditis E. Posterior MI
D. Pericarditis
29
60 yr old woman • Collapse • BP: 120/70 mmHg • No postural drop • HS: S1+S2+ ESM What does her ECG suggest? A. Left atrial hypertrophy B. Left ventricular hypertrophy C. Right atrial hypertrophy D. Right ventricular hypertrophy E. NAD
B. Left ventricular hypertrophy aortic stenosis- left ventricle needs to work harder
30
40 year old man • Loin pain • CRP: normal • Urinalysis: blood ++ What investigation would you request? A. Abdominal X-ray B. Abdominal USS C. CT KUB D. CT with contrast E. MR Angiogram
C. CT KUB
31
What does this show?
CT KUB Pelvi-ureteric junction obstruction Calculus within the dilated renal pelvis
32
50 year old man • Hypercalcaemia • Low PTH • Backache • Normal ALP What is the most likely diagnosis? A. Bone metastases B. Multiple myeloma C. Osteoporosis D. Primary hyperparathyroidism E. Secondary hyperparathyroidism
B. Multiple myeloma
33
Where is ALP produced and in which pathologies is it elevated?
Sources: liver & bone (osteoblasts) High in obstructive liver disease & bone disease (malignancy, fracture, Paget’s disease)
34
What is the ALP level in myeloma?
normal becuase Plasma cells suppress osteoblasts
35
What are the clinical features of multiple myeloma's?
CRAB * **C**alcium * **R**enal impairment * **A**naemia * **B**one
36
23 yr old woman • Breast lump • 1cm • Smooth mobile What is the most likely diagnosis? A. Basal cell carcinoma B. Ductal carcinoma C. Fat necrosis D. Fibroadenoma E. Galactocele
D. Fibroadenoma
37
60-year-old man • Cough • Haemoptysis **What does his chest X-ray show?** A. Cavitating lesion B. Interstitial shadowing C. Pleural effusion D. Reticulonodular shadowing E. Bilateral hilar lymphadenopathy
A. Cavitating lesion
38
What are causes for this?
CAVITATING LESION * Infection * TB * Staph * Klebsiella (e.g. alcoholics) * Inflammation (RA) * Infarction (PE) * Malignancy
39
35 yr old woman • Ankle oedema • Recent Echocardiogram: NAD • U&Es: normal • ALT, AST & ALP: normal • Albumin: 15 **What test would you order next?** A. Coronary angiogram B. Renal USS C. Troponin D. Urinalysis E. Repeat LFTs
D. Urinalysis
40
What is the triad of nephrotic syndrome? What is the pathophysiology?
**Proteinura\> 3g/day • Hypoalbuminaemia • Oedema** increased permeability of GBM to protein
41
30 year old man • Recurrent GI & nose bleeds • Facial examination shows: **What is the diagnosis?** A. Acromegaly B. Cirrhosis C. Hereditary telangiecstasia D. Peutz-Jegher syndrome E. Systemic sclerosis
C. Hereditary telangiecstasia
42
What are features of Hereditary Haemorrhagic Telangiecstasia? What is the inheritance pattern?
**Autosomal dominant** **Abnormal blood vessels in** * Skin * Mucous membranes * lungs * Liver * brain
43
Na+ : 120 K + : 5 Short Synacthen test 0 min cortisol: 100 30 min cortisol: 200 **select the single most likely diagnosis from the list.** A. Adrenal insufficiency B. Cushing’s syndrome C. Graves’ disease D. Myxoedema (hypothyroidism) E. Premature ovarian failure F. Primary hyperaldosteronism G. Prolactinoma H. Multinodular goitre I. Thyroiditis
adrenal insufficiency
44
PRL: 1000 (high) IGF-1: 100 (high) OGTT: failure of GH suppression **select the single most likely diagnosis from the list** A. Acromegaly B. Adrenal insufficiency C. Cushing’s syndrome D. Graves’ disease E. Myxoedema (hypothyroidism) F. Premature ovarian failure G. Primary hyperaldosteronism H. Prolactinoma I. Multinodular goitre J. Thyroiditis
acromegaly
45
Oestradiol: 50 FSH: 40 (high) LH: 35 (high) PRL: 200 **select the single most likely diagnosis from the list** A. Acromegaly B. Adrenal insufficiency C. Cushing’s syndrome D. Graves’ disease E. Myxoedema (hypothyroidism) F. Premature ovarian insufficiency G. Primary hyperaldosteronism H. Prolactinoma I. Multinodular goitre J. Thyroiditis
premature ovarian insufficiency
46
Free T4: 5 TSH: 60 PRL: 700 **select the single most likely diagnosis from the list** A. Acromegaly B. Adrenal insufficiency C. Cushing’s syndrome D. Graves’ disease E. Myxoedema (hypothyroidism) F. Premature ovarian failure G. Primary hyperaldosteronism H. Prolactinoma I. Multinodular goitre J. Thyroiditis
hypothyroidsim
47
Free T4: 12 TSH: 1.0 LH: 1 PRL: 300 Cortisol: 500 **select the single most likely diagnosis from the list.** A. Acromegaly B. Adrenal insufficiency C. Cushing’s syndrome D. Graves’ disease E. Myxoedema (hypothyroidism) F. Premature ovarian failure G. Primary hyperaldosteronism H. Prolactinoma I. Multinodular goitre J. Thyroiditis
multinodular goitre normal endocrine
48
PRL: 10,000 (high) Testosterone: 6 (low) LH \<1 (low) FSH \<1 (low) select the single most likely diagnosis from the list A. Acromegaly B. Adrenal insufficiency C. Cushing’s syndrome D. Graves’ disease E. Myxoedema (hypothyroidism) F. Premature ovarian failure G. Primary hyperaldosteronism H. Prolactinoma I. Multinodular goitre J. Thyroiditis
prolactinoma

DPD 2020 (48 decks)

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