January Flashcards
(119 cards)
1
Q
What score do we use to assess need for anticoagulant medication?
A
CHADVASC HASBLED CHADVASC gives risk of stroke HASBLED risk of bleeding If risk of bleeding higher do not start anticoagulant
2
Q
What’s the carina?
A
Bifurcation into right and left bronchus
3
Q
Side effects of prolonged steroid use
A
Cushingoid Bones - osteoporosis Skin - thinning and bruising Weight gain Glucose - diabetes Hypertension Psychosis
4
Q
Atrial fibrillation increases the risk of what condition
A
Stroke
5
Q
Causes of loss of consciousness
A
Arrhythmias Head injury Hypercapnia Hypoglycaemia Hypotension Stroke
6
Q
Symptoms of Hypoglycaemia
A
Anxious Tired Hunger Sweating Headache Nausea Coma
7
Q
Which vessel is damaged if patient has following symptoms - Contralateral hemiplegia, hemisensory loss, homonymous hemianopia, aphasia?
A
Middle Cerebral artery
8
Q
Which vessel is damaged if patient displays following symptoms - Contralateral weakness and sensory loss in the leg more than in the arm.
Urinary incontinence, confusion and behavioural disturbances are common.?
A
Anterior cerebral artery
9
Q
Which vessel is damaged if patient displays following symptoms - Contralateral homonymous hemianopia, agnosia?
A
Posterior cerebral artery
10
Q
What symptoms are caused by a lacunar stroke?
A
Pure motor
Pure sensory
Ataxia
Dysarthria clumsy hand syndrome
11
Q
What investigations required for stroke?
A
Non-contrast CT head MRI head Carotid doppler ECHO ECG
12
Q
TPA is given under 4.5 hours when which condition has been excluded in stroke?
A
Haemorrhagic stroke
13
Q
Risk factors for stroke?
A
Hypertension Diabetes Smoking Lipids Alcohol excess
14
Q
What is the term given when someone is unable to recognise and interpret visual information?
A
Visual agnosia
15
Q
What is the term given when someone is unable to recognise objects, smells, shapes and sounds?
A
Sensory agnosia
16
Q
What term is given to the denial of hemiplegia?
A
Anosagnosia
17
Q
What term is given to the inability to recognise your own and others faces?
A
Prosopagnosia
18
Q
Signs and symptoms of subarachnoid haemorrhage?
A
Thunderclap headache Loss of consciousness Photophobia Phonophobia Neck stiffness - nuchal rigidity
19
Q
3 causes of aneurysmal subarachnoid haemorrhage
A
Trauma
Ehler Danlos
Polycystic kidney disease
20
Q
Investigations for SAH?
A
CT head
Spinal tap - if CT head negative
21
Q
Cause of SAH
A
Rupture of berry aneurysm
Rupture of arteriovenous malformation
Head injury
22
Q
Where do intracranial aneurysms usually occur?
A
In circle of willis where arteries connect
40% - at junction of anterior cerebral and anterior communicating
23
Q
Complications of subarachnoid haemorrhage
A
Cardiogenic shock Vasospasm Hydrocephalus Rebleeding Seizure Infection
24
Q
How are SAH graded?
A
World Federation of Neurological Societies (WFNS) scale which uses GCS and motor deficits to grade the severity of the sub arachnoid haemorrhage
25
What is included in the WFNS scale to grade severity of SAH?
GCS
| Motor deficits
26
3 points of HHS
Hypovolaemia
Hyperglycaemia
Hyperosmolality
27
How is SAH treated?
```
Treatment of aneurysm
Coiling of aneurysm
Craniotomy and clipping of aneurysm
Nimodipine - for vasospasm
HHH therapy - used to prevent or treat cerebral vasospasm after SAH
Hypervolaemia
Haemodilution
Hypertension
```
28
What is meckel's diverticulum?
Congenital diverticulum of small intestine
29
What type of cells are found in meckel's diverticulum?
Ectopic ileal, gastric or pancreatic mucosa
30
Where does meckel's diverticulum occur?
2 feet (60cm) from ileocaecal valve
31
What percentage of the population have meckel's diverticulum?
2%
32
What is meckel's diverticulum a remnant of?
omphalomesenteric duct (vitellomesenteric duct) - vitelline duct: joins yolk sac to midgut in foetus
33
Presenting symptoms of meckel's diverticulum?
Abdominal pain; mimics appendicitis
Rectal bleeding
Intestinal obstruction
34
How does intestinal obstruction occur in meckel's diverticulum?
Secondary to volvulus, omphalomesenteric band and intussusception
35
What is the most common cause of painless massive GI bleeding in children between ages 1 and 2?
Meckel's diverticulum
36
When does the attachment between the vitellointestinal duct and yolk sac disappear?
6 weeks
37
Management of meckel's diverticulum
Surgery - wedge excision or formal small bowel resection and anastomosis
38
Which plexuses fail to develop in Hirschspung's disease?
Auerbach and Meissner parasympathetic
39
Risk factors for hirschsprung's disease
Male
Down's Syndrome
Family history
40
A defect in the anterior abdominal wall leading to protruding bowel is known as
Gastroschisis
41
Hypertrophy of the pyloric muscle leads to
Pyloric stenosis
42
Telescoping of the ileocolic junction occurs in which disease
Intussusception
43
Symptoms of intussusception
Bilious vomiting
| Red currant jelly like stool
44
Treatment for intussusception
Air enema
45
What is Grey Turner's sign?
Retroperitoneal haemorrhage leading to blue discolouration of the flanks.
46
Name the organs which are retroperitoneal
S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: oesophagus
R: rectum
47
Which part of the pancreas is intraperitoneal?
Tail
48
Barrett's oesophagus increases the risk of what disease?
Oesophageal adenocarcinoma
49
Which type of cell present in a histological sample taken from the lower oesophagus is diagnostic of barrett's?
Goblet cell
50
Risk factors for barrett's
Male
GORD
Smoker
Centra obesity
51
Management for barrett's oesophagus
Endoscopy for surveillance and biopsies every 3-5 years
| Proton pump inhibitors
52
Endoscopic intervention used to treat Barrett's oesophagus?
endoscopic mucosal resection
| radiofrequency ablation
53
Which monoclonal antibody targets Toxin b of C difficile?
Bezlotoxumab
54
Which type of organism is Clostridium difficile?
Gram poositive bacillus
55
Which syndrome is caused by exotoxin released by C difficile?
Pseudomembranous colitis
56
How does c difficile infection tend to occur?
Normal gut flora suppressed by antibiotics
57
Which antibiotic is associated in causing c difficile?
Clindamycin
58
Which drugs other than clindamycin are associated with c diff?
Second and third gen cephalosporins
| PPIs
59
Signs and symptoms of c difficile
Diarrhoea
Abdominal pain
Raised WCC
Toxic megacolon if severe
60
How is c difficile diagnosed?
Presenting signs and symptoms with history
| Detection of CD toxin in the stool
61
First line treatment for c difficile
Metronidazole
62
Second line treatment for c difficile
Vancomycin
63
Life threatening c difficile is treated with which drug combination?
Oral vancomycin and IV metronidazole
64
Complications of diverticular disease
```
Diverticular stricture leading to obstruction
Colovesical fistula
Colovaginal fistula
Haemorrhage
Peritonitis
Perforation and abscess
```
65
Risk factors for formation of diverticulum
```
Age
Low dietary fibre intake
Smoking
Obesity
Family history
NSAIDS
```
66
Features of diverticular disease
Intermittent lower abdominal pain, colicky, relieved by defecation
Change in bowel habit
Nausea
Flatulence
67
Features of acute diverticulitis
```
Sharp left iliac fossa pain
Worse on movement
Decreased appetite
Pyrexia
Nausea
```
68
General causes of lower abdominal pain
```
Diverticular disease
Bowel cancer
Inflammatory bowel disease
Gynaecological
Renal stones
Mesenteric ischaemia
```
69
Investigations for Diverticular disease
Bloods
CT abdopelvis
Barium enema
70
How does gastroschisis differ from exomphalos?
Both abdominal wall defects leading to protusion of contents
Contents held in amniotic sac in exomphalos
Exomphalos also associated with cardiac (cardiomegaly) and kidney (cysts) conditions
Exomphalos occurs at base of insertion of umbilical cord
Gastroschisis occurs lateral to umbilical cord
71
When do abdominal contents normally protrude in development?
Six weeks
| Return by the twelth week
72
Foetal anomaly scan showing exomphalos and enlarged liver is indicative of which condition?
Beckwith-wiedemann syndrome
73
Features of Beckwith-wiedemann syndrome?
Overgrowth symptoms - large for gestational age, macrosomia, macroglossia, organomegaly and abdominal wall defects (exomphalos, umbilical hernia).
Blood sugar issues - neonatal hypoglycaemia, hyperinsulinism
Increased risk of childhood cancers - Wilm's tumour, hepatoblastoma
74
What is Behcet's disease?
Inflammatory disorder causing genital sores, uveitis and arthritis
Can't pee, can't see, can't climb a tree
75
What is Dandy-walker syndrome?
Failure of growth or abscence of central part of cerebellum
76
Which mutation is a risk factor for a desmoid tumour?
APC
77
In which group of patients do desmoid tumours most commonly occur?
Women in the rectus abdominis after childbirth
78
How are desmoid tumours treated?
Surgical resection
79
Which 2 structures are most likely to be penetrated in peptic ulcer disease?
Posterior medial wall of second part of the duodenum
| Into the gastroduodenal artery
80
What is a complication of peptic ulcer disease?
GI Bleed leading to Shock
81
How does a patient present with shock?
Low blood pressure
Sweating
Collapse
82
What is the most common cause of peptic ulcer disease?
Bleeding
83
Most common presenting symptoms of peptic ulcer disease?
Haematemesis
Melaena
Hypotension
Tachycardia
84
Management of peptic ulcer disease
```
ABCDE approach
PPIs via IV
Endoscopic intervention
FAILURE OF FIRST LINE
urgent interventional angiography with transarterial embolization or
surgery
```
85
What is the method of inheritance of Gilbert's syndrome?
Autosomal recessive
86
Which deficiency is present in Gilbert's syndrome?
UDP glucoronosyltransferase
87
What is the prevalence of Gilbert's syndrome>
1-2%
88
What are the features of Gilbert's syndrome?
Unconjugated Hyperbilirubinaemia
| Jaundice
89
What does unconjugated hyperbilirubinaemia indicate?
Bilirubin not present in the urine
90
When might someone experience jaundice if they have Gilbert's syndrome?
In illness
Exercise
Fasting
91
What is the treatment for Gilbert's?
No management
92
What type of epithelium lines the oesophagus?
Stratified squamous epithelium
93
Define metaplasia
Reversible change of differentiated cells to another ccell type
94
What type of metaplasia can smoking cause and what is the name given to this?
Ciliated columnar to simple squamous - Schistosomiasis
95
What is the acute treatment of variceal haemorrhage?
ABC
Clotting - FFP, Vitamin K
Vasoactive reagents - terlipressin, octreotide
Endoscopic variceal band ligation
Endoscopic sclerotherapy
If both methods fail - TIPP - Transjugular Intrahepatic Portosystemic Shunt
96
Which drug should be given to a patient with cirrhosis in acute variceal bleeding to reduce mortality?
Antibiotics - quinolones
97
What is the prophylactic treatment of variceal bleeding?
Endoscopic band ligation - particularly to patient with cirrhosis
Propanolol
98
What kind of drug is propanolol and why is it used in the prophylaxis of variceal bleeds?
Non-cardioselective B blocker
| Causes splanchnic vasoconstriction - reduces portal flow
99
Which drug can cause oligospermia in men?
Sulfasalzine
100
What are the indications for sulfasalazine?
Crohns
Ulcerative colitis
Rheumatoid arthritis
101
Which vein is commonly harvested for CABG?
Great saphenous vein
102
Which nerve is prone to damage when harvesting vessel for CABG?
Saphenous nerve
103
What is carcinoid syndrome?
Occurs when metastases present in the liver - release serotonin
Also can occur in lung carcinoid
104
Features of a carcinoid tumour
```
Flushing
Diarrhoea
Bronchospasm
Hypotension
Right vavular stenosis
ACTH and GHRH secretion
Pellagra - inflamed skin, diarrhea, dementia, and sores in the mouth
```
105
ACTH and GHRH secretion as seen in carcinoid syndrome can result in what condition?
Cushing's syndrome
106
investigations for carcinoid syndrome?
Urinary 5 HIAA
| Plasma chromogranin A
107
Management of carcinoid syndrome
somatostatin analogues e.g. octreotide
| diarrhoea: cyproheptadine may help
108
Which type of drug is metoclopramide and what is its action?
Antiemetic - D2 receptor antagonist
| Metoclopramide functions both at the chemoreceptor trigger zone and on 5-HT receptors in the GI tract
109
Indications of metoclopramide
Nausea
Migraine
GORD
110
Adverse effects of metoclopramide
extrapyramidal effects: oculogyric crisis. This is particularly a problem in children and young adults
hyperprolactinaemia
tardive dyskinesia
parkinsonism
111
Symptoms of small bowel obstruction
Vomiting, severe abdominal pain and abdominal distension
112
Sign on Abdominal X ray in cholecystoenteric fistula
Air in the gallbladder and biliary tree on AXR is most likely due to cholecystoenteric fistula
Pneumobilia
113
What needs to be checked before prescribing a biologic - eg infliximab for Crohns?
Interferon gamma release assay - TB
114
What is the most common site affected in ischaemic colitis?
The splenic flexure is a watershed area for arterial supply from the superior and inferior mesenteric artery, and is the location most susceptible to ischaemic colitis.
Sigmoid - 2nd most affected
115
What is the typical presentation of acute mesenteric ischaemia?
Severe, sudden onset, constant abdominal pain
Diarrhoea
Out of keeping with physical examination findings
116
What condition is a risk factor for acute mesenteric ischaemia?
Atrial fibrillation
117
Which other conditions can result in raised troponin?
```
Pulmonary embolism
Myocarditis
Arrhythmia
Heart failure
Sepsis
Renal failure
Aortic dissection
```
118
Mechanism of methotrexate
Folic acid antagonist - deprives cells of functional folic acid
119
What monitoring is required with methotrexate?
Lowers the blood count
| Remedy with fullinic acid????
