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Misc Flashcards

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1
Q

Causes of Cushing’s syndrome

A

High ACTH = Pituitary adenoma (Cushing’s disease) OR Ectopic ACTH
Low ACTH = adenoma of adrenal cortex; carcinoma of adrenal cortex; iatrogenic

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2
Q

Cushing’s syndrome Ix

A
  1. Preliminary: overnight dexamethosone suppression test OR 24 hour urinary free cortisol
  2. Confirmation: 48 hour dexamethasone suppression test
  3. Localise lesion: Plasma ACTH + high dose dexamethasone (Cushing’s disease shows response) + imaging (CT chest and adrenals or MRI pituitary)
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3
Q

Claudication with normal pulses

A
  1. Neurogenic
  2. Anaemia
  3. B-blockers
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4
Q

Critical limb ischaemia O/E

A 
6 Ps
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysis (best indicator of danger to limb)
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5
Q

ABPI measurements

A

> 1 normal
0.5-1 intermittent claudication
0.3-0.5 rest pain/critical limb ischaemia
<0.3 gangrene + ulceration

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6
Q

Leriche’s syndrome

A

bilateral buttock pain and erectile impotence due to common iliac disease

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7
Q

A red foot!

A

May have chronic arterial disease with pooling, feel temperature and raise leg to see if fast exsanguination (means it is chronic)

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8
Q

Venous ulcer features

A 
Site = Medial gaiter region of leg
Sloped edges
Lots of exudate
Usually associated with limb oedema
Extra features of venous insufficiency
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9
Q

Extra features of venous insufficiency

A

Varicose veins
DVT
Venous eczema
Haemosiderosis (cayenne pepper petechiae)
Lipodermatosclerosis (scarring of subcutaneous fat)
Atrophie blanche (angular scarring after injury)
Inverted champagne bottle leg

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10
Q

Arterial ulcer feature

A

Site = Feet/toes/ankle
Punched out edges
Painful
with trophic changes and gangrene

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11
Q

Venous ulcer Rx

A

Graduated compression dressing

Antibiotics for any infection

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12
Q

Arterial ulcer Rx

A 
Conservative
Endovascular revascularisation (angioplasty)
Surgical revascularisation eg fem-pop bypass, fem-distal bypass etc
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13
Q

Trendelenburg Tourniquet test

A

Raise leg vertical (if no pain) and empty varicose veins; once empty place tourniquet on upper thigh, ask to stand and see whether veins refill:
If doesn’t fill then sapheno-femoral incompetence
If fills slowly then mix of sapheno-femoral incompetence and perforating veins (that bridge deep and superficial) incompetence
NB can also have sapheno-popliteal incompetence which typically affect short saphenous vein

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14
Q

Sapheno-femoral incompetence test

A

Place finger at SFJ (2cm infero-lateral to pubic tubercle) and get patient to cough, if can feel then positive

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15
Q

Varicose veins warm and tender

A

= superificial phlebitis

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16
Q

Varicose veins Rx

A

Conservative = elastic support hose; weight loss; regular exercise
Injection sclerotherapy = suitable for small varices from perforating veins (not for SFJ incompetence)
Surgery = SFJ ligated or Long saphenous vein stripped; for sapheno-popliteal can ligate the junction (do not strip short saphenous vein as can damage sural nerve)

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17
Q

Post-thrombotic syndrome

A

Chronic venous insufficiency secondary to DVT

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18
Q

Intradermal lump (impossible to slide skin over)

A

Sebaceous cyst (punctum)
Abscess
Dermoid cyst
Granuloma

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19
Q

Subcutaneous lumps (skin can slide over)

A

Lipoma (smooth and fluctuant)
Ganglion (moves with tendon)
Neurofibroma
Lymph node

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20
Q

Neurofibromatosis Type 1 (AD)

A 
aka von Recklinghausen's disease: CATCHES
Cafe au lait (>6)
Axillary freckling
Tumours of nervous system
Cutaneous neurofibromata
HTN
Eye features (lisch nodules)
Scoliosis
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21
Q

Neurofibromatosis Type 2 (AD)

A

Bilateral acoustic neuromas (key)
Other tumours of nervous system
Fewer cutaneous features

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22
Q

Sloping edge

A

Venous ulcer

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23
Q

Punched out edge

A

Arterial ulcer

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24
Q

Undetermined edge

A

TB, pressure necrosis

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25
Rolling edge
BCC
26
Everted edge
SCC
27
Erythema nodosum DDx
``` Painful, purple raised lesion on shins Idiopathic Sarcoidosis Infection (strep, TB) IBD Drugs (Sulphonamides) Malignancy (lymphoma, leukaemia) Pregnancy ```
28
Melanoma
``` ABCDE Asymmetry of shape Border irregular Colour variation Diameter >6mm or increasing Elevation ```
29
Hernia
Protusion of whole or part of viscus through an opening in the wall of its containing cavity into a place where it is not normally found
30
Direct inguinal hernia
Through weak point in posterior wall of inguinal canal (Hesselbach's triangle)
31
Indirect inguinal hernia
Through internal inguinal ring down inguinal canal and out of external inguinal ring
32
Femoral vs inguinal
Femoral inferior to pubic tubercle and usually not reducible as usually incarcerated with high likelihood to strangulate; direct moderate risk of incarceration and indirect = low risk Femoral needs urgent surgery
33
Borders of Hesselbach's triangle
Inferior epigastric artery Inguinal ligament Linea semilunaris (lateral border of rectus muscle) Within = direct hernia (so inferior to inferior epigastric artery)
34
Hernia Repair
``` Open mesh repair Open suture repair Laparoscopic: 1. Total extraperitoneal procedure (TEP) 2. Trans-abdominal procedure (TAP) ```
35
Richter's hernia
Only part of bowel herniates meaning strangulation can occur without obstruction. More common in femoral hernia
36
Deep ring
Opens at midpoint of inguinal ligament into transversalis fascia
37
Superficial ring
In aponeurosis of external oblique superior to pubic tubercle
38
Inguinal canal
Roof = internal oblique Floor = inguinal ligament Back wall = transversalis fascia Front wall = external oblique
39
Mid-inguinal point
Midpoint of ASIS and pubic symphysis | Where femoral artery crosses
40
Midpoint of inguinal ligament
MIdpoint of ASIS and pubic tubercle
41
Pulsation in neck lump
Carotid body tumour
42
Neck cysts (transilluminate)
Thyroglossal, branchial, cystic hygroma
43
Pembreton's test
Raise hands slowly and watch for facial plethora (venous compression, SVCO) and ask to take a deep breath in to see if stridor (tracheal compression)
44
Classic Grave's features
``` Goitre Specific to Graves: Exopthalmos Ophthalmaplegia Pretibial myxoedema Thyroid acropathy ```
45
Signs of active disease
AF Tremor Lid lag Thyroid bruit
46
End colostomy
Usually left with 1 lumen, doesn't spout and hard stool Can be from Abdomino-peroneal (AP) resection for low rectal tumour (no back passage) or Hartmann's procedure for higher tumour (have back passage)
47
End ileostomy
Usually right, 1 lumen, spouting and soft/liquid stool | For UC or FAP, panproctocolectomy
48
Loop ileostomy (temporary stoma)
Usually right, 2 lumens, spout and soft/liquid stool | To defunction obstruction or anus is bad Crohn's
49
Loop colostomy (temporary stoma)
Upper abdomen, 2 lumens, not spouting and hard stool
50
Stoma complications
``` Haemorrhage Necrosis Prolapse Retraction Obstruction Parastoma hernia High output ```
51
Spigelian hernia
Through semilunaris at upper border of rectus sheath | High risk of incarceration so always repaired
52
Epigastric hernia
Through linea alba at epigastric region
53
True umbilical herna (congenital)
In neonates | Through umbilicus and usually resolves in early life
54
Paraumbilical hernia (acquired)
Through linea alba usually above umbilicus, often irreducible and always repaired as high chance of incarceration
55
Surgical emphysema on X-Ray of anterior chest wall
If the anterior chest wall is affected air can outline the pectoralis major muscle, giving rise to the 'ginkgo leaf' sign
56
Goodsall's rule
States that if the perianal skin opening is posterior to the transverse anal line, the fistulous tract will open into the anal canal in the midline posteriorly, sometimes taking a curvilinear course. A perianal skin opening anterior to the transverse anal line is usually associated with a radial fistulous tract Rule not applicable to fistulas >2.5cm from anal verge
57
Haemorrhoids seen at
3, 7 and 11 o'clock
58
Proctitis causes
Crohn's, UC and C. diff
59
Anal fissure seen at
Location: midline 6 (posterior midline 90%) & 12 o'clock position. Distal to the dentate line Chronic fissure > 6/52: triad: Ulcer, sentinel pile, enlarged anal papillae
60
Dentate (pectinate) line significance
Divides upper 2/3 (columnar) and lower 1/3 (squamous) of anus which distinguishes: [] iliac and superficial inguinal lymph drainage [] superior and middle + inferior rectal arteries [] internal and external haemorrhoids (makes sense if you think about arteries)
61
Medication for PAD
naftidrofuryl oxalate OR cilostazol Remember to prescribe clopidogrel (1st line now) and statin
62
Cavernous sinus syndrome
Most commonly caused by cavernous sinus tumours (like nasopharyngeal). Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner's syndrome.
63
Co-presciption with goserelin for prostate cancer
Cyproterone acetate as this avoids the flare up of prostate symptoms
64
Homonymous quadrantanopias
PITS: Parietal=Inferior Temporal=Superior Left pathology ==> right sided lesion and vice versa In practice though most homonymous quadrantanopias are caused by occipital lesions
65
Bitemporal hemianopia
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
66
Tumour markers: S-100
Melanoma | Schwannoma
67
Tumour markers: bombesin
Small Cell lung cancer gastric cancer neuroblastoma
68
Gingival hyperplasia causes
phenytoin, ciclosporin, calcium channel blockers and AML

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