Mixed Flashcards
Remember me (351 cards)
1
Q
Bloody diarrhoea causing organisms
A
Bac: E coli, Campylobacter, Salmonella, Shigella, Clostridium
Viruses: rotavirus
Parasites: Giardia, Entamoeba
2
Q
4 histological layers of colon
A
Mucosa: epithelium + lamina propria + muscularis mucosa
Sub-muscosa
Muscularis propria
Adventitia
3
Q
Pancreatic enzymes
A
Amylase: starch
Lipase: lipids
Chymotrypsin, trypsin, elastase: proteins
4
Q
Role of cholesterol
A
Component of cell membranes, precursor of steroid hormones, precursor of bile acids, component of plasma lipoproteins
5
Q
Why would ferritin be high if iron is low?
A
Ferritin= acute phase reactant of liver, elevated in times of illness or inflammation
6
Q
3 bands of colon that longitudinal muscle fibres of muscular external are arranged into
A
taeniae coli
7
Q
Venous ulcer typical appearance
A
Gaiter region- lower 1/3 of leg
Common over medial malleolus
May form Majrjolin’s ulcer (squamous cell carcinoma) if left
8
Q
Basal cell carcinoma
A
May present as ulcer/lesion on sun exposed places
Starts as slow growing nodule that may be itchy/bleeds
Necrosis of centre leaves rolled edge
No lymphadenopathy + no mets
9
Q
Squamous cell carcinoma
A
Bleeding more common + lymphadenopathy
Characteristic everted edge
10
Q
Ischaemic ulcers
A
Very painful
Deeper than venous ulcers -> can penetrate down to the bone
Surrounding area cold as result of ischaemia
11
Q
Neuropathic ulcers
A
Impaired sensation
DM most common cause
Characteristically painless
12
Q
Ankle brachial pressure index
A
> 0.9 normal
0.6-0.9 claudication but no rest pain
<0.6 rest pain, critical ischaemia
13
Q
Big surgical risk factors for PE
A
Pelvic + orthopaedic surgery
14
Q
Bladder cancer presentation
A
Painless haematuria
Males
50-70yrs old
15
Q
UK incidence of bladder cancer
A
1/6000 a year
16
Q
Dilated tapering oesophagus on Ba swallow
A
Achalasia
17
Q
Ddx of abdo cases
A
Abdo pain Abdo distention Change in bowel habits GI bleed Jaundice Ascites
18
Q
Constant gastro pain indicates
A
Inflammation
19
Q
Colicky gastro pain indicates
A
Obstruction
20
Q
Enzyme reduced in chronic pancreatitis
A
Faecal elastase
21
Q
5 causes of abdo distension
A
Fluid Flatus Faeces Fat Fetus
22
Q
What may cause Flatus and what signs/Hx might you be looking for?
A
Obstruction - N&V - Bowels not opening - High pitched tinkling sounds Look for previous surgery eg adhesions Tender irreducible hernia in groin
23
Q
According to old classification, what are the two types of ascites and what may cause them
A
Transudate
- Cirrhosis, Cardiac failure, Nephrotic syndrome ie the failures
Exudate
- Malignancy (abdo, pelvic, peritoneal mesothelioma)
- Infection (TB, myogenic)
- Budd-chiari syndrome (hepatic vein thrombosis)
24
Q
Low albumin gradient (ascites)
A
Serum-ascites albumin gradient <11g/L
- nephrotic syndrome
- TB
- pancreatitis (acute, chronic)
- cancer
- peritonitis
25
High albumin gradient (ascites)
Serum-ascites albumin gradient >11g/L
- Portal HTN
- Constrictive pericarditis
- Cardiac failure (acute, chronic)
- Cirrhosis
26
Pale stools is caused by lack of
stercobilinogen
27
Cause of decreased conjugation of bilirubin
Gilberts syndrome
28
Causes of post-hepatic jaundice
Gallstones in GBD
Stricture
Cancer of head of pancreas
29
What is Trousseau's sign of malignancy?
Superficial thrombophlebitis
| -> Pancreatic cancer
30
Marker for pancreatic cancer
CA19-9
31
Possible differentials for bloody diarrhoea
Infective colitis
- C -> Campylobacter
- H -> Haemorrhagic E Coli
- E -> Entamoeba histolytica
- S -> Salmonella
- S -> Shigella
Inflammatory colitis
- In young
- Extra-GI manifestations: episcleritis, scleritis, uveitis, erythema nodosum, pyoderma gangrenosum
Ischaemic colitis
- In elderly
Diverticulitis
Malignancy
32
Management of acute GI bleed
```
ABC
IV access
Fluids
G&S, Cross-match (X-match)
OGD: find underlying cause
If variceal bleed treat with:
-> Antibiotics (Tazosin to treat any bac translocation)
-> Terlipressin (causes splanchnic vasoconstriction)
```
33
Terlipressin causes
splanchnic vasoconstriction
| - use in variceal bleed
34
How to manage acute abdo?
Fluids
NBM + NG tube
```
TRIPLE A:
Analgesia
Anti-emetics
Anti-biotics:
--> cover anaerobes (metronidazole)
--> Cef + Met
```
Monitor vitals + Urine output
35
How to manage ascites
- Diuretics (furosemide/spiro)
- Fluid restriction if Na <120
- Weight management (daily)
- Dietary Na restriction
- Therapeutic paracentesis
- If neutrophils >250 then SBP so ANTIBIOTICS
36
Investigations for Jaundice
```
Bloods
- FBC/LFTs/CRP
Abdo USS
- Gallstones better seen after pt has fasted due to distended, bile filled gallbladder
- Look for duct dilatation
```
37
Dysphagia + weight loss investigations
Bloods
| OGD
38
PR bleed + weight loss
Colonoscopy
39
How to manage encephalopathy
Lactulose
Phosphate enemas
Avoid sedation
Treat infections
Exclude a GI bleed
Treat cause
40
Anastamotic leak (cause + presentation)
Post-op complication
- Diffuse abdo tenderness (due to peritonitis)
- Guarding/tenderness
- Hypotensive/tachycardic
41
Pelvic abscess presentation
eg due to post-appendectomy
- Pain
- Fever
- Sweats
- Mucus in diarrhoea
42
Recurrent abdo pain, bloating
Improves with defecation
Change in the frequency/form of stool
Suggests?
IBS
| there will be no anaemia, weight loss, PR bleeding or nocturnal symptoms
43
Treatment of IBS
Anti-spasmodics: for abdo pain
If constipation: laxatives
If diarrhoea: anti-diarrhoeals eg loperamide
44
A 26yo woman has intermittent loose stool for the last 3 months on a background of IBS. She is otherwise well, no abdo pain, no vomiting, no weight loss. Her abdomen is soft and non-tender, bowel sounds normal. Her temperature is 37.1°C, pulse rate 64bpm, BP 114/76mmHg, RR of 14 breaths/min and Oxygen sat 100% breathing air.
Investigations:
Hb 140, WCC: 5.4, Urea: 3.6, Creatinine: 66, LFT: Normal, CRP <5, Uripe dip: no abnormality
Prescribe a med
Loperamide, 2mg, Oral, PRN
45
A 54 year old man has epigastric pain for 2 months. The pain started after he sustained a sporting injury, for which he took ibuprofen. His physical examination is normal. His temperature is 37.3°C, pulse rate 78 bpm, BP 136/76 mmHg, respiratory rate 14 breaths per minute and oxygen saturation 100 % breathing air.
Investigations:
Full blood count unremarkable
Upper GI Endoscopy: Small gastric ulcer with a smooth rounded edge, appears benign
Helicobacter pylori test negative
Please prescribe the most appropriate medication.
omeprazole
46
The target blood pressure for patients with chronic renal disease or diabetes plus microalbuminuria is a blood pressure less than
125/75
47
What is the KDIGO classification used for?
AKI
Serum creatinine >26micromol/L within last 48hrs
Serum creatinine 1.5x baseline within preceding 7 days
Urine volume <0.5ml/kg/hr for 6hours
48
Causes of hypokalaemia
Haemorrhage
| Severe vomiting
49
Anuria
Failure of kidneys to produce urine
50
What can be checked in blood for lupus?
1. Complement levels: low in active lupus
2. Anti dsDNA antibodies: high in active lupus
3. ANA - associated with SLE
51
4 indications of RRT
1. Hyperkalaemia refractory to medical management
2. Pulmonary oedema refractory to medical management
3. Severe metabolic academia
4. Uraemic complications
52
Normal eGFR
>90ml/min per 1.73m2
53
Chronic use of which drugs are a risk of CKD
NSAIDs
54
Painless haematuria in a 50-70yr old think
Bladder cancer
55
Cytoscopy is
Endoscopy of urinary bladder via the urethra
56
FUND HIPS
```
LUTS
Frequency
Urgency
Nocturia
Dysuria
Hesitancy
Incomplete voiding
Poor stream
Straining
```
57
First line treatment for UTI
Trimethoprim or Nitrofurantoin
58
Normal urine output
1mL per kg per hour
59
Oliguria
<0.5mL per kg per hour or <400mL per day
60
First thing to check with pt on ward who has reduced urinary output
Catheter not blocked
61
How much fluid do febrile pts need
500mL for every 1 degree above 37
62
What types of drugs can be nephrotoxic
NSAIDs
ACE inhibitors
Diuretics
Antibiotics eg gentamicin or vancomycin
63
What marker is unhelpful when checking for an obstructive cause in acute urinary retention?
PSA as raised anyway so can't tell if prostate problem or not
64
Typical presentation of acromegaly
Prominent jaw and brow
Large hands and feet
Sweating
65
Typical presentation of acromegaly
```
Prominent jaw and brow
Large hands and feet
Sweating
glycosuria
enlarged nose
soft tissue changes
organomegaly
visual impairment (if impact on optic chiasm)
```
66
Cadmium is related to which type of cancer
Prostate
67
How can you distinguish between BPH and prostate cancer on DRE?
BPH: smooth enlargement, bilateral, midline sulcus
Ca: Hard, asymmetrical, nodular, loss of midline sulcus
68
Polycystic kidney disease mode of inheritance
Autosomal dominant
69
Mutation on PKD1 on chromosome 16
Polycystic kidney disease
| 85% of cases
70
PKD2 mutation chromosome 4
15% of cases
71
Condition associated with berry aneurysms
Polycystic kidney disease
| May present as SAH
72
ACEi are contra-indicated in which renal condition
Renal artery stenosis
73
What lung finding may you see in renal artery stenosis pts?
Hx of flash pulmonary oedema
74
Gold standard investigation for renal artery stenosis
Digital subtraction angiography
75
Markers for testicular cancer
1. alpha feto-protein
2. beta-HCG
3. lactate dehydrogenase
76
What is the problem with myoglobin?
Renotoxic
77
Excess insulin injection results in
Hypoglycaemia
Reduction in K+ due to shift into intracellular compartment
Pts become sweaty, irritable, can eventually fall into coma
78
MOA biguanides
decrease HGO
| increase peripheral glucose uptake
79
MOA thiazolidinediones
activate PPAR-gamma, which increases LPL and FATP1 transcription -> increases peripheral insulin sensitivity
80
MOA sulphonylureas
block K(ATP) channel in pancreatic b cells, causing depolarisation and Ca entry -> stimulates insulin secretion
81
What is needed to manage a HONKC
```
IV insulin (50U soluble in 50ml of normal saline)
+ thromboprophylaxis
```
82
Groin lump in male that reduces completely when they lie down
Saphena varix
83
Where is the saphenofemoral junction?
2-3cm inferolateral to pubic tubercle
84
Pantaloon hernia
coexisting direct and indirect inguinal hernias
85
Differentials for non-tender, fluctuant groin lump with cough impulse
hernia or
| saphena varix
86
Boundaries of Hesselbach's triangle
Medially: rectus sheath
Inferiorly: inguinal ligament
Superiorly: deep inferior epigastric artery
87
Boundaries of inguinal canal
Anterior: Skin, superficial fascia, external oblique aponeurosis, internal oblique (lateral 1/3)
Posterior: Transversalis abdominis + conjoint tendon
Roof: internal oblique + transverses abdominis
Floor: inguinal ligament
88
Boundaries of femoral canal
Anterior: Inguinal ligament
Posterior: pectineal ligament and pectineus
Medial: lacunar ligament
Lateral: femoral vein
89
Risks of surgery in general
```
Haemorrhage
Infection
Thromboembolism
Anaesthetic complications
Death
```
90
Maydl's hernia
W loop ie two loops of bowel herniate, with intraabdo portion in the middle
91
Urine dip result in diabetes
Glucose
| Ketones
92
Management of hyperkalaemia
```
IV calcium
Insulin and dextrose (moves K from extra-cellular compartment to intra-cellular)
Nebulised salbutamol
Ca resonium
Dialysis
```
93
Management of hyperkalaemia
IV calcium
Insulin and dextrose (moves K from extra-cellular compartment to intra-cellular)
Nebulised salbutamol
Ca resonium
Dialysis
(would see massive inverted t waves on ecg)
94
Nephrotic syndrome
>3g protein
95
Normal protein in urine
<150mg/day
96
Normal protein to creatinine ratio
<20
97
Robson staging
Renal cell carcinoma
98
Diabetics are at risk of which condition between buttocks
Pilonidal sinus
99
Oesophageal varices treatment
Propanolol + endoscopic variceal banding
100
Koilonychia
Iron deficiency
Haematochromatosis
Endocrine disorders eg acromegaly or hypothyroidism
Malnutrition
101
What happens to cells in alcoholism?
Increased MCV
102
Mutation in a gene on chromosome 13 for ATP7B
copper transporting ATPase
| wilsons disease
103
Caeruloplasmin is a
acute phase protein
104
Inflammatory infiltrate, crypt abscesses + goblet cell depletion on histology report
UC
105
Barium enema in Crohn's reveals
cobblestoning, rose thorn ulcers, +/- colonic strictures
106
Smoking increases risk of which bowel disease
Crohn's (3-4x)
107
Triple therapy
Seven-day course of twice daily omeprazole 20mg, 1g amoxicillin and 500 mg clarithromycin
108
Most common cause of upper GI bleeding
Peptic ulcer
109
Treatment for chronic hep B
```
Interferon alpha (but SEs of flu symptoms eg headaches, myalgia, pyrexia, chills, bone marrow suppression + depression)
Nucleoside/nucleotide analogues eg tenofovir, adefovir, entecavir
```
110
Histological report of HAV/HEV
Zone 3 necrosis
Inflammatory cell infiltration of portal tracts
Bile duct proliferation
111
Histological report of HCV
Chronic hepatitis
Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present
112
Cholestyramine
Bile acid sequestrant
- either lowers cholesterol
OR
- used in hepatitis infections to reduce diarrhoea
113
Signs of portal HTN
Caput medusae
Ascites
Splenomegaly
114
Hepatic hydrothorax
A tranudative pleural effusion in pts with portal HTN with no underlying primary cardiopulmonary cause
115
Opthalmoplegia, ataxia, confusion
Wernicke's
| Thiamine/B1 deficiency
116
3Ds of pellagra
Diarrhoea
Dementia
Dermatitis
117
Halitosis
Foul breath
118
Potential causes of peritonitis
```
Perforation of
peptic/duodenal ulcer
diverticulum
appendix
bowel
gallbladder
```
119
Who is primary peritonitis seen in
Adolescent females
120
SBP management
IV
Cefuroxime + Metronidazole
OR
Quinolones
121
Nausea + sweating usually associated with
cardiac pain
| indicates ischaemia
122
Who do silent infarcts occur in?
Elderly & diabetics
123
Which two enzymes can be raised post MI?
AST (24hrs)
| LDH (48hrs)
124
Unstable angina or NSTEMI on ECG may show
ST depression
| T wave inversion
125
STEMI on ECG
```
ST elevation (>1mm in limb leads, >2mm in chest leads)
Hyperacute T waves
New onset LBBB
Later changes:
- T wave inversion
- Pathological Q waves
```
126
Posterior MI on ECG
Tall R wave
| ST DEPRESSION V1-3
127
5 (weird) tests to do for ischaemic heart disease
```
rMPI (technetium 99 or tetrofosmin)
Echo (either at rest or exercise/dobutamine stress)
Pharm stress testing
Cardiac catheterisation/angiography
Coronary Ca scoring
```
128
What pharm agents can induce a tachycardia
Dipyridamole
Adenosine
Dobutamine
(don't give 1/2 in reactive airway disease or AV block)
129
What should all stable angina patients receive?
75mg aspirin per day
130
Echo in MI may reveal
RWMA: regional wall motion abnormality
131
Right heart murmurs are louder on...
Inspiration
| ie tricuspid or pulmonary
132
Pan systolic murmur indicates
Mitral regurg
Tricuspid regurg
Ventricular septal defect
133
Slow rising pulse associated with
aortic stenosis
134
Mitral regurgitation is associated with
Displaced apex beat
135
Tricuspid regurgitation is associated with
raised JVP
136
Ventricular septal defect
Loudest left sternal border, accompanied with parasternal thrill
137
Coarse crackles
Consolidation or bronchiectasis
138
Fine crackles
Pulmonary oedema or fibrosis
139
On ECG how do you differentiate between AF and SVT?
Both have no P waves before the QRS complexes
BUT
in AF its irregular rhythm
140
In AVRT what do you see on ECG leading into QRS complex
Delta wave
141
When will a varicocele be palpable
Only when pt is standing
142
In hydrocele is it possible to palpate the testes
No
143
Sudden left varicocele consider
Renal tumour
144
young pt complaining of regular palpitations think
SVT
145
CHAD VASC score
```
for stroke prevention in AF
Age >75yrs
Diabetes
HTN
Hx of stroke/TIA
Hx of CCF
```
if low score -> aspirin
high score -> warfarin
146
Valsalva manoeuvre
blow out cheeks while holding breath
147
Diagnosing HTN via ECG
V1/2 DEEP S
| V5/6 TALL R
148
Two causes left ventricular hypertrophy
HTN
| Aortic stenosis
149
Lupus antibodies
Anti-dsDNA
ANA
Anti-cardiolipin
150
Difference between LVH by voltage criteria and LVH
LVH by voltage criteria is using ECG to diagnose
| LVH is definitively diagnosed by ECHO
151
Difference between sinus tachycardia + SVT or VT on ECG
P waves present in sinus tachycardia
152
Difference between cardioversion and defibrillation?
Defibrillation: shock pt, ie not syncronised
Cardioversion: synchronised
153
How to treat acute heart failure?
Sit up
60-100% oxygen
IV furosemide (to prevent lack of absorption due to gut oedema)
Treat underlying cause
(can give GTN infusion if they have angina too)
154
ST elevation in all leads suggests
Pericarditis (saddle shaped ST elevation)
| can't be MI as otherwise would be dead
155
Pleuritic chest pain causes
```
Pericarditis
Pneumonia
Pneumothorax
PE
Pleural pathology
(Sub-diaphragmatic pathology eg hepatic abscess)
```
156
Where is a pericardial friction rub best heard?
Left lower sternal edge, on expiration, pt sitting forward
157
Tamponade
Pressure that restricts blood flow
158
Pulsus paradoxus
Drop in SBP >10mmHG during inspiration
159
Beck's triad
Raised JVP
Low BP
Muffled heart sounds
160
Pericardial effusion on x-ray
bottle water shaped enlarged cardiac silhouette
161
ASO titre
anti streptolysin O
162
Drugs that can induce liver cirrhosis
Amiodarone
Methyldopa
Methotrexate
163
Hepatic failure leads to
```
coagulopathy
hepatic encephalopathy
hypoalbuminaemia
sepsis
hypoglycaemia
```
164
Things to test in ascitic tap
```
neutrophils to check for SBP
glucose
protein
LDH
cell count
biochem
```
165
Koilonychia
signs of IRON deficiency anaemia
166
How do cells haemotologically change in chronic alcohol disease
raised MCV
167
Mutation in HFE gene
Hereditary haemochromatosis
168
Slate grey skin pigmentation
Hereditary haemochromatosis
169
Recent dental work or poor dental hygiene predisposes you to
Streptococcus viridans
| infective endocarditis!!
170
Roth spots on retina
Infective endocarditis
171
Many infective endocarditis pts tend to be positive for what
rheumatoid factor positive
172
20-30% pts with PSC are more likely to develop
Cholangiocarcinoma
173
Thrombophlebitis migrans
vessel inflammation due to blot clot occurring in multiple places over time
(pancreatic cancer)
174
Aortic dissection
Male, 40-60yrs
175
Collapsing pulse
aortic regurg
176
For what condition do you x match 10 blood units
Aortic dissection
177
Seen in aortic regurgitation (wrt pressure)
increase in low end diastolic AORTIC pressure
178
Collapsing pulse/early diastolic murmur
Aortic regurgitation
179
Austin flint mid-diastolic murmur
heard at apex
| reflux of blood in aortic regurgitation hitting ant cusp of mitral valve causing physiological mitral stenosis
180
Slow rising pulse
Aortic stenosis
181
Signs of right heart failure
Pleural effusion
Ascites
Hepatomegaly
Pitting oedema
182
Common sign seen in mitral regurgitation
AF -> IRREGULARLY IRREGULAR PULSE
183
Malar flush is seen in
Mitral stenosis
184
Which ulcers have a punched out appearance
arterial
185
Lipodermatosclerosis
champagne bottle leg
| seen in severe venous ulcer disease
186
Marjolin's ulcer
aggressive, ulcerating squamous carcinoma in area of skin where previous inflammation/trauma
187
When do you give a precordial thump to a pt?
Ulnar aspect of wrist to thump sternum in cardiac arrest if you witness
188
What do you do in acute cardiac tamponade
Pericardiocentesis
189
Prinzmetal angina
variant angina due to coronary vasospasm rather than atherosclerotic disease (see ST elevation on ECG rather than depression)
190
DEXA criteria
0 or greater: good bone
0 to -1 BMD in top 84%, no evidence of osteoporosis
-1 to -2.5 osteopenia
-2.5 or worse osteoporosis
191
Pruritis after a hot bath suggests
polycythaemia
192
Faecolith
calcified stone of faeces
193
Which type of melanoma is more common in non-whites?
Acral lentiginous (5% of melanomas)
194
What is a common site of metastasis in melanoma
Liver
195
Surveillance of AAA every 1 years is done for
| every 3 months is done for
- > 3-4.5cm
| - > 4.5-5.5cm
196
How does the clotting screen change in haemolytic uraemic syndrome?
Stays the same ie its normal
197
How does the clotting profile change in DIC?
Decreased platelets
Decreased Hb
Decreased fibrinogen
Increased APTT/PT
198
What condition is suggested by an ejection systolic murmur that decreases on squatting and increases on valsalva manoeuvre
HOCM
199
Heinz bodies seen on smear of
G6PD deficiency
| - cause of hereditary haemolytic anaemia
200
In MAHA/HUS what is seen on blood film
schistocytosis
| reticulocytosis
201
tear drop poikilocyte red cells
myelofibrosis
202
3 tests to do in acute left ventricular failure
ABG
Troponin
BNP
203
Colchicine is given for
```
recurrent pericarditis
along with
- NSAIDs + PPIS
- immunosuppressants
- steroids
```
204
Clostridia perfringens
Causes gas gangrene
205
Crepitus
Crackling sound due to air trapped in tissue, can get in gas gangrene
206
Stoke adams attack
Syncope caused by ventricular assystole
207
Canon a waves
seen in jugular vein
happen when atria and ventricles contract simultaneously
can be seen in complete heart block along with slow, large vol pulse
208
Radiofemoral delay
Aortic coarctation distal to left subclavian artery
209
Leriche syndrome
Absent/weak distal pulses
Buttock claudication
Impotence
210
Grading system for PVD
```
Fontaine classification
1 Asymptomatic
2 Intermittent claudication
3 Rest pain
4 Ulcers/gangrene
```
211
Ebstein's abnormality
Congenital abnormality of heart, displacement of septal and posterior tricuspid valve leaflets
212
Shortened PR interval
Broad QRS complex
Slurred upstroke producing delta wave
suggests...
Wolff-Parkinson-White syndrome
213
Which type of tachycardia is more common in females?
SVT
214
Why do we only do carotid sinus massage in younger pts?
Can dislodge atherosclerotic plaques so cause older ppl stroke
215
When would adenosine be contra-indicated?
Severe asthma
216
Murmur on back, below left scapula, descending into abdomen
Aortic dissection
217
Wide pulse pressure
Aortic dissection
| Aortic regurgitation
218
Pulsus alternans
Acute left ventricular failure
219
Globally dilated, hypokinetic heart is seen on echo with which condition
dilated cardiomyopathy
220
Cardiac tamponade signs
PULSUS PARADOXUS
Tachycardia
Becks triad (muffled heart sounds, hypotension, distended jugular vein)
221
Kartagener's syndrome
cause of bronchiectasis, immobile cilia, chronic sinusitis, infertility, situs invertus
222
How big should a fibroadenoma be before its excised?
>4cm
223
Pattern of headache for CNS tumour
Worse in morning and lying down
224
What is seen on double contrast barium enema in colorectal carcinoma?
Apple core strictures
225
What can often be the first sign of gastric cancer?
Virchow's node
226
Sister Mary Joseph's nodule
Indicates metastatic umbilical nodule eg due to gastric carcinoma
227
Krukenberg's tumour
Mets in ovaries, most commonly from gastric adenocarcinoma
228
Keratoconjunctivitis sicca
Dry eyes
229
SE of beta 2 adrenoceptor agonists eg salbutamol
hypokalaemia in high doses
230
What causes gigantism?
excess GH secretion pre-puberty
231
Octreotide + Cabergoline are used to treat which condition
Octreotide: SS analogue
Cabergoline: oral dopamine agonist
Acromegaly
232
What happens in an addisonian crisis?
acute adrenal insufficiency
major haemodynamic collapse
precipitated by stress eg trauma or infection
233
Electrolytes in addisonian crisis
raised urea
low Na
raised K
may be raised Ca
234
Treating hypothyroid + adrenal insufficiency
give hydrocortisone before thyroxine
235
Management of addisonian crisis
IV fluid resus
50mL bolus of 50% dextrose to treat hypoglycaemia
IV 200mg hydrocortisone bolus
followed by 6 hourly 100mg hydrocortisone until BP stable
Treat cause + monitor
236
Definition of obesity wrt BMI
>30kg/m2
237
What drug can cause nephrogenic diabetes insipidous?
Lithium
238
Enuresis is
bed wetting
239
Dehydration signs
Dry mouth/mucous membranes
Tachycardia
Reduced skin turgor
Postural hypotension
240
How do you treat mild diabetes insipidus?
Potentiate ADH so chlorpropamide or carbamazepine
241
Nelsons syndrome
Locally aggressive pituitary tumour causing skin pigmentation due to ACTH secretion
242
What is hyperchloraemic acidosis?
Happens in primary hyperparathyroidism
Normal anion gap
High PTH inhibits bicarbonate reabsorption in kidneys
243
How can you distinguish familial hypocalciuric hypercalcaemia from primary hyperPTH?
Check urine Ca:creatinine ratio
244
Dyspareunia
painful sex
245
Eunuchoid
Long legs, arm span > height
246
Kallman's syndrome
Deficiency of GnRH
| Key symptom: anosmia
247
Lawrence moon biedel causes what...and features are
```
hypogonadism in males
obesity
polydactyly
learning difficulties
retinitis pigmentosa
```
248
Klinefelter's syndrome
```
Tall stature
Lack of secondary characteristics
Gynaecomastia
Lower IQ than siblings
Small testes/infertility
```
249
Signs of pituitary apoplexy
Signs of hypopituitarism
- headache
- visual loss
- cranial nerve palsies
250
Causative organism for syphilis
Treponema pallidum
251
Signs of myxoedema coma
```
Hypoventilation
Hypothermia
Hyponatraemia
Confusion
Cardiac failure
Coma
```
252
Sail sign on cxr indicates
left lower lobe collapse
253
Golden s sign on cxr
Right upper lobe collapse
254
Dilated loops of bowel on x-ray indicate
bowel obstruction
255
pt with painful sensation on outer thigh, tingling or burning sensation at times. no PMHx/DHx/SHx
Meralgia paraesthetica
256
Which clinical test is used to diagnose ankylosing spondylitis?
Schober's test
Mark L5 at level of PSIS, mark 10cm above. Get pt to bend over, normally should make 15cm gap, if not -> reduced spinal flexion -> ankylosing spondylitis
257
Schirmir's test
Tear production in Sjogrens
258
Buerger's test
PVD
259
Tensilon test
Myasthenia gravis
| Administer short acting acetylcholinesterase inhibitor -> rapid improvement in muscle weakness
260
5 Ps of pleuritic chest pain
```
Pneumonia
Pneumothorax
Pericarditis
PE
Pleurisy
```
Otherwise
Fractured rib
Costochondritis
Sub-phrenic pathology
261
Jelly like stools or mucoid?
Salmonella infection or villous polyps in colon
262
Foul smelling and floating stools
Malabsorption eg coeliac
Biliary insufficiency eg cholecystectomy
Pancreatic problem eg cancer, duct obstruction, CF
263
Hirschsprung's disease
Chronic constipation due to lack of ganglion cells in myenteric plexus. Affects children.
264
Left axillary nodule
Irish node
| Can be felt in gastric cancer
265
Fox's sign
Brusing in abdomen over inguinal ligament, acute haemorrhagic pancreatitis
266
Haemorrhoids
Painless PR bleeding/perianal pain + mass in area. Mucus discharge. Blood in pan.
267
Risk factors for anal abscess
Anal fistulae
Crohn's
Need to surgically drain abscess + antibiotics if elderly/diabetic
268
Treatment options for haemorrhoids
```
Fibre
Ligation
Photocoagulation
Sclerotherapy
Surgical haemorrhoidectomy
```
269
Most common cause of hypothyroidism worldwide
Iodine deficiency
270
Anti-spasmodics
Peppermint oil
| Dicycloverine
271
Opiate overdose treatment
Naloxone
272
A 70 year old woman has seen her GP for depression on several occasions. She now complains of abdominal pain, constipation & thirst
"Stones, bones, abdominal groans + psychiatric moans"
273
A 30 year old male intravenous drug user with a history of tuberculosis develops profuse watery diarrhoea with no abdominal pain.
Cryptosporidium
think 'HIV/immunocompromised/T cell deficient ppl' + watery diarrhoea
can be painless
otherwise: crampy abdo pain for 7+days
274
If pt with infection due to food poisoning type problem, and vomiting main symptom, suspect which organisms
Staph aureus
Bacillus cereus
Norovirus
275
What should you check in chronic pancreatitis?
Has pt become diabetic?
276
When to suspect villous adenoma
Villous adenomas secrete large amounts of mucus and result in hypokalaemia.
+ watery diarrhoea
277
Colles vs smith's fracture
osteoporosis
both falling on hands but colles is outstretched so fracture radius out
smith's is inward fracture
278
Severe pain when hip is flexed and externally rotated suggests
NOF fracture
| Osteoporosis
279
Osteoporosis circumscripta
Areas of osteolysis in frontal and occipital lobe seen on radiographs in pagets
280
acthanthosis nigricans in women can be a sign of
PCOS
| -> velvet thickening + increased pigmentation in skin folds
281
Signs of hypokalaemia
Muscle weakness
Tetany
Paraesthesia
Polyuria/polydypsia -> Nephrogenic DI
282
Two confirmatory tests for primary hyperaldosteronism
Salt loading
| Postural test
283
TRH can stimulate release of which other pituitary hormone
Prolactin
| so check TFTs in hyperprolactinaemia, ie hypothyroid -> raised TRH -> raised prolactin
284
Test for suspected SAH
CT head looking for blood in CSF if <6hrs
| If 12hrs-12days post do LP looking for xanthochromia
285
Difference between TIAs/strokes and epilepsy
TIAs/Strokes are LACK of blood so LACK of function -> negative symptoms ie things STOP working -> lose sight, muscle power, sensation
Epilepsy -> GAIN of function symptoms -> flashing lights, muscle convulsions, odd sensations in the skin
286
Pt with recurring episodes of shimmering lights, noises, zigzag lines, last half an hour at time, no PMHx etc
Migraine aura WITHOUT headache
287
Main causes of SAH
Aneurysm rupture (berry)
Trauma
Arteriovenous malformations, rupture of hemangiomas, rupture of cerebral vein around brainstem
288
Neurofibromatosis type II predisposed to
meningiomas
| schwannomas
289
Where to find place to do LP and what landmarks?
Spinal cord ends around L1/2
So do below L4
Tuffier's line: line between PSIS(s) at L4/5 space
290
Structures transversed during LP
```
Skin
Subcutaneous tissue
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Dura mater
Arachnoid space
```
291
Subtotal villous atrophy with crypt hyperplasia
Coeliac disease
292
Ziehl-Neelsen stain
Used in TB sputum sample for acid fast bacilli
293
Magnesium ammonium phosphate
Struvite (type of renal stone)
294
Reflex in response to raised ICP
Cushing's reflex -> triad
High BP
Bradycardia
Irregular breathing
295
Kussmaul sign
Paradoxical rise in JVP on inspiration, indicates right ventricular filling defect eg constrictive pericarditis, restrictive cardiomyopathy
296
Triad seen in cardiac tamponade
Beck's triad
- raised JVP
- muffled heart sounds
- hypotension
297
Charcot's triad
Ascending cholangitis
- right upper quadrant pain
- jaundice
- fever
298
Embryo sign on AXR
caecal bowel obstruction
299
DR PITHS
```
causes of oncholysis
Drugs eg tetracyclines, oral contraceptive pill, diabetic drugs
Reactive arthritis, Rieter's syndrome
Psoriasis
Infection
Trauma
Hyper+Hypothyroidism
Sarcoidosis, scleroderma
```
300
Damage to Wernicke's area
Area for speech understanding, pt cannot understand language, but can produce fluent but nonsensical speech
301
Damage to Broca's area
Intact understanding but can't produce speech
302
Arcuate fasciculus lesion
Connects wercicke's + broca's area -> intact language comprehension + speech production but poor repetition
303
Severe hyperkalaemia is treated...
10mL 10% calcium gluconate
304
Aortic and Pulmonary Regurgitation
EARLY DIASTOLIC MURMURS
305
Mitral and Tricuspid Stenosis
Mid-diastolic murmurs
306
H pylori tests
1. Urea breath test, look for CO2 in breath 10-30mins later, urea cleaved by urease produced by H pylori
2. Blood antibody test
3. Stool antibody test
4. Rapid urease/campylobacter like organism test
307
HLA-B27 allele
Ankylosing spondylitis
308
What can cause central pontine myelinolysis?
Rapid correction of hyponatraemia
Quadriparesis
Respiratory arrest
Fits
309
What can cause central pontine myelinolysis?
Rapid correction of hyponatraemia (50% mortality)
Quadriparesis
Respiratory arrest
Fits
310
Coeliac causes malabsorption of which minerals
Fat soluble: A, D, E, K
311
HYPERKALAEMIA can cause on ECG
tall tented T waves
312
Hypokalaemia on ECG
flattened T waves, prominent U waves
313
Charcot's joints
Severe neuropathic arthropathy
314
Diabetic amyotrophy
More common in elderly untreated pts
Painful proximal motor neuropathy
Lower limbs
weakness + wasting of thigh muscles
315
Treatment for hep C
Peginterferon
| Ribavirin
316
Auer rods
Cytoplasmic inclusions in myeloid blast cells -> acute myeloid leukaemia
317
Sternberg-Reed cells
Hogkin's lymphoma
318
In Hogkin's lymphoma what can happen to the mass after drinking alcohol
Mass can become painful
319
Bell's phenomenon
Eye balls roll up but eye remains open when try to close the eye
320
Classification for depression
DSM-IV
321
Conjunctival injection
Dilation of the blood vessels in conjunctiva
322
Drugs that make GORD worse
Damage the mucosa: NSAIDs, aspirin, steroids, bisphosphonate
| Affect oesophageal motility: TCAs, nitrates, anti-cholingerics
323
Slurred upstroke of QRS complex and short PR interval
AVRT, eg bundle of kent in wolff parkinson white syndrome
324
Oxygen therapy for COPD pts
```
PaO2 <7.3kPa despite max treatment
OR
PaO2 7.3-8kPa + one of
pul HTN
peripheral oedema
polycythaemia
nocturnal hypoxia
palliative
```
325
Hypopyon
Exudate + inflammatory cells in inferior angle of anterior chamber
326
Sympathetic Ophthalmia
Inflammation in contralateral eye weeks or months after penetrating injury to original eye (due to T cell response to eye antigens)
327
Herpetic whitlow
abscess at end of finger as result of HSV1 infection
328
Herpes labialis
reactivation of HSV-1 (ie oral herpes, cold sores)
329
Dendritic ulcer on iris with fluorescein stain
HSV keratoconjunctivation
330
Maculopapular rash occurring in dermatomal distribution
shingles
331
Zoster ophthalmicus
rash in the ophthalmic division of the trigeminal nerve
332
Ramsay hunt syndrome
```
reactivation of HSV (ie shingles) in geniculate ganglion
triad:
vesicles behind pinna or in ear canal
lmn facial nerve palsy
loss of taste ant 2/3 tongue
```
333
Stoke-Adams attack
Transient loss of consciousness due to cardiac arrhythmia eg bradycardia due to complete heart block. pt out for couple of seconds, flushed upon recovery.
334
What systemic diseases is pyoderma gangrenous associated with?
IBD, Sarcoidosis, Behcet's
335
Associations of pyoderma gangrenosum
```
IBD
Autoimmune hepatitis
Granulomatosis with polyangiitis
Myeloma
Neoplasm
```
336
Signs of malabsorption
Dry skin
Leukonychia
Easy bruising
Hair loss
337
Haematological SE of methotrexate
Megoblastic macrocytic anaemia
| dihydrofolate reductase inhibitor
338
4 signs of pernicious anaemia
mild jaundice
weight loss
angular stomatitis
glossitis
339
Why would pregnant women take folic acid supplements?
Lack of folate can cause neural tube defects
340
Sideroblastic anaemia
abnormal haem synthesis, microcytic anaemia (can be primary/secondary)
341
What anaemia can cause glossitis and angular stomatitis?
Pernicious anaemia
| Iron deficiency anaemia
342
Scoring system for predicting stroke after TIA
ABCD2 (score of 4+ needs TIA clinic within 48hrs)
Age >60 (1)
BP >140/90 (1)
Clinical features (1) speech disturbance no weakness (2) unilateral weakness
Duration of symptoms (1) 10-59mins, (2) >60mins
Diabetes
343
MRC scale for power
5: Normal power
4: Can move limb against gravity and a bit against resistance
3: Can move limb against gravity
2: Movement if gravity eliminated
1: Flicker in muscle
0: No movement
344
Charcot bouchard microaneurysm
Aneurysms in brain in small vessels, can rupture and cause haemorrhagic stroke
345
Mid-systolic click
Mitral valve prolapse
346
Lichenification
Chronic itching
347
Which type of eczema is a medical emergency?
Eczema herpeticum
348
Two types of contact dermatitis
Allergic
| Irritant
349
Define eczema
Pruritic papulovesicular skin reaction to endogenous and exogenous agents
350
What type of eczema mainly affects the hands and feet
Pompholyx
351
Panniculitis
Inflammation of sub-cut fat tissue
