Passmed Questions Flashcards
(54 cards)
What is the most common cause of large bowel obstruction?
colorectal cancer
tumours cause 60% of LBOs
particularly the case in more distal colonic and rectal tumours, as these tend to obstruct earlier due to the smaller lumen diameter
How does large bowel obstruction present?
absence of passing flatus or stool
abdominal pain
abdominal distention
nausea and vomiting are late symptoms that may suggest a more proximal lesion
peritonism may be present if there is associated bowel perforation
How can LBO be investigated?
Abdominal x-ray:
commonly used first-line
upper limits of normal diameter: 3cm for the small bowel, 6cm for the large bowel and 9cm for the caecum (3/6/9 rule)
presence of free intra-peritoneal gas indicates colonic perforation
CT scan
How can LBO be managed?
‘drip and suck’
NBM
IV fluids
nasogastric tube with free drainage
IV abx if perf
consider surgery
Subacute productive cough, foul-smelling sputum, night sweats →
?lung abscess
How can confined RCC be managed?
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
otherwise radical nephrectomy
Give 4 key features of myeloma
C - calcium raised
R - renal failure
A - anaemia (technically a pancytopenia)
B - bone pain
What is a ‘rouleaux formation’?
a stacking of red blood cells seen in a blood film. It is characteristic of a myeloma.
raised ESR + osteoporosis = what until proven otherwise?
multiple myeloma
Hypercalcaemia, renal failure, high total protein suggests what dx?
multiple myeloma
Impaired renal function is typical. Lower back pain is classical, a symptom of osteolytic lesions in the lower spine.
Rectal cancer on the anal verge can be managed with →
Abdomino-perineal excision of rectum
diagnostic investigation of choice for pancreatic cancer?
High resolution CT of pancreas
What side effects should the patient be warned about regarding prostate brachytherapy?
proctitis- inflammation of the rectum resulting in bloody diarrhoea
In an emergency setting, if a colonic tumour is associated with perforation the risk of an anastomosis is greater →
end colostomy
High-dose dexamethasone suppression test results with an adrenal adenoma?
Cortisol: not suppressed
ACTH: suppressed
High-dose dexamethasone suppression test results with a pituitary adenoma?
Cortisol: suppressed
ACTH: suppressed
When is pleural fluid considered exudative?
> 30g/L protein
What type of pleural effusion is caused by lung cancer?
exudative
Myasthenia gravis is associated with what tumours?
thymomas
How can myasthenia gravis be differentiated from Lambert- Eaton syndrome?
In myasthenia gravis key feature is muscle fatigability - muscles become progressively weaker during periods of activity and slowly improve after periods of rest
What can cause a raised serum amylase other than pancreatitis?
small bowel obstruction - due to pressure on the pancreatic duct
old man, bone pain, raised ALP =
Paget’s disease!!
What is the preferred management option for patients with low-grade prostate cancer and significant co-morbidities?
watchful waiting
What pain relief is availale to palliative patients with varying renal function?
first line = morphine sulphate
moderate renal impairment =oxycodone
end-stage renal failure = buprenorphine
