PasTest Flashcards
1
Q
What is the main determinant of fasting plasma phosphate concentration?
A
Rate of renal tubular absorption.
Therefore 1* hyperparathyroid, hypercalcaemia of malignancy, inherited hypophosphatemic rickets, prolonged IV nutrition = low PO4
2
Q
What is the main site for the tumour in Zollinger Ellison?
A
Proximal wall of duodenum (90% located there or tail of pancreas)
3
Q
Where does the ampulla of vater enter the bowel?
A
Descending (2nd) part of duodenum
4
Q
Viral Causes of Pancreatitis
A
mumps
Coxsackie B
Hepatitis B
5
Q
Posterior hip dislocation
A
Internal rotation, adduction, flexion at the hip
6
Q
Anterior hip dislocation
A
Leg extended and externally rotataed at the hip
7
Q
Therapeutic management of thromboembolic stroke
A
Thrombolysis - tPa
Aspirin 300 mg OD
Warfarin - AF, LV thrombus, enlarged L atrium
MDT rehab
8
Q
Kussmaul’s Sign
A
Paradoxical rise in JVP in acute tamponade.
9
Q
Supranuclear Palsy
A
Symmetrical Parkinsonism, initially slow saccades (esp vertical), progressing to limitation of eye movements.
10
Q
Corticobasal syndrome
A
Asymmetrical cortical syndrome, prominent gait unsteadiness, falls, parkinsonism, apraxia, alien limb syndrome
11
Q
Potencies of steroid creams
A
Help EVERY BUDDING DERMATOLOGIST
Hydrocortisone Eumovate Betnovate Dermovate
12
Q
Causes of Carpal Tunnel - mnemonic
A
CARPAL C - cardiac failure / COCP A - acromegaly R - renal (nephrotic, DM) A - arthritis of wrist (RA, OA) L - large size (obesity)
13
Q
What is the correct B12 replacing regimen?
A
Hydroxycolbalamin 1mg IM 3 times a week for 2 weeks, monthly for 3 months, once every 3 months
14
Q
Risk factors for cataracts + mneumonic
A
DEHYDRATION DM / dehydration Eye disease - glaucoma, uveitis Hypertension, hypocalcaemia dYstophia myotonica Diet - low in carotene and antioxidants Race and FH Alcohol Toxicity - steroids, tobacco Ionising radiation Old age No protection (prophylactic aspirin, osetrogens)
15
Q
Pemphigus vulgaris - what is it caused by?
A
IgG autoAb to desmoglein 3 leading to intra-epidermal splitting
16
Q
Which carpal bone dislocates most frequently?
A
Lunate
Typically disloctes anteriorly into carpal tunnel, compressing median nerve
17
Q
Meckel’s Diverticulum rule
A
Rule of 2s
2 inches in length, 2 feet from ileocaecal junction, 2% of population, 2 types of tissue - gastric and pancreatic
18
Q
Which main vessels exit the abdominal aorta?
A
T12 - coeliac plexus (stomach, spleen, liver)
L1 - SMA (D2 - right 2/3 transverse colon)
L3 - IMA (transverse colon L to dentate line)
Gonadal Arteries
4 paired lumbar arteries
Birucation into CI arteries
19
Q
Triad of Pellagre
A
3 D
Diarrhoea, dermatitis, dementia
20
Q
Yellow Nail Syndrome
A
yellow deformed nails, lymph oedema, exudative pleural effusion. Maldevelopment of lymphatic system.
21
Q
Branches of the abdominal aorta
A
T12 - coeliac trunk L1 - SMA L3 - IMA Paired gonadal arteries (from which ureteric arise) 4 paired lumbar arteries Common iliac
22
Q
Cerebello-pontine angle tumour
A
V, VI, VII, VIII palsy
Likely acoustic neuroma in NF-1
23
Q
Causes of pellagra - primary and secondary
A
Presents with diarrhoea, dementia and dermatitis (B3 niacin def)
Primary due to dietary insufficiency
Secondary due to decreased absorption in chronic alcohol, carcinoid tumour or GI disease (e.g. IBD)
24
Q
Which MODY associated with hepatic neoplasm?
A
MODY3
25
Classifying severity of eczema
Clear - no signs
Mild - areas of dry skin, infrequent itching ± small erythematous patches
Moderate - dry skin, frequent itching, erythematous patches + excoriations
Severe - widespread, continous itching, redness, excoriations, bleeding, oozing, skin thickening or altered pigmentation
26
Smudge cell?
CLL
27
Clonal population of immature cels with intracytoplasmic dark pink rods?
APML (auer rods)
| Note can cause DIC, treated with all-trans retinoic acid
28
Lymphocytes with thin projections of cytoplasm?
Hairy cell leukaemia
29
What is indapamide? What are its advantages?
Thiazide diuretic, less propensity for hyponatreamia and no effect on insulin resistance vs bendroflumathazide
30
Why must sodium nitroprusside infusions be covered?
Degrades in sunlight to form cyanide. If poison - sodium thiosulphate
31
Cat scratch disease?
Bartonella henselae - brownish red papules around inoculation site after 3-10 days. Can take 6-12 months to resolve completely. Also fever, malaise, anorexia.
Azithromycin 5 days
32
Post herpatic neuralgia?
TCA
33
What can increase T1/2 of morphine?
Imparied renal and/or liver function
34
Gilbert's mutation?
UDP glucuronyl transferase
35
SE - cisplatin
Tinnitus, metallic taste in mouth
36
SE - bleomycin
Lung injury
37
SE - imatinib
Fluid retention, esp peri orbital
38
SE - vincristine
Peripheral neuropathy
39
SE - capecitabine
Loose stool and severe diarrhoea
40
SLE symptoms - pneumonic
```
DOPAMINE RASH
Discoid Lupus
Oral Ulcers
Photosensitivity
Arthritis
Malar Rash
Immunological (dsDNA, Ro, La, Smith)
Neuroloical
ESR
Renal
ANA
Serositis (pleurisy, pericarditis)
Haematological (HA, leukopenia, thrombocytopenia)
```
41
What is the mechanism of osteoporosis in cushings?
Elevated cortisol reduced intestinal Ca absorption, leading to secondary hyperPTH which favours PO4 loss. Results in increased osteoclast activity and bone turnover. Also causes less osteoid matrix synthesis
42
Rose spots, salmon pink spots
Typhoid fever
| Ciprofloxacin
43
Anion gap
Na+K-Cl-HCO3
44
P450 inducers
Qunidine Barbiturates Phenytoin Rifampin Griseofulvin Carbamazepine Chronic Alcohol intake
45
P450 inhibitors
Protease inhibitors, isionizid, cimetidine, ketoconazole, erythromycin, grapefruit juice, sulfonamide
46
Lhermitte's phenomenon
test for intrinsic lesion of the cervical cord usually seen in multiple sclerosis but can occur in SACD. Passive flexion of the neck gives an electric shock like sensation down the back.
Ddx diabetes with cord compression, tabes dorsalis, friedichs ataxia
47
Lesions of the temporal lobe classically produce which visual field loss?
Superior quadrantinopias
48
Lesion of the parietal lobe classically produce which visual field loss?
Inferior quadrantinopias
49
what is another name for Wallenbergs syndrome?
Lateral medullary syndrome (PICA)
50
Lateral Medullary Syndrome (Wallenbergs)
Loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face.
Dysphagia (IX and X) slurred speech, ataxia (broad based gait), facial pain, vertigo, nystagmus, Horner's (ipsilateral), diplopia, and possibly palatal myoclonus.
51
Anoscoria - def
difference in size between pupils
52
What suppresses gastrin? Name of drug in this group?
Somatostatin - octreotide e.g. for ZE syndrome
53
Treatment of dermatitis herpetiformis?
Dapsone
| Papulovesicular rash caused by IgA complex deposition in papillary dermis
54
Which is the only laryngeal muscle not supplied by recurrent laryngeal?
Cricothyroid muscle - external laryngeal branches of superior laryngeal nerve
55
Turner's and heart problems
Coarctation, dissection, congenital bicuspid valve, mitral prolapse
56
Anatomical boundaries of the inguinal canal
MALT - muscles, aponeuroses, ligaments, tendon/transversalis
Superior - Muscles (internal oblique and transversus abdominis
Anterior - Aponeurosis (internal and external oblique)
Inferior - Ligments (Inguinal and lacunar)
Posterior - Tendon (conjoint) and Transversalis fascia
57
Which lymph nodes drain testes?
Para-aortic
58
Measuring burns areas
9% head, arm
18% leg (9% anterior/posterior)
36% torso (18% front, 18% back)
1% genitals/perineum
59
Warfarin - which juice to avoid
Grapefruit and cranberry
60
Symptoms of Paget's disease of bone - mnemonic
```
PANICS
Pain
Arthritis
Nerve Compression
Increased bone size
Cardiac Failure
osteoSarcoma (1-2% of cases)
```
61
What iron chelator is given in both B Thalassaemia major and haemochormatosis
Desferrioxamine
62
Which infection commonly precedes Guillan Barre' syndrome?
Campylobacter gastroenteritis
63
Lithium poisoning
Diarrhoea, hypokalaemia, hypotension, arrythmias, seizures, coma, metallic taste, fine tremor
64
Treating septic arthritis
Irrigation and drainage of joint (open or arthroscopic approach), + targeted IV Abx 2/52 + PO 4/52
65
Boxer's Fracture - presentation and management
Fracture of 5th MCP after punching. Usually wool + crepe bandage but i angulated/rotated may need manipulation + K-wire
66
MM pt with neck pain + focal neurological deficit?
Plasmacytoma (malignant plasma cell tumour, occur in axial skeleton/soft tissue and may cause compression/fracture)
MRI spine
Rx needed
67
What anatomical landmark key to fistula in ano?
Pectinate (detonate) line. Junction of columnar (above line) with SC epithelium (below line). Low fistula = not lie across sphincter = lie it open. High fistula = crosses sphincter above line = seton (thread woven into fistula then tightened over several weeks to cut through surface
68
Managing fractures - mneumonic
```
6 Rs
Resuscitate
Radiology (XR)
Reduce
Restrict (fixate, internal vs external)
Remain
Rehabilitate
```
69
Causes of erythema nodosum - mnemonic
```
NODOSUM
NOne (idiopathic0
Drugs (sulphonamides, penicillin)
Oral contraceptive pill
Sarcoidosis
UC (IBD)
Microbiology (strep throat, TB)
```
70
Causes of alveolar haemorrhage
SLE, Goodpasture, GPA
71
Traumatic splenic injury grades
I - sub scapular haematoma <10% surface area; laceration <1cm depth
II - haematoma 10-50% SA or intraparenchymal <5cm; laceration 1-3cm w/o involving vessel
III - haematoma >50% SA or expanding, or ruptured or intraparenchymal >5cm; laceration >3cm involving vessel
IV - major devascularisation (>25% spleen(
V - completely shattered spleen, hilar vascular injury
72
RF for cataracts - mnemonic
```
DEHYDRATION
DM, dehydration
Eye disease - glaucoma, uveitis
HTN, hypo Ca
dYstrophia myotonica
Diet low in fit A and antioxidants
Race and FH
Accidents, Alcohol excess
Toxicity - roids, tobacco, toxoplasmosis
Ionising radiation
Old Age
No protection - oestrogens, aspirin use
```
73
Normal presure hydrocephalus triad
Unsteady gait dementia with psychomotor retardation and urinary incontinence.
Typically gait broad based and small stepping with difficulty on initiation.
74
Risk factors for different renal stones
CaPO4 - idiopathic, hypercalcuria, hyperparathyroidism
Struvite (MgNH3PO4) - chronic UTI
Uric acid - hypercalcuria
Cysteine - intrinsic metabolic defects
Drug precipitation - Acyclovir, Indinavir, Mg Silicate, Sulfasalazine
75
Site of bronchiectasis can point to underlying disease. Which?
Upper lobe: CF, TB
Middle lobe: mycobacterium avium complex infection
Lower lobe: congenital immunodeficiency, recurrent aspiration
Central: allergic bronchopulmonary aspergillosis
76
Was is a common cause of paraphimosis?
The foreskin retracted during catheterisation has not been replaced leading to glans swelling. Urological emergency.
Attempt gradual manual reduction. If fails, inform urologist.
77
What is the distribution of myasthenia gravis?
Bimodal - in 30s and 60/70s
78
What scan is performed in varcioceles and why?
Kidney US, L sided varicocele associated with L renal malignancy. Anatomy of gonadal veins asymmetrical, R drains into IVC, L drains into L renal vein (and the fore may be compressed by tumour to cause L varicocele)
79
RF for avascular necrosis of femoral head
Chronic corticosteroids, excessive alcohol consumption
| MRI is investigation of choice
80
Tropical sprue - presentation, biopsy and treatment
Chronic diarrhoea, weight loss, B12 & B9 deficiency, positive travel Hx
SI biopsy - mononuclear infiltration and villous atrophy
Broad spectrum Abx - tetracyclines and B9 supplements
81
Whipple's disease - biopsy and treatment
PAS-positive macrophage in lamina propria
| Double strength trimethoprim and sulfamethaxozole
82
Causes of dilated cardiomyopathy
```
Dilation of all 4 chambers of the heart
Viral - Coxsackie, Parvovirus B19, HIV
Alcohol
Methamphetamines
Chaga's disease
```
83
Carcinoid syndrome
Neuroendocrine GI tumour producing serotonin. Does not manifest until liver mets - as liver metabolises serotonin
Facial flushing, diarrhoea, right sided valvular disease (does not cause L sided as lungs metabolise serotonin)
84
Tinea versicolour
```
Malassezia furfur (fungus)
Pale, velvety, hypo pigmented macule which does not tan and is non scaly
```
85
Causes of TEN
NSAIDS, steroids, methotrexate, allopurinol, penicillins
86
Sutures: Silk
Non absorbable natural multifilament suture
87
Sutures: Prolene
Non absorbable, synthetic monofilament suture
88
Sutures: Polyester
Non absorbable synthetic multifilament suture
89
Sutures: Vicryl
Absorbable, synthetic, multifilament suture
90
Polyarteritis nodosa spares which arteries?
Associated with hep B
| Spares pulmonary arteries
91
Humeral fractures and neuro deficits
Mid-humeral shaft fracture - Radial
Medial humeral epicondyle - Ulnar
Supracondylar humeral fractures - Median
92
What is a classical examination finding in P. jirovecii infection?
Destauration on exercise
| Pulse oximetry before and after walking up and down on ward
93
What is transient hypocalcaemia?
Common complication of partial thyroidectomy, usually resolves.
If Ca <1.9 or frank tetany, OV calcium glucuronate bolus
Usually patients preloaded with 1alphacalcidol pre-op
94
Behcet's antibodies
Anti saccharomyces cervisiae
95
Penicillamine is associated with which type of GN?
Membranous
96
Protein Deposition: Alzheimer's
Amyloid precursor protein (APP) and Tau hyperphosphorylated protein
97
Protein Deposition: Lewy Body dementia
Alpha synuclein
98
Protein Deposition: PD
Alpha synuclein
99
Protein Deposition: Fronto-temporal dementia and ALS
TAR DNA binding protein 43 (TARDBP43)
100
Protein Deposition: Pick's disease
Tau protein, Pick bodies (large ballooned neuronal cells)
101
Branches of the facial nerve - mnemonic
```
Ten Zulus Baked My Cat
Temporal
Zygomatic
Buccal
Mandibular
Cervical
```
102
Steroid regimens for surgery
Pre-op requirement <10mg and minor surgery - none
Pre-op >10mg daily and minor surgery - 25mg IV hydro + normal post op
>10mg and intermediate - 25mg IV + 25mg TDS 24h
>10mg and major - 50mg IV + 50mg TDS 72h
103
SIRS criteria
T >38 / <36
RR >20 / PaCO2 <4.25
HR >90
WCC >12 / <4
104
Pre-op management of pt with IDDM
Two common regimens - 1:1 (50u insulin in 50ml saline) or PIG (potassium insulin glucose)
Continue normal SC insulin until NBM before surgery
105
Mount Vernon formula for fluid replacement in burns
Use rule of 9s
(weight x % burn)/2 = Volume of colloid (mL)
First 3 sets every 4h, 2 sets every 6 hours, final set over 12h
106
Classes of shock
I - <15% blood loss (750ml), Obs within range
II - <30% (1500ml), tachycardia, tachypnoea, anxiety
III - <40% (2000ml), tachycardia, low BP, RR 30-40, low UO, confusion
IV- >40% (2500ml), Obs fucked, confused/drowsy
107
On which grade od splenic injury do we operate?
IV only
| I-III conservative
108
GCS in intubated patients
Discount vocal entirely, out of 10 points, rest normal
109
Monroe-Kellie concept
In cranial bleeding (fixed space), initial compensation (volume sacrificing) is provided by loss of CSF and venous volume. However when overwhelmed (150ml), exponential increase in ICP
110
Foramen of Winslow
Only communication between greater and lesser sac
| IVC, D1, hepatoduodenal ligament (contains portal triad), caudate lobe of liver
111
What runs in hepatoduodenal ligament?
Portal triad (HA, PV, CBD)
112
The anorectal ring is made up of?
Combined fibres of the puborectal muscle and external sphincter
113
Carcinoma of the anal canal presents with:
RF: Gay man (HPV)
Bleeding and incontinence
70% have sphincter involvement at resentation
25% have palpable mass
114
Peri-anal abscesses - different presentations
Majority of abscesses originate from infection within gland between internal and external sphincters.
65% will track down - perianal abscess (discrete red swelling close to anal verge)
15% track through external sphincter into ischiorectal fossae (systemic illness, extreme pain on palpation/DRE)
15% remain within muscle layers - intersphincteric abscess (chronic anal pain)
5% upwards through levitator ani - supralevator abscess (next to bladder - braider irritation)
115
Most CRC occur in the:
```
Rectum (33%)
Sigmoid (25%)
Caecum and ascending colon (18%)
Transverse (9%)
Descending
```
116
Inguinal Canal anatomy: MALT
Superior: M (internal oblique and transversus abdominis)
Anterior: A (aponeurosis of EO and IO)
Floor: L (Inguinal and Lacunar ligaments)
Posterior: T (transversalis fascia and conjoint tendon)
117
MoA colchicine for gout
Inhibits activation of neutrophils by irate crystal through inhibiting polymerisation of B tubulin
118
Breast imaging - cut off for US vs mammogram
35 years
119
Triple assessment
Examination + Hx
Imaging (mammogram / USS)
FNA ± core biopsy
120
Abx for acute mastitis
Flucloxacillin
| Pathogens likely skin commensals - majority Staph
121
Suitability for carotid endarterectomy - who?
Pts with symptomatic (TIA) carotid artery stenosis >70-80% good candidates
Symptomatic pts with stenosis 50-70% - optimise medical therapy and review regularly - if continue to be symptomatic operate
If asymptomatic but stenosis >80% consider endarterectomy but may be controversial
122
AAA - indications for surgery
>5.5 cm (at this size will increase 4-6mm per annum)
<5.5 but growing at rate of 1cm per annum or more
Symptomatic - back pain, distal embolisation
123
AAA repair principles
Either lapatotomy with dacron artificial graft or EVAR (endovascular aneurysm repair)
EVAR - femoral approach, radio guidance, endoluminal stunting. Better for patients less fit for surgery, shorter inpatient stay with less blood transfusions
124
Varicose veins - treatment options
Conservative - compression stockings, weight loss, avoiding standing, frequent periods of walking
Medical - injection sclerotherapy (e.g. Na tetradecyl) increases amount of granulation tissue (injection followed by compression bandage for few weeks). Foam sclerotherapy also done. SE: long term pigmentation changes at site.
Surgery - best option, if QoL severely impaired. Ligation of saphenopopliteal or saphenofemoal junctional endoluminal RF ablation
High recurrence rates all methods
125
Complications of carotid endarterectomy
Post-op HTN (66% pts) - close eye on BP for 72h
Stroke (5-8%)
Cranial nerve injury (5%)
Wound infection / patch rupture
126
Causes of necrotising fasciitis
Group A strep, vibrio vulnificus, clostridium perfringens, bacteroides fragilis
127
Indications for amputation
Useless limb - fixed flexion deformity, vestigial fingers
Dead limb - unsalvageable trauma, necrosis, PVD
Lethal limb - malignancy
128
Causes of Raynauds phenomenon
Primary - idiopathic
Scleroderma, SLE, polyarteritis nodosa, RA, cervical rib, polycythaemia, cryoglobulinaemia, B blockers,
Ix --> FBC, TFT, LFTs, ANA, RF, cold provocation tests, cryoglobulins
129
Popliteal aneurysms are associated with?
AAA - always look
| 50% B/L, 40% with AAA
130
What is the anatomy of the femoral artery?
As the external iliac passes under the inguinal ligament, it becomes the common femoral and gives of the profunda femurs artery before continuing down as the superficial femoral artery
131
Broadly, when would you use synthetic grafts, when organic?
Reversed (remember valves) autologous vein grafts indicated for below inguinal ligament, above use dacron / PTFE
132
How do you classify bypass procedures
Anatomical (e.g. femoropopiteal) vs Extra-anatomical (e.g. axillofemoral, axillo-bifemoral)
133
Branches of the external carotid
```
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
```
134
Renal arteries - anatomical relation
L1/L2 (right below SMA at L1)
135
At rest how much blood do kidneys receive?
20% via renal arteries
| R renal artery lives posterior to IVC and is the longer one
136
Which muscle is posteromedial to kidneys?
Psoas. Also separates ureters from lumber vertebrae.
137
Widest and narrowest part of male urethra
Widest - prostatic, approx 3cm in length, vas deference and prostatic duct open here.
Narrowest - membranous urethra - where pierces the urogenital diaphragm
138
Frequency of stone composition
```
60% Ca oxalate
30% triple (Mg, Ca, PO4)
5% Uric acid
2% Cysteine
1% Xanthine
```
139
What size stones can a person pass?
Usually <5mm
140
Which scan can estimate renal function?
DMSA scan
141
Which organisms predispose to renal calculi?
```
Proteus
Pseudomonas
Staphylococcus
Mycoplasma
Klebsiella
These are urease splitting organisms which hydrolyse urea to ammonia causing alkylotic urine and precipitation
```
142
Fournier's gangrene
Rare necrotising fascists of the perineum and genitals
Middle aged - elderly men
Co-morbidities include DM
143
ADPKD genes
PKD1 chr 16 (85%)
| PKD2 chr 4 (15%)
144
ECG hypokalaemia
```
Small/inverted T waves
Prominent U waves
Prolonged PR
ST depression
Prolonged QT
```
145
ECG hyperkalaemia
Tented T waves
Small P waves
Wide QRS
146
RF RCC
```
Dialysis (causes acquired cystic disease in 90%)
Smoking
Lead
Asbetos
Polycarbons
FH: VHL
```
147
Treatment of bladder cancer - medical
BCG for 6wks can be tried
148
Testicular tumours
1. Stromal. Leydig cells (secrete androgens); Sertoli cells (secrete androgens and can present with testicular feminisation)
2. Lymphoma. <10%, elderly, poor prognosis
3. Germ cell. Seminomas - 20 to 40 years, solid, slow growing, very Rx (5yr 90%), AFP. Teratomas - 15 to 35 years, solid or cystic, bHCG + AFP
ALL Drain to para-aortic LN
149
Peyronie's disease - associations and treatment
Dupuytren's and palmar fascitis
1 year conservative - allow disease to stabilise
Surgical --> Nesbit's (cut opposite side, shortens penis)
150
Prostate anatomy
Transition zone - innermost, surrounds urethra, enlarged in BPH
Central zone - surrounds ejaculatory ducts, projects beneath bladder to seminal vesicles
Peripheral zone - most Ca here (causes bulky irregular palpable prostate)
Anterior fibromuscular stroma
151
BPH treatment
Medical - alpha blockers (tamsulosin, alfuzosin); 5 alpha reductase inhibitors (finasteride, dudasteride)
Surgical - TURP
152
A partial radial nerve injury causing weakness in finger and wrist extension but no wrist drop or sensory loss is associated with?
Radial nerve winds around shaft of humerus, enters the forearm laterally, runs adjacent to head of radius.
Head of radius fracture
Proximal to this gives off superficial radial (sensory), posterior interosseus, superficial radial
153
RA and OA - valgus or varus?
RA causes valgus (more commonly affects lateral compartment)
OA causes varus (moe commonly affects medial compartment)
However since OA >>> RA, overall valgus more likely to be caused by OA
154
What is the most common cause of traumatic haemarthrosis?
ACL injury
155
What disease is associated with Baker cyst rupture
Both OA and RA, rupture with active RA
156
Papillary thyroid Ca histology
Ground glass "Orphan Annie" nuclei with psammoma bodies (calcified spherical bodies)
157
Early non-invasive bladder tumours and treatment
CaIS (confined to epithelial layer)
Ta (papillary neoplasm confined to bladder epithelium)
T1 (invasion into subepithelial layer but not muscle layer)
Tx = TUR of bladder tumour (TURBT) + intravesical chemo (e.g. doxorubicin) or BCG intravesical depending on grade:
Low grade (single dose chemo)
Medium (6/52 weekly chemo)
High (5/52 BCG)
5yr survival 80-90%§
158
Lower parietal lesion
Lower quadrantanopia
159
Temporal lobe lesion
Upper quadrantanopia
160
Delayed gastric emptying in DM
Stop GLP-1 agonists
| Add pro kinetic agent (metoclopramide / domperidone)
161
Comedocarcinoma
High grade malignant ductal epithelial cells with dark staining nuclei and mitotic figures under high powered field
Necrosis and central calcification + intact BM
High grade ductal carcinoma in situ
162
Axillary nerve injury
C5, C6. Commonly anterior dislocation with flattening of deltoid muscle after injury.
Loss of lateral rotation and abduction of affected shoulder, loss of sensation over lateral arm
163
Median nerve injury
C5 - T1
Supracondylar fracture of humorous.
Loss of flexion of digits, thenar muscle and lumbricals 1&2, loss of pronation and sensory loss on lateral palm and 3 half digits
164
Meniere's disease
Episodic vertigo, tinnitus, hearing loss, fullness/pressure in ear before attack
165
Smith's fracture
Reverse colle's
Distal radius fractues with velar angulation of distal bony fragment.
Fall on flexed wrist
166
Monteggia's fracture
Proximal ulna with dislocation of radial head
167
Galleazii's fracture
Fracture of radius with dislocation of radio ulnar joint
168
Hangman's fracture
C2 vertebrae due to hyperextension of neck
169
Jefferson's fracture
C1 vertebrae caused by axial loading to head - diving in shallow water and hitting bottom
170
Air crescent sign
Invasive aspergillosis
| Sign of recovering from infection
171
ASD
Prominent RV cardiac impulse, ESM in pulmonary area & along left sternal border, fixed splitting of S2
172
HHT
Epistaxis, telangectasia, visceral lesions and FDR with OWR
173
Penicillamine
Membranous nephropathy
174
Salter Harris Fracture classification of physeal fractures
SALTR
Physeal = involving the growth plate
I - Slipped (5-7%, though growth plate, cannot occur if gp fused)
II - Above (75%, passes across gp and up through metaphysis)
III - Lower (7-10%, passes some distance along gp and down through epiphysis
IV - Through/Transvers/Together
IV - Ruined (crush injury of growth plate)
175
Kruckenberg tumours
Gastric Ca mets to ovary - contains signet ring cells
176
Vaughan & Williams classification
```
I - Na channel blocker (flecanide)
II - Beta blocker (atenolol)
III - K channel blocker (amiodarone)
IV - Ca channel blocker (diltiazem)
V - Other (digoxin)
Note amiodarone has I, II, III and IV activity
```
177
Epistaxic point?
Little's area
178
Surgical neck of humerus fracture
Posterior and or anterior humeral circumflex artery
| Axillary nerve
179
Complications of blood transfusion
Hyperacute: allergic, haemolytic, non haemolytic fever, pulmonary oedema
Acute: haemolytic, TRALI, bacterial infection
Late: viral infection, GVHD, Fe overload, immune sensitisation
180
Subcostal, transpyloric, supracristal and intertubercular planes
Transpyloric - L1
Subcostal - L3
Supracristal - L4
Intertubercular - L5
181
Skier's thumb
Ulnar collateral ligament tear
| Pain on ulnar side on MCP, weakness of grasp & pinch
182
HA - warm or cold
Warm --> Idiopathic, SLE
| Cold --> infectious mononucleosis, idiopathic cold haemagglutinin syndrome
183
Popcorn wool calcification XR
Chondrosarcoma
| Paget's
184
Codman's triangle
```
Ewings sarcoma (+ Onion skin periostitis)
Osteosarcoma (+sun ray speculation
```
185
Structures passing behind medial malleolus
```
Tibialis posterior tendon
Flexor digitorum longus tendon
Posterior tibial vein
Posterior tibial artery
Tibial nerve
Flexor hallucis longus
```
186
Anaesthetic muscle relaxants
1. Non depolarising (pancuronium, atracurium). Reversible competitive antagonists of acetylcholine at nicotinic receptor. Terminated by anticholinesterase (neostigmine)
2. Depolarising (suxamethonium, succinylcholine). Irreversible, initially stimulating.
187
In which pts suxamethonium dangerous as fuck?
Normally metabolised by pseudocholinesterase
| Some pts familial deficiency of this enzyme
188
PNH
Phosphatidylinositol glycan A defect in RBC
Increased binding of complement to RBC, makes cells susceptible to lysis in mildly acidotic environment (e.g. relative hypoventilation at night)
Thrombosis of major veins common
189
BRCA1
Breast prostate pancreas ovarian melanoma
190
Complications of acromegaly
```
ABCDEFGH
Acromegaly
BP / Bowel Ca
Cardiomyopathy / Carpal tunnel
DM
Enlarged viscera
Field defects
Galactorrhoea
HF / HTN
```
191
Old guy, acute onset dizziness / R hearing loss?
Anterior inferior cerebellar artery stroke
| Supplies lateral inferior pons (vestibular and cochlear nuclei
192
Parkland formula burns
4ml/kg x % burn = 24 hour requirement
| 1/2 in first 8h, remainder over 16 hours
193
Otosclerosis
AD, conductive heraing loss, classically worse in pregnancy.
Incomplete penetrance
Fixation of stapes bone in ear
Hearing aids, stapedectomy/stapedotomy
194
Open angle glaucoma
OPEN
Optic disc pales (atrophy)
Pressure >21mmHg (disk cupping + capillary closure = nerve damage)
Emerging blood vessels have breaks
Nasal and superior fields lost first (last to go temporal)
195
Acute closed angle glaucoma
CLOSED
Cornea hazy
Lights have haloes and blurred
Occurs due to blocked drainage of aqueous humour from anterior chamber via canal of Schlemm
Shallow anterior chamber is RF
Dilatation of pupil at night worsens condition
196
Retinal detachment
```
FFFF
Floaters
Flashes (migraine)
Field loss (dark cloud)
Falling acuity
```
197
Carpal Bones
Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate
198
Silicosis
Small numerous opacities in upper lung zones with hilar lymphadenopathy
199
Blood supply to NoF
Medial circumflex femoral
200
Hand of benediction
In median nerve injury, inability to flex MCP of index and middle finger (loss of innervation to lateral 2 lumbricals
201
Rapid sequence induction
Thiopentona and Suxamethonium
202
Whipple's disease
Infection by tropheryma whopplei (actinomycete)
| Malabsorption + Intestinal LN ± cognitive decline / arthritis / hyperpigmentation / retinitis / endocarditis
203
Surface anatomy: R lung
Oblique fissure = rib 6 (inf vs sup & middle lobe)
| Horizontal fissure = R 4th costal cartilage (mid vs sup)
204
Coagulation disease: Vit K def / Warf
PT +
APTT =
PLT =
BT =
205
Coagulation disease: DIC
PT +
APTT +
PLT -
BT +
206
Coagulation disease: Thrombocytopenia
PT =
APTT =
PLT -
BT +
207
Coagulation disease: Bernard Soulier
```
Giant platelet syndrome, defectin in GP1b. Megakaryocytes on film
PT =
APTT =
PLT -
BT +
```
208
Coagulation disease: Haemophilia
PT =
APTT +
PLT =
BT =
209
Coagulation disease: vWD
PT =
APTT +
PLT =
BT +
210
Coagulation disease: Glanzmann's
```
Defect in GP IIb/IIIa
PT =
APTT =
PLT =
BT +
```
211
Tennis elbow
Extensor carpi radialis brevis
Also known as lateral epicondylitis
Overuse condition
RICE + NSAID + Physio may take a year to fully effect
212
C1 inhibitor deficiency
Hereditary angiodema
213
C3 deficiency
Inpaired response to encapsulated bacteria
214
Terminal compliment deficiency
Neisseria infections
215
Congenital neutrophil deficiency
Pyogenic bacteira and fungi
| Chronic granulomatous disease / Hyper IgE syndrome
216
Congenital B cell deficiency
Hypogammaglobulinaemia, bacterial and fungal infections
| Common variable deficiency
217
Congenital T cell deficiency
Imparied cell mediated immunity - viral, mycobacterial, fungal infections
DiGeorge
218
Congenital B and T cell deficiency
Viral, bacterial, mycobacterial and fungal
| SCID, Wiskot-Aldrich
219
t14:18 translocation
BCL2 gene, Follicular lymphoma
220
t8:14 translocation
cMyc - Burkitt's
