Random Flashcards by Maredudd Harris

In the management of a patient with DKA, what is the most important factor:

give vigorous IV fluids

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Patient with chest pain history and ECG finding ST elevation all leads

Pericarditis

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Patient has upper abdominal pain, in which one of the following conditions will the pain not radiate to the back:

a. PUD
b. perforated appendicitis
c. acute pancreatitis
d. AAA (rupture?)
e. biliary colic

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: (o)esophagus

R: rectum

THerefore biliary colic

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70 y/o male patient presents with weight loss, anorexia and constipation. Bloods show a microcytic anaemia. Which diagnosis is likely:

a. carcinoma of sigmoid colon
b. small bowel tumour
c. angiodysplasia of caecum
d. PUD
e. rectal polyp

Anorexia - cancer

Age - cancer

Constipation - obstruction

Microcytic anaemia - Iron deficient

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Footballer injures shin during game, thereafter has painful toes, bandaging and analgesia do not relieve pain which is getting worser. What would you do next

Compartment syndrome

Decompress with fasciotomy

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Patient has left homonymous hemi-anopia. Where is the lesion

Right Occipital Lobe

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35 y/o female presents spitting blood 1 week post-tonsillectomy. What type of bleed is this

secondary

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Patient presents with midline swelling that moves on tongue protrusion

thyroglossal cyst

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Patient present with chronic suppurative chronic external otitis media. Which is most common symptom

conductive hearing loss

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Middle-aged male eats fruit & nut chocolate bar. 15 minutes later he becomes short of breath and has stridor. How would you treat him

IM adrenaline

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Patient is a slow eater, chest x-ray shows… , barium swallow shows tapering of the oesophagus distally. Diagnosis is

achalasia

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DM fundoscopy. Proliferative retinopathy involves

neovascularization

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50 y/o patient present s with headache, protruding L eye with a droop and dilated pupil. What is diagnosis

cavernous sinus aneurysm

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20 y/o female, presents with painless irregular lump in L breast. Skin dimpling and tethering are present. No nodes on L are palpable. What is the diagnosis

GO OVER BREAST CANCER

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Iron deficiency anaemia associated with MCV

Microcytic Anaemia

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Anaemic patient with leg ulcers and priapism suffers from

Sickle Cell

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Mid-diastolic murmur in a patient who has atrial fibrillation controlled by digoxin

Mitral Stenosis

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Which ECG leads would suggest an inferior MI:

Ii III aVF

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Male patient presents with history of shaft of femur fracture 1-2 weeks post-op. He has bilirubin of 80 and is jaundiced. There are no other symptoms and all other LFTs are normal. What is the likely cause

Gilberts

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26 y/o builder, 3 hour history of R colic which radiates into genitalia and lasts ½ hour at a time. He also vomits and has microscopic haematuria:

a. UTI

b .ureteric colic

c. testicular torsion
d. bladder cancer
e. renal tuberculosis

Ureteric Colic

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65 y/o female, 10 days post-THR, has chest pain, HR: 110 bpm, BP: 110/80, JVP: +15cm. The investigation of choice is

CTPA for PE

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13 y/o female, has argument with grandmother and takes 12 tablets of 10mg diazepam. How will you treat her

flumazenil

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80 y/o male with hypertension and atrial fibrillation. How would you reduce the risk of “embolic stroke”:

Warfarin

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Male with alcoholic cirrhosis. On examination percussion dullness and fluid suggest ascites. USS shows fluid and diagnostic ascetic tap show sterile transudate with no malignant cells. He is not SOB. First line treatment

Sprio

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70 y/o female with SOB on exertion has ejection systolic murmur, diagnosis

Aortic stenosis

26 y/o male homosexual footballer has fever, SOB and cough. He is admitted for 2 weeks and treated for pneumonia. He is very ill, however decides to self-discharge, what advice would you give him

IF TB then notifiable disease and keep in by force Otherwise - to advise to stay

50 y/o male smoker has a cough, hoarseness and a “breathy” voice. There are no findings on examination. Nasoendoscopy reveals a vocal cord palsy. What investigation would you do next

Chest X ray for lung mets

Patient presents with hepatosplenomegaly, but no lymphadenopathy. Bloods show ↑ plt ,↑ wbc, ↓ hb. Blood film shows Philadelphia

CML

Patient with increased BP has coarctation of aorta, which of the following sign

radio femoral

Patient 5 days post-anterior resection operation. The fluid balance chart shows -1370 ml/24 hr. What is the likely cause

third space losses

Old male presents in A&E with 1 day history of acute L eye pain. The cornea was cloudy and the pupils mid-dilated. What is the diagnosis

acute closed angle glaucoma

Hypernatraemia is associated with: a. Cirrhosis of the liver b heart failure c. SIADH d. diabetic coma

diabetic coma others cause hypo

A patient and his family present with history of itching. Likely diagnosis

scabies

An old male with diabetes present complaining of hand pain at night relieved by shaking etc. What is the likely cause

CTS

An old lady with rheumatoid arthritis presents with gradual reduction in visual acuity. What is the likely cause

Steroid induced glaucoma

A patients blood film shows rouleaux formation and his bloods show ↓ hb, ↓ plt, ↓ wcc, ↑Ca2+. What is the likely diagnosis

Myeloma

A patient presents with haematuria 1 week post-URTI. What is the likely cause:

IgA nephropathy (Berger’s Disease)

An alcoholic patient vomits blood. He has surgical emphysema etc. etc. What is the likely cause

lower oesophageal rupture

Patient has cellulitis of leg. You need to prescribe an antibiotic. Which organism would you ensure you covered

Haemolytic streptoccoi

treat trichomonas

Metronidazole

AMitriptaline overdose

IV bicarb

How do you treat HIV encecphalitis (toxoplasma gondii)

pyrimethamine plus sulfadiazine or clindamycin

Pneumovax indications

all over 65 defunctioning spleen chronic resp conditions chronic heart, kideny, liver conditions immunosupressed cochlear implants CSF leak occupational hazard

TB meningitis treatment

rifampicin + isonoazid + pyrazinamide + ethambutol

An old male presents with a unilateral swelling of the parotid gland. On examination cranial nerve VII function has not been affected

Pleopmorphic adenoma * 80% of tumours in the parotid are benign pleopmorphic adenomas * Typically: middle age, slow growth * Removed by superficial parotidectomy or enucleation. Radiotherapy has a role eg in residual disease or recurrence (recurrence rate of 1-2% at 12 years) VII nerve paresis suggests malignancy * Rapid growth, hard fixed mass, pain and VII nerve palsy

Non-necrotising granulomas found in

* Chron’s: non-necrostising granulomas are found within the inflammation in the gut wall. * Sarcoidosis: get graulomas in multiple organs. Most do not contain necrosis and are surrounded by concentric scar tissue (fibrosis).

caseating granulomas found in

* TB: Said to be caseating – grossly visible cheese like appearance * Wegeners granulomatosis

A lady presents with constipation, abdominal pain and vomiting. She has other symptoms suggestive of malignancy. most important/first line investigation

Calcium

ABCDEFGHI of vomiting

* Acute renal failure/Addisons, brain (eg raised ICP), cardiac (MI), DKA, ears (labyrinthitis, Menieres), foreign substances (alcohol, drugs), gravidy (eh hyperemesis gravidarum), hypercalcamia/hyponatraemia, infection (eg UTI, meningitis)

Isosorbide mononitrate

1. _postural hypotension,_ fast/fluttering heart beat, flushing

Frusemide

postural hypotension, ringing in the ears, increased sensitivity to sunlight

Phenytoin

increased hair growth, acne, numbness/tingling, sore/swollen gums

Simvastatin

muscle/joint pain, numb/pins+needles, nightmares, mood change, sexual probs

Bisoprolol

postural hypotension, coldness of the extremities, disturbed sleep, nightmares

Enalapril

dry cough, low mood, taste disturbance

Verapamil/diltiazem

postural hypotension, flushing, muscle/joint pain, , swollen ankles, rash

B2-agonist (maybe salbutamol)

tremor, palpitations

achondroplasia is what type of inheritance

85% sporadic mutation auto dominant

when to suspect ampyema

if resolving pneumonia but swinging fevers and lower lobe effusion

lung cancer histological finding of increased keratinisation

SCC

1. 20 y/o male who is otherwise fit and healthy develops typical community acquired pneumonia:

Streptococcus pneumoniae

75 y/o male with COPD has an acute exacerbation

1. viral- influenza/ rhinovirus/ adenovirus streptococcus or haemophilus

20 y/o male with cystic fibrosis

pseudomonas

male with SOB. worse on week days, better on weekends. works in zoo

psittaci

40 y/o male develops life-threatening community acquired pneumonia after returning from sprain/brazil

legionella

young male presents with 19 day history of gradual SOB and low fever. His chest x-ray reveals “diffuse perihilar shadowing

PCP

if a patient has random bits of palpitations what the best ivx

Holter monitor

in A.fib how do you manage?

Rate vs rhythm Rhythm first in young - amioderone Rate in old or ICH - bb or digoxin