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Flashcards in Revision Deck (79):
1

Normal oeseophageal histology

Non-keratinised squamous epithelium, lots of mucous glands

2

Definition of reflux oesophagitis

Inflammation of oesophagus due to refluxed low pH gastric content

3

Microscopic findings in reflux oesophagitis

Basal zone epithelial expansion
Intraepithelial neutrophils, lymphocytes and eosinophils

4

Infections with what virus causes squamous papilloma?

Infection with HPV

5

What is a Kruckenberg tumour?

A tumour in the ovary that has metastasised from a primary site (usually GI e.g. stomach)

6

The most metabolically active part of the bowel wall

The mucosa - therefore most sensitive to infarction

7

Amyloidosis is a rare but serious complication which may occur in which disease?

In Crohn's
(basically protein is deposited and ruins organs- most commonly the kidneys and patients present with nephrotic syndrome/impaired renal function/renal failure)

8

Rare features of pancreatitis

Ischaemic (Purtscher) retinopathy
-may cause temporary or permanent blindness

9

Two potentially life-threatening causes of epigastric pain in young people?

-appendicitis
-peptic ulcer disease

10

Preferred diagnostic test for pancreatitis?

CT pancreas WITH contrast - look for calcification
(with contrast gives clearer resolution than non-contrast)
(MRI poor at picking up calcifications)

11

When is pain worse in pancreatitis?

Typically worse 15-30 minutes after a meal

12

Gradual onset obstructive jaundice without a palpable gallbladder

Think cholangiocarcinoma

13

Typically painless jaundice WITH palpable gallbladder

Pancreatic cancer

14

Why do you need to manage jaundice?

Patients with unrelieved jaundice have a much higher incidence of septic complications, bleeding and death

15

What type of suture should be used for vascular anastamoses?

Non-absorbable monofilament suture

16

What are retractile testis?

A testis that appears in warm conditions, or which can be brought down on clinical examination and does not immediately retract

17

What is Boas' sign

This is when you get pain under the right scapula in acute cholecystitis

18

What is Rovsing's sign?

This is when you press on the left lower quadrant and get pain in the right lower quadrant (appendicitis)

19

When do you see Cullen's sign?

Seen in pancreatitis and in other causes of intra-abdominal haemorrhage (e.g. ectopic pregnancy rupture)

20

When would you see Grey-Turner's sign?

In pancreatitis, or other retroperitoneal haemorrhage

21

A thyroidectomy may damage which nerve?

The laryngeal nerve

22

Inguinal hernia surgery may damage which nerve?

The ilioinguinal nerve

23

A carotid endarterectomy may damage which nerve?

The hypoglossal nerve

24

A 34-year-old lady presents with a long standing offensive discharge from the ear and on examination is noted to have a reduction in her hearing of 40 decibels compared to the opposite side

Cholesteatoma
(combination of offensive discharge and hearing loss is strongly suggestive of cholesteatoma)

25

Treatment for C.diff

Vancomycin

26

Where would you find peyers patches?

Small intestine

27

Mucosal defence of large intestine

Enterocytes do defence

28

What do paneth cells release and where would you find them?

Release defensins
Found in small intestine

29

What could cause dry mouth?

Lack of saliva (e.g. infection, dehydration)
Salivary gland disease (sjogrens syndrome, radiotherapy)
Diabeties (diuretics!)

30

What might raise PSA levels?

benign prostatic hyperplasia (BPH)
prostatitis and

urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)

ejaculation (ideally not in the previous 48 hours)

vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

31

What might cause orofacial granulomatosis?

Allergy
Crohn's disease
Sarcoidosis

32

H. pylori can either increase acid secretion and cause ulceration, or decrease acid secretion and predispose to gastric cancer, how does the latter occur?

IL-1 beta production in stimulated by H. pylori infection
IL-1 beta is a powerful inhibitor of acid secretion

33

Imaging studies for oesophageal cancer?

Upper GI endoscopy
Barium meal
CT (MRI) scan of chest and abdomen
Bronchoscopy

34

Treatment of oesophageal cancer

Surgery is only chance of "cure"
(not suitable for T4/M1)
Radiotherapy

35

Gastric cancer treatment

Total gastrectomy for proximal lesions
Partial gastrectomy for distal lesions
Radiotherapy
Chemotherapy

36

Treatment of typhoid

Chloramphenicol and ciprofloxacin

37

How would you diagnose typhoid?

Blood culture is key to diagnosis

38

Which strains of hepatitis may cause fever and jaundice?

Hep A and Hep E (occasionally hep B)

39

Side effects of steroids

MSK - avascular necrosis, osteoporosis
GI
Cutaneous - acne, thinning of the skin
Metabolic - weight gain, diabetes, hypertension
Neuropsychiatric
Cataracts
Growth failure

40

Treatment of rectal gonorrhoea

Cephalosporin e.g. ceftriaxone
IM in the bum stat

41

Treatment of rectal chlamydia

Azithromycin (STAT dose)
Doxycycline (7/7 course)
Test of cure at 6 weeks

42

What is the nutcracker angle?

Angle between the abdominal aorta and superior mesenteric vein (renal vein may become compressed here in renal cancer --> varicocele)

43

Treatment of lymphogranuloma venerum

Doxycycline

44

Triad of Budd-Chiari syndrome

Abdominal pain
Ascites
Enlarged liver

45

What is Fitz-High curtis syndrome?

This is when pelvic inflammatory disease (usually chlamydia) causes adhesions between the abdominal wall and the liver

46

Usually recent upper respiratory tract infection.
High grade fever.
Generalised abdominal discomfort

Mesenteric adenitis

47

You think someone might have appendicitis, what other test must you do?

Pregnancy test

48

What is mittelschmerz?

Only seen in females - midcycle pain
Usually occurs two weeks after last menstrual period
Pain is usually suprapubic location.
Usually subsides over a 24-48 hour period

49

Only seen in females - midcycle pain
Usually occurs two weeks after last menstrual period
Pain is usually suprapubic location.
Usually subsides over a 24-48 hour period

Mittelschmerz

50

US findings of Fitz-Hugh Curtis syndrome?

Abdominal ultrasound may show free0flui

51

Management of Fitz-Hugh Curtis syndrome

Usually managed medically - doxycylcine or azithromycin

52

Most common type of renal carcinoma?

Renal cell carcinoma (adenocarcinoma)

53

Is vasectomy effective immediately?

No, need to perform semen analysis at 16 and 20 weeks

54

Complications of vasectomy

Bruising, haematoma, sperm granuloma
Chronic testicular pain (affects between 5 and 30% of men)

55

"Someone is taking analgesia for a sore hip what do they have"

Perforated peptic ulcer (LOL MOST VAGUE PASSMEDICINE Q ever)

56

Which type of transplants are at risk of hyperacute rejection?

Renal transplants at greater risk, liver transplants least risk

57

Name a class of drugs that are nephrotoxic

NSAIDS
e.g. diclofenac

58

What type of cells are responsible for acute organ transplant rejection?

T cells

59

Someone has bubbly urine and frequent UTI, what causes this and what should you investigate for?

Enterovesical fistula - must investigate for underlying colorectal malignancy

60

Acute management of renal colic

IM diclofenac

61

Kidney stone treatment:
1) 0.7cm stone associated with hydronephrosis
2) A 1cm left sided ureteric caculus with no associated hydronephrosis
3) large staghorn calculus that measures 2.3cm in diameter

1) nephrostomy/uteroscopy and IV antibiotics
2) Extracorpeal shock wave lithotripsy
3) Percutaneous nephrolithotomy (nephrolithotomy for large unusual shaped stones)

62

Thiazide diuretics may cause which type of stone?

Calcium stones

63

Cholestyramine may cause which type of stone?

Oxalate stones

64

Allopurinol may cause which type of stone?

Uric acid stone

65

What might raise PSA levels?

benign prostatic hyperplasia (BPH)
prostatitis and

urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)

ejaculation (ideally not in the previous 48 hours)

vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

66

Anti-muscarinic for overactive bladder

NICE recommend oxybutynin, tolterodine or darifenacin

67

Management of nocturia

-advise about moderating fluid intake at night
-furosemide 40mg in late afternoon may be considered helpful
-desmopressin may also be helpful

68

Diagnosis of pagets disease of the nipple

Punch biopsy, mammography and ultrasound of the breast

69

Where would you find Cloquet's lymph node?

In the inguinal canal

70

Borders of the femoral canal

Laterally - femoral vein
Medially - lacunar ligament
Anteriorly- inguinal ligament
Posteriorly - pectineal ligament

71

Differences between hyperacute, acute and chronic organ rejection

Hyperacute - occurs immediately through presence of preformed antigens (e.g. HLA, ABO, complement)

Acute - T cell mediated, occurs within first 6 months, MONONUCLEAR CELLS PREDOMINATE

Chronic - occurs after 6 months, vascular changes predominate

72

Who is most likely to get intussception and KEY BUZZWORD?

Most likely to occur in children
Symptoms include rectal bleeding and RED JELLY STOOL

73

If Meckel's diverticulum were to present how might it?

Usually asymptomatic, but if it does present then usually before age 2
Symptoms include rectal bleeding, bowel obstruction, intusussception, volvulus or a picture similar to acute appendicitis

74

What is the lowest Gleason score for prostate cancer?

6
(the gleason score is comprised of the sum of the two most common histological patterns seen, the first number reflects the most common grading seen in all the samples, the second number is the highest grade of remaining tissue
As such, the score can range from 2 to 10, however grades 1 and2 not usually used so lowest score is 3+3 = 6)

75

What side are varicoceles most likely to present?

Left side

76

What is the most sensitive test of acute pancreatitis?

Lipase

77

What is the nutcracker angle?

Angle between the abdominal aorta and superior mesenteric vein (renal vein may become compressed here in renal cancer --> varicocele)

78

Investigation of suspected renal stone

FIRST do ultrasound and then if you think there is a stone, do non-contrast CT (NON-CONTRAST)
- if you use contrast then it basically becomes invisible

79

A 73 year old lady is admitted with a brisk rectal bleed. She is otherwise well and the bleed settles. On examination her abdomen is soft and non-tender. Elective colonoscopy shows a small erythematous lesion in the right colon, but no other abnormality

Angiodysplasia

(can be difficult to identify and treat because might be missed if poor bowel preparation)

Bleeding may be massive however may cause few symptoms

The right side of the colon is more commonly affected