Spotter Flashcards

Question

What is this skin complication of DMT2? [1]

Answer 1

**Necrobiosis lipoidica diabeticorum**

Answer 2

**Granuloma annulare**

Answer 3

**Diabetic cheiroarthropathy** is also called diabetic hand syndrome or stiff hand syndrome

Answer 4

Pharyngitis -> Group A strep Rx – penicillin V x10 days (or clarithromycin/erythromycin if allergic)

Answer 5

A patient has infective mononucleosis. What drug has been given to cause this complication? **Amoxicillin** Ciprofloxacin Azithromycin Doxycycline Cephalexin

Answer 6

Oncholysis - Hyperthyroidism, fungal infections, psoriasis

Answer 7

**Beaus lines** - temporary arrest of nail growth at times of biological stress Severe infection eg malaria, typhus, rheumatic fever, Kawasaki disease, MI, chemo, trauma, high altitude climbing, deep sea diving

Answer 8

**Terrys nails** - Cirrhosis, CKD, congestive cardiac failure

Answer 9

** Mees lines:** - **single white transverse bands classically seen in arsenic poisoning, CKD, carbon monoxide poisoning **

Answer 10

**Chronic paronychia** – chronic infxn of nail fold, painful swollen nail + intermittent discharge

Answer 11

Nail fungal infection

Answer 12

**Muehrcke’s lines** – paired white parallel transverse bands without furrowing of the nail seen in chronic hypoalbuminemia, hodgkins, pallegra (niacin/B3 deficiency), CKD

Answer 13

**Red man syndrome – vancomycin**

Answer 14

Person with AIDS. What infection has caused this KS? [1] HPV 2 HPV 4 HPV 6 **HPV 8** HPV 10

Answer 15

C. diff (pseudomembrane colitis)

Answer 16

**Diplococci bacteria** -> **strep pneumoniae** Rx – **amoxicillin, ciprafloxicin** if not available/allergic

Answer 17

Otitis media

Answer 18

Roth spots Infective endocarditis

Answer 19

**Central retinal vein occlusion** - **‘Stormy sunset’ appearance**

Answer 20

**Hypertensive retinopathy.** The retinal arteries have become **narrow and tortuous.**

Answer 21

Papilloedema Disc cupping **Optic atrophy** Central retinal artery occlusion Central retinal vein occlusion Hypertensive retinopathy

Answer 22

**Exudative (Wet) macula degeneration** - characterized by the formation of pathological choroidal neovascular membranes (CNM) under the retina, which can leak fluid and blood.

Answer 23

**IgA nephropathy** Membranous nephropathy Focal segmental glomerulosclerosis (FSGS) Membranoproliferative glomerulonephritis (MPGN) Rapidly progressive glomerulonephritis (RPGN)

Answer 24

Patient has malaria - which type? **P. vivax** - signet ring; ameboid shape P. ovale P. falciparum P. malaraie

Answer 25

**P. falciparum**

Answer 26

Patient has malaria - which type? P. vivax P. ovale P. falciparum **P. malaraie** - bands

Answer 27

Patient has malaria - which type? P. vivax **P. ovale** P. falciparum P. malaraie

Answer 28

Patient with BHL and this histological slide. What type of HS? 1 2 3 **4** - TB

Answer 29

Bronchiectasis

Answer 30

Hiatus hernia

Answer 31

Anion gap = Na + K – (Cl+HCO3) Osmolarity = 2(Na+K) + urea + glucose

Answer 32

LV aneurysm

Answer 33

**LA enlargement**

Answer 34

**Pulmonary mets**

Answer 35

**Phrenic nerve palsy**

Answer 36

**Pneumothorax**

Answer 37

**Surgical emphysema**

Answer 38

**Chest drain**

Answer 39

Cor pulmonale - RVH

Answer 40

**Kantors string sign - Crohns**

Answer 41

The abdominal x-ray is consistent a diagnosis of ulcerative colitis showing lead pipe appearance of the colon (red arrows). Ankylosis of the left sacroiliac joint and partial ankylosis on the right (yellow arrow), reinforcing the link with sacroilitis.

Answer 42

**Cobblestoning** - **Crohns**

Answer 43

**Crohns**

Answer 44

Signet ring cells -> gastric cancer

Answer 45

Signet ring cells -> gastric cancer

Answer 46

**Peptic ulcer**

Answer 47

A: acute tubular necrosis B" acute interstitial nephritis

Answer 48

**Myocarditis**

Answer 49

**Double duct sign** - main pancreatic duct (short arrow) and common bile duct (long arrow). Caused by **pancreatic cancer**

Answer 50

**Snowstorm - breast implant rupture**

Answer 51

**B. Branch retinal vein occlusion**

Answer 52

Which is the cause of her sudden loss of vision? A. Branch retinal artery occlusion B. Branch retinal vein occlusion C. Central retinal artery occlusion **D. Central retinal vein occlusion** E. Cilioretinal vein occlusion

Answer 53

**C. Central retinal artery occlusion**

Answer 54

**D. Pneumothorax**

Answer 55

**Lipodermatosclerosis**

Answer 56

**Buerger's syndrome**; corkscrew collaterals

Answer 57

**green wound = pseudomnas aerugonisa.**

Answer 58

**Extensive Osler's nodes** on the hand of a patient with infective endocarditis.

Answer 59

Endoscopic Image of **Ulcerative Colitis** with **Pseudopolyps**

Answer 60

**Cobblestone appearance** of Crohn's with skip lesions

Answer 61

A patient presents with these changes to their nails. You find they are suffering from micocytic anaemia. What is the most likely cause? Thalassemia Anemia of chronic disease Iron deficiency **Lead poisoning** Sideroblastic anemia.

Answer 62

**Psoriasis**

Answer 63

Koilonychia refers to spoon-shaped nails. Can be caused by: * Iron deficiency anaemia (e.g. Crohn’s disease) * Lichen planus * **Rheumatic fever**: therefore **Streptococcus pyogenes**

Answer 64

Erythema nodosum is a self-limiting disease that can be treated with **NSAIDs** (e.g. naproxen). Steroids may be prescribed in some setting (e.g. sarcoidosis).

Answer 65

**Pyostomatitis vegetans**: an inflammatory stomatitis

Answer 66

**Rosehorn ulcer**

Answer 67

**Aphthous ulcers**

Answer 68

**pyoderma gangrenosum**

Answer 69

**Non-caseating granuloma** (w/ Langhan giant cells)

Answer 70

**Erythema Nodosum**

Answer 71

**Pyoderma gangrenosum**: large, painful sores (ulcers) to develop on your skin, most often on your legs.

Answer 72

**Superficial thrombophlebitis**

Answer 73

**Superficial thrombophlebitis**

Answer 74

A: **Cullens sign** B: **Grey-Turners sign** Cullen's and Grey-Turner's signs are associated with **severe necrotising pancreatitis**

Answer 75

Hard exudates

Answer 76

Lipid exudates

Answer 77

intraretinal microvascular abnormality (IRMA; **green arrow**) venous beading and segmentation (**blue arrow**) cluster haemorrhage (**red circle**) featureless retina suggestive of capillary non-perfusion (**white ellipse**)

Answer 78

**Cotton wool spots** (severe NPDR

Answer 79

**Diabetic maculopathy:** hard exudates near to the macula

Answer 80

**Proliferative diabetic retinopathy:** extensive vitreous haemorrhage obscuring most of fundus (white circle)}

Answer 81

Cotton wool spot

Answer 82

**Non-proliferative diabetic retinopathy:** blot haemorrhage (white circle)}

Answer 83

**Proliferative diabetic retinopathy:** **NVD** new vessels on the optic disc

Answer 84

Kimmelstein-Wilson lesion

Answer 85

Necrobiosis Lipoidica Diabeticorum

Answer 86

Granuloma annulare

Answer 87

Bullosis Diabeticorum

Answer 88

Charcot neuroarthropathy

Answer 89

**Prayer sign; diabetic cheiroarthropathy**

Answer 90

Pan-retinal photocoagulation (PRP)

Answer 91

Patient with severe abdominal pain. What does the image show? **Rigler’s/ double wall sign** **Free gas (pneumoperitoneum)** can be seen on both sides of the bowel wall. This is Rigler’s sign or the double wall sign. Whenever sharp points or triangles of low density are seen adjacent to loops of bowel, pneumoperitoneum should be suspected. Note: In patients with an acute abdomen an erect chest X-ray is more sensitive for small volumes of free gas.

Answer 92

Patient with severe abdominal pain. What does the image show? Ascites Lead pipe colon Normal gas pattern Rigler’s/ double wall sign **Thumbprinting** **Inflammation of the bowel wall leads to thickening of the haustral folds.** This results in the radiological sign of thumbprinting, a **characteristic finding in patients with active ulcerative colitis.**

Answer 93

What is the cause of the abnormal calcification? **Staghorn renal calculus**

Answer 94

24-year-old patient with suspected appendicitis. What does the image show? **Small bowel obstruction** Dilated loops of bowel with valvulae conniventes – lines crossing the full width of the bowel – indicates small bowel obstruction.

Answer 95

Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray? **Caecal volvulus** Normal appearances Pneumoperitoneum Small bowel obstruction Toxic megacolon

Answer 96

What is the artifact shown in this image? Biliary stent Colonic stent External tubing Percutaneous nephrostomy tube **Ureteric stent**

Answer 97

Patient with abdominal pain and vomiting. What is the radiological diagnosis? Caecal volvulus **Large bowel obstruction** Small bowel obstruction Bowel perforation Normal

Answer 98

What is the radiological diagnosis? Sigmoid volvulus Normal **Ascites** Small bowel obstruction Pneumoperitoneum

Answer 99

What is the cause of the abnormal calcification in this image? Calcified gallstones Calcified mesenteric lymph nodes **Pancreatic calcification** Malignant calcification Calcified uterine fibroid

Answer 100

Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis? **Caecal volvulus** Sigmoid volvulus Small bowel obstruction Perforation Normal

Answer 101

What is the cause of the area of increased density in the pelvis? Calcified pelvic kidney Calcified abdominal lymph node **Calcified uterine fibroid** Ingested barium Calcified adrenal gland

Answer 102

History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis? **Small bowel obstruction** Post-operative ileus Normal Perforation Sigmoid volvulus

Answer 103

If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action? Place an abdominal drain Request abdominal ultrasound Request abdominal MRI **Resuscitate the patient and inform the surgeons** Take a break ## Footnote A large volume of free gas is present under the diaphragm. In the context of acute abdominal pain this finding indicates perforation. Emergency resuscitation and informing the surgeons would be the most appropriate action.

Answer 104

Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances? Pneumoperitoneum Ascites Psoas abscess Small bowel obstruction **Normal**

Answer 105

Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances? Large bowel obstruction **Sigmoid volvulus** Caecal volvulus Perforation Small bowel obstruction

Answer 106

Normally **only the inner wall** of the bowel is visible If there is **pneumoperitoneum** **both** **sides** of the **bowel** **wall** may be visible

Answer 107

When **perforation** of a **duodenal** **ulcer** **occurs**, and results in a **pneumoperitoneum**: **Gas** collects in **Morison's pouch** (the hepato-renal space), and **rise on the supine film to the anterior abdominal wall outlining the edge of the liver** diagnostic of duodenal perforation.

Answer 108

**False Rigler's/double wall sign** * Be careful not to mistake the gas within two adjacent bowel segments for Rigler's sign. * Gas seen on both sides of the bowel wall is contained within adjacent bowel * There are no black triangles or sharp angles on the outside of the bowel wall

Answer 109

**Small bowel obstruction - features** **Centrally located** multiple dilated loops of gas filled bowel (arrowheads) **Valvulae conniventes** (arrow) are visible - confirming this is small bowel

Answer 110

**Large bowel obstruction** * Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon. * Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow). * An obstructing colon carcinoma was confirmed on CT and at surgery.

Answer 111

**Mucosal thickening - 'thumbprinting'** This patient presented with an exacerbation of symptoms of **ulcerative colitis.**

Answer 112

**Lead pipe colon** This patient with **ulcerative** **colitis** has a featureless segment of transverse colon with loss of the normal haustral markings. This 'lead pipe' appearance is associated with longstanding ulcerative colitis.

Answer 113

**Toxic megacolon** The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of **ulcerative colitis.** The clinical features and X-ray appearances are consistent with toxic megacolon.

Answer 114

**Bladder stones** form in the bladder as a result of **urinary stasis**, e.g. **bladder outflow obstruction** (enlarged prostate) or in **patients with a neurogenic bladder** (loss of bladder function due to spinal cord injury/disease)

Answer 115

**Vascular calcification** There is striking calcification of the aorta and iliac vessels **This is a sign of generalised atherosclerosis elsewhere in the body**

Answer 116

**Abdominal aortic aneurysm - AAA** There is calcification of the dilated aortic wall Frequently only one side of the aneurysm is visible - as in this image - the other being projected over the spine

Answer 117

What is the cause of the abnormal calcification? **Adrenal calcification** Appendicolith Gallstones Pancreatic calcification Staghorn renal calculus

Answer 118

What is the cause of the abnormal calcification? Adrenal calcification Appendicolith Gallstones **Pancreatic calcification** Staghorn renal calculus

Answer 119

**Appendicolith** Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain ## Footnote Appendicoliths are calcific masses in the appendix, formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix

Answer 120

**Inferior vena cava (IVC) filter** An IVC filter may be used to reduce the risk of large pulmonary emboli

Answer 121

**Colonic stent** Large bowel obstruction can be treated with placement of a metallic colonic stent This is often used as a temporary measure allowing a patient to recover from the effects of obstruction prior to definitive colonic resection

Answer 122

**Pig-tail (JJ) stent** A ureteric stent has been placed to relieve ureteric obstruction The catheter has loops (pig-tails) at both ends which hold it in place

Answer 123

**Naso-jejunal tube** Placed for the purpose of enteral feeding The tube passes through the stomach and forms a C-shape as it navigates the 4 parts of the duodenum (D1-4) The tube tip lies beyond the duodenojejunal flexure which lies on the left

Answer 124

**Ascites** There is generalised hazy density of the entire abdomen In the presence of ascites gas within bowel is located centrally

Answer 125

A 73-year-old male presents with a 2-hour history of sudden-onset abdominal pain, accompanied by a bowel motion and vomiting. He has a history of non-specific heart problems and takes antihypertensive medication. He also had a previous appendicectomy performed 45 years ago. Examination of the abdomen reveals a distended and generally tender abdomen with no guarding. There is a scar present in the right iliac fossa and bowel sounds are absent. Rectal examination is unremarkable. An ECG performed is shown below: What is the most likely diagnosis? Small bowel obstruction Large bowel obstruction Caecal volvulus **Mesenteric ischaemia** Ileus

Answer 126

Figure 4 – CT Chest of Stanford Type B Aortic Dissection

Answer 127

What is DeBakey classification for aortic dissection is this? Type I **Type II** Type IIIa Type IIIB The Aortic dissection classified as involving the aorta proximal to the left subclavian artery and requires further surgical intervention to avoid coronary artery occlusion or cardiac tamponade.

Answer 128

This is a case of aortic dissection: **hypertension** is the most likely etiology for a dissection.

Answer 129

This aortic dissection is essentially limited to the ascending aorta making it a Stanford type A / **DeBakey type 2.**

Answer 130

**DeBakey type 2.**

Answer 131

What is this complication of varicose veins? Lipodermatosclerosis Thrombophlebitis **Haemosiderin** Varicose eczema

Answer 132

What is this complication of varicose veins? Lipodermatosclerosis **Thrombophlebitis** Haemosiderin Varicose eczema

Answer 133

**Lipodermatosclerosis**

Answer 134

**Laser photocoagulation therapy is performed to stop the growth of new blood vessels.** *The white circular lesions represent focal laser surgery for proliferative diabetic retinopathy. Cotton wool spots, microhaemorrhages and neovascularisation can be seen across the remaining retina.*

Answer 135

Extensive new vessel proliferation / **neovascularisation** **Cotton wool spots** **Microhaemorrhages**

Answer 136

Icteric sclera

Answer 137

**Pseudomembrane colitis**: inflammation of the colon associated with an overgrowth of the bacterium Clostridioides difficile

Answer 138

**Achalasia** * bird beak sign * esophageal dilatation

Answer 139

Findings are most suggestive of **achalasia**. There is a classic bird beak sign at the gastro-esophageal junction.

Answer 140

**achalasia**

Answer 141

**eosinophilic oesophagitis**

Answer 142

**eosinophilic oesophagitis** Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus"

Answer 143

**eosinophilic oesophagitis** Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus"

Answer 144

**nodular mesangial expansion = kimmelstell-wilson lesions (pathognomonic)**

Answer 145

sclerosis isolated to a specific region (arrow) i.e. **focal sclerosis: focal segmental GS** causes GS and CKD in young patients, presenting with nephrotic picture idiopathic or secondary to IgA nephropathy, HIV, Alport's, SCA Steroids ± immuonsuppression

Answer 146

**howell-jolly body** - nuclear remnant in RBC. RBCs usually expell their nuclei, and those that don't are destroyed in the spleen. HJBs therefore suggest a/**hyposplenism**

Answer 147

normal light microscopy with podocyte fusion and **foot process effacement on EM - minimal change disease**

Answer 148

**IgA nephropathy (Berger's)** most common GN worldwide - - mesangial hypercellularity (top) with +ve immunofluorescence for IgA and C3

Answer 149

**Meckel diverticulum** - detection and localization of a symptomatic Meckel’s diverticulum are based on accumulation of **technetium-99m**

Answer 150

glomeruli are full of **cresents** therefore it's likely to be **rapidly progressive GN**

Answer 151

glomeruli are full of **cresents** therefore it's likely to be **rapidly progressive GN**

Answer 152

**Goodpastures**

Answer 153

stacks of aggregated RBCs - **rouleaux formation** - suggestive of MM

Answer 154

inclusions of denatured Hb attached to RBC - **heinz bodies**

Answer 155

**Cataract**

Answer 156

**CML** AML: usually more symptoms of BM failure, leucostasis with neuropenia CLL: usually with thrombocytopenia Myelodyslpasia: older patients, full BM failure myeloma: usually bony/renal involvement

Answer 157

A to B is associated with which type of hypersensitivity reaction? Type 1 Type 2 Type 3 **Type 4**

Answer 158

patient x comes into contact with posion ivy and has the following reaction. This is which type of hypersensitivity reaction? Type 1 Type 2 Type 3 **Type 4**

Answer 159

top: trophozoite infecting a reticulocyte bottom: trophozoite infecting an RBC with Schuffner's dots (eosinophilic) with preserved cell morphology suggestive of **plasmodium vivax** - similar to ovale but without RBC shape change - treated with **oral artemeter + lumefantrine** or **quinine sulphate or doxycyline** - consider **artesunate + quinine dihydrochloride IV** if **severe** infection

Answer 160

**commence IV ABx and admit**

Answer 161

A - potency B - efficacy

Answer 162

**congo red staining** revealing characteristic apple-green birefringence - amyloid deposition

Answer 163

**congo red staining** revealing characteristic apple-green birefringence - amyloid deposition

Answer 164

dark dots in RBC: infected RBC. Note presence of ring trophozoites (almost like signet-ring cells in RBC) and **crescent-shaped gameocytes - pathognomonic of falciparum malaria** Treat with IV artesunate and quinine dihydrochloride

Answer 165

spironolactone - tall tented T waves with abnormal QRS suggests hyperkalaemia

Answer 166

Ligament of treitz

Answer 167

cystic duct (lateral) liver (superior) CBD (medial)

Answer 168

**decompression sigmoidoscopy**

Answer 169

**Crypt abscesses**

Answer 170

**ABVD** - **HL**

Answer 171

**stop transfusion, reasses**

Answer 172

clerosis isolated to a specific region (arrow) i.e. focal sclerosis: **focal segmental GS** causes GS and CKD in young patients, presenting with nephrotic picture idiopathic or secondary to IgA nephropathy, HIV, Alport's, SCA Steroids ± immuonsuppression

Answer 173

Note neutrophil infiltrate on biopsy, in contrast to Berger's (IgA) which has no neutrophil infiltration nephritic syndrome with headache, malaise, low serum C3 and raised ASO starry sky appearance on immunofluorescence = **post-strep!!**

Answer 174

You treat a 20 year old who came in to the GP with vague infective symptoms. The next day she comes back and presents with this rash. Investigations reveal she has EBV. Which abx was initially given? **Amoxicillin** - causes a reaction with EBV infection

Answer 175

**Erysipelas** - **flucloxacillin**

Answer 176

**Acute mesenteric ischaemia**

Answer 177

Pacemaker spikes

Answer 178

**Oral vancomycin**

Answer 179

**Hyperkalaemia**

Answer 180

Erythrocyte sedimentation rate of 50 mm/hr

Answer 181

L-thyroxine

Answer 182

**Vitamin B12**

Answer 183

No immediate investigation required

Answer 184

Administer IV fluids and insert NG tube

Answer 185

**Myocarditis**

Answer 186

Pyoderma gangrenosum

Answer 187

**Lupus nephropathy**

Answer 188

Loop ileostomy

Answer 189

**DIC** - microangiopathic haemolytic anaemia

Answer 190

**St Judes valve is the best**

Answer 191

**Sick sinus syndrome** Runs of tachycardia interspersed with long sinus pauses (up to 6 seconds). The sinus rate is extremely slow, varying from 40 bpm down to around 10 bpm in places.

Answer 192

Brugada syndrome

Answer 193

Loop stoma

Answer 194

Double barrel stoma A: Proximal B: Distal

Answer 195

E: **Battle** F: **Lanz** Both for open appendicectomy

Answer 196

**Rooftop scar**: **Liver transplant**

Answer 197

**Kocher scar**: open cholecystectomy

Answer 198

**Rutherford Morison**

Answer 199

The gridiron and lanz incisions are muscle-splitting incisions which are the incisions of choice for open appendicectomy. They differ in the orientation of the skin incision alone. The gridiron incision can be more readily extended laterally into an oblique, curvilinear muscle-cutting incision: the Rutherford Morison.

Answer 200

This type of scar is A Rutherford Morrison Lanz Kocher Hockey-Stick Chevron Gridiron **Pfannenstiel**

Answer 201

A patient has this anal fissure. Which is the most likely cause? **Malignancy** Also **Crohns**

Answer 202

Congo red stain Amyloidosis can cause nephrotic syndrome