Written Exam Y3 S1 Flashcards
(84 cards)
1
Q
Acute Abdomen:
A
rapid onset of severe symptoms that may indicate a potentially life threatening abdo/pelvic pathology, requiring urgent referral
2
Q
Red flags for AA
A
- over 65
- immunocompromised
- previous abdo surgery
- multiple comorbidities
cardiac disease
alcoholism
pregnancy
3
Q
Typical signs of acute abdomen:
A
fever tachycardia (^ HR) signs of shock rigid abdomen involuntary guarding peritonitis
4
Q
3 factors determining whether AA requires GP or urgent hospital referral
A
- severity of presentaton
- presence of red flags
- DD’s
5
Q
Typical imaging for acute abdomen:
A
- CT for generalised abdomen pain or when patients over 50, or LIF pain over 40
- ultrasound: epigastric or RUQ pain, under 50 in females only or when patients pregnant
6
Q
Typical other acute abdomen investigations:
A
blood tests
urinalysis
pregnancy test in women of childbearing age
7
Q
Typical blood test types:
A
LFT - liver function test
BSL - Blood sugar level
EUC - electrolytes, urea and creatinine
FBC - full blood count
8
Q
AAA definition:
A
AA >3.0cm
9
Q
AAA risk factors:
A
smoker males old age caucasion atherosclerosis HTN family history of AAA other peripheral artery aneurysm
10
Q
AAA classic triad:
A
severe acute pain, pulsatile abdominal mass and hypotension
11
Q
symptoms of ruptured aneurysm may mimic that of:
A
renal colic
diverticulitis
GI haemorrhage
other intra abdominal conditions
12
Q
acute appendicitis:
A
inflam of the lining of the vermiform appendix.
13
Q
typical causes of appendicitis?
A
bacterial infection precipitated by an obstruction of the lumen via a fecalith
14
Q
Alvardo score for appendicitis?
A
MANTRELS M: migration of pain to RLQ A: anorexia N: nausea/vomiting T: tenderness in RLQ R: rebound tenderness E: elevated temperature L: leukocytosis S: shift of WBC to the left (high amount of immature WBCs)
15
Q
Scoring of ALvardo (MANTRELS)
A
> 7 - probable append
4-6: further imaging required
<4: unlikely append
16
Q
common age of onset for diverticulosis:
A
40 years
seen in ~50% of people over 70
17
Q
common presentation of diverticulitis:
A
sharp LIF pain fever bloating change in bowel habits nausea/vomiting
18
Q
how will an abscess present in diverticulitis patients:
A
palpable abdo mass
19
Q
How will peritonitis typically present:
A
- general tenderness with rebound and guarding
- distended and tympanic abdomen
- diminished abdo sounds
20
Q
preferred diverticulitis imaging?
A
CT abdomen: will usually find: - colonic diverticula bowel wall thickening soft tissue inflam masses abscess
21
Q
typical changes in blood test results for patients with diverticulitis:
A
- leukocytosis and left shift
other tests are used to rule out other DD’s
22
Q
PID covers spectrum of inflam disorders of the female genital tract
A
- endometritis
- salpingitis
- pelvic peritonitis
- tubo-ovarian abscess
23
Q
common organisms of PID:
A
chlamydia, gonorrhoea, mycoplasma
24
Q
pyelonephritis:
A
infection of the renal parenchyma and calyces system
25
typical questions to ask in patients presenting with PID ssx?
- early coitarche
- high number of sexual partners
- recent UID
- operative procedures? abortion
26
Symptoms of PID:
abdo pain
pelvic pain with sex
abnormal bleeding
urinary symptoms
27
signs of PID:
- tenderness during cervical, uterine or adnexal movement
- cervicitis
- adnexal swelling
- increased or decrease in temperature
28
PID diagnostic interventions:
preg test
STI check
urinalysis
blood tests
29
acute cholecystitis?
inflammation of the GB, typically presents with RUQ pain, fever and leucocytosis
30
gall stones/cholelithiasis common people with:
```
- obesity
female gender
increasing age
rapid weight loss
sedentary lifestyle
```
31
common DDS for acute cholecystitis:
acute pancreatitis
Rt sided pneumonia
cardiac ischaemia
perforated viscus (peptic ulcer/ectopic pregnancy)
32
Common blood test changes in cholecystitis:
- increased neutrophils especially immature
| - ECG to rule out AMI
33
Imaging for acute cholecystitis?
Ultrasound often most used
| CT useful to exclude differentials
34
acute pancreatitis definition?
acute inflam of the pancreas which can range from mild to severe with extensive necrosis and multiple organ failure
35
risk factors for pancreatitis:
```
gall stones
ethanol (alcohol)
endoscopic procedures
trauma
infections
metabolic conditions
```
36
SSX of pancreatitis:
- abdominal pain in upper quadrants that is typically severe and may radiate to the back
- nausea, diaphoresis: abnormal sweating)
37
blood test changes in acute pancreatitis
serum lipase 3 times higher than normal
38
Bowel obstruction:
when normal flow of the bowel is interrupted.
| can be mechanical or functional, as well as complete or partial
39
where does bowel obstruction usually occur?
small intestine
40
risk factors for bowel obstruction
- previous abdo/pelvic surgery
- hernias (groin, inguinal)
- intestinal inflammation
- intestinal malignancy
41
high pitched bowel sounds may indicate:
bowel obstruction
42
common imaging findings of small bowel obstruction
XRAY: dilated loops of bowel with air fluid levels
proximal bowel dilation >2.5cm
gasless abdomen
CT abdomen: better to indicate site and severity
43
Gastroscopy definition:
inspection of the interior stomach with a flexible, lighted, optical instrument that is passed through the mouth and esophagus to the stomach
44
Wwhat is the only test that confims Barrett's esophagus?
Gastroscopy
45
when is a gastroscopy indicated?
- if treatment/therapy for suspected benign digestive disorder was unsuccessful
- initial method of evaluation as an alternative to radiographic studies
- if change in management is probable based on results of endoscopy
46
What pathologies can a gastroscopy detect:
```
tumours
varices (enlarged veins)
mucosal inflam
hiatal hernia
polyps (projecting growth from mucosal membrane)
ulcers
obstructions
```
47
invasive H. pylori investigations:
- biopsy with urea and pH measure
| - H.pylori is positive when the measurement is more alkaline
48
what does H.pylori do?
converts urea to ammonia and CO2
49
Non-invasive H.pylori investigations
test for presence of H.pylori in blood serum:
| presence of H.pylori-specific IgG antibodies
50
bowel cancer screening program test for?
blood in the feces
51
what ages is the bowel cancer screening program offered free
ages 50-74 years
52
Colonoscopy definition:
visual inspection of the interior aspect of the colon with a flexible tube inserted through the rectum
53
Indications for colonoscopy?
- abnormal results on other tests or unexplained SSX
```
positive iFOBT
unexplained weight loss or abdo pain
OR
investigate suspected colorectal cancer in relatively high risk patients such as:
- family history
rectal bleeding
change of bowel habit
significant/unexplained weight loss
```
54
therapeutic use of colonoscopy:
ulceration,
vascular malformation,
balloon dilation of stenotic lesions
55
LFT:
liver function test:
| - group of tests performed together to detect, evaluate and monitor liver disease or damage
56
What does a LFT evaluate?
synthetic capability of the liver
or
evidence of hepatocellular disease
57
LFT that asses the Synthetic capability of liver include:
(bilirubin, albumin, total protein)
| an abnormal level of these may indicate an in ability of hepatocytes to function normally
58
LFT that assess hepatocellular damage evaluate:
AST: Aspartate aminotransferase
ALT: alanine aminotransferase
Both are enzymes found in hepatocyte. And are released into the blood stream when hepatocytes are damaged
59
raised ALT levels usually indicates:
hepatitis
60
LFT indications?
jaundice
history of alcohol abuse
signs of chronic liver disease
family history of haemochromatosis
61
Cholestasis?
reduced bile flow due to impaired secretion by hepatocytes or due to obstruction of intra/extrahepatic bile ducts
62
in cholestasis, substances normally secreted into bile by hepatocytes will build up in their cytoplasm and eventually diffuse back into?
blood stream
63
What usually result in increased plasma levels of alkaline phosphatase?
high pressures in the biliary pathways and subsequent obstruction. which cause damage to canalicular surface of hepatocytes and cause an increase in alkaline phosphatase
64
what would a LFT show in a patient with cholestasis?
ALP>200IU/L
| ALP 3 times greater than ALT
65
What is ALP?
Alkaline phosphatase:
an enzyme found in hepatocytes.
it originates from the canicular surface of hepatocytes, thus anything causing cholestasis will damage these cells and cause their release into the blood stream
66
suspected pancreatic tumour what test?
abdominal CT or US
67
suspected diabetes what test?
BSL and insulin levels
68
suspected acute pancreatitis what test?
pancreatic enzyme tests
69
why wouldnt an increase in lipase (associated with damaged pancreas) be seen in a urinalysis?
kidneys reabsorb lipase, therefore it would be seen only in a blood test
70
serum amylase and serum lipase increase for how long and by how much when acute pancreatitis is present?
lipase: 2 weeks & x3-5
amylase: 2 days & >5x
71
Urinalysis is a group of chemical, physical and microscopic tests on urine used to detect and measure:
- byproducts of normal/abnormal metabolism
- drugs
- preg-related hormones
- cells/cellular fragments
- bacteria
72
different types of urine samples:
- first morning sample
- midstream sample
- first pass (any time of day but first part)
73
common uses of urinalysis?
- check renal function
- diagnose UTI's
- look for blood in urine
- confirm pregnancy
- diagnose and monitor diseases such as diabetes, bladder cancer or STIs
- monitor recreational or performance enhancing drug use
74
Urine SG measures?
specific gravity: assesses the ability of the kidney to concentrate or dilute urine
75
decreased SG:
inability of kidney to concentrate urine
76
increased SG:
indicates concentrated urine with large volume of dissolved solutes: eg - dehydration, adrenal insufficiency
also can indicate glycosuria
77
what may cause acidic urine?
high protein diet
systemic acidosis
diabetes
diarrhoea
78
what may cause alkaline urine?
vegetarian diet
systemic alkalosis
UTIs with urea splitting organisms
drugs (carbonic anhydrase inhibitors - a diuretic)
79
what condition can cause excess protein in the urine?
- nephrotic syndrome
- glomerular disease
- congestive heart failure
- NSAIDs
80
How do nitrates form nitrites?
nitrates are converted to nitrites in the urine in the presence of bacteria
81
causes of haematuria?
```
trauma
infection
inflammation
infarction
calculi
neoplasia
coagulation disorders
```
82
Normal bilirubin metabolism:
- unconjugated bilirubin is formed when RBC are broken down (predominantly by the spleen)
- hepatocytes (liver) conjugate bilirubin with glucouronic acid to make it water soluble
- hepatocytes excrete conjugated bilirubin in bile which enters the small intestine and is converted to stercobilin and urobilinogen
83
bilirubin is converted to urobilinogen by bacteria in the duodenum, 90% is excreted in faeces and the other 10% is?
transported back to the liver and converted into bile
| the remaining <1% is excreted in the urine
84
Typical level of RBC, WBC and epithelial cells in a microscopic & culture examination
RBC - very low (higher - inflamm, urinary tract disease)
WBC - low (higher - UTI and inflamm)
Epithelial cells - less than 15-20 per hpf (higher - infections, malignancies)
