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Alski's Stack No. 1
T Year Revision
| Question | Answer |
|---|---|
| STI advice to 2 HIV+ve partners | use protection, ie condoms |
| HIV with eye problems | CMV/ Herpes |
| HIV detection window is | 6-12 weeks (test 3 months after last possible infection encounter) |
| HIV opportunistic infections p/c encephalitis think what pathogen | toxoplasmo gondii |
| HIV p/c Weight loss, abdo pain, night sweats, diarrhoea think what bacteria | disseminated mycobateria avium |
| HIV p/c meningeal signs think what infectious agent | cryptococcal meningitis |
| HIV white patches on tongue (peelable) | candida |
| HIV white patches on tongue (non peelable) | oral hairy leukoplakia |
| HIV To test pt for HIV you will need to get/give | discussion (benefits) + informed consent (no counseling needed) |
| 2/3/4 day peaking fever, rigors, chills, icteric, abdo pain, vomit, confusion, recent travel | Malaria |
| Rifampicin SE’s (2) | hepatotoxic + orange fluids |
| Isoniazid SE (2) | hepatotoxic + peripheral neuropathy |
| Pyrazinamide SE | hepatotoxic |
| Ethanbutol SE | toxic optic neuropathy (esp. colour vision) |
| TB medication, non compliance an issue? Rx Protocol to suggest? | Directly Observed Therapy |
| Hepatosplenomegaly + green pea soup diarrhoea | typhoid |
| 75% 90% UTIs caused by | eColi |
| Opportunistic Pathogen associated with CF | pseudomonas aeruoginosa |
| Organism causing infected gold crusty skin | staph aureus |
| Meningitis cause in adults in developed countries (2) | strep pneumoniae or neisseria meningitis |
| Cause of most hospital acquired diarrhoea (agent and risk factor) | cDiff after ABx therapy |
| Metronidazole C/I with what | ETOH |
| Fluclox can cause what | cholestatic jaundice |
| ABx that inhibit breakdown of Warfarin (3) | Metronidazole, Ciprofloxacin, Clarithromycin |
| Vancomycin given too quickly causes | itchy, red rash on face and chest (angry red van man) |
| Uncomplicated UTI ABx Rx | Trimethoprim |
| MSRA ABx first line Rx | Vancomycin |
| C diff ABx Rx (3) | Oral Met >Oral Vanc >IV Met |
| Prophylactic ABx for clean surgery | cefuroxime |
| Atypical pneumonia ABx Rx | erythromycin |
| Dysphagia with liquids and solids, no reflux, regurgitates recently eaten food | achalasia |
| Achalasia Ix | barium swallow (rat’s tail) |
| Retrosternal pain, no loss of appetite, inflammation and irritation of oesophagus | bisphosphonates Rx |
| Diarrhoea in elderly or immunocompromised requires | hospital admission |
| Epigastric pain with nausea with sweating + some CV risk factors | rule out cardio first when have CV risk factors eg. Fat, smokes |
| Worsening reflux, persistent or unexplained dyspepsia >55yr +/- ALARM symptoms next step is | urgent endoscopy |
| What are GI ALARMS symptoms? | A anemia L loss of weight A anorexia R recent onset of symptoms M malena or haematemesis S swallow difficulties |
| Cause of dysphagia + coughing (difficult making swallowing movement) | bulbarpalsy (can result from rapid correction of hyponatraemia) |
| Neck bulges on drinking | oesophageal pouch |
| Intermittent retrosternal pain | oesophageal spasm |
| Regurgitation of undigested food + dysphagia for liquid & solid | motility problem (achalasia) rather than mechanical (stricture) |
| Achalasia Ix | barium swallow |
| Progressive difficulty swallowing + Hoarse voice, (smoking) | Ca Oeso |
| Rip-roaring central chest pain, may feel like MI, dysphagia, regurgitation | oesophageal spasm |
| oesophageal spasm Ix & pathog sign | barium swallow (corkscrew oesophagus) |
| Alternating diarrhoea & constipation + stress | IBS |
| Alternating diarrhoea & constipation + mucus, tenesmus | Ca |
| Alternating diarrhoea & constipation + abdo pain, diarrhoea, conjunctivitis, arthritis | IBD |
| IBD Ix | sigmoidoscope |
| steatorrhoea | pancreatitis |
| unconjugated hyperbilirubinaemia, no billi in urine, generally asymptomatic | Gilbert’s |
| unconjugated hyperbilirubinaemia, p/c neonatally | Crigler-Najjar (needs liver transplant) |
| conjugated hyperbilirubinaemia + bili in urine | Rotor Syndrome |
| Liver failure + odd behaviour | hepatic encephalopathy (Rx bowel cleansing c lactulose) |
| Long term steroids + malaena + hypotension | high chance of bleeding ulcer |
| Intense prolonged vomiting | Mallory Wiess tear |
| Terminal Illeum resection requires what Rx | B12 supplementation |
| Child Pugh score (which grades cirrhosis + risk of variceal bleeding) requires what | Billi + Albumin + Prothrombin time + grades for ascites and encephalopathy |
| Ascites Rx | IN (fingers) OUT (fluid ascitic tap) SCAN (liver/abdo) |
| H pylori eradication Rx | 1 month triple therapy amoxicillin, metronidazole, PPI; (unless alcoholic, don’t give metro give clarithromycin) |
| Pre endoscopy preparation | No PPI, No H2 antagonists, arginate antacid for symptom relief |
| Symptoms of Systemic inflammatory response (eg. febrile neutropoenia) and Rx | T>38, HR >90, Rx is broad spectrum ABx before cultures as urgent |
| Chronic alcoholic admitted Rx | give pabrinex (as thiamine deficient + vits B & C) before IV dextrose |
| NG tube, how do u check placement | pH check of aspirate, should be <6 |
| Any unexplained iron deficient man Hb <11 Rx | urgent referral to rule out Ca |
| Rx To reduce portal hypertension | terlipressin |
| PR bleeding in >60yrs >6 weeks, next management step | 2 week referral |
| Refeeding syndrome is and therefore causes | body reverts back to carb metabolism from fat→ produces insulin which requires increased glycogen, fat and protein synthesis →uses up phosphate, mg and K → electrolyte imbalance→main problem is cardiac arrythmias, confusion, coma |
| Palpable gall bladder + jaundice + No pain | NOT gall stones (Courvoisier’s Law) |
| Palpable ball bladder which illicits pain + no jaundice is suggestive of | cholecystitis/Choledocholithiasis (gallstones in the common bile duct) |
| Rib fracture Pain produced with attempts to sleeping on...? | one's back |
| Tetanus sign | Risus sardonicus (sustained spasm of the facial muscles, grinning) |
| Typhoid fever sign | Rose spots in abdomen (small red spots on the belly and chest) |
| Duchenne’s muscular dystrophy | Gower’s sign (inability to rise off floor without using upper extremities) |
| Slapped-cheek appearance | Erythema infectiosum (aka Fifth disease) (infection by erythrovirus aka parvovirus B19) |
| Loss of central vision | Age-related macular degeneration |
| Spiderlike extremities, long and hypermobile hands and feet | Marfan’s syndrome |
| distal paresthesia elicited by tapping the median nerve on the wrist | Carpal tunnel syndrome (Tinel’s sign) |
| whitish/grayish discoloration of the pupil with light shone in eye | Retinoblastoma sign (Leukocoria) |
| Heavy sensation in the testicles | Testicular cancer |
| Barking cough | Pertussis |
| Slight rubbing of skin exfoliates outermost layer (in absence of burns or bacterial infection) | (Nikolsky’s Sign) Pemphingus |
| Rusty Sputum | Pneumococcal Pneumonia |
| Very Sharp angle in spine | Potts’ Disease, is gibbus formation a presentation of extrapulmonary tuberculous spondylitis |
| Pink Frothy Sputum | Pulmonary Oedema |
| Hydrophobia, production of large quantities of saliva and tears coupled with inability to speak or swallow | Rabies, (typical during the later stages of the disease) |
| Low-grade afternoon fever | Pulmonary TB |
| wheezing on expiration | Asthma |
| barrel chest | Emphysema |
| strawberry tongue | Kawasaki Syndrome |
| red beefy tongue | Pernicious Anemia |
| protruding tongue | Down’s |
| rice watery diarrhoea | Cholera |
| sore throat, low fever and adherent membrane on tonsils, pharynx | (pseudo membrane) formation |
| cough, fever and runny nose and red eyes, white lesions on buccal mucosa | Measles p/c with the three Cs—cough, coryza (runny nose) and conjunctivitis (koplik’s spots in mouth don’t always appear, but presence is pathognomonic) |
| pt p/c with malar, what Ix would help make a dx | the butterfly/malar rash is not found in all SLE sufferers, detecting ANA is a positive for auto-antibodies and thus an autoimmune pathology only |
| lioning face | Leprosy |
| Bulimia | chipmunk face |
| Dengue | petechiae or (+) Herman’s sign |
| Meningitis | Kernig’s sign (leg pain), Brudzinski sign (neck pain) this is stupid one really…. |
| Tetany | Hypocalcaemia (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm) |
| Pancreatitis signs | Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots |
| olive like mass in epigastric region | Pyloric Stenosis |
| machine like murmur, what pathology? | Patent DA |
| Addisons | bronze like skin pigmentation |
| Cushings Syndrome | moon face appearance and buffalo hump |
| Graves | exopthalmus |
| Intussusception | sausage shaped mass |
| Cytomegalovirus infection | Owl's eye appearance of inclusion bodies[1][2] |
| Inclusion body myositis | Filamentous material seen in inclusion bodies under electron microscopy |
| Bulimia Nervosa | Chipmunk facies (parotid gland swelling) (Chipmunk facies also seen in marrow expansion secondary to Beta Thalassemia Major) |
| Leprosy | Leonine facies (thickened lion-like facial skin) |
| Chronic hemorrhagic pancreatitis | Grey-Turner's sign (ecchymosis in flank area) |
| Pleural Effusion | Stony-dull percussion |
| Parkinson's disease | Pill-rolling tremors |
| Blood film shows Auer rods | Acute Myeloid Leukemia |
| Multiple Sclerosis | Bilateral internuclear ophthalmoplegia |
| Congestive heart failure | Third heart sound |
| Pericarditis | Pericardial friction rub, pain eases with NSAIDs and leaning forward |
| Neurofibromatosis I | Plexiform neurofibroma |
| Hodgkin's lymphoma | Hodgkin and Reed-Sternberg cells (giant mono- and multinucleated cells) |
| Pyelonephritis | White blood cell casts |
| Rheumatic fever | Aschoff nodules |
| Lyme Disease | Bullseye Rash |
| Urothelial (bladder/UTI) carcinoma | Dyes/rubber manufacture + Painless haematuria + Thick bladder wall |
| Causes of Clubbing GI (name 4) | IBD (esp. Crohns), Cirrhosis, GI Lymphoma, Malabsorption (think infection, inflammation, neoplasm) |
| Causes of Clubbing CV (name 3) | Atrial Myxoma, Cyanotic Heart Disease, Endocarditis, (ACE) (think infection, inflammation, neoplasm) |
| Causes of Clubbing Thoracic (name) | Abscess, Bronchiectasis, CF/CFA/Any fibrosis, Emphyema, Mesothelioma (think infection, inflammation, neoplasm) |
| Spoon shape + brittle nails (name and cause) | Koilynichia, iron deficiency |
| Whitening of the entire nail (name and cause) | Leukonychia totalis may be due to hypoalbuminaemia (from nephrotic syndrome, liver failure, protein malabsorption and protein-losing enteropathies) |
| paronychia is | tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail |
| contracture of the palmar aponeurosis mostly affecting ring & little finger (called and causes) | Dupuytren's contracture, unproven causes include trauma, diabetes, alcoholism, epilepsy therapy with phenytoin and liver disease |
| Mouth Ulcers (some common causes) | vit defic, poor diet, malignancies, Crohns, UC, Coeliac, Behcet’s SLE |
| Gingivitis (common associations) | gingival hyperplasia from CML, anticonvulsants, CCBs, Vit D defic, Sarcoid, Wegener’s |
| Common Hand Nodes, their location and association | Heberden's nodes, are hard, bony outgrowths on DIPs, Bouchard's nodes are similar growths on the PIPs generally less common than Heberden’s |
| lymph node in the left supraclavicular fossa | (Virchow’s Node/Troisier’s Sign): strongly indicative of cancer in abdomen, specifically gastric cancer, differentials include lymphoma, breast cancer, infection (e.g. arm) |
| ECG presentation of Digoxin | reversed tick (after QRS complex, leading into T wave) NOT necessarily a pathology |
| central red spot and reddish extensions which radiate outwards on face, neck and upper trunk (name and common associations) | Spider Naevi/angiomas: often benign, present 10/15% healthy, refill from centre, caused by incr estrogen levels, pregnant women, hormonal contraception, hepatic disease (liver cant detoxify estrogen from blood, 33% cirrhotics exhibit SN) |
| Bifid or wide P waves on an ECG, what could be the cause | dilated atrium, possibly from |
| Describe SLE, classic presentations, high risk group and Rx | Generalised disorder affect any system,commonly women 15-45, Symptoms/signs accumulate over time (fatigue, fever, weight loss, arthralgia/arthritis, Raynaud’s +more), Rx NSAIDs, hydroxychloroquine, corticosteroids |
| What Ix is used for Wegener’s | ANCA |
| What Ix is used for Goodpastures, but what sign would you expect to be suggestive before you test | Anti GBM Ab+lung haemorrhages: GPs major cause of pulm renal synd: AutoAB to type IV collagen found in lung and basement membrane of glomeruli leads to pathology in both organs |
| Indications for surgery on a AAA | AAA >5.5cm diameter, Rapid AAA enlargement (>1cm/yr), Symptomatic AAA of any size |
| Rx of AAA | ABC, O2, 2x large bore cannula, CT, permissive hypotension (<100), surgery pronto |
| 6 P’s of critical limb ischaemia | pain, pallor, parasthesiae, pulselessness, perishingly cold, paralysis, Critical Ischaemia, but really: rest pain >2/52 +/- tissue loss, night pain |
| Diagnosing DM from fasting BG requires | one test>7.1 |
| Diagnosing DM from random BG requires | one test>11.1+symptoms OR 2 tests>11.1 with no symptoms |
| Pt p/c with small but deep ulcer on toe in great pain, what is its cause and Rx | Arterial ulcer, Rx is improve arterial blood supply |
| Pt p/c with large but shallow and painless ulcer with irregular edges with sloughing on the gaiter region, what is the cause and the Rx | Venous ulcer, Rx is elevation and compression |
| 14 yr old boy p/c with swollen and discoloured left testicle after a football tackle 1 hour previously, it appears higher than the right and has an absent cremasteric reflex, what is the next management step? | USS can be used within 4 hours of a testicular torsion to help confirm a dx, presentations after 4 hours must have surgical exploration |
| Pt: man who recently retired from industrial dye manufacturing, his history reveals that he has never smoked and has no family history of GI problems p/c with painless haematuria, what is your leading differential? | Rubber and dyes is med exam pathognomic for urothelial carcinoma (aka transitional cell carcinoma) |
| diabetic woman 40yr p/c epigastric pain after a huge curry +several beers, lasted for an hour, thinks she had an MI. Hx and examination reveals she is on COCP, CXR clear, FBC+LFTs are normal, what is dx and next appropriate Ix? | Abdo USS. Gallstones don’t show up on XR because they don’t contain Calcium unlike Renal calculi, NOT all renal stones show up though. Will Probably need her gallbladder out. |
| Pregnant women with suspected PE, what’s your Rx and Ix? | ABC, 100% O2, heparin but Warfarin C/I in pregnancy, CTPA not ideal for confirming the diagnosis…not sure about this. |
| Virchow's triad describes | three broad categories of factors that are thought to contribute to thrombosis: Hypercoagulability, Hemodynamic changes (stasis, turbulence), Endothelial injury/dysfunction |
| 5 most common Ca that spreads to bone | Prostate, Kidney, Breast, Lung, Thyroid |
| 23 yr man p/c 8/12 hx fatigue, sleep disturbance, progressively worse back pain, morning stiffness which improves over day and NSAIDs, o/e tender sacroiliac joints, red itchy eyes. First Ix to help with dx? | Pelvic XR to investigate Sacroiliitis in suspected Ankylosing Spondylitis, may take years to develop, so normal pelvic x-ray does not exclude the dx |
| 72yr man p/c incr fatigue, generalised bone pain, Hx of alcoholism, lactose intolerance, vertebral compression fracture 1yr ago, housebound, o/e tenderness of legs+arms, proximal muscle weakness, waddling gait. 1st Ix, expected results+Rx? | Old age, general bone pain (osteoporosis generally specific to weak areas) +Hx suggests suspected osteomalacia,. Rx first line is Calcium+Vit D |
| 55yr man p/c persistently aching legs, initially diagnosed with fibromyalgia, blood tests reveal elevated ALP + x-ray of tibia/fibia shows defects in cortical and cancellous bone, with degree of tibial bowing. Whats new dx? | Paget’s is incr bone resorp+disorganized remodel, longbone/skull deform, often asymptom, diag. incidental x-ray or elevated ALP (biliary, bone, bowel, kidney), neuro signs: skull remodeling,also fracture,heart failure,rx bisphos incr osteoclast apoptosis |
| 43yr woman p/c chronic r hip and anterior thigh pain, increased localised temperature, lately needs walking stick. Last 6 months her relatives noticed a progressive hearing loss on left side, facial changes, enlargement of mandible. What’s the dx? | Paget’s is incr bone resorp+disorganized remodel, longbone/skull deform, often asymptom, diag. incidental x-ray or elevated ALP (biliary, bone, bowel, kidney), neuro signs: skull remodeling,also fracture,heart failure,rx bisphos incr osteoclast apoptosis |
| Bone biopsy of elderly asian woman finds decreased rate of bone turnover with excessive unmineralised osteoid, what is probable dx? | Osteomalacia, biopsy is normal in osteoporosis |
| What are the Ix differences btw osteoporosis and osteomalacia? | Osteomalacia difficult to discriminate clinically from other osteopenias (osteoporosis, osteitis fibrosa, Paget's) however, biochemically in osteomalacia mineralisation is reduced |
| Why would u want to avoid Diclofenac in the elderly? | causes renal failure |
| An atopic person produces lots of what? | IgE |
| What do IgE Abs do in relation to allergy? | Bind to mast cells |
| What test determines whether an anaphylaxis has occurred? | Tryptase, which is released when mast cells degranulate |
| AMTS Aide Memoire | Old Timers Remember Places for Years & People’s Birthdays while Monarchs start wars, Count Down and Recall their previous Addresses |
| After inserting a catheter, the FY1 fails to replace the foreskin of the pt, what possible complication might this create? | paraphimosis: if foreskin is left retracted for long period, some foreskin tissue may become edematous and reduction of foreskin difficult |
| After inserting a catheter, what observation should be made? | What fluid comes out, how much, colour, blood etc. |
| This tumour marker is associated with…Alpha-fetoprotein | hepatocellular carcinoma, testicular tumours |
| This tumour marker is associated with…Beta-HCG | choriocarcinoma, testicular tumours (detects pregnancy!) |
| This tumour marker is associated with…CA 125 | ovarian carcinoma |
| This tumour marker is associated with…CA 15-3 | breast cancer |
| This tumour marker is associated with…CA 19-9 | pancreatic cancer, biliary tract malignancy |
| This tumour marker is associated with…Calcitonin | medullary thyroid cancer |
| This tumour marker is associated with…Carcinoembryonic antigen | colorectal tumours |
| This tumour marker is associated with…Monoclonal IgG (paraprotein) | multiple myeloma |
| This tumour marker is associated with…Neurone specific enolase | small cell lung cancer |
| This tumour marker is associated with…Placental alkaline phosphatase | ovarian carcinoma, testicular tumours |
| This tumour marker is associated with…Prostate specific antigen | prostate cancer |
| This tumour marker is associated with…S-100 | malignant melanoma |
| This tumour marker is associated with…Thyroglobulin | thyroid tumours |
| What signs are of hyperthyroidism only occur with Grave’s? | Proptosis (bulging eyes), chemosis (swelling & ulceration of the conjunctiva) opthalmoplegia, acropatchy (pseudo-clubbing), pretibial myxoedema |
| Presence of a thyroid bruit is a very sensistive clinical sign of what? | thyrotoxicosis |
| What blood type can someone with type A receive in a transfusion? | A (Surface Antigen)(Plasma Antibodies to B) so receive A or O |
| What blood type can someone with type B receive in a transfusion? | B (Surface Antigen)(Plasma Antibodies to A) so receive B or O |
| What blood type can someone with type AB receive in a transfusion? | AB (Surface Antigen A and B)(NO Plasma Antibodies) so receive A, B, AB or O |
| What blood type can someone with type O receive in a transfusion? | O (NO Surface Antigen)(Plasma Antibodies to A and B) so only receive O |
| What does the CAGE questionnaire letters stand for | Thought about Cutting down? A Angy when critisised about drinking?, Guilty about drinking?, Eye opener in the morning? |
Created by:
alski
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