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Alski's Stack No. 1

T Year Revision

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