T Year Revision
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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STI advice to 2 HIV+ve partners | use protection, ie condoms
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HIV with eye problems | CMV/ Herpes
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HIV detection window is | 6-12 weeks (test 3 months after last possible infection encounter)
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HIV opportunistic infections p/c encephalitis think what pathogen | toxoplasmo gondii
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HIV p/c Weight loss, abdo pain, night sweats, diarrhoea think what bacteria | disseminated mycobateria avium
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HIV p/c meningeal signs think what infectious agent | cryptococcal meningitis
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HIV white patches on tongue (peelable) | candida
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HIV white patches on tongue (non peelable) | oral hairy leukoplakia
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HIV To test pt for HIV you will need to get/give | discussion (benefits) + informed consent (no counseling needed)
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2/3/4 day peaking fever, rigors, chills, icteric, abdo pain, vomit, confusion, recent travel | Malaria
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Rifampicin SE’s (2) | hepatotoxic + orange fluids
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Isoniazid SE (2) | hepatotoxic + peripheral neuropathy
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Pyrazinamide SE | hepatotoxic
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Ethanbutol SE | toxic optic neuropathy (esp. colour vision)
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TB medication, non compliance an issue? Rx Protocol to suggest? | Directly Observed Therapy
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Hepatosplenomegaly + green pea soup diarrhoea | typhoid
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75% 90% UTIs caused by | eColi
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Opportunistic Pathogen associated with CF | pseudomonas aeruoginosa
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Organism causing infected gold crusty skin | staph aureus
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Meningitis cause in adults in developed countries (2) | strep pneumoniae or neisseria meningitis
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Cause of most hospital acquired diarrhoea (agent and risk factor) | cDiff after ABx therapy
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Metronidazole C/I with what | ETOH
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Fluclox can cause what | cholestatic jaundice
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ABx that inhibit breakdown of Warfarin (3) | Metronidazole, Ciprofloxacin, Clarithromycin
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Vancomycin given too quickly causes | itchy, red rash on face and chest (angry red van man)
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Uncomplicated UTI ABx Rx | Trimethoprim
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MSRA ABx first line Rx | Vancomycin
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C diff ABx Rx (3) | Oral Met >Oral Vanc >IV Met
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Prophylactic ABx for clean surgery | cefuroxime
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Atypical pneumonia ABx Rx | erythromycin
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Dysphagia with liquids and solids, no reflux, regurgitates recently eaten food | achalasia
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Achalasia Ix | barium swallow (rat’s tail)
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Retrosternal pain, no loss of appetite, inflammation and irritation of oesophagus | bisphosphonates Rx
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Diarrhoea in elderly or immunocompromised requires | hospital admission
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Epigastric pain with nausea with sweating + some CV risk factors | rule out cardio first when have CV risk factors eg. Fat, smokes
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Worsening reflux, persistent or unexplained dyspepsia >55yr +/- ALARM symptoms next step is | urgent endoscopy
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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
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Cause of dysphagia + coughing (difficult making swallowing movement) | bulbarpalsy (can result from rapid correction of hyponatraemia)
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Neck bulges on drinking | oesophageal pouch
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Intermittent retrosternal pain | oesophageal spasm
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Regurgitation of undigested food + dysphagia for liquid & solid | motility problem (achalasia) rather than mechanical (stricture)
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Achalasia Ix | barium swallow
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Progressive difficulty swallowing + Hoarse voice, (smoking) | Ca Oeso
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Rip-roaring central chest pain, may feel like MI, dysphagia, regurgitation | oesophageal spasm
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oesophageal spasm Ix & pathog sign | barium swallow (corkscrew oesophagus)
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Alternating diarrhoea & constipation + stress | IBS
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Alternating diarrhoea & constipation + mucus, tenesmus | Ca
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Alternating diarrhoea & constipation + abdo pain, diarrhoea, conjunctivitis, arthritis | IBD
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IBD Ix | sigmoidoscope
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steatorrhoea | pancreatitis
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unconjugated hyperbilirubinaemia, no billi in urine, generally asymptomatic | Gilbert’s
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unconjugated hyperbilirubinaemia, p/c neonatally | Crigler-Najjar (needs liver transplant)
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conjugated hyperbilirubinaemia + bili in urine | Rotor Syndrome
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Liver failure + odd behaviour | hepatic encephalopathy (Rx bowel cleansing c lactulose)
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Long term steroids + malaena + hypotension | high chance of bleeding ulcer
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Intense prolonged vomiting | Mallory Wiess tear
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Terminal Illeum resection requires what Rx | B12 supplementation
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Child Pugh score (which grades cirrhosis + risk of variceal bleeding) requires what | Billi + Albumin + Prothrombin time + grades for ascites and encephalopathy
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Ascites Rx | IN (fingers) OUT (fluid ascitic tap) SCAN (liver/abdo)
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H pylori eradication Rx | 1 month triple therapy amoxicillin, metronidazole, PPI; (unless alcoholic, don’t give metro give clarithromycin)
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Pre endoscopy preparation | No PPI, No H2 antagonists, arginate antacid for symptom relief
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Symptoms of Systemic inflammatory response (eg. febrile neutropoenia) and Rx | T>38, HR >90, Rx is broad spectrum ABx before cultures as urgent
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Chronic alcoholic admitted Rx | give pabrinex (as thiamine deficient + vits B & C) before IV dextrose
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NG tube, how do u check placement | pH check of aspirate, should be <6
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Any unexplained iron deficient man Hb <11 Rx | urgent referral to rule out Ca
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Rx To reduce portal hypertension | terlipressin
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PR bleeding in >60yrs >6 weeks, next management step | 2 week referral
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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
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Palpable gall bladder + jaundice + No pain | NOT gall stones (Courvoisier’s Law)
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Palpable ball bladder which illicits pain + no jaundice is suggestive of | cholecystitis/Choledocholithiasis (gallstones in the common bile duct)
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Rib fracture Pain produced with attempts to sleeping on...? | one's back
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Tetanus sign | Risus sardonicus (sustained spasm of the facial muscles, grinning)
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Typhoid fever sign | Rose spots in abdomen (small red spots on the belly and chest)
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Duchenne’s muscular dystrophy | Gower’s sign (inability to rise off floor without using upper extremities)
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Slapped-cheek appearance | Erythema infectiosum (aka Fifth disease) (infection by erythrovirus aka parvovirus B19)
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Loss of central vision | Age-related macular degeneration
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Spiderlike extremities, long and hypermobile hands and feet | Marfan’s syndrome
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distal paresthesia elicited by tapping the median nerve on the wrist | Carpal tunnel syndrome (Tinel’s sign)
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whitish/grayish discoloration of the pupil with light shone in eye | Retinoblastoma sign (Leukocoria)
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Heavy sensation in the testicles | Testicular cancer
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Barking cough | Pertussis
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Slight rubbing of skin exfoliates outermost layer (in absence of burns or bacterial infection) | (Nikolsky’s Sign) Pemphingus
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Rusty Sputum | Pneumococcal Pneumonia
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Very Sharp angle in spine | Potts’ Disease, is gibbus formation a presentation of extrapulmonary tuberculous spondylitis
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Pink Frothy Sputum | Pulmonary Oedema
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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)
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Low-grade afternoon fever | Pulmonary TB
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wheezing on expiration | Asthma
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barrel chest | Emphysema
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strawberry tongue | Kawasaki Syndrome
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red beefy tongue | Pernicious Anemia
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protruding tongue | Down’s
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rice watery diarrhoea | Cholera
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sore throat, low fever and adherent membrane on tonsils, pharynx | (pseudo membrane) formation
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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)
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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
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lioning face | Leprosy
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Bulimia | chipmunk face
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Dengue | petechiae or (+) Herman’s sign
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Meningitis | Kernig’s sign (leg pain), Brudzinski sign (neck pain) this is stupid one really….
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Tetany | Hypocalcaemia (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm)
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Pancreatitis signs | Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots
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olive like mass in epigastric region | Pyloric Stenosis
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machine like murmur, what pathology? | Patent DA
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Addisons | bronze like skin pigmentation
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Cushings Syndrome | moon face appearance and buffalo hump
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Graves | exopthalmus
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Intussusception | sausage shaped mass
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Cytomegalovirus infection | Owl's eye appearance of inclusion bodies[1][2]
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Inclusion body myositis | Filamentous material seen in inclusion bodies under electron microscopy
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Bulimia Nervosa | Chipmunk facies (parotid gland swelling) (Chipmunk facies also seen in marrow expansion secondary to Beta Thalassemia Major)
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Leprosy | Leonine facies (thickened lion-like facial skin)
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Chronic hemorrhagic pancreatitis | Grey-Turner's sign (ecchymosis in flank area)
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Pleural Effusion | Stony-dull percussion
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Parkinson's disease | Pill-rolling tremors
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Blood film shows Auer rods | Acute Myeloid Leukemia
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Multiple Sclerosis | Bilateral internuclear ophthalmoplegia
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Congestive heart failure | Third heart sound
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Pericarditis | Pericardial friction rub, pain eases with NSAIDs and leaning forward
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Neurofibromatosis I | Plexiform neurofibroma
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Hodgkin's lymphoma | Hodgkin and Reed-Sternberg cells (giant mono- and multinucleated cells)
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Pyelonephritis | White blood cell casts
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Rheumatic fever | Aschoff nodules
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Lyme Disease | Bullseye Rash
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Urothelial (bladder/UTI) carcinoma | Dyes/rubber manufacture + Painless haematuria + Thick bladder wall
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Causes of Clubbing GI (name 4) | IBD (esp. Crohns), Cirrhosis, GI Lymphoma, Malabsorption (think infection, inflammation, neoplasm)
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Causes of Clubbing CV (name 3) | Atrial Myxoma, Cyanotic Heart Disease, Endocarditis, (ACE) (think infection, inflammation, neoplasm)
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Causes of Clubbing Thoracic (name) | Abscess, Bronchiectasis, CF/CFA/Any fibrosis, Emphyema, Mesothelioma (think infection, inflammation, neoplasm)
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Spoon shape + brittle nails (name and cause) | Koilynichia, iron deficiency
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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)
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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
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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
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Mouth Ulcers (some common causes) | vit defic, poor diet, malignancies, Crohns, UC, Coeliac, Behcet’s SLE
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Gingivitis (common associations) | gingival hyperplasia from CML, anticonvulsants, CCBs, Vit D defic, Sarcoid, Wegener’s
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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
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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)
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ECG presentation of Digoxin | reversed tick (after QRS complex, leading into T wave) NOT necessarily a pathology
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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)
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Bifid or wide P waves on an ECG, what could be the cause | dilated atrium, possibly from
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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
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What Ix is used for Wegener’s | ANCA
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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
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Indications for surgery on a AAA | AAA >5.5cm diameter, Rapid AAA enlargement (>1cm/yr), Symptomatic AAA of any size
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Rx of AAA | ABC, O2, 2x large bore cannula, CT, permissive hypotension (<100), surgery pronto
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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
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Diagnosing DM from fasting BG requires | one test>7.1
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Diagnosing DM from random BG requires | one test>11.1+symptoms OR 2 tests>11.1 with no symptoms
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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
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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
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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
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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)
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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.
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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.
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Virchow's triad describes | three broad categories of factors that are thought to contribute to thrombosis: Hypercoagulability, Hemodynamic changes (stasis, turbulence), Endothelial injury/dysfunction
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5 most common Ca that spreads to bone | Prostate, Kidney, Breast, Lung, Thyroid
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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
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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
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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
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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
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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
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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
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Why would u want to avoid Diclofenac in the elderly? | causes renal failure
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An atopic person produces lots of what? | IgE
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What do IgE Abs do in relation to allergy? | Bind to mast cells
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What test determines whether an anaphylaxis has occurred? | Tryptase, which is released when mast cells degranulate
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AMTS Aide Memoire | Old Timers Remember Places for Years & People’s Birthdays while Monarchs start wars, Count Down and Recall their previous Addresses
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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
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After inserting a catheter, what observation should be made? | What fluid comes out, how much, colour, blood etc.
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This tumour marker is associated with…Alpha-fetoprotein | hepatocellular carcinoma, testicular tumours
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This tumour marker is associated with…Beta-HCG | choriocarcinoma, testicular tumours (detects pregnancy!)
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This tumour marker is associated with…CA 125 | ovarian carcinoma
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This tumour marker is associated with…CA 15-3 | breast cancer
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This tumour marker is associated with…CA 19-9 | pancreatic cancer, biliary tract malignancy
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This tumour marker is associated with…Calcitonin | medullary thyroid cancer
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This tumour marker is associated with…Carcinoembryonic antigen | colorectal tumours
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This tumour marker is associated with…Monoclonal IgG (paraprotein) | multiple myeloma
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This tumour marker is associated with…Neurone specific enolase | small cell lung cancer
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This tumour marker is associated with…Placental alkaline phosphatase | ovarian carcinoma, testicular tumours
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This tumour marker is associated with…Prostate specific antigen | prostate cancer
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This tumour marker is associated with…S-100 | malignant melanoma
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This tumour marker is associated with…Thyroglobulin | thyroid tumours
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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
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Presence of a thyroid bruit is a very sensistive clinical sign of what? | thyrotoxicosis
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What blood type can someone with type A receive in a transfusion? | A (Surface Antigen)(Plasma Antibodies to B) so receive A or O
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What blood type can someone with type B receive in a transfusion? | B (Surface Antigen)(Plasma Antibodies to A) so receive B or O
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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
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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
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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?
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