-
what acid-base abnormality do you get in pyloric stenosis?
hypochloraemic hypokalaemic metabolic alkalosis
-
what is octreotide and 3 uses
- Somatostatin analogue (inhibits GH release)
- 1. Variceal bleeding
- 2. Acromegaly
- 3. Carcinoid tumours: blocks release of tumour mediators and counters peripheral effects
-
which type of rectal tumours is managed by AP resection?
abdomino-perineal resection for low rectal tumours
-
what kind of resection is done for a high rectal tumour?
anterior resection
-
what is the management of ascites?
- ascitic tap: urgent MC&S (SBP)
- dietary sodium restriction, fluid restriction
- bed rest
- spironolactone, add frusemide if it doesn't work
-
what is the management of refractory ascites…what do you have to remember?
- total paracentesis (therapeutic)
- infusion of albumin or colloid with it (otherwise ascites will come back)
-
what is the differential for left lower quadrant pain?
- sigmoid diverticulitis
- sigmoid cancer
- salpingitis
- ruptured ectopic pregnancy
- perforated colon
- UC, Crohns
- period pain
- tubo-ovarian abscess
- rénal or ureteric colic
-
name 5 other differentials that come in right but not left lower quadrant pain
- appendicitis
- perforated caecum
- meckel's diverticulum
- psoas abscess
- mesenteric adenitis
-
in elderly, what are the 2 main causes of significant rectal bleeding and how to differentiate?
- angiodysplasia
- diverticulae
- barium enema: abnormal in diverticulae but would look normal angiodysplasia
- diagnose angio: colonoscopy
-
what are the symptoms of scurvy? where is vitamin C absorbed?
- vitamin C: proximal ileum
- bleeding from gums, hair follicles, into joints
- gingivitis
- loose teeth
-
if you have vitamin B3 (nicotinamide) deficiency, what is disease and symptoms?
- pellagra
- diarrhoea
- dementia
- depression
- dermatitis
- delusions
-
what happens in B6 deficiency? and which drug can cause this?
- pyridoxine deficiency: polyneuropathy
- caused by isoniazid
-
what are 3 features of B12 deficiency?
- glossitis
- macrocytic anaemia
- neuropathy (subacute combined degen of spinal cord)
-
what is the triad of subacute combined degeneration of the spinal cord?
- (mix UMN and LMN)
- 1. extensor plantars (UMN)
- 2. absent knee jerks (LMN)
- 3. absent ankle jerks (LMN)
-
how may subacute combined degeneration of the spinal cord present?
- falls at night due to ataxia and reduced vision
- note STT in tact
-
in alcoholics, they commonly have low glucose, what else must be checked before giving glucose?
- thiamine level as wernicke's can be precipitated by glucose administrated to a thiamine-deficient patient.
- so make sure thiamine is given BEFORE glucose
-
what is the inheritance of peutz-jeghers syndrome?
autosomal dominant
-
what is the risk of peutz-jeghers transforming to malignancy?
low <3%
-
what are the 3 main categories for splenomegaly?
- haematological malignancies: lymphoma…
- infections: malaria EBV
- cirrhosis
-
which infection has to be considered a differential for coeliac?
- giardiasis
- get watery diarrhoea and villous atrophy
-
what is the differential for right upper quadrant pain?
- acute cholecystitis
- duodenal ulcer
- hepatitis
- congestive hepatomegaly
- appendicitis
- pyelonephritis
- R base pneumonia
-
what is the differential for left upper quadrant pain?
- ruptured spleen
- perforated colon
- gastric ulcer
- MI
- aortic aneurysm
- pyelonephritis
- L basal pneumonia
-
what is the differential for bilateral leg oedema?
- increased venous pressure: right heart failure
- low oncotic pressure: low albumin: cirrhosis, renal failure, protein losing enteropathy
- venous insufficiency: acute e.g. sitting too long; chronic: haemosiderin, itchy, eczema, ulcers
- drugs: nifedipine (vasodilators
- pelvic mass, pregnancy
-
what is the differential for unilateral leg oedema?
- DVT
- cellulitis
- compartment syndrome
- necrotising fasciitis
- bone or muscle tumours
- impaired mobility: trauma, arthritis, bakers cyst
-
which drugs can cause acute pancreatitis?
- L-asparignase
- azathioprine
- valproate
- steroids
- oestrogens
-
which artery supplies the transverse colon and what is it a branch of?
- middle colic artery
- branch of superior mesenteric artery
-
what is the AXR sign of Crohn's?
string sign
-
what can you see on AXR of UC?
finely granular appearance e.g. of TC and absence of hausfrau
-
what is a sentinel loop on xray? give e.g.
- indicates localised ileus from nearby inflammation
- e.g. in acute pancreatitis see a sentinel loop in left hypochondrium
- acute appendicitis
- in acute appendicitis see in RIF
- in acute cholecystitis see in RUQ
-
what is status epilepticus?
- seizures lasting > 30 mins
- or repeated seizures without intervening consciousness
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