Slideshow Revision

Ian AndersonMarch 2008

Question 1

WCC 8.24 Ferritin LowHb 8.06 Folate NormalMCV 69 Vit B12 NormalPlts 350 TIBC High

a) What is the diagnosis? (1 mark)

b) What cells might you see on a blood film? (1 mark)

Question 2

a) What is this sign? (1 mark)

b) What is the diagnosis?(1 mark)

c) How long will it typically take to heal? (1 mark)

Question 3

a) What is your diagnosis in this patient who presented with chest pain? (1 mark)

b) How would you further investigate this patient?

Question 4a) What is this sign called?

(1 mark)

b) What is it diagnostic of?(1 mark)

Question 5What is your diagnosis in this lady who has deranged LFTs?

(1 mark)

Question 6

a) What is the diagnosis? (1 mark)

b) What should you do? (1 mark)

Question 7

a) What is this investigation?(1 mark)

b) What is the diagnosis?(1 mark)

Question 8

a) What is the diagnosis? (1 mark)

b) Name two life-saving treatments that you would give. (1 marks)

Question 9

a) What is the diagnosis? (1 mark)

b) Name two treatments. (2 marks)

Question 10a) What is the

diagnosis?

(1 mark)

Question 11a) What is the diagnosis?

Question 12

a) What operation has this elderly gentleman had?

Question 13

This man has started a new tablet because he’s “Got blood pressure, Dr”.

a) What is your diagnosis of this painful toe?

b) What class of tablet is likely to be responsible?

Question 14a) What is this sign?

(1 mark)

b) What is it usually predictive of?(1 mark)

Question 15a) What is this sign?

b) What is the underlying pathology?

Question 16a) What is this

procedure?(1 mark)

b) Name a potential complication(1 mark)

Question 17a) What is the diagnosis in this patient with a history of atrial fibrilation and collapse? (1 mark)

Question 18

a) Diagnosis (1 mark)

b) Treatment in non-diabetic(1 mark)

Question 19a) What does the

arrow denote?

b) What is it diagnostic of?

Question 20

a) What is this? (1 mark)

Question 21a) What is this clinical

sign?

b) What is the diagnosis in this 30 year old man with chronic backache?

Question 22a) What did this patient die of?

Question 23

a) What is the device that has been circled? (1 mark)

b) What are the indications for this?(1 mark)

Question 24

a) What procedure has been performed here?

b) What complication has occurred?

Question 25

a) What procedure has been performed?

b) What is the indication for doing this?

Question 26A) Diagnosis? B) Treatment?

Answers

Answer 1WCC 8.24 Ferritin LowHb 8.06 Folate NormalMCV 69 Vit B12 NormalPlts 350 TIBC Higha) Iron deficiency anaemia (microcytic anaemia with low ferritin)

b) Poikilocytosis / anisocytosis

NB: Other microcytic anaemias include: Chronic disease (where MCV may be normal or low but ferritin is

high and TIBC is low)Thalassaemia / sideroblastic anaemia (where ferritin is high and

TIBC is low)

Answer 2

a) Dinner fork deformity

b) Colle’s fracture of left hand

c) 6 weeks

Answer 3

a) PE (1 mark)

b) D-dimer, V/Q Scan or CTPA

Answer 4a) Pepperpot skull

(1 mark)

b) Multiple myeloma(1 mark)

NB: If you suspect myeloma in a patient, first line investigation is Bence Jones protein (urine sample) together with myeloma screen (blood electrophoresis), not a skull x-ray!

Answer 5Wilson’s Disease

(1 mark)

These are Kayser-Fleischer rings

You will never diagnose Wilson’s disease as a Dr. as is almost always picked up in childhood

a) Acute angle closure (blockage of the drainage angle causes IOP to rise. High pressure results in a constellation of signs seen in acute angle closure glaucoma including redness of conjunctiva (red arrow), haziness of the cornea, and a mid-dilated pupil (white arrow).

b) Get help! (We think that this was the answer they were looking for, rather than starting IV acetazolamide)

Answer 6

Answer 7

a) Barium swallow(1 mark)

b) Oesophageal stricture(1 mark)

Answer 8

a) Non ST-elevation MI (MI alone is not enough)

b) Oxygen, Aspirin, (GTN & Morphine)

Answer 9

a) Atrial Flutter (1 mark) [With 4:1 block – for the geeks]

b) DC cardioversion, pharmacological cardioversion (flecanide, sotalol), digoxin, beta blockers, verapamil, AV node ablation & PPM, overdrive pacing.

Answer 10

a) Cystic fibrosis

Frontal chest x-ray in cystic fibrosis shows diffuse interstitial disease with bronchiectasis and nodular densities of mucoid impaction

Answer 11a) Left pleural effusion

Answer 12

a) Pnemonectomy

Answer 13

This man has started a new tablet because he’s “Got blood pressure, Dr”.

a) Gout

b) Thiazide diuretics (e.g. bendroflumethiazide)

Answer 14a) Cullen’s sign

(peri-umbilical bruising)

b) Acute pancreatitis

Answer 15a) Ascites

b) Cirrhosis of the liver

Answer 16a) Coronary

angiogram

b) Stroke, MI, rupture, death, femoral haematoma & (pseudo) aneurysms

Answer 17a) Extradural haematoma(Subdual shown for comparison)

Answer 18

a) Cellulitis

b) Ben-pen & fluxlox

Answer 19a) “Looser’s

zone” (pseudo-fracture)

b) Osteomalacia(Note diffuse osteopenia)

Answer 20

a) Incisional hernia

Answer 21a) Bamboo spine

b) Ank Spondy

Answer 22a) Saddle PE

Answer 23

a) REVEAL implant (not a pacemaker, see top image)

b) Dizziness, syncope, palpitations, collapse, brady/tachy arrhythmias

Answer 24

Answer 25

a) Fasciotomy

b) Compartment syndrome

Answer 26A) Small bowel obstruction B) Drip & suck!

Good luck in your finals

You’ll all be fine. If I can pass, ANYONE can!