H&N Super Quiz

1. H&N Super Quiz Rick Allen

2. Feeling tired • Histologically, list two defining features of the stomach • Glandular epithelium • gastric pits and glands • extra layer in muscularispropria (inner oblique)

3. Does vitamin B12 have an appreciable toxicity • false

4. List the 5 Geriatric Giants, providing an example of each • Iatrogenic – drug issues (↓ clearance, polypharmacy, pharmodynamics) • Intellectual – dementia, delirium, depression, or a combination • Instability – falls (environmental, cognitive, sensory, neuromuscular, CVS) • Immobility – weakness, stiffness, pain, imbalance, psychological • Incontinence – detrusor inactivity, stress incontinence, urethral obstruction • Infection - ↓ immune capability

5. Is the law of parsimony more or less relevant in the elderly? • Less – can have multiple diseases, the symptoms they have may not be related.

6. Define what a medical record is: • A compilation of documents which record the health history, condition and treatment of clients of a person professionally practicing health care.

7. Who owns medical records? • Doctor (sole practitioner), partners of private practice, the practice (if corporately owned), hospitals

8. Can a patient access their own medical records? • No common law right, but can be done under FOI legislation if it is made in writing, access poses no risk to pt. or others and if it doesn’t breach privacy.

9. What do the following Liver Function Tests test for/show? • Alanine aminotransferase (ALT) • Metabolism, foodenergy. Liver damage  ↑ presence in bloodstream • Aspartate aminotransferase (AST) • Processes proteins, found in liver, heart, muscles kidneys. Liver damaged/inflamed  ↑ presence in blood stream • Alkaline phosphatase (ALP) • Found in liver, bones, intestines, kidneys, others. Raised in viral infection, blocked bile ducts, liver diseases • Total/direct billirubin • By-product of normal RBC breakdown. Explores characteristics of liver disese.

10. List two probability diagnoses for dizziness/vertigo, and two serious disorders that shouldn’t be missed • Anxiety (hyperventilation), postural hypotension, vasovagal, motion sickness, post-head injury, benign paroxysmal positional vertigo, spondylosis • Neoplasia (acoustic neuroma, brain tumour), Intracerebral infection, CVS (arrhythmia, MI, aortic stenosis), cerebrovascular, MS

11. What changes (if any) would you expect in the levels of the following parameters in haemolyticanaemia? Briefly explain your answer. • (a) serum lactate dehydrogenase • ↑ - blood cell lysis • (b) serum haptoglobin • ↓ - used up in collection of free globins • (c) urinary urobilinogen • ↑ or stay the same – saturated liver

12. Describe this slide • What is the condition it represents? • Sickle cell

13. What is the condition it represents? • B12 (neuro), B9 (no neuro)

14. G6PD deficiency

15. decreased MCV, MCHC, High RDW • (Iron deficiency

16. What is vit B12 used for? • Recycle vit B9.

17. And vit B9? • DNA synthesis

18. What vit is required for ferric uptake and why? • Vit C – ferricreductase/ duodenal cyt.B

19. In iron overload, what storage molecule is found in unusually high amounts? • Haemosiderin

20. What is pernicious anaemia and what three pathophysiologies cause it? • A cell mediated autoimmune response, primarily humoral, which results in decreased uptake of vit B12. • Kills parietal cells • Stops IF – B12 bind • Stops IF/B12 compound from entering enterocytes

21. Describe the RBC’s you would expect to see in a pt. with renal failure. Why? • Normochromic, normocytic. • ↓ EPO therefore decreased production of RBC.

22. Describe the RBC’s you would expect to see in a pt. with chronic disease. Other interesting observations? • Normochromic, normocytic – • Hypochromic, microcytic – hepcidin is an acute phase protein. Causes ↓ ferroportin. No Fe available for blood cells. • Macrophages filled with iron.

23. Little Johnny is diagnosed with anaemia. He has a family history of bleeding disorders and is currently being treated effectively for asthma. He is also a type I diabetic. What is wrong with this scenario? • You cannot be diagnosed with anaemia. What is the cause of the anaemia?

24. Which cytokine promotes the differentiation and development of the eosinophil? • IL-5

25. Back Pain from a minor fall • What are the key factors and major concerns associated with admitting a patient into hospital • Communication, keeping everyone informed, paperwork, insurance/money, continuity of care

26. What are yellow flags associated with back pain • Psychosocial factors shown to be indicative of long-term chronicity and disability • Fear avoidance behaviour, expecting passive better than active Tx is better, social/financial/morale problems, depression, social withdrawal

27. Describe the basics of management for acute back pain • Resume normal activity and ‘let the pain be their guide’ • Encourage return to work • Paracetamol/NSAIDS • Local ice or heat • Education • Follow-up as required in 1-3 wks. • Ix. – imaging not rec. unless red flags.

28. List a cause for LBP associated with each of the following: • Skin • Herpes zoster • Muscle • Strain, tear, bleed, • Visceral referred • Kidney, gynae, anything retroperitoneal, aorta, cystitis, cholecyctitis • Joint • Dislocation, osteoarthritic, infection, mass lesion • Ligament • sprain • Bone • Inflam. (spondylitis), fracture (norm or path), spur • Disc • Discitis, herniation • Spinal cord • Compression • Meninges • Infection, compression. Dura only • Nerve • Irritation/ inflammation • Vascular • Vasculitis, stenosis (ischaemic injury) • Psychological • Somatisation, malingering

29. What are the RED flags for LBP? • Radiating past knee • <18, >50 y.o. (cancer or infection) • Bladder/bowel incontinence, saddle parasthesia (Caudaequina syndrome) • B symptoms/ Hx. Of cancer (breast, thyroid, lung, prostate, kidney metastasis) • Wake during night (cancer) • Fever, immunocompromised (infection, cancer) • Neurological symptoms • Pt. has seen multiple doctors (pain meds malingerer)

30. What is the most abundant plasma protein? • albumin

31. Which two cytokines are important in inducing acute phase proteins? • IL-1 and IL-6

32. What percentage of ingested calcium is absorbed, and what percentage of Ca in glomeluar filtrate is passively reabsorbed in the kidney? • 90%

33. What are the effects of Parathyroid hormone in relation to Calcium control? • Stimulates osteoclast development and activation • Increases the action of 1α-hydroxylase (convert 25 hydroxycholecalciferol) • Increases reabsorption of Ca in the kidneys (distal tubule lumen channels) • ↑ phosphate secretion

34. What is the role of the Professional Services Committee? • To determine whether a referral from the PSR director is an example of inappropriate behaviour (medical overservicing) and if so, forwarding it onto the determining authority.

35. Briefly describe the microscopic picture of an adenoma causing primary parathyroidism. • Group of chief cells all together, no fat separating them.

36. Describe the mechanism behind renal osteodystrophy. • Renal failure  phosphate retention hyperphosphataemia secondary parathyroidism • Renal failure  hypocalcaemia  ↑PTH ↑OC activity

37. State the diagnostic definition of osteoporosis • >2.5 SD below the avg. bone density for healthy young adults.

38. Describe the pathogenesis of osteomalacia • Poor mineralization of newly formed bone due to lack of Vit D (therefore loss of Ca and PO)  thin fragile bones - fractures and bone pain.

39. List two reasons for chronic constipation • Inadequate fibre or water intake • Disordered colonic transit • Disordered anorectal function (drugs, age, systemic diseases)

40. Provide the definition for an occupational injury • Any personal injury, disease or death resulting from an occupational accident.

41. List three social impacts felt by a terminal patient: • Loss of normal activities • Pre-death grief • Guilt • Burden on family and friends (health system?) • Getting affairs in order

42. List three clinical features of Multiple Myeloma and explain the Pathophysiology behind them: • Immunosuppression – due to ↑ monoclonal Ig,  infections • Space occupying lesion  normocytic, normochromic anaemia (BM replacement and renal failure), bone pain, pathological breaks, hypercalcaemia (↑OC activation, ↓ OB via ↑ IL-6 and ↓OPG), lytic lesions moving inside to out • Bence Jones bodies – cause renal failure via clogging and toxicity. Amyloidosis. ↓ renal function

43. List the requirements for diagnosing MM • 2/3 of: • serum/urine bence jones bodies/ M proteins, • radiological evidence of lytic lesions/ end-organ damage, • >10% plasma cells in BM trephine.

44. Describe the ‘pot’ below Same again

46. A lump in the throat • Explain each element of “SPIKES” in relation to breaking bad news • Setting • Perception • Invitation • Knowledge • Explore emotion • Strategy and summary

47. Explain the basis of the double effect without causing an argument • The action must be good in itself, the agent only intending the good effect and not the evil one, the good effect not being achieved through the evil effect and there is sufficient reason to permit the evil effect.

48. Where is Virchow’s node located, and what can it be a sign of? • Left supraclavicular. • Stomach cancer classically, but also lung, testis, ovarian, breast…. Non- neo plastic include toxoplasmosis, TB and sarcoidosis.

49. Describe three different characteristics of lymph nodes that could be observed during examination, and what these characteristics mean. • Enlarged/ palpable – could be idiopathic • Tender – infection • Rubbery and large – B cell neoplasm • Hard and/or fixed in place – secondary carcinoma

50. Provide two probability Dx. for hoarse voice. • Viral URTI (acute laryngitis) • Non-specific irritative laryngitis • Vocal abuse • Acute tonsillitis • Nodules and polyps of cords • Tired voice in elderly (phonaesthenia)