AMSS teaching series: Swotvac - PowerPoint Presentation

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AMSS teaching series: Swotvac - PPT Presentation

Stephen B Disclaimer While this talk is as accurate as we could make it we are students Accordingly there may be errors Please do not rely on this talk when making clinical decisions The AMSS and authors of this talk do not accept any responsibility or liability relating to the use o ID: 754600

shows pain marker presents pain shows presents marker case talk urine type concerned reveals rash weight principles blood exam

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Slide1

AMSS teaching series:

Swotvac

Stephen BSlide2

DisclaimerWhile this talk is as accurate as we could make it, we are students. Accordingly, there may be errors. Please do not rely on this talk when making clinical decisions. The AMSS and authors of this talk do not accept any responsibility or liability relating to the use of the information.Slide3

Preparing for?

(i.e.)

MCQs!!

+ Y5 OSCE stations that take viva structureSlide4

SummaryCombination of exam feedback and assorted high-yield/challenging topicsSlide5

Haem

onc

Tumour

markers!

Relatively straightforward

66M being treated for pancreatic ca



Marker?

59F being treated for breast ca 

Marker

58M w haemochromatosis and

hep

C has weight loss 

Marker?

74F w colorectal ca 

Marker

64M w nodular prostate 

Marker?

44F w MEN2 and a neck lump 

Marker?

Frighteningly complex. Oversimplified:

Ovarian ca



Marker?

Non-specific ovarian cyst, what do I do about it? Any score I can calculate?

Other markers: AFP, LDH,

hCG

, testosterone, inhibin/

oestrogen

Testicular ca



marker?

(bonus: but which type does this miss out)

Almost any testicular pathology,

first Ix?

(except torsion!)

Other markers: AFP, ALP, LDH

And there are more

…

S-100, chromogranin, TRAP Slide6

Lung cancerCase66M. Sees GP w cough, night sweats and weight loss. 50 p/y smoking

hx. No travel.Top Dx?Different types?

Paraneoplastic syndromes?Ix reveals hyponatraemia  ? (which type of lung ca)Physical exam reveals central adiposity, proximal myopathy and multiple bruises  ? (type?)

Proximal weakness, improved strength w repeated efforts, dry mouth  ? (type

Polyuria, polydipsia and bone pain 

? (type

?) How does it cause thisSlide7

Superior vena cava syndromeCase70M. Known stage 4 lung ca. Managed palliative. Presents to ED w SOB and dysphagia of new onset (<12 hours). Stridor. Swollen face. Prominent veins over upper chest.

Dx?Other causes of this syndrome?Mx principles?Slide8

Haemolytic anaemia

Case35M. SOBOE. Ix reveals: decreased Hb, normocytic, increased unconjugated bilirubin, increased LDH.Category cause of anaemia

?Breaking it down:Associated w hemoglobinuria (causing dark urine) and may have schistocytes  where is breakdown occurring? Examples:Past

hx of cardiac surgery  ?

Child recently unwell w gastroenteritis 

? Which organism?

Bongo drums 

Neither of the above.

Spleen breaking down problematic 

Where is breakdown occurring?

Examples:

Newborn baby, jaundice, blood film shows

spherocytes



Inheritance?

These are classic classifications

–

in reality there may be overlap!

(extravascular

haemolysis

can

overwhelm spleen and present as

intravascular)

29F. Atypical CAP. Erythema

nodosum

. Hemoglobinuria 

What is causing

haemolysis

How to test for this?

Note this is only one method of classifying (can also classify by

cause

of hemolysis

–

e.g. intrinsic vs extrinsic)Slide9

Renal

Case

13M. Presents to GP w cola

coloured

urine for 1 day. Had a sore throat 2-3 weeks ago for which he did not seek medical attention. Hypertensive + ankle swelling. Urine microscopy shows RBC casts.

Name for category of presentation?

in this case?

Ix to confirm exposure to causative agent?

Which other condition are these tests relevant for?

principles?

Other causes of this kind of presentation

IgA mentioned

Membranoproliferative

glomerulonephritis

Vasculitidies

(see MSK talk)

Alport

Infective endocarditis

SLESlide10

RhabdomyolysisCase55M. DLP. Started on statin. Presents to GP w dark urine. No muscle pain. Urine dipstick shows +++ blood. Microscopy of urine shows no RBCs (

 huh that’s weird).Dx?Ix to confirm dx?So why the blood on dipstick?

Key concerns?Other classic causes of this?Slide11

Neuro

CSF problems!

For approach to hydrocephalus see

paeds

EoR

talk

Case

21F. Obese. Presents w headaches and pulsatile tinnitus.

Papilloedema

. Head CT NAD.

Ix?

Case

24F. 4 hours post-partum. Had spinal anaesthetic. Describes headache worse when standing, better when lying down. BP 120/80.

Must rule out?

In this instance classic features suggest? What is this?

Case NPH

60M. Family concerned re cognition over 6-12 months. Urinary incontinence. Magnetic/shuffling gait. CT shows enlarged ventricles. LP shows normal pressure and symptoms improve post-LP.

?Slide12

MGCase44F. Presents to ED w weakness + diplopia. Over last 7 days. Worse at end of day. Struggles to stand from seated position. Examination shows fatigable ptosis.

Dx?Where is weakness usually most prominent?Other characteristic exam findings?Ix:Spirometry/PEFR

 Why?Chest CT  Why?Autoantibodies  which?EMG  shows what?

Edrophonium  What does it do?Principles of

?Slide13

Psych - overdoses

Case

71F. Being treated for CAP.

PMHx

: AF and COPD. Meds: warfarin,

nebivolol

, salbutamol, tiotropium and azithromycin +

amoxicilllin

. After forceful coughing reports

abdo

pain/swelling. CT shows:

Rectus sheath hematoma

Concerned about?

Why is INR elevated?

Which other meds may inhibit this pathway?

What other meds that are

metabolised

by the pathway?

Principles of

?Slide14

73M. Hx of depression and CCF. Deliberate overdose. Unknown medication. HR 30. BP 80/60. Wheeze.Dx

?Mx?Slide15

2M. 2 hrs ago ate a bunch of tablets from grandmothers purse as were brightly coloured

. Now has vomiting w blood and abdo pain. XR reveals radioopaque pills in stomach.Top dx?Concerned about which complications?Mx

?Potential long term complications?Slide16

While we are talking about GI perforation…44M. Out w friends drinking after large meal. Profuse vomiting. Presents to ED w chest pain. H/d stable. Examination reveals subcutaneous emphysema. CXR shows

pneumomediastinum and sc emphysemaDx?Ix?

Tx?Slide17

44F. Bipolar disorder. Presents to ED as partner thinks is behaving oddly. Confused, slurred speech, ataxia, tremor. Has recently been taking large numbers of NSAIDs for joint pain suffered while exercising. No unusual medication intake.Dx

?Why has it occurred?Mx?Slide18

See psych talk for most common examplesSlide19

SummaryHaem/onc

Tumour markersLung cancer w paraneoplastic syndromes Superior vena cava syndromeHaemolysisRenal

Nephritic syndrome(Rhabdomyolysis)NeuroCSF problemsMGSpinal cord syndromesSlide20

AMSS TS 2017

Summary:

32 talks (!!)

At every metropolitan hospital affiliated w

UofA

! (and at Cambridge)

Approx

500

Freddos

Thank you to all of the presenters and presentation writers:

Ivana

Chim

Ian Tan

Frank Zhang

Alyssa Pradhan

Gordon Goh

Kathy

Chooi

Jane Collinson

Linda Bi

Bhuwan

Tandon

Michael Mills

Georgina

Minns

Lachlan

Tamlin

Thank you to the staff who assisted with room bookings.Slide21

Good luck Y4!Slide22

Paeds

2 day old male. Clunk on Barlow and

Ortolani’s

tests

How do you perform these tests?

Ix?

What if the child was older than 6

What do you look for on XR?

?Slide23

Case7 male. Sprinting athlete. Hip pain over last 2-3 mo. Limited active and passive ROM. In particular limited internal rotationDX?

Ix? Tx?Slide24

Case13M. Obese. Sudden onset knee pain. Difficulty weight bearing. No trauma. No pain w knee movement on exam. Pain w hip movement.Ix?

Tx?Slide25

Case4M. Hip pain for 12 hours. Fever, sweats, fatigued. Tachycardia. Erythema + swelling of knee. Severe limitation of passive ROM. Won’t weight bear.Dx

?Ix?Tx?Slide26

2M. Fever. Ear pain. For 2 days.Presents to ED following 2 min generalised tonic

clonic seizure. Erythematous bulging R tympanic membrane. Now well.Likely Dx?Ix?EEG?

Simple vs complex?Do antipyretics reduce future seizures?Tx?Slide27

2 mo male. Flaking, scaly waxy rash. Nasolabial folds and scalpDx

?Ix?Tx?What about in adults?Slide28

6M. Rash around mouth/neck. Dx?Causative organism?

Tx?Rugby playersSlide29

4M. Rash over left side of body. Papules with central umbilication. 2yo F sibling has simlar

rash.Dx?Causative agent?Mx?Slide30

OBGYN

28F. G1P0. 32 weeks gestation. Pregnancy uncomplicated so far. Comes to ED w uterine contractions. Regular. No cervical change.