Q9/7
11 Hiep N is the 68-year-old grandmother of a patient of yours. She is proficient in English. Her daughters have noticed that she has become increasingly confused over the last six months. She can't remember the names of her friends, and more than once has forgotten that she has left the stove on. This has been a steady deterioration. You consider that the most likely cause is Alzheimer’s type dementia. However you need to exclude other causes of this clinical presentation. Which of the following is most likely to give this pattern of cognitive deterioration?
a) Urinary tract infection
b) Multi infarct dementia
c) Space occupying lesion
d) Hyperthyroidism
Q9/8
Olga, aged 74 presents to you complaining of a pain in the mid back which is worse when she tries to sleep. You consider that her pain is indicative of bony pathology. She has no other symptoms. Which part of your physical examination is MOST likely to reveal the underlying pathology?
a) Palpation of the breasts
b) Assessment of the thyroid
c) Digital rectal examination
d) Examination of the urine
Q9/9
Diabetic retinopathy is primarily characterised by:
a) Drusen formation
b) Vascular leakage
c) Retinal ischaemia
d) Detachment of retina from choroid
Q9/10
Jack M, aged 70, complains of pain in his right leg, particularly in his right calf, of recent onset. There are no localised findings on examination. He has been an active man, but a recent injury has severely limited his mobility. He is MOST likely to have:
a) Baker's Cyst
b) Torn gastrocnemius
c) L4 Sciatica
d) Deep venous thrombosis
Q9/11
Try this and see how close you get to the answer (to be posted later).
What are the common symptoms of ovarian cancer?
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6 comments:
Q9/7 B. multiple infarct also give a picture of progressive cognitive deterioration.
Q9/8 A or B. Both are common in bone metastasis. My guess is A, because breast CA is more common than thyroid CA.
Q9/9 B. H'rage & exudates. PRIMARILY is the keyword.
Q9/10 C. No localised fidings exclude torn muscle.Baker's cyst is at the back of knee. DVT happen in immobilsed person.
Q9/11 Common symptoms are no symptom, esp in early stage. late symptoms incl abd distension, LOW LOA, abd mass, compressing sx incl lower abd pain, constipation, lower limbs oedema/congestion/pain. ascites.inguinal lymphadenopathy....etc
alamak! unforced error. Q9/10 should be D. How could I be so careless!
Q9/7 A
Q9/8 A
Q9/9 B
Q9/10 D
Q9/11 ABDOMINAL DISCOMFORT AND DISTENSION. PT MIGHT PRESENT WITH BOWEL OBSTRUCTIVE SYMPTOMS
Q9/7 B (over 6 months, breast ca not sure at her age, still possible but maybe not so common)
Q9/8 C
Q9/9 B
Q9/10 D (this one so tricky - actually we all know is DVT but keep concentrating on first half of the question)
Q9/11
I would guess symptoms will be of metastasis to lungs or bone - bone pain, cough with weight loss
Q9/7 C SOL
Q9/8 A
Q9/9 B
Q9/10 C
Q9/11 COMMON SYMPTOMS.USUALLY ASX.GENERAL SX LIKE LOA LOW.ABD DISTENSION WITH BLOATING SENSATION.
A9/7
The correct response is
c) Space occupying lesion
Infection such as a UTI would be more likely to cause an acute delirium rather than a chronic progressing dementia. Hypothyroidism is more likely to produce this clinical picture than hyperthyroidism. Multi infarct dementia typically progresses in a step wise fashion. Like Alzheimer's disease, cognitive deterioration with a space occupying lesion tends to progress in a linear fashion.
A9/8
The correct response is
a) Palpation of the breasts
Pain in the mid part of the back preventing sleep is indicative of bony pathology, particularly a crush fracture of the vertebrae or a bony secondary deposit from cancers susceptible to haematogenous spread. The most common of these in an older woman is breast cancer, although lung cancer is also a significant possibility. Follicular carcinoma of the thyroid does spread haematogenously, but is quite uncommon. Carcinoma of the rectum or kidney (showing haematuria on urinalysis) is less likely to cause these findings than breast cancer. The spine itself should be examined although localisation of the pain to a particular vertebra will not necessarily be diagnostic. Evidence of liver involvement should also be sought.
A9/9
The correct answer is (b)Vascular leakage .
Diabetic retinopathy is primarily characterised by serous leakage from faulty capillaries, which leads to retinal oedema, occlusion of retinal capillaries, saccular aneurysms, haemorrhages, fusiform and neovascularization. Vision can be spared by the early use of laser surgery to seal the leakages. Regular ophthalmological review of diabetic patients is essential.
A9/10
The exception is (c)L4 Sciatica .
Sciatica leads to altered sensation and leg discomfort. The pain of sciatica radiates to the calf from the buttock, although the calf per se is not tender and there will be no localised abnormalities in the calf if the injury is recent. Torn gastrocnemius, DVT and Bakers cyst are possibilities but less likely in this scenario. Each will usually be associated with some localised abnormal findings.
A9/11
abdominal bloating
increased abdominal girth
indigestion
lack of appetite
feeling full after only a small meal
weight gain or loss
change in bowel habits
fatigue
urinary frequency or incontinence
abdominal and/or pelvic pain
feeling of pressure in the abdomen
Assessment of symptoms that may be Ovarian cancer: a guide for GPs, National Breast Cancer Centre 2005.
Before diagnosis, 77% of ovarian cancer patients report abdominal symptoms, 70% report gastro-intestinal symptoms and 50% report constitutional symptoms such as fatigue.
As these symptoms are vague and very common presentations in general practice the diagnosis of ovarian cancer can be difficult. Any one GP may only see very few cases of ovarian cancer in their entire working life.
A high index of suspicion, especially in women with a family history, which places them at increased risk is necessary. If symptoms are persistent and present for over 1 month, a careful abdominal and pelvic examination should be performed. A transvaginal ultrasound is more reliable than an abdominal ultrasound in detecting ovarian abnormalities.
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