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3A > 2A bits n bobs > Flashcards

2A bits n bobs Flashcards

1
Q

What are the stages of hypertension?

A

Stage 1 = >140/90
Stage 2 = >160/100
Severe = >180/120

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2
Q

What are the causes of peptic ulcers?

A

H.pylori, increased acid production, reccurent NSAID use, mucosal ischaemia

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3
Q

What causes small and large bowel obstructions?

A 
Small = adhesions and hernias
Large = malignancy, diverticular disease and volvulous
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4
Q

How can you differentiate clinically between small and large bowel obstructions?

A

Small bowel = abdo pain is higher up, vomiting is earlier in onset (there will be a time when there is vomiting and stools are still passed - in LBO stopping passing stools occurs much more closely to symptoms onset), pain and bloating are often less severe in SBO

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5
Q

What are the cuases of GORD?

A

Obesity, hiatus hernia, smoking/alcohol/caffeine/chocolate, pregnancy, gastroparesis and medications (e.g. NSAIDs, CCBs and nitrates)

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6
Q

What can barium swallow used to be diagnosed?

A

Achalasia, hiatus hernia, structural problems in the oesophagus

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7
Q

Sx of achalasia?

A

Dysphagia, regurgitation of food/saliva, heartburn, belching, coughing at night, aspiration pneumonia and chest pain

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8
Q

What is the management of eczema?

A

1st line = emollients

topical corticosteroids -> non sedating anti-histamines (e.g. cetirizine) -> oral corticosteroids

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9
Q

Sx of eczema herpeticum? How do you treat?

A

Clusters of small, itchy and painful blisters which look red/purple/blac and ooze when broken.
Systemic symptoms e.g. fever, malaise and lymphadenopathy
Tx = MEDICAL EMERGENCY give acyclovir

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10
Q

RFs for atopic eczema?

A

Some food alleries (e.g. egg, gluten, nuts)
Family or personal Hx of asthma, eczema or hayfever.
Skin irritants can trigger flare ups but are NOT a risk factor for disease development!

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11
Q

What is the most common complication of atopic eczema?

A

Staph. aureus infection

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12
Q

What is contact dermatitis?

A

Acute skin reaction to an irritant (affects everyone, no sensitization required) or allergen (sensitization required - type IV hypersensitivity reaction, can be delayed for up to 48-72 hours)

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13
Q

How can you diagnose and treat contact dermaititis?

A 
Dx = patch test
Tx = remove allergen/irritant, cold compress and topical steroids
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14
Q

What is seborrheric dermatitis?

A

Erythematous rash with yellow scales. Peak incidence in 1st 2 months of life and adolesence.
Non-itchy scaly patches on the head or flexural areas.

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15
Q

Tx of seborrheric dermatitis?

A

Scalp = shampoo, baby oil and combing
Body = mild topical corticosteroids
Use ketocanozole if there is skin infection (fungal)

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16
Q

What is psoriasis?

A

Autoimmune condition where there are well demarcated erythematous papules and plaques with a silvery scalre. Seen on the extensor surfaces.

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17
Q

Mx of psoriasis?

A

Avoid itching, emollients, sunlight exposure, tar preparations, topical steroids and vitamin D analogues

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18
Q

What is impetigo?

A

Highly contagious group A strep or staph. aureus infection. Leads to honey coloured crusted lesions on the face.
Bullae (staph scolded skin syndrome) are seen as cirlce lesions of erosion - inidicates more serious disease

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19
Q

Tx of impetigo?

A

Fusidic acid or mupirocin (both topical antibiotics).
Hydrogen peroxide if not systemically unwell and oral flucloxacillin if bullae.
School exclusion until crusted and healed or 48 hours after Abx treatment

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20
Q

What are the stages of hypertension?

A

Stage 1 = BP 140/90 - 159/99 AND ABPM of 135/85 - 149/94
Stage 2 = BP 160/100 - 180/120 AND ABPM >= 150/95
Stage 3 = Systolic BP >= 180 or diastolic >= 120

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21
Q

What is malignant hypertension? What should you do?

A

Increase in Bp to 180/120 or higher with signs of retinal haemorrhage and/or papilloedema.
Refer for same day specialist assessment - give labetalol

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22
Q

How do you manage BP in a <55 who is not black african or afro-carribean?

A
  1. ACEi or ARB (if cough from ACEi not tolerated)
  2. Add CCB or thiazide like diuretic (e.g. indapamide)
  3. All 3
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23
Q

How do you manage BP in a >=55 who is black african or afro-carribean?

A
  1. CCB
  2. Add ACEi (or ARB is preferable if black african or afro-carribean) or thiazide like diuretic (e.g. indapamide)
  3. All 3
24
Q

What is the target blood pressure in HTN treatment?

A

<140/90 or <150/90 if >=80

25
Q

What is the most common cause of heart failure?

A

Coronary artery disease followed by aortic stenosis and AF

26
Q

Sx heart failure?

A

Dyspnoea (worse on exertion), cough (may be pink/white frothy sputum), orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema

27
Q

Ix of HF?

A

NT-proBNP.
>2000 = 2 week wait transthoracic echo
400-2000 = 6 week wait transthoracic echo

28
Q

Mx of HF (with reduced ejection fraction)?

A

Loop diuretic, ACEi and beta-blocker
Start ACEi first if DM or fluid overload
Start Beta-blocker first if angina
Consider antiplatelet and statin. If Sx not controlled by diruetic ACEi and Beta-blocker consider adding aldosterone antagonist (e.g. spironolactone)

29
Q

Mx of HF (with preserved ejection fraction)?

A

Loop diuretic and specialist refferal

Consider antiplatelet and statin

30
Q

Sx of TB?

A

Cough, fever, night sweats, weight loss, sputum (rusty), haemoptysis

31
Q

Ix of TB?

A

CXR = fibronodular opacities in the upper lobes +/- cavitation
Acid-fast bacilli go red on Zeihl-Neelsen stain
Mantoux skin test and interferon-gamma release assay can show presence of previous, latent or active TB

32
Q

What is disseminated TB? What is seen on CXR?

A

AKA miliary TB
The immune system is no longer able to control the TB.
CXR = uniformly distributed millet seeds seen throughout the lung fields

33
Q

Mx of TB?

A

Rifampicin (6/12), Isoniazib (6/12), Pyrazinamide (2/12), Ethambutol (2/12) and Pyridoxine (vitamin B6)

34
Q

SEs of TB Mx?

A

Rifampicin = red/orange secretions and reduced efficacy of oral contraceptives
Isoniazib = peripheral neruopathy (why pyridoxine is taken)
Pyrazinamide = hyperuricaemia and gout
Ethambutol = colour blindness and reduced visual acuity
ALL cause hepatotoxicity

35
Q

Sx of PMR?

A

Acute onset shoulder/hip girdle stiffness and/or pain. Difficulty standing from seated/prone.

36
Q

Sx of the strongest association with PMR?

A

GCA

Temporal headache with scalp tenderness, jaw claudication and vision loss

37
Q

Ix and Mx of PMR?

A

Raised ESR and CRP

Mx = prednisolone. Bone protection = alendronic acid, colecalcierol and calcium carbonate

38
Q

Ix and Mx of the strongest association with PMR?

A

Temporal artery biopsy and US

Prednisolone before waiting for confirmation of diagnosis

39
Q

What is diverticular disease?

A

Asymptomatic herniation of the mucosa and submucosa through the colonic wall due to low fibre diet.
If inflammed becomes diverticulitis

40
Q

Sx diverticulitis?

A

Fever, constant and severe abdo pain, diarrhoea or constipation, mucus in the stools, rectal bleeding

41
Q

Ix and Mx of diverticulitis?

A 
Ix = leckocytosis, raised CRP and do contrast CT abdomen
Mx = IV Abx and fluids, supportive care and low-residue diet
42
Q

What are the main causes of AF?

A

IHD, HTN, valvular heart disease (especially mitral issues), sepsis and hyperthyroidism

43
Q

Sx of AF?

A

Breathlessness, palpitations, chest pain, reduced exercise tolerance and iregular pulse

44
Q

ECG findings in AF?

A

Irregularly irregular. No p waves and tachycardia

45
Q

Mx of AF?

A

Haemodynamically unstable and presenting within 48 hours = electrical cardioversion
Stable = rate control with beta blocer or CCB. Rhythm control with delayed cardioversion (amiodarone or electrical cardioversion) - pt. must be anticoagulated for 3 weeks before this
Anticoagulate = warfarin or DOAC

46
Q

Sx of GORD?

A

Acid burn, acid reflux, dysphagia, bloating, early satiety, laryngitis and enamel erosion

47
Q

Mx of GORD?

A

Acid neutralising = gaviscon or rennie
PPI = omeprazole
H2 receptor antagonist = Rinatidine

48
Q

What is the most significant complication in GORD?

A 
Barrets oesophagus (simple squamous to columnar epithelium).
This is a premnalignant state and comes with risk of developing adenocarcinoma. 
Mx = PPIs
49
Q

Cardiac causes of clubbing?

A

Atrial myxoma, congenital heart disease, endocarditis and pericarditits

50
Q

GI causes of clubbing?

A

Malabsorption, IBD and liver cirrhosis

51
Q

Resp causes of clubbing?

A

CF, TB, pulmonary fibrosis, bronchiectasis and bronchial cancer

52
Q

Gold standard investigation for angina?

A

CT angiography

53
Q

Mx of angina?

A

Acutely = GTN spray (give 5 mins) GTN spray (give 5 mins) 999
Chronic = Beta-blocker or CCB
Secondary prevention = Aspirin, Atorvostatin, ACEi, Atenolol

54
Q

What commonly causes DI?

A

craniopharyngioma

55
Q

What is seen on biopsy in coeliac’s disease?

A

Intraepithelial lymphocytes
The mucosa is often of a normal thickness as villous atrophy is compensated by crypt
hyperplasia

56
Q

What is the 2nd line treatment of gout prevention (after allupurinol)?

A

Febuxostat

3A (11 decks)

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