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Finals Revision > Day 6 > Flashcards

Day 6 Flashcards

1
Q

Loss of Haustra

A

ulcerative colitis

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2
Q

drainpipe colon

A

ulcerative colitis

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3
Q

rose thorn ulcers

A

chrons

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4
Q

coble stone appearance

A

chrons

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5
Q

granulomas and increased goblet cells

A

chrons

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6
Q

crypt abscesses

A

ulcerative colitis

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7
Q

Features of DKA

A

Abdominal pain
Polyuria, polydipsia, dehydration
Kussmaul respiration (deeo hyperventilation)
Acetone-smelling breath

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8
Q

Management of DKA

A

fluid replacement- isotonic saline

insulin- IV infusion at -0.1unit/kg/hour

once blood glucose is <15mmol/l an infusion of 5% dextrose started

Long acting insulin continues, short-acting insulin stopped

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9
Q

COPD stages

A

Stage 1 (Mild) as his FEV1 is >80% of what is expected.

Stage 2 (Moderate) is an FEV1 which is 50-79% of the predicted value.

Stage 3 (Severe) is an FEV1 which is 30-49% of the predicted value.

Stage 4 (Very severe) is an FEV1 <30% of the predicted value.

Stage 5 is not an option in COPD staging.

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10
Q

COPD initial management

A
  • smoking cessation
  • annual influenza vaccine
  • pneumococcal vaccine
  • pulmonary rehab
Bronchodilator therapy (SABA or SAMA)
if still struggling check for steroid responsiveness...
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11
Q

Signs of asthmatic/steroid responsive features

A

> any previous, secure diagnosis of asthma or of atopy
a higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)

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12
Q

Management of COPD with no asthmatic features

A

add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)

if already taking a SAMA, discontinue and switch to a SABA

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13
Q

Management of COPD with asthmatic features

A

LABA + inhaled corticosteroid (ICS)
if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS

if already taking a SAMA, discontinue and switch to a SABA

NICE recommend the use of combined inhalers where possible

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14
Q

When is oral theophylline recommended in COPD

A

when inhaled therapy can’t be used

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15
Q

When is antibiotic prophylaxis recommended in COPD

A

> azithromycin prophylaxis
patients should not smoke, > have optimised standard treatments
continue to have exacerbations
other prerequisites include;
:a CT thorax (to exclude bronchiectasis)
: sputum culture (to exclude atypical infections and tuberculosis)
:LFTs and an ECG to exclude QT prolongation should also be done as azithromycin can prolong the QT interval

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16
Q

When should mucolytics be considered in COPD

A

patients with a chronic productive cough and continued if symptoms improve

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17
Q

Features of cor pulmonale

A

peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2

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18
Q

Management of cor pulmonale

A

use a loop diuretic for oedema, consider long-term oxygen therapy

ACE-inhibitors, calcium channel blockers and alpha blockers are not recommended by NICE

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19
Q

tear drop cells on blood film

A

myelofibrosis
thalassaemia
megaloblastic anaemia

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20
Q

What is myelofibrosis

A

> myeloproliferative disorder
hyperplasia of abnormal megakaryocytes
resultant release of platelet derived growth factor is thought to stimulate fibroblasts
haematopoiesis in liver and spleen

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21
Q

Features of myelofibrosis

A
  • elderly person with anaemia
  • massive splenomegaly
  • hypermetabolic symptoms: weight loss, night sweats
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22
Q

Lab findings in myelofibrosis

A

> anaemia
high WBC and platelet count early in the disease
‘tear-drop’ poikilocytes on blood film
unobtainable bone marrow biopsy - ‘dry tap’ therefore trephine biopsy needed
high urate and LDH (reflect increased cell turnover)

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23
Q

Death in HOCM

A

Ventricular arrythmia

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24
Q

COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive feature

A

LABA + ICS

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25
Q

Types of transfusion reaction

A
  • non-haemolytic febrile reaction
  • minor allergic reaction
  • anaphylaxis
  • acute haemolytic reaction
  • transfer associated circulatory overload (TACO)
  • transfusion-related acute lung injury (TRALI)
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26
Q

Cause of non-haemolytic febrile reaction

A

due to white blood cell HLA antibodies

often result of sensitisation by previous pregnancies or transfusions

27
Q

management of non-haemolytic febrile reaction

A

paracetamol

28
Q

Cause of minor allergic reaction

A

hypersensitivity reactions to components within the transfusion

29
Q

Symptoms of allergic/anaphylaxis reaction

A

> Symptoms typically arise within minutes of starting the transfusion and severity can range from urticaria to anaphylaxis with hypotension, dyspnoea, wheezing, and stridor, or angioedema.

30
Q

Management of simple urticaria

A

discontinuing transfusion and give antihistamine

Once the symptoms resolve, the transfusion may be continued with no need for further workup.

31
Q

Management of anaphylaxis

A

transfusion should be permanently discontinued, intramuscular adrenaline should be administered and supportive care. Antihistamine, corticosteroids and bronchodilators should also be considered for these patients.

32
Q

Features of TRALI

A

> development of hypoxaemia/acute respiratory distress syndrome within 6 hours of transfusion.

Features include:
hypoxia
pulmonary infiltrates on chest x-ray
fever
hypotension
33
Q

Features of TACO

A

common reaction due to fluid overload resulting in pulmonary oedema. As well as features of pulmonary oedema the patient may also by hypertensive, a key difference from patients with TRALI.

34
Q

Infective transfusion reaction cause

A

Transmission of vCJD

although the absolute risk is very small, vCJD may be transmitted via blood transfusion

35
Q

rapid hyponatraemia correction

A

osmotic demyelination syndrome

36
Q

rapid hypernatraemia correction

A

cerebral oedema

37
Q

Symptoms of osmotic demyelination syndrome

A

brainstem damage- spastic quadriparesis, pseudobulbar palsy, emotional lability

38
Q

Signs of cerebral oedema

A

bradycardia

gaze paresis

39
Q

medications to be stopped in AKI

A 
NSAIDs (except aspirin at cardiac dose 75mg)
aminoglycosides
ACE inhibitors
A2RB
diuretics
metformin
lithium
digoxin
40
Q

medications to be continued in AKI

A 
> paracetamol
> warfarin
> statins
> aspirin
> clopidogrel
> beta-blockers
41
Q

Plucking of clothes, smacking of lips, aura and feelings of de-ja-vu

A

temporal lobe seizures

42
Q

sensory abnormalities seizure

A

parietal

43
Q

Most common cause of thyrotoxicosis

A

grave’s

44
Q

MOA of orlistat

A

inhibiting gastric and pancreatic lipase to reduce the digestion of fat

45
Q

Who is eligible for orlistat?

A

> BMI of 28 or more with associated risks
BMI of 30 or more
continued weight loss e.g. 5% at 3 months
orlistat used for <1 year

46
Q

Post-eradication test of cure H.pylori

A

urea breath test

47
Q

Features of anaplastic carcinoma

A

local invasion common

48
Q

features of medullary carcinoma

A

serum calcitonin raised

49
Q

features of follicular carcinoma

A

macroscopically encapsulated, microscopically capsular invasion seen- > without this it is follicular adenoma

vascular invasion predominates

50
Q

how does follicular adenoma present

A

solitary thyroid nodule

51
Q

features of papillary carcinoma

A

> Histologically tumour has papillary projections and pale empty nuclei
Seldom encapsulated
Lymph node metastasis predominate
Haematogenous metastasis rare

52
Q

features of chronic lymphocytic leukaemia

A

often none: incidental finding of lymphocytosis

constitutional: anorexia, weight loss

bleeding, infections

lymphadenopathy more marked than chronic myeloid leukaemia

53
Q

Investigations for CLL

A

FBC: lymphocytosis, leukaemia

blood film: smudge cells

immunophenotyping is key

54
Q

Endocrine complication of SCLC

A

SIADH

55
Q

Management of SIADH

A

slow correction
fluid restriction
demeclocycline: reduces responsiveness of the collecting tubule cells to ADH
ADH (vasopressin receptor antagonists) have been developed

56
Q

screening for haemochromatosis

A

gen population: transferrin saturation > ferritin

family members: HFE genetic testing

57
Q

Most common cause of peritonitis secondary to peritoneal dialysis

A

staphylococcus epidermidis

58
Q

what do patients who’ve had catheter ablation for AF require

A

lifelong anticoagulation

59
Q

patients with cellulitis who are penicillin allegic

A

clarithromycin, erythromycin (pregnancy), or doxycycline

60
Q

Common trigger for cluster headaches

A

alcohol

61
Q

charts acronym

A 
fibrosis of upper lobes
C- coal workers pneumoconiosis 
H- histiocytosis/hypersensitivity pneumonitis
A- ankylosing spondylitis
R- radiation
T- tuberculosis
S- silicosis/sarcoidosis
62
Q

What can result in a lower HbA1c reading

A

lower average blood glucose concentration and a shorter red cell life span.

63
Q

What causes reduced RBC lifespan?

A

hereditary spherocytosis
sickle cell
G6PD

64
Q

multiple endocrine neoplasia type IIa

A

Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma

Finals Revision (29 decks)

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