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Third Year, Still Here > Essentials of Clinical Practice > Flashcards

Essentials of Clinical Practice Flashcards

1
Q

Why might a patient with diabetes present with a silent myocardial infarction?

A

Diabetic neuropathy reduces their sense of pain, so they don’t experience the crushing chest pain they would otherwise have.

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2
Q

_ angina is caused by the rupture of plaque, causing an occlusion.

A

Unstable.

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3
Q

What is the difference between an NSTEMI and unstable angina?

A

In unstable angina there is occlusion but no infarction. In NSTEMI there is an infarct.

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4
Q

Which ECG changes would you expect to see in a STEMI?

A

ST elevation or new LBBB.

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5
Q

Why would you not administer an antithrombin straight away in a STEMI?

A

Most patients experiencing a STEMI will need surgical intervention as soon as possible, and giving an antithrombin would increase their bleeding risk.

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6
Q

When would an ACE inhibitor be prescribed as a form of secondary prevention in angina?

A

ACE inhibitors are prescribed to patients with diabetes or concurrent hypertension.

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7
Q

Define heart failure.

A

A state characterised by increased intracardiac pressure and/or reduced cardiac output.

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8
Q

Anaemia can result in heart failure. True or false?

A

True.

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9
Q

Respiratory symptoms of heart failure include orthopnea and _ _ dyspnoea.

A

Paroxysmal nocturnal dyspnoea.

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10
Q

‘Bat wings’ on a chest X-ray indicate _ _.

A

Alveolar oedema.

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11
Q

The typical starting dose of furosemide is what?

A

40 - 50mg.

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12
Q

Asthma is a type _ hypersensitivity reaction.

A

Asthma is a type 1 hypersensitivity reaction.

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13
Q

Define variable expiratory airflow limitation in asthma.

A

Diurnal variation in obstructive symptoms. Asthma tends to be worse in the evening or at night.

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14
Q

Haemoptysis is a common sign of a pulmonary embolism. True or false?

A

False. It only occurs in approximately 5% to 13% of patients.

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15
Q

A Wells score of greater than _ means a pulmonary embolism is moderately likely and a CT _ should be performed.

A

4, angiogram.

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16
Q

How would you respond to a suspected pulmonary embolism in a patient with a Wells score below four?

A

Request a D-dimer, and if positive, perform a CT angiogram. Anticoagulant therapy should be commenced as an immediate precaution unless there is a high bleeding risk.

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17
Q

Why is it important to distinguish between hospital- and community-acquired pneumonia?

A

The causative bacteria tend to be different, so where the patient became ill will guide the choice of antibiotics.

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18
Q

What Wells score would indicate that the likelihood of a pulmonary embolism is low?

A

2 or lower.

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19
Q

Which blood test result contributes to a patient’s CURB-65 score (measuring likelihood of community-acquired pneumonia)?

A

Blood urea nitrate (BUN). Levels greater than 19mg/dL would increase the score.

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20
Q

Why is serum urea elevated in pneumonia?

A

Two possible causes: the increased rate of protein catabolism in infection, and the fact that patients are likely to be dehydrated.

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21
Q

The three main subtypes of non-small cell lung cancer are _ cell, _, and large cell.

A

Squamous cell, adenocarcinoma.

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22
Q

Which type of lung cancer comprises approximately 15% of cases?

A

Small cell lung cancer.

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23
Q

Patients aged 40 and above with unexplained _ should be referred to oncology on the two-week wait pathway due to probable lung cancer.

A

Haemoptysis.

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24
Q

Successful chest X-ray interpretation involves consideration of rotation, inspiration, _ and _.

A

Projection, exposure

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25
Q

Congestive heart failure can affect either the left or right ventricle. True or false?

A

True.

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26
Q

Define heart failure.

A

Heart failure is the heart’s inability to circulate enough blood to meet the body’s metabolic needs.

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27
Q

Adequate inspiration is required for a chest X-ray. We should be able to count how many ribs above the diagram?

A

5 or 6 ribs should be visible above the diaphragm.

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28
Q

What is the standard projection for a chest-X ray and why?

A

Posterior-anterior (PA). An anterior-posterior projection will magnify the heart and make the X-ray more difficult to interpret.

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29
Q

What would prominent vertebral bodies that are clearly visible through the cardiac shadow indicate on a chest X-ray?

A

The film has been overexposed.

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30
Q

What is the normal range for PaCO2?

A

4.5 - 6.0 kPa

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31
Q

In _ acidosis, arterial pH and arterial CO2 will be congruent.

A

Respiratory.

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32
Q

Type 1 respiratory failure is a problem with _ exchange.

A

Gas.

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33
Q

What is the indication for adding inhaled corticosteroids to a SABA?

A

ICS should be given if the patient is using their SABA inhaler three or more times a week, having symptoms three or more times a week, or being woken at night by symptoms.

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34
Q

If asthma cannot be controlled with SABAs and ICS, the next step would be to add a _ _ antagonist. A specific example is _.

A

Leukotriene receptor antagonist (LTRA). Montelukast.

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35
Q

A pneumothorax can be a complication of an asthma attack. True or false?

A

True.

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36
Q

If asthma patients experiencing a life-threatening exacerbation do not respond to oxygen, nebulised salbutamol and ipratropium, and IV steroids, the next step before intubation is what?

A

Administer IV magnesium sulphate first, followed by a theophylline if this does not help.

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37
Q

Polycythemia is characterised by a high _ or haemoglobin.

A

Haematocrit.

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38
Q

What type of lung cancer might cause sudden onset Horner’s syndrome and why?

A

Pancoast tumours are a form of small cell lung cancer that form in the apical cells of the lungs. They can cause nerve compression as they grow, resulting in Horner’s syndrome.

39
Q

A first-degree heart block is a medical emergency. True or false?

A

False. First-degree heart block does not present any immediate risks.

40
Q

What is the main purpose of the PERC score?

A

The PERC score is a probability-based tool to stratify patients who are at low risk of developing a pulmonary embolism (less than 15%). If a patient fulfills all the PERC criteria, meaning they score 0, they do not need a Wells screening.

41
Q

An atypical pneumonia screen consists of urinalysis for which bacteria?

A

Pneumococcal and legionella.

42
Q

Which antibiotic is typically added to amoxicillin in the treatment of atypical pneumonia?

A

Clarithromycin.

43
Q

If they are experiencing breathlessness and exercise limitation, people with COPD should be offered either a short-acting beta _ or a short-acting _ antagonist.

A

Agonist, muscarinic.

44
Q

Why might we see prominent upper lobe veins on the chest X-ray of a COPD patient?

A

The blood supply is diverted to areas of the lung where there is most healthy tissue and where gas exchange can still take place. This vascular remodelling results in prominent upper lobe veins.

45
Q

Pancreatic alpha cells synthesise _.

A

Glucagon.

46
Q

Which pancreatic cells secrete insulin?

A

Pancreatic beta cells.

47
Q

Which pancreatic cells secrete somatostatin?

A

Delta cells.

48
Q

Insulin is released in response to a rise in glucose in the _ fluid.

A

Extracellular.

49
Q

C-peptide and insulin are secreted in equal amounts. True or false?

A

True.

50
Q

Which protein channel enables glucose uptake?

A

GLUT4.

51
Q

What should be added to a metformin regimen if the patient is at risk of cardiovascular disease?

A

SGLT2 inhibitors should be prescribed in addition to or instead of metformin if the patient is at risk of CVD.

52
Q

What significant adverse effects can pioglitazone cause?

A

Bone fractures and bladder cancer.

53
Q

Thyroiditis can be an adverse effect of amiodarone. True or false?

A

True.

54
Q

What type of imaging is used to investigate hyperthyroidism?

A

Ultrasound of the neck.

55
Q

Thyroid _ antibodies are raised in Hashimoto’s disease.

A

Thyroid peroxidase antibodies (TPO).

56
Q

Which antibodies are raised in Graves disease?

A

TSH receptor antibodies.

57
Q

Why might ACE inhibitors lead to AKI despite not being directly nephrotoxic?

A

By reducing blood pressure and overall fluid volume, ACE inhibitors reduce the filtration rate of the kidney, which can result in an AKI.

58
Q

Why must lower doses of opioids be prescribed if the patient has an AKI?

A

Opioids accumulate in the kidney, so if the patient’s GFR is already compromised, they will need a lower dose.

59
Q

Metformin can cause diarrhoea. True or false?

A

True.

60
Q

Which antibiotic should be prescribed for moderate to severe C. difficile, according to NICE guidelines?

A

Fidaxomicin (200mg PO BD for 10 days).

61
Q

How is severity of C. diff determined?

A

It is determined mostly by frequency of diarrhoea. Fewer than five episodes per day is considered mild. (However, in severe C. diff the frequency may actually decrease due to complications such as toxic megacolon.)

62
Q

Which type of cancer is associated with long-term coeliac disease?

A

Lymphoma.

63
Q

Which immunoglobulin is associated with coeliac disease?

A

IgA.

64
Q

Patients who are referred with a suspected cancer should ideally commence treatment within _ days of referral.

A

62.

65
Q

The tips of the bone in an oblique fracture will be rounded/pointed.

A

Rounded.

66
Q

The tips of the bone in a spiral fracture will be rounded/pointed.

A

Pointed.

67
Q

A short sharp blow to the ulna is likely to result in which type of fracture?

A

Transverse.

68
Q

Which type of humoral shaft fracture is most likely to be sustained when arm-wrestling and why?

A

Spiral, as your arm will twist as the force is applied.

69
Q

Sesamoid bones are embedded within a _.

A

Tendon.

70
Q

The medial and lateral circumflex arteries branch off the _ _ artery.

A

Profunda femoris.

71
Q

The blood supply to the acetabulum is via the _ artery.

A

Obdurator.

72
Q

Cancers of paired organs (kidneys, ovaries, breasts, etc.) are more likely to metastasise to the _.

A

Bone.

73
Q

Why is thoracic back pain more concerning than lumbar pain?

A

As the thoracic spine is less mobile, pain here is less likely to have a ‘simple’ mechanical cause and is more likely to be the result of a malignancy or infection.

74
Q

Sensation to the area around the medial malleolus is supplied by which spinal nerve root?

A

L4.

75
Q

Which spinal nerve root is involved in knee extension?

A

L3.

76
Q

Which type of imaging would we request to confirm a suspected disc prolapse and why?

A

MRI, as soft tissue is clearer in this modality. CT and X-ray are better for imaging bony pathology.

77
Q

Injuries at T11/T12/L1/L2 are most commonly caused by …?

A

High-impact falls and other trauma.

78
Q

Rheumatoid arthritis is characterised by thickening of the _ membrane, infiltration of _, and proliferation of capillaries.

A

Synovial, neutrophils, capillaries.

79
Q

The genes HLA DR4 and DR1 are implicated in which form of arthritis?

A

Rheumatoid arthritis.

80
Q

HLA-DR4 screening is performed when a patient has suspected rheumatoid arthritis. True or false?

A

False. This screening has limited clinical value, as a diagnosis can be made on the basis of presenting symptoms and blood results.

81
Q

Which antibody is most specific and may be more sensitive in rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide (anti-CCP).

82
Q

Why can trimethoprim not be prescribed for patients taking methotrexate?

A

They are both folate inhibitors, and the significantly reduced folate level can cause bone marrow suppression.

83
Q

Which DMARD is used in women who may wish to become pregnant?

A

Sulfasalazine.

84
Q

Which DMARD has the fewest adverse effects and comes with the lowest risk of infection?

A

Hydroxychloroquine.

85
Q

Which DMARD may cause retinal damage after five years of consistent use?

A

Hydroxychloroquine.

86
Q

Ophthalmic screening is important for rheumatoid arthritis patients who are taking the DMARD _, as risk of retinal problems increases after five years of use.

A

Hydroxychloroquine.

87
Q

Biologics can be prescribed for rheumatoid arthritis patients who have unsuccessfully tried two DMARDs. True or false?

A

True.

88
Q

Which biologics are contraindicated in people with a demyelinating disease or a history of tuberculosis?

A

Anti-TNF drugs (e.g. adalimumab, infliximab).

89
Q

Skin infections are a risk associated with biologics targeting _.

A

TNF.

90
Q

Which biologic targets T cells and is often useful if rituximab has not been effective?

A

Abatacept.

91
Q

Which biologics can be taken orally?

A

JAK inhibitors.

92
Q

Tocilizumab inhibits which cytokine?

A

IL-6.

93
Q
A

Third Year, Still Here (3 decks)

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