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3A > Friday 6th > Flashcards

Friday 6th Flashcards

1
Q

What are the three features of typical stable angina

A
  1. central heavy chest discomfort which may spread to face/ arms/ neck
  2. bought on by exertion
  3. Relieved by rest (<5mins) or GTN spray
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2
Q

What is the first line investigation of stable angina

A

CT coronary angiogram

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3
Q

what are second line investigations of stable angina?

A

functional testing- stress echo, myocardial perfusion SPECT, cardiac MRI

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4
Q

what is the third line and gold standard investigation of stable angina?

A

invasive coronary angiography

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5
Q

What is first line management of stable angina (excluding medications everyone should be put on)

A

beta blocker or calcium channel blocker

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6
Q

what type of calcium channel blocker should be used if used as monotherapy?

A

a rate limiting CCB such as verapamil

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7
Q

what is second line management of stable angina

A

combination of calcium channel blocker and beta blocker

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8
Q

what type of calcium channel blocker should be used if it is in combination with a beta blocker?

A

long-acting dihydropyridine calcium channel blocker (amlodipine or nifedipine)

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9
Q

What is third line management of stable angina (while also referring for revascularisation)

A

Beta blocker, calcium chanel blocker and addition drug:
- long acting nitrate
- ivabradine
- nicrorandil
- ranolazine

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10
Q

What two options for revascularisation are there?

A

precutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

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11
Q

What medications should someone with stable angina be put on aside from the anti-angina medications?

A

atrovastatin
aspirin
GTN

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12
Q

What can trigger psoriasis attacks? (7)
- including which drugs (4)

A
  • skin trauma
  • infections (streptococcal)
  • drugs: BALI- beta blockers, anti-malarias, lithium and indomethacin/NSAIDs
  • withdrawal from steroids
  • stress
  • alcohol and smoking
  • cold/dry weather
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13
Q

What different types of psoriasis are there?

A

chronic plaque psoriasis
flexural psoriasis
gluttate psoriasis
pustular psoriasis
scalp psoriasis
erythrodermic psoriasis

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14
Q

describe chronic plaque psoriasis

A

thickened erythematous plaques with silver scales, commonly on the extensor surfaces and the scalp.
plaques are typically 1-10cm in diameter

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15
Q

describe gluttate psoriasis

A

common in young people following streptococcal infection
- multiple tear dropped shaped plaques on the trunk
- typically resolves spontaneously within 3-4 months
-

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16
Q

desribe flexural psoriasis

A

smooth erythematous plaques without scales on the flexures and skin folds

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17
Q

describe eryhthrodermic psoriasis

A

A rare and severe form of psoriasis where there is extensive erythematous areas covering most of the surface of the skin.
The skin comes away in large patches.
Medical emergency

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18
Q

what is koebner phenomenon

A

the development of psoriatic lesions in areas of skin affected by trauma

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19
Q

What nail signs might accompany psoriasis

A

subungal hyperkeratosis
nail pitting
oil drop discoloration
leukonychia
onycholisis

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20
Q

What is the first line treatment of chronic plaque psoriasis?

A

potent topical corticosteroids (such as benovate) plue topical vitamin D (calcitriol, dovonex) used at alternate times

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21
Q

what is second line treatment of chronic plaque psoriasis?

A

just topical vitamin D applied twice daily (the corticosteroid is stopped)

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22
Q

what is third line treatment of chronic plaque psoriasis?

A

topical corticosteroid twice daily (the vitamin D is stopped)

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23
Q

If topical therapy does not work what intervention may be used for psoriasis?

A

phototherapy with narrow band UV B light

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24
Q

if topical treatments fail what drug treatment may be used for psoriasis?

A

systemic therapy-
1. methotrexate
2. ciclosporin
3. acitretin

then biologics

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25
Q

what are some side effects of ciclosporin

A

the 5 H’s
Hypertrophy of the gums
Hypertension
Hypertichosis
hyperkalaemia
hyperglycaemai

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26
Q

what biologics might be used in psoriasis?

A

infliximab
entanercept
adaliimumab

27
Q

what autoantibodies are associated with rheumatoid arthritis?

A

anti-CCP and rheumatoid factor

28
Q

what joint deformities are seen in rheumatoid arthritis?

A

z shaped deformity of the thumb
swan neck deformity (flexed DIP)
boutonniere deformity (flexed PIP)
ulnar deviation

29
Q

what eye manifestations may be present in RA (3)

A

episcleritis
scleritis
keratoconjunctivitis

30
Q

what extraarticular manifestations may be present in RA?

A

eye
pulmonary- pulmonary fibrosis, serositis
cardiac- pericarditis, myocarditis
renal- glomerulonephritis
neurological -peripheral neuropathy, carpal tunnel syndrome
Rheumatoid nodeules

31
Q

What may be seen on x ray of rheumatoid arthritis?

A

joint space narrowing
bone erosions
periarticular osteoporosis
soft tissue swelling

32
Q

1st line management of RA

A

DMARDs such as methotrexate (others- sulfasalazine, hydroxychloroquine)

33
Q

what are some complications of RA?

A

Felty syndrome- splenomegary, RA and neutropenia
amyloidosis

34
Q

1st line management of reactive arthritis?

A

NSAIDs

35
Q

what cells do most testicular cancers arise from?

A

germ cells

36
Q

what two types of germ cell testicular cancers are there?

A

seminomas and non-seminomas (mainly teratomas)

37
Q

1st line investigation of testicular cancer?

A

scrotal USS

38
Q

what are some tumour markers for testicular cancer?

A

alpha-fetoprotein (seminomas), beta HCG (seminomas and teratomas) and lactate dehydrogenase

39
Q

1st line management of venous ulcers?

A

compression bandaging

40
Q

what drug might be used to help venous leg ulcers?

A

oral pentoxyfylline

41
Q

what medical therapy might be used in vasovagal syncope? (2)

A

fludocortisone
midodrine

42
Q

How would Edwards and Patau’s differ from downs on quadruple test

A

their beta hCG will be down not up
They will also have normal inihibin A

43
Q

what does ABG show in asthma attack?

A

initially there will be respiratory alkalosis then there will be acidosis (bad sign - means they are tiring)

44
Q

how can tet spells be managed medically?

A

phenyephrine

45
Q

How does a CT scan of someone with cystic fibrosis present?

A

finger in glove appearance (mucous plugging)

46
Q

What does the blood spot test for to diagnose CF?

A

it will have raised immunoreactive trypsinogen

47
Q

what value of chloride on the sweat test is diagnostic of CF?

A

above 60

48
Q

What two key organisms may colonise CF?

A

pseudomonas aeruginosa and staph aureus

49
Q

What may be given as prophylaxis for staph aureus infection in CF

A

oral flucloxacillin

50
Q

How might ebstein anamaly present of examination

A

prominent A wave in JVP
pansystolic murmer due to tricuspid regurg

51
Q

What medication may be used to treat pulmonary HTN in eisenmenger’s ?

A

sildenafil

52
Q

What signs on examination are there of pulmonary hypertension in congenital heart defects?

A

RV heave
loud S2
raised JVP
peripheral oedema

53
Q

what are some complications of whoopng cough?

A

bronchiectasis
subconjunctival haemorrhages
bronchiectasis
seizures

54
Q

what are two specific types of innocent murmer that children might have?

A

venous hums - turbulent blood flow in the veins of the heart, heard just below the clavicles
still’s murmur - low pitched heart sound at left sternal edge

55
Q

key features of innocent murmurs

A

soft
systolic
symptomless
situational
short

56
Q

What are some signs that may indicate problematic reflux?

A

chronic cough
hoarse cry
distress after feeding
pneumonia
failure to thrive

57
Q

first line treatment of GORD in infants?

A

thickened formula

58
Q

second line treatment of GORD in infants?

A

gaviscon trial for 1-2 weeks.

59
Q

third line treatment of GORD in infants?

A

PPI trial for 4 weeks

60
Q

What are some risks of GORD

A

aspiration pneumonia
barrets oesophagus
dysphagia

61
Q

How would you manage constipation in those under 6 months

A

give extra water between feeds

62
Q

Order of management of constipation

A

1- paediatric movicol
2- stimulant laxative (Senna)
3- osmotic (lactulose)

63
Q
A

3A (42 decks)

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