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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
what are some side effects of ciclosporin
the 5 H's Hypertrophy of the gums Hypertension Hypertichosis hyperkalaemia hyperglycaemai
26
what biologics might be used in psoriasis?
infliximab entanercept adaliimumab
27
what autoantibodies are associated with rheumatoid arthritis?
anti-CCP and rheumatoid factor
28
what joint deformities are seen in rheumatoid arthritis?
z shaped deformity of the thumb swan neck deformity (flexed DIP) boutonniere deformity (flexed PIP) ulnar deviation
29
what eye manifestations may be present in RA (3)
episcleritis scleritis keratoconjunctivitis
30
what extraarticular manifestations may be present in RA?
eye pulmonary- pulmonary fibrosis, serositis cardiac- pericarditis, myocarditis renal- glomerulonephritis neurological -peripheral neuropathy, carpal tunnel syndrome Rheumatoid nodeules
31
What may be seen on x ray of rheumatoid arthritis?
joint space narrowing bone erosions periarticular osteoporosis soft tissue swelling
32
1st line management of RA
DMARDs such as methotrexate (others- sulfasalazine, hydroxychloroquine)
33
what are some complications of RA?
Felty syndrome- splenomegary, RA and neutropenia amyloidosis
34
1st line management of reactive arthritis?
NSAIDs
35
what cells do most testicular cancers arise from?
germ cells
36
what two types of germ cell testicular cancers are there?
seminomas and non-seminomas (mainly teratomas)
37
1st line investigation of testicular cancer?
scrotal USS
38
what are some tumour markers for testicular cancer?
alpha-fetoprotein (seminomas), beta HCG (seminomas and teratomas) and lactate dehydrogenase
39
1st line management of venous ulcers?
compression bandaging
40
what drug might be used to help venous leg ulcers?
oral pentoxyfylline
41
what medical therapy might be used in vasovagal syncope? (2)
fludocortisone midodrine
42
How would Edwards and Patau's differ from downs on quadruple test
their beta hCG will be down not up They will also have normal inihibin A
43
what does ABG show in asthma attack?
initially there will be respiratory alkalosis then there will be acidosis (bad sign - means they are tiring)
44
how can tet spells be managed medically?
phenyephrine
45
How does a CT scan of someone with cystic fibrosis present?
finger in glove appearance (mucous plugging)
46
What does the blood spot test for to diagnose CF?
it will have raised immunoreactive trypsinogen
47
what value of chloride on the sweat test is diagnostic of CF?
above 60
48
What two key organisms may colonise CF?
pseudomonas aeruginosa and staph aureus
49
What may be given as prophylaxis for staph aureus infection in CF
oral flucloxacillin
50
How might ebstein anamaly present of examination
prominent A wave in JVP pansystolic murmer due to tricuspid regurg
51
What medication may be used to treat pulmonary HTN in eisenmenger's ?
sildenafil
52
What signs on examination are there of pulmonary hypertension in congenital heart defects?
RV heave loud S2 raised JVP peripheral oedema
53
what are some complications of whoopng cough?
bronchiectasis subconjunctival haemorrhages bronchiectasis seizures
54
what are two specific types of innocent murmer that children might have?
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
key features of innocent murmurs
soft systolic symptomless situational short
56
What are some signs that may indicate problematic reflux?
chronic cough hoarse cry distress after feeding pneumonia failure to thrive
57
first line treatment of GORD in infants?
thickened formula
58
second line treatment of GORD in infants?
gaviscon trial for 1-2 weeks.
59
third line treatment of GORD in infants?
PPI trial for 4 weeks
60
What are some risks of GORD
aspiration pneumonia barrets oesophagus dysphagia
61
How would you manage constipation in those under 6 months
give extra water between feeds
62
Order of management of constipation
1- paediatric movicol 2- stimulant laxative (Senna) 3- osmotic (lactulose)
63

3A (42 decks)

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