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year 3 > GP > Flashcards

GP Flashcards

1
Q

Describe the physiology of wound healing

A
  1. Vascular response (vasoconstriction, clotting)
  2. Inflammation
  3. Proliferation
  4. Maturation
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2
Q

Name three inflammatory mediators

A
  1. Histamine
  2. Prostaglandin
  3. PDGF
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3
Q

Role of histamine in inflammatory response

A

Causes vasodilation in adjacent vessels to re-direct flow of blood

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4
Q

How long after injury does vasodilation peak

A

20 minutes after

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5
Q

Describe the inflammatory response

A
  1. Neutrophils and macrophages recruited into the wound by growth factors
  2. Release free radicals / macrophages ingest dead tissues
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6
Q

How long after inflammatory process do lymphocytes enter the area

A

72 hours

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7
Q

What part of the healing process is slough seen

A

Inflammatory response

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8
Q

Describe the proliferative stage

A
  1. 2-3 days after inflammatory stage
    Fibroblasts secrete collagen and glycosaminoglycans

Collagen fills up the wound

Summary: granulation, epithelialisation and contraction

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9
Q

How long in the process does maturation take place

A

20 days later

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10
Q

What is primary intention suturing

A
  1. ONLY ACHIEVED if no tissue loss
    WOUNDS NEED TO BE CLOSE TO EACH OTHER

Has a linear scar

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11
Q

What is secondary intention suturing

A
  1. Ulcer, traumatic skin loss
  2. Wound is allowed to granulate
  3. Epithelialisation occurs from follicle hair remnants of base wound
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12
Q

What is tertiary intention

A
  1. Wound is purposely kept open by cause
  2. Initially cleaned, derided and observed
  3. Later, surgically closed
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13
Q

Barriers to healing

A
  1. Elderly
  2. Diabetes
  3. Malnutrition
  4. Malignancy
  5. Site
  6. Infection
  7. Oedema
  8. Vascular insufficiency
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14
Q

Treatment for otitis media

A
  1. Amoxicillin
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15
Q

Treatment for sinusitis

A
  1. Amoxicillin
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16
Q

Treatment for tonsilitis

A
  1. Penicillin
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17
Q

Treatment for LRTI

A

Amoxicillin

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18
Q

Treatment for UTI

A

Trimethoprim

Nitrofurantoin

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19
Q

What are the risk levels for domestic abuse

A

STANDARD - current evidence does not indicate likelihood of serious harm

MEDIUM - Identifiable indications of serious harm risks - potential?

HIGH - Identifiable indicators of IMMINENT risk of harm

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20
Q

What TOOL is used for domestic abuse risk assessment

A

DASH

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21
Q

How can we lower risk of domestic abuse

A
  1. HEALTH RECORDS
  2. Ask direct questions
  3. Give information
  4. Non-judgemental
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22
Q

How are high risk DA patients managed

A

Refer to MARAC

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23
Q

What is MARAC

A

meetings that provide up to date information and provision of services

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24
Q

Define incidence

A
  1. Number of new cases in a population
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25
Q

Define prevalcence

A

Number of existing cases in a population

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26
Q

What is person-time

A
  1. Measure of time at risk used to calculate incidence rate
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27
Q

Formula for incidence rate

A

No of persons who have become cases in a period of time/ total person-time at risk during that period

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28
Q

Define absolute risk

A
  1. Gives feel for actual number involved (50 deaths/1000 population)
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29
Q

Define relative risk

A

Risk in one category relative to another

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30
Q

Define attributable risk

A

Rate of disease in exposure that may be attributed to exposure

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31
Q

Define relative risk

A

Ratio of risk of disease in the exposed to the risk in unexposed

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32
Q

Name two types of bias

A
  1. Selection

2. Information

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33
Q

Define confounding

A
  1. Situation where a factor is associated with exposure of interest and independently influences the outcome
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34
Q

What is the criteria for causality

A
  1. Strength of association
  2. Dose-response
  3. Consistency
  4. Temporality
  5. Reversibility
  6. Biological plausibility
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35
Q

What is an ecological study

A

observational study defined by the level at which data are analysed, namely at the population or group level, rather than individual level.

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36
Q

What is a case control study

A

A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls)

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37
Q

What is a meta analysis

A

Study of combining multiple studies in an effort to increase estimate size

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38
Q

What is reverse causation

A

One factor can cause the outcomes and those outcomes are causing the factor (like a loop) - temporal sequence issues

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39
Q

What is a cohort study

A
  1. PROSPECTIVE

People without disease are exposed and not = see who gets the disease

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40
Q

What is a case-control study

A

RETROSPECTIVE and PROSPECTIVE

Looking at people with (case) and without the disease (control) and seeing who are exposed and not exposed to risk

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41
Q

What is a prevention paradox

A

Preventative measures bring benefit to population but not to each participating individual (e.g. carseat idea)

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42
Q

Define screening

A

Process which sorts out apparently well people who PROBABLY don’t have the disease from those who PROBABLY do

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43
Q

Define sensitivity

A

Proportion of people correctly identified by test

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44
Q

Define specificity

A

Proportion of people correctly excluded by test

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45
Q

Define PPV

A

Proportion of people who actually have the disease (hint, NPV is opposite)

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46
Q

Define lead time bias

A

Early diagnosis falsely makes it look like people are surviving longer

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47
Q

Define length time bias

A

Overestimation of survival duration due to excess cases lowly progression

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48
Q

Define horizontal equity

A

Equal treatment for equal need (those with pneumonia should get equal treatment)

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49
Q

Define vertical equity

A

Unequal treatment for unequal need ( those with cold vs pneumonia need unequal treatment)

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50
Q

Dimensions of health equity

A

Age
Gender
Class Ethnicity

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51
Q

4 determinants of health

A

Diet
Smoking
Helathseeking behaviour
Socioeconomic

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52
Q

Three domains of public health

A
  1. Health imprvoement
  2. Helath protection
  3. Improving services
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53
Q

Equity vs equality

A

What is fair and just vs concerned with equal shares

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54
Q

Describe public measures at each level

A
  1. Individual: patient centred (care responsive to individual need)
  2. C`community: local Alcohol sales boost, A and e events
  3. Population: health promotion e.g. 5 a day, movember
    Screening: MMR
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55
Q

Define health psychology

A

emphasises the role of psychological factors in the cause, progression and consequences of health and illness

Aims to put theory into practice

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56
Q

Name three health behaviours

A
  1. Helath (bevhioure to prevent disease
  2. illness (behaviour to seek remedy)
  3. Sick role (behaviour at getting well)
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57
Q

Four factors that influence perception of risk

A
  1. Lack of personal experience
  2. Belief that preventable by personal action
  3. Belief that if not happened now, won’t happen
  4. Belief its a rare problem
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58
Q

4 things we can do for behavioural change

A
  1. Individual level intervention
  2. community
  3. Population
  4. Evaluating cost effectiveness
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59
Q

Define need, demand and supply

A

Need - ability to benefit from an intervention
Demand - what people ask for
Supply - what is provided

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60
Q

Define health needs assessment

A

Systematic method for reviewing health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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61
Q

Health need vs health care need

A
  1. Need for health vs need for health care
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62
Q 
Define the following:
Felt need
Expressed need
Normative need
Comparative need
A

Felt - individual perceptions of variation from normal health
Expressed: individual seeks help to overcome variation in normal health (demand)
Normative: professional defines intervention appropriate for the expressed need
Comparative: comparison between severity, range of interventions and cost

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63
Q

What is a comparative approach

A

Compares the services received by a population (or subgroup) with others

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64
Q

Cons of comparative approach

A

Data may not be available
Data may be of variable quality
May be difficult to find a comparable population

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65
Q

Cons of a corporate approach

A

Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence

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66
Q

Give one health related example of something that you consider is demanded but not needed or supplied, clearly explaining the reasoning for your example.

A

Antibiotics for a viral infection

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67
Q

What is a corporate approach

A

Politicians, press and providers conduct studies into epidemiology issues

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68
Q

Cons of an epidemiological approach

A

Required data may not be available
Variable data quality
Evidence base may be inadequate

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69
Q

Define 4 aspects of epidemiological approach

A
  1. Size of issue
  2. Services available
  3. Evidence base
  4. Models of care
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70
Q

How is blood pressure measured

A
  1. Measure BP in both arms
    - If the difference in readings between arm is more than 15mmHg repeat the measurements.
  2. If the difference between arms remains more than 15mmHg on the second measurement, measure subsequent blood pressures in the arm with higher reading
  3. If BP measured in the clinic is 140/90 mmHg or higher, take a second measurement during the consultation.
  4. Record three measurements
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71
Q

What should be done if the BP is 140/90mmHg or higher

A

Take second measurementt

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72
Q

Name two types of ways we monitor blood pressure

A

ABPM

HBPM

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73
Q

How is ABPM done

A

2 measurements per hour during waking time

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74
Q

How is HBPM done

A

2 consecutive measurements at least 1 minute apart with person seated

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75
Q

Diagnosis of hypertension

A

140/90mmHg

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76
Q

How often is BP measured in diabetics

A

Annually: give lifestyle advice

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77
Q

What tests do we offer to people diagnosed with hypertension (CV risk assessment)

A
  1. Proteinuria
  2. HbA1c
  3. Hypertensive retinopathy - fundoscopy
  4. 12 lead ECG
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78
Q

Lifestyle advice for HTN

A
  1. Discourage coffee and caffeine
  2. Lower sodium intake
  3. Smoking cessation
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79
Q

Treatment pathway for hypertension

A
  1. ACE/ARB if black or over 65
  2. ACE + C
  3. ACE + C + D
  4. ACE + C + D + ALPHA BLOCKER (doxazocin)
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80
Q

Essential vs secondary hypertension

A
  1. Essential has no identifiable cause, secondary is caused by other diseases e.g. CKD
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81
Q

How is hypertension treatment monitored

A
  1. Clinic BP
  2. Advise to self monitor BP
  3. Consider HBPM, ABPM
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82
Q

What is stage 1 hypertension

A
  1. 140/90 to 150/99
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83
Q

What is stage 2 HTN

A
  1. 160/100 to 180/120
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84
Q

What is stage 3 HTN

A
  1. 180mmHg or higher
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85
Q

Systolic vs diastolic heart failure

A
  1. When the heart ventricles can’t pump enough during systole vs when the heart ventricles do not fill up with enough blood during diastole
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86
Q

What is CO

A

HR x SV

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87
Q

What is the Ejection Fraction

A

How much of the total volume in the ventricles is ejected into the carotid artery. Usually 50-70

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88
Q

Pathophysiology of systolic HF

A
  1. Decreased contractility of LV causes decreased CO
    Decreased EF
  2. Happens due to ischaemia caused by MI
  3. OR Dilated CARDIOMYOPATHY where ventricles dilate and weaken
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89
Q

What is the EVD (End Diastolic pressure volume)

A
  1. The volume of blood that returns from the pulmonary artery into the LV and combines with the leftover blood that wasn’t ejected

This increases in systolic HF

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90
Q

What is diastolic HF

A
  1. Contractility is fine but less blood returns to ventricles
  2. EDP is higher as LV is not compliant enough
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91
Q

Effect of EF in diastolic HF

A

Normal, this is because less blood is returning to the heart but the ventricle is pushing out the same proportion of blood

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92
Q

What causes diastolic HF

A
  1. Ventricular hypertrophy - becomes thicker and less compliant
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93
Q

Main cause of RHF

A
  1. LHF or cor pulmonale
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94
Q

Symptoms of LHF

A
  1. Congestion of Lung vessels
  2. Pulmonary oedema, sob
  3. Haemoptysis
  4. Dyspnoea
  5. Orthopnoea as there is more venous return from the lower body back into the heart
  6. Paroxysmal nocturnal dyspnoea (wakes people up at night)
  7. Crackles on auscultations

BECAUSE there is decreased CO, less blood flow to organs causing fatigue
2. Less blood to kidneys causes RAAS so fluid retention to compensate - this then fails
Leads to pitting oedema
3. Low CO also activates sympathetic nervous system which increases contractility temporarily

EXTRA SOUND on auscultation: S3 gallop (S3 are overly compliant)

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95
Q

What is S4

A

Ventricles stiff, when blood hits the wall as atria contract harder to overcome LV non compliance)

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96
Q

Causes of RHF

A
  1. Chronic lung disease, emphysema
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97
Q

Symptoms of RHF

A
  1. Congestion in veins (JUGULAR VENOUS DISTENTION), venous congestion in liver causing congestive hepatomegaly (u can see nutmeg liver on inspection as fluid has leaked into hepatocytes) = cardiac cirrhosis
  2. Pitting oedema
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98
Q

How is HF diagnosed

A
  1. NT-proBNP (raised = poor prognosis)
  2. Transthoracic Echocradigram
  3. Cardiac MRI/transoesophageal echo if image is poor
  4. ECG/urinalysis/blood tests
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99
Q

What would be seen on an ECG

A
  1. LV hypertrophy
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100
Q

Role of BNP

A
  1. Reduce Ventricular preload and acts on kidneys to increase Na excretion
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101
Q

Treatment of HF with reduced EF

A
  1. ACE/ARB and beta blocker (monitor Na, K+ and renal functions)

IF symptoms do not go, Mineralocorticoid receptor antagonist

Ivabradine/valsartan/hydralazine+nitrates for NYHA Class II to IV or combine with standard therapy

OR DIGOXIN if this doesnt work

Diuretics, calcium channel blockers, amiodarone, anticoags, vaccinations

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102
Q

Lifestyle advice for HF people

A
  1. Lower Na levels, smoking and alcohol,
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103
Q

Describe the classification of HF (NYHA)

A
  1. Class I: Patient comfortable with high physical activity, but causes symptoms of HF
    2: Comfortable at rest but norma; physical activity causes symptoms
  2. Light activity causes fatigue, palpitations and sob
  3. Patient shows symptoms at rest
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104
Q

Mortality rate of HF

A

60%

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105
Q

Primary, secondary and tertiary prevention of HF

A
  1. Stop disease before it begins (stop smoking, alcohol
  2. Early detection and stopping progression
  3. Tertiary: PCI, CABG to prevent further deterioration
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106
Q

At 8 weeks of age, what immunisations are given

A
  1. DTap
  2. IPV
  3. Hib
  4. HepB
  5. PCV
  6. MenB
  7. Rotavirus
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107
Q

At 12 weeks of age, what immunisations are given

A
  1. DTap/IPV/Hib/HepB

2. Rotavirus

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108
Q

At 16 weeks of age, what immunisations are given

A
  1. DTap/IPV/Hib/HepB
  2. Men B
  3. PCV
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109
Q

At the age of 1, what immunisations are given

A
  1. Hib/MenC
  2. PCV
  3. Men B
  4. MMR
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110
Q

At the age of 2 to 10, what immunisations are given

A
  1. LAIV

3 years 4 months old:
Tap, polio, MMR,

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111
Q

What immunisation is given from 12 to 13

A

HPV,

Yr 9: Td/IPV, MAN ACWY

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112
Q

Ethical dilemmas concerning vaccination

A
  1. Beneficence, nonmaleficience, etc
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113
Q

Name 2 notifiable diseases

A

MMR, contact PHE

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114
Q

Assessment of an unwell child

A
  1. PAT
  2. ABCDE
  3. Vital signs, history, examination
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115
Q

What is the paediatric assessment triangle

A
  1. Appearance: observing state of mind, TICLS
Tone
Mental status
Consolability 
Look
Speech
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116
Q

Describe the traffic light system for fevers

A 
GREEN: 
Normal colour
Responds normally to stimuli 
Normal skin and eyes
Moist mucous membranes
AMBER:
Pallor reported by parent
Not responding to stimulus, wakes only with prolonged stimulation 
Nasal flaring 
Tachypnoea
Crackles in chest 
Oxygen sats less than 95
Tachycardia
Dry mucous membranes
Poor feeding 
3-6 months
Fever over 5 days
Temp over 39
Riggers
Swelling of limb 
RED:
1. PALE/BLUE
2. NO responses to stimuli 
3. High pitched cry 
4. Tachypnoea (>60)
5. Rudecuded skin turgor
6. <3 months
7. Non blanching rash
8. uldging fontanelle
9. Neck stiffness
NEURO SIGNS
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117
Q

Management of an infant with red features

A
  1. Assess within 2 hours if there is no life-threatening features
  2. HOSPITAL ASSESSMENT
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118
Q

Management of an infant with amber features

A
  1. Admission if UTI
  2. 5 days = kawasaki disease
  3. The recommendation to safety net and/or reassess the child is based on the need to check for any clinical deterioration and to assess for new symptoms or signs suggesting an underlying cause for fever
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119
Q

Fever pain score

A
  1. Fever in past 24 hours
  2. Absence of cough or coryza
  3. Symptom onset <3 days
  4. Prurulent tonsils
  5. Severe tonsil inflammation
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120
Q

Safety netting advice for parents with child who has a fever

A

RED:
Pale
Stiff for prolongs period of time
Lethargic

A AND E

AMBER:
No wet nappies in last 8 months
Dry mouth
Between 1-3 months with a high temperature

GP surgery

GREEN:
Feeds well
Wet nappies
Stay at home self care

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121
Q

Cognitive assessments about Dementia

A
  1. AMTS
  2. 6-item cognitive impairment test
  3. GPCOG
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122
Q

Examples of social support for people with dementia

A
  1. Laundry
  2. Meals on wheels
  3. OT
  4. Access to day centres

Needs assessment

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123
Q

Name two effects of being a carer

A
  1. Stress

2. Anxiety

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124
Q

5 principles of MCA

A
  1. Assume capacity if not otherwise
  2. Do not treat as incapable of making a decision unless all practicable steps have been tried to help them
  3. A person should not be treated as incapable of making a decision because it seems unique
  4. Always take decisions for lack of capacity patients in their best interest
  5. Before making a decision on their behalf, consider if outcome could be done in a less restrictive way
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125
Q

How to test capacity

A
  1. Retain information
  2. Use information to weigh up and com etc a conclusion
  3. Communicate decision
  4. Unerstdand information
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126
Q

Anxiety disorder test

A

GAD-7

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127
Q

Depression severity assessment

A

PHQ-9

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128
Q

Risk factors for TB

A
  1. Diabetes mellitus
  2. Low body weight
  3. Close contact
  4. Silicosis
  5. HIV
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129
Q

Methods to protect against TB

A
  1. Early detection of TB
  2. Reducing time to treatment
  3. BCG vaccination
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130
Q

What other health problems other than TB can people abroad face

A
  1. HIV
  2. Enteric fever
  3. Malaria
  4. FGM
  5. Diabetes
  6. Smokers
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131
Q

What is the FGM act 2003, section 5b

A

Anyone who reports FGM and under 18, the person has a mandatory duty to report it

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132
Q

What people are commonly susceptible to FGM

A
  1. Women from Africa and Middle East
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133
Q

What types of FGm are ther

A
  1. Partial removal of clitoris
  2. Removal of clitoris and minor
  3. this is the narrowing of the vaginal opening through the creation of a covering seal.
  4. This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
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134
Q

In patients with HTN and at risk of dementia, what should be given as treatment

A
  1. Calcium channel blocker/dihydropyridine
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135
Q

What is the effects of multi morbidity

A
  1. Poor medication adherence and adverse drug reaction - polypharmacy
  2. Greater susceptibility to failures of care delivery and coordination
  3. Complex management regimens
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136
Q

Define appropriate polypharmacy

A
  1. Optimisation of medication regimes has the potential to improve quality of life, longevity and minimise the harm from medications
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137
Q

Define problematic polypharmacy

A
  1. Interactions from drug combinations and demands of medicine taking are unacceptable to patients
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138
Q

Name the three types of opioids

A
  1. MOR, KOR, DOR
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139
Q

Side effects of Opioids

A
  1. Withdrawal
  2. Tolerance
  3. Weight Gain
  4. Hyperalgesia
  5. Depression
  6. Osteoporosis
  7. Constipation
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140
Q

Signs of opioid abuse and dependency

A
  1. Craving
  2. Altering prescriptions
  3. Stealing
  4. Calls of early refills
  5. Reluctance to try nonpharmacologic interventions
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141
Q

Risk factors for opioid dependance

A
  1. Young
  2. White
  3. Smoker
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142
Q

What are the four aspects of the health belief model

A

Will change if:

  1. Belief they are susceptible to condition in question
  2. Belief it has serious consequences
  3. Belief that taking action reduces seceptibility
  4. Belief that the benefits of taking action outweigh the cost
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143
Q

Cons of the HBM

A
  1. Does not consider emotions on behaviour

2. Does not differentiate between first time and recent behaviour

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144
Q

What is the theory of planned behaviour

A
  1. proposes best predictor of behaviour is intention
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145
Q

What determines intention according to the theory of planned behaviour

A
  1. A person’s attitude to the behaviour
  2. Subjectie norm (social pressure to do s o)
  3. Perceived behavioural control (if they can do it or not)
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146
Q

Cons of theory of planned behaviour

A
  1. Lack of causality
  2. Does not explain how attitudes, intention and perceived behavioural norms interact
  3. Relies of self-reported behaviour
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147
Q

Describe the transtehoretical model

A 
Pre-Contemplation 
Contemplation 
Preparation 
Action 
Maintenance
Relapse
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148
Q

Pros of transtheoretical model

A
  1. Acknowledges each individual stag e
  2. Accounts for relapse
  3. Temporary element
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149
Q

Cons of transtheoretical model

A
  1. Not all people move through these stages in the same direction
  2. Might be continuous and not discrete
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150
Q

Name other models of behavioural change

A
  1. Motivational interviewing

2. Nudge theory

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151
Q

Define evaluation of health services

A
  1. Evaluation is the assessment of wether a service achieves its objectives
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152
Q

Framework for health service evaluation

A
  1. Structure (what is there - staff, buildings)
  2. Process
  3. Outcome
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153
Q

Define process

A
  1. What is done (e.g. number of patients seen in a and e)
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154
Q

What four factors classify health outcomes

A
  1. Mortality
  2. Morbidity
  3. QOL
  4. Patient satisfaction
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155
Q

Issues with health outcomes

A
  1. Time lag between service provided and outcome

2. Large SAMPLE SIZEs may e needed to detect statically significant effects

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156
Q

Name four of maxwell’s dimensions of quality

A
  1. Effectiveness
  2. Efficiency
  3. Equity
  4. Accessibility
  5. Appropriateness
  6. Acceptability
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157
Q

Two examples of qualitative methods of evaluation

A
  1. Interviews

2. Focus groups

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158
Q

Two examples of quantitative methods

A
  1. Records

2. Survey

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159
Q

What is the framework for evaluating health services

A
  1. Define what the service is
  2. Aims and objectives of service
  3. Framework: structure, process and outcome
  4. Methodology to be used
  5. Results, conclusions and recommendations
160
Q

Define malnutrition

A

Deficiencies, excess or imbalance in a person’s intake of energy or nutrients (undernutrition or overweight)

161
Q

Early influences on feeding behaviour

A
  1. Maternal diet and test preference

2. Parenting practices

162
Q

What are the three components of breastmilk

A
  1. Colostrum
  2. Foremilk
  3. Hindmilk
163
Q

Three basic forms of dieting

A
  1. Restrict the total amount of food eaten
  2. Do not eat certainn types of food
  3. Avoid eating for long periods of time
164
Q

4 challenges with dieting

A
  1. Risk of eating disorder
  2. Loss of lean body mass not just fat
  3. Dieting slows metabolic rate and energy expenditure
  4. Chronic dieting can disrupt normal appetite responses
165
Q

What is portion size effect

A

Consumption of large portion sizes of energy dense food facilitates over consumption

166
Q

Why is dieting challenging for some people

A
  1. Unresponsiveness to internal queues to satiety

2. Vulnerable to external queues

167
Q

How do we calculate NNT

A

1/ARR

168
Q

Example of Prevention Paradox

A
  1. Giving everyone who has a 10% risk of having a CVD statins
169
Q

Define disability

A

Related to anyone with a physical, sensory or mental impairment which seriously affects their daily activities

170
Q

Most common type of eye condition in the UK

A
  1. AGE RELATED MACULAR DEGENERATION
171
Q

What is retinitis pigmentosa

A

Disease of retina which leads to a GRADUAL reduction in vision

172
Q

What is glaucoma

A

Effects the optic nerve

173
Q

Four ways we can recognise a visually impaired person

A
  1. Guide dog
  2. Dar glasses
  3. Reading braille
  4. Guiding cane
174
Q

2 ways we can improve communication for the blind

A
  1. LARGE print
  2. Braille
  3. Speech package
  4. CD
175
Q

What are the 3 core principles of the NHS

A
  1. Meets everyone’s needs
  2. Free at point of delivery
  3. Based on clinical need, not pay
176
Q

Causes of homelessness

A
  1. Domestic abuse
  2. Poverty
  3. Housing affordability
  4. Unemployment
177
Q

Barries to access to healthcare by homesless

A
  1. Lack of integration
  2. Other priorities
  3. May not know where to get help
178
Q

Barries to access to healthcare by GYPSIES

A
  1. Communication problems
  2. Frequent movement
  3. Poor reading skills
  4. Reluctane by GPs to register
179
Q

Health problems faces by LGBTQ

A
  1. Depression
  2. Suicide
  3. Drugs
  4. STIs
180
Q

Barries to healthcare by LGBTW

A
  1. Stigma
  2. Discomfort discussing their gay
  3. Previous negative experiences
181
Q

Signs and symptoms of Physical and sexual abuse

A
  1. Brusing, cuts and scored
  2. Anxiety
  3. Depression
  4. Aggressiveness
  5. PTSD

Sexual Abuse:

  1. Fear and anxiety towards sexual activity
  2. Suicide risk
  3. STis, UTIs
182
Q

Signs and symptoms of Physical and sexual abuse

A
  1. Brusing, cuts and scored
  2. Anxiety
  3. Depression
  4. Aggressiveness
  5. PTSD

Sexual Abuse:

  1. Fear and anxiety towards sexual activity
  2. Suicide risk
  3. STis, UTIs
183
Q

Three causes of of communication disorders

A
  1. Stroke
  2. MND
  3. Cerebral Palsy
184
Q

Four presentations of speech difficulties

A
  1. Dysarthria
  2. Apraxia
  3. Dysfluent speech
  4. Stammer
185
Q

Comprehension difficulties

A
  1. No Spoken/written language at all
  2. Word-finding difficulties
  3. Trouble with grammar
  4. Sounds fine but content isn’t right
186
Q

Name a condition in which primary progressive aphasia is seen

A

Dementia

187
Q

Presentation of pragmatic impairment

A
  1. Atypical body language, eye contact
  2. Difficulties with turn taking
  3. Atypical intonation, speech rate/voluem
  4. Poor awareness of how others are responding
188
Q

Define cultural expertise

A

Where training focuses on providing information about different groups based on one characteristic

189
Q

Define cultural sensibility

A

relates to a person’s moral, emotional or aesthetic ideas or standards.

190
Q

Negative aspects of cultural knowledge

A
  1. Too many categories to learn

2. Risks oversimplification and stereotyping

191
Q

Define Culture

A
  1. Socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life
192
Q

Define Ethnocentrism

A
  1. Tendancy to evaluate other groups according to values and standards of one’s own cultural group - especially with conviction that one’s own cultural group is superior to other groups
193
Q

4 aspects of iceberg model of culture

A
  1. Gender
  2. Age
  3. Ethnicity
  4. Socioeconomic status
194
Q

What is individual culture

A

Based on heritage, individual circumstances and dynamic.

195
Q

Define stereotype

A

Involve generalisations about typical characteristics of members of a group

196
Q

Define prejudice

A

Attitude towards another person based solely on their membership of a group

197
Q

Define discrimination

A

Actual positive or negative actions towards the objects of prejudice

198
Q

What is Hofstede’s cultural dimensions

A
  1. Effects of society’s culture on values of its members
199
Q

Define flexibility

A

Capacity to adapt, accommodate or modify change

200
Q

Define intellectual integrity

A

I questioned my bias and assumptions and examined my thinking

201
Q

Duties of a doctor (3)

A
  1. Make sure patient is first concern
  2. Take prompt action if you think patient safety is compromised
  3. Maintain trust
202
Q

Example of HNA in a population , condition and an intervention

A

Manor practice population

COPD

Coronary angioplasty

203
Q

What is a cross-sectional study

A

Analysis of data rom a population at a SPECIFIC POINT in time

204
Q

What type of anaemia is seen in Liver disease

A

Macrocytic

205
Q

What does raised ALT indicate in liver disease

A

Chronic liver disease - elevates later on in the disease

206
Q

Signs of liver cirrhosis

A 
Jaundice
hepatomegaly 
Splenomegaly due to portal hypertension 
Spider Naevi 
Palmar Erythema
Gynecomastia 
Ascites
Caput medusae (distended paraumbilical veins due to portal hypertension)
Asterixis
207
Q

What is the first line investigation for non-alcoholic fatty liver disease

A

Enhanced liver fibrosis test

208
Q

What would a USS of the liver in cirrhosis look like

A

Nodularity of the liver surface
Ascites
Splenomegaly

209
Q

Treatment of oesophageal varices

A

caused by portal hypotension

TIPS (Transjugular Intra-Hepatic Portosystemic Shunt)

210
Q

Management of bleeding oesophageal varices

A

vasopressin analogues (terlipressin) to cause vasoconstriction

Correct with Vit J and plasma

211
Q

What antigen shows active Hep B infection

A

HBsAg

212
Q

What antigens are a marker of Hep B viral replication and high infectivity

A

HBeAg

213
Q

What is the marker for a previous Hep B infection

A

HBcAb

214
Q

What marker implies vaccination to hep B

A

HBsAb

215
Q

What marker is used to check viral load in Hep B infections

A

HBV DNA

216
Q

Treatment of autoimmune hepatitis

A

Oral Prednisolone

217
Q

Symptoms of Haemochromatosis

A
  1. Chronic fatigue
  2. joint Pain
  3. Pigmentation (slate grey/bronze)
    Hair Loss
    Erectile Dysfunction
    Amenorrhoea
    Dementia
218
Q

Diagnosis of haemahcromatosis

A

Serum ferritin levels

Genetic Testing

219
Q

Complications of haemochromatosis

A
  1. T1DM
  2. Liver Cirrhosis
  3. Cardiomyopathy
  4. Hepatocellular carcinoma
  5. Hypothyroidism
  6. Chrondrocalcinosis (calcium deposits causing arthritis)
220
Q

Management of haemochromatosis

A

venesection

221
Q

Signs of Wilson’s disease

A
  1. Chronic Hepatitis
  2. Dysarthria and Dystonia, Parkinsonism from copper deposition in the basal ganglia
  3. Depression
  4. Kayser-Fleischer rings
222
Q

Diagnosis of Wilson’s

A

Serum Caeruloplasmin levels

24-hour urinary copper assay

223
Q

Management of Wilson’s

A

Penicillamine

224
Q

Where is alpha-1-antitripsin produced

A

Liver, coded by chromosome 14

225
Q

Signs of alpha-1-antitripsin deficiency

A

Inhibits Elastase:

Liver: Mutated porteins accumulatie = cirrhosis of the liver -> hepatocellular carcinoma

Lung: Excess protease enzymes -> Bronchiectasis + Emphysema

226
Q

Diagnosis of alpha-1 antitripsin deficiency

A

Low alpha-1 antitripsin

  1. Liver biopsy: acid-Schiff-positive staining globules
  2. Genetic testing: A1AT gene
227
Q

Management of alpha 1 antitripsin deficiency

A

Symptomatic management

Then Organ transplant

228
Q

Signs of Primary biliary sclerosis

A
  1. Fatigue
  2. Itching
  3. Abdo pain
  4. Jaundice
  5. Pale Stools
  6. Xanthoma (cholesterol deposits in the skin and blood vessels)
229
Q

RF for primary biliary sclerosis

A

Middle Aged Women
Autoimmune Conditions
Rheumatoid conditions

230
Q

Diagnosis of primary biliary sclerosis

A
  1. Anti-mitochondrial antibodies

2. ANA

231
Q

Treatment of primary biliary sclerosis

A
  1. Urseodeoxycholic acid

2. Colestyramine (binds to bile acid and prevents absorption, reducing itching

232
Q

RF for primary sclerosing cholangitis

A
  1. Male
  2. 30-40
  3. UC
  4. FH
233
Q

Presentation of primary scleorsing cholangitis

A
  1. Jaundice
  2. Chronic RUQ pain
  3. Pruritis
  4. Fatigue
  5. Hepatomegaly
234
Q

Autoantibodies found in primary sclerosing cholangitis

A

p-ANCA
ANA
Anticardiolipin antibodies

235
Q

Diagnosis for primary sclerosing cholangitis

A

MRCP

236
Q

Management of primary sclerosing cholanhgitis

A

Liver Transplant

237
Q

Complication of primary sclerosing cholangitis

A

Cholangiocarcinoma

238
Q

What isa tumour marker for hepatocellular carcnioma

A

AFP

239
Q

What is the tumour marker for cholangiocarcinoma

A

CA19-9

240
Q

Gastric vs duodenal ulcers

A

Eating makes peptic ulcers worse, while eating makes duodenal ulcers better

241
Q

Management of COPD

A

First Line: Salbutamol or Ipratropium Bromide

Then: LABA PLUS LAMA if asymptomatic now.

If still asthmatic, give an ICS.

Long term oxygen therapy by Venturi mask

242
Q

Medical Treatment at home for COPD exacerbation

A
  1. Prednisolone

2. Regular inhalers

243
Q

Medical treatment for COPD exacerbation in hospital

A
  1. Nebulised salbutamol
  2. Hydrocortisone (IV)
  3. Antibiotics + Physio

IV Aminophylline as second line

244
Q

CXR signs for lung cancer

A
  1. Hilary enlargement
  2. Peripheral opacity (a visible lesion in the lung)
  3. UNILATERAL pleural effusion
  4. Collapse
245
Q

What are case-control Studies

A

People who have ALREADY developed the disease are identified with their past exposure and compared with those who do not have the disease or other controls

246
Q

What are cohort studies

A

Where participants are recruited who share a common characteristic and are followed up over a LONG period of time to measure the impact of a variable (e.g., smoking and lung cancer)

247
Q

What are cross-sectional studies

A

Studies that are used to look at an association between to variables (no causality).

A single point in time, like a snapshot (so interviewing participants at a single point in time)

Cohort: Prospective

Case-Control: Retrospective

248
Q

What are randomised control trials

A

Randomly picking participants from the population with shared characteristics that are wanted to be studied.

249
Q

What research is used to establish causality

A

RCT not a cross-sectional study

250
Q

What can cause selection bias

A

Non-Response

Loss to follow up

251
Q

Four types of information bias

A
  1. Measurement (using different equipment to measur outcomes
  2. Observer (the researcher knows the participants and subconsciously reports the outcome differently)
  3. Recall
  4. Reporting
252
Q

What is strength in the Bradford-Hill Criteria

A

Stronger Association between exposure and outcome

253
Q

What is dose-response in Bradford-Hill’s criteria for strengthening causality

A

Increased risk of outcome with increased exposure

254
Q

Formula for screening

A

Have Disease + Positive / (Have Disease + Tested Positive and Have Disease + Tested Negative)

255
Q

Formula for Specificty

A

(Do not have the disease + Negative/ Do not have the disease + Negative and Do not have the disease + Positive)

256
Q

Formula for Positive Predictive Value

A

True number of people who actually have the disease out of all the people who teste dpositive

257
Q

Formula for negative predictive value

A

True negatives that didn’t have the disease as a proportion of all the people who tested negative

258
Q

What is the NHS criteria for a screening test

A

Screening should be on-going and not one off

Costs of screening should be economically balanced to healthcare spending as a whole

259
Q

NHS criteria for mass screening for a condition

A
  1. The condition should be important
  2. The epidemiology and history of the condition should be adequately understood with detectable risk factors
  3. All cost effective primary prevention should have been implemented as far as possible
  4. If carriers are identified, the implications must be understood
260
Q

NHS criteria for testing

A
  1. Simple screening programme should be available
  2. Cut off levels for test values must be agreed nationally.
  3. Tests should be acceptable to the population
  4. There should be an agreed policy for diagnostic investigation following a positive result
261
Q

What is Case-Fatality rate

A

The % of people who are at risk of dying from a disease

262
Q

What does an Odds Ratio show us

A

An association between exposure and outcome

If >1 = positiver association

If <1 = negative association

263
Q

Formula for NNT

A

1/ Absolute Risk Reduction

264
Q

What is NNT

A

The number of patients needed to treat to prevent one additional bad outcome

265
Q

What is the absolute risk reduction

A

For example, if in an RCT 20% of the control group received bad outcomes compared to only 12% in the intervention group, the ARR is 8%.

This means iff 100 children were treated, the intervention prevents 8 people from developing bad outcomes

Then NNT is, if 8 children benefit out of 100 people going treatment, 100/8 means for every 12.5 that are treated, one child is saved.

266
Q

What is an observation bias

A

Where participants are aware they’re being examined and change their behaviour as a result

267
Q

What is selection bias

A

Preferential selection of participants who may not represent the true population that the research question tries to study

268
Q

How to calculate relative risk

A

The risk of disease in one group / the risk of disease in another group

269
Q

What does an odds ratio show us

A

The probability that an event will occur in a given exposure compared to the probability that event will happen without the exposure

270
Q

What is distinctive about an ecological study

A

They look at population statistics as opposed to investigating anything at individual level. No interviewing or case-based issues.

271
Q

How do we differ out relative risk reduction from a relative risk figure

A

100- relative risk

272
Q

What is attrition bias

A

Loss of participants, leading to a type of selection bias.

273
Q

What drugs can cause AKI

A
  1. NSAIDs
  2. ACEi
  3. ARBs
  4. CCBs
  5. alpha-blockers
  6. Beta-blockers
  7. Opioids
  8. Diuretics
  9. Acyclovir
  10. Trimethoprim
  11. Lithium
274
Q

What does aspirin inhibit

A

COX-1 only

It MAY inhibit activity of COX-2 by disabling enzymes but not directly.

275
Q

What drug is used to reverse to effect of Heparin

A

Protamine

276
Q

How does N-Acetylcysteine work?

A

Replenishes Glutathione stores

277
Q

Which malarial parasite reside in the liver

A

Plasmodium Vivax/Ovale

278
Q

Signs of p. vivid and ovale

A

Cyclical fevers ever 48 hours

279
Q

Management of p viva and ovale

A

Chloroquine for all

Primaquine for any relapses

280
Q

In areas where there is chloroquine resistance, what medication should be given for malaria

A

Artemisinin-based combination therapy

281
Q

Primary prevention of Cardiovascular Disease

A

QRISK3 score: Risk of developing CVD in the next 10 years

282
Q

If QRISK is greater than 10%, what should be given

A

Statins

283
Q

What conditions are absolute indications for CVD

A

CKD

T1 DM

284
Q

What is secondary prevention of CVD

A

AAAA

A- Aspirin (+ Clopidogrel for 12 months)
A - Atoravstatin
A - Atenolol
A - ACEi

285
Q

Side effects of Statins

A

T2 DM
Creatine Kinase is elevated due to myopathy
Haemorrhagic strokes

286
Q

Management of Angina

A
  1. RAMP

R - Refer to Cardiology
A - Advice
M - Medical Treatment
P - Proceedurol or surgical intervention

287
Q

What is given as immediate symptomatic relief of angina

A

GTN spray - vasodilator

Take GTN then repeat after 5 minutes.

288
Q

When in angina treatment, should a patient call for an ambulance

A

If there is still pain 5 mins after the second dose of GTN

289
Q

Long term symptomatic relief of Angina

A
  1. Betablockers
  2. CCB

Others include nitrates and ivabradine

All vasodilators

290
Q

Secondary prevention of Angina

A

AAAA

Aspirin
Atorvastatin
Atenolol
ACEi

291
Q

Where is a PCI scar seen

A

Brachial artery and femoral artery scars

292
Q

Where are CABG scars seen

A

Midline sternotomy

Great Saphenous Veins

293
Q

What supplies the right ventricle and atrium

A

Right coronary artery

294
Q

What supplies the left atrium

A

Circumflex artery

295
Q

What supplies the left ventricle and septu,m

A

LAD

296
Q

What supplies the inferior left ventricle and posterior septal area

A

Right coronary artery

297
Q

What coronary artery condition is primarily associated with left bundle branch block

A

New onset = STEMI

298
Q

What distinguishes angina from MI

A

Troponin levels are normal

299
Q

What can be done within 12 hours of acute STEMi onset

A
  1. PCI

2. Thrombolysis (sletplase or streptokinase)

300
Q

Acute NSTEMI treatment

A

BATMAN

B - Beta blockers
A - Aspirin 300mg stat
T - Ticagrelor (or clopidogrel if higher bleed risk)
M - Morphine
A - Anticoagulant: Fondaparinux
N - Nitrates
301
Q

What is the GRACE score

A

Assess 6 month risk of death or repeat MI after PCI

302
Q

Complications of MI

A 
DREAD
D - Death
R - Rupture of septum
E - Edema
A - Arrhythmia and Aneurysm
D - Dressler's Syndrome
303
Q

What is Dressler’s syndrome

A

Immune response causing pericarditis: Pleuritic chest pain and a pericardial rub

Needs NSAIDs

304
Q

Secondary prevention of an MI

A
  1. Aspirin 75mg
  2. Clopidogrel 12 months
  3. Atorvastatin
  4. ACEi
  5. Atenolol
  6. Aldosterone antagonist
305
Q

Management of supra ventricular tachycardias

A

Adenosine (can’t be given in COPD, HF, Heart Block)

Instead give beta blockers, calcium channel blockers or amiodarone

306
Q

When should a GP refer a patient to a specialist for chronic HF

A

> 2,000 ng/litre

307
Q

What vaccinations does someone with Chronic HF need

A

Yearly flu and pneumococcal vaccine

308
Q

First line treatment of Chronic HF

A

ABAL

ACEi
Beta Blockers
Aldosterone antagonist (3rd line)
Loop Diuretics

309
Q

What does HIV treatment consist of

A

2 NRTIs + one of any other HAART medication classes

310
Q

Name some HAART medication classes

A
  1. Protease Inhibitors
  2. Integrase Inhibitors
  3. Nucleoside Reverse Transcriptase Inhibitors
  4. Non-Nucleoside Reverse Transcriptase Inhibitors
  5. Entry Inhibitors
311
Q

What consists of Post Exposure Prophylaxes

A

Truvada and Raltegravir

This is cART

312
Q

Signs of disseminated TB on an X-Ray

A

Millet Seeds uniformly distributed across the chest

313
Q

Side Effect of Pyrazinamide

A

Hyperuricaemia

314
Q

Side effect of Ethambutol

A

Colour Blindness and reduced visual acuity

315
Q

Side effect of isoniazid

A

Peripheral Neuropathy

316
Q

What antibiotic prevents folic acid metabolism

A

Trimethoprim

317
Q

What can be given to treat MRSA

A

Teicoplanin or Vancomycin

318
Q

Absolute Risk Reduction vs Relative Risk Reduction

A

Absolute: Risk (control) - Risk (experimental)

Relative: 1 - [Risk (Experimental Group) / Risk (Control Group)]

319
Q

What is intention to treat analysis

A

Avoids the effects of drop outs in an experiment

320
Q

What is a time interval bias

A

Termination of a trial at a tie when its results support a desired outcome

321
Q

What is a type I error

A

False Positive: Incorrect rejection of the null hypothesis when it is true

322
Q

What is a type II error

A

Failure to reject the null hypothesis when it is false

323
Q

What is a confidence interval

A

A range of values where there is a certain level of confidence that the value parameters lie within

324
Q

What HbA1c level is diabetes diagnosed at

A

> 48 mmol/mol

325
Q

What Random Glucose is Diabetes diagnosed at

A

> 11 mmol/mol

326
Q

What Fasting Glucose is diabetes diagnosed at

A

> 7 mmol/mol

327
Q

What is the target Hb1ac for diabetes

A

48 mmol/mol on metformin or 53mmol/mol if they’re on multiple medications

328
Q

How long should antibiotics be given for men , pregnant women and catheter-related UTIs (complex)

A

7 Days of trimethoprim or nitrofurantoin

329
Q

When is nitrofurantoin contraindicated

A

eGFR < 45

330
Q

Why should nitrofurantoin be avoided in the third trimester of pregnancies

A

There is a risk of neonatal haemolytic

331
Q

Why should trimethoprim be avoided in the first trimester for pregnancy

A

Folate antagonist

332
Q

First line treatment for rate control in AF

A

Beta lockers

Second: CCB/Digoxin

333
Q

What is the first line pharmacological cardio version tactics used for AF

A
  1. Flecanide
334
Q

At what chadsvasc score are anticoagulants recommended for

A

> 1

335
Q

First line treatment of AV node blocks

A

Atropine

336
Q

Complication of a third degree heart block

A

Asystole

337
Q

Diagnostic for HF

A

ECHO

338
Q

What gene causes PCKD

A

Autosomal dominant: Chromosome 16

339
Q

What does autosomal recessive PKCD present with during pregnancy

A

Oligohydramnios

340
Q

Management of PCKD

A

Tolvaptan

341
Q

What is TWOC

A

This is a trial without catheterisation. We check if the bladder output is good and they do not need a replacement

342
Q

How long do people with catheters need to be on antibiotics for in UTIs

A

7 Days

343
Q

Main cause of epididymo-orchitis

A

E.coli

344
Q

Signs of mumps

A

Testicular swelling (sparing of the epididymis) and parotid gland swelling

345
Q

First line treatment of epididymo-orchitis

A

Ofloxacin

346
Q

Four risk factors of bladder cancer

A
  1. Older Age
  2. Aromatic amines in dye and rubber
  3. Smoking
  4. Schistosomiasis
347
Q

Most common type of bladder cancer

A

Transitional cell carcnioma

348
Q

Diagnosis of Bladder cancers

A

Cystoscopy with biopsy

349
Q

Treatment of bladder cancer

A
  1. Transurethral resection of bladder tumour

Intravesical chemotherapy

350
Q

Features of multiple myeloma

A

CRAB

C - Hypercalcaemia
R - Renal Failure
A - Normocytic anaemia
B - Bone Pain

351
Q

How do we test for Myeloma

A

B - Bence-Jones Protein
L - Serum free light chain assay
I - Serum IgG
P - Serum Protein Electrophoresis

352
Q

What kind of skull is seen on an X-Ray for Myeloma

A

Raindrop skull (lytic lesions that look like raindrops)

353
Q

How do we manage a tension pneumothorax

A

Insert a large bore cannula into the second intercostal space of the midclavicular line

354
Q

Main hospital cause of pneumonia

A

Pseudomonas Aerguinosa

355
Q

Advantages of Cohort STudies

A

Can follow up groups with rare exposures
Good for multiple outcome analysis
Less risk of selection and recall bias

356
Q

Disadvantages of cohort studies

A

Takes a while
Loss for follow up
Needs large sample size

357
Q

Advantages of case-control

A
  1. Good for rare outcomes
  2. Quicker than cohort or interventional studies
  3. Inexpensive
358
Q

Disadvantages of case-control studies

A
  1. Difficult to find controls to match with cases
  2. Prone to selection and information bias
  3. Data may not be reliable due to patient memory
359
Q

Disadvantages of cross-sectional

A

Risk of reverse causality

360
Q

What does a relative risk number show

A 
1 = no difference between groups
>1 = the intervention increases risk

<1 = The intervention decreases risk

361
Q

Mode of action of cocaine

A
  1. Enhances neurotransmitter synapse (serotonin and dopamine)
362
Q

Define Altruism

A

The moral value of an individual’s action depends solely on the impact on other individuals

363
Q

Define egoism

A

Self interest of an action is the sole foundation of the morality of the action

364
Q

Define Utilitarianism

A

Promotes actions that maximises happiness and well being for the majority of the population

365
Q

Define deontological

A

The morality of an action should be based on whether then action itself is right or wrong

366
Q

Define consequentialist

A

The consequence of the action is the ultimate basis of whether what we did is morally right

367
Q

Define virtue ethics

A

Focuses on character traits

Emphasises the mind, character and sense of honesty

368
Q

Dimensions of Healthcare Equity

A

Spatial - Geographical

Social - AGe, Gender, Class, Socioeconomic and ethnicity

369
Q

What is the Wilson and Jugner Screening Criteria

A

The condition must:
Be important
Have a latent/preclinical phase
Known aetiology

The screening test must:
Be suitable
Be Acceptable

The treatment must:
Be Effective
Have an agreed policy on who to treat

The organisation and cost:
Facilities must be available
Costs and Benefits measured
Be an ongoing process

370
Q

Second line treatment for rheumatoid arthritis

A

Dual therapy using two DMARDs

371
Q

What should be prescribed alongside methotrexate in RA

A

Folic acid, to be taken on a different day to the methotrexate

372
Q

What RA drug can cause pulmonary fibrosis

A

Methotrexate

373
Q

Signs of psoriatic arthritis

A

Onycholysis
Dactylitis
Enthesitis

Conjunctivitis + Anterior Uveitis

374
Q

X-Ray changes seen in psoriatic arthritis

A
  1. Periostitis
  2. Osteolysis
  3. Dactylitis
  4. Pencil-in-cup appearance
375
Q

What is arthritis Mutilans

A

Destruction of the bones around the joints in the digits. Th skin then folds as the digit shortens, giving a ‘telescopic finger’ appearance

376
Q

Management of Psoriatic Arthritis

A
  1. NSAIDs for pain
  2. DMARDs (Methotrexate)
  3. Anti-TNF medications (Etanercept)

Ustekinumab LAST LINE

377
Q

What key joints are affected in ankylosing spondylitis

A

Fusion of sacroiliac joints

Stiffness in vertebral joints -> Bamboo spine

378
Q

Presentation of ankylosing spondylitis

A
  1. Lower back pain and stiffness
  2. Sacroiliac pain in the buttock

Worst at rest and better on movement

379
Q

Extraarticular presentation of AS

A
  1. Chest pain (cost vertebral and costosternal tenderness)
  2. Enthesitis
  3. Dactylitis
  4. Anaemia
  5. Anterior Uveitis
  6. Aortitis
  7. Heart Block
  8. Pulmonary Fibrosis
380
Q

What test is done to check for AS

A

Schober’s test

Find L5 vertebrae and draw a line 10 cm above and 5 cm below and ask to bend over.

381
Q

What specific structure is found in AS on XRay

A

Syndesmophytes

382
Q

Management of AS

A
  1. NSAIDs
  2. Steroids
  3. Etanercept (TNF-alpha inhibitors)
383
Q

What is a key investigation for polymyositis and dermatomyositis

A

Serum Creatine Kinase measurements

384
Q

Signs of Dermatomyositis

A
  1. Gottron Lesions on knuckles
  2. Photosensitive erythematous rash
  3. Purple rash on the face and eyelids
  4. Periorbital oedema
  5. Subcutaneous calcinosis
385
Q

Management of polymyositis

A

Corticosteroids

386
Q

What range INR is used for APL

A

2-3

387
Q

What medication is given for APL

A

Long term warfarin or LMWH in pregnant women PLUS aspirin

388
Q

Definitive diagnosis of a Pulmonary Embolism

A

V/Q mismatch or CT Angiography

389
Q

Initial Management of a Pulmonary Embolism

A

LMWH Heparin

Then switch to Warfarin or Doacs for 3 months

390
Q

In what testicular tumour is AFP raised

A

Teratomas

391
Q

In what testicular cancer is Beta hCG raised

A

BOTH teratomas and Seminomas

392
Q

What testicular cancer has the better prognosis

A

Seminomas

393
Q

What is Conn’s syndrome

A

Primary Hyperaldosteronism

394
Q

Investigations for suspected Conn’s/Hyperaldosteronism

A

Renin/Aldosterone ratio:

High Aldosterone + Low Renin = Primary Hyperaldosteronism

High Aldosterone + High Renin = Secondary

395
Q

The effects of hyperaldosteronism

A

Hypernatraemia
Hypokalaemia
Alkalosis

396
Q

Management of Conn’s Syndrome

A

Eplerenone

year 3 (25 decks)

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