Last min SBA Flashcards
You see a 48-year-old woman in clinic following a cholecystectomy 6 months ago. She complains that since the operation she has experienced chronic diarrhoea which seems to float in the toilet.
What would be the best medication to offer to help with these symptoms?
Bismuth salts
11%
Cholestyramine
46%
Creon
30%
Loperamide
10%
Rehydration salts
You see a 48-year-old woman in clinic following a cholecystectomy 6 months ago. She complains that since the operation she has experienced chronic diarrhoea which seems to float in the toilet.
What would be the best medication to offer to help with these symptoms?
Bismuth salts
Cholestyramine
Creon
Loperamide
Rehydration salts
Cholestyramine
A 74-year-old Caucasian man presents for a management review of his heart failure. He was previously classified as NYHA class II but now describes worsening symptoms and significant breathlessness when climbing the stairs. His medications include the maximum dose of ramipril, spironolactone, and bisoprolol.
An echocardiogram is performed revealing an ejection fraction of 31%. An ECG shows a right bundle branch block with a QRS width of 164 milliseconds. It is decided that this patient should undergo an interventional procedure to improve symptoms.
What is the most appropriate management?
Cardiac catheter ablation
Cardiac resynchronisation therapy (CRT)
Coronary angiography
Implantable cardiac defibrillator (ICD)
Primary percutaneous coronary intervention
Cardiac resynchronisation therapy (CRT)
While covering an emergency, you evaluate a 30-year-old man brought in by his partner after having a sudden seizure attack. The patient has a history of epilepsy that has been well-controlled.
Recently, he has adopted new healthy habits following his father’s heart attack, including quitting smoking, exercising to lose weight, and taking multivitamins. However, the patient informs you that he has also started taking aspirin, left over from his wife, in the hope of reducing his risk.
What of the patient’s new habits or medications is most likely to have a significant influence on his epilepsy control?
Taking aspirin
Taking bupropion
Taking multivitamins
Taking nicotine replacement therapy
Taking varenicline
Taking bupropion
An 18 month old boy is brought to the emergency room by his parents. He was found in bed with a nappy filled with dark red blood. He is haemodynamically unstable and requires a blood transfusion. Prior to this episode he was well with no prior medical history.
What is the most likely cause?
A. Necrotising enterocolitis B. Anal fissure C. Oesophageal varices D. Meckels diverticulum E. Crohns disease
Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
A 32-year-old pregnant female is due to have an induction of labour at 38 weeks gestation due to cholestasis of pregnancy. She undergoes a pelvic examination and a Bishop’s score of 4 is calculated.
What treatment is most suitable?
A. Vaginal prostaglandin (PGE2) B. Syntocinon C. Caesarian section D. No treatment required E. Syntometrine
Vaginal PGE2 or oral misoprostol is the preferred method of induction of labour if the Bishop score is <6
Addison’s patient with intercurrent illness →
double the glucocorticoids, keep fludrocortisone dose the same
A 65-year-old lady has recently had a colonoscopy and been found to have a malignant tumour in the most distal portion of the rectum, involving the anal sphincter.
Which of the following surgical procedures would be the best option for her?
A. Hartmann's procedure B. Left hemicolectomy C. Abdominoperineal (AP) resection D. Transverse colectomy E. Anterior resection
Rectal cancer on the anal verge → Abdomino-perineal excision of rectum
A 61-year-old man is admitted to the surgical assessment unit with renal colic. He has had pain for the past four days, but worst in the last 24 hours. His renal function is normal and an ultrasound scan demonstrates a dilated right ureter and right hydronephrosis. A CT of his urinary tract demonstrates a right ureteric stone.
What is the most appropriate first line management for this man?
A. Flexible cystoscopy and stone retrieval B. Extra-corporeal shockwave lithotripsy (ESWL) C. Conservative management D. Open stone retrieval E. Nephrostomy
Nephrostomy
Acute upper urinary tract obstruction is managed with nephrostomy
A 53-year-old man with alcoholic liver cirrhosis is seen in the hepatology outpatient clinic. He is slightly tremulous and visibly jaundiced. Since his last follow-up appointment, he has developed worsening ascites.
Which of the following blood tests, when compared to his previous, will best represent changes in his liver function?
A. Alanine transaminase (ALT) B. Alkaline phosphatase (ALP) C. Aspartate transaminase (AST) D. Gamma-glutamyl transferase (GGT) E. Prothrombin time (PT)
Liver enzymes are a poor way to look at liver function - they are usually low in end-stage cirrhosis whereas coagulation and albumin are better measures
A 40-year-old male attends the GP surgery requesting further information regarding vasectomy for contraception. He and his wife have 4 children, and are both confident that they do not want any further children.
What advice do you give him with regards to vasectomy as a form of contraception?
A. Vasectomy is an immediate form of contraception B. Sterilisation is confirmed following clear semen analysis C. Sterilisation is established following 30 ejaculations D. Sterilisation is established after 4 months E. Sterilisation is established after 6 months
Sterilisation is confirmed following clear semen analysis
Vasectomy isn’t an immediate form of contraception; semen analysis must be performed and azoospermia confirmed before used as contraception
A 35-year-old female G1 P0 presents to her local hospital at 36 weeks pregnancy. She is carrying a singleton fetus. She is in the early stages of labour (cervical dilation = 2cm). The amniotic sac has not yet ruptured. An abdominal exam reveals the fetus is presenting in transverse lie. There have been no complications in the pregnancy to date. There is no evidence of abnormal bleeding.
What is the most suitable next step?
A. Perform an emergency cesarean section in the next 30 minutes B. Perform an elective cesarean section C. Attempt vaginal delivery D. Attempt forceps delivery E. Perform external cephalic version
. Perform external cephalic version
You can attempt external cephalic version for a transverse lie if the amniotic sac has not ruptured
Baby born after being in breech
What further DDH screening, if any, is required in this case?
A. Ultrasound screening is required within 72 hours of birth B. Bilateral hip x-rays should be taken 3 weeks after birth C. Repeat Ortolani and Barlow tests at 4 weeks after birth D. Ultrasound screening is required 6 weeks after birth E. No further screening is required
Ultrasound screening is required 6 weeks after birth
A 40-year-old male presents to his GP as he has had long-standing fatigue. The also reports some joint pain, mostly in his hands. He denies any weight loss, fevers, or night sweats. He reports that his father had something similar and he thinks he used to have to give blood regularly.
On examination, the joints in his hands do not appear inflamed or hot to touch, but his skin has a grey / brown appearance.
You decide to order some blood tests.
Given the likely diagnosis, what are the iron studies most likely to show?
TIBC = total iron binding capacity
A. Raised transferrin saturation, low ferritin, raised TIBC B. Low transferrin saturation, low ferritin, low TIBC C. Low transferrin saturation, raised ferritin, low TIBC D. Raised transferrin saturation, raised ferritin, raised TIBC E. Raised transferrin saturation, raised ferritin, low TIBC
Raised transferrin saturation and ferritin, with low TIBC is the characteristic iron study profile in haemochromatosis
Raised transferrin saturation, raised ferritin, low TIBC
Haemochromatosis causes excess iron accumulation.
Transferrin is the main protein that iron binds to for transport in the blood. Haemochromatosis causes increased iron, so more will be available to bind to transferrin so the saturation (percentage of transferrin bound to iron) is increased.
Ferritin is the intracellular storage form of iron, with a small amount found in blood, so increased body iron raises this value.
TIBC is a measure of available binding sites on transferrin. If there is a lot of iron, these sites are taken up so there is less capacity to bind more, hence TIBC is low in iron overload.
A 62-year-old publican is admitted with ascites. Following investigations he is diagnosed with decompensated cirrhosis and is to undergo paracentesis to remove a large amount of fluid from his abdomen. An albumin infusion is started.
What is the main benefit of prescribing albumin when treating large volume ascites’?
A. Reduce postparacentesis circulatory dysfunction B. Minimise seizure risk C. Reduce incidence of recurrence D. Maintain eGFR E. Minimise infection risk
Large-volume paracentesis for the treatment of ascites requires albumin ‘cover’. Evidence suggests this reduces paracentesis-induced circulatory dysfunction and mortality
You are on the night on-call team, and a 76-year-old woman on one of your wards has developed increasing confusion. She is wandering around the ward asking for her husband and is shouting at staff and other patients. She was admitted this morning with a high fever and a one-week history of a productive, purulent cough. She also has a history of Parkinson’s disease.
Nursing staff have been unable to calm her and she has now started to throw objects and hit staff members. The nurses have however been able to give you the following obs:
Temperature 37.8°C
Heart Rate 105 bpm
BP 138/78 mmHg
SaO2 95% on room air
Blood glucose 5 mmol/L
Which of the following is the most appropriate treatment?
A. Immediate release carbidopa-levodopa B. Olanzapine C. Lorazepam D. Amitriptyline E. Haloperidol
Lorazepam
Typical antipsychotics should be avoided in delirious patients with a background of Parkinson’s disease
