Last min SBA 2 Flashcards
A systematic review on the use of apixaban for left ventricular thrombus has shown a significant reduction in hospitalisation and mortality. Twenty randomised and non-randomised studies were included in the meta-analysis. The authors were concerned about the potential impact of studies with significant results being published more frequently than studies with negative findings and decided to investigate for publication bias.
What is the most appropriate method of assessing for publication bias in this study?
Forest plot
Funnel plot
GRADE analysis
Meta-regression analysis
Sensitivity analysis
Funnel plot for publication bias
A 64-year-old woman presents to her GP with complaints of diffuse joint pain, which has been particularly severe in her right first interphalangeal joint and left wrist for the past six months. The pain is worse in the morning and improves as the day passes. She reports having had a sore throat one week before the onset of her symptoms.
On examination, swelling of the distal interphalangeal joints on her left hand is observed, and the whole fingers seem swollen.
What is the most likely diagnosis?
Osteoarthritis
Psoriatic arthritis
Reactive arthritis
Rheumatoid arthritis
Systemic lupus erythematosus
Psoriatic arthritis
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis
A 40-year-old woman presents to the rheumatology clinic with a 3-month history of myalgia and widespread bony tenderness. She describes increased fatigue and weakness whilst lifting heavy objects. Her past medical history includes coeliac disease.
On examination, there is tenderness over the shoulder girdle and arms. There is no associated joint stiffness. She has a waddling gait.
Blood tests are taken:
Calcium 1.9 mmol/L (2.1 - 2.6)
Phosphate 0.8 mmol/L (0.8 - 1.4)
ALP 176 u/L (30 - 100)
What is the most likely diagnosis?
Myositis
Myotonic dystrophy
Osteomalacia
Osteoporosis
Polymyalgia rheumatica
Osteomalacia
dermatomyositis related to
malignancy
A 58-year-old undergoes a triple assessment after finding a lump in the right upper lateral quadrant of her breast. Her last menstrual period was 8 years ago, she has never used any hormonal contraceptives or hormone replacement therapy and has no other past medical history.
A biopsy shows the presence of ductal carcinoma in situ that is progesterone receptor-negative, HER2-negative, and oestrogen receptor-positive. She is offered a lumpectomy with adjuvant radiotherapy and endocrine therapy.
What is the mechanism of action of the most likely drug she will be given?
Complete oestrogen receptor antagonism
GnRH receptor agonism
GnRH receptor antagonism
Inhibition of peripheral oestrogen synthesis
Partial oestrogen receptor antagonism
Inhibition of peripheral oestrogen synthesis- aromatase inhibitors
A 48-year-old man is due to undergo a laparotomy for small bowel obstruction.
The correct answer is: Endotracheal intubation
A 63-year-old man has been on the intensive care unit for a week with adult respiratory distress syndrome complicating acute pancreatitis. He has required ventilation and is still being mechanically ventilated.
Tracheostomy 33%
Tracheostomy is often used to facilitate long term weaning. The percutaneous devices are popular. These involve a seldinger type insertion of the tube. A second operator inserts a bronchoscope to ensure the device is not advanced through the posterior wall of the trachea. Complications include damage to adjacent structures and bleeding (contra indication in coagulopathy).
A 47-year-old man is brought to the emergency department with a laceration on his left arm after falling at home. There was copious blood at the scene and the patient received a transfusion of one unit of packed red blood cells on arrival at the hospital.
The patient remains haemodynamically stable throughout and his wound is numbed with 10mls of 2% lidocaine prior to suturing by a junior member of the team.
Before suturing can begin the patient becomes profoundly tachycardia and hypotensive with a heart rate of 150 bpm and blood pressure of 70/40mmHg.
What is the most appropriate reversal agent?
IM glucagon
IV atropine
IV labetalol
IV lipid emulsion
IV magnesium sulfate
IV lipid emulsion
which anaesthetic can cause adrenal suppression
Etomidate
A 9-year-old boy is diagnosed as having Attention Deficit Hyperactivity Disorder and started on methylphenidate. Which one of the following should be monitored during treatment?
Visual acuity
Electrocardiogram to measure QRS duration every 12 months
Growth
Urinalysis
Liver function tests
Growth
A 68-year-old man was recently admitted with diverticulitis. He has a past medical history of hypertension, diabetes, and atrial fibrillation and he is currently on amlodipine, metformin, gliclazide, and warfarin.
On digital rectal examination, you notice some mild minor rectal bleeding. He is otherwise haemodynamically stable.
International normalized ratio (INR) 8.2 (2.0-3.0)
What should the patient’s management plan be with regard to his warfarin treatment?
Stop warfarin, give intravenous vitamin K
Stop warfarin, give intravenous vitamin K, give prothrombin complex concentrate
Stop warfarin, give oral vitamin K
Stop warfarin, give prothrombin complex concentrate
Withhold 1 or 2 doses of warfarin
INR > 8.0 (minor bleeding) - stop warfarin, give intravenous vitamin K 1-3mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0
On CT imaging, acute haematomas appear
bright (hyperdense) whereas chronic haematomas appear dark (hypodense).
turners associated with
aortic stenosis and coarc
A 45-year-old woman who is being treated for Hodgkin’s lymphoma with ABVD chemotherapy is reviewed on the haematology ward. She has been admitted by her GP with a fever of 38.9ºC. Her blood count from two days ago was as follows:
Hb 10.1 g/dl
Platelets 311 * 109/l
WBC 0.8 * 109/l
Neutrophils 0.35 * 109/l
Lymphocytes 0.35 * 109/l
Blood pressure is 102/66 mmHg and the heart rate is 96/min. Respiratory examination is unremarkable. You insert an intravenous cannula and take bloods including cultures.
What is the most appropriate next step in management?
A. Start intravenous ceftriaxone + amphotericin B B. Await the repeat white blood cell count then phone the haematology consultant C. Start intravenous piperacillin with tazobactam (Tazocin) D. Start intravenous ceftriaxone + gentamicin E. Start intravenous piperacillin with tazobactam (Tazocin) + G-CSF
Piperacillin with tazobactam (Tazocin) is the empirical antibiotic of choice for neutropenic sepsis
G-CSF is not used routinely in neutropenic sepsis.
Lactational amenorrhoea
is a reliable method of contraception as long as amenorrhoeic, baby <6 months, and breastfeeding exclusively
Red Flags for back pain include -
Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity
steroids. which can be given preterm
dexamethasone
betamethasone
A 21-year-old history student is admitted to the acute medical unit with a headache. He says he has had it for the past 4 days and it is present all the time but worst when he is lying down or when he coughs. He has a temperature of 38.2ºC, a heart rate of 94 bpm and complains that bright lights hurt his vision. On examination he is drowsy, he has a Glasgow coma score of 14, opening his eyes to voice and he has neck stiffness.
Which of the following investigations should be performed first?
A. MRI brain B. CT head C. Lumbar puncture D. Carotid artery Doppler E. Optic pressure measurement
CT
Headache linked to Valsalva manoeuvres = raised ICP until proven otherwise so LP is contraindicated
A 4-year-old boy with recurrent urinary tract infections is referred to the paediatric team due to worries over reflux nephropathy.
Which of the following is the investigation of choice when it comes to diagnosing this condition?
A. CT of the kidneys, ureters and bladder B. Intravenous pyelogram C. Micturating cystography D. Renal ultrasound E. Renal biopsy
Micturating cystography is the investigation of choice for reflux nephropathy
…………. is the antibiotic of choice for GBS prophylaxis
Benzylpenicillin
Heparin can cause drug induced
thrombocytopaenia
which drug can precipitate digoxin toxicity
Yellow vision, bradycardia, nausea and vomiting are symptoms suggestive of digoxin toxicity. Digoxin toxicity can be precipitated by numerous drugs and other factors, particularly hypokalemia. As thiazide diuretics increase the likelihood of hypokalemia, they may precipitate digoxin toxicity.
which drugs to avoid in G6PD deficiency:
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis
Cushing’s syndrome metabolic result -
hypokalaemic metabolic alkalosis
Anaphylactoid reactions to IV N-Acetylcysteine are generally treated by
stopping the infusion, then restarting at a slower rate
penicillin allergic treatment of cellulitis
erythromycin
when does time out stage occur WHO checlist
The ‘time out’ stage of the WHO Checklist refers to the period before the first skin incision is made
management of acute pancreatitis
fluids and analgesia
Antibiotics should not be offered routinely to patients with acute pancreatitis
Acute exacerbation of COPD:
BiPaP is indicated if type 2 respiratory failure develops despite medical therapy
adrenaline for paeds anaphylaxis
0-6 years old: 150micrograms (0.15ml 1 in 1,000).
6-12 years old: 300micrograms (0.3ml 1 in 1,000).
13+ years old: 500micrograms (0.5ml 1 in 1,000).
antidepressant therapy for PTSD
If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI
A 29-year-old female patient has a telephone consultation with her GP, worried about an incident that occurred two days ago. She is currently 18 weeks pregnant, with no complications thus far. She works in a children’s nursery. Her boss called her today, informing her that one of the children she had cared for, two days prior, has since developed a chickenpox rash. The patient is worried about the impact that this exposure may have on her pregnancy. She feels well in herself and has no symptoms, nor rash. She is uncertain of whether or not she had chickenpox herself as a child.
What is the most appropriate management?
A. Give oral aciclovir immediately B. Give varicella-zoster immunoglobulin immediately C. Perform a blood test for varicella antibodies and await the result D. Give oral aciclovir 7 days post-exposure E. Give varicella-zoster immunoglobulin 7 days post-exposure
Perform a blood test for varicella antibodies and await the result
