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Phase 2A GP > Last minute things > Flashcards

Last minute things Flashcards

1
Q

Symptoms and treatment of anaphylaxis

A

Urticaria, itching, swelling of lips, cold extremities, central cyanosis, light headed, dizziness

Treatment -
ABCDE then
Relive any airway obstruction
CPR if patient not breathing
IV fluids for rehydration
Place them in a more comfortable position
THEN
500mcg IM adrenaline (if no improvement, repeat every 5 mins)

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2
Q

Factors that can increase incidence of allergies/anaphylaxis

A

Bee/wasp sting
Exposure to latex
Family history
Exposure to allergens which individuals are sensitive to
Previous anaphylactic episodes (increase likelihood of future episodes)
Increase in air pollution

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3
Q

Confirmation blood test for anaphylaxis?

A

Tryptase blood test - a marker of mast cell degranulation

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4
Q

Characteristics of an ideal intravenous anaesthetic induction agent

A

Rapid onset
Fast clearance
Water soluble - to increase the distribution
Minimal cardiovascular and respiratory depression
No withdrawal effects

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5
Q
A
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6
Q

What investigations do you do for anorexia and which questionnaire do you use?

A

First line - FBC
Serum chemistry - metabolic alkalosis (in patient induced vomiting)

Questionnaire: SCOFF questionnaire

Can use the SCOFF questionnaire
Do you make yourself sick because you feel uncomfortably full?
Do you worry that you have lost control over how much you eat?
Have you recently lost more than (one stone) 14lb(6.35kg) in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?

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7
Q

Indications for dialysis

A
  • Uraemic encephalopathy
  • Refractory pulmonary oedema
  • Persistent hyperkalemia
  • Severe metabolic acidosis
  • Severe renal failure (urea >30, creatinine >500)
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8
Q

Pros and cons of haemodialysis and peritoneal dialysis

A

Pro - 3 days of dialysis per week
Cons
- Need to TRAVEL regularly for treatment as most sessions are carried out in dialysis clinic
- Need to avoid certain foods and fluid intake is restricted

Peritoneal dialysis
Pro - can be carried out at home
Cons
- Needs to be done everyday
- Catheter is left there permanently
- Risk of developing peritonitis
- Dialysis fluid used can cause malnutrition as it can reduce protein levels

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9
Q

Continuous ambulatory peritoneal dialysis vs automated peritoneal dialysis

A

CAPD main advantage
- Equipment is portable

Disadvantage - need to spend at least 2 hours a day performing dialysis

APD main advantage
- Dialysis free in the day, allowing more freedom to engage in daily activities
- Improved quality of life

Disadvantage - A dialysis machine needs to be kept in the house which may be bulky and require regular maintenance - not practical for some people.

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10
Q

Renal transplant pros and cons

A

Pros
- Can stop dialysis
- Improved quality of life with normal diet and activity

Cons
- Operative complications e.g Infection, DVT
- Side effect of immunosuppressive drugs
- Opportunistic infections
- Recurrence of original disease in the transplant

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11
Q

Why is folic acid given with methotrexate? When specifically must it be taken?

A

Folic acid is given to counteract the folate antagonist action of methotrexate (dihydrodrofolate reductase)

Folic acid is given at 5mg once weekly on any day as long as not the same day as methotrexate (it would reduce the effectiveness on methotrexate)

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12
Q

Symptoms of hypoglycemia

A

HE IS TIRED
HE - Headache
I - Irritability
S - Sweating
T - Tachycardia
I - Inability to concentrate
R - Restlessness
E - Excessive hunger
D - Dizziness

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13
Q

Causes of SIADH

A

Head trauma
Drugs - carbamazepine
Infection - pneumonia, TB
SCLC, prostate cancer

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14
Q

Indications of surgical treatment in obesity

A

BMI >40
>5 years of obesity
Failure of conservative treatment

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15
Q

5 symptoms of hyperthyroidism

A

THYROIDISM
Tremor
Heart rate up - Tachycardia
Yawning - Fatigue
Restlessness
Oligomenorrhea
Intolerance to heat
Diarrhoea
Irritability
Sweating
Muscle wasting
(STING - Sweating, tremor, tachycardia, intolerance to heat, nervousness, goitre)

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16
Q

5 symptoms of hypothyroidism

A

MOM’S SO TIRED
Memory loss
Obesity - weight gain
Menorrhagia
Slow heartbeat - bradycardia + slow reflexes
Skin and hair become dry (dry skin, hair loss, hair thinning)
Oedema of the lower limbs
Tired
Intolerance to cold
Raised BP
Energy levels are low
Depressed
Goitre

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17
Q

Symptoms of hyponatremia

A

CLOSSS
Limp muscles - weakness
Orthostatic hypotension
Seizures/headache
Stomach cramps
Stupor/coma
(confusion, n+v)

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18
Q

Which chromosomes are affected in alpha and beta thalassemia?

A

Alpha - 16
Beta - 11

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19
Q

2 Causes of DIC

A

Sepsis
Trauma
Malignancy
Acute promyelocytic leukaemia (type of AML)

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20
Q

HUS triad

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute Kidney injury

HUS: Diarrhoea, younger
TTP: Neurological symptoms, ADAMTS 13

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21
Q

Extra intestinal symptoms of Crohn’s and UC

A

Common extra-intestinal Sx of Crohn’s & UC
Skin: erythema nodosum, pyoderma gangrenosum
Eye: anterior uveitis, episcleritis
Arthritis

Unique extra-intestinal Sx of Crohn’s & UC

Crohn’s: gallstones, renal stones, mouth ulcers
UC: PSC

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22
Q

RF for GORD

Causes of GORD

A

Family history, older age, obesity, hiatus hernia

Causes:
- Increased intrabdominal pressure - Obesity, pregnancy

  • Hiatus hernia
  • Drugs like - Anti muscarinics
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23
Q

What makes the lower esophageal sphincter physiological?

A

1.⁠ ⁠It doesn’t have a specific sphincter muscle. It enters the stomach at an acute angle

  1. The crura of the diaphragm has a pinch-cock effect

Its main function is to prevent reflux of acidic gastric contents into the oesophagus rather than regulation of flow of material like true sphincters

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24
Q

Last resort/surgical treatment for GORD?

A

Surgery - Nissen fundoplication (laparoscopic fundoplication) –> tightens the junction between the esophagus and stomach to prevent acid reflux.

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25
Q

2 causes of raised troponin

A

Myocarditis, PE

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26
Q

3 complications of MI

A

Heart failure, Dressler’s syndrome, cardiac tamponade, arrhythmias

27
Q

If Q risk score above 10% what do you do?

A

Offer statins

28
Q

Give 1 pro & 1 con of PCI vs CABG

A

PCI - less invasive, but less suitable for more complex cases, higher chance of recurrence
CABG - more invasive, better for more complex cases

29
Q

Causes of portal hypertension.

A

Pre-hepatic (increased pressure in the portal vein before reaching the liver) → Portal vein thrombosis, splenic vein thrombosis

Hepatic (liver related factors related to increased pressure) → Liver cirrhosis (most common in UK), Schistosomiasis (most common worldwide)

Post-hepatic (Conditions affecting outflow tract - increased pressure in the right heart increases the resistance against blood flow from the liver) → Budd-chiari syndrome, constrictive pericarditis, valvular heart disease

30
Q

Causes of Ascites

A

Non peritoneal causes (that can result in portal hypertension) → Liver cirrhosis (biggest cause), budd chiari syndrome, constrictive pericarditis.
+
Nephrotic syndrome (that can lead to hypoalbuminemia)

Peritoneal causes → Infectious peritonitis (Tb, chlamydia)- causes inflammation, SLE

31
Q

2 causes of LHF and RHF

A

LHF - Dilated cardiomyopathy, hypertension

RHF - PE, COPD

32
Q

Biggest risk factor for AAA

A

Smoking

33
Q

What is the classification system used for determining the severity of heart failure?

A

NEW YORK HEART ASSOCIATION CLASSIFICATION

1 - No limit on physical activity
2 - Slight limit on moderate activity
3 - Marked limit on moderate activity
4 - Inability to carry out physical activity without discomfort.

34
Q

What condition is it when a venous thromboembolism completely occludes a large vein?

A

Phlegmasia cerulea dolens

35
Q

Acute liver failure causes

A

Paracetamol overdose (main cause)
Autoimmune hepatitis, budd chiari syndrome, Hep A and B

36
Q

What happens in gilbert’s syndrome

A

Unconjucated hyperbilirubinemia - Decreased UDP glucuronosyltransferase

37
Q

RF for acute pancreatitis

A

I - Idiopathic
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion sting
H - Hyperlipidaemia/hypercalcemia
E - ERCP
D - Drugs

38
Q

complications of acute pancreatitis

A

4 complications of acute pancreatitis
Chronic pancreatitis
Necrosis/Necrotising pancreatitis
Disseminated intravascular coagulation
Acute respiratory distress syndrome
Ascites
Obstructive jaundice
Sepsis
Death

39
Q

Indications for RRT in AKI

A

Severe acidosis
Fluid overload non-responsive to Tx
Hyperkalaemia non-responsive to Tx
Uraemia (more common in CKD)

40
Q

4 parameters of eGFR

A

Creatinine (serum)
Age
Gender
Ethnicity

41
Q

Disadvantage of using eGFR

A

Serum creatinine can be affected by muscle mass, & diet (red meat intake)

42
Q

Causes of CKD

A

Diabetes mellitus - Main cause
Glomerulonephritis
HTN

43
Q

Triad of nephrotic syndrome

A

Proteinuria (>3.5g/day)
Hypoalbuminaemia (<30g/L)
Oedema

44
Q

Complications of nephrotic syndrome

A
  1. hyperlipidaemia (1 mark) due to either over production in the liver ( 1 mark)
  3. hypercoagulability (1 mark) due to renal loss of antithrombin III (1 mark)
  4. Infections (1 mark) due to renal loss of immunoglobulin (1 mark)
  5. Renal impairment (1 mark) due to hypovolaemia (1
  6. Anaemia (1 mark) due to renal loss of ferritin (accept iron) (1 mark)
  7. Vitamin D deficiency (1 mark) due to renal loss of Vitamin D binding globule (1
45
Q

Why shouldn’t catheter urine samples be used for urinalysis?

A

Bacteria colonise catheter
Catheter irritate urethral mucosa, causing inflammatory response & producing leucocytes

46
Q

3 examples of complicated UTI

A

Pregnant women, men, in-dwelling catheter, immunocompromised, underlying renal disease (e.g. stones, PKD)

47
Q

status epilepticus treatment

A

lorazepam

48
Q

Causes of seizures

A

V - Vascular
I - Infection e.g. fever symptom
T - Trauma e.g. head injury
A - Autoimmune e.g. SLE
M - Metabolic e.g. Hypocalcemia
I - Idiopathic
N - Neoplasms
D - Dementia + Drugs (Cocaine, alcohol)
E - Eclampsia

49
Q

Stroke symptoms from different arteries

A

Anterior cerebral artery - Contralateral hemiparesis and sensory loss (more of the lower limbs)

Middle cerebral artery - Weak+numb contralateral side of body, face drooping with forehead sparing, dysphasia
Posterior cerebral artery - Contralateral homonymous hemianopia with macular sparing
Retinal/ophthalmic artery - Amaurosis fugax - harbinger of imminent stroke
Vertebral arteries - Cerebellar syndrome - DANISH + CN lesions 3-12

50
Q

2 cancers that can spread to the brain

A

breast and RCC

51
Q

What condition is trigeminal neuralgia associated with

A

MS

52
Q

Causes of bronchiectasis

A

Causes: Cystic fibrosis, Post infection (pneumonia, TB), A1AT deficiency

53
Q

3 conservative treatments for bronchiectasis

A

Chest physiotherapy
Vaccination against infections e.g. influenza
Stop smoking

54
Q

MRC dyspnoea scale

A

1 - Breathless with strenuous exercise
2 - short on breath when hurrying on level ground or walking up a slight hill
3 - Walks slower than people of the same age on the same level because of breathlessness/stopping for breath while walking at own pace
4 - Stops for a breath after walking 100m or after a few minutes on level ground

55
Q

Causes of secondary pulmonary fibrosis

A

RA
SLE
Systemic sclerosis
A1AT Deficiency
Sarcoidosis

56
Q

Pathophysiology of osteoarthritis

A

Imbalanced cartilage synthesis & destruction
↑chondrocyte activity, loss of T2 collagen
Bone remodelling + osteophyte formation

57
Q

Extraarticular manifestations of RA

A

Eyes - episcleritis/anterior uveitis/keratoconjunctivitis sicca
Heart - IHD risk
Lungs - PE, pulmonary fibrosis
Kidney - CKD
Note: Sjogren’s, carpal tunnel syndrome

58
Q

SLE symptoms

A

RASH OR PAIN
Rash
Arthritis
Serositis - pericarditis and pleuritis
Haematological disorders - Pancytopenia
Oral ulcers
Raynaud’s phenomenon
Photosensitive rash
Anti nuclear antibodies
Immunologic disorders - Anti DS DNA antibodies
Neurologic disorder - tonic clonic seizure

59
Q

Treatment for APL + treatment in pregnancy?

Complication of APL

A

Tx:
Warfarin
Pregnant: LMWH & aspirin (warfarin is teratogenic)

Complication?
Catastrophic antiphospholipid syndrome - rapid thrombosis in multiple organs within a few days

60
Q

Crest syndrome antibodies

A

ANA
Anti-centromere - limited SS
Anti-Scl-70 - diffuse SS

61
Q

Bones affected in Paget’s

A

Skull, pelvis, femur

62
Q

Osteomalacia blood test

A

↑ALP, ↓25(OH)D, hypocalcaemia + hypophosphataemia, ↑PTH

63
Q

What is haemodialysis?

A

Blood and dialysis fluid flow on either side of a semi permeable membrane and molecules diffuse down their concentration gradient, thus changing plasma biochemistry to be more like the dialysis fluid

64
Q
A

Phase 2A GP (6 decks)

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