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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
2 causes of raised troponin
Myocarditis, PE
26
3 complications of MI
Heart failure, Dressler's syndrome, cardiac tamponade, arrhythmias
27
If Q risk score above 10% what do you do?
Offer statins
28
Give 1 pro & 1 con of PCI vs CABG
PCI - less invasive, but less suitable for more complex cases, higher chance of recurrence CABG - more invasive, better for more complex cases
29
Causes of portal hypertension.
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
Causes of Ascites
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
2 causes of LHF and RHF
LHF - Dilated cardiomyopathy, hypertension RHF - PE, COPD
32
Biggest risk factor for AAA
Smoking
33
What is the classification system used for determining the severity of heart failure?
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
What condition is it when a venous thromboembolism completely occludes a large vein?
Phlegmasia cerulea dolens
35
Acute liver failure causes
Paracetamol overdose (main cause) Autoimmune hepatitis, budd chiari syndrome, Hep A and B
36
What happens in gilbert's syndrome
Unconjucated hyperbilirubinemia - Decreased UDP glucuronosyltransferase
37
RF for acute pancreatitis
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
complications of acute pancreatitis
4 complications of acute pancreatitis Chronic pancreatitis Necrosis/Necrotising pancreatitis Disseminated intravascular coagulation Acute respiratory distress syndrome Ascites Obstructive jaundice Sepsis Death
39
Indications for RRT in AKI
Severe acidosis Fluid overload non-responsive to Tx Hyperkalaemia non-responsive to Tx Uraemia (more common in CKD)
40
4 parameters of eGFR
Creatinine (serum) Age Gender Ethnicity
41
Disadvantage of using eGFR
Serum creatinine can be affected by muscle mass, & diet (red meat intake)
42
Causes of CKD
Diabetes mellitus - Main cause Glomerulonephritis HTN
43
Triad of nephrotic syndrome
Proteinuria (>3.5g/day) Hypoalbuminaemia (<30g/L) Oedema
44
Complications of nephrotic syndrome
1. hyperlipidaemia (1 mark) due to either over production in the liver ( 1 mark) 2. 3. hypercoagulability (1 mark) due to renal loss of antithrombin III (1 mark) 1. Infections (1 mark) due to renal loss of immunoglobulin (1 mark) 1. Renal impairment (1 mark) due to hypovolaemia (1 1. Anaemia (1 mark) due to renal loss of ferritin (accept iron) (1 mark) 1. Vitamin D deficiency (1 mark) due to renal loss of Vitamin D binding globule (1
45
Why shouldn't catheter urine samples be used for urinalysis?
Bacteria colonise catheter Catheter irritate urethral mucosa, causing inflammatory response & producing leucocytes
46
3 examples of complicated UTI
Pregnant women, men, in-dwelling catheter, immunocompromised, underlying renal disease (e.g. stones, PKD)
47
status epilepticus treatment
lorazepam
48
Causes of seizures
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
Stroke symptoms from different arteries
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
2 cancers that can spread to the brain
breast and RCC
51
What condition is trigeminal neuralgia associated with
MS
52
Causes of bronchiectasis
Causes: Cystic fibrosis, Post infection (pneumonia, TB), A1AT deficiency
53
3 conservative treatments for bronchiectasis
Chest physiotherapy Vaccination against infections e.g. influenza Stop smoking
54
MRC dyspnoea scale
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
Causes of secondary pulmonary fibrosis
RA SLE Systemic sclerosis A1AT Deficiency Sarcoidosis
56
Pathophysiology of osteoarthritis
Imbalanced cartilage synthesis & destruction ↑chondrocyte activity, loss of T2 collagen Bone remodelling + osteophyte formation
57
Extraarticular manifestations of RA
Eyes - episcleritis/anterior uveitis/keratoconjunctivitis sicca Heart - IHD risk Lungs - PE, pulmonary fibrosis Kidney - CKD Note: Sjogren's, carpal tunnel syndrome
58
SLE symptoms
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
Treatment for APL + treatment in pregnancy? Complication of APL
Tx: Warfarin Pregnant: LMWH & aspirin (warfarin is teratogenic) Complication? Catastrophic antiphospholipid syndrome - rapid thrombosis in multiple organs within a few days
60
Crest syndrome antibodies
ANA Anti-centromere - limited SS Anti-Scl-70 - diffuse SS
61
Bones affected in Paget's
Skull, pelvis, femur
62
Osteomalacia blood test
↑ALP, ↓25(OH)D, hypocalcaemia + hypophosphataemia, ↑PTH
63
What is haemodialysis?
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

Phase 2A GP (6 decks)

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