Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BPT Clinical > Long Case > Flashcards

Long Case Flashcards

(195 cards)

Start Studying
1
Q

What investigations should be ordered for resistant hypertension?

A 
electrolytes
glucose
creatinine
urine ACR
ambulatory blood pressure monitor 
screen for primary aldosteronism
image for renal artery stenosis
sleep study
urinary catecholamines
investigations for cushing’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What did the sprint study show?

A

intensive blood pressure management (SBP 120) had reduced death from any cause compared with standard management (SBP 130-140)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NYHA classes?

A

NYHA I: no symptoms even during exercise
NYHA II: symptoms with moderate exercise
NYHA III: symptoms with slight exercise
NYHA IV: symptomatic at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First line therapy for all heart failure patients?

A

treat iron deficiency (if ferritin < 100 and tsats < 20%)
lifestyle modification: exercise, weight loss, reduce salt and fluid intake, smoking cessation, reduce EtOH intake
education
avoid exacerbating drugs
manage comorbidities - sleep apnoea, depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which heart failure patients qualify for cardiac resynchronisation therapy?

A

LVEF < 35% and QRS > 150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which heart failure patients qualify for ICD?

A

LVEF < 35% and NYHA class II to III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of pulmonary hypertension?

A 
pulmonary arterial hypertension
due to left heart disease
due to lung disease
CTEPH
unclear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations should be done for pulmonary hypertension?

A 
CXR
ECG
TTE
right heart catheterisation
RFTs
V/Q scan
HRCT
sleep study
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What management may be beneficial for all types of pulmonary hypertension?

A

diuretics
oxygen (mortality benefit if group 3)
exercise training
transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the lipid targets for IHD?

A

LDL < 1.8 and TC < 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of long term steroids?

A 
infections 
osteoporosis
hyperglycaemia 
skin thinning
moon facies
buffalo hump
ecchymoses
obesity 
cataracts
glaucoma 
fluid retention
hypertension
premature atherosclerotic disease
atrial fibrillation 
myopathy 
mood disorders
psychosis
leukocytosis 
avascular necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

First line investigations for cushings?

A

late night salivary cortisol
24 hour urinary free cortisol
low dose dexamethasone suppression test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the anterior pituitary hormones?

A 
GH
FSH
LH
ACTH
TSH
prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the definition of osteoporosis on T score?

A

osteopaenia -1 to -2.5

osteoporosis < -2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If T score not < -2.5 and no minimal trauma fracture what is the indication for osteoporosis treatment?

A

using FRAX calculator hip fracture risk > 3% or any fracture > 20%
OR T < -1.5 and on prednisolone > 7.5mg for 3/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How often should DEXA scans be repeated?

A

2 yearly once diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What tests should be done for a secondary osteoporosis screen?

A

FBE, UEC, SPEP, serum FLCs, UPEP, LFTs, CMP, vitamin D, PTH, TSH, ESR, CRP, testosterone
consider: coeliac antibodies, oestrogen/LH/FSH in women, hypercortisolism screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the MOA of bisphosphonates?

A

binds hydroxyapeptite in bone and act as osteoclast toxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Side effects of bisphosphonates?

A

GI irritation (oral)
flu like symptoms, hypocalcaemia (IV)
atypical femoral fracture
osteonecrosis of the jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the MOA of denosumab?

A

antibody that binds RANKL to prevent osteoclast bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the general HbA1c target?

A

<1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What did the DAPA-HF study show?

A

reduced risk of worsening heart failure or death from cardiovascular disease in HFrEF patients regardless of whether they had diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the relative contraindications for SGLT2 inhibitors?

A

general thrush infections, recurrent UTI, ketosis prone, frail elderly, prone to dehydration, immunocompromised, active foot ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When are DPP-4 inhibitors contraindicated?

A

previous pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the side effects of GLP1 agonists?
nausea (usually transient), ?pancreatitis, ?neuroendocrine tumours, injection site nodules
26
To what GFR can SGLT2 inhibitors be used?
according to AMH < 30 as at this level will have reduced glycaemic lowering effect but may still have benefits for CV risk and BP control
27
What investigations should be ordered in a liver screen?
``` hepatitis serology (A/B/C) EBV CMV Anti-mitochondrial antibody Anti-smooth muscle antibody Anti-liver/kidney microsomal antibodies Anti-nuclear antibody p-ANCA Alpha-1 Antitrypsin Serum Copper Ceruloplasmin Ferritin ```
28
What investigations should be done for coeliac disease?
tTG-IgA (tissue tranglutaminase antibody) + total IgA level OR tTG-IgA and DPG-IgG (deamidated gliadin peptide)
29
What other tests should be done in a new diagnosis of coeliac disease?
``` DEXA TSH fasting BSL LFTs nutrition assessment: iron, B12, folate, vitamin D, magnesium, zinc ```
30
What are the extra intestinal manifestations of IBD?
``` oral ulcers erythema nodosum large joint arthritis episcleritis primary sclerosing cholangitis ankylosing spondylitis uveitis pyoderma gangrenosum kidney stones, gallstones ```
31
Which medications are used for crohn's?
corticosteroids thiopurines methotrexate biologics
32
Which biologics are used for crohn's?
infliximab/adalimumab (anti TNF) vedolizumab ustekinumab
33
What pharmacotherapy options are available for fatty liver disease?
none on PBS metformin - but doesn't improve histology pioglitazone - but risk of weight gain, CCF, osteoporosis vitamin E - but risk of haemorrhagic stroke liraglutide
34
What are the complications of fatty liver disease?
``` fibrosis cirrhosis HCC CVD (independent risk factor) mortality (all cause) ```
35
What are the extra hepatic manifestations of hepatitis C?
``` membranoproliferative GN porphyria cutanea tarda cryoglobulinaemia lymphoproliferative disorders lichen planus thyroid dysfunction diabetes sjogren’s syndrome polyarthritis ```
36
What issues need to be considered for direct acting antiviral therapy for hepatitis C?
``` genotype presence of cirrhosis concomitant medications/drug interactions (PPIs, statins, amiodarone, anti epileptics) HBV HIV serology eGFR avoidance of pregnancy ```
37
What investigations should be done in a patient with chronic hepatitis B?
``` HBeAg HBV DNA hep A IgG, Hep C Ab, Hep D Ab, HIV LFTs INR AFP liver US fibroscan ```
38
Which patients with HCC are eligible for transplant?
a single nodule < 6.5cm or up to 3 nodules the largest of which is < 4.5cm
39
What is the treatment for PBC?
ursodeoxycholic acid
40
What is PSC associated with?
UC
41
What additional treatments are available for UC but not crohns?
5-aminosalicylates | cyclosporin
42
How often should patients with UC have a colonoscopy to monitor for bowel cancer?
every 3 years after 9 years
43
What are the treatment related complications of UC?
infections lymphoma non melanoma skin cancer (thiopurines) melanoma (anti TNF)
44
What are the causes of microcytic anaemia?
``` iron deficiency thalassaemia anaemia of chronic disease sideroblastic anaemia lead poisoning ```
45
What are the causes of normocytic anaemia?
``` bleeding haemolysis anaemia of chronic disease renal failure bone marrow failure ```
46
What are the causes of macrocytic anaemia?
``` B12 deficiency folate deficiency drugs alcohol chronic liver disease reticulocytosis hypothyroidism MDS ```
47
What are the elements of the child pugh score?
``` encephalopathy INR ascites albumin bilirubin ```
48
What diet should chronic liver disease patients be on?
high protein low salt
49
What are the complications of chronic liver disease?
``` oesophageal varices ascites +/- SBP hepatic encephalopathy malnutrition sarcopaenia osteoporosis coagulopathy thrombocytopaenia hepatorenal syndrome hepatopulmonary syndrome HCC ```
50
When should patients with chronic liver disease have gastroscopy?
screening gastroscopy then annually if small varices and second yearly if no varices
51
What is the primary prophylaxis for oesophageal varices?
non selective beta blocker or endoscopic band ligation
52
What is the secondary prophylaxis for oesophageal varices?
variceal banding and non selective beta blocker
53
What is the pharmacological treatment for ascites?
spironolactone 100mg daily +/- frusemide 20mg daily | max dose spironolactone 400mg daily
54
How is spontaneous bacterial peritonitis diagnosed?
> 500 leuks or > 250 PMN in ascitic tap
55
When is primary prophylaxis indicated for SBP?
if low protein < 10g/L or bili >50 with impaired renal function
56
What are precipitating factors for hepatorenal syndrome?
sepsis/bleeding, acute on chronic liver failure, NSAIDs, paracentesis without albumin replacement, recent TIPS
57
What is the treatment for hepatorenal syndrome?
avoid nephrotoxic drugs, treat underlying precipitants, withhold diuretics, albumin, terlipressin
58
What are the precipitants for hepatic encephalopathy?
infection, bleeding, constipation, diarrhoea, metabolic/electrolyte derangement, drugs (opioids, benzos)
59
What is the treatment for warfarin reversal if life threatening bleeding?
vitamin K infusion prothrombinex FFP
60
What are the common sites affected in graft vs host disease?
skin, GIT, liver, lungs, mucosal surfaces
61
What is the treatment for graft vs host disease?
steroids | calcineurin inhibitors
62
What are the complications of multiple myeloma?
``` hypercalcaemia hyperviscocity spinal cord compression tumour lysis renal disease ```
63
What are the complications of thalassaemia?
``` renal disease due to hyperuricaemia cardiomyopathy due to iron toxicity diabetes due to iron toxicity infections osteoporosis ```
64
What are the treatment options for von willebrands disease?
DDAVP during any interventions TXA human plasma derived VWF
65
What is required for a thrombophilia screen?
``` factor V leiden antiphospholipid antibodies antithrombin protein C, protein S prothrombin gene mutation ```
66
What are the complications of CVID?
``` immune cytopaenia - ITP, AIHA thyroid disease pernicious anemia polyarthropathy polymyositis vitiligo lymphoma gastric cancer amyloidosis impaired lung function/interstitial lung disease/bronchiectasis lymphoproliferation: lymphadenopathy, splenomegaly granulomatous disease ```
67
What are the live vaccines?
``` MMR MMRV oral poliovirus yellow fever varicella HSV rotavirus smallpox adenovirus BCG ```
68
What are the major and minor duke criteria for infective endocarditis?
``` major: positive BC with typical organism in 2 seperate cultures or positive C. burnetii serology evidence of endocardial involvement minor: predisposition fever vascular phenomena immunological phenomena microbiological evidence increased ESR, CRP ```
69
What are the indications for valve surgery in infective endocarditis?
``` IE with signs/symptoms of heart failure paravalvular extension of infection infection with difficult to treat pathogens persistent infections complete heart block +/- large vegetations (>10mm) ```
70
What is the management for CIDP?
``` steroids steroid sparing agent IVIG PLEX rituximab for nodal disease ```
71
What lifestyle advice should be given to patients with seizures?
consider occupational safety driving - usually need to be 6 months seizure free good sleep patterns avoid alcohol no baths, when having a shower turn cold tap on first no ladders medical alert bracelet
72
What is the McDonalds criteria in MS?
to decide if this is a clinically isolated syndrome vs MS | 2 lesions disseminated in time AND space
73
What tests should be done to exclude MS mimics?
ANA/ENA, vasculitic screen, anti-aquaporin 4 and anti MOG antibodies, syphillis serology
74
How can you manage bladder dysfunction in MS?
oxybutinin betmiga botox pelvic physiotherapy
75
How can you manage spasticity in MS?
baclofen gabapentin physiotherapy
76
How can you manage fatigue in MS?
``` treat concurrent depression review sleep hygiene amantadine modafanil OT assessment ```
77
What tests are used to investigate myasthenia gravis?
antibodies - AChR, MuSK repeated nerve stimulation study single fibre EMG CT chest (thymoma)
78
What are management options for myasthenia gravis?
``` pyridostigmine (cholinesterase inhibitor) steroids steroid sparing agents IVIG PLEX ```
79
What are some "pre symptomatic" signs of parkinsons?
``` anosmia constipation REM sleep behavioural disorder mood changes increased fatigue/daytime sleepiness urinary symptoms ```
80
Which levodopa sparing agents can be used to treat parkinsons?
``` COMT inhibitors MAO inhibitors dopamine agonists amantadine anticholinergics ```
81
What advances therapies are available for parkinsons?
DBS apomorphine infusion intraduodenal levodopa
82
What are the contraindications for DBS in parkinsons?
severe non motor symptoms (dementia), active psychiatric disorders, structural abnormalities on MRI
83
What investigations should be done for a peripheral neuropathy?
``` UEC TFT B12, folate HbA1c ESR CRP ANA SPEP nerve conduction studies LP ```
84
What are the complications of peritoneal dialysis?
peritonitis pleuroperitoneal leak membrane sclerosis catheter malfunction
85
What are useful signs of dialysis adequacy?
symptoms nutritional fluid balance and blood pressure control
86
What are the indications for biopsy in IgA nephropathy?
persistent proteinuria > 1g/day elevated Cr new onset hypertension or significant elevation from stable baseline
87
What is the management of IgA nephropathy?
persistent proteinuria (>0.5-1g/day) and normal/slightly reduced GFR: - ACE inhibitor/ARB if urinary protein excretion >1g/day continues for 3-6 months after ACE/ARB: - 6 months of glucocorticoid therapy rapidly declining eGFR: - glucocorticoids and cyclophosphamide
88
What is the general management for nephrotic syndrome?
``` BP control RAAS blockade treat dyslipidaemia (statin) anticoagulation dietary sodium/fluid restriction diuretics ```
89
What is the non pharmacological management for ADPKD?
``` smoking cessation salt restriction moderate protein intake BMI < 25 increase fluid intake > 3L per day ```
90
What is the PBS indication for tolvaptan for ADPKD?
need eGFR < 90 and decline > 5 per year or more than 2.5 per year for 5+ years
91
What are the targets for renal anaemia?
Hb 100-115 TSAT > 20% ferritin > 200
92
What is calcitriol?
The active form of vitamin D
93
What is cinacalcet?
a calcimimetic - binds to PTH receptors
94
What does vitamin D do to calcium and phosphate?
increased absorption of both from gut/kidneys
95
What does PTH do to calcium and phosphate?
increase calcium decrease phosphate
96
What are the causes of early worsening renal graft function?
``` graft thrombosis acute rejection CNI toxicity renal artery stenosis obstruction/leak/collection BK nephropathy CMV recurrent disease ```
97
What are the risk factors for chronic allograft nephropathy?
``` prior episodes of acute rejection delayed graft function at transplant HTN excess calcineurin inhibitor inadequate calcineurin inhibitor presence of DSAs ```
98
What is the main side effect of valgancyclovir?
neutropaenia
99
What additional investigations should be done in bronchiectasis?
``` aspergillus precipitins serum immunoglobulins CF genotype TTE bronchoscopy immune tests including HIV nasal brushings upper GI endoscopy ```
100
What is the management for bronchiectasis?
``` treat the cause smoking cessation vaccination improve airway clearance azithromycin inhaled hypertonic saline treat airway obstruction ```
101
What are the elements of the BODE index for COPD?
BMI obstruction (FEV1) dyspnoea score exercise capacity
102
What did the IMPACT study for COPD show?
in patients with a history of exacerbations triple therapy gave a lower rate of exacerbations/hospitilisations
103
What are the indications for referral for lung transplantation in IPF?
refer if DLCO < 40, FVC < 80, dyspnoea/functional limitation, SpO2 < 88%
104
What are the features of obesity hypoventilation syndrome?
awake hypercapnoea BMI > 30 sleep disordered breathing
105
What is the diagnostic criteria for OSA?
AHI > 5 + symptoms | AHI > 15 +/- symptoms
106
What are the complications of OSA?
``` MVA AF (no effect on mortality) CAD heart failure stroke systemic HTN pulmonary HTN metabolic dysregulation increased all cause mortality CKD GORD NASH ```
107
What pharmacotherapy is used for pulmonary arterial hypertension?
calcium channel blockers endothelin receptor antagonists PDE5 inhibitors
108
What are the features of a spondyloarthropathy?
``` inflammatory back pain sacroilitis enthesitis uveitis dactylitis psoriasis crohn’s/colitis good response to NSAIDs family history HLA-B27 elevated CRP ```
109
What are the cardiac and pulmonary extra articular manifestations of spondyloarthropathy?
``` aortitis aortic regurgitation pericarditis conduction disturbances heart failure IHD stroke VTE pulmonary apical fibrosis (1.3-15%) restrictive lung disease due to diminished chest wall and spinal mobility ```
110
What are the complications of ankylosing spondylitis?
``` osteopaenia/osteoporosis transverse fracture through a fused spine spinal cord injury atlantoaxial subluxation cauda equina symptoms nephropathy ```
111
What is the pharmacological management of ankylosing spondylitis?
``` NSAIDs glucocorticoid injections DMARDs for peripheral arthritis TNF blockers IL-17 blockers ```
112
What are the complications of antiphospholipid syndrome?
``` vascular thrombosis pregnancy complications thrombotic microangiopathic syndromes autoimmune haemolytic anaemia pulmonary hypertension livedo reticularis ```
113
What is the management of antiphospholipid syndrome in pregnancy?
positive antibodies only and no clinical manifestations: aspirin during pregnancy venous/arterial thrombosis: LMWH + aspirin if recurrent miscarriages: aspirin > add LMWH > add prednisolone all require LMWH in post partum period
114
What are the TNF inhibitors?
infliximab certolizumab adalimumab golimumab
115
What are the contraindications for TNF inhibitors?
``` previous untreated TB recurrent chest infections/bronchiectasis septic arthritis within 12 months infected prosthesis indwelling IDC MS/demyelinating illness malignancy within 10 years heart failure (NYHA class III-IV) chronic cutaneous ulceration active/chronic infection e.g. osteomyelitis ```
116
What are the side effects of methotrexate?
``` GI upset fatigue mental clouding mouth ulcers hair thinning cytopaenias (monitor FBE) deranged LFTs pneumonitis ```
117
What are the side effects of leflunomide?
``` diarrhoea dry mouth mouth ulcers hair thinning HTN dizziness cytopaenia deranged LFTs pneumonitis peripheral neuropathy shingles ```
118
What are the side effects of azathioprine?
bone marrow suppression hepatitis fever increased malignancy (skin - SCC, cervical cancer)
119
What are the side effects of mycophenolate?
GIT symptoms cytopaenia (uncommon) - monitor FBE alopecia
120
What are the side effects of cyclophosphamide?
``` bone marrow suppression gonadal suppression alopecia infections GIT effects haemorrhagic cystitis bladder fibrosis bladder ca lymphoma/leukaemia ```
121
What tests should be done before starting immunosuppression?
``` check FBE, UEC, LFTs quantiferon consider CXR HBV and HCV serology HIV varicella ```
122
What are the features of dermatomyositis?
``` symmetrical proximal myopathy heliotrope rash gottron's papules poikiloderma arthirits raynaud's ILD myocarditis associated malignancy ```
123
What investigations should be done for dermatomyositis?
``` CK myositis specific antibodies EMG MRI muscle biopsy TTE RFTs HRCT oesophageal motility studies ```
124
What is the target serum urate in gout?
< 0.36 or < 0.30 in tophaceous gout
125
What is the non pharmacological management of RA?
``` education smoking cessation maintain active lifestyle physiotherapy occupational therapy ```
126
What titre of ANA is significant?
1:320
127
What are the extra pulmonary sites that can be involved in sarcoidosis?
``` skin ocular upper respiratory tract cardiac lymph nodes hepatosplenomegaly musculoskeletal neurologic renal ```
128
What non blood tests should be done in scleroderma?
``` barium swallow TTE XR hands HRCT RFTs gastroscopy right heart catheter urinalysis ```
129
What is the non pharmacological management for raynaud's phenonmenon?
keep warm, avoid caffeine, smoking cessation
130
What is the pharmacological management for raynaud's phenomenon?
``` CCB (nifedipine) angiotensin II receptor antagonist PDE5 inhibitors topical or systemic nitrates alpha blockers SSRI antiplatelet/statin IV prostacyclin ```
131
What is the pharmacological management of ILD?
mycophenolate 3g/ day | if unresponsive consider cylclophosphamide or azathioprine
132
What is first line management for scleroderma renal crisis?
captopril
133
What is the PBS criteria for teriparatide?
“3-2-1” - T score < 3, 2 fractures, at least one fracture while treatment for > 12 months
134
What investigations should be done for chronic diarrhoea?
iron studies, B12, folate, albumin, FBE, vitamin D, INR, faecal fat estimation, faecal elastase, faecal calprotectin, stool MCS, carbohydrate breath test (SIBO), gastroscopy, colonoscopy, coeliac serology
135
What are the complications of IBD?
``` toxic megacolon perforation fistula strictures/obstruction bowel cancer PSC anaemia thromboembolism gallstones/renal stones osteomalacia depression ```
136
What investigations should be done for IBD?
stool culture, AXR, FBE, ESR, CRP, faecal calprotectin, LFTs, colonoscopy, mucosal biopsies, antibody testing (ASCA - crohn’s, pANCA - UC), small bowel MRI
137
What is the management for an acute flare of IBD?
check stool MCS, IV steroids, infliximab, IV abx, surgical mx
138
How often should screening for HCC be done in chronic liver disease?
6 monthly US and AFP
139
What are the contraindications for liver transplant?
active sepsis, metastatic malignancy, cholangiocarcinoma, continuing alcohol consumption, advanced cardiopulmonary or renal disease, life limiting co-morbidities, smoking, IVDU
140
What are the indications for liver transplant?
``` MELD > 15 HCC sarcopaenia diuretic refractory hepatorenal syndrome refractory hepatic encephalopathy fulminant liver failure ```
141
What should you examine for in a patient with falls?
``` cognitive assessment postural blood pressure romberg's test gait timed up and go parkinsonism visual acuity cerebellar testing peripheral neuropathy ```
142
What are management strategies for falls?
``` review medications correct electrolytes/Hb footwear gait aids strength and balance training vitamin D rehabilitation/physiotherapy home assessment cataract operation education on getting up after a fall personal alarm ix and mx of osteoporosis ```
143
What is the usual infection prophylaxis used in bone marrow transplants?
anti fungal - posaconazole, fluconazole - stopped at 2-3 months PJP - bactrim for 6/12 HSV, VZV - valacivlocir for 1-2 years CMV - valganciclovir
144
What vaccinations should HIV patients have had?
hepatitis A/B, meningococcal, pneumococcal, influenza
145
What regular investigations should HIV patients have?
``` CD4 count viral load HIV genotype STI tests pap tests (3 yearly) HbA1c, lipids bone mineral density liver function/renal function ```
146
What are common side effects of HIV medications?
renal disease, osteoporosis, dyslipidaemia, GI side effects, obesity
147
What vaccinations are required for splenectomy?
pneumococcus, meningococcus, Hib, influenza
148
What are the treatment targets for hypertension?
<140/90 is usual target | <130/80 if CKD/T2DM/stroke
149
What are the contraindications for hydrotherapy?
open wounds, incontinence, severe COPD/heart failure, extreme obesity
150
What are the side effects of pregabalin?
dizziness, drowsiness, weight gain, peripheral oedema, depression/anxiety
151
What is the mechanism of action of tapentadol?
opioid agonist and noradrenaline reuptake inhibitor
152
What are some non pharmacological management options for chronic pain?
``` pain education resetting expectations CBT referral to chronic pain clinic heat packs TENS physical therapy hydrotherapy ```
153
What questions should ask for an obesity history?
timing of weight gain, heighest and lowest weight as an adult, dietary pattern and exercise
154
What pharmacotherapy can be used in obesity?
GLP-1 agonists, SGLT2 inhibitors, orlistat, phentermine, topiramate
155
What is an appropriate target for weight loss?
aim reduction of 10% of body weight in 6 months
156
What is the MOA and CI for phentermine?
MOA: sympathomimetic agent to reduce appetite CI: severe HTN, CV disease
157
What is the MOA, SE and CI for orlistat?
MOA: inhibits pancreatic and gastric lipase to reduce fat absorption SE: steatorrhoea, faecal incontinence, vitamin deficiency CI: pregnancy
158
What is the MOA and CI for liraglutide?
MOA: GLP-1 agonist to reduce appetite CI: severe renal or hepatic disease, phx pancreatitis
159
What is the main side effect of topiramate and the contraindications?
side effect: cognitive | contrainidcations: glaucoma, renal stones, pregnancy
160
What are the criteria for bariatric surgery?
BMI > 40 or > 35 with obesity-related contraindication
161
What should you look for on examination to assess nutrition?
BMI, muscle bulk, pallor, glossitis, angular stomatitis, bruising, peripheral oedema, peripheral neuropathy, bone pain/proximal weakness (vit D)
162
How should nutritional issues be managed?
investigate for nutritional deficiencies, investigate for reversible contributors (TFTs, endoscopy, malignancy), dietician, optimise other medical conditions, supplementation, MOW, shopping assistance
163
What are the DSM criteria for depression?
``` depressed mood anhedonia weight loss or gain insomnia or hypersomnia psychomotor agitation or retardation fatigue worthlessness/guilt decreased concentration suicidal ideation ```
164
What is the MOA and CI for varenicline?
MOA: blocks nicotinic AcH receptor CI: previous SI/psychiatric illness
165
What is the MOA and CI for bupropion?
MOA: dopamine/NA reuptake inhibitor CI: seizure disorder
166
What examination features should you look for in a patient with alcoholism?
``` wasting jaundice dupuytren's palmar erythema peripheral stigmata of chronic liver disease parotiditis cerebellar/peripheral neuropathy cognitive impairment ```
167
What is the MOA, SE and CI for naltrexone?
MOA: opioid antagonist CIL in liver disease SE: HA, nausea, dizziness, LFT derangement
168
What is the MOA and SE for acamprosate?
MOA: GABA agonist to reduce craving SE: diarrhoea
169
What is the MOA and CI for disulfiram?
MOA: interferes with breakdown of alcohol CI: CVD/DM/HTN/CVA note not on PBS
170
Template for opening statement
X is a “social statement”. Statement about why they are a long case then in the setting of their other issues. Their main concern is x
171
Template for closing statement?
adjusted well/poorly, good/guarded prognosis, struggles with…, their health and wellbeing will largely be governed by….
172
Approach to questions?
why is it important confirm/establish diagnosis assess current severity/control establish usual target/goal +/- modifications for this patient discuss management options to achieve goal in this patient discuss follow up
173
What should you examine for in MS?
``` spastic paraparesis posterior column sensory loss cerebellar signs cranial nerve examination RAPD ```
174
What are the complications of tamoxifen?
VTE endometrial cancer hot flushes cataracts
175
What are the complications of aromatase inhibitors?
osteoporosis | arthralgia
176
What are common complications of chemotherapy?
``` nausea vomiting alopecia cardiotoxicty myelodysplasia peripheral neuropathy ```
177
What are the stages of CKD?
1: eGFR > 90 2: eGFR 60-90 3: eGFR 30-59 4: eGFR 15-29 5: eGFR < 15
178
What is the non pharmacological management of CKD?
``` fluid restriction salt restriction low protein/potassium diet smoking cessation avoid nephrotoxics ```
179
What are the complications of CKD?
``` HTN renal bone disease renal anaemia hyperkalaemia acidosis fluid overload CVD uraemic pericarditis uraemic encephalopathy ```
180
What is required in a transplant workup?
``` HLA typing DSA typing infections - CMV, EBV, hepatitis, strongyloides, TB skin check FOBT/pap smear/mammogram TTE/stress test ```
181
When is home oxygen indicated in COPD?
indicated if PaO2 < 55mmHg
182
Which COPD patients are a candidate for lung transplant?
only a candidate if < 65, stopped smoking, without other serious comorbidities
183
What are symptoms of sarcoidosis?
fever, weight loss, LOA, malaise, cough, dyspnoea, erythema nodosum, arthralgia, uveitis, sicca symptoms
184
What issues should always be considered in a rheumatology case?
``` disease activity irreversible damage impact on function complications of disease and treatment cardiovascular risk ```
185
Which patients with RA qualify for a biologic?
if failed MTX + one other DMARD
186
Complications of RA?
raynaud's sicca symptoms ILD CKD (either due to medications or amyloid) ischaemic heart disease peripheral neuropathy/mononeuritis multiplex anaemia of chronic disease felty’s syndrome - leukopenia + splenomegaly serositis
187
What are the elements of the DAS28 score for RA?
tender joint count swollen joint count ESR global health
188
What are the common symptoms of SLE?
rash, oral ulcer, arthritis, serositis, renal disease, neurological disease, haematological disease, constitutional symptoms
189
What opportunistic infections should be considered in transplant patients?
PJP, aspergillus, TB, nocardia, CMV, VZV, strongyloides
190
What are the driving restrictions for syncope?
Unknown cause – conditional license after 6/12 (or 12/12 if 2+ episodes separated by at least 24h) CV cause – 4 wks
191
What are the driving restrictions for IHD?
PCI – 2 days AMI – 2 weeks CABG – 4 wks
192
What are the driving restrictions for arrhythmia?
Cardiac arrest – 6/12 ICD insertion – 6/12 PPM insertion – 2 wks
193
What visual acuity is required to drive?
At least 6/12 vision in one eye
194
What are the driving restrictions after stroke?
At least 4 weeks | TIA – 2 wks
195
What are the driving restrictions for epilepsy?
6 months seizure free

BPT Clinical (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions