Past Paper Q's 2014 Flashcards
What are the RF for VTE?
Active malignancy Recent immobility Obesity HRT/COCP Previous DVT/VTE Known thrombophilia Pregnancy or given brith in <6weeks
How would you initially investigate a ?DVT
Venous doppler USS of proximal veins in leg
D Dimer
How does warfarin work?
It inhibits the VK dependant factors 2, 7, 9, 10
Reducing the intrinsic pathway in the coagulation cascade
What blood tests should you do before starting someone on warfarin?
U&E, FBC,
LFT and weight
How does heparin work?
Binds to enzyme inhibitor antithrombin III and activates it - this then deactivates factor Xa and thrombin
Give some of the features of downs syndrome (6)
- Hyperreflexia, muscular hypotonia
- Head: epicanthic folds, flat nasal bridge, low set ears, ring of iris speckles = brushfield’s spots
- Mouth: protruding tongue and high arched palate
- Neck: short
- Hands: Single palmar crease, incurved little finger, short, broad hands
- Feat: Gap between hallux and 2nd toe
Name 2 genetic mutations that can give rise to Down’s syndrome
- Non-disjunciton 95%
(failure of homologous chromosomes/sister chromosomes to separate properly during cell division) - Mosaicism
- Robertsonium translocation
Give the CV defects associated with Downs
ASD
VSD
PDA
Tetralogy of fallot
Give the GI problems associated with downs syndrome
Oesophageal atresia
Pyloric stenosis
GOR
Hirschsprungs
What are the RF associated with vitamin D deficiency?
Pigmented skin Lack of sun exposure - religion covering or institutionalised or suncream Malabsorption - short bowel Poor diet Cholestatic liver disease CKD
Explain VD metabolism
VD3 from the sun
VD2 from diet (fish, milk)
There are converted to 25(OH)D3 in the liver which is then convetered to 1,25(OH)2D3 in the kidneys which is called calcitriol
Give the function of the PTH
1) Increases renal reabsorption of Ca (while increased PO4 excretion)
2) Increased osteoclast activity (releasing ca from the bones)
3) Stimulates the production of 1,25(OH)2D3 (calcitriol) from the kidneys
What affect does PTH have on the bones?
It binds to osteoblasts and causes them to produce RANK-ligand
RANK ligand stimulates the osteoclasts to resorb bone
Why does vitamin D deficiency lead to under mineralisation of bone?
VD deficiency leads to lack of calcitriol (1,25(OH)2VD3) - therefore calcium in the blood. This leads to increased PTH which increases osteoclast activity causing bones to become under mineralised
What are the triggers of a gout attack?
Dehydration Prolonged fasting Aspirin Starting allopurinol Alcohol Thiazide diuretics
How would cauda equina present in the lower limbs?
Paraplegia
Numbness
Weekness
How would cauda equina present peri-anally?
Saddle anaesthesia and loss of anal tone
Which artery supplies the super vesicular artery?
The internal iliac artery
Give the fat soluble vitamins and what you would get if you were deficient in them
A - night blindness
D - Osteomalacia
E - ataxia & muscle weakness
K - bleeding/bruising
What is the skin disease that is associated with coeliacs?
Dermatitis herpetiformis
What malignancy is associated with coeliacs?
Enteropathy-associated T-cell lymphoma of the small bowel
What is economic evaluation?
It is the assessment of efficiency
It is a comparative study of the costs and benefits of healthcare interventions
What makes a QALY?
Its the quality and quality of life lived
What 2 things make an economic evaluation?
Cost and effectiveness
Define efficiency
When resources are allocated between activities in such a way to maximise benefits for a give budget
Define opportunity cost
The sacrifice in terms of benefits foregone from not allocating resources to the next best activity
Give 3 types of economic evaluation
Cost-benefit analysis
Cost utility analysis
Cost-effectiveness
What is equity in health economics?
It is fairness and justice in distribution of cost and benefits
How can you prevent malaria?
C - long sleeve tops and trousers, use of DEET and insecticidal nets
M - doxycyline
How do you dx malaria?
Thick and thin blood smears with giemsa stain
What do you need to have to make a dx of bipolar?
At least 2 episodes where a persons mood is significantly disturbed - they need at leas t one episode of mania for it to be dx
What tests should you do before starting someone on lithium?
TFT ECG Pregnancy test U&E FBC
Give some signs of hypothyroidism
Obesity Dry skin and hair Depressed Myxedema Malar flush Cold peripheries Goiter Bradycardia Slow reflexes
Give 3 neuro signs of lithium toxicity
Coarse tremor Hyperreflexia Coma Ataxia Nystagmus
What is an apical lung tumour called?
Pancoasts tumour
Give the 3 symptoms of corners syndrome
Miosis, partial ptosis and anhidrosis
Why would someone with a pancoasts tumour get pain in the shoulder and the scapula?
If they have involvement of the phrenic nerves C345 - referred pain
Which nerve root causes wasting of the thenar eminence?
Median nerve - C8-T1
Give 6 signs of MND
Hyperreflexia Fasciculations Muscle wasting Spasticity/hypotponia Hemiparesis Dysarthria/dysphagia
Give 4 signs of bulbar palsy
Dysarthria
Dysphagia
Weak tongue
Fasciculations on tongue
Name 4 MDT members for MND
Consultant Physio OT Specialist nurse GP SALT
What is an advanced directive?
It is a living will/a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity
