Phase 2 SBA Mock Flashcards
What medication is used to treat severe hyperkalaemia ?
Calcium gluconate
What ECG changes are seen in hyperkalaemia ?
Go, go long, go wide, go tall Loss of P waves Prolonged PR interval Widened QRS Tall tented T waves
ECG changes seen in hypercalcaemia
Shortening of the QT interval
In severe cases J waves may be seen
Ventricular and VF in extreme cases
ECG changes seen in hypocalcaemia
Lengthening of the QT interval
Causes of hyperkalaemia
AKI
Medications which interfere with renal potassium excretion e.g. spironolactone, trimethoprim NSAIDs
Medications which infer with cellular K+ e.g. digoxin, beta blockers
Hypoaldosteronism
Acidosis
Tumour lysis syndrome
What is 2nd and 3rd line in treating hyperkalaemia ?
2nd = Insulin and glucose 3rd = Salbutamol
What artery plays a role in ED ?
Internal pudendal artery
What is Wilson’s disease ?
A rare disorder characterised by excess copper stored in various body tissues
Characteristic brownish yellow rings at the corneoscleral junction of both eyes
What is the pulse of a patient presenting with aortic stenosis
A small volume and slow rising pulse
What is 3rd degree atrioventricular heart block ?
Complete heart block
There is no observable relationship between P waves and QRS complexes
What is 1st degree heart block ?
Occurs when there is delayed atrioventricular conduction through the AV node
Despite this every atrial impulse leads to a ventricular contraction
On an ECG this can be visualised as an extended PR interval
2nd Degree heart block ?
Where some of the atrial impulses do not make it through the AV node to the ventricles
On an ECG this will mean that some P waves do not lead to QRS complexes
There are several types of 2nd degree block
Mobitz type 1
Mobitz type 2
What is Mobitz type 1 HB
Where the atrial impulse becomes gradually weaker until it does not pass through the AV node
After failing to stimulate a ventricular contraction the atrial impulse returns to being strong and then the cycle repeats agai
How does Mobitz type 1 HB present on an ECG
On an ECG this will show up as an increasing PR interval until the P wave no long conducts the ventricles
Culminating in an absent QRS complex after a P wave
The PR interval then returns to normal but becomes progressively longer again until another QRS complex is missed
Then repates
What is Mobitz type 2 HB
Intermittent failure of interruption of AV conduction
This results in missing QRS complexes
There is usually a set ratio of P waves to QRS complexes e.g. 3 P waves to each QRS complex = a 3:1 block
The PR remains normal
What is a major complication of 3rd degree HB and Mobitz type 2 (2nd degree) HB ?
Asystole (flatline)
Treatment for unstable arrhythmia or risk of asystole (i.e. MT2, T3B or previous asystole)
1st line = atropine
Treatment for unstable arrhythmia or risk of asystole after 500mcg IV atropine
Atropine IV repeated up to 6 doses
Other inotropes e.g. noradrenaline
Transcutaneous cardiac pacing (Defib)
Treatment for patients at high risk of asystole
Temporary transvenous cardiac pacing
Permanent implantable pacemaker
MOA Atropine
Antimuscarinic that works by inhibiting the parasympathetic nervous system
A 70 year old woman presents with an ulcer above the medial malleolus. She also has swelling and pigmentation on the medial aspect of the lower leg. What type of ulcer is this most likely to be?
Venous
Where do arterial ulcers typically present ?
Periphery e.g. toes
Name some dermatological manifestations of IBD
Erythema nodosum Oral aphthous stomatitis Psoriasis Pyoderma gangrenosum Sweet syndrome
A 62 year old man with longstanding peripheral vascular disease notices central chest discomfort whilst moving furniture. He then develops similar but more severe chest pain whilst watching TV the following day. His wife rings 999 and the paramedics arrive to find him now pain free. An ECG shows deep T wave inversion from leads V2 to V6.
What is the diagnosis ?
Non-ST elevation myocardial infarction
Which is the most common dermatological manifestation of IBD ?
Erythema nodosum
A 40 year old man is admitted with jaundice. Urine analysis shows no evidence of bilirubin in the urine.
Which is the most likely cause of this man’s jaundice?
Acquired haemolytic anaemia
How does acute pancreatitis present ?
Severe epigastric pain radiating to the back
Vomiting
Association with smoko and alcohol
Bowel sounds are still present
A 42 year old man collapses with abdominal pain and vomits some fresh blood. An emergency endoscopy shows major fresh bleeding from the base of an ulcer in the second part of the duodenum. Which artery is the most likely source of the bleeding?
Gastroduodenal artery
Blood supply to jejunum and ileum
Superior mesenteric artery
Blood supply to the stomach
Comes from the celiac trunk
The common hepatic artery leads into the right and left gastric arteries as well as the right gastro-omental and the left gastro-omental branches
What is the impact of the release of PTH on phosphate ?
Decreases phosphate reabsorption in the kidney
What is Turner’s syndrome ?
A condition that only affects females
Results when one of the X chromosome is missing or partially missing
What is amenorrhoea ?
Absence of menstruation
A 60 year old man who is an ex-smoker presents with cough, weight loss, and mass on chest X-ray. His blood pressure is low and potassium is very low at 2.1 mmol/L (3.5-5.3). Which is the most likely cause of the hypokalaemia?
Ectopic ACTH from a small cell lung cancer
What is the most common type of lung cancer ?
Adenocarcinoma
What is the most common type of cancer in smokers ?
Squamous cell carcinoma
A 25 year old man presents with new hypertension. His blood pressure is 160/105 mmHg. He is taking no medication. His sodium is at the upper limit of normal, his potassium is low at 2.9 mmol/L (3.5-5.3) and his renin is suppressed. Which is the most likely diagnosis?
Primary hyperaldosteronism (Conn’s syndrome)
What is desmopressin you for ?
Determining the difference between cranial and nephrogenic DI
What is a Dexamethasone suppression test ?
Dexamethasone is a synthetic corticosteroid that is used in diagnosis of Cushing’s syndrome
Infusion of dexamethasone should negatively feedback and reduce the levels of ACTH in the body
Which medication can lead to elevated TSH levels ?
Lithium
What is a germinoma
A type of tumour that begins in the germ cells
Can occur in the ovaries or testicles but most often occur in the CNS when they travel there during development
An 18 year old man presents with headache, double vision, drowsiness, polydipsia
and polyuria. He is taking no medication and his bloods show him to have a low FT4,
very low 0900h cortisol levels and positive pregnancy test.
Which is the most likely diagnosis?
germinoma
What am I going to do carefully in the exam ?
Read each question carefully
For a patient taking naproxen what could be the cause of severe epigastric pain ?
Reduction in mucus and bicarbonate secretion
MOA for a salbutamol inhaler
Short acting beta 2 adrenergic receptor agonist
Relaxing the smooth muscle of the airways
What is a medication used to treat BPD ?
Doxazosin or Terazosin
What is the physiology behind postural hypotension ?
Dilation of venous capacitance vessels
What medication can help reverse warfarin ?
Vitamin K
A patient is started on a commonly used medication. Unfortunately, they develop an
adverse drug reaction you have not seen before. The patient is hospitalised due to
the adverse drug reaction (ADR).
Which is the correct course of action once the drug has been stopped and the
patient informed
Report the ADR via the yellow card system
Which is the most appropriate therapy for emergency reversal of this patient’s warfarin?
IV prothrombin complex concentrate and IV vitamin K
A 32 year old woman is being treated for sepsis and disseminated intravascular
coagulation (DIC). She has a low fibrinogen level.
Which would be the most appropriate blood product to give in this setting ?
Cryoprecipitate
What is cryoprecipitate ?
The liquid part of our blood. Cryo is rich in clotting factors, which are proteins that can reduce blood loss by helping to slow or stop bleeding. Includes Fibrinogen Factor VIII Factor XIII Von Willebrand factor
What type of cell is diagnosed with multiple myeloma ?
Plasma cell
A 35 year old woman presents to her General Practitioner with increased bruising
following her annual influenza vaccine. She describes some blood blisters in her
mouth, and some bruising on her arms and legs, without having injured herself. Her
blood tests show a platelet count of 2 × 109/L (150-400). Her haemoglobin and white
cell count are both within normal ranges.
Which is the most likely diagnosis?
Immune thrombocytopenic purpura (ITP)
What is a typical feature of non-eosinophilic asthma ?
History of smoko
What peak flow result would suggest a moderate severity asthma exacerbation ?
65%
What is the MOA of ipratropium bromide ?
AChMR antagonist, which acts as a bronchodilator
How will bronchiectasis appear on a CT ?
Permanent dilation of bronchi and bronchioles
Which Toll-like receptor is responsible for sensing lipopolysaccharide found on the
outer membrane of gram-negative bacteria?
TLR4
Which TLR rense the flagellin component of flagellated bacteria ?
TLR5
Which blood test results is most specific for a diagnosis of
rheumatoid arthritis?
Positive anti-CCP Abs
Common extra-articular features of spondyloarthropathy ?
Weight loss and fatigue Chest pain Pulmonary fibrosis IBD Uveitis
What is Uveitis
Inflammation of the middle layer of the eye
What is Granulomatosis with polyangiitis ?
A small and medium vessel vasculitis
Most associated with lung and skin problem but can affect other organs such as the kidneys
Often presents with severe asthma in late teenage years
High eosinophil level on FBC
A 35 year old woman with a diagnosis of systemic lupus erythematosus (SLE) is
admitted with a flare of her disease. Which result is in keeping with active SLE?
Low serum complement 3 and 4
What malignancy does a patient with Sjorgens syndrome have a risk of developing ?
Lymphoma
What is Felty syndrome ?
RA, splenomegaly and decreased WBC count with repeated infections
A bone marrow transplant recipient with a fever and shortness of breath has a
positive 1,3 beta-D-glucan assay.
Which organisms does this test detect?
Aspergillus fumigatus and Candida albicans and Pneumocystis jirovecii
A 62 year old woman goes to her General Practitioner complaining of a cough
productive of green sputum. She is usually fit and well. She is slightly breathless, her
temperature is 37.8°C and she has some audible crackles at the right lung base.
Other vital signs are all normal.
Which is the most appropriate antibiotic?
Amoxicillin
Which cell wall feature enables the causative pathogen to resist phagocytic killing?
Mycolic acid
MOA for ABs
Disrupts peptidoglycan
Which was the probable mechanism of amoxicillin antibiotic resistance?
Beta-lactamase hydrolysis
What is osteomyelitis ?
Infection that usually causes pain in the long bones in the legs
Most likely cause of vomiting and watery diarrhoea but no blood in stools following childrens party ?
Rotavirus
What kind of diarrhoea does Campylobacter
jejuni cause ?
Bloody
What nutrient agar is used to grow Mycobacterium tuberculosis?
Lowenstein-Jensen
Non-lactose
fermenting aerobic bacilli with negative oxidase test
S. Proteus
Salmonella
Shigella
Felty’s syndrome
The presence of three conditions:
RA
Spenomelgaly
Neutropenia
