Practice SAQ Flashcards
Mx options for OA before surgery (other than analgesia)?
activity modification
mobility aids
physio
steroid joint injection
Reasons for doing a spinal over GA?
lower cost
better post op pain scores
allergy / contraindication to GA (e.g. COPD)
Which 2 anatomical layers is spinal anaesthetic given between ?
arachnoid and pia mater
What can be used for post-op thromboprophylaxis other than aspirin ? MOA?
LMWH e.g. dalteparin
inhibits factor Xa
What nerve can be injured in a knee op to create foot drop? area of sensation loss?
common peroneal / fibular nerve
dorsum of foot and lateral leg
malignant and non-malignant conditions that obesity is a risk factor for?
malignant : ovarian, breast, endometrial, bowel cancer
non-malignant: T2DM, htn, IHD, stroke, OA
Which joints are most commonly involved in RA?
What are the antibodies seen?
proximal interphalangeal
metacarpophalangeal
RF, anti- CCP
Extra-articular manifestations of RA?
dry eyes / mouth
scleritis
pericarditis
lung nodules / ILD
lymphadenopathy
splenomegaly
renal involvement
tendonitis
peripheral neuropathy (carpal tunnel)
What specific classes of monoclonal antibodies can be used to treat RA?
anti- TNF
anti- interleukin 6
anti-CD20
Anatomical landmark of the deep inguinal ring?
halfway between ASIS and pubic tubercle
2 types of anaesthesia that could be used for inguinal hernia repair other than GA?
spinal, local
What behavioural strategies can be implemented to help toddlers with constipation?
scheduled toileting - e.g. after each meal or 5 mins before bedtime
bowel habit diary for frequency and consistency ( ERIC toilet tool wall chart)
reward systems
address any social / psychological problems
What is the first line medication for simple constipation in kids?
macrogol / Movicol
Describe the role of a health visitor
offer support and encouragement to families through early years from pregnancy and birth to primary school
Give some features that suggest that asthma is poorly controlled
difficulty sleeping due to sxs
frequently symptomatic during the day
interfering with usual activities
need to use SABA > 1/week
decreasing PEFR
What should you ask a patient with a newly reduced peak flow?
adherence to tx?
increase in smoking / starting smoking?
new triggers - new pets, occupational exposure?
Key questions to ask in hx of heavy, painful periods?
pattern of pain - onset, timing, character
blood loss - number of pads and tampons, length of period
associated sxs - bloating, mood change
abnormal bleeding (e.g. post-coital), discharge
Sexual hx - STI
What advice should you give someone starting COCP?
how to start
how to take (same time each day)
missed pill advice / what to do with D+v
interaction with abx
side effects
does not protect against STI
Describe how to perform the Dix-Hallpike manoeuvre
sit patient up on a couch and get them to focus on a point straight ahead
then lower patient down so lying on the bed, keeping eyes open
move head below level of bed and turn left or right
observe for nystagmus
What is the pathophysiology of BPPV?
small fragments of crystals deposited in inner ear that can be swept along the fluid filled canal when head moves, send confusing messages to brain causing vertigo
Initial advice for BPPV management?
avoid sudden position changes
rest and hydrate
don’t drive if symptomatic
consider adjustments at work
Which arteries are likely to be stenosed in intermittent claudication?
superficial femoral or popliteal
mechanism of action of aspirin?
irreversible cyclo-oxygenase inhibitor
prevents platelet aggregation
Below which ABPI do patients experience rest pain?
0.5
Why do patients feet often appear red (hyperaemic) at the end of Buerger’s test?
severe ischaemia = release of local vasodilators that increases perfusion of foot
most appropriate urgent intervention for hydronephrosis ?
percutaneous nephrostomy
important steps in a patient in Urgent Care who is acutely unwell with exacerbation of COPD?
admit to hospital
prescribe steroids and abx
most likely causative organism of exacerbation of COPD?
strep pneumoniae
Key points of COPD management post exacerbation?
regular review
review inhaler technique
vaccines
self management plan
rescue pack (abx and steroids)
pulmonary rehab
1st line for severe CAP?
IV co-amoxiclav and PO doxycyline
2 investigations that must be done before initiating TB tx?
LFTs and visual acuity testing
Risk factors for palpitations?
hypertension
OSA
obesity
metabolic syndrome
Investigations for underlying cause of palpitations?
U&Es - CKD or hypokalaemia ( AF )
TFTs - hyperthyroidism (AF)
Echo - structural heart disease
Ambulatory BP monitoring / Holter monitoring
Overnight pulse ox (if OSA)
Most important tx to commence in AF?
anticoagulant e.g. DOAC to reduce stroke risk
Tx for severe dehydration in a patient with diabetes insipidus?
Iv fluids and desmopressin
Risks of severe dehydration?
stroke / thrombus
LOC
seizures
worsening hypernatraemia
