PTS SBA 1 corrections/notes Flashcards
Treatment of MI
Dual antiPLATELET therapy
aspirin and PY12 inhibitor (clopidogrel, ticagrelor, prasugrel).
DUAL AP
(AntiPlatelet, Aspirin + py12i)
how and where does aspirin affect the kidney?
inhibits COX in the PCT
how and where do CCB act?
inhib L type voltage gated calcium channels in the nephrons
eg. amlodipine
how and where do thiazide like diuretics act?
inhib sodium chloride transporter in DCT
eg. bendroflumethiazide
how and where do loop diuretics work?
inhib the na/k/cl sympoter in the loop of henle
eg. furosemide
how and where does a k sparing diuretic work?
inhib aldosterone in the distal tubules.
differentiate between mitral stenosis and mitral regurgitation?
stenosis would have a diastolic murmur as well as a systolic (heard at the apex)
describe the changes on an ECG of an MI
ST elevation, ST depression, T wave inversion, abnormal Q wave.
which conditions are absent P waves commonly seen in?
SVT, A fib, atrial flutter.
what ECG finding indicates hyperkalaemia?
tall tented T wave
when are wide QRS complexes commonly seen
in bundle branch blocks
what are the recommendations for managing hypertension?
-blood pressure >135/85 requires pharmacological management
-differences in Caucasian vs Afro-Caribbean: first line for C= ACEi (ramipril)- if intolerant start an ARB (losartan). if no response start thiazide like diuretic.
first line for AC= CCB (amlodipine)
what is CHA2DS2-VASc score used for?
calculates stroke risk for patients with ATRIAL FIBRILLATION
What is QRISK3 score used for
Calculates stroke risk in patients over the next ten years
what are three key aspects of conns syndrome?
hypertension with hypokalaemia
hypertension despite being on 3 or more antihypertensives
hypertension before 40 years old
which diuretic should be used in conns syndrome
spironolactone as it is potassium sparing- this reduces the risk of hypokalaemia.
renin and aldosterone values in primary and secondary hyperaldosteronism
primary- renin is decreased while aldosterone increases
secondary- both renin and aldosterone are increased
describe addisons
Addison’s is a form of adrenal insufficiency (primary)
it causes reduced aldosterone levels due to an autoimmune response destroying the tissue of the adrenal glands.
signs of hypercalcaemia
bones, stones, groans and psychic moans.
describe carcinoid syndrome
D+, heart palpitations, feeling flushed.
paraneoplastic syndrome, symptoms are due to tumour cells producing 5-HT.
which tests are specific to coeliac disease?
IgA tissue transglutaminase or IgA endomysial
why is hyperkalaemia a medical emergency?
it can cause cardiac arrest
which lymphoma causes pain when drinking alcohol
Hodgkins
is non hodgkins lymphoma a symmetrical or asymmetrical presentation?
non hodgkins is symmetrical, while hodgkins is asymmetrical
which leaukaemia is the phildelphia chromosome linked to?
CML
when are auer rods found
in aml
which condition is reed sternberg cells found in?
hodgkins lymphoma (owl cells)
what clinical findings are in myeloma?
bence jones proteins and monoclonal antibodies.
which type of anaemia causes reduced reflexes?
macrocytic from hypothyroidism or b12 deficiency.
what is the action of warfarin?
vitamin K antagonist
vitK is used in synthesis of factors 2,7,9,10 (1972)
how can spinach affect warfarin
high in vitamin K so there will be reduced effect.
how can grapefruit, cranberries and alcohol affect warfarin?
increases the effect
what does a high/low INR indicate a risk of?
high INR= haemorrhage (H-H)
low INR= clotting (lo-lot)
what is the pathology of coffee ground vomitus?
indicates a bleed in the upper GI
blood mixes with acid and looks like black spots
which valve is most affected in infective endocarditis?
tricuspid- it is the first valve touched by the blood from the circulation.
which antibiotics inhibit cell wall synthesis?
penicillins, cephalosporins, glycopeptides
what is the mechanism of macrolide abx?
erythromycin and clarithromycin inhibit PROTEIN synthesis
what is the first and second line treatments for osteoporosis
first; alendronic acid (bisphosphonate) and AdCal (vit D and calcium).
second; introduce Denosumab (MAB to RANK ligand, inhibits osteoclast activity and bone resorption
what is colchicine used for?
reduce inflammatory responses such as acute gout
what is the most specific investigation for RA?
Anti citrullinated peptide antibody (anti CCP)
what is the first line treatment for a migraine?
NSAIDS- Ibuprofen
what is the history for a medication headache?
regular (>3 months) history of drug use such as triptans, opioids and NSAIDS
which nerve is involved in carpal tunnel?
median nerve
how to tell which acidosis/ alkalosis it is
pH: >7.45= alkalosis. If it is <7.35= acidotic.
CO2: If the CO2 goes in the same direction as the pH it is metabolic, if it goes in the
opposite direction it is respiratory. (Tip to remember= 2 people who travel in the same direction
are likely to ‘meet’= ‘met).
what is a key finding of sarcoidosis
hypercalaemia
