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SAQ Mistakes Flashcards

1
Q

Describe the medications used in TB, their length of course and common side effects

A

Rifampicin - 6 months - red/orange urine/tears

Isoniazid - 6 months - peripheral neuropathy

Pyrazinamide - 2 months - hyperuricaemia/gout

Ethambutol - 2 months - optic neuritis

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2
Q

Which drug is co-prescribed with RIPE and why?

A

Pyridoxine - prevents isoniazid induced neuropathy

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3
Q

Give 4 causes of erythema nodosum

A
  1. TB
  2. Sarcoidosis
  3. Pregnancy
  4. IBD
  5. Idiopathic
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4
Q

Describe bronchiectasis

A

Permanent dilation of the airways secondary to chronic infection

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5
Q

Describe the common causative organisms of pneumonia in cystic fibrosis

A
  1. Pseudomonas aeruginosa
  2. Streptococcus pneumoniae
  3. Haemophilus influenzae
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6
Q

Describe the causes of bronchiectasis

A
  1. Pneumonia
  2. Idiopathic
  3. Post-obstructive (e.g. foreign body)
  4. Alpha-1 antitrypsin deficiency
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7
Q

Describe the mechanism by which type II respiratory failure occurs in PE

A

Ventilation-perfusion mismatch

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8
Q

Describe the target INR and anticoagulant treatment time following PE

A

Target INR = 2-3

Treat for AT LEAST 6 months (if unprovoked), AT LEAST 3 months if provoked

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9
Q

Describe the common metastases sites of lung cancer

A
  1. Brain
  2. Liver
  3. Bone
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10
Q

What spirometry pattern is seen in asthma?

A

Obstructive (low FEV1:FVC, low FEV1 with normal FVC)

> 15% improvement in FEV1 after SABA

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11
Q

What measurement is used to measure COPD severity?

A

FEV1

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12
Q

Why do COPD patients have reduced target saturations?

A

Risk of losing hypoxic drive!

Avoids oxygen induced hypercapnoea and subsequent worsening acidosis.
This is because raised O2 slows the respiratory drive.

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13
Q

What contraindicates LTOT in COPD?

A

Current smoker

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14
Q

Describe the signs of lung consolidation on examination

A
  1. Dullness to percussion
  2. Reduced chest expansion
  3. Crepitations on auscultation
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15
Q

Describe the CURB-65 score

A

C - new confusion
U - urea >7
R - RR>=30
B - BP <90 sys or <=60 dys
65 - age >65

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16
Q

Give 3 common causative organisms of pneumonia

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Mycoplasma pneumoniae
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17
Q

Describe the complications of pneumonia

A
  1. Sepsis
  2. Effusion
  3. Respiratory failure
  4. Atrial fibrillation
  5. Abscess
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18
Q

Which staging system is used in lung cancer?

A

TNM

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19
Q

Describe a test for SVC obstruction

A

Pemberton’s test - raise hands above head and assess for cyanosis of face, raised JVP or breathlessness

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20
Q

Describe the CXR findings in pulmonary fibrosis

A
  1. Honeycomb lung
  2. Reduced lung volume
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21
Q

Give 3 causes of extrinsic allergic alveolitis

A
  1. Bird fancier’s lung (allergy to bird faeces)
  2. Farmer’s lung (allergy to mold spores in hay)
  3. Malt worker’s lung (allergy to mold in malt)
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22
Q

Give 3 extra-pulmonary causes of pulmonary fibrosis

A
  1. Medications (e.g. methotrexate)
  2. Rheumatoid arthritis
  3. Systemic lupus erythematosus
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23
Q

Give 5 respiratory causes of clubbing

A
  1. Lung cancer
  2. Pulmonary fibrosis
  3. Bronchiectasis
  4. Mesothelioma
  5. Chronic empyema
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24
Q

Define cor pulmonale

A

Right heart failure secondary to chronic pulmonary hypertension

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25
Q

Describe the CXR findings in cor pulmonale

A
  1. Dilated pulmonary vessels
  2. Dilated R atrium
  3. Dilated R ventricle
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26
Q

Describe the ECG findings in cor pulmonale

A

Right axis deviation

Inverted T waves in chest leads

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27
Q

Give 4 causes of bilateral hilar lymphadenopathy

A
  1. Lymphoma
  2. TB
  3. Extrinsic allergic alveolitis
  4. Bronchial carcinoma
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28
Q

Give 3 signs of aortic regurgitation

A
  1. Quincke’s sign: pulsatile nail capillary beds
  2. De Musset’s sign: head nodding with pulse
  3. Collapsing pulse
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29
Q

Describe the blood culture technique in infective endocarditis

A

3 samples, from 3 different locations, at 3 different times

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30
Q

Describe the biopsy findings in sarcoidosis

A

Non-caseating granulomas

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31
Q

Describe the extrapulmonary manifestations of sarcoidosis

A
  1. Erythema nodosum
  2. Arthralgia
  3. Anterior uveitis
  4. Hepatosplenomegaly
  5. Lymphadenopathy
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32
Q

Give 8 side effects of steroids

A
  1. Osteoporosis
  2. Thinning hair
  3. Hypertension
  4. Cushing’s syndrome (abdominal striae, buffalo hump, moon face)
  5. Peptic ulceration
  6. Immunosuppression
  7. AVN of the femoral head
  8. Hyperglycaemia
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33
Q

Describe the differences between transudative and exudative effusions on aspiration

A

High protein = exudative
High LDH = exudative

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34
Q

Describe empyema

A

Infected pleural effusion

Aspirate shows pus and pH<7.2 (acidic)
Low glucose and low LDH
Treat with a chest drain and antibiotics

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35
Q

Describe the causes of exudative pleural effusion

A

Anything unilateral!
1. Lung cancer
2. TB
3. Pneumonia

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36
Q

Describe the causes of transudative pleural effusion

A

Anything bilateral!
1. Congestive heart failure
2. Hypoalbuminaemia
3. Meig’s syndrome

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37
Q

Describe the chemical ‘plug’ used in pleural effusion

A

Pleurodesis with talc

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38
Q

Where does the rib’s neurovascular bundle run?

A

Below the rib - so do aspiration/drain above the rib!

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39
Q

Describe the medications for primary prevention of MI

A

4 A’s!
1. Atorvastatin
2. Aspirin
3. ACEi (e.g. ramipril)
4. Atenolol

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40
Q

Give the lateral ECG leads

A

V5, V6, I, aVL

Supplied by left circumflex artery

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41
Q

Give the anteroseptal ECG leads

A

Septal: V1, V2
Anterior: V3, V4

Supplied by left anterior descending artery

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42
Q

Give the inferior ECG leads

A

II, III, aVF

Supplied by right coronary artery

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43
Q

Describe the remnant signs of MI on ECG

A

T-wave inversion

Pathological Q waves

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44
Q

Describe the mechanism of action of aspirin

A

Irreversibly inhibits cyclo-oxygenase

Prevents further production of thromboxine

Subsequent anti-platelet effect

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45
Q

Describe the medical management of hypokalaemia

A

Oral: SandoK

IV: KCl (added to normal fluids)

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46
Q

Describe the medical management of hyperkalaemia

A

Salbutamol nebuliser

Insulin (+dextrose)

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47
Q

Give the normal QRS duration

A

<0.12s

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48
Q

Give the normal PR interval

A

<0.2s

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49
Q

Give the symptoms of left ventricular failure

A
  1. Dyspnoea
  2. Orthopnoea
  3. Cough
  4. Pink frothy sputum
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50
Q

Give the signs of heart failure on CXR

A
  1. ‘Bat wings’ (alveolar/interstitial oedema)
  2. Cardiomegaly
  3. Pleural effusion
  4. Kerley-B lines
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51
Q

Describe the mechanism of action of furosemide

A

Acts on Na+/K+/2Cl- co-transporter in the thick ascending limb of the loop of Henle

Causes increased sodium, and therefore water, excretion

Subsequent K+ retention

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52
Q

What are capture beats?

A

Normal QRS complexes within a VT rhythm

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53
Q

Describe the findings of hypertensive retinopathy on fundoscopy

A
  1. Cotton wool spots
  2. Flame haemorrhages
  3. A-V nipping
  4. Papilloedema
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54
Q

Describe the mechanism of action of statins

A

Inhibits HMG-CoA

Subsequently prevents cholesterol synthesis

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55
Q

Give 4 causes of AF

A
  1. MI
  2. PE
  3. Hyperthyroidism
  4. Alcohol excess
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56
Q

Give 2 signs of AF on ECG

A
  1. Absent P waves
  2. Irregular QRS complex
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57
Q

Give the common causative organisms of infective endocarditis

A
  1. Viridans streptococci
  2. Staphylococcus aureus (in IVDU)
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58
Q

What are Roth spots?

A

Boat-shaped retinal haemorrhages with pale centres, seen on fundoscopy

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59
Q

Describe the staging of chronic kidney disease

A

G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15 (known as “end-stage renal failure”)

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60
Q

Give the causes of CKD

A
  1. Hypertension
  2. Glomerulonephritis
  3. Pyelonephritis
  4. Polycystic kidney disease
  5. Obstructive uropathy
  6. Renovascular disease
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61
Q

Which medication is used in CKD?

A

ACEi

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62
Q

Which blood tests should be monitored in CKD?

A
  1. Bone profile (Ca, PO4, alk phos, PTH)
  2. FBC
  3. U&Es (for renal function)
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63
Q

Describe the findings on examination of patients with CKD

A
  1. Hypertension
  2. Pallor
  3. Bruising
  4. Brown discolouration of nails
  5. Peripheral oedema
  6. Pleural effusion
  7. Signs of treatment (e.g. AV fistula)
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64
Q

Describe how dialysis works

A

Blood and dialysis fluid run adjacent, separated by a semi-permeable membrane.

Electrolytes flow down their concentration gradients, with the blood becoming more like the dialysis fluid.

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65
Q

Give the complications of peritoneal dialysis

A
  1. Bacterial peritonitis
  2. Local infection at site of catheter insertion
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66
Q

Describe the time frame discerning acute and chronic organ transplantation rejection

A

6 months

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67
Q

Why do patients on immunosuppressants require annual dermatological appointments?

A

Higher risk of skin cancers if on immunosuppression (i.e. organ transplant recipient)

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68
Q

What type of hyperparathyroidism does CKD cause?

A

Secondary

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69
Q

Describe the action of PTH

A
  1. Increases osteoclast activity - raising Ca
  2. Increases Ca and PO4 reabsorption in the kidney
  3. Increases hydroxylation of vit. D
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70
Q

What is the name given to bone disease in people with renal failure?

A

Renal osteodystrophy

71
Q

Describe the management of bone disease in people with renal failure

A

Restrict dietary phosphate

Calcium supplementation

Vitamin D analogues

72
Q

Describe the effects on calcium and phosphate in tertiary hyperparathyroidism

A

High calcium

High phosphate

73
Q

Describe the cause of tertiary hyperparathyroidism

A

Prolonged secondary hyperparathyroidism causing the parathyroid glands to start acting autonomously

74
Q

Describe the subclassifications of AKI

A

Pre-renal

Intra-renal

Post-renal

75
Q

Give 2 causes of prerenal AKI

A

Hypovolaemia (e.g. sepsis)

Renal artery stenosis

76
Q

Give 3 causes of intrarenal AKI

A

Glomerulonephritis

ATN

Acute interstitial nephritis

77
Q

Give 2 causes of postrenal AKI

A

Renal tract calculi

Renal tract cancer

78
Q

Give 2 complications of AKI

A

Pulmonary oedema

Hyperkalaemia

Haemorrhage

79
Q

Give 3 indications for dialysis in AKI

A

Severe metabolic acidosis

Uraemic encephalopathy

Persistent hyperkalaemia

80
Q

Describe how rhabdomyolysis impacts the kidneys

A

Causes acute tubular necrosis

81
Q

Describe the diagnostic investigations for rhabdomyolysis

A

Urinary myoglobin

Raised creatinine kinase

82
Q

Describe the causes of rhabdomyolysis

A
  1. Long lie
  2. Crush injuries
  3. Vigorous exercise
  4. Burns
  5. Seizures
  6. Neuroleptic malignant syndrome
83
Q

Describe the ECG changes in hyperkalaemia

A
  1. Tall tented T-waves
  2. Prolonged PR interval
  3. Wide QRS complexes
84
Q

Describe the acute management of hyperkalaemia

A
  1. Calcium gluconate
  2. Insulin (+dextrose)
  3. Salbutamol nebuliser
  4. Calcium resonium
85
Q

Describe the investigations for Goodpasture’s syndrome

A

Anti-GBM antibodies

ANCA

86
Q

Describe the management of Goodpasture’s syndrome

A

Steroids!

87
Q

Describe nephrotic syndrome

A

Proteinuria

Hypoalbuminaemia

Hypercholesterolaemia

Oedema

88
Q

What is the most common cause of nephrotic syndrome in an adult?

A

Membranous glomerulonephritis

89
Q

What is the most common cause of nephrotic syndrome in a child?

A

Minimal change disease

90
Q

Describe the recommended diet in nephrotic syndrome

A

Low sodium

Normal protein

91
Q

Describe the calculation for serum osmolality

A

2Na + Urea + Glucose

OR

2Na + 2K + Urea + Glucose

idk which sorry

92
Q

Describe a fluid status assessment

A

Lying and standing BP

Serial weights

Fluid balance chart

JVP assessment

Assess for peripheral oedema

93
Q

Why must hyponatraemia be corrected gradually?

A

Risk of central pontine myelinolysis

94
Q

Describe the mechanism of action of ADH

A

Acts on aquaporin 2 channels in the collecting duct, causing increased reabsorption of water

95
Q

What medication can be used to treat SIADH?

A

Demeclocycline

96
Q

Give 5 risk factors for urinary tract infection

A
  1. Female
  2. Pregnancy
  3. Diabetes
  4. Structural abnormality
  5. Immunosuppression
  6. Frequent unprotected sexual intercourse
97
Q

Give 4 preventative methods for UTIs

A
  1. Drink cranberry juice
  2. Urinate after sexual intercourse
  3. Keep well hydrated
  4. Wipe from front to back
98
Q

Describe the signs of anaphylaxis in the airway, breathing and circulation

A

A: stridor, tongue swelling
B: wheeze, tachypnoea
C: hypotension, tachycardia

99
Q

Describe the management of anaphylaxis

A

Adrenaline (0.5mL 1:1000 IM)

Chlorphenamine

Hydrocortisone

100
Q

Give the contraindications to renal biopsy

A

Single functioning kidney

Anticoagulation

CKD with small kidneys

101
Q

Give the risks of renal biopsy

A

Infection

Haematuria (potentially requiring transfusion)

Pain

Death

102
Q

Describe the biopsy changes seen in IgA nephropathy

A

IgA complex deposits

Mesangial proliferation

C3 deposits

103
Q

Give 4 causes of purpuric rash

A

ITP
TTP
Septicaemia (commonly meningococcal)
Amyloidosis
Steroids
DIC

104
Q

Give the two blood tests for rheumatoid arthritis

A

Anti-CCP

RF

105
Q

Give 3 signs of RA on examination

A

Ulnar deviation of the fingers

‘Z-thumb’

Swan-neck deformity

Boutonniere deformity

106
Q

Give 3 signs of RA on XR

A

Loss of joint space

Soft tissue swelling

Bony erosions

107
Q

Give 5 extra-articular signs of RA

A

Scleritis

Episcleritis

Lymphadenopathy

Pulmonary fibrosis

Vasculitis

Anaemia

108
Q

Describe a severe complication of RA

A

Fety’s syndrome:
1. RA
2. Neutropenia
3. Splenomegaly

Causing repeated infection

109
Q

Give 6 causes of polyarthritis

A

OA

SLE

RA

Reiter’s syndrome

Psoriatic arthritis

Reactive arthritis

110
Q

Give the mechanism of action of NSAIDs

A

Inhibit cyclo-oxygenase

Preventing prostaglandin release

Resulting in reduced inflammation

111
Q

Give 7 triggers for gout

A

Infection

Trauma

High purine foods

Surgery

Dehydration

Starvation

Alcohol

112
Q

Give 3 signs of gout on XR

A

Normal joint space

Soft-tissue swelling

Peri-articular erosions

113
Q

What is seen on light microscopy in gout

A

Negatively bifringent needle-shaped crystals

114
Q

Define chondrocalcinosis

A

Calcification within a joint

115
Q

Give 3 common sites for pseudogout

A

Knee

Hip

Wrist

116
Q

Give 5 risk factors or pseudogout

A

Hyperparathyroidism

Haemochromatosis

Wilson’s disease

OA

Increasing age

117
Q

Describe the findings on light microscopy of joint aspirate in pseudogout

A

Positively bifringent rhomboid shaped crystals

118
Q

Give 3 skin signs in SLE

A

Discoid rash

Malar rash

Photosensitive rash

119
Q

Give 4 signs of anti-phospholipid syndrome

A

Recurrent miscarriage

Coagulation defect

Livedo reticularis

Thrombocytopenia

120
Q

Give the management of anti-phospholipid syndrome

A

Aspirin

Clopidogrel

Warfarin

Heparin

121
Q

Describe heliotroped

A

Purple discolouration of eyelids

Seen in dermatomyositis

122
Q

Describe Gottron’s papules

A

Rough red papules over knuckles

Seen in dermatomyositis

123
Q

Which autoantibodies are seen in dermatomyositis

A

Anti-Jo-1

Rheumatoid factor

ANA

124
Q

Describe the pathophysiology of Raynaud’s phenomenon

A

Disruption to blood flow of distal phalanges as a result of vasospasm elicited by cold weather or emotion.

Causes pallor and pain

125
Q

Describe the causes of Raynaud’s phenomenon

A

Scleroderma

SLE

RA

Ehler’s Danlos syndrome

Beta blockers

126
Q

Describe the presentation of limited cutaneous scleroderma

A

Calcinosis

Oesophageal dysmotility

Sclerodactyly

Telangiectasia

127
Q

Give 4 seronegative spondyloarthropathies

A

Reiter’s syndrome

Reactive arthritis

Ankylosing spondylitis

Psoriatic arthritis

128
Q

Describe the classical radiographic signs seen in ankylosing spondylitis

A

BAMBOO SPINE:
1. Calcification of intervertebral ligaments
2. Fusion of spinal facet joints
3. Formation of bridging syndesmophytes

129
Q

Describe the management of ankylosing spondylitis

A
  1. NSAIDs
  2. Anti-TNFa (e.g. infliximab)
  3. Intra-articular injections
130
Q

Give 3 types of psoriasis

A

Guttate psoriasis

Chronic plaque psoriasis

Flexural psoriasis

131
Q

Describe 2 extra-articular associations with ankylosing spondylitis

A

Aortic regurgitation

Pulmonary fibrosis

132
Q

What is the name given to psoriatic arthritis leading to periarticular osteolysis and bone shortening

A

Arthritis mutilans

133
Q

Give 4 causative organisms of reactive arthritis

A

Chlamydia trachomatis

Campylobacter

Salmonella

Shigella

134
Q

Give the 3 signs of Reiter’s syndrome

A

Conjunctivitis

Urethritis

Arthritis

135
Q

Give and example of an ANCA+ vasculitis

A

Churg-Strauss syndrome

136
Q

Give an example of an ANCE- vasculitis

A

HSP

137
Q

Give 2 examples of large vessel vasculitis

A

GCA

Takayasu arteritis

138
Q

Give 2 examples of medium vessel vasculitis

A

Kawasaki disease

Polyarteritis nodosa

139
Q

Give 4 systemic conditions which have a vasculitis component

A

RA

SLE

IBD

Scleroderma

140
Q

Give 5 causes of mononeuritis multiplex

A

HIV/AIDS

RA

Sarcoidosis

Polyarteritis nodosa

Leprosy

141
Q

Why do patients with acromegaly act clumsily?

A

Bitemporal hemianopia!

Can’t see many obstacles

142
Q

Which blood test can diagnose acromegaly?

A

Insulin-like growth factor 1 (IGF-1)

143
Q

Which endocrine disorder is usually seen alongside acromegaly and why?

A

GH is an anti-insulin

Leads to a state of insulin resistance

Causing T2DM

144
Q

What is the most common cause of death in acromegaly?

A

Cardiovascular disease

145
Q

Give 8 signs of hypothyroidism

A

Dry/thinning hair

Dry skin

Bradycardia

Hyporeflexia

Goitre

Ataxia

Peaches and cream complexion

146
Q

Give 3 causes of hypothyroidism

A

Iodine deficiency

Hashimoto’s thyroiditis

Thyroid cancer

147
Q

Give 1 sign of hypothyroidism seen on FBC

A

Macrocytic anaemia

148
Q

What is the embryological origin of the thyroid, prior to it’s descent?

A

Foramen caecum

149
Q

Give 2 drugs used to “block” thyroid function in hyperthyroidism

A

Carbimazole

Propylthiouracil

150
Q

Describe the presentation of diabetes insipidus

A

Excessive thirst

Weight loss

Increased urine production

151
Q

In diabetes insipidus, is plasma/urine osmolality high/low?

A

Plasma: high

Urine: low

152
Q

What drug is used to treat cranial diabetes insipidus?

A

Desmopressin

153
Q

What can result from repeated episodes of hypoglycaemia?

A

Reduced hypoglycaemic awareness

154
Q

What can cause hypoglycaemia in non-diabetic patients?

A

Liver failure, alcohol binge, pituitary insufficiency, Addison’s disease

155
Q

What dose of glucose is given in OGTT?

A

75g in 300ml water

Patient fasts overnight before test

156
Q

What times are blood glucose measures in OGTT?

A

Before test

120 mins after drinking liquid

157
Q

What criteria is needed to diagnose diabetes on OGTT?

A

> 7 on fasting

> 11.1 after 120 mins

158
Q

What bedside investigation is conducted to diagnose DKA?

A

Urine dip - presence of ketones

159
Q

What blood tests are conducted to diagnose DKA?

A

FBC

U&E (for K+)

ABG

160
Q

Describe the pathophysiology of DKA

A

Insulin deficiency causing glucose production by liver

Causes lipolysis and subsequent breakdown of fatty acids into ketones

161
Q

Describe the pathophysiology of Addison’s disease

A

Autoimmune destruction of adrenal glands

Causing primary hypoaldosteronism

162
Q

What test is used to diagnose Addison’s disease?

A

Short synacthen test

U&E

163
Q

What medication is used to treat Addison’s disease?

A

Mineralocorticoid - hydrocortisone

164
Q

Give 5 symptoms of prolactinoma

A

Galactorrhoea (milky nipple discharge)

Visual field defect (bitemporal hemianopia)

Headache

Subfertility

Decreased libido

165
Q

What medication is used to treat prolactinoma?

A

Cabergoline/bromocriptine

(Dopamine agonists)

166
Q

What medication can be used to treat acromegaly?

A

Octreotide (somatostatin analogue)

167
Q

Give 7 symptoms of hypercalcaemia

A

Depression

Weakness

Polydipsia

Polyuria

Constipation

Bone pain

Abdominal pain

168
Q

Give 2 risks of parathyroidectomy

A

Hypoparathyroidism

Laryngeal nerve palsy

169
Q

Give the function of vit. D in relation to calcium

A

Facilitates the absorption of calcium in the gut

170
Q

Which sense is lost first in diabetic peripheral neuropathy?

A

Vibration sense

171
Q

What signs may be seen in the feet of diabetic patients?

A

Charcot’s joint

High arched foot

Clawing of toes

Diminished reflexes

172
Q

What types of neuropathy may occur in diabetic patients?

A

Autonomic neuropathy

Diabetic amyotrophy

Mononeuritis multiplex

173
Q

What may cause profuse vomiting in poorly controlled diabetic patients?

A

Autonomic gastroparesis

Finals (11 decks)

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