SAQ paper 2 notes/corrections

Question 1

features of an iron deficiency anaemia

Answer 1

hypochromic red cells
microcytic red cells
poikilocytosis
thrombocytosis

Question 2

what symptoms would you enquire about in a patient with suggested iron deficiency anaemia

Answer 2

menorrhagia (heavy periods!)
haematuria
haematemesis
PR bleeding
nose bleeds
gum bleeding
PREGNANCY

Question 3

features of iron deficiency anaemia on physical examination

Answer 3

pallor
pale conjunctiva
angular stomatitis
koilonychia (spoon shaped nails)
brittle nails
tachycardia
postural hypotension

Question 4

which serum protein carries iron around the body

Answer 4

transferrin

Question 5

which blood test is used to diagnose iron deficiency anaemia

Answer 5

serum ferritin

Question 6

would serum ferritin be high or low in an iron deficient anaemic?

Answer 6

low

Question 7

what symptoms does graves disease present with

Answer 7

D+
heat intolerance
agitation/anxiety
fatigue
exopthalmos
double vision
reduced vision

Question 8

what other causes than graves disease is there for hyperthyroidism

Answer 8

toxic nodular goitre
excessive iodine consumption
iodine goitre
pregnancy
multi nodular goitre
thyroiditis

Question 9

What is a TSH receptor antibodies test used for

Answer 9

confirm diagnosis of graves disease

Question 10

what are the three modalities of treatment for graves disease

Answer 10

anti thyroid drugs
radioactive iodine
thyroidectomy

Question 11

risk factors other than age and sex for osteoporosis

Answer 11

family history of OP
previous history of fractures
BMI<18.5
inactivity
smoking
alcohol

Question 12

what medications are given as a primary for osteoporosis

Answer 12

vitamin D and calcium
ADCAL

Question 13

what are relevant questions in a history of epilepsy

Answer 13

previous head injury, underlying brain disease, fever, history of fits, taken any drugs or alcohol

Question 14

what is the brain scan used after someone has an epileptic seizure

Answer 14

EEG
electroencephalography

Question 15

what features in a history of diarrhoea point to IBD

Answer 15

presence of blood or mucus in the stool, abdo pain, family history of bowel problems, presence of bloating, weight loss

Question 16

give histological features of ulcerative colitis

Answer 16

increase in plasma cells in the lamina propria, crypt distortion/branching/abcess/ulceration

Question 17

what features of a history would suggest asthma

Answer 17

diurnal variation, exertional shortness of breath, exertional wheeze

Question 18

what other investigations of asthma should be used, other than spirometry with reversibility

Answer 18

chest Xray, sputum, peak flow
neoplasm, infection, resp function test

Question 19

what feature of spirometry confirms obstructive airways disease

Answer 19

FEV1/FVC less than 0.7/70%

Question 20

in spirometry with reversibility what suggests asthma rather than COPD

Answer 20

Increase in FEV1 of > 400ml or 20% after 10 puffs of salbutamol

Question 21

what are the pathophysiological elements of asthma

Answer 21

airways inflammation
airways hypersensitivity
bronchospasm
bronchoconstriction

Question 22

what receptor does salbutamol work on

Answer 22

beta 2 adrenergic receptors

Question 23

three routes by which a carcinoma may metastasise

Answer 23

haematogenous (blood)
lymphatic
trans coelomic
iatrogenic spread

Question 24

which cancers can metastasis to bone

Answer 24

breast, thyroid, kidney, prostate, lung

Question 25

list diagnostic criteria for nephrotic syndrome

Answer 25

proteinuria >3g/l
hypoalbuminaemia <25g/l
oedema

Question 26

list complications of nephrotic syndrome

Answer 26

hyperlipidaemia- abnormal catabolism
thrombosis- due to renal loss of antithrombin III
infections- renal loss of Ig
renal impairment- due to hypovolaemia
anaemia- due to renal loss of ferritin
hypothyroid- renal loss of thyroid binding globulin

Question 27

what is the most likely histological classification of a patient with no underlying conditions and a failure to respond to treatment in nephrotic syndrome?

Answer 27

focal segment glomerulosclerosis

Question 28

if a urine culture of a suspected UTI has mixed growth what is the next step

Answer 28

ignore the result, send a second CSU, investigate other causes

Question 29

when is it appropriate to send urine samples for culture

Answer 29

pregnancy- if symptomatic or during first antenatal visit for asymptomatic bacteriuria
men with symptoms of UTI
severe symptoms
failed ABX tx

Question 30

give clinical features which support the diagnosis of SEVERE aortic stenosis

Answer 30

slow rising carotid pulse
reduced volume carotid pulse
ejection systolic murmur
heaving apex beat
systolic thrill

Question 31

which three initial tests would be used in a patient SOB with a suspected aortic stenosis

Answer 31

transthoracic echocardiogram
echocardiography
full blood count
chest Xray

Question 32

what is the best treatment option for severe aortic stenosis

Answer 32

surgical aortic valve replacement

Question 33

what is an alternative approach to a surgical aortic valve replacement?

Answer 33

transcatheter aortic valve implantation
well established, more effective and safer than balloon aortic valvuloplasty

Question 34

possible symptoms of severe anaphylactic shock

Answer 34

diffuse erythema
coughing, wheezing
faintness, hypotension
abdominal pain, v+ D+

Question 35

what is the mechanism of action of adrenaline

Answer 35

alpha and beta adrenergic receptor agonists

Question 36

in anaphylaxis which other drugs are given to reduce the severity of the reaction

Answer 36

IV chlorphenamine
IV hydrocortisone