SBA 3 Mock Flashcards
COPD spirometry results
FEV <80% predicted
FEV1/FVC <0.7
COPD = Obstructive
Pharmacological management of adult diagnosed with asthma
- SABA - Salbutamol
- Low ICS - beclomethasone
- LTRA - Montelukast
- LABA - Salmeterol
- MART = ICS + fast-LABA
6 Mod ICS
7. High ICS
What would indicate that a pt should add ICS to their asthma management?
If they:
- use SABA > 2/week +/- asthma symptoms
- use SABA >2/week +/- woken at night by asthma weekly
Which lung cancer is strongly associated with cigarette smoking?
Small Cell Carcinoma
Which lung cancer is most common in NON-SMOKERS? Any risk-factors?
Adenocarcinoma
RF: Asbestos exposure
Common sites for lung cancers to metastasise to?
Adrenal glands Bone Brain Liver Lymph nodes
Common site for breast cancer to metastasise to?
Lungs
but lung cancer does not usually metastasise to breast
Pt is a 55yr old pilot. He is a smoker. He has noticed pain and swelling in his right calf for weeks but has ignored it. He now has pain in his chest.
Gold standard investigation for likely diagnosis? What RF does he have?
CT Pulmonary Angiogram
Likely diagnosis: Pulmonary Embolism
His RF:
- Likely DVT
- Long flights
- smoking
Most common causes of typical pneumoniae in both the community and hospital
TYPICAL CAP
1. Strep pneumonia
TYPICAL HAP
1. Staph aureus
COPD
1. Haemophilus influenza B
Causes of atypical bacterial pneumoniae
Are they detectable on gram stain?
Mycoplasma pneumonia
Chlamydophila pneumonia
Legionella pneumonia
- Not detectable on gram stain
Most common cause of pneumonia in COPD patients
Haemophilus influenza B
CURB-65 parameters and use
CAP Severity
Confusion
Urea >7
RR >30
BP s<90 or d<60
> 65
TB Management and side effects
4 for 2, 2 for 4 RIPE
Rifampicin - Red/orange
Isoniazid - peripheral neuropathy (give pyridoxine)
Pyrazinamide - uric acid: arthralgia, gout, rash
Ethambutol - Eyes; Optic neuritis
Chromosome 7 mutation
Cystic Fibrosis
c/s 7 codes CFTR protein > defective Cl- secretion/ Na+ absorption
Chromosome 6 mutation
Hereditary Haemochromatosis
Chromosome 13 mutation
Wilson’s disease
Chromosome 14 mutation
Alpha-1 Antitrypsin deficiency
Chromosome 21 mutation
Trisomy - Down’s syndrome
29-F presents with painless genital ulcer. She had unprotected sex with a new partner in the last 6 months.
EIA IgM is positive for syphilis. She has no allergies; she is not pregnant.
Management?
Primary Syphilis
1L: Benzathine penicillin
2L: Azithromycin/ Doxycycline (if penicillin-allergic)
Below are the underlying causes of Raynaud’s syndrome. What features differentiate them?
- Carpal Tunnel
- Dupuytren’s contracture
- SLE
- Hand arm vibration syndrome
- Carpal Tunnel - median nerve distribution weakness, tingling
- Dupuytren’s contracture - permanently flexed digits
- SLE - young, autoimmune, rash
- Hand-arm vibration - power tools
Pt presents with tingling, weakness and aching of his hands. He works an office job.
Likely diagnosis?
Repetitive Strain Injury
Meningitis management
- primary care
- hospital care
- prophylaxis
Primary care: Benzylpenicillin (if non-blanching rash)
Hospital:
1. IV Ceftriaxone
2. a) Amoxicillin - Neisseria
b) Ampicillin - Listeria (young, old, immunosuppressed)
c) Vancomycin - Strep pneumonia
d) Acyclovir - Viral
<3months - IV Cefotaxime + ampicillin/amoxicillin
Prophylaxis
- Ciprofloxacin
- Rifampicin
Bacterial causes of meningitis
Strep pneumonia
Neisseria meningitides
Haemophilus influenza
Listeria monocytogenes
SHiLN
Viral causes of meningitis
Enterovirus - Echo/Coxsackie
HSV
Measles, Rubella
Fungal causes of meningitis
Cryptococcus neoformans
Mycobacterial
Chemoprophylaxis for meningitis
Ciprofloxacin
Rifampicin
Most common work-related ill-health in the UK
1 Stress, anxiety, depression
Define sensitivity
The proportion of patients who have the disease AND test positive
Define specificity
The proportion of patients who don’t have the disease AND test negative
Define positive predictive value
The proportion of patients who test positive who have the condition
Define negative predictive value
The proportion of patients who test negative who don’t have the condition
Standard screening programmes in the UK
AAA
Breast
Cervical
Newborn/Infant Exam
Cardinal symptoms of Parkinson’s disease
Cardinal triad:
- Resting tremor
- Cogwheel rigidity
- Bradykinesia
Also depression!
Most common metastasis of cancer TO the brain?
To the brain, from:
- lung
- breast
- skin
- kidney
- bowel
Pt presents with weakness and atrophy of her peripheries. Her foot is dragging as she walks and her feet appear arched.
Likely diagnosis?
Charcot-Marie-Tooth (HMSN - inherited conditions that damage peripheral nerves)
- distal weakness
- foot drop
- pes cavus
Pt recently recovered from a viral infection. She complains of fatigue, and finds that she slows down when walking on flat land and needs to rest. She has a Coeliac disease, and she struggles to finish sentences.
Likely diagnosis? Management?
Myasthenia Gravis
- fatigue
- limb weakness
- bulbar weakness (dysarthria)
- worse on EXERTION
- AUTOIMMUNE
Mx:
- Prednisolone
- Acetylcholinesterase inhibitor - Pyridostigmine, Neostigmine
Acute mx: IV IgG, plasma
Temporal/ Giant cell arteritis triggers
Investigations
Management
Temperature change, shaving, combing, eating
Inv: Temporal biopsy w/in 14 days starting steroids
- RAISED ESR, CRP, ALP, platelets
Management: Steroids
Headache that occurs in cyclical patterns, with severe pain in one eye + tearing/ nasal congestion/ runny nose
Cluster headache
Headache that is dull, aching and feels tight around your forehead. Scalp, neck and shoulders are tender.
Tension headache
Median nerve roots
C5-T1
Brachial plexus:
- lateral cord: C5-7
- medial cord: C8-T1
How long after a seizure must a patient wait before they can have their license reinstated?
12 months
Features of Rheumatoid arthritis on X-Ray
Lost joint space
Erosions
Soft-tissue swell
Soft bones (osteopenia)
Pt has a history of chronic alcoholism and liver disease.
What would you expect to find on their FBC?
- Macrocytic anaemia, raised MCV
