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Year 3 > SBA DECK 03/5 > Flashcards

SBA DECK 03/5 Flashcards

1
Q

what side of the heart is strained in PE and why?

A

right side

there is backflow of blood from the pulmonary vasculature due to the embolism blocking vessels

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2
Q

what type of lung cancer is most associated with smoking?

A

SCLC

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3
Q

if there is a lesion in the spinal cord, on what side is there loss of pain/temp (+where) and on what side are there UMN signs?

A

loss of pain/temp= contralateral side starting 2 vertebral levels below the lesion
UMN signs= ipsilateral side

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4
Q

what type of sepsis does chemo cause and how is this managed?

A

neutropenic sepsis

manage with IV abx

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5
Q

what is co2 level in life threatening/ severe asthma?

A

it can be normal

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6
Q

what are signs of life threatening asthma?

A 
cyanosis
use of accessory muscles
inability to complete a sentence 
PEF <33%
o2 sats <92% 
silent chest
hypotension
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7
Q

what is initially measured in blood if someone is suspected to have acromegaly? what will be seen

A

IGF-1

it will be raised

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8
Q

what ix is used to confirm a diagnosis of acromegaly once someone’s IGF is raised?

A

OGTT with serial GH measurements

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9
Q

why does acromegaly cause galactorrheoa?

A

GH stimulates milk production

GNRH also increases prolactin production causing hyperprolactinaemia

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10
Q

how is angina pharmacologically managed?

A

all patients should be on aspirin and a statin unless contraindicated
GTN spray to abort angina attacks
first line use either a CCB (rate limiting) or a beta blocker

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11
Q

how long should patients be anticoagulated if they have a DVT?

A

provoked (eg surgery)= 3 months

unprovoked= 6 months

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12
Q

what electrolyte imbalance is likely to happen in bowel obstruction and why?

A

hypokalemia
the proximal section of the bowel will undergo enlargement and peristalsis causing secretion of electrolytes especially potassium

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13
Q

what is the most common cause of drug induced angioedema?

A

ace inhibitors

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14
Q

if PCI is not possible for STEMI, in how much time must fibrinolysis be offered?

A

12 hours

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15
Q

in bells palsy is the affected nerve on the ipsilateral or contralateral side to the side of the face where the patient has symptoms?

A

ipisilateral

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16
Q

what is hba1c target for a patient with diabetes who is on a sulphonylurea? why?

A

53

it may cause hypoglycaemia

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17
Q

what class of drug for diabetes might cause hypoglycaemia?

A

sulphonylurea

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18
Q

what medications are used to manage encephalitis?

A

IV acyclovir- to cover viral infection

IV ceftriaxone- to cover bacterial infection

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19
Q

what 2 common medications can worsen asthma symptoms?

A

aspirin

beta blockers

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20
Q

what happens to sodium and potassium levels in conns syndrome?

A

hypernatraemia

hypokalemia

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21
Q

what happens to vocal resonance over a tension pneumothorax?

A

decreases

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22
Q

how does furosimide help in cardiac failure?

A

it only provides symptomatic relief

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23
Q

what are the 2 shockable rhythmns?

A

v fib

pulseless VT

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24
Q

what are target oxygen sats for someone with COPD?

A

88-92%

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25
Q

how does myocarditis present?

A

follows a viral illness

chest pain and SOB- pain in sharp, severe, doesnt change with movement

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26
Q

what % do the carotids need to blocked for there to be indication for a carotid endartectomy?

A

over 50% with previous hx of TIA or stroke

over 70% without previous hx of TIA or stroke

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27
Q

how can you differentiate compartment syndrome from critical limb ischaemia?

A

compartment syndrome= pulses are usually palpable

critical lim ischaemia= 6Ps therefore no pulses

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28
Q

how do you manage someone with heart failure and renal failure?

A

the renal failure is usually do to poor cardiac output causing reduced perfusion to the kidney
cardiac output is poor because fluid build up due to renal failure means there is reduced stroke volume (too much fluid returns to the heart, starlings law etc)
therefore treatment involves diuresing the patient so stroke volume can improve along with perfusion to the kidney

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29
Q

what are the 2 biopsy methods for breast. Which is better for identifying histology?

A

fine needle aspiration biopsy- only gives info about cytology
core biopsy- this is better for analysing histology

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30
Q

how many blood cultures need to be in infective endocarditis and from where?

A

3 sets of cultures from different sites

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31
Q

what artery does giant cell arteritis affect?

A

temporal

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32
Q

what is the triad for optic neuritis?

A

visual loss
loss of colour vision
periocular pain

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33
Q

what is gilberts syndrome?

A

a genetic condition where there is deficiency of the enzyme which conjugates bilirubin

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34
Q

how will gilberts syndrome present?

A

episodes of jaundice where LFTs are normal and the patient is asymptomatic but there is an isolated rise in unconjugated bilirubin

35
Q

how is gilbert’s syndrome managed?

A

no management is needed just reassure them

36
Q

what might trigger episodes of jaundice in gilberts syndrome?

A

stress eg illness, exercise and fasting

37
Q

what is indapamide?

A

a thiazide like diuretic

38
Q

what anti emetic is contraindicated in bowel obstruction and why?

A

metaclopromide because it is pro kinetic so it might cause perforation

39
Q

what steroid is given immediately for spinal mets?

A

dexamethasone

40
Q

what is the most common cause of hypothyroidism worldwide?

A

iodine deficiency

41
Q

whats first line management for someone with SVT who is haemodynamically stable?

A

carotid sinus massage

42
Q

what abx are given for severe cellulitis?

A

IV benzylpenicillin and flucoxacillin

43
Q

what dose of prednisolone is given in giant cell arteritis?

A

60 mg dexamethasone daily (high dose in order to prevent irreversible blindness)

44
Q

when are triptans taken and what are they used for?

A

used to stop an acute attack of migraine

they should be taken at the start of the headache (not at the start of aura)

45
Q

what is temporal artery biopsy used for? what are results

A

it is used to help diagnose temporal arteritis
it is important to remember a negative result does not exclude diagnosis because there may be skip lesions so where the biopsy was taken might be unaffected

46
Q

what is first line ix for peripheral arterial disease?

A

duplex ultrasound

47
Q

what deficiency does isoniazid cause and what does this result in?

A

causes a b6 deficiency causing polyneuropathy

48
Q

what is the difference in presentation of diarrhoea in UC vs crohns

A 
crohns= non bloody diarrhoea
UC= bloody diarrhoea
49
Q

what CK isoenzyme will be elevated in a reinfarct?

A

CK MB

50
Q

describe pain in osteoarthritis?

A

unilateral/ isolated joint pain
morning stiffness is not prolonged (<20 mins)
worse with movement and at the end of the day

51
Q

what are features of osteoarthritis on x ray? what oneumonic is used to remember?

A 
LOSS:
loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis
52
Q

how is osteoarthritis managed?

A 
conservative= weight loss, avoid weight bearing exercise 
pharmacological= for moderate disease paracetamol, if of hands or knee then paracetamol and topical nsaids, then progress to oral nsaids and opiates etc
53
Q

what is the defining feature of bechet’s disease?

A

relapsing remitting oral and genital ulcers

54
Q

how is status epilepticus managed?

A 
ABCDE
ensure IV access 
ABG
bloods 
anaesthetic review 
IV lorazepam 4mg (give a second dose if not effective, if no IV access then PR diazepam or buccal midazolam)
55
Q

what medications are given in status epilepticus? include specific doses, number of doses and alternative/second line medications

A

IV 4mg lorazepam
give this twice if it doesnt work first time
if there is no IV access give PR diazepam or buccal midazolam
if this still doesnt work give other anticonvulsants like levitiracetam, phenytoin etc

56
Q

what is first line medication in someone with painful peripheral neuropathy?

A

tricyclic antidepressants

57
Q

what should you think when you see heinz bodies?

A

G6PD deficiency

58
Q

in what condition do bisphosphonates need to be prescribed with great caution? what is done?

A

if someone has upper GI upset

advise them to take it in the morning, sitting upright with a glass of water

59
Q

in spinal stenosis what makes pain worse/ relieves it?

A 
worse= extension
better= flexion (ie sitting leaning forward)
60
Q

what are features of rheumatic fever?

A

erythema marginatum
syndenham’s chorea
polyarthritis
carditis and valvulitis

61
Q

how is rheumatic fever managed?

A

NSAIDs first line

oral penicillin

62
Q

what marker can be used to differentiate between type 1 and type 2 diabetes?

A

c peptide
in type 1 it will be low or undetectable because there is absolute insulin deficiency
in type 2 it may be raised

63
Q

what are causes of raised ferritin?

A

with iron overload= hereditary haemochromatosis or repeated transfusions
without iron overload= inflammation, alcohol excess, liver disease, CKD

64
Q

what cancer is lambert eaton syndrome associated with?

A

lung cancer

65
Q

what is pharmacological management of PE acute and long term? when is this indicated?

A

is there is a massive PE= thrombolysis with IV bolus of alteplase
long term anticoagulation with a DOAC

66
Q

what are the 5 causes of parkinsonism?

A 
parkinson's disease
progressive supranuclear palsy 
corticobasal degeneration
multi system atrophy 
lewy body dementia
67
Q

if someone has resting tremor, bradykinesia, hypertonia and jerky limb movements what parkinsonian syndrome are they likely to have?

A

cortico basal degeneration

68
Q

if someone has resting tremor, bradykinesia, hypertonia, cognitive decline and visual hallucinations movements what parkinsonian syndrome are they likely to have?

A

lewy body dementia

69
Q

if someone has resting tremor, bradykinesia, hypertonia, postural hypotension, impotence and incontinence what parkinsonian syndrome are they likely to have?

A

multi system atrophy

70
Q

if someone has resting tremor, bradykinesia, hypertonia, and vertical gaze palsy what parkinsonian syndrome are they likely to have?

A

progressive supranuclear nerve palsy

71
Q

if someone has adverse affects on an ACEi for hypertension control what should you give instead first line?

A

ARB

72
Q

what are features of a strangulated hernia?

A

irreducible, tender and erythematous lump

73
Q

how does scurvy manifest?

A

bleeding gums
ecchymoses
pale conjunctiva
expothalamos

74
Q

how can osteoarthritis be clinically diagnosed?

A

patient over 45 and activity related joint pain and no morning stiffness/morning stiffness that lasts <30 mins

75
Q

what is used as secondary prevention in myocardial infarction?

A 
ace inhibitor
plus beta blocker
plus statin
plus aspirin
plus antiplatelet drug
76
Q

what is fasting glucose and OGTT 2 hour glucose in someone with impaired glucose tolerance?

A

fasting glucose= <7
OGTT 2 hour glucose= >7.8 but <11.1

ie normal fasting glucose but raised 2 hour glucose

77
Q

what part of the brain is commonly involved in neurological deficits in encephalitis?

A

temporal lobes

78
Q

what is the vol of maintenance fluid that are usually prescribed?

A

25-30 ml/kg/day

79
Q

how is stroke managed?

A

non contrast CT head to rule haemorrhagic stroke
if presenting within 4.5 hrs= IV alteplase then start aspirin after 24 hrs
if presenting after 4.5 hrs= thrombectomy first line, if not possible aspirin
continue aspirin for 2 weeks and then switch to clopi lifelong

80
Q

what organism is the most common cause of food poisoning in the UK?

A

campylobacter jejuni

81
Q

what 3 drugs are given for PPI eradication therapy?

A

amoxicillin
clarithromycin
PPI

if they are allergic to penicillin give metronidazole instead of amoxicillin

82
Q

what is the most common organism for septic arthritis?

A

staph aureus

83
Q

what are fine end inspiratory crepitations a sign of?

A

idiopathic pulmonary fibrosis

84
Q

how much does systolic and diastolic blood pressure drop when there is orthostatic hypotension?

A

systolic= drops by at least 20mmHg
OR
diastolic= drops by at least 10 mmHg
after 3 mins of standing

Year 3 (104 decks)

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