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Year 3 > SBA DECK 11/4 > Flashcards

SBA DECK 11/4 Flashcards

1
Q

what is first line management for haemodynamically stable v tach?

A

amiodarone

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2
Q

how is spinal cord compression due to malignancy treated?

A

16mg daily dexamethasone

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3
Q

how is renal cancer managed?

A

t1= partial nephrectomy

t2 or above= radical nephrectomy, partial if other kidney is working insufficiently

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4
Q

what are vagal manoeuvres used for?

A

first line treatment of SVT

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5
Q

what are the defining features of nephrotic syndrome?

A

proteinuria (>3-3.5g/day)
hypoalbuminaemia
hyperlipidaemia
periorbital and peripheral oedema

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6
Q

what is a common side effect of oral bisphosphonates?

A

oesophageal reactions eg oesophagitis, dysphagia, erosions, strictures

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7
Q

how does treatment with digoxin affect an ECG?

A

causes downsloping of ST segments- looks similar to ST depression

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8
Q

what 2 conditions is the HLA B27 gene associated with?

A

ankylosing spondylitis

UC

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9
Q

how does ankylosing spondylitis present?

A

back pain
worse in the morning
better with exercise

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10
Q

what abdominal regions is loin to groin pain associated with?

A

starts in the flank

moves to the iliac fossa

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11
Q

how does lead poisoning present?

A 
abdo pain
haemolysis 
peripheral neuropathy\
confusion
bowel disturbance 
metallic taste in mouth
blue line on gums
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12
Q

in acute neuro, do we do non contrast CT head or contrast CT head?

A

non contrast CT head

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13
Q

what test is diagnostic for septic arthritis?

A

microscopy of joint fluid aspirate (will have a high WCC of which is mostly neutrophils- 90%)

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14
Q

what are those with coeliacs disease more at risk of?

A

small bowel lymphoma

adenocarcinoma

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15
Q

what is the most common complication of dialysis?

A

dialysis induced hypotension

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16
Q

how is uncomplicated mastitis managed?

A

tell them to keep breast feeding so that ilk is not static in the ducts, this can cause ascending infection

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17
Q

what is a good way to manage postural hypotension?

A

increase dietary salt intake

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18
Q

what is GS ix for coeliacs disease and what is seen?

A

endoscopy with duodenal biopsy

atrophy of villi and crypt hyperplasia are seen

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19
Q

if diagnostic imaging is not available immediately for suspected DVT what should management be?

A

anticoagulation with DOACs eg rivaroxiban and apixaban

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20
Q

what should you think when you see hypersegmented neutrophils?

A

b12 deficiency

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21
Q

what medications can be given for cluster headaches?

A

nasal sumatriptan for prevention

verapamil for prevention

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22
Q

what ethnicity is more likely to get MS?

A

scandanavian

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23
Q

what are some ways a posterior circulation stroke presents?

A

vertigo
dysarthria
ataxia

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24
Q

what is honeycombing on high res chest CT suggestive of?

A

pulmonary fibrosis

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25
Q

what is a mottled, lace like appearance on the legs called?

A

livedo reticularis

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26
Q

in what conditions might you get livedo reticularis? when is it normal?

A

it is normal in cold temps

is abnormal when it doesn’t go away eg antiphospholipid sydnrome

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27
Q

what conditions are indicative for a pacemaker?

A 
symptomatic bradycardia
mobtiz type 2 AV block
third degree heart block
severe HF
HOCM (ICD)
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28
Q

what does alpha 1 antitrypsin deficiency cause?

A

SOB
wheeze
jaundice

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29
Q

what is the likely diagnosis if there are lung symptoms and jaundice?

A

alpha 1 antitripsin deficiency

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30
Q

what happens to d dimer levels in DIC? why?

A

they rise

it is a fibrin degradation product and in DIC there are lots of blood clots

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31
Q

is there bleeding or thrombosis in DIC?

A

there can be both

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32
Q

what type of drug is naproxen?

A

an NSAID

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33
Q

what is used to manage pseudogout?

A

NSAIDs first line

if this doesnt work colchicine

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34
Q

what is a significant side effect of colchicine?

A

GI disturbance- most significantly diarrhoea

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35
Q

what antihypertensives should not be used during pregnancy and why?

A

ace inhibitors

they are potentially teratogenic

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36
Q

what is the most common glomerulonephritis?

A

IgA nephropathy

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37
Q

what are signs of brugada syndrome on ECG?

A

coved ST segment elevation

saddle/ saddle back shaped ST segment

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38
Q

what is first line and definitive investigation for giant cell arteritis?

A

first line= ESR, CRP, FBC, LFTs

definitive= temporal artery biopsy

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39
Q

what type of drug is labetalol?

A

beta blocker

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40
Q

what is the initial step in management for stanford type A dissection and why?

A

IV beta blocker to reduce HR

this must be while the patient is being transferred to theatre for surgical repair

41
Q

what is the best initial investigation for a painful hip?

A

x ray of the pelvis/hip

42
Q

how does rheumatic fever present?

A

preceding: sore throat, malaise, fever, arthralgia

clinical features: new murmur (aortic stenosis)

43
Q

what pathogen causes rheumatic fever?

A

group a beta haemolytic streptococcus

44
Q

what long term treatment is needed for rheumatic fever and why?

A

penicillin to prevent progression to rheumatic disease

45
Q

what might you find on abdo exam in infective endocarditis?

A

hepatosplenomegaly

46
Q

what is optic neuritis?

A

inflammatory demyelination of the optic nerve

47
Q

who is most likely to get optic neuritis?

A

adult women who live at high latitudes

48
Q

what is first line ix for optic neuritis?

A

MRI head

49
Q

what is given first and second line in bradycardia/ haemodynamic compromise? include dosage, how many time and at what intervals drugs can be given

A

first line: IV atropine 500 micrograms at 3-5 min intervals until 3mg is given
second line: IV adrenaline 2-10 mg

50
Q

what is first line treatment for focal seizures?

A

crabamazepine or lamotrigine

51
Q

what metabolic imbalance will an aspirin OD cause?

A

respiratory alkalosis or metab acidosis

52
Q

what does aspirin target?

A

non selective irreversible COX inhibitor

53
Q

what is acute angle closure glaucoma?

A

damage to the optic nerve due to a sudden raise in intra ocular pressure, arises due to closure of irido corneal angle so aqueous humor can’t be drained

54
Q

how does acute angle closure glaucoma present?

A 
headache
nausea
red eye
cloudy cornea
mid dilated pupil
visual disturbance eg seeing halos 
worse at night as the pupil dilates and the angle further closes
55
Q

when do symptoms of acute angle closure glaucoma get worse and why?

A

at night because the pupil dilates more in the dark and this closes the irido corneal angle more

56
Q

what is initial and long term management for acute angle closure glaucoma?

A

initial= topical beta blocker and IV acetazolamide

long term= peripheral iridiotomy (removal of part of the iris to drain the aqeous humor)

57
Q

what is seen on x ray/CT in chronic pancreatitis?

A

calcification

58
Q

when is amylase/lipase raised in pacreatitis?

A

only in acute situations

they will not be raised in chronic pancreatitis

59
Q

what eGFR value warrants start of dialysis?

A

eGFR<10

eGFR <15 in diabetic patients

60
Q

eGFR of what value warrants a start of haemodialysis in patients with diabetes?

A

<15

61
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

62
Q

what valve problem causes a low rumbling murmur? where is it best hear and with what

A

mitral stenosis

heard best at apex with bell

63
Q

what solution is best to use as diasylate in peritoneal dialysis? why?

A

1.5 % glucose solution

it is osmotic so it helps draws water across the semi permeable membrane

64
Q

in osteoarthritis what pain relief if given first and why?

A

paracetamol first for mild pain
NSAIDs should be reserved for more moderate pain, they are more effective at relieving MSK pain and they also have significant side effects

65
Q

how is gout managed first line?

A

first line NSAIDs

if contraindicated given colchicine

66
Q

when is allopurinol used in gout? when is it started and what is doage

A

for prophylaxis because it reduces levels of uric acid

it is started 2 weeks after an attack of gout at a low dose and then titrated up

67
Q

When someone is started on an ACEi for hypertension control, their baseline creatinine is measured. By how much does it have to rise and in how long to warrant stopping the ACEi?

A

It has to rise by more than 30% in 2 weeks

68
Q

what is a complication of glaucoma if it isn’t recognised and treated early?

A

peripheral visual field loss

69
Q

what is the most important immediate investigation when someone presents with guillian barre syndrome? why?

A

vital capacity- guillian barre can cause respiratory failure which can be fatal so it needs to be carefully monitored

70
Q

what is the most concerning complication of tricyclic antidepressant OD?

A

heart block

71
Q

what abnormality is myasthenia gravis strongly associated with and how do you test for this?

A

thymus abnormality

do a CT chest

72
Q

what does pancoast tumor compress?

A

the sympathetic chain

73
Q

what is temporal arteritis also known as?

A

giant cell arteritis

74
Q

what is the likely diagnosis if someone has an irregular narrow complex tachycardia?

A

AF

75
Q

how is a regular narrow complex tachycardia managed? give first and second line

A

first line= vagal manoeuvres

second line= IV adenosine (6mg to start and then go to 12mg and then to 18 if needed)

76
Q

what chemo is used for her2 positive breast cancer?

A

herceptin ie trastuzumab

77
Q

what is a common complication with herceptin/transtuzumab treatment?

A

cardiotoxicity causing HF

78
Q

how will someone with HF present?

A

ankle oedema
ascites
exertional dysponoea
paroxysmal nocturnal dyspnoea

79
Q

what is the main causative agent of infective endocarditis in IV drug users?

A

staph aureus

80
Q

what is first line treatment for pneumocystitis pneumonia?

A

co trimoxazole

81
Q

what are side effects of co trimoxazole?

A

steven johnsons syndrome
agranulocytosis
drug induced lupus

82
Q

how is ankylosing spondylitis managed?

A

exercise, NSAIDs and biologics if severe

83
Q

what ix are done for ankylosing spondylitis before referral, after referral and if diagnosis is highly suspected?

A

before referral at GP: inflammatory markers and bloods
at referral: HLA testing and antibodies
diagnosis highly suspected: MRI

84
Q

how is septic arthritis managed?

A

joint aspiration and wash out in theatre- it needs to be done in a sterile environment to avoid introducing new organisms
IV abx
Post op physiotherapy

85
Q

what infusion is used to lower raised ICP?

A

hypertonic saline solution

86
Q

what is used instead of mannitol? why is it used?

A

hypertonic saline solution
it is used to reduce raised ICP
it is used instead of mannitol because it works just as well and has less side effects

87
Q

what is the purpose of mannitol and hypertonic saline solution?

A

to reduce raised ICP

88
Q

why is mannitol not used commonly anymore?

A

because hypertonic saline works just as well as it and it doesn’t cause side effects

89
Q

what acute neuro problem are those with polycystic kidney disease at higher risk of?

A

sub arachnoid haemorrhage

90
Q

what is the most common inheritance pattern of polycystic kidney disease?

A

autosomal dominant

91
Q

what should remember when suspecting sepsis/acute medical conditions?

A

a lack of systemic symptoms doesn’t mean you can rule out the condition, the systemic symptoms might just not have appeared yet

92
Q

explain how hypothyroidism causes secondary hypotension

A

hypothyroidism causes decreased peripheral vascular resistance ie peripheral blood vessels dilate
this causes a compensatory increase in force of heart contraction and causes hypertension

93
Q

what do hypo v hyperthyroidism do to blood pressure? why/how

A

they both increase blood pressure and cause hypertension
hypothyroidism= causes dilation of peripheral blood vessels which causes a compensatory increase in HR causing hypertension
hyperthyroidism= directly increases HR causing hypertension

94
Q

how does addison’s disease present?

A 
hypotension
n+v
muscle weakness
fatigue
anorexia 
weight loss
hyper pigmentation (especially in palmar areas and creases)
95
Q

what is the diagnostic test for addisons? how does it work

A

synacthen test- a synthetic form of ACTH is given and cortisol levels are monitored, if they don’t rise this indicates adrenal insufficiency

96
Q

what is addisons? describe the onset

A

it is primary adrenal insufficiency due to destruction of the adrenal cortex
onset can be insidious or acute

97
Q

how is addisons managed?

A

with glucocorticoid (hydrocortisone and if not prednisolone) and mineralocorticoid (fludrocortisone) replacement

98
Q

what is the definitive diagnostic test for autoimmune hepatitis?

A

liver biopsy

99
Q

what should you say if a pregnant/ of child bearing age woman comes to concerned about being on azothioprine?

A

reassure them that there is research to demonstrate that pregnancy on azathioprine is safe and that it is not teratogenic

Year 3 (104 decks)

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