SBA DECK 11/4 Flashcards
what is first line management for haemodynamically stable v tach?
amiodarone
how is spinal cord compression due to malignancy treated?
16mg daily dexamethasone
how is renal cancer managed?
t1= partial nephrectomy
t2 or above= radical nephrectomy, partial if other kidney is working insufficiently
what are vagal manoeuvres used for?
first line treatment of SVT
what are the defining features of nephrotic syndrome?
proteinuria (>3-3.5g/day)
hypoalbuminaemia
hyperlipidaemia
periorbital and peripheral oedema
what is a common side effect of oral bisphosphonates?
oesophageal reactions eg oesophagitis, dysphagia, erosions, strictures
how does treatment with digoxin affect an ECG?
causes downsloping of ST segments- looks similar to ST depression
what 2 conditions is the HLA B27 gene associated with?
ankylosing spondylitis
UC
how does ankylosing spondylitis present?
back pain
worse in the morning
better with exercise
what abdominal regions is loin to groin pain associated with?
starts in the flank
moves to the iliac fossa
how does lead poisoning present?
abdo pain haemolysis peripheral neuropathy\ confusion bowel disturbance metallic taste in mouth blue line on gums
in acute neuro, do we do non contrast CT head or contrast CT head?
non contrast CT head
what test is diagnostic for septic arthritis?
microscopy of joint fluid aspirate (will have a high WCC of which is mostly neutrophils- 90%)
what are those with coeliacs disease more at risk of?
small bowel lymphoma
adenocarcinoma
what is the most common complication of dialysis?
dialysis induced hypotension
how is uncomplicated mastitis managed?
tell them to keep breast feeding so that ilk is not static in the ducts, this can cause ascending infection
what is a good way to manage postural hypotension?
increase dietary salt intake
what is GS ix for coeliacs disease and what is seen?
endoscopy with duodenal biopsy
atrophy of villi and crypt hyperplasia are seen
if diagnostic imaging is not available immediately for suspected DVT what should management be?
anticoagulation with DOACs eg rivaroxiban and apixaban
what should you think when you see hypersegmented neutrophils?
b12 deficiency
what medications can be given for cluster headaches?
nasal sumatriptan for prevention
verapamil for prevention
what ethnicity is more likely to get MS?
scandanavian
what are some ways a posterior circulation stroke presents?
vertigo
dysarthria
ataxia
what is honeycombing on high res chest CT suggestive of?
pulmonary fibrosis
what is a mottled, lace like appearance on the legs called?
livedo reticularis
in what conditions might you get livedo reticularis? when is it normal?
it is normal in cold temps
is abnormal when it doesn’t go away eg antiphospholipid sydnrome
what conditions are indicative for a pacemaker?
symptomatic bradycardia mobtiz type 2 AV block third degree heart block severe HF HOCM (ICD)
what does alpha 1 antitrypsin deficiency cause?
SOB
wheeze
jaundice
what is the likely diagnosis if there are lung symptoms and jaundice?
alpha 1 antitripsin deficiency
what happens to d dimer levels in DIC? why?
they rise
it is a fibrin degradation product and in DIC there are lots of blood clots
is there bleeding or thrombosis in DIC?
there can be both
what type of drug is naproxen?
an NSAID
what is used to manage pseudogout?
NSAIDs first line
if this doesnt work colchicine
what is a significant side effect of colchicine?
GI disturbance- most significantly diarrhoea
what antihypertensives should not be used during pregnancy and why?
ace inhibitors
they are potentially teratogenic
what is the most common glomerulonephritis?
IgA nephropathy
what are signs of brugada syndrome on ECG?
coved ST segment elevation
saddle/ saddle back shaped ST segment
what is first line and definitive investigation for giant cell arteritis?
first line= ESR, CRP, FBC, LFTs
definitive= temporal artery biopsy
what type of drug is labetalol?
beta blocker
what is the initial step in management for stanford type A dissection and why?
IV beta blocker to reduce HR
this must be while the patient is being transferred to theatre for surgical repair
what is the best initial investigation for a painful hip?
x ray of the pelvis/hip
how does rheumatic fever present?
preceding: sore throat, malaise, fever, arthralgia
clinical features: new murmur (aortic stenosis)
what pathogen causes rheumatic fever?
group a beta haemolytic streptococcus
what long term treatment is needed for rheumatic fever and why?
penicillin to prevent progression to rheumatic disease
what might you find on abdo exam in infective endocarditis?
hepatosplenomegaly
what is optic neuritis?
inflammatory demyelination of the optic nerve
who is most likely to get optic neuritis?
adult women who live at high latitudes
what is first line ix for optic neuritis?
MRI head
what is given first and second line in bradycardia/ haemodynamic compromise? include dosage, how many time and at what intervals drugs can be given
first line: IV atropine 500 micrograms at 3-5 min intervals until 3mg is given
second line: IV adrenaline 2-10 mg
what is first line treatment for focal seizures?
crabamazepine or lamotrigine
what metabolic imbalance will an aspirin OD cause?
respiratory alkalosis or metab acidosis
what does aspirin target?
non selective irreversible COX inhibitor
what is acute angle closure glaucoma?
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
how does acute angle closure glaucoma present?
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
when do symptoms of acute angle closure glaucoma get worse and why?
at night because the pupil dilates more in the dark and this closes the irido corneal angle more
what is initial and long term management for acute angle closure glaucoma?
initial= topical beta blocker and IV acetazolamide
long term= peripheral iridiotomy (removal of part of the iris to drain the aqeous humor)
what is seen on x ray/CT in chronic pancreatitis?
calcification
when is amylase/lipase raised in pacreatitis?
only in acute situations
they will not be raised in chronic pancreatitis
what eGFR value warrants start of dialysis?
eGFR<10
eGFR <15 in diabetic patients
eGFR of what value warrants a start of haemodialysis in patients with diabetes?
<15
what is the most common cause of mitral stenosis?
rheumatic fever
what valve problem causes a low rumbling murmur? where is it best hear and with what
mitral stenosis
heard best at apex with bell
what solution is best to use as diasylate in peritoneal dialysis? why?
1.5 % glucose solution
it is osmotic so it helps draws water across the semi permeable membrane
in osteoarthritis what pain relief if given first and why?
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
how is gout managed first line?
first line NSAIDs
if contraindicated given colchicine
when is allopurinol used in gout? when is it started and what is doage
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
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?
It has to rise by more than 30% in 2 weeks
what is a complication of glaucoma if it isn’t recognised and treated early?
peripheral visual field loss
what is the most important immediate investigation when someone presents with guillian barre syndrome? why?
vital capacity- guillian barre can cause respiratory failure which can be fatal so it needs to be carefully monitored
what is the most concerning complication of tricyclic antidepressant OD?
heart block
what abnormality is myasthenia gravis strongly associated with and how do you test for this?
thymus abnormality
do a CT chest
what does pancoast tumor compress?
the sympathetic chain
what is temporal arteritis also known as?
giant cell arteritis
what is the likely diagnosis if someone has an irregular narrow complex tachycardia?
AF
how is a regular narrow complex tachycardia managed? give first and second line
first line= vagal manoeuvres
second line= IV adenosine (6mg to start and then go to 12mg and then to 18 if needed)
what chemo is used for her2 positive breast cancer?
herceptin ie trastuzumab
what is a common complication with herceptin/transtuzumab treatment?
cardiotoxicity causing HF
how will someone with HF present?
ankle oedema
ascites
exertional dysponoea
paroxysmal nocturnal dyspnoea
what is the main causative agent of infective endocarditis in IV drug users?
staph aureus
what is first line treatment for pneumocystitis pneumonia?
co trimoxazole
what are side effects of co trimoxazole?
steven johnsons syndrome
agranulocytosis
drug induced lupus
how is ankylosing spondylitis managed?
exercise, NSAIDs and biologics if severe
what ix are done for ankylosing spondylitis before referral, after referral and if diagnosis is highly suspected?
before referral at GP: inflammatory markers and bloods
at referral: HLA testing and antibodies
diagnosis highly suspected: MRI
how is septic arthritis managed?
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
what infusion is used to lower raised ICP?
hypertonic saline solution
what is used instead of mannitol? why is it used?
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
what is the purpose of mannitol and hypertonic saline solution?
to reduce raised ICP
why is mannitol not used commonly anymore?
because hypertonic saline works just as well as it and it doesn’t cause side effects
what acute neuro problem are those with polycystic kidney disease at higher risk of?
sub arachnoid haemorrhage
what is the most common inheritance pattern of polycystic kidney disease?
autosomal dominant
what should remember when suspecting sepsis/acute medical conditions?
a lack of systemic symptoms doesn’t mean you can rule out the condition, the systemic symptoms might just not have appeared yet
explain how hypothyroidism causes secondary hypotension
hypothyroidism causes decreased peripheral vascular resistance ie peripheral blood vessels dilate
this causes a compensatory increase in force of heart contraction and causes hypertension
what do hypo v hyperthyroidism do to blood pressure? why/how
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
how does addison’s disease present?
hypotension n+v muscle weakness fatigue anorexia weight loss hyper pigmentation (especially in palmar areas and creases)
what is the diagnostic test for addisons? how does it work
synacthen test- a synthetic form of ACTH is given and cortisol levels are monitored, if they don’t rise this indicates adrenal insufficiency
what is addisons? describe the onset
it is primary adrenal insufficiency due to destruction of the adrenal cortex
onset can be insidious or acute
how is addisons managed?
with glucocorticoid (hydrocortisone and if not prednisolone) and mineralocorticoid (fludrocortisone) replacement
what is the definitive diagnostic test for autoimmune hepatitis?
liver biopsy
what should you say if a pregnant/ of child bearing age woman comes to concerned about being on azothioprine?
reassure them that there is research to demonstrate that pregnancy on azathioprine is safe and that it is not teratogenic
