SBA DECK 18/4 Flashcards
what type of HF does diastolic dysfunction cause?
HFpEF
what type of HF does systolic dysfunction cause?
HFrEF
What are some clinical signs of HFpEF?
slower onset
reduced heart sounds
S3 is heard
what dose of adrenaline is given to patients when an anaphylactic reaction occurs? via what rute
0.5 ml 1 in 1000 adrenaline IM
1 in 1000 is 1g in 1000mls
what is the most common cause of portal hypertension? what type of cause is this
cirrhosis is the most common cause. it is a hepatic cause of portal hypertension
what is caput medusae a sign of?
portal hypertension
how do oesophageal varcies arise?
when the pressure in the portal system is higher than in the systemic system blood is redirected to systemic circulation by collaterals. These vessels dilate and can rupture if too much blood is flowing into them at a very high pressure
how do you treat an upper GI bleed?
ABCDE assessment insert 2 wide bore cannulae for IV access IV fluids catheterise urgent edoscopy
what score is used when someone has an acute upper GI bleed?
glasgow blatchford
how is paracetmol OD managed?
n acetylcysteine
give immediately if the OD was staggered
if paracetamol taken is not known and they are well, can measure serum paracetamol and then decide if treatment is needed
what is n acetylcysteine used for?
paracetamol OD
what is seen on MRI in huntington’s?
atrophy of caudate nucleus and putamen
how is huntington’s pharmacologically managed?
there is no management and no medications to slow the progression of disease
what is riluzole used for?
to slow the progression of MND
what is seen on MRI in alzheimers?
generalised atrophy and enlargement of sulci and ventricles
give some examples of DMARDs?
methotrexate
sulfasalazine
hydroxychloroquine
leflunomide
when are biologics used in RA and what type (give specific names)
they are used in severe disease (DAS28 score above 5.1)
anti TNF alpha are used first line, most commonly infliximab
what artery is commonly associated with first degree heart block?
right coronary artery
what is the first choice drug for epilepsy in pregnancy?
lamotrigine
what is carcinoid syndrome?
when a neuroendocrine tumor metastasises to the liver
what size stones in renal colic warrant what treatment?
<5mm= watchful waiting under urology 5-10mm= alpha blocker and wait for it to pass >10mm= surgical management/ shockwave lithotripsy
when is adrenaline given when someone collapses? how often can it be administered
after 3 shocks are administered
give every 1-2 mins thereafter
what rhythms are shockable?
pulseless VT and VF
what are DVLA guidelines on stopping driving due to hypoglycaemia?
if someone has more than one episode of severe hypoglycaemia they must tell the DVLA and cannot drive anymore (their license is taken away but they can reapply 3 months later)
how is mallory weiss tear managed?
it resolves by itself
what abx are used for osteomyelitis?
IV flucoxacillin and rifampicin
what antibody is associated with autoimmune haemolytic anaemia?
IgM
what test is used for autoimmune haemolytic anaemia?
direct coombs test
what is first line treatment for ascites? what is second line
first line spironolactone
if this doesnt work second line furosemide
what blood test should you always do in someone with suspected depression? why?
TFTs
hypothyroidism is a common cause of depression
what might cause cushings triad?
brainstem compression
what is cushings triad?
hypertension
bradycardia
irregular breathing
how does nimodipine work in subarachnoid haemorrhage?
it reduces vasospasm to optimise cerebral perfusion
what medication used for SVT is contraindicated in asthmatics? what is given instead?
adenosine
verapamil is given instead
how does haemoglobin level change after massive blood loss?
it remains unchanged because it is a measure of conc of haemoglobin which doesnt change with loss of volume
what happens to residual volume in COPD? explain why
in increases because patients are unable to expel all the air out from their lungs
how many episodes are needed per hour in the apnoea hypopnoea index to diagnose OSA?
15 or more
lymph node from what cancer might be painless and then painful after drinking alcohol?
hodgkin’s lymphoma
what type of arrhythmia is wolff parkinson white syndrome?
supraventricular tachycardia
what is used for prophylaxis long term after someone has a variceal bleed?
beta blocker
what is FEV1/FVC in an obstructive condition?
<0.7
what is normal FEV1/FVC?
> 0.7
out of FVC and FEV1 what is the numerator when calculating the ratio between them?
FEV1
so the ratio is FEV1/FVC
what happens to FEV1/FVC in pulmonary fibrosis?
the ratio is normal because they are bith reduced
if someone presents with lethargy and fever after receiving chemo what should you suspect they have? how is this managed
neutropeaenic sepsis
send them to hospital for IV abx- tazocin usually
what ix can you not do when someone has a pharyngeal pouch and why?
endoscopy- can’t do because there is a risk of perforation
how is pharyngeal pouch managed?
if not symptomatic you don’t have to do anything
can surgically resect it
what vasculitis presents similar to herpes with mouth and genital ulcers? how can you differentiate it?
bechet’s disease
in the triad with mouth and genital ulcers there will also be eye symptoms (uveitis) and erythema nodosum
what is the diagnosis if there are mouth and genital ulcers, uveitis and erythema nodosum?
bechets disease
what is given when some had an anaphylactic reaction?
500 micrograms adrenaline (1:1000)
how does adrenaline help in an anaphylactic reaction?
it reduces angioedema to minimise airway compromise
it increases blood pressure
what are the ules for anticoagulation for someone with valvular disease who has AF?
they must be anticoagulated despite chadsvasc score
they should be anticoagulated with vitamin K antagonists like warfarin and not DOACs
what type of anticoagulant is used in AF patients?
valvular disease= vitamin k antagonists
non valvular disease= DOACs
what anticoagulant is a vitamin K antagonist?
warfarin
what is the character/colour of CSF in someone with bacterial meningitis?
it will be cloudy/purulent
what urological affect do tricylic antidepressants have?
urinary retention
how does paget’s disease of the breast present?
nipple eczema and an underlying lump, usually in over 50s
what does autonomic neuropathy due to poorly controlled diabetes cause?
gastroparesis (feeling full v soon into a meal, nausea, bloating etc)
postural hypotension
what stain is used for pneumocystitis pneumonia?
silver stain
in what condition is there loss of outer third of the eyebrow?
hypothyrodism
what is first line diagnostic ix for stable angina?
CT coronary angiogram
what is aplastic anaemia?
when the bone marrow doesn’t produce enough blood cells
in a severe flare of UC how many stools need to be passed per day?
6
how is a moderate flare of UC managed?
topical or oral aminosalicyclate
what is a crypt abscess?
a collection of neutrophils in an intestinal crypt
what are histological findings in UC disease?
crypt abscess
goblet cell depletion
changes limited to the submucos
in what type of IBD are crypt abscesses seen? what is this?
ulcerative colitis
collections of neutrophils in intestinal crypts
what is a percutaneous endoscopic gastrostomy (PEG) tube used for?
used in patients who cannot eat or drink long term and have a high risk of aspiration
is thrombus or embolus more common in cerebrovascular accident?
thrombus
what is the difference between carbimazole and carbamazepine and what are they used for?
carbimazole= used alongside propanolol in hyperthyroidism carbamazepine= an antiepileptic
what is fulminant liver failure?
acute liver failure
what is chronic liver failure?
liver failure on a background of cirrhosis
what is the diagnostic test for typhoid fever?
bone marrow aspirate and culture is most sensitive
can also do blood cultures or stool cultures
how is typhoid fever managed?
abx- cipro unless resistant
supportive treatment
advise that they are contagious so hand washing and contacts etc
what are common side effects of levodopa?
hypotension
restlessness
GI upset
with long term use= drug induced dyskinesia (slow writhing movements)
what vaccines are contraindicated in those on methotrexate? why?
live vaccines because they are too immunosupressed
what drugs are given in heart failure?
ace inhibitor
beta blocker
spironolactone
if in a SAH non contrast CT head is unclear, what test can be done, when should it be done and what will be seen?
do a LP 12 hrs after onset and look for xanthochromia
what cells might be seen on blood film in someone who has had a splenectomy? what does this mean
target cells might be seen but they are non specific
what is target hba1c for an adult with diabetes managed with lifestyle and one drug?
48 mmol/L
what is the most appropriate first test for addison’s disease?
9am cortisol test
what is 9am cortisol used for?
addisons disease
what happens to ventricles and sulci on CT head in hydrocephalus?
ventricles enlarge and sulci are absent
what happens to potassium in DKA?
it is low
what is a common cause of hypokalemia?
DKA
what is used to investigate carotid stenosis?
carotid doppler
once it has been identified do CT/MR angiography
in whom might carotid endartectomy be done?
those with symptomatic TIA
those with good recovery from stroke
those who had CVAs involving anterior circulation
if a patient’s stable angina is not controlled by a beta blocker what should the next step for medication be?
add a dihydropiridine CCB
what is a myoclonic seizure?
sudden jerking of the limb/ random movements
what is first line management when you see bradycardia?
IV atropine 500 micrograms
what is atropine used for? what is the route and dose?
bradycardia
give it IV 500 micrograms
when someone presents with acute epididymitis secondary from suspected STI what should you give them and what does this cover?
IM ceftriaxone and PO doxycycline
this covers gonorrhoea and chlamydia
what presents with confusion and seizure acutely when there are no signs of meningism?
encephalitis
what is the most common causative organism of encephalitis?
herpes simplex virus
is encephalitis more commonly bacterial or viral?
viral
how is encephalitis managed?
IV aciclovir
what is first line medication for maintaining remission in crohn’s?
azothioprine
or mercatopurine
what is a specific sign for early HIV presentation?
macropapular rash on upper body
mucosal ulcers
what are macropapular rash on upper body and mucosal ulcers a sign of?
early signs of HIV infection
what medication is used to treat bi polar disorder and how does it work?
lithium- it reduces the number of manic episodes
what affect does dopamine have on prolactin?
it inhibits prolactin release
in what time must a patient present with MI for PCI to be the primary management? what happens if they present after this time?
if they present within 12 hr symptom onset PCI is first line
if they present after 12 hours PCI should be considered as first line
what class of drugs commonly cause galactorrhea as a side effect?
antipsychotics
what is first line analgesia in someone with renal colic? when should it be used with caution?
diclofenac
use with caution if someone has kidney failure
what is diclofenac?
analgesia (commonly used first line in renal colic)
what medication is used to relieve itching in PBC?
cholestyramine
what do patients need to be warned about when they take cholestyramine?
take it 2-4 hrs before eating as it affects absorption of food
what is first line treatment for HHS?
hydrate with 0.9% saline over an hour (give 1L)
what happens to epithelial cells in cystic fibrosis?
there is increased sodium absorption and chloride secretion leading to thickening of mucus
what is creon?
enzyme replacement
what might be seen in CSF in SAH after 12 hrs? what is this
xanthochromia- this is the presence of red blood cells
what is given for hyperthyroidism in the first trimester of pregnancy? why?
propyluracil
because carbimazole is contraindicated (it can cross the placenta and have negative affects on the foetus)
when is carbimazole contraindicated for hyperthyroidism?
in the first trimester of pregnancy
if transsphenoidal surgery cannot be done for acromegaly caused by tumor how is it managed?
ocreotide which is a somatostatin receptor ligand
what type of drug is ocreotide?
somatostatin receptor ligand
what is common supportive therapy for any bowel obstruction? explain
drip and suck
drip= IV fluids to maintain hydration
suck= insert an NG tube to decompress
also note: they should be NBM
what is thumbprinting a sign of?
toxic megacolon
what diuretic is used first line for ascites?
spironolactone
what type of diuretic is spironolactone?
potassium sparing
how will cystic fibrosis present? explain why
recurrent pneumonia- due to thickening of mucus and reduced clearance there is high risk of infection
diabetes- due to pancreatic insufficiency reduced insulin
steatorrhea- due to pancreatic insufficiency reduced lipase causes lack of fat absorption
how is cardiac tamponade managed?
urgent pericardiocentesis
what is beck’s triad? when is it seen?
muffled heart sounds
raised JVP
hypotension
is seen in cardiac tamponade
how are symptomatic, benign peptic strictures managed?
balloon dilatation following benign biopsy
what is a common lung complication of APS?
pulmonary embolism
what is contraindicated in toxic megacolon and why?
NSAIDs and analgesia as they increase risk of perforation
where is b12 normally absorbed?
terminal ileum
how is wernicke’s encephalopathy managed?
IV pabrinex (thiamine replacement)
what is the triad for wernicke’s encephalopathy?
confusion
ataxia
nystagmus/opthalmoplegia
what is pabrinex?
thiamine replacement
what do you need to test patients for before starting a biologic? why?
latent TB because biologics can cause reactivation of TB
what cardiac emergency does marfans syndrome increase the risk of developing?
aortic dissection
when you see blood transfusion what should you think of risk of?
HIV transmission- especially if done in a rural area/ less developed country
what does a brown grey tinge of the skin indicate?
urea build up
what needs to be corrected first when someone presents with HHS and how is this done?
dehydration
give them 1-2L 0.9% saline over an hour
how does CKD affect calcium levels?
causes hypocalcaemia
explain how CKD causes hypocalcaemia
less phosphate is removed from the blood so the calcium in the blood binds to excess phosphate and serum calcium falls
vitamin D is also not converted to its active form so absorption of calcium falls
what test helps identify carcinoid syndrome?
urinary 5-HIAA
what abx can cause jaundice in someone being treated for pneuonia?
co amoxiclav
what is the only type of shock that will cause warm peripheries
distributive
how does methotrexate work and what must you not give alongside it?
it impairs folate metabolism
you shouldn’t give any other drugs that impair folate metabolism alongside it
what type of anaemia does koilonychia and menorrhagia suggest?
iron deficiency
what might trigger an addisonian crisis?
stopping long term steroids trauma infection injury surgery
what are symptoms of an addisonian crisis?
dizziness vomitting weakness hyponatremia hyperkaelmia hypoglycaemia hypercalcaemia
