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Year 3 > SBA DECK 23/05 > Flashcards

SBA DECK 23/05 Flashcards

1
Q

what is first line management for HHS?

A

0.9% nacl at a rate of 1000ml/hour

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2
Q

what abx is used for infective endocarditis if caused by gram positive bacteria?

A

amoxicillin

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3
Q

how is stable angina managed?

A

beta blocker or rate limiting CCB

plus GTN spray

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4
Q

what endocrine conditions is pseudogout associated with?

A

hypothyroidism

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5
Q

what happens to fibrinogen levels in DIC? why?

A

they fall

due to excess clot production- fibrinogen is a coagulation factor needed to produce clots so will be used up on

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6
Q

what happens to d dimer in DIC? why?

A

it rises

d dimer is a fibrin degredation product and breakdown of lots of bloodclots causes it to be raised

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7
Q

what effect does thyrotoxicosis have on the heart?

A

high output cardiac failure

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8
Q

what side effect does adenosine cause?

A

chest pain

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9
Q

what is the most common cause of nephrotic syndrome in children?

A

minimal change disease

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10
Q

how is minimal change disease managed?

A

oral prednisolone

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11
Q

what abx is used for prohylaxis in COPD?

A

azithromycin

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12
Q

what condition is antinuclear antibody associated with?

A

SLE

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13
Q

what is synacthen?

A

synthetic ACTH

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14
Q

what is hereditary telangiectasia?

A

abnormal blood vessels causing bleeding and telangiectasis

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15
Q

how does prolactin affect testosterone, LH and FSH?

A

reduces them all

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16
Q

how do you ix acromegaly?

A

measure IGF-1 to identify excess GH

then do an OGTT

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17
Q

what anaemia does nsaids cause?

A

microcytic anaemia

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18
Q

how does portal hypertension present?

A

ascites
SBP
encephalopathy
variceal bleed

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19
Q

what do you see on blood film in HUS? why?

A

shistocytes

due to haemolytic anaemia

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20
Q

what will you see on blood film in haemolytic anaemia?

A

shistocytes

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21
Q

how do you identify uraemic syndrome?

A

high creatinine

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22
Q

what is the triad for HUS? how will this present?

A

haemolytic anaemia- shistocytes
uraemic syndrome- high creatinine
thrombocytopenia

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23
Q

what are the 3 types of MAHA? what does MAHA stand for?

A

microangiopathic autoimmune haemolytic anaemia

1) DIC
2) HUS
3) TTP

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24
Q

how do you differentiate HUS from TTP?

A 
HUS= triad of haemolytic anaemia, uraemia and thrombocytopenia 
TTP= HUS plus fever and neurological symptoms
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25
Q

what are the 2 types of haemolytic anaemias? what are causes of each?

A 
hereditary= G6PD deficiency, hereditary spherocytosis, sickle cell/thalassaemia 
acquired= autoimmune, drugs, infection, MAHA
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26
Q

what are the hypo/eu/hypervolemic causes of hyponatraemia?

A 
hypovolemic= vomiting, diarrhoea, diuretics
euvolemic= hypothyroidism, SIADH, adrenal insufficiency
hypervolemic= cardiac, liver or kidney failure
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27
Q

what are the 3 macro vascular complications of diabetes mellitus?

A

stroke
MI
PVD

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28
Q

what infections cause cavitating lung lesions?

A

legionella
klebsiella
staphyclococcus

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29
Q

what are the causes of cavitating lung lesions?

A

infections- klebsiella, staph, legionella
inflammation- rheumatoid arthritis
PE

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30
Q

what is hereditary haemorrhagic telangiectasia? how does it present?

A

an inherited disorder where blood vessels don’t form properly and are prone to bleeding
presents with epistaxis and telangiectasia

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31
Q

what is the most common causative agent for osteomyelitis? what about in those with sickle cell disease?

A

most common is staph aureus

most common in patients with sickle cell is salmonella

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32
Q

what murmur is mid systolic?

A

aortic stenosis

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33
Q

where is aortic stenosis best auscultated?

A

right upper sternal border

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34
Q

where does aortic stenosis radiate to?

A

carotids

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35
Q

what murmur is mid diastolic?

A

mitral stenosis

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36
Q

where is mitral stenosis best auscultated?

A

apex

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37
Q

where does mitral stenosis radiate to?

A

nowhere

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38
Q

what murmur is pan systolic?

A

mitral regurg

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39
Q

where is mitral regurg best auscultated?

A

apex

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40
Q

where does mitral regurg radiate to?

A

left axilla

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41
Q

what murmur is disatolic?

A

aortic regurg

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42
Q

where is aortic regurg best auscultated?

A

LUSB or apex

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43
Q

where does aortic regurg radiate to?

A

LUSB

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44
Q

if there is a right sided murmur what should you think?

A

infective endocarditis/ IV drug use

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45
Q

what are the differences between b12 and thiamine deficiency?

A 
b12= due to diet, gastric surgery, chronic GI illness 
thiamine= due to alcohol intake, acute deficiency causes wernickes encephalopathy
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46
Q

what drug increases risk of pneumonia in COPD patients with T2DM?

A

metformin

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47
Q

what is the most common complication of TURP?

A

retrograde ejaculation- when semen is ejected into the bladder instead of out the penis during a male orgasm (ie dry orgasm)

this has no negative effects but can cause infertility

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48
Q

what drugs improve prognosis in patients with heart failure? what drugs only provide symptomatic relief?

A

ace inhibitors and beta blockers improve morbidity and mortality
diuretics only provide symptom relief

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49
Q

what drugs are contraindicated in heart failure?

A

rate limiting CCBs or dihydropiridines
eg verapamil, diltiazem and nifedipine

amlodipine can be given safely

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50
Q

what conditions is pyoderma gangrenosum associated with?

A

IBD

rheumatoid arthritis

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51
Q

when is lactulose given to patients? describe why?

A

it is given in hepatic encephalopathy

it reduces the amount of ammonia in the blood which

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52
Q

what is charcot marie tooth disease? how is it investigated and what is seen?

A

inherited peripheral neuropathy

it is investigated with nerve conduction studies which will show it is either demyelinating or axonal

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53
Q

what is another name for pyramidal tract?

A

corticospinal tract

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54
Q

what else is the corticospinal tract known as?

A

pyramidal tract

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55
Q

what is the difference between spastic hemiparesis, spastic diplegia and spastic quadpriplegia?

A

spastic hemiparesis= ipsilateral arm and leg affected
spastic dipelgia= ipsilateral arm and leg affected but legs more
spastic quadriplegia= ipsilateral arm and leg affected but arms more

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56
Q

a lesion where will result in parkinsonism or hyperkinesis?

A

extrapyramidal tract or basal ganglia

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57
Q

what will a lesion in the extrapyramidal tract or basal ganglia cause?

A

parkinsonism (triad of bradykinesia, resting tremor and rigidity)
OR
hyperkinesis (eg in Huntingtons)

58
Q

what part of the brain is affected in motor neurone disease?

A

anterior horn cell

59
Q

what will a dorsal column lesion cause?

A

ipsilateral impairment in position and sense

60
Q

what are features of spastic paraparesis?

A 
UMN signs:
hypertonia
ankle clonus 
hyper reflexia 
upgoing plantars
61
Q

what are the 2 main causes of spastic paraparesis?

A

cerebral palsy

multiple sclerosis

62
Q

what steroid and what dosage is given for cord compression due to malignancy?

A

dexamethasone 8mg BD

63
Q

what should you think when you see poikilocytes?

A

myelofibrosis

64
Q

what is ix for myelofibrosis?

A

bone marrow biopsy

65
Q

what is the most common causative agent of infective endocarditis?

A

staph aureus

66
Q

what is triple therapy for h pylori eradication?

A

amoxicillin (this can be replaced for metronidazole if allergic)
clarithromycin
omeprazole

67
Q

in triple eradiction therapy for h pylori what is given instead of amoxicillin if someone is allergic?

A

metronidazole

68
Q

what is the most common causative agent for septic arthritis?

A

staph aureus

69
Q

what advice about sex should be given to someone with herpes?

A

avoid all sexual activity until the viral prodrome is over and until all lesions are gone

70
Q

describe PTH, folate and calcium levels in primary hyperparathyroidism

A 
PTH= high
calcium= high
folate= low
71
Q

what is coronary artery vasospasm associated with and how will it present?

A

it is associated with cocaine use

it presents with central chest pain on exertion

72
Q

what is the difference in administration of steroid in someone with giant cell arteritis when they are symptomatic v asymptomatic?

A 
symptomatic= IV methylprednisolone 
asymptomatic= oral prednisolone
73
Q

what abx is given in cellulitis if they are allergic to amoxicillin?

A

clindamycin or clarthromycin

74
Q

what us affected in cellulitis vs erysipelas?

A 
cellulitis= epidermis and subcut tissue
erysipelas= epidermis and upper subcut tissue
75
Q

what abx is given in erysipelas if they are allergic to amoxicillin?

A

erythromycin

76
Q

what is abx course for cellulitis?

A

flucloxacillin (add benzylpenicillin if severe)

clindamycin/clarithromycin if allergic to penicillin

77
Q

what are causative agents of cellulitis vs erysipelas?

A 
cellulitis= group a beta haemolytic streptococcus or staph aureus
erysipelas= mainly just group a beta haemolytic strep
78
Q

how do you differentiate cellulitis and erysipelas?

A

erysipelas is has better demarcated borders, is more raised and pruritic

79
Q

What blood test is diagnostic of rhabdomyolysis and what will you see?

A

CK 5x higher than normal

80
Q

what is rhabomyolysis? what 2 molecules are released and what does this cause?

A

it is breakdown of skeletal muscle

this releases myoglobin (which can cause kidney injury/AKI) and electrolytes (like potassium, calcium and urea)

81
Q

what is initial management of hypercalcaemia?

A

IV fluids

82
Q

what is myxoedema coma?

A

a condition that results from severe hypothyroidism

83
Q

what is associated with thinning hair and nails?

A

hypothyoidism

84
Q

what 2 things are given to treat myxoedema coma?

A

IV thyroxine

hydrocortisone

85
Q

what type of anti emetic is ondansetron? how does it work

A

5HT3 antagonist

acts on chemoreceptor trigger zone in medulla oblongata

86
Q

if there is a short incubation period for gastroenteritis and profuse vomiting, what is the likely causative organism?

A

staph aureus

87
Q

if urea is high is there likely to be an upper or lower GI bleed?

A

upper

88
Q

how can you differentiate upper v lower GI bleed on bloods?

A

upper GI bleed will have high urea

89
Q

in anaemia associated with CKD what must you do before starting erythropoietin?

A

correct other deficiencies eg iron

90
Q

what medication increases incidence of gout and why?

A

thiazide like diuretics

they reduce excretion of uric acid from the kidneys

91
Q

what is used to image the brain and confirm a diagnosis of MS?

A

MRI head

92
Q

what is given first line to treat hepatic encephalopathy? how does it work

A

lactulose

it works by having a laxative affect and reducing levels of ammonia in the body

93
Q

what ix confirms diagnosis of TB?

A

sputum acid fast bacilli smear

94
Q

what do you need to do if someone has infective endocarditis caused by strep bovis? why?

A

colonoscopy
the source of strep bovis is the GI tract and people are more likely to grow it if they have IBD or a colonic tumor so you should do a colonoscopy to check

95
Q

what IBD is tenesmus more commonly seen with?

A

ulcerative colitis

96
Q

what must be co prescribed with methotrexate? why and how must it be taken?

A

folate
it is prescribed as methotrexate impairs folate metabolism so it will avoid folate deficiency
it must not be taken on the same day as methotrexate to avoid impairing its metabolism

97
Q

what are guidelines for medications for hypertension in T2DM?

A

start them on an ACEi or ARB regardless of age

98
Q

what is the most common clinical pattern seen in motor neurone disease?

A

amyotrophic lateral sclerosis

99
Q

what are the zones of the adrenal cortex from outside in and what do they produce?

A

glomerulosa- mineralocorticoids
fasiculata- glucocorticoids
reticularis- androgens

100
Q

whats the commonest cause of intracerebral haemorrhage?

A

hypertension

101
Q

what are signs of mycoplasma pneumonia specifically?

A

target shaped lesions (erythema multiforme)

anaemia

102
Q

what is erythema multiforme?

A

target shaped skin lesions

103
Q

what are changes to percussion, tactile vocal fremitus and vocal resonance in pneumonia?

A

percussion= dull
tactile vocal fremitus= increased
vocal resonance= increased

104
Q

what type of hearing loss does otitis media cause?

A

conductive

105
Q

how does otitis media present?

A

hearing loss
bulging and erythematous tympanic membrane
discharge from ear

106
Q

how does vestibular schwannoma present?

A

sensorineural hearing loss
facial nerve palsy
tinnitus
vertigo

107
Q

what is the order of pharmacological treatment in a UC flare?

A 
oral melsalazine
oral prednisolone (moderate flare)
IV corticosteroids (severe flare)
108
Q

what crackles are heard and where in IPF?

A

fine bi basal end inspiratory crackles

109
Q

what is hba1c for a diagnosis of diabetes?

A

> 48 mmol/L

110
Q

what is first line treatment for nephrogenic diabetes insipidus?

A

thiazide diuretic

111
Q

what is the regime for ripe drugs when someone has TB?

A

rifampicin, isoniazid, pyrazinamide, ethambutol to start with for 2 months
then after 2 months continue rifampicin and isoniazid for 4 more months (they have a 6 month course in total)

112
Q

what are the side effects for the abx used to manage TB?

A 
rifampicin= red secretions 
isoniazid= peripheral neuropathy 
pyrazinamide= hyperuricaemia causing gout 
ethambutol= optic neuritis
113
Q

describe the percussion notes and what they mean

A

resonant= normal
dull= increased tissue density eg lobe collapse, consolidation
stoney dull= pleural effusion
hyper resonant= decreased tissue density eg pneumothorax

114
Q

how do you test for tactile vocal fremitus vs vocal resonance. which one do i test for when doing a resp exam?

A

tactile vocal fremitus= using ulnar borders of the hand place across chest and get them to say 99
vocal resonance= auscultate with steth and get them to say 99 each time

i do vocal resonance

115
Q

describe abnormal results for vocal resonance and what they mean?

A

when thinking about vocal resonance think vibrations

increased vocal resonance= increased vibrations due to presence of fluid or dense tissue eg lobe collapse, pleural effusion
decreased vocal resonance= decreased vibrations due to presence of air getting in the way eg pneumothorax

116
Q

describe percussion note and vocal resonance over a pleural effusion and explain

A

percussion= stoney dull

vocal resonance= increased (increased vibration through a fluid)

117
Q

describe percussion note and vocal resonance over a pneumothorax and explain

A

percussion= hyper resonant

vocal resonance= decreased due to decreased vibrations through air

118
Q

describe percussion note and vocal resonance over a lobe collapse and explain

A

percussion= dull

vocal resonance= increased due to increased vibrations over a solid

119
Q

what is sideroblastic anaemia?

A

anaemia wherein there are excess amounts of iron in the serum but the body is unable to use this iron to synthesise haem, producing ringed sideroblasts instead of healthy RBCs

120
Q

what iron study is the same as transferrin?

A

TIBC

121
Q

what are heberdens and bouvhards nodes a sign of?

A

osteoarthritis

122
Q

what drugs for diabetics causes hypoglycaemia? give specific examples of drugs in the drug class

A

sulphonylureas

an example is gliclazide

123
Q

what is overflow diarrhoea? what should you do when this occurs and what is it important to avoid?

A

it is when there is a large faecalith blocking the bowel and backed up stools overflow to get past it
do a DRE when this happens
it is important not to reduce laxatives in this case and may be a good idea to actually increase them

124
Q

what are indications for carotid endartectomy?

A

70% or greater blockage of the carotids and symptomatic

125
Q

according to nice guidelines what score should not be used after TIA and what should be done instead?

A

the ABCD2 score should NOT be used to assess stroke risk

instead the clinician should refer the patient to a stroke specialist clinic within 24 hrs

126
Q

what type of cancer most commonly causes hyperparathyroidism?

A

solitary adenoma

127
Q

give a specific example of SABA/SAMA?

A

salbutamol (SABA)

ipatropium (SAMA)

128
Q

what is the most common cause of exudative pleural effusion?

A

pneumonia

129
Q

what are rules for driving after 1st seizure?

A

if unprovoked they cannot drive for 6 months

130
Q

what is used for anticoagulation in a DVT in interim v long term?

A

DOAC

131
Q

what is used as pharmacotherapy for Philadelphia chromosome positive CML?

A

imatinib

132
Q

what medication for osteoporosis is contraindicated in someone who also has CKD?

A

bisphosphonates

133
Q

haematologically, what is a rf for the development of gout?

A

recurrent episodes of hemolysis

134
Q

what should you immediately think when you see left sided variocele? why?

A

renal cell carcinoma
the carcinoma can cause obstruction of the gondal vein so fluid cannot drain out of the testes properly, this leads to variocele

135
Q

how do you differentiate duodenal and gastric ulcers?

A 
gastric= worse after eating 
duodenal= better after eating
136
Q

what does average ambulatory blood pressure need to be in someone for a diagnosis of hypertension?

A

> 135/85 mmHg

137
Q

what causes a painful third nerve palsy?

A

posterior communicating artery aneurysm

138
Q

what is used for reversal of anticoagulation in patients with a severe bleed or injury?

A

prothrombin complex concentrate

139
Q

if hbA2 is raised what condition does the patient have? why

A

BETA thalassaemia

excess alpha chains are present as they cannot be synthesised into RBCs becuase the beta chains are faulty

140
Q

what is the inheritance pattern of HOCM?

A

autosomal dominant

141
Q

what are the ix of choice when you suspect multiple myeloma?

A

serum protein electrophoresis

urinary bence jones proteins

142
Q

how does warfarin affect PT and APTT?

A

prolongs PT

reduces APTT

Year 3 (104 decks)

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