SBA DECK 25/4 Flashcards
what drug can be given to slow the progression of diabetic nephropathy?
ramipril
what heart phase is affected in HOCM and how?
diastole
thickening of the left ventricle wall means the heart muscle cannot appropriately relax
what are some common live virus vaccines (that therefore cannot be given to immunocompromised patients)
MMR varicella zoster BCG yellow fever rotavirus
what should you remember about those on high dose steroid therapy?
they are immunocompromised
this has implications eg they should not be given live vaccines
how is hereditary spherocytosis inherited?
autosomal dominant
what is the mechanism of anaemia in hereditary spherocytosis? explain why it arises
normocytic haemolytic anaemia
arises because there is a defect in the RBC cytoskeleton so RBCs are destroyed
what ix confirms cystic fibrosis? what will it show?
sweat test- will have abnormally high chloride in their sweat
what will you see on ABG in HHS?
pH >7.3
Hco3 >15
ie NO evidence of ketoacidosis
what transferral time for PCI is acceptable in someone who presents with an MI?
2 hours ie if they can be transferred and PCI done within 2 hrs do that, if it takes longer do alteplase thrombolysis
what is GS treatment for patients presenting within 12 hrs of chest pain and diagnosed with MI?
angiography PLUS PCI
Describe pharmacological asthma management starting with SABA
SABA
Add ICS
Add LABA
If benefits but inadequate increase ICS dose, if not beneficial stop and increase
If still no benefit stop LABA and trial LTRA
what is the most common lung cancer in non smokers?
lung adenocarcinoma
what are some features of lung adenocarcinoma?
most common lung cancer in non smokers
peripherally located
associated with peripheral osetoarthropathy
how is cushings medically managed? how do they drugs work
first line metyrapone
ketoconazole
the drugs work by inhibiting steroid synthesis
what primary ix can you do if you suspect cushings and what does it tell you?
overnight dexamethasone test- give dex at midnight and then measure cortisol in the morning
this test is used to identify hypercortisolism but to diagnose cushings more specific tests need to be done if it comes back positive
how is normal pressure hydrocephalus managed?
LP to diagnose and relieve pressure
then ventriculoperitoneal shunting
what cancers is elevated ca 19-9 most associated with?
cholangiocarcinoma
pancreatic cancer
gastric cancer
what are characteristics of menieres disease?
vertigo
tinnitus
aural fullness
sensorineural hearing loss
what are differentials for vertigo and how are they differentiated?
BPPV- triggered by head movements
Menieres disease- accompanied by tinnitus, sensorineural hearing loss and aural fullness
Vestibular neuritis- no hearing loss/tinnitus, may be preceded by an infection
what happens to PT, APTT and fibrinogen in disseminated intravascular coagulation?
PT and APTT are prolonged
fibrinogen is reduced
what are some features of carcinoid syndrome?
flushing
wheezing
sweating
if someone meets criteria for IBS what ix should you go next?
transglutaminase antibodies to rule out coeliacs
what is paroxysmal AF?
AF that lasts <7days and is intermittent
how is paroxysmal AF in young people managed?
oral flecanide
what are some presenting features of SLE?
systemic upset (myalgia, weakness, fatigue, weight loss) joint and/or skin involvement photosensitivity (malar rash) discoid rash (round/raised plaques)
what bacteria most commonly causes septic arthritis of a prosthetic joint?
staph epidermis
pneumonia caused by what organism can often result in hyponatraemia and lymphopenia?
legionella pneumoniae
what is the most important risk factor for bladder cancer?
smoking
what does azothioprine do for someone who has UC? when is it not used
maintain remission
it is not used in an acute flare
what is given in a mild/moderate flare of UC?
enema or oral aminosalicyclate
what is give in a moderate/severe flare for UC? when is this is not tolerated
IV corticosteroids
if not tolerated IV ciclosporin
why can’t you give triptans to patients presenting with cluster headache who have CAD?
they can induce coronary vasospasm
what do delta waves and a short PR interval on ECG indicate?
wolff parkinson white syndrome
what ix is done when IBS is suspected? why?
faecal calprotectin to rule out IBD
what are characteristics of IBS?
abdo discomfort
bloating
discomfort relieved by defecation and made worse by eating
what ix is diagnostic for malaria?
thick and thing blood smear
what affect does malaria have on RBCs?
it causes haemolytic anaemia
what test is best for diagnosing herpes virus infection?
HSV PCR (nucleic acid amplification)
when is adenosine vs adrenaline used?
adenosine= SVT second line management or first line if haemodynamically unstable adrenaline= after CPR or in anaphylaxis
what mutation is most commonly associated with MND?
SOD 1
what would be seen on urinalysis in goodpastures?
haematuria
may have mild proteinuria
whats the most common cause of nephrotic syndrome in children?
minimal change disease
what is first line to induce remission of a flare in crohn’s disease?
glucocorticoids
when is sumatriptan used in migraines?
to stop an acute attack- patients are asked to take it as soon as the attack starts
what medications are used for migraine prophylaxis?
beta blockers- propanolol
topiramate
when is topiramate contraindicated?
what is it used for?
used for migraine prophylaxis
contraindicated in pregnancy
what is first line for spasticity in MS?
baclofen
gabapentin
how is aortic dissection standford type a vs b managed?
a= labetolol for BP control+ emergency surgical repair b= labetolol for BP control+ supportive care
what is first line rate control in someone with fast AF who is haemodynamically stable?
bisoprolol
how does ankylosing spondylitis present?
recurrent lower back pain worse in the morning better with exercise buttock pain pain wakes them up at night anterior uveitis
how is mechanical back pain ruled out?
it should resolve in 6 weeks
what are red flags for back pain and what should be done?
progressive pain not relieved by rest
spinal tenderness
new onset <20 or >55
thoracic or cervical spine pain
what dosage of aspirin and clopi are given to patients who present with STEMI?
300mg each
how long do you have to wait after changing a levothyroxine dose to measure TFTs? why?
4-6 weeks because the half life of TSH is 4-6 weeks
what is the main difference between a myopathy and poly/dermomyositis?
myopathy= muscle weakness myositis= muscle pain
what is not a feature in poly/dermatomyositis and can help distinguish it from myopathy?
pain will not be present
what blood test is raised in poly/dermatomyotsitis but not in polymyalgia rheumatica?
CK
what might CCBs cause as a side effect? how is this managed?
leg swelling
it is not responsive to diuretics so you have to stop the drug and try something else
what is the most appropriate first ix for pancytopenia? what else do you need to do
blood film
if there is true pancytopenia a bone marrow biopsy will need to be done
what valve problem causes collapsing pulse?
aortic regurg
a lesion where most commonly causes coning?
in the posterior fossa
what are some signs of compartment syndrome?
severe pain especially on passive flexion
6Ps of an acute limb
what are the 6 ps of an acute limb?
pain pallor parasthesia paralysis pulselessness perishingly cold
what should you examine in a male patient with RIF pain?
external genitalia
how will high aldosterone affect potassium and sodium levels?
sodium= increased reabsorption potassium= increased excretion
what drugs should be stopped when someone has an AKI?
ACEi ARBs NSAIDs diuretics aminoglycosides metformin lithium
if ALP is a lot higher than GGT and ALT what type of jaundice is occuring?
obstructive- the biliary tree is obstructed
what are some examples of commonly used thiazide like diuretics eg in hypertension control?
indapamide
chlortalidone
what is the most common lung malignancy in non smokers?
adenocarcinoma
what type of lung cancer is associated with gynaecomastia and hypertrophic pulmonary osteoarthropathy?
adenocarcinoma
what disease is notably NOT notifiable?
HIV
what types of dysphagia are considered red flag?
any new onset dysphagia regardless of age or other symptoms is red falg and needs a 2 week referral
what is the deal with ACEi and kidney failure?
ACEi are renoprotective eg reduces risk of developing kidney failure
However, they must be stopped if someone has kidney failure as it can cause it to worsen
what is thumbprinting seen in and what does it look like?
seen in UC
there will be white indents along the length of the bowel where it looks like someone has placed there thumbprint
how do you differentiate large and small bowel obstruction on XR?
large bowel= there will be haustra present (white marks which are small indents coming in from the sides of the bowel)
small bowel= there will be vulvae coniventaes (white lines across the whole length of the bowel)
how is acute hf managed?
sit patient up
give oxygen
give IV furosimide (40mg)
give SC morphine
what affect do loop diuretics have on HF?
they improve symptoms but not mortality
how will hereditary haemochromatosis present?
joint pain (especially 2nd and 3rd MCP joints) erectile dysfunction grey pigmentation cirrhosis dilated cardiomypoathy osteoporosis
what type of pleural effusion does malignancy cause?
exudative
what is the difference between transudate and exudate? how do you remember this
transudate= not high in protein exudate= high in protein (you need to execute the protein cos its high)
if there is pulmonary oedema out of transudate and exudate which is more likely to be unilateral vs bilateral?
transudate= bilateral exudate= unilateral
what are characteristics of arterial ulcers?
punched out appearance
very painful
pain wakes them up at night
cold, white and shiny
how are arterial ulcers managed?
lifestyle factors= weight loss, exercise
prescribe an antiplatelet
what are the features of venous insufficiency?
ankle swelling varicose veins haemosiderin deposition lipodermatosclerosis stasis eczema
what are characteristics of venous ulcers?
red, shallow, warm
features of chronic venous insufficiency: lipodermatosclerosis, stasis eczema, ankle swelling, haemosiderin deposition, varicose veins
out of arterial and venous ulcers which are more likely to be above v below the medial malleolus?
above= venous below= arterial
what acronym is used to remember which lesions cause superior vs inferior quadrantopias?
PITS
Parietal lesion= contralateral Inferior homonymous quadrantopia
Temporal lesion= contralateral superior homonymous quadrantopia
what might cxr show in pneumocystitis pneumonia?
bilateral hilar infiltrates
how does someone with carbon monoxide poisoning present?
nausea and vomitting confusion cherry red skin 100% oxygen sats tachycardia new onset of all symptoms
what is GS treatment for someone with carbon monoxide poisoning? how does it work
hyperbaric oxygen- works to unbind CO from haemoglobin
what should you think if you see cherry red skin?
carbon monoxide poisoning
why will someone with CO poisoning have 100% oxygen sats?
the probe only measures the saturation of non affected/normal ahemoglobin molecules
what arrhythmia is a common complication of hyperthyroidism?
atrial fibrillation
when does an AAA need to be surgically repaired?
if its large (>5.5cm)
or if its rapidly enlarging
what size are norma, small, medium and large AAAs? what action is taken with each size?
<3cm is normal= discharge
3-4.4cm= small, rescan in 12 months
4.5-5.4cm= medium, rescan in 3 months
>5.5cm= large, 2 week referral for surgical repair
what is the characteristic presentation of paget’s disease?
elderly nordic male patient presents with bone pain and an isolated rise in ALP
what will be the only raised LFT in pagets disease?
ALP
what happens to goblet cells in crohns?
increase
what condition are crypt abscesses found in?
UC
what type of hypersensitivity is SLE?
type 3- antibody antigen complex deposition
on a normal ECG how will posterior MI manifest?
tall R waves in V1 and V2
what is the most common cause of cushings syndrome?
cushings disease ie pituitary adenoma
what drug causes gynacomastia?
spironolactone
what lobe of the brain is involved when there are automatisms in seizures?
temporal
what is found in CSF in multiple sclerosis?
oligoclonal bands
What are the 4 parkinsonism plus syndromes? what do they mean?
Progressive supranuclear palsy
Multiple system atrophy
Corticobasal degeneration
Lewy body dementia
they present with the triad of parkinsonism (bradykinesia, hypertonia and resting tremor) plus other symptoms
What is the triad of parkinsonism?
bradykinesia
hypertonia
resting tremor
how does progressive supranuclear palsy present?
parkinsonism plus vertical gaze palsy
how does multiple system atrophy present?
parkinsonism plus loss of autonomic function eg impotence, incontinence, postural hypotension
how does corticobasal degeneration present?
parkinsonism plus spontaneous activity of affected limb or akinetic rigidity of limb
how does lewy body dementia present?
parkinsonism preceeded by visual hallucinations and cognitive impairment
whats first line management for guillian barre?
IV immunoglobulins
what do random blood glucose, fasting blood glucose and hba1c need to be for a diagnosis of diabetes?
randomn blood glucose= 11.1
fasting blood glucose= 7
hba1c= 48
you need either 2 of these to be positive at separate times or 1 with symptoms for diagnosis
what type of shock does sepsis cause?
distributive
what are the most common findings on examination in someone with pernicious anaemia?
angular stomatitis
glossitis
how do you manage syncope?
500 mcg IV atropine
if transferrin is raised what happens to transferrin saturation?
it falls
what is the most common ECG finding in PE?
sinus tachycardia
what must be given on discharge if someone has SBP?
prophylactic antibiotics- ciprofloxacin
what are guidelines for DVT anticoagulation?
anticoagulate with a DOAC
unprovoked= 6 months
provoked (eg surgery)= 3 months
how do you differentiate ileostomy and colostomy?
ileostomy= contents are liquid and its spouted colostomy= contents are solid and its flushed
why are ileostomies spouted and colostomies flushed?
ileostomies are spouted to prevent the enzymes of the small intestinte form coming into contact with the skin
colostomies are flat because the large bowel doesnt have enzymes
what anticoagulation is used in pregnancy if someone has antiphospholipid syndrome?
aspirin and LMWH
