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Year 3 > SBA DECK 25/4 > Flashcards

SBA DECK 25/4 Flashcards

1
Q

what drug can be given to slow the progression of diabetic nephropathy?

A

ramipril

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2
Q

what heart phase is affected in HOCM and how?

A

diastole

thickening of the left ventricle wall means the heart muscle cannot appropriately relax

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3
Q

what are some common live virus vaccines (that therefore cannot be given to immunocompromised patients)

A 
MMR
varicella zoster 
BCG
yellow fever
rotavirus
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4
Q

what should you remember about those on high dose steroid therapy?

A

they are immunocompromised

this has implications eg they should not be given live vaccines

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5
Q

how is hereditary spherocytosis inherited?

A

autosomal dominant

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6
Q

what is the mechanism of anaemia in hereditary spherocytosis? explain why it arises

A

normocytic haemolytic anaemia

arises because there is a defect in the RBC cytoskeleton so RBCs are destroyed

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7
Q

what ix confirms cystic fibrosis? what will it show?

A

sweat test- will have abnormally high chloride in their sweat

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8
Q

what will you see on ABG in HHS?

A

pH >7.3
Hco3 >15

ie NO evidence of ketoacidosis

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9
Q

what transferral time for PCI is acceptable in someone who presents with an MI?

A

2 hours ie if they can be transferred and PCI done within 2 hrs do that, if it takes longer do alteplase thrombolysis

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10
Q

what is GS treatment for patients presenting within 12 hrs of chest pain and diagnosed with MI?

A

angiography PLUS PCI

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11
Q

Describe pharmacological asthma management starting with SABA

A

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

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12
Q

what is the most common lung cancer in non smokers?

A

lung adenocarcinoma

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13
Q

what are some features of lung adenocarcinoma?

A

most common lung cancer in non smokers
peripherally located
associated with peripheral osetoarthropathy

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14
Q

how is cushings medically managed? how do they drugs work

A

first line metyrapone
ketoconazole
the drugs work by inhibiting steroid synthesis

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15
Q

what primary ix can you do if you suspect cushings and what does it tell you?

A

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

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16
Q

how is normal pressure hydrocephalus managed?

A

LP to diagnose and relieve pressure

then ventriculoperitoneal shunting

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17
Q

what cancers is elevated ca 19-9 most associated with?

A

cholangiocarcinoma
pancreatic cancer
gastric cancer

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18
Q

what are characteristics of menieres disease?

A

vertigo
tinnitus
aural fullness
sensorineural hearing loss

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19
Q

what are differentials for vertigo and how are they differentiated?

A

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

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20
Q

what happens to PT, APTT and fibrinogen in disseminated intravascular coagulation?

A

PT and APTT are prolonged

fibrinogen is reduced

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21
Q

what are some features of carcinoid syndrome?

A

flushing
wheezing
sweating

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22
Q

if someone meets criteria for IBS what ix should you go next?

A

transglutaminase antibodies to rule out coeliacs

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23
Q

what is paroxysmal AF?

A

AF that lasts <7days and is intermittent

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24
Q

how is paroxysmal AF in young people managed?

A

oral flecanide

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25
Q

what are some presenting features of SLE?

A 
systemic upset (myalgia, weakness, fatigue, weight loss) 
joint and/or skin involvement 
photosensitivity (malar rash)
discoid rash (round/raised plaques)
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26
Q

what bacteria most commonly causes septic arthritis of a prosthetic joint?

A

staph epidermis

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27
Q

pneumonia caused by what organism can often result in hyponatraemia and lymphopenia?

A

legionella pneumoniae

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28
Q

what is the most important risk factor for bladder cancer?

A

smoking

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29
Q

what does azothioprine do for someone who has UC? when is it not used

A

maintain remission

it is not used in an acute flare

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30
Q

what is given in a mild/moderate flare of UC?

A

enema or oral aminosalicyclate

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31
Q

what is give in a moderate/severe flare for UC? when is this is not tolerated

A

IV corticosteroids

if not tolerated IV ciclosporin

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32
Q

why can’t you give triptans to patients presenting with cluster headache who have CAD?

A

they can induce coronary vasospasm

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33
Q

what do delta waves and a short PR interval on ECG indicate?

A

wolff parkinson white syndrome

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34
Q

what ix is done when IBS is suspected? why?

A

faecal calprotectin to rule out IBD

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35
Q

what are characteristics of IBS?

A

abdo discomfort
bloating
discomfort relieved by defecation and made worse by eating

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36
Q

what ix is diagnostic for malaria?

A

thick and thing blood smear

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37
Q

what affect does malaria have on RBCs?

A

it causes haemolytic anaemia

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38
Q

what test is best for diagnosing herpes virus infection?

A

HSV PCR (nucleic acid amplification)

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39
Q

when is adenosine vs adrenaline used?

A 
adenosine= SVT second line management or first line if haemodynamically unstable 
adrenaline= after CPR or in anaphylaxis
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40
Q

what mutation is most commonly associated with MND?

A

SOD 1

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41
Q

what would be seen on urinalysis in goodpastures?

A

haematuria

may have mild proteinuria

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42
Q

whats the most common cause of nephrotic syndrome in children?

A

minimal change disease

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43
Q

what is first line to induce remission of a flare in crohn’s disease?

A

glucocorticoids

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44
Q

when is sumatriptan used in migraines?

A

to stop an acute attack- patients are asked to take it as soon as the attack starts

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45
Q

what medications are used for migraine prophylaxis?

A

beta blockers- propanolol

topiramate

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46
Q

when is topiramate contraindicated?

what is it used for?

A

used for migraine prophylaxis

contraindicated in pregnancy

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47
Q

what is first line for spasticity in MS?

A

baclofen

gabapentin

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48
Q

how is aortic dissection standford type a vs b managed?

A 
a= labetolol for BP control+ emergency surgical repair
b= labetolol for BP control+ supportive care
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49
Q

what is first line rate control in someone with fast AF who is haemodynamically stable?

A

bisoprolol

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50
Q

how does ankylosing spondylitis present?

A 
recurrent lower back pain
worse in the morning
better with exercise
buttock pain 
pain wakes them up at night
anterior uveitis
51
Q

how is mechanical back pain ruled out?

A

it should resolve in 6 weeks

52
Q

what are red flags for back pain and what should be done?

A

progressive pain not relieved by rest
spinal tenderness
new onset <20 or >55
thoracic or cervical spine pain

53
Q

what dosage of aspirin and clopi are given to patients who present with STEMI?

A

300mg each

54
Q

how long do you have to wait after changing a levothyroxine dose to measure TFTs? why?

A

4-6 weeks because the half life of TSH is 4-6 weeks

55
Q

what is the main difference between a myopathy and poly/dermomyositis?

A 
myopathy= muscle weakness
myositis= muscle pain
56
Q

what is not a feature in poly/dermatomyositis and can help distinguish it from myopathy?

A

pain will not be present

57
Q

what blood test is raised in poly/dermatomyotsitis but not in polymyalgia rheumatica?

A

CK

58
Q

what might CCBs cause as a side effect? how is this managed?

A

leg swelling

it is not responsive to diuretics so you have to stop the drug and try something else

59
Q

what is the most appropriate first ix for pancytopenia? what else do you need to do

A

blood film

if there is true pancytopenia a bone marrow biopsy will need to be done

60
Q

what valve problem causes collapsing pulse?

A

aortic regurg

61
Q

a lesion where most commonly causes coning?

A

in the posterior fossa

62
Q

what are some signs of compartment syndrome?

A

severe pain especially on passive flexion

6Ps of an acute limb

63
Q

what are the 6 ps of an acute limb?

A 
pain
pallor
parasthesia
paralysis
pulselessness
perishingly cold
64
Q

what should you examine in a male patient with RIF pain?

A

external genitalia

65
Q

how will high aldosterone affect potassium and sodium levels?

A 
sodium= increased reabsorption
potassium= increased excretion
66
Q

what drugs should be stopped when someone has an AKI?

A 
ACEi
ARBs
NSAIDs
diuretics
aminoglycosides
metformin
lithium
67
Q

if ALP is a lot higher than GGT and ALT what type of jaundice is occuring?

A

obstructive- the biliary tree is obstructed

68
Q

what are some examples of commonly used thiazide like diuretics eg in hypertension control?

A

indapamide

chlortalidone

69
Q

what is the most common lung malignancy in non smokers?

A

adenocarcinoma

70
Q

what type of lung cancer is associated with gynaecomastia and hypertrophic pulmonary osteoarthropathy?

A

adenocarcinoma

71
Q

what disease is notably NOT notifiable?

A

HIV

72
Q

what types of dysphagia are considered red flag?

A

any new onset dysphagia regardless of age or other symptoms is red falg and needs a 2 week referral

73
Q

what is the deal with ACEi and kidney failure?

A

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

74
Q

what is thumbprinting seen in and what does it look like?

A

seen in UC

there will be white indents along the length of the bowel where it looks like someone has placed there thumbprint

75
Q

how do you differentiate large and small bowel obstruction on XR?

A

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)

76
Q

how is acute hf managed?

A

sit patient up
give oxygen
give IV furosimide (40mg)
give SC morphine

77
Q

what affect do loop diuretics have on HF?

A

they improve symptoms but not mortality

78
Q

how will hereditary haemochromatosis present?

A 
joint pain (especially 2nd and 3rd MCP joints) 
erectile dysfunction
grey pigmentation
cirrhosis 
dilated cardiomypoathy
osteoporosis
79
Q

what type of pleural effusion does malignancy cause?

A

exudative

80
Q

what is the difference between transudate and exudate? how do you remember this

A 
transudate= not high in protein
exudate= high in protein (you need to execute the protein cos its high)
81
Q

if there is pulmonary oedema out of transudate and exudate which is more likely to be unilateral vs bilateral?

A 
transudate= bilateral
exudate= unilateral
82
Q

what are characteristics of arterial ulcers?

A

punched out appearance
very painful
pain wakes them up at night
cold, white and shiny

83
Q

how are arterial ulcers managed?

A

lifestyle factors= weight loss, exercise

prescribe an antiplatelet

84
Q

what are the features of venous insufficiency?

A 
ankle swelling
varicose veins
haemosiderin deposition
lipodermatosclerosis
stasis eczema
85
Q

what are characteristics of venous ulcers?

A

red, shallow, warm
features of chronic venous insufficiency: lipodermatosclerosis, stasis eczema, ankle swelling, haemosiderin deposition, varicose veins

86
Q

out of arterial and venous ulcers which are more likely to be above v below the medial malleolus?

A 
above= venous
below= arterial
87
Q

what acronym is used to remember which lesions cause superior vs inferior quadrantopias?

A

PITS
Parietal lesion= contralateral Inferior homonymous quadrantopia
Temporal lesion= contralateral superior homonymous quadrantopia

88
Q

what might cxr show in pneumocystitis pneumonia?

A

bilateral hilar infiltrates

89
Q

how does someone with carbon monoxide poisoning present?

A 
nausea and vomitting
confusion
cherry red skin
100% oxygen sats 
tachycardia
new onset of all symptoms
90
Q

what is GS treatment for someone with carbon monoxide poisoning? how does it work

A

hyperbaric oxygen- works to unbind CO from haemoglobin

91
Q

what should you think if you see cherry red skin?

A

carbon monoxide poisoning

92
Q

why will someone with CO poisoning have 100% oxygen sats?

A

the probe only measures the saturation of non affected/normal ahemoglobin molecules

93
Q

what arrhythmia is a common complication of hyperthyroidism?

A

atrial fibrillation

94
Q

when does an AAA need to be surgically repaired?

A

if its large (>5.5cm)

or if its rapidly enlarging

95
Q

what size are norma, small, medium and large AAAs? what action is taken with each size?

A

<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

96
Q

what is the characteristic presentation of paget’s disease?

A

elderly nordic male patient presents with bone pain and an isolated rise in ALP

97
Q

what will be the only raised LFT in pagets disease?

A

ALP

98
Q

what happens to goblet cells in crohns?

A

increase

99
Q

what condition are crypt abscesses found in?

A

UC

100
Q

what type of hypersensitivity is SLE?

A

type 3- antibody antigen complex deposition

101
Q

on a normal ECG how will posterior MI manifest?

A

tall R waves in V1 and V2

102
Q

what is the most common cause of cushings syndrome?

A

cushings disease ie pituitary adenoma

103
Q

what drug causes gynacomastia?

A

spironolactone

104
Q

what lobe of the brain is involved when there are automatisms in seizures?

A

temporal

105
Q

what is found in CSF in multiple sclerosis?

A

oligoclonal bands

106
Q

What are the 4 parkinsonism plus syndromes? what do they mean?

A

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

107
Q

What is the triad of parkinsonism?

A

bradykinesia
hypertonia
resting tremor

108
Q

how does progressive supranuclear palsy present?

A

parkinsonism plus vertical gaze palsy

109
Q

how does multiple system atrophy present?

A

parkinsonism plus loss of autonomic function eg impotence, incontinence, postural hypotension

110
Q

how does corticobasal degeneration present?

A

parkinsonism plus spontaneous activity of affected limb or akinetic rigidity of limb

111
Q

how does lewy body dementia present?

A

parkinsonism preceeded by visual hallucinations and cognitive impairment

112
Q

whats first line management for guillian barre?

A

IV immunoglobulins

113
Q

what do random blood glucose, fasting blood glucose and hba1c need to be for a diagnosis of diabetes?

A

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

114
Q

what type of shock does sepsis cause?

A

distributive

115
Q

what are the most common findings on examination in someone with pernicious anaemia?

A

angular stomatitis

glossitis

116
Q

how do you manage syncope?

A

500 mcg IV atropine

117
Q

if transferrin is raised what happens to transferrin saturation?

A

it falls

118
Q

what is the most common ECG finding in PE?

A

sinus tachycardia

119
Q

what must be given on discharge if someone has SBP?

A

prophylactic antibiotics- ciprofloxacin

120
Q

what are guidelines for DVT anticoagulation?

A

anticoagulate with a DOAC
unprovoked= 6 months
provoked (eg surgery)= 3 months

121
Q

how do you differentiate ileostomy and colostomy?

A 
ileostomy= contents are liquid and its spouted
colostomy= contents are solid and its flushed
122
Q

why are ileostomies spouted and colostomies flushed?

A

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

123
Q

what anticoagulation is used in pregnancy if someone has antiphospholipid syndrome?

A

aspirin and LMWH

Year 3 (104 decks)

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