SBA DECK 30/05 Flashcards
what is koilonychia?
a nail sign that arises due to iron deficiency anaemia
the nails look soft and scooped out
what might predispose someone to c diff infections?
being on broad spectrum antibiotics eg cifpro, penicillins, clindamycin
what is first line management for c diff?
oral vancomycin
make sure to isolate the patient
what joint does pseudogout most commonly affect?
the knee
what antiemetic should not be given to those with parkinsons and why?
metoclopramide
it is a dopamine antagonist and can make their symptoms way worse
what antibody is associated with psoriatic arthritis?
none, it is seronegative
what are the rules for using US to image the breast instead of mammogram?
use in under 35 if there is an actual lump
use in everyone under 40 if they are asymptomatic
what medication might cause proximal myopathy?
corticosteroids
what toxic product is produced in rhabdomyolysis?
myoglobin
where in the lung does fibrosis occur in coal workers pneumocosis and silicosis?
upper lung zones
what medication causes lower lung zone fibrosis?
amiodarone
how are gallstones in the CBD treated when found during cholecystectomy?
ERCP in the day
urgent exploration of the bile duct
what are the rules for someone taking the OCP when they need to have surgery?
stop it 4 weeks before, take an alternative form of contraception
start it 2 weeks after
if a breast lump invades the muscle what is the most likely diagnosis?
invasive breast cancer
what symptom will an empyema in a pneumonia classically cause?
swinging fever
how long do you have be admitted for a pneumonia to be a HAP?
48 hrs
describe ABPI results and their meanings
>1.2= abnormal thickening of vascular walls (due to diabetes usually) 0.9-1.2= normal 0.8-0.9= mild disease 0.5-0.8= moderate disease <0.5= severe disease
what does an ABPI over 1.2 indicate?
abnormal artery thickening= stenosis
what is ABPI used to diagnose?
peripheral arterial disease
what granulomas do you see in sarcoidosis?
non caseating
what is the most common complication of multiple myeloma?
hypercalcaemia
what is 1st line treatment for hereditary haemochromatosis?
venesection
what is 1st line treatment for wilsons disease?
penicillamine
what should you think when you see villous atrophy, crypt hyperplasia and raised intra epithelial lymphocytes?
coeliacs disease
what is the most appropriate ix when you suspect a phaeo?
24h urinary metanephrines
how is a phaeo managed?
surgical resection
before this alpha blockade then beta blockade
when calculating GCS and 2 sides of the body have different responses, which side do u take as the score?
the better side
what are epidemiological rf for idiopathic inter cranial hypertension?
obese
young female
what is bradykinesia?
difficulty initiating movement
what is first line mx in someone with septic arthritis?
joint aspiration and culture
what is the first step in managing complete heart block if they are haemodynamically unstable?
IV atropine- for bradycardia
where does the qt interval start and end?
start of the q wave
end of the t wave
where does the pr interval start and end?
start of the p wave
start of the qrs complex
what is treatment for acute malaria?
IV artesunate
what is the most common causative organism for encephalitis?
herpes simplex virus
how is encephalitis diagnosed?
lumbar puncture will show HSV on PCR
what test is most helpful in diagnosing acute liver failure? what will the result be?
INR
1.5 or above
what cardiac medication should be avoided in those with myasthenia gravis?
beta blockers
if someone is on metformin what must their hba1c be in order for there to be an indication to add another drug?
if hba1c rises from the acceptable 48mmol/L to 50 mmol/L
if someone is taking metformin in T2DM what should target hba1c be?
48 mmol/L
what type of anaemia may prosthetic heart valves cause?
haemolytic
what is the most common metabolic abnormality in sarcoidosis?
hypercalcaemia
what is spared in motor neurone disease?
eye movements
how do you differentiate gastric v duodenal ulcers?
duodenal= better after eating gastric= worse when you eat
how is h pylori negative peptic ulcer disease managed?
4-8 week dose of PPI until the ulcer has healed
how is peptic ulcer disease managed if associated with NSAID use and h pylori positive?
2 month PPI
after this is over eradication therapy
what is first line ix if you suspect testicular cancer?
ultrasound testes
why can you not biopsy a testicular mass if you suspect cancer?
risk of seeding cancer cells into the rest of the testes
what cancer is it important to remember you can’t biopsy and why?
testicular cancer
there is risk of seeding other cells into the rest of the testes
how is hypoglycaemia managed if a patient is unconscious?
if there is no IV access IM glucagon 1mg
if there is IV access give 100ml 20% glucose IV over 10 mins
when is IM glucagon not effective in hypoglycaemia?
when its due to alcohol
how do you differentiate cluster headache from acute angle closure glaucoma?
cluster headache= will have a hx of occurring in clusters as well as a triad of periocular pain, rhinorrhoea/lacrimation/some form of secretion
acute angle closure glaucoma= will present with a headache, nausea/vomiting, visual changes, redness of the eye
what is the presentation of acute angle closure glaucoma?
visual disturbance sudden onset headache redness of the eye nausea and vomiting loss of vision worse at night (when pupil dilates and irido corneal angle closes more) floaters and flashes mild pupil dilation
how is acute angle closure glaucoma initially managed?
IV acetazolamide
topical timolol
urgent referral to opthamology
what is first line ix for someone with stable angina?
CT coronary angiography
when is non invasive ventilation used in COPD?
when theres a respiratory acidosis
what feature is specific to graves disease?
exopthalamos
what site is most commonly affected in uc
rectum
what is used to image the brain when someone has a suspected TIA?
MRI brain with diffusion weighted imaging
what tumor marker is used for medullary thyroid cancer?
calcitonin
what tumor marker is used for papillary and medullary cancer?
thyroglobulin
how is menieres disease managed prophylactically and acutely?
acute attack= prochlorperazine Im or buccal
prophylaxis= betahistine
how is thalassaemia managed?
regular blood transfusions
or stem cell transplant
what chronic cardiac condition causes positive hepatojugular reflux?
heart failure
what drug is used to treat CML?
imatinib
how do co2 levels change as an acute asthma attack progresses. what does this tell you?
initially= hypocapnic as they hyperventilate progressing= normocapnic and then hypercapnic as they tire
if co2 is normal or high they need to be intubated and ventilated as this is life thretening
what is the programme for breast cancer screening in the UK?
offered to all women aged 50-70 every 3 years
what artery is affected if there is an inferior stemi and what leads does this affect?
II, III, avF
right coronary artery affected
why may a CKD patient not respond to EPO therapy?
if they have pre existing iron deficiency
what organism most commonly causes infective exacerbations of COPD?
haemophilius influenzae
how many doses of adrenaline can be given in anaphylaxis and how far apart do they have to be? what is done if this doesnt work
2 doses 5 mins apart
if refractory consider IV adrenaline
what lobes are brocas v wernickes area found in?
brocas= frontal lobe wernickes= temporal lobe
what speech problems would lesions in the frontal v temporal lobe cause?
frontal= brocas area affected so issues with speech production temporal= wernickes area affected so issues with speech comprehension
how is PE managed?
stable= start on DOAC immediately, 3 months if the PE was provoked and 6 months if the PE was unprovoked
unstable (ie massive PE)= thrombolysis
when is thrombolysis indicated in a PE?
when the PE is massive
when the patient is haemodynamically unstable
what type of seizure are automatisms associated with?
temporal lobe
when is flecanide v amiodarone used in AF for rhythmn control?
flecanide= young person w no IHD or structural heart disease amiodarone= old person or has IHD/ structural heart disease
whats first line imaging in prostate cancer
MRI prostate
whats the best way to ix suspected gonorrhoea?
nucleic acid amplification test
how can you identify portal hypertension on bloods? explain why
look at platelets
portal hypertension causes thrombocytopenia due to splenomegaly
what organ is enlarged in portal hypertension?
spleen
how is gout managed?
NSAID first line
if pmhx of CKD, GI issues or heart failure use colchicine
if current CKD use steroids
how does ovarian cancer usually present?
non specific symptoms bloating early satiety abdo distention bowel obstruction
what cancer is associated with tumor marker ca 19-9 and how will it present?
pancreatic
painless obstructive jaundice
FLAWS
palpable GB/ RUQ mass
what cancer is associated with tumor marker ca 125 and how will it present?
ovarian non specific symptoms: bloating early satiety abdo distention bowel obstruction
what cancer is associated with tumor marker CEA and how will it present?
colorectal cancer
FLAWS
lower GI bleed
bowel obstruction
what cancer is associated with tumor marker AFP and how will it present?
hepatocellular carcinoma
FLAWS
jaundice
what cancer is associated with tumor marker ca 15-3 and how will it present?
breast cancer
mass
FLAWS
if there is loss in pain and temp where is the lesion in the spinal cord? (include name of tract and location in cord)
spinothalamic tract
located laterally
if there is loss in fine touch, vibration and proprioception where is the lesion in the spinal cord? (include name of tract and location in cord)
dorsal column
posterior part of spinal cord
if there is loss motor function where is the lesion in the spinal cord? (include name of tract and location in cord)
corticospinal tract
if there is sphincter involvement eg urinary retention or constipation in a neuro injury what does this signify and explain why?
lesion in the spinal cord
it is essentially hypertonia of the sphincters which causes these symptoms (due to UMN lesion)
how can you differentiate thoracic and cervical spinal cord lesions?
thoracic= only arms affected cervical= all 4 limbs affected
what medication is contraindicated in hiatus hernia and why?
CCB
because it relaxes the sphincter and increases reflux
what do howell jolly bodies indicate? what are they
they are the nuclear remnants of RBC breakdown
they are indicative of hyposplenism
whats used for first line management in someone with symptomatic varicose veins?
NSAIDs
in DKA what is first line insulin management?
infusion of 0.1 unit/kg/hr
