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Year 3 > SBA DECK 6/06 > Flashcards

SBA DECK 6/06 Flashcards

1
Q

what TB drug increases INR?

A

isoniazid

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2
Q

whats the most common cause of annovulation in women?

A

PCOS

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3
Q

is deformities like swan neck, boutonnieres, ulnar deviation are present whats the diagnosis?

A

rheumatoid arthritis

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4
Q

how can you differentiate mallory weiss and variceal bleed?

A

in variceal bleed there will be: ascites/abdo distention, encephalopathy, alcohol hx, signs of portal hypertension

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5
Q

what is a mallory weiss tear?

A

a laceration in the oesophagus often caused by retching/vomitting

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6
Q

what doses of adenosine and how many are given in SVT?

A

6 mg IV to start
if unsuccessful 12 mg
if unsuccessful a further 18 mg

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7
Q

describe acute management of SVT

A 
first line vagal manoeuvres
second line IV adenosine 6 mg
if unsuccessful 12 mg
if unsuccessful a further 18 mg
if unsuccessful electrical cardioversion
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8
Q

what are side effects of adenosine and are they normal?

A

chest pain
flushing
yes they are normal and will self terminate

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9
Q

what are some symptoms of carcinoid syndrome?

A 
flushing 
bronchospasm
diarrhoea
weight loss
hypotension
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10
Q

how do dpp4 inhibitors work?

A

they reduce the peripheral breakdown of incretins eg GLP 1

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11
Q

describe management of STEMI

A

start on aspirin 300mg, morphine (+anti emetic) if in severe pain, nitrates (caution if theyre hypotensive)
if PCI available in 120 mins do this, give pasrugel and unfractionated hep, do PCI with radial access preferred
if PCI not available in 120 mins do thrombolysis and give ticagrelor after

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12
Q

describe management of NSTEMI/ unstable angina

A

give 300mg aspirin and fondaparinux if immediate PCI is not being done
if haem unstable= PCI, give pasrugel or ticagrelor and unfractionated heparin
if stable and PCI not done give ticagrelor
decide risk on GRACE score

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13
Q

what is anion gap in DKA?

A

high

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14
Q

what diabetes drug should not be used in heart failure?

A

pioglitazone

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15
Q

what is contraindicated in asthmatics who have AF? what should you give them instead?

A

beta blockers

give a rate limiting CCB like verapamil instead

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16
Q

what should you give alongside terlipressin in variceal bleed?

A

IV abx

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17
Q

what do you see on lumbar puncture in GBS?

A

raised protein

normal WCC

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18
Q

what is protein and WCC on lumbar puncture in GBS?

A

protein is raised

WCC is normal

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19
Q

before polysomnography what is initial ic for OSA?

A

overnight pulse oximetry

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20
Q

what agent is most common in causing pneumonia in patients with bronchiectasis?

A

haem influenzae

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21
Q

what does a headache thats worse on defecating/straining indicative of? what should you do

A

indicative of raised ICP

must do non contrast CT head

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22
Q

what happens to vocal resonance over the area of a tension pneumothorax?

A

it decreases

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23
Q

what electrolyte abnormality do thiazide diuretics cause?

A

hypercalcaemia

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24
Q

in what patients is triptan for migraines contraindicated?

A

hx of IHD

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25
Q

what type of lump will mastitis cause?

A

warm, tender and fluctuant swelling

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26
Q

what is a staghorn calculus and how is it managed?

A

it is a type of renal stone that wont pass without surgery
PCNL is preferred to remove it
shockwave lithotripsy is reserved for those who are at high risk of surgery

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27
Q

how does systemic sclerosis present?

A

raynauds phenomenon
sclerodactyly
pulmonary hypertension
odonyphagia

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28
Q

how do you manage a patient with a catheter who has an infection?

A

change the catheter first line to remove the source of the infection

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29
Q

what ix is diagnostic for bronchiectasis?

A

high res CT chest

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30
Q

what acronym is used to remember HAP organisms and what does it stand for?

A 
SEP K:
staph aureus
e coli
pseudomonas
klebsiella
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31
Q

what is the most common organism for septic arthritis?

A

staph aureus

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32
Q

what is superior vena cava syndrome and how does it present?

A

compression of the superior vena cava eg due to a tumor

presents with dyspnoea, orthopnoea, swollen face and arms, cough, positive pembertons test

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33
Q

what causes raised PT?

A

anticoag use
liver failure
DIC

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34
Q

what does PT measure? how do you remember this?

A

extrinsic pathway

PT= Play Tennis outside= extrinsic

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35
Q

what is synonymous with PT?

A

INR

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36
Q

what causes raised APTT?

A

haemophilia

DIC

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37
Q

what does APTT measure?

A

intrinsic pathway

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38
Q

what is the main ECG abnormality in hypercalcaemia?

A

short QT interval

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39
Q

what does longer term PPI use increase the risk of? explain why

A

c diff infections

less gastric acid is produced which means bacteria aren’t killed

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40
Q

in a massive PE what one factor is an indication for thrombolysis?

A

hypotension

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41
Q

how is PBC managed?

A

oral ursodeoxycholic acid

42
Q

when do you use IM lorazepam vs PR diazepam in status epilepticus?

A

IM lorazepam is only really used in hospital settings

use PR diazepam in GPs etc

43
Q

when is colonoscopy avoided in UC? why? what is done instead

A

in severe flares due to risk of perforation

do a flexible sigmoidoscopy instead

44
Q

is a child has HUS caused by food poisoning what is the likely causative organism?

A

e coli

45
Q

what is alpha 1 antitripsin deficiency?

A

deficiency of a protease inhibitor made in the liver

46
Q

what are symptoms of alpha 1 antitripsin deficiency? why do they arise

A

deficiency means neutrophil elastase damages the lungs causing emphysema
there is also cirrhosis of the liver due to accumulation of defective alpha 1 antitripsin in the liver (this can be carcinoma in adults and cholestasis in children)

47
Q

how is alpha 1 antitripsin managed?

A

stop smoking
supportive physiotherapy and bronchodilators
A1AT infusion
can do lung vol reduction surgery etc

48
Q

what 1st line management of septic arthritis?

A

joint aspiration and culture

this has to be done before empirical abx can be given

49
Q

how are skin cancer referrals done based on type?

A 
BCC= non urgent/routine 6 week referral to derm
SCC/SCLC= urgent 2 week referral to derm
50
Q

if there is itchiness in jaundice what does this tell you about the bilirubin?

A

its conjugated

51
Q

what helps you identify pancreatic cancer in the way it presents?

A

flaws for a while

then very suddenly unwell as it obstructs the biliary system with jaundice and pruritus

52
Q

what is given first in alcohol withdrawal? explain

A

give benzos first line as the seizures are what will kill them
pabrinex can then be given after to support them

53
Q

what antibodies are present in dermatomyositis?

A

anti jo1
anti mi 2
anti SRP

54
Q

how does dermatomyositis present?

A 
proximal myopathy
photosensitivity
heliotrope rash over face
grottons papules (red on fingers) 
raynauds phenomenon
resp muscle weakness
55
Q

what cells mediate polymyositis?

A

t cells

56
Q

what the most sensitive test for acute pancreatitis ie whats done first?

A

bloods

57
Q

what is percussion over a pneumothorax?

A

increased

58
Q

how do you differentiate epididymal cyst from hydrocele

A

epididymal cyst= single mass

hydrocele= a mass but covering the whole testes so it looks like its enlarged

59
Q

how do you differentiate between the different types of ACS?

A

STEMI= ST elevation on ECG and raised troponin
NSTEMI= raised troponin
unstable angina= normal troponin

60
Q

what ECG changes might you see in NSTEMI?

A

T wave inversion

ST depression

61
Q

what are the 3 features of critical limb ischaemia?

A

pain at rest
tissue loss (arterial ulcers)
gangrene

62
Q

how is SAAG calculated and interpreted?

A

serum albumin- ascitic albumin
<8g= ascitic albumin is high= exudate
>8g= ascitic albumin isn’t that high= transudate

63
Q

what is the cut off for SAAG and what does this mean?

A

if its <8g= exudate

64
Q

how can you tell if ascitic fluid is transudate or exudate?

A

SAAG
<8= exudate
>8= transudate

65
Q

what are the 3 classes of beta lactams?

A

penicillins
cephalosporins
carbapenems

66
Q

what 2 substances are partially reabsorbed by the kidneys to increase water reabsorption?

A

urea and sodium

67
Q

what 2 molecules are good markers of dehydration and why

A

sodium and urea
they are partially reabsorbed by the kidney to increase osmolarity which helps reabsorb water (usually urea is completely excreted, therefore if levels are high this suggests dehydration)

68
Q

what does high urea indicate? explain why

A

dehydration (among other things)
usually urea is completely excreted so when its reabsorbed it is to increase osmolarity in the kidney so more water is reabsorbed

69
Q

what are the 4 indications for dialysis in chronic kidney failure?

A

acidosis
refractory pulmonary oedema
refractory hyperkalemia
uraemic complications

70
Q

what zone undergoes hyperplasia in BPH?

A

periurethral

71
Q

when you see anaemia and painless jaundice what should you think?

A

haemolytic anaemia

72
Q

what does high calcium with low PTH indicate? explain

A

malignancy
the high calcium should reduce PTH so the PTH axis is normal, therefore the high calcium is probably caused by malignancy

73
Q

what is salmterol?

A

LABA

74
Q

what is given to reverse anticoagulation when someone is on warfarin which needs to be stopped?

A

vitamin K and prothrombin concentrate

75
Q

how is VT managed in a haemodynamically stable patient?

A

amiodarone

76
Q

what blood test is most helpful in confirming diagnosis of hereditary haemochromatosis and what will it be?

A

transferrin saturation

this will be high

77
Q

how id idiopathic autoimmune haemolytic anaemia managed first line? why?

A

provided transfusion isnt needed give steroids, they surpress the immune system and reduce RBC haemolysis

78
Q

what type of shock does cardiac tamponade cause? explain

A

obstructive- the heart is prevented from filling properly

79
Q

when do you give LMWH vs alteplase first line in a PE?

A 
LMWH= if haemodynamically stable
alteplase= thrombolyse immediately if haemodynamically unstable
80
Q

How does LEMS present?

A

lung cancer
muscle weakness mostly in legs
autonomic symptoms like dry mouth, impotence, difficulty urinating

81
Q

in type 2 diabetes what is BP cutoff range?

A

if BP is not <140/80 mmHg start an ACE inhibitor

82
Q

what should you think first when you see a hypertension management q?

A

look to see if they are diabetic, if yes first line ACE inhibitor

83
Q

what 2 medications if given together will cause rhabomyolysis?

A

statin and erythromycin/clarithromycin

84
Q

what is the presentation of rhabdomyolysis?

A

dark urine

muscle aches

85
Q

what ix should be done in a PE prior to CTPA? why

A

CXR

to rule out other pathologies that can cause chest pain

86
Q

what happens to ejection fraction and the heart muscle in alcoholics?

A

EF is reduced

heart muscle= dilated cardiomyopathy

87
Q

whats first line ix for suspected HF?

A

BNP

do this before echo

88
Q

if calcium is high and PTH is normal whats the most likely diagnosis? explain

A

primary hyperparathyroidism
PTH levels can be normal in primary hyperparathyroidism
although malignancy is a valid cause of these results primary hyperparathyroidism is still more likely

89
Q

what valve abnormality is associated with marfans syndrome?

A

mitral valve prolapse

90
Q

how is an acute asthma attack managed?

A

back to back salbutamol nebs and ipatropium bromide, steroids and IV magnesium sulphate

91
Q

what type of hepatitis is sexuall transmitted?

A

b

92
Q

what signs do you see in aortic stenosis?

A

ejection systolic murmur
bibasal creps due to LHF causing pulmonary oedema
SOB

93
Q

if a patient is bleeding profusely due to varices how do you manage them?

A

first line= IV terlipressin and blood if transfusion is indicated
second line= IV fluids and IV abx

94
Q

whats is seen on dix hallpike manouevre if someone has BPPV?

A

delayed onset vertigo (2 secs after turning head) and unilateral nystagmus on the affected side

95
Q

whats first line ix fr gastric cancer?

A

OGD and biopsy

NOT bloods

96
Q

what is lupus pernio and what condition is it associated with?

A

purple rash on the face associated with sarcoidosis

97
Q

what ix is done to confirm SIADH? what is the result

A

a normal short synacthen test will confirm it

98
Q

what are the euvolemic causes of hyponatraemia?

A

SIADH
hypothyrodism
secondary adrenal insufficiency

99
Q

in renal when do you get white cell casts?

A

in AKI when its tubular

100
Q

in renal when do you get red cell casts?

A

in AKI when its interstitial

101
Q

what is the test for chronic pancreatitis?

A

faecal elastase

Year 3 (104 decks)

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