SBA DECK 6/06 Flashcards
what TB drug increases INR?
isoniazid
whats the most common cause of annovulation in women?
PCOS
is deformities like swan neck, boutonnieres, ulnar deviation are present whats the diagnosis?
rheumatoid arthritis
how can you differentiate mallory weiss and variceal bleed?
in variceal bleed there will be: ascites/abdo distention, encephalopathy, alcohol hx, signs of portal hypertension
what is a mallory weiss tear?
a laceration in the oesophagus often caused by retching/vomitting
what doses of adenosine and how many are given in SVT?
6 mg IV to start
if unsuccessful 12 mg
if unsuccessful a further 18 mg
describe acute management of SVT
first line vagal manoeuvres second line IV adenosine 6 mg if unsuccessful 12 mg if unsuccessful a further 18 mg if unsuccessful electrical cardioversion
what are side effects of adenosine and are they normal?
chest pain
flushing
yes they are normal and will self terminate
what are some symptoms of carcinoid syndrome?
flushing bronchospasm diarrhoea weight loss hypotension
how do dpp4 inhibitors work?
they reduce the peripheral breakdown of incretins eg GLP 1
describe management of STEMI
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
describe management of NSTEMI/ unstable angina
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
what is anion gap in DKA?
high
what diabetes drug should not be used in heart failure?
pioglitazone
what is contraindicated in asthmatics who have AF? what should you give them instead?
beta blockers
give a rate limiting CCB like verapamil instead
what should you give alongside terlipressin in variceal bleed?
IV abx
what do you see on lumbar puncture in GBS?
raised protein
normal WCC
what is protein and WCC on lumbar puncture in GBS?
protein is raised
WCC is normal
before polysomnography what is initial ic for OSA?
overnight pulse oximetry
what agent is most common in causing pneumonia in patients with bronchiectasis?
haem influenzae
what does a headache thats worse on defecating/straining indicative of? what should you do
indicative of raised ICP
must do non contrast CT head
what happens to vocal resonance over the area of a tension pneumothorax?
it decreases
what electrolyte abnormality do thiazide diuretics cause?
hypercalcaemia
in what patients is triptan for migraines contraindicated?
hx of IHD
what type of lump will mastitis cause?
warm, tender and fluctuant swelling
what is a staghorn calculus and how is it managed?
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
how does systemic sclerosis present?
raynauds phenomenon
sclerodactyly
pulmonary hypertension
odonyphagia
how do you manage a patient with a catheter who has an infection?
change the catheter first line to remove the source of the infection
what ix is diagnostic for bronchiectasis?
high res CT chest
what acronym is used to remember HAP organisms and what does it stand for?
SEP K: staph aureus e coli pseudomonas klebsiella
what is the most common organism for septic arthritis?
staph aureus
what is superior vena cava syndrome and how does it present?
compression of the superior vena cava eg due to a tumor
presents with dyspnoea, orthopnoea, swollen face and arms, cough, positive pembertons test
what causes raised PT?
anticoag use
liver failure
DIC
what does PT measure? how do you remember this?
extrinsic pathway
PT= Play Tennis outside= extrinsic
what is synonymous with PT?
INR
what causes raised APTT?
haemophilia
DIC
what does APTT measure?
intrinsic pathway
what is the main ECG abnormality in hypercalcaemia?
short QT interval
what does longer term PPI use increase the risk of? explain why
c diff infections
less gastric acid is produced which means bacteria aren’t killed
in a massive PE what one factor is an indication for thrombolysis?
hypotension
how is PBC managed?
oral ursodeoxycholic acid
when do you use IM lorazepam vs PR diazepam in status epilepticus?
IM lorazepam is only really used in hospital settings
use PR diazepam in GPs etc
when is colonoscopy avoided in UC? why? what is done instead
in severe flares due to risk of perforation
do a flexible sigmoidoscopy instead
is a child has HUS caused by food poisoning what is the likely causative organism?
e coli
what is alpha 1 antitripsin deficiency?
deficiency of a protease inhibitor made in the liver
what are symptoms of alpha 1 antitripsin deficiency? why do they arise
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)
how is alpha 1 antitripsin managed?
stop smoking
supportive physiotherapy and bronchodilators
A1AT infusion
can do lung vol reduction surgery etc
what 1st line management of septic arthritis?
joint aspiration and culture
this has to be done before empirical abx can be given
how are skin cancer referrals done based on type?
BCC= non urgent/routine 6 week referral to derm SCC/SCLC= urgent 2 week referral to derm
if there is itchiness in jaundice what does this tell you about the bilirubin?
its conjugated
what helps you identify pancreatic cancer in the way it presents?
flaws for a while
then very suddenly unwell as it obstructs the biliary system with jaundice and pruritus
what is given first in alcohol withdrawal? explain
give benzos first line as the seizures are what will kill them
pabrinex can then be given after to support them
what antibodies are present in dermatomyositis?
anti jo1
anti mi 2
anti SRP
how does dermatomyositis present?
proximal myopathy photosensitivity heliotrope rash over face grottons papules (red on fingers) raynauds phenomenon resp muscle weakness
what cells mediate polymyositis?
t cells
what the most sensitive test for acute pancreatitis ie whats done first?
bloods
what is percussion over a pneumothorax?
increased
how do you differentiate epididymal cyst from hydrocele
epididymal cyst= single mass
hydrocele= a mass but covering the whole testes so it looks like its enlarged
how do you differentiate between the different types of ACS?
STEMI= ST elevation on ECG and raised troponin
NSTEMI= raised troponin
unstable angina= normal troponin
what ECG changes might you see in NSTEMI?
T wave inversion
ST depression
what are the 3 features of critical limb ischaemia?
pain at rest
tissue loss (arterial ulcers)
gangrene
how is SAAG calculated and interpreted?
serum albumin- ascitic albumin
<8g= ascitic albumin is high= exudate
>8g= ascitic albumin isn’t that high= transudate
what is the cut off for SAAG and what does this mean?
if its <8g= exudate
how can you tell if ascitic fluid is transudate or exudate?
SAAG
<8= exudate
>8= transudate
what are the 3 classes of beta lactams?
penicillins
cephalosporins
carbapenems
what 2 substances are partially reabsorbed by the kidneys to increase water reabsorption?
urea and sodium
what 2 molecules are good markers of dehydration and why
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)
what does high urea indicate? explain why
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
what are the 4 indications for dialysis in chronic kidney failure?
acidosis
refractory pulmonary oedema
refractory hyperkalemia
uraemic complications
what zone undergoes hyperplasia in BPH?
periurethral
when you see anaemia and painless jaundice what should you think?
haemolytic anaemia
what does high calcium with low PTH indicate? explain
malignancy
the high calcium should reduce PTH so the PTH axis is normal, therefore the high calcium is probably caused by malignancy
what is salmterol?
LABA
what is given to reverse anticoagulation when someone is on warfarin which needs to be stopped?
vitamin K and prothrombin concentrate
how is VT managed in a haemodynamically stable patient?
amiodarone
what blood test is most helpful in confirming diagnosis of hereditary haemochromatosis and what will it be?
transferrin saturation
this will be high
how id idiopathic autoimmune haemolytic anaemia managed first line? why?
provided transfusion isnt needed give steroids, they surpress the immune system and reduce RBC haemolysis
what type of shock does cardiac tamponade cause? explain
obstructive- the heart is prevented from filling properly
when do you give LMWH vs alteplase first line in a PE?
LMWH= if haemodynamically stable alteplase= thrombolyse immediately if haemodynamically unstable
How does LEMS present?
lung cancer
muscle weakness mostly in legs
autonomic symptoms like dry mouth, impotence, difficulty urinating
in type 2 diabetes what is BP cutoff range?
if BP is not <140/80 mmHg start an ACE inhibitor
what should you think first when you see a hypertension management q?
look to see if they are diabetic, if yes first line ACE inhibitor
what 2 medications if given together will cause rhabomyolysis?
statin and erythromycin/clarithromycin
what is the presentation of rhabdomyolysis?
dark urine
muscle aches
what ix should be done in a PE prior to CTPA? why
CXR
to rule out other pathologies that can cause chest pain
what happens to ejection fraction and the heart muscle in alcoholics?
EF is reduced
heart muscle= dilated cardiomyopathy
whats first line ix for suspected HF?
BNP
do this before echo
if calcium is high and PTH is normal whats the most likely diagnosis? explain
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
what valve abnormality is associated with marfans syndrome?
mitral valve prolapse
how is an acute asthma attack managed?
back to back salbutamol nebs and ipatropium bromide, steroids and IV magnesium sulphate
what type of hepatitis is sexuall transmitted?
b
what signs do you see in aortic stenosis?
ejection systolic murmur
bibasal creps due to LHF causing pulmonary oedema
SOB
if a patient is bleeding profusely due to varices how do you manage them?
first line= IV terlipressin and blood if transfusion is indicated
second line= IV fluids and IV abx
whats is seen on dix hallpike manouevre if someone has BPPV?
delayed onset vertigo (2 secs after turning head) and unilateral nystagmus on the affected side
whats first line ix fr gastric cancer?
OGD and biopsy
NOT bloods
what is lupus pernio and what condition is it associated with?
purple rash on the face associated with sarcoidosis
what ix is done to confirm SIADH? what is the result
a normal short synacthen test will confirm it
what are the euvolemic causes of hyponatraemia?
SIADH
hypothyrodism
secondary adrenal insufficiency
in renal when do you get white cell casts?
in AKI when its tubular
in renal when do you get red cell casts?
in AKI when its interstitial
what is the test for chronic pancreatitis?
faecal elastase
