SMURF SAQ Flashcards
what are the hallmarks for Horners syndrome
ptosis, miosis, anhidrosis
tx for acute pancreatitis
IV fluids
catheterisation
analgesia
antiemetics
E. The episode of pancreatitis is successfully treated. 10 years later, the same gentleman presents to A&E jaundiced and a palpable gallbladder on abdominal examination. What is the name of this clinical sign and what does it suggest? (2 marks)
what is the sign for
Courvoisier’s sign is a palpable gallbladder in a jaundiced patient in the absence of pain suggesting pancreatic cancer
rf for oesophageal cancers
Smoking (1), alcohol (1), obesity (1), consuming very hot drinks regularly (1), hiatus hernia (1), family history (1), GORD (1), Barrett’s oesophagus (1)
investigations for oesophageal cancer
Upper GI endoscopy (1), with biopsy (1
What class of drug should be started 1st line to treat his underlying condition and to improve heart failure? (
ACEi (eg Ramipril); ACEi or beta-blocker monotherapy is first line treatment in heart failure but as Ron has asthma, beta blockers are contraindicated due to the risk of bronchoconstriction. Furosemide would offer symptomatic relief but confers no prognostic benefit.
how do u diagnose DVT
A D-dimer test (1)
· Interim therapeutic anticoagulation (if possible, choose an anticoagulant that can be continued if DVT is confirmed) if an ultrasound can’t be obtained within 4 hours (1)
common side effect of ACEi
Dry tickly cough; troublesome dry cough occurs in ~10% of patients taking an ACEi, if not tolerated this should be switched to an ARB such as Losartan
what medications are used to treat dvt?
. Medications – DOAC (Rivaroxaban, Apixaban) (1) / LMWH (Heparin, Dalteparin, Enoxaparin) (1) / Warfarin (1)
what is MOA of DOAC
DOAC - DOACs act on the common pathway of the coagulation cascade by directly inhibiting factor Xa (apiXaban) preventing conversion of prothrombin to thrombin (1)
· LMWH - Enhances the anticoagulant effects of Antithrombin by binding to it which inactivates clotting factors such as IIa (thrombin) and Xa (1)
· Warfarin (vitamin K antagonist) - prevents synthesis of active factors II, VII, IX and X via antagonism of vitamin K, prolonging the prothrombin time (1)
increases ur risk of DVT
· Active cancer / ongoing chemotherapy (1)
· Hip/leg fracture (1)
· Hip/knee replacement (1)
· Major trauma (1)
· Clotting disorders, eg. Antiphospholipid syndrome, Thrombophilia (1)
· Increased oestrogen - Postpartum / pregnant women / HRT / contraception (1)
What must VTE definition
Venous thromboembolism (VTE) includes both deep-vein thrombosis (DVT) and pulmonary embolism (PE), and refers to a blood clot that forms in a vein which partially or completely obstructs blood flow. (1)
· Must mention both DVT + PE
pathophysiology for T2DM
Inadequate insulin secretion
Damage to pancreatic beta cells from hyperglycaemia, therefore less insulin is produced
What does biguanide do
Increases peripheral glucose uptake and sensitivity
and
Inhibits hepatic gluconeogenesis
most common subtype of HPV
16 and 18 are the most common subtypes of HPV to cause cervical cancer (2)
how do u stain?
Crystal violate (1), iodine (1), acetate/alcohol (1), saprain counterstain (1). (4 total)
C. a patient presents to you with an infection after eating dodgy food, he tells you he likes to eat his chicken cooked medium rare. You suspect either an infection of salmonella, or shigella as the food may have been contaminated. How would you differentiate between the two bacteria. (2)
Grow samples on an XLD plate (1). Salmonella will grow as a red dot with black centres, shigella will be colonies of only red dots (1)
define gout
. Gout is a type of crystal arthropathy associated with chronically high blood uric acid levels (1). These high levels cause urate crystals to be deposited in the joint and cause inflammation (1).
in gout which joints are most commonly affected
· Base of the thumb – carpometacarpal joints (1)
· Wrist joints (1)
· Knee joints (1)
· Ankle joints (1)
Name three findings in the fluid that would indicate a gout diagnosis (3)
No bacterial growth (1)
· Needle shaped crystals (1)
· Negatively birefringent of polarised light (1)
· Monosodium urate crystals (1)
. Name 3 reasons why patients may be inappropriate for NSAIDs. (3)
existing conditions such as:
· Renal impairment
· Significant heart disease
· Asthma
· GI ulcers/bleeding
· H. pylori infection previously
· Diabetes
· Hypertension
· Pregnancy
side effects
Side effects such as:
· Abdominal symptoms
· Diarrhoea
· Allergic reaction
