SMURF SAQ

Question 1

what are the hallmarks for Horners syndrome

Answer 1

ptosis, miosis, anhidrosis

Question 2

tx for acute pancreatitis

Answer 2

IV fluids
catheterisation
analgesia
antiemetics

Question 3

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

Answer 3

Courvoisier’s sign is a palpable gallbladder in a jaundiced patient in the absence of pain suggesting pancreatic cancer

Question 4

rf for oesophageal cancers

Answer 4

Smoking (1), alcohol (1), obesity (1), consuming very hot drinks regularly (1), hiatus hernia (1), family history (1), GORD (1), Barrett’s oesophagus (1)

Question 5

investigations for oesophageal cancer

Answer 5

Upper GI endoscopy (1), with biopsy (1

Question 6

What class of drug should be started 1st line to treat his underlying condition and to improve heart failure? (

Answer 6

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.

Question 7

how do u diagnose DVT

Answer 7

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)

Question 7

common side effect of ACEi

Answer 7

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

Question 8

what medications are used to treat dvt?

Answer 8

. Medications – DOAC (Rivaroxaban, Apixaban) (1) / LMWH (Heparin, Dalteparin, Enoxaparin) (1) / Warfarin (1)

Question 9

what is MOA of DOAC

Answer 9

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)

Question 10

increases ur risk of DVT

Answer 10

· 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)

Question 11

What must VTE definition

Answer 11

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

Question 12

pathophysiology for T2DM

Answer 12

Inadequate insulin secretion
Damage to pancreatic beta cells from hyperglycaemia, therefore less insulin is produced

Question 13

What does biguanide do

Answer 13

Increases peripheral glucose uptake and sensitivity
and
Inhibits hepatic gluconeogenesis

Question 14

most common subtype of HPV

Answer 14

16 and 18 are the most common subtypes of HPV to cause cervical cancer (2)

Question 15

how do u stain?

Answer 15

Crystal violate (1), iodine (1), acetate/alcohol (1), saprain counterstain (1). (4 total)

Question 16

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)

Answer 16

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)

Question 17

define gout

Answer 17

. 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).

Question 19

in gout which joints are most commonly affected

Answer 19

· Base of the thumb – carpometacarpal joints (1)
· Wrist joints (1)
· Knee joints (1)
· Ankle joints (1)

Question 20

Name three findings in the fluid that would indicate a gout diagnosis (3)

Answer 20

No bacterial growth (1)
· Needle shaped crystals (1)
· Negatively birefringent of polarised light (1)
· Monosodium urate crystals (1)

Question 21

. Name 3 reasons why patients may be inappropriate for NSAIDs. (3)

Answer 21

existing conditions such as:
· Renal impairment
· Significant heart disease
· Asthma
· GI ulcers/bleeding
· H. pylori infection previously
· Diabetes
· Hypertension
· Pregnancy

Question 22

side effects

Answer 22

Side effects such as:
· Abdominal symptoms
· Diarrhoea
· Allergic reaction