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SBA - wrong answers > wrong answers > Flashcards

wrong answers Flashcards

1
Q

How is normoglycemic ketoacidosis different to DKA?

A

DKA - type 1 diabetes
NKA - type 2 diabetes, risk factor SGLT-2 inhibitors

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2
Q

What is a side effect of antithyroid medications?

How does this present?

A

Agranulocytosis

Fever, sore throat, illness etc after being commenced on anti-thyroid medication (eg. carbimazole, propylthiouracil)

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3
Q

What is the treatment of newly diagnosed type 1 diabeties

A

Immediate insulin therapy and referal

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4
Q

How to treat DKA?

A

Continue basal insulin - start on fixed rate (cells start to use glucose, switching off ketone production)

Correct dehydration over 48hrs –> to dilute hyperglycaemia and ketones

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5
Q

How to treat HHS

A

Fluid

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6
Q

How does adrenal crisis present and why?

A

Hypotension (low aldosterone –> no water retained)

Hypoenatremia (Na follows water)

Hyperkalemia (oposite to Na)

Hypoglycemia (low cortisol –> increase glucose utilisation/ insulin response to increase energy)

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7
Q

What is plummers disease?

A

Toxic multi nodular disease - nodules release thyroid hormones and are NOT regulated by thyroid axis

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8
Q

What is key for diagnosis of graves disease and why

A

Anti TSH receptor antibodies –> Graves is autoimmune disease - bind to TSH receptors and TSH is released –> increase T3 and T4

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9
Q

How to visualise the pituitary gland?

A

MRI is preferred but CT if not MRI devices (eg. pacemaker)

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10
Q

What is the most common reason for DKA?

A

Insulin ommision

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11
Q

What is the presentation of hypercalcemia

A

Stones - renal stones

Bones - painful bones

Thrones - polyuria, polydipsia, constipation (increased sitting on the toilet)

Groans - Abdominal moans

Moans - Psychiatric groans

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12
Q

What is the presentation of hypocalcemia

A

Tetany
Muscle spasm
Cramping
Parastesia
Muscle cramping
Cardiac arrtyhmias

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13
Q

How to stabilise the cardiac membrane?

When is this needed?

A

Calcium gluconate
Calcium chloried

Hyperkalemia
Hypocalcemia

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14
Q

When are SGLT2 inhibitors beneficial in diabetic control

A

Beneficial in diabetic nephropathy and cardiac issues

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15
Q

What is (and how to test for):

Addisons

Conns

Phaeochyrom

Cushings

A

Addisons - Adrenal insufficiency
- Low cortisol, low aldosterone
- 9am cortisol, ACTH stimulation test

Conns - high aldosterone
- Renin:aldosterone

Phao - high adrenaline
- 24hr urinary catecholamies

Cushings - high cortisol
- Dexamethasone supression test

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16
Q

What is thyrotoxicosis

How to treat?
What to avoid?

A

Excess state of circulating thyroid hormone causing excess thyroid activity

Treat with NSAIDS
avoid anti-thyroid drugs

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17
Q

How to differentiate between thyrotoxicosis and graves disease?

A

Anti-thyroid antibodies - positive in graves

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18
Q

How does thyrotoxicosis present?

A

Proceeding viral prodrome
Raised EST
Tender goitre

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19
Q

How to distinguish between myeloma and hyperparathyroidism?

A

Calcium released via myeloma with SUPPRESS PTH as is not a problem with the pituitary (axis will still work)

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20
Q

What percentage of oxygen is in air?

How does % oxygen relate to litres?

A

21%

1 litre –> 24%
increase 4% with every litre

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21
Q

When to use NIV in COPD management?

A

When patients are on maximum treatment with ongoing resp acidosis

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22
Q

How to calculate the CURB65 score

A

Confusion
Urea >7
Resp rate >30
BP <90/60
>65

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23
Q

What is the most common causative organism for CAP?

A

Streptococcus pneumoniae

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24
Q

What is the most common causative organism for HAP?

A

Haemophillia influenza
MRSA

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25
Q

What is bronchiectasis?

How does it present

A

Permanent dilation and scarring of the airways

Obstructive condition
Cough
Purulent sputum
Fatigue
Crepatations
Recurrent infections in childhood

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26
Q

What is gold standard for diagnosis of bronchiectasis?

A

CT scan

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27
Q

What is pulmonary fibrosis?

How does it present?

A

Scarring in the lungs

Restrictive pattern
Coal miners
Clubbing
Dry cough
SOB
Inspiratory crackles

Reticular shadowing on CXR
Ground glass opacificities on CT scan

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28
Q

What is a pancoast tumour

A

Tumour at the apices of the lungs
Horners syndrome
Involvement of the brachial plexus

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29
Q

What are the different types of lung tumour and how to distinguish between them?

A

Small cell
- metastasises quickly - normally before diagnosis
- mediastinal mass

Squamous cell
- most common
- smokers
- centra

Adenocarcinoma
- non-smokers (BUT more common in female smokers)
- peripheral

Pancoast
- apex
- horners
- brachial plexus involvement

Mesothelimoa
- asbestos exposure
- pleural thickening
- not circular

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30
Q

When to use oxygen therapy in COPD?

A

When sats <92 when stable

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31
Q

COPD managment

A
  1. SABA or SAMA
  2. LABA and LAMA (discontinue SAMA)
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32
Q

What is trimbow inhaler

A

triple therapy

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33
Q

What is ventolin inhaler

A

saba (salbutamol)

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34
Q

What is symbicort inhaler

A

SABA and LABA

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35
Q

FEV/FVC for obstructive

A

<70%

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36
Q

FEV/FVC for restricitve

A

> 70%

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37
Q

obstrucitve lung conditions

A
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38
Q

Restrictive lung conditions

A
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39
Q

COPD vs asthma spirometry

A

Asthma >12% reversable

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40
Q

What is life threatening asthma?

A

33 peak flow
92 sats
Normal PCO2
oxygen <8
Features of respiratory distress

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41
Q

What is the causative organism for pneumonia that occurs with target lesions and dry cough

A

Mycoplasma pneumonia

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42
Q

What are hypotension, muffled heart sounds and raised JVP a sign of?

What is the first investigation?

A

Cardiac tamponade (Beck’s triad)

Echo

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43
Q

Describe the ECG location of ST elevation and which vessels this relates to

A
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44
Q

Describe aortic stenosis murmur

A
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45
Q

Describe aortic stenosis regurg murmur

A
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46
Q

Describe mitral stenosis murmur

A
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47
Q

Describe mitral regurg murmur

A
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48
Q

When is digoxin used over bisoprolol for rate control?

A

heart failure or low BP

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49
Q

How to calculate CHA2DS2VASc score

A

CHF Hx
Hypertension Hx
Age (2 for >75, 1 for 65-74)
Diabetes Hx
Stroke/TIA/PE Hx (2)
Vascular disease Hx
Sex (1 for female)

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50
Q

First choice of antihypertensive in black origin?

A

CCB

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51
Q

First choice of antihypertensive in diabetics?

A

ACE inhib

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52
Q

What to use in treatment of HTN in black african origin when CCB is not tolerated?

A

Thiazide diuretic

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53
Q

What is indapamide?

A

Thiazide like diuretic

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54
Q

What is spironalactone?

A

K sparing diuretic

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55
Q

What is fruosemide?

A

Loop diuretic

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56
Q

What is the starting dos of ramapril?

A

2.5

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57
Q

What is the treatment for c diff?

A

Oral vancomycin (first episode)

Fidaxomicin (resistant, recurrent)

Metronidazole (severe)

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58
Q

Why not use loperamide in c diff infection?

A

Reduced diarrhea - antimotility –> reduced expulsion of the c diff toxin

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59
Q

What is the treatment for cholesytitis?

A

co amox

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60
Q

What score for upper GI bleed for outpatient management?

A

Glasgow-blatchford - before endoscopy

Rockall score - after endoscopy

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61
Q

What does constipation feel like on PR exam?

A

Hard stool in the rectum

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62
Q

What is the treatment for H pylori

A

PPI
Amox
Clari
Metronidazole

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63
Q

What are the complications of H pylori?

A

GORD
Peptic ulcers
Stomach cancer

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64
Q

How to tell the difference between different type of peptic ulcer?

A

Gastric - Worse after eating –> tend to loose weight

Duodenal - better after eating –> tend to gain weight

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65
Q

What are the risks for peptic ulcers?

A

Things that disrupt the mucosal membrane or increase the stomach acid
- stress
- spicy food
- alcohol
- smoking

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66
Q

What are the investigations for an obstructing gallstone?

A

USS - if one not seen then MRCP

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67
Q

What is an MRCP compared to an ERCP?

A

MRCP - MRI
–> visualise gall stones

ERCP - endoscopic procedure
–> visualise and remove gall stones

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68
Q

What is chronic mesenteric ischemia and how does it present?Why?

A

Narrowing of the mesenteric arteries (think risk factors)

  • abdominal bruit
  • colicky epigastric pain –> occurs after eating and relieved by defication
  • weight loss due to food fear

Blood supply to the gut is adequate during rest but inadequate during active digestion

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69
Q

How to diagnose chronic mesenteric ishemia?

A

CT angio

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70
Q

How to check for strictures in the small bowel?

A

CT

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71
Q

What are the more specific differences between chrons and ulcerative collitis?

A

UC:
Extra-intestinal disease (episcelriis, erythema nodosum)

Reduced globlet cells and granulomas

Drain pipe colon risk

lower left abdominal pain

Crohns:
Strictures
Fistulas

Increase in goblet cells
Granulomas
Right illiac fossa mass (terminal ileum mostly affected)

cobblestone appearance, skip lesions

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72
Q

Is there more weight loss in UC or crohns? Why?

A

Crohns - affects the terminal ileum mostly (where nutients etc are absorbd)

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73
Q

What is the difference between primary billiary cholangitis and primary sclerosing cholangitis?

A

Biliary:

  • Affects women more
  • Affects the inside of the liver
  • AMA antibodies, raised ALP (cholestatic picture)
  • Associated with other rheumatoid conditions –> Sjogrens, RA, systemic sclerosis

Sclerosing:

  • Associated with ulcerative collitis
  • Affects the inside and outside of the liver
  • Males affected more
  • MRI bile ducts
  • Beads on a string
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74
Q

What is ursodeoxycholic acid used for?

A

Treatment of gallstones
PSC

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75
Q

What is Charcots triad?

A

Abdominal pain, jaundice, fever

Associated with ascending cholangitis

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76
Q

What is the most common causative oragnism for ascedning cholangitis?

A

E coli

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77
Q

What is the next step for somebody presenting with dysphagia?

A

2WW endoscopy to rule out malignancy

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78
Q

How does intussception present?

Who is it more common in?

A

between 6 months - 2 years of age

redcurrant jelly stool

sausage shaped mass in abdomen

More common in children with CF

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79
Q

How does pyloric stenosis present?

A

projectile vomiting
between 2-12 weeks old

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80
Q

What is the difference between a strangulated hernia and an incarcerated hernia?

A

Incarcerated - not reducible

Strangulated - blood supply is compromised

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81
Q

What can be used as treatment for visceral pain in IBS?

A

Amityptaline

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82
Q

What are the risk factors for biliary colic?

A

Female
fat
forty
fertile

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83
Q

What score is used to assess mortality rate in cirrhosis?

A

Child pugh score

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84
Q

How is cirrhosis described on a scan?

A

nodular liver surface
hypoechoic nodules

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85
Q

What are the presentations of neurosyphillis?

A

Pupils react to accommodation and not light

Lack of proprioception and vibration sensations

Focal neurological signs

20-40 years after first presentation

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86
Q

What is Zollinger-Ellison syndrome?

What is the test for it?

A

Traid of:
Pancreatic cancer
Gastric hypersecretjons
Peptic ulcers (in unusual places)

Test —> secretions

THINK if features of ZES - cancers

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87
Q

What is a HINTS exam?

What do the results indicaete

A

Test to perform following prolonged vertigo and nystagmus with a normal cerebellar examination

Head impulse, nystagmus, skew
- NEGATIVE HEAD IMPULSE –> central issue (eg posterior stroke)

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88
Q

What is the treatment and prophylaxis for migrane?

A

Prophylaxis propranalol

Treatment tryptans

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89
Q

What is the classification for CT within 1 hr following fall

A

more than one episode of vomiting

GCS <13

GCS deteriorating within 2 hrs

Opened or depressed skull fracture

Focal neurology

Post traumatic seixure

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90
Q

What is the classification for CT within 8 hr following fall

A

retrograde amnesia
on anticoagulation
dangerous mechanism of injury
LOC

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91
Q

What is the treatment for seizures in hospital

A

Lorazepam over diazepam

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92
Q

What are the treatments for AD?

A

1) ACh inhbitors (donzepil, rivatigmine, galantamine)

2) memantine

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93
Q

What are the treatments for seizures?

A

Male - sodium valproate

Female - lamotrigine or levetiracetam

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94
Q

What is the treament for temporal arteritis? bells palsy? trigeminal neuraliga?

A

TA - prednisolone
Bells palsy - prednisolone
TN - carbamazepine

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95
Q

What is venous sinus thrombosis? How does it present?why?

A

Stroke
Headache
vomiting
difficulty speaking/understanding language

BLURRED VISION due to increase in ICP behind the clot (unable to drain blood out of the brain) –> pappiloedema

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96
Q

How does polycythemia ruba vera present a risk for venous sinus thrombosis?

A

increase in RBC –> more cells –> thicker blood –> clot

ALSO concurrent increase in platelets

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97
Q

What are the differences between focal and complex seizures?

A

focal - one side of the brain. repetative movments. can be comples (not aware) or simplae (aware)

comples - both hemispheres, lose conciousness, tonic-clonc (grand mal), absence (petite mal)

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98
Q

meningitis prophylaxis?

A

cipro

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99
Q

How to screen for gestational diabeties?

A

OGTT at 24-28 weeks

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100
Q

What are the different emergency contraceptives and when can they be taken?

A

Copper coil
ulipristal
<120 hrs (5 days)

levenogesteral <72 hrs (3 days)

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101
Q

When is ulipristal effectiveness reduced?

A

If the patient is on progesterone pill

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102
Q

When is levenogesteral as EC effectiveness reduced? How to over come?

A

If obese (overcome by doubling dose)

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103
Q

How to treat seizure in pregnancy?

A

Mag sulf until 24hrs post delivery or last seizure (whichever is first)

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104
Q

What is the first line treatment for heavy periods?

A

IUS

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105
Q

What is sheehans syndrome? Cause? Sx? tretmanet?

A

complication of postpartum haemorrhage –> pituitary infarction (hypopituitary) du to rapid depletion of blood in heamorrhage/obstetric shock

amenoherra
Lack of lactation
fatigue
loss of pubic hhair

HRT is the treatment

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106
Q

How to visualise ectopic pregnancy?

A

Transvaginal USS

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107
Q

What is the abx of choice for ottitis media?

when to use

A

amoxicillin

use when sx lasting more than 4 days/not improving

systemically unwell

immunocompromised

<2 y/o with bilateral otitis media

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108
Q

what abx are contraindicated in tympanic membrane perforation?

When can these abx used

A

gentamycin

used in ottis externa

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109
Q

what is the centor score?

when to prescribe abx?

A

fever
lymphandopathy
lack of cough
exudate

Prescribe DELAYED abx in score of 3 or 4

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110
Q

Treatment of acute sinusitis?

A

nasal douche

intranasal corticosteroids - reduce inflammation

abx considered after 10 days OR if bacterial

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111
Q

treatment of ottitis externa
mild vs more severe

What are mild sx

A

MILD: acetic acid

More severe: topical abx +/- topical steroid

Mild - no hearing loss or discharge

IF systemically unwell - consider abx

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112
Q

Treatment for ottis media with perforation/

A

ORAL abx

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113
Q

What is the difference between acute and chronic sinusitis?

A

Acute <12 weeks
Chronic >12 weeks (3 months)

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114
Q

How to distinguish between CSOM and acute otitis media and ottitis media with effusion?

A

CSOM has membrane perforation and a prolonged Hx of discharge and hearing loss

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115
Q

Difference between chalazion and stye?

A

Stye tends to be painful whereas chalazion tends to be none painful as C is sterile inflammation

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116
Q

Blephritis vs uveitis vs scleritis vs keratitis vs episcleritis?

A

BLEPHRITIS: inflammation of the eyelash margin - gritty, red, crusting

UVEITIS/IRITIS: inflammation of the uvea of the eye (including where the AH is released from the cillary body) –> cloudy AH, flare
painful red eye, pain on movement, abnormally shaped pupil, hyponon, photophobia, pain on movement, flashes, floaters

SCLERITIS: inflammation of the sclera of the eye (white part)
SEVERE pain, photophobia, abnormal pupil reaction to light, redness, associated with rheumatoid conditions

KERATITIS: inflammation of the cornea (covering the front of the eye) due to microbial invasion
common in contact lens wearers
forgein body sensation

EPISCLERITIS: inflammation of the lateral part of the eye causing segmental redness and dilation of the blood vessels
Mild pain, watering, forgein body sesation
associated with herpes and inflammatory conditions

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117
Q

What is the difference between smith and colles fracture?

A

Smith - Spade deformity ( back of hand to floor - hand makes s shape

Colles - Dinner fork deformity (distally displaced) Palm flat on floor - hand make c shape

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118
Q

what confirms the diagnosis of polymyalgia?

A

response to oral steroids

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119
Q

Heberdens nodes vs bouchards nodes?

A

H - OA
B - RA

B before H in the alphabet (B closet to body)

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120
Q

What is goodpastures disease? How to diagnose?

A

Affects the lungs and the kidneys –> Ant GBM

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121
Q

Is codine used in gout?

A

NOT indicated - but NSAIDs are

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122
Q

What is APTT affected by?

A

vW disease
Haemophillia A
Hameophillia B

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123
Q

What is PT affected by?

A

Vit K deficiency
Warfarin

124
Q

How to remember leukemia types

A

ALL downsyndrome (most common in kids)
CLL richter, smudge
AML rods
CML philladelphia chromosome

All dogs cant really sit amonst really crap people

125
Q

Difference between leukemia, lymphoma and myeloma

A

LEUKEMIA - cancer of the bloods cells –>

LYMPHOMA - cancer of the lymph nodes –> lymphandopathy

MYELOMA - cancer of the plasma cells –> infiltrate into the bone marrow. Hyperviscosity.

126
Q

What is tumor lysis syndrome?

A

Release of substances from RBC that are destroyed using chemo/radiotherapy

–> uric acid, phosphate, potassium

127
Q

What is a myeloproliferative neoplasm and how is this different to a myelodysplastic syndrome

A

myeloproliferative –> uncontrolled proliferation of single type of stem cells

myelodysplastic –> mutation of the myeloid cells in the bone marrow

128
Q

What investigations confirm a diagnosis of myeloproliferative syndrome?

A

Bone marrow aspiration/biopsy

JAK2 mutation

129
Q

What sydromes have the potential to turn into AML?

A

Myelodysplastic and myeloproliferative

130
Q

What happens in myeloproliferative disease?

A

Bone marrow is replaced with scar tissue –> production of blood cells takes place in other areas of the body
–> splenomegaly
–> hepatomegaly
–> spinal cord compression if happens in the spinal cord

131
Q

What are the different types of myeloproliferative diseases?

132
Q

What is seen on the blood film from myeloproliferative disease?

A

Tear drop RBC
Blasts
Anisocytosis (varying sizes of RBC)

133
Q

How might myeloproliferative diseases present?

A

POLYCYTHEMIA/THROMBOCYTHEMIA:
Thrombosis - DVT and PE
due to increased number of cells
- blood clots in unusual places

POLYCYTHEMIA:
Due to increased number of RBC AND platelets
Ruddy complexion (red face)
Conjunctival plethora (opposite of conjunctival pallor)
Splenomegaly
Hypertension

134
Q

What are the different types of myelodysplastic syndromes?

A

Anemia
Neutropenia
Thrombocytopenia

135
Q

Diangosis of myelodysplastic disease?

A

Blood count
Blood film
Bone marrow biopsy

136
Q

What are the causes of normocytic anemia?

A

Anemia of chronic dieases
Acute blood loss
Aplastic anemia
Haemolytic anemia
Hypothyroidism

137
Q

What is aplastic anemia?

A

Pancytopenia with hypocellular bone marrow in the absence of any infiltrates (unlike marrow fibrosis or leukemia)

138
Q

How does heamophillia A present

A

Prolonged APTT that does not correct with mixing (similar to lypys, clotting factor INHIBITORS)

Mixing –> highlights DEFICIENCY not inhibitors/antibodies

139
Q

How are heamophillia A and B inherited

140
Q

what is G6PD deficiency?

when does it usually present

A

lack of the enzyme that helps RBC to function properly –> RBC break down/heamolyse –> jaundice, dark urine

Usually presents following oxidative challenge (eg fever, viral illness, exposure to drugs) –> nitro, cipro
FAVA BEANS

141
Q

What are the causes of megaloblastic anemia?

A

B12 or folate deficiency (large cells)

142
Q

What is seen in warm hemolysis?

cold agglutinin?

143
Q

What conditions are hyper-segmented neutrophills seen in?

A

Megloblastic anemias (B12, folate)

144
Q

What anemia can metformin cause?

Aspirin?

A

Metformin –> B12

Aspirin –> iron deficiencyW

145
Q

What do heinz bodies show?

A

GPD6 deficiency

146
Q

What do reed steniburg cells show

A

Hodgkin lymphoma

147
Q

What do target cells show

A

iron D anemia
Sickle cell anemia
thalassemia

148
Q

What do schistocytes show?

A

fragments of RBC –> haemolytic anemaic, TTP

149
Q

What do tear drop RBC show

A

Myeloproliferative disease

150
Q

What type of anemia is sickle cell?

A

normochromic normocytotis

151
Q

How does thalasemia present?

A

Heamolysis –> fragile RBC due to defective RBC

Splenomegaly –> due to removal of the damaged RBC

Microcytic anemia

Bone deformity –>strain of producing extra RBC

152
Q

How does major B thalasemia presnet

A

same as other B thalasemia but MORE serious:
- fractures
- faliure to thrive

153
Q

how does major A thalasemia present?

A

interuterine death

154
Q

treatment for moderate B thalasmeia

A

Blood transfusion
Iron chelation

155
Q

treatment for major B thalasmeia

A

Blood transfusion
Iron chelation

Splenectomy

Bone marrow transplant (curative)

156
Q

What deficiency is more common in patients taking methotrexate?

157
Q

What are the electrolytes seen in tumour lysis syndrome?

A

RELEASE OF ELECTROLYTES
high K
High phosphate
High Urea

BUT low Ca –> mopped up by phosphate

158
Q

How to distinguish between ALL/CLL and CML/AML

A

Dependant on the FBC - different cell lines

myeloid gives rise to RBC, platelets and WBC

Lymphoid gives rise to WBC only

THEREFORE - CLL/ALL –> platelets and RBC decreased and WBC increased

AML/CML –> All increased

159
Q

How to diagnose ITP

A

Diagnosis of exclusion -isolated low platelets with no other cause of low platelets

160
Q

Rouleaux formation in cells?

A

Multiple myeloma

161
Q

What to suspect with painless asymmetric swelling in the neck?

A

Hodgkin lymphoma

162
Q

Shingles treatment

A

Acyclovir if present <72 hrs of rash

Support if >72 hrs and no Hx of immunocompromise

163
Q

What is dermatitis herpatiformis?

A

Skin bumps and blisters caused by sensitivity to glutenT

164
Q

Treatment for perioral dermatitis? Why?

A

Topical metronidazole as it if often preceeded by used of steroids (eg. hydrocortisone)

165
Q

What is SJS?

What is often the cause?

A

Rapid epidermal necrosis of the skin and mucositis following viral prodrome and rash that spreads over the skin –> blistering of the skin

affects the skin, mucous membranes
eyes inflamed and ulcerated

Can affect the internal organs

85% are drug related –> especially lamigotrine

166
Q

when should antiviral treatment be used for shingles?

A

immunocompromised

those with non-truncal shingles, those with moderate or severe rash and/or pain

and those over 50 years old (in the latter group, antiviral treatment has been shown to reduce the incidence of post-herpetic neuralgia, persistent neuropathic pain in the affected dermatome after the shingles has resolved)

167
Q

Who to avoid when have shingles?

A

Anybody who has not had chickenpox (can catch virus –> cause chicken pox)

168
Q

What is erysipelas?

How does it present?

What is it caused by?

A

Infection of the deeper layers of the skin - form of cellulitis that affects the lower legs and the face

Erythema with raised, well demarcated areas, superficial

Streptococcus pyogenes (not staph aures –> affects more superficial layers of the skin)

169
Q

What is SLE?

A

Inflammatory autoimmune connective tissue –> SYSTEMIC: affecting multiple systems
ERTHEMATOSUS: Malar rash across the face

170
Q

What is kawasaki disease?

How does it present?

What is the main complication?

Treatement?

A

Lymph node disease/vasculitis

High grade fever FOR MORE THAN 5 DAYS

Conjunctival irritation
Cracked, dry lips
Strawberry tongue
Lymphandopathy
Rash
Red palms and feet that peel

Main complication - coronary artery aneurysm

Treatment - high dose aspirin, IV immunoglobulins

171
Q

How to differentiate aplastic anemia from other leukemias?

A

Blood film –> no abnormalities

172
Q

What does parovirus B19 cause?

A

slapped cheek

aplastic crisis in patients with:
- Sickle cell
- Thalasemia
- Hereditary spherocytosis

173
Q

How to distinguish between splenic sequestration and aplastic crisis

A

BOTH cause LIFE THREATENING ANEMIA BUT

splenic sequestration - due to rapidly increased spleen size –> traps RBC
–> reticulocyte (RBC number) is increased as cells produce more
–> common with sickle cell

aplastic crisis - bone marrow stops producing RBC
–> reticulocyte count decreased as cells cannot produce more
–> common with hereditary spherocytosis

174
Q

Which leukemia causes splenomegaly?

A

CML and AML
CRAZY MASSIVE LARGE spleen

175
Q

Where are blasts seen on blood smear?

A

ALL and AML

176
Q

How to differentiate between lymphoblastic leukemia and myeloid leukemia?

A

Myeloid - spleen enlarged

Lymphoma - lymph nodes enlarged

177
Q

What can cause anemia in pregnancy?

A

Normal physiological reaction (dilutional) with normal MCV

178
Q

What is the difference between HUS and TTP?

A

HUS triad:
- Acute renal faliure
- Microangiopathic heamolyric anemia
- Thrombocytopenia

Associated with E coli

TTP:
Above +
- fever
- neurological

ADAMTS 13

179
Q

How is HSP diangnosed?

A

Purpura
abdo pain
arthritis
glomerulonephritis
periarticular oedema
renal faliure

usually follows URTI

180
Q

What malignancy is associated with HIV? (AIDS-related)

A

Non hodgkin

181
Q

What is the difference between hodgkin and non hodkin lymphoma

A

Hodgkin - painless, lymp node swelling. reed-steinburg cells

Non- hodgkin - spreads to involve other sites eg. skin, brain, gi tract

182
Q

How does diabeties insipidus present?

What happens to these patients following fluid restriction?how is this different to normal people?

A

Excess fluid loss and excess fluid intake

Fluid restriction - urine output remains high and osmolality (concentration) is decreased

Normal people in fluid restriction - urine output is reduced and urine osmolality (concentration) is increased

183
Q

What happens to urine output and osmolality in central diabeties insipidus patients when desmopressin is given?why?

Nephrogenic?why?

A

Decrease in urine volume and and increase in osmolality (returns back to normal patient)
–> due to lack of ADH (vasopressin) release from the brain BUT kidney still responsive
–> bypass this
–> replace this and kidney can work

No change in nephrogenic
–> lack of the ability of the kidney to respond to ADH (vasopressin) so increasing vasopressin has no affect

184
Q

How is potassium lost from the body

A

vommiting, diahrrea

185
Q

What is the main cause of addisons disease?

A

Medication -steroids take over the production of ACTH –> withdrawal of steroids, symptoms become evident

186
Q

What visual disturbance is associated with a pituitary adenoma?

A

Bilateral hemianopenia

187
Q

What is one of the main causes of SIADH?

How does it present?

A

meningitis, stroke, tumours, SCC, chest infections

Normo/euvolemic hyponatremia
‘peeing out salt when you dont have enough salt in the body already’

188
Q

How to diagnose SIADH?

A

urine and plasma osmolality
ADH levels

189
Q

What is the difference between SIADH and conns syndrome?

A

SIADH –> too much vasopressin
(from the hypothalamus)
- Vasopressin increases the water permeability of the tubule

Conns –> too much aldosterone (in the adrenal gland)
- Aldosterone increases reabsorption of Na
- Affects the electrolytes

190
Q

What are the symptoms of phaeochromocytoma?

A

PH
P palpitations
H headaches
PH phlushing (flushing)

191
Q

Difference between diagnosing type 1 diabeties vs type 2 diabeties

A

type 1 –> fasting
type 2 –> HbA1c

192
Q

What is the test for diabeties insipidus?

A

Water deprivation test

193
Q

What precipitates pseudogout?

A

hypothyroidism

194
Q

How to diagnose cushings (pituitary adenoma) vs ectopic producing tumours

A

High dose –> diagnose CUSHINGS or ECTOPIC ACTH

  • if cortisol is suppressed –> pituitary adenoma (semiautonimous)
  • if cortisol not supressed –> ectopic producing tumour
195
Q

How to diagnose cushings? (inpatient vs outpatient tests and order)

A

Outpatient:
- 24hr urinary cortisol
- over night dex

Inpatient:
- ACTH
- high dose dex

196
Q

What is postpartum thyroiditis?

How to treat?

A

thyroid antibodties attack the thyroid, 2 stages

1) Hyper (4 months)
- As the cells release T3/T4
- treat symptomatically with propranolol

2) Hypo (6 months)
- As t3/t4 is used up/depleted and TSH levels have to catch up
- treat with levothyroxine

197
Q

Investigation of a thyroid lump?

A

USS
followed by fine needle aspiration

198
Q

What is increased thirst a symptom of?

A

Hypercalcemia

199
Q

when to use warfarin with AF

A

Antiphospholipid syndrome
metalic heart valves

200
Q

When to give VZIG to newborn of mother?

A

If she gets rash between 7 days pre and 7 days post delivery

201
Q

treatment for pyloric stenosis?

A

check for any abnomalities in electrolytes
USS

202
Q

What is used in the prevention of cluster headaches?

203
Q

how to treat IIH?

204
Q

what are the indications of hypocalcemia?

A

S spasms
P perioral parastehesia
A anxious
S seizures
M muscle tone increase in smooth muscles
O orientation impaired
D dermatitis
I impetigo herpatiformis
C chozveks sign

trousseus sign

205
Q

What medication to use in thyroid crisis?

A

PTU (blocks conversion, carbimazole has slower effect)

206
Q

What do paraneoplasms release?

What is the affect of this?

A

PTH –> hypercalcemia

ADH(vasopressin) –> hyponatremia

hCG –> gynaecomastia

GH –> acromegaly

ACTH –> Cushings

207
Q

when to reduce dose of metformin?

When to stop

A

eGFR <45

eGFR<30

208
Q

What is the test for congenital adrenal hyperplasia?

A

17-hydroxyprogesterone

209
Q

primary vs secondary hyperparathyroidism?

A

LOOK AT PTH

primary - calcium high, PTH normal or high
- due to excess PTH (problem with parathyroid)

secondary - calcium low, PTH high
- PTH high to compensate for low Ca (problem with calcium)

OPPOSITE to thyroid where look at T4 levels first and then TSH levles

210
Q

what is conns

A

hypertension with hypokalemia –> hyperaldosteronism

sodium normal or at high end of normal

211
Q

treatment for SIADH

A

Fluid restriction

212
Q

How to distinguish between graves and thryroiditis vs solitary nodule vs toxic multinodular? How to treat?

A

BOTH cause hyperthyroidism

Graves, solitary nodule, multinodular - uptake of radioactive iodine is increased (‘hot’)

Graves - ani TPO and TSH receptor antibodies. Diffuse uptake of iodine

solitary nodule - One painless swelling. uptake of iodine in specific small area

Toxic multinodular -diffuse swelling. multiple areas of iodine uptake

Thyroiditis - uptake of radioactive iodine is reduced. Usually following URTI –> PROPRANALOL

213
Q

What is needed for a diagnosis of diabeties?

A

1) Diabeties symptoms AND abnormal value

OR

2) 2 abnormal values
- HbA1C >48
- fasting glucose >7
- 2 hrs post p >11
(think 7/11)

214
Q

How to differentiate between vWd and haemophillia and DIC

A

vWD –> mucosal bleeding

Hameophilia –> bleeding into joints and muscles
Reduced active form of clotting factor

DIC –> bleeding everywhere. PT and APPT prolonged

215
Q

What is the difference between ITP and TTP

How are they similar?

A

ITP - happens following an URTI –> produced antibodies agains antibodies
- Absence of schistocytes
- Bili normal

TTP - due to mutation with ADAM13 –> unable to produce vWF. precursors to vWF produce thrombi. RBC passing through the vessels shear –> systerocytes –> heamolysis (MAHA). Altered mental status
- Schistocytes present
- Bili rised

Similar:
BLEEDING TIME increased (as low platelets) BUT PT and aPTT normal

216
Q

Side affects of thiazide diuretics?

A

Postural hypotension
Hyponatremia
Hypokalemia
Gout

217
Q

What are the initial investigations for black outs?

A

Lying standing blood pressure
ECG

218
Q

What is the treatment for heart faliure?

A

A ACE inhib
B Beta blocker
A Aldosterone agonist (when sx not controlled with A or B)
L Loop diuretic (fruoesemide)

219
Q

When to avoid NSAIDs? Why?

A

Heart faliure - exacerbated due to the reduced effectiveness of ACE inhibitors and the reduction of clearance of Na from the kidney –> retain more water

Kidney disease - cause reduced renal perfusion

Ischemic heart disease

220
Q

Initial intervention 3rd degree heart block

A

Atropine
THEN if no response - temporary pacing whilst waiting for permanent pacemaker

221
Q

How to treat atrial fib?

A

1) Rate control - beta blocker OR CCB (diltiazem) OR dig

2) Combination of rate control

3) Rhythm control IF
- not working
- unstable (electrical cardiov)
- young patients
- first presentation
- paraxosimal
- symptomatic
–> amiodarone

222
Q

What is adenosine used for?

amiodarone?

A

Cardioversion in SVT

Cardioversion in atril fib, VF, VT

223
Q

What is the normal length of the PR interval?

A

3-5 small squares (begning of P to start of Q)

224
Q

How does AF present?

A

SOB
Chest pain
syncope/dizziness

225
Q

Causes of AF?

A

S – Sepsis
M – Mitral valve pathology (stenosis or regurgitation)
I – Ischaemic heart disease
T – Thyrotoxicosis
H – Hypertension

226
Q

What is secondary prevention of ACS?

A

6 A’s:
A spirin 75mg indefinitely
A CEinhib
A torvastatin
A tenalol (or other)
A ldosterone antagoist
A nother antiplatelet (tigacrelor or clopi for 12 months)

227
Q

symptoms of aortic stenosis

A

syncope
dysponea
chest pain

228
Q

What is long QT associated with?

A

Ventricular T

229
Q

What is tetralogy of fallot?

A

VSD - Blood can flow between ventricles (normally L–>R due to increased pressures in the L side)

Pulmonary valve stenosis - Greater resistance –> encourage blood from R–>L instead of L–>R

Overriding aorta - placed more to the right than normal, blood can pass through into circulation from the R side - deoxygenated)

Right ventricular hypertrophy - has to pump against resistance of the L ventricle and the pulmonary valve that is stenosed

230
Q

What is a tet spell

A

Temporary cyanotic episodes where L–>R shunt is temporarily worsened

231
Q

What does a split of the second heart sound indicate?

A

Pulmonary and aortic valves closing at different times due to blood flowing between the atria through the defect (L –> R) increasing the pressure in the R atrium before th

232
Q

which murmurs are pan systolic?

233
Q

What type of murmur is heard in ASD?

A

Mid systolic

234
Q

What type of murmur is heard in PDA?

A

Continuous machinery like murmur

235
Q

What are normal mumurs in children

A

Soft
Systolic
Short
Symptomless
Situation dependant (eg. quiet on standing, appears when the child is unwell)

236
Q

What is an atrial myxoma?

Symptoms?

A

Benign tumours in the left atrium –> cause obstruction similar to mitral stenosis

  • fever, malaise
  • a fib
  • mid diastolic murmur
  • tumour plot (hitting the mitral valve)
  • better on lying down due to clearing the obstruction from the mitral valve
  • loud first heart sound at the apex
237
Q

What is hydroxcobalamin treatment for?

A

B12 replacement in B12 deficiency

238
Q

What to do if somebody has recurrent balanitis?

A

Check blood sugar

239
Q

What is the treatment for pomphylx?

A

Topical steroids

240
Q

Wells score 2 what to do?
Wells score 1 what to do?

A

2 - USS
1 - d dimer

241
Q

What is the most common cancer of the oesophagus?

Bladder?

A

Osophagus - adenocarcinoma

Bladder - transitional cell

242
Q

What are the side affects of tamsulosin?

Finesteride?

A

T - retrograde ejaculation

F - erectile dysfunction, loss of libico

243
Q

What is the treatment for a collateral ligament tear?

A

Partial (redness, swelling, pain) –> RICE

full (no pain) –> refer

244
Q

What to test if hair loss and low MCV?

A

Ferritin (regardless of Hb)

245
Q

Treatment of TIA?

A

300mg aspirin, stroke follow up 24hrs

246
Q

What happens with verapamil and lithium

A

lithum toxicity

247
Q

Treatment for warts

A

Topical salicylic acid

248
Q

Differene between atinic and sebhorraic keratosis?

A

atinic - skin colour, sandpaper
Sebhorraic - brown

249
Q

Measles sX?

A

3 C
- coryza
- cough
- conjunctivitis

250
Q

How to treat mastitis?

A

Infective (nipple discharge) –> fluclox
non infective/milk mastitis –> warm compress, continue to breastfeed

251
Q

Alarm bells for malaria?

A

fever
neurological involvement/meningism
recent vist to endemic area

252
Q

When is IGF-1 increased?

A

Acromegaly (increase in GH)

253
Q

What is fecal elastase used to measure?

A

Pancreatic function - if high, pancreatic function is normal (no chronic issue)

254
Q

What raises suspision of wilms tumour?

A

recurrent UTI
Abdominal mass
Raised BP
Haematuria

255
Q

How to visualise brain tumour?

256
Q

Prophylaxis against pneumonia in HIV?

A

co trimoxazole

257
Q

What to do with a patient with a high BNP?

A

ECHO and referall within 2 weeks

258
Q

What to do if wells score >2 but ddimer is neg?

A

repeat doppler in 1 week

259
Q

How can ferritin be high in iron deficiency anemia? How to tell if it still is iron deficiency?

A

Ferritin - acute phase reactant, raised in infection

Iron biding capacity high
transferrin saturation low

260
Q

What is the test to diagnose chronic pancreatitis?

Acute pancreatitis?

A

Chronic –> fecal elastase

Acute –> amylase/lipase

261
Q

What causes sudden cardiac death in children?

How does this murmur present?

A

Hypertrophic cardiomyopathy

Ejection systolic mumur that increases in intensity during the VALSAVA MANOUVERE

262
Q

What should hypertensive patients with ACR >30 be started on?

263
Q

How to treat somebody who is immunocompromised who has been exposed to chicken pox?

A

obtain seriology (regardless of previous exposure)

264
Q

What medications should people be started on following an MI (STEMI or NSTEMI)

A

Ace inhibitor
Atorvastatin
Atenalol
Aspirin
Another antiplatelet

265
Q

What is diagnostic for PCOS?

A

high LH:FSH

265
Q

Treatment for PCOS?

A

Infertility - clomifine
Acne/menstural cycles - COCP

266
Q

What is seen in scarlet fever?

A

White coating on the tounge ‘strawberry tounge’
Rash
Swollen neck glands
sore throat/infection
High temperature

267
Q

What is the difference between hypertrophic obstructive cardiomyopathy and restrictive cardiomyopathy?Dilated cardiomyopathy?

A

Restrictive - heart chamber stays the same size but the muscle walls become less compliant, equal thickening of the wall of the heart

Hypertrophic obstructive
- young athletes with family Hx of collapse and sudden cardiac arrest
- one side of the ventricle thickens –> chamber is smaller

Dilated cardiomyopathy
- event which damages the myocardium

268
Q

What should diabetics with microalbuminemia be started on?

A

ACE inhibitor

269
Q

Treatment for c diff?

A

Vancomycin

270
Q

difference between sigmoid volvulus and caecel volvulus on XR?

A

Sig - coffee bean sign
Caecel - Foetus sign

271
Q

How to visualise bowel obstruction?

272
Q

First line for GORD

A

Trial of PPI (full dose)

273
Q

ANYBODY presenting with dysphagia what to do?

274
Q

Incarcirated vs strangulated hernia?

A

Incarcerated - cannot be reduced
strangulated - Blood supply cut off, systemic symptoms

275
Q

How to investigate elderly patient for suspected UTI?Why?

A

MSU - urine dip is not reliable as bacteria and inflammatory cells can be in the urine without infection

276
Q

nitro dose?

A

3 days 50mg

277
Q

What is merckels diverticulum?how does it present?

A

Out pouch of the lower intestine - remains of the umbilical cord

Painless rectal bleeding, 2 years old

278
Q

what causes scarlett fever?

A

strep pyrogenes

279
Q

Difference between presentation of scleritis and episcleritis?

A

Scleritis - painful, light pressure doesnt move the vessles

Episcleritis - painless, light pressure moves the vessels

280
Q

how to diagnose MS

A

MRI brain - shows areas of demyelination

281
Q

risk factor for retinal detachment>

282
Q

Advice on DVLA with TIA?

A

Stop driving for 1 month (no need to tell them if drive car if one TIA)
W
Need to inform DVLA if multiple TIA or drive lorry

283
Q

What antibody aids in diagnosis of SLE?

A

anti-dsDNA (anti-double stranded DNA)

284
Q

What to use in post stroke neuropathic pain?

A

Gabapentin

285
Q

treatment for ring worm?

A

topical miconazole

286
Q

likely cause of collapse in young people?

A

prolonged QT –> preciptates psaudes des pointes/VF

287
Q

What medication causes increase in WBC?

288
Q

treatment for ottitis media with perforation?

A

ammoxicilin

289
Q

treatment for urge incontinence?

A

tolteradine

290
Q

treatment for oral thrush?

A

fluconazole

291
Q

what is seen in central artery occlusion?

A

PALE retina with cherry red spot

292
Q

how to distinguish between diabetic retinopathy and hypertensive?

A

Hypertensive - AV nicking (veins cross arteries)
diabetic - exudates

293
Q

how long does adjustment disorder last?

294
Q

What is a galactocele

A

milk filled cyst in breast feeding women, hard, painless

295
Q

How to investigate raised ICP?

A

MRi brain to see if brain tumour THEN lumbar puncture if dont see anything

296
Q

what is osteomalacia?

A

Bone softening in adults due to lack of vitamin D

297
Q

what is pagets disease?

How to diagnose?

A

bone recycling problem - bones become missshapen, bone pain

Isolated rise in ALP (nothing to do with calcium/PTH axis)

298
Q

How to treat squint in children?

A

Patch the UNAFFECTED eye

299
Q

COnsitpation treatment in pregnancy

A

IH first
Lactulose second

300
Q

What organism is present in osters?

301
Q

what improves long term survival of COPD patients?

A

Stop smoking
Long term oxygen therapy

302
Q

What to do if cant visualise foetus in early pregnancy?

A

Rescan 7 days

303
Q

What is the time frame that poeple are infectious for with chicken pox?

what is the incubation period

A

2 days before and 5 days after rash appears

21 days

304
Q

What is the test for T1D

A

Random blood glucose

SBA - wrong answers (1 decks)

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