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Y3 GP > 21 - Vertical Themes (Uni Days) > Flashcards

21 - Vertical Themes (Uni Days) Flashcards

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1
Q

What is a standard LFT panel?

A

Look at clinical picture, often LFTs are isolated on their own and this is common and normal

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2
Q

What are the different ducts in the HPB system?

A
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3
Q

What LFTs are raised in hepatocellular injury and cholestasis? What would cause these raised LFTs?

A

Hepatocellular Injury: infection, malignancy, autoimmune, alcohol, drugs, NAFLD

Cholestasis: pregancy, drugs, biliary atresia, primary biliary cholangitis, gallstones

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4
Q

What are some extended liver screening tests?

A
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5
Q

What are the different types of jaundice and the causes?

A
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6
Q

How does haemostasis occur?

A

Primary clot: see image

Secondary clot:

  1. Initiation
  2. Amplification
  3. Propagation
  4. Termination
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7
Q

How does post hepatic obstructive jaundice present?

A

Pale stools and dark urine

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8
Q

What is included in a basic clotting screen?

A

PT/INR: extrinsic clotting. FVII, V, X, prothrombin and fibrinogen

APTT: FVIII, IX, XI, XII, V, X, prothrombin and fibrinogen

Bleeding Time: platelets

Thrombin time: how long for fibrinogen to fibrin

ALWAYS TAKE FBC TO LOOK AT PLATELETS WITH CLOTTING SCREEN

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9
Q

What are some causes of abnormalities on clotting screens?

A
  • Inherited deficiency of a clotting factor
  • Inherited deficiency of or defective von Willibrand factor
  • Consumption – clotting factors used up by DIC
  • Dilution – massive blood loss when replacement is with IV fluids and red cells only
  • Vitamin K deficiency or antagonism (affects factors II, VII, IX and X)
  • Liver disease
  • Anticoagulants
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10
Q

All clotting factors apart from two are made by the liver, which are these?

A

vWF

Factor 8

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11
Q

How will clotting screens (PT, APTT, fibrinogen, platelets) be affected in the following:

  • Haemophillia A or B
  • DIC
  • End stage liver disease due to cirrhosis
A

Platelets adhere to vWF

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12
Q

How will clotting screens (PT, APTT, fibrinogen, platelets) be affected in the following:

  • Over anticoagulation with warfarin
  • Patient on therapeutic dose LMWH for DVT
A
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13
Q

What empirical antibiotic should you use for meningitis?

A
  • IV Ceftriaxone
  • If over 60 use Ceftriaxone and Amoxicillin for listeria cover
  • If allergy use Meropenem

Once cultures have come back can switch to narrower spectrum antibiotic

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14
Q

Why is vancomycin not used for meningitis?

A

Poor penetration through the BBB

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15
Q

What are some risk factors for a C.Diff infection?

A
  • Recent broad spectrum abx use
  • Prolonged hospital stay
  • >65
  • PPI therapy
  • Immunosuppressed
  • Chemotherapy
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16
Q

What antibiotics are used for cholecystitis?

A

- Co-amoxiclav or Metronidazole+Ciprofloxacin or Meropenem

  • Also give IV fluids, analgesia and arrange for cholecystectomy
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17
Q

Is meropenem safe in penicillin allergy?

A

Has a beta lactam ring so can still cause some reactions

Check if patient has true penicillin allergy

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18
Q

How long do patients need to take antibiotics for acute cholecystitis?

A
  • If no surgery due to being too frail then 4-6 weeks
  • If cholecystectomy and no perforation none needed after surgery
  • If perforation then 5 days post operatively

IV fluids, analgesia, antibiotics

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19
Q

What is evidence based medicine?

A

Incorporates value based medicine

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20
Q

What are the benefits of value based medicine?

A

Never assume you and the patient hold the same values!!!

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21
Q

What is the difference between a sign and symptom?

A

Sign: objective that can be viewed by another person

Subjective: subjective that is only felt by the patient

If asked in an exam what symptoms by the examiner use jargon, if asked to ask the patients about their symptoms DO NOT use jargon

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22
Q

What investigations would you order for this patient?

A

- Bloods: FBC, U+Es, LFTs, CXR, eGFR, HbA1c, Lipid profile, NT-proBNP

- ECG

- Echocardiogram

- CXR

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23
Q

What signs will you see on a CXR for a heart failure patient?

A
  • Cardiomegaly
  • Pulmonary oedema (bilateral infiltrates/Batwing)
  • Fluid in right fissure
  • Pleural effusion
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24
Q

When do you refer to secondary care for suspected heart failure?

A
  • Refer for echo within 2/52 if NT-proBNP >236
  • Refer straight for echo if previous MI
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25
What are the two options for gall bladder removal?
- Laparoscopic cholecystectomy - Open cholecystectomy
26
What can you include in your management plan apart from the treatment?
- Self help advice e.g monitor BM, stop smoking - Escalate to senior - Analgesia and antiemetic
27
What do you need to remember to report on a CXR before A-D?
RIPE!!!
28
What is a silhouette sign?
If you lose a key line then there is consolidation in a specific place
29
What is this x-ray showing?
**Veil Sign** Left upper lobe collapse
30
What is the exposure with a AXR and what review system should you use?
From diaphragm to pubic symphis ABDO X A: air - where it should and should not be- Should only be in the lumen, erect x rays are more sensitive B: bowel - position, size and wall thickness- 3-6-9 rule D: dense structures, calcification and bones- calcified renal tract/ gallstones O: organs and soft tissues- remember lung bases X: eXternal objects and artifacts
31
What should you be looking at on a pelvic x-ray?
Joints are SI and pubic symphis
32
What should you always look for when given an x-ray of a joint?
A second view of the joint!
33
What two layers is an epidural and spinal anaesthesia between?
**Epidural:** dura mater and arachnoid mater **Spinal Anaesthesia (subarachnoid space):** arachnoid mater and pia mater
34
What conservative action can be taken for hip OA?
- Mobility aids - Physio - Activity modification - Weight loss
35
What is dalteparin and how does it work?
LMWH Works by binding to factor Xa and inactivating it and binding to ATIII to potentiate it's action
36
How does dabigatran and rivaroxaban work?
**Dabigatran:** binds to factor II (thrombin) and inactivates it **Rivaroxaban:** binds to factor Xa and inactivates it
37
What malignancy and non-malignant diseases are related to obesity?
OBESITY IS A RISK FACTOR FOR **- Cancer:** bowel, ovarian, breast, endometrial **- Non-malignant:** stroke, OA, T2DM, MI
38
What joints in the hand does RA usually affect?
- PIPJ - MCP of thumb
39
What are some examples of macrogols?
- Movicol - Laxido
40
What do you need to tell someone that is starting on the pill?
- Does not protect against STI - What to do with missed pill - Vomiting and diarrhoea - Interaction with antibiotics
41
How do you treat BPPV?
- Dix Hallpike to diagnose and should resolve spontaneously - If does not resolve then use Epley
42
What is the mechanism of aspirin?
Irreversible COX inhibitor and TXA2 inhibitor
43
What are some contraindications for the pill?
- Breast cancer - \>35 - Raised BMI - Previous VTE - Migraine with aura
44
What procedure should you use for hydronephrosis?
Percutaneous nephrostomy
45
What are the side effects of active TB meds?
**Ethambutol -** Retrobulbar neuritis **Pyrazinamide -** Gout so joint aches, hepatitis
46
What are some extra-articular features of RA?
- Pulmonary nodules - Pericarditis - Interstitial lung disease (ILD) - Lymphadenopathy - Carpal tunnel syndrome - Splenomegaly - Dry eyes/mouth - Scleritis
47
Where do you find the deep inguinal ring?
Halway between ASIS and pubic tubercle
48
What is the role of a healthcare visitor?
Offer support to families through early years from pregnancy and birth to school years
49
What are some features of poorly controlled asthma?
- Difficulty sleeping due to asthma - Asthma interfering with normal daily activities - Using salbutamol \>once a week - Declining PEFR
50
How can you teach a patient to improve their asthma control?
- Review inhaler technique - Avoid triggers - Smoking cessation - Self management plan - Step up drugs
51
How do you perform the Dix-Hallpike test?
- Ask patient to sit upright on couch and focus on a point keeping eyes open - Lower head and torso down to level of bed - Move head directly below level of bed and turn head left or right - Watch for **nystagmus** for 30-60 secs - Repeat on opposite side
52
How is BPPV managed?
- Avoid sudden change in position - Adequate hydration - Advise not to drive whilst symptomatic
53
What are some risks of not treating hypernatraemia?
- Seizures - Thrombotic episode - Stroke - Loss of consciousness
54
What is a waterlow score?
Estimated risk of development of a pressure sore in a patient
55
1. What is the treatment for LRTI in a bronchiectasis patient? 2. What is the likeliest organisms in a diabetic leg ulcer? 3. What should you check before startin azathioprine?
1. Amoxicillin for 14 days 2. E.Coli 3. TPMT levels
56
What is the murmur like in Aortic stenosis (AS), what are the symptoms, how does it appear on ECG and how is it managed?
- Ejection systolic loudest in aortic area radiating to carotids - SOB, Syncope, Palpitations, Chest pain - LVH, AF, Heart block - Transcatheter aortic valve implantation (TAVI) if elderly, cardiac surgery if young and fit
57
What are some questions you should ask if a patient has ascites?
- Alcohol history - Risks for viral hepatitis e.g IVDU, blood transfusions - Obesity
58
Why is the INR prolonged in alcoholic liver disease?
- Liver not able to produce clotting factors - Vit K deficiency from alcohol
59
How should you treat nephrotic syndrome in adults initially and when in CKD are people consider for RRT?
-This depends on the cause of Nephrotic syndrome. - Diuretics reduce Fluid retention - Severe cases, Heparin and Warfarin are used Stage 4
60
What rhythm can adenosine TERMINATE?
Narrow complex tachycardia (NOT atrial and sinus tachycardia)
61
What is a side effect of alendronic acid?
- GORD!!!!
62
Why do you need an ABG in sepsis?
Lactate!!!!!
63
What antibiotics should you give for bacterial meningitis?
- Benzylpenicillin stat dose at GP - Ceftriaxone definitive - Dexamethasone with bacterial meningitis
64
How do the LP parameters vary for bacterial, viral and fungal meningitis?
**Appearance:** cloudy and turbid in bacterial, clear in viral, clear or cloudy in fungal **Opening pressure:** rasied in bacterial, normal or raised in viral, raised in fungal **WBC:** raised in all, mostly in viral **Glucose:** low in bacterial and fungal, normal in viral **Protein:** elevated in all
65
What are some investigations and management you should do for a patient in post op with a suspected PE?
**_Ix:_** - Bedside: ECG - Bloods: Trop, D-dimer, - Imaging: CTPA **_Mx_** - Start rivaroxaban - Oxygen - IV fluids - Analgesia - Stop any precipitating medications
66
What are some differentials for tiredness?
- Hypothyroidism - Anaemia - Coealics - Cushings - Diabetes - OSA
67
Where should you insert a chest drain?
At the top of the rib
68
What are some signs and symptoms of ILD?
**Symptoms**: dry cough, SOB on exercise that is progressive **Signs:** clubbing, fine inspiratory crackles, reduced chst expansion
69
What are some signs of lung cancer?
- Horners - SVC obstruction - Paraneoplastic syndromes - Signs of metastases: jaundice, ascites, bone pain, hepatomegaly - Night sweats - Hoarse voice - NOTHING
70
When can't you use a V/Q scan for a PE?
Obstructive lung disease e.g COPD, Asthma
71
What are some causes of pulmonary artery hypertension?
- PE - Hypoxia - LVH - Idiopathic
72
How do you work out the causes of hyponatraemia?
**Pseudo:** check serum osmolality, if normal then due to hyperlipidaemia, mannitol, TURP or high BM **Hypervolemic**: CCF, Nephrotic syndrome, Cirrhosis **Euvolemic:** SIADH (ADH stops RAAS and aldosterone production so Na goes into urine) **Hypovolemic:** Diuretics, vomiting, addisons, sweat, diarrhoea
73
What is the pathophysiology of dementia?
- Amyloid plaques extracellularly - Neurofibillary tangles intracellularly
74
What are some reversible causes of a dementia like presentation?
- Polypharmacy with anticholinergics - Thiamine deficiency - Normal pressure hydrocephalus - Syphilis
75
Why does CKD-BMD develop?
- Active Vit D not being hydroxylated by kidneys - Low Ca - Raised PTH - Takes Ca from bone **Mx:** phosphate binders, calcimimmetics, vit D replacement, parathyroidectomy if tertiary hyperPTH
76
What is seen on fundoscopy of diabetic retinopathy? **(IMPORTANT)**
**1. Background retinopathy:** microaneurysms and hard exudates **2. Pre-proliferative retinopathy:** cotton wool spots, haemorraghe **3. Proliferative:** new vessels form, urgent referral **4. Maculopathy:** decreased visual acuity
77
What is seen on fundoscopy with hypertensive retinopathy?
Grade: ## Footnote **I =** silver wiring **II =** AV nipping **III =** flame haemorraghes and cotton wool spots **IV =** papilloedema
78
What is the dose of adrenaline for anaphylaxis?
IM 1:1000 500 mcg
79
What are some symptoms of hyperthyroidism?
80
Can you DC cardiovert someone who has hyperthyroidism with AF?
No they need to be euthyroid for 8-10 weeks
81
Why do people with CKD get hyperK+?
- Impaired GFR plus a frequently high dietary potassium intake - Extracellular shift of potassium caused by the metabolic acidosis - Treatment with K+sparing drugs e.g. ACEi/ARBs
82
What are some non-pharmacological interventions for delirium?
83
After completeing an A-E assessment, how should you manage this patient?
CONTROLLED OXYGEN
84
What are some pathophysiological features of asthma?

Y3 GP (21 decks)

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