2A bits n bobs

Question 1

What are the stages of hypertension?

Answer 1

Stage 1 = >140/90
Stage 2 = >160/100
Severe = >180/120

Question 2

What are the causes of peptic ulcers?

Answer 2

H.pylori, increased acid production, reccurent NSAID use, mucosal ischaemia

Question 3

What causes small and large bowel obstructions?

Answer 3

Small = adhesions and hernias
Large = malignancy, diverticular disease and volvulous

Question 4

How can you differentiate clinically between small and large bowel obstructions?

Answer 4

Small bowel = abdo pain is higher up, vomiting is earlier in onset (there will be a time when there is vomiting and stools are still passed - in LBO stopping passing stools occurs much more closely to symptoms onset), pain and bloating are often less severe in SBO

Question 5

What are the cuases of GORD?

Answer 5

Obesity, hiatus hernia, smoking/alcohol/caffeine/chocolate, pregnancy, gastroparesis and medications (e.g. NSAIDs, CCBs and nitrates)

Question 6

What can barium swallow used to be diagnosed?

Answer 6

Achalasia, hiatus hernia, structural problems in the oesophagus

Question 7

Sx of achalasia?

Answer 7

Dysphagia, regurgitation of food/saliva, heartburn, belching, coughing at night, aspiration pneumonia and chest pain

Question 8

What is the management of eczema?

Answer 8

1st line = emollients

topical corticosteroids -> non sedating anti-histamines (e.g. cetirizine) -> oral corticosteroids

Question 9

Sx of eczema herpeticum? How do you treat?

Answer 9

Clusters of small, itchy and painful blisters which look red/purple/blac and ooze when broken.
Systemic symptoms e.g. fever, malaise and lymphadenopathy
Tx = MEDICAL EMERGENCY give acyclovir

Question 10

RFs for atopic eczema?

Answer 10

Some food alleries (e.g. egg, gluten, nuts)
Family or personal Hx of asthma, eczema or hayfever.
Skin irritants can trigger flare ups but are NOT a risk factor for disease development!

Question 11

What is the most common complication of atopic eczema?

Answer 11

Staph. aureus infection

Question 12

What is contact dermatitis?

Answer 12

Acute skin reaction to an irritant (affects everyone, no sensitization required) or allergen (sensitization required - type IV hypersensitivity reaction, can be delayed for up to 48-72 hours)

Question 13

How can you diagnose and treat contact dermaititis?

Answer 13

Dx = patch test
Tx = remove allergen/irritant, cold compress and topical steroids

Question 14

What is seborrheric dermatitis?

Answer 14

Erythematous rash with yellow scales. Peak incidence in 1st 2 months of life and adolesence.
Non-itchy scaly patches on the head or flexural areas.

Question 15

Tx of seborrheric dermatitis?

Answer 15

Scalp = shampoo, baby oil and combing
Body = mild topical corticosteroids
Use ketocanozole if there is skin infection (fungal)

Question 16

What is psoriasis?

Answer 16

Autoimmune condition where there are well demarcated erythematous papules and plaques with a silvery scalre. Seen on the extensor surfaces.

Question 17

Mx of psoriasis?

Answer 17

Avoid itching, emollients, sunlight exposure, tar preparations, topical steroids and vitamin D analogues

Question 18

What is impetigo?

Answer 18

Highly contagious group A strep or staph. aureus infection. Leads to honey coloured crusted lesions on the face.
Bullae (staph scolded skin syndrome) are seen as cirlce lesions of erosion - inidicates more serious disease

Question 19

Tx of impetigo?

Answer 19

Fusidic acid or mupirocin (both topical antibiotics).
Hydrogen peroxide if not systemically unwell and oral flucloxacillin if bullae.
School exclusion until crusted and healed or 48 hours after Abx treatment

Question 20

What are the stages of hypertension?

Answer 20

Stage 1 = BP 140/90 - 159/99 AND ABPM of 135/85 - 149/94
Stage 2 = BP 160/100 - 180/120 AND ABPM >= 150/95
Stage 3 = Systolic BP >= 180 or diastolic >= 120

Question 21

What is malignant hypertension? What should you do?

Answer 21

Increase in Bp to 180/120 or higher with signs of retinal haemorrhage and/or papilloedema.
Refer for same day specialist assessment - give labetalol

Question 22

How do you manage BP in a <55 who is not black african or afro-carribean?

Answer 22

1. ACEi or ARB (if cough from ACEi not tolerated)
2. Add CCB or thiazide like diuretic (e.g. indapamide)
3. All 3

Question 23

How do you manage BP in a >=55 who is black african or afro-carribean?

Answer 23

1. CCB
2. Add ACEi (or ARB is preferable if black african or afro-carribean) or thiazide like diuretic (e.g. indapamide)
3. All 3

Question 24

What is the target blood pressure in HTN treatment?

Answer 24

<140/90 or <150/90 if >=80

Question 25

What is the most common cause of heart failure?

Answer 25

Coronary artery disease followed by aortic stenosis and AF

Question 26

Sx heart failure?

Answer 26

Dyspnoea (worse on exertion), cough (may be pink/white frothy sputum), orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema

Question 27

Ix of HF?

Answer 27

NT-proBNP. >2000 = 2 week wait transthoracic echo 400-2000 = 6 week wait transthoracic echo

Question 28

Mx of HF (with reduced ejection fraction)?

Answer 28

Loop diuretic, ACEi and beta-blocker Start ACEi first if DM or fluid overload Start Beta-blocker first if angina Consider antiplatelet and statin. If Sx not controlled by diruetic ACEi and Beta-blocker consider adding aldosterone antagonist (e.g. spironolactone)

Question 29

Mx of HF (with preserved ejection fraction)?

Answer 29

Loop diuretic and specialist refferal | Consider antiplatelet and statin

Question 30

Sx of TB?

Answer 30

Cough, fever, night sweats, weight loss, sputum (rusty), haemoptysis

Question 31

Ix of TB?

Answer 31

CXR = fibronodular opacities in the upper lobes +/- cavitation Acid-fast bacilli go red on Zeihl-Neelsen stain Mantoux skin test and interferon-gamma release assay can show presence of previous, latent or active TB

Question 32

What is disseminated TB? What is seen on CXR?

Answer 32

AKA miliary TB The immune system is no longer able to control the TB. CXR = uniformly distributed millet seeds seen throughout the lung fields

Question 33

Mx of TB?

Answer 33

Rifampicin (6/12), Isoniazib (6/12), Pyrazinamide (2/12), Ethambutol (2/12) and Pyridoxine (vitamin B6)

Question 34

SEs of TB Mx?

Answer 34

Rifampicin = red/orange secretions and reduced efficacy of oral contraceptives Isoniazib = peripheral neruopathy (why pyridoxine is taken) Pyrazinamide = hyperuricaemia and gout Ethambutol = colour blindness and reduced visual acuity ALL cause hepatotoxicity

Question 35

Sx of PMR?

Answer 35

Acute onset shoulder/hip girdle stiffness and/or pain. Difficulty standing from seated/prone.

Question 36

Sx of the strongest association with PMR?

Answer 36

GCA | Temporal headache with scalp tenderness, jaw claudication and vision loss

Question 37

Ix and Mx of PMR?

Answer 37

Raised ESR and CRP | Mx = prednisolone. Bone protection = alendronic acid, colecalcierol and calcium carbonate

Question 38

Ix and Mx of the strongest association with PMR?

Answer 38

Temporal artery biopsy and US | Prednisolone before waiting for confirmation of diagnosis

Question 39

What is diverticular disease?

Answer 39

Asymptomatic herniation of the mucosa and submucosa through the colonic wall due to low fibre diet. If inflammed becomes diverticulitis

Question 40

Sx diverticulitis?

Answer 40

Fever, constant and severe abdo pain, diarrhoea or constipation, mucus in the stools, rectal bleeding

Question 41

Ix and Mx of diverticulitis?

Answer 41

``` Ix = leckocytosis, raised CRP and do contrast CT abdomen Mx = IV Abx and fluids, supportive care and low-residue diet ```

Question 42

What are the main causes of AF?

Answer 42

IHD, HTN, valvular heart disease (especially mitral issues), sepsis and hyperthyroidism

Question 43

Sx of AF?

Answer 43

Breathlessness, palpitations, chest pain, reduced exercise tolerance and iregular pulse

Question 44

ECG findings in AF?

Answer 44

Irregularly irregular. No p waves and tachycardia

Question 45

Mx of AF?

Answer 45

Haemodynamically unstable and presenting within 48 hours = electrical cardioversion Stable = rate control with beta blocer or CCB. Rhythm control with delayed cardioversion (amiodarone or electrical cardioversion) - pt. must be anticoagulated for 3 weeks before this Anticoagulate = warfarin or DOAC

Question 46

Sx of GORD?

Answer 46

Acid burn, acid reflux, dysphagia, bloating, early satiety, laryngitis and enamel erosion

Question 47

Mx of GORD?

Answer 47

Acid neutralising = gaviscon or rennie PPI = omeprazole H2 receptor antagonist = Rinatidine

Question 48

What is the most significant complication in GORD?

Answer 48

``` Barrets oesophagus (simple squamous to columnar epithelium). This is a premnalignant state and comes with risk of developing adenocarcinoma. Mx = PPIs ```

Question 49

Cardiac causes of clubbing?

Answer 49

Atrial myxoma, congenital heart disease, endocarditis and pericarditits

Question 50

GI causes of clubbing?

Answer 50

Malabsorption, IBD and liver cirrhosis

Question 51

Resp causes of clubbing?

Answer 51

CF, TB, pulmonary fibrosis, bronchiectasis and bronchial cancer

Question 52

Gold standard investigation for angina?

Answer 52

CT angiography

Question 53

Mx of angina?

Answer 53

Acutely = GTN spray (give 5 mins) GTN spray (give 5 mins) 999 Chronic = Beta-blocker or CCB Secondary prevention = Aspirin, Atorvostatin, ACEi, Atenolol

Question 54

What commonly causes DI?

Answer 54

craniopharyngioma

Question 55

What is seen on biopsy in coeliac's disease?

Answer 55

Intraepithelial lymphocytes The mucosa is often of a normal thickness as villous atrophy is compensated by crypt hyperplasia

Question 56

What is the 2nd line treatment of gout prevention (after allupurinol)?

Answer 56

Febuxostat