Autumn 2017 mid-term exam Flashcards Preview

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Flashcards in Autumn 2017 mid-term exam Deck (60):
1

Asthma classification figures

  • moderate: 50-75% PEF, no other symptoms

 

  • acute severe 33-50% PEF, Resp >25, Heart rate >110. Can't complete breaths in one sentence

 

  • life-threatening <33%  O2Sats <92%

 

2

laxative - lactulose

function and indications

increase bulk by retaining water.

Takes 48 hrs to act and must be given regularly.

3

Why are ACEI drugs good for heart failure?

lower BOTH arterial and venous resistance.

4

Which is the quickest blood type to give for blood loss?

O negative

5

Ciprofloxacin

Fluoroquinolone group

Effective for many gram -ve bacteria.

Used to treat anthrax - postexposure prophylaxis of inhalational anthrax.

serious adverse effects; tendonitis and tendon rupture.

alters blood glucose, phototoxicity, prolongation of QT interval

Contraindicated; children, adolescents, pregnant and lactating women.

6

Peptic ulcers location

stomach

upper part of duodenum

 

7

Indications for senna; stimulant laxative

+ side effect

Increase mobility by stimulating the myenteric plexus.

mobility maybe damaged due to drug use.

Side effect: abdominal cramps

* don't use for impacted feces *

8

What drugs treat TB? (mycobacterium tuberculosis)

Rifampicin (prevents RNA transcription). Resistance develops quickly, therefore needs to be combined with other drugs; isoniazid

9

Differences between UC and CD

A image thumb
10

What are the QRS complexed like with LBBB?

WIDE

Sometimes W-shaped complex in V1

Sometimes M pattern in V4-V6

 

11

Management of AF

cardioversion if < 48 hour onset

Rate and rhythm control

CCB - verapamil or a Beta Blocker

Rate control; amiodarone

anticoagulants to prevent thromboembolism/ stroke

surgical catheter ablation

 

12

What are the symptoms of hypovolaemia?

  • pallor
  • orthostatic hypotension
  • tachycardia
  • absence of JVP at 45 degrees
  • dry mucous membranes
  • absent axillary sweat
  • decreaed skin turgor
  • oliguria
  • organ failure

13

Three rules of fluid replacement

  • Replace blood with blood
  • Replace extracellular fluid depletion with saline
  • REHDRATE with DEXTROSE. NOT FOR RESUSCITATION

14

15

Which receptors are abundant in the CTZ of the medulla?

D2 dopamine receptors

5HT3 receptors

16

Ticarcillin and be combined with clavulanate to treat......

pseudomonas aeruginosa

 

(ticarcillin is an antipseudomonal penicillin)

17

Angina drug management

First step: Nitrates - reduce preload

Second step: Diltiazem; vasodilator of arteries incl. coronary. Thus reduces afterload. Also < cardiac rate and contractility (reducing oxygen demand)

 

Statins - reduce atherosclerotic plaque risk

Beta-blockers (less popular) if tachycardic.

 

18

Some signs and symptoms of infective endocarditis

splinter haemorrhages

Janeway lesions

Osler's nodes

dental hygiene

 

19

Domperidone

D2 antagonist

Similar to metoclopramide but doesn't cross the blood-brain barrier and rarely causes sedation or extrapyramidal effects.

20

What is metaplasia?

the transformation of one type of tissue into another

21

Acute asthma treatment; what O2 levels should be maintained?

What should be continued after discharge?

 

94-98%

 

40-50mg prednisolone for 5 days minimum.

22

Metoclopramide

moa, indications, side effects

D2 antagonist

Also has prokinetic effect on the gut, and increases the absorption of many drugs.

23

Relationship of aldosterone and spironolactone

Aldosterone raises BP by stimulating Na+ absorption.

Spironolactone competitively blocks the binding of aldersterone.

* weak diuretic *

SE: severe hyperkalaemia, especially in px with renal impairment.

Indications: Liver disease with ascites, severe heart failure, Conn's syndrome

24

What are the symptoms of hypervolaemia? overfilling

  • jugular venous distension
  • S3 gallop
  • dyspnoea
  • ascites
  • pulmonary oedema
  • pleural effusions
  • peripheral oedema
  • hypertension

25

Physiology of heart failure

Insufficient cardiac output unable to perfuse tissues. Adaptive changes; increases in heart rate and force, increases in renal volume and increase blood pressure.

Heart unable to compensate and physiological changes further decrease cardiac output.

26

What's the problem with taking nitrates for angina?

Headaches

Reflex tachycardia (prevented by taking beta blockers)

Tolerance to nitrates can occur.

27

Signs of aortic regurgitation

collapsing pulse

investiations; echocardiography

 

 

28

ADH

made in hypothalamus

released via posterior pituitary gland

osmoreceptors in hypothalamus

29

NYHA

A image thumb
30

What is CHA₂DS₂-VASc Score?

Risk for stroke for AF patients

 

helps determine the 1 year risk of a thromboembolic event in a non-anticoagulated patient with non-valvular AF.

31

Which lung cells secrete surfactant?

pneumocytes type II

32

Prophylactic tx for angina

Aspirin + Clopidogrel (anti-platelet)

Dabigatran - doesn't need monitoring. Fixed dose. MOA: direct thrombin inhibitor.

Problem: no antidote if bleeding occurs.

33

Coronary arteries territories

A image thumb
34

What would you use for impacted stool?

Glycerol suppository

Glycerol suppositories stimulate the rectum because glycerol is mildly irritant.

May need to be repeated. Digital assistance needed.

35

Common causes of acute mitral regurgitation

infective endocarditis

ruptured chordae tendineae

ischaemic papillary muscle rupture

36

What is vancomycin used for?

 

+ what happens if >> infusion rate?

MRSA (rem. staphlococcus) - given orally.

Adminstered parenterally to treat systemic infections.

>>> infusion rate = hypotension, erythematous rash on face/ upper body "red man syndrome"

37

Extragastrointestinal manifestations of IBD

Joint problems

Skin rashes; pyoderma gangrenosum, erythema nodosum

Iritis/ uveitis

Aphthous ulcers.

 

38

39

What are the main causes of heart failure?

  • CORONARY HEART DISEASE
  • hypertension
  • valvular disease
  • cardiomyopathy

40

Macrolides

moa, drugs, indications, side effects

erythromycin, clarithromycin, azithromycin

 

 

41

T Waves

 

Three abnormal types

Upright in all leads except aVR and V1

 

  • Flattened T waves (hyperkalaemia)
  • Inverted T waves
  • Hyperacute T waves

42

aminoglycerides

injection only

narrow therapeutic index

Renal excretion + nephrotoxic

ototoxicity (VIIIth cranial nerve)

43

Beta blockers and asthma?

Don't do it!

(bronchospasm potential)

 

44

What do u waves signify?

hypokalaemia

45

Loop diuretic

moa, indications, side effects

Inhibits NaCl reabsorption in the thick ascending loop of Henle

Indications; oedema with heart failure.

effective in patients with << GFR

High doses; endolymph disturbances and deafness.

Adverse : 4 hypos; hypokalaemia (little), hyponatraemia, hypotension, hypovolaemia.

IMP. >>> CALCIUM and >>> MAGNESIUM excretion

46

What's the function of cholecystokinin?

stimulates pancreatic secretions when food enters the duodenum, and stimulates bile release from gall bladder.

Cholecystokinin is synthesized and secreted by cells in the duodenum.

47

What does a collapsing pulse indicate?

severe aortic regurgitation

48

Thiazides

moa

side effects

Act on early segment of the distal tubule. Inhibit NaCl reabsorption.

Side effects (due to >> excretion of K+ and H+ ions)

hypokalaemia

metabolic alkalosis

Hyperuricaemia. Increase in uric acid levels may result in gout.

Glucose tolerance; thiazides are contraindicated in patients with non-insulin-dependent diabetes.

49

What pneumonia can gentamicin treat?

Life-threatening Gram -ve infections, eg. pseudomonas aeruginosa

50

Which group of drugs are indicated for unusual organisms such as Mycoplasma pneumoniae and Legionnaire's disease?

Macrolides

51

triple therapy for gastric ulcers

Omeprazole

amoxicillin

Clarithromycin

or

omeprazole

amoxillin

metronidazole

52

What do D cells (pancreas) produce?

somatostatin

53

Most common cause of aortic stenosis and physiological effect

senile calcification

Heart has to work harder to push blood through the stenotic valve.

>> Volume load = hypertrophy + myocardial dysfunction, arrhythmias, heart failure.

54

Cockcroft-Gault equation

is often used as a method of estimating GFR 

from knowledge of serum creatinine, age and weight:

The calculation is unreliable if the patient has unstable renal function, is very obese, or is oedematous.

55

What is flucloxacillin indicated for?

infections caused by penicillinase-producing penicillin-resistant staphylocci.

i.e. most hospital-acquired staphlococcal infections.

56

A good drug for gram +ve bacteria?

erythromycin

(macrolide)

because they accumulate 100 x of the drug.

57

Aortic regurgitation

- causes

Blood flows back into the ventricle at start of diastole.

causes; infective endocarditis

rheumatic disease.

Usually asymptomatic until LVF

58

Apart from conserving water via >> reabsorption, what else does ADH do?

<< sweat in glands

>> arteriole constriction, therefore BP rises

59

pericarditis ECG changes (findings in first two weeks)

saddleback ST elevation and PR depression throughout most of the leads.

RECIPROCAL deviation in lead aVR

60

Commonest cause of mesothelioma?

+ symptoms

asbestos esposure

  • persistent chest wall pain
  • pleural effusion