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Progress Tests > CD1 > Flashcards

CD1 Flashcards

1
Q

Target BP in patients over 80

A

<150/90

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2
Q

Target BP in patients under 80

A

<140/90

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3
Q

Target BP in diabetic patients or patients with CKD

A

<130/80

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4
Q

Drug options in emergency HTN (>180 with papilloedema)

A

nitroprusside, labetalol, GTN or phentolamine

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5
Q

Second line to statins

A

Ezetimibe

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6
Q

MOA of ezetimibe

A

Reduces bile secretion to minimise fat absorption

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7
Q

Investigation of patients with angina but low risk of coronary artery disease

A

CT coronary angiogram

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8
Q

Investigation of patients with angina and high risk of coronary artery disease

A

Dobutamine stress echo or coronary angiogram

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9
Q

MOA of ivabradine

A

Inhibits funny current to reduce heart rate

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10
Q

MOA of nicorandil

A

Calcium channel blocker

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11
Q

MOA of ransolazine

A

Sodium channel blocker

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12
Q

Management of patients with intermediate risk on GRACE score

A

antiplatelet and anticoagulant then non-emergency angiogram with or without stent insertion

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13
Q

Management of patients with low risk on GRACE score

A

non-invasive monitoring such as an echo or CT coronary angiography

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14
Q

Medication following an MI

A

Beta-blocker
ACE inhibitor
Statin
Anti-platelet for a year

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15
Q

Screening tests for complications after an MI

A

ECG and echo

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16
Q

Causes of acute AF

A

thyrotoxicosis, an infective exacerbation of COPD, pneumonia, alcohol (holiday heart syndrome) or an infection such as myocarditis

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17
Q

Causes of chronic AF

A

hypertension, ischaemic heart disease, dilated cardiomyopathy or idiopathic

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18
Q

How does “pace and ablate” therapy work?

A

AV node is ablated to isolate the ventricles, which are then paced with a pacemaker for rate control

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19
Q

When to choose chemical and electrical cardioversion in AF

A

Chemical if onset <48 hours ago, electrical if >48 hours ago

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20
Q

Medication after cardioversion

A

Anti-arrhythmic e.g. sotolol/flecainide

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21
Q

CHADSVASC cut off for anticoagulation

A

1 or more (unless female)

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22
Q

Use of BNP in diagnosis of heart failure

A

Guides how urgently an echo is needed

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23
Q

What is entresto?

A

a combination of sacubitril and valsartan which acts as a diuretic and ARB

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24
Q

Treatment for diastolic heart failure

A

Diuretics for symptomatic relief and specialist help

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25
Q

Why may patients with aortic stenosis get frequent nosebleeds and easy bruising?

A

The blood moving through the stiffened valve can disform von Willebrand factor, causing an acquired von Willebrand disease

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26
Q

Causes of chronic aortic regurgitation

A

hypertension, a congenital bicuspid valve, degeneration such as calcification, connective tissue disorders e.g. Marfan’s

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27
Q

Causes of acute aortic regurgitation

A

rheumatic heart disease
aortic dissection
infective endocarditis

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28
Q

Murmur in mitral stenosis

A

low-pitched rumbling diastolic murmur over the mitral area

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29
Q

Medication in aortic stenosis

A

Diuretics for symptom relief

Consider anticoagulant prophylaxis as increased risk of clots

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30
Q

Treatment of acute limb ischaemia

A

given anti-platelets (e.g. aspirin), anticoagulants (e.g. heparin) and analgesia (e.g. an opioid)
Consideration for surgery (revascularisation if limb is viable or amputation of limb isn’t viable)

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31
Q

Medication in mild - moderate peripheral vascular disease

A

Anti-platelets

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32
Q

Symptoms of HHS

A

polyuria, polydipsia, headache, nausea, vomiting and abdo pain, tachycardia, hypotension and confusion

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33
Q

Cancer most associated with Cushing’s

A

Small cell lung cancer

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34
Q

First line investigation in Cushing’s

A

24 hour urinary cortisol

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35
Q

Investigation of acromegaly

A

First line is look for raised serum IGF-1
Then oral glucose suppression test (growth hormone will remain high)
Then MRI to look for pituitary tumour

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36
Q

Complications of acromegaly

A

Diabetes
Hypertension
Cardiomyopathy
Sweating
Sleep apnoea (due to increased tongue size)
Colon cancer (screened for on diagnosis with a colonoscopy)
Reduced secretion of other pituitary hormones due to pituitary compression or visual field defects due to optic chiasm compression

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37
Q

Investigation of Cushing’s

A

First line test is usually 24-hour urinary cortisol
Midnight cortisol can be taken to show loss in circadian rhythm (it’s usually lowest at night)
Low dose dexamethasone suppression test involves giving a low dose of dexamethasone at 11pm then measuring serum cortisol at 8am and showing a lack of suppression
Once Cushing’s is confirmed and exogenous steroid use excluded, serum ACTH may be measured to see if it is ACTH dependent. The ACTH can be measured after a high-dose dexamethasone suppression test to see if the ACTH is from the pituitary gland (ACTH will fall) or an ectopic source (ACTH will stay high).
If carcinoma suspected, give CT/MRI scan

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38
Q

Treatment of prolactinoma

A

dopamine agonists (e.g. cabergoline) to reduce prolactin levels via negative feedback and shrink the tumour. If unresponsive to this, surgery may be considered

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39
Q

SIADH treatment

A

Diuretics and treatment of the cause if appropriate. In some patients tolvaptan may be used, which is a competitive inhibitor of ADH

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40
Q

First line investigations in Addison’s

A

U&Es will show hyperkalaemia and hyponatraemia (due to low aldosterone). 9 am cortisol would be measured (should be highest at this time)

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41
Q

How to interpret 9am cortisol in diagnosis of Addison’s

A

If very low, admit to hospital. If slightly low, refer for a synacthen test. If normal or high Addison’s is unlikely.

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42
Q

Symptoms of Addisonian crisis

A

dehydration, hypotension, confusion, abdominal pain, diarrhoea and vomiting, hyponatraemia and hyperkalaemia.

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43
Q

Treatment of Addisonian crisis

A

IV hydrocortisone and IV fluid resuscitation
Close monitoring of electrolytes with ECGs to look for any associated changes
Following initial resuscitation, an IV hydrocortisone and dextrose infusion is given and reduced over a few days

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44
Q

Frist line medication in hyperthyroidism

A

Carbimazole

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45
Q

Second line medication in hyperthyroidism

A

Propylthiouracil

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46
Q

Management of Grave’s ophthalmopathy

A

a combination of lifestyle changes like smoking cessation, medication such as steroids, decompressive surgery and irradiation

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47
Q

Management of thyrotoxic crisis

A

beta-blockers for symptomatic relief
propylthiouracil (a drug to reduce thyroid hormone) corticosteroids (reduce the conversion of T4 to T3)
iodine solution

48
Q

First line medication in CKD

A

ACE inhibitors

49
Q

Medications in mild alzheimers

A

acetylcholinesterase inhibitors such as donepezil and rivastigmine

50
Q

Medications in severe alzheimers

A

an n-methyl-d-aspartic acid antagonist such as memantine

51
Q

Extra-articular manifestations of RA

A

Ocular manifestations include dry eyes, episcleritis and scleritis
Oral manifestations include dry mouth and ulcers
Lung manifestations include pleuritis, interstitial lung disease and costochondritis
Cardiac manifestations include pericarditis, myocarditis, endocarditis and increased risk of ischaemic heart disease
Renal manifestations are glomerulonephritis
Neurological manifestations include peripheral neuropathy and carpal tunnel syndrome
Haematological manifestations include neutropenia, thrombocytopaenia and thrombocytosis
Skin manifestations include rheumatoid nodules (often on the elbow), rash and gangrene

52
Q

Screening tests on patients with RA

A

hypertension, ischaemic heart disease and osteoporosis as these are common comorbidities that harm prognosis

53
Q

Common DMARDs

A

methotrexate, leflunomide, sulfasalazine or hydroxychloroquine

54
Q

ADRs of DMARDS

A

depends on drug but bone marrow suppression, hepatotoxicity, osteoporosis and increased risk of cancer and infections are common among many of them

55
Q

Main antibodies in SLE

A

ANA

56
Q

Lifestyle advice in SLE

A

avoid sun exposure, use sun screen, have the annual flu vaccine and regularly exercise

57
Q

ESR and CRP in SLE

A

ESR usually raised

CRP usually normal

58
Q

Symptoms of SLE

A

Symptoms are non-specific and can include fatigue, malaise, fever, splenomegaly, lymphadenopathy, weight loss, arthralgia, myalgia, mouth ulcers, rashes (classically a malar rash), headache, chest pain, altered sensation, dry eyes, dry mouth and hair loss. There may also be symptoms associated with inflammation in specific tissues.

59
Q

Medications in SLE

A

immunosuppressants such as steroids, hydroxychloroquine, cyclophosphamide, mycophenolate mofetil and azathioprine
If this is ineffective, biological agents such as belimumab and rituximab may be considered

60
Q

Causative agent of bronchiolitis

A

RSV

61
Q

Symptoms of bronchiolitis

A

Symptoms are typically cold-like symptoms such as fever and a blocked nose followed by a cough, reduced feeding (may lead to signs of dehydration), increased work of breathing and use of accessory muscles, crepitations, a wheeze, cyanosis and tachycardia. Usually, the symptoms are mild and only last a few days

62
Q

Age range for bronchiolitis

A

Young children (typically under 2)

63
Q

Symptoms of PCOS

A

irregular or absent periods, infertility or reduced fertility, acne, hirsutism, male patten baldness, obesity, sleep apnoea and anxiety or depression

64
Q

Blood tests in PCOS

A

FSH, LH (usually raised), oestrogen, progesterone, free testosterone (will be raised) and sex-hormone binding globulin (usually decreased)
Also tests for other differentials and risk factors e.g. diabetes

65
Q

Monitoring in patients with PCOS who aren’t having regular periods

A

Trans-vaginal ultrasound scans for signs of endometrial cancer

66
Q

Complications of PCOS

A

type 2 diabetes, gestational diabetes (people with PCOS should have an oral glucose tolerance test before they get pregnant and at 24-28 weeks to screen for this), cardiovascular disease, sleep apnoea and depression or anxiety

67
Q

Second line medication in migraine prophylaxis

A

topiramate or amitriptyline

68
Q

Complications of migraine

A

psychiatric conditions such as depression, anxiety and bipolar disorder
cardiovascular events, in particular stroke

69
Q

Diagnosis of cystic fibrosis

A

Newborn heel prick screening

If this shows that a neonate is high risk, they will have a sweat test for increased chloride

70
Q

Management of cystic fibrosis

A

Respiratory: pulmonary physiotherapy, bronchodilator inhalers, inhaled corticosteroids and shaking jackets or inhaled mucolytics to try and break up mucus. Prophylactic / treatment abx
Pancreatic / GI: high calorie and high fat diet, pancreatic enzyme supplementation, vitamin ADEK supplementation and proton pump inhibitors

71
Q

Extra-pulmonary symptoms of pulmonary fibrosis

A

arthralgia, muscle pains, skin rashes and sleep apnoea

72
Q

Prognosis in pulmonary fibrosis

A

Poor

73
Q

Pulmonary fibrosis risk factors

A

older age
connective tissue disorders such systemic sclerosis
autoimmune disorders such as RA and lupus
exposure to chemicals such as coal dust, asbestos, silica, and mould
some medications such as amiodarone
smoking
family history or a genetic predisposition
chronic viral infections such as EBV and Hep C
GORD associated with aspiration

74
Q

Medications in pulmonary fibrosis

A

Medical management with pirfenidone or nitedanib can slow disease progression but isn’t an option in all patients

75
Q

Complications of pulmonary fibrosis

A

infective exacerbations, pulmonary hypertension, lung cancer, pulmonary embolism, right sided heart failure and cor pulmonale and coronary artery disease

76
Q

Treatment of infective exacerbation of pulmonary fibrosis

A

Steroids

77
Q

Gold standard in diagnosis of sleep apnoea

A

polysomnography, which uses an overnight EEG recording to look at brain activity, electro-oculograms to look at eye activity and electromyograms to look at muscle activity. Information from this can be used to calculate apnoea frequency

78
Q

Standard test to diagnose sleep apnoea

A

overnight pulse oximetry and respiratory monitoring

79
Q

Driving advice in sleep apnoea

A

Until it is controlled, the patient may need to stop driving as excessive daytime sleepiness increases risk of a road traffic accidents

80
Q

MRC dyspneoa scale

A

grade 1 is SOB on strenuous exertion
grade 2 is SOB on mild exertion e.g. walking fast,
grade 3 is needing to walk slower and stop after 15 minutes
grade 4 is stopping for breath after 100 yards
grade 5 is SOB when dressing

81
Q

Indications for home oxygen therapy in COPD

A

a PaO2 of <7.3 or who have a PaO2 of <8 and either pulmonary hypertension, peripheral oedema, nocturnal hypoxia or polycythaemia. It may be unsuitable for patients who smoke due to the fire hazard

82
Q

First line investigation in asthma

A

NICE guidelines recommend fraction of exhaled nitric oxide (FeNO) as the first line investigation, which will be increased due to the production of nitric oxide by inflammatory cells.

83
Q

Components of a MART inhaler

A

long acting beta agonist and a low dose inhaled corticosteroid

84
Q

Definition of poorly-controlled asthma

A

symptoms in the day or night, frequent use of rescue medication or a severe exacerbation needing in-patient treatment

85
Q

Histology of ulcerative colitis

A

crypt abscesses, inflammatory infiltration and goblet cell depletion

86
Q

Histology of Crohn’s

A

inflammatory infiltration, lymphoid hyperplasia and granulomas

87
Q

Extra-intestinal manifestations of IBD

A

mouth ulcers, arthritis, ankylosing spondylitis, sacroiliitis, erythema nodosum, gangrene, episcleritis or uveitis, PSC (in ulcerative colitis), fatty liver disease, gallstones, renal calculi and osteoporosis

88
Q

Imaging after a diagnosis of Crohn’s

A

endoscopy is usually done to look for duodenal disease

CT or MRI scans may be used to look for abscesses or fistulae or to assess perianal disease

89
Q

Diet in a flare or Crohn’s

A

Liquid diet

90
Q

Medication in crohn’s

A

Steroids first line
Immunosuppressants or Mesalazine second line
Biologics third line

91
Q

Follow-up in mild diverticulitis managed in the community

A

48 hours and safety netting advice

92
Q

Management of moderate diverticulitis

A

The patient should be made nil-by-mouth until they have been surgically reviewed and they should be started on IV antibiotics (typically co-amoxiclav) and fluids

93
Q

Antibody testing for coeliac disease

A

First this is IgA anti-tissue transglutaminase (tTGA) and if this is negative then IgA anti-endomysial (EMA) would be tested (total IgA should be tested at the same time to ensure these tests are valid)

94
Q

What condition is dermatitis herpetiformis associated with?

A

Coeliac

95
Q

Histology of coeliac

A

villous atrophy, crypt hyperplasia and inflammatory infiltration

96
Q

Diagnosis of coeliac disease

A

Antibody testing

If positive, endoscopy and biopsy

97
Q

Symptoms of dermatitis herpetiformis

A

very itchy papulovesicular rash with a typical histological appearance

98
Q

What serious malignancy does coeliac predispose to?

A

enteropathy-associated T cell lymphoma

99
Q

Cause of chronic pancreatitis

A

alcohol consumption, genetics, autoimmune destruction or an unknown cause

100
Q

Classification of chronic pancreatitis

A

large duct pancreatitis - large ducts that can be seen on imaging are calcified and damaged
small duct pancreatitis - smaller ducts are damaged (not due to calcification)

101
Q

Symptoms of chronic pancreatitis

A

The main symptom is episodes of severe epigastric pain which radiates to the back.
Other symptoms include nausea and vomiting, decreased appetite, symptoms of malabsorption such as weight loss, steatorrhea, protein deficiency and diabetes

102
Q

What country is associated with a high incidence of autoimmune chronic pancreatitis?

A

Japan

103
Q

Risk factors for chronic pancreatitis

A

Males
Alcohol consumption is a major risk factor.
Smoking
Family history is a risk factor and genetics
Biliary disease
ERCP imaging
Metabolic disorders such as hypercalcaemia
Trauma
Cystic fibrosis
Some drugs
Abdominal radiotherapy

104
Q

Indication for secretin test

A

Chronic pancreatitis

105
Q

What is a secretin test?

A

A secretin test involves giving secretin to stimulate the pancreas then using an endoscope to collect the pancreatic secretions for analysis in order to assess pancreatic function

106
Q

Imaging in chronic pancreatitis

A

CT scan to look for duct atrophy, calcification or dilation
Secretin enhanced MRI or MRCP scan
Endoscopic ultrasound to assess the duct walls

107
Q

Conservative management of chronic pancreatitis

A

Lifestyle advice (smoking and alcohol cessation)
Pain relief (NSAIDs initially but often opioids are needed)
In patients with ductal strictures, ERCP can be used to insert a stent into the ducts which can reduce pain
Lipase supplements to reduce the symptoms of malabsorption
In around a third of patients (particularly those with small vessel disease), giving supplements of pancreatic enzymes improves symptoms.

108
Q

How pancreatic enzyme supplements are given

A

Trial for 1 month then continued for 6 months at a time if symptoms improve

109
Q

Surgical options in chronic pancreatitis

A

open, laparoscopic or endoscopic
procedures include cyst decompression, stone dislodging, decompression of duct dilation and in some cases removal of the pancreas (sometimes the duodenum as well)
Some newer surgical and pain management treatments are being studied

110
Q

Complications of chronic pancreatitis

A

malabsorption, diabetes, pericardial, peritoneal or pleural effusion, cysts, GI bleeds and increased risk of pancreatic cancer

111
Q

Scoring system in chronic liver disease

A

Child-Pugh score

112
Q

Medication to reduce portal hypertension

A

Beta-blockers

113
Q

Management of hepatic encephalopathy

A

Laxatives (lactulose) and antibiotics if evidence of infection

114
Q

Management of ascites

A

diuretics (spironolactone and a loop diuretic)

paracentesis if severe

115
Q

Screening in patients with chronic liver disease

A

Patients should be monitored for hepatocellular carcinoma with ultrasound scans with or without AFP levels

116
Q

Drug to reduce desire to drink

A

Naltrexone

Progress Tests (17 decks)

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