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Year 3 > SBA DECK 03/5 > Flashcards

SBA DECK 03/5 Flashcards

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1
Q

what side of the heart is strained in PE and why?

A

right side

there is backflow of blood from the pulmonary vasculature due to the embolism blocking vessels

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2
Q

what type of lung cancer is most associated with smoking?

A

SCLC

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3
Q

if there is a lesion in the spinal cord, on what side is there loss of pain/temp (+where) and on what side are there UMN signs?

A

loss of pain/temp= contralateral side starting 2 vertebral levels below the lesion
UMN signs= ipsilateral side

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4
Q

what type of sepsis does chemo cause and how is this managed?

A

neutropenic sepsis

manage with IV abx

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5
Q

what is co2 level in life threatening/ severe asthma?

A

it can be normal

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6
Q

what are signs of life threatening asthma?

A 
cyanosis
use of accessory muscles
inability to complete a sentence 
PEF <33%
o2 sats <92% 
silent chest
hypotension
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7
Q

what is initially measured in blood if someone is suspected to have acromegaly? what will be seen

A

IGF-1

it will be raised

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8
Q

what ix is used to confirm a diagnosis of acromegaly once someone’s IGF is raised?

A

OGTT with serial GH measurements

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9
Q

why does acromegaly cause galactorrheoa?

A

GH stimulates milk production

GNRH also increases prolactin production causing hyperprolactinaemia

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10
Q

how is angina pharmacologically managed?

A

all patients should be on aspirin and a statin unless contraindicated
GTN spray to abort angina attacks
first line use either a CCB (rate limiting) or a beta blocker

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11
Q

how long should patients be anticoagulated if they have a DVT?

A

provoked (eg surgery)= 3 months

unprovoked= 6 months

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12
Q

what electrolyte imbalance is likely to happen in bowel obstruction and why?

A

hypokalemia
the proximal section of the bowel will undergo enlargement and peristalsis causing secretion of electrolytes especially potassium

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13
Q

what is the most common cause of drug induced angioedema?

A

ace inhibitors

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14
Q

if PCI is not possible for STEMI, in how much time must fibrinolysis be offered?

A

12 hours

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15
Q

in bells palsy is the affected nerve on the ipsilateral or contralateral side to the side of the face where the patient has symptoms?

A

ipisilateral

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16
Q

what is hba1c target for a patient with diabetes who is on a sulphonylurea? why?

A

53

it may cause hypoglycaemia

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17
Q

what class of drug for diabetes might cause hypoglycaemia?

A

sulphonylurea

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18
Q

what medications are used to manage encephalitis?

A

IV acyclovir- to cover viral infection

IV ceftriaxone- to cover bacterial infection

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19
Q

what 2 common medications can worsen asthma symptoms?

A

aspirin

beta blockers

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20
Q

what happens to sodium and potassium levels in conns syndrome?

A

hypernatraemia

hypokalemia

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21
Q

what happens to vocal resonance over a tension pneumothorax?

A

decreases

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22
Q

how does furosimide help in cardiac failure?

A

it only provides symptomatic relief

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23
Q

what are the 2 shockable rhythmns?

A

v fib

pulseless VT

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24
Q

what are target oxygen sats for someone with COPD?

A

88-92%

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25
how does myocarditis present?
follows a viral illness | chest pain and SOB- pain in sharp, severe, doesnt change with movement
26
what % do the carotids need to blocked for there to be indication for a carotid endartectomy?
over 50% with previous hx of TIA or stroke | over 70% without previous hx of TIA or stroke
27
how can you differentiate compartment syndrome from critical limb ischaemia?
compartment syndrome= pulses are usually palpable | critical lim ischaemia= 6Ps therefore no pulses
28
how do you manage someone with heart failure and renal failure?
the renal failure is usually do to poor cardiac output causing reduced perfusion to the kidney cardiac output is poor because fluid build up due to renal failure means there is reduced stroke volume (too much fluid returns to the heart, starlings law etc) therefore treatment involves diuresing the patient so stroke volume can improve along with perfusion to the kidney
29
what are the 2 biopsy methods for breast. Which is better for identifying histology?
fine needle aspiration biopsy- only gives info about cytology core biopsy- this is better for analysing histology
30
how many blood cultures need to be in infective endocarditis and from where?
3 sets of cultures from different sites
31
what artery does giant cell arteritis affect?
temporal
32
what is the triad for optic neuritis?
visual loss loss of colour vision periocular pain
33
what is gilberts syndrome?
a genetic condition where there is deficiency of the enzyme which conjugates bilirubin
34
how will gilberts syndrome present?
episodes of jaundice where LFTs are normal and the patient is asymptomatic but there is an isolated rise in unconjugated bilirubin
35
how is gilbert's syndrome managed?
no management is needed just reassure them
36
what might trigger episodes of jaundice in gilberts syndrome?
stress eg illness, exercise and fasting
37
what is indapamide?
a thiazide like diuretic
38
what anti emetic is contraindicated in bowel obstruction and why?
metaclopromide because it is pro kinetic so it might cause perforation
39
what steroid is given immediately for spinal mets?
dexamethasone
40
what is the most common cause of hypothyroidism worldwide?
iodine deficiency
41
whats first line management for someone with SVT who is haemodynamically stable?
carotid sinus massage
42
what abx are given for severe cellulitis?
IV benzylpenicillin and flucoxacillin
43
what dose of prednisolone is given in giant cell arteritis?
60 mg dexamethasone daily (high dose in order to prevent irreversible blindness)
44
when are triptans taken and what are they used for?
used to stop an acute attack of migraine | they should be taken at the start of the headache (not at the start of aura)
45
what is temporal artery biopsy used for? what are results
it is used to help diagnose temporal arteritis it is important to remember a negative result does not exclude diagnosis because there may be skip lesions so where the biopsy was taken might be unaffected
46
what is first line ix for peripheral arterial disease?
duplex ultrasound
47
what deficiency does isoniazid cause and what does this result in?
causes a b6 deficiency causing polyneuropathy
48
what is the difference in presentation of diarrhoea in UC vs crohns
``` crohns= non bloody diarrhoea UC= bloody diarrhoea ```
49
what CK isoenzyme will be elevated in a reinfarct?
CK MB
50
describe pain in osteoarthritis?
unilateral/ isolated joint pain morning stiffness is not prolonged (<20 mins) worse with movement and at the end of the day
51
what are features of osteoarthritis on x ray? what oneumonic is used to remember?
``` LOSS: loss of joint space osteophytes subchondral cysts subarticular sclerosis ```
52
how is osteoarthritis managed?
``` conservative= weight loss, avoid weight bearing exercise pharmacological= for moderate disease paracetamol, if of hands or knee then paracetamol and topical nsaids, then progress to oral nsaids and opiates etc ```
53
what is the defining feature of bechet's disease?
relapsing remitting oral and genital ulcers
54
how is status epilepticus managed?
``` ABCDE ensure IV access ABG bloods anaesthetic review IV lorazepam 4mg (give a second dose if not effective, if no IV access then PR diazepam or buccal midazolam) ```
55
what medications are given in status epilepticus? include specific doses, number of doses and alternative/second line medications
IV 4mg lorazepam give this twice if it doesnt work first time if there is no IV access give PR diazepam or buccal midazolam if this still doesnt work give other anticonvulsants like levitiracetam, phenytoin etc
56
what is first line medication in someone with painful peripheral neuropathy?
tricyclic antidepressants
57
what should you think when you see heinz bodies?
G6PD deficiency
58
in what condition do bisphosphonates need to be prescribed with great caution? what is done?
if someone has upper GI upset | advise them to take it in the morning, sitting upright with a glass of water
59
in spinal stenosis what makes pain worse/ relieves it?
``` worse= extension better= flexion (ie sitting leaning forward) ```
60
what are features of rheumatic fever?
erythema marginatum syndenham's chorea polyarthritis carditis and valvulitis
61
how is rheumatic fever managed?
NSAIDs first line | oral penicillin
62
what marker can be used to differentiate between type 1 and type 2 diabetes?
c peptide in type 1 it will be low or undetectable because there is absolute insulin deficiency in type 2 it may be raised
63
what are causes of raised ferritin?
with iron overload= hereditary haemochromatosis or repeated transfusions without iron overload= inflammation, alcohol excess, liver disease, CKD
64
what cancer is lambert eaton syndrome associated with?
lung cancer
65
what is pharmacological management of PE acute and long term? when is this indicated?
is there is a massive PE= thrombolysis with IV bolus of alteplase long term anticoagulation with a DOAC
66
what are the 5 causes of parkinsonism?
``` parkinson's disease progressive supranuclear palsy corticobasal degeneration multi system atrophy lewy body dementia ```
67
if someone has resting tremor, bradykinesia, hypertonia and jerky limb movements what parkinsonian syndrome are they likely to have?
cortico basal degeneration
68
if someone has resting tremor, bradykinesia, hypertonia, cognitive decline and visual hallucinations movements what parkinsonian syndrome are they likely to have?
lewy body dementia
69
if someone has resting tremor, bradykinesia, hypertonia, postural hypotension, impotence and incontinence what parkinsonian syndrome are they likely to have?
multi system atrophy
70
if someone has resting tremor, bradykinesia, hypertonia, and vertical gaze palsy what parkinsonian syndrome are they likely to have?
progressive supranuclear nerve palsy
71
if someone has adverse affects on an ACEi for hypertension control what should you give instead first line?
ARB
72
what are features of a strangulated hernia?
irreducible, tender and erythematous lump
73
how does scurvy manifest?
bleeding gums ecchymoses pale conjunctiva expothalamos
74
how can osteoarthritis be clinically diagnosed?
patient over 45 and activity related joint pain and no morning stiffness/morning stiffness that lasts <30 mins
75
what is used as secondary prevention in myocardial infarction?
``` ace inhibitor plus beta blocker plus statin plus aspirin plus antiplatelet drug ```
76
what is fasting glucose and OGTT 2 hour glucose in someone with impaired glucose tolerance?
fasting glucose= <7 OGTT 2 hour glucose= >7.8 but <11.1 ie normal fasting glucose but raised 2 hour glucose
77
what part of the brain is commonly involved in neurological deficits in encephalitis?
temporal lobes
78
what is the vol of maintenance fluid that are usually prescribed?
25-30 ml/kg/day
79
how is stroke managed?
non contrast CT head to rule haemorrhagic stroke if presenting within 4.5 hrs= IV alteplase then start aspirin after 24 hrs if presenting after 4.5 hrs= thrombectomy first line, if not possible aspirin continue aspirin for 2 weeks and then switch to clopi lifelong
80
what organism is the most common cause of food poisoning in the UK?
campylobacter jejuni
81
what 3 drugs are given for PPI eradication therapy?
amoxicillin clarithromycin PPI if they are allergic to penicillin give metronidazole instead of amoxicillin
82
what is the most common organism for septic arthritis?
staph aureus
83
what are fine end inspiratory crepitations a sign of?
idiopathic pulmonary fibrosis
84
how much does systolic and diastolic blood pressure drop when there is orthostatic hypotension?
systolic= drops by at least 20mmHg OR diastolic= drops by at least 10 mmHg after 3 mins of standing

Year 3 (104 decks)

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