SBA DECK 23/05 Flashcards
(142 cards)
1
Q
what is first line management for HHS?
A
0.9% nacl at a rate of 1000ml/hour
2
Q
what abx is used for infective endocarditis if caused by gram positive bacteria?
A
amoxicillin
3
Q
how is stable angina managed?
A
beta blocker or rate limiting CCB
plus GTN spray
4
Q
what endocrine conditions is pseudogout associated with?
A
hypothyroidism
5
Q
what happens to fibrinogen levels in DIC? why?
A
they fall
due to excess clot production- fibrinogen is a coagulation factor needed to produce clots so will be used up on
6
Q
what happens to d dimer in DIC? why?
A
it rises
d dimer is a fibrin degredation product and breakdown of lots of bloodclots causes it to be raised
7
Q
what effect does thyrotoxicosis have on the heart?
A
high output cardiac failure
8
Q
what side effect does adenosine cause?
A
chest pain
9
Q
what is the most common cause of nephrotic syndrome in children?
A
minimal change disease
10
Q
how is minimal change disease managed?
A
oral prednisolone
11
Q
what abx is used for prohylaxis in COPD?
A
azithromycin
12
Q
what condition is antinuclear antibody associated with?
A
SLE
13
Q
what is synacthen?
A
synthetic ACTH
14
Q
what is hereditary telangiectasia?
A
abnormal blood vessels causing bleeding and telangiectasis
15
Q
how does prolactin affect testosterone, LH and FSH?
A
reduces them all
16
Q
how do you ix acromegaly?
A
measure IGF-1 to identify excess GH
then do an OGTT
17
Q
what anaemia does nsaids cause?
A
microcytic anaemia
18
Q
how does portal hypertension present?
A
ascites
SBP
encephalopathy
variceal bleed
19
Q
what do you see on blood film in HUS? why?
A
shistocytes
due to haemolytic anaemia
20
Q
what will you see on blood film in haemolytic anaemia?
A
shistocytes
21
Q
how do you identify uraemic syndrome?
A
high creatinine
22
Q
what is the triad for HUS? how will this present?
A
haemolytic anaemia- shistocytes
uraemic syndrome- high creatinine
thrombocytopenia
23
Q
what are the 3 types of MAHA? what does MAHA stand for?
A
microangiopathic autoimmune haemolytic anaemia
1) DIC
2) HUS
3) TTP
24
Q
how do you differentiate HUS from TTP?
A
HUS= triad of haemolytic anaemia, uraemia and thrombocytopenia TTP= HUS plus fever and neurological symptoms
25
what are the 2 types of haemolytic anaemias? what are causes of each?
```
hereditary= G6PD deficiency, hereditary spherocytosis, sickle cell/thalassaemia
acquired= autoimmune, drugs, infection, MAHA
```
26
what are the hypo/eu/hypervolemic causes of hyponatraemia?
```
hypovolemic= vomiting, diarrhoea, diuretics
euvolemic= hypothyroidism, SIADH, adrenal insufficiency
hypervolemic= cardiac, liver or kidney failure
```
27
what are the 3 macro vascular complications of diabetes mellitus?
stroke
MI
PVD
28
what infections cause cavitating lung lesions?
legionella
klebsiella
staphyclococcus
29
what are the causes of cavitating lung lesions?
infections- klebsiella, staph, legionella
inflammation- rheumatoid arthritis
PE
30
what is hereditary haemorrhagic telangiectasia? how does it present?
an inherited disorder where blood vessels don't form properly and are prone to bleeding
presents with epistaxis and telangiectasia
31
what is the most common causative agent for osteomyelitis? what about in those with sickle cell disease?
most common is staph aureus
| most common in patients with sickle cell is salmonella
32
what murmur is mid systolic?
aortic stenosis
33
where is aortic stenosis best auscultated?
right upper sternal border
34
where does aortic stenosis radiate to?
carotids
35
what murmur is mid diastolic?
mitral stenosis
36
where is mitral stenosis best auscultated?
apex
37
where does mitral stenosis radiate to?
nowhere
38
what murmur is pan systolic?
mitral regurg
39
where is mitral regurg best auscultated?
apex
40
where does mitral regurg radiate to?
left axilla
41
what murmur is disatolic?
aortic regurg
42
where is aortic regurg best auscultated?
LUSB or apex
43
where does aortic regurg radiate to?
LUSB
44
if there is a right sided murmur what should you think?
infective endocarditis/ IV drug use
45
what are the differences between b12 and thiamine deficiency?
```
b12= due to diet, gastric surgery, chronic GI illness
thiamine= due to alcohol intake, acute deficiency causes wernickes encephalopathy
```
46
what drug increases risk of pneumonia in COPD patients with T2DM?
metformin
47
what is the most common complication of TURP?
retrograde ejaculation- when semen is ejected into the bladder instead of out the penis during a male orgasm (ie dry orgasm)
this has no negative effects but can cause infertility
48
what drugs improve prognosis in patients with heart failure? what drugs only provide symptomatic relief?
ace inhibitors and beta blockers improve morbidity and mortality
diuretics only provide symptom relief
49
what drugs are contraindicated in heart failure?
rate limiting CCBs or dihydropiridines
eg verapamil, diltiazem and nifedipine
amlodipine can be given safely
50
what conditions is pyoderma gangrenosum associated with?
IBD
| rheumatoid arthritis
51
when is lactulose given to patients? describe why?
it is given in hepatic encephalopathy
| it reduces the amount of ammonia in the blood which
52
what is charcot marie tooth disease? how is it investigated and what is seen?
inherited peripheral neuropathy
| it is investigated with nerve conduction studies which will show it is either demyelinating or axonal
53
what is another name for pyramidal tract?
corticospinal tract
54
what else is the corticospinal tract known as?
pyramidal tract
55
what is the difference between spastic hemiparesis, spastic diplegia and spastic quadpriplegia?
spastic hemiparesis= ipsilateral arm and leg affected
spastic dipelgia= ipsilateral arm and leg affected but legs more
spastic quadriplegia= ipsilateral arm and leg affected but arms more
56
a lesion where will result in parkinsonism or hyperkinesis?
extrapyramidal tract or basal ganglia
57
what will a lesion in the extrapyramidal tract or basal ganglia cause?
parkinsonism (triad of bradykinesia, resting tremor and rigidity)
OR
hyperkinesis (eg in Huntingtons)
58
what part of the brain is affected in motor neurone disease?
anterior horn cell
59
what will a dorsal column lesion cause?
ipsilateral impairment in position and sense
60
what are features of spastic paraparesis?
```
UMN signs:
hypertonia
ankle clonus
hyper reflexia
upgoing plantars
```
61
what are the 2 main causes of spastic paraparesis?
cerebral palsy
| multiple sclerosis
62
what steroid and what dosage is given for cord compression due to malignancy?
dexamethasone 8mg BD
63
what should you think when you see poikilocytes?
myelofibrosis
64
what is ix for myelofibrosis?
bone marrow biopsy
65
what is the most common causative agent of infective endocarditis?
staph aureus
66
what is triple therapy for h pylori eradication?
amoxicillin (this can be replaced for metronidazole if allergic)
clarithromycin
omeprazole
67
in triple eradiction therapy for h pylori what is given instead of amoxicillin if someone is allergic?
metronidazole
68
what is the most common causative agent for septic arthritis?
staph aureus
69
what advice about sex should be given to someone with herpes?
avoid all sexual activity until the viral prodrome is over and until all lesions are gone
70
describe PTH, folate and calcium levels in primary hyperparathyroidism
```
PTH= high
calcium= high
folate= low
```
71
what is coronary artery vasospasm associated with and how will it present?
it is associated with cocaine use
| it presents with central chest pain on exertion
72
what is the difference in administration of steroid in someone with giant cell arteritis when they are symptomatic v asymptomatic?
```
symptomatic= IV methylprednisolone
asymptomatic= oral prednisolone
```
73
what abx is given in cellulitis if they are allergic to amoxicillin?
clindamycin or clarthromycin
74
what us affected in cellulitis vs erysipelas?
```
cellulitis= epidermis and subcut tissue
erysipelas= epidermis and upper subcut tissue
```
75
what abx is given in erysipelas if they are allergic to amoxicillin?
erythromycin
76
what is abx course for cellulitis?
flucloxacillin (add benzylpenicillin if severe)
| clindamycin/clarithromycin if allergic to penicillin
77
what are causative agents of cellulitis vs erysipelas?
```
cellulitis= group a beta haemolytic streptococcus or staph aureus
erysipelas= mainly just group a beta haemolytic strep
```
78
how do you differentiate cellulitis and erysipelas?
erysipelas is has better demarcated borders, is more raised and pruritic
79
What blood test is diagnostic of rhabdomyolysis and what will you see?
CK 5x higher than normal
80
what is rhabomyolysis? what 2 molecules are released and what does this cause?
it is breakdown of skeletal muscle
| this releases myoglobin (which can cause kidney injury/AKI) and electrolytes (like potassium, calcium and urea)
81
what is initial management of hypercalcaemia?
IV fluids
82
what is myxoedema coma?
a condition that results from severe hypothyroidism
83
what is associated with thinning hair and nails?
hypothyoidism
84
what 2 things are given to treat myxoedema coma?
IV thyroxine
| hydrocortisone
85
what type of anti emetic is ondansetron? how does it work
5HT3 antagonist
| acts on chemoreceptor trigger zone in medulla oblongata
86
if there is a short incubation period for gastroenteritis and profuse vomiting, what is the likely causative organism?
staph aureus
87
if urea is high is there likely to be an upper or lower GI bleed?
upper
88
how can you differentiate upper v lower GI bleed on bloods?
upper GI bleed will have high urea
89
in anaemia associated with CKD what must you do before starting erythropoietin?
correct other deficiencies eg iron
90
what medication increases incidence of gout and why?
thiazide like diuretics
| they reduce excretion of uric acid from the kidneys
91
what is used to image the brain and confirm a diagnosis of MS?
MRI head
92
what is given first line to treat hepatic encephalopathy? how does it work
lactulose
| it works by having a laxative affect and reducing levels of ammonia in the body
93
what ix confirms diagnosis of TB?
sputum acid fast bacilli smear
94
what do you need to do if someone has infective endocarditis caused by strep bovis? why?
colonoscopy
the source of strep bovis is the GI tract and people are more likely to grow it if they have IBD or a colonic tumor so you should do a colonoscopy to check
95
what IBD is tenesmus more commonly seen with?
ulcerative colitis
96
what must be co prescribed with methotrexate? why and how must it be taken?
folate
it is prescribed as methotrexate impairs folate metabolism so it will avoid folate deficiency
it must not be taken on the same day as methotrexate to avoid impairing its metabolism
97
what are guidelines for medications for hypertension in T2DM?
start them on an ACEi or ARB regardless of age
98
what is the most common clinical pattern seen in motor neurone disease?
amyotrophic lateral sclerosis
99
what are the zones of the adrenal cortex from outside in and what do they produce?
glomerulosa- mineralocorticoids
fasiculata- glucocorticoids
reticularis- androgens
100
whats the commonest cause of intracerebral haemorrhage?
hypertension
101
what are signs of mycoplasma pneumonia specifically?
target shaped lesions (erythema multiforme)
| anaemia
102
what is erythema multiforme?
target shaped skin lesions
103
what are changes to percussion, tactile vocal fremitus and vocal resonance in pneumonia?
percussion= dull
tactile vocal fremitus= increased
vocal resonance= increased
104
what type of hearing loss does otitis media cause?
conductive
105
how does otitis media present?
hearing loss
bulging and erythematous tympanic membrane
discharge from ear
106
how does vestibular schwannoma present?
sensorineural hearing loss
facial nerve palsy
tinnitus
vertigo
107
what is the order of pharmacological treatment in a UC flare?
```
oral melsalazine
oral prednisolone (moderate flare)
IV corticosteroids (severe flare)
```
108
what crackles are heard and where in IPF?
fine bi basal end inspiratory crackles
109
what is hba1c for a diagnosis of diabetes?
>48 mmol/L
110
what is first line treatment for nephrogenic diabetes insipidus?
thiazide diuretic
111
what is the regime for ripe drugs when someone has TB?
rifampicin, isoniazid, pyrazinamide, ethambutol to start with for 2 months
then after 2 months continue rifampicin and isoniazid for 4 more months (they have a 6 month course in total)
112
what are the side effects for the abx used to manage TB?
```
rifampicin= red secretions
isoniazid= peripheral neuropathy
pyrazinamide= hyperuricaemia causing gout
ethambutol= optic neuritis
```
113
describe the percussion notes and what they mean
resonant= normal
dull= increased tissue density eg lobe collapse, consolidation
stoney dull= pleural effusion
hyper resonant= decreased tissue density eg pneumothorax
114
how do you test for tactile vocal fremitus vs vocal resonance. which one do i test for when doing a resp exam?
tactile vocal fremitus= using ulnar borders of the hand place across chest and get them to say 99
vocal resonance= auscultate with steth and get them to say 99 each time
i do vocal resonance
115
describe abnormal results for vocal resonance and what they mean?
when thinking about vocal resonance think vibrations
increased vocal resonance= increased vibrations due to presence of fluid or dense tissue eg lobe collapse, pleural effusion
decreased vocal resonance= decreased vibrations due to presence of air getting in the way eg pneumothorax
116
describe percussion note and vocal resonance over a pleural effusion and explain
percussion= stoney dull
| vocal resonance= increased (increased vibration through a fluid)
117
describe percussion note and vocal resonance over a pneumothorax and explain
percussion= hyper resonant
| vocal resonance= decreased due to decreased vibrations through air
118
describe percussion note and vocal resonance over a lobe collapse and explain
percussion= dull
| vocal resonance= increased due to increased vibrations over a solid
119
what is sideroblastic anaemia?
anaemia wherein there are excess amounts of iron in the serum but the body is unable to use this iron to synthesise haem, producing ringed sideroblasts instead of healthy RBCs
120
what iron study is the same as transferrin?
TIBC
121
what are heberdens and bouvhards nodes a sign of?
osteoarthritis
122
what drugs for diabetics causes hypoglycaemia? give specific examples of drugs in the drug class
sulphonylureas
| an example is gliclazide
123
what is overflow diarrhoea? what should you do when this occurs and what is it important to avoid?
it is when there is a large faecalith blocking the bowel and backed up stools overflow to get past it
do a DRE when this happens
it is important not to reduce laxatives in this case and may be a good idea to actually increase them
124
what are indications for carotid endartectomy?
70% or greater blockage of the carotids and symptomatic
125
according to nice guidelines what score should not be used after TIA and what should be done instead?
the ABCD2 score should NOT be used to assess stroke risk
| instead the clinician should refer the patient to a stroke specialist clinic within 24 hrs
126
what type of cancer most commonly causes hyperparathyroidism?
solitary adenoma
127
give a specific example of SABA/SAMA?
salbutamol (SABA)
| ipatropium (SAMA)
128
what is the most common cause of exudative pleural effusion?
pneumonia
129
what are rules for driving after 1st seizure?
if unprovoked they cannot drive for 6 months
130
what is used for anticoagulation in a DVT in interim v long term?
DOAC
131
what is used as pharmacotherapy for Philadelphia chromosome positive CML?
imatinib
132
what medication for osteoporosis is contraindicated in someone who also has CKD?
bisphosphonates
133
haematologically, what is a rf for the development of gout?
recurrent episodes of hemolysis
134
what should you immediately think when you see left sided variocele? why?
renal cell carcinoma
the carcinoma can cause obstruction of the gondal vein so fluid cannot drain out of the testes properly, this leads to variocele
135
how do you differentiate duodenal and gastric ulcers?
```
gastric= worse after eating
duodenal= better after eating
```
136
what does average ambulatory blood pressure need to be in someone for a diagnosis of hypertension?
>135/85 mmHg
137
what causes a painful third nerve palsy?
posterior communicating artery aneurysm
138
what is used for reversal of anticoagulation in patients with a severe bleed or injury?
prothrombin complex concentrate
139
if hbA2 is raised what condition does the patient have? why
BETA thalassaemia
| excess alpha chains are present as they cannot be synthesised into RBCs becuase the beta chains are faulty
140
what is the inheritance pattern of HOCM?
autosomal dominant
141
what are the ix of choice when you suspect multiple myeloma?
serum protein electrophoresis
| urinary bence jones proteins
142
how does warfarin affect PT and APTT?
prolongs PT
| reduces APTT
