SBA DECK 25/4 Flashcards by Aaska Banthiya

what drug can be given to slow the progression of diabetic nephropathy?

ramipril

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what heart phase is affected in HOCM and how?

diastole

thickening of the left ventricle wall means the heart muscle cannot appropriately relax

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what are some common live virus vaccines (that therefore cannot be given to immunocompromised patients)

MMR
varicella zoster 
BCG
yellow fever
rotavirus

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what should you remember about those on high dose steroid therapy?

they are immunocompromised

this has implications eg they should not be given live vaccines

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how is hereditary spherocytosis inherited?

autosomal dominant

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what is the mechanism of anaemia in hereditary spherocytosis? explain why it arises

normocytic haemolytic anaemia

arises because there is a defect in the RBC cytoskeleton so RBCs are destroyed

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what ix confirms cystic fibrosis? what will it show?

sweat test- will have abnormally high chloride in their sweat

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what will you see on ABG in HHS?

pH >7.3
Hco3 >15

ie NO evidence of ketoacidosis

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what transferral time for PCI is acceptable in someone who presents with an MI?

2 hours ie if they can be transferred and PCI done within 2 hrs do that, if it takes longer do alteplase thrombolysis

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what is GS treatment for patients presenting within 12 hrs of chest pain and diagnosed with MI?

angiography PLUS PCI

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Describe pharmacological asthma management starting with SABA

SABA
Add ICS
Add LABA
If benefits but inadequate increase ICS dose, if not beneficial stop and increase
If still no benefit stop LABA and trial LTRA

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what is the most common lung cancer in non smokers?

lung adenocarcinoma

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what are some features of lung adenocarcinoma?

most common lung cancer in non smokers
peripherally located
associated with peripheral osetoarthropathy

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how is cushings medically managed? how do they drugs work

first line metyrapone
ketoconazole
the drugs work by inhibiting steroid synthesis

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what primary ix can you do if you suspect cushings and what does it tell you?

overnight dexamethasone test- give dex at midnight and then measure cortisol in the morning
this test is used to identify hypercortisolism but to diagnose cushings more specific tests need to be done if it comes back positive

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how is normal pressure hydrocephalus managed?

LP to diagnose and relieve pressure

then ventriculoperitoneal shunting

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what cancers is elevated ca 19-9 most associated with?

cholangiocarcinoma
pancreatic cancer
gastric cancer

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what are characteristics of menieres disease?

vertigo
tinnitus
aural fullness
sensorineural hearing loss

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what are differentials for vertigo and how are they differentiated?

BPPV- triggered by head movements
Menieres disease- accompanied by tinnitus, sensorineural hearing loss and aural fullness
Vestibular neuritis- no hearing loss/tinnitus, may be preceded by an infection

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what happens to PT, APTT and fibrinogen in disseminated intravascular coagulation?

PT and APTT are prolonged

fibrinogen is reduced

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what are some features of carcinoid syndrome?

flushing
wheezing
sweating

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if someone meets criteria for IBS what ix should you go next?

transglutaminase antibodies to rule out coeliacs

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what is paroxysmal AF?

AF that lasts <7days and is intermittent

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how is paroxysmal AF in young people managed?

oral flecanide

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what are some presenting features of SLE?

``` systemic upset (myalgia, weakness, fatigue, weight loss) joint and/or skin involvement photosensitivity (malar rash) discoid rash (round/raised plaques) ```

what bacteria most commonly causes septic arthritis of a prosthetic joint?

staph epidermis

pneumonia caused by what organism can often result in hyponatraemia and lymphopenia?

legionella pneumoniae

what is the most important risk factor for bladder cancer?

smoking

what does azothioprine do for someone who has UC? when is it not used

maintain remission | it is not used in an acute flare

what is given in a mild/moderate flare of UC?

enema or oral aminosalicyclate

what is give in a moderate/severe flare for UC? when is this is not tolerated

IV corticosteroids | if not tolerated IV ciclosporin

why can't you give triptans to patients presenting with cluster headache who have CAD?

they can induce coronary vasospasm

what do delta waves and a short PR interval on ECG indicate?

wolff parkinson white syndrome

what ix is done when IBS is suspected? why?

faecal calprotectin to rule out IBD

what are characteristics of IBS?

abdo discomfort bloating discomfort relieved by defecation and made worse by eating

what ix is diagnostic for malaria?

thick and thing blood smear

what affect does malaria have on RBCs?

it causes haemolytic anaemia

what test is best for diagnosing herpes virus infection?

HSV PCR (nucleic acid amplification)

when is adenosine vs adrenaline used?

``` adenosine= SVT second line management or first line if haemodynamically unstable adrenaline= after CPR or in anaphylaxis ```

what mutation is most commonly associated with MND?

SOD 1

what would be seen on urinalysis in goodpastures?

haematuria | may have mild proteinuria

whats the most common cause of nephrotic syndrome in children?

minimal change disease

what is first line to induce remission of a flare in crohn's disease?

glucocorticoids

when is sumatriptan used in migraines?

to stop an acute attack- patients are asked to take it as soon as the attack starts

what medications are used for migraine prophylaxis?

beta blockers- propanolol | topiramate

when is topiramate contraindicated? | what is it used for?

used for migraine prophylaxis | contraindicated in pregnancy

what is first line for spasticity in MS?

baclofen | gabapentin

how is aortic dissection standford type a vs b managed?

``` a= labetolol for BP control+ emergency surgical repair b= labetolol for BP control+ supportive care ```

what is first line rate control in someone with fast AF who is haemodynamically stable?

bisoprolol

how does ankylosing spondylitis present?

``` recurrent lower back pain worse in the morning better with exercise buttock pain pain wakes them up at night anterior uveitis ```

how is mechanical back pain ruled out?

it should resolve in 6 weeks

what are red flags for back pain and what should be done?

progressive pain not relieved by rest spinal tenderness new onset <20 or >55 thoracic or cervical spine pain

what dosage of aspirin and clopi are given to patients who present with STEMI?

300mg each

how long do you have to wait after changing a levothyroxine dose to measure TFTs? why?

4-6 weeks because the half life of TSH is 4-6 weeks

what is the main difference between a myopathy and poly/dermomyositis?

``` myopathy= muscle weakness myositis= muscle pain ```

what is not a feature in poly/dermatomyositis and can help distinguish it from myopathy?

pain will not be present

what blood test is raised in poly/dermatomyotsitis but not in polymyalgia rheumatica?

what might CCBs cause as a side effect? how is this managed?

leg swelling | it is not responsive to diuretics so you have to stop the drug and try something else

what is the most appropriate first ix for pancytopenia? what else do you need to do

blood film | if there is true pancytopenia a bone marrow biopsy will need to be done

what valve problem causes collapsing pulse?

aortic regurg

a lesion where most commonly causes coning?

in the posterior fossa

what are some signs of compartment syndrome?

severe pain especially on passive flexion | 6Ps of an acute limb

what are the 6 ps of an acute limb?

``` pain pallor parasthesia paralysis pulselessness perishingly cold ```

what should you examine in a male patient with RIF pain?

external genitalia

how will high aldosterone affect potassium and sodium levels?

``` sodium= increased reabsorption potassium= increased excretion ```

what drugs should be stopped when someone has an AKI?

``` ACEi ARBs NSAIDs diuretics aminoglycosides metformin lithium ```

if ALP is a lot higher than GGT and ALT what type of jaundice is occuring?

obstructive- the biliary tree is obstructed

what are some examples of commonly used thiazide like diuretics eg in hypertension control?

indapamide | chlortalidone

what is the most common lung malignancy in non smokers?

adenocarcinoma

what type of lung cancer is associated with gynaecomastia and hypertrophic pulmonary osteoarthropathy?

adenocarcinoma

what disease is notably NOT notifiable?

HIV

what types of dysphagia are considered red flag?

any new onset dysphagia regardless of age or other symptoms is red falg and needs a 2 week referral

what is the deal with ACEi and kidney failure?

ACEi are renoprotective eg reduces risk of developing kidney failure However, they must be stopped if someone has kidney failure as it can cause it to worsen

what is thumbprinting seen in and what does it look like?

seen in UC | there will be white indents along the length of the bowel where it looks like someone has placed there thumbprint

how do you differentiate large and small bowel obstruction on XR?

large bowel= there will be haustra present (white marks which are small indents coming in from the sides of the bowel) small bowel= there will be vulvae coniventaes (white lines across the whole length of the bowel)

how is acute hf managed?

sit patient up give oxygen give IV furosimide (40mg) give SC morphine

what affect do loop diuretics have on HF?

they improve symptoms but not mortality

how will hereditary haemochromatosis present?

``` joint pain (especially 2nd and 3rd MCP joints) erectile dysfunction grey pigmentation cirrhosis dilated cardiomypoathy osteoporosis ```

what type of pleural effusion does malignancy cause?

exudative

what is the difference between transudate and exudate? how do you remember this

``` transudate= not high in protein exudate= high in protein (you need to execute the protein cos its high) ```

if there is pulmonary oedema out of transudate and exudate which is more likely to be unilateral vs bilateral?

``` transudate= bilateral exudate= unilateral ```

what are characteristics of arterial ulcers?

punched out appearance very painful pain wakes them up at night cold, white and shiny

how are arterial ulcers managed?

lifestyle factors= weight loss, exercise | prescribe an antiplatelet

what are the features of venous insufficiency?

``` ankle swelling varicose veins haemosiderin deposition lipodermatosclerosis stasis eczema ```

what are characteristics of venous ulcers?

red, shallow, warm features of chronic venous insufficiency: lipodermatosclerosis, stasis eczema, ankle swelling, haemosiderin deposition, varicose veins

out of arterial and venous ulcers which are more likely to be above v below the medial malleolus?

``` above= venous below= arterial ```

what acronym is used to remember which lesions cause superior vs inferior quadrantopias?

PITS Parietal lesion= contralateral Inferior homonymous quadrantopia Temporal lesion= contralateral superior homonymous quadrantopia

what might cxr show in pneumocystitis pneumonia?

bilateral hilar infiltrates

how does someone with carbon monoxide poisoning present?

``` nausea and vomitting confusion cherry red skin 100% oxygen sats tachycardia new onset of all symptoms ```

what is GS treatment for someone with carbon monoxide poisoning? how does it work

hyperbaric oxygen- works to unbind CO from haemoglobin

what should you think if you see cherry red skin?

carbon monoxide poisoning

why will someone with CO poisoning have 100% oxygen sats?

the probe only measures the saturation of non affected/normal ahemoglobin molecules

what arrhythmia is a common complication of hyperthyroidism?

atrial fibrillation

when does an AAA need to be surgically repaired?

if its large (>5.5cm) | or if its rapidly enlarging

what size are norma, small, medium and large AAAs? what action is taken with each size?

<3cm is normal= discharge 3-4.4cm= small, rescan in 12 months 4.5-5.4cm= medium, rescan in 3 months >5.5cm= large, 2 week referral for surgical repair

what is the characteristic presentation of paget's disease?

elderly nordic male patient presents with bone pain and an isolated rise in ALP

what will be the only raised LFT in pagets disease?

ALP

what happens to goblet cells in crohns?

increase

what condition are crypt abscesses found in?

what type of hypersensitivity is SLE?

type 3- antibody antigen complex deposition

on a normal ECG how will posterior MI manifest?

tall R waves in V1 and V2

what is the most common cause of cushings syndrome?

cushings disease ie pituitary adenoma

what drug causes gynacomastia?

spironolactone

what lobe of the brain is involved when there are automatisms in seizures?

temporal

what is found in CSF in multiple sclerosis?

oligoclonal bands

What are the 4 parkinsonism plus syndromes? what do they mean?

Progressive supranuclear palsy Multiple system atrophy Corticobasal degeneration Lewy body dementia they present with the triad of parkinsonism (bradykinesia, hypertonia and resting tremor) plus other symptoms

What is the triad of parkinsonism?

bradykinesia hypertonia resting tremor

how does progressive supranuclear palsy present?

parkinsonism plus vertical gaze palsy

how does multiple system atrophy present?

parkinsonism plus loss of autonomic function eg impotence, incontinence, postural hypotension

how does corticobasal degeneration present?

parkinsonism plus spontaneous activity of affected limb or akinetic rigidity of limb

how does lewy body dementia present?

parkinsonism preceeded by visual hallucinations and cognitive impairment

whats first line management for guillian barre?

IV immunoglobulins

what do random blood glucose, fasting blood glucose and hba1c need to be for a diagnosis of diabetes?

randomn blood glucose= 11.1 fasting blood glucose= 7 hba1c= 48 you need either 2 of these to be positive at separate times or 1 with symptoms for diagnosis

what type of shock does sepsis cause?

distributive

what are the most common findings on examination in someone with pernicious anaemia?

angular stomatitis | glossitis

how do you manage syncope?

500 mcg IV atropine

if transferrin is raised what happens to transferrin saturation?

it falls

what is the most common ECG finding in PE?

sinus tachycardia

what must be given on discharge if someone has SBP?

prophylactic antibiotics- ciprofloxacin

what are guidelines for DVT anticoagulation?

anticoagulate with a DOAC unprovoked= 6 months provoked (eg surgery)= 3 months

how do you differentiate ileostomy and colostomy?

``` ileostomy= contents are liquid and its spouted colostomy= contents are solid and its flushed ```

why are ileostomies spouted and colostomies flushed?

ileostomies are spouted to prevent the enzymes of the small intestinte form coming into contact with the skin colostomies are flat because the large bowel doesnt have enzymes

what anticoagulation is used in pregnancy if someone has antiphospholipid syndrome?

aspirin and LMWH

SBA DECK 25/4 Flashcards

(123 cards)