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Year 3 > SBA DECK 6/06 > Flashcards

SBA DECK 6/06 Flashcards

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1
Q

what TB drug increases INR?

A

isoniazid

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2
Q

whats the most common cause of annovulation in women?

A

PCOS

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3
Q

is deformities like swan neck, boutonnieres, ulnar deviation are present whats the diagnosis?

A

rheumatoid arthritis

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4
Q

how can you differentiate mallory weiss and variceal bleed?

A

in variceal bleed there will be: ascites/abdo distention, encephalopathy, alcohol hx, signs of portal hypertension

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5
Q

what is a mallory weiss tear?

A

a laceration in the oesophagus often caused by retching/vomitting

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6
Q

what doses of adenosine and how many are given in SVT?

A

6 mg IV to start
if unsuccessful 12 mg
if unsuccessful a further 18 mg

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7
Q

describe acute management of SVT

A 
first line vagal manoeuvres
second line IV adenosine 6 mg
if unsuccessful 12 mg
if unsuccessful a further 18 mg
if unsuccessful electrical cardioversion
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8
Q

what are side effects of adenosine and are they normal?

A

chest pain
flushing
yes they are normal and will self terminate

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9
Q

what are some symptoms of carcinoid syndrome?

A 
flushing 
bronchospasm
diarrhoea
weight loss
hypotension
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10
Q

how do dpp4 inhibitors work?

A

they reduce the peripheral breakdown of incretins eg GLP 1

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11
Q

describe management of STEMI

A

start on aspirin 300mg, morphine (+anti emetic) if in severe pain, nitrates (caution if theyre hypotensive)
if PCI available in 120 mins do this, give pasrugel and unfractionated hep, do PCI with radial access preferred
if PCI not available in 120 mins do thrombolysis and give ticagrelor after

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12
Q

describe management of NSTEMI/ unstable angina

A

give 300mg aspirin and fondaparinux if immediate PCI is not being done
if haem unstable= PCI, give pasrugel or ticagrelor and unfractionated heparin
if stable and PCI not done give ticagrelor
decide risk on GRACE score

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13
Q

what is anion gap in DKA?

A

high

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14
Q

what diabetes drug should not be used in heart failure?

A

pioglitazone

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15
Q

what is contraindicated in asthmatics who have AF? what should you give them instead?

A

beta blockers

give a rate limiting CCB like verapamil instead

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16
Q

what should you give alongside terlipressin in variceal bleed?

A

IV abx

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17
Q

what do you see on lumbar puncture in GBS?

A

raised protein

normal WCC

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18
Q

what is protein and WCC on lumbar puncture in GBS?

A

protein is raised

WCC is normal

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19
Q

before polysomnography what is initial ic for OSA?

A

overnight pulse oximetry

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20
Q

what agent is most common in causing pneumonia in patients with bronchiectasis?

A

haem influenzae

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21
Q

what does a headache thats worse on defecating/straining indicative of? what should you do

A

indicative of raised ICP

must do non contrast CT head

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22
Q

what happens to vocal resonance over the area of a tension pneumothorax?

A

it decreases

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23
Q

what electrolyte abnormality do thiazide diuretics cause?

A

hypercalcaemia

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24
Q

in what patients is triptan for migraines contraindicated?

A

hx of IHD

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25
what type of lump will mastitis cause?
warm, tender and fluctuant swelling
26
what is a staghorn calculus and how is it managed?
it is a type of renal stone that wont pass without surgery PCNL is preferred to remove it shockwave lithotripsy is reserved for those who are at high risk of surgery
27
how does systemic sclerosis present?
raynauds phenomenon sclerodactyly pulmonary hypertension odonyphagia
28
how do you manage a patient with a catheter who has an infection?
change the catheter first line to remove the source of the infection
29
what ix is diagnostic for bronchiectasis?
high res CT chest
30
what acronym is used to remember HAP organisms and what does it stand for?
``` SEP K: staph aureus e coli pseudomonas klebsiella ```
31
what is the most common organism for septic arthritis?
staph aureus
32
what is superior vena cava syndrome and how does it present?
compression of the superior vena cava eg due to a tumor | presents with dyspnoea, orthopnoea, swollen face and arms, cough, positive pembertons test
33
what causes raised PT?
anticoag use liver failure DIC
34
what does PT measure? how do you remember this?
extrinsic pathway | PT= Play Tennis outside= extrinsic
35
what is synonymous with PT?
INR
36
what causes raised APTT?
haemophilia | DIC
37
what does APTT measure?
intrinsic pathway
38
what is the main ECG abnormality in hypercalcaemia?
short QT interval
39
what does longer term PPI use increase the risk of? explain why
c diff infections | less gastric acid is produced which means bacteria aren't killed
40
in a massive PE what one factor is an indication for thrombolysis?
hypotension
41
how is PBC managed?
oral ursodeoxycholic acid
42
when do you use IM lorazepam vs PR diazepam in status epilepticus?
IM lorazepam is only really used in hospital settings | use PR diazepam in GPs etc
43
when is colonoscopy avoided in UC? why? what is done instead
in severe flares due to risk of perforation | do a flexible sigmoidoscopy instead
44
is a child has HUS caused by food poisoning what is the likely causative organism?
e coli
45
what is alpha 1 antitripsin deficiency?
deficiency of a protease inhibitor made in the liver
46
what are symptoms of alpha 1 antitripsin deficiency? why do they arise
deficiency means neutrophil elastase damages the lungs causing emphysema there is also cirrhosis of the liver due to accumulation of defective alpha 1 antitripsin in the liver (this can be carcinoma in adults and cholestasis in children)
47
how is alpha 1 antitripsin managed?
stop smoking supportive physiotherapy and bronchodilators A1AT infusion can do lung vol reduction surgery etc
48
what 1st line management of septic arthritis?
joint aspiration and culture | this has to be done before empirical abx can be given
49
how are skin cancer referrals done based on type?
``` BCC= non urgent/routine 6 week referral to derm SCC/SCLC= urgent 2 week referral to derm ```
50
if there is itchiness in jaundice what does this tell you about the bilirubin?
its conjugated
51
what helps you identify pancreatic cancer in the way it presents?
flaws for a while | then very suddenly unwell as it obstructs the biliary system with jaundice and pruritus
52
what is given first in alcohol withdrawal? explain
give benzos first line as the seizures are what will kill them pabrinex can then be given after to support them
53
what antibodies are present in dermatomyositis?
anti jo1 anti mi 2 anti SRP
54
how does dermatomyositis present?
``` proximal myopathy photosensitivity heliotrope rash over face grottons papules (red on fingers) raynauds phenomenon resp muscle weakness ```
55
what cells mediate polymyositis?
t cells
56
what the most sensitive test for acute pancreatitis ie whats done first?
bloods
57
what is percussion over a pneumothorax?
increased
58
how do you differentiate epididymal cyst from hydrocele
epididymal cyst= single mass | hydrocele= a mass but covering the whole testes so it looks like its enlarged
59
how do you differentiate between the different types of ACS?
STEMI= ST elevation on ECG and raised troponin NSTEMI= raised troponin unstable angina= normal troponin
60
what ECG changes might you see in NSTEMI?
T wave inversion | ST depression
61
what are the 3 features of critical limb ischaemia?
pain at rest tissue loss (arterial ulcers) gangrene
62
how is SAAG calculated and interpreted?
serum albumin- ascitic albumin <8g= ascitic albumin is high= exudate >8g= ascitic albumin isn't that high= transudate
63
what is the cut off for SAAG and what does this mean?
if its <8g= exudate
64
how can you tell if ascitic fluid is transudate or exudate?
SAAG <8= exudate >8= transudate
65
what are the 3 classes of beta lactams?
penicillins cephalosporins carbapenems
66
what 2 substances are partially reabsorbed by the kidneys to increase water reabsorption?
urea and sodium
67
what 2 molecules are good markers of dehydration and why
sodium and urea they are partially reabsorbed by the kidney to increase osmolarity which helps reabsorb water (usually urea is completely excreted, therefore if levels are high this suggests dehydration)
68
what does high urea indicate? explain why
dehydration (among other things) usually urea is completely excreted so when its reabsorbed it is to increase osmolarity in the kidney so more water is reabsorbed
69
what are the 4 indications for dialysis in chronic kidney failure?
acidosis refractory pulmonary oedema refractory hyperkalemia uraemic complications
70
what zone undergoes hyperplasia in BPH?
periurethral
71
when you see anaemia and painless jaundice what should you think?
haemolytic anaemia
72
what does high calcium with low PTH indicate? explain
malignancy the high calcium should reduce PTH so the PTH axis is normal, therefore the high calcium is probably caused by malignancy
73
what is salmterol?
LABA
74
what is given to reverse anticoagulation when someone is on warfarin which needs to be stopped?
vitamin K and prothrombin concentrate
75
how is VT managed in a haemodynamically stable patient?
amiodarone
76
what blood test is most helpful in confirming diagnosis of hereditary haemochromatosis and what will it be?
transferrin saturation | this will be high
77
how id idiopathic autoimmune haemolytic anaemia managed first line? why?
provided transfusion isnt needed give steroids, they surpress the immune system and reduce RBC haemolysis
78
what type of shock does cardiac tamponade cause? explain
obstructive- the heart is prevented from filling properly
79
when do you give LMWH vs alteplase first line in a PE?
``` LMWH= if haemodynamically stable alteplase= thrombolyse immediately if haemodynamically unstable ```
80
How does LEMS present?
lung cancer muscle weakness mostly in legs autonomic symptoms like dry mouth, impotence, difficulty urinating
81
in type 2 diabetes what is BP cutoff range?
if BP is not <140/80 mmHg start an ACE inhibitor
82
what should you think first when you see a hypertension management q?
look to see if they are diabetic, if yes first line ACE inhibitor
83
what 2 medications if given together will cause rhabomyolysis?
statin and erythromycin/clarithromycin
84
what is the presentation of rhabdomyolysis?
dark urine | muscle aches
85
what ix should be done in a PE prior to CTPA? why
CXR | to rule out other pathologies that can cause chest pain
86
what happens to ejection fraction and the heart muscle in alcoholics?
EF is reduced | heart muscle= dilated cardiomyopathy
87
whats first line ix for suspected HF?
BNP | do this before echo
88
if calcium is high and PTH is normal whats the most likely diagnosis? explain
primary hyperparathyroidism PTH levels can be normal in primary hyperparathyroidism although malignancy is a valid cause of these results primary hyperparathyroidism is still more likely
89
what valve abnormality is associated with marfans syndrome?
mitral valve prolapse
90
how is an acute asthma attack managed?
back to back salbutamol nebs and ipatropium bromide, steroids and IV magnesium sulphate
91
what type of hepatitis is sexuall transmitted?
b
92
what signs do you see in aortic stenosis?
ejection systolic murmur bibasal creps due to LHF causing pulmonary oedema SOB
93
if a patient is bleeding profusely due to varices how do you manage them?
first line= IV terlipressin and blood if transfusion is indicated second line= IV fluids and IV abx
94
whats is seen on dix hallpike manouevre if someone has BPPV?
delayed onset vertigo (2 secs after turning head) and unilateral nystagmus on the affected side
95
whats first line ix fr gastric cancer?
OGD and biopsy | NOT bloods
96
what is lupus pernio and what condition is it associated with?
purple rash on the face associated with sarcoidosis
97
what ix is done to confirm SIADH? what is the result
a normal short synacthen test will confirm it
98
what are the euvolemic causes of hyponatraemia?
SIADH hypothyrodism secondary adrenal insufficiency
99
in renal when do you get white cell casts?
in AKI when its tubular
100
in renal when do you get red cell casts?
in AKI when its interstitial
101
what is the test for chronic pancreatitis?
faecal elastase

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