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Schofield medicine SAQs Flashcards

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1
Q

2 later ECG changes post MI?

A

Pathological Q waves and inverted T waves

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2
Q

How long until you can drive post-MI?

A

Can’t drive for 4 weeks, no need to inform DVLA

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3
Q

Complications of coronary angiography?

A

Bleeding
Infx
MI
Stroke
Death

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4
Q

Symptoms apart from pain during episode of angina?

A

SOB
Sweating
Feeling faint/lightheaded

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5
Q

Blood tests for angina?

A

FBC for anaemia
TFTs for thyrotoxicosis
Glucose for diabetes

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6
Q

Investigations for angina?

A

ECG
ECHO
Coronary angiography

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7
Q

How does aspirin reduce the risk of coronary events?

A

Aspirin irreversibly binds to COX, preventing further production of TXA2, which then inhibits platelet aggregation.

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8
Q

Signs of acute pulmonary oedema?

A

Tachypnoea
Tachycardia
Raised JVP
Wheeze
Cyanosis
Fine lung crepitations

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9
Q

Drugs to treat pulmonary oedema?

A

Furosemide
GTN
Morphine
Oxygen

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10
Q

Give two ways to increase someone’s potassium medically?

A

Orally (e.g. sando-K)
IV (Add KCl to IV fluids)

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11
Q

Normal QRS interval?

A

<0.12s (<3 small squares)

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12
Q

ECG shows regular rhythm, rate 140bpm, broad QRS complex and occasional capture beat?

A

Ventricular tachycardia

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13
Q

What is a capture beat?

A

Normal QRS complex between VT complexes

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14
Q

Two drugs that may be used during V tacky?

A

Amiodarone
Lidocaine
Oxygen
Adrenaline

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15
Q

What system is used to classify the severity of heart failure?

A

New York Heart Association Classification

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16
Q

Symptoms of left ventricular failure?

A

Dyspnoea
Fatigue
Paroxysmal nocturnal dyspnoea
Orthopnoea
Wheeze
Cough
Pink, frothy sputum

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17
Q

Signs of heart failure on CXR?

A

Kerley B lines
Cardiomegaly
Pleural effusions
Alveolar/interstitial oedema in ‘bat wings’ distribution

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18
Q

How and where does furosemide act?

A

Competitively inhibits the Na-K-2Cl cotransporter in the thick ascending limb of the LoH, diminishing the osmotic gradient for water reabsorption.

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19
Q

Side effects of ACEi?

A

Dry cough
Hyperkalaemia
Renal impairment
Angioedema/urticaria
Hypotension

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20
Q

Signs that may be visible on fundoscopy of someone with hypertensive retinopathy?

A

Cotton wool spots
Flame haemorrhages
A-V nipping
Papilloedema

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21
Q

Complications of hypertension?

A

Heart failure
Stroke
IHD
CKD
Hypertensive retinopathy
Peripheral vascular disease

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22
Q

Mechanism of action of statins?

A

Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis

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23
Q

Signs of hypercholesterolaemia?

A

Xanthelasma
Xanthoma
Corneal arcus

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24
Q

Causes of AF?

A

IHD
HTN
Hyperthyroidism
Heart failure
Endocarditis

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25
Symptoms of AF?
SOB Light-headed Dizzy
26
Methods of cardioversion?
Electrical - DC cardioversion Pharmacological - Amiodarone and flecainide
27
Long term meds in AF patients?
Beta-blocker CCB Digoxin DOAC
28
Target INR on warfarin?
2-3
29
Complications of atrial fibrillation?
Stroke TIA Heart failure
30
Most common cause of infective endocarditis?
Staphylococcus aureus If prosthetic valve - staphylococcus epidermis
31
Why do urine dip in infective endocarditis?
Microscopic haematuria
32
Infective endocarditis fundoscopy: boat-shaped retinal haemorrhage with a pale centre?
Roth spots
33
Criteria used to diagnose infective endocarditis?
Modified Duke criteria 1 major and 3 minor OR 5 minor
34
Examination findings infective endocarditis?
New heart murmur Splinter haemorrhages Petechiae on the trunk, limbs, oral mucosa or conjunctiva Janeway lesions (painless red flat macules on the palms of the hands and soles of the feet) Osler’s nodes (tender red/purple nodules on the pads of the fingers and toes) Roth spots Splenomegaly (in longstanding disease) Finger clubbing (in longstanding disease)
35
Pansystolic murmur heard loudest on inspiration?
Tricuspid regurgitation
36
How should blood cultures be taken for infective endocarditis?
3 sets, from 3 diff sites at 3 diff times
37
What increases the risk of infective endocarditis?
IVDU Prosthetic valves PDA VSD Mitral valve disease Bicuspid aortic valve
38
What pattern on spirometry is seen in asthma?
Obstructive (FEV1/FVC <0.7)
39
How does salbutamol work?
SABA Stimulates B2 receptors of resp tract, increases sympathetic activity and relaxes bronchial smooth muscle
40
Oxygen therapy for Type 2 respiratory failure (low O2, high CO2)
Controlled oxygen therapy via venturi mask as at risk of losing hypoxic drive
41
Management of acute infective exacerbation of COPD?
Abx Steroids Salbutamol/ipratropium NEB Resp physiotherapy
42
CURB-65?
C - confusion U - urea >7 R - RR >30 B - BP <90 systolic or <= 60 diastolic 65 - >65
43
Most common causes of community acquired pneumonia
Streptococcus pneumonia Haemophilus influenzae Staphylococcus aureus
44
Why may cases of TB be on the rise?
HIV/AIDs prevalence Use of immunosuppressive drugs Increased immigration from areas of high prevalence of TB Poor socio-economic conditions and overcrowding
45
Why multi-drug therapy for TB?
To combat multidrug resistance
46
Causes of erythema nodosum?
Idiopathic Crohns TB Ulcerative colitis Sarcoidosis
47
Incidence of Cystic Fibrosis?
One in 2500 births
48
Organisms that colonise the lungs of those with cystic fibrosis?
Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa
49
Causes of bronchiectasis?
Idiopathic Post-infective Post-obstructive (foreign body, tumour) Congenital (Young's, Kartagener's) RA Alpha-1-antitrypsin deficiency
50
Complications of bronchiectasis?
Pneumonia Sepsis Recurrent LRTIs Resp failure Cor pulmonale Pneumothorax
51
Lung cancer commonly metastases sites?
Brain bone Liver Lung Adrenals
52
Causes of finger clubbing?
Idiopathic pulmonary fibrosis Bronchial carcinoma Mesothelioma Bronchiectasis
53
Other than obesity give risk factors for OSA?
Acromegaly Enlarged tonsils Enlarged adenoids Nasal polyps Alcohol
54
What is cor pulmonale?
Right sided heart failure secondary to chronic pulmonary hypertension
55
ECG changes in cor pulmonale?
Right axis deviation Inverted T waves in chest leads P pulmonale Dominant R wave in VI
56
Causes of bilateral hilarity lymphadenopathy?
Sarcoidosis Lymphoma Bronchial carcinoma TB
57
Sarcoidosis biopsy?
Non-caseating granuloma
58
Extrapulmonary manifestations of sarcoidosis?
Erythema nodosum Lymphadenopathy Arthralgia Anterior uveitis Cardiomyopathy Hepatosplenomegaly
59
Advice for patient before starting long-term steroids?
Do not stop taking steroids abruptly Carry 'steroid card' at all times Doses need to be increased during illness
60
Side effects of long-term steroids?
Adrenal suppression Hyperglycaemia Central obesity Moon face Skin thinning Cataracts Muscle wasting Osteoporosis
61
Signs of pleural effusion on examination?
Reduced chest expansion on affected side Dull percussion Absent breath sounds Reduced vocal resonance Tracheal deviation away from effusion if large
62
Where to insert needle in pleural tap?
Above the rib to avoid the neuromuscular bundle which sit directly inferior each rib.
63
Causes of CKD?
Diabetes Hypertension Glomerulonephritis Polycystic kidney disease
64
Signs of CKD on examination?
Peripheral oedema Pallor Purpura Bruising Evidence of excoriation
65
Basic principles of haemodialysis?
Blood and dialysis fluid flow either side of a semipermeable membrane, molecules diffuse down their concentration gradient.
66
Complications of peritoneal dialysis?
Bacterial peritonitis Infx at catheter site Weight gain (due to dextrose solution)
67
What sites does hydroxylation of Vitamin D take place?
Liver Kidney
68
Causes of post-renal AKI
renal calculi renal tumour ureteric tumour BPH prostate cancer
69
Other than blood tests, investigations for AKI?
US KUB Urinalysis ABG
70
Life-threatening complications of AKI?
Pulmonary oedema Hyperkalaemia Haemorrhage
71
Indications for dialysis for patients with AKI?
Refractory pulmonary oedema Refractory hyperkalaemia Severe metabolic acidosis Uraemic encephalopathy Uraemic pericarditis
72
By what mechanism does rhabdomyolysis cause AKI?
Acute tubular necrosis
73
What would you see on urine microscopy with rhabdomyolysis
Muddy brown/ granular casts (due to myoglobinuria)
74
Why withhold metformin and lisinopril during AKI?
Metformin - risk of metabolic acidosis Lisinopril - nephrotoxic
75
Hyperkalaemia ECG changes?
Tall tented T waves Widening of QRS complex Flat P waves Prolonged PR interval
76
If suspected rapidly progressive glomerulonephritis what blood tests should be requested urgently?
ANCA, anti - GBM
77
What should be started immediately with rapidly progressive Glomerulonephritis?
steroids
78
Most common cause of nephrotic syndrome in kids and adults?
Kids - minimal change disease Adults - membranous nephropathy
79
Complications of nephrotic syndrome?
Increased susceptibility to infections Increased risk of thromboembolism Hyperlipidaemia
80
Dietary advice for those with nephrotic syndrome?
Low salt diet Normal protein diet
81
How to calculate serum osmolality?
Serum osmolality = 2(Na + K) + urea + glucose Normal range = 275-295mOsm/kg
82
How to examine for someone's volume status?
Postural blood pressures Serial weights Examine for peripheral oedema Measure urine output
83
Where is ADH secreted?
Posterior pituitary
84
How to treat SIADH pharmacologically?
Tolvaptan
85
Risk factors for UTI?
Female Pregnancy Diabetes Immunosuppressed Sexual intercourse
86
Contraindications for renal biopsy?
Abnormal coagulation studies Single functioning kidney CKD with small kidneys
87
Complications of renal biopsy?
Macroscopic haematuria Pain Haematoma Infection Death
88
Histological finding in patient with IgA nephropathy?
Mesangial proliferation IgA deposits C3 deposits
89
Causes of purpuric rash?
Henoch-Schonlien purpura Immune thrombocytopenic purpura Thrombotic thrombocytopenic Purpura DIC
90
Hand findings in RA?
Swan-neck deformity Boutonnieres deformity Z-shaped deformity of the thumb Ulnar deviation of the fingers
91
X ray findings in RA
Loss of joint space Juxta-articular osteopenia Subluxation Soft tissue swelling
92
Extra-articular features of RA?
Sjogren's syndrome Carpal tunnel syndrome Pulmonary fibrosis Lymphadenopathy Raynaud's phenomenon
93
RA with palpable spleen and neutropenia?
Felty's syndrome
94
Causes of poly arthritis?
RA Osteoarthritis Psoriatic arthritis SLE
95
Mechanism of NSAIDS
COX inhibition Reduces prostaglandin synthesis Reduces inflammation
96
How is methotrexate administered and how often in RA?
Orally/IM once a week - take with folic acid
97
Other than GP and rheumatologist - who else will be involved in RA patient's care?
Rheumatology specialist nurse Physiotherapist Occupational therapist
98
Common precipitants to gout?
Starting bendroflumethiazide High purine diet Alcohol Trauma Infection
99
X ray findings in gout?
Normal joint space Soft tissue swelling
100
Commonly affected joints in pseudo gout?
Knee Hips Wrist
101
Risk factors for pseudo gout?
Hypothyroidism Hyperparathyroidism Wilson's disease OA Increasing age
102
Investigation for gout/pseudogout?
Polarised light microscopy of synovial fluid
103
Treatment options for OA?
Conservative (weight loss, exercise) Physiotherapy Topical NSAIDs Intra-articular steroid injections Joint replacement
104
Positive blood tests in antiphospolipid syndrome?
ANA and anti-cardiolipin antibodies
105
Skin effects of SLE
Malar rash Photosensitive rash Discoid rash
106
Features of anti phospholipid syndrome?
Recurrent miscarriages Coagulation defects Livedo reticularis Thrombocytopenia
107
Drugs to treat anti phospholipid syndrome?
Aspirin Clopidogrel Heparin
108
Dermatomyositis autoantibodies?
Anti-Jo1 ANA Anti-Mi2 RF
109
What is Raynaud's phenomenon?
Peripheral digital Ischaemia due to vasospasm precipitated by cold or emotion.
110
Causes of Raynaud's phenomenon?
Raynaud's disease SLE RA Dermatomyositis/polymyositis B-blockers
111
Features of limited cutaneous scleroderma? (CREST)
Calcinosis Raynaud's phenomenon Oesophageal dysfunction Sclerodactyly (thick and tight skin over fingers/hands) Telangiectasia
112
X ray findings in ankylosing spondylitis?
Calcification of intervertebral ligaments Bamboo spine
113
Ank spond with ant. uveitis - what may you hear on heart and lungs?
Early diastolic murmur (Aortic regurgitation) Fine inspiratory crepitations at apices
114
Forms of psoriasis?
Chronic plaque psoriasis Flexural psoriasis Guttate psoriasis
115
Commonly affected sites of skin lesions of chronic plaque psoriasis?
Extensor surface of arms Extensor surface of legs Scalp Lower back
116
Some patients with psoriatic arthritis develop periarticular osteolysis and shortening of the bones. What is this form of psoriatic arthritis called?
Arthritis mutilans
117
Organisms that may trigger reactive arthritis?
Chlamydia Campylobacter Salmonella Shigella
118
Name ANCA positive and ANCA negative small vessel vasculitis:
p-ANCA : eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome) p-ANCA: Microscopic polyangitis ANCA negative: Goodpasture's, Henoch-Schonlein purpura
119
Large and medium vessel vasculitis?
Large - Takayasu arteritis, temporal arteritis Medium - Kawasaki's disease, polyarteritis nodosa
120
Systemic conditions in which vasculitis is a feature of the disease?
Infective endocarditis RA Behcet's SLE IBD Hep B & C Dermatomyositis
121
What is mononeuritis multiplex?
Type of peripheral neuropathy Used to describe inflammation or damage to >= 2 peripheral nerves
122
Causes of mononeuritis multiplex?
Granulomatosis with polyangiitis HIV RA Diabetes Sarcoidosis Leprosy Polyarteritis nodosa
123
What is acromegaly?
Hypersecretion of GH by a tumour in the ant pituitary gland
124
Signs and symptoms of acromegaly?
Macroglossia Bitemporal hemianopia Voice changes Carpal tunnel syndrome OSA Frontal bossing Increased blood pressure Prognathism (jaw protrusion)
125
How does oral glucose tolerance test aid in acromegaly diagnosis?
Rapid increase in blood glucose should suppress GH secretion - this will not happen in acromegaly.
126
If acromegaly is confirmed, what other endo disorder do you screen for?
Diabetes mellitus as GH is anti-insulin leading to insulin resistance and eventually diabetes.
127
Main complication and cause of death in acromegaly patients?
Cardiovascular disease
128
Signs of hypothyroidism?
Fatigue Weight gain Cold intolerance Dry/thinning hair Bradycardia Dry skin Ataxia Goitre CTS Loss of lateral 1/3rd of eyebrows
129
Causes of hypothyroidism
Amiodarone Radiotherapy Iodine deficiency Autoimmune (Hashimoto's) Cancer Hypopituitarism
130
What will FBC show in hypothyroidism?
Macrocytic anaemia
131
What anatomical structure represents the site at which the thyroid gland originated before embryological descent?
Foramen caecum
132
What is Grave's disease
Autoimmune disease caused by TSH receptor antibodies
133
Sign's specific to Grave's disease
Pretibial myxoedema Exophthalmos
134
Excessive thirst, polyuria, and weight loss - urine dip is negative for glucose. Most likely diagnosis?
Diabetes insipidus
135
In diabetes insipidus describe the urine osmolality and plasma osmolality?
Urine osmolality will be low Plasma osmolality will be high
136
How does water deprivation test used to diagnose diabetes insipidus?
Patient is starved of any fluid intake. Normal response = concentrate urine and decrease urine output. Diabetes insipidus = continued production of large vol of urine with low osmolality
137
How to treat cranial diabetes insipidus?
Desmopressin
138
Advice for patient and family to prevent hypoglycaemic episodes?
Regular glucose monitoring Never miss a meal Keep 'emergency supply' of glucose in pocket
139
Causes of hypoglycaemia in non-diabetic patients?
Liver failure Addison's Insulin-secreting tumours Alcohol binging Pituitary insufficiency
140
Explain the OGTT?
Patient fasts overnight prior to test. Drink containing 75g of glucose in 300ml water is given. Blood glucose is measured before drink and then at 120 mins. Diabetes = >11.1mmol/L at 2 hours
141
T2DM macrovascular and microvascular complications?
Macrovascular: Cerebrovascular disease MI IHD Peripheral vascular disease Microvascular: nephropathy neuropathy retinopathy
142
Confirm DKA bedside test?
Urine dip - presence of ketonuria
143
Pathophysiology of DKA?
Insulin deficiency = more glucose production in the liver and lipolysis. Fatty acids get broken down to form ketone bodies = metabolic acidosis.
144
Investigations for Addison's?
U&Es SynACTHen test
145
What would you expect serum sodium and potassium to be in Addison's?
Hyponatraemia Hyperkalaemia
146
Advice for patients starting on steroid therapy for Addison's?
Carry steroid card Medic alert bracelet Know how to alter dosage in illness
147
Signs and symptoms of prolactinoma in women?
Amenorrhea Galactorrhea Decreased libido Subfertility Headache Visual field defect
148
Drug/apart from surgery treatment for prolactinoma?
Dopamine agonist: Cabergoline/ bromocriptine Radiotherapy
149
Investigations for primary hyperparathyroidism?
DEXA scan USS Abdo CT/MRI neck (look at parathyroid gland)
150
Complications of surgical resection of parathyroid adenoma?
Hypoparathyroidism Laryngeal nerve palsy
151
Relationship between calcium and Vitamin D?
Vitamin D is needed to absorb calcium in the gut
152
Name of distribution of sensory loss in diabetes - (hands and feet)
Glove and stocking distribution
153
In neuropathy secondary to diabetes, what is the first type of sense to be lost?
Vibration sense
154
Feet findings in diabetes?
Loss of sensation Charcot's foot Painless ulcer Diminished reflexes
155
In light of finding neuropathy (microvascular complication of diabetes), what two other area must now be investigated?
Eyes Kidneys
156
Diabetic with intractable vomiting?
Autonomic gastroparesis
157
Histological features of Crohn's?
Granuloma formation Transmural inflammation Lymphocytic infiltration
158
Extraintestinal features of Crohn's?
Erythema nodosum Pyoderma gangrenosum Conjunctivitis Ankylosing spondylitis Apthous ulcers
159
Long term complications of Crohn's?
Perianal abscess and fistulae Bowel perforation SBO Colon carcinoma Malnutrition
160
MOA of infliximab?
Infliximab is TNFalpha inhibitor. Antibody is directed against tumour necrosis factor - important in establishing inflammation and granuloma formation.
161
What meds can contribute to upper GI bleed?
NSAIDS Aspirin Steroids Anticoagulants Thrombolytics
162
What will blood results be in upper GI bleed?
Urea raised out of proportion to creatinine indicated upper GI bleed.
163
How doe liver cirrhosis lead to oesophageal varices?
Venous portal hypertension
164
Site of portosystemic anastomoses and the symptom it would cause.
Superior rectal vein shunts cause haemorrhoids
165
Risk factors for peptic ulcer disease?
H. Pylori infx NSAIDs/steroids Smoking Alcohol Stress Spicy foods
166
Investigation for peptic ulcer perforation?
Erect chest X-ray
167
What would you see on Xray with peptic ulcer perforation
Pneumoperitoneum is seen as free air under the diaphragm
168
Define GORD
Excessive entry of gastric contents into the oesophagus through the gastro-oesophageal junction
169
Exacerbating factors of GORD?
Lying flat Alcohol Obesity Food Hiatus hernia
170
Patient suffers with GORD also suffers from night-time wheeze but no asthma - what is causing this?
Inhalation of small amounts of gastric contents.
171
Causes of dysphagia of someone with GORD?
Benign stricture secondary to GORD Malignant stricture Pharyngeal pouch Oesophagitis Myasthenia gravis
172
Gold standard for proving GORD?
Oesophageal manometry
173
Complication of Nissens fundoplication
Dysphagia from compression of the GOJ Dumping syndrome Achalasia
174
Pre-hepatic causes of jaundice?
Malaria Sickle cell Thalassemia G6PD deficiency Gilbert's syndrome
175
Intra-hepatic causes of jaundice?
Viral hepatitis Paracetamol overdose Alcoholic hepatitis Haemochromatosis
176
Post-hepatic causes of jaundice?
CBD bile stones Pancreatic caner PBS PSC
177
Why does conjugated bilirubin appear in the urine and unconjugated doesn't?
Conjugated bilirubin is water-soluble, so dissolves in the urine, making it dark.
178
What investigation do you do for obstructive jaundice?
USS Abdo
179
At risk groups for Hepatitis B?
IVDU Sex workers Healthcare workers
180
What does anti-HBC indicate?
Past infection
181
Long term complications of Hepatitis B?
Cholestasis Hepatocellular cancer Cirrhosis Chronic hepatitis
182
Viruses that may be co-infected post needle stick injury with Hep B?
HIV Hep C
183
Inherited vs acquired causes of cirrhosis?
Inherited: Haemochromatosis Wilson's disease Alpha-1-antitrypsin deficiency Acquired: Chronic alcohol abuse Chronic viral hepatitis Autoimmune hepatitis PBC Idiopathic
184
Investigations for synthetic function of the liver?
Albumin or INR/PT
185
Complications of cirrhosis?
Coagulopathy Encephalopathy Hypoalbuminaemia Sepsis SBP Hypoglycaemia Ascites Oesophageal varices
186
Investigations for ascitic fluid?
WCC MC&S Cytology LDH Glucose
187
How does lactulose work in hepatic encephalopathy?
Lactulose increases bowel transit which will reduce the number of nitrogen producing bacteria in the gut which contributes to hepatic encephalopathy.
188
Causes of GI malabsorption?
Coeliac's Crohn's Chronic pancreatitis Cystic Fibrosis
189
Coeliac's disease signs and symptoms?
Abdo pain Weight loss Diarrhoea N+V Fatigue Iron deficiency anaemia Osteomalacia Dermatitis herpetiformis
190
Commonest source of gluten?
Wheat
191
Blood test for Coeliac's?
Anti-TTG antibodies and IgA
192
Histological findings on Coeliac's biopsy?
Crypt hyperplasia and villous atrophy
193
Autoimmune diseases that Coeliac's is associated with?
T1DM Thyroid disease
194
Drugs that cause constipation?
Opioids Iron Anticholinergics
195
Mechanical causes of constipation?
Colorectal cancer Stricture (e.g. Crohn's) Pelvic mass
196
Lifestyle causes of constipation?
Dehydration Immobility Poor diet
197
Psychological disorders related to IBS?
Depression Stress disorder Anxiety
198
IBS patient with weight loss, fatigue, increasing abdo pain and new iron-deficiency anaemia. What investigation and why?
Colonoscopy Investigate for right sided colonic tumour as may present as unexplained iron-deficiency anaemia.
199
Predisposing factors to colonic carcinoma?
Ulcerative colitis Crohn's disease FAP (familial adenomatous polyps) HNPCC Low-fibre diet
200
Colorectal cancer metastases sites?
Liver Lung Bone Lymph
201
Viral cause of gastroenteritis?
Rotavirus Norovirus Adenovirus Astrovirus
202
Drugs that increase risk of C.diff infection?
Fluoroquinolones Clindamycin Cephalosporins Penicillins
203
Infection control measures used when treating acute diarrhoea?
Isolation of patient Hand-washing PPE Reduce number of contacts with patient

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