Key facts from MSCAA test Flashcards by Stephanie Scullion

What is the life long management of mechanical heart valve?

A - clopidogrel
B - Apixaban
C - Warfarin

Warfarin (cause of type of valve)

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Patient presents with vomiting and severe chest pain after a large meal….

Oesophageal rupture

Boerhaave’s syndrome

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What is the treatment for prolactinoma?

1st line - Carbergoline

2nd line - Transspheniodal surgery

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What is haemochromotosis?

What is the screening test for haemochromotosis?

Management?

Autosomal recessive disorder of iron absorption and metabolism

Transferrin saturations
(Typical bloods: High ferritin levels)

Venesection

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Which rheumatology conditions correlate to:
Anti CCP 
Anti-dsDNA 
Antinuclear antibody 
Anti-Ro & Anti-La 
RF
Anti-Jo1
Anti-Scl-70

Anti CCP most specific for RA
RF - also for RA but not specific

Anti-dsDNA - SLE (Anti-Sm also)

ANA - not specific - seen in SLE, Sjrogrens and mixed connective tissue

Anti-Ro & Anti-La - Sjogren’s

Anti-Jo1 - Polymyositis/Dermatomyositis

Anti-scl-70 -scleroderma

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Mechanism of action for cocaine on heart

Coronary artery spasm

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What malaria causes cerebral involvement?

Plasmodium falciparum

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How do you differentiate between hydrocele and epididymal cyst?

Both transilluminate however, hydrocele surrounds entire testis whereas epididymal cyst is isolated to one side of the scrotum and superior to the testis

Hydrocele can be idiopathic or secondary to testicular cancer

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What is the equation for working out maintenance fluids of an adult for 24 hours?

For eg if the patient is 70kg

Typically 25ml per kilogram

Eg - 70 x 25 = 1750ml

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What is the equation for working out fluids for burns?

Rules for administration

Hopefully they give % of burn

If not - Use the rule of 9s

4 x weight x % of body burn

Rules for administration - give first 50% over 8 hours then next 50% over following 16 hours

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What do you give for delirium in MFE?

Haloperidol

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What do you give for delirium in Parkinson’s

Lorazepam

can’t give haloperidol cause of extrapyryidmal effects

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Does RA or OA affect the 1st carpometacarapl (CMC) joint? At the base of the thumb.

OA will affects the 1st CMC not RA (affects the MCP)

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Ureter stones management

If up to 5mm - pass themselves
If up to 2cm - shockwave
If infected/obstructed - Nephrostomy

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Investigations for Ureteric stones

1st line - Abdo X-ray

Definitive - CT scan

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Young men who smoke cannabis who present breathless and reduced O2 sats…

Pneumothorax

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Primary pneumothorax management

If <2cm and asymptomatic - discharge home with worsening advice

If symptomatic - aspiration
–> Needle in 2nd intercostal sp

If >2cm or symptomatic (SOB) - chest drain
–> 5th intercostal space mid axillary line

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What is the most common pathogen for leg cellulitis?

Is it the same for diabetic patients?

Streptococcus pyogenes
or Staphylococcus Aureus

Yes its the same

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What is the first line treatment for superficial thrombophlebitis?

And if there is a clot…

NSAIDs

Rivoraxaban

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What diabetic drugs do you omit in diabetic patients going for surgery?

Omit SU (gliclazide and short acting Insulin and continue everything else

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When do you stop Clopidogrel before surgery?

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When do you stop Warfarin before surgery?

Remember to cover with low molecular weight heparin until night before surgery

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When do you stop COCP before surgery?

4-6 weeks

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Young women who experiences cyclical pain in both breasts. Drained and brown fluid is removed. No malignant cells found…diagnosis?

Fibrocystic disease

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What's is a partial seizure?

A focal seizure | Can be simple or complex

Management of partial seizures?

1st line - Carbmazepine or Lamotrigine

Sudden, red, painful eye... What other symptoms for this condition?

Acute angle glaucoma (closed) It is a medical emergency It's acute because drainage of aqueous humour is suddenly blocked Photophobia and halos around lights

What vision do you lose in glaucoma: peripheral or central?

Peripheral vision

Management of: Closed (acute) angle Glaucoma? Open (chronic) angle glaucoma?

Closed angle - acute - Urgent (same day) referral to ophthalmology. Pilocarpine eye drops. Acetazolamide. Open angle glaucoma - Lantanoprost drops Can give B blocker Timolol as well

Vision lost in macular degeneration is,...

Central

Management: Dry vs Wet

Wet - VEGF | Dry - control Bit and BP

Is Central Vein Artery occlusion painful or painless loss of vision?

Painless

Recurrent candidiasis in women, what dyou test for?

Hb1AC (think undiagnosed diabetes)

Management for BV

Lifestyle + Metronidazole

Reduced Platelets + Fibrinogen and increased PT & APTT plus schistocytes...

DIC

Cause of DIC

Trauma, Sepsis, Obs complication (placenta abruption)

Management for each of the following Oncological emergency - SVC obstruction (engorgement of neck veins) - Spinal cord compression - Tumour lysis

First two dexamathasone IV or oral allopurinol Long term management of SVC obstruction - stent

Antiemetic in oncology management

Ondansetron

Management of warfarin in Major bleeds

In major bleeding - stop warfarin and give IV Vit K 5mg & PTC INR >8 minor bleed - stop warfarin, give IV Vit K 1-3mg Repeat dose if INR still high after 24hrs Restart Warfarin when INR <5

What is the definitive diagnostic test in conditions which present with nephrotic syndrome?

Renal biopsy

Nephrotic syndrome

Frothy urine, proteinuria, hypoalbuminaemia | + hypercholesterol

Management of nephrotic syndromes? What is the exception?

ACEi/ARBs +/ steroids Exception is - Minimal Change - Just Prednisolone (kids don't need too much)

Conditions classed as Nephritic

IgA nephropathy & Poststrep & Anti-GBM (good pastures - presents with lung disturbances)

Nephrotic conditions

Minimal change disease Focal segmental Membranous nephropathy

Lithium side effects

Hyperparathyroidism Hypercalcaemia Polyuria, polydysia, weight gain

Long term management of Stroke by itself vs with history of AF

Itself - Clopidogrel | Stroke + AF - DOAC - Apixaban

What do you give to a patient who has fucked kidneys who needs CT with contrast?

IV saline - to protect kidneys

What level of CK in Rhabdo would give an AKI? Under this value, the AKI would be hypovolaemia due to long lie

>10,000

Diagnostic investigation for PSC Findings...

MRCP (as its non-invasive) Beaded appearance

Management of PSC

ERCP

Ventilatory support for COPD in infected exacerbation of COPD/struggling to breath

Bipap (non-invasive ventilation)

Epigastric pain better after eating and worse when fasting...

Duodenal ulcer

What do you give for acute treatment of Gout in patient with CKD?

Avoid NSAIDs - give prednisolone

What area of the brain is involved in early Alzheimers?

Temporal

What is the antidote to TCA (amitriptyline) overdose?

IV sodium bicarbonate

What is the best analgesia for early postoperative period following major abdominal surgery?

Epidural anaesthesia

Delirium Tremens is,... Treat with...

Delirium tremens (DTs) -> rapid onset of confusion usually caused by withdrawal from alcohol. Often three days into the withdrawal symptoms and lasts for two to three days. Physical effects may include shaking, shivering, irregular heart rate, and sweating. People may also hallucinate. Treat with Benzos - Chlorodiazepoxide

Sudden onset visual disturbance, floaters and flashing lights and loss of vision in upper quadrant of eyes... Classic history statement..

Retinal detachment 'like a curtain coming down over my vision'

Positive antimitochondrial antibodies (AMA) on a background of non tender hepatosplenomegaly and tiredness jaundice... Management..

Primary Biliary Cholangitis Ursodeoxycholic acid

Combination of headaches, hypertension and hypokalaemia...diagnosis?

Conn's

What is the meds for TB? SE for each

``` RIPE Rifampacin - orange pee, hepatotoxicity Isonizaide - peripheral neuropathy Pyrazinamide - hyperuraemia - gout Ethambutol - eyes ```

What type of transformation of cells is seen in GORD?

Intestinal metaplasia

What do the antimitochondrial antibodies indicate?

AMA - part of the diagnostic criteria for PBC Primary Biliary Cirrhosis

What is the screening test for IBD?

Faecal calprotectin

Cataplexy is...

Loss of skeletal muscle/collapse with strong emotions (eg laughing)

Adhesive capsulitis is linked to what condition? How does it present? Mangement?

Diabetes Watch and wait

What vessels are damaged in extradural haemorrhage? | Is it biconvex or concave?

Middle meningeal arteries | Biconvex

What vessels are damaged in subdural haemorrhage? | Is it biconvex or concave?

Bridging veins | Concave

Best diuretic to use in liver cirrhosis (PMH of alcohol excess/oesophageal varies/ascited etc)... - Furosemide - Thiazide - Acetazolamide - Spironolactone?

Spironolactone It is an aldosterone antagonist which means it displaces aldosterone leading to diuresis (peeing out fluid). This will aid with ascites. Its potassium sparing which is crucial in hepatitis/liver injury or cirrhosis - as it prevents accumulation of ammonia and subsequent hepatic encephalopathy

Acute abdominal pain & fever after taking anti-diarrhoea meds in patient with UC PMH... How do we investigate this?

Think toxic megacolon Erect xray of the abdomen

Treatment for C diff?

Oral vancomycin (+/- IV metronidazole if severe) In cases of recurrence - consider faecal transplant if above options do not work/aren't available