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MSRA Content > Learning Points from Questios > Flashcards

Learning Points from Questios Flashcards

1
Q

3 Conditions in MEN 1 (Werner’s Syndrome)

A

PaPaPi
 Parathyroid hyperplasia
 Pancreatic tumour
 Pituitary Adenoma

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2
Q

3 Conditions in MEN2A (Sipple Syndrome)

A

PaMePhe
 Parathyroid hyperplasia
 Medullary Thyroid Cancer
 Phaeochromocytoma

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3
Q

1st Line treatment of seborrheic dermatitis?

A

Topical ketoconazole

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4
Q

3 Conditions in MEN2B

A

MaMePhe
 Marfarnoid Body Habitus
 Medullary Thyroid Cancer
 Phaeochromocytoma
 Mucosal Neuromas

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5
Q

1st Line treatment of allergic conjunctivitis?

A

Topical Antihistamines
Oral if rhino sinusitis also

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6
Q

Causes of acanthosis nigricans?

A

o Gastric Cancer
o Obesity
o Insulin Resistance
o Diabetes Mellitus
o PCOS
o Metabolic Syndrome

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7
Q

Weight loss aim in NAFLD?

A

5-10% in 6 months

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8
Q

UMN Lesion Signs?

A

Spastic
Hyperreflexic
Hypertonic
Disuse atrophy
No fasciculations
Babinski positive

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9
Q

LMN Lesion Signs?

A

Flacid paralysis
Hyporeflexic
Hypotonic
Wasting atrophy
Fasciculations
Small area

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10
Q

Bone profile bloods in Osteoporosis?

A

Ca - normal
PO4 - Normal
ALP - Normal

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11
Q

Bone profile bloods in Osteomalacia?

A

Ca - Low
PO4 - Low
ALP - Raised

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12
Q

Bone profile bloods in Paget’s?

A

Ca - Normal
PO4 - Normal
ALP - Very raised

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13
Q

Bone profile bloods in Myeloma?

A

Ca - Raised
PO4 - Normal or raised
ALP - Normal

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14
Q

Bone profile bloods in primary hyperparathyroidism?

A

Ca - Raised
PO4 - Low
ALP - Normal/Raised

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15
Q

Main side effect of hydroxychloroquine?

A

Retinopathy

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16
Q

1st line treatment in acute urticaria?

A

Non sedating antihistamines (cetirizine, fexofenadine, loratidine)

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17
Q

1st Line treatment for prolactinomas?

A

Dopamine Agonists (bromocriptiline, cabergoline)

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18
Q

Definition of Fitz Hugh Curtis Syndrome?

A

Perihepatitis with violin string adhesions associated with pelvic inflammatory disease (PID)

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19
Q

Definition of Meig’s Syndrome?

A

Benign ovarian tumour (fibroma) + Ascites + Pleural Effusion

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20
Q

Types of HSV in oral and genital ulcers?

A

o HSV 1 (oral)
o HSV 2 (Genital)

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21
Q

HSV implicated in VZV?

A

HH3

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22
Q

HSV implicated in EBV?

A

HH4

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23
Q

HSV implicated in roseola?

A

HH6

Affects children younger than 3 years of age.
Mild rhinorrhoea, sore throat, and sudden onset of high fever.
As the fever subsides, typical rash of tiny pink papules or is maculopapular, and not usually itchy
It starts on the trunk before spreading peripherally to the face and limbs.

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24
Q

HSV implicated in Kaposi Sarcoma?

A

HH8

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25
Q

Definition of Jarisch Herxheimer Reaction?
Common causes?

A

o Caused by release of endotoxin-like substances when large numbers of bacteria killed by antibiotics
o Most commonly in treatment of Syphilis, but also Lyme Disease, leptospirosis
o Reaction 1-12 hours after first antibiotics, lasts for few hours to a day
o Malaise, pyrexia, flushing, tachycardia

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26
Q

How to confirm ovulation, what blood test?

A
  • Confirm ovulation – Serum progesterone 7 days before next expected period
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27
Q

Management of intermittent squint in <3 months old?

A

Normal - reassure

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28
Q

Guidance for urea breath test? Abx and PPI

A

No Abx for 4 weeks
No PPI for 2 weeks

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29
Q

Definition of hyperemesis gravidarum?

A

5% WL + Electrolyte imbalance + dehydration (ketosis)

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30
Q

SSRI of choice post MI?

A

Sertraline

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31
Q

Blood film appearance in G6PD?

A

Auer rods

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32
Q

Blood film appearance in Myeloma?

A

Rouleau formation

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33
Q

Management of inguinal hernia in children?

A

Refer to paediatric surgery

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34
Q

Common side effect of vincristine?

A

Peripheral neuropathy

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35
Q

What medication should be avoided in HOCM?

A

ACE inhibitors

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36
Q

Blood gas analysis in Cushing’s syndrome?

A

Hypokalaemic metabolic alkalosis

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37
Q

Long term prophylaxis of cluster headaches?

A

Verapamil

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38
Q

Acute management of cluster headaches?

A

Sumatriptan SC
Sumatriptan nasal
Zolmitriptan nasal (off licence)
Short burst oxygen therapy

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39
Q

Management of depression - less severe - score? and Mx?

A

PHQ-9 < 16 – less severe depression

 Does not want treatment – active monitoring, consider treatment at any time
 Wants treatmet – guided self help 1st line, then group/individual CBT, offer SSRI if wants antidepressant

40
Q

Management of depression - more severe - score? Mx?

A

o PHQ-9 >16 – more severe depression

– SSRI + CBT

41
Q

Management of hip fractures - intracapsular undisplaced?

A

Internal fixation or hemiarthroplasty if unfit

42
Q

Management of hip fractures - intracapsular displaced?

A

Arthroplasty (THR favoured over hemiarthroplasty, if were able to walk independently, not cognitively impaired, fit for procedure)

43
Q

Management of hip fractures - extra capsular stable?

A

Stable intertrochanteric fractures – dynamic hip screw

44
Q

Management of hip fractures - extra capsular reverse, oblique, subtrochanteric, transverse?

A

 If reverse oblique, transverse or subtrochanteric – intramedullary device

45
Q

When is BCG not offered?

A

Over age of 35

46
Q

Starting contraception after EC - for both Ella One and Levonelle?

A

Ella One - after 5 days
Levonelle - immediately

47
Q

When is EC indicated?

A

UPSI of any day of natural menstrual cycle

UPSI after compromised or incorrect use of hormonal contraception

From day 21 post partum, unless lactational amenorrhoea criteria met (complete amenorrhoea, fully breastfeeding and 6 months or less post partum)

From day 5 after miscarriage, abortion, ectopic pregnancy or uterine extraction for gestational trophoblastic disease

48
Q

When can Copper Coil be given?

A

Within 5 days (120 hours) after first UPSI in cycle or within 5 days of earliest estimated date of ovulation whichever is later

49
Q

When can Ulipristal Acetate (EllaOne) be given?

A

Within 5 days (120 hours) after UPSI or contraception failure?

50
Q

When can levonorgestrel (Levonelle) be given?

A

Within 72 hours after UPSI or contraception failure, can be used off label up to 96 hours

51
Q

First line EC?

A

Copper IUD

52
Q

When should you avoid using Ella One?

A

If taking liver enzyme inducing medications (rifampicin, carbamazepine)

Severe asthma controlled by oral steroids

53
Q

When should you avoid Levonelle?

A

Severe hepatic dysfunction
BMI >26

54
Q

1st line antiemetic in palliative care - reduced gastric motility?

A

Metoclopramide
Domperidone

55
Q

1st line antiemetic in palliative care - chemically mediated?

A

Ondansetron/haloperidol/levomepromazine

56
Q

1st line antiemetic in palliative care - visceral causes?

A

Cyclizine or levopromazezine

57
Q

1st line antiemetic in palliative care - raised ICP?

A

Cyclizie
Dexamethasone added if not working

58
Q

1st line antiemetic in palliative care - vestibular cause?

59
Q

1st line antiemetic in palliative care - cortical cause?

A

Anticipatory - benzos
Or cyclizine

60
Q

Side effects of carbemazepine?

A

P450 inducer
Leukopenia and agranulocytosis
Hyponatraemia
Auto induction - may get return of seizures after 3-4 weeks

61
Q

Side effects of phenytoin?

A

P450 inducer
Gingival hyperplasia
Megaloblastic anaemia
Teratogenic

62
Q

Side effects of sodium valproate?

A

P450 inhibitor
Weight gain
Alopecia (curly)
Hepatotoxicity/Pancreatitis
Hyponatraemia

63
Q

Colorectal tumour marker?

64
Q

Hepatocellular tumour marker?

65
Q

Pancreatic tumour marker?

66
Q

Ovarian tumour marker?

67
Q

Breast tumour marker?

68
Q

Germ cell tumour marker?

69
Q

Melanoma tumour markers.

70
Q

Thyroid tumour marker

A

Thyroglobulin

71
Q

Management of mild to moderate acne?

A

12 week course of OD evening:
Topical adapalene with topical benzoyl peroxide
Topical tretinoin with topical Clindamycin
Topical benzoyl peroxide with topical clindamycin
Topical benzoyl peroxide (if tretonoin/Abx CI or not wanted)

72
Q

Management of moderate to severe acne?
Severe = widespread pamphlets, pustules, nodules or cysts or scarring

A

12week course of:
Topical adapalene with topical Benzoyl peroxide
Topical tretinoin with topical clindamycin
Topical adapalene with topical benzoyl peroxide with oral doxycycline/lymecycline
Topical azelaic acid with lymecycline/doxycycline

73
Q

Necrobiosis lipoidica
What is it?

A

Irregularly shaped lesions with reddish brown pigmentation progressing to yellow and central atrophy
Pretibial area
Can occur with diabetes
Potent topical steroids is treatment

74
Q

Mollescum Contagiosum
What is it?
Who does it affect?
Causes?
Treatment?
When to refer?

A

Localised clusters of umbilicated epidermal papules
Infants and kids under 10

Caused by poxvirus- spread direct, indirect, autoimnoculation, sexual

Often none and self limiting in 18 months
Imiquimod, podophyllotoxin, cryotherapy

Refer - urgent HIV, eyelid or ocular with red eye, anogenital lesions

75
Q

Alopecia acreta
What is it?
Sign?
Treatment?

A

Non scarring allopecia, scalp and beard, patchy with circular areas of hair loss
Exclamation mark hairs

Watchful waiting
Potent topical steroid (betamethasone)
Or very potent
Referral to dermatologist

76
Q

Pityriasis Rosea?

A

Multiple salmon pink patches scaly, circular, symmetrical and on trunk
Starts with herald patch
Caused by viral infections
No treatment and settles in 2-3 months
Symptomatic itch with emollients and mild steroid

77
Q

Pityriasis versicolor
What is it?
Cause?
Rash?
Management

A

Known as tines versicolor
Fungal infection of epidermis
Causes by malassezia yeasts
Multiple round macules and confluent patches seen - extensive and often noticed as doesn’t tan in sun
Occurs in upper trunk, upper arms and neck

Extensive - ketokonazole shampoo , selenium shampoo
Small area - imidazole cream (clotrimazole)

78
Q

What is retinitis pigmentosa?
Symptoms?

A

Inherited eye condition
Trouble with night vision and decreased peripheral vision in adolescence

79
Q

Age related macular degeneration- wet treatment

A

Anti-VEGF (ranibizumab)
Laser photocoagulation
Photodynamic therapy

80
Q

Age related macular degeneration- dry treatment

A

No treatment
High dose vitamins C, E, lutein, zexanthin, zinc, copper (AREDS2)

81
Q

What is telogen effluvium?

A

Excessive shedding of telogen hair

It occurs around 3 months after a triggering event and is usually self-limiting, lasting for about 6 months.

Triggers include childbirth, severe infection, excessive diets, major surgery, and drug treatment (for example antidepressants, anticoagulants, or chemotherapy).

Usually widespread hair loss.

In the active phase, the hair pull test may be positive. Later, regrowth with tapered short hairs may be seen.

82
Q

What is Trichotillomania?

A

Psychiatric condition in which people pull their hair out

Associated with OCD

More common in women than in men

Hair loss is asymmetrical and has an unusual shape. Single or multiple areas can be affected, including eyebrows and eyelashes.

83
Q

What is traction alopecia?

A

Hair loss caused by constant pulling, such as from hair being persistently pulled back in styles like a ponytail or long-term use of hair rollers

Affects frontal hairline

84
Q

What is Anagen effluvium?

A

Hair shedding that happens during growth phase of hair cycle

Due to acute injury to follicles, sudden diffuse hair loss

Common in 2-3 weeks post chemotherapy

Usually grows back if chemotherapy related but could be curly

85
Q

When to refer child - late walkers?

A

Red flag features.

Delayed walking at age more than 18 months, especially in boys.

Waddling gait, enlarged muscle bulk, or proximal muscle weakness (consider muscular dystrophies).

Frequent falls or clumsiness.

Delay or regression of milestones (for example speech, communication, feeding).

A family history of delayed walking or muscle disease.

86
Q

Red flag childhood milestone at 5 months?’

A

Not able to hold an object

87
Q

Red flag childhood milestone at 9 months?’

A

Not sitting unsupported

88
Q

Red flag childhood milestone at 18 months?

A

Not standing independently

89
Q

Red flag childhood milestone at 18 months?’

A

No words
No interest in others

90
Q

What age to refer child if not sitting unsupported?

91
Q

What age to refer child if not walking independently?

A

15 months girls
18 months boys

92
Q

What age to refer child if showing preference to asymmetric hand function?

A

Before 1 year

93
Q

Key features in rosacea?

A

Phymatous change
Erythema
Flushing
Papules and pustules
Telangiectasia
Ocular rosacea
Skin stinging or dryness

94
Q

Management of rosacea?

A

If erythema - topical brimonidine 0.5% gel OD

If mild papules or pustules - topical ivermectin for 8-12 weeks (alternative metronidazole cream/acetic acid)

If moderate to severe papules or pustules - topical ivermectin with oral doxycycline for 8-12 weeks

If phymatous - oral doxycycline

95
Q

Definition of postpartum haemorrhage

Primary vs secondary?
Causes of each?

A

Blood loss >500mls after vaginal delivery

Primary - within 24 hours
- Tone (uterine atony MC), Trauma (perineal tear), Tissue (retained placenta), Thrombin (clotting problem)

Secondary - between 24 hours and 6 weeks - due to retained placental tissue or endometritis

96
Q

Management of primary postpartum haemorrhage

A

ABCDE approach
Lie woman flat, IV fluids
Mechanical - palpate uterine fundus to stimulate contractions, catheterise
Medical
1) IV Oxytocin
2) IV/IM ergometrine
3) IM Carboprost (CI asthma)

Surgical if medical management fails
- intrauterine balloon tamponade
- B lynch suture, ligation of uterine arteries, hysterectomy

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