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MSRA- Imo > Medicine > Flashcards

Medicine Flashcards

1
Q

Most common form of MS?

A

Relapsing remitting

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2
Q

Management of mild to moderate Alzheimers?

A

donepezil
galantamine
rivastigmine

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3
Q

Management of severe Alzheimers

A

Memantine

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4
Q

When is donepezil contraindicated?

A

In bradycardia
Can also cause insomnia

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5
Q

Typical features of frontotemporal dementia?

A

Onset <65
Insidious
relatively preserved memory and visuospatial skills
Personality change and social problems

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6
Q

What bacteria causes gas gangrene/foul smelling black blisters

A

Clostridium Perfringens

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7
Q

What Hep B antibodies are positive if immunised/what antibodies are NEVER positive if only immunised and not been infected

A

Anti-HBs is positive

IgG Anti-HBc and IgM Anti-HBc are ALWAYS negative

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8
Q

Most common SE of meningitis?

A

Sensorineural hearing loss

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9
Q

45y/o man with nausea, pallor and lethargy

Tx?

A

Hyperkalaemia!

Anyone with K>6.5 or ECG changes;
First give IV calcium gluconate then insulin/dextrose

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10
Q

Tx of temporal arteritis?
If vision loss associated?

A

High dose oral pred

If evolving vision loss give IV methylpred

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11
Q

Mx of T2DM with high risk for CVD/established CVD or HF?

A

Metformin + SGLT2 inhibitor (empagliflozin)

Establish and titrate metformin first

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12
Q

What HbA1C level do you add in a second drug for T2DM

A

58

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13
Q

What is an absolute contraindication to use of triptans?

A

Cardiovascular disease

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14
Q

In paracetamol OD what is the criteria for liver transplant?

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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15
Q

Mx of Angina?
1st line—->
2nd line—->
3rd line—–>

A

1st: B blocker or CCB (verapamil or diltiazem), scope to increase to max dose

2nd: Combination of B Blocker and CCB (amlodipine or modified release nifedipine)

3rd line: long acting nitrate, ivabradine, nicorandil, ranolazine

Everyone put on aspirin and statin

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16
Q

Treatment of EBV?

A

Nothing, self limiting within about 2 weeks
Avoid contact sports for 4 weeks

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17
Q

What size of fibroadenoma should be managed by surgical excision?

A

> 3cm

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18
Q

Most common extra intestinal manifestation of UC or Chrons?

A

Arthritis

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19
Q

What are the three features of an acoustic neuroma

A

Vertigo
Sensorineural hearing loss
Tinnitus
Absent corneal reflex

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20
Q

What condition is associated with bilateral acoustic neuromas?

A

Neurofibromatosis type 2

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21
Q

What cardiac drug can cause hearing loss?

A

Furosemide

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22
Q

What does secondary prevention after an MI comprise of?

What do you add in if they have heart failure?

A

Aspirin (+Ticagrelor or Prasugrel for 12 months)
ACE inhibitor
B blocker
Statin

Add in spironolactone

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23
Q

What drugs do you give to patient undergoing PCI?
What if they are >75 ir have high bleeding risk

A

Aspirin + Prasugrel
Give unfractionated heparin via radial access

If high bleeding risk then give ticagrelor or clopidogrel

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24
Q

What do you give for patients undergoing fibrinolysis

Which patients will then be transferred for PCI?

A

Give alteplase/streptokinase for fibrinolysis as well as antithrombin such as fondaparinux

Transfer for PCI if ongoing ischaemia- either pain or evidence on testing

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25
Q

Which patients having an NSTEMI have an angiography right away?

A

If GRACE score >3% + unstable condition

If stable condition, angiography within 72hrs

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26
Q

What are the dihydropyridine CCBs?

A

The PINES
Amlodipine, Nifedipine

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27
Q

What are the non dihydropyridine CCBs

A

RATE LIMITING

Verapamil
Diltiazem

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28
Q

What are 3rd line drugs for angina if B blocker or CCB not enough

A

Nicorandil
Isosorbide mononitrate
Ivabradine
Ranolazine

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29
Q

When do you start anticoagulation in acute stroke patients who have AF?

A

After 4 weeks

30
Q

How long do you anticoagulate someone after ablation for AF if CHADSVASc score is 0?
If score is 1 or more?

A

If 0, anticoagulate for 2 months
If 1 or more, anticoagulate lifelong

31
Q

Side Effects of ACEi

A

-Cough
-Angioedma
-First dose hypotension
-Hyperkalaemia

32
Q

Monitoring for ACEi?

A

-U&Es prior to starting and everytime dose is increased
-Expect an increase of about 30% in creatinine, K should not be allowed to exceed >5.5

33
Q

Who do you avoid adenosine in?

A

Asthmatics as it causes bronchospasm

34
Q

Monitoring for amiodarone?

A

Before starting: TFTs, LFTs, U&Es and CXR

Then TFTs and LFTs every 6 months

35
Q

Side effects of amiodarone?

A

-Hypo and hyperthyroidism
-Bradycardia
-Slate grey appearance
-Pulmonary fibrosis/pneumonitis
-Liver fibrosis/hepatitis
-Photosensitivity
-Thrombophlebitis and injection site reactions
-Lengthens QT
-Corneal deposits

36
Q

What is Quinke’s sign and what is assoc with?

A

Pulsating nailbed assoc with AR

37
Q

What is Corrigan’s sign and what is it assoc with?

A

Collapsing pulse associated with AR

38
Q

What is De Musset’s sign?

A

Visible head bobbing assoc with AR

39
Q

What are the features of aortic regurgitation?

What is Austin-Flint murumur?

A

-Collapsing pulse
-Wide pulse pressure
-Early diastolic murmur
-Increases with handgrip manoeuvre

Mid diastolic murmur associated with severe aortic regurg

40
Q

What are the most common causes of AS in patients >65yrs vs <65yrs

A

> 65= aortic calcification

<65= bicuspid aortic valve

41
Q

What is this disease?
What cardiac manifestation does it have?

A

Naxos disease: Autosomal recessive disease

-Wooly hair
-Palmoplantar keratosis
-ARVD

42
Q

2nd most common cause of sudden cardiac death in young people after HOCM?

A

Arrythmogenic right ventricular cardiomyopathy

Triad of: palpitations, syncope, sudden cardiac death

Inherited in AD fashion
Right ventricular myocardium is replaced by fatty tissue

43
Q

What does this ECG show?

Mx?

A

Shows ARVD
-Epislon wave after QRS in V1
-TWI in precordial leads
-Widened QRS in leads V1 and V2

-Use soltatol, cosnider implantable defib and catheter ablation to prevent VT

44
Q

What is Beck’s triad?

A

-Raised JVP
-Muffled heart sounds
-Falling BP

In cardiac tamponade

45
Q

Important side effect of loop diuretics?

A

Hypokalaemia

46
Q

When are nitrates CI in the treatment of ACS?

A

Do not give nitrates when hypotensive at BP <90

47
Q

Most common cause of secondary hypertension?

A

Primary hyperaldosteronism such as conns syndrome

48
Q

What is stage 1 hypertension and how do you treat it?

A

Stage 1 is ABPM of >135/85

Only treat if <80 and any of;
-Target organ damage
-Established CVD
-Renal disease
-Diabetes
-10yr CVD risk of >10%

48
Q

What are random and fasting glucose levels needed to Dx T1DM

A

Random glucose 11.1mmol
Fasting glucose 7.0mmol

49
Q

Who needs c-peptide or autoantibody testing if suspect T1DM and they have hyperglycaemia?

A

If they are
>50y/o
BMI >25
Slow evolution of hyperglycaemia

50
Q

What conditions can you not use HBA1c values to dx T2DM?

A

-Haemoglobinopathies
-Haemolytic anaemia
-untreated iron deficiency anaemia
-Suspected gestational diabetes
-children
-HIV
-CKD
-People taking medications that may cause hyperglycaemia (corticosteroids)

51
Q

Impaired fasting glucose values?

Impaired glucose tolerance values?

A

Fasting glucose of >/=6 but <7.0mmol

Impaired glucose tolerance is after 75mg of oral glucose, fasting >/=7.8 but below 11.1mmol

52
Q

What diabetic drug is linked to pancreatitis?

A

Exenatide

53
Q

When is FeNO considered positive?

A

In adults, level >40 parts per billion is considered positive
In children >35 parts per billion is considered positive

54
Q

What reversibility testing number is considered positive for asthma?

A

An improvement of FEV1 of 12% post bronchodilator therapy

55
Q

Example of ;

SABA
SAMA
LAMA
LABA

A

SABA= Salbutamol (Ventolin)
SAMA= Ipatroprium (atrovent)
LAMA=Tiotropium (spiriva)
ICS= Fluticasone or Beclometasone or Budesonide (QVAR, Pulmicort)
LABA= salmetrol, formoterol

ICS/LABA combination= budesonide/formoterol (Symbicort or Seretide)

56
Q

Indications for surgery in bronchiectasis?

A

Uncontrollable haemoptysis
Localised disease

57
Q

What is lights criteria?

A

-Effusion LDH >2/3 upper limit of serum LDH
-Effusion protein/serum protein >0.5
-Pleural fluid LDH/Serum LDH is >0.6

58
Q

What is an example of exudative pleural effusion

A

Protein >35

Pneumonia
Cancer
TB
PE

59
Q

What is the criteria for doing a CTH within 1hr?

A

-GCS <13 on initial assessment
-GCS <15 at 2hrs post injury
-More than 1 episode of vomiting
-Post-traumatic seizure
-Signs of basal skull fracture
-Focal neurological deficit
-Suspected open or depressed skull fracture

60
Q

Criteria for doing CTH within 8hrs of head injury?

A

Any of the below who have experienced some loss of consciousness or amnesia;
-Age 65yrs or more
-Any history of bleeding or clotting disorders
-Dangerous mechanism of injury (a pedestrian or cyclist struck by motor vehicle, passenger of car ejected from vehicle, fall from >1m or fall from >5 stairs)
-More than 30mins of retrograde amnesia

Any patient on warfarin should have a CTH within 8hrs

61
Q

Management of generalised tonic clonic epiplepsy?

A

1st line in Men: Sodium valproate
1st line in women: Lamotrigine or levetiracetam

62
Q

Management of absence seizure?

A

Ethosuxamide
Carbamazepine makes them worse

63
Q

Presentation of IgA nephropathy vs post-streptococcal glomerulonephritis?

A

IgA nephropathy develops 1-2 days after URTI with visible haematuria. Typically young male

PostStrep glomerulonephritis is 1-2 weeks and presents with proteinuria and low complement

64
Q

Treatment of IgA nephropathy

A

-If visible haematuria, no proteinuria and normal eGFR: no treatment
-Persistent proteinuria treat with ACEi
3rd line is steroids

65
Q

What is ‘double duct’ sign in MRCP

A

Sign of pancreatic cancer, typically head of pancreas or ampullary tumors

66
Q

What are the stages of AKI?

A

STAGE 1: urine output <0.5ml/kg over >/= 6hrs, creatinine increased by 1.5-1.9x

STAGE 2: Urine output <0.5ml/kg over >/= 10hrs, creatinine increased by 2-2.9x

STAGE 3: Urine output <0.3mk/kg over >/= 24hrs, creatinine is >3x baseline

67
Q

How can you tell difference between IDA and anaemia of chronic disease?

A

TIBC is increased in IDA
Ferritin is typically low in IDA, but can be normal in initial phases or increased as an acute inflammatory response

68
Q

What drugs typically worsen dementia?

A

TCAs- amitryptilline

69
Q

What BP reading is a contraindication to thrombolysis?

A

A BP of >200/120

70
Q

Antibodies most associated with dermatomyositis?

A

Anti-Jo1

71
Q

What do you give to reverse warfarin?

A

Vitamin K
Prothrombin Complex concentrate eg octaplex

MSRA- Imo (10 decks)

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