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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
Which patients having an NSTEMI have an angiography right away?
If GRACE score >3% + unstable condition If stable condition, angiography within 72hrs
26
What are the dihydropyridine CCBs?
The PINES Amlodipine, Nifedipine
27
What are the non dihydropyridine CCBs
RATE LIMITING Verapamil Diltiazem
28
What are 3rd line drugs for angina if B blocker or CCB not enough
Nicorandil Isosorbide mononitrate Ivabradine Ranolazine
29
When do you start anticoagulation in acute stroke patients who have AF?
After 4 weeks
30
How long do you anticoagulate someone after ablation for AF if CHADSVASc score is 0? If score is 1 or more?
If 0, anticoagulate for 2 months If 1 or more, anticoagulate lifelong
31
Side Effects of ACEi
-Cough -Angioedma -First dose hypotension -Hyperkalaemia
32
Monitoring for ACEi?
-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
Who do you avoid adenosine in?
Asthmatics as it causes bronchospasm
34
Monitoring for amiodarone?
Before starting: TFTs, LFTs, U&Es and CXR Then TFTs and LFTs every 6 months
35
Side effects of amiodarone?
-Hypo and hyperthyroidism -Bradycardia -Slate grey appearance -Pulmonary fibrosis/pneumonitis -Liver fibrosis/hepatitis -Photosensitivity -Thrombophlebitis and injection site reactions -Lengthens QT -Corneal deposits
36
What is Quinke's sign and what is assoc with?
Pulsating nailbed assoc with AR
37
What is Corrigan's sign and what is it assoc with?
Collapsing pulse associated with AR
38
What is De Musset's sign?
Visible head bobbing assoc with AR
39
What are the features of aortic regurgitation? What is Austin-Flint murumur?
-Collapsing pulse -Wide pulse pressure -Early diastolic murmur -Increases with handgrip manoeuvre Mid diastolic murmur associated with severe aortic regurg
40
What are the most common causes of AS in patients >65yrs vs <65yrs
>65= aortic calcification <65= bicuspid aortic valve
41
What is this disease? What cardiac manifestation does it have?
Naxos disease: Autosomal recessive disease -Wooly hair -Palmoplantar keratosis -ARVD
42
2nd most common cause of sudden cardiac death in young people after HOCM?
Arrythmogenic right ventricular cardiomyopathy Triad of: palpitations, syncope, sudden cardiac death Inherited in AD fashion Right ventricular myocardium is replaced by fatty tissue
43
What does this ECG show? Mx?
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
What is Beck's triad?
-Raised JVP -Muffled heart sounds -Falling BP In cardiac tamponade
45
Important side effect of loop diuretics?
Hypokalaemia
46
When are nitrates CI in the treatment of ACS?
Do not give nitrates when hypotensive at BP <90
47
Most common cause of secondary hypertension?
Primary hyperaldosteronism such as conns syndrome
48
What is stage 1 hypertension and how do you treat it?
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
What are random and fasting glucose levels needed to Dx T1DM
Random glucose 11.1mmol Fasting glucose 7.0mmol
49
Who needs c-peptide or autoantibody testing if suspect T1DM and they have hyperglycaemia?
If they are >50y/o BMI >25 Slow evolution of hyperglycaemia
50
What conditions can you not use HBA1c values to dx T2DM?
-Haemoglobinopathies -Haemolytic anaemia -untreated iron deficiency anaemia -Suspected gestational diabetes -children -HIV -CKD -People taking medications that may cause hyperglycaemia (corticosteroids)
51
Impaired fasting glucose values? Impaired glucose tolerance values?
Fasting glucose of >/=6 but <7.0mmol Impaired glucose tolerance is after 75mg of oral glucose, fasting >/=7.8 but below 11.1mmol
52
What diabetic drug is linked to pancreatitis?
Exenatide
53
When is FeNO considered positive?
In adults, level >40 parts per billion is considered positive In children >35 parts per billion is considered positive
54
What reversibility testing number is considered positive for asthma?
An improvement of FEV1 of 12% post bronchodilator therapy
55
Example of ; SABA SAMA LAMA LABA
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
Indications for surgery in bronchiectasis?
Uncontrollable haemoptysis Localised disease
57
What is lights criteria?
-Effusion LDH >2/3 upper limit of serum LDH -Effusion protein/serum protein >0.5 -Pleural fluid LDH/Serum LDH is >0.6
58
What is an example of exudative pleural effusion
Protein >35 Pneumonia Cancer TB PE
59
What is the criteria for doing a CTH within 1hr?
-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
Criteria for doing CTH within 8hrs of head injury?
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
Management of generalised tonic clonic epiplepsy?
1st line in Men: Sodium valproate 1st line in women: Lamotrigine or levetiracetam
62
Management of absence seizure?
Ethosuxamide Carbamazepine makes them worse
63
Presentation of IgA nephropathy vs post-streptococcal glomerulonephritis?
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
Treatment of IgA nephropathy
-If visible haematuria, no proteinuria and normal eGFR: no treatment -Persistent proteinuria treat with ACEi 3rd line is steroids
65
What is 'double duct' sign in MRCP
Sign of pancreatic cancer, typically head of pancreas or ampullary tumors
66
What are the stages of AKI?
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
How can you tell difference between IDA and anaemia of chronic disease?
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
What drugs typically worsen dementia?
TCAs- amitryptilline
69
What BP reading is a contraindication to thrombolysis?
A BP of >200/120
70
Antibodies most associated with dermatomyositis?
Anti-Jo1
71
What do you give to reverse warfarin?
Vitamin K Prothrombin Complex concentrate eg octaplex
72
Who gets offered a qFIT test?
Anyone with; -abdominal mass -change in bowel habit -IDA -Aged >40y/o with unexplained weight loss AND abdominal pain -Aged <50y/o with rectal bleeding and any unexplained abdominal pain or weight loss -Aged >50y/o with any unexplained rectal bleeding, abdominal mass, weight loss Aged >60y/o with anaemia
73
What is a positive qFIT?
>10ug Hb g/faeces
74
Who goes straight to urgent suspected cancer?
unexplained anal or rectal mass or anal ulceration

MSRA- Imo (10 decks)

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