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MSRA > Medicine > Flashcards

Medicine Flashcards

1
Q

When to give O2 in MI

A

If sats <94%

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2
Q

Mx of Ramsay Hunt

A

oral aciclovir and corticosteroids are usually given

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3
Q

Obstructive vs restrictive pul function test

A

Obstructive
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

Restrictive
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

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4
Q

Examples of obstructive vs restrictive

A

Restrictive
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders

Obs
Asthma
BE
COPD

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5
Q

To who are pneumococcal vaccinations offered to

A

65 years and those with:
Spleen
Resp disease- Asthma is only included if ‘it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant’

chronic heart disease

chronic kidney disease (at stages 4 and 5, nephrotic syndrome, kidney transplantation)

chronic liver disease

immunosuppression (either due to disease or treatment). This includes patients with any stage of HIV infection

cochlear implants

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6
Q

Who is influenza vaccine offered to

A

chronic respiratory disease

chronic heart disease

chronic kidney disease (at stages 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation)
chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis

chronic neurological disease: (e.g. Stroke/TIAs)

diabetes mellitus (including diet controlled)

immunosuppression due to disease or treatment (e.g. HIV)

asplenia or splenic dysfunction

pregnant women

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7
Q

Other than abx what increases risk of C diff

A

PPI

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8
Q

Third nerve palsy

A

Down and out
ptosis
‘down and out’ eye
dilated, fixed pupil

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9
Q

IV and VI palsy

A

IV- vertical diplopia

VI - horizontal diplopia

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10
Q

Anaphylaxis doses

A

6 months
100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

6 months - 6 years
150 micrograms (0.15 ml 1 in 1,000)

6-12 years
300 micrograms (0.3ml 1 in 1,000)

Adult and child > 12 years
500 micrograms (0.5ml 1 in 1,000)

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11
Q

Drugs causing torsades

A

Antiarrhythmics (e.g. amiodarone, sotalol)

Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)

Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

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12
Q

Hereditary haemorrhagic telangiectasia SX

A

epistaxis

telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)

visceral lesions

family history

2/4

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13
Q

CT head in <1hr

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

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14
Q

CT head <8 hrs

A

some loss of consciousness or amnesia since the injury:
age 65 years or older

any history of bleeding or clotting disorders including anticogulants

dangerous mechanism of injury

more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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15
Q

What can accentuate digoxin toxicity

A

HypoK

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16
Q

Long term prophylaxis for cluster headaches and acute tx

A

Verapamil- proph

Sumatriptan is used as an acute rescue therapy (along with high-flow oxygen)

17
Q

Step ladder for asthma

A

1- SABA
2- SABA + low-dose inhaled corticosteroid (ICS)

3- SABA + low-dose ICS + leukotriene receptor antagonist (LTRA)

4- SABA + low-dose ICS + long-acting beta agonist (LABA)
Continue LTRA depending on patient’s response to LTRA

5- Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

18
Q

UTI tx

A

NICE recommend trimethoprim or nitrofurantoin for 3 days
send a urine culture if:
aged > 65 years
visible or non-visible haematuria

Men - 7 days

Preg- nitro then amoxicillin
7 days
Culture

Catheter- 7 days
Do not treat asymptomatic

19
Q

Step down of asthma

A

step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids

3 months

20
Q

Mx of Addisons with intercurrent illness

A

glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same

21
Q

Reactive arthritis sx

A

typically develops within 4 weeks of initial infection - symptoms generally last around 4-6 months

arthritis is typically an asymmetrical oligoarthritis of lower limbs
dactylitis

symptoms of urethritis

conjunctivitis (seen in 10-30%)
anterior uveitis

circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica

22
Q

Who qualifies for FITT testing

A

with an abdominal mass

with a change in bowel habit

with iron-deficiency anaemia, or

aged 40 and over with unexplained weight loss and abdominal pain, or

aged under 50 with rectal bleeding and either of the following unexplained symptoms:
abdominal pain
weight loss, or

aged 50 and over with any of the following unexplained symptoms:
rectal bleeding
abdominal pain
weight loss, or

aged 60 and over with anaemia even in the absence of iron deficiency

23
Q

Cavitating lesion in CXR in alcoholic

A

Klebsiella

24
Q

SE of thyroxine therapy

A

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

25
Q

What reduces levo absorption

A

Iron and CaCO3

26
Q

Where Pagets affects

A

Paget’s disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities

27
Q

Tx of bradycardia

A

IV atropine

28
Q

Pagets Mx

A

Bisphosphonates

29
Q

Somatisation disorder vs conversion

A

Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results

Conversion
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms

30
Q

Asthma classification

A

Moderate
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

Severe
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

Life threatening
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

31
Q

Cauda Equina sx

A

low back pain
bilateral sciatica
present in around 50% of cases
reduced sensation/pins-and-needles in the perianal area
decreased anal tone
it is good practice to check anal tone in patients with new-onset back pain
however, studies show this has poor sensitivity and specificity for CES
urinary dysfunction

32
Q

When to sync DC cardiovert

A

tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks

33
Q

Mx of TIA

A

be given aspirin 300 mg immediately unless contraindicated
clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od

assessed urgently within 24 hours by a stroke specialist clinician

34
Q

Argyll-Robertson pupil.

A

Accommodate but do not respond to light

35
Q

?PMR no response to steroids

A

Stop steroids consider alternative

36
Q

RA mx

A

Rheumatoid arthritis: initial management is conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid

37
Q
A

MSRA (8 decks)

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