Medicine MSRA Flashcards
What is the first-line treatment for Paracetamol overdose?
Activated charcoal if ingested < 1 hour ago, N-acetylcysteine (NAC), liver transplantation
Activated charcoal is effective only if administered shortly after ingestion.
What are the main treatments for Salicylate overdose?
Urinary alkalinization with IV bicarbonate, haemodialysis
Urinary alkalinization helps in promoting the excretion of salicylate.
What is the antidote for opioid/opiates overdose?
Naloxone
Naloxone is a specific opioid antagonist used to reverse the effects of opioid overdose.
What is the management for benzodiazepine overdose?
Flumazenil
Flumazenil is generally avoided due to the risk of seizures, especially in severe cases.
True or False: Flumazenil is safe to use in all benzodiazepine overdoses.
False
It is generally only used in severe or iatrogenic overdoses due to seizure risk.
What is the management for tricyclic antidepressant overdose?
IV bicarbonate, avoid class 1a and class Ic antiarrhythmics, avoid class III drugs, correct acidosis first
Dialysis is ineffective in removing tricyclics.
In lithium toxicity, what may be used for mild-moderate cases?
Volume resuscitation with normal saline
Severe toxicity may require haemodialysis.
What is the treatment for Warfarin overdose?
Vitamin K, prothrombin complex
These treatments help reverse the anticoagulation effects of Warfarin.
What is the antidote for Heparin overdose?
Protamine sulphate
Protamine sulphate is used to neutralize the effects of heparin.
What should be administered if a patient is bradycardic due to beta-blocker overdose?
Atropine
Glucagon may be used in resistant cases.
What is the first-line treatment for ethylene glycol poisoning?
Fomepizole
Ethanol has historically been used but is now less favored.
What is the management for methanol poisoning?
Fomepizole or ethanol, haemodialysis
Both fomepizole and ethanol inhibit alcohol dehydrogenase to prevent toxic metabolite formation.
What is the primary treatment for organophosphate insecticide poisoning?
Atropine
The role of pralidoxime in treatment remains unclear.
What is used to treat digoxin toxicity?
Digoxin-specific antibody fragments
These fragments bind to digoxin and help reverse its effects.
What is the treatment for iron overdose?
Desferrioxamine, a chelating agent
Desferrioxamine helps remove excess iron from the body.
What are the treatments for lead poisoning?
Dimercaprol, calcium edetate
These agents chelate lead to facilitate its excretion.
What is the management for carbon monoxide poisoning?
100% oxygen, hyperbaric oxygen
Administering high concentrations of oxygen helps displace carbon monoxide from hemoglobin.
What is the treatment for cyanide poisoning?
Hydroxocobalamin; combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
Hydroxocobalamin binds to cyanide, forming a non-toxic compound.
What are antipsychotics primarily used for?
Management of schizophrenia and other forms of psychosis, mania, and agitation
How are antipsychotics categorized?
Typical and atypical antipsychotics
What issue led to the development of atypical antipsychotics?
Problematic extrapyramidal side-effects associated with typical antipsychotics
What is the mechanism of action for typical antipsychotics?
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in mesolimbic pathways
What receptors do atypical antipsychotics act on?
D2, D3, D4, 5-HT
What are common adverse effects of typical antipsychotics?
Extrapyramidal side-effects and hyperprolactinaemia
What are examples of typical antipsychotics?
- Haloperidol
- Chlorpromazine
What are examples of atypical antipsychotics?
- Clozapine
- Risperidone
- Olanzapine
What are extrapyramidal side-effects (EPSEs)?
Motor control symptoms caused by antipsychotic medications
What are some types of extrapyramidal side-effects?
- Parkinsonism
- Acute dystonia
- Akathisia
- Tardive dyskinesia
What is tardive dyskinesia?
Late onset of choreoathetoid movements, abnormal and involuntary, may be irreversible
What specific warnings has the Medicines and Healthcare products Regulatory Agency issued for antipsychotics in elderly patients?
- Increased risk of stroke
- Increased risk of venous thromboembolism
What are some other side-effects of antipsychotics?
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Sedation
- Weight gain
- Raised prolactin
What can raised prolactin levels result in?
Galactorrhoea
What syndrome is characterized by pyrexia and muscle stiffness?
Neuroleptic malignant syndrome
What effect do atypical antipsychotics have on seizure threshold?
Greater reduction in seizure threshold compared to typical antipsychotics
Which antipsychotic is particularly associated with a prolonged QT interval?
Haloperidol
Fill in the blank: Typical antipsychotics are primarily _______ receptor antagonists.
D2
True or False: Atypical antipsychotics are less likely to cause extrapyramidal side-effects than typical antipsychotics.
True
What percentage of intracranial tumors do vestibular schwannomas account for?
Approximately 5%
Vestibular schwannomas are also known as acoustic neuromas.
What percentage of cerebellopontine angle tumors are vestibular schwannomas?
90%
This highlights their prevalence in that specific region.
What are the classical symptoms of vestibular schwannoma?
Vertigo, hearing loss, tinnitus, absent corneal reflex
Symptoms vary based on the affected cranial nerves.
Which cranial nerve is associated with vertigo and unilateral sensorineural hearing loss in vestibular schwannoma?
Cranial nerve VIII
This nerve is crucial for balance and hearing.
What is the significance of cranial nerve V in vestibular schwannoma?
Absent corneal reflex
This indicates involvement of sensory function.
What symptom is associated with cranial nerve VII in vestibular schwannoma?
Facial palsy
This indicates the impact on motor function.
In which condition are bilateral vestibular schwannomas commonly seen?
Neurofibromatosis type 2
This genetic disorder is characterized by the development of tumors.
What should be done for patients with a suspected vestibular schwannoma?
Refer urgently to ENT
Urgent referral is crucial for proper management.
How do vestibular schwannomas typically behave?
Slow growing, benign, often observed initially
This means they may not require immediate intervention.
What is the investigation of choice for vestibular schwannoma?
MRI of the cerebellopontine angle
MRI provides detailed imaging for diagnosis.
What role does audiometry play in the evaluation of vestibular schwannoma?
Important as only 5% of patients will have a normal audiogram
Audiometry helps assess hearing function.
What are the management options for vestibular schwannoma?
Surgery, radiotherapy, observation
Management depends on various factors including tumor size and symptoms.
What condition has no exclusion from school?
Conjunctivitis
Other conditions with no exclusion include Fifth disease, Roseola, Infectious mononucleosis, Head lice, Threadworms, and Hand, foot and mouth.
How long after commencing antibiotics can a child with scarlet fever return to school?
24 hours
Alternatively, a child may return 21 days from the onset of symptoms if no antibiotics are given.
What is the exclusion period for whooping cough?
2 days after commencing antibiotics or 21 days from onset of symptoms
If no antibiotics are administered.
How many days after the onset of rash does measles require exclusion?
4 days
This is the period during which a child must be excluded from school.
What is the exclusion period for rubella?
5 days from onset of rash
When can a child with chickenpox return to school?
All lesions crusted over
The exclusion period has varied, but lesions must be crusted before returning.
How long after swollen glands onset does mumps require exclusion?
5 days
What is the exclusion requirement for diarrhea & vomiting?
Until symptoms have settled for 48 hours
What are the exclusion conditions for impetigo?
Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
What is the exclusion requirement for scabies?
Until treated
When can a child with influenza return to school?
Until recovered
Fill in the blank: Cases of chickenpox are generally infectious from 2 days before the rash appears to _______.
5 days after the onset of rash
