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MSRA > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Mx of salicylate overdose? (e.g. aspirin, ibuprofen, diclofenac)

A
  • urinary alkalinization w IV bicarb - Haemodialysis if AEIOU
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2
Q

Mx of TCA overdose?

A
  • IV bicarb to reduce risk of seizures/ arrhythmias dialysis is ineffective in removing TCAs
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3
Q

Mx of Lithium overdose?

A

Fluids, haemodialysis in severe toxicity

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4
Q

Mx of Beta Blocker overdose?

A

Atropine. If resistant to atropine, glucagon

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5
Q

Mx of Ethylene glycol poisoning?

A

1st line: fomepizole (Alcohol dehydrogenase inhibitor) haemodialysis if refractory.

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6
Q

Mx of digoxin overdose

A

Digoxin-specific antibody fragments

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7
Q

Mx of lead poisoning?

A

Dimercaprol, calcium edetate

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8
Q

Mx of organophosphate insecticide poisoning?

A

Atropine

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9
Q

Mx of cyanide poisoning?

A

hydroxocobalamin

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10
Q

Antiplatelet mx after ischaemic stroke?

A

Aspirin 300mg daily for 2 weeks + Clopidogrel 75mg daily lifelong -> if clopidogrel contraindicated, Aspirin & dipyridamole lifelong

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11
Q

Antiplatelet mx after medically treated ACS?

A

Aspirin lifelong, Ticagrelor for 12 months. if aspirin contraindicated, clopidogrel lifelong

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12
Q

Antiplatelet mx after PCI?

A

Aspirin lifelong, Prasugrel or Ticagrelor for 12 months. if aspirin contraindicated, lifelong clopidogrel

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13
Q

Antiplatelet mx after TIA?

A

Lifelong clopidogrel 2nd line: lifelong aspirin & dipyridamole

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14
Q

Antiplatelet mx for peripheral arterial disease?

A

Lifelong clopidogrel 2nd line: lifelong aspirin

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15
Q

Mx of Bell’s palsy?

A

10 days of prednisolone 1mg/kg within 72 hours of onset. + artificial tears

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16
Q

what could falsely lower BNP levels?

A

spironolactone, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics. + obesity

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17
Q

classic presentation of primary biliary cholangitis?

A

itching in a middle-aged woman - autoimmune condition causing progressive cholestasis which progress to cirrhosis

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18
Q

conditions assoc with Primary biliary cholangitis?

A

Sjogrens (in up to 80%), rheumatoid arthritis, systemic sclerosis, thyroid disease

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19
Q

diagnosis of Primary biliary cholangitis?

A

anti-mitochondrial antibodies M2 subtype (highly specific, seen in 98% of patients), smooth muscle antibodies (~30%), raised serum igM

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20
Q

management of primary biliary cholangitis?

A

pruritus: cholestyramine, fat soluble vitamin supplementation, ursodeoxycholic acid, liver transplant (e.g. if bili>100)

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21
Q

Complications of primary biliary cholangitis?

A

cirrhosis, osteomalacia and osteoporosis, significantly increased risk of hepatocellular carcinoma

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22
Q

lifestyle advice for managing hypertension?

A

low salt diet (<6g/day, ideally <3g), reduce caffeine intake, stop smoking, less alcohol, balanced diet, more exercise, lose weight

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23
Q

Mx of NAFLD?

A

weight loss and monitoring. those with advanced fibrosis should be referred to liver specialist for liver biopsy for staging.

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24
Q

Investigation of NAFLD as recommended by NICE?

A

enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

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25
Q

when to put a chest tube in with a pleural effusion?

A
  • if fluid is purulent or turbid/ cloudy - if pH<7.2
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26
Q

what electrolyte abnormalities may cause Long QT?

A

HypoK, HypoCa, hypoMg

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27
Q

Mx of Long QT syndrome?

A

beta blockers (except for sotalol), implantable cardioverter defibrillators in high risk cases

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28
Q

Most likely cause of death of pt with CKD on haemodialysis?

A

IHD - CV events account for 50% mortality in patients receiving dialysis

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29
Q

features of left ventricular aneurysm post-MI?

A

persistent ST elevation and LV failure. need anticoagulation due to risk of stroke (thrombus may form within the aneurysm)

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30
Q

Most useful investigation to diagnose ankylosing spondylitis?

A

Plain X-ray of sacroiliac joints. May include changes: sacroilitis: subchondral erosions, scelrosis; squaring of lumbar vertebrae, bamboo spine

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31
Q

If Xray negative for sacroiliac joint involvement, but suspicion for ankylosing spondylitis remains high, what investigation to do next?

A

MRI - inflammation involving sacroiliac joints, radiographs may be normal in early disease.

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32
Q

spirometry results in ank spond? Why?

A

Restrictive defect. Combination pulmonary (apical) fibrosis, kyphosis and ankylosis of costovertebral joints

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33
Q

Mx of Ank Spond?

A

1st line: NSAIDs + Physiotherapy, regular exercise

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34
Q

If no response to NSAIDS in Ank Spond, what mx?

A

Anti-TNF therapies e.g. etanercept, adalimumab

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35
Q

Mx of PTSD?

A

watchful waiting if mild symptoms lasting < 4wks. Trauma focused Cognitive behavioural therapy or eye movement desensitisation and reprocessing therapy.

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36
Q

Medical mx of PTSD if CBT/ EMDR not enough?

A

1st line: Venlafaxine or SSRI (Sertraline). If severe: risperidone

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37
Q

Adverse effects of St johns wort?

A

Serotonin syndrome, P450 inducer

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38
Q

How does St John’s Wort work?

A

mechanism thought to be similar to SSRIs. beneficial for mild-moderate depression

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39
Q

Charcot’s triad?

A

Fever, Jaundice, RUQ pain -> Ascending cholangitis

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40
Q

Reynolds pentad?

A

in ascending cholangitis. Fever + RUQ pain + Jaundice (Charcots triad) + Hypotension + confusion

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41
Q

Mx of ascending cholangitis?

A

IV antibiotics, ERCP after 24-48h to relieve any obstruction

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42
Q

Most common cause of ascending cholangitis?

A

gallstones

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43
Q

What medications might induce acute pancreatitis?

A

Azathioprine, mesalazine, didanosine, Bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

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44
Q

the As of ankylosing spondylitis?

A

Apical fibrosis, Anterior uveitis, Aortic regurgitation, Achilles tendonitis, AV node block, Amyloidosis

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45
Q

1st line medical mx of Raynauds?

A

CCB e.g. nifedipine.

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46
Q

Mx of Raynauds?

A

Keep hands warm, stop smoking

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47
Q

High risk patients of developing pre eclampsia in pregnancy?

A

hypertensive disease during previous pregnancies, CKD, autoimmune disorders such as SLE or antiphospholipid syndrome, type 1 or 2 diabetes mellitus

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48
Q

What medication to give pts at high risk of developing pre-eclampsia in pregnancy?

A

low-dose aspirin, start at 12-14 wks gestation

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49
Q

1st line mx of acute prostatitis?

A

Ciprofloxacin / Trimethoprim

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50
Q

1st line antibiotic choice for cellulitis near eyes/ nose?

A

co-amoxiclav

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51
Q

1st line antibiotic choice for erysipelas?

A

Flucloxacillin

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52
Q

1st line antibiotic choice for Campylobacter diarrhoea?

A

Clarithromycin

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53
Q

1st line antibiotic choice for salmonella gastroenteritis (non typhoid)?

A

ciprofloxacin

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54
Q

1st line antibiotic choice for shigellosis diarrhoea?

A

ciprofloxacin

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55
Q

1st line antibiotic choice for syphilis?

A

benzathine benzylpenicillin (or doxycycline/ erythromycin)

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56
Q

1st choice antibiotic choice for gonorrhoea?

A

IM ceftriaxone

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57
Q

1st line antibiotic choice for chlamydia?

A

doxycycline (or azithromycin)

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58
Q

Mx of PID?

A

Oral ofloxacin + Oral metronidazole OR IM ceftriaxone + oral doxycycline + Oral metronidazole

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59
Q

1st line antibiotic choice of otitis media?

A

Amoxicillin

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60
Q

1st line antibiotic choice of otitis externa?

A

Flucloxacillin

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61
Q

1st line antibiotic choice for acute necrotising ulcerative gingivitis?

A

Metronidazole

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62
Q

1st line mx of DVT? (new 2020 NICE guidelines)

A

DOACs- apixaban or rivaroxaban if unprovoked - 6 months. Provoked - 3 months

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63
Q

1st line mx of DVT in pt with active cancer? (New 2020 NICE Guidelines)

A

DOAC. for 3 to 6 months unless severe renal impairments (CrCl<15) -> LMWH, Unfractionated heparin or LMWH followed by Warfarin

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64
Q

1st line mx of DVT in pt with antiphospholipid syndrome?

A

LMWH followed by warfarin

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65
Q

Mx of Kawasakis?

A

High dose aspirin, IV Ig, Echo to screen for coronary artery aneurysms

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66
Q

Mx after being bitten by animal in at-risk countries for rabies?

A

Wash wound. If already immunised -> 2 further doses of vaccine. +/- abx. If not immunised: Human rabies Ig + full course of vaccination +/- abs

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67
Q

titubation?

A

head tremor. most common cause is essential tremor

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68
Q

Causes of bilateral parotid gland swelling?

A

viruses: mumps; sarcoidosis; Sjogren’s syndrome; lymphoma; alcoholic liver disease

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69
Q

1st line treatment of onychomycosis (dermatophyte infection)?

A

oral terbinafine.

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70
Q

1st line treatment of onychomycosis (candida infection)?

A

Topical antifungals (e.g. amorolfine) if mild. Severe infections - oral itraconazole

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71
Q

features of Stevens Johnson?

A

Rash - target lesions, which may develop into vesicles or bull.ae, mucosal involvement, fever, arthralgia

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72
Q

Adjuvant hormonal therapy for ER+ve patients with breast cancer?

A

if pre-menopausal: Tamoxifen (SERM) if post menopausal: Aromatase inhibitors e.g. anastrozole

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73
Q

1st line antihypertensive in pre-eclampsia?

A

oral labetalol. (nifedipine if asthmatic, or hydralazine)

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74
Q

what may clopidogrel interact with?

A

PPIs may make clopidogrel less effective. e.g. omeprazole, esomeprazole (lansoprazole is ok)

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75
Q

what is the 1st line SSRI in mother with postpartum depression and breastfeeding?

A

Paroxetine preferred due to low milk/plasma ratio.

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76
Q

Fundoscopy showing black bone spicule shaped pigmentation of peripheral retina

A

Retinitis pigments

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77
Q

features of retinitis pigmentosa

A

night blindness often initial sign. Tunnel vision.

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78
Q

What type of lung cancer is associated with SIADH?

A

small cell lung cancer

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79
Q

Mx of SIADH?

A

Fluid restrict. Can consider demeclocycline (reduces responsiveness of collecting tubule cells to ADH), ADH receptor antagonists

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80
Q

What ix is used in venous ulcers?

A

ABPI: to assess for poor arterial flow which could impair healing.

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81
Q

Mx of venous ulceration?

A

Compression bandaging, usually four layer + Oral pentoxifylline (peripheral vasodilator which improves healing rate)

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82
Q

what is CMV chorioretinitis?

A
  • inflammation of choroid and retina - form of posterior uveitis - pizza pie appearance on fundoscopy - can also be caused by syphilis, Toxoplasmosis, sarcoidosis, TB
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83
Q

most specific ECG marker for pericarditis?

A

PR depression

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84
Q

Ix of Pericarditis?

A

ECG: Widespread saddle shaped ST elevation, PR depression. ALL should have an echo

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85
Q

Mx of acute pericarditis?

A

treat the underlying cause, NSAIDS+ colchicine as first line (if acute idiopathic/ viral cause)

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86
Q

Adverse effects of hydroxychloroquine?

A

Bull’s eye retinopathy -> may result in severe and permanent visual loss. Annual screening is recommended.

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87
Q

presenting features of cholangiocarcinoma?

A

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen

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88
Q

What blood tests are raised in anorexia?

A

Growth hormone levels, glucose (impaired glucose tolerance), salivary glands swollen, cortisol, cholesterol, carotinaemia

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89
Q

management of vestibular neuronitis?

A

vestibular rehabilitation exercises, prochlorperazine for rapid relief in severe cases,

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90
Q

If acanthosis nigricans develops rapidly and in atypical locations such as in the oral cavity…?

A

internal malignancy should be suspected, particularly gastric cancer.

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91
Q

mx of c diff?

A

1st line: 10-14 days oral metronidazole, 2nd: oral vancomycin (if severe or not responding). If still not responding: fidaxomicin. life threatening: oral Vancomycin + IV metronidazole

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92
Q

most common reason for revision of total hip replacement?

A

aseptic loosening of the implant

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93
Q

what drugs are assoc w erythema nodosum?

A

penicillin, sulphonamides e.g. sulfasalazine, COCP

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94
Q

risk factor for Vit K deficiency in newborns?

A

exclusive breastfeeding. maternal use of antiepileptics. (all newborns in the UK are offered Via K)

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95
Q

what electrolyte abnormality can cause cataracts?

A

hypocalcaemia

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96
Q

melanosis coli?

A

a disorder of pigmentation of the bowel wall. histology demonstrates pigment laden macrophages. associated with laxative abuse esp Senna

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97
Q

what chemotherapy agent may cause dilated cardiomyopathy?

A

doxorubicin

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98
Q

side effects of cyclophosphamide?

A

haemorrhage cystitis, myelosuppression, transitional cell carcinoma

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99
Q

side effect of bleomycin?

A

lung fibrosis

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100
Q

side effects of methotrexate?

A

BM suppression, mucositis, lung fibrosis, liver fibrosis

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101
Q

side effects of cisplatin?

A

ototoxicity, peripheral neuropathy, hypomagnesaemia

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102
Q

side effects of vincristine?

A

peripheral neuropathy, paralytic ileus

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103
Q

first line mx for Idiopathic thrombocytopenic purpura?

A

oral pred

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104
Q

what is Evans syndrome?

A

ITP in association with AIHA

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105
Q

palliative confusion +/- psychosis, 1st line mx?

A

oral haloperidol. if terminal agitation-> subcut midazolam

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106
Q

mx of psoriatic arthritis?

A

should be managed by a rheumatologist, treat as rheumatoid arthritis but better prognosis

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107
Q

main joints affected in psoriatic arthritis?

A

DIPs

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108
Q

types of psoriatic arthritis?

A
  1. rheumatoid-like polyarthritis: (30-40%, most common type) 2. asymmetrical oligoarthritis: typically affects hands and feet (20-30%) 3. sacroilitis 4. DIP joint disease (10%) 5. arthritis mutilans (severe deformity fingers/hand, ‘telescoping fingers’)
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109
Q

Causes of transient or spurious non-visible haematuria/

A

urinary tract infection menstruation vigorous exercise (this normally settles after around 3 days) sexual intercourse

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110
Q

Spurious causes (- red/orange urine, where blood is not present on dipstick) of haematuria?

A

foods: beetroot, rhubarb drugs: rifampicin, doxorubicin

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111
Q

urgent 2ww referral re haematuria?

A

Aged >= 45 years AND: unexplained visible haematuria without UTI, or visible haematuria that persists or recurs after successful treatment of UTI Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

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112
Q

assessment tools recommended by nice to assess cognition in ?dementia

A

10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)

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113
Q

most common drug causes of drug induced lupus?

A

procainamide hydralazine less common: isoniazid, minocycline, phenytoin

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114
Q

Adverse effects of metformin?

A
  • GI upsets are common (nausea, anorexia, diarrhoea), intolerable in 20% - reduced vitamin B12 absorption - rarely a clinical problem - lactic acidosis* with severe liver disease or renal failure
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115
Q

bone protection management for patient starting long term prednisolone?

A

if >7.5mg pred for 3 or more months: - if >65, offer bone protection immediately: alendronic acid + ensure ca / vit D replete - if <65, DEXA scan. if bone protection

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116
Q

most common psychiatric problem in Parkinson’s disease is….?

A

depression

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117
Q

what are the different features in drug induced Parkinsonism compared to Parkinson’s disease?

A
  • motor symptoms are generally rapid onset and bilateral - rigidity and rest tremor are uncommon
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118
Q

what Ix can help distinguish between essential tremor and Parkinson’s?

A

NICE recommend considering 123I‑FP‑CIT single photon emission computed tomography (SPECT).

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119
Q

Mx of trichomonad vaginalis?

A

oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole

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120
Q

drug ototoxicity?

A

Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents

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121
Q

features of acoustic neuroma?

A

can be predicted by the affected cranial nerves - cranial nerve VIII: hearing loss, vertigo, tinnitus - cranial nerve V: absent corneal reflex - cranial nerve VII: facial palsy Bilateral acoustic neuromas are seen in neurofibromatosis type 2

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122
Q

mx of peripheral arterial disease?

A

1st line: supervised exercise programme 2. atorvastatin 80, clopidogrel

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123
Q

mx in critical limb ischaemia/ severe peripheral arterial disease?

A

angioplasty, stenting, bypass surgery

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124
Q

after how many mins can u repeat im adrenaline in anaphylaxis?

A

5 min

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125
Q

usual site of anterior epistaxis

A

Kiesselbach’s Plexus

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126
Q

1st line mx in epistaxis?

A

Pinch the cartilaginous (soft) area of the nose firmly and consistently for at least 20 minutes + lean forward

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127
Q

mx of epistaxis If bleeding does not stop after 10-15 minutes of continuous pressure on the nose?

A
  1. Cautery- if the source of bleed is visible and cautery is tolerated- not so well-tolerated in younger children! 2. Packing- if cautery is not viable or the bleeding point cannot be visualised
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128
Q

most common cause of childhood hypothyroidism?

A

autoimmune thyroiditis (iodine deficiency most common in the developing world)

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129
Q

associations of spider naevi?

A

liver disease pregnancy combined oral contraceptive pill

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130
Q

Antibiotic management for severe cellulitis?

A

co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.

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131
Q

Management of guttate psoriasis in children?

A
  • most cases resolve spontaneously within 2-3 months - no firm evidence to support the use of antibiotics - topical agents as per psoriasis - UVB phototherapy - tonsillectomy may be necessary with recurrent episodes
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132
Q

mx of fibroadenoma?

A

If >3cm surgical excision is usual, Phyllodes tumours should be widely excised (mastectomy if the lesion is large)

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133
Q

mx of breast cyst?

A

Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised

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134
Q

what is lymphogranuloma venereum?

A

caused by Chlamydia trachomatis. Typically infection comprises of three stages stage 1: small painless pustule which later forms an ulcer stage 2: painful inguinal lymphadenopathy stage 3: proctocolitis

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135
Q

PSA tests should not be done when?… (as can cause false positives)

A

6 weeks of a prostate biopsy 4 weeks following a proven urinary infection 1 week of digital rectal examination 48 hours of vigorous exercise 48 hours of ejaculation

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136
Q

mx of palliative hiccups?

A

chlorpromazine or haloperidol dexamethasone is also used, particularly if there are hepatic lesions

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137
Q

mx of suspected candidal nappy rash?

A

topical imidazole. Cease the use of a barrier cream until the candida has settled

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138
Q

Lens dislocation in Marfans vs homocystinuria?

A

Marfan’s syndrome: upwards homocystinuria: downwards

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139
Q

features of ecstasy poisoning?

A

neurological: agitation, anxiety, confusion, ataxia cardiovascular: tachycardia, hypertension hyponatraemia hyperthermia rhabdomyolysis

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140
Q

Management of ecstasy poisoning?

A

supportive dantrolene may be used for hyperthermia if simple measures fail

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141
Q

mx of suspected pneumonia in children?

A

1st line: amoxicillin if suspected mycoplasma or pen allergic: clarithromycin if assoc influenza: co-amoxiclav

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142
Q

breast cancer screening?

A

women aged 47-73 years, mammogram every 3 years.

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143
Q

what clotting factors are low in liver failure?

A

all clotting factors are low, except for factor VIII which is paradoxically supra-normal. - factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells. - liver required to clear activated factor VIII from the blood stream -> leading to increases in circulating factor VIII. - increased risk of bleeding AND clotting

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144
Q

DVLA guidance on driving after an acute coronary syndrome?

A

If successfully treated by coronary angioplasty, driving may recommence after 1 week provided: LVEF>40%, no other urgent revascularisation planned within 4 wks If not successfully treated by coronary angioplasty: 4 wks If the patient in this scenario was a bus, taxi or lorry driver inform DVLA + cease driving for at least 6 weeks.

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145
Q

DVLA guidance after elective angioplasty?

A

1 week off driving

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146
Q

DVLA guidance after CABG?

A

4 wks off driving

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147
Q

DVLA guidance in someone with angina?

A

driving must cease if symptoms occur at rest/at the wheel

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148
Q

DVLA guidance after pacemaker insertion?

A

1 week off driving

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149
Q

DVLA Guidance after ICD insertion?

A

if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers

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150
Q

DVLA guidance after successful catheter ablation for an arrhythmia?

A

2 days off driving

151
Q

DVLA guidance for pt with aortic aneurysm (>6cm)?

A

notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving

152
Q

DVLA guidance for heart transplant?

A

do not drive for 6 weeks, no need to notify DVLA

153
Q

factors associated with poor prognosis for schizophrenia?

A

strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant

154
Q

Heberdens vs Bouchards?

A

Heberden’s nodes - swelling of the distal interphalangeal joints. Bouchard’s nodes - swelling of proximal interphalangeal joints

155
Q

What HbA1c might warrant addition of diabetic medications?

A

58 mmol/mol (7.5%)

156
Q

1st line diabetic medication after lifestyle interventions?

A

metformin

157
Q

2nd line diabetic medication after addition of metformin + HbA1c > 58mmol/mol?

A

a second drug should be added from the following list: sulfonylurea gliptin pioglitazone SGLT-2 inhibitor

158
Q

triple therapy options: diabetic medication if HbA1c still > 58mmol/mol?

A
  1. metformin + gliptin + sulfonylurea 2. metformin + pioglitazone + sulfonylurea 3. metformin + sulfonylurea + SGLT-2 inhibitor (-gliflozin) 4. metformin + pioglitazone + SGLT-2 inhibitor OR insulin therapy should be considered
159
Q

features of seborrhoeic dermatitis?

A
  • eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds - otitis externa and blepharitis may develop
160
Q

Scalp management in seborrhoeic dermatitis?

A
  • OTC preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) are first-line - 2nd line: ketoconazole - selenium sulphide and topical corticosteroid may also be useful
161
Q

What conditions are assoc w seborrhoeic dermatitis?

A

HIV, Parkinsons disease

162
Q

Management of body+ face in seborrhoeic dermatitis?

A
  • Topical antifungals: e.g. ketoconazole - topical steroids: best used for short periods - difficult to treat - recurrences are common
163
Q

management of acne rosacea?

A
  1. mild - topical metronidazole 2. predominant flushing but limited telangiectasia: topical brimonidine gel 3. more severe disease: systemic antibiotics e.g. Oxytetracycline
164
Q

1st line management of angina?

A

Beta blocker or CCB. if CCB alone: verapamil / diltiazem if used w CCB: use modified release nifedipine

165
Q

medications one can give in renal stone management?

A

1st line: diclofenac IM alpha-adrenergic blockers can aid ureteric stone passage

166
Q

causes of bradycardia in Cardiotocography?

A

HR<100. Increased fetal vagal tone, maternal beta-blocker use

167
Q

causes of tachycardia in Cardiotocography?

A

HR>100. Maternal pyrexia, chorioamnionitis, hypoxia, prematurity

168
Q

causes of Loss of baseline variability in cardiotocography?

A

< 5 beats / min. Prematurity, hypoxia

169
Q

causes of variable decelerations independent of contractions in cardiotocography?

A

May indicate cord compression

170
Q

causes of early decelerations in cardiotocography? (ie. Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction)

A

Usually an innocuous feature and indicates head compression

171
Q

Causes of late decelerations in cardiotocography? (ie. Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction)

A

Indicates fetal distress e.g. asphyxia or placental insufficiency

172
Q

Booking visit? when?

A

8 - 12 wks, ideally <10

173
Q

What happens at booking visit?

A

Booking visit: - general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes - BP, urine dipstick, check BMI - Booking bloods/urine: FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies - hepatitis B, syphilis - HIV test is offered to all women - urine culture to detect asymptomatic bacteriuria

174
Q

Dating scan?

A

10 - 13+6 wks. To exclude multiple pregnancy

175
Q

When does nuchal scan for downs syndrome screening occur?

A

11 - 13+6 weeks

176
Q

when is anomaly scan?

A

18 - 20+6 weeks

177
Q

What happens at 28 wks for antenatal care?

A

Second screen for anaemia and atypical red cell alloantibodies. First dose of anti-D prophylaxis to rhesus negative women

178
Q

When is the second dose of anti-D prophylaxis given?

A

34 weeks

179
Q

causes of painless genital ulcers?

A

C. trachomatis causes lymphogranuloma venereum; T. pallidum causes syphilis; K. granulomatis causes granuloma inguinale.

180
Q

Chancroid features?

A
  • tropical disease caused by Haemophilus ducreyi. - painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. - The ulcers typically have a sharply defined, ragged, undermined border.
181
Q

typical features of neuroleptic malignant syndrome?

A
  • pyrexia - muscle rigidity - autonomic lability: typical features include hypertension, tachycardia and tachypnoea - agitated delirium with confusion - may see raised CK, AKI, raised WCC
182
Q

management of neuroleptic malignant syndrome?

A
  1. stop antipsychotic 2. IV fluids to prevent renal failure 3. dantrolene may be useful in selected cases (decreasing the release of calcium from the sarcoplasmic reticulum) 4. bromocriptine, dopamine agonist, may also be used
183
Q

trigger for cluster headache?

A

alcohol

184
Q

prophylaxis for cluster headaches?

A

verapamil

185
Q

what medication can you use for stress incontinence?

A

duloxetine: a combined noradrenaline and serotonin reuptake inhibitor - mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction

186
Q

how to monitor response to treatment in rheumatoid arthritis?

A

CRP + DAS28

187
Q

mx of flares of rheumatoid arthritis?

A

oral or intramuscular corticosteroid

188
Q

what TNF inhibitors can u use in rheumatoid arthritis?

A

Etanercept, infliximab, adalimumab

189
Q

features of rhabdomyolysis?

A
  • acute kidney injury with disproportionately raised creatinine - elevated creatine kinase (CK) - myoglobinuria - hypocalcaemia (myoglobin binds calcium) - elevated phosphate (released from myocytes) - hyperkalaemia (may develop before renal failure) - metabolic acidosis
190
Q

Causes of rhabdomyolysis?

A

seizure collapse/coma (e.g. elderly patients collapses at home, found 8 hours later) ecstasy crush injury McArdle’s syndrome drugs: statins (especially if co-prescribed with clarithromycin)

191
Q

Ix for suspected age related macular degeneration?

A

1st line: slit-lamp microscopy - to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD. 2. fluorescein angiography if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation. 3. ocular coherence tomography is used to visualise the retina in three dimensions, because it can reveal areas of disease which aren’t visible using microscopy alone.

192
Q

features of post thrombotic syndrome?

A
  • painful, heavy calves - pruritus - swelling - varicose veins - venous ulceration
193
Q

management of post thrombotic syndrome?

A
  • elastic graduated compression stockings - keep leg elevated
194
Q

Risk factors of prostate cancer?

A

increasing age, obesity, Afro-Caribbean ethnicity, family history

195
Q

initial empirical therapy for suspected meningitis in <3 months old or >50 years old?

A

IV cefotaxime + amoxicillin

196
Q

initial empirical therapy for suspected meningitis in 3 months - 50 years old?

A

IV cefotaxime OR Children > 3m (updated guidelines): IV ceftriaxone

197
Q

Empirical therapy for meningococcal meningitis?

A

IV Benzylpenicillin or Cefotaxime

198
Q

empirical therapy for pneumococcal / haemophilus influenza meningitis?

A

IV cefotaxime

199
Q

Empirical therapy for meningitis caused by listeria?

A

IV amoxicillin + Gentamicin

200
Q

What is used in empirical treatment of meningococcal meningitis if patient has immediate hypersensitivity reaction to penicillin/ cephalosporins?

A

Chloramphenicol

201
Q

what happens to pregnant women who are not immune to MMR?

A

MMR cannot be given during pregnancy. She needs to keep away from people who might have M/M/R and be offered the MMR vaccination in the postnatal period.

202
Q

Rubella in pregnancy: Risk to fetus ?

A
  • up to 90% risk of damage in first 8-10 wks. - sensorineural deafness - congenital cataracts - congenital heart disease (e.g. PDA) - growth retardation - hepatosplenomegaly - purpuric skin lesions - ‘salt and pepper’ chorioretinitis - microphthalmia - cerebral palsy
203
Q

CMV infection in pregnancy: risk to baby?

A

cerebral calcification, microcephaly and sensorineural deafness

204
Q

Risk of Varicella Zoster infection in pregnancy: risk to baby?

A

Fetal varicella syndrome: skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

205
Q

Mx of patient who presents within 7 days of clinically suspected TIA?

A

300mg Aspirin immediately + Refer for specialist review within 24h

206
Q

management of congenital inguinal hernias?

A
  • resulting from a patent processus vaginalis Should be surgically repaired soon after diagnosis as at risk of incarceration
207
Q

management of acute otitis externa? in mild cases - mild discomfort, no deafness or discharge

A

consider topical acetic acid 2% spray.

208
Q

management of acute otitis external with severe inflammation e.g. with deafness/ discharge?

A

7 days of a topical antibiotic +/- topical steroid.

209
Q

causes of otitis externa?

A

infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal, seborrhoeic dermatitis, contact dermatitis (allergic and irritant)

210
Q

posterior vitreous detachment vs retinal detachment?

A

PVD: flashes of light in peripheries, floaters (often on temporal side). Retinal detachment: dense shadow that starts peripherally progresses towards central vision. Veil/ curtain. Straight lines appear curved, central vision loss

211
Q

Vitreous haemorrhage features?

A

large bleeds can cause sudden visual loss. moderate bleeds can cause numerous dark spots. small bleeds may cause floaters

212
Q

management of perforated tympanic membrane?

A
  • watch and wait. usually heals after 6-8 weeks. - Prescribe antibiotics to perforations which occur following episode of acute otitis media - refer to ENT for consideration of tymapnoplasty at 6-8 wks if it persists for 1 mo
213
Q

features of patent ductus arteriosus

A

left subclavicular thrill, continuous machinery murmur, wide pulse pressure, large volume bounding collapsing pulse, heaving apex beat

214
Q

What is Foucher’s sign?

A

increase in tension of Baker’s cyst on extension of the knee

215
Q

neonatal blood spot screening tests for?

A
  • congenital hypothyroidism - cystic fibrosis - sickle cell disease - phenylketonuria - medium chain acyl-CoA dehydrogenase deficiency (MCADD) - maple syrup urine disease (MSUD) - isovaleric acidaemia (IVA) - glutaric aciduria type 1 (GA1) - homocystinuria (pyridoxine unresponsive) (HCU)
216
Q

Mx of Bacterial vaginosis in pregnancy?

A

Symptomatic BV assoc w late miscarriage and preterm delivery. Oral metronidazole 400mg BD for 5-7 days

217
Q

Features of Peutz-Jeghers syndrome?

A

hamartomatous polyps in GI tract (mainly small bowel), pigmented lesions on lips, oral mucosa, face, palms and soles, intestinal obstruction e.g. intussusception, GI bleeding

218
Q

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers

A

Edward’s syndrome (trisomy 18)

219
Q

Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions

A

Patau syndrome (trisomy 13)

220
Q

Micrognathia , Posterior displacement of the tongue (may result in upper airway obstruction), Cleft palate

A

Pierre-Robin syndrome *this condition has many similarities with Treacher-Collins syndrome. One of the key differences is that Treacher-Collins syndrome is autosomal dominant so there is usually a family history of similar problems

221
Q

Learning difficulties Macrocephaly Long face Large ears Macro-orchidism

A

Fragile X

222
Q

Hypotonia Hypogonadism Obesity

A

Prader-Willi syndrome

223
Q

Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis

A

Williams syndrome

224
Q

Characteristic cry due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism

A

Cri du chat syndrome (chromosome 5p deletion syndrome)

225
Q

management of lithium toxicity?

A

mild-moderate: volume resuscitation severe: haemodialysis

226
Q

features of digoxin toxicity?

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia

227
Q

Ansel criteria for BV?

A
  • clue cells on saline smear (most specific) - ph >4.5 - characteristic thin, grey homogeneous discharge - positive whiff test (up to 70%)
228
Q

choice of anti epileptic in pt on warfarin?

A

lamotrigine

229
Q

First line treatment for capillary haemangioma?

A

Propranolol If topical beta blockers used, may use timolol

230
Q

Potential complications of capillary haemangiomas aka strawberry naevus?

A
  • mechanical, e.g. obstructing visual fields or airway - bleeding - ulceration - thrombocytopenia
231
Q

What vitamin supplementation is recommended to all pregnant and breastfeeding women?

A

Vitamin D

232
Q

Contraindications to gentamicin?

A

Myasthenia gravis

233
Q

Treatment of acne rosacea? Mild vs severe

A

Mild/ moderate: topical metronidazole Severe/ resistant: oral tetracycline e.g. oxytetracycline

234
Q

Causes of hemiballismus?

A

Stroke, SOL, traumatic brain injury, non ketotic hyperglycaemia (diabetes)

235
Q

Most common symptom of posterior circulation stroke?

A

Dizziness

236
Q

Common symptoms in posterior circulation stroke?

A

Often gets misdiagnosed as migraine. - double vision, disorientation, visual disturbance, confusion, memory loss, dizziness

237
Q

What is alopecia areata?

A

An autoimmune condition causing localised, well demarcated (usually coin shaped) patches of hair loss.

238
Q

Management of alopecia areata?

A
  • hair will regrow in 50% of patients by 1 year and in 80-90% eventually. - Careful explanation of natural course of condition - in 50% with no regrowth: trial of topical corticosteroids - referral to dermatologist if hair loss not responsive/ child/ pregnant or breast feeding
239
Q

mx of acne vulgaris in pregnancy?

A

erythromycin - doxycycline/ lymecycline CI in pregnancy/ breastfeeding - topical/ oral retinoid CI

240
Q

MX of suspected Meniere’s Disease?

A
  • routine referral to ENT to establish diagnosis - DVLA: cease driving until control of symptoms - acute attacks: buccal or IM prochlorperazine - prevention: betahistine and vestibular rehabilitation exercises may be of benefit
241
Q

mx of muscle spasticity in multiple sclerosis?

A
  • Baclofen and gabapentin are first-line. - Other options include diazepam, dantrolene and tizanidine - physiotherapy
242
Q

Mx of Bladder dysfunction in multiple sclerosis?

A
  • 1st line US. - if significant residual volume → intermittent self-catheterisation - if no significant residual volume → anticholinergics
243
Q

Mx of oscillopsia in multiple sclerosis? (visual fields apper to oscillate)

A

gabapentin is first-line

244
Q

Mx of CML 1st line?

A

imatinib

245
Q

primary thromboprophylaxis in antiphospholipid syndrome?

A

aspirin

246
Q

which type of testicular cancer has better prognosis?

A

seminomas > teratomas

247
Q

risk factors of testicular cancer?

A

infertility (increases risk by a factor of 3) cryptorchidism family history Klinefelter’s syndrome mumps orchitis

248
Q

Asherman’s syndrome?

A

intrauterine adhesions may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would ->> secondary amenorrhoea

249
Q

lateral epicondylitis: what movements are restricted?

A

pain worse on: wrist extension against resistance with the elbow extended + supination of the forearm with the elbow extended

250
Q

antidote for rivaroxaban?

A

Andexanet alfa: recombinant form of human factor Xa protein

251
Q

antidote for overdose of dabigatran?

A

Idarucizumab

252
Q

Pioglitazone: side effects?

A
  • weight gain - liver impairment -> monitor LFTs - fluid retention: CI in HF - increased risk #s - increased risk Bladder Ca
253
Q

Starting ACEi: what rise in Cr will you tolerate?

A

up to 30% rise from baseline

254
Q

Starting ACEi: what rise in K+ will you tolerate?

A

up to 5.5

255
Q

what antibiotic lowers seizure threshold in patients with epilepsy?

A

ciprofloxacin

256
Q

What should u do with someone’s Metformin medication (ideally) if they are due investigation containing contrast media?

A

Stop it on the day and for 48 hours after due to risk of renal impairment

257
Q

ankle inversion injury: what ligament is likely to be strained?

A

anterior talofibular ligament: it is the weakest of the lateral ligaments

258
Q

vaginal thrush in pregnancy - mx?

A

Clotrimazole pessary (local only). oral treatments are contraindicated

259
Q

What to prescribe as first line for Heart failure if pt has asthma (not tolerating BB) and HF?

A

amlodipine or felodipine

*Rate-limiting CCBs, such as verapamil and diltiazem, have the additional action of decreasing myocardial contractility and heart rate -> so not recommended in patients with heart failure

260
Q

effect of menstrual cycle on body temperature?

A

Rises following ovulation in response to higher progesterone levels

Falls prior to ovulation due to the influence of oestradiol

261
Q

management of endoscopically proven oesphagitis?

A

full dose PPI for 1-2 months

then low dose tx as required.

if no response then double dose PPI for 1 month

262
Q

mx of endoscopically negative reflux disease?

A

full dose PPI for 1 mo then low dose treatment PRN

if no response then H2RA or prokinetic for 1 mo

263
Q

what is ropinirole?

or bromocriptine, cabergoline

A

a dopamine agonist

  • uesd in parkinsons
264
Q

what is selegiline?

A

used in Parkinsons

  • a MAO-B inhibitor
265
Q

What is entacapone?

A

COMT inhibitor

  • used in Parkinsons
266
Q

long acting reversible contraceptive of choice for young people?

A

Nexplanon - the progesterone-only implant

267
Q

treatment of microprolactinoma?

A

dopamine agonist (e.g. bromocriptine, cabergoline) which inhibits prolactin release from pituitary gland

268
Q

What is the PERC rule?

A

all criteria must be present to rule out PE

269
Q

what is the abx of choice for prophylaxis of IECOPD?

A

azithromycin

270
Q

Malignancies assoc with EBV infection?

A

Burkitt’s lymphoma*

Hodgkin’s lymphoma

nasopharyngeal carcinoma

HIV-associated central nervous system lymphomas

271
Q

first line mx of threadworm?

A

mebendazole to pt and all household members

272
Q

Examples of Non sedating antihistamines?

A

loratidine and cetirizine

273
Q

Diagnostic investigation of choice for pancreatic cancer?

A

High resolution CT scan

274
Q

what malignancy is

Acquired ichthyosis
assoc with?

A

Lymphoma

ichythosis - widespread and persistent thick, dry, “fish-scale” skin

275
Q

what malignancy is tylosis assoc with?

A

oeosphageal SCC

tylosis = hyperkeratosis of the palms and soles

276
Q

what malignancy is associated with

Migratory thrombophlebitis?

A

pancreatic cancer

277
Q

what malignancy is associated with erythroderma?

A

lymphoma

278
Q

what malignancy is associated with

Erythema gyratum repens?

A

Lung cancer

  • type of annular erythema with a distinctive figurate ‘wood-grain’ appearance
279
Q

what malignancies are associated with Dermatomyositis?

A

ovarian, lung ca

280
Q

what malignancy is assoc w Sweet’s syndrome?

A

Haematological malignancy e.g. Myelodysplasia - tender, purple plaques

Sweet’s syndrome = (aka acute febrile neutrophilic dermatosis) fever + tender red or purple lumps or patches that may ulcerate

281
Q

what malignancy is assoc w

Necrolytic migratory erythema?

A

Glucagonoma

282
Q

what maligancies assoc w

Acquired hypertrichosis lanuginosa?

A

GI and lung ca

development of excessive, long, fine, nonpigmented hairs, preferentially located on the face.

283
Q

sewage worker/ farmer/ returning traveller with

fever, myalgia

subconjuctival haemorrhages,

+/-

AKI,

hepatitis,

aseptic meningitis

A

Leptospirosis

+/-

Weil’s disease

284
Q

Mx of Leptospirosis?

A

high-dose benzylpenicillin or doxycycline

285
Q

Main ix of leptospirosis?

A

serology: antibodies to Leptospira develop after about 7 days

286
Q

Mx of Allergic Bronchopulmonary Aspergillosis?

A

oral glucocorticoids

itraconazole is sometimes introduced as a second-line agent

287
Q

Drug causes of gynaecomastia?

A

spironolactone (most common drug cause)

cimetidine

digoxin

cannabis

finasteride

GnRH agonists e.g. goserelin, buserelin

oestrogens, anabolic steroids

288
Q

mx for prophylaxis with recurrent copd exacerbations?

A

consider azithromycin (usually 250 mg 3 times a week)

289
Q

Risks of Hormone Replacement therapy to treat postmenopausal symptoms?

with oral HRT vs transdermal

A

Oral:

​VTE, stroke

Coronary heart disease, breast ca, ovarian ca

Transdermal:

Coronary heart disease, breast ca, ovarian ca

290
Q

first line mx of gestational diabetes if plasma glucose fastin >7

A

insulin

if plasma level between 6.0-6.9 + evidence of complications such as macrosomia or hydramnios -> insulin too

291
Q

Mx of head lice?

A

Dimeticone 4% lotion

  • applied twice, with 7 days between

Wet combing

  • four applications over 2 weeks

Permethrin no longer recommended due to resistance

292
Q

Caplans Syndrome?

A

pulmonary fibrosis, usually in coal miners with rheuamtoid arthritis.

CXR shows multiple, well definied round nodules

293
Q

Mx of Caplans Syndrome?

A

steroids

  • exlcude TB first
294
Q

1st line ix for Cushing’s syndrome?

A

overnight dexamethasone suppression test

or

24h urinary free cortisol test

295
Q

telogen effluvium?

A

physiological (ie. infection) or stress

general thinning of hair

296
Q

anagen effluvium?

A

when chemo, immunotherapy or radiotx causes rapid hair loss

hair will return within a few months of stopping tx

297
Q

What is Ewart or Pins sign?

A
  • in pts w large pericardial effusions
  • an area of dullness, with bronchial breath sounds and bronchophony below the angle of the left scapula
298
Q

Mx of TB meningitis?

A

isoniazid, rifampicin, pyrazinamide, streptomycin

299
Q

when to organize an ultrasound of urinary tract of child >3 mo?

A

if atypical or recurrent UTI

atypical:

seriously ill, raised Cr, septicaemia, failure to respond to tx within 48h, non e coli organisms

recurrent:

2 or more with acute pyelo

3 or more lower UTI

1 pyelo + 1 or more lower uti

300
Q

anti-U1RNP antibodies?

A

Mixed connective tissue disease

  • features of scleroderma, SLE, rheumatoid arthrtits and myositis
301
Q

What drugs are associated with lichenoid eruptions ie. lichen planus?

A

ACEi

NSAIDs

Methyldopa

Chloroquine

Oral antidiabetics

Thiazide diuretics

Gold

302
Q

what. causes constipation in Parkinsons disease?

A

lewy body degeneration in the myenteric plexus of the colon -> slow transit times, megacolon, intestinal pseudo-obstruction, volvulus

exacerbated by medication e.g. dopamine agonist & antimuscarinics

303
Q

most common organism in erysipelas?

A

superficial form of cellulitis

  • Stretococcus pyogenes
304
Q

cracked red lips, mouth ulcers, angular cheilitis, sore throat

what vitamin deficiency?

A

RIbaflavin (B2)

  • can also cause dry scaling skin, IDA, bloodshot itchy eyes.
  • angular cheilitis, photophobia and scrotal dermatitis
305
Q

rubbery subcutaneous swelling on lateral aspect of the right eyebrow?

A

Dermoid cyst

  • cystic teratoma containing developmentally mature skin
  • usually occur in young children
  • near lateral aspect of the eyebrow

benign

306
Q

what extraintestinal features of IBD are related to activity of colitis?

A

Erythema nodosum

aphthous ulcers

episcleritis

acute arthropathy

307
Q

what extraintestinal features of IBD are not related to activity of colitis?

A

sacroiliitis

ank spond

primary sclerosing cholangitis

308
Q

what do you see in wet exudative age related macular degeneration?

A

choiroidal neovascularisation

  • development of immature blood vessels that grow between the retinal pigment epitheial cells and the photoreceptor cells
309
Q

twice daily spike in temp causes?

A

Visceral leishmaniasis

adult Stills disease

310
Q

advice if missed progestogen only pill?

A

missed pill = >3h overdue (except for Cezarette- desogestrel where 12h period allowed

take missed pill now and extra protection for next 48h

311
Q

medication to help cancer related anorexia?

A

steroids

  • pred 15-30mg daily or dexamethasone 2-4mg daily
312
Q

medication for palliative related constipation?

A

co-danthramer (combination laxative stimulant/softener)

313
Q

1st line mx of partial seizures

A

carbmazepine

314
Q

1st line mx of myoclonic seizures?

A

sodium valproate

315
Q

1st line mx of generalized tonic clonic seizures?

A

sodium valproate

lamotrigine (ie. in pregnancy)

316
Q

1st line mx of absence seizures?

A

ethosuximide

sodium valproate

317
Q

mx of refractory convulsive status epilepticus?

A

IV midazolam

318
Q

rose colored rash after several days of fever?

A

roseola (aka exanthem subitum)

caused by HHV 6

319
Q

what antihypertensive worsens glycaemic control?

A

thiazides e.g bendroflumethazide

beta blockers

320
Q

which lung cancer is most assoc w hyperca?

A

Squamous cell lung cancer

-> PTHrP -> Hyperca

321
Q

what blood group is assoc w increased risk of gastric ca?

A

blood group A

322
Q

what antidiabetic medication causes increased risk UTI?

A

Dapagliflozin

  • sodium glucose co transporter 2 inhibitor
  • increases excretion of excess glucose in urine
323
Q

mx of ethmoidal sinusitis?

A

surgical drainage of the sinuses

followed by abx

  • ethmoidal sinusitis is one of the most common causes of orbital cellulitis
324
Q

MOA of pioglitazone?

A

reduces peripheral insulin resistance

325
Q

MOA of DPP4 inhibitors e.g. sitagliptin?

A

increases insulin secretion

lower glucagon secretion

326
Q

what is a furunculosis?

A

infection of a hair follicle in the external canal

  • > usually staph
  • severe pain exacerbated by pressure on tragus/ movement of pinna

usually runs their course within 4-10 days

327
Q

what is bullous myringitis?

A

painful vesicles on the tympanic membrane

  • assoc with viral resp infections, mycoplasma
  • often occurs w bacterial otitis media

Mx: abx, analgesia, surgical drainage of vesicles

328
Q

earliest sign of diabetic retinopathy>

A

microaneurysms

  • outpouching of capillaries
329
Q

milk alkali syndrome?

A

triad hyperCa, renal failure, met alkalosis

secondary to ingestion of large amts of calcium and absorbable alkali

historically due to milk and alkali given for peptic ulcer disease

330
Q

comminuted fracture of the metacarpal base of thumb?

A

rolando fracture

331
Q
A

Pitted keratolysis

  • affects people who sweat excessively
  • damp, smelly feet
  • corynebacterium
  • white with clusters of punched out pits
332
Q
A

Palmoplantar pustulosis

  • affects palms and soles
  • crops of sterile pustules, with thickened, red skin
  • skin scaly, may crack

more common in smokers

333
Q
A

juvenile plantar dermatosis

  • affects children
  • more common in atopy/ eczema
  • shiny, hard soles with cracks causing pain

worse in the summer

334
Q
A

verruca/ mosaic wart

  • secondary to HPV
  • firm, hyperkeratotic
  • pinpoint petechiae centrally within lesion
335
Q

Which lipid lowering drug acts as a bile acid sequestrant, binding bile in the GI tract to prevent its reabsorption?

A

Cholestyramine

  • increased bile excreted in faeces
  • as bile acids are excreted, plasma cholesterol -> bile acid to normalize bile acid levels thereby lowering plasma [cholesterol]
  • can also be used to treat itching that occurs w liver failure due to liver’s inability to eliminate bile
336
Q

SEs of cholestyramine (bile acide sequestrant)?

A

most frequent: constipation

increased risk of gallstones

tooth discoloration/ erosion/ decay from prolonged oral exposure to suspension

337
Q

mx of hyperthyroidism in pregnancy?

A

pre-conception: Thyroidectomy

  • ablation w radiotx can be offered, but cannot become pregnant in next 6 mo

1st trimester: Propylthiouracil

(Carbimazole high risk of congenital abnormalities)

2nd trimester: Carbimazole

(PTU risk of severe hepatic injury)

338
Q

most common pathogen in Fournier’s gangrene?

A

Strep pyogenes

339
Q

Asbestosis - Highest risk of developing which cancer?

A
  1. Lung Cancer

(mesothelioma rarer)

340
Q

what can precipitate wernickes encephalopathy?

A

infusion of glucose

341
Q

which antidepressant is first line in obese patient?

A

fluoxetine

342
Q

which antidepressants have lowest drug interactions and thus best for elderly?

A

citalopram, sertraline

343
Q

best antidepressant post MI?

A

sertraline

344
Q

what is the ABCD2 score?

A

determines the risk of stroke within first 2 days post TIA

345
Q

what makes up the ABCD2 score?

A

A: Age >/= 60 (1)

B: BP (>140 syst/ >90 diastolic) - 1

C: Clin features

  • unilateral weakness = 2 pt
  • speech disturbance w/o weakness = 1 pt

D: duration of symptoms

60 or more mins: 2 pt

10 -59 = 1 pt

D: diabetes = 1 pt

Total score:

6-7 pts = high risk

346
Q

first line antiemetic for n+v in advanced cancer due to:

mechanical obstruction

raised ICP

motion sickness

A

cyclizine

347
Q

first line antiemetic for N+V in advanced cancer due to metabolic causes ie.

renal failure, hyperCa?

A

haloperidol

348
Q

preferred SSRIs in breastfeeding ladies?

A

Paroxetine, sertraline

349
Q

advice re: diet to reduce risk of kidney stones?

A

normal calcium intake, low oxalate intake

  • reduce tea, chocolates, nuts, strawberries, rhubarb, spinach
  • drink plenty of fluids
350
Q

When would u do ERCP > cholecystectomy?

A
  • too high risk for cholecystectomy if:
  • recent cholangitis or recent acute pancreatitis or in the presence of jaundice
  • abnormal LFTs (ALP > 2x Normal)
  • dilated CBD >10mm
351
Q

cataracts, muscle weakness, frontal balding

A

myotonic dystrophy

  • autosomal dominant
  • degree of anticipation
352
Q

features of myotonic dystrophy?

A

facial weakness

hollowing of temples

atrophy of jaw muscles

frontal balding

grip myotonia (often 1st symptom)

progressive muscle weakness and wasting -> scm, distal limb muscles first

353
Q

Mx of UTI in patient with CKD (eGFR<45)?

A

Trimethoprim

  • AVOID nitrofurantoin as risk of peripheral neuropathy + ineffective bc of inadequate urine concentrations
354
Q

Mx of acute dystonic reactions following administration of antipsychotic?

A

Procyclidine

355
Q

acne conglobata?

A

unusually severe form of acne

  • characterized by burrowing and interconnecting abscesses and irregular scars

can be induced by anabolic steroid abuse

assoc w hydradenitis suppurativa

356
Q

Freiburg’s syndrome?

A

osteochondritis affecting the toes - articular surfaces of the 2nd/ 3rd metatarsal heads collapse

commonest in girls, 12-15 yo

pain on weight bearing

357
Q

Most likely pathogen in Fournier’s gangrene?

A

Strep pyogenes

358
Q

Ottawa knee rules - when to order a knee XR?

A
  1. Age 55 or over
  2. Isolated tenderness over the patella
  3. Tenderness at the head of the fibula
  4. Inability to flexto 90 degrees
  5. Inability to weight bear both immediately and in ED
359
Q

If CCB is not tolerated due to ankle swelling, what is the medication to prescribe next for HTN?

A

thiazide-like diuretic

ie. indapamide

360
Q

which conditions cause a twice daily spike in temperature?

A

Visceral leishmaniasis

Adult Stills disease

361
Q

management of head lice?

A

dimeticone lotion

  • applied twice w 7d in between

wet combing

362
Q

intractable cough in palliative care?

A

oral morphine

363
Q

SE of aromatase inhibitors for ER+ve Breast Cancer?

ie. anastrazole, letrozole

A

reduces peripheral oestrogen synthesis

  • Osteoporosis
  • hot flushes

arthralgia, myalgia, insomnia

364
Q

What is screened for in heel prick test?

A

phenylketonuria

congenital hypothyroidism

Sickle cell

cystic fibrosis

MCADD

Maple syrup urine disease

homocystinuria

glutaric acidaemia type 1

isovaleric acidaemia

365
Q

Defect in amino acid metabolism

  • very fair child with pale blue eyes
  • general learning disability
  • behavioural problems including self mutilation

unusual musty odour

A

Phenylketonuria

  • autosomal recessive deficiency of phenylalanine hydroxylase -> build up of phenylalanine
    tx: diet low in foods containing phenylalanine
366
Q

Amino acid disorder

  • sweet odour of maple syrup found in urine and sweat
  • encephalopathy and progressive neurodegeneration
  • infants seem health at birth, developing poor feeding and vomiting in 1st wk of life -> lethargy and coma with brain damage

if untreated - death occurs in first 5 months

A

Maple syrup urine disease

  • auto recess
  • build up of branched chain aas (leucine, isoleucine, valine)
    tx: diet low in foods that contain branched chain amino acids
367
Q

amino acid disorder

multi-systemic disorder of CNS, msk, cardiovasc systems

  • appear normal at birth, serious complications in childhood
  • learning disability, seizures, psych disorder
  • marfanoid, dislocation of lens downwards and medially, myopia, glaucoma
A

Homocystinuria

  • auto reccess, accumulation of homocysteine
  • no cure
  • tx w high doses of vit b6 (pyridoxine)
368
Q

amino acid disorder

  • movement disorder in first 2 years of life
  • increased Head circumference in infancy
  • neurological decompensation (basal ganglia neuronal loss)
A

glutaric acidaemia type 1

  • auto recess
  • build up of lysine, hydroxylysine, tryptophan
  • causing basal ganglia neuronal loss
369
Q

amino acid disoder

  • apparent within few days after birth

poor feeding, vomiting, seizures, lack of energy -> coma

in some: episodic features triggered by infection/ eating increased amt of protein-rich foods

  • distinctive odour of sweaty feet
A

isovaleric acidaemia

  • auto recess
  • build up of isovaleric acid which is toxic to CNS

*distinctive odour of sweaty feet

tx: diet low in leucine

370
Q

amino acid disorder

  • episodic neurologic and dermatologic features

(provoked by change of season w increasing sunlight, febrile illness, poor nutrition, increased physical activity)

  • symptoms progress over several days and last 1-4 wks before spontaneous remission
  • cutaneous signs preceding neurologic / psych symptoms
A

Hartnup disease

  • auto reccess
  • defective renal and intestinal absorption of amino acids
  • tx with high protein diet to overcome defective absorption, supplement with nictotinic acid and avoid excessive exposure to sunlight
371
Q

typically presents in milk fed infants shortly after birth

results in cataracts, hepatosplenomegaly, intellectual disability

A

galactosaemia

  • failure to break down galactose to glucose
372
Q

perennial allergic rhinitis

cause?

A

house dust mites

symptoms occur throughout the year

373
Q

interaction between simvastatin and amlodipine?

A

concurrent use of amlodipine and simvastatin causes significant increase in blood lvls of simvastatin

as simvastatin is metabolized by CYP3A4 & amlodipine is a weak inhibitor of CYP3A4

MSRA (11 decks)

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