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MSRA > Mixed practice review > Flashcards

Mixed practice review Flashcards

1
Q

Visual field defects:

Define congruous vs incongruous:

Homonymous hemianopia - sites of:

Incongruous defect:

Congruous defect:

Macular sparing:

A

A congruous defect: complete or symmetrical visual field loss
Incongruous defect: incomplete or asymmetric.

Incongruous defect: Lesion of optic tracts

congruous defect: lesion of optic radiation or occipital cortex

macula sparing: lesion of occipital cortex

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2
Q

Visual field defects:

Homonymous quadrantopias:

Superior vs inferior

A

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)

inferior: lesion of the superior optic radiations in the parietal lobe

mnemonic = PITS (Parietal-Inferior, Temporal-Superior)

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3
Q

Bitemporal hemianopia: sites of compression
Lesion site?

Upper quadrant defect
Lower quadrant defect

A

lesion of optic chiasm

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

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4
Q

Bell’s Palsy

Forehead:

Treatment:

A

Not spared - lower MN lesion thus forehead affected by paralysis

Oral prednisolone and artificial tears

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5
Q

Urge incontinence management:

A

1) Bladder re-training for 6 weeks
2) Anti-muscarinics: Oxybutinin (immediate release) or tolterodine (immediate release)

Oxybutinin should be avoided in frail elderly people
Mirabegron may be used if concerned about anti-cholinergic side-effects

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6
Q

Stress incontinence management

A

Pelvic floor excercises

surgical procedures: e.g. retropubic mid-urethral tape procedures

Duloxetine may be offered to women if they decline surgical procedures

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7
Q

Features of essential tremor

Management

A

Postural tremor:
Worst when arms outstretched
Improved by alcohol and rest
Most common cause of titubation (head tremor)

Management: Propranolol

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8
Q

Hypertrophic obstructive cardiomyopathy (HOCM)

Management:

Drugs to avoid:

A

ABCDE
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defib
Dual chamber pacemaker
Endocarditis prophylaxis

Nitrates
ACEis
Inotropes

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9
Q

T2DM Diagnosis

1) If symptomatic:

2) If asymptomatic

A

1) Fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test

2) On two occasions: HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus

HbA1c value of less than 48 mmol/mol (6.5%) does not exclude diabetes (i.e. it is not as sensitive as fasting samples for detecting diabetes)

In patients without symptoms, the test must be repeated to confirm the diagnosis

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10
Q

Impaired glucose tolerance criteria:

A

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

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11
Q

Factors affecting HbA1c
1) Falsely elevated

2) Falsely reduce

A

1) Due to increased RBC lifespan: IDA, Splenectomy, Vit B12 and folic acid def.

2) Due to reduced RBC lifespan: Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

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12
Q

AF pharmacologic cardioversion methods:

Which cannot be used in structural heart disease

A

Amiodarone

Flecainide (if no structural heart disease)

others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone

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13
Q

Genital ulcers:

single painless:
single painful:
Multiple painless:
Multiple painful:

A

single painless: syphilis
single painful: Haemophillus ducreyi (chancroid)
Multiple painless: HPV warts
Multiple painful: Herpes Simplex

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14
Q

Potential class of side effects of Donepezil

May be exacerbated by:

A

Bradycardia -> SA/AV block

Rate limiting CCBs -> Verapamil

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15
Q

Acute ischaemic stroke management:

A

If within 4.5 hours of symptoms on-set = thrombolysis AND thrombectomy
If within 6 hours = thrombectomy

if well within 6-24 hours = thrombectomy

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16
Q

SVT with haemodynamic compromise Tx.

A

SYNCHRONISED DC Cardioverson

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17
Q

Apple core sign seen in:

A

Oesophageal cancer

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18
Q

Most common endogenous cause of Cushing’s

A

PITUITARY adenoma

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19
Q

Endometrial cancer risk factors:

Protective factors:

A

Excess oestrogen (nulliparity,early menarche,late menopause,unopposed oestrogen

Metabolic syndrome (obesity, diabetes, PCOS)

Smoking, multi-parity, COCP

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20
Q

Acute epiglottitis
Causative organism:

Diagnosis

Treatment:

A

Haemophilus I. type B

Clinically or may use X-ray (thumb-sign)

Oxygen + IV antibiotics

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21
Q

Red eye:
Answer:
pain or no pain?
visual acuity affected?
Pupil size/dilated?
other features

Acute angle closure glaucoma
Anterior uveitis
Scleritis
Endophthalmitis

A

Acute angle closure glaucoma:
Severe pain
Reduced VA, patient sees haloes
Semi-dilated pupil
Hazy cornea

Anterior uveitis
Acute onset, pain, blurred vision and photophobia
Small fixed oval pupil, ciliary flush

Scleritis
Severe pain, worse with movement

Endophthalmitis
Painful red eye, visual loss following intraocular surgery

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22
Q

Rinne’s and Weber’s

Normal
CHL
SNHL

A

Normal: Rinne = AC>BC // Weber= midline

CHL: Rinne = BC>AC (affected ear) Weber: Lateralised to affected ear (contrary to instinct)

SNHL = AC>BC Weber: Lateralises to unaffected ear

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23
Q

Blurring of vision again years after cataract surgery may be due to:

A

Posterior capsule opacification

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24
Q

Cauda Equina:
Causes - most common:
Discs affected:

A

Most common cause is central disc prolapse L4/L5 or L5/S1
Other causes: tumours, infection, trauma, haematoma

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25
Q

Degenerative cervical myelopathy
Risk factors:

Symptoms

Hoffman’s sign

Test of choice

A

smoking, genetics, occupation (high axial loads)

Pain (affecting the neck, upper or lower limbs)
Loss of motor function
Loss of sensory function causing numbness
Loss of autonomic function (urinary/faecal incontinence)

Gently flicking one finger on patients hand

MRI -> to then be referred to orthopaedic spinal team

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26
Q

Accumulation of acetylcholine features (SLUD)

A

Salivation
Lacrimation
Urination
Defecation/diarrhoea

Also small pupils, muscle fasciculation

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27
Q

Malignant otitis externa
Most common organism:

Key features:

Investigation:

Antibiotics

A

Pseudomonas aeruginosa

Diabetes (90%) or immunosuppression
Severe, unrelenting deep-seated otalgia, purulent otorrhoea, dysphagia, hoarseness, and/or facial nerve dysfunction

CT scan

Ciprofloxacin

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28
Q

BMI classes:

<18.5
18.5 - 24.9
25 -29.9
30 -34.9
35 - 39.9
>40

A

<18.5 underweight
18.5 - 24.9 Normal
25 -29.9 Overweight
30 -34.9 Obese ( I )
35 - 39.9 Clinically obese ( II )
>40 Morbidly obese ( III )

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29
Q

Phaeochromocytoma:

Secretes:
Where:
Features:
Tests:
Treatment:

A

Catecholamines

Adrenals

Hypertension, headaches, palpitations, sweating, anxiety

24 hour urinary collection of metanephrines

Phenoxybenzamine (alpha blocker) given BEFORE Beta blocker e.g propranolol

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30
Q

Preferred SSRI in MI

A

Sertraline

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31
Q

Suspected colorectal cancer pathway:
Change

A

Now use FIT tests more widely rather than colonoscopy first line:

NICE recommend a FIT is used to guide referral in the following scenarios:

with an abdominal mass, or

with a change in bowel habit, or

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

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32
Q

Which cognitive impairment may present with intermittent confusion/fluctuating cognition:

A

Lewy Body dementia

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33
Q

Asthma initial tests

A

FeNO and bronchodilator reversibility test

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34
Q

Most common cause of traveller’s diarrhoea

Profuse watery diarrhoea, NOT common amongst travellers

Flu-like prodrome followed by crampy abdominal pains - may mimic appendicitis. Complications include GBS

2 types: vomiting within 6 hours (rice) or diarrhoeal illness occurring after 6 hours

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last several weeks

Prolonged non-bloody diarrhoea

A

E.coli

Cholera

Campylobacter

Bacillus Cereus

Amoebiasis

Giardiasis

35
Q

STEMI -> PCI: drugs to give

Fibrinoysis for MI:
what should be given at same time:
Following procedure:

A

Prasugrel with unfractionated heparin and bailout glycoprotein IIb/IIIa inhibitor

Antithrombin (Fondaparinux)
Ticagrelor

36
Q

Vaccinations:

Live attenuated viruses:

Inactivated form

A

BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid

rabies
hepatitis A
influenza (intramuscular)

37
Q

Pneumonia causing skin rash (erythematous lesions on trunk)

Treatment:

A

Mycoplasma Pneumoniae

Doxycycline or macrolide (clindamycin (C.diff risk) or erythromycin)

38
Q

Pneumonia organism secondary to influenza infection:

A

Staph aureus

39
Q

Capgras syndrome:

A

Delusion that people have been replaced by an identical imposter

40
Q

Cluster headaches:
Acute management:
Prophylaxis

A

100% oxygen + Sc triptan

Prophylaxis: Verapamil

41
Q

Asthma steps of therapy:

A

1) SABA
2) SABA ICS
3) SABA ICS LTRA
4) SABA ICS LABA
5) SABA LTRA MART
6) SABA LTRA med dose MART
7) SABA LTRA high dose MART

MART is ICS plus LABA in single inhaler

42
Q

Pneumonia with cavitation on XR organism:

A

Klebsiella Pneumoniae

43
Q

Asthma assessment of severity features:
Moderate:
Severe:
Life threatening:

A

Moderate:
PEFR 50-75% best or predicted
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

44
Q

Time restrictions for delivering PPCI in STEMI

A

Within 12 hours of symptoms on-set
and within 2 hours of presentation

45
Q

Gout management
Acute:

ULT: When offered
What it involves: first line agent
Second line agent

A

monosodium urate

NSAIDs or colchicine are first line
Oral steroids may be considered if NSAIDs or colchicine contraindicated
If patient taking allopurinol already it should be CONTINUED

After first attack of gout
2 weeks after exacerbation - ALLOPURINOL first line
Colchicine cover should be considered when starting allopurinol.

Febuxostat (also a xanthine oxidase inibitor)

46
Q

Overstimulation of parasympathetic system (as seen in organophosphate poisoning) symptoms : DUMBELS mnemonic

A

Defecation and diaphoresis
Urinary incontinence
Miosis (pupil constriction)
Bradycardia
Emesis
Lacrimation
Salivation

More in depth than SLUD

47
Q

Examples of dopamine receptor antagonists
Commonly used in
side effects

A

Bromocriptine, ropinirole, cabergoline
Parkinson’s
Impulse control disorder, hallucinations, daytime somnolence

Cabergoline and bromocriptine may cause pulmonary, retroperitoneal and cardiac fibrosis

48
Q

Features of Tetralogy of Fallot (4)

A

VSD
RV hypertrophy
Overriding aorta
RV outflow tract obstruction

49
Q

Difference between DKA and alcoholic ketoacidosis

A

Normal or low glucose in AKA

50
Q

5 red rashes of childhood:

Cold with fever which is followed 1-2 weeks later by erythematous rash across the trunk and limbs:

Starts with erythematous rash behind the ears and spreads to rest of body. Associated with fever, conjunctivitis, coryzal symptoms and white Koplik spots inside the mouth:

Rash first appears on the cheeks, spreading to trunk and arms, preceded by 2-5 days of mild fever and non-specific viral symptoms

Caused by group A strep usually begins as tonsillitis, red-pink rash that begins on the trunk. Associated with fever, strawberry tongue and cervical lymphadenopathy

A

Roseola infantum

Measles

Parvovirus B19

Scarlet fever

51
Q

Hypersensitivity reaction, commonly caused by infections. Commonly caused by herpes simplex virus.
Appears as target lesions, initially seen on the back of hands before spreading to the torso.
Also seen as a drug reaction to penicillin, NSAIDs, COCP, SLE, sarcoidosis and malignancy

A

Erythema multiforme

52
Q

Marker of acute infection in Hep B
How long does this typically last

Antibody implying immunity

Antibody implying current or previous infection.

Which immunoglobulin is seen in acute infection, which one persists

A

HBsAg
1-6 months

Anti-HBs - negative in chronic disease

Anti-HBc

IgM -> IgG

53
Q

Monomorphic punched out lesions

Caused by

A

Eczema herpeticum

HSV 1or 2

54
Q

Management of varicella zoster (shingles)

Main benefit of antivirals

A

Antivirals within 72 hours unless <50 with mild truncal rash

Reduced incidence of post-herpetic neuralgia

55
Q

Most common testicular swelling with posterior swelling, separate to testicle

Soft non-tender swelling of the hemi-scrotum, usually anterior to and below the testicle, transilluminates with pen torch

Most common on the left side, bag of worms associated with subfertility

A

Epidiymal cyst

Hydrocele

Varicocele

56
Q

Definitions of conditions:

Rubbery, painless lymphadenopathy, night sweats, organomegaly, pain while drinking alcohol (uncommon)

More common in patients <20, usually in the mid-line, moves upwards with protrusion of tongue

More common in older men, usually not seen, may gurgle on palpation, symptoms of dysphagia, regurgitation, aspiration, chronic cough.

Congenital lymphatic lesion typically found in the neck on the left side, most evident at birth, 90% before aged 2 years.

Oval mobile, cystic mass, develops between SCM. Due to failure of the obliteration of second branchial cleft in embryonic development. Presents in early adulthood.

More common in females, may cause thoracic outlet syndrome

A

Lymphoma

Thyroglossal cyst

Pharyngeal pouch

Cystic hygroma

Branchial cyst

Branchial cyst

Cervical rib

57
Q

Side effects of which drug:

Angioedema, hyperkalaemia, first dose hypotension, cough

A

ACEi

58
Q

Paediatric squint management:

A

Refer to secondary care for further management

59
Q

Pneumonia causing: Dry cough, confusion, hyponatraemia, bradycardia and deranged LFTs

Treat with

A

Legionella pneumophilia

Erythromycin or clarithromycin

60
Q

1) DVT management if Wells greater than 2 ->

2) If investigation can not occur for 4 hours:

3) If US is negative but D-dimer positive

A

1) Proximal leg vein ultrasound should be carried out within 4 hours -> if negative, a D-dimer should be sent.

2) D-dimer should be sent and interim anti-coagulants started

3) Stop interim DOAC offer repeat leg vein US 6-8 days later

61
Q

Most common organsim for COPD exacerbation

A

Haemophilus influenzae

62
Q

Migraine management:
Acute vs prophylaxis

A

Acute: NSAID or triptan
Prophylaxis: Propranolol (not if asthmatic) or topiramate (not in women of child bearing age)

63
Q

1) Dysphagia to both solids AND liquids from the beginning with heartburn

2) Process:

A

Achalasia

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter due to degenerative loss of ganglia from Auerbach’s plexus

64
Q

Most effective form of contraception

Are additional contraception methods required for this after insertion

Main adverse effects:

A

Nexplanon

If not inserted between days 1-5 of woman’s menstrual cycle.

Irregular/heavy bleeding
Progestogen effects (headache, nausea, breast pain)

65
Q

COPD step up therapy

A

1) LABA or LAMA
2) DEPENDS ON ATOPY
-> If atopic, SABA or SAMA plus LABA and ICS
-> If not, SABA or SAMA plus LABA plus LAMA
3) SABA LABA LAMA ICS

66
Q

Infertility - How long should couples be having regular intercourse for before referral to specialist

First line investigation -

A

1 year

Day 21 progesterone (7 days prior to next expected period)

67
Q

1) Name the condition:
Acute onset, ocular pain, pupil may be small and irregular due to sphincter muscle contraction, photophobia, blurred vision, red eye, lacrimation with ciliary flush, hypopyon (pus in anterior chamber)

2) Associated conditions: HLA B27 -> ankylosing spondylitis, reactive arthritis, UC, Crohn’s, Sarcoidosis

3) Management

A

1) Anterior uveitis

2) HLA B27 -> ankylosing spondylitis, reactive arthritis, UC, Crohn’s, Sarcoidosis

3) Urgent review ophthalmology -> Cycoplegics (dilate pupil which relieves pain and photophobia) e.g atropine or cyclopentolate
Steroid eye drops

68
Q

Eczema which commonly shows up in the hands due to high humidity and increased temperatures

A

Pompholyx eczema

69
Q

Name the condition:
Painful red eye, watering and photophobia, gradual reduction in vision. Risk factors include Rheumatoid arthritis, SLE, GPA

Management:

A

Scleritis

Same day assessment by ophthalmology
Oral NSAIDs
Oral glucocorticoids

70
Q

Metabolic acidosis causes:

Normal anion gap:

Raised anion gap:

A

Norma (hyperchloraemic metabolic acidosis): GRAAD

GI bicarbonate loss
Renal tubular acidosis
Addison’s
Ammonium chloride injection
Drugs

Raised: LUKA
Lactate: shock, sepsis, hypoxia
Urate: Renal failure
Ketones : DKA, AKA
Acid poisoning: Salicylates, methanol

71
Q

Arteries implicated:

1) POCI (posterior circulation infarcts)

2) Lacunar

A

Vertebrobasilar arteries

Perforating arteries around the internal capsules

TACI and PACI: Middle and anterior cerebral arteries (partial anterior = smaller arteries)

72
Q

Name the disease: Thromboangitis obliterans. Small and medium vessel vasculitis which is strongly associated with smoking.

Extremity ischaemia, superficial thrombophlebitis, Raynaud’s

A

Buerger’s disease

73
Q

Courvoiser’s law:

A

A palpable non tender enlarged gallbladder accompanied with PAINLESS jaundice is unlikely to be gallstones. Instead consider malignancy.

74
Q

RAPD:
Define:
Seen in:

A

The affected and normal eye appear to dilate when light is shone on the affected eye

Retina detachment and optic neuritis (common first sign of MS)

75
Q

Angina management:

A

BB or CCB (rate limiting) first line -> dose maximised before switching/adding.

If adding CCB to BB, a dihydropyridine CCB should be used.

If patient cannot tolerate BB and CCB, add one of: Long-acting nitrate, Ivabradine, Nicorandil, Ranolazine

76
Q

Vitamin name and effects of deficit:
A
B1
B3
B6
B9

C
D

A

retinoid - night blindness

Thiamine - Beriberi, Wernicke, heart failure

Niacin - Pellagra (dermatitis, diarrhoea, dementia)

Folic acid - Megaloblastic anaemia, NTDs

Scurvy - gingivitis, bleeding

chole/ergocalciferol - rickets, osteomalacia

77
Q

Testicular cancer:
95% of tumours are:
These are divided into:
Examples of each:

Markers:

A

Germ cell tumours
Seminoma and non-seminoma

Non-seminoma: embryonal, yolk sac, teratoma, choriocarcinoma

Non-germ cell tumours include: leydig cell tumours and sarcomas

Seminoma: hCG
Non-seminoma: AFP or b-hCG
LDH is raised in around 40% of germ cell tumours

78
Q

1st line anti-platelet in PAD
What should be co-prescribed

A

Clopidogrel
Atorvastatin 80mg

79
Q

Heart murmur:
Early diastolic murmur: intensity increased by handgrip manoeuvre
Wide pulse pressure
Quincke sign (nailbed pulsation)
De Musset’s sign (head bobbing)

Common causes:

A

Aortic regurgitation

Disease: Rheumatic fever (developing world)
CTDs
Infective endocarditis

Structural: Bicuspid aortic valve, spondyloarthropathies, hypertension
Aortic dissection

80
Q

Presents in the first 24-48 hours of life with abdominal distension and bilious vomiting, more common in cystic fibrosis

A

Meconium ileus

81
Q

Vertigo , hearing loss, tinnitus, absent corneal reflex:

Location
Nerves implicated:

A

Acoustic neuroma (vestibular schwannoma)

Cerebellopontine tumour

V,VI, VIII

82
Q

Time from myocardial infarction to complication:
0-4 hours
4-24 hours
1-3 days
4-7 days
Months:

A

0-4 hours: Cardiogenic shock, CHF, Arrhythmia
4-24 hours: Arrhythmia
1-3 days: Pericarditis
4-7 days: Rupture of free wall, septum or papillary muscle (causes mitral regurgitation)
Months: Dresslers, aneurysm, thrombus

83
Q

Surgical management of cancer:

1) Colorectal cancer with perforation treated with which procedure?

2) Caecal, ascending or proximal transverse colon?

3) Distal transverse, descending colon

4) Sigmoid

5) Upper rectum

6) Low rectum

7) Anal verge

A

1) Hartmann’s

2) Right hemi-colectomy

3) Left hemi-colectomy

4) High anterior resection

5) Anterior resection (TME)

6) Anterior resection (low TME)

7) Abdomino-perineal excision of rectum

84
Q

Primary amenorrhoea, little or no pubic hair, undescended testes showing as groin swellings
Breast development as a result of testosterone breakdown to oestradiol

Genotype:

How does this differ from congenital adrenal hyperplasia

A

Androgen insensitivity syndrome

46XY - but raised as female

Development of male characteristics in females (hirsutism, deep voice) Body is still responsive to testosterone. No bilateral lower pelvic swellings (no undescended testes)

MSRA (8 decks)

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