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MSRA > Mixed practice review 2 > Flashcards

Mixed practice review 2 Flashcards

1
Q

NSTEMI DAPT:
If not high bleeding risk
If high bleeding risk

A

ASPIRIN plus
Ticagrelor
Clopidogrel

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2
Q

Ankylosing spondylitis
Features
‘A’ features

A

Reduced lateral flexion, reduced forward flexion, reduced chest expansion

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

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3
Q

Skin disorders associated with malignancy

1) Acanthosis nigricans

2) Acquired ichthyosis

3) Hypertrichosis lanuginosa

4) Dermatomyositis

5) Erythema gyratum repens

6) Migratory thrombophlebitis

7) Tylosis

A

1) Gastric cancer = acanthosis nigricans

2) Lymphoma = acquired ichthyosis

3) GI or lung cancer = hypertrichosis lanuginosa

4) Ovarian and lung cancer = dermatomyositis

5) Lung cancer = Erythema Graytum repens

6) pancreatic cancer - migratory thrombophlebitis

7) Oesophageal cancer - tylosis

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4
Q
A
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5
Q

Heart failure:
First line management:
Second line:
Third line:

A

ACEi and Beta Blocker (generally one started at a time)

Aldosterone antagonist

Ivanradine
Sacubitril and Valsartan
Digoxin strongly indicated if patient has AF

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6
Q

Oxford stroke classification: 3 core initial symptoms

A

1) unilateral hemiparesis
2) homonynous hemianopia
3) higher cognitive dysfunction - dysphasia

All 3 for total anterior circulation
2 for partial

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7
Q

Lacunar strokes: one of three of these symptoms

A

1) Unilateral weakness of face and/or leg and/or arm

2) pure sensory stroke

3) ataxic hemiparesis

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8
Q

Posterior circulation stroke
Involves:
Symptoms:

A

Basilar arteries
1) cerebellar or brainstem syndromes
2) loss consciousness
3) isolated homonynous hemianopia

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9
Q

Acute otitis media
Common bugs:

A

Streptococcus pneumoniae, Haemophilus influenzae, moraxella catarrhalis

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10
Q

Prevention of renal stones:
Calcium
Oxalate
Uric acid

A

Calcium: thiazide diuretics increase tubular calcium secretion

Oxalate stones: cholestyramine, pyridoxine

Uric acid: allopurinol, urinary alkalinisation

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11
Q

Key features of PROLIFERATIVE diabetic retinopathy that distinguishes it from non-proliferative

A

Retinal neovascularisation (50% are blind in 5 years)
Maculopathy

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12
Q

Non-proliferative diabetic retinopathy features:

A

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots

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13
Q

Bed wetting - at which age do you intervene
Management

A

Under 5 years reassurance and advice.

Look for causes
Reward systems
Enuresis alarm
Desmopressin - short term control mostly.

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14
Q

Epididymo-orchitis management
Most commonly caused by:

A

Chlamydia trachomatus and Neisseria gonorrhoea

Management: if STI most likely - organism unknown: IM ceftriaxone single dose plus 100mg Doxycycline PO for 10-14 days

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15
Q

Surfactant deficient lung disease:
Seen in:
Other risk factors:
XR shows:

Management:

A

Premature babies (risk decreases with gestational age)
Male sex, diabetic mothers, C-sections

Ground glass with in distinct heart border

Maternal corticosteroids to induce fetal
lung maturity.
Oxygen
Assisted ventilation (caffeine helps wean)
Exogenous surfactant via ET tube

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16
Q

Anatomical differentiation between inguinal and femoral hernias

Definitions
Incarceration vs strangulation

A

Femoral = inferolateral to the pubic tubercle

Inguinal = superomedial to pubic tubercle

Incarceration = cannot be reduced
Strangulation = likely non-reducible, follows on from incarceration. Causes systemic upset

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17
Q

Causes of increased ferritin WITHOUT iron overload:

A

Inflammation (acute phase reactant)
Alcohol excess
Liver disease
CKD
Malignancy

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18
Q

Increased Ferritin WITH iron overload

A

Hereditary haemochromatosis
Secondary iron overload: repeated transfusions

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19
Q

B symptoms:

A

Weight loss >10% in last 6 months
Fever >38 degrees
Night sweats

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20
Q

CRABBI mnemonic for myeloma

A

Calcium (increased)
Renal (damage which causes thirst and dehydration)
Anaemia
Bleeding (bone marrow crowding = thrombocytopenia)
Bones (may present as pain in the back)
Infection - reduction in normal immunoglobulins -> increased susceptibility to infection

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21
Q

Myeloma investigations findings: Peripheral blood film:
UEs

Bone profile

A

Rouleaux formation

Renal failure

Hypercalcaemia

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22
Q

Electrolyte disturbance in rhabdomyloysis/long lie

A

Hypocalcaemia

Calcium binds to myoglobulin released from damaged muscles causing hypocalcaemia)

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23
Q

ECG features of hypokalaemia

A

U waves
Small/absent T waves
Prolonged QT interval
ST depression
Long QT

24
Q

Commonest cause of glomerulonephritis worldwide?

How to differentiate this from Post-streptococcal nephropathy?

Treatment:

A

IgA nephropathy

Develops 1-2 WEEKS after strep infection (IgA develops in 1-2 days)

Post-streptococcal has low complement typically

Both involve haematuria and recent URTI

Only if persistent proteinuria - Give ACEi if this does not respond - give immunosuppression with corticosteroids

25
Q

Hair loss in response to severe stress name:

A

Telogen effluvium

26
Q

Treatment of choice in capillary haemangioma

A

Propranolol

27
Q

DVT pathway:
Wells score of X means DVT ‘likely’
Actions on:

DVT ‘unlikely’ score
Actions on:

If scan us negative but D-dimer is positive:

A

2 points or more
proximal leg ultrasound should be carried out within 4 hours.
If US cannot be carried out within 4 hours, D-dimer should be sent and interim anticoagulation commenced.

1 point or less
D-dimer -> If positive, proximal leg ultrasound should be arranged within 4 hours

Stop interim therapeutic anticoagulation, offer a REPEAT leg vein ultrasound 6 to 8 days later

28
Q

Anti-depressant which is most likely to increase QT interval -> cause torsades du point

A

Citalopram

29
Q

Treatment of congenital inguinal hernia in paediatrics

A

congenital inguinal hernias should be REPAIRED promptly once identified

More common in babies and boys

30
Q

COCP:
Protective against which cancers?
Increases risk of which cancers?

A

Protective: Colorectal, ovarian, endometrial

Not-protective: Breast, cervical

31
Q

Breast feeding on anti-epileptics: Which are safe?

A

Breast feeding is acceptable with nearly ALL AEDs

32
Q

Spider naevi vs talengectasias

What are spider naevi common in ?

A

Spider naevi fill from the centre (think of a spider -> Central body with legs spreading outwards)

Talengectasia fill from the edge

Liver disease
Pregnancy
COCP

33
Q

Kallman syndrome gonadotrophins:
FSH/LH
Testosterone

Height

Key finding

A

X-linked recessive

LH/FSH low
Testosterone low

Height: Normal or above avergae (contrary to belief)

Lack of smell

34
Q

Effect on pupil with:
third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital

Drugs:
Atropine, amphetamines, cocaine, TCAs

A

Mydriasis -> dilated pupil

35
Q

If blood sugar readings still not met on metformin on pregnancy, what should happen and why?

A

Start insulin -> increasing metformin and waiting to see response will delay necessary control of patients glucose

36
Q

Scabies:
How long may itch persist after treatment

Treatment:

A

6 weeks

Permethrin is first line
Malathion lotion is second line

Household contacts should all the treated

37
Q

Psoriasis treatment laddder

A

Regular emollients may help to reduce scale loss and reduce pruritis
1) Potent topical corticosteroid once daily plus vitamin D analogue applied once daily -> Up to 4 weeks for initial treatment

2) If no improvement in 8 weeks -> Vitamin D analogue twice daily

3) No improvement after 8-12 weeks then offer potent corticosteroid twice daily or COAL TAR applied 1/2 times weekly.

38
Q

Management of Crohn’s:
Inducing remission
Maintaining remission

A

Glucocorticoids (5-ASAs mesalzine may be used but are less effective)

Azathioprine or mercaptopurine (methotrexate is second line or first if TPMT)

39
Q

Live attenuated vaccines:
mnemonic and vaccines:

A

‘MY BOO’

MMR
Yellow fever

BCG
Oral typhoid
Oral polio/rotavirus

40
Q

Vestibular schwannoma:

Affected nerves - symptoms

A

CNV
CNVII
CNVIII

CNV: Absent corneal reflex
CNVII: Facial nerve palsy
CNVIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

41
Q

Respiratory alkalosis causes:

A

Anxiety leading to hyperventilation

Pulmonary embolism

salicylate poisoning*

CNS disorders: stroke, subarachnoid haemorrhage,

Encephalitis

Altitude

Pregnancy

*salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

42
Q

Drug to administer in confirmed SAH:
What does it do?

A

Nimodipine

Calcium channel blocker that is specifically indicated for the prevention of cerebral vasospasm following subarachnoid haemorrhage

43
Q

Where does Crohn’s most commonly affect:

A

Terminal ileum

44
Q

Vesicoureteric reflux
Initial investigation:

Investigation to look for scarring:

A

Micturating cystourethrogram

DMSA

45
Q

Management of whooping cough:
Management of whooping cough if child <6 months

Is prophylaxis needed?

A

Azithromycin if within 21 days on on-set

Admit to hospital

Yes

46
Q

Useful blood test to investigate whether true anaphylaxis has occurred:

A

Serum tryptase

47
Q

Most common cause of hirsutism:
Other causes of hirsutism:

Assessment tool for hirsutism:

A

PCOS

Cushing’s syndrome
congenital adrenal hyperplasia
androgen therapy
obesity: thought to be due to insulin resistance
adrenal tumour
androgen secreting ovarian tumour
drugs: phenytoin, corticosteroids

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

48
Q

If on COCP or any hormonal contraception, how long after taking:
1) Levonorgestrel
2) Ulipristal
should you wait before re-starting COCP

In which common condition is Ulipristal Acetate contraindicated in

A

1) immediately restart
2) Advised to wait for 5 days

Asthma

49
Q

Vit D, Calcium, phosphate, ALP levels in:

Osteomalacia -

Pagets -

Hypoparathyroid -

Primary hyperparathyroid -

A

Osteomalacia- low vit d, low calcium, low phos. High ALP
(the bone is trying but has poor supplies)

Pagets - Isolated ALP rise
(bone is just doing its own thing)

Hypoparathyroid- low ca, high phos, normal ALP
(ca/phos affected but bones aren’t really involved)

Primary hyperparathyroid- high ca, low phos, high ALP
(the parathyroid is demanding calcium to the blood, so bones have to break down)

50
Q

Phaeochromocytomas presents with triad of what?

A

headache, palpitations, hyperhidrosis

51
Q

Commonest cause of UTI in
Children:
Adults:

A

E.coli

E.coli

52
Q

After giving birth, how long are women protected without additional contraception

A

21 days

53
Q

Shaken baby triad:

A

Retinal haemorrhages
Subdural haemorrhage
Encephalopathy

54
Q

How long should antidepressants continue, despite ‘resolution’ to reduce risk of relapse:

A

6 months

55
Q

When should OGTT be checked in pregnancy?
If prev. GDM ?

A

16-18 weeks

AS soon as possible after booking

56
Q

M/C cause of hypercalcaemia:

Causes of hyperparathyroidism?

Bloods in primary hyperparathyroidism:

A

Hyperparathyroidism

85% solitary parathyroid adenoma

raised calcium, low phosphate
PTH may be raised or (inappropriately, given the raised calcium) normal

57
Q

Blistering skin conditions: Difference between pemphigoid and pemphigus

A

no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris

MSRA (12 decks)

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