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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

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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

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25
Q

Hair loss in response to severe stress name:

A

Telogen effluvium

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26
Q

Treatment of choice in capillary haemangioma

A

Propranolol

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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

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28
Q

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

A

Citalopram

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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

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30
Q

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

A

Protective: Colorectal, ovarian, endometrial

Not-protective: Breast, cervical

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31
Q

Breast feeding on anti-epileptics: Which are safe?

A

Breast feeding is acceptable with nearly ALL AEDs

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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

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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

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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

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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

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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

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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.

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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)

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39
Q

Live attenuated vaccines:
mnemonic and vaccines:

A

‘MY BOO’

MMR
Yellow fever

BCG
Oral typhoid
Oral polio/rotavirus

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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

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41
Q

Respiratory alkalosis causes:

A

CHAMPS mnemonic:
CNS disease: Stroke, SAH
Hypoxia - PE
Anxiety
Mechanical over ventillation
Progesterone, pregnancy
Salicylate poisoning

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

58
Q

Excess fluid resus with saline - electrolyte disturbance?

A

Hyperchloraemic ACIDOSIS

59
Q

Coeliac -> Hyposplenism on blood film:

A

target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

60
Q

Iron deficiency anaemia on blood film:

A

target cells
‘pencil’ poikilocytes
if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

61
Q

Myelofibrosis on blood film

A

‘tear-drop’ poikilocytes

62
Q

Intravascular haemolysis on blood film

A

schistocytes

63
Q

which finding is an indication that kidney disease is chronic and not acute

A

Hypocalcaemia

64
Q

Addisons disease investigations:

If primary test is unavailable?

A

Short SYNACTHEN

9am serum cortisol (>500 makes addisons very unlikely)
<100 definitely abnormal

65
Q

Tests to confirm Cushing’s syndrome:

A

Overnight (low dose) dexamethasone suppression test (patients with Cushings do NOT have their morning cortisol spike suppressed

24 hour urinary free cortisol (2 measurements required)

Bedtime salivary cortisol (2 measurements required)

66
Q

Cushing’s syndrome: Localisation tests

A

1) 9am and midnight plasma ACTH (and cortisol) levels -> if acth is suppressed then a non-acth dependent cause is likely such as adrenal adenoma

2) High dose dexamethasone suppression test:

3) CRH stimulation - if pituitary source, then cortisol rises
4) if ectopic then no change in cortisol

Petrosal sinus sampling of ACTH may be needed to differentiate between pituitary and ectopic acth secretion.

67
Q

Primary hyperaldosteronism investigations

A

1) Renin:Aldosterone ratio is first line investigation

Following this, a high resolution CT abdomen and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess

If this is normal, adrenal venous sampling can differentiate between unilateral a denial and bilateral hyperplasia

68
Q

Acromegaly investigations
1)
2)

What levels are used to monitor disease

A

1) Serum IGF-1 with serial GH measurements
2) OGTT recommended to confirm the diagnosis if IGF-1 levels are raised

Also serum IGF-1

69
Q

Gastroenteritis: organism which causes constipation as well as diarrhoea

Which other manifestation is associated with this disease:

A

Typhoid

‘rose spots’

70
Q

Dizziness, electric shock sensations and anxiety can occur on the cessation of which widely prescribed medication:

A

SSRIs

(SSRI discontinuation syndrome)

71
Q

Need for contraception after the menopause:

A

12 months after the last period in women > 50 years
24 months after the last period in women < 50 years

72
Q

UTI in pregnancy: Tx. to be AVOIDED near term:

A

Nitrofurantoin. First line antibiotic for UTI in pregnancy but is to be avoided near term

73
Q

UTI antibiotic to avoid in FIRST TRIMESTER of pregnancy

A

Trimethoprim (teratogenic)

74
Q

Osteomalacia ->
Calcium:
Phosphate:
PTH:
ALP:

A

Calcium: decreased
Phosphate: decreased
PTH: increased
ALP: increased

75
Q

Primary hyperparathyroidism ->
Calcium:
Phosphate:
PTH:
ALP:

A

Calcium: high
Phosphate: low
PTH: high
ALP: high

76
Q

Chronic kidney disease (→ secondary hyperparathyroidism)

Calcium:
Phosphate:
PTH:
ALP:

A

Calcium: low
Phosphate: high
PTH: high
ALP: high

77
Q

Paget’s disease ->

Calcium:
Phosphate:
PTH:
ALP:

A

Calcium: normal
Phosphate: normal
PTH: normal
ALP: increased

78
Q

Anti-diabetes drug if not tolerating metformin and QRISK > 10% or established CV disease

A

Add/start SGLT2 inhibitory monotherapy

79
Q

Most common causative organism of infective endocarditis:

Previous most common bug:

A

Staph aureus

Strep viridans -> think dental procedure

80
Q

What constitutes severe UC:

A

severe: >6 bloody stools per day
+ features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

81
Q

Commonest ocular manifestation of SLE

A

Keratoconjunctivitis sicca
- dry eyes

82
Q

Common condition in which meconium ileus is common.

When does meconium ileus present:

A

Cystic fibrosis

Typically in first 24-48 hours of life with abdominal distension and bilious vomiting

83
Q

When does necrotising enterocolitis present?

How does it present?

A

typically in second week of life

Dilated bowel loops on AXR, pneumatosis and portal venous air

84
Q

AXR shows double bubble sign, contrast study may confirm -> presents in first few hours of life

A

Duodenal atresia

85
Q

When does Malrotation with volvulus present

A

Usually 3-7 days after birth

volvulus with compromised circulation may result in peritoneal signs and haemodynamic instability

86
Q

What should be offered post-WLE in breast cancer

A

Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

87
Q

Breast cancer screening:
When is this offered
What does it consist of

A

women between the ages of 50-70 years

Mammogram every 3 years

88
Q

Define fibroadenosis (fibrocystic disease, benign mammary dysplasia)

A

Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

89
Q

Common in women under the age of 30 years
Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

A

fibroadenoma

90
Q

All patients with PVD should be on which 2 drugs

A

Statin and clopidogrel

91
Q

What is Asherman’s syndrome

A

Asherman’s syndrome is a rare condition that occurs when scar tissue forms in the uterus or cervix.

Causes secondary amenorrhoea.
Commonly after an intra-uterine/cervical procedure

92
Q

What is Sheehan’s syndrome?

A

Sheehan syndrome is a rare condition that occurs when the PITUITARY gland is damaged during childbirth due to severe blood loss

Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock.

93
Q

1) Where is Broca’s area

2) Where is Wernicke’s area

A

1) Frontal lobe - assoc with difficulty in speech PRODUCTION

2) temporal lobe - assoc. with impaired comprehension of speech but intact production

94
Q

Four phases of subacute (De Quervains thyroiditis)

What is seen on scintigraphy

A

phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal

Globally reduced uptake of contrast

Seen m/c post/during viral illness

95
Q

Group B streptococcus in pregnancy antibiotics: when given?

A

Antibiotics at time of diagnosis AND INTRAPARTUM antibiotics

96
Q

Which blood dyscrasia does antiphospholipid syndrome cause

A

Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets

97
Q

Next line of treatment for lung abscess failing to respond to antibiotics?

A

Percutaneous drainage

98
Q

Glucose requirement for patients NBM per day in g

A

50-100g regardless of body mass

99
Q

If patient has stage 1 hypertension, is less than 80 years-old and has QRISK <10, do they need antihypertensives?

A

No

100
Q

Electrolyte disturbance seen in sarcoidosis:

A

Hypercalcaemia

101
Q
A

MSRA (15 decks)

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