MLA: Derm, Medicine of older adult & GP

Question 1

which condition contraindicates the use of an LMA to maintain an airway during surgery?

Answer 1

being non-fasted - they provide poor control against reflux of gastric contents

Question 2

what is a main difference between neuroleptic malignant syndrome and serotonin syndrome?

Answer 2

NMS develops over days to weeks, whereas serotonin syndrome develops over 24 hours. NMS is characterised by rigidity and bradyreflexia. Hyperreflexia and myoclonus are rare in NMS.

Question 3

how does salicylate (aspirin) toxicity cause derangement of the blood gas?

Answer 3

by two mechanisms:
1. stimulation of CNS respiratory centres, causing hyperventilation and respiratory alkalosis
2. uncoupling of oxidative phosphorylation, leading to metabolic acidosis

Question 4

what does the GRACE score need to be for acute admission of NSTEMI for them to require coronary angiography within 72 hours of admission?

Answer 4

> 3%

Question 5

what are some risk factors for retinal artery stroke (amaurosis fugax)?

Answer 5

male sex, increasing age, hyperlipidaemia, hypertension, heart disease, smoking

Question 6

when are three shocks given in ALS, when a patient is found to be in VF?

Answer 6

if the cardiac arrest was monitored and witnessed, otherwise it is just one shock followed by 2 minutes of CPR

Question 7

which bacteria is most commonly associated with caveatting lesions when it causes pneumonia?

Answer 7

staphylococcus aureus

Question 8

which medication should be given if there is a widened QRS or arrhythmia in TCA overdose?

Answer 8

IV bicarbonate

Question 9

what is beta thalassaemia trait?

Answer 9

autosomal recessive condition characterised by a mild hypo chromic, microcytic anaemia - it is usually asymptomatic

Question 10

what are the features of beta thalassaemia trait?

Answer 10

1. mild hypo chromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia
2. HbA2 raised (>3.5%)

Question 11

what is the first line double drug combination for patients with HF with reduced LVEF?

Answer 11

beta-blocker and an ACEi first line - the primary aim is to protect the heart

Question 12

what is the most useful prognostic marker in paracetamol overdose?

Answer 12

prothrombin time - signifies liver failure and is a marker of poor prognosis

Question 13

what are the markers of a need for liver transplantation in paracetamol overdose?

Answer 13

arterial pH, creatinine and encephalopathy

Question 14

what is the first line drug for regular broad complex tachycardias without adverse features?

Answer 14

IV amiodarone