MSCA Flashcards by Yash Kapoor

Patient has right-sided pleuritic chest pain and sudden onset breathlessness. She has bleeding peptic ulcer. CT pulmonary angiogram: thrombus in both pulmonary arteries. Initial treatment?

IV unfrractionated heparin

Risk of haemorrhage - can be stopped and reversed.

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Investigation for sudden onset constant pain radiating from right flank to groin. 2+ blood, 1+ leucocytes.

Non-contrast CT of renal tract (CTKUB)

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Patient with DEXA T-score -3.9. Taking colecalciferal and calcium carbonate. What else should they be given?

Alendronic acid (bisphosphonate)

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Patient is breathless 3 hours after removal of chest drain. Diagnosis?

Pneumothorax

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Severe abdominal pain 4 weeks after aortiobifemoral bypass graft. Diffuse abdominal tenderness with absent bowel sounds. Unremarkable AXR. High lactate. Cause?

Mesenteric ischaemia

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65 year old woman with bloody diarrhoea for 4 weeks. Urgency to pass stool and to get up in the night to pass stool. Left eye has been red. Diagnosis?

Ulcerative colitis

Can get anterior uveitis in both UC and CD

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public health one?

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Patient has pain on radial side of wrist, worse when playing piano. Swelling and tenderness over distal end of left radial styloid. Exacerbated by ulnar deviation when the thumb is clasped in the palm. Diagnosis?

de Quervain tendiopathy

(Finkelstein test described in question)

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Patient has 25% change in serum creatinine following medication addition. What do you do next?

Repeat bloods

Only change treatment if >30%

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Patient has HbA1c of 45. What do you do next?

Refer for Diabetes Prevention Programme

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24 year old man falls and gets low back pain. What do you advise?

Continue usual activity

Short duration acute low back pain in fit person

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Patient on chemotherapy becomes septic. What do you do first? Discuss with local oncology team? Give IV abx? Give IV fluids? Admit to medical receiving unit?

Give IV broad spectrum abx

Neutropenic sepsis potential - prompt abx most important

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Patient has painful, swollen left elbow and fever. History of rheumatoid arthitis. WCC is high, CRP is high.

Joint aspiration: no organisms, high WCC, neutrophils, no crystals. Advised to take oral paracetamol. What’s the most appropriate additional management?

IV flucloxacillin

Gram stain only positive in 50% of cases of septic arthritis.

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Patient collapses. Unrousable and clammy. Glucose 2.3mmol/L. Immediate management?

20% glucose IV infusion

IM glucagon has unpleasant effects e.g. nausea and flushing, but is a reasonable second choice if no venous access available.

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T2DM patient. Metformin stopped due to worsening CKD (eGFR 28) Taking maximum dose of gliclazide (sulfonylurea). What is the most appropriate additional diabetes treatment? Patient wants to avoid injections.

DPP4 inhibitor (sitagliptin)

Approved for use in CKD. SGL2 not approved. GLP-1 is SC.

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Patient has nausea, fever and rigors. Foul smelling urine. Had PE 3 days ago. LMWH injections since. High HR, low BP, high APTT, high PT. Condition causing high PT?

DIC

Sepsis triggering DIC

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Patient has unilateral sensorineural hearing loss (abnormal pure-tone, normal tympanometry). What is the most appropriate diagnostic investigation?

MR internal acoustic meatus

Exclude vestibular schwannoma or other neoplasm

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Patient in GP has symptoms of Crohn’s. Which investigation is first?
- AMA
- anti-TTG
- faecal calprotectin
- FOB
- stool culture

Stool culture

Part of work up in primary care before referral

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Patient laughs then collapses, but remains conscious. What is the diagnosis?

Cataplexy

Loss of skeletal muscle tone with strong emotions

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56F has worsening hip pain from osteoartheiti. Controlled with paracetamol and ibuprogen gel. Has peptic ulcer disease. Creptisu on movement of hips. Most appropriate management for pain?

Switch paracetamol to co-codamol

Could give NSAID instead but peptic ulcer disease is a contraindication.

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48M has painful, stiff left shoulder. Dull and worse at night. PMH diabetes. Reduced movement of left shoulders with pain at extremes. CRP is 6. Diagnosis?

Adhesive capsulitis

More likely > 40 years
Rotator cuff tear more likely > 70 yeas
Subacromial pathology - occupational/athletic, heavy lifting or reptitive movements above shoulder

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Patient has abdominal pain after gastrectomy. Reduced breath sounds in both bases. Abdominal tenderness with guarding and reduced bowel sounds. Diagnostic investigation?

CT abdomen

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Patient SOB 12 hours after abdominal surgery. Large amount of blood in abdominal drains. Treated with IV fluid bolus and surgical registrar informed. What next?
- Major haemorrhage protocol
- IV noradrenaline
- IV tranexamic acid
- Prothrombin complex concentrate

Activate major haemorrhage protocol

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Patient taking insulin, lisinopril, metoprolol, aspirin. BP high. Pitting oedema to mid shin. Potassium 5.4 (3.5-5.3). What medication should you stop, switch, or add?

Add furosemide
- help with peripheral oedema
- lower BP
- lower potassium

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Pregnant woman in resus after being kicked by a horse. Low BP. High HR. Fluid resus started and bloods sent. What next? - full primary survey - scan and monitor baby - transfer to theatre and deliver baby - x-ray cervical spine

Full primary survey

Patient with metastatic lung cancer has back pain at L1, leg weakness, and urinary retention. Most appropriate investigation?

MR whole spine

75F comes to GP with breathlessness on exertion. Cough with white sputum. Lost 2kg in weight. 2 chest infections in last year. 15 pack-year smoking history. CXR normal. Diagnostic investigation?

Spirometry For COPD

Patient has signs of extradural haemorrhage. Lens-shaped haemorrhage seen on CT in right parietal region. Which vessel was injured?

Middle meningeal artery

Patient gets numbness that starts in hands, moves up the hand to the face, then a pulsating frontal headache lasting 2 days associated with nausea. Which treatment can reduce the frequency of these episodes?

Propranolol Prophylaxis for migraine Triptan + NSAID/paracetamol for attack

Students living in the same halls get diarrhoea. No foreign travel and haven't eaten similar foods. What should be tested in the stool to confirm the diagnosis?

Stool for viral PCR Confirming norovirus

Red flag back pain symptoms i.e. waking up at night. Initial investigation?

X-ray lumbar spine If negative, do MRI

Patient taking amlodipine, doxazosin, gliclazide, metformin, and oxybutinin. Which is worsening her constipation?

Oxybutinin Anticholinergic

Patient has fever 2 days after elective subtotal gastrectomy. O2 sats low. Reduced breath sounds at both lung bases. Abdomen is soft, with tenderness around her wound. Her drain has serous output. What is the most likely postoperative complication?

Atelectasis

Patient has back pain extending into the back of his thighs. Worse when standing and walking. Relieved when sitting and leaning forward. Weakness of hip flexion bilaterally. Peripheral pulses are palpable. Diagnosis?

Lumbar spinal stenosis Neurogenic claudication

Most important prognostic indicator for superficial spreading melanoma.

Breslow depth

22 year old student goes to bed after a party. He wakes up in the middle of the night by the need to pass urine. He feels faint and nauseated while bearing down to pass urine and loses consciousness. Examination and ECG are normal. Most likely diagnosis?

Vasovagal syncope

Anaesthetist applies cricoid pressure during induction of anaesthesia. Why?

Seals oesophagus, preventing gastric contents from passing up and entering the airway.

18F has single episode of dizziness and nausea lasting 6 hours. Room is spinning around. Hearing not chamged. Nystagmus with fast phase to the left. Diagnosis?

Vestibular neuritis Hearing not involved. Young patient with a single episode.

Patient has weakness of right hand with reduced sensation of forearm. Wasting of all instrinsic muscles. Weakness of finger abduction. Altered light touch along ulnar aspect of forearm. Reflexes all normal. Site of lesion?

T1 Not ulnar as sensation of forearm is affected.

Patient has a fall. Takes ibuprofen for osteoarthritis. Has no signs of infection. Midstream urine shows mixed growth of organism. What is the cause of this urine result?

Contamination Mixed growth and no signs of infection

Patient presents with a painful eye and loss of acuity. Management?

Emergency ophthalmology referral

Is a biopsy required to make a diagnosis of PBC?

Patient has very high blood pressure (220/130 mmHg), normal sodium, low potassium. Has had 3 months of intermitten, worsening headaches. Diagnosis?

Conn's

Patient is confused, disorientated, and SOB 24 hours after surgical fixation of multiple fractures following a car accident. He is on morphine, LMWH, flucloxicillin, and IV saline. HR 100, BP 110/60, RR 30, SpO2 85% on 4L O2. Clear chest. Diagnosis?

Fat embolism syndrome Early onset hypoxia, dypnoae, and tachypnoea and neurologic manifestations following multple fractures. Petechial rash may appear last. PE doesn't have neurologic abnormalities.

Patient still has VF after 3x DC shocks. What drug should be given with IV adrenaline?

Amiodarone VF/VT: No response after 3 shocks, resume compressions, 1mg adrenaline IV and amidarone IV whilst performing a further 2 min CPT.

Patient has funny sensation in abdomen followed by loss of awareness with a vacant stare and waving left arm. Which part of the brain is the most likely site of origin.

Right temporal lobe Aura implicates temporal lobe

Chest infection with brown sputum. Bronchial breathing over right-mid zone. Pathogen?

Streptococcus penumoniae

Pressure, protein, and cell changes seen in CSF of bacterial meningitis?

High pressure, raised protein, excess neutrophils

Man has unprovoked DVT. CXR normal. Venous duplex USS shows thrombus in superficial femoral vein. What further imaging should be done in this patient?

CT abdomen pelvis Identify possible malignancy

Treatment post-coronary revascularisation in patient with mechanical aortic valve replacement.

LMWH as bridging anticoagulant Aspirin Warfarin

Patient with chronic skin condition gets well-defined areas of scale formation at sites of minor skin injuries e.g. insect bites. What is the underlying skin condition?

Psoiasis Koebnerisation Less common in vitiligo

Investigation after water deprivation for crianial diabetes inspidus?

MR pituitary

First line treatment for prolactinoma

Cabergoline Dopamine agonist

Screening test for haemochromatosis

Transferrin

Severe headache 24 hours after spinal anaesthetic. Diagnosis?

Low pressure headache

What imaging should be done before doing a Well's score for considering PE diagnosis?

CXR

Clinician does not invite man to a diabetes programme because she thinks he is too old to engage. - discrimination - prejudice - stereotyping - bias

Discrimination

Maintenance fluid calculation for someone with underlying cardiac disease?

20-25ml/kg (in 24 hours)

Delerium first-line medical treatment

Haloperidol (low-dose) Benzodiazepine if contraindicated e.g. Parkinson's

Most appropriate test to monitor respiratory function in a myasthenic crisis?

FVC Below 1L

Patient takes cocaine. Has right-sided chest pain and breathlessness on exertion. SpO2 94%. Trache central. Reduced breath sounds at right apex. Diagnosis?

Primary pneumothorax Cocaine induced coronary artery spasm would be considered if there were cardiac signs/investigations instead.

First line treatment for sinus bradycardia (patient collapsed at home and has central chest pain)

Atropine

Most common pathogen in leg cellulitis

Streptococcus (pyogenes)

First line treatment for superficial thrombophlebitis

NSAIDs

Patient has twitch in left hand that spreads up the arm over 2 minutes. His arm feels week for an hour after. He had an ischaemic stroke affecting his left side 6 months ago. Normal neurological examination. Diagnosis?

Partial seizure Result of previous stroke

Ovaries main lymphatic drainage nodes

Para-aortic

Management of venous ulcer that is already slowly healing.

Compression stockings

65M with sudden pain and redness in right eye. Has headache and nausea. Visual acuity reduced in right eye. Eye is congested, with a hazy cornea and mid-dilated pupil. Diagnosis?

Acute glaucoma

Initial treatment for lung cancer/mediastinal lymphadenopathy compressing superior vena cava

Dexamethasone Endovenous stent considered if there was stridor, but would follow intubation and steroids.

Patient has polyuria and polydipsia. Patient takes lithium. Serum osmolality is high. Which test should be done next?

Serum corrected calcium Hypercalcaemia should be excluded before water deprivation test.

Patient with CKD about to have CT scan with contrast. What should you give before the scan?

IV saline infusion Volume expansion due to risk of contrast nephropathy

CK level if rhabdomyolosis

>10,000

Condition where 24F feels like the heart stops for a second followed by a pounding sensation. No other issues.

Supraventricular premature beats

Top 2 causes of prosthetic join infections

1. Staphylococcus aureus 2. Coagulase negative staph

First line treatment for urge incontinence

Oxybutynin

Management of patient with asymptomatic atrial fibrillation and CHA2DS2-VASc score of 0

No treatment

Abdominal distention and vomiting for 48 hours after sigmoid colectomy. Not passed flatus for 24 hours. Abdomen distended with tenderness over wound. No bowel sounds. Condition and management?

Paralytic ileus Nasogastric tube

Patient has perianal ulcer and tender inguinal lymphadenopathy after unprotected anal sex. Diagnosis?

Lymphogranuloma venereum

Old man has cord compression from metastasis (destructive bony lesions of T12, L2-L4). Best treatment to preserve neurological function?

Radiotherapy - multiple lesions and too old for surgery

Patient has pain in righ arm/shoulder that worsens when elevating his arm above his head. Pain on abduction of right shoulder that is worse with internal rotation. Diagnosis and management?

Supraspinatus tendinopathy Physiotherapy

Which part of the brain are changes most likely to be found in early Alzheimer's disease?

Temporal lobe

Most appropriate eary post-operative analgesia following abdominoperineal resection. History of severe COPD and hypertension.

Epidural anaesthesia - avoid opioid because of respiratory disease - epidural can be topped up and titrated, spinal can't

Treatment for fluid overload following blood transfusions.

IV furosemide