msca questions and more Flashcards
Ectopic pregnancy management (Conservative, Medical and Surgical Management)
CONSERVATIVE MANAGEMENT - rarely done
-Only if No or very minimal symptoms
-Adnexal mass < 35mm
-No visible heartbeat
-The ectopic needs to be unruptured
-HCG level < 1500 IU / l
-Close follow up required, if b-hcg is not going down then active management
MEDICAL MANAGEMENT
One of dose of IM methotrexate in bum
Criteria: low hcg, ability to attend follow up,
adherence to avoiding pregnancy for 3 months following treatment
same as conservative essentially except: HCG level must be < 5000 IU / l
If first dose doesn’t work give second or surgical management
SURGICAL MANAGEMENT (MAJORITY OF PATIENTS)
Recommend in cases where patients are unable to attend follow-up, the ectopic pregnancy is advanced or the patient is haemodynamically unstable.
1st line laproscopic salpingectomy
Surgical management often involves removing that tube, unless the patient only has one functioning tube and wishes to remain fertile. In that case is salpingotomy may be performed where only the ectopic pregnancies removed. However, there is a risk that all the tissue will be removed and so the beta CG needs to be performed to exclude any remaining trophoblastic tissue within the Fallopian tube.
What is the only reliable method for diagnosing active tb?
Sputum culture
First thing to give in suspected spinal chord compression before mri
Dexamethasone
Number needed to treat calculation
1 divided by absolute risk reduction
Mrsa antibiotic treatment?
Vancomycin
But if found on skin just do wash
Most common abdominal Tumour in kids
Wilms tumour aka nephroblastoma
Most common in children under 5
Management of undescended testes at birth
-Undescended bilateral testes at birth
Immediate investigation
-Unilateral- review at 6-8 weeks
-Undescended unilateral testis refer for surgery before 6 months at the 4-5th month mark
What disease is muddy brown cast Pathognomnic of?
Acute tubular necrosis
Limp causes in child
Slipped upper femoral epiphysis-
gradual onset Fat kids, flexed externally rotated leg
Perthes disease- gradual onset, avascular necrosis of femoral head, boys 4-8 most common
Transient synovitis- preceded by viral infection
Typically a young boy complaining of mild hip or knee pain with a low-grade fever
Developmental dysplasia of the hip – more common in females and babies born in breech position. no pain
When is prolonged prenatal Jaundiced considered prolonged and the 3 main causes?
14 days in term babies
21 days in pre term babies
biliary atresia- narrowing or absence of bile duct
hypothyroidism
G6PD deficiency
Pagets bone disease blood results: alp, calcium, phospahte
Isolated raised alp
Normal calcium
Normal phosphate
What is the initial investigation for ovarian cancer
Abdominal & Pelvic ultrasound
Investigation of choice for suspected pancreatic cancer
CT abdominal
But ultrasound is also highly sensitive
myeloma signs? CRABBI
C-Hypercalcemia
R-renal dysfunction
A- anemia
B-bleeding
B-bones- lyric lesions, back pain
I- infection (reduction in ig production)
Myeloma investigation
Serum Protein electrophoresis
Investigation for post steptococcul glomerilnephritis
Renal biopsy
Four classic features of henoch-schonlein purpura ans IgA Vasculitis
Pupura
Joint pain
Abdominal pain
Renal involvement
Cause of biloius vomiting in a downs syndrome babe on 2 days?
Dudoneal atresia
Treatment of Myasthenic Crisis
Iv immunoglobulins
What type of aneamia is sickle cell (mcv)?
Normacytic
Immune thrombocytopenia purpura vs henoch scholein pupura
Both present after an infection
Itp- isolated thrombocytopenia, self limiting
Hsp- rash usually over buttocks and extensor surface of arms and legs
Joint pain
Abdo pain
Usually haematuria on dipstick
Most common bacteria affecting Hickman line
staphylococcus aureus
staphylococcus aureus type of bacteria
gram positive cocci
Most likely cause of erectile dysfunction in a person with poorly controlled diabetes?
autonomic neuropathy
Timolol eye drops in excess can cause:
bradycardia
Red watery eye, irregular pupil, 24 male
Anterior uveitis
tumour markers? CA 125, CA19-9, CA 15-3, AFP, CEA
Ca 125
Ovarian
Ca19-9
Pancreatic and bile duct
Ca 15-3
Breast
Afp
Hepatocellular/teratoma
Cea
Colorectal cancer
Which type of lung cancer causes hypercalceamia?
Squamous Cell Carcinoma
Breast cancer found in SNA and all nodes what to offer?
Axillary lymph nodes removal although this increases risk of lymphoma in this arm
Management of stress vs urge incontinence
Urge
Bladder retraining – oxybutynin (anticholinergic drugs)
Stress
Pelvic floor exercises – duloxetine
Difference between two heart valves/pros and cons
- Mechanical heart valve lasts over 20 years but requires lifelong anticoagulation with warfarin (Better for younger patients)
- Biological prosthetic valves last around 10 years
Different murmurs sounds?
Aortic stenosis
Ejection systolic radiates to carotids
mitral regurgitation
pan systolic radiates to axilla
aortic regurgitation
early diastolic
Mitral stenosis
Mid diastolic
What is Creatine Kinase usually raised to in cases of rhabdomyolysis?
10,000 (upper limit 200)
What is the management of Aortic stenosis?
Management
- if asymptomatic then observe the patient is a general rule
- if symptomatic then valve replacement
- if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
Collapsing Pusle is a sign of?
Aortic regurgitation
Pulmonary fibrosis vs Bronchiectasis?
Bronchiectasis- permanent dilation of the bronchi causing sputum and organisms to drown leading to chronic PRODUCTIVE cough and recurrent infections, HAEMOPTYSIS
finger clubbing, scattered wheeze, squeaks and crackles EVERYWHERE
Idiopathic pulmonary fibrosis
- finger clubbing, DRY cough, BIBASAL fine end-inspiratory crepitations on auscultation, progressive exertional dyspnoea
Zig Zags in vision what diagnosis?
Migraines
TAVI vs Open heart surgery. which is preffered when?
Transcatheter Aortic Valve Implantation
Long-term outcomes for TAVI still need to be clarified as it is a relatively new procedure. Therefore, open surgery is still the first-line option in younger, fitter patients.
Patients with a TAVI do not typically require warfarin as the valve is bioprosthetic.
HOW do you manage INR less than 5
do nothing
yellow nails syndrome? Triad
Yellow nails, bronchiectasis and lymphedema
what is cranial nerve 5 called and how do you test for it?
trigeminal nerve
light and sharo touch in v1,2,3
test muscles in face
bite down for me- hand in tmj
open mouth dont let me push it closed
jar jerk
corneal reflex
what is cranial nerve 7 and how do we test for it?
facial nerve?
have you noticed any changes to your sense of taste or hearing
Testing for facial expressions
raise eyebrows
close eyes
puffed cheeks
purse lips
dont let me open
smile
bells palsy is a problem with which cranial nerve?
7the facial nerve
which cranial nerve is 8 and how do you test for it?
vestibulochoclear
gross hearing and whinnes and webber
What are cranial nerves 9 and 10 and how do u test for them?
glossopharyngeal and vagus
any chane in voice or difficulty swallowing
inspect soft pallate and uvula deviation will be away from the lesion
cough
sip of water
gag reflex (tounge depresser)
what is cranial nerve 11 and how do you test for it?
Accessory nerve
raise shoulders dont let me push down
press cheek into my hand
what is cranial nerve 12 and how do you test for it?
inpect for tounge wasting and fasiculations
stick out tounge
push tongue towards cheek stop me from pushing in
difference bewteen cranial nerve 9 and 12
9 is glossopharyngeal nerve and in this one the uvula deviates away from the lesion.
12 is the hypoglossal nerve and the tongue deviates towards the lesion
drug treatment and diet change for ascites?
aldosterone antagonists e.g. spironolactone
reduce dietary sodium
symptoms of Retinitis pigmentosa?
night blindness + tunnel vision
when do you send a urine culture for non-pregnant women, pregnant women and men?
non-pregnant:
aged > 65 years
visible or non-visible haematuria
pregnant:
if symptomatic:
a urine culture should be sent in all cases
asymptomatic:
urine culture should be performed routinely at the first antenatal visit
if found treat it
then repeat culture
men:
a urine culture should be sent in all cases
treatment of uti in catheterised patients?
do not treat asymptomatic bacteria in catheterised patients
if the patient is symptomatic they should be treated with an antibiotic
a 7-day, rather than a 3-day course should be given
consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days
The concurrent use of methotrexate and trimethoprim containing antibiotics can lead to?
bone marrow suppression and severe or fatal pancytopaenia
what is Myxoedema coma?
Myxoedema coma is a potentially fatal complication of longstanding undertreated hypothyroidism. It may be precipitated by illness, stress, and certain drugs.
Myxoedema coma typically presents with confusion and hypothermia.
Placenta accreta,Placenta percreta,Placenta increta most to least serious?
Placenta percreta, Placenta increta, Placenta accreta
what to give for chronic anal fissure if laxatives have been tried?
Chronic anal fissure - topical glyceryl trinitrate
expanding the blood vessels around the area helps it to heal faster.
how to calculate number needed to treat?
NNT = 1 / Absolute Risk Reduction
staghorn calculus in kidney, what is this stone made from
Struvite
kidney stones after chemo what is this stone made from
uric acid
most kidney stones are made from
calcium oxelate
severe iron deficiency can cause
dysphagia
Patients who are allergic to aspirin may also react to
sulfasalazine
An FEV1/FVC ratio <WHAT? (it is an obstructive lung disease)
70
Therapeutic monitoring of lithium vs digoxin?
Lithium 12 and digoxin 6
how does lidocaine work?
Blockage of sodium channels disrupting the action potential
what artery is ruptured in extradural vs subdural bleed?
AND which is limited to the cranial sutures?
extra- medial meningeal artery
sub- bridging veins
extra- doesnt cross sutures
what to check for in a patient with peripheral neuropathy, particulary pins and needles?
b12 Deficiency
what must you co prescribe methotrexate with?
folic acid
treatment of bowens disease and actinic keratosis?
topical 5-fluorouracil
typically used twice daily for 4 weeks
fluorouracil cream
Treatment of postpartum thyroiditis?
propanolol
It works by blocking the
effects of thyroid hormones on the heart and peripheral tissues. Propranolol can be
started immediately to control the patient’s symptoms while further investigations and
management are initiated.
which diabetic drug should be stopped before a CT scan?
Metformin should be stopped before a CT scan
with contrast as it can increase the risk of contrast-induced nephropathy. The risk is
greater in patients with impaired renal function
how to calculate serum osmolarity
2Na + Urea + Glucose
normal urine output for an hour for a 60kg man
30ml
what neurotransmitter is deficient in Parkinsons
dopamine
Treatment of cellulitis (in pregnancy too) vs treatment of MRSA cellulitis
cellulitis
first line flucloxacillin for everyone
if pen allergy
can give clarithromycin and erythromycin in pregnancy
MRSA Cellultiis is resistent to fluclox
so give VANCOMYCIN
CRVO VS CRAO eye
vein- stormy sunset
arterial- cherry red spot
painful left eye with no discharge.
There is a diffuse area of redness in the medial aspect of his left sclera. His pupils and visual acuity are normal.
Scleritis
scleritis vs keratitis presentation and treatment
scleritis no discharge - keratitis watery discharge
both emergency ophthalmology review
scleritis- NSAIDS/steroids/ antibiotics if infectious cause
keratitis- anti viral
note episcleritis is self limiting
what is mesothelioma?
lung cancer related to asbestos exposure
A 35 year old woman was admitted two days ago after taking 32 paracetamol
tablets. She has alcohol use disorder and weighs 40 kg. She has been treated
with a full dose of acetylcysteine.
Which investigation best demonstrates restoration of liver synthetic function?
prothrombin time
contraception after child birth
The progestogen-only pill and implant are considered safe in breastfeeding and can be started at any time after birth.
The combined contraceptive pill should be avoided in breastfeeding (UKMEC 4 before 6 weeks postpartum, UKMEC 2 after 6 weeks).
A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).
TOM TIP: Remember that the combined pill should not be started before 6 weeks after childbirth in women that are breastfeeding. The progestogen-only pill or implant can be started any time after birth.
What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?
isoniazid is an antibiotic for TB,
It can cause peripheral neuropathy,
For which there is a quick fix,
prescribe concurrently with B6
What medication is used to treat negative symptoms of schizophrenia?
clozapine
BCC vs SCC presentation and management
bcc slow growing, pale, shiny, rolled edge or overlying telangiectasia
m- routine referral to dermatology
scc: red in colour usually, faster growing
m- 2ww referral to dermatology
investigation for suspected renal malignancy vs polycystic kidney disease.
PKD- ultrasound of renal tract
malignancy- CT KUB
If you come across a patient in your exams with significant acute kidney injury and haemoptysis, the top conditions to consider can be differentiated based on the antibodies
Anti-GBM antibodies – Goodpasture syndrome
p-ANCA (or MPO antibodies) – microscopic polyangiitis
c-ANCA (or PR3 antibodies) – granulomatosis with polyangiitis
gladular fever aka infectious mononucleosis symptoms? AND INVESTIGATION
Fever
Sore throat
Fatigue
Lymphadenopathy (swollen lymph nodes)
Tonsillar enlargement
Splenomegaly and in rare cases splenic rupture
Test for ebv virus/other antibodies once patient has been ill for more than 7 days
exam question that describes an adolescent with a sore throat, who develops an itchy rash after taking amoxicillin- condition?
infectious mononucleosis (Glandular fever)
Mononucleosis causes an intensely itchy maculopapular rash in response to amoxicillin or cefalosporins.
what are the side effects of the TB Drugs: Rifampicin,Isoniazid,Pyrazinamide,Ethambutol
Rifampicin can cause red/orange discolouration of secretions, such as urine and tears. It is a potent inducer of the cytochrome P450 enzymes and reduces the effects of drugs such as the combined contraceptive pill.
Isoniazid can cause peripheral neuropathy. Pyridoxine (vitamin B6) is co-prescribed to reduce the risk.
Pyrazinamide can cause hyperuricaemia (high uric acid levels), resulting in gout and kidney stones.
Ethambutol can cause colour blindness and reduced visual acuity.
Rifampicin, isoniazid and pyrazinamide are all associated with hepatotoxicity.
Numbness or unusual sensations in their feet implicates isoniazide (“I’m-so-numb-azid”).
Difficulty recognising colours implicates ethambutol (“eye-thambutol”).
Urine or tears that are orange or red implicates rifampicin (“red-I’m-pissin’”).
Isoniazid can cause ????, therefore ????? is co-prescribed to reduce the risk
peripheral neuropathy
Pyridoxine (vitamin B6)
treatment for latent and active tb?
Latent tuberculosis is treated with either:
Isoniazid and rifampicin for 3 months
Isoniazid for 6 months
The treatment for active tuberculosis can be remembered with the RIPE mnemonic:
R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months
oral antibiotic you can give if topical stuff for acne has failed/in moderate/severe acne/
oral lymecycline or doxycycline,
hypercalcemia symptoms
Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation.
Increased thirst or more frequent urination, due to changes in the kidneys.
Muscle weakness or twitches.
Changes in how your brain works, such as feeling tired or fatigued or confused.
Bone pain and fragile bones that break more easily.
how to tell if erectile dysfunction is being cause by autonomic neuropathy or peripheral arterial disease in diabetic patients?
look at which they have the most features of
drugs causing hyperkalemia (4)
ACEi, ARB (e.g. losartan),spironolactone,NSAIDS
Tripple A screening guidelines
-Yearly for patients with aneurysms 3-4.4cm
-3 monthly for patients with aneurysms 4.5-5.4cm
Elective repair for patients with any of:
Symptomatic aneurysm
Diameter growing more than 1cm per year
Diameter above 5.5cm
how to decrease chances of oral candidiasis from inhaler?
use a large volume spacer as there will be less local deposition of the drug in the mouth
which vitamin deficiency presents with gingival hyperplasia and petechial rash?
vit c
What is the most common causative organism for imeptigo?
Staphylococcus aureus
exudative vs transudative pleural effusion causes
Exudative – a high protein content (more than 30g/L)
Transudative – a lower protein content (less than 30g/L)
Exudative causes are related to inflammation.
Cancer (e.g., lung cancer or mesothelioma)
Infection (e.g., pneumonia or tuberculosis)
Rheumatoid arthritis
Transudative causes relate to fluid moving across or shifting into the pleural space (trans- meaning moving across):
Congestive cardiac failure
Hypoalbuminaemia
Hypothyroidism
Meigs syndrome
if a murmur is heard best in the apex where is this?
mid clavicular line 5th intercostal space
What aspect of cognition is likely to show the greatest impairment in dementia ?
short term memory
The most appropriate radiological test for
suspected acute cholecystitis
an ultrasound scan of the abdomen.
what makes C diff difficult to destroy
spore formation
when is termination legally allowed until
24 weeks
Investigation of choice for neuroleptic malignant syndrome?
creatine kinase
What is Spondylolisthesis?
A condition where one
vertebra slips out of line with the one above it, most commonly in the lumbar spine.
treatment of eclampsia seizures
magnesium sulphate
molar pregnancy presentation
large for gestation uterus and severe
early onset pre-eclampsia as a secondary phenomenon.
What is the most appropriate therapy for anorexia nervosa
family therapy
treament of acute manic episode
give an antisyphycotic such as olanzapine because lithium takes a few days to kick in
milk to give baby with cow protein allergy?
B. Hydrolysed formula
management of acute low back pain with no red flag symptoms?
Encourage the person to keep active, resume normal activities, and return to work/study as soon as possible.
Discourage prolonged bed rest. Reassure that normal back movements may produce some pain, but this is not harmful if activities are resumed gradually. Advise there is no need to be pain-free before resuming normal activities.
you normally treat a pe with a doac. but how do you treat a Massive PE with haemodynamic compromise
continuous infusion of unfractionated heparin and considering thrombolysis
cant use a doac because its oral not quick enough
in chad vasc what are the 2 age score
65 and above scores 1
75 and above scores 2
Which diabetic drug is contraindicated in heart failure? and which to add in CVD?
Pioglitazone- contraindicated
SGLT2 inhibitor (flozins)- add if any CVD
2 main side effects of SGLT2 inhibitor
utis/thrush
diabetic ketoacidosis
main 2 side effects of Sulfonylureas
e.g. Gliclazide
hypos
weight gain
side effects of Pioglitazone
Weight gain
Heart failure
Increased risk of bone fractures
A small increase in the risk of bladder cancer
which diabetic medicine is licensed to use in CKD?
Sitagliptin (DPP4 inhibitor)
Diabetic drugs given as injections?
insulin
GLP-1 mimetics
pre diabetic vs diabetic
HBA1c of 42 to 47 puts you in the Pre-diabetes range. HBa1c of 48 and above puts you in the Diabetic rang
diagnosis of DIC
: Diagnosis of DIC is based on presenceof ≥1
known underlying condition causing DIC plus abnormal global coagulation
tests: decreased platelet count, increased prothrombin time, elevated fibrinrelated marker (D-dimer/fibrin degradation products) and deccreased
fibrinogen level.
cataplexy presentation
Cataplexy classically presents with loss of
skeletal muscle tone with strong (usually postive) emotions
norovirus vs rotavirus and how do you test for it
Rotavirus- mostly in kids
Norovirus- can effect any age
viral PCR
treatment for gout
IA or oral steroids, colchicine or NSAIDs are all effective
treatments for acute gout. NSAIDs are contraindicated in CKD of this stage.
Allopurinol will not help the acute attack.
what do u give if a patient has had adequate hydration but is till tanking?
: description of adequate (if not over) hydration.
needs vasconstriction
so Noradrenaline/norepinephrine
In which part of the brain are changes most likely to be in Alzheimer’s disease?
Temporal lobe
Which is the most appropriate method for providing analgesia during the early
postoperative period of abdominal surgery?
epidural
Epidural is
best because it can be topped up and titrated; spinal anaesthesia cannot.
treatment of scabies?
Topical permethrin
Delerium tremens, wernikes and korsakoffs
DT- visual and audible hallucinations, tremors, can lead to seziures
caused by alcohol withdrawal
treated with benzos
WK- caused by long term alcohol abuse leading to a thiamine defficiency
w- cognitive impairment, eye symptoms like nystagmus ataxia (acute phase)
k- (chronic phase)- profound memory deficits making new ones and retrieving old ones. + confabulation where the individual may fabricate stories to fill in memory gaps.
treatment- urgent replacement of thiamine (pabrinex)
first line treatment of hepatic encephalopathy?
lactulose
reduces ammonia in blood
which sinus when bending forward snot comes out?
maxillary
sandpaper rash, which condition?
scarlet fever
first line treatment for lower mechanical back pain
NSAIDS if no other contracindaications
The most appropriate agent
to administer to reverse the effects of neuromuscular blockade
Neostigmine
when testing for tumor lysis syndrome which marker should you use?
urate
another name for coobs test and what does it test for?
Direct antiglobulin test
The Coombs test checks if your immune system is mistakenly attacking your own red blood cells
antibodies for rheumatoid vs SLE
RA- RF, anti-ccp (most specififc to RA, preffered)
SLE- ANA, anti-dsdna
Anti ro and la
sjorgens syndrome
The most appropriate initial analgesic agent in bilary colic
nsaid such as dicolofenac
what is the screening test for haemacromatosis?
transferrin saturation
treatment of delerium
short course of haloperidol
most common pathogen in leg cellulitis
E. Streptococcus pyogenes
The main lymphatic drainage of the ovary is to
the
para aortic nodes
he patient has superior vena cava
obstruction initial treatment
iv dexamethasone
Nephrotic syndrome in adults requires ?????? to identify the cause, prior to definitive treatment.
renal
biopsy
treament of acute angle glaucoma
Pilocarpine eye drops
Acetazolamide (oral or intravenous)
graves disease pathological mechanism
Antibody directed against the thyroid stimulating hormone receptor
Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and
tachypnea are the most frequent finding of?
fat emboli
first line treatment for acute flare of chrons vs UC?
Ulcerative Colitis Management
Mild to moderate acute ulcerative colitis is treated with:
-Aminosalicylate (e.g., oral or rectal mesalazine) first-line
-Corticosteroids (e.g., oral or rectal prednisolone) second-line
Severe acute ulcerative colitis is treated with:
-Intravenous steroids (e.g., IV hydrocortisone) first-line
Crohn’s Management
Inducing remission in an exacerbation of Crohn’s disease is with:
-Steroids (e.g., oral prednisolone or IV hydrocortisone) first-line
