MSCAA notes

Question 1

What is this?

Answer 1

central retinal vein occulsion

CRVO is painless with blurry vision

Question 2

What is this?

Answer 2

Central retinal artery occlusion

CV risk factors

Question 3

What is this?

Answer 3

Cilioretinal vein occlusion

Question 4

What is this?

Answer 4

branch of retinal artery occlusion

Question 5

What is this?

Answer 5

branch of retinal vein occlusion

Question 6

How is CRAO caused

Answer 6

Carotid artery atherosclerotic disease (~30%): embolic fragments may break off and occlude the retinal artery

Cardioembolic events: embolic event arising from the heart. Usually secondary to atrial fibrillation and clot formation in the left atrial appendage

Small vessel disease: local atherosclerotic disease

Question 7

What does the central retinal artery supply

Answer 7

optic and inner retina

unilateral

central area of visual sparing, sudden onset and painful loss

Question 8

Signs of CRAO

Answer 8

Relative afferent pupillary defect (RAPD): Asymmetrical pupillary reaction to light due to optic nerve disease.
Pale retina
‘Cherry red spot’: Suggestive macular sparing due to patent blood supply via the cilioretinal artery.
Retinal emboli: May be seen in up to 40%.

fluorescein angiography diagnosis

Question 9

CRAO treatment

Answer 9

intravenous methylprednisolone

Question 10

Delirium Mx

Answer 10

1. verbal de escalation techniques
2. short term haloperiodol
3. lorazepam if contraindicated e.g. parkinsons

Question 11

Spinal cord compression

Answer 11

The key features include back pain, bilateral leg weakness, and sensory abnormalities in the feet, along with signs of upper motor neuron involvement such as brisk knee reflexes and extensor plantar responses.

breast cancer

Question 12

What does lumbar disc prolapse not present with

Answer 12

does not present with bilateral leg weakness and upper motor neuron signs

Question 13

What does mechanical back pain not present with

Answer 13

bilateral leg weakness or neurological signs like brisk knee reflexes and extensor plantar responses.

Question 14

Osteomalacia presenting symptoms

Answer 14

It can cause generalized bone pain and muscle weakness but is unlikely to manifest as sudden-onset bilateral leg weakness and upper motor neuron signs.

Question 15

Osteoporotic vertrebral collapse

Answer 15

This condition usually involves compression fractures of vertebral bodies, which can lead to height loss and kyphosis.

Question 16

poly uria and poly dipsia all results par calcium and use lithium

Answer 16

assess calcium due to needing to exclude hyperparathyroidism before water deprivation test

Question 17

existing ckd due to receive iv contrast

Answer 17

contrast nephropathy
give fluids

not iv acetyl - anaphylaxis

Question 18

thiazide consequence

Answer 18

hyponatraemia

Question 19

cervical spine fracture

Answer 19

ct neck

Question 20

Features of a carcinoma

Answer 20

nuclear enlargement,
hyperchromasia and pleomorphism

Question 21

COpd resp acidosis

Answer 21

NIV

Question 22

epistaxis treatment

Answer 22

Minor bleeding from an accessible site can be
treated with cautery using a silver nitrate stick or electrocautery. Anterior pack is
for profuse bleeding with sites difficult to localise

Question 23

Ulcer chat

Answer 23

Duodenal ulcers tend to be made worse with
stress and the pain is often worse at night radiating into the back - it is relieved by
eating and patients tend to put weight on - in contrast to a gastric ulcer which is
made worse with eating and people often lose weight.

Question 24

NSAIDS contraindicated in what for gout

Answer 24

ckd - give steroids

Question 25

lobe for alzheimer

Answer 25

temporal

Question 26

Days for acute nephritis intersitital to appear

Answer 26

4-7

HUS anaemia and thrombocytopenia

Question 27

renal hypoperfusion

Answer 27

think post pneumonia = sepsis and leading to acute tubular necrosis

Question 28

zoledronic acid

Answer 28

I V and reserved for intolerant to oral bisphosphonates

Question 29

woken from sleep

Answer 29

red flag - plain xr - mri if negative

Question 30

alert to swallow

Answer 30

give tablet not gel if glucose above 2

Question 31

oxybutynin

Answer 31

constipation

Question 32

retinal detachment

Answer 32

floaters

Question 33

neurogenic claudication

Answer 33

better on leaning forwards