MSCAA questions revision Flashcards
Acute Pancreatitis vs Acute Cholecystitis
Both have raised amylase levels.
ALP will be raised
Management of acute duration low back pain in fit person
Continue usual activity
What is the management of a PE in hospitals (major)
IV heparin not a DOAC
What is the CHADS2Vasc score
CHF - 1
H - Hypertension
A - Age (either 65+ is 1 or 75+ is 2)
D - Diabetes
S - Stroke (2)
Vasc - Vascular disease history
How do we calculate the lifetime risk of having a stroke from chadsvasc
score of risk x years from life expectancy (83)
Initial invetsigation of renal stones
Non enhanced CTKUB
When should drugs be stopped in suspected CKD
Only if there is >30% increase in serum creatinine
If not, repeat 2-4 weeks later
First line managemnet of hypoglycaemia
75ml of 20% glucose (IV)
What diabetic drug is approved for use in CKD (the only one)
Sitagliptin (DPP4 inhibtor)
In what condition is Pioglitazone contra-indicated for use
HF and bladder cancer
WHat is the diagnostic investigation for sensineural hearing loss
MRI imaging
What invetsigation must be done before suspectiing IBD
STool Cultures
Management of osteoarthritis on the pain ladder
First: Paracetamol/ibuprofen gel
Second Line: EITHER Co-Codamol or an NSAID (depending on contraidnications)
First line managemen of poisoning - is it gastric lavage or actiavted charcoal first
Activated charcoal
What condition gives way to adhesive capsulitis
Diabetes
What is an iatrogenic secondary pneumothorax cause
Chest drains themselves
Central lines
Management of hypertension
<55:
ACEi/ARB
ACEI/ARB + CCB or thiazide like diuretic
> 55:
CCB
CCB + ACEi/ARB or thiazide
Both:
Triple therapy of the three
What defines rapidly progressive glomerulonephritis
A drop in over 50% eGFR over 3 months
What are the indications for an ascites tap
To determine what’s causing ascites if unkown
To check for suspected sponatenous bacterial peritonitis
What diagnoses Spontaneous bacterial peritonitis
Neutrophil count >250 cells
What does an ascitic tap show for potential malignancy
RBC <1,000 cells/mm^3
What Serum albumin- Ascitic Albumin concentration indicates liekly cirrhosis and cardiac failure cause of ascites
> 11g/L
Management of a red eye
ALWAYS refer to Opthalmologist (could be corneal abrasions, endopthlamitis, acute glaucoma
What is the initial management of suspected bowel obstruction
NG tube striaght away for decompression
What type of fluid is 1.8% Sodium CHolride also known as
HYPERtonic saline
What are the role of goblet cells
Secrete mucin (provides a mucosal layer to the stomach)
In what condition is urseodeoxycholic acid a mainstay treatment for
Primary Biliary Cirrhosis
Where are adenocarcinomas of the lungs typically located
Peripherally
Where are squamous cell carcinomas typically located
Centrally
What do squamous cell carcinomas typically secrete
PTHrP
What do small cell carcinomas typically secrete
Cushing’s (ACTH)
ADH
Until blood gas can be measures, what oxygen therapy should be initially started
24 or 28%
What is the main indication for low concentration oxygen therapy
Hypercapnia
When should Oxygen therapy be considered in patients with COPD
PaO2 < 7.3 kPA when stable and do not smoke
What is a contraindictaion to using IV Adenosine for supreventiruclar tachycardia
Asthma- use verapamil
Signs of supraventricular tacchycardia in an ECG
Absent p waves and sinus tacchycardia
Management of a suspected tension pneumothorax
NO chest x ray needed
14G cannula needle decompression
First line management of a primary pneumothorax with rim of air <2cm
Dishcarge + X-Ray
Management of a primary pneumothorax with >2cm air rim
Aspiration
If aspiration fials, what is second line treatment of a primary pneumothorax
Chest Drain
First line management of a secondary pneumothorax if >50 and rim of air >2cm
Chest drain
Management of a secondary pneumothorax if rim of air 1-2cm
Aspiration
On an X-ray reading, what differentiates between a penumothorax and tension pneumothorax
Trachea not deviated vs devaited trachea
What medication improves motor symptoms in Parkinson’
Levodopa
What type of nutrition is given to patients with motor neurone disease
Percutaneous gastrostomy tube
First line management of asystole
Chest compression and ventilation
Once chest compressions and ventilation are started, what should be done in asystole
IV Adrenaline/epinerphine
Investigations of an unprovoked DVT
CT of the abdomen and pelvis
Log term anticoagulation for people with mechanical valves
Aspirin + Warfarin
What anaesthetic airway device protects the lungs from stomach contents
Tracheal tube
What is the first investigation for someone with a suspected PE
First do a chest X-Ray to rule out other things, then do the well’s score
INvestigation of choice for a thyroid neck swelling
USS of the neck
What are the maintenance fluid requirmenets for someone with underlying cardiac disease
20-25ml/kg not 25-30
What needs to be monitored in someone with MG exacerbation
FVC
Most common cause of cellulitis
Strep pyogenes
Drainage of the ovary
Para-aortic nodes
How to calculate GCS
Eye:
None
Opens to pain
Open to commands or speech
Open spontaneously
Motor:
No motor response
Extensors response
Abnormal flexion
Withdraws from pain
Moves purposefully to painful stimulus
Obeys commands
WHat is diagnostic for nephrotic syndrome
Renal biopsy
What is the initial screening tool for Syphillis
EIA
What is used to monitor syphillis
RPR (decreasing means succerssful treatment)
Management of asymptomatic aortic stenosis
If LV function is impaired (less than 55%) - they need to be referred for aortic valve replacement
Signs of Heart Failure with AS
At what mean gradient across the aortic valve, should someone be referred for aortic valve replacement
> 40 mmHg
Complication of aortic stenosis
Herat Failure
What is the most likely outcome of HZV opthalmicus
Usually complete resolution with no sequelae
What is the normal urine output
800 to 2,000 mls a day
PTH levels in primary hyperparathyroidism
NORMAL
Species that causes Infective endocarditis in IVDU users
Staph aureus
Strep viridian’s - dental care
What fibre deficiencies can cause colon cancer
Fibre
Folate
Calcium
What chronic condition can cause colic cancer
UC and Crohn’s
DM
Clinical features of right colon cancers
Weight loss
Anaemia
Masses
Clinical features of left colon cancers
Increased frequency of stools (change in bowel habits)
Bowel obstruction
Rectal bleeding
First line investigation for colon cancers
Proctoscopy with or without sigmoidoscopy
Sounds heart in a ventricular septal rupture
Sudden harsh pan systolic murmur at the apex
Clinical features of a ventricular septal rupture
Sudden angina/hypotension and pulmonary oedema
Clinical features of a free wall rupture (MI)
Cardiac tamponade
How do we diagnose a pseudo aneurysm
ECHO
Management of a papillary muscle rupture
Mitral valve replacement - cause mitral regurgitation (pan systolic murmur)
Most common type of arrhythmia seen post MI
Ventricular fibrillation
Management of obesity (25-29.9)
General advice on lifestyle;e
management of obese people with 27 BMI + Diabetes, HTN or dysplipidaemia
Consider Orlostat (definitive management at 30+)
Management of Obesity in T2DM with BMI 30-35+
Refer to bariatric surgery
Management of BMI >40 with no other health issues
Consider bariatric surgery
Definitive first line if BMI is over 50
Management of asymptomatic AF
As long as rate is controlled - no further treatment is needed
Management of cord compression in palliative care
Radiotherapy and then bisphosphonates
What lobe of the brain does Alzheimer’s effect
Temporal lobe
Management of pain postoperatively in people with respiratory distress risk
Epidural anaesthesia
