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MSRA > MSRA 1 > Flashcards

MSRA 1 Flashcards

1
Q

Polymyalgia Rheumatica - Associations and treeatment

A

Temporal arteritis

Oral steroids

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2
Q

POEMs syndrome

A

polyneuropathy
organomegaly
endocrinopathy (hypothyroidism)
m-protein band from plasmacytoma
skin pigmentation

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3
Q

Associated syndromes of hypothyroidism

A

Downs syndrome
Turners syndrome
POEMs syndome
CF
PBC (NOT PSC)

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4
Q

vocal resonance/fremitus

A

INCREASED = Consolidation
DECREASED = effusion, collapse

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5
Q

Acute asthma - types

A

Moderate: PEF 50-75%
SpO2 > 92%

Acute severe: PEF 33-50%
SpO2 > 92%
RR >25
HR >110
Cannot complete sentences

Life threatening: PEF <33%
Silent chest, cyanosis, poor resp effort
Arrythmia, hypotension
Exhaustion
Altered conciousness

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6
Q

Epiglottitis

A

H influenzae type B
Tripod sign
Lateral neck X-ray - thumbprint sign

Cefotaxime (cephalosporin) and corticostseroids

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7
Q

Meniere disease

A

triad - hearing loss, tinnitis, vertigo
Age 35-55
Lastshours
sensorineural hearing loss

Cinnarizine or prochlorperazine
REGULAR - betahistine hydrochloride as prophylaxis

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8
Q

methotrexate pneumonitis treatment

A

methotrexate cessation
high dose steroids

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9
Q

Babies sitting independent

A

6-8 months

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10
Q

symptoms of hypocalcaemia

A

cicumoral paraesthesis
mental status changes
tetany
carpopenal spasm
laryngospasm
seizures
QT prolongation on ECG
Cardiac arrest

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11
Q

chvostek

A

tapping facial nerve in preauricula area = facial contraction

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12
Q

trousseau

A

inducing carpal spasm upon inflation of BP cuff

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13
Q

superior homonymous quadrantopia

A

temporal lesion

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14
Q

inferior homonymous quadrantopia

A

parietal lesion (think i remembered PITS???)

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15
Q

felty syndrome

A

SANTA - splenomegaly, anaemiea, neutropenia, thrombocytopenia, arthritis (rhematoid)

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16
Q

Tx of rheumatoid

A

DMARD - methotrexate and sulfalazine
no need to start with NSAIDS

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17
Q

bloodshot, itchy eyes
cracked red lips

A

Riboflavin (Vitamin B2) deficiency

cracked red lips
inflammation of lining of mouth and tongue
mouth ulcers
angular cheilitis
sore throat

also associated with oral-ocular-genital syndrome

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18
Q

Lung abscess Ix and Mx

A

CT scan
clindamycin 4-6 weeks

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19
Q

antidepressants in post partum breastfeeding women

A

imipramine and nortriptylline , paroxetine, sertraline
DO NOT give citalopram or fluoxeine (can consider if used sucessfully with one of these during pregnancy.

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20
Q

common organisms in copd penumonia

A

strep pneumonia
h influenzae
moraxella catarrhalis

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21
Q

klebsiella penumoniae

A

alcoholic patients, may cavitate

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22
Q

mycoplasma pneumonia

A

disease of younger people
fever, malaise, several days duration, non-productive cough
faint bilat interstitial infiltrates

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23
Q

lidocaine max dose

A

1% lidocaine = 10mg/ml
max dose = 3mg/kg OR 7mg/kg with epinephrine

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24
Q

femoral hernias

A

below inguinal ligament
lateral and inferior to pubic tubercle (INGUINAL IS SUPERIOR AND MEDIAL)

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25
Q

distribution of colon cancer

A

rectum (45%)
signmoid
caecum and ascending colon
transverse
descending

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26
Q

2ww criteria for colon ca

A

> 40yo, weight loss + abdo pain
50 yo, rectal bleeding
60 yo with IDA, OR change in bowel habit
+ve faecal occult blood

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27
Q

GRACE score

A

assess ACS - identifying higher risk patients (age, HR, SBP, renal function, CHF, ST segment deviation, cardiac arrest, elevated biomarkers)

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28
Q

Interpretation of DVT Wells score

A

<2 - unlikely, consider D-diemr
2 or over: leg vein imaging

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29
Q

CHADVASc score interpretation

A

Oral anticoagulation for all AF patients with CHA2DS2-VASc score 1 or more

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30
Q

ORBIT score

A

risk of major bleeding with anticoagulation with patients with AF

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31
Q

Pre-labour scoring system

A

PEDSS
Position of cervix
Effacement or length of cervix
Dilation of cervix
Softness (or consistency) of cervix
Station of foetus

5 or under: labour unlikely to start without induction
9 or more - labour will likely commence spontaenusly

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32
Q

first trimester uti

A

nitrofurantoin

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33
Q

adult asthma- non acute

A

salbutamol
low dose icx
add - inhaled LABA (fixed dose or MART)
increase ICX to medium dose OR add LTRA (consider stopping laba if no respond)
refer

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34
Q

anal pain whilst defecating, blood, red/purplish pea size lump at anal margin

A

perianal haematoma

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35
Q

haemorrhoid grades

A

1: do not prolapse outside anal canal
2. prolapse of defacation but reduce spontaneously
3. requires manual reduction
4. cannot be reduced

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36
Q

sentinel pile

A

torn, bunched up strip of mucosa at base of anal fissue

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37
Q

corneal ulceration - mx

A

chloramphenicol

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38
Q

sarcoidosis mx

A

steriods

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39
Q

uti, hearing loss

A

gentamicin - vestibulotoxin , permanent loss
nephrotoxic - ATN

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40
Q

loss of vision, cherry red spot

A

central retinal artery occlusion
retina pale and opaque due to odema

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41
Q

treatment of pseudogout

A

from calcium pyrophosphate crystals
treatment is symptomatic
aspiraiton
NSAIDs
intra-articular steroid injection
systemic steriods
cochicine if above contraindicated

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42
Q

Snellen - 6/12 vision

A

person can read at 6 metres what a normal person can read at 12

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43
Q

Caplan’s syndrome

A

pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis
multiple, round, well-defined nodules, usually 0.5-2cm in diameter, can cavitate
treat with steroids

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44
Q

myotonic dystrophy

A

cataract, muscle weakness, frontal balding ** exam q
autosomal dominant
severity increases in successive generations (anticipation)

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45
Q

active tb treatment

A

RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol (2 months)
THEN
R AND I for 4 months

If latent TB: R and I (3 monhts) OR I alone for 6 months)

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46
Q

commonest cause of CAP

A

Strep pneumoniae

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47
Q

rose coloured macular rash following fever

A

roseola (exathmem subitum)
roseola infantum (HHV-6)
incubation period 10 to 15 days
high fever, mild pharyngitis, lymphadenopathy
rose-pink macular non-pruiritic rash

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48
Q

drugs after STEMI

A

ACEi - indefinitely
dual antiplatelet therapy - aspiring indefinitely, P2Y12 inhibitor 12 months)
beta blocker - indefinitely if reduced LVEF, or 12 months if not
statin - indefinitely

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49
Q

menieres , and management

A

triad: vertigo, tinnitus, hearing loss

cinnarizine, prochlorperazine - acute attack

betahistine hydrochlordie - prohylaxis

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50
Q

most common bladder cancer

A

painless haematuria
transition cell carcinoma

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51
Q

pinworm infection

A

mebendazole - single oral dose. all family should be treated together . repeated in 203 weejs in case re-infection has occured

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52
Q

drop to constrict /dilate pupil

A

constrict: pilocarpine

dilate: tropicamide, cyclopentolate, atopine, phenylephrine

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53
Q

most common cause of infective endocarditis

A

staph aureus

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54
Q

most common childhood epilepsy

A

benign rolandic epilepsy - 7-10 yeras, focal motor aware seizures (simple partial seizures), night, involves one side of face and muscles affecting speech and swallowing

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55
Q

impotence, joint pains, increased skin pigmentation

A

haemochromatosis - iron overload disorder - abnormal HFE gene
autosomal recessive

TRIAD: cirrhosis, DM, skin pigmentation

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56
Q

budd chiari syndrome

A

obstruction to hepatic venous outflow

hepatomegaly, ascites, abdo pain
LFT mildly elevated
ascitic fluid high protein content

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57
Q

bergers disease (IgA nephropathy)

A

visible haematuria (nephritic syndrome) 24-48hrs after a URTI.

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58
Q

wegeners dranulomatosis

A

granulomatosis with polyangiitis - systemic vasculitis involves small and large vessels

TRIAD: upper and lower resp tract involvement, pauci-immune glomerulonephritis

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59
Q

haemolytic uraemic syndrome

A

e coli (enterohaemorrhagic)

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60
Q

reversal of severe INR increase

A

prothrombin complex concentrate (PCC) eg. octaplex
has clotting factors 2, 7, 9 and 10

do not use ffp unless no pcc avaliable

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61
Q

HFrEF treatment

A

beta blocker
ACE inhibitor

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62
Q

organism in CSOM - chronic suppurative otitis media

A

p aeruginosa

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63
Q

pterygia vs pingueculae

A

pterygia grows over edge of cornea but pingueculae does not

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64
Q

MEN1

A

age of onset - teenage years

hypercalcaemia
recurrent nephrolithiasis (hyperparathryoidism - in 80% of patients)
amenorrhoea (hyperprolactaemia)
acromegaly (excess GH)

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65
Q

MEN2

A

Relates to medually thyroid cancer (MTC)
hyperparathyroidism
phaeochromocytosa

hypertension, episodic sweating, diarrhoea, pruritis skin lesions, lumb in neck, hypercalacaemia 2nd to hyperparathyrodism

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66
Q

bubbles in urinary stream, foul smelling, green-brown urine. diagnosis and Ix of choice

A

pneumaturia
passage of gas mixed with urine, vesico-colic fistula

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67
Q

ruptured achilles tendon after abx

A

ciprofloxacin

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68
Q

punched out, small, dome-shaped, pearly lesions in young boy

A

molluscum contagiosum - no need for exclusion,

caused by pox virus

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69
Q

painful ear, pinna tender to movements, canal partially occluded by red swelling close to entrance of canal

A

furunculosis - infection of hair follicle - staphylococcus

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70
Q

painful vesicles on tympanic membrane and deep meatal skin

A

bullous myringitis

associated with mycoplasma or viral resp infections (influenza)

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71
Q

autoantibodies to thyroid peroxaidase

A

hasimotos thyroiditis

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72
Q

head lice mx

A

dimeticone 4% lotion

DO NOT USE PERMETHRIN

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73
Q

fungal nail infection

A

5% amorolfine nail lacquer - 6 months fingernails or 12 months toenails

terbinafine 250mg daily for 12 weeks fingernaisl, 6 months toenails

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74
Q

labyrinthitis

A

inflammatory disorder of inner ear, 2nd to viral/bacterial infection or ischaemic event in elderly

acute vertigo
tinnitus
sensorineural deafness
nystagmus towards side OPPOSITE lesion

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75
Q

labyrinthitis vs vestibular neuronitis

A

vestibular neuronitis is inflammation of vestibular apparatus and the causes and symptoms are similar to labyrinthitis.

Can be differentiated by ABSENCE OF TINNITUS OR DEAFNESS

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76
Q

Low back pain, radiates to leg, associated with walking, relieved by rest. pain stops when leaning forwards

A

spinal stenosis

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77
Q

best marker for acute phase of Ibd

A

faecal calprotectin

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78
Q

drugs for glaucoma

A

aims to CONSTRICT pupil

Note: reduce IOP
beta blockers
sympathomimetics
carbonic anhydrase inhibitors

increase drainage of aqueous humour:
prostaglandin analogues
sympathomimetics
miotics (eg. pilocarpine)

acetazolamide

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79
Q

most common pathogen in otitis externa

A

p aeurogenosa

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80
Q

confusion, ataxia, horizontal nystagmus

A

wernicke’s encephalopathy - defiency of thiamine (Vit B1)

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81
Q

types of inguinal hernias

A

indirect: lateral to inferior epigastric artery
direct: originate medial to inferior epigastric artery

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82
Q

organism in fifths disease

A

human parvovirus b19

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83
Q

management of patient w/ lung cancer w/ intractable cough

A

oral morphine

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84
Q

Mx of c difficile

A

vancomycin oral

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85
Q

Mx of amoebic liver abscess

A

metronidazole

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86
Q

HTN and diabetes, first line

A

ACEi

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87
Q

ashermans syndrome

A

intrauterine adhesions within uterus, cavity becomes partly obliterated
frequently after D&C
hysteroscopy gold standard
presents with amenorhhea

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88
Q

goodpastures

A

anti-BGM antibodiy
haemoptysis, renal failure

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89
Q

telangiectasia, recurrent epistaxis, positive FH

A

osler-Weber-rendu syndrome, AD disorder

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90
Q

chinese, nosebleeds and hearing loss

A

nasopharyngeal carcinoma
associated with EBV

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91
Q

extracorporeal memberane oxygenation

A

ECMO

used to support cardiac and respiratory in patients, primary pulmonay HTN or respiratory distress syndrome

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92
Q

cysts in neck

A

branchial cysts - lateral in neck
cystic hygromas - posterior triangle
thyrogloassal cyst - midline, moves upwards if protrudes tongue

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93
Q

first line, stable angina

A

beta blocker
CCB (like verapamil)

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94
Q

humeral head under coracoid process

A

anterior dislocation

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95
Q

peritonsillar abscess organism and treatment

A

strep pyogenes
quinsy
benzylpenicillin and metronidazole

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96
Q

reduced visual acuity, reduced colour perception, preceded by orbital pain worst on exercise

A

optic neuritis - denyelinating inflamamtion of optic nerve usually associated with MS

note: reduced colour perception = dyschromatopsia

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97
Q

commonest congenital cardiac defect in down syndrome

A

atrioventricular septal defect

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98
Q

weber and rinne test

A

webers test: localisation to left implies either L middle ear deafness OR right nerve deafness

Rinne +ve on R = nerve deafness

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99
Q

recurrent episodes of vertigo lasting days , preceding illness

A

vestibular neuritis

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100
Q

how to differentiate between vertigo

A

BPPV - seconds, Menieres disease - hours, vestibular neuritis - days

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101
Q

initial investigation for polycystic kidney disease

A

USS abdo

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102
Q

drugs contraindicated with azathioprine

A

ACEi (eg. ramipril)

azathioprine is metabolised by TPMT enzyme

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103
Q

lupus vulgaris

A

painful, cutaneous tuberculosis skin lesions with nodular appearance

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104
Q

conjunctivitis, urethritis, arthritis

A

reactive arthritis
reiters
can’t see, cant pee, can’t bend the knee

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105
Q

ankle swelling with antihypertensive

A

amlodipine

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106
Q

types of cushings syndrome

A

bought on by exogenous steriods

acth dependent: increased acth, can include exogenous ACTH administration, pituitary (cushing disease) and ectopic cushings

acth independent - increased cortisol but acth decreased due to neg feedback. caused by exogenous administration of glucocorticoids or by adrenal adenoma, carcinoma or nodule hyperplasia

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107
Q

most likely shoulder dislocation

A

anterior (95% of time)

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108
Q

Haemolytic uraemic syndrome triad

A

acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia

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109
Q

siplopia, ptosis, ubable to adduct eye

A

3rd nerve palsy

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110
Q

most common bacterial sti

A

chylamdia (note bacterial)

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111
Q

treatment of chlymdia

A

dozycycline

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112
Q

mx of gout

A

colchicine or nsaid in acute
prednisolone if cannot tolerate both

allopurinol after acute attack

113
Q

dysphagia in elderly men, first mouthful easy then gradually worst

A

pharyngeal pouch
confirm by barium swallow
do not do endoscopy

114
Q

electrolytes in addisons

A

hyperkalaemia
hyponatraemia

115
Q

coal miner, eggshell calcification on lymph nodes on CXR

A

silicosis

116
Q

cirrhosis, DM and skin pigmentation

A

haemochromatosis

117
Q

painful genital ulcer, swollen inguinal lymph nodes, no discharge

A

trichomas vaginalis - chancroid

118
Q

strawberry cervix

A

trichomonias, strawberry cervix

green, odour, fishy

119
Q

first line anticoagulant for AF

A

DOAC

120
Q

risk of cocp

A

breast ca
cervical ca
vte
mi
stroke

121
Q

steeple sign

A

subglottic narrowing - croup

122
Q

brown sequard syndrome

A

incomplete spinal cord lesion - hemisection of spinal cord

ipsilateral loss of proprioception and motor
contralateral loss of pain and temp

123
Q

young man, pleuritic chest pain, rusty colour sputum

A

strep oneumoniae

124
Q

treatment of alopecia areata

A

minoxidil

125
Q

fertility testing for women

A

28 day progesterone - mid luteal cycle progesterone

(aim for sample taken 7d prior to expected period - i.e d21 on d28 cycle

126
Q

best indicator for diabetic rephropathy

A

microalbuminuria

127
Q

young man, 3 week hx steadily progressive cough - organism?

A

mycoplasma pneumonia

128
Q

HTN, muscle cramps, weakness, hypok

A

conns - increased aldosterone secretion from adrenal glands, suppressed renal activity, HTN, hypokaelamia

129
Q

pathognomic ecg feature in hypothermia

A

j-waves

130
Q

37 weeks pregnant, uti

A

cefalexin 7 days

131
Q

HIV patient, meningoencephalitis - organism?

A

cyrptococcosis

132
Q

Section 5(2) duration

A

drs holding power - detained for 72 hrs - must be admitted to ward

133
Q

Section 5(2) duration

A

drs holding power - detained for 72 hrs - must be admitted to ward to hosp

134
Q

aplastic anaemia vs mds

A

aplastic anaemia - hypocellular marrow , marrow stops making enough stem cells

mds - hypercellular marrow, marrow produces abnormal cells and in some not enought stem cells

135
Q

3 month old, failure to thrive, symmetrically poor weight gain, reduced length and head circumference, umbilical hernia

A

congenital hypothyroidism

136
Q

abx that stains teeth

A

tetracycline

137
Q

fatigue, pruirits, steatorrhoea, dry eyes, mouth, jaundiced, xanthelasma, enlarged liver and spleen

A

Primary biliary cirrhosis - antimitochondrial antibodies

138
Q

chronic pain and tingling of butt. pain worse sitting on toilet/chair. no lumbar pain. pain on internal rotation of extended thigh

A

piriformis syndrome

139
Q

rubella triad

A

sensorineural hearing loss
ocular abnormalities (cataracts, rubella retinopathy)
congenital heart defects

140
Q

neonate, double bubble sign on uss

A

duodenal atresia

141
Q

dix-hallpike positive

A

BPPV

142
Q

tx of impetigo

A

if localised non-bullous impetigo - hydrogen peroxide 1% cream, OR if unsuitable fusidic acid or mupirocin

if widespread non-bullous impetigo - short course of topical or oral abx

143
Q

anion gap formula

A

(na + k) - (hco3 + cl)

144
Q

itchy, flat, purplish, flat-topped pustules with interspersed lacy white lines on wrist

A

lichen planus

145
Q

definition of imparied fasting glucose

A

fasting glucose >6.1 - 7.0

146
Q

acute cholangitis presentation

A

triad: fever, RUQ, jaundice

147
Q

types of elbow pathology

A

lateral epicondylitis (tennis elbow) - overuse injury involving extensor muscle that originate on lateral epicondylar region of distal humerus

148
Q

positive simmons/thompson test

A

+VE TEST = RUPTURE
absences of normal plantar flexion on squeexing the calf muscle indicates a complete tendon rupture

149
Q

treatment in mild myasthenia gravis

A

pyridostigmine - acetylcholinesterase inhibitor

150
Q

caution when using simvastatin

A

max dose of simvastatin is 20mg if used in conjunction with amlodipine - as amlodipine is a weak inhibitor of CYP3A4

151
Q

what drug can treat spironolactone

A

tamoxifen

NOT spirolactone - this causes gynaecomastia

152
Q

ringworm infection of scalp

A

griseofulvin

153
Q

resistant htn treatment

A

if K <4.5 - spironolactone

if K >4.5 - alpha or beta blocker

154
Q

commonest cause of pcb

A

cervical ectropion

155
Q

commonest organisms in erysipelas

A

streptococcus PYOGENES

borders of infection are sharply demarcated

156
Q

purpura, arthritis, abdo pain, GI bleeding, orchitis, nephritis

A

Henoch-Schonlein purpura - systemic vasculitis by deposition of immune complexes containing IgA in skin and kidney

157
Q

young boy, painful knees, lumps over tibial tuberosities

A

Osgood schlatter
small avulsion fractures within tibial tuberosity

158
Q

optic palsies

A

2 - lack of sight
3 (oculomotor) - down and out, ptosis
4 (trochler) - superior oblique, deviated upwards, difficulty going upstairs

6 - abducens, lateral rectus, failure in ABDUCTION

159
Q

soft transilluminable mass in posterior triangle

A

cystic hygroma

160
Q

longstanding, solitary, painless mass on lateral side of neck

A

branchial cyst

161
Q

ccb not tolerated in black pt

A

thiazide like diuretic like indapamide

162
Q

21yo, new onset asthma, what to start on

A

salbutamol and steriods

163
Q

lung cancer, hypercalacaemia

A

squamous cell carcinoma (secretes PTHrP)

164
Q

deranged LFTs, macrocytic anaemia. presented acutely confused. ataxic gait, horizontal nystagmus and bilat abducens nerve palsy. offending drug?

A

glucose

infusion of glucose in a chronic thiamine deficiency can precipitate wernickes encephalopathy - triad of acute mental confusion, ataxia, ophthalmoplegia

165
Q

recurrent infections
diarrhoea
dermatitis
failure to thrive
paeds

A

scid

166
Q

kid, bulging opaque tympanic membrane

A

acute otitis media

167
Q

aggressive thyroid carcinoma

A

anaplastic
features of hoarsenss and dyspnoea

168
Q

thyroid cancer, diarrhoea and flushing

A

medually due to excessive calcitonin

169
Q

old man, progressive deafness, ringing bilat. audiometry shows bilar loss of hearing at higher frequencies

A

presbycusis

170
Q

young woman, progressive bilar hearing loss and tinnitus. low frequency conductive hearing loss

A

otosclerosis

171
Q

missed progesterone pill

A

if >3 hrs overdue, take missed pill now and use extra precautions for 48 hrs

172
Q

side effect of SGLT inhibitors

A

lower limb amputation

173
Q

se of pioglitazone

A

bladder ca

174
Q

se of metformin

A

decreased Vitamin 12 levels

175
Q

goodpastures

A

triad of
diffuse pulmonary haemorrhage
glomerulonephritis
circulating anti GBM antibodies

176
Q

contraception for someone with past breast cancer

A

no hormones
copper intrauterine device

177
Q

interpretation of PE wells score

A

> 4 CTPA
4 of less, - d simer and start therapeutic anticoagulation

178
Q

k w/ steriods and furosemide

A

hypok

179
Q

pregnant woman, new onset hyperthyroidism

A

prothiouracil and carbiazole
avoid carbimazole in first trimester - teterogenic

180
Q

active cancer, has dvt

A

doac

181
Q

treatment of scabies

A

permethrin 5%

182
Q

side effect of tb drugs

A

R: orange secretions (orange coloured tears), liver, reddish colour urine
I: peripheral neuropathy, liver, agranulocytosis, TINGLING SENSATION IN HANDS
P: hyperuricaemia, hepatitis
E: (EYES) optic neuritis, red-green colour blindness, peripheral neuropathy

183
Q

painful vesicles on tympanic membrane

A

bullous MYRINGITIS

184
Q

htn drug causing hypok

A

indapamide (thiazide diuretic

185
Q

htn causing hyperk

A

spironolactone, beta b, acei. arb, digoxin, heparin, trimethoprim

186
Q

mx of roseasea

A

metronidazole (topical)

187
Q

mx of uncomplicated acute diverticulitis

A

co-amoxiclav

188
Q

small child, whoop sound cough, Dx and Mx

A

bordetella pertussis / pertussis

3 days azithromycin or 7 days clarithromycin

189
Q

ecg changes in digoxin toxicity

A

st depression
inverted t waves in v5 to v6 (reverse tick)§

190
Q

ecg changes in hypokalaemia

A

small or flatted t waves,
prominent u waves
prolonged pr interval
depression st segments

191
Q

punched on left jaw, which nerve affected, unable to oppose teeth

A

mental nerve

192
Q

drug that can provoke seizures

A

tramadol
short tonic-clonic seizures

193
Q

mx of menopausal in woman not keen for hrt

A

antidepressants like citalopram
clonidine
gabapentin

194
Q

osmolality equation

A

2Na +urea +glucose

195
Q

drug used in rheumatoid. caused reduced visual acuity

A

hydroxychloroquine - ocular toxicity
whorl like corneal deposits
bulls eye macular lesions

therefore ALL patients taking chloroquine should have regular ocular examinations

196
Q

depression, breastfeeding medications

A

sertraline, paroxetine

197
Q

tingling and weakness of intrinsic muscles of L hand as well as ipsilateral ptosis

A

pancoast tumour

leads to horners syndrome - miosis enopthalmos, ptosis

198
Q

treatment of acute Superior venous cava obstruction

A

dexamethasone

other treatment includes radiotherapy, chemotherapy, vascular stent

199
Q

lachman test positive

A

acl injury

200
Q

tremor, hyperreflexia, ataxia, flattened T wave - what toxicity? ***

A

lithium

201
Q

se of hyoscine

A

dry mouth

202
Q

se of clozapine

A

increase saliva production

203
Q

orbit score

A

assess risk of bleeding in pts with AF on anticoag (more accurate than prev used hasbled

204
Q

abcd2

A

risk of stroke in days after a tia

205
Q

spondylolisthesis

A

forward slippage of a vertebra and the spine above it relative to the vertebra below

206
Q

side effects of tamoxifen

A

PREVENTS BONE LOSS (benefit)

endometrial damage inc. hyperplasia, cancer etc
VTE
fatty liver
hypertriglyceridaemia

207
Q

wild flinging of limbs

A

hemiballismus - due to infarction/haemorrhage in the contralateral subthalmic nucleus

208
Q

semi-directed, irrgeular movements, not repetitive or rhythmic, appears to flow from one muscle to next

A

chorea

209
Q

march fracture

A

stress fracture from repeitive walking or running - commonest site is 2nd MT shaft, tender lump on dorsum of foot

210
Q

se of copper iud

A

prolonged, heavier, more painful periods

211
Q

mx of myasthenia gravis

A

acetylcholinesterase inhibitors - pyridostigmine

212
Q

mx of onychomycosis

A

oral terbinafine - for fungal nail infection caused by trichophyton rubrum - for several months

213
Q

Hartnup disease

A

** exam q**
inborn abnormality of renal and intestinal transport involving neural amino acids

pellagra like dermatitis - red, scaly, photosensitive rash on face, arms, extremities and sun exposed areas
neurological involvement - sudden ataxia, unsteady gait, dysarthria, tremors, speasticity

needs high protein diet, avoid sulphonamide drugs. supplementation with nicotinamide or niacin

214
Q

neonate, chorioretinitis, intracranial calcifications, hydrocephalus

A

congenital toxoplasmosis

215
Q

teenager, widespread rash. multiple discreet flat red lesions (small) and one larger lesion about 5cm on torso

A

pityriasis ROSEA

has a herald patch - characteristic of rosea

**prev exam q

216
Q

rash with christmas tree distribution

A

guttate psoarsis

217
Q

ulcerative colitis is associated with which condition

A

PSC!!!

218
Q

pruritis, xanthelasmtic lesions around eye, hepatosplenomegaly , jaundice

A

PBC - primary biliary cirrhosis

autoimmune condition!

antimitochondrial antibodies

219
Q

worldwide illness, facial flushing, fever, abdo pain

A

dengue fever, diagnosed with serology

220
Q

breast cancer tumour marker

A

15-3

221
Q

cancer related to lambert eaton

A

small cell carcinoma of lung

222
Q

memory issues, down syndrome

A

alzheimers

223
Q

is hiv a notififiable disease?

A

no

224
Q

rocker bottom feet

A

edward syndrome

225
Q

risk of down syndrome baby in 40yo mohter

A

1 in 100

226
Q

conversion disorder

A

‘hysteria’
alteration or loss of physical function suggestive of physical disorder - loss of motor or sensory function
pt does NOT consciously geign the symptoms and are not seeking for material gain

227
Q

drugs causing impotence

A

atenolol, thiazide diurectics, beta blockers
oestrogens
finasteride
antiandrogens
benzodiazepines
phenothiazines

228
Q

colles fractures

A

dorsally displacted, distal radius fracture

229
Q

long face, big testicles

A

fragile X

learning difficulties
large jaw

230
Q

se of amiodarone

A

pulmonary fibrosis
corneal deposits
skin pigmentation (blue/grey) on sun exposed areas
thyroid disturbance
hepatotoxicity

231
Q

se of digoxin

A

dizziness
zanthopsia (blurred/yellow vision)
arrythmyas
ST depression and inverted T waves in V4-6 (reverse tick)

232
Q

se of adenosine

A

flushing
bronchospasm
chest pain

233
Q

drug which can predispose to gallstones

A

cholestyramine - binds bile in the GI tract to prevent its reabsorption which are then excreted in faeces

also causes consitpation

234
Q

drug causing severe flushing

A

nicotinic acidl

235
Q

large irregular pupil that constricts slowly to light but accomodates nromally

A

holmes-adie pupil: considered variation of normal

236
Q

shining light on normal eye causes full constriction of both pupils. but when light shines on affected eye there is apparent dilation of both pupils

A

marcus gunn pupil - unilateral lesion in afferent visual pathway anterior to chiasm

237
Q

small irregular pupil that DO NOT react to light but accomodates normally

A

argyll roberson pupil:most common cause is syphilis

“the prostitutes pupil - doesn’t react but accomodates

238
Q

causes of small bowel obstruction

A

most likely cause is adhesions postoperative (60%)
malignancy
crohns
hernias

239
Q

fixed flexion deformity at PIP joint along with hyperextension of DIP joint in fingers

A

boutonniere deformity

240
Q

hyperextension of interphalangeal join and fixed flexion and subluxation of the metacarpophalangeal joint

A

z deformity
occurs in RA

241
Q

when can you use surgical haemorrhoidectomy

A

reserved for grade 4
but can be considered for grade 3

242
Q

monitoring for lithium patient

A

*past exam paper

lithium needs THYROID function tests
aksi beeds fbc, u&e, calcium, ecg

243
Q

chronic pain and stiffness to L foot, poorly localised to forefoot, related to activity, minor foot injurt a few months ago

A

freiberg’s disease - osteochondrosis affecting the toes - articular surgaces of 2nd and 3rd metatarsal heads collapse

244
Q

mx of vit d overdose

A

bisphosphonates

pt presents with signs of hypercalcaemia

245
Q

drugs causing raised serum calcium levels

A

thiazide diuretics, lithium, antacids, cholcalciferol

246
Q

9 weeks into pregnancy, small pv bleeding, cramping painds. scan shows confirmed death of foetus at 7 wees

A

missed miscarraige

247
Q

delusion of being loved generally by someone of superior social status

A

de clarambault syndrome / erotomaia

248
Q

familiar person falsely identified by strangers

A

fregoli syndrome

249
Q

familiar person supplanted by stranger who is their exact double

A

capgras sydnrome

250
Q

nihilistic delusions of body/self disappeared

A

cotard syndrome

251
Q

steeple sign on xray

A

croup

252
Q

asbestosis, most common cancer

A

*past exam q

lung ca not mesothelioma

253
Q

weight loss, palpaitions, trmor. grossly enlarged anterior neck swelling . high t4, low tsh

A

toxic nodular goitre

also known as plummers disease

2nd most common cause of hyperthyroidism after graves

254
Q

6 week. baby, rash on face and neck, apyrecix, well in self

A

erythma toxicum neonatorum

254
Q

antiemetics in bowel obstructions

A

functional - metoclopramide
mechanical - cyclixine

255
Q

antiemetic used for pts with hypercalcaemia

A

haloperidol (for metabolic causes of vomiting - hypercalcaemia, renal failure

256
Q

vaginal discharge green/yellow, cervix has strawberry spots

A

metronidazole

trichomonas vaginalis

257
Q

RUQ pain, white vaginal discharge, gram -ve

A

gonorrhoea
ceftrixone

258
Q

poly uria, poly dipsia, dehydration, rickets or osteomalaxia

A

fanconi syndrome - results from excessive urinary loss of ca and phos and defect in hydrozylation of 25-yhydroxyvitamin D3 and impared growth

259
Q

drug that causes gout

A

bendroflumethiazide (past exam q)

diuretics
salicyclates
ethambutol
nicotinic acid
pyreazinamide

260
Q

detection of neural tube defects if uss is equivocal

A

amniotic fluid a-fetoprotein obtained by amniocentesis at 16 weeks

261
Q

se of pop

A

irregular bleeding - most commn resason to stop

breasth tenderness
weight gain
acne
headaches

262
Q

most common organism in acute otitis media

A

rsv, rhinorus, adenovirus, influexna, parainfluenza
strep pneumonia
h influenza
moraxella catarhalis

263
Q

50yo caucasian man cannot tolerate acei

A

arb

264
Q

started on risperidone, restless, lower-limb movment.

A

akathisia - prominence of lower limb restlessness after starting antipsychotic

the restless leg syndrome differens as it is restlessness interfering wiht sleep

265
Q

mx of listeria

A

amox and gent

266
Q

mx of syphilis

A

from treponema pallidum

benzathine benzylpenicillin

267
Q

mx of toxoplasmosis

A

spiramycin

268
Q

what. is pseudoobstruction

A

colonic obstruction but a MECHANICAL causes cannot be found
usually in elderly and bedrudden pts
gas in rectum on abdo xray

269
Q

vomiting, hyperventiliation, tinnitus, sweating, respiratory alkalossi

A

aspirin overdose

270
Q

dry mouth, dilated pupils, blurred vision, tachy, seizures, wide qrs complexes

A

amitripllyine overdose

give activated charcoal

271
Q

most common cause of septic arthritis

A

staph aureus

272
Q

rapidly expanding, painless, ulcerating nodules

A

squamous cell carcinoma

273
Q

non-healing ulcer, edges are rolled

A

basal cell

274
Q

drugs that worsen glycaemic control

A

bendrofluzamide (thiazide)
beta blockers

glucocorticoides
antipsychotic drugs

275
Q

drug to give after thrombolysis in acs

A

heparin or lmwh

also consider iv betablocker

276
Q

drug to avoid in renal artery stenosis

A

ace inhibitor

277
Q

commonest se to ssri

A

increase f=gi bleeding

GIVE Ppi with it

also increased anxiety and agitation

278
Q

treamtn of trigeminal neuralgia

A

carbamazepine

DO NOT CLICK AMITRIPLLINE
past q

MSRA (2 decks)

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