MSRA 10

Question 1

What tool is used to diagnosed acute rheumatic fever?
What are its major and minor criteria?

Answer 1

Revised Jones criteria

Major - migratory polyarthritis, Carditis, Sydenham Chorea, subcutaneous nodules, erythema marginatum

Minor - high fever, polyarthritis, esr >60 crp>30, ecg showing prolonged PR

2majors
1major and 2minor

Question 2

What are the rheumatic fever effects on the heart valve?

Answer 2

Pancarditis
Mitral valvulitis
(Acute mutral regurgitation)
(Chronic mitral stenosis) or mixed
Aortic stenosis or regurgitation

Question 3

What is aortic sclerosis

Answer 3

Aortic valve sclerosis occurs without aortic stenosis in its early stages, but can progress to aortic stenosis once signs of LVOT obstruction begin to occur.

Question 4

Which genetic condition cause a bicuspid aortic valve?

Answer 4

Turner syndrome

Question 5

What is Reye syndrome

Answer 5

A rare but potentially life-threatening condition in children < 19 years that generally develops after treating a viral illness (e.g., influenza, varicella) with salicylates like aspirin. The viral infection alters the metabolism of salicylates and leads to accumulation of metabolites in the liver, which causes hepatic mitochondrial injury that prevents hepatic ATP production. The result is hepatic failure (hyperammonemia, metabolic acidosis, and hepatic steatosis) that manifests with acute hepatic encephalopathy.

Question 6

At what age does paediatric BLS be used from?

Answer 6

1month to 18 yeats

Question 7

When are signs of life assessed for after 5rescue breathes in paediatric BLS and what would be the next step in the

Answer 7

During rescue breathes, if no signed of life then 15:2 chest compressions

Question 8

How is a UTI investigated if it shows an atypical organism or if is under 6 months?

Answer 8

Ultrasound kidneys during the infection

Question 9

How should a treated UTI in an under 6month be managed if they responded to antibiotics?

Answer 9

US within 6 weeks

Question 10

How do you manage a uti in under 3months?

Answer 10

Urgent referral

Question 11

What are the APGAR readings?

Answer 11

Activity - Nothing 0 / Some flexion 1 / Active 2
Pulse - Nothing 0 / under 100 1 / over 100 2
Grimace - No reactio 0 / Reactive 1 / cough, sneezing, cry 2
Appearance - Blue 0 / Blue hands, feet 1 / Good colour 2
Respiration - Nothing 0 / weak 1 / strong 2

Question 12

What are the CI for 5-flouracil cream and what can be given instead?

Answer 12

Diclifenac gel

Question 13

What is bacterial exanthem?

Answer 13

Scarlet fever

Question 14

What would you give to treat the cosmetic appearance in mild psoriasis plaques in a child

Answer 14

Vit D cream

Question 15

What is pustules on the hands with eczema that improved with steroids with widespread rash?

Answer 15

Scabies incognito

Question 16

Is cefelexane safe in pregnancy

Answer 16

Yes, it is a cephalosporon and cephalosporin is safe in pregnancy

Question 17

Which is always the preferred option for emergency contraception?

Answer 17

IUD

Question 18

Can you sterilise at the same time as a continuous section?

Answer 18

Yes

Question 19

What does a broken foot with lots of swelling in a cast signify? What treatment does it need?

Answer 19

Compartment syndrome, remove the cast

Question 20

What is the antimitochondrial antibody associated with?

Answer 20

PBC

Question 21

How is Salmonella spread?

Answer 21

Faecol oral route

Question 22

What is Hoagland sign

Answer 22

Eye lid swelling in EBV infections

Question 23

Which nerve is affected in Ramsey hunt syndrome

Answer 23

Trigeminal nerve

Question 24

What is a shower of floater characteristic of?
What are the risk factors for it?

Answer 24

Retinal tear
Myopia, cataract surgery

Question 25

Retrobulbar haemorrhage risks what complication? How quickly can this complication occur?

Answer 25

Oribtal compartment syndrome OCS can cause irreversible loss of vision within 1–2 hours.

Question 26

What is a rhabdomyoscarcoma

Answer 26

Most common soft tissue sarcoma and malignant orbital tumor in children

Question 27

What are the features of fragile X

Answer 27

Second commonest cause of intellectual disability after trisomy 21 X-linked dominant Hypermobile joints, mitral valve prolapse, seizures

Question 28

How do you differentiate between Edward and Patau?

Answer 28

Edwards has a prominent occiput

Question 29

What are the cardiac feature of Turner's syndrome?

Answer 29

COA and bicuspid aorta

Question 30

What is the commonest cause of male hypogonadism?

Answer 30

Klinerfelter

Question 31

Which adenoma is the commonest pituitary adenoma?

Answer 31

Prolactinoma

Question 32

Is ibuprofen associated with cardiovascular events?

Answer 32

No

Question 33

What would an insulinoma be associated with? (with genetic condition)

Answer 33

MEN a

Question 34

What are the tools to assess for possible FH?

Answer 34

Use the Simon Broome criteria or the Dutch Lipid Clinic Network (DLCN)

Question 35

When would you suspect FH and when would you make a clinical diagnosis?

Answer 35

A total cholesterol level greater than 7.5 mmol/L and/or A personal or family history of premature coronary heart disease (CHD, an event before 60 years in an index person or first-degree relative [parents, siblings, children]). Take two measurements of low-density lipoprotein (LDL) cholesterol concentration. Consider a clinical diagnosis of homozygous FH in adults with LDL cholesterol concentration greater than 13 mmol/L. Consider a clinical diagnosis of homozygous FH in a child or young person (up to 15 years of age) with an LDL cholesterol concentration greater than 11 mmol/L.

Question 36

Which drug must you not co-prescribe with erythromycin?

Answer 36

Using simvastatin, tolterodine, mizolastine, amisulpride, astemizole, terfenadine, domperidone, cisapride, pimozide, ergotamine, or lomitapide.

Question 37

What is rubeosis iridis

Answer 37

a condition in which abnormal blood vessels form on the surface of the iris

Question 38

What is enteric fever

Answer 38

Caused by invasive diarrhoea Caused by Salmonella enterica serotypes Typhi and Paratyphi. Manifestations include fever, abdominal pain, and rose spots on the trunk and abdomen.

Question 39

What are the features of Yersinia?

Answer 39

Causes pseudopancreatitis. Caught from mil and pork. A condition that presents with signs and symptoms classically associated with appendicitis (e.g., right lower quadrant pain, fever, vomiting, leukocytosis). Caused by mesenteric lymphadenitis, typically as a complication of Yersinia infection. Management involves antibiotic therapy to eradicate the underlying infection.

Question 40

Which DI does Lithium cause?

Answer 40

Nephrogenic diabetes insipidus

Question 41

What is Troisier's sign

Answer 41

Troisier's sign, also known as the Virchow node, is a clinical sign that indicates an enlarged left supraclavicular lymph node.

Question 42

What are the big SE of cholchicine?

Answer 42

Diarrhoea

Question 43

What is Epiphora

Answer 43

Epiphora is the medical term for watery eyes,

Question 44

Give 3 characteristic features of open angle glaucoma

Answer 44

Impaired adaptation to darkness Generally bilateral, progressive visual field loss (from peripheral to central) Arcuate scotoma: arch-shaped scotoma that starts from the blind spot

Question 45

What are the risk factors for open angle glaucoma

Answer 45

Age > 40 years Increased IOP European or African descent Diabetes mellitus Familial predisposition Myopia Steroid use

Question 46

What should you not do in acute angle glaucoma

Answer 46

Do not use mydriatic drugs (e.g., atropine and epinephrine) during ophthalmologic examination in patients with acute angle-closure glaucoma! Moreover, do not cover the eye, since darkness induces mydriasis and worsens the condition!

Question 47

What is the normal optic disc cup ratio?

Answer 47

The normal optic disc cup-to-disc ratio is less than 0.5. A ratio of 0.6 or greater is generally considered suspicious for glaucoma, but there are other factors to consider:

Question 48

What are the features of gonorrhoea conjunctivitis?

Answer 48

Hyperacute conjunctivitis Marked eye swelling Profuse purulent discharge Preauricular lymphadenopathy Possibly, corneal infiltrates or ulcers

Question 49

What are features of chlamydia conjunctivitis?

Answer 49

Inflamed upper tarsal conjunctiva Conjunctival scarring Corneal ulcers and opacities Superficial neovascularization with cellular infiltration (corneal pannus) Entropion Trichiasis

Question 50

What are the three gross motor delay findings needing urgent referral?

Answer 50

not sitting by 8 months (corrected for gestational age) not walking by 18 months (corrected for gestational age) early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age).

Question 51

When should a child with difficulty walking be referred?

Answer 51

Delayed walking after 15 months of age for girls or 18 months for boys. Waddling gait, enlarged muscle bulk, or proximal muscle weakness (consider muscular dystrophies). Frequent falls or clumsiness. Delay or regression of milestones (for example speech, communication, and feeding). A family history of delayed walking or muscle disease.