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Explanation > MSRA > Flashcards

MSRA Flashcards

1
Q

What are the pre-op requirements for fasting?

A

6hrs pre-op = non-clear fluids and food

2hrs = clear fluid

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2
Q

What are the peri-op requirements for metformin?

A

Day before = take as normal

Day of = if OD/BD take as normal, if TDS omit lunchtime

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3
Q

What are the peri-op requirements for sulfonylureas?

A

Day before = take as normal

Day of = if OD omit, if BD & am op omit am dose, if BD and pm op omit both

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4
Q

What are the peri-op requirements for gliptins?

A

Take as normal

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5
Q

What are the peri-op requirements for GLP-1 (gliptides)?

A

Take as normal

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6
Q

What are the peri-op requirements for SLGT-2 inhibitors?

A

Day before = take as normal

Day of = omit

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7
Q

What are the peri-op requirements for insulin?

A

OD (levemir, lantus) = reduce by 20% day before & of

BD (novomix, humulin) = day before take as normal, day of 1/2 morning dose, normal evening

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8
Q

Post-bronchodilator FEV1/FVC <70% + FEV1 >80% predicted

A

Stage 1 COPD = mild

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9
Q

Post-bronchodilator FEV1/FVC <70% + FEV1 50-79% predicted

A

Stage 2 COPD = moderate

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10
Q

Post-bronchodilator FEV1/FVC <70% + FEV1 30-49% predicted

A

Stage 3 COPD = severe

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11
Q

Post-bronchodilator FEV1/FVC <70% + FEV1 <30% predicted

A

Stage 4 COPD = very severe

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12
Q

Most common type of oesophageal cancer, location, and risk factors

A

Adenocarcinoma
Location = lower 1/3
Risk factors = GORD, Barrett’s, smoking, achalasia, obesity

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13
Q

Types of sickle cell crises

A

Thrombotic = painful, initiated by dehydration/infection/deoxy

Sequestration = splenomegaly, anaemia, inc reticulocyte

Acute chest = infarct of lung parenchyma, dyspnoea, chest pain

Aplastic = parvovirus infection, sudden drop in Hb, bone marrow suppression

Haemolytic = rare, fall in Hb due to haemolysis

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14
Q

Side effects of methotrexate

A

Myelosuppression
Liver cirrhosis
Pneumonitis

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15
Q

Side effects of sulfasalazine

A

Rashes
Oligospermia
Heinz body anaemia
ILD

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16
Q

Side effects of leflunomide

A

Liver impairment
ILD
HTN

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17
Q

Side effects of hydroxychloroquine

A

Retinopathy

Corneal deposits

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18
Q

Side effects of prednisolone

A 
Cushingoid
Osteoporosis
Impaired glucose tolerance
HTN
Cataracts
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19
Q

Diagnosis of impaired glucose tolerance (IGT)

A

IGT = fasting plasma gluc <7.0 and OGTT 2hr >=7.8 but <11.1

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20
Q

Fasting glucose <6?

A

Normal

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21
Q

Fasting glucose between 6 and 7?

A

Impaired fasting glucose

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22
Q

Fasting glucose >7

A

Diabetes

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23
Q

HbA1c diagnostic for diabetes

A

> 48mmol/L

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24
Q

Normal HbA1c

A

<41mmol/L

25
Q

When should COCP be stopped before major elective surgery?

A

Stop 4wks prior

Can be restarted when mobilising

26
Q

Medications for Heart Failure

A

1) ACEi & B-block (1st line)
2) Aldosterone antagonist - e.g. spironolactone (monitor K+ with ACEi)
3) Specialist-initiated

27
Q

Timing and components of antenatal booking visit

A

8-12wks

  • general info, BP, urine, BMI
  • bloods -> iron, antibodies
28
Q

Timing and components of antenatal early scan

A

10-13+6 wks

  • confirm dates
  • excl multiple
29
Q

Timing of antenatal Down’s screening

A

11 - 13+6

30
Q

Timing of antenatal anomaly scan

A

18 - 20+6

31
Q

Timing of anti-D prophylaxis

A

1st - 28wks

2nd - 34wks

32
Q

Features and management of herpes simplex keratitis

A

Red, painful eye
Photophobia
Dec visual acuity
Epithelial ulcer on fluorescein

Treat = refer to ophthal, topical aciclovir

33
Q

Outline COPD management

A

1) SABA or SAMA PRN
2) If asthmatic features -> SABA or SAMA PRN, add LABA + ICS regular
No asthmatic features -> SABA PRN, add LABA + LAMA regular
3) SABA PRN, LABA + LAMA + ICS regular

34
Q

Contraindications to HRT

A

Current/past breast Ca
Any oestrogen-sensitive Ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

35
Q

3rd trimester, itchy, no rash, raised bilirubin

A

Intrahepatic cholestasis of pregnancy

36
Q

Features and management of intrahepatic cholestasis of pregnancy

A

Features - pruritis, no rash, raised bilirubin

Management - ursodeoxycholic acid, weekly LFT, induce at 37wks

37
Q

3rd trimester, abdo pain, N+v, headache, jaundice

A

Acute fatty liver of pregnancy

38
Q

Features and management of acute fatty liver of pregnancy

A

Features - abdo pain, n+v, headache, jaundice, hypoglycaemia

Management - delivery

39
Q

3rd trimester, malaise, headaches, vomiting, HTN, raised liver enzymes

A

HELLP
H - haemolysis
EL - elevated liver enzymes
LP - low platelets

40
Q

Features and management of idiopathic thrombocytopenic purpura

A

Features - may be incidental, or may have petechae/purpura, bleeding

Management - prednisolone

41
Q

Hx autoimmune disorders, raised LFTs, SNT abdo, fatigue, pruiritis. Diagnosis and management

A 
Primary biliary cholangitis
Treatment:
1st line ursodeoxycholic acid - slows progression.
For pruritis - cholestyramine
If bilirubin >100 -> transplant
42
Q

Pt advice for metronidazole

A

Avoid alcohol - disulfiram-like reaction

Inc effect of warfarin

43
Q

Calculation of morphine dose for breakthrough pain

A

1/6th of total daily morphine
e.g. 90mg BD
Breakthrough = 90x2/6 = 30mg oral morphine

44
Q

Features of acoustic neuroma

A

Dependent on nerve involved.
CN8 - vertigo, unilat sensorineural HL, tinnitus
CN5 - absent corneal reflex
CN7 - facial palsy

45
Q

Lacunar stroke features

A

Purely motor
Purely sensory
Mixed

46
Q

Type of stroke: purely numbness

A

Lacunar

47
Q

Management of T2DM

A

First-line is metformin.
(If high-risk/established CVD - metformin + SGLT-2 inhib)
Second-line -> add DPP-4i, pioglitazone, SU, SGLT-2i
Third-line -> Add third drug OR start insulin

If HbA1c >58 then move to next line

48
Q

Management of MS

A

Acute relapse - pred (5d)
DMARD - natalizumab
Fatigue - amantadine
Spasticity - baclofen and gabapentin

49
Q

Palpable purpuric rash + abdo pain + arthritis + haematuria

A

Henoch-Schonlein purpura

50
Q

Cause of Henoch-Schonlein purpura

A

IgA mediated small vessel vasculitis

51
Q

Features of Henoch-Schonlein purpura

A

Palpable purpuric rash over buttocks and extensor surfaces of arms and legs
Abdo pain
Polyarthritis
May have features of IgA nephropathy (haematuria)

52
Q

Management of HTN in <55yo (or T2DM)

A

1) A
2) A+C or A+D
3) A+C+D
4) If K+ <4.5, +spirololactone. If K+ >4.5 +alpha/beta block

A = ACEi or ARB
C = CCB
D = thiazide-like diuretic
53
Q

Management of HTN in >55yo or African-Caribbean descent

A

1) C
2) C+A or C+D
3) A+C+D
4) If K+ <4.5, +spirololactone. If K+ >4.5 +alpha/beta block

A = ACEi or ARB
C = CCB
D = thiazide-like diuretic
54
Q

Organism in ieCOPD

A

Haemophilus influenzae

55
Q

Diabetes drug contraindicated in heart failure

A

Pioglitazone (thiazolidinediones)

56
Q

Converting oral to sc morphine

A

Total daily oral morphine / 2 -> sc syringe driver

57
Q

Diarrhoea in HIV+ patient

A

Cryptosporidium

58
Q

2nd line angina management

A

If not controlled with B-block, add CCB (nifedipine)

Explanation (1 decks)

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