MSRA Flashcards
Outline the time taken for various contraceptive preparations to become effective.
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Which rheumatoid arthritis drug is associated with causing interstitial lung disease?
Sulfsalazine
What are the main side-effects of hydroxychloroquine?
Retinopathy
Corneal opacities
List the absolute contraindications for COCP use.
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
What is usually used as initial management of plaque psoriasis?
Corticosteroid + vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks
What can slow down the progression of disease in dry age-related macular degeneration?
High dose of beta-carotene, vitamins C and E, and zinc
List the motor milestones that should raise suspicion of cerebral palsy.
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)
Persistent toe-walking
List the motor milestones that should raise suspicion of cerebral palsy.
Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmWhat isetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking
List the motor milestones that should raise suspicion of cerebral palsy.
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)
Persistent toe-walking
What is unusual about the relationship between mirtazapine dose and sedation?
More sedating at lower doses
How is rosace treated?
Mild/Moderate: Topical Metronidazole
Severe: Oral Doxycycline
How should C. difficile be treated?
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
Recurrent
within 12 weeks of symptom resolution: oral fidaxomicin
after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
What GRACE score is considered high risk?
> 3%
Outline how Down syndrome risk is estimated based on maternal age.
1/1,000 at 30 years then divide by 3 for every 5 years
What CBG targets should be set for patients with GDM?
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
What is the main adverse effect of hydroxychloroquine?
Bull’s eye retinopathy (need to monitor visual acuity)
Which antiepileptics should be recommended for patients with generalised tonic clonic seizures?
males: sodium valproate
females: lamotrigine or levetiracetam
Which antiepileptics should be recommended for patients with focal seizures?
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Which antiepileptics should be recommended for patients with absence seizures?
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
Which antiepileptics should be recommended for patients with myoclonic seizures?
males: sodium valproate
females: levetiracetam
Which antiepileptics should be recommended to patients with tonic or atonic seizures?
males: sodium valproate
females: lamotrigine
List the causes of concentric visual loss.
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
Which cardiac drug is contraindicated in ventricular tachycardia?
Verapamil
How is methanol poisoning managed?
Fomepizole (ethanol used to be used)
How should the finding of an ovarian cyst that is < 5 cm in diameter on an ultrasound scan be managed?
A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.
How does presbyacusis present?
Bilateral high frequency hearing loss
Downward sloping pure tone thresholds
What effect does St John’s Wort have on CYP450?
Inducer
How often is breast cancer screening offered?
every 3 years between the ages of 50 and 71
How does radial tunnel syndrome present?
presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
What is the main ECG feature of hypocalcaemia?
Long QT
Which opioids are preferred in CKD?
Alfentanil, buprenorphine and fentanyl
What is tibolone and why should it not be used within 12 months of the last period?
Has weak oestrogenic properties
Can be used for menopause and osteoporosis
Can cause irregular bleeding within 12 months of last menstrual period
What are some side-effects of clonidine?
Dry mouth and dizziness
If someone has had a previous pregnancy complicated by GDM, when should they have an OGTT in the subsequent pregnancy?
As soon as possible after booking
What are the UKMEC4 criteria for COCP?
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
Which drug is strongly indicated in patients with AF and heart failure?
Digoxin
What are the features of Edwards syndrome?
micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
What are the features of Patau syndrome (trisomy 13)?
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What is a strong risk factor for adhesive capsulitis?
Diabetes mellitus
How should severe cellulitis be treated?
co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
How does viral labyrinthitis present?
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo
Which lymphoma drug causes peripheral neuropathy?
Vincristine
When can hormonal contraception be restarted after taking Levonelle?
Immediately
Have to wait 5 days for EllaOne (ulipristal)
How is vaginal candidiasis managed?
oral fluconazole 150 mg as a single dose first-line
contraindicated in pregnancy
NOTE: for recurrent candidiasis, use induction and maintenance therapy with fluconazole
How is facial psoriasis managed?
Mild potency topical steroids or calcitriol
NOTE: calcipotrol is irritant and coal tar is smelly
What is seen upon fluorescein staining of patients with dry eyes?
Punctate fluorescein staining of the cornea
How quickly do various contraceptive forms work?
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
What is used to monitor treatment in haemochromatosis?
Ferritin and transferrin saturation
How should metformin and gliclazide be managed on the day of elective surgery?
METFORMIN
Give dose as per usual
SULFONYLUREAS
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose
When can SGLT2 inhibitors be started as initial therapy for T2DM?
After metformin has been fully uptitrated
What are the criteria for starting SGLT2 inhibitors in patients with T2DM?
T2DM associated with:
- A high risk of developing cardiovascular disease (CVD) i.e. a Q-RISK score greater than 10%
- Established CVD
- Heart failure
List some risk factors for endometrial cancer.
obesity
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma
Outline the emergency management of epistaxis.
adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help)
topical adrenaline/local anaesthetic
topical tranexamic acid
nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter).
surgical intervention (sphenopalatine artery ligation).
Which investigation should be performed before starting a patient on anastrazole?
DEXA Scan
What are the features of scarlet fever and how is it treated?
sore throat, fever, headache, bright red tongue and a coarse, red rash
Penicillin V for 10 days
Why should SSRIs be avoided in patients on warfarin?
Increased risk of bleeding
How does acute angle closure glaucoma present?
Fixed dilated pupil with conjunctival injection
How is acute sinusitis managed?
Analgesia and fluids
If persisting for more than 10 days, use intranasal steroids
How is acute sinusitis managed?
Analgesia and fluids
If persisting for more than 10 days, use intranasal steroids
Phenoxymethylpenicillin can be used if acute sinusitis is complicated
What does NICE recommend for rapid tranquilisation of patients with acutely disturbed behaviour?
intramuscular (IM) lorazepam or IM haloperidol + IM promethazine
What are the indications for placing a chest drain in a patient with pleural infection?
- Frankly purulent pleural fluid on aspirate
- Presence of organisms visualised in a non-purulent sample
- Pleural fluid pH < 7.2
What are the indications for placing a chest drain in a patient with pleural infection?
- Frankly purulent pleural fluid on aspirate
- Presence of organisms visualised in a non-purulent sample
- Pleural fluid pH < 7.2
How should persistent unexplained hoarseness in a patient aged >45 years old be managed?
Urgent referral to ENT
What is the strongest risk factor for psychotic disorders?
Family history
What is Hoffman’s sign suggestive of?
Upper motor neurone lesion (e.g. DCM)
What should be started alongside allopurinol in patients with recurrent gout?
Colchicine (or NSAID if not tolerated)
Should start at a dose of 100 mg OD and up-titrate every few weeks based on serum uric acid level
What is a Buckle fracture?
Incomplete transverse fracture of the radius (common in children due to increased elasticity)
What is the first-line investigation for chronic heart failure?
NT-proBNP
How is SUFE managed surgically?
In situ fixation with cannulated screws
What is caput succadaneum and how long does it take to resolve?
Soft tissue swelling from ventouse delivery, crosses suture lines
Resolves within days
What is caput succadaneum and how long does it take to resolve?
Soft tissue swelling from ventouse delivery, crosses suture lines
Resolves within days
List the incubation periods of common diarrhoeal diseases.
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
How is otitis externa managed?
topical antibiotic or a combined topical antibiotic with a steroid
Which diseases are associated with seborrhoeic dermatitis?
HIV
Parkinson’s disease
How is seborrhoeic dermatitis in children managed?
mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone
How should congenital inguinal hernias be managed?
Urgent referral to paediatric surgeon as high risk of complications
List some common eyelid problems.
blepharitis: inflammation of the eyelid margins typically leading to a red eye
stye (hordeola internum and externum): infection of the glands of the eyelids
chalazion (Meibomian cyst)
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids
What is the most common reason for a hip replacement having to be revised?
Aseptic loosening
Other reasons include pain and loosening
What are the criteria for diagnosing diabetes mellitus?
fasting > 7.0, random > 11.1 - if asymptomatic need two readings
What is the positive predictive value of faecal occult blood test?
5-15%
How do you work out the units of alcohol in a drink?
Volume x Percentage/1000
List some causes of gingival hyperplasia.
phenytoin, ciclosporin, calcium channel blockers and AML
How is a recurrence of C. difficile within 12 weeks treated?
Oral fidaxomicin
Which extra-intestinal manifestations of Crohn’s disease are associated with disease activity?
Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
What causes blurring of vision after cataract surgery?
posterior capsule opacification
What resting blood pressure would prevent someone from driving buses or lorries?
> 180/100
List drugs that are associated with causing lung fibrosis.
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
What causes chorioretinitis?
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
How should pregnant women with chickenpox presenting after 20 weeks’ gestation be managed?
treated with oral aciclovir if they present within 24 hours of the rash
Which antiepileptic drug is associated with pancreatitis?
Sodium valproate
What is the triad of shaken baby syndrome?
Retinal haemorrhages
Subdural haemorrhage
Encephalopathy
Outline the interpretation of the FAST alcohol questionnaire.
4 item questionnaire
minimum score = 0, maximum score = 16
the score for hazardous drinking is 3 or more
What are the first line treatment options for painful diabetic neuropathy?
first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
List some side-effects of sodium valproate.
teratogenic
P450 inhibitor
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatotoxicity
pancreatitis
thrombocytopaenia
hyponatraemia
hyperammonemic encephalopathy: L-carnitine may be used as treatment if this develops
List the main live attenuated vaccines.
Yellow fever
Oral polio
Intranasal influenza
Varicella
Measles, mumps and rubella (MMR)
List some precipitants of digoxin toxicity.
hypokalaemia
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
What change in creatinine and eGFR after starting an ACE inhibitor would prompt stopping the ACE inhibitor?
creatinine increases by 30% or eGFR falls by 25% or greater
What is an important contraindication for ulipristal acetate?
Severe asthma
What is used for long-term prophylaxis of cluster headaches?
Verapamil
Which malignancy is Acquired ichthyosis associated with?
Lymphoma
Which malignancy is Acquired hypertrichosis lanuginosa associated with?
Gastrointestinal and lung cancer
Which malignancies is dermatomyositis associated with?
Ovarian cancer and lung cancer
Which malignancy is Erythema gyratum repens associated with?
Lung cancer
Which malignancy is erythroderma associated with?
Lymphoma
Which malignancy is Necrolytic migratory erythema associated with?
Glucagonoma
Which malignancies are Pyoderma gangrenosum associated with?
Myeloproliferative disorders
Which malignancies is Sweet syndrome associated with?
Haematological malignancy e.g. Myelodysplasia
Which malignancy is tylosis associated with?
Oesophageal cancer
Which malignancy is migratory thrombophlebitis associated with?
Pancreatic cancer
How is trichomonas vaginalis treated?
Oral metronidazole
Outline the speech developmental milestones.
12 months Knows and responds to own name
12-15 months Knows about 2-6 words (Refer at 18 months)
Understands simple commands - ‘give it to mummy’
2 years Combine two words
Points to parts of the body
2½ years Vocabulary of 200 words
3 years Talks in short sentences (e.g. 3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
4 years Asks ‘why’, ‘when’ and ‘how’ questions
What is the reversal agent for dabigatran?
idarucizumab
NOTE: rivaroxaban - andexanet alfa
What is the first-line treatment option for capillary haemangiomas?
Propranolol
How is latent TB treated?
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
When should referral be considered for otitis media with effusion?
children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.
Or if
- affecting hearing, development or education
- children with Down syndrome or cleft palate
When should referral be considered for otitis media with effusion?
children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.
Or if
- affecting hearing, development or education
- children with Down syndrome or cleft palate
What is the screening interval for cervical screening?
aged 25-49 years every three years and women aged 50-64 years every five years
Who is considered eligible for azithromycin prophylaxis in the context of COPD?
non-smokers who have optimised therapy and experience any of:
Frequent exacerbations with sputum production.
Prolonged exacerbations with sputum production.
Hospitalisations from exacerbations.
When is additional contraception not needed in someone being started on the COCP?
If the combined pill is started between day 1-5 of the cycle then there is no need for additional contraception.
When is additional contraception not needed in someone being started on the COCP?
If the combined pill is started between day 1-5 of the cycle then there is no need for additional contraception.
How does viral labyrinthitis present?
recently developed an upper respiratory tract infection presents with vertigo and vomiting. Hearing is also affected. The symptoms came on suddenly
Why does splenectomy give a falsely high HbA1c?
Increased red cell survival
What should be prescribed to a patient who has had an ACS and is also in AF?
generally patients are given triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event and dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months
What makes up the sciatic nerve and what are the consequences of loss of function?
L4-5, S1-3
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact
What make lateral epicondylitis worse?
worse on resisted wrist extension/suppination whilst elbow extended
What is the main indication for cardiac resynchronisation therapy?
patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms
Outline the fine vision and motor milestones.
3 months Reaches for object
Holds rattle briefly if given to hand
Visually alert, particularly human faces
Fixes and follows to 180 degrees
6 months Holds in palmar grasp
Pass objects from one hand to another
Visually insatiable, looking around in every direction
9 months Points with finger
Early pincer
12 months Good pincer grip
Bangs toys together
Outline the doses of IM adrenaline in different age groups.
< 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000)
6-12 years 300 micrograms (0.3ml 1 in 1,000)
Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)
How should bacterial conjunctivitis in pregnant women be treated?
Topical fusidic acid
What are the features of lithium toxicity?
Diarrhoea, vomiting, abdominal pain, coarse tremor, weakness, seizures, muscle twitches and blurred vision
When is test-of-cure recommended for pregnant women being treated for chlamydia?
6 weeks
How does contact tracing work for sexually transmitted infections?
symptomatic men: all partners from the 4 weeks prior to the onset of symptoms
women + asymptomatic men: all partners from the last 6 months or the most recent sexual partner
In which type of age-related macular degeneration are intravitreal VEGF injections useful?
Wet
How should occupational exposure to hepatitis B be managed?
if the person exposed is a known responder to the HBV vaccine then a booster dose should be given
if they are a non-responder (anti-HBs < 10mIU/ml 1-2 months post-immunisation) they need to have hepatitis B immune globulin (HBIG) and a booster vaccine
List some contraindications for sildenafil.
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
When should individuals with type 1 diabetes mellitus with no established cardiovascular disease be offered statin treatment for primary prevention?
Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)
List the nerve roots responsible for common reflexes.
Ankle S1-S2
Knee L3-L4
Biceps C5-C6
Triceps C7-C8
How are corneal abrasions managed?
Topical antibiotic to prevent secondary bacterial infection
List some causes of microcephaly.
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
List drugs that should be avoided if breastfeeding.
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
List some causes of scarring alopecia.
trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*
What are the features of L3 nerve root compression?
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
What are the features of L4 nerve root compression?
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
What are the features of L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
What are the features of S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
How should two missed COCPs be managed?
Take the last missed pill and continue as per usual (even if it means taking two pills on the same day)
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
Which drugs cause erythema nodosum?
penicillins
sulphonamides
combined oral contraceptive pill
When should women be advised to stop COCP or HRT before surgery?
28 days before
What is Hoover sign?
quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
What advice about driving should be given to people that have suffered a TIA?
1 month off driving, may not need to inform DVLA if no residual neurological deficit
Which antihistamines are non-sedating?
Loratidine
Cetirizine
How can early keloids be managed?
Intralesional steroids (e.g. triamcinolone)
When should mefloquine and chloroquine be taken and in whom is it contraindicated?
Weekly
Depression and epilepsy
How is Ramsay Hunt syndrome treated?
Oral aciclovir and steroids
What are the main side-effects experienced when starting levetiracetam?
Abdominal pain and diarrhoea
Anorexia (and, hence, weight loss)
Anxiety
What effect do inhaled steroids have on COPD patients?
Reduced frequency of exacerbations
What is the key clinical difference between viral labyrinthitis and vestibular neuronitis?
Labyrinthitis is associated with hearing loss
What should be prescribed for a patient with pustular acne who is awaiting an appointment with the dermatologist?
oral antibiotic and topical retinoid or benzoyl peroxide
What advice should be given to people undergoing a urea breath test?
no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
From what point postpartum is contraception needed?
21 days if not breastfeeding
When should nitrofurantoin be avoided in pregnancy?
Towards term as it can cause neonatal haemolysis
What does of IM benzylpenicillin should be used in the community for suspected meningitis?
Age Dose
< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg
Which nerve roots contribute to the nerves of the arm?
Musculocutaneous nerve (C5-C7)
Axillary nerve (C5,C6)
Radial nerve (C5-C8)
Median nerve (C5-T1)
Ulnar nerve (C8, T1)
Long thoracic nerve (C5-C7)
How is caffeine used in newborns?
Respiratory stimulant that aids weaning off a ventilator
Which hearing test is done at school entry in schools in the UK?
Pure tone audiometry
How is the newborn hearing screen conducted?
Initially: Otoacoustic emission test
If above is abnormal: Auditory Brainstem Response
Which antibiotic is used to treat extensive otitis externa?
Flucloxacillin
Which features distinguish glaucoma from uveitis?
glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush
What advice should be provided for patients who have had successful coronary angioplasty about driving?
driving may recommence after 1 week provided:
No other urgent revascularisation is planned. (Urgent refers to within 4 weeks from acute event)
Left ventricular ejection fraction is at least 40% prior to hospital discharge.
There is no other disqualifying condition.
How does chancroid present?
deep, painful ulcer and is often associated with inguinal lymphadenopathy.
What is the mechanism of action of bupropion?
Norepinephrine and dopamine reuptake inhibitor
AND
Nicotinic antagonist
How long does finasteride take to be effective for BPH?
6 Months
Which medications are first-line for treating spasticity in MS?
Baclofen and gabapentin
How should potential tetanus exposure be managed in someone without a clear vaccine history?
booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old
List some CYP450 inhibitors.
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
List some CYP450 inducers.
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
If someone has had a TIA should they be given aspirin?
A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately
If someone has had a TIA should they be given aspirin?
A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately
When are pregnant women offered the pertussis vaccine?
16-32 weeks pregnant
How should shingles be managed?
Treat within antivirals within 72 hours
Which drugs cause erythema multiforme?
penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
How should a patient be managed if they had a full course of tetanus vaccine with the last dose more than 10 years ago?
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
How should patients with unclear tetanus vaccine history be managed?
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
What is the criteria for certification of blindness?
<3/60 with a full visual field
How soon after a decision should a category 1 and category 2 C section be performed?
Category 1: 30 mins
Category 2: 75 mins
Outline the mechanism of action of glaucoma medications.
Prostaglandin analogues (e.g. latanoprost): Increases uveoscleral outflow
Beta-blockers (e.g. timolol, betaxolol): Reduces aqueous production
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist): Reduces aqueous production and increases outflow
Carbonic anhydrase inhibitors (e.g. Dorzolamide): Reduces aqueous production
Miotics (e.g. pilocarpine, a muscarinic receptor agonist): Increases uveoscleral outflow
How is scalp psoriasis managed?
topical potent corticosteroids
When is the anomaly scan done?
18-20 + 6 weeks
How are dermatophyte nail infections treated?
Oral terbinafine
Outline the stages of AKI.,
Stage 1 Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
Stage 2 Increase in creatinine to 2.0 to 2.9 times baseline, or
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
Stage 3 Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
What is pulsus alternans?
Occurs in left ventricular failure, myocarditis and paroxysmal tachycardia
Characterised by alternate large and small amplitude beats (doubling of rate noted as mercury level falls)
What is pulsus paradoxus?
Abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration
Suggestive of cardiac tamponade, constrictive pericarditis, chronic sleep apnoea and COPD
What is another name for a slow-rising pulse?
Plateau pulse
What is a pinguecula?
Harmless yellowish deposit beneath the conjunctiva , found between the canthus and the corneal edge.
What is a pterygium?
Fold of conjunctiva on the cornea
What is first line for primary open angle glaucoma?
Prostaglandin analogue (e.g. latanoprost)
Which cardiac drug is known to shorten the QT interval?
Digoxin
What side effect is commonly associated with varenicline?
Abnormal dreams
Which antihypertensive is second line in pregnancy?
Nifedipine
When is the dating scan done?
10 to 13+6 weeks
What is Schwartz sign?
Sign on otoscopy suggestive of otosclerosis
How does ezetimibe work?
Reduces intestinal cholesterol absorption
How do you test for foetal CMV in utero?
Amniocentesis (CMV concentrates in the foetal urine)
How is foetal sickle cell disease status best established?
Chorionic Villus Sampling
Which investigation is used to check for foetal anaemia?
Cordocentesis
What are some distinguishing features of PSP?
Early postural instability
Onset > 40 years
Gradually progressive
Vertical supranuclear palsy
How is a chalazion managed?
Warm compress and massage
List some conditions that deteriorate in pregnancy.
SLE
Herpes simplex
Acne rosacea
What PPI washout period is recommended for people undergoing a urea breath test or stool antigen test?
2 weeks
What investigation should be offered to all patients with tinnitus?
Audiogram
What is a distinguishing feature of chondromalacia patellae?
Anterior knee pain on walking up and down stairs and rising from prolonged sitting
What advice is offered regarding when you can do a PSA?
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
List some factors that decrease BNP.
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
List some factors that increase BNP.
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
