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MSRA Flashcards

1
Q

Which 5 medications are commonly first line in the treatment of TB?

A

Isoniazid
Ethambutol
Rifampicin
Pyrazinamide
+Pyridoxine (vitamin supplement given with Isoniazid to prevent peripheral neuropathy)

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2
Q

What is the most common cause of adrenal insufficiency?

A

Secondary - Long term exogenous steroid exposure

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3
Q

What is the first line treatment for an Addisonian Crisis?

A

IV Hydrocortisone (e.g. 100mg STAT)

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4
Q

Is primary biliary cirrohsis/cholangitis (PBC) more common in women or men?

A

Women

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5
Q

Is primary sclerosis cholangitis more common in women or men?

A

Men

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6
Q

Are anti-mitochondrial antibodies positive in PBC or PSC?

A

Anti-mitochondrial (AMA) antibodies are positive in PBC

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7
Q

What appearance of the bile ducts is indicative of PSC on cholangiogram/MRCP/ERCP?

A

Beaded appearance of the bile ducts

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8
Q

Which condition is strongly associated with ulcerative colitis? PBC or PSC?

A

PSC

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9
Q

Both PBC and PSC can lead to cirrhosis however which one can lead to cholangiocarcinoma?

A

PSC

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10
Q

For a diagnosis of COPD, what is the FEV1/FVC ratio?

A

<0.7

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11
Q

Mild COPD FEV1 is?

A

> 80% predicted

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11
Q

Moderate COPD FEV1 is?

A

50-79% predicted

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12
Q

Severe COPD FEV1 is?

A

30-49% predicted

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13
Q

Very severe COPD FEV1 is?

A

<30% predicted

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14
Q

What is the first line treatment for COPD patients?

A

Offer a
- Short acting beta-2 agonist (SABA) - e.g. salbutamol, terbutaline
Or
- Short-acting muscarinic antagonist (SAMA) e.g. ipratropium

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15
Q

If patients have exacerbations despite first line treatment for COPD, with NO asthmatic features, what should be offered?

A
  • Long acting beta-2 agonist (LABA) e.g. salmeterol, formoterol PLUS a long acting muscarinic antagonist (LAMA) e.g. tiotropium
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16
Q

If patients have exacerbations despite first line treatment for COPD, with NO asthmatic features but have trialled a LABA/LAMA, what should be offered?

A

Consider a 3 month trial of LABA+LAMA AND inhaled corticosteroid (ICS).

If not improvement @ 3 months - stop ICS and continue LABA+LAMA

If symptoms have improved, continue LABA+LAMA+ICS and review annually.

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17
Q

If patients have exacerbations despite first line treatment for COPD, WITH asthmatic features, what should be offered?

A

LABA (e.g.salmeterol,formoterol) + ICS

If continue to be symptomatic, offer LABA+LAMA+ICS

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18
Q

Complication of taking an ACE inhibitor during pregnancy

A

First trimester: Relatively safe

Second and third trimester: Associated with renal tubular aplasia and intrauterine growth retardation (IUGR)

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19
Q

Which antibiotics are safe during pregnancy?

A

Penicillins, erythromycin and cephalosporins

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20
Q

Which trimester is trimethoprim contraindicated in?

A

First

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21
Q

Which trimester are tetracyclines contraindicated in?

A

Third

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22
Q

What is diethylstillbestrol and why is it contraindicated in pregnancy?

A

Synthetic, non-steroidal oestrogen used in the treatment of breast cancer in postmenopausal women.

Causes a rare vaginal tumour (vaginal clear cell adenocarcinoma) in girls and young women exposed in utero

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23
Q

Malformation linked to Vitamin A (e.g. retinoid acid) and pregnancy?

A

Malformations of the ear

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24
Q

Malformation linked to warfarin and pregnancy?

A

First trimester:
- Foetal warfarin syndrome: skeletal abnormalities, brachydactyly (short fingers and toes), underdeveloped extremities

Second and third trimester:
- Less commonly assoc with birth defects. Most commonly: CNS disorders

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25
Q

Most common paediatric malignancy?

A

Acute lymphoblastic leukaemia (ALL)

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26
Q

Peak age incidence of Acute lymphoblastic leukaemia (ALL)?

A

2-5 years old

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27
Q

Which type of haematological malignancy is associated with clonal expansion of immature lymphoid progenitor cells (e.g. T-lympocytes) that express a protein called terminal deoxynucleotidyl transferase (TdT)?

A

Acute lymphoblastic leukaemia (ALL)

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28
Q

Which infectious disease often presents with erythema migrans?

A

Lyme Disease
- Bulls eye rash around tick bite

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29
Q

Which oral antibiotics can be used to treat Lyme disease?

A

Doxycycline or Amoxicillin

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30
Q

Which haematological malignancy features the Philadelphia chromosome?

A

Chronic Myeloid Leukaemia

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31
Q

What a two main risk factors for chronic myeloid leukaemia?

A
  • Male Sex
  • Exposure to ionising radiation
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32
Q

Most common age affected by CML?

A

65-74 years old

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33
Q

FBC findings in CML?

A
  • Raised WCC
  • Anaemia
  • Platlets can be normal, raised or low
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34
Q

3 conditions which can worsen during pregnancy?

A
  • SLE
  • HSV
  • Acne Rosacea
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35
Q

First cranial nerve?

A

Olfactory
- smell

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36
Q

Second cranial nerve?

A

Optic
- Vision

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37
Q

Third cranial nerve?

A

Oculomotor
- Pupillary constriction (light and accommodation)
- Moves eye up, down and peripherally
- Moves eye lid

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38
Q

Fourth cranial nerve?

A

Trochlear
- Inferior lateral movement of the eye (superior oblique - SO4)

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39
Q

Fifth cranial nerve?

A

Trigeminal
- Corneal reflex
- Sensation of eyebrows, cheeks and chin)
- Chewing, biting and lateral jaw movements

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40
Q

Sixth cranial nerve?

A

Abducens
- Inferior lateral movements of the eye (lateral rectus - LR6)

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41
Q

Seventh cranial nerve?

A

Facial
- Taste - anterior 2 thirds of tongue
- Forehead and facial movements

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42
Q

Eighth cranial nerve?

A

Vestibulocochlear
- Hearing and balance

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43
Q

Ninth cranial nerve?

A

Glossopharyngeal
- Swallowing and phonation
- Posterior third of tongue

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44
Q

Tenth cranial nerve?

A

Vagus
- Tongue and back of throat sensation
- Gag reflex
- Swallowing

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45
Q

Eleventh cranial nerve?

A

Accessory
- Shoulder movement

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46
Q

Twelfth cranial nerve?

A

Hypoglossal
- Tongue movement

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47
Q

Incubation period of campylobacter jejuni?

A

2-5 days (long)

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48
Q

Incubation period of Bacillus cereus?

A

2-12 hours (short)

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49
Q

Incubation period of clostridium perfringens?

A

8-18 hours (short)

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50
Q

Incubation period of s aureus (gastroenteritis)?

A

2-6 hours (short)

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51
Q

Recurrent infection, especially with n. meningitidis and n. gonorrhoea could indicate what kind of immunodeficiency?

A

Membrane attack complex (MAC) deficiency
- Made up of C5-9
- Final stage of complement activation which leads to the formation of a hole in the cell wall and cell lysis

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52
Q

Anaphylaxis to blood transfusions could indicate what kind of immunodeficiency?

A

IgA deficiency

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53
Q

Which cancers does the COCP increase risk of?

A

Breast and Cervical
- Way to remember: increased the risk of cancers we screen for

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54
Q

Which cancers does the COCP decrease risk of?

A

Endometrial and ovarian

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55
Q

Unwanted side effect of nicorandil?

A

Oral ulceration

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56
Q

Which other skin condition is palmoplantar pustulosis associated with?

A

Psoriasis. Also strong association with smoking.

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57
Q

Which type of hypersensitivity reaction is mediated by IgE?

A

Type 1 (allergy) - mast cell degranulation

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58
Q

Which type of hypersensitivity reaction is antibody mediated i.e. antibody/antigen interaction? And what are some examples?

A

Type 2. Examples include haemolytic anaemia of the newborn and goodpastures syndrome.

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59
Q

Which type of hypersensitivity reaction is immune complex mediation? Give examples.

A

Type 3 - e.g. rheumatoid arthritis and SLE

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60
Q

Which type of hypersensitivity is ‘delayed hypersensitivity’ reaction? Give examples

A

Type 4 - chronic transplant rejection and contact dermatitis.

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61
Q

Which type of hypersensitivity is ‘receptor mediated’ or ‘autoimmune’? Give examples

A

Type 5 - Grave’s disease, Myasthenia gravis

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62
Q

What is the first stage of diabetic retinopathy and what are some of the findings on fundoscopy?

A

First stage = Background diabetic retinopathy
Features:
- Microaneurysms
- Haemaorrhages
- Exudates

No Rx needed. Needs annual screening and improving diabetic control

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63
Q

What is the second stage of diabetic retinopathy and what are some of the findings on fundoscopy?

A

Second stage = Pre-proliferative retinopathy

Features:
- Multiple large deep haemorrhages (blots)
- Cotton wool spots

Second = blots and spots

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64
Q

What is the third stage of diabetic retinopathy and what are some of the findings on fundoscopy?

A

Third stage = Proliferative retinopathy

Features:
- Neovascularisation however these are fragile vessels which can burst and cause vitreous haemorrhages

More common in T1DM

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65
Q

What is the fourth stage of diabetic retinopathy and what are some of the findings on fundoscopy?

A

Fourth stage = Diabetic maculopathy

More common in T2DM

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66
Q

Which pneumonia (causative organism) often follows a viral infection such as influenza and is commonly seen in IVDUs? And what changes are seen on FBC?

A

Staphylococcus chest infections. Causes a raised leucocyte count.

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67
Q

What is the most common causative organism in community acquire pneumonia?

A

S. Pneumoniae

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68
Q

Which type of pneumonia (causative organism) is associated with cavitating lesions in the upper lobes and associated with alcoholism and the elderly?

A

Klebsiella

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69
Q

Which immunoglobulin deficiency predisposes to mucosal infections?

A

IgA

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70
Q

Which immunoglobulin deficiency predisposes to parasitic/helminthic infections and non-allergic reactive airways disease?

A

IgE

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71
Q

Which immunoglobulin deficiency predisposes to bacterial, fungal and viral infections?

A

IgM
(think M = microbes)

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72
Q

Which immunoglobulin deficiency predisposes to infections from encapsulated bacteria?

A

IgG
(e.g. N. meningococcus, H. influenzae, S. Pneumoniae)

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73
Q

What type of inheritance pattern is seen in multiple endocrine neoplasia (MEN)?

A

Autosomal dominant

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74
Q

What type of tumours are seen in multiple endocrine neoplasia 1 (MEN1)?

A

3 Ps
- Parathyroid
- Pituitary
- Pancreas

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75
Q

What type of tumours are seen in multiple endocrine neoplasia 2A (MEN2A)?

A

Phaeochromocytoma
Parathyroid
Medullary thyroid

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76
Q

What type of tumours are seen in multiple endocrine neoplasia 2B (MEN2B)?

A

Phaeochromocytoma
Medullary thyroid
Marfanoid appearance
Mucosal neuromas

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77
Q

What is the preferred option for treatment of thyrotoxicosis in pregnancy? What are the potential risks of the contraindicated treatments?

A

Thyroidectomy
- Carbimazole = teratogenic
- Propylthiouracil = crosses the placenta and can cause neonatal goitre and hypothyroidism

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78
Q

Fetal limb injury is a risk with amniocentesis? TRUE OR FALSE

A

TRUE although uncommon

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79
Q

After how many weeks should amniocentesis be carried out?

A

15 weeks

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80
Q

What is the ICD-10 criteria for anorexia nervosa? (5 criteria - all must be fulfilled)

A
  1. BMI <17.5
  2. Self induced weight loss

3.Body image distortion

  1. Endocrine consequences e.g amenorrhoea

5.If onset if prepubertal, it can cause delay of pubery

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81
Q

In adrenal insufficiency (e.g. addisons), what will the potassium, sodium, calcium and glucose be? (high or low)

A

Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Hypercalcaemia

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82
Q

What is the gold standard test for diagnosing adrenal insufficiency? E.g. Addisons. And how is it carried out?

A

Short synacthen test
- Administer exogenous ACTH, then measure cortisol levels at 30 or 60 minutes
- Normal response = rise in cortison. If there is a deficiency then there will be no rise
- Failure to rise above 550nmol/l = deficiency

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83
Q

By what age should a child be able to walk?

A

18 months

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84
Q

By what age to children develop shyness around strangers?

A

12 months

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85
Q

By what age should a child be able to pull themselves up from the floor to standing and cruise?

A

12 months

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86
Q

By what age should primitive reflexes have disappeared e.g. moro and grasp reflex?

A

6 months

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87
Q

By what age can most children hop on one foot?

A

4 years

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88
Q

By what age can most children jump on 2 feet?

A

3 years

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89
Q

Why are children with DiGeorge syndrome pre-disposed to recurrent infections?

A

Absent or hypoplastic thymus leading to low T-cell production

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90
Q

Features of DiGeorge syndrome (CATCH 22)?

A

C - Cardiac abnormalities (most common = ToF)
A - Abnorma faces - smooth philtrum, low set nasal bridge
T - Thymic aplasia
C - Cleft palate
H - Hypocalcaemia and hypoparathyroidism
22 - Deletion on chromosome 22

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91
Q

Complication of tetracyclines and pregnancy?

A

Discoloured teeth if taken in 2nd and 3rd trimester and skeletal development abnormalities if taken in 1st trimester

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92
Q

Complication of ACE inhibitors in pregnancy?

A

Renal impairment of the foetus + possible skull deformities and oligohydramnios

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93
Q

Complication of streptomycin (and all other aminoglycosides) in pregnancy?

A

Auditory and vestibular nerve damage

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94
Q

Complication of B-blockers in pregnancy?

A

Neonatal hypoglycaemia, bradycardia and intrauterine growth restriction

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95
Q

Complication of NSAIDs in pregnancy?

A

MANY!
- Premature closure of ductus arteriosus
- Persistent pulmonary hypertension of the child
- Reduced placental blood flow
- Prolonged labour

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96
Q

When does physiological jaundice in newborns usually develops and when does it usually disappear?

A

2-7 days, usually clears by 10 days

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97
Q

When is jaundice pathological in newborn?

A

Within 24 hours of birth

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98
Q

When is jaundice considered prolonged in term babies?

A

14 days - causes inc biliary atresia, hypothyroidism, G6PD deficiency

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99
Q

When is jaundice considered prolonged in pre-term babies?

A

21 days - causes inc biliary atresia, hypothyroidism, G6PD deficiency

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100
Q

How is jaundice monitored to assess if action is needed? Which blood test is used? What are three outcomes?

A

Treatment threshold charts
Uses TOTAL BILIRUBIN LEVELS
3 outcomes:
- No action
- Phototherapy
- Exchange transfusion

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101
Q

A raised conjugated bilirubin in the newborn suggest the pathology originates from where?

A

Hepatobiliary e.g. biliary atresia

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102
Q

In neonatal jaundice, what does a direct coombs test look for?

A

Haemolysis

103
Q

Why are thyroid function tests important in the investigation of neonatal jaundice?

A

Hypothyroidism is a cause

104
Q

How do you test of G6PD deficiency?

A

G6PD levels

105
Q

What is the causative agent in measles?

A

Paramyxovirus

106
Q

What is the incubation period of measles?

A

7-21 days

107
Q

What is the time children should be kept off school with measles?

A

5 days after rash develops

108
Q

How does the rash develop in measles?

A

Face and descends crainio-caudally

109
Q

Is measles a notifiable illness?

A

YES

110
Q

Name 3 complications of measles

A

Otitis media
Subacute sclerosing pan-encephalitis
Acute encephalitis
Pneumonia

111
Q

Laboratory serology test for measles? And which sites can be samples also in acute infection

A

Measles IgM
In acute infection, throat and urine can be sampled

112
Q

Causative agent in scarlet fever?

A

Group A Beta-haemolytic strep

113
Q

Incubation period of scarlet fever?

A

2-5 days

114
Q

What is the rash like in scarlet fever?

A

Confluent erythematous rash which feels like sandpaper to touch

115
Q

Is scarlet fever notifiable?

A

YES

116
Q

Other signs/symps of scarlet fever

A

Strawberry Tongue
Pastias Lines - erythematous lines in creases of flexors

117
Q

What is the gold standard test for scarlet fever?

A

Throat swab culture - need good quality sample

118
Q

Management of scarlet fever?

A

Antibiotics for 10 days. Options
- Pen V
- Erythromycin
- Cephalosporins

119
Q

How long does a child need to stay off school with scarlet fever?

A

5 days AFTER STARTING ANTIBIOTICS

120
Q

Causative agent in rubella?

A

Rubella virus

121
Q

Incubation period of rubella?

A

2 weeks

122
Q

What is the rash like in rubella?

A

Similar to measles
- starts on face and descends to feet

123
Q

Name 3 other features in rubella?

A
  • Fever
  • Tender occipital and posterior auricular lymphadenopathy
  • Forschheiner spots: spots on soft palate and uvula
124
Q

Lab serology test for rubella?

A

IgG + IgM

125
Q

How long does a child need to stay off school with rubella?

A

5 days after onset of rash

126
Q

How long after a rubella vaccination should a woman avoid pregnancy?

A

3 months

127
Q

Incubation period of erythema infectiosum/slap cheek?

A

4-14 days

128
Q

Rash characteristics in slap cheek?

A

facial rash which spares periorbital areas and nasal bridge. After this rash then develop a rash on body

129
Q

Which individuals are high risk in terms of slap cheek?

A
  • Haemoglobinopathies (e.g. sickle cell patients) - can get aplastic crisis
  • Immunocompromised
  • Pregnant women
130
Q

When is serological testing for slap cheek indicated and what test should be sent?

A

In high risk groups
- Haemoglobinopathies (e.g. sickle cell patients) - can get aplastic crisis
- Immunocompromised
- Pregnant women

Sent IgG/IgM

131
Q

Causative agent in exanthem subitium/sixth disease/roseola infantum?

A

HHV-6 AND HHV-7

132
Q

Incubation of exanthem subitium/sixth disease/roseola infantum?

A

5-15 days

133
Q

In what percentage of patients with exanthem subitium/sixth disease/roseola infantum does a rash occur? And what are the characteristics of this rash?

A

10%
Starts behind ears (macules and papules) and descends down
Lasts 1-2 days

134
Q

Common symps in exanthem subitium/sixth disease/roseola infantum?

A
  • Fever
  • Diarrhoea (68%)
  • Cough (50%)
  • Eyelid swelling (30%)
135
Q

Children with exanthem subitium/sixth disease/roseola infantum are high risk of..?

A

Febrile seizures

136
Q

Is exanthem subitium/sixth disease/roseola infantum notfiable?

A

NO

137
Q

Is slap cheek notifiable?

A

NO

138
Q

Oral rehydration solution is recommended in children with gastroenteritis who are high risk of dehydration, what are the criteria of high risk for dehydration?

A

Any of:
- Age <1 year old
- Low birth weight
- More than FIVE diarrhoeal stools within 24 hours
- More than TWO diarrhoeal stools within 24 hours
- Unable to tolerate fluids or breastfeeding
- Signs of malnutrition

139
Q

IV fluids are recommended in children with gastroenteritis who are clinically dehydrated and meet the what criteria?

A
  • Deteriorating despite oral rehydration solution (ORS)
  • Not tolerating ORS orally or via NG tube
  • Have confirmed or suspected shock
140
Q

Which ethnic group is at highest risk of developing prostate cancer?

A

African-caribbean

141
Q

Give 4 extrapyramidal side effects

A

Acute dystonia
Parkinsonism
Tardive dyskinesia
Akathisia

142
Q

What are the signs/symps of acute dystonia associated with drug extrapyramidal side effects and what is the management?

A

Painful contractions of neck, jaw or eye muscles

Onset: hours - days

Management: IM/IV anticholinergics e.g. procyclidine

143
Q

What are the signs/symps of parkinsonism associated with drug extrapyramidal side effects and what is the management?

A

Shuffling gait, termor, stiffness

Onset: Within a few weeks of starting treatment

Management: Reducing dose or adding anticholinergic

144
Q

What are the signs/symps of akathisia associated with drug extrapyramidal side effects and what is the management?

A

Restlessness

Occurs within first few months of starting treatment

Management: Lower dose or add in propranolol

145
Q

What are the signs/symps of tardive dyskinesia associated with drug extrapyramidal side effects and what is the management?

A

Uncontrollable movements of face, tongue, upper body.

Occurs when taking anti-psychotics for long time

Irreversible in 50% if cases.

146
Q

In general, a raised TSH and low T3/T4 indicates what? And what are some causes?

A

Primary Hypothyroidism
- Autoimmune thyroiditis (50%) e.g. Hashmioto’s thyroiditis - antibodies against thyroid peroxidase (TPO) and thyroglobulin. Will get a large, firm, lobulared thyroid gland
- Iodine deficiency or excess
- Thyroidectomy

147
Q

In general, a low or normal TSH and low T4 indicates what?

A

Secondary hypothyroidism

148
Q

In general, a low TSH and high T3/T4 indicates what? And what are some causes?

A

Primary Hyperthyroidism
- Grave’s Disease - 75% of cases. Cause by anti-THSR antibodies.
- Toxic multinodular goitre
- Toxic adenoma

149
Q

In general, a high TSH and high T3/T4 indicates what?

A

Secondary hyperthyroidism
- Usually causes by a TSH-secreting tumour

150
Q

A stone hard thyroid with euthyroid on TFTs (although 1/3 become hypothyroid) may indicate what disease?

A

Riedel’s Thyroiditis

151
Q

A painful thyroid, fever and initial hyperthyroidism which develops to hypothyroidism may indicate what condition?

A

De Quervain’s Thyroiditis

152
Q

Which is the most common thyroid cancer?

A

Papillary thyroid carcinoma

153
Q

What are the components of Charcot’s triad? And which condition does it indicate?

A
  • Fever
  • Right upper quadrant pain
  • Jaundice

Acute cholangitis

154
Q

What is the definition of a staggered overdose of paracetamol?

A

An overdose taken over a period >1 hour

155
Q

In a paracetamol overdose, when is it indicated to commence immediately?

A
  • Staggered overdose (taken over a period >1 hour)
  • ALT in the upper limits of normal
156
Q

Which PaO2 range is an indication for LTOT?
Which conditions (3) should also be present (just need one to be present)?

A

7.3 - 8.0 kPa
Plus
- Secondary polycythaemia
- Pulmonary hypertension
- Peripheral oedema

157
Q

Which anti-epileptic has the side effects the following side effects?
- Gingival hypertrophy
- Facial hair in women (hirtuism)
- Coarse facial features
- Acne

A

Phenytoin
- Think -toin, -goin to look like a man

158
Q

Which anti-epileptic has the side effects the following side effects?
- Aggressive behaviour
- Transient hair loss
- Weight gain

A

Sodium Valproate
think - valerie jackson - thin har, aggressive, fat

159
Q

Which anti-epileptic has the side effects the following side effects?
- Hyponatraemia
- Dry mouth
- Gynaecomastia
- Male infertility
- Bloods: aplastic anaemia, thrombocytopenia, haemolytic anaemia, eosinophilia)

A

Carbamazapine

160
Q

Which anti-epileptic has the side effects the following side effects?
- Sleep disturbance
- Blurred vision
- Skin rashes/hypersensitivity
- Joint pains

A

Lamotrigine

161
Q

Which anti-epileptic has the side effects the following side effects?
- Diarrhoea
- Abdominal pain
- Weight loss
- Nausea

A

Levetiracetam (keppra)
GI SEs

162
Q

What is the single most important thing to control in polycystic kidney disease in terms of long-term survival?

A

Blood pressure (<130/90)

163
Q

Tumour marker used to monitor colorectal cancer?

A

CEA
(NOT! a screening or diagnostic test)

164
Q

Tumour marker used to monitor hepatocellular cancer?

A

AFP

165
Q

Tumour marker used to monitor pancreatic cancer?

A

CA-19-9

166
Q

Tumour marker used to monitor/diagnose ovarian cancer?

A

CA-125

167
Q

Tumour marker used to aid a diagnosis of breast cancer?

A

CA-15-3

168
Q

Most common cardiac abnormality in Marfan’s?

A

Aortic root dilatation

169
Q

Along with phenytoin, which other medication is associated with gum hypertrophy?

A

Nifedipine

170
Q

What is the murmur associated with HOCM?

A

Mid-systolic murmur

171
Q

What is the murmur associated with aortic stenosis?

A

Crescendo-decrescendo which radiated to the carotids

172
Q

NICE guideline - first line management of OA?

A

Paracetamol with topical NSAIDs

173
Q

NICE guideline - patient newly diagnosed with T2DM and weight LOSS, which test should be arranged within 2 weeks and why?

A

CT abdomen - T2DM can be a first sign of pancreatic ca when associated with weight loss

174
Q

Which abnormalities in the FBC can clozapine cause?

A

Agranulocystosis and neutropenia

175
Q

What age should a child be able to crawl?

A

9-12 months

176
Q

What age should a child be able to walk unsupported?

A

13 months

177
Q

What age should a child be able to sit unsupported?

A

6-8 months

178
Q

In phaeochromocytoma, should alpha or beta blockers be used? And give some examples of the correct agents.

A

Alpha blockers e.g. doxazosin
(Isolated beta blockade causes refractory hypertension)

179
Q

What is first line used in paediatric constipation when dietary changes have been made?

A

Movicol (macrogol)

180
Q

What is the effect of prescribing omeprazole and clopidogrel together?

A

Reduced efficacy of clopidogrel

181
Q

Which epilepsy medication is associated with gum hypertrophy?

A

Phenytoin

182
Q

In which patients is it appropriate to use oestrogen-only HRT for management of menopause?

A

Women who have had a hysterectomy (unopposed oestrogen can cause endometrial hyperplasia which is a pre-cursor to endometrial cancer)

183
Q

Which pulmonary function test is reduced in both restrictive and obstructive lung conditions?

A

Tidal volume

184
Q

How long should a person who has had a stroke or TIA not drive for?
And when should they inform the DVLA?

A

1 month
Should inform DVLA if there is any neurological deficit

185
Q

what is the triad of symptoms in mernier’s disease?

A
  • Hearing loss
  • Tinnitus
  • Vertigo
186
Q

Is the PR interval shortened or prolonged in WPW?

A

Short

187
Q

Which lung pathology is associated with alpha-1-antitrypsin?

A

Emphysema

188
Q

What class of diabetes medication is sitagliptin?

A

DPP-4 inhibitor

189
Q

Which autoantibodies are associated with SLE?

A

Anti-double stranded DNA antibodies

190
Q

Which autoantibodies are associated with systemic sclerosis?

A

Anti-centromere

191
Q

First line treatment for primary hyperparathyroidism?

A

Parathyroidectomy

192
Q

Which blood tests are used in monitoring patients on amiodarone? And how often?

A

TFTs
LFTs
U+Es

Every 6 months

193
Q

Which blood tests are used in monitoring patients on lithium? And how often?

A

U+Es - 6 months
TFTs - 6 months
Lithium levels - 3-6 months

194
Q

Which blood tests are used in monitoring patients on methotrexate? And how often?

A

FBCs
U+Es
LFTs

2-3 months

195
Q

Which age range are teratomas more common in?

A

20-30

196
Q

Which age range are seminomas more common in?

A

35-45

197
Q

What is the most common causative organism of an infective exacerbation of COPD?

A

H. influenzae

198
Q

What pattern of vision loss is described in amaurosis fugax?

A

Curtain coming down

199
Q

What are the features of life-threatening acute asthma?

A

SpO2 <92%
PEFR <33% predicted
Silent Chest
Cyanosis
Poor resp effort
Hypotension
Exhaustion
Confusion

200
Q

What are the features of acute severe asthma?

A

SpO2 <92%
PEFR 33%-50%
Can speak in full sentences
Heart rate >125 (or >140 1-5 y/o)
Resp rate >30 (>40 1-5 y/o)

201
Q

Which medication used in heart failure are shown to reduce mortality?

A

ACE inhibitors and beta-blockers

202
Q

Which anti-hypertensive is first line in african-carribean patients and patients >55 years old?

A

CCB - e.g. amlodipine

203
Q

Which anti-hypertensive is first line in non-african-carribean patients and patients <55 years old?

A

ACEi or ARB

204
Q

In the menopause, a woman >50 years old requires contraception until how many months after their last period?

A

12 months

205
Q

In the menopause, a woman <50 years old requires contraception until how many months after their last period?

A

24 months

206
Q

Common causes of drug induced lupus? (2)

A

Procinamide (anti-arrhythmic)
Hydralazine (vasodilator)

207
Q

Most common cause of primary hyperparathyroidism?

A

Solitary adenoma (80%)

208
Q

Features of primary hyperparathyroidism?
- Demographic
- Calcium
- Phosphate
- PTH level
- Main symp

A

Elderly females
Hypercalcaemia
Low phosphate
Polydipsia
Normal or raised PTH

209
Q

Skull x-ray finding in primary hyperparathyroidism?

A

Pepperpot skull

210
Q

Definitive management of primary hyperparathyroidism?

A

Total parathyroidectomy

211
Q

Patients who are not suitable for surgical management of primary hyperparathyroidism can be offered which medication?

A

Cinacalet - calcimimetic

212
Q

Biochemical findings in secondary hyperparathyroidism?
- Calcium, PTH, phosphate and ALP

A
  • Low calcium
  • Raised PTH
  • Raised phosphate
  • Raised ALP
213
Q

Cause of secondary hyperparathyroidism?

A

Chronic hypocalcaemia e.g. CKD

214
Q

Biochemical findings in tertiary hyperparathyroidism?
- Calcium, PTH, phosphate and ALP

A
  • Raised calcium
  • Low phosphate
  • Raised PTH ++
  • Raised ALP
215
Q

Cause of tertiary hyperparathyroidism?

A

Occurs following prolonged secondary hyperparathyroidism and get autonomous PTH secretion e.g end stage CKD

216
Q

4 ECG findings in hypokalaemia?

A

U- waves
Small or absent T-waves
Prolonged PR interval
Long QT

217
Q

MI secondary prevention - key feature (ABCDEF)

A

A - ACE inhibitor
B - Beta blocker
C - Cholesterol - statin
D - Dual anti-platelet (e.g. aspirin and either prasugrel, ticagrelor, clopidogrel)
E - Exercise (20-30 mins a day)
F - Fucking (resume sex 4 weeks after MI)

218
Q

First line treatment in heart failure?

A

ACEi + Beta blocker (start one at a time)

219
Q

Second line treatment in heart failure?

A

Aldosterone antagonist e.g. eplerenone or spironolactone

220
Q

Possible consequence of ACEi and aldosterone antagonist prescribed together?

A

Hyperkalaemia

221
Q

Features of anterior uveitis?

A
  • Acute onset
  • Pain
  • Irregular + small pupil
  • Intense photophobia
  • Red eye
  • Hypopyon
222
Q

Management of anterior uveitis?

A

Urgent referral to opthalmology
Cycloplegics - dilates pupil and relieves the pain (e.g. atropine, cyclopentolate)
Steroid eye drops

223
Q

First line treatments in angina?

A

Aspirin
Statin
Beta-blocker
Calcium channel blocker

224
Q

If using a calcium channel blocker as monotherapy (without beta blocker) in angina, which type should be used?

A

Rate limiting CCB e.g. verapamil, diltiazem

225
Q

If using beta blocker AND CCB for angina, which kind of CCB should be used?

A

Long acting dihydropyridine e.g.nifedipine

226
Q

Patients who require urgent referral for endoscopy with dyspepsia?

A
  • Any patient with dysphagia
  • Any patient with an upper abdominal mass
  • Patients aged >55 years old + weight loss AND any of:
    • Upper abdo pain
    • Reflux
    • Dyspepsia
227
Q

What are some of the symptoms of a prolactinoma in a man?

A
  • Impotence
  • Loss of libido
  • Galactorrhoea
228
Q

What are some of the symptoms of a prolactinoma in a woman?

A
  • Amenorrhoea
  • Infertility
  • Osteoporosis
  • Galactorrhoea
229
Q

Management of prolactinoma?

A

Dopamine agonists e.g. cabergoline, bromocriptine
Inhibits prolactin release

230
Q

Protein level of >30g/L indicates what kind of pleural effusion?

A

Exudate

231
Q

Protein level of <30g/L indicates what kind of pleural effusion?

A

Transudate

232
Q

Older male, bone pain, isolated raised ALP and normal calcium indicates what? What is the management?

A

Paget’s disease
- Bisphosphonates

233
Q

Most common cause of death post-MI?

A

Cardiac arrest secondary to ventricular fibrillation

234
Q

Dose of folic acid in non-high risk women during pregnancy?

A

400 mcg until 12th week

235
Q

Dose of folic acid in high risk women during pregnancy?

A

5mg until 12th week

236
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

237
Q

First line treatment for acne

A

Topical treatment - either retinoids or benzoyl peroxide

238
Q

Second line treatment for acne

A

Combination topical treatment - Topical antibiotics plus topics retinoid/benzoyl

239
Q

Third line treatment for acne, given examples of agents used

A

Oral antibiotics - tetracyclines (doxy, lyme, oxytetra) - not suitable in pregnancy

In pregnancy - erythromycin

Prescribe for 3 months

Always continue topical retinoid or benzoyl peroxide to reduce chance of abx resitance

240
Q

Fourth line treatment for acne

A

Oral retinoids

241
Q

MHA section 2 - purpose and how long valid

A

Admission for assessment
28 days - can’t be renewed

242
Q

MHA section 3 - purpose and how long valid

A

Admission for treatment
6 months - CAN be renewed

243
Q

Pulmonary function tests:
- Obstructive picture, what will it show?
- FEV1
- FVC
- FEV1/FVC ratio

A

FEV1 - significantly reduced
FVC - Normal (can be reduced)
FEV1/FVC ratio - reduced

244
Q

Pulmonary function tests:
- Restrictive picture, what will it show?
- FEV1
- FVC
- FEV1/FVC ratio

A

FEV1 - reduced
FVC - significantly reduced
FEV1/FVC ratio - normal or increased

245
Q

Features of vestibular neuronitis?

A
  • Vertigo
  • Horizontal nystagmus
  • NO hearing loss or tinnitus

Usual cause: viral infection

246
Q

After starting metformin, which HBA1c would prompt to add in a second agent?

A

> 58 mmol/mol

247
Q

Rinne’s:
- Is bone conduction louder or quieter in CONDUCTIVE HEARING LOSS?

A

LOUDER

248
Q

Rinne’s:
- Is bone conduction louder or quieter in SENSORINEURAL HEARING LOSS?

A

QUIETER

249
Q

Webber’s
- When does the sound localise to the affected ear?

A

CONDUCTIVE

250
Q

Webber’s
- When does the sound localise to the contralateral ear?

A

SENSORINEURAL

251
Q

Anti-dsDNA associated with…

A

SLE

252
Q

Anti-mitrochindrial associated with..

A

PBC

253
Q

Anti-smooth muscle associated with

A

chronic active hepatitis C
and autoimmune hepatitis

254
Q

pANCA associated with

A

Ulcerative colitis

255
Q

Anti-centromere associated with

A

CREST/Scleroderma

MSRA (1 decks)

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