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MSRA Flashcards

1
Q

What is the first line treatment for narrow complex tachycardia with no adverse features?

A

Vagal Manouveres

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1
Q

What is the first line treatment for narrow complex tachycardia in a patient with severe heart failure?

A

Synchronised DC shocks

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2
Q

What is the first line treatment for Broad complex tachycardia in a patient presenting with BP 85/66?

A

Synchronised DC shocks

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3
Q

What is the first line treatment for broad complex tachycardia with no adverse features?

A

Amiodarone

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4
Q

What do you do if vagal manoeuvres fail for narrow complex tachycardia with no adverse features?

A

Adenosine (6mg first, then 12mg, then 18mg)

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5
Q

What are the steps for synchronised DC shocks?

A

3 attempts - then amiodarone 300mg IV over 10-20mins - and reshock after this

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6
Q

What antibiotic class can cause Torsades De Pointes?

A

Macrolides (e.g. azithromycin)

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7
Q

GIve some examples of macrolides

A

Azithromycin, clarithromycin, erythromycin

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8
Q

How do macrolides work

A

Inhibit bacterial protein synthesis - by inhibiting 50s Ribosome

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9
Q

Describe Torsades

A

Polymorphic ventricular tachycardia (characterised by changing of amplitude and twisting of the QRS around the isoelectric line

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10
Q

What is the first line in treatment of Torsades?

A

IV magnesium

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11
Q

What is Beurgers disease?

A

AKA thromboaniitis obliterans. Progressive inflammation and thrombosis of the small and medium arteries in the hands and feet - can present acute ischaemia or chornic progressive ischaemic changes. May result in gangrene and often requires amputation.

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12
Q

An MI in which territory is likely to cause bradycardia?

A

Inferior MI (right Coronary Artery) - supplies the AV node - ECG territory II, III, AVF

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13
Q

Inferior MI shows on which leads, and affects which cornoary artery

A

II, III, AVF, right coronary artery

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14
Q

Lateral MI shows on which leads and affects which coronary artery?

A

I, AVL, V5, V6 - circumflex

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15
Q

Describe First degree heart block

A

A fixed increased PR interval

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16
Q

Describe second degree heart block

A

Type 1 - increasing PR interval and then dropped QRS

Type 2 - Consisten PR interval furation with interrmitently dropped QRS

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17
Q

Describe third degree heart block

A

P waves and WRS complexes have no association with on another due to atria and ventricles functioning independently

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18
Q

What is the first line for chronic heart failure

A

ACE I + Beta blocker (one drug should be started ata time and NICE advise that clinical judgement is used when determining which one to start first

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19
Q

DO you give antibiotic prophylaxis to prevent infective endocarditis in the UK for dental procedures

A

No none is required

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20
Q

Acute worsening of heartfailure - with acidosis - not responding to treatment what do you do? In a patient on 15l O2

A

Consider CPAP

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21
Q

What is Ivabridine

A

Ivabradine - is a negative chronotrope that acts specifically on the SAN (CYP4A2)

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22
Q

What is Ranolazine used for?

A

Angina

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23
Q

What is the mechanism of action of spironolactone?

A

Aldosterone antagonist

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24
Q

What is the first line treatment of Angina?

A

Beta blocker or CCB (such as verapamil)

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25
Q

For fibrinolysis - which drug do you give before hand?

A

Anti-thrombin drugs such as fondaparinux

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26
Q

Treatment of bradycardia and shock

A

Atropine (500mcg repeated up to a max of 3mg)

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27
Q

For AF if you cardiovert someone successfully what do you do with the aticoagulation

A

Following elective DC cardioversion, in patients at high risk of stroke, anticoagulation should be continued long-term, even if they remain in sinus rhythm. Therefore, the correct answer is continue anticoagulation lifelong. This would need to be regularly evaluated against bleeding risk.

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28
Q

What increases and decreases BNP levels

A

Increases BNP Level
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis

Decreases BNP levels
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists

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29
Q

what is the most common cause of death post MI?

A

VF

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30
Q

What medication causes anal ulceration?

A

Nicorandil

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31
Q

How long do you treat an unprovoked PE with anticoagulation?

A

6 months

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32
Q

What valve is most commonly affected in IVDUs with IE?

A

Tricuspid (right)

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33
Q

What statin and at what dose is required for secondary prevention of MI?

A

80mg Atoirvastatin

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34
Q

What statin and at what dose is required for primary prevention of MI?

A

20mg Atorvastatin

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35
Q

What are the two most commmon causes of headaches in children?

A
  1. Migraine
  2. Tension type headaches
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36
Q

What are breast fed babies at risk for?

A

Vitamin K deficiency (haemorrhagic disease of the newborn)
Maternal use of antiepileptics also worsen this
All newborns offered vitamin K in the UK IM or orally

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37
Q

What in Pabrinex can help prevent the development of Wernicke’s encephalopathy?

A

Vitamin B1 (thiamine)

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38
Q

In the treatment of anaphylaxis how often can you give adrenaline?

A

Every 5 minutes - any quicker can cause side effects tachy + HTN and any slower is undertreatment

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39
Q

Patient planning to kill himself - as he has no hope - what is the first step?

A

Crisis team referral first and then triage to ED

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40
Q

What is associated with vitiligo?

A

Alopecia areoata
The opposite acanthosis nigricans is associated with Cushings

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41
Q

Recall the HTN flow chart

A

HTN + TIIDM or age<55 and not of black african or afrocaribean descent

  1. ACEi/ARB
    • CCB or thiazide-like diuretic
    • CCB or thiazide like diuretic (whichever you didn’t add in 2)
  4. Confirm resistant HTN
    - Seek expert advice
    - Low dose spiro if blood potassium <4.5
    - alpha/beta blocker if K+ >4.5

Age >55 or black African or afrocaribean descent
1. CCB
2. +ACEi/ARB or thiazide like diuretic
3. CCB + ACEi/ARB + Thiazide like diuretic
4. Confirm resistant HTN
- Seek expert advice
- Low dose spiro if K+ <4.5
- Alpha/beta blocker if K+ >4.5

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42
Q

What is an aboslute contraindication to COCP?

A

Contraindicated in those above 35 who smoke more than 15 cigarettes per day (increased risk of cardiovascular events) - risk increases with age and number of cigarettes smoked daily

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43
Q

Swelling in left side of neck below the angle of the jaw (tender to palpation) + pyrexial + tender lymphadenopathy

A

Sialadenitis - inflammation of the salivary fland secondary to obstruction by a stone impacted in the duct - lmost common tumour causing this is pleomorphic adenomas (benign, mixed parotid tumour). Managed conservatively - eat more lemons to wash out stones

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44
Q

Grading system of internal haemorrhoid

A

Grade 1 - no prolapse just prominent blood vessels
Grade 2 - prolapse upon bearing down spontaneous reduction
Grade 3 - prolapse upon bearing down - requires manual reduction
Grade 4 - prolapse with inability to be manually reduced

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45
Q

2 minute episode of olgactor halluncatinations whilst retaining consciousness. What is the diagnosis

A

Focal aware seizure

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46
Q

Can you recall the GCS scale

A

Motor (6)
6. Obeys command
5. Localises to pain
4. Withdraws from pain
3. Abdnormal flexion (decoritcate posture)
2. Extending to pain
1. None

Verbal response (5)
5. Orientated
4. Confusion
3. Words
2. Sounds
1. None

Eye opening (4)
4. Spontaneous
3. Speech
2. To pain
1. None

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47
Q

What risks classically increase with tamoxifen usage?

A

VTE + Endometrial cancer - women should be counselled about this prior to starting treatment

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48
Q

Overdose of paracetamol management

A

Activated charcoal if less than 1 hour - if over this then NAC

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49
Q

Overdose of salicylate management

A

Urinary alkanization with IV bicarbonate –> haemodialysis

50
Q

Overdose of opiods/opiates management

A

Naloxone

51
Q

BZD overdose management

A

Flumazenil
Majority of overdoses managed with supportive care due to risk of seizures with flumazenil - generally only used with severe or iatrogenic overdoses

52
Q

TCAs overdose management

A

IV bicarbonate - reduce risk of seizures
Class 1a and class Ic antiarrhythmics _ Class III all prolong depolarisation/QT interval
- Dialysis is ineffective

53
Q

Lithium overdose management

A

mild to moderate toxicitiy - volume resuscitation with normal saline
haemodialysis in severe toxicity
Sodium bicarbonate used sonmetimes but has limited evidence

54
Q

Warfarin overdose management

A

Vit K
Prothrombin complex

55
Q

Heparin overdose management

A

Protamine sulphate

56
Q

Betablockers overdose management

A

if bradycardia - atropine
in restistant cases consider glucagon

57
Q

Ethylene glycol overdose management

A

Ethanol was used for many years and is still used
fomepizole - is now first line (ETOH dehydrogenase inhibitor)
Haemodialysis in refractory cases

58
Q

Methanol poisoning management

A

Fomepizole or ethanol
Haemodialysis

59
Q

organophophate insecticide poisoning

A

Atropine
Pralidoxime unclear benefit no clear benefit

60
Q

Digoxin overdose management

A

Digoxin specific antibody fragments

61
Q

Iron overdose management

A

Desferrioxamine (chelating agent)

62
Q

Lead poisoning management

A

dimercaprol
calcium edetate

63
Q

Carbon monoxide poosoning management

A

100% oxygen
Hyperbarric oxygen

64
Q

Cyanide

A

Hydroxocobalamin

65
Q

For unprovoked PE how long do you anticoagulate?

A

6 months

66
Q

For provoked PE how long do you anticoagulate

A

3 months (generally)
3-6 months in those with active cancer

67
Q

Patient with AF new over the last 24 hours, what do you do?

A

Admit - as he is suitable for electrical cardioversion

68
Q

In a patient with a STEMI - if PCI cannot be delivered within 120 minutes what is the first course of action?

A

Fibrinolysis - repeat ECG after 90 minutes if ST elevation not resolved then transfer for PCI

69
Q

What are the side effects of Nicorandil

A

Nicorandil is vasodilatory drug used to treat angina - potassium channel acitvator with vasodilation (Nicoran-dil-ation)

Adverse effects include
1. Headache
2. Flushing
3. Skin, mucosal, eye, GI (including anal) ulceration

70
Q

Infective endocarditis in IV drug users most commonly affects which valve?

A

Tricuspid

71
Q

What are the most common causes of IE

A
  1. Staph aureus
  2. Strep viridans - name for either streptococcus mitis/sanguinis
  3. Coagulase-negative staphylococci (stph epidermidis) - most common in indwelling lines - most common post-prosthetic valve surgery usually result of peripoperative contamination
  4. Streptococcus bovis - associated with colorectal cancer
  5. Non-infective - SLE/Malignancy
72
Q

In patients with stable heart failure what is management

A

Bisoprolol/carvedilol both reduce mortality in stable HF - other beta-blockers have no evidence base

NICE recommends both ACE-I and beta blocker

73
Q

Contraindications of statins

A

HMGCoA

H: Hepatotoxicity
M: Myalgia/Myopathy
G: GI upset
C: PK increase
A: Avoid in pregnancy

74
Q

At what age does hand preference become normal?

A

12 months - hand preference before this is abnormal and could indicate cerebal palsy - important to urgently refer to child development service for MDT assessment - if they have risk factors for CP (such as low birth weight

75
Q

At what age should a child be smiling, sitting, walking, and having hand preference by

A

Smiling 10 weeks
Sitting 12 months
Walking 18 months
Hand preference 12 months

76
Q

How long do classes of contraceptives take to be effective if it is not first taken on the first day of period?

A

IUD - instant
POP - 2 days
COC/Infection/Implant/IUS - 7 days

77
Q

You start an SSRI in a patient on aspirin for long term ischaemic heart disease - what do you have to give alongside?

A

PPI - as SSRI + NSAID = GI bleeding risk

78
Q

Treatment of croup?

A

Single dose of oral dexamethasone (0.15mg/kg( to be taken immediately regardless of severity

79
Q

What is the window of taking POP late?

A

3 hours - anything outside of this advise to take missed pill and continue pills as usual but use condoms for 48 hours

80
Q

What is the most commonly affected age of croup?

A

6 months to 3 years

81
Q

Would you perform a complete throat examination in a child with suspected croup?

A

No it should be avoided as it can percipitate complete airway obstruction due to reflex laryngospasm

82
Q

Child with severe croup has received oral dexamethasone - oxygen saturations 89% on room air and obvious increased respiratory effort - what do you use as the next line?

A

Oxygen + nebulised adrenaline - nebulised adrenaline causes vasoconstriction in the upper airway mucosa - reducing oedema and improving airflow - this can rapidly alleviate the sympotms of severe croup

83
Q

53 year old woman with sepsis develops AF - hypotensive and tachy, what do you treat with first?

A

IV fluids first - sepsis mediated AF

84
Q

What is seen on the blood film of someone with acute promyelocytic leukaemia?

A

Auer rods

85
Q

In which condition do you see tear-drop poikilocytes?

A

Myelofibrosis - occur as they are squeezed through the fibrotic tissue in the bone marrow

86
Q

In which condition do you see smear cells?

A

CLL - smear cells are remenants of cells that have no identifiable plasma membrane or nuclear structure

87
Q

In which condition(s) do you find spherocytes?

A

Hereditary spherocytosis or autoimmune haemolytic anaemia - occur due to abnormalities in the red cell membrane

88
Q

In what condition(s) do you see target cells?

A

Iron deficiency or hyposplenism - target with a bullseye - increase in red cell surface area or decrease in intracellular haemoglobin

89
Q

What is the presentation of bronchiolitis?

A

Wheeze and fast breathing - rather than stridor - affecting infants younger than 2 and caused by RSV

90
Q

What is the presentation of Bacterial tracheitis?

A

Similar to croup but a more toxic appearance - high fever and rapid progression to respiratory distress

91
Q

How does pertussis present?

A

mild upper respiratory tract symptoms progressing to paroxysms of coughing followed by an inspiratory “whoop” sound.

92
Q

How does acute epiglottitis present?

A

Indection and inflammation of the epiglottis most commonly due to haeomphilus influenzae type B - sudden onset nhigh fever, DROOLING, severe sore throuat. Child prfers to sit in tripod position to maintain the airwayI

93
Q

In which thyroiditis do you get a tender goitre?

A

Subacute thyroiditis (De QUervain’s) - usually self limiting - may respond to aspirin ot other NSAIDs - in more severe cases can use steroids

94
Q

AST to ALT ratios classically in non-alcoholic and alcoholic hepatitis respectively?

A

In Alcoholics you do the Salt before the Lime (in a tequila shot) - Alc: AST>ALT (Ratio of over 2)

Non Alcoholic ALT>AST (ratio of over 2)

95
Q

What is the first line treatment for chronic plaque psoriasis?

A

Topical potent corticosteroid (betamethasone - NOT HYDROCORTISONE WHICH IS WEAK TOPICALLY) + Vitamin D analogue

96
Q

A patient with a breast fibroadenomna of >3cm, what is the treatment?

A

Surgical excision if >3cm +/- sympotmatic - and leave alone if under 3 cm

97
Q

In a patient with wide-local excision of breast lump, what is the treatment?

A

Whole breast radiotherapy

98
Q

How do you monitor treatment in haemochromatosis?

A

Ferritin and transferrin saturation

99
Q

What are the risk factors and protective factors for endometrial cancer

A

Endometrial cancer risk is worsened by increased oestrogen:

  1. Obesity - increased oestrogen
  2. DM - increased circulating oestrogens
  3. Late menopause - increased oestrogen
  4. Nulliparity - reduces the oestrogen break seen in pregnancy

Protective factors
1. Early menopause
2. Parity
3, COCP - increases progesterone which counteracts oestrogen impact on the endometrial tissue
4. POP - same as above

100
Q

What is the treatment for a 74 year old man with symptomatic aortic stenosis keen for intervention

A

Biprosthetic aortic valve replacement

Balloon valvuloplasty in those patient who are too high-riosk for surgical intervention or as a bridge to definitive treatment - largely replaced by transcatheter methods

101
Q

Patient with high POSA - next step

A

Multiparametrix MRI - replacing TRUS biopsy as first-line investigation

If Likert scale is >=3 offer prostate biopsy

If 1-2 then recommend discussing with the patient the pros and cons of having a biopsy

102
Q

What is the most likelyt cause of death of patients with CKD on haemodiualysis?

A

IHD - significantly higher rates oif vardiovascular disease due to

  1. HTN
  2. Dyslipidaemia
  3. Anaemia
  4. Systemic inflammation
103
Q

Pregnant woman with a rash consistent with chicken pox - otherwise stable what is the treatment?

A

Aciclovir oral

IV if severe infection

VZIG is only beneficial prior to rash starting

104
Q

Patient with ascites has TAP - no organisms but protein of 12 what is the treatment?

A

Oral ciprofloxacin or norfloxacin as prophylaxis as protein conc <=15g/L

105
Q

What can make the urea breath test not accurate?

A

Abx in the past 4 weeks
No PPI in last 2 weeks (or other antisecretory drugs)

106
Q

Haemolytic uraemic syndrome - what is the causative agent?

A

E. Coli

107
Q

What can effect HBA1C levels ?

A

Lower (Low SHH G)
1. Sickle cell anaemia
2. G6PD deficiency
3. Hereditary spherocytosis
4. Haemodialysis

Higher (Hi VIS)
1. Vitamin B12/folic acid deficiency
2. Iron-deficiency anaemia
3. Splenectomy

108
Q

Baby with recurrent sticky eye - with no poisitive swab. Otherwise well in self and no visual development issues. Treatment?

A

Reassurance and advise to continue conservative treatment unless symptoms persist beyond 1 year of age

109
Q

What is the most comon congenital cardiac abnormality in Down’s Syndrome?

A

AVSD

110
Q

What are urinary metanephrines used to diagnose?

A

Phaechromacytoma

111
Q

For PAD what are the ABPI normal ranges - and what is the treatment

A

0.9-1.4
Clopi + atorvastatin

112
Q

What is the target times of thrombolysis and thombectomy respectively in acute ischaemic stroke?

A

4.5 hours thrombolysis
6 hours thrombectomy

113
Q

Patient with gestational diabetes - if fasting plasma <7 mmol/l what do you do?

A

a trial of diet and exercise should be offered for 1-2 weeks

114
Q

What typoe of urinary incontinence is seen in TCAs?

A

overflow incontinence

115
Q
A
116
Q

Describe normal pressure hydrocephalus

A

Wet (incontinent)
Wacky (confused)
Wobbly (gait disturbance)

117
Q

What is the treatment for normal pressure hydrocephalus?

A

VP shunt

118
Q

Treatment for carotid stenosis causing stroke?

A

Carotid endarterectomy

119
Q

What is MND

A

Neurodegenerative disease mostly affecting those between 60 and 80
Sporadic in nature (rarely genetic)
Clinical diagnosis
Treated with Ruluzole (glutamate release antagonist) used in all patients at point of diagnosis and can prolong survival with disease

120
Q

What are the subtypes of MND?

A

Amyotrophic lateral sclerosis (most common)
Progressive bulbar (UMN and LMN)
Progressive muscular atrophy (LMN)
Primary lateral sclerosis (Isolated upper motor neuron disorder)

121
Q

Explain Dermatomyositis

A

Autoimmune inflammatory disorder characterised by myopathy with distinctive cutaneous eruption

122
Q

Describe Henoch Schonlein

A

MSRA (1 decks)

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