MSRA Flashcards
Live Attenuated Vaccines
BCG
MMR
Oral polio
Yellow fever
oral typhoid
oral rotavirus
intranasal influenza
Ramsay-Hunt Syndrome
Cause:
Features:
Treatment:
Cause = shingles of facial nerve ( CN 7)
Features = auricular pain, facial nerve palsy, vesicular rash around ear, vertigo/tinnitus
Treatment = oral aciclovir and corticosteroids
Most common headache type in children:
Acute management:
1st Line prevention:
Migraine
Ibuprofen/Nasal Triptans
Pizotifen or Propranolol
Ottawa Ankle Rules:
Pain in the malleolar zone plus any one of:
-tenderness of lateral malleolus
-tenderness of medial malleolus
-inability to walk >4 steps immediately after injury and in ED
Asthma Management:
Step 1) Short acting beta agonist e.g Salbutamol
Step 2) Short acting beta agonist and low dose inhaled corticosteroid
Step 3) SABA, ICS and Leukotriene Receptor Antagonist
Step 4) SABA, ICS, Long acting beta agonist (e.g salmeterol), +/- LRTA depending on response
Step 5) SABA, LRTA and Maintenance/Reliever Therapy (Combined ICS and LABA)
Step 6) SABA, LRTA and medium dose MART
Step 7) SABA, LRTA and a) high dose ICS b) antimuscarinic drug e.g Theophylline, c) refer
Doses of Inhaled Corticosteroid
Low dose:
Medium:
High:
400micrograms
400-800 micrograms
>800 micrograms
Enuresis management:
1st line -
2nd line -
3rd line -
1st line = rewards system
2nd line = enuresis alarm
3rd line/short term = desmopressin
Developmental Dysplasia of the Hip features:
Picked up on newborn exam
positive barlow’s and ortolani’s test
uneven skin folds/leg length
Transient Synovitis features:
Acute hip pain
preceding viral infection
typically affects 2-10yr olds
*The commonest cause of hip pain in children
Perthes disease:
Degenerative condition of the hips affecting 4-8yr olds
-Avascular necrosis of the femoral head
More common in boys
progressive hip pain
usually bilateral
limp
stiffness
Slipped Upper Femoral Epiphysis features:
typically 10-15yr olds
more common if obese
may present acutely following trauma but is generally chronic
knee or distal thigh pain
loss of internal rotation
Juvenile Idiopathic Arthritis features:
Arthritis if <16yrs old and for >3 months
joint pain and swelling (usually medium joints such as knees, ankles, elbows)
limping
may have positive ANA
Septic Arthritis:
Acute hip pain with systemic features e.g temperature, severe limitation of affected joint
Likelihood based on Kochers score
Combined Oral Contraceptive Pill Absolute Contraindications (UKMEC 4)
Age 35 smokes >15 cigarettes/day
Migraine with aura
History of thrombus or thrombogenic disease
Previous stroke/heart attack
Breastfeeding <6 weeks postpartum
Ucontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
Positive antiphospholipid antibodies
Shin lesions
erythema nodosum:
Pretibial Myxoedema:
Pyoderma Gangrenosum:
Necrobiosis Lipooidica Diabeticorum:
erythema nodosum = symmetrical, erythematous, tender. Due to: Strep infections, sarcoidosis, IBD, medications (penicillins, sulphonamides, COCP)
Pretibial Myxoedema: symmetrical, erythematous, orange peel texture. Seen in Graves Disease
Pyoderma Gangrenosum: small papule that becomes deep red ulcerated. 50% idiopathic; IBD, connective tissue and myeloproliferative disorders
Necrobiosis Lipooidica Diabeticorum: shiny painless red/yellow skin with telangiectasia. Seen in diabetics
Valves affected in Endocarditis
Normal valves:
IVDU:
Normal = Mitral Valve
IVDU = tricuspid
3 month motor milestones:
Little/no head lag
on tummy = good head control
held sitting = lumbar curve
6 months motor milestones:
on tummy = arms extended
lying on back = lifts legs and grasps feet
pulls self to sitting
rolls front to back
7-8 months motor milestones:
sits unaided - refer if not reached by 12 months
9 months motor milestones:
Pulls to standing
crawls
12 months motor milestones:
Cruises
walks with one hand held
13-15 months motor milestones
Walks unsupported
*Refer if not achieved by 18 months
18 months motor milestones:
Squats to pick up a toy
2 years motor milestones:
Runs
walks up and downstairs holding on to rail
3 years motor milestones:
rides a tricycle
walks upstairs without a handrail
4 years motor milestones:
Hops on one leg
Reasons for referral for developmental delay:
1) not smiling by 10 weeks
2) cannot sit unsupported at 12 months
3) not walking by 18 months
4) hand preference <12 months
Features of Retinitis Pigmentosa:
Night blindness
tunnel vision
Family history
black spiked pigments on retinal fundoscopy
Acute Pancreatitis Causes:
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypertriglyceridaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (Azathioprine, sodium valproate, furosemide, bendroflumethiazide)
Investigations indicating Antiphospholipid Syndrome:
Prolonged APTT
low platelets
Lupus antibodies
Codeine to Morphine dose conversion
divide by 10
Contraindications to Diclofenac (i.e switch to a different NSAID)
Ischaemic heart disease
Peripheral arterial disease
Cerebrovascular Disease
Congestive Heart Failure
What QRisk score warrants prescription of a statin?
> 10%
What causes Seborrhoeic Dermatitis and what conditions is it associated with?
Inflammation secondary to proliferation of fungus Malassezia Furfur
Eczematous lesions on sebum rich areas- including Blepharitis and Otitis Externa
Associated with HIV and Parkinsons
1st Line Treatment of C Difficilie?
-2nd line if recurrence?
Treatment option if severely unwell?
1st line = oral vancomycin
2nd line = oral fidaxomicin
Severely unwell = oral vancomycin and IV metronidazole
Side effects of TB medication
Rifampicin:
Ethambutol:
Pyrazinamide:
Rifampicin = orange secretions, abdominal discomfort
Ethambutol = optic neuritis (needs eye test first)
Pyrazinamide = myalgia, arthritis, hepatitis
Side effects of Sildenafil:
Headaches
flushing
blue tinge to vision
dyspepsia
What is Cataplexy and what is it associated with?
Sudden and transient loss of muscular tone due to strong emotion
-associated with narcolepsy
Features of Acute Angle Closure Glaucoma
Red eye
Severe pain (ocular or headache)
Decreased visual acuity
Semi-dilated pupil
Hazy cornea
Features of anterior uveitis:
Red eye
acute onset
pain
small fixed oval pupil
ciliary flush
blurred vision and photophobia
Symptoms of Psoriatic Arthropathy:
Usually symmetrical poly arthritis but can have asymmetrical oligoarthritis
psoriatic skin lesions
dactylitis (sausage fingers)
Primary Biliary Cholangitis:
Demographic: middle aged females
Associated conditions: sjogren’s syndrome, autoimmune conditions
First line treatment: ursodeoxycholic acid
Treatments for Chlamydia:
1st line = doxycycline
alternatives if pregnant = azithromycin, erythromycin, amoxicillin
Examples of P450 Enzyme Inducers:
(increased clearance by enzymes)
Rifampicin
St Johns Wort
Antiepileptics e.g phenytoin, carbemazepine
Chronic Alcohol
Smoking
Examples of P450 Enzyme Inhibitors:
(decreased clearance by enzymes)
Ciprofloxacin/Erythromycin
Amiodarone
Sodium Valproate
SSRIs
Antifungals
Isoniazid
Acute alcohol
Features of a Lacunar Stroke:
Purely motor
or
Purely sensory
Features of Hypocalcaemia:
Muscle weakness
Tetany
Convulsions
Cataracts
Positive chvostek sign (tapping on cheek causes spasm)
Positive trousseau sign (blood pressure cuff inflation induces tetany in the hand)
What is the hallmark difference between Bullous Pemphigoid and Pemphigoid Vulgaris?
Bullous pemphigoid = no mucosal involvement
Indication for starting Clozapine:
Schizophrenic patient who has not responded adequately to at least 2 anti-psychotics
When should COCP be stopped prior to elective surgery?
4 weeks prior
When should anti-coagulation for atrial fibrillation be initiated post-thrombotic stroke?
2 weeks post-stroke
Cause and treatment of Eczema Herpeticum
Infection of atopic eczema with Herpes Simplex Virus 1
Needs admission to hospital for IV Aciclovir
What is Presbycusis?
Age-related sensorineural hearing loss
usually presents with bilateral high-frequency hearing loss
Treatment target times for Thrombolysis and Thrombectomy in Acute Thrombotic Stroke
Thrombolysis = 4.5hrs
Thrombectomy = 6hrs
What monitoring is required whilst taking Hydroxychloroquine?
Visual acuity (can precipitate a retinopathy)
What two treatments should be prescribed for patients with Peripheral arterial disease?
Clopidogrel and Atorvastatin (80mg)
What is the 1st line treatment for plaque psoriasis?
Potent topical corticosteroid and topical vitamin D analogue
What is the most common causative organism of Infective Exacerbation of COPD?
Haemophilus Influenza
What is the most common cause of atypical pneumonia in younger patients?
Mycoplasma Pneumoniae
What mechanism of action and what is the most common side effect of Varenicycline?
Mechanism = Nicotinic Partical Receptor agonist
Nausea
What is the treatment for Whooping Cough/Pertussis
Oral Macrolide e.g clarithromycin/Erythromycin/Azithromycin
What should be started alongside allopurinol as gout prophylaxis?
Colchicine - or NSAID if colchicine not tolerated
What is the UK carrier rate of Cystic Fibrosis?
1 in 25
What is an Argyll-robertson pupil?
Both pupils constrict to near object accommodation but affected pupil doesn’t constrict upon bright light
-Seen in Diabetes Mellitus and Neurosyphillis
What is the reversal agent for Warfarin?
IV Prothrombin Concentrate in severe bleeding
Vitamin K if deranged INR but stable
What is the most common reason for revision of total hip replacement?
Aseptic loosening of the joint
