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MSRA Flashcards

1
Q

first line paediatric migraine

A

ibuprofen

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2
Q

pertussis (whooping cough) rx

A

azithromycin/clarithromycin

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3
Q

flushing, diarrhoea, bronchospasm, hypotension, and weight loss indicative of what condition

A

Carcinoid syndrome

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4
Q

Most common cause of thrombophilia

A

factor V leiden (activated protein C resistance)

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5
Q

Croup pathogen

A

parainfluenza

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6
Q

Pre menopausal oestrogen receptor positive breast ca treatment

A

Tamoxifen

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7
Q

Post menopausal oestrogen receptor positive breast ca treatment

A

anastrazole/letrozole

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8
Q

> 55 or afrocaribbean first line HTN rx

A

CCB

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9
Q

Migraine prophylaxis

A

propranolol or topiramate
(propran preferable in women of child bearing age)

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10
Q

Acute migraine rx first and 2nd line

A

Triptan + NSAID/Para
2nd line- metoclopromide or prochlorperazine

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11
Q

Diabetic or <55 and not african/afrocaribbean first line HTN rx

A

ACEi or ARB (ARB preferences in afrocaribbean)

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12
Q

Heart failure 1, 2 3rd line drugs

A
  1. ACE and beta blocker
  2. Aldosterone agonist (spiro) or eplerenone
  3. Empagliflozin
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13
Q

Anti-HBc positive means?

A

previous or current infection

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14
Q

Anti-HBs positive means

A

immunised

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15
Q

HBsAg positive means

A

active infection

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16
Q

Indications for CT after head injury within 1 hour

A

Within 1hr: BANGSS
- Basal skull fracture signs
- Any suspected open / depressed skull fracture
- Neurological deficit focal
- GCS <13 on initial assessment or <15 2hrs after injury
- Sick more than ×1 post injury
- Seizure post injury

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17
Q

Indicates for CT head post injury within 8hrs (not 1hr)

A

-Age over 65
- Bleeding risk: anti-coagulation, clotting disorder
- Concussion: retrograde amnesia before head injury
- Dangerous mechanism of injury: e.g. hit by car / fall from height / from 1m height or >5 stairs

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18
Q

Anti-HCV antibodies positive means?

A

present in acute but also in recent infection- need PCR to confirm acute

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19
Q

Ix for carcinoid syndrome

A

urinary 5-HIAA

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20
Q

phaeochromocytoma ix

A

urinary metanephrines

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21
Q

Further treatment if angina not controlled on a max dose beta blocker?

A

Add CCB such as amlodipine, modified-release nifedipine, or modified-release felodipine

(note not diltiazem or verapamil as they are rate limiting CCBs- not to use in combo with BB)

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22
Q

First line meds to start in angina

A

Aspirin, statin, GTN spray and beta blocker or CCB (if CCB used as monotherapy then rate limiting one eg verapamil/diltiazem. If in combo with BB then amlod/nifed)

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23
Q

Achalasia- liquids or solids dysphagia?

A

Both from the start

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24
Q

Dysphagia plus eye weakness/ptosis =?

A

Myaesthenia Gravis

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25
Q

What do the letters stand for in CREST syndrome?

A

Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

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26
Q

CREST is a subtype of what?

A

limited systemic sclerosis

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27
Q

A drug which should not be used with azathioprine?

A

allopurinol- can cause pancytopenia

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28
Q

C peptide high in which type of diabetes?

A

Type 2 (In type 1 diabetes, we would expect a low or undetectable level of plasma C-peptide due to absolute insulin deficiency. C peptide is used in insulin production)

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29
Q

following a first unprovoked or isolated seizure if brain imaging and EEG normal, how long can they not drive for?

A

6 months

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30
Q

In breast Ca what treatment should follow a wide local excision to reduce recurrence?

A

Whole breast RT

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31
Q

Cocaine induced MI extra rx

A

benzodiazepam IV

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32
Q

in CKD are calcium, phos, ALP and PTH high or low

A

Low Ca
High phos, ALP and PTH

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33
Q

Genital warts treatment

A

Topical podophyllum.

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34
Q

how soon before surgery to stop COCP/HRT

A

4 weeks

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35
Q

UTI abx to avoid in CKD

A

Nitro

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36
Q

when do ascites patients get prophylactic cipro against SBP?

A

if ascites and protein <15 on a tap

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37
Q

In urea breath test for h pylori what meds can you not have taken recently and how long for?

A

no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

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38
Q

Mild-mod flare of distal UC treatment

A

rectal mesalazine

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39
Q

what gestation is delivery offered in preeclampsia

A

34w

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40
Q

cause of 85% primary hyperparathyroid

A

parathyroid adenoma

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41
Q

Secondary hyperparathyroidism is caused by

A

chronic hypocalcaemia (e.g. chronic kidney disease). Serum calcium is low or normal which parathyroid normal levels are high.

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42
Q

What is tertiary hyperparathyroid cause

A

Develops from secondary- atrophy of PT glands leads to autonomous PTH production (ie at random). High PTH, high Ca, high Ph

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43
Q

ABPI of what indicates PAD?

A

<0.9

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44
Q

All patients with peripheral vascular disease should get?

A

Statin and clopidogrel

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45
Q

the most common cause of breast abscess in lactational women.

A

staph aureus

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46
Q

Indications for high dose folic acid in pregnancy

A

BMI >30
Hx/FHx NTD
AEDs
Coeliac
Thalassaemia trait
Diabetes

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47
Q

Which antibiotics affect efficacy of the pill?

A

only enzyme-inducing antibiotics, such as rifampicin

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48
Q

First line for infertility in PCOS

A

Clomifene

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49
Q

soap bubble appearance bone tumour

A

osteoclastoma (giant cell tumour)

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50
Q

sunburst appearance bone tumour

A

osteosarcoma

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51
Q

onion appeareance bone tumour

A

Ewing’s sarcoma

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52
Q

Don’t do a PSA within what time frames of which activities

A

NICE advise that, as PSA levels may be increased, testing should not be done within at least:
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

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53
Q

Smoking during pregnancy increases risk of

A

pre term labour

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54
Q

what enzyme to check before starting azathioprine

A

tpmt

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55
Q

shin rash + cough suggests

A

sarcoidosis

56
Q

hand preference <12 months is concerning for

A

cerebral palsy

57
Q

what is the sign in Duchenne’s when they use arms to stand up from squat

A

Gower’s sign

58
Q

How can you check if raised ferritin is due to iron overload?

A

Transferrin (high if iron overload)

59
Q

Ferritin is high or low in IDA

A

low

60
Q

Adrenaline doses in anaphylaxis

A

< 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)

61
Q

Beck’s triad of cardiac tamponade is what 3 signs

A

falling BP, rising JVP and muffled heart sound

62
Q

Painless jaundice is classically suggestive of

A

pancreatic cancer

63
Q

Non urgent endoscopy referral criteria

A

Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or

upper abdominal pain with low haemoglobin levels or

raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or

vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

64
Q

Urgent endoscopy referral criteria

A

All patients who’ve got dysphagia

All patients who’ve got an upper abdominal mass consistent with stomach cancer

Patients aged >= 55 years who’ve got weight loss, AND any of the following:
-upper abdominal pain
-reflux
-dyspepsia

65
Q

Treatment of mild-moderate UC flare

A

Aminosalicylate rectal +/- oral
Second line would be oral corticosteroid

66
Q

Treatment for severe UC flare

A

IV steroid (possibly ciclosporin)
or surgery

67
Q

How to maintain remission of UC following a severe relapse or >=2 exacerbations in the past year

A

oral azathioprine or oral mercaptopurine

68
Q

How to maintain remission of mild to mod UC

A

Aminosalicylate rectal and/or oral depending on site

69
Q

Important CF LRTI pathogen

A

pseudomonas

70
Q

valve most affected in endocarditis of IVDUs

A

tricuspid

71
Q

Bronchiolitis management

A

mainly supportive

72
Q

bronchiolitis pathogen

A

RSV

73
Q

Croup management

A

oral dex
Admit if stridor/resp distress
Nebulised adrenaline

74
Q

Whooping cough management

A

-Admit under 6 months
-If within 21 days of sx oral macrolide (clarith/azith/eryth)
-School exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
-Pertussis is a notifiable disease

75
Q

capillary haemangioma rx

A

propranolol if rx required eg visual obstruction
95% self resolve before 10 years

76
Q

Most common symptom of posterior stroke

A

dizziness

77
Q

TACI has which of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

A

All 3

78
Q

PACI has which of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

A

2 of them

79
Q

LACI has what presentation (lacunar infarct)

A

presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

80
Q

POCI presents with

A

presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

81
Q

early menopause rx

A

combined hrt until age 51

82
Q

Acute angle closure Rx

A

pilocarpine, timolol, and brimonidine eye drops

Definitive is laser peripheral iridotomy

83
Q

Early menopause increases risk of osteoporosis and what?

A

Cardiovascular disease

84
Q

First line mx of symptomatic haemorrhoids

A

Increased fibre intake

85
Q

What would bloods show in menopause

A

raised FSH/LH and low oestradiol

86
Q

Scabies 1st line rx

A

permethrin 5%
Itching can persist 4-6 weeks post eradication

87
Q

Type 1 hypersensitivity

A

Allergic reaction/anaphylaxis
IgE
Asthma/rhinitis
Immediate

88
Q

Type 2 hypersensitivity

A

-AntiBodies attack body cells
-IgG/M
-Intermediate timing
-Rheumatic heart disease/autoimmune haemolytic anaemia

89
Q

Type 3 hypersensitivity

A

-Immune complexes form and deposit at sites like joints, glomerulus and blood vessels. Subsequent destruction.
-IgG/M
-Intermediate timing
-RA/ post streptococcal glom.

90
Q

Type 4 hypersensitivity

A

-Cell mediated cytotoxicity
-T helper cells
-Delayed
-Transplant rejection/contact dermatitis/scabies

91
Q

ECG finding of TCA overdose

A

Sinus tachy, broad QRS, dominant R wave in aVR

92
Q

Niacin/vit B3 deficiency symptoms

A

Pellagra:
dermatitis
diarrhoea
dementia

93
Q

Pyridoxine/B6 deficiency sx

A

Anaemia, irritability, seizures

94
Q

Vitamin E deficiency symptoms

A

Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy

95
Q

MI causing a new left bundle branch block is most likely to be in what region?

A

anterior or anteroseptal

96
Q

Can new LBBB be a normal variant?

A

No always pathological

97
Q

Smoker with a history of reynauds and extremity ischaemia is suggestive of?

A

Buergers disease (a small and medium vessel vasculitis)

98
Q

Most common paediatric renal malignancy and how does it most commonly present

A

Wilms tumour (nephroblastoma)
asymptomatic abdominal mass

99
Q

Encephalitis symptoms with bilat temporal lobe changes on CT suggests

A

Herpes simplex encephalitis

100
Q

Autoimmune encephalitis is typically the result of ..?

A

A paraneoplastic syndrome (usually secondary to small cell lung cancer or ovarian teratoma)

101
Q

Cryptococcal meningoencephalitis typically affects what demographic?

A

Those with severe immunodeficiency (especially AIDS).
It has a subacute presentation, with symptoms progressing over several weeks (as opposed to a few days).

102
Q

CMV encephalitis typically affects?

A

almost always occurs in patients with severe immunodeficiency. In those with HIV, it typically occurs once the CD4 count is <50.

103
Q

In liver failure coagulopathy which clotting factors are high/low?

A

In liver failure, all clotting factors are low except for factor VIII which is high (factor VIII is an acute phase reactant)

104
Q

Coagulation factor missing in haemophilia B

A

IX

105
Q

Rhabdo is associated with what other electrolyte imbalances other than CK

A

Hypocalcaemia (Calcium typically binds to myoglobin released from damaged muscle tissue causing serum hypocalcaemia.)
Hyperkalaemia
Hyperphosphataemia
High urea
Also urinary myoglobins

106
Q

What specific blood tests for HIV test

A

Combination test- HIV p24 antigen and HIV antibody.

Antibody can take 4-6 weeks to develop
Antigen within 1 week

107
Q

Type of dementia with fluctuating cognition and REM sleep disorder

A

Lewy Body

108
Q

Lewy body dementia should not get what drug?

A

antipsychotic- could develop irreversible parkinsonism

109
Q

Most common cause of B12 deficiency

A

pernicious anaemia

110
Q

What would you test to diagnose pernicious anaemia (other than FBC)

A

Anti-intrinsic factor abs

111
Q

ALT:AST/AST:ALT ratios in alcoholic vs fatty liver disease?

A

Alcoholic: AST:ALT >2
Fatty: ALT:AST >2

112
Q

Campylobacter rx

A

clarithromycin if severe

113
Q

Latent TB treatment

A

Isoniazid with pyridoxine (vit B6) for 6 months
OR
dual therapy with isoniazid (with pyridoxine) + rifampicin for 3 months.

114
Q

Lyme disease antibiotic

A

doxy
Cef if disseminated

115
Q

How do you manage risk of osteoporosis in long term steroid patients?

A

Start bone protection straight away if on equivalent of >7.5mg pred/day for >3 months.

If >65 or prev fragility # then start alendronate (and ensure vit D and Ca replete)

If <65 to a DEXA, further mx depends on the T score (reassure/repeat/offer alendronate)

116
Q

Electrolyte imbalance that increases risk of digoxin toxicity

A

hypokalaemia

117
Q

FEV1/FVC is reduced (<0.7) in what type of lung disease

A

obstructive

118
Q

Tumour lysis syndrome prophylaxis

A

allopurinol or rasburicase

119
Q

shortened, adducted, and internally rotated leg after trauma is?

A

Posterior dislocation (90% of dislocations are posterior)

120
Q

BRCA2 is associated with what cancer in men

A

prostate

121
Q

electrolyte imbalances in addisons

A

Hyperkalaemia
Hyponatraemia

122
Q

Test for cushings

A

overnight dexamethasone suppression test
Urine cortisol

123
Q

DIC shows what on blood film

A

schistocytes

124
Q

BNP level can be falsely lowered by what?

A

ACE inhibitors, angiotensin-2 receptor blockers and diuretics.

125
Q

primary open angle glaucoma first line rx

A

Latanoprost (a prostaglandin analogue that increases outflow)

126
Q

Tetralogy of fallot normally presents at what age

A

1-2 months

127
Q

3 causes of congenital CYANOTIC heart disease

A

tetralogy of Fallot
transposition of the great arteries (TGA) (most common to present at birth)
tricuspid atresia

128
Q

Most common cause of acyanotic congenital heart disease

A

VSD

129
Q

Skin lesion with ‘dimple’ sign
solitary firm papule or nodule, typically on a limb

A

dermatofibroma

130
Q

<25 starting SSRI should be reviewed in how long

A

1 week

131
Q

most common genetic bleeding disorder

A

Von Willebrand

132
Q

Scalp psoriasis first line rx

A

topical potent corticosteroids

133
Q

Primary biliary cholangitis first line rx

A

Ursodeoxycholic acid

134
Q

Primary biliary cholangitis antibody test

A

anti mitochondrial antobody

135
Q

prophylaxis for contacts of patients with meningococcal meningitis

A

oral cipro

136
Q

Most common pathogen IECOPD

A

Haemophilus influenzae

137
Q

Where do you biopsy to confirm dx coeliac

A

jejunum

MSRA (21 decks)

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