MSRA Flashcards
first line paediatric migraine
ibuprofen
pertussis (whooping cough) rx
azithromycin/clarithromycin
flushing, diarrhoea, bronchospasm, hypotension, and weight loss indicative of what condition
Carcinoid syndrome
Most common cause of thrombophilia
factor V leiden (activated protein C resistance)
Croup pathogen
parainfluenza
Pre menopausal oestrogen receptor positive breast ca treatment
Tamoxifen
Post menopausal oestrogen receptor positive breast ca treatment
anastrazole/letrozole
> 55 or afrocaribbean first line HTN rx
CCB
Migraine prophylaxis
propranolol or topiramate
(propran preferable in women of child bearing age)
Acute migraine rx first and 2nd line
Triptan + NSAID/Para
2nd line- metoclopromide or prochlorperazine
Diabetic or <55 and not african/afrocaribbean first line HTN rx
ACEi or ARB (ARB preferences in afrocaribbean)
Heart failure 1, 2 3rd line drugs
- ACE and beta blocker
- Aldosterone agonist (spiro) or eplerenone
- Empagliflozin
Anti-HBc positive means?
previous or current infection
Anti-HBs positive means
immunised
HBsAg positive means
active infection
Indications for CT after head injury within 1 hour
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
Indicates for CT head post injury within 8hrs (not 1hr)
-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
Anti-HCV antibodies positive means?
present in acute but also in recent infection- need PCR to confirm acute
Ix for carcinoid syndrome
urinary 5-HIAA
phaeochromocytoma ix
urinary metanephrines
Further treatment if angina not controlled on a max dose beta blocker?
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)
First line meds to start in angina
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)
Achalasia- liquids or solids dysphagia?
Both from the start
Dysphagia plus eye weakness/ptosis =?
Myaesthenia Gravis
What do the letters stand for in CREST syndrome?
Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia
CREST is a subtype of what?
limited systemic sclerosis
A drug which should not be used with azathioprine?
allopurinol- can cause pancytopenia
C peptide high in which type of diabetes?
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)
following a first unprovoked or isolated seizure if brain imaging and EEG normal, how long can they not drive for?
6 months
In breast Ca what treatment should follow a wide local excision to reduce recurrence?
Whole breast RT
Cocaine induced MI extra rx
benzodiazepam IV
in CKD are calcium, phos, ALP and PTH high or low
Low Ca
High phos, ALP and PTH
Genital warts treatment
Topical podophyllum.
how soon before surgery to stop COCP/HRT
4 weeks
UTI abx to avoid in CKD
Nitro
when do ascites patients get prophylactic cipro against SBP?
if ascites and protein <15 on a tap
In urea breath test for h pylori what meds can you not have taken recently and how long for?
no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
Mild-mod flare of distal UC treatment
rectal mesalazine
what gestation is delivery offered in preeclampsia
34w
cause of 85% primary hyperparathyroid
parathyroid adenoma
Secondary hyperparathyroidism is caused by
chronic hypocalcaemia (e.g. chronic kidney disease). Serum calcium is low or normal which parathyroid normal levels are high.
What is tertiary hyperparathyroid cause
Develops from secondary- atrophy of PT glands leads to autonomous PTH production (ie at random). High PTH, high Ca, high Ph
ABPI of what indicates PAD?
<0.9
All patients with peripheral vascular disease should get?
Statin and clopidogrel
the most common cause of breast abscess in lactational women.
staph aureus
Indications for high dose folic acid in pregnancy
BMI >30
Hx/FHx NTD
AEDs
Coeliac
Thalassaemia trait
Diabetes
Which antibiotics affect efficacy of the pill?
only enzyme-inducing antibiotics, such as rifampicin
First line for infertility in PCOS
Clomifene
soap bubble appearance bone tumour
osteoclastoma (giant cell tumour)
sunburst appearance bone tumour
osteosarcoma
onion appeareance bone tumour
Ewing’s sarcoma
Don’t do a PSA within what time frames of which activities
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
Smoking during pregnancy increases risk of
pre term labour
what enzyme to check before starting azathioprine
tpmt
shin rash + cough suggests
sarcoidosis
hand preference <12 months is concerning for
cerebral palsy
what is the sign in Duchenne’s when they use arms to stand up from squat
Gower’s sign
How can you check if raised ferritin is due to iron overload?
Transferrin (high if iron overload)
Ferritin is high or low in IDA
low
Adrenaline doses in anaphylaxis
< 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)
Beck’s triad of cardiac tamponade is what 3 signs
falling BP, rising JVP and muffled heart sound
Painless jaundice is classically suggestive of
pancreatic cancer
Non urgent endoscopy referral criteria
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
Urgent endoscopy referral criteria
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
Treatment of mild-moderate UC flare
Aminosalicylate rectal +/- oral
Second line would be oral corticosteroid
Treatment for severe UC flare
IV steroid (possibly ciclosporin)
or surgery
How to maintain remission of UC following a severe relapse or >=2 exacerbations in the past year
oral azathioprine or oral mercaptopurine
How to maintain remission of mild to mod UC
Aminosalicylate rectal and/or oral depending on site
Important CF LRTI pathogen
pseudomonas
valve most affected in endocarditis of IVDUs
tricuspid
Bronchiolitis management
mainly supportive
bronchiolitis pathogen
RSV
Croup management
oral dex
Admit if stridor/resp distress
Nebulised adrenaline
Whooping cough management
-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
capillary haemangioma rx
propranolol if rx required eg visual obstruction
95% self resolve before 10 years
Most common symptom of posterior stroke
dizziness
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
All 3
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
2 of them
LACI has what presentation (lacunar infarct)
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
POCI presents with
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
early menopause rx
combined hrt until age 51
Acute angle closure Rx
pilocarpine, timolol, and brimonidine eye drops
Definitive is laser peripheral iridotomy
Early menopause increases risk of osteoporosis and what?
Cardiovascular disease
First line mx of symptomatic haemorrhoids
Increased fibre intake
What would bloods show in menopause
raised FSH/LH and low oestradiol
Scabies 1st line rx
permethrin 5%
Itching can persist 4-6 weeks post eradication
Type 1 hypersensitivity
Allergic reaction/anaphylaxis
IgE
Asthma/rhinitis
Immediate
Type 2 hypersensitivity
-AntiBodies attack body cells
-IgG/M
-Intermediate timing
-Rheumatic heart disease/autoimmune haemolytic anaemia
Type 3 hypersensitivity
-Immune complexes form and deposit at sites like joints, glomerulus and blood vessels. Subsequent destruction.
-IgG/M
-Intermediate timing
-RA/ post streptococcal glom.
Type 4 hypersensitivity
-Cell mediated cytotoxicity
-T helper cells
-Delayed
-Transplant rejection/contact dermatitis/scabies
ECG finding of TCA overdose
Sinus tachy, broad QRS, dominant R wave in aVR
Niacin/vit B3 deficiency symptoms
Pellagra:
dermatitis
diarrhoea
dementia
Pyridoxine/B6 deficiency sx
Anaemia, irritability, seizures
Vitamin E deficiency symptoms
Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
MI causing a new left bundle branch block is most likely to be in what region?
anterior or anteroseptal
Can new LBBB be a normal variant?
No always pathological
Smoker with a history of reynauds and extremity ischaemia is suggestive of?
Buergers disease (a small and medium vessel vasculitis)
Most common paediatric renal malignancy and how does it most commonly present
Wilms tumour (nephroblastoma)
asymptomatic abdominal mass
Encephalitis symptoms with bilat temporal lobe changes on CT suggests
Herpes simplex encephalitis
Autoimmune encephalitis is typically the result of ..?
A paraneoplastic syndrome (usually secondary to small cell lung cancer or ovarian teratoma)
Cryptococcal meningoencephalitis typically affects what demographic?
Those with severe immunodeficiency (especially AIDS).
It has a subacute presentation, with symptoms progressing over several weeks (as opposed to a few days).
CMV encephalitis typically affects?
almost always occurs in patients with severe immunodeficiency. In those with HIV, it typically occurs once the CD4 count is <50.
In liver failure coagulopathy which clotting factors are high/low?
In liver failure, all clotting factors are low except for factor VIII which is high (factor VIII is an acute phase reactant)
Coagulation factor missing in haemophilia B
IX
Rhabdo is associated with what other electrolyte imbalances other than CK
Hypocalcaemia (Calcium typically binds to myoglobin released from damaged muscle tissue causing serum hypocalcaemia.)
Hyperkalaemia
Hyperphosphataemia
High urea
Also urinary myoglobins
What specific blood tests for HIV test
Combination test- HIV p24 antigen and HIV antibody.
Antibody can take 4-6 weeks to develop
Antigen within 1 week
Type of dementia with fluctuating cognition and REM sleep disorder
Lewy Body
Lewy body dementia should not get what drug?
antipsychotic- could develop irreversible parkinsonism
Most common cause of B12 deficiency
pernicious anaemia
What would you test to diagnose pernicious anaemia (other than FBC)
Anti-intrinsic factor abs
ALT:AST/AST:ALT ratios in alcoholic vs fatty liver disease?
Alcoholic: AST:ALT >2
Fatty: ALT:AST >2
Campylobacter rx
clarithromycin if severe
Latent TB treatment
Isoniazid with pyridoxine (vit B6) for 6 months
OR
dual therapy with isoniazid (with pyridoxine) + rifampicin for 3 months.
Lyme disease antibiotic
doxy
Cef if disseminated
How do you manage risk of osteoporosis in long term steroid patients?
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)
Electrolyte imbalance that increases risk of digoxin toxicity
hypokalaemia
FEV1/FVC is reduced (<0.7) in what type of lung disease
obstructive
Tumour lysis syndrome prophylaxis
allopurinol or rasburicase
shortened, adducted, and internally rotated leg after trauma is?
Posterior dislocation (90% of dislocations are posterior)
BRCA2 is associated with what cancer in men
prostate
electrolyte imbalances in addisons
Hyperkalaemia
Hyponatraemia
Test for cushings
overnight dexamethasone suppression test
Urine cortisol
DIC shows what on blood film
schistocytes
BNP level can be falsely lowered by what?
ACE inhibitors, angiotensin-2 receptor blockers and diuretics.
primary open angle glaucoma first line rx
Latanoprost (a prostaglandin analogue that increases outflow)
Tetralogy of fallot normally presents at what age
1-2 months
3 causes of congenital CYANOTIC heart disease
tetralogy of Fallot
transposition of the great arteries (TGA) (most common to present at birth)
tricuspid atresia
Most common cause of acyanotic congenital heart disease
VSD
Skin lesion with ‘dimple’ sign
solitary firm papule or nodule, typically on a limb
dermatofibroma
<25 starting SSRI should be reviewed in how long
1 week
most common genetic bleeding disorder
Von Willebrand
Scalp psoriasis first line rx
topical potent corticosteroids
Primary biliary cholangitis first line rx
Ursodeoxycholic acid
Primary biliary cholangitis antibody test
anti mitochondrial antobody
prophylaxis for contacts of patients with meningococcal meningitis
oral cipro
Most common pathogen IECOPD
Haemophilus influenzae
Where do you biopsy to confirm dx coeliac
jejunum
