MSRA Flashcards
MSRA
SLR positive indicated which pathology
sciatic nerve pain
Acute dystonia
sustain muscle contractions - torticollis, oculogyric crisis
management of acute dystonia
procyclidine
akathisia
severe restlessness
tardive dyskinesia
Late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw
Antipsychotics increase the risk of _______ in elderly patients
VTE
Stroke
Side effects of antipsychotics (excl. extrapyramidal)
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
impaired glucose tolerance
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)
Extrapyramidal side effects of antipsychotics
Parkinsonism
acute dystonia
tardive dyskinesia
akathesia
mechanism of action of typical antipsychotics and examples
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
Haloperidol
chlorpromazine
mechanism of action of atypical antipsychotics and examples
Act on a variety of receptors (D2, D3, D4, 5-HT)
clozapine
risperidone
olanzapine
Allergy to what other medications may cause allergic reaction to sulfasalazine and mesalazine (5-aminosalicylic acids)
aspirin
sulfasaline cations
asprin allergy
G6PD deficiency
Is sulfasalazine safe in preganancy and breastfeeding
yes
sulfasalzine side effects
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
ptosis and constricted pupil
horners
ptosis and dilated pupil
third nerve palsy
bilateral irregularly shaped pupils that constrict poorly to light but accommodate well to near vision
assoc neurosyphilis
Argyll-Robertson pupil
large, irregularly shaped pupil that reacts slowly to light stimulation but constricts well upon accommodation. typically seen in young women
holmes-adie pupil
sudden visual loss, pain upon eye movement and dyschromatopsia (impaired colour vision)
optic neurtis
features of horners syndrome
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
causes of horners syndrome
CENTRAL LESIONS - anhydrosis of face arms and trunk
Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis
PRE-GANGLIONIC LESION - anhydrosis of face
Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib
POST-GANGLIONIC LESION - no anhydrosis
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
garden criteria fracture
Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption
management of intracapsular fractures
Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.
Displaced Fracture:
NICE recommend replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.
management of extracapsular fracture
Management
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
conditions that cause aortic stenosis in babies
William’s syndrome (causes supravalvular aortic stenosis)
coarctation of the aorta
Turner’s syndrome
prediabetes hba1c
42-47
fasting plasma glucose prediabetes range
6.1 - 6.9
hba1c and fasting glucose that indicate diabetes
hba1c >48
fasting glucose >7
how to define impaired fasting glucose
due to hepatic insulin resistance
fasting glucose of 6.1 - 7
how to define impaired glucose tolerance
due to muscle insulin resistance
fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
features of pityriasis versicolor
most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus
management of pityriasis vesicolor
ketaconazole/antifungal
what causes pityriasis vesicolor
overgrowth of Malassezia yeast
adverse side effects of SSRIs
gastrointestinal symptoms are the most common side-effect
there is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
patients should be counselled to be vigilant for increased anxiety and agitation after starting a SSRI
fluoxetine and paroxetine have a higher propensity for drug interactions
which antidepressant would you use in someone who has had a MI
sertraline - more evidence it is safe
which SSRI is most appropriate for children and adolescents
fluoxetine
which SSRIs cause QT prologation
citalopram and escitalpram
ssris drug interactions
NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
when starting an antidepressant when should patients be reviewed
in 2 weeks or in 1 week if under 25
when stopping SSRIs how gradually should you reduce the dose
over 4 weeks
risk of SSRIs in pregnancy
BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.
- Use during the first trimester gives a small increased risk of congenital heart defects
- Use during the third trimester can result in persistent pulmonary hypertension of the newborn
- Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
onset and duration of reactive arthritis
starts 4 weeks after illness tends to last 4-6months
around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease
what is keratoderma blenorrhagica
waxy yellow/brown papules on palms and soles
what is keratoderma blenorrhagia associated with
reactive arthritis
criteria for gestational diabetes
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
management of gestational diabetes
if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met insulin should be added to diet/exercise/metformin
gestational diabetes is treated with short-acting, not long-acting, insulin
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered
glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment
what causes hyperacute rejection of a renal transplant
due to pre-existing antibodies against ABO or HLA antigens
an example of a type II hypersensitivity reaction
leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
no treatment is possible and the graft must be removed
acute graft failure of renal transplant <6months
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
other causes include cytomegalovirus infection
may be reversible with steroids and immunosuppressants
Causes of chronic graft failure (> 6 months)
both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)
recurrence of original renal disease (MCGN > IgA > FSGS)
risk factors for Surfactant deficient lung disease
The risk of SDLD decreases with gestation
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks
Other risk factors for SDLD include
male sex
diabetic mothers
Caesarean section
second born of premature twins
management of surfactant deficient lung disease
prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube
what causes dermatitis herpitiformis
disposition of IgA in the dermis
management of dermatitis herpitformis
gluten free diet
dapsone
bullous pemphigoid/pemphigus causes mucosal lesions
pemphigus
