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MSRA Flashcards

MSRA

1
Q

SLR positive indicated which pathology

A

sciatic nerve pain

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2
Q

Acute dystonia

A

sustain muscle contractions - torticollis, oculogyric crisis

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3
Q

management of acute dystonia

A

procyclidine

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4
Q

akathisia

A

severe restlessness

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5
Q

tardive dyskinesia

A

Late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw

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6
Q

Antipsychotics increase the risk of _______ in elderly patients

A

VTE
Stroke

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7
Q

Side effects of antipsychotics (excl. extrapyramidal)

A

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)

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8
Q

Extrapyramidal side effects of antipsychotics

A

Parkinsonism
acute dystonia
tardive dyskinesia
akathesia

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9
Q

mechanism of action of typical antipsychotics and examples

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

Haloperidol
chlorpromazine

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10
Q

mechanism of action of atypical antipsychotics and examples

A

Act on a variety of receptors (D2, D3, D4, 5-HT)

clozapine
risperidone
olanzapine

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11
Q

Allergy to what other medications may cause allergic reaction to sulfasalazine and mesalazine (5-aminosalicylic acids)

A

aspirin

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12
Q

sulfasaline cations

A

asprin allergy
G6PD deficiency

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13
Q

Is sulfasalazine safe in preganancy and breastfeeding

A

yes

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13
Q

sulfasalzine side effects

A

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

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13
Q

ptosis and constricted pupil

A

horners

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14
Q

ptosis and dilated pupil

A

third nerve palsy

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15
Q

bilateral irregularly shaped pupils that constrict poorly to light but accommodate well to near vision
assoc neurosyphilis

A

Argyll-Robertson pupil

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16
Q

large, irregularly shaped pupil that reacts slowly to light stimulation but constricts well upon accommodation. typically seen in young women

A

holmes-adie pupil

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17
Q

sudden visual loss, pain upon eye movement and dyschromatopsia (impaired colour vision)

A

optic neurtis

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18
Q

features of horners syndrome

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

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19
Q

causes of horners syndrome

A

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

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20
Q

garden criteria fracture

A

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

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21
Q

management of intracapsular fractures

A

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.

22
Q

management of extracapsular fracture

A

Management
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

23
Q

conditions that cause aortic stenosis in babies

A

William’s syndrome (causes supravalvular aortic stenosis)
coarctation of the aorta
Turner’s syndrome

24
Q

prediabetes hba1c

A

42-47

25
Q

fasting plasma glucose prediabetes range

A

6.1 - 6.9

26
Q

hba1c and fasting glucose that indicate diabetes

A

hba1c >48
fasting glucose >7

27
Q

how to define impaired fasting glucose

A

due to hepatic insulin resistance
fasting glucose of 6.1 - 7

28
Q

how to define impaired glucose tolerance

A

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

29
Q

features of pityriasis versicolor

A

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

30
Q

management of pityriasis vesicolor

A

ketaconazole/antifungal

31
Q

what causes pityriasis vesicolor

A

overgrowth of Malassezia yeast

32
Q

adverse side effects of SSRIs

A

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

33
Q

which antidepressant would you use in someone who has had a MI

A

sertraline - more evidence it is safe

34
Q

which SSRI is most appropriate for children and adolescents

A

fluoxetine

35
Q

which SSRIs cause QT prologation

A

citalopram and escitalpram

36
Q

ssris drug interactions

A

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

37
Q

when starting an antidepressant when should patients be reviewed

A

in 2 weeks or in 1 week if under 25

38
Q

when stopping SSRIs how gradually should you reduce the dose

A

over 4 weeks

39
Q

risk of SSRIs in pregnancy

A

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

40
Q

onset and duration of reactive arthritis

A

starts 4 weeks after illness tends to last 4-6months
around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease

41
Q

what is keratoderma blenorrhagica

A

waxy yellow/brown papules on palms and soles

42
Q

what is keratoderma blenorrhagia associated with

A

reactive arthritis

43
Q

criteria for gestational diabetes

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

44
Q

management of gestational diabetes

A

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

45
Q

what causes hyperacute rejection of a renal transplant

A

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

46
Q

acute graft failure of renal transplant <6months

A

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

47
Q

Causes of chronic graft failure (> 6 months)

A

both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)
recurrence of original renal disease (MCGN > IgA > FSGS)

48
Q

risk factors for Surfactant deficient lung disease

A

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

49
Q

management of surfactant deficient lung disease

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube

50
Q

what causes dermatitis herpitiformis

A

disposition of IgA in the dermis

51
Q

management of dermatitis herpitformis

A

gluten free diet
dapsone

52
Q

bullous pemphigoid/pemphigus causes mucosal lesions

A

pemphigus

53
Q
A

MSRA (1 decks)

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