MSRA Flashcards
mock 2
which med is used in OCD if sertraline not effectvie?
Clomipramine
Downs screening
combined test used to stratify high and low risk
High risk (1 in 150) are offered either invasive testing - CVS or amniocentesis
CVS between 11-14 weeks and involves sample from placenta
Amniocentesis after 15 weeks & involves takiking sample from amniotic fluid
How is stress incontinence managed
1st line - pelvic floor training
2nd line - surgery - mid-urethral mesh sling
If no surgery - duloxetine
pain is reproduced upon ulnar deviation of the wrist once the thumb is flexed across the patient’s palm.
Finkelstein’s test for dequervains tenosynobitis
How to treat bacterial conjunctivitis
conservative mx (usually resolve in 5-7 days)
if symptoms ongoing after 3 days, severe sx or rapid resolution needed then chloramphenicol 0.5% drops or 1% ointment for 5 days
2nd line fusidic acid 1% for 7 days
What are presenting features and managment of polycythaemia
chronic pruritis, lethargy, plethoric appearnace. Smoker
FBC!
Urgent haem referral - ?JAK 2 mutation
Venesection and aspirrin in primary care
CVS primary prevention and risk factors addressed
causes of duputrens
smoking
alcohol
manual lavour
phenytoin
How to manage in primary care - Childhoo;d leukaemia
urgent haem referral
urgent blood test within 48 hours
How does dermatomyosisitis present
violaceous rash on chesks and sun exposed area
heliotrope on eyelids
gottron papules on knuckels
proximal nuscle weakness
POIKILODERMA
part of paraneoplastic syndrome
What is parnychia and ow to manage
localised, superficial inection off skin folds around nail often caused by staph A
Rx - I&D if collection
-fluclox or clari
-erythromycin iff pregnan, breast feeding or allergic
How are children 5-11 asthma managed
1) Twice daily low dose ICS & SABA PRN
2a) If able to manage a MART regime (Steroid (budesomide) and LABA (salmetraol/formetrol combined)
-first low dose MART and then moderate if no benefit
2b) if not able to manage MART
-Trial of LTRA for 8-12 weeks (e.g monteleukast)
-if no beneitt, twice daily ICS/LABA combo with PRN SABA
- if still no beneff,
prophylactic and treatement antibiotic used for human bite
none if skin not broken
Treatment -co-amoxiclav 5 days
-metro & doxy 5 days if pen allergic
Prophylaxis - 3 days with same abx’s
How klebsiella pneumonia presents
alcohol, diabetes, heart disease, cancer
unwell, fever, rigors pleuritic pain
consolidation off upper lobes and features off cavitation
How to investigate haematospermia?
Most cases or benign and resolve spontaneoulsy
Men >40 - mid stream MSU and culture and PSA
Scrotal US if swellling
If STI - genitourinary medicine
Intranasal spray used in allergic rhinitis?
azelastine hydrchloride
Which antidepressant is liscensed for use in Bulimia nervosa
Fluoxetine at a higher daily dose of 60mg
-patients under 30 should be warnedo higher suicidal thinking and should be seen within week of presciring
CBT also needed
What age should prompt referral to child development service if not walking
18 months
8 months if not sitting
showing hand preference before 1 year old
What are the B symptoms of lymphoma
night sweats, unexplained fever, weight loss more than 10% body weight over 6 months
How pneuocystyis jiroveci presents
in HIV /immunocompromised
dry cough, dsypnoea
interstital bilateral perhilar shadowing
Lichen planus presentation and Rx
ishiny, flat topped, violaceous papules and plaques commonly affecting the flexural aspects of the wrists, ankles and lower back.
Wickham striea - fine lines occuring on plaques
Rx - symptmatic itch releif with topical steroids
Invesigation for conns
high sodium low potassimu
RENIN/ALDOSTERONE - low renin and raised aldosterone
Surgical removal of ademona but spironolactone can be used medically prior to surgery
How to manage Rosacea
avoid triggers
metronidazole 0.75% gel if infected spots
brimondine 0.33% topical gel for erythema predominant
croup pathogen and treatemnt?>
parainfluenza virus type 1 or 3 (6months to 3 years)
dexamethasone oral single dose (0.15mg/kg)
when should LFTs be performed startying a statin
What is abnormal levels
3 and 12 months
more than 3x upper limit of normal
what is cholinergic urticaria
heat bumps - due to rise in body temp leading to sweating and usually very itchy - occuring within minutes of sweating
When should suespected AMD be referred
within 1 week to ophthalmology
Which bloods sgould be done in women with IBS sx
FBC, ESR, CRP, coeliac screen and CA 125
What are treatments for endometriosis
Paras/NSAIDs
COCP or POP, implant, inectable, mirena
hysterectomy
No evidence for copper coil or chinese herbal meds
what are the directions of nmystagmus for BPPV
left sided BPPV - clockwise horizontral (AWAY FROM EAR)
Right sided - anticlockwise horizontal
Posteior semicurcular canals - rotatory upbeating
what meds are used for H.pylori
PPI, amox and either clari or metro
levo can be used alongside PPI and metro were there is pen allergy and there has been previous exposure to clari
management of sickness and nausea in pregnancy
acupresure bands, cold meals
proemthazine, cylclizine, prochlorperazxine
if ketonuria, then consider metoclopramisde or ondansetron but not for more than 5 days
what is test in achilles tendon rupture
simmonds-thompson test
Management of angina
GTN for relief
1st line - beta blocker or CCB
- if either not tolerated/contraindicated then switch
-if both contraindicated/not tolerated ten monotherapy with long acting nitrate
2nd - combining beta blocker and CCB and if either not tolerated - long acting nitrate
3rd line Rx - already on dual therapy referral to cardio for third line antianginal
DO NOT COMBINE BETA-BLOCKER WITH RATE LIMITING CCB (diltiazem or verapamil)
