MSRA 6 Flashcards
1
Q
What do you give as VTE prophylaxis for APSL in pregnany?
A
Antiphospholipid syndrome in pregnancy: aspirin and LMWH
2
Q
When is the pertussis vaccine given to pregnant mothers?
A
16-32 week
3
Q
Phenytoin causes which type of anaemia?
A
Megaloblastic anaemia
4
Q
What is the commonest heart defect in down syndromes?
A
Atrioventricular septal defects are the most common congenital cardiac abnormality in Down’s syndrome
5
Q
How do you treat TIA and stroke if they have AF?
A
following a TIA, anticoagulation for AF should start immediately once imaging has excluded haemorrhage
in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks.
Antiplatelet therapy should be given in the intervening period. If imaging shows a very large cerebral infarction then the initiation of anticoagulation should be delayed
6
Q
How does Myasthenia gravis present?
A
Myasthenia gravis causes fluctuating weakness that worsens with activity and as the day progresses, and ocular weakness, causing ptosis and diplopia in 15% of patients being the commonest presentation.
Life-threatening respiratory weakness can occur, called myasthenic crisis
Around two-thirds of patients progressing to generalized disease - generally within the first 2 years
7
Q
What is myasthenia gravis crisis and what can drugs cause it?
A
The following drugs may exacerbate myasthenia:
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
8
Q
What is the urine amount to define an AKI?
A
↓ urine output <0.5 mL/kg/hr for ≥ 6 hours
9
Q
What is the creatinine amount for AKI stage 1?
A
↑ creatinine 1.5-1.9 times
10
Q
How does GTN effect the breathing?
A
It doesn’t effect the breathing
11
Q
stresseD=Duloxetine
Overactive=Oxybutynin
A
stresseD=Duloxetine
Overactive=Oxybutynin
12
Q
What is first line treatment for an unprovoked DVT?
A
a DOAC
13
Q
Blatchford score?
A
Score if they can go Back
14
Q
What would not need school exclusion for?
A
conjunctivitis, slapped cheek, roseola, infectious mononucleosis, head lice, threadworms and hand, foot and mouth.
15
Q
Ankylosing spondylitis features - the ‘A’s
A
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
16
Q
What are 1st line for spasticity in MS?
A
Baclofen and gabapentin
17
Q
What causes a stroke after a MI?
A
LV wall thrombus
18
Q
What causes a persistent ST elevation in the anterior leads.
A
LV aneurysm
19
Q
A
20
Q
What 1st line treatment would you consider if a HFrEF is intolerant to ACEi?
A
Consider a ARB
21
Q
What would you do when prescribing ACEi, MRA if a HFrEF has an eGFR of 30-45 (CKD 3)
A
Start at low dose, check for hyperkalaemia always
22
Q
What are the side effects of quinine resulting in CI THOM
A
Tinnitus.
Haemolysis or haemoglobinuria.
Optic neuritis.
Myasthenia gravis (quinine can cause severe respiratory distress and dysphagia in this group).
23
Q
What are the drug treatments for overactive bladder OTD M
A
bladder stabilising drugs: antimuscarinics are first-line
NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
Immediate release oxybutynin should, however, be avoided in ‘frail older women’
mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
24
Q
What do you screen for prior to starting a monoclonal antibody and how do you do it?
A
CXR for TB
25
What are the DOAC reversal agents
A is for Apixaban and rivAroxiban and Andexanet Alfa - Direct factor XA inhibitor
D is for Dabigatran and iDarucizumab - Direct Thrombin inhibitor
E is for Edoxaban for which theres no Escape - Direct factor XA inhibitor
26
What is meconium ileus
Small bowel obstruction caused by thick meconium, same SBO symptoms
27
How long is pneumococcal for?
It's for life
28
When would it not be a good idea to start insulin?
Driving heavy vehicles
29
What are the side effects of pioglitazone?
Weight gain, DKA, hepatitis, HF, bladder cancer
30
Which cancer has a higher rate in men with the BRCA1 gene?
Prostate
31
Name the psych and parkinsonism MAOI and name the drugs and foods not to be taken with them and the complications which can occur if not followed?
MAOI B Selegiline, Rasagiline
MAOI A Phenelzine, Isocarboxazid Tranylcypromine
Do not take any sympathetic drugs
Foods containing tyramine
Hypertensive crisis
32
Which condition is meconium ileus more common in?
Cystic fibrosis
33
What is trigger finger?
Stenosing tenosynovitis, occurs when inflammation or nodules develop in the flexor tendon sheath
34
How is dressers syndrome different from pericarditis in their post MI presentation?
Pericarditis presents with days vs 2weeks for Dresslers
35
Are antipsychotics OK in breastfeeding?
Breast feeding is acceptable with nearly all anti-epileptic drugs
36
What is the max number of days you can take metochlopramide?
5days
37
Which drugs are used to treat mild to moderate Alzheimers disease?
donepezil, galantamine and rivastigmine
38
Which drugs can be co prescribed with AchInh in moderate and severe alzheimers disease or as a replacement?
Memantidine
39
Which drugs can be co prescribed with AchInh in moderate and severe alzheimers disease or as a replacement?
Memantidine
40
How are the urogenital symptoms treated in menopause
Urogenital symptoms
if suffering from urogenital atrophy vaginal oestrogen can be prescribed. This is appropriate if they are taking HRT or not
vaginal dryness can be treated with moisturisers and lubricants. These can be offered alongside vaginal oestrogens if required.
41
What is the treatment for BV/TV is allergic to metronidazole?
Topical clindamycin
42
What are the things that go up in anorexia nervous
most things low
G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
43
How do you manage infectious diarrhoea?
the BNF advises treatment if severe or the patient is immunocompromised. Antibiotics are recommended if severe symptoms (high fever, bloody diarrhoea, or more than eight stools per day) or symptoms have lasted more than one week
the first-line antibiotic is clarithromycin
44
Which PPI should you not give with clopidogrel after stroke?
Omeprazole, switch to lansoprazole
45
What is the management of primary dysmenorrhoea?
1st line Ibuprofen/Mefenamic acid
2nd line COCP
46
What are the normal vaginal flora?
Lactobacilli
47
How can symptoms of syringomalacia present?
Symptoms include a cape-like distribution of decreased sensitivity to pain and temperature and flaccid atrophic paralysis in the upper extremities.
48
What treatment do you give for lifethreatening c.diff
Oral vancomycin AND IV metronidazole are used to treat life-threatening Clostridium difficile
49
What is the commonest infectious intestinal bacterial disease in the UK?
Campylobacter infection is the most common bacterial cause of infectious intestinal disease in the UK.
50
When should NSAIDs be avoided in pregnancy?
30weeks
51
What are the three skin conditions associated with pregnancy and what are they?
Atopic eruption of pregnancy
is the commonest skin disorder found in pregnancy
it typically presents as an eczematous, itchy red rash.
no specific treatment is needed
Polymorphic eruption of pregnancy
pruritic condition associated with last trimester
lesions often first appear in abdominal striae
management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
Pemphigoid gestationis
pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required
52
What is a dermatofibroma and what test is performed to confirm what it is?
Dermatofibromas (also known as histiocytomas) are common benign fibrous skin lesions. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury. Common areas include the arms and legs.
overlying skin dimples on pinching the lesion
53
What are the drugs to prescribe post PCI to an MI?
Atorvastatin, ramipril, clopidogrel, aspirin and carvedilol is the correct option, as all patients should be offered a statin, an ACE inhibitor, a beta-blocker and dual antiplatelet therapy after percutaneous coronary intervention (PCI) to reduce the likelihood of future coronary events. Statins are given to reduce cholesterol and thus reduce the risk of further coronary plaque formation. ACE inhibitors such as ramipril are given to prevent cardiac re-modelling and subsequently preserve left ventricular systolic function. Dual antiplatelet therapy, with lifelong aspirin and at least 12 months of a second antiplatelet agent such as clopidogrel, is given to patients who have undergone PCI (or who have high-risk acute coronary syndrome) to reduce the risk of further thrombosis formation. Finally, beta blockers are given as they have been found to have cardioprotective effects, reduce the risk of future arrhythmias, and improve prognosis in those with left ventricular systolic impairment. Consequently, they result in reduced mortality.
54
When should foetal.movements be felt?
24weeks
55
How does Lambert Eaton syndrome present?
Proximal weakness which improves with exercise with autonomic dysfunction.
Associated with SCLC causing paraneoplastic syndrome.
Myasthenia gravis is associated with a thymoma, eye weakness (ptosis, diplopia) Bulbar weakness, proximal weakness worsens with exercise.
56
What are the risk factors for pancreatic cancer?
Whilst chronic pancreatitis is a risk factor, neither gallstone disease nor alcohol are independent risk factors
57
What are the three main familial cancer syndromes?
HNCC - hereditary non-polyposis colorectal carcinoma, gastric, coloreactal, ovarian a nd endometrial cancer
FAP - familial adenomatois polyposis, hundreds to thousands of polyps
PJ syndrome - Peutz-Jeghers syndrome, pigmented freckles but with polyps but no cancer
58
What is the inherited condition with talengiectasia?
Familial haemorrhagic telangiectasia/Osler Weber Rendu
59
What is the test for post H.pyroli eradication therapy?
Urea breath test is the only test recommended for H. pylori post-eradication therapy
60
What condition causes the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed causing pain over her radial styloid on forced abduction/flexion of the thumb.
DeQuervians Tenosynovitis
61
What are the first line treatments for endometriosis?
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn't help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
62
What is the treatment for threadworm and household contacts?
Treatment is recommended if threadworms have been seen or eggs detected. Treatment of all household members at the same time (unless contraindicated) should be considered.
For adults and children aged over 6 months, an anthelmintic (mebendazole) combined with hygiene measures is recommended — mebendazole is not licensed for children under the age of 2 years.
For children aged 6 months and under, hygiene measures alone for 6 weeks, are recommended.
For pregnant or breastfeeding women, the recommended treatment is hygiene measures for 6 weeks.
63
What is 1st line to induce UC remission?
mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral and rectal aminosalicylates.
For severe disease or not responding it is steroids
64
How does the POP stop fertility?
POP: thickens cervical mucus (Exception to this is desogestrel POP which inhibits ovulation)
65
For pregnancy how much and for how long do you take folic acid in those taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
folic acid 5mg once a day 3 months before conception to 12 weeks of pregnancy.
66
What is the commonest inherited thrombophilia condition?
Activated protein C resistance (Factor V Leiden) is the most common inherited thrombophilia
67
What can sodium valproate do to your weight?
Sodium valproate may cause weight gain
68
What is the risk whilst on anastrozole?
Osteoporosis
69
How common is mastitis in breast feeding?
When do you give antibiotics and for how long and what advise should you give?
Mastitis affects around 1 in 10 breastfeeding women. The BNF advises to treat 'if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection'. The first-line antibiotic is flucloxacillin for 10-14 days. Breastfeeding or expressing should continue during treatment.
70
How do you treat coccaine associated chest pain (causing MI) and hypertension?
chest pain:
benzodiazepines + glyceryl trinitrate
if myocardial infarction develops then primary percutaneous coronary intervention
hypertension: benzodiazepines + sodium nitroprusside
71
Which drugs treats galactorrhoea?
Bromocrptine
72
Erythromycin and clarithyromycin should not be co prescribed with which drug or what happens?
Any statins, causes prolonged QT
73
What is BITCH2 mnemonic for amiodrarones side effects?
Bradycardia, blue man syndrome
Interstitial pneumonitis, other pneumonia manifestations
Impaired memory and ataxia
Tremors, peripheral neuropathy
Thyroid problems
Cutaneous photosensitivity
Corneal microdeposits, optic neuritis
Hypotension, heart block, long QT
Hepatotoxocity
74
What is the commonest viral cause of viral conjunctivitis?
Adenovirus
75
How is multiple endocrine neoplasia (MEN) inherited
Autosomal dominant
76
What are the different types of multiple endocrine neoplasia (MEN)
MEN A - 3Ps parathyroid, pancreas, pituitary
MEN BI - 2Ps, phae, parathyroid
MEN BII - 1P, phae
77
What is the phenytoin mnemonic for its side effects?
P450 inducer
Hirstiusim
Enlarged gums
Nystagmus, dizziness, diplopia
Yucky skin rash
Teratogenic
Osteoporosis/Osteomalacia
Interferes with folic acid causing anaemia
Neuropathies
78
What are the main retinoid side effects
Depression, dry skin lips and mouth, teratogenic, hair thinning
79
Why is it an absolute CI to co prescribe reinoids and tetracycline?
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
80
Which electrolyte abnormality is caused by thyrotoxicosis
Hypercalcaemia
81
What are the side effects of Pyrazinamide
It can causes gout, arthralgia, myalga, hepatitis
82
Which cancer is common in Downs?
ALL
83
What are the side effects of TCA
Antihistamine - drowsy
Antimuscarinic - dry eyes, blurred vision, constipation, urinary retention
Hypotension
Prolonged QT
84
How is Duchennes and Beckers muscular dystrophy inherited and how are the different
X linked recessive
Duchene is dumb, younger, have cardiomyopathy
Beckers is older
85
What can digoxin do to your physical body
Gynaecomastia
86
What is the difference from renal tubular acidosis and ureteric acidosis
Patients with uremic acidosis (metabolic acidosis due to renal failure) have a decreased glomerular filtration rate (increased serum creatinine) and increased anion gap metabolic acidosis. Patients with renal tubular acidosis have relatively normal glomerular filtration rates and normal anion gap metabolic acidosis!
87
An opening snap is associated with which valvular defect?
Mitral or tricuspid stenosis
88
Which malaria species is the deadliest?
Plasmodium flaciparum
89
What is the treatment for non flaciparum malaria?
Chloroquine
90
How is infective endocarditis diagnosed and what is the criteria for diagnosis?
3 BC 6hrs aparts
Modified Dukes criteria
91
What are the characteristics cells for Hodgkins lymphoma?
Reed sternburg cells
92
What is the test for sleepiness for OSA and what is the main treatment?
Epworth sleepiness scale
CPAP
93
What is the CAPE causes for excess cortisol?
Cushings disease
Adenoma
Paraneoplastic syndrome - ectopic ACTH
Exogenous
94
Which side effect does SGLT 2 I have similar to sulfonylurea
Hypoglycaemia
95
What blood tests looks for anaphylaxis
Mast cell tryptase
96
When should antibiotic prophylaxis be offered to those exposed to pertussis?
Offer antibiotic prophylaxis to close contacts of the ‘index case’ when coughing in the 'index case’ started within the previous 14 days and the close contact is in a priority group for public health action (Group 1 or 2
97
What are the group 1 people for reasons for giving post pertussis antibiotic prophylaxis?
Infants born when mum did not get a vaccine less than 2 months
All infants aged between 2 - 5 months
All infants who have not received their 3 percussive jabs
98
What are the group 2 group for giving pertussis antibiotic prophylaxis? It all about transmission.
Pregnant more than 32 weeks
Anyone who works with pregnant women or group 1 infants
People who live with a group 1 member
99
Which antibiotics do you give as pertussis prophylaxis?
Under 1 month is clarithromycin
Older than 1 month is azithromycin
Non pregnant adults is azithromycin or clarithromycin
Pregnant women is erythromycin
100
What are the two uraemic lowering therapy drugs?
What is the serum urate targets?
When would you pick one ULT over the other?
Allopurinol and Feboxustat
Target is under 360, under 300 if having recurrent attacks or gout arthritis or tophi
Start allopurinol if has a history of CVD (stroke/IHD)
101
Which drugs should you co-prescribe if starting allopurinol or feboxustat and why?
Colchicine to prevent an acute gout attack (if giving an NSAID give a PPI)
102
What is the duration of NSAID or colchicine treatment in an acute gout flare?
Take 1-2 days after it has settled down
103
When is feboxustat CI?
CVD, organ transplant, hepatic or renal impairment
104
Which ethnicity should you screen for what problem when considering starting allopurinol and why?
Han Chinese, Thai and Korean populations
HLA-B*5801 allele — it is associated with the risk of developing allopurinol hypersensitivity syndrome and Stevens-Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN).
105
How is allopurinol dose adjusted?
Titrate from the lowest dose to target uric acid levels
106
When is Colchicine contraindicated?
Blood disorders
Severe renal impairment or severe hepatic impairment.
107
Who are at risk of Colchicine toxicity and what are its features?
Renal or hepatic impairment, gastrointestinal or cardiac disease, and patients at extremes of age.
Nausea, vomiting, diarrhoea, being very unwell.
108
What are the indications for urate lowering therapy? (5)
Multiple or troublesome flares.
Chronic kidney disease (CKD) stages 3 to 5 (glomerular filtration rate [GFR] categories G3 to G5).
Diuretic therapy.
Tophi.
Chronic gouty arthritis.
109
How should allopurinol and febuxostat be monitored
Allopurinol — monitor closely for hypersensitivity syndrome when therapy is initiated, check serum uric acid levels.
Febuxostat — monitor liver function periodically, based on clinical judgement, monitor serum uric acid levels.
110
What does a rash in-between your fingers with pruritis mean and what is the treatment
Scabies, treat with Permethrin
111
What is a side effect of minocycline?
Skin pigmentation
112
Does a asymptomatic candida swab on a vuvlovaginal swab need treatment?
No
113
How many vuvlovaginal candida infections do you need for it to become recurrent?
4
114
What are the signs of severe vulvovaginal candidiasis
Erythema — usually localized to the vagina and vulva, but may extend to the labia majora and perineum.
Vaginal fissuring and/or oedema.
Satellite lesions (rare; may indicate other fungal conditions or herpes simplex virus [HSV] infection), or vulval excoriation.
115
What test may you do if you are are unsure of a diagnosis of candida vuvlovaginitis?
High vaginal swab
116
What is cytolytic vaginitis
Cheese-like vaginal discharge and itch, but microscopy and fungal culture is negative.
117
What are the first and second line treatment for vaginal candidiasis?
Fluconazole 150 mg oral capsule as a single dose first-line.
Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated.
118
If there are vulval symptoms what do you give to treat it?
consider advising on use of a topical imidazole (clotrimoxazole) in addition to an oral or intravaginal antifungal.
Options include clotrimazole 1% or 2% cream applied 2–3 times a day.
119
What should you advise when prescribing clotrimazole cream?
Advise that topical imidazole preparations may damage latex condoms and diaphragms.
120
How do you treat severe vuvlovaginal candidiasis?
repeat antifungal drug treatment (oral or pessary) after 72 hours and prescribe fluconazole 150 mg oral capsule or clotrimoazole 500mg pessary on day 1 and 4 first-line.
121
How do you treat vuvlovaginal candidiasis in pregnancy?
Do not prescribe an oral antifungal. Topical imidazoles are a safe and equally effective alternative.
122
How do you treat vulvovaginal candidiasis in teenage women?
topical clotrimazole 1% or 2% applied 2–3 times a day, or seek specialist advice. Do not prescribe an intravaginal or oral antifungal.
123
When is oral fluconazole CI?
Pregnancy, breastfeeding, porphyria
QT prolongation, hepatic impairment and on hepatic drugs, eGFR less than 50
Taking any other drug which prolongs the QT (any psych drugs), erythromycin, clarithromycin, amiodarone
124
When is itraconazole CI?
Same CI as fluconazole, it is an liver enzymes inhibitor (prolonged effects)
125
What are the complications of CLL?
hypogammaglobulinaemia leading to recurrent infections
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter's transformation)
126
What would you test for if a patient over 60 presents with hypercalcaemia or leukopenia or if the plasma viscosity or erythrocyte sedimentation rate and presentation are consistent with possible myeloma.
Offer very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours
127
What are the shin manifestations of Grave's disease which looks like orange peel?
Pre-tibial myxoedema
128
Name the X-linked recessive conditions
Androgen insensitivity syndrome
Becker muscular dystrophy
Colour blindness
Duchenne muscular dystrophy
G6PD deficiency
Haemophilia A,B
Hunter's disease
Nephrogenic diabetes insipidus
Ocular albinism
Retinitis pigmentosa
129
What is the different effect of trastuzumab and tamoxifen?
It is a MCA which can cause cardiotoxicity
130
What are the 4H and 1A features of tumour lysis syndrome?
hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure
131
What is Burkitt's lymphoma?
A B-cell lymphoma associated with EBV, high rates of tumour lysis syndrome when treated
132
Which vascular condition is associated with thrombophlebitis and VTE? And what is PATHERGY
Behcets
PATHERGY: Positive pathergy test, Aphthous oral ulcers, Thrombosis (arterial and venous), Hemoptysis (pulmonary artery aneurysm), Eye lesions (uveitis, retinal vasculitis), Recurrent Genital ulcers, Young at presentation (3rd decade)
133
Which vascular conditions is associated with smoking?
Buergers
134
A positive Trendelenburg sign is a sign of which nerve injury?
Superior gluteal nerve
135
An anterior hip dislocation damages which nerve and impairs which movement?
Obturator nerve, hip Adduction
136
Misplaced intramuscular injection, Hip surgery, Pelvic fracture, Posterior hip dislocation risks damaging which nerve?
Superior gluteal nerve
137
Injury to which nerve results in inability to perform Knee extension, thigh flexion and loss of sensation in the Anterior and medial aspect of the thigh and lower leg
Femoral nerve
138
What are the CI for retinoids? And what do you need to do to monitor?
Hyperlipidaemia (pancreatitis)
Pregnancy (need to be on contraception)
Depression
Measure hepatic function and serum lipids before treatment, 1 month after starting and then every 3 months
139
Why should you not co-prescribe retinoids and tetracycline (minocycline, doxycycline)
Intracranial hypertension
140
What kind of drug is Adapalene
It is a retinoid
141
What are the antibiotics for triple H pylori eradication therapy?
PPI, amoxicillin and either clarithromycin or metronidazole
142
What are the CI for erythromycin and clarithromycin
With porphyria.
A history of QT interval prolongation or ventricular cardiac arrhythmia.
Conditions that predispose to QT interval prolongation such as electrolyte disturbances and people taking drugs that prolong the QT interval. - Diuretics, corticosteroids, and short-acting beta2-agonists
With known hypersensitivity to erythromycin or other macrolide antibiotics.
Using simvastatin, tolterodine, mizolastine, amisulpride, astemizole, terfenadine, domperidone, cisapride, pimozide, ergotamine, or lomitapide.
Myasthenia gravis
143
Which co-prescribed medications with erythromycin and clarithromycin should be avoided with the increased risk of bleeding?
Rivaroxaban — erythromycin may increase levels of rivaroxaban, increasing the risk of bleeding.
Warfarin — the anticoagulant effect of warfarin may be increased by erythromycin. Monitor the international normalized ratio (INR), and adjust the warfarin dose accordingly.
144
CHAMPL
Ciclosporin, Cyclophosphamide, Hydroxychloroquine, Azathioprine, Methotrexate Mycophenolate, Penicillamine, Leflunomide, Tacrolimus, Sulfasalazine
145
Which valvular disease has an association with AF?
Mitral stenosis
146
What test would you perform for someone with bloody mucous sputum whos hypoxic?
Think PE, order a CTPA
147
What test would you perform in someone breathless, productive cough with bronchiectasis or COPD?
Sputum, sample, do not perform a CXR as the diagnosis is clinical.
148
Beta-blockers suppresses which problem?
Hypoglycaemia episodes
149
When do you check for retinopathy when on a DMARD
Annually for all people who have taken hydroxychloroquine for greater than 5 years.
150
When is a GLP-1 CI?
Ketoacidosis.
Pancreatitis.
Renal impairment: glomerular filtration rate (eGFR) is less than 30 mL/min/1.73 m2.
Severe hepatic impairment — avoid liraglutide.
Severe gastrointestinal disease
151
What is the first line therapy for allergic rhinitis?
First-line treatment options are intranasal corticosteroids and antihistamines (intranasal or non-sedating oral antihistamines), either alone or in combination.
152
How does a dendritic ulcer of the cornea present?
acutely watering, painful and red with some blurring of her vision with reduced visual acuity and a normal pupillary reaction
153
what are Anti-neutrophil cytoplasmic antibodies
it is ANCA
154
Anti-gliadin antibodies, what is it found in?
Coeliacs disease - the test is not used anymore
155
Anti-centromere antibodies, what is it found in?
CREST
156
Anti-smooth muscle antibody, what is it found in?
autoimmune hepatitis
157
Anti-dsDNA antibody, what is it found in?
Specific for SLE
158
How would you treat a child with:
A history of severe symptoms of constipation.
The presence of overflow soiling.
Faecal mass palpable on abdominal examination.
Check for faecal impaction - give macrogol escalating dose regimen for one week
Then give regular macrogol for regular laxatives
159
How is IgE and non-IgE mediated cows milk protein allergy present?
Most skin manifestations (atopic eczema, urticaria, pruritic) with some abdo problems
160
What should you suspect if a constipated child does not respond to laxatives?
If younger than 1 year of age and no response to laxatives after 4 weeks — refer urgently to a clinician competent to perform a digital rectal examination to exclude Hirschsprung's disease or other underlying pathology.
161
When is the Down's syndrome screening including nuchal scan
11 - 13+6 weeks
162
What is the first line treatment for tinea corpis (ring worm)
Topical 1% Hydrocortisone OD for 7 days
163
What does a scaly, red annular rash signify?
Ring worm (tinea corpis)
164
What are the first and second line treatments for severe or extensive disease tinea corpis (ring worm)
1st line Oral terbinafine
2nd line Oral itraconazole or oral griseofulvin
165
What is the name of ring worm in the groin?
Tinea Crusis
166
What is this rash?
Discrete lesions are pink-red (salmon coloured) or fawn coloured, flat or slightly raised, circular or oval, typically 0.5–1 cm in diameter, and usually slightly scaly (scaling is typically confined to the edge of the lesion with central clearance).
Distribution of lesions is usually symmetrical. Most occur on the trunk (forming a 'Christmas tree' pattern on the upper back and a V-shape on the upper chest) and proximal limbs, with few distal to the mid-upper arm and mid-thigh.
Pityriasis rosacea
167
How it pityriasis rosacea managed in pregnancy?
If pityriasis rosea develops in pregnancy — management should be discussed urgently with secondary care.
168
When is terbinafine CI? and does it need any monitoring? Antifungal
Hepatic impairment — the manufacturer recommends that terbinafine should not be prescribed in people with chronic or active hepatic disease. It recommends for other people, liver function tests (LFTs) should be performed. Hepatotoxicity may occur in people with and without pre-existing hepatic disease, therefore periodic monitoring of LFTs (after 4–6 weeks of treatment) is recommended. Terbinafine should be stopped immediately if LFTs are deranged.
Severe renal impairment.
169
When is Griseofulvin CI?
Acute porphyria.
Severe liver disease.
Systemic lupus erythematosus — increased risk of exacerbation.
170
What is the effect of griseofulvin on alcohol?
Alcohol — concurrent use of alcohol and griseofulvin may cause a disulfiram-like reaction (flushing, tachycardia). Warn people about the possibility of this reaction.
171
How long does tinea corpis last for and does it need any treatment?
Explain that the rash may worsen before it resolves, with new crops of skin lesions continuing to appear for up to 6 weeks.
Reassure the person that:
The rash will settle without treatment, usually within 2–3 months.
No treatment is required apart from symptomatic treatment for itch. Treat with weak steroids and emollient if itchy
172
What is the treatment for Candida or non-dermatophyte nail infection
Oral itraconazole
173
What is the treatment for dermatophyte nail infection
Oral terbinafine
174
When is a topical antifungal used to treat a fungal nail infection and what is the treatment of choice??
Amorolfine 5% nail lacquer
Only very early, distal, and superficial nail involvement.
Superficial white onychomycosis.
A contraindication to oral antifungal treatment.
175
What is the treatment for mild non-extensive athletes foot (Tinea pedis)
terbinafine cream or an imidazole such as clotrimazole, miconazole, or econazole cream
With Hydrocortisone 1% cream to be applied once daily for a maximum of 7 days if there is local inflammation
176
What the commonest cause of a vitreous haemorrhage?
Neovascularisation in proliferative diabetic retinopoathy or posterior retinal detachment
177
What is the cause for unilateral sudden onset of flashes and floater without vision loss?
Posterior retinal detachment - occurs as the eye ages or from trauma
178
What is the cause for unilateral sudden onset of flashes and floater with vision loss?
Retinal detachment
179
What is the skin and cardiac manifestation of antiphospholipid syndrome?
Levido retinculatris
MI leading to cardiomyopathy
180
What is the pathophysiology of antiphsopholipid syndrome and which HLA is it associated in idiopathic cases?
Formation of autoantibodies which either deactivate protein C, S and antithrombin III or binds to plt to activate them. HLA DR7
181
When should you admit haemorrhoids?
Extremely painful, acutely thrombosed external haemorrhoids who present within 72 hours of onset (reduction or excision may be needed).
Internal haemorrhoids which have prolapsed and become swollen, incarcerated, and thrombosed (haemorrhoidectomy may be needed).
Perianal sepsis (a rare but life-threatening complication).
182
When and how is mastitis treated they are lactating?
1st line Fluclox, 2nd line erythromycin for 10-14days
Nipple fissure that is infected, symptoms have not improved (or are worsening) after 12–24 hours despite effective milk removal, and/or breast milk culture is positive.
183
When and how is mastitis treated they are not lactating?
Prescribe an oral antibiotic for all women with non-lactational mastitis:
Prescribe co-amoxiclav 500/125 mg three times a day for 10–14 days.
184
What are the two causes of lactational mastitis and what are their treatments?
Candidiasis - miconazole cream and nystatin mouth wash for baby
Bacterial - only if fissures, not improved after 12-24hrs, if culture positive - fluclox
185
What is Kochers criteria?
* Non-weight bearing - 1 point
* Fever >38.5ºC - 1 point
* WCC >12 * 109/L - 1 point
* ESR >40mm/hr
186
Tibialis anterior is the muscle that acts to dorsiflex and invert the foot and is innervated by the deep peroneal nerve, which is a branch of the common peroneal nerve.
.
187
When is gestational HTN diagnosed?
After 20weeks
188
Offer oral bisphosphonates to people taking glucocorticoid therapy without waiting for bone density assessment (which should follow later) if they have any of the following risk factors:
A prior fragility fracture.
Women age 70 years or over.
Postmenopausal women, and men age 50 years or over taking high dose glucocorticoids (7.5 mg or more of prednisolone daily or equivalent over 3 months).
Postmenopausal women, and men age 50 years or over with a FRAX probability of major osteoporotic fracture or of hip fracture exceeding the intervention threshold.
189
How is a osteoporosis assessment performed
Calculating the fragility fracture risk (if no exceptions), if high risk or intermediate risk with other risk factors perform BMD scan and start bisphosphonate if T score less than -2.5
190
When do you skip a fracture risk score and go straight to a BMD scan?
Over 50 years of age with a history of fragility fracture.
Younger than 40 years of age who have a major risk factor for fragility fracture
191
What should you do if someone on a bisphosphonate presents with new onset hip, groin, or thigh pain.
Stop drug and get an x-ray ?fragility fracture
192
How long should people on corticosteroid be on bisphosphonates for?
For ever
193
When should bisphosphonate therapy be re-assessed
For all other people, reassess the need for continuing treatment with oral bisphosphonates after 5 years and perform a BMD scan
Continuing treatment for another 5 years if the T-score is -2.5 or lower, and then reassessing fracture risk.
Pausing treatment for 1.5 to 3 years if the BMD T-score is greater than -2.5, and then reassessing fracture risk.
For people who remain at high risk of an osteoporotic fragility fracture, continue treatment for at least 10 years. This includes people with any of the following risk factors:
Aged 70 years or over at the start of bisphosphonate treatment.
A previous hip or vertebral fracture.
People who experience one or more fragility fractures during the first 5 years of treatment (if treatment is not changed).
194
How does delirium tremens present?
o Profound confusion/delirium.
o Visual, auditory, and tactile hallucinations — this affects up to 25% of people.
o Coarse tremor.
o Features of clinical instability, such as tachycardia, fever, ketoacidosis, and circulatory collapse.
195
What is the treatment for BV or trichomonas in pregnancy?
Prescribe oral metronidazole 400 mg twice a day for 5 to 7 days
196
What is the prophylaxis for cluster headaches?
Verapamil is the prophylaxis for cluster headaches
197
What happens to calcium, phosphate and potassium in rhabdomyloysis?
Hypocalcaema, hyperphosphataemia and hyperkalaemia
198
How should managed a 2 month with a fever
A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness
199
What is the gold standard test for TB?
Sputum culture is the gold standard for TB
200
How much does an AST need to be raised for there to be alcohol related ALT
AST needs to be twice as much as ALT to be alcoholic hepatitis
201
How long is the DOAC duration for VTE with cancer
Cancer patients with VTE - 6 months of a DOAC
202
Which autoimmune condition is associated acute cholecystitis or cholangiocarcinoma
PSC
203
Which liver condition is associated with autoimmune condition?
Autoimmune condition - anti-smooth muscle
204
What are the risk factors for pseudogout
Common risk factors include haemochromatosis, parathyroid disorders, renal impairment, and thyroid dysfunction.
