MSRA 8 Flashcards
1
Q
How should you manage diarrhoea in someone taking a PPI?
A
Send a stool sample, possible C.diff
2
Q
Who have the highest rates of diarrhoea caused by E.coli?
A
Under 5s
3
Q
What do you suspect in a under 5 with bloody diarrhoea, fever, vomiting?
What is its complication?
How do you manage it?
How does it cause diarrhoea?
A
E.coli O157:H7 or Shigella
Haemorrhagic colitis, HUS
Send a stool sample, supportive, there is no antibiotic treatment available.
Shiga toxin
4
Q
What is the commonest parasitic cause for gastroenteritis?
What are the other causes of parasitic diarrhoea?
What are their complications?
What are their treatments?
A
Cryptosporidium - chronic diarrhoea, pancreatitis - specialist advise
Entamoeba histolytica (amoebiasis) - Giardia spp. and Cryptosporidium spp
Giardiasis - chronic diarrhoea - Metronidazole
5
Q
What is the commonest cause of bacterial gastroenteritis?
What is its complications?
How is it treated?
How are all the other bacterial diarrhoeas treated?
A
Campylobacter
Reactive arthritis, GBS
Clarithromycin
Ciprofloxacin
6
Q
When should prophylactic antibiotics be provided to cirrhotic patients and which antibiotic is chosen?
A
Antibiotic prophylaxis should be given to patients with ascites if: with ciprofloxacin
patients who have had an episode of SBP patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
7
Q
When should I refer a person with chronic diarrhoea to a suspected cancer pathway referral
A
They are aged 40 and over with unexplained weight loss and abdominal pain, or
They are aged 50 and over with unexplained rectal bleeding, or
They are aged 60 and over with iron deficiency anaemia or changes in their bowel habit, or tests show occult blood in their faeces.
8
Q
How is hypo-mania differentiated from mania?
A
Delusions of grandeur, or grandiose delusions, are a key feature that differentiates mania from hypomania according to the DSM-5 criteria
9
Q
What are the spirometry readings for obstructive lung function
A
FEV1/FVC reduced (<70%)
FEV1 reduced <80%
10
Q
When are the two reasons for referring someone for genetic triglyceride or cholesterol testing?
A
A total cholesterol level greater than 7.5 mmol/l and/
A personal or family history of premature coronary heart disease (an event before 60 years in an index individual or first-degree relative)
11
Q
What does this history suggest? a 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present.
A
Ectopic pregnancy
12
Q
What does a the history suggest? A rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen.
A
Vasa praevia
13
Q
How long should iron therapy be continued after iron deficiency is corrected?
A
3 months to allows iron stores to be replenished
14
Q
What is good-pasteurs syndrome?
What is the blood test to identify it?
A
An anti-glomerular basement membrane disease affecting the lungs and kidneys.
Anti-GBM antibodies against collagen IV
15
Q
Which paraneoplastic conditions does SCLC cause?
A
- SIADH
- ACTH dependent Cushings syndrome
- Lambert-eaton syndrome
16
Q
What kind of drugs are cabergoline and bromocriptine?
A
Dopamine agonists used to treat prolactinomas.
17
Q
What is HELLP syndrome?
What are the complications?
How is it managed?
A
- Hemolysis (H), elevated liver (EL) enzymes, and low platelet (LP) count.
-DIC, pulmonary oedema, ARDS, AKI - Give platelets, IV Mg as seizure prophylaxis, Caesarian section (give steroids if under 34weeks)
18
Q
Resting tremor is a CI of which anti-emetic?
A
Meochlopramide
19
Q
Define severe pre-eclampsia
A
Pre-eclampsia with severe hypertension that does not respond to treatment or is associated with ongoing or recurring severe headaches, visual scotomata, nausea or vomiting, epigastric pain, oliguria and severe hypertension, as well as progressive deterioration in laboratory blood tests such as rising creatinine or liver transaminases or falling platelet count, or failure of fetal growth or abnormal doppler findings
20
Q
Should you prescribe calcium and vitamin D in CKS 4/5 or renal stone disease?
A
No
21
Q
What are the defining features of Nephrotic syndrome?
A
Proteinuria (>3.5 g/24 hours)
Hypoalbuminaemia (<30 g/L)
Peripheral oedema
22
Q
Granulomatous disease is associated with which skin condition?
A
Erythema nodosum
23
Q
What is contained in Cryoprecipitate and when it is given?
A
- Factor VIII, fibrinogen, von Willebrand factor and factor XIII
- Used in fibrinogen deficiency
- Use in vWF deficiency, Haemophilia A if single factors are not available
24
Q
What is used to manage PBC?
A
Ursodeoxycholic acid
25
What are the side effects of finasteride?
How does it effects PSA levels?
Impotence
Decreased libido, Ejaculation disorder, Breast disorders (Advise the man to promptly report any changes in their breast tissue (such as lumps, pain, or nipple discharge)
PSA levels should decrease by 50%
26
What are the CI for melfoquine?
Depression
Seizures
27
Name the tocolytics
Indomethecin
Nifedipine
Mg sulfate
Terbutamine
28
What does a Bishop score of less than 6 mean?
The cervix is not likely to proceed to labour
- Ripen the cervix with misoprost
29
Name the 3 migraine prophylaxis drugs
Propranolol, Topiramate, Amitriptyline
30
What is the treatment for Genital warts?
Topical podophllum
31
What are the levels of anaemia in pregnancy?
How is it treated?
110 g/L in the first trimester
105 g/L in the second and third trimesters.
100 g/L post partum
Must take oral iron
32
What causes Hereditary angioedema
Hereditary angioedema caused by a deficiency of the C1 esterase inhibitor. This protein regulates the complement system
33
How do you manage a focal wheeze in a paeds patient
Investigate further for a focal airway obstruction such as an inhaled foreign body or tumour. These patients will require an urgent senior review.
34
What are the complications of CF
Pancreatic insufficiency
Diabetes
Liver disease
Infertility
35
What are the weights for new-born babies?
The average normal birth weight at term is about 3.5 kg.
Low birth weight, LBW, less than 2.5 kg
Very low birth weight, VLBW, between 1.0 and 1.5 kg
Extremely low birth weight, ELBW, up to 1.0 kg
36
Which SSRI is licensed in pregnancy and depression
What is the risk if SSRIs are taken after 20weeks?
Which SSRI is associated with a foetal heart defect?
Fluoxetine
Persistent pulmonary hypertension
Paroxetine
37
Which congenital heart defect is assocated with alcohol
TOF, PDA
38
Which congenital heart defect is associated with diabetes?
TOGV and TOF is associated with maternal diabetes
39
What is a key complications of whooping cough?
bronchiectasis
40
Which statins do you try in someone who has had intolerable symptoms or a CK greater than 4x
Pravastatin, Rosuvastatin 5mg, Lower dose atorvastatin 10mg
41
What condition causes raised CK after stopping their statin?
Statin induced necrotising autoimmune myopathy
42
What should you do if CK levels are greater than 10 times but less than 50times?
Check renal function, if deranged it is rhabdomyolysis
43
What are the causes for acanthosis nigracans?
Diabetes
Obesity (sometimes referred to as pseudoacanthosis nigricans)
Cushing syndrome
Polycystic ovarian syndrome
44
How is CKD stage 1 and 2 diagnosed?
CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR
45
How is chickenpox exposure in pregnancy managed?
first step is to check antibodies for if you have immunity if unsure
Give aciclovir from Day 7 to day 14 of exposure - Immunoglobulins are now not given
46
Painful rash is indicative of what?
Shingles
47
How is a purpuric rash managed in GP in an unwell child?
IM Benpen and ambulance
48
The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later. What is the last day in the menstrual cycle can a IUD be inserted if someone has a 28days cycle?
Day 19
49
How is HIV infection in pregnancy managed?
All pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously
Vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
A zidovudine infusion should be started four hours before beginning the caesarean section
Zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
Breastfeeding should not happen
50
What is the only bacterial infection to cause punctate lesions on the cervix (strawberry cervix)
TV
51
What is the only bacterial gastroenteritis infection to cause RIF pain?
Campylobacter jejuni infection may cause marked right iliac fossa pain mimicking appendicitis. It is a cause of bloody diarrhoea.
52
What role does steroids and mesalazine have in UC vs azathioprine?
Flare treatment, azathioprine is maintenance of remission
53
What is the definition of a TIA?
The definition of a TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction
54
When is a DMARD considered for treating rheumatoid arthritis?
After two medications have failed
55
How do you manage rheumatoid arthritis methotrexate is not controlling attacks?
Switch to another medication like azithromycin of leflunomide
56
What is the treatment for a flare in rheumatoid arthritis
oral or intramuscular steroid
57
What is a flare of rheumatoid arthritis?
When symptoms worsen e.g. stiffness, pain, swelling
58
What is the prophylaxis for meningitis?
Ciprofloxacin
59
How is Hep A transmitted?
How does Hep A present?
Faecal-oral route and intravenous drug users are more at risk
'Prodromal phase; flu-like symptoms, gastrointestinal symptoms (such as anorexia, nausea, vomiting, and abdominal right upper quadrant discomfort), and occasionally headache, cough, pharyngitis, constipation, diarrhoea, itch, and urticaria. Usually, there are no specific signs on examination.
Icteric phase; jaundice, pale stools, and dark urine (if there is cholestasis), pruritus, fatigue, anorexia, nausea, and vomiting ' symptoms often improve once jaundice occurs. Hepatomegaly, splenomegaly, lymphadenopathy, and hepatic tenderness are often present on examination.
Convalescent phase; includes malaise and hepatic tenderness.'
60
What is bullimia nervosa?
Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.
61
What is the time gap between giving IM adrenaline for anaphylaxis?
5 minutes
62
What is the management for the different severities of croup?
When do you admit croup to hospital?
Mild - give dexamethasone
Moderate or severe croup - admit to hospital
Mod to severe
< 3 months of age
Known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome)
Uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
63
What are the moderate and severe features of croup?
Mod
Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings
Severe
Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
64
What is the 1st and 2nd line treatment for Menorrhagia?
1st Intrauterine system (Mirena) is first-line
2nd is tranexamic acid
65
What are the two types of Vitamin D3 and what is the activated version of vitamin D
Ergocalciferol and Cholecalciferol
Calcitriol
65
What is conversion disorder
Functional neurological disorder
66
What is the difference between Factitious disorder vs Somatisation disorder
Factitious disorder production of physical or psychological symptoms
Somatisation disorder patient refuses to accept reassurance or negative test results
66
What test should you perform in someone who is elderly and has iron deficiency anaemia, what level does it need to be before referring to a two week wait?
faecal immunochemical testing (FIT) result of at least 10 micrograms of haemoglobin per gram of faeces.
67
How is a spontaneous pneumothorax managed?
If there are not symptomatic - conservative management regardless of size
If symptomatic if they have high risk features and the size is 2cm or greater chest drain, if not then CT chest
If symptomatic and not high risk then either ambulatory, chest drain devise or needle drainage
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
68
What is decubitus angina
What is variant angina
What is unstable (crescendo angina)
Angina on lying flat
Angina at rest
Angina on minimal exertion, at rest or with a high frequency
69
What ECG findings do you get in PE?
RBBB
Inverted Twaves in V1-V4
70
What is Tietze syndrome
An MSK cause for chest pain
71
What is pleurisy
A condition of inflammation of the pleura that lines the lungs. Most commonly caused by viral infection but can also occur secondary to pneumonia, lung cancer, autoimmune disease, and pulmonary embolism. Typically causes sharp chest pain that is worse with inhalation.
72
Mitral valve regurgitation causes which type of murmur?
Pan-systolic
73
How is a AAA of a size of 4.5cm managed?
3monthly surveillance
74
Malignant pleural effusion is seen in which condition?
Mesothelioma
75
What is the commonest cause for FE deficiency anaemia
Coeliacs disease
GI bleeding
76
How can you tell the difference between atrial fibrillation and atrial flutter on ECG
Flutter has consistent F waves, fibrillation has inconsitent F waves
77
How long does the QRS need to be for it to be broad complex?
Greater than 120ms
78
What is Stoke adams syndrome
Sudden losses of consciousness that may occur with brief prodromal symptoms, e.g., dizziness, or without any warning, usually lasting a few seconds
Attacks are caused by ventricular asystole, most commonly due to third-degree heart block,
79
How does a atrial myxoma present?
Commoner in females
Blocks the mitral valve so causes mitral stenosis
Symptoms vary with position
80
What is cor pulmonale?
Altered structure (hypertrophy, dilation) or impaired functioning of the right ventricle caused by a primary disorder of the respiratory system (e.g., COPD, cystic fibrosis, interstitial lung disease, pulmonary embolism). The primary respiratory disorder causes acute/chronic pulmonary hypertension, which in turn causes acute/chronic right heart failure.
81
Which valve is most likely to be infected by infective endocarditis?
Tricuspid
82
What are the major factors in the Dukes criteria
Positive BC (Staph aureas, enterrococcus, vividens)
Endocardium involvement
83
What are the minor factors for Dukes criteria?
What are the classifications for the diagnosis of EC?
Risk factors (ICDU)
Fever
Vascular features (Janeway lesions, emboli)
Immune features (Osler nodes, GN)
BC but not the typical ones
2Major
1Major 3 minor
5minor
84
What are the absolute CI to thrombolysis?
Previous IC haemorrhage
Ischaemic stroke <6months
Cerebral cancer or AVmalformation
Recent major trauma or surgery <3weeks
Aortic dissection
Active bleeding (excluding menstruation)
Known bleeding disorder
GI bleeding <1month
Non-compressable puncture <24hours old
85
What are the relative CI to thrombolysis?
TIA <6months
anticoagulation therapy
Pregnancy
Refractory HTN )>180/110)
Advanced liver disease
Infective endocarditis
Active peptic ulcer disease
Prolonged resuscisation
86
What is Graham steel murmur?
Pulmonary regurgitation
87
Where is a VSD heard? (typical post MI complication)
Left Parasternal edge
88
What does asbestos do to the lungs apart from pleural plaques?
Interstitial pulmonary fibrosis
89
Exposure to silicone to the lungs causes what?
Potters rot - nodular lesions in the upper lung lobes
90
When is an MRI good for lung cancers?
Tumour invading the spinal canal or pancoast tumour
91
What is the Ranson criteria
Ranson criteria was created to predict mortality in acute pancreatitis
92
What is DAS 29
Describes severity of rheumatoid arthritis using clinical and laboratory data.
93
What are the features you need to be considered for IBS
Passage of mucus
Bloating, distension
Worse on eating
Altered stool passage
94
What is Weil's disease and what are its triad features?
Leptospirosis infection
- Signs of acute kidney injury (e.g., oliguria, anuria)
- Signs of liver failure (e.g., jaundice)
- Hemorrhagic diathesis (e.g., hemoptysis, purpura, melena)
95
Which antibiotics causes cholestasis?
Co-amoxicillin
Flucloxacillin
96
What is the treatment for severe acute otitis media
amoxicillin
97
Juvenile idiopathic arthritis
98
What does modafinil treat?
Narcolepsy
99
What are the 1st and 2nd line treatment for ADHD
Methyphenidate
Lisdexamfetamine
100
What are the criteria you need for a diagnosis of ADHD
6 months of symptoms
Present before the age of 7
Affects home and school
101
How does non-Hodgkins lymphoma present?
Multiple lumps in the armpits
102
Which eye cancer is associated with neurofibromatosis?
Optic glioma
103
Respiratory distress in children?
Pneumonia
104
What are the first and second line treatment for childhood absent seizures
Ethosuxamide
Sodium valproate
105
Williams syndrome
takes ICE cream from Strangers
Autosomal dominant deletion of Ch 7
Intellectual disability
Cardiac - Supra valvular aortic stenosis
Elf lie featurs
Star iris, comfort with strangers, Happy
106
What are the problems in Di-Georges syndrome
CATCH 22
Cardiac defect
Abnormal face
Thymic hypoplasia
Cleft palate
Hypocalcaemia
Deletion of chromosome 22
107
How frequent is functional abdominal syndrome in children
10%
Normal examination
108
What are the features of a trochlear nerve palsy
Vertical torsion or oblique diplopia worse on downward gaze and gaze away from the affected side
109
When can you consider stopping an anti-epileptic
After 2 years seizure free
110
What is West syndrome?
What can cause it?
What can it result in?
Infantile spasms of drawing the knee up caused by perinatal asphyxia.
Learning difficulties
111
What is Janz syndrome
Generalised seizures
Daytime absence
Sudden involuntary jerky movements
112
How do you treat TIA after the TIA have resolved?
Give aspirin 300mg
113
What are the features of Friedreich's ataxia?
GAA
Kyphoscoliosis
Hypertrophic cardiomyopathy
Progressive ataxia
114
What is Bowens disease
A precancerous skin lesion that manifests as an erythematous and scaly plaque with irregularly shaped and sharply defined borders. May progress to invasive squamous cell carcinoma.
115
How do you treat palmar psoriasis?
Emollients
116
How do you treat hirsutism
Eflornithine
117
What is dithranol ointment
Coal tar
118
What is the treatment for CML?
imatinib
119
What are target cell seen in?
iron deficiency anaemia
120
Which contraceptive also treats acne and irregular periods?
COCP
121
What is crucial to be seen on foetal ultrasound to confirm a live pregnancy
if greater than 25mm must have a foetal pole
122
How is symphysis pubis dysfunction managed?
Advise and reassurance
123
Which contraception can you not give in porphyrias?
POP
124
What is the name of the memory clinic test for a memory assessment that is long.
Addenbrooke's
125
Russells sign is in bullimia nervosa, what is it
Scratched on back of hand from inducing vomiting
126
Which rheumatoid drug causes hypertension?
Leflunomide
127
What is Felty syndrome in rheumatoid arthritis
Triad of arthritis, splenomeegaly and neutropaenia
128
Which drugs cause drug induced lupus - My Two HIPS
My Two HIPS”: Methyldopa/Minocycline, TNF-α inhibitors, Hydralazine, Isoniazid, Procainamide/Phenytoin, and Sulfa drugs are triggers for DILE.
129
Which medication do you give to treat mild SLE?
Hydroxychloroquine
130
What is the treatment for GCA
The standard initial dose for GCA without visual symptoms is 40–60 mg oral prednisolone per day.
131
Which rashes worsen in the light
Lupus
132
Which pneumonia is caused by parrots
Which malaria cause sjaundice, hepatosplenomegaly and low plts.
Which infection causes cardiac problems?
Which infection slows the heart down?
Which infection cause river blindness
Chlymydia psittacia
Malaria faliparum
Chagas
Yellow fever
Onchocerciasis
133
What do you give to treat the eye in UV burns or welding burns?
Topical antibiotic and analgesia
134
What is the difference between a dendritic and corneal ulcer
a dendritic ulcer is caused by the herpes simplex virus (HSV), while a corneal ulcer can be caused by a number of things, including bacteria, viruses, fungi, or parasites
135
What is Barter syndrome?
An inherited kidney problem causing hypokalaemia
