MSRA Flashcards
1
Q
acute epiglottitis causative bacteria
A
haemophilus influenzae
2
Q
Croup causative agent
A
parainfluenzae
3
Q
amiodarone side effects
A
corneal opacities
optic neuritis
4
Q
paviluzimab used to treat
A
respiratory synctial virus causing bronchiolitis
5
Q
Barlow and ortolani
A
Barlow bring out (dislocate)
Ortolani originate relocate
6
Q
hand foot and mouth causative agent
A
coxsackie virus
7
Q
most common cardiac abnormality in downs syndrome
A
atrioventricular septal defect
8
Q
Bartters
A
Autosomal recessive, severe hypokalaemia, normotension, polydipsia, polyuria
9
Q
patau
A
trisomy 13 cleft lip/palate Polydactyly microcephalic small eyes
10
Q
Edwards
A
Trisomy 18
micrognathia, low set ears, rocker bottom feet, overlapping fingers
11
Q
Fragile X
A
macro-orchidism, large ears, long face (XL size), macrocephaly, learning difficulties
12
Q
Noonan
A
webbed neck, pectus excavatum, short stature
13
Q
Prada Willi syndrome
A
hypotonia, hypogonadism, obesity
14
Q
Williams syndrome
A
.short stature, extroverted, learning difficulties
15
Q
gross motor milestones
A
3 - pull to sitting no head lag, held sitting 6 - rolls front to back, held sitting with straight back 7-8 sits without support 9 pulls to standing, crawls 12 cruises, walks with one hand 13-15 walks unsupported (refer at 18) 18 squats 2 runs 3 tricycle 4 hops
16
Q
speech milestones
A
9 mama dada 12-15 knows 2-6 words 2 combines 2 words 3 short sentences 4 why when how
17
Q
what pathogen causes osteomyelitis in sickle cell
A
salmonella
18
Q
croup cause and treatment
A
parainfluenza, O2, dex, nebulised adrenaline
19
Q
anorexia blood results
A
most things low, Gs and Cs raised
20
Q
bloody diarrhoea and fever - antibiotic
A
ciprofloxacin
21
Q
impaired fasting glucose
Impaired glucose tolerance
A
6.1
22
Q
diagnosing diabetes
A
fasting glucose >/ 7 or random glucose >/11.1
if asymptomatic then fasting flucose >/7 twice or HBa1c >/48
23
Q
dresslers syndrome
A
pericarditis following MI
24
Q
crohns disease management
A
glucocorticoids to induce remision, azathioprine/methotrexate to maintain
25
amiodarone side effect endocrine
can cause hypo and hyperthyroidisim
26
clinical features, causes and microscopic changes: minimal change nephropathy
80% idiopathic, 10-20% nsaids/mono.hodgkins, increased permiability of glomeruli to albumin therefore +++ protein, EM see podocytes
27
beta blocker overdose
atropine, if resistant give glucagon
28
gingival hyperlasia
phenytoin, cyclosporin, CCBs, AML
29
reiter
| reactive
reiter - cant see, cant pee, cant climb a tree
| reactive - kerattoderma blenorrhagica
30
homonymous quadrantanopita
PITS
| Parietal inferior, temporal superior
31
treatment of trigeminal neuralgia
carbamazepine
32
BC>AC
conductive deafness
33
rinnes vs webers
rinnes on mastoid until cant hear then over meatus. If BC>AC then conductive deafness
Wiines - sensorineural loss localises to unaffected side, conductive loss localises to affective side
34
rate control
beta blockers, CCBs, digoxin
35
rhythm control
amiodarone, flecanide
36
ascending cholangitis
charcots triad: fever, jaundice, RUQ pain
37
```
T4
T10
L1
L4
L5
S1
S23
```
```
teat pore
belly button
1nguinal ligament
knees
big toe
small toe
genitalia
```
38
rash with infectious mononucleosis
amoxicillin
39
antibiotics causing cholestasis
co-amoxiclav and flucloxacillin
40
<55 yrs or T2DM with HTN
ace inhibitor then ace inhibitor or CCB or thiazide diuretic
41
NSAIDs in heart failure
can promote fluid retention
42
when to add a second drug after metformin and lifestyle changes
>58 HBA1c (target 48)
43
when to use glp1
triple therapy failed, and BMI >=35 or BMI =<35 but insulin not possible
44
premature menopause
menopause in a women <45
45
transient idiopathic osteoporosis
groin pain, reduced RoM in hip, ESR elevated, sometimes in 3rd trimester of pregnancy
46
Premature ovarian failure hormones
high gonadotrophins
47
hypertension in pregnancy
>140/>90 or increase in booking readings of >30/>15
48
First line for eclamptic seizures
magnesium sulphate
49
dating scan
nuchal scan
Anomaly scan
```
8 weeks (earliest)
(chromosomal) 11 weeks (earliest)
18 weeks (earliest)
```
50
COCP cancer risk
increases risk of cervix and breast, decreases risk of ovarian and endometrial
51
UPSIs
levonogestrel for up to 3 days post
ellaone for 5 but cant have ovulated
IUDs up to 5 days after
52
hutchinsons sign
rash on the tip or side of the nose - strong risk racftor for herpes zoster ophthalmicus
53
central retinal vein occlusion
more common than arterial, increases with age, caused by glaucoma, polycythaemia, HTN. Severe retinal haemorrhages seen on fundoscopy
54
central retinal artery occlusion
due to thromboembolism or arteritis, cherry red spot on pale retina
55
symptoms of optic neuritis
visual loss, eye pain, red desaturation
56
holmes adie pupil
benign condition, dilated
57
hordelium externon
infection of the glands of the eyelid
58
hutchinsons pupil
inlaterally dilated pupil secondary to complression of the occulomotor nerve of the same side
59
argyll tobertson pupilS
bilaterally small pupils that accomodate but dont react to light. neurosphilis and DM
60
risk factors for open angle glaucoma
raised IOP without vitreous outflow; hypermetropia, mydriasis, lens growth secondaryt o age
61
presentation of acute open angle glaucoma
eye pain, reduced vision, worse with mydriasis, hard red eye, halos. treat with acetazolamide and pilocarpine
62
when to stop COCP before surgery and what to switch to
4 weeks before and POP
63
when to do cephalic version for breech presentation
36 weeks
64
how long before urea breath test to stop:
a. PPIs
b. antibiotics
a. 2 weeks
| b. 4 weeks
65
mechanism of action of finasteride
5 alpha reductase inhibitor
66
diagnosing PMR
rapid onset morning stiffness in proximal limbs can also have depression, low grade fever, night sweats and raised ESR
67
prevalence of thrombophilias
Factor V Leiden (heterozygous) 5%
Factor V Leiden (homozygous) 0.05%
Prothrombin gene mutation (heterozygous) 1.5%
Protein C deficiency 0.3%
68
sore throat, pyrexia, lymphadenopathy
infectious mononucleosis
69
treatment of lyme in pregnancy
doxycycline contraindicated so use amoxicillin
70
first line for generalised seizures
sodium valproate, 2nd line lamotrigine
71
first line for focal seizures
carbamazepine/lamotrigine
72
which drug causes corneal opacities
amiodarone
73
first line for investigation of prostate Ca
multiparametric mri
74
Venous thromoboembolism - length of warfarin treatment
provoked (e.g. recent surgery): 3 months
| unprovoked: 6 months
75
treatment of acute menieres attack
betahistine
76
Vestibular schwannoma (acoustic neuroma) classic symptoms
hearing loss, tinnitus, absent corneal reflex, vertigo
77
seborrhoeic dermatitis
caused by fungus, first line is ketoconazole
78
paediatric meningitis doses of benpen <1, 1-10, >10
300mg, 600mg, 1200mg
79
distinguishing between episcleritis and scleritis
phenylephrine drops which blanch episcleritis (as blanch episcleral vessels but not scleral)
80
sickle cell disease genicity
autosomal recessive
81
dry cough reticulo-nodular shadowing and erythema multiforme
mycoplasma pneumonia
82
antibiotic prophylaxis for contacts of meningococcal menigitis
Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis
83
acute and prophylactic management of migraines
Migraine
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
84
EBV is associated with which cancers
hodgkins, nasopharyngeal, burkitts
85
HELLP syndrome stands for
Haemolysis
Elevated liver proteins
low platelets
86
solphonylurea: MOA, name one, common side effects
causes insulin secretion and hypoglycaemic effects, gliclazide, weight gain
87
management of whooping cough (pertussis)
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
88
rigns and furrows on ogd
eosinophilic oesophagitis
89
which vitamin in high doses can be teratogenic in pregnancy
vitamin A
90
increasing fertility inPCOS
clomifene and metformin
91
linked to cleft palate/lip in pregnancy - medication
topiramate
92
prophylaxis for contacts of meningococcal menigitis
ciprophylaxis
93
treatment of acne rosacea
topical metronidazole
94
LRTI in cystic fibrosis
pseudomonas causing fluid level and bronchiectasis
95
criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
96
CHA2DS2VaS
```
C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke or TIA 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1
```
97
management of AAOG
pilocarpine (sympathomimetic), timolol (reduce aquous humour production), IV acetazolamide
Laser iridotomy
98
first line in BPH
alpha 1 antagonists such as tamsulosin - reduce smooth muscle tone
99
antibiotic to avoid in UTI with CKD
NITRO: In order to be effective at treating urinary tract infections, nitrofurantoin needs to be concentrated in the urine and an adequate glomerular filtration is required for this to occur. An eGFR of less than 40-60ml/min means that the drug is wholly ineffective as a bactericidal agent and is not recommended in patients with CKD stage 3 or worse due to the likelihood of treatment failure. Coupled with this is the risk of drug toxicity in the patient. Without adequate renal filtration, the drug is likely to accumulate
100
pain over tibial tuberosity in child
osgood schlatter - tibial apophysitis
101
when to use spironolactone
ascites: patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used
hypertension: used in some patients as a NICE 'step 4' treatment
heart failure (see RALES study below)
nephrotic syndrome
Conn's syndrome
102
heart failure with AF: medication
digoxin
103
holmes addie pupil
unilateral in 80%, benign, associated with absent knee and ankle reflexes. very slowly reactive to light and accomodation, dilated pupil
104
antidepressant after MI
sertraline
105
hyperkalaemia on ECG
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
106
antidepressant to avoid if warfarin coprescribed
citalopram as risk of bleeding
107
HBA1c diagnostic for DM
48mmol
108
best antiemetic in parkinsons
domperidone (does not cross BBB)
109
tetanus wound management
classify, not likely to have tetanus, tetanus prone, high risk. If not likely and vaccine in <10 yrs previous then nothing. If vaccine in <10yrs and tetanus prone or high risk then give vaccine, if vaccine >10yrs give vaccine, if other vaccine and immunoglobulin
110
lump between sternocleidomastoid and pharynx following URTI
branchial cyst - An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
111
acute management of menieres
betahistine
112
MI - when to thrombolyse and when to PCI
primary coronary intervention should be offered if the presentation is within 12 hours of onset of symptoms AND PCI can be delivered within 120 minutes of the time when thrombolysis could have been given (i.e. consider thrombolysis if there is a significant delay in being able to provide PCI)
if patients present after 12 hours and still have evidence of ongoing ischaemia then PCI should still be considered
should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when thrombolysis could have been given
If patients have persistent myocardial ischaemia following thrombolysis then PCI should be considered.
113
when to place a chest drain
Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.
114
hoffmans sign
used to determine if UMN lesion present
115
primary biliary cholangitis
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
first line is ursodeoxycholic acid
116
ecg changes of hyperkalaemia
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
117
huntingtons genetics
chromosome 4, autosomal dominant, genetic anticipation
118
monitoring of bloods with statins
LFTs at baseline, 3 and 12 months
119
drugs for epilepsy
Generalised seizures:
First line is sodium valproate
Second line lamotrigine/carbamazepine
Focal seizures:
First line is carbamazepine or lamotrigine
second line levetiracetam/sodium valproate
Exceptions
Second line for absence is ethosuximide
second line for myoclonic is clonazepam or lamotrigine
120
common features in motor neurone disease
There are a number of clues which point towards a diagnosis of motor neuron disease:
fasciculations
the absence of sensory signs/symptoms*
the mixture of lower motor neuron and upper motor neuron signs
wasting of the small hand muscles/tibialis anterior is common
121
migraine prophylaxis
NICE advise either topiramate or propranolol 'according to the person's preference, comorbidities and risk of adverse events'. Propranolol should be used in preference to topiramate in women of child bearing age as it may be teratogenic and it can reduce the effectiveness of hormonal contraceptives
122
AF and heart failure medication
digoxin
123
uti near term
cefalexin; avoid nitro near term as may get fetal haemolysis
124
prophylaxis for contacts of menigitis
ciprophylaxis
125
heart stuff and driving
CABG - 4 weeks off
ACS - 4 weeks off
post angioplasty - 1 week off
126
statins with which antibiotics can cause CK rise
macrolides
127
how much of a creatinine rise is needed to stop a new prescription of ACEi
>30%
128
driving following stroke/TIA
4 weeks off, can restart if no residual symptoms,
129
most common cause of diarrhoea in HIV patient
cryptosporidium
130
causes of massive splenomegaly
```
myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher's syndrome
```
131
causes of oligohydramnios (<500ml)
```
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
```
132
which contraceptive can cause osteoporosis
depo provera
133
Hyperemesis gravidarum, diagnostic criteria triad:
5% pre-pregnancy weight loss
dehydration
electrolyte imbalanc`e
134
Most common type of ovarian pathology associated with Meigs' syndrome
fibroma
135
things to think about with macrolides
```
P450 inhibitors
therefore cant use with statins
prolong QT interval
GI side effects
azithromycin can cause hearing loss and tinnitus
```
136
what things precipitate digoxin toxicity
classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
137
drugs that may worsen heart failure
thiazolidinediones
pioglitazone is contraindicated as it causes fluid retention
verapamil
negative inotropic effect
NSAIDs/glucocorticoids
should be used with caution as they cause fluid retention
low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
class I antiarrhythmics
flecainide (negative inotropic and proarrhythmic effect
138
ECG changes in digoxin toxicity
ST depression and T wave inversion in V5-6
139
campylobacter post infection can lead to
reiters and guillan barre
140
thumbprint sign on lateral neck xray
epiglotittis from HIb
141
ccb not tolerated for htn next step
thiazide diuretic
142
depression in obesity - which antidepressant
and
intolerant to SSRIs
fluoxetine as is associated with weight loss
and
SNRI - venlafaxine
143
Immune deficiency - lacks protection through MMs. Can get anaphylaxis to blood transfusions
selective immunoglobulin A defiency
144
painful vesicles on the tympanic membrane
bullous myringitis
145
what hormones do the following release:
anterior pituitary
Posterior pitutatry
Hypothalamus
AP: LH, FSH, GH, TSH, ACTH
PP:oxytocin and adh
Hypothalamus: CRH, GHRH, GnRH, Somatostatin, TRH
146
hencoh schonlein purpura
systemic vasculitis caused by deposition of immune complexes containing iga in the skin.
Causes: cutaneous purpura, arthritis, abdominal pain, GI bleeds, orchitis, nephritis
30% of children have URTI before
treat supportively
147
contraindications with azathioprine
allopurinol - raises levels,
ACEi - anaemia and leukpenia
Warfarin - reduces levels of warfarin
148
reed sternburg cells and pain at nodules when drinking alcohol
hodgkins lymphoma
149
gait instability, urinary incontinence, dementia
normal pressure hydrocephalus - VP shunt
150
viral neuronitis vs labyrnthitis - which one causes tinnitue/hearing loss
labrynthitis
151
scrufaloderma vs lupus vulgaris
scrofuloderma - skin breakdown overlying tuberculoid focus
| lupus vulgaris lesions on normal skin
152
what is xanthopsia
yellow vision
153
anti TPO
| Anti TSH
hashimotos
| Graves
154
philedelphia chromosome
CML
155
rapid growing, locally invasive, firm nodule, thyroid mass
anaplastic, often has mets at presentation. can present with dyspnoea and hoarseness
156
thyroid mass with diarrhoea and facial flushing
medullary - calcitonin release
157
most common thyroid cancer, slow growing, sometime secondary to radiation
papillary
158
centor criteria
whether to give antibiotics in strep - temperature, Tender/swollen anterior cervical lymph nodes, exudate on tonsils, absent cough
159
anti nuclear and anti centromere antibodies
```
CREST syndrome - limited cutaneous sclerosis
calcinosis
raynauds
oesophageal dysmotility
scleroderma
telangectasia
```
160
friedreich's ataxis
autosomal recessive ataxia: degenerative disease that mostly affects nervous system and heart:
unsteadiness of gait, ataxis, dysarthria, cardiomyopathy
161
screening in the UK:
| breast, cervical, bowel
Breast screening - every 3 years between 50-70
Cervical screening - 25-49 every 3 years, 50-64 every 5 years
Bowel - one off at 55
162
mitral stenosis and dysphagia
left atrial hypertrophy
163
HIV, with pleural effusions, erythema nodosum, erythema marginatum, fungus
histoplasma
164
equation for plasma osmolality
2na +urea + glucose
165
risks of smoking during pregnancy
preterm labour, miscarriage, reduction in ovulations, abnormal sperm production, reduced reading ability, light for dates
166
common organisms causing pneumonia in patients with COPD
streptococcus pneumonia
haemophilus influenzae
moraxella catarrhalis
167
syringomyelia
fluid filled tubular cavitation (syrinx) - loss of pain and temperature sensation, in cape like distribution, may be muscle wasting or weakness
168
side effects of thiazide diuretics
```
Common adverse effects
dehydration
postural hypotension
hyponatraemia, hypokalaemia, hypercalcaemia*
gout
impaired glucose tolerance
impotence
```
```
Rare adverse effects
thrombocytopaenia
agranulocytosis
photosensitivity rash
pancreatitis
```
169
anticardiolipin antibodies are found in:
antiphospholipid syndrome, SLE, ITP, RA, psoriatic arthritis, sjogrens
170
causative agent in erysipleas
streptococcus pyogenes
171
difference between IgA nephropathy and post strep glomerulonephritis
IgA - haematuria: 24-48 following URTI.
| Post strep glomerulonephritis: haematuria 1-3 weeks following
172
retinal detachment types
rhegmatogenous - detachment of sensory retina, most common
non rhegmatogenous - either tractional or exudative (tractional from vitreous contracting e.g. from DR or exudative from fluid under RPE)
173
earliest clinical manifestation of chronic renal impairment
microalbuminuria
174
test for ovulation
progesterone 1 week before expected period - progesterone is produced mainly by the corpus luteum, helps to prepare the ueterus forimplantation
175
high fever, pharyngitis, lympadenopathy in child then rash rose pink macular intially on trunk.
roseola HHV6
176
Drugs used in Acute Open Angle Glaucoma
Reduce IOP:
Carbonic anhydrase inhibitors e.g. acetazolamide
Sympathomimethics e.g. dipverine
Beta Blockers e.g. timolol
Increase outflow of aqueous humour
Sympathomimethics
Miotics e.g. pilocarpine
Prostaglandin analogues e.g. latanoprost
177
overdose causing: hyperventilation, tinnitus, vomiting, resp alkalosis then met acidosis
aspirin
178
what is budd chiari, what causes it and how is it treated
caused by hepatic vein outflow obstruction e.g. due to thrombosis. presented with enlarged caudate lobe, ascites, deranged LFTs. Treated with TIPS
179
telling the differnce between alcohol liver disease and non alcohol liver disease on LFTs
Alcoholic liver disease is typically associated with an AST:ALT ratio >2 in contrast to non-alcoholic fatty liver disease which is associated with an ALT:AST ratio >2.
180
piere robin
micrognathia, cleft palate
181
ACEi drug monitoring
U&Es before, annually and after dose increase
182
Amiodarone monitoring
U&Es, CXR, LFT, TFTs before
| LFTs and TFTs every 6 months
183
Statin monitoring
LFTs before, 3 months, 12 months
184
methotrexate monitoring
The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months'
185
azathioprine monitoring
FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months
186
causes of jaundice in first 24hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
187
pseudohyperparathyroidism, what causes it and what clinical signs are there
resistance to PTH leading to hypocalcaemia, hyperphosphataemia, can lead to small stature, short neck, short metacarpals
188
lung cancer cancer causing hypercalcaemia
squamous cell cancer - PTHrP
189
weird things small cell lung cancer does
cushings - ACTH
SIADH
Lambert Eaton myasthenic syndrome
190
palpable lump in flank and varicocele
renal cancer
191
what type of virus is influenza
orthmyxovirus
192
2nd leading cause of lower GI bleeding after diverticulitis, typically large volume
angiodysplasia
193
Finasteride MoA
5 alpha reductase inhibitor: used for BPH and male pattern baldness. Can cause impotence, decreased libido, gynaecomastia.
F = Five = 5
194
labyrnthitis vs vestibular neuronitis: which one causes heading Loss
Labyrinthitis causes Loss
195
first line treatment for angina
A-BC
| Beta blocker and CCB
196
antidepressant of choice during breast feeding
sertraline
