MSRA Clinical 2 Flashcards
1
Q
L3 nerve root compression
A
- Sensory loss over anterior thigh
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
2
Q
L4 nerve root compression
A
- Sensory loss anterior knee
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
3
Q
L5 nerve root compression
A
- Sensory loss dorsum of foot
- Weakness in foot and big toe dorsiflexion
- Reflexes intact
- Positive sciatic nerve stretch test
4
Q
S1 nerve root compression
A
- Sensory loss posterolateral leg and lateral foot
- Weakness in plantar flexion
- Reduced ankle reflex
- Positive sciatic nerve stretch test
5
Q
Ottawa rules
A
Ankle x-ray if there is pain in malleolar zone and one of:
- Bony tenderness at lateral malleolar zone (including distal 6cm fibular)
- Bony tenderness at medial malleolar zone (including distal 6cm tibia)
- Inability to weight bear 4 steps immediately and in ED
6
Q
Golfer’s elbow
A
Medial epiondylitis
- Tender medial epicondyle
- Medial wrist pain on resisted wrist pronation
7
Q
Tennis elbow
A
Lateral epicondylitis
- Tender lateral epicondyle
- Lateral elbow pain on resisted wrist extension
8
Q
Causative organism bone infections in SCA/malaria
A
Non-typhi salmonella
9
Q
Patellofemoral pain syndrome AKA
A
chondromalacia patellae
10
Q
Patellofemoral pain syndrome features
A
Softening of cartilage of patella
Teenage girls
Anterior knee pain on alking up/down stairs and rising from prolonged sitting
Responds to physio
11
Q
Infraptellar bursitis
A
=clergyman’s knee
Associated with kneeling
12
Q
Prepatellar bursitis
A
=Housemaid’s knee
Associated with upright kneeling
13
Q
ACL injury
A
Caused by twisting of knee + popping noise
Rapid knee effusion
Positive draw test
14
Q
PCL injury
A
Anterior force applied to proximal tibia (eg knee hitting dashboard)
15
Q
Collateral ligament injury
A
Tenderness over affected ligament
Knee effusion
16
Q
Mensical lesion
A
Caused by twisting of the knee
Locking and giving way are common features
Tender joint line
17
Q
OA of knee
A
Intermittent swelling, crepitus, limitation of movement
18
Q
Methotrexate side effects
A
Myelosuppression
Liver cirrhosis
Pneumonitis
19
Q
Sulfasalazine side effects
A
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
20
Q
Leflunomide side effects
A
Liver impairment
Interstitial lung disease
Hypertension
21
Q
Hydroxychloroquine side effects
A
Retinopathy
Corneal deposits
22
Q
Prednisolone side effects
A
Cushingoid Osteoporosis Impaired glucose tolerance Hypertension Cataracts
23
Q
Gold side effects
A
Proteinuria
24
Q
Penicillamine side effects
A
Proteinuria
Exacerbation of myasthenia gravis
25
Etanercept side effects
Demyelination
| Reactivation of Tb
26
Infliximab side effects
Reactivation of Tb
27
Adalimumab side effects
Reactivation of Tb
28
Rituximab side effects
Infusion reaction
29
Hip OA findings
Reduction in internal rotation
30
Referred lumbar spine pain
Femoral nerve stretch positive
31
Ankylosing spondylitis A features
```
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
```
32
Antiphospholipid syndrome clotting screen
Paradoxically prolonged APTT
| Low platelets
33
Drugs which cause drug-induced lupus
- procainamide
- hydralazine
less common causes:
- isoniazid
- minocycline
- phenytoin
34
Indication for secondary prevention of osteoporotic fracture
After osteoporotic fracture in post-menopausal woman with confirmed osteoporosis (T-score of -2.5 SD or below)
35
Antibodies associated with diffuse cutaneous systemic sclerosis
anti-scl-70
| + ANA + RF
36
Antibodies associated with limited cutaneous systemic sclerosis
anti-centromere
| + ANA + RF
37
Lesch-Nyhan syndrome
Inherited enzyme deficiency.
"juvenile gout",
self-mutilation behaviour
38
Pseudogout findings
- calcium pyrophosphate dihydrate crystals
- x-ray: chondrocalcinosis
- aspiration: weakly-positively birefringent rhomboid crystals
39
Pseudogout risk factors
- haemochromatosis
- hyperparathyroidism
- acromegaly
- low magnesium, low phosphate
- Wilson's disease
40
Kocher criteria for septic arthritis
- fever >38.5
- non-weight bearing
- raised ESR
- raised WCC
41
Common side effect of Amoxicillin
Rash with infectious mononucleosis
42
Common side effect of Co-amoxiclav
Cholestasis
43
Common side effect of Flucloxacillin
Cholestasis (usually develops several weeks after use)
44
Common side effect of Erythromycin
Gastrointestinal upset
| Prolongs QT interval
45
Common side effect of Ciprofloxacin
Lowers seizure threshold
| Tendonitis
46
Common side effect of Metronidazole
Reaction following alcohol ingestion
47
Common side effect of Doxycycline
Photosensitivity
48
Common side effect of Trimethoprim
Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis
49
Antibiotics harmful in pregnancy
- Tetracyclines
- Aminoglycosides
- Sulphonamides and trimethoprim
- Quinolones
50
Non-antibiotic drugs which are harmful in pregnancy
- ACEi, ARBs
- Statins
- Warfarin
- Sulfonylureas
- Retinoids (including topical)
- Cytotoxic agents
51
Statin monitoring
LFTs at baseline, 3 months and 12 months
52
ACEi monitoring
U&E prior to treatement, after increasing dose, at least annually
53
Amiodarone monitoring
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
54
Methotrexate monitoring
FBC, U&E, LFT prior to treatment.
Repeat weekly until stabilised.
Thereater every 2-3 months
55
Azathioprine moniroting
FBC, LFT before treatment
FBC weekly for first 4 weeks
FBC, LFT every 3 months
56
Lithium monitoring
TFT, U&E prior to treatment
Lithium levels weekly until stabilised, then every 3 months
TFT, U&E every 6 months
57
Sodium Valproate monitoring
LFT, FBC before treatment
LFT periodically during first 6 months
58
Glitazones monitoring
LFT before treatment and regularly during treatment
59
Drugs which may cause urinary retention
- TCAs
- Anticholinergics
- Opioids
- NSAIDs
- Disopyramide
60
Common side effects of calcium channel blockers
Headache
Flushing
Ankle oedema
Verapamil also causes constipation
61
Common side effects of beta-blockers
Bronchospasm
Fatigue
Cold peripheries
Sleep disturbance
62
Common side effects of Nitrates
Headache
Postural hypotension
Tachycardia
63
Common side effects of Nicorandil
Headache
Flushing
Anal ulceration
64
Features of organophosphate poisoning
Accumulation of acetylcholine = SLUD
Salivation
Lacrimation
Urination
Defecation/diarrhoea
Hypotension, bradycardia, sall pupils, fasciculation
65
Management of organophosphate poisoning
Atropine
66
Common side effects of ACE inhibitors
Cough
| Hyperkalaemia
67
Common side effects of Bendroflumethiazide
Gout
Hypokalamia
Hyponatraemia
Impaired glucose tolerance
68
Common side effects of Doxazosin
Postural hypotension
69
Managemeny of beta-blocker overdose
If bradycardic then atropine
Glucagon in resistant cases
70
Features of beta-blocker overodse
Bradycardia
Hypotension
Heart failure
Syncope
71
Finasteride - indications
BPH
| Male-pattern baldness
72
Finasteride - mechanism of action
Inhibitor of 5 alpha-reductase, and enzyme which metabolises testosterone to dihydrotestosterone
73
Finasteride - adverse effects
- impotence
- decreased libido
- ejaculation disorders
- gynaecomastia and breast tenderness
74
Salicylate overdose management
haemodialysis
75
Benzodiazepine overdose management
Mainly conservative as flumazenil increases risk of seizures
76
TCA overdose management
IV bicarbonate may reduce risk of seizure and arrhythmia
77
Lithium overdose management
Saline
| Haemodialysis
78
Digoxin overdose management
Digoxin-specific antibody fragments
79
Lead overdose management
Dimercaprol, calcium edetate
80
Cyanide overdose management
Hydroxocobalamin
81
Additional ACS treatment in MI secondary to cocaine use
IV benzodiazepine
82
Metformin and contrast CT
Discontinue metforming for 48 hours following contrast CT
83
Common side effects of rifampicin
Orange bodily fluids
Rash
Hepatotoxicity
Drug interactions
84
Common side effects of Isoniazid
Peripheral neuropathy
Psychosis
Hepatotoxicity
85
Common side effects of pyrazinamide
Arthralgia
Gout
Hepatotoxicity
Nausea
86
Common side effects of Ethambutol
Optic neuritis
| Rash
87
Common side effects of metformin
GI upset
| Lactic acidosis
88
Common side effects of sulfonylureas
Hypoglycaemia
Increased appetite and weight gain
SIADH
Cholestasis
89
Common side effects of glitazones
Weight gian
Fluid retention
Liver dysfunction
Fractures
90
Common side effects of gliptins
Pancreatitis
91
Side effect bleomycin
lung fibrosis
92
Side effect doxorubicin
cardiomyopathy
93
Side effect 5-FU
myelosuppression, mucositis, dermatitis
94
side effect vincristine
peripheral neuropathy
| paralytic ileus
95
side effects cisplatin
ototoxicity
peripheral neuropathy
hypomagnenaemia
96
Drugs used in mild to moderate Alzheimer's: 1st line
Acetylcholinesterase inhibitor: donepezil, galantamine or rivastigmine
97
Drugs used in Alzheimer's: 2nd line
Memantine (NMDA antagonist)
98
Palliative care: hiccups
chlorpromazine
