MSRA EXAM Flashcards
NICE recognise any of the following criteria to diagnose AKI in adults?
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
MOTOR NEURONE EYE SYMPTOMS?
This condition = demyelinating disease of CNS
often presents with optic neuritis = eye pain and a relative afferent pupillary defect (RAPD).
RAPD
relative afferent pupillary defect (RAPD).
RAPD is an abnormal finding on the swinging flashlight test where the pupils dilate when light swings from the unaffected to the affected eye. It’s indicative of an optic nerve lesion, such as in optic neuritis - a common early symptom of multiple sclerosis.
Patient >= 60 years old with new iron-deficiency anaemia →
FIT TEST THEN urgent colorectal cancer pathway referral
Primary hyperparathyroidism is caused by
BLOODS =
excess secretion of PTH resulting in hypercalcaemia
raised calcium, low phosphate
symptomatic features of primary hyperparathyroidism ….
‘bones, stones, abdominal groans and psychic moans’
painful bones, kidney stones,
lung abscess features
Characterised by swinging fevers, night sweats, pleuritic chest pain, dyspnoea, and cough.
breast cancer medication OR+
pre menopause
post menopause
pre-menopause = tamoxifen
post menopause = Anastrozole (aromatase inhibitor)
Osteoarthritis 1st line treatment?
paracetamol + topical NSAIDs (if knee/hand) first-line
management post MI?
+ HF or LV dysfunction add..
- dual antiplatelet therapy (aspirin plus ticagrelor)
- ACE inhibitor
- beta-blocker
- statin
.. add aldosterone antagonist eg epelerone (K sparing like spiro)
primary dysmenorrhoea treatment
secondary dysmenorrhoea
Offer a trial of mefenamic
2 - refer to gynae as likely underlying cause
COPD management general
> smoking cessation advice: including offering nicotine replacement therapy, varenicline or bupropion
annual influenza vaccination
one-off pneumococcal vaccination
pulmonary rehabilitation to all people who view themselves as functionally disabled by COPD (usually Medical Research Council [MRC] grade 3 and above)
COPD INHALER therapy
1st line - SABA OR SAMA
2nd line
- if steroid response –> LABA + ICS
- if no steroid response –> LABA + LAMA
positively birefringent crystals on aspirate?
pseudogout = calcium pyrophosphate deposition disease
presents as a monoarticular effusion in a patient RF = disease that disrupt iron and calcium homeostasis.
EG include haemochromatosis, parathyroid disorders, renal impairment, and thyroid dysfunction.
Central retinal artery occlusion
sudden, painless vision loss in one eye
poor direct pupillary light response, normal consensual light reaction
Fundoscopic findings - pale and opaque retina with a cherry-red spot
Treatment for onychomycosis.
oral terbinafine
Thiazides / Bendroflumethiazide affect which mineral?
cause hypercalcaemia (loss of appetite, nausea, fatigue)
Acute presentation of atrial fibrillatio + HISS ->
(HF, ISCHAEMIA, shock, syncope)
electrical cardioversion, as per the peri-arrest tachycardia guidelines
Pneumonia follow up ?
All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution
Pericarditis ECG changes
widespread ST elevation
PE ECG
Large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III describes the S1Q3T3 pattern,
URTI symptoms + amoxicillin → rash ?
glandular fever
Bishop score
should be assessed prior to induction of labour
Cervical position (posterior/intermediate/anterior)
Cervical consistency (firm/intermediate/soft)
Cervical effacement (0-30%/40-50%/60-70%/80%)
Cervical dilation (<1 cm/1-2 cm/3-4 cm/>5 cm)
Foetal station (-3/-2/-1, 0/+1,+2)
De Quervain’s tenosynovitis
Pain on the radial side of the wrist/tenderness over the radial styloid process
Finkelsteins test = thumb under fingers, ulnar deviation
step down treatment of asthma?
aim for a reduction of 25-50% in the dose of inhaled corticosteroids
already taking Ace + B + thiazide and high BP?
if K under 4.5- –> add K sparing
first-line treatment for Pneumocystis jiroveci pneumonia (PJP) in HIV-positive patients
co-trimoxole
supplements in pregnancy?
diabetic?
400mcg folic acid first 12 weeks and vitamin D all pregnancy
diabetic 5mg folic acidall pregnancy and vit d
polycythaemia vera
Raised haemoglobin, plethoric appearance, pruritus, splenomegaly, hypertension
intussusception
syx?
exam sign
imaging?
inconsolable crying + episodic vomiting , draw knees up
sign
sausage-shaped mass is palpable in the right upper quadrant.
USS
moderate asthma
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
severe asthma
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
life threatening asthma
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
prolactinoma treatment
bromocriptine
Silicosis?
job
where lung changes?
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes
what drug to avoid in bowel obstruction?
Metoclopramide
Best SSRI post MI?
Sertraline
VTE treatment?
DOAC
provoked (e.g. recent surgery): 3 months
unprovoked: 6 months
ARMD
WET VS DRY
Wet age-related macular degeneration is characterised by choroidal neovascularisation (vessels)
Dry age-related macular degeneration is characterised by drusen
Doxorubicin side effects
cardiotoxicity eg congestive heart failure
Who should be offered statins?
offered to people who have a 10% or greater 10-year risk of developing cardiovascular disease
/ all those with Cerebrovascular disease eg prior TIA/ MI / stroke/ peripheral vascular disease
type 1 diabetics general HbA1c target?
target of 48 mmol/mol (6.5%) should be used
Age of Adrenaline dose anapphylaxis
< 6 months
6 months - 6 years
6-12 years
Adult and child +12
100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
150 micrograms (0.15 ml 1 in 1,000)
300 micrograms (0.3ml 1 in 1,000)
500 micrograms (0.5ml 1 in 1,000)
OCP and surgery?
cease intake of the pill 4 weeks pre op to reduce risk PE
oral glucose tolerance test (OGTT)
DM
impaired glucose tolerance
impaired fasting glucose fasting
DM = fasting > 7.0, random > 11.1 - if asymptomatic need two readings
impaired glucose tolerance
when an OGTT 7.8 - 11.1 mmol/l.
6.1 - 7.0 mmol/l
oesophageal cancer
adenocarcioma
squamous cell
adeno -RF GORd/ barrets most common UK
squamous cell - RF smoking, alcohol
URTI symptoms + amoxicillin → rash
?glandular fever
raised d dimer but no DVT in USS?
stop apixaban and schedule a repeat ultrasound in 1 week.
shockable
non shockable
shock- VF / pulseless VT
non shock -PEA / asystole
ethambutol syx
optic neuritis
if occurs stop
cocaine + MI
tx with benzodiazepam
?DVT
steps >2
or under 2
> 2 USS in 4 hours - if cant do that then d dimer and anticoag apixiban
under 2 = d dimer
isoniazid
se
tx prevent
se = peripheral neuropathy
prevent with pyridoxine (Vitamin B6)
combination drugs can potentially cause profound bradycardia and asystole ?
Beta-blockers combined with verapamil
test for addisons disease?
short synacthen
mild croup
NO stridor at rest
moderate vs severe = admit
reynauds
tx
makes worse
tx = nifedipine
propranolol makes worse
All patients with peripheral arterial disease should take
clopidogrel 75mg and atorvastatin 80mg
C diff
abx make worse?
abx treats it?
make worse - clindamycin
tx - vancomycin
> = 75 years + following a fragility fracture ?
Start alendronate before scan
threadworm tx?
mebendazole to patient and all family
hyperthyroid cause
hypothyroid cause
hyperthyroid = graves or toxi multinodular
hypothyroid
hashimotots (non tender)
subacute thyroiditis (de queverains) = tender
iodine def
