MSRA part 3 Flashcards
1
Q
What is the main feature of Kawasaki disease and their addition features
A
Bilateral conjunctivitis without exudate
Erythema and cracking of the lips, strawberry tongue
Oedema and erythema of the hands
Cervical lymphoedema
2
Q
Which opthalmic emergency is a central scotoma a feature of?
A
A central scotoma is a feature of optic neuritis
3
Q
What is the characteristic feature of vision loss for Retinitis pigmentosa and which eyes are affected?
A
Retinitis pigmentosa causes a more gradual loss of peripheral vision rather than a central scotoma. As it is a genetic condition it would normally have a family history, bilateral eye involvement, and pigmented lesions are visible along the peripheral retina.
4
Q
What is the characteristic feature of vision loss for Retinitis pigmentosa?
A
Retinitis pigmentosa causes a more gradual loss of peripheral vision rather than a central scotoma. As it is a genetic condition it would normally have a family history, bilateral eye involvement, and pigmented lesions are visible along the peripheral retina.
5
Q
What is the diagnostic triad of optic neuritis
A
The diagnosis of optic neuritis is supported by the classic triad of visual loss, periocular pain, and dyschromatopsia (change in colour perception). Classic features on examination include a central scotoma and relative afferent pupillary defect.
6
Q
What is the typical age of onset for ischaemic optic neuropathy, how quick does the vision loss occur and does it cause pain?
A
Anterior ischaemic optic neuropathy is normally seen in people over the age of 50. It causes sudden, painless loss of vision.
7
Q
Does optic neuritis cause pain and what are it’s causes?
A
MS is the commonest
Diabetes
Syphilis
8
Q
How quickly does optic neuritis occur and what colour changes occur
A
Vision loss occurs hours to days
Loss of red colour occurs first
9
Q
What is the clinical examination to support a diagnosis of optic neuritis?
A
RAPD
Central scotoma on examination
10
Q
What is the treatment and investigations for optic neuritis?
A
MRI bran and orbits
High dose steroids
11
Q
What are the conservative and surgical treatment options for carpal tunnel syndrome and when are they considered?
A
NICE recommends a 6-week trial of conservative treatments if the symptoms are mild-moderate
avoidance/ minimising activities that exacerbate symptoms and patient reassurance, corticosteroid injection and wrist splints at night: particularly useful if transient factors present e.g. pregnancy
if there are severe symptoms or symptoms persist with conservative management:
Surgical management should be considered in patients with severe or constant symptoms, progressive motor or sensory deficit, or if there is no improvement within 3 months of conservative treatment, surgical decompression (flexor retinaculum division)
12
Q
What drugs causes pancreatitis?
A
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
13
Q
What are the smoking cessation therapies in pregnant patients?
A
the first-line interventions for smoking cessation in pregnancy should be cognitive behaviour therapy, motivational interviewing or structured self-help and support from NHS Stop Smoking Services
14
Q
What are the contraindications to bupropion
A
hypersensitivity
previous/current seizure or eating disorder or bipolar
recent/current MAOIs (including selegiline)
severe hepatic cirrhosis
pregnancy and lactation - not recommended
15
Q
When is Bupropion started to stop smoking?
A
Start 1 to 2 weeks before planning to stop smoking, increase the dose from day 7 if treatment. Continue the course for 7 to 9 weeks
16
Q
How do you restarted smoking cessation therapy after failed attempts
A
if a smoker’s attempt to quit is unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless special circumstances have hampered the person’s initial attempt to stop smoking, when it may be reasonable to try again sooner
17
Q
Can you combine NRT, varenicline, buproprion
A
No
18
Q
Can you combine NRT, varenicline, buproprion
A
No
19
Q
Can you give varenicline or bupropion to those under 18
A
No
20
Q
How does varenicline work?
A
varenicline is the first in a new class of drugs which are selective partial nicotinic receptor agonists
21
Q
What is the contraindication for varenicline
A
Suicide
22
Q
Drug triggers of psoriasis - BLANQ (French for white, plaques are white-ish)
A
B - beta blockers
L - lithium
A - ACEI/ARBs + alcohol
N - NSAIDs
Q - quinines
23
Q
What is the inheritance pattern of Haemophilia?
A
Haemophilia A and B is X-linked recessive
24
Q
What are the 5 causes for carpal tunnel?
A
Causes for carpal tunnel - idiopathic, pregnancy, rheumatoid arthritis, oedema, trauma
25
What is the age of incidence of Perthes disease (idiopathic avascular necrosis of the femoral head) and how long does it present over?
It occurs primarily in children aged between 5 and 12 years; typically between 3 and 7 years.
Present over a month
26
What is secondary dysmenorrheoa and how is it managed?
Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period. Causes include:
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids
NICE recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation.
27
When is FIT testing used and what is is used to screen?
Faecal immunochemical tests (FIT) are used to screen for colorectal cancer. Screening kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland
28
What is the long term risk of PV and how is this risk monitored. How is PV treated?
Polycythemia vera can progress to myelofibrosis or leukaemia thus yearly blood tests are needed. Venesection and aspirin are the main stay of the treatment.
29
What is the first line treatment for heart failure?
First line for heart failure is beta blockers (bisoprolol, carveolol, nebivolol) and an ACE-I. Start one at a time only in reduced ejection fraction, if they have preserved ejection fraction then they're OK don't prescribe medications and optimise other comorbidities.
30
Where is the thickening in Duputyns contracture?
Palmar aponeurosis
31
What happens to the gonads in Tuner syndrome and what is the karytotype?
Turner syndrome, pure gonadal dysgenesis. 45, X0
32
What is is gonadal dysgenesis?
Gonadal dysgenesis is characterised by a progressive loss of primordial germ cells on the developing gonads of an embryo. This loss leads to extremely hypoplastic and dysfunctioning gonads mainly composed of fibrous tissue; hence the name ‘streak gonads’.
33
What are the three key things to remember about the children's flu vaccine?
It is given intranasally
The first dose is given at 2-3 years, then annually after that
It is a live vaccine (cf. injectable vaccine below)
34
What are the three key things to remember about the children's flu vaccine?
It is given intranasally
The first dose is given at 2-3 years, then annually after that
It is a live vaccine (cf. injectable vaccine below)
35
What is the commonest valvular defect in polycystic kidney disease
Mitral valve prolapse is the most common valvular abnormality associated with PKD
36
What are the antibiotics for Whooping cough and when should the treatment be started?
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
37
What is the treatment regimen for TB?
According to the UK guidelines, the initial treatment of pulmonary tuberculosis involves a combination of four drugs: rifampicin, isoniazid, pyrazinamide, and ethambutol. This regimen should be taken for two months (intensive phase), followed by a continuation phase with rifampicin and isoniazid for an additional four months. The use of these four drugs helps to prevent the development of drug resistance and ensures effective treatment.
38
How is chronic fatigue syndrome diagnosed?
Chronic fatigue syndrome is a diagnosis of exclusion that should only be given once other causes of fatigue have been excluded must be present for 3 months
39
What anti-HTN do you give in those with diabetes?
Hypertension in diabetics - ACE inhibitors/ARBs are first-line regardless of age
40
What is HSP
HSP is an IgA vasculitis disorder, It is the commonest vasculitic disorder on children with purpura on the legs and buttocks, causes vasculitis everywhere - haematuria, AKI,
41
How it ITP diagnosed and what blood cell it affect?
immune thrombocytopenia purpura-autoantibodies against plt - it is a diagnosis of exclusion
42
Which chronic GI infection leads to MALT lymphoma?
MALT lymphoma: this is a cancer that arises from the mucosal-associated lymphoid tissue. It is a response to chronic Helicobacter pylori infection.
43
What is the bone profile of low calcium caused by a poor diet?
low level of calcium causes secondary hyperparathyroidism, where there is an increase in parathyroid hormone (PTH) in order to try and raise calcium levels. It does this by stimulating osteoclast activity to release more calcium, and this activity causes a rise in ALP found in bone. Therefore, the overall blood results expected are raised phosphate (due to an inability to excrete it), raised PTH (due to a reaction to hypocalcaemia) and raised ALP (due to the action of PTH).
44
Which lymphoma is associated with coeliacs disease?
Enteropathic associated t cell lymphoma is associated with coeliacs
45
What is transient tachypnoea of the newborn? Where is it common? What are the findings of chest xray and management.
Transient tachypnoea of the newborn (TTN) is the commonest cause of respiratory distress in the newborn period. It is caused by delayed resorption of fluid in the lungs
It is more common following caesarean sections, possibly due to the lung fluid not being 'squeezed out' during the passage through the birth canal
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations
Transient tachypnoea of the newborn usually settles within 1-2 days
46
What are the rules for seizures and driving?
1st seizure and nothing wrong then don't drive for 3 months. If seizure controlled for 12 month can drive
47
When do you refer unilateral and bilateral undescended testes?
NICE guidelines, if there is an unilateral undescended testes, if it has not descended by around six months of age, a referral to a urological surgeon should be made to complete surgical correction (orchidopexy) before 12 months of age. Early intervention helps reduce the risks of infertility, torsion, and testicular cancer, which are associated with undescended testes.
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
48
How do you manage Herpetic neuralgia?
Herpetic neuralgia
first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
49
How does post-streptococcal glomerulonephritis develop and what is the test to help confirm it?
Post-streptococcal glomerulonephritis; streptococcal throat infection 1-2 weeks ago followed by visible haematuria, malaise with hypertension, and a urine dip positive for blood and protein.
Anti-streptolysin O titre. This measures antibodies against streptolysin O, a substance produced by group A streptococcus bacteria.
50
What is the inheritance pattern of familial hypercholesterolaemia and how does it affect cholesterol levels?
Familial hypercholesterolaemia (FH) is an autosomal dominant condition that is thought to affect around 1 in 500 people. It results in high levels of LDL-cholesterol which, if untreated, may cause early cardiovascular disease (CVD). FH is caused by mutations in the gene which encodes the LDL-receptor protein.
51
Which coronary artery supplies the AV node
RCA supplies the AV node
52
When is a pregnant women diagnosed with chronic hypertension?
Chronic hypertension
Hypertension that is present at the booking visit, or before 20 weeks, or if the woman is already taking antihypertensive medication when referred to maternity services. It can be primary or secondary in aetiology.
53
What is Antiphospholipid syndrome
It has primary or secondary causes
It is an acquired autoimmune disorder characterised by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia. It may occur as a primary disorder or secondary to other conditions, most commonly systemic lupus erythematosus (SLE). Around 30% of patients with SLE have positive antiphospholipid antibodies.
54
What causes pityriasis rosacea and what are its features?
Pityriasis rosea is a common, acute, self limiting, papulosquamous condition thought to be due to HHV7. Most commonly seen in children and young adults. Classically features a gerald patch, these are salmon colored, ovoid, raised lesions with a collarette of scale as well.
may last for 4 to 10 weeks and will involve the trunk, rarely the limbs.
55
What are the biochemical features of hyperaldosteronism and what are the causes of primary hyperaldosteronism?
Causes of primary hyperaldosteronism - features are hypokalaemia, hypertension.
Causes
Bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases
Adrenal adenoma: 20-30% of cases
unilateral hyperplasia
familial hyperaldosteronism
adrenal carcinoma
56
Do you give anticoagulation to AF under 65?
Do not offer stroke prevention therapy to people aged under 65 years with atrial fibrillation and no risk factors other than their sex (that is, very low risk of stroke equating to a CHA2DS2-VASc score of 0 for men or 1 for women)
57
Do you give anticoagulation to AF under 65?
Do not offer stroke prevention therapy to people aged under 65 years with atrial fibrillation and no risk factors other than their sex (that is, very low risk of stroke equating to a CHA2DS2-VASc score of 0 for men or 1 for women)
58
What investigation do you order in a patient with AF
12 lead ECG - tape if no AF seen in 12 lead
full blood count
urea and electrolytes
thyroid function tests
chest X-ray - to identify lung diseases if suggested by clinical findings (3)
echocardiography:
59
What is an osteosarcoma?
Osteosarcoma - malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
60
When can impetigo go back to school
Healed over or after 48hours of treatment
61
What are the significance of the different Hep B antigens found on serology
HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity.
HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)
62
How long does it take IUD, POP, IUS, depot, implant, COCP take to work?
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
63
Is BRCA1, BRCA2 or HER2 a genetic risk factor for breast cancer
Only BRCA1 or BRCA2
64
Whatis the HER2 receptor and what is the treatment if it is found on breast cancer cells
Human epidermal growth factor receptor 2
Oestrogen receptor growth factor receptor, trastuzumab
65
What is the treatment for an ischaemic stroke
Aspirin 300 mg daily for 2 weeks should be given immediately after an ischaemic stroke is confirmed by brain imaging. Following this, clopidogrel 75 mg daily should be given long-term
66
What does acromegaly do to the blood pressure and what else does it cause?
Excessive sweating
features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
coarse facial appearance, spade-like hands, increase in shoe size
large tongue, prognathism, interdental spaces
67
Which ethnicity has a higher rate of prostate cancer?
Afro-Caribbean
68
What is the incidence of a congenital inguinal hernia
1-5% of all newborns and up to 30% of premature infants according to UK guidelines.
Commoner in boys
Effects the right side more often
69
What is the first line test for suspect hyperaldosteronism and what would a positive results show?
Plasma aldosterone should be raised
Plamsa renin should be reduced
If bot hare raised it is renal artery stenosis
70
Argyll-Robertson Pupil
Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
71
recurrent, smelly discharge from her right ear with a reduced hearing on the affected side?
Cholesteatoma
72
Auer rods
These needle-shaped inclusions found within the cytoplasm of myeloid blasts indicate acute myeloid leukaemia
73
Howell-Jolly bodies
A collection of basophilic remnants of DNA found in circulating immature RBCs that are normally removed by the spleen. Their presence is greatly increased in patients with decreased splenic function or asplenia.
74
Causes for dactylitis
Causes include:
spondyloarthritis: e.g. Psoriatic and reactive arthritis
sickle-cell disease
75
What does neurofibromatosis type 2cause?
Vestibular schawanomas
76
How do you manage neurofibromatosis type 1?
Refer all worsening of symptoms
77
When would you consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention
or erectile dysfunction
or visible haematuria
78
When would you perform a U&E old men?
NICE suggest that men with LUTS a serum creatinine test at initial assessment (plus estimated glomerular filtration rate [eGFR] calculation) only if suspect renal impairment (for example, the man has a palpable bladder, nocturnal enuresis, recurrent urinary tract infections or a history of renal stones)
- 80% of renal function must be lost before creatinine rises
79
When would you suggest starting BPH medication?
offer an alpha blocker (alfuzosin, doxazosin, tamsulosin or terazosin) to men with moderate to severe LUTS, especially if voiding type (hesitancy, poor stream)
offer a 5-alpha reductase inhibitor to men with LUTS who have prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml, and who are considered to be at high risk of progression (for example, older men)
consider offering a combination of an alpha blocker and a 5-alpha reductase inhibitor to men with bothersome moderate to severe LUTS and prostates estimated to be larger than 30 g or a PSA level greater than 1.4 ng/ml
80
Pierre-Robin sequence congenital birth defect
severe micrognathia
midline cleft palate without cleft lip
glossoptosis - an abnormal attachment of the genioglossi muscles allowing the normally sized tongue to fall back and block the airway especially during feeding and in the supine position
81
What is thrombophilia and its genetic causes and the acquired causes
An inherited tendency to thrombosis is termed thrombophilia.
factor V Leiden (activated protein C resistance): most common cause of thrombophilia
prothrombin gene mutation: second most common cause
Acquired causes is phospholipid syndrome
82
What skin findings can be found in lymphoma?
Acquired ichthyosis and Erythroderma
83
What skin conditions can be found in myeloma?
Pyoderma gangrenosum (bullous and non-bullous forms)
84
what are the dermatological features of dermatomyositis?
possible dermatological features include
a heliotrope rash (a red-to-violet - colored rash around the eyes that might be accompanied by swelling)
Gottron papules (red bumps most prominently seen on the knuckles of the hands)
other characteristic dermatological findings include:
red purplish discoloration on the face, exposed surfaces of the arms, forearms and hands, scalp, upper chest, upper back (known as a Shawl sign), and the lateral hips (known as the holster sign) in addition to changes around the cuticles of the fingernails
photosensitivity may occur
85
What are the different aphasia classifications and their causes?
Fluent speech (sentences make no sense) - comprehension intact (conductive) comprehension not intact (Wernickes)
Non-fluent speech (laboured speech, content may be preserved) - comprehension intact (Brocas) comprehension not intact (global aphasia)
86
Where is the stroke in conductive aphasia?
Arcuate fasciculus (connection between Wernickes and Brocas area
87
88
DPP-4 causes what GI pathology?
Lipton Ice tea PP more
Pamcreatitis
89
GLP-1 causes what GI pathology
Gulping tide pods
Exenatide
Pamcreatitis
90
Rosiglitazone and pioglitazone is CI in which 4 conditions and what does it do to your weight
Heart failure and bladder cancer and liver impairment and fracture risk
91
When would you not prescribe a SGLT2 inhibitor?
And risk of DKA: previous DKA, low carbon diet, any illness
Renal impairment
92
What happens when you co-prescribe Diuretics and SGLT2 inhibitors
Diuretics SGLT2 inhibitors may add to the diuretic effect of thiazide and loop diuretics and may increase the risk of dehydration and hypotension.
93
How do you manage a diabetic patient with atherosclerosis or heart failure
Initiate metformin, once tolerated start a SGLT-2 Inhibitor.
94
How do you manage a T2DM with a Q risk greater than 10%
Start metformin, once tolerated consider starting a SGLT-2 Inhibitor
95
What is the absolute CI for mefloquine
Anxiety and depression
96
What are the 5 cases when you should not prescribe Carbamazepine
With a known hypersensitivity to carbamazepine or structurally related drugs (for example tricyclic antidepressants) or any other component of the formulation.
With atrioventricular block.
With a history of bone marrow depression.
With a history of hepatic porphyrias.
Taking a monoamine oxidase inhibitor.
97
Give 9 side effects of carbamazepine
P450 enzyme inducer
dizziness and ataxia
drowsiness
headache
visual disturbances (especially diplopia)
Steven-Johnson syndrome
leucopenia and agranulocytosis
hyponatraemia secondary to syndrome of inappropriate ADH secretion
98
What is the long term effect of taking too much pyridoxine and how much is the max to take?
Taking more than 200mg a day of vitamin B6 for several months can lead to peripheral neuropathy.
99
Clarithromycin Cannot be given in pregnancy, what other antibiotic can be given?
Erythromycin
100
Which valve is commonly effected in endocarditis in IVDU patients?
Infective endocarditis in intravenous drug users most commonly affects the tricuspid valve
101
What are the 7 red flags in trigeminal neuralgia symptoms which could signify another cause of the symptoms
Sensory changes.
Deafness or other ear problems.
History of skin or oral lesions that could spread perineurally.
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally.
Optic neuritis.
Family history of multiple sclerosis.
Age of onset before 40 years.
102
Give the 5 side effects of beta blockers
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
103
What is Noonan Syndrome and how is it inherited?
Noonan syndrome is an autosomal dominant disorder characterized by a wide spectrum of symptoms and physical features, which may vary greatly in range and severity. Two key features that are often associated with this condition are pectus excavatum (a concave or 'sunken' appearance of the chest) and pulmonary stenosis (a narrowing of the pulmonary valve).
104
Pain is felt in the anterior aspect of the knee joint and is worse when walking up and down stairs. Examination is unremarkable. What is the most likely diagnosis?
Chondromalacia patellae.
105
Is Azathioprine safe to use in pregnancy?
Azathioprine is safe to use in pregnancy
106
What does a history of pelvic inflammatory disease resulting in scarring of the right fallopian tube. A last period was 6 weeks ago and presenting with abdominal pain make you suspect?
Ectopic pregnancy
107
What is step 2 for BP management after CCB or ACEi/ARB?
Add CCB or ACE-i or Thiazide diuretic
108
Can diabetes cause optic problems?
Yes, it can cause optic neuritis
109
What is the test for acromegaly?
Check IGF-1 levels
In the investigation of acromegaly, if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis
110
What is CA 15-3 a marker for?
Breast cancer
111
What is Carcinoembryonic antigen a marker for?
Carcinoembryonic antigen, also called CEA, is a protein that may be elevated in many colorectal cancer patients and is detected in the blood.
112
How does clubfoot present in a newborn exam and how is it managed?
Inverted + plantar flexed foot which is not passively correctable.
Ponseti method
113
What is anti-Jo-1 associated with?
Myositis
114
What are the features of poly and dermatomysositis?
Proximal, symmetrical muscle weakness and myalgia with skin changes (gottron nodules and heliotrope rash to the face)
115
What are the 6 cancers associated with HNPCC (Lynch syndrome)
colon, small intestine, stomach, endometrium, upper urinary tract and sebaceous tumors of the skin.
116
When is the neonatal blood spot screening test performed?
Between fifth and ninth day of life.
117
Which bacteria occurs after a TB infection which lives in the cavity?
Aspergillous
118
Where is the lapin likely to present in an adolescent boy with SUFE?
groin/thigh/knee pain → ?slipped capital femoral epiphysis
119
Which hormone can you check to assess infertility in females on day 21 of their period?
Progesterone
120
When are infants vaccinated against rotavirus, what kind of virus is it, when is the last dates you can give it by and what is the risk if it is given too late?
it is an oral, live attenuated vaccine
2 doses are required, the first at 2 months, the second at 3 months
the first dose should not be given after 14 weeks + 6 days and the second dose cannot be given after 23 weeks + 6 days due to a theoretical risk of intussusception
121
how do you differentiate between IgA nephropathy and minimal change disease?
Visible Haematuria
122
How is symphysis-fundal-height calculated and and how is it used to estimate gestational age?
The symphysis-fundal height (SFH) is measured from the top of the pubic bone to the top of the uterus in centimetres
It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm
123
124
What is the treatment for suspected bacterial balanitis
If there is suspected or confirmed bacterial balanitis:
If there is mild infection, consider use of a topical antibiotic preparation such as mupirocin 2% ointment 2–3 times a day for 7–10 days.
If there is severe infection, consider prescribing oral phenoxymethylpenicillin for 10 days while awaiting swab results. If there is a true penicillin allergy, prescribe oral clarithromycin for seven days.
