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MSRA > PassMed > Flashcards

PassMed Flashcards

1
Q

Likely diagnosis?

‘Pop’ in ankle, sudden onset significant pain in calf / ankle + inability to continue sport or walk. Positive Simmond’s sign,

A

Achilles tendon rupture

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2
Q

Likely diagnosis?

Pain on forced plantar flexion when jumping or kicking. Common in gymnasts and ballet dancers.

A

Posterior ankle impingement

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3
Q

Likely diagnosis?

Athletes involved in sprinting and jumping. Pain in foot.

A

Navicular bone fracture - stress #

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4
Q

Likely diagnosis?

Repeated ankle sprains causing friction and inflammation of tendon

A

Peroneal tendon dislocation

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5
Q

Likely diagnosis?

Foot injury common in soldiers and hikers; long periods of standing or walking.

A

Stress metatarsal fracture - march #

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6
Q

Statins inhibit which enzyme in hepatic cholesterol synthesis?

A

HMG-CoA reductase

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7
Q

Risk factors for myopathy with statins?

A
  • Advanced age
  • Female
  • Low BMI
  • Multisystem disease - DM
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8
Q

Myopathy is more common in:
1 - Lipophilic statins (simvastatin, atorvastatin)
2 - Hydrophilic statins

A
  1. Lipophilic
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9
Q

When starting statins, LFTs should be checked at ______ months and ________ months. Stop statins if transaminase concentrations rise to _____ times the upper limit.

A
  • 3 months
  • 12 months
  • Three
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10
Q

Statins should be stopped with what Abx?

A

Macrolides (e.g. erythromycin)

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11
Q

Assessment tool for starting statins?

A

QRISK2

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12
Q

NICE - Primary prevention (20mg) with statins should be given to:

  1. ?
  2. ?
  3. ?
A
  1. 10 year CVR >/ 10%
  2. T1DM
  3. CKD if eGFR <60
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13
Q

NICE - Secondary prevention (80mg) with statins should be given to?

A

Cardiovascular disease

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14
Q

NICE - Dose of primary prevention statin should be increased if non-HDL has not reduced by _____ %

A

> / 40%

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15
Q

Who should receive a statin?

  1. All people with established ________.
  2. Anyone with 10-year CV risk _______ (QRISK2).
  3. T1DM patients who were diagnosed _______ or aged _______ or have _________.
A
  1. CVD - stroke, TIA, IHD, PAD
  2. > / 10%
  3. More than 10 years ago / over 40 / established nephropathy.
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16
Q

Likely diagnosis?

25F + 8 weeks gestation presents to GP with circular and outwardly expanding painless rash on right arm (looks like a target). Rash started 2 weeks after coming back from hiking trip in the USA.

A

Lyme disease

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17
Q

Rx for Lyme Disease?

A

Doxycycline (early disease)

Ceftriaxone (disseminated disease)

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18
Q

Rx for Lyme Disease in pregnancy?

A

Amoxicillin

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19
Q

What is erythema migrans?

A

‘Bulls-eye’ rash seen in Lyme Disease.

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20
Q

What investigation to order for suspected Lyme Disease?

A

First line:
- Enzyme-linked immunosorbent assay (ELISA) - antibodies to Borrelia burgdorferi

  • If negative but disease still suspected; repeat 4-6 weeks after first test

Second line:
- In people with symptoms for 12 weeks +

  • Immunoblot test
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21
Q

What is Jarisch-Herxheimer reaction?

A

Seen after initiating therapy for Lyme Disease - fever, rash, tachycardia. Occurs after first dose of Abx. (Also seen in syphilis).

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22
Q

Symptoms of Lyme Disease?

A
  • Erythema Migrans rash (80%)
  • Systemic: fever, arthralgia
  • CV: heart block, myocarditis
  • Neuro: facial nerve palsy, meningitis
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23
Q
  1. vWD is what type of genetic trait?
  2. What does vWF do?
  3. Ix for vWD?
  4. Rx for vWD?
A
  1. Autosomal dominant (type 1)
  2. Promote normal platelet function (adhesion to endothelium) + stabilising F8 (acts as carrier molecule)
  3. Coag - APTT prolonged, vWD assay (x3 blues)
  4. Desmopressin (DDAVP)

Note: Type 3 is the worst and is autosomal recessive.

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24
Q

First line Rx for generalised seizures? This works by ________ activity.

A

Sodium Valproate

Increasing GABA activity.

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25
Q

Examples of ARB?
(Angiotensin reception blocker)

How do these work?

A

Losartan, Candesartan - all the -TANs.

Blocks AT1 receptors which angiotensin II would usually act on - found in heart, blood vessels and kidneys.

Reduces action of angiotensin II - causes vasodilation of blood vessels and stops retention of salt + water - lowering BP.

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26
Q

Examples of CCB?

How do these work?

A

Amlodipine, Felodipine, Verapamil, Diltiazem

Reduce amount of calcium entering heart and blood vessels, thus reduces muscular contraction and allowing the relaxed muscles to receive more oxygenated blood - lowering BP and treat angina.

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27
Q

Examples of thiazide-like diuretic?

How do these work?

A

Indapamide

Works in the kidneys on the proximal part of distal tubule - increases sodium excretion and urine volume - long term reduces peripheral resistance.

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28
Q

Stage 4 of HTN Rx - if potassium >4.5 then treat with _______ or _______. If <4.5 then treat with __________.

A
  1. Alpha-blocker (Doxazocin) or Beta-blocker.

2. Spironalactone.

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29
Q

How do alpha-blockers work?

A

Blocks alpha-1-adrenoreceptors found on vascular smooth muscle, preventing norepinephrine acting here which would cause vasoconstriction - allowing better blood flow + lowering blood pressure.

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30
Q

First trimester of pregnancy is up to ________ weeks gestation. Second trimester is from ___ weeks to _________. Third trimester is from ___ weeks to end of pregnancy.

A
  • 12+6 weeks
  • 26+6 weeks
  • 27 weeks
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31
Q

Likely diagnosis?

Scaly lesions under eyebrows, around nose + top of chest. Hx of dandruff.

How would you Rx?

A
  • Seborrhoeic dermatitis

- Topical Ketoconazole

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32
Q

Proliferation of Malassezia furfur causes what skin condition?

Associated with what health conditions?

A

Seborrhoeic dermatitis

HIV + Parkinson’s

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33
Q

Pregnant women with UTI. ___1____ should be avoided in first trimester; ____2____ is first line. However, this should be avoided near term because it can cause ____3_____. Second line is ___4____ or ____4____.

Asymptomatic UTI should also be treated to reduce risk of progression to _____5______.

Total of __ days Rx.

A
  1. Trimethoprim
  2. Nitrofurantoin
  3. Haemolytic disease of the newborn
  4. Amoxicillin or Cefalexin
  5. Acute pyelonephritis

Total: 7 days Rx

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34
Q

Catheterised patients with asymptomatic bacteria should or should not be Rx with Abx?

A

Should NOT

If symptomatic Rx with Abx for 3 days

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35
Q

Acute pyelonephritis should be treated with Abx for ________ days.

BNF recommends broad-spectrum ___________ for pregnant women or ____________ otherwise.

A

10-14 days

Cephalosporin - cefuroxime, ceftriaxone. (Safe in pregnancy).

Quinolone - ciprofloxacin, levofloxacin. (Avoid in pregnancy).

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36
Q

How long should SSRI be continued before thinking about stopping?

A

6 months - reduces risk of relapse.

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37
Q

What class of drugs may be associated with increased risk of VTE and stroke in elderly?

A

Atypical antipsychotics

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38
Q

Treatment with Clozapine for schizophrenia should only be commenced if there is not clinical improvement following use of at least ___ anti-psychotics for _________. One of these must be an atypical class.

Serious side effects of Clozapine include:

A
  1. 2
  2. 6-8 weeks
    • Bloods: agranulocytosis (causing neutropenia)
    • CV: myocarditis, arrhythmia
    • Other: hypersalivation + weight gain
    • Reduce seizure threshold
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39
Q

Which SSRI is recommended post MI?

If also on anti-platelet therapy what advice should be given?

A

Sertraline

Risk of dyspepsia / GI bleed - consider starting PPI.

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40
Q

In anorexia nervosa are the levels high or low?

  1. Potassium
  2. Cortisol
  3. Growth hormone
  4. Sex hormones
  5. Cholesterol
A
  1. Low
  2. High
  3. High
  4. Low
  5. High

Remember most things low except G’s and C’s which are high - growth hormone, glucose, salivary glands AND cortisol, cholesterol and carotinaemia.

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41
Q

Examples of atypical antipsychotics?

A

Clozapine, Olanzapine, Risperidone, Quetiapine, Amisulpride, Aripiprazole

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42
Q

Main side effects of atypical antipsychotics?

A
  • Weight gain
  • Agranulocytosis (clozapine)
  • Hyperprolactinaemia
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43
Q

Which atypical antipsychotic is high risk for dyslipidemia?

A

Olanzapine

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44
Q

Patient needs to be commenced on atypical antipsychotic but has a high BMI. Which one should be avoided.

A

Olanzapine

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45
Q

Which atypical antipsychotic should be used in patients with high prolactin?

A

Aripiprazole

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46
Q

Psych condition:

Patient convinced partner is cheating.

A

Othello syndrome

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47
Q

Psych condition:

Patient believes that a celebrity is in love with them. (Clare from the Bachelor)

A

De Clerambault Syndrome

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48
Q

Psych condition:

Patient believes that bugs are under their skin.

A

Delusional parasitosis or Ekbom syndrome

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49
Q

Psych condition:

Patient believes family member has been replaced by an imposter.

A

Capgras delusion

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50
Q

What SSRI is associated with hyponatraemia?

A

Sertraline

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51
Q

If patient is needing Rx for depression but is on warfarin, what medication is best?

A

Avoid SSRIs - antiplatelet effect increases risk of bleeding.

Mirtazapine should be used.

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52
Q

Monitoring when starting SSRI:

Patients should be reviewed after __ weeks or __ week if under 30 or suicidal.

SSRIs should be reduced over _______. The one that does not require this is _________.

A

2 weeks

1 week if under 30 or with suicidal ideation

Reduce over 4 weeks unless on Fluoxetine - doesn’t require.

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53
Q

Panic disorder is Rx with what?

A

SSRIs

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54
Q

You are reviewing a 24-year-old PhD student who presents with feeling on edge all of the time. He feels that nothing specific makes him feel worse. He cannot relax and as a result is not sleeping too well, but his appetite is good. He tells you that his mood is okay. You have reviewed him for several weeks with the same symptoms and despite referral to self-help sessions he has made no improvement

  • Likely diagnosis?
  • What Rx?
A

GAD

SSRIs

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55
Q

Patient usually takes POP (not Desogestrel) at 08:00 but has remembered at 12:30 that she has yet to take it - what advice would you give?

A

3 hour window

Take the missed pill ASAP and continue taking the pills as normal.

Use a condom until pill taking has been re-established for 48 hours.

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56
Q

Cerazette usually taken at 08:00 is taken at 13:00 - what should be done?

A

Nothing. 12 hour window for Desogestrel.

If longer than 12 hours then would have to use condoms until pill taking has been re-established for 48 hours.

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57
Q

Women at high risk of developing pre-eclampsia should take ___________ from _________ until delivery.

A

75mg aspirin

12 weeks

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58
Q

High risk groups for pre-eclampsia?

A
  1. Previous pre-eclampsia or pregnancy induced HTN
  2. CKD
  3. Autoimmune disorder - SLE or antiphospholipid
  4. Diabetics
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59
Q

What blood pressure is regarded as HTN in pregnancy?

From what week gestation is this regarded as pregnancy induced?

A

140/90 mmHg

20 weeks

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60
Q

What is pre-eclampsia?

A

Pregnancy induced HTN (BP of >140/90) + proteinuria (>0.3g / 24 hrs)

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61
Q

Most common cause of cyanotic congenital heart disease? What age does it typically present?

  1. VSD
  2. AVSD
  3. Tetralogy of Fallot
  4. Patent ductus arteriosus
A

Tetralogy of Fallot

Presents at 1-2 months

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62
Q

What conditions cause cyanotic congenital heart disease?

A

Tetralogy of Fallot

Transposition of the great arteries

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63
Q

Transposition of the great arteries causes what in the newborn and what age does it present?

A

Cyanosis

Within the first 24 hours of life

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64
Q

What are the features of Tetralogy of Fallot?

A

(PROV)

  1. Pulmonary stenosis
  2. Right ventricular hypertrophy
  3. Overriding aorta
  4. Ventricular septal defect
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65
Q

What are the features of Ovarian Hyperstimulation Syndrome?

A

Mild - abdo pain

Moderate - N+V, ascites

Severe - clinical ascites, oliguria

Critical - thromboembolism, ARDS, anuria, tense ascites

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66
Q

Ovarian Hyperstimulation Syndrome is caused by the presence of multiple ___________ within the ovaries, resulting in high levels of ___________ and _________ and vasoactive substances - e.g. ____________.

This causes _________________ and therefore loss of fluid from the intravascular compartment.

A

Multiple luteinized cysts

Progesterone and Oestrogen

Vascular Endothelial Growth Factor (VEGF)

Increased membrane permeability

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67
Q

Likely diagnosis?

55F presents with pain in bilateral shoulders and hips for 3 weeks, worse in the morning and increased fatigue. Bloods - ESR >40.

Rx for condition?

A

Polymyalgia rheumatica (PMR)

Steroids

Note: PMR usually in patients 60+, not associated with weakness just stiffness and lethargy. Can also have depression, fever and night sweats.

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68
Q

Rx of SLE?

A

Hydroxychloroquine

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69
Q

Rx for RA and psoriasis?

A

Sulfasalazine (DMARD)

Disease Modifying Anti-Rheumatic Drug

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70
Q

Patients with HF should be offered the ______ vaccine annually.

A

Influenza vaccine

(Pneumococcal vaccine as a once off - unless spleen issues or CKD then every 5 years).

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71
Q

First line Rx for HF?

A

ACE-inhibitor + Beta-blocker

(Bisoprolol, Carvedilol and Nebivolol tend to be used).

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72
Q

Second line Rx for HF?

A

Aldosterone antagonist - potassium sparing

E.g. Spironolactone and Eplerenone.

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73
Q

Drug mostly associated with this side-effect:

Cataracts

A

Prednisolone

  • Cushingoid
  • Osteoporosis
  • Impaired GT
  • HTN
  • Cataracts
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74
Q

Drug mostly associated with this side-effect:

Interstitial lung disease

A

Sulfasalazine (DMARD)

  • Rash
  • Oligospermia
  • Heinz body anaemia
  • Interstital lung disease
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75
Q

Drug mostly associated with this side-effect:

Corneal opacities

A

Hydroxychloroquine

  • Retinopathy
  • Corneal deposits
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76
Q

Drug mostly associated with this side-effect:

Bronchospasm in asthmatics

A

NSAIDs

  • Peptic ulcer / dyspepsia
  • Bronchospasm in asthmatics
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77
Q

Drug mostly associated with this side-effect:

Pneumonitis

A

Methotrexate

  • Myelosuppression
  • Liver cirrhosis
  • Pneumonitis
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78
Q

Drug mostly associated with this side-effect:

Exacerbation of Myasthenia Gravis

A

Penicillamine

  • Used to Rx Wilson’s disease
  • Fun fact about MG = associated with thymoma
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79
Q

Drug mostly associated with this side-effect:

Reactivation of TB

A

Infliximab or Adalimumab

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80
Q

If patient has B12 and folate deficiency, _______ must be Rx first to prevent subacute combined degeneration of spinal cord.

A

B12

- give Cobalamin injections

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81
Q

Vitamin B12 is used for RBC development and maintain CNS.

It is mostly absorbed after binding to __________ and is actively absorbed in __________.

B12 deficiency is the most common cause of ____________.

A

Intrinsic factor

Terminal ileum

Pernicious anaemia - macrocytic anaemia, sore tongue / mouth, mood disturbances (think psych)

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82
Q

Replacing folate before B12 can cause what?

A

Subacute combined degeneration of spinal cord.

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83
Q

Rx of pernicious anaemia with no neuro involvement?

A

1mg Hydroxocobalamin (IM)

  • 3 times / week for 2 weeks
  • Then once every 3 months.
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84
Q

First line Rx to induce remission in severe UC?

A

IV steroids

If no improvement in 72 hours - can consider adding ciclosporin

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85
Q

Second line Rx to induce remission in severe UC?

A

IV ciclosporin

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86
Q

Ulcerative colitis severity is dependant on number of stool and blood in stool:

Mild = ? stools / day
Moderate =
Severe =

A

Mild = <4 stools

Moderate = 4-6 stools

Severe = >6 stools + systemically unwell

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87
Q

Rx for mild to moderate flare of UC?

E.g. proctitis, left-sided UC

A

Rectal aminosalicylate with oral also given in extensive disease - Mesalazine

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88
Q

Anti-D should be given to Rhesus negative women at _____ and ______ weeks.

A

28 + 34 weeks

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89
Q

Elderly patient with non-healing skin ulcer on shin + not improved with Flucloxacillin. What Ix should be ordered?

A

Ankle-brachial pressure index - ABPI

  • ?arterial insufficiency
  • if abnormal then refer to vascular
  • biopsy to exclude malignancy to be considered

Note: Infection is not a common cause of non-healing leg ULCERS

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90
Q

Normal range of ABPI?

A

0.9 - 1.2

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91
Q

ABPI above 1.3 indicates arterial disease secondary to ______________ - seen in DM.

A

Arterial calcification

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92
Q

Mx of venous ulcers?

A

Compression bandaging

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93
Q

Fist-line of Rx for obese women with PCOS trying to conceive?

A

Weight-loss

94
Q

_________ can be given to obese women with PCOS trying to conceive to increase ovulation

A

Metformin

95
Q

General management for PCOS?

A
  1. Weight loss
  2. Combined oral contraceptive pill - regulate periods and induce bleed (if trying to conceive). Can also help with hirsutism.
96
Q

Likely diagnosis?

Bilateral + painful neck swellings post infection.

A

Reactive lymphadenopathy

97
Q

Likely diagnosis?

Rubbery + painless neck swelling. Associated with night sweats and splenomegaly.

A

Lymphoma

Burkitt’s - associated with EBV

98
Q

Likely diagnosis?

Neck swelling that moves up when swallowing. Hypo or Hyper-thyroid features also present.

A

Thyroid swelling

99
Q

Likely diagnosis?

Neck swelling that moves up when sticking out tongue. Common in young patients (< 20 years). Can be painful if infected.

A

Thyroglossal cyst

100
Q

Likely diagnosis?

Neck swelling classically on the left-side. Mostly evident around birth, 90% present before the age of 2.

A

Cystic hygroma - lymphangioma.

101
Q

Likely diagnosis?

Mobile cystic mass, develops between sternocleidomastoid and pharynx. Present in early adulthood.

A

Branchial cyst

  • Failure of obliteration of second branchial cleft in embryonic development
102
Q

Likely diagnosis?

Common in adult females. Can cause pain / tingling / weakness in the shoulder when raising arm.

A

Cervical rib - causing thoracic outlet syndrome

103
Q

All anti-malarial tablets need to be taken for 4 weeks post return from travel, apart from _________.

A

Malarone (Atorvaquone + Proguanil)

104
Q

Which anti-malarial drugs are contraindicated in epilepsy?

A

The QUINEs - Chloroquine, Mefloquine

105
Q

Which anti-malarial drug should be avoided in depression?

A

Mefloquine

106
Q

Which anti-malarial drug is contraindicated in pregnancy?

A

Doxycycline

107
Q

Which anti-malarial drug should be given with folate if taken in pregnancy?

A

Proguanil and Malarone (Atovaguone + Proguanil)

108
Q

Primary amenorrhoea is?

A

No periods by age 16 years

109
Q

Secondary amenorrhoea is?

A

Stopping of normal periods for 6 months +

110
Q

Causes if primary amenorrhoea?

A
  • Turner’s syndrome
  • Congenital adrenal hyperplasia
  • Congenital malformation of the genital tract
111
Q

Causes of secondary amenorrhoea?

A
  • PCOS
  • hypothalamic amenorrhoea (stress, excessive exercise)
  • Hyperprolactinaemia
  • Premature ovarian failure,

Other:

  • Sheehan’s syndrome
  • Asherman’s syndrome

Note: Sheehan’s syndrome = postpartum pituitary gland necrosis caused by PPH

Asherman’s syndrome = adhesions in the uterus (interuterine)

112
Q

Hutchinson’s sign?

A

Rash on the tip or side of nose - seen in Herpes zoster opthalmicus. Indicates potential ocular involvement

113
Q

Likely diagnosis?

67M presents with painful blistering rash around right eye - examination shows vesicular rash covering right trigeminal nerve dermatome.

A

Herpes zoster opthalmatica

114
Q

Likely diagnosis?

39F returns from Spain and notices two large circular plaques on scalp - resulting in hair loss at the site. On going joint pain and stiffness.

A

Discoid lupus

115
Q

Allopurinol should be given to patients with gout when?

ULT = urate-lowering therapy

A

After acute symptoms of gout have gone.

Although if attacks are super frequent then you can consider allopurinol even if inflammation hasn’t fully settled.

116
Q

Acute management of gout?

A
  1. NSAIDs (or Colchicine if contraindicated however this has a slower mechanism of action).
  2. Oral steroids if both contraindicated - Prednisolone 15mg, OD for 3 days (seen in renal)
117
Q

If patient is on Allopurinol during an acute flair of gout, it should be __________.

A

Continued

118
Q

ULT is particularly recommended if patients have > __ gout flares in 12 months, if there is _______ present and in _______ disease

A
  • 2
  • Tophi
  • Renal disease
119
Q

What drugs can precipitate gout?

A

Thiazides

120
Q

Erythema multiforme is a _________ reaction commonly triggered by _________.

A

Hypersensitivity reaction

Infection

121
Q

Likely diagnosis?

Patient with hx of viral illness 5 days ago has blisters on mouth and is now haemodynamically unstable with target lesions on back of hands and feet before spreading to chest.

A

Erythema multiforme MAJOR
- mucosal involvement

Otherwise minor

122
Q

Likely diagnosis?

Red, itchy, painful lesion usually appearing on fingers or hands. Caused by paropox virus spread from sheep and goats.

A

Orf

123
Q

First-line RX for hypercalcaemia?

A

IV fluids

124
Q

________ seizures (previously known as partial seizures) start in a specific area on ______ side of the brain.

Level of awareness can vary:

  1. ______ aware
  2. _______ impaired
  3. Awareness unknown
A
  • Focal

- One

125
Q

Generalised seizures involve ______ sides of the brain and involve loss of consciousness.

Two subdivisions:

  1. _____ (tonic-clonic)
  2. _______ (absence)
A
  • Both
  • Motor
  • Non-motor
126
Q

Acromegaly is caused by __________ secondary to a ___________ in 95%.

A
  • Excess growth hormone

- Pituitary tumour

127
Q

Features of pituitary tumour?

A

Hypopituitarism

Headaches

Bitemporal hemianopia

128
Q

Features of acromegaly?

A
  • Spade hands, large feet, large tongue, coarse facial appearance
  • Sweat gland hypertrophy = excessive sweating + oily sin
  • Galactorrhea
129
Q

Complications of acromegaly?

A

HTN
Cardiomyopathy
DM
Colorectal ca

Associated with MEN-1

130
Q

Childhood syndrome caused by:

Trisomy 13

A

Patau

131
Q

Childhood syndrome caused by:

Trisomy 18

A

Edward’s

132
Q

Childhood syndrome:

Small head, small eyes, cleft lip, polydactyly, scalp lesions

A

Patau (Trisomy 13)

133
Q

Childhood syndrome:

Small lower-jaw, low-set ears, rocker bottom feet, overlapping fingers

A

Edward’s (Trisomy 18)

134
Q

Childhood syndrome:

LD, big head, long face, long ears, big ball

A

Fragile X

135
Q

Childhood syndrome:

Webbed neck, sunken in chest (excavatum), short, congenital heart defect - which one?

A

Noonan’s syndrome

Pulmonary stenosis

136
Q

What is micrognathia?

A

Small lower jaw

137
Q

Childhood syndrome:

Micrognathia, upper airway obstruction, cleft palate

A

Pierre-Robin syndrome

138
Q

Childhood syndrome:

Obesity (constant hunger), floppy baby, low sex hormones

A

Prader-Willi

139
Q

Childhood syndrome:

Short, overly chatty, LD, congenital heart disease - which one?

A

William’s syndrome

Supravalvular aoritc stenosis

140
Q

Childhood syndrome caused by:

Chromosome 5p deletion

A

Cri du chat

141
Q

Childhood syndrome:

Characteristic cry (sounds like a kitten) - larynx + neuro problems, feeding problems, LD, small head and small lower jaw

A

Cri du chat

142
Q

Childhood syndrome:

Micrognathia, upper airway obstruction, cleft palate, family hx of same

A

Treacher-Collins

143
Q

Causes of oligohydramnios?

A 
PROM
Renal agenesis
IUGR
Post-term gestation
Pre-eclampsia
144
Q

AFI at 32-36 weeks is considered low at what ml?

A

< 500 ml

145
Q

Oral morphine conversion to subcut?

A

Divide by 2

146
Q

Oral morphine conversion to subcut diamorphine?

A

Divide by 3

147
Q

Oral codeine conversion to oral morphine?

A

Divide by 10

148
Q

Rx for otitis media?

A

Amoxicillin for 5 days

If allergy = macrolide (erythromycin or clarithromycin)

149
Q

Rx for lichen planus?

A

Topical clobetasone butyrate

150
Q

Likely diagnosis?

Abnormal flexion of finger, finger becomes ‘stuck’, common in rheumatoid arthritis

A

Trigger finger

151
Q

Patient on quadruple therapy for TB c/o vision deteriorating and becoming less vivid. What medication is the likely cause of this?

A

Ethambutol - s/e include optic neuropathy and colour blindness

152
Q

What is given alongside Ethambutol in the Rx of TB to prevent its side effects?

A

Pyridoxine (vitamin B6)

153
Q

Quadruple therapy for TB?

A

Rifampacin
Isoniazid
Pyrazinamide
Ethambutol

154
Q

What is the mechanism of action of Bupropion - help stop smoking?

  1. SSRI
  2. Norepinephrine and dopamine reuptake inhibitor + nicotinic antagonist
  3. Dopamine agonist
  4. Nicotinic receptor partial agnosit
A

2

155
Q

When should Bupropion be started?

A

1-2 weeks before patient’s target date to stop smoking

156
Q

What smoking cessation aid can be given in pregnancy / breast feeding?

  1. Varenicline
  2. Bupropion
A

Both contraindicated

157
Q

First line Rx for ankylosing spondylitis?

A

Exercise and NSAIDs

158
Q

Pregnant women <20 weeks + not immune to varicella zoster virus should be offered _________ asap if exposed.

This is effective up to ____ days after contact.

A

Varicella-zoster IG (VZIG)

10 days

159
Q

Mx of chickenpox in pregnant woman - 19 week gestation?

A

Oral Aciclovir should be CONSIDERED WITH CAUTION

160
Q

Mx of chickenpox in pregnant woman - 32 weeks gestation

A

Oral Aciclovir

161
Q

Swinging light test - right pupil constricts + left pupil constricts less than normal (looks dilated)

This is an example of what condition?

A

Optic neuritis

162
Q

Optic neuritis causes _______ in the region of eye which is aggravated by _________.

What examination should be performed?

A

Dull ache

Movement

Swinging-light test

163
Q

Rx for chlamydia in pregnant women?

A

Azithromycin 1g stat

164
Q

Test of cure should be performed _________ after infection in pregnant women.

A

6 weeks

165
Q

Perihepatitis post chlamydia?

A

Fitz-High-Curtis syndrome

166
Q

Incubation period of chlamydia?

A

7-21 days

167
Q

Characteristic of chlamydia seen on pap smear?

A

Red inclusion bodies

168
Q

Mx of chlamydia?

A

7 day doxycycline

Stat azithromycin - pregnancy

169
Q

Common side effect of sulfonylureas?

A

Hypoglycaemia

Weight gain

170
Q

Risk factor of DDH?

  1. Male sex
  2. Maternal DM
  3. Polyhydramnios
  4. Oligohydramnios
A

Oligohydramnios

171
Q

UKMEC 4 means?

A

Unacceptable health risk and should not be prescribed

172
Q

Absolute contraindications for COCP?

A
  • Migraine with aura
  • Over 35 years and smoking
  • Hx stroke, IHD, VTE
  • HTN
  • Breast feeding < 6 weeks post-partum
  • Current breat ca
173
Q

Is having a first degree relative with hx of DVT a complete contraindication for COCP?

A

No - UKMEC 3

HOWEVER risks outweigh the benefits

174
Q

Likely diagnosis?

28M c/o dry cough for 10 days, abdominal pain, widespread target lesions.

A

CAP

Mycoplasma pneumoniae

175
Q

Length of LMWH for provoked DVT?

A

3 months

176
Q

Length of LMWH for unprovoked DVT?

A

6 months

177
Q

CHANGE IN 2020:

First-line Rx for DVT - to be given if suspected + continued if confirmed?

A

DOAC

Apixaban or Rivaroxaban

178
Q

CHANGE IN 2020:

First-line Rx for DVT if eGFR < 15?

A

LMWH

179
Q

Weakness in external rotation is classically impaired in _________

A

Adhesive capsulitis

180
Q

Shoulder problems:

Popping or grinding of shoulder + positive scarf test

A

Acromioclavicular degeneration

181
Q

Shoulder problems:

Pain when reaching up to top shelves in kitchen. Shoulder abduction worse between 90-120 degrees. Popping / grinding.

A

Subacromial impingement

182
Q

Shoulder problems:

Avid gardener / fall onto arm. Weakness in shoulder and pain. Muscle wasting.

A

Rotator cuff tear

183
Q

Unilateral ENT symptoms, unilateral polyps or blood-stained discharge should be ___________?

A

Urgently referred to ENT

  • Increased suspicion of cancer.
184
Q

GORD in infants typically develops before what age?

A

8 weeks

185
Q

Next step of management for infants with GORD not responding to Gaviscon?

A

H2RA or PPI

e.g. Ranitidine

186
Q

First-line Rx for stroke?

A

Clopidogrel

187
Q

What is phimosis?

A

Foreskin cannot be retracted

188
Q

What is paraphimosis?

A

Foreskin becomes stuck behind the tip of the penis + cannot be unretracted

189
Q

What is balanitis?

A

Head of penis is swollen

190
Q

Chronic + progressive disease. Can lead to phimosis and urethral stenosis if left untreated. White, crinkly platches on foreskin

A

Lichen sclerosis of male genitalia - Balanitis xerotica obliterans

191
Q

Menopause is a clinical diagnosis. No periods for?

A

12 months

192
Q

How long do menopausal symptoms last for?

A

7 years +

193
Q

Mx of menopause:

Unsuitable for use within 12 months of last menstrual period as may cause irregular bleeding?

A

Tibolone

Replaces sex hormones - oestrogen + progesterone, but also some androgen effects

194
Q

Mx of menopause:

Used for hot flushes?

A

Clonidine

195
Q

When are pregnant women advised to get the whooping cough vaccine?

A

Between 16-32 weeks

196
Q

Whooping cough immunisation in infants is when?

A

2, 3, 4 months and then booster at 3-5 years old.

197
Q

Sx of pertussis?

A

Acute cough for 14 days

  • paroxysmal
  • inspiratory whoop
  • vomiting post cough
  • apnoea in infants
198
Q

Mx of whooping cough?

A

Admit if child is < 6 months
Clarithromycin or azithromycin
Household contacts given prophylaxis

199
Q

Kawasaki symptoms?

A 
High grade fever
Conjunctiva
Red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms and soles of feet
200
Q

Rx of Kawasaki?

A

High dose aspirin

IV Ig

201
Q

Ix in Kawasaki?

A

ECHO - coronary artery aneurysms

202
Q

Rx of salicylate OD

A

Urinary alkalinization with IV bicarb

Haemodialysis

203
Q

Rx of tricyclic antidepressant OD

A

IV bicarbonate

204
Q

Rx of digoxin OD

A

Digoxin-specific antibody

205
Q

Rx of breast cancer in pre-menopause

A

Tamoxifen

  • 5 years max
206
Q

Rx of breast ca in post-menopause

A

Anastrazole

207
Q

Tamoxifen side effects?

A

Increased risk:

  • Endometrial cancer
  • VTE
  • Menopause symptoms
208
Q

X-ray: Flattened and fragmented femoral head and widened joint space of hip

What condition is this describing?

A

Avascular necrosis of femoral head

Perthes’ disease

209
Q

What age does Perthes’ disease typically present?

A

4-8 years

210
Q

What medication could make clopidogrel less effective?

A

Omeprazole

Can use lansoprazole

211
Q

Harmful drugs in pregnancy?

A

Tetracyclines (doxy)
Aminoglycosides (gentamicin)
Sulphonamides and trimethprim
Quinolones

ACI-i
Statins 
Warfarin
Sulfonylureas
Retinoids
212
Q

Likely diagnosis?

An adult with erythematous target lesions on the hands which later spread to the torso following herpes simplex infection

A

Erythema multiforme

213
Q

Likely diagnosis?

A man with poorly controlled coeliac disease develops itchy vesicles on his elbow and bottom

A

Dermatitis herpetiformis

214
Q

Likely diagnosis?

Young adult with an abdominal herald patch, followed by erythematous, oval, scaly patches in a ‘fir-tree’ distribution

A

Pityriasis rosea

215
Q

Likely diagnosis?

An elderly woman develops itchy, tense blisters around the flexures. No mucosal involvement

A

Bullous pemphigoid

216
Q

Likely diagnosis?

A man presents with an itchy, purple, papular rash on the palms and flexor surfaces of arms. The lesions are polygonal + covered in ‘white lace’

A

Lichen planus

217
Q

Likely diagnosis?

A young adult notices hypopigmented patches on the trunk after getting a tan. Mildly pruritic with some scale.

A

Pityriasis versicolor

218
Q

Likely diagnosis?

Dementia, diarrhoea, dermatitis

A

Niacin deficiency

219
Q

Rx for mild acne rosacea

A

Topical metronidazole

220
Q

Likely diagnosis?

Young child with history of atopic eczema develops eruption of painful vesicles and pustules. Systemically unwell with fever

A

Eczema herpeticum

221
Q

Likely diagnosis?

A man presents with raised, red, spherical lesion on his neck. Initially a red spot that rapidly grew over 4 weeks

A

Pyogenic granuloma

  • ‘Eruptive haemangioma’
  • Benign skin lesion
  • Linked to: trauma, pregnancy, more common in women
222
Q

AKA ‘eruptive haemangioma’?

A

Pyogenic granuloma

223
Q

Likely diagnosis?

Itchy, red skin lesions, lymphadenopathy, hepatosplenomegaly

A

Mycosis fungoides

T-cell lymphoma

224
Q

Psoriasis made worse by which drugs?

A 
Propanolol (B-Blockers)
Lithium
ACE-i
Anti-Malarials
NSAIDs
Alcohol
225
Q

Likely diagnosis?

An elderly woman presents with an itchy lesion on her vulva. Started of red and now turned white plaque

A

Lichen sclerosis

226
Q

Rx for seborrhoeic dermatitis?

A

Topical ketoconazole

227
Q

Likely diagnosis?

Epistaxis, spider naevi, arteriovenous malformations

A

Hereditary Haemorrhagic telangiectasia

228
Q

Likely diagnosis?

Middle-aged woman develops painful, erythematous, nodular lesions over both shins

A

Erythema nodosum

229
Q

Likely diagnosis?

Grave’s disease, orange peel shin lesions

A

Pretibial myxoedema

230
Q

Likely diagnosis?

Diabetes, waxy yellow shin lesions

A

Necrobiosis lipodica diabeticorum

MSRA (2 decks)

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