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1
Q

statins RFs

when to stop

who gets it

A

include advanced age, female sex, low body mass index and presence of multisystem disease such as diabetes mellitus. Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)

3x upper limit

Who should receive a statin?
all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

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2
Q

Diagnostic criteria for diabetes

A

If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/

C-peptides low

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3
Q

first line Mx for neuropathic pain

A

amitriptyline, duloxetine, gabapentin or pregabalin

tramadol is rescue therapy

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4
Q

organism after influenza A

A

staph aureus

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5
Q

most common bone mets place

A

The spine is the most common site for bone metastases due to its high content of red marrow, which contains many blood vessels that provide a suitable environment for tumor cells to grow. Additionally, the spine’s venous plexus allows for easy access of circulating tumor cells to the vertebral column.

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6
Q

In which conditions should uliprilsal be used in caution

A

severe asthma

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7
Q

Diagnosis of a mesothelioma

A

is made on histology, following a thoracoscopy

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8
Q

when to screen for diabetes in first time pregnant woman

A

All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks

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9
Q

worst prognostic factor for melanoma

A

Melanoma: the invasion depth of the tumour is the single most important prognostic factor

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10
Q

Meningitis in children < 3 months mX

A

give IV amoxicillin in addition to cefotaxime to cover for Listeria

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11
Q

CT changes for HSV encephalitis

A

medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients

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12
Q

Mx of osteoporosis

A

1st line - oral alendronate
then denosumab - diarrhoea, dyspnoea
rare hypocalcaemia, URTI

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13
Q

HOCM sound

A

ejection systolic murmur, louder on performing Valsalva and quieter on squatting

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14
Q

First line treatment for leigonella

A

macrolide - clartihromycin

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15
Q

RF for adhesive capsulitis

A

Diabetes mellitus

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16
Q

granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis.

A

The combination of ENT, respiratory and renal involvement

upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions

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17
Q

scarlet fever features

A

Group A haemolytic streptococci
2-6 years
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash - sandpaper

oral penicillin V for 10 days

complications
otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

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18
Q

nitrogen washout test

A

differentiate cardiac from non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

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19
Q

Drug to maintain PDA

A

PG E1

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19
Q

Ix for coeliac disease

A

TTG IgA
Gold standard
Endoscopic intestinal biopsy

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

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19
Q
A

renal transplant
fever
BL pneumonia, deranged LFT and lymphadenopathy

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19
Q

Ix for acromegaly

A

IGF 1 measurements
oral glucose tolerance test with serial GH measurements

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20
Q

adjuvant treatment in HER2+ breast cancer treatment

A

transtuzmab

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21
Q

at what age does children start walking at

A

13-15 months

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22
when do you start antibiotics in whooping cough and what is given when are pregnant woman given vaccinationa
ram-negative bacterium Bordetella pertussis. an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread Women who are between 16-32 weeks pregnant will be offered the vaccine.
23
Discitis features
Back pain General features pyrexia, rigors sepsis Neurological features e.g. changing lower limb neurology if an epidural abscess develops six to eight weeks of intravenous antibiotic therapy need to be assessed for endocarditis
24
features Ix
abdominal pain - in acute mesenteric ischaemia this is often of sudden onset, severe and out-of-keeping with physical exam findings rectal bleeding diarrhoea fever bloods typically show an elevated white blood cell count associated with a lactic acidosis CT
25
Hypercalcaemia features
Features 'bones, stones, groans and psychic moans' corneal calcification shortened QT interval on ECG hypertension
26
Types of heart block
First degree heart block PR interval > 0.2 seconds Second degree heart block type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex Third degree (complete) heart block there is no association between the P waves and QRS complexes
27
Management of hyperthyroidism in pregnant woman
First trimester - Porpylurathicil then carbimazole
28
Antibiotics used to treat MRSA
vancomycin teicoplanin linezolid
29
Features of subclinical hypothyroidism Mx
TSH raised but T3, T4 normal TSH is > 10mU/L and the free thyroxine level is within the normal range consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range if < 65 years consider offering a 6-month trial of levothyroxine if: the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and there are symptoms of hypothyroidism in older people (especially those aged over 80 years) follow a 'watch and wait' strategy is often used if asymptomatic people, observe and repeat thyroid function in 6 months
30
Define blindness
<3/60 with a full visual field and wearing glasses or contact lenses as prescribed.
31
H.Pylori complications
peptic ulcer disease, MALT, Gastric adenocarcinoma, IDA, Coronarits
32
contraindication of MMR vaccine
undiagnosed neurological condition
33
Mx of corneal abrasion
topical antibiotics
34
Myelofibrosis feature
Myelofibrosis is associated with 'tear drop' poikilocytes on blood film
35
Stroke Mx
aspirin 2 weeks then clopidogrel in AF warfarin direct Xa inhibitor
36
common cold is caused by
rhinovirus
37
38
how long does it take for finasteride to work
6 months
39
Tx for hot flushes
SSRIs
40
Mx of unilateral descended testis when to refer
3 months
41
cyst management
pre menopausal <5cm repeat US in 8-12 weeks
42
if they are at high risk of developing what do we give
aspirin
43
definition of HTN in pregnancy
Hypertension in pregnancy in usually defined as: systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic labetalol
44
Mx of HTN in diabetic patients
ACE inhibitors/A2RBs are first-line regardless of age
45
do we continue antcoag if DC cardioversion is successful
yes
46
what is cushings triad
hypertension and bradycardia irregular breadthing raised intracranial pressure
47
when to give contraception or stop it in menopausal woman
>50 stopped a year no contraception <50 2 years stopped
48
MS Mx fatigue spasticity bladder dysfunction oscillopsia
fatigue - amantadine spasticity - baclofen and gabapentin bladder dysfunction - oscillopsia
49
Mx of stress urge incontinence
stress -> Duloxetine Urge -> oxybutynin/ mirabegron
50
Mx for keloid scarring
intralesional steroids
51
antidote for antifreeze antidote for organophosphate insecticide poisoning
fomepizole atropine
52
what type of anaemia can phenytoin cuase
megaloblastic anaemia
53
which medication cannot be prescirbed with methotrexate
co-trimoxazole avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
54
kallmans syndrome
LH & FSH low-normal and testosterone is low
55
isolation criteria mumps Rubella measles
5 days from onset of glands Rubella - 5 days from rash Measels 4 days from rash
56
how to wean off temazepam
switch to diazepam then wean off 2 1/2 months as diazepam has a longer half life
57
Mx of bacterial vaginosis
oral metronidazole
58
ARMD RFs Dry v Wet
smoking FH advancing age Dry - yellow deposits wet - choroidal neovascularisation - in wet ARMD well demarcated red patches Sx- distortion -> Dry Mx zinc with anti-oxidant vitamins A,C and E reduced progression Wet Mx - anti vegf
59
Adverse effects of sulphonylurea
hypoglycaemia, weight gain avoid in breastfeedng and pregnancy
60
Mx of umbilical hernia in children
resolve by 3 years of age
61
Mx Generalised tonic clonic seizures Focal seizures Absence seizures Myoclonic seizures Tonic or atonic seizures
Generalised tonic clonic seizures males: sodium valproate females: lamotrigine or levetiracetam Focal seizures first line: lamotrigine or levetiracetam second line: carbamazepine, oxcarbazepine or zonisamide Absence seizures (Petit mal) first line: ethosuximide second line: male: sodium valproate female: lamotrigine or levetiracetam Myoclonic seizures males: sodium valproate females: levetiracetam Tonic or atonic seizures males: sodium valproate females: lamotrigine
62
Mx of impetigo
localised hydrogen peroxide cream topical fusidic acid extensive oral fluclox
63
Sx of HUS
HUS is associated with a triad of microangiopathic haemolytic uraemia, acute kidney injury and thrombocytopenia
64
HSP features
Features of HSP are typically a non-blanching rash affecting the legs and buttocks, arthralgia and abdominal pain
65
when to refer to maternal unit if you cant feel any kicks
24 weeks
66
if a woman is rhesus -ve Mx
28 + 34 weeks
67
antibody of drug induced lupus
antihistone
68
which antibiotic lowers threshold for seizures
ciprofloxacin
69
triad of shaken baby syndrom
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of the shaken baby syndrome
70
what does the grace score include
age ECG troponin renal function
71
when can you given sidenalfil after MI
6 Months
72
achalasia define
dysphagia both liquids and solids
73
Rubella features
congenital cataracts, sensorineural deafness and pulmonary artery stenosis
74
Mx of blepharitis
hot compression and removal of lid debris
75
donepezil cannot be used with what condition
bradycardia
76
cubital tunnel syndrome?
compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger
77
Diclofenac is contraindicated in which condition
cardiovascular disease
78
Mx of MSRA
Vancomycin
79
Schisotosoma haematobium predisposes you to which cancer
squamous cell bladder cancer
80
useful test of exocrine function in chronic pancreatits
faecal elastase
81
what medication can be given to reduce the risk of tumor lysis syndrome
allopurinol or rasburicase
82
what Ix is done before starting trastuzumab
echo as it causes cardiac toxicity
83
PAD Mx
Clopidogrel and statin
84
Levonogestrel
stop ovulation and inhibit implantation 72 hours
84
relationship between body temp and ovulation
temp rises after ovualtion
85
ullipristal
inhibition of ovulation 120 hours caution in asthmatic
86
Septic arthritis
4-6 weeks
87
which valve is affected in infective endocarditis
tricuspid valve
88
what to monitor when giving mg sulphate
respiratory rate + reflexes
89
simvastatin is lowered for which drug
amlodipine
90
causes of dupytrens contracture
manual labour phenytoin treatment alcoholic liver disease diabetes mellitus trauma to the hand
91
venlafaxine MOA
serotonin and noradrenaline reuptake inhibitor
92
Drugs that cause gingivial hyperplasia
phenytoin, ciclosporin, calcium channel blockers and AML
93
Nicorandil SE
anal ulceration
94

MSRA (1 decks)

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