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Deepa's MSRA > Was in the exam before > Flashcards

Was in the exam before Flashcards

1
Q

Baby blue

A

Mild mood disorder
Peaks on day 3-5
Improves by 10th day (review on this day)
Reassure

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2
Q

Normal pressure hydrocephalus

A

Gait disturbance - ataxia
Urinary incontinence
Dementia
VP Shunt

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3
Q

Basal Cell Carcinoma

A

Shiny pearly nodule
Central ulceration
Rolled edges
Telangiectasia
Mild trauma can cause bleeding
Tx: Imiquimod, 5-FU, cutterage, surgical excision/ Moh’s micrographic surgery if cosmetic appearance importance
Radiotherapy

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3
Q

Clonazpine monitoring

A

FBC
Weekly for 18 weeks
Fortnightly for next 34 weeks
Monthly after first 52 weeks
Risk of neutropenia, agranulocytosis, seizures, myocarditis, cardiomyopathy

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4
Q

Bacteria susceptible to after Splenectomy

A

Encapsulated bacteria : NHS GSK
Neiserria meinigitdis
HIB
Strep pneumonia
GBS
Salmonella typhi
Klebsiella pneumoniae

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5
Q

Commonest cause of septic arthritis

A

Staph aureus

Newborns can get neisseria gonnorhoeae

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6
Q

Contraception - 35F, HTN, HMB

A

IUS - Mirena
HTN makes COCP UKMEC 3/4

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7
Q

Diffuse interstital pattern CXR post RA drug?

A

Methotrexate
Hypersensitivity reaction
High dose steroids

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8
Q

45M, 2/12 Hx dyspesia, abdo SNT, Initial investigation?

A

If abscence of ALARM Sx: 13-C Urea breath test for H pylori or trial PPI
Stop NSAID if possible

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9
Q

ALARMSEP features dyspepsia

A

Anaemia (iron deficiency)
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena / haematemesis
Swallowing difficulty
Epigastric mass
Persistent vomiting

?Ca after barium meal
>55 and persistent/ new onset dyspepsia
URGENT ENDOSCOPY & FBC

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10
Q

Monitoring post anaphylaxis Tx

A

2 hours: if good response (within 5-10 mins) of single adrenaline post, complete resolution, knows how to use autoinjector, has follow up
6 hours: if needed 2 doses IM or previous biphasic response
12 hours at least: > 2dose, severe asthma, respiratory compromise, possibility of continuing slow absorption of allergen, presenting late at night, or unable to respond to deterioration/ far from A&E

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11
Q

Amlodipine side effects

A

Peripheral oedema
Aterior

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12
Q

Lithium toxicity signs

A

D&V, drowsiness, muscular weakness, uncoordination
Ataxia, blurred vision, tinnitus, dilute urine
Hyperreflexia, convulsions, renal failure

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13
Q

ECG finding in lithium toxicity

A

Reversible flattening or inversion of T waves

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14
Q

Aripiprazole toxicity signs

A

Lethargy, increased BP & HR, sleep, N&V, diarrhoea

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15
Q

Clozapine toxicity

A

Sedation, deliuruim, coma, tachycardic, hypotensive, respiratory depression, hypersalivation

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16
Q

Valproate toxicity

A

increased GABA
CNS depression - drowsiness, confusion
Tacycardic, hypotensive
N&V, abdo pain, High Na, lactic acidosis, Low Ca, hypoglycaemia

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17
Q

Fluoxetine toxicity

A

Tachycardic, drowsiness, tremor, N&V, seizures, cardiac conduction abnormality

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18
Q

Molluscum Contagiosum : cause and clinical findings

A

Poxvirus
Small shiny papules, umbilicated center
May grow in a row
Inflamed and crusty
Flexural skin

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19
Q

Molluscum Contagiosum : Tx

A

Reassure: clean towels, don’t scratch
Self limiting 12-18 month duration
Molludab 5% potassium hydroxide - BD until lesions inflamed
Cyrotherapy/ curretage

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20
Q

Inheritance pattern CF

A

Autosomal recessive
Chromosome 7
CTRF gene
If both parents carriers:
1 normal, 2 carrier, 1 affected child

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21
Q

Optic neuritis investigation

A

MRI

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22
Q

Optic neuritis presentation

A
  1. Loss of colour vision
  2. Painful eye movement
  3. Vision loss subacute
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23
Q

Wernicke’s encephalopathy (x2)

A

B1 deficiency

Confusion
Opthalmoplegia: nystagmus, lateral rectus palsy, conjugate gaze palsy
Ataxia

Petechial haemorrhages
Periperhal sensory neuropathy

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24
Q

Wernicke’s encephalopathy preciptated by:

A

Infusion of glucose in those with thiamine deficiency

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25
Q

Korsakoff syndrome

A

antero- & retrograde amnesia
confabulation

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26
Q

B12 vs folate deficiency replacement

A

1st replace B12 then folate
Otherwise risk of Subacute combined degen of cord

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27
Q

Investigation to exclude Crohn’s disease in ?acute flare

A

Faecal calprotectin

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28
Q

Faecal calprotectin

A

More specific for intestinal inflammation than CRP

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29
Q

Dry cough side effect

A

ACE inhibitor: -pril
Due to bradkinin
Switch to ARB

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30
Q

Blood transfusion reaction: Non-haemolytic febrile reaction

A

antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage

Fever, chills
Stop/ slow transfusion, monitor

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31
Q

Blood transfusion reaction: Anaphylaxis

A

Hypotension, dyspnoea, wheezing, angioedema.
Stop, IM adrenaline

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32
Q

Blood transfusion reaction: Acute haemolytic reaction

A

ABO mismatch
Fever, abdominal pain, hypotension

33
Q

Blood transfusion reaction: TACO. Transfusion-associated circulatory overload (TACO)

A

Fast transfusion
Pulmonary oedema, hypertension
Stop/slow/ Loop diuretic

34
Q

Blood transfusion reaction: TRALI Transfusion-related acute lung injury

A

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension Stop the transfusion

Oxygen and supportive care

35
Q

Platelets

A

are stored at room temperature, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus.

36
Q

Blood test to check ovulation

A

Progesterone - 7 days before peroid
Depends on length of cycle
e.g. 28 days, means a 21 day level.
35 days, means a 28 day level

> 30 = ovulation
10-30 = repeat with checks of cycle duration
<10 = unlikely ovulation

37
Q

42F presents with amenorrhoea for 5 months and palpable abdo mass

A

Most likely pregnancy

38
Q

Carcinoid syndrome vitamin deficiency

A

Increased conversion of trytophan to serotonin
Tytophan and niacin deficiency

39
Q

Niacin deficiency

A

B3
Pellagra:
dermatitis
diarrhoea
dementia

40
Q

Fungal nail infection : Treat if….

A

Walking uncomfortable
Psych stress
DM, vascular, connective tissue disorder
Causing fungal skin infection
Immunocompromised

41
Q

Fungal nail infection treatment

A

Mild superficial: topical amorofine 5% nail laquer (6 months fingernails, 9-12 months toenails)
Oral treatment for most however:
Oral terbinafine 6 weeks-3 months for fingers, 3-6 months for toenails
Oral itraconazole: pulsed

42
Q

Dx 2yo with red eye, runny nose and cough for few days, white spots on buccal mucosa

A

Measles

43
Q

9 month, vomiting, inconsolable crying, pain, redcurrant jelly diarrhoea, mass in RUQ

A

Intussception
Donut sign/ target sign on US

44
Q

Heinz body

A

G6PD deficiency

45
Q

65M, SOB, haemoptysis, WL, clubbing

A

CXR
?Lung cancer

46
Q

Waddling, climbs using arms rather than legs, prominent calf

A

Duchenne Muscular Dystrophy
X linked
No dystrophin (Beckers has abnormal dystrophin)
High CK

47
Q

Progressive whilstling and sucking through straw difficulty

A

Fascioscapulohumeral muscular dystrophy
Dominant inheritance
Face downwards - eyes, mouth, then cheeks
Winging of scapula

48
Q

Severe headache, lacrimation, most evenings for 4 weeks, 1-2 hour duration

A

Cluster headache
Can’t keep still, dark room doesn’t help

49
Q

Coal miner with SOB and eggshell calcification of lymph nodes

A

Silicosis
often in upper part of lung
if associated with RA - caplan syndrome

50
Q

asbestosis

A

gradual SOB and reduced ET
productive cough wheeze
bilateral lower zone interstital changes
pleural plaque and thickening

51
Q

Which lung cancer most frequently associated with high Ca?

A

Squamous cell carcinoma
PTHrP

52
Q

3 month old, eczema, bouts of diarrhoea and vomiting

A

Cow’s Milk Protein Allergy

Associated with GORD
Usually has good remission rates
Can be both Acute IGE related, or delayed reaction (eczema)
Comfort milk
Extensively hydrolysed or amino acid
Milk ladder - malted milk biscuits

53
Q

Achille’s tendon rupture

A

Ciprofloxacin

54
Q

Contraception, young person, travelling for a year

A

Progesterone only subdermal implant

Don’t use CU-IUD as increased PVB in first 6 months

55
Q

Risk factor for cervical cancer

A

Early first age of sex
Multiple sexual partner
Prev STI
Immunosuppression
Smoking
>5 baby, < 17 at first baby
FH

56
Q

New onset hyperthyroidism in pregnancy

A

CBZ and PTU both used in pregnancy
Carbimazole - avoid in 1st
Propythiouracil - maternal hepatotoxicity

Thus: Ideally use PTU in 1st, and switch to CBZ after

57
Q

Cataracts, frontal balding, muscle weakness. 35M

A

Myotonic dystrophy
Autosomal dominant
Facial weakness, ptosis, hollow temples, atrophy of jaw muscles
Hypernasal speech
Grop myotonia
Distal limb muscle weakness -> prooximal

58
Q

Trigeminal neuralgia treatment

A
  1. Carbamazepine
    - aplastic anaemia
    - CYP450 inducer
59
Q

DM patient with reduced shoulder movement

A

Adhesive capsulitis/ frozen shoulder

60
Q

40M with reduced peripheral vision, prominent jaw, increased shoe size, wedding ring doesn’t fit

A

Acromegaly

61
Q

Drug that increases risk of gout

A

Bendroflumethazide
Loop and thiazide diuretic
Saliclyate
Alcohol
Ethambutol
Nictonic acid
Cytotoxic agents
Pyrazinamide

62
Q

Dysphagia, bad breath (halitosis)

A

Zenker diverticulum
Constrast filling false diverticulum from posterior oeseophagus

63
Q

Erythema infectiosum

A

5th disease or slapped cheek
Parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
No school exclusion
pancytopaenia, aplastic crisis, hydrops fetalis

64
Q

IBS

A

Abdo pain relieved by opening bowels
Altered stool freq/ consistency

65
Q

ST elevation in 2,3, AVF

A

Inferior MI
RCA affected
Bradycardic

66
Q

Risk of down syndrome with maternal age

A

> 1 in 50 if >40
1 in 100 at 40 years
1 in 270 at 35 years
1 in 800 at 30 years
1 in 2500 at 20 years

67
Q

Hand foot and mouth disease

A

Coxsackie A16
Sore throat, difficulty swallowing, fever
Oral vesicles
Tender red maculopapular eruptions on buttocks and arms

68
Q

Myasthenia gravis antibody

A

Anti-Acetylcholine receptor

69
Q

Antimitochondrial antibody

A

PBC Primary biliary cirhossis

70
Q

ANA antibody

A

Many, SLE

71
Q

Anti-centromere antibody

A

CREST syndrome

72
Q

Anti-Ro or Anti- La

A

Sjogren’s syndrome

73
Q

50F lethargic, weight gain, thining, cold all the time.

A

Hashimoto’s thyroiditis
Thyroid peroxidase autoantibodies (TPO)
Diffusely enlarged thyroid glad

74
Q

Antibody to thyroid

A

TPO Antithyroid peroxidase -> Hashimoto/ hypothyriod
TSH receptors -> activates thyrotropin receptors -> Grave’s/ hyperthyroid

75
Q

Lithium maintenance tests

A

Yearly TFT, TFT, U&E, Calcium, creatinine
Lithium levels 5 days after starting/ change in dose/ intercurrent illness then weekly for 4 weeks

76
Q

27F self harm cutting herself. Mood all over the place, changes quickly, ODs with 4-6 paracetamol, voices but recognise these as own thoughts

A

Borderline personality disorder
Impulsive, emotional instability, feeling empty, intense and unable relationships, self harm/ sucidal thoughts
Pseudeohallucinations

77
Q

40F tender breast lump, changes in size during menstrual cycle

A

Breast cyst

78
Q

Dull CP and SOB. Raised JVP. Soft heart sounds. BP that drops on inspiration. What investigation?

A

Cardiac tamponade
Echo

79
Q

Dry cough and red eye

A

SLE

80
Q

Milk alkali syndrome

A

High calcuim, renal failure, metabolic alkalosis
High ingestion of antaacids

Deepa's MSRA (3 decks)

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