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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, 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
Wernicke's encephalopathy preciptated by:
Infusion of glucose in those with thiamine deficiency
25
Korsakoff syndrome
antero- & retrograde amnesia confabulation
26
B12 vs folate deficiency replacement
1st replace B12 then folate Otherwise risk of Subacute combined degen of cord
27
Investigation to exclude Crohn's disease in ?acute flare
Faecal calprotectin
28
Faecal calprotectin
More specific for intestinal inflammation than CRP
29
Dry cough side effect
ACE inhibitor: -pril Due to bradkinin Switch to ARB
30
Blood transfusion reaction: Non-haemolytic febrile reaction
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
31
Blood transfusion reaction: Anaphylaxis
Hypotension, dyspnoea, wheezing, angioedema. Stop, IM adrenaline
32
Blood transfusion reaction: Acute haemolytic reaction
ABO mismatch Fever, abdominal pain, hypotension
33
Blood transfusion reaction: TACO. Transfusion-associated circulatory overload (TACO)
Fast transfusion Pulmonary oedema, hypertension Stop/slow/ Loop diuretic
34
Blood transfusion reaction: TRALI Transfusion-related acute lung injury
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
Platelets
are stored at room temperature, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus.
36
Blood test to check ovulation
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
42F presents with amenorrhoea for 5 months and palpable abdo mass
Most likely pregnancy
38
Carcinoid syndrome vitamin deficiency
Increased conversion of trytophan to serotonin Tytophan and niacin deficiency
39
Niacin deficiency
B3 Pellagra: dermatitis diarrhoea dementia
40
Fungal nail infection : Treat if....
Walking uncomfortable Psych stress DM, vascular, connective tissue disorder Causing fungal skin infection Immunocompromised
41
Fungal nail infection treatment
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
Dx 2yo with red eye, runny nose and cough for few days, white spots on buccal mucosa
Measles
43
9 month, vomiting, inconsolable crying, pain, redcurrant jelly diarrhoea, mass in RUQ
Intussception Donut sign/ target sign on US
44
Heinz body
G6PD deficiency
45
65M, SOB, haemoptysis, WL, clubbing
CXR ?Lung cancer
46
Waddling, climbs using arms rather than legs, prominent calf
Duchenne Muscular Dystrophy X linked No dystrophin (Beckers has abnormal dystrophin) High CK
47
Progressive whilstling and sucking through straw difficulty
Fascioscapulohumeral muscular dystrophy Dominant inheritance Face downwards - eyes, mouth, then cheeks Winging of scapula
48
Severe headache, lacrimation, most evenings for 4 weeks, 1-2 hour duration
Cluster headache Can't keep still, dark room doesn't help
49
Coal miner with SOB and eggshell calcification of lymph nodes
Silicosis often in upper part of lung if associated with RA - caplan syndrome
50
asbestosis
gradual SOB and reduced ET productive cough wheeze bilateral lower zone interstital changes pleural plaque and thickening
51
Which lung cancer most frequently associated with high Ca?
Squamous cell carcinoma PTHrP
52
3 month old, eczema, bouts of diarrhoea and vomiting
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
Achille's tendon rupture
Ciprofloxacin
54
Contraception, young person, travelling for a year
Progesterone only subdermal implant Don't use CU-IUD as increased PVB in first 6 months
55
Risk factor for cervical cancer
Early first age of sex Multiple sexual partner Prev STI Immunosuppression Smoking >5 baby, < 17 at first baby FH
56
New onset hyperthyroidism in pregnancy
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
Cataracts, frontal balding, muscle weakness. 35M
Myotonic dystrophy Autosomal dominant Facial weakness, ptosis, hollow temples, atrophy of jaw muscles Hypernasal speech Grop myotonia Distal limb muscle weakness -> prooximal
58
Trigeminal neuralgia treatment
1. Carbamazepine - aplastic anaemia - CYP450 inducer
59
DM patient with reduced shoulder movement
Adhesive capsulitis/ frozen shoulder
60
40M with reduced peripheral vision, prominent jaw, increased shoe size, wedding ring doesn't fit
Acromegaly
61
Drug that increases risk of gout
Bendroflumethazide Loop and thiazide diuretic Saliclyate Alcohol Ethambutol Nictonic acid Cytotoxic agents Pyrazinamide
62
Dysphagia, bad breath (halitosis)
Zenker diverticulum Constrast filling false diverticulum from posterior oeseophagus
63
Erythema infectiosum
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
IBS
Abdo pain relieved by opening bowels Altered stool freq/ consistency
65
ST elevation in 2,3, AVF
Inferior MI RCA affected Bradycardic
66
Risk of down syndrome with maternal age
>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
Hand foot and mouth disease
Coxsackie A16 Sore throat, difficulty swallowing, fever Oral vesicles Tender red maculopapular eruptions on buttocks and arms
68
Myasthenia gravis antibody
Anti-Acetylcholine receptor
69
Antimitochondrial antibody
PBC Primary biliary cirhossis
70
ANA antibody
Many, SLE
71
Anti-centromere antibody
CREST syndrome
72
Anti-Ro or Anti- La
Sjogren's syndrome
73
50F lethargic, weight gain, thining, cold all the time.
Hashimoto's thyroiditis Thyroid peroxidase autoantibodies (TPO) Diffusely enlarged thyroid glad
74
Antibody to thyroid
TPO Antithyroid peroxidase -> Hashimoto/ hypothyriod TSH receptors -> activates thyrotropin receptors -> Grave's/ hyperthyroid
75
Lithium maintenance tests
Yearly TFT, TFT, U&E, Calcium, creatinine Lithium levels 5 days after starting/ change in dose/ intercurrent illness then weekly for 4 weeks
76
27F self harm cutting herself. Mood all over the place, changes quickly, ODs with 4-6 paracetamol, voices but recognise these as own thoughts
Borderline personality disorder Impulsive, emotional instability, feeling empty, intense and unable relationships, self harm/ sucidal thoughts Pseudeohallucinations
77
40F tender breast lump, changes in size during menstrual cycle
Breast cyst
78
Dull CP and SOB. Raised JVP. Soft heart sounds. BP that drops on inspiration. What investigation?
Cardiac tamponade Echo
79
Dry cough and red eye
SLE
80
Milk alkali syndrome
High calcuim, renal failure, metabolic alkalosis High ingestion of antaacids
81
Asbestos which cancer
Lung cancer more than mesothelioma larynx, ovarian cancer, stomach, pharynx, rectal
82
New Anti HTN medication Tiredness, weakness, leg cramps Long PR and flattened T waves Which drug?
Hypokalaemia Sx Indapamide Diuretics - thiazide, loop or osmotic
83

Deepa's MSRA (4 decks)

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