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MLA Content > MLA Paper 1 > Flashcards

MLA Paper 1 Flashcards

1
Q

motor neuron disease: types

typically LMN signs in arms and UMN signs in legs
in familial cases the gene responsible lies on chromosome 21 and codes for superoxide dismutase

A

Amyotrophic lateral sclerosis (50% of patients)

Primary lateral sclerosis
* UMN signs only

Progressive muscular atrophy
* LMN signs only
* affects distal muscles before proximal
* carries best prognosis

Progressive bulbar palsy
* palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
* carries worst prognosis

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2
Q

Upper vs lower motor neuron signs

A
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3
Q

common clinical sign that may be found with a mid shaft humeral fracture

A

Wrist drop
- radial nerve runs in the radial groove of the mid shaft of the humerous
- very vulnerable to damage in a mid shaft fracture

Axillary nerve located near proximal humerus !

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4
Q

this type of medication has the strongest evidence base for reducing relapse in multiple sclerosis

A

Natalizumab : monoclonal antibody

Note: amantadine can reduce fatigue

antagonises alpha-4-beta-1 integrin found on surface of leucocytes - reducing migration of leukocytes across the blood brain barrier

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5
Q

Multiple sclerosis: specific problems and management

A

1. Fatigue –> amantadine , mindfullness training and CBT

2. Spasticity –>
* 1st line:baclofen & gabapentin
* 2nd line: diazepam, dantrolene and tizanidine, physio

3. Bladder dysfunction
* urgency, incontinence, overfloq?
* USS
* If significant residual volume –> intermittent self-catheterisation
* If no significant residual volume –> anticholingerics may improve

4. Oscillopsia (visual fields appear to oscillate)
* 1st line: Gabapentin

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6
Q

what type of imaging should be used to view demyelinating lesions?

A

MRI w/ contrast

Will show plaques representing areas of demyelination

MRI showing multiple white matter plaques perpendicular to the corpus callosum --> DAWSONs fingers!
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7
Q

‘Tear drop’ poikilocytes are seen in:

A

Myelofibrosis

Seen within the cytoplasm of myeloid blast cells

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8
Q

Smear cells are typically seen in

A

chronic lymphocytic leukaemia (CLL)

they are remnants of cells and have no identifiable plasma membrane or nuclear structure

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9
Q

these type of cells are generally found in hereditary spherocytosis or autoimmune haemolytic anaemia

A

SPHEROCYTES

Sphere shaped cells rather than donut shaped , more fragile than normal red blood cells.

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10
Q

these type of cells are generally seen within iron-deficiency anaemia or hyposplenism

A

TARGET CELLS

Increase in red cell surface area or decrease in intracellular haemoglobin

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11
Q

first line treatment in otitis externa

A

Ciprofloxacin and dexamethasone

Topical antibiotics with or without steroid

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12
Q

Chicken pox exposure in pregnancy:

A
  1. Ask patients chicken pox history
  2. check maternal blood for varicella antibodies
  3. If confirmed not immune then considr varicella immunoglobulin (effective up to 10 days post exposure, given at any point)
  4. oral aciclovir now 1st choice of PEP (day 7 to day 14 after exposure)
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13
Q

Infective endocarditis in intravenous drug users most commonly affects

A

tricuspid valve

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14
Q

If a mild-moderate flare of distal ulcerative colitis doesn’t respond to topical (rectal) aminosalicylates then what should be added

A

oral aminosalicylates

e.g. mesalazine / sulphalazine

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15
Q

What test is used for the diagnosis of T1DM?

A

Random plasma glucose >11 is diagnostic for T1DM or fasting plasma glucose > 7

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16
Q

This

classically presents with a sore throat, fever, headache, bright red tongue and a coarse, red rash

A

SCARLET FEVER

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17
Q

Scarlet fever: management

A

10 days of phenoxymethylpenicillin or azithromycin (if pen allergic)

Notifiable disease.
Children can reutrn to school 24 hours after commencing antibiotics

18
Q

This condition presents with an erythematous polymorphous rash, strawberry tongue, cervical lymphadenopathy, bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.

Patients may have a fever lasting 5 days

A

KAWASAKI DISEASE

19
Q

this presents with a diffuse erythematous facial rash appearing on one or both cheeks (resembling a ‘slapped cheek’) in children

A

Parvovirus b19

20
Q

Critieria for discharge post asthma exacerbatio

A
  1. Been stable on their discharge medication for 12-24 hours
  2. Inhaler technique checked and recorded
  3. PEF > 75% of best or predicted
21
Q

this is a test for infectious mononucleosis, glandular fever, detecting the Epstein Barr virus

A

Monospot test

22
Q

these medications are known to exacerbate plaque psoriasis

A

Beta blockers

B - beta blockers
L - lithium
A - ACEi
N - NSAIDs
Q - quinines

23
Q

Prophylaxis for spontaneous bacterial peritonitis:

A

Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin as prophylaxis

Treat - Cefotaxime
Prevent - Ciprofloxacin

24
Q

How might you reduce the risk of hypertensive disorders in pregnancy?

A

women should take 75-150mg daily from 12 weeks gestation until birth

> 1 high risk factors
2 moderate risk factors

25
Q

pulseless VT management

A

CPR and Defibrillation

26
Q

VT with a pulse

A

Synchronised DC cardioversion

27
Q

Polymyalgia rheumatic: tx

A

Tx
–> prednisolone e.g. 15mg/od

Patients typically respond dramatically to steroids!

Weakness is not considered a symptom of polymyalgia rheumatica –> its mainly due to pain inhibition

28
Q

Patients with heart failure with reduced LVEF should be given

A

beta blocker and an ACE inhibitor as first-line treatment

29
Q

Drugs that may lead to serotonin syndrome?

A

STEAM

S: SSRI
T: Tramadol
E: Ecstasy
A: Amphetamines
M: MAOi

30
Q

lithium toxicity: management

A
  1. Mild-moderate = volume resuscitation with normal saline
  2. Haemodialysis in severe toxicity
  3. Sodium bicarbonate (increasing alkalinity of urine thus promotes lithium excretion)
31
Q

Dialysis Indications

A

A - Acidosis
E - Electrolyte (Refractory Hyperkalaemia)
I - Ingested Toxins (SLIME = Salicylates, Lithium, Isopropanol, Methanol/Mg Laxatives, Ethylene Glycol)
O - Refractory oedema
U - Uraemic Encephalopathy/Carditis

32
Q

What is subclinical hypothyroidism?

A

TSH raised, but T3,T4 normal.
No obvious symptoms.

Management
1. TSH > 10 and free thyroxine normal range : offer levothyroxine if TSH level is >10 on 2 separate occasions 3 months apart

  1. TSH between 5.5-10 and free thyroxine w/i normal range
    a) < 65 years then consider 6 month trial of levothyroxine if TSH level between .5-10 on two separate occasions three months apart AND hypothyroidism symptoms
  2. If older: (over 80) then watch and wait strategy is used
33
Q

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either …………. or …………. to maintain remission

A

Oral azathioprine or oral mercaptopurine to maintain remission

Topical aminosalicylate may be used to induce and maintain remission of mild to moderate ulcerative colitis.

34
Q

Painful shin rash + cough → sarcoidosis?

What abnormality is most likely to be seen on bloods:

A

serum ACE level

35
Q

Irreducible, painful lump inferolateral to the pubic tubercle → ?

A

strangulated femoral hernia

36
Q

triad of falling BP, rising JVP and muffled heart sound is characteristic of

A

BECKS TRIAD

CARDIAC TAMPONADE

Mx –> urgent pericardiocentesis

37
Q

Warfarin drug interactions

A

Inducers:
“SCARS”
* S → Smoking
* C → Chronic alcohol intake
* A → Anti- epileptics: Phenytoin, Carbamazepine, Phenobarbitone (all barbiturates)
* R → Rifampicin
* S → St John’s Wort

Inhibitors:
“ASS-ZOLES”
* A → Antibiotics: Ciprofloxacin, Erythromycin, Isoniazid
* S → SSRIs: Fluoxetine, Sertraline
* S → Sodium Valproate
* - Zoles → Omeprazole, Ketoconazole, Fluconazole

38
Q

Galeazzi vs Monteggia’s fracture

A
  • G: Galeazzi
  • R: radius
  • I: inferior
  • M: Monteggia
  • U: ulna
  • S: superior
39
Q

Acute heart failure with hypotension: mx

A

inotropic support on the high dependency unit

e.g. dobutamine

40
Q

INR 5.0-8.0 (no bleeding) -

A

withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose

41
Q

INR

Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)

A
  • Stop warfarin
  • Give intravenous vitamin K 5mg
  • Prothrombin complex concentrate - if not available then FFP*

MLA Content (25 decks)

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