Medicine MSRA

Question 1

What is the first-line treatment for Paracetamol overdose?

Answer 1

Activated charcoal if ingested < 1 hour ago, N-acetylcysteine (NAC), liver transplantation

Activated charcoal is effective only if administered shortly after ingestion.

Question 2

What are the main treatments for Salicylate overdose?

Answer 2

Urinary alkalinization with IV bicarbonate, haemodialysis

Urinary alkalinization helps in promoting the excretion of salicylate.

Question 3

What is the antidote for opioid/opiates overdose?

Answer 3

Naloxone

Naloxone is a specific opioid antagonist used to reverse the effects of opioid overdose.

Question 4

What is the management for benzodiazepine overdose?

Answer 4

Flumazenil

Flumazenil is generally avoided due to the risk of seizures, especially in severe cases.

Question 5

True or False: Flumazenil is safe to use in all benzodiazepine overdoses.

Answer 5

False

It is generally only used in severe or iatrogenic overdoses due to seizure risk.

Question 6

What is the management for tricyclic antidepressant overdose?

Answer 6

IV bicarbonate, avoid class 1a and class Ic antiarrhythmics, avoid class III drugs, correct acidosis first

Dialysis is ineffective in removing tricyclics.

Question 7

In lithium toxicity, what may be used for mild-moderate cases?

Answer 7

Volume resuscitation with normal saline

Severe toxicity may require haemodialysis.

Question 8

What is the treatment for Warfarin overdose?

Answer 8

Vitamin K, prothrombin complex

These treatments help reverse the anticoagulation effects of Warfarin.

Question 9

What is the antidote for Heparin overdose?

Answer 9

Protamine sulphate

Protamine sulphate is used to neutralize the effects of heparin.

Question 10

What should be administered if a patient is bradycardic due to beta-blocker overdose?

Answer 10

Atropine

Glucagon may be used in resistant cases.

Question 11

What is the first-line treatment for ethylene glycol poisoning?

Answer 11

Fomepizole

Ethanol has historically been used but is now less favored.

Question 12

What is the management for methanol poisoning?

Answer 12

Fomepizole or ethanol, haemodialysis

Both fomepizole and ethanol inhibit alcohol dehydrogenase to prevent toxic metabolite formation.

Question 13

What is the primary treatment for organophosphate insecticide poisoning?

Answer 13

Atropine

The role of pralidoxime in treatment remains unclear.

Question 14

What is used to treat digoxin toxicity?

Answer 14

Digoxin-specific antibody fragments

These fragments bind to digoxin and help reverse its effects.

Question 15

What is the treatment for iron overdose?

Answer 15

Desferrioxamine, a chelating agent

Desferrioxamine helps remove excess iron from the body.

Question 16

What are the treatments for lead poisoning?

Answer 16

Dimercaprol, calcium edetate

These agents chelate lead to facilitate its excretion.

Question 17

What is the management for carbon monoxide poisoning?

Answer 17

100% oxygen, hyperbaric oxygen

Administering high concentrations of oxygen helps displace carbon monoxide from hemoglobin.

Question 18

What is the treatment for cyanide poisoning?

Answer 18

Hydroxocobalamin; combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

Hydroxocobalamin binds to cyanide, forming a non-toxic compound.

Question 20

What are antipsychotics primarily used for?

Answer 20

Management of schizophrenia and other forms of psychosis, mania, and agitation

Question 21

How are antipsychotics categorized?

Answer 21

Typical and atypical antipsychotics

Question 22

What issue led to the development of atypical antipsychotics?

Answer 22

Problematic extrapyramidal side-effects associated with typical antipsychotics

Question 23

What is the mechanism of action for typical antipsychotics?

Answer 23

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in mesolimbic pathways

Question 24

What receptors do atypical antipsychotics act on?

Answer 24

D2, D3, D4, 5-HT

Question 25

What are common adverse effects of typical antipsychotics?

Answer 25

Extrapyramidal side-effects and hyperprolactinaemia

Question 26

What are examples of typical antipsychotics?

Answer 26

* Haloperidol * Chlorpromazine

Question 27

What are examples of atypical antipsychotics?

Answer 27

* Clozapine * Risperidone * Olanzapine

Question 28

What are extrapyramidal side-effects (EPSEs)?

Answer 28

Motor control symptoms caused by antipsychotic medications

Question 29

What are some types of extrapyramidal side-effects?

Answer 29

* Parkinsonism * Acute dystonia * Akathisia * Tardive dyskinesia

Question 30

What is tardive dyskinesia?

Answer 30

Late onset of choreoathetoid movements, abnormal and involuntary, may be irreversible

Question 31

What specific warnings has the Medicines and Healthcare products Regulatory Agency issued for antipsychotics in elderly patients?

Answer 31

* Increased risk of stroke * Increased risk of venous thromboembolism

Question 32

What are some other side-effects of antipsychotics?

Answer 32

* Dry mouth * Blurred vision * Urinary retention * Constipation * Sedation * Weight gain * Raised prolactin

Question 33

What can raised prolactin levels result in?

Answer 33

Galactorrhoea

Question 34

What syndrome is characterized by pyrexia and muscle stiffness?

Answer 34

Neuroleptic malignant syndrome

Question 35

What effect do atypical antipsychotics have on seizure threshold?

Answer 35

Greater reduction in seizure threshold compared to typical antipsychotics

Question 36

Which antipsychotic is particularly associated with a prolonged QT interval?

Answer 36

Haloperidol

Question 37

Fill in the blank: Typical antipsychotics are primarily _______ receptor antagonists.

Answer 37

D2

Question 38

True or False: Atypical antipsychotics are less likely to cause extrapyramidal side-effects than typical antipsychotics.

Answer 38

True

Question 39

What percentage of intracranial tumors do vestibular schwannomas account for?

Answer 39

Approximately 5% ## Footnote Vestibular schwannomas are also known as acoustic neuromas.

Question 40

What percentage of cerebellopontine angle tumors are vestibular schwannomas?

Answer 40

90% ## Footnote This highlights their prevalence in that specific region.

Question 41

What are the classical symptoms of vestibular schwannoma?

Answer 41

Vertigo, hearing loss, tinnitus, absent corneal reflex ## Footnote Symptoms vary based on the affected cranial nerves.

Question 42

Which cranial nerve is associated with vertigo and unilateral sensorineural hearing loss in vestibular schwannoma?

Answer 42

Cranial nerve VIII ## Footnote This nerve is crucial for balance and hearing.

Question 43

What is the significance of cranial nerve V in vestibular schwannoma?

Answer 43

Absent corneal reflex ## Footnote This indicates involvement of sensory function.

Question 44

What symptom is associated with cranial nerve VII in vestibular schwannoma?

Answer 44

Facial palsy ## Footnote This indicates the impact on motor function.

Question 45

In which condition are bilateral vestibular schwannomas commonly seen?

Answer 45

Neurofibromatosis type 2 ## Footnote This genetic disorder is characterized by the development of tumors.

Question 46

What should be done for patients with a suspected vestibular schwannoma?

Answer 46

Refer urgently to ENT ## Footnote Urgent referral is crucial for proper management.

Question 47

How do vestibular schwannomas typically behave?

Answer 47

Slow growing, benign, often observed initially ## Footnote This means they may not require immediate intervention.

Question 48

What is the investigation of choice for vestibular schwannoma?

Answer 48

MRI of the cerebellopontine angle ## Footnote MRI provides detailed imaging for diagnosis.

Question 49

What role does audiometry play in the evaluation of vestibular schwannoma?

Answer 49

Important as only 5% of patients will have a normal audiogram ## Footnote Audiometry helps assess hearing function.

Question 50

What are the management options for vestibular schwannoma?

Answer 50

Surgery, radiotherapy, observation ## Footnote Management depends on various factors including tumor size and symptoms.

Question 52

What condition has no exclusion from school?

Answer 52

Conjunctivitis ## Footnote Other conditions with no exclusion include Fifth disease, Roseola, Infectious mononucleosis, Head lice, Threadworms, and Hand, foot and mouth.

Question 53

How long after commencing antibiotics can a child with scarlet fever return to school?

Answer 53

24 hours ## Footnote Alternatively, a child may return 21 days from the onset of symptoms if no antibiotics are given.

Question 54

What is the exclusion period for whooping cough?

Answer 54

2 days after commencing antibiotics or 21 days from onset of symptoms ## Footnote If no antibiotics are administered.

Question 55

How many days after the onset of rash does measles require exclusion?

Answer 55

4 days ## Footnote This is the period during which a child must be excluded from school.

Question 56

What is the exclusion period for rubella?

Answer 56

5 days from onset of rash

Question 57

When can a child with chickenpox return to school?

Answer 57

All lesions crusted over ## Footnote The exclusion period has varied, but lesions must be crusted before returning.

Question 58

How long after swollen glands onset does mumps require exclusion?

Answer 58

5 days

Question 59

What is the exclusion requirement for diarrhea & vomiting?

Answer 59

Until symptoms have settled for 48 hours

Question 60

What are the exclusion conditions for impetigo?

Answer 60

Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment

Question 61

What is the exclusion requirement for scabies?

Answer 61

Until treated

Question 62

When can a child with influenza return to school?

Answer 62

Until recovered

Question 63

Fill in the blank: Cases of chickenpox are generally infectious from 2 days before the rash appears to _______.

Answer 63

5 days after the onset of rash