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Make a Medic Postgraduate Decks > MSRA > Flashcards

MSRA Flashcards

1
Q

Outline the time taken for various contraceptive preparations to become effective.

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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2
Q

Which rheumatoid arthritis drug is associated with causing interstitial lung disease?

A

Sulfsalazine

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3
Q

What are the main side-effects of hydroxychloroquine?

A

Retinopathy
Corneal opacities

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4
Q

List the absolute contraindications for COCP use.

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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5
Q

What is usually used as initial management of plaque psoriasis?

A

Corticosteroid + vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks

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6
Q

What can slow down the progression of disease in dry age-related macular degeneration?

A

High dose of beta-carotene, vitamins C and E, and zinc

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7
Q

List the motor milestones that should raise suspicion of cerebral palsy.

A

Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking

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8
Q

List the motor milestones that should raise suspicion of cerebral palsy.

A

Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmWhat isetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking

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9
Q

List the motor milestones that should raise suspicion of cerebral palsy.

A

Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking

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10
Q

What is unusual about the relationship between mirtazapine dose and sedation?

A

More sedating at lower doses

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11
Q

How is rosace treated?

A

Mild/Moderate: Topical Metronidazole
Severe: Oral Doxycycline

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12
Q

How should C. difficile be treated?

A

first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

Recurrent
within 12 weeks of symptom resolution: oral fidaxomicin
after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin

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13
Q

What GRACE score is considered high risk?

A

> 3%

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14
Q

Outline how Down syndrome risk is estimated based on maternal age.

A

1/1,000 at 30 years then divide by 3 for every 5 years

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15
Q

What CBG targets should be set for patients with GDM?

A

fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

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16
Q

What is the main adverse effect of hydroxychloroquine?

A

Bull’s eye retinopathy (need to monitor visual acuity)

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17
Q

Which antiepileptics should be recommended for patients with generalised tonic clonic seizures?

A

males: sodium valproate
females: lamotrigine or levetiracetam

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18
Q

Which antiepileptics should be recommended for patients with focal seizures?

A

first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

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19
Q

Which antiepileptics should be recommended for patients with absence seizures?

A

first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures

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20
Q

Which antiepileptics should be recommended for patients with myoclonic seizures?

A

males: sodium valproate
females: levetiracetam

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21
Q

Which antiepileptics should be recommended to patients with tonic or atonic seizures?

A

males: sodium valproate
females: lamotrigine

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22
Q

List the causes of concentric visual loss.

A

papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria

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23
Q

Which cardiac drug is contraindicated in ventricular tachycardia?

A

Verapamil

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24
Q

How is methanol poisoning managed?

A

Fomepizole (ethanol used to be used)

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25
Q

How should the finding of an ovarian cyst that is < 5 cm in diameter on an ultrasound scan be managed?

A

A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.

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26
Q

How does presbyacusis present?

A

Bilateral high frequency hearing loss
Downward sloping pure tone thresholds

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27
Q

What effect does St John’s Wort have on CYP450?

A

Inducer

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28
Q

How often is breast cancer screening offered?

A

every 3 years between the ages of 50 and 71

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29
Q

How does radial tunnel syndrome present?

A

presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

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30
Q

What is the main ECG feature of hypocalcaemia?

A

Long QT

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31
Q

Which opioids are preferred in CKD?

A

Alfentanil, buprenorphine and fentanyl

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32
Q

What is tibolone and why should it not be used within 12 months of the last period?

A

Has weak oestrogenic properties
Can be used for menopause and osteoporosis
Can cause irregular bleeding within 12 months of last menstrual period

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33
Q

What are some side-effects of clonidine?

A

Dry mouth and dizziness

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34
Q

If someone has had a previous pregnancy complicated by GDM, when should they have an OGTT in the subsequent pregnancy?

A

As soon as possible after booking

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35
Q

What are the UKMEC4 criteria for COCP?

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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36
Q

Which drug is strongly indicated in patients with AF and heart failure?

A

Digoxin

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37
Q

What are the features of Edwards syndrome?

A

micrognathia, low-set ears, rocker bottom feet and overlapping of fingers

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38
Q

What are the features of Patau syndrome (trisomy 13)?

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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39
Q

What is a strong risk factor for adhesive capsulitis?

A

Diabetes mellitus

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40
Q

How should severe cellulitis be treated?

A

co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

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41
Q

How does viral labyrinthitis present?

A

sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo

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42
Q

Which lymphoma drug causes peripheral neuropathy?

A

Vincristine

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43
Q

When can hormonal contraception be restarted after taking Levonelle?

A

Immediately

Have to wait 5 days for EllaOne (ulipristal)

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44
Q

How is vaginal candidiasis managed?

A

oral fluconazole 150 mg as a single dose first-line
contraindicated in pregnancy

NOTE: for recurrent candidiasis, use induction and maintenance therapy with fluconazole

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45
Q

How is facial psoriasis managed?

A

Mild potency topical steroids or calcitriol

NOTE: calcipotrol is irritant and coal tar is smelly

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46
Q

What is seen upon fluorescein staining of patients with dry eyes?

A

Punctate fluorescein staining of the cornea

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47
Q

How quickly do various contraceptive forms work?

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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48
Q

What is used to monitor treatment in haemochromatosis?

A

Ferritin and transferrin saturation

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49
Q

How should metformin and gliclazide be managed on the day of elective surgery?

A

METFORMIN
Give dose as per usual

SULFONYLUREAS
omit on the day of surgery
exception is morning surgery in patients who take BD - they can have the afternoon dose

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50
Q

When can SGLT2 inhibitors be started as initial therapy for T2DM?

A

After metformin has been fully uptitrated

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51
Q

What are the criteria for starting SGLT2 inhibitors in patients with T2DM?

A

T2DM associated with:
- A high risk of developing cardiovascular disease (CVD) i.e. a Q-RISK score greater than 10%
- Established CVD
- Heart failure

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52
Q

List some risk factors for endometrial cancer.

A

obesity
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma

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53
Q

Outline the emergency management of epistaxis.

A

adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help)
topical adrenaline/local anaesthetic
topical tranexamic acid
nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter).
surgical intervention (sphenopalatine artery ligation).

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54
Q

Which investigation should be performed before starting a patient on anastrazole?

A

DEXA Scan

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55
Q

What are the features of scarlet fever and how is it treated?

A

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

Penicillin V for 10 days

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56
Q

Why should SSRIs be avoided in patients on warfarin?

A

Increased risk of bleeding

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57
Q

How does acute angle closure glaucoma present?

A

Fixed dilated pupil with conjunctival injection

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58
Q

How is acute sinusitis managed?

A

Analgesia and fluids

If persisting for more than 10 days, use intranasal steroids

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59
Q

How is acute sinusitis managed?

A

Analgesia and fluids

If persisting for more than 10 days, use intranasal steroids

Phenoxymethylpenicillin can be used if acute sinusitis is complicated

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60
Q

What does NICE recommend for rapid tranquilisation of patients with acutely disturbed behaviour?

A

intramuscular (IM) lorazepam or IM haloperidol + IM promethazine

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61
Q

What are the indications for placing a chest drain in a patient with pleural infection?

A
  • Frankly purulent pleural fluid on aspirate
  • Presence of organisms visualised in a non-purulent sample
  • Pleural fluid pH < 7.2
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62
Q

What are the indications for placing a chest drain in a patient with pleural infection?

A
  • Frankly purulent pleural fluid on aspirate
  • Presence of organisms visualised in a non-purulent sample
  • Pleural fluid pH < 7.2
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63
Q

How should persistent unexplained hoarseness in a patient aged >45 years old be managed?

A

Urgent referral to ENT

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64
Q

What is the strongest risk factor for psychotic disorders?

A

Family history

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65
Q

What is Hoffman’s sign suggestive of?

A

Upper motor neurone lesion (e.g. DCM)

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66
Q

What should be started alongside allopurinol in patients with recurrent gout?

A

Colchicine (or NSAID if not tolerated)

Should start at a dose of 100 mg OD and up-titrate every few weeks based on serum uric acid level

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67
Q

What is a Buckle fracture?

A

Incomplete transverse fracture of the radius (common in children due to increased elasticity)

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68
Q

What is the first-line investigation for chronic heart failure?

A

NT-proBNP

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69
Q

How is SUFE managed surgically?

A

In situ fixation with cannulated screws

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70
Q

What is caput succadaneum and how long does it take to resolve?

A

Soft tissue swelling from ventouse delivery, crosses suture lines
Resolves within days

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71
Q

What is caput succadaneum and how long does it take to resolve?

A

Soft tissue swelling from ventouse delivery, crosses suture lines
Resolves within days

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72
Q

List the incubation periods of common diarrhoeal diseases.

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

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73
Q

How is otitis externa managed?

A

topical antibiotic or a combined topical antibiotic with a steroid

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74
Q

Which diseases are associated with seborrhoeic dermatitis?

A

HIV
Parkinson’s disease

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75
Q

How is seborrhoeic dermatitis in children managed?

A

mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone

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76
Q

How should congenital inguinal hernias be managed?

A

Urgent referral to paediatric surgeon as high risk of complications

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77
Q

List some common eyelid problems.

A

blepharitis: inflammation of the eyelid margins typically leading to a red eye
stye (hordeola internum and externum): infection of the glands of the eyelids
chalazion (Meibomian cyst)
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids

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78
Q

What is the most common reason for a hip replacement having to be revised?

A

Aseptic loosening

Other reasons include pain and loosening

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79
Q

What are the criteria for diagnosing diabetes mellitus?

A

fasting > 7.0, random > 11.1 - if asymptomatic need two readings

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80
Q

What is the positive predictive value of faecal occult blood test?

A

5-15%

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81
Q

How do you work out the units of alcohol in a drink?

A

Volume x Percentage/1000

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82
Q

List some causes of gingival hyperplasia.

A

phenytoin, ciclosporin, calcium channel blockers and AML

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83
Q

How is a recurrence of C. difficile within 12 weeks treated?

A

Oral fidaxomicin

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84
Q

Which extra-intestinal manifestations of Crohn’s disease are associated with disease activity?

A

Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis

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85
Q

What causes blurring of vision after cataract surgery?

A

posterior capsule opacification

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86
Q

What resting blood pressure would prevent someone from driving buses or lorries?

A

> 180/100

87
Q

List drugs that are associated with causing lung fibrosis.

A

amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

88
Q

What causes chorioretinitis?

A

syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis

89
Q

How should pregnant women with chickenpox presenting after 20 weeks’ gestation be managed?

A

treated with oral aciclovir if they present within 24 hours of the rash

90
Q

Which antiepileptic drug is associated with pancreatitis?

A

Sodium valproate

91
Q

What is the triad of shaken baby syndrome?

A

Retinal haemorrhages
Subdural haemorrhage
Encephalopathy

92
Q

Outline the interpretation of the FAST alcohol questionnaire.

A

4 item questionnaire
minimum score = 0, maximum score = 16
the score for hazardous drinking is 3 or more

93
Q

What are the first line treatment options for painful diabetic neuropathy?

A

first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin

94
Q

List some side-effects of sodium valproate.

A

teratogenic
P450 inhibitor
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatotoxicity
pancreatitis
thrombocytopaenia
hyponatraemia
hyperammonemic encephalopathy: L-carnitine may be used as treatment if this develops

95
Q

List the main live attenuated vaccines.

A

Yellow fever
Oral polio
Intranasal influenza
Varicella
Measles, mumps and rubella (MMR)

96
Q

List some precipitants of digoxin toxicity.

A

hypokalaemia
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

97
Q

What change in creatinine and eGFR after starting an ACE inhibitor would prompt stopping the ACE inhibitor?

A

creatinine increases by 30% or eGFR falls by 25% or greater

98
Q

What is an important contraindication for ulipristal acetate?

A

Severe asthma

99
Q

What is used for long-term prophylaxis of cluster headaches?

A

Verapamil

100
Q

Which malignancy is Acquired ichthyosis associated with?

A

Lymphoma

101
Q

Which malignancy is Acquired hypertrichosis lanuginosa associated with?

A

Gastrointestinal and lung cancer

102
Q

Which malignancies is dermatomyositis associated with?

A

Ovarian cancer and lung cancer

103
Q

Which malignancy is Erythema gyratum repens associated with?

A

Lung cancer

104
Q

Which malignancy is erythroderma associated with?

A

Lymphoma

105
Q

Which malignancy is Necrolytic migratory erythema associated with?

A

Glucagonoma

106
Q

Which malignancies are Pyoderma gangrenosum associated with?

A

Myeloproliferative disorders

107
Q

Which malignancies is Sweet syndrome associated with?

A

Haematological malignancy e.g. Myelodysplasia

108
Q

Which malignancy is tylosis associated with?

A

Oesophageal cancer

109
Q

Which malignancy is migratory thrombophlebitis associated with?

A

Pancreatic cancer

110
Q

How is trichomonas vaginalis treated?

A

Oral metronidazole

111
Q

Outline the speech developmental milestones.

A

12 months Knows and responds to own name
12-15 months Knows about 2-6 words (Refer at 18 months)
Understands simple commands - ‘give it to mummy’
2 years Combine two words
Points to parts of the body
2½ years Vocabulary of 200 words
3 years Talks in short sentences (e.g. 3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
4 years Asks ‘why’, ‘when’ and ‘how’ questions

112
Q

What is the reversal agent for dabigatran?

A

idarucizumab

NOTE: rivaroxaban - andexanet alfa

113
Q

What is the first-line treatment option for capillary haemangiomas?

A

Propranolol

114
Q

How is latent TB treated?

A

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

115
Q

When should referral be considered for otitis media with effusion?

A

children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.

Or if
- affecting hearing, development or education
- children with Down syndrome or cleft palate

115
Q

When should referral be considered for otitis media with effusion?

A

children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period.

Or if
- affecting hearing, development or education
- children with Down syndrome or cleft palate

116
Q

What is the screening interval for cervical screening?

A

aged 25-49 years every three years and women aged 50-64 years every five years

117
Q

Who is considered eligible for azithromycin prophylaxis in the context of COPD?

A

non-smokers who have optimised therapy and experience any of:
Frequent exacerbations with sputum production.
Prolonged exacerbations with sputum production.
Hospitalisations from exacerbations.

118
Q

When is additional contraception not needed in someone being started on the COCP?

A

If the combined pill is started between day 1-5 of the cycle then there is no need for additional contraception.

118
Q

When is additional contraception not needed in someone being started on the COCP?

A

If the combined pill is started between day 1-5 of the cycle then there is no need for additional contraception.

119
Q

How does viral labyrinthitis present?

A

recently developed an upper respiratory tract infection presents with vertigo and vomiting. Hearing is also affected. The symptoms came on suddenly

120
Q

Why does splenectomy give a falsely high HbA1c?

A

Increased red cell survival

121
Q

What should be prescribed to a patient who has had an ACS and is also in AF?

A

generally patients are given triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event and dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months

122
Q

What makes up the sciatic nerve and what are the consequences of loss of function?

A

L4-5, S1-3
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact

123
Q

What make lateral epicondylitis worse?

A

worse on resisted wrist extension/suppination whilst elbow extended

124
Q

What is the main indication for cardiac resynchronisation therapy?

A

patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms

125
Q

Outline the fine vision and motor milestones.

A

3 months Reaches for object
Holds rattle briefly if given to hand
Visually alert, particularly human faces
Fixes and follows to 180 degrees
6 months Holds in palmar grasp
Pass objects from one hand to another
Visually insatiable, looking around in every direction
9 months Points with finger
Early pincer
12 months Good pincer grip
Bangs toys together

126
Q

Outline the doses of IM adrenaline in different age groups.

A

< 6 months 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
6 months - 6 years 150 micrograms (0.15 ml 1 in 1,000)
6-12 years 300 micrograms (0.3ml 1 in 1,000)
Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000)

127
Q

How should bacterial conjunctivitis in pregnant women be treated?

A

Topical fusidic acid

128
Q

What are the features of lithium toxicity?

A

Diarrhoea, vomiting, abdominal pain, coarse tremor, weakness, seizures, muscle twitches and blurred vision

129
Q

When is test-of-cure recommended for pregnant women being treated for chlamydia?

A

6 weeks

130
Q

How does contact tracing work for sexually transmitted infections?

A

symptomatic men: all partners from the 4 weeks prior to the onset of symptoms
women + asymptomatic men: all partners from the last 6 months or the most recent sexual partner

131
Q

In which type of age-related macular degeneration are intravitreal VEGF injections useful?

A

Wet

132
Q

How should occupational exposure to hepatitis B be managed?

A

if the person exposed is a known responder to the HBV vaccine then a booster dose should be given
if they are a non-responder (anti-HBs < 10mIU/ml 1-2 months post-immunisation) they need to have hepatitis B immune globulin (HBIG) and a booster vaccine

133
Q

List some contraindications for sildenafil.

A

patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

134
Q

When should individuals with type 1 diabetes mellitus with no established cardiovascular disease be offered statin treatment for primary prevention?

A

Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)

135
Q

List the nerve roots responsible for common reflexes.

A

Ankle S1-S2
Knee L3-L4
Biceps C5-C6
Triceps C7-C8

136
Q

How are corneal abrasions managed?

A

Topical antibiotic to prevent secondary bacterial infection

137
Q

List some causes of microcephaly.

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

138
Q

List drugs that should be avoided if breastfeeding.

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

139
Q

List some causes of scarring alopecia.

A

trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*

140
Q

What are the features of L3 nerve root compression?

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

141
Q

What are the features of L4 nerve root compression?

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

142
Q

What are the features of L5 nerve root compression?

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

143
Q

What are the features of S1 nerve root compression?

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

144
Q

How should two missed COCPs be managed?

A

Take the last missed pill and continue as per usual (even if it means taking two pills on the same day)

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

145
Q

Which drugs cause erythema nodosum?

A

penicillins
sulphonamides
combined oral contraceptive pill

146
Q

When should women be advised to stop COCP or HRT before surgery?

A

28 days before

147
Q

What is Hoover sign?

A

quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension

148
Q

What advice about driving should be given to people that have suffered a TIA?

A

1 month off driving, may not need to inform DVLA if no residual neurological deficit

149
Q

Which antihistamines are non-sedating?

A

Loratidine
Cetirizine

150
Q

How can early keloids be managed?

A

Intralesional steroids (e.g. triamcinolone)

151
Q

When should mefloquine and chloroquine be taken and in whom is it contraindicated?

A

Weekly
Depression and epilepsy

152
Q

How is Ramsay Hunt syndrome treated?

A

Oral aciclovir and steroids

153
Q

What are the main side-effects experienced when starting levetiracetam?

A

Abdominal pain and diarrhoea
Anorexia (and, hence, weight loss)
Anxiety

154
Q

What effect do inhaled steroids have on COPD patients?

A

Reduced frequency of exacerbations

155
Q

What is the key clinical difference between viral labyrinthitis and vestibular neuronitis?

A

Labyrinthitis is associated with hearing loss

156
Q

What should be prescribed for a patient with pustular acne who is awaiting an appointment with the dermatologist?

A

oral antibiotic and topical retinoid or benzoyl peroxide

157
Q

What advice should be given to people undergoing a urea breath test?

A

no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

158
Q

From what point postpartum is contraception needed?

A

21 days if not breastfeeding

159
Q

When should nitrofurantoin be avoided in pregnancy?

A

Towards term as it can cause neonatal haemolysis

160
Q

What does of IM benzylpenicillin should be used in the community for suspected meningitis?

A

Age Dose
< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg

161
Q

Which nerve roots contribute to the nerves of the arm?

A

Musculocutaneous nerve (C5-C7)
Axillary nerve (C5,C6)
Radial nerve (C5-C8)
Median nerve (C5-T1)
Ulnar nerve (C8, T1)
Long thoracic nerve (C5-C7)

162
Q

How is caffeine used in newborns?

A

Respiratory stimulant that aids weaning off a ventilator

163
Q

Which hearing test is done at school entry in schools in the UK?

A

Pure tone audiometry

164
Q

How is the newborn hearing screen conducted?

A

Initially: Otoacoustic emission test
If above is abnormal: Auditory Brainstem Response

165
Q

Which antibiotic is used to treat extensive otitis externa?

A

Flucloxacillin

166
Q

Which features distinguish glaucoma from uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

167
Q

What advice should be provided for patients who have had successful coronary angioplasty about driving?

A

driving may recommence after 1 week provided:

No other urgent revascularisation is planned. (Urgent refers to within 4 weeks from acute event)
Left ventricular ejection fraction is at least 40% prior to hospital discharge.
There is no other disqualifying condition.

168
Q

How does chancroid present?

A

deep, painful ulcer and is often associated with inguinal lymphadenopathy.

169
Q

What is the mechanism of action of bupropion?

A

Norepinephrine and dopamine reuptake inhibitor
AND
Nicotinic antagonist

170
Q

How long does finasteride take to be effective for BPH?

A

6 Months

171
Q

Which medications are first-line for treating spasticity in MS?

A

Baclofen and gabapentin

172
Q

How should potential tetanus exposure be managed in someone without a clear vaccine history?

A

booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old

173
Q

List some CYP450 inhibitors.

A

antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

174
Q

List some CYP450 inducers.

A

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

175
Q

If someone has had a TIA should they be given aspirin?

A

A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately

176
Q

If someone has had a TIA should they be given aspirin?

A

A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately

177
Q

When are pregnant women offered the pertussis vaccine?

A

16-32 weeks pregnant

178
Q

How should shingles be managed?

A

Treat within antivirals within 72 hours

179
Q

Which drugs cause erythema multiforme?

A

penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

180
Q

How should a patient be managed if they had a full course of tetanus vaccine with the last dose more than 10 years ago?

A

if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

181
Q

How should patients with unclear tetanus vaccine history be managed?

A

reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

182
Q

What is the criteria for certification of blindness?

A

<3/60 with a full visual field

183
Q

How soon after a decision should a category 1 and category 2 C section be performed?

A

Category 1: 30 mins
Category 2: 75 mins

184
Q

Outline the mechanism of action of glaucoma medications.

A

Prostaglandin analogues (e.g. latanoprost): Increases uveoscleral outflow

Beta-blockers (e.g. timolol, betaxolol): Reduces aqueous production

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist): Reduces aqueous production and increases outflow

Carbonic anhydrase inhibitors (e.g. Dorzolamide): Reduces aqueous production

Miotics (e.g. pilocarpine, a muscarinic receptor agonist): Increases uveoscleral outflow

185
Q

How is scalp psoriasis managed?

A

topical potent corticosteroids

186
Q

When is the anomaly scan done?

A

18-20 + 6 weeks

187
Q

How are dermatophyte nail infections treated?

A

Oral terbinafine

188
Q

Outline the stages of AKI.,

A

Stage 1 Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
Stage 2 Increase in creatinine to 2.0 to 2.9 times baseline, or
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
Stage 3 Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2

189
Q

What is pulsus alternans?

A

Occurs in left ventricular failure, myocarditis and paroxysmal tachycardia
Characterised by alternate large and small amplitude beats (doubling of rate noted as mercury level falls)

190
Q

What is pulsus paradoxus?

A

Abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

Suggestive of cardiac tamponade, constrictive pericarditis, chronic sleep apnoea and COPD

191
Q

What is another name for a slow-rising pulse?

A

Plateau pulse

192
Q

What is a pinguecula?

A

Harmless yellowish deposit beneath the conjunctiva , found between the canthus and the corneal edge.

193
Q

What is a pterygium?

A

Fold of conjunctiva on the cornea

194
Q

What is first line for primary open angle glaucoma?

A

Prostaglandin analogue (e.g. latanoprost)

195
Q

Which cardiac drug is known to shorten the QT interval?

A

Digoxin

196
Q

What side effect is commonly associated with varenicline?

A

Abnormal dreams

197
Q

Which antihypertensive is second line in pregnancy?

A

Nifedipine

198
Q

When is the dating scan done?

A

10 to 13+6 weeks

199
Q

What is Schwartz sign?

A

Sign on otoscopy suggestive of otosclerosis

200
Q

How does ezetimibe work?

A

Reduces intestinal cholesterol absorption

201
Q

How do you test for foetal CMV in utero?

A

Amniocentesis (CMV concentrates in the foetal urine)

202
Q

How is foetal sickle cell disease status best established?

A

Chorionic Villus Sampling

203
Q

Which investigation is used to check for foetal anaemia?

A

Cordocentesis

204
Q

What are some distinguishing features of PSP?

A

Early postural instability
Onset > 40 years
Gradually progressive
Vertical supranuclear palsy

205
Q

How is a chalazion managed?

A

Warm compress and massage

206
Q

List some conditions that deteriorate in pregnancy.

A

SLE
Herpes simplex
Acne rosacea

207
Q

What PPI washout period is recommended for people undergoing a urea breath test or stool antigen test?

A

2 weeks

208
Q

What investigation should be offered to all patients with tinnitus?

A

Audiogram

209
Q

What is a distinguishing feature of chondromalacia patellae?

A

Anterior knee pain on walking up and down stairs and rising from prolonged sitting

210
Q

What advice is offered regarding when you can do a PSA?

A

6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

211
Q

List some factors that decrease BNP.

A

Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists

212
Q

List some factors that increase BNP.

A

Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis

Make a Medic Postgraduate Decks (3 decks)

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