MSRA Flashcards by Charlotte Bowles

Live Attenuated Vaccines

BCG
MMR
Oral polio
Yellow fever
oral typhoid
oral rotavirus
intranasal influenza

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Ramsay-Hunt Syndrome
Cause:
Features:
Treatment:

Cause = shingles of facial nerve ( CN 7)
Features = auricular pain, facial nerve palsy, vesicular rash around ear, vertigo/tinnitus
Treatment = oral aciclovir and corticosteroids

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Most common headache type in children:
Acute management:
1st Line prevention:

Migraine
Ibuprofen/Nasal Triptans
Pizotifen or Propranolol

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Ottawa Ankle Rules:

Pain in the malleolar zone plus any one of:
-tenderness of lateral malleolus
-tenderness of medial malleolus
-inability to walk >4 steps immediately after injury and in ED

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Asthma Management:

Step 1) Short acting beta agonist e.g Salbutamol
Step 2) Short acting beta agonist and low dose inhaled corticosteroid
Step 3) SABA, ICS and Leukotriene Receptor Antagonist
Step 4) SABA, ICS, Long acting beta agonist (e.g salmeterol), +/- LRTA depending on response
Step 5) SABA, LRTA and Maintenance/Reliever Therapy (Combined ICS and LABA)
Step 6) SABA, LRTA and medium dose MART
Step 7) SABA, LRTA and a) high dose ICS b) antimuscarinic drug e.g Theophylline, c) refer

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Doses of Inhaled Corticosteroid
Low dose:
Medium:
High:

400micrograms
400-800 micrograms
>800 micrograms

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Enuresis management:
1st line -
2nd line -
3rd line -

1st line = rewards system
2nd line = enuresis alarm
3rd line/short term = desmopressin

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Developmental Dysplasia of the Hip features:

Picked up on newborn exam
positive barlow’s and ortolani’s test
uneven skin folds/leg length

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Transient Synovitis features:

Acute hip pain
preceding viral infection
typically affects 2-10yr olds
*The commonest cause of hip pain in children

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Perthes disease:

Degenerative condition of the hips affecting 4-8yr olds
-Avascular necrosis of the femoral head
More common in boys
progressive hip pain
usually bilateral
limp
stiffness

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Slipped Upper Femoral Epiphysis features:

typically 10-15yr olds
more common if obese
may present acutely following trauma but is generally chronic
knee or distal thigh pain
loss of internal rotation

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Juvenile Idiopathic Arthritis features:

Arthritis if <16yrs old and for >3 months
joint pain and swelling (usually medium joints such as knees, ankles, elbows)
limping
may have positive ANA

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Septic Arthritis:

Acute hip pain with systemic features e.g temperature, severe limitation of affected joint
Likelihood based on Kochers score

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Combined Oral Contraceptive Pill Absolute Contraindications (UKMEC 4)

Age 35 smokes >15 cigarettes/day
Migraine with aura
History of thrombus or thrombogenic disease
Previous stroke/heart attack
Breastfeeding <6 weeks postpartum
Ucontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
Positive antiphospholipid antibodies

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Shin lesions

erythema nodosum:

Pretibial Myxoedema:

Pyoderma Gangrenosum:

Necrobiosis Lipooidica Diabeticorum:

erythema nodosum = symmetrical, erythematous, tender. Due to: Strep infections, sarcoidosis, IBD, medications (penicillins, sulphonamides, COCP)

Pretibial Myxoedema: symmetrical, erythematous, orange peel texture. Seen in Graves Disease

Pyoderma Gangrenosum: small papule that becomes deep red ulcerated. 50% idiopathic; IBD, connective tissue and myeloproliferative disorders

Necrobiosis Lipooidica Diabeticorum: shiny painless red/yellow skin with telangiectasia. Seen in diabetics

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Valves affected in Endocarditis

Normal valves:

IVDU:

Normal = Mitral Valve

IVDU = tricuspid

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3 month motor milestones:

Little/no head lag
on tummy = good head control
held sitting = lumbar curve

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6 months motor milestones:

on tummy = arms extended
lying on back = lifts legs and grasps feet
pulls self to sitting
rolls front to back

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7-8 months motor milestones:

sits unaided - refer if not reached by 12 months

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9 months motor milestones:

Pulls to standing
crawls

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12 months motor milestones:

Cruises
walks with one hand held

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13-15 months motor milestones

Walks unsupported
*Refer if not achieved by 18 months

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18 months motor milestones:

Squats to pick up a toy

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2 years motor milestones:

Runs
walks up and downstairs holding on to rail

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3 years motor milestones:

rides a tricycle walks upstairs without a handrail

4 years motor milestones:

Hops on one leg

Reasons for referral for developmental delay:

1) not smiling by 10 weeks 2) cannot sit unsupported at 12 months 3) not walking by 18 months 4) hand preference <12 months

Features of Retinitis Pigmentosa:

Night blindness tunnel vision Family history black spiked pigments on retinal fundoscopy

Acute Pancreatitis Causes:

Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hypertriglyceridaemia, Hypercalcaemia, Hypothermia ERCP Drugs (Azathioprine, sodium valproate, furosemide, bendroflumethiazide)

Investigations indicating Antiphospholipid Syndrome:

Prolonged APTT low platelets Lupus antibodies

Codeine to Morphine dose conversion

divide by 10

Contraindications to Diclofenac (i.e switch to a different NSAID)

Ischaemic heart disease Peripheral arterial disease Cerebrovascular Disease Congestive Heart Failure

What QRisk score warrants prescription of a statin?

>10%

What causes Seborrhoeic Dermatitis and what conditions is it associated with?

Inflammation secondary to proliferation of fungus Malassezia Furfur Eczematous lesions on sebum rich areas- including Blepharitis and Otitis Externa Associated with HIV and Parkinsons

1st Line Treatment of C Difficilie? -2nd line if recurrence? Treatment option if severely unwell?

1st line = oral vancomycin 2nd line = oral fidaxomicin Severely unwell = oral vancomycin and IV metronidazole

Side effects of TB medication Rifampicin: Ethambutol: Pyrazinamide:

Rifampicin = orange secretions, abdominal discomfort Ethambutol = optic neuritis (needs eye test first) Pyrazinamide = myalgia, arthritis, hepatitis

Side effects of Sildenafil:

Headaches flushing blue tinge to vision dyspepsia

What is Cataplexy and what is it associated with?

Sudden and transient loss of muscular tone due to strong emotion -associated with narcolepsy

Features of Acute Angle Closure Glaucoma

Red eye Severe pain (ocular or headache) Decreased visual acuity Semi-dilated pupil Hazy cornea

Features of anterior uveitis:

Red eye acute onset pain small fixed oval pupil ciliary flush blurred vision and photophobia

Symptoms of Psoriatic Arthropathy:

Usually symmetrical poly arthritis but can have asymmetrical oligoarthritis psoriatic skin lesions dactylitis (sausage fingers)

Primary Biliary Cholangitis:

Demographic: middle aged females Associated conditions: sjogren's syndrome, autoimmune conditions First line treatment: ursodeoxycholic acid

Treatments for Chlamydia:

1st line = doxycycline alternatives if pregnant = azithromycin, erythromycin, amoxicillin

Examples of P450 Enzyme Inducers: (increased clearance by enzymes)

Rifampicin St Johns Wort Antiepileptics e.g phenytoin, carbemazepine Chronic Alcohol Smoking

Examples of P450 Enzyme Inhibitors: (decreased clearance by enzymes)

Ciprofloxacin/Erythromycin Amiodarone Sodium Valproate SSRIs Antifungals Isoniazid Acute alcohol

Features of a Lacunar Stroke:

Purely motor or Purely sensory

Features of Hypocalcaemia:

Muscle weakness Tetany Convulsions Cataracts Positive chvostek sign (tapping on cheek causes spasm) Positive trousseau sign (blood pressure cuff inflation induces tetany in the hand)

What is the hallmark difference between Bullous Pemphigoid and Pemphigoid Vulgaris?

Bullous pemphigoid = no mucosal involvement

Indication for starting Clozapine:

Schizophrenic patient who has not responded adequately to at least 2 anti-psychotics

When should COCP be stopped prior to elective surgery?

4 weeks prior

When should anti-coagulation for atrial fibrillation be initiated post-thrombotic stroke?

2 weeks post-stroke

Cause and treatment of Eczema Herpeticum

Infection of atopic eczema with Herpes Simplex Virus 1 Needs admission to hospital for IV Aciclovir

What is Presbycusis?

Age-related sensorineural hearing loss usually presents with bilateral high-frequency hearing loss

Treatment target times for Thrombolysis and Thrombectomy in Acute Thrombotic Stroke

Thrombolysis = 4.5hrs Thrombectomy = 6hrs

What monitoring is required whilst taking Hydroxychloroquine?

Visual acuity (can precipitate a retinopathy)

What two treatments should be prescribed for patients with Peripheral arterial disease?

Clopidogrel and Atorvastatin (80mg)

What is the 1st line treatment for plaque psoriasis?

Potent topical corticosteroid and topical vitamin D analogue

What is the most common causative organism of Infective Exacerbation of COPD?

Haemophilus Influenza

What is the most common cause of atypical pneumonia in younger patients?

Mycoplasma Pneumoniae

What mechanism of action and what is the most common side effect of Varenicycline?

Mechanism = Nicotinic Partical Receptor agonist Nausea

What is the treatment for Whooping Cough/Pertussis

Oral Macrolide e.g clarithromycin/Erythromycin/Azithromycin

What should be started alongside allopurinol as gout prophylaxis?

Colchicine - or NSAID if colchicine not tolerated

What is the UK carrier rate of Cystic Fibrosis?

1 in 25

What is an Argyll-robertson pupil?

Both pupils constrict to near object accommodation but affected pupil doesn't constrict upon bright light -Seen in Diabetes Mellitus and Neurosyphillis

What is the reversal agent for Warfarin?

IV Prothrombin Concentrate in severe bleeding Vitamin K if deranged INR but stable

What is the most common reason for revision of total hip replacement?

Aseptic loosening of the joint

MSRA Flashcards

(66 cards)