Unofficial Mock MLAs Flashcards
(152 cards)
1
Q
Anal fissure - what to do if conservative (including topical GTN) management doesn’t work?
A
Sphincterotomy
2
Q
Tachyarrhythmia + adverse feature (shock, syncope, myocardial ischaemia or heart failure)
A
DC cardioversion
3
Q
Cushing’s reflex/triad in raised ICP =
A
Bradycardia
Wide pulse pressure (hypertension)
Irregular respirations (Cheyne-Stokes respirations)
- indicates raised ICP and potential brain herniation
4
Q
Pansystolic murmur + soft S1 =
A
Mitral stenosis
5
Q
Is vancomycin only given orally?
A
Only given orally in C. difficile infection, otherwise can be given IV
6
Q
What is secondary hyperparathyroidism?
A
Physiological elevation of PTH levels in response to hypocalcaemia.
- commonly due to renal failure or vitamin D deficiency.
7
Q
What is tertiary hyperparathyroidism?
A
PERSISTENT
End-stage renal failure
- thought to be due to prolonged secondary hyperparathyroidism which results in the inappropriate continued release of PTH despite normalisation of calcium levels
8
Q
Key diagnostic test in Guillain-Barre syndrome?
A
Lumbar puncture
- elevated protein with normal white cell count
9
Q
Broca’s area is found in which lobe?
A
Frontal lobe
B comes before W so it’s at the front
10
Q
Wernicke’s area is found in which lobe?
A
Temporal lobe
11
Q
Medical therapy to prevent angina attacks?
A
CCB +/- beta blocker
12
Q
Exudative vs transudative PE ?
A
Things that aren’t meant to be there = exudative
Failures e.g. heart, liver, kidney = transudative
EXudative = EXtra protein
Pleural fluid with a protein level >30g/L = exudative
13
Q
All men with erectile dysfunction should have what checked?
A
Morning testosterone
14
Q
What medication to avoid in myasthenia gravis?
A
Beta-blockers
15
Q
Triangle of safety for chest drain insertion =
A
Base of axilla, lateral pectoralis major, 5th intercostal space, anterior latissimus dorsi
16
Q
How long before results are seen when using finasteride for BPH ?
A
6 months
17
Q
Potassium fluid requirement per day = ?
A
1 mmol/kg/day
18
Q
Medical management of pregnant women who smoke ?
A
Nicotine replacement therapy only
- Varenicline and bupropion are contraindicated
19
Q
What is Hartmann’s procedure ?
A
Sigmoid colectomy and formation of end stoma
- usually used in emergencies, e.g. bowel obstruction or perforation
20
Q
What surgical procedure is used to defunction the colon to protect an anastomosis?
A
Loop ileostomy
(it is reversible)
21
Q
In COPD, when is LTOT indicated?
A
pO2 of 7.3 - 8 kPa
AND one of the following:
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension
22
Q
Severe alcoholic hepatitis management = ?
A
Prednisolone
23
Q
Acute management of insulin in DKA = ?
A
Fixed-rate insulin infusion (0.1units/kg/hour)
Continue long-acting insulin
STOP short-acting insulin
24
Q
Scoring systems for upper GI bleeds
A
Glasgow-Blatchford = what management? (Glasgow = schemey)
Rockall = Recurrence
25
Rolled, pearly edges + telangiectasia = ?
Basal cell carcinoma
26
Isolated motor loss (hemiplegia) on left side = ?
Right-sided lacunar stroke
27
Stroke management + times =
Within 4.5 hours: Thrombolysis with Alteplase, followed 24 hours later by aspirin 300mg
After 4.5 hours: No thrombolysis; just give Aspirin 300mg
28
Left temporal lesion = which visual field defect ?
PITS
Right SUPERIOR homonymous quadratanopia
29
MUST score =
Assessment of nutritional status
30
Lung white-out on CXR: how to differentiate between pleural effusion vs lung collapse
Look for tracheal deviation
31
Memantine vs donepezil drug class
Memantine = NDMA antagonist (memandy)
Donepezil = Acetylcholinesterase inhibitor
32
CRVO vs CRAO ?
CRVO = sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
CRAO = sudden painless loss of vision, cherry-red spot at the fovea
33
COPD standby medication (to keep at home)
Prednisolone and an antibiotic
34
Overactive bladder medication
Oxybutynin
35
Hepatitis serology :
HbsAg - acute/chronic ongoing disease
IgM anti-HBc - acute disease
IgG anti-HBc - previous or current infection
anti-HBs - immunity
36
HBsAg positive,
IgM anti-HBc positive,
IgG anti-HBc positive
anti-HBs negative
Acute infection
37
HBsAg positive/negative,
IgM anti-HBc negative
IgG anti-HBc positive
anti-HBs negative
Chronic infection
38
Anti-HBs positive ?
Immune
39
Which blood abnormality is caused by prednisolone?
Neutrophilia
40
Which drug to treat delirium in Parkinson's patient?
IM lorazepam
41
TIA + patient is on an anticoagulant or has a bleeding disorder ?
Perform CT head to exclude haemorrhagic stroke
42
Reversal agents
Anaesthetics
Obs and Gynae
MSK
ENT
43
Specificity calculation?
TN / (TN + FP)
44
Proximal scaphoid pole fracture - definitive management?
Surgical fixation
45
Cervical screening due during pregnancy - what to do?
Delay cervical screening until 3 months post-partum
46
DIC typical blood picture
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
47
What to monitor in post-operative ileus?
U&Es (important as electrolyte derangement worsens ileus)
48
What to do if 2nd repeat smear hrHPV positive at 24 months?
Colposcopy
49
Acute epiglottitis causative organism?
Haemophilus influenzae B
50
Genital herpes treatment?
Oral aciclovir
51
Placental abruption management when no signs of distress?
Admit for IV corticosteroids and monitor maternal and foetal condition
52
preferred surgical management for intertrochanteric (extracapsular) proximal femoral fracture?
Dynamic hip screw
53
Management of subtrochanteric fracture?
IM nail
54
MOA of hyoscine hydrobromide/butylbromide ?
Muscarinic receptor antagonist
55
Management of preterm prelabour rupture of membranes?
IM corticosteroids
(reduces complications if baby born preterm - stimulates surfactant)
56
Local anaesthetic toxicity reversal?
IV 20% lipid emulsion
57
Fibroadenoma >3cm = ?
Surgical excision
58
Low Ca, raised ALP, raised PTH =
Osteomalacia
59
PTSD drug treatment?
Veterans - Venlafaxine
(if CBT or EMDR therapy are ineffective)
60
TRALI vs TACO
TRALI = trolley down the escalator = hypotension
TACO = weight goes up = hypertension
61
Why use ketamine as an induction agent for anaesthesia?
Ketamine doesn't cause a drop in blood pressure
- useful in trauma
62
Treatment of chlamydia in pregnancy?
Azithromycin/erythromycin/amoxicillin
63
How long post-UPSI can Ulipristal acetate (EllaOne) be given?
120 hours
64
Hiccups in palliative care - what to prescribe?
Chlorpromazine or haloperidol
65
Lateral epicondylitis worse on...
Resisted wrist extension (when elbow extended)
Tennis worse on backhand
66
Treatment of Kawasaki disease ?
High-dose aspirin (despite contraindicated in children)
67
Chickenpox is a risk factor for which soft tissue infection?
Necrotising fasciitis
68
No blast cells in leukaemia = ?
Chronic leukaemia
69
CK level in PMR?
Normal CK
70
Bruising in a non-mobile infant
Same day paediatric assessment
"Those who can't cruise, should not be bruised".
71
Most common cause of PPH?
Uterine atony (failure of adequate uterine contractions)
72
White, curdy vaginal discharge ?
Diagnosis + pH
Diagnosis = Candidiasis
pH = <4.5
(pH >4.5: BV + fishy smell)
73
SUFE management ?
Internal fixation
74
Eclampsia management ?
Intravenous magnesium sulphate
75
Sickle cell crisis management ?
Exchange transfusions
76
Pseudomonas aeruginosa eradication in cystic fibrosis?
Oral ciprofloxacin
77
Aromatase inhibitor - effect on bone health?
Osteoporosis
- stops oestrogen production so brings on menopause
78
Reduced foetal movements - initial step in management?
Handheld doppler to confirm foetal heartbeat
then a CTG
79
Rivaroxaban / apixaban reversal agents
Andexanet alfa
80
DEXA Z score vs T score
T score = healthy 30-year-old
Z score = age, gender, ethnicity
81
When can the copper IUD be inserted for emergency contraception?
5 days after UPSI
or
5 days after ovulation
82
diver perforates tympanic membrane - management?
Reassure and follow up (self-limiting)
83
Long-term mechanical ventilation in trauma patients can cause ?
Tracheo-oesophageal fistula formation
84
Patients taking prednisolone - what should be given before and after surgery?
IV hydrocortisone
85
Schizophrenia DVLA rules
3 months, follow-up with psychiatrist
86
Which contraceptive causes weight gain?
Depo-provera
87
What to assess prior to induction of labour?
Bishop score
(helps to assess whether induction will be required)
88
Postpartum period - when to give iron supplementation?
Hb of < 100g/L
89
Hepatic adhesions = ?
Fitz-Hugh-Curtis syndrome
90
When to use Ulipristal acetate?
Risk of implantation from previous incident - potential implantation is a contraindication for IUD
Ulipristal acetate can be used up to 120 hours after sex
91
TB essential features
Haemoptysis, night sweats, cough for a few weeks
92
Toxoplasmosis treatment?
Administer sulfadiazine and pyramethamine
93
Diarrhoea, flushing, hypotension, and predominantly right-sided heart murmurs
Carcinoid syndrome
(due to serotonin production from a tumour)
- prescribe OCREOTIDE
94
Hepatitis A vs E - severity?
E = Mgoingtodie2
E can cause acute liver failure
A is normally self-limiting
95
Throbbing pain behind right eye
Migraine features vs Cluster headache features
Migraine = Nausea, photophobia
Cluster headache = Eye-watering, runny nose
96
What is a bubble echocardiogram used for?
DVT which causes a stroke
This means the thrombus has moved from venous circulation to arterial circulation.
Bubble echo can identify cardiac defects like a patent foramen ovale.
97
What drug contraindicates sildenafil?
And what is second line for organic erectile dysfunction?
Nitrates
2nd line = intracavernosal prostaglandins
98
Annular lesion = ?
Ring-shaped lesion
99
Lung cancer which causes hyponatraemia?
And why?
Small cell lung cancer
causes paraneoplastic SIADH
100
Dendritic ulcers - causative organism + management ?
Herpes simplex virus - herpes keratitis
Topical aciclovir eye drops
101
Hyponatraemia + normal serum osmolality = ?
Pseudohyponatraemia
usually caused by hyperlipidaemia
102
CURB65 = ?
Confusion
Urea
Respiratory rate
Blood pressure
>65 years old
103
Type IV hypersensitivity reaction = ?
Delayed e.g. contact dermatitis
104
Type III hypersensitivity reaction = ?
Immune complexes form e.g. SLE, RA
105
oesophageal varices prophylaxis and treatment?
Propranolol for prophylaxis
Terlipressin to treat
106
Patient with PMR collapses and has hyponatraemia, hyperkalaemia, hypoglycaemia
Adrenal crisis (patient likely on long-term steroids)
107
Ascites - test for spontaneous bacterial peritonitis?
Diagnostic paracentesis
(given to any patient with ascites in hospital)
108
Which investigation should be undertaken before biologics can be administered?
TB interferon gamma release assay
(can reactivate latent TB)
109
Overflow diarrhoea - how to get rid of obstructing stool?
Phosphate enema
110
Main causes of electrical alternans
Pericardial effusion and cardiac tamponade
(heart swings in pericardial sac)
111
Narrow complexes with large amplitudes on ECG?
Left ventricular hypertrophy
112
Legionella electrolyte derangement?
Hyponatraemia
(caused by SIADH)
113
Complications of high-dose salbumatol?
- Tachycardia
- Tremor
- Hypokalaemia
- Anxiety
- Hyperglycaemia
114
Anterior uveitis management
Topical steroid drops to reduce inflammation (frequency depending on severity)
+ Pupil dilating drops (e.g. cyclopentolate) to alleviate symptoms of photophobia
+ Treatment of the underlying cause (e.g. antimicrobials for infections)
115
Gradual onset erectile dysfunction in a middle-aged male?
Diabetes
116
Tertiary hyperparathyroidism - what are the results for:
- Calcium?
- Phosphate?
- PTH?
Tertiary = ALL THREE!
Calcium up
Phosphate up
PTH up
117
How to calculate alcohol units?
How many units is a 750ml bottle of 40% vodka?
Volume (ml) x ABV / 1000
750 x 40 / 1000 = 30 units
118
Patient has MI, then days later has another potential MI - which blood test to use?
Creatine Kinase MB (CK-MB)
(CK-MB levels normalise after 48-72 hours, whereas troponin remains elevated for days)
119
Acute mesenteric ischaemia imaging modality?
CT angiography
to assess blood supply to the bowel
120
Gallstones with no symptoms?
Reassure and discharge
121
Suspected appendicitis in a female - imaging modality?
Abdominal ultrasound
to exclude ovarian/gynae pathology
122
Describe features of Behcet's disease
Relapsing-remitting oral and genital ulceration
Ocular involvement
Erythema + arthritis
(Turkish, Mediterranean, Japanese)
123
Flu-like symptoms + tender parotid glands = test for Mumps
What is the test for Mumps?
Specific salivary IgM testing
124
QRISK score > 10% ?
Lifestyle modifications
- if no improvement to cholesterol, start a statin
125
Medication used for passive immunity to RSV in babies (if there has been close contact between babies)
Palivizumab
126
Congenital syphilis symptoms?
- Sensorineural deafness
- Desquamating rash
- Hutchinson's teeth (malformed incisors)
127
Congenital rubella symptoms?
- Sensorineural deafness
- Cataracts
- Blueberry muffin rash
- Heart defects (pulmonary stenosis)
128
PPROM management?
- Antibiotics (typically erythromycin) for 10 days
- Steroids until 34 weeks
129
Faecal calprotectin used for?
IBD
130
Thalassaemia major patient has jaundice + haemochromatosis-like symptoms
What is the likely cause?
Blood transfusions
which cause iatrogenic iron overload
131
Baby having Tetralogy of Fallot episode - what should parent do?
Pick the child up and bring knees to the chest
(compresses the femoral arteries and increases peripheral vascular resistance)
132
Anti-histone antibodies ?
Drug-induced lupus
Commonly, due to...
- isoniazid (used for TB)
- procainamide
- hydralazine
- minocycline
- phenytoin
133
Minimal change blood derangements?
Low serum albumin
High cholesterol/triglycerides
134
PMHx of retinoblastoma + sore bone with "sunburst appearance" on X-ray
Osteosarcoma
135
Chondrosarcoma
1. Demographic
2. Finding on X-ray
1. Over 40s
2. Lytic lesions with "fluffy popcorn calcification"
136
Dupuytren's contracture risk factors?
Alcohol
Family history
Northern European descent
Male
Over 40s
137
Ottawa ankle rules
Painful over medial/lateral malleolus
+ at least one of:
1. Inability to weight bear
2. Bony tenderness along medial/lateral malleolus
138
Pregnant woman with vaginal thrush - management?
Clotrimazole pessary
(oral fluconazole is contraindicated)
139
Lymphogranuloma venereum blisters - painful or painless?
Painless
Painful blisters = HSV
140
Describe malignant hyperthermia
Reaction to anaesthetic drugs
- very high temperature
- rigidity/stiffness
- increased HR and RR
Due to genetic defect in RYR1 gene
AUTOSOMAL DOMINANT (50% chance)
141
HNPCC (Lynch syndrome) increases risk of which 3 cancers?
1. COLORECTAL
2. Endometrial
3. Pancreatic
142
Baby yawning loads = ?
Opiate withdrawal
143
5-day-old, vomiting, reduced skin turgor, dry mucous membranes, hyponatraemia, hyperkalaemia - diagnosis?
Congenital adrenal hyperplasia
144
SLE
1. Most specific test?
2. Most sensitive test?
1. Most specific = anti-dsDNA
2. Most sensitive = ANA
145
Rheumatoid arthritis medication toxicity causing retinal toxicity (scotoma, colour vision loss)
Which medication?
Hydroxychloroquine
146
Lactic acidosis
If patient is acidotic, CHECK LACTATE
Which drug should be withheld?
Metformin
147
Charcot's triad (RUQ pain, fever, jaundice) = ?
Management = ?
Ascending cholangitis
- do ERCP to remove gallstone
- then plan elective laparoscopic cholecystectomy
148
Colicky pain in a palliative patient
Management?
Hyoscine
(antispasmodic and antimuscarinic)
149
Neutrophilia flare common cause?
Steroids
Also,
Lithium
Infection
Malignancy
Stress
150
Lymphoma:
two sites of disease on either side of diaphragm
+ B symptoms
Stage III B
151
Non-lactational mastitis
1. Typical distribution?
2. Management?
1. Wedge-shaped distribution
2. Co-amoxiclav
(if penicillin-allergic, give erythromycin + metronidazole)
152
