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MSRA
| Question | Answer |
|---|---|
| Side effects of Methotrexate | Myelosuppression Liver cirrhosis Pneumonitis |
| Side effects of Sulfasalazine | Rashes Oligospermia Heinz body anaemia Interstitial lung disease |
| Side effects of Leflunomide | Liver impairment Interstitial lung disease Hypertension |
| Side effects of Hydroxychloroquine | Retinopathy Corneal deposits |
| Side effects of Prednisolone | Cushingoid features Osteoporosis Impaired glucose tolerance Hypertension Cataracts |
| Side effects of Gold | Proteinuria |
| Side effects of penicilliniamine | Proteinuria Exacerbation of Mysathenia Gravis |
| Side effects of Etanercept | Demyleination Reactivation of tuberculosis |
| Side effects of 'MABs' | Reactivation of TB |
| Side effects of NSAIDs | Bronchospasm in asthmatics Dyspepsia/peptic ulceration |
| What is Section 2 | admission for assessment for up to 28 days, not renewable |
| What is Section 3 | admission for treatment for up to 6 months, can be renewed |
| What is Section 4 | 72 hour assessment order used as an emergency, when a section 2 would involve an unacceptable delay |
| What is Section 5(2) | a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours |
| What is Section 5(4) | similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours |
| What is Section 17a | Supervised Community Treatment (Community Treatment Order) |
| What is Section 135 | a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety |
| What is Section 136 | someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety |
| hat is the most appropriate anti-emetic to prescribe in PArkinson's? | Domperidone |
| What Is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications | Atenolol |
| Management of acute sensorineural hearing loss? | Acute sensorineural hearing loss is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI |
| What is the incubation period of Staphylococcus aureus, Bacillus cereus? | 1-6 hours |
| What is the incubation period of Salmonella, Escherichia coli? | 12-48 hours |
| What is the incubation period of Shigella, Campylobacter? | 48-72 hours |
| What is the incubation period of Giardiasis, Amoebiasis? | >7 days |
| Abx for Acute prostatitis | Quinolone or trimethoprim |
| Abx for Acute pyelonephritis | Broad-spectrum cephalosporin or quinolone |
| Abx for Erysipelas | Phenoxymethylpenicillin (erythromycin if penicillin-allergic) |
| Abx for Otitis externa* | Flucloxaacillin |
| Abx for Campylobacter enteritis | Clarithromycin |
| Abx for Salmonella (non-typhoid | Ciprofloxacin |
| Which skin disorders is most associated with antiphospholipid syndrome? | Livedo reticularis |
| Which may give a falsely low BNP result? | aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretic |
| What can be given To induce remission in adults with a mild to moderate first presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis | offer a high induction dose of an oral aminosalicylate consider adding a topical aminosalicylate or oral beclometasone dipropionate, taking into account the person's preferences. |
| What are the side effects of Calcium channel blockers? | Headache Flushing Ankle oedema Verapamil also commonly causes constipation |
| What are the side effects of beta blockers? | Bronchospasm (especially in asthmatics) Fatigue Cold peripheries Sleep disturbances |
| What are the side effects of nitrates? | Headache Postural hypotension Tachycardia |
| What are the side effects of nicorandil? | Headache Flushing Anal ulceration |
| An 84-year-old female has been an inpatient in a psychiatric ward for the past 6 months with a fixed belief that her insides are rotting as she is deceased. | Cotaard Syndrome |
| belief that friends or family members have been replaced by an identical looking imposter. | Capgras Delusion |
| A nurse undergoes primary immunisation against hepatitis B. Levels of which one of the following should be checked four months later to ensure an adequate response to immunisation? | Anti-HbS |
| surface antigen (HBsAg) | first marker to appear and causes the production of anti-HBs |
| HBsAg | implies acute disease (present for 1-6 months) |
| Anti-HBs | implies immunity (either exposure or immunisation). It is negative in chronic disease |
| Anti-HBc | implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists |
| What is second-line treatment of Heart failure? | either an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate |
| A 71-year-old woman is diagnosed with polymyalgia rheumatica. She is started on prednisolone 15mg od. What is the most appropriate approach to bone protection? | Oral alendronate, ensure calcium and vitaamin D replete |
| Which abx cause cholestasis? | Flucloxacillin, Co-Amoxiclav |
| Which abx cause Gastrointestinal upset and Prolongs QT interval | Erythromyicn |
| Which abx cause Lowerd seizure threshold +/-Tendonitis | Ciprofloxacin |
| Which abx cause: Rashes, including photosensitivity Pruritus Suppression of haematopoiesis | Trimethoprim |
| Which drugs should be avoided in breastfeeding? | antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone |
| Causes of meningitis Neonatal to 3 months | Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes E. coli and other Gram -ve organisms Listeria monocytogenes |
| Knee locking and giving-way are common features of | meniscal lesions. A positive Thessaly's test confirms the diagnosis. |
| ACL injury typically presents with... | acutely with a history of popping, immediate pain and swelling and instability of the knee. |
| Examples of UKMEC 3 conditions include | more than 35 years old and smoking less than 15 cigarettes/day BMI > 35 kg/m^2* family history of thromboembolic disease in first degree relatives < 45 years controlled HTN immobility carrier of(e.g. BRCA1/BRCA2) |
| Examples of UKMEC 4 conditions include | >35 years old and smoking > 15 cigarettes/day migraine with aura Hx thromboembolic disease or thrombogenic mutation Hx of stroke/IHD breast feeding < 6 weeks post-partum uncontrolled HTN current breast ca major surgery with prolonged immobilisation |
| Investigation ? early miscarriage | Transvaginal ultrasound |
| Arteriolar narrowing and tortuosity Increased light reflex - silver wiring | Grade 1 HTN retinopathy |
| Arteriovenous nipping | Grade 2 HTN retinopathy |
| Cotton-wool exudates Flame and blot haemorrhages | Grade 3 HTN retinopathy |
| Papilloedema | Grade 4 retinopathy |
| How is premature ovarian failure defined? | Onset of menopause symptoms + raised gonadotrophins before 40 yrs |
| A 45-year-old female with a history of bipolar disorder presents with an acute confusional state. Which one of the following drugs is most likely to precipitate lithium toxicity? | Bendroflumethiazide |
| Bilaterally small pupils that accommodate but don't react to bright light. Causes include neurosyphilis and diabetes mellitus | Argyll-Robertson pupil |
| Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma) | Hutchinson's |
| Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side. . | Horner's syndrome |
| Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and appear to dilate when a light is swung from unaffected to affected eye. | Marcus-Gunn pupil |
| Dilated pupil | Adie pupil |
| The stroke consultant diagnoses him clinically as a POCI (posterior circulation infarct). What part of the brain anatomy is affected for this kind of stroke? | Verterbrobasillar arteries |
| Causes of oligohydraminos | premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia |
| Which one of the following types of anti-anginal medication do patients commonly develop tolerance to? | Standard release ISMN |
| Prostaglandin analogues (e.g. latanoprost) | Adverse effects include brown pigmentation of the iris, increased eyelid length |
| Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) | Avoid if taking MAOI or tricyclic antidepressants Adverse effects include hyperaemia |
| Carbonic anhydrase inhibitors (e.g. Dorzolamide) | Systemic absorption may cause sulphonamide-like reactions |
| Miotics (e.g. pilocarpine, a muscarinic receptor agonist) | Adverse effects included a constricted pupil, headache and blurred vision |
| A 52-year-old male presents with 3yr Hx of worsening hip and back pain. He reports the hip pain is worse on weight-bearing and improves with rest. You noticed frontal bossing and bowing of the legs. What is the first-line treatment for his condition ? | Alendronate |
| Should be added in the treatment of pneumonia if secondary to influenza | clarithromycin |
| Which one of the following is a contraindication to the use of a triptan in the management of migraine? | A history of IHD |
| Atovaquone + proguanil (Malarone) | SE: GI upset, finish 7/7 post trvel |
| Chloroquine | Headache Contraindicated in epilepsy Taken weekly until 4/52 post travel |
| Mefloquine (Lariam) | Dizziness Neuropsychiatric disturbance Contraindicated in epilepsy Taken weekly |
| A 15yr old has a past history of acne and is currently treated with oral lymecycline. There has been no response to treatment and examination reveals evidence of scarring on his face. What is the most suitable treatment? | Oral retinoids |
| Should be avoided due to an increased risk of drug-induced lupus and hyperpigmentation | Oral minocycline |
| Prolonged treatment may depress haematopoiesis | Oral trimethoprim |
| Thrombotic crises | also known as painful crises or vaso-occlusive crises precipitated by infection, dehydration, deoxygenation infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain |
| Sequestration crises | sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia |
| Acute chest syndrome | dyspnoea, chest pain, pulmonary infiltrates, low pO2 the most common cause of death after childhood |
| Aplastic crises | caused by infection with parvovirus sudden fall in haemoglobin |
| Haemolytic crises | rare fall in haemoglobin due an increased rate of haemolysis |
| Raised ALP and low calcium | Osteomalacia Renal failure |
| Raised ALP and raised calcium | Bone metastases Hyperparathyroidism |
| Generalised tonic-clonic seizures | sodium valproate second line: lamotrigine, carbamazepine |
| Absence seizures* (Petit mal) | sodium valproate or ethosuximide sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy |
| Myoclonic seizures | sodium valproate second line: clonazepam, lamotrigine |
| Focal seizures | carbamazepine or lamotrigine second line: levetiracetam, oxcarbazepine or sodium valproate |
| Drugs that cause pancreatitis | azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate |
| Acne rosacea treatment: mild/moderate | topical metronidazole |
| Acne rosacea treatment:severe/resistant | oral tetracycline |
| Oligohydramnios | premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia |
| Responds to their own name | 9-12 months |
| Vocabulary of 2-6 words | 12-18 months |
| Which one of the following conditions is most likely to result in secondary dysmenorrhoea? | Adenomyosis |
| X-linked recessive condition | no male-to-male transmission |
| Causes of scarring alopecia | trauma/burns, radiotherapy, lichen planus, discoid lupus, tinea capitis |
| Cataracts | steroids |
| Corneal opacities | amiodarone indomethacin |
| Optic neuritis | ethambutol amiodarone metronidazole |
| Retinopathy | chloroquine, quinine |
| Hepatitis B | 20-30% |
| Hepatitis C | 0.5-2% |
| HIV | 0.3% |
| Acute viral labrynthitis | sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo |
| First line BPH | Alpha-1 antagonists |
| Risk factors for DDH | female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity |
| Parietal lobe lesions | sensory inattention apraxias astereognosis (tactile agnosia) inferior homonymous quadrantanopia Gerstmann's syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation |
| Occipital lobe lesions | homonymous hemianopia (with macula sparing) cortical blindness visual agnosia |
| Temporal lobe lesion | Wernicke's aphasia: this area 'forms' the speech before 'sending it' to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent superior homonymous quadrantanopia auditory agnosia prosopagnosia |
| Frontal lobes lesions | expressive (Broca's) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting disinhibition perseveration anosmia inability to generate a list |
| A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face | Scarlet fever |
| A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted | Rubella |
| A 4-year-old boy presents with fever, malaise and a 'slapped-cheek' appearance | Parvovirus B19 |
| Prodrome: irritable, conjunctivitis, fever Koplik spots: white spots ('grain of salt') on buccal mucosa Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent | Measles |
| Fever, malaise, muscular pain Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70% | Mumps |
| Caused by the coxsackie A16 virus Mild systemic upset: sore throat, fever Vesicles in the mouth and on the palms and soles of the feet | Hand, foot and mouth disease |
| Combined oral contraceptive pill Implanatable contraceptive (etonogestrel) Injectable contraceptive | Inhibits ovulation |
| Progestogen-only pill (excluding desogestrel) | Thickens cervical mucus |
| Intrauterine system (levonorgestrel) | Primary: Prevents endometrial proliferation Also: Thickens cervical mucus |
| Hypomagnesaemia | Cisplatin |
| Myelosuppression, liver fibrosis and oral mucositis | Methotrexate |
| Cardiomyopathy | Doxorubicin |
| Toxoplasmosis retinitis | white focal retinitis with overlying vitreous inflammation |
| Cytomegalovirus retinitis | appearance of a 'pizza pie', with retinal spots and flame haemorrhages. |
| CABG | 4 weeks off driving |
| acute coronary syndrome | 4 weeks off driving, 1 week if successfully treated by angioplasty |
| pacemaker insertion | 1 week off driving |
| successful catheter ablation for an arrhythmia | 2 days off driving |
| heart transplant | DVLA do not need to be notified |
| 72 hour assessment order for a patient who is not in hospital | Section 4 |
| 6 months - 6 years adrenaline dose for anaphylaxis | 150 mcg (0.15ml 1 in 1,000) |
| tear drop shaped cells | myelofibrosis |
| A 58-year-old retired miner develops smear-positive Mycobacterium tuberculosis. Which of the following dusts is most likely to have increased the risk of this infection in this patient? | silica |
| This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). | Left ventricular free wall rupture |
| The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. | Left ventricular aneurysm |
| Rupture of the interventricular septum usually occurs in the first week and is seen in around 1-2% of patients. Features: acute heart failure associated with a pan-systolic murmur. | VSD |
| More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle. Acute hypotension and pulmonary oedema may occur. An early-to-mid systolic murmur is typically heard. | Acute MR |
| A 23-year-old man develops watery diarrhoea whilst travelling in Egypt. Which one of the following is the most likely responsible organism? | E.Coli |
| Sensory loss over anterior thigh Weak quadriceps Reduced knee reflex Positive femoral stretch test | L3 nerve root compression |
| Sensory loss anterior aspect of knee Weak quadriceps Reduced knee reflex Positive femoral stretch test | L4 nerve root compression |
| Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test | L5 nerve root compression |
| 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 | S1 nerve root compression |
Created by:
laylag