17/01/2025

Question 1

Cause of autonomic dysreflexia?

Answer 1

When there is a spinal cord injury at level T6 or above
Most commonly triggered by faecal impaction or urinary retention. These cause a sympathetic spinal reflex and the normal parasympathetic response is prevented by the cord lesion

Question 2

Sx of autonomic dysreflexia

Answer 2

the result is an unbalanced physiological response, characterised by extreme hypertension
flushing and sweating above the level of the cord lesion
agitation
in untreated cases, severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.

Question 3

What should you do if you suspect a TIA and a pt is on an anticoagulant or has a bleeding disorder?

Answer 3

CT head non-contrast urgently

Question 4

When should you do a carotid endarterectomy?

Answer 4

If carotid artery stenosis is >50%
Remember you do the carotid artery on the C/L side to the Sx of the stroke/TIA first even if it is less stenosed than the other side!

Question 5

Where is the lesion if a pt has wernickes dysphasia?

Answer 5

Superior temporal gyrus

Question 6

Where is the lesion if a pt has brocas dysphasia?

Answer 6

Inferior frontal gyrus

Question 7

Where is the lesion if a pt has conduction dysphasia?

Answer 7

Arcuate fasiculus (the neural pathway that connects the posterior part of the superior temporal gyrus to the frontal lobe - connects frontal, parietal and temporal lobes of the brain)

Question 8

Tetrad of Mccune Albright syndrome?

Answer 8

Cafe au lait spots
polyostotic fibrous dysplasia - in multiple bones the bone is replaced by fibrous tissue
Precocious puberty
Short stature

Question 9

What are the main features of leptospirosis?

Answer 9

Pt works in sewage, farms, vets, abattoirs - also very common in returning travellers
Spread by contact with infected rat urine

Mild flu Sx, fever, subconjunctival redness -> second immune phase is more severe with possibility of AKI, hepatitis or aseptic meningitis

Investigate with serology for antibodies to leptospira

Question 10

What causes oral hairy leukoplakia?

Answer 10

EBV infection of the tongue
Usually in immunocompromised e.g. HIV pts, drug-induced immunosuppression, primary blood disorders and ICS for asthma

Question 11

Clinical features of oral hairy leukoplakia?

Answer 11

Painless white plaques on lateral tongue which cannot be wiped off
Sometimes they can cause some discomfort, burning or stinging

Question 12

What ABx group are used to treat legionella?

Answer 12

Macrolides

Question 13

What causes giardiasis?

Answer 13

The flagellate protozoan giardia lamblia
Spread by faeco-oral route - typically foreign travel & swimming/drinking water from a river or lake

Question 14

Sx of giardiasis?

Answer 14

Often no Sx

Non-bloody steatorrhoea
Bloating
Abdo pain
Flatulance
Lethargy
Weight loss
Malabritpion and lactose intolerance

Question 15

Why can giardiasis cause lactose intolerance?

Answer 15

It reduces the expression of the brush border enzymes in the small intestine, including lactase = undigested lactose remains in the intestine, leading to osmotic diarrhoea, bloating and gas
Can precipitate lactose intolerance for months even after primary infection has resolves!

Question 16

How should you Tx a pt with a catheter in whose urine tests positive for bacterial UTI but they are asymptmatic?

Answer 16

Dont treat if asymptomatic!
If pregnant then do!
Most people will self-resolve, risk of AB resistance, disrupts normal urinary and gut microbiome making future infections more likely, potential SE

Question 17

Brown sequard syndrome cause?

Answer 17

Lateral hemisection of the spinal cord
Disrupts the following tracts:
- Dorsal columns which travel ipsilaterally up the spinal cord and decussate at the lower medulla = ipsilateral loss of fine touch, vibration & proprioception below the level of the lesion
- Lateral corticospinal tract which decussates at the medulla = ipsilateral weakness below the level of the lesion
- Lateral and anterior spinothalamic - enters spinal cord ascends 1-2 levels above and then decussates = contralateral loss of pain and temp sensations 1-2 levels below the levels of the lesion of the spinal cord

Question 18

Brown sequard syndrome Sx?

Answer 18

I/L weakness below lesion & loss of proprioception and vibration sensation
C/L loss of pain and temperature sensation

Question 19

Is a craniopharyngioma or a pituitary adenoma more likely to cause central diabetes insipidus?

Answer 19

Craniopharyngioma!
More likely to compress the hypothalamus and posterior pituitary gland where ADH is produced and secreted from

Question 20

What is a cholesteatoma?

Answer 20

a non-cancerous growth of squamous epithelium that is ‘trapped’ within the middle ear and/or mastoid air cell spaces causing local destruction.

Question 21

Risk factors for cholesteatoma?

Answer 21

Male
Age 10-20
Middle ear disease e.g. recurrent OM
ENT surgery
Congenital anomalies and genetic syndrome
Cleft palate increases risk by 100 fold

Question 22

Sx of cholesteatoma?

Answer 22

Recurrent/prsistent U/L purulent ear discharge that doesn’t respond to Tx. Malodorous and scanty
Progressive hearing loss or tinnitus
Ear pain, vertigo, facial weakness in advanced disease

Question 23

Otoscopy findings in cholesteatoma?

Answer 23

Attic crust
Retraction pocket in the attic or posterosuperior quadrant
Round, white or yellow mass behind the TM

Question 24

Tx of cholesteatoma?

Answer 24

Refer to ENT as may need audiology & CT/MRI of temporal bone
Consideration of surgical removal

Question 25

What is factor 5 leiden also known as?

Answer 25

Activated protein C resistance

Question 26

What is the most common inherited thrombophilia?

Answer 26

Factor V leiden
5% of UK population

Question 27

Pathophysiology of factor V leiden?

Answer 27

Mutation of factor V leiden protein so it is inactivated 10 times more slowly by activated protein C than normal!
This means there is an increased tendency to clot

Question 28

What are the 3 symptomatic phases of whooping cough?

Answer 28

Catarrhal phase - Sx of an URTI for 1-2 weeks

Paroxysmal phase - coughing bouts which may end by vomiting or cause central cyanosis. Inspiratory whoop, spells of apnoea. persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures. 2-8 weeks

Convalescent phase - cough subsides over weeks/months

Question 29

Diagnostic criteria for whooping cough?

Answer 29

Acute cough for >=14 days without another apparent cause and has at least 1 of the following:
- paroxysmal cough
- inspiratory whoop
- post-tussive vomiting
- undiagnosed apnoea attacks in young infants

Question 30

Management of whooping cough?

Answer 30

If <6 months admit
Notifiable disease

Oral macrolide if onset of cough is within the previous 21 days
ABx prophylaxis to household contacts

School exclusion: 21 days from onset of Sx or 48 hours after staring ABx

Question 31

Management of lichen sclerosis?

Answer 31

Topical steroids and emolients

Question 32

Whats the risk of lichen sclerosus?

Answer 32

Increased risk of SCC vulval cancer - 2-5% lifetime risk

Question 33

Presentation of lichen sclerosus?

Answer 33

White atrophic patches on the skin - usually and genital region
Itching
Pain if skin undergoes fissuring or erosions e.g. clitoral hood fusion
Dysparuenia or dysuria

Question 34

What is erythrasma?

Answer 34

Chronic superficial infection of intertriginois areas of skin caused by an overgrowth of cornyebacterium minutissimum

Asymptmatic flat, scaly pink/brown rash in groin or axilla

Question 35

What is erythema nodosum?

Answer 35

Inflamation of subcutaneous fat (panniculitis) causing tender, erythematous nodular lesions typically over the shins

Question 36

Prognosis of erythema nodosum?

Answer 36

Lesions heal without scarring and resolve within 6 weeks!

Question 37

Causes of erythema nodosum?

Answer 37

Infection e.g. TB, strep or brucellosis
Sarcoidosis
IBD
Behcets
Malignancy/lymphoma
Drugs e.g. COCP, penicillins, sulphonamides
Pregnancy

Question 38

What test can you do to confirm a recent streptococcal infection in a pt?

Answer 38

Look for a raised anti-streptolysin O titre

Question 39

What is seborrhoeic dermatitis associated with?

Answer 39

HIV
Parkinson’s disease

Question 40

What is otosclerosis?

Answer 40

Replacement of normal bone by vascular spongy bone which causes progressive conductive deafness due to fixation of the stapes at the oval window
AD & positive FHx. Typically affects young adults.