17.02.24

Question 1

Causes of false negative TB testing:

Answer 1

HIV, lymphoma, miliary TB, sarcoidosis and very young age <6months.

Question 2

Different tests for active TB:

Answer 2

CXR - cavitating upper lobe lesions is classical of TB.

Sputum culture is gold standard, is more sensitive than a smear and NAAT. Can also assess drug sensitivities, but it takes 1-3 weeks to come back.

NAAT test is rapid, but less sensitive than culture.

Smear needs 3 specifimens, acid fast bacilli stain - but all mycobacteria will stain positive, not just TB.

Question 3

Order of sensitivity of TB tests:

Answer 3

Sputum culture > NAAT > sputum smear

Question 4

Diagnosis of TB:

Answer 4

CXR

3 deep sputum samples:
- one early morning for microscopy of acid fast bacilli
- mycobacteria culture
- drug sensitivity testing

Question 5

Assessment of an upper GI bleed:

Answer 5

A-E, focus on haemodynamic status.

Question 6

What medications are given in the acute management of a variceal haemorrhage?

Answer 6

Terlipressin and Co-amoxiclav

Prophylaxis = carvedilol

Question 7

4 histological findings in Coeliac disease:

Answer 7

Villous atrophy.
Crypt hyperplasia.
Intraepithelial lymphocytes.
Lamina propria infiltration with lymphocytes.

Question 8

Who should be screened for coeliac disease?

Answer 8

T1DM new diagnosis
Autoimmune thyroid disease new diagnosis
Dermatitis herptiformis
IBS
First degree relatives

Question 9

Which HLA is Coeliac disease most associated with?

Answer 9

HLA-DQ2 & DQ8

Question 10

Timeline and features of acute alcohol withdrawal:

Answer 10

6-12 hour = sweating, anxiety, tachycardia, tremor

36 hours = peak seizure

48-72 hours = delirium tremens inc course tremor, auditory and visual hallucinations, confusion, delusion, tachycardia and fever

Question 11

Differentials for acute alcohol withdrawal:

Answer 11

TBI
Encephalopathy
Delirium

Question 12

Indications for lorazepam over diazepam in acute alcohol withdrawal:

Answer 12

Evidence of liver disease e.g. encephalopathy, jaundice.

Other comorbdiity e.g. pneumonia, reduced GCS, COPD.

Over 70 years old.

Question 13

Symptoms of Wernicke’s encephalopathy:

Answer 13

Confusion, decreased consciousness, ataxia, nystagmus, opthalmoplegia, hypothermia, hypotension

Question 14

Treatment of Wernicke’s encephalopathy:

Answer 14

URGENT

Day 1-2: Start 2pairs of vials IV Pabrinex tds + check magnesium levels and correct

Day 3-5: 1 pair of vials tds

Day >5: oral thiamine if tolerated

Question 15

What is the most sensitive and specific lab finding for diagnosis of cirrhosis in CLD?

Answer 15

Thrombocytopenia

Question 16

Causes of liver cirrhosis:

Answer 16

NAFLD
HBV and HCV
Alcohol

Question 17

Indications for a transient elastography / Fibroscan?

Answer 17

Diagnosed ALD
Diagnosed HCV
Men who drink >50 units and women over >35 units per week

Question 18

Further investigations in patients with liver cirrhosis:

Answer 18

Upper endoscopy to check for varices in a new diagnosis

Liver US +/- AFP every 6 months for HCC

Question 19

What score is used in patients with NAFLD to assess for further cirrhosis investigations?

Answer 19

ELF

Combines 3 fibrosis markers into a single value.

> 10.51 = advanced liver fibrosis

Question 20

What investigation is indicated in an acute flare of UC?

Answer 20

Flexible sigmoidoscopy.

Can examine disease severity and effectiveness of ongoing treatment.

Colonoscopy contraindicated due to risk of rupture,

Question 21

Discuss relationship between anti-TTG, IgA and EMA.

Question 22

First line management for NAFLD:

Answer 22

WEIGHT LOSS

Question 23

Factors associated with NAFLD:

Answer 23

Obesity
Sudden weight loss / starvation
Jejunoileal bypass
Hyperlipidaemia
T2DM

Question 24

Features of NAFLD:

Answer 24

Usually asx
Hepatomegaly
ALT >AST
Increased echogenicity on US

Question 25

Which cancer does Coeliac disease increase the risk of?

Answer 25

enteropathy-associated T-cell lymphoma Risk factors include poor adherence to gluten-free diet and late diagnosis.

Question 26

What are classic LFT findings in alcoholic hepatitis?

Answer 26

AST:ALT is 2:1 (>3:! = acute) Gamma-GT elevated.

Question 27

Cause of acute liver decompensation:

Answer 27

Constipation, electrolyte imbalance, infection, dehydration, upper GI bleed or increased alcohol intake.

Question 28

Symptoms of coeliac disease that prompt investigation:

Answer 28

Tired all the time Unexplained anaemia Recurrent abdo pain and cramping or distension FTT or faltering growth in children Sudden weight loss Chronic or intermittent diarrhoea

Question 29

6 Ps of acute limb ischaemia:

Answer 29

Pain Pallor Paraesthesia Paralysis Perishingly cold Pulseless

Question 30

Complications of coeliac disease:

Answer 30

Anaemia Hyposplenism Osteoporosis and osteomalacia Lactose intolerance Enteropathy-assocaited t cell lymphoma

Question 31

Symptoms of pernicious anaemia / B12 deficiency:

Answer 31

Anaemia symptoms: pallor, SOB, lethargy Neuro symptoms: - Peripheral neuropathy e.g. pins and needles, paraesthesia, legs >arms - SCDC: progressive weakness, ataxia and parasthesia leading to spasticity and paraplegia. - Neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritability.

Question 32

Indications for dialysis:

Answer 32

Diuretic resistant pulmonary oedema Hyperkalaemia refractory to medical therapy Metabolic acidosis refractory to medical therapy Uraemic complications e.g. pericarditis, encephalopathy, bleeding Dialysable toxins e.g. lithium, salicylates

Question 33

What conditions other than MS can oligoclonal bands be found in?

Answer 33

GBS CNS infection e.g. HIV Post CVA

Question 34

MS relapse management:

Answer 34

Methylprednisolone IV + PPI Physio / OT Review medication

Question 35

Modifiable risk factors for relapse or progression of MS:

Answer 35

Exercise Smoking Vaccinations

Question 36

First line drug for treating spasticity in MS:

Answer 36

Baclofen Or gabapentin

Question 37

What is a common feature of MS, due to a frontal lobe lesion?

Answer 37

Emotional lability. Can be treated with amitriptyline.

Question 38

Classic signs of ALS:

Answer 38

Mixed UMN and LMN signs - UMN in legs, LMN in arms. Little sensory involvement. Fasciculations, atrophy and absent reflexes = LMN Spasticity, brisk reflexes, upgoing plantar = UMN

Question 39

4 types of MND:

Answer 39

Amyotrophic lateral sclerosis Primary lateral sclerosis - UMN only Progressive muscular atrophy - LMN only, best prognosis Progressive bulbar palsy - worst prognosis. Palsy of tongue, chewing/swallowing and facial muscles due to loss of function of brainstem nuclei.

Question 40

Definition of vertigo:

Answer 40

False sensation that the body or environment is moving.

Question 41

Causes of vertigo:

Answer 41

Viral labrynthitis Vestibular neuronitis BPPV Meniere's disease Acoustic neuroma Vertebrobasilar ischaemia

Question 42

Managing bladder dysfunction in MS:

Answer 42

US KUB to assess bladder emptying. If retention, self catheterisation. If not, anticholinergics may improve symptoms e.g. oxybutynin

Question 43

Most common type of MS:

Answer 43

RRMS