19.02.24

Question 1

Order of potency of topical steroids:

Answer 1

Hydrocortisone acetate
Euvomate
Betnovate
Dermovate

Question 2

Venous ulcer features:

Answer 2

Shallow, flat margins
Gaiter area location
Palpable peripheral pulses and normal CRT

Haemosiderin deposits
Venous eczema
Varicosity
Lipodermatosclerosis

Question 3

Lifestyle factors to help prevent recurrence of venous ulcers:

Answer 3

Stop smoking
Weight loss
Wear correctly fitted compression stockings
Avoid injury to legs, and proper care
Avoid sedentary lifestyle
Elevation on rest

Question 4

‘E’ scoring on GCS:

Answer 4

E1 - no response
E2 - opens to pain
E3 - opens to speech
E4 - opens spontenously

Question 5

‘V’ scoring on GCS:

Answer 5

V1 - no response
V2 - incomprehensible sounds
V3 - inappropriate words
V4 - confused
V5 - orientated to time, place and person

Question 6

‘M’ scoring on GCS:

Answer 6

M1 - no response
M2 - abnormal extension (decerebrate)
M3 - abnormal flexion (decorticate)
M4 - flexion withdrawal from pain
M5 - localises to pain
M6 - obeys command

Question 7

Figures in nephrotic syndrome:

Answer 7

Hypoalbuminaemia <30g/L

Proteinuria >3g/24hrs

Question 8

What score is used for diagnosing RA?

Answer 8

EULAR criteria - need 6/10 for a diagosis.

It assesses joint involvement, serology, acute phase reactants and duration of symptoms.

Question 9

Types of psoriasis:

Answer 9

Plaque
Guttate
Flexural
Pustular
Erythrodermic

Question 10

4 drugs that can cause exacerbation of psoriasis:

Answer 10

NSAIDs
BB
Lithium
Hydroxychloroquine

Question 11

Discuss the inflammatory process in RA:

Answer 11

RA is characterised by synovitis. Inflamed synovium released cytokines including IL-6 that activate the liver to produce acute phase proteins such as CRP to clear dead and damaged cells.

Inflammatory cytokines also reduce iron metabolism by decreasing the sensitivity of bone marrow to EPO, reducing Hb.

Bone marrow may also be suppressed due to antirheumatoid drugs like MTX, and NSAID use can cause GI blood loss.

Question 12

H.pylori eradication therapy:

Answer 12

Omeprazole
Clarithromycin
Amoxicillin / Metronidazole if allergic

Question 13

Who should be tested for H.pylori?

Answer 13

All patients with gastroduodenal ulcer history

Patients with persistent dyspepsia for >1 month

ITP and gastric MALT lymphoma

Question 14

What do you give post endoscopic haemostasis for a bleeding ulcer:

Answer 14

Hong Kong Protocol: IV PPI infusion

Repeat endoscopy 6-8 weeks later to check healing of gastric ulcer.

Question 15

4 different types of Clostridium infection:

Answer 15

Difficile - diarrhoea
Perfringens - gas gangrene
Botulinum - flaccid paralysis
Tetani - spastic paralysis

Question 16

When considering fluid resus in a patient, you should consider if there are any ongoing fluid losses:

Answer 16

Third space losses e.g. pancreatitis or bowel obstruction
High output stoma
Diuresis
Tachypnoiec or febrile

Question 17

Types of surgery that most commonly require prophylactic antibiotics:

Answer 17

GI, vascular and orthopaedic

Bolus / infusion should be given <60 mins prior to skin incision.

Question 18

Virchow’s triad:

Answer 18

At least 1 must be present for VTE:

Hypercoagulability
Stasis of blood flow
Endothelial damage

Question 19

qSOFA score:

Answer 19

Altered mental state

SBP <100

RR >22

Question 20

SIRS criteria:

Answer 20

HR >90
Temp <36 or >38
RR >20
WCC <4 or >20

Sepsis is defined as infection (SIRS criteria) with evidence of organ hypoperfusion, which can be elicited using qSOFA.

Question 21

Definiton of sepsis:

Answer 21

Life threatening organ dysfunciton due to inapproprite response to infection

Septic shock = sepsis + hypotension , despite adequte fluid resus, or requiring ongoing inotropic agents. Underlying circulatory or metabolic abnoramlities are profound enough to substanitally increase mortality.

Question 22

What non-invasive imaging should be performed in all patients with SAB?

Answer 22

TTE

Refer to cardio if suggestive of endocarditis

Refer for TOE if negative but still high suspicion of endocarditis

Question 23

How often should blood cultures be reassessed in SAB?

Answer 23

48 hours after starting Abx, and at 48 hour intervals until negative.

Question 24

Assessment of SAB:

Answer 24

1. Assess for severity and sepsis: if NEWS>5 then seek immediate senior help
2. Consider source of SAB e.g. skin or soft tissue, surgical site, vascular device, indwelling device or prosthesis, bone or joint, spine, endocarditis, pacemaker etc etc
3. Take relevant blood samples e.g. additional 2 if endocarditis suspected.
4. Document SAB source and management plan