20 December

Question 1

What should be done if clinic BP is 140/90- 179/119?

Answer 1

Offer ABPM or HBPM
Investigate for organ damage
Assess CV risk

If BP in clinic >180/120 on 2 readings in clinic- consider starting drug treatment with no ABPM and repeat BP in 7 days if no sign of organ damage

Question 2

What is stasis dermatitis?

Answer 2

Discolouration and ulceration of the lower legs near the ankles

Question 3

What are features of lateral epicondylitis?

Answer 3

Tennis elbow
Lateral elbow and forearm pain worse on use
Pain just distal to lateral epicondyle
Pain on wrist extension and supination

Treat
- rest
- elbow strap
- NSAIDs
- Steroid injections if severe

Question 4

What is the management of urticaria?

Answer 4

Antihistamines are mainstay

Trial non sedation first
If not responding to treatment- double dose of antihistamines
Add sedating antihistamine at night if sleep disturbed
Topical anti-pruritic treatment

Severe- oral steroids with non sedating antihistamine

Omalizumab and immunomodulatory medication in refractory cases

Question 5

How can you calculate units of alcohol drunk?

Answer 5

Volume in ml x %ABV divided by 1000

Question 6

What are live vaccines?

Answer 6

MMR
BCG
Oral polio
Yellow Fever
VZV
Oral typhoid

Question 7

When should live vaccines not be given?

Answer 7

Evolving neurological problems e.g. poorly controlled epilepsy
HIV severe immunity impairment

Question 8

What is Freiberg disease?

Answer 8

Osteochondrosis affecting the toes- particularly 2nd or 3rd metatarsal heads
Seen in teen girls
Pain on weight bearing
Rest and metatarsal pad
Surgery in severe cases

Question 9

What are 1st line abx for IECOPD?

Answer 9

1) Amoxicillin 500mg TDS for 5 days
2) Doxycycline 200mg day 1 then 100mg OD for 4 days
3) Clarithromycin 500mg BD for 5 days

Question 10

What is Hypertrophic Cardiomyopathy?

Answer 10

Asymmetrical left ventricular hypertrophy due to septal hypertrophy
Can lead to impaired diastolic function and sudden onset death

Question 11

What are investigations of HCM?

Answer 11

ECG- non specific changes
2) CXR can be normal
ECHO- first line imaging
Cardiac MRI- gold standard if ECHO inconclusive
Cardiac catheterisation- to determine degree of obstruction

Question 12

What are risk factors for bowel cancer?

Answer 12

FH of cancer
Polyps
IBD
Genetic conditions- HNPCC
Hormonal factors- no children
- Diet- high in fat, red meet, folate
Smoking
Obese
Diabetes

Question 13

What antibodies are seen in diffuse sclerosis?

Answer 13

Anti-Scl- 70

Question 14

What antibodies are seen in limited sclerosis?

Answer 14

Anti centromere
Anti nucleolus

Question 15

What is Behcets disease?

Answer 15

Chronic multisystem vasculitis

Genital ulcers
Skin lesions- erythema nodosum, folliculitis, acne in adults
Eye inflammation- iritis, uveitis
Behavioural changes
Arthritis

Treat with steroids in severe disease
Biologics

Question 16

What is the most common lung injury following blunt chest trauma?

Answer 16

Pulmonary contusion

Present with dyspnoea, tachypnoea, chest pain, haemoptysis

Question 17

What investigations are needed for multiple myeloma?

Answer 17

Blood film- rouloux formation
Serum/urine elctrophoresis- bence jones protein in urine
U&Es- renal impairment
Ca- Hypercalcemia
FBC- pancytopenia

Question 18

What are ottawa rules for foot XR in suspected ankle fractures?

Answer 18

Bone tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus
Bone tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
Inability to weight bear immediately after injury or in ED for 4 steps

Question 19

What are ottawa rules for foot XR in suspected foot fractures?

Answer 19

Bone tenderness at base of 5th metatarsal
Bone tenderness at navicular bone
Inability to weight bear immediately after injury or in ED for 4 steps

Question 20

What is milk-alkali syndrome?

Answer 20

Hypercalcaemia, renal failure and metabolic alkalosis due to excessive absorption of calcium
Due to widespread use of calcium carbonate (antacids or calcium replacement to prevent osteoporosis)

Question 21

What are features of pinworm infection?

Answer 21

Enterobius vermicularis

Faecal oral contamination

Live in intestines- often asymptomatic but if symptoms
- pruritis ani, restlessness during sleep, excoriation around anus/vulva

Treat with mebendazole - one off dose and then repeated within 2-3 weeks

Question 22

What are features of polymorphic eruption of pregnancy?

Answer 22

Pruritic condition seen in last trimester of pregnancy
Abdominal striae without excoriations sparing umbilicus
Lesions spread to trunk, thighs, arms
resolves following delivery of baby
Can use emollients and steroids if needed