21/02/24 (morning)

Question 1

What is the best biologic treatment for a young lady who’s undergone wide excision for ER negative breast cancer with extensive nodal disease?

Answer 1

Trastuzumab (Herceptin)

Question 2

What biologic treatment is used for complex peri-anal Crohn’s and what must be done first?

Answer 2

• Infliximab
• All sepsis must be drained prior to starting

Question 3

What biologic treatments used for gastrointestinal stroll tumour, and what precaution must be taken?

Answer 3

• Imatinib
• Need to review patients after 12 weeks

Question 4

What 4 skin changes are seen in SLE?

Answer 4

Butterfly rash, photosensitivity, livedo reticularis, alopecia

Question 5

Psychosis is a rare but recognised adverse reaction to what drug class?

Answer 5

• Steroids
• Particularly in high doses

Question 6

What must you initially rule of in TIA and why?

Answer 6

Hypoglycaemia(by measuring blood glucose) as it is a common mimic

Question 7

What extra precautions must be taken if taking antibiotics with the POP?

Answer 7

None

Question 8

Features of G6PD deficiency?

Answer 8

• Neonatal jaundice
• Intravascualr haemolysis
• Gallstones common
• Splenomegaly
• Heinzbodis on blood film
• Attacks triggered by fava beans

Question 9

Aetiology of G6PD deficiency?

Answer 9

• More common in afrocaribbean and Mediterranean people
• X-linked recessive

Question 10

What drugs can triggered G6PD deficiency?

Answer 10

• Fava beans
• anti-malarials: primaquine
• ciprofloxacin
• sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

Question 11

What nail sign is seen in coeliac disease and why?

Answer 11

• Koilonychia (spoon nails)
• Coeliac disease causes iron deficiency anaemia

Question 12

Th triad of post-operative bleeding, epistaxis and menorrhagia is suggestive of what blood disorder?

Answer 12

von Willebrand disease

Question 13

What sign/investigation is best supportive of ankylosing spondylitis?

Answer 13

Sacro-ilitis on X-ray

Question 14

In a woman over 75 with a fragility fracture what drug should be started and why isn’t a scan needed?

Answer 14

• Start bisphosphonates without DEXA scan
• Following a fragility fracture in women ≥ 75 years, a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate

Question 15

Moderate/severe intercostal recession is what colour flag in children?

Answer 15

Red flag

Question 16

What are the steps in treatment for children with asthma aged <5?

Answer 16

1) SABA
2) SABA + moderate dose ICS
3) SABA + moderate dose ICS + LTRA
4) Stop LTRA and refer for assessment

Question 17

What are the steps in treatment for children aged 5-16 with asthma?

Answer 17

1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS + LTRA
4) SABA + low dose ICS + swap LTRA for LABA
5) SABA + low dose ICS MART
6) SABA + moderate dose ICS MART
7) SABA + high dose ICS MART (or trial of additional drug like aminophylline) + ask for senior opinion

Question 18

What should be given to all children presenting with acute asthma attack?

Answer 18

Oral prednisolone for 3-5 days