21 December

Question 1

What are signs of anterior cranial fossa fracture?

Answer 1

CSF rhinorrhoea
Racoon/panda eyes (subcutaneous ecchymosis)

Question 2

What are features of petrous temporal bone fracture?

Answer 2

Battle sign
CSF otorrhoea
Otorrhagia

Question 3

What are extra-articular manifestations of ankylosing spondylitits?

Answer 3

Anterior uveitis
Aortic valve insufficiency
Restrictive lung disease
Renal Amyloid
Cauda equina syndrome
Osteoporosis

Question 4

What are investigations for beta thalassaemia?

Answer 4

Microcytic anaemia
Normal reticulocyte
Normal Iron studies
Haemoglobin electrophoresis- absent beta bands

Question 5

When should anaphylaxis reactions be monitored for 24 hours instead of the standard 6 hours?

Answer 5

Severe reactions with slow onset and unknown cause
Reactions in patients with severe asthma
Reactions with potential of continued absorption of allergen
Patients with a history of biphasic reactions
Patients presenting in evening or night
Patients in isolated areas where access to medical care is sparseh

Question 6

What are features of benzodiazepine overdose?

Answer 6

Drowsiness
Diplopia
Ataxia
Slurred Speech
Anxiety/agitation
Resp depression
Hypotension
Coma

Flumazenil is management

Question 7

What are features of aspirin overdose?

Answer 7

Hyperventilating
Sweating
N&V
Abdominal pain
Tinnitus
Coma
Seizure

Resp alkalosis may be seen then metabolic acidosis

Question 8

What is the management of aspirin overdose?

Answer 8

Activated charcoal if >125mg/kg ingested <1hr
Gastric lavage within 24 hours
Rehydration and symptomatic support for mild
Moderate- urinary alkanisation with sodium bicarb
Severe- haemodialysis

Question 9

What is the earliest sign of diabetic retinopathy?

Answer 9

Microaneurysms

Question 10

What are investigations for myasthenia gravis?

Answer 10

Serum Anti- AChR antibodies
Repetitive nerve stimulation studies

CT scan of thorax once diagnosis is confirmed to rule out thymoma

Question 11

What is the management of myasthenia gravis?

Answer 11

Acetylcholinesterase inhibitors e.g. pyridostigmine
As disease becomes generalised then immunomodulatory agents e.g. steroids/azathioprine

Question 12

What is the management of urge incontinence?

Answer 12

Antyicholinergics e.g. oxybutynin, tolterodine, darifenacin

Oxybutynin not in older patients

Mirabegron if anticholinergic contraindicated

Review after 4 weeks
- if not working consider alternate for 4 weeks or mirebegron 4 weeks or refer

Question 13

When is colchicine in gout contraindicated?

Answer 13

Blood disorders
EGFR <10
Renal impairment
Severe hepatic impairment
Pregnant/breastfeeding
Medication e.g. macrolides, ketoconazole

Question 14

What vitamin deficiency can be seen in carcinoid syndrome?

Answer 14

Niacin (B3) and tryptophan

Present with pellagra
Dermatitis
Diarrhoea
Weakness and confusion

Question 15

What are features of carcinoid syndrome?

Answer 15

Neuroendocrine tumour found in GI tract

Vage symptoms
- abdominal pain
GI obstruction
Fibrosis- retroperitonealricardial
Vitamin deficiency
May secrete compounds such as bradykinin

Question 16

How is carcinoid syndrome diagnosed and managed?

Answer 16

Elevated urinary 5-hydroxyindoleacetic acid
Chromogranin A elevated if liver mets

Treat with
- somatostatin analogues, radionuclide therapies
Resection of tumours

Question 17

What is Peutz Jegher syndrome?

Answer 17

Autosomal dominat disease leading to pigmented lesions in buccol mucosa and GI polyps

Often presents as bowel obstruction from intussception