22 December #2

Question 1

What medications can be given if adenosine does not work in SVT?

Answer 1

Beta blockers e.g. metoprolol or CCB e.g. Verapamil

Question 2

What is Prehns sign?

Answer 2

Elevation of the scrotal sac relieves pain
If true epididymo-orchitis
If untrue then torsion

Question 3

What are features of bullous pemiphigoid?

Answer 3

Autoimmune condition with antibodies against BP 180 and 230

Itchy tense blisters around flexures, heal with no scarring
No mucosal involvement (rarely can be)

Immunofluorescence shows IgG and C3 at dermoepidermal junction

Treat with oral steroids as mainstay

Question 4

What are features of Legionnaires disease?

Answer 4

Caused by Legionella pneumophilia

Flu like symptoms
Dry cough
bradycardia
Confusion
Hyponatraemia
Lymphopaenia
Deranged LFTs

Diagnose with urinary antigen

Treat with erythromycin/clarithromycin/ ciprofloxacin (?rifampicin?)

Question 5

What are features of Pneumocystis carinii pneumonia?

Answer 5

Affects immunocompromised (HIV)

Present with dry cough, fever, exertional dyspnoea

CXR- bilateral perihilar interstitial shadowing

Diagnose- bronchoalveolar lavage/sputum

Treat with Co-trimoxazole

Question 6

What is the management of staph pnuemonia in CF patients?

Answer 6

Flucloxacillin

Question 7

What tumour marker is present for bowel cancer?

Answer 7

CEA

Question 8

What tumour marker can be used for breast cancer?

Answer 8

Ca27.29
Ca153
AFP
Ca 199

Question 9

What questionnaire is used for alcohol dependence?

Answer 9

CAGE

Question 10

What questionnaire is used for anxiety/depression?

Answer 10

HADS

Question 11

What score is used for pressure sores?

Answer 11

Waterlow

Question 12

What are features of anterior uveitis?

Answer 12

Acute painful red eye
Ciliary flush
Fixed small irregular shaped pupil
Hypopyon
Photophobia- intense
Lacrimation
Impaired vision

Question 13

How can you differentiate between teratoma and epidymal cyst?

Answer 13

Teratoma does not trans illuminate

Question 14

What are features of Klinefelters syndrome?

Answer 14

XXY
Small firm testes
Gynaecomastia
Low testosterone- elevated gondaotrophin levels
Taller than average
Delayed puberty
Primary gonadal failure- most common type

Question 15

What is diagnostic criteria for diabetes?

Answer 15

HbA1c >48
Fasting glucose >7
Random glucose ?11/1
OGTT 2 hour glucose >11.1

If asymptomatic then need two results

Question 16

What is DVT advice for long haul flight in low risk?

Answer 16

Stay hydrated
Avoid alcohol/sedatives
Walk around regularly

Question 17

What is Brucellosis?

Answer 17

Mediterranean fever

Infects farm animals but can spread to humans in close contact or drinking unpasteurised milk

-Headache
-Fever
-Sweating
-Muscle cramps
- Splenomegaly

Question 18

What are features of Cholera?

Answer 18

GI infection from food/water
Watery diarrhoea
Fever
Vomiting
Colicky abdominal pain

Question 19

What are symptoms of Lyme Disease?

Answer 19

Early
- erythema migrans- bulls eye rash
- headache
- fever
-arthralgia

Later
- Heart block
- peri/myocarditis
- facial nerve palsay
- meningitits

Question 20

What are investigations/management of Lyme Disease?

Answer 20

Can be clinical if erythema migrans present
Antibodies to Borrelia burgforferi are first line test on immunosorbent assay

Doxycycline if Lyme disease
Ceftriaxone if disseminated disease

Question 21

What are features of constrictive pericarditis?

Answer 21

Abdominal pain
Ascites
Dyspnoea
Ankle swelling
Tachycardia
Raised JVP
Impalpable apex beat
Pericardial calcification on CXR

Question 22

How to convert from oral morphine to fentanyl patch?

Answer 22

Fentanyl is just under twice as potentH

Question 23

How to convert from oral morphine to SC diamorphine?

Answer 23

Diamorphine 60mg= 180mg oral morphine

Question 24

How is prediabetes diagnosed?

Answer 24

HbA1c42-48
Impaired fasting glucose 6.1-6.9
Impaired glucose tolerance
- fasting <7
- OGTT value 7.8-11.0

Question 25

What Criteria is used to validate IBS?

Answer 25

Rome