23 December

Question 1

What is the management of TIA?

Answer 1

1) Aspirin 300mg STAT
2) Following review by specialist for 1st 21 days= Aspirin and Clopidogrel
3) Long term post 21 days= Clopidogrel

Question 2

What is the management of erectile dysfunction?

Answer 2

1) Oral Phosphodiesterase inhibitors e.g. slidenafil to improve smooth relaxation of muscles OR Vacuum devices
2) Intraurethral alprostadil- pellet inserted into penis for erection, Intracavernosal alprostadil inserted into corporus cavernosum to produce erection
3) Penile Prosthesis- devices inserted to cause a erection

Question 3

What are side effects of Phosphodiesterase inhibitors? e.g. slidenafil

Answer 3

GI upset
Headache
Blue discolouration of vision,
Non arteritic anterior ischaemic optic neuropathy
Nasal Congestion
Flushing

Avoid if
- hypotension
- on nitrates
- recent stroke/MI
- unstable angina

Question 4

What is Vasa Praevia?

Answer 4

Foetal vessels cross/close to inner cervical os
Antepartum haemorrhage post artifical rupture of membranes= highly suggestive
- High foetal mortality rate

Question 5

What is the management of amoebic liver abscess?

Answer 5

Metronidazole

Question 6

What is the management of tinea capitis?

Answer 6

If Trichophyton infection then terbinafine
If Microsporum infection then Griseofulvin

Topical ketoconazole shampoo for 2 weeks as well

Question 7

What us UK MEC 4 for COCP?

Answer 7

> 35 yo smoking >15 a day
Migraine with aura
Uncontrolled HTN
Previous/current VTE
Postpartum <6 weeks (bf) or <3 weeks (not bf)
- AF
- History of stroke/IHD
- Current breast cancer
- Severe cirrhosis
- Cardiac problems- myopathy, valvular heart disease
- Anti-phospholipid antibodies present
- Major surgery

Question 8

What is otic barotrauma?

Answer 8

Seen post flights/divers
Ear popping- in severe cases leads to epistaxis
May have haemorrhagic areas within in the ear drum
May get conductive hearing loss

Question 9

What are features of Nasopharyngeal carcinoma?

Answer 9

Seen in SE asia esp Chinese
Assocaited with EBV

Presents late due to mets symptoms
- bilateral cervical node enlargement
- nasal voice
- epistaxis
- nasal obstruction
- deafness
- may get Cn involvement

MRI with gadolinium and fat suppression is gold standard

Treatment is external irridation

Question 10

What is the management of stable angina?

Answer 10

1) BB or CCB
2) Add other in (if adding CCB must be amlodipine), long acting nitrate, nicrorandil (only if other meds unsuitable)

Question 11

What is the first line management of RA?

Answer 11

1) Methotrexate
- NSAIDs, Steroids whilst DMARD working

Question 12

What are features of retroperitoneal fibrosis?

Answer 12

Associated with autoimmune diseases, metastatic malignancy, drugs

Non specific symptoms (long time to diagnose)
- pain in flank/backk. scrotum, fever, HTN

Bloods- raised ESR, CRP, anaemia, uraemia
AXR- Maiden Waist sign (ureters brought in close)
Para aortic mass

Management
- steroids, tamoxifen, azathioprine

Question 13

What is prophylaxis of tension headaches?

Answer 13

Amitryptilli8ne

Question 14

What is Lichen Simplex Chronicus?

Answer 14

Thickening of the skin with variable scaling due to repetitive scratching or rubbing
Often caused by eczema, bites, scars

Localised demarcated plaque withscaling and excoriations overlying

Treatment- potent topical steroids, tar or ichthyol preparations

Question 15

What are features of Rubeosis iridis?

Answer 15

Caused by retinal ischaemia due to diabetic retinopathy or CVRO
Painless and asymptomatic

Characterised by visible blood vessels on the iris

Treat with pain retinal photocoagulation to reduce vascularisation

Question 16

What are features of Cryptococcosis?

Answer 16

Fungal infection seen in HIV people
Lungs primary infection
Can get meningoencephalitis

Treatment
-asymptomatic/mild disease oral fluconazole
Severe- Amphotericin B and Flucytosine

Question 17

What are features of Colles fracture?

Answer 17

Due to FOOSH
Dorsal displacement of distal fracture fragment
Dinner form deformity may be seen

Question 18

What are features of Gameskeeper thumb?

Answer 18

Tear of ulnar collaterol ligament of thumb
May get small avulsion fracture of the thumb

Question 19

What are features of Lambert Eaton Syndrome?

Answer 19

Due to SC lung cancer
Progressive weakness that does not involve resp muscles or face
Symptoms tend to be worse in the morning and improve with exercise
Proximal legs and arms are affected
Reduced reflexes

Steroids, azathioprine, 3,4-diaminopyridine mainstay of treatment

Question 20

What are features of Alport Syndrome?

Answer 20

X linked/ autosomal recessive

Sensorineural deafness
Pyelonephritis
Haematuria
Renal failure

Treat with dialysis of transplant

Question 21

What are features of Balkan nephropathy?

Answer 21

People from Danube river

Only presents in adults
Normotensive
Bilirubin on palms and soles (tanchev sign)
NAnaemia
Slow progressive renal failure

Question 22

What are features of paroxysmal nocturnal haemoglobinuria?

Answer 22

Haemolytic anaemia
- urine dark brown in colour worse in morning
- urine dipstick positive for blood but no red blood cells on microscopy
Thrombosis
Deficient haematopiesis- anaemia like Sob on exercise

Diagnosed via flow cytometry

Treatment
- blood transfusion
- meningococcal vaccination
- eculizumab
- anticoagulation