3 December #2

Question 1

What are symptoms of cataracts?

Answer 1

Gradual progressive loss of visual acuity/blurring of vision
Fading colour vision esp blues
Glares and halos around lights
Impaired night vision

Question 2

What are findings/investigations for cataracts?

Answer 2

Leukocoria- grey/white discolouration of pupil
Loss of red reflex

Slip lamp exam to visualise

Question 3

What are features of depression

Answer 3

Low mood
Anhedonia- loss of enjoyment
Weight change
Difficulty concentrating
Sleep disturbance
Irritability

Question 4

What are causes of lower zone pulmonary fibrosis?

Answer 4

Asbestosis
Connective tissue disorder e.g. SLE
Idiopathic pulmonary fibrosis
Drugs e.g. amiodarone, methotrexate, nitrofurantoin

Question 5

What are causes of upper zone Fibrosis?

Answer 5

Coal works
Hypersensitivity pneumonitis
Ankylosing spondylitits
TB
Sarcoidosis

Question 6

What is the management of idiopathic pulmonary fibrosis?

Answer 6

Nintendanib or Pirfenidone if FVC 50-80%

Otherwise supportive, e.g., pulmonary rehab, LTOT, transplant

Question 7

What investigations should be done in Idiopathic pulmonary fibrosis?

Answer 7

Gold standard High resolution CT- honeycombing/ground glass
Spirometry- restrictive picture (low FVC, high FEV1:FVC)
Low TLCO

Question 8

What are features of Mortons neuroma?

Answer 8

Thickening of the common digital plantar nerve
Forefoot pain- sharp or burning
Altered sensation in toes (3rd intermetatarsal space)
Worse on activity
Stone in shoe feeling
=ve mulders click

Question 9

What are clinical features of digoxin toxicity?

Answer 9

Confusion
N&V
Yellow-green vision
Bradycardia
Hypokalaemia
Treat with digibind

Question 10

What is the management in acute mania?

Answer 10

1- oral antipsychotic
2- if not effective try alternative
3- add lithium

Question 11

What is the management of post partum depression?

Answer 11

Mild- self help
Moderate/severe- CBT
2nd line medication- SSRI/SNRI/TCA (if breastfeeding, then paroxetine or sertraline

Question 12

What are features of drug hypersensitivity syndrome?

Answer 12

High temp
Rash- morbilliform- target lesions or blisters
Organ involvement e.g. hepatitis or AKI
High eosinophils, leukocytosis

Treat with steroids

Question 13

What antibodies are found in autoimmune hepatitis?

Answer 13

type 1- Anti-smooth muscle (adults and kids
2- Anti liver kidney microsomal antibodies (kids only)
3- Anti soluble liver antigen antibodies- middle aged adults

Question 14

What are symptoms of autoimmune hepatitis?

Answer 14

Jaundice
Derranged LFTs- ALT/AST 5-10x upper limit
Features of CLD
INR high

Question 15

What investigations findings are present in encephjalitis?

Answer 15

LP- lymphocytosis, raised protein, PCR- HSV
MRI- temporal and frontal lobe inflammation and oedema
If T2 weighted MRI- increased signal in temporal or frontal lobes

Question 16

What is the management of PID?

Answer 16

If OP
1) Im ceftriaxone, PO doxy, PO metro 14 days
2) PO ofloxacin and PO metro 14 days
3) PO moxifloxacin 14 days

If admitted
1) IV cef and IV doxy
Or IV clindamycin and IV gent

Question 17

What are features of Lambert Eaton Syndrome

Answer 17

Due to antibodies against voltage gated Ca channels due to cancer e.g. small cell/ovarian/breast

Symptoms
- hyporeflexia
- waddling gait
- muscle weakness

Question 18

What is the management of absence seizures?

Answer 18

1) Ethosuximide
2) Valproate

Question 19

What is the management of tonic clonic?

Answer 19

1) Valproate
2) Lamotrigine or keppra (women)

Question 20

What is the management of myoclonic seizures?

Answer 20

1) Valprotate
2) Keppra

Question 21

What is the management of focal seizures?

Answer 21

1) Lamotrigine or keppra

Question 22

What are features of Osgood Schlatter disease?

Answer 22

Inflammation of patellar ligaent at tibial tuberosity
Affects children/teens
Progressive knee pain worst over tibial tuberosity
Worse after sports
Pain on palpation of tibial tuberosity
Pain reproduced on knee extension against resistance

Question 23

What are clinical features of Psittacosis?

Answer 23

Die tp Chlamydia Psittaci
Transmitted from birds
Flu like symptoms
Atypical pneumonia- dry non productive cough
Hepatosplenomegaly
Fever with no tachycardia

Treat with doxy or clarithromycin

Question 24

What are features of orbital cellulitis?

Answer 24

Often due to URTI or sinusitis
Acute severe ocular pain
Opthalmoplegia with diplopia
Lid oedema and erythema

CT with contrast
IV abx