6/4/22

Question 1

Can immunological treatments break down granulomas?

Answer 1

Yes

But IL-7 specific etc. don’t so can be used in TB

Question 2

How can lupus appear?

Answer 2

Mouth ulcers
Small joint pain
Malar rash
Raynauds

Question 3

Sjorgens antibodies

Answer 3

Anti Ro

Anti La

Question 4

The new name for vaginal atrophy?

Answer 4

Genitourinary syndrome of menopause

Question 5

In aspiration where is the item most likely to go?

Answer 5

Right lower lobe

Question 6

If someone is lying supine where is the most likely space for the fluid to gather~?

Answer 6

Hepatorenal recess

Question 7

What would you expect to feel in a Hodgkin’s lymphoma lymph node

Answer 7

Smooth
Soft
Non-tender
Rubbery 
Mobile

Question 8

What coagulation test is used to monitor heparin?

What is it’s MoA?

Answer 8

aPTT

Intesifies the properites of anti-thrombin

Question 9

What is DI caused by?

What psych drug is it related to? What kind of DI does it cause?

What tests would you want to do?

How would you then manage the paitent?

Answer 9

Insuffiency of ADH

Lithium - nephrogenic DI (resistance to ADH in kidneys)

Serum and urine osmolality
- serum increased
- urine decreased
(lower = more diluted)

After water deprivation test (where desmopressin is given after 8hrs)
- urine osmolaity will remain low before and after synthetic ADH

V. high desmopressin can be used but have to monitor closely - in cranial DI can be given without such close monitoring

Question 10

Can you prescribe antidepressants to an alcoholic?

Answer 10

Only after a month of abstinence

Self help groups e.g. AA much better

Question 11

What abnormality on ECG can be seen in patients with anorexia nervosa

Answer 11

Long QT (>450ms)

Question 12

What is the nice way to remember the triad for normal pressure hydrocepahlus?

Answer 12

‘Wet, weird and wobbly’

Question 13

What lead is used for the rhythm strip?

Answer 13

Lead II

Question 14

What rhythms are shockable and unshockable?

Answer 14

Shockable

• VF
• Pulseless VT

Non-shockable

• PEA (pulseless electrical activity)
• Astoyle

Question 15

What do you include in a sexual history?

Answer 15

HPC

• what’s brought you in?
• when did this start?
• discharge
• any smell?
• any colour?
• consitency?
• how much?

any skin changes?

• lumps?
• ulcers?
• multiple or just one?
• where abouts?
• any itchiness?
• any swelling?
• any pain?
• are they bursting open?

Peeing

• any pain?
• holding in your pee because of it?

Pain
General SOCRATES
When?
Where? - more superifical or deeper (pelvic)

Any unusual bleeding from down there at all?

Sexual history

• when was last sex?
• regular partner? how long seeing them?
• sex of partner?
• oral, (vaginal) or anal?
• receptive or insertive?
• DID YOU USE CONDOMS?

keep going for 3 months + note how many in the 3 months

Risk of BBV Questions ‘these are a set of qs I just have to ask regarding your risk of contracting a BBV e.g. HepB and Hep C or HIV
(remember MMOTDD)
- ever had sex with someone from outwith the UK?
- Ever been diagnosed with a BBV e.g. Hepatitis or HIV or had sex with a partner who has?
- ever use recreational drugs during sex?
- ever been paid for sex?
- ever paid someone else for sex?
- Ever injected drugs or had sex with someone who has?
- ever had sex with a man or a MSM?
- ever had any tattoos from somewhere where hygiene practices weren’t up to standard or any stick and poke tattoos?

PMH

• normal
• surgeries

DH + ALLERGIES
- used an online pharmacy to manage symptoms?

GIRLS ONLY

Obs

• ask if on long term contraception if they ever use barrier methods
• any side effects
• compliance
• any kids?
• ever been preganant before?

Gynae

• smear tests
• up to date?
• ever had follow up?
• anything else that you see gynaecologist for before?
• LMP
• regular?
• any bleeding after sex or in-between periods?

Social

• home - partner?
• work?
• alcohol?
• smoker?
• recreational drug user?

Question 16

At the end of a sexual history taking it is really important to establish how to tell partners if test does come back positive.

What ways can you offer the patient?

Answer 16

Stress the importance of it but also empathise and if they decline contacting that’s okay too

Can contact themselves
Or can give us the patients details and we can contact sexual partners on their behalf - via telephone, text or letter

Question 17

When do 80% of HIV patients present with primary infection?

How do they present?

Answer 17

Maculopapular rash mainly on trunk and face 
Fever
Myalgia
Headache 
General prodromal symptoms 

2-4 weeks

Question 18

Name 3 cancers associated with HIV?

Answer 18

Kaposkis sarcoma (vascular epithelial cancer)
Non-Hodgkin’s lymphoma
Cervical

Question 19

Pneumocystis pneumonia is an opportunistic infection that can infect HIV patients. How is it managed?

Answer 19

Co-trimoxazolone both acutely and as prophylaxis

Steroids also used acutely

Question 20

What is the treatment for prostatitis?

Answer 20

Ofloxacin 400mg BD for 28 days

Question 21

In HIV:

CD4 level above what is normal?
At what level can opportunistic infections arise?

Answer 21

CD4 above 500 = enough to fight off infections
200-500 = lymphadenopathy, oral candidiasis
<200 = opportunistic infections and kaposis sarcoma

Question 22

When testing for HIV what antigen are you testing for alongside HIV antibody?

What is the testing window post exposure?

If someone tests negative in this window what should be done next?

Answer 22

p24

14-45 days

Return after 45 days for a repeat test if that is negative then all good

Question 23

What blood imbalance do up to 90% of HIV patients have?

Answer 23

Anaemia

Question 24

What is the name for cachexia that occurs in HIV?

Answer 24

Slims disease