9/6/22

Question 1

1st + 2nd line Impetigo mx?

Answer 1

1st line = Hygiene advice + topical fulsilic acid

2nd line = Oral Flucloxacillin (Clarithromycin - if allergic)

Question 2

What are the LT complications of minimal change disease and why?

Answer 2

Minimal change disease -> loss of protein in urine hence

Loss of anti-thrombin -> Increased risk of THROMBOSIS

Loss of Ig -> Increased risk of INFECTIONS

Loss of albumin -> Increased choleseterol synthesis (HYPERCHOLESTERAEMIA)

Question 3

Presentation of:

• Chondromalacia patellae
• Osgood schlatter
• Osteochondritis dissecans

Answer 3

Chondromalacia patellae:
- Anterior knee pain often in active teens (F>), grating sensation / creptius + worse when using stairs

Osgood schlatter:
- Knee pain after exercise + swelling over tibial tuberosity (M>)

Osteochondritis dissecans:
- Cracks in articular cartilage + subchondral bone due to reduce blood flow -> activity related pain w/ locking and giving way sensation

NB: subluxation of patella can also present w/ sensation of giving way and general knee instability

Question 4

Mx of Chondromalacia patellae?

Answer 4

Referral to physio - strengthen quadriceps

Question 5

Main features of:

• Spina bifida occulta
• Meningomyelocele
• Meningocele

Answer 5

Spina bifida occulta
- NTD + some neuro signs +back lump

Meningomyelocele:
- WORST TYPE - spinal cord protrudes through unfused spinal column causing severe neuro issues

Meningocele:
- Herniation of meninges between vertebrae - no neuro symptomsas no neural tissue inside (just csf)

Question 6

What is the gold standard ix for bronchiectasis? inhaled foreign body?

Answer 6

CT scan

Bronchoscopy

Question 7

What is the normal dose of Levorgestrel (UPSI)? When should this be changed?

Answer 7

1. 5mg

3. 0mg if woman is 70+ kg or BMI >26

Question 8

What are the short and long-term side effects of ECT?

Answer 8

ST: Arrythmias, headaches, nausea, muscle ache

LT: Impaired memory

Question 9

How do you manage the following EPSE symptoms:

• Dystonia
• Akathisia
• Parkinsonianism
• Tardive Dyskinesia

Answer 9

Dystonia:
- Procyclidine

Akathisia:
- Reduce dose, change drug or propanolol

Parkinsonianism:
- Reduce dose, change drug or procyclidine

Tardive Dyskinesia:
- Stop / change drug to atypical antipsychotic, reduce dose and Tetrabenazine in moderate or severe cases

Question 10

Describe the following terms:

• Extracampine hallucination
• Elemental hallucination
• Pareidolic illusion

Answer 10

Extracampine hallucination = Hallucination that exceeds the normal sensory fields

Elemental hallucination = Simple hallucinations such as flashes of light or noises

Pareidolic illusion = Interpretation of meaningful images from a vague stimulus (eg face in fire)

Question 11

What ix for menopause and in who?

Answer 11

Women <45y = Day 2-5 follicular-stimulating hormone, two measurements 4-6 weeks apart

Women >45y = clinical diagnosis (provided no suggestions of organic cause)

Question 12

Mx of CIN?

Answer 12

CIN I = Observation + F/U smear test in 12m

CIN II / III = Large loop excision of the transformation zone (LLETZ)

Question 13

Biopsy results in hirschsprungs (not just absence of ganglion cells)

Answer 13

Absence of ganglion cells, along with presence oflarge acetylcholinesterase-positive nerve trunks

Question 14

What is the Ladd procedure used to treat?

Answer 14

Volvulus and Malrotation

Question 15

What causes most cases of epiglottitis in the UK?

Answer 15

Group A B-haemolytic Strep - successful vaccination programmes have reduced incidence of HiB

Question 16

Mx of epiglottitis?

Answer 16

A to E approach to secure the airway and prevent respiratory obstruction.

Once stable, blood cultures are taken from the child, and IV ceftriaxone is administered for 7-10 days

Question 17

What is WAGR syndrome?

Answer 17

Rare genetic syndrome seen in 10% of Wilm’s tumour pts

Presents w/ Wilms tumour + aniridia (abnormal development of the iris of the eye) + genitourinary abnormalities + mental retardation

Question 18

What is another name for croup?

Answer 18

Laryngo-tracheo-bronchitis

Question 19

How is croup severity quantified?

Answer 19

Westley Croup Severity Score

Question 20

Mx of Croup as per severity scale?

Answer 20

Mild (<3) = 1 dose of dex

Moderate (3-7) = 1 dose of dex + neb adrenaline

Severe (8-11) = Admit + 1 dose of dex PO/IV/IM + repeated neb adrenaline

Impending resp failure (>11) = ICU admission + 1 dose of dex PO/IV/IM + repeated doses of neb adrenaline + intubation

Question 21

First step in mx of painful vaso-occulsive crisis in sickle cell pt?

Answer 21

The first step in the management of a crisis is analgesia; crises are extremely painful. In children less than 12 years of age, morphine should be avoided; other opiates are suitable.

Following administration of analgesia, hydration status should be restored. This is achieved by oral and intravenous fluids

Question 22

What changes can be found in neuroleptic malignant syndrome on bloods?

Answer 22

Metabolic acidosis

Raisd CK, ?WCC, hepatic transaminases

Can also have AKI -> deranged U+Es

Question 23

What is fornication (can occur secondary to cocaine use)?

Answer 23

Formication is a term used to describe the feeling of insects crawling across or underneath the skin (in ekbom’s they believe this is real)

This is a paraesthesia that may present in patients withdrawing from alcohol or using recreational drugs, such as cocaine

Question 24

What is CJD and how does it generally present?

Answer 24

Creutzfeldt-Jakob disease is a rare, prion disease and patients present with dementia along with extensive neurological signs

Question 25

82y dementia pt experiences N+V whilst using donepezil, what should you do?

Answer 25

In older pts + generally in pts at risk of confusion best to avoid polypharmacy -> switch donepezil to suitable medication

Memantine is a dementia drug that is a different class to donepezil hence would be suitable

Question 26

Describe the dysplasia and presence of aytpia in the different stages of CIN?

Answer 26

CIN I:
Dysplasia: Mild
Atypia: Only in lower (deepest) 1/3 of epithelium

CIN II:
Dysplasia: Moderate
Atypia: Only in lower 2/3 of epithelium

CIN III:
Dysplasia: Severe
Atypia: Occupies full thickness of the epithelium (carcinoma in situ)

Question 27

How can prolapses be categorised? + what organs do they affect

Answer 27

Prolapse of anterior vaginal wall:
- Urethrocele (urethra)
- Cystocoele (bladder)
- Cystourethrocoele (urethra 
\+ bladder)

Prolapse of posterior vaginal wall (differentiated by DRE):

• Rectocoele (rectum) bulges on DRE
• Enterocoele (bowel)