A

Question 1

Side effect of bisoprolol

Answer 1

Erectile dysfunction

Question 2

Contraindications for statins

Answer 2

• Macrolides (erythromycin, clarithromycin)
• Pregnancy

Question 3

Beck’s Triad for cardiac tamponade

Answer 3

ECG: electrical alternans

1. Hypotension
2. Raised JVP
3. Muffled heart sound

Question 4

ECG for acute pericarditis

Answer 4

1. Widespread/global saddle-shaped ST elevation
2. PR depression

Question 5

Distinguish Cowden’s syndrome and familial juvenile polyposis

Answer 5

Familial juvenile polyposis — multiple polyps in the colon + NO oral lesion

Cowden — multiple polyps in the colon + oral mucosal papillomas, palmoplantar keratoses and trichilemmomas (benign tumour of hair follicle)

Question 6

Crohn’s VS Ulcerative colitis (UC)

Answer 6

Crohn’s — skip lesion, anywhere from mouth to anus, non-bloody diarrhea, weight loss, abdominal mass palpable in RIF, stricture (Kantor’s string sign), proximal bowel dilatation, “rose thorn” ulcer, cobblestoning

UC — continuous disease, start at rectum, bloody diarrhea, abdo pain in LLQ, tenesmus, higher risk of colorectal cancer, crypt abscesses, pseudopolyps, loss of haustrations, “drainpipe colon” (short and narrow)

Question 7

Primary biliary cirrhosis (PBC) — M rules

Answer 7

• IgM
• Anti-Mitochondrial antibodies, M2 subtype
• Midle aged female

Question 8

Alcoholic VS Non-alcoholic Liver Disease

Answer 8

• AST : ALT > 2 = Alcoholic
• AST : ALT < 1 = Non-alcoholic

Question 9

Scoring system to assess severity of liver cirrhosis

Answer 9

Child-Pugh classification
- Bilirubin
- Albumin
- Prothrombin time
- Encephalopathy
- Ascites

Question 10

Tumour markers

Answer 10

• CA 125 = Ovarian
• CA 19-9 = Pancreatic
• CA 15-3 = Breast
• PSA = Prostate
• A-FP = HCC, teratoma
• CEA = Colorectal

Question 11

Spontaneous Bacterial Peritonitis

Answer 11

• Ascites, abdominal pain, fever
• Diagnosed by paracentesis: neutrophil count > 250 cells/ul
• Most common organism found on ascitic fluid = E. Coli
• IV cefotaxime

Question 12

• Joint aspiration showing weakly-positively birefrigent rhomboid shaped crystals
• X-ray show chondrocalcinosis (linear calcification of particular cartilage)

Answer 12

Pseudogout (deposition of calcium pyrophosphate)

Question 13

Rheumatoid arthritis
Splenomegaly
Neutropenia (low WCC)

Answer 13

Felty’s syndrome

Question 14

Absolutely contraindicated in pregnancy

Answer 14

• Methotrexate
• NSAIDs

Question 15

Triad of Reiter’s syndrome (Reactive Arthritis)

Answer 15

• Arthritis (knee)
• Urethritis
• Conjunctivitis

Patient cant see, can’t pee, can’t bend the knee

HLA-B27

Ankylosing spondylitis develop in 50% of HLA B27 +ve patients

Patient develop arthritis following an infection

Question 16

Episcleritis VS Scleritis

Answer 16

Scleritis = Painful
Episcleritis = NO pain

Question 17

Ankylosing spondylitis features

Answer 17

A’s
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis

Question 18

Hip fracture

Answer 18

• Shortened
• Abducted (out)
• Externally rotated leg

Unable to weight bear

Question 19

Hip dislocation

Answer 19

• Shortened
• Adducted
• Internally rotated leg

Question 20

Boxer’s fracture

Answer 20

• After punches hard surface
• Minimally displaced 5th metacarpal fracture

Question 21

Ankylosing spondylitis

Answer 21

• Reduced lateral flexion
• Reduced forward flexion (Schober’s test)
• Reduced chest expansion
• Stiffness worse in the morning and improve with exercise
• Pain at night