Amir Sam's conditions

Question 1

A patient presents with an ataxic gait, failure to abduct the right eye and is very confused. What is the likely diagnosis?

Answer 1

Wernicke’s encephalopathy

TRIAD: confusion + ataxia + opthalmoplegia (nystagmus + LR palsy)

Question 2

Wernicke’s encephalopathy presents with what distinctive lab result?

Answer 2

Reduced red cell transketolase

Question 3

A known alcoholic patient presents confusion, ataxia and opthalmoplegia. He is also noted to be slightly hypoglycaemic. In what order do you provide treatment options for this patient.

Answer 3

IV thiamine (Pabrinex) BEFORE giving glucose.

Glucose metabolism uses up thiamine so precipitates an acute worsening of any Wernicke’s

Question 4

Definition of dementia

Answer 4

Global impairment of higher cortical function in clear consciousness.

ICD-10 definition
Decline in:
- memory
- other cognition: planning, organising, problem solving
Absence of clouded consciousness
Change in emotion, personality or behaviour

Question 5

Most common organism that causes Septic arthritis

Answer 5

Staph aureus

Question 6

Cause of septic arthritis in a young, sexually active person

Answer 6

Neisseria gonococcus

Question 7

Initial choice of antibiotics in septic arthritis

Answer 7

IV Vancomycin and 3rd generation cephalosporin: cefotaxime.

Change once culture and sensitivities tested.

Question 8

A patient presents with a shooting radicular pain in the C7 distribution. Below this level he is complaining of increasing loss of sensation and weakness.
The patient is known to have lung cancer.

What are you most worried about in the acute setting?

Answer 8

Acute cord compression = neurosurgical tumour.

Probably due to bony mets.

Cancers that spread to bone:
Breast
Prostate
Lungs
Thyroid
Kidneys
Testes

Question 9

Definition of erythroderma

Answer 9

Exfoliative dermatitis involving >90% of the skin

Question 10

What are the 4 types of sickle cell crisis?

Answer 10

1) Thrombotic painful crisis
2) Sequestration crisis
3) Aplastic crisis
4) Haemolytic crisis (rare)

Question 11

What are the 3 main medical options for smoking cessation

Answer 11

Nicotine replacement therapy

Varenicline

• nicotine R partial agonist
• CI in depression and pregnancy

Bupropion

• NA + DA reuptake inhibitor, nicotine antagonist
• CI in epilepsy and pregnancy

Question 12

Treatment for Torsades des pointes

Answer 12

IV MgSO4 2g over 10 mins

Question 13

A patient presents with a severe headache and a fixed dilated,oval-shaped pupil. What is the diagnosis?

Answer 13

Acute glaucoma

Question 14

6 Stages of Death verification

Answer 14

1) Unresponsive to voice or pain
2) No palpable carotid pulse
3) No heart sounds - 2 minutes
4) No breath sounds - 2 minutes
5) Pupils fixed & dilated - unresponsive to light
6) Document in notes.

Question 15

3 types of autopsy

Answer 15

1) Consented autopsy
- Appropriate consent allowing for teaching, audit and/or research

2) Coronial autopsy
- Coroner instructs pathologist to take tissue samples to determine cause of death within the balance of probability.

3) Forensic autopsy
- Police involvement to determine cause of death beyond reasonable doubt.

Question 16

5 types of psoriasis

Answer 16

1) Chronic plaque psoriasis
2) Flexural
3) Guttate
4) Pustular - generalised or palmo-plantar
5) Erythroderma

Question 17

5 types of psoriatic arthritis

Answer 17

Asymmetrical oligoarthritis (

Question 18

Large vessel vasculitis in a 30 year old Japanese lady in whom you cannot feel the pulse

Answer 18

Takayasu arteritis

Question 19

55 year old lady with jaw pain on eating, scalp tenderness and reducing vision

Answer 19

Giant cell arteritis

Question 20

A gentleman with a history of HBV infection has angiography that reveals microaneurysms

Answer 20

Polyarteritis nodosa

Question 21

A man with a saddle nose, haemoptysis and haematuria.

Answer 21

Granulomatosis with polyangitis = Wegener’s

Question 22

Patient with asthma and vasculitis

Answer 22

Eosinophilic granulomatosis with polyangitis = Churg-Strauss

Question 23

Urine osmolality expected in Diabetes insipidus

Answer 23

> 200 mmol

Question 24

Painful asymmetrical wasting of the quadriceps muscles in T2DM associated with weight loss and autonomic failure.

Answer 24

Diabetic amotrophy

Question 25

Chondrocalcinosis visible on Xray is associated with which cause of arthritis?

Answer 25

Pseudogout

Question 26

1st line treatment for Ank Spond

Answer 26

NSAIDs + spinal exercises

Question 27

Which is painful polymyositis or polymyalgia rheumatica

Answer 27

Polymyalgia rheumatica

Question 28

Shirmer’s Test

Answer 28

Test for Sjogren’s

Filter paper on lower eyelid to measure tear production.

Question 29

Behcets triad

Answer 29

Oral ulcers + genital ulcers + anterior uveitis

Question 30

Anion Gap calculation

Answer 30

= (Na + K) - (Cl + HCO3)

Question 31

3 Phases of CML

Answer 31

Chronic phase: 10% blasts

Blast phase: >20% blasts

Question 32

Gout and massive splenomegaly are associated with which haematological malignancy

Answer 32

CML

Question 33

Evan’s Syndrome =

Answer 33

AIHA + ITP

Associated with CLL

Question 34

Richter transformation

Answer 34

Transformation of CLL → DLBCL

Question 35

Smear cells

Answer 35

CLL

Question 36

Staging system in CLL

Answer 36

Binet staging
Stage A: 3 enlarged lymph nodes
Stage C: anaemia or thrombocytopenia

Question 37

BM aspirate findings in multiple myeloma

Answer 37

> 10% plasma cells

>30 g/L paraprotein

Question 38

BM aspirate findings in MGUS

Question 39

BM aspirate findings in Smouldering myeloma

Answer 39

> 10% plasma cells
30 g/L paraprotein

= Same as multiple myeloma but NO CRAB

Question 40

Prognostic factors in Myeloma

Answer 40

B2 microglobulin and albumin