Bits and bobs

Question 1

Which gram positive diplococci causes meningitis?

Answer 1

Strep pneumoniae

Question 2

What are the causes of bacterial meningitis?

Answer 2

Neisseria meningitidis (meningococcus)

Strep pneumoniae (pneumococcus)

In neonates E.Coli, group B strep (strep agalactiae is an example)

Question 3

What is the treatment of bacterial meningitis?

Answer 3

Benzylpenicillin

Ceftriaxone

After treatment given a course of

Rifampicin or ciprofloxacin (adults only)

This is to eradicate carriage of N. meningitidis from the nasopharynx

Question 4

What are the features of a colles fracture?

Answer 4

Classical Colles’ fractures have the following 3 features:

Transverse fracture of the radius

1 inch proximal to the radio-carpal joint

Dorsal displacement and angulation

Question 5

What are the risk factors for osteoporosis?

Answer 5

SHATTERED:

Steroid use (over 5mg a day of prednisolone)

Hyperthyroidism

Alcohol / tobacco use

Thin (BMI less than 22)

Testosterone decrease

Early menopause

Renal or liver failure

Erosive bone disease (such as RA or myeloma)
Dietary calcium (decrease)

Question 6

What are the thenar muscles supplied by the median nerve?

Answer 6

abductor pollicis brevis

Opponens pollicis

FLexor pollicis brevis

Question 7

What are the complications of colles fracture?

Answer 7

Damage to the median nerve

Malunion

Finger stiffness

Rupture of extensor pollicis longus

Question 8

What is the sensory supply of the median nerve?

Answer 8

Question 9

What causes carpal tunnel syndrome?

Answer 9

Repetitive stress injury leading to infalmmation, oedema, fluid in the narrow space and compression of the structures

Question 10

What are risk factors /causes of carpal tunnel syndrome?

Answer 10

TRAMP

Trauma (repetitive stess injury)

Rheumatoid arthritis

Acromegaly

Myxoedema

Pregnancy

Question 11

Why is there no sensory loss in carpal tunnel syndrome?

Answer 11

Because sensory function is supplied by the palmar branch of the median nerve (does not go through the carpal tunnel)

Question 12

What is the treatment of carpal tunnel syndrome?

Answer 12

corticosteroid injection

wrist splints at night

surgical decompression (flexor retinaculum division)

Question 13

What are causes of post parum haemorrhage?

Answer 13

Tone - prolonged labour, multiple pregnancy

Trauma - Cesarean, instrumental delivery, episiotomy

Tissue - retained placenta, placenta accretta

Thrombin - coagulopathies (secondary to pre-eclampsia/sepsis/anticoagulants)

Question 14

What are examples of drugs which increase uterine tone?

Answer 14

Oxytocin

Ergometrine / methylergometrine

Prostaglandins such as misprostol and carboprost

Question 15

What are drugs that decrease uterine tone?

Answer 15

Terbutaline

Nifedipine

Indomethacin

Question 16

What are the investigations for infertility?

Answer 16

Semen analysis

Chlamydia

Thyroid stimulating hormone

Mid luteal progesterone if periods are regular (day 21 of a 28 day cycle)

If cycle is not regular do a blood test to look for serum gonadotrophins

Rubella immunity

Question 17

What are 3 tests for tubal patency?

Answer 17

Histosalpingogram

HyCoSy

Laparoscopy

Question 18

What are initial investigations for amenorrhoea?

Answer 18

exclude pregnancy with urinary or serum bHCG

gonadotrophins: low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)

prolactin

androgen levels: raised levels may be seen in PCOS

oestradiol

thyroid function tests

Question 19

What organisms can cause tubal damage?

Answer 19

Chlamydia

Gonorrhoea

Mycoplasma

Question 20

What are causes of audotory hallucinations?

Answer 20

Delerium tremens

Depression with psychosis

Delerium

PTSD

Schizophrenia

Question 21

What are characteristic findings on history for people with anorexia?

Answer 21

Weight loss: as a result of dieting, strict exercise, appetite suppressants and diuretics

Overactivity - such as obsessive housework

Cooling - keeping wondows open and not wearing sufficient clothing

Endocrine dysfunction (amenorrhoea / libido)

Potential for history of fainting, fatugie, cold intolerance

Body image disturbance

Question 22

What are findings on investigation for anorexia?

Answer 22

Low blood glucose

Lanugo hair

Low BMI

ECG - arrhythmias

DEXA - reduced bone density

Question 23

What are treatments for anorexia and bulimia?

Answer 23

Anorexia:

• Cognitive analytical therapy
• Cognitive behavioural therapy
• Interpersonal psychotherapy
• Family interventions
• Hospitilisation - symptom focussed weight restoration programme

Bulimia:

• Evidence based self-help programme
• CBT
• SSRI (fluoxetine)

Question 24

What are causes of dehydration?

Answer 24

Fever

Vomit

Exercise

Heat exposure

Diabetes mellitus

Question 25

What are the features of hypercalcaemia?

Answer 25

Confusion

Somnolence

Constipation

Nausea

Thirst

Question 26

What is the possible treatment for multiple myeloma?

Answer 26

Chemotherapy

Immunomodulators such as thalidomide

Bisphosphonates to prevent bone loss

Antibiotics to treat infections

Glucocorticoids for hypercalcaemia (They increase renal calcium excretion and decrease gastrointestinal calcium absorption, resulting in reduced serum calcium)

Question 27

What are diagnostic tests for multiple myeloma?

Answer 27

monoclonal proteins (usually IgG or IgA) in the serum and urine (Bence Jones proteins)

increased plasma cells in the bone marrow (over 30% plasma cells)

Protein electrophoresis - (shows monoclonal band)

X-Ray - skeletal survey looking for lytic lesions

Question 28

What is the prognosis for multiple myeloma?

Answer 28

With treatment = 48% 5 year survivial