BMJ Assorted Good Qs

Question 1

What is acanthosis nigricans?

Answer 1

Thickened, velvet-like hyperpigmentation of flexor areas.
Common a/w: obesity and diabetes.
Also, a/w tumour ==> most commonly stomach or intestinal and endocrine disorders

Question 2

Is clubbing associated with non-small cell lung ca?

Answer 2

Finger clubbing is a/w both small cell lung carcinoma and non-small cell lung carcinoma.
Seen more frequently in non-small cell carcinoma; more frequently in women than in men

Question 3

What is pyoderma gangrenosum?

Answer 3

Non-infectious, inflammatory, necrotising skin condition.

Presents as painful ulceration- usually the legs. Commonly associated with IBD e.g. UC; RA; myelodysplasia.

Question 4

Is allopurinol indicated in acute gout attack?

Answer 4

No - treats chronic gout. Iniating in acute setting will exacerbate.
Acute = NSAIDs and/or colchicine.

Question 5

What is Horner’s associated with? (conditions)

Answer 5

• Pancoast tumours
• Cervical rib
• Goitre
• Syringomyelia
• Lateral medullary syndrome

Question 6

Common test abnormalities of multiple myeloma?

Answer 6

• Hypercalcaemia
• High ESR
• High urate
• Renal impairment, and
• Low Hb

Question 7

How does multiple myeloma present?

Answer 7

With bone pain and lassitude from anaemia and renal complications, as well as signs of hyper viscosity.

Question 8

Which medicinal herb may reduce effectiveness of warfarin?

Answer 8

St John’s wort; induces hepatic enzymes thus increasing metabolism of drugs metabolised by CYP-450 hepatic enzymes.

Question 9

Which immunosuppressant should not be used in patients treated with allopurinol?

Answer 9

Azathioprine.

Allopurinol leads to build up of 6-mercaptopurine a metabolite of azathioprine; build up leads to bone marrow toxicity.

Question 10

What is an aspergilloma?

Answer 10

Aspergilloma is a fungal ball (Aspergillus spp.) which develops in pre-existing pulmonary cavities (TB or sarcoidosis) or cysts, usually upper lobes, w/o tissue invasion. It can cause haemoptysis (which may be severe).

Question 11

Red jelly sputum characteristic of infection with which pathogen?

Answer 11

Klebsiella pneumoniae

Alcoholism and chronic disease thought to predispose

Question 12

What is a thyroglossal cyst?

Answer 12

Thyroglossal tract develops at foramen caecum and descends to final position anteriorly and inferiorly to thyroid cartilage. The tract then obliterates. Thyroglossal cyst occurs when tract does not obliterate. Often present as an infected cyst in the midline at the level of the hyoid bone which moves upwards on protrusion of the tongue. If infected it may need to be aspirated before surgical excision.

Question 13

What are the contents of the carpal tunnel?

Answer 13

• The median nerve
• 4 x FDP tendons
• 4 x FDS tendons
• Flexor pollicis longus

Question 14

Presentation of scurvy?

Answer 14

Proximal myopathy, loss of teeth with bleeding gums, weakness, general muscle pain.

Question 15

What is pellagra?

Answer 15

Caused by niacin deficiency; over dependence on maize, pts with carcinoid syndrome.
A/w 3 Ds:
-Dermatitis
-Diarrhoea
-Dementia

Question 16

What will a CNIII palsy cause?

Answer 16

• Upper lid ptosis
• Abduction and infraction of the globe (down and out)
• Dilate pupil

Question 17

Which CN lesion causes increased lacrimation?

Answer 17

The cranial nerve palsy most likely to cause increased lacrimation is a seventh nerve palsy as incomplete lid closure will cause exposure keratopathy with secondary reflex lacrimation.

Question 18

Why does Horner’s cause enophthalmos?

Answer 18

Apparent enophthalmos is seen in Horner’s syndrome as Muller’s muscle (jointly responsible for elevating the upper lid) and a corresponding muscle responsible for retracting the lower lid have impaired function when their sympathetic innervation is disrupted. The result of the lids moving closer together is that the eye appears as if it has sunken inwards.

Question 19

Drugs causing gynaecomastia?

Answer 19

• Digoxin
• Spironolactone
• Cimetidine
• LHRH analogues

Question 20

Adverse affects of B-blockers?

Answer 20

• Cold extremities
• Bronchospasm
• Bradycardia

Question 21

Ddx of single red, swollen, painful knee and Ix with findings

Answer 21

Joint aspirate

• Septic arthritis: increased PMNs and organisms.
• Gout: -vely birefringent chrystals
• Pseudogout: +vely birefringent chrystals

Question 22

Which conditions display autosomal dominant inheritance patterns?

Answer 22

• Adult polycystic kidney disease
• Multiple endocrine neoplasia type 1
• Huntington’s chorea
• Myotonic dystrophy
• Neurofibromatosis, and
• Polyposis coli.

Question 23

Action of benzodiaezepines?

Answer 23

Benzodiazepines bind to gamma-aminobutyric acid (GABA) receptors in the central nervous system and potentiate the anxiolytic and hypnotic effects of this transmitter.

Question 24

Drug to reverse effects of benzodiazepines

Answer 24

Flumazenil

Question 25

Function of protamine?

Answer 25

Reverse over-heparinisation

Question 26

Parietal lobe tumour likely to cause which visual field defect?

Answer 26

Lower homonymous quadrantanopia.

Affects upper fibres of optic radiation.

Question 27

Visual field defect of bilateral occipital lobe infarction?

Answer 27

Cortical blindness.

Question 28

Calculation of number needed to treat?

Answer 28

Number of pts treated (total) - number of outcomes avoided (i.e. placebo - intervention outcomes)

Question 29

How may hyperprolactinemia present in women?

Answer 29

• Anovulatory infertility
• Reduced menstruation
• Production of breast milk
• Reduced libido
• Vaginal dryness.

Question 30

Which medications are associated with hyperprolactinemia?

Answer 30

• Antihistamines
• Butyrophenones e.g haloperidol
• Cimetidine
• Methyldopa
• Metoclopramide
• Phenothiazines e.g. chlorpromazine

Question 31

MoA allopurinol?

Answer 31

Lowers uric acid levels by inhibiting xanthine oxidase.

Question 32

Indications for allopurinol treatment?

Answer 32

• Frequent attacks
• Polyarticular gouty arthritis
• Tophaceous gout

Question 33

Joint aspirate findings for gout?

Answer 33

needle shaped negatively birefringent monosodium urate crystals