Clinical questions/passmedicine

Question 1

What does the murmumr of tricuspid regurgitation sound like?

Answer 1

Pansystolic murmur heard best at the lower left sternal edge heard loudest on inspiration

Question 2

Why are right sided murmurs heard best on inspiration?

Answer 2

Inspiration reduces intrathoracic pressure and causes blood to go into the lungs, This increases the venous return to the right side of the heart and increases the volume of right sided murmurs

Question 3

What are the most common bacteria causing infection in CF?

Answer 3

Initially staph aureus

Gram negative bacteria (Burkholderia cepacia and pseudomonas aerginosa)

Question 4

What type of pneumonia is more common in alcoholics?

Answer 4

Klebsiella

Question 5

What are the main histopathological hallmarks of COPD?

Answer 5

Mucous gland hypertrophy
Goblet cell hyperplasia
Loss of cilia
Squamous metaplasia of the respiratorye pithelium

Question 6

What antibodies is autoimmune hepatitis associated with?

Answer 6

Anti smooth muscle

Question 7

What antibodies is primary biliary cirrhosis associated with?

Answer 7

Anti mitochondrial antibodies

Question 8

What medication should patients with multiple myeloma be given before they start chemotheraoy? Why?

Answer 8

Allopurinol (inhibits xanthine oxidase)

To reduce the risk of tumour lysis syndrome

Question 9

What is the first blood product that is used to treat DIC?

Answer 9

Fresh frozen plasma

Question 10

Are phosphate levels high or low in CKD stage 4?

Answer 10

High as the kidney is not able to excrete phosphate well enough

Question 11

Whta is the difference in presentation between an upper motor neurone facial nerve paralysis

Answer 11

LMN - Patient cannot wrinkle the forehead (final common pathway to the muscles is destroyed) and the lesion must be in the pons or outside the brainstem
In an UMN lesion the upper facial muscles are partially spared because of alternative pathways in the brainstem

Question 12

What can cause afacial nerve paralysis with forehead involvement?

Answer 12

LMN

• Idiopathic (bells palsy)
• pregnancy
• Diabetes
• Stroke
• Herpes zoster (Ramsey hunt)
• HIV
• EBV
• Trauma
• Guillan barre

Question 13

What can cause a facial nerve paralysis with forehead sparing?

Answer 13

UMN lesion

• Cerebrovascular disease
• Intracranial tumour
• MS
• Syphillis
• HIV
• Vasculitis

Question 14

What is the treatment of a bells palsy?

Answer 14

Prednicolone within 72 hours

Question 15

What is pagets disease?

Answer 15

An increase in bone turnover with bony enlargement, deformation, pain and stress fractures

Question 16

What is the biochemistry in pagets disease?

Answer 16

Normal Calcium
Normal phosphate
Raised alk phos

Question 17

How does levofloxacin work?

Answer 17

Quinolone antibiotic

Inhibits bacterial DNA

Question 18

Which type of lung cancer is associated with hypercalcaemia?

Answer 18

Squmous cell carcinoma

Question 19

Which lung cancer is associated with hyponetremia?

Answer 19

Small cell carcinoma

Question 20

How do you distinguish between nephrogenic and cranial diabetes?

Answer 20

Fluid deprivation test which involves restricting fluid intake and monitoring urine osmolality. In diabetes insiipidus osmolality will remain low despite lack of fluid intake. They will respond to desmopressin and osmolality will increase.

Nephrogenic diabetes insipidus cannot respond to desmopressin