Corrections 2

Question 1

What does a history of IVDU coupled with a descending paralysis, diplopia and bulbar palsy indicate?

Answer 1

Clostridium botulinum infection

Question 2

What can acute toxoplasmosis in immunocompromised patients mimic?

Answer 2

EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise)

Question 3

What is the most reliable method to assess a patient’s response to hep C treatmnet?

Answer 3

Viral load

Question 4

Mx of campylobacter infections?

Answer 4

Often supportive

However, if severe (e.g. high fever, >8 bowel motions a day) –> treat with clarithromycin

Question 5

What abx can be used in the mx of severe cases of campylobacter?

Answer 5

Clarithromycin

Question 6

Triad of features in disseminated gonoccocal infection?

Answer 6

1) tenosynovitis
2) migratory polyarthritis
3) dermatitis

Question 7

Classical features of dengue fever?

Answer 7

1) retro-orbital headache (behind the eyes)

2) fever

3) facial flushing

4) rash

5) thrombocytopenia

Question 8

Order of LP vs abx in bacterial meningitis?

Answer 8

Suspected bacterial meningitis: an LP should be done before IV antibiotics, unless:

1) cannot be done within 1 hour
2) LP is contraindicated e.g.
- significant bleeding risk
- signs of raised ICP
- signs of severe sepsis or a rapidly evolving rash

Question 9

Mx of bed bug infestation?

Answer 9

Fumigation of household via pest management

Question 10

Why are chemotherapy patients at increased risk of gout?

Answer 10

Chemotherapy causes rapid cell death, leading to the release of purines which are then metabolised to uric acid.

Question 11

What is Marjolin’s ulcer?

Answer 11

SCC occurring at sites of chronic inflammation or previous injury.

Question 12

What is pyoderma gangrenosum?

Answer 12

A rare, non-infectious, inflammatory disorder.

It is an uncommon cause of very painful skin ulceration.

It may affect any part of the skin, but the lower legs are the most common site.

Question 13

What are some associations with pyoderma gangrenosum?

Answer 13

1) Idiopathic (50%)

2) IBD

3) Rheum:
- SLE
- RA

4) Haem:
- lymphoma

5) PBC

Question 14

Clinical features of pyoderma gangrenosum?

Answer 14

• typically on the lower limb
• small pustule, red bump or blood-blister
• then skin breaks down resulting in an ulcer which is often painful
• the ulcer itself may be deep and necrotic

Look up pics!

Question 15

Mx of pyoderma gangrenosum?

Answer 15

Steroids

Question 16

Investigations in fungal nail infection?

Answer 16

nail clippings +/- scrapings of the affected nail –> microscopy & culture

Question 17

When should microscopy & culture be done in fungal nail infections?

Answer 17

should be done for all patients if antifungal treatment is being considered

N.B. the false-negative rate for cultures are around 30%, so repeat samples may need to be sent if the clinical suspicion is high

Question 18

Mx of fungal nail infection?

Answer 18

Only treat if symptomatic and patient is bothered by appearance.

If dermatophyte or Candida infection is confirmed:

1st line –> topical treatment with amorolfine 5% nail lacquer (6-12m)

2nd line –> oral terbinafine

3rd line –> oral itraconazole (if Candida infection)

Question 19

Where does dermatitis herpetiformis typically appear?

Answer 19

Over extensor surfaces

Question 20

What are the live vaccines?

Answer 20

1) MMR
2) BCG
3) Yellow fever
4) Oral polio
5) Intranasal influenza
6) Varicella

Question 21

After an initial negative result when testing for HIV in an asymptomatic patient, when should a repeat test be offered?

Answer 21

At 12 weeks post-exposure

Question 22

Why are platelet transfusions at a particular risk of bacterial contamination?

Answer 22

As they are stored at room temperature

Question 23

CT results in HSV encephalitis?

Answer 23

Temporal lobe changes

Question 24

CT findings in a brain abscess?

Answer 24

Ring enhancing lesion with surrounding oedema

(look up pic)

Question 25

Mx of cerebral toxoplasmosis?

Answer 25

Sulfadiazine + pyrimethamine

Question 26

1st line abx in a brain abscess?

Answer 26

IV 3rd generation cephalosporin + metronidazole

Question 27

Investigation of choice in genital herpes?

Answer 27

NAAT

Question 28

What conditions should ALL pregnant women be offered screening for?

Answer 28

1) HIV
2) Hep B
3) Bacteriuria
4) Anaemia
5) Thalassaemia
6) Syphilis
7) Blood group, Rhesus status and anti-red cell antibodies
8) Risk factors for pre-eclampsia

Question 29

For patients with gonorrhoea, what can be given if the patient refuses IM ceftriaxone (e.g. needle phobic)?

Answer 29

Cefixime + azithromycin

Question 30

Features of constrictive pericarditis?

Answer 30

1) dyspnoea
2) peripheral oedema
3) a positive Kussmaul’s sign (the raised JVP that doesn’t fall with inspiration)

Question 31

Acute vs constrictive pericarditis?

Answer 31

Acute pericarditis is an inflammation of the pericardium that can occur suddenly and resolve on its own, while constrictive pericarditis is a chronic condition that can lead to heart failure.

Question 32

2 key causes of constrictive pericarditis?

Answer 32

1) any cause of pericarditis (typically repeated episodes)

2) TB

Question 33

CSF findings in a viral meningitis?

Answer 33

1) raised WCC (lymphocyte predominance)

2) normal glucose

3) normal protein

Question 34

What is the most common cause of viral meningitis in adults?

Answer 34

Enteroviruses e.g. Coxsackie

Question 35

What is Bechet’s syndrome?

Answer 35

A a rare multisystem inflammatory disorder characterised by recurrent ORAL AND GENITAL ULCERS, uveitis, and systemic vasculitis.