Corrections 8

Question 1

Corrections of Kaposi’s sarcoma in paeds?

Answer 1

Much rarer to find the characteristic skin lesions.

Most common symptom –> lymphadenopathy

Question 2

Which NSAID is contraindicated in breastfeeding?

Answer 2

Naproxen

Question 3

Cause of hepatic encephalopathy after a TIPS?

Answer 3

Due to inadequate metabolism of nitrogenous waste products by the liver.

TIPS causes blood from the portal system to bypass the liver and enter the systemic circulation without the metabolism of nitrogenous waste products such as ammonia.

As these build up in the systemic circulation, increased ammonia is able to cross the blood brain barrier resulting in hepatic encephalopathy

Question 4

Mechanism of dabigatran?

Answer 4

Direct thrombin inhibitor

Question 5

Mechanism of rivaroxaban & apixaban?

Answer 5

Factor Xa inhibitors

Question 6

Mechanism of heparin?

Answer 6

Activates antithrombin III

Question 7

Why is a multi-level PT required instead of a standard PT following TOP?

Answer 7

A standard pregnancy test is unable to quantify the levels of hCG.

A multi-level pregnancy test helps guide further management if hCG levels have not fallen adequately.

Question 8

Referral criteria for suspected cancreatic cancer?

Answer 8

2ww referral: ≥40 y/o + jaundice

Direct access urgent CT scan: ≥60 y/o + weight loss and one of the following; diarrhoea, N&V, constipation, new onset diabetes, abdo pain, back pain

Question 9

When are ACEi indicated in CKD?

Answer 9

CKD stage 3 or higher

ACR >30

Question 10

What mutation is seen in Li-Fraumeni syndrome?

Answer 10

p53 (tumour suppressor)

Question 11

Breast cancer screening?

Answer 11

Mammogram every 3 years in women aged 50-70

Question 12

What can be considered in very high/refractory cases of hypercalcaemia?

Answer 12

Calcitonin

Question 13

Liver cancer referral guidelines?

Answer 13

Urgent direct access US (within 2 weeks) to assess in people with an upper abdominal mass consistent with an enlarged liver.

Question 14

Which lung cancer has the strongest association with smoking?

Answer 14

Squamous cell lung cancer

Question 15

Most common side effect of ondansetron?

Answer 15

Constipation

Question 16

1st line anti-emetic for intracranial causes of nausea and vomiting?

Answer 16

Cyclizine

Question 17

Pharmacological management of hiccups in palliative care?

Answer 17

Chlorpromazine or haloperidol

Question 18

Describe WHO performance status

Answer 18

0 = normal

1 = Ambulatory and able to perform light work, but restricted from strenuous activity

2 = Ambulatory and able to perform self-care, but unable to work

3 = Confined to bed or chair >50% waking hours

4 = Bedbound and unable to perform self-care

5 = Dead

Question 19

What drug is indicated for agitation and confusion in patients who are NOT in the terminal phase?

Answer 19

Haloperidol

(midazolam in the terminal phase)

Question 20

What side effect of radiation therapy can cause difficulty swallowing, hoarseness and coughing?

Answer 20

Radiation induced laryngeal oedema

Question 21

Typical dose of morphine in end-of-life?

Answer 21

2.5-5mg SC every 4 hours

Question 22

What cancer can long-term exposure to high levels of benzene in the air lead to?

Answer 22

Benzene

Question 23

What is the usual treatment regime for active tuberculosis? (4)

Answer 23

Rifampicin for 4 months
Isoniazid for 6 months
Ethambutol for 2 months
Pyrazinamide for 2 months

Question 24

What is required to exclude malaria in a patient where malaria is a possible diagnosis?

Answer 24

3 negative malaria blood films taken over 3 days

Question 25

What is involved in the Mantoux test?

Answer 25

Injecting tuberculin into the intradermal space on the forearm and assessing the reaction after 72 hours

Question 26

What is the usual first-line treatment for severe or complicated malaria? (1)

Answer 26

IV artesunate

Question 27

What are the key characteristics that distinguish gram-positive bacteria from gram-negative bacteria? (2)

Answer 27

Gram +ve bacteria have a thick peptidoglycan cell wall that stains with crystal violet stain.

Question 28

For patients with acute heart failure, what may be useful if the patient has concomitant myocardial ischaemia or severe hypertension?

Answer 28

Nitrates e.g. GTN

Nitrates function by dilating the coronary arteries, thereby enhancing blood flow to the cardiac myocardium. In addition, the vasodilatory effects of nitrates reduce preload and afterload.

Question 29

what is seen on a peripheral semar in malaria?

Answer 29

Parasites

Question 30

What urine osmolality result post-water deprivation excludes diabetes insipidus?

Answer 30

> 600

Question 31

What urine osmolality result post-water deprivation indicates diabetes insipidus?

Answer 31

Urine osmolality < 400mOsm/kg and raised serum osmolality indicates an inability to concentrate urine

Question 32

1st line mx of superficial thrombophlebitis?

Answer 32

NSAIDs +/- compression stockings