Dec 2021

Question 1

HEV

Answer 1

Fever, N/V, RUQ pain, return from south east asia, 22 weeks pregnancy. ALT > 500.

Question 2

temporal lobe seizures

Answer 2

rising sensation in abdomen
smacking movements with his mouth

Question 3

parietal lobe seizures

Answer 3

Contralateral sensory disturbance, usually tingling or numbness

Question 4

riedel thyroiditis

Answer 4

fibrosis of thyroid gland, dense woody gland. difficult to differ from malignancy. very rare to present with hyperthyroidism

Question 5

migraine prophylaxis in asthmatics ?

Answer 5

candesartan (not verapamil)

Question 6

DM usually have HbA1C > 48 mmol/mol. however its affected by red cell life span. decreasing red cell span falsely show good glycemic control. causes ?

Answer 6

Hemodialysis
sickle cell anemia
(splenectomy - increase red cell span - high false hba1c)

Question 7

loffler’s syn

Answer 7

eosinophilic pneumonia
s/t ascaris lumbricodies
fever + dry cough + night sweats

Question 8

after starting SSRI. follow-up ?

Answer 8

1 week (risk of suicide in such pts)

Question 9

Emphysema

Answer 9

total gas transfer - low

Question 10

MM features
Dx ?

Answer 10

MRI spine (not x-ray)

Question 11

paget’s dz
Dx ?

Answer 11

isotope scan

Question 12

cipro effect on theophylline

Answer 12

cipro inhibit this enzyme - increase theophylline levels

Question 13

I.E. in IV drug user
Rx ?

Answer 13

Flucloxacillin

Question 14

I.E. - strep

Answer 14

benzyl penicillin + genta

Question 15

MM Pain relief ?

Answer 15

opiate analgesia
(bisphosphonate - reduce fracture risk with osteoporosis)

Question 16

Friedrich ataxia

Answer 16

progressive limb and gait ataxia, cerebellar dysarthria, areflexia, Dorsal column sensory loss, pyramidal weakness, weakness start in late adolescence. Dx - repeat expension in frataxin gene Ch9.

Question 17

acute UGI bleed.
recent MI

Answer 17

Stop clodigogrel
continue aspirin

Question 18

extrinsic allergic alveolitis

Answer 18

veterinarian, dry cough, lack apetite, weakness, ground glass changes in upper zones.

Question 19

osteoarthritis
foot
DM + Pt
Rx ?

Answer 19

flucloxacillin

Question 20

Vit B12 deficiency
Dx ?

Answer 20

serum methylmalonic acid and homocysteine

Question 21

pt in ICU in shock. abx not helpful. next step ?

Answer 21

amphoteracin B

Question 22

medications causing myasthenia crisis ?

Answer 22

doxy
azithro
cipro
erthro
genta
levo

Question 23

drug induced hepatitis ?

Answer 23

sodium valproate
MTX
amiodarone
statins
paracetamol

Question 24

drug induced psychosis
1 cause ?

Answer 24

cannabis use

Question 25

hyperNa+ but pt very dehydrated. Fluid ?

Answer 25

IV 5% dextrose (not N/S)

Question 26

achalasia
Rx ?

Answer 26

CCB or nitrates