EMQs

Question 1

An 18-year-old known asthmatic with a respiratory rate of 50, mx?

Answer 1

Endotracheal intubation

Question 2

Features of sarcoidosis?

Answer 2

Exocrine- swollen parotid glands
Lupus pernio- indurated plaques + discoloration
Non- caseating granulomas- transbronchial biopsy is essential for diagnosis in most cases

Question 3

Can measles cause bronchiectasis?

Answer 3

Yes

Question 4

Most common identifiable cause of bronchiectasis?

Answer 4

Cystic fibrosis

Question 5

Baker’s cyst

Answer 5

A popliteal cyst is an accumulation of synovial fluid which in this case has resulted from this woman’s arthritis. This is an accumulation of synovial fluid behind the knee, usually in response to injury or inflammation. It will self-resolve but the underlying cause should be addressed i.e. arthritis. First line treatment for grade 1 or 2 injuries is with RICE: rest, ice, compression and elevation followed by gentle mobilisation. Adjunctive analgesia can be offered with paracetamol. Treatment is conservative, particularly if asymptomatic. Surgery is only indicated in those with extensive symptoms where conservative and percutaneous treatments have failed. Corticosteroid injections (intra-articular) can also be considered.

Question 6

Non small cell carcinoma

Answer 6

Clubbing

Question 7

PE on CXR

Answer 7

Band atelectasis, hemidiaphragm elevation, Fleischner’s sign, Westermark’s sign and Hampton hump.

Question 8

What can precipitate immune thrombocytopenic purpura?

Answer 8

HIV

Varicella zoster

Question 9

Hep A

Answer 9

shellfish which is harvested from sewage contaminated water

Question 10

Symptoms of Hep A

Answer 10

pre-icteric phase, lasting 5-7 days, consisting characteristically of N&V, abdominal pain, fever, malaise and headache. Rarer symptoms may be present such as arthralgias and even severe thrombocytopenia and signs that may be found include splenomegaly, RUQ tenderness and tender hepatomegaly as well as bradycardia. The icteric phase is characterised by dark urine, pale stools, jaundice and pruritis. When jaundice comes on, the pre-icteric phase symptoms usually diminish, and jaundice typically peaks at 2 weeks. However, a fulminant course runs in <1% of patients with worsenining jaundice and encephalopathy.

Question 11

Gallstones ix

Answer 11

USS is the definitive initial investigation. HIDA scanning and MRI may help if the diagnosis remains unclear.

Question 12

Long term treatment after MI

Answer 12

aspirin, ace, beta blockers, statin

Clopidogrel for twelve months

Question 13

Risk factors for SVT

Answer 13

Infiltrative disease- eg sarcoidosis, amyloidosis- can cause scar tissue in AV node

Question 14

angina mx

Answer 14

beta blockers first line
ccb second line

+
GTN

+ aspirin- prevention

Question 15

What is EBV associated with?

Answer 15

Mononucleosis (associated with
lymphomas, nasopharyngeal
carcinoma)

Question 16

How is VZV spread?

Answer 16

Respiratory

Question 17

Shingles treatment?

Answer 17

First line: Valacyclovir

Second line:

Question 18

Hepatitis Ix?

Answer 18

FBC,U+E, LFT, Clotting, CRP
Viral serology + PCR
Liver USS
In extreme cases- Liver biopsy

Question 19

Shingles treatment?

Answer 19

First line: Valacyclovir or famacyclovir
Second line: Acyclovir
If within 72 hours of onset
Give for 7 days

Question 20

What autonomic symptoms can GBS have?

Answer 20

Urinary retention, ileus

Question 21

Risk factors for GBS

Answer 21

Cancer - esp lymphoma

Immunisation

Question 22

Ix for GBS?

Answer 22

Nerve conduction studies- decreased nere conduction

Lumbar puncture

• Albuminocytological dissociation - high protein [due to inflammation], normal glucose, normal cell count

Bloods- Anti ganglioside antibodies in 25% of GBS and all Miller Fischer variant

Spirometry- [bedside, every 6 hours]

Question 23

Hydropcephalus first line?

Answer 23

CT or MRI

Question 24

Types of herpes simplex I- different presentations

Answer 24

j

Question 25

Coeliac gold standard?

Answer 25

Endoscopy and biopsy

Question 26

Coeliac Mx?

Answer 26

Avoid gluten

Pneumococcal vaccine every 5 years

Question 27

Types of uveitis

Answer 27

Anterior
Posterior
Complete
Intermediate

Question 28

Difference between posterior and anterior uveitis

Answer 28

Anterior= autoimmune condition, painful, red, increased lacrimation and photophobia

Posterior uveitis = infective disease, painless, floaters and scotoma

Both present with blurry vision

Question 29

ix for uveitis

Answer 29

Fundoscopy

Slit lamp

Question 30

Pain in types of conjunctivitis

Answer 30

Viral conjunctivitis is painless

Bacterial conjunctivitis is painful

Question 31

fOURTH NERVE palsy causes

Answer 31

Most common= head trauma

tumours
vascular- diabetes, atherosclerosis, hypertension

Question 32

Causes of sixth nerve palsy

Answer 32

Stroke, trauma, viral illness, brain tumour, inflammation, infection, migraine headache and elevated pressure inside thebrain

Question 33

Other symptoms of sixth nerve palsy

Answer 33

Hearing loss, facial weakness, decreased facial sensation, droopy eyelid and/or abnormal eye movement

Question 34

Causes of sixth nerve palsy

Answer 34

Stroke, trauma, brain tumour

viral illness,inflammation, infection

migraine headache and elevated pressure inside thebrain

Question 35

Bulbar palsy signs

Answer 35

Gag reflex – absent
Tongue – wasted, fasciculations
Palatal movement – absent
Jaw jerk – absent or normal
Speech – nasal
Emotions – normal
Other – signs of the underlying cause, e.g. limb fasciculations.

X, XI and XII

Motor neuron disease
Guillain-Barre

Question 36

Pseudobulbar palsy

Answer 36

UMN - limbs bilateral
Gag reflex= increased/normal
Tongue= spastic
Palatal movement= absent
Jaw jerk= increased/normal
Speech= donald duck- monotonous, slurred, high pitched
Emotions- labile

V, VII, VIII, IX, X

Stroke of internal capsule
MS
Motor neuron disease

Question 37

Causes of cranial diabetes insipidus?

Answer 37

Pituitary tumour
Meningitis/infection
Sarcoidosis

Question 38

Causes of nephrogenic diabetes insipidus?

Answer 38

Lithium
Hypercalcaemia
Hypokalaemia
AVPV2
Idiopathic

Question 39

Causes of nephrogenic diabetes insipidus?

Answer 39

Lithium
Hypercalcaemia
Hypokalaemia
AVPV2 gene- inherited
Idiopathic

Question 40

What happens to urea in acute addisons?

Answer 40

Urea

Question 41

What happens to urea in acute addisons?

What happens to glucose?

Answer 41

High urea

Low glucose