ENDO/RENAL/MSK MIX 6.6.23

Question 1

What are the two potential heart complications of Ehlers Danlos?

Answer 1

Mitral valve prolapse
Aortic regurgitation

Question 2

What is ehlers danlos

Answer 2

Genetically inherited
Occurs due to defect in synthesis of collagen => hyperextensibility of skin , recurrent joint problems , repeat dislocations

Question 3

What type of haemorrhage is associated with ehlers danlos

Answer 3

Subarachnoid haemorrhage

Question 4

What are berry aneurysms

Answer 4

Precursor to a subarachnoid haemorrhage

Question 5

What are the two acute complications that must be monitored doses in toxic epidermal necrolysis

Answer 5

Fluid loss and electrolyte derangement

Question 6

What are all acute complications of toxic epidermal necrolysis

Answer 6

Volume loss
Electrolyte derangement
Hypothermia
Secondary infection

Question 7

What are the known drugs that cause TEN

Answer 7

Allopurinol
Phenytoin
Sulphonamides
Penicillins
Carbamazepine
NSAIDs

Question 8

What is first line for TEN is now commonly used

Answer 8

IV immunoglobulins

Question 9

What muscle of forearm inserts/attaches into radial tuberosity

Answer 9

Biceps brachii

Question 10

What innervates the trapezius

Answer 10

Spinal accessory

Question 11

Injury to the spinal accessory nerve affects which movement

Answer 11

Upward rotation of the scapula

Question 12

What complication of acute severe hyponatraemia causes severe headaches, nausea, vomiting and confusion

Answer 12

Cerebral oedema

Low sodium level disturbs the body’s osmotic balance - acute means that the brain does not have enough time to adjust

As a result water shifts rapidly from the extracellular space into brain cells due to osmotic gradient

Question 13

Start of what drug can sometimes cause SIADH

Answer 13

SSRI prescription

Question 14

What mode of inheritance is familial hyper cholesterol anemia

Answer 14

Autosomal dominant

Question 15

How to assess endogenous insulin production

Answer 15

C-peptide

(Secreted in proportion to insulin and is a marker of endogenous insulin production)

Question 16

What would histology show for IgA nephropathy

Answer 16

Mesangial hypercellularity with positive immunofluorescence for IgA and C 3

Question 17

What would show on histology for post-strep glomerulonephritis

Answer 17

Endothelial proliferation with neutrophils with ‘starry sky’ appearance on immunofluorescence

Question 18

Minimal change histology

Answer 18

Fusion of podocytes and effacement of foot processes

Question 19

Histology of anti-GBM

Answer 19

Linear IgG deposits along basement membrane

Question 20

Histology for acute interstitial nephritis

Answer 20

Marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules

Question 21

Management of IgA nephropathy if there is isolated haematuria , no or minimal proteinuria (less than 500-1000) and a normal eGFR

Answer 21

No treatment needed - just follow up renal functions

Question 22

Management of IgA nephropathy with persistent proteinuria (above 500-1000d) with slightly reduced eGFR

Answer 22

ACEi

Question 23

Management of IgA nephropathy with active disease (falling eGFR) or failure to respond to ACEi

Answer 23

Immunosuppression with corticosteroids

Question 24

Best long term management for osteoarthritis

Answer 24

Regular low impact aerobic exercises and muscles strengthening

Question 25

*old man with bone pain and isolated raised ALP

Answer 25

Paget’s disease of bone

Question 26

*commonest cause of lateral knee pain in keen runners

Answer 26

Iliotibial band syndrome

Question 27

Should synovial fluid sampling be taken before or after starting antibiotics for someone with suspected septic arthritis

Answer 27

NICE suggest sampling before giving antibiotics

Question 28

*twisting sports injury followed by delayed onset of knee swelling and locking

Answer 28

Meniscus tear

Question 29

What is the treatment for a torn meniscus

Answer 29

Arthroscopic menisectomy

Question 30

*tibia lying back on femur injury

Answer 30

PCL rupture

Can be drawn forward during a paradoxical drawer test

Question 31

What is the classification system for tibial plateau fractures

Answer 31

Schatzker classification

Question 32

Why wouldn’t doctors use colchicine in a gout flare up

Answer 32

Diarrhoea

Question 33

Mutation in what protein is responsible for Marfans

Answer 33

Fibrillin

Question 34

What would blood tests show for someone with osteoporosis

Answer 34

Normal ALP
Normal calcium
Normal phosphate
Normal PTH

Question 35

What would blood tests show for osteomalacia

Answer 35

Raised ALP
Raised PTH
Decreased calcium and phosphate

Question 36

Why is PTH raised in osteomalacia

Answer 36

In an attempt to raise calcium stores for bone mineralisation

Osteomalacia is characterised by impaired mineralisation of bone due to vit D deficiency / liver disease

Question 37

X-ray findings of AS

Answer 37

Subchondral erosions
Sclerosis
Squaring of lumbar vertebrae

Question 38

What is the main neurovascular structure that is compromised in a scaphoid fracture

Answer 38

Dorsal carpal arch of the radial artery

Question 39

What is the best investigation to confirm AS

Answer 39

Pelvic x-ray

(More so than HLAB27 etc)

Question 40

Common complication of someone with RA

Answer 40

IHD

Question 41

Which nerve is commonly injured in a posterior hip dislocation

Answer 41

Sciatic nerve

Question 42

*ped planus, pectus excavatum

Answer 42

Marfans

Question 43

*fever / back pain with pain on extension of hip

Answer 43

Iliopsoas abscess