Extras

Question 1

When should sciatica be referred for a scan?

Answer 1

12 weeks of conservative management

Question 2

Discontinuation features from SSRIs

Answer 2

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

Question 3

What are the guidelines for treating acute sinusitis?

Answer 3

Conservative management e.g analgesia is 10 days or less
>10 days consider high dose intranasal corticosteroids for 14days
If bacterial suspected - first line phenyoxymethylpenicillin or co-amoxiclav (doxycycline if pen allergic)

If sx worsening after 3 days of 1st abx, co-amox or clarithromycin

> 3 episodes requiring abx in 1 year = ENT referral

Question 4

What features would lead to suspicion of bacterial sinusitis?

Answer 4

Sx >10 days with no improvement
Fever >38
Discoloured or purulent discharge (unilateral prominence)
Severe local pain (unilateral prominence)
Marked deterioration after initial milder form of illness (double sickening)

Question 5

What test results would you expect in a Hydatidiform mole (molar pregnancy)?

Answer 5

High bHCG
Low TSH
High thyroxine
The biochemical structure of beta hCG is very similar to that of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH).
can result in signs and symptoms of thyrotoxicosis. High levels of T4 and T3 have a negative feedback effect on the pituitary gland to stop secretion of TSH, causing and overall reduction in TSH levels.

Question 6

How to differentiate caput succedaneum and cephalhaematoma?

Answer 6

(C)aput (S)uccedaneum = (C)rosses (S)uture lines
Caput succedaneum is a subcutaneous, extraperiosteal, collection of fluid that collects as the result of pressure on the baby’s head during delivery.

A cephalhaematoma is a haemorrhage between the skull and periosteum. Because the swelling is subperiosteal, it’s limited by the boundaries of the baby’s cranial bones.

Question 7

When is a transcutaneous bilirubinometer appropriate to use?

Answer 7

On babies >24hrs old

Question 8

Which drugs can cause corneal opacities?

Answer 8

amiodarone
indomethacin

Question 9

Drugs that can cause optic neuritis?

Answer 9

ethambutol
amiodarone
metronidazole

Question 10

What ocular issue can steroids cause?

Answer 10

Cataracts

Question 11

Which drugs can cause retinopathy?

Answer 11

chloroquine, quinine

Question 12

Which antibiotics can result in QT prolongation?

Answer 12

Macrolides e.g Clarithromycin

Question 13

SSRI + NSAID =

Answer 13

Risk of GI bleed give PPI with SSRI

Question 14

Unilateral glue ear in adults =

Answer 14

Refer to ENT as needs evaluation for posterior nasal space tumour

Question 15

Patients >65 with anaemia should have what investigation?

Answer 15

FIT (faecal immunochemical test) to rule out need for urgent colorectal referral pathway

Question 16

First line treatment for early Lyme disease?

Answer 16

14-21 day course of doxycycline

Question 17

What drugs should be stopped when you have diarrhoea or vomiting? (Sick day rules)

Answer 17

SGLT2(dapa/empa/flozin)
ARBs
Diuretics
Metformin
ACEi
NSAIDs

Question 18

What is the definition of polypharmacy?

Answer 18

> /= 5 medications

Question 19

Spot diagnosis: Elderly patient dizzy when fully extending neck

Answer 19

Vertebrobasilar ischaemia

Question 20

What is vertebrobasilar ischaemia?

Answer 20

Risk with cardiovascular disease
-atherosclerosis in the vertebrobasilar distribution is exacerbated by changes in head position, causing ischaemia and resultant symptoms.

Question 21

Classic pathological finding in branchial cyst?

Answer 21

acellular fluid with cholesterol crystals

Question 22

Where is a branchial cyst normally located?

Answer 22

benign lesion that is situated in the lateral neck, superficial to the sternocleidomastoid muscle