General

Question 1

Common uses of opiates

Answer 1

Analgesia
Anti-tussive (ACh suppression needed for cough activation)
Euphoric effects (serotonin release nucleus accumbens)

Question 2

Opiates side effects

Answer 2

Decreased gastric motility
Decreased emptying
Increased water reabsorption
(Constipation)

Respiratory depression
N&V
Pupillary constriction 
Pruritis 
Hypotension

Question 3

Opiate overdose prescription

Answer 3

Naloxone

Question 4

Hypercalcaemia symptoms

Answer 4

Stones- renal or biliary
Bones- bone pain
Abdominal Groans- abdo pain, N&V
Thrones- polyuria, leading to dehydration
Psychiatric Overtones- depression, anxiety, cognitive dysfunction

Also: Constipation, lethargy

Question 5

Which is forehead sparing?

UMN lesion or LMN lesion

Answer 5

UMN lesion is forehead sparing (due to alternative pathways in the brainstem)

Question 6

Brisk reflexes suggest the presence of?

Answer 6

An upper motor neurone lesion

Question 7

3 Cardiac causes of clubbing

Answer 7

CIA

Congenital cyanotic heart disease
IE
Atrial myxoma

Question 8

4 Resp causes of clubbing

Answer 8

CBC

Lung cancer
Bronchiectasis
Cystic fibrosis

Interstitial lung disease (Fibrosing alveolitis)

Question 9

3 Abdo causes of clubbing

Answer 9

CCC

Cirrhosis
Coeliac disease (Malabsorption in general)
Crohn’s disease

Question 10

Na normal range

Answer 10

135-145 mM

Question 11

K normal range

Answer 11

3.5-5.0 mM

Question 12

U normal range

Answer 12

3.5-6.5 mM

Question 13

Cr normal range

Answer 13

70-120 micromol/l

Question 14

Hb normal range

Answer 14

M 135-175

F 115-165 g/L

Question 15

WCC normal range

Answer 15

3.6-11.0 x10^9 L

Question 16

Platelets normal range

Answer 16

140-400 x 10^9 L

Question 17

3 Cardiac Differentials of Chest Pain

Answer 17

IHD
Aortic dissection
Pericarditis

Question 18

Phaechromocytoma hypertensive crisis, drug to give

Answer 18

Phentolamine

a1 antagonist causing vasodilation

Question 19

BCC characteristics

Answer 19

Shiny, pearly nodule, rolled edges and central ulceration.

Blood vessel: Telangiecstsasia

Question 20

Eczema (atopic dermatitis) characteristics

Answer 20

“Itchy, dry, erythematous, rough rash”
Usually on flexor surfaces (elbows, knees), Cheek and chin in children
Family history of atopy (hay-fever, asthma)

Pathophysiology:
Low fillagrin: Skin barrier defect
Type I hypersensitivity

Question 21

Psoriasis key points

Answer 21

Immune-mediated inflammatory condition

Affects:
Nails: Pitting, onycholysis
Joints: Psoriatic arthritis

Question 22

Types of psoriasis

Answer 22

Plaque
Localised
Guttate
Erythrodermic

Question 23

Contact dermatitis key points

Answer 23

Type IV hypersensitivity reaction (after 2-3 days)

Question 24

Lupus antibodies and type of HS reaction

Answer 24

ANA (anti-nucleus) most sensitive

Anti-dsDNA- most specific

Type III Hypersensitivity reaction (immune complex mediated)

Question 25

Antiphospholipid syndrome

Answer 25

Hypercoagulable state caused by antiphospholipid antibodies

CLOTS
Clots (arterial + venous)
Livedo reticularis
Obstretic complications
Thrombocytopenia

Question 26

Dermatomyositis

Answer 26

Inflammation of muscles and overlying skin

Signs:
Gottren’s papules: Discrete erythematous papules over MCP and IP joint

Heliotrope/ iliar rash: Violet rash on upper eyelids

Shawl sign: Diffuse rash over back and shoulders

Periungual telangiectsasia: Around nails

Question 27

Systemic sclerosis CREST

Answer 27

Calcinosis
Raynaud's phenomenon
oEsophageal dysmotility
Sclerodactylity
Telangiectstasia

Question 28

Diffuse and limited systemic sclerosis Ab

Answer 28

Limited- anticentromere

Diffuse- antitopoisomerase

Question 29

Pseudogout key finding on X-ray

Answer 29

Chondrocalcinosis

Question 30

Anti-phospholipid syndrome Auto-Ab

Answer 30

Anti-cardiolipin Abs