General Medicine

Question 1

How much energy in fat, carbohydrates and protein (kcal/g)?

Answer 1

Fat = 9kcal/g
Protein = 4kcal/g
Carbohydrate 4kcal/g

Question 2

Features of zinc deficiency

Answer 2

• increased morbidity and mortality from diarrhoea, pneumonia and other infectious diseases
• impaired linear growth
• alopecia
• dermatitis

Question 3

What vitamin/mineral is goats milk deficient in?

Answer 3

Folate

Question 4

What proportion of total Hb does HbF make up during pregnancy, at birth and in the 1st year of life?

Answer 4

HbF accounts for 90% of total Hb at 24/40
70% at term
<20% at 4months
<2% at 12months

Question 5

What diseases are associated with sickle cell TRAIT?

Answer 5

• Renal medullary cancer
• Exercise induced rhabdomyolysis
• Splenic infarction

Have protection against malaria falciparum infection

Question 6

Features to distinguish serotonin syndrome from neuroleptic malignant syndrome?

Answer 6

• SS causes hyperreflexia and clonus (which you don’t get in NMS)
• NMS causes muscle rigidity (lead pipe rigidity) which is less common in SS (get more myoclonus)
• NMS commonly causes high CK
• NMS due to antipsychotics, SS more often due to antidepressants

Question 7

Recurrence risk of Autism Spectrum Disorder?

Answer 7

~10%

Higher if index case is female (highest for younger brother of affected female)

Question 8

MOA of atomoxetine?

Answer 8

SNRI (selective noradrenaline reuptake inhibitor)

Question 9

Adverse effects of atomoxetine?

Answer 9

Suicidal ideation (black box warning)
Somnolence
Reduced appetite, weight loss, N+V, abdominal pain

Question 10

Adverse effects of methylphenidate?

Answer 10

Reduced appetite, weight loss
Reduced growth (1-2cm)
Sleep disturbance
Headache
GI upset
Can exacerbate tics

Question 11

Mechanism of clonidine

Answer 11

Alpha2 adrenergic agonist

Question 12

Adverse effects of clonidine?

Answer 12

Hypotension
Bradycardia
Sedation

Question 13

Adverse effects of risperidone?

Answer 13

Metabolic syndrome: weight gain, hyperlipidemia, hyperglycaemia, hyperprolactinemia; sedation

Question 14

Features of Osteogenesis Imperfecta?

Answer 14

1. Osteoporosis + abnormal bone fragility (-> recurrent #s)
2. Blue-grey hue
3. Hearing loss
4. Dentinogenesis imperfect

Question 15

2 major domains of Autism DSM 5 criteria?

Answer 15

1. Impairment in social communication and interaction
2. Restricted and repetitive behaviour

*must cause impairment in social, occupational or other areas of functioning
*not better explained by ID or GDD

Question 16

Which vitamin deficiency causes dermatitis, diarrhoea and dementia?

Answer 16

Vitamin B3 (niacin). This is called “pellagra”

Question 17

How does vitamin B6 (pyridoxine) deficiency present?

Answer 17

Anaemia, peripheral neuropathy,
seizures.

May occur in child with metabolic defect or on isoniazid for TB

Question 18

What is absorbed in terminal ileum

Answer 18

Vit B12 and bile acids

Question 19

5mg prednisolone is equivalent to how much
- hydrocortisone?
- dexamethasone?

Answer 19

5mg pred
= 20mg hydrocortisone
= 0.75mg dexamethasone

Question 20

What is the potency of prednisolone relative to hydrocortisone?

Answer 20

Pred: hydrocortisone = 4:1

(5:1 for IV Methylpred: hydrocortisone)

Question 21

What is the potency of dexamethasone relative to hydrocortisone?

Answer 21

If hydrocortisone = 1
Dexamethasone 30x
Prednisolone 4x
Methylpred 5x

Question 22

Management of PTSD?

Answer 22

Trauma-focussed CBT

Question 23

Management of anxiety?

Answer 23

Therapy is first line - CBT
Medication can be added if poor response - fluoxetine, sertraline, fluvoxamine

Question 24

Management of OCD?

Answer 24

Exposure-response therapy (a form of CBT)
2nd line = fluoxetine
3rd line = TCA

Question 25

Management of Tourettes?

Answer 25

CBT- habit reversal therapy
Antipsychotics at low dose (eg haloperidol or risperidone)

Question 26

Mechanisms of influenza vaccine and oseltamavir?

Answer 26

Vaccination -> antibodies against haemagluttinin

Oseltamavir is a neuraminidase inhibitor