Investigations

Question 1

Dermatophyte

Answer 1

Woods Lamp

Question 2

Porphyria Cutanea Tarda

Answer 2

Woods Lamp

Question 3

T1 Hypersensitivity

Answer 3

Take history
Specific IgE
Skin prick
Challenge test
Induce anaphylaxis- look for Serum mast cell tryptase

Question 4

T4 Hypersensitivity

Answer 4

Patch Test

Question 5

Pemphigus vulgaris

Answer 5

Tzanck smear

Question 6

Pemphigus/ pemphigoid (blistering conditions)

Answer 6

Biopsy + direct immunofluorescence
Pemphigus- nikolsky’s positive
Pemphigoid- nikolsky’s negative

Question 7

Temporal Arteritis

Answer 7

Temporal biopsy (be aware of skip lesions)
Raised ESR
Raised CRP

Question 8

Soft tissue swelling

Answer 8

USS

MRI

Question 9

Crystal arthropathies

Answer 9

Needle aspirate and bifringence
Negative crystals- Uric acid = gout
Positive crystals- Calcium pyrophosphate = pseudogout
Alizarin red stain- hydroxyapatite = Milwakee Shoulder

Question 10

Saddle anesthesia

Answer 10

Urgent MRI <6hrs

Mandator PR

Question 11

Suspected SLE

Answer 11

Urinalysis to rule out Lupus nephritis

Biopsy

Question 12

Suspected polymyositis

Answer 12

Serum CK (always elevated, can be normal in dermatomyositis)
Muscle biopsy (CDT8 cells in polymyositis, CDT4 in dermatomyositis) 
Electromyography (EMG)

Question 13

Acromegaly

Answer 13

Screening serum IGF-1

Oral Glucose Tolerance test (OGTT) (normal <0.4micrograms)

Question 14

Cushing’s

Answer 14

Screening overnight dexamethasone suppression

2day 3mg/day dexamethasone suppression (normal <50)

Question 15

Conn’s

Answer 15

Renin: Aldosterone ratio- screening

Saline suppression test (failure to suppress Aldosterone by 50% from 2L)

Question 16

GH Deficiency

Answer 16

Screening Serum IGF-1

Oral insulin tolerance (expect GH to increase)

Question 17

T1DM

Answer 17

Antibodies: Anti GAD, Anti IA2
Hba1c : > or equal to 48
Random glucose: > or equal: 11.1
Fasting glucose: > 7

Question 18

T2DM

Answer 18

Random glucose: > or equal: 11.1
Fasting glucose: > 7
OGTT: > or equal to 11.1 (in 2 hours)
Hba1c : > or equal to 48

Question 19

Diabetes Insipidus

Answer 19

Water deprivation test (serum : urine osmolarity = 2:1)

Question 20

Polycystic Ovarian Syndrome

Answer 20

Rotterdam criteria: 2/3 of:

• Evidence of PSO on USS
• Menstrual irregularities
• Evidence of increased androgens

Question 21

Pyloric Stenosis

Answer 21

Abdominal USS

Question 22

Malrotation

Answer 22

XR

Question 23

Interssusception

Answer 23

USS (Target sign)

Question 24

Bacterial keratitis

Answer 24

Corneal scrape

Question 25

Endopthalmitis

Answer 25

Aqueous/Vitreous culture

Question 26

Acanthamoeba

Answer 26

Microscopy/culture

Question 27

Toxoplasma/Toxocara

Answer 27

Serology:
Toxoplasm- parasite
Toxocara- nematode

Question 28

Corneal trauma

Answer 28

Siedel’s test (fluorescein leakage)

Question 29

Scleritis

Answer 29

Phenylephrine drops- blood vessels should show contriction

Question 30

BPPV

Answer 30

Dix-Hallpike test

Question 31

Nose fracture

Answer 31

Nothing

Question 32

Sinusitis

Answer 32

CT

Question 33

Meniere’s

Answer 33

Romberg test

Question 34

Acoustic Neuroma

Answer 34

MRI

Question 35

Glandular fever

Answer 35

Paul-Bunnel Monospot test

EBV IgM

Question 36

Dysphagia

Answer 36

Barium swallow (strictures/ pharyngeal pouch/achalasia= bird beak, cork screw= oesophageal spasm)

Question 37

Sensonneural hearing loss

Answer 37

MRI

Question 38

Conductive hearing loss

Answer 38

CT

Question 39

Suspect calculi

Answer 39

CT KUB

Question 40

Frank haematuria/ clot retention

Answer 40

3 way irrigating haematuria catheter

Question 41

Painless haematuria

Answer 41

Cytoscopy

Question 42

Fournier’s gangrene

Answer 42

XR

USS

Question 43

Urge incontinence

Answer 43

Urodynamics

Question 44

E. coli

Answer 44

Stool culture

Question 45

C. diff

Answer 45

Stool toxin