Key concepts part 4

Question 1

what are the key features of optic neurtis?

Answer 1

• painful eye movements
• reduced visual acuity
• poor colour discrimination (red saturation)
• central scotoma
• RAPD

Question 2

Describe the syphilis testing system

Answer 2

Consists of both non-treponemal test (not specific for syphilis) and treponemal test.

A positive non-treponemal test (VDRL) + positive treponemal test (TPHA) = active syphilis

A positive VDRL + negative TPHA = false positive (due to pregnancy, SLE, HIV etc)

A negative VDRL + positive TPHA = treated syphilis (as VDRL eventually goes away)

Question 3

what are examples of things that can result in false positive VDRL

Answer 3

pregnancy, SLE, TB, HIV, malaria, leprosy

Question 4

what condition can cause a false negative mantoux test

Answer 4

sarcoidosis

Question 5

what is the most common cause of endocarditis <2 months post prosthetic valve replacement? and >2 months?

Answer 5

<2 months = staph epi

> 2 months = staph aureus

Question 6

what drug causes colourful visual hallucinations, depersonalisation, psychosis and paranoia

Answer 6

LSD (lysergic acid diethylamine)

Question 7

how do you treat pneumocystis jirovecci

Answer 7

co-trimox

Question 8

what is a suitable screening tool for childhood squints?

Answer 8

corneal light reflection test

Question 9

what can be used to monitor LMWH (if needed)

Answer 9

anti-factor Xa

Question 10

what can be used to monitor unfractioned heparin

Answer 10

APTT

Question 11

what is an example of a poor prognosis factor for liver cirrhosis

Answer 11

ascites

Question 12

what thyroid function tests would be demonstrated in sick euthyroid?

Answer 12

normal TSH, low T3/T4

Question 13

what is the most common site of metatarsal stress fractures?

Answer 13

2nd metatarsal

Question 14

what are contraindications to lung cancer surgery?

Answer 14

• SVC obstruction
• FEV <1.5
• malignant plural effusion
• vocal cord paralysis

Question 15

which haem cancer is associated with massive splenomegaly

Answer 15

CML

Question 16

in which patient population is malignant otitis externa most common?

Answer 16

diabetics

Question 17

which nerve is most likely to be injured in a mid shaft humeral fracture and what will that present as?

Answer 17

radial nerve - wrist drop, loss of finger extension

Question 18

what is the management of myasthenic crisis?

Answer 18

IVIG + plasmapheresis

Question 19

what investigation findings are seen in renal TB

Answer 19

persistent pyuria and negative urine culture

Question 20

what can trigger liver decompensation in cirrhosis

Answer 20

constipation

Question 21

what condition is pigmented gallstones associated with

Answer 21

sickle cell

Question 22

what investigation should be done in patients with symptoms suggestive of colorectal cancer but who do not fit 2 week wait criteria?

Answer 22

faecal immunochemical test (FIT)

Question 23

what is the preferred drug for pain relief in a palliative patient with mild/mod renal failure?

Answer 23

oxycodone

Question 24

when should you start allopurinol following a gout attack?

Answer 24

immediately after the inflammation has settled/patient is no longer in pain

Question 25

what antibodies are present in dermatositis?

Answer 25

Anti-Jo, anti Mi2, ANA (80% of patients are +ve)

Question 26

what are the Wells score cut offs?

Answer 26

PE likely = >4 points

PE unlikely = 4 or less

Question 27

what is required once a diagnosis of dermatomyositis is made?

Answer 27

a malignancy screen (ovarian, breast, lungs)

Question 28

what is lupus pernio?

Answer 28

a manifestation of sarcoid presenting with a purple plaque that involves the tip of the nose and the skin around the nostrils

Question 29

what is a pfannensteils incision used for?

Answer 29

C/S

Question 30

what is a Kocher’s incision used for?

Answer 30

open cholecystectomy

Question 31

what is a rooftop/midline incision used for?

Answer 31

whipples

Question 32

what is a key risk of over replacement with thyroid?

Answer 32

osteoporosis

Question 33

Is trimethoprim safe in breastfeeding?

Answer 33

yes