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MCQ bank incorrect Flashcards

1
Q

Treatment for fungal nail infection?

A

1) Amorolifine topical 5% nail lacquer
2) Terbinafine PO 250mg OD

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2
Q

Treatment for head lice?

A

Dimeticone 4% lotion
Wet combing

(permethrin no longer recommended)

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3
Q

HIV patient with diarrhoea, Ziel-Neilsen stained stool sample shows characteristic cysts?

A

Cryptosporidiosis

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4
Q

HIV patient with headache, neck stiffness, vomiting + photophobia. LP shows organism that stains positive with India ink dye. Organism?

A

Cryptococcosis

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5
Q

What is the effect of pilocarpine on the pupil?

A

Constriction (it is a parasympathomimetic agent)

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6
Q

What is co-cyprindiol? When is it indicated (2)?

A

Dianette (cyproterone acetate, a synthetic progestogen + ethinylestradiol) - suppresses the actions of testosterone

Indications:

1) Mod-severe acne refractory to TOP Rx/ PO abx
2) Mod-severe hirsutism

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7
Q

3 week hx progressively worsening cough. CXR bilateral patchy consolidation. Likely diagnosis? Rx?

A

Mycoplasma pneumonia
Rx: erythromycin

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8
Q

3mo-old with failure to thrive. Symmetrically poor weight gain, umbilical hernia. Likely diagnosis?

A

Congenital hypothyroidism

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9
Q

6y/o with short stature, increased central obesity, immature facial features. Likely cause?

A

Growth hormone deficiency

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10
Q

What is the most appropriate medicine to prescribe for a patient with cervical cancer causing local nerve compression?

A

Dexamethasone
- reduces oedema around the tumour

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11
Q

Large irregular pupil that constricts slowly to light but accommodates normally

A

Holmes-Adie pupil

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12
Q

Shining a torch in normal eye -> full constriction of both pupils, but light shone in affected eye -> apparent dilation of both pupils

A

Marcus Gunn pupil

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13
Q

Small irregular pupils that do not react to light but accommodates normally

A

Argyll-Robertson pupil
Most common cause is syphilis

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14
Q

Colchicine has a narrow therapeutic index and is extremely toxic in overdose. When should it be avoided?

A
  1. Blood disorders
  2. eGFR <10 / renal impairment
  3. Severe hepatic impairment
  4. Pregnant / breastfeeding
  5. Taking p450 inhibitors (eg clarithromycin)
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15
Q

Mx of acute gout attack?

A

1) NSAID (until 1-2d after attack) + PPI
OR
2) PO colchicine

PO steroids (eg prednisolone) can be used if NSAID / colchicine not appropriate

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16
Q

Prevention of gout attack?

A

1) Allopurinol is first-line
2) Febuxostat if allopurinol C/I or not tolerated

Should be started AFTER acute attack resolved, but should be continued during acute attack

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17
Q

5y/o with 1wk Hx malaise, fever, headache. Admitted with sudden left-sided hemiplegia. CSF +ve for tuberculosis. CT head shows nodular, enhancing lesion with central hypo-dense area and MRI shows obliteration of subarachnoid space.
Diagnosis? Rx?

A

Tuberculous meningitis
Rx: RIP (rifampicin + isoniazid + pyrazinamide) and streptomycin

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18
Q

11y/o with enlarging, sharply marginated, nodular lesion on cheek -> evolves into large plaque, following BCG vaccination
Likely diagnosis?

A

Lupus vulgaris
- painful cutaneous tuberculosis skin lesions with nodular appearance

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19
Q

What is milk-alkali syndrome?

A

Triad of 1) Hypercalcaemia 2) Renal failure 3) Metabolic alkalosis secondary to ingestion of large amounts of antacids + calcium

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20
Q

SOB, palpitations and fatigue with malar flush. Rumbling mid-diastolic murmur. ?valvular abnormality

A

Mitral stenosis

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21
Q

Which drugs are associated with lichenoid eruptions? (7)

A

ACEi
NSAIDs
Methyldopa
Chloroquine
PO antidiabetics
Thiazide diuretics
Gold

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22
Q

55y/o man returns from Africa with progressively high temp, diffuse abdo pain, constipation, headache and cough. O/E temp 41, maculopapular rash on trunk, abdo distended, palpable spleen. Likely Dx? Most useful Ix?

A

Typhoid
Blood culture

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23
Q

What is Hartnup disease? What are the key symptoms?

A

Rare AR genetic disorder affecting tryptophan
Symptoms: pellagra-like dermatitis. Red, scaly photosensitive rash. Ataxia. Stiff legs

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24
Q 
Genetic condition (AR) leading to accumulation of phenylalanine -\> learning disability, behavioural problems, musty odour, fair complexion, pale blue eyes.
What is it?
A

Phenylketonuria

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25
Q

Rare AR genetic condition. Accumulation of branched-chain AAs (leucine, isoleucine, valine -> encephalopathy and progressive neurodegeneration. Lethargy and coma within few days. Sweet odour to urine + sweat.
What is this condition?

A

Maple syrup urine disease (MSUD)

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26
Q

Rare AR genetic condition leading to accumulation of homocysteine -> LD, seizures, psych disorders, marfanoid habitus, brittle hair, high arched palate, lens dislocation, etc
What is this condition?

A

Homocystinuria

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27
Q

Rare AR genetic disorder due to deficiency of glutaryl-CoA dehydrogenase -> movement disorder with basal ganglia loss.
What is it?

A

Glutaric acidaemia type 1

28
Q

Rare AR genetic disorder with accumulation of isovaleric acid -> characteristic odour of sweaty feet.
What is it?

A

Isovaleric acidaemia

29
Q

Alveolar haemorrhage + glomerulonephritis = what disease?

A

Goodpasture’s syndrome (anti-glomerular basement membrane antibody disease)

30
Q

Bloody nasal discharge + glomerulonephritis = what disease?

A

Wegener’s granulomatosis (granulomatosis with polyangiitis)

31
Q

Key features of Lesch-Nyhan syndrome?

A

Self-mutilation with lip and finger biting

32
Q

Patient with N+V from hypercalcaemia. What antiemetic is indicated?

A

Haloperidol 1.5mg OD / BD (can be increased)
- used for most metabolic causes of N+V eg hypercalcaemia, renal faiure

33
Q

Patient with mechanical bowel obstruction secondary to colorectal cancer. Which antiemetic?

A

Cyclizine (50mg, up to TDS)

  • mechanical bowel obstruction
  • raised ICP
  • motion sickness
34
Q

How long should a patient with a suspected anaphylactic reaction be kept for observation?

A

Minimum of 6 hours

35
Q

Why should the maximum dose of simvastatin be 20mg in a patient who is concurrently taking amlodipine?

A

Amlodipine is a weak inhibitor of P450 system, leading to increased levels of simvastatin

36
Q

What are the most common causes of epididymo-orchitis in:

1) <35yrs
2) >35yrs

A

1) Chlamydia trachomatis + Neisseria gonorrhoea
2) E.coli + Pseudomonas

If the organism is unknown BASHH recommend: ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

37
Q

How are the following drugs altered in patients with chronic renal failure?

1) Phenytoin
2) Furosemide
3) Cefuroxime

A
  1. No change (metabolised by liver)
  2. Increase dose (fewer functioning nephrons)
  3. Reduce dose (cephalosporins excreted by kidney - will accumulate in impairment)
38
Q

What is the most likely causative organism of Fournier’s gangrene (necrotising fasciitis of the scrotum)?

A

Strep pyogenes (Group A Beta-haemolytic streptococci)

39
Q

How is hyperthyroidism managed in pregnancy?

A

First trimester: Propylthiouracil (crosses placenta less readily)

Second trimester onwards: Carbimazole (liver toxicity associated with PTU)

40
Q

How does Propylthiouracil work?

A

Double action: 1) blocks thyroxine synthesis, 2) blocks conversion of T4 to T3

41
Q

How does carbimazole work?

A

Blocks thyroxine synthesis

42
Q

Which drug is most likely responsible for the following overdose symptoms: vomiting, hyperventilation, tinnitus + sweating, blood gas: respiratory alkalosis

A

aspirin

43
Q

Treatment of nephrogenic diabetes insipidus?

A
  1. Remove cause (eg drug)
  2. Fluid intake
  3. Thiazide diuretics (inhibit NaCl reabsorption in distal renal tubules

Note central DI can be treated with desmopressin

44
Q

What are the 4 Fs of retinal detachment?

A
  • Floaters
  • Flashes
  • Field loss
  • Fall in acuity (‘curtain’ falling over vision - painless)
45
Q

A lesion of the LEFT temporal lobe is most likely to cause what visual field defect?

A

Right superior homonymous quadrantanopia

46
Q

A lesion of the LEFT parietal lobe is most likely to cause what visual field defect?

A

Right inferior homonymous quadrantanopia

47
Q

Which mediations are known to improve survival in chronic heart failure (5)?

A
  1. ACEi
  2. Beta-blockers
  3. Nitrates (PO)
  4. Hydralazine
  5. Spironolactone
48
Q

What is co-danthramer, and when/why is it useful?

A

Combination laxative (stimulant + softener)

Licensed in palliative care

49
Q

What medication can help with anorexia in terminal cancer?

A

Steroids, eg prednisolone 15-30mg OD or dexamethasone 2-4mg OD

50
Q

Hereditary immune deficiency. Recurrent sinusitis, URTI and chronic diarrhoea. Advised to warn doctors if needs blood transfusion or IVIG

A

Selective IgA deficiency

Undetectable IgA levels in presence of normal serum levels of IgG and IgM. Body may develop immune response against IgA (leading to anaphylaxis to blood transfusions / IVIG)

51
Q

Hereditary immune deficiency. <3mo with persistent oral thrush (refractory), chronic diarrhoea, skin rashes, recurrent otitis media. Cured with bone marrow transplant.

A

Severe combined immunodeficiency (SCID)

52
Q

Hereditary immune deficiency. Rapid swelling of the face, lips and hands.

A

Hereditary angioedema (C1 inhibitor deficiency)

Prevention: danazol (increases production of C1-INH) and fibrinolysis inhibitors (tranexamic acid)

53
Q

Vitamin deficiency. Night blindness + dry skin

A

Vitamin A (retinol)

54
Q

Vitamin deficiency. Beriberi / Wernicke’s

A

Vitamin B1 (thiamine)

55
Q

Vitamin deficiency. Angular stomatitis

A

Vitamin B2 (riboflavin)

56
Q

Vitamin deficiency. Pellagra (inflamed skin, diarrhea, dementia, and sores in the mouth)

A

Vitamin B3 (niacin)

57
Q

Vitamin deficiencies. Dermatitis, enteritis, alopecia, adrenal insufficiency.

A

Vitamin B5 (pantothenate)

58
Q

Vitamin deficiencies. Convulsions, hyperirritability

A

Vitamin B6 (pyridoxine)

59
Q

Vitamin deficiencies. Dermatitis + enteritis

A

Biotin

60
Q

Vitamin deficiencies. Macrocytic, megaloblastic anaemia.Sprue

A

Folic acid

61
Q

Vitamin deficiencies. Glossitis, macrocytic megaloblastic anaemia, neurological sx (subacute combined cord degeneration, optic neuropathy, paraesthesia)

A

Vitamin B12 (cobalamin)

62
Q

Vitamin deficiencies. Scurvy

A

Vitamin C (ascorbic acid)

63
Q

Vitamin deficiencies. Rickets (children), osteomalacia (adults), hypocalcaemia tetany

A

Vitamin D

64
Q

Vitamin deficiencies. Increased fragility of erythrocytes

A

Vitamin E

65
Q

Vitamin deficiencies. Neonatal haemorrhage

A

Vitamin K

66
Q

Transfusion reactions. Fever, chills, flushing, nausea, burning at IV line site, chest tightening, restlessness, joint + back pain - begins shortly after transfusion started (ALWAYS before unit finished)

Dx? Mx?

A

Acute haemolytic transfusion (result of antiB in recipient’s plasma directed against antigens on donor blood cells)

Mx: stop transfusion, replace with NaCl, send unit back to blood bank. Can give furosemide.

67
Q

Blood transfusion reactions. Fevers, chills, malaise and dyspnoea towards ed of transfusion / in subsequent 2 hours

Dx? Mx?

A

Non-haemolytic transfusion reaction (cytokines from leukocytes in transfused red cells)

Slow/stop transfusion + give paracetamol

MSRA (10 decks)

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