MCQ bank incorrect Flashcards
Treatment for fungal nail infection?
1) Amorolifine topical 5% nail lacquer
2) Terbinafine PO 250mg OD
Treatment for head lice?
Dimeticone 4% lotion
Wet combing
(permethrin no longer recommended)
HIV patient with diarrhoea, Ziel-Neilsen stained stool sample shows characteristic cysts?
Cryptosporidiosis
HIV patient with headache, neck stiffness, vomiting + photophobia. LP shows organism that stains positive with India ink dye. Organism?
Cryptococcosis
What is the effect of pilocarpine on the pupil?
Constriction (it is a parasympathomimetic agent)
What is co-cyprindiol? When is it indicated (2)?
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
3 week hx progressively worsening cough. CXR bilateral patchy consolidation. Likely diagnosis? Rx?
Mycoplasma pneumonia
Rx: erythromycin
3mo-old with failure to thrive. Symmetrically poor weight gain, umbilical hernia. Likely diagnosis?
Congenital hypothyroidism
6y/o with short stature, increased central obesity, immature facial features. Likely cause?
Growth hormone deficiency
What is the most appropriate medicine to prescribe for a patient with cervical cancer causing local nerve compression?
Dexamethasone
- reduces oedema around the tumour
Large irregular pupil that constricts slowly to light but accommodates normally
Holmes-Adie pupil
Shining a torch in normal eye -> full constriction of both pupils, but light shone in affected eye -> apparent dilation of both pupils
Marcus Gunn pupil
Small irregular pupils that do not react to light but accommodates normally
Argyll-Robertson pupil
Most common cause is syphilis
Colchicine has a narrow therapeutic index and is extremely toxic in overdose. When should it be avoided?
- Blood disorders
- eGFR <10 / renal impairment
- Severe hepatic impairment
- Pregnant / breastfeeding
- Taking p450 inhibitors (eg clarithromycin)
Mx of acute gout attack?
1) NSAID (until 1-2d after attack) + PPI
OR
2) PO colchicine
PO steroids (eg prednisolone) can be used if NSAID / colchicine not appropriate
Prevention of gout attack?
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
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?
Tuberculous meningitis
Rx: RIP (rifampicin + isoniazid + pyrazinamide) and streptomycin
11y/o with enlarging, sharply marginated, nodular lesion on cheek -> evolves into large plaque, following BCG vaccination
Likely diagnosis?
Lupus vulgaris
- painful cutaneous tuberculosis skin lesions with nodular appearance
What is milk-alkali syndrome?
Triad of 1) Hypercalcaemia 2) Renal failure 3) Metabolic alkalosis secondary to ingestion of large amounts of antacids + calcium
SOB, palpitations and fatigue with malar flush. Rumbling mid-diastolic murmur. ?valvular abnormality
Mitral stenosis
Which drugs are associated with lichenoid eruptions? (7)
ACEi
NSAIDs
Methyldopa
Chloroquine
PO antidiabetics
Thiazide diuretics
Gold
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?
Typhoid
Blood culture
What is Hartnup disease? What are the key symptoms?
Rare AR genetic disorder affecting tryptophan
Symptoms: pellagra-like dermatitis. Red, scaly photosensitive rash. Ataxia. Stiff legs
Genetic condition (AR) leading to accumulation of phenylalanine -\> learning disability, behavioural problems, musty odour, fair complexion, pale blue eyes. What is it?
Phenylketonuria
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?
Maple syrup urine disease (MSUD)
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?
Homocystinuria
Rare AR genetic disorder due to deficiency of glutaryl-CoA dehydrogenase -> movement disorder with basal ganglia loss.
What is it?
Glutaric acidaemia type 1
Rare AR genetic disorder with accumulation of isovaleric acid -> characteristic odour of sweaty feet.
What is it?
Isovaleric acidaemia
Alveolar haemorrhage + glomerulonephritis = what disease?
Goodpasture’s syndrome (anti-glomerular basement membrane antibody disease)
Bloody nasal discharge + glomerulonephritis = what disease?
Wegener’s granulomatosis (granulomatosis with polyangiitis)
Key features of Lesch-Nyhan syndrome?
Self-mutilation with lip and finger biting
Patient with N+V from hypercalcaemia. What antiemetic is indicated?
Haloperidol 1.5mg OD / BD (can be increased)
- used for most metabolic causes of N+V eg hypercalcaemia, renal faiure
Patient with mechanical bowel obstruction secondary to colorectal cancer. Which antiemetic?
Cyclizine (50mg, up to TDS)
- mechanical bowel obstruction
- raised ICP
- motion sickness
How long should a patient with a suspected anaphylactic reaction be kept for observation?
Minimum of 6 hours
Why should the maximum dose of simvastatin be 20mg in a patient who is concurrently taking amlodipine?
Amlodipine is a weak inhibitor of P450 system, leading to increased levels of simvastatin
What are the most common causes of epididymo-orchitis in:
1) <35yrs
2) >35yrs
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
How are the following drugs altered in patients with chronic renal failure?
1) Phenytoin
2) Furosemide
3) Cefuroxime
- No change (metabolised by liver)
- Increase dose (fewer functioning nephrons)
- Reduce dose (cephalosporins excreted by kidney - will accumulate in impairment)
What is the most likely causative organism of Fournier’s gangrene (necrotising fasciitis of the scrotum)?
Strep pyogenes (Group A Beta-haemolytic streptococci)
How is hyperthyroidism managed in pregnancy?
First trimester: Propylthiouracil (crosses placenta less readily)
Second trimester onwards: Carbimazole (liver toxicity associated with PTU)
How does Propylthiouracil work?
Double action: 1) blocks thyroxine synthesis, 2) blocks conversion of T4 to T3
How does carbimazole work?
Blocks thyroxine synthesis
Which drug is most likely responsible for the following overdose symptoms: vomiting, hyperventilation, tinnitus + sweating, blood gas: respiratory alkalosis
aspirin
Treatment of nephrogenic diabetes insipidus?
- Remove cause (eg drug)
- Fluid intake
- Thiazide diuretics (inhibit NaCl reabsorption in distal renal tubules
Note central DI can be treated with desmopressin
What are the 4 Fs of retinal detachment?
- Floaters
- Flashes
- Field loss
- Fall in acuity (‘curtain’ falling over vision - painless)
A lesion of the LEFT temporal lobe is most likely to cause what visual field defect?
Right superior homonymous quadrantanopia
A lesion of the LEFT parietal lobe is most likely to cause what visual field defect?
Right inferior homonymous quadrantanopia
Which mediations are known to improve survival in chronic heart failure (5)?
- ACEi
- Beta-blockers
- Nitrates (PO)
- Hydralazine
- Spironolactone
What is co-danthramer, and when/why is it useful?
Combination laxative (stimulant + softener)
Licensed in palliative care
What medication can help with anorexia in terminal cancer?
Steroids, eg prednisolone 15-30mg OD or dexamethasone 2-4mg OD
Hereditary immune deficiency. Recurrent sinusitis, URTI and chronic diarrhoea. Advised to warn doctors if needs blood transfusion or IVIG
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)
Hereditary immune deficiency. <3mo with persistent oral thrush (refractory), chronic diarrhoea, skin rashes, recurrent otitis media. Cured with bone marrow transplant.
Severe combined immunodeficiency (SCID)
Hereditary immune deficiency. Rapid swelling of the face, lips and hands.
Hereditary angioedema (C1 inhibitor deficiency)
Prevention: danazol (increases production of C1-INH) and fibrinolysis inhibitors (tranexamic acid)
Vitamin deficiency. Night blindness + dry skin
Vitamin A (retinol)
Vitamin deficiency. Beriberi / Wernicke’s
Vitamin B1 (thiamine)
Vitamin deficiency. Angular stomatitis
Vitamin B2 (riboflavin)
Vitamin deficiency. Pellagra (inflamed skin, diarrhea, dementia, and sores in the mouth)
Vitamin B3 (niacin)
Vitamin deficiencies. Dermatitis, enteritis, alopecia, adrenal insufficiency.
Vitamin B5 (pantothenate)
Vitamin deficiencies. Convulsions, hyperirritability
Vitamin B6 (pyridoxine)
Vitamin deficiencies. Dermatitis + enteritis
Biotin
Vitamin deficiencies. Macrocytic, megaloblastic anaemia.Sprue
Folic acid
Vitamin deficiencies. Glossitis, macrocytic megaloblastic anaemia, neurological sx (subacute combined cord degeneration, optic neuropathy, paraesthesia)
Vitamin B12 (cobalamin)
Vitamin deficiencies. Scurvy
Vitamin C (ascorbic acid)
Vitamin deficiencies. Rickets (children), osteomalacia (adults), hypocalcaemia tetany
Vitamin D
Vitamin deficiencies. Increased fragility of erythrocytes
Vitamin E
Vitamin deficiencies. Neonatal haemorrhage
Vitamin K
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?
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.
Blood transfusion reactions. Fevers, chills, malaise and dyspnoea towards ed of transfusion / in subsequent 2 hours
Dx? Mx?
Non-haemolytic transfusion reaction (cytokines from leukocytes in transfused red cells)
Slow/stop transfusion + give paracetamol
