medicine

Question 1

young person, no other lung issues, minimal to zero smoking hx, bilateral lower lobe emphysematous bullae - most likely aetiology ?

Answer 1

alpha 1 antitrypsin deficiency - usually associated with lower lobe panacinar emphysema

Question 2

clinical features of hepatorenal syndrome

Answer 2

Progressive rise in serum creatinine
Benign urine sediment
Urine sodium < 10 mEq/L
Cirrhosis with ascites
May have oliguria or nonoliguria
No improvement in serum creatinine after volume expansion with IV albumin for at least 2 days and no diuretics
No current or recent treatment with nephrotoxic drugs
Absence of parenchymal renal disease/normal renal ultrasonography
Urine red cell excretion < 50 cells per high power field (when no urinary catheter is in place) and protein excretion < 500 mg/day

Question 3

ADA recommendation for opthalmic examination for T2DM and T1DM

Answer 3

the American Diabetes Association (ADA) recommends an ophthalmologic screening exam at the time of diagnosis, then annually if retinopathy is present or every 2 years if there is no retinopathy.

For patients with type 1 diabetes, an ophthalmologic exam is recommended within 5 years after diagnosis or when the patient is age 10.

Question 4

when are antibiotics indicated in salmonella gastroenteritis?

Answer 4

immunocompromised adults, children for eg those on corticosteroids. also patients requiring hospitalization for the disease due to the severity of the illness

Question 5

congenital - cleft palate, boot shaped heart, tetralogy of fallot, thymus hypoplasia, hypocalcaemia/hypoparathyroidism

Answer 5

digeorge syndrome

cardiac anomalies (tetralogy of Fallot, truncus arteriosus, aortic coarctation), abnormal facies (low-set ears, micrognathia, hypertelorism), thymic hypoplasia, cleft palate, and hypocalcemia/hypoparathyroidism (note that the possible symptoms spell CATCH).

Question 6

diastolic rumble at the cardiac apex with an opening snap

Answer 6

mitral stenosis

Question 7

ductus arteriosus : alprostadil vs indomethacin

Answer 7

alprostadil - pge1 analogue - keeps the ductus arteriosus open
indomethacin - NSAID that helps to end the patency of the ductus arteriosus

Question 8

in which situations does a screening CTB prior to LP is needed for suspected meningoencephalitis

Answer 8

new onset seizures
focal neurological deficits
papilloedema
GCS less than ten
immunocompromised

Question 9

hepatitis c + nephrotic syndrome

Answer 9

immune-complex mediated membranoproliferative glomerulonephritis

Question 10

treatment of porphyria cutanea tarda

Answer 10

phlebotomy and hydroxychloroquine

Question 11

power

Answer 11

statistical measurement of the likelihood that a stastically significant difference is true

Question 12

Raynaud, shiny thickened skin + oliguria, elevated creatinine, hypertensive encephalopathy

Answer 12

think scleroderma renal crisis

Question 13

number needed to harm

Answer 13

inverse of the absolute risk increase (which is th number who gets the disease who was exposed - number who gets the disease who was controlled/total number of people who got the disease)

Question 14

calcified cystic parasellar lesion on CT or MRI vs solid sellar masses with sellar enlargement

Answer 14

craniopharyngoma vs pituitary adenoma

Question 15

how to minimise haemodialysis related orthostatic hypotension

Answer 15

ultrafiltration modeling (ie removing more fluid earlier in the dialysis), avoiding rapid fluid removal , cooling the dialysate, avoiding heavy metals during dialysis

Question 16

treating hypotension during haemodialysis

Answer 16

stop ultrafiltration, start saline

Question 17

under EMTALA unstable patients can only be transferred if one of the following conditions apply:

Answer 17

a. treating physician determines medical benefits of transfer outweigh the benefits
b. pt makes a written request showing informed consent

Question 18

allergic bronchopulomonary aspergillosis a) characteristics b)1st line and 2nd line treatment

Answer 18

a) in patients with asthma/CF refractor, raised serum IgE or eosinophils, it is a hypersensitive reaction to aspergillus fumigatus
b) prednisolone then itraconazole

Question 19

tx of localised prostate cancer with no further invasion (3 possibel options)

Answer 19

radical prostectomy OR RT with androgen depriving therapy OR active surveillance

Question 20

hepatitis c can lead to ———, a condition chracterised by palpable purpura, arthritis, peripheral neuropathy and glomerulal nephritis

Answer 20

mixed cryoglobulinaemia

Question 21

treatment of following disease: 4 week history of sudden onset diarrhoea, foul-smelling fatty stools, abdominal cramps, flatulence. 1 month and ahalf ago, was on a camping trip

Answer 21

this is giardia. tx is tinidazole

Question 22

shy-drager syndrome

Answer 22

One of 3 clinical syndromes called multiple system atrophy, presents with prominent autonomic dysfunction and parkinsonism

Question 23

motor and phonetic tics are present, persisting for more than a year

Answer 23

Tourettes syndrome