Medicine

Question 1

What is thalassaemia

Answer 1

genetic defect in the protein chains that make up haemoglobin

Question 2

What is the normal structure of haemoglobin?

Answer 2

2 alpha chains
2 beta chains

Question 3

Why does beta thalassaemia have different severities?

Answer 3

gene can be abnormal or have deletion
ie. 1 abnormal 1 normal
2 abnormal or 1 abnormal 1 deletion
Most severe - 2 deletions

Question 4

management of reactive arthritis?

Answer 4

ibuprofen
if contraindicated then steroids

Question 5

what medication should be given to women with anti-phospholipid syndrome?

Answer 5

LMW heparin acutely
warfarin lifelong

Question 6

when are nitrates contraindicated?

Answer 6

severe aortic stenosis - risk of profound hypotension

Question 7

What disease causes erythema marginatum? Annular erythematous rash on trunk and inner arms/legs, non-pruritic

Answer 7

Rheumatic fever

Question 8

Which valvular pathology is assoc with rheumatic fever?

Answer 8

Mitral stenosis - mid diastolic

Question 9

Which bacteria causes typhoid?

Answer 9

Salmonella type - constipation not diarrhoea

Question 10

what’s assoc with bence jones protein?

Answer 10

multiple myeloma

Question 11

features of multiple myeloma

Answer 11

hypercalcaemia, renal damage, anaemia, thrombocytopenia, infection

Question 12

on CXR, what does a widened mediastinum represent?

Answer 12

aortic dissection

Question 13

what are the causes of dilated cardiomyopathy?

Answer 13

idiopathic
alcohol
coxsackie B virus
wet beri beri
doxorubicin

Question 14

Features of tuberous sclerosis

Answer 14

ash leaf spots, fibromata underneath nails, cafe au lait spots, epilepsy, delay, learning difficulties, retinal hamartomas, polycystic kidneys

Question 15

Features of dengue fever

Answer 15

retro-orbital headache, fever, facial flushing, rash, thrombocytopenia, recent travel
flavivirus spread by mosquitoes

Question 16

typical feature of chagas disease

Answer 16

swelling of eyelids

Question 17

features of malaria

Answer 17

prodrome = headache, myalgia, diarrhoea
cold stage
hot stage = fever, vomit, flushing
sweating stage

Question 18

Pt had a PCI this afternoon, now experiencing severe chest pain again, management?

Answer 18

CABG

Question 19

What is thoracic outlet syndrome?

Answer 19

compression of brachial plexus/subclavian artery/vein at thoracic outlet due to trauma or anatomical abnormality (cervical rib)

Question 19

What is thoracic outlet syndrome?

Answer 19

compression of brachial plexus/subclavian artery/vein at thoracic outlet due to trauma or anatomical abnormality (cervical rib)

Question 20

how is anion gap calculated?

Answer 20

(Na + K) - (bicarb+ Cl)

Question 21

what is indapamide?

Answer 21

a thiazide-like diuretic

Question 22

what are the fluid requirements for an adult?

Answer 22

25 ml/kg/day water
1mmol/kg/day K
50-100g/day glucose

Question 23

signs of R heart failure

Answer 23

raised JVP, hepatomegaly, peripheral oedema

Question 24

MEN type 1 features

Answer 24

3 Ps Parathyroid (hyper) Pituitary Pancreas - insulinoma/gastrinoma (recurrent peptic ulceration)

Question 25

MEN IIa

Answer 25

Parathyroid Phaeochromocytoma +medullary thyroid cancer

Question 26

MEN IIb

Answer 26

Phaeochromocytoma + medullary thyroid cancer, marfanoid body, neuromas

Question 27

Zollinger Ellison syndrome

Answer 27

gastrin secreting tumour in pancreas/duodenal wall leads to increased HCl acid production -> recurrent peptic/duodenal ulcers

Question 28

co-amoxiclav + deranged LFTs

Answer 28

cholestasis

Question 29

How does Gilbert's syndrome affect LFTs?

Answer 29

solitary raised bilirubin

Question 29

How does Gilbert's syndrome affect LFTs?

Answer 29

solitary raised bilirubin

Question 30

Lyme disease treatment?

Answer 30

oral doxycycline

Question 31

What causes Lyme disease?

Answer 31

borrelia burgdorferi - spirochaete spread by ticks

Question 32

which causes of nausea is cyclizine appropriate for?

Answer 32

intracranial/vestibular GI obstruction raised ICP

Question 33

Pneumonia after influenza, what's the most likely organism?

Answer 33

Staph aureus

Question 34

migraine medical management?

Answer 34

acute = NSAID + Triptan + paracetamol prevention = topiramate or propanolol

Question 35

which medication can be used for ER (oestrogen receptor) positive breast cancers?

Answer 35

if post menopausal -> anastrozole (reduces peripheral oestrogen synthesis)

Question 36

which medication is used in HER2 positive breast cancers?

Answer 36

trastuzumab (Herceptin)

Question 37

features of wernickes encephalopathy?

Answer 37

Confusion Ataxia Nystagmus Opthalmoplegia Peripheral Neuropathy

Question 38

patient presents with TIA, which medication should be given?

Answer 38

300mg aspirin + specialist review within 24 hours (don't drive until this)

Question 39

which antibiotic can't be prescribed with methotrexate?

Answer 39

Trimethoprim/co-trimoxazole - all folate antagonists -> myelosuppression means risk of life-threatening infection and severe bleeding

Question 40

which contraceptive is assoc with weight gain?

Answer 40

depo-provera

Question 41

how do you diagnose a miscarriage on USS?

Answer 41

Crown-rump length >7mm and no heart beat

Question 42

what test is diagnostic for acromegaly?

Answer 42

OGTT + measurement of GH, MRI pituitary showing adenoma

Question 43

back pain, weak hip abduction + foot drop = which dermatome?

Answer 43

L5

Question 44

Cluster headache - long term prevention?

Answer 44

verapamil