Medicine

Question 1

The main 2 indications for surgery in bronchiectasis

Answer 1

uncontrollable haemoptysis and localised disease.

Question 2

Most common organisms isolated from patients with bronchiectasis:

Answer 2

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 3

Yellow nail syndrome

Answer 3

Bronchiectasis, yellow nails, lymphoedema

Question 4

Cor pulmonale

Answer 4

Raised JVP, peripheral oedema

Question 5

Bronchiectasis chest X-ray

Answer 5

Tram track opacities, ring shadows living unde the cages of the mind drains

Hrct- test of choice

Question 6

Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart

Question 7

Site of the lesion Associated effects

Answer 7

Anterior cerebral artery Contralateral hemiparesis and sensory loss, lower extremity > upper

Middle cerebral artery Contralateral hemiparesis and sensory loss, upper extremity > lower Contralateral homonymous hemianopia Aphasia

Posterior cerebral artery Contralateral homonymous hemianopia with macular sparing Visual agnosia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus

Anterior inferior cerebellar artery (lateral pontine syndrome) Symptoms are similar to Wallenberg’s (see above), but: l
Ipsilateral: facial paralysis and deafness

Retinal/ophthalmic artery Amaurosis fugax

Basilar artery ‘Locked-in’ syndrome

Question 8

Giardia infection

Answer 8

Metronidazole
Main feature malabsorption if chronic(more than 6 weeks)

Question 9

First episode of C. difficile infection

Answer 9

first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

Question 10

C diff
(Clindamycin,cephalosporin ,PPIs)

Answer 10

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop

Question 11

homonymous quadrantanopias: - PITS (Parietal-Inferior, Temporal-Superior)

Question 12

Key features of disseminated gonococcal infection

Answer 12

tenosynovitis
migratory polyarthritis
dermatitis (lesions can be maculopapular or vesicular)

Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)

Question 13

Heart Murmur auscultation

Answer 13

Apartment M - A P T M

Question 14

Murmer

Answer 14

On inspiration → right sided murmurs →louder
On expiration → left sided murmurs → louder

Question 15

Rheumatic fever

Answer 15

Mitral regurgitation (radiates to axilla)

Question 16

Tricuspid regurgitation

Answer 16

Intra venous drug users

Question 17

Mitral stenosis(opening snap)

Answer 17

Rheumatic fever

Question 18

Baclofen and gabapentin are first-line for spasticity in multiple sclerosis

Amantadine for fatigue

Question 19

Weber’s syndrome → brainstem stroke, specifically in the midbrain → due to an occlusion in a branch of the posterior cerebral artery.

Answer 19

ipsilateral CN III palsy and contralateral hemiparesis

Question 20

Lacunar stroke

Answer 20

Hemiparesis and hemisensory loss

Question 21

Lateral pontine syndrome

Answer 21

Facial paralysis and deafness are common findings on the same side as the infarction. This is accompanied by contralateral weakness.

Question 22

Wallenburg syndrome (lateral medullary syndrome)

Answer 22

ipsilateral facial pain and temperature loss. Along with contralateral limb/ torso pain, ataxia and nystagmus.

Question 23

midbrain syndromes

Answer 23

Webers, Benedict’s , Parinauds syndrome ( argyl Robertson pupil - impaired light reflex)

Question 24

Midbrain - Webers
Pons - locked in syndrome
Medulla - Wallenberg - lateral medullary / PICA syndrome

Answer 24

Wallenberg syndrome-DANVAH
Dysohagia
Ataxia
Nystagmus
Vertigo
Anaesthesia
Horners syndrome

Question 25

Hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow tract obstruction Drugs to avoid

Answer 25

ACE Inhibitors Inotropes Nitrates

Question 26

HOCM

Answer 26

Midsystolic murmur Treatment-Beta blockers,CCB,Diuretics,

Question 27

Primary sclerosing cholangitis (PSC) has a well-established association with ulcerative colitis (UC)

Question 28

The most common organism causing infective exacerbations of COPD

Answer 28

Haemophilus influenzae

Question 29

Persistent ST elevation following recent MI, no chest pain

Answer 29

left ventricular aneurysm

Question 30

PE

Answer 30

S1Q3T3

Question 31

Malaria prophylaxis A. Quinine B. Mefloquine C. Atovaquone + proguanil D. Doxycycline E. Proguanil F. Artemether + lumefantrine G. Primaquine

Answer 31

Chloroquine & Mefloquine - taken weekly ,contraindicated in people with epilepsy

Question 32

Multiple myeloma

Answer 32

hypercalcaemia (increased urination and thirst), anaemia (tiredness) and back pain. Myeloma is diagnosed by urine protein electrophoresis and serum-free light-chain assay - Rouleaux formation In urine -Bence Jones proteins

Question 33

Heinz bodies - G6PD deficiency

Question 34

Relapsing C diff (2nd line)

Answer 34

Oral Fidaxomicin

Question 35

The HIV antibody develops 4-6 weeks after infection and the p24 antigen can become positive as soon as 1 week after infection.

Question 36

Four weeks after an anterior myocardial infarction a 69-year-old presents with pulmonary oedema. The ECG shows persistent ST elevation in the anterior leads.

Answer 36

Left ventricular aneurysm The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure.

Question 37

Left ventricular free wall rupture

Answer 37

This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.

Question 38

One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

Answer 38

Papillary muscle rupture

Question 39

The classic triad in Behcet's is oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen

Question 40

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis. Typically infection comprises of three stages Rx-Doxycyclin

Answer 40

stage 1: small painless pustule which later forms an ulcer stage 2: painful inguinal lymphadenopathy stage 3: proctocolitis

Question 41

KDIGO AKI stage 1

Answer 41

↑ creatinine 1.5-1.9 times, or ↓ urine output <0.5 mL/kg/hr for ≥ 6 hours

Question 42

Acoustic neuroma

Answer 42

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex. Features can be predicted by the affected cranial nerves: cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus cranial nerve V: absent corneal reflex cranial nerve VII: facial palsy

Question 43

RABDOMYOLISIS

Answer 43

Elevated CK Hypocalcaemia - Calcium typically binds to myoglobin released from damaged muscle tissue causing serum Elevated phosphate Hyperkalemia Metabolic acidosis Myoglobinuria

Question 44

CA 19-9 (carbohydrate antigen 19-9)

Answer 44

tumour marker that is primarily elevated in pancreatic adenocarcinoma

Question 45

Tumor markers

Answer 45

The primary tumour markers used in breast cancer are CA 15-3, carcinoembryonic antigen (CEA), and more recently, circulating tumour cells and circulating tumour DNA AFP is elevated in approximately 70% of HCC cases and is the standard tumour marker used for screening and monitoring this cancer CA 125 is elevated in approximately 80% of epithelial ovarian cancers and is the standard tumour marker used for monitoring treatment response and detecting recurrence CEA is the standard tumour marker used for monitoring treatment response and surveillance in colorectal cancer S100 - Melanoma , schwannoma

Question 46

Amyotrophic Lateral Sclerosis (motor neurone disease)

Answer 46

Patients often have more difficulty swallowing liquids than solids in the early stages. Facial weakness, hypophonic speech, fasciculations and reduced jaw jerk reflex (LMN sign) are all features. Eye movements are typically spared.

Question 47

Preceding influenza predisposes to Staphylococcus aureus pneumonia. Pneumococcus is also a common cause of post-viral pneumonia

Question 48

Respiratory alkalosis

Answer 48

anxiety leading to hyperventilation pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy

Question 49

Opiate overdose would lead to respiratory depression and hence a respiratory acidosis