Medicine Block Formatives

Question 1

What is erythema nodosum? What infections and systemic conditions can it be associated with?

Answer 1

tender, erythematous, nodular lesions usually on the shins

infections:
strep, TB, brucellosis

systemic:
sarcoidosis, IBD, Behcet’s

Question 2

What is the first line tx for meningococcal sepsis?

Answer 2

IV Benzylpenicillin

Question 3

What drug (and at what dose) should be given to patients in anaphylaxis?

Answer 3

Intramuscular Adrenaline (epinephrine) 1:1000 500 micrograms

Question 4

Give some key clinical findings on examination of AF

Answer 4

Hypotension
Signs of Valvular heart disease
Signs of hyperthyroidism
Signs of Heart failure
Signs of infection

Question 5

What 3 drugs should be given in hyperthyroidism?

Answer 5

Propranolol: rate control in hyperthyroidism
Carbimazole: treatment for hyperthyroidism
LMWH: VTE prophylaxis

Question 6

Would you electrically cardiovert someone who collapses due to AF who has hyperthyroidism?

Answer 6

No, they need to be euthyroid first

Question 7

What chronic conditions can cause CKD?

Answer 7

Diabetes Mellitus
Hypertension
Renal vascular disease
Adult polycystic kidney disease
Glomerular Nephritis

Question 8

Causes of hyperkalaemia in CKD?

Answer 8

Impaired GFR plus a frequently high dietary potassium intake

Extracellular shift of potassium caused by the metabolic
acidosis

Treatment with K+ sparing drugs e.g. ACEi/ARBs

Question 9

What are the major potential complications of haemodialysis?

Answer 9

Line infection
Failed AV graft/Fistula
SVC stenosis

Question 10

Give the main causes of eosinophilia

Answer 10

Asthma / Airway inflammation (COPD)
Hayfever
Allergic Bronchopulmonary Aspergillosis
Eosinophilic granulomatosis with polyangiitis / vasculitis
Eosinophilic Pneumonia
Hypereosinophilic syndrome
Parasites
Lymphoma
SLE

Question 11

What IV medication should be given immediately in suspected sepsis?

Answer 11

Broad spectrum antibiotic e.g. meropenem

Question 12

A 22 year old man presents with 3 days of malaise,
abdo discomfort, diarrhoea and dry cough. He has recently returned from a camping trip in South America.

On examination he has a fever, tachycardia and low bp. Examination reveals hepatosplenomegaly.

What intravenous treatment should be commenced immediately?

Answer 12

IV Ceftriaxone

Clinical presentation suggests Typhoid Fever. Will need blood and stool cultures to diagnose but treatment should not be delayed.

Question 13

What is the management of suspected severe C Diff before stool sample results get back?

Answer 13

Metronidazole in the meantime

Question 14

Common drug prescribed in the elderly that may cause dyspepsia and vomiting?

Answer 14

alendronic acid

Question 15

Major complication of nephrotic syndrome?

Answer 15

VTE - especially DVT

Question 16

An 81 year old man presents with new sudden onset of proximal limb pain and stiffness in his neck and shoulders. He also has difficulty rising from a chair. The pain is also present at night and he has felt more fatigued recently.

What is the most likely diagnosis?

Answer 16

Polymyalgia rheumatica

Question 17

DEXA scan reveals osteopenia. What is the first treatment offered after lifestyle advice?

Answer 17

Vitamin D

Question 18

Risk factors for infective endocarditis?

Answer 18

rheumatic heart disease
mitral valve prolapse
prosthetic valves or patches
degenerative and bicuspid aortic valve disease
an intravascular device
IV drug user

Question 19

2 key investigations for infective endocarditis?

Answer 19

Blood Cultures - at least 3 sets from different sites

TOE ideally or Transthoracic Echo

Question 20

Complications of infective endocarditis?

Answer 20

Haematuria
Splenomegaly
Septic emboli
Splinter haemorrhages
Skin manifestations
Cardiac valve damage
Valvular abscess/ Aortic root abscess
Neurological effects

Question 21

What is the single gold standard diagnostic investigation for bronchiectasis and describe the findings of this investigation that would support the diagnosis?

Answer 21

High Resolution CT

Signet ring sign
Dilated bronchi with diameter bigger than adjacent blood vessel, with bronchial wall thickening

Question 22

What are the key components of a continence exam?

Answer 22

Review of bladder and bowel diary
Urine dipstick and MSU
A post micturition bladder scan
Abdominal examination and PR exam
External genitalia review particularly looking for atrophic vaginitis in females