Misc

Question 1

What are the key features of sarcoidosis?

Answer 1

Lymphadenopathy (see h)

ACE is high

Calcium is high

Afro-caribbean

Hiolar non caseating granuloma

Question 2

What condition is LEMS associated with?

Answer 2

LEMS is closely associated with cancer, in particular small cell lung cancer. More than half the individuals diagnosed with LEMS also develop small cell lung cancer. LEMS may appear up to 3 years before cancer is diagnosed.

Question 3

How is Wilson’s disease treated?

Answer 3

Penicillamine

Question 4

What are some side effects of apixaban (2.5g and 5g)

Answer 4

Bleeding gums and bruising

Question 5

What is Lantus and Humolog?

Answer 5

Types of insulin

Question 6

What algorithm can you use to describe a skin lesion?

Answer 6

Assymetry

Border

Color

Diameter

Evolving

Flat or raised

Question 7

Whar is ‘WIlliam ‘Morrow’ used for?

Answer 7

Bundle branch block - if one of the fascicles is impaired.Look at V1 and V6, Larger QRS

WiLLiaM - LBBB

MoRRoW - RBBB

Question 8

What does BBB often get confused with? e.g. LBBB is confused with

Answer 8

Right ventricle pacing lead placement results in a QRS morphology similar to LBBB. Left epicardial pacing lead placement results in a QRS morphology similar to RBBB.

Question 9

What is the name of a stroke detection score?

Answer 9

Rosier

Banford to further classify what type

Question 10

What is a sister mary joseph lesion?

Answer 10

Sister Mary Joseph’s nodule is an eponymous term referring to a malignant metastatic umbilical nodule. It is a rare but important physical finding as it is a sign of advanced stage of malignancy. This case report describes an 82-year-old female diagnosed with metastatic pancreatic adenocarcinoma presenting with a Sister Mary Joseph’s nodule.

Question 11

Do patients need a tetanus booster if they step on a rusty nail?

Answer 11

No. If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they don’t require a booster vaccine nor immunoglobulins, regardless of how severe the wound is

Question 12

How is necrotising facitis treated?

Answer 12

Management of necrotising fasciitis revolves around immediate surgical debridement nd IV antibiotics

Question 13

What is the difference between diabetes and prediabetes?

Answer 13

In 2011 WHO released supplementary guidance on the use of HbA1c on the diagnosis of diabetes:

a HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus

a HbAlc value of less than 48 mmol/mol (6.5%) does not exclude diabetes (i.e. it is not as sensitive as fasting samples for detecting diabetes)

Prediabees is 42-47 mmol/mol

in patients without symptoms, the test must be repeated to confirm the diagnosis

it should be remembered that misleading HbA1c results can be caused by increased red cell turnover (see below)

Question 14

What drugs can cause peripheral coldness.

Answer 14

Peripheral coldness is a common side effect of beta-blocker use.

Question 15

When should Hartmann’s be avoided?

Answer 15

In patients with hyperkalemia

Question 16

An 18 year old man is brought into the Emergency Department after being injured in a pub-brawl. He complains of abdominal pain. On examination the abdomen is bruised and tender. His heart rate is 136 beats per minute and blood pressure is 72/54mmHg. Which fluid would be most suitable for resuscitation?

Answer 16

500mls sodium chloride 0.9% for 15 minutes

Question 17

What are some features of lead poisoning?

Answer 17

These include: abdominal pain, motor peripheral neuropathy, paraesthesia, bowel disturbance, confusion/personality change, metallic taste in the mouth, haemolysis (clinically presenting with dark urine and pallor), blue line on gum and dense metaphysial lines on radiograph. His exposure to lead is likely to come from his painting job.

Question 18

What is microangiopathic haemolytic anaemia?

Answer 18

Microangiopathic haemolytic anaemia is an intravascular haemolytic disorder caused by physical lysis of red cells by deposited fibrin strands, resulting in the presence of schistocytes (fragments of red blood cells) on the blood film. It may be isolated, or occur in association with a thrombotic microangiopathy syndrome (such as haemolytic uraemic syndrome and thrombotic thrombocytopenia purpura), or in severe cases, disseminated intravascular coagulation.

Question 19

What is haemophilia A?

Answer 19

Hemophilia A is an X-linked recessive inherited bleeding disorder caused by deficiency in clotting factor VIII – an integral part of the intrinsic component of the coagulation cascade (measured using the APTT).

Question 20

What type of autoantibodies is SLE associated with?

Answer 20

SLE is associated with a warm autoimmune haemolytic anaemia. The presence of spherocytes on the blood film and a positive direct Coombs test confirm that this is the case here. Reticulocytosis is consistent with ongoing haemolysis of any cause.

Question 21

What does a high INR mean?

Answer 21

Takes a longer time to clot

Question 22

How should a patient with epitaxis be treated with a high INR?

Answer 22

The patient is on warfarin and has an INR >8 with a minor bleed (epistaxis) so, after stopping the Warfarin, they should be started on urgent IV vitamin K. Vitamin K counteracts Warfarin, which works by inhibiting the enzyme that creates the active form of vitamin K. If the INR was between 5-8 with minor bleeding, then IV vitamin K should also be given but take care to make sure that is given slowly so not to risk thromboembolisms or strokes.

Question 24

What is SBP? How is it treated?

Answer 24

spontaneous bacterial peritonitis (SBP), a form of peritonitis caused by an infection of ascitic fluid in the peritoneal cavity, common in patients with cirrhosis. The diagnosis is indicated by fever, abdominal pain, and a neutrophil count of >250 cells/ul on an ascitic tap. Patients who have ascites and a previous episode of SBP require prophylactic antibiotics. Ciprofloxacin or norfloxacin is the prophylactic antibiotic of choice.

Question 25

How is torades de pointes treated?

Answer 25

IV magnesium sulfate is used to treat torsades de pointes

Question 26

How might anti glomerular basesment membrane disease present

Answer 26

This condition is defined as a small-vessel vasculitis associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis.

Question 27

How can appendictis be screened in the female?

Answer 27

Ultrasound

Question 28

What should be given if clopidogrel is contraindictaed?

Answer 28

If clopidogrel is contraindicated or not tolerated, given aspirin and modified release dipyramidole for secondary prevention following stroke

Question 29

What are cannonball mestastesis?

Answer 29

Chest x-ray showing cannonball metastases secondary to renal cell cancer. Multiple well defined nodules are noted distributed in both lung fields

Question 30

What is Meig’s syndrome?

Answer 30

Meig’s syndrome: Benign ovarian tumour, ascites, and pleural effusion.

Question 32

What does a elevated ST, depressed ST and saddle shaped ST suggest?

Answer 32

Elevated - MI

Depressed - ischaemic

Saddle shaped - pericarditis

Question 33

What is a gallop rythm suggestive of?

Answer 33

Gallop rhythm (S3) is an early sign of LVF

Question 34

What disease are Shargreen patches seen in?

Answer 34

Tuberous sclerosis

Question 36

What is the difference between Parkinsonism and Parkinson plus?

Answer 36

A Parkinson plus condition is different to Parkinsonism which is linked to drug used such as anti-psychotics and anti-emetics, as well as lithium.

The syndromes associated are: progressive supernuclear palsy, multi-system atrophy, corticobasal degeneration and Lewy body dementia.

Question 38

What are cluster headaches?

Answer 38

pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours

clusters typically last 4-12 weeks

intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)

patient is restless and agitated during an attack

accompanied by redness, lacrimation, lid swelling

nasal stuffiness

miosis and ptosis in a minority

Question 39

What is hereditary haemochromatosis?

Answer 39

Lethargy and arthralgia are a common first presentation of hereditary haemochromatosis, which may cause central diabetes insipidus. The family history is also suggestive. This disease is autosomal recessive so skips generations (in this question, parents are unaffected but grandparent affected). The biggest clue is that regular removal of blood is the treatment of haemochromatosis, with the aim of preventing iron toxicity. Also, these patients often die of heart disease due to iron deposition, which can be seen on autopsy as grey pigmentation of the myocardium.

Question 40

What is intestinal angina?

Answer 40

Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit - by far the most common cause is atherosclerotic disease in arteries supplying the GI tract