Misc

Question 1

What abnormalities are seen on a hypothermic ECG

Answer 1

Bradycardia
J waves
Prolonged PR, QT, QRS
Shivering artefacts
VT, VF, asystole

Question 2

Management for vaginal candidiasis

Answer 2

Oral fluconazole (non-pregnant)
Clotrimazole (pregnant)

Question 3

Management for oral candidiasis

Answer 3

Topical azoles e.g. clotrimazole, miconazole, nystatin

Fungins for azole resistant
Topical corticosteroid for itchiness, angular cheilitis

Question 4

Investigations for EBV?

Answer 4

Diagnostic in 2nd week:
Monospot test (heterophile antibodies)

EBV antibodies
PCR

Question 5

Treatment for grave’s disease/hyperthyroidism

Answer 5

Carbimazole/thiamazole
If block and replace (+levothyroxine)

Propranolol for symptomatic control
Radioactive iodine +/- corticosteroid
Thyroid surgery

Question 6

Management for thyroid storm

Answer 6

Propranolol
Propylthiouracil/carbimazole/thiamazole
Hydrocortisone
Potassium iodide

Question 7

What antibodies elevated in graves?

Answer 7

Anti TSH receptor
Anti thyroid peroxidase

Question 8

What antibodies elevated in Hashimotos

Answer 8

Anti-thyroid peroxidase antibodies
Anti-thyroglobulin antibodies

Question 9

Management for myxoedema coma?

Answer 9

O2
Rewarding
Fluids
IV liothyronine (t4/3)
IV hydrocortisone (assume adrenal insufficiency until excluded)

Question 10

MRC power scale

Answer 10

0 - no movement
1 - muscle contraction
2 - no gravity
3 - against gravity
4 - against added resistance
5 - normal

Question 11

Management for rheumatoid?

Answer 11

Mild: Hydroxychloroquine
Moderate: Methotrexate

If failure after 3 months of medicine:
- methotrexate + anti-TNF (biologic)
- triple DMARD therapy

Corticosteroids and NSAIDs can be used for acute flares with DMARDs

Question 12

Describe the results seen in overnight high dose dexamethasone suppression testing for all the causes of Cushing’s syndrome

Answer 12

Cushings disease:
suppressed cortisol and ACTH

Ectopic ACTH:
Elevated cortisol and ACTH

Other causes (adrenal adenoma…):
Elevated cortisol
Suppressed ACTH

Question 13

Cortisol levels in low dose vs high dose dexamethasone testing for different causes of cushings

Answer 13

Cushings disease:
Low dose - not suppressed
High dose - suppressed

Ectopic/other causes:
Low dose - not suppressed
High dose - not suppressed

Question 14

Breast cancer management

Answer 14

Stage 0-IIA:
Lump/mastectomy + sentinel node biopsy + consider radio

Stage IIB-IIIB:
Mastectomy + sentinel node biopsy + chemo/radio

Stage IIIC - IV:
Systemic therapy (CDK 4/6 inhibitors)

HR+ve: tamoxifen, anastrazole
HER2 +ve: trastuzumab +/- pertuzumab

Question 15

ECG of hypokalaemia

Answer 15

U waves - specific NO MATTER WHAT
Small/absent T waves
Prolonged PR and QT
ST depression sometimes

Question 16

Bloody diarrhoea in gastroenteritis causes

Answer 16

SEECSY

Salmonella
E. coli (EHEC, ETEC)
Entamoeba
Campylobacter
Shigella
Yersinia

Question 17

Values for sub clinical hypothyroidism

Answer 17

Normal T3/4
Elevated TSH

Question 18

Hyperkalaemia management

Answer 18

ECG 1st if K < 6.5
Then calcium gluconate if ecg changes present

Calcium gluconate 1st if K >= 6.5

Question 19

Investigations for orbital cellulitis

Answer 19

Urgent contrast CT sinus and brain for cellulitis red flegs

Nasendoscopy and cranial neurological examination can be done

Question 20

Management of varicose veins

Answer 20

Compression stockings
Leg elevation, weight loss, exercise

Refer to secondary care:
- lower limb symptoms
- skin changes
- active or healed venous leg ulcer

Ablation (radio frequency/endovenous)
Foam/liquid sclerotherapy

Surgery e.g. ligation, stripping

Question 21

What is used to alleviate itch in patients with chickenpox?

Answer 21

Topical calamine lotion
Chlorphenamine if > 1 year old

Question 22

Contraindications to metformin

Answer 22

Active lactic acidosis
eGFR < 30