Misc

Question 1

antibiotic treatment for an animal bite

Answer 1

co-amoxiclav

doxycycline and metronidazole if pen allergic

Question 2

indications for haemodialysis in salicylate OD

Answer 2

conc >700mg/dL
coma
seizures
metabolic acidosis resistant to treatment
pulmonary oedema
AKI

Question 3

features of a salicylate (aspirin) OD

Answer 3

> 2.5mmol/l (350mg/dl) indicates significant poisoning, >5.1 (700) is associated with death

pyrexia
hyperventilation (centrally acting)
tinnitus
lethargy
n&v
seizures and coma

Question 4

Rheumatoid arthritis HLA association

Answer 4

HLA DR4

• rheumatoid arthritis
• type 1 DM

Question 5

HLA B27 associations

Answer 5

reiter’s syndrome (can’t see can’t pee can’t stand on 1 knee)
acute anterior uveitis
ank spond

Question 6

cyclophosphamide:
mode of action
SEs - and how to prevent them

Answer 6

alkylating agent- causes crosslinking in DNA
haemorrhagic cystitis (mesna binds urotoxic metabolites) myelosuppression, transitional cell carcinoma

Question 7

methotrexate
mode of action
SEs

Answer 7

inhibits dihydrofolate reductase

myelosuppression, liver and lung fibrosis, mucositis

Question 8

Vincristine
action
SEs

Answer 8

inhibits microtubule formation
peripheral neuropathy (reversible), paralytic ileus

Question 9

Features of Wegener’s Granulomatosis

Answer 9

upper resp: epistaxis, sinusitis, nasal crusting
lower resp: SOB, haemoptysis
renal: rapidly progressive glomerulonephritis
vasculitic rash

Question 10

Ix for wegener’s granulomatosis

Answer 10

cANCA >90% positive

renal biopsy: epithelial crescents in bowman’s capsule

Question 11

what is the most common infection in solid organ transplant patients?
Rx?

Answer 11

cytomegalovirus (CMV) - inclusion bodies seen

Rx with ganciclovir

Question 12

Features of lead poisoning

Answer 12

abdominal pain
peripheral neuropathy (mainly motor)
constipation
blue lines in gums (in 20%)
fatigue
microcytic anaemia

Question 13

What is the cause of pellagra and what are the features?

Answer 13

B3 (niacin) deficiency
3 Ds: dementia, dermatitis, diarrhoea
can also be due to isoniazid Rx (stops conversion of tryptophan to niacin)

Question 14

which complement levels are low in SLE?

Answer 14

C3 and C4

Question 15

which SLE antibody is associated with congenital heart block?

Answer 15

anti-ro

Question 16

Treatment of accidental adrenaline injection

Answer 16

Phentolamine (alpha 1 blocker) injection

Vasodilates the affected area

Question 17

What is the indication for starting treatment for osteoporosis?

Answer 17

T score < -2.5 in post menopausal women or steroid induced

or woman >75 with clinical suspicion (DEXA not necessarily needed)

Question 18

What is the treatment for osteoporosis?

Answer 18

bisphosphonate - alendronate 1st line, risedronate 2nd line

calcium and vit D supplements

Question 19

features of severe pre-eclampsia

Answer 19

headache
RUQ/epigastric pain
papilloedema
visual disturbance
hyper-reflexia/clonus
hypertension >170/110
platelets <100, abnormal LFTs or HELLP syn (Haemolysis, Elevated Lfts, Low Platelets)

Question 20

What is the therapeutic range for lithium and when do you take bloods for monitoring?

Answer 20

0.4-1

take 12 hours post dose

Question 21

What is the target range for digoxin and when do you take bloods for monitoring?

Answer 21

0.5-1

6 hours post dose

Question 22

Indications for plasma exchange

Answer 22

neuro: acute guillian barre, MG, chronic inflam demyelinating polyneuropathy
haem: TTP, cyroglobinaemias, hyperviscosity syndromes, post transfusion purpura
renal: Goodpastures, ANCA positive nephritis
metabolic: hypercholesterolaemia, Refsum’s disease

Question 23

reason for azathioprine toxicity in a patient

Answer 23

thiopurine methyltransferase deficiency
1 in 200 people
leads to pancytopenia

Question 24

Features and pathology of Botulism

Answer 24

toxinogenic strains of Clostridium botulinum
usually caught from improperly tinned foods, meats seafoods and injecting abscesses.

Sx: diplopia, blurred vision, photophobia, bulbar palsy, ataxia, sudden cardioresp failure. No GI symptoms.

Question 25

Dx and Mx of botulism

Answer 25

Dx: stool culture, blood test to identify toxin.

Mx: early intubation and Mx on ITU.
Give antitoxin asap to avoid cardiac arrest

Question 26

Risk stratification for aspirin (salicylate) poisoning

Answer 26

> 125mg/kg - likely no effect
125-250mg/kg - mild
350 - 500 - moderate
500mg/kg - severe (eg 35g in 70kg man)

Question 27

features of digoxin toxicity

Answer 27

arrhythmias - ventricular bi/trigeminy, atrial tachycardia with CHB
n&v and diarrhoea
confusion
yellowing of vision (xanthopsia), blurred vision and photophobia

Question 28

Mx of digoxin toxicity

Answer 28

activated charcoal (within 6-8 hours of acute ingestion)
cholestyramine (binding resin, prevents enterohepatic circulation. Better for chronic toxicity)
If high K+, insulin/dextrose. AVOID calcium (as can precipitate VT/VF)
digibind (digoxin immune Fab)
Phenytoin (or lidocaine) for VT if digibind unavailable/ineffective

Question 29

Anti-Hu

Answer 29

associated with small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis

Question 30

Anti-Yo

Answer 30

associated with ovarian and breast cancer

cerebellar syndrome

Question 31

Anti-GAD

Answer 31

associated with breast, colorectal and small cell lung carcinoma
stiff person’s syndrome or diffuse hypertonia

Question 32

Anti-Ri

Answer 32

associated with breast and small cell lung carcinoma

ocular opsoclonus-myoclonus