MLA

Question 1

Acne Vulgaris

Pathophysiology

Answer 1

• Obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules
• Colonidation by the anaerobic bacterium - propionibacterium acnes

Question 2

Acne Vulgaris

Classification

Answer 2

• mild: open or closed comedones with or without sprase inflammatory lesions
• moderate: widespread non-inflammatory lesions and numerous papules and pustules
• severe: extensive inflammatory lesions, which may include nodules, pitting and scarring

Question 3

Acne Vulgaris
Management
1st line and 2nd line

Answer 3

Single topical therapy (topical retinoids, benzoyl peroxide)

Topical combination therapy

Question 4

Acne Vulgaris
Management
3rd and 4th line

Answer 4

• oral antibiotics
• COCP alternative in women
• oral isotretinoin (only under specilaist supervision)

Question 5

Acoustic neuroma

Presentation

Answer 5

• also called vestibular schwannoma

- vertigo, hearign loss, tinnitus and an absent corneal reflex

Question 6

Acoustic neuroma

What cranial nerve is affected

Answer 6

• cranial nerve VIII: vertigo, unilateral sensorineural hearign loss, unilateral tinnitus
• cranial nerve V: absent corneal reflex
• cranial nerev VII: facial palsy

Question 7

Acoustic neuroma

Association/ risk factors

Answer 7

Bilateral vestibular schwannomas are seen in neurofibromatosis type 2

Question 8

Acoustic neuroma

Investigation

Answer 8

MRI of the cerebellopontine angle

Question 9

Acoustic neuroma

Pathophysiology

Answer 9

Benign tumours of the Schwann cells surrounding the vestibulocochlear nerve that innervates the inner ear.

Question 10

Acoustic neuroma

Management

Answer 10

• conservative - monitoring
• surgery
• radiotherapy

Question 11

Acute bronchitis

Pathophysiology

Answer 11

Inflammation of the trachea and major bronchi

- oedematous large airways and sputum production

Question 12

Acute bronchitis

Presentation

Answer 12

Cough: may or may not be productive
Sore throar
Rhinorrhoea
Wheeze

Question 13

Acute bronchitis

Management

Answer 13

Doxycycline 1st line
*If child or pregnant use amoxicillin

• consider delay antibiotisc if CRP 20-100
• consider immediate antibiotics if CRP is >100

Question 14

Ascending cholangitis

Pathophysiology

Answer 14

• infection of the bile ducts commonly seconadry to gallstones

Question 15

Ascending cholangitis

Charcot’s Triad

Answer 15

• fever (rigors are common)
• RUQ pain
• jaundice

Question 16

Ascending cholangitis

Management

Answer 16

Antibiotics alone do not provide sufficient treatment in the majority of patients.
Drainage of the biliary tree is the most critical step in management.

Question 17

ACS

Prognostic factors

Answer 17

GRACE (global registry of acute coronary events)

Cardiogenic shock is the poorest prognositc factor