MLA

Question 1

what type of laxative is ispaghula hulk?

Answer 1

bulk forming

Question 2

what type of laxative is docusate?

Answer 2

softener/ mild stimulant

Question 3

what type of laxative is bisacodyl/ senna/ glycerin ?

Answer 3

stimulant

Question 4

what types of laxative is macrogel?

Answer 4

osmotic

Question 5

what is important with osmotic and bulk forming laxatives?

Answer 5

adequate fluid intake

Question 6

when should stimulant laxatives not be used?

Answer 6

intestinal obstruction

Question 7

when should osmotic laxatives not be used?

Answer 7

IBS

Question 8

what is first line in drug induced constipation?

Answer 8

stimulant laxatives

Question 9

what laxative is typically used in chronic constipation?

Answer 9

bulk fomring

Question 10

what laxative is typically used in chronic constipation in IBS/ frail patients?

Answer 10

stool softeners

Question 11

what is first line for faecal impaction?

Answer 11

enema
then movicol

Question 12

beckers MD

Answer 12

Beckers muscular dystrophy is very similar to Duchennes, however the dystrophin gene is less severely affected and maintains some of its function. The clinical course is less predictable than Duchennes. Symptoms only start to appear around 8 – 12 years. Some patient require wheelchairs in their late 20s or 30s . Others able to walk with assistance into later adulthood. Management is similar to Duchennes.

Question 13

myotonic dystrophy

Answer 13

Myotonic dystrophy is a genetic disorder that usually presents in adulthood. Typical features are:

Progressive muscle weakness
Prolonged muscle contractions
Cataracts
Cardiac arrhythmias
TOM TIP: The key feature of myotonic dystrophy to remember is the prolonged muscle contraction. This may present in exams with a patient that is unable to let go after shaking someones hand, or unable to release their grip on a doorknob after opening a door. When doing an upper limb neurological examination always shake the patients hand and observe for difficulty releasing their grip

Question 14

fasciulohumeral MD

Answer 14

Facioscapulohumeral muscular dystrophy usually presents in childhood with weakness around the face, progressing to the shoulders and arms. A classic initial symptom is sleeping with their eyes slightly open and weakness in pursing their lips. They are unable to blow their cheeks out without air leaking from their mouth.

Question 15

occulopharyngeal MD

Answer 15

Oculopharyngeal muscular dystrophy usually presents in late adulthood with weakness of the ocular muscles (around the eyes) and pharynx (around the throat) as the name suggests. It typically presents with bilateral ptosis, restricted eye movement and swallowing problems. Muscles around the limb girdles are also affected to varying degrees

Question 16

Limb girdle MD

Answer 16

Limb-girdle muscular dystrophy usually presents in teenage years with progressive weakness around the limb girdles (hips and shoulders)

Question 17

emery dreifus MD

Answer 17

Emery-Dreifuss muscular dystrophy usually presents in childhood with contractures, most commonly in the elbows and ankles. Contractures are shortening of muscles and tendons that restrict the range of movement in limbs. Patients also suffer with progressive weakness and wasting of muscles, starting with the upper arms and lower legs

Question 18

Contralateral hemiparesis and sensory loss, lower extremity > upper

Answer 18

anterior cerebral artery stroke

Question 19

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Answer 19

middle cerebral artery

Question 20

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Answer 20

posterior cerebral artery

Question 21

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Answer 21

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

Question 22

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Answer 22

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Question 23

Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness

Answer 23

Anterior inferior cerebellar artery (lateral pontine syndrome)

Question 24

‘Locked-in’ syndrome

Answer 24

basilar artery

Question 25

what are UKMEC 3 conditions?

Answer 25

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

Question 26

what are UKMEC4 conditions?

Answer 26

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

Question 27

describe surgery planning in breast cancer

Answer 27

surgery and planning in breast cancer:
if no axillary lymphadenopathy then axillary US > sentinal node biopsy
if palpable lymphadenopathy, axillary node clearance is indicated.

Question 28

when is radiotherapy given in breast cancer?

Answer 28

with wide local excision

Question 29

describe hormonal therapy in breast cancer

Answer 29

hormonal therapy if hormone receptor positive - tamoxifen in pre and peri menopause. anastrozole in post.

trastuzuman (herceptin) in HER2 positive

Question 30

what is management of intrahepatic cholestasis of pregnancy?

Answer 30

induction of labour at 37-38 weeks

ursodeoxycholic acid for symptom control

Question 31

what happens in shaken babies?

Answer 31

retinal haemorrhages, subdural haematoma and encephalopathy

Question 32

symptoms of focal frontal lobe seizures

Answer 32

-Pelvic thrusting, kicking, pedalling, thrashing or rocking movements
-Screaming, swearing or laughing
-Unintentionally passing urine (urinary incontinence)
-Your head or eyes turning to one side
-Having unusual body movements, such as stretching one arm while the other bends
-Twitching, jerking or stiffening of muscles in one area of your body

Question 33

occipital focal seizures symptoms

Answer 33

Seeing flashing lights, colours or simple patterns
Seeing more complex images, such as pictures of people, animals or scenes
Not being able to see as well as usual, or not being able to see at all
Having eye movements you can’t control, such as your eyes closing, moving to one side or moving quickly from side-to-side
Repeated blinking

Question 34

parietal lobe seizure symptoms

Answer 34

Having feelings of numbness or tingling
Prickling, crawling or electric-shock sensations, which may spread along the affected body part
Sensations of burning, cold or pain
Feeling like part or all of your body is moving or floating
Feeling like a body part has shrunk, become bigger or is missing
Sexual sensations
Difficulty understanding language, reading, writing or doing simple maths
Seeing things as bigger or smaller than they really are, or seeing things that aren’t there