MLA: Medicine 2

Question 1

what are the steps of correct inhaler technique?

Answer 1

1. remove cap and shake
2. breathe out gently
3. put mouthpiece in mouth - deep and slow
4. hold breath for 10 seconds, or as long as comfortable
5. for 2nd dose, wait for 30 seconds before repeating steps 1-4

Question 2

what is the most common cause of thyrotoxicosis?

Answer 2

Grave’s

Question 3

what are the specific features in Graves’ but not in other causes of thyrotoxicosis?

Answer 3

1. eye signs (30%) - exophthalmos, ophthalmoplegia
2. pretibial myxoedema
3. thyroid acropachy - triad of digital clubbing, soft tissue swelling of hands and feet, periostea new bone formation

Question 4

what are the autoantibodies associated with Grave’s?

Answer 4

1. TSH receptor stimulating antibodies (90%)
2. anti-thyroid peroxidase antibodies (75%)

Question 5

what is mitral stenosis?

Answer 5

describes the obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. This leads to increases in pressure within the left atrium, pulmonary vasculature and right side of the heart.

Question 6

what is the character of the murmur in mitral stenosis?

Answer 6

mid-diastolic heard best on expiration, over the fifth intercostal space, midclavicular line

Question 7

why does mitral stenosis increase the risk of AF?

Answer 7

As left atrial pressure remains elevated, the left atrium will increase in size. As the left atrium increases in size, there is a greater chance of developing atrial fibrillation. If atrial fibrillation develops, the atrial kick is lost.

Question 8

what are the main causes of mitral stenosis?

Answer 8

rheumatic fever - rarer causes include mucopolysaccharidoses, carcinoid, and endocardial fibroelastosis

Question 9

what are the features of mitral stenosis?

Answer 9

1. dyspnoea due to increased left atrial pressure -> pulmonary venous HTN
2. haemoptysis -> due to pulmonary pressures and vascular congestion
3. mid-late diastolic murmur
4. loud S1
5. opening snap
6. low volume pulse
7. malar flush
8. AF -> secondary to increased left atrial pressure -> left atrial enlargement

Question 10

what are the CXR features of mitral stenosis

Answer 10

left atrial enlargement may be seen

Question 11

what is the current anticoagulant used in mitral stenosis with AF?

Answer 11

warfarin is still recommended for patients with moderate/severe MS

Question 12

what is the strongest RF for the development of Barrett’s oesophagus?

Answer 12

GORD

Question 13

which nerve is affected in a Bell’s palsy?

Answer 13

facial nerve

Question 14

what is the first line for regular broad complex tachycardias w/o adverse features?

Answer 14

IV amiodarone

Question 15

what additional drug therapy should be given to diabetic patients with high HbA1c despite metformin therapy and with high risk of CVD or CHF?

Answer 15

SGLT-2 inhibitors e.g. Empagliflozin

Question 16

which virus can trigger an aplastic crisis in patients with hereditary spherocytosis?

Answer 16

Parovirus