others

Question 1

in what proportion is depression found in adolescent that completed suicide

Answer 1

2/3

Question 2

when is serum acid phosphatase raised?

Answer 2

metastatic prostate ca

Question 3

what eye cx can herpes zoster of first branch of trigeminal nerve cause?

Answer 3

glaucoma, keratitis, iritis, uveitis, conjunctivitis

Question 4

pt with LSIL- when to rpt pap smear?

Answer 4

1yr if 30 with no neg pap smear in last 2-3yrs

Question 5

what signs whld u find in pt with meniscal tear

Answer 5

joint line tenderness, mcmurray test positive

Question 6

when to start depot provera post partum?

Answer 6

preferably 6/52 post partum as earlier could cause increase bleeding

Question 7

febrile convulsion 
age grp
percentage of children who get it
common length of time seizure goes on for
simple/complex/status epilepticus
recurrence rate
risk of epilepsy in future

Answer 7

occurs in 6month-6yr of life
3%of healthy children have it
simple- 15min, localised seizure, occur >1x in same illness, incomplete recovery in 1hr
status- >30min
1yr old child 50%, 2yr old child 30% recurrent rate
risk of epilepsy in future- 1% (population risk) with no risk, 1 risk factor 2%, 2 RF 10%
(RF- complex seizure, fam hx of epilepsy, CNS tumour)

Question 8

alcoholic- what changes to expect on bloods?

Answer 8

high MCV, raised GGT, raised TAG

Question 9

what are the common dressings used for wound care and for what sort of wound

Answer 9

The correct response is occlusive hydrocolloid gel. As the wound is superficial a hydrocolloid will retain the moisture and aid healing. Calcium alginates and polysaccharide dextromer beads require a moderate amount of exudate to be effective. The amorphous hydrogel would not remain in place in a superficial wound.

Question 10

hypercalcamia- sx

cause

Answer 10

moans abdo pain/pancreatitis/constipation
bones pain
stones renal stones/polyuria
groans psychic groans
ddx- common malig/raised PTH from PT adenoma

Question 11

risk of heterosex transmission of chlamydia and hiv

Answer 11

30% and 0.3%

Question 12

testing for MI- when does trop appear and howlong does it stay for? and ckm?

Answer 12

trop- within a few hrs. last 7-10/7

CKMA- 3-8hr, last 2-3/7. to test reinfarction

Question 13

what is q fever and how does it present?

Answer 13

Q fever, a zoonosis, is transmitted from cattle and other farm and domestic animals. Concentrations of the organism are particularly high in birth products. It is mostly inhaled as an aerosol.

Acute Q fever may be asymptomatic; however typical features are headache, myalgia, chills and sweats. Patients may also present with pneumonia or hepatitis. Hepatomegaly may be present without jaundice or gastro intestinal symptoms and petechial or maculopapular rash

Question 14

sx of malaria

Answer 14

fever, chills, non bloody diarrhea
incubation 2/52-40/7
ddx typhoid fever- but more likely initial diarrhea then turn into constipation

Question 15

Scarlett fever rash

Answer 15

mostly body, spare head, hands and feet

mac, pap. affect skin folds more

Question 16

when to start using mammogram on women?

Answer 16

> 35yo

Question 17

how much radiation with mammo?

Answer 17

0.7mSv for 4 images (2/breast)= 4/12 back ground rad. in <40yo= 1:10,000 lifetime increase risk of Breast CA, 1:100,000 risk each screen

Question 18

RF and protective factor and breast ca

Answer 18

Risk- personal factors- Female, old, tall,fat
breast factor- previous lesion, dense breast,
hormone and menstrual hx- on ocp/hrt, late menopause
strong fam hx, gene positive, lifestyle (EtOH, Smoke, Fat), Hodgkins,
protective- exercise, child bearing,breast feeding

Question 19

breast cancer and family history categories and risk

Answer 19

Cat 1- average or slight increase. no family hx, distant relative/old relatives with breast ca- 95% women in this cat. increase risk at most1.5x of popn. popn background risk 1:8-1:11 of getting breast Ca

Question 20

at what thickness of endometrium for post men pv bleed to have endometrial bx?

Answer 20

4mm

Question 21

tamoxifen- increased risk of which cancer by how much?

Answer 21

endometrial. 6.9x RR increase over 5 yr

Question 22

how to ix for pcos

Answer 22

rule out CAH (17OH P4), thyroid dz (TFT), High PRL (PRL)
hyperandro- free testos/FAI; plus minus DHEA, androstenedione
US PCO

Question 23

diff between open and closed angle glaucoma

Answer 23

open- slow process

closed- fast- acute red eye

Question 24

closed angle glaucoma- sx and ex

Answer 24

acute red eye, haloes around light, N&V, blur vision/suddent loss of vision
Ex: raised IOP, increased disc:cup ratio
mid dilated pupil

Question 25

diff between itp and ttp

Answer 25

itp- more benign cause. low plately.

ttp- pentad- fever, fluc CNS sx, hamolytic anaemia, thrombocytopenia, renal failure.

Question 26

how much vit d

Answer 26

few min a day on face, arms, hand during summer

2-3 hr/wk = ~25min/d during winter.

Question 27

Rx acne

Answer 27

mild- topical stuff- benzyl peroxide/ retinioids (adapalene/ tretinoin (retin a)/ antis (clindamycin)
combis- duac/epiduo
mod- oral antis/ cocp
severe- oral retinioids (roaccutane)

Question 28

what is polymoyositis

Answer 28

Polymyositis is associated with underlying malignancy and is typified by profound muscle weakness (usually proximal), diminished reflexes and grossly elevated CPK. Biopsy would be confirmatory. Polymyositis may also occur without underlying neoplasia and its aetiology is obscure. In association with dermatological findings heliotrope rash and patches on the knuckles a diagnosis of dermatomyositis should be considered.

Question 29

what is retinitis pigmentosa and associated visual defect?

Answer 29

Retinitis pigmentosa, a hereditary condition associated with destruction of the retina, often begins as poor night vision. Fundoscopy reveals a trabeculated, pigmented appearance of the retina usually beginning at the periphery. This is associated with the typical tunnel vision seen in this disorder.

Question 30

what drinks should celiacs avoid?

Answer 30

all ales

Question 31

diff between pityriasis rosea and roseala infantum

Answer 31

Pityriasis rosea - also caused by herpes virus. nil associated feverThis disorder begins with an erythematous “herald patch”- a slightly raised, oval lesion about 2 to 6 cm in diameter that may appear anywhere on the body. A few days to weeks later, yellow to tan or erythematous patches with scaly edges appear on the trunk, arms, and legs, commonly erupting along body cleavage lines in a characteristic “pine tree” pattern. These patches may be asymptomatic or slightly pruritic, are 0.5 to 1 cm in diameter and typically improve with moderate skin exposure to sunlight. This treatment should be used cautiously, however, to avoid sunburn.
Roseola infantum is usually a macular rash. A macule is an area of colour change less than 1.5 cm diameter. The surface is smooth, and not usually palpable. part of herpes family. high fever ~3-4/7 then rash appears after fever subsides and goes in 1-2/7

Question 32

what is diab amoyotrophy

Answer 32

Diabetic amyotrophy may be the first presenting sign of diabetes and the fasting glucose in this patient confirms the diagnosis. It is associated with a painful asymmetrical myopathy affecting the quadriceps. Investigations are usually normal except for plasma glucose. Generally, symptoms improve with insulin possibly due to the anabolic effects of the latter.

Question 33

what is de querain’s tenosynovitis

Answer 33

de Quervain’s tenosynovitis implies inflammation of the tendons of two specific muscles on the thumb side of the hand - the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). The condition is 10 times more common in women, more often arises in the dominant hand, and usually occurs between the ages of 35 and 55. Rest and analgesics are the most appropriate treatment.

Question 34

The history of severe headache and diplopia, with a dilated pupil and a misaligned eye on primary gaze, should ring alarm bells of?

Answer 34

a berry aneurysm around the posterior communicating artery of the Circle of Willis.

Question 35

how to test for pertussis?

Answer 35

Serology for anti-pertussis IgG antibodies is the correct answer; detection of anti-pertussis IgG antibody in serum is the recommended investigation if the patient presents more than two weeks from onset in older children and adults. Anti-pertussis IgG greater than 70 IU/ml in the absence of vaccination in the past year is a serologically defined case.
if before 2/52–> pcr

Question 36

is maco or micro scopic haematuria more alarming?

Answer 36

Put simply: any man or woman presenting with painless macroscopic haematuria should be referred urgently.

Question 37

psa numbers

Answer 37

Two out of three men with a raised PSA will not have prostate cancer. if raised psa plus abnorm dre= 1:2 have ca
15 out 100 with a negative PSA will have prostate cancer.
need to rx 48 men to save 1 life
fam hx increases the risk by 2x

Question 38

HSP core sx

Answer 38

The core clinical features are
The characteristic skin rash (‘palpable’ purpura affecting the buttocks and extensor surfaces of the legs and arms)
Joint pain
Periarticular oedema
Renal involvement (glomerulonephritis) and
Abdominal pain (intussusception can occur).

Question 39

when to stop ace-i

Answer 39

if egfr drop by >25%

Question 40

what sort of LFT is statin contraindicated?

when shld u stop statin?

Answer 40

ALT or AST >3x normal

severe myalgia/ CK>5x upper limit of normal

Question 41

when to refer port wine stain for Rx

Answer 41

The best consensus answer here is for referral at around one year of age.

Laser treatment is best done when children are younger. It doesn’t work for everyone and some patients merely see an alleviation of the lesion, rather than a complete cure. It is generally accepted that the lesions can become thicker and more difficult to treat as the patient gets older, although untreated lesions can fade in time and leave only mild cosmetic problems.

Question 42

diff between hamangioma of infancy, cong hameangioma, capillary vascular malformation

Answer 42

HOI- not present at birth, appear at 1-2/52, definite growth. often resolves in child hood with some scarring, Rx if Cx.
Cong haemangioma- present at birth. 2 kinds, spont involute, doesnt spont involute
cap vasc malform- salmon patch- fades on own.
Port wine stain- no spont resolution, assoc with av malformation.

Question 43

otitismedia with effusion. when to refer?

Answer 43

The recently published National Institute of Clinical Excellence (NICE) guidelines on the management of OME recommend a period of watchful waiting for three months, to check that the symptoms are persistent. Ideally, this would entail two pure-tone audiograms three months apart.
SIGN also provide guidance on this topic and in terms of referral suggest that any child with persistent bilateral OME over the age of 3 and who has speech and language developmental or behavioural problems should be referred to a specialist. For children under 3 watchful waiting can be employed if hearing loss is ≤25 dB and they have no speech and language, developmental or behavioural problems.

Question 44

when to rx hydrocele in new borns?

Answer 44

The majority of hydrocoeles resolve spontaneously within the first year of life (as the processus vaginalis gradually becomes obliterated). Thus, in most cases, watchful waiting is indicated and the hydrocoele can be reviewed after the first year of life.

Question 45

when can women cease using contraception?

Answer 45

Current guidance issued by the Faculty for Sexual and Reproductive Healthcare advises that it is possible to measure FSH levels whilst using progestogen only methods of contraception, but that testing should be limited to women over the age of 50 years.

Amenorrhoeic women taking progestogen-only pill can stop at age 55 when natural loss of fertility can be assumed for most women.

A single elevated FSH is insufficient and if FSH is >30, then it should be repeated six weeks later. If both readings are >30, then contraception can be stopped after a year.

Question 46

triad of HUS?

Answer 46

Haemolytic uraemic syndrome is a triad of

Acute renal failure
Thrombocytopenia and
Microangiopathic haemolytic anaemia.

Question 47

HSP sx and sign

Answer 47

Henoch-Schönlein purpura (HSP) typically presents with a palpable purpura that affects the buttocks and extensor surfaces. The trunk is usually spared. HSP also causes arthralgia, abdominal pain, and renal problems.