Past paper pop quiz 4

Question 1

How do the 2 forms of systemic sclerosis differ?

Answer 1

Limited: face + limbs distal to knees + elbows ‘CREST’
Diffuse: entire body

Question 2

What are the features of limited systemic sclerosis?

Answer 2

Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

Question 3

How does a tension pneumothorax arise?

Answer 3

When damaged area of pleura forms a 1-way valve resulting in the progressive accumulation of air in the pleural space

Question 4

What is a positive Brudzinskis sign?

Answer 4

Passive flexion of neck causes involuntarily flexion of hip.

Question 5

What is a positive Kernigs sign?

Answer 5

Lying supine, with hip flexed + knee flexed at 90 degrees to the hip joint.
Passive extension of knee causes pain

Question 6

What 2 signs may be seen in MS?

Answer 6

Uhthoff’s sign: Worsening of neuro symptoms when body is overheated
Lhermitte’s sign: flexion of the neck causes a shooting pain running down the spine.

Question 7

How are haemodynamically unstable patients in AF treated, irrespective of the time of onset?

Answer 7

DC cardioversion.

Question 8

How are stable patients with AF presenting within 48 hours of onset treated?

Answer 8

DC cardioversion or chemical cardioversion

Question 9

How are stable patients with AF presenting >48 hours since onset be treated?

Answer 9

Anticoagulation, using LMWH followed by warfarin, for > 3 weeks before elective cardioversion.

Question 10

Name 2 drugs that can be used for chemical cardioversion

Answer 10

Flecainide- contraindicated in those with hx of IHD

Amiodarone.

Question 11

Describe the pattern of features in MEN2a. What acronym can be used for this?

Answer 11

Thyroid: Medullary thyroid cancer
Adrenal: Phaeochromocytomas
Parathyroid hyperplasia
TAP

Question 12

What could you investigate if you suspected a Phaeochromocytoma?

Answer 12

24 hr urine metanephrines

Question 13

Which virus is implicated in ~50% of cases of Hodgkin’s lymphoma

Answer 13

EBV

Question 14

List 6 causes of a high SAAG

Answer 14

Portal HTN
Cirrhosis
Constrictive pericarditis
Congestive cardiac failure
Budd-Chiari syndrome
Hepatic venous obstruction

Question 15

List 5 causes of a low SAAG

Answer 15

Nephrotic syndrome
Malignancy
Pancreatitis
Infection
Bowel obstruction

Question 16

What are the lower urinary tract symptoms?

Answer 16

FUN (storage/ irritative) WISE (Voiding/ obstructive)
Frequency
Urgency
Nocturia
Weak stream
Intermittency
Straining
incomplete Emptying

Question 17

Name 2 causes of a prolonged PT

Answer 17

Warfarin (depletion of factors II, VII, IX + X)

Liver disease

Question 18

Name 3 causes of a prolonged APTT

Answer 18

Heparin
Haemophilia A (factor VIII)
Haemophilia B (factor IX)

Question 19

What clotting results are seen in haemophilia A and B?

Answer 19

Prolonged APTT

Normal PT

Question 20

Give 2 indications of a ruptured abdominal aortic aneurysm

Answer 20

Sudden-onset flank pain

Features of circulatory collapse (e.g. tachycardia + hypotension)

Question 21

In a patient with perforated diverticulitis what is the most appropriate procedure?

Answer 21

Hartmann’s procedure
Removal of sigmoid colon with formation of a rectal stump + end colostomy.
Allows time for inflammatory process to resolve + can be reversed, forming an anastomosis.

Question 22

What condition may present with paresis, weakness, sensory loss, sphincter dysfunction and erectile problems?

Answer 22

Spinal cord compression

Question 23

How can you distinguish between acute cord compression (Cauda equina) and gradual cord compression (spinal stenosis)?

Answer 23

Acute: LMN signs
Gradual: UMN signs

Question 24

What mnemonic can be used to remember the major criteria for rheumatic fever?

Answer 24

JONES:
Joints (arthritis)
O – looks like a heart (carditis e.g. tachycardia, murmurs)
Subcutaneous Nodules
Erythema marginatum (a rash with red, raised edges + clear centre)
Sydenham’s chorea (involuntary semi-purposeful movements)

Question 25

What is rheumatic fever usually caused by?

Answer 25

Streptococcus pyogenes

Question 26

Where do testicular tumours spread? What symptom may this occasionally cause?

Answer 26

Para-aortic lymph nodes

may cause backache

Question 27

Define the parameters for type 1 and type 2 respiratory failure?

Answer 27

Type 1: PaO2 < 8 kPa, PaCO2 = normal

Type 2 = PaO2 < 8 kPa + PaCO2 > 6 kPa

Question 28

What is an anal fissure?

Answer 28

Painful tear in squamous lining of lower anal canal

Question 29

Give 4 features of an anal fissure?

Answer 29

Pain on defecation
Bright red blood streaked on toilet paper/ stools but not mixed in with the stools.
Low fibre diet
Poor fluid intake
(May be constipated + strain at the stool)

Question 30

What triad characterises Felty’s syndrome?

Answer 30

Rheumatoid arthritis
Splenomegaly
Neutropenia

Question 31

In a hyponatraemic patient, what is a major consequence of raising plasma sodium concentration too rapidly?

Answer 31

Central pontine myelinolysis

Myelin cells dont have enough time to adapt to increasing extracellular osmolality, draws water out of the myelin cells

Question 32

What acronym can be used to remember the drugs indicating need for dialysis in the “intoxication” part of AEIOU?

Answer 32

BLAST
Barbituates
Lithium
Alcohol
Salicylates
Theophyline