PT 2.0

Question 1

Clozapine monitoring

Answer 1

FBC- risk of atypical antipsychotics, neutropenia and agranulocytosis
-SE: reduced seizure threshold, myocarditis

Question 2

Neuropathic bladder Sx+ Mx

Answer 2

Seen in MS: can lead to significant post-void residual urine volumes due to impaired bladder emptying
Mx: intermittent self-catherisation

Question 3

BPH urinary incontinence

Answer 3

ɑ-Adrenoceptor blockers would relax muscles (inhibit sympathetic activation) to ease the flow and reduce sudden urges to empty the bladder

Question 4

Exudate vs transudate

Answer 4

-exudates protein level MORE THAN 30 g/L
-transudates protein level LESS <30 g/L

Exudate is bcs of inflammation i.e. Cancer, Infection, Rheumatoid arthritis
Transudate is bcs of fluid moving across the membrane i.e. congestive heart failure, meig’s syndrome

Question 5

TB diagnosis

Answer 5

Sputum microscopy and smear (using Ziehl-Neelsen stain to identify acid-fast bacilli (AFB))

Question 6

Post wide local excision and axillary node clearance swelling

Answer 6

Seroma

Question 7

Immunocompromised pneumonia causative agent

Answer 7

Pneumocystits jirovecci

Question 8

Baby blues vs postnatal depression vs puerperal psychosis

Answer 8

BB: 3-7 days post birth, low mood, tearful etc
PND: typically peaks 3 months after, cardinal depression sx, SSRI
PP:Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)

Question 9

Knee injuries

Answer 9

ACL: twisting mechanism, + ve drawer and lachman test
PCL: dashboard injury
MCL: usually skiing or valgus stress, abnormal passove abduction
Menisci: locking and giving way also twisting mechanism

Question 10

Complete heart block artery occluded

Answer 10

Right coronary

Question 11

Heparin and warfarin monitoring

Answer 11

Heparin: Activated partial thromboplastin time (APTT)

Warfarin: prothrombin time (PT)

Question 12

JIA (Still’s disease)

Answer 12

-arthralgia
-elevated serum ferritin
-rash: salmon-pink, maculopapular
-pyrexia typically rises in the LATE AFTERNOON/ EVENING in a daily pattern and accompanies a worsening of joint symptoms and rash
-lymphadenopathy

Question 13

Fibrocystic disease

Answer 13

benign changes in the breast tissue- development of cysts, fibrosis, and pain or tenderness that typically fluctuates with the menstrual cycle due to hormonal variations. The symptoms often worsen during the luteal phase (second half) of the cycle when estrogen and progesterone levels are higher.

Question 14

Subarachnoid Haemorrhage Ix

Answer 14

1. non-contrast CT head is the first-line investigation of choice
   acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.
   -CT head is done within 6 hours of symptom onset and is normal
   do not do a lumbar puncture
   (consider an alternative diagnosis)
   -if CT head is done more than 6 hours after symptom onset and is normal
   do a lumber puncture (LP)

Question 15

Zolpidem, zopiclone SEs

Answer 15

‘Z drugs’ make you zzzzz increase falls risk

Question 16

Monitoring requirements aminophylline

Answer 16

continuous ECG- arrhythmia SE narrow therapeutic window

Question 17

Non-shockable vs shockable rhythmns

Answer 17

1. ‘shockable 100-200j’ rhythms: ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)
2. ‘non-shockable’ rhythms: asystole/pulseless-electrical activity (asystole/PEA)

Question 18

hypocalcaemia MOA in CKD

Answer 18

Reduced 1-alpha-hydroxylation which catalyses conversion of 25-hydroxyvitamin D to its active form, 1,25-dihydroxyvitamin D (calcitriol)

Question 19

Peripheral arterial disease mx

Answer 19

-Pt with established cardiovascular disease should be taking a statin. -Atorvastatin 80 mg.
Clopidogrel should be used first-line in patients with peripheral arterial disease.

Exercise training also recommend.

Question 20

Breast cancer surgical management

Answer 20

women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery: if negative then they should have a sentinel node biopsy

in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery (SE: this may lead to arm lymphedema and functional arm impairment)

Question 21

Von Willebrand disease Sx Ix Mx

Answer 21

Autosomal dominant- most common inherited bleeding disorder
Sx: epistaxis and menorrhagia
Ix: prolonged bleeding time (APTT)
Mx: tranexamic acid and desmopressin

Question 22

Key feature of Haemophillia

Answer 22

haemoarthroses- bleeding into joint space (prolonged APTT)

Question 23

Acne vulagris management

Answer 23

Mild to moderate:
12-week
1. topical adapalene with topical benzoyl peroxide
2. topical tretinoin with topical clindamycin

Moderate to severe: as above then
1. a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
2. a topical azelaic acid + either oral lymecycline or oral doxycycline

Erythromycin in pregnant women

Question 24

Acne vulgaris referral guidelines

Answer 24

Refer if scarring or persistent pigmentary changes

Question 25

Biggest depression predictor amongst elderly

Answer 25

Poor health

Question 26

High risk influenza prophylaxsis

Answer 26

oral oselatamvir

Question 27

Colorectal cancer surgical management site

Answer 27

Caecal, ascending or proximal transverse colon: Right hemicolectomy

Distal transverse, descending colon: Left hemicolectomy

Emergent e.g. perforated bowel- hartmann’s

Question 28

Malaria vs Dengue vs Typhoid Sx

Answer 28

Malaria: recurring fever, chills, sweats, headache, muscle aches, fatigue, nausea, and vomiting.

Dengue: sudden high fever, severe headache, pain behind the eyes, joint and muscle pain severe abdominal pain, persistent vomiting, bleeding gums.

Typhoid: sustained fever, headache, weakness, stomach pain, constipation or diarrhea, and a rose-colored rash.

Question 29

ABO incompatibility sx

Answer 29

if a Rh -ve mother delivers a Rh +ve child a leak of fetal red blood cells may occur this causes anti-D IgG antibodies to form in mother: in later pregnancies these can cross placenta and cause haemolysis in fetus

Sx: jaundice, anaemia, hepatosplenomegaly

Mx: transfusions, UV

Question 30

Most common UTI cause

Answer 30

E. coli, gram negative bacteria, is a rod-shaped (bacillus).