Ques Med 1

Question 1

Side effect of Ethambutol used in the TB drug treatment

Answer 1

Visual disturbances
- toxic effect on retinal ganglion cells

Question 2

32 F

pc: 6/12 hx progressive fatigue, malaise
- polydipsia
- polyuria
- nocturia

ix: low urine osmolality + high serum osmolality

elevated sodium

glucose 6.2 mmol/L

likely diagnosis and why?

Answer 2

Diabetes Insipidus

Osmolality: the measure of the body’s electrolyte water balance. Osmolality increases when dehydrated.

2 Types
- Cranial
- Nephrogenic

Question 3

Coffee-bean shaped structure on abdominal X-ray may indicate :

Answer 3

SIGMOID VOLVULUS

• twisting of bowel on mesenteric base

Treatment of large bowel obstruction secondary to volvulus
- conservatively
- insertion of flatus tube following decompression with sigmoidoscope

Question 4

Treatment for H-Pylori

Answer 4

Amoxicillin, clarithromycin and a PPI

If penicillin allergic
- Metronidazole can replace amoxicillin

Question 5

What type of bacteria is H-Pylori and how does it cause damage?

Answer 5

• gram negative
• buries itself into gastric epithelium
• releases urease that neutralises the pH of stomach
• this damages the epithelium

Question 6

Management of Hyperkalaemia

Answer 6

Treat K+ > 6.5mmol/L

1. 10mls of 10% calcium gluconate over 10 mins (cardioprotective)
2. IV insulin in 25g glucose
   - causes intracellular K+ potassium shift and glucose to prevent hypoglycaemia
3. Nebulised salbutamol
   - also causes intracellular K+ shift

Question 7

ECG changes in hyperkalaemia

Answer 7

1. Tall tented T-waves
2. Flattened P-waves
3. Prolonged PR interval
4. Widened QRS complexes
5. Idioventricular rhythms
6. Sine wave patterns
7. VF/asystole

Question 8

67 F

pc: 7/7 n + v , confused , not passed any urine in 2/7.

pmh: CKD 4

oe: greyish brown tinge to patients skin

build up of what metabolite has contributes to this patients presentation?

Answer 8

Urea
- normally excreted in kidneys

Uraemia
- nausea
- vomitting
- confusion
- seizures

Question 9

Side effect of clozapine

Answer 9

agranulocytosis

Question 10

Combined test in Down’s syndrome screening covers

Answer 10

• Nuchal translucency using USS scan
• PAPP-A hormone (reduced in pregnancy affected by Down’s)
• beta-hCG hormone (raised in pregnancy affected by Down’s)

Done 11-13 weeks of pregnancy.

Question 11

Summarise Down’s syndrome Screening

Answer 11

Combined test
- Nuchal translucency
- PAPP-A
- beta-hCG

Triple test
- beta-hCG
- AFP (reduced in Down’s pregnancies)
- uE3 (reduced in pregnancies affected by Down’s)

Quadruple test
- Triple test
- addition of Inhibin-A levels (raised in Down’s pregnancies)

Question 12

what test needs to be done at baseline as part of the monitoring protocol for hydroxychloroquine?

Answer 12

baseline opthalmology assessment including visual acuity

Question 13

painless cystic mass anterior to the sternocleidomastoid muscle just below the ear that typically becomes apparent in late childhood

Answer 13

branchial cyst

Question 14

patient clinically ill with hyperemesis gravidarum.

oe: dehydrated

choice of anti-emetic

Answer 14

prochlorperazine 12mg intramuscular

Question 15

small red spots with white centres on buccal mucosa are known as :

Answer 15

Koplik spots
- pathognomonic for measles

Question 16

64 F

pc: sudden loss of vision over 60seconds , no pain

pmh: HTN, T2DM

oe: visual acuity reduced, RAPD

fundoscopy: disorganized ‘stormy sunset’ appearance

likely diagnosis?

Answer 16

central retinal vein occlusion

in contrast:
- central retinal artery occlusion much less common
- view on fundoscopy is pale retina with cherry red spot at macula