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Question 1

What is fibromyalgia?

Answer 1

Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomical sites. The cause of fibromyalgia is unknown.

Question 2

What is the epidemiology of fibromyalgia?

Answer 2

Epidemiology
women are around 5 times more likely to be affected
typically presents between 30-50 years old

Question 3

What are the signs and symptoms of fibromyalgia?

Answer 3

The cardinal symptom of fibromyalgia is chronic, widespread body pain, often described as a constant dull ache. This is accompanied by:

Fatigue, often waking up tired despite sufficient sleep
Cognitive disturbances, such as problems with focus and memory, known as ““fibro fog””
Mood disorders, particularly depression and anxiety
Sleep disturbances, including insomnia

Question 4

How do you diagnose fibromyalgia?

Answer 4

The American College of Rheumatology (ACR) criteria, which include widespread pain for at least three months and tenderness at 11 or more of the 18 specific tender points, are commonly used.

Question 5

How do you manage fibromyalgia?

Answer 5

There is no known cure for fibromyalgia, but symptoms can be managed with:

Medications, including antidepressants and painkillers
Cognitive behavioural therapy (CBT), to help manage the psychological aspects of chronic pain
Lifestyle modifications, such as regular exercise, stress management, and relaxation techniques

Question 6

What is scleroderma and how can you remember it?

Answer 6

Also known as systemic sclerosis is a condition of unknown aetiology characterised by hardened, sclerotic skin and other connective tissues. It is four times more common in females.

CREST

Calcinosis
Raynaud’s
Eosophageal dysfunction
Sclerodactylyl
Telangiectasia

Question 7

What is the number needed to treat?

Answer 7

For example, if the NNT for a painkiller is 5, it means that you would need to treat 5 people with this painkiller for one of them to feel relief from their pain. A lower NNT is generally better because it means the treatment is more effective and helps more people.

Question 8

What are the 5 geriatric giants?

Answer 8

Immobility, instability, incontinence, intellectual impairment and impaired vision

Question 9

Why do elderly people feel less thirst/more likely to become dehydreated?

Answer 9

Age related changes to the osmoreceptors in the hypothalamus.Reduced Osmoreceptor Function: The hypothalamus contains specialized cells called osmoreceptors that detect changes in blood osmolarity (solute concentration). When blood becomes more concentrated due to dehydration, these osmoreceptors signal the brain to trigger thirst. However, in some older individuals, the osmoreceptors may become less sensitive, leading to a delayed or diminished response to dehydration.

Decreased Total Body Water: As people age, their total body water content often decreases. This means that older adults have less water available for maintaining hydration, which can contribute to a reduced thirst response.

Medications: Some medications commonly used by older adults can have side effects that impact thirst perception or interfere with the body’s water balance.

Cognitive Changes: Cognitive decline associated with aging can affect an individual’s ability to recognize and respond to thirst cues.

Altered Hormone Regulation: Kidneys are less sensitive to ADH so you don’t reabsorb as much water.

Question 10

What is glaucoma and what are the two different types?

Answer 10

Glaucoma= a sight threatening condition. Optic nerve damage secondary to raised intraocular pressure.

Drainage of aqueous humor from the anterior chamber blocked causing a rise in intra-ocular pressure.

Chronic open angle: Trabecular meshwork deteriorates as you age. Many are asymptompatic and are picked up on routine eye tests. The drainage angle in the eye remains open, but the trabecular meshwork, which drains the aqueous humor, becomes less efficient.

Acute closed angle glaucoma: Emergency. Narrowing of the iridiocorneal angle.

Question 11

How do you treat hypermagmesemia?

Answer 11

IV calcium gluconate or calcium chloride.

Question 12

What are some causes of hypomagnesemia?

Answer 12

Coeliac, Crohn’s, IBS, PPIs

Question 13

What are some causes of hypermagnesemia?

Answer 13

CKD, Thiazide like diuretics or hypothyroidism

Question 14

What is the first line treatment in status epilepticus?

Answer 14

4mg of IV Lorazepam

Question 15

What is spondyloarthropy?

Answer 15

A group of inflammatory rheumatic diseases that primarily affect the spine and joints

Question 16

What is one of the key genetic markers associated with spondyloarthropathy

Answer 16

HLA-B27

Question 17

What is ankylosing spondylitis?

Answer 17

A chronic inflammatory disease of the spine.

Question 18

What is the typical patient for anklyosing spondylitis?

Answer 18

A man <30, gradual onsest of low back pain, worse at night, with spinal morning stiffness relieved by exercise. Pain radiates from sacroilac joints to hips/buttocks, and usually improves towards the end of the day.

Question 19

What is pallindromic rheumatism?

Answer 19

Palindromic rheumatism is a form of inflammatory arthritis. It causes attacks or flare-ups of joint pain and inflammation that come and go. The joints look and feel normal between attacks. It’s sometimes known as palindromic arthritis.

Question 20

What is sjogren’s syndrome?

Answer 20

A chronic inflammatory autoimmune disorder. Primary or secondary (RA, SLE). Fibrosis of exocrine glands (lacrimal and salivary). Vaginal dryness, dysphagia and a cough.

Question 21

Vasculitis

Answer 21

Inflammatory disorder of blood vessel walls. It can affect the vessels of any organ.

Question 22

What are two examples of ‘large’ vasculitis?

Answer 22

Giant cell arteritis and Takayasu’s arteritis

Question 23

What are two examples of ‘medium’ vasculitis?

Answer 23

Polyarteritis nodosa and Kawasaki disease

Question 24

What are ANCA positive small vasculitis conditions?

Answer 24

ANCA= antineutrophil cytoplasmic antibodies. Eosinophilic granulomatosis with polyangiitis and GAP

Question 25

What are ANCA negative vasculitis conditions?

Answer 25

Goodpasture’s syndrome and henoch-schonlein purpura

Question 26

What are 2 useful tools in diagnosis of RA? Describe each tool.

Answer 26

DAS28 and VAS.

DAS28= is a numerical index used to assess the level of disease activity in rheumatoid arthritis by combining the counts of tender and swollen joints,

VAS= the patient is asked to mark their level of pain or overall health on a horizontal line with endpoints labeled from 0 to 100. The scale is typically anchored with “0” representing no pain or the best possible health and “100” representing the worst pain or the worst possible health.

Disease severity and the efficacy of treatment are often monitored using the DAS28 score, which is a composite score including CRP or ESR, the number of swollen or tender joints, and a patient-reported measure of global health.

DAS-28 scores can be interpreted as follows:

<2.6 – disease remission
2.6–3.2 – low disease activity
3.2–5.1 – moderate disease activity
≥5.1 – high disease activity

Question 27

What antibody is indicative of RA?

Answer 27

Anti-CCP

Question 28

What test can you do for Crohn’s?

Answer 28

Fecal calprotectin

Question 29

What are the different weight recommendations for the igels?

Answer 29

Yellow= 30-60kg
Green= 50-90kg
Orange= 90+

Question 30

What is Jod basedown phemomenon?

Answer 30

Iodine-induced hyperthyroidism, also known as iodine-induced thyrotoxicosis or Jod-Basedow phenomenon, occurs when excessive iodine intake leads to an overactive thyroid gland (hyperthyroidism).

Question 31

What is wolf chairkoff phenomenon?

Answer 31

When excess iodine causes hypothyroidism. Think ‘off’ switches thyroxine synthesis off.

Question 32

What is MRCP?

Answer 32

MRCP is a non-invasive medical imaging technique that uses magnetic resonance imaging (MRI) to create detailed images of the bile ducts, liver, and pancreas. It is primarily used for diagnostic purposes to visualize and assess conditions such as gallstones, strictures, tumors, and other abnormalities in the biliary and pancreatic systems.

Question 33

What is ERCP?

Answer 33

Endoscopic retrograde Cholangiopancreatography

ERCP is an invasive medical procedure that combines endoscopy and fluoroscopy (X-ray imaging). During an ERCP, an endoscope (a flexible tube with a camera at the end) is inserted through the mouth and into the duodenum (the first part of the small intestine). A contrast dye is then injected into the bile ducts and pancreatic ducts, and X-ray images are taken to examine the anatomy and identify issues such as gallstones, tumors, strictures, or blockages.

Question 34

What is dressler’s syndrome?

Answer 34

Dressler’s syndrome, also known as post-myocardial infarction syndrome, is a rare condition characterized by inflammation of the pericardium, which is the thin membrane surrounding the heart (pericarditis). This syndrome typically occurs in the weeks to months following a heart attack (myocardial infarction) or certain cardiac surgeries.

Question 35

What is the most common injection to lose weight?

Answer 35

Liraglutide (Saxenda): Originally developed to treat type 2 diabetes, liraglutide has been approved for weight loss. It acts on the appetite control centers in the brain to reduce hunger and increase feelings of fullness.

Ozempic is semaglutide (kardashians)

Question 36

What does VATS stand for?

Answer 36

Video assisted thorascopic surgery?

Question 37

What is pleurisy?

Answer 37

Pleurisy, also known as pleuritis, is a condition characterized by inflammation of the pleura, which are the thin membranes that line the inner chest wall and cover the lungs. The pleura have two layers: the visceral pleura, which covers the lungs, and the parietal pleura, which lines the chest cavity.

Question 38

What is a fostair inhaler?

Answer 38

A mixed inhaler that contains formoterol (LABA) and beclometasone (corticosteroid)

Question 39

What is BNP and what is it’s role?

Answer 39

Brain natriuretic hormone is released from the ventricles to lower blood pressure. Through vasodilation and diuresis.

Question 40

What is the LENT score?

Answer 40

The LENT Score is a clinical tool used in the field of dermatology and wound care to assess the severity and prognosis of chronic wounds, particularly leg ulcers. The name “LENT” is an acronym that stands for:

L - Location of the ulcer
E - Etiology or cause of the ulcer
N - Size of the ulcer (measured in centimeters)
T - Tissue type (description of the wound bed)

Question 41

What is a whipples procedure?

Answer 41

The Whipple procedure involves the removal of the following organs and structures:

The head of the pancreas: This is the part of the pancreas that is located near the small intestine and bile duct.

The duodenum: The first part of the small intestine, which is connected to the stomach.

A portion of the common bile duct: The duct that carries bile from the liver and gallbladder to the small intestine.

Question 42

What is syndromic diabetes?

Answer 42

Syndromic diabetes refers to a group of rare genetic syndromes or disorders that are associated with diabetes as one of their clinical features.

Down syndrome, wolfram syndrome, alstrom

Question 43

What is suxamethonium apnoea?

Answer 43

Suxamethonium (succinylcholine) apnoea occurs when a patient has been given the muscle relaxant suxamethonium, but does not have the enzymes to metabolise it. Thus they remain paralysed for an increased length of time and cannot breathe adequately at the end of an anaesthetic.

Jane the phlebotomist has it.

Question 44

What are haemitinics and give examples?

Answer 44

Haematinics are the nutrients needed by the bone marrow to make blood cells in the process of haematopoiesis.

Iron, copper, zinc, folate, vitamin B12, EPO

Question 45

Give examples, peak activity and duration of basal insulins.

Answer 45

Question 46

Give examples, peak activity and duration of bolus insulins.

Answer 46

Question 47

Give examples of mixed insulins

Answer 47

Question 48

What is sliding scale insulin?

Answer 48

Sliding scale insulin is a method of dosing insulin in response to a person’s current blood glucose (blood sugar) level.

Question 49

What is the A-E approach of reading chest x rays?

Answer 49

The ABCDE approach can be used to carry out a structured interpretation of a chest X-ray:

Airway: trachea, carina, bronchi and hilar structures.
Breathing: lungs and pleura.
Cardiac: heart size and borders.
Diaphragm: including assessment of costophrenic angles.
Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas.

Question 50

What is Chlamydophila psittaci pneumonia?

Answer 50

Chlamydophila psittaci is an intracellular bacteria that results in psittacosis. It is acquired from contact with infected birds such as parrots, cattle, horse and sheep.
Features include lethargy, arthralgia, headache, anorexia, dry cough and fever.
Additional features include: hepatitis; splenomegaly; nephritis; infective endocarditis; meningoencephalitis and a rash.