Random

Question 1

statins RFs

when to stop

who gets it

Answer 1

include advanced age, female sex, low body mass index and presence of multisystem disease such as diabetes mellitus. Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)

3x upper limit

Who should receive a statin?
all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Question 2

Diagnostic criteria for diabetes

Answer 2

If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/

C-peptides low

Question 3

first line Mx for neuropathic pain

Answer 3

amitriptyline, duloxetine, gabapentin or pregabalin

tramadol is rescue therapy

Question 4

organism after influenza A

Answer 4

staph aureus

Question 5

most common bone mets place

Answer 5

The spine is the most common site for bone metastases due to its high content of red marrow, which contains many blood vessels that provide a suitable environment for tumor cells to grow. Additionally, the spine’s venous plexus allows for easy access of circulating tumor cells to the vertebral column.

Question 6

In which conditions should uliprilsal be used in caution

Answer 6

severe asthma

Question 7

Diagnosis of a mesothelioma

Answer 7

is made on histology, following a thoracoscopy

Question 8

when to screen for diabetes in first time pregnant woman

Answer 8

All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks

Question 9

worst prognostic factor for melanoma

Answer 9

Melanoma: the invasion depth of the tumour is the single most important prognostic factor

Question 10

Meningitis in children < 3 months mX

Answer 10

give IV amoxicillin in addition to cefotaxime to cover for Listeria

Question 11

CT changes for HSV encephalitis

Answer 11

medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients

Question 12

Mx of osteoporosis

Answer 12

1st line - oral alendronate
then denosumab - diarrhoea, dyspnoea
rare hypocalcaemia, URTI

Question 13

HOCM sound

Answer 13

ejection systolic murmur, louder on performing Valsalva and quieter on squatting

Question 14

First line treatment for leigonella

Answer 14

macrolide - clartihromycin

Question 15

RF for adhesive capsulitis

Answer 15

Diabetes mellitus

Question 16

granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis.

Answer 16

The combination of ENT, respiratory and renal involvement

upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions

Question 17

scarlet fever features

Answer 17

Group A haemolytic streptococci
2-6 years
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash - sandpaper

oral penicillin V for 10 days

complications
otitis media: the most common complication
rheumatic fever: typically occurs 20 days after infection
acute glomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

Question 18

nitrogen washout test

Answer 18

differentiate cardiac from non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

Question 19

Drug to maintain PDA

Answer 19

PG E1

Question 19

Ix for coeliac disease

Answer 19

TTG IgA
Gold standard
Endoscopic intestinal biopsy

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

Answer 19

renal transplant
fever
BL pneumonia, deranged LFT and lymphadenopathy

Question 19

Ix for acromegaly

Answer 19

IGF 1 measurements
oral glucose tolerance test with serial GH measurements

Question 20

adjuvant treatment in HER2+ breast cancer treatment

Answer 20

transtuzmab

Question 21

at what age does children start walking at

Answer 21

13-15 months

Question 22

when do you start antibiotics in whooping cough and what is given

when are pregnant woman given vaccinationa

Answer 22

ram-negative bacterium Bordetella pertussis.

an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread

Women who are between 16-32 weeks pregnant will be offered the vaccine.

Question 23

Discitis features

Answer 23

Back pain
General features
pyrexia,
rigors
sepsis
Neurological features
e.g. changing lower limb neurology
if an epidural abscess develops

six to eight weeks of intravenous antibiotic therapy

need to be assessed for endocarditis

Question 24

features
Ix

Answer 24

abdominal pain - in acute mesenteric ischaemia this is often of sudden onset, severe and out-of-keeping with physical exam findings
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis

CT

Question 25

Hypercalcaemia features

Answer 25

Features
‘bones, stones, groans and psychic moans’
corneal calcification
shortened QT interval on ECG
hypertension

Question 26

Types of heart block

Answer 26

First degree heart block
PR interval > 0.2 seconds

Second degree heart block
type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs
type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex

Third degree (complete) heart block
there is no association between the P waves and QRS complexes

Question 27

Management of hyperthyroidism in pregnant woman

Answer 27

First trimester - Porpylurathicil
then carbimazole

Question 28

Antibiotics used to treat MRSA

Answer 28

vancomycin
teicoplanin
linezolid

Question 29

Features of subclinical hypothyroidism
Mx

Answer 29

TSH raised but T3, T4 normal

TSH is > 10mU/L and the free thyroxine level is within the normal range
consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range
if < 65 years consider offering a 6-month trial of levothyroxine if:
the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
there are symptoms of hypothyroidism
in older people (especially those aged over 80 years) follow a ‘watch and wait’ strategy is often used
if asymptomatic people, observe and repeat thyroid function in 6 months

Question 30

Define blindness

Answer 30

<3/60 with a full visual field and wearing glasses or contact lenses as prescribed.