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Question 1

Duration of Warfarin Tx post successful DC Cardioversion for Paroxysmal AF

Answer 1

4 weeks

Where the risk of recurrence is high (abnormal echo or multiple failed attempts) then long term therapy advised

Question 2

Risk Factors for Gallstone disease

Answer 2

Female
Multiparity
Oral contraceptive use
Crohns Disease (Terminal Ileum)- presumed to be due to lithogenic bile
High animal fat diet
Rapid Weight loss
DM

Question 3

DYN: Facticious Hypoglycaemia

Insulinoma collapse normally precipitated by a period of fasting with or without exercise

Answer 3

Raised insulin in absence of raised c Peptide is usually due to illicit insulin use (or sulphonylureas)

Question 4

Difference between limited and diffuse cutaneous scleroderma

Answer 4

Limited: Below Elbows and Knees +/- Face
Diffuse: includes areas above elbows and knees

Raynauds phenomenon normally starts just before develop diffuse scleroderma but years prior to limited.

Question 5

What is the most common complication of Heparin induced thrombocytopenia?

Answer 5

DVT
There is a paradoxical predisposition to thrombosis despite platelets dropping

HIT is caused by IgG antibodies that recognise complexes of platelet fact 4 and heparin. Thrombosis then results.

Typically falls 5-10 days after heparin started.

More common with unfractionated heparin than LMW

Venous Thrombosis is more common than Arterial Thrombosis
Skin Necrosis can also occur

Question 6

What type of medication is Verapamil?

Answer 6

Calcium Channel Blocker

Reduced Resting Heart Rate

Question 7

What medications can result in digoxin toxicity when co-administered?

Answer 7

Verapamil
Nifedipine
Quinine
Quinidine

Question 8

Rationale Behind LTOT

Answer 8

MRC Trial: If PaO2 >8 for >15hrs a day the 3 year survival improved by 50%

Question 9

Criteria for LTOT

Answer 9

Clinically Stable Non Smokers Who have:
PaO2 <7.3 kPa
FEV1 <1.5
FVC< 2
Despite Maximal treatment
(These values should be stable on 2 occasions >3 weeks apart)

OR Patients with PaO2 7.2-8 and pulmonary hypertension showing features of cor pulmonale

Question 10

Features of Lead Poisoning

Answer 10

Abdominal Pain (?Due to effect on intestinal smooth muscle)
Lead interferes with Red Cell Enzymes and creates characteristic features: Puncate basophilic stippling and clover leaf morphology.

Peripheral Neuropathy also occurs but is usually motor.

Interstitial Nephrirtis

20% patients get gingival blue black line

Question 11

Reasons for high viral load of HIV despite treatment

Answer 11

1. Poor Adherence
2. Drug Interactions
3. Absorption poor
4. Primary resistance or superinfection with new resistant strain

All patients should have resistance test at baseline

Question 12

Side Effect of Trastuzamab

Answer 12

Cardiotoxicity

used for HER2 Positive Metastatic Breast Cancer

Question 13

Side Effect Cyclophosphamide

Answer 13

Haemorrhagic Cysitis

Question 14

Side Effect Cisplatin

Answer 14

Ototoxicity, Nephrotoxicity, Neurotoxicity

Question 15

Side Effect Rituximab

Answer 15

Cytokine Release

Question 16

Side Effect Sunitinib

Answer 16

Fatigue, Diarrhoea, Hypertension