Random Topics from past papers

Question 1

A patient undergoes throacic surgery and develops a pleural effusion. A milky-white liquid is drained. What is the most likely diagnsosi?
What are the characteristics of the fluid?

Answer 1

Chylothorax

Chyle (triglyceride-rich lymphaticfluid in the thoracic duct) would be
* high in triglycerides (>110mg)
* high in other lipids
* total cholesterole ususally < 200mg
* LDH low
* glucose similar to plasma
* lymphocytes present

Question 2

What are the most common causes of a chylothorax?

Answer 2

Traumatic - thoracic surgery
non-traumatic - usually due to compression (lymphoma, lung cancer, mediastinal malingnancy)

Question 3

How should a person with recurrent total loss of conciousness and normal ECG be invesigated?

Answer 3

Depending on suspected cause of Loss of conciousness

• seizure: neurological opinion within 2 weeks
• Cardiac asessment within 24h in high-risk cardiac features
• Or specialist cardiac asessment including possible halter metthods for event monitoring

Question 4

Which cells are most commonly affected in MS?

Answer 4

Activation of autoreactive T-lymphocytes → inflammatory processes → focal demyelination with partial preservation of axons (acute plaques) → **loss of axons and atrophy of oligodendrocytes (chronic plaques) **→ gliosis → inadequate remyelination

Question 5

What are the first-line investigations in peple with suspected MS?

Answer 5

1. MRI brain + spinal cord with contrast
   * hyperintensities in the periventricular white matter
   * Brain more sensitive but less specific than spinal cord white matter
2. Looking for alternative explanation
   * FBC (normal), TSH, B12, metabolic panel, HIV test

CSF analyis can be considered
* to rule out other causes
* will show oligoclonoal bands (in 80%)
* slightly increased cell count (not much) with lymphocytic predominance

Question 6

What is the managment of acute exacerbations of MS?

Answer 6

1. Methylprednisolone
2. consider plasma exchange

Question 7

What is the first-line investigation for Obstructive sleep apnoea? What are diagnostic criteria?

Answer 7

Polysomnography

• attended PSG gold-standard (in sleep lab)
• Unattended at home first line/ more commonly done

Usually diagnosed with
* Apnoea/Hypopnea index (AHI) with >15 apnoeic episodes/ h or >5 and co-morbidities

Question 8

What is the first line management for people with OSA?

Answer 8

Oral appliance therapy

Unless >30 episodes/ h then CPAP first line, OAT 2nd line

Question 9

Summarise the gross blood supply of the duodenum

Answer 9

First to parts : branches from the gastricduodenal artery, usually deriving from the coeliac artery

3rd and 4th part: supplied by branches from the superior mesensteric artery

Question 10

What is one unit of alcohol?

Answer 10

10ml or 8g

Question 11

What are the NICE CT Head indications within 1h?

Answer 11

CT head within 1 hour

• GCS < 13 on initial assessment
• GCS < 15 at 2 hours post-injury
• suspected open or depressed skull fracture
• any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
• post-traumatic seizure.
• focal neurological deficit.
• more than 1 episode of vomiting

Question 12

What are the NICE CT Head indications within 8h?

Answer 12

with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:

• age 65 years or older
• any history of bleeding or clotting disorders including anticogulants
• dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
• more than 30 minutes’ retrograde amnesia of events immediately before the head injury

Question 13

What are the criteria in the CHADSVASC score?
When would you anticoagulate?

Answer 13

Consider with 1
Anticoagulate with 2