Recalls Flashcards
1) Non healing diabetic ulcer duration not remembered, both dorsalis pedis pulse are absent. Xray done showing osteomyelitis. Most appropriate investigation?
a. MRI
b. Arterial doppler study
ANSWER: B
Diagnosis: peripheral arterial occlusive disease - complication of DM that can develop into both non-healing ulcers and osteomyelitis.
Initial diagnostic tool is ABI, however Duplex/doppler ultrasound (B) is often the only imaging required to plan endovascular interventions. It is also the main investigation for follow up of vascular interventions
Source: RACGP Peripheral Arterial Disease
2) A 35 year old man went to pub, where a woman bit him, totally unknown and
she went away. 2 cm lesion, bleeding continues, teeth mark, he is fully tetanus immunized 3 years.
ago. What to do now?
A-suture and review in 24 hours B-hep B vaccine and immunoglobulin C- zidovudine D- Azithromycin E- tetanus immunoglobulin
Answer: B
Hepatitis B and C can be transmitted by human bites and human immunodeficiency virus (HIV) transmission has occurred on at least five occasions, mostly in the setting of bloody saliva and late stage HIV disease.
• For human bites consider hepatitis B prophylaxis if not immune and HIV postexposure prophylaxis if at high risk (seek advice from infectious diseases physician)
______
A - Primary closure could be considered in carefully selected bite wounds where cosmesis is an issue; suturing is not recommended in wounds at high risk of infection
C - HIV postexposure prophylaxis should be considered in high risk human bite injuries (ie. from a known HIV positive source).
D - Mammalian bite antibiotic guidelines:
E - Tetanus toxoid should be administered if 5 years since the last dose and the patient has completed a full primary course of tetanus immunisation. If the patient is unvaccinated, they should receive tetanus toxoid plus tetanus immunoglobulin
3) A patient with prostate ca T3b N0M0. Management A.Radical prostatectomy B.orchidectomy C. External beam radiation therapy D. Androgen deprivation
Best answer: B? (more specific than D?)
In this case, prostate CA stage T3b N0M0 describes a locally invasive disease spreading to the seminal vesicles.
MURTAGH (1076): For metastatic or locally advanced disease, androgen deprivation is the cornerstone of treatment, the options
being:
bilateral orchidectomy
or
daily anti-androgenic tablets, for example:
— cyproterone acetate (Androcur)
— flutamide (Eulexin)
— bicalutamide (Cosudex)
or
luteinising hormone releasing hormone (LHRH)
agonists: depot injections of LHRH analogues, for
example:
— goserelin (Zoladex)
— leuprorelin acetate (Lucrin, Eligard)
GUIDELINES:
Locally advanced prostate cancer (stage C)
It is questionable whether patients with locally advanced disease are able to be cured using currently available treatment. These men are not candidates for surgical resection and treatment is usually with radiotherapy or with hormonal ablation.
Bilateral orchidectomy is the gold standard for androgen ablation in men with prostate cancer. It results in a rapid and permanent decrease in circulating testosterone levels. A dramatic improvement in the symptoms of metastatic prostate cancer can occur within a few hours or days.
Note: ideal is combination of EBRT and Androgen Deprivation… so maybe the question is poor recall, and if the question was least appropriate management, the answer is A
4) Case of old woman with iron deficiency anemia, no symptoms, no complaints, cause? A. Carcinoma of caecum B. Carcinoma of..... C. Carcinoma of stomach D. nutritional deficiency #Surgery #2018
Answer: A
Carcinoma of caecum and
ascending colon:
Malignancy in this area is more likely to present with
symptoms of anaemia without the patient noting obvious
blood in the faeces or alteration of bowel habit.
DxT: blood in stools + abdominal discomfort +
change in bowel habit = colon cancer
Source: Murtagh, (236, 265)
5) Drawing pentagon, which hemisphere test..with scenario
a. Fronto parietal
b. Dominant parietal
c. Occipital
d. temporal
e. Non dominant parietal
#Neurology #2018
Answer: E
The nondominant parietal lobe integrates the contralateral side of the body with its environment, enabling people to be aware of this environmental space, and is important for abilities such as drawing. Acute injury to the nondominant parietal lobe may cause neglect of the contralateral side (usually the left), resulting in decreased awareness of that part of the body, its environment, and any associated injury to that side (anosognosia). For example, patients with large right parietal lesions may deny the existence of left-sided paralysis. Patients with smaller lesions may lose the ability to do learned motor tasks (eg, dressing, other well-learned activities)—a spatial-manual deficit called apraxia.
_________
A - frontal cortex: Behavioral changes, primary motor area, Broca’s area
B - Dominant parietal: primary somatosensory area. Calculation, writing, left-right orientation, and finger recognition (Gertsmann syndrome)
C - occipital: cortical blindness; in one form, called Anton syndrome, patients become unable to recognize objects by sight and are generally unaware of their deficits
D - temporal: auditory perception, receptive components of language, visual memory, declarative (factual) memory, and emotion
6) 17 year old boy says he must count till 20 otherwise his mom will be killed. They had a minor accident 3 months ago. Boys keeping himself in the room most of the time. He is hearing voices but could not recognize them. What is the diagnosis? A. OCD B. Major Depression C. Schizophreniform Disorder D. PTSD
Best Answer: C
Symptoms: command hallucinations, auditory hallucinations. No No mood symptoms (rule out B), no anxiety or panic attack symptoms (rule out D).
The symptom profile of a schizophreniform disorder is identical to that of schizophrenia; however, the total duration of illness, including prodromal or residual phases, must be less than 6 months.
SOURCE
Swelling on anterior neck, lateral
Asking what will you find on physical examination
A palpable hard nodule under tongue
B movement on swallowing
C movement on tongue protrusion
Best answer: A
The picture attached is that of a branchial cleft cyst, a lateral neck mass not movable with deglutition, along the anterior border of the SCM. However, none of the given choices are consistent with a diagnosis of a branchial cleft cyst. Both b and c are features of a thyroglossal duct cyst, usually presenting as a midline neck mass.
A ranula can present as a small lateral neck mass, in the submandibular area, presenting with a palpable nodule under the tongue. This is the most likely answer (prob. with poor recall of the image)
8) Picture of facial palsy 1 day and ear discharge for 2 days, asking treatment?
Steroid
Famcyclovir
ANSWER: Neither
Both Otitis media and Otitis externa (swimmer’s ear) can develop facial palsy. Bell’s Palsy is a diagnosis of exclusion, Ramsay-Hunt syndrome, caused by the VZV usually presents with a painful ear rash, not ear discharge.
Treatment: bilateral myringotomy, antibiotic treatment, decongestants.
9) HSP scenario with leg photo, developed rash in buttock and leg, next investigation A) abdominal USG B) urinary phase-contrast microscopy C) blood culture D) CXR #Medicine #2018
ANSWER: B
Urinalysis is usually the only investigation needed in a classic presentation of HSP
If there is hypertension, macroscopic haematuria or significant proteinuria:
● Formal urine microscopy and urinary protein-creatinine ratio (UPCR)
● Bloods for urea/electrolytes/creatinine (UEC) and albumin
In some instances further investigations may be required to rule out differentials if the diagnosis is unclear eg ITP, leukaemia, or to identify potential complications of HSP.
These may include:
● FBE, UEC, albumin
● Blood and urine culture
● Abdominal imaging
● ANA, dsDNA, ANCA, C3/C4 if significant renal involvement with an unclear diagnosis
10) Ankylosing spondylitis x-ray. Paracetamol, codeine taken but not improved
a. Indomethacin
b. prednisolone
c. Methotrexate
d. Infliximab
(no naproxen in option)
Answer: A
MURTAGH (347): Ankylosing spondylitis usually presents with an insidious onset of inflammatory back and buttock pain (sacroiliac joints and spine) and stiffness in young adults (age <40 years), and 20% present with peripheral joint involvement before the onset of back pain. It usually
affects the girdle joints (hips and shoulders), knees
or ankles. At some stage over 35% have joints other
than the spine affected. The symptoms are responsive
to NSAIDs
AS X-ray: Lumbar spine changes A) Shiny corners and erosions. B) Early syndesmophytes C) Spinal fusion or ankylosis
11) A female patient comes to you for medical check-up. You notice she has bruises and cuts on her limbs with a swollen left eye. She looks frightened and tells you that she does not want to go home. What do you do next?
A. Advise her to go home
B. Call her husband and counsel him
C. Refer to domestic violence (center?)
D. Admit her to hospital
E. Tell her to call relatives and stay with them
ANSWER: C
● High suspicion of intimate partner violence
● General practitioners can refer patients to local community legal centres, women’s legal services, legal aid and court support services.
● Joint counselling is not recommended and specific counselling needs to be by professionals trained in abuse and violence
24 years old lady with history of smoking otherwise healthy, BMI 35, taking OCP. Her mother was diagnosed with breast cancer at the age 75. She is not complaining of any breast lump. Came to you for advice regarding breast carcinoma. What will be your advice for her?
a) Quit smoking
b) Reduce weight
c) Stop OCP
d) Do self breast examination
e) Mammography annually
ANSWER: B
MURTAGH (953)
● Risk factors include increasing age (>40 years), Caucasian race, pre-existing benign breast lumps, alcohol, HRT >5 years, personal history of breast cancer, family history in a first-degree relative (raises risk about threefold), nulliparity, late menopause (after 53), obesity, childless until after 30 years of age, early menarche, ionising radiation exposure.
● Regular BSE is recommended for all women 35 years and over.
● Regular screening mammography after 50 years of age—every 2 years
13) 50 year old male presents with recurrent ca oxalate stones... Treatment? Hydrochlorthiazide Spironolactone Decrease Ca Decrease salt Allopurinol
Answer: D
MURTAGH (323)
Recurrent urinary calculi
The dietary advice for recurrent urinary calculi includes:
1 Drink at least 2 L of water every day, or more if there is
increased fluid loss: this is the most important step.
2 Minimise consumption of foods that contain oxalate or uric acid. Foods that contain oxalate include: • chocolate • coffee • cola drinks • rhubarb • tea
Foods that contain uric acid include: • beer • red wine • red meat • organ meats
3 Avoid milk in tea—calcium precipitates oxalate.
4 Avoid processed meats, organ meats (e.g. brain,
kidney, liver and sweetbread), yeast spreads and other
high-salt foods. Restrict salt intake.
5 Reduce animal protein consumption: restriction to one
major meat meal a day (includes chicken and fish).
6 Add citrate-containing fruit juices to the diet, including
grapefruit, apple and orange juice.
7 Eat a healthy diet of vegetables and fruit with a high fibre content.
GUIDELINES:
Patients with calcium oxalate stones, which are the most common,should be further advised to keep a low oxalate diet. The majority of published evidence now favours dietary salt and oxalate reduction rather than calcium reduction in these patients. The evidence in favour of salt reduction is strongest for patients with hypercalciuria. Common oxalate rich foods include: tea, chocolate, spinach, beetroot, rhubarb, peanuts, cola, and vitamin C (most supplementary vitamin C is converted to oxalate).
1) A 15-year-old girl presents with a palpable purpuric rash over her lower limbs accompanied by polyarthralgia following a recent sore throat. What is the most likely diagnosis? A. Rubella B. Measles C. Erythema multiforme D. Idiopathic thrombocytopenic purpura E. Henoch-Schonlein purpura
Answer: E
HSP is characterised by palpable purpura with arthritis/arthralgia (~50-75%), abdominal pain (~50%) and/or renal involvement (~25-50%) (haematuria/proteinuria/hypertension). In ~50% of cases there is a history of a recent upper respiratory tract infection.
2) Patient comes for vaccination for cervical cancer. LSIL on pap 6 months ago. Today pap is taken again for testing. what advise for hpv vaccines?? a No need Depends on hpv serology result c Depends on hpv culture result d vaccines now e depend on today’s pap result
Answer: D (?)
● Women with a history of previous HPV infection will most likely benefit from protection against disease caused by the other HPV vaccine genotypes with which they have not been infected.
● The vaccine can be given to patients with previous cervical intraepithelial neoplasia, but practitioners need to emphasise that the benefits will be limited to future HPV exposure. Cervical cytology screening and corresponding management based on NHMRC and RANZCOG recommendations must continue
