Sample Questions learnings

Question 1

What is crescenteric glomerulonephritis

Answer 1

Crescenteric glomerulonephritis is used interchangebly with Rapidly Progressive Glomerulonephritis.

Pathology - Crescent shaped structures in glomeruli due to proliferation of cells in Bowman’s space.

Rapid progression - kidney failure in weeks to months if untreated.

Caused by ANCA associated vasculitis, Goodpastures, Lupus, IgA Nephropathy.

Symptoms - Haematuria, Proteinuira, Oedema

Question 2

When is Doxapram used?

Answer 2

Doxapram is used in ICU settings as a respiratory stimulant to treat respiratory depression.

Complications include arrhythmias

Question 3

What is the difference between multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS)?

Answer 3

M spike of IgG in both MM and MGUS

However MGUS is benign. MM is cancer of plasma cells.

MM usually has end organ damage presenting as bone disease (lytic lesions, vertebral collapse, fracture), hypercalcemia, bone marrow failure ( anaemia), kidney failure due to light chain deposits.

Question 4

What causes bony destruction and subperiosteal erosions in a patient on dialysis?

Answer 4

Secondary Hyperparathyroidism due to reduced activation of vitamin D as patient is on haemodyalisis.

Question 5

What drugs are most effective at lowering triglycerides?

Answer 5

fibrates

Question 6

what is coumarin necrosis?

Answer 6

skin necrosis that occurs within 2 weeks of starting warfarin

Question 7

a patient presents with fasciculations and associated weakness in one limb

Answer 7

Motor neuron disease

Question 8

cramps on initial exertion (no fasiculations)

Answer 8

McArdle Syndrome

Question 9

What is Mcardle Syndrome

Answer 9

AKA Glycogen Storage Disease Type V.
Lacks enzyme which breaks down glycogen to glucose during exercise.
- Severe muscle pain and fatigue within first few minutes
- Muscle cramps
- dark urine

Question 10

What is Myotonic Dystrophy?

Answer 10

2 types
- DM1 - more severe and common. affects muscles of face, neck and lower legs first.
- DM2 affects centre of body e.g. shoulder / hips.

Progressive muscle weakness and wasting of muscles.
Myotonia - delayed relaxation of muscles.
Cataracts

Question 11

What is cryptogenic organising pneumonia?

Answer 11

non-infectious pneumonic process occuring in the context of pre-existing inflammatory / autoimmune conditions such as rheumatoid arthritis. Can mimic bacterial pneumonia on Xray. Crackles and inflammatory markers eg. ESR raised.
Responds to corticosteroids not antibiotics.

Question 12

What are the criteria for SLE diagnosis?

Answer 12

Need a score of 10 or more with at least one clinical.
1. Positive ANA
2. Clinical criteria e.g. MSK involvement, renal (proteinuria, lupus nephritis on biopsy)
3. Immunologic criteria (antiphospholipid antibodies, low c3 or c4, AntidsDNA or Antismith antibodies.

Question 13

What does the posterior column (dorsal column) do?

Answer 13

• Fine touch
• proprioception

3 synapses
- sensory neuron to dorsal column
-Dorsal column to thalamus
- thalamus to primary sensory cortex

Question 14

What does Lateral corticospinal tract do?

Answer 14

Controls voluntary movement.

Upper motor neurone starts from primary motor cortex decusates in medulla
goes down the lateral corticospinal tract
synapses in anterior horn. Lower motor neurone then innervates muscle.

Question 15

What is the lateral spinothalamic tract?

Answer 15

Pain and temperature sensation 2-3 segments below the level of the spinal cord on the contralateral side.

Lateral Spinothalamic Tract - L S T - lower segment three

Question 16

What are the symptoms of a hemi-section of the spinal cord?

Answer 16

Brown Sequard Syndrome

Corticospinal tract - UMN symptoms below T8. (e.g. muscle weakness, spasticity, upward going plantars)

Dorsal column - loss of fine touch and proprioception on the same side.

Lateral spinothalamic tract - loss of pain and temperature sensation 2-3 segments below on the contralateral side.

Question 17

What is paraneoplastic sensory ataxic neuropathy?

Answer 17

• when body’s immune response to tumour mistakenly attacks the nervous system.
• linked to small cell lung ca, breast, ovarian and hodgkin’s lymphoma.

Symptoms
- sensory ataxia - loss of co-ordination.
- Painful dysesthesias - abnormal burning / tingling sensation
- loss of proprioception.

Question 18

How does syringomyelia present?

Answer 18

Fluid filled cyst in spinal cord

• shawl like distribution
• pain in shoulders, back , arms
• loss of hot / cold sensation especially in hands
  -progressive muscle weakness / stiffness

Question 19

thyroid mass following adrenal resection for pheochromocytoma?

Answer 19

check plasma calcitonin as higher risk of calcitonin producing medullary cell tumour

Question 20

what are the features of microscopic polyangiitis?

Answer 20

haematuria, fever, raised inflammatory markers

Question 21

Describe the renin-angiotensin-aldosterone system

Answer 21

When the blood pressure is low the kidneys secrete renin.

Angiotensin is secreted by the lungs and converted to Angiotensin ii by renin.

Angiotensin ii causes vasoconstriction and increased blood pressure. Also stimulates release of aldosterone from the adrenal cortex. Also stimulates posterior pituitary gland to secrete ADH which increases water re-absorption in the collecting duct.

Aldosterone increased water and sodium retention and gets rid of K+. Leading to increased circulatory volume and BP.

Aldosterone has a negative feedback loop to kidney to stop renin production.

Question 22

What is Conn’s Syndrome

Answer 22

aka Primary HyperAldosteronism
adrenals produce too much aldosterone
leading to increased water and sodium retention causing hypertension. Increased potassium excretion.

Question 23

What is microscopic polyangiitis?

Answer 23

Inflammation and necrosis of small blood vessels.

pANCA positive
Myeloperoxidase (MPO) positive

Affects skin, kidneys, lungs, brain, heart

Symptoms
- haematuria, proteinuria
- haemoptysis
- palpable pupuric rash (evidence of small vessel vasculitis)
- tingling, numbness, weakness

Question 24

How does a rupture of sinus of valsalva present?

Answer 24

under age 30
chest pain
acute heart failure
continuous murmur accentuated in diastole.

Question 25

how does diptheria present?

Answer 25

pharyngitis
grey membrane over soft palate / tonsils