Sunday

Question 1

Emphysema

Answer 1

Histological description of alveolar wall destruction with airway collapse and air trapping

Question 2

Chest X-ray features of COPD

Answer 2

Hyperinflation over 10 posterior ribs, flat diaphragm
Pulmonary hypertension: prominent pulmonary arteries
Bullae

Question 3

Management of COPD

Answer 3

MDT
Smoking cessation
Pulmonary Rehabilitation (tailored exercise program, psychosocial support)
Comorbidites and vaccines (pneumococcal and flu)
Med: SABA, SAMA, inhaled corticosteroids
Home emergency pack

Ltot if PaO2

Question 4

Chronic bronchitis definition

Answer 4

Cough productive of sputum for over 3 months on most days for over 2 consecutive years

Question 5

Management of Fibrotic lung disease

Answer 5

Find underlying cause

Stop smoking
Pulmonary rehabilitation
LTOT
sympathetic treatment: antitussives, heart failure

Surgery only if Idiopathic Lung Fibrosis

Question 6

Imaging features of bronchiectasis

Answer 6

X-ray: tramlines and ring shadows(bunch of grapes)

High resolution CT: Signet Ring Sign (thickened dilated bronchi and smaller adjacent vascular bundle)
Pools of mucus in saccule dilatation a

Question 7

Complications of Bronchiectasis

Answer 7

Cachexia
Pulmonary hypertension
Massive haemoptysis
Type 2 respiratory failure
Amyloidosis

Question 8

Management of Bronchiectasis

Answer 8

Conservative:
MDT and physio

Medical:
Antibiotics for exacerbations
Bronchodilators
Treat underlying cause
Vaccination (flu and pneumococcus)

Surgical: may be indicated in severe localised disease or obstruction

Question 9

Ghon focus

Answer 9

Primary TB, organism multiplies at pleural surface

Question 10

Ranke Complex

Answer 10

Fibrosis of Ghon complex giving calcified nodule

Question 11

Investigations in TB

Answer 11

Active TB:
Chest X-ray and cultures, also microscopy for acid fast bacilli

Latent:
Mantoux test,
Elispot (patient lymphocytes incubated with specific TB antigens to see if IFNgamma production)
PCR

Question 12

Extra pulmonary features of Cystic Fibrosis

Answer 12

Pancreatic: Diabetes, malabsorption
Gut: Distal Intestinal Obstruction Syndrome
Reproductive: infertility
Liver: gallstones and cirrhosis

Question 13

Management of Cystic Fibrosis

Answer 13

Physiotherapy: postural drainage
Antibiotics: prophylactic and for acute exacerbations
Mucolytics
Segregate from other CF patients (Burkholderia risk)
Vaccination

Pancreatic supplements, ADEK, insulin

Fertility and genetic counselling

Question 14

Causes of hyperthyroidism

Answer 14

Graves (increased uptake)

Toxic multinodular goitre= plummers
De quervains

Question 15

Common causes hypothyroidism

Answer 15

Primary atrophic goitre (autoimmune)
Hashimotos
Simple colloid goitre (iodine deficiency)

Question 16

Triple assessment for suspected thyroid lesion

Answer 16

Clinical examination
Ultrasound
FNAC

Question 17

Practicalities of thyroid surgery

Answer 17

Render euthyroid pre op with antithyroid drugs but stop 10 days before surgery (they increase vascularity)

Check for phaeo pre op if medullary carcinoma

Laryngoscopy pre and post op

Question 18

Causes of lump in anterior triangle

Answer 18

Lymph node
Goitre
Branchial cyst
Carotid body tumour (at carotid bifurcation, mostly benign)

Question 19

Causes lump in posterior triangle

Answer 19

Lymph node
Pharyngeal pouch
Cervical rib (overdevelopment of transverse process of c7)

Question 20

Causes of a cervical lymphadenopathy

Answer 20

LIST
Lymphoma or Leukaemia
Infection: EBV, TB, tonsillitis
Sarcoidosis
Tumours from elsewhere: breast, lung, ENT, gastro

Question 21

Complications of a parotidectomy

Answer 21

Immediate:
Facial nerve injury
Reactionary haemorrhage

Early:
Temporary facial weakness
Salivary fistula
Loss of pinna sensation (greater auricular nerve damage)

Late:
Frey’s syndrome= facial sweating whilst eating

Question 22

Risk factors for breast disease

Answer 22

BOOBYS
Bleeding in life (early menarche, late menopause)
Oestrogen: OCP, HRT
Other breast disease: previous cancer, DCIS
Breast feeding is protective
Young un > 35
Sister (family history)

Question 23

Classification of chronic venous disease (varicose)

Answer 23

CEAP
Clinical signs (>6 +symptomatic or asymptomatic)
Etiology
Anatomy
Pathophysiology

Question 24

Conservative measures for varicose veins

Answer 24

Lose weight and regular exercise
Avoid prolonged standing
Compression stockings
Skin care: emollients

Question 25

Management of chronic limb ischaemia

Answer 25

Non surgical:
Walk through pain
Optimise risk factors
Antiplatelets and statins
Foot care

Interventional:
Angioplasty with or without stenting

Surgical:
Endarterectomy
Bypass grafting
Amputation

Question 26

What is a DatScan?

Answer 26

Injection of Ioflupane isotope, binds to dopamine rigid neurones and allows visualisation if substantia nigra

Used in diagnosis of Parkinson’s

Question 27

Causes of cerebellar pathology

Answer 27

DATIES
Demyelination
Alcohol
Tumours or Trauma
Inherited eg Wilsons
Epilepsy medications eg Phenytoin
Stroke

Question 28

Management of Multiple Sclerosis

Answer 28

MDT

Acute: methylprednisolone

Preventing relapse: disease modifying
IFNbeta
Glatirimir

Preventing Relapse: Biologics
Natalizumab (anti VLa4 antibodies)
Alemtuzumab (Campath)

Symptomatic: fatigue, depression, pain, spasticity, urgency

Question 29

What is Myasthenia Gravis?

Answer 29

Neuromuscular disease causing fluctuating muscle weakness as a result of antibodies to Acetylcholine receptors on the post synaptic membrane

Question 30

Management of Myasthenia Gravis

Answer 30

Acute: plasmapheresis or IVIg, monitor FVC and consider ventilation

Chronic:
Pyridostigmine (anticholinesterase inhibitor)
Immunosuppression with steroids and Azathioprine
Thymectomy