Was in the exam before

Question 1

Baby blue

Answer 1

Mild mood disorder
Peaks on day 3-5
Improves by 10th day (review on this day)
Reassure

Question 2

Normal pressure hydrocephalus

Answer 2

Gait disturbance - ataxia
Urinary incontinence
Dementia
VP Shunt

Question 3

Basal Cell Carcinoma

Answer 3

Shiny pearly nodule
Central ulceration
Rolled edges
Telangiectasia
Mild trauma can cause bleeding
Tx: Imiquimod, 5-FU, cutterage, surgical excision/ Moh’s micrographic surgery if cosmetic appearance importance
Radiotherapy

Question 3

Clonazpine monitoring

Answer 3

FBC
Weekly for 18 weeks
Fortnightly for next 34 weeks
Monthly after first 52 weeks
Risk of neutropenia, agranulocytosis, seizures, myocarditis, cardiomyopathy

Question 4

Bacteria susceptible to after Splenectomy

Answer 4

Encapsulated bacteria
Strep pneumonia
HIB
Neiserria meinigitdis
GBS
Klebsiella pneumoniae
Salmonella typhi

Question 5

Commonest cause of septic arthritis

Answer 5

Staph aureus

Newborns can get neisseria gonnorhoeae

Question 6

Contraception - 35F, HTN, HMB

Answer 6

IUS - Mirena
HTN makes COCP UKMEC 3/4

Question 7

Diffuse interstital pattern CXR post RA drug?

Answer 7

Methotrexate
Hypersensitivity reaction
High dose steroids

Question 8

45M, 2/12 Hx dyspesia, abdo SNT, Initial investigation?

Answer 8

If abscence of ALARM Sx: 13-C Urea breath test for H pylori or trial PPI
Stop NSAID if possible

Question 9

ALARM features dyspepsia

Answer 9

Chronic GI bleeding
Unintentional WL
Difficulty swallowing
Persistent vomiting
IDA
Epigastric mass
?Ca after barium meal
>55 and persistent/ new onset dyspepsia
URGENT ENDOSCOPY & FBC

Question 10

Monitoring post anaphylaxis Tx

Answer 10

2 hours: if good response (within 5-10 mins) of single adrenaline post, complete resolution, knows how to use autoinjector, has follow up
6 hours: if needed 2 doses IM or previous biphasic response
12 hours at least: > 2dose, severe asthma, respiratory compromise, possibility of continuing slow absorption of allergen, presenting late at night, or unable to respond to deterioration/ far from A&E

Question 11

Amlodipine side effects

Answer 11

Peripheral oedema
Aterior

Question 12

Lithium toxicity signs

Answer 12

D&V, drowsiness, muscular weakness, uncoordination
Ataxia, blurred vision, tinnitus, dilute urine
Hyperreflexia, convulsions, renal failure

Question 13

ECG finding in lithium toxicity

Answer 13

Reversible flattening or inversion of T waves

Question 14

Aripiprazole toxicity signs

Answer 14

Lethargy, increased BP & HR, sleep, N&V, diarrhoea

Question 15

Clozapine toxicity

Answer 15

Sedation, deliuruim, coma, tachycardic, hypotensive, respiratory depression, hypersalivation

Question 16

Valproate toxicity

Answer 16

increased GABA
CNS depression - drowsiness, confusion
Tacycardic, hypotensive
N&V, abdo pain, High Na, lactic acidosis, Low Ca, hypoglycaemia

Question 17

Fluoxetine toxicity

Answer 17

Tachycardic, drowsiness, tremor, N&V, seizures, cardiac conduction abnormality

Question 18

Molluscum Contagiosum : cause and clinical findings

Answer 18

Poxvirus
Small shiny papules, umbilicated center
May grow in a row
Inflamed and crusty
Flexural skin

Question 19

Molluscum Contagiosum : Tx

Answer 19

Reassure: clean towels, don’t scratch
Self limiting 12-18 month duration
Molludab 5% potassium hydroxide - BD until lesions inflamed
Cyrotherapy/ curretage

Question 20

Inheritance pattern CF

Answer 20

Autosomal recessive
Chromosome 7
CTRF gene
If both parents carriers:
1 normal, 2 carrier, 1 affected child

Question 21

Optic neuritis investigation

Answer 21

MRI

Question 22

Optic neuritis presentation

Answer 22

1. Loss of colour vision
2. Painful eye movement
3. Vision loss subacute

Question 23

Wernicke’s encephalopathy

Answer 23

Confusion
Opthalmoplegia: nystagmus, lateral rectus palsy, conjugate gaze palsy
Ataxia

Petechial haemorrhages
Periperhal sensory neuropathy

Question 24

Wernicke’s encephalopathy preciptated by:

Answer 24

Infusion of glucose in those with thiamine deficiency

Question 25

Korsakoff syndrome

Answer 25

antero- & retrograde amnesia
confabulation

Question 26

B12 vs folate deficiency replacement

Answer 26

1st replace B12 then folate
Otherwise risk of Subacute combined degen of cord

Question 27

Investigation to exclude Crohn’s disease in ?acute flare

Answer 27

Faecal calprotectin

Question 28

Faecal calprotectin

Answer 28

More specific for intestinal inflammation than CRP

Question 29

Dry cough side effect

Answer 29

ACE inhibitor: -pril
Due to bradkinin
Switch to ARB

Question 30

Blood transfusion reaction: Non-haemolytic febrile reaction

Answer 30

antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage

Fever, chills
Stop/ slow transfusion, monitor

Question 31

Blood transfusion reaction: Anaphylaxis

Answer 31

Hypotension, dyspnoea, wheezing, angioedema.
Stop, IM adrenaline

Question 32

Blood transfusion reaction: Acute haemolytic reaction

Answer 32

ABO mismatch
Fever, abdominal pain, hypotension

Question 33

Blood transfusion reaction: TACO. Transfusion-associated circulatory overload (TACO)

Answer 33

Fast transfusion
Pulmonary oedema, hypertension
Stop/slow/ Loop diuretic

Question 34

Blood transfusion reaction: TRALI Transfusion-related acute lung injury

Answer 34

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension Stop the transfusion

Oxygen and supportive care

Question 35

Platelets

Answer 35

are stored at room temperature, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus.