Wednesday [13/10/2021]

Question 1

Erythropoetin SE [3]

Answer 1

Bone aches, flu-like symptoms and skin rashes are all potential side effects of erythropoietin

Question 2

1st and 2nd line for acromegaly [2]

Answer 2

1st line transphenoidal surgery

2nd line octreotide

Question 3

Factors determining if IV glycoprotein ilb/IIIa receptor atangonist is given

Answer 3

High grade GRACE risk score + whether PCI is to be performed

Question 4

Causes of hyperkalaemia [5]

Answer 4

acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison's disease
rhabdomyolysis
massive blood transfusion

Question 5

ECG changes in hyperkalaemia [3]

Answer 5

These include tall, tented T waves, diminished P waves, and widened QRS complexes.

Question 6

Why is mirtazapine Rx? [1]

Answer 6

Useful SE in old people incl. sedation and increased appetite

Question 7

Features of optic neuritis [5]

Answer 7

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

Question 8

Mx of optic neuritis [2]

Answer 8

high-dose steroids

recovery usually takes 4-6 weeks

Question 9

Prognosis optic neuritis [1]

Answer 9

MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

Question 10

What is an incarcerated hernia? [1]

Answer 10

If a hernia cannot be reduced it is referred to as an incarcerated hernia

Question 11

Femoral vs inguinal hernias [2]

Answer 11

Femoral = inferior and lateral to the pubic tubercle
Inguinal = inferior and materal ot the puic tubercle I think?

Question 12

Features of CURB65 [4]

Answer 12

Confusion [8/10]
Urea > 7
RR over 30
BP over 90/60
Over 65

Question 13

First Mx of pleural effusion? [1]

Answer 13

Pleural aspiration

Question 14

First-line for hyperhidrosis [1]

Answer 14

Topical aluminum chloride preps are first-line

Question 15

Which drugs interact with statins? [1]

Answer 15

Statins + erythromycin/clarithromycin - an important and common interactio

Question 16

When can you diagnose CKD [1]

Answer 16

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

Question 17

Signs of right sided HF [3]

Answer 17

riased JVP, ankle oedema and hepatomegaly

Question 18

First-line Mx for HF [1]

Answer 18

ACE and beta-blocker

Question 19

Second-line Mx for HF [1]

Answer 19

Aldosterone atnagonist [e.g. spironolactone]

Question 20

Vacceines for HF [2]

Answer 20

offer annual influenza vaccine
offer one-off pneumococcal vaccine
adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years

Question 21

Ejection systolic murmur heard loudest on inspiration? [1]

Answer 21

Pulmonary stenosis

Question 22

Mitral stenosis murmur [1]

Answer 22

Mid-late diastolic murmur heard loudest in expiration

Question 23

Aortic stenosis murmur [!]

Answer 23

Aortic stenosis is incorrect. This is an ejection systolic murmur heard loudest in expiration.

Question 24

Ticuspid stenosis murmur [1]

Answer 24

Tricuspid stenosis is incorrect. This is also associated with carcinoid but this is a mid/late diastolic murmur heard loudest in inspiration.

Question 25

Mitral valve prolapse [1]

Answer 25

Mitral valve prolapse is incorrect. This is a mid-systolic murmur heard loudest in expiration.