100 common qs

Question 1

What medications can cause drug induced pneumonitis?

Answer 1

Sulfasalazine
Leflunomide
Amiodarone
Methotrexate

Question 2

Who is idiopathic intracranial hypertension classically seen in? What are risk factors for it?

Answer 2

Young, overweight females

RF) Obesity, female sex, pregnancy and certain drugs

Question 3

Idiopathic intracranial hypertension: what are the features? What is the management?

Answer 3

Features - headache, blurred vision, papilloedema, enlarged blind spot, 6th nerve palsy
Weight loss, diuretics (acetazolamide), topiramate, repeated LP, surgery

Question 4

Acetazolamide: MOA?

Answer 4

MOA: Carbonic anhydrase inhibitor.. Diuretic action is in the PCT, where carbonic anhydrase causes reabsorption of bicarbonate, sodium, and chloride. With reabsorption blocked these components hold water with them, causing increased urination.

Question 5

Acetazolamide: Uses?

Answer 5

IIH
Prevention of acute mountain sickness and treatment of high altitude pulmonary oedema
Acute closed angle glaucoma - (IV)

Question 6

Where in the brain does herpes simplex encephalitis commonly effect?
How does it commonly present?

Answer 6

Temporal and inferior frontal lobes

Fever, headache, psych problems, seizures, vomitting, aphasia

Question 7

HERPES SIMPLEX ENCEPHALITIS:
What is the pathophysiology?
What will you see on investigation?
What is the managment?

Answer 7

HSV-1 is responsible in 95% of cases in adults
CSF: Lymphocytosis, increased protein
PCR - HSV
CT/MRI: Petechial haemorrhages 
Management: IV aciclovir

Question 8

ADDISON’S DISEASE: Investigation of choice? How does it work?

Answer 8

ACTH stimulation test (AKA short synacthen test)

Plasma cortisol is measures before and 30 minutes after giving synacthen 250 micrograms IM.

Question 9

ADDISON’S DISEASE: What is it?

Answer 9

Autoimmune destruction of the adrenal glands

Question 10

DERMATITIS HERPETIFORMIS:
What is it?
When do you see it?
Pathophysiology?
Where on the body do you see it?

Answer 10

An autoimmune blistering disorder
Associated with coeliac’s disease
IgA deposition in the dermis
Elbows, knees and buttocks

Question 11

CUSHINGS: What test is used to confirm?

Answer 11

Overnight dexamethasone suppression test (most sensitive)
OR
24 hour urinary free cortisol

Question 12

What anticoagulants should patients with AF be started on post stroke?

Answer 12

After 2 weeks high dose aspirin:

Warfarin on a factor Xa inhibitor (apoxaban, rivaroxaban, dabigatran, edoxaban)

Question 13

ACROMEGALY
Investigation?
What Ix results would you expect with acromegaly?

Answer 13

Serum IGF-1 levels
If serum IGF-1 levels are uncertain or raised do OGTT (in acromegaly you commonly see raised IGF-1)

OGTT: In normal patients GH is suppressed to <2 with hyperglycaemia (which is induced in this test)
In acromegaly there is no suppression of GH

Question 14

Chest discomfort and dysphagia with liquids and solids - what should you think of?

Answer 14

Achalasia

Question 15

What is achalasia?

Answer 15

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

Question 16

Foreign travel, maculopapular rash, flu like illness - what should you think of?

Answer 16

Acute HIV (seroconversion)

Question 17

What should you think of if you see: photosensitive rash with blistering and skin fragility (i.e may me torn) on the face and dorsal aspect of hands. This can occur after minor trauma ??

Answer 17

Porphyria cutanea tarda

Question 18

When should vaccination for a splenectomy be carried out?

Answer 18

If elective 2 weeks before operation

Question 19

What vaccinations are required for a splenectomy? Why?

Answer 19

Hib, meningitis A & C, Annual influenza vaccination,
pneumococcal vaccine every 5 years
Also
Prophylactic penicillin V

Question 20

In primary hyperthyroidism what do you expect the levels of:
Calcium
PO4
PTH to be?

Answer 20

Calcium: High
PO4: Low
PTH: High or normal

Question 21

Young/middle aged man with knee arthritis what should you think of?

Answer 21

Gonococcal sepsis

Question 22

What should you think if:

sarcoidosis - bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia

Answer 22

Lofgren’s syndrome

Question 23

What is titubation?

Answer 23

Head tremor

Question 24

What should you think if a tremor is:
Postural
Slow progression
Titubation 
Improved with alcohol?

Answer 24

Benign essential tremor

Question 25

In what fashion is benign essential tremor inherited?

Answer 25

Autosomal dominant

Question 26

What are the focal features of a temporal lobe encephalitis?

Answer 26

Aphasia