22/02/24 (morning)

Question 1

What can occur after initiation of goserelin (GnRH agonist) for prostate cancer and what is given to prevent it?

Answer 1

• Tumour flare (a paradoxical increase in symptoms)
• Cyproterone acetate is given to prevent this

Question 2

What is the reversal agent for dabigatran (a DOAC)?

Answer 2

Idarucizumab

Question 3

Features of staphylococcal toxic shock syndrome?

Answer 3

• Fever, hypotension, diffuse erythmatous rash (with desquamation over palms and soles, and involvement of 3 or more organ systems
• Typically after leaving a tampon in too long (qustions may say ‘after a long flight’)

Question 4

A middle age/elderly patient presents with concerning GI signs but is found to be positive for H. pylori, what should you do?

Answer 4

• 2 week wait referral
• Presence of H. pylori should not affect decision to refer for suspected cancer

Question 5

Signs , investigation and treatment of achalasia in an adult?

Answer 5

• Signs: Dysphagia to both liquids and solid, sometimes with chest pain
• Investigations: pH and manometry studies + contrast and swallow endoscopy
• Treatment: botulinum toxin, pneumatic dilation, or cardiomyotomy

Question 6

Features of seborrhoeic dermatitis and hat organism causes it?

Answer 6

• Eczematous lesions in sebum rich areas: scalp (dandruff), periorbital, auricular and nasolabial folds
• Caused by overreaction to Malassezia furfur

Question 7

What is circumstantiality?

Answer 7

• The inability to answer questions without giving excessive information
• Will eventually get to the answer in a roundabout way

Question 8

IVF-aided single pregnancies increase the risk of what?

Answer 8

Placenta praevia

Question 9

Treatment of aortic dissection?

Answer 9

• Type A (ascending): IV labtalol and surgery
• Type B (descending): IV labetalol alone

Question 10

What murmur can be heard in type A aortic dissection?

Answer 10

• Aortic regurgitation
• High pitched, blowing, early diastolic murmur loudest at the second intercostal space right sternal border

Question 11

Different between lateral medullary syndrome (PICA) and lateral pontine syndrome (AICA)?

Answer 11

Lateral pontine syndrome (AICA) presents the same as lateral medullary syndrome (PICA) but with additional ipsilateral facial paralysis and deafness

Question 12

How often should lithium be monitored after changing dose?

Answer 12

One week after the dose change and then weekly until the levels are stable

Question 13

What should b co-prescribed with isoniazid and why?

Answer 13

Pyridoxine (B6) to prevent peripheral neuropathy

Question 14

What is the medication of choice in suppressing lactation and why?

Answer 14

Cabergoline as it has a better side effect profile than bromocriptine

Question 15

What tests ned to b done when starting a statin and when (and what tests aren’t necessary unless there are signs?

Answer 15

• Lipid profile and LFTs at initiation and 3 months
• CK is only indicated if presenting with unexplained muscle symptoms such as pain, tenderness or weakness

Question 16

What murmurs are found in aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation?

Answer 16

• AS: esection systolic, high-pitched, crescendo-decrescendo that radiates to carotids
• AR: early diastolic, soft murmur, decrescendo
• MS: mid-diastolic, low pitched, rumbling murmur
• MR: pan-systolic, high pitched, whistling murmur

Question 17

Treatment of symptomatic aortic stenosis?

Answer 17

• Low risk patients: surgical valve replacement
• High risk patient: transcatheter valve replacement

Question 18

Functional tricuspid regurgitation often occurs secondary to what?

Answer 18

Pulmonary hypertension

Question 19

Features of congenital diaphragmatic hernia?

Answer 19

• Scaphoid abdomen
• Concave chest
• Dyspnoea and tachypnoea at birth
• Auscultation: Reduced breath sounds and medially displaced heart sounds

Question 20

What pulse character is found in PDA?

Answer 20

Large volume, bounding, collapsing pulse