MLA Paper 1

Question 1

This condition is a severe complication of sickle cell anaemia, characterised by the presence of new pulmonary infiltrates on chest x-ray, accompanied by symptoms such as fever, cough, sputum production, dyspnoea or hypoxia.

Answer 1

Acute sickle chest syndrome
* vaso-occlusion w/i pulmonary microvasculature –> infarction in lung parenchyma

Management
1. pain relief
2. resp support e.g. oxygen therapy
3. Anx
4. tranfusion? may improve oxygenation

Question 2

reflex test to investigate corticospinal tract lesions

Answer 2

Hoffman’s sign:

HoFFman - Finger Flick (to see reflex of index finger Exaggerated or not- if exaggerated reflex then UMN lesion)

Question 3

this differentiates between organic and non-organic lower leg weakness

Answer 3

Hoover’s sign

Question 4

Pernicious anaemia predisposes to what type of cancer

Answer 4

gastric carcinoma

Macro - FAT RBC
folate, alcohol, hypothyroid, reticulocytotic, B12, cytotoxics

normo - 3As and 2Hs
acute blood loss, anaemia of chronic disease, aplastic anaemia
haemolytic anaemia, hypothyroidism

micro - TAILS
thalassaemia, anaemia of chronic disease (more likely to be normo), iron, lead poisoning, sideroblastic

Question 5

A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.

Fracture is

Answer 5

POTT’S FRACTURE

like plant pot

Question 6

A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.

Answer 6

Bennett’s fracture

Question 7

A 73-year-old woman presents with pain in her wrist after falling on to an outstretched hand. On examination there is dorsal displacement and angulation. An x-ray shows a transverse fracture of the radius around 2 cm proximal to the radio-carpal joint.

Answer 7

COLLEs fracture

Dorsal displacement,

Question 8

treatment of choice for SLE

Answer 8

Hydroxychloroquine

DMARD

SLE
- fatigue
- msk pain
- low mood
- lymphadenopathy

Bloods showed
- anaemia
- leukopenia
- thrombocytopenia

Question 9

Pathology affcting upper and lower lung zones

Answer 9

Upper (CHARTS):

C- Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

Lower Zone PF (DAIM - chocolate):

D - Drugs
A - Asbestosis
I - Idiopaathic
M - Most connective tissue disorders but AS

Question 10

Diabetes insipidus is characterised by a

Answer 10

high plasma osmolality and a low urine osmolality

Causes of nephrogenic DI
1. genetic: affcting ADH receptor
2. electrolytes: hypercalcaemia, hypokalaemia
3. lithium: desentizies kidney’s abilities to respond to ADH in collecting ducts
4. Demeclocycline
5. Tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Features
- polyuria
- polydipsia

Investigation
1. high plasma osmolality, low urine osmolality
2. urine osmolality > 700 excludes DI
3. water deprivation test

Management

1. Nephrogenic DI
   –> thiazides
   –> low salt/ protein diet
2. central diabetes insipidus
   –> desmopressin

Question 11

Impaired fasting glucose and impaired glucose toelrance

Answer 11

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 12

which medications should be stopped in c.difficile infections?

Answer 12

opioids

First episode of C. difficile infection
* first-line therapy is oral vancomycin for 10 days
* second-line therapy: oral fidaxomicin
* third-line therapy: oral vancomycin +/- IV metronidazole

Recurrent episode
* recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode
* within 12 weeks of symptom resolution: oral fidaxomicin
* after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin**

Life-threatening C. difficile infection
* oral vancomycin AND IV metronidazole
* specialist advice - surgery may be considered

Question 13

What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?

Answer 13

Loss of antithrombin III

Question 14

classical biochemical findings in primary hyperparathyroidism

Answer 14

High serum calcium

low phosphate

PTH may be high or inappropriately normal

Causes of primary hyperparathyroidism
85%: solitary adenoma
10%: hyperplasia
4%: multiple adenoma
1%: carcinoma

Question 15

Confusion, gait ataxia, nystagmus + ophthalmoplegia are features of

Answer 15

Wernicke’s encephalopathy

Korsakoff’s syndrome
- anterograde / retrograde amnesia, confabulation and apathy

COAT (Wernicke’s encephalopathy), RACK (Korsakoff’s syndrome)

Confusion
Ophthalmoplegia (nystagmus)
Ataxia
Thiamine deficiency

Retrograde amnesia
Anterograde amnesia
Confabulation
Korsakoff’s syndrome

Question 16

revision card

RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy
Pyrazinamide: Gout
Ethambutol: Optic Neuritis

Answer 16

RIPE ONGO
Rifampicin: Orange secretions
Isoniazid: Neuropathy
Pyrazinamide: Gout
Ethambutol: Optic Neuritis

Question 17

HIV serology

Answer 17

‘A Gal is for life, a Man is temporary’

IgG vs IgM

Question 18

pain on palpation of the tragus, itching, discharge and hearing loss are classical of

Answer 18

Otitis externa

Question 19

Thyrotoxicosis with tender goitre =

Answer 19

subacute (De Quervain’s) thyroiditis

There is an initial period of hyperthyroid, due to the release of thyroid hormone from damaged cells. Following the hyperthyroid state, a period of hypothyroid then ensues, eventually resolving back to a euthyroid state.