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Question 1

Pathology of myasthenia gravis vs Lambert-eaton syndrome

How do they present?

Answer 1

MG - autoimmune condition against POST-SYNAPTIC ACh receptors

Lambert-eaton - autoimmune condition against PRE-SYNAPTIC voltage gated Ca+ channels -> prevents release of ACh

Affects the small muscles of head and neck (PROXIMAL - can be important to differentiate between this and Gullian-barre) more
- Drooping eyelids
- bilateral facial weakness
- diplopia

Question 2

How are focal seizures managed vs generalised seizures

How are absence seizures managed in children?

Answer 2

FoCal (C in focal = carb.. first)
1. carbamazepine
2. lamotrigine

GeneraLiSed (S and L = sodium/lamotrigine first)
1. lamotrigine/sodium valproate
2. carbamazepine

Absence
- ethosuximide

Question 3

What is more associated with retinal detachment - hypermetropia or myopia?

Answer 3

Myopia - due to enlongated shape of lens putting increased pressure on retina

Question 4

Osteoporosis management

Question 5

What should be done in patient 75+ following a fragility fracture?

What is a fragility fracture?

Answer 5

Start on alendronate + vit D

Fracture from standing height or less, in absence of significant trauma

Question 6

What type of bug is neiserria meningitidis?

What is the most common complication post meningitis?

Answer 6

Gram negative diplococci

Sensorineural hearing loss

Question 7

Radiculopathy vs neuropathy

Question 8

Go over dermatomes on the body.

What dermatomes are associated with the following sites:
- umbilicus
- nipple
- badge patch area
- big toe
- little toe
- perineum
- heel

Answer 8

1. T10
2. T4
3. C5
4. L5
5. S1
6. S4
7. S1

Big toe = largest of 5 = L5
Little toe = smallest 1 = S1

Question 9

How do you remember the anatomical positions for S nerve roots?

Answer 9

You stand on S1(heel and little toe)
You lie on S2 (posterior knee and thigh)
You sit on S3 (bum)
You wipe S4 (bum hole)

Question 10

How is anterior uveitis managed?

Answer 10

Steroid + mydiatric drops

Question 11

What is the difference between simple and complex focal seizures?

Answer 11

Complex = lose conciousness

Simple = remain concious

Question 12

What side effects are associated with carbamazepine?

Answer 12

Hyponatremia
Agranulocytosis

Question 13

What is the management of status epilecus?

Answer 13

ABCDE + DFG

1. bucal midazolam/ IV lorazepam
   - wait 5 mins
2. bucal midazolam/ IV lorazepam
   wait 5 mins
3. phenyotonin/sodium valproate

If no response in 45 mins - general anaesthesia

Question 14

What kind of tumours are MG and Lambert-eaton associated with?

Answer 14

MG - thyomas

Lambert-eaton - small cell lung cancer

Question 15

What role does ACh have on muscles?

Answer 15

Causes muscle contraction

Question 16

How can you tell the difference between Lambert-eaton and myasethina gravis?

Answer 16

MG - good response to edrophium/pyriodostigimine (acetylcholinterase inhibitors - improves amount of ACh at junction)

Lambert-eaton does not have a response
- manage with amifampridine

MG - muscle weakness worsens a lot after exertion unlike Lambert - improves after exertion

Question 17

What investigation is done in MG and Lambert-eaton?

Answer 17

Nerve conduction studies

May want to image for potential thyoma (MG) or small cell lung cancer (Lambert-eaton)

Question 18

If someone is identified as a carrier of MRSA (done via nasal swab) - what is done?

Answer 18

Nasal mupirocin

Chlorhexidine for the skin

Question 19

What medical management is used for diarrhoea dominant IBS vs constipation dominant IBS?

Answer 19

LOPeramide for SLOP
- anti-diarrhoea

linaCLOTide for CLOT
- anti-constipation

Question 20

How do you calculate the anion gap?

What is normal?

Answer 20

(Na + K) - (HCO3 + Cl)

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