1st April [28th-4th]

Question 1

What is Ramsay Hunter syndrome?

Answer 1

Group of three neurological syndromes. Main presenteation is facial nerve palsy due to a herpes zoster virus.

Question 2

Types 1-3 of Ramsay Hunter

Answer 2

type 1 = cerebellar syndrome [incl. myoclonic epilepsy, ataxia, tremor, dementia]
type 2 = facial nerve paralysis, vertigo, deafness, pain
type 3 = neuropathy deep palmar branch ulnar nerve [rareist]

Question 3

When is orlistat used?

Answer 3

overweight people to lose weight

Question 4

What is orlistat?

Answer 4

Class of medication called lipase inhibitors, prevents fat in foods being absorbed intestines, then removed by stools.

Question 5

Muscles in the rotator cuff

Answer 5

Supraspinatus, infraspinatus, subscapularis and teres minor

Question 6

What is rotator cuff tendonitis

Answer 6

Rotator cuff tendonitis refers to inflammation of the tendons of the rotator cuff muscles. This usually occurs secondary to repetitive use of the shoulder joint.

The muscle most commonly affected is the supraspinatus. During abduction, it ‘rubs’ against the coraco-acromial arch. Over time, this causes inflammation and degenerative changes in the tendon itself

Question 7

Movements of the rotator cuff muscles

Answer 7

Subscapularis: Medial (internal) rotation of the shoulder
Supraspinatus: Abduction of the arm
- Necessary for the initial 0 to 15 degrees of shoulder abduction motion
- The deltoid muscle abducts the arm beyond 15 degrees
Infraspinatus: Lateral (external) rotation of the shoulder
Teres Minor: Lateral (external) rotation of the shoulder

Question 8

Tx of a stye?

Answer 8

soak clean flannel in warm water, hold against eye 5-10m, repeat 3-4 times per day
Avoid wearing contact lenses and eye make-up until stye has burst and healed.

Question 9

What is a stye?

Answer 9

A stye is caused by staphylococcal bacteria. This bacterium is found in the nose and is transferred easily to the eye when you rub your nose, then your eye.

Bacteria can cause inflammation or infection of the eyelash follicle, oil glands that drain through ducts into the eyelashes. When the duct is clogged, oil can’t drain and backs up into the glands. The gland becomes swollen and inflamed, causing the stye.

Question 10

What is blepharitis?

Answer 10

Common ocular condiiton characterised by chronic inflammation, scaling, reddening and crusting of the eyelid.

Question 11

Cx of blepharitis?

Answer 11

Not sight-threatening, but cna lead to permanent alterations in the eyelid margin

Question 12

Cause blepharitis

Answer 12

Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic

Question 13

Tx for menorrhagia

Answer 13

1st line - LNG-IUS Mirena [long-term Tx, in for at least q2m].
2nd line - tranexamic acid, NSIADs [like mefenmic acid reduces 25% menstrual loss], traneamic acid [50% loss], COC [50% reduction]
3rd line - with progestogens, either norethisterone or injected long-acting progestens like Depo-Provera every 12w

Question 14

Tx for earwax

Answer 14

2/3 drops olive/almond oil twice daily for a few days. After 2w wax should fall out.
No evidence ear candles or ear vacuums ger ride of earwax.

Question 15

What is a meningioma?

Answer 15

Tumour that forms on membranes that cover brain/spinal cord. Slow growing, as many as 90% are benign. Different Sx depend on what structures it presses on.

Question 16

Charles bonnet syndrome

Answer 16

Group of visual hallucinations brain’s adjustment to vision loss. Most common elderly who have lost their sight.

Question 17

What is the drug riveroxibane used for?

Answer 17

Anticoagulation medication used to prevent blood vclots. Specifically used to Tx DVT and pulmonary emboli and prevent blood v=clots in AF following knee surgery.

Question 18

Rule of thumb old men and prostate

Answer 18

80% prostate cancer by 80, 100% by 100

Question 19

What is telengiectasia?

Answer 19

Condition which widened tiny blood vessels [caalled venules] cause threadlike red lines or patterns in skin. From gradually and often clustewrs. Spider veins.

Question 20

Pre=diabetes HbA1c

Answer 20

42-47mmol/mol, 48 if diabetic

Question 21

What is patellofemoral syndrome?

Answer 21

Pain as a result of problems with kneecap and femur. Pain generally worse front of knee and comes on gradually. Worsen excessive use and climbing.

Question 22

Who is HRT unsuitable for?

Answer 22

Hx breast, ovarian or womb cancer
Hx of blood clots
HTN that is untreated
Liver disease
Pregnancy

[menopausal Sx typically last 5-10 years, average 7y]

Question 23

Alterantive to HRT

Answer 23

• Lifestyle measures like exercising regularly, eating healthy diet, cutting down on coffee/alcohol/spicy foods/stop smoking.
• Tibolone - medicine similar to combined HRT, but may not be as effectivr and is only suitable for women who had last period more than a year ago
• Antidepressants - some AD might help with hot flushes and night sweats, although can cause unpleasant SE like agitation and dizziness
• Clonidine - non-hormonal medicine may help reduce hot flushes and night sweats some women, although benefits small

Question 24

Guidance for HRT

Answer 24

Wiltshire HRT

• points like oestrogen only if no uterus [unopposed oestrogen if womb and not progresterone can thicken lining of womb and lead to Ca]
• sequential combined [uterus; monthly bleed]

Question 25

Sx of B12 defieincy, Tx, common cause B12 defieincy

Answer 25

Fatigue, tiredness, breathlessness, hadache, pale skin, palpitations, pins and needles, depression, yellowing of skin, decline cognition function
Tx - hydroxocobalamin, or cyanocobalamin. Both injectable.
Cause commonly perniicious anaemia

Question 26

Example medication for neuropathic pain

Answer 26

Amtriptyline - headaches and depression
Duloxetine - bladder problems and depression
Pregabalin and gabapetin - treat epilepsy, headache, anxiety

Question 27

Dx for fibromyalgia

Answer 27

First, r/o conditionslike MS/RA/MS
The Dx
- severe pai in 3-6 different areas of your body, or milder pain in 7 or more different areas
- Sx have stayed similar level for 3m
- no other reason for Sx

Question 28

Gout vs pseudogout

Answer 28

Gout

• abrupt onset, red, hot swollen, painful joint, most often big toe less frequently ankle, knee wrist, elbow, finger, usually confined to just one joint early disease
• caused by high uric acid
• Dx by history/exam/bloods/aspiration/USS/XR
• Tx: acute flare then COC, colchicine, dietary changes, uric acid loweirn drugs

CPPD

• abrupt onset red hot swollen joint, most often knee/wrist/ankle/spinal ligaments
• CPPD crystals build up in cartilage
• Dx same as gout, except no CT
• TX NSAIDs, COC, colchicine

Question 29

AIDs defining cancers

Answer 29

Kaposi sarcoma
Non-Hodgkin lyphoma [NHL]
Cervical cancer

Question 30

Sx, cause, PP, Mx

Answer 30

Contagious skin infestations by the mite Sarcoptes sabei.
Most common Sx - severe itchiness, pimple-rash. Occasionally burrows may appear.
Sx due to allergic reaction to the mites.
Mx - sexual contacts/people living should be Tx. Bedding/clothing washed.
Mx - premethrin most effective. Ivermectin also another option.

Question 31

Sx of lyphoma

Answer 31

Enlarged lymph nodes, fever, drenched sweats, unintented weight loss, ithcing, tiredness.
Enlarged LN are painless.
Sweats common night.
Other Sx: enlarged spleen or liver.

Question 32

Categories of lymphomas [according to the WHO]

Answer 32

Lymphoma means blood malignancies that develop from lymphocytes. 4 categories [WHO]:

1. NHL
2. HL
3. Multiple myeloma
4. Immunoproliferative diseases

Question 33

Differences between HL and NHL

Answer 33

Different type of lymphocyte affected;

• HL marked presence of Reed-Sternberg cells, 15-24 y/o. Progresses almost orderly fashion throughout body.
• NHL these are not present, 60+ y/o. Various sites of the body, often Dx at an older age.

Question 34

Types of mastalgia

Answer 34

Cyclic and non-cyclic [breast pain]

Question 35

Breast examination

Answer 35

Inspection
Hands above head
Hands below head
Palpation
LN

Asymetry, swelling, skin changes, nipple changes, masses.