Consultation

Question 1

Acromegaly investigations

Answer 1

Baseline insulting like growth factor will be raised
Glucose tolerance test - failure or suppression of growth hormone
MRI - pituitary views

Question 2

Which systems are affected in acromegaly?

Answer 2

Cardiac - cardiomyopathy, IHD
HTN
T2DM
Visual impairment
Carpal tunnel

Question 3

Visual impairment in acromegaly

Answer 3

Bitemporal hemianopia
Compression of the adenoma on the optic chiasm

Question 4

Treatment for acromegaly

Answer 4

Surgery which is transphenoidal and aims to be curative
Medical therapy is somatostatin analogis i.e. octreotide and second line agents is bromocriptine
Radiotherapy to pituitary

Question 5

Risk of surgery for acromegaly

Answer 5

Risk of panhypopituitarism

Question 6

Scoring system for OSA

Answer 6

Epworth
STOP bang questionnaire

Question 7

Osteogenesis imperfecta inheritance

Answer 7

8 types
Most commonly dominant
Spontaneous is more severe

Question 8

Ehlers Danlos heart murmur

Answer 8

MV prolapse or MR

Question 9

For investigating lymphoma is a biopsy of a lymph node or FNA more appropriate

Answer 9

For lymphoma you need histology so biopsy needed as FNA does not provide enough information (FNA fine for cytology only)

Question 10

Cholesterol target for stroke

Answer 10

Fasting LDL <1.8
Or 2.5 if non fasting

Question 11

Treatment for anti phospholipid

Answer 11

Warfarin over doac

Question 12

Differentials for the appearance of retinitis pigmentosa

Answer 12

Diabetic retinopathy
Laser treatment scars
Toxoplasmosis
Rubella

Question 13

Inheritance of R pigmentosa

Answer 13

30% de novo
Can be dominant recessive or x linked

Question 14

Why does R pigmentosa happen and how does it affect vision

Answer 14

Build up of pigment
Night time vision first affected then they get tunnel vision

Question 15

What type of arthritis does gonococcal usually cause?

Answer 15

Septic arthritis

Question 16

Reactive arthritis genetics

Answer 16

Associated with HLA B27 gene
Seronegative spondyloarthopathies
Reactive arthritis
Psoriatic arthritis
Enteric arthritis
Ank spond

Question 17

Jaccouds arthropathy

Answer 17

Looks like RA hands ulnar deviation but is in SLE

Question 18

Sarcoid stages

Answer 18

Stage zero normal chest x-ray
Stage one hilar lymphadenopathy
Stage two HL + pulmonary infiltrates
Stage three infiltrate only
Stage four pulmonary fibrosis

Question 19

Inheritance of spherocytosis

Answer 19

Dominant

Question 20

Rheumatoid extra articular features

Answer 20

Eyes; scleritis, scleromalacia, sicca
Lungs; fibrosis, nodules
Kidneys; nephrotic syndrome (GN)
Heart; constrictive pericarditis, effusion
Nerves; peripheral neuropathy, carpal tunnel from subluxation
Splenomegaly, neutropenia - feltys

Question 21

XR findings RA

Answer 21

Soft tissue swelling
Subluxation
Loss of joint space
Periarticular osteopenia
Erosions

Question 22

RA HLA

Answer 22

DR4

Question 23

Treatments for Parkinson’s

Answer 23

Physio
OT
Mood
Levodopa and peripheral decarboxylase inhibitors, dopamine agonists

Question 24

Hashimotos antibodies

Answer 24

Anti tpo and anti thyroglobulin

Question 25

Hashimotos what is it

Answer 25

Most common cause of hypothyroidism Autoimmune inflammation and goitre then thyroid gland atrophies

Question 26

Meds causes of hypothyroidism

Answer 26

Lithium Amiodarone (can also cause hyper)

Question 27

Radio isotope scanning in Graves versus thyroiditis

Answer 27

Increased uptake in graves disease. Reduced in thyroiditis

Question 28

Treatment option if thyrotoxicosis returns

Answer 28

Radio iodine, but hypothyroidism is common afterwards Subtotal thyroidectomy

Question 29

Causes of hypoadrenalism

Answer 29

Autoimmune adrenalitis TB or sarcoid Amyloidosis Haemochromatosis metastatic infiltration Congenital adrenal hyperplasia Secondary is anterior pituitary failure

Question 30

Investigations for Cushing’s syndrome

Answer 30

Overnight dexamethasone suppression test: give 1 mg of dexamethasone at midnight and check 9 am cortisol If positive i.e. cortisol level above 50 then proceeded to identify the cause of Cushing syndrome with plasma ACTH level and high dose dexamethasone suppression test. Give 2 mg dexamethasone six hourly for 48 hours and measure the cortisol which should fall by more than 50% in pituitary Cushing’s but not adrenal or ectopic

Question 31

Gynaecomastia plus infertility plus tall man equals

Answer 31

Klinefelter’s syndrome Need to confirm primary gonadal failure, i.e. high LH and FSH with low testosterone

Question 32

Pupils in compressive third nerve palsy versus Horners

Answer 32

Dilated pupil and third nerve palsy. Constricted pupil in Horners

Question 33

Vitamin C surgical sieve

Answer 33

Vascular Infection Trauma Autoimmune Metabolic Idiopathic or iatrogenic Neoplastic Congenital Degenerative Endocrine