Day 9

Question 1

What is prehn’s sign?

Answer 1

In testicular torsion the elevation of the testis does not ease pain compared to epididymitis

Question 2

Most common cause of watery eye in infant

Answer 2

Nasolacrimal duct obstruction

Question 3

What is wernickes

Answer 3

receptive aphasia, due to a lesion of the superior temporal gyrus, which results in patients being able to produce fluent speech, but comprehension and repetition is impaired.

Question 4

what causes conduction aphasia

Answer 4

A lesion to the arcuate fasciculus

Question 5

what causes broca’s

Answer 5

A lesion to the left inferior frontal gyrus

Question 6

How does serotonin syndrome present?

Answer 6

diaphoresis, tremor, confusion and hyperreflexia

Question 7

Management of status epilepticus

Answer 7

> ABC
-airway adjunct
-oxygen
-check blood glucose
First-line drugs are benzodiazepines such as diazepam or lorazepam
-in the prehospital setting diazepam may be given rectally
-in hospital IV lorazepam is generally used. This may be repeated once after 10-20 minutes
If ongoing (or ‘established’) status it is appropriate to start a second-line agent such as phenytoin or phenobarbital infusion
If no response (‘refractory status’) within 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of general anaesthesia.

Question 8

where are lesions of HSP normally found?

Answer 8

buttocks, extensor surfaces of legs and arms.

Question 9

How is dehydration characterised with U&E tests

Answer 9

urea that is proportionally higher than the rise in creatinine

Question 10

How does fracture of the 5th metatarsal often occur?

Answer 10

forced inversion of the foot and ankle

Question 11

How does lsd present?

Answer 11

colourful visual hallucinations, depersonalisation , psychosis and paranoia

Question 12

how is LSD toxicity managed

Answer 12

> Agitation, e.g. from a ‘bad trip’, should be first managed with supportive reassurance in a calm, stress-free environment.
If ineffective, benzodiazepines are the medication of choice.
LSD-induced psychosis may require antipsychotics.
Massive ingestions of LSD should be treated with supportive care, including respiratory support and endotracheal intubation if needed.
Hypertension, tachycardia, and hyperthermia should be treated symptomatically. >Hypotension should be treated initially with fluids and subsequently with vasopressors if required.
Because LSD is rapidly absorbed through the gastrointestinal tract, activated charcoal administration and gastric emptying are of little clinical value by the time a patient presents to the emergency department.

Question 13

What is beck’s triad

Answer 13

found in cardiac tamponade

Beck’s triad: elevated venous pressure, reduced arterial pressure, reduced heart sounds.
Pulsus paradoxus
May occur with as little as 100ml blood

Question 14

What is aortic rupture often found?

Answer 14

Deceleration injury

Question 15

Global t wave inversion in all leads

Answer 15

non-cardiac cause

Question 16

ECG changes in hypothermia

Answer 16

QT prolongation

Question 17

What is the marker for carcinoid syndrome?

Answer 17

they release serotonin so urinary 5-HIAA will be high

Question 18

Cause of croup

Answer 18

parainfluenza virus

Question 19

risk factors for degenerative cervical myelopathy

Answer 19

> smoking due to its effects on the intervertebral discs
genetics
occupation

Question 20

investigation for degenerative cervical myelopathy

Answer 20

MRI of cervical spine

showing disc degeneration and ligament hypertrophy, with accompanying cord signal change

Question 21

What is the M rule

Answer 21

for PBC
: IgM
: anti-mitochondrial antibodies, M2 subtype
: middle aged females

Question 22

Expected LFTs in hepatocellular disease

Answer 22

ALT: raised 2 fold
ALP: normal
ALT/ALP:5 x

Question 23

Expected LFTs in cholestatic disease

Answer 23

ALT: normal
ALP: raised 2-fold
ALT/ALP: <2

Question 24

Expected LFTs in mixed disease

Answer 24

ALT: raised at least 2-fold
ALP: raised 2-fold
ALT/ALP: 2-5

Question 25

Drugs causing urinary retention

Answer 25

tricyclic antidepressants e.g. amitriptyline
anticholinergics
opioids
NSAIDs
disopyramide

Question 26

DPP4 inhibitors

Answer 26

:increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
:oral preparation
:relatively well tolerated with no increased incidence of hypoglycaemia
:do not cause weight gain

Question 27

Management of secondary pneumothorax

Answer 27

<1cm, admit and give oxygen for 24 hours and review

Question 28

what is the only ccb licensed in HF

Answer 28

Amlodipine

Question 29

most common and important viral infection in solid organ transplant recipients

Answer 29

cytomegalovirus

Question 30

antibodies in anti-phospholipid

Answer 30

anticardiolipin

Question 31

patterns of damage of radial nerve

Answer 31

wrist drop

sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals

Question 32

diagnosis of pertussis

Answer 32

nasal swab

Question 33

squaring of thumbs

Answer 33

osteoarthritis

Question 34

management of wells score >2

Answer 34

Doppler proximal leg ultrasound within 4 hours. If a scan cannot be arranged within 4 hours she should be given low-molecular weight heparin to ‘cover her’ until the scan.

Question 35

presentation of G6PD deficiency

Answer 35

Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies

Question 36

diagnosis of G6PD

Answer 36

enzyme assay around 3 months after acute episode of haemolysis

Question 37

What is EATL

Answer 37

complication of coeliac disease- enteropathy-associated T cell lymphoma (EATL),

Question 38

A&E assessment for fluid in abdomen and thorax

Answer 38

FAST scan