Deck 9

Question 1

What are the features of S1 nerve root compression?

Answer 1

Sensory loss of posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Question 2

How long should patients be anticoagulated for if they are to have elective DC cardioversion?

Answer 2

Anticoagulated for at least 3 weeks

After DCCV, the patient should be anticoagulated for at least 4 weeks before decisions about anticoagulation should be made

NOTE: patients can have a TOE and, if negative, be heparinised and receive DCCV then and there. If there is high risk of cardioversion failure (e.g. previous failure or AF recurrence) then patients should also have at least 4 weeks of amiodarone or sotalol before DCCV.

Question 3

What are the main homozygous genotypes of alpha 1 antitrypsin deficiency?

Answer 3

PiMM = normal
PiSS = A1AT 50% of normal 
PiZZ = A1AT 10% or normal - this is the type that gets lung/liver manifestations

Question 4

What are the manifestations of a parietal lobe lesion?

Answer 4

Sensory inattention
Apraxia
Astereognosis
Inferior homonymous quadrantanopia
Gerstmann syndrome (lesion of dominant parietal lobe): alexia, acalculia, finger agnosia and right-left disorientation

Question 5

What is an important complication of topiramate treatment?

Answer 5

Acute angle closure glaucoma

Presents with acute myopia, headache and unreactive pupils

Question 6

Which dermatomes are affected by C6-8 radiculopathies?

Answer 6

C6 - thumb and index finger
C7 - middle finger + palm of hand
C8 - ring + little finger

Question 7

How is idiopathic pulmonary artery hypertension treated?

Answer 7

Prostacyclin analogues (treprostinil)
Endothelin receptor antagonists (bosentan)
Phosophodiesterase inhibitors (sildenafil)

NOTE: if good response to acute vasodilator testing - CCBs may be used (minority of patients)

Question 8

List some NRTIs and NNRTIS.

Answer 8

NRTI: zidovudine, abacavir, emtricitabine, lamivudine, tenofovir

NNRTI: nevirapine, efavirenz

Question 9

What are the presenting features of porphyria cutanea tarda?

Answer 9

Photosensitive rash with blistering in sun exposed areas (usually hands)
Hypertrichosis
Hyperpigmentation

NOTE: treated with chloroquine and venesection

Question 10

What is internuclear ophthalmoplegia and which part of the brain is affected?

Answer 10

Inability to adduct the affected eye resulting in nystagmus and diplopia

It is caused by damage to the median longitudinal fasciculus which is found in the paramedian area of the midbrain and pons

Question 11

How is ethylene glycol poisoning treated?

Answer 11

Fomepizole (inhibitor of alcohol dehydrogenase)

NOTE: ethanol used to be used to treat this k

Question 12

How does Kearns-Sayre syndrome present?

Answer 12

External ophthalmoplegia
Retinitis pigmentosa (night blindness)
Ptosis
Usually < 20 yrs
Diabetes mellitus (insulin-dependent)
Complete heart block 
Cardiomyopathy 
Recurrent stroke 

Maternal inheritance

Question 13

What is the first-line treatment for severe mitral stenosis?

Answer 13

Percutaneous mitral commisurotomy (balloon valvulotomy)

NOTE: transcatheter mitral valve repair is a second choice

Question 14

List some medications that can exacerbate myasthenia gravis.

Answer 14

Beta-blockers
Antibiotics (gentamicin, macrolides, quinolones, tetracyclines)
Phenytoin
Lithium
Penicillamine
Procainamide

Question 15

Which antigen is the antibody in pemphigus vulgaris and bullous pemphigoid directed against?

Answer 15

Pemphigus Vulgaris: Desmoglein 3

Bullous Pemphigoid: Hemidesmosome

Question 16

What does the Golgi apparatus add to protein in order to traffic them to lysosomes?

Answer 16

Mannose-6-phosphate

Question 17

What is the second-line treatment option for angina if beta-blockers and rate-limiting calcium channel blockers are contraindicated?

Answer 17

Nicorandil (potassium channel activator)

NOTE: it is associated with causing gastrointestinal ulceration (ranging from oral ulcers to anal ulcers)

Question 18

List the commonly used steroids in order of decreasing mineralocorticoid activity.

Answer 18

Hydrocortisone (most mineralocorticoid activity)
Prednisolone
Dexamethasone/Betamethasone

Question 19

What are the main symptoms of renal vein thrombosis?

Answer 19

Sudden-onset flank pain
Deterioration in renal function
Haematuria

Question 20

What is chronic granulomatous disease and how does it present?

Answer 20

Neutrophil disorder resulting from a lack of NADPH oxidase, which reduces the ability of the neutrophil to produce ROS

Presents with recurrent pneumonia/abscesses (particularly S. aureus and funguses like Aspergillus)