Laz Paper 4

Question 1

What is myaesthenia gravis?

Answer 1

An autoimmune condition characterised by anti-ach receptor antibodies, leading to increased weakness with muscle use but preserved reflexes

Question 2

What are some of the early signs of myaesthenia gravis?

Answer 2

The most common early signs are ptosis and fatigue of the face/ neck muscles

Question 3

What are the two types of bladder cancer?

Answer 3

• Transitional cell carcinoma
• Squamous cell carcinoma
  
  • Schistosomiasis

Question 4

What’s the gold standard investigation for bladder cancer?

Answer 4

Cystoscopy and biopsy

Question 5

Does glomerulonephritis cause haematuria?

Answer 5

It causes microscopic haematuria

Question 6

Which drugs can lead to GORD?

Answer 6

Mucosal damage

• Steroids
• NSAIDs
• Bisphosphonates
• Aspirin

Drugs that reduce motility

• Nitrates
• TCAs
• Anti-cholinergics

Question 7

What is the management of GORD?

Answer 7

Medical

• PPI once daily
• PPI twice daily (if not responding)

Conservative

• Smaller meals
• Stop smoking
• Weight loss
• Not eating before bed

Question 8

Which organism is seborrhaic eczema thought to be associated with?

Answer 8

Pityrosporum yeast

Question 9

What is the atopic triad?

Answer 9

• Asthma
• Hay fever
• Eczema

Question 10

Which COPD patients should long term O2 therapy be started in?

Answer 10

• O2 <7.3kPa on maximum treatment
• O2 7.3-8 kPa with pulmonary hypertension, polycythaemia, nocturnal hypoxia, peripheral oedema
• Terminally ill patients

Question 11

What is the triad of acute mesenteric ischaemia?

Answer 11

Patients are classically female

• Severe abdominal pain
• Normal abdominal examination
• Shock

Question 12

What is mesenteric ischaemia?

Answer 12

Occlusion of the superior mesenteric artery leading to ischaemia

Question 13

What is the traid of chronic mesenteric ischaemia?

Answer 13

• Gut claudication
• PR bleeding
• Weight loss

Question 14

What would abdominal x-ray of chronic mesenteric ischaemia show?

Answer 14

• Gasless abdomen
• Pneumatosis
• Thickening of the bowel wall

Question 15

What are the most common causes of viral meningitis?

Answer 15

• Coxsackie A
• Herpes viruses
  
  • HSV
  • EBV
  • VSV

Question 16

What is not a feature of goodpasture’s syndrome?

Answer 16

Nasal bleeding

Question 17

Which antibodies are present in auto-immune hepatitis?

Answer 17

Type 1

• Anti-smooth muscle
• ANA

Type 2

• Anti-LKM1

Question 18

Why is lactate measured in sepsis?

Answer 18

Because increased lactate levels indicate increased end organ failure due to lack of perfusion

Question 19

What is arthritis mutilans?

Answer 19

Pencilling of the joints in psoriatic arthritis

Question 20

How long are patients unconscious in an epileptic seizure?

Answer 20

Minutes

Question 21

What is overflow diarrhoea?

Answer 21

Faecal impaction/ blockage leads to constipation which leads to build up of faecal matter behind the blockage. Eventually diarrhoea seeps through

Question 22

What is a rectocele?

Answer 22

A herniation of the rectum into the vaginal canal due to loss of integrity of the rectovaginal septum

Question 23

What is the presentation of rectocele?

Answer 23

• Tenesmus
• Dysparunia
• Constipation
• Faecal incontinence

Question 24

What is the inheritance pattern of PCOS?

Answer 24

Autosomal dominant with variable expressivity

Question 25

What are the features of Turner's syndrome?

Answer 25

Females only inheriting one X chromosome * Short stature * Primary amenorrhea * Low set posterior hairline * Webbed neck

Question 26

What is a hypopyon?

Answer 26

Yellow exudate seen on the anterior chamber of the eye associated with corneal ulcers

Question 27

What is a hyphema?

Answer 27

Blood seen in the anterior chamber of the eye associated with ocular trauma

Question 28

What is the inheritance pattern of HOCM?

Answer 28

Autosomal dominant

Question 29

What are the examination findings of HOCM?

Answer 29

* Ejection systolic murmur * Double apex beat * Jerky carotid pulse

Question 30

Which medication is used to reduce the symptoms of alcohol withdrawal?

Answer 30

IV chlordiazepoxide

Question 31

What is the function of loperamide?

Answer 31

Low level opioid used as an anti-diarrhoeal agent

Question 32

What is the function of risperidone?

Answer 32

Anti-psychotic used in schizophrenia and bipolar disorder

Question 33

Which stain is used for AML?

Answer 33

Sudan black stain

Question 34

What are the two features of CLL?

Answer 34

* Smear cells on blood film * Warm agglutinins

Question 35

What is the presentation of Hodgekin's lymphoma?

Answer 35

* Lymphadenopathy painful after alcohol * Reed-Sternberg cells

Question 36

What is the presentation of non-hodgekin's lymphoma?

Answer 36

Painless cervical lymphadenopathy (enlarging)

Question 37

What are the haematological features of myelodysplasia?

Answer 37

* Granulocytes without granules * Hyposegmented leukocytes * Ringed sideroblasts

Question 38

What are the defining features of myelofibrosis?

Answer 38

* Dacrocytes * Dry tap on biopsy/ aspiration * Exposure to radiation * Massive splenomegaly

Question 39

What is Steven Johnson Syndrome?

Answer 39

A really really bad case of erythema multiforme

Question 40

What is Stevens-Johnson syndrome most commonly associated with?

Answer 40

Anti-epileptic drugs eg. lamotrigine

Question 41

What should be given alongside RIPE TB treatment?

Answer 41

Pyridoxine which is a vitamin B6 replacement as Isoniazid decreases B6 levels, which can lead to peripheral neuropathy

Question 42

What is the normal pressure hydrocephalus triad?

Answer 42

* Dementia/ confusion * Urinary incontinence * Gait ataxia Wacky, wet, wobbly