Miscellaneous

Question 1

What volume of blood drained immediately via a chest drain in a haemothorax indicates surgical exploraiton?

Answer 1

> 1500ml

Question 2

A Mediterranean man presents with oral ulcers, genital ulcers and anterior uveitis. What is the likely diagnosis?

Answer 2

Behcet’s disease

Classical triad

Question 3

Definition of neutropenic sepsis?

Answer 3

PMN count of 38C or another clinical sign of sepsis.

Question 4

Initial treatment of neutropenic sepsis

Answer 4

Urgent empirical antibiotics - Tazocin

Question 5

4 main clinical features of Refsum’s disease

Answer 5

Retinitis Pigmentosa
Cerebellar ataxia
Peripheral Neuropathy
Raised CSF protein with no raised cell count

Question 6

Which examination should be avoided in a patient with AML who is neutropenic and anaemic?

Answer 6

DRE

Rectal exams should be avoided in patients who are neutropenic as trauma to the ano-rectum provides an easy access route for GI organisms to enter the bloodstream.

Question 7

Causes of Horner syndrome

Answer 7

Central

• Stroke: Wallenberg
• MS
• Syringomyelia

Pre-ganglionic

• Tumour (Pancoast)
• Trauma: CVA insertion, carotid endarcterectomy
• Thyroidectomy

Post-ganglionic

• Cavernous sinus thrombosis
• Carotid artery aneurysm
• Carotid dissection

Question 8

Medical management options for Primary chronic open angle glaucoma?

Answer 8

B-blockers

• reduced aqueous production
• CI in asthmatics

Prostaglandin analogues (latanoprost)

• increase uveoscleral outflow
• brown pigmentation of eye

a-blockers (brimonidine)

• reduce production and increase outflow
• avoid if MAOi or TCA

Carbonic anhydrase inhibitor

Miotics: Pilocarpine
- pupil constriction, headache, diplopia

Question 9

Types of cataract

Answer 9

Nuclear sclerotis
Posterior subcapsular
Cortical

Question 10

Most common ocular manifestation of RA?

Answer 10

Keratoconjunctivitis sicca

Question 11

Distinguishing between scleritis and episcleritis

Answer 11

Scleritis is painful

Episcleritis is not.

Question 12

Contents of the Carpal Tunnel

Answer 12

10 items:
Median Nerve
4x tendons of FDP
4x tendons of FDS
1x tendon of Flexos pollicis longus

Question 13

Which nerves are affected in Erb’s palsy?

Answer 13

Disruption of C5/6 nerve root → suprascapular, musculo-cutaneous and axillary nerves

Waiter’s tip position: paralysis of abductors + external rotators. Biceps and supinators

Loss of sensation in C5/6

Question 14

Causes of Carpal Tunnel Syndrome

Answer 14

Occupational
- typing

Endocrine

• obesity
• DM
• acromegaly
• hypothyroid

Hormonal
- pregnancy, OCP, menopause

Rheumatological
- RA, gout

Granulomatous
- TB, sarcoid,

Neoplastic
- myeloma

Renal
- fluid overload, steal syndrome, B2 amyloidosis