Mix 4

Question 1

When do you specifically start insulin tx in GD? [2]

Answer 1

If fasting glucose is greater than 7
OR
if 6-6.9 and evidence of macrosomia or polyhydromanios

Question 2

What is Alport’s syndrome? [1]
State three key features [3]

Answer 2

Alport syndrome is a genetic condition affecting type 4 collagen, characterised by progressive sensorineural hearing loss, kidney disease, and eye abnormalities.
- Hearing loss is typically bilateral, affecting high frequencies first, and is not associated with conductive hearing loss.
- The Weber test will not lateralise because both ears are equally affected. The Rinne test will show air conduction greater than bone conduction (AC > BC) in both ears (positive result), which is consistent with sensorineural hearing loss.

Question 3

What are renal biopsy findings for eGPA? [1]

Answer 3

This is a rare vasculitis which causes granulomatous inflammation.

Question 4

What are the 5H’s of ciclosporin? [5]

Answer 4

H’s: hypertrophy of the gums, hypertrichosis, hypertension, hyperkalaemia and hyperglycaemia (diabetes)

Question 5

[1] is the first-line treatment for uncomplicated cases of oral candidiasis in immunocompetent adults,

Answer 5

Oral miconazole gel is the first-line treatment for uncomplicated cases of oral candidiasis in immunocompetent adults,

Question 6

What is a key differentiating feature for PAN vs MPA? [1]

Answer 6

Abdominal pain due to mesenteric ischaemia

Question 7

CN6 palsy x diploplia could be a sign of what? [1]

Answer 7

Brain cancer - due to long nature of nerve (goes along back of skull) - easier to get compressed

Question 8

First line tx for wet AMD? [1]

Answer 8

anti-VEGF meds

Question 9

If a person has a stroke and has fluent speech but poor repitition - where is the lesion? [1]

Answer 9

arcuate fasiculus

Question 10

How long should septic arthritis tx last? [1]

Answer 10

4-6 weeks

Question 11

If someone is pulling off clothes in their seizure - where is it from? [1]

Answer 11

Temporal

Question 12

What is the Simmons triad? [3]

Answer 12

“The Simmonds’ triad of altered angle of declination (the foot of the injured leg rests in a more dorsiflexed position than the other side when the patient lies prone), palpable gap, and lack of plantarflexion on calf squeeze test will detect a rupture in nearly all cases”

Question 13

How do you differentiate between discitis and psoas abscess? [2]

Answer 13

Discitis will have more localised tender back pain
- worse with hip movement

PA will present with more flank pain

Question 14

In presbycusis, describe the specific type of hearing loss [2]

Answer 14

Bilateral high frequency hearing loss
Causes people to talk quietly

Question 15

Wilm’s tumour can met. to where? [1]

Answer 15

Cannonball mets - lungs

Question 17

What are the main causes of viral men. and encephalitis in kids? [2]

Answer 17

Men: Coxsackie v
Encephalitis: HSV-1/2

Question 18

Oropharnygeal cancer is linked with which organism? [1]
How does it often present? [1]

Answer 18

HPV
Localised neck mass with no symptoms. Tongue and tonsils primary sites

Question 19

CGA is linked with which cardic condition?[1]

Answer 19

Aortic aneurysm

Question 20

Meninigitis x gram -ve coccobacilli = ? [1]

Answer 20

HiB

Question 21

Quincy 1st line tx? [1]

Answer 21

Incision and drainage (and then abx)

Question 22

Difference in vision loss in retinal detachment vs posterior retinal detachment? [1]

Answer 22

RD: Descending black curtain
PVD: block spots appear

Question 23

How do you differentiate between syringomyelia and transverse myelitis? [2]

Answer 23

Pain and temp bilaterally first in syrinx
- occurs at cross level of cervical cord
- light touch and proprioception spared
AND
- LMN picture - wasting and absent reflexes

Transverse myelitis presents with acute illness; not chronic

Question 24

When treating meconium ileus - what is the Ix of choice? [1] Tx? [1]

Answer 24

Gastrogaffin enema - can help to dislodge the meconium to due osmotic effect
- If needed then can tx with laparatomy

Question 25

Most common cause of erypiselas? [1]

Answer 25

GAS

Question 26

Where exactly are the following located: - Hammer toe - Mallet toe - Claw toe

Answer 26

MHC Mallet: DIP Hammer toe: PIP Claw: MCP

Question 27

What would indicate proteinuria in pre-eclampsia? [1]

Answer 27

A **urine PCR of 30 mg/mmol or more is the threshold for significant proteinuria**. Urine PCR is more accurate and easier to use than a 24 h urine collection test.

Question 29

Describe how you calculate gravidy and parity [+]

Answer 29

Multiple pregnancies are always counted as one. Parity is the number of 'parous events' i.e. number of times a person has given birth (either vaginally or via caesarean section), to a pregnancy with a gestational age of at least 24+0 weeks, regardless of whether the foetus was live or stillborn. (Three in this case). Giving birth to a multiple pregnancy is always counted as one. Parity is suffixed by the number of miscarriages or terminations earlier than 24+0 weeks (+2 in this case)

Question 30

Which one of the following complications is most associated with psoralen + ultraviolet A light (PUVA) therapy? Squamous cell cancer Osteoporosis Basal cell cancer Dermoid cysts Malignant melanoma

Answer 30

Squamous cell cancer

Question 31

How do you alter antidepressant medication pre-ECT? [1]

Answer 31

Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment

Question 32

Describe what is meant by Ramsey-Hunt syndrome [1]

Answer 32

Ramsay-Hunt syndrome is shingles affecting the facial nerve. This results in ear pain, vesicles in the external ear canal associated with vertigo and deafness.

Question 33

Which type of juvinile epilepsy syndrome is most common in teenage girls? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 33

**Juvenile myoclonic epilepsy (Janz syndrome)**

Question 34

Which of the following is most associated with paraesthesia (e.g. unilateral face), usually on waking up Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 34

Which of the following is most associated with paraesthesia (e.g. unilateral face), usually on waking up Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome **Benign rolandic epilepsy**

Question 35

Which of the following is most associated with EEG: slow spike? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 35

Which of the following is most associated with EEG: slow spike? Juvenile myoclonic epilepsy (Janz syndrome) **Lennox-Gastaut syndrome** Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Question 36

Which of the following is most associated with EEG: hypsarrhythmia? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 36

Which of the following is most associated with EEG: hypsarrhythmia? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures **West Syndrome** Benign rolandic epilepsy

Question 37

Which of the following is most associated with EEG: 3Hz generalized, symmetrical? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 37

**Typical (petit mal) absence seizures**

Question 38

Describe features of the following: Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 38

Question 39

How do you manage a child with DKA? [+]

Answer 39

**Management of DKA should be based on the A to E approach followed by the following treatments:** * IV fluids (initial bolus of 10ml/kg 0.9% NaCl, even if the patient is shocked) given over 15 minutes. * Repeat as needed to restore circulation * At 40 ml/kg then discuss with a senior for consideration for inotropes * Insulin infusion at 0.1 units/kg/hour 1 hour after starting IV fluids **Fluids**: * Further fluids, following initial boluses should contain 40 mmol/l potassium chloride to protect against hypokalaemia. * Total fluid required = deficit + maintenance

Question 40

What is the typical description of a VSD? [1]

Answer 40

**harsh** systolic murmur

Question 41

What is used prior to ECV to increase success? [1]

Answer 41

Terbutaline

Question 42

Name 5 side effects of POP [+]

Answer 42

Depression breast tenderness dizziness diarrhoea fatigue

Question 43

1st line tx for acne in PCOS? [1]

Answer 43

Weight loss

Question 44

Which x-ray changes might you see in PsA? [3]

Answer 44

**Periostitis** (inflammation of the periosteum, causing a thickened and irregular outline of the bone) **Ankylosis** (fixation or fusion of the bones at the joint) **Osteolysis** (destruction of bone) **Dactylitis** (inflammation of the whole digit, seen as soft tissue swelling) ## Footnote **TOM TIP: Psoriatic arthritis** tends to affect the distal interphalangeal (**DIP**) joints and **axial skeleton**, whereas rheumatoid arthritis tends not to affect these joints. This can help you distinguish them. Photo: presented with fluffy periotitis in the proximal phalanges in both hands (arrow head)