Nov 2023

Question 1

Nodular lesion,
shiny surface,
telangiectasis.
skin cancer ?

Answer 1

Basal cell CA

Question 2

Heart block post-IWMI.
Next step ?

Answer 2

observation

Question 3

Urine - E.Coli while
fever (–)
Pain (–)
Blood markers (–)
next step?

Answer 3

observation
(no need to change catheter)

Question 4

alcohol withdrawl / delirium tremons
Dx ?

Answer 4

48 - 72 hrs post admission
low PLT/Anemia
acutely confused, spiders crawling on bed/skin

Question 5

acute schizophrenia Rx ?

Answer 5

Risperidone
(atypical anti-psychotic)

Question 6

DEXA Scan ?

Answer 6

underlying osteoporosis
(back pain after RTA, possible wedge fracture)

Question 7

CO Poisoning in COPD pts
Rx ?

Answer 7

NIPV
(Avoid hyperbaric O2 - worsen COPD)

Question 8

keratocanthoma ?

Answer 8

initially grow rapidly in size, then start to reduce in size
(d/d - squamous cell CA don’t reduce in size)

Question 9

Gonococcal proctitis.
Rx (non-pregnant vs pregnant)

Answer 9

Ceftriaxone 1gm IM stat
(pregnancy - azithro 2gm stat)

Question 10

Vit B12 deficiency ?

Answer 10

nitric oxide inactivate methionine - substrate for THF - DNA synthesis - Vit B12 def

Question 11

haloperidol use ?

Answer 11

Rx acute delirium with psychotic features

Question 12

Pemphigus Dx ?

Answer 12

oral lesion almost always (+) and often appears before skin lesions.

Question 13

pseudo-thrombocytopenia and PLT clumping. high K+, asymptomatic pt.

Answer 13

traumatic venepuncture

Question 14

acute dystonia Rx ?

Answer 14

procyclidine

Question 15

RTA-1
Pathogenesis ?

Answer 15

imapired Distal tubule H+ secretion.

Question 16

COPD
not managed with
ICS (Fluticasone) + LABA (Salmetrol) + LAMA (Tiotropium).
Next step?

Answer 16

roflumilast (PDE4 inhibitor)

Question 17

necrobios lipoidica
appearance ?

Answer 17

DM pt
erythematous plaques below knees
later atrophied with yellowing/thinning

Question 18

low grade dysplasia with Barrett esophagus. next step?

Answer 18

radio frequency ablation
(if only barrette - 2yr surveillance)

Question 19

candida albicans Rx ?

Answer 19

Caspofungin
(if not enough - Amphoteracin B)

Question 20

Name of vitamin D in CKD ?

Answer 20

Calcitriol

Question 21

DVT prophylaxis in Cancer pt ?

Answer 21

dalteparin/enoxaparin (LMWH)
(Apiban - only if DVT while treated with LMWH)

Question 22

Daily fever, oligoarthritis, salman pink rash, raise CRP/Ferritin. RA (–)

Answer 22

Adult-onset still’s Dz

Question 23

carbamazepine effect on thyroid metabolism?
what happen when you replace it with levetiracetam?

Answer 23

(1) increase production of TBG
(2) increase activity of UGT
thereby catalyze the breakdown of thyroid hormone.
levetiracetam - reduce UGT - increase T4 levels - mild thyrotoxicosis s/s.

Question 24

cause of dysphagia post-chemo for hodgkin’s ?

Answer 24

esophageal stricture

Question 25

Needle stick injury (HBV) but Anti-HBs titer < 10 next step?

Answer 25

HepB Ig (2 doses) + HepB vaccine (1 booster)

Question 26

hereditary motor & sensory neuropathy type1 (charcot-marie-tooth disease) Dx ? Rx ?

Answer 26

distal muscle atrophy loss of fine touch and vibration Rx - physiotherapy

Question 27

Roxadustat in CKD ?

Answer 27

PO treatment for anemia in CKD where pt have enough Iron. alternative to EPO

Question 28

peritoneal dialysis fluid leak ?

Answer 28

pleural fluid: low glucose, low pH alongwith R-sided pleural effusion.

Question 29

Valsartan - angioedema ?

Answer 29

yes, rarely (10% pts who showed angioedema on ACE-i)

Question 30

hemodynamic stable VT Rx ?

Answer 30

amiodarone

Question 31

31 wk pregnant female, RUQ pain, normal LFTs/CRP. mild increase ALP (due to placenta). no stone in bile duct. plan ?

Answer 31

re-assurance

Question 32

syphilis Rx (Penicillin allergic) ?

Answer 32

Doxycycline (100mg BD - 2weeks)

Question 33

hyperCa++ (lung CA) ?

Answer 33

Squamous cell CA

Question 34

Pt on Apiban - develops ICH. Next step ?

Answer 34

andeXanet alpha (better than PCC)

Question 35

Vaccination C/I in HIV (+) pt? 2 vaccines...

Answer 35

Live attenuated influenza vaccination (note Yellow fever vaccination C/I if CD4 < 200 or age > 60)

Question 36

OSA Rx (besides CPAP) ?

Answer 36

Mild Dz (mandibular advancement device) moderate to severe Dz (uvuloplasty)

Question 37

Acute Gout flare Rx (pt = CKD + HFrEF)

Answer 37

Colchicine (not steroids) upto eGFR of 11.

Question 38

bradycardia/syncope causes ?

Answer 38

Donepezil other cholinesterase inhibitors Rx alzheimer's Dz

Question 39

Pt on PPM - Need ventricular lead extraction. Why?

Answer 39

(1) dropped ventricular beats with P waves only (2) frequent Ventricular ectopics (3) change from LBBB to RBBB

Question 40

Tacrolimus (post-renal transplant) + antifungal/macrolides ?

Answer 40

antifungal/macrolides = potent inhibitors of CYP3A4 liver enzyme. this enzyme metabolize tacrolimus/ciclosoprin. leading to toxicity of Tacrolimus.

Question 41

HyperCa++ Management (PTHrP s/t Squamous cell CA) ?

Answer 41

zoledronate

Question 42

HyperCa++ Management (s/t Tertiary hyperparathyroidism)

Answer 42

Cinacalcet (calcimimetic) - pt not fit for surgery.

Question 43

8 hr threshold below which N-acetylcysteine be stop?

Answer 43

50mg/l