Paper 2 prep

Question 1

Mx of fibromyalgia?

Answer 1

Explain + CBT

Aerobic exercise - best evidence

neuropathic pain meds

Question 1

Shoulder dislocations - which is when?

Answer 1

95% + = anterior (external rotation and abduction)

Seizure = posterior

Question 2

Calf squeeze + absent plantar flexion = ???

Ix?

Answer 2

Achilles tendon rupture (simmonds test +ve)

US + refer to ortho

Question 3

What to do when starting allopurinol for gout prevention?

Answer 3

Provide NSAID or colchine cover as it can trigger acute flare up

Question 4

Which nerve is used for finger abduction and adduction? How can you distinguish if leison is at the wrist or elbow?

Answer 4

Ulnar (palmer and dorsal interossei muscles)

Ulnar injury at wrist : marked claw
Ulnar injury at elbow : less claw but get worse before getting better
(The closer to the paw, the bigger the claw)

Question 5

Which is better to diagnose ank spond:

Lumbar XR = bamboo spine

Pelvic XR = sacro iliits

Answer 5

Pelvic XR = sacro iliits - the other is a late stage sign

Question 6

Loss of foot dorsiflexion + sensory loss of dorsum of foot = what nerve root leison?

Answer 6

L5

Question 7

How to distinguish between L3 and L4 nerve root compression?

Answer 7

Both cause:
- Reduced knee reflex
- +ve femoral stretch test

L3:
- Sensory loss over anterior thigh
- Weak hip flexion, knee extension and hip adduction

L4:
- Sensory loss anterior aspect of knee and medial malleolus
- Weak knee extension and hip adduction

Question 8

Mx of achilles tendonitis?

Answer 8

Rest, NSAIDs, and physio if symptoms persist beyond 7 days

Question 9

What are some RFs for achilles tenrdon disorders?

Answer 9

quinolone use (e.g. ciprofloxacin) is associated with tendon disorders

hypercholesterolaemia (predisposes to tendon xanthomata)

Question 10

ITP type of hypersenitivity?

Answer 10

Type II hypersensitivity reaction

Question 11

DMARD w/ mouth ulcers?

Answer 11

Methotrexate

Question 12

What drug can cause dupuytrens contracture?

Answer 12

Phenytoin

Question 13

The humeral head is seen in a subcoracoid position in anteroposterior view on X-ray

Answer 13

Anterior shoulder dislocation

Question 14

Compression of what nerve root = present with back, groin, and anterior thigh pain. There may be weakness of hip flexion but lower limb reflexes tend to be normal.

Answer 14

L2

Question 15

Compression of what nerve root = present with back, groin, and anterior thigh pain. There may be weakness of hip flexion but lower limb reflexes tend to be normal.

Answer 15

L2

Question 16

Ulnar parasthesia + weak digit flexion (inc thumb) =??

Answer 16

C8 radiculopathy

Question 17

A knee radiograph identifies a triangular area of new subperiosteal bone in the metaphyseal region of the femur, with a ‘sunburst’ pattern

Dx??

Answer 17

Osteosarcoma

Question 18

Signs of primary raynauds (disease)?

Answer 18

Bilateral raynauds + onset <40y

Question 19

Best initial mx of open fractures?

Answer 19

IV Abx

photography of wound

application of a sterile soaked gauze and impermeable film

Question 20

Behcets - derm finding?

Answer 20

Erythema nodosum

Question 21

Nursemaid elbow mx (subluxation of radial head - pulled elbow)?

Answer 21

Passive supination of the elbow joint whilst flexed to 90 degrees

Question 22

Mx of patellar fractures?

Answer 22

Undisplaced fractures with intact extensor mechanism:
- Non-operative management
- Hinged knee brace for 6 weeks
- Full weight bearing allowed

Displaced fractures or those with disrupted extensor mechanism:
- Operative management with various techniques (tension band wire, interfragmentary screws or cerclage wires)
- Hinged knee brace for 4 to 6 weeks
- Full weight bearing allowed

Question 23

allergic contact dermatitis - hypersenitivity type?

Answer 23

Type 4 (IV)

Question 24

What is antisynthetase syndrome?

Answer 24

Myositis with +ve anti-Jo1 antibodies can predispose to lung fibrosis

Question 25

Why may a pt w/ temporal arteritis have a pale and oedematous optic disc on fundoscopy?

Answer 25

Anterior ischaemic optic neuropathy

Question 26

What nerve is damaged: Weakness in hip adduction, numbness over the medial thigh

Answer 26

Obturator

Question 27

What nerve is damaged: Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

Answer 27

Sciatic

Question 27

What nerve is damaged: Weakness in ankle dorsiflexion, numbness of the calf and foot

Answer 27

Lumbosacral

Question 28

Weakness in knee extension, loss of the patella reflex, numbness of the thigh

Answer 28

Femoral

Question 29

Mx of suspected scaphoid fracture w/ no signs on initial XR?

Answer 29

This could well be a scaphoid fracture and should be temporarily immobilised pending further review. A futura splint will immobilise better than an arm sling for this problem. Clinic review @7-10d

Question 30

Chemo pts - gout or pseudogout?

Answer 30

GOUT

Question 31

Which antibodies are associated w drug induced lupus? Which drugs can cause this?

Answer 31

Anti histone Drugs: - Most common = Procainamid + hydralazine - Less common = Isoniazid, minocycline and phenytoin

Question 32

What indicates that hip pain may be due to referred lumbar spine pain?

Answer 32

+ve femoral nerve stretch test

Question 33

Gout meds - cause of diarrhoea?

Answer 33

Colchicine

Question 34

What can cause a false +ve VDRL / RPR (for syphilis)

Answer 34

SLE, TB, Malaria, HIV

Question 35

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests what infection?

Answer 35

Leptospirosis

Question 36

Mx of chlamydia trachomatis - in pregnancy and otherwise?

Answer 36

Pregnancy = azithro, erythro / amox Non-pregnant = doxycycline

Question 37

Mx of pubic lice?

Answer 37

Malathion / permethrin

Question 38

Mx of flagellated protozoa - STI?

Answer 38

Trichomonas vaginalis -> Metronidazole

Question 39

PainLESS penile ulcer - likely organism?

Answer 39

Treponema pallidum - syphilis

Question 40

Ix for symptomatic schistosomiasis?

Answer 40

Stool + Urine microscopy - look for eggs chronic infection mx = 1 dose praziquantel

Question 41

Exudative tonsiliits - organism

Answer 41

Strep pyogenes

Question 42

What is post exposure prophylaxis for HIV?

Answer 42

Refer to ED and oral ART 4w

Question 43

Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel → ??? ix? mx?

Answer 43

Giardiasis ix = stool microscopy, antigen detection assay = more sensitive + quicker mx = metronidazole

Question 44

Syphilis test result interpretations: RPR and TPHA

Answer 44

Question 45

Skin hypopigmentation + Loss of sensation = ???

Answer 45

Leprosy mx = RDC - rifampicin, dapson and clofazimine

Question 46

MRSA (when pt is vancomycin allergic)

Answer 46

Linezolid

Question 47

Most common cause of diarrhoea in HIV pts?

Answer 47

Cryptosporidium

Question 48

Pt w/ previous TB + An X-ray is taken which shows a target-shaped lesion in the right upper lobe with air crescent sign present Likely dx?

Answer 48

Aspergilloma - developing in lung cavity caused by TB

Question 49

Farmer, fever, transaminitis - dx and mx?

Answer 49

Q fever - Coxiella burnetti (from animals) Doxycycline

Question 50

When to suspect reinfection w/ syphilis?

Answer 50

If RPR rises by 4x or more

Question 51

What is CSF glucose like in bacterial meningitis?

Answer 51

CSF glucose is <1/2 of serum glucose

Question 52

HIV, neuro symptoms, widespread demyelination - dx?

Answer 52

progressive multifocal leukoencephalopathy (PML) - JC / BK Virus

Question 53

IDA + itchy rash + Eosinophilia -> dx?

Answer 53

Hookworm

Question 54

Man returns from trip abroad with maculopapular rash and flu-like illness

Answer 54

HIV seroconversion

Question 55

What pneumonia is often preceeded by influenza infection?

Answer 55

Staph aureus

Question 56

Returning south american traveller + primary skin leisons w/ mucosal involvement - dx?

Answer 56

Leishmaniasis

Question 57

undercooked pork - which hep?

Answer 57

HEP E

Question 58

Avoid usuing hypotonic (0.45%) in paeds pts - why?

Answer 58

Risk of hyponatraemic encephalopathy

Question 59

When should suxamethonium be avoided in anasthesia?

Answer 59

Suxamethonium is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure

Question 60

Ix for anastomotic leak

Answer 60

CT abdo

Question 61

Adhesions - more common in laparoscopic or open surgeries?

Answer 61

Open - lap reduces risk

Question 62

Mx of hypocalcaemic tetany following thyroidectomy?

Answer 62

IV ca

Question 63

How much should morphine doses be increased by in palliative pt if pain isnt conrolled by current dose?

Answer 63

30-50%

Question 64

Mx of Warm AIHA?

Answer 64

Steroids +- Rituximab

Question 65

What drug can cause renal failure in MM?

Answer 65

NSAIDs

Question 66

typical blood film findings of hyposplenism?

Answer 66

Howell-Jolly bodies and siderocytes