passmed corrections may part 1

Question 1

Pneumonia, peripheral blood smear showing red blood cell agglutination →

Answer 1

Mycoplasma pneumoniae

often affects younger patients.
Mycoplasma serology
haemolytic anaemia/ITP
enceph/GBS
peri/myocarditis
eyrthema multiforme

Question 2

treat atypical pneumonia with

Answer 2

macrolide

legionella
mycoplasma

Question 3

Ankylosing spondylitis features other than spinal

Answer 3

• the ‘A’s
  Apical fibrosis
  Anterior uveitis
  Aortic regurgitation
  Achilles tendonitis
  AV node block
  Amyloidosis

Question 4

what infants get ultraaound of pelvis at 6 weeks for DDH screening

Answer 4

first-degree family history of hip problems in early life
breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
multiple pregnancy

all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests

Question 5

signs of aortic regurg

Answer 5

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)

mostly caused by RF but also spondyloarthropathies, marfans, hypertension, syphilis and ehlers danlos

Question 6

nasopharnygeal carcinoma

Answer 6

Southern China
Associated with Epstein Barr virus infection

Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI
cervical lymphadenopathy

CT MRI

Radiotherapy is first line therapy.

Question 7

antibody for drug induced lupus

Answer 7

Antihistone antibodies

caused by
isoniazid
minocycline
procainamide
hydralazine
phenytoin

Question 8

bronchiectasis signs

Answer 8

productive cough along with crackles that clear on coughing with radiographic evidence of dilated bronchi and thickened walls in the lower zones (‘tram-track sign’)
dyspnoea
haemoptysis
abnormal chest auscultation
wheeze
clubbing may be present

organisms:
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 9

management for cluster headache

Answer 9

acute
100% oxygen
subcutaneous triptan (not in coronary artery disease)

prophylaxis
verapamil is the drug of choice

Question 10

serotonin syndrome features

Answer 10

hyperreflexia
myoclonus
rigidity
hyperthermia
sweating
altered mental state
confusion

monoamine oxidase inhibitors
SSRIs
St John’s Wort
tramadol may also interact with SSRIs
ecstasy
amphetamines

Question 11

when to stop COCP before surgery

Answer 11

Advise women to stop taking their COCP/HRT 4 weeks before surgery

Question 12

A non-healing painless ulcer associated with a chronic scar

Answer 12

is indicative of squamous cell carcinoma (SCC)

Question 13

management of myasthenia gravis

Answer 13

Pyridostigmine is the 1st line - long-acting acetylcholinesterase inhibitor
prednisolone initially
azathioprine, cyclosporine, mycophenolate mofetil
thymectomy

iv immuno and plasmaphoresis for crisis

Question 14

investigation for pyloric stenosis

Answer 14

abdo US

Question 15

managemtn of GBS

Answer 15

intravenous immunoglobulin (IVIG) or plasma exchange (plasmapheresis)

Question 16

do notgive platelt tranfusion to

Answer 16

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia,
Thrombotic thrombocytopenic purpura.

Question 17

Compartment syndrome is most commonly associated with

Answer 17

supracondylar and tibial shaft fractures

Question 18

complication of correcting hyoernatraemia too fast

Answer 18

cerebrl oedema
correct over 48 hours with hypotonic solutions like 5% dextrose or 0.45% saline

Question 19

what should be avoided in V tach

Answer 19

Verapamil should NOT be used in VT

lidocaine: use with caution in severe left ventricular impairment

Question 20

electrolyte imbalances in addsionsn

Answer 20

Hyponatraemia and hyperkalaemia

Question 21

management of SUFE

Answer 21

internal fixation: typically a single cannulated screw placed in the centre of the epiphysis

so fat he needs to look internally and fix himself (sorry)

Question 22

most commonly affected dermatomes in shingles

Answer 22

T1-L2.

Question 23

tetralogy of fallot featrues

Answer 23

Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge

pulmonary stenosis, an overriding aorta, a ventricular septal defect (VSD), and right ventricular hypertrophy.

Question 24

EBV malignancys associated

Answer 24

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma
cns lymphoma

Question 25

Wellens syndrome

Answer 25

stenosis of the left anterior descending artery and is a medical emergency, requiring urgent PCI as per ACS protocol self-resolving cardiac chest pain on a background of ischaemic heart ECG -deeply inverted T-waves in leads V2-V3 (which may extend to V1-V6) no or minimal ST-elevation preserved R wave progression Ll - lad W is vv- inverted v2 v3

Question 26

PCOS results

Answer 26

raised LH:FSH ratio testosterone may be normal or mildly elevated SHBG is normal to low (serum hormone binding globulin) Low concs of SHBG increase the concentration of unbound, biologically active testosterone and dihydrotestosterone, leading to features of hyperandrogenism associated with PCOS.

Question 27

Suspected bacterial meningitis: if recent prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococci

Answer 27

add IV vancomycin to ceftriaxone

Question 28

risk factors for pseudogout

Answer 28

increasing age haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly Wilson's disease

Question 29

thyrotoxic storm is treated with

Answer 29

ABC A nti thyroid (propylthiouracil, methimazole) - helps stop disease process B eta Blocker (Propanolol) - helps with symptoms C orticosteroid (Dexamethasone) - stops T4 conversion to T3 (hydrocortis) fever > 38.5ºC tachycardia confusion and agitation nausea and vomiting hypertension heart failure abnormal liver function test - jaundice

Question 30

what tranfusion products is most assoc with bacterial contamin

Answer 30

: Platelets are stored at room temperature, which increases the risk of bacterial proliferation Staphylococcus epidermidis and Bacillus cereus.

Question 31

RBCs transmission risks

Answer 31

risk for transmitting viral agents such as HIV, HBV, and HCV. Bacterial contamination is less common but possible, particularly from skin flora during collection

Question 32

causes of post surgical fever

Answer 32

Day 1-2: 'Wind' - Pneumonia, aspiration, pulmonary embolism Day 3-5: 'Water' - Urinary tract infection (especially if the patient was catheterised) Day 5-7: 'Wound' - Infection at the surgical site or abscess formation Day 5+: 'Walking' - Deep vein thrombosis or pulmonary embolism Any time: Drugs, transfusion reactions, sepsis, line contamination.

Question 33

potassium sparing diuretics

Answer 33

STEAK Spironolactone Triamterene Eplerenone Amiloride K+ dont use in combo used with caution in patients taking ACE inhibitors

Question 34

what can cause torsade de pointes