Passmed wrong

Question 1

Tumour lysis syndrome: electrolyte abnormalities

Answer 1

UKPc (↑ Urate,↑Potassium,↑Phosphate and ↓calcium(small c).

Question 2

What feature can help differentiate between dementia and depression?

Answer 2

Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia

Global memory loss -depression
Short term memory loss -dementia

Question 3

Management of acne vulgaris in pregnancy?

Answer 3

Continue topical benzoyl peroxide and change topical clindamycin to* oral erythromycin*

Question 4

Causes of hepatosplenomegaly

Answer 4

chronic liver disease* with portal hypertension
infections: glandular fever, malaria, hepatitis
lymphoproliferative disorders
myeloproliferative disorders e.g. CML
amyloidosis

*the latter stages of cirrhosis are associated with a small liver

Question 5

Examples of mitochondrial diseases?

Answer 5

Leber’s optic atrophy: symptoms typically develop at around the age of 30 years
central scotoma → loss of colour vision → rapid onset of significant visual impairment

MELAS syndrome: mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes

MERRF syndrome: myoclonus epilepsy with ragged-red fibres

Kearns-Sayre syndrome: onset in patients < 20 years old, external ophthalmoplegia, retinitis pigmentosa. Ptosis may be seen
sensorineural hearing loss

Question 6

T-Helper cells of the Th2 subset typically secrete:

Answer 6

IL-4, IL-5, IL-6, IL-10, IL-13

Question 7

Th1 secretes

Answer 7

IL2, IL3 (1,2,3) +gamma

Question 8

What is the mechanism in MM that leads to hyperCa?

Answer 8

Increased osteoclastic activation. In multiple myeloma, malignant plasma cells produce cytokines and other factors that stimulate osteoclasts, leading to increased bone resorption. This results in the release of calcium from the bones into the bloodstream, causing hypercalcaemia. Confusion is a common symptom of hypercalcaemia, which can also cause polyuria, polydipsia, constipation, and renal stones.

Question 9

What would the CSF sample of a bacterial meningitis show?

Answer 9

Low glucose
high protein
high polymorphs

Question 10

Most common cause of bacterial meningitis in 6 years - 60 year olds?

Answer 10

Neisseria meningitidis
Streptococcus pneumoniae

Question 11

Most common cause of bacterial meningitis in > 60 year olds?

Answer 11

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

Question 12

Most common cause of bacterial meningitis in immunosuppressed?

Answer 12

Listeria monocytogenes

Question 13

Three mechanisms by which malignancy causes hyperCa?

Answer 13

• PTHrP from the tumour e.g. squamous cell lung cancer
• bone metastases
• myeloma,: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells

Question 14

causes of hyperCa

Answer 14

1. primary hyperparathyroidism
2. malignancy
3. sarcoidosis
   other causes of granulomas may lead to hypercalcaemia e.g. tuberculosis and histoplasmosis
4. vitamin D intoxication
5. acromegaly
   6.thyrotoxicosis
6. Milk-alkali syndrome
7. drugs:
   thiazides
   calcium-containing antacids
8. dehydration
9. Addison’s disease

Question 15

Causes of respiratory acidosis

Answer 15

1. COPD
2. decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
3. neuromuscular disease
4. obesity hypoventilation syndrome
5. sedative drugs: benzodiazepines, opiate overdose

Question 16

Causes of warm AIHA

Answer 16

• idiopathic
• autoimmune disease: e.g. systemic lupus erythematosus*
• neoplasia
• lymphoma
• chronic lymphocytic leukaemia
• drugs: e.g. methyldopa

Question 17

Causes of cold AIHA

Answer 17

neoplasia: e.g. lymphoma
infections: e.g. mycoplasma, EBV

Question 18

Congenital rubella-characteristic features

Answer 18

1. Sensorineural deafness
2. Congenital cataracts
3. Congenital heart disease (e.g. patent ductus arteriosus)
4. Glaucoma

Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
‘Salt and pepper’ chorioretinitis
Microphthalmia
Cerebral palsy

Question 19

*

Congenital CMV-characteristic features

Answer 19

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

Visual impairment
Learning disability
Encephalitis/seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy

Question 20

Congenital Toxoplasmosis-characteristic features

Answer 20

Cerebral calcification
Chorioretinitis
Hydrocephalus

Anaemia
Hepatosplenomegaly
Cerebral palsy

“Fundoscopy shows a moderately exudative, whitish lesion with ill-defined borders located at the superior temporal fundus adjacent to a pigmented scar. Two atrophic scars were also visualized on her right fundus. A CT head was performed due to her fundoscopy findings. This revealed multiple calcifications within the basal ganglia and periventricular regions.”

Question 21

Standard error of the mean

Answer 21

standard deviation / square root (number of patients)

Question 22

Levels of evidence: What is meta-analysis evidence?

Answer 22

Ia - evidence from meta-analysis of randomised controlled trials

Question 23

Levels of evidence, what is 1b

Answer 23

Ib - evidence from at least one randomised controlled trial

Question 24

Levels of evidence: what is II/III?

Answer 24

IIa - evidence from at least one well-designed controlled trial which is not randomised
IIb - evidence from at least one well-designed experimental trial
III - evidence from case, correlation and comparative studies
IV - evidence from a panel of experts

Question 25

Levels of evidence what is IV?

Answer 25

IV - evidence from a panel of experts

Question 26

What kind of disorder is Gaucher's disease and what is the defect in?

Answer 26

Lysosomal storage disorder: Beta-glucocerebrosidase

Question 27

Clinical features of Gaucher's disease?

Answer 27

Most common lipid storage disorder resulting in accumulation of glucocerebrosidase in the brain, liver and spleen. Key features include *hepatosplenomegaly aseptic necrosis of the femur*

Question 28

Causes of metabolic alkalosis

Answer 28

vomiting / aspiration diuretics liquorice, carbenoxolone hypokalaemia primary hyperaldosteronism Cushing's syndrome Bartter's syndrome ## Footnote (e.g. peptic ulcer leading to pyloric stenos, nasogastric suction) vomiting may also lead to hypokalaemia

Question 29

Causes of respiratory alkalosis

Answer 29

anxiety leading to hyperventilation pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy

Question 30

Causes of respiratory acidosis

Answer 30

COPD decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema neuromuscular disease obesity hypoventilation syndrome sedative drugs: benzodiazepines, opiate overdose

Question 31

Most common cause of bronchiectasis exacerbations

Answer 31

Haemophilus influenzae

Question 32

Causes of decreased lung compliance

Answer 32

pulmonary oedema pulmonary fibrosis pneumonectomy kyphosis

Question 33

MoA of montelukast

Answer 33

leukotriene receptor antagonist (LTRA) inhibits leukotrienes, which are inflammatory mediators that contribute to bronchoconstriction, mucus production, and airway inflammation.

Question 34

Causes of massive splenomegaly

Answer 34

myelofibrosis chronic myeloid leukaemia visceral leishmaniasis (kala-azar) malaria Gaucher's syndrome

Question 35

Other causes of splenomegaly

Answer 35

portal hypertension e.g. secondary to cirrhosis lymphoproliferative disease e.g. CLL, Hodgkin's haemolytic anaemia infection: hepatitis, glandular fever infective endocarditis sickle-cell*, thalassaemia rheumatoid arthritis (Felty's syndrome ## Footnote the majority of adults patients with sickle-cell will have an atrophied spleen due to repeated infarction

Question 36

Causes of hepatosplenomegaly

Answer 36

chronic liver disease* with portal hypertension infections: glandular fever, malaria, hepatitis lymphoproliferative disorders myeloproliferative disorders e.g. CML amyloidosis

Question 37

S1 lesion features

Answer 37

Sensory loss of posterolateral aspect of leg and lateral aspect of foot weakness in plantar flexion of foot reduced ankle reflex positive sciatic nerve stretch test

Question 38

# mostly H and M Autosomal dominant conditions

Answer 38

Achondroplasia Acute intermittent porphyria Adult polycystic disease Antithrombin III deficiency Ehlers-Danlos syndrome Familial adenomatous polyposis Hereditary haemorrhagic telangiectasia Hereditary spherocytosis Hereditary non-polyposis colorectal carcinoma Huntington's disease Hyperlipidaemia type II Hypokalaemic periodic paralysis Malignant hyperthermia Marfan's syndromes Myotonic dystrophy Neurofibromatosis Noonan syndrome Osteogenesis imperfecta Peutz-Jeghers syndrome Retinoblastoma Romano-Ward syndrome tuberous sclerosis Von Hippel-Lindau syndrome Von Willebrand's disease*

Question 39

What is raised in aip?

Answer 39

urinary porphobilinogen

Question 40

Treatment in acute attack of AIP

Answer 40

IV haematin/haem arginate IV glucose should be used if haematin/haem arginate is not immediately available

Question 41

Basis of poryphrias

Answer 41

abnormality in enzymes responsible for the biosynthesis of haem results in overproduction of intermediate compounds (porphyrins)

Question 42

When would you see ischaemic colitis in young people

Answer 42

cocaine

Question 43

Features of msa

Answer 43

parkinsonism autonomic disturbance erectile dysfunction: often an early feature postural hypotension atonic bladder cerebellar signs