quesmed

Question 1

A 17-year-old boy presents to the GP as he is yet to start puberty. On examination, he is taller than average but has gynaecomastia and small firm testicles, with no secondary sexual characteristics.

What is the most likely diagnosis?

Answer 1

Klinefelter’s

Question 2

Genotyping result for Gilbert’s?

Answer 2

Homozygous UGT1A1 gene with mutated promoter region

Question 3

MODY gene affected?

Answer 3

Hepatocyte nuclear factor (HNF)-1 alpha gene

Question 4

Transdermal fentanyl 12 µg patch = approximately x mg oral morphine
Transdermal buprenorphine 10 µg patch = approximately y mg oral morphine

Answer 4

x - 30mg
y - 24mg

Question 5

Commonest Hodgkin’s in young adults?

Answer 5

Nodular sclerosing

Question 6

Origins of CNs?

Answer 6

Cerebrum (x2) - Olfactory (I) + Optic (II)

Midbrain (x2) - Oculomotor (III) + Trochlear (IV)

Pons (x4) - Trigeminal (CN V), Abducens (VI), Facial (VII) + Vestibulocochlear (VIII)

Medulla oblongata (x4) - Glossopharyngeal (IX), Vagus (X), Accessory (XI) + Hypoglossal (XII)

Question 7

Normal platelets; prolonged bleeding time; prolonged APTT, normal PT and TT

Answer 7

Von Wille’s disease

Question 8

High calcium, low phosphate, high ALP, normal PTH

Answer 8

Primary hyperparathyroidism

Question 9

2nd line rx if bisphosp not tolerated?

Answer 9

Denosumab

Question 10

Which antibody can cross placenta?

Answer 10

IgG is the only class of antibody that can cross the placenta and enter the fetal circulation

Question 11

Why HBA1c is unreliable in pregnancy?

Answer 11

Decreased erythrocyte lifespan

Question 12

Auer rods associated with which pathology?

Answer 12

AML

Question 13

Rx post stroke?

Answer 13

Start Aspirin 300mg OD for 2 weeks, then switch to Clopidogrel 75mg OD

Question 14

Carcinoid syndrome associations?

Answer 14

Heart valve defects most frequently associated with the carcinoid syndrome can be memorised using the acronym TIPS = Tricuspid Insufficiency, Pulmonary Stenosis

Question 15

Vasculature of stomach?

Answer 15

Lesser: left and right gastric arteries
Greater curvature: left gastroepiploic artery
Posterior stomach: splenic artery
Second part of the duodenum: inferior pancreaticoduodenal artery
Posterior duodenum: gastroduodenal artery

Question 16

Oxybutinin side effects?

Answer 16

Dry mouth, constipation, dilated pupils, tachycardia

Question 17

Carcinoid syndrome associated murmur?

Answer 17

Pulmonary stenosis

Question 18

Purely sensory loss in stroke?

Answer 18

Lacunar stroke - thalamus affected

Question 19

Full thickness keratinocyte atypia within epidermis?

Answer 19

Bowen’s disease

Question 20

How does alcohol cause hypoglycemia?

Answer 20

Inhibits gluconeogenesis

Question 21

Unsafe vaccines in HIV?

Answer 21

Yellow fever, BCG, MMR, typhoid

Question 21

Chromosome 6 - mutation?
Chromosome 16 - mutation?

Answer 21

6 - haemochromatosis
16 - ADPKD

Question 22

Anti-smooth muscle antibodies - ?
Anti-liver/kidney microsomal antibodies - ?

Answer 22

Autoimmune hepatitis 1
Autoimmune hepatitis 2

Question 23

Raised LDH, raised bilirubin, low haptoglobin?

Answer 23

Hereditary spherocytosis

Question 24

Capture beats?

Answer 24

VT

Question 25

Drugs worsening psoriasis?

Answer 25

Drugs: Beta blockers, Anti-malarials, Lithium, Indomethacin/NSAIDs (useful mnemonic - BALI)

Question 26

Mechanism of action of abx? Rifamp - Ciproflox - Aminoglycosides - Penicillins and cephalosporins -

Answer 26

Rifamp - inhibits RNA synthesis Ciproflox - inhibits DNA synthesis Aminoglycosides - inhibits protein synthesis Penicillins and cephalosporins - inhibits cell wall synthesis Daptomycin - disrupts the cell membrane

Question 27

The Koebner phenomenon describes skin lesions that appear at the site of injury. It is seen in?

Answer 27

Psoriasis, vitiligo, warts, lichen sclerosus and planus, molluscum

Question 28

Pigmented - Struvite - Urate - Cysteine - Cholesterol -

Answer 28

Pigmented - haemolysis Struvite - Urate - Cysteine - Cholesterol -

Question 29

TEN vs SSSS

Answer 29

TEN - preceding infection and drug use, mucosal involvement SSSS - no mucosal involvement

Question 30

Which organisms are splenectomy pts most susceptible to?

Answer 30

Streptococcus pneumoniae, Haemophilus influenza and Neisseria meningitidis

Question 31

Relapses of GCA?

Answer 31

Tocilizumab

Question 32

Homo hemianopia without macular sparing?

Answer 32

Lateral geniculate body

Question 33

Painful genital ulcers/painless genital ulcers?

Answer 33

Painful - Herpes , Chlamydia Painless - Treponema,

Question 34

IL1, IL4, IL12

Answer 34

IL1 - secreted by macrophages IL4 - activates T2 cells IL12 - activates T1 cells