Quick recall 2

Question 1

Drugs to give for neuropathic pain:

Answer 1

Don’t Get Pain Again
1. Duloxetine
2. Gabapentin
3. Pregabalin
4. Amitriptyline

Question 2

Erythematous pustular rash, sunlight exacerbates symptoms: diagnosis

Answer 2

ROSCEA

Features: nose, cheeks, forehead
Late sign: Rhinophyma
Ocular involvement: blepharitis

Question 3

Acne Rosacea: mx

Answer 3

1. Sunscreen
2. Topical brimonidine if predominant flushing
3. Topical ivermectin (mild-moderate pustules)
4. Topical ivermectin + oral doxy (moderate to severe)

Refferal consideration:
1. Prominent telangiectasia –> laser therapy
2. Rhinophyma

Question 4

Urinary incontinence + gait abnormality + dementia :

Answer 4

Normal pressure hydrocephalus: wet, wobbly, wackly

Question 5

Normal pressure hydrocephalus: mx

Answer 5

1. Ventriculoperitoneal shunting

Dilatation of 3rd and lateral ventricles, absence of sulcal enarlgement

Question 6

Head injury: NICE guidance on investigation

Answer 6

CT within 1 hour
* GCS < 13 on initial assessment
* GCS < 15 , 2hrs post injury
* open or depressed fracture
* basal skull fracture ?
* post-traumatic seizure
* focal neurological deficit
* > 1 episode vomitting

CT Within 8 hours
* 65 y/o <
* on AC, bleeding pmhx
* dangerous MOI
* > 30 mins retrograde amnesia

Question 7

Types of MS

Answer 7

**1. Relapsing-remitting **
- most common!
- acue attacks (1-2 months) followed by periods of remission

**2. Secondary progressive disease **
- R-R pts who have deteriorated and have neurolgoical symptoms between relapses
- gait / bladder disorders

**3. Primary progressive **
- progressive deterioration from onset

Question 8

Cytotoxic drugs

Answer 8

Question 9

Presentation, investigation and Management of Meckels

Answer 9

Presentation:
- abdo pain
- painless rectal bleeding
- intestinal obstruction

**Investigation
**
- if haemodynamically stable –> meckel scan (99m technetium pertechnetate)
- mesenteric arteriography (severe cases)

Management
- removal if narrow neck or symptomatic

Question 10

This condition usually presents with:
- paroxysmal abnominal colic pain
- sudden onset inconsolable crying
- pallor
- child may draw knees up to check
- 3-12 months of age

Answer 10

Intussception

Question 11

What monitoring is important for a patient starting citalopram?

Answer 11

ECG

Question 12

What monitoring is important for patients on SNRIs such as venlafaxine?

Answer 12

Blood pressure
- assocaited with HTN

Question 13

Menopausal women suffering from vasomotor symptoms may be given:

Answer 13

SSRI
- fluoxetine

Clonidine may also be used

Question 14

Contraindications for HRT?

Answer 14

• Current or past breast cancer
• Any oestrogen-sensitive cancer
• Undiagnosed vaginal bleeding
• Untreated endometrial hyperplasia

Question 15

Risks of HRT

Answer 15

1. VTE:
- in oral, no increased risk with transdermal
2. Stroke
- slightly increased with oral oestrogen
3. Breast cancer
- increased risk with all combined HRT
4. Ovarian cancer

Question 16

ECG changes and coronary territories:

Answer 16

Question 17

Cluster headache Mx

Answer 17

1. Bleep the neurologist!
2. Acute
   - 100% oxygen
   - subcut triptan
3. Prophylaxis
   - verapamil

Question 18

Takotsubo cardiomyopathy

Answer 18

Bottom of heart does not contract therefore appears to balloon out.

Tx - supportive

Question 19

AF post stroke: mx

Answer 19

1. Exclude haemorrhage!
2. Longer tern stroke prevention: warfarin
3. Following TIA –> AC start immediately for AF
4. In acute stroke –> AC start 2 weeks after. Give Antiplatelet therapy in the interrim

Question 20

A wide-based gait with loss of heel to toe walking is called an

Answer 20

ataxic gait

Question 21

Causes of ataxic gait

Answer 21

P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich’s ataxia)
E - Epilepsy treatments
S - Stroke

Question 22

Immunisation schedule

Answer 22

https://assets.publishing.service.gov.uk/media/64f9b3eca78c5f000d2657df/UKHSA_12706_complete_immunisation_schedule_September2023.pdf

Question 23

Bilious vomiting within 24 hours of birth is most commonly caused by

Answer 23

intestinal atresia

Question 24

72 Male: SOB, central chest pain, RR24, 102bpm, temperature 37.3 Likely diagnosis:

Answer 24

Pulmonary embolism:
- saddle embolus

Question 25

Severe, sudden abdominal pain + out-of-keeping physical exam findings + AF? may point to diagnosis of:

Answer 25

ACUTE MESENTERIC ISCHAEMIA Management: immediate laparotomy

Question 26

Diuretics revision

Answer 26

**1. Thiazide diuretics ** * increase excretion of [Na] * excretion of [k+] **2. Loop diuretic ** * inhibits sodium reabsorption in ALOH * increased excretion of sodium + potassium ** 3. Potassium sparing diuretic** * leads to hyperkalaemia

Question 27

Important SE of hydroxychloroquine

Answer 27

Bull's eye retinopathy

Question 28

Antibodies in anti-phospholipid syndrome

Answer 28

1. **antibodies** anticardiolipin antibodies anti-beta2 glycoprotein I (anti-beta2GPI) antibodies lupus anticoagulant 2. **thrombocytopenia** 3. **prolonged APTT**

Question 29

treatment of choice for Gonorrhoea

Answer 29

gram negative diplococcus 1st line - IM Ceftraizone 1g OR Oral cefizime 400mg + Oral azithromycin 2g (both single dose)

Question 30

Key features of disseminated gonococcal infection

Answer 30

tenosynovitis migratory polyarthritis dermatitis (lesions can be maculopapular or vesicular)

Question 31

SGLT-2i : Important adverse effects include

Answer 31

1. Increased risk of UTIs 2. Fournier's gangrene 3. Normoglycaemic ketoacidosis 4. Increased risk of lower limb amputation

Question 32

Rule of thumb: LOAF muscles of the hand are median innervation, all other flexor hand muscles are ulnar.

Answer 32

L ateral two lumbricals O pponens pollicis A bductor pollicis brevis F lexor pollicis brevis

Question 33

The most common infective causes of COPD exacerbations are:

Answer 33

**Bacterial:** Haemophilus influenzae (most common cause) Streptococcus pneumoniae Moraxella catarrhalis **Viral ** - human rhinovirus

Question 34

Acute exacerbations of COPD: mx guideline

Answer 34

1. Increase bronchodilator use, consider nebs 2. PREDNISOLONE 30mg 5 days 3. Abx -** amoxicillin / clarithromycin** OR *doxycycline*

Question 35

COPD: Severe exacerbations requiring secondary care mx

Answer 35

**1. O2 --> aim 88-92% w/ 28% venturi @ 4l/min** **2. Neb bronchodilator** a) Salbutamol (SABA) b) Ipratropium (muscarinic antagonist) **3. Steroid** a) IV hydrocortisone > oral pred **4. IV theophilline** T2RF? If Resp acidosis --> NIV , BiPap

Question 36

2 Level PE Wells test

Answer 36

Question 37

If ruptures may cause pseudomyxoma peritonei:

Answer 37

****Mucinous cystadenoma | Pseudo**m**yxoma peritonei: ## Footnote second most common benign epithelial tumour

Question 38

# Ovarian cysts? The most common type of epithelial cell tumour

Answer 38

Serous cystadenoma

Question 39

Diabetes drug which does not cause weight gain:

Answer 39

DPP-4 inhibitor (-gliptins) | 'the fat flows with the tides' SGLT2- flozins GLP-1 - tides

Question 40

The FEV1/FVC of a normal healthy lung is

Answer 40

70-80%

Question 41

What should be given before starting allopurinol and why:

Answer 41

NSAID or colchicine cover | Allupuronol -->xanthine oxidase inhibitor --> reduces production of uri

Question 42

Headaches, amenorrhoea, visual field defects →

Answer 42

prolactinoma | High levels of prolactin from prolactinoma --> hypogonadotrophic hypogon ## Footnote Diagnosis: MRI Management: dopamine agonist (cabergoline, bromocriptine) , or surgery trans-phenoidal approach

Question 43

Anion gap interpreation

Answer 43

Elevated --> metabolic acidosis

Question 44

Drugs which increase uvoscleral OUTflow | Pout - Pilocarpine and prostaglandin analogues

Answer 44

Drugs that inhibit aqueous humour production | Hold aqueous humous production BAC ## Footnote **Beta blockers** Alpha 2 agonists (increase and block , non-selective!) **Carbonic anhydrase inhibitors **

Question 45

A 42-year-old woman presents with a goitre. On examination the goitre feels 'lumpy'. The blood results reveal a TSH of 12 mu/l and a free T4 of 2 pmol/l. Antithyroid peroxidase antibodies are high.

Answer 45

Hashimoto's thyroiditis - goitre - hypothryoidism - anti-thyroid peroxidase

Question 46

An elevated T4 and a low TSH should indicate this diagnosis.

Answer 46

Thyrotoxicosis

Question 47

2 y/o F, 1 day hx rash on legs - now spread to rest of body

Answer 47

Erythema multiforme - target lesions!

Question 48

60 Male: flushing, diarrhoea, bronchospasm, hypotension, and weight loss classical hx of:

Answer 48

****Carcinoid tumours - tumour will secrete serotonin Ix = 5HIAA, plasma chromogranin A | Management: - somatostatin analogues e.g. octreotide - diarrhoea: cryp

Question 49

drug induced lupus:

Answer 49

S: Sulfonamide - ABx H: Hydralizine - heart failure I: Isoniazid - TB P: Phenytoin - seizures P: Procainamid - arrhythmia | anti-histone antibodies positive

Question 50

diabetes management algorithm:

Answer 50

## Footnote Remember BP targets < 80 --> 140/90 (clinic), 135/85 (home) > 80 --> 150/90 (clinic) , 145/85 (home)

Question 51

High-dose dexamethasone suppression test with a pituitary adenoma: results

Answer 51

Cortisol: suppressed ACTH: suppressed