Quick recall 3

Question 1

Drug options for reducing the risk of relapse in MS

Answer 1

1. Natalizumab (IV)
2. Ocrelizumab (anti-cd20 monoclonal antibody)
3. Fingolimond
4. beta interferon
5. glatiraemer acetate

Question 2

Multiple sclerosis: tackling

1. Fatigue
2. Spasticity
3. Bladder dysfunction
4. Oscillopsia (visual fields appear to oscillate)

Answer 2

1. Fatigue
   –> trial of amantadine
2. Spasticity
   –> baclofen and gabapentin
   OR –> diazepam, dantrolene and tizanidine
   –> physio
3. Bladder dysfunction
   –> significant residual volume: intermittent self catheterisation
   –> no significant volume: ACH to improve urinary frequency
4. Oscillopsia (visual fields appear to oscillate)

Question 3

The loss of proprioception and vibration sense (dorsal columns) points towards

Answer 3

subacute combined degeneration of the spinal cord

Question 4

Lip smacking + post-ictal dysphasia are localising features of a

Answer 4

temporal lobe seizure

Question 5

paediatric Status epilepticus guidelines

Answer 5

1. Buccal midazolam / Iv Lorazepam (2 max doses)
2. IV lorazepam
3. IV levetiracetam, phenytoin or sodium valproate
4. RSI , anaesthetics, using thiopental sodium

Question 6

reflexes and nerve roots

• ankle
• knee
• bicep
• tricep

Answer 6

Ankle - S1-S2
Knee - L3-L4
Bicep - C5-C6
Triceps - C7-C8

Question 7

Primary Motor Cortex = Motor Sx = Frontal Lobe
Primary Somatosensory Cortex = Sensory Sx = Parietal Lobe

Answer 7

F = Frontal = Fidgetting
P = Parietal = Paraesthesia

Question 8

Migraine mx: ACUTE

Answer 8

1ST LINE
- oral triptan + nsaid
OR
- oral triptan + paracetamol

If 12-17 years –> nasal triptan?

Question 9

Migraine mx: prophylaxis

Answer 9

1. Propranolol
2. Topiramate (avoid in women of childbearing age)
3. amitriptylline

10 sessions acupuncture.

Others
- candesaratan
- calcitonin gene related peptide receptor

Question 10

Mx myasthenia gravis

Answer 10

1. Long acting ACH inhibitors
   –> PYRIDOSTIGMINE

Question 11

Autonomic dysreflexia can only occur if the spinal cord injury occurs above the

Answer 11

T6 level

The combination of severe hypertension, flushing and sweating without a congruent response in heart rate in the context of spinal cord injury indicates an autonomic dysreflexia

Question 12

Cushing’s triad:

Answer 12

widening pulse pressure
bradycardia
irregular breathing

Question 13

treatment of choice for essential tremor

Answer 13

Propranolol

resting tremor is seen in parkinsons and this is managed with co-careldopa

Question 14

this characteristically presents with sensorineural deafness and congenital cataracts.

Answer 14

Rubella!

Rubella the sensitive cat

Question 15

This may also be associated with cerebral palsy, anaemia, and jaundice. Also is associated with congenital sensorineural deafness

Answer 15

Congenital cytomegalovirus infection

Question 16

Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone →

Answer 16

androgen insensitivity syndrome
- bilateral lower pelvic swellings likely to be undescended testes

Question 17

Alzheimer’s disease causes widespread cerebral atrophy mainly involving the:

Answer 17

cortex and hippocampus

Question 18

Metabolic alkalosis + hypokalaemia → ?

Answer 18

prolonged vomiting

Question 19

interpret ecg & likely diagnosis

Answer 19

peaked or ‘tall-tented’ T waves (occurs first)
loss of P waves
broad QRS complexes
sinusoidal wave pattern

Question 20

Hyperkalaemia: management

Answer 20

1. Stablisation of cardiac membrane only –> IV calcium gluconate
2. Short term shift K+ from extracellular to intracellular fluid
   –> combined insulin / dextrose infusion
   –> nebulised salbutamol
3. Removal of potassium from body
   a) calcium resonium (orally or enema)
   b) loop diuretics
   c) dialysis

Question 21

A 41-year-old man presents with a persistent itch rash that has been present for the past few weeks. On examination he has erythematous, scaly lesions underneath the eyebrows, around the nose and at the top of his chest. He also has a history of dandruff which is well controlled with over the counter shampoos.

likely diagnosis and tx:

Answer 21

1st line tx –> topical ketoconazole

Question 22

Inguinal Hernia -> get INto surgery
Umbilical Hernia -> UM I’ll wait and see

Answer 22

Inguinal Hernia -> get INto surgery
Umbilical Hernia -> UM I’ll wait and see

Question 23

features of Wernicke’s encephalopathy

Answer 23

CAN OPEN
Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

Retrograde amnesia and confabulation are features of Korsakoff’s psychosis

Question 24

The three criteria for aneurysm surgery are:

Answer 24

• An asymptomatic aneurysm larger than 5.5 cm in diameter.
• An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
• A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.

Question 25

these are used in the used in the management of alcohol withdrawal

Answer 25

Decreasing doses of long-acting benzodiazepines e.g. chlordiazepoxide

Question 26

55 Male: RTA unconsciouss. OE: multiple cuts and bruises, skin warm and flushed. PEARL. No respiratory distress. ECG: sinus bradycardia likely cause for patients presentation:

Answer 26

- low HR, warm flushed peripheries indicates spinal shock as underlying cause. - loss of sympathetic outflow resulting in hypotension and bradycardia , warm peripheries due to v.dilation and inability to vasoconstrict NEUROGENIC SHOCK

Question 27

Complications of thyroid surgery

Answer 27

damage to parathyroid glands can result in hypocalcaemia - prolonged QT

Question 28

Visual hallucinations with dementia

Answer 28

Lewy body dementia

Question 29

Myxoedemic coma is treated with

Answer 29

thyroxine and hydrocortisone

Question 30

Thyrotoxic storm is treated with

Answer 30

beta blockers, propylthiouracil and hydrocortisone

Question 31

4Hs

Answer 31

Hypothermia Hypoxia Hypovolaemia Hypokalaemia / hyperkalaemia / hypoglycaemia

Question 32

4Ts

Answer 32

Tension pneumothorax Toxins Tamponade Thrombosis

Question 33

In the acute management of DKA: mx

Answer 33

1. Insulin --> fixed rate 2. Continue regular injected long acting 3. Stop short acting injected insulin

Question 34

Hepatitis serology

Answer 34

If patient has antigen: active infection IgM - acute IgG - chronic

Question 35

ECG shows:

Answer 35

Polymorphic changes: Torsades de pointes

Question 36

Anterior uveitis is most likely to be treated with

Answer 36

1. Steroid eye drops: prednisolone acetate --> treats underlying infection 2. Mydriatic eye drops (cyclopentolate) --> dilate eye and reduce pain

Question 37

Vestibular neuronitis vs Labrinthitis

Answer 37

Vestibular neuronitis = inflammation of the vestibular nerve, which deals with balance but not hearing Labyrinthitis = inflammation of labyrinth, which deals with both balance AND hearing

Question 38

Hyponatraemia correction may lead to:

Answer 38

osmotic demyelination syndrome

Question 39

Hypernatreamia correction may lead to:

Answer 39

cerebral oedema

Question 40

Acute dystonia secondary to antipsychotics is usually managed with:

Answer 40

Procyclidine

Question 41

Human bites, like animal bites, should be treated with

Answer 41

co-amoxiclav