Random Passmed/Quesmed

Question 1

Allopurinol is used in the ______ of gout. It works by ______.

Answer 1

prevention

inhibiting xanthine oxidase

Question 2

when and how to initiate allopurinol prophylaxis

Answer 2

• delay until inflammation (pain) settled
• initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 300 µmol/l. Lower initial doses should be given if the patient has a reduced eGFR
• colchicine cover may be needed. NSAIDs if colchicine not tolerated

Question 3

Indications for allopurinol

Answer 3

ULT to all patients after their first attack of gout

Esp if: >= 2 attacks in 12 months, tophi, renal disease, uric acid renal stones, prophylaxis if on cytotoxics or diuretics

Lesch-Nyhan syndrome pts often take allopurinol for life

Question 4

Adverse effects of allopurinol. What warning to safety net patients with?

Answer 4

Mainly dermatological. Tell patients to STOP IF DEVELOP A RASH:

• severe cutaneous adverse reaction (SCAR)
• drug reaction with eosinophilia and systemic symptoms (DRESS)
• Stevens-Johnson syndrome
• Certain ethnic groups at higher risk: Chinese, Korean and Thai. High risk pts to be screened for* HLA-B *5801 allele.

Question 5

Interactions for allopurinol

Answer 5

Azathioprine - xanthine oxidase is responsible for the oxidation of 6-mercaptopurine –> toxicity, so reduce dose

Cyclophosphamide - allo reduces renal clearance

Theophylline - allo inhibits breakdown

Question 6

why does lithium cause nephrogenic DI?

Answer 6

lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts

Question 7

Patients cannot drive for _____ following a first unprovoked or isolated seizure if brain imaging and EEG normal

Answer 7

6 months

(first event = not a formal Dx of epilepsy)

(irrespective of if Tx initiate or not)

(if EEG changes, can’t drive for 12mo)

Question 8

treatment for flares of acute intermittent porphyria

Answer 8

IV haematin/haem arginate

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

Question 9

Classic sx of acute intermittent porphoryia

Answer 9

abdominal and neuropsychiatric symptoms in 20-40-year-olds, typically females (5:1).

abdominal: abdo pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression

HTN and tachycardia common

Urine: turns red on standing, raised urine porphobillinogen

Blood: assay of red cells for porphobilinogen deaminase, raised serum levels of delta aminolaevulinic acid and porphobilinogen

Question 10

painless PV bleeding in the 3rd trimester in the absence of abdominal tenderness is suggestive of

Answer 10

placenta praevia

Question 11

What is the investigation of choice for Chlamydia?

Answer 11

Nucleic acid amplification tests (NAATs)

Question 12

First-line DMARD in preventing relapse of MS

Answer 12

natalizumab

Question 13

Firm and well-circumscribed mass that transilluminates on the dorsal aspect of the wrist.

Usually female, young.

Non-tender

Answer 13

Ganglion (cyst)

Question 14

In a patient with sialolithiasis, where is the stone most likely to be?

Answer 14

Submandibular gland, possibly in Wharton’s (like warbuton’s) duct - can be removed orally if distal

Stenson’s = sky (parotid gland)

Question 15

What are the boundaries of the ‘safe triangle’ for chest drain insertion?

Answer 15

Ant edge latissimus dorsi

lat border of pec major

line superior to the horizontal level of the nipple

apex below the axilla