Mix 2

Question 1

Tx for mumps? [1]

Answer 1

supportive

Question 2

PCP patient - when do you add pred? [1]

Answer 2

If PO02 < 92

Question 3

1st line tx for antisocial personality disorder? [1]

Answer 3

group based cognitive behaviour

Question 4

1st line treatment for breathlessness in palliative care? [1]

Answer 4

Subcut morphine sulphate

Question 5

[] is commonly used for migraine prevention, particularly in patients with contraindications to beta-blockers.

Answer 5

Amitriptyline is commonly used for migraine prevention, particularly in patients with contraindications to beta-blockers.

Question 6

The uterus usually returns to its non-pregnant size by [] weeks post-partum

Answer 6

The uterus usually returns to its non-pregnant size by 4 weeks post-partum

Question 7

[] tears are the most commonly associated soft tissue injury with tibial plateau fractures, occurring in over 50% of cases.

Answer 7

Lateral meniscus tears are the most commonly associated soft tissue injury with tibial plateau fractures, occurring in over 50% of cases.

Question 8

Large loop excision of the transformation zone (LLETZ).

What is the mx plan? [1]

Answer 8

Large loop excision of the transformation zone (LLETZ)

Question 9

Late-onset sepsis (>72 hours of life) is frequently caused by [1]?

Answer 9

Late-onset sepsis (>72 hours of life) is frequently caused by:
* Staphylococcus aureus (most common)

Question 10

Tx for this? [1]

Answer 10

Topical salicylic acid is a first-line treatment for plantar warts (verrucae), especially in children

Question 11

On examination, a right foot drop is noted, with prominent weakness of ankle dorsiflexion, inversion and eversion.

Dx? [1]

Answer 11

L5 radiculopathy:
- L5 has both inversion and eversion

Question 12

What level of steroids do you initiate for patients with lichen sclerosus? [1]

Answer 12

Very potent topical steroids

Question 13

Describe what is meant by cerebral amyloid angiopathy [1]

Answer 13

Cerebral amyloid angiopathy is a form of vessel disease in which amyloid builds up in the wall of blood vessels. It is a risk factor for haemorrhagic stroke and dementia, and is thought to be associated with hypertension

Question 14

Essential tremor is inherited in an [] fashion.

Answer 14

Essential tremor is inherited in an autosomal dominant fashion.

Question 15

How would you distinguish HSV encephalitis c.f cerebral toxoplasmosis on a CT? [1]

Answer 15

CT head **showing temporal lobe changes ** - think herpes simplex encephalitis

Toxoplasmosis - imaging would typically reveal single or multiple ring-enhancing lesions with clearly defined edges and possible mass effects

Question 16

[] nerve injury is a common complication of posterior hip dislocation
- How would this present? [2]

Answer 16

Sciatic nerve injury is a common complication of posterior hip dislocation
- The distribution of pain follows the course of the sciatic nerve. The foot drop is secondary to compromise of the common peroneal nerve, supplied by the sciatic nerve.

Question 17

Which pathology is linked to seborrheic dermatitis? [1]

Answer 17

P.D.

Question 18

Describe the management plan for gestational diabetes [3]

Answer 18

1. Diet and exercise
2. Metformin
3. Insulin

NB: If fasting glucose > 7 skip straight to insulin

Question 19

When do you give someone with APS warfarin with INR of 3-4 c.f 2-3? [1]

Answer 19

INR 3-4: recurrent VTE when ON wafarin medication already (not prior)

Question 20

What is a presentation of a PICA stroke? [+]

Answer 20

Ipsilateral Horners
Ataxia
Dysarthria
Contralateral pain, temp and sensation loss on body

Question 21

What are side effects of tramadol? [3]

Answer 21

Lower seizure threshold
Delirium
Impotence

Question 22

How would you measure resp. function in LES/MG? [1]

Answer 22

FVC:
- better at detecting changes in tiring resp muscles

Question 23

1st line surgical treatment for SAH ? [1]

Answer 23

Endovascular coiling
- Then surgical clipping

Question 24

Symptoms of lithium toxicity include tremors, slurred speech, and confusion.

If left untreated, lithium toxicity can progress to more severe neurological symptoms such as [+]

Answer 24

Symptoms of lithium toxicity include tremors, slurred speech, and confusion. If left untreated, lithium toxicity can progress to more severe neurological symptoms such as visual disturbances, including blurred vision or nystagmus, seizures, and coma.

Question 25

What would indicate MS on a MRI? [1]

Answer 25

**Plaques of gadolinium-enhancing T2 hyperintensity** * Plaques of demyelination, and eventual axonal loss, are the radiological and pathological hallmark of multiple sclerosis

Question 26

Which clinical test would indicate ?testicular torsion [1]

Answer 26

**Cremasteric reflex** would be **absent** (**no tightening of the scrotal skin on stroking of the inner thigh**) if this was testicular torsion

Question 27

Which specific tests do you use for ?HIV in a patient with exposure a while ago [1]

Answer 27

**HIV Antibody** is the correct choice here. Antibody tests consist of a screening test (**ELISA**) and a confirmatory test (**Western Blot Assay**).

Question 28

A patient is on carbamazapine. How would you manage their wish for contraception based off this? [3]

Answer 28

CONTRACEPTION WHEN ON EIDS (e.g. Carbamazepine, Rifampicin, Rifabutin) Contraceptives unaffected: - **Copper IUD** (preferred) - **depo-provera** (risk of weight gain so CI if BMI >30) - **IUS**

Question 29

Painful third nerve palsy = **[]** artery aneurysm

Answer 29

Painful third nerve palsy = **posterior communicating artery aneurysm**

Question 30

Which of the following has the most evidence for SH? Cognitive Behavioural Therapy (CBT) Dialectical behaviour therapy (DBT) Mentalization-based treatment (in day hospital) Transference-Focused Psychotherapy

Answer 30

**Dialectical behaviour therapy (DBT)**

Question 31

The investigation of choice for narcolepsy is **[]**

Answer 31

The investigation of choice for narcolepsy is **multiple sleep latency EEG**

Question 32

If a semen sample is abnormal, a repeat test should be arranged, ideally **[] months later**

Answer 32

If a semen sample is abnormal, a repeat test should be arranged, **ideally 3 months later**

Question 33

Human papillomavirus subtype **[]** is associated with **plantar warts.**

Answer 33

Human papillomavirus **subtype 1** is associated with **plantar warts.**

Question 34

A 4 year old boy is referred for an urgent MRI due to ongoing headaches and nausea. He is otherwise well, with no past medical history. He is growing well and hitting all of his developmental milestones. The MRI report says there is a cerebellar lesion that is most likely benign. What is the most likely diagnosis? [1]

Answer 34

**Pilocytic astrocytoma** is the most common benign brain tumour in children, often arising in the cerebellum

Question 35

[] arise from Rathke's pouch remnants and typically present with symptoms of endocrine dysfunction (e.g., growth failure due to hypothalamic or pituitary involvement) or visual disturbances due to proximity to the optic chiasm.

Answer 35

**Craniopharyngiomas** arise from Rathke's pouch remnants and typically present with symptoms of endocrine dysfunction (e.g., growth failure due to hypothalamic or pituitary involvement) or visual disturbances due to proximity to the optic chiasm.

Question 36

[] are glial tumours that often arise from the ependymal lining of the ventricles, particularly in the posterior fossa in children. **These tumours may obstruct cerebrospinal fluid flow, causing hydrocephalus**

Answer 36

**Ependymomas** are glial tumours that often arise from the ependymal lining of the ventricles, particularly in the posterior fossa in children. **These tumours may obstruct cerebrospinal fluid flow, causing hydrocephalus**

Question 37

Which ligaments would be impact in: * foot eversion * foot inversion

Answer 37

**Foot eversion**: medial **Foot inversion**: lateral - AFLT

Question 38

Which part of bone is more likely to suffer from osteomyelitis in children and adults? [2]

Answer 38

**Minor**: **M**etaphysis Adults (**elders**): **E**piphysis

Question 39

Multiple sclerosis is a cause of spastic paraparesis Describe this presentation [+]

Answer 39

**hypertonia, hyperreflexia, clonus and a pyramidal pattern of weakness** (with flexors affected more than extensors in the lower limbs)

Question 40

This patient is likely suffering from lupus nephritis due to her AKI in the context of an SLE flare with features of nephritic syndrome including haematuria and hypertension. Lupus nephritis is usually treated with a combination of **[]**

Answer 40

This patient is likely suffering from lupus nephritis due to her AKI in the context of an SLE flare with features of nephritic syndrome including haematuria and hypertension. Lupus nephritis is usually treated with a combination of **high dose corticosteroids in combination with a cytotixic drug. Cyclophosphamide is usually very effective and preferred, though tacrolimus and mycophenylate are alternatives**

Question 41

Which brain region is affected in antipsychotic induced parkinsonism? [1]

Answer 41

**Nigrostriatal tract**

Question 42

PD medications can make patients excessively drowsy. This can be combated by adjusting medication. However, if this does not work then which anti-drowsiness medication can you use? [1]

Answer 42

**Modafinil**

Question 43

Describe what is meant by **amaurosis fugax** [1] What are the sx? [2]

Answer 43

**Painless, transient monocular blindness** together with the description of a '**black curtain coming down**' is characteristic of amaurosis fugax - due to **disruption of the blood flow to the retina.**

Question 44

Describe what is meant by Meralgia paresthetica [1]

Answer 44

**Meralgia paresthetica** is due to compression of the lateral femoral cutaneous nerve and would tend to present with paraesthesia/numbness, not pain.

Question 45

If subarachnoid haemorrhage is suspected but a CT head done > 6 hours after symptom onset is normal, what investigation should be performed? [1]

Answer 45

**LP**

Question 46

Describe the fracture seen here [1]

Answer 46

The **double-arc sign** is characterised on a lateral radiograph of the elbow by **two separately visible arcs representing the displaced capitellum and the trochlea** 1,2.

Question 47

When treating herpes - do you use topical or oral acyclovir? [1]

Answer 47

**Oral aciclovir** is effective for treating genital herpes, especially when there is a presentation of painful genital lesions and systemic symptoms such as fever.

Question 48

Under what conditions can you stop anti-epileptic medications? [1] How do you withdraw? [1]

Answer 48

Can be considered if **seizure** **free** for **> 2 years**, with **AEDs being stopped over 2-3 months**