part 5

Question 1

How is gestational diabetes managed (2)?

Answer 1

• Fasting glucose > 7 or 6-7 with complications e.g. macrosomia = insulin +/- metformin
• Fasting glucose 5.6 - 7 = lifestyle for 1-2 weeks, then metformin

Question 2

Why is up to date retinal screening important before pregnancy?

Answer 2

Glycaemic control rapidly improves at the start of pregnancy due to intensive treatment –> paradoxical worsening of diabetic retinopathy

Question 3

What is conus medullaris?

Answer 3

Compression higher, above the cauda equina
pain is uncommon, symptoms usually symmetrical

Question 4

Where does CSF flow in the brain (2)?

Answer 4

• Subarachnoid space
• Ventricles

Question 5

What two drugs can be used to treat neuroleptic malignant syndrome?

Answer 5

• Dantrolene
• Bromocriptine

Question 6

How do you calculate the anion gap?

Answer 6

(Na + K) - (Cl + HCO3)

Question 7

What could be seen on a blood gas in those given large volumes of saline?

Answer 7

Hyperchloraemic metabolic acidosis

Question 8

What is the name of the criteria for a screening programme?

Answer 8

Wilson and jugner criteria

Question 9

What are the classical features of croup (5)?

Answer 9

• Barking cough
• Stridor
• Fever
• Coryzal Sx
• Hoarse voice

Question 10

What is the dose of dexamethasone for croup?

Answer 10

0.15mg/ kg

Question 11

What is an important criteria requiring admission for croup?

Answer 11

Stridor at rest

Question 12

When does pyloric stenosis usually present?

Answer 12

2-4 weeks

Question 13

Other than exertion, what are some triggers for angina (3)?

Answer 13

• Strong emotions (e.g. anger/ excitement)
• Lying down (decubitus angina)
• Cold weather

Question 14

How does aspirin work?

Answer 14

COX 1+2 inhibitor –> thromboxane A2 inhibition –> reduced ability for platelets to aggregate

Question 15

What is considered to be confused on the CURB-65 score?

Answer 15

Abbreviated mental test score </= 8

Question 16

Why are 4 drugs used to target TB?

Answer 16

Prevent antibiotic resistance

Question 17

How is SIADH treated with medications?

Answer 17

• Demeclocycline
• Tolvaptan (ADH receptor antagonist)

Question 18

How is serum osmolality calculated?

Answer 18

2 x Na + glucose + urea

Question 19

Where is vitamin D hydroxylated (2)?

Answer 19

• Liver
• Kidney

Question 20

What is the name of bone disease in those with renal failure?

Answer 20

Renal osteodystrophy

Question 21

What are some precipitants for gout (6)?

Answer 21

• Starting bendroflumethiazide
• Alcohol
• Purine rich foods
• Trauma
• Infection
• Dehydration

Question 22

What are some common causes of reactive arthritis (4)?

Answer 22

• Chlamydia trachomatis
• Salmonella
• Campylobacter
• Shigella

Question 23

What is myeloma?

Answer 23

Neoplastic proliferation of plasma cells

Question 24

What are the features of myeloma (6)?

Answer 24

• Calcium raised
• Renal ( AKI/ light chain deposition)
• Anaemia
• Bleeding
• Bone pain
• Infection (increased risk)

Question 25

What node is commonly affected in tonsillitis?

Answer 25

Jugulodigastric node

Question 26

What is considered a massive blood transfusion?

Answer 26

> 10 units blood/ entire circulating volume within 24 hours

Question 27

What are some late complications of a blood transfusion (3)?

Answer 27

* Iron overload * Graft vs host disease * Infection

Question 28

What is the pathway/ anatomy of the optic nerve to the brain?

Answer 28

Optic nerve --> optic chiasm --> optic tract --> lateral geniculate body --> optic radiation --> visual cortex

Question 29

How is carpal tunnel syndrome managed (3)?

Answer 29

* Wrist splint * Corticosteroid injections * Carpal tunnel release

Question 30

Where are the two types of inguinal hernias in relation to the inferior epigastric vessels?

Answer 30

* Indirect = lateral * Direct = medial

Question 31

How is acute mesenteric ischemia managed prior to surgery (3)?

Answer 31

* Fluid resus * IV heparin * Antibiotics

Question 32

What are the arteries from the femoral artery to the aorta?

Answer 32

Common femoral artery --> external iliac artery --> common iliac artery --> aorta

Question 33

What is becks triad?

Answer 33

* Hypotension * Raised JVP * Muffled heart sounds

Question 34

How quickly are pneumothorax reabsorbed into the body?

Answer 34

1.25% per day

Question 35

What are some complications of ADPKD (5)?

Answer 35

* SAH * Liver cysts * CKD * Hypertension * Mitral valve prolapse

Question 36

What anticoagulant is usually used for bridging regimens/ perioperative use?

Answer 36

LMWH

Question 37

How should patients with 2 unprovoked DVTs be managed?

Answer 37

Usually lifelong anticoagulation

Question 38

What are the two signs in pancreatitis?

Answer 38

* Cullens = bruising around belly button * Grey-turners = bruising along flanks

Question 39

What is the difference in presentation between left and right sided bowel cancer (2)?

Answer 39

* Left = PR bleeding, change in bowel habit, * Right = more insidious (weight loss, fatigue, anaemia)

Question 40

What are the two inherited causes of colon cancer?

Answer 40

* Familial adenomatous polyposis * **Hereditary non-polyposis colon cancer**

Question 41

How is colon cancer staged?

Answer 41

Dukes classification

Question 42

What are 3 causes of midline neck lumps?

Answer 42

* Thyroglossal cysts * Goitre * Dermoid cyst

Question 43

How is postpartum haemorrhage managed (8)?

Answer 43

1. A-E 2. Uterine massage 3. Oxytocin 4. Ergometrine (unless hypertensive) 5. Carboprost (unless asthma) 6. Misoprostol (sublingual) 7. Intrauterine balloon tamponade/ B-lynch suture/ hysterectomy * Tanexamic acid early on

Question 44

What muscles maintain continence in females (2)?

Answer 44

* Pelvic floor * External urethral sphincter

Question 45

How can incontinence be investigated?

Answer 45

Urodynamics