Random facts_2

Question 1

MEN I

• what types of cancers
• which gene?

Answer 1

MEN I

3 Ps:

• Parathyroid
• Pituitary
• Pancreas e.g. insulinoma

Also:

• adrenal and thyroid

Gene: MEN1

Question 2

MEN II

• what types of cancers
• which gene?

Answer 2

MEN II

2 P’s

• Parathyroid
• Phaemochromacytoma
• Medullary Thyroid

Gene: RET oncogene

Question 3

MEN III

• what types of cancers
• which gene?

Answer 3

MEN III

1 P

• Phaeochromocytoma
• Medullary thyroid
• Marfanoid body habitus
• Neuromas

Gene: RET oncogene

Question 4

In the picture of haemolytic anaemia, what does it mean that reticulocytes are within normal range?

Answer 4

Reticulocytes within normal range = acute, not chronic

(so anaemia was not going on for a long time - as no immature RBCs release)

Question 5

What are these blood results suggestive of:

• raised bilirubin
• inflammatory picture

Answer 5

Haemolysis

*if additionally, decreased Hb = haemolytic anaemia

Question 6

What is causative organism:

CAP Pneumonia + erythema multiforme

Answer 6

Mycoplasma pneumonia

(atypical pneumonia)

Atypical picture of pneumonia with:

*acute haemolysis

*erythema multiforme

Question 7

Does atypical pneumonia respond to penicillin or cephalosporins?

Answer 7

No, they lack peptidoglycan cell wall

Management of atypical pneumonia:

• doxycycline or a macrolide (e.g. erythromycin/clarithromycin)

Question 9

Where the tumour is located if:

• high level of dexamethasone will suppress ACTH secretion
• high level of dexamethasone would not suppress ACTH

Answer 9

High-dose dexamethasone suppression test

• if pituitary source then cortisol suppressed
• if ectopic/adrenal then no change in cortisol

Question 10

Organisms responsible for exacerbations of COPD

Answer 10

The most common bacterial organisms that cause infective exacerbations of COPD are:

• Haemophilus influenzae (most common cause)
• Streptococcus pneumoniae
• Moraxella catarrhalis

Respiratory viruses account for around 30% of exacerbations, with the human rhinovirus being the most important pathogen.

Question 11

Management of acute exacerbation of COPD

Answer 11

• increase frequency of bronchodilator use and consider giving via a nebuliser
• give prednisolone 30 mg daily for 7-14 days
• it is common practice for all patients with an exacerbation of COPD to receive antibiotics. NICE do not support this approach. They recommend giving oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
• the BNF recommends one of the following oral antibiotics first-line: amoxicillin or tetracycline or clarithromycin

Question 12

CURB 65

Answer 12

Criterion Marker C Confusion (abbreviated mental test score <= 8/10) U urea > 7 mmol/L R Respiration rate >= 30/min B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg 65 Aged >= 65 years

Question 13

What electrolyte imbalance may occur with dehydration?

Answer 13

Hypernatraemia

Question 14

Management of hypernatremia

Answer 14

• aim for reduction of sodium <12mmol/day (therefore <0.5mmol/hour)
• IV 5% dextrose can be used slowly, (risk correction of sodium too fast = fluid shift -> cerebral oedema)
• If sodium >170 mmol/l or haemodynamically unstable then IV 0.9% NaCl -> this would correct the sodium more slowly and prevent cerebral oedema

Question 15

Following MI, on discharge from the hospital, patients should be prescribed what drugs?

Answer 15

• dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
• ACE inhibitor
• beta-blocker
• statin