A 35-year-old man presents to the Emergency department complaining of severe pain in his lower back after lifting a heavy box at work. The pain radiates to his right buttock and thigh. He has had no urinary symptoms.On examination he can straight leg raise to 90 degrees on the left side but only to 30 degrees on the right. Sciatic stretch test is positive.He has difficulty plantarflexing his right ankle and has abnormal sensation on the plantar aspect of the foot. His right ankle reflex is absent but all other reflexes are normal. There is no other sensory disturbance.What is the likely diagnosis?
Disc prolapse at L5\S1
Sensory loss to the posterior calf and the plantar surface of the foot
Motor loss to gastrocnemius and soleus and
Loss of ankle jerk.
Which of the following increase renal blood flow?
Adrenaline
Noradrenaline
Dopamine
Dobutamine
Dopamine
the others are agonists of the sympathetic system which causes vasocon of the splanchnic and renal systems and diverts blood flow to the skeletal muscles.
Palsies of the third, fourth and sixth cranial nerves with involvement of the ophthalmic division of the fifth nerve, suggests a lesion of which of the following?
Apex of the orbit
Base of skull
Brainstem
Cavernous sinus
Cavernous sinus.
Aswell as these nerves the internal carotid with its sympathetic plexus and the superior and inferior orbital veins also traverse thru it.
One unit of fresh blood raises the haemoglobin concentration by how much?
1g\dl
What is the macula densa and what is its function?
(renal)
The macula densa is a tissue that is found on the distal convoluted tubule, and sits at the hilum of the Bowman's capsule. Its role is to monitor blood flow into the capsule, and hence is involved in blood pressure control.
On what part of the filtration system of the kidney does aldosterone act?
Distal convoluted tuble, as opposed to ADH which acts mainly on the collecting duct
What is courvoseiers law?
Painless obstructive jaundice with a mass in the RUQ means the patient most probably has cancer.
DO A CT!
What is Faecal elastase a test for?
Pancreatic insufficiency, indicated if the patient presents with steatorrhoea, chronic epigastric pain, wieght loss and anorexia.
If faecal elastase is low then do the exocrine job of the pancreas by giving creon.
which artery Arises from the aorta between the level of L1 and L2 vertebrae, and forms five segmental arteries that do not anastomose.
Renal
Drug A has endpoint mortality of 40% and drug B has endpoint mortality of 30%...What is the absoloute risk reduction of drug b compared to A?
10% dont confuse with Relative risk reduction.
How do you stage malignant melanoma?
Following biopsy with Breslow's thickness
What is pagets disease of the bone?
An abnormality in osteoclast activation which leaves them turned on and causes extensive bone resorption. Causes Bowing of the tibia.
What are the layers of the scalp?
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Periosteum\pericranium
What Does secretin do and where is it released from?
Released from the small intestine in respones to acid in the small intestine, stimulates bicarb secretion from pancreas and liver.
Where is Ghrelin released from and what does it do?
Released from the fundus of the stomach, stimulates appetite.
Where is CCK released from? in response to what? what does it do?
Released from small intestine in response to AA and fats in small intestine.
Causes pancreatic enzyme secretion, gall bladder contraction and sphincter of oddi relaxation
Where is Glucose-dependent released from? in response to what? what does it do?
What are the 2 main organisms that cause epididymo-orchitis?
What antibiotic(s) would you prescribe to treat this.?
What other aspects would make up your managment plan?
C.trachomatis and N.gonnorhoea
Give ciprofloxacin 500mg bd and doxycycline 100mg tds
Bed rest, NSAIDS and scrotal elevation with an ice pack will aid recovery.
A 28 year old is 8 weeks post partum and develops a flutuant mass in the RUQ of her right breast. The overlying skin in Red and tender.
What is the diagnosis and how is it best managed?
Breast abscess, best managed with USS guided needle aspiration.
Incision and drainage is contraindcated due to risk of mammary-cutaneous fistula. Only indicated if:
Abcess is multiloculated
Repeated aspiration doesnt work
Overlying skin is necrotic
Hoe does a man with Renal cell carcinoma present?
Haematuria
Flank mass
Weight loss
Hypertension
Could have a varicocoele if renal vein is occluded
What is onychogryphosis?
Rams-horn nails
What is onychocryptosis?
Ingrowing toe nail
What is Hidradentis suppurativa?
Blockage of apocrine glands with antigen antibody complexes, leads to things that look like sebaceous cysts but in the axilla, groin and anywhere that has apocrine glands and hair basically.
What would be the examination findings of Dressler's syndrome?
Soft systolic murmur in the tricuspid area louder on leaning forward and possibly a pericardial rub.
They will also have a fever and lethargy.
ESR is likely to be raised
Best treated with NSAIDS
A 49-year-old female two days post total thyroidectomy has developed tetany in both hands. Her corrected serum calcium is 1.90 mmol/l (2.2-2.6).
What is the most appropriate management for this patient?
IV calcium gluconate.
Hypocalcaemia is the most common complication following total thyroidectomy.
What kind of cardiac abnormality is associated with carcinoid syndrom?
Excess serotonin and kallkrien leads to fibrosis of the tricuspid and pulmonary valves leading to TIPS:
Tricuspid insufficiency
Pulmonary stenosis
What is brucellosis?
A Zoonosis caused by Brucella abortus found in UNPASTEURISED MILK.
Presents with Undulant fevers, migrating ARTHRALGIA and myalgia, anaemia, lethargy, and SWEATING.
Can easily become chronic and is a known cause of depression.
True or false, IgG can cross the placenta irrespective of subclass?
True
Name 3 autosomal dominant conditions.
Huntingtons
Familial Hypercholesterolaemia
Spherocytosis
Adult Polycystic Kidney disease
MEN 1
Neurofibromatosis 1 and 2
HNPCC
Achondroplasia
Enzyme inducers?
Phenytoin
Carbemazepine
Barbiturates
Rifampicin
Alcohol (chronic) and smoking
Sulfapyrazine
Enzyme Inhibitors?
Macrolides and Metronidazole
Amiodarone
Grapefruit juice
Isoniazid
Cimetidine, ciprofloxacin, chloramphenicol
Valproate
Alcohol binge
SSRIs
Esomeprazole
Sulphonamides
True or false...The primary attack of genital herpes is worse than subsequent episodes.
True
Incubation period of herpes?
2-10 days
Incubation period of gonorrhoea?
3-10 days
Incubation period of Chlamydia?
7-21 days
In which of the following is bicarb raised?
Hypokalemia
Pyloric stenosis
COPD
DKA
Chronic renal failure
HypoK
Pyloric Stenosis These 2 cause alkalosis
COPD Co2 retention means more converted to bicarb
DKA - acidosis, uses up all the bicarb
CRF - Causes Mild acidosis
How would you manage incontinence of old age?
Follow regular toilet regime
Do not use hypnotics to aid sleep
Treat any constipation or atrophic vaginitis
What are the Duckett-Jones criteria for a diagnosis of Ehumatic fever?
The Duckett Jones criteria are divided into major and minor:
Glandular fever type illness, Fever, rashes, cranial nerve palsies
What drugs can cause Ataxia?
Lithium and phenytoin. Dose dependent.
Whats the risk of a 35 year old woman having a child with downs?
1-300
What is a Gelastic seizure?
A sudden uncontrolled outburst of energy or laughter.
ASSOC hypothalamic Hamartomas
What is a hamartoma?
An abnormal growth that consists of the same tissue from which it is derived.
Cellular structure may be disorganized.
Studies seem to indicate that a hamartoma occurs when the tissue in growth did not develop completely. Hamartomas may occur throughout the body, but are often found in the head and neck, particularly around the ears.
If hamartomas occur in multiple sites throughout the body, their presence is called Cowden disease.
By definition there is no metaplasia in hamartomata.
What is Pityriasis Rosea?
A benign skin rash.
The initial patch is called as the herald patch/ mother patch. This is followed in crops by smaller daughter patches which have a fine colarette of scales at the periphery. The patches are distributed over the upper trunk along the lines of the ribs and hence termed as having a Christmas tree appearance.
A viral aetiology is blamed.
It lasts approximately six to eight weeks and treatment is symptomatic.
What is the classic presentation of an acoustic neuroma?
Vertigo
Nystagmus
Tendency to fall towards the side of the lesion
Loss of corneal reflex.
What is Kallmann's syndrome?
Colour blindness
Congenital Anosmia
hypogonadotrophic hypogonadism
In what situations do you have to report a death to the coroner?
These include:
The cause of death is unknown.
The deceased was not seen by the certifying doctor either after death or within 14 days before death.
The death was violent or unnatural.
The death may be due to an accident.
The death may be due to self neglect or neglect by others.
The death may be the result of industrial illness or due to the persons employment
The death may be due to an abortion.
The death occurred during an operation or before recovery from anaesthesia.
The death may be suicide.
The death occurred during or shortly after being taken into police custody.
What is Exenatide, and what are its metabolic effects?