Passmedicine Questions & Answers |
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2024 Version
patient comes in with new onset astham, bilateral wheeze. facial pain
and nasal polyps are found
A chest x-ray demonstrated pulmonary infiltrates.
what is the most likely diagnosis and investigations - ch...
Passmedicine Questions & Answers |
100% Correct Answers | Verified | Latest
2024 Version
patient comes in with new onset astham, bilateral wheeze. facial pain
and nasal polyps are found
A chest x-ray demonstrated pulmonary infiltrates.
what is the most likely diagnosis and investigations - ✔✔chrug straus syndrome
and investigations
check pANCA levels
treatment with high dose of corticoid steroids and if not controlled then add immunosuppressants
treatment once an individual with mrsa is found - ✔✔nasal mupirocin and chlorhixadine
what is neurofibromatosis - ✔✔its a benign tumour that grows along the nerves
autososmal dominant two types
type 1 most common
skin symptoms:
freckles in unusal places axilla groin
cafe au spots (indicates neurocutaneous syndromes
neurofibromas which are lumps under the skin scoliosis
leanring difficulties:
mild cognitive impairment- stuggle with radin or wiritng
can aalso have attention deficit disorder
or be part of the autism spectrum
,the eyes: can get optic pathway glioma (OPG)- CASUE BLURRING THE CHILDS VISION- may bump into
things
can also get brown spot on the iris- Lisch nodules
high blood pressure- phaemocytochropma
physical development-
may have scoliosis
may have larger heads
may be generally small
can also develop psuedoarthiritis- pathological fractures
what is tuberous sclerosis - ✔✔case- A 19-year-old man is admitted following a generalised seizure. No
past history is available as the man is currently in a postictal state. On examination it is noted that he has
three patches of hypopigmented skin and fibromata under two of his finger nails. What is the most likely
diagnosis?
Given the areas of hypopigmentation and subungual fibromas the most likely diagnosis is tuberous
sclerosis
and epilepsy (can also get infantile spasms
A 45-year-old alcoholic patient starts to fit in the waiting room. You place him in the recovery position
and apply oxygen. After 5 minutes he is still fitting. What is the most appropriate medication to
administer? - ✔✔diazepam 10mg
A 23 year old woman attends a fertility clinic with her partner. She complains of oligomenorrhoea and
galactorrhea and has failed to get pregnant after 18 months of regular unprotected intercourse. Blood
tests reveal a serum prolactin level of 6000 mIU/l (normal <500 mIU/l). A pituitary MRI is arranged which
shows a microprolactinoma.
Which of the following is the best initial treatment? - ✔✔bromocriptine
,This patient has a prolactinoma. In the majority of cases, symptomatic patients are treated medically
with dopamine agonists (e.g. bromocriptine) which inhibit the release of prolactin from the pituitary
gland. Surgery is performed for patients who cannot tolerate or fail to respond to medical therapy. A
trans-sphenoidal approach is generally preferred unless there is significant extra-pituitary extension
treatment for acromegaly medical - ✔✔transphenoidal surgery is normally first line for every patient, but
medical treatment can include octeotride-somatostatin analgoues which stop the production of growth
hormone but can also use bromcriptine but not as effective
A 78-year-old man is admitted to the stroke ward. You are asked to examine him. He denies any
headache. You find he has normal motor function but has completely lost sensation on the right hand
side of his body. There is no hemianopia or dysphasia. What type of stroke is this? - ✔✔lacunar stroke
A 31-year-old female with no past medical history of note is admitted to hospital with dyspnoea and
fever. She has recently returned from holiday in Turkey. A clinical diagnosis of pneumonia is made. On
examination she is noted to have an ulcerated lesion on her upper lip consistent with reactivation of
herpes simplex. Which organism is most associated with this examination finding? - ✔✔streptococcus
pneumonia- can cause herpes labialis
A 52-year-old man presents with a 5 day history of cough, feeling hot and facial pains. He is generally fit
and well although does currently take sertraline for anxiety and depression. He describes a cough
productive of pale yellow sputum. He also describes difficulty breathing through his nose and pain in his
face, particularly when coughing on leaning forward.
On examination he is alert, pulse rate is 84/min, temperature is 37.3º and respiratory rate is 16/min. His
blood pressure is 122/74 mmHg. Chest auscultation is unremarkable. He is tender over the maxilla.
What is the most appropriate next step in management? - ✔✔viral upper respiratory tract infection-
facial pain due rhinosinusitis
just give paracetamol and review in a few days
A 54-year-old female presents to the endocrinology clinic following referral from her GP. His referral
letter gives a background of treatment resistant hypertension and polyuria, with additional symptoms of
tingling in the fingertips and increasing fatigue. It is reported that routine bloods were deranged, but you
are unable to find them on the system. An MRI scan performed as an outpatient shows a small
suspected adenoma in the right adrenal gland and nil else of note. Which arterial blood gas would be
, consistent with the underlying condition? - ✔✔resitant hypertension and hypokalemia - muscle
weakness
think conns
abg would show alkalosis
A 60-year-old man who is known to have lung cancer comes for review. For the past three weeks he has
lost his appetite, has been feeling sick and generally feels tired. On examination he appears to be mildly
dehydrated. You order some blood tests:
high calcium
which one would cause it
Amlodipine
Simvastatin
Bendroflumethiazide
Aspirin
Lisinopril - ✔✔bendrofluemthiazide- high calcium
A 27-year-old female presents with weakness of both hands. On examination you note wasting and
weakness of the small muscles of the hands and loss of pain and temperature sensation over the trunk
and arms. Vibration sense is intact.
What is the most likely diagnosis? - ✔✔syringomyelia
Syringomyelia is a condition whereby fluid filled cavities develop within the spinal cord. Pressure can
increase resulting in compression of the spinal cord tracts. The syrinx can extend to and damage the
anterior horn cells, thereby resulting in lower motor neurone features. The spinothalamic tract axons
decussate to the other side of the spinal cord via the anterior white commissure, and they are
particularly susceptible to damage from the syrinx. Pain and temperature sensation are lost due to
spinothalamic tract damage, and one side may be affected more than the other. Classically, the sensation
loss is experienced in a shawl-like distribution over the arms, shoulders and upper body. Light touch,
vibration and proprioception may also be affected as the syrinx enlarges into the dorsal columns.
risk factors for developmental dysplasia of the hip - ✔✔oligohydramnios
breech presentation
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