Marks
A 78 year old woman is brought into A&E by her home help. She has
become increasingly confused over the last three days which is
uncharacteristic for her. The home help can give you little information.
3
(a)
Name three vitamin deficiencies that can cause acute confusion.
Thiamine/Nicotinic acid/Vitamin B12
(b)
Once the family arrive it transpires that she has complained of increased
urinary frequency, abdominal pain and urinary incontinence. On dipping her
urine you suspect a UTI is the cause of her confusion. Give four findings that
would suggest this.
4
Nitrates/Protein/ Leucocytes/Blood
(c)
1
Name the most common organism to cause UTIs in the community
E.Coli
(d)
1
The patient is started on an antibiotic. She has normal renal function and a
normal urinary tract. Which antibiotic would you choose?
Trimethoprim/Amoxicillin
(e)
1
Give two other pieces of advice to reduce the chance of recurrence.
Take full course of antibiotics/Good personal hygiene/Drink lots of
water/Drink cranberry juice/Void frequently/Double void/Void after
intercourse
PASS MARK: 6/10
Marks
David a 16 year old boy is referred to dermatology by his GP. He has
extensive red, raised oval plaques with white scaling on his scalp, knees and
elbows. The plaques are itchy and he is very self conscious. You make the
diagnosis of moderate classic plaque psoriasis.
3
(a)
Name three other types of psoriasis
Guttate/Erythrodermic/Seborrhoeic or flexural/Pustular
(b)
2
A number of environmental factors can trigger an outbreak of psoriasis.
Name two groups of drugs that may make psoriasis more active.
Beta blockers/NSAIDs/Antimalarials
(c)
2
David also complains his nails look different. Give four nail changes that
may occur in psoriasis.
Pitting/Onycholisis/Hyperkeratosis/Ridging/Oil spots/Discoloration
(d)
2
What types of topical treatments could you start David on? Name four.
Emollient/Topical Vit D analogue/ Topical retinoid/ Topical Antimitotic/
Topical steroid
(e)
1
You see David frequently over the next year, his psoriasis did not respond as
well as you expected and you would now class is as severe. He is very
anxious and you decide on a systemic treatment. Your consultant prescribes
Acitretin, an oral retinoid. Who would you not give this drug and why?
Young women. This drug is teratinogenic and can be stored in body fat for
3yrs.
PASS MARK: 7/10
Marks
You are called out to see a 38 year old woman who has not left the house
since losing her job two months ago. Her daughter tells you she has not
been eating properly and has stopped washing and getting dressed. You
suspect she is suffering from reactive depression.
Name three other biological symptoms that would suggest depression
3
(a)
Weight loss
Constipation
Sleep disturbance: early morning wakening/ initial insomnia/ broken sleep
Diurnal variation of mood
Decreased libido
Amenorrhoea
(b)
After taking a history and examining Mrs. Park you both decide that trying an
anti-depressant is the best option. Below are three classes of anti-depressant.
Give an example and the most common side effect of each.
3
TCAs – amitriptyline, imipramine, dothiepin, trazedone, clomipramineanitcholinergics SEs
MAOIs – phenelzine, isocarboxazid, tranylcypromine – hypertensive crisis
SSRIs – fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram –
hyponatraemia.
(c)
(d)
(e)
Take one of the groups of anti-depressants above and describe its mode of
action.
TCAs – inhibit reuptake of both serotonin and noradrenaline into the
presynaptic neurone so that both NTs accumulate within the synapse.
MAOIs – inhibit the enzyme monoamine oxidase present in the presynaptic
neurone, inhibiting the intraneuronal metabolism of monamines. Results in
increased release of amine NTs into the synapse.
SSRIs – highly selective serotonin reuptake inhibitors, resulting in
accumulation of serotonin within the synapse with little or no effect on
noradrenaline.
You start Mrs. Park on fluoxetine. What would be your starting dose?
20mg OD
Name two types of non-pharmacological treatment that Mrs. Park may benefit
from.
Cognitive therapy
Psychotherapy
In severe cases, ECT
PASS MARK: 7/10
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