1. List the main causes of chronic liver disease
1. Alcohol 2. Viral hepatitis 3. Autoimmune hepatitis
4. Primary biliary cirrhosis
2. What investigations would you initiate to
investigate the underlying cause of chronic liver
disease?
Viral and autoimmune hepatitis screen Metabolic
screen(ceruloplasmin, ferritin, alpha-1 antitrypsin)
AFP (hepaocellular carcinoma) liver US and biopsy.
3. Which three things suggest decompensated liver
function?
1. Jaundice 2. Ascites 3. Encephalopathy (asterixis)
4. Up to how many spider naevi can be considered
normal on examination of a patient?
4
5 List the main stigmata of chronic liver disease
Spider angioma (naevi) Jaundice Scleral icterus
Palmar erythema Gynecomastia Encephalopathy
Asterixis (liver flap)
6. What are the main feature of decompensated
pulmonary fibrosis?
Cor pulmonale central cyanosis (Hypercapnic flap?)
7. What are the main causes of pulmonary fibrosis?
Idiopathic (70%) Connective tissue disease (RA, SLE)
Extrinsic Allergic Aveolitis Industrial lung disease
(asbestosis, silicosis) Drugs (methotrexate,
amiodarone)
FBC (incl ESR due to CTD) ABG (Type 1 failure) CXR
8. What Ix would you initiate for pulmonary fibrosis? (reduce lung vol, diffuse reticular nodular shadowing
+ honeycombing in severe disease) High res CT
9. Main points to elicit in the Hx of a Bell's palsy?
Onset sudden or over several hours? Severe pain at
Sx onset? (RHS/bad prognosis) Signs of stroke? (arm
or leg weakness) Any blisters in mouth/tongue?
Tinnitus, hearing loss or vertigo (vestibulocochlear
involvement)
10. What would you examine to assess a Bell's
palsy?
CN 5, 7 (excluding Glabellar sparing) and 8 nb. The
corneal reflex is often absent. The ears and oral
cavity looking for herpetic rashes (RHS).
11. What would your Mx plan for a Bell's palsy
consist of?
1. Steroids in the acute phase 2. Slit lamp eye exam
(corneal ulcers) 3. Otoscopic ear exam.
12. What are the functions of the facial nerve?
-Blinking and closing the eyes, smiling, frowning,
flaring nostrils and raising eyebrows. -Lacrimation
and salivation. -Taste in the anterior two-thirds of the
tongue, via the chorda tympani nerve. -Innervates
the stapedius muscle of the inner ear (via tympanic
branch)
13What are the muscles of mastication and what is
their innervation?
The masseter, temporals, medial pterygoid, and
lateral pterygoid are innervated by the 3rd
(mandibular) branch of the trigeminal nerve
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14. Which nerve mediates both the efferent and
afferent limb of the jaw jerk?
The trigeminal nerve
15. The combination of pes caves, muscle wasting, a
high stepping gait and a predominantly motor
peripheral neuropathy is characteristic of which
condition?
Charcot-Marie-Tooth (aka Hereditary Sensory Motor
Neuropathy and Peroneal Muscular Atrophy. Axonal
and demyelinating forms can be differentiated by
EP.
16. What investigations would you request to
investigate episodes of collapse of a presumed
cardiac origin?
FBC(?anaemia) U&E(?arrhythmia) TFT ECG + 24 hour
tape Echocardiogram Tilt test
In the short term, post op, est. that the prosthetic
17. After valvular replacement surgery how should a valve is well seated, not sig regurgitant, and no parapatient ideally be followed up?
prosthetic leak. Once est. long term FU should is
usually an annual echo.
18. How do you assess the risk of a prosthetic valve
developing thrombus?
Tissue valves carry low risk and usually require only
anti-platelets. Both aortic and mitral metallic valves
are at thrombus risk, mitral>aortic, due to lower
trans-mitral velocities and associated AF and require
anti-coagulation with wafarin.
19. What are the indications for urgent aortic valve
replacement?
1. Symptomatology: incl. new onset angina,
dyspnoea or syncope. 2. Using reg echos: precipitous
change in LV size or function.
20. What are the characteristic features of psoriasis
on examination?
Well circumscribed erythematous silvery scaly
plaques Nail changes(pitting and onycholysis)
Assymetric joint involvement (esp. DIPJs)
21. What are the management options for psoriatic
arthropathy?
Physio OT simple analgesia/NSAIDS In severe cases:
methotrexate or other systemic Tx (nb.systemic
steroids may cause a flare on withdrawal)
22. What is the most usual indication for
thoracoplasty?
Old TB
23. What are the causes of bronchiectasis?
Childhood infection (e.g. measles) Obstruction
(tumour, nodes, FB) CF Hypogammaglobulinaemia
Kartagener's Syndrome
24. What would bronchiectasis show on
spirometry?
Obstructive pattern (type IV) red FVC and FEV1
FEV1/FVC <0.7
25. What is the differential for a ejection cardiac
murmur?
Aortic stenosis Aortic sclerosis (?doesn't radiate)
HCM (Hokum) Pulmonary valve stenosis VSD
Tetralogy of Fallot
26. What is the differential for a regurgitant systolic
cardiac murmur?
Mitral regurg Tricuspid regurg VSD (a. Roger's type 1
(with pulm HTN) and 2 (wo pull HTN) b. slitlike)
27. What are indications for thoracoplasty?
Cavitary TB Empyema Bronchopleural fistula
Persistent spaces following pulmonary resection
28. What are the three classical signs of Parkinson's
disease?
Tremor Rigidity Hypokinesia
29. What are the classical features of cerebellar
syndrome?
Dysdiadochokinesia Ataxia Nystagmus Intention
tremor Slurring Hypotonia
30. What is the DDx for expyramidal Sx?
Parkinson's PSP MSA Normal pressure hydrocephalus
31. What is the differential for hepatomegaly
HEPATIC Heamatological (CLL, haemochromatosis)
Ethanol (ASH and NASH) PSC, PBC, Portal HTN
Autoimmune or vial hepatitis Tumour Infiltration
(Wilson's, sarcoid, amyloid, ) Cardiac (CCF,
pericarditis)
32. What are the causes of Parkinsonian syndrome?
Idiopathic Drugs -(phenothiazides, metoclopramide,
haloperidol, reserpine) Postencephalitis Cerebral
tumours (involving the BG)
33. What are the complications of Parkinson's
disease?
Dysphagia Constipation Recurrent falls Postural
hypotension Memory loss Depression
34. What is the most common organism causing
exacerbvation of bronchiectasis?
pseudomonas
35. What complications of liver cirrhosis do you
know?
Ascites Coagulopathy Portal HTN Encephalopathy
36. What might precipitate encephalopathy?
GI bleed Infection Constipation Increased protein
intake Renal failure Electrolyte imbalance Drugs
(benzos, opiates)
37. How would you Mx a Pt with encephalopathy?
Tx precipitating cause Give lactulose (to decrease
ammonia) Correct hypokalaemia Involve liver team
38. What are the clinical signs of coarctation of the
aorta?
HTN Radiofemoral delay Absent femoral pulses Midsystolic or cont murmur Subscapular bruit Rib
notching (figure of 3 on CXR) Post-stenotic dilatation
of aorta (CXR)
39. What at the signs of a third nerve palsy?
Eye is deviated downwards and outwards Ptosis Pupil
dilatation (Surgical -parasymp damage) No pupil
dilatation(medical-no parasymp damage)
40. What are common causes of a medical third
nerve palsy?
Mononeuritis multiplex (eg. DMII) MS Midbrain
infarction Migraine
41. What are common causes of a surgical third
nerve palsy?
Cavernous sinus pathology PCA aneurysm (classically
painful)
42. What are the contents of the cavernous sinus?
O TOM CAT Oculomotor nerve Trochlear nerver
Ophthalmic div of 5th Maxillary div of 5th Carotid
(internal) Abducens nerve Trochlear nerve
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43. What are the typical clinical signs in COPD?
Tar stains CO2 flap and bounding pulse Central
cyanosis Pursed lips (prolonged expiratory phase)
Use of accessory muscles Hyper-expanded chest
Crackles if infection present
44. What are the signs of cor pulmonale?
Loud P2 Rt ventricular heave Raised JVP Peripheral
oedema
45. What is COPD?
COPD is a spirometric diagnosis characterised by
airflow obstruction which is not fully reversible. It
comprises chronic bronchitis with emphysema.
FEV1/FVC<0.7
46. How would you investigate a possible new
diagnosis of COPD seen in clinic?
Spirometry after bronchodilators CXR (hyperinflation
or other causes of SOB) FBC (polycythaemia or
anaemia) ABG (type II resp failure) ECG (Rt heart
failure) Anti-trypsin deficiency (in a young person)
47. What Tx would you offer a stable COPD Pt seen
in clinic?
Smoking cessation clinic 'Reliever' inhaler (e.g.
salbutamol) 'Preventor' inhaler (eg. salmeterol or
seretide ie. salmeterol + fluticasone) Aminophylline
IV/PO
48. What features of a patient's presentation with
COPD would suggest LTOT should be considered?
FEV1<0.3 of predicted Peripheral oedema raised JVP
cyanosis polycythaemia Sats<92% on RA
49. What are the criteria for LTOT?
2 ABGs 3 weeks apart where stable & PaO2<7.3 or
7.3<PaO2<8 + 1 or more of 1. Nocturnal hypoxia 2.
Pulmonary HTN 3. Peripheral oedema 4. Secondary
polycythaemia
50. How long does LTOT need to be used for?
At least 15 hours per day
51. Are there any risks associated with
aminophylline?
Aminophylline has a fairly narrow therapeutic
window. Toxicity: nausea, vomiting, diarrhoea,
agitation, dilated pupils. Severe toxicity: arrhythmias
and convulsions. Can also cause hypokalaemia.
52. What dosing regime would you use for
aminophylline?
5mg/kg loading over 30mins. Then: Infusion of
0.5mk/kg/hour. Check levels at 24 hours and daily
thereafter.
53. How would you manage an exacerbation of
COPD?
Controlled O2 through a venturi mask Salbutamol
and ipratropium nebs Oral pred IV aminophylline if
poor response to above. If infective give ABx NIV if
required.
54. How and why would you initiate NIV?
If after 1 hour of medical Mx the Pt is still acidotic
and in type II respiratory failure, then NIV should be
considered. (initially IPAP = 10, PEEP=5 and titrate
IPAP us as per ABGs)
55. What is alpha-1 antitrypsin deficiency?
Alpha-1 antitrypsin is a protease inhibitor produced
by the liver. In the lungs this protects alveolar tissue
from damage by neutrophil elastase. Deficiency
makes COPD likely in the 3rd or 4th decade in a
smoker. Classic pattern: pan lobar emphysema in
lower lobes.
With anaemia: myeloproliferative or
56. How do you categorise haematological causes of
lymphoproliferative disorders With lymph nodes: CLL
hepatosplenomegaly?
or lymphoma
57. How would you CONFIRM a diagnosis of liver
cirrhosis?
Liver US may be suggestive, but a liver biopsy is
required for definitive diagnosis.
58. What is the Child Pughs score used for?
59. Prognosis in liver cirrhosis (i.e. predicting 1 and 2
year survival)
60. What features contribute to the Child Pughs
score?
Bilirubin Serum albumin INR Ascites Hepatic
encephalopathy
61. What is the purpose of the Rockall score?
To identify patients at risk of an adverse outcome
following an acute GI bleed.
62. What factors contribute to the Rockall score?
Age Shock Co-morbidity Diagnosis Evidence of
bleeding on endoscopy (score<3 = good prognosis,
but >8 = high risk)
63. What might the examination findings be in a
patient with a renal transplant?
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64. What are the causes of hepatosplenomegaly?
1-Infection: Acute viral hepatitis, Infectious
mononucleosis, Cytomegalovirus 2-Haem: Myelo(CML ,Myelofibrosis) and lympho-(CLL, Hodgkin's
Lymphoma) proliferative disease.
Anaemia:Pernicious anaemia, Sickle cell anaemia,
Thalassaemia 3-Chronic liver disease and portal
hypertension: Chronic active hepatitis 4-Amyloidosis
5-Acromegaly 6-Systemic lupus erythematosus
65. What is your differential for splenomegaly?
CHINA Congestion - portal HTN Heam (Haemolytic
anaemia, SSD, hereditary spherocytosis) Infection
(Malaria, EBV, CMV, HIV) Neoplastic (CLL,
Myelofibrosis, lymphoma) Autoimmune (sarcoid,
amyloid, RA)
66. What are the causes of a massive spleen?
Three Ms CML Myelofibrosis Malaria
67. What drugs do you know which cause
pulmonary fibrosis?
Chemo Tx: Methotrexate, cyclophosphamide,
bleomycin Cardiac Tx: amiodarone, propanolol Abx:
nitrofurantoin, sulphasalazine
68. What is caplan's syndrome?
Large rheumatoid nodules in coal workers' lungs.
69. What would you expect to happen to the second
loud HS II
heart sound in cor pulmonale?
70, What investigations would you do to assess
acromegaly?
CXR: cardiomegaly ECG and echo: IHD (DM and HTN)
Pituitary function tests (GH, IGF-1, T4, ACTH, PRL and
testosterone) Glucose: DM Visual perimetery:
bitemporal hemianopia MRI pituitary
71. What are the important points to check for in
taking a Hx of acromegaly?
Increased hand, feet and jaw size Change in
appearance Coarse oily skin Headaches Peripheral
vision loss Joint pain
72. What classes of disease would you consider if
asked to examine the hands in PACES?
Neurological (nerve entrapment or muscle disease)
Rheum (RA) Endocrine (acromegaly)
73. How long would you expect a bioprosthetic
versus a mechanical valve replacement to last?
A bioprosthetic valve would be expected to fail
within 10-15 years whereas a mechanical valve would
function for 20-30 years.
74. What is the mortality rate of a patient with
prosthetic valve endocarditis?
PVE has an overall mortality of around 50%. If the
PVE occurs within 60 days of implantation the
mortality is much higher, at around 75%
75. What are the causes of mitral regurgitation?
Acute: IHD, endocarditis (BE) Chronic: Degenerative
mitral valve disease Rheumatic heart disease LV
dilatation mitral valse prolapse papillary muscle
dysfunction Connective tissue disease
76. What are the clinical signs of severity in mitral
regurgitation?
Soft first heart sound Palpable thrill Heaving apex
beat 3rd heart sound
77. What are the consequences for group 1 and 2
driving licence holders after an MI?
Group 1: must stop for 4 weeks but need not inform
the DVLA. Group 2: Must stop and can only retrieve
licence if can pass stage 3 of and ETT off anti-anginal
Tx.
78. What conditions would be expected to give rise
to a pure motor syndrome?
Distal myopathy Multifocal motor neuropathy MND
Myasthenia gravis
79. What are the complications of coronary
angiography?
Heamatoma at access point Reaction to
contrast/renal toxicity Embolic stroke (1/500)
80. What clotting disorders might be associated with Factor V Leiden Protein C or S deficiency
DVT?
Antithrombin III deficiency
Lymphoedema (+/- lymphadenopathy, Pancoast's
81. What would your DDx be for a unilateral swollen
tumour) Subclavian thrombosis Superior VC
arm?
obstruction
82. What are the main complications of cardiac
valve replacement?
Heamorrhage Thomboembolus Infective endocarditis
83. What is your DDx for spastic paraparesis?
Transverse myelitis (eg. MS) Cord compression Vit
B12 deficiency MND Trauma Cerebral palsy
84. What are the radiologic features of
osteoarthritis?
Narrowing of joint space Subchondral bone sclerosis
Osteophytes Bone cysts
85. What are the clinical features of osteoarthritis in Heberden's nodes (osteophytes) Squaring of the
the hands?
thumb Reduced ROM
86. What is your Ddx for pain and swelling in the
joints of the hands?
RA OA Psoriatic arthritis Crystal arthropathy
87. How would you distinguish between
inflammatory and non-inflammatory causes of pain
and swelling in the hands?
Duration of morning stiffness Pattern of joint
involvement (Prox and symmetric = RA, distal and
asymmetric = gout or psoriatic ) Involvement of CMC
(carpometacarpal) joint is typical of OA (squaring of
thumb).
88. What is your Ddx for the cause of end stage
renal failure?
DM HTN Glomerular nephritis PKD Reflux
nephropathy Renal vascular disease
89. What autoantibodies are seen in lupus?
ANA: pres in 95% Anti-histone: may suggest a drug
cause Anti-dsDNA: v specific but sen = 60% Anti-Sm: v
specific bu sen = 20% Anti-Ro and ant-La: ANA -ve
subacute cutaneous lupus Antiphospholipid: sens =
40%
90. What Ix would you request to investigate the
cause of end stage renal disease?
BP Bloods: glucose, renal function, ESR, Ab-screen for
vasculitis. Renal US +/- renal angiography
91. What are the stages of kidney failure based on
the eGFR levels?
1: eGFR>90 + evidence of damage 2: eGFR 60-90 +
evidence of damage 3: eGFR 30-60 4: eGFR 15-30 5:
eGFR<15
92. What is the frequency of testing and FU required
1 & 2: Annually 3: 6 months 4: 3 months 5: 6 weeks
for each of the 5 stages of renal failure?
93. What are the principal side effects of
haemodialysis?
Fatigue Hypotension Staph infections Muscle cramps
Itchy skin Insomnia Bone and joint pain Loss of libido
Dry mouth Anxiety
94. What pharmacological agent might you use to
treat neuropathic pain in diabetic neuropathy?
Tricyclics (eg Amitriptyline) or anticonvulsants (e.g.
gabapentin) IV lidocaine or topical capsaicin in
intractable cases
95. What are the indications for lobectomy?
Old TB Non-small cell carcinoma Bronchectasis with
recurrent haemoptysis Solitary pulmonary nodule
96. What are some of the complications of lung
cancer?
SVC obstruction Recurrent laryngeal nerve palsy
Horner's + wasted small muscles of hand T1
Endocrine: gynaecomastic (ectopic
β
HCG) Neuro: LEM, periph neuropathy, proximal
myopathy, paraneoplastic cerebellar degeneration.
Derm: acanthosis nigricans, dermatomyositis
97. What are the possible treatments for NSCLC?
Surgery: lobectomy or pneumonectomy Rx Chemo:
EGFR +ve - erlotinib
98. What are the possble treatments for SCLC?
Chemo: benefit with 6 courses.
99. What form might palliative medical care take in
lung malignancy?
MDT Dexamethasone and Rx for mets Stent and dex
for SVCO Rx for haemoptysis, bone pain, cough
Chemical pleurodesis - talc Opiates for cough and
pain
100. What is the Abx Tx for pulmonary TB?
PIRE Pyrazinamide (6M): se=hepatitis Isoniazid (2M):
se = periph neuropathy Rifampicin(2M): se =
Hepatitis + rogers the OCP Ethambutol(6M):
retrobulbar neuritis and hepatitis
101. What is the Tx for extra pulmonary TB?
Abx (PIRE) up to 12 months Corticosteroids (e.g.
pred) if cerebral disease
102. When should latent TB be Tx?
1. People aged <36 2. People with HIV 3. Healthcare
workers 4. People with evidence of scarring caused
by TB, as shown on a chest X-ray, but who never
received treatment
103. What is the Ddx for a new proximal myopathy?
Endocrine disorders (Cushing's) Polymyositis
104. How would you distinguish polymyositis from
PMR?
CK, AST, ALT +/- muscle biopsy
105. Which of the following drugs is contraindicated
in severe aortic stenosis?... Beta-blockers,
ACE inhibitors
furosemide, spironolactone, ACE inhibitors,
amiodarone.
106. What are the indications for aortic valve
replacement?
Secondary dyspnoea, angina, syncope or presyncope. Pressure gradient >60mmHg Serial evidence
of left ventricular dysfunction
All valves Valvular dysfunction Infective endocarditis
107. What are the complications of prothetic cardiac
Metallic only Microagiopathic haemolytic anaemia
valves?
Thromboembolism
108. What are the causes of aortic stenosis?
Degenerative calcific change Bicuspid valve
Rheumatic heart disease
109. What is the difference between an essential
tremor and an intention tremor?
An intention tremor is only present as the target is
approached, whereas an essential tremor may be
present throughout all phases of movement.
110. What is the difference between a stroke and a
TIA?
They are both focal neurological deficits secondary to
a vascular lesions, however a TIA resolves within 24
hours and a stroke does not.
111. What is a consent form 4?
A form documenting a decision to perform a
procedure on a patient where… 1. The patient lacks
capacity to consent to or refuse the treatment. AND
2. The treatment is in the best interest of the
patient.
112. What is the differential diagnosis for erythema
nodosum?
Sarcoidosis Streptococcal infection Drugs
(sulphonamides) TB IBD
113. What skin lesions are seen in sarcoid?
Lupus pernio Erythema nodosum Nodules Scar
infiltration Plaques
114. What are the most common organs affected in
sarcoidosis?
The lungs (90%), eyes (25%), skin (25%) lymph nodes.
115. What investigations would you request in a
suspected new presentation of sarcoid?
FBC, U&E, LFTs, ACE level, CXR ECG Pulmonary
function tests Urinalysis Eye clinic Specialist referral
(eg resp in pulmonary involvement)
116. What symptoms should you ask about in
sarcoid?
Fever, fatigue, SOB, weight loss, vision changes,
palpitations, abdominal symptoms, LOC.
117. What treatment approaches exist for sarcoid?
Inhaled steroids (for minor cough) Topical steroids
(for skin) NSAIDs for joint involvement Oral steroids
(prednisolone)
118. Which joints are commonly affected by RA?
PIPJs, MCPJ, MTPJ, wrists, knees.
119. What are the causes of anaemia in RA?
Chronic disease Felty's syndrome Irod deficiency
NSAIDS Folate deficiency Coexisting pernicious
anaemia B12 deficiency
120. What is Felty Syndrome?
RS, splenomegaly and neutropenia.
121. What are the grades of diabetic retinopathy?
Background: micro-aneurysms, retinal
haemorrhages, +/- exudates Pre-proliferative: cotton
wool spots. Proliferative: new vessel formation. +/maculopathy (hard exudates near macula)
Diabetic control, HTN control etc. + Background:
122. What is the Tx for background, pre-proliferative annual screening Pre-proliferative: every 4 months
and proliferative retinopathy?
Active proliferative requires pan-retinal
photocoagulation.
123. What are the clinical features of cor
pulmonale?
Parasternal heave Raised JVP Ankle/sacral oedema.
124. What are the consequences for a group 1
driving licence holder who has a seizure?
Stop driving for 1 year, with 3 exceptions 1. First fit:
no driving for 6 months 2. All seizures in past 3 years
were nocturnal-you can drive. 3. Seizure was
provoked (e.g. head injury)
125. What are the consequences for a group 2
driving licence holder who has a seizure?
Needs to stop driving for 10 years, and can only
regain it if fit free for 10 years and off
anticonvulsants when reassessed. i.e. end of career.
126. What are the implications for a group 1 driving
licence holder who is diabetic?
Okay as long as you do not have poor vision, frequent
hypos, severe hypos (requiring hospitalisation), or
loss of hypo awareness.
127. What are the implications for a group 2 driving
licence holder who is diabetic?
You can drive even on insulin provided: 1. You have
stable glycaemic control over 3 months. 2. You can
evidence this using a monitor with a memory
function. 3. You are checking your BM at least twice a
day.
128. What is the target HbA1c for a type II diabetic?
<6.5%
129. At what HbA1c would you consider beginning
insulin Tx on top of oral Tx for diabetes?
>7.5%
130. What are the second line oral Txs available if
diet and metformin fail to achieve glycaemic
control?
1. Sulphonylureas (weight gain + hypo risk) 2. Gliptins
3. GLP-1 mimetic 4. Glitazone 5. SLGT-inhibitor (2-5
have low hypo risk and are weight neutral or induce
weight loss)
131. What is your Ddx for binocular diplopia?
Nerve palsies Thyroid eye disease Myasthenia Ocular
myopathies (e.g. Oculopharyngeal muscular
dystrophy)
132. What is an Adies pupil? Who gets it typically?
What other sign is commonly present?
A tonically dilated pupil. More common in women.
Absent ankle reflexes often accompany it.
133. What does an RAPD generally denote?
Optic nerve disease
134. What is your differential for painful loss of
vision?
Retrobulbar neuritis Giant cell arteritis
135. What are the possible components of
treatment for hypopituitarism?
Hydrocortisone Thyroxine Sex hormones (HRT or
testosterone) Desmopressin (ADH anologue)
136. What are the clinical features of
hyperthyroidism?
Eyes: lid retraction & lid lag Peripheral: agitation,
sweating, tremor, palmar erythema, tachy/AF, brisk
reflexes
137. What are the clinical features of Grave's which
distinguish it from simple hyperthyroidism?
Eyes: Proptosis, chemosis, ophthalmoplegia
Peripheral: Thyroid acropachy, Pretibial myxoedema
138. What are the potential complications of thyroid Exposure keratitis Optic nerve compression
eye disease?
Papilloedema
139. What Ix would you undertake for suspected
case of Grave's disease?
TFTs: TSH and T3/T4 Thyroid autoantibodies
Radioisotope scanning: increased I-131 uptake in
Graves, reduced in thyroiditis.
140. What treatments exist for Grave's disease?
B-block (e.g. propanolol) & Thionamide (e.g.
Carbimazole) Stop at 18 months and assess. 1/3
remain euthyroid. For other 2/3 repeat thionamide
Radioiodine I-131 Subtotal thyroidectomy.
141. What are the salient complications of
carbimazole?
Bone marrow suppression causing neutropenia and
agranulocytosis.
142. What are the clinical features of
hypothyroidism?
FAT, TIRED and COLD Fatigue and low energy levels
Cold intolerance Weight gain
143. What drugs are known to cause
hypothyroidism?
Amiodarone, lithium, thionamides (e.g. carbimazole)
144. What are the causes of a Goitre?
Idiopathic Iodine deficiency Hashimoto's thyroiditis
Grave's Goitrogens (e.g. lithium) Multinodular goitre
Adenoma Carcinoma.
145. What is your differential for a mixed
sensorimotor peripheral neuropathy?
Diabetes Hypothyroidism Charcot-Marie-Tooth CIDP
CTD (SLE and RA) POEMS Paraneoplastic (esp haem)
Drugs (phenytoin)
QRISK2 (USES: age, BP, smoking, ratio of total serum
cholesterol to high-density lipoprotein cholesterol)
146. What tool would you use to assess risk in a new
body mass index, ethnicity, deprivation, family
presentation of angina or hypertension?
history, CKD, RA, AF, DM, and antihypertensive
treatment.)
147. What is your differential for haemoptysis?
LRTI (pneumonia, abscess, TB, fungus) Malignancy PE
Vasculitis Osler-Weber-Rendu Parenchymal disease
(sarcoid, fibrosis) Cardiac (pulm oedema, mitral
stenosis) Bleeding diathesis