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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 spectrumthe 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 developmentmay 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? - bromocriptineThis 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 infectionfacial 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 beconsistent 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 presentationbirth weight over 5kg positive family history more common in the left hip but 20 percent are bilateral foot deformities treatment: most unstable hips strengthen by 3-6 weeks otherwise a pavlik harness is worn which flexes and abducts the knees n older children may require surgery A 2-year-old child comes in too see you with his mother at the GP surgery. The mother tells you that for the past few months the child has