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MCQs – 19 Feb 2015

Q.1

ELDERLY PATIENTS WITH THE FOLLOWING EYE PROBLEMS REQUIRE REFERRAL FOR OPHTHALMIC OPINION

Dark areas in the sclera.

Difficulty seeing near objects closely.

Flashes of light, in the dark or at night.

Floaters with field loss.

Arcus senilis.

Q.2

AFTER TOTAL HIP REPLACEMENT

About 2 per cent of patients will have died within three months.

The prosthetic hip will dislocate in up to 5 per cent of patients.

A patient who develops infection will need a wheelchair or crutches for one-to-two months.

The sciatic nerve may be damaged.

About 90 per cent of hips should still be working after 10 years.

Q.3

RECOGNISED CLINICAL FEATURES OF PERIPHERAL NEUROPATHY INCLUDE

Burning pain affecting both feet.

Incontinence.

Areflexia.

Positive Romberg’s sign.

Distal muscle wasting.

Q.4

YELLOW FEVER VACCINE

Is not recommended for use in children under the age of nine years.

Rarely causes any reaction.

Must be given at a special centre, otherwise the international certificate will not be valid.

After primary vaccination, international certificate is valid for 20 years.

Use is contraindicated in pregnancy.

Q.5

POLYCYTHAEMIA VERA

Median age of presentation is 55-60 years.

Presenting symptoms include pruritus.

Patients are at risk of developing myelofibrosis.

Initial treatment is frequent venesection.

Contraindicates the use of low-dose aspirin.

A.1.

False. Some patients develop these where the sclera thins adjacent to the extra ocular muscle insertions.

False. Presbyopia — a progressive loss of ability to accommodate — becomes symptomatic from 45 on.

False. But if the patient experiences this in daytime it is almost always a symptom of vitreous or retinal detachment.

True. This may be a sign of retinal detachment.

False. Most elderly patients develop this.

A.2.

False. 0.4-0.7 per cent of patients die and 2.6 per cent have to have a second operation on their hip within a year.

True. Requiring revision surgery or traction followed by the wearing of an abduction brace.

True. While infection treated with antibiotics.

True. In about 1 per cent of cases operated on by a posterior approach.

True. Beyond five years the failure rate grows.

A.3.

True. Progressive, worse at night.

False. Sphincters normal.

True. And possibly glove and stocking anaesthesia.

False. Would suggest a cord syndrome with loss of proprioception.

True. And weakness.

A.4.

False. Under nine months, as in this group, may be associated with encephalitis.

True. Occasionally redness and swelling at injection site.

True. Must also use WHO-approved vaccine.

False. After 10 days is valid for 10 years.

True. Live vaccine. Pregnant women should be discouraged from travelling in areas where yellow fever outbreaks are reported.

A.5.

True. And median time to death if untreated is 18 months.

True. Plethora, conjunctival injection, gout, splenomegaly, cerebral symptoms, CVA.

True. And leukaemia.

True. And then, if necessary, hydroxyurea.

False. Reduces thrombotic events and, in the absence of significant contraindication, all these patients should be on it.

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