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MCQs – 22 Jan 2015

Q.1

IN ECTROPION

The lower lid drops away from the eye.

The affected eye constantly waters.

A stringy, white mucoid discharge is characteristic.

Eyelid retraction causes the patient to have a ‘staring’ appearance.

Plastic surgery may help to correct the problem.

Q.2

UMBILICAL HERNIA

Is a protrusion through a split in the linea alba.

Never strangulates.

Left alone will normally heal in the first few months of life.

Should be strapped until healing has occurred.

If still present at one year, should be operated on.

Q.3

LONG-TERM ANTIHYPERURICAEMIC TREATMENT WITH ALLOPURINOL

Is indicated in patients with urate nephropathy.

Should be given in combination with an NSAID for the first four months of therapy.

Should start at 300mg a day.

Side-effects include Stevens-Johnson syndrome.

When fails to prevent gout, should lead to enquiry about the patient’s alcohol intake.

Q.4

IN DIABETIC NEPHROPATHY

Microalbuminuria is the earliest clinically-detectable sign.

Race is a risk factor.

The patient’s target blood pressure is 110/79mmHg or less.

ACE inhibitors can prevent early death.

In type 2 diabetes, statins are contraindicated.

Q.5

IN MOTOR NEURONE DISEASE

Dysphagia is more prominent than dysarthria.

Fasciculation without weakness is a key diagnostic pointer.

Most patients are significantly cognitively impaired.

There are no sensory symptoms or signs.

Average survival time from symptom onset is two years.

A.1

True. It is common in the elderly and those with facial palsies.

True. As the lower punctum of the tear duct is no longer draining.

False. This occurs in entropion.

False. This would suggest hyperthyroidism.

True. A lubricating ointment may help in the interim.

A.2

False. Through a weakened umbilical cicatrix. The para-umbilical hernia will not heal spontaneously unless small.

False. Generally easily reduced though very rarely may strangulate.

True. Unless an underlying abnormality exists, e.g. ascites, hypothyroidism.

False. No treatment required unless still present at age of two years when can be repaired as a day case.

E. False. See D.

A.3

True. Or tophi or frequent gouty attacks.

False. For one month after hyperuricaemia corrected.

False. Start at 100mg per day and increase until serum urate is normalised.

True. And leucopenia, gastro-intestinal disturbance.

True. Excess alcohol intake and non-compliance are the commonest reasons for recurrent gout in patients on allopurinol.

A.4

True. For type 2 diabetes, screen at diagnosis and annually thereafter.

True. Highest in Afro-Caribbeans, Asian Indians and Japanese.

False. 130/80mmHg or less.

True. Have particular renoprotective benefits as reduce glomerular capillary pressure and proteinuria.

False. May reduce proteinuria as well as cardiovascular benefit.

A.5

False. Get dysarthria with or without some dysphagia.

False. Fasciculation with brisk reflexes in a weak and wasted limb.

False. Rarely any cognitive impairment or dementia.

True. Also no autonomic dysfunction, eye movement abnormalities, or bladder or bowel symptoms.

False. Nowadays three-to-four years.

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