S4S Pub Quiz 2

1. S4S Pub Quiz 2

2. What is going to happen… • Split yourself into groups of 4/5 • 5 Rounds of question • Answers after each round • No phones!! • Winners get a prize… • Winners will also be put into a draw for PODmedicssubscripstion • We will answer any questions you have about 3rd year at the end 

3. Round 1 Topics (numbers 1-10) • Peptic Ulcer disease & GORD • Viral Hepatitis • Meningitis

4. Peptic ulcer disease & GORD 1. Define peptic ulcer disease.

5. Peptic ulcer disease & GORD 2. What are the main complications of gastro-oesophageal reflux disease?

6. Peptic ulcer disease & GORD 3. How would you manage a patient suffering from gastro-oesophageal reflux disease?

7. Viral Hepatitis A 45 year old man presents to you complains of lethargy, nausea and vomiting. You can see that he is jaundiced and has a maculopapular rash and on enquiry mentions that he has dark urine. 4. What other questions would you like to ask this patient to determine the diagnosis?

8. Viral Hepatitis During history taking he mentions that he is an intravenous drug user but mentions that he last injected drug 6 months ago. 5. What viral hepatitis is he most likely to have? And what classification of viruses does it fall into?

9. Viral Hepatitis • 6. How likely is someone with Hep B to develop chronic liver disease?

10. Meningitis 7. What causative organism is responsible for most cases of bacterial meningitis? 8. Describe the 3 red flag symptoms of meningitis

11. Meningitis 9. Which type of meningitis has worse prognosis- Bacteria or Viral?

12. Meningitis 10. Miss FP presents to A&E with a 24 hour history of photophobia, severe headache and fever. You also notice a petechial rash on her lower limbs which is non-blanching on examination. a) What does this rash indicate? b) Outline your immediate management of Miss FP (Investigation and Tx) c) What further management does she require?

13. Round 1- answers

14. Peptic ulcer disease & GORD 1. Define peptic ulcer disease. A. A break in the epithelial cells lining the stomach or duodenum, penetrating down to the muscularis mucosa. There are 2 types of peptic ulcer: 1. Gastric Ulcers 2. Duodenal Ulcers

15. Peptic ulcer disease & GORD 2. What are the main complications of gastro-oesophageal reflux disease? A. Severe symptoms Severe Oesophagitis – bleeding can lead to melena, hematemesis or anaemia. Strictures – narrowing of the oesophagus can occur and impair swallowing – surgery may be required if the stricture is impairing daily living Barrett’s Oesophagus Adenocarcinoma

16. Peptic ulcer disease & GORD 3. How would you manage a patient suffering from gastro-oesophageal reflux disease? Lifestyle – weight loss, less alcohol, reduce food consumption 3 hours before bed. Small, regular meals and sleeping with the head of the bed raised. Medical management – neutralise stomach acid with antacids (aluminium hydroxide). Reduce stomach acid release using proton pump inhibitors (omeprazole) and histamine antagonists (cimetidine). Surgical management – if severe GORD or hiatus hernia = fundoplication.

17. Viral Hepatitis A 45 year old man presents to you complains of lethargy, nausea and vomiting. You can see that he is jaundiced and has a maculopapular rash and on enquiry mentions that he has dark urine. 4. What other questions would you like to ask this patient to determine the diagnosis? Travel history Sexual History Blood transfusion/IV drug use

18. Viral Hepatitis During history taking he mentions that he is an intravenous drug user but mentions that he last injected drug 6 months ago. 5. What viral hepatitis is he most likely to have? And what classification of viruses does it fall into? Hepatitis B (long incubation period) – DNA virus

19. Viral Hepatitis • 6. How likely is someone with Hep B to develop chronic liver disease? Cirrhosis – 5-10% of those with the initial infection develop chronic liver disease Hepatocellular cancer- 5-10% of those with chronic hepatitis will develop

20. Meningitis 7. What causative organism is responsible for most cases of bacterial meningitis? NeisseriaMengitidis (meningiococcal meningitis). 8. Describe the 3 red flag symptoms of meningitis Fever, Severe Headache (acute onset), Neck stiffness.

21. Meningitis 9. Which type of meningitis has worse prognosis- Bacteria or Viral? Bacteria is associated with more serious complications and carries a mortality rate of 5-10% (more if complicated with meningioccocal septicaemia). Viral meningitis tends to produce a benign, self-limiting infection (4-10 days) and has less severe consquences.

22. Meningitis 10. Miss FP presents to A&E with a 24 hour history of photophobia, severe headache and fever. You also notice a petechial rash on her lower limbs which is non-blanching on examination. a) What does this rash indicate? Meningiococcal Septicaemia b) Outline your immediate management of Miss FP (Investigation and Tx) ABCDE, supplemental Oxygen, IV access, IM benzylpenicillin (as likely she has meningiococcal meningitis). Do blood cultures to confirm organism. c) What further management does she require? CT scan followed by a lumbar puncture if not C/I, notify the public health authority to start contact tracing. Tx contacts with rifampicin. Check with the lab to confirm causative organism and tailor further Abx treatment accordingly.

23. Round 2 Topics (1-10) • Epilepsy • Adrenal Disease • Principles of cancer

24. Epilepsy • 1. What is the definition of epilepsy?

25. Epilepsy 2. What are the two main catergories in the classification of seizures? And what differentiates between the two?

26. Epilepsy • 3. The main medical management of epilepsy is use of anti-epileptic drugs (AEDs). What is the common mechanism of action with all AEDs?

27. Adrenal disease 4. What is Addison’s disease?

28. Adrenal disease 5. How do you manage Addison’s disease?

29. Adrenal disease 6. What are the signs and symptoms of Cushing’s disease?

30. Principles of cancer 7. Name the 4 hallmarks of a cancer cell

31. Principles of cancer 8. Name 2 routes of metastasis

32. Principles of cancer 9. Name 5 items of the WHO screening criteria

33. Principles of cancer 10. Describe the cervical cancer screening programme

34. Round 2- answers

35. Epilepsy • 1. What is the definition of epilepsy?Answer: The reccurent tendency for spontaneous, intermittent, abnormal electrical activity in the brain manifesting in seizures. (In contrast with seizure which is a one off event)

36. Epilepsy 2. What are the two main catergories in the classification of seizures? And what differentiates between the two?Answer: Generalised and Partial. Differentiated by seizure activity affecting the entire brain in generalised seizures, such as tonic-clonic, whereas, seizure activity only affects part of the brain in partial seizures.

37. Epilepsy • 3. The main medical management of epilepsy is use of anti-epileptic drugs (AEDs). What is the common mechanism of action with all AEDs?Answer: Inhibit sodium channels to stabilise neuronal tissue and prevent breaching of the seizure threshold

38. Adrenal disease 4. What is Addison’s disease? A syndrome resulting from inadequate secretion of corticosteroid hormones due to the progressive destruction of the adrenal cortex. Glucocorticoid, mineralocorticoid and sex steroid production are reduced.

39. Adrenal disease 5. How do you manage Addison’s disease? Acutely – Saline 0.9% with 100mg bolus of hydrocortisone. Continue this for 24hours. If the patient is hypoglycaemic, glucose should be infused. Long term – replacement glucocorticoid, mineralocorticoid and DHEA (sex steroid) Patient should know to increase steroid dose in illness, carry a steroid card and have emergency ampoule of hydrocortisone to be used if necessary. You should never withdraw treatment suddenly!!

40. Adrenal disease 6. What are the signs and symptoms of Cushing’s disease? Symptoms Weight gain (central) Depression Insomnia Amenorrhoea Poor libido Thin skin/easy bruising Hair growth/acne Muscular weakness Back pain Polyuria/polydipsia Psychosis Signs Moon face, Buffalo hump, Central obesity Plethora Acne and Hirsutism Thin skin and Bruising Poor wound healing Pigmentation Skin infections Hypertension Osteoporosis Striae Proximal myopathy Proximal muscle wasting Glycosuria

41. Principles of cancer 7. Name the 4 hallmarks of a cancer cell May invade and metastasis Self sufficient of growth signals Insensitivity to inhibitory signals Avoid apoptosis Unlimited replication potential Sustained angiogenesis (>1mm)

42. Principles of cancer 8. Name 2 routes of metastasis Transcoelomic- across a cavity ie peritoneum Lymphatic spread Haematogenous Direct

43. Principles of cancer 9. Name 5 items of the WHO screening criteria Should be an important health problem Natural history of the disease should be well understood Recognised early or latent phase Available facilities for diagnosis and treatment Suitable examination or test 'acceptable' test to the population Accepted treatment for the disease Agreed policy on who to treat Case finding economical to medical care of the condition Should be a continuing process

44. Principles of cancer 10. Describe the cervical cancer screening programme Pap smear offered every 3 years to women aged 24-49 Pap smear every 5 years for women aged 50-64

45. Round 3 Topics (Q1-10) • Asthma • Hernia and bowel obstruction • DVT/PE

46. Asthma 1. In a patient presenting with shortness of breath, which of the following most strongly supports a diagnosis of asthma: A- Breathlessness on exertion B- FH of hayfever C- FEV1/FVC <0.7 at the clinic visit D- Nocturnal waking due to cough or breathlessness E- Asymmetry of chest expansion on examination

47. Asthma 2. Which of the following are features of a life threatening attack of asthma? A- PEF 33-50% predicted B- Respiratory rate ≥25 C- O2 sats <92% D- Heart rate >110bpm

48. Asthma 3. Which 2 are true about Asthma and COPD: A- Total lung capacity is reduced in both B- Both may present with cough C- Cough is typically worse in the morning with asthma D- Wheeze is only present in asthma E- Air trapping is a feature of both disorders

49. Hernia and Bowel obstruction 4) What are the three most common types of hernia? 5) What is the most common cause of small bowel obstruction in the UK? (1 mark)

50. Hernia and bowel obstruction 6) What is the difference between a direct and indirect hernia? (2 marks)