Exam Intelligence

1. The following are associated with a decrease in muscle strength/power:
A. Eaton-Lambert syndrome - TRUE
Myasthaenic syndrome is associated with a decreased release of Acetylcholine from the nerve terminal, and therefore patients will have decreased strength.

B. Fallot’s Tetralogy - FALSE
Sorry, we just made that up. You can find out all about the Tetralogy of Fallot by looking at this link (http://www.emedicine.com/med/topic3579.htm)

C. Treacher-Collins syndrome - FALSE
This one too. Treacher-Collins is a syndrome known by several other names. As a hater of eponyms (and I would hate to inflict my name on future students of medicine for some little known group of signs or symptoms), I would rather people just called it mandibulofacial dysostosis. Read about, and see photos of patients with it, here (http://www.treachercollins.net/syndrome.html). Once you have seen the gallery of photos, you will not forget it. It is important to anaesthetists because of the associated airway problems that may arise.

D. Guillain-Barrè syndrome - TRUE
Need we say more?

E. Kawasaki disease - FALSE
Nope. This is an acute febrile vasculitic syndrome of early childhood. There is increasing evidence for an infective cause. The vasculitis is most can occur in veins, capillaries, small arterioles, and arteries. characterized by fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, and erythema and edema of the hands and feet.

2. Tetanus
A. is caused by the Gram-positive bacillus Tetanus botulinum - FALSE
Um, no. It’s a Gram-positive rod-shaped anaerobic bacterium called Clostridium tetani.

B. has an incubation period from 1 to 36 days - FALSE
The incubation period is 3-21 days.

C. is fatal >50% of the time - FALSE
Mortality in untreated patients is apparently up to 45% (66% in neonates), with treatment <10%, the rate in those who have received 1-2 doses of vaccine previously being approximately half that of the unvaccinated. (http://www.patient.co.uk/showdoc/40000432/)

D. is associated with myocardial infarction - FALSE
Nope.

E. can be prevented by vaccination with inactivated tetanus toxoid which should be boosted every 3 years. - FALSE
Vaccination is a core tenet of the childhood vaccination program. Its normally given as part of “triple vaccine”, followed by boosters at school entry and leaving. It is thought that 5 doses likely to confer lifelong immunity. Additional boosters may be given to travellers to areas where medical attention may be unavailable,(and likely to sustain at-risk injury) if last dose >10yrs ago, even if completed 5 dose schedule.

As a part of a drive to bring you better intelligence we are developing a new website. This will be up and running very very shortly. We’re just learning how to operate the more sophisticated parts of our webhost, which is a stunning machine based in the US, with ridiculous amounts of bandwidth, power and storage, so keep checking back.

In the meantime, for a little fun, we thought you might like to see some MCQs, which are definitely different from the ones you’ll have seen elsewhere:

Some of them will be at the same level, some will be harder, some will be easier, and some of them will be plain ridiculous (and therefore tagged as work distraction).

So:

1. The following are associated with a decrease in muscle strength/power:
A. Eaton-Lambert syndrome
B. Fallot’s Tetralogy
C. Treacher-Collins syndrome
D. Guillain-Barrè syndrome
E. Kawasaki disease

2. Tetanus
A. is caused by the Gram-positive bacillus Tetanus botulinum
B. has an incubation period from 1 to 36 days
C. is fatal >50% of the time
D. is associated with myocardial infarction
E. can be prevented by vaccination with inactivated tetanus toxoid which should be boosted every 3 years.