Medicine
During the holiday season, many people experience weight gain. Which hormone, produced by adipose tissue, helps to regulate energy balance by inhibiting hunger?
A. Gherlin
B. Leptin
C. Insulin
D. Cortisol
E. Prolactin
B. Leptin
A 45-year-old man is carving a Christmas turkey when he accidentally cuts his hand deeply. He presents to the emergency department with a 5 cm laceration on his palm.
He complains of numbness and tingling in his thumb, index finger, middle finger, and the radial half of his ring finger on the palmar side of his hand. He also has difficulty with thumb opposition and reduced grip strength.
Which nerve is most likely severed?
Median nerve
The 1978 version of 'Mary's Boy Child' reached number one in the UK singles chart and was the Christmas number one that year.
Which band sang this version?
Boney M
A 28-year-old woman, Gemma, who is 2 weeks post-partum, believes the Ghost of Christmas Past is directly telling her to harm her newborn. She believes that she can see in the corner of her room and has conversations with it.
Given the likely diagnosis, what is the most appropriate management?
Immediate admission to hospital, ideally, a specialist mother and baby psychiatric unit
Kevin McCallister ends up in New York City while his family goes to Florida. He uses his father's credit card to check into a luxurious hotel. What is the name of the hotel where Kevin stays?
A. The Plaza Hotel
B. The Ritz-Carlton
C. The Hilton
D. The Four Seasons
E. Holiday Inn
A. The Plaza Hotel
When Santa fell down the chimney, he hit his head and became unconscious. He was taken to the hospital and on examination, his eyes open only to painful stimuli, he makes grunts and groans, and he withdraws from pain.
What is his Glasgow Coma Scale (GCS) score?
8
Eye Opening (E): Opens to pain (2 points)
Verbal Response (V): Incomprehensible sounds (2 points)
Motor Response (M): Withdraws from pain (4 points)
An 80-year-old woman slips on ice whilst out getting Christmas presents in town. She is brought to the emergency department with severe pain in her right hip. X-rays reveal a displaced intracapsular fracture of the femoral neck. She has a history of osteoporosis but is otherwise in good health. What is the most appropriate surgical management for her condition?
C. Hemiarthroplasty
Although she is generally fit and well, with known poor bone quality, hemiarthroplasty can be more suitable as it involves less bone removal and stress on the remaining bone.
A 6-year-old child presents with fever, conjunctivitis and is generally irritable. On examination, there is a maculopapular rash that started behind his ears before spreading, becoming blotchy and confluent. His parents say he returned from a Christmas party where another child was also complaining of a rash. He has no PMH, however has not been vaccinated.
Which childhood condition is he likely to be suffering from?
Measles
Vaccines given at 12-13months and 3years 4months
A 27-year-old woman named Star, who is 30 weeks pregnant, presents with severe itching, especially on her palms and soles, after attending a Christmas cookie exchange. What is the most likely diagnosis?
Cholestasis of pregnancy
What is otherwise known as Christmas Disease?
Haemophillia B
It's New Years Eve in Times Square and Stephanie's boyfriend has just proposed! Her boyfriend said "her eyes were popping out of her head" when he asked, she was tachycardic and tremulous. Stephanie says she regularly suffers from these symptoms, has troubles sleeping and has recently lost 2kg unintentionally.
Elevation of which autoantibody maybe contributing to Stephanie's underlying condition?
Anti-TPO
Rudolf the red nose reindeer, had a very big nosebleed. Santa's been holding little's area for that last 20 mins, but it seems that the bleeding is relentless.
Name 3 further interventions on how to manage this...
Topical adrenaline
Topical tranexamic acid
Nasal packing (RapidRhino)
Surgical intervention: cautery, sphenopalatine ligation
Mamma Elf has just given birth to Baby Elvin a few hours ago. On NIPE examination, they notice Baby Elvin has low set ears, an overbite and rocker-bottom feet.
These features are often characteristic of which childhood syndrome?
Edward's Syndrome (Trisomy 18)
Joanne is 30-week primip with a background of asthma presents to her GP with frequent headaches and nausea. She thinks this is secondary to the stress of buying Xmas presents and is seeking some reassurance. The GP notes BP = 175/115 and on urine dip she has 3+ protein. The GP arranges for admission.
Given the likely diagnosis, what is the first-line most appropriate management?
Nifedipine
(Would be labetolol but given PMH asthma, nifedipine first-line)
What is the medical term for the condition often referred to as "holiday heart syndrome," which can be triggered by excessive alcohol consumption during festive periods?
Atrial Fibrillation
Mr Jones was putting up his Christmas lights; there was a surge of electricity that electrocuted Mr Jones and he fell to the floor unconscious. Paramedics note that Mr Jones is in VF arrest and begin chest compressions.
Following ALS guidelines, what other interventions can be made at this stage? (Name 4 if possible)
Continuous CPR 30:2
Defibrillation
Airway management and oxygen
IV adrenaline 1:10,000 after every 3rd shock then every 3-5 minutes
IV amiodarone 300mg after 3rd shock, then 150mg after the 5th shock
75-year-old Grandpa John attends A&E after developing epigastric pain radiating to the back associated with fevers and ascites. He admits over the Christmas period, he has been enjoying lots of rich foods washed down with plenty of alcohol.
Given the likely diagnosis, name 5 potential causes of this condition
Causes of pancreatitis: I GET SMASHED
Idiopathic,
Gallstones,
Ethanol,
Trauma,
Steroids,
Mumps,
Autoimmune,
Scorpion sting,
Hyperlipidemia / hypertriglyceridemia / hypercalcaemia / hypothermia,
ERCP
Drugs: furosemide, thiazides, aziothioprine
Ernie Elf is a 15-year-old boy presents with progressive hearing loss, hematuria, and a family history of kidney disease. A renal biopsy reveals glomerular basement membrane abnormalities. Genetic testing confirms a mutation in the COL4A5 gene. What is the most likely diagnosis?
Alport Syndrome
A G2P1 named Lucy calls her midwife for advice, as she has developed painful blisters around her genitalia. She is 38 weeks pregnant and has had the lesions approximately 8 days. She has never had any such lesion before.
During the consultation, Lucy's son Tommy comes in and exclaims that he seen "Mummy kissing Santa Claus" last night.
Given the likely diagnosis, what is the most appropriate management?
Offer caesarean section
Offer acyclovir 400mg TDS until delivery for mother
Intrapartum IV acyclovir for both mother and baby
Which country is credited with starting the tradition of putting up a Christmas tree?"
A. Norway
B. Germany
C. Sweden
D. England
E. Israel
Germany
A 70-year-old man named Ebeneezer, who has a history of chronic kidney disease, presents to the emergency department after feeling increasingly unwell during a Christmas family gathering. He complains of severe fatigue, shortness of breath, and swelling in his legs and abdomen. On examination, he has pitting oedema, crackles in his lungs, and a pericardial friction rub. Ebeneezer worries that he may need dialysis.
Name 5 indications for haemofiltration / dialysis?
U-FAKE
Uremia >30 with encephalopathy / haemorrhage
Fluid overload (refractory pulmonary oedema)
Acidosis (pH <7.2)
K+ >6.0
Extras - hypotensive (not responding to fluids), hypernatraemia >160, circulating toxins
Claire, a 35-year-old Mum was out making Christmas dinner for her family. As she lifted the saucepan of gravy the handle came off and the contents of the gravy covered her whole anterior torso and both legs. She has been sent to A&E with 3rd degree burns and requires IV fluids. She weighs 50kg.
Using the Parkland Formula, please calculate the total fluid requirements over the next 24 hours.
Parkland Formula: 4ml x total body weight (kg) x total body surface area (TBSA) burned
Total body surface area = 18 + 9 + 9 = 36
Therefore,
4 x 50 x 36 = 7200ml in 24 hours
A 5-year-old boy presents with a sore throat, fever, and difficulty swallowing. His parents mention he has been drooling and sitting in a tripod position since attending a Christmas parade. What is the most likely diagnosis, pathogenic cause and initial management to ensure he can safely enjoy the holiday festivities?
Croup
Caused by Haemophilus influenzae type b (Hib)
Management: secure airway, oxygen, IV antibiotics (ceftriaxone)
A 33-year-old woman named Belle, who is 24 weeks pregnant, presents with a sudden gush of fluid after attending a Christmas parade. She attends her GP who performs a speculum examination which shows pooling of amniotic fluid in the posterior vaginal vault.
Given the most likely diagnosis, please name 3 recommendations for management...
Admit,
Oral erythromycin (for 10 days)
IM steroid injection (betomethasone 12mg, 2 doses, each dose 24 hours apart; dexamethasone 6mg each dose 12 hours apart, total 4 doses)
In the song, 12 days of Christmas, what did their true love give them on the 10th day?
Ten lords leaping, nine ladies dancing, eight maids milking, seven swans swimming, six geese laying, five gold rings, four calling birds, three French hens, two turtle doves and a partridge in a pear tree