List the typical findings in the following investigation-disease pairs:
a) The nerve conduction findings in Guillain-Barre syndrome. (20% marks)
b) The cerebral spinal fluid findings in Listeria meningitis. (20% marks)
c) MRI features in posterior reversible encephalopathy syndrome (PRES). (20% marks)
d) Full blood count and blood film in Vitamin B12 deficiency. (20% marks)
e) Plain cervical spine X-ray in ankylosing spondylitis. (20% marks)
Generally poor knowledge in this area with many factual errors in some candidates’ answers.
Though some might say that a test of analytic capabilities is more important, it is clearly still relevant for the college to make sure their trainees have strong semantic memory, even though more recently data storage has been extensively outsourced to external structures such as the Internet. One may still argue that the 31.8% of trainees who were able to effortlessly recall these details would make slightly sharper intensivists.
The nerve conduction findings in Guillain-Barre syndrome
Some very old diagnostic guidelines from 1990 (Asbury & Cornblath)
The cerebral spinal fluid findings in Listeria meningitis
The lymphocyte-rich CSF in Listeria meningitis can occasionally confuse a young player, where "the unwary may dismiss lymphocytic meningitis as being of 'viral' origin", according to an old paper by Hearmon & Ghosh (1989). It is otherwise classical bacterial meningitis (low glucose, high CSF protein, and of course characteristic Gram-postive rods of which there are not many).
MRI features in posterior reversible encephalopathy syndrome (PRES)
As listed by Bartynski (2008):
Full blood count and blood film in Vitamin B12 deficiency
Plain cervical spine x-ray in ankylosing spondylitis
As the practice of ordering plain C-spine radiographs has largely died out over 10 years ago, it is strange to find it in the 2019 paper, but here we are. From Radiopedia and Østergaard (2012):
Bartynski, W. S. "Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features." American Journal of Neuroradiology 29.6 (2008): 1036-1042.
Asbury, Arthur K., and David R. Cornblath. "Assessment of current diagnostic criteria for Guillain‐Barré syndrome." Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 27.S1 (1990): S21-S24.
Hearmon, Christine J., and Salil K. Ghosh. "Listeria monocytogenes meningitis in previously healthy adults." Postgraduate medical journal 65.760 (1989): 74-78.
Snow, Christopher F. "Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician." Archives of internal medicine 159.12 (1999): 1289-1298.
Østergaard, Mikkel. "Imaging of ankylosing spondylitis." Arthritis Research & Therapy. Vol. 14. No. 2. BioMed Central, 2012.