1 Flashcards
- RTA. Conscious at the event. Brought into the A&E with reducing consciousness. Had to work out GCS from the info. Calculated as 6.:
a. Neurosurgical review
b. Intubated and ventilated
c. Rapid CT
d. Burr hole
b. Intubated and ventilated
- Anterior neck lump biopsied as a squamous cell carcinoma of a tonsillar primary. Which infection causes this cancer:
a. EBV
b. HPV
c. Cytomegalovirus
d. HTLV-1
e. HIV
a. EBV
(apparently this is HPV according to wikipedia but EBV does give you nasopharyngeal cancers)
- Man with rheumatoid arthritis and T2DM has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis:
a. venous ulcer
b. pyoderma gangrenosum
c. Granuloma annulare
d. Necrobiosis lipoidica
a. venous ulcer
- DCIS diagnosed on right outer quadrant, on first mammography what is the treatment
a. wide local excision
b. Mastectomy
c. Radiotherapy
d. Review in 6 months
e. Tamoxifen
a. wide local excision
- 55 year old Woman smokes 10 per day with a 6 month history of white sputum and a cough what should be done first
a. CXR
b. PEF diary
c. Spirometry
d. ?Culture
a. CXR
- Private healthcare screening 61 y/o asymptomatic. Fasting bm was 7.2. BMI 21. What should you do with him?
a. HbA1c
b. Metformin
c. Gliclazide
d. Dietary advice
e. Insulin
d. Dietary advice
DM diagnostic guidelines
• Symptoms AND:
o Fasting >7 OR* (impaired – 6.1-8)
o OGTT >11.1 OR* (impaired – 7.8-11.1)
• HbA1c >48 mmol/mol
• *If no Sx must demonstrate on 2 occasions
- Breast cancer with lung and bone mets. On low-dose haloperidol. Confused, constipated. What is causing these symptoms?:
a. Hypercalcaemia
b. Brain mets
c. Haloperidol
a. Hypercalcaemia
- Soldier getting off cramped long haul flight. Went pale, collapsed and hit head. Peers also noticed asynchronous jerky movements for 15 seconds. Recovered consciousness within less than 5 min (???) Cause?:
a. Vasovagal
b. PE
c. Tachyarrhythmia
d. Epilepsy
a. Vasovagal
- Young woman, no lump, bloody discharge from boob:
a. Intraductal papilloma
b. DCIS
c. Duct ectasia
a. Intraductal papilloma
- Woman who had been in bangladesh for 6 months found to have decreased chest expansion, reduced VR, reduced AE, dull percussion on R side, productive cough
a. Pleural effusion
b. Pneumothorax
c. Emphysema
d. bronchiectasis
effusion?
- Patient with symptoms of UC, which investigation is diagnostic
a. Colonoscopy*
b. Faecal calprotectin
a. Colonoscopy*
If a patient has a major comorbidity offer flexisig and barium enema
- Patient with UC, what features indicate for colectomy
a. Epithelial dysplasia
b. Paneth cell metaplasia
c. Crypt abscess
d. Crypt architecture disruption
e. Numerous granulomas
a. Epithelial dysplasia
- Greek guy takes antimalarials and becomes jaundice
a. G6PD deficiency
b. Hep A
c. Hep B
a. G6PD deficiency
- Asthma lady with unable to finish sentences, hypoxic, high PCO2, pH on ABG 7.30. Already given salbutamol, ipratropium and hydrocortisone. Next?
a. CPAP
b. IV aminophylline
c. Intubate ventilate
d. Reduce her O2
c. Intubate ventilate
- Old guy with COPD with Carboxyhaemoglobin of 35% (normal <1.5%), normal O2 sats. What immediate mx?
a. 15L non rebreather mask
b. 2L nasal cannula
c. Different concentrations with venturi mask
a. 15L non rebreather mask
- PEFR 65%, Sats 95%, Pulse 130 bpm. What clinical feature is most useful in determining whether someone with asthma needs admission? PEFT, O2 sats, pulse, RR
a. Peak flow
b. O2 sats
c. Heart rate
d. Respiratory Rate
c. Heart rate
Moderate
• PEFR >50%
Acute severe
• PEFR 33-50%
• RR >25
• HR >110
Life threatening
• PEFR <30%
• Sats <92%
- Hypotensive patient post op and has epidural in, has been given 500ml bolus, no signs of HF, 10 ml urine over 1 hour, no pain
a. Remove epidural
b. Give fluids
c. Give vasoconstrictor
d. Give diuretics
e. Put them head down
c. Give vasoconstrictor
- Sickle cell disease with back pain, what analgesia do you give first
a. paracetamol/ibuprofen
b. Epidural
c. Fluids
d. Exchange transfusion
Criteria for home care
• Adults, mild-mod pain and temperature 38 or less
• Children, mild-mod pain no temperature
Low threshold admission
• Child
• Fever >38
• Chest symptoms
Home Mx
• Fluids
• Avoid triggers
• Paracetamol and/or ibuprofen (not if renal impairment)
• Add codeine if not effective
Hospital Mx
• Strong opiates
- Old guy confused and shouting after after hip replacement, obs stable, he has no pain
a. Stop morphine
b. Haloperidol
c. Well lit side room
d. Midazolam
c. Well lit side room
- Epilepsy not responsive to two x lorazepam
a. Phenytoin
b. Propofol
c. Diazepam
d. Thiopentone
e. Thiamine
a. Phenytoin
- Peripheral oedema, scrotal oedema, proteinuria. Which diagnostic investigation do you do
a. Renal biopsy
- Post tonsillitis guy who got proteinuria, haematuria, swollen face, red cell casts, self resolved over the next 3 months
a. Iga nephropathy
b. Acute glomerulonephritis – post strep
c. Nephrotic syndrome
b. Acute glomerulonephritis – post strep
- 18yo man with tonsillar exudates, gland swelling, jaundice (change in skin colour), upper abdo pain. What was the cause
a. EBV
b. Tonsillitis
c. Staph sepsis
d. Influenza
e. Malaria
a. EBV
- Guy with seizure and no focal neurology. LP results normal protein, normal glucose, raised cell count (20). CT head clear.
a. Viral encephalitis
b. Pneumococcal meningitis
c. Viral meningitis
d. TB meningitis.
a. Viral encephalitis
- 80 year old guy with increased confusion, type 2 diabetes AF with warfarin. Complains of headaches and had 2 falls, increased confusion
a. UTI
b. Chronic subdural
c. Extradural
d. Thrombotic emboli
b. Chronic subdural
- Old lady falls in nursing home, GCS 14 dropped next day to 9, had headache
a. Extradural
b. Subdural
c. SAH
d. Intracerebral haemorrhage
b. Subdural
- Someone has watery vomiting and diarrhoea. What precautions will you take
a. None
b. Don’t let kids see her
c. Ask staff and visitors to wash hands
d. Side room + enteric precautions
e. take regular blood cultures
d. Side room + enteric precautions
- Woman calls GP about husband with terminal prostate cancer and is breathless. What do you do?
a. Call 999
b. Ask another GP to go next week
c. Visit them in that morning + community palliative care discussion
d. Ask district nurse to see them urgently
e. Tell her you will prescribe abx for LRTI
Probs call 999
Just because palliative still can be treated?? Idk
- Erectile dysfunction in a man with HF and hypothyroidism on metformin, BBlocker, statin etc no vasc symptoms, palpable peripheral pulses, normal sensation peripherally, no postural hypotension (<5mmHg changed). What’s the cause?
a. Autonomic neuropathy
b. Side effect meds
c. Vascular insufficiency
d. Cauda equina
e. BPH
b. Side effect meds
- Facial swelling, distended chest veins, weight loss, JVP raised but non pulsating, clubbing
a. Bronchial carcinoma
b. Chronic liver disease
a. Bronchial carcinoma
- Pneumonia with 30 pack year history, background of prostate antigen, with blood gas with a borderline sodium (136), high urea, already had blood and sputum cultures.
a. urine antigens and legionella
b. Spirometry
c. PCP
a. urine antigens and legionella
- 36 year old guy, pain in lumbar back and swollen DIP
a. Psoriatic
b. Anky spond
c. Reactive
d. Osteo
a. Psoriatic
- 30 year old guy with morning stiffness reduced lumbar flexion. Can no longer touch toes
a. Ank spond
- Bell palsy (facial weakness, non forehead sparing, normal ear and no rash) treatment
a. Prednisone
b. No treatment
c. Cinnarizine
d. Aciclovir
e. ?Aspirin
a. Prednisone
- Faecal incontinence, long standing back pain, anal sphincter loose, heavy lifter
a. MR lumbar
b. CT lumbar
c. X-Ray lumbar
a. MR lumbar
- Bilateral knee pain, stiffness 20 min in morning, swollen at night
a. Osteoarthritis
b. Psoriatic
c. Septic arthritis
d. Rheumatoid
a. Osteoarthritis
- Pain in small joints and wrists, pleuritic pain, protein ++ and blood ++, what abs do you expect?
a. ANA
b. Rheumatoid factor
c. Anti Centromere
d. Anti Glomerular Basement Membrane
e. ANCA
b. Rheumatoid factor
- chest pain, 2 days post PCI with stent for STEMI, ECG shows ST elevation in anterior leads and T-wave inversion, pleuritic chest pain, worse pain on movement, quiet heart sounds and auscultation, chest clear
a. Coronary artery dissection
b. Pericarditis
c. Another anterior MI
d. PE
b. Pericarditis
- Arrhythmia after MI
a. VF
b. SVT
c. AF
a. VF
- Anti-jo with signs of polymyositis. Which ix would confirm dx?
a. CK
b. Muscle bx
c. Electromyography
d. Serum myoglobin
e. MR of thighs
b. Muscle bx
- CREST sx on a patient. Pleuritic CP/sob with crackles? Which ix?
a. HRCT
b. Spirometry
c. Echo
d. VQ scan
e. CXR
a. HRCT
- First ix for lady with exertional breathless, HR 42. 1st ix?
a. 12 lead ECG
b. Echo
c. BNP
d. FBC
a. 12 lead ECG
- Myelodysplasia which has got worse in the last few weeks. Primitive cells on slide and pancytopenia, what have they developed?
a. AML
b. CML
c. Myelofibrosis
d. Aplastic anaemia
a. AML
- Features of SLE, on hydroxychloroquine. Jaundiced, raised reticulocytes. Spherocytes and polychromasia:
a. AIHA
b. Hereditary spherocytosis
c. SCD
a. AIHA
- Traveler back from Thailand 3 months ago with anaemia, jaundice and back pain. Intermittent fever:
a. Malaria
b. Hep A
c. Chronic liver disease
d. Leptospirosis
a. Malaria
- British black patient. Long history of limb and back pain, previously big spleen now normal:
a. Sickle cell disease
b. Hereditary spherocytosis
a. Sickle cell disease
- Miscarriage at 11 and 14 weeks. DVTs. Livedo reticularis on the legs:
a. SLE
b. Antiphospholipid syndrome
c. Factor V leiden
b. Antiphospholipid syndrome
- Calculate GCS, opened eyes to pain and withdrew hand to pain. No sounds. (no sounds, opened eyes and withdrew hand to cannulation)
a. 7
b. 5
c. 9
d. 11
7
- Hyponatraemia and dehydrated. Dry mucous membrane. How do you decide on fluid status:
a. Serum urea
b. Serum creatine
c. Urine sodium
d. Urine osmolarity
e. Serum calcium
a. Serum urea
- Unit of blood after upper GI bleed, on second unit has crackles in lung bases (fluid overload), decreasing O2 sats, WHat should you do:
a. IV furosemide
b. Chlorphenamine
c. Adrenaline
d. IV Fluids
a. IV furosemide
- Bowel screening question. that is Faecal occult blood for:
a. Monitoring people with existing disease
b. Screening for people with asymptomatic disease
c. Screening for symptomatic disease
d. Screening for people at risk of developing colonic disease
b. Screening for people with asymptomatic disease
- Described ABO incompatibility, Immediate transfusion reaction shortly after transfusion of second bag of blood. Red urine catheter. What is going on?
a. Immediate transfusion reaction
b. Fluid overload
a. Immediate transfusion reaction
- Women on long term lithium. Peeing loads even at night. Blood results showing hyponatremia, normal blood glucose:
a. DM
b. DI
c. SIADH
d. Psychogenic Polydipsia
b. DI
- Classic pneumonia signs (Gram +ve in pairs) what antibiotic to give:
a. Amoxicillin
b. Clarithromycin
c. Gentamicin
a. Amoxicillin
- Clarithromycin and atorvastatin, metformin:
a. Continue
b. Stop statin
c. Stop metformin
b. Stop statin
- Vocal cord endoscopy, struggling to speak, tachypnoeic 28, could not maintain a strong grip when asked by nurses to squeeze. What is the antidote?:
a. Neostigmine
b. Glycopyronium
c. Rocuronium
d. Doxapram
e. Naloxone
a. Neostigmine
- 21 year old female has acne, tried topical antibiotics and topical retinoids no success. DVT in past after plane. What to try next?
a. Lymecycline
b. Isotretinoin
c. Flucloxacillin
d. Desogestrel
e. Co-cyprindiol
a. Lymecycline
- Guy has dyspepsia, pain a few hours after food, wakes him up in night and drinks milk to make it better. Nocturnal asthma.
a. Gastric ulcer
b. Duodenal ulcer
c. Pancreatitis
d. GORD
b. Duodenal ulcer
- Old woman forgetting over 18 months - remembers the past well. Mother had similar presentation.
a. Alzheimer’s disease
b. Frontotemporal
c. Parkinsons
d. Huntington’s chorea
e. Lewy Body dementia
a. Alzheimer’s disease
- Guy whos epidural fell out and took ages to get PCA (had “pain” in the meantime). 1 day post op has fever.
a. Atelectasis
b. PE
c. Wound infection
d. UTI
e. Chest infection
a. Atelectasis
- Guy with swollen face, jaundice, distended abdomen, drinks 90 units a week. Recently losing weight unintentional. Didn’t mention if it was acute setting or not - just told us what he had.
a. Chronic liver disease
b. Hepatic vein thrombosis
c. Acute pancreatitis
?
- 5 days post AP resection and now peritonitic, temp 38 abdo distension and lower abdo pain.
a. Pelvic abcess
b. Anastomotic leak
c. Subphrenic abscess
d. Subpelvic abscess
b. Anastomotic leak
- Guy with faecal incontinence and tenesmus
a. Rectal cancer
b. Haemorrhoids
a. Rectal cancer
- Guy with terminal dribbling etc
BPH
- Person with nephrectomy and had stone in the good kidney at PUJ and swelling of upper urinary tract on imaging. Had fever. ?Septic obs. How to manage?
a. Percutaneous nephrostomy
b. Lithotripsy
c. Conservative
d. Antibiotics
e. Cystoscopy and Stent
a. Percutaneous nephrostomy
- Black man with high ACE, high Calcium and CXR showed hilar lymphadenopathy
a. Sarcoidosis
b. TB
c. Lymphoma
a. Sarcoidosis
- A man post renal transplant (on mycophenalte, prednisolone, etc) develops chest infection. Some blood results were given (Hb, Na, K, urea). No sounds on listening to chest and CXR showing perihilar haziness..
a. PCP
b. Pneumoccocus
c. Hemophilus B
d. Klebsiella
a. PCP
- Palpitations, weight loss and altered bowel habit in old lady, what nail changes are seen? What was the answer here someone please? Here - skin changes in hyperthyroid include - Onycholysis
a. Onycholysis
b. Pitting
c. Staining
d. Leukonychia
e. Koilonychia
a. Onycholysis
- Young guy in A+E breathless, 4cm pneumothorax, trachea non-deviated, how to manage?
a. Aspirate
b. Chest Drain
c. Nebulizers
d. Oxygen 15L
e. Send home and OP review
a. Aspirate
- Bloody diarrhoea + vomiting after eating chicken at barbecue initial Culture at 37C Negative, Culture at 42C - curved gram negative rods
a. Campylobacter Jejuni
b. Shigella
c. E. Coli
d. Salmonella
e. C. diff
a. Campylobacter Jejuni
- Guy falls off roof, gets chest pain for one day, painful on breathing deeply or coughing, in R Axilla, O2 sats - 95%
a. Costochondritis
b. Fractured ribs
c. Pneumothorax
d. Pneumonia
b. Fractured ribs
- Another man falls 10m, ?wide pulse pressure, enlarged mediastinum on CXR,
a. Traumatic aortic Dissection
b. Cardiac Tamponade
c. Pneumothorax
a. Traumatic aortic Dissection
- Guy with ECG - P wave 70, QRS wave 45 (repeat from prev. paper)
a. Complete heart block
b. Type 2 heart block
c. AF
a. Complete heart block
- Young guy, collapses frequently during sport? with ECG - Sinus rhythm. PR or QRS 120ms, cQT 510ms (Repeat since 2014 - Meeran’s writtens reports always get upset that people don’t recognize prolonged QT = VT. They didn’t give values of normal QT interval)
a. supraventricular arrhythmia
b. Sick sinus syndrome
c. AF
d. VT
e. Asystole
f. Complete heart block
d. VT
- Man on motorbike crashes into a car, he now has an internally rotated and shortened leg, adducted and flexed
a. Neck of femur fracture
b. Posterior dislocation of femur
c. Anterior dislocation of femur
d. Shaft of femur fracture
b. Posterior dislocation of femur
Posterior dislocation (most common) = Shortened adducted internally rotated
Anterior dislocation = Abducted, externally rotated, no shortening
- Patient with sputum culture of Pneumocystis jirovecii. Antibiotic treatment
a. Co-trimoxazole
b. Ciprofloxacin
c. Metronidazole
a. Co-trimoxazole
PCP
• Co-trimoxazole
• IV pentamidine in severe cases
• Steroids if hypoxic
- Woman with new headaches and sweaty. Her blood results showed raised IGF1 and raised prolactin (roughly 1200)
a. Acromegaly
b. Pituitary macroadenoma
c. Hyperthyroidism
a. Acromegaly
- Woman BMI32, drinks loads of coffee, smokes, drinks alcohol etc - Getting recurrent headaches, losing vision when straining to poo. Exam shows papilledema. LP pressure high (40) Best advice to give to her?
a. Lose weight
b. Stop drinking
c. Stop Smoking
d. Stop having Caffeine
a. Lose weight
Old lady falls down. Has shortened and externally rotated leg. What is likely cause?
a. Pubic rami fracture
b. #NOF
c. Femur shaft fracture
d. Hip dislocation
b. #NOF
. Lady has fallen down. Has history of Left sided THR 8 years ago. Today has shortened and internally rotated left leg - what’s the likely cause? (past paper repeat)
a. #NOF left side
b. Shaft of femur
c. Pelvis fracture
d. Hip dislocated
d. Hip dislocated
Woman with metastatic cancer, taking Morphine 60 mg BD oral and can’t tolerate oral anymore, what to replace it with?
a. Morphine subcut 240mg/24h
b. morphine subcut 60mg/24h
c. Gabapentin
d. morphine oral solution
b. morphine subcut 60mg/24h
Oral to subcut x 0.5
Mc Murray’s positive, twisted knee during sport and heard a pop, what Ix most appropriate?
a. MR knee
b. X-ray knee
c. Arthrography
d. Ultrasound
a. MR knee
Patient with COPD had several previous courses of steroids and now has postural hypotension and cushingoid facies, palmar crease pigmentation. What test?
a. Short synacthen
b. Plasma glucose
c. Dexamethasone suppression test
d. 9am cortisol
a. Short synacthen
Fatigue, diabetic with photocoagulation, urine had protein etc
a. CKD
b. Urinary tract infection
a. CKD
Treatment for meningitis (neck stiffness etc)
IV ceftriaxone
Young lady with massive HTN. High Na, low K - which hormone is likely cause of high blood pressure?
A. Aldosterone
B. Cortisol
C. Catecholamine
A. Aldosterone
Young Woman breast-feeding- fever, breast pain, lump:
abscess, cancer, fat necrosis
abscess
(pp repeat) Anal abscess - erythema and swelling -
Treatment: incision and drainage, flucloxacillin, Amox + Metro + wait
incision and drainage
(pp repeat) History of constipation, severe pain on DRE so unable to perform it. Anal fissure, haemorrhoids
Anal fissure
Severe abdo pain radiating to the back. Suddenly goes unresponsive and pale, pulse 120, BP unrecordable - likely diagnosis? Ruptured AAA, mesenteric ischaemia
Ruptured AAA
59 yr old female with pruritus and got IgM anti-mitochondrial antibodies. What makes PBC likely? Xanthelasma, Tendon xanthomata, hepatomegaly 8cm, macroglossia, facial rash
Xanthelasma
BCC - what does it do? Local invasion only, Mets to liver, Mets to local lymph nodes, spontaneous regression
Local invasion only
Guy with AF who had a pale leg. Weak movement and loss of sensation. How to manage? Urgent embolectomy, Prostacyclin infusion, Amputate, venogram
Urgent embolectomy
Most likely diagnosis. 36 yo black man who had multiple episodes of limb pain in the past. Previously had a big spleen but now it’s small. What condition explains it best? Sickle cell anaemia, Thalassemia B, G6PD Deficiency
Sickle cell anaemia
Patient with floaters and sudden loss of vision in left superotemporal quadrant? Retinal detachment, infranasal artery occlusion, superotemporal artery occlusion, vein occlusion
Retinal detachment,
Pt recently had dosage of atorvastatin increased, presents with myalgia etc. CK elevated to 5x upper limit of normal (2000): Stop atorvastatin, stop and switch to rosuvastatin, stop and switch to simvastatin, half dose of atorvastatin, give NSAID.
Stop atorvastatin
Guy with renal failure. Which drug is contributing to abnormal blood tests? Diclofenac, Simvastatin, Aspirin, metformin
Diclofenac
IVDU with back pain. urine blood 1+ protein +. Systolic murmur. Anaemia on bloods.Tenderness over L1 to L3. Diagnosis?
Pyelonephritis, Infective endocarditis, reactivation of Hep C
Infective endocarditis
. APTT and PT raised (?low platelets). What to measure?
1. D-dimer and fibrinogen, vWF
2. Bone marrow biopsy
3. FBC
- D-dimer and fibrinogen, vWF
Dysphagia to both liquid and solids, Birds beak appearance - achalasia, oesophageal webs, oesophageal cancer, Barett’s
achalasia
Patient with cough. Bordetella pertussis found on culture. What’s the diagnosis? Whooping cough, Flu, Pneumonia,
Whooping cough
Acute diverticulitis. What is the diagnostic investigation: Flexi sig, CT abdomen, MRI
CT abdomen
Surfer’s ear (pain on pulling pinna, can’t visualise the membrane due to artefact in the canal, she felt she had hearing loss):
Otitis externa, Otitis media, cholesteatoma, perf tymp membrane
Otitis externa
Mx
• Most common = pseudomonas or staph aureus
• Clear ear canal if obstructed
• Analgesia
• Topical abx ± steroid: gentamicin, chloramphenicol 7-14 days
• Consider ear wick if extensive swelling
Blurred vision, painful right eye, right eye congested and bigger. Angle closure glaucoma, temporal arteritis,
Glaucoma
o Cloudy cornea
o Fixed, dilated irregular pupil
o Mx
Pilocarpine (constricts to open blockage)
Topical B-blocker: decrease aqueous formation
Acetazolamide: decrease aqueous formation
Later: YAG iridotomy
Uveitis
o Small pupil
o Hypopyon
o Talbot’s: pain on convergence
o Mx:
Prednisolone eye drops
Cyclopentolate drops: dilates pupil and prevents adhesions between iris and lens
Graves disease picture - eyes bulging forward, lens dislocation, losing weight. mechanism? Rectus muscle thickening, retrobulbar tumour, cavernous sinus, retinal vein thrombosis
Rectus muscle thickening
60 year old gentlemen with recurrent lower GI bleeding. Rigid sigmoidoscopy was normal up to 15 cm. What is the next appropriate investigation? CT pneumocolon, colonoscopy, Red cell scan, Mesenteric angiogram, MR scan of the abdomen
• Colonoscopy
Guy recently got a parrot and now has pneumonia - chlamydia psittaci, H5N1 pneumonia, EAA, Mycoplasma infection
chlamydia psittaci - Clarithromycin
Management of Person with metastatic cancer and has brain lesions and raised ICP - dexamethasone, mannitol, ?levetiracetam (or was this a different question?)
• Dexamethasone
Young Man who gets exertional dizziness and dyspnea. Slow rising pulse - what murmur? Ejection systolic, pan systolic, mid diastolic, end diastolic
Ejection systolic
Man who has AF with two previous TIAs. Not on any medication. How would you manage him? Warfarin, aspirin, digoxin
• Warfarin
Man with leg claudication and ABPI of 0.84 - what do you do? Structured exercise programmes, fempop bypass, another type of bypass, vasodilator medications
Structured exercise programmes
30 year old male. Only sexual partner is his wife. Has symptoms of epididymo-orchitis. What is the cause? Chlamydia, Gonorrhoea, E.Coli
E.Coli
• <35: chlamydia
• >35: E. coli
• Mx:
o Doxycycline 100mg
o Ciprofloxacin 500mg
o 2-4 weeks course
Lady with chronic renal failure for 9 years on dialysis. PTH massively increased (148), Ca high (2.9), Phosphate high. Multiple myeloma, Primary hyperparathyroidism, Secondary hyperparathyroidism, Tertiary hyperparathyroidism,
Tertiary hyperparathyroidism,
Hyperkalaemia and symptoms of pneumonia. ECG changes - tented T waves and broad QRS. What is the most important initial treatment? Calcium gluconate, Glucose/insulin, co-amoxiclav, amiodarone
Calcium gluconate
Man has ultrasound to look for gallstones, incidental finding of 4cm solid renal mass. No other Sx: angiomyolipoma, renal cyst, renal cell carcinoma, renal metastases
• Angiomyolipomas are the most common benign solid renal lesion
CXR: Bronchial wall thickening. Coarse creps on the right side. Bronchiectasis, Idiopathic pulmonary fibrosis
Bronchiectasis
(pp repeat) Patient had a stroke. SALT assessment showed he can’t feed himself. What is the most appropriate way to give nutrition? NGT, PEG, Parenteral nutrition
• Up to 1 month: NGT
• Long term dysphagia: PEG
What markers are high in this patient with obstructive jaundice picture? High bilirubin, high ALP, normal ALT (and all variants of that - NNN, Normal High Normal, etc)
increased conjugated bilirubin
slightly raised AST and ALT
high ALP
high GGT
Acute onset pain ‘under her breast’. Has just come back 2 days ago from a holiday in India. ECG shows sinus tachy. Options: PE, Myocardial infarction
PE
Caucasian man presents with dysphagia/weight loss ‘food getting stuck behind chest’: Squamous cell carcinoma, adenocarcinoma, barrett’s, GORD
adenocarcinoma
Variable ventricular rate and absent P waves? AF (Wasn’t it an irregular ventricular rhythm? AF, atrial flutter, ventricular tachycardia, ventricular fibrilation, supraventriular tachycardia)
??
60 year old man with 2 cm smooth non tender swelling fixed to underlying structures - on left wrist? Ganglion, lipoma
Ganglion
Lady with asthma. On various inhalers + LTRA + Theophylline tablet. Which one has caused his painful swallow
Beclomethasone
(pp repeat) Alcoholic with diplopia on looking laterally both sides, nystagmus, what to give him. Also hypotensive and tachycardic? Thiamine, IV fluids, chlordiazepoxide
• Thiamine
• Wernicke: ophthaloplegia + ataxia + confusion
Patient with fine end inspiratory crackles, clubbing.
Pulmonary fibrosis
Man with sciatic pain after ?heavy lifting. Disc prolapse, spondylolisthesis
. Disc prolapse
Pain on exercise associated with anxiety and sweating, radiates into neck. Comes on with walking and relieved by 5 minutes of rest. Troponin is normal. ECG no abnormalities. What is diagnosis? Angina, NSTEMI, GORD, achalasia, anxiety
Angina
Zig zag lines and painful eyes+ N&V for 30 min episodes? Migraine, Glaucoma
Migraine
Patient with pain on chewing and speaking. Occasionally gets unilateral headaches. Raised CRP - what is the next step to make diagnosis? Temporal artery biopsy, sialogram, CT head
Temporal artery biopsy
• 60mg prednisolone
Footballer hits shin, progressive pain with pain on active and passive flexion of the foot. How do you manage? 4 compartment fasciotomy within 6 hours, review in 12 hours, send them home with analgesia, imaging
4 compartment fasciotomy
Patient with RUQ pain, jaundice, fever. Raised AST. Did not give other liver function tests. Ascending cholangitis, Hep A, Hep B, pancreatic cancer.
Ascending cholangitis??
20ish year old woman, with bowel problems. Patient with IDA, low folate, rest bloods normal. Options: Coeliac disease, IBS, UC, Crohn’s
Coeliac disease
Patient on bendroflumethiazide, painful toe, what is the diagnosis
A. Gout
B. Pseudogout
C. osteoarthritis
Gout
Q. about a 2nd degree (4:1?) block somewhere? HR 75bpm, can’t remember rest of details
??
