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