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Phase 2a SBA/EMQ > 2013 paper > Flashcards

2013 paper Flashcards

1
Q
  1. Man comes into A&E with a deep (penetrating superficial fascia) police dog bite in thigh.

The wound is irrigated and debrided under local. What ABx do you prescribe?

a. Flucloxacillin po
b. Co-amoxiclav
c. Doxycycline po
d. Doesn’t require antibiotics

A

b. Co-amoxiclav

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2
Q

Woman presents with 2/7 Hx dysuria, haematuria, now severe flank pain, fever, rigors. What

is most likely organism on urine culture?

a. Serratia marcescens
b. Pseudomonas aeruginosa
c. E coli
d. Proteus mirabilis
e. Enterococcus faecalis

A

c. e coli

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3
Q

Gentleman attends with 1 day Hx vomiting, non-bloody voluminous diarrhoea, previously fit

and well, no other significant symptoms/signs, no foreign travel Hx, eaten takeaway food 3h

before onset symptoms. What is most likely causative organism?

a. Campylobacter jejuni
b. Staphylococcus aureus
c. Salmonella sp
d. Shigella sp
e. E coli

A

b. staph aureus

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4
Q

53 yo F presents with headache, fever, photophobia. O/E nuchal rigidity. Lumbar puncture

demonstrates gram +ve cocci. Which organism?

a. N meningitidis
b. Listeria monocytogenes
c. E coli
d. Strep pneumoniae
e. Strep agalactiae

A

d. Strep pneumoniae

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5
Q

Middle-aged M w/ HTN, increased serum Cr and urea, proteinuria and haematuria, bilateral

palpable costovertebral angle masses, dad died of SAH. Most likely diagnosis?

a. Horseshoe kidney
b. ADPKD
c. Nephrotic syndrome
d. Rapidly progressive glomerulonephritis
e. Conn’s syndrome

A

b. ADPKD

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6
Q

33yo plumber presents with acute-onset SoB, cough, haemoptysis. Urinalysis shows

haematuria and proteinuria, anti-GBM Ab +ve. Dx?

a. Goodpasture syndrome
b. PE
c. TB
d. Mesothelioma
e. Diabetic nephropathy

A

a. Goodpasture syndrome

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7
Q

Middle-aged M presents with ulcer L hallux. Sharp borders, deep, minimal granulation tissue

in base. Sensation preserved around edges of ulcer. Does not recall any trauma Hx. ABPI 0.68

L leg, 0.92 R. Major factor in pathogenesis of ulcer?

a. Venous insufficiency
b. Peripheral neuropathy
c. Arterial insufficiency
d. Infection

A

c. Arterial insufficiency

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8
Q

50-60something M has two fasting glucose measurements 7.2 and 7.9mmol/l, given diet and

lifestyle advice. Returns to GP couple of months later, fasting BM 10.2mmol/L. BMI 31kg/m 2 ,

renal function normal, liver function normal, glucose ++ on urinalysis, otherwise normal. Most appropriate starting medication?

a. Gliclazide
b. Glibenclamide
c. Metformin
d. Exenatide
e. Mannitol

A

c. Metformin

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9
Q

49yo Caucasian M with HTN, doesn’t respond to lifestyle modification. Renal function OK.

What drug should GP start him on?

a. Alpha-blocker
b. ACE inhibitor
c. Beta-blocker
d. CCB
e. Thiazide diuretic

A

b. ACE inhibitor

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10
Q

30-something F with 2/12 Hx diarrhoea with blood and mucus, some LLQ discomfort. No

weight loss, some other relevant stuff mild-moderate UC Hx What appropriate 1 st -line

treatment?

a. Betamethasone?? See if it responds to steroids
b. Methotrexate
c. Azathioprine
d. Aspirin
e. Mesalazine

A

e. Mesalazine

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11
Q

20-something M with diagnosed asthma presents with increasing chest tightness and waking

up at night coughing. On SABA, no other medication, otherwise fit and well. Symptomatic

episodes well managed with 2x SABA puffs. After lifestyle/education advice and assessment of inhaler technique, appropriate mgmt.?

a. Long-acting beta 2 agonist
b. PO corticosteroid
c. PO theophylline
d. Inhaled corticosteroid
e. Anti-muscarinic

A

d. Inhaled corticosteroid

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12
Q

30-something F with diagnosed asthma presents with… *worsening of asthma symptoms

over wks*. Already on SABA and ICS, using them appropriately. Appropriate mgmt.?

a. Increased ICS dose
b. Add po corticosteroid
c. Add po theophylline
d. Add cromone
e. Add inhaled LABA

A

e. Add inhaled LABA

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13
Q

30-something F with known asthma presents at A&E with severe breathlessness, barely able

to speak. O/E dynamic hyperinflation, severe wheeze throughout both lungs, accessory

breathing,… Sats ?lowish, RR ?28/min, HR ?110/min. Appropriate 1 st -line mgmt.?

a. 4L O 2 nasal cannulae
b. 15L O 2 reservoir mask
c. 24% O 2 venturi mask
d. Perform ABG
e. Intubate immediately

A

c. 24% O 2 venturi mask

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14
Q

Middle-aged M w/ 40-yr smoking Hx, worked in office all life, presents w/ progressive severe breathlessness over time course of ? months, ? yrs. 20ml white sputum produced daily. Wheeze

throughout both lungs. Spirometry given – something around FEV 1 < 50% predicted, FVC ~

60% predicted, FEV 1 /FVC v low. Most likely Dx?

a. Bronchiectasis
b. TB
c. COPD
d. Pulmonary fibrosis
e. Pneumonia

A

c. COPD

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15
Q

M presents at A&E after being involved in RTA. GCS 15/15 on arrival, within 1h deteriorated to

9/15. Some other detail inc fixed dilated R pupil. What most likely Dx?

a. Subdural haematoma
b. Extradural haematoma
c. Sub arach
d. Carotid artery dissection
e. Intracranial haemorrhage

A

b. Extradural haematoma

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16
Q

Older F presents w/fever, malaise, transient episode R-sided weakness. Long-standing

rheumatic mitral valve disease. O/E temperature 38 o C, pansystolic murmur loudest at apex,

think there may’ve been some clubbing going on. First-line investigation?

a. Cerebral angiogram
b. Blood cultures
c. Chest Xray
d. Carotid dopplers
e. something else

A

b. Blood cultures

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17
Q

Older M presents with 1 hour of having a …barn-door L-sided CVA. Bruit over L carotid

artery. First investigation?
a. Carotid Doppler
b. Carotid angiography
c. CT brain
d. Lumbar puncture
e. Summat else

A

c. CT brain

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18
Q

19yo F attends w/ father c/o lower abdo pain. She is unable to speak any English, he is. She
doesn’t make eye contact at any point. Do you:

a. Take Hx w/ father as interpreter
b. Ask father to leave, take Hx w/interpreter
c. Take Hx w/interpreter, allow father to hang around
d. Skip Hx and proceed to examination with chaperone and no Dad
e. Take Hx from father

A

b. Ask father to leave, take Hx w/interpreter

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19
Q

Chap signs a valid DNAR, deteriorates, daughter demands resuscitation. Which ethical principle does she violate?

a. Autonomy
b. Beneficence
c. Non-maleficence
d. Justice
e. Compassion

A

a. Autonomy

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20
Q

Chap makes some nonspecific arrangements about end-of- life mgmt., deteriorates, managing

team consult family in making care-related decisions. ACCORDING TO MENTAL CAPACITY

ACT, why should family be consulted?

a. Next of kin have decision-making authority when pt lacks capacity and wishes

unknown in advance

b. Helps family deal w/ situation to be involved in mgmt.
c. Family may be able to make managing team better aware of patient’s values and preferences when they have capacity
d. So that team incorporates family’s wishes in making care-related decisions
e. Summat else

A

d. So that team incorporates family’s wishes in making care-related decisions

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21
Q

Someone gets a biopsy of a growth in their colon. Which of these benign lesions has the highest risk of malignant transition?

a. Villous adenoma
b. Tubular adenoma
c. Tubulovillous adenoma
d. Hyperplastic polyp
e. Some other kind of polyp

A

a. Villous adenoma

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22
Q

Here are some ABG results showing low CO2, middling to high O2, Low Bicarb and low ph.

Interpret them: (to make it even easier there was a story about a 20 year old kussmauling)

a. Uncompensated metabolic acidosis
b. Respiratory alkalosis
c. Normal
d. Respiratory acidosis with metabolic compensation
e. Metabolic acidosis with respiratory compensation

A

e. Metabolic acidosis with respiratory compensation

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23
Q

Chap has an MI while he’s on ramipril for HTN. Looks like he’s suffering AKI. What compensatory mechanism for maintaining GFR is the ramipril messing up?

a. Afferent arteriolar dilation
b. Efferent arteriolar constriction
c. Positive inotropism

A

b. Efferent arteriolar constriction

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24
Q

A 40 year old lady is having an ovarian tumour removed. She previously had a PE during

her first pregnancy. During the surgery she had all the usual DVT prophylaxis (compression stockings, calf balloons, etc.), and is now on the ward recovering. She is currently wearing compression stockings. What is the most appropriate medical DVT prophylaxis?

a. Unfractionated heparin
b. LMWH
c. Aspirin
d. Clopidogrel
e. Warfarin

A

b. LMWH

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25
Q

Someone’s put on amoxicillin. How does amoxicillin work as an antibiotic?

a. Inhibits peptidoglycan cross-linking in cell wall formation
b. Inhibits sterol synthesis in cell wall formation
c. Inhibits protein synthesis
d. Inhibits RNA transcription

A

a. Inhibits peptidoglycan cross-linking in cell wall formation

26
Q

A 40 year old lady presents with weight gain, hirsuitism, acne and other PCOS symptoms.

She is referred to an endocrinologist. What is the most appropriate 1st line investigation?

a. Serum LH and FSH
b. Serum testosterone
c. USS of her ovaries
d. Thyroid function tests
e. Dexamethasone suppression

A

c. USS of her ovaries

27
Q 
A 42 year old lady comes in vomitting blood and has oesophageal varices banded by
endoscopist. She has various stigmata of chronic liver disease and bloods which agree. First
line ix (?to confirm cirrhosis), not counting bloods?

a. US abdo
b. Liver biopsy
c. CT abdo
d. Chest X ray
e. Can’t remember

A

c. CT abdo

28
Q

MSK - a lady has fairly obvious RA. What changes would you expect to see on x-ray of her hand?

a. subchondral cysts
b. osteophytes
c. periarticular erosions
d. subchondral sclerosis

A

c. periarticular erosions

29
Q

Chap has acute gout in the knee and 1st MTP. What is the acute management of gout?

a, Oral diclofenac-

b. Oral opiates
c. Oral allopurinol
d. IV fluids
e. Oral ABx

A

a, Oral diclofenac-

30
Q

First Ix in suspected septic arthritis. Afebrile.

a. Blood cultures
b. Aspirate the knee and send for MC&S
c. X ray of the knee
d. Ultrasound of the knee
e. MRI (or something)

A

b. Aspirate the knee and send for MC&S

31
Q

A 60 year old man has just had surgery on his carotids and is complaining of difficulty speaking and swallowing. OE his tongue is deviated to the right. Which nerve has most likely been damaged during the operation?

a. Left Facial
b. Left glossopharyngeal
c. Right glossopharyngeal
d. Left hypoglossal
e. Right hypoglossal

A

e. Right hypoglossal

32
Q

A 57 year old man with a 40 year pack history presents with a 4 week history of a hoarse
voice. Examination of the neck is unremarkable, but laryngoscopy (?) reveals paralysis of the vocal cords. Which nerve has most likely been damaged?

a. Recurrent laryngeal
b. Superior laryngeal
c. Vagus
d. External laryngeal
e. Internal laryngeal

A

a. Recurrent laryngeal

33
Q

a 50 year old male presents with central crushing chest pain…blah blah, lateral STEMI. No PMH of note. What is the most appropriate initial management?

a. Thrombolysis
b. Primary angioplasty
c. Emergency cabbage
d. Morphine
e. Hydrotherapy

A

d. Morphine

34
Q

A 74 year old gentleman presents with a resting tremor and difficulty starting movements.

OE his has a festinant gait. What is the pathophysiology behind his symptoms?

a. Degeneration of neurones in the corpus callosum
b. Neuronal degeneration in the substantia nigra
c. Cortical infarcts
d. Neuronal degeneration in the caudate nucleus
e. Neuronal degeneration in the subthalamic nucleus

A

b. Neuronal degeneration in the substantia nigra

35
Q

A 33 year old window cleaner falls off his ladder and breaks his arm. X-ray shows a mid- shaft fracture of the humerus with posterior displacement. OE he is unable to extend his wrist or fingers. What nerve has he likely damaged?

a. Common peroneal
b. Ulnar
c. Median
d. Radial
e. Musculocutaneous

A

d. Radial

36
Q

A 48 year old lady presents with episodes of sweating and palpitations. OE her BP is 220/140. CT abdo shows a mass in the left adrenal. What substance is being released by this mass that is responsible for her symptoms?

a. Aldosterone
b. ACTH
c. Adrenaline
d. Cortisol
e. Oestrogen

A

c. Adrenaline

37
Q

A 28 year old woman presents with a 2 day history of copious bloody diarrhoea. 16 days ago she returned from India. What is the most likely organism?

a. entamoeba histolytica
b. giardia lambidia
c. plasmodium vivax
d. salmonella paratyphi
e. e. coli

A

a. entamoeba histolytica

38
Q

A 65 year old gentleman presents with a 6 month history of dry cough and increasing shortness of breath. Following ix he is diagnosed with IPF. What would you expect his PFTs to show relative to the expected for his age, sex and height?

a. Reduced FEV1/FVC
b. Reduced FVC
c. Increased functional residual capacity
d. Increased TLC
e. Something else.

A

b. Reduced FVC

39
Q

A 52 year old has a total gastrectomy, and is told that they have to be given B12 injex for life. What has changed to make this a necessity?

a. Achlorhydria
b. Lack of pepsin
c. Lack of intrinsic factor
d. To build them up big and strong after their operation
e. Lack of gastrin

A

c. Lack of intrinsic factor

40
Q

A Chap has suspected Charcot foot. What additional finding on examination of the feet would support this?

a. Lack of foot pulses
b. Varicose veins
c. Fungal infection
d. Lack of sensation
e. Lack of feet.

A

d. Lack of sensation

41
Q

A 20 year old man is diagnosed with retinitis pigmentosa. Neither of his parents were affected, but his maternal grandfather and his maternal brother’s brother both were. What mode

of inheritance does this suggest?

a. Autosomal recessive
b. Autosomal dominant
c. Sporadic mutation
d. x linked recessive
e. x linked dominant

A

e. x linked dominant

42
Q

A 60 year old male had an MI 8 days ago, and now presents with sudden onset shortness of
breath. OE he has a pansystolic murmur radiating to the axilla and basal creps bilaterally. What imaging would you request to confirm the diagnosis?

a. Spiral CT thorax
b. CXR
c. Echocardio
d. Plain film AXR
e. Coronary angiogram

A

c. Echocardio

43
Q

A 72 year old gentleman presents with progressive hearing loss and ill-fitting dentures. [insert loads of blood results, the only deranged one of which was raised alk phos]. What is the cause?

a. Acoustic neuroma
b. Paget’s disease of bone
c. Astrocytoma
d. Subdural haemorrhage
e. Parkinson’s disease

A

b. Paget’s disease of bone

44
Q

A 56 year old gentleman with known PUD presents with haematemesis. Following resus and OGD is performed which show a vessel bleeding in a pulsatile fashion at the bottom of an ulcer at the pylorus. Which vessel is this likely to be?

a. Splenic artery
b. Left gastric artery ??
c. Superior mesenteric artery
d. Right hepatic artery
e. Gastroduodenal artery

A

e. Gastroduodenal artery

45
Q

A 68 year old woman presents with several episodes dizziness associated with SOB. OE her pulse is regularly irregular. An ECG shows a gradually increasing PR interval followed by dropped QRS, which then rinses and repeats. What’s this arrhythmia called?

a. Atrial flutter
b. 2nd degree Mobitz type 1 (Wenckebach)
c. 2nd degree Mobitz type 2
d. 3rd degree heart block
e. Ventricular tachycardia

A

b. 2nd degree Mobitz type 1 (Wenckebach)

46
Q

A 71 year old Lady presents with acute CP and SOB, other evidence of decompensation (low BP, bibasal crackles). ECG shows wide-complex tachycardia. Initial Management?

a. Cardioversion
b. Chest X ray
c. Primary PCI
d. Thrombolysis
e. Aspirin

A

a. Cardioversion

47
Q

48 year old chap has STEMI - what substance is likely to be depleted in his cardiac myocytes?

a. AMP
b. ADP
c. ATP
d. cAMP
e. IMP

A

c. ATP

48
Q

A 35 year old currently undergoing chemo for Ca breast presents with sudden onset shortness of breath. Tachycardic, tachypnoeic, low-normal BP, afebrile, low sats. Cause?

a. Pulmonary embolism
b. Pneumothorax
c. Acute exacerbation of asthma
d. Pneumonia
e. Decompensated liver disease

A

a. Pulmonary embolism

49
Q

A 20 year old presents with odd behaviour and abdominal pain. His breath smells fruity, he’s breathing heavily his BMs are 30 and his BP is 94/56. (I don’t think U&Es were given although I could be wrong). What is your initial management?

a. IV insulin
b. IV fluids
c. IV bicarb
d. Investigate the underlying cause
e. IV glucose

A

b. IV fluids

50
Q

A 70 year old with a 1/52 history of watery diarrhoea is now confused and hypotensive. She is afebrile. Why has she got low BP?

a. Heart failure
b. LVOT obstruction
c. Peripheral vasodilation
d. Reduction in circulating volume
e. Peripheral vasoconstriction

A

d. Reduction in circulating volume

51
Q

A 30 year old woman presents with weight loss, diarrhoea, anxiety and heat intolerance. OE she has bilateral proptosis and is a bit tachy. What is the likely diagnosis?

a. Grave’s
b. Grave’s disease
c. Autoimmune hyperthyroidism
d. Thyrotoxicosis 2o to a type 5 hypersensitivity reaction
e. A potato

A

b. Grave’s disease

52
Q

Lady presents with oedema. Pissing out protein, but no blood or leukocytes. Also hypertensive and dyslipidaemia. What’s up doc?

a. Nephrotic syndrome
b. UTI
c. Nephrolithiasis
d. ATN
e. Goodpasture’s

A

a. Nephrotic syndrome

53
Q

A 4 year old girl presents with diarrhoea and is a bit hypotensive. What is the physiological reason that fluid moves from the interstitium to the vascular compartment in this case?

a. Increased hydrostatic pressure
b. Increased osmotic pressure
c. Decreased hydrostatic pressure
d. Increased capillary permeability
e. Low sodium.

A

c. Decreased hydrostatic pressure

54
Q

60 yo woman presents with tiredness. Bloods show hypochromic, microcytic anaemia, 60 yo woman with PMH of rheumatoid arthritis (currently inactive) no change of bowel habit, no abnormalities on exam. What’s the likely diagnosis?

a. Coeliac
b. Crohn’s
c. Ca Colon
d. Sarcoid
e. SLE

A

e. SLE

55
Q

A 66 year old lady is admitted suffering from renal colic due to stones. You prescribe morphine but it turns out her liver isn’t what it used to be and she collapses on the ward. OE her resps are 6/min, SpO2 is 88% and her pupils are pinpricks. What is the (?) initial management?

a. 6L/min of O2 through
b. IV N-Acetyl- cysteine
c. IV paracetamol
d. IV Naloxone
e. Liver transplant

A

a. 6L/min of O2 through

56
Q

A 32-year old mature student presents within a day of taking a 24 paracetamol. His bloods are back and the paracetamol level in his blood is above the threshold for treatment. How would you manage?

a. 6L/min of O2 through
b. IV N-Acetyl- cysteine
c. IV paracetamol
d. IV Naloxone
e. Liver transplant

A

b. IV N-Acetyl- cysteine

57
Q

A 48 year old man requires a blood transfusion. His RBCs have the A antigen and B antigen in their cell membranes and he is Rhesus negative. Which type of blood should you give as it is least likely to cause an adverse reaction?

a. AB positive
b. A positive
c. B positive
d. O positive
e. O negative

A

a. AB positive

58
Q

A 71 year old man presents with 4 weeks of progressive painless jaundice and general malaise (I think). Stable obs, (might have had an epigastric mass) PR demonstrated soft, pale stool. Blood results were cholestatic jaundice. Can’t remember other info. ?cause:

a. Ca head of pancreas
b. Cholangiocarcinoma
c. Choledocholithiasis
d. Cirrhosis
e. Liver mets

A

a. Ca head of pancreas

59
Q

65 year old lady with 2/52 progressive jaundice, 10kg weight loss, palpable liver edge, no other masses, extremely high alk phos - like in the 1000s. Likely cause?

a. Ca head of pancreas
b. Cholangiocarcinoma
c. Choledocholithiasis
d. Cirrhosis
e. Liver mets

A

e. Liver mets

60
Q

42 year old woman presents having developed severe RUQ pain after a heavy meal. This is
on a background of several months of intermittent RUQ discomfort. Bit of a temperature,
otherwise unremarkable.

a. Ca head of pancreas
b. Cholangiocarcinoma
c. Choledocholithiasis
d. Cirrhosis
e. Liver mets

A

c. Choledocholithiasis

Phase 2a SBA/EMQ (2 decks)

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