2015 MCQ Flashcards
Aboriginal boy from Western Sydney with recurrent otitis media and sometimes perforations.
What is appropriate management for next presentation?
Options:
Warmed olive oil irrigation
Damp tissue spears in ears
Cotrimoxazole
Cefotaxime IV 3 days
Oral abx for 1 week
oral Abx for 1 weeks
A woman presents with left sided ear deafness. Which is true about Weber’s test?
Options:
a. Weber’s test heard in the deaf ear, indicates conductive loss.
b. Weber’s test heard in normal ear = sensorineural
c.Weber’s test louder in opposite indicates sensorineural hearing loss.
d. A person without any hearing loss will have a normal result.
E.Tuning fork 215Hz used.
a person w/o any hearing loss will have a normal result
40M, 3-4 ETOH/ day, non-smoker, 3 motnhs R knee pain O/E: R knee effusion w/ some crepitus, ligaments intat=ct, painful MCP and MTP, scaly rash on elbows
what is it
psoriatic arthritis
55M, sudden onset chest and abdo pain after vomiting post-heavy meal. Dies few hrs later. Most likely diagnosis?
Oesophageal rupture
14yo girl with menarche at 13 has heavy painful periods. She has lower abdominal pain which
radiates to her groin and down her legs? Misses ½ day at school each month. Which is NOT
appropriate management?
options
COCP
Iron tablets while menstruating.
Mefenamic acid 2 days before menses
Mefenamic acid D1 of period
paracetamol QID
paracetamol QID
CXR: mostly normal, opacification of R hilar area. Cough and fever 1/52 treated w/ augmentin. WCC normal range. Most likely organism?
why?
Mycoplamsa pneumonia
- M. pneumoniae= common C.A for atypical pneumonia in children
-Not responding to augmentin which is (usually) effective against Strep pneumonia or Haemophilus influenzae - R hilar opacification= consistent w/ atypical pneumonia
- WCC being in normal range is typical for mycoplasma
Mo present w/ 18mo for vaccines. Fever and cold for >2days and today grizzly w/ mild fever at 37.6. What should you do and why?
Give vaccines today. 37.6 is fine. If more than 38.5 then thing about delaying until well
Mum presents for 4yo’s MMR vaccination. He had anaphylaxis previously to 12mth
vaccination, did not receive 18mo vaccines because of that, premature baby, recent URTI, global
developmental delay. Currently slightly unwell. Which is the absolute contraindication to
vaccination?
Options
Previous anaphylaxis
Global developmental delay
Prematurity at birth
Unwell
Previous illness
previous anaphylaxis
21yo woman has just come home from honeymoon in Paris. She has dysuria with increased
frequency and urgency. She also has nausea, vomiting, and breast tenderness.
What is this stem describing and Which antibiotic
is most appropriate for her condition and why?
trimethoprim
(trimethoprim and sulfamethoxazole= 1st line for uncomplicated UTI as it is very effective against common C.A such as E.coli)
Pyloric stenosis- what would you see on ABG?
Metabolic alkalosis w. hypOK, hypOchloraemic and hypOnatremic
Pt with diabetes and sudden onset visual loss- painless; floaters, no flashes, vitreous cavity
hazy, difficult to visualise retina.
Abnormal red reflex
What is it? and WHY
A. Amaurosis fugax
B.Vitreous haemorrhage
C. Retinal detachment
D. Closedangle glaucoma.
E. Temporal arteritis.
Vitreous haemorrhage
- key is the hazy vitreous cavity. common in diabetics w/ retinopathy
Someonewithsomesymptomsandhasabutterflyrash.
Which antibody is most specific at
diagnosing SLE and why?
Options
A. Anti-cardiolipin Ab
A. Anti-dsDNA
B. ANA
C. W-ANC
anti-ds DNA= more SPECIFIC to SLE
Although ANA is done more routinely (1st line) in SLE- it is not specific and is a marker used to detect many autoimmune condition. (+ve in 98% SLE)
.Which is not associated with H.pylori?
A. GIST
A. Gastritis
B. Gastric adenocarcinoma
C. Gastric lymphoma
D. Peptic Ulcer
GIST is NOT associated w/ H.pylori (GI stromal tumours) whereas all the other conditions are
Inferior nasal meatus drains which structure?
A. Nasolacrimal duct
A. Eustachian tube
B. Maxillary sinus
C. Sphenoid sinus
D. Ethmoidal
nasolacrimal duct
3yo brought in by family after falling off climbing frame. Bruises on neck and back. R-ray shows 3 R-sided rib # and spiral fracture of left humerus.What is the most likely cause
of his injuries?
A. Non-accidental injury
A. Accidental injury
B. Osteogenesisimperfecta
C. Osteomalacia
Non-accidental injury
what cancer is most likely to spread to bone?
- breast adenocarcinoma
2.colon - gastric
- melanoma
5.cervical
Breast
remember: prostate, lung, renal and breast
80+yo with depression and insomnia. Which medication would you prescribe
A. Prochlorperazine
A. Citalopram
B. Amitriptyline
C. Diazepam
amitriptylline- because of insomnia AND depression although SSRI would usually be 1st line
Mother concerned about developmental delay in 18mth kid- 20 words, not interested in
crayons, plays alongside but does not play with other children. On observation, does engage in
good imaginative play, initial shyness but eventually engages well with you.
Options:
Normal kid
Autism
Developmental delay
Hearing problem
Isolated language delay
normal
Parents bring in 2yo child. Has been treated with antibiotics 4 times for suspected otitis
media infections, since starting daycare 6 months ago. Childcare says he’s angry, parents say
he’s fine at home although sometimes gets frustrated and lashes out. Has about 50 single words,
but not yet stringing them together. Plays well with kids at home but not at daycare. What do you
do?
Options
Refer for autism spectrum assessment
Tell the parents to get a new childcare centre.
Refer for brain scan
Refer to audiologist for hearing assessment.
Normal child
refer to audiologist for hearing assessment
32yo overweight female diabetic, on OCP, smoker, bed-bound after operation for ankle
fracture for last few weeks. Presents with chest pain and shortness of breath. Tachycardic,
tachypnoeic. What is the most appropriate initial test?
ECG OR cxr?
Which of the following is not true about the use of LMAs?
Options
LMAs should not be used after failed ETT intubation
LMA may have already been inserted by the ambulance officers.
LMAs require less equipment to insert than ETT
LMA will stop aspiration
LMAs are safe in suspected neck injury
LMA will stop aspiration is NOT true
28 year old woman with MS. Can’t void urine, has had multiple UTIs, in urinary retention.
What’s the most appropriate management?
Options:
Electro-stimulation of bladder
In-dwelling urethral catheter
Indwelling suprapubic catheter
Intermittent self-catheterise
Ileal conduit
intermittent self-catheterisation
The dude with the thoracic vertebra T12 total severance. What will be immediately evident?
Options
Detrusor hyperexcitability
External sphincter hyperexcitability
Overflow incontinence
Stress incontinence
Unable to pass urine
detrusor hyperexcitability
3 month old baby girl, mother noticed small amount of mucous and blood in nappy
Options
Refer to paediatrician
Vaginal swab for MCS
Reassure mother
Pelvic ultrasound
refer to paediatrician
Refugee presents to ED with headache (3am) .Limited English,12year old daughter helped
translate the history for triage.Which is most appropriate:
A. Organise interpreter
A. Assess Need for interpreter.
B. Conduct the consultation with the patient.
C. Use daughter as interpreter
D. Pre-read all available information
organise interpreter
9YO comes in with asthma (again),what indicates that it is a life-threatening episode?
A. RR24
A. HR110
B. expiratory wheeze without inspiratory wheeze
C. accessory muscle use with intercostal recession
D. SaO286%
accessory muscle use with intercostal recession
F has ache in shoulder and can’t lift arm following modified particle mastectomy. Husband noticed bump on back. Which nerve is likely injured?
long thoracic
6 month old, flat frontalle, purpuric rash and fever. Has had IV bolus of fluid. What is the most appropriate next step?
a. Hx from Mo
b. CSF culture
c. urine culture
d. blood culture
e. IV abx
This sounds like septic meningitis (meningococcal sepsis) so start IV Abx
.Young male with headache in early hours of morning for 5-6 successive days.Previous
episode of 3 in1day.Also associated with, intense pain, could not open eyes for examination during the episode.
A. Cluster
A. Temporal arteritis
B. Acuteangle-closureglaucoma
C. Subacute angle closure glaucoma
cluster
The most appropriate investigation to diagnose the condition in a 3-year-old female with wide-set nipples and a wide, thick webbed neck is?
A. Karyotype
A. FISHforWilliam’s
B. DoaneckUSS
C. Totalgenomesequencing
D. 17-progesterone
karyotype for Turner’s syndrome (one X chromosome is missing or partially missing)
Ankle injury forced eversion,pain at infero medial malleolus
A. Deltoid ligament
A. Anterior talofibular ligament
B. Anterior tibiofibular ligament
C. talocalcaneal ligament
D. medial calcaneofibular ligament
deltoid ligament
R middle finger held in flexion following puncture wound by rusty nail to lateral side
previously. Now systemically unwell (febrile), pain in finger, diffusely swollen finger. Movement of distal phalanx is painful, particularly on extension. What is going on?
Options:
Infected extensor tendon.
Infected flexor tendon sheath
Pulp infection
paronychia
cellulitis
and what are the cardinal signs of this condition?
infected flexor tendon sheath
Pyogenic flexor tenosynovitis
Kanavel’s signs
- exquisite tenderness throughout and limited to the sheath
- fusiform swelling of affected digit (sausage finger)
- extreme pain on extension
-held in felxion
Female w/ sudden onset acutely painful L-sided throbbing headache. L ptosis, miosis and anhydrosis (Horner’s syndrome). L eye sunken and vision impaired on L.
OPTIONS:
ICA dissection
Temporal arteritis
Migraine
Stroke
SAH.
ICA dissection
2yo child with wheezing and shortness of breath. Has had previous wheezing episodes.
Talking in sentences. 97% O2 sats. What is management?
Options
Salbutamol via spacer
Salbutamol via spacer and fluticasone via spacer
Salbutamol via nebuliser
Salbutamol via spacer or nebuliser + O
salbutamol via spacer and fluticasone via spacer
Woman with [symptoms of urge incontinence]. What is the most appropriate medication?
Options
Oxybutynin
Minipress (prazosin)
Betachol
Atropine
Methyldopa
oxybutynin- used to treat overactive bladder/ urge incontinence (anticholinergic)
contraindicated in urinary or bowel retention, myesthenia gravis, glaucoma and severe UC
Which is correct about Crohn’s
Options
Get fissures & fistula formation
continuous inflammation
superficial layer
something about the rectum UC
more cancer than UC
get fissure and fictula formation
Child 3 day hx of abdo cramps, watery diarrhoea with streaks of blood in stools, No Fhx
A.Salmonella
A. Rotavirus
B. Norovirus
C. Giardia
D. Clostridium difficile
c. diff- need to look over this
45M, active, no risk factors, sudden onset chest pain wrose on inspiration, no SDOB, mild fever, widespread STE in all leads
acute pericarditis: saddle ST elevation
elderly F present with confusion, hx of renal dx and cardiac dx, Bloods show hyponatremia, low-normal K, Cr 120. Which drug is most likely to cause her confusion?
a. indapamide
b. ramipril
c. aspirin
indapamide (thiazide)
febrile child with jt effusion, limited ROM
septic arthritis
6yo F, upper tibia pain, normal x-ray, pain note affected by movement and fever
osteomyelitis
40M, poor sleep, poor concentration, loss of appetite. Has not taken antidepressants before. What would be first line?
a. sertraline
b. venalfaxine
c. amisulpride
d. mianserin
sertraline (SSRI)
patient presents with foot drop, unable to dorsiflex and revert. Decreased sensation in webspace between hallux and 2nd digit. What neuro structure most likely affected.
common peroneal n (branch of sciatic n)
aspirin OD- what would early ABG show
EARLY: respiratory alkalosis due to hyperventilation but then later develop metabolic acidosis with partial respiratory compensation
aspirin= salicylic acid
health primagravida F, labour 12 hours and is going well. 6hrs in= rupture membranes. Cervix 3cm effacing. Baby good and position ROT. - appropriate next step?
augment with syntocinon
best way to observe adverse effect of opioid.
sedation score
Baby born with Apgars 8 and 9. Cyanotic 4 hours after birth despite full 100% O2
Options
atrial septal defect
Strep B sepsis
Transposition of great vessels
transposition of great vessels
12yo M came in with testicular pain. O/E L testis swollen and palpable. Eaten 3 hours ago. Immediate mx?
surgical exploration
Child presents with DKA. pH 7.09 what would be your first step in initial mx
IV fluids
Injury to the ulnar nerve- with complete transection, will result in all of the following signs
except?
Options
Atrophy of the thenar eminence
Hyperextension of MCP of digits 4-5
Loss of thumb adduction
Sensory loss over digits 4-5
Loss of abduction of digits 4-5
atrophy of thenar eminence
2yo F, reluctant to walk, especially in morning. Raised ESR nad CRP.
a. JIA
B. septic arthritis
c. ALL
d. slipped femoral epiphysis
and why?
JIA (due to raised inflammatory markers, afebrile, stiff in mornings, no other sx.s)
septic arthritis: hot, swollen jt and febrile
ALL: easy bruising, hepatosplenomegaly, generalized sx.s
slipped cap: more common in older overweight children, no raised inflammatory markers or mane stiffness
baby with purpuric rash on butt, jt pain and abdo pain
a. Henoch-schonlein purpura
b. meningococcal
b. HUS (haemolytic uremic syndrome)
d. ITP (immune throbocytppenic purpura)
and why
HSP triad: purpuric rash (often lower exttremitis and butt), jt pain and abdo pain.
HSP is a small vessle vasculitis and most common vasculittis in children
HUS triad of haemolytic anaemia, thrombocytopenia and AKI, often following diarrhoeal illness (purpuric rasha nd jt pain are LESS TYPICAL)
ITP: isolated thrombocytopenia= petechiae and purpura withOUT jt pain or abdo pain associated
what is donepezil?
anti-cholinesterase for the mx of alzheimer’s
9yo M, large penis has growth spurt. XR bown age 2years ahead of actual age. Testes nromal for 9yo. What test to determine growth spurt?
GH stimulation test or GH assay
baby normal. Dveelops SOB 6hrs after delivery. X-ray show fluid in interlobar fissures.
a. meconium aspiration pneumonia
b. transient tachypnoea of newborn
c. respiratory distress syndrome/ hyaline membrane dx
d. group B strep infection
d. diaphragmatic hernia
what is it and why?
transient tachypneoa of newborn: respir distress shortly after birth caused by delayed clearing offetal lung fluid= CXR fluid in interlobar fissures
Meconium aspiration pneumonia: meconium stained, patchy infiltartes on CXR
RDS: due to surfactant deficiency, in premature infants
diaphragmatic hernia: abdo contents in thoracic cavity on CXR
group B strep: signs of infection including fever and diffuse pattern on CXR
10yo F, started periods , breast and pubic hair at tanner stage 3, height 25th percentile, weight 50th, mid-parental height 10-25th percentile. What Ix?
normal
recentlt arrived refugee, stool sample in GP showed giardia cysts. How to manage?
options:
metronidazole 7days QDS
tinidazole stat
ivermectin 15mg today and again in 2 weeks
azithromycin
no tx needed
metronidazole 7days QDS
M, overdose on something. HR70, BP 100/50, RR 14, T 37.3. Presented with miosis (contricted pupils), hyporeflexia, otherwise neurologically intact no focal neuro signs.
a. opiate
b. anticholinergic
b. antihistamine
c. phenothiazines
d. TCA
opiates
7yo F, asymptomatic, loud pansystolic murmur and palpable thrill LSE on routine check. Heart sounds and apex beat other wise normal.
VSD
M with sweating, weight loss of 6kg, tremor, no mention of exopthalmos, diffuse selling of neck
a. graves
b. toxic multinodular goitre
c. toxic adenoma
d. subacute thyroiditis
e. hashimoto’s
Graves
8month old aboriginal child with UTD immunisations, meningitis sx.s cloudy CSF on LP- most likely organism
neisseria meningitidis
6 week old, forceful vomitting initially clear and later bile-stained. Paucity of gas seen after duodenum on AXR
a. pyloric stenosis
b. duodenal atresia
c. Hirschprun
d. malrotation w/ vovulus
pyloric stenosis
Boy with gastroenteritis going into shock. Bolus 0.9% saline. He is 14kg- how much fluid and why
for children 0-18 normal 0.9% saline 10-20ml/kg
so 140-280ml for this boy
Old F, few weeks hx o abdo colic and intermittent abdo distensio. She had microcytic anaemia. What is the most likely diagnosis?
a. diverticulitis
b. sigmoid volvulus
c. carcinoma of caecum
d. cholelithiasis
carcinoma of the caecum
5yo F, cervical lymphadenopathy, had fever. Not getting better after more than a week, then developed viral exanthem on chest, bilateral non-purulent conjunctivitis, oedematous hand causing failure to cannulated. what is most likely?
Kawasaki dx
what sign if present in head of pancreas cancer?
a. caput medusa
b. pain at costovertebral angle
c. shifting dullness
d. mass in RUQ palpable during respiration
e. gastric succession splash
Mass in RUQ palpable during respiration
