2016 EMQ Flashcards
30yoM, rigors, SOB, R-side chest pain worse on inspiration
pneumonia
what oral med after treatment for DVT post 5-hr flight?
A. Alteplase
B. Aspirin
C. Atorvastatin
D. Heparin
E. Warfarin
F. Clopidogrel
warfarin (anticoagulant)
A. Start Insulin Glargine
B. Metformin
C. Cease metformin and reassess
D. Increase Metformin Dose
E. Start Insulin post prandil
F. Gliptin
G. Glicadize
- pt on 2g SR metformin and high dose glipizide, hba1c 9.5
- T2DM F on metformin w/ recent eGFR drop to 29%
- 60yo F on metformin 2g daily and 30IU glargine nocte; fasting BG 5.8mmpl and hba1c 8.1%
- introduse insulin glargine
- stop metformin and reassess
- introduce postprandial insluin
3yo M presented w. fever, bleeding gum and weight loss. Recurrent chest infections in the past.
O/E: pale, cervical lymphadenopathy and mild hepatosplenomegaly. Blood smears show blasts
what is the diagnosis and why
ALL
- most common in children
-hepatosplenomegaly
-cervical lymphadenopathy
-majority blasts on blood smear
What are normal hba1c and normal fasting BG?
normal hba1c <5.7%; 5.7-6.4% prediabetic and diabetes diagnosed >6.5%
nromal fasting BG 3.9-5.6mmol/L
A. Duchenne MD
B. Cerebral Palsy
C. Normal variant
D. Osteomyelitis
E. Juvenile idiopathic arthritis
F. Perthes disease
G. Slipped capital femoral epiphysis
H. Non-accidental injury/fracture
what is the diagnosis and why?
- previously active 8yo, limping past 2 week and complaints of R knee pain over >2 weeks; no memory of trauma
- 7yo M, fever and sore R hip. O/E R thigh swollen nd red
- 4yo child initially developed normally and began walking. Later developed difficulty walking up stairs. Symmetrical waddling gait. O/E: neuro intact but noticed thick calves.
- 22 month old, not walking. When crawls tends to drag legs along. When you stand her up she stands on her toes.
what is the diagnosis and why?
- JIA (50% monoarticular, commonly knee, usually sore especially in the morning, stiffness, fever, swollen LN and rash)
I think more likely to be JIA than Perthes (stiffness and reduced ROM in hip)
- osteomyelitis: swollen dn red over the skin but has fever so not just cellulitis
- pseudo- hypertrophy of calves= Duchenne
- delayed gross motor development, stands on toes= cerebral palsy
A. CXR & AXR
B. CT
C. Laparotomy
D. Diagnostic Laparoscopy
E. Gastroscopy
F. Colonoscopy
G. Abdominal Ultrasound
H. No investigations required
- 14yo M, increasing central and R sided abdo pain. O/E: 38 C temp, hard abdo w/ rebound tenderness and guarding, elevated WCC
- 40yo F, intermittent RUQ pain, exacerbated after eating
- diagnostic laparoscopy
- abdo USS
78 y/o M 24 hours post surgical repair of fractured neck of femur starts seeing spiders on his bed
sheets with associated fluctuation in consciousness and agitation. His wife reports that he is taking a
Tri-cyclic Antidepressant and that he drinks roughly 10 beers a night.
what is the most likely diagnosis and why?
delerium
- post-surgical delerium is common- due to infection or pain medications
- especially visual hallucinations
-usually takes tricyclics and ETOH - no previous schizophrenia or hx of psychosis
A. Salmonella typhi
B. Hookworm
C. C. diff
D. Novovirus
E. Trichuris trichuria
F. enterotoxic E.coli
G. Staphylococcus aureus enterotoxin
H. Giardia intestinalis
I. Shigella
what is diagnosis and why
- 40yo M, occasional diarrhoea, abdo pain and mild anaemia, liked to walk around barefoot. Aboriginal, remote community
- med student travelling and drinking unfiltered and untreated tank water for 4/52. 6 loose bowel motions daily 5 weeks, noticed floaty stool (pale, foul-smelling floating)
- hookworm (walking barefoot= itchy, anaemia and diarrhoea, aboriginal
- giardia (foul-smelling, floaty and pale stools and unfiltered H2O)
A. Acute suppurative otitis media
B. Glue ear (bilateral)
C. Serous otitis media
D. Traumatic ruptured tympanic membrane
E. Otitis externa
F. Presbycusis
- girl URTI 2/52 oreviosult, feeling of fullness in ears and pain
- 21yoM, diving trip in maldives, R ear pain, d/c and sensation of blocked ear
- serous OM
- ruptured tympanic membrane
55yo F, periods stopped 4 years ago, irregular spotting
endometrial cancer
A. acute gastroenteritis
B. coeliac disease
C. colorectal carcinoma
D. faecal impaction
E. inflammatory bowel disease
F. irritable bowel
G. sphincter disruption
H. spinal cord lesion
I. systemic neuropathology
What is the most likely underlying condition in the following cases with “bowel changes”
- 83yo F, constant diarrhoea, incontinence pad day and night, constipated prior to this
- 23yo F, 3year hs of intermittent abdo pain, bloating and flatulence, colonoscopy of upper endoscopy= normal, anti-tissue tranglutaminase Abs negative
- faecal impaction
- IBS
A. Medication
B. Double dose of folic acid and iron
C. Frequent small meals
D. Mylanta
E. Increase protein in diet
42 yo woman, 10/40, some nausea and vomiting associated with pregnancy. Doesn’t want to take
any medications.
small frequent meals
A. Aortic stenosis
B. Pulmonary stenosis
C. Coarctation of aorta
D. Tetralogy of fallot
E. Transposition of great vessels
F. ASD
G. PDA
- 4yo M, well comes to GP w/ Mo. O/E: well, not cyanotic, auscultation has soft ejection systolic murmur in pulmonary area. Low splitting of heart sounds.
- 8yo F, systolic murmur radiating to carotids
what and why
- ASD which would cause shunt L to R
- radiating to carotids and systolic murmur= coarctation of aorta
A. BPH
B. Prostate cancer
C. Urethral stricture
D. UTI
E. Pyelonephritis
F. Prostatitis
G. STI
- 32 yo M, increasing hesitancy over last few months. Never feels as thought he empties his bladder. Experienced some dysuria and frequency after overseas trip.
- 70yo M, PSA 5 (normal <4), enlarged prostate
- urethral stricture
- BPH
A. Bone marrow suppression
B. Folate deficiency
C. Iron deficiency
D. B12 deficiency
E. Increased red cell destruction
what is the most likely cause or type of anaemia?
- 20yo F, hx of abdo bloating and loose, bulky stools
- 45 F heavy periods
- 24yo M, laparoscopy for suspected appendicitis. thickened segment of fat wrapping terminal ileum.
- child- Pugh B cirrhosis hep c+ve
- folate deficiency
- Fe deficiency
- B12 deficiency (malabsorption)
- Destruction of RBCs (haemolytic anaemia)
A. FBC
B. ECG
C. Spirometry
D. Stress ECG
E. Serum troponin
F. Sleep Study
G. echocardiogram
- 75yo fatigue, increasing SOBOE >6months, well controlled T2DM and HTN. Sleeps on one pillor, no swelling of ankles.
- tried truck driver, 100kg 160cm tall, fatigue, restless sleep, separate bed from wife, nocturia, HTN, night sweats- what is the 1st appropriate Ix?
- Stress ECG
- sleep study
32yo M, ED w/ large amounts of bright red blood in stools, increasing fatigue over last few weeks. Bleeding gums and pain in back and ribs. O/E: patechaie everywhere
AML
(adult) acute myeloid leukemia
what medication would cause this and why?
A. Metoclopramide
B. Diltiazem
C. Bisoprolol
D. Thiazide diuretic
- shuffling gait after starting new med.
- peripheral oedema after new HTN med
- metoclopramide
- it is a dopamine receptor antagonist which is used as an antiemetic
-other: prochlorperazine
-causes tardive dyskinesia - diltiazem= Ca channel blocker (non-dihydropyridine)
- CCBs cause peripheral oedema
-however more common w/ dihydropyridine: amlodipine, nifedipine
-less common with verapamil and diltiazem (non-dihydro…)
pt presents w/ palpable rubbery mass in the posterior triangle, and generalized cervical lymphadenopathy. Reed-Sternberg cells
Hodgkin’s
A. Diabetes
B. Hypertension
C. Phaeochromocytoma
D. Conn’s syndrome
E. Renal artery stenosis
F. acute tubular necrosis
- 35yo M to GP, recent onset severe headaches and palpitations. 2 years ago: thyroidectomy for medullary thyroid cancer. Note glucosuria and HTN.
what is the most likely cause of his sx.s? - 72yo M, surgical ward repair of AAA rupture. BP recorded 60 MAP. AAA repaired but ongoing renal impairment.
- phaeochromocytoma
- acute tubular necrosis
what is tardive dyskinesia and what medications can cause it?
medication-induced hyperkinetic disorder
- oro-bucco-lingual and facial dyskinesia
- limb, trunk and respi
-dystonia: sustained or repetitive muscle contractions
-akathisia: motor restlessness
-tics, tremor
caused by: dopamine receptor antagonists
- first-gen antipsychotics e.g. haloperidol
-2nd gen antipsychotics e.g. risperidone, aripiprazole, olanzapine, CLOZAPINE
- antiemetics: metoclopramide, prochlorperazine
a. Dexamethasone
b. Ondansetron
c. Metoclopromide
d. Olanzapine
e. Haloperidol
f. Benzotropine
g. Clomazepine
h. Cyclizine
i. domperidone
72yo M, lung small cell carcinoma. Has CT scan confirming brain met.s and cerebral odema. Which med to manage nausea and vomiting? why?
Dexamethasone
- ondansetron is frequently used to relieve chemo- induced nausea HOWEVER,
this patient has cerebral odema and dexamethasone (corticosteroid) will help reduce cerebral oedema and have anti-inflammatory effects as well as relieving nausea
A. Acquired renal cystic disease
B. Acute tubular necrosis
C. Acute interstitial nephritis
D. Diabetic nephropathy
E. Polycystic kidney disease
F. Renal artery stenosis
G. Reflux nephropathy
H. ANCA - glomerulonephritis
I. Nephrotic syndrome
J. Other glomerulonephritis
- 45yo M, abdo pain, HTN 180/110 w/ anaemia Hb 120 and raised creatinine. Na and K normal. +++ blood and trace protein on urinalysis. Renal USS: calculus in L ureter and enlarged kidney w/ multiple bilateral cysts of 5mm-2cm diameter. Most likely cause of underlying kidney dx?
- 20 yo F, PHx severe UTI requiring hospitalisation/ 160/90 Cr raised and electrolytes NAD. Small and oddly shaped kidneys. Most likely underlying cause? WHY
- PKD
- reflux nephropathy (or VUR= vesicoureteral reflux)
- flow backward from bladder into ureters and kidneys. Can cause recurrent infections and inflammation damage and scarring of renal parenchyma CKD and renal impairment.
- recurrent severe UTI
-HTN
-raised Cr
-small and oddly shaped kidneys
A. Ross river virus
B. Metapneumavirus
C. Adenovirus
D. Enterovirus
E. Rhinovirus
F. Influenza
G. EBV
H. Measles
I. Rubella
J. Parainfluenza
- 4yo M, returns to tasmania after living in NT for 2 years. SOB, clear nasal d/c >1/52. Worsened >24hrs nor fever, fatigue, cough and SOB. Generalised rash over body and small white lesions over reddened pharynx and buccal mucosa. why
- 11-month-old 2 day hx URTI. Loss of appetite, super clingy to Mo, alert. Mild tachypenoa and tachycardia w/ reduced SpO2. Mild increased WOB, generalized widespread wheeze and crackles
- 3yo F, unwell then inspiratory stridor and barking cough
- Koplik spots= white spots on mucosa= measles (rubeola virus)
- respiratory syncytial virus (RSV)
- Parainfluenza= croup
young child 7-day hx fever, bilateral conjunctivitis, red palms and red mucosa, strawberry tongue
kawasaki dx
4yo M, skin lesions 2-4mm, pruritic
molluscum contagiosum
A. ECT
B. SSRI
C. Benztropine
D. Flupenthixol decanoate
E. Sodium valproate
F. Clozapine
- Patient with schizophrenia who is unable to take his oral medications daily when discharged from
hospital and why - Patient whose eyes start rolling back after dose of one of his psychotropic medications was
increased. Whats med and why
- Flupenthixol decanoate
- antipsychotic; depression and schizophrenia
-depot injection - benztropine (to reverse) as this is describing an oculogyric crisis= dystonic reaction invlosing extraocular muscles, usually upwards deviation of eyes
A. PID
B. Acute appendicitis
C. Acute cholecystitis
D. Pyelonephritis
E. Renal colic
F. Ectopic pregnancy
G. Mittelschmerz
H.infective endo
- F dysuria, flank pain, new sexual partner
- 37M, intermittent severe L flank pain w/ hx of chron’s dx, urinalysis small amount of blood and leukocytes, no nitrates
- 60M, treated osteomyelitis of tibia on surg ward. PMhx of copd and IV drug use. Spiking fevers and pansystolic murmur
- pyelonephritis
- renal colic
- infective endocarditis
. 60 y.o. M presents with R hemiparesis, on B/G of HTN, previous CABG. On CT brain there is a wedge area of pallor
Options
- cerebral infarct
- intracerebral haemorrhage
-tumour
cerebral infarct
A. Carbon monoxide
B. Methane
C. Glycerol
D. Organic solvents
E. Organophosphates
F. Lead
G. Isopropyl
H. Glyphosate
- 45F, selling tickets for a farm festival in a newly constructed iron shed. She is feeling cold so decides to light a fire w/ firewood. Later that day she presents to her GP w/ nausea, vomiting, dizziness and headache. She has increased RR and HR but no cyanosis.
- middle-aged M accidentally dropped a barrel of unknown chemicals on the floor and spilled some on himself. There was no H2O tap around so he decided to just wipe it on his pants. Hrs later, he experienced teary eyes, blurred vision, constant drooling, sweating, and SOB. Pupils constricted in ED.
- carbon monoxide
- organophosphates
22yo female had frequency dysuria and frequency, denied of any sexual activity before. Causative
organisms
e coli
A. Placental abruption
B. Placental praevia
C. Vasa praevia
D. Vaginal carcinoma
E. Cervical carcinoma
F. Endometrial carcinoma
G. Threatened abortion
H. Gestational trophoblastic disease
I. Ectopic
J. Dysfunctional uterine bleeding
- fetal HR 80bpm, dark red PV bleeding and constant abdo pain. G4P3, 32/40
- 30yo F, G2P1 at 28/40 w/ painless bright red PV bleeding. Fetal HR 140
- 32yo 3rd pregnancy, 12/40 PV spotting. Palpation: correct size for gestation. O/E: closed OS w/ some spots of bloods from it. On USS: fuzzy signal w/ machine working properly.
- G8P6T2 45F, PV bleeding, not seen dr in 9 years. Refises pelvic exam.
- F on OCP; post-coital bleeding >6/52. Been on OCP for 6 years w/ similar post-coital bleeding but less severe and no other issues.
- placental abruption
- placenta previa
- GTD
- cervical cancer
- cervical ectropion
F, PID and yellow d/c, normal swab
chlamydia
A. Acute glaucoma
B. Iritis
C. Endophthalmitis
D. Foreign body in eye
E. Scleritis
F. Brain trauma of some sort
- red painful eye, hypopyon (pus in anterior chamber), recent eye surgery
- 60F, acute painful eye and seeing through mist w/ halos of light. Similar less severe episodes in the past. Also wears contact lenses. Exam: L pupil dilated and unreactive to light. R NAD
- endopthalmitis
- acute glaucoma
A. WIlson’s disease
B. Alpha-1 antitrypsin deficiency
C. Viral hepatitis
D. Alcoholic hepatitis
E. Fatty liver disease
F. Haemochromatosis
G. Autoimmune hepatitis
- M, Gp noticed he looked darker than usual, RUQ pain, arthralgia, HFE gene identified on C282Y
- 48M, increasing SOB, deranged LFTs, no biliary tree changes on US
- haemochromatosis
- a1- antitrypsin deficiency
GCS
Eye-opening
- 4 spontaneous
- 3 to speech
- 2 to pain
- 1 none
Verbal response
Oriented: 5
Confused: 4
Inappropriate words: 3
Incomprehensible sounds: 2
None: 1
Motor response
Obeys commands: 6
Localizes pain: 5
Withdrawal from pain: 4
Abnormal flexion (decorticate): 3
Abnormal extension (decerebrate): 2
None: 1
