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Past Paper Questions > 2019 > Flashcards

2019 Flashcards

1
Q

Patient is post MI with pansystolic murmur and bibasal crackles - cause?

A

Papillary muscle rupture and acute MR

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2
Q

Patient is 4 weeks post inferior MI with chest pain and fever.

On examiation - systolic murmur, temp 37.5, ECG shows Q waves and ST depression in II, III, aVF.

Diagnosis?

A

Pericarditis (likely Dressler’s syndrome)

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3
Q

Patient has a pansystolic murmur, that is loudest at the apex and radiated to the axilla. JVP is raised at 8cm.

Diagnosis?

A

Mitral regurgitation

The murmur here strongly suggestive of MR, JVP being raised likely a red herring, but could be due to left–>right failure

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4
Q

Patient with early diastolic murmur and mid-diastolic murmur. JVP 8cm.

Diagnosis?

A

Mid-diastolic murmur –> mitral stenosis

Early diastolic murmur –> pulmonary insufficiency

This is a Graham-Steel murmur caused by pulmonary hypertension

Therefore pulmonary regurgitation is the diagnosis.

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5
Q

Patient with hyperkalaemia, raised urea, ECG shows bradycardia with 2:1 block

A

Many features here for digoxin toxicity

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6
Q

Young person collapsed, but is now fine, after genetic testing diagnosed with Long QT syndrome. What is the most common cause of death in these patients?

A

Ventricular tachycardia

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7
Q

Person has syncope, chest pain, and faints. Which investigation best to identify cause?

Echo, ECG, carotid doppler

A

This question largely depends on age..

Elderly –> ECHO (?aortic stenosis)

Younger –> ECG (?arrhythmia)

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8
Q

ST elevation in II, III, aVF - what artery is affected?

A

Right coronary artery

More specifically, the posterior interventricular branch

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9
Q

You are called to see a 75yo patient who is unresponsive. Nurses saw her choking. You cannot detect a pulse and there is no respiratory effort, with nothing visible in the mouth. What do you do?

5 back blows, 5 abdominal thrusts, start CPR, inspect using laryngoscope

A

Start CPR (+ get help)

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10
Q

62yo man with Hx EtOH, weight loss, cachectic, jaundice, ascites. What tumour marker?

A

alpha-fetoprotein (for HCC)

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11
Q

Patient with ?ank spond. Most diagnostic investigation?

HLA-B27, MRI sacroiliac joints, lumbar XR, CT

A

MRI sacroiliac joints

HLA-B27 90% specific and only in Caucasians

MRI > xray + CT

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12
Q

What investigation for polymyositis?

A

Anti-Jo antibodies

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13
Q

Patient with flexural surface rash and anaemia. What investigation would be diagnostic?

A

Flexural rash –> dermatitis herpetiformis –> coeliac disease

Therefore, answer = faecal calprotectin

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14
Q

Patient being treated for exacerbation of asthma. Responding well, then suddenly deteriorates with no air entry on left. Diagnosis?

PTX, PE, increased severity of asthma, anaphylaxis

A

Increased severity of asthma

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15
Q

Patient with cancer and metastasis with nausea and vomiting, not on chemo or radiotherapy. Which antiemetic to give?

A

Cyclizine

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16
Q

Which of the following can cause cholestasis?

Bendroflumethiazide, benzos, carbamazepine

A

Benzodiazepine

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17
Q

30yo gentleman with intermittent swallowing + difficults for solid that is relieved with drinking large amounts of water. Bad smelling breath. Diagnosis?

A

pharyngeal pouch

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18
Q

Rapidly growing parotid gland swelling (2 -> 5 cm)

Diagnosis?

A

Largely depends on other details, my guess would be lymphadenopathy

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19
Q

Gentleman with AF and stroke, Hx of intracerebral bleed 6 years ago. What medication should be added?

A

Inpatient –> clopidogrel

Long-term –> needs anticoagulation

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20
Q

Patient with fever, reduced air entry on left, stony dullness, etc etc

Most useful next investigation?

A

Pleural fluid aspiration

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21
Q

Tension PTX - tracheal deviation, deteriorating clinical picture

Management?

A

Needle decompression

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22
Q

ECG suggestive of SVT, what drug would you give?

A

Adenosine IV (after failed vagal maouevres)

23
Q

Gentleman with deficits related to cranial nerves III to VI - where is the lesion?

A

Cavernous sinus

24
Q

Elderly man sitting in a chair, just goes unconscious for 5 mins, but is then fine. ECG shows prolonged PR, LAD, RBBB = incomplete trifascicular block.

Cause of syncope?

A

Complete heart block (complete trifascicular block)

25
Q

Patient with SIADH history and mild hyponatraemia - how do you manage?

A

Vasopressin antagonist, eg. vaptans

+hypertonic saline

26
Q

Urinary + eye + joint symptoms. Dx?

A

Reactive arthritis (?gonococcal)

27
Q

Person has dry eyes and needs eye drops. Which ones?

A

Hypromellose

28
Q

VTE prophylaxis in pregnancy?

A

LMWH

29
Q

Asthmatic is taking many meds. Has ongoing throat issues. Which medication likely to be responible?

A

Assuming this is candida secondary to steroids

Beclametasone

30
Q

Patient with HIV + lobar consolidation on CXR. Diagnosis?

A

Pneumocystis jirovecii

31
Q

Stroke pt puts clothes on wrong way / upside down. Likely location of stroke?

A

Parietal lobe

32
Q

Gout + CKD - treatment?

A

Allopurinol

Can also use febuxostat

33
Q

Ankylosing spondylitis - failed on >2 NSAIDS. Next step in management?

A

Etanercept (from options given)

Also adalimumab, infliximab

34
Q

Old lady at care home on nitrofurantoin for UTI. Now has watery diarrhoea & vomiting. 2 other residents have similar Sx. Diagnosis?

A

Norovirus

35
Q

Antibodies associated with systemic sclerosis?

A

Anti-centromere (from PPQ)
ANA
Anti-Scl70

36
Q

Mouth ulcers + bloody diarrhoea. Likely diagnosis?

A

Bloody diarrhoea –> UC > Crohn’s

37
Q

Ophthalmoplegia + facial nerve palsy. Diagnosis?

A

Cavernous sinus thrombosis

38
Q

380yo stable man, BMI 21, fit and healthy. T1DM picture. Management?

A

NICE guidelines –> SC basal-bolus insulin

39
Q

Patient has T2DM. Best insulin regime?

A

NICE guidelines –> intermediate acting insuline, e.g. isophane insulin

40
Q

Clinical picture suggestive of phaeochromocytoma - investigation?

A

Urinary metanephrines

41
Q

Old lady with back pain that is relieved when leaning on her shopping trolley. Also has a feeling of heaviness in her legs.

Diagnosis?

A

Spinal stenosis

42
Q

Person is on lithium. Bloods are normal except for hypernatraemia. Diagnosis?

A

Nephrogenic DI

43
Q

What do you monitor in a patient at risk of refeeding syndrome?

A

Phosphate

44
Q

Patient with low Ca, low phosphase, high PTH.

Diagnosis?

A

Secondary hyperparathyroidism

e.g. due to intestinal malabsorption

45
Q

Ascites + encephalopathy - management?

A

Lactulose –> increase excretion of NH4+

46
Q

Melaena and vomiting + haemodynamically unstable - next step in management?

A

OGD within 2 hours

47
Q

Most common cause of Addison’s?

A

Assuming in developed countries..

Autoimmune

48
Q

N&V, tinnitus, horizontal nystagmus, but NO hearing loss - diagnosis?

A

Vestibular neuronitis

49
Q

Lower lobe fibrosis. Pt has RA, raised Ca2+, bilateral hilar shadowing. What is the cause of fibrosis?

A

Lower lobe –> RA

Upper lobe –> sarcoid

50
Q

Spiculated lesion in lung

A

Malignancy

51
Q

Calf claudication - which vessel?

A

Superficial femoral

52
Q

Patient has a laceration to palm of hand, and is unable to flex the MCP and PIP joints of the middle finger, but can flex the DIP joint - what is injured?

A

Flexor digiti superficialis

53
Q

Patient presents with lumbar back pain and is hypotensive. What investigation?

A

MRI spine

54
Q

Patient is diabetic and has blood glucose of 5.8 night before surgery. Best management?

A

Sliding scale to start night before surgery + first on list in morning

Past Paper Questions (1 decks)

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