2019 Flashcards
Patient is post MI with pansystolic murmur and bibasal crackles - cause?
Papillary muscle rupture and acute MR
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?
Pericarditis (likely Dressler’s syndrome)
Patient has a pansystolic murmur, that is loudest at the apex and radiated to the axilla. JVP is raised at 8cm.
Diagnosis?
Mitral regurgitation
The murmur here strongly suggestive of MR, JVP being raised likely a red herring, but could be due to left–>right failure
Patient with early diastolic murmur and mid-diastolic murmur. JVP 8cm.
Diagnosis?
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.
Patient with hyperkalaemia, raised urea, ECG shows bradycardia with 2:1 block
Many features here for digoxin toxicity
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?
Ventricular tachycardia
Person has syncope, chest pain, and faints. Which investigation best to identify cause?
Echo, ECG, carotid doppler
This question largely depends on age..
Elderly –> ECHO (?aortic stenosis)
Younger –> ECG (?arrhythmia)
ST elevation in II, III, aVF - what artery is affected?
Right coronary artery
More specifically, the posterior interventricular branch
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
Start CPR (+ get help)
62yo man with Hx EtOH, weight loss, cachectic, jaundice, ascites. What tumour marker?
alpha-fetoprotein (for HCC)
Patient with ?ank spond. Most diagnostic investigation?
HLA-B27, MRI sacroiliac joints, lumbar XR, CT
MRI sacroiliac joints
HLA-B27 90% specific and only in Caucasians
MRI > xray + CT
What investigation for polymyositis?
Anti-Jo antibodies
Patient with flexural surface rash and anaemia. What investigation would be diagnostic?
Flexural rash –> dermatitis herpetiformis –> coeliac disease
Therefore, answer = faecal calprotectin
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
Increased severity of asthma
Patient with cancer and metastasis with nausea and vomiting, not on chemo or radiotherapy. Which antiemetic to give?
Cyclizine
Which of the following can cause cholestasis?
Bendroflumethiazide, benzos, carbamazepine
Benzodiazepine
30yo gentleman with intermittent swallowing + difficults for solid that is relieved with drinking large amounts of water. Bad smelling breath. Diagnosis?
pharyngeal pouch
Rapidly growing parotid gland swelling (2 -> 5 cm)
Diagnosis?
Largely depends on other details, my guess would be lymphadenopathy
Gentleman with AF and stroke, Hx of intracerebral bleed 6 years ago. What medication should be added?
Inpatient –> clopidogrel
Long-term –> needs anticoagulation
Patient with fever, reduced air entry on left, stony dullness, etc etc
Most useful next investigation?
Pleural fluid aspiration
Tension PTX - tracheal deviation, deteriorating clinical picture
Management?
Needle decompression
ECG suggestive of SVT, what drug would you give?
Adenosine IV (after failed vagal maouevres)
Gentleman with deficits related to cranial nerves III to VI - where is the lesion?
Cavernous sinus
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?
Complete heart block (complete trifascicular block)
Patient with SIADH history and mild hyponatraemia - how do you manage?
Vasopressin antagonist, eg. vaptans
+hypertonic saline
Urinary + eye + joint symptoms. Dx?
Reactive arthritis (?gonococcal)
Person has dry eyes and needs eye drops. Which ones?
Hypromellose
VTE prophylaxis in pregnancy?
LMWH
Asthmatic is taking many meds. Has ongoing throat issues. Which medication likely to be responible?
Assuming this is candida secondary to steroids
Beclametasone
Patient with HIV + lobar consolidation on CXR. Diagnosis?
Pneumocystis jirovecii
Stroke pt puts clothes on wrong way / upside down. Likely location of stroke?
Parietal lobe
Gout + CKD - treatment?
Allopurinol
Can also use febuxostat
Ankylosing spondylitis - failed on >2 NSAIDS. Next step in management?
Etanercept (from options given)
Also adalimumab, infliximab
Old lady at care home on nitrofurantoin for UTI. Now has watery diarrhoea & vomiting. 2 other residents have similar Sx. Diagnosis?
Norovirus
Antibodies associated with systemic sclerosis?
Anti-centromere (from PPQ)
ANA
Anti-Scl70
Mouth ulcers + bloody diarrhoea. Likely diagnosis?
Bloody diarrhoea –> UC > Crohn’s
Ophthalmoplegia + facial nerve palsy. Diagnosis?
Cavernous sinus thrombosis
380yo stable man, BMI 21, fit and healthy. T1DM picture. Management?
NICE guidelines –> SC basal-bolus insulin
Patient has T2DM. Best insulin regime?
NICE guidelines –> intermediate acting insuline, e.g. isophane insulin
Clinical picture suggestive of phaeochromocytoma - investigation?
Urinary metanephrines
Old lady with back pain that is relieved when leaning on her shopping trolley. Also has a feeling of heaviness in her legs.
Diagnosis?
Spinal stenosis
Person is on lithium. Bloods are normal except for hypernatraemia. Diagnosis?
Nephrogenic DI
What do you monitor in a patient at risk of refeeding syndrome?
Phosphate
Patient with low Ca, low phosphase, high PTH.
Diagnosis?
Secondary hyperparathyroidism
e.g. due to intestinal malabsorption
Ascites + encephalopathy - management?
Lactulose –> increase excretion of NH4+
Melaena and vomiting + haemodynamically unstable - next step in management?
OGD within 2 hours
Most common cause of Addison’s?
Assuming in developed countries..
Autoimmune
N&V, tinnitus, horizontal nystagmus, but NO hearing loss - diagnosis?
Vestibular neuronitis
Lower lobe fibrosis. Pt has RA, raised Ca2+, bilateral hilar shadowing. What is the cause of fibrosis?
Lower lobe –> RA
Upper lobe –> sarcoid
Spiculated lesion in lung
Malignancy
Calf claudication - which vessel?
Superficial femoral
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?
Flexor digiti superficialis
Patient presents with lumbar back pain and is hypotensive. What investigation?
MRI spine
Patient is diabetic and has blood glucose of 5.8 night before surgery. Best management?
Sliding scale to start night before surgery + first on list in morning
