2019 paper Flashcards
Person with early diastolic murmur
and mid-diastolic murmur. JVP 8cm?
Aortic Regurgitation
pulmonary regurgitation
Pulmonary stenosis
Tricuspid regurgitation
Aortic Regurg
The early diastolic murmur is seen when there is AR or PR and the prescence of the mid diastolic mumur might be suggesting an austin flint murmur suggestie of Severe AR. The raised JVP suggests that there is a Right heart strain, this can be due to AR -> Pulmonary hypertension -> RHS ?
Person on various meds, high potassium,
high ?urea, ECG changes showing bradycardia with 2:1 block. Cause?
Digoxin toxicity,
Ramipril
Digoxin toxicity
ON ECG presents can cause a complete heart block. and can lead to hyperkalaemia….
It also can present with a reverse tick sign. arrythmias()
GI symptoms -> N+ V + Diarrhoea
gynaecomastia
CNS symptoms -> Lethargy weakness and condusion
YELLOW GREEN VISION
Causes of AV block – beta blockers, digoxin, CCB
You are called to see a 75 Y/O patient
who is unresponsive. Nurses saw her choking. No pulses or respiratory effort, nothing visible in mouth. What do you do?
5 back blows
5 abdominal thrusts
start chest compressions
Inspect using laryngoscope
Start Chest compression
If unconsciouss -> check if removal of choking hazard is possible, attempts rescue breaths if not possible then start CPR
62yo man with history of alcohol excess
presents with abdominal distention and weight loss. He appears cachectic, jaundiced and has ascites. What tumour marker would be most appropriate for confirming his diagnosis? Tests: AST ~120; ALT ~150; ALP ~200+; yGT ~300+; Bilirubin ~60.
Carcinoembryonic antigen
Alpha-fetoprotein
Ca 19-9
Ca-125
Prostate specific antigen
Ca19 -9
The obstructive picture is suggestive of pancreatic cancer
AFP liver or testicular
CEA colorectal cacner
PSA prostate cancer
ca 125 ovarian cancer
Diabetic on insulin due for surgery
first thing next morning, has HbA1c of 58mmol/l. What do you do?
Convert to sliding scale night before,
convert to sliding scale morning of surgery
continue long acting,
stop short acting
**Continue long acting , stop short acting **
According to JBDS-IP guidelines, there are five scenarios in which perioperative VRIII is indicated:
Type 1 diabetes+more than 1 missed meal.
Type 1 diabetes+has not received background insulin.
Type 2 diabetes+more than 1 missed meal+capillary blood glucose >12 mmol/mol.
Type 1 or 2 diabetes+HbA1 c >69 mmol/mol.
Type 1 or 2 diabetes+emergency surgery.
Ankylosing spondylitis type history,
most diagnostic investigation?
HLA-B27,
MRI sacroiliac joints,
lumbar X ray,
CT
MRI sacroiliac joints
This is the best investigation for diagnosis for ankylosing spondylitis
Fitst line is an X-ray of the lumbar spine
Management
Conservative physiotherapy
NSAIDs
DMARDs if peripheral joint invovment
Question with ?myopathy, high CK, possible
polymyositis type history, investigation?
Antibody?
Anti Jo1
Patient with cancer and metastasis,
with nausea and vomiting, not on chemotherapy/ radiotherapy, which medication to give?
Cyclizine,
ondansetron,
pro-chlor,
haloperidol,
metoclopramide
cyclising if brain mets OR Haloperidol if hypercalcaemia or palliative
-
Cyclizine
- Indications
- Central vomiting
- CNS lesion
- Labyrinthitis
- Caution/relative or absolute contraindications
- Irritant SC
- Severe HF
- Indications
-
Metoclopramide (oral or IVB)/Domperidone (only oral)
- Indications
- Delayed GIT transit -> MIGRAINE IS ASSOCIATED WITH THIS AND SO METOCLOPRAMIDE FOR MIGRAINE
- Bowel obstruction WITHOUT colic
- with morphine?
- Caution/relative or absolute contraindications
- Bowel obstruction WITH colic
- Parkinsons
- cadiac conduction disorder
- young women ⇒ SF or SE Movement disorder
- Indications
- Haloperidol
- Indications
- Chemical causes
- REnal failure
- Drug induced
- Caution/relative or absolute contraindications
- Lowers seizure threshold
- PArkinsons DONT GIVE WITH
- Indications
- Ondansetron
- Indications
- Restricted to
- Post chemo (in respect to palliative care often only used after chemo)
- Abdominal surgery
- Abdominal radiotherapy
- Restricted to
- Caution/relative or absolute contraindications
- Very constipating
- QT prolongation
- Indications
- Levomepromazine
- Indications
- Third line
- Caution/relative or absolute contraindications
- Long half life.
- Sedating
- Lower seizure threshold
- Severe heart failure
- CVS disease
- Parkinsons
- Indications
Medication side effect with a obstructive
hepatic picture:
Bendroflumethiazide
Benzodiazepine
Carbamazepine
Carbamazepine
NO CLUE WE JUT SEARCHED AND FOUND THE BELOW
30yo gentleman with intermittent swallowing
difficulties for solids that relieves with large amount of water , no mass, but describes bad smelling breath?
Stricture
pouch
globus hystericus
Globus hystericus OR Pharyngeal pouch
Globus hystericus-> this is the feeling that there is something in your throat.
this is often relieved by water and the symptoms are often intermittent -> There is normally a history of anxiety This will lokely present in younger individiuals…
I have screenchoteted 2 passmed qs below read them and get an idea of how they may present the 2 differently and make a choice in the exam…
Pouch and stricture shouldbt be intermittent -> POUCH CAN BE INTERMITTENT IF SMALL
The bad breath could be a suggestion of a pouch -> I AM LEANING TO POUCH
THE other question SCREENSHOT shows someone elses recolleection of the qs and for that ir seems more like pouch…. MAybe 2 different qs with slight different stem,
Parotid gland swelling 2cm, which became
larger rather quickly (~5cm), diagnosis?
Parotid adenoma,
Parotid carcinoma,
lymphoma,
partotid stone,
lympahdenopathy
Parotid Carcinoma
Parotid adenoma we think is slow growing…
We think that the change in speed from a slightly large to a really large seems abnormal for lymphadenopthy
ADD SCREENSHOT
History of a gentleman with a bronchial
cancer ?7cm and other features of the cancer, which would be the symptom suggesting surgery isn’t viable?
Hoarseness of voice
Evidence of pneumonia
Size
Breathlessness
Hoarseness of voice
Contraindications to the surgery include :
* Mets
* Poor health -> Pneumonia
* Vocal cord paralysis
Gentleman with deficits described of
cranial nerves 3-6, where is the site of the stroke?
Pons,
Midbrain,
Cerebellum, ?
Basal ganglia,
Cavernous sinus
Cavernous sinus thrombosis
Cavernous sinus thrombosis
other causes of cavernous sinus syndrome: local infection (e.g. sinusitis), neoplasia, trauma
periorbital oedema
ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th
trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain
central retinal vein thrombosis
Patient has cancer, flushing+other symptoms, which of these is the responsible hormone?
ACTH,
Serotonin,
PTH,
Serotonin
I think this is describing Carcinoid syndrome:
Presents as flushing often lasts <30 minutes, diarrhoea , abdominal cramps wheezing or dysnopea
In a patient presenting with secretory diarrhoea, episodic flushing, wheezing, and cardiac valvular abnormalities, consider a carcinoid tumour!
Person had stroke, still unable to
put clothes on, puts it on back to front/ upside down etc. What part of brain was affected?
Parietal,
temporal,
frontal,
occipital,
cerebellum
Parietal lobe
Aoraxias are from parietal lobe
19 year old returning from India, 1 week history of dry cough. Examination revealed crackles in right lung base and CXR with right lower lobe consolidation. He has well controlled HIV and is on HAART. His saturations are 88% on room air. Mild oral thrush.
Candida pneumonia
Tuberculosis
Strep pneumo
PCP pneumonia
Tuberculosis??
Not 100% sure … but PCP with well controlled HIV seems unlikely
Tuberculosis as oral thrush is associated with it. Tuberculosis is common in india…
The chest x ray seems a bit a typical and supports strep pneumonia but not sure….
Gout, but has CKD stage 3? Colchicine
(caused vomiting for patient, so wasn’t an answer option),
Ibuprofen,
naproxen,
allopurinol,
Steroid
Steroids
Treatment of gout is NSAIDS but this patient has CKD so thats no longer possible. they were intolerant to colchine and so that is also ruled out.
Steroids can be used in the short term.
Ankylosing spondylitis management?
NSAIDS
Physiotherapy
DMARDs -> TNF alpha blockake -> Etanercept , infliximab adalimumab
IL-17 blocker -> Secukinumab ustekinumab
IF PERIPHERAL DISEASE (Psoriatic?) -> Methotrexate OR Sulphasaline
Steroids can be enjected to the joint…Increases risk of osteoperosis.
old lady in care
home on Nitrofurantoin, now has water diarrhoea & vomiting. 2 other people ill at care home?
Norovirus,
C. diff,
rotavirus
Norovirus
Rotavirus is think is more inchildren
What is the investigation for Phaechromocytoma?
Urinary metanephrines
If there is mention of palpitation and sweaating that is intermittent it is suggestive of this condition….
However I feel if this presents in GP early initial invesitgation would beCG.
SIADH management
Cluster headache acute tx with no oxygen as option? Extreme pain behind eye, redness, tearing, and was restless during these episodes
Acute
Prophylaxis
100% ocygen + Subcut or intranasal triptans
Prophylaxis -> verapamil
Patient sliced palm of hand. Not able
to flex middle finger MCP and PIP joints but can flex DIP joint. Which structure has been damaged?
Flexor digiti profundus,
flexor digiti superficialis,
ulnar nerve,
median nerve,
lumbricals
Flexor digitalis superficialis
Man working on construction site with
rats and pigeons, living in caravan nearby. Has abdo pain and nausea. Blood film showed basophilic stippling and sideroblasts.
Which investigation?
Total body lead,
leptospira antibodies
Lead poisoning
Basophilic stipling and sideroblast is a feature of this
malignant hyperthermia What is the presentation ?
What is the manafement of this?
Presentation:
* Administer anaesthetic agents complications
* Excessive release of Ca 2+
* CAUED by -> Suxamethonium + Halothane + antipsychotics
IX
* CK raised
Management
* Dantrolene
Hyperextension neck injury. What is
the best view to determine a C-Spine fracture(they do them all for C-Spine don’t they? fml) -
Closed PEG,
Open PEG,
Swimmer’s abduction view,
Lateral view,
Anterior.
Lateral view
Guy with Ank Spond(wrote features of
it - young male with low back pain). He had a red painful eye and photophobia. Diagnosis?
Scleritis,
Episcleritis,
conjunctivitis,
uveitis.
Uveitis
Patient with subacute combined degeneration
of the cord (peripheral neuropathy, weakness, etc. in legs).
What do you give them?
Hydroxycobalamin,
thiamine,
pyridoxime,
folate
Describe the features of this condition
Hydroxycobalamin
subacute combined degeneration is due to B12 deficiency
The motor symptoms happen later and is less significant. Though this can have UMN signs as shown in the screenshot
Lady has previous diagnosis with breast
cancer and had mastectomy, has recently had a course of chemotherapy. Now has back pain. What do you do?
Urgent MRI spine
Incidental finding of a solid mass
on right kidney during USS. What is the most likely diagnosis?
Renal cell carcinoma,
renal cyst,
angiomyolipoma,
If it says a firm mass then it is a Angiomyolipoma
Renal Cyst -> We think this is the most common
Patient has had surgery, has pain on
passive straight leg raise. What is the diagnosis?
Any pain on passive movment post surgery is suggestive of caompartment syndrome
Patient has RUQ pain, USS shows dilated
intrahepatic ducts, what antibody will you test for to confirm the diagnosis?
pANCA
Describing PSC -> pANCA
PBC -> AMA
Autoimmune hepatitis -> ASMA
ANA not very specific
Person after accident has internal
rotate leg and shortened. Can’t dorsiflex. Previous total hip replacement. Where is the injury? Common peroneal, femoral, sciatic, obturator
Sciatic
Too low for the common peroneal nerve. The injury described is a posterior dislocation
26yr guy with unilateral gynaecomastia
→ bilateral. No nipple discharge. Most likely additional finding?
Testicular mass,
bitemporal hemianopia,
abdominal striae (for Cushing’s?),
less hair
Testicular mass
Testicular cancer history we think… For males with gynaecomastia the testicles need to be examined.
Person has supraclavicular lymphadenopathy,
fever, aphthous ulcers and generally ill after coming back from South Africa, stopped taking malaria prophylaxis after 2d.
Cause?
HIV seroconversion,
malaria
EBV,
TB
HIV seroconversion
Person with calcium stones (doesn’t
say specifically, but gave lots of results for oxalate, cysteine, etc and calcium was high),
best preventative?
Restrict dietary calcium,
restrict Na,
urinary alkalinisation,
allopurinol
Restrict Na
What is the most common type of bladder cancer?
Transitional cell carcinoma
This presents as painless macroscopic haematuria
A 32 year old lady is 10 weeks pregnant
and has dysuria. She is diagnosed with a UTI. What medication should she be treated with?
Trimetoprim,
Nitrofurantoin,
amoxicillin,
Nitrofurantoin
This is the first line for UTI in pregnant women as long as it is not in the final term of the pregnancy,
If it is the final term the answer is amox
Old guy (?palliative) who lives in
a care home has been admitted with urinary retention, has had 5 previous admissions in the past year for the same reason. PMH includes BPH and visual impairment for which he is on an alpha blocker. Recently failed TWOC. What is the most appropriate management?
Long term catheter
intermittent self catheterisation
TURP
prostatectomy
intermittent Catheter -> If palliative patient
IF HE CANT SEE THEN NOT INTERMITTENT BUT LONG TERM CATHETER
IF not palliative then TURP
