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Y6 Past Papers NEW > 2019 paper > Flashcards

2019 paper Flashcards

1
Q

Person with early diastolic murmur
and mid-diastolic murmur. JVP 8cm?

Aortic Regurgitation
pulmonary regurgitation
Pulmonary stenosis
Tricuspid regurgitation

A

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 ?

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2
Q

Person on various meds, high potassium,
high ?urea, ECG changes showing bradycardia with 2:1 block. Cause?

Digoxin toxicity,
Ramipril

A

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

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3
Q

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

A

Start Chest compression

If unconsciouss -> check if removal of choking hazard is possible, attempts rescue breaths if not possible then start CPR

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4
Q

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

A

Ca19 -9
The obstructive picture is suggestive of pancreatic cancer
AFP liver or testicular
CEA colorectal cacner
PSA prostate cancer
ca 125 ovarian cancer

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5
Q

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

A

**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.

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6
Q

Ankylosing spondylitis type history,
most diagnostic investigation?

HLA-B27,
MRI sacroiliac joints,
lumbar X ray,
CT

A

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

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7
Q

Question with ?myopathy, high CK, possible
polymyositis type history, investigation?
Antibody?

A

Anti Jo1

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8
Q

Patient with cancer and metastasis,
with nausea and vomiting, not on chemotherapy/ radiotherapy, which medication to give?
Cyclizine,
ondansetron,
pro-chlor,
haloperidol,
metoclopramide

A

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
  • 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
  • Haloperidol
    • Indications
      • Chemical causes
      • REnal failure
      • Drug induced
    • Caution/relative or absolute contraindications
      • Lowers seizure threshold
      • PArkinsons DONT GIVE WITH
  • Ondansetron
    • Indications
      • Restricted to
        • Post chemo (in respect to palliative care often only used after chemo)
        • Abdominal surgery
        • Abdominal radiotherapy
    • Caution/relative or absolute contraindications
      • Very constipating
      • QT prolongation
  • Levomepromazine
    • Indications
      • Third line
    • Caution/relative or absolute contraindications
      • Long half life.
      • Sedating
      • Lower seizure threshold
      • Severe heart failure
      • CVS disease
      • Parkinsons
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9
Q

Medication side effect with a obstructive
hepatic picture:
Bendroflumethiazide
Benzodiazepine
Carbamazepine

A

Carbamazepine

NO CLUE WE JUT SEARCHED AND FOUND THE BELOW

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10
Q

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

A

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,

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11
Q

Parotid gland swelling 2cm, which became
larger rather quickly (~5cm), diagnosis?

Parotid adenoma,
Parotid carcinoma,
lymphoma,
partotid stone,
lympahdenopathy

A

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

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12
Q

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

A

Hoarseness of voice

Contraindications to the surgery include :
* Mets
* Poor health -> Pneumonia
* Vocal cord paralysis

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13
Q

Gentleman with deficits described of
cranial nerves 3-6, where is the site of the stroke?

Pons,
Midbrain,
Cerebellum, ?
Basal ganglia,
Cavernous sinus

A

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

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14
Q

Patient has cancer, flushing+other symptoms, which of these is the responsible hormone?
ACTH,
Serotonin,
PTH,

A

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!

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15
Q

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

A

Parietal lobe
Aoraxias are from parietal lobe

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16
Q

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

A

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….

17
Q

Gout, but has CKD stage 3? Colchicine
(caused vomiting for patient, so wasn’t an answer option),

Ibuprofen,
naproxen,
allopurinol,
Steroid

A

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.

18
Q

Ankylosing spondylitis management?

A

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.

19
Q

old lady in care
home on Nitrofurantoin, now has water diarrhoea & vomiting. 2 other people ill at care home?

Norovirus,
C. diff,
rotavirus

A

Norovirus

Rotavirus is think is more inchildren

20
Q

What is the investigation for Phaechromocytoma?

A

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.

21
Q

SIADH management

A
22
Q

Cluster headache acute tx with no oxygen as option? Extreme pain behind eye, redness, tearing, and was restless during these episodes

Acute
Prophylaxis

A

100% ocygen + Subcut or intranasal triptans

Prophylaxis -> verapamil

23
Q

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

A

Flexor digitalis superficialis

24
Q

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

A

Lead poisoning

Basophilic stipling and sideroblast is a feature of this

25
Q

malignant hyperthermia What is the presentation ?
What is the manafement of this?

A

Presentation:
* Administer anaesthetic agents complications
* Excessive release of Ca 2+
* CAUED by -> Suxamethonium + Halothane + antipsychotics

IX
* CK raised

Management
* Dantrolene

26
Q

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.

A

Lateral view

27
Q

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.

A

Uveitis

28
Q

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

A

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

29
Q

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?

A

Urgent MRI spine

30
Q

Incidental finding of a solid mass
on right kidney during USS. What is the most likely diagnosis?
Renal cell carcinoma,
renal cyst,
angiomyolipoma,

A

If it says a firm mass then it is a Angiomyolipoma

Renal Cyst -> We think this is the most common

31
Q

Patient has had surgery, has pain on
passive straight leg raise. What is the diagnosis?

A

Any pain on passive movment post surgery is suggestive of caompartment syndrome

32
Q

Patient has RUQ pain, USS shows dilated
intrahepatic ducts, what antibody will you test for to confirm the diagnosis?

A

pANCA

Describing PSC -> pANCA
PBC -> AMA
Autoimmune hepatitis -> ASMA
ANA not very specific

33
Q

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

A

Sciatic

Too low for the common peroneal nerve. The injury described is a posterior dislocation

34
Q

26yr guy with unilateral gynaecomastia
→ bilateral. No nipple discharge. Most likely additional finding?

Testicular mass,
bitemporal hemianopia,
abdominal striae (for Cushing’s?),
less hair

A

Testicular mass

Testicular cancer history we think… For males with gynaecomastia the testicles need to be examined.

35
Q

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

A

HIV seroconversion

36
Q

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

A

Restrict Na

37
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

This presents as painless macroscopic haematuria

38
Q

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,

A

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

39
Q

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

A

intermittent Catheter -> If palliative patient

IF HE CANT SEE THEN NOT INTERMITTENT BUT LONG TERM CATHETER

IF not palliative then TURP

Y6 Past Papers NEW (9 decks)

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