2020 paper Flashcards
We think are answers??
Keen runner who has irregular periods, where is the pathology?
Hypothalamus
Pituitary
Ovaries
Hypothalamic -> Think this is hypothalamic hypogonadism seen in anorexics/
Which factor signifies greatest risk of progression in RA?
Joint involvement >8
CRP
Anti-CCP
RF
Anti CCP
We arent 100% sure but the following are poor prognostic features:
- rheumatoid factor positive
- anti-CCP antibodies
- poor functional status at presentation
- X-ray: early erosions (e.g. after < 2 years)
- extra articular features e.g. nodules
- HLA DR4
- insidious onset
Pt with bradycardia and bilateral crackles, was on O2. Next step of mx?
IV furosemide
Atropine
IV furosemide
Abx for infective exacerbation of COPD
)
Amoxicillin
BNF states that it is either amoxicillin, tetracycline or clarithromycin
Woman 55yo? with pain in groin, mets in femur, where was primary lesion located?
Renal
Cervical
Lung
Renal cancer is normally loin pain, mass and haemtauria… this could be the loin pain COMMONLY mets to bone, like lung.
Cervical or lung as lung more commonly metastasised to long bones
We think that this is cervical as it is more common and it would explain the mets and groin pain??? Not sure
Q described the findings from a CXR which showed bilateral multiple air filled sacs 10-20mm
Sarcoidosis
TB
Lung cancer
Lymphoma
Septic emboli
Septic emboli
We just searched up a bunch of pictures and picked the one which looked like it had air filled sacs… That being said the other ones we think present with caseating or non caseating granulomas or hard masses neither of which are air filled.
Analgesia for osteoarthritis.
Topical Diclofenac -> This was the option in this exam qs -> There was only one answer…
Paracetamol or Topical NSAIDS
Milky fluid drained from chest after surgery
Chylothorax
Empyema
Chylothorax -> this is a collection of fluid where the source is the lymphatics,
Women with headaches, pushing on the frontal lobe. Which brain tumour?
Meningioma
Glioblastoma
Astrocytoma
Meningioma -> The most common in adults is Meningioma
-> Listened to the guy with a neuro BSc no other fact checking…
Jiwonn seo fact checked Imperial Neuro BSc is not worth it-> he gonna be a radioologist
NVM turns out jess cant read below is a pie chart that shows a neuro bsc in imperial is worth it. (Glioblastoma is the most common malignant tumour meningiaoma is the most common in tumour)
Screenshot from Giulia
45 year old man with BP 190/90, tx?
So in the past paper it said Perindopril
Could be Oral labetolol
IV labetolol
Nitroprurosside
The following was an explanation in MaM mock answers to the question in the picture
This patient has presented with heart failure secondary to severe hypertension. In this circumstance, IV nitrates (e.g. sodium nitroprusside) are the first-line option to reduce blood pressure. GTN is an alternative agent that may be used in the same circumstance. Beta-blockers should be avoided as it can further compromise a heart that is already failing. Methyldopa is an old drug that may be used in the treatment of hypertension in pregnancy. Phentolamine is an alpha-blocker that may be used in the management of blood pressure in patients with phaeochromocytoma.
What cell is primarily affected in MS?
Oligodendrocytes
Astrocytes
Schwann cells
Oligodendrocytes ->These are what creates the myelin in the central nervouse systemn
Schwann cells are the ones that create Myelin on the peripheral nervous system
MS attacks the central nervous system
What additional vaccine is given to COPD patients?
PCV
The other possible answer ios Influenzaaaa
CXR was normal. Upper lobe diversion, what test to do?
CTPA -> CXR is apparently not good at telling upper lobe diversion so you need to do CTPA to confirm,
Cholesterol >9.0, triglycerides normal, HDL normal. Dx?
Heterozygous familial hypercholesterolaemia -> Isolated increase in LDL with all other levels are normal is suggestive of this condition.
Polymyositis description, what blood test would help diagnosis? (Anti-Jo was not an option)
CK
ANA
ASMA
CK -> Is what the majority think it is
Antijo-1 would be more correct apparently for screening ANA is used.
COPD wasn’t eating much. Which tool would be most useful?
Mini nutritional assessment
Honestly not sure what the answer is… Seems pretty low yield..
Malnutrition universal screening tool
Mini nutritional assessment
Malnutrition universal screening tool
Tx for spinal cord compression caused by mets.
Radiotherapy
Surgical decompression
Chemotherapy
surgical decompression
Surgical decompression is not done for metatstatic disease. If there is multiple mets or they are unstable.
Guy who kept falling asleep in the daytime.
Polysomnography
Guy who had an incident where he nearly fell asleep while driving a lorry. What is the most important thing to do?
Tell him to inform the DVLA
Polysomnography
Tell him to inform the DVLA
Blood supply to 2nd part of duodenum.
**Gastroduodenal artery
**
Essentially everything upto the 2nd part of the duodenum is supplied by the gastroduodenal artery.
After this the next component the midgut is supplied by the SMA and the final component is the IMA.
Abdominal osesophagus to the major duodenal papilla; oancreas; liver; gall bladder; spleen are all part of the coeliac trunk and its branches
SMA -> latter 2 parts of the duodenum the jejunum ileum caecum ascending colon and 2/3rds of the transverse colon
IMA -> distal 1/3rd of the transverse colon, descending, sigmoid,rectum and canal colon.
Lymphadenopathy, fever, bilateral conjunctival swelling.
Leptospirosis
This was the option that was on the paper. This is often seens with rat places.
What pneumoia causes cavitations on CXR? these are Gram +ve Cocci
Staphylococcus aureus -> This is also associated wtih recent viral infection.
Lacunar infarct, what drug to give in addition to aspirin?
Statin
Beta blocker
ACEi
ARB
Statin
This is the secondary prevention for strokes.
ACEi is provided if the causes if a haemorhragic hypertensive stroke.
Loud 2nd HS, pansystolic murmur. Right bundle branch block. - queried
Pulmonary HTN
Mixed aortic disease
Pulmonary HTN -> Giulia’s dad said its this… He a surgeon so we shall believe him…Mitral Regurgitation, causing Pul HTN I think that leads to a snapping close of the pulmonary valve. The Mitral regurg probably also causes the PSM.
NOT SURE
Mixed aortic disease would explain the PSM -> MR -> also leads to Pulmonary HTN + Aortic Stenosis (Loud S2) -> the RBBB -> Is a sign of Pulmonary HTN …… Leaning towards mixed diasease
Woman gave birth 4 months ago. High TSH, low T3/4.
Primary hypothyroidism
Viral thyroiditis
Postpartum thyroiditis
Post-partum thyroiditis -> this is a common post pregnancy and often presents a couple of months after pregnancy. Initially it presents like thyrotoxicosis.
this is often self limiting
I believe the history of the recent pregnancy makes Postpartum more likely. Primary hypothyroidism however is still another cause of low thyroxine and HIGH TSH.
Prevention of steroid-induced osteoporosis.
Bisphosphonates
Post hysterectomy and ovaries removal what is the prophylactic treatment of osteoperosis?
Oestrogen
While looking this up online, we found that for risk reducing surgery with bilateral oopherectomy, HRT is given as prophylactic treat.
I thought oestrogen but i think bisphosphonates were reccomended whereas oestrodial was like suggested as a possible option.
Tx of neuropathic heel ulcer which had black crust.
Low contact cast
Sharp debridement
Larval therapy
Low contact cast -> i believe this is done to relieve the pressure that is causing the ulcer in the first place
Sharp debridement – used in the presence of infection This is only treated if there is a wet gangrene.
Type of aphasia in women who can talk fluently but doesnt follow instructions
Receptive
Expressive
Global
Progressive
Conductive
Receptive
Colon biopsy showed caseous necrosis and Langerhan histiocytes. Feverish and GI sx.
Tuberculosis -> This is a cause of Caseating granulomas
They also have langerhan histocytes…
CXR shows widened mediastinum with different BP in arms. What investigation to do next?
CT angiography
TEE
TOE
CT angiography
Stable and AD -> CT angio
IF unstable and AD -> TTE
The widened mediastinum is more suggestive of Aortic dissection. If there was
43 year old with pain in bilateral knees, wrists.
RA
Osteoarthritis
RA -> too young for osteoarthritis and RA is often bilateral and affects the small joints with later progression to the knee.
Pt with COPD on 28% mask, but O2 sats are 85% after 30mins. What should you do?
Increase to 35%
100% O2
Stay on 28%
Reduce to 24%
Increase to 35%
If NIV or BiPAP is an option it is that. I dont think that you go down on Oxygen if they are desaturating.
Intrinsic muscle wasting of hands, biceps reflex reduced.
C5 nerve damage
Axillary nerve damage
Posterior brachial plexus damage
Posterior brachial plexus damage
Basically the C5-6 nerve is what controls the reflexes and we think thats the reason that is not functional. However, the intrinsic muscles are innervated with the ulnar nerve which is innervated by the nerve roots C8 - T.
The nerves where the above 2 interact are in the posterior cord as that cord recieves input from all of C5 all the way to T1. Therefore we thought that The posterior brachial plexus made the most sense.
28yo with some episodes of semi-loose stools. He is healthy between episodes. Tx for IBS diet??
FODMAP -> This is the treatment for IBS. this is the reccomended diet. you can also do symptomatic management.
Options were:
FODMAP diet
Lactulose diet
CXR showed multiple lung mets in a guy with an undescended testicle. Which tumour marker?
HCG
It could also be AFP, both are related with testicular cancer
Aortic stenosis pt, gradient 50%, LEVF 45%, mx?
Refer for aortic valve replacement
Reassure
Refer for Aortic Valve replacement
- In Severe Aortic Stenosis ⇒ GTN spray may be contraindicated because it can cause a reduction of preload of the heart leading to a risk of rapid decrease in Blood pressure and myocardial perfusion.
- Surgical treatment is indicated when ⇒ Symptomatic or there is SEVERE AS + LVEF <50% and undergoing other cardiac surgery
- What is Severe AS?
- Jet velocity > 4
- pressure gradient ≥ 40
- aortic valve area > 1cm
- TAVI or SAVR
- SAVR if younger
- TAVI if older
- What is Severe AS?
What test to assess liver damage after paracetamol overdose?
PT The only answer in the options provided…
Friction rub. Dx?
PE
So this was again the only option, the possible causes inc pericardits and PE apparently also pneumonia.
SVC obstruction
Most likely cause?
Treatment 1st and 2nd line
Lung tumour
1st line is dexamethasone
2nd line is Intubat and stent.
Dejavu and picking at clothes, where is the lesion?
Temproral lobe -> Memory is in the temporal lobe. the deja vu is suggestve of this,
Lung cancer with low Na and K. What hormone is being produced?
ADH
Person had an endoscopy and colonoscopy, what investigation next?
Capsule endoscopy
CT abdomen
Capsule endoscopy
Small bowel monitoring is the same thing as this. The next step after endo and colonscopy is the small bowel monitoring.
Bare in mind that this is the answer if the previous 2 investigations found no results on malignancy… If there was then this would be a CT abdo.
Oesophageal cancer with mets, how would they feed?
Gastrostomy -> this is for long term and also obstructive cancer
NGT -> Acute obstruction and also short term use where they may improve with physio
Paraenteral -> GI tract is not really work, so things like UC and Crohn’s. Maybe CF??
Endoscopy showed granulation tissue with necrotic layer on top
Ulceration
Colonoscopy found inflammation in rectum and colon.
UC
Diverticulitis
UC
Cholestatic picture in pt with thyroid problem.
PBC -> Autoimmune disease with thyroid so suggests another autoimmune disease, such as PBC which will present with a cholestatic picture. This is only Extrhepatic bile duct involvment
Supraclavicular lymphadenopathy and weight loss
Gastric carcinoma -> this is likely to be a gastric cancer. Colorectal cancer rarely presents with virchow node thickening.
Swabbed ulcer had MRSA, tx?
Vancomycin
options were:
Flucloxacillin
Vancomycin
Pt had a resection and epidural was not controlling his pain. What do you do?
Oral morphine
IV morphine
Check level of block
Check level of block
If epidural doesnt work then opioids will not work either so need to see if epidural has taken effect. Epidural is better that spinal as it can be titrated and topped up.
19yo girl inverted her ankle during football practice. WHat ligament is most likely to be damaged?
Anterior tabofibular ligament
Posterior talofibular ligament
Transverse tibiofibular ligament
Calcaneal fibular ligament
Interosseus ligament
Anterior tabofibular ligament
The lateral complex is made up of the Anterior tabofibular complex, Calcaneal fibular ligament and the Posterior tabofibular ligament.
The injuries to this lateral comples is in the order described above, with the most likely injury being the anterior tabofibular complex..
Deltiod ligament for eversion…. I am not gonna learn the anatomy.
Pt is diagnosed with Hodgkin’s lymphoma, how would you describe the treatment?
Neoadjuvant chemotherapy
Adjuvant chemotherapy
Curative chemotherapy –
Curative Chemotherapy -> this is for Hodgkin’s, ALL, testicular cancers these are the curative option.
Pt with MS with neurogenic bladder. Urine was sterile and no signs of infection, what catheter to use?
Suprapubic catheter
Intermittent catheterisation
Intermittent Cathertisation -> Catheter is a good option for treatment of MS
Gleason score 3 + 3, what is the appropriate mx?
Watchful waiting
Surgery
Medication
Surgery
This is a guess… What we found online was actually something called brachytherapy.
Signs of upper abdominal bruising in pt after RTA who is on warfarin. INR is 5.3 after IV vitamin K, what to do next?
Stop warfarin
Reduce warfarin
PCC
Stop Warfarin this describes a person with a person with INR >5. this requires warfarin to be stopped
We think PCC should be added as I think it is a major internal bleed post RTA. However defininetly needs to warfarin,,, so this is pretty dumb as a question.
A 43 year old man is involved in a low speed road traffic collision. Following this he develops pain in his lower back that it is still troublesome several months later. The pain is worse after activity and is relieved by rest. He has an exaggerated lumbar lordosis with a palpable depression above L5. The range of movement of his spine is grossly normal. Neurological examination of his lower limbs is also normal. An MR scan is obtained (see image).
What is the diagnosis?
A. Cauda equina syndrome
B. Compression fracture
C. Herniated intervertebral disc
D. Spondylolisthesis
E. Spondylosis
Spondylolisthesis -> This means that the disc has slipped forward. as seen in the bottom vertebra of this MRI scan.
Pt post-surgery had been given 3L of 0.9% saline, 4 glucose and 10mmol/L of potassium. Had paralytic ileus? What biochemical abnormality is most likely to be seen?
Hypokalaemia
Hypernatraemia
Hypercalcaemia
Hyponatraemia
Hypokalaemia -> Paralytic ileus is associated with Hypokalaemia and Hypercalcaeimia and Hypomagnesium.
We think there was insufficient fluids and with detrose fluids, we think this lead to hypokalaemia and so we THINK this is the answer
Ogilvie -> Hypokal, hypomag, hypothyr + hypercal
REcent surgery + medication can cause this
Neuro causes -> Parkinsons+MS+hirschspruung
The 30 mmol of K+ is to low for the day as they need roughly 1mmol.kg… This means it is likely they are hypokalaemic… Or the hypokalaemia cuased the ileus…
Bone most likely fractured in pt with diplopia, facial anaesthesia
Zygomatic
Maxilla not an option
Frontal
Zygomatic -> This needs to be afracture at the base of the orbital floor, so this includes the Zygomatic bone and the Maxilla.
Cause of thrombocytosis in pt who had a flare of UC trated with steroids and azathioprine?
Primary proliferative thrombocytosis
Reactive thrombocytosis
Side effect of steroids
Side effect of azathioprine
Side effect of steroids.
Woman found passed out on the street with an empty bottle of vodka. WHat is the most urgent test that needs to be done?
Alcohol level in blood
Urea and electrolytes
Urine dip
U + Es
If glucose is an option it is probably that otherwise, we think U and Es would be helpful in knowing the level of dehydration.
Urea 16, calcium slightly raised. Drowsiness and other sx in pt with CKD.
Hypercalcaemia
Uraemia
Uraemia -> More raised so more likely to be the cause of the symptoms…
Pt with hyperkalaemia, how would you manage?
Calcium gluconate was not an option
IV 500ml 0.9% saline
IV sodium bicarbonate
Insulin and glucose
Insulin and glucose
What explains fast progression of atherosclerosis?
Less HDL breakdown
More LDL production
More LDL
LDL badddd
HDL gooood
I got no pneumonics
Pt just underwent allogenic haematopoiteic stem cell transplant. Few days later develops a fever and breathing diffuclties, consolidation found.. What is most likely causative orgsnism?
Staph aureus
Klebsiella
Strep pneumoniae
Pneumocytstic jiroveci
PCP
The patient is immunosuppressed,
The presentation of the CXR is also supportive of the
Bristol stool scale of 7 after surgery. What to do next?
Stool sample over 3 days
Start vancomycin
Start metronidazole
Isolate pt in side room
Isolate pt in side room
An 86 year old woman has had three falls in the past 3 months. On each occasion, she describes feeling lightheaded and dizzy prior to falling. She is taking alendronic acid, amlodipine, atorvastatin, metformin and zolpidem tartrate. Her BP is 132/80 mmHg sitting and 138/84 mmHg standing.
Which medication is most likely to be contributing to her falls?
A. Alendronic acid
B. Amlodipine
C. Atorvastatin
D. Metformin
E. Zolpidem tartrate
Zolpidem
Pt on NSAIDs for 2 weeks has blood, leukocytes, protein on urine dip.
Interstitial nephritis
ATN
Membranous nephropathy
Interstitial Nephritis -> 4-7 days after the precipitating factor -> 95 % are drug induced esp NSAIDS
Different pt with blood, leukocytes, protein on urine dip and oedema.
Interstitial nephritis
ATN
Membranous nephropathy
Minimal change disease
Membranous nephropathy
None of these were nephritic syndrome but we think this is the most common anyway but not sure?
Man comes in after RTA, unconscious, pulseless, not breathing, CPR started.
IV adrenaline
Synchronised 200J shock
Unsynchronised 360J shock
IV 500ml 0.9% saline
unsynchronised 360 J shock -> This a defibrillation and that is an unsynchronised shock.
The management of pulseless VT is CPR as well as Shock.
Management of hernia causing small bowel obstruction.
CT abdomen
Surgery
Surgery -> this is the management of this… The CT abdomen
NGT decompression is possible as well
CT would be the investigation of choice but this is not done!!! Hernia is investigated with US but most of the time it is a clincial diagnosis… If this patient had an incarcerated hernia then the management would be the Surgical decompression
Most urgent investigation for intraocular foreign body in metal welder.
CT orbit
Fluorescein angiography
CT orbit -> one of the most important things is to confirm if there is an intraocular object still. This confirmation of diagnosis is done with CT orbit.
Woman’s dad has haemophilia A. What is the chance that the woman is a carrier?
0
1 in 1
1 in 2
1 in 4
1 in 1
This is an X-linked condition and so if a male has the condition and they have a daughter they will 100 % be at least a carrier.
Woman on recreational drugs has hypokalaemia and hyponatraemia?
Ketamine
MDMA (ecstasy)
Nitrous oxide
MDMA (ecstacy)
We searched it up apparently, the MDMA causes SIADH or increased release of the pituitary hormones leading to the low Na and K
The nitrous oxide I think does the opposite and causes the collecting ducts to be less permable.
Pt presents with left superotemporal vision loss after having floaters for a few days.
Retinal detachment
Infranasal artery occlusion
Retinal detachement -> the floaters and the loss of vision is characteristic of this…
Apparently Infranasal artery occlusion will be a much more acute history.
Long term diabetes pt with peripheral microaneurysms and RADP, blurry optic disc.
AION
Diabetic maculopathy
AION
Anterior ischemic optic neuropathy. This is a quick loss of vision due to there not being enough blood flow to the eye.
optic neuropathy is normally the cause of a RAPD… Apparently it is also associated with the other findings that were described.
Diabetic retinopathy would not explain the RAPD (rare to present with this). Microaneurysms would be present. Hard exudates may be present.
Pt with haemoptysis and renal dysfunction, what antibody test.
ANCA
Anti-GBM
ANA
Anti-GBM – for Goodpasture’s
ANCA – for microscopic polyangiitis- but would expect palpable purpura
Which resection for UC?
Hartmann’s
Right hemicolectomy
Anterior resection
Anteroir Resection -> hartman’s is often used in emergencies so this is unlikely. Therefore we thought anterior resection cause it seems similar to the proctocolectomy
Pt on atorvastatin, cholesterol was still >5.3, LDL and HDL were normal. What to do?
Increase statin
Keep statin same
Reduce statin
Stop statin
Add something else
Increase Statin
(if <80mg -> increase; if >80mg -> ezetemide) – check medicines complete for treatment summary
40 year old patient whacked by football 2 days ago, noticed swelling in left groin, diffuse swelling at upper pole of left testes, does not transluminate, right one normal.
Epididymo-orchitis
Seminoma
Teratoma
Spermatocoele
Epididymo- Orchitis
This needs more information. If this is an acute onset unilateral pain then this is the above as described.
Otherwise the below questions suggests how the other conditions may present.
Sickle cell pt with severe pain leg
IV Morphine
If no options of opioids give fluidsss
AAA screen 3.3cm
Yearly review
3-4.4 yearly review
4.5-5.4 3 month review
>-5.5 refer for surgery.
AAA rupture, already been given 4 units of blood, what else can you give?
FFP
Platelets
Cryoprecipitate
TXA
FFP
We dont think you are able to keep give too much blood all at once
The TXA is only really effective at the start of bleeding
Primary pneumothorax 4cm tx?
Aspirate
Chest drain
Needle decompression – this is only for tension
NEW GUIDELINES
If they are symptomatic you treat… If they are not you reassure and discharge
If they are symptomatic and at high risk and >2cm then you give Chest drain-> if less than 2cm need a CT to reassess then get a chest drain
IF they are symptomatic but not at high risk eg this persion then it would be based on the preference of the patient
Pt with acne. Tried retinoin and topical abx.
Lymecycline -> its the next step oral abx. this or doxy
Pain at 80-120 degree, shoulder movement?
Subacromial bursitis
Sx of C3-6 dysfunction. Where is lesion?
Cavernous sinus thrombosis
55yo male with change in bowel habit had rigid sigmoidoscopy that was normal. Next investigation
Colonoscopy
Capsule endoscopy
CT abdomen
Colonoscopy
Best investigation to diagnose 20yo male with sweats, fever, rubbery lump in neck.
Excision biopsy
BM aspirate
Excision biopsy
This is an iffy one cause it is either Lymphoma or leukaemia
We think that it is a lymphoma because of – rubbery lump probs suggest lymphoma.
Guy with sinusitis i think, was given abx but sx persist.
Refer to ENT
Continue abx
Change abx
Refer to ENT
Most likely cause of bloody diarrhoea after BBQ 5 days ago
Campylobacter jejuni
Reactive changes found in axillary LNs, next step?
* Reassure
* Sentinel LN biopsy
* Axillary LN clearance
Reassure
Not enough info to answer this question… If simple reactive lymph nodes theis is common with infections so would not need biopsy or clearance.?
