2020 Recall Flashcards
What sign is least likely to be present in cauda equina syndrome?
A - Lower limb weakness
B - Saddle anaesthesia
C - Hyperreflexia
D - Reduced anal tone
C - Hyperreflexia
It is recommended that patients infected with chlamydia come back 3 months after treatment with azithromycin to be re-tested. Why is this recommended?
A - high rate of azithromycin resistance (is common)
B - poor compliance with treatment
C - high rate of reinfection
D - It is a legal requirement under public health law
E - it takes three months after appropriate treatment to clear chlamydia infection
C - high rate of reinfection
A 35 year old man presents to the general practice with a 5-day history of haematuria. He has no relevant past medical history other than a throat infection that he is currently experiencing. Urine dipstick shows +++ blood and + protein with no glucose. An ultrasound of the kidney shows a single cyst in the upper lobe of the left kidney. What is the most likely diagnosis?
a. Chronic Kidney Disease
b. IgA nephropathy
c. Membranous glomerulonephritis
d. Post-streptococcal glomerulonephritis
A 22 year-old woman presents with lethargy, abdominal pain, constipation and polyuria. Her past medical history includes chronic kidney disease. Blood tests show hypercalcemia with raised PTH. Which of the following is the least likely cause of her hypercalcemia?
A. Familial hypocalciuric hypercalcaemia B. Primary hyperparathyroidism
C. Tertiary hyperparathyroidism
D. Thiazide diuretics
E. Lithium
D. Thiazide diuretics
Mr Thompson is a 65-year-old male who presents to the emergency department with a 6-day history of progressive weakness of his lower limbs. He can no longer walk unsupported due to this weakness. He reports mild “pins and needles” in his feet. His cardiovascular, respiratory and gastrointestinal examinations were unremarkable. He was noted to have hypotonia, areflexia and 1/5 power in both lower limbs. Neurological examinations of the upper limbs and cranial nerves were unremarkable. He has a past history of hypertension and hypercholesterolemia for which he takes perindopril and atorvastatin respectively. On further questioning, he reports that last month he was treated for gastroenteritis by his GP. A stool sample was sent at that time found Campylobacter jejuni.
What is the most appropriate investigation to assist in the diagnosis of this patient’s condition?
A. Acetylcholine receptor antibody test.
B. Cerebrospinal fluid analysis.
C. RNA.
D. MRI of the brain PCR of cerebrospinal fluid for poliovirus.
E. Serum vitamin B12 levels.
B. Cerebrospinal fluid analysis.
27 year old woman with type 1 diabetes mellitus presents to ED with abdominal pain, vomiting, altered mental status (+ other symptoms of DKA). Which is the most likely ABG result?
A. LowpH,highCO2,lowHCO3 B. LowpH,lowCO2,lowHCO3 C. HighpH,highHCO3,lowCO2 D. HighpH,lowHCO3,highCO2 E. LowpH,highCO2,highHCO3
B. LowpH,lowCO2,lowHCO3
- A 40 year old female requires antibiotic treatment for her acute cystitis. She is currently on methotrexate for her rheumatoid arthritis. Which is the least appropriate antibiotic choice for her to be placed on?
A. Amoxicillin
B. Cefazolin
C. Furomycin
D. Nitrofurantoin
E. Trimethoprim
E. Trimethoprim
- A man has been recently diagnosed with HF by his GP, with his echocardiogram showcasing a LVEF of 34%. Which of the following drugs is least likely to improve his mortality with this condition?
A. Metoprolol
B. Spironolactone
C. Frusemide
D. Perindopril
E. Irbesartan
C. Frusemide
A man on the general medical ward is deemed to be at a high risk of VTE. He was started on prophylactic unfractionated heparin one week ago. Today you are asked to review him and you notice that his platelet count is now 78 x 10^9 d/L - much lower than it was yesterday (20010^9 d/L). He also had a painful, red, swollen calf. What should you do?
A. Continue heparin because platelet count is expected to drop
B. Increase heparin because he has symptoms of a DVT
C. Cease heparin immediately and switch to dabigatran
D. Cease heparin immediately and switch to Aspirin
C. Cease heparin immediately and switch to dabigatran
A 60 year old gentleman with a history of Type 2 Diabetes Mellitus is admitted to hospital with Diabetic Ketoacidosis.
On urine dipstick glucose ++++, ketones +++
His blood glucose is very high.
Potassium 4.2
He is given an insulin infusion and his urine blood glucose decreases - it is now +. He then develops a severe arrhythmia
What is the cause?
A. Low sodium
B. Low potassium
C. Low glucose
D. Low phosphate
E. Low pH
B. Low potassium
A young woman presents because her husband has noticed she has been needing to go to the bathroom more frequently. Symptoms including polyuria, polydipsia and polyphagia. She has been getting up 2-3 times a night to go to the toilet. Her liver is enlarged and the GP also notes areas of tanning/pigmentation. They organise some blood tests which show increased AST, ALT, GGT and ALP. A random BGL is 4.5.
What investigation is most useful for diagnosis?
A. Hba1c
B. Transferrin Saturation
C. HbsAg
D. Copper
E. CT head
B. Transferrin Saturation
What is the first ECG change associated with hyperkalaemia?
A. Tall P waves
B. Narrow QRS
C. Tented T waves
D. Shortened QT interval
E. Elevated ST segments
C. Tented T waves
A 58 year old man presents to your clinic with a 6 month history of progressively worsening lower limb swelling and multiple bruises along his arms and legs. Upon taking a history, he states that he has had a high alcohol intake for the past 30 years, drinking around 15-20 beers per day on average. You perform a physical examination and order some blood tests to assess the severity of his disease.
Which of the following is NOT a component of the Child-Pugh score?
A. INR
B. Ascites
C. Albumin
D. Platelets
E. Bilirubin
D. Platelets
What is NOT a poor prognostic factor for CAP?
A. Disorientated
B. Age>65
C. High CRP
D. High Urea
E. Respiratory rate
C. High CRP
A 55-year-old man presents to the emergency department with profuse haematemesis and signs of hypovolemic shock. His wife, who called the ambulance, reports he had been well all day with no previous nausea and vomiting up until 40 minutes ago when she called the ambulance. It is also made known to the emergency team that he has a background of alcoholic liver disease with current Class B Child-Pugh score, as well as an upcoming appointment with his specialist due to concerns of abdominal swelling. Airway protection and IV fluids are commenced, as well as complete bloods, clotting factors and crossmatching is sent for in preparation for a possible blood transfusion. The bleeding has not yet ceased and despite IV fluids the man has continued to become disorientated. What immediate management should be started in order to reduce the bleeding?
A) Emergency endoscopy
B) Gastric balloon tamponade
C) IV esomeprazole
D) IV terlipressin
E) Transjugular Intrahepatic Portosystemic Shunt (TIPS)
D) IV terlipressin
