2023 paper Flashcards
hx of sore throat for 1 week, coryzal symptoms in child then bilateral red, watery eyes.
What is the treatment?
a) Antibiotic eye drops
b) Antiviral eye drops
c) Do nothing
d) Oral antibiotics
e) Steroid eye drops
Do nothing
This is viral conjunctivitis as there is a hx of a recent URTI…
Bacterial will have purulent discharge or sticky eyess
Patient with ascending weakness of arms and legs.
Which is the best to manage/monitor their respiratory muscles (status)?
a) FVC (this is part of spirometry)
b) Peak flow
c) ABG
d) Oxygen saturation
FVC
to monitor lung respiratory muscle function
Old patient with upper GI pain and dyspepsia. On ibuprofen for arthritis. Next step?
a) Stop NSAID,
b) Prescribe sulfracrate
c) Prescribe antacids
d) Refer for OGD/colonoscopy
Stop NSAIDs
NSAIDs associated with ulcer and so this might be precipating the problems so this should be stopped.
Painful muscles in patient on statin, HDLs, LDLs, Cholesterol all within normal range. High CK 1250
a) Stop statin
b) Reduce dose by x
c) Replace with simvastatin
d) Replace with another fibrate
Stop Statins
This is a PSA question… but essentially if there is an option to stop the statin and the restart is at a lower dose after the CK has dropped and the symptoms has settled then that would be the right answer.
Patient with CKD
bloods: Ferritin 208, Hb 98, MCV 82, transferrin sat 25%
Which of the following is the most likely?
a) Anaemia of chronic disease
b) renal anaemia
c) haemolysis
d) Iron deficiency anaemia
e) intrinsic factor deficiency
Anaemia of chronic disease
CKD is a cause of Anaemia of chronic disease….
Microcytic anaemia
* IDA
* ACD
* Thalassaemia
Normocytic anaemia
* Haemolytic anaemia
Hereditary causes:
Membrane deficits: Hereditary Spherocytosis; Hereditary elliptocytosis
Metabolic defects: G6PD deficiency; Pyruvate kinase deficiency; Haemoglobinopathies; Sickle Cell disease
Acquired causes:
Autoimmune: Warm (SLE, viral inf or lymphomas) or Cold (Leuk + Lymphoma)
Non-autoimmune: Microangiopathic haemolytic anaemia;
Haemolytic uraemic syndrome
Thrombotic Thrombocytopenic purpura (TTP)
- Non-haemolytic
Severe blood loss
Aplastic anaemia
Myelofibrosis
Macrocytic anaemia
* Alcohol
* B12 deficiency
* Folate deficiency
Patient had a PE, needs anticoagulation, with egfr 12. Which of the following is the most appropriate to give? (think the same as the CKD stage 3 one later on)
a) Apixaban
b) dabigatran
c) dalteparin
d) fondaparinux
e) warfarin
Dalteparin
LMWH is the management of choice when egfr < 15
Lady in nursing home with itchy rash worse at night, described as linear on hand and all over the body.
Which of the following is the most appropriate management?
a) Permethrin
b) Topical hydrocortisone
c) Topical betamethasone
Permethrin
The linear itchy rash is descriptive of Scabies. This must therefore be treated with permethrin first.
All the household and close contacts should be treated and there is a need to clean all the clothin as well on the first day of treatments.
Elderly woman from nursing home has diarrhoea, 4 other residents at the home have similar symptoms. What is the best investigation?
a) Stool viral PCR
b) CT abdo
c) Stool culture for cysts, ova and parasites
d) Stool culture for clostridium toxin A and B
Stool Viral PCR
If there was an option for no investigation is needed I am not sure what I would pick… I thought viral gastroenteritis is self limiting and did not need to be investigated?
Patient history: bilateral lymphadenopathy, weight loss.
What is the next most important next step?
a) CXR
b) Venography
c) Oral Prednisolone
CXR
I am thinking Sarcoidosis.
Patient with mass in apex of lung and signs of SVCO.
What is the best diagnostic investigation?
a) CT chest
b) Venography
c) US duplex of subclavian vein
CT Chest
Venography would confirm the compressed SVC but is not diagnostic of the cause… We think that the CT chest will give us an idea of the cause of the blockage.
Patient who has been treated with doxycycline for a Community Acquired Pneumonia presents with the following rash on their arms.
What is the most likely causative organism?
a) Mycoplasma pneumoniae
b) Haemophilus influenzae
c) Streptococcus pneumoniae
d) Staphylococcus aureus
e) Legionella pneumophila
Mycoplasma pneumoniae
The rash shown is erythema Multiforme and it is associated with the Mycoplasm pneumoniae
Legionella pneumophilia is associated with hyponatreamia and has antigen in urine…
Staphyloccus aureus this is associated with a recent ciral infection
Haemophilus influenza is associated with smoking and COPD
Strep pneumonia -> This is the most common and is associated with rusty coloured sputum … Vaccination for this is required in at risk groups…
Patient’s wife says he snores, and he’s now waking up with headaches in the morning. High BMI (45?)
What is the best initial investigation?
CT head
Lumbar puncture
ABG (?)
Polysomnography
Polysomnography
It depends what you think the diagnosis is. I think this is Hypoventilation syndrome and it is associated with obesity and obstructive sleep apnoea, this has an ABG as an intial investigation in BMJ.
If this is OSA which is more common hence then it is Polysomnography. THIS IS MORE COMMON so probs this….
If this is headaches early in the morning which is insidious then this could also be raised ICP so CT head???
RED FLAG IS WAKING UP BECAUE OF PAIN then defo CT HEAD
Patient with confirmed alcoholic hepatitis. Stopped drinking 3 weeks ago. Presents with palmar erythema, dupuytren’s contracture, spider naevi. Has splenomegaly.
Bloods showed low Hb, low albumin, low WBCs and low platelets?
What investigation should you do? –
a) OGD
b) CT abdomen
c) Bone marrow aspirate
OGD
We think this is decompensated liver disease, with the low albumin showing poor synthetic liver function…The OGD we think will confirm this with the prescence of oesophageal varices as a sign of portal hypertension?
The CT abdomen doesnt really diagnose anything except maybe a tumour and I dont think this patient has HCC, maybe liver cirrhosis in which case a liver biopsy or a fibroscan would be more approaproate,
bone marrow aspiration is if you think this is a leukaemia and we think that generally the lowe readings are due to the alchol intake causeing bone marrow suppression.
alcohol suppresses bone marrow -> thrombocytopaenia (most commonly), anaemia, leukopaenia (less commonly)
Patient recently treated for a pneumonia last 7 days or so and now has worsening symptoms and increasingly unwell. CXR showed opacification (?)
What is the diagnosis?
* Lung abscess
* TB (?)
Lung Abscess
Patient presented with SBP and treated. What to prescribe in addition?
* Ciprofloxacin
* Prednisolone
* Propranolol
Ciprofloxacin
SBP >25o
Patient with symptoms of hyperthyroidism and a left sided smooth goitre. Lid retraction but no other eye signs. (May have said normal Anti-TSHr?) What is the next best test to reach a diagnosis?
- Anti-TPO
- Thyroid scintigraphy
- Biopsy of thyroid
- Neck US
In this case anti-THSr has already been done. While anti-TPO can be positive in Graves disease they are also present in 90% of patient with Hashimoto’s thyroiditis therefore wouldn’t help to find a diagnosis.
Scintigraphy (tc-99) is therefore the best test to reach a diagnosis
Type 2 diabetes mellitus patient presents confused. Mildly hyponatraemic and hyperkalaemic, Glucose is 35mmol.
What is the next best step?
* 1L over 1 hour normal saline
* 500ml Plasmalyte over 15 mins – whats plamalyte
* Insulin stat
* Corticosteroid
1L over 1 hour normal saline
0.9% sodium chloride should be used
Insulin will also need to be given but that is always after fluids
* Use a rate of 0.05 units/kg/hour if blood ketones (beta-hydroxybutyrate) are ≤3.0 mmol/L and the patient is not acidotic
* Use a rate of 0.1 units/kg/hour if the patient is acidotic (pH < 7.3 and bicarbonate < 15 mmol/L) and blood ketones (beta-hydroxybutyrate) are >3.0 mmol/L
Stage 3 CKD hyponatraemia with fluid overload, pitting oedema, Urate high, BP 121.
What is the best action?
a) Furosemide
b) Refer to nephrology for dialysis
c) Fluid restrict
Fluid restrict
Hypovolaemic Hyponatreamia -> Fluid replacement
Euvolaemic hyponatraeima -> depends on diagnosis (Dont kniow what the treatment is for the below)
Psychogenic polydipsoa
SIADH
Glucocortioid deficiency
Chronic Hypothyroid
Hypervolaemic Hyponatraeia -> Fluid restrict and treat cause -> furosemide
Man with CKD stage 3 had a provoked DVT needing 3 months of treatment. Which of the following medication do you use?
a) Apixaban
b) Dalteparin sodium
c) Warfarin
d) Dabigatran
e) Fondaparinnux
Apixaban
DVT treatment -> DOAC unless the egfr < 30
If DOAC is not suitable then
LMWH -> dabigatran or edoxaban
OR LMWH -> Warfarin
The treatment should be for 3 months,…
If unprovoked for a further 3 months
48 year old with childhood TB, now has progressive shortness of breath with sputum. CT given. What is the diagnosis?
Bronchiectasis
The HRCT you can see the black holes and I think it shows the dilated bronchioles that happens because of recurrant infections and destruction of the elastin and the muscular components
Decrease in vision, painless (?), fluorescein stain showing hypolucent areas in periretinal area with hemorrhages, swollen optic disc and dilated retinal veins.
Which of the following is most likely?
a) retinal vein occlusion
b) age related macular degeneration
c) retinal detachment
d) vitreous haemorrhage
e) diabetic retinopathy
Retinal Vein occlusion
Presentation:
* Painless + blurred cission / OR VISION LOSS
Vein occlusion causes haemorrhages :
* Dilated torturous retinal vein
* Flame and blot haemorrhages
* Retinal Oedema
* cotton wool spots -> Hypolucent areas
* Hard exudates
Treatments : Anti-VEGF, dexamethasion and or laser coacgulations
*Age related macular degeneration *
Wet AMD is more acute than Dry
Presentation
* Gradual loss of entral vision
* Worsening Visual Acuity
* Worsening night time visions
* Straight lines become WAVVY
Ix Optical coherence tomography, slit lamp examination. fluorscein angiography (oedema + neovascularisation wet AMD)
Mx Anti VEGF is Wet AMD
Retinal Detachement
Presentaiton
* Peripheral vision loss that is sudden
* Flashing lights and Floaters
Needs immediate referrals
Management
* Vitrectomy,, scleral bucklin and penumatic retinoplexy
Vitreous Haemorrhage
Presentation
* Painless vision loss SEVERE often unilateral
* Red hue in vision
* Floated or shadows + Dark spots in vision
* Symptoms worse in the morning?
* Hx or RF (HTN, DM or SCD)
Mx : laser photcoagulation, Anti VEGF
Diabetic Retinopathy
Fundoscopy findings
- Background -> Microanurysm, retinal haemorrhages, hard exudates and cotton wool spots
- Pre-proliferative -> Venous bleeding, multiple blot haemorrhages and intracrainal microvasculae abnormality
- Proliferative -> neovasculariation and vitrous haemorrhage
Hypertensive retinopathy
Fundoscopy
* Silver wiring or copper wiring is where the walls of the arterioles become thickened and sclerosed and reflect more light on examination.
* Arteriovenous nipping (AV nipping) is where the arterioles cause compression of the veins where they cross due to sclerosis and hardening of the arterioles.
* Cotton wool spots are caused by ischaemia and infarction in the retina, causing damage to nerve fibres.
* Hard exudates
* Retinal haemorrhages > Dot and blot haemorrhages occur in the inner nuclear layer or outer plexiform layer. Flame haemorrhages occur in the nerve fiber layer.
* Papilloedema > optic nerve swelling (oedema).
Kieth Wagener classification:
SAVE
S Silver wiring
Av nipping
Viterous haemorrhage
E papilloEdema
Old lady had increasing blurry vision, specifically patches of text on newspaper were missing. Colours are also faded in one eye. What is the diagnosis?
a) AMD
b) cataracts
c) open angle glaucoma
d) presbyopia
Cataracts
Presentation:
* Slow reduction in Visual Acuity + Blurring
* Colours becoming faded, brown or yellow
* Starbursts can appear around lights
* Hx of steroid use
Loss of red reflex
Cataract surgery
*Age related macular degeneration *
Wet AMD is more acute than Dry
Presentation
* Gradual loss of entral vision
* Worsening Visual Acuity
* Worsening night time visions
* Straight lines become WAVVY
Ix Optical coherence tomography, slit lamp examination. fluorscein angiography (oedema + neovascularisation wet AMD)
Open angle Glaucoma
Presentation:
* Gradual Peripheral vision loss -> Tunnel vision
* Fluctuating pain
* Blurred vision
* Halos around lights at night
Ix : Non-contact tonometry; Slit lamp (cup to disk ratio); gonioscopy
Mx: >24 mmHg -> 360 selective laser trabeculoplasty; Latanoprost; Beta blockers; Dorzolamide; Brimonidine
Presobyopia
Presentation:
* Gradual onset blurred near vision
* Just associated with old age.
patient had deterioration in vision, right eye non-responsive to light but left consensual intact. Left responsive directly and right not to consensual. Right eye is abducted.
Where is the lesion?
a) Left optic
b) Left oculomotor
c) Optic chiasm
d) Right optic
e) Right oculomotor
Right Oculormotor
this patient has nno motor response in the right eye and this is a sign of oculormotor lesion.
If there was an optic nerve problem it would be an afferemnt
Patient had dementia and was post colon resection(?)
What is the best method for controlling pain? – nikhils gonna find out
a) PCA
b) IV morphine boluses
c) SC morphine infusion
d) IV Morphine infusion
e) Oxycodone
IV Subcut morphine infusion
IF POST SURGERY AND NO DEMENTIA then PCA…
EMAILED LECTURER?? -> Giulia follow up with regards to IV infusion or Subcut infusion
With regards to PCA we thought if it is after surgery then we use PCA but we found that dementia was a contraindication but we arent sure If this is always the case even if for example it was mild dementia.
you are spot on - if mild dementia of course a PCA could be used - equally with severe dementia it makes sense to avoid this - PCA’a are anaesthetist / pain team territory, not end of life / pallliative care - so if i was you i would ask this to someone from those specialties.
Young patient with displaced apex beat, systolic murmur related to exercise. Which investigation to diagnose? (HOCM test, Echo/TOE not given as options)
a) Cardiac MRI
b) CT angiography
c) Myocardial perfusion scan
Cardiac MRI
This will let us know about the structure of the heart aka the valves.
Lady fell at home trying to get the toilet in the night. Daughter visits every day to bring food, cook, clean and lives right around the corner. What is important to add post discharge?
a) Package of care
b) Commode
c) Pendant alarm
d) Mobile phone
Package of Care -> They assess the house and come up with a plan of changes to help with life. This includes adaptations at home to get in and out of the shower etc.
Renal colic, young man with loin pain that spread to the groin and was severe. What pain management do you give? (diclofenac not an option)
a) IV morphine
b) IV paracetamol
c) Oral naproxen
Oral Naproxen
For renal Colic NSAIDS via any route is first line before trying anything else.
IV paracetamol is given if NSAIDS are contraindicated
IV morphine only if the previous 2 is not effective
12 year old with Turner’s syndrome has increasing tiredness when playing netball. Examination finds a systolic murmur at interscapular area. No radio-femoral delay.
What is the most likely diagnosis?
* ASD
* Coarctation of the aorta
* Pulmonary stenosis
* Tetralogy of Fallot
* Ventricular Septal Defect
Coarctation of the Aorta
Turners syndrome is associated with CoA and Bicuspid Aortic valve… The intrascapular area and the murmur is suggestive of CoA
The Radiofemoral delay is not always present..
The answer has been confirmed by GIULIAS DADDY, aka Mr or Dr Iacona surgeon at some hospital somewhere
Alcoholic homeless man with BMI 18 and cachectic presents with nystagmus and known to have alcoholic exacerbations. Blood tests normal currently, given IV pabrinex, IV fluids, oral nutrition with build up drinks. What electrolyte abnormality is to be expected in the next 48 hours?
a) Hypophosphataemia
b) Hyperkalaemia
c) Hyperglycaemia
**Hypophosphataemia
We believe the implication from this stem is that the patient has not eated in a while and that we are worried about refeeding syndrome and as such the electrolyte to look out for is phosphate levels. This is because low phosphate can cause weakness of muscles -> Resp failure or cardiac failure (diapghram or heart muscles weakening)
However it also causes -> hypo - kal - mag and abnormal fluid babalance
NICE produced guidelines in 2006 on nutritional support. Refeeding syndrome may avoided by identifying patients at a high-risk of developing refeeding syndrome:
Patients are considered high-risk if one or more of the following:
* BMI < 16 kg/m2
* unintentional weight loss >15% over 3-6 months
* little nutritional intake > 10 days
* hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
If two or more of the following: (*THE PATIENT HAS TWO OF THE FOLLOWING*)
* BMI < 18.5 kg/m2
* unintentional weight loss > 10% over 3-6 months
* little nutritional intake > 5 days
* history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids
Small rounded deflections following T waves seen on an ECG. What is the electrolyte imbalance responsible for this phenomenon? (Description of U waves)
a) hypokalaemia
b) hyperkalaemia
c) hypercalcaemia
d) hypocalcemia
e) hyponatremia
Hypokalaemia
Features:
* Taller P waves
* Longer PR interval
* ST depression
* T wave inversion/flattening
* U waves
Hyperkalaemia
Features:
* Tall tented T waves
* P wave flattening and prolongation
* Broad bizarre QRS
Hypomagnesamia
Features:
* Prolonged PR
* Prolonged QT
* Atrial and ventricular ectopy
* Predisposition to ventricular tachycardia and torsades de pointes
Suspected Idiopathic Pulmonary Fibrosis. (What are the features of this?)
What is the best investigation?
a) HRCT
b) CT Thorax with contrast
c) Chest X-Ray
d) Spirometry
HRCT
This is should be done in all patients with IPF. It is required to make a diagnosis.
There will be a reduced TLCO.
Spirometry will show a restricive pattern and is suggestive of IPF but not the best investigation to diagnose it…
FEATURES OF IPF:
* Progressve exertional dyspnoea
* Bibasal fine end inspiratory crackles
* Dry cough
* Clubbing
Management:
* Pulmonary rehabilitation
* Pirfenidone (antifibrolytics may be used)
* supplementary O2 or ung transplant may be required.
Patient has ongoing Hypertension.
CT Urinary Tract shows one kidney measured to be 7cm whilst the other one is 11cm.
Which is the most likely?
a) Fibrodysplasia of renal artery
b) rapidly progressive essential hypertension
c) Phaeochromocytoma
d) Primary hyperaldosteronism
Fibrodysplasia of renal artery
So the stem would have to be of a young female with hypertension for this diagnosis I thing… 90% are female and this is a cause of RAS in young population.
basically this patient has Renal artery stenosis…
One of the features of RAS is the fact that there is a difference in the size of the kidneys, which is what we think this is elluding to
This can present with
* Flash pulmonary oedema
* CKD that rapidly progresses
* Episodic AKI
* Abdominal Bruit
Phaeochromocytoma
* episodic features
* Headache
* Sweating
* Palpiations
* Tremor
* Anxiety
Rapidly progressing essential HTN
* I am pretty sure this is what Doctors say when they have no clue whats causing this problems “no identified secondary cause.”
Primary Hyperaldosteronism
* Mostly asympptomatic
* Incidental finding of HTN in a young pt
* HYPOKALAEMIA features : muscle weakness, polyuria and polydipsia etc.
Lady had weight loss and kidney US showed a one-sided mass measuring 7.5cm in her left kidney.
What is the management?
a) Nephrectomy
b) Chemotherapy
c) Radiotherapy
d) Immunotherapy
Nephrectomy
Renal Cell Carcinoma:
Features are shown in the images below
Investigations
* Initial -> USS but does not confirm diagnosis.
* Definitive -> CT with contrast
Management:
* Generally speaking it is either partial nephrectomy or complete nephrectomy. (BMJ has < 4cm and passmed >7cm)
* If there was metastatic disease or they are elderly with loads of comorbidities -> a more palliative care approach is likely These patients get targeted therapies sounds like immunotherapy options
Referral for RCC:
* >45 + Haematuria ++++ with no infection OR treated infection
Lady >50yo with a hip fracture. Had menopause at 45. What is the best medication to prevent future fractures?
Alendronate
Osteoperosis management:
ALL patients -> Vit K and Ca, only not if doctor is convinced there is adequate intake
FIRST LINE -> Alendronate
SECOND LINE -> risedronate or etidronate
Man had bilateral tremor with no bradykinesia and small stepping gait. MI 10 years ago, vertigo 5 years ago, dementia(?) 3 years ago. On statin, clopidogrel, prochlorperazine. What is the diagnosis?
a) Lewy body with dementia
b) Parkinson’s
c) Drug induced tremor
d) Essential tremor
Lewy body dementia
PArkinosims + dementia -> Lewy body dementia
THERE IS NOT REALLY CLEAR INFORMATION TO ANSWER THIS QUESTION
Features LWD:
* progressive cognitive impairment
* in contrast to Alzheimer’s, early impairments in attention and executive function rather than just memory loss
* cognition may be fluctuating, in contrast to other forms of dementia
usually develops before parkinsonism
* parkinsonism
* visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)
Parkinson's THIS IS UNILATERAL features, hence why this is not parkinsons
Features:
* Tremor is asymmetrical
* Masked facies
ECG: widespread ST elevation and t wave inversion
a) Myocarditis
b) Myocardial infarction
c) Pulmonary embolism
d) Aortic dissection
Myocarditis
Myocarditis can have the changes that are described…
Clinically will present with Sharp chest pain worse on inspiration, breathlessness and palitation along with a flu like illness.
TREATMENT : supportive, if autoimmune then Steroids, if HF then standard treatment,
MI -> Central crushing Chest pain, The wide spread ECG could be suggestive of a SEVERE MI with triple vessel disease but that is hard to determine
PE will have a similar Hx to the myocarditis except ECG will show tachycardia and maybe also s1q3t1
Patient has itchy rash Was recently unwell and taken paracetamol 6 hours ago. What is the best management?
a) Oral cetirizine
b) Topical hydrocortisone
c) Acyclovir
Oral Cetirizine
This is Urticaria->
FIRST LINE : Non - sedating antihistamines (Loratadine + Cetirizine) -> for 6 weeks
SEDATING antihistamine -> for problems of symotoms at night time (Chlorphenamine)
PREDNISOLONE is for severe and persistent presentations
Type 1 diabetes mellitus lady with subclinical hypothyroid TSH 6.5. Anti thyroid peroxidase is normal.
What is the next step?
a) Reassure and check in 3 months
b) Measure anti-TSHr
c) US neck
d) Give levothyroxine 25mg
NEEDS CLARIFICATIONNNNN
Reassure and check in 3 months
We think this is subclinical hypothyroidism.
In the case of the above diagnosis there is a need for 2 blood tests before treatment is started.
What is subclinical hypothyroidism?
This is when there is a raised TSH but the T3/T4 levels are normal.
IF TSH > 10 -> 2 tests 3 months apart
IF TSH < 10 + < 65 + symptoms + 2 tests 3 months aparts shows raised TSH -> levothyroxine trial
IF TSH < 10 + > 65 -> Watch and wait
If TSH < 10 + No symptoms -> repeat thyroid function in 6 months.
If there is an option for check in 6 months I would do that
Waterlow’s score done on patient. Where is the most likely place to get a Pressure ulcer?
a) Heel
b) Sacrum
c) Elbow
d) Medial aspect of lower leg
e) Under the breast
Sacrum
We just searched it up, and thats what came up…
If it isnt saccrum its heel.
Triad of fever, jaundice, pain. US scan shows stone in common bile duct present and dilatation. What is the next best step?
a) MRCP
b) ERCP
c) Laparoscopy cholecystectomy
d) HIDA scan
ERCP
Triad represents the charcot triad for ascending cholangitis, the US confirms this with a stone in the common bile duct. The best management option or next step is the removal of the stone and imaging and that is throught the ERCP.
Elderly woman seeing small children and animals playing in home, they don’t interact with her. Happens mostly in the evenings when at home. Denies other hallucinations or psychosis. No changes to memory and normal AMTS. Registered as partially sighted officially.
a) Charles De Bonnet syndrome
b) Lewy-body dementia
c) Alzheimer’s
d) Parkinson’s plus syndrome
Charles de bonnet syndrome
This is the association with long term vision impairment and visual hallucinations.
Stroke lady has been treated medically but struggling with ADLS. What scoring tool is commonly used to assess if she needs help?
a) Barthel
b) Rockwood
c) MUST
d) Barlow
e) Waterlow
f) PRIMSA-7 (added by me)
Barthel
This scoring system is used to measure the extent to which somebody can function independently and has mobility in their activities of daily living.
Rockwood score This is to summarise the overall fitness or frailty of patients that are elderly. Apparently this is used to assess frailty in dementia..,
IF YOU KNOW WHAT THE INDICATIONS OF ANY OF THESE ARE CAN YOU LET ME KNOW
MUST
Malnutrition universal screening tool, This is a way to identify patients who are at risk of malnourishment or obesity
Barlow
Hip stability???? No clue
Waterlow
This is used to assess the risk of a patient developing a pressure ulcer.
PRIMSA-7
This is a general frailty score
12 year old child with acute severe asthma exacerbations requiring hospitalisation. Up to date with vaccines. What additional vaccine to give?
* Influenza vaccine
* Pneumococcal conjugate vaccine
* Haemophilus influenzae type B
* BCG
Pneumococcal Conjugate vaccine
Apparently kids get the flu vaccine anyway and so the PCV is the additional vaccine that is needed.
Pulsatile mass felt in abdomen of middle aged man, otherwise asymptomatic. What is the next best investigation?
a) US Abdomen
b) CT Abdomen
c) CT Angiography
d) XR Abdomen
US abdomen
House fire patient with increasing tidal O2 volumes needed.
ABG results given with O2 < 8 and CO2 7.something.
What is the pathological mechanism?
- Reduced surfactant
- Altered alveolar capillary permeability (ARDS)
- Bronchospasm causing reduced perfusion
- Rapid onset pulmonary fibrosis
Altered alveolar capillary permeability
Apparently this is bronchospasm
So alveolar capillary permeability is how leaky the capillaries are in the alveoli. In cacses of ARDS this is often altered or increased leading to an accumulation of fluids in the alveoli.
ARDS is when this the above happens and is known as non-cardiogenic pulmonary oedema…
Causes include:
* Infections
* Blood transfusion
* Trauma
* Smoke inhalations such as in this case
* Acute pacreatitis
* Covid 19
* Cardio pulmonary bypass.
INVESTIGATIONS:
A pulmonary wedge pressure may be needed to ensure the causes is not cardiogenic.
Hepatitis A patient in hospital is put into a side-room.
What additional action must be taken in addition to routine side-room safety measures?
a) Separate bathroom facilities
b) Long aprons for visitors
c) FFP3
d) Surgical mask
Separate bathroom facilities
35 year old lady experiencing focal seizures. Taking the CoCP. Has a history of anxiety and panic attacks. What is best to prescribe?
a) Lamotrigine
b) Levetiracetam
c) Valproate
d) Carbamazepine
What is the management of generalised seizures?
WHAT IS THE MANAGEMENT OF ABSCENCE SEIZURES?
What is the management of? Myoclonic seizures
What is the management of Tonic or atonic seizures?
Levetiracetam
The reason it isnt lamotrigine is because lamotrigine interacts with the COCP…
Epilepsy management?
Generalised
* Male -> sodium Valproate
* Female -> Lamotrigine or levietiracetam
Focal
* Lamotrigine or levetiracetam
* Carbamzepine, oxcarbazepine or zonisamide
Abscence -> LOC with posture maintained.
* 1st - Ethosuxemide
* 2nd - Male - Sodium valproate
* 2nd - Female - Lamotrigine or levetiracetam
* CARBAMAZEPINE WILL MAKE THESE SEIZURES WORSE
Myoclonic
* Male - Sodium Valproate
* Female - Levetiracetam
Tonic or clonic seizures
* Male - Sodium Valproate
* Female - Lamotrigine
Patient with seizures and hypertension. On amlodipine, indapamide, sodium valproate, levetiracetam and now adding half the usual dose of lamotrigine due to drug-drug interaction.
Which drug interacts with lamotrigine to necessitate this?
a) Sodium valproate
b) Amlodipine
c) Indapamide
d) Levetiracetam
Sodium Valproate
Patient had cancer and now has metastases causing spinal cord compression. What is the initial management
a) Dexamethasone
b) Radiotherapy
c) Surgery
high dose dexamethasone
Then radiotherapy
Patient with testicular cancer had orchidectomy. CT showed enlarged para-aortic lymph nodes. What will the MDT likely advise?
a) Chemotherapy
b) Lymph node resection
c) Radiotherapy
d) Immunotherapy
Chemotherapy
Bas all the options in the BMJ had chemotherapy as an option.
If there is a suspected malignant testicular mass a radical orchidectomy is done.
BIOPSY is not done but US imaging will be done as well as tumour markers
A 39 year old female presented with diarrhoea and a Right Iliac Fossa mass which was presumed to be an appendiceal mass. She is sent for surgery. A specimen is sent to pathology and when opened showed a 1.7cm yellow mass.
What is the most likely cause of the mass?
a) Carcinoid
b) Abscess
c) Faecolith
d) Lipoma
Carcinoid
There is a mass and there is diarrhoea.
Often presents with diarrhoea, flushing and palpitations
Abscess would be a more unwell patient.
Lipoma wont really cause these symptoms
Faecolith will cause overflow diarrhoea, but I dont think is yellow in colour as it is just essentially compacted stool.
Patient with vomiting and abdominal pain. Patient took paracetamol and codeine phosphate 2 hours ago. Probable appendicitis diagnosed. Surgical review will be in an hour, pain currently 8/10.
What is the most appropriate pain management?
a) IV morphine
b) IV paracetamol
c) Oral tramadol
d) Rectal diclofenac
e) Do nothing, until reviewed by the surgical team
IV morphine
So there is still pain and it needs to be managed, Step 1 and 2 of the pain ladder have been done.
There needs to be excalation to the third step and that is the addition of the IV morphine.
NEEDS TO BE NON ORAL as they are NBM.
An old lady is seen with her husband in GP with weight loss, stopped playing organ at local church, increasing forgetfulness. MMSE score 21/30.
What is the most likely diagnosis?
– need the whole stem (Probs)
a) Depression
b) Alzheimer’s Dementia
c) Parkinsons
d) Folate deficiency
Depression
Could be Alzheimers because of the low MMSE but depends on the onset of symptoms…
I think the precesnce of the Wt loss is a biologic signs that points me more towards depression…
Patient is complaining of suprapubic pain. They are currently in hospital for a pneumonia (admitted 4 days ago) treated with amoxicillin. He has been making good improvement till now. A catheter was inserted on admission. Obs normal, bloods normal.
Urine blood+ protein+ and sample from the catheter grew E.Coli.
What is the best course of action to take?
a) Remove with gent cover
b) Remove catheter
c) Add ciprofloxacin
d) Do nothing
Remove with Gent cover
This person has symptomatic UTI, CYstitis with suprapubic pain + a +ve culture this there fore needs to be treated. Additionally the Catheter would need to be changed.
Confirmation asked my sister and her husband…
Patient had some painless rectal bleeding and had a proctoscope showing internal haemorrhoids only.
How do you manage?
Explain How this will change with the different grades and explain the different grades.
a) Fibre supplementation
b) Rubber band ligation
c) Sclerotherapy
Fibre supplementation
Parkinsons patient on carbidopa (the lowest dose possible) behaving aggressively, given Lorazepam but did not work. She is abusing the staff, which is causing some concern. What is the next step?
a) Entacapone
b) Quetiapine
c) Risperidone
d) Haloperidol
Quetiapine
So if this is an acute confusional state and lorazepam was not successful then the next option that can be used is quetiapine. Eventhough it is an antipsychotic and most are contraindicated in Parkinsons disease
However if this seems to be describing more a patient, whose parkinsons medication is wearing off then it might be worth thinking about entacapone as apparently this medication is used as it stops the “wearing off affects” of the Levodopa
Young adult in car crash, GCS on scene 8 and intubated (?). GCS at 60 minutes was 12. Had memory loss of 18 hours after event. Has basal skull fracture on imaging. What is the best prognostic indicator of cognitive function?
a) GCS on scene
b) GCS at 60 minutes
c) Basal skull fracture
d) CT head
e) Length of time of amnesia
Length of time of amnesia
Bascially, there is a scoring system that looks at the cognitive function post a head injury and that scoring system is called GOAT (Galveston Orientation and Amnesia Test ). This as well as Westmead post traumatic amnesia scale are both scales that use post traumatic amnesia to try and predict the cognitive/outcome of patients….
Old patient with hip pain. X-rays showed mild degenerative changes but patient complains of severe hip pain and won’t let anyone touch it.
What is the next best step?
A) CT Hips and pelvis
b) Refer to old age psychiatry
c) Do nothing
d) Encourage to mobilise
e) Repeat x-ray of hips and pelvis
CT hip and pelvis
Again this is something where we collectively thought this was the answer. There seems to be a high clinical suspicoin something is not right and the way to ivestigate it would be to do a CT hip and pelvis
NVM I am a genius found it
Aortic stenosis with right ventricular hypertrophy.
Which of these would you be most worried about?
Exertional chest pain
Exertional Syncope
Dyspnea
Right ventricular hypertrophy
Low volume pulse
Dyspnoea
We found this in one of the MaM flashcards.
Question had a stem with lots of filler then report of CXR showing bilateral diffuse alveolar space disease.
What is the diagnosis?
a) ARDS
b) heart failure
c) pneumonia
This is bascially pulmonary oedema
Diffuse alveolar infiltration
If it is ARDS then there needs to be mention of a trigger in the stem and if it is heart failure then that would be the other cause.
Which marker first rises in acute myocardial infarction?
a) Myoglobin
b) CK-MB
c) Troponin
d) AST
e) LDH
Myoglobin
Patient with hepatic hypoperfusion in lactic acidosis needs maintenance fluids. Which fluid is most important to avoid giving to prevent worsening of the acidosis?
* Hartmann’s solution
* Normal saline
* 5% dextrose
* Plasmalyte
Hartmann’s solution
This should not be used in Lactic acidosis. This is because it can make it worse…
It has lactate and so makes it worse…
Patient had difficulty breathing O2 sat 90%, BP fine, temp fine, and had an ABG done showing PO2 9.2 CO2 N pH normal, HCO3- ?N, Na+ 131, K+ of 7.2. Put on high flow oxygen.
What is the best next step?
- ECG
- Repeat ABG on oxygen
- IV fluid bolus
ECG
This patient has Hyperkalaemia, and patients with a high K+ should have an ECG and a repeat blood test for K+ ions.
Patient with severe learning disabilities, lacks capacity. Had a fall, carers think
he has fractured his ribs and he is tender on 3rd and 4th anterior ribs, but
they are worried if he goes into hospital he will become very agitated. They
ask the GP if he needs to have an X-Ray.
What should the GP do?
1. Apply for DOLS for a CXR
2. Send him in for a CXR anyway
3. Prescribe analgesia
4. Send to ED
5. Prescribe 2 weeks bed rest
Needs to be seen in ED (Screen for other injuries CONFIRMED WITH ORTHO REG)
Rib fractures are only really X-rayed if there is suspicion of complications that is associated with it.
Only indication otherwise would be if they are haemodynamically unstable or is there is a worry of abuse…
Diabetic ulcer in 66 y/o lady noticed by her husband when he was cutting her toenails. It is superficial 1.5?cm with 1-2 cm of erythema around the ulcer. Patient is well, haemodynamically stable, all observations are normal. Has loss of sensation bilaterally in the feet and it is not tender and she is not in pain. CXR shows no signs of osteomyelitis. Swab and culture sent.
What do you do next?
* Prescribe empirical oral antibiotics
* Await culture then prescribe antibiotics
* IV antibiotics
* MRI scan
Prescribe emperical oral Abx
In the case of diabetic ulcers abx are given if there are signs of infections
The following is the treatment of a diabetic foot ulcer:
* Offloading, in which a plaster cast is used to take pressure off the ulcer and help with healing
* treating any foot infection with antibiotics
* Making sure the foot has a good blood supply
* Clearing away the dead, damaged and infected skin from the ulcer (the medical name for this is debridement)
* Using dressings while the ulcer heals.
Patient has discomfort around neck and chest with crackling. CXR shown.
What is the most likely cause of their neck discomfort?
* Subcutaneous emphysema
* Emphysema
* Pneumothorax
* Pneumonia
Subcutaneous Emphysema
Look at the right side of the chest the weird translucency and opacifications on the right shoulder is suggestive of air there and this is likely to be air under the skin aka subcutaneous emphysema.
Patient presents to GP with deep puncture wound following cat bite. He had a tetanus booster 2 years ago. Wound has been thoroughly washed. Patient is well.
What is the most appropriate action?
* Prescribe Co-Amoxiclav
* Send to A&E
* Dressing
Prescribe Co-amoxiclav
Honestly this is a dumb question… but essentially deep cat bites need to be treated with Co-amoxiclav
Otherwise the question is refering to test the tetanus prophylaxis in which case this wound just needs a dressing…
BELOW is the management of Tetanus wounds
So this is split based on the vaccination status of the patient.
If you are** unsure about their vaccination history (ASSUME NO VACCINATION)** then there is a need to give the patient IG and also give them a reinforcing or intial dose of Tetanus vaccinations, if this a tetanus prone wound or high risk wound. If it is a clean wound then there is a need only for the vaccine.
If the patient** was vaccinated more than 10 years ago **a clean wound does not require treatment but a an at risk wound would require a tetanus vaccine with a high risk wound requirinig both IG and a tetnus vaccine.
If they have been vaccinated within 10 years then there is no need to do anything…
- Patient with increasing thickness of the palm of their had over the last 9 months(did not say this->stenosing tenosynovitis) (did not say this ->Flexion deformity) On examination - unable to extend finger fully and interfering with their daily activities.
What is the most appropriate management option for this patient? - Finger splint
- Steroid injection
- Physiotherapy
- Reassurance
- Needle fasciotomy
Needle Fasciotomy
IF this is Dupuytren’s contracture then the management is Needle Fasciotomy
Stenosing tenosynovitis (trigger finger) -> steroid injection -> finger splint -> surgery
IF injury then fixesd deformity then it is a finger splint.
.
.
To differentiate between the 2 diagnosis consider the description… Dupetryn contracture is when there is a thickening of the skin on the hand and leads to soft tissue contracture, whereas in stenosing tenosynovitis there is inflammation that leads to trapping of the flexor tendon.
Stenosing tenosynovitis -> Will present with pain at the base of the affected finger… There will be stiffness of clicking when moving the finger… worse in the morning
Dupuytren's contracture -> Will often start with nodules and cords as the soft tissue hardens -> This will then progress to reduced functionallity as the affected finger becomes more flexed…
Incontinent, confused 74 y/o gentleman.
What is the next action?
- Lumbar puncture
- Refer to neurosurgery
Lumbar puncture
The diagnosis is normal pressure Hydrocephalus. These patients presents with ataxia, diuresis and dementia/bradyphrenia
The gold standard treatment is neurosurgery with a ventricular peritoneal shunt.
However this is only done after LP as there needs to be evidence that the surgery will actually help manage this patient
COULD ASK NEURO CONSULTANT AS THIS COULD BE A CASE LIKE THE STROKE THING WHERE IF LESS THAN 4.5 hrs there is a pathway for them
Palliative care patient on end of life pathway. Due to die within the next couple days. Was previously on oral phenytoin (pretty certain it was levetiracetam) for prophylaxis of seizures. Now unable to take oral medication.
What do you give them?
- IV phenytoin infusion
- IV phenytoin boluses
- Midazolam
- PR diazepam as required
- IV levetiracetam
Midazolam
There are many potential causes of seizures in advanced disease (such as brain tumours or biochemical abnormalities) and specialist advice should be sought where the diagnosis of seizures, or choice or dose of antiepileptic drug is in doubt. Antiepileptic drugs should not be used prophylactically in the absence of a history of seizures. In palliative care, levetiracetam is generally preferred as a first-line option as the dose can be titrated rapidly and there are fewer drug interactions. In the last days of life, midazolam may be preferred due to benefit in concurrent symptoms and compatibility with other drugs in a CSCI.
Patient with back pain, has been trying paracetamol and NSAIDs.
What should be prescribed next?
* Co-Codamol
* Morphine
* Tramadol
Co-codamol
The next step in the pain ladder is Co-codamol or tramadol. However there is no real way to pick between the 2.
HOWEVER in this particular case with regards to back pain an SNRI should not be used in the management of pain and the tramadol is both a weak opioid and a SNRI. This makes it the wrong drug to use.
The screenshot does generally say to avoid opioids but in this case it is the only remaining choice
Patient with diarrhoea. Background of Non-Hodgkin’s lymphoma which has recently gone into remittance. Low blood pressure, high HR, normal temperature. IV fluids are given and blood cultures are sent.
What is the next step?
* Administer broad spectrum IV antibiotics
* Wait for cultures to come back before giving antibiotics
* Check the ABG results
* Catheterise
Administer broad spectrum antibiotics
With regards to the lack of temperature, the screenshot below shows that it cant be used to rule out sepsis in certain pt groups, and with the next step I think you would assume it is sepsis and it is more important to give Abx than it is to place a catheter.
CONTROVERSY between above and cathertise
Reasoning for abx is because of sepsis becasuse of potentially neurtopenic sepsis if he is having chemo. This will need abx…
Cathertise -> this is part of the sepsis 6 and so needs to be done anyway and if the condition is not sepsis but dehydration then there is a need to monitor fluid balance and so the patient needs to be cathertised anyway.
44y/o breast lump found 8 weeks ago and painless. No weight loss and no breast changes. It is mobile and not tethered (1cm) at breast clinic. US and mammography showed dense breast tissue only.
What is the best management? - Nikhil double checking
* Fine needle aspiration
* Excision biopsy
* Discharge
* Review in 3 months
* Review after her period
Fine needle aspiration
NOTE that not all patients do need all 3 of the triple assessment.
Now with what we are expected to know for this exam I dunno how this exam would work if there are any worrying signs for example an irregular lump…
This question becomes more problematic if the lump was regular mobile and then an image found just regular breast tissue, cause then it is a guess between them.
The screenshot is from a consultant, honsetly no clue…
Patient had sudden onset vision changes with a mid-dilated pupil on examination. She was given timolol and pilocarpine drops already but symptoms haven’t improved.
What do you prescribe next?
Acetazolamide
the mid dilated pupils and the sudden onset visions changes we think is suggestive of an acute close angle glaucoma.
This however would present with pain, which is not mentioned in the stem.
They may have a red eye, halos around lights
Investigation for this inc:
* Tanometry
* gonioscopy
MAnagment:
* Topical beta blockers, alpha agonist and prostaglandin analogues (latanoprost) may be used
* NEXT step is topical carbonic anhydrase -> Acetazolamide or dorzolamide
* Systemic hyperospmotic agents (IV mannitol)
SURGERY
* DEFINITIVE MANAGEMENT -> Laser peripheral iridotomy
IF MORE OF AN ACUTE SCENARIO LOOK AT THE IMAGE,
Metastatic cancer, bone pain. Decreased anal tone on DRE and incontinent of urine ad faeces ad saddle anaesthesia (said this directly). Lack of achilles reflex and hyperreflexive knee reflexes. Clinical imaging is indeterminate as there is widespread bone destruction.
What nerve roots are most likely compressed?
* L4-S1
* T12-L2
* C5-C7
L4-S1
Muscle and nerver roots
* Hip flexion L2
* Hip Extentsion L5
* Knee extension L34
* Knee flexion S1
* Ankle dorsiflexion L4
* Ankle plantarflexion S1
* Great toe flexor L5
Reflexes
* Knee jerk -> L3+4
* Achilies reflex -> S1
* Babinski reflex -> L5 + S1
Dermatome
The booty is ze S1
Lady had diabetes and a swollen ankle for 2 weeks, it was not tender or red and no ulcers present but obviously swollen.
What is the best management option?
Aircast
Antibiotics
Aircast
If there is no signs of infection there is no need for abx.
The aircast other than being the only other option left we think is used in diabetic foot as a way to ease pressure in high pressure areas as a way to reduce the chance of an ulcer
Patient with lower back pain for 5 days. Comes back to GP asking for additional sick note as can’t work as roofer due to pain. What do you do?
Decline as best evidence suggests mobility is best
BELOW IS FROM THE NHS WEBSITE:
If you need a fit note, contact the healthcare professional treating you. This should be a doctor, nurse, occupational therapist, pharmacist or physiotherapist.
Your healthcare professional will assess you, and if they decide your health affects your fitness for work, they can issue a fit note and advise either that:
you are “not fit for work”
you “may be fit for work taking into account the following advice”
Your healthcare professional will choose the “may be fit for work” option if they think that you are able to do some work, even if it is not your usual job, with support from your employer.
28 year old lady had a breast lump, it was ?tethered on examination.
What is your next step? - Nikhil is asking
* Non-urgent referral
* Urgent referral
* Review after period
Urgent referral
This patient has features of cancer so should be referred urgently…
Now there is something where breast lump below the age of 30 can have a non urgent refferral and hopfully that question doesnt come up cause the consultant again has said bas everything should be referred urgently… I would say if they are less than 30 and had features of a fibroadenoma then I would do a non-urgent referral.
Patient on warfarin had GCS 12/15 and imaging showed an intracerebral haematoma. She had an INR of 3.3 and platelets etc all fine. She was given IV vitamin K.
What is the next step in management?
* Repeat vit k in 12 hours
* Give IV PCC
IV PCC
Intracranial bleed is major bleeding and this requires a PCC.
RTC and patient was bleeding with ?pelvic fracture with low BP despite 2 units of blood given.
What is the next step in management?
* Tranexamic acid
* FPP
* Cryoprecipitate
Tranexamix acid
Elderly gentleman had hoarse voice for 2 months. Smoker of many many years. What is the most appropriate management?
* Refer to ENT surgeon
* CXR
* Other imaging
Refer to ENT surgeon
I think this is a chronic presentation of a hoarse voice and needs to be referred with a 2 week wait…
RE: Voice hoarseness
Do you mean in the context of a fishbone or just separately?
In the context of a fishbone, at a stretch it might be that the fishbone is lying directly over the vocal cords, which I think is very unlikely to be honest - but you would proceed with investigations/ management as above. You would have to be very careful as it would be at higher risk of slipping into the airway.
In the context of a patient presenting with voice hoarseness, this depends again on whether its an acute or chronic presentation.
Acute hoarse voice could be laryngitis (what we would say is a sore throat - likely secondary to viral infection), but if accompanied by other more worrying signs it could be due to supraglottitis or deep neck space abscess. Laryngitis would not need any investigation and can be discharged. For both supraglottitis and deep neck space abscess you would need to start airway compromise management, and for suspected abscess get a CT neck with contrast if patient is stable enough.
In chronic presentation
What you are looking for is if they have a ‘persistent unexplained hoarse voice’ in age >45yrs - then they need to be referred on 2 week wait pathway to head & neck team (as per nice guidelines).
Persistent generally means >3 weeks. In exam questions look out for those head and neck cancer risk factors like smoking that would make you more suspicious.
In head and neck clinic they would first get flexible nasoendoscopy, and depending on both the history and what they saw, next would be CT neck with contrast. MRI neck would usually be after CT neck if they want to characterise further. The BMJ best practice page is quite useful for stuff on laryngeal cancer.
Patient had chest pain, dizziness and palpitations. Hr 26, BP 77/45. ECG given showing 3rd degree heart block (no association between p and qrs almost certain it was this) What is next best step in management?
* Iv adenosine
* IV amiodarone
* IV atropine
* DC cardioversion
IV atropine
Patient with multiple brain metastases but no seizures at all so far.
What is the best option with regards to her driving?
If she gets treatment with radiotherapy she can drive
No action need
If she remains seizure free she can drive
Patient needs to tell and she can’t
You need to tell DVLA she can’t
Patient needs to tell DVLA that she cant drive
What are the cases when the doctors have a responsibilty to tell the DVLA???
Patient had COPD and bringing up white sputum recently. Was undergoing elective hysterectomy.
What is the most important preoperative investigation?
* Spirometry
* Echocardiography
* CXR
SPirometry
Major controversy
Basically if there is an option for ECG go for that…
If not
If there is severe COPD then there is a need to do spirometry
If there are signs of Heart failure then an Echo is needed
A chest x-ray is not indicated….
If i am not sure between there being severe COPD or HF signs I will probably go for spirometry if ECG is not an option
Patient with osteoarthritis pain ?what is the first management ?
* Naproxen
* Paracetamol
* Codeine
Naproxen
NSAIDS -> Pracetamol
Pregnant lady 12 weeks with chlamydia positive on her test.
What is the management?
- Oral doxycycline
- Oral ofloxacin
- Oral azithromycin
- Oral amoxicillin
Oral azithromycin
This patient has Chlamydia
There is a need to treat this…. Doxycycline is contraindicated in pregnanacy and so Oral azithromycin is used
Low velocity Road Traffic accident like a week ago. Patient had neck injury but was discharged and managed with paracetamol and NSAIDS. She has no focal neurology but is painful on the trapezius. What is the best step?
* Physiotherapy
* Switch to regular co-codamol
* Refer to ortho
* Add tramadol
Physiotherapy
The sore trapezius is a common feature of whiplash.
I think this depends if pain is controlled or not…. If not step up pain meds if not then physio?
Painless ulcer a few weeks ago and now has maculopapular (?) rash on body including palms and soles.
What is the likely diagnosis?
Syphylis
Investigations
Refer to GUM
they will -> Dark field microscopy and serology
Treatment:
* Benzathine penacillin
* Doxy
* Erythromycin if PREGNANT
Lady had increasing flushing of the face with telangiectasia and small red dots/bumps (didn’t say papule/pustule) She also had dry gritty eyes.
What is most appropriate management? –
Refer to dermatology
Refer to ophthalmology
Oral doxycycline
Metronidazole gel
Metronidazole gel
` rosacea` -> only refer if optimal care in GP has failed / red nose
Patient diagnosed with small cell lung cancer imaging showed 4cm apical mass with PET showing mediastinal nodes positive.
What is the initial management?
* Chemo
* Radiotherapy
* Radio ablation
* Surgery
*
Chemotherapy
Small Cell lung cancer is basically always treated with Chemotherpy
