22/04 corrections

Question 1

Wolf Parkinson-white syndrome

Answer 1

• Young people
• Syncope , palpitations
• Can get ventricular fibrillation
• Shirt PR interval, wide QRS complex

Question 2

COPD patient, male, SoB, pO2 80%, bilateral reduced air entry and course crackles

next step

Answer 2

do ABG first then CXR

Question 3

Raised urea plasma levels

Answer 3

gastric ulcer not colon cancer

Question 4

Tampons can cause

Answer 4

staphylococcus aureus= endotoxic shock and not fluid depletion

Question 5

Raised amylase

Answer 5

acute pancreatitis

Can lead to shock due to fluid depletion

Question 6

Ectopic pregnancy

Answer 6

lower abdominal pain and scant, dark brown discharge= haemorrhagic shock

Question 7

67 yo man, used to work as stonemason, restrictive pulmonary function tests, smokes

Answer 7

occupational interstitial lung disease not COPD

Question 8

Digoxin toxicity

Answer 8

can cause visual disturbances, digoxin not treatment for VF

Question 9

VHL gene

Answer 9

renal carcinoma, pancreatic neuroendocrine tumour and retinal hemangioblastoma

Question 10

Side effects of immunosuppressive drugs

Answer 10

nephrotoxicity/ kidney toxicity

Question 11

Gangrenous necrosis

Answer 11

green/black tissue

Question 12

Spironolactone

Answer 12

reduces mortality in HF not statins

Question 13

CF patient with cholestasis

Answer 13

due to defective CFTR protein on bile duct epithelial cells

Question 14

Occupational asthma

Answer 14

work somewhere else first line

Question 15

Hypertrophic obstructive cardiomyopathy

Answer 15

reduced L ventricular cavity size not mitral stenosis

Question 16

perianal abscess, bloody diarrhoea.

Answer 16

Crohns

Question 17

Appendicitis pathophysiology

Answer 17

lymphoid hyperplasia or a faecolith → obstruction of appendiceal lumen, 10yo

Question 18

3-14 days post-MI histology

Answer 18

macrophages + granulation tissue at margins. High risk of free wall rupture, papillary muscle rupture and LV pseudoaneurysm

Question 19

Haemosiderin deposition leads to

Answer 19

the hyperpigmentation like brown discolouration seen in patients with varicose eczema/venous ulcers

Question 20

Troponin C binds

Answer 20

calcium ions

Question 21

Asthma hypersensitivity

Answer 21

type 1

Question 22

most common cause of acute liver failure

Answer 22

paracetamol overdose

Question 23

Familial adenomatous polyposis is due to

Answer 23

mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), colorectal cancer

Question 24

Clostridium difficile infection treatment

Answer 24

Oral vancomycin is the first

Question 25

Posterior tibial pulse

Answer 25

behind and below the medial ankle

Question 26

coryzal symptoms and increased work of breathing causing feeding difficulty in a child <1 year.

Answer 26

Respiratory syncytial virus is the most common cause of bronchiolitis

Question 27

Coeliac disease causes

Answer 27

malabsorption due to villous atrophy

iron, folate and vitamin B12 deficiency

Question 28

2 weeks to several months post-MI histology

Answer 28

contracted scar complete. Associated with Dressler syndrome, HF, arrhythmias, mural thrombus

Question 29

decrease in blood pressure will be sensed by

Answer 29

juxtaglomerular cells in the kidney. This will cause renin secretion.

Question 30

Greater omentum is connected with

Answer 30

lesser sac and the transverse colon

Question 31

chest drain insertion complications

Answer 31

Long thoracic nerve is susceptible to damage during chest drain insertion which can cause winging of the scapula

Question 32

Hereditary haemochromatosis

Answer 32

autosomal recessive inherited disorder of iron metabolism. The presentation can be very non-specific in the early stages (e.g. lethargy and arthralgia). Later the classic features of chronic liver disease and bronze diabetes (iron deposition in the pancreas leading to diabetes, and deposition in the skin resulting in a bronze or grey pigmentation) may become apparent.

In this case, the arthralgia, deranged ALT and very high ferritin are highly suggestive of haemochromatosis.

Question 33

musculi pectinati

Answer 33

found in the atria, hence the reason that the atrial walls in the right atrium are irregular anteriorly.
The musculi pectinati of the atria are internal muscular ridges on the anterolateral surface of the chambers and they are only present in the area derived from the embryological true atrium.