26/04

Question 1

Clarithromycin SE

Answer 1

dyspepsia

Question 2

supraventricular tachycardia +Wolff-Parkinson-White syndrome ecg sign

Answer 2

Delta wave and short PR interval

The delta wave means heart conducts earlier than usual just before the QRS complex, which together with the short PR interval are characteristic of Wolff-Parkinson-White syndrome. It can sometimes establish a re-entrant circuit resulting in supraventricular tachycardia due to an accessory conducting bundle.

Question 3

Radiotherapy for breast cancer increased risk for ?

Answer 3

lung cancer

Question 4

beta blocker/ bisoprolo overdose treatment

Answer 4

glucagon

Question 5

treatment for group A strep sore throat in patients with penicillin allergy.

Answer 5

Erythromycin 500mg

Question 6

abdominal pain and bloating ongoing for over 6 months. This is associated with intermittent loose and smelly stools with no blood or mucus. She has a past medical history of B12 deficiency and her mum is on levothyroxine for thyroid disease.

On examination she is pale, her abdomen is generally tender but soft with no guarding. Digital Rectal Examination is normal.

Answer 6

coeliac disease

Question 7

faecal calprotectin tested for

Answer 7

IBD

Question 8

which drug can cause peripheral oedema?

Answer 8

amlodipine

P O

Question 9

tension pneumothorax signs

Answer 9

Tracheal deviation to the left because build-up of pressure in lung, reduced chest expansion, hyperresonant percussion on the right, decreased vocal resonance on the right

Question 10

tumour marker for cholangiocarcinoma

Answer 10

CA 19-9

Question 11

mode of action of imatinib

Answer 11

Inhibition of tyrosine kinase

Question 12

vitamin B3 (niacin) deficiency symptoms

Answer 12

Dementia, Dermatitis/skin irritation and Diarrhoea.

3D

Question 13

Pneumocystis jirovecii is best stained by

Answer 13

silver stain

Question 14

Bullous pemphigoid

Answer 14

rare skin condition that causes large, fluid-filled blisters.

Question 15

electrical alternans

Answer 15

change in QRS

Question 16

Lyme disease

Answer 16

infectious disease caused by the bacterium Borrelia burgdorferi

Question 17

hysterectomy

Answer 17

removed womb

Question 18

polydipsia

Answer 18

excessive or abnormal thirst, accompanied by intake of excessive quantities of water or fluid

dips like water

Question 19

Polycythaemia rubra vera (PRV)

Answer 19

which means the bone marrow makes too many blood cells.

Question 20

afebrile

Answer 20

not feverish

Question 21

low O2 sats , which test ?

Answer 21

ABG

Question 22

consolidation on R heart border for CAPn

which lobe affected

Answer 22

middle R

Question 23

does 65 yo count as a point in CURB 65?

what does score of 2 mean

Answer 23

yes

hospital

Question 24

CURB 65 mortality risk

Answer 24

0 – 0.7%

1 – 3.2%

2 - 13%

3 - 17%

4 - 41.5%

5 - 57%

Question 25

Systemic inflammatory response syndrome (SIRS)/ sepsis

Answer 25

≥ 2 of:

> 38°C or < 36°C
Heart rate > 90
Respiratory rate > 20
WBC > 12,000/mm³ or < 4,000/mm³

Question 26

target O2 levels for COPD patient

Answer 26

88-92%

Question 27

indications for long-term oxygen therapy.

Answer 27

PaO2 score of between 7.3 and 8 with the presence of peripheral oedema

Question 28

smoke inhalation damages the lungs to cause emphysema

Answer 28

Smoke inactivates alpha-1 antitrypsin in the lungs, which leads to increased action of elastases and breakdown of elastic tissue.
Smoke activates polymorphonuclear leucocytes to cause emphysema.

Question 29

smoke inhalation damages the lungs to cause chronic bronchitis

Answer 29

Mucous gland hyperplasia, basal cell metaplasia and basement membrane thickening

mmm

Question 30

pneumothorax >2cm and/or breathless management

Answer 30

aspirate 16-18 gauge cannula

Question 31

pneumothorax >2cm

Answer 31

chest drain

Question 32

indications for use of long term oxygen therapy in COPD

Answer 32

Clinically stable non-smokers with PaO2 of <7.3 (approximately equal to oxygen saturations of 88%) measured at least twice, a minimum of 3 weeks apart, despite maximum treatment
OR

A PaO2 of 7.3-8.0 with concurrent secondary complications of COPD (one of the following):

Pulmonary hypertension

Secondary polycythaemia

Peripheral oedema

Nocturnal hypoxaemia
OR

In terminally ill patients for palliation

Question 33

lung volume reduction surgery in COPD

Answer 33

upper lobe predominant emphysema, FEV1 >20% predicted, PaCO2 below 7.3 kPa, and TlCO/ transfer capacity for CO above 20% predicted.

Question 34

infection changes to sputum

Answer 34

Change in volume and colour of sputum

Question 35

ECG changes are present which may be seen in COPD:

Answer 35

P pulmonale: peaked P waves in leads II, III and aVF
Right axis deviation
Absent R waves in right facing leads
Low voltage QRS in left facing leads
Sinus tachycardia (hypoxia, dyspnea, medication related e.g. salbutamol, theophylline)

Question 36

Indications for surgery in COPD

Answer 36

lung volume reduction surgery if:

They have upper lobe predominant emphysema
FEV1 >20% predicted
PaCO2 below 7.3 kPa
TlCO above 20% predicted.