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3B Flashcards

1
Q

Absent popliteal and ankle pulses but present femoral pulse.

  1. What investigations would you do?
  2. Where is the occlusion?
  3. Difference between graft occlusion and compartment syndrome?
A
  1. Ankle brachial pressure index. Colour duplex scan.
  2. Superficial femoral artery.
  3. still don’t know 🥴
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2
Q

26y/o has 30min seizure.

  1. What is the definition of status epilepticus?
  2. Immediate bed side test?
  3. A+E immediate medication
  4. Further medication
  5. If is it alcohol induced what’s the Rx?
  6. 4 other causes of a seizure?
A
  1. Continuous seizure activity lasting 5 minutes or more or repetitive seizures without regaining consciousness (3 in 1 hr).
  2. BM
  3. IV lorazepam, buccal midazolam.
  4. Phenytoin.
  5. Thiamine/Pabrinex.
  6. Meningitis, trauma, hepatic encephalopathy, hypoglycaemia, brain tumour
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3
Q
  1. Mx of Addisonian crisis?

2. How to avoid future ones?

A
  1. IV hydrocortisone

2. Sick day rule to increase steroids when ill. Ensure good adherence to medications. Good patient education.

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4
Q
  1. Signs of paediatric deterioration?
  2. 6 blood test for a paeds ?sepsis?
  3. Mx of paeds sepsis?
A
  1. Unrousable, altered mental state, chest indrawing, grunting, decrease skin turgor, prolonged CRT, TC <60pm, TP, PaO2 <90%, mottled skin, cyanotic, non-blanching rash.
  2. ABG, blood cultures, FBC, clotting, ESR/CRP, creatinine, U+E.
  3. Broad spec ABx e.g. tazosin/ceftriaxone. IV fluids Analgesia. Inform senior for support.
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5
Q
  1. RFx for oesophageal cancer

2. Mx

A
  1. smoking, male, GORD + Barrett’s oesophagus, alcohol

2. early disease = endoscopic resection later do oesophagectomy.

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6
Q
  1. S+S of SLE.

2. Name 3 SLE drugs and how they work

A
  1. Discoid rash, painless oral ulcers, photosensitive rash, arthritis/arthralgia, malar rash, seizures, psychosis, proteinuria, HTN, oedema, chest pain + SOB (pericarditis and serositis) pallor and jaundice (haemolytic anaemia). Weight loss, fever.
  2. Methotrexate = dihydrofolate reductase inhibitor.
    Cyclophosphamide = prevent DNA replication (alkylating agent). Ibuprofen = inhibits COX-1 and COX2. Etanercept = Anti-TNF.
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7
Q
  1. Score for PE assessment?
  2. Components of this score?
  3. What to do if low risk?
  4. Signs of a PE?
  5. Assess 30 day prognosis of a PE?
  6. What to do when discharging a PE patient?
A
  1. Wells score for pulmonary embolism
  2. Clinical features suggest PE, Heart rate >100bpm, PE is likely ∆, immobilised for 3days or surgery in past month, Hx of a PE/DVT, haemoptysis, Hx of malignancy.
  3. D Dimer
  4. Tachycardia, tachypnoea, elevated JVP, low BP, cyanotic.
  5. PESI = pulmonary embolism severity index.
  6. Dunno 🤷‍♀️
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8
Q

What drug class is most likely to improve prognosis in left ventricular systolic dysfunction?

A

ACE inhibitor.

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9
Q

Cause of deterioration and weakness in pt treated for acute asthma attack?

A

Hypokalaemia. Steroids and beta-agonist lower potassium.

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10
Q

Nerve involved in lung Ca pt with wasting and weakness of small muscles in right hand?

A

T1 nerve root

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11
Q

Ix for SAH if CT normal

A

LP in 12hrs - Xanthochromia

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12
Q

Nerve damaged if ankle examination ankle dorsiflexion and eversion are weak but ankle inversion is normal. The right ankle jerk is normal. Sensation is intact.

A

Common perineal nerve.

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13
Q

Causative organism if NON-bloody diarrhoea, vomiting, abdo pain but resolves spontaneously with 24hrs.

A

S.aureus

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14
Q

Why do coeliacs get malabsorption?

A

Reduced surface area from villous atrophy.

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15
Q

Metabolic disturbances in DKA

A

Increased protein catabolism, increased lipolysis, increased glucogenolysis, increased gluconeogenesis. Increased lipolysis = ketone production.

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16
Q

ABG of compensatory DKA

A

Decreased pH, decreased PaCO2.

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17
Q

1st line DMT2 med

A

Metformin

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18
Q

Hypercalaemia, high creatinine, high ESR and complaining of back pain and weight loss?

A

Multiple myeloma.

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19
Q

Hx of tiredness, chest pain, arthralgia, miscarriages, poor renal function and abnormal FBC

A

SLE

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20
Q

What do the antibodies in Goodpasture’s attack

A

Glomerular basement membrane

Haemoptysis and haematuria.

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21
Q

Lung Ca and hyponatreamia cause?

A

Paraneoplastic ADH release causing increased collecting duct permeability.

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22
Q

Analgesia in nephrolithiasis

A

diclofenac

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23
Q

ABG and U+E if severe vomiting

A

Hypochloraemic alkalosis.

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24
Q

Newborn baby goes home to family with chickenpox, mum has detectable varicella antibodies. what action?

A

None. Protected by placentally-acquired maternal antibodies and is therefore not at risk of overwhelming chicken pox infection.

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25
Q

Drug to Rx absence childhood seizure epilepsy

A

Sodium valproate

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26
Q

Hx of cataract surgery now has red eye, poor acuity, pain.

A

Endophthalmitis

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27
Q

4 questions to ask in a history of OSA

A

Headache
Decreased libido
Poor cognition e.g. concentration
Daytime tiredness

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28
Q
  1. FBC
  2. ABG
    in OSA
A

polycythaemia (raised Hb)

Type 2 resp failure, respiratory acidosis

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29
Q

Mx of OSA

A

Loose weight, stop smoking.

Nocturnal continuous positive airway pressure.

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30
Q

Ix for cuada equina syndrome

A

MRI

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31
Q

Ankle reflex in cauda equina syndrome

A

Decreased

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32
Q

Causes of cauda equina syndrome

A 
Bony metastasis
Spinal tumours
Spinal abscess
Myeloma
Spinal haemorrhage e.g. SAH.
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33
Q 
A 73 year old is admitted for the investigation of jaundice. He noticed that he become jaundiced about a week ago. Liver function tests show a grossly elevated
bilirubin at 220 micromol/l (HIGH) AST 25 u/l (N) and alkaline phosphatase 520 u/l (HIGH).
1. What type of jaundice?
2. 2 features to ask in Hx?
3. surface marking on pancreas?
4. 2 causes.?
5. 2 imaging Ix?
6. Rx for long INR?
A
  1. Obstructive.
  2. Pale stool, dark urine.
  3. Head of pancreas on transpyloric line in loop of second part of duodenum. Body extends upwards and left.
  4. Gall stones, pancreatic tumour.
  5. ERCP, abdo CT.
  6. Vitamin K.
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34
Q

Testiuclar Cancer:

  1. Histological type of tumour which on biopsy is form all 3 embryonic layers?
  2. Name a tissue which originates from each 3 embryonic layers?
  3. Lymph nodes testicular cancer spreads to?
  4. 2 testicular cancer biomarkers?
  5. RFx
A
  1. Teratoma
  2. Ectoderm = CNS, Mesoderm = muscle, Endoderm = stomach.
  3. Para-aortic
  4. beta- human chorionic gonadotrophin and alpha fetoprotein.
  5. maldescent, FHx, infertility, Klinefelter’s
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35
Q
  1. 2 drugs used in post-MI which can cause postural Hypotension?
  2. 1 drug to treat postural hypotension?
A
  1. Bendroflumethiazide, beta-blocker.

2. Fludrocortisone (aldosterone).

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36
Q

Causes for confusion in a ∆ lung cancer patient

A

Brain mets
Hyponatraemia from SIAD
Hypercalcaemia

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37
Q

Adverse effect of too rapid sodium correct in hyponatraemia

A

Central pontine myelinolysis.

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38
Q

PE signs on ECG

A 
Sinus tachycardia
RBBB
Deep S wave in lead 1
Q wave in leads 3
Inverted T wave in lead 3.
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39
Q

4 eye clinical features of MS

A

Reduced visual acuity
Even worse acuity on exposure to heat (Uthoff’s)
Colour desaturation
Pain on eye movement
Oscilopsia (objects appear to oscillate).

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40
Q
  1. 3 Ix for MS.
  2. 2 things seen on histology.
  3. 1 Rx that delays disease progression
A
  1. MRI, LP/CSF, evoked potentials.
  2. Demylination, plaques, oligodendrocyte loss.
  3. Beta-interferon.
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41
Q

Mx of Polymylagia rheumatica

A

Prednisolone (not very responsive to NSAIDs).

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42
Q

Man is exposed to house fire, what is cause of poor resp function and what Ix would you do?

A

Carbon monoxide poisoning - carboxyhaemoglobin

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43
Q

Unprovoked DVT Ix

A

CT abdo pelvis for ?malignancy

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44
Q

Mx of a prolatinoma

A

Dopamine agonist e.g. cabergoline

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45
Q

Non-functional thyroid nodule Ix

A

USS and fine needle biopsy.

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46
Q

Best Ix for rheumatoid arthritis

A

antiCCP (more specific than RF)

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47
Q

How does cocaine cause ACS

A

Coronary artery spasm

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48
Q

Difference between hydrocele and epididymal cyst

A

Both trans-illuminate.
Hydrocele is surround testis
Epididymal cyst are superior to testis

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49
Q

What LuFT do you do in myasthenia gravis

A

FVC <1litre

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50
Q

Man has left ureteric stone with hydronephrosis whats the best Mx

A

Fluids, ABx and nephrstomy (not lithotripsy as need to compress renal pelvis).

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51
Q

Sinus Brady Rx

A

Atropine

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52
Q

First line Mx for gout even if on allopurinol

A

NSAID (naproxen)

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53
Q

Lateralisation of sound in Weber’s test to the right ear and a negative Rinne’s test on the right

A

Right conductive deafness.

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54
Q

Most common pathogen for leg cellulitis

A

Strep pyogenes.

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55
Q

1st line mx for superficial thrombophlebitis

A

NSAIDs

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56
Q

Foot drop nerve and impairment

A

Common peroneal, no active dorsiflexion.

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57
Q

Mx of symptomatic gallstones

A

Laparoscopic cholecystectomy

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58
Q

Signs of cerebellar stroke

A 
Ipsilateral:
Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor (on voluntary movements e.g. holding hands outstretched)
Staccato speech
Hypotonia.
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59
Q
  1. Red blood cell appearance in iron def anaemia?

2. CVS examination findings in IDA?

A
  1. Microcytic, hypochromic.

2. Bradycardia, flow murmur, arrythmia.

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60
Q

Metabolic and electrolyte disturbances in anorexia nervosa?

A

Metabolic alkalosis.

Hypokalaemia.

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61
Q

Hx of swelling around right ear and jaw angle.

  1. Likely affected structure?
  2. 2 causative pathogens?
  3. 2 Ix
A
  1. Parotid gland.
  2. Paramyxovirus, Epstein-Barr, Mycobacterium tuberculosis.
  3. Throat swab PCR, blood cultures.
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62
Q

The trust has only got a budget for cardiac rehab for a certain number of pts, how would you identify such at risk individuals?

A

health needs assessments

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63
Q

Difference between essential tremor and the tremor in parkinson’s

A

Essential = fine tremor, worse on voluntary movements.

Resting tremor in Parkinsons = occurs at rest, improved by actions.

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64
Q

L-dopa helps what symptoms in PD

A

Bradykinesia and rigidity, not tremor.

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65
Q

4 non infective causes of rectal bleeding, loose stools, mucus

A

Crohn’s, Ulcerative colitis, carcinoid syndrome, CRC, diverticulitis.

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66
Q

4 pathogens to cause rectal bleeding, loose stools, mucus

A

E.coli, Campylobacter jejuni, salmonella, shigella.

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67
Q

Old lady with osteoarthritis, hypertension for 10 years. Is on
diclofenac, atenolol and bendroflumethiazide. found to be anaemia (IDA).
1. what drug is causing IDA, and how?
You decide to give her a blood transfusion, but 4hrs later you find that she has a pyrexia of 38 degrees.
2. What is the most likely problem?
3. 3 other acute transfusion complications?

A
  1. Diclofenac, peptic ulcer with subsequent bleed.
  2. ABO incompatibility.
  3. Bacterial contamination infection, anaphylaxis, fluid overload - pulmonary oedema, transfusion related lung injury.
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68
Q

Ocular complication of GCA

A

Anterior ischaemia optic neuropathy

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69
Q

8 side effects of prednisolone

A

Cushing’s syndrome, fluid retention, headache, hypertension, increased infection risk, nausea+vomiting, osteoporosis, PUD, glaucoma.

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70
Q
  1. How does paracetamol destroy the liver?
  2. When does this happen?
  3. Rx drug
A
  1. High pcm causes liver to try and metabolise it in different pathway. Leads to NAPQI toxic metabolite synthesis. NAPQU causes hepatocyte necrosis.
  2. Hepatic necrosis develops after 24hrs.
  3. N-acetylcysteine.
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71
Q

4 pathogens for CAP

A 
Strep.pneumoniae
H.influenzae
S.aureus
Mycoplasma pneumoniae
Legionella pneumophila
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72
Q
  1. Ix for legionella
  2. Electrolye disturbance in Legionella
  3. Rx for legionella
A
  1. Urine antigen test
  2. Hyponatraemia, elevated liver enzymes,
  3. Oral Clarithromycin
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73
Q
  1. 3 findings O/E of leg with ?limb ischaemia?
  2. 3 things O/E which would suggest where blockage is?
  3. 2 non-invasive Ix?
A
  1. Paraesthesia, pallor, paralysis, cold, pulseless, pain.
  2. Palpate pulses, atrophy of hair, Buerger’s angle reduced, ulcers.
  3. ABPI, Doppler USS.
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74
Q
  1. What is compartment syndrome?
  2. S+S of compartment syndrome?
  3. Rx?
A
  1. Elevated interstitial pressure in a closed fascial compartment leads to ischaemia and poor perfusion.
  2. Pain, paraesthesia, paralysis.
  3. Fasciotomy.
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75
Q

VIRAL CONJUNCTIVIS

  1. 4 symptoms
  2. 4 signs
  3. 2 differentials
  4. Mx
A
  1. Non-purulent watery discharge, gritty sensation, normal vision, swollen, itchiness, redness.
  2. Conjunctival follicles, swollen/oedematous, unilateral, lymphadenopathy.
  3. Acute closed angle glaucoma, acute anterior uveitis, blepharitis.
  4. Eye hygiene, avoid sharing towels. Topical antihistamines.
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76
Q
  1. 2 clinical signs to check of O/E of patient with acute back pain and incontinence?
  2. Ix?
  3. 2 longterm complications?
  4. 4 parts to Mx?
A
  1. DRE sphincter laxity, motor weakness, areflexia.
  2. MRI
  3. Permanent neurological deficit e.g. paralysis, sexual dysfunction, chronic pain.
  4. Immobilise, anagelsia, neurosurgical referral, IV steroids, physio and OT rehab.
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77
Q

2 ways to sustain an ankle fracture

A

Extreme supination or extreme pronation of foot.

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78
Q

2 findings of ECG for AF

A

No p waves,

Irregular irregularly spaced QRS complexes

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79
Q
  1. 3 meds for AF?

2. Other therapeutics would you consider, name 2 and their actions?

A
  1. beta-blocker, CCB, Digoxin.

2. Warfarin, inhibit epoxide reductase, no 10, 9, 7 2. Apixaban, inhibits factor Xa.

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80
Q

Guy goes to GP and has left-sided facial palsy, some vesicles, some pain. GP diagnoses Ramsay-Hunt syndrome.

  1. 3 other causes of facial nerve palsy?
  2. What is the causative organism,
  3. Where does it reside?
  4. What would you treat it with?
  5. What other symptoms might this guy be complaining of?
  6. Who should he avoid?
A
  1. Bells palsy, gullian barre, MS, stroke.
  2. Varisella zoster
  3. Geniculate ganglion of facial nerve.
  4. Acyclovir, prednisolone, NSAIDs for analgesia.
  5. Ear pain, tinnitus, dry mouth, vesicles.
  6. Pregnant women.
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81
Q

Middle-aged/old-ish lady, presents with fatigue and constipation. Blood results given, shown high corrected serum calcium, high PTH.

  1. What is the diagnosis?
  2. What is PTH was low?
  3. 3 actions of PTH?
A
  1. Primary hyperparathyroidism
  2. Bone met/malignancy
  3. Osteoclast activation, active vitamin D in kidneys, increase calcium absorption in gut, decrease calcium excretion in kidneys.
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82
Q

β-thalassaemia:

  1. How to ∆?
  2. What must parents have?
  3. If the child had been born in the UK, what 2 public health initiatives would have allowed his condition to be picked up earlier?
  4. Mx, 3 complications of it and how to Mx the complications?
  5. Why no α-thalassaemia major?
A
  1. Haemoglobin electrophoresis.
  2. Thalassaemia minor/carriers.
  3. Preconseptual testing, ante-natal screening.
  4. Regular blood transfusions, deposit in heart = arrythmia, skin = pigmentation, pancreas = DM. Mx with iron chelation.
  5. Severe uterine haemolytic anaemia = Bart’s Hydrops Fetalis.
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83
Q

4 RFx for oropharyngeal cancer

A
  1. Alcohol, smoking, HPV16, Betal nuts, FHx.
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84
Q

Guy comes in with rectal bleeding, no pain, just blood mixed in with stool, maybe having some loose stools these days.

  1. 3 differentials?
  2. 4 important things O/E?
  3. 2 Ix
A
  1. Diverticulitis, ulcerative colitis, bowel cancer, anal fissure.
  2. Conjunctival pallor, DRE, Rash, Abdo exam.
  3. Colonoscopy, faecal calprotectin, CEA.
85
Q

Name 3 classes and an example for each of antidepressants

A

SSRI - sertraline
SNRI - venlafaxine
Tricyclic - amitriptyline

86
Q

If an association is not causal, what might it be due to?

A

Bias, confounding factors, reverse causality, chance.

87
Q
  1. Signs O/E of appendicitis?
  2. Differentials for appendicitis?
  3. Mx of perforated appendicitis?
A
  1. +Rovsing’s sign (press on left side of abdo causes pain in right lower quad), Right Lowe quad tenderness esp at McBurney’s point can be rebound.
  2. Right sided ureteric stone, ovarian cyst rupture, PID, small bowel obstruction.
  3. ABx, fluids, senior surgical review!
88
Q

3 causes of secondary HTN

A

Acromegaly, Conn’s (hyperaldosteronism), renal artery stenosis, pheochromocytoma.

89
Q

Which arm has higher BP in coarctation of aorta?

A

Normal in Right so is higher.
Weak/delayed in left.
Narrowing before left subclavian artery.

90
Q

4 changes seen in HTN retinopathy

A 
AV nipping
Flame haemorrhages
Cotton-wool spots
Optic disc oedema
Silver wiring from vascular wall hyperplasia
Yellow hard exudates
91
Q

4 Rfx for baby NAI

A 
Premature
Parental Hx of abuse
Parental Hx of substance abuse
Parental mental illness
Poor social support
Age of baby <1
92
Q

Child with Hx of NAI and apparent pneumothorax gets bradycardia and firm fontanelle.

  1. What are you worried about and what Ix to do?
  2. What imaging for fractures?
A
  1. CT head, intra-cranial haemorrhage.

2. ?skeletal survey ?xray

93
Q

Man is short sighted, wears contact lenses. Painful red eye, left eye visual acuity 6/9 right 6/12 (??), left pupil smaller than the right, left eye normal on examination, eye watering, red conjunctival vessels, sensitive to light in right eye.
FHx = sister has congenital cataracts, 2 uncles have open angle glaucoma.
GP thinks its anterior uveitis.
1. 2 differentials and why?
2. 3 findings on slit-lamp?
3. 2 treatments and route?
4. An infectious cause?

A
  1. Acute closed angle glaucoma, FHx, need to rule out. Keratitis from contact lens use. Meningitis from photophobia.
  2. Keratin precipitates, hypopygon, aqueous cells and flare, posterior synechiae.
  3. Corticosteroids e.g. topical prednisolone. Mydriatics e.g. topical atropine.
  4. Herpes simplex virus.
94
Q

Question on SLE.

  1. cause of renal impairment?
  2. why?
  3. why ankle oedema?
  4. 4 drugs and mechanism of action/class?
A
  1. Lupus nephritis
  2. Autoimmune attack on glomerular, causing glomerulonephritis????
  3. Protein loss = hypoalbuminaemia = fluid moves out into intersitium???
  4. Corticosteroids = prednisolone, NSAIDs (cox-2 inhibitor) = Naproxen, Immunosuppressant = azathioprine.

really don’t get this qu and not definite on answers

95
Q

2 drugs which cause depression

A 
Lithium
Antipsychotics
Malarone
Diazepam
Gabapentin
96
Q

Ascites.

  1. 2 signs O/E?
  2. 3 signs O/E of hands?
  3. 2 Ix to find cause?
  4. 3 complications?
A
  1. Shifting dullness, fluid thrill.
  2. clubbing, Dupuytren’s contracture, palmar erythema, asterixis, leuconychia.
  3. Abdo USS, ??ascitic tap, LFT.
  4. coagulopathy, GI bleed form varicies, portal HTN, HCC, encephalopathy.
97
Q

23 year old Somalian male with 3 weeks progressive SOB. Also had some weight loss, temp 37.5.

  1. Pathophysiology of pleural effusion and cause?
  2. 2 Ix except routine bloods and aspiration?
  3. 2 things to exclude ASAP?
  4. 4 Ix to confirm TB Dx?
A
  1. Vasodilation, increased vascular permeability, fluid leaks into pleural space. Due to inflammation in area.
  2. CXR, ?ECG, ?FBC, ?ABG
  3. TB, cancer, pneumothorax, PE????
  4. HIV test, sputum samples for acid fast bacilli, pleural fluid mc+s, CT chest, blood PCR
98
Q

Chap comes in. Has had some dysuria, has flank pain, fever. Blood pressure 80/40, tachypneic. Bloods given - K+ 7.5, Cr >700, Urea >30. Has Ischaemic heart disease. Ex-smoker doesn’t drink. On ramipril, Beta blocker and statin.

  1. 2 causes for AKI?
  2. 2 RFx he has?
  3. Why hypotensive?
  4. Why tachypnoeic?
  5. 2 ECG signs?
  6. 4 actions in Mx?
A
  1. ACE inhibitor, septic (hypovalaemic)
  2. ACEi on medications, maybe age, HTN, IHD.
  3. Sepsis?
  4. Compensate for metabolic acidosis from ureic acid.
  5. tall T waves, long PR interval, sine waves.
  6. Calcium gluconate, IV fluids catheterise, stop ramipril, O2.
99
Q
  1. Cells for Hodgkins lymphoma?
  2. 3 B symptoms?
  3. 2 Ix for lymphoma except lymph biopsy?
  4. What to explain to Pt?
A
  1. Reed-Sternberg.
  2. weight loss, with sweats, fatigue.
  3. CT for other nodes, bone marrow biopsy.
  4. Cancer condition of white blood cells which are in lymph nodes all over body. Can still spread outside lymph nodes.
100
Q

Man had seizure, witnessed by wife. Lost consciousness. Was seen to shake all 4 limbs and was incontinent. On examination he has an expressive dysphasia, weak legs + arms on the right and upgoing plantars on the right

  1. Where is seizure in brain?
  2. What type of seizure?
  3. 3 causes of increased uptake on CT scan of head?
  4. Drug Rx?
  5. 2 things to do with driving?
A
  1. ?left frontal lobe
  2. Generalised tonic clonic.
  3. tumour, abscess, ?extra-dural haematoma, ?demylination.
  4. Sodium valproate.
  5. No drive for 1 yr seizure free and must tell DVLA.
101
Q
  1. Define an SAH?
  2. Why does it cause a coma?
  3. 4 other causes of coma?
  4. What is her GCS if she flexes to pain, produces incomprehensible sounds and does not open eyes to pain?
  5. Why does she have a fixed dilated pupil?
  6. Immediate Mx?
  7. 4 features of brainstem death?
A
  1. Bleeding into space between Pia and Arachnoid mater.
  2. Raised ICP, ?hydrocephalus.
  3. Hypoglycaemia, hyperureamia, trauma, seizures, meningococcal septicaemia.
  4. 7 (E1, V2, M4).
  5. Compression of CN3, parasympathetic nerve are more superficial so are more vulnerable to compression leading to no parasympathetic stimulation to constrict.
  6. A to E, Nimodipine, get anaesthetist as will need intubation, CT head, surgical review!
  7. No respiratory effort on withdrawing ventilation machinery, no corneal reflex, no cough reflex, fixed pupils not responsive to light, no response to pain.
102
Q

A 52 female teacher has had type one diabetes since she was 10. She is a smoker of ten a year and her last HbA1c was 86.0. BMI is 23.6. On Sunday morning she was found unresponsive by her husband and sweating profusely. He called an ambulance. The paramedics administered a treatment. She woke up and wasn’t admitted to hospital.

  1. What happened?
  2. What did paramedics give?
  3. What could have caused this?
  4. GP screening for microvascular damage?
  5. Long term health risks?
A
  1. Hypoglycaemic (sweating).
  2. Glucose
  3. Incorrect insulin dose, poor diet/appetite, excessive exercise.
  4. Urine albumin to creatinine ratio, foot care, sensation with microfilament, retinal screening, ABPI.
  5. Stroke, MI, IHD, limb claudication.
103
Q

45 year old woman finds a lump in her breast. It is well-circumscribed, soft and non- tender.

  1. what other features would you check on examination?
  2. Immediate GP Mx?
  3. Next Ix?
  4. Signs the woman should be safety-netted about?
A
  1. Axial lymphadenopathy, adhered or mobile lump, other breast, nipple changes….
  2. Referred for 2WW, council lady on reasons for urgent referral, take FHx, menopausal status.
  3. Mamogram, USS, fine-needle biopsy, core biopsy, receptor profile.
  4. Nipple discharge or bleeding, skin changes such as tethering, peau d’orange.
104
Q
  1. Causes for retinal floaters?
  2. 3 Ix and what you would see?
  3. Driving advice?
A
  1. Diabetic retinopathy, retinal detachment/tear, posterior vitreous detachment
  2. Fundoscopy will show retinal tear or detachment, slit-lamp will show ?? and maybe do ultrasonography of eye…?????
  3. No driving until acuity at least 6/12 in both eyes.
105
Q 
Young female with PV bleeding and mild abdo pain, least period 7 weeks ago. She has a positive pregnancy test, a closed os and a slightly enlarged uterus with blood in her
vagina.
1. 4 other parts of Hx to illicit?
2. 3 causes of results?
3. 3 Ix?
A
  1. STI, contraceptive use, quantity of blood, sexual Hx, menstrual Hx.
  2. Ectopic, molar pregnancy, vaginal trauma, complete miscarriage.
  3. TVUS, cerivcal swab, serum beta-hCG, transabdo USS.
106
Q
  1. What histology for bladder Ca?
  2. Where else can this occur?
  3. Other type of bladder Ca?
  4. 4 Rfx?
  5. What artery suppled superior and inferior vesicle arteries?
  6. Which lymph nodes?
A
  1. Transitional cell carcinoma,
  2. Ureter, urethra.
  3. Squamous cell.
  4. Smoking, FHx, radiation, chronic bladder infection, aromatic amines and dye exposure.
  5. Internal iliac artery.
  6. internal iliac, para-aortic
107
Q

2 signs for cauda quina syndrome in:

  1. perianal skin
  2. lower limb
  3. sphincters
A
  1. paraesthesia, reduced tone.
  2. Upgoing plantars, pain.
  3. Loss of anal tone, incontinence.
108
Q 
Pericarditis.
1. What heart sound is heard?
2. 4 Ix?
3. 2 Rx?
Now has raised JVP, low BP and high HR.
4. What is caused this?
5. 2 causes of pericarditis?
A
  1. Pericardial rub
  2. CXR, ECG, FBC, ESR, echocardiogram.
  3. Pericardiocentesis, NSAIDs, colchicine, ABX.
  4. Cardiac tamponade.
  5. SLE, post-MI (Dressler’s), EBC, CMV.
109
Q

Male, 75 year old smoker with haemoptysis. CXR shows a suspicious lump and there is concern that he has a cancer with cerebral mets.
1. 3 Ix and reasons why?
Cancer in right hilum spreading throughout lobe. Also some supraclavicular lymph nodes. No abdo or cerebral mets. Bloods: low albumin (30), high platelets (500) and low sodium (131).
2. What type of cancer is it and why?
3. How to get biopsy?
4. Name 2 Rx

A
  1. Brain MRI, chest CT, PET scan, biopsy.
  2. Squamous cell carcinoma - due to location near right hilum, smoking RFx.
  3. CT guided.
  4. Radiotherapy, chemotherapy, surgical.
110
Q

Old lady with abdo pain, vomitn and abdo distention.

  1. 2 mechanisms and 4 causes for each mechanism?
  2. Ix?
  3. Mx for bowel obstruction?
A
  1. Bowel obstruction - cancer, adhesions, hernia, sidmoif volvulus, diverticulitis. Constipation = opiates, dehydration, hypothyroidism, hypercalcaemia, Parkinsons.
  2. AXR, CT abdo pelvis.
  3. IV fluids, NG tube, senior surgical review.
111
Q 
58 year old male scaffolder reports bilateral shoulder pain which moves to his left arm. History of neck pain of three years.
1. how should GP Ix at the practise?
On examination he has patchy sensory loss on his left hand, loss of his left brachial reflex and cervical tenderness.
2. 3 causes of this?
3. 3 Ix?
4. 2 Rx for degenerative changes?
5. Most likely ∆?
6. Long term C-spine management?
A
  1. Upper limb neuro examination, shoulder examination, thorough Hx…?
  2. Cervical spine fracture, degenerative cervical spondylosis, intervertebral disc herniation.
  3. Cervical MRI, Upper extremity EMG/nerve conduction studies, X-ray of cerival spine.
  4. Physiotherapy and strengthening exercises, NSAIDs (ibuprofen), muscle relaxants, facet joint injections (dexamethasone).
  5. Osteoarthritis of the spine
  6. Physio, ?surgical decompression…?
112
Q
  1. What is the malignant cell in multiple myeloma?
  2. What do you look for in the pt’s urine?
  3. 2 cause of confusion for patient?
  4. What bone imaging to do?
A
  1. Plasma cells.
  2. Bence-Jones protein.
  3. Uraemia, hypercalcaemia.
  4. Full skeletal survey x-ray
113
Q
  1. 4 features of the skin lesion in psoriasis?
  2. 2 signs to distinguish RA and psoriatic arthritis?
  3. If RF is -ve does it exclude RA?
  4. 2 precautions to reduce side-effects of methotrexate?
A
  1. well demarcated, silver scaly, erythematous, symmetrical distribution, thickening.
  2. Onycholysis, splinter haemorrhages, nail pits, DIPS affected in PA.
  3. No, only +ve in 70% of patients.
  4. Folic acid, contraception.
114
Q
  1. What hormone is high in Conn’s and where is it secreted form?
  2. What hormone is suppressed in Conn’s and where is it secreted from?
  3. 4 features of hyperkalaemia ECG?
  4. Best imaging for Conn’s
  5. Where does spironolactone act?
A
  1. Aldosterone from glomerulosa of adrenal glands.
  2. Renin from kidneys.
  3. Tall T waves, long PR interval, Board QRS, sine wave rhythm.
  4. Adrenal CT.
  5. Inhibits aldosterone dependant sodium-potassium exchange channels in distal convoluted tubule. Increase sodium and water excretion, potassium retention.
115
Q
  1. 2 Intra-cranial causes for confusion?
  2. 2 causes of confusion for a hospital in-patient?
  3. Rx for Korsakoff’s?
  4. Rx for delirium tremens?
A
  1. SOL, encephalitis, meningitis.
  2. HAP, UTI.
  3. Pabrinex IV
  4. Chlordiazepoxide.
116
Q

2 specific readings/score to look for on spirometry that is diagnostic of COPD, give the values as well?

A

FEV1/FVC <0.7

FEV1 <0.8

117
Q
  1. 6 signs that is suggestive of hypothyroidism, apart from weight gain, hair loss and goitre?
  2. Why might Rx not work?
A
  1. Bradycardia, slow reflex relaxation, cold extremities, cold intolerance, constipation, depression.
  2. Malabsorption, not taking it properly, still titrating dose to correct therapeutic level.
118
Q

6 RFx for Osteoporosis

A 
Hyperparathyroidism
CKD
Chronic liver disease
Low BMI
Alcohol
Smoking
Steroids
Older age
Post-menopause
119
Q

MND

  1. 3 UMN and 3 LMN signs?
  2. 4 features of bulbar presentation?
  3. 4 people in MDT.
  4. Wants to make legal document writing out his wishes…?
A
  1. UMN = weakness, hyper-reflexia, upgoing plantars. LMN = fasciculations, hypo-reflexia, atrophy of muscles
  2. Dysphasia, dysphagia, tongue fasciculations, slurred speech, drooling.
  3. PT, OT, SALT, specialist nurse, dietician.
  4. Advanced directive.
120
Q

Crohn’s

  1. 2 Ix?
  2. 2 historical features?
  3. 1st drug to prevent relapse?
  4. Skin lesion?
  5. Drug to Rx relapse?
  6. Rx for skin condition
A
  1. faecal calprotectin, colonoscopy, ESR and CRP.
  2. Granulomas, transmural inflammation.
  3. Azathioprine
  4. Erythema nodosum
  5. Prednisolone
  6. NSAIDs….
121
Q

Acoustic neuroma.

  1. How would you ever know if this was an upper or motor facial nerve palsy 🥴🥴??
  2. If there is hearing loss + weakness, where the hell is the lesion?
  3. 2 other symptoms please?
  4. Results of that Weber and Rinne’s test 🦻?
  5. IS IT CANCER? AM I GOING TO DIE?
A
  1. Forehead spared in UMN.
  2. Cerebellopontine angle me thinks.
  3. Tinnitus, signs of raised ICP, vertigo, nystagmus maybe too.
  4. I think…. Rinne’s test is normal on both, and Weber’s lateralised to Right.
  5. WE ARE ALL GOING TO DIE BUT YOU PROBS WONT DIE OF THE NEUROMA, stop over reacting.
122
Q

Nephrotic syndrome.

  1. What to look for urine with values?
  2. 2 other biochem Ix and results.
  3. Body’s response to this…?
  4. 2 drug Rx.
  5. Changes in DM nephrology.
A
  1. Proteinurea >3.5g/day.
  2. Hypoalbuminaemia (<30g/L), high lipids.
  3. dunno
  4. Fluid and salt restriction, spironolactone, statin, ACE inhibitor….? steroids.
  5. Thickening of GBM, nodules, mesangial expansion.
123
Q

Coeliac.

  1. blood test?
  2. Diet advice?
  3. Consequences of malabsorption?
  4. Skin disease associated?
  5. Long term complications?
A
  1. IgA-tissue transglutaminase + endomysial antibody.
  2. Gluten free diet.
  3. C=scurvy, K=coagulopathy, D=osteomalacia, B=macrocytic anaemia, A=poor eyesight.
  4. Dermatitis herpetiformis.
  5. Anaemia, lymphomas, psychological impact.
124
Q

TB.

  1. Sounds on auscultation?
  2. Confirmatory test?
  3. RFx?
  4. Rx
A
  1. crackles, bronchial breath sounds.
  2. Acid fast bacilli of induced sputum sample.
  3. HIV, birth in endemic country e.g. India, IVDU, DM.
  4. Rifampicin, Isoniazid, Pyrazinamide, Ethambutol.
125
Q

Long term complications of meningitis

A

Hearing loss, epilepsy, brain abscess

126
Q

How does mitral stenosis cause pulmonary oedema

A

Increased left atrial pressure, left atria dilated and hypertrophy, increased pulmonary arterial pressure, increased pulmonary capillary pressure = fluid forced into interstitial of lungs.

127
Q
  1. Rfx for gout?
  2. Precipitating facts for acute attack?
  3. Mx?
A
  1. older age, male sex, diet high in red meat and alcohol.
  2. Alcohol binge??, use of diuretics, trauma, infection.
  3. NSAID, colchicine warn of diarrhoea.
128
Q
  1. CFx of acromegaly?
  2. Pathophysiology?
  3. Ix?
  4. Rx?
A
  1. Coarse facial features, arthralgia, low libido, snoring, large hands, Macroglossia, darkening of skin.
  2. Pituitary adenoma secreting growth hormone.
  3. High IGF-1, OGTT, pituitary MRI.
  4. Trans-sphenoidal surgery
129
Q
  1. What is a hydrocele?
  2. Causes?
  3. Ix?
  4. Rx?
A
  1. Collection of fluid in tunica vaginalis.
  2. Minor trauma, congenital, infection, renal cell carcinoma, post-surgical.
  3. USS - transilluminates.
  4. Observation…
130
Q 
27 year old male presents with recurrent epistaxis, fatigue. Fever of 38.7 degrees.  On examination multiple blood blisters in mouth, pale. Blood tests -  pancytopenia
Blood smear shows some circulating nucleated blast cells
1. Whats the ∆?
2. Complication he has?
3. Ix before Rx?
4. Rx for complication?
5. 2 blood products you could give?
6. Other Mx?
A
  1. Acute myeloid leukaemia.
  2. Neutropenic sepsis.
  3. Blood cultures.
  4. IV tazosin.
  5. Red blood cells, platelets.
  6. Allogenic stem cell transplant.
131
Q

Previous anterior MI. Admitted for 2 days. Now SOB and wide spread crackles.

  1. What 4 investigations would you get to confirm your diagnosis?
  2. What 4 cardiac complications from the MI could exacerbate his condition?
  3. What 2 immediate treatment while waiting for your senior to arrive?
A
  1. ECG, ABG, CXR, D-dimer.
  2. Pericarditis (Dressler’s), CHF, Arrhythmia e.g. AF, cardiomyopathy, IHD.
  3. Oxygen, Morphine, Furosemide, GTN.
132
Q

Priorities for NOF#

  1. In 2hrs
  2. In 2 days
  3. In 2 weeks
A
  1. Imaging (hip xray), NBM for surgery, adequate analgesia.
  2. VTE prophylaxis from surgery, mobilise ASAP, analgesia and discharge to home plan.
  3. Physiotherapy, follow-up with orthopaedics??, sick-note for work if appropriate.
133
Q
  1. Clinical filing to confirm acute closed angle glaucoma?
  2. 2 Rx, mechanism and route?
  3. Laser Rx?
A
  1. raised IOP on tonometry.
  2. Acetazolamide - reduce secretion, oral. Pilocarpine, mitotic, topical.
  3. Iridotomy, make hole in iris to help secretions drain.
134
Q

What is a confounding factor?

A

A variable that could cause the examined end-outcome of the study (dependent variable) as well as the independent variable.
e.g. Smoking cause lung cancer but does it take into consideration the occupation….?

135
Q

Prostate. Recurrent UTI in man.

  1. 4 other questions to ask in GP Hx?
  2. 3 features possible on a DRE and possible cause?
  3. ∆∆?
  4. Test to confirm?
  5. Complications fo BPH?
A
  1. Weight loss, blood in urine, STI Hx, not peed for prolonged period, completed course of ABX…?
  2. Smooth but large = BPH, nodular and hard = Prostate cancer, Painful = prostatitis.
  3. Prostatitis, BPH, PrCa.
  4. Transrectal USS guided biopsy.
  5. Retention, recurrent UTI.
136
Q

Head injury with pic of panda eyes.

  1. What is in picture?
  2. What is ∆?
  3. Ways to assess awareness except GCS?
  4. How is GCS useful in head injury?
  5. Components of GCS?
  6. Mx when GCS <8
A
  1. Perioribital ecchymosis.
  2. Basal skull fracture.
  3. AVPU, AMT
  4. When to CT, when to intubate….??
  5. Motor (6), eye (4), verbal (5).
  6. Intubate, get anaesthetics, CT head.
137
Q

Acne, hirsuitism, no signs of viralisation, amenorrhea.

  1. 2 ∆∆?
  2. 4 Ix?
  3. 2 non-lab Ix?
  4. 2 Rx for PCOS?
A
  1. PCOS, acromegaly, androgen-secreting tumour.
  2. Sex hormone binding globulin, FSH + LH, testosterone, prolactin.
  3. USS of ovaries, CT adrenals, MRI pituitary.
  4. COCP, metformine, clomifene for fertility.
138
Q
  1. 2 causes of obstruction in infant cystic fibrosis patient?
  2. Mutation in CF?
  3. Screening test for CF?
  4. 3 organisms for CF disease…???
  5. 1 specific organism to isolate?
  6. Complications in later life of CF?
A
  1. Meconium ileus, rectal prolapse, constipation from reduced pancreatic enzymes.
  2. CFTR on chromosome 7.
  3. Guthrie test for immunoreactive trypsinogen.
  4. P.aeruginosa, S.aureus, H.influenza.
  5. ?Burkholderia species.
  6. Infertility, diabetes, depression, chronic sinusitis.
139
Q
  1. Genetics of widely spaced nipples?
  2. Inheritance of Down’s?
  3. Name another trisomy?
  4. Chromosome in Down’s?
  5. Type of inheritance shown whereby the disease is different depending on if the defect is inherited from the mother or the father?
A
  1. Turner’s = Chromsome 45X.
  2. Non-dysfunction of chromosome 21.
  3. Edwards Chr18.
  4. 21
  5. Imprinting.
140
Q

Medical student returns from elective – not feeling well. On examination, has big splenic notch.

  1. 4 medical conditions that can cause this presentation?
  2. 4 gram -ve bacilli in GI tract?
  3. SHO has specific one in mind….?
  4. Sore throat + lymphadenopathy ∆?
  5. Main Ix for this?
A
  1. AML, sickle cell disease, EBV, malaria.
  2. E.coli, Shigella, Salmonella, Campylobacter.
  3. Dunno babe.
  4. EBC, infectious mononucleosis.
  5. Monospot.
141
Q

Example of DNA gras inhibitor.

A

Ciprofloxacin.

142
Q

Inheritance of huntington’s

143
Q

What are neurofibrillary tangles

A

Protein tau

144
Q

Endometriosis.

  1. 2 Qus in Hx?
  2. 4 types of drug to Rx?
A
  1. Cyclical pain, dyspareunia.

2. COCP, GnRH analogues + HRT, NSAIDs

145
Q

2 hormones for calcium regulation and how they act?

A

Parathyroid hormone - raised calcium.

Calcitonin - lowers calcium

146
Q

Principle of the short synacthen test

A

Test for adrenal insufficiency.

Measure cortisol before and after injection of synthetics ACTH.

147
Q

Pulmonary Embolism.

  1. 2 RFx?
  2. 4 preventative measures?
  3. Best Ix?
  4. What to measure before starting LMWH?
  5. Which other anticoagulant to use and how it works?
  6. Complications of a PE and how?
A
  1. COCP, malignancy, recent major surgery.
  2. Compression stockings, early mobilisation from surgery, stop COCP before major surgery, prophylactic anticoagulant e.g. LMWH.
  3. CT pulmonary angiogram.
  4. U+E, FBC, LFT, weight, INR/PT?
  5. APIXABAN, factor Xa inhibitor.
  6. Cardiac arrest due to occlusion of pulmonary vasculature and ventricular collapse. Also chronic VTE can cause pulmonary HTN.
148
Q

Down’s

  1. 6 signs on observation.
  2. Risk factor.
  3. 2 genetic mutations.
  4. 2 CVD malformations.
  5. 2 GI malformations.
  6. 2 things to council patient
A
  1. Small head, epicentral folds, low nasal bridge, small ears, protruding tongue, single palmar crease, wide saddle gap, down-slanting palpebral fissure.
  2. Maternal age.
  3. Non-dysfunction, translocation.
  4. AVSD, PDA, Fallot.
  5. Duodenal atresia, Hirschsprung’s
  6. Psych things, chance of baby inheriting it is same as normal population if conceive under 35years apparently…
149
Q

Staging of malignant melanoma and tumour marker

A

American Joint Committee on Cancer (AJCC) staging system, or Breslow’s thickness….
S-100

150
Q

2 RFx for Vit D def and why does low vit D cause poor bone mineralisation?

A
  1. Malabsorption (coeliac), religious clothing, renal disease.
  2. Low Vit D, reduce calcitriol, activate PTH, increases osteoclastic activity and loose bone.
151
Q
  1. 4 Rfx for gout
  2. 4 trigger for gout
  3. 2 acute drugs and class.
  4. Why favours small distal joints?
  5. MOA of allopurinol?
A
  1. Male, diet high in meat, alcohol intake, renal disease.
  2. Dehydration, alcohol binge, thiazide diuretic, starting allopurinol.
  3. NSAID/COX2 inhibitor e.g. Naproxen, Corticosteroid e.g. pred.
  4. Distal blood supply, cooler, more likely to precipitate crystals.
  5. Xanthine oxidase inhibitor.
152
Q

Histology of coeliacs

A

Crypt hyperplasia, lymphocyte infiltration, villous atrophy.

153
Q

3 fat soluble vitamins and their deficient state

A 
D = osteomalacia.
K = bleeding
E = ataxia
A = poor night vision.
154
Q

Malignancy risk with coeliac

155
Q
  1. Define economic evaluation?

2. What are the 2 parts?

A
  1. The comparative analysis of both cost and consequences of alternative actions.
  2. Cost and effectiveness.
156
Q

What makes up QALYs

A

Quality (utility) and quantity (years)

157
Q

2 types of economic evaluation

A

Cost-benefit, cost-effectiveness, cost-minimisation, cost-utility.

158
Q

What is

  1. Opportunity cost.
  2. Equity
A
  1. spend resources on one activity means a sacrifice in terms of 
lost opportunity elsewhere.
  2. Fair and just distribution.
159
Q

Malaria

  1. Give an antimalarial prophylaxis
  2. 3 reasons for prophlyaxis failure
  3. 2 other measures
  4. Diagnostic test
  5. Cerebral complications
  6. Which species
  7. Which drug to treat
A
  1. Doxycycline
  2. Complicance, resistance, malabsorption…, not 100% effective.
  3. Net, DEET
  4. GIEMSA thick and think blood film. Thick to see if parasite present, thin to identify species/morphology.
  5. Seizure, encephalopathy, cerebral oedema.
  6. Plasmodium falciparum.
  7. Artesunate, chloroquine, primaquine.
160
Q

2 Ix before starting lithium

161
Q

3 neuro signs of lithium toxiciy

A

Coarse tremor, ataxia, hyperreflexia

162
Q

Lung cancer

  1. What is an apical tumour called
  2. 3 features of Horner’s syndrome
  3. Which fibres involved
  4. Why do they get pain in the shoulder and scapula
  5. Which nerve root causes wasting of thenar eminence
A
  1. Pancoast.
  2. Miosis, ptosis, anhydrosis.
  3. Sympathetics.
  4. Referred pain from involvement of phrenic nerve…??
  5. I think T1….?
163
Q
  1. Target sats in acutely unwell patient?
  2. Why would oxygen sats fail to improve with high-flow O2?
  3. What could you do to ensure better sats?
A
  1. 94-98% bless Hypercapnic patient then 88-92%.
  2. V/Q mismatch ?pneumothorax, PE, pulmonary HTN.
  3. Not too sure, maybe less high-flow…?
164
Q

Acute asthma Rx and what to monitor

A
  • A to E, oxygen, IV access etc.
  • Salbutamol high dose, inhaled/nebuliser.
  • Nebulised Ipratrooium bromide.
  • Steroids either oral if tolerated or IV hydrocortisone.
  • Magnesium sulfate IV, Aminiphylline IV –> need senior staff review first!
  • Monitor PaO2, ABG (lactates), U+E (hypokalaemia).
165
Q

Management of chronic asthma and what to monitor

A
  • Monitor spirometry, inhaler technique, use of PRN salbutamol, hospital admissions.
    1. PRN nebulsed salbutamol.
    2. Low dose inhaled corticosteroid e.g. beclametasone.
    3. Add Leukotriene receptor antagonist e.g. Montelukast.
    4. + LABA e.g. salmeterol as part of MART regime.
166
Q

Angina.

  1. 2 features may see on ECG?
  2. What to council patient on when prescribing GTN?
  3. 2 drugs to Rx angina and mechanisms of action?
  4. ECG has changes in leads 1, V4-V6, what artery is affected?
  5. What is definitive Rx?
A
  1. None, ST depression, T wave inversion, evidence of old MI with Q waves.
  2. SE e.g. headache, postural hypotension, not to take viagra, if having angina attack that GTN, wait 5 mins then take again, if after 2nd dose no relief call 999.
  3. beta-blocker, CCB
  4. Left Circumflex artery.
  5. PCI.
167
Q
  1. 2 signs for Cushing’s?
  2. 2 initial investigations?
  3. Ix to find cause?
    Then Patient’s U&E’s = Sodium normal, potassium low, urea and creatinine normal.
  4. What hormone is causing this?
  5. What receptor does it act on?
  6. 2 Rx to acutely treat this problem?
A
  1. Central obesity, hirsutism, acne, facial plethroa, HTN.
  2. Overnight dexamethasone suppression test, serum ACTH.
  3. CT adrenals/pituitary MRI.
  4. ?ADH (Diabetes insipidus…?)
  5. V2 receptor.
  6. Desmopressin, IV fluids (0.9% saline) not too sure how correct this is (maybe its excess aldosteronism…).
168
Q
  1. 4 causes of acute pancreatitis?
  2. Blood test for ∆?
  3. Except USS what Ix for gallstones in common bile duct?
  4. Next step in Ix/Mx for gallstones?
  5. Patient isn’t a diabetic but has high glucose, why can pancreatitis lead to impaired glucose tolerance?
  6. Gets diarrhoea later, why?
A
  1. Gallstones, alcohol, hypercalcaemia, EMV, trauma.
  2. amylase, lipase.
  3. Endoscopic retrograde cholangiopancreatography.
  4. If keeps getting them or lots in gallbladder - laparoscopic cholecystectomy
  5. Inflammation of pancreas, poor secretion of insulin.
  6. Malabsorption from excessive bile acid…?
169
Q

Osteoarthritis.

  1. 2 RFx?
  2. 4 features on Xray?
  3. 2 meds to use?
  4. 2 non-drug Mx?
A
  1. Obese, older age, physical/manual work.
  2. Loss of joint space, oeseophytes, subcentral sclerosis, sybchondral cysts.
  3. Topical NSAID e.g. diclofenac, intra-articular corticosteroid injections e.g. methylprednisolone.
  4. Physio exercises, correct footwear, walking aids.
170
Q

Pre-eclampsia.

  1. 3 material or fetal complications.
  2. 3 parts to management plan.
  3. Has low Hb and high liver enzymes - why, what is rare condition?
A
  1. Placenta abruption, eclampsia/seizures, intra-uterine growth restriction.
  2. labetalol, nifedipine, regular BP monitoring, deliver baby in hospital.
  3. I think HELLP
171
Q

Best imaging for multiple areas of lymphoma

172
Q

Stage of lymphoma if cervical lymphadenopathy, splenomegaly and ascites + night sweats

A

Ann Arbor IVB

173
Q

4 causes of ascites

A

Chronic liver disease
Ovarian cancer
Congestive heart failure
Nephrotic syndrome

174
Q

6 year old with hearing loss and bilateral crusty yellow ears/red ear.

  1. Explain how an audiograms works and what it shows.
  2. Explain what a tympanogram measures.
  3. Given audiogram. Explain what is shown. Bone conduction > air conduction
A
  1. Shows what frequencies patient is able to hear in left and right ears.
  2. Assess middle ear functioning. Compliance of tympanic membrane to changes in pressure.
  3. Conductive hearing loss.
175
Q

2 compilations of mumps

A

Meningits, deafness, infertility

176
Q

Difference between Parkinson’s tremor and essential tremor

A

Essential = worse on activity.

177
Q

3 causes of AF

A

Hypertension, mitral stenosis, post-MI.

178
Q

Paracetamol OD.

  1. What aspect of law can you treat her under?
  2. What part can you use to admit her?
A
  1. MHA.

2. Section 2.

179
Q
  1. Pathogen in Legionella?

2. Mx of Legionella?

A
  1. Legionella pneumophila

2. Clarithromycin.

180
Q

Pt comes in with a cold, extremely painful lower leg. You believe he may have lower limb ischaemia.

  1. List 3 findings from examination of the leg which would indicate that this is the diagnosis
  2. List 3 things you might find on examination which would suggest the cause of the blockage?
  3. Before the vascular surgeons arrive, which one drug would you give to help?
  4. List 2 non-invasive tests which you would perform urgently?
A
  1. Pallor, pulseless, paraesthesia, paralysis.
  2. CRT at different levels of leg, hair presence, ulcers, Buerger’s angle.
  3. Aspirin.
  4. Doppler USS, ABPI.
181
Q

What is primary ovarian failure?

A

Menopause before 40.

182
Q

What hormones are similar structure to beta-hCG

A

TSH, LH, FSH

183
Q

Difference between comminuted and compound fracture

A 
Compound = pierce skin.
Comminuted = fracture creates 2 separate bone components.
184
Q

Good drug for hyperthyroidism in pregnancy

A

Propylthiouracil

185
Q

Drug to prevent tumour lysis syndrome/uric acid build up

A

Rasburicase / Allopurinol.

186
Q
  1. 4 definitive Mx for fracture?

2. Non-surgical parts to management (basically what would you do as FY1 on TAO ward)?

A 
1. Open reduction and internal fixation (re-align and stabilise with plates/screws).
External fixation (immobile with external framing and screws).
Short leg cast/splint.
?Closed reduction (not surgically exposing bone)
  1. Immobilise joint, analgesia, VTE prophylaxis for surgery and NMB, order imaging, ABx if open injury.
187
Q

best Ix for diabetic nephropathy

A

Albumin:creatinine ratio (ACR) in early morning specimens. An ACR of > 2.5 = microalbuminuria

188
Q
  1. 2 early signs of dementia?
  2. Which type of dementia has a fluctuating course with visual hallucinations?
  3. CFx which would suggest an organic cause for poor cognitive function?
A
  1. Amnesia, decrease cognitive function, apraxia, aphasia.
  2. Lewy body
  3. Focal neurological deficit e.g weakness, acute/rapid onset.
189
Q
  1. Which blood vessel is involved in an subdural?
  2. Why are old people are more risk?
  3. 2 reasons for draining a subdural?
  4. 4 complications of drainage?
A
  1. Bridging veins from hemisphere to dural sinus.
  2. Brain atrophy with age means longer bridging veins, so more susceptible to rupture.
  3. Raised ICP, focal neuro deficit, seizures.
  4. Infection, haemorrhage, brain tissue injury causing permanent damage, brain oedema, seizures.
190
Q
  1. 3 classic symptoms of DKA
  2. What are 3 metabolic/biochemical abnormalities you would expect in DKA?
  3. 5managements for this pt in next 24 hours?
A
  1. Polyuria, polydipsia, keton smell, Kassmaul’s breathing.
  2. Hyperglycaemia, metabolic acidosis, hyperkalaemia (can be low esp with Rx).
  3. A to E, fluids and electrolyte correction (0.9% saline with potassium supplements if necessary), fast action insulin e.g. ACTRAPID, monitor BM when below 13 infuse insulin, monitor ketones.
191
Q
  1. Common valve for endocarditis in IVDU?
  2. Pathology behind raised JVP abnormality?
  3. Why do you need high dose and long course of ABx?
A
  1. tricuspid.
  2. Prominent V wave in JVP. tricuspid valve damage leads to regurgitation in systole causing increase in right atrial pressure.
  3. Heart valve and vegetation have little direct blood supply to them.
192
Q
  1. Landmark for top of scrotum?
  2. 3 things to palpate on scrotom?
  3. GP Ix for hydrocele?
  4. Urologist Ix for hydrocele?
  5. Where is a hydrocele?
  6. What structure does it arise from embryologically?
  7. 2 causes not surgery or trauma?
A
  1. Pubic tubercle.
  2. testes, epididymis, spermatic cord.
  3. Transilluminates with pen torch
  4. USS
  5. Tunica vaginalis
  6. Processus vaginalis
  7. testicular tumour, nephrotic syndrome, heart failure.
193
Q

Most likely cause of primary hyperparathyroidism?

A

Parathyroid gland adenoma

194
Q

10 week old baby with respiratory distress (noisy breathing, resp rate 64).

  1. 2 signs of respiratory distress on inspection?
  2. 2 signs of bronchiolitis on auscultation?
  3. Would you ask for CXR, and why?
  4. What organism is the most common cause of bronchiolitis?
  5. 2 other organisms which can cause bronchiolitis?
  6. 2 safety net advise for parents?
A
  1. intercostal recessions, nasal flaring, grunting.
  2. High pitched wheeze, crackles
  3. No required, if querying diagnosis.
  4. Respiratory syncytial virus.
  5. Rhinovirus, influenza virus.
  6. Cyanosis, drowsy, drooling.
195
Q
  1. triggers for vaso-occulsive crisis in sickle cell?

2. Other than analgesia and blood ix, what are 4 parts tot the management plan?

A
  1. Exercise, infection, hypoxia.

2. Oxygen, fluid correction, blood transfusion, hydroxycarbamide.

196
Q

Wells score for DVT

A

Active cancer
Paralysis or recent immobilisation
Recent surgery or bed ridden
Localised tenderness in deep vein distribution
Entire leg swollen
Calf swelling >3cm than unaffected leg
Pitting oedema in symptomatic leg
Collateral superficial veins which are not varicose
PMHx of DVT
Alternative diagnosis is likely then MINUS 2 PTS.

DVT likely is greater or equal to 2 pts.

197
Q

Wells score for PE

A 
Active cancer
Haemoptysis
PMHx of PE or DVT
Recent surgery or immobilisation
HR >100bpm
Alternative ∆ not likely
CFx of a DVT

PE likely if greater or equal to 5 points.

198
Q
  1. why take 3 samples of CSF in SAH?

2. What would you see in CSF and when?

A
  1. make sure if blood is in sample it is from bleed not traumatic tap.
  2. Xanthochromia after 12hrs.
199
Q

Addisons.

  1. Why raised urea, creatinine, potassium and low sodium?
  2. Ix?
  3. 2 drug classes and an example used to Rx?
  4. 2 Cfx of an Addisonian crisis?
A
  1. No aldosterone so lack of sodium reabsorption and lack of potassium secretion into urine. Urea and creatinine indicate renal failure form hypovolaemia.
  2. Short synathen test.
  3. Hydrocortisone – glucocorticoid
    Fludrocortisone – mineralocorticoid
  4. Abdo pain, N+V, hypotension (dizzyness)
200
Q

Cause of itch in liver disease? and Rx

A

Raised bile salts.

Colestyramine.

201
Q

Primary biliary cirrhosis.

  1. 3x complications of PBC
  2. Reason for oesophageal varices?
  3. Management
A
  1. Cirrhosis, hepatic encephalopathy, coagulopathy, hepatocellular carcinoma.
  2. Portal hypertension causes collaterals to form between systemic and portal circulation including in lower oesophagus.
  3. Of Varicose = prophylactic beta-blockers, If acute IV terlipressin, band ligation, endoscopy.
202
Q

2 drug Rx for angina and mechanism of action

A

Beta-blockers = decrease HR, decrease conduction velocity, reduce work of heart –> reduce oxygen demand.
Calcium channel blockers = decrease contractility, decrease heart rate, decrease conduction velocity –> reduce after load, reduce oxygen demand

203
Q

2 side effects of lithium in therapeutic limits

2 side effects of lithium in toxic dose

A

Metallic taste, fine tremor, weight gain,

Coarse tremor, ataxia, confusion.

204
Q

haemophilia:

  1. Inheritance
  2. 2x management (1x mechanical, 1x pharmacological)
  3. Treatment that GP can prescribe-
  4. PT/APTT/Bleeding time: increased, decreased or normal?
A
  1. X linked
  2. Elevate limb, Factor 8
  3. Desmopressin, tranexamic acid.
  4. PT normal, APTT long, bleeding time normal.
205
Q
  1. pathogen in haemolytic uraemia syndorme?
  2. Why anaemic?
  3. Seen in blood film?
A
  1. Escherichia coli O157:H7
  2. Microangiopathic haemolytic anaemia.
  3. Schistocytes.
206
Q

1 symptom and 1 sign in hypokalaemia

A

Muscle weakness
Tetany
Palpitations

207
Q

If in stroke they get amaurosis fugax, what artery?

A

Ophthalmic or retinal artery emboli.

208
Q

Full name of H.pylori
Eradication meds
best Ix

A

Helicobacter pylori
Lansoprazole + amoxicillin + clarithromycin
Carbon urea breath test.

Past Questions (3 decks)

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