4th Year CAP

Question 1

What strongly suggests congenital heart disease in a newborn?

Answer 1

delay in femoral pulses

Question 2

What is smasmodic torticollis also known as?

Answer 2

cervical dystonia

Question 3

Describe cervical dystonia.

Answer 3

Head turns to one side due to contraction of sternocleidomastoid muscle, patient finds it difficult to keep head facing forward

Question 4

What is blepharospasm?

Answer 4

spasm of eyelid

Question 5

What is hemiballismus?

Answer 5

uncontrolled flailing of the limbs

Question 6

What causes bronchiolitis?

Answer 6

RSV

Question 7

Treatment for campylobacter in an otherwise well individual?

Answer 7

supportive care only

Question 8

Treatment for salmonella typhoid?

Answer 8

IV ceftriaxone

Question 9

Rapidly contracting human muscle cells start producing lactic acid - why?

Answer 9

because the cells must convert NADH to NAD+

Question 10

What certificate is needed is a psychiatrist wants to give ECT to a patient with severe depression, but the patient doesn’t want it as he believes it will kill him?

Answer 10

certificate of designated medical practitioner

Question 11

What type of hearing loss occurs is otosclerosis?

Answer 11

conductive hearing loss

Question 12

In what condition do the vessels cross fetal membranes, causing severe fetal distress and intrapartum bleeding following rupture of membranes?

Answer 12

vasa previa

Question 13

What are responsible for elevating the section of the respiratory tract containing the vocal cords?

Answer 13

longitudinal muscles of the pharynx

Question 14

Which muscles are just superficial to the transversus abdominus?

Answer 14

internal obliques

Question 15

What muscle acts as a respiratory accessory muscle and is attached to rib 1?

Answer 15

Scalenus anterior

Question 16

6 week histoy of sore throad and hoarse voice?

Answer 16

laryngopharyngeal reflux

Question 17

Paraproteins associated with?

Answer 17

multiple myeloma

Question 18

Which neurotransmitter is most involved in appetitive and approach
systems?

Answer 18

Dopamine

Question 19

Treatment of MODY Diabetes?

Answer 19

Low dose sulfonylureas eg gliclazide

Question 20

A 16 year old man presents with a 48 hour history of cramping lower
abdominal pain, associated with diarrhoea and vomiting. The pain is worst
just prior to defecation. On examination he has a temperature of 37.5, heart
rate of 84bpm and his abdomen is soft but generally tender

Answer 20

Gastroenteritis

Question 21

A 40 year old lady presents with a 3 day history of progressive, sharp, right
upper abdominal pain. She states that the pain radiates to her right shoulder
and is worse on inspiration. On examination she has a temperature of 38.9,
heart rate of 102bpm and is tender in her right upper quadrant

Answer 21

Cholecystitis

Question 22

A 21 year old man presents with a 6 hour history of severe, constant, central
abdominal pain. He has vomited twice and describes shaking
uncontrollably at times. On examination he is bent over with the pain, his
temperature is 38.5 and heart rate 128bpm.

Answer 22

Appendicitis

Question 23

What allows detention of a patient in hospital for 6 months in the first instance?

Answer 23

compulsory treatment order

Question 24

. A 78 year old female presents with a gradual painless loss of vision in both
eyes. Visual acuities are 6/12 in the right and 6/18 in the left eye. Red
reflexes are diminished on examination

Answer 24

cataracts

Question 25

An 84 year old male presents with a sudden painless loss of central vision in his right eye. He has been aware of distorted vision from this eye for the past few days. Ophthalmoscopy reveals a large solitary haemorrhage at the fovea in the affected eye.

Answer 25

wet age related macular degeneration

Question 26

A long-sighted 52 year old male presents with a sudden loss of vision in his left eye which is painful and red. He has noticed halos around lights, is nauseated and has vomited. On examination the pupil is mid-dilated and non-reactive.

Answer 26

Acute closed angle glaucoma

Question 27

Highest mortality rate out of bipolar, schizoaffective disorder, depression and anorexia nervosa?

Answer 27

Anorexia nervosa (approx 18% mortality rate)

Question 28

A change from one mature cell type to another is known as what?

Answer 28

metaplasia

Question 29

abnormal cell | proliferation?

Answer 29

neoplasia

Question 30

A 30 year old presents with itchy blisters on extensor surfaces. Immunofluorescence reveals granular IgA at the dermal papillae. What is the most likely diagnosis?

Answer 30

dermatitis herpetiformis

Question 31

A 54 year old man presents with cough, fever and right sided chest pain. Chest x-ray shows right sided consolidation. Blood cultures are positive. Which is the most likely organism and what is its stain?

Answer 31

strep pneumonia | Gram positive diplococci

Question 32

What antibody would be involved in the following: A 45 year old woman who has experienced red hot swollen joints, symmetrically in her hands and feet. Her inflammatory markers are raised.

Answer 32

Anti-CCP antibodies (Rheumatoid arthritis)

Question 33

What antibody would be involved in the following: A middle-aged woman who complains of her fingers turning blue in the cold, and heartburn. Her echocardiogram shows elevated pulmonary arterial pressures.

Answer 33

Anti-centromere antibody (Systemic sclerosis)

Question 34

A 40 year old man is admitted with fever and confusion. A CT scan is performed prior to lumbar puncture and shows evidence of inflammation in the right temporal lobe.

Answer 34

Herpes Simplex encephalitis

Question 35

A preterm neonate born at 32 weeks becomes floppy and cyanosed. Meningitis is suspected. CSF is obtained and gram positive cocci in chains are observed. Mum was noted to be carrying this organism in the vagina earlier in pregnancy

Answer 35

Group B Strep

Question 36

Which neurotransmitter is most involved in aversive and defensive systems?

Answer 36

Serotonin

Question 37

What is important to note about phenytoin in woman's health?

Answer 37

It reduces contraceptive efficacy as it induces liver enzymes.

Question 38

Is bradycardia or tachycardia a side effect of Anticholinesterase inhibitors?

Answer 38

Bradycardia

Question 39

Describe how the detrusor muscle is inhibited.

Answer 39

``` Sympathetic innervation acts via beta adrenergic receptors to inhibit the detrusor ```

Question 40

A 75 year old man with COPD, ischaemic heart disease and hypertension who has a painful ulcer on the right foot. ABPIs are left 0.76, right 0.68

Answer 40

Arterial Disease

Question 41

A 58 year old lady with an undiagnosed mixed connective tissue disease has multiple superficial ulcers over both lower legs from the knee down. Purpura is evident on the intact skin

Answer 41

Vasculitis

Question 42

An 82 year old lady with ulcers on both malleoli of the left leg and lipodermatosclerosis of surrounding skin. ABPI left 1.13, right, 0.96.

Answer 42

Venous insufficiency

Question 43

Drainage of the aqueous humour is via what?

Answer 43

Trabecular meshwork

Question 44

A 2 day old infant born at term after uneventful pregnancy started vomiting. The vomit is non projectile, mild and green in colour.

Answer 44

volvulus

Question 45

A 2 week old infant who was born at term after uneventful pregnancy and developed vomiting at the age of four days. The infant has been breast fed. The vomiting is projectile and associated with constipation. The infant appeared well and eager to feed.

Answer 45

Pyloric stenosis

Question 46

. A 3 week old infant born at term, bottle fed, who started vomiting on day seven. The vomit is of small amount, effortless and after almost every feed. The infant appears well and gains weight appropriately. The infant is taking around 150 ml/kg/day of milk.

Answer 46

Gastri-oesophageal reflux

Question 47

A 27 year old man presents to the Emergency Department stating he has taken an overdose of paracetamol (approximately 16 tablets) 6 hours ago. Blood tests show a paracetamol level of 100mg/L What should be done?

Answer 47

start acetylcysteine infusion

Question 48

Most common symptom in compartment syndrome?

Answer 48

pain out of proportion

Question 49

Treatment for endometriosis?

Answer 49

combined oral contraceptive pill/IUD

Question 50

A 56 year old woman with proximal muscle pain and weakness for 4 months. On examination, her muscle power is 3/5 on the MRC scale. Her inflammatory markers are elevated and her creatinine kinase is 12,000. (normal range between 40 and 320)

Answer 50

Polymyositis

Question 51

A 56 year old woman with proximal muscle pain and stiffness for 4 months. On examination, her muscle power is 5/5 on the MRC scale. Her inflammatory markers are elevated. Her creatinine kinase is normal

Answer 51

Polymyalgia rheumatica

Question 52

How does lamotrigine work?

Answer 52

Blockade of voltage sensitive sodium channels

Question 53

What is the age (in months) at which it is recommended that child height rather than length should be measured.

Answer 53

24

Question 54

The percentage of children that will have a height within 2 standard deviations of the mean?

Answer 54

95%

Question 55

Complication of thyroidectomy?

Answer 55

damage to recurrent laryngeal nerve can lead to hoarse voice

Question 56

. A 24 year old man with schizophrenia is brought to hospital by the police. He is very agitated and attempts to punch one of the nurses. He is restrained and given 5mg haloperidol intramuscularly. He initially becomes calmer but two hours later he becomes agitated again. The psychiatrist examines him and finds him to be sweaty with pyrexia and rigidity.

Answer 56

Neuroleptic malignant sydrome

Question 57

An 82 year old woman with dementia is agitated in the evenings. No physical cause is found and she is prescribed amisulpride 25mg at 6pm. She is reviewed the following week and is found to have muscular rigidity, tremor and reduced mobility

Answer 57

Parkinsonism

Question 58

Common signs of digoxin toxicity?

Answer 58

blurred vision