AKT

Question 1

Answer 1

C) essential to exclude hypercalcaemia due to hyperparathyroidism before continuing to water deprivation test

Question 2

Answer 2

CHADSVASC -> AF with stroke, anticoagulate

Question 3

Answer 3

increased risk of contrast nephropathy -> IV saline

Question 4

Answer 4

B

rhabdo would give CK of over 10,000

Question 5

Answer 5

D

Sounds like cervical spine fracture -> CT neck

Question 6

Answer 6

D

Non-invasive diagnostic test for PSC is MRCP

Question 7

nuclear enlargement,
hyperchromasia and pleomorphism suggest…

Answer 7

carcinoma

Question 8

treating respiratory acidosis in an alert patient

Answer 8

NIV

Question 9

anterior pack vs cautery for epistaxis?

Answer 9

cautery - bleeding point visible
anterior pack - profuse bleeding with site difficult to localise

Question 10

source of major bleeding in peptic ulcer disease

Answer 10

gastroduodenal artery runs posterior to
the first and second parts of the duodenum and may be a source of major
haemorrhage in peptic ulcer disease

Question 11

Answer 11

spinal cord compression, likely due to mets -> frail so radiotherapy

Question 12

Answer 12

vasopressors after fluid resuscitation!

Question 13

Answer 13

supraspinatus tendinopathy -> refer for physio/general advice for home exercises

Question 14

Answer 14

early Alzheimer’s - particularly temporal lobe affected, especially hippocampus

Question 15

treating TCA overdose

Answer 15

bicarbonates

Question 16

Answer 16

for major abdominal surgery in
respiratory disease opioid, by whatever route, should be avoided!!

epidural anaesthia can be topped up and titrated

Question 17

Answer 17

i-gels are often used in cardiac arrest
situations as they are easier to place than tracheal tubes. However, only the
tracheal tube can seal the trachea off and protect against aspiration.

Question 18

Answer 18

B) 2h for clear liquids, 6h for solids

Question 20

Answer 20

osteoarthritis - RA typically affects multiple joints

Question 21

Answer 21

Myasthenic crisis is an acute respiratory failure
characterised by forced vital capacity (FVC) below 1 L, negative inspiratory
force (NIF) of 20 cm H2O or less, and the need for ventilatory support.

Question 22

Answer 22

ovary commonly drains to para-aortic

Question 23

diabetes medications pre-op

Answer 23

diabetes medication can be broadly subdivided
into two categories.
o Drugs that lower blood glucose levels.
These include insulin and the
sulphonylureas. These drugs are
associated with hypoglycaemia in the
fasted state, and will always require
perioperative dose manipulation.
o Drugs that prevent blood glucose from
rising e.g. metformin, GLP-1 analogues,
DPP-IV inhibitors, SGLT2 inhibitors.
These drugs will never/rarely cause
hypoglycaemia in the fasted state, and
will only require dose manipulation if
there are other concerns.
* In basal – bolus insulin regimens and the
continuous subcutaneous insulin infusion (CSII),
the basal component provides the background
insulin, whilst the bolus component provides the
insulin to deal with the glucose load from meal
times. Perioperative manipulation will always
involve avoidance of the bolus dose associated
with meals. Minor reduction of the basal dose is
prudent to avoid hypoglycaemia that may be
associated with lack of snacking/ lack of early
morning breakfast.

Question 24

symptomatic gallstone disease

Answer 24

laparoscopic cholecystectomy

Question 25

compression bandages vs stocking

Answer 25

bandages - treating a venous ulcer stockings - preventing further lesions

Question 26

Answer 26

The combination of hypoalbuminaemia, proteinuria, oedema, hypercholesterolaemia etc. is characteristic of nephrotic syndrome. The most likely causes in the age group (without diabetes) would be membranous nephropathy, minimal change or FSGS. Myeloma would also need to be considered. A renal biopsy would be required to confirm the diagnosis

Question 27

Answer 27

neurogenic claudcation (coming on with walking, better when leaning forwards incl riding a bike)

Question 28

Answer 28

prevents passage of gastric contents into the airway - cricoid cartilage is a complete ring; pressure on the front is transmitted to the back and this seals the oesophagus, preventing gastric contents in a patient who is not fasted or has abdominal problems from passing higher up and possibly entering the airway

Question 29

Answer 29

the breakthrough dose should be one-sixth of the total daily dose. The current daily morphine dose is 180 mg, hence MST continus at 90 mg 12 hourly and the breakthrough at morphine 30 mg.

Question 30

Answer 30

T1 nerve root - intrinsic hand muscle wasting suggests T1. normal reflexes and normal other arm are against a cord lesion. sensory loss on forearm excludes median and ulnar nerve lesions. T1 dermatome often thought to be higher in the arm medially

Question 31

Answer 31

cervical spine immobilisation! sequence of care for potential trauma patient. no mention of a collar so should be applied. need to be done before any of the other options. CT head and CXR required. IV vit K not indicated as he is not on warfarin

Question 32

Answer 32

right temporal lobe: aura implicates this

Question 33

Answer 33

lobar pneumonia -> strep pneumoniae

Question 34

Answer 34

intestinal metaplasia

Question 35

compression bandages vs stockings

Answer 35

bandages - treating a venous ulcer stockings - preventing further lesions

Question 36

Answer 36

acute cholecystitis - amylase not high enough for pancreatitis, bilirubin not high enough for choalngitis, no inflammatory response for biliary colic, LFTs normal excluding hepatitis

Question 37

Answer 37

ICP secondary to mets

Question 38

Answer 38

short duration acute low back pain in fit person -> continue usual activity

Question 39

Answer 39

sub-massive pulmonary embolus but also at risk of haemorrhage. in this setting, IV unfractionated heparin can be stopped and reversed in event of recurrent bleeding

Question 40

first line investigation for renal stones

Answer 40

CT KUB

Question 41

Answer 41

repeat urea and electrolytes in 2 weeks

Question 42

Answer 42

culture results can be false -ve, immuosuppressed so higher risk of SA -> treat with IV fluclox

Question 43

Answer 43

sitagliptin approved for use in CKD

Question 44

Answer 44

when there is a unilateral sensorineural hearing loss, it is vital to exclude the presence of a vestibular schwannoma or other neoplasm of VIII nerve or brainstem - done via an MRI scan

Question 45

Answer 45

E: stool cultures should form part of work up in primary care before referral

Question 46

Answer 46

cataplexy - presents with loss of skeletal muscle tone with strong (usually positive) emotions

Question 47

Answer 47

De Quervain tendinopathy - history of atraumatic radial wrist pain with tenderness and enlargement at the first dorsal compartment over the radial styloid and pain at the radial styloid with active or passive stretch the thumb tendons over the radial styloid in thumb flexion

Question 48

Answer 48

activated charcoal for people who have self harmed by poisoning, who present early (within 1 hour of ingestion), fully conscious with a protected airway, and are at risk of significant harm as a result of poisoning

Question 49

Answer 49

perform a full primary survey

Question 50

clinical cord compression imaging

Answer 50

MRI

Question 51

Answer 51

spirometry -> COPD

Question 52

Answer 52

lung mets

Question 53

Answer 53

add paracetamol as required

Question 54

Answer 54

SNB is diagnostic not therapeutic if 3 nodes are involved, so more surgery is needed

Question 55

Answer 55

patient has had 2 weeks of tx for suspected mastitis with no effect - if condition does not improve with Abx treatment, raises questionof whether diagnosis correct or if underlying issue e.g. abscess or inflammatory breast cancer which can mimic mastitis

Question 56

Answer 56

all patients with claudication to be offered structured exercise programme before considering angioplasty, surgical intervention, or vasodilator therapy. Intervention only considered if structured exercise programme has been followed but no satisfactory improvement in Sx. Vasodilator therapy after structured exercise programme + patient declines angioplasty/surgery

Question 57

Answer 57

Heterozygous familial hypercholesterolaemia commonest genetic lipid disorder which would give this profile NICE CKS says to suspected FH in an adult if: - total cholesterol concentration > 7.5mmol/L and there is a personal or family history of premature CHD (before age of 60 in first-degree relative)

Question 58

what is this rash

Answer 58

urticaria

Question 59

Answer 59

classic history of malignant transformation in a pleomorphic salivary adenoma

Question 60

Answer 60

primary pneumothorax: 2cm or w symptoms -> treat with aspiration or ambulatory device secondary pneumothorax: chest drain for pneumothorax greater than 2cm

Question 61

osteoarthritis first line management

Answer 61

topical NSAID

Question 62

trigeminal neuralgia first line

Answer 62

carbamazepine

Question 63

Answer 63

haemorrhage compressing the airway - complication of carotid endarterectomy

Question 64

Answer 64

amaurosis fugax due to emboli from atherosclerotic plaques in carotid artery. Emboli typically originate from the ipsilateral internal carotid artery. Right eye sx -> right internal carotid artery

Question 65

Answer 65

if SABA insufficient, either LAMA or LABA may be used patient hsa a history of prostatic enlargement, so LAMA contraindicated

Question 66

cryptosporidium management

Answer 66

self limiting, usually no treatment needed

Question 67

Answer 67

bendroflumethiazide increases renal calcium absorpion -> low level hypercalcaemia