AKT Flashcards
1
Q
A
- Branch retinal vein occlusion
2
Q
- A 78 year old woman has back pain and bilateral leg weakness. She had
surgery for breast cancer 14 years ago. She had a minor fall at home a few days ago. She has weakness of hip flexion bilaterally. What is the diagnosis ?
A
- Spinal cord compression
3
Q
- When investigating polyuria and polydipsia what tests should be ordered ?
A
- U+E
- Serum and urine osmolality
- Ca2+ should be checked before water deprivation test
4
Q
- What medication is used for long term secondary stroke prevention ?
A
- Anticoagulation e.g. Apixaban or warfarin
5
Q
- When using contrast in a CT scan for a patient with CKD what should be given before the scan ?
A
- 0.9% NaCl infusion at 1mL/Kg
6
Q
- What value CK would a patient with rhabdomyolysis have ?
A
- > 10000
7
Q
- What metabolic abnormality can Bendroflumethiazide cause ?
A
- Hyponatremia and hypokalemia
8
Q
- How best if a suspected cervical spine fracture investigated ?
A
- CT neck
9
Q
- How does supraventricular premature beats present ?
A
- Intermittent palpitations
- Episodes of feeling like heart stops for a second followed by pounding sensation
- Commonly while falling asleep
10
Q
- How is primary sclerosing cholangitis investigated ?
A
- MR cholangiopancreatography
11
Q
- What features of needle biopsy would suggest a carcinoma ?
A
- Nuclear enlargement
- Hyperchromasia
- Pleomorphism
12
Q
- How is a COPD exacerbation with acidosis treated ?
A
- Non-invasive ventilation (BiPaP)
13
Q
- How is a endocarditis diagnosis confirmed ?
A
- Transesophageal echocardiogram
- Blood cultures
14
Q
- What are the components of a CHA2DS2-VASc score ?
A
- Congestive heart failure
- Hypertension (inc. being treated)
- Age (65-74 = 1) (>75 = 2)
- Diabetes
- Stroke/TIA
- Age (again)
- Vascular disease
- Sex (female = 1)
15
Q
- How is extensive epistaxis with a visible bleeding site ?
A
- Cautery using silver nitrate
16
Q
- When is an anterior pack useful for profuse epistaxis ?
A
- When the bleeding site is difficult to localise (often due to profuse bleeding)
17
Q
- What is a paralytic ileus ?
A
- Normal peristalsis that pushes the contents of the small bowel along the length of the intestines temporarily stops
18
Q
- What are potential causes of ileus (paralytic ileus) ?
A
- Injury to bowel
- Handling of the bowel during surgery
- Inflammation or infection in or nearby the bowel e.g. peritonitis, appendicitis, pancreatitis or pneumonia
- Electrolyte imbalance e.g. hypokalemia or hyponatremia
- MCC is following abdominal surgery
19
Q
- Signs and symptoms of paralytic ileus
A
- Vomiting – particularly green bilious vomiting
- Abdominal distension
- Diffuse abdominal pain
- Absolute constipation and lack of flatulence
- Absent bowel sounds
20
Q
- How will bowel sounds differ between paralytic ileus and mechanical obstruction ?
A
- Absence of bowel sounds in paralytic ileus
- Mechanical obstruction will have ‘tinkling’ bowel sounds
21
Q
- A 65 year old man has abdominal distension and vomiting 48 hours after a sigmoid colectomy with primary anastomosis for bowel cancer. He has not passed any flatus for 24 hours. He is taking regular paracetamol and as required intravenous morphine. His abdomen is distended with tenderness over the wound but no rebound or guarding. There are no bowel sounds. His temperature is 37.6°C, pulse rate 96 bpm and BP 122/85 mmHg. What is the diagnosis and what management should be implemented ?
A
- Paralytic ileus
- NIB
- NG tube if vomiting
- IV fluids to prevent dehydration and correct electrolytes
- Mobilization
- TPN may be required whilst waiting for the bowel to regain function
22
Q
- A 23 year old man attends the sexual health clinic with a painful swelling in his groin and pain when opening his bowels. He had unprotected anal sex with a new male partner 4 weeks ago. He has a perianal ulcer and tender inguinal lymphadenopathy. What is the most likely diagnosis ?
A
- Lymphogranuloma venereum
- A type of chlamydia that is common in MSM in the UK
23
Q
- What blood vessel runs posterior to the 1st and 2nd parts of the duodenum and is a source of major haemorrhage in peptic ulcer disease ?
A
- Gastroduodenal artery
24
Q
- What blood vessel supplies the distal 3rd of the duodenum ?
A
- Superior mesenteric artery
25
Q
- What hormone levels would suggest PCOS and what additional symptoms would aid diagnosis ?
A
- Increased ratio of LH:FSH
- Oligomenorrhoea
- High BMI
26
Q
- How does IgA nephropathy present ?
A
- Visible haematuria
- A few days after URTI
- Blood 3 + and protein 3+
27
Q
- How does postinfectious glomerulonephritis
A
- Haematuria ~2 weeks post infection
- More benign than IgA nephropathy (less blood)
28
Q
- What type of ulcer is worse on eating ?
A
- Gastric ulcer
29
Q
- What kind of ulcer is better on eating ?
A
- Duodenal ulcer
30
Q
- How would a duodenal ulcer present ?
A
- Epigastric pain that radiates into his back
- Worse at night
- Better after eating
- Made worse by stress
31
Q
- How would a gastric ulcer present ?
A
- Epigastric pain
- Worse on eating
- Weight loss
32
Q
- What is a specific feature of inflammatory back pain ?
A
- Improves with activity
33
Q
- How is acute gout managed ?
A
- 1st line = NSAIDs or colchicine
- 2nd line = oral steroids e.g. prednisolone 15mg/day
34
Q
- A patient with sepsis is hypotensive despite fluid resuscitation. What should they be treated with next ?
A
- Vasoconstrictors e.g. Noradrenaline/norepinephrine
35
Q
- How is right supraspinatus tendinopathy managed ?
A
- General advice and home exercise
- Referral to physiotherapist
36
Q
- A 34 year old man has pain in his right shoulder and upper arm for 6 weeks that worsens when elevating his arm above his head. He does not recall any injury. There is no deformity, tenderness or reduced range of movement. There is pain on abduction of the right shoulder that is worse with the arm in internal rotation and when abduction is resisted. He is treated with ibuprofen. What does this patient have ?
A
- Supraspinatus tendinopathy
37
Q
- What part of the brain is most affected in early Alzheimer’s disease ?
A
- Temporal lobe
38
Q
- Why is Bicarbonate given in amitriptyline overdose ?
A
- Reduces the prolonged QRS complexes seen in TCA overdose
39
Q
- What is the best analgesic option for a patient with COPD and HTN following major abdominal surgery ?
A
- Epidural anesthesia
- Opioids cause respiratory depression
- Epidural anesthesia can be topped up and titrated whereas spinal anesthesia cannot
40
Q
- What would be 1st line management for a pt with a BP of 160/90, T1DM and diabetic nephropathy
A
- ACE-I
41
Q
- What medications can cause pulmonary fibrosis ?
A
- Amiodarone, bleomycin and methotrexate
42
Q
- How can SIADH result in hyponatremia ?
A
- ADH inappropriately concentrates urine
- ADH stimulates synthesis of aquaporin-2 in the apical membrane of the collecting duct which promotes water absorption
- This leads to dilutional hyponatremia
43
Q
- What neurological condition is autosomal dominant polycystic kidney disease associated with ?
A
- Subarachnoid haemorrhage
44
Q
- A 74 year old man had progressively worsening muscle aches that are now causing him to struggle to get up from a chair or raise his arms above his head. He has a PMHx of oesophageal cancer treated surgically and IHD for which he takes bisoprolol, clopidogrel, ramipril and simvastatin. Blood results show the patient to be marginally anemic and have a significantly raised ESR. What is the diagnosis ?
A
- Polymyalgia Rheumatica
45
Q
- What is Osteomalacia ?
A
- The softening of the bones secondary to low vitamin D levels
- This in turn leads to decreased bone mineral content
- In child this is called rickets
46
Q
- What can cause Osteomalacia ?
A
- Vitamin D deficiency
- CKD
- Medications e.g. anticonvulsants
- Liver disease e.g. cirrhosis
- Coeliac disease
47
Q
- What is the management of polymyalgia rheumatica ?
A
- Prednisolone
48
Q
- What blood measurement should be taken to investigate carbon monoxide poisoning ?
A
- Carboxyhemoglobin
- Pulse oximetry will not show hypoxia
49
Q
- What investigation should follow for a patient following the diagnosis of an unprovoked DVT ?
A
- CT abdomen and pelvis
- To rule out malignancy
50
Q
- What anti-coagulation should be used for mechanical valves ?
A
- Warfarin
51
Q
- What factors can exacerbate psoriasis ?
A
- Trauma
- Alcohol
- Drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine, NSAIDs, ACE-I and infliximab
- Withdrawal of systemic steroids
- Streptococcal infection can trigger guttate psoriasis
52
Q
- How would the serum osmolality and urine osmolality present in cranial DI and how will it respond to desmopressin
A
- Serum osmolality – High (>300)
- Urine osmolality – low (<300)
- If you think ADH is not being produced and so the urine is not able to be concentrated
- Giving desmopressin will therefore concentrate the urine (unlike nephrogenic DI where the kidneys are unable to concentrate urine due to damage)
53
Q
- How would the serum osmolality and urine osmolality present in nephrogenic DI
A
- Serum osmolality – High (>300)
- Urine osmolality – low (<300)
- Desmopressin will have no impact
54
Q
- What is fine line management for prolactinoma ?
A
- Cabergoline (a dopamine agonist)
- If this is not tolerated then 2nd line is trans-sphenoidal surgery
55
Q
- What is 1st line management of acromegaly ?
A
- Trans-sphenoidal surgery
- 2nd line = somatostatin analogue = octreotide
56
Q
- What are the rules for solids and liquids before surgery ?
A
- 2 hours for clear liquids and 6 hours for solids
57
Q
- What is the most specific test for RA ?
A
- Anti-CCP
- Found in 80% of people with RA but only 0.5% of the healthy population
58
Q
- A 31 year old man visits his GP with a painless lump in his scrotum. There is a well-defined, non-tender spherical 1 cm mass on the right side of the scrotum. It is superior to the testis and transilluminates. What is the most likely diagnosis ?
A
- Epididymal cyst
59
Q
- A 68 year old man has 3 days of worsening vomiting and abdominal pain. He has not passed any stool for 3 days. He has a history of a right hemicolectomy for Dukes’ A (T1, N0) bowel cancer 6 months ago. He is dehydrated and his abdomen is distended. What is the diagnosis ?
A
- Adhesional small bowel obstruction
60
Q
- What is the recommend maintenance fluid requirements for an adult ?
A
- 20-25mL/Kg/24hout
- E.g. 70kg = 70*25 = 1750ml/24 hours
61
Q
- A 62 year old man has acute breathlessness with a weak cough, following a recent viral upper respiratory infection. Over the past 4 months, he has had double vision, limb weakness and slurred speech when tired. His respiratory rate is 18 breaths per minute and oxygen saturation 96% breathing air. He is sweating and using his accessory muscles of inspiration. What is the diagnosis and what is the best investigation of lung function ?
A
- Myasthenic crisis causing acute respiratory failure
- FCV (below 1L and negative inspiratory force (NIF) of 20cm H20 or less and pt needs ventilation support)
62
Q
- How should an obstructing proximal left ureteric stone causing severe hydronephrosis be managed ?
A
- Nephrostomy
63
Q
- What can atropine be used to treat ?
A
- Sinus bradycardia
64
Q
- Tuning fork tests show:
a) when the tuning fork is placed in the middle of his forehead he hears the tone loudest in his right ear;
b) when the tuning fork is held in front of his right external auditory meatus it is quieter than when it is placed on the bone behind the same ear;
c) when the tuning fork is held in front of the left external auditory meatus the sound is louder than when it is placed on the bone behind the same ear.
What is the diagnosis ?
A
- Right conductive hearing loss
65
Q
- What is the most common pathogen in diabetes patients with cellulitis ?
A
- Streptococcus pyogenes
66
Q
- What is superficial thrombophlebitis ?
A
- Inflammation associated with thrombosis of one of the superficial veins, usually the long saphenous vein of the leg
67
Q
- How is superficial thrombophlebitis managed ?
A
- NSAIDs
- Compression stockings are also used
- An ankle-brachial pressure index (ABPI) should be measured before prescribing compression stockings particularly if using class 2 or above stockings.
68
Q
- What should a patient taking metformin and gliclazide do before surgery ?
A
- Continue metformin
- Omit gliclazide
69
Q
- A 67 year old man has difficulty walking. He states that he has to raise his left leg higher in the air than normal to avoid scraping his toes on the ground when he walks. When he raises the left foot from the floor, the ankle assumes a plantar-flexed position with the toes directed towards the floor ?
A
- Common peroneal
70
Q
- A 35 year old woman has 6 months of cyclical pain in both breasts. She has recently noticed a lump in the right breast. There is diffuse nodularity of the axillary tails of both breasts with a discrete 20 mm mass in the upper outer quadrant of the right breast. Fine needle aspiration is performed and 5 mL of brown fluid is removed, with disappearance of the mass. Cytology shows cellular debris with no malignant cells. What is the most likely diagnosis ?
A
- Fibrocystic disease
71
Q
- What are common features of fibrocystic disease ?
A
- Presents in middle age
- ‘Lumpy’ breasts which may be painful
- Symptoms are worse prior to menstruation
72
Q
- Where is the main lymphatic drainage sire from the ovary ? (and where therefore is metastatic disease likely to spread)
A
- Para-aortic nodes
73
Q
- How is symptomatic gallstones disease treated ?
A
- Laparoscopic cholecystectomy
74
Q
- How would a cerebellar stoke present ?
A
- Headache, nausea/vomiting and ataxia
- Profound imbalance, sudden onset and prominent/intense headache
75
Q
- What is the management of a slowly healing venous ulcer ?
A
- Compression stockings
76
Q
- How does acute glaucoma present ?
A
- Sudden onset pain and redness in eye
- Headache and nausea
- Visual disturbance
- Hazy cornea and mid-dilated pupil
77
Q
- A patient with repeated episodes of candida infection should be screened for what other condition ?
A
- Glycated haemoglobin
78
Q
A
79
Q
- A patient suffers 40% full thickness burns. They become breathless and hypotensive and develop a petechial rash ? Clotting factors are deranged. What is the diagnosis ?
A
- Disseminated intravascular coagulation
80
Q
- A 65 year old woman with newly diagnosed advanced lung cancer has 1 day of breathlessness and 1 week of progressive headache. Her pulse rate is 88 bpm, respiratory rate 20 breaths per minute and oxygen saturation 95% breathing 4 L/min oxygen via nasal prongs. She has a swollen face and neck and distended veins on her chest. Her chest is clear. What is the diagnosis and how would you find this on investigation and how would this be treated ?
A
- Superior vena cava obstruction
- CT scan
- IV dexamethasone
81
Q
- What is given in major bleeds in patients taking warfarin ?
A
- Prothrombin complex concentrate
82
Q
- What investigation does nephrotic syndrome need ?
A
- Renal biopsy
83
Q
A
