Answers Flashcards
What antibiotic shouldn’t be used in children?
Tetracycline
A 76 year old lady undergoes a right total knee replacement. The first post-operative day she has severe lateral right knee pain, inability to move her ipsilateral foot and generalised numbness. She has an indwelling femoral nerve block catheter.
Common peroneal nerve injury
The surface landmark of the horizontal fissure.
Rib 4
Primary open angle glaucoma has which of the following clinical features:
- Sudden vision loss - Painful eye - Red eye - Optic disc cupping - Dilated pupil
Optic disc cupping
A 72 year old man undergoes right total knee replacement. He has a previous medical history of non-insulin dependent diabetes and atrial fibrillation on warfarin. Warfarin was stopped before his operation and restarted on the first post-operative day. He also received low molecular weight heparin and had intermittent compression devices fitted on his lower legs. On the second post-operative day he complained of diplopia and mild shortness of breath on exertion. He is mobilising with a zimmer frame in the ward bay without significant concerns. The operated knee is hot and effused. Heart rate is 80/min, blood pressure 110/70mmHg, respiratory rate: 20/min, SaO2: 90% on air. White blood count is 11.5 x 109/L with 75% neutrophils.
Pulmonary embolism
A 68 year old retired male farmer presents with progressively deteriorating flexion deformity of his little finger of the left non-dominant hand. The patient complains of mild discomfort over the left 5th metacarpophalangeal joint. There is no obvious inflammation. Several non-painful nodules are palpated along the course of the flexor tendon of the 5th digit. The flexion deformity is not correctable.
Dupuytren’s disease
What causes a neurogenic itch?
Renal/Liver failur
Thyroid disease
Malignancy
What drug used in the treatment of RA can cause decreased Haemoglobin and malaena?
Diclofenca
A 2 day old infant born at term after uneventful pregnancy started vomiting. The vomit is non projectile, mild and green in colour.
Volvulus or Malrotation
A 2 weeks 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.
Pyloric stenosis
A 3 week old infant born at term, bottle fed, who started vomiting on day 7. The vomit is of small amount, effortless and after almost every feed. The infant appear well and gains weight appropriately. The infant is taking around 150 ml/kg/day of milk.
GORD
A 6 month old infant is seen by a GP, being unwell with mild fever, cough, reduced oral intake and noisy breathing for two days. On examination there are signs of mild respiratory distress with O2 saturation 92% on air. Auscultation of the chest revealed good air entry bilaterally with widely scattered high pitch rhonchi and fine crepitations. Diagnosis and treatment?
Bronchiolitis
Admit and supportive therapy
What causes the active contractile phase of Dupuytren’s?
Myofibroblasts within lesion
A 25 year old man with poorly controlled diabetes and sudden onset visual loss in his right eye.
Retinal haemorrhage
What is always important when assessing a child?
Observation of the infant/child on a number of occasions may be needed to get an accurate assessment of his/her development.
For each of the following scenarios in which a toddler presents with hypovolaemic shock and a non-blanching purpuric rash select the MOST APPROPRIATE option from the list below:
- This diagnostic blood test is an alternative to a blood culture.
- This must be checked before considering whether a lumbar puncture should be performed.
- This can be useful for monitoring response to fluid resuscitation.
- Meningococcal PCR
- Clotting screen
- U+Es
Which of the following is a cause of conductive hearing loss?
- Meniere's Disease - Otosclerosis - Occupational loud noise exposure - Vestibular Schwannoma - Gentamicin
Otosclerosis
All others cause sensorineural hearing loss
What types of Hepatitis are spread via the faeco-oral route?
Hep A
Hep E
At developmental assessment an 18 month boy can sit unsupported, build a tower of 3 bricks, enjoys picture books, can say 10 -15 words and can point to body parts. He feeds with a spoon and mimics adults
Delayed gross motor development
A 6 month old girl is assessed for developmental progress. She pushes up on her arms in prone, grasps toys and transfers from hand to hand. She makes a few sounds of similar pitch. She is still friendly with strangers.
Concern about hearing/language development
A 6 month old boy is assessed for developmental progress. He has head lag when pulled to sit. He holds his hands in the midline and has hand regard. He stills to voice but is not yet babbling. He has a social smile. He does not react pleasurably to familiar situations.
Global developmental delay
Which of the following causes a left shift of the oxyhaemoglobin dissociation curve:
- Hyperthermia - Hypercapnia - Reduced 2, 3 DPG - Sickle cell disease - Acidosis
Reduced 2, 3 DPG
All others cause a right shift
A 26 year old woman has an episode of macroscopic haematuria, which lasts for 2 days, and is accompanied by left loin pain. Her mother is on regular haemodialysis and her maternal uncle has had a subarachnoid haemorrhage.
Polycystic kidney disease
A 65 year old diabetic patient complains of left ankle swelling for many months. He has very little pain. There is slight erythema over the ankle and the foot is insensate. The ankle feels unstable.
Charcot arthropathy
A 40 year old man complaining of a painful neck swelling. He is heat intolerant, has diarrhoea and has had a recent flu-like illness
Thyroiditis
A 20 year old university student presents with lethargy, headaches, fever, nausea and abdominal pain for 4 days. He has no rash. He returned from backpacking in India about 28 days ago. His friends noticed his eyes are yellow.
Hep A
In which age group are the symptoms of attention deficit hyperactivity disorder (ADHD) usually recognised?
6-12 years
A 20 year old medical student with a history of atopic eczema has developed itchy red and dry hands and peri-orbital areas during her surgical block.
Type 4 hypersensitivity reaction mediated by T lymphocytes
A 70 year old patient in an acute medical ward develops vomiting and diarrhoea. How do you test for norovirus.
Stool for Polymerase Chain Reaction (PCR)
This hormone can cause poor brain development if deficient in utero.
Thyroxine
This hormone has a marked diurnal variation, with high level soon after waking
Cortisol
This hormone level is raised acutely during labour and breastfeeding.
Oxytocin
How do we investigate the following:
1. Unilateral sensorineural hearing los 2. Direct nose trauma with visible bone deformity 3. Recurrent episodes of acute sinusitis
- MRI
- No investigation needed
- CT
Which foramen do the following structures pass through when entering or exiting the skull?
- Internal carotid artery
- Middle meningeal artery
- Facial nerve
- Foramen lacerum
- Foramen spinosum
- Stylomastoid foramen
What stage of embryogenesis are the germ layers formed in?
Gastrulation
What is morphogenesis?
Formation of body plan
How long will the following supply energy for:
1. ATP 2. Phosphocreatinine 3. Free circulating glucose 4. Glycogen stores 5. Fat stores
- 4 seconds
- 15 seconds
- 4 minutes
- 77 minutes
- 4+ days
When is skin development complete and what is the last part to form?
6 months gestation
Sweat glands
What is the most metabolically active part of the epidermis?
Basal layer
When is the basal layer of the epidermis present?
4 weeks gestation
Wgat do healthy-start vitamins help prevent?
Rickets and osteomalacia
What causes Beri-Beri?
Vitamin B1 deficiency
What causes Pellagra?
Vitamin B3/Niacin deficiency
What enzyme transcribes genetic material?
RNA polymerase
A 25 year old female presents with an area of hair loss. On examination there is inflammation and a pustular swelling.
Kerion
A patient with type 1 diabetes who has sudden onset double vision. What is the underlying neurological oricess?
Cranial focal mononeuropathy
A 58 year old lady with undiagnosed mixed connective tissue disease has multiple superficial ulcers over both lower legs from the knee down. Purpura is evident on the intact skin. What is the cause of her leg ulcer?
Vasculitis
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. What is the cause of her leg ulcer?
Venous insufficiency
Hexokinase I in red blood cells and Glucokinase in liver and pancreas both catalyse the phosphorylation of glucose to glucose-6-phosphate. Hexokinase I has a KM for glucose of 0.05 mM, while Glucokinase has a KM for the same substrate of 5 - 6 mM. What does this mean?
Hexokinase I has a higher affinity for glucose than Glucokinase.
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.
Cataract
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.
Wet age-related macular degeneration
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.
Acute closed angle glaucoma
