AST stuff forgetting Flashcards
1
Q
What hormones are imbalanced in:
Cushings
Conn’s
Addison’s
A
● Cushings - excess cortisol
● Conn’s - excess aldosterone
● Addison’s - aldosterone and cortisol deficiency
2
Q
G cells produce what? Where found?
A
G-cells; Gastrin, antrum
3
Q
Parietal cells produce what? Where found?
A
Parietal cells - HCL and intrinsic, fundus + body (stimulated by ACh + histamine)
4
Q
what do chief cells produce?
A
Chief cells - pepsinogen
5
Q
Smoking cessation
A
○ ready
○ steady
○ stop
○ pre-contemplation - not thinking about stopping
○ contemplation - thinking about it but not ready
○ preparation - setting a date, throwing away ashtrays
○ action - not smoked 6months
○ relapse - had a cig which led back into regular smoking
6
Q
What is bradykinin
A
● bradykinin is a vasodilator and mediator of pain - broken down by ACE
7
Q
Features of obstructive lung disease
A
○ raised TLC, IRV, ERV, FVC
○ reduced FEV1
○ COPD, emphysema, asthma
8
Q
Features of restrictive lung disease
A
○ reduced everything
○ pulmonary fibrosis + asbestosis
9
Q
Role of lymphatics
A
transport antigens to immune system, drain extracellular fluid, transport antibodies
10
Q
Vital capacity
A
Vital capacity is the maximum amount of air a person can expel from the lungs after a maximum inhalation.
11
Q
3 layers of oesophagus
A
Mucosa, submucosa, muscularis externa.
12
Q
BMI calculation
A
MASS (KG) / HEIGHT (M2) = BMI (KG/M2)
13
Q
5 food groups
A
○ milk and dairy ○ fruit and veg ○ meat and fish ○ starchy foods ○ fat + sugar
14
Q
stress
A
a state of mental, physical or emotional strain where the demands made upon an individual are greater than their capacity to cope
○ eustress - positive, motivational
○ distress - detrimental, negative stress
15
Q
internal pharyngeal constrictor
A
upper oesophageal sphincter muscle
16
Q
epileptic seizure
A
abnormal excessive or synchronous neuronal activity in the brain
17
Q
What can low dose aspirin, ACE inhibitors and diuretics do?
A
cause a buildup of sodium urate and cause gout
18
Q
anion gap
A
the difference in amount of positive and negatively charged ions in serum
19
Q
allopurinol
A
a gout medication that inhibits xanthine oxidase which causes uric acid buildup. Allopurinol is metabolised by aldehyde oxidase
20
Q
pathological fracture definition
A
a soft tissue injury characterised by the break in the continuity of bone which has been weakened by a disease process
21
Q
testicular cancer
A
○ cryptorchidism, HIV, smoking - risk factors
○ germ, sertoli, leydig - 3 types
○ seminomas and non-seminomas
○ HCG, AFP, LDH - tumour markers
22
Q
how do NSAIDs work
A
block COX enzymes so no prostaglandins produced. prostaglandins mediate pain, inflammation and clotting
23
Q
d-cells produce
A
somatostatin
24
Q
behavioural signs of smoking
A
(don’t confuse with emotion or mental)
○ increase in alcohol/smoking
○ weight gain/loss
○ sleep disturbances
25
aldosterone synthase
the enzyme responsible for making aldosterone in the glomerulosa of the adrenal cortex
26
vision: rods and cones
○ rods - black and white, scattered peripherally, more sensitive (due to convergence), give vision in low light,
○ cones - colour, definition, all over retina, work in bright light, no convergence
○ use rhodopsin as a pigment mainly
27
normal CD4 count
400-1500 PER MILLIMETRE CUBED
28
AIDS CD4 count
29
AIDs defining features
■ pulmonary - TB, pneumocystis, pulmonary candida
■ neuro - cerebral toxoplasmosis, primary cerebral lymphoma
■ cancers - burkitts lymphoma, karposi sarcoma, NHL, cervical Ca,
30
HIV/AIDs risk factors
MSM, IVDU, sex in high risk countries, unprotected sex
31
AIDS cancer viruses
epstein barr, HSV and HPV
32
osteoporosis common in which bones
neck of femur, vertebrae, distal radius
33
pagets common features
skull, hip, vertebrae, CN compression (deafness). deep dull ache worse at night
34
avascular necrosis
scaphoid, head of femur, talus
35
tropicamide
drug that inhibits the parasympathetic system. pupil dilation
36
anencephaly
spina bifida but in the skull
37
normal GFR
90mls/min/1.73m2
38
what need to do before renal transplant? Absolute CIs?
○ blood type, tissue cross match and HLA
| ○ DM and recent malignancy are absolute contraindications
39
why can pain from the diaphragm can be felt in the shoulder?
pain from the diaphragm can be felt in the shoulder because the phrenic nerve does all that stuff
40
difference between anaesthetics and analgesics
analgesics stop pain, anaesthetics stop feeling/sensation
41
osteomalacia
is failure of bone mineralisation due to lack of vit D
42
calcium intake
700mg daily
43
what are fibroids
benign leiomyoma - increase surface area
44
how do NSAIDs inc production of HCl
prostaglandins inhibit parietal cells from producing HCL. NSAIDS stop prostaglandins so increase the production of HCL, causing ulcers
45
what do curves in the pinna of the ear do?
curves in pinna help determine the direction of sounds and emphasise the sounds close to human speech
46
what structures make up the middle ear? function?
MIS
| malleus, incus, stapes - amplify
47
purpose of the cochlea
cochlea determines high sounds from low sounds
higher sounds as base of cochlea, lower sounds at the apex
48
what do louder sounds do?
louder sounds vibrate more hairs on the organ of corti which fires action potentials
49
tympanic membrane:
loud / quiet sounds?
higher sounds?
■ louder/quieter sounds - vibrate the membrane more/less dramatically/harder or softer
■ higher sounds produce a quicker vibration
■ A high, loud sound produces a quick, big vibration
50
which muscles control hearing?
tensor tympani and stapedius muscles
51
smoking cessation treatments
bupropion and NRT
52
secondary prevention
slowing down/preventing spread/screening
53
tertiary prevention
stopping effect once disease is established
54
recommended alcohol intake for men and women
○ men - 3-4 units
| ○ women 2-3
55
how much in a unit of alcohol
○ 8g/10mls
56
fetal alcohol syndrome
close set eyes
| cns abnormalities - mental retardation
57
prehepatic jaundice
○ increased haemolysis - more unconjugated bilirubin in blood
○ liver can only conjugate a bit at a time
○ raised unconjugated bilirubin in blood but normal amounts in urine and feces is it isn't water soluable - normal colours
58
hepatic jaundice
○ normal amounts of unconjugated bilirubin reach liver
○ liver conjugates as normal
○ a blockage in the liver stops conjugated bilirubin reaching the gut as bile pigments and so it’s absorbed into blood
○ filtered by kidneys and the pigment comes out in wee. Normal stools, dark urine.
59
post-hepatic jaundice
○ blockage after bile duct
○ liver conjugates everything as normal but a later blockage causes all pigment to be released into blood
○ same again pale/normal stools, dark urine PURITUS
60
MS
numbness, reduced red visions, reduced visual evoked potentials, blind spot, problems hopping on one leg. YOUNG
61
guillian barre can be brought on by
flu-like illness
62
spermatogenesis can be interfered with by
wearing tight jeans
63
sensitivity
number of true positives (true positives/true positives + false negatives)
64
specificity
number of true negatives (true negatives/true negatives + false positives)
65
what is raised in giant cell arteritis
ESR
66
stages of labour
○ latent
○ active
○ fetal expulsion
○ delivery of placenta
67
normal blood glucose
3.5-5.5mmol/L after overnight fast
68
diabetes blood glucose
6-7mmol/L fasting blood glucose on two occasions
69
what is alports
an X-linked kidney disease characterised by a triad of nephritis, deafness and ocular lesions
70
WAIT why does hypokalemia cause alkalosis?
○ okay so you have a low potassium in the blood
○ to try and raise blood potassium, cells begin to give up the potassium within their cytoplasm
○ however as potassium is a positively charged ion, this leaves the inside of the cells with a big negative charge as all the K+ has left
○ to make up for this, H+ from the blood moves into the cells to bring the charges back to normal
○ because loads of H+ has now been removed from the blood, blood pH will rise, causing an alkalosis
71
proteus mirabilis
is responsible for bladder stones
72
kidney stones are made up from
calcium (oxalate?)
73
gout crystals are
sodium urate (negatively bifringent needles)
74
pseudogout is
calcium pyrophosphate
75
hypersensitivity 1
allergy - asthma - IgE - fast, basophils, histamine
76
hypersensitivity 2
cytotoxicity - graves, goodpastures, IgM/G - complement, MAC, antibody binds to pathogen and kills it
77
hypersensitivity 3
immune complex - SLE - IgG - antibody binds to foreign antigens in the blood and stick together, starting the basis of immunity
78
hypersensitivity 4
delayed - TB, chronic transplant rejection - T-cells find antigen and activate macrophages
79
what immunoglobulin can cross placenta
IgG
80
IgM is
primary response
81
IgG is
secondary response
82
TH lymphocytes express what type of marker?
CD4
83
what type of sensitivity are contact allergies (mantoux test)>
type 4 sensitivity
84
knee ligaments: ant and post cruciate ligaments
aid backwards and forwards motion of the knee, provide stability when bending
85
knee ligaments: lat and med collateral ligaments
provide sideways stability
86
knee ligaments: anterior cruciate injury
knee bends wrong way, car crash, hyperextension
87
knee ligaments: Medial collateral injury
impact from the side, sideways tackle
88
knee ligaments: meniscal tear
from twisting motions
89
chrons
any part of the tract
genetic
patchy
flare ups
90
UC
colon
91
telomerase
is the enzyme which lengthens telomeres
92
thrombosis
- a blood clot within a vessel
93
embolism
- vascular occlusion caused by foreign body
94
virchow's triad
- abnormal blood flow, vessel injury, hypercoagulation
95
neoplasm
a new abnormal tissue growth which is autonomous and continues to grow after the stimulus has been removed
96
BP =
vasc resistance x CO
97
CO =
SV x HR
98
fatty streaks are characteristic of
ATHEROscleriosis
| whereas hardening = arteriosclerosis
99
list 4 duties of a dr
○ care for patient first concern
○ provide good standard of practice and care
○ never discriminate unfairly against patients or colleagues
○ be honest, open and act with integrity lol
100
normal sperm conc
>15million/ml
101
where are baroreceptors
in carotid sinus and aortic arch
102
where are stretch receptors
right atrium
103
3 components of virchows triad
change in vessel wall (endothelial damage)
change in blood constituents (hypercoaguability)
change in flow (stasis)
104
calculate blood pressure from stroke volume, heart rate and systemic vascular resistance
BP = SV x HR x SVR
105
classic triad meningitis
neck stiffness
photophobia
fever
106
xray features osteoarthritis
joint space narrowing
hardening of bone (osteophyte formation)
subchondral sclerosis
subchondral cysts
107
definition of a fracture
soft tissue injury caused by a break in the continuity of bone
108
what causes the sound of a murmur
turbulent blood flow
109
what causes an ejection systolic murmur that radiates to the carotids
aortic stenosis
a mid-systolic ejection murmur, heard best over the “aortic area” or right second intercostal space, with radiation into the right neck (carotids)
110
RAAS - describe
renal blood flow reduced
juxtaglomerular cells release renin
plasma renin converts angiotensinogen to Angiotensin I in liver
angiotensin I converted to II by ACE in lungs
Angiotensin II = potent vasoconstrictor = inc BP
Angiotensin II stimulates release of aldosterone from renal cortex (glomerulosa)
Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood, while at the same time causing the excretion of potassium (to maintain electrochemical balance).
This increases the volume of extracellular fluid in the body, which also increases blood pressure.
111
gold standard test diagnosis for coeliacs
duodenal biopsy
112
what do u see histologically coeliacs
villous atrophy and crypt hyperplasia
113
Antibodies in coeliacs
anti tissue transglutaminase (a-TTG) and anti endomysial
114
cancer most associated with asbestos exposure
mesothelioma
115
What are the 2 cardiac arrhythmias which are responsive to emergency external cardioversion?
VF, pulseless VT
116
Give 2 locations in which baroreceptors are found?
Aortic arch, carotid sinus
117
In a 38 year old woman who had recent dental surgery, what is the most common organism responsible for infective endocarditis
strep viridans
118
What are the four features of tetralogy of fallot?
Overriding aorta, pulmonary stenosis, VSD, right ventricular hypertrophy
119
What are the ECG changes in Hyperkalaemia
Tall tented t-waves, wide QRS, absent (hidden) p waves
120
define shock
Circulatory failure resulting in inadequate tissue perfusion resulting in cellular injury - life-threatening
121
What is the screening test for AAA
Abdo USS
122
What is de’musset’s sign?
Bobbing of the head with aortic regurg
123
What score is used to calculate risk of stroke after diagnosis of AF
chads2vasc
124
chads2vasc
C Congestive heart failure (or Left ventricular systolic dysfunction) (1)
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) (1)
A2 Age ≥75 years (2)
D Diabetes Mellitus (1)
S2 Prior Stroke or TIA or thromboembolism (2)
V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) (1)
A Age 65–74 years (1)
Sc Sex category (i.e. female sex) (1)
125
Give 3 bacterial causes of community acquired pneumonia
Any of: strep. Pneumoniae, h.influenzae, klebsiella, staph aureus, mycoplasma, e.coli, pseudomonas aeruginosa, legionella, chlamydophilia pneumoniae, coxiella burnetii.
126
How do the Penicillin group of antibiotics work?
They inhibit formation of peptidoglycan cross links in the bacterial cell wall.
127
What is the antibiotic treatment of community acquired pneumonia in a high risk patient?
IV amoxicillin and clarithromycin (to cover atypicals)
128
What does each of the components of CURB 65 stand for?
```
Confusion
Urea (over 7)
Resp rate (above 30)
BP (below 90/60)
Age over 65.
Over 3 indicates a high risk.
```
129
What is vital capacity?
Total lung capacity - residual volume.
| So this is the amount of air that can be breathed out from total lung volume. It is usually between 3-5L.
130
What is the diagnostic test to confirm Cystic Fibrosis?
Sweat test. This is the diagnostic test. Immunoreactive trypsinogen is the screening test to identify newborns for the sweat test.
131
Sandra is having an asthma attack. She is too breathless to speak in full sentences, her RR is 40 and her HR is 130. Her peak flow is 40% of predicted value. How would you manage her?
O2 via facemask
nebulised salbutamol
oral prednisolone/ IV hydrocortisone
Repeat salbutamol every 20-30 mins as needed.
132
What is the treatment of TB (give the names of the drugs and the durations)
RIPE (avocado hehe)
| Rifampicin, isoniazid (6 months), pyrazinamide, ethambutol (2 months)
133
A patient who has had a previous heart attack is given aspirin to prevent any further events occurring. Is this primary, secondary or tertiary prevention?
Secondary
134
Define Incidence?
The number of new cases occurring in a population over a specified period of time
135
Define Prevalence?
The number of people with the disease in the population at a specific point in time
136
Give 3 interventions to control the spread of STIs?
Contact tracing, Contraception - Condoms, Diaphragm , Education
137
What are the 4 pillars of Medical Ethics?
Autonomy, Beneficence, Non-Maleficence and Justice
| BANJo - lil old dr man sat on a step singing bout ethics with his banjo
138
What are three primary preventions that can prevent Type 2 diabetes according to the NICE guidelines?
Exercise, healthy diet and education
139
Give 3 examples of psychosocial risk factors of coronary heart disease.
Low socio-economic status, lack of social support, stress in work or within family life, depression, anxiety,
140
How many ml/gm of pure alcohol are the in a single unit of alcohol?
10ml or 8g
141
What are the 4 parts to the CAGE questionnaire?
Have you ever felt you need to cut down on your drinking, Have people annoyed you by criticizing your drinking, have you ever felt guilty about your drinking, have you ever felt you needed a drink in the morning (eye opener) to steady yourself?
142
What is the treatment for an opioid overdose?
Naloxone
143
What is the difference between a physical dependence and a psychological dependence?
Psychological - life seems impossible without the drug - emotional
Physical - Body needs more of the drug for an effect and withdrawals occur.
144
Describe the 5 parts to the stages of change model
Pre-contemplation, contemplation, preparation, action, maintenance
145
What prophylaxis would you give at risk close family members of a patient who has meningococcal meningitis.
Ciprofloxacin or Rifampicin plus a vaccination if they have not been previously immunized.
146
What is the first line non-invasive screening test for Helicobacter Pylori infection?
C13 urea Breath Test
147
What class of drug in Ranitidine?
Histamine-2 blocker (H2 blocker)
is a medication that decreases stomach acid production. It is commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease,
148
Name the 4 fat-soluble vitamins
ADEK
149
Presence of which antibody would indicate that someone has seropositive coeliac disease?
Anti-endomysial (also accept anti-tissue transglutaminase)
150
Which inflammatory bowel disease would cause depletion of goblet cells and continuous mucosal inflammation?
UC
151
Which marker is usually very raised in pancreatitis?
serum amylase
152
What is the most common cause of upper GI obstruction in adults?
adhesions (80%)
153
What is the name of the eosinophilic bodies which can be found in the liver cells of those who drink heavily?
MALLORY BODIES
154
What are most gallstones formed of/from?
cholesterol (80%)
155
On which chromosome is the gene responsible for causing alpha1-antitrypsin found?
chromosome 14
156
Name the 4 questions in the CAGE questionnaire.
Have you ever felt you ought to cut down on your drinking? Are you annoyed if people criticise your drinking? Do you ever feel guilty about your drinking? Have you ever had a drink in the morning?
157
Gentleman attends with 1 day Hx vomiting, non-bloody voluminous diarrhoea, previously fit and well, no other significant symptoms/signs, no foreign travel Hx, eaten takeaway food 3h before onset symptoms. What is most likely causative organism?
staph aureus
158
53 yo F presents with headache, fever, photophobia. O/E nuchal rigidity. Lumbar puncture demonstrates gram +ve cocci. Which organism?
Strep pneumoniae
| Meningitis also caused by N meningitidis but that's gram neg cocci
159
Middle-aged M w/ HTN, increased serum Cr and urea, proteinuria and haematuria, bilateral palpable costovertebral angle masses, dad died of SAH. Most likely diagnosis?
a. Horseshoe kidney
b. ADPKD
c. Nephrotic syndrome
d. Rapidly progressive glomerulonephritis
e. Conn’s syndrome
b. ADPKD
autosomal dominant polycystic kidney disease
160
goodpastures syndrome
a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure.
161
Major factor in pathogenesis of ulcer?
a. Venous insufficiency
b. Peripheral neuropathy
c. Arterial insufficiency
d. Infection
c. Arterial insufficiency
162
49yo Caucasian M with HTN, doesn’t respond to lifestyle modification. Renal function OK.
What drug should GP start him on?
a. Alpha-blocker
b. ACE inhibitor
c. Beta-blocker
d. CCB
e. Thiazide diuretic
b. ACEi
163
betamethasone
Betamethasone is a steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis
164
Azathioprine
Azathioprine is an immunosuppressive drug used in organ transplantation and autoimmune diseases and belongs to the chemical class of purine analogues.
165
Methotrexate
Methotrexate is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions.
166
Mesalazine
Mesalazine, also known as mesalamine or 5-aminosalicylic acid, is an aminosalicylate anti-inflammatory drug used to treat inflammatory bowel disease, including ulcerative colitis
167
30-something F with 2/12 Hx diarrhoea with blood and mucus, some LLQ discomfort. No weight loss, some other relevant stuff *mild-moderate UC Hx* What appropriate 1 st -line treatment?
a. Betamethasone?? See if it responds to steroids
b. Methotrexate
c. Azathioprine
d. Aspirin
e. Mesalazine
e. Mesalazine - 5 aminosalicyclic acid
168
20-something M with diagnosed asthma presents with increasing chest tightness and waking up at night coughing. On SABA, no other medication, otherwise fit and well. Symptomatic episodes well managed with 2x SABA puffs. After lifestyle/education advice and assessment of inhaler technique, appropriate mgmt.?
a. Long-acting beta 2 agonist
b. PO corticosteroid
c. PO theophylline
d. Inhaled corticosteroid
e. Anti-muscarinic
d. inhaled corticosteroid
169
30-something F with diagnosed asthma presents with… *worsening of asthma symptoms over wks*. Already on SABA and ICS, using them appropriately. Appropriate mgmt.?
a. Increased ICS dose
b. Add po corticosteroid
c. Add po theophylline
d. Add cromone
e. Add inhaled LABA
e. Add inhaled LABA
170
30-something F with known asthma presents at A&E with severe breathlessness, barely able to speak. O/E dynamic hyperinflation, severe wheeze throughout both lungs, accessory breathing,… Sats ?lowish, RR ?28/min, HR ?110/min. Appropriate 1 st -line mgmt.?
a. 4L O 2 nasal cannulae
b. 15L O 2 reservoir mask
c. 24% O 2 venturi mask
d. Perform ABG
e. Intubate immediately
c. 24% O 2 venturi mask
171
M presents at A&E after being involved in RTA. GCS 15/15 on arrival, within 1h deteriorated to 9/15. Some other detail inc fixed dilated R pupil. What most likely Dx?
a. Subdural haematoma
b. Extradural haematoma
c. Sub arach
d. Carotid artery dissection
b. Extradural haematoma
TRAUMA CAUSED
build up of pressure presses on brain
Unlike subdural haemorrhages, in which a history of head trauma is often difficult to clearly identify, extradural haemorrhages usually are precipitated by clearly defined head trauma.
A typical presentation is of a young patient involved in a head strike (either during sport or a result of a motor vehicle accident) who may or may not lose consciousness transiently. Following the injury, they regain a normal level of consciousness (lucid interval), but usually have an ongoing and often severe headache. Over the next few hours, they gradually lose consciousness.
172
Older F presents w/fever, malaise, transient episode R-sided weakness. Long-standing rheumatic mitral valve disease. O/E temperature 38 o C, pansystolic murmur loudest at apex, think there may’ve been some clubbing going on. First-line investigation?
a. Cerebral angiogram
b. Blood cultures
c. Chest Xray
d. Carotid dopplers
e. something else
b blood cultures
173
Older M presents with 1 hour of having a …barn-door L-sided CVA. Bruit over L carotid artery. First investigation?
a. Carotid Doppler
b. Carotid angiography
c. CT brain
d. Lumbar puncture
e. Summat else
c
174
Chap makes some nonspecific arrangements about end-of- life mgmt., deteriorates, managing team consult family in making care-related decisions. ACCORDING TO MENTAL CAPACITY ACT, why should family be consulted?
a. Next of kin have decision-making authority when pt lacks capacity and wishes unknown in advance
b. Helps family deal w/ situation to be involved in mgmt.
c. Family may be able to make managing team better aware of patient’s values and preferences when they have capacity
d. So that team incorporates family’s wishes in making care-related decisions
d. So that team incorporates family’s wishes in making care-related decisions
175
Someone gets a biopsy of a growth in their colon. Which of these benign lesions has the highest risk of malignant transition?
a. Villous adenoma
b. Tubular adenoma
c. Tubulovillous adenoma
d. Hyperplastic polyp
e. Some other kind of polyp
a. Villous adenoma
176
A 40 year old lady presents with weight gain, hirsuitism, acne and other PCOS symptoms.
She is referred to an endocrinologist. What is the most appropriate 1st line investigation?
a. Serum LH and FSH
b. Serum testosterone
c. USS of her ovaries
d. Thyroid function tests
e. Dexamethasone suppression
c. USS of her ovaries
177
A 42 year old lady comes in vomitting blood and has oesophageal varices banded by
endoscopist. She has various stigmata of chronic liver disease and bloods which agree. First line ix (?to confirm cirrhosis), not counting bloods?
a. US abdo
b. Liver biopsy
c. CT abdo
d. Chest X ray
e. Can’t remember
c. CT abdo
178
MSK - a lady has fairly obvious RA. What changes would you expect to see on x-ray of her hand?
a. subchondral cysts
b. osteophytes
c. periarticular erosions
d. subchondral sclerosis
c. periarticular erosions
179
Chap has acute gout in the knee and 1st MTP. What is the acute management of gout?
a, Oral diclofenac-
b. Oral opiates
c. Oral allopurinol
d. IV fluids
e. Oral ABx
a, Oral diclofenac-
allopurinol = CHRONIC GOUT
Diclofenac is a nonsteroidal anti-inflammatory drug taken or applied to reduce inflammation and as an analgesic reducing pain in certain conditions.
180
A 60 year old man has just had surgery on his carotids and is complaining of difficulty speaking and swallowing. OE his tongue is deviated to the right. Which nerve has most likely been damaged during the operation?
a. Left Facial
b. Left glossopharyngeal
c. Right glossopharyngeal
d. Left hypoglossal
e. Right hypoglossal
e. Right hypoglossal
hypoglossal supplies the tongue
181
A 74 year old gentleman presents with a resting tremor and difficulty starting movements.
OE his has a festinant gait. What is the pathophysiology behind his symptoms?
a. Degeneration of neurones in the corpus callosum
b. Neuronal degeneration in the substantia nigra
c. Cortical infarcts
d. Neuronal degeneration in the caudate nucleus
e. Neuronal degeneration in the subthalamic nucleus
b. Neuronal degeneration in the substantia nigra
182
A 33 year old window cleaner falls off his ladder and breaks his arm. X-ray shows a mid- shaft fracture of the humerus with posterior displacement. OE he is unable to extend his wrist or fingers. What nerve has he likely damaged?
a. Common peroneal
b. Ulnar
c. Median
d. Radial
e. musculocutaneous
radial
```
ulnar = flexion
radial = extension
```
183
A 48 year old lady presents with episodes of sweating and palpitations. OE her BP is 220/140. CT abdo shows a mass in the left adrenal. What substance is being released by this mass that is responsible for her symptoms?
a. Aldosterone
b. ACTH
c. Adrenaline
d. Cortisol
c Adrenaline
184
A 28 year old woman presents with a 2 day history of copious bloody diarrhoea. 16 days ago she returned from India. What is the most likely organism?
a. entamoeba histolytica
b. giardia lambidia
c. plasmodium vivax
d. salmonella paratyphi
e. e. coli
a. entamoeba histolytica
185
A 60 year old male had an MI 8 days ago, and now presents with sudden onset shortness of
breath. OE he has a pansystolic murmur radiating to the axilla and basal creps bilaterally. What imaging would you request to confirm the diagnosis?
a. Spiral CT thorax
b. CXR
c. Echocardio
c. echo
186
A 71 year old Lady presents with acute CP and SOB, other evidence of decompensation (low BP, bibasal crackles). ECG shows wide-complex tachycardia. Initial Management?
a. Cardioversion
b. Chest X ray
c. Primary PCI
d. Thrombolysis
e. Aspirin
a. cardioversion
187
A 35 year old currently undergoing chemo for Ca breast presents with sudden onset shortness of breath. Tachycardic, tachypnoeic, low-normal BP, afebrile, low sats. Cause?
a. Pulmonary embolism
b. Pneumothorax
c. Acute exacerbation of asthma
d. Pneumonia
e. Decompensated liver disease
a. PE
188
A 20 year old presents with odd behaviour and abdominal pain. His breath smells fruity, he’s breathing heavily his BMs are 30 and his BP is 94/56. (I don’t think U&Es were given although I could be wrong). What is your initial management?
a. IV insulin
b. IV fluids
c. IV bicarb
d. Investigate the underlying cause
e. IV glucose
fluids
189
A 4 year old girl presents with diarrhoea and is a bit hypotensive. What is the physiological reason that fluid moves from the interstitium to the vascular compartment in this case?
a. Increased hydrostatic pressure
b. Increased osmotic pressure
c. Decreased hydrostatic pressure
d. Increased capillary permeability
e. Low sodium
c. Decreased hydrostatic pressure
190
A 66 year old lady is admitted suffering from renal colic due to stones. You prescribe morphine but it turns out her liver isn’t what it used to be and she collapses on the ward. OE her resps are 6/min, SpO2 is 88% and her pupils are pinpricks. What is the (?) initial management?
a. 6L/min of O2 through
b. IV N-Acetyl- cysteine
c. IV paracetamol
d. IV Naloxone
e. Liver transplant
a. oxy
Acetylcysteine, also known as N-acetylcysteine or N-acetyl-L-cysteine, is a medication used to treat paracetamol overdose and to loosen thick mucus such as in cystic fibrosis or chronic obstructive pulmonary disease.
191
A 48 year old man requires a blood transfusion. His RBCs have the A antigen and B antigen in their cell membranes and he is Rhesus negative. Which type of blood should you give as it is least likely to cause an adverse reaction?
a. AB positive
b. A positive
c. B positive
d. O positive
e. O negative
AB positive
192
A 71 year old man presents with 4 weeks of progressive painless jaundice and general malaise (I think). Stable obs, (might have had an epigastric mass) PR demonstrated soft, pale stool. Blood results were cholestatic jaundice. Can’t remember other info. ?cause:
a. Ca head of pancreas
b. Cholangiocarcinoma
c. Choledocholithiasis
d. Cirrhosis
e. liver mets
a
Choledocholithiasis is the presence of at least one gallstone in the common bile duct. pain
cholangiocarcinoma = pain due to colic ??
193
carbamazapine
a synthetic compound of the benzodiazepine class, used as an anticonvulsant and analgesic drug.
194
Chlorpropamide
Chlorpropamide is a drug in the sulfonylurea class used to treat type 2 diabetes mellitus. It is a long-acting 1st generation sulfonylurea. It has more side effects than other sulfonylureas and its use is no longer recommended.
195
democlocycline
inhibits actions of vasopressin on the kidney (SIADH)
196
vit D def hypocalcaemia rx
ergocalciferol (vit D2)
cholecalciferol (vit D3 1,25-dihydroxyvit)
if hypoparathyroidism wont have pth to convert D3
197
non selective alpha blocker
phenoxybenzamine
198
rx carcinoid tumours
somatostatin analogue = ocreotide
| 5HT anagonist
199
How to confirm cortisol excess cushings
48hr low-dose dexamethasone suppression test (normal individuals suppress plasma cortisol)
24 hr urinary free cortisol (raised)
Circadian rhythm studies (loss of normal circadian fall of plasma cortisol at 2400 in those with Cushing's!)
200
How to treat iatrogenic Cushing's syndrome
reduce steroid dosage
use azathioprine (a steroid sparing agent) in combination with a steroid to enable lower steroid doses
201
A 60-year-old man visits his GP complaining of tiredness. He has noticed weight loss over the last six months and irritation of the tip of his penis which appears inflamed on examination (balantis). He mentions he has been visiting the toilet more often than usual and feeling thirsty. The most appropriate investigation would be:
A. Oral glucose tolerance test – borderline cases of DM or gestational
B. Measurement of glycated haemoglobin – HBA1C – monitor progress- over last 3 months
C. Random plasma glucose test
D. Water deprivation test – for polydipsia- diabetes insipidus
E. Measurement of triglyceride levels- monitor after diagnosis for potential RFs
C. Random plasma glucose test
202
A 6-year-old girl presents to accident and emergency with severe abdominal pain, nausea and vomiting. On examination, the patient is tachypnoeic, capillary refill is 3 seconds and she has a dry tongue. While listening to the patient’s lungs, you detect a sweet odour from her breath. The most likely diagnosis is:
A. Diabetic ketoacidosis
B. Non-ketotic hyperosmolar state – T2 DM hyperglycaemic > polyuria and dehydration which exacerbate the elevated glucose
C. Gastroenteritis – more abdo pain
D. Pancreatitis
E. Adrenal crisis – adrenal gland destroyed from TB or autoimmunity- reduced cortisol, sex steroids and aldosterone > postural hypotension from low aldosterone
A
DKA- ketones(pear drop smell) from breakdown of fat > acidotic > N and V, dehydration, abdo pain. Acidosis is partially compensated by hyperventilation- Kussmaul breathing
203
first line after diet changes t2d?
| then what?
metformin
| Sulphonylureas eg gliclazide and GLP1 analogues exenatide increase insulin release
204
What sign is found in diabetic nephropathy and how would you treat it?
Microalbuminuria. Treat with ace inhibitors/blood pressure control.
205
Management options for Graves?
Titration eg carbimazole , block and replace eg carbimazole + thyroxine
Radioiodine I 131
Thyroidectomy
206
carbimazole
carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4
207
Treatment for acromegaly
Trans-sphenoidal surgery is first line, pituitary radiotherapy if unsuccessful (bromocriptine is a dopamine agonist and is primarily used to reduce the tumour size before surgery)
208
phaeochromacytoma
for phaeochromacytoma – sympathetic paraganglia in adrenal medulla > headache, sweating and high HR
test urinary catecholamines
209
test cushings
Urinary free cortisol measurement- not very specific to diagnosis but must confirm raised cortisol then localise source
Low-dose dexamethasone test – second step, would have no suppression of ACTH in syndrome and disease
High-dose dexamethasone test – third step- disease= ACTH suppression after dexamethasone but not in syndrome
210
What test is sensitive to picking up Addison’s disease
Short ACTH test- synacthen – still low cortisol despite giving ACTH to make cortisol
211
Symptoms of Conn’s (ie aldosterone producing adenoma)
(signs)Excess aldosterone > high sodium and water retention, decreased renin
Weakness, cramps, polyuria, polydipsia, weakness, low K
Think of Conn’s if HT and hypokalaemia, refractory HT, HT
212
features of crohns
deep fissuring ulcers (transmural granulomatous inflammation)
fibrous scarring and cobblestone
narrow lumen, thickened wall
213
rx mild UC
5-ASA e.g.sulfasalazine
214
Tx moderate UC
if 4-6 motions/day but otherwise well, try prednisolone
215
Tx severe UC
>6 months.
admit for NBM & IV hydration
hydrocortisone
rectal steroids
216
Tx mild attacks in CD
prednisolone
217
Tx severe attacks in CD
admit for IV steroids, NBM
hydrocortisone
? blood transfusion
218
What causes rheumatic fever?
Pharyngeal infection with streptococcus pyogenes
| group A beta-haemolytic streptococcus
219
MS what happens
young adult
AI
CNS white mater
inflam > demyelination > axonal loss
220
MS areas affected
optic neuropathy
brainstem demyelination
spinal cord lesions
periventricular white mater
221
symptoms MS - eyes
optic N - blurred vision, unilateral eye pain
optic disc swelling - optic neuritis
pallor - optic atrophy
222
symptoms MS brainstem
dipoplia - double vision
vertigo
dysphagia
nystagmus
223
symptoms MS spinal cord
numbness + pins and needles (spinothalamic and posterior tract lesions
spastic parapesis - plaques in cervical or thoracic cord
224
Give 2 non-motor symptoms of parkinsons
Depression, lewy body dementia, REM sleep disorder, autonomic dysregulation (tachycardia, anhydrosis, incontinence, constipation, sexual problems)
225
What disease is characterised by beta amyloid plaques and neurofibrillary tangles?
Alzheimer's dementia
226
What feature is seen in the microscopy of csf of patients with subarachnoid hemorrhage
Xanthochromia - oxyhaemoglobin and bilirubin
227
There is an important genetic condition which predisposes people to subarachnoid hemorrhage, give me the name of the condition, its pattern of inheritance and how it causes SAH
Polycystic kidney disease, autosomal dominant, predisposes to berry aneurysms
228
Give me the class and name of drug which is first line in treating myasthenia gravis
Acetylcholinesterase inhibitors, pyridostigmine
229
Which cerebral artery supplies the medial part of the brain?
Anterior cerebral
230
Other than basic analgesics, give one drug for prevention and one drug for management of migraines
Sodium valproate/propranolol + sumatriptan (triptans!)
231
ABCD2 risk of stroke after TIA
A - age >60 (1)
B- BP >140s or 90d (1)
C- clinical features: unilateral weakness (2), speech disturbance without weakness (1)
D - duration of TIA: > 60 min (2), 10-59 min (1), presence of DM (1)
2 - 2 day risk of stroke is 4.1% with a score of 4-5, and 8.1% with a score 6-7
232
thrombolysis drug
IV alteplase = thrombolysis – give within 4.5h of stroke symptoms ALT key smash it to break up the clot
233
first line for general sezuires
anticonvulsant; Sodium valproate (Na+Veed the IC singer guy had a seizure) first line for general seizures
234
what is a seizure
a convulsion or a transient abnormal event caused by a paroxysmal discharge of cerebral neurones
235
Rx parkinsons
levodopa (L-dopa, a dopamine precursor) with a peripheral dopa-decarboxylase inhibitor e.g. bensarazide or carbidopa (reduces nausea SE)
236
SSRI eg
fluoxetine
237
MS rx
- short courses of steroids - iv methylprednisolone used in relapses to reduce severity
- subcut ß-interferon reduces the relapse rate by one third
- glatiramer acetate - antigenically similar to myelin basic protein - competes for presentation to T cells
238
diploplia
double vision
239
rx HD
no rx arrests disease
antidepressants: fluoxetine, amitriptyline
mood stabilisers - carbamazepine
chorea suppression - antipsychotics e.g. olanzapine
240
triptans
severe migraine treatment AND CLUSTER HEADACHES
Triptans (eg sumatriptan) are serotonin (5HT) 1B/1D agonists - they inhibit the release of vasoactive peptides, promote vasoconstriction & block pain pathways
241
verapamil
```
calcium channel blocker
hypertension
angina
cardiac arrhythmia
cluster headaches
```
242
dexamethasone
```
steroid
rheumatic
skin diseases
severe allergies
asthma & COPD
croup
brain and spinal oedema *****
and along with antibiotics in tuberculosis
```
243
mx motor neurone disease
riluzone - sodium channel blocker that inhibits glutamate release, slows progression slightly
ventilatory support & feeding via a PEG helps prolong survival for some months
244
egs of polyneurophathies where autonomic feautures predominate
guillain barre
DM
amyloidosis
245
guillain barre
most common acute PERIPHERAL neuropathy
inflammatory demyelinating usually
life threatening resp failure
246
guillain barre pathogenesis
triggered by infection - campylobacter, jejuni, EBV, cytomegalovirus
infectious organism shares epiptopes with antigen in peripheral N tissue leading to autoantibody mediated N cell damage formation
247
guillain barre clinical features
progressive onset of limb weakness - symmetrical - over 4 weeks
reflexes lost early
sensory symps- paraesthesias
mild to severe resp and facial muscle disability
autonomic - postural hypotension, cardiac arrhythmias, ileus & bladder
248
Classic pathological features of alzheimer's
neuronal reduction
neurofibrillary tangles
argentophile plaques - amyloid protein
249
apraxia
impaired ability to carry out skilled motor tasks
250
vit b12
is a water-soluble vitamin (needs intrinsic F) that has a key role in the normal functioning of the brain and nervous system, and the formation of red blood cells.
Not enough = polyneuropathy and degeneration of cord, and macrocytic anaemia with huge RBCs
251
myasthenia gravis ix and mx 1st and 2nd line. Crisis?
ix - ACh-R antibodies 90% (THYMIC HYPERPLASIA)
mx - anticholinesterases - pyridostigmine, inc availability of ACh at the receptor. second line - immunosuppressants and corticosteroids
myasthenic crisis: plasmapheresis and iv immunoglobilin
252
Mechanism of action for benzodiazepines (hypnotics) and anxiolytics?
Benzodiazepines bind to receptor sites that are closely linked to the GABA-A receptor, inducing a conformational change that enhances the action of the inhibitory neurotransmitter GABA
dependence and tolerance
253
Carbamazepine (antiepileptic) mechanism of action
| CI's/SEs?
Inhibition of repetitive neuronal firing by blockade of transmembrane Na+ Channels
Nausea and vomiting. has anticoag effect dont use with warfarin
254
Sodium valproate MOA
Inhibition of repetitive neuronal firing by blockade of transmembrane Na+ Channels
Same for phenytoin
255
SE's and CIs benzodiazepines and anxiolytics
drowsiness
resp depression (so CI in myasthenia gravis!!)
bsically all drugs CAUTION WITH OLD PEOPLE
256
myasthenia gravis
weakness of ocular, bulbar and proximal limb muscles
thymic hyperplasia
fatiguability of muscle on sustained or repeated activity that improves after rest
ocular muscles first to be involved = ptosis
weakness works its way down: difficulty talking, chewing, swallowing and resp dif
257
where is a mitral regurgitation murmur radiated to?
pan systolic murmur radiates to the axilla
258
grapefruit
CYP450 Inhibitor
Prolongs drug effect
Drugs affected
Ca channel blockers (heart drug), cyclosporine (immune suppressant), carbamazepine (epilepsy), midazolam (benzodiazepine) simvastatin (cholesterol)
259
```
An elderly man has been followed in clinic for several years because he has Paget’s disease of bone. This affects his left femur and right tibia. On review, he reports an increase in pain in his right shin. He has an investigation which confirms an increase in activity of his Paget’s disease.
Choose the correct investigation from the list below:
a - bone biopsy
b - bone mineral density scan
c - CT scan
d - isotope bone scan
e - MIR scan
f - parathyroid hormone measurement
g - serum alkaline phosphatase
h - serum calcium measurement
i - serum protein electrophoresis
```
G
260
A 70 year old lady presents with severe back pain and height loss of 4 inches which has developed over a few weeks. She has been generally unwell and her GP has found her to be anaemic. She has an investigation which suggests that the cause of her back pain is myeloma.
```
Choose the correct investigation from the list below:
a - bone biopsy
b - bone mineral density scan
c - CT scan
d - isotope bone scan
e - MIR scan
f - parathyroid hormone measurement
g - serum alkaline phosphatase
h - serum calcium measurement
i - serum protein electrophoresis
```
i
261
```
A 78 year old woman had been complaining of chest pain a week ago. A neighbour is worried because she hasn’t seen the woman for a couple of days and calls the police who break into the missing woman’s house. The woman is found sat in her armchair in front of the television with no signs of life. Postmortem examination shows the pericardial sac contains 400ml of clotted blood.
Acute myocardial infarction is a significant cause of mortality and morbidity in the UK. For each of the following scenarios select the most likely sequelae described.
a. Cardiac tamponade
b. Contractile dysfunction
c. Dressler’s syndrome
d. Ischaemic cardiomyopathy
e. Mural thrombosis
f. Myocardial rupture
g. Papillary muscle rupture
h. Supraventricular tachycardia
i. Ventricular aneurysm
j. Ventricular tachycardia
```
F
262
```
A 62 year old man retired from work after suffering from an acute myocardial infarction 6 months ago. He has recently been feeling unwell with a fever and sharp chest pain. Auscultation reveals a pericardial rub.
Acute myocardial infarction is a significant cause of mortality and morbidity in the UK. For each of the following scenarios select the most likely sequelae described.
a. Cardiac tamponade
b. Contractile dysfunction
c. Dressler’s syndrome
d. Ischaemic cardiomyopathy
e. Mural thrombosis
f. Myocardial rupture
g. Papillary muscle rupture
h. Supraventricular tachycardia
i. Ventricular aneurysm
j. Ventricular tachycardia
```
C
nb Dressler syndrome is a secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.
263
```
A 19-year- old girl with no previous history of skin problems developed a slightly itchy eruption on the chest and back two weeks after a sore throat. What is the most likely diagnosis?
For each of these patients with rash, select the most likely diagnosis from the list below.
a. Atopic eczema
b. Drug eruption
c. Guttate psoriasis
d. Lichen planus
e. Pityriasis rosea
f. Pityriasis versicolor
g. Seborrhoeic dermatitis
h. Tinea corporis
i. Urticaria
j. Viral exanthem
```
C
264
```
A 40 year old woman has noticed a swelling around 3cm in diameter in the left side of her neck that has increased in size over 3 months. It is painless and moves with swallowing. Thyroid function tests reveal a TSH of 2.5 mU/L (normal range 0.4 – 4.0) and TPO antibodies are negative. There is lymphadenopathy of the cervical nodes on both sides. There is no family history of note.
Identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre
```
E
Papillary carcinoma (PTC) is the most common form of well-differentiated thyroid cancer, and the most common form of thyroid cancer to result from exposure to radiation. Papillary carcinoma appears as an irregular solid or cystic mass or nodule in a normal thyroid parenchyma.
265
```
A 78 year old woman presents with breathlessness and weight loss; she is found to be in atrial fibrillation. Thyroid function tests show a TSH of 0.1 (normal range 0.4 – 4.0) and elevated free T4. She tells you she has had a goitre for many years but tests for this have been satisfactory.
Identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre
```
J
266
```
A 51 year old woman with pernicious anaemia has noticed a painless swelling on both sides of her neck which has gradually increased in size over 2 years. She is well. Thyroid function tests show a normal free T4 but the TSH is 10mU/l (normal range 0.4 – 4.0).
identify the most likely type of swelling from the list below:
a. Colloid nodule
b. De Quervain’s (subacute) thyroiditis
c. Graves’ disease
d. Hashimoto’s thyroiditis
e. Papillary carcinoma
f. Parathyroid carcinoma
g. Reidel’s thyroiditis
h. Thyroglossal cyst
i. Toxic adenoma
j. Toxic multinodular goitre
```
D
267
A 69 year old man presents with lower abdominal pain which has been getting worse for 24 hours. Onset of symptoms occurred after a coach trip to Blackpool and pub crawl. He gives a history of treated hypertension, intermittent constipation and urinary hesitancy. On examination, there is acute tenderness in the lower abdomen, associated with a mass arising out of the pelvis. The mass is soft and dull to percussion. Nothing is heard over it on auscultation.
a. Chronic pancreatitis
b. Distended loops of bowel
c. Enlarged bladder
d. Enlarged kidney
e. Enlarged liver
f. Enlarged spleen
g. Enlarged stomach
h. Gastro-intestinal stromal tumour
i. Metastatic carcinoma
j. Pregnant uterus
C
268
A 45 year old woman, with a known history of alcoholism, presents with acute fever. Although this has just come on, she has been feeling very tired and run down for the last few months, and has had a dragging sensation in her abdomen. Palpation reveals a firm slightly tender mass arising under the ribs in the left upper quadrant which moves down on inspiration. A full blood count reveals haemoglobin 10g/dl, white cell count 400 x 10 9 /l (mainly neutrophils) and platelets 450 x 10 9 /l.
a. Chronic pancreatitis
b. Distended loops of bowel
c. Enlarged bladder
d. Enlarged kidney
e. Enlarged liver
f. Enlarged spleen
g. Enlarged stomach
h. Gastro-intestinal stromal tumour
i. Metastatic carcinoma
j. Pregnant uterus
F
269
A 15 year old boy presents at his GP’s surgery with a temperature of 38 o C, erythematous pharynx with white papillae, and swollen neck glands only. A throat swab reveals an organism which grows on blood agar, with colonies with a clear zone of lysis around them.
Select the most likely microbial cause from the list below:
a. Adenovirus
b. Coronavirus
c. Haemophilus influenzae
d. Influenza A
e. Influenza C
f. Respiratory syncytial virus
g. Rhinovirus
h. Streptococcus pneumoniae
i. Streptococcus pyogenes
j. Streptococcus viridans
I
270
```
A 60 year old man with chronic obstructive pulmonary disease has cough with production of green phlegm. Sputum culture reveals an organism that grows on agar but which requires factors X and V.
Select the most likely microbial cause from the list below:
a. Adenovirus
b. Coronavirus
c. Haemophilus influenzae
d. Influenza A
e. Influenza C
f. Respiratory syncytial virus
g. Rhinovirus
h. Streptococcus pneumoniae
i. Streptococcus pyogenes
j. Streptococcus viridans
```
C
271
```
A 71 year old male presents with anginal symptoms, shortness of breath and syncopal attacks when exercising. He has a harsh systolic flow murmur in the aortic region.
Identify, from the patients’ symptoms and investigation results, the most likely cause of the collapse.
a. Acute rheumatic fever
b. Amyloid valve tissue
c. Congenital valve anatomy abnormality
d. Infective endocarditis
e. Metallic valve prosthesis
f. Mitral valve prolapse
g. Non-bacterial thrombotic endocarditis
h. Normal valve
i. Senile calcific valve stenosis
j. Xenograft valve
```
I
272
```
An 81 year old male patient with carcinoma of the bronchus collapses and dies. The autopsy shows irregular vegetations on the mitral valve. No septic event was identified prior to the patient’s death, and the clinicians did not detect an ante-mortem murmur.
Identify, from the patients’ symptoms and investigation results, the most likely cause of the collapse.
a. Acute rheumatic fever
b. Amyloid valve tissue
c. Congenital valve anatomy abnormality
d. Infective endocarditis
e. Metallic valve prosthesis
f. Mitral valve prolapse
g. Non-bacterial thrombotic endocarditis
h. Normal valve
i. Senile calcific valve stenosis
j. Xenograft valve
```
G
273
```
A 55 year old woman has had severe rheumatoid arthritis for over 20 years. Urine testing reveals albuminuria. Liver enlargement and bilateral ankle oedema, but no evidence of heart failure, are noted on clinical examination. Apart from a low serum albumin, her liver biochemistry tests are normal. A liver biopsy reveals the cause of her albuminuria, ankle oedema and liver enlargement.
Choose the most likely intrahepatic feature from the list below:
a. Alkaline phosphatase
b. Amyloid
c. Granulomas
d. Haemosiderin
e. Liver cell apoptosis
f. Lymphocytic infiltration
g. Mallory’s hyalin
h. Nodular regeneration
i. Portal hypertension
j. Steatosis (fatty change)
```
B
274
```
A 45 year old man has abnormal liver biochemistry, principally raised transaminases and gamma-glutamyltransferase. He admits to drinking, on average, one bottle of wine a day and often more at weekends. However, following a period of intravenous drug abuse, he is also infected with hepatitis C virus. Liver biopsy reveals a distinctive feature favouring alcohol rather than hepatitis C virus as the predominant cause of his liver abnormalities.
Choose the most likely intrahepatic feature from the list below:
a. Alkaline phosphatase
b. Amyloid
c. Granulomas
d. Haemosiderin
e. Liver cell apoptosis
f. Lymphocytic infiltration
g. Mallory’s hyalin
h. Nodular regeneration
i. Portal hypertension
j. Steatosis (fatty change)
```
G
275
```
A 60 year old man presents with haematemesis. Upper gastrointestinal endoscopy reveals bleeding oesophageal varices. There is no relevant past history of liver disease. Liver biochemistry tests show a low serum albumin and only slight elevations of serum transaminases and bilirubin. A liver biopsy is performed and a feature is seen that is diagnostic of cirrhosis.
Choose the most likely intrahepatic feature from the list below:
a. Alkaline phosphatase
b. Amyloid
c. Granulomas
d. Haemosiderin
e. Liver cell apoptosis
f. Lymphocytic infiltration
g. Mallory’s hyalin
h. Nodular regeneration
i. Portal hypertension
j. Steatosis (fatty change)
```
H
276
```
A 23-year- old woman presents to her GP with a 2-day history of urinary frequency and dysuria. Her last menstrual period was six weeks previously. She reports that she experienced facial swelling and wheezing when she was given either penicillins or cephalosporins as a teenager. Microscopy of her urine shows numerous white and red blood cells. Culture yields >10^5 /ml of a fully sensitive Escherichia coli.
Identify the most appropriate treatment from the list below:
a. Amoxicillin
b. Antibiotic treatment is not indicated
c. Ceftazidime
d. Cephalexin
e. Ciprofloxacin
f. Flucoxacillin
g. Gentamicin
h. Nitrofurantoin
i. Trimethoprim
j. Vancomycin
```
H
277
A 60-year- old man is admitted with a fever. He has had repeated hospital admissions over the preceding year for an unrelated condition, and is known to carry MRSA in his nose. On taking a history, he describes recent onset urinary frequency, nocturia and loin pain. An MSU is sent to the laboratory. Microscopy shows numerous white blood cells and a culture yields >10^5 /ml of Staphylococcus aureus. This morning he has become hypotensive and confused.
a. Amoxicillin
b. Antibiotic treatment is not indicated
c. Ceftazidime
d. Cephalexin
e. Ciprofloxacin
f. Flucoxacillin
g. Gentamicin
h. Nitrofurantoin
i. Trimethoprim
j. Vancomycin
J
278
On admission to a residential home, a urine sample is sent from a 75- year-old man with a long-standing indwelling urinary catheter, because it looks cloudy and contains protein on dipstick. The patient is otherwise well. The culture yields >10^5 /ml of a Pseudomonas aeruginosa sensitive to standard antipseudomonal antibiotics.
a. Amoxicillin
b. Antibiotic treatment is not indicated
c. Ceftazidime
d. Cephalexin
e. Ciprofloxacin
f. Flucoxacillin
g. Gentamicin
h. Nitrofurantoin
i. Trimethoprim
j. Vancomycin
B
279
```
A 56 year old man with a previous history of angina is admitted with prolonged central chest pain radiating to the neck and left arm. He has already received acetylsalicylic acid in the ambulance. His ECG shows ST elevation in the leads V2 to V4 with reciprocal ST depression in the lateral leads.
What is your first treatment of choice?
a. Amiodarone
b. Aspirin
c. Atenolol
d. Furosemide (frusemide)
e. Low molecular weight heparin
f. Naloxone
g. Oxygen
h. Ramipril
i. Simvastatin
j. Streptokinase
```
J
Streptokinase (SK) is an enzyme secreted by several species of streptococci that can bind and activate human plasminogen. SK is used as an effective and inexpensive thrombolysis medication in some cases of myocardial infarction (heart attack) and pulmonary embolism.
280
```
A 55 year old woman notices that her left nipple is red and crusty. Biopsy reveals atypical cells (pleomorphic, hyperchromatic nuclei) within the epidermis.
Choose the most likely diagnosis from below:
a. Eczema
b. Fat necrosis
c. Fibroadenoma
d. Fibrocystic change
e. Gynaecomastia
f. Intraduct papilloma
g. Invasive adenocarcinoma
h. Lipoma
i. Paget’s disease
j. Squamous cell carcinoma
```
I
281
```
A 28 year old woman notices a painless lump in her left breast. On palpation, it is quite mobile and seems to be about 20 mm in diameter.
Choose the most likely diagnosis from below:
a. Eczema
b. Fat necrosis
c. Fibroadenoma
d. Fibrocystic change
e. Gynaecomastia
f. Intraduct papilloma
g. Invasive adenocarcinoma
h. Lipoma
i. Paget’s disease
j. Squamous cell carcinoma
```
C
282
```
A 27-year old female who is an intravenous drug user presents at her GP’s surgery with mild fever, malaise, weakness, abdominal pains and jaundice commencing over the past 4 or 5 days. A blood test confirms the presence of antibodies against a microorganism, and this is confirmed by detecting Ribose-nucleic acid (RNA) of the organism by polymerase chain reaction (PCR).
identify the most likely micro organism to be the causative infectious agent from the list:
a. Cytomegalovirus (CMV)
b. Entamoeba histolytica
c. Epstein-Barr virus (EBV)
d. Hepatitis A virus (HAV)
e. Hepatitis B virus (HBV)
f. Hepatitis C virus
g. Hepatitis D virus (Delta agent)
h. Hepatitis E virus
i. Hepatitis F/G virus
j. Treponema pallidum
```
F
283
```
A 21-year old student traveller just returned from Morocco reports to his GP with mild fever, diarrhoea and slight jaundice. He reports that on a number of occasions during his vacation he has drunk water from streams, and also on questioning, reveals that he did not receive all the vaccinations available to him prior to leaving on his travels.
identify the most likely micro organism to be the causative infectious agent from the list:
a. Cytomegalovirus (CMV)
b. Entamoeba histolytica
c. Epstein-Barr virus (EBV)
d. Hepatitis A virus (HAV)
e. Hepatitis B virus (HBV)
f. Hepatitis C virus
g. Hepatitis D virus (Delta agent)
h. Hepatitis E virus
i. Hepatitis F/G virus
j. Treponema pallidum
```
D
284
```
An 18-year old female medical student complains of feeling generally unwell with a mild sore throat and slight fever, and also tired and lethargic over the past month or so. On examination, her GP notices a slight yellowing of her skin. A blood sample is collected, and in the laboratory the presence of numerous ‘abnormal’ monocytes is noted in the blood film.
identify the most likely micro organism to be the causative infectious agent from the list:
a. Cytomegalovirus (CMV)
b. Entamoeba histolytica
c. Epstein-Barr virus (EBV)
d. Hepatitis A virus (HAV)
e. Hepatitis B virus (HBV)
f. Hepatitis C virus
g. Hepatitis D virus (Delta agent)
h. Hepatitis E virus
i. Hepatitis F/G virus
j. Treponema pallidum
```
C
285
```
A 42 year old woman presents with anorectal pain. She says the pain can come on at any time, day or night, with no obvious precipitating factors. She describes the pain as excruciating but it does not last long. She is otherwise well. There is no abnormality on digital rectal examination.
Most likely pathology?
a. Anal fissure
b. Anorectal cancer
c. Coccdynia
d. Crohn’s disease
e. Endometriosis
f. Ovarian cyst
g. Perianal abscess
h. Proctalgia fugax
i. Prostatitis
j. Thrombosed haemorrhoids
```
H
286
A 40 year old man presents with Pneumocystis carinii pneumonia and is found to have extensive Kaposi’s sarcoma.
Which of the below immune defects is most likely to be relevant to the following cases, each of whom presented with fever.
a. B-cell failure
b. CD18/11b deficiency
c. Ciliary dyskinesia
d. Hypogammaglobulinaemia
e. IgA deficiency
f. Leukocyte esterase deficiency
g. Mannose binding lectin deficiency
h. Neutropenia
i. Terminal complement component deficiency
j. T-helper (CD4) cell dysfunction/depletion
J
287
```
A 75 year old female is found by her neighbour lying on the floor of her kitchen. She has slipped and fallen, and has fractured her femur. She is thirsty, has a dry mouth and tongue, and is generally weak. It is unclear how long she has been lying there.
Choose the most likely values for the plasma sodium, potassium and urea. All values are given in mmol/l.
Norm urea: 2.5 to 7.1
Norm potassium: 3.5-5.0
Norm sodium: 135-145
a Sodium 105 Potassium 1.0 Urea 5
b Sodium 131 Potassium 4.0 Urea 18.0
c Sodium 131 Potassium 4.0 Urea 35.0
d Sodium 131 Potassium 6.5 Urea 3.0
e Sodium 131 Potassium 6.5 Urea 35.0
f Sodium 140 Potassium 4.0 Urea 2
g Sodium 152 Potassium 4.0 Urea 18.0
h Sodium 152 Potassium 4.0 Urea 35.0
i Sodium 152 Potassium 6.5 Urea 3.0
j Sodium 152 Potassium 6.5 Urea 35.0
```
G
288
```
An 80 year old male has a 3 day history of abdominal cramps and profuse watery diarrhoea. He is thirsty and lethargic.
Choose the most likely values for the plasma sodium, potassium and urea. All values are given in mmol/l.
Norm urea: 2.5 to 7.1
Norm potassium: 3.5-5.0
Norm sodium: 135-145
a Sodium 105 Potassium 1.0 Urea 5
b Sodium 131 Potassium 4.0 Urea 18.0
c Sodium 131 Potassium 4.0 Urea 35.0
d Sodium 131 Potassium 6.5 Urea 3.0
e Sodium 131 Potassium 6.5 Urea 35.0
f Sodium 140 Potassium 4.0 Urea 2
g Sodium 152 Potassium 4.0 Urea 18.0
h Sodium 152 Potassium 4.0 Urea 35.0
i Sodium 152 Potassium 6.5 Urea 3.0
j Sodium 152 Potassium 6.5 Urea 35.0
```
B
289
```
A 23-year- old man with recent onset of paranoid delusions and auditory hallucinations becomes acutely unwell with a pyrexial illness and epistaxis after starting antipsychotic medication.
The following patients have all presented with aplastic anaemia secondary to their drug therapy. Please choose the most appropriate cause from the above list.
a. Carbimazole
b. Chlorpromazine
c. Chlorpropamide
d. Cyclophosphamide
e. Gold
f. Methotrexate
g. Naproxen
h. Phenytoin
i. Propanolol
j. Propylthiouracil
```
B
290
```
A 40-year- old woman with rheumatoid arthritis, who is receiving regular intramuscular injections in the outpatient clinic, presents to her GP with malaise and severe pharyngitis.
The following patients have all presented with aplastic anaemia secondary to their drug therapy. Please choose the most appropriate cause from the above list.
a. Carbimazole
b. Chlorpromazine
c. Chlorpropamide
d. Cyclophosphamide
e. Gold
f. Methotrexate
g. Naproxen
h. Phenytoin
i. Propanolol
j. Propylthiouracil
```
E
291
A 45-year- old woman who is taking medication to prevent complication two weeks after post excision of a large frontal meningioma, develops severe bruising and menorrhagia. The following patients have all presented with aplastic anaemia secondary to their drug therapy. Please choose the most appropriate cause from the above list.
a. Carbimazole
b. Chlorpromazine
c. Chlorpropamide
d. Cyclophosphamide
e. Gold
f. Methotrexate
g. Naproxen
h. Phenytoin
i. Propanolol
j. Propylthiouracil
H
292
What will the % of the HbA1c be over in a patient with diabetes?(
Over 6.5% (1mrk)
293
How would you carry out an oral glucose tolerance test?(2 - method of the test + timings)
Starve for 8hrs before the test. Measure fasting blood glucose then give 100gs of sweet liquid. Take blood test after 1-2 hrs of this. An abnormal result is over 11.1 mmol/L (2mrks- one for glucose challenge, one for timings)
294
What are the rules for driving when you are an insulin dependant diabetic? (2)
Notify DVLA. take blood glucose levels within 2 hours before driving and then take again every 2 hours while driving. If glucose level is below 4, you cannot drive. (2 marks for any of above points)
295
Give 3 long term complications of diabetes (1)
Vascular disease, nephropathy, retinopathy, maculopathy, peripheral neuropathy, ulcers, autonomic neuropathy, erectile dysfunction, charcot foot. (1mark)
296
Sally is a 15 year old diabetic who suffers from a long standing eating disorder. She comes to A+E reporting abdominal pain and vomiting. Her mother states that she appears to be drowsier than usual and confused. She is breathing rapidly on examination and her cap refill time is 4. How would you treat her? (2mrks)
What ion level in her bloods would you want to watch out for closely during this treatment? (1)
Firstly fluids, 0.9% sodium chloride for 1hr. Start to introduce insulin 0.05-0.1 U (aim to reduce glucose by 2mmol/hr) hourly neuro obs, repeat bloods every 2 hrs. (2 marks, one for fluids, one for insulin)
Potassium levels may fall as consequence of insulin treatment. This can cause life threatening arrythmias . watch out for ECG changes! A low level is under 3.5. (1 mark)
297
A lady who is previously known to suffer from graves presents with palpitations, tremor, confusion, vomiting, abdo pain and extreme anxiety. Her temperature is high and HR is 150 bpm. What condition would you suspect? (1)
Thyrotoxic crisis/ thyroid storm. (1 mark)
298
Give an eye sign that is seen in graves disease. (1)
Exopthalmus, opthalmoplagia. (1 mark)
299
How would you test a patient with suspected Addison’s disease? (1)
A synacthen test / Short ACTH test. This tests the cortisol level after stimulation with adrenocorticotropic hormone or a corticotropic agent such as tetracosactide. If there is response (cortisol over 550 after test) addisons can be excluded. (1 mark)
300
Give 2 causes of raised calcium?
Primary hyperparathyroidism, malignancy, sarcoidosis, TB, thyrotoxicosis, phaeochromocytoma, addisons, drugs. (2 marks)
301
What are three features of a nephrotic syndrome? (3)
Proteinurea (over 3g) hypoalbuminaemia, oedema, hyperlipidaemia. (3 marks)
302
An 18 year old man presents with frank haematuria for 1 day. He also has a sore throat. He has also suffered the past 2 years from ankylosing spondylitis. On examination he is hypertensive. He also has elevated serum creatinine. Throat swabs have excluded a streptococcal infection. A kidney biopsy shows tubulointerstitial fibrosis. What is his diagnosis? (1)
IgA nephropathy. This is the leading cause of nephritis and is caused by an exaggerated immune response causing immune complexes to be deposited in the glomerular mesangium. Treat him with steroids. (1 mark)
303
A lady has suffered from cramp like colicly pain which shoots from her left groin to her left loin. What investigation would you order to try to visualise any renal stones? (1)
Give a non contrast CT to assess the size of the stone. This assesses if the stone is of a suitable size to be spontaneously passed or not. (1 mark)
304
A 20 year old man presents to his GP after finding a painless lump in his testicle. What is a simple non invasive test you can do in the GP clinic to indicate a possible testicular cancer? (1)
Pregnancy test- beta HCG is raised in germ cell tumors (1mark)
305
Where is testicular cancer most likely to spread? (1)
Lungs (1 mark)
306
Give three lower urinary tract symptoms you might get with benign prostate hyperplasia (3)
Nocturia, terminal dribbling, hesitancy, poor flow rate, intermittent flow, incomplete emptying, retention. (3mrks)
307
What class of drug is finasteride and how does it work to improve urinary symptoms? (1)
A 5 alpha reductase inhibitor, which blocks the conversion of testosterone (1)
308
What leukaemia is most commonly seen in children? (1 mark). And what is required for diagnosis? (2 marks)
ALL Over 20% blast cells on bone marrow (3)
309
How many blood films are needed to rule out a diagnosis of malaria? (1 mark)
3. (1)
310
A patient presents with purpura, fever, fluctuating consciousness, haemolytic anaemia and renal failure. Lactate dehydrogenase levels are markedly raised. What condition do you suspect? (1 mark)
Thrombotic thrombocytopenic purpura(1)
311
What condition is defined as an increase in haemoglobin, packed cell volume and red blood cell count? (1 mark)
Polycythemia (1)
312
What are the three cardinal features of acne? (3 marks)
comedones, inflammatory papules and pustules.(3)
313
Alongside eczema, what two other conditions are associated with atopy? (2 marks)
Hayfever and asthma. (2)
314
A patient comes in with red scaly plaques on the extensor surfaces of their arms and on their scalp. What is the diagnosis? (1 mark) Give two treatments other than emollients and topical steroids. (2 marks)
Chronic plaque psoriasis. Vit. D analogues, coal tar, dithranol, phototheraphy or anti-TNF (3)
315
Which skin cancer is said to be ‘locally invasive’? (1 mark)
BCC (1)
316
A lady comes in with a swollen, red, hot leg. She has a small cut on her foot and you suspect cellulitis. What is the most common causative organism and what would you use to treat? (2 marks)
Strep A and flucloxacillin. (2)
317
List 2 AIDS defining conditions (2 marks)
Candidiasis, burkitt’s lymphoma, TB, Lymphoma, CMV
318
A patient presents with non-pitting oedema of the leg after returning from the DRC. She has an associated fever. What do you suspect is the cause and how would you treat? (2 marks)
Filiarial Infection – Onchocerciasis or lymphatic filiarias. Ivermectin.(1)
319
What’s the most common cause of a breast lump in a pre-menopausal woman? (1 mark)
Fibroadenosis (1)
320
Which reflex would be affected in pathology affecting the L4 nerve root? (1)
Knee jerk reflex (1)
321
Which antibody is highly specific for rheumatoid arthritis? (1)
Anti-CCP (anti-cyclic citrullinated peptide antibodies) (1)
322
What would be seen in polarised light in someone with psuedogout (calcium pyrophosphate deposition)? (1)
Positively birefringent, rhomboid shaped crystals (1)
323
What makes up the triad of Reiter’s syndrome? (3)
Arthritis, urethritis, conjunctivitis (3)
324
What is likely to be raised on the LFTs of someone with osteomalacia? (1)
Alkaline Phosphatase (1)
325
rx psoriasis
emollients to hydrate skin
mild to moderate steroids
synthetic vit D3 analogues e.g. calcipotriol
0.05% tazarotene (a retinoid)
326
acne pathogenesis
- Follicular epidermal hyperproliferation
- Blockage of pilosebaceous units with surrounding inflammation
- Increased sebum production
- Infection with propionibacterium acnes
327
1L rx acne
- kertolytics e.g. benzoyl peroxide, azelaic acid
- topical retinoids (tretinoin, isotretinoin)
- topical antibiotics e.g. erythromycin for inflammatory acne
328
acne presentation areas and 3 cardinal signs
face, back, sternal area (where theres lots of sebaceous glands)
1. open comedones (blackheads)
2. closed comedones (whiteheads)
3. pustules
skin may be greasy
premenstrual exacerbation
329
skin biopsy psoriasis
epidermal hyperplasia and parakeratosis ---> reflects the increase in skin turnover
Glandular layer often absent
Dermal: capillary dilation
330
presentation chronic psoriasis
pinkish red scaly plaques, silver scale seen, esp. on extensor surfaces e.g. knees + elbows
331
cellulitis
inflammation of subcutaneous connective tissue.
332
necrotising faciitis
an acute disease in which inflammation of the fasciae of muscles or other organs results in rapid destruction of overlying tissues.
333
rx necrotising faciitis
radical debridement +/- amputation, IV antibiotics
