CBE 2019

Question 1

CBE SURGERY - Oesophageal cancer
- Pt presents with difficulty swallowing.
- Ask specific history?
- 6 possible diagnoses?
- Common causes?
- Common types of oesophageal cancer?
- Investigations?
- 2 main post-operative complications?

Answer 1

Differentials for dysphagia
- GORD
- Esophageal stricture
- Esophageal web
- Achalasia
- MS
- GBS
- Hiatal hernia
- Eosinophilic esophagitis
- Oesophageal candidiasis

Question 2

Answer 2

5 causes of a groin lump in a female:
1. Lymphadenopathy
2. Femoral hernia
3. Abscess
4. Lipoma
5. Cyst

Question 3

Answer 3

MOA of Clopidogrel = Selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor and the subsequent ADP- mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. irreversible.

Question 4

ENT Case - SSNHL
Middle-aged/30y M comes in complaining of sudden onset hearing loss and fullness in one ear, no recent illness, no wax etc.
1. What other features would you ask about on history?
2. Outline what examination would you do, what specific features you would be looking for?
3. Given pic of normal looking tympanic membrane, table of results from Rinne and Webber testing and an audiogram. What is the Dx /list two differentials
4. What is your management?
5. Patient re-presents in 6 weeks, but has no improvement in hearing in the left ear. How will you manage?

Answer 4

Hx - No vertigo, no tinnitus, no dizziness, no pain, not recently unwell

Tx - 1mg/kg of Pred up to 60mg daily

Long term Mx - Rule out other causes? Follow up Audiometry? Tinnitus mx

Question 5

ENT CBE – Peritonsillar abscess
30y M comes in with a sore throat
1. What four things do you want to ask about the sore throat?
2. Given pic similar to this, what is your diagnosis?
3. Based on the current evidence based guidelines, what is your management?
4. Guy comes back 6 weeks later. Pain gone and feeling much better but swelling still persists. What is your management now? (we didn’t really know what he was getting at/asking)

Answer 5

Hx - Fx of peritonsillar abscess are given (hot potato voice, truisms, drooling, dysphagia, weight loss, 2 weeks onset of disease, fever).

Mx - Incision & Drainage & Abx?

Question 6

MSK - SLS/APS
23y F comes in complaining of six months of LL polyarthritis and lethargy
1. What are ten things you’d ask about on history to support your diagnosis (8 marks)
2. List six signs you’d look for on clinical examination (3 marks)
a. Gives examination findings suggestive of SLE and scleroderma.
3. What is the one investigation you’d do to confirm your diagnosis?
4. Then you were given this picture of immunofluorescence and asked ‘what does this mean’?
5. List another two investigations you want to confirm your diagnosis?
2. What medication would you start her on?
3. What is the monitoring required for this drug?
4. Now she has had three recurrent miscarriages, what do you think this means? What two investigations do you want to do to confirm your diagnosis?
5. Now she’s pregnant, what would her management be during pregnancy?

Answer 6

1 ix = ANA

Homogenous ANA indicative of SLE.

2 other ixs to confirm dx = anti-dsDNA and ENA

Tx = Hydroxychloroquine (Plaquenil)

Miscarriages = anti-phospholipid syndrome, testing = lupus anticoagulant, anti-cardiolipin or anti-beta-2 glycoprotein 1 (β2GP1) - Mx = LMWH

Question 7

Gen Surg 1 - Breast cancer case
- Hormonal receptor status = ER-ve, PR-ve and HER2-ve
- Does a triple negative result lead to a better or worse outcome?
- Most common finding on histo?

Answer 7

Approx. ~10% of breast Ca, very aggressive, usually high grade tumour = worse prognosis, can’t use hormone targeting therapies so limited therapy available.

Most common finding on histo = infiltrative ductal carcinoma

Question 8

Gen Surg 2 – Pancreatic Cancer

Answer 8

Question 9

RGP - Cough/Pneumonia

Question 10