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PLABABLE GEMS > CLINCHER > Flashcards

CLINCHER Flashcards

1
Q

Middle aged smoker + Metastatic esophageal carcinoma in the middle 3rd of the esophagus + SEVERE DYSPHAGIA + on palliative care.

How to help with dysphagia?

A

ESOPHAGEAL STENT

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2
Q

A 30-year old lady with Rt EAR DEAFNESS + reduced RIGHT CORNEAL REFLEX

Rinne’s Test AC>BC
Weber’s Test: Sound lateralizes to the LEFT EAR

Type of Hearing Loss?
Most appropriate investigation?
Diagnosis?

A

Right Sensorineural Hearing Loss
MRI of the Cerebellopontine Angle
Acoustic Neuroma: Unilateral Sensorineural Deafness (CN VIII) + Facial Palsy CN VII) + Absent Corneal Reflex (CN V)

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3
Q

Middle-aged alcoholic man + Painless Abdominal Distention + Spider Nevi on anterior abdominal wall

VS: Normal
Investigations: Low albumin, Ascitic tap (ascitic fluid amylase around 50% of serum amylase)

Appropriate Medication to start?

A

SPIRONOLACTONE (aldosterone antagonist)

  • may be used in Heart failure, Liver cirrhosis and Nephrotic syndrome
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4
Q

Old lady with metastatic gastric cancer + On palliative care + Vomited 600 mL of Blood + anxious

BP 80/60
HR 120

How would you manage her?

A

S/C Midazolam - aim is to make her comfortable and reduce her anxiety
(Morphine S/C can also be added to help with pain)

*IV Fluids or S/C Fluids are not appropriate in this case

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5
Q

Old woman with poor vision + Poorly-controlled hypertension + Headache

Current BP: 160/100

Fundoscopy: Dot and blot hemorrhages

Most likely diagnosis?

A

Hypertensive Retinopathy

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6
Q

Old man presented to A&E after consuming 50 Paroxetine + 1 bottle of whiskey 12 hours ago.

VS - normal

Investigations”
ECG - normal
FBC, LFT, U&E - normal

Medically fit for discharge

What would you do before discharging the patient?

A

Refer to the Psychiatry Liaison team prior to discharge

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7
Q

Middle-aged man + Multiple painless yellowish plaques on eyelids + Hypertension + Hyperlipidemia

A

Xanthelasma

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8
Q

Man currently on Ramipril for hypertension
Poorly-controlled hypertension
Past Hx of Pedal edema with Amlodipine

What to give instead?

A

Amlodipine + Leg swelling + already on ACEi = use THIAZIDE-like diuretics such as INDAPAMIDE

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9
Q

25-year old man + develops anxiety symptoms on boarding a train or going to a shopping mall

What is the most likely diagnosis?

Treatment?

A

AGORAPHOBIA

Management: CBT + Graded Exposure

Do not pick social phobia
*Social Phobia is the persistent fear of performance or social situations

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10
Q

Old Lady + Gradual impairment of vision over 6 months + Glare and difficulty driving at night + Changing glasses frequently

On examination: Cornea and pupil are normal

Diagnosis?

A

Cataract

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11
Q

65-year old man + 2-3 fainting episodes in 7 days + ECG showing 3rd degree heart block.

Definitive treatment?

A

PERMANENT PACEMAKER

Remember: For Mobitz Type 2 and 3rd degree Heart block: Permanent Pacemaker

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12
Q

24-year old female + mobile non-tender firm lump in the right breast + family history of maternal breast cancer

Most likely diagnosis?

A

FIBROADENOMA

(Remember, mobile, non-tender, firm mass in a young female is most likely a FIBROADENOMA. History of CA is given as a distraction.)

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13
Q

25-year old man + Cough with sputum + Fever + Consolidation on CXR + PCN allergy

Diagnosis

Most appropriate Treatment

A

Pneumonia

Doxycycline or Clarithromycin

(In patients with Penicillin allergy taking statins, diagnosed with Pneumonia, Doxycycline is DOC. Clarithromycin cannot be combined with statins as this has drug interactions, requiring hospitalization).

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14
Q

70-year old woman with urinary frequency, nocturia and urgency

Diagnosis

Most appropriate treatment

A

URGE INCONTINENCE

Bladder retraining (If bladder retraining is not in the options, pick anticholinergics (antimuscarinic) instead e.g. Tolterodine)

*Remember, pelvic floor exercises are not the same as bladder retraining. Pelvic floor exercises are used for stress incontinence

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15
Q

40-year old woman + history of recurrent breast abscess + thick discharge from periareolar area

Most likely diagnosis?

A

Mammary duct fistula

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16
Q

30-year old man + Halitosis + no underlying cause found + not improving after oral hygiene measures

Most appropriate treatment

A

Antibacterial mouthwash like Chlorhexidine

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17
Q

3-year old child brought to A&E with swelling of arm. X-ray shows spiral fracture of the humerus with callus formation + another healed fracture in radius

Most likely diagnosis?

A

Non-accidental injury

Important to rule out NAI in all children with suspicious injuries + Signs of previous healed injuries

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18
Q

70-year old man + just had successful cholecystectomy + now has RR of 8/min + Bilateral miosis + airway has been maintained

Most likely diagnosis?

Next step?

A

Opioid Overdose (Post-operative analgesia)

IV Naloxone

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19
Q

10–year old child + unilateral greenish nasal discharge + history of asthma

Most likely diagnosis?

A

Foreign Body

History of BA is a distractor. Nasal polyps are rare in children and usually cause watery discharge

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20
Q

50-year old man on Amlodipine for hypertension + BP not controlled now + Cannot tolerate Ramipril due to dry cough

Which antihypertensive can be added?

A

Give either an ARB or thiazide-like diuretic
Options for step 2 management of hypertension include ACEi/ARBs/thiazide-like diuretics (ACEi cannot be the answer here as the patient does not tolerate it)

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21
Q

Woman with 34 weeks pregnancy + History of recent flu + Reduced fetal movements

Next step?

A

Check fetal viability using handheld doppler

Once viability is confirmed, perform a CTG

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22
Q

65 year old man + underwent TURP + developed confusion and seizures

Which electrolyte balance could have occurred?

A

HYPONATREMIA

Management: Fluid restriction

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23
Q

21-year old woman + Concerned about her weight + takes laxatives and diuretics + BMI of 17 kg/sq m + BP 88/60

What would you do next?

A

Admit to medical unit

BMI < 17.5 kg/sq. M + Evidence of systemic failure should be admitted immediately

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24
Q

Pregnant woman came in contact with 50-year old man with shingles

A

Check her immunity with VZV

VZIG should be given only to those pregnant females who come in contact with shingles who do not have immunity to VZV

*If >20weeks gestation, Aciclovir is preferred over VZIG due to national shortage, but VZIG can still be given if there is no option for antivirals.

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25
Q

Young female + Sudden severe occipital headache + has a history of migraine +/- neck stiffness

What is the next investigation?

A

CT brain

CT Brain is the initial investigation in suspected cases of SAH or acute stroke

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26
Q

50-year old man scheduled for rotator cuff surgery + on Amlodipine, Beclomethasone, Lisinopril, Atorvastatin + Current BP is 131/78

Which medications should be omitted before surgery?

A

Lisinopril

ACEi and ARBs should be discontinued on day of surgery due to risk of hypotension

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27
Q

2-weeks old baby whose mother is deaf and uses a hearing aid

Which hearing test should be performed?

A

Otoacoustic emissions (OAE) or Audiological brainstem responses (ABR)

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28
Q

60-year old female + breast cancer + metastasis to brain + headache and vomiting

What could be the cause of her symptoms?

What is the most appropriate treatment?

A

Raised intracranial pressure

Cyclizine (1st line) OR Dexamethasone

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29
Q

35-year old man with a painless firm mass in upper part of right testes

What is the most appropriate initial investigation?

A

USG scan of scrotum

USG scan of scrotum is the first line investigation for any scrotal lump
Do not pick tumor markers are most appropriate initial investigation

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30
Q

40-year old woman + acute onset chest pain and shortness of breath + history of long flight 2 days back + ECG shows sinus rhythm

What is the most appropriate initial investigation?

A

Chest X-ray

(CXR is the initial investigation of choice in patients with a suspected pulmonary embolism to rule out other causes such as pneumonia and pneumothorax

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31
Q

33-year old man + loss of libido + erectile dysfunction
Prolactin is elevated
MRI suggestive of prolactinoma

What is the most appropriate management?

A

Cabergoline

*Cabergoline is a dopamine agonist (Another option is Bromocriptine - 2nd line)

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32
Q

65-year old man with central chest pain + dyspnea + sweating + nausea

ECG: LBBB

What is the most likely diagnosis?

A

Myocardial Infarction

Possible ECG changes seen in MI: ST segment elevation, pathological Q wave, LBBB

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33
Q

70-year old woman + Had a fall + sustained a fracture of the distal radius + minor displacement of distal radius + swelling of hand

What is the initial management of analgesia?

A

CLOSED REDUCTION

Followed by Below-elbow POP back slab

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34
Q

38-year old male + maculopapular rash on palms and soles + had penile ulcer 1 week ago which has resolved + now developed mouth ulcers.

What is the most appropriate investigation?

A

Swab from mouth ulcer for PCR

Penile ulcer - darkfield microscopy or PCR
Mouth ulcer - PCR or serology

If both ulcers have healed, pick serology

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35
Q

25-year old woman + acne + irregular period + raised serum testosterone

What is the most likely diagnosis?

What is the most appropriate treatment for her irregular periods

A

PCOS

Weight Loss + COCPs (Metformin does not regulate her periods)

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36
Q

65-year old female + metastatic breast cancer + right hip pain + currently on oral morphine

What is the most likely cause of her pain?

What is the most appropriate treatment for her pain?

A

Bone metastasis

Radiotherapy (Bisphosphonates + NSAIDs [2nd line])

37
Q

Middle -aged man recovering from GBS

What is the underlying cause of this condition?

A

Demyelination of peripheral nerves (Usually starts a progressive symmetrical weakness from the lower extremities)

38
Q

24-year old woman + fatigue + irregular menstrual cycle
TSH - normal
PRL - normal
FSH - raised

What is the most likely diagnosis?

A

PREMATURE OVARIAN FAILURE

Another raised value of FSH > 25 IU/L taken 4 weeks later will be diagnostic of POI

39
Q

30-year old man + painful urination for 3 days + 4 painful non-indurated ulcers on his penis

What is the most likely diagnosis?

A

Herpes simplex virus infection - multiple painful ulcers +/- dysuria of suggestive of HSV infection

40
Q

7-year old boy who has 3 recurrent throat infections in the last 1 year + history of cough + mild inflammation of tonsils with no exudate + no fever or palpable lymph nodes

What is the most appropriate action?

A

REASSURE

Centor Score:0 - viral tonsillitis which is self limiting does not warrant further treatment or investigation; patient does not meet the criteria for being offered tonsillectomy

41
Q

Young man with past history of acne + prescribed a drug for it by GP
He has now developed dry lips

What is the most likely drug that was prescribed to him?

A

ISOTRETINOIN

Isotretinoin causes dryness —- dry skin, dry lips, dry eyes and dry nose

42
Q

18-year old woman + palpitations + tremors + symptoms of thyroid eye disease + weight loss + increased appetite

What is the most likely cause of her symptoms?

What is the most likely finding that will be observed on thyroid function tests?

A

Grave’s Disease

Low TSH, High T4, High T3

43
Q

21-year old female + requesting GP to give a fitness note + has had repeated episodes of panic attacks + anxious that her job might be at risk

Besides recommending treatment for panic attacks, what is the most appropriate action?

A

Refer to occupational therapist

44
Q

51-year old female with amenorrhea for 6 months + Flushing + Excessive sweating

Which of the following is an appropriate investigation in her case? TSH, estrogen OR FSH?

A

Thyroid Function Test - to distinguish thyroid disease symptoms from menopause

FSH not needed for women over age 45 with typical menopausal symptoms while Estrogen testing not recommended for diagnosing menopause

45
Q

25-year old woman with sudden onset of vertigo for 2 weeks + symptoms worse on lying down and turning in bed + last for 20 seconds with spontanous resolution + no hearing loss

What is the most likely diagnosis?

What is the most appropriate diagnostic test and treatment for the patient?

A

BENIGN PAROXYSMAL POSITIONAL VERTIGO

Diagnostic tests: Dix-Hallpike maneuver
Therapeutic: Epley’s maneuver

46
Q

31-year old woman + has 2 children + does not want more children + very heavy menstrual periods + Diagnosed with Iron-deficiency anemia

What is the appropriate contraception to use?

A

Levonorgestrel IUS is the ideal contraception in this case.

If LNG IUS is not in the options, pick COCPs
Do not pick tubal ligation as it will not help with the heavy menstrual periods

47
Q

25-year old woman + wants contraception for 6 months + wants to conceive after 6 months + history of dysmenorrhea and migraine with aura + currently on inhaled salbutamol and inhaled corticosteroids

What is the appropriate contraception to use?

A

Progesterone-only Pill

POP is UKMEC 2 in migraine with aura
Copper IUCD is UKMEC 2 in dysmenorrhea

For short term contraception, POP is more appropriate here

48
Q

25-year old man + suspected drug ingestion + muscle rigidity + elevated temperature + euphoria

Likely drug ingestion - ecstacy/MDMA

What is the most appropriate treatment?

A

Dantrolene

49
Q

66-year old woman with recurrent falls in the last 3 months + feels dizzy a few seconds before falling + currently on a number of medications
Apixaban, Atorvastatin, Duloxetine, Denosumab, Clozapine

Which of the above mentioned medications could be the cause of her falls?

A

Duloxetine (SNRI) - Both SSRIs and SNRIs increase the risk of falling

50
Q

35-year old man with double vision when he looks to the left + Normalises when he closes either eye

What is the most likely diagnosis?

A

Left 6th cranial nerve

51
Q

65-year old man + rigidity of muscles + tremors + stopped taking medicines of Parkinson’s medicines
O/E - shuffling gait + bradykinesia

What is the most likely anatomical structure involved?

A

Substantia nigra - low levels of dopamine are a result of the damage to the neurons in the substantia nigra

52
Q

30-year old woman + Injured during car accident in her thigh and groin + Reduced sensation with mild burning sensation on lateral side of left thigh

What is the most likely nerve affected?

A

LATERAL FEMORAL CUTANEOUS NERVE
- supplies the sensation to the surface of the lateral thigh; compression of this nerve causes meralgia paresthetica which can cause burning, numbness of tingling of the lateral thigh

53
Q

25-year old with generalized tonic-clonic seizure + seizing for 30 minutes + 2 doses of IV Lorazepam already given + takes Na valproate for epilepsy

What is the most likely diagnosis?

What is the single most apppropriate management?

A

STATUS EPILEPTICUS

IV PHENYTOIN
IV Phenytoin and IV Phenobarbital can both be used but IV Phenytoin is preferred
If the patient was already on phenytoin then IV Phenobarbital will be used

54
Q

44-year old woman with left leg weakness (power reduced) + history of controlled epilepsy + MRI brain and spinal cord are normal + Flexion of left hip against resistance is not followed by extension of her right hip

What is the most likely diagnosis?

A

FUNCTIONAL WEAKNESS

Hoover’s sign is used to identify functional weakness
In functional weakness, there is no involuntary extension of hip when flexing the contralateral hip against resistance.

55
Q

43-year old stabbed in the back of the neck + Open wound on back of the neck with minimal bleeding + Stridor + Asymmetrical rise and fall of chest on breathing

What is the most likely nerve that is affected?

A

PHRENIC NERVE

Supplies the diaphragm and damage to this nerve is responsible for the asymmetrical movements of chest
Stridor is probably due to airway injuries like tracheal or laryngeal injuries

56
Q

60-year old man + recently underwent right submandibular gland excision for silaolithiasis + now has decreased tongue movement + no numbness of pain in tongue + on protrusion, the tongue deviates to the right

What is the most likely nerve that is affected?

A

HYPOGLOSSAL NERVE

-can cause decreased tongue movements and deviation of tongue

57
Q

50-year old woman + history of breast carcinoma and left-sided mastectomy with ipsilateral axillary lymph node clearance 2 years back + swelling of left upper limb for 2 weeks + tightness of hand + insect bite 4 weeks ago + no rash or fever

What is the most likely reason for swelling?

A

LYMPHEDEMA
Angioedema would NOT cause the swelling since the time frame does not match. It usually starts within a few hours and resolves in 1-3 days

58
Q

6-year old boy + golden brown crust in left perioral area + started off as thin-walled vesicles which ruptured + no fever + drinking and eating well + mother has been using antiseptic creams

What is the most likely diagnosis?

What is the most appropriate medication to prescribe?

A

IMPETIGO (uncomplicated)

TOPICAL ANTIBIOTICS (Fucidic acid or Mupirocin)

1st line - Hydrogen peroxide (antiseptic cream) - already tried
2nd line - Topical antibiotics
Oral antibiotics like Flucloxacillin are third line or in systemically unwell patients

59
Q

30-year old woman + abdominal pain and vomiting for 12 hours + past history of Type 1 Diabetes on Insulin + CBG 19 mmol/L and urine ketones is 3+

What is the most likely diagnosis?

What is the most appropriate/initial investigation?

A

DKA

Blood gases (arterial or venous) - check pH and HCO3 levels to diagnosis DKA

Criteria for DKA

  • CBG >11 mmol or known history of diabetes
  • urine ketones level > +2 or capillary glucose > 2mmol /L
  • blood gases: pH < 7.3 and/or HCO3 <15 mmol/L
60
Q

44-year old man collapsed in park and brought by the police + he smells of alcohol + GCS 14 + CBG is 1.5 + there is no IV access and medical staff is struggling to get IV access

What is the single most appropriate management?

A

Oral glucose gel
As he is conscious and aware, his hypoglycemia can be resolved with oral glucose gel
Do not pick IM glucagon for this case

61
Q

47-year old diabetic man found unconscious + paramedics are unable to arouse him + CBG is 1.2 + profusely sweating + starts seizing + there is no intravenous access

What is the single most appropriate management?

A

IM Glucagon 1mg

As this patient is seizing, it is not appropriate to gain IV access

62
Q

20-year old found unconscious smells of alcohol + paramedisc are unable to arouse him + CBG is 1.2 + there is no intravenous access

What is the single most appropriate management?

A

Insert IV line and administer 75 mL of 20% glucose intravenously
*Remember, glucagon is ineffective in alcohol-related hypoglycemia

63
Q

21-year old man + abdominal pain over the last 8 months + mucus in stools + abdominal bloating + bloating and pain worsened after a meal and relieved by defecation + no weight loss

What is the single most likely diagnosis?

A

Irritable Bowel Syndrome
(Abdominal bloating + Pain + worse during eating + Relieved by defecation + Passage of mucus —> Part of the diagnostic criteria of IBS)

64
Q

21-year old with acute shortness of breath and wheezing + History of asthma on inhalers + has been taking more Salbutamol over last 2 days + SpO2 is 93% + Unable to finish a sentence

What is the single most appropriate test to be performed to determine the severity of his asthma exacerbation?

A

Peak expiratory flow rate using peak flow meter

Moderate asthma exacerbation - PEFR 50-75%
Acute severe asthma - PEFR 33-50%
Life-threatening asthma - PEFR < 33%

65
Q

25-year old heroin addict unconscious found next to a gas stove in the kitchen which is turned on. His pupils are dilated.

What is the single most appropriate management?

A

Oxygen

(The history of heroin is just a distractor. Heroin causes pupil constriction. Those who are unfamiliar with this may go on to choose options like Naloxone because of the Heroin history.

66
Q

59-year old man with coughing + Shortness of breath + fever + Pleuritic chest pain for 3 weeks + ECG is normal + CXR shows blunting of CP angle

What is the most likely diagnosis?

A

Parapneumonic effusion

Parapneumonic effusion. - pleural effusion adjacent to pneumonia

67
Q

20-year old with wheezing + Occasional shortness of breath + asthmatic on salbutamol and low-dose inhaled steroids + uses salbutamol 6-7 times per day

What is the next medication to add according to BTS/SIGN asthma guidelines?

A

Salmeterol inhalers

Salmeterol is a LABA

68
Q

40-year old with hemoptysis for 1 month + Sinusitis + bloody discharge from nose + saddle nose deformity

What is the most likely diagnosis?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

Components of Disease

  1. Nasal - saddle nose deformity, sinusitis, bloody rhinorrhea
  2. Lower respiratory - hemoptysis
  3. Kidney - Hematuria
  4. Skin - subcutaneous nodules; purpura
69
Q

60-year old with continuous leakage of small amount of urine vaginally + not worsened by cough + history of radiotherapy for cervical cancer

What is the most likely diagnosis?

A

Vesicovaginal fistula

Radiation to pelvis is one of the risk factors for VVF

70
Q

30-year old man admitted with nausea + vomiting + abdominal pain + malaise for 2 months + currently on salbutamol, salmeterol + fluticasone for asthma + hyponatremia + hyperkalemia

What is the most appropriate investigation to confirm the diagnosis?

A

Short ACTH stimulation test

Malaise + hyponatremia + hyperkalemia is highly suggestive for addisonian crisis

Synacthen test (short ACTH stimulation test) can be used to confirm the diagnosis

71
Q

29-year old + 25 weeks pregnant + diagnosed with hyperthyroidism + thyoid peroxidase positive + heart rate is 110 bpm

What is the single most appropriate treatment?

A

Carbimazole

In pregnancy: 1st tri - PTU; 2nd/3rd tri - switch to carbimazole
If carbimazole is not in the options, then prescribe PTU

72
Q

21-year old woman + milk secretion from nipples for 2 months + LMP was 6 months ago + urine pregnancy tests is negative + no masses in her breasts

What is the single most appropriate investigation?

A

Prolactin levelss

Galactorrhea + Amenorrhea —> Prolactinoma

73
Q

20-year old woman + tiredness + weight loss + polyuria + polydipsia + BMI is 19 kg/sq m + family history of DM + HbA1c of 65 mmol/mol + no ketonuria

What is the single most appropriate next step in management?

A

Genetic counselling for MODY

MODY - <25 years old + low BMI + family history of DM
Refer for genetic counselling before genetic testing

LADA - consider in patients 30 to 50 years old

74
Q

31-year old man with polydipsia and polyuria + hypernatremia

What is the most likely diagnosis?

What is the single most appropriate INITIAL test?

A

Diabetes insipidus

Urine osmolality

Polyuria + Polydipsia + hypernatremia = Diabetes Insipidus

Initial test = urine osm
If urine osm <800 mOsm/kg —> fluid deprivation test

75
Q

44-year old with tiredness + TSH is high (12.8 mU/L) + normal free T4 (11 pmol/L)

What is the most likely diagnosis?

What is the single most appropriate next step?

A

Subclinical hypothyroidism

Repeat TSH in 3 months
Do not start treatment in subclinical hypothyroidism
Further action will be decided after repeat test in 3 months

76
Q

75-year old man + PEG inserted 1 day back due to a stroke + one episode of leaking of minimal gastric fluid + no abdominal pain/bloating/skin irritation + no discharge at PEG site

What is the single most appropriate management?

A

Reassure and continue enteral feeding

77
Q

49-year old woman + history of 5 urinary tract infections + confirmed to be E. Coli + regular menstrual cycles + not secually active + USG and cystoscopy are normal

What is the most appropriate management?

A

Long-term antibiotic prophylaxis

For recurrent UTI in premenopausal woman prescribe long term antibiotics once underlying causes have been ruled out

78
Q

58-year old woman + history of 4 UTI + confirmed to be E. Coli + no hematuria + menstruation stopped at 51 years + not sexually active + USG and cystoscopy are normal + no postmenopausal bleeding

What is the most appropriate next management?

A

Vaginal estrogen
Recurrent UTI in postmenopausal woman + underlying causes ruled out —> Consider prescribing vaginal estrogen before long term antibiotic prophylaxis

79
Q

49-year old man + fasting blood glucose of 7.7 mmol/L no symptoms of diabetes

What is the next step for diagnosing T2DM?

A

Repeat fasting blood glucose

Diagnosis of diabetes in asymptomatic patients should be made only after 2 tests
If this patient was symptomatic, onlly 1 test is needed to diagnose diabetes

80
Q

41-year old man + history of diabetes currently on metformin + BMI of 33 kg/sq mL + HbA1c is 58 mmol/mol

What is the next most appropriate step?

A

Reinforce lifestyle changes

It is appropriate to reinforce lifestyle changes and add a new medication in this case. But, if the candidate has to pick between lifestyle changes and adding a new drug, the most appropriate step is to select lifestyle changes

81
Q

59-year old with constipation + fatigue + body aches + history of renal colic and colles fracture + high corrected calcium + high PTH levels

What is the most likely diagnosis?

What is the single most appropriate management?

A

Primary Hyperparathyroidism

Parathyroidectomy
Cinaclet is reserved for patients unsuitable for surgery
Bisphosphonates may be used for preventing fractres, but should not be used for chronic hypercalcemia with primary hyperparathyroidism

82
Q

32-year old woman with dysuria + 11 weeks pregnant + urine dipstick shows +1 nitrates and +1 leukocytes + urine culture sent

What is the most likely diagnosis?

What is the most appropriate treatment?

A

UTI
Nitrofurantoin

1st line (Early pregnancy) - Pick Nitrofurantoin
If Nitrofurantoin is not an option - Cefalexin
If Nitrofurantoin/Cefalexin are not options - Amoxicillin

83
Q

5-years old + recently treated for UTI 4 weeks back + history mof 3 UTIs in the past year + currently asymptomatic

What is the single most appropriate investigation?

A

Ultrasound scan

In children > 3 years old:
1st - ultrasound scan. It is normal n this case
2nd - DMSA scan to look for renal scarring. Performed 4-6 months after infection

Remember not to pick MCUG. MCUG, never pick over three.

84
Q

70-year old man + ulcer above his right medial malleolus + weak dorsalis pedis and posterior tibial pulses on both feet + hemosiderin deposits around the ulcer + history of diabetes mellitus + mild pain at ulcer

What is the most likely diagnosis?

A

Venous ulcer

Ulcers at medial malleolus + hemosiderin deposits = Venous ulcers

Neuropathic ulcers = reduced sensation on toes or sole of foot
Arterial ulcers = lateral malleolus. Would not have hemosiderin deposits

85
Q

65-year old man + 5 episodes of frank painless hematuria + smooth enlarged prostate + PSA is 2.9 ng/mL (0-4)

What is the most appropriate test to request?

A

Cystourethroscopy

> 40 years old with frank hematuria —> bladder cancer must be investigated —> cystoscopy
Remember, cystourethroscopy is synonymous with cystoscopy

86
Q

80-year old lady + recent fracture T-score of -2.6

Most likely diagnosis?

Which drug would be given to prevent fractures after osteoporosis is diagnosed?

A

Osteoporosis

Bisphosphonates
(T-score less than -2.5 is an indication to begin bisphosphonate therapy. Supplements like calcium and vitamin D may added if dietary intake is inadequate)

87
Q

50-year old man + voiding difficulties + incomplete evacuation of bladder + increased frequency + urgency + smooth enlarged prostate

What is the best medication to start?

A

Tamsulosin

Do not pick finasteride as the first-line treatment option as it takes around 6 months to become effective

88
Q

55-year old man with intermittent frank hematuria + no fever or dysuria + booked for cystoscopy + urine cytology

What is the most appropriate additional investigation to request in this appointment?

A

CT Urogram

> 40 year old with frank hematuria should undergo:

  • Cystoscopy - to look for bladder cancer
  • CT urogram - to look for renal and ureteric cancers
  • urine cytology - to pick up cancer cells

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