Deck 1

Question 1

What would be seen on a CXR and on examination during a lung collapse

Answer 1

Trachea pulled towards affected side, reduced breath sounds (with or without crackles and bronchial breathing) and dullness to percussion on affected side

Question 2

When should inhaled corticosterioids be given to a patient with COPD

Answer 2

If FEV1

Question 3

Name some causes of LBBB

Answer 3

Aortic stenosis, dilated cardiomyopathy, chronic hypertension and extensive coronary artery disease

Question 4

What is the treatment for C.difficile?

Answer 4

Metronidazole or Vancomycin

Question 5

How do you know if the axis is undeviated on an ECG?

Answer 5

QRS amplitude is greatest in lead II and leads I and III have identical magnitudes

Question 6

How many squares should the QRS complex not be greater than?

Answer 6

3 small squares

Question 7

What is Alpha-1 anti-trypsin?

Answer 7

A serine protease inhibitor normally synthesised in the liver whose role is to leave and inhibit the proteolytic enzyme neutrophil elastase

Question 8

In renal disease, ACEi can be both beneficial as well as damaging. When can they be used and when can they not be used?

Answer 8

Should be avoided in patients with renal artery stenosis

They are beneficial in protecting the kidneys of renal failure patients

Question 9

What are the 5Fs patients in which gallstones commonly appears?

Answer 9

Fat, forty, female, fair, fertile

Question 10

What can lead to a double impulse apex beat?

Answer 10

Hypertrophic obstructive cardiomyopathy

Question 11

What is the four defining malformations of Tetralogy of Fallot?

Answer 11

1) VSD
2) Pulmonary stenosis- turns the VSD into a right-left shunt, causing cyanosis; acute attacks (due to pulmonary vascular resistance) can be managed by squatting, which raises peripheral vascular resistance and therefor reduces the right-left shunt

3) Right ventricular hypertrophy
4) Overriding aorta i.e. the aorta is connected to both ventricles and in this sense acts like a second VSD

Question 12

How can Tetralogy of Fallot be managed by squatting in acute attacks?

Answer 12

It raises peripheral vascular resistance and therefore reduces the right-left shunt

Question 13

Is Digoxin an inotophic or a chronotrophic drug?

Answer 13

An inotrophic drug: blocks the Na/K pump to cause a rise in intracellular Na, increasing Ca and contractility

Question 14

What does the CURB-65 scoring indicate?

Answer 14

Score of 2: receive short stay hospital supervised treatment

Score of 3 or more: should be managed in the hospital as severe pneumonia

Score of 4 or 5, ICU admission

Question 15

Inverted P waves seen on an ECG

Answer 15

Dextrocardia

Can occur in Kartagener’s Syndrome

Question 16

High risk of malignancy associated with coeliac disease

Answer 16

Intestinal lymphoma

Question 17

Patient with known metastatic carcinoma presents with vague abdominal symptoms

Answer 17

Hypercalcaemia

Question 18

What is the gold standard test in CF?

Answer 18

Sweat test- there should be an increased excess concentration of NaCl in sweat

Question 19

What are organisms typically involved in lung infections in CF?

Answer 19

Pseudomonas aeruginosa and Burkholderia cepacia

Question 20

What investigations should be carried out in a suspected PE?

Answer 20

Do a D dimer test first, then if CXR is clear do a V/Q scan

If CXR is not clear do a CTPA

Question 21

Explain the pathology of COPD

Answer 21

Hypertrophy of Goblet cells, decreased cilia with loss of alveoli elastic recoil

Question 22

Treatment for C.diff

Answer 22

Oral metronidazole or oral vancomycin