Difficult Past Paper Questions Flashcards by Sachin Ananth

Drooping of eyelid, and hurts to move in all directions, pupil constricted – Cavernous sinus aneurysm? Migraine? TIA?

Cavernous Sinus Aneurysm: Presents with cavernous sinus syndrome. This comprises of unilateral and isolated CN III, IV and VI palsy. There is also painful opthalmoplegia, proptosis, ocular bruit. Pupils in midposition and nonreactive if both sympathetic and parasympathetic function is affected in CN III.

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Dysphagia, weight loss, regurgitation, crackles in R base – Hiatus Hernia? Achalasia? Post cricoid web?

Achalasia: Patients usually have long history of intermittent dysphagia, characteristically for both liquids and solids from the onset. Regurgitation of food from dilated oesophagus occurs, particularly at night and aspiration pneumonia is a complication. Weight loss is usually not marked. ‘Bird’s beak’ appearance on barium swallow.

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Young man with urethritis and obstructive urinary symptoms

Urethral stricture: Urethritis due to gonorrhoea or Chlamydia can result in urethral stricture which is the commonest cause in young men.

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Tender hepatomegaly, raised JVP, ascites, AF. Ca-125 is 40 – Heart failure? Ca ovary? Meigs syndrome? Krukenberg’s tumour? Liver cirrhosis?

Heart failure (Ca 125 < 35 is normal)

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Lymph node biopsy had 5% larger cells – CLL/Hodgkins/NHL?

NHL: Diffuse Large Cell Lymphoma is subtype (CLL may contain blasts, but these are not found in lymph node biopsy)

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Most common site for pancreatic cancer – Head? Tail? Body?

Head = 75%

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Haemophilia: mum is carrier, dad has disease – what is chance of getting it?

50%

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Renal transplant treated with immunosupressants. Lesion with keratinising centre on arm – SCC? Kaposi’s sarcoma?

Squamous Cell Carcinoma: presents as an indurated keratinising or crusted tumour that may ulcerate. Common in sun exposed areas. Bleeding may occur from the tumour.

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DKA patient comes in with persistent vomiting, then vomits up a large amount of blood – Acute gastritis? Oesophagitis? Duodenal Ulcer? Gastric ulcer?

Oesophagitis: Coffee ground vomiting occurs in a minority of patients this tends to originate from erosion of the oesophagus.

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Which the most likely indicator of a bowel perforation – Rigidity? Abdominal distension?

Rigidity: board-like

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Naloxone indications – RR of 7? Pinpoint pupils?

RR of 7

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DIC clotting results?

Elevated PT, elevated aPTT, low platelet, low fibrinogen, and high D-dimer.

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Old woman with fractured NOF and also has asthma. Which analgesic do you give – Ibuprofen? Diclofenac? Codeine? Morphine?

Codeine: morphine too strong for 1st-line treatment in old woman

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Which metastases are sclerotic to spine – Prostate. Lung. Bronchus. Thyroid. Kidney.

Prostate: called blastic bone mets

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Young woman unable to close eye and drooping one side of face, and facial discomfort. – Bell’s palsy? Ramsay Hunt?

Ramsay-Hunt: pain differentiates from Bell’s Palsy

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Pt has MI, 2 days later new murmur and unwell. Harsh systolic murmur – Papillary muscle rupture? AS?

Papillary muscle rupture: worsening mitral regurgitation

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Lady with previous mastectomy for Breast Ca 4 years ago. Has become thirsty, polyuria and constipated. Now confused. No focal neurology – Cerebellar mets? Hyponatraemia? Hypercalcaemia? Infection? T2DM?

Hypercalcaemia

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What is the biggest intervention in a young person to reduce overall cancer risk – Lose weight? Protection during sex? Stop smoking? Alcohol control? Increase exercise?

Stop smoking

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Patient has pain on walking. Angio shows calcified distal aorta and femorals on both sides. – Stent? Aortic-bifemoral bypass graft? Embolectomy? Aortic endarterectomy?

Aortic-bifemoral bypass graft

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Old man is anaemic, newly constipated and has had weight loss for 6 months. – Sigmoid Ca? Caecal angiodysplasia? Small bowel cancer? Ulcerative colitis? Diverticulitis?

Sigmoid cancer

but could be caecal cancer, as this is more likely to give anaemia, whereas sigmoid cancer presents with fresh blood

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Lady is pre-op and will need a GA. He has RA in hands, knees, hips and neck. She has HTN (150ish) and T2DM. What is the most important pre-op check – Cervical XR? FBC? BP monitoring? Glucose finger prick? ECHO?

Cervical X-Ray: need to intubate as undergoing GA

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Young athlete (25) keeps fainting. ECG shows sinus rhythm with narrow QRS and long QT. What arrhythmia is happening – Asystole? SVT? AF? Sick sinus syndrome? Irregular ventricular arrhythmia?

Irregular ventricular arrhythmia: Torsade de pointes

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Most important thing to correct in DKA – Hyperglycaemia? Fluids? Acidosis?

Fluids

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Patient with sudden pale, cold, clamy, pulseless leg, has AF. Best management?

Embolectomy (thrombolysis if this fails)

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Teenage boy with tender lumps in breasts on both sides. What investigation -- Leave and observe? Biopsy? Mammogram? FNA? Lumpectomy?

Leave and observe: normal puberty

Antidote to TCA overdose

IV sodium bicarbonate (also give activated charcoal if present within 2hrs)

Pt has stroke affecting R arm, R leg and inattention. Where is the stroke -- L internal capsule? L thalamus? Occipital lobe? Pons? R internal capsule?

Left thalamus

Man admitted for nasal polyp removal. He is T1DM. What is the best way to control his sugars -- Increase insulin? Don’t fast for procedure? Insulin sliding scale until eating and drinking normally? Insulin sliding scale until the operation ends? Continue insulin on the day of surgery? Regular BM monitoring only?

Insulin sliding scale until eating and drinking normally

L sided homonymous Hemianopia. Where is the lesion -- L occipital? Optic chiasm? L lateral geniculate nucleus? R occipital?

Right occipital (will be macula sparing)

Patient collapses in garden. P waves – 75, ventricular rate is 40. Wide QRS -- WPW? First degree heart block? Second degree (2:1)? Complete heart block? AF?

Complete heart block: due to wide QRS

Old lady is brought in by daughter. She has been deteriorating for 3 days. Has been noticed by neighbours shouting and banging during the night and appears dishevelled -- Depression? Dementia? Delirium? Schizophrenia? Anxiety?

Delirium

28 year old painter has pain. It hurts when he grips brushes and when he paints. On examination there is pain in the lateral epicondyle. What action causes pain -- Wrist flexion? Thumb flexion? Elbow flexion? Elbow extension? Wrist extension? Finger flexion?

Wrist extension

Old lady has lesion on her labia majora which is ulcerated. What is the cell type on biopsy -- BCC? SCC?

SCC

Patient has leg weakness that has spread to the arms over last day. Sensation is only minimally affected -- Demyelinating peripheral neuropathy? Destructive something? Amyloid infiltration?

Demyelinating peripheral neuropathy = GBS!

Patient has nosebleed. How do you manage -- Tilt head back pinch bridge? Tilt head back pinch nostrils? Tilt head forward pinch bridge? Tilt head back pinch nostrils? Pack with tampax?

Tilt head forward pinch bridge

Patient jumps during sports. Falls over and lands on right leg with it bent and twisted. Comes to A+E with leg in flexion at 30 degrees, O/E you can’t move it passively beyond 30 degrees. -- Medial collateral ligament? Medial meniscus? Patella fracture? Tibeal osteochondral fracture? Femur condyle fracture?

Medial meniscus tear: can't extend leg

Which drug is commonly co-prescribed with morphine -- Aspirin? Hyoscine? Co-danthramer? Loperamide?

Co-danthramer

Lady with palmar erythema, raised ALT, raised bilirubin, strongly positive ANA -- Autoimmune hepatitis? SLE? Drug-induced cholestasis? PBC?

Autoimmune hepatitis (also has anti-smooth muscle antibodies)

Haematemesis and abdo pain, BP 120/80, HR >100 What do you give IV whilst waiting for endoscopy -- IV crystalloid? O-ve blood? IV terlipressin? IV PPI?

IV crystalloid (terlipressin only in variceal bleeding, PPIs only post-endoscopy)

Diabetic with weakness in all four limbs started 3 days ago, weakness worse proximally vs distally in LL, no change to sensation in LL, UL has some pins and needles, bilateral eyelid weakness. Loss of reflex and plantar response -- GBS? Myasthenia? Diabetic neuropathy? MS?

Myasthenia Gravis

Some guy flew in from Tel Aviv he has chest pain and then a few hours later his leg goes white and there are no pulses -- Aortic dissection? Thromboses of the popliteal artery? PE? MI? DVT?

Thromboses of the popliteal artery (from mural thrombus)

Patient has bad claudication and can only walk 10m. Distal aorta and both iliac vessels occluded -- Endarterectomy? Femoral crossover bypass? Aorto bifemoral bypass?

Aorto bifemoral bypass: do this for thrombosis if groin arteries, like iliac

Guy gets claudication in calf. Where is the block -- Superficial Femoral Artery, posterior tibial, common iliac

Superficial Femoral Artery = calf pain | Iliac artery = bum pain

Man does not open his eyes, localises to pain, groaning. What airway is right for him -- Nasopharyngeal? Oropharyngeal? Cuffed endotracheal? LMA? Tracheostomy?

Cuffed endotracheal

Lady with RA and purple nodule on shin ulcerating with raised edges -- Pyoderma gangrenosum? SCC? Venous ulcer?

Pyoderma gangrenosum

Guy with pneumonia with green sputum, hyponatraemia, euvolaemic. Initial treatment -- Fluid restrict? Oral vasopressin antagonist? Normal saline?

Fluid restrict (SIADH)

Man had 1cm painless penile ulcer on the shaft -- Neisseria? Gonorrhoea? Chlamydia Trachomatis? Treponema Pallidum? Herpes simplex?

``` Treponema Pallidum (Painful = herpes, chancroid Painless = syphillis, lymphogranuloma venereum) ```

Somebody comes in to A&E with drug resistant TB, where do you keep them -- Side room + respiratory measures for staff? Negative pressure room + respiratory measures for staff?

Negative pressure room + respiratory measures for staff

A man with stab injury to the back - hemisection of the cord. Where would he lose pain sensation from?

Contralateral side to weakness

Which of the DMARDs cause retinopathy?

Hydroxychloroquine

Which of the DMARDs cause azoospermia and bone marrow suppression?

Sulfasalazine

Lady from some Pakistan with HTN controlled on amlodipine and BP of 150/90 has retinal findings: blot haemorrhages and yellow deposits (hard exudates I think) on macula. What is this -- Hypertensive retinopathy? Diabetic retinopathy?

Hypertensive retinopathy (macula involved in diabetic maculopathy, not retinopathy)

Person with 4cm head of pancreas ca that has invaded mesenteric vessels. How do you manage -- ERCP and biliary stent? PTC drainage? Whipple’s? Vit K? Antibiotics?

ERCP and biliary stent (do Whipple's if no mets)

Guy presenting to GP with nocturia. PSA 18, urinalysis trace blood and protein, urea and cr mildly elevated -- Refer routinely to uro? Refer urgently to uro? Refer routinely to renal? Refer urgently to renal?

Refer urgently to uro

45 year old lady with spontaneous dark brown nipple discharge. Examination reveals only one duct producing discharge -- Intraductal papilloma? Duct ectasia?

Intraductal papilloma (duct ectasia = yellow-green discharge)

Guy with metastatic renal cancer has severe pain. Has vomited 4 times. Currently on oral morphine solution prn and helps for about 2 hours. What pain therapy should he be on -- Fentanyl transdermal? Morphine sub cut infusion? Morphine subcut prn? Oral morph slow release tablets? Oral morph solution prn?

Fentanyl transdermal

Raynaud's colour order (re. red, white and blue)

White --> blue --> red

Commonest cause of branching corneal ulceration -- HSV? VZV? HIV?

HSV (Herpes Simplex Keratitis)

Lady coming to GP with blood test results showing raised prolactin levels and raised IGF-1. Normal TSH, LH, FSH, ACTH -- Acromegaly? Macroprolactinoma? TSHoma?

Acromegaly

Thin 18 year old girl comes in with low potassium, macrocytic anaemia and raised urea, physical examination otherwise normal -- Anorexia nervosa? Coeliac disease?

Anorexia (lose K through vomiting)

Guy with epilepsy and now housebound. Pain in spine and on compressing rib cage -- Osteomalacia? Osteoarthritis? Polychondritis?

Osteomalacia (anti-epileptic reduce BMD, housebound = less sunlight)

Guy falls down from somewhere and has no more biceps reflex, hand held in Erb’s palsy. What got damaged -- Upper brachial plexus? Lower brachial plexus? Median? Ulnar? Radial?

Upper brachial plexus (C5-6) | Klumpke's Palsy = lower brachial plexus, C8-T1

Guy with haemorrhoids that do not prolapse. First line-- Fibre? Sclerotherapy? Surgery? Topical GTN?

Fibre (GTN is for fissure!)

Hypertensive young guy with mildly raised cr and proteinuria on multiple occasions. Physical exam otherwise unremarkable -- Orthostatic proteinuria? Amyloid? Hypertensive nephropathy?

Hypertensive nephropathy

Patient gets pain to right of epigastrium a few hours after food. Relieved by milk and wakes up at night with pain -- Duodenal ulcer? Gastric ulcer? Gastritis?

Duodenal ulcer (worsen few hrs after food)

Guy with pulseless electrical activity, given one dose of adrenaline/epinephrine. Still no carotid pulse -- Another dose of adrenaline? Shock? Pericardiocentiesis?

Another dose of adrenaline (give after every other cycle)

Patient has carotid endarterectomy and develops stridor post-op -- Haemorrhage? False aneurysm?

Haemorrhage (haematoma compresses airway)

``` Anterior neck lump biopsy shows squamous cell carcinoma of tonsillar origin, which infection caused the cancer? ⁃ HPV ⁃ CMV ⁃ HTLV-1 ⁃ HIV ⁃ EBV ```

HPV (causes tonsillar cancer) | EBV causes nasopharyngeal primary

``` 3cm ductal carcinoma in situ diagnosed in RUQ on first mammography, treatment? ⁃ Mastectomy ⁃ Radiotherapy ⁃ Review in 6 months ⁃ Tamoxifen ⁃ Wide local excision ```

Wide local excision = <4cm | Mastectomy = >4cm

``` Women was in Bangladesh for 6 months, has decreased chest expansion, reduced vocal resonance, reduced air entry, dull to percussion on R side, productive cough? ⁃ Pneumothorax ⁃ Emphysema ⁃ Bronchiectasis ⁃ Pleural effusion. ```

Pleural effusion

``` Asthmatic lady unable to finish sentences, hypoxic, high pCO2, pH on ABG is 7.3, already given salbutamol, ipratropium and hydrocortisone, next? ⁃ CPAP ⁃ IV aminophylline ⁃ Reduce her O2 ⁃ Intubate and ventilate ```

Intubate and ventilated (life-threatening asthma as high PCO2 implies that patient is tiring)

``` Patient with UC, which features are indicators for colectomy? ⁃ Paneth cell metaplasia ⁃ Crypt abscess ⁃ Cypt architecture disruption ⁃ Epithelial dysplasia ```

Epithelial dysplasia

Elderly man with COPD, carboxyHb is 35% (normal < 1.5%), normal O2 sats, immediate Mx? ⁃ 2l nasal cannula ⁃ Different concentrations with venturi mask ⁃ 15l non-rebreather mask.

15L non-rebreather (as he has CO poisoning)

Post tonsillitis patient, proteinuria, haematuria, swollen face, red cell casts, self resolves over next 3 months? ⁃ Acute glomerulonephritis ⁃ Nephrotic syndrome ⁃ IgA nephropathy

IgA nephropathy (red cell casts = nephritic; post-tonsillitis = IgA)

``` Bilateral knee pain, stiffness for 20 mins in the morning, swollen at night, diagnosis? ⁃ Psoriatic arthritis ⁃ Septic arthritis ⁃ RhA ⁃ OA ```

Osteoarthritis (because morning stiffness in rheumatoid lasts longer)

``` Hyponatraemic, dehydrated, dry mucous membrane, what to use to decide on fluid status? ⁃ Serum creatinine ⁃ Urine sodium ⁃ Urine osmolality ⁃ Serum calcium ⁃ Serum urea ```

Serum urea (rise more in dehydration compared to creatinine)

``` Vocal cord endoscopy, struggling to speak, tachypnoeic (28), cannot maintain strong grip, antidote? ⁃ Glycopyronium ⁃ Rocuronium ⁃ Doxapram ⁃ Naloxone ⁃ Neostigmine ```

Neostigmine ⁃ Glycopyronium (muscarinic anticholinergic, reduces saliva and stomach acid secretion, can be sued in COPD treatment) ⁃ Rocuronium (muscle relaxant) ⁃ Doxapram (respiratory stimulant) ⁃ Naloxone (treatment of opioid overdose)

``` Patient with nephrectomy and stone in the native kidney at pelvic-ureteric junction, swelling of upper urinary tract on imaging, febrile, Mx? ⁃ Lithiotripsy ⁃ Conservative ⁃ Abx ⁃ Cystoscopy and stent ⁃ Percutaneous nephrostomy ```

Percutaneous nephrostomy (rather than lithotripsy as septic)

``` Man falls off roof, CP until next day, pain in R axilla on breathing deeply or coughing, O2 sats 95%? ⁃ Costochondritis ⁃ Pneumothorax ⁃ Pneumonia ⁃ Fractured ribs ```

Fractured ribs

``` Young man, collapses frequently during sport, ECG shows sinus rhythm, cQT 510ms? ⁃ Supraventricular arrhythmia ⁃ Sick sinus syndrome ⁃ AF ⁃ VT ```

VT (prolonged QT = VT)

Acute diverticulitis, diagnostic IX? ⁃ Flexible sigmoidoscopy ⁃ MRI ⁃ CT abdo

CT abdo

``` Picture of Grave’s disease, eyes bulging forward, lens dislocation and losing weight, mechanism? ⁃ Retrobulbar tumour ⁃ Cavernous sinus syndrome ⁃ Retinal vein thrombosis ⁃ Rectus muscle thickening ```

Rectus muscle thickening

``` Caucasian man presents with dysphagia/weight loss, “food is getting stuck behind chest”? ⁃ Adenocarcinoma ⁃ Barrrett’s ⁃ GORD ⁃ Squamous cell carcinoma ```

Squamous cell carcinoma: history of progressive dysphagia, no GORD history, 2/3 of oesophageal cancer

Ring and little finger tingling, which nerve has been damaged? ⁃ Ulnar nerve - Median nerve - Radial nerve

Ulnar nerve: wrist flexion, intrinsic hand (except LLOAF), damaged in medial epicondyle fractures Median causes loss of wrist flexion + forearm pronation

Epicondylitis, pain on wrist extension? ⁃ Golfer’s elbow ⁃ Tennis elbow

Tennis elbow Tennis = lateral = pain on wrist extension Golfer = medial = pain on wrist flexion and pronation

Man has footdrop after hip fracture, which nerve was damaged? ⁃ Common peroneal ⁃ Gluteal ⁃ Sciatic

Sciatic

Patient has signs of High potassium, low calcium and acidosis post chemo for lymphoma. What is the best investigation -- Urate levels? Phosphate levels?

Phosphate is most sensitive for tumour lysis syndrome

Patient with new-onset nystagmus and ataxia. Ipsilateral Horner's. Contralateral impairment of pain and thermal sensation in trunk and legs. Where is the infarct? ⁃ Posterior inferior cerebral artery ⁃ Posterior cerebral artery ⁃ Inferior cerebral artery

Posterior inferior cerebral artery (Lateral Medullary Syndrome aka Wallenberg's Syndrome)

A woman’s right arm keeps banging into door, can’t read whole page of a book -- which artery is affected? ⁃ MCA ⁃ PCA ⁃ ACA

PCA • 1. cerebellar or brainstem syndromes • 2. loss of consciousness • 3. isolated homonymous hemianopia

``` Ank Spon, NSAIDs not showing benefit, what to give next? ⁃ Prednisolone ⁃ Methotrexate ⁃ Infliximab ⁃ Anti-IL-17a ```

Infliximab

Patient with suspected DVT, calf not tender or swollen, pitting oedema up to knee on one side, started amlodipine a month ago, D-dimer normal, what do you do? ⁃ Reassure and discharge ⁃ IV furosemide ⁃ Start ACE inhibitor

Reassure and discharge (peripheral oedema is side effect of CCB - would not stop as not really causing patient any agro)

``` 18-month-old boy drank paracetamol 2 hours ago, mum has brought him to A&E, what time is best to measure paracetamol levels? ⁃ Measure paracetamol levels in 2 hours ⁃ Measure paracetamol levels in 4 hours ⁃ Immediately ⁃ In 24 hours ```

Measure paracetamol levels in 2 hours

Patient with BRCA1 mutation, she is worried that her children (son + daughter) and her sister might have it? ⁃ Sister and daughter have a 50% chance of getting it and son has 25% chance. ⁃ Children and sister all have 25% chance of getting it ⁃ Children and sister all have 50% chance of getting it ⁃ Children have 50% chance of getting it and sister has 25% chance

Children and sister all have 50% chance of getting it (BRCA = autosomal dominant)

In a RCT, what is the most likely form of bias? ⁃ Attrition ⁃ Recall ⁃ Selection

Attrition = drop-outs

35 y/o woman with SOB, ECG shows sinus tachycardia, overall well, pleural rub on R side on auscultation? ⁃ Viral pericarditis ⁃ Pulmonary embolism ⁃ Viral pleurisy

PE (pleural rub can occur here too)

FAP, 18 y/o man with hundreds of polyps, dad and grandfather had CRC, what to do? ⁃ Total colectomy ⁃ Panproctocoelctomy and ileal anastomosis ⁃ Panproctocolectomy + ileostomy

Panproctocoelctomy and ileal anastomosis (J pouch)

``` Man has 3 black-outs, most recent one was while washing the car, he goes pale, loses consciousness, arm jerks on ground, wakes up and feels fine/fast recovery, ECG normal, next most appropriate IX? ⁃ 24 hour ECG ⁃ Tilt table test ⁃ EEG ⁃ Echo ```

24-hour ECG (must rule out arrhythmia before do EEG)

Man has posterior hip dislocation, what is he most at risk of? ⁃ Sciatic nerve injury ⁃ AVN

Sciatic nerve injury

Lady with falciparum. Other than doxy, what other abx would you give her -- Chloroquine? Quinine? Proguanil? Pyrimethamine?

Quinine (according to BNF)

You are called to see a 75yo patient who is unresponsive. Nurses saw her choking. No pulses or respiratory effort, nothing visible in mouth. What do you do? 5 back blows? 5 abdominal thrusts? Start chest compressions? Inspect using laryngoscope?

Start chest compressions ``` Mild obstruction (good cough): encourage cough Severe obstruction: 5 black blows/abdo thrusts if conscious; start CPR if unconscious ```

Question with myopathy, high CK, possible polymyositis type history -- best antibody investigation?

Anti-Jo

Medication side effect with a obstructive hepatic picture -- Bendroflumethiazide? Benzo? Carbamazepine?

Bendroflumethiazide (causes gallstones)

Parotid gland swelling 2cm, which became larger rather quickly (~5cm) -- Parotid adenoma? Parotid carcinoma? Lymphoma? Parotid stone? Lympahdenopathy

Parotid stone

History of a gentleman with a bronchial cancer 7cm and other features of the cancer, which would be the symptom suggesting surgery isn’t viable -- Hoarseness of voice? Evidence of pneumonia? Size? Breathlessness

Hoarseness of voice

Gentleman with deficits described of cranial nerves 3-6, where is the site of the stroke -- Pons? Midbrain? Cerebellum? Basal ganglia? Cavernous sinus?

Cavernous sinus

Illness --> progressive weakness and absent reflexes

GBS

Person with dry eyes needs eye drops

Hypromellose

Person had stroke, still unable to put clothes on, puts it on back to front/ upside down etc. What part of brain was affected -- Parietal? Temporal? Frontal? Occipital? Cerebellum?

Frontal = executive function ``` Parietal = perception Temporal = memory/understanding ```

Gout, but has CKD stage 3, colchicine (caused vomiting for patient, so wasn’t an answer option) -- Ibuprofen? Naproxen? Allopurinol? Steroid?

Oral steroids

Old lady in care home on Nitrofurantoin, now has water diarrhoea & vomiting. 2 other people ill at care home -- Norovirus? C. diff? Rotavirus?

Rotavirus

What causes production of ketones in DKA -- Increased lipolysis? Increased protein breakdown? Decreased lipolysis?

Increased lipolysis (fatty acids)

What ion do you monitor in refeeding syndrome?

Phosphate

Person with daytime somnolence and high Epworth. What is most likely to improve after treatment -- Weight? Exercise tolerance? Vital capacity? Hypertension?

Hypertension

Spiculated lesion in lung -- Nodule? Empyema? Cancer?

Cancer (nodule is smooth)

Antidote for malignant hyperthermia -- Dantrolene Sodium? Diazepam? Flumenazil?

Dantrolene Sodium

Surgery, on metformin and gliclazide; what do you do?

Stop gliclazide on day of surgery | Only stop metformin if missing >1 meal and AKI risk

Person found unconscious with empty packets of amitriptyline and diazepam, what would be the first drug to give to reverse symptoms. They had long QT or QRS on ECG -- Flumazenil? Sodium bicarbonate?

Flumazenil

Patient admitted to AE, has small pneumothorax no tracheal deviation, paramedics insert chest drain. What is the reason for inserting a chest drain -- Prevent tension pneumothorax? Drain blood from tension pneumothorax?

Prevents tension pneumothorax (tube is connected to an underwater seal which acts as a one way valve, allowing air to escape from the pleural space and thereby preventing tension pneumothorax)

Hyperextension neck injury. What is the best view to determine a C-Spine fracture -- Closed PEG? Open PEG? Swimmer’s abduction view? Lateral view? Anterior view?

Lateral view (see 85% of c-spine fractures)

Guy with Ank Spond. He had a red painful eye and photophobia -- Scleritis? Episcleritis? Conjunctivitis? Uveitis?

Uveitis (30%)

Patient with subacute combined degeneration of the cord (peripheral neuropathy, weakness, etc. in legs). What do you give them -- Hydroxycobalamin? Thiamine? Pyridoxime? Folate?

Hydroxycobalamin (B12)

Abdo pain, imaging shows decreased perfusion to left colon, which is most likely to be affected -- IMA? SMA?

IMA (SMA is duodenum to 2/3 of transverse)

Female patient had a partially fixed, dilated pupil, with hazy vision

AACG

Which investigation would be best to confirm the glaucoma diagnosis -- Tonometry? Fundoscopy? Slit Lamp?

Tonometry

Person after accident has internal rotate leg and shortened. Can’t dorsiflex. Previous total hip replacement. Where is the injury -- Common peroneal? Femoral? Sciatic? Obturator?

Sciatic (occurs in posterior hip dislocation, or THR in general)

Person with superficial bullae, oral involvement -- Pemiphoid? Pemphigus? SJS?

Pemphigus = mucosal involvement

Person with oedema, low albumin and protein in urine. Best treatment for proteinuria -- Fluid restrict? Restrict dietary protein? Give ramipril? Give furosemide?

Proteinuria: ACEi / ARA - Oedema: salt and fluid restrict + frusemide - ↑ Lipids: Statin - VTE: Tinzaparin

Bladder cancer, most likely type (gave no risk factors) -- TCC? SCC?

TCC = 90% (SCC is schistosomiasis)

Person treated with steroids for Crohns a week ago, now asymptomatic (blood results given, CRP normal, WCC high, neutrophils high). What is the cause of the raised WCC -- Prednisolone? Continuing inflammation? Infection?

Prednisolone causes neutrophils to migrate to blood

Lady with #NOF - IV paracetamol not helping. What analgesia next -- Patient-controlled pethidine? Femoral block? IM diclofenac? IV repeated bolus of morphine? Gas and Air?

IV repeated bolus of morphine (then do femoral block)

Ankylosing spondylitis type history - most diagnostic investigation -- HLA-B27? MRI sacroiliac joints? Lumbar X-ray? CT?

Lumbar X-ray (sacroiliac X-ray is gold-standard, so lumbar is close enough)

Patient sliced palm of hand. Not able to flex middle finger MCP and PIP joints but can flex DIP joint. Which structure has been damaged -- Flexor digiti profundus? Flexor digiti superficialis? Ulnar nerve? Median nerve? Lumbricals?

Flexor digiti superficialis (because FDP innervates DIP)