Everything Flashcards
Lucid interval
Extradural haemorrhage
Asthma exacerbation most likely to cause what emergency resp pathology?
Pneumothorax
17yo girl loses vision after seeing RTA
Acute stress reaction
Lung Ca on CXR
Flushing due to 5HT from carcinoid
Hyponatremia cranial cause
SIADH
Severe unilat headache, photophobia
GCA/migraine/meningitis
Poor prognostic factor in ICU pt who is intubated
APACHE II score
2.5cm breast lump w septum
breast cyst
intermittent breast bleeding
duct papilloma
Palliative care, breathlessness tx
morphine
non haemolytic febrile rxn, increase in temp when giving blood products
give paracetemol
glaucoma presentation
headache, unilat poor vision over few days
red, fixed, dilated pupil
glaucoma
pt consumes alcohol, headache, nausea, vomiting - what is ABG
normal O2, low CO2, met acidosis w raised anion gap
tx for complete heart block
pacing
VT on ECG, BP 80/60 tx
cardioversion
ketones from breakdown of fat or protein?
fat
Artery supplying L colon
IMA
Severe epigastric pain, collapsed, regains consciousness after fluid BP 56/40
AAA
woman w palm laceration, weak flexion of MCP, PIP middle finger, which muscle affected
flexor digitorum superficialis
what are lumbricals
intrinsic hadn muscles, flex MCPJ and extend IPJ
haemarthrosis and pain on lat aspect of knee
ACL > Collateral
Achillies tendon rupture IX
USS
diabetes w slurred speech, most important IX
BM
repeated DM with slurred speech
TIA
gram pos diplococcus cause of pneumonia
streptococus pnuemoniae
gram neg diplo cause of STI
neisseria gonorrhoea
Hypotensive, bradycardia, unresponsive to 500mg atropine, ECG:
Transcutaenous pacing
Perforated diverticulitis, unwell, surgery of choice?
Hartmanns
Obese, diabetic, 3w oedema, hyperlipidaemia, protein 4+, cause of hyperlipidaemia
nephrotic syndrome
man comes in after RTA, unconscious, pulseless, not breathing, chest compressions, ECG shows VT
Unsynchronised 360J shock
man comes to ED, unproteced anal sex, wants pill to stop getting HIV, what is the time limit for HIV PEP
72h
11yo anorexia in about to die can be fed agains her will under which legal framework
MHA
teen, low mood, weight loss, doesn’t feel like eating
depression
Pt collapse, P wave rate 75, broad QRS rate 40
complete AV block
T1DM goes to an all night party, presents to A&E w vomiting, pH 7.24
DKA
Student come to UK from Nigeria, jaundice, anaemia, fever
falciparum
40yo farmer w wheeze, normal CXR
farmers lung
anal abscess, swelling, fever, lump, MX
incision and drainage
pain on passsive dorsiflexion, compartment syndrome in young guy w fractured tibia plawying football
4 compartment fasciotomy within 6h
30yo man w joint pain, sacroilitis and DIP pain
psoriatic arthritis
transfusion rxn, fever, other obs normal, tranfusion stopped, what next
check bag against pt details
Pt on wararin having nasal polypectomy, what to do w warfarin
admit pt 2d pre-op and start heparin
Breast ca biggest RF in pt
obestiy
Legionella, Abx?
Clarithromycin
Which drug is co-prescribed with morphine in palliative care
co-danthramer
Mid diastolic murmur
mitral stenosis
pt with widespread ST elevation, what sound
pericardial friction rub
which abs are most specific/raised in SLE
dsDNA
EDM aortic regurg murmur w sudden onset CP radiating to back
aortic dissection
pt w symptoms of aortic dissection, AR, what test to confirm dx
contrast CT chest
lady w yellow eyes and high reticulocytes
haemolysis
70yo lady falls onto outstretched hand, fracture, what test to follow up
DEXA
pt on warfarin for AF has INR 3.3, falls, found on CT to have intracerebral haematoma, warfarin stopped, given vit K, what next
prothrombin complex
pt has central CP, what is ECG criteria for thrombolysis
ST elevation in leads II, III, Avf
male, married, sex w wife only, pain in testicle and epididymis, organsim?
E Coli
45yo w intracapsular #NOF, otherwise well (not given garden classification) - mx?
cannulated screw
pt with cough, apical cavitating lesions, haemolysis, firm LN in neck, test?
sputum culture and sensitivity for AAFB
lady w palmar erythema, raised ALT, raised bilirubim, ++ ANA
AI hepatitis
haematemesis, abdo pain, BP 120/80, tachycardia, what do you give while waiting for endoscopy
O neg blood
alcoholic w diplopia looking laterally, both sides, nystagmus, vitamin?
thiamine
diabetic, weakness in 4 limbs, worse proximally > distally in LL, no change to sensation in LL, UL has some pins and needles, bilat eyelid weakness
MG
alcoholic w multiple bruises on legs, has bloods and clotting which shows low bili, low pt, low fibrinogen, raised APTT, raised PT
DIC
pt w nephrotic syndrome (oedema, proteinuria, low albumin) what test for specific dx
renal bx
small cell lung ca, hilar LN, no distant mets, what tx
chemo
klebsiella pneumonia abx
cefotaxime
pneumocystis jiroveci abx
co trimoxazole
guy flew from tel aviv, CP then few hrs later leg goes white, no pulses
aortic dissection
pt has bad claudication, can only walk 10m, distal aorta and both iliac vessels occluded mx
aorto bifem bypass
lady has surg 4 days ago, given mutliple bags of 5% dex, now drowsy, what is the mechanism
cerebral oedema
60yo man, unilat L hand tremor at rest, worse when people look, can do up buttons and hold teacup without shaking, mild cogwheeling at wrist + fingers on left
early parkinsonism
stroke w hemiparesis, 2d later SALT assessment = unsafe swallow
NG tube
Dx legionella - definitive test
urinary antigen
open communited fracture, skin loss, dirty, mx
external fixation
T2DM controlled on diet, painful red eye, blurry vision mx
refer urgently to opthal
guy gets claudication in calf, where is block
superficial femoral artery
guy afte RTA has shortened, internally rotated, flexed, adducted right leg
posterior hip dislocation
man does not open eyes, localises to pain, groaning, airway?
nasopharyngeal
guy falls 10m what is 1st line mx
secure airway
56yo w weight loss, heart burn responding to antacids, smoker, drinker, what to do
gastroscopy
lady w RA has purple nodule on shin w ulcerating and raised edges
proderma gangrenosum
guy w prostate ca has back pain, bone scan shows increased uptake in spine, how to help w pain
RT
32yo woman w mobile non-tender lump in breast
fibroadenoma
woman w folate and iron deficiency, weird bowel sx, gastroenterirtis as child, IX
anti TTG abs
post partum breast feeding lady w red tender breast + no mass
flucloxacillin
triple assessment for breast ca
clinical exam, imaging, core bx
lady w sudden onset headache 12hr ago, CT normal, next?
LP
old guy w bacteruria grown from catheter, what next
treat if symptomatic
guy post thyroidectomy w hoarse voice, weak cough
recurrent laryngeal nerve
Smoker has lung ca near R brochus removed w raised ca, what will histo show
SCC
few months of breathlessness, fine end-inspiratory crackles, bi basal creps, clubbing, JVP 5cm
pulmonary fibrosis
keratoderma blenhorrhagicum is a feature of
reactive arthritis
primary tension pneumothorax mx
aspirate
lady w AI hx, has sore, gritty eyes, dry mouth, bilat parotid swelling
Sjogren’s
Man has no pain, jaundice, dark urine, pale stools
pancreatic ca
lady has headaches, transiently loses vision when she strains to defecate, signs in eyes, drinks, smokes, 12 coffees a day, what to do
lose weight
man w known AF presents with 1h hx of epigastric pain 15min after a meal
mesenteric ischemia
why is MRI spine best imaging in someone w disc prolapse
better soft tissue detail
pt has CEA and develops stridor post op
false aneurysm
man w newly dx DM, glucose +++ in urine, BMI 32, random BG 14, first line
diet and exercise
pt with asthma has short hx of yellow sputum, wheeze, given oral amox which improved sputum but still febrile, what next
give oral pred
RA pt w previous TKR has red hot swollen knee, recently had cystoscopy for longstanding urinary tract probs
infection
marathon runner w large heart
hypertrophy
opioid OD
naloxone
young guy, poor stream, takes ages to pee, previous episode of non-specific urethritis
urethral stricture
pt with 4cm head of pancreas ca, invaded mesenteric vessels mx
ERCP and biliary stent
pt w known renal cell ca gets swollen legs and distended veins below umbilicus, dx
obstruction of IVC
IVDU develops harsh murmur
staph aureus
slow rising pulse
aortic stenosis
high ESR, pain on abducting shoulder
PMR
patent ductus arteriosus murmur
machinery murmur
pt w dislocated shoulder, what nerve palsy
axillary
patient has long term indwelling suprapubic catheter, keeps getting blocked, flushed out by nurse a few times, what to do
bladder washout
40yo banker, headaches, taking ibu and para daily, no neuro/eye signs, no wt loss, mx
stop meds, reassess in 1m
pneumonia, green sputum, hyponat, euvolemic, initial tx
Clarithromycin (legionella causes hyponatraemia)
hearing changes, haemoptysis, nasal discharge, renal probs, CXR shows 3 cavitated lesions
wegeners
pt on immunosuppression develops difficulty swallowing, on lansoprazole, ibuprofen, dex, neutropenia, cause?
oesophageal candidiasis
man w low Egfr, high Ca, high creatinine, Ca was also high 1yo, dx
multiple myeloma
man w lateral epicondyle tennis elbow pain, which mvoement hurts
wrist extension
man w dull ache in groin, lump on standing, no cough impulse, does not transilluminate
varicocoele
49yo lady, 2m hx of diffuse thyroid swelling, intense sweating at night
graves
bipolar, on Li, glucose normal, thrist and polyuria w hypothyroidism
diabetic insipidus
test for gestational diabetes
OGTT at 28w
low TSH, high T4, post-URTI, reduced iodine uptake, hyperthyroid
Viral thyroiditis
60yo man is diagnosed with diabetes, diet and exercise have failed. Mx
metformin
pt has bowel op 4do, not opened bowels for 24h, distended bowel w scant bowel sounds, cause?
post op ileus
pt has op for perforated duodenal ulcer, gets hiccups and nausea, what is the cause
subphrenic abscess
pt w symptoms of guarding, peritonism, next test?
erect CXR
pt w symptoms of bowel obstruction, next test?
supine AXR
renal colic, what is the first IX
CT KUB
PT has been unwell for a week, dysuria and going frequently, gets more unwell, bad loin pain
pyelonephritis
80yo w essential HTN, PVD, what HTN med?
felodipine
pt w stiff shoulders, thighs, buttocks, fatigue, ESR 80, normal CK
polymyalgia rheumatica
testicular pain in sexually active 18yo patient - next step
take to theatre
AF, cold pale leg, 6 hours duration
amputate
uvula deviated, cervical lymph nodes, sore throat, infammed soft palate
peritonsilar abscess
man w 2cm painless penile ulcer, cause
treponema pallidum (syphillis)
lady w flushing, pustular rash, telangiectasia on face
rosacea
man w bald head, lumpy hyperketotic lesions on scalp, at risk from?
SCC
lesion on shin, irregular borders, multiple colours, suspect melanoma, which is the commonest type
superficial spreading
pale stools, abdo pain, calcification
decrease in exocrine pancreatic function
lady w #NOF, IV paracetemol not helping, what analgesia next
femoral block
guy who was lifting heavy things, lumbar pain, mx?
NSAID
Hayfever is mediated by?
IgE
patient w 3w of fevers, cough, unwell. OE: dull percussion, absent VR, reduced expansion
empyema
what vitamin do you give someone when starting TB treatment
pyridoxine
drug-resistant TB pt comes to A&E, where do you keep them
negative pressure room + resp measures for staff
pt with features of UC, what IX
flexi sigmoidoscopy
pt comes in fitting, has had 2 doses of lorazepam, what next
phenytoin loading
lady with splenectomy, needs penicillin, why?
pneumococcus (capsulated) infections
patient ventilated on ITU, develops respiratory alkalosis, what next
decrease frequency of ventilations
FEV1/FVC ratio shows a restrictive pattern, what is dx
pulmonary fibrosis
man w obstructive features, long term smoker, dx
chronic bronchitis
20yo female, 2y hx of intermittent diarrheoa, IDA, apthous ulcers, raised ESR, dx
crohn’s
2d post MI, pt develops SOB, raised JVP and harsh systolic murmur
MR
man w stab injury to back, hemisection of cord, where does he lose pain sensation
lose pain sensation from contralateral side, lose power and proprioception on ipsilateral side
ECG shows STEMI in leads V4-V6, I, AVL
anterolateral infarct
lady with falciparum, apart from doxy, what other abx do you give
quinine
which DMARD causes retinopathy
hydroxychloroquine
which DMARD causes azoospermia
sulfasalazine
lady with tremor, weight loss, proptosis, exopthalmos, opthalmoplegia - cause
rectus muscle thickening
69yo guy w 2 prev TIAs and AF, what do you start him on
warfarin
lady w hx of AF presents to A&E w fast AF, pulmonay oedema, peripheral oedema, what do you give initially
frusemide
lady w acute MI, what do you give
aspirin and beta blocker
guy on prednisolone presents with darkened red reflex, problems w night vision, dx
cataracts
post mastectomy, LN clearance, lady gets winging of scapula, which nerve is damaged
long thoracic nerve
pt post MI with PSM, bi basal crackles
papillary muscle rupture
pt w PSM, louder apex, rad to axilla, JVP 8cm
MR
pt w early diastolic murmur, mid diastolic murmur, JVP 8cm
aortic regurgitation
pt on many meds, has high potassium and high urea, ECG shows bradycardia w 2:1 block
digoxin toxicity
ST elevation in leads II, III, AVF, which coronary artery
RCA
young pt collapsed, long QT, what is cause of death
VT
pt has syncope, chest pain, faints - what IX will help ID cause
echocardiogram
75yo patient, unresponsive, nurses saw her choking, no pulses or resp effort, nothing visible in mouth - next steps
start chest compressions
62yo man with hx of xs ETOH, presents w abdo distension, wt loss, cachetic, jaundice, ascites, LFTs show obstructive picture - which tumour maker would be most appropriate for confirming dx
AFP
pt w wt loss, deranged U&E, painless haematuria
renal cell carcinoma
most common bladder cancer
transitional cell carcinom a
pt w well controlled HIV has bilateral infiltrates
pneumocystis jirovecci
pneumonia, gram +ve diplococci
streptococus pnuemoniae
25yo pt with scaly head/dandruff in eyebrows and eyes, not itchy, cause
seborrhoeic dermatitis
Pt from pakistan, HTN controlled w amlodipine and BP 150/90 with retinal findings: blot haemorrhages and yellow deposits on macula - Dx
diabetic retinopathy
Footballer inverts ankle, presents with foot pain, no ankle pain, DX
fractured base of 5th metatarsal
guy jumps and lands on knee
medial meniscus tear
pulmonary adenocarcinoma mets to liver via what route
haematological spread
lady playing squash, runs, hears a crack from behind ankle then pain when she does plantar reflex
ruptured achilles
Son of 75 year old lady requests home visit for mother who has recent behavioural changes. Sometimes gets confused and sees people in the room who aren’t there. Recent loss of appetite. Cause?
depression w psychosis
guy post-op with delirium, morphine epidural in situ, best intial mx
put in well lit side room
guy with short hx of back pain, painless black lesions appear on feet
CT abdo
guy w nocturia, PSA 18, urinalysis trace blood, protein, urea and creatinine mildly elevated - next steps
urgent referal to urology
75yo lady with 2.5cm firm breast lump, not tethered to skin, no skin changes. Daughter 40yo and has had benign breast cyst dx. What does the old lady have?
ductal carcinoma
45yo lady w spontaneous dark brown nipple discharge, examination reveals one duct producing discharge. Dx
intraductal papilloma
tall 28yo man w radiofemoral delay, HTN, BP 210/110, rib nothching, DX
co arctation of aorta
young guy vomiting after a night out presents with chest and epigastric pain, L sided pleural effusion, subcut emphysema
oesophageal rupture (boerhaave syndrome)
sickle cell girl w severe back pain, what first?
paracetemol/ibuprofen
Smear cells
CLL
Guy on ibuprofen, pain, 2 episodes of haematemesis w bright red blood. No further episodes. Stable obs, low Hb. What next
OGD within 2 hours
Lady collapses on hosp ward, had co-amox in A&E earlier, reports feeling breathless before collapse. 2h later is tachy, hypotensive, RR 34 on 10L O2. What do you give first
adrenaline
PBC antibody
anti mitochondrial
guy with metastatic renal ca has severe pain, vomited 4x, currently on oral morphine solution PRN, helps for 2 hours. What pain tx?
morphine sub cut infusion
Pt w previous TKR, tender, febrile, hot, swollen. No evidence of crystals on microscopy. Aspirate shows turbid fluid
septic arthritis
nutrition deficiency in coeliac
folate, b 12, iron (FBI)
guy smokes and keeps pigeons, progressive SOB on climbing hills. CXR shows reticonodular shadowing
extrinsic allergic alveolitis
acute presentation of gout, PMH HF, on ramipril. Mx?
colchicine
Caucasian lady, Raynaud’s colour order
white - blue - red
post-transplant pt has dry cough and SOB, desats from 90+ to 83 on exercising. What does he have
pneumocystis jirovecci pneumonia
bilateral conductive hearing loss in old lady
otosclerosis
pt with URTI has purple nodules on shin
erythema nodosum
commonest cause of corneal ulceration
HSV = dendritic ulcer
painful vesicular derm lesion on side of face, around forehead, eye, check - cause
VZV
66yo guy comes to GP with new onset dyspepsis, no wt loss or dysphagia, what next
refer on 2ww
30yo lady with fever and fits, temporal lobe necrosis, cause
HSV encephalitis
ring enhancing lesion on CT brain in pt with HIV
toxoplasmosis
lady comes to GP with raised prolactin, raised IGF-1, normal TSH/LH/FSH/ACTH. Dx
acromegaly
old lady, takes nitrofurantoin, gets watery diarrhoea, 2 other in carehome have this too
norovirus
blood transfusion, starts second unit, immediately gets chest pain, SOB, dark urine - what happened
ABO incompatibility
T1DM on subcut insulin pump comes in frequent episodes of SOB, palps and tingling in fingers. Cause
hyperventilation syndrome
most appropriate pre-op IX in well controlled asthamatic about to undergo diagnostic laparoscopy
PEFR
guy falls down, can’t remember how long he’s been on the floor, comes in with renal failure and dark urine, raised K
rhabdomyolysis
thin 18yo girl comes in with low K, macrocytic anaemia, raised urea and normal physical examination. Cause
coeliac disease
smoker comes in w progressive breathlessness, GP does spirometry and send home w PEFR diary, what will help diagnose COPD
normal FVC and low FEV1
guy comes in with swollen legs, bilateral scrotal swelling, 10kg weight gain
peripheral oedema
lady with met breast ca, hypercalcaemia, what do you give first
IV fluids
guy with loin to groin pain, blood +++ on dip, what IX first
CT urogram without contrast
old man, one episode of painless haematuria
refer to urology 2WW
pt with pernicious anaemia, iron deficency as well, gastroscopy shows stomach ulcer, what malignancy
adenocarcinoma
guy comes in with hypercalcaemia, renal failure, anaemia, bone pain
multiple myeloma
lady back from afghanistan, low Ca, raised PTH, what test to confirm Dx
serum vitamin D
guy with epilepsy and housebound, pain in spine and compressing rib cage
osteomalacia (due to epilepsy med)
guy has episodes of syncope, goes blue during, no other problems, IX
24H ECG
pt with right sided hemiparesis, aphasia, visual defect (does not blink to hand waving on R side but does on left) which arter
L MCA
bitemporal hemianopia person - where is the lesion
optic chiasm
fit guy whose dad died early comes to you worried, passes out during sports, IX
echocardiogram
guy falls down, no biceps, hand held in Erb’s palsy - what is damaged
Upper Brachial Plexus (C5,6)
zig zag lines, painful eyes, NV, no cluster headache
migraine
guy w haemorrhoids, do not prolapse, first line
Fibre
old person, swollen knee, now swollen hip
OA
lady with fever, catheter in situ 14d, E&D normal
UTI
purulent otorrhoea, hearing loss, keratin
cholesteatoma
lady comes back from india 3da with abdo pain, diarrhoea, vomiting
stool MCS
HTN young guy, raised CR, proteinuria
hypertensive nephropathy
lady about to undergo ovarian tumour resection, needs thromboprophylaxis, had PE
LMWH
guy w droopy face including forehead
bell’s palsy
osteoporosis prophylaxis for 65yo lady on long term prednisolone
bisphosphonates
pt with lung ca findings + cushingoid, smoker
small cell lung cancer
someone w Hodgkin’s lymphoma, mediastinal mass, night sweats
curative chemo
change to bowel habit, wt loss, free blood in stool, dilation of colon proximal to sigmoid
colorectal ca
bloody stool, normal proctosigmoidoscopy
colonoscopy
pt with hx of biliary colic, presenting w jaundice, obstructive picture
gallstone in CBD
lady with collapse, high K, low Na, other bloods suggesting addisons, IX
ACTH and cortisol levels
alcoholic comes in confused, ataxic, what do you give
thiamine
pain right of epigastrium few hours after food, relieved by milk, wakes him up at night
duodenal ulcer
guy with hx of delirium tremens, wants to quit
refer to local specialist alcohol services
Sjogren’s ab
anti-Ro
SLE ab
anti dsDNA
post-op lady w DVT, what test confims dx
venous duplex
which cardiac drug is CI in asthma
atenolol
CXR pleural plaques, presents with pleural effusion, breathlessness, what IX
USS guided tap
guy with PEA, given one dose adrenaline, no pulse, what next
another dose adrenaline
pt with RTA, white out of lung
haemothorax
vas, leaking AAA, IX
CT abdo
guy w hx of BPH, IHD, indifestion, diabetes on metformin, simvastatin, bisoprolol, has erectile dysfunction - cause
adverse drug effect
RTA, conscious at event, brought into A&E with reducing consciousness, GCS 6
intubate and ventilate
anterior neck lump, bx as SCC of tonsilar primary, which infection causes this
HPV
Man with rheumatoid arthritis and T2DM has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis
venous ulcer
DCIS dx on right outer quadrant, on first mammogrpahy, what is the treatment
wide local incision
55y woman smokes 10/d, 6m hx of white sputum and cough - what is done first
CXR
61yo asymptomatic, fasting BM 7.2, BMI 21, what should you do
dietary advice
breast ca with lung and bone mets, on low dose haloperidol, confused, constipated, cause
hypercalcaemia
soldier gets off long flight, went pale, collapsed, hit head, mates noticed asynchronous jerky movements for 15s, recovered consciousness <5 mins
vasovagal
young woman, no lump, bloody discharge from nipple
intraductal papilloma
ankylosing spond hx, what diagnostic IX
HLAB27
Myopathy, high CK, polymyositis hx, IX
anti-Jo
asthmatic being treated for exacerbation, responding well after tx, suddenly deteriorates, no air entry on L
pneumothorax
rash on flexural surfaces, anaemia, diagnostic IX
upper GI bx
pt w cancer and mets, nausea, vomiting, not on chemo/RT, which medication to give
cyclizine
medication with SE of a obsturctive hepatic picture
bendroflumethiazide
30yo gentleman w intermittent swallowing difficulties for solids, but relieves w large amounts of water, no mass, bad breath
pouch
parotid gland swelling 2cm, which has become 5cm quickly - dx
parotid carcinoma
man w AF, stroke, hx of intracerebral bleed 6yo, which medication to add onto his current tx
beta blocker
woman w hx of fever, reduced air entry LLZ, fluid level (pneumonia, pleural effusion) - what next
pleural fluid aspiration
tension pneumothorax (tracheal deviation, deteriorating)
needle thoracostomy
ECG showing SVT, what do you give
adenosine 6mg
Hx of man w bronchial ca of 7cm, other features of ca, which would be the Sx suggesting that surg is not viable
hoarseness of voice = suggests L recurrent laryngeal nerve invasion
man w deficits described by CN 3-6, where is the stroke
pons
serotonin sx patient had cancer, flushing + other symptoms, which hormone is responsible
serotonin
person w COPD, previous courses of steroids, stopped 1-2w ago, postural hypotension. Cushingoid face. What IX next?
overnight oral dex suppression
SVT management
Adenosine
parotid gland became large quickly 5cm
parotid carcinoma
Weakness post illness, guy who had visual problems (optic neuritis?)
MS
Progressive weakness post URTI, absent reflexes, ascending tingling, sensory level to umbilicus
GBS
Female soldier who had seizure/jerks after cramped longhaul flight
vasovagal episode
Elderly man sitting in chair, goes unconscious for 3-5 mins, no shaking or bladder problems. BG of prolonged PR interval, L axis deviation, RBBB, regained consciousness and is fine after. HR 60. Cause?
complete heart block
SIADH hx with slight hypernatraeamia, how do you treat?
vasopressin antagonist
Urine, eye, joint problems
reactive arthritis
Person with dry eyes, needs eye drops
hypromellose
Pregnant lady w DVT, mx?
LMWH (warfarin = teratogenic)
asthmatic on typical meds, gets recurrent throat issues, which med is causing this?
Beclamethasone - sounds like oesophageal candiasis
Person w HIV, on anti retrovirals, has oral thrush, no cough, no fever, lobar consolidation on CXR. Cause?
Streptococcus pneumoniae
Asthmatic on salbutamol + ICS, what is next? (no LTRA offered in options)
Ipratropium (SAMA)
Pt with stroke, unable to put clothes on, puts on back to front/upside down. Which part of the brain is affected?
Parietal lobe
Pt with gout, has CKD stage 3, colchicne causes vomiting for the patient. Mx?
Steroid (NSAID CI in CKD)
Ankylosing spondylitis, failed on 3 NSAIDS, what next?
Etanercept
Old lady in care, home on nitrofurantoin, has watery diarrhoea and vomiting. 2 other people ill at care home. Organism?
Norovirus
Person w lung fibrosis, ?rheumatoid arthritis symptoms - which antibody?
anti CCP
Pt with mouth ulcers, bloody diarrhoea
Crohn’s disease
Opthalmoplagia and facial palsy
SOL (although only option remembered is cavernous sinus thrombosis)
Person with previous history of alcohol misuse, 1 year sober, on thiamine, presents with hypotension and increasing confusion. What do you give first?
IV pabrinex
What causes production of ketones in DKA?
increased lipolysis
38yo guy, stable, BMI 21, fit and healthy. Eats greens. Ketones 1+ Glucose 2+, BM 18. Mx?
SC basal bolus insulin
Pheochromocytoma investigation
urinary metanephrines
Pt with previous exposure to asbestosis, heavy smoker, CXR shows hyperexpansion and pleural plaques. Cause of breathlessness?
Asbestosis
Pt with previous exposure to asbestos, pleural plaques and thickened pleura
mesothelioma
Old lady with pain in back, relieved by leaning on shopping trolley, heavy legs. Cause?
spinal stenosis (leaning = increased spaces between spinal vertebrae)
Pt on Li, normal TFTs, hypernatraemic. Cause
Diabetes insipidius (due to Li)
Pt at risk of refeeding sx, what do you monitor
phosphate
Pt w low Ca, phosphate, high PTH. Cause
osteomalacia
Pt fluid restricted due to hyponatraemia, not improving 1 week later. What next?
Vasopressin
Ascites, neutrophils 500. Cause
Spontaenous bacterial peritonitis
Ascites + encephalopathy mx
lactulose
Melena, vomiting, haemodynamically unstable. MX?
OGD <2h
Addison’s commonest cause (UK)
autoimmune (ww = TB)
nausea & vomiting, horizontal nystagmus, no hearing loss
vestibular neuronitis
Asthma classsification: BP 105, RR 30, O2 94%
Severe
Pt with daytime somnolence, high epwoth score, overweight. Tx?
Weight loss
Lower lobe fibrosis, RA, raised Ca, bilateral shadowing. Cause?
sarcoidosis
Spiculated lesion in lung
Breast ca (Wiki says - In oncology, a spiculated mass is a lump of tissue with spikes or points on the surface. It is suggestive but not diagnostic of malignancy, i.e. cancer. It’s a common mammography finding in carcinoma breast.)
patient has pain in right calf when walking, where is the blockage
right superficial femoral
Pt sliced palm of hand, not able to flex middle finger, MCP, PIP joints but can flex DIP joint. Which struture is damaged
flexor digitorum superficialis
Pt drank black coffee @ 6am, scheduled for surgery at 8.30am, what do you do?
Continue surgery as normal (foods = 6h, clear fluids = 2h)
pt w lumbar back pain, hypotensive. What IX
US Abdo (FAST Scan) for suspected AAA
Man working on construction site, rats and pigeons, lives in caravan. Abdo pain and nausea, blood film shows basophilic stippling + sideroblasts. What IX?
Total body lead
Diabetes on insulin due for surgery, first thing next morning has HbA1C of 58mmol/L. What do you do?
Convert to sliding scale on morning of surgery
What is a haemodialysis fistula?
Connection between artery and vein
40yo woman goes for check, has FHx of thyroid, heart disease. TSH slightly high, T4 normal, triglycereides high, LDL norm, HDL norm. What do you do?
recheck 3 months
describes malignant hyperthermia, antidote
dantrolene sodium
converting oral morphine to SC infusion, currently on 60mg OD (2mg/5ml). How much do you give?
oral morphine –> subcut morphine = 1/2
surgery on metformin, and gliclazide, what do you do
stop metformin and gliclazide in the morning of surgery (omit hypoglycaemics if 2 meals skipped)
old person w splenomegaly, cervical lymphadenopathy, anaemia, ?lymphocytosis, normal platelets, most likely dx
CLL
Pt found unconscious with empty packets of amitryptiline, diazepam, what would be the first drug to give to reverse sx if they had long QT/QRS on ECG
Sodium bicarbonate (wide QRS = amitryp = sodium bicarb)
Which of the following is a notiable disease?
measles
pt with vertigo when turning her head in bed/waking up, what is the mechanism
otoconia in canals
pt admitted to A&E with small pneumothorax, no tracheal deviation, paramedics insert chest drain. Why?
to prevent tension pneumo
Old lady with CKD stage 3, high Ca, high phosphate, high PTH. Cause?
tertiary hyperparathyroidism
Hyperextension neck injury, what is the best view to determine a CS fracture?
open PEG?
20yo female, loin pain, LMP 3w ago, urinalysis shows blood 2+ diagnosis
pyelonephritis
young male with features of low back pain, painful red eye, photophobia
uveitis
Parent comes in with 9yo, child was playing w friend who’s brother had bacterial meningitis and has friends taken antibiotics for this. Father wants Abx for child, what do you do? Child is well.
Give abx propylaxis?
Patient with subacute combined degen of cord (peripheral neuropathy, weakness in legs) what do you give them?
thiamine
Patient w GCS 7, O2 sats 96% on air, airway mx?
intubate and ventilate
72yo lady has tripped and fallen, husband reports she did not black out, has a scalp laceration, amnesia for an hour, vomited once, was on aspirin. What is the indication for an immediate CT
amnesia
32yo lady is 10w pregnant, has dysuria, diagnosed with UTI, what medication should she be treated with?
nitrofurantoin
what is an indication for colectomy in UC
epithelial dysplasia
abdo pain, imaging showing decreased perfusion to L colon. What is likely to be affected?
IMA
Woman with BRCA1 gene, what is the inheritance % for her sister and children
0.5
Man with bloody diarrhoea (blood and mucus 4w, 6x day), came back from thailand 6w ago, no granulomas, DX
Amoebic colitis
Patient with epistaxis now stopped, on warfarin, warfarin 5.8. What is the best thing to give to prevent further prolonged bleeding?
PTC
guy with intermittent bleeding, bright red stool, haemorrhoids that are non-prolapsing. He is otherwise well, no other symptoms. What is first like mx?
increased dietary fibre
50yo guy with COPD admitted with breathlessness. Carboxyhaemoglobin is 35%, what is first line O2 to give him?
15L O2 via non rebreather mask
Abdo pain, black toes. What is the best imaging modality to proceed with?
CT abdo
Patient previously diagnosed with MGUS 8yo, no features of CRAB. Now has bence jones proteins in urine. Glossitis, IgG 11. What is dx?
multiple myeloma
Patient has tingling in her fingers (median distribution), when you tap on the anterior portion of forearm is positive. What other sign would prompt urgent surgical decompression?
thenar wasting
Candida found in old man’s catheter on the ward, no urinary symptoms, crackles in lungs. What do you do?
Change catheter
Middle aged man comes to see the doctor for the past 6 months, has been forgetting where he puts his car keys. Stressful job but keeping up wth work, no problems. Recent death inf family. Diagnosis?
normal inattention
old guy, lives in carehome, admitted with urinary retention, 5 previous admissions in the past year or the same reason. PMH includes BPH and visual impairment, on alpha blocker. Recently failed TWOC. What is the most appropriate management?
Long term catheter
Male patient in 70s is adamant, he wants to be at home instead of hospital, means that he can’t get all of his treatment. What is the best action to proceed with this for this to happne?
advance statement
Which of the following should be checked before haemodialysis in the main dialysis unit?
EBV or CMV
28yo male, radio-femoral delay, notching of ribs on CXR. Dx
coarctation of aorta
Patient presents with tonsillitis, CENTOR criteria 3 - had fever, exudates. How do you manage?
phenoxymethylpenicillin
patient 20yo, severe pain in testes which is red and swollen, how to proceed?
Emergency surgical exploration
Person has an ulcer on medial malleolus 1cm x 2cm, non healing for 3 months, slough, rolled edge, haemosiderin, peripheral pitting oedema, sensation and reflexes intact. Dx
Vvenous ulcer
Young lady has multiple lumps in both breasts which are 1cm x 2cm, fluctuant swellings, painful around period. Dx?
fibrocystic changes
Patient had surgery for pancreas. Has been taking diclofenac post-op for a few days, collapses. Dx?
perforated peptic ulcer
Patient in late 20s, closed tibial shaft fracture that is displaced. How do you manage?
closed reduction and fix with cannulated screws
lady with previous diagnosis with breast cancer, had mastectomy, recently had a course of chemotherapy, now has back pain. What next?
MRI spine (cord compression) or XR spine (mets/lytic lesions) - insufficient info
Lady who is 3m postpartum and breastfeeding, lump in right breast, inferior quadrant that is warm, tender and fluctuant. What is the diagnosis?
mastitis
Incidental finding of solid mass on right kidney during USS. What is the most likely diagnosis?
RCC
17yo patient has raised rash on buttocks and back of thighs and legs had sore throat a week ago. Dx
HSP
Patient on ward has C difficile, they are started on metronidazole. What additional measures do you need to take?
Side room and isolate
Another patient has C difficle now. How do you treat them?
Side room and isolate
Patient with obstructive sleep apnoea, snores at night, daytime somnolence, overweight. What MX will help his symptoms?
CPAP
Patient has surgery, pain on passive straight leg raise. What is the diagnosis?
compartment syndrome
Pt has RUQ pain, USS shows dilated intrahepatic ducts, what Ab would you test for to confirm the diagnosis?
p ANCA
neck stiffness, headache, admitted to A&E, CT clear, LP done which has low opening pressure. What is the causative organism (gram +ve cocci)
strep pneumoniae
hyperextension neck, tetraplegic (UL > LL), XR shows degenerative changes. What is the likely lesion?
anterior cord
Male patient with 28y hx of UC. Has a flare of UC which is treated with prednisolone. Bloods taken, show raised WCC, raised neutrophils. What is the reasoning behind his abnormal result?
ongoing inflammation
Female patient with partially fixed, dilated pupil, hazy vision. DX?
acute angle glaucoma
Paitent with suspected glaucoma. Which investigation would best confirm dx?
tonometer
patient who is brain dead/comatose (post cardiac arrest). What is best test to determine prognosis?
brainstem reflexes
middle aged doctor, really severe chest pain, CXR shows widened mediastinum. Dx?
aortic dissection
Elderly patient, few days post-op for ortho surgery, has epidural in, becomes drowsy. BP 80/62. What is the first thing you do?
IV saline over 15 mins
Old lady fell down the stairs, she ‘jarred’ her leg straight when walking a she didn’t realise there was another step. Was unable to weight bear afrer, haemarthosis. More tender on lateral side. Pain on all movements. Diagnosis?
ACL rupture
Person after accident has internally rotated leg and shortened, can’t dorsiflex. Previous THR. Where is the injury
common peroneal nerve
Person presents to GP with pain in foot, pulseless, cold. Hx of claudication. Cause
critical limb ischemia
person with AF, sudden acute limb. Tx
Embolectomy
Person with hx of PKD, had renal transplant 1yo. Now has blood+, protein+, lymphocytes+. Cause?
UTI
RUQ pain, jaundice, temp 37.6, raised ALP
acute cholecystitis
Patient drinks alcohol, BMI 29, has had previous episodes, now continuous pain - raised ALP, normal ALT, no AST. Imaging shows dilated common and hepatic ducts.
alcoholic steatohepatitis
person with supraclavicular lymphadenopathy, fever, apthous ulcers, generally ill after coming back from southa africa, stopped taking malaria prophylaxis afer 2d. Cause
HIV seroconversion
frail lady, not mobile, in care home. Has bright red blood in stools, refuses endoscopy. What is the most appropriate to give dx?
capsule endoscopy
person not taking oral fluids, has white plaques in mouth, most likely cause
oesophageal candiasis
person with superficial bullae, oral involvement.
Pemphigus
person with calcium stones, best preventative tx
depends on results. Uric acid stones = Allopurinol
Cystine stones = Urinary alkalinisation
person with nephrotic syndome, best treatment for hyperproteinuria
Ramipril
<p>person treated with steroids for crohn's 1 week ago, now asymp (CRP N, WCC high, neutrophils high), what is the cause of the raised WCC</p>
<p>infection - prednisolone suppresses CRP</p>
presentation of acute asthma, had been given neb salbutamol, ipratropium. ABG shows high CO2, breath sounds quiet. What next
intubate and ventilate
man in 70s with hydrocoele, it is not symptomatic, not changed in 10 years, next step?
do nothing
Surgeon has asked you do grade a pre-op patient on the ASA mortality scale. He has asthma which is well controlled. What ASA grading? 1,2,3,4,5.
2
Calculate GCS, opened eyes to pain and withdrew hand to pain. No sounds. (no sounds, opened eyes and withdrew hand to cannulation)
7
200 pts in 2mths period out of 10,000 people get influenza. They ask how many people out of 100,000 in one month period get infection
1000
What markers are high in this patient with obstructive jaundice picture?
High bilirubin, high ALP, normal ALT
Student returns from Nigeria with jaundice, anaemia and fever
?Falciparum, Hep A, Influenza A, Typhoid, Paratyphoid fever
- Eye that has industrial liquid splashed on his eye after workplace accident. Eye is now red and painful. What to do next? 0.9 NaCl saline wash out, neomycin drops, chloramphenicol drops
0.9% NaCl
Old guy with COPD, carboxyhaemoglobin of 35% (normal <1.5%), normal O2 sats. What immediate mx?
15L O2 via non rebreather mask
- Guy has had 3 black outs, most recent one while washing car- goes pale, LOC, arm jerks while on ground, wakes up and feels fine/fast recovery. ECG is normal. What is next most appropriate investigation? 24 ECG, tilt table test, EEG, Echo
24hr ECG
Footballer hits shin, progressive pain with pain on active and passive flexion of the foot. How do you manage? 4 compartment fasciotomy within 6 hours, review in 12 hours, send them home with analgesia, imaging
4 compartment fasciotomy
Blood transfusion. On 2nd unit. Immediate chest pain. SOB, dark urine.
ABO incompatibility
- Which drug causing hyperkalaemia? ARB, CCB
ACEI
- Guy with heart failure gets pulmonary edema, you give him oxygen, sit him up, furosemide- what is appropriate to do next?
ACEI
Dysphagia to both liquid and solids, Birds beak appearance - achalasia, oesophageal webs, oesophageal cancer, Barett’s
Achalasia
Woman with new headaches and sweaty. Her blood results showed raised IGF1 and raised prolactin (roughly 1200)
Acromegaly
- A man is getting worried that the gaps in his teeth are getting wider and his chin is becoming more prominent. What does he have?
Acromegaly
Post tonsillitis guy who got proteinuria, haematuria, swollen face, red cell casts, self resolved over the next 3 months
Options: IgA nephropathy, Acute GN, Nephrotic syndrome
Acute GN.- Post-strep
Immediate reaction shortly after transfusion of second bag of blood. Red urine catheter. What is going on?
Acute haemolytic transfusion reaction
- Guy has sore throat, hard to swallow, tonsils were symmetrical and of a normal size., painful- quinsy, acute laryngitis, acute tonsillitis, mono infec?
Acute laryngitis
Pernicous anaemia + IDA. Gastroscopy shows ulcer in stomach. What malignancy?
Adenocarcinoma
Caucasian man presents with dysphagia/weight loss ‘food getting stuck behind chest’: Squamous cell carcinoma, adenocarcinoma, barrett’s, GORD
Adenocarcinoma
- A patient has 6 month smoking history (lung cancer picture) and hyponatremia- what hormone caused this?
ADH
Patient on warfarin having nasal polypectomy.
Options: admit patient two days pre-op and start heparin. Change to aspirin post-op, Measure APTT, Stop warfarin on day of surgery
Admit patient two days pre-op + start heparin
- Old patient wishes to be cared for at home. He has no living family. He understands that he is refusing hospital treatment. What is the most appropriate way to fulfil his wishes? Fill out a DNAR form, advance request, advance request for refusal of treatment, appoint a LPA
Advance request for refusal of treatment
- Patient on beclametasone inhaler and salbutamol inhaler and now has pain on swallowing. What advice do you give him?
Advice to take beclometasone with spacer, switch beclametasone to fluticasone, swap beclametasone for salmetrol, advise to take his salbutamol and beclamethasone inhaler an hour apart,
Advise spacer
40y banker with headaches which have led to taking ibuprofen and paracetamol daily. No neuro or eye signs. No weight loss
Advise to stop taking meds and reassess in month
Variable ventricular rate and absent P waves? irregular ventricular rhythm? AF, atrial flutter, ventricular tachycardia, ventricular fibrilation, supraventriular tachycardia)
AF
Features of SLE, on hydroxychloroquine. Jaundiced, raised reticulocytes. Spherocytes and polychromasia:
AIHA
Young lady with massive HTN. High Na, low K - which hormone is likely cause of high blood pressure?
Aldosterone
Old woman forgetting over 18 months - remembers the past well. Mother had similar presentation.
Alzheimer’s
Myelodysplasia which has got worse in the last few weeks. Primitive cells on slide and pancytopenia, what have they developed?
AML
Classic pneumonia signs (Gram +ve in pairs) what antibiotic to give:
Amoxicillin
AF patient has cold pale leg for 6hrs. Mx?
Amputate
History of constipation, severe pain on DRE so unable to perform it.
Anal fissure
5 days post AP resection and now peritonitic, temp 38 abdo distension and lower abdo pain.
Anastomotic leak
Pain on exercise associated with anxiety and sweating, radiates into neck. Comes on with walking and relieved by 5 minutes of rest. Troponin is normal. ECG no abnormalities. What is diagnosis? Angina, NSTEMI, GORD, achalasia, anxiety
Angina
Man has ultrasound to look for gallstones, incidental finding of 4cm solid renal mass. No other Sx: angiomyolipoma, renal cyst, renal cell carcinoma, renal metastases
Angiomyoplipoma
Blurred vision, painful right eye, right eye congested and bigger. Angle closure glaucoma, temporal arteritis,
Angle closure glaucoma
30 year old guy with morning stiffness reduced lumbar flexion. Can no longer touch toes
Ank spond
30yo M with joint pain - sacroiliitis + DIP pain
Ankylosing spondylitis
- Alcoholic with long standing ascites, has been abstinent for 6 months. Increasing confusion. Is on regular thiamine and spironolactone. Has recently been started on oral furosemide. Has been feeling unwell and has some worsening of ascites. Na: low, BP low (can’t remember other figures).
What is the most important IV therapy to start: furosemide, pabrinex, 500mL of Hartmann’s, antibiotics.
Antibiotics
What antibody most specific in SLE?
Anti-ds DNA
Miscarriage at 11 and 14 weeks. DVTs. Livedo reticularis on the legs:
Antiphospholipid syndrome
F with folate + iron deficiency. Some bowel symptoms following bouts of gastroenteritis as a child. What ix?
Anti-TTG
EDM + sudden onset chest pain going to back
Aortic dissection
Man flew in from Tel Aviv - chest pain + few hrs later his leg goes white + no pulses
Options: Aortic dissection, thromboses of popliteal artery, PE, MI, DVT
Aortic dissection
Another man falls 10m, ?wide pulse pressure, enlarged mediastinum on CXR,
Aortic dissection
Claudication - can only walk 10m. Distal aorta nad both iliac vessels occluded. What do?
Aorto-bifemoral bypass
Patient with RUQ pain, jaundice, fever. Raised AST. Did not give other liver function tests. Ascending cholangitis, Hep A, Hep B, pancreatic cancer.
Ascending cholangitis
Primary tension pneumothorax. Mx?
Aspirate
Young guy in A+E breathless, 4cm pneumothorax, trachea non-deviated, how to manage?
Aspirate
- In a randomised controlled trial, what is the most likely form of bias? Attrition, Recall, selection
Attrition
Dislocated shoulder. Injury to which nerve?
Axillary
Patient with symptoms of bowel ob. What test?
AXR
What vitamin to give fi startingi TB treatment
B6/Pyridoxine
- Patient has a oesophageal carcinoma (didn’t they specify adenocarcinoma?) in the lower part of oesophagus. What is the most likely cause? Alcohol, smoking, barrett’s oesophagus, H Pylori
Barrett’s oesophagus
Lady with asthma. On various inhalers + LTRA + Theophylline tablet. Which one has caused his painful swallow?
Beclometasone
- Dry eye and dry mouth. Bilateral parotid swelling. Which investigation? Anti-Ro, sialography, biopsy
Biopsy
- Patient recently had an MI. Has already been started on ramipril, atorvastatin. What is another drug that should be added? ARB, Bisoprolol, hydralazine, digoxin
Bisoprolol
Guy with terminal dribbling
BPH
HRT increases which cancer type
Breast
Facial swelling, distended chest veins, weight loss, JVP raised but non pulsating, clubbing
Options: Bronch ca, Chronic liver disease
Bronchial carcinoma
Man, non smoker, episodes of severe productive cough with chronic productive cough in between. O/E: LLZ wheeze and crackles. Dx?
Bronchiectasis
CXR: Bronchial wall thickening. Coarse creps on the right side. Bronchiectasis, Idiopathic pulmonary fibrosis
Bronchiectasis
- Patient has inguinal lymphadenopathy. Lymph node biopsy finds sheets of RAPIDLY GROWING moderately sized B cells. What is the diagnosis? Burkitt’s lymphoma, CLL, CML, AML, ALL
Burkitt Lymphoma
Hyperkalaemia and symptoms of pneumonia. ECG changes - tented T waves and broad QRS. What is the most important initial treatment? Calcium gluconate, Glucose/insulin, co-amoxiclav, amiodarone
Calcium gluconate
Bloody diarrhoea + vomiting after eating chicken at barbecue initial Culture at 37C Negative, Culture at 42C - curved gram negative rods
Campylobacter
- 40 year old fit and well patient with displaced intracapsular fracture. What is the most appropriate management? Hemiarthroplasty, cannulated screws, dynamic hip screw
Cannulated screws
Taking prednisolone. Darkened red reflex. Problems with night vision. Dx?
Cataracts
Klebsiella pneumonia Abx?
Options: Ciprofloxacin, Clarithromycin, Cefotaxime
Cefotaxime
Treatment for meningitis (neck stiffness etc)
Ceftriaxone
Lady has surgery 4 days ago. She was given mutiple bags of 5% dextrose. Now she is drowsy. What is the mechanism?
Cerebral oedema
Transfusion reaction - fever, other obs normal. Transfusion stopped. What next?
Options: check bag against patient details, start transfusion again. Give chlorpheniramine
Check bag against patient details
Small cell lung ca. Hilar LN. No distant mets. Tx?
Chemo
Guy recently got a parrot and now has pneumonia - chlamydia psittaci, H5N1 pneumonia, EAA, Mycoplasma infection
Chlamydia psittaci
Purulent otorrhoea, hearing loss. Keratin. Cause?
Choleastoma
- Chest pain worse on breathing- it sounded like rib fracture but no trauma
Chostochondritis
Fatigue, diabetic with photocoagulation, urine had protein etc
Chronic kidney disease
Guy with swollen face, jaundice, distended abdomen, drinks 90 units a week. Recently losing weight unintentional. Didn’t mention if it was acute setting or not - just told us what he had.
Options: Chronic liver disease, Hepatic vein thrombosis, Acute pancreatitis
Chronic liver disease
Legionella - Abx?
Clarithromycin
What does triple assessment consist of
Clinical exam, Imaging, Biopsy
Which drug is commonly co-prescribed with morphine?
Aspirin, Hyoscine, Co-danthramer, Loperamide
Co-danthramer
- He had paracetamol 1g TDS for pain. What to give next? Codeine phosphate, morphine
Codeine phosphate
20ish year old woman, with bowel problems. Patient with IDA, low folate, rest bloods normal. Options: Coeliac disease, IBS, UC, Crohn’s
Coeliac
- Histopathological findings: summary was villous atrophy. Diagnosis? Coeliac, IBS, Crohn’s, UC
Coeliac
paitent with symptoms of UC, which ix is diagnostic
colonoscopy
Patient with symptoms of UC, which investigation is diagnostic
Colonoscopy
60 year old gentlemen with recurrent lower GI bleeding. Rigid sigmoidoscopy was normal up to 15 cm. What is the next appropriate investigation? CT pneumocolon, colonoscopy, Red cell scan, Mesenteric angiogram, MR scan of the abdomen
Colonoscopy
Collapse, p wave rate fo 75, Broad QRS rate of 40
Complete HB
Guy with ECG - P wave 70, QRS wave 45 (repeat from prev. paper)
Complete heart block
Haemorrhoids that do not prolapse. Mx?
Conservative
Pneumocystis jiroveci abx?
Co-trimoxazole
Patient with sputum culture of Pneumocystis jirovecii. Antibiotic treatment
Co-trimoxazole
Colonoscopy skip lesions
Crohns
Acute diverticulitis. What is the diagnostic investigation: Flexi sig, CT abdomen, MRI
CT abdo
Ix for aortic dissection?
CT chest
Best ix for angina
CT Coronary angio
Renal colic. First line imaging?
CTKUB
- Sats 90%, unwell (nauseous) for a week. ECG sinus tachy. No chest pain. Which Ix: CTPA, Echo, Coronary angiogram
CTPA
55 year old Woman smokes 10 per day with a 6 month history of white sputum and a cough what should be done first
CXR
- Patient has weight loss, haemoptysis (symptoms of lung cancer). What is the most appropriate initial investigation? CXR, CT thorax
CXR
APTT and PT raised (?low platelets). What to measure?
Options: D-dimer + Fibrinogen + vWF. Bone marrow biopsy. FBC
D-dimer, fibrinogen, VWF
Patient ventilated on ITU. Respiratory alkalosis. What do you do?
Decrease frequency of ventilations
- A woman brings in her boyfriend who has starting getting hallucinations (?) long term alcoholic and just stopped alcohol 3 days ago. GP started him on acamprosate.
What is causing symptoms? Delirium Tremens, Korsakoff, side effect of acamprosate, encephalopathy
Delirium tremens
70y F FOOSH - fracture. What test should GP follow-up with?
DEXA
- Something about woman on predisilone and keeping track of risk of fractures? What investigation?
DEXA
Management of Person with metastatic cancer and has brain lesions and raised ICP
Dexamethasone
Bipolar taking lithium. Glucose N. Thirst, polyuria. Cause?
Diabetes insipidus
Guy with renal failure. Which drug is contributing to abnormal blood tests? Diclofenac, Simvastatin, Aspirin, metformin
Diclofenac
Private healthcare screening 61 y/o asymptomatic. Fasting bm was 7.2. BMI 21. What should you do with him?
Dietary advice
Man with sciatic pain after ?heavy lifting. Disc prolapse, spondylolisthesis
Disc prolapse
T1DM goes to an all night part, does not eat and sleeps all day. Presents to A&E with vomiting. pH 7.24
DKA
Guy has dyspepsia, pain a few hours after food, wakes him up in night and drinks milk to make it better. Nocturnal asthma.
Duodenal ulcer
Epigastric pain relieved by eating, worse at night
Duodenal ulcer
- Has lumbar pain. Popliteal and foot pulses missing. Investigation?
Duplex
Patient with UC, What features indicate colectomy?
Dysplasia
Male married 30y, sex only with wife. Pain in testicle and epididymis. Organism? Chlamydia trachomatis, E. coli, Neisseria gonorrhoea
E. coli
30 year old male. Only sexual partner is his wife. Has symptoms of epididymo-orchitis. What is the cause? Chlamydia, Gonorrhoea, E.Coli
E. coli
Calculate GCS - eyes open to pain, localising to pain, making noises
E2V2M5
60M unilaeral left hand tremor at rest. Worse when people look at tremor. Able to do buttons and hold teacup without shaknig. Mild cogwheeling at wrist and fingers on left. Cause?
Options: Anxiety, early parkinsonism, Benign essential, Right sidded cerebellar lesion
Early parkinsons
18yo man with tonsillar exudates, gland swelling, jaundice, upper abdo pain. What was the cause
EBV
Anterior neck lump biopsied as a squamous cell carcinoma of a tonsillar primary. Which infection causes this cancer:
EBV
18yo man with tonsillar exudates, gland swelling, jaundice (change in skin colour), upper abdo pain. What was the cause?
Options: EBV, Tonsillitis, Staph sepsis, Influenza, Malaria
EBV
First ix for lady with exertional breathless, HR 42. 1st ix?
Options: ECG, Spiro, Echo, VQ scan, CXR
ECG
- Infective endocarditis. Which investigation would give a definitive diagnosis? Echo (TTE), Blood cultures, sputum culture
Echo
Fit guy passes out during sports. Father died early. Ix?>
Echocardiogram
Young Man who gets exertional dizziness and dyspnea. Slow rising pulse - what murmur? Ejection systolic, pan systolic, mid diastolic, end diastolic
Ejection systolic
3 weeks of fevers, cough, feeling unwell. Dull percussion, absent VR, ↓expansion
Empyema
- Patient has progressive dysphagia to solid foods and weight loss. What is the diagnostic investigation? Barium swallow, Endoscopy
Endoscopy
- Man about to have hip replacement. Already been given TEDs, which other DVT prophylaxis should you give? Dibagatran, Enoxaparin (LMWH), Unfractionated heparin
Enoxaparin
Man in office had episodes of smelling something funny and then went into a daze or a ‘trance like state’. No headache. Options: Migraine, cerebral vasculitis, idiopathic epilepsy
Epilepsy
patient w UC, what features indicate for colectomy
epithelial dysplasia
Patient with symptoms of guarding, peritonism. What test?
Erect CXR
Man with leg claudication and ABPI of 0.84 - what do you do? Structured exercise programmes, fempop bypass, another type of bypass, vasodilator medications
Exercise
Open comminuted fracture with some kind of skin loss and dirty. Mx?
External fixation
- How is Hepatitis A spread
Faeco-oral
Post carotid endarterectomy develops stidor
False aneurysm
40yo farmer with wheeze for few weeks. Normal CXR
Farmer’s lung
Pain on passive dorsiflexion. Compartment syndrome with fracture tibia. Mx?
Fasciotomy within 6h
80y with HTN and PVD. What meds?
Options: diltiazem, felodipine, irbesartan, moxonidine
Felodipine
32F with mobile non-tender lump in breast
Fibroadenoma
- Women with mobile, smooth breast lump
Fibroadenoma
Severe pain on defecation + blood on paper
Fissure
45yo with intracapsular #NOF, otherwsie well. Mx?
Fixation with screws
Features of UC. Ix?
Flexi sig
Post-partum breast feeding lady with red tender breast no mass. Mx?
Flucloxacillin
Pneumonia with green sputum, hyponatraemia, euvolaemic. Initial treatment?
Options: fluid restrict, oral vasopressin antagonist, give normal saline
Fluid restrict
Footballer inverts ankle and presents with fot pain. No ankle pain. Dx?
Fractured base of 5th metatarsal
Guy falls off roof, gets chest pain for one day, painful on breathing deeply or coughing, in R Axilla, O2 sats - 95%
Fractured rib
Greek guy takes antimalarials, becomes jaundice
G6PD def
Greek guy takes antimalarials. Becomes jaundice. Dx?
G6PD deficiency
- Women getting pain after eating, fat, middle aged- now she has obstructive jaundice what was cause –
Gallstones
60 year old man with 2 cm smooth non tender swelling fixed to underlying structures - on left wrist? Ganglion, lipoma
Ganglion
56y weight loss, heart burn responding to antacids, smoker, drinker, What do you do?
Options: Gastroscopy, Gastroscopy + treat H pylori, Trial of PPI, More antacids + lifestyle advice
Gastroscopy
- Patient has a sore throat a few weeks ago. Now has ascending limb paralysis. Loss of plantar reflexes. Options: GBS, Motor neurone disease
GBS
- Woman has pneumonia- breathless, 90% on room air, low BP, tachycardic, symptoms of sepsis. Already given IV fluids- what do you do next? Give broad spectrum Abx, call ITU, non invasive ventilation,
Give broad spectrum abx
Hypotensive patient post op and has epidural in, has been given 500ml bolus, no signs of HF, 10 ml urine over 1 hour, no pain. What to do next?
Give vasoconstrictor
hypotensive patient post op, has epidural, given 500ml bolus, no signs of HF, 10ml urine over 1 hour, no pain
give vasoconstrictors
Patient on bendroflumethiazide, painful toe, what is the diagnosis
Gout
49F with 2mth Hx of diffuse thyroid swelling and intense sweating at night.
Grave’s disease
Yellow eyes + high reticulocytes
Haemolysis
- What in an ABG of a COPD person indicates a state of chronic respiratory acidosis?-
High bicarbonate
Old guy with COPD with Carboxyhaemoglobin of 35% (normal <1.5%), normal O2 sats. What immediate mx?
High flow O2 - 15L non-rebreather mask
CREST sx on a patient. Pleuritic CP/sob with crackles? Which ix?
High res CT
- Crushing pain for an hour and collapsed, young guy.
HOCM/VF?
- Has an eosinophilia, iron deficiency anaemia, and bloody diarrhoea. Which infection? Hookworm, shigella, salmonella
Hookworm
35M presents with squamous cell carcinoma of the tonsils. He is a non smoker. Which of the following infective agents increases the risk of SCC?
HPV
PEFR 65%, Sats 95%, pulse 130bpm. What clinical feature is most useful in determining whether someone with asthma needs admission
HR
Commonest cause of corneal ulceration
HSV
30F fever, fits, temporal lobe necrosis. Cause?
HSV
- Patient has swelling not separate to testis. Translluminates.
Hydrocoele
Which of the DMARDs cause retinopathy?
Hydroxychloroquine
Breast cancer with lung and bone mets. On low-dose haloperidol. Confused, constipated. What is causing these symptoms?:
Hypercalcaemia
- Patient with normal duodenal and jejunal biopsies. Has had a year of intermittent constipation and diarrhoea. What is the diagnosis? Coeliac disease, IBS, Crohn’s, UC
IBS
3yo kid presents with recurring noesbleeds and bruising. Ix: PLT low. Dx?
Idiopathic thrombocytopenic purpura
post tonsilitis guy who got proteinuria, haematuria, swollen face, red cell casts, self resolved over the next 3 months
IgA nephropathy
Hayfever symptoms. How is it mediated?
IgE
Perianal erythema + swelling + fever. What do you do?
Options: Give abx + review, incision & drainage, oral fluclox
Incision & Drainage
Anal abscess - erythema and swelling - Treatment: incision and drainage, flucloxacillin, Amox + Metro + wait
Incision & Drainage
IVDU with back pain. urine blood 1+ protein +. Systolic murmur. Anaemia on bloods.Tenderness over L1 to L3. Diagnosis?
Pyelonephritis, Infective endocarditis, reactivation of Hep C
Infective endocarditis
- Ank spond. NSAIDs not working. What to give next? Prednisolone, Methotrexate, Infliximab, other monoclonal antibody
Infliximab
- Intermittent swelling in groin, now stays and is tender.
Inguinal hernia
45yo spontaneous dark brown nipple discharge. Only one duct producting discharge.
Intraductal papilloma
Young woman, no lump, bloody discharge from boob: Dx?
Intraductal papilloma
RTA. Conscious at the event. Brought into the A&E with reducing consciousness. Had to work out GCS from the info. Calculated as 6∴ Mx:
Options: Neurosurg r/w, Intubated + ventilate, Rapid CT, Burr hole
Intubate & Ventilate
- 70 year old patient has 2 cm irregular, mobile lump in upper outer quadrant of breast. What is the most likely diagnosis? DCIS, LCIS, invasive ductal carcinoma, invasive lobular carcinoma, medullary carcinoma
Invasive ductal carcinoma
Nutrient defiency in Coeliac
Iron, Folate, B12
Haematemesis + abdo pain, BP N, HR >100. What do you give IV whilst waitingi for endoscopy?
Options: Crystalloid, O-ve blood, IV terlipressin, IV PPI
IV fluids
Unit of blood after upper GI bleed, on second unit has crackles in lung bases (fluid overload), decreasing O2 sats. Tx?
IV furosemide
Asthma lady with unable to finish sentences, hypoxic, high PCO2, pH on ABG 7.30. Already given salbutamol, ipratropium and hydrocortisone. Next?
IV MgSO4
Seizure for a long time. Already given 2x lorazepam
IV phenytoin
Epilepsy not responsive to two x lorazepam
IV phenytoin
Cutaneous manifestation of reactive arthritis?
Keratoderma blenhorrhagicum
- Patient with BRCA1 mutation. She is worried that her kids (son + daughter) and sister might have it. Options: Sister and daughter have 50% chance of getting it and son has 25% chance, Kids and sister all have 25% chance of getting it, kids and sister have 50% chance of getting it, kids have 50% chance of getting it and sister has 25% chance
Kids and sister have 50% chance of getting it
- So there was one about a tongue deviating to the left. Which nerve is damaged? Left hypoglossal, left glosopharyngeal, left something else, Right hypoglossal, right glossopharyngeal
Left hypoglossal
21 year old female has acne, tried topical antibiotics and topical retinoids no success. DVT in past after plane. What to try next?
Options: Lymecycline, Isotretinoin, Flucloxacillin, Desogestrel, Co-cypryndiol
Limecycline
BCC - what does it do? Local invasion only, Mets to liver, Mets to local lymph nodes, spontaneous regression
Local invasion
Post-mastectomy + LN clearance - winging of scapula. Nerve?
Long thoracic
Woman BMI32, drinks loads of coffee, smokes, drinks alcohol etc - Getting recurrent headaches, losing vision when straining to poo. Exam shows papilledema. LP pressure high (40) Best advice to give to her?
Lose weight
Sudden onset severe headache starting 12hrs ago. CT normal. What do you do?
LP
- Which cells responsible for uptake of fat in fatty plaque formation- macrophages, neutrophils, platelets
Macrophages
45F with known brain tumors presents with headache, raised ICP. Awaiting neurosurgical transfer. WHat is the immediate Mx?
Mannitol
- 18 month old boy drinks paracetamol 2 hours ago, and mum has now brought him into A&E. What time is it best to measure his paracetamol levels? Measure paracetamol level in 2 hours, measure paracetamol level in 4 hours, immediately, in 24 hours
Measure paracetamol levels in 2hrs
- Abdominal pain 20 mins after meal. Weight loss. Options: mesenteric angina, gastric carcinoma
Mesenteric angina
Man with AF presents with 1hr hx of epigastric pain 15 after meal
Options: mesenteric ischaemia, duodenal ulcer, biliary colic, cholestasis
Mesenteric ischaemia
60M diagnosed with diabetes. BMI 30. Diet and exercise has failed. What do you do next?
Metformin
Diabetic with weakness in all four limbs started 3 days ago. Weakness worse proximally in LL. No change to sensation in LL. UL has some pins and needles, BL eyelid weakness. Loss of reflex and plantar response
Options: GBS, Myasthenia, Diabetic neuropathy, MS
MG
asthma, unable to finish sentences, hypoxic, high PCO2, pH 7.3. Has been given salbutamol, ipratropium, hydrocortisone. Next?
MgSO4 IV bolus
Zig zag lines and painful eyes+ N&V for 30 min episodes? Migraine, Glaucoma
Migraine
Mid-diastolic murmur
Mitral stenosis
- Patient (with cancer maybe..) is having severe pain. Already on oral morphine solution. What is the most appropriate pain relief? Morphine subcutaneous infusion continuous, morphine subcut prn, fentanyl transdermal patch
Morphine SC
Mc Murray’s positive, twisted knee during sport and heard a pop, what Ix most appropriate?
MR knee
Faecal incontinence, long standing back pain, anal sphincter loose, heavy lifter. Ix?
MRI spine
- Loss of vision every now and then in right eye which resolves, and weakness in arm.
MS
Low eGFR, High Ca,High Cr, Calcium was high a year ago.
Options: Vit D deficiency, Primary hyperPTH, Secondary hyperPTH, Multiple myeloma
Multiple myeloma
45F presents with worsening proximal limb weakness. Positive anti-Jo-1. What is the diagnostic test for this condition?
Muscle biopsy
Anti-jo with signs of polymyositis. Which ix would confirm dx?
Muscle biopsy’
- Patient has low platelets, low Hb, low WCC. Bone marrow biopsy shows dry tap with some odd shaped red cells. Positive JAK2 mutation. What is the diagnosis? Myelofibrosis, Essential thrombocythemia, Polycythaemia rubra vera, myelodysplastic syndrome
Myelofibrosis
Taken 32 paracetamol 500mg tablets 18hrs ago. Weighs 80kg. You take bloods. What do you do?
Options: Wait for levels. Give saline. Give naloxone. Give acetylcysteine
N-acetylcysteine
35M in recovery bay after excision of vocal cord cyst. Patient begins dropping sats. The nurse notes the patient is fully conscious, but his voice is weak and he is unable to maintain hand grip. What is the antidote?
Neostigmine
Vocal cord endoscopy, struggling to speak, tachypnoeic 28, could not maintain a strong grip when asked by nurses to squeeze. What is the antidote?:
Options: Neostigmine, Glycopyronium. Rocuronium. Doxapram. Naloxone
Neostigmine
Women on long term lithium. Peeing loads even at night. Blood results showing hyponatremia, normal blood glucose:
Nephrogenic DI
Drug-resistant TB. Where should you keep them
Ngative pressure rom + resp measures for staff
Stroke with hemiparesis, 2 days later SALT assessment, unsafe swallow. Best feeding?
NGT
Patient had a stroke. SALT assessment showed he can’t feed himself. What is the most appropriate way to give nutrition? NGT, PEG, Parenteral nutrition
NGT
- Patient has increasing breathlessness on exertion, which resolves with GTN spray. It’s getting worse. What is an appropriate drug to start to relieve his symptoms? Isosorbide nitrate, Nicorandil
Nicorandil
- Patient 10 weeks pregnant has urinary frequency and urgency. What is the most appropriate antibiotic? Amoxicillin, nitrofurantoin, trimethoprim
Nitrofurantoin
Old lady falls down. Has shortened and externally rotated leg. What is likely cause?
NOF
Smoker with progressive SOB. Spirometry and PEFR diary performed. What will help GP diagnose COPD?
Options: Long hx of smoking, reversible airflow limitation with betablocker, normal FVC and low FEV1
Normal FVC and Low FEV1
Old lady. On nitrofurantoin. Watery diarrhoea. 2 others in care home have diarrhoea too. Cause?
Norovirus
Guy lifitng heavy things. Lumbar pain only. Mx?
NSAIDs
Breast Ca - biggest RF
Obesity, smoking, Multiple pregnancies, Breast feeding, Late menarche
Obesity
Known RCC gets swollen legs and distended veins below umbilicus. Dx?
Obstruction of IVC
Immunosuppressed patient dysphagia, taking lansoprazole, ibuprofen, dexamethasone. Neutropenia. Cause?
Oesophageal candidiasis
Test for gestational diabetes
Options: Random BM, fasting BM, OGTT at 28wks
OGTT at 28wks
- Diabetic due for inguinal hernia surgery taking both gliclazide and metformin - HbA1c < 69mmmol/L. Omit gliclazide and keep metformin, start IV insulin infusion, omit metformin and keep gliclazide, omit both
Omit gliclazide and keep metformin
Palpitations, weight loss and altered bowel habit in old lady, what nail changes are seen? What was the answer here someone please?
Onycholysis
Man does not open eyes, localises to pain, groaning. What airway?
Oropharyngeal
Bilateral knee pain, stiffness 20 min in morning, swollen at night
Osteoarthritis
Guy with epilepsy, now housebound. Pain in spine and compressing on rib cage. Dx?
Osteomalacia
- A rheumatoid patient who is taking pred and methotrexate has a sudden onset lower back pain. What is the cause? Osteoporotic fracture, acute pancreatitis
Osteoporotic fracture
Surfer’s ear (pain on pulling pinna, can’t visualise the membrane due to artefact in the canal, she felt she had hearing loss): Otitis externa, Otitis media, cholesteatoma, perf tymp membrane
Otitis externa
55F ~3 week onset of increasing abdominal distention and leg swelling. O/E abdomen: shifting dullness.
Options: Ovarian ca, Liver failure, Cervical ca
Ovarian ca
Man with no pain, jaundice, dark urine, pale stols
Pancreatic ca
Sickle cell disease with back pain. What Mx first?
Paracetamol/Ibuprofen
Sickle cell disease with back pain, what analgesia do you give first?
paracetemol/ibuprofen
Bowel opeartion 4 days ago. Not opened bowels for 24h. Distended with scant bowel sounds. Cause?
Paralytic ileus
- A woman’s right arm keeps banging into door, can’t read whole page of a book i.e. hinting she has homonymous hemianopia-. Which artery is affected? MCA, PCA, ACA
PCA
A man post renal transplant (on mycophenalte, prednisolone, etc) develops chest infection. Some blood results were given (Hb, Na, K, urea). No sounds on listening to chest and CXR showing perihilar haziness..
PCP
- Desaturation on exertion, perihilar hazing.
PCP
Acute onset pain ‘under her breast’. Has just come back 2 days ago from a holiday in India. ECG shows sinus tachy. Options: PE, Myocardial infarction
PE
- Woman with SOB, ecg- sinus tachy, 35 year olds overall well, ascultation- pleural rub on right side- viral pericarditis, pulmonary emoblism, viral pleurisy
PE
PEFR 65%, Sats 95%, Pulse 130 bpm. What clinical feature is most useful in determining whether someone with asthma needs admission? PEFT, O2 sats, pulse, RR
PEFR
50M presents with inability to pass urine, loin to groin pain, fever + N/V. PSHx: one kidney resected for RCC. USS renal Tract-dilated kidneys, dilated ureters, stone in PUJ. Mx
Percutaneous nephrostomy
- Person with nephrectomy and had stone in the good kidney at PUJ and swelling of upper urinary tract on imaging. Had fever. ?Septic obs. How to manage?
Percutaneous nephrostomy
Widespread ST elevation. What sound on auscultation?
Pericardial rub
Uvula deviated, cervical LN, sore throat, inflamed soft palate
Peritonsilar abscess
Epilepsy not responsive to 2 x lorazepam
phenytoin loading
- 81y lady with 30y history of RA. Cannot have a bath for herself and finding increasing difficulty eating with knife and fork.
What is the next line of management? Refer to rheum OP, care package three times a day, physio and home OT assessment, admit to hospital for comprehensive geriatric assess
Physio and home OT assessment
- Lateral medullary syndrome picture. Which artery? Posterior inferior cerebellar artery, posterior cerebral, inferior cerebral
PICA
Woman who had been in bangladesh for 6 months found to have decreased chest expansion, reduced VR, reduced AE, dull percussion on R side, productive cough
Pleural effusion
woman who had been in bangladesh for 6m has decreased chest expansion, reduced VR, reduced air entry, dull percussion on R side, productive cough
pleural effusion
Lady with spelenctomy needs to be on penicillin. Why?
Pneumoccal infections
- What is the likely diagnosis when there is bronchial breathing? Pneumonia, pneumothorax, pleural effusion
Pneumonia
Stiffness in shoulders, thighs, buttocks, fatigue. ESR 80. Normal CK
Polymyalgia rheumatica
RTA shortened, internally rotated, slightly flexed and adducted right leg
Posterior hip dislocation
Man on motorbike crashes into a car, he now has an internally rotated and shortened leg, adducted and flexed
Posterior hip dislocation
- 18 yr old guy with hundreds of polyps, dad and grandfather had colorectal cancer- what do you do- Total colectomy, panproctocolectomy + ileal anastomosis, panproctocolectomy + ileostomy
Proctocolectomy + ileal anastomososis
OR
Total colectomy + IRA
Patient on warfarin for AF has INR of 3.3. Falls. CT shows intracerebral haematoma. Warfarin stopped and given IV vit K. What next?
Prothrombin complex
36 year old guy, pain in lumbar back and swollen DIP
Psoriatic arthropathy
Few months of SOB, Fine end-inspiratory bibasal creps, clubbing, JVP at 5cm?
Pulmonary fibrosis
Patient with fine end inspiratory crackles, clubbing.
Pulmonary fibrosis
Post-op delirium. Morphine + epidural in situ. Best initial management?
Options: haloperidol, put in well lit side room, discontinue drugs
Put in well lit side room
- Suspected DVT, calf was not tender or swelling. He had pitting oedema up to his knee in one foot. Started amlodipine a month ago. D-dimer normal. What do you do? Reassure and discharge, IV frusdemide, put on ace inhibitor
Put on ACEi (switch amlodipine out)
Unwell for one week. Dysuria and frequency. Gets more unwell with loin pain.
Pyelonephritis
Lady with RA and purple nodule on shin ulcerating with riased edges
Pyoderma grangrenosum
Lady with falciparum. Other than doxycycline, what other abx would you give her?
Options: Chloroquine, Quinine, Proguanil, Pyrimethamine
Quinine
Guy with prostate ca has back pain and bone scan shows increased uptake in spine. How to help with pain?
Radiotherapy
Guy with faecal incontinence and tenesmus
OptionsL Rectal cancer, Haemorrhoids
Rectal cancer
Graves disease picture - eyes bulging forward, lens dislocation, losing weight. mechanism? Rectus muscle thickening, retrobulbar tumour, cavernous sinus, retinal vein thrombosis
Rectus muscle thickening
Post-thyroidectomy with hoarse voice and weak cough. What damage?
Recurrent laryngeal nerve
T2DM controlled on diet presenting with red painful eye and blurry vision. What do you do?
Options: Refer urgently to ophthal, get urgent retinal imaging, start topical timolol, start topical chloramphenicol, start topical steroids
Refer urgently to ophthal
peripheral oedema, scrotal oedema, proteinuria - what IX
renal biopsy
Oedema, Proteinuria, Low albumin. What test for specific dx?
Renal biopsy
Peripheral oedema, scrotal oedema, proteinuria. Which diagnostic investigation do you do
Renal biopsy
- Loin pain for a few months. Progressive worsening haematuria. No pain. Options: renal cancer, bladder cancer, ureteric colic
Renal cancer
Patient with floaters and sudden loss of vision in left superotemporal quadrant? Retinal detachment, infranasal artery occlusion, superotemporal artery occlusion, vein occlusion
Retinal detachment
Pain in small joints and wrists, pleuritic pain, protein ++ and blood ++, what abs do you expect?
Rheumatoid factor
Flushing, pustular rash, telangiectasia
Rosacea
Severe abdo pain radiating to the back. Suddenly goes unresponsive and pale, pulse 120, BP unrecordable - likely diagnosis? Ruptured AAA, mesenteric ischaemia
Ruptured AAA
- Guy comes back from travelling a month ago- had headaches and one week ago started getting diarrhea/ fever? Long time since travel- amoebiasis, salmonella, shigella, giardia
Salmonella typhi
Black man with high ACE, high Calcium and CXR showed hilar lymphadenopathy
Sarcoidosis
- Widened mediastinum. Erythema nodosum. High Ca.
Sarcoidosis
- A patient with ascites, and widespread abdo tenderness. No guarding no peritonitis. Ascitic tap reveals 500mm3 neutrophils. What does he have? Spontaneous bacterial peritonitis, hepatocellular carcinoma
SBP
Woman with metastatic cancer, taking Morphine 60 mg BD oral and can’t tolerate oral anymore, what to replace it with?
SC morphine 60mg/24h
- Man has footdrop after hip fracture. Which nerve was damaged? common peroneal, gluteal, sciatic
Sciatic
- Guy gets posterior hip dislocation, what is he most at risk of- sciatic nerve injury, AVN necrosis
Sciatic nerve injury
Bowel screening question. that is Faecal occult blood for:
Screening for people with asymptomatic disease
- COPD patient with high Hb: options were secondary polycythemia, renal failure, polycythemia rubra vera
Secondary polycythaemia
Guy falls 10m. First thing to do?
Secure airway
Woman with rheumatoid arthritis previous knee replacement, having cystoscopy for urinary symptoms. Now knee is hot swollen and tender.
Septic arthritis
Claudication in calf. Where is the block?
Options: SFA, Posterior tibial, Common iliac
SFA
Patient with COPD had several previous courses of steroids and now has postural hypotension and cushingoid facies, palmar crease pigmentation. What test?
Short Synacthen
- Woman with postural hypotension, which test would give you the diagnosis?
Short synacthen
Most likely diagnosis. 36 yo black man who had multiple episodes of limb pain in the past. Previously had a big spleen but now it’s small. What condition explains it best? Sickle cell anaemia, Thalassemia B, G6PD Deficiency
Sickle cell
Erectile dysfunction in a man with HF and hypothyroidism on metformin, BBlocker, statin etc no vasc symptoms, palpable peripheral pulses, normal sensation peripherally, no postural hypotension (<5mmHg changed). What’s the cause?
Side effect meds (BB)
Someone has watery vomiting and diarrhoea. What precautions will you take?
Options: None, Don’t let kids see her. Ask staff and visitors to was hands. Side room + enteric precautions. Take regular blood cultures
Side rom + enteric precautions
AI hx with sore grity eye, dry mouth and BL parotid swelling
Sjogren’s syndrome
Cough, apical cavitating lesions, haemoptysis, firm LN in neck. What test?
Auramine stain, Sputum culture + sensitivity, LN biopsy
Sputum culture
Smoker with lung cancer near right bronchus removed with ↑ Ca. What wll histology show?
Squamous cell carcinoma
Gentlemn with bald head, lumpy hyperkeratotic lesions on scalp. What is he at risk of?
Squamous cell carcinoma
Central chest pain. Which ECG criteria for thrombolysis?
Options: New RBBB, ST elevation in leads II, III, aVF, T wave inversion in aVR, ST depression in lead V1-4
ST elevation in leads II, III, aVF
IVDU develops harsh murmur. Causative organism?
Staph aureus
Bell palsy (facial weakness, non forehead sparing, normal ear and no rash) treatment
Steroids
Clarithromycin and atorvastatin, metformin:
Options: Continue. Stop statin. Stop metformin
Stop statin
Pt recently had dosage of atorvastatin increased, presents with myalgia etc. CK elevated to 5x upper limit of normal (2000): Stop atorvastatin, stop and switch to rosuvastatin, stop and switch to simvastatin, half dose of atorvastatin, give NSAID.
Stop statin
- A patient with PKD has a bleed. What is the most likely cause? Sub arachnoid haemorrhage, intercerebral bleed, extradural haematoma
Subarachnoid
80 year old guy with increased confusion, type 2 diabetes AF with warfarin. Complains of headaches and had 2 falls, increased confusion
Subdural haematoma
Old lady falls in nursing home, GCS 14 dropped next day to 9, had headache
Subdural haematoma
Operation for perforated ulcer. Gets hiccoughs and nausea, What is the cause?
Options: subphrenic abscess, pelvic abscess, SBO
Subphrenic abscess
Which of the DMARDSs cause azospermia and bone marrow suppression?
Suflasalazine
Most common type of melanoma
Superficial spreading
Testicular pain in sexually active 18yo. Mx?
Take to theatre
- 30 year old, night sweats, weight loss, pyrexia. Right iliac fossa pain. No change in abdo. Histology shows caseating granulomas. Tuberculosis, Crohn’s, UC, Coeliac
TB
Patient with pain on chewing and speaking. Occasionally gets unilateral headaches. Raised CRP - what is the next step to make diagnosis? Temporal artery biopsy, sialogram, CT head
Temporal artery biopsy
- Lateral epicondylitis question, pain on wrist extension. Options: Golfers elbow, tennis elbow
Tennis
Lady with chronic renal failure for 9 years on dialysis. PTH massively increased (148), Ca high (2.9), Phosphate high. Multiple myeloma, Primary hyperparathyroidism, Secondary hyperparathyroidism, Tertiary hyperparathyroidism,
Tertiary hyperparathyroidism
Alcoholic with diplopia on looking laterally both sides, nystagmus, what to give him. Also hypotensive and tachycardic? Thiamine, IV fluids, chlordiazepoxide
Thiamine
Alcoholic with diplopia on loking laterally both sides, nystagmus. What vitamin?
Thiamine (B1)
- Alcoholic with symmetrical clawed (basically can’t move fingers- dupotryen’s picture). What is the pathophysiology? thickened palmar fascia, thickened flexor tendon sheaths,
Thickened palmar fascia
- Woman lost 6 kg, diplopia in every direction, can see sclera on downward gaze (?), difficulty with most movements of eyes (except medial direction i think)- what do you do- MRI head, CT, check thyroid function
Thyroid function
30M with family history of early bowel cancer, colonoscopy results: extensive polyposis in colon. Surgery of choice for complete risk reduction is:
Options: Total colectomy + ileorectal anastomosis, Panproctocolectomy + IPAA, Protcolectomy + ileostomy
Total colectomy + ileorectal anastomosis
Old guy with bacteriuria grown from catheter. What do you do?
Treat if symptomatic
1cm painless penile ulcer on shaft. Cause?
Treponema pallidum
- He just started chemo for Burkitt’s, high K
Tumour lysis syndrome
Ring and little finger tingling - which nerve has been damaged?
Ulnar
Deltoid wasting, weakness of flexion and supination - Upper brachial plexus damage, Lower brachial plexus damage, Ulnar nerve damage, Median nerve damage
Upper brachial damage
Guy with AF who had a pale leg. Weak movement and loss of sensation. How to manage? Urgent embolectomy, Prostacyclin infusion, Amputate, venogram
Urgent embolectomy
Diagnosing legionella
Urinary antigen
Pneumonia with 30 pack year history, background of prostate antigen, with blood gas with a borderline sodium (136), high urea, already had blood and sputum cultures. Ix?
Urinary Legionella antigen
Hyponatraemia and dehydrated. Dry mucous membrane. How do you decide on fluid status:
Options: Serum urea. Serum Cr. Urine Na. Urine osm. Serum Ca
Urine osm
Dull ache in groin, lump appears on standing, no cough impulse, does not transilluminate, Cause?
Options: Varicocele, Ingunal hernia, Epididymal cyst
Varicoele
- Patient with hyponatremia, has bronchogenic carcinoma. IV furosemide, vasopressin receptor antagonist
Vasopressin receptor antagonist
Soldier getting off cramped long haul flight. Went pale, collapsed and hit head. Peers also noticed asynchronous jerky movements for 15 seconds. Recovered consciousness within less than 5 min (???) Cause?:
Vasovagal
Man with rheumatoid arthritis and T2DM has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis:
Venous ulcer
Arrhythmia after MI
VF
guy with seizure, no focal neurology, LP = normal protein, normal glucose, raised cell count, CT head clear
viral encephalitis
Guy with seizure and no focal neurology. LP results normal protein, normal glucose, raised cell count (20). CT head clear.
Viral encephalitis
Low TSH, High T4 - post URTI, ↓iodine uptake, Hyperthyroid.
Options: Graves, viral thyroiditis, Hashimoto, Nodule
Viral thyroiditis
Woman calls GP about husband with terminal prostate cancer and is breathless. What do you do?
Options: Call 999. Ask another GP to go next week. Visit them that morning + community palliatve care. Ask district nurses to see them urgently. Tell her you will prescribe Abx for URTI
Visit them that morning + Commmunity palliative care
Young guy, collapses frequently during sport? with ECG - Sinus rhythm. PR or QRS 120ms, cQT 510ms
VT
69M with two previous TIAs and AF. What medication to start?
Warfarin
Man who has AF with two previous TIAs. Not on any medication. How would you manage him? Warfarin, aspirin, digoxin
Warfarin
Hearing changes, haemoptysis, nasal discharge, renal problems. CXR shows 3 cavitated lesions
Wegener’s
Lady with headaches, transient loss of vision when she strains to defecate. Signs seen in eyes. Obese, smoker, alcoholicm drinks 12 coffees a day. What can she do to help?
Weight loss
old guy confused and shouting after hip replacement, obs stable, no pain
well lit room
Old guy confused and shouting after after hip replacement, obs stable, he has no pain.
Options: Stop morphine. Haloperidol. Well lit side room. Midazolam
Well lit SR
Patient with cough. Bordetella pertussis found on culture. What’s the diagnosis? Whooping cough, Flu, Pneumonia,
Whooping cough
DCIS diagnosed on right outer quadrant, on first mammography what is the treatment
Wide local excision
Lateral epicondyle tennis elbow pain. Which movement hurts?
Wrist extension, wrist flexion, elbow flexion, elbow extension
Wrist extension
59 yr old female with pruritus and got IgM anti-mitochondrial antibodies. What makes PBC likely? Xanthelasma, Tendon xanthomata, hepatomegaly 8cm, macroglossia, facial rash
Xanthelasma
