Everything

Question 1

Lucid interval

Answer 1

Extradural haemorrhage

Question 2

Asthma exacerbation most likely to cause what emergency resp pathology?

Answer 2

Pneumothorax

Question 3

17yo girl loses vision after seeing RTA

Answer 3

Acute stress reaction

Question 4

Lung Ca on CXR

Answer 4

Flushing due to 5HT from carcinoid

Question 5

Hyponatremia cranial cause

Answer 5

SIADH

Question 6

Severe unilat headache, photophobia

Answer 6

GCA/migraine/meningitis

Question 7

Poor prognostic factor in ICU pt who is intubated

Answer 7

APACHE II score

Question 8

2.5cm breast lump w septum

Answer 8

breast cyst

Question 9

intermittent breast bleeding

Answer 9

duct papilloma

Question 10

Palliative care, breathlessness tx

Answer 10

morphine

Question 11

non haemolytic febrile rxn, increase in temp when giving blood products

Answer 11

give paracetemol

Question 12

glaucoma presentation

Answer 12

headache, unilat poor vision over few days

Question 13

red, fixed, dilated pupil

Answer 13

glaucoma

Question 14

pt consumes alcohol, headache, nausea, vomiting - what is ABG

Answer 14

normal O2, low CO2, met acidosis w raised anion gap

Question 15

tx for complete heart block

Answer 15

pacing

Question 16

VT on ECG, BP 80/60 tx

Answer 16

cardioversion

Question 17

ketones from breakdown of fat or protein?

Answer 17

fat

Question 18

Artery supplying L colon

Answer 18

IMA

Question 19

Severe epigastric pain, collapsed, regains consciousness after fluid BP 56/40

Answer 19

AAA

Question 20

woman w palm laceration, weak flexion of MCP, PIP middle finger, which muscle affected

Answer 20

flexor digitorum superficialis

Question 21

what are lumbricals

Answer 21

intrinsic hadn muscles, flex MCPJ and extend IPJ

Question 22

haemarthrosis and pain on lat aspect of knee

Answer 22

ACL > Collateral

Question 23

Achillies tendon rupture IX

Answer 23

USS

Question 24

diabetes w slurred speech, most important IX

Answer 24

BM

Question 25

repeated DM with slurred speech

Answer 25

TIA

Question 26

gram pos diplococcus cause of pneumonia

Answer 26

streptococus pnuemoniae

Question 27

gram neg diplo cause of STI

Answer 27

neisseria gonorrhoea

Question 28

Hypotensive, bradycardia, unresponsive to 500mg atropine, ECG:

Answer 28

Transcutaenous pacing

Question 29

Perforated diverticulitis, unwell, surgery of choice?

Answer 29

Hartmanns

Question 30

Obese, diabetic, 3w oedema, hyperlipidaemia, protein 4+, cause of hyperlipidaemia

Answer 30

nephrotic syndrome

Question 31

man comes in after RTA, unconscious, pulseless, not breathing, chest compressions, ECG shows VT

Answer 31

Unsynchronised 360J shock

Question 32

man comes to ED, unproteced anal sex, wants pill to stop getting HIV, what is the time limit for HIV PEP

Answer 32

72h

Question 33

11yo anorexia in about to die can be fed agains her will under which legal framework

Answer 33

MHA

Question 34

teen, low mood, weight loss, doesn't feel like eating

Answer 34

depression

Question 35

Pt collapse, P wave rate 75, broad QRS rate 40

Answer 35

complete AV block

Question 36

T1DM goes to an all night party, presents to A&E w vomiting, pH 7.24

Answer 36

DKA

Question 37

Student come to UK from Nigeria, jaundice, anaemia, fever

Answer 37

falciparum

Question 38

40yo farmer w wheeze, normal CXR

Answer 38

farmers lung

Question 39

anal abscess, swelling, fever, lump, MX

Answer 39

incision and drainage

Question 40

pain on passsive dorsiflexion, compartment syndrome in young guy w fractured tibia plawying football

Answer 40

4 compartment fasciotomy within 6h

Question 41

30yo man w joint pain, sacroilitis and DIP pain

Answer 41

psoriatic arthritis

Question 42

transfusion rxn, fever, other obs normal, tranfusion stopped, what next

Answer 42

check bag against pt details

Question 43

Pt on wararin having nasal polypectomy, what to do w warfarin

Answer 43

admit pt 2d pre-op and start heparin

Question 44

Breast ca biggest RF in pt

Answer 44

obestiy

Question 45

Legionella, Abx?

Answer 45

Clarithromycin

Question 46

Which drug is co-prescribed with morphine in palliative care

Answer 46

co-danthramer

Question 47

Mid diastolic murmur

Answer 47

mitral stenosis

Question 48

pt with widespread ST elevation, what sound

Answer 48

pericardial friction rub

Question 49

which abs are most specific/raised in SLE

Answer 49

dsDNA

Question 50

EDM aortic regurg murmur w sudden onset CP radiating to back

Answer 50

aortic dissection

Question 51

pt w symptoms of aortic dissection, AR, what test to confirm dx

Answer 51

contrast CT chest

Question 52

lady w yellow eyes and high reticulocytes

Answer 52

haemolysis

Question 53

70yo lady falls onto outstretched hand, fracture, what test to follow up

Answer 53

DEXA

Question 54

pt on warfarin for AF has INR 3.3, falls, found on CT to have intracerebral haematoma, warfarin stopped, given vit K, what next

Answer 54

prothrombin complex

Question 55

pt has central CP, what is ECG criteria for thrombolysis

Answer 55

ST elevation in leads II, III, Avf

Question 56

male, married, sex w wife only, pain in testicle and epididymis, organsim?

Answer 56

E Coli

Question 57

45yo w intracapsular #NOF, otherwise well (not given garden classification) - mx?

Answer 57

cannulated screw

Question 58

pt with cough, apical cavitating lesions, haemolysis, firm LN in neck, test?

Answer 58

sputum culture and sensitivity for AAFB

Question 59

lady w palmar erythema, raised ALT, raised bilirubim, ++ ANA

Answer 59

AI hepatitis

Question 60

haematemesis, abdo pain, BP 120/80, tachycardia, what do you give while waiting for endoscopy

Answer 60

O neg blood

Question 61

alcoholic w diplopia looking laterally, both sides, nystagmus, vitamin?

Answer 61

thiamine

Question 62

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

Answer 62

MG

Question 63

alcoholic w multiple bruises on legs, has bloods and clotting which shows low bili, low pt, low fibrinogen, raised APTT, raised PT

Answer 63

DIC

Question 64

pt w nephrotic syndrome (oedema, proteinuria, low albumin) what test for specific dx

Answer 64

renal bx

Question 65

small cell lung ca, hilar LN, no distant mets, what tx

Answer 65

chemo

Question 66

klebsiella pneumonia abx

Answer 66

cefotaxime

Question 67

pneumocystis jiroveci abx

Answer 67

co trimoxazole

Question 68

guy flew from tel aviv, CP then few hrs later leg goes white, no pulses

Answer 68

aortic dissection

Question 69

pt has bad claudication, can only walk 10m, distal aorta and both iliac vessels occluded mx

Answer 69

aorto bifem bypass

Question 70

lady has surg 4 days ago, given mutliple bags of 5% dex, now drowsy, what is the mechanism

Answer 70

cerebral oedema

Question 71

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

Answer 71

early parkinsonism

Question 72

stroke w hemiparesis, 2d later SALT assessment = unsafe swallow

Answer 72

NG tube

Question 73

Dx legionella - definitive test

Answer 73

urinary antigen

Question 74

open communited fracture, skin loss, dirty, mx

Answer 74

external fixation

Question 75

T2DM controlled on diet, painful red eye, blurry vision mx

Answer 75

refer urgently to opthal

Question 76

guy gets claudication in calf, where is block

Answer 76

superficial femoral artery

Question 77

guy afte RTA has shortened, internally rotated, flexed, adducted right leg

Answer 77

posterior hip dislocation

Question 78

man does not open eyes, localises to pain, groaning, airway?

Answer 78

nasopharyngeal

Question 79

guy falls 10m what is 1st line mx

Answer 79

secure airway

Question 80

56yo w weight loss, heart burn responding to antacids, smoker, drinker, what to do

Answer 80

gastroscopy

Question 81

lady w RA has purple nodule on shin w ulcerating and raised edges

Answer 81

proderma gangrenosum

Question 82

guy w prostate ca has back pain, bone scan shows increased uptake in spine, how to help w pain

Answer 82

RT

Question 83

32yo woman w mobile non-tender lump in breast

Answer 83

fibroadenoma

Question 84

woman w folate and iron deficiency, weird bowel sx, gastroenterirtis as child, IX

Answer 84

anti TTG abs

Question 85

post partum breast feeding lady w red tender breast + no mass

Answer 85

flucloxacillin

Question 86

triple assessment for breast ca

Answer 86

clinical exam, imaging, core bx

Question 87

lady w sudden onset headache 12hr ago, CT normal, next?

Answer 87

LP

Question 88

old guy w bacteruria grown from catheter, what next

Answer 88

treat if symptomatic

Question 89

guy post thyroidectomy w hoarse voice, weak cough

Answer 89

recurrent laryngeal nerve

Question 90

Smoker has lung ca near R brochus removed w raised ca, what will histo show

Answer 90

SCC

Question 91

few months of breathlessness, fine end-inspiratory crackles, bi basal creps, clubbing, JVP 5cm

Answer 91

pulmonary fibrosis

Question 92

keratoderma blenhorrhagicum is a feature of

Answer 92

reactive arthritis

Question 93

primary tension pneumothorax mx

Answer 93

aspirate

Question 94

lady w AI hx, has sore, gritty eyes, dry mouth, bilat parotid swelling

Answer 94

Sjogren's

Question 95

Man has no pain, jaundice, dark urine, pale stools

Answer 95

pancreatic ca

Question 96

lady has headaches, transiently loses vision when she strains to defecate, signs in eyes, drinks, smokes, 12 coffees a day, what to do

Answer 96

lose weight

Question 97

man w known AF presents with 1h hx of epigastric pain 15min after a meal

Answer 97

mesenteric ischemia

Question 98

why is MRI spine best imaging in someone w disc prolapse

Answer 98

better soft tissue detail

Question 99

pt has CEA and develops stridor post op

Answer 99

false aneurysm

Question 100

man w newly dx DM, glucose +++ in urine, BMI 32, random BG 14, first line

Answer 100

diet and exercise

Question 101

pt with asthma has short hx of yellow sputum, wheeze, given oral amox which improved sputum but still febrile, what next

Answer 101

give oral pred

Question 102

RA pt w previous TKR has red hot swollen knee, recently had cystoscopy for longstanding urinary tract probs

Answer 102

infection

Question 103

marathon runner w large heart

Answer 103

hypertrophy

Question 104

opioid OD

Answer 104

naloxone

Question 105

young guy, poor stream, takes ages to pee, previous episode of non-specific urethritis

Answer 105

urethral stricture

Question 106

pt with 4cm head of pancreas ca, invaded mesenteric vessels mx

Answer 106

ERCP and biliary stent

Question 107

pt w known renal cell ca gets swollen legs and distended veins below umbilicus, dx

Answer 107

obstruction of IVC

Question 108

IVDU develops harsh murmur

Answer 108

staph aureus

Question 109

slow rising pulse

Answer 109

aortic stenosis

Question 110

high ESR, pain on abducting shoulder

Answer 110

PMR

Question 111

patent ductus arteriosus murmur

Answer 111

machinery murmur

Question 112

pt w dislocated shoulder, what nerve palsy

Answer 112

axillary

Question 113

patient has long term indwelling suprapubic catheter, keeps getting blocked, flushed out by nurse a few times, what to do

Answer 113

bladder washout

Question 114

40yo banker, headaches, taking ibu and para daily, no neuro/eye signs, no wt loss, mx

Answer 114

stop meds, reassess in 1m

Question 115

pneumonia, green sputum, hyponat, euvolemic, initial tx

Answer 115

Clarithromycin (legionella causes hyponatraemia)

Question 116

hearing changes, haemoptysis, nasal discharge, renal probs, CXR shows 3 cavitated lesions

Answer 116

wegeners

Question 117

pt on immunosuppression develops difficulty swallowing, on lansoprazole, ibuprofen, dex, neutropenia, cause?

Answer 117

oesophageal candidiasis

Question 118

man w low Egfr, high Ca, high creatinine, Ca was also high 1yo, dx

Answer 118

multiple myeloma

Question 119

man w lateral epicondyle tennis elbow pain, which mvoement hurts

Answer 119

wrist extension

Question 120

man w dull ache in groin, lump on standing, no cough impulse, does not transilluminate

Answer 120

varicocoele

Question 121

49yo lady, 2m hx of diffuse thyroid swelling, intense sweating at night

Answer 121

graves

Question 122

bipolar, on Li, glucose normal, thrist and polyuria w hypothyroidism

Answer 122

diabetic insipidus

Question 123

test for gestational diabetes

Answer 123

OGTT at 28w

Question 124

low TSH, high T4, post-URTI, reduced iodine uptake, hyperthyroid

Answer 124

Viral thyroiditis

Question 125

60yo man is diagnosed with diabetes, diet and exercise have failed. Mx

Answer 125

metformin

Question 126

pt has bowel op 4do, not opened bowels for 24h, distended bowel w scant bowel sounds, cause?

Answer 126

post op ileus

Question 127

pt has op for perforated duodenal ulcer, gets hiccups and nausea, what is the cause

Answer 127

subphrenic abscess

Question 128

pt w symptoms of guarding, peritonism, next test?

Answer 128

erect CXR

Question 129

pt w symptoms of bowel obstruction, next test?

Answer 129

supine AXR

Question 130

renal colic, what is the first IX

Answer 130

CT KUB

Question 131

PT has been unwell for a week, dysuria and going frequently, gets more unwell, bad loin pain

Answer 131

pyelonephritis

Question 132

80yo w essential HTN, PVD, what HTN med?

Answer 132

felodipine

Question 133

pt w stiff shoulders, thighs, buttocks, fatigue, ESR 80, normal CK

Answer 133

polymyalgia rheumatica

Question 134

testicular pain in sexually active 18yo patient - next step

Answer 134

take to theatre

Question 135

AF, cold pale leg, 6 hours duration

Answer 135

amputate

Question 136

uvula deviated, cervical lymph nodes, sore throat, infammed soft palate

Answer 136

peritonsilar abscess

Question 137

man w 2cm painless penile ulcer, cause

Answer 137

treponema pallidum (syphillis)

Question 138

lady w flushing, pustular rash, telangiectasia on face

Answer 138

rosacea

Question 139

man w bald head, lumpy hyperketotic lesions on scalp, at risk from?

Answer 139

SCC

Question 140

lesion on shin, irregular borders, multiple colours, suspect melanoma, which is the commonest type

Answer 140

superficial spreading

Question 141

pale stools, abdo pain, calcification

Answer 141

decrease in exocrine pancreatic function

Question 142

lady w #NOF, IV paracetemol not helping, what analgesia next

Answer 142

femoral block

Question 143

guy who was lifting heavy things, lumbar pain, mx?

Answer 143

NSAID

Question 144

Hayfever is mediated by?

Answer 144

IgE

Question 145

patient w 3w of fevers, cough, unwell. OE: dull percussion, absent VR, reduced expansion

Answer 145

empyema

Question 146

what vitamin do you give someone when starting TB treatment

Answer 146

pyridoxine

Question 147

drug-resistant TB pt comes to A&E, where do you keep them

Answer 147

negative pressure room + resp measures for staff

Question 148

pt with features of UC, what IX

Answer 148

flexi sigmoidoscopy

Question 149

pt comes in fitting, has had 2 doses of lorazepam, what next

Answer 149

phenytoin loading

Question 150

lady with splenectomy, needs penicillin, why?

Answer 150

pneumococcus (capsulated) infections

Question 151

patient ventilated on ITU, develops respiratory alkalosis, what next

Answer 151

decrease frequency of ventilations

Question 152

FEV1/FVC ratio shows a restrictive pattern, what is dx

Answer 152

pulmonary fibrosis

Question 153

man w obstructive features, long term smoker, dx

Answer 153

chronic bronchitis

Question 154

20yo female, 2y hx of intermittent diarrheoa, IDA, apthous ulcers, raised ESR, dx

Answer 154

crohn's

Question 155

2d post MI, pt develops SOB, raised JVP and harsh systolic murmur

Answer 155

MR

Question 156

man w stab injury to back, hemisection of cord, where does he lose pain sensation

Answer 156

lose pain sensation from contralateral side, lose power and proprioception on ipsilateral side

Question 157

ECG shows STEMI in leads V4-V6, I, AVL

Answer 157

anterolateral infarct

Question 158

lady with falciparum, apart from doxy, what other abx do you give

Answer 158

quinine

Question 159

which DMARD causes retinopathy

Answer 159

hydroxychloroquine

Question 160

which DMARD causes azoospermia

Answer 160

sulfasalazine

Question 161

lady with tremor, weight loss, proptosis, exopthalmos, opthalmoplegia - cause

Answer 161

rectus muscle thickening

Question 162

69yo guy w 2 prev TIAs and AF, what do you start him on

Answer 162

warfarin

Question 163

lady w hx of AF presents to A&E w fast AF, pulmonay oedema, peripheral oedema, what do you give initially

Answer 163

frusemide

Question 164

lady w acute MI, what do you give

Answer 164

aspirin and beta blocker

Question 165

guy on prednisolone presents with darkened red reflex, problems w night vision, dx

Answer 165

cataracts

Question 166

post mastectomy, LN clearance, lady gets winging of scapula, which nerve is damaged

Answer 166

long thoracic nerve

Question 167

pt post MI with PSM, bi basal crackles

Answer 167

papillary muscle rupture

Question 168

pt w PSM, louder apex, rad to axilla, JVP 8cm

Answer 168

MR

Question 169

pt w early diastolic murmur, mid diastolic murmur, JVP 8cm

Answer 169

aortic regurgitation

Question 170

pt on many meds, has high potassium and high urea, ECG shows bradycardia w 2:1 block

Answer 170

digoxin toxicity

Question 171

ST elevation in leads II, III, AVF, which coronary artery

Answer 171

RCA

Question 172

young pt collapsed, long QT, what is cause of death

Answer 172

VT

Question 173

pt has syncope, chest pain, faints - what IX will help ID cause

Answer 173

echocardiogram

Question 174

75yo patient, unresponsive, nurses saw her choking, no pulses or resp effort, nothing visible in mouth - next steps

Answer 174

start chest compressions

Question 175

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

Answer 175

AFP

Question 176

pt w wt loss, deranged U&E, painless haematuria

Answer 176

renal cell carcinoma

Question 177

most common bladder cancer

Answer 177

transitional cell carcinom a

Question 178

pt w well controlled HIV has bilateral infiltrates

Answer 178

pneumocystis jirovecci

Question 179

pneumonia, gram +ve diplococci

Answer 179

streptococus pnuemoniae

Question 180

25yo pt with scaly head/dandruff in eyebrows and eyes, not itchy, cause

Answer 180

seborrhoeic dermatitis

Question 181

Pt from pakistan, HTN controlled w amlodipine and BP 150/90 with retinal findings: blot haemorrhages and yellow deposits on macula - Dx

Answer 181

diabetic retinopathy

Question 182

Footballer inverts ankle, presents with foot pain, no ankle pain, DX

Answer 182

fractured base of 5th metatarsal

Question 183

guy jumps and lands on knee

Answer 183

medial meniscus tear

Question 184

pulmonary adenocarcinoma mets to liver via what route

Answer 184

haematological spread

Question 185

lady playing squash, runs, hears a crack from behind ankle then pain when she does plantar reflex

Answer 185

ruptured achilles

Question 186

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?

Answer 186

depression w psychosis

Question 187

guy post-op with delirium, morphine epidural in situ, best intial mx

Answer 187

put in well lit side room

Question 188

guy with short hx of back pain, painless black lesions appear on feet

Answer 188

CT abdo

Question 189

guy w nocturia, PSA 18, urinalysis trace blood, protein, urea and creatinine mildly elevated - next steps

Answer 189

urgent referal to urology

Question 190

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?

Answer 190

ductal carcinoma

Question 191

45yo lady w spontaneous dark brown nipple discharge, examination reveals one duct producing discharge. Dx

Answer 191

intraductal papilloma

Question 192

tall 28yo man w radiofemoral delay, HTN, BP 210/110, rib nothching, DX

Answer 192

co arctation of aorta

Question 193

young guy vomiting after a night out presents with chest and epigastric pain, L sided pleural effusion, subcut emphysema

Answer 193

oesophageal rupture (boerhaave syndrome)

Question 194

sickle cell girl w severe back pain, what first?

Answer 194

paracetemol/ibuprofen

Question 195

Smear cells

Answer 195

CLL

Question 196

Guy on ibuprofen, pain, 2 episodes of haematemesis w bright red blood. No further episodes. Stable obs, low Hb. What next

Answer 196

OGD within 2 hours

Question 197

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

Answer 197

adrenaline

Question 198

PBC antibody

Answer 198

anti mitochondrial

Question 199

guy with metastatic renal ca has severe pain, vomited 4x, currently on oral morphine solution PRN, helps for 2 hours. What pain tx?

Answer 199

morphine sub cut infusion

Question 200

Pt w previous TKR, tender, febrile, hot, swollen. No evidence of crystals on microscopy. Aspirate shows turbid fluid

Answer 200

septic arthritis

Question 201

nutrition deficiency in coeliac

Answer 201

folate, b 12, iron (FBI)

Question 202

guy smokes and keeps pigeons, progressive SOB on climbing hills. CXR shows reticonodular shadowing

Answer 202

extrinsic allergic alveolitis

Question 203

acute presentation of gout, PMH HF, on ramipril. Mx?

Answer 203

colchicine

Question 204

Caucasian lady, Raynaud's colour order

Answer 204

white - blue - red

Question 205

post-transplant pt has dry cough and SOB, desats from 90+ to 83 on exercising. What does he have

Answer 205

pneumocystis jirovecci pneumonia

Question 206

bilateral conductive hearing loss in old lady

Answer 206

otosclerosis

Question 207

pt with URTI has purple nodules on shin

Answer 207

erythema nodosum

Question 208

commonest cause of corneal ulceration

Answer 208

HSV = dendritic ulcer

Question 209

painful vesicular derm lesion on side of face, around forehead, eye, check - cause

Answer 209

VZV

Question 210

66yo guy comes to GP with new onset dyspepsis, no wt loss or dysphagia, what next

Answer 210

refer on 2ww

Question 211

30yo lady with fever and fits, temporal lobe necrosis, cause

Answer 211

HSV encephalitis

Question 212

ring enhancing lesion on CT brain in pt with HIV

Answer 212

toxoplasmosis

Question 213

lady comes to GP with raised prolactin, raised IGF-1, normal TSH/LH/FSH/ACTH. Dx

Answer 213

acromegaly

Question 214

old lady, takes nitrofurantoin, gets watery diarrhoea, 2 other in carehome have this too

Answer 214

norovirus

Question 215

blood transfusion, starts second unit, immediately gets chest pain, SOB, dark urine - what happened

Answer 215

ABO incompatibility

Question 216

T1DM on subcut insulin pump comes in frequent episodes of SOB, palps and tingling in fingers. Cause

Answer 216

hyperventilation syndrome

Question 217

most appropriate pre-op IX in well controlled asthamatic about to undergo diagnostic laparoscopy

Answer 217

PEFR

Question 218

guy falls down, can't remember how long he's been on the floor, comes in with renal failure and dark urine, raised K

Answer 218

rhabdomyolysis

Question 219

thin 18yo girl comes in with low K, macrocytic anaemia, raised urea and normal physical examination. Cause

Answer 219

coeliac disease

Question 220

smoker comes in w progressive breathlessness, GP does spirometry and send home w PEFR diary, what will help diagnose COPD

Answer 220

normal FVC and low FEV1

Question 221

guy comes in with swollen legs, bilateral scrotal swelling, 10kg weight gain

Answer 221

peripheral oedema

Question 222

lady with met breast ca, hypercalcaemia, what do you give first

Answer 222

IV fluids

Question 223

guy with loin to groin pain, blood +++ on dip, what IX first

Answer 223

CT urogram without contrast

Question 224

old man, one episode of painless haematuria

Answer 224

refer to urology 2WW

Question 225

pt with pernicious anaemia, iron deficency as well, gastroscopy shows stomach ulcer, what malignancy

Answer 225

adenocarcinoma

Question 226

guy comes in with hypercalcaemia, renal failure, anaemia, bone pain

Answer 226

multiple myeloma

Question 227

lady back from afghanistan, low Ca, raised PTH, what test to confirm Dx

Answer 227

serum vitamin D

Question 228

guy with epilepsy and housebound, pain in spine and compressing rib cage

Answer 228

osteomalacia (due to epilepsy med)

Question 229

guy has episodes of syncope, goes blue during, no other problems, IX

Answer 229

24H ECG

Question 230

pt with right sided hemiparesis, aphasia, visual defect (does not blink to hand waving on R side but does on left) which arter

Answer 230

L MCA

Question 231

bitemporal hemianopia person - where is the lesion

Answer 231

optic chiasm

Question 232

fit guy whose dad died early comes to you worried, passes out during sports, IX

Answer 232

echocardiogram

Question 233

guy falls down, no biceps, hand held in Erb's palsy - what is damaged

Answer 233

Upper Brachial Plexus (C5,6)

Question 234

zig zag lines, painful eyes, NV, no cluster headache

Answer 234

migraine

Question 235

guy w haemorrhoids, do not prolapse, first line

Answer 235

Fibre

Question 236

old person, swollen knee, now swollen hip

Answer 236

OA

Question 237

lady with fever, catheter in situ 14d, E&D normal

Answer 237

UTI

Question 238

purulent otorrhoea, hearing loss, keratin

Answer 238

cholesteatoma

Question 239

lady comes back from india 3da with abdo pain, diarrhoea, vomiting

Answer 239

stool MCS

Question 240

HTN young guy, raised CR, proteinuria

Answer 240

hypertensive nephropathy

Question 241

lady about to undergo ovarian tumour resection, needs thromboprophylaxis, had PE

Answer 241

LMWH

Question 242

guy w droopy face including forehead

Answer 242

bell's palsy

Question 243

osteoporosis prophylaxis for 65yo lady on long term prednisolone

Answer 243

bisphosphonates

Question 244

pt with lung ca findings + cushingoid, smoker

Answer 244

small cell lung cancer

Question 245

someone w Hodgkin's lymphoma, mediastinal mass, night sweats

Answer 245

curative chemo

Question 246

change to bowel habit, wt loss, free blood in stool, dilation of colon proximal to sigmoid

Answer 246

colorectal ca

Question 247

bloody stool, normal proctosigmoidoscopy

Answer 247

colonoscopy

Question 248

pt with hx of biliary colic, presenting w jaundice, obstructive picture

Answer 248

gallstone in CBD

Question 249

lady with collapse, high K, low Na, other bloods suggesting addisons, IX

Answer 249

ACTH and cortisol levels

Question 250

alcoholic comes in confused, ataxic, what do you give

Answer 250

thiamine

Question 251

pain right of epigastrium few hours after food, relieved by milk, wakes him up at night

Answer 251

duodenal ulcer

Question 252

guy with hx of delirium tremens, wants to quit

Answer 252

refer to local specialist alcohol services

Question 253

Sjogren's ab

Answer 253

anti-Ro

Question 254

SLE ab

Answer 254

anti dsDNA

Question 255

post-op lady w DVT, what test confims dx

Answer 255

venous duplex

Question 256

which cardiac drug is CI in asthma

Answer 256

atenolol

Question 257

CXR pleural plaques, presents with pleural effusion, breathlessness, what IX

Answer 257

USS guided tap

Question 258

guy with PEA, given one dose adrenaline, no pulse, what next

Answer 258

another dose adrenaline

Question 259

pt with RTA, white out of lung

Answer 259

haemothorax

Question 260

vas, leaking AAA, IX

Answer 260

CT abdo

Question 261

guy w hx of BPH, IHD, indifestion, diabetes on metformin, simvastatin, bisoprolol, has erectile dysfunction - cause

Answer 261

adverse drug effect

Question 262

RTA, conscious at event, brought into A&E with reducing consciousness, GCS 6

Answer 262

intubate and ventilate

Question 263

anterior neck lump, bx as SCC of tonsilar primary, which infection causes this

Answer 263

HPV

Question 264

Man with rheumatoid arthritis and T2DM has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis

Answer 264

venous ulcer

Question 265

DCIS dx on right outer quadrant, on first mammogrpahy, what is the treatment

Answer 265

wide local incision

Question 266

55y woman smokes 10/d, 6m hx of white sputum and cough - what is done first

Answer 266

CXR

Question 267

61yo asymptomatic, fasting BM 7.2, BMI 21, what should you do

Answer 267

dietary advice

Question 268

breast ca with lung and bone mets, on low dose haloperidol, confused, constipated, cause

Answer 268

hypercalcaemia

Question 269

soldier gets off long flight, went pale, collapsed, hit head, mates noticed asynchronous jerky movements for 15s, recovered consciousness <5 mins

Answer 269

vasovagal

Question 270

young woman, no lump, bloody discharge from nipple

Answer 270

intraductal papilloma

Question 271

ankylosing spond hx, what diagnostic IX

Answer 271

HLAB27

Question 272

Myopathy, high CK, polymyositis hx, IX

Answer 272

anti-Jo

Question 273

asthmatic being treated for exacerbation, responding well after tx, suddenly deteriorates, no air entry on L

Answer 273

pneumothorax

Question 274

rash on flexural surfaces, anaemia, diagnostic IX

Answer 274

upper GI bx

Question 275

pt w cancer and mets, nausea, vomiting, not on chemo/RT, which medication to give

Answer 275

cyclizine

Question 276

medication with SE of a obsturctive hepatic picture

Answer 276

bendroflumethiazide

Question 277

30yo gentleman w intermittent swallowing difficulties for solids, but relieves w large amounts of water, no mass, bad breath

Answer 277

pouch

Question 278

parotid gland swelling 2cm, which has become 5cm quickly - dx

Answer 278

parotid carcinoma

Question 279

man w AF, stroke, hx of intracerebral bleed 6yo, which medication to add onto his current tx

Answer 279

beta blocker

Question 280

woman w hx of fever, reduced air entry LLZ, fluid level (pneumonia, pleural effusion) - what next

Answer 280

pleural fluid aspiration

Question 281

tension pneumothorax (tracheal deviation, deteriorating)

Answer 281

needle thoracostomy

Question 282

ECG showing SVT, what do you give

Answer 282

adenosine 6mg

Question 283

Hx of man w bronchial ca of 7cm, other features of ca, which would be the Sx suggesting that surg is not viable

Answer 283

hoarseness of voice = suggests L recurrent laryngeal nerve invasion

Question 284

man w deficits described by CN 3-6, where is the stroke

Answer 284

pons

Question 285

serotonin sx patient had cancer, flushing + other symptoms, which hormone is responsible

Answer 285

serotonin

Question 286

person w COPD, previous courses of steroids, stopped 1-2w ago, postural hypotension. Cushingoid face. What IX next?

Answer 286

overnight oral dex suppression

Question 287

SVT management

Answer 287

Adenosine

Question 288

parotid gland became large quickly 5cm

Answer 288

parotid carcinoma

Question 289

Weakness post illness, guy who had visual problems (optic neuritis?)

Answer 289

MS

Question 290

Progressive weakness post URTI, absent reflexes, ascending tingling, sensory level to umbilicus

Answer 290

GBS

Question 291

Female soldier who had seizure/jerks after cramped longhaul flight

Answer 291

vasovagal episode

Question 292

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?

Answer 292

complete heart block

Question 293

SIADH hx with slight hypernatraeamia, how do you treat?

Answer 293

vasopressin antagonist

Question 294

Urine, eye, joint problems

Answer 294

reactive arthritis

Question 295

Person with dry eyes, needs eye drops

Answer 295

hypromellose

Question 296

Pregnant lady w DVT, mx?

Answer 296

LMWH (warfarin = teratogenic)

Question 297

asthmatic on typical meds, gets recurrent throat issues, which med is causing this?

Answer 297

Beclamethasone - sounds like oesophageal candiasis

Question 298

Person w HIV, on anti retrovirals, has oral thrush, no cough, no fever, lobar consolidation on CXR. Cause?

Answer 298

Streptococcus pneumoniae

Question 299

Asthmatic on salbutamol + ICS, what is next? (no LTRA offered in options)

Answer 299

Ipratropium (SAMA)

Question 300

Pt with stroke, unable to put clothes on, puts on back to front/upside down. Which part of the brain is affected?

Answer 300

Parietal lobe

Question 301

Pt with gout, has CKD stage 3, colchicne causes vomiting for the patient. Mx?

Answer 301

Steroid (NSAID CI in CKD)

Question 302

Ankylosing spondylitis, failed on 3 NSAIDS, what next?

Answer 302

Etanercept

Question 303

Old lady in care, home on nitrofurantoin, has watery diarrhoea and vomiting. 2 other people ill at care home. Organism?

Answer 303

Norovirus

Question 304

Person w lung fibrosis, ?rheumatoid arthritis symptoms - which antibody?

Answer 304

anti CCP

Question 305

Pt with mouth ulcers, bloody diarrhoea

Answer 305

Crohn's disease

Question 306

Opthalmoplagia and facial palsy

Answer 306

SOL (although only option remembered is cavernous sinus thrombosis)

Question 307

Person with previous history of alcohol misuse, 1 year sober, on thiamine, presents with hypotension and increasing confusion. What do you give first?

Answer 307

IV pabrinex

Question 308

What causes production of ketones in DKA?

Answer 308

increased lipolysis

Question 309

38yo guy, stable, BMI 21, fit and healthy. Eats greens. Ketones 1+ Glucose 2+, BM 18. Mx?

Answer 309

SC basal bolus insulin

Question 310

Pheochromocytoma investigation

Answer 310

urinary metanephrines

Question 311

Pt with previous exposure to asbestosis, heavy smoker, CXR shows hyperexpansion and pleural plaques. Cause of breathlessness?

Answer 311

Asbestosis

Question 312

Pt with previous exposure to asbestos, pleural plaques and thickened pleura

Answer 312

mesothelioma

Question 313

Old lady with pain in back, relieved by leaning on shopping trolley, heavy legs. Cause?

Answer 313

spinal stenosis (leaning = increased spaces between spinal vertebrae)

Question 314

Pt on Li, normal TFTs, hypernatraemic. Cause

Answer 314

Diabetes insipidius (due to Li)

Question 315

Pt at risk of refeeding sx, what do you monitor

Answer 315

phosphate

Question 316

Pt w low Ca, phosphate, high PTH. Cause

Answer 316

osteomalacia

Question 317

Pt fluid restricted due to hyponatraemia, not improving 1 week later. What next?

Answer 317

Vasopressin

Question 318

Ascites, neutrophils 500. Cause

Answer 318

Spontaenous bacterial peritonitis

Question 319

Ascites + encephalopathy mx

Answer 319

lactulose

Question 320

Melena, vomiting, haemodynamically unstable. MX?

Answer 320

OGD <2h

Question 321

Addison's commonest cause (UK)

Answer 321

autoimmune (ww = TB)

Question 322

nausea & vomiting, horizontal nystagmus, no hearing loss

Answer 322

vestibular neuronitis

Question 323

Asthma classsification: BP 105, RR 30, O2 94%

Answer 323

Severe

Question 324

Pt with daytime somnolence, high epwoth score, overweight. Tx?

Answer 324

Weight loss

Question 325

Lower lobe fibrosis, RA, raised Ca, bilateral shadowing. Cause?

Answer 325

sarcoidosis

Question 326

Spiculated lesion in lung

Answer 326

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.)

Question 327

patient has pain in right calf when walking, where is the blockage

Answer 327

right superficial femoral

Question 328

Pt sliced palm of hand, not able to flex middle finger, MCP, PIP joints but can flex DIP joint. Which struture is damaged

Answer 328

flexor digitorum superficialis

Question 329

Pt drank black coffee @ 6am, scheduled for surgery at 8.30am, what do you do?

Answer 329

Continue surgery as normal (foods = 6h, clear fluids = 2h)

Question 330

pt w lumbar back pain, hypotensive. What IX

Answer 330

US Abdo (FAST Scan) for suspected AAA

Question 331

Man working on construction site, rats and pigeons, lives in caravan. Abdo pain and nausea, blood film shows basophilic stippling + sideroblasts. What IX?

Answer 331

Total body lead

Question 332

Diabetes on insulin due for surgery, first thing next morning has HbA1C of 58mmol/L. What do you do?

Answer 332

Convert to sliding scale on morning of surgery

Question 333

What is a haemodialysis fistula?

Answer 333

Connection between artery and vein

Question 334

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?

Answer 334

recheck 3 months

Question 335

describes malignant hyperthermia, antidote

Answer 335

dantrolene sodium

Question 336

converting oral morphine to SC infusion, currently on 60mg OD (2mg/5ml). How much do you give?

Answer 336

oral morphine --> subcut morphine = 1/2

Question 337

surgery on metformin, and gliclazide, what do you do

Answer 337

stop metformin and gliclazide in the morning of surgery (omit hypoglycaemics if 2 meals skipped)

Question 338

old person w splenomegaly, cervical lymphadenopathy, anaemia, ?lymphocytosis, normal platelets, most likely dx

Answer 338

CLL

Question 339

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

Answer 339

Sodium bicarbonate (wide QRS = amitryp = sodium bicarb)

Question 340

Which of the following is a notiable disease?

Answer 340

measles

Question 341

pt with vertigo when turning her head in bed/waking up, what is the mechanism

Answer 341

otoconia in canals

Question 342

pt admitted to A&E with small pneumothorax, no tracheal deviation, paramedics insert chest drain. Why?

Answer 342

to prevent tension pneumo

Question 343

Old lady with CKD stage 3, high Ca, high phosphate, high PTH. Cause?

Answer 343

tertiary hyperparathyroidism

Question 344

Hyperextension neck injury, what is the best view to determine a CS fracture?

Answer 344

open PEG?

Question 345

20yo female, loin pain, LMP 3w ago, urinalysis shows blood 2+ diagnosis

Answer 345

pyelonephritis

Question 346

young male with features of low back pain, painful red eye, photophobia

Answer 346

uveitis

Question 347

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.

Answer 347

Give abx propylaxis?

Question 348

Patient with subacute combined degen of cord (peripheral neuropathy, weakness in legs) what do you give them?

Answer 348

thiamine

Question 349

Patient w GCS 7, O2 sats 96% on air, airway mx?

Answer 349

intubate and ventilate

Question 350

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

Answer 350

amnesia

Question 351

32yo lady is 10w pregnant, has dysuria, diagnosed with UTI, what medication should she be treated with?

Answer 351

nitrofurantoin

Question 352

what is an indication for colectomy in UC

Answer 352

epithelial dysplasia

Question 353

abdo pain, imaging showing decreased perfusion to L colon. What is likely to be affected?

Answer 353

IMA

Question 354

Woman with BRCA1 gene, what is the inheritance % for her sister and children

Answer 354

0.5

Question 355

Man with bloody diarrhoea (blood and mucus 4w, 6x day), came back from thailand 6w ago, no granulomas, DX

Answer 355

Amoebic colitis

Question 356

Patient with epistaxis now stopped, on warfarin, warfarin 5.8. What is the best thing to give to prevent further prolonged bleeding?

Answer 356

PTC

Question 357

guy with intermittent bleeding, bright red stool, haemorrhoids that are non-prolapsing. He is otherwise well, no other symptoms. What is first like mx?

Answer 357

increased dietary fibre

Question 358

50yo guy with COPD admitted with breathlessness. Carboxyhaemoglobin is 35%, what is first line O2 to give him?

Answer 358

15L O2 via non rebreather mask

Question 359

Abdo pain, black toes. What is the best imaging modality to proceed with?

Answer 359

CT abdo

Question 360

Patient previously diagnosed with MGUS 8yo, no features of CRAB. Now has bence jones proteins in urine. Glossitis, IgG 11. What is dx?

Answer 360

multiple myeloma

Question 361

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?

Answer 361

thenar wasting

Question 362

Candida found in old man's catheter on the ward, no urinary symptoms, crackles in lungs. What do you do?

Answer 362

Change catheter

Question 363

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?

Answer 363

normal inattention

Question 364

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?

Answer 364

Long term catheter

Question 365

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?

Answer 365

advance statement

Question 366

Which of the following should be checked before haemodialysis in the main dialysis unit?

Answer 366

EBV or CMV

Question 367

28yo male, radio-femoral delay, notching of ribs on CXR. Dx

Answer 367

coarctation of aorta

Question 368

Patient presents with tonsillitis, CENTOR criteria 3 - had fever, exudates. How do you manage?

Answer 368

phenoxymethylpenicillin

Question 369

patient 20yo, severe pain in testes which is red and swollen, how to proceed?

Answer 369

Emergency surgical exploration

Question 370

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

Answer 370

Vvenous ulcer

Question 371

Young lady has multiple lumps in both breasts which are 1cm x 2cm, fluctuant swellings, painful around period. Dx?

Answer 371

fibrocystic changes

Question 372

Patient had surgery for pancreas. Has been taking diclofenac post-op for a few days, collapses. Dx?

Answer 372

perforated peptic ulcer

Question 373

Patient in late 20s, closed tibial shaft fracture that is displaced. How do you manage?

Answer 373

closed reduction and fix with cannulated screws

Question 374

lady with previous diagnosis with breast cancer, had mastectomy, recently had a course of chemotherapy, now has back pain. What next?

Answer 374

MRI spine (cord compression) or XR spine (mets/lytic lesions) - insufficient info

Question 375

Lady who is 3m postpartum and breastfeeding, lump in right breast, inferior quadrant that is warm, tender and fluctuant. What is the diagnosis?

Answer 375

mastitis

Question 376

Incidental finding of solid mass on right kidney during USS. What is the most likely diagnosis?

Answer 376

RCC

Question 377

17yo patient has raised rash on buttocks and back of thighs and legs had sore throat a week ago. Dx

Answer 377

HSP

Question 378

Patient on ward has C difficile, they are started on metronidazole. What additional measures do you need to take?

Answer 378

Side room and isolate

Question 379

Another patient has C difficle now. How do you treat them?

Answer 379

Side room and isolate

Question 380

Patient with obstructive sleep apnoea, snores at night, daytime somnolence, overweight. What MX will help his symptoms?

Answer 380

CPAP

Question 381

Patient has surgery, pain on passive straight leg raise. What is the diagnosis?

Answer 381

compartment syndrome

Question 382

Pt has RUQ pain, USS shows dilated intrahepatic ducts, what Ab would you test for to confirm the diagnosis?

Answer 382

p ANCA

Question 383

neck stiffness, headache, admitted to A&E, CT clear, LP done which has low opening pressure. What is the causative organism (gram +ve cocci)

Answer 383

strep pneumoniae

Question 384

hyperextension neck, tetraplegic (UL > LL), XR shows degenerative changes. What is the likely lesion?

Answer 384

anterior cord

Question 385

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?

Answer 385

ongoing inflammation

Question 386

Female patient with partially fixed, dilated pupil, hazy vision. DX?

Answer 386

acute angle glaucoma

Question 387

Paitent with suspected glaucoma. Which investigation would best confirm dx?

Answer 387

tonometer

Question 388

patient who is brain dead/comatose (post cardiac arrest). What is best test to determine prognosis?

Answer 388

brainstem reflexes

Question 389

middle aged doctor, really severe chest pain, CXR shows widened mediastinum. Dx?

Answer 389

aortic dissection

Question 390

Elderly patient, few days post-op for ortho surgery, has epidural in, becomes drowsy. BP 80/62. What is the first thing you do?

Answer 390

IV saline over 15 mins

Question 391

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?

Answer 391

ACL rupture

Question 392

Person after accident has internally rotated leg and shortened, can't dorsiflex. Previous THR. Where is the injury

Answer 392

common peroneal nerve

Question 393

Person presents to GP with pain in foot, pulseless, cold. Hx of claudication. Cause

Answer 393

critical limb ischemia

Question 394

person with AF, sudden acute limb. Tx

Answer 394

Embolectomy

Question 395

Person with hx of PKD, had renal transplant 1yo. Now has blood+, protein+, lymphocytes+. Cause?

Answer 395

UTI

Question 396

RUQ pain, jaundice, temp 37.6, raised ALP

Answer 396

acute cholecystitis

Question 397

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.

Answer 397

alcoholic steatohepatitis

Question 398

person with supraclavicular lymphadenopathy, fever, apthous ulcers, generally ill after coming back from southa africa, stopped taking malaria prophylaxis afer 2d. Cause

Answer 398

HIV seroconversion

Question 399

frail lady, not mobile, in care home. Has bright red blood in stools, refuses endoscopy. What is the most appropriate to give dx?

Answer 399

capsule endoscopy

Question 400

person not taking oral fluids, has white plaques in mouth, most likely cause

Answer 400

oesophageal candiasis

Question 401

person with superficial bullae, oral involvement.

Answer 401

Pemphigus

Question 402

person with calcium stones, best preventative tx

Answer 402

depends on results. Uric acid stones = Allopurinol | Cystine stones = Urinary alkalinisation

Question 403

person with nephrotic syndome, best treatment for hyperproteinuria

Answer 403

Ramipril

Question 404

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

Answer 404

infection - prednisolone suppresses CRP

Question 405

presentation of acute asthma, had been given neb salbutamol, ipratropium. ABG shows high CO2, breath sounds quiet. What next

Answer 405

intubate and ventilate

Question 406

man in 70s with hydrocoele, it is not symptomatic, not changed in 10 years, next step?

Answer 406

do nothing

Question 407

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.

Answer 407

2

Question 408

Calculate GCS, opened eyes to pain and withdrew hand to pain. No sounds. (no sounds, opened eyes and withdrew hand to cannulation)

Answer 408

7

Question 409

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

Answer 409

1000

Question 410

What markers are high in this patient with obstructive jaundice picture?

Answer 410

High bilirubin, high ALP, normal ALT

Question 411

Student returns from Nigeria with jaundice, anaemia and fever

Answer 411

?Falciparum, Hep A, Influenza A, Typhoid, Paratyphoid fever

Question 412

72. 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

Answer 412

0.9% NaCl

Question 413

Old guy with COPD, carboxyhaemoglobin of 35% (normal <1.5%), normal O2 sats. What immediate mx?

Answer 413

15L O2 via non rebreather mask

Question 414

82. 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

Answer 414

24hr ECG

Question 415

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

Answer 415

4 compartment fasciotomy

Question 416

Blood transfusion. On 2nd unit. Immediate chest pain. SOB, dark urine.

Answer 416

ABO incompatibility

Question 417

16. Which drug causing hyperkalaemia? ARB, CCB

Answer 417

ACEI

Question 418

84. Guy with heart failure gets pulmonary edema, you give him oxygen, sit him up, furosemide- what is appropriate to do next?

Answer 418

ACEI

Question 419

Dysphagia to both liquid and solids, Birds beak appearance - achalasia, oesophageal webs, oesophageal cancer, Barett’s

Answer 419

Achalasia

Question 420

Woman with new headaches and sweaty. Her blood results showed raised IGF1 and raised prolactin (roughly 1200)

Answer 420

Acromegaly

Question 421

23. 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?

Answer 421

Acromegaly

Question 422

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

Answer 422

Acute GN.- Post-strep

Question 423

Immediate reaction shortly after transfusion of second bag of blood. Red urine catheter. What is going on?

Answer 423

Acute haemolytic transfusion reaction

Question 424

75. Guy has sore throat, hard to swallow, tonsils were symmetrical and of a normal size., painful- quinsy, acute laryngitis, acute tonsillitis, mono infec?

Answer 424

Acute laryngitis

Question 425

Pernicous anaemia + IDA. Gastroscopy shows ulcer in stomach. What malignancy?

Answer 425

Adenocarcinoma

Question 426

Caucasian man presents with dysphagia/weight loss ‘food getting stuck behind chest’: Squamous cell carcinoma, adenocarcinoma, barrett's, GORD

Answer 426

Adenocarcinoma

Question 427

77. A patient has 6 month smoking history (lung cancer picture) and hyponatremia- what hormone caused this?

Answer 427

ADH

Question 428

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

Answer 428

Admit patient two days pre-op + start heparin

Question 429

54. 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

Answer 429

Advance request for refusal of treatment

Question 430

35. 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,

Answer 430

Advise spacer

Question 431

40y banker with headaches which have led to taking ibuprofen and paracetamol daily. No neuro or eye signs. No weight loss

Answer 431

Advise to stop taking meds and reassess in month

Question 432

Variable ventricular rate and absent P waves? irregular ventricular rhythm? AF, atrial flutter, ventricular tachycardia, ventricular fibrilation, supraventriular tachycardia)

Answer 432

AF

Question 433

Features of SLE, on hydroxychloroquine. Jaundiced, raised reticulocytes. Spherocytes and polychromasia:

Answer 433

AIHA

Question 434

Young lady with massive HTN. High Na, low K - which hormone is likely cause of high blood pressure?

Answer 434

Aldosterone

Question 435

Old woman forgetting over 18 months - remembers the past well. Mother had similar presentation.

Answer 435

Alzheimer's

Question 436

Myelodysplasia which has got worse in the last few weeks. Primitive cells on slide and pancytopenia, what have they developed?

Answer 436

AML

Question 437

Classic pneumonia signs (Gram +ve in pairs) what antibiotic to give:

Answer 437

Amoxicillin

Question 438

AF patient has cold pale leg for 6hrs. Mx?

Answer 438

Amputate

Question 439

History of constipation, severe pain on DRE so unable to perform it.

Answer 439

Anal fissure

Question 440

5 days post AP resection and now peritonitic, temp 38 abdo distension and lower abdo pain.

Answer 440

Anastomotic leak

Question 441

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

Answer 441

Angina

Question 442

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

Answer 442

Angiomyoplipoma

Question 443

Blurred vision, painful right eye, right eye congested and bigger. Angle closure glaucoma, temporal arteritis,

Answer 443

Angle closure glaucoma

Question 444

30 year old guy with morning stiffness reduced lumbar flexion. Can no longer touch toes

Answer 444

Ank spond

Question 445

30yo M with joint pain - sacroiliitis + DIP pain

Answer 445

Ankylosing spondylitis

Question 446

36. 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.

Answer 446

Antibiotics

Question 447

What antibody most specific in SLE?

Answer 447

Anti-ds DNA

Question 448

Miscarriage at 11 and 14 weeks. DVTs. Livedo reticularis on the legs:

Answer 448

Antiphospholipid syndrome

Question 449

F with folate + iron deficiency. Some bowel symptoms following bouts of gastroenteritis as a child. What ix?

Answer 449

Anti-TTG

Question 450

EDM + sudden onset chest pain going to back

Answer 450

Aortic dissection

Question 451

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

Answer 451

Aortic dissection

Question 452

Another man falls 10m, ?wide pulse pressure, enlarged mediastinum on CXR,

Answer 452

Aortic dissection

Question 453

Claudication - can only walk 10m. Distal aorta nad both iliac vessels occluded. What do?

Answer 453

Aorto-bifemoral bypass

Question 454

Patient with RUQ pain, jaundice, fever. Raised AST. Did not give other liver function tests. Ascending cholangitis, Hep A, Hep B, pancreatic cancer.

Answer 454

Ascending cholangitis

Question 455

Primary tension pneumothorax. Mx?

Answer 455

Aspirate

Question 456

Young guy in A+E breathless, 4cm pneumothorax, trachea non-deviated, how to manage?

Answer 456

Aspirate

Question 457

59. In a randomised controlled trial, what is the most likely form of bias? Attrition, Recall, selection

Answer 457

Attrition

Question 458

Dislocated shoulder. Injury to which nerve?

Answer 458

Axillary

Question 459

Patient with symptoms of bowel ob. What test?

Answer 459

AXR

Question 460

What vitamin to give fi startingi TB treatment

Answer 460

B6/Pyridoxine

Question 461

60. 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

Answer 461

Barrett's oesophagus

Question 462

Lady with asthma. On various inhalers + LTRA + Theophylline tablet. Which one has caused his painful swallow?

Answer 462

Beclometasone

Question 463

27. Dry eye and dry mouth. Bilateral parotid swelling. Which investigation? Anti-Ro, sialography, biopsy

Answer 463

Biopsy

Question 464

33. Patient recently had an MI. Has already been started on ramipril, atorvastatin. What is another drug that should be added? ARB, Bisoprolol, hydralazine, digoxin

Answer 464

Bisoprolol

Question 465

Guy with terminal dribbling

Answer 465

BPH

Question 466

HRT increases which cancer type

Answer 466

Breast

Question 467

Facial swelling, distended chest veins, weight loss, JVP raised but non pulsating, clubbing Options: Bronch ca, Chronic liver disease

Answer 467

Bronchial carcinoma

Question 468

Man, non smoker, episodes of severe productive cough with chronic productive cough in between. O/E: LLZ wheeze and crackles. Dx?

Answer 468

Bronchiectasis

Question 469

CXR: Bronchial wall thickening. Coarse creps on the right side. Bronchiectasis, Idiopathic pulmonary fibrosis

Answer 469

Bronchiectasis

Question 470

46. 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

Answer 470

Burkitt Lymphoma

Question 471

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

Answer 471

Calcium gluconate

Question 472

Bloody diarrhoea + vomiting after eating chicken at barbecue initial Culture at 37C Negative, Culture at 42C - curved gram negative rods

Answer 472

Campylobacter

Question 473

43. 40 year old fit and well patient with displaced intracapsular fracture. What is the most appropriate management? Hemiarthroplasty, cannulated screws, dynamic hip screw

Answer 473

Cannulated screws

Question 474

Taking prednisolone. Darkened red reflex. Problems with night vision. Dx?

Answer 474

Cataracts

Question 475

Klebsiella pneumonia Abx? | Options: Ciprofloxacin, Clarithromycin, Cefotaxime

Answer 475

Cefotaxime

Question 476

Treatment for meningitis (neck stiffness etc)

Answer 476

Ceftriaxone

Question 477

Lady has surgery 4 days ago. She was given mutiple bags of 5% dextrose. Now she is drowsy. What is the mechanism?

Answer 477

Cerebral oedema

Question 478

Transfusion reaction - fever, other obs normal. Transfusion stopped. What next? Options: check bag against patient details, start transfusion again. Give chlorpheniramine

Answer 478

Check bag against patient details

Question 479

Small cell lung ca. Hilar LN. No distant mets. Tx?

Answer 479

Chemo

Question 480

Guy recently got a parrot and now has pneumonia - chlamydia psittaci, H5N1 pneumonia, EAA, Mycoplasma infection

Answer 480

Chlamydia psittaci

Question 481

Purulent otorrhoea, hearing loss. Keratin. Cause?

Answer 481

Choleastoma

Question 482

87. Chest pain worse on breathing- it sounded like rib fracture but no trauma

Answer 482

Chostochondritis

Question 483

Fatigue, diabetic with photocoagulation, urine had protein etc

Answer 483

Chronic kidney disease

Question 484

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

Answer 484

Chronic liver disease

Question 485

Legionella - Abx?

Answer 485

Clarithromycin

Question 486

What does triple assessment consist of

Answer 486

Clinical exam, Imaging, Biopsy

Question 487

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

Answer 487

Co-danthramer

Question 488

29. He had paracetamol 1g TDS for pain. What to give next? Codeine phosphate, morphine

Answer 488

Codeine phosphate

Question 489

20ish year old woman, with bowel problems. Patient with IDA, low folate, rest bloods normal. Options: Coeliac disease, IBS, UC, Crohn’s

Answer 489

Coeliac

Question 490

52. Histopathological findings: summary was villous atrophy. Diagnosis? Coeliac, IBS, Crohn’s, UC

Answer 490

Coeliac

Question 491

paitent with symptoms of UC, which ix is diagnostic

Answer 491

colonoscopy

Question 492

Patient with symptoms of UC, which investigation is diagnostic

Answer 492

Colonoscopy

Question 493

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

Answer 493

Colonoscopy

Question 494

Collapse, p wave rate fo 75, Broad QRS rate of 40

Answer 494

Complete HB

Question 495

Guy with ECG - P wave 70, QRS wave 45 (repeat from prev. paper)

Answer 495

Complete heart block

Question 496

Haemorrhoids that do not prolapse. Mx?

Answer 496

Conservative

Question 497

Pneumocystis jiroveci abx?

Answer 497

Co-trimoxazole

Question 498

Patient with sputum culture of Pneumocystis jirovecii. Antibiotic treatment

Answer 498

Co-trimoxazole

Question 499

Colonoscopy skip lesions

Answer 499

Crohns

Question 500

Acute diverticulitis. What is the diagnostic investigation: Flexi sig, CT abdomen, MRI

Answer 500

CT abdo

Question 501

Ix for aortic dissection?

Answer 501

CT chest

Question 502

Best ix for angina

Answer 502

CT Coronary angio

Question 503

Renal colic. First line imaging?

Answer 503

CTKUB

Question 504

32. Sats 90%, unwell (nauseous) for a week. ECG sinus tachy. No chest pain. Which Ix: CTPA, Echo, Coronary angiogram

Answer 504

CTPA

Question 505

55 year old Woman smokes 10 per day with a 6 month history of white sputum and a cough what should be done first

Answer 505

CXR

Question 506

48. Patient has weight loss, haemoptysis (symptoms of lung cancer). What is the most appropriate initial investigation? CXR, CT thorax

Answer 506

CXR

Question 507

APTT and PT raised (?low platelets). What to measure? | Options: D-dimer + Fibrinogen + vWF. Bone marrow biopsy. FBC

Answer 507

D-dimer, fibrinogen, VWF

Question 508

Patient ventilated on ITU. Respiratory alkalosis. What do you do?

Answer 508

Decrease frequency of ventilations

Question 509

90. 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

Answer 509

Delirium tremens

Question 510

70y F FOOSH - fracture. What test should GP follow-up with?

Answer 510

DEXA

Question 511

83. Something about woman on predisilone and keeping track of risk of fractures? What investigation?

Answer 511

DEXA

Question 512

Management of Person with metastatic cancer and has brain lesions and raised ICP

Answer 512

Dexamethasone

Question 513

Bipolar taking lithium. Glucose N. Thirst, polyuria. Cause?

Answer 513

Diabetes insipidus

Question 514

Guy with renal failure. Which drug is contributing to abnormal blood tests? Diclofenac, Simvastatin, Aspirin, metformin

Answer 514

Diclofenac

Question 515

Private healthcare screening 61 y/o asymptomatic. Fasting bm was 7.2. BMI 21. What should you do with him?

Answer 515

Dietary advice

Question 516

Man with sciatic pain after ?heavy lifting. Disc prolapse, spondylolisthesis

Answer 516

Disc prolapse

Question 517

T1DM goes to an all night part, does not eat and sleeps all day. Presents to A&E with vomiting. pH 7.24

Answer 517

DKA

Question 518

Guy has dyspepsia, pain a few hours after food, wakes him up in night and drinks milk to make it better. Nocturnal asthma.

Answer 518

Duodenal ulcer

Question 519

Epigastric pain relieved by eating, worse at night

Answer 519

Duodenal ulcer

Question 520

17. Has lumbar pain. Popliteal and foot pulses missing. Investigation?

Answer 520

Duplex

Question 521

Patient with UC, What features indicate colectomy?

Answer 521

Dysplasia

Question 522

Male married 30y, sex only with wife. Pain in testicle and epididymis. Organism? Chlamydia trachomatis, E. coli, Neisseria gonorrhoea

Answer 522

E. coli

Question 523

30 year old male. Only sexual partner is his wife. Has symptoms of epididymo-orchitis. What is the cause? Chlamydia, Gonorrhoea, E.Coli

Answer 523

E. coli

Question 524

Calculate GCS - eyes open to pain, localising to pain, making noises

Answer 524

E2V2M5

Question 525

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

Answer 525

Early parkinsons

Question 526

18yo man with tonsillar exudates, gland swelling, jaundice, upper abdo pain. What was the cause

Answer 526

EBV

Question 527

Anterior neck lump biopsied as a squamous cell carcinoma of a tonsillar primary. Which infection causes this cancer:

Answer 527

EBV

Question 528

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

Answer 528

EBV

Question 529

First ix for lady with exertional breathless, HR 42. 1st ix? | Options: ECG, Spiro, Echo, VQ scan, CXR

Answer 529

ECG

Question 530

26. Infective endocarditis. Which investigation would give a definitive diagnosis? Echo (TTE), Blood cultures, sputum culture

Answer 530

Echo

Question 531

Fit guy passes out during sports. Father died early. Ix?>

Answer 531

Echocardiogram

Question 532

Young Man who gets exertional dizziness and dyspnea. Slow rising pulse - what murmur? Ejection systolic, pan systolic, mid diastolic, end diastolic

Answer 532

Ejection systolic

Question 533

3 weeks of fevers, cough, feeling unwell. Dull percussion, absent VR, ↓expansion

Answer 533

Empyema

Question 534

62. Patient has progressive dysphagia to solid foods and weight loss. What is the diagnostic investigation? Barium swallow, Endoscopy

Answer 534

Endoscopy

Question 535

30. Man about to have hip replacement. Already been given TEDs, which other DVT prophylaxis should you give? Dibagatran, Enoxaparin (LMWH), Unfractionated heparin

Answer 535

Enoxaparin

Question 536

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

Answer 536

Epilepsy

Question 537

patient w UC, what features indicate for colectomy

Answer 537

epithelial dysplasia

Question 538

Patient with symptoms of guarding, peritonism. What test?

Answer 538

Erect CXR

Question 539

Man with leg claudication and ABPI of 0.84 - what do you do? Structured exercise programmes, fempop bypass, another type of bypass, vasodilator medications

Answer 539

Exercise

Question 540

Open comminuted fracture with some kind of skin loss and dirty. Mx?

Answer 540

External fixation

Question 541

70. How is Hepatitis A spread

Answer 541

Faeco-oral

Question 542

Post carotid endarterectomy develops stidor

Answer 542

False aneurysm

Question 543

40yo farmer with wheeze for few weeks. Normal CXR

Answer 543

Farmer's lung

Question 544

Pain on passive dorsiflexion. Compartment syndrome with fracture tibia. Mx?

Answer 544

Fasciotomy within 6h

Question 545

80y with HTN and PVD. What meds? | Options: diltiazem, felodipine, irbesartan, moxonidine

Answer 545

Felodipine

Question 546

32F with mobile non-tender lump in breast

Answer 546

Fibroadenoma

Question 547

74. Women with mobile, smooth breast lump

Answer 547

Fibroadenoma

Question 548

Severe pain on defecation + blood on paper

Answer 548

Fissure

Question 549

45yo with intracapsular #NOF, otherwsie well. Mx?

Answer 549

Fixation with screws

Question 550

Features of UC. Ix?

Answer 550

Flexi sig

Question 551

Post-partum breast feeding lady with red tender breast no mass. Mx?

Answer 551

Flucloxacillin

Question 552

Pneumonia with green sputum, hyponatraemia, euvolaemic. Initial treatment? Options: fluid restrict, oral vasopressin antagonist, give normal saline

Answer 552

Fluid restrict

Question 553

Footballer inverts ankle and presents with fot pain. No ankle pain. Dx?

Answer 553

Fractured base of 5th metatarsal

Question 554

Guy falls off roof, gets chest pain for one day, painful on breathing deeply or coughing, in R Axilla, O2 sats - 95%

Answer 554

Fractured rib

Question 555

Greek guy takes antimalarials, becomes jaundice

Answer 555

G6PD def

Question 556

Greek guy takes antimalarials. Becomes jaundice. Dx?

Answer 556

G6PD deficiency

Question 557

81. Women getting pain after eating, fat, middle aged- now she has obstructive jaundice what was cause –

Answer 557

Gallstones

Question 558

60 year old man with 2 cm smooth non tender swelling fixed to underlying structures - on left wrist? Ganglion, lipoma

Answer 558

Ganglion

Question 559

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

Answer 559

Gastroscopy

Question 560

56. Patient has a sore throat a few weeks ago. Now has ascending limb paralysis. Loss of plantar reflexes. Options: GBS, Motor neurone disease

Answer 560

GBS

Question 561

78. 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,

Answer 561

Give broad spectrum abx

Question 562

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?

Answer 562

Give vasoconstrictor

Question 563

hypotensive patient post op, has epidural, given 500ml bolus, no signs of HF, 10ml urine over 1 hour, no pain

Answer 563

give vasoconstrictors

Question 564

Patient on bendroflumethiazide, painful toe, what is the diagnosis

Answer 564

Gout

Question 565

49F with 2mth Hx of diffuse thyroid swelling and intense sweating at night.

Answer 565

Grave's disease

Question 566

Yellow eyes + high reticulocytes

Answer 566

Haemolysis

Question 567

89. What in an ABG of a COPD person indicates a state of chronic respiratory acidosis?-

Answer 567

High bicarbonate

Question 568

Old guy with COPD with Carboxyhaemoglobin of 35% (normal <1.5%), normal O2 sats. What immediate mx?

Answer 568

High flow O2 - 15L non-rebreather mask

Question 569

CREST sx on a patient. Pleuritic CP/sob with crackles? Which ix?

Answer 569

High res CT

Question 570

6. Crushing pain for an hour and collapsed, young guy.

Answer 570

HOCM/VF?

Question 571

93. Has an eosinophilia, iron deficiency anaemia, and bloody diarrhoea. Which infection? Hookworm, shigella, salmonella

Answer 571

Hookworm

Question 572

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?

Answer 572

HPV

Question 573

PEFR 65%, Sats 95%, pulse 130bpm. What clinical feature is most useful in determining whether someone with asthma needs admission

Answer 573

HR

Question 574

Commonest cause of corneal ulceration

Answer 574

HSV

Question 575

30F fever, fits, temporal lobe necrosis. Cause?

Answer 575

HSV

Question 576

11. Patient has swelling not separate to testis. Translluminates.

Answer 576

Hydrocoele

Question 577

Which of the DMARDs cause retinopathy?

Answer 577

Hydroxychloroquine

Question 578

Breast cancer with lung and bone mets. On low-dose haloperidol. Confused, constipated. What is causing these symptoms?:

Answer 578

Hypercalcaemia

Question 579

39. 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

Answer 579

IBS

Question 580

3yo kid presents with recurring noesbleeds and bruising. Ix: PLT low. Dx?

Answer 580

Idiopathic thrombocytopenic purpura

Question 581

post tonsilitis guy who got proteinuria, haematuria, swollen face, red cell casts, self resolved over the next 3 months

Answer 581

IgA nephropathy

Question 582

Hayfever symptoms. How is it mediated?

Answer 582

IgE

Question 583

Perianal erythema + swelling + fever. What do you do? | Options: Give abx + review, incision & drainage, oral fluclox

Answer 583

Incision & Drainage

Question 584

Anal abscess - erythema and swelling - Treatment: incision and drainage, flucloxacillin, Amox + Metro + wait

Answer 584

Incision & Drainage

Question 585

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

Answer 585

Infective endocarditis

Question 586

28. Ank spond. NSAIDs not working. What to give next? Prednisolone, Methotrexate, Infliximab, other monoclonal antibody

Answer 586

Infliximab

Question 587

13. Intermittent swelling in groin, now stays and is tender.

Answer 587

Inguinal hernia

Question 588

45yo spontaneous dark brown nipple discharge. Only one duct producting discharge.

Answer 588

Intraductal papilloma

Question 589

Young woman, no lump, bloody discharge from boob: Dx?

Answer 589

Intraductal papilloma

Question 590

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

Answer 590

Intubate & Ventilate

Question 591

44. 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

Answer 591

Invasive ductal carcinoma

Question 592

Nutrient defiency in Coeliac

Answer 592

Iron, Folate, B12

Question 593

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

Answer 593

IV fluids

Question 594

Unit of blood after upper GI bleed, on second unit has crackles in lung bases (fluid overload), decreasing O2 sats. Tx?

Answer 594

IV furosemide

Question 595

Asthma lady with unable to finish sentences, hypoxic, high PCO2, pH on ABG 7.30. Already given salbutamol, ipratropium and hydrocortisone. Next?

Answer 595

IV MgSO4

Question 596

Seizure for a long time. Already given 2x lorazepam

Answer 596

IV phenytoin

Question 597

Epilepsy not responsive to two x lorazepam

Answer 597

IV phenytoin

Question 598

Cutaneous manifestation of reactive arthritis?

Answer 598

Keratoderma blenhorrhagicum

Question 599

51. 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

Answer 599

Kids and sister have 50% chance of getting it

Question 600

53. 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

Answer 600

Left hypoglossal

Question 601

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

Answer 601

Limecycline

Question 602

BCC - what does it do? Local invasion only, Mets to liver, Mets to local lymph nodes, spontaneous regression

Answer 602

Local invasion

Question 603

Post-mastectomy + LN clearance - winging of scapula. Nerve?

Answer 603

Long thoracic

Question 604

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?

Answer 604

Lose weight

Question 605

Sudden onset severe headache starting 12hrs ago. CT normal. What do you do?

Answer 605

LP

Question 606

68. Which cells responsible for uptake of fat in fatty plaque formation- macrophages, neutrophils, platelets

Answer 606

Macrophages

Question 607

45F with known brain tumors presents with headache, raised ICP. Awaiting neurosurgical transfer. WHat is the immediate Mx?

Answer 607

Mannitol

Question 608

37. 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

Answer 608

Measure paracetamol levels in 2hrs

Question 609

64. Abdominal pain 20 mins after meal. Weight loss. Options: mesenteric angina, gastric carcinoma

Answer 609

Mesenteric angina

Question 610

Man with AF presents with 1hr hx of epigastric pain 15 after meal Options: mesenteric ischaemia, duodenal ulcer, biliary colic, cholestasis

Answer 610

Mesenteric ischaemia

Question 611

60M diagnosed with diabetes. BMI 30. Diet and exercise has failed. What do you do next?

Answer 611

Metformin

Question 612

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

Answer 612

MG

Question 613

asthma, unable to finish sentences, hypoxic, high PCO2, pH 7.3. Has been given salbutamol, ipratropium, hydrocortisone. Next?

Answer 613

MgSO4 IV bolus

Question 614

Zig zag lines and painful eyes+ N&V for 30 min episodes? Migraine, Glaucoma

Answer 614

Migraine

Question 615

Mid-diastolic murmur

Answer 615

Mitral stenosis

Question 616

57. 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

Answer 616

Morphine SC

Question 617

Mc Murray’s positive, twisted knee during sport and heard a pop, what Ix most appropriate?

Answer 617

MR knee

Question 618

Faecal incontinence, long standing back pain, anal sphincter loose, heavy lifter. Ix?

Answer 618

MRI spine

Question 619

19. Loss of vision every now and then in right eye which resolves, and weakness in arm.

Answer 619

MS

Question 620

Low eGFR, High Ca,High Cr, Calcium was high a year ago. | Options: Vit D deficiency, Primary hyperPTH, Secondary hyperPTH, Multiple myeloma

Answer 620

Multiple myeloma

Question 621

45F presents with worsening proximal limb weakness. Positive anti-Jo-1. What is the diagnostic test for this condition?

Answer 621

Muscle biopsy

Question 622

Anti-jo with signs of polymyositis. Which ix would confirm dx?

Answer 622

Muscle biopsy'

Question 623

47. 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

Answer 623

Myelofibrosis

Question 624

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

Answer 624

N-acetylcysteine

Question 625

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?

Answer 625

Neostigmine

Question 626

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

Answer 626

Neostigmine

Question 627

Women on long term lithium. Peeing loads even at night. Blood results showing hyponatremia, normal blood glucose:

Answer 627

Nephrogenic DI

Question 628

Drug-resistant TB. Where should you keep them

Answer 628

Ngative pressure rom + resp measures for staff

Question 629

Stroke with hemiparesis, 2 days later SALT assessment, unsafe swallow. Best feeding?

Answer 629

NGT

Question 630

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

Answer 630

NGT

Question 631

34. 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

Answer 631

Nicorandil

Question 632

41. Patient 10 weeks pregnant has urinary frequency and urgency. What is the most appropriate antibiotic? Amoxicillin, nitrofurantoin, trimethoprim

Answer 632

Nitrofurantoin

Question 633

Old lady falls down. Has shortened and externally rotated leg. What is likely cause?

Answer 633

NOF

Question 634

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

Answer 634

Normal FVC and Low FEV1

Question 635

Old lady. On nitrofurantoin. Watery diarrhoea. 2 others in care home have diarrhoea too. Cause?

Answer 635

Norovirus

Question 636

Guy lifitng heavy things. Lumbar pain only. Mx?

Answer 636

NSAIDs

Question 637

Breast Ca - biggest RF | Obesity, smoking, Multiple pregnancies, Breast feeding, Late menarche

Answer 637

Obesity

Question 638

Known RCC gets swollen legs and distended veins below umbilicus. Dx?

Answer 638

Obstruction of IVC

Question 639

Immunosuppressed patient dysphagia, taking lansoprazole, ibuprofen, dexamethasone. Neutropenia. Cause?

Answer 639

Oesophageal candidiasis

Question 640

Test for gestational diabetes | Options: Random BM, fasting BM, OGTT at 28wks

Answer 640

OGTT at 28wks

Question 641

10. 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

Answer 641

Omit gliclazide and keep metformin

Question 642

Palpitations, weight loss and altered bowel habit in old lady, what nail changes are seen? What was the answer here someone please?

Answer 642

Onycholysis

Question 643

Man does not open eyes, localises to pain, groaning. What airway?

Answer 643

Oropharyngeal

Question 644

Bilateral knee pain, stiffness 20 min in morning, swollen at night

Answer 644

Osteoarthritis

Question 645

Guy with epilepsy, now housebound. Pain in spine and compressing on rib cage. Dx?

Answer 645

Osteomalacia

Question 646

50. A rheumatoid patient who is taking pred and methotrexate has a sudden onset lower back pain. What is the cause? Osteoporotic fracture, acute pancreatitis

Answer 646

Osteoporotic fracture

Question 647

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

Answer 647

Otitis externa

Question 648

55F ~3 week onset of increasing abdominal distention and leg swelling. O/E abdomen: shifting dullness. Options: Ovarian ca, Liver failure, Cervical ca

Answer 648

Ovarian ca

Question 649

Man with no pain, jaundice, dark urine, pale stols

Answer 649

Pancreatic ca

Question 650

Sickle cell disease with back pain. What Mx first?

Answer 650

Paracetamol/Ibuprofen

Question 651

Sickle cell disease with back pain, what analgesia do you give first?

Answer 651

paracetemol/ibuprofen

Question 652

Bowel opeartion 4 days ago. Not opened bowels for 24h. Distended with scant bowel sounds. Cause?

Answer 652

Paralytic ileus

Question 653

22. 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

Answer 653

PCA

Question 654

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..

Answer 654

PCP

Question 655

14. Desaturation on exertion, perihilar hazing.

Answer 655

PCP

Question 656

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

Answer 656

PE

Question 657

69. Woman with SOB, ecg- sinus tachy, 35 year olds overall well, ascultation- pleural rub on right side- viral pericarditis, pulmonary emoblism, viral pleurisy

Answer 657

PE

Question 658

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

Answer 658

PEFR

Question 659

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

Answer 659

Percutaneous nephrostomy

Question 660

67. 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?

Answer 660

Percutaneous nephrostomy

Question 661

Widespread ST elevation. What sound on auscultation?

Answer 661

Pericardial rub

Question 662

Uvula deviated, cervical LN, sore throat, inflamed soft palate

Answer 662

Peritonsilar abscess

Question 663

Epilepsy not responsive to 2 x lorazepam

Answer 663

phenytoin loading

Question 664

42. 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

Answer 664

Physio and home OT assessment

Question 665

20. Lateral medullary syndrome picture. Which artery? Posterior inferior cerebellar artery, posterior cerebral, inferior cerebral

Answer 665

PICA

Question 666

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

Answer 666

Pleural effusion

Question 667

woman who had been in bangladesh for 6m has decreased chest expansion, reduced VR, reduced air entry, dull percussion on R side, productive cough

Answer 667

pleural effusion

Question 668

Lady with spelenctomy needs to be on penicillin. Why?

Answer 668

Pneumoccal infections

Question 669

40. What is the likely diagnosis when there is bronchial breathing? Pneumonia, pneumothorax, pleural effusion

Answer 669

Pneumonia

Question 670

Stiffness in shoulders, thighs, buttocks, fatigue. ESR 80. Normal CK

Answer 670

Polymyalgia rheumatica

Question 671

RTA shortened, internally rotated, slightly flexed and adducted right leg

Answer 671

Posterior hip dislocation

Question 672

Man on motorbike crashes into a car, he now has an internally rotated and shortened leg, adducted and flexed

Answer 672

Posterior hip dislocation

Question 673

79. 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

Answer 673

Proctocolectomy + ileal anastomososis OR Total colectomy + IRA

Question 674

Patient on warfarin for AF has INR of 3.3. Falls. CT shows intracerebral haematoma. Warfarin stopped and given IV vit K. What next?

Answer 674

Prothrombin complex

Question 675

36 year old guy, pain in lumbar back and swollen DIP

Answer 675

Psoriatic arthropathy

Question 676

Few months of SOB, Fine end-inspiratory bibasal creps, clubbing, JVP at 5cm?

Answer 676

Pulmonary fibrosis

Question 677

Patient with fine end inspiratory crackles, clubbing.

Answer 677

Pulmonary fibrosis

Question 678

Post-op delirium. Morphine + epidural in situ. Best initial management? Options: haloperidol, put in well lit side room, discontinue drugs

Answer 678

Put in well lit side room

Question 679

31. 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

Answer 679

Put on ACEi (switch amlodipine out)

Question 680

Unwell for one week. Dysuria and frequency. Gets more unwell with loin pain.

Answer 680

Pyelonephritis

Question 681

Lady with RA and purple nodule on shin ulcerating with riased edges

Answer 681

Pyoderma grangrenosum

Question 682

Lady with falciparum. Other than doxycycline, what other abx would you give her? Options: Chloroquine, Quinine, Proguanil, Pyrimethamine

Answer 682

Quinine

Question 683

Guy with prostate ca has back pain and bone scan shows increased uptake in spine. How to help with pain?

Answer 683

Radiotherapy

Question 684

Guy with faecal incontinence and tenesmus | OptionsL Rectal cancer, Haemorrhoids

Answer 684

Rectal cancer

Question 685

Graves disease picture - eyes bulging forward, lens dislocation, losing weight. mechanism? Rectus muscle thickening, retrobulbar tumour, cavernous sinus, retinal vein thrombosis

Answer 685

Rectus muscle thickening

Question 686

Post-thyroidectomy with hoarse voice and weak cough. What damage?

Answer 686

Recurrent laryngeal nerve

Question 687

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

Answer 687

Refer urgently to ophthal

Question 688

peripheral oedema, scrotal oedema, proteinuria - what IX

Answer 688

renal biopsy

Question 689

Oedema, Proteinuria, Low albumin. What test for specific dx?

Answer 689

Renal biopsy

Question 690

Peripheral oedema, scrotal oedema, proteinuria. Which diagnostic investigation do you do

Answer 690

Renal biopsy

Question 691

65. Loin pain for a few months. Progressive worsening haematuria. No pain. Options: renal cancer, bladder cancer, ureteric colic

Answer 691

Renal cancer

Question 692

Patient with floaters and sudden loss of vision in left superotemporal quadrant? Retinal detachment, infranasal artery occlusion, superotemporal artery occlusion, vein occlusion

Answer 692

Retinal detachment

Question 693

Pain in small joints and wrists, pleuritic pain, protein ++ and blood ++, what abs do you expect?

Answer 693

Rheumatoid factor

Question 694

Flushing, pustular rash, telangiectasia

Answer 694

Rosacea

Question 695

Severe abdo pain radiating to the back. Suddenly goes unresponsive and pale, pulse 120, BP unrecordable - likely diagnosis? Ruptured AAA, mesenteric ischaemia

Answer 695

Ruptured AAA

Question 696

80. 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

Answer 696

Salmonella typhi

Question 697

Black man with high ACE, high Calcium and CXR showed hilar lymphadenopathy

Answer 697

Sarcoidosis

Question 698

9. Widened mediastinum. Erythema nodosum. High Ca.

Answer 698

Sarcoidosis

Question 699

49. 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

Answer 699

SBP

Question 700

Woman with metastatic cancer, taking Morphine 60 mg BD oral and can’t tolerate oral anymore, what to replace it with?

Answer 700

SC morphine 60mg/24h

Question 701

18. Man has footdrop after hip fracture. Which nerve was damaged? common peroneal, gluteal, sciatic

Answer 701

Sciatic

Question 702

85. Guy gets posterior hip dislocation, what is he most at risk of- sciatic nerve injury, AVN necrosis

Answer 702

Sciatic nerve injury

Question 703

Bowel screening question. that is Faecal occult blood for:

Answer 703

Screening for people with asymptomatic disease

Question 704

58. COPD patient with high Hb: options were secondary polycythemia, renal failure, polycythemia rubra vera

Answer 704

Secondary polycythaemia

Question 705

Guy falls 10m. First thing to do?

Answer 705

Secure airway

Question 706

Woman with rheumatoid arthritis previous knee replacement, having cystoscopy for urinary symptoms. Now knee is hot swollen and tender.

Answer 706

Septic arthritis

Question 707

Claudication in calf. Where is the block? | Options: SFA, Posterior tibial, Common iliac

Answer 707

SFA

Question 708

Patient with COPD had several previous courses of steroids and now has postural hypotension and cushingoid facies, palmar crease pigmentation. What test?

Answer 708

Short Synacthen

Question 709

24. Woman with postural hypotension, which test would give you the diagnosis?

Answer 709

Short synacthen

Question 710

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

Answer 710

Sickle cell

Question 711

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?

Answer 711

Side effect meds (BB)

Question 712

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

Answer 712

Side rom + enteric precautions

Question 713

AI hx with sore grity eye, dry mouth and BL parotid swelling

Answer 713

Sjogren's syndrome

Question 714

Cough, apical cavitating lesions, haemoptysis, firm LN in neck. What test? Auramine stain, Sputum culture + sensitivity, LN biopsy

Answer 714

Sputum culture

Question 715

Smoker with lung cancer near right bronchus removed with ↑ Ca. What wll histology show?

Answer 715

Squamous cell carcinoma

Question 716

Gentlemn with bald head, lumpy hyperkeratotic lesions on scalp. What is he at risk of?

Answer 716

Squamous cell carcinoma

Question 717

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

Answer 717

ST elevation in leads II, III, aVF

Question 718

IVDU develops harsh murmur. Causative organism?

Answer 718

Staph aureus

Question 719

Bell palsy (facial weakness, non forehead sparing, normal ear and no rash) treatment

Answer 719

Steroids

Question 720

Clarithromycin and atorvastatin, metformin: | Options: Continue. Stop statin. Stop metformin

Answer 720

Stop statin

Question 721

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.

Answer 721

Stop statin

Question 722

21. A patient with PKD has a bleed. What is the most likely cause? Sub arachnoid haemorrhage, intercerebral bleed, extradural haematoma

Answer 722

Subarachnoid

Question 723

80 year old guy with increased confusion, type 2 diabetes AF with warfarin. Complains of headaches and had 2 falls, increased confusion

Answer 723

Subdural haematoma

Question 724

Old lady falls in nursing home, GCS 14 dropped next day to 9, had headache

Answer 724

Subdural haematoma

Question 725

Operation for perforated ulcer. Gets hiccoughs and nausea, What is the cause? Options: subphrenic abscess, pelvic abscess, SBO

Answer 725

Subphrenic abscess

Question 726

Which of the DMARDSs cause azospermia and bone marrow suppression?

Answer 726

Suflasalazine

Question 727

Most common type of melanoma

Answer 727

Superficial spreading

Question 728

Testicular pain in sexually active 18yo. Mx?

Answer 728

Take to theatre

Question 729

38. 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

Answer 729

TB

Question 730

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

Answer 730

Temporal artery biopsy

Question 731

15. Lateral epicondylitis question, pain on wrist extension. Options: Golfers elbow, tennis elbow

Answer 731

Tennis

Question 732

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,

Answer 732

Tertiary hyperparathyroidism

Question 733

Alcoholic with diplopia on looking laterally both sides, nystagmus, what to give him. Also hypotensive and tachycardic? Thiamine, IV fluids, chlordiazepoxide

Answer 733

Thiamine

Question 734

Alcoholic with diplopia on loking laterally both sides, nystagmus. What vitamin?

Answer 734

Thiamine (B1)

Question 735

66. Alcoholic with symmetrical clawed (basically can’t move fingers- dupotryen’s picture). What is the pathophysiology? thickened palmar fascia, thickened flexor tendon sheaths,

Answer 735

Thickened palmar fascia

Question 736

76. 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

Answer 736

Thyroid function

Question 737

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

Answer 737

Total colectomy + ileorectal anastomosis

Question 738

Old guy with bacteriuria grown from catheter. What do you do?

Answer 738

Treat if symptomatic

Question 739

1cm painless penile ulcer on shaft. Cause?

Answer 739

Treponema pallidum

Question 740

7. He just started chemo for Burkitt’s, high K

Answer 740

Tumour lysis syndrome

Question 741

Ring and little finger tingling - which nerve has been damaged?

Answer 741

Ulnar

Question 742

Deltoid wasting, weakness of flexion and supination - Upper brachial plexus damage, Lower brachial plexus damage, Ulnar nerve damage, Median nerve damage

Answer 742

Upper brachial damage

Question 743

Guy with AF who had a pale leg. Weak movement and loss of sensation. How to manage? Urgent embolectomy, Prostacyclin infusion, Amputate, venogram

Answer 743

Urgent embolectomy

Question 744

Diagnosing legionella

Answer 744

Urinary antigen

Question 745

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?

Answer 745

Urinary Legionella antigen

Question 746

Hyponatraemia and dehydrated. Dry mucous membrane. How do you decide on fluid status: Options: Serum urea. Serum Cr. Urine Na. Urine osm. Serum Ca

Answer 746

Urine osm

Question 747

Dull ache in groin, lump appears on standing, no cough impulse, does not transilluminate, Cause? Options: Varicocele, Ingunal hernia, Epididymal cyst

Answer 747

Varicoele

Question 748

25. Patient with hyponatremia, has bronchogenic carcinoma. IV furosemide, vasopressin receptor antagonist

Answer 748

Vasopressin receptor antagonist

Question 749

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?:

Answer 749

Vasovagal

Question 750

Man with rheumatoid arthritis and T2DM has painless ulcer on the medial malleolus what’s the diagnosis, had evidence of lipodermatosclerosis and hemosiderosis:

Answer 750

Venous ulcer

Question 751

Arrhythmia after MI

Answer 751

VF

Question 752

guy with seizure, no focal neurology, LP = normal protein, normal glucose, raised cell count, CT head clear

Answer 752

viral encephalitis

Question 753

Guy with seizure and no focal neurology. LP results normal protein, normal glucose, raised cell count (20). CT head clear.

Answer 753

Viral encephalitis

Question 754

Low TSH, High T4 - post URTI, ↓iodine uptake, Hyperthyroid. | Options: Graves, viral thyroiditis, Hashimoto, Nodule

Answer 754

Viral thyroiditis

Question 755

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

Answer 755

Visit them that morning + Commmunity palliative care

Question 756

Young guy, collapses frequently during sport? with ECG - Sinus rhythm. PR or QRS 120ms, cQT 510ms

Answer 756

VT

Question 757

69M with two previous TIAs and AF. What medication to start?

Answer 757

Warfarin

Question 758

Man who has AF with two previous TIAs. Not on any medication. How would you manage him? Warfarin, aspirin, digoxin

Answer 758

Warfarin

Question 759

Hearing changes, haemoptysis, nasal discharge, renal problems. CXR shows 3 cavitated lesions

Answer 759

Wegener's

Question 760

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?

Answer 760

Weight loss

Question 761

old guy confused and shouting after hip replacement, obs stable, no pain

Answer 761

well lit room

Question 762

Old guy confused and shouting after after hip replacement, obs stable, he has no pain. Options: Stop morphine. Haloperidol. Well lit side room. Midazolam

Answer 762

Well lit SR

Question 763

Patient with cough. Bordetella pertussis found on culture. What’s the diagnosis? Whooping cough, Flu, Pneumonia,

Answer 763

Whooping cough

Question 764

DCIS diagnosed on right outer quadrant, on first mammography what is the treatment

Answer 764

Wide local excision

Question 765

Lateral epicondyle tennis elbow pain. Which movement hurts? | Wrist extension, wrist flexion, elbow flexion, elbow extension

Answer 765

Wrist extension

Question 766

59 yr old female with pruritus and got IgM anti-mitochondrial antibodies. What makes PBC likely? Xanthelasma, Tendon xanthomata, hepatomegaly 8cm, macroglossia, facial rash

Answer 766

Xanthelasma