extra passmed questions Flashcards
PPIs can increase risk of what…
and why?
increased risk of osteoporosis and fractures
due to malabsorption of calcium and magnesium
long term PPI use can also mask symptoms of gastric cancer
first line anti-hypertensive in pre-eclampsia patiens
labetalol
give nifedipine is patient asthmatic
beta blockers should be avoided in patients with asthma
A 65-year-old man with liver cirrhosis of unknown cause is reviewed in clinic. Which one of the following factors is most likely to indicate a poor prognosis?
- ALT > 200
- caput medusae
- ascites
- gynaecomastia
- splenomegaly
ascites
child pugh classification
the following characteristics indicate:
- sudden onset
- concealed bleeding
- severe pain
- shock greater than visible blood loss
- firm, woody uterus
placental abruption
the following characteristics indicate:
- insidious onset
- visible bleeding
- painless
- shock in proportion to visible blood loss
- uterus relaxed
placenta praevia
management of premature rupture of membranes
IX - speculum + USS
TX- admit, regular obs, oral erythromycin, antenatal corticosteroids to reduce RDS risk, delivery considered at 34 weeks gestation?
70 y/o
pc: sudden onset of central chest pain, radiating to his jaw and left shoulder. The chest pain occurred an hour ago when he was sitting on a chair after his dinner.
pmh: HTN
OE: sweaty, nauseas, SOB, 120bpm, 150/100mmHg
ECG: T wave inversion, ST segment depression in anterior leads
Troponin not elevated.
likely diagnosis?
unstable angina
elevated trop will differ NSTEMI from unstable angina
COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive
next step:
LABA + LAMA
if patient is still breathless after laba and lama, then you would add ICS : LABA, LAMA + ICS
COPD - still breathless despite using SABA/SAMA and patient has features of asthma / steroid responsiveness
then give:
LABA and ICS
44 y/o female with Addisons
- hypotensive
- low grade fever
- increased urea
what does she have and what is first line management?
Addisonian crisis
give IV hydrocortisone
85 y/o male
ambulatory BP reading of 142/84
no pmh of CHD, Renal disease, or diabetes
dx: lansoprazole
10 year QRISK is 8%
management will include:
stage 1 hypertension : ambulatory reading of 135/85 or higher
HOWEVER only TX only offered if
- aged less than 80
- with either target organ damage, CHD, renal disease, diabetes or QRISK > 10%
so LIFESTYLE ADVICE
if stage 2, then antihypertensive should be started regardless
A 34-year-old woman with longstanding varicose veins is referred to hospital. Over the past few days she has developed a burning pain over one of the veins, with associated tenderness. It is hard to the touch, and the surrounding skin has become red. She is otherwise well, and has not noticed any calf swelling or pain, nor any shortness of breath. She has no other significant past medical history, nor family history, and does not take any regular medications.
On examination, a worm-like mass is felt, corresponding to the physical location of a varicose vein. The surrounding tissue appears erythematous and is hard. There are no ulcers. here is no evidence of deep vein thrombosis. Observations are normal. A couple of investigations are performed:
indicative of:
superficial thromboplebitis
- inflammation of one of the superficial veins
management
- compression stockings
What is target blood pressure for a 56-year-old man with type 2 diabetes mellitus who has no end-organ damage, if using a clinic blood pressure reading?
T2DM blood pressure targets are the same as non-T2DM. If < 80 years:
clinic reading: < 140 / 90
ABPM / HBPM: < 135 / 85
A patient presents to the emergency department with shortness of breath. They undergo an erect chest X-ray. The report states:
The left hemithorax demonstrates blunting of the costophrenic angle and cardiophrenic angle with fluid within the horizontal or oblique fissures.
Pleural fluid analysis demonstrates the following:
pH - 7.55
protein - 36 (10-20)
a) heart failure
b) hepatitis
c) meig’s syndrome
d) nephrotic syndrome
e) pulmonary embolism
EXUDATIVE
- rheumatoid arthritis
- TB
- Pulmonary embolism
Transudative
- Heart failure (most common)
- Meig’s syndrome
- hepatitis
- nephrotic syndrome
in this case: PULMONARY EMBOLISM
what type of effusion does Meig’s syndrome cause?
transudative pleural effusion and ascites
in presence of benign ovarian tumour
Boerhaave’s syndrome is a
spontaneous rupture of oesophagus
resulting in repeated episodes of vomiting
diagnosis: CT contrast swallow
baby boy:
Auscultation of the chest reveals a systolic murmur heard loudest at the left sternal edge and bilateral femoral pulses are weak.
indicative of what abnormality
coarcation of aorta
- narrowing of aorta leading to hypoperfusion of lower body
- babies: cardiac failure, poor feeding, lethargy and SOB
associated with
- turners
- bicuspid aortic valve
- berry aneurysms
- neurofibromastosis
treatment of choice for allergic bronchopulmonary aspergillosis
oral glucocorticoids
- prednisolone
A 65-year-old Caucasian male visits the GP complaining of tiredness, which has been worsening over the past few months. He also reports feeling short of breath on exertion and being more fatigued than usual.
next appropriate step:
URGENT COLORECTAL CANCER 2WW REFFERAL
- 60 years old with new iron deficiency anaemia
classical ‘bird’s beak’ appearance of the lower oesophagus. air fluid level seen.
indicative of:
achalasia
- failure of oesophageal peristalsis and relaxation of lower oesophageal sphincter
due to:
- degenerative loss of ganglia of Auerbach’s plexus
imaging of choice in suspected renal colic
non contrast CT KUB
A 45-year-old man attends the emergency department with acute-onset loin-to-groin pain. He states he has had similar pain before, but never as bad as this. A set of observations are carried out on his arrival:
Blood pressure: 110/85 mmHg Heart rate: 119 bpm Temperature: 38.6ºC Oxygen saturation: 98% on air Respiratory rate: 22/min
Given the most likely diagnosis, what is the definitive management?
obstructive renal calculi
+ signs of infection
ureteric colic from urinary calculi
MX = IV antibiotics, urgent renal decompression
Which of the following therapies is most likely to increase her risk of breast cancer?
a) combined HRT
b) primrose oil
c) oestrogen only HRT
d) SSRI
combined HRT has been shown to increase risk of breast cancer
The Mackler triad :vomiting, thoracic pain, subcutaneous emphysema.
It commonly presents in middle aged men with a background of alcohol abuse.
this is:
Boerhaave syndrome
A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.
indicative of:
proximal aortic dissection
an inferior myocardial infarction and AR murmur should raise suspicions of ascending aorta dissection
A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the
hepatic vein and portal vein
