FA

Question 1

which is the cell for acute inflammation

Answer 1

neutrophil

Question 2

what cell produces collagen in scarring

Answer 2

fibroblast

Question 3

is leprosy acute inflammation

Answer 3

no. chronic

mycobacteria

Question 4

is glandular fever acute inflammation

Answer 4

no. it is acute but not not acute inflammation. as it is caused by a virus, lymphocytes (chronic inf) are involved, not neutrophils (acute inf)

Question 5

what crystals are deposited in gout

Answer 5

urate crystals

monosodium urate

Question 6

which of the following has granulomatous inflammation

A -chrons
B acute apendicits
C infectious mononucleoisis
D - lobar pneumonia

Answer 6

A- Crohns

• granulomatous inflammation occurs in chronic inflammation only
• granuloma = macrophages (endotheloid cells) surrounded by lymphocytes
• mononucleosis = mono (EBV virus) - lymphocytes only even though acute illness
• acute appendicitis and lobar pneumonia are neutrophils only

Question 7

name 4 diseases with granulomatos inflammation

Answer 7

TB
Crohns
sarcoidosis
leprosy

Question 8

what is the name for calcification in diseased (as opposed to normal) tissues

Answer 8

dystrophic calcification

Question 9

which of the following is a chronic inflammatory process from its start

A appendicitis
B cholecystitis
C infectious mononucleosis
D lobar pneumonia

Answer 9

C - infectious mononucleosis (lymphocyte even though it is an acute illness)

A and D are classic acute inflammation (neutrophils)

B, cholecystitis is acute then chronic

Question 10

which of the following never metastasises

A malignant melanoma
B small cell carcinoma of the lung
C basal cell carcinoma
D breast cancer

Answer 10

C basal cell carcinoma of skin

excision = cure

Question 11

which of the following tumours does not commonly metastasise to bone

A breast cancer
B lung cancer
C prostate cancer
D liposarcoma

Answer 11

D liposarcoma

Question 12

which of the following does not have a screening programme in the UK

A breast cancer
B colorectal cancer
C cervical cancer
D lung cancer

Answer 12

D lung cancer

• colorectal screening for over 60 - faeces smear looking for blood

Question 13

which of the following is not known to be a carcinogen in humans?

A hepatitis C
B ionising radiation
C aromatic amines
D aspergillus niger

Answer 13

D aspergillus niger

• hep B and C damages liver to increase cell divisions. increases chance of hepatocellular carcinoma
• aromatic amines concentrate in urine and cause bladder cancer
• aspergillus niger = black fungus in shower

Question 14

what is the name of malignant tumour of glandular epithelium?

A adenocarcinoma
B adenosarcoma

Answer 14

A adenocarcinoma

sarcoma = connective tissue

Question 15

which of the following is not a feature of malignant tumours

A vascular invasion
B metastasis
C increased cell division
D growth related to overall body growth

Answer 15

D growth related to body growth

Question 16

a transitional cell carcinoma of the bladder is a malignant tumour

A true
B false

Answer 16

A true

carcinoma = malignant

Question 17

radon gas is a cause of lung cancer true or false

Answer 17

true

radon = radioactive –> alpha particles damage nearby lung cells

Question 18

asbestos is a human carcinogen true or false

Answer 18

true

Question 19

which of the following is most likely to cause cancer

A drinking half a bottle of wine per day
B being obese
C running 20m 2x a week
D smoking 20 cigarettes a day

Answer 19

D smoking

Question 20

which tumour has the shortest median survival

A basal cell carcinoma of the skin
B malignant melanoma of the skin
C breast cancer
D anaplastic carcinoma of the thyroid

Answer 20

D anaplastic carcinoma of the thyroid

rare
2 months survival

this question is asking about patient survival not cancer survival u dilt

Question 21

true or false - ovarian cancer commonly spreads in the peritoneum

Answer 21

true

Question 22

Activation of naïve T cells is bet achieved by which antigen presenting cells?

a) Neutrophils
b) Mast cells
c) Macrophages
d) Dendritic cells

Answer 22

D dendritic cells

Question 23

What cell type is :located exclusively in tissues, has an important role in both the innate and adaptive immune system, are antigen presenting cells and have phagocytic properties

a) Macrophage
b) Neutrophil
c) Eosinophil
d) Mast cell
e) Fibroblast

Answer 23

A macrophage

Question 24

Which of the following is not involved in innate immune mechanisms

a) Anatomic barriers
b) Phagocytic
c) Inflammatory mechanisms
d) Antibody production
e) Skin

Answer 24

D antibody production

Question 25

T cells recognise antigens... a) In solution in plasma b) When presented on red blood cells c) Following presentation on antigen presenting cells d) In a 3-dimensional form e) Following presentation on pattern recognition receptors

Answer 25

C

Question 26

Influenza vaccine is targeted towards 'at risk' groups in the UK. Which of the following are classified as 'at risk'? a) Over 65 years b) 16 years old c) The obese of any age d) Teenagers e) Under 2 years old

Answer 26

A and E

Question 27

Which of the following is administered as a live attenuated vaccine in the UK a) Hepatitis A b) Measles, Mumps, Rubella c) Tetanus d) Flu e) Polio

Answer 27

B - MMR - BCG is also live vaccine - hep A , polio, flu = inactivated organisms - tetanus = subunit

Question 28

Complements are the proteins that are involved in the clearance of antigen/bacteria. Which of the following is not part of the Elimination phase of complement activation? a) Opsonisation b) Target cell lysis c) Chemoattraction of leukocytes d) Production of interferons e) Phagocytosis

Answer 28

D - complements and interferons (antiviral resistance in unaffected cells) are both soluble serum factors but one does not produce the other - complements do not phagocytose but osponisation directly aids phagocytosis so it is involved

Question 29

Which of the following is a polysaccharide vaccine a) anthrax vaccine b) Hib vaccine (Haemophilus influenza type b) c) rabies vaccine d) hepatitis A

Answer 29

B (like subunit type) - hep A, rabies = inactivated organism. i think anthrax is too (or live)

Question 30

Which of the following are features of the adaptive immune response a) Does not require prior contact with the pathogen b) It works with B and T lymphocytes c) Lacks specificity d) Distinguishes "self" from "non-self" e) Enhanced by complement

Answer 30

B - complements work in innate system mainly - autoimmune is lymphocyte and that is unable to distinguish self and non self

Question 31

What are the two types of immune response in humans? a) Immunological tolerance b) Immune surveillance c) Innate and acquired d) Intrinsic and extrinisic e) Overt and covert

Answer 31

C

Question 32

Which of the following is not an organ-specific auto-immune disease? a) Ulcerative colitis b) Type 1 diabetes mellitus c) Graves disease d) Hashimoto’s thyroiditis e) Sjogren's syndrome

Answer 32

a and E - UC - rectum and large intestines and lower intestine (gut contains multiple organs) - both UC and crohns are autoimmune - E not officially correct but two emails suggest it is

Question 33

Which of the following is not a classical PAMP? a) peptidoglycan, found in bacterial cell walls; b) flagellin, a protein found in bacterial flagella; c) lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria; d) Interleukin 12 e) nucleic acids such as viral DNA or RNA.

Answer 33

D

Question 34

Infection control: which is false? The five steps of hand hygiene are to wash hands ``` A Before contact with patient B Before bodily fluid exposure C Before aseptic procedures D After contact with patient surroundings E After patient contact ```

Answer 34

B

Question 35

Which of these does NOT feature in the definition of Sepsis? ``` A Temperature >38.3oC or <36oC B Heart rate >90 C Systolic blood pressure >130 D White Cell count >12 E Hypoxia ```

Answer 35

C - hypoxia relates to respiratory rate - sepsis decreases BP, not raises it

Question 36

A 21 year old complains of myalgia, sore throat and tiredness. He is febrile and has an enlarged spleen. Which is the best answer? A He has sepsis and needs broad spectrum antimicrobial therapy with cefotaxime B A charcoal throat swab will confirm the diagnosis C Finding atypical lymphocytes on a blood film and a positive EBV IgM in serum would be consistent D PCR on a viral throat swab will confirm the diagnosis E This is a viral upper respiratory tract infection and doesn’t warrant investigation or antimicrobial therapy

Answer 36

C

Question 37

A 34 year old gay man who has had prolonged diarrhoea now presents short of breath with a dry cough and hypoxia. Which is most accurate? A This is bacterial pneumonia caused by pneumocysitis jirovecii. B It is too early for a 4th generation HIV test to be positive C The CD4 T cell count will be between 500 and 750 D Even if the HIV test is negative this man has AIDS E With appropriate therapy he has a good prognosis

Answer 37

E - 4th generation HIV test works within 4w. this man has had prolonged symptoms

Question 38

Which is the incorrect antimicrobial pairing: ``` A S. pyogenes : can use penicillin B Meropenem : a carbapenem C Glycopeptides : use for MRSA D Co-amoxiclav : contains a Beta-lactamase inhibitor E Cefuroxime : a macrolide ```

Answer 38

E - cefuroxime is a cephalosporin

Question 39

Which is true of antimicrobial resistance? A it is spread by plasmid mediate gene transfer B spontaneous gene mutations do not occur C MRSA refers to vancomycin resistant S. aureus D Only Mereopenem is effective against all gram negative bacteria

Answer 39

c i acc think i might now be which is NOT true but this is not confirmed

Question 40

Which is NOT a feature of mycobacteria? A Resistance to destaining by acid and alcohol B Cell wall contains lipoarabinomannan C They only divide every 20 hours D They cannot withstand phagolysosomal killing E May cause meningitis

Answer 40

d

Question 41

which pair is correct: ``` A Pityriasis versicolor = bacterium B Ringworm = helminth C Aspergillus fumigatus = mycobacterium D Falciparum malariae = fungal E Giardia lamblia = protozoal ```

Answer 41

e - giardia lambia is a flagellate protozoa - ringworm and aspergillus fumigatus and Pityriasis versicolor = fungus - falciparum malariae= sporozoa (nonmotile) protozoa

Question 42

which is correct for what a HIV virus envelope contains? A RNA + capsid + DNA polymerase B DNA + capsid + Reverse transcriptase C DNA + p24 + protease D RNA + capsid + reverse transcriptase

Answer 42

D

Question 43

When diagnosing viral infections which is not true? A The sample must come from a sterile site B Electron microscopy is rarely used C Use a green swab not a black swab D PCR results take 1-2 days E A detectable IgM in serum may be diagnostic

Answer 43

a

Question 44

Which of these is NOT a means by which viruses cause disease? A direct destruction of host cells B cell proliferation and cell immortalisation C inducing immune system mediated damage D Endotoxin production E modification of host cell structure or function

Answer 44

D - endotoxin is produced by gram - bacteria

Question 45

Which site is normally sterile? ``` A The pharynx B The urethra C Cerebrospinal fluid D The lung E Skin ```

Answer 45

C

Question 46

Which is incorrect? Haemophilus influenzae is an important cause of ``` A meningitis in pre-school children B Otitis media C Pharyngitis D Gastroenteritis E Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) ```

Answer 46

D - otitis media are middle ear inflammatory diseases - gastroenteritis pathogens = camplyobacter, e coli, salmonella, shigella, yersinia, staphylococcus

Question 47

Which of these is a gram negative bacillus that ferments lactose? ``` A Shigella sonnei B Listeria monocytogenes C Neisseria meningitidis D Eschericia coli E Streptococcus pyogenes ```

Answer 47

D - e.coli/ klebsiella = gram neg bacilli lactose fermenters - shigella/salmonella, proteus, psuedomonas = gram neg bacilli non-fermenters - neisseria = gram neg cocci

Question 48

Chains of purple cocci are seen on a gram film. They show alpha haemolysis when grown on blood agar. They don't grow near the optochin disc. These are probably ``` A Streptococcus pneumoniae B Staphylococcus epidermidis C Viridans Streptococci D Group A streptococci (S. pyogenes) E Neisseria meningitidis ```

Answer 48

A - not growing near optochin disc = optochin sensitive

Question 49

Which of the following is not under the control of the pituitary gland? ``` A Thyroid B Adrenal cortex C Adrenal medulla D Testis E Ovary ```

Answer 49

c

Question 50

Which of the following statements is false? A The pituitary gland lies in the sella turcica B The weight of the pituitary gland is around 0.5g C ACTH is secreted from the pituitary during stress D The pituitary regulates calcium metabolism E The anterior and posterior pituitary are distinct on an MRI scan

Answer 50

D - parathyroid controls calcium (not thyroid) and is not related to pituitary

Question 51

In men all the following are mainly produced in the adrenal cortex except ``` A DHEAS B Testosterone C Aldosterone D 17-OH progesterone E Androstenedione ```

Answer 51

B

Question 52

Which of the following regarding AVP is false? A AVP levels have a linear relationship with serum osmolality B is produced in the pituitary gland C stimulates reabsorption of water in the collecting duct of the nephron D in hypotension baroreceptors predominantly activate ADH production and secretion E Further AVP production is no longer effective once urine osmolality has reached a plateau

Answer 52

B - AVP = arginine vasopressin

Question 53

Where is growth hormone’s main site of action to stimulate IGF1 release? ``` A bone B liver C adrenal cortex D muscle E pancreas ```

Answer 53

b

Question 54

The following are typical features of excess growth hormone secretion except? ``` A Polyuria B Joint pains C Sweating D Hypotension E Headaches ```

Answer 54

D

Question 55

The following hormones all have a circadian rhythm except? ``` A Cortisol B Testosterone C DHEA D 17OH progesterone E Thyroxine (T4) ```

Answer 55

E

Question 56

Typical features of cortisol deficiency include the following except? ``` A Hypotension B Muscle aches C Weight loss D Hyperglycaemia E Lethargy ```

Answer 56

D

Question 57

A 38 year old lady presented with weight gain, menorrhagia and constipation. She is most likely to be suffering from? ``` A Cushing’s syndrome B Addison’s disease C Primary hypothyroidism D Graves disease E Acromegaly ```

Answer 57

C

Question 58

Which test would you likely want to perform in a patient with proximal muscle weakness, purple striae and thin skin? ``` A Synacthen test B Overnight dexamethasone suppression test C Insulin tolerance test D Glucagon test E Skin allergy tests ```

Answer 58

B - this patient has cushings. the purple striae, thin skin and proximal muscle weakness are a result of protein catabolism. first line = overnight dexamethasone test (corticosteroid injected. serum cortisol measured in morning normal: ACTH/ cortisol suppressed. cushings: no suppression). second line = 48h dexamethoaone (same but steroid taken for longer) - synachten test differentiates between addisons/ adrenal insufficiency. synACTHen (ACTH analogue = tetracosactide). Addisons: cortisol should be low- not raised by the stimulant. Secondary : cortisol rises

Question 59

A 24 year old girl presented with hirsutism, oligomenorrhoea and acne. What test would you likely carry out from the ones below? ``` A Ultra sound adrenals B Ultra sound ovaries C MRI ovaries D CT scan adrenals E Prolactin ```

Answer 59

B

Question 60

A 54 year old gentleman presented with hyponatraemia. All the following conditions need excluding before confirming SIADH except? ``` A Hypothyroidism B Hypervolaemia C Euvolaemia D Adrenal insufficiency E Diuretic use ```

Answer 60

C

Question 61

A 66 year old gentleman had a serum sodium of 124 mmol/l, serum osmolality 265 mmol/l and a urine sodium of 52 mmol/l. What would you like to perform first? ``` A Chest X-ray B CT brain C Skin turgor and jugular venous pressure test D Thyroid function tests E Synacthen test ```

Answer 61

C - first thing to decide with hyponatraemia is : euvolemic or not... skin turgor and jugular venous pressure indicate blood volume (decreased turgor and decreased BP = hypovolemia) - this is SIADH

Question 62

The following may cause nephrogenic diabetes insipidus except? ``` A Lithium B Myeloma C Amyloidosis D Hyperkalaemia E Hypercalcaemia ```

Answer 62

D - hypokalemia also a cause

Question 63

The following are most likely causes of SIADH except? ``` A Multiple sclerosis B Lung abscess C Subdural haemorrhage D Lymphoma E Cerebrovascular accident ```

Answer 63

A

Question 64

A 28 year old presented with a microprolactinoma? What is the most unlikely symptom? ``` A Galactorrhoea B Oligomenorrhoea C Decreased sexual appetite D Headaches E Visual field defects ```

Answer 64

E - this does happen but is more severe

Question 65

The following suppress appetite except: ``` A Peptide YY B Ghrelin C CCK D GLP1 E Glucose ```

Answer 65

B

Question 66

The main adipose signal to the brain is ``` A CCK B Neuropeptide y C Leptin D Agouti-related peptide E Adiponectin ```

Answer 66

C

Question 67

A 65 year old lady is diagnosed with SIADH. Her sodium is 123mmol/l. What is your first line of management? A If she is symptomatic I will treat with fluid restriction B If she is asymptomatic I will treat with hypertonic saline C If she is asymptomatic I will treat with fluid restriction D If she is asymptomatic I will repeat the sodium level the next day E If she is asymptomatic I will give normal saline

Answer 67

C - saline given for severe symptoms if chronic and any symptoms if acute (<48h)

Question 68

``` Typical features of hypogonadism in a male include the following except: A Decreased sweating B Joint and muscular aches C Decreased sexual appetite D Decreased hair growth E Asymptomatic ```

Answer 68

A

Question 69

What is the next step for a low testosterone sample

Answer 69

repeat at a different time of day

Question 70

The first line treatment for a patient with a symptomatic prolactinoma is usually: ``` A Radiotherapy B Transphenoidal surgery C Dopamine agonists D Transfrontal surgery E Somatostatin analogues ```

Answer 70

C - E would increase prolactin further

Question 71

High routine blood glucose. which is NOT a physiological response ti increased blood glucose? ``` A Decreased breakdown of muscle B Glycogenesis C Increased lipolysis D Increased uptake of glucose by cells E Production of insulin from the pancreas ```

Answer 71

C - high glucose causes decrease in breakdown of fats, to prevent further increase in glucose - a refers to one of the routes of gluconeogenesis

Question 72

what hormone is produced when blood glucose levels are low

Answer 72

glucagon

Question 73

whos results do not suggest type 2 diabetes? ``` Angela= Fasting plasma glucose- 10mmol/L Betty= Fasting plasma glucose- 8mmol/L Cheryl= Oral Glucose Tolerance Test- 25mmol/mol Dianne= HbA1c of 47 Edith= Random plasma glucose of 13mmol/L (with other symptoms of DM) ```

Answer 73

Dianne. - 42-47 (6-6.5%) = pre-diabetes - 48 + (6.5%) =. diabetes

Question 74

Emily tells you she’s all hot and bothered, she’s recently been snapping , which is out of character for her, eating more, actually lost a bit of weight. Which of the following symptoms would align with your suspected diagnosis? ``` A dry skin B hair loss C constipation D lethargy e clubbing ```

Answer 74

E - dry skin and hair loss are soley hypothyroidism

Question 75

how does carbimazole affect the thyroid

Answer 75

treats hyperthyroidism (along with radioiodine and surgery) - ``` Prevents thyroid peroxidase enzyme from iodinating the tyrosine that is in thyroglobulin, so prevents thyroid hormone synthesis Also immunosuppressive (good for graves) Can either titrate dose down slowly, according to thyroid function tests, or do ‘block and replace’ where you give carbimazole and give T4 alongside ```

Question 76

Chloe, a 16 year old girl, has had abdominal pain for the past 24hrs. Over the past few weeks she’s been unwell, has lost 12kg and has been drinking excessive quantities of water. She is tachycardic, tachypnoeic, clammy and confused. What is the most likely diagnosis? ``` A)Cushing’s B) DI C) DKA D) Hyperaldosteronism E) Hyperthyroidism ```

Answer 76

c - Cushings: weight gain, nor drinking symptoms, No acute crisis. - DI : Does cause polydipsia. Not weight loss. Less likely to cause profound dehydration/ shock. - T1DM- young, weight loss, polydipsia leading to DKA - hyperaldosteronism: Polydipsia, polyuria, paraesthesia/ paralysis, no weight loss - hyperthyroidism: Weight loss but no thirst or polydipsia

Question 77

TRH= T3=

Answer 77

thyrotropin releasing hormone triiodothyronine

Question 78

Deborah, a 68 year old lady, has a tan without being abroad. She’s been feeling tired and tearful. Routine U&E investigations reveal a low sodium, high potassium. What is the most likely diagnosis? ``` A Addison’s B Conns C Cushings D Depression E T1DM ```

Answer 78

A - Addison’s =Tanned, Tired, Tearful. - Conns= High levels of aldosterone, so Low potassium and high sodium (other way round)

Question 79

Otto has completely lost his sex drive, has noticed some skin thinning and easy bruising on his lower arms and says he’s been having mood swings. When you check his blood pressure it’s 160/105. What endocrine investigation would you perform? ``` A Arterial Blood Gas B 24 hour urine cortisol collection. C CT Head D Thyroid Function Tests E Liver Function Tests ```

Answer 79

B - looks like cushings

Question 80

what can taking steroids for a prolonged time cause

Answer 80

secondary adrenal insufficiency | primary = addisons is main cause

Question 81

drinking tons of milk raises your calcium levels. which of the following is not an effect: ``` A Bone pain B Constipation C Depression D Hypertension E Kidney Stones ```

Answer 81

D - bones, stones groans moans

Question 82

true or false: bisphosponates are a medical treatment for hypercalcaemia

Answer 82

true. prevent bone resorption/ osteoperosis

Question 83

Lidocaine is effective in the treatment of ventricular tachycardias because it........... 1. slows conduction in healthy heart tissue 2. opens sodium channels 3. blocks sodium channels at rest 4. blocks the activation gate of the sodium channel 5. blocks the inactivation gate of the sodium channel

Answer 83

5 It blocks the inactivation gate of the sodium channel. so it prolongs inactivation so it raises the depolarization threshold so the heart is less likely to conduct early action potentials.

Question 84

Digoxin can be a useful drug in the treatment of supraventricular tachycardias because it............... 1. stimulates the release of acetylcholine from sympathetic nerves 2. is inotropic 3. makes the membrane potential more positive releasing acetylcholine from parasympathetic nerves 4. inhibits calcium channels 5. stimulates sodium/calcium exchange

Answer 84

3 - Increased vagus (parasympathetic) stimulation - ACh released - Bradycardia (chonotropic) - Slows AV node conduction also: - Inhibit Na/K pump (blocks Na out and K in action) - So more Ca in heart - Increased force of contraction (ionotropic)

Question 85

Amlodipine and verapamil are both calcium channel blockers, what property makes verapamil the more effective anti-arrhythmic agent ? 1. Additional sodium channel blockade 2. Once daily treatment 3. Lack of effect on the calcium channel at rest 4. Blockade of all calcium channel types (L,N & T) 5. Additional potassium channel blockade

Answer 85

3

Question 86

Which additional property makes propranolol the most useful beta blocker to help control the arrhythmias which occur immediately following a heart attack ? 1. Calcium channel block 2. Potassium channel block 3. Heart block 4. Sodium channel block 5. Parasympathetic activation

Answer 86

4

Question 87

In the treatment of heart failure, which transport protein or ion channel is inhibited by the loop diuretic, furosemide? 1. Na/K ATP-ase 2. Epithelial Na channel 3. K channel 4. Na/K/2Cl transporter 5. Na/Cl transporter

Answer 87

4

Question 88

ACE inhibitors reduce the circulating levels of which adrenal hormone ? 1. Aldosterone 2. Adrenaline 3. Cortisone 4. Angiotensin II 5. Atrial Natriuretic Peptide

Answer 88

1 - angiotensin 2 is not an adrenal hormone

Question 89

Which drug exerts a direct inotropic effect (+ force of contraction) on heart muscle? 1. Ramipril 2. Furosemide 3. Losartan 4. Digoxin 5. Spironolactone 6. Glyceryl Trinitrate

Answer 89

4 it does this by: Inhibit Na/K pump (blocks Na out and K in action) - So more Ca in heart - Increased force of contraction (ionotropic)

Question 90

In chronic heart failure beta blockers are..... 1. Contra-indicated 2. Beneficial by slowing the heart rate 3. Beneficial by depressing the myocardium 4. Beneficial by increasing oxygen demand 5. Effective by blocking reflex sympathetic responses which stress the failing heart

Answer 90

5

Question 91

For which CVS drug is BRONCHOSPASM a potential side effect? 1. Morphine 2. Beta blocker 3. Calcium Antagonist 4. Aspirin 5. Nitrate 6. ACE inhibitor

Answer 91

2

Question 92

. For which CVS drug is COUGH a potential side effect ? 1. Morphine 2. Beta Blockers 3. Calcium antagonists 4. Aspirin 5. Nitrates 6. ACE inhibitors

Answer 92

6 - due to build up of bradykinin (ACE function is to metabolise this but unable to do so with ACEi) - can also occur with CCB (calcium antagonist) but this isnt so common

Question 93

For which CVS drug is TOLERANCE a potential side effect? 1. Bendroflumethazide 2. Beta blockers 3. Calcium antagonist 4. Aspirin 5. Nitrate 6. ACE inhibitor

Answer 93

5

Question 94

Which CVS drug is most likely to induce POSTURAL HYPOTENSION as a potential side effect? 1. Morphine 2. Beta blocker 3. Calcium antagonist 4. Aspirin 5. Nitrate 6. ACE inhibitor

Answer 94

3 - calcium antagonist = CCB - also occur with ACEi, ARB but less so

Question 95

Doxazosin is an antagonist at which type of peripheral receptor? 1. Alpha-1 adrenoceptor 2. Purine receptor 3. Angiotensin II receptor 4. Vasopressin receptor 5. Beta-1 adrenoceptor 6. Dopamine receptor

Answer 95

1 - doxasosin is an alpha blocker

Question 96

Atenolol is an antagonist at which type of peripheral receptor? 1. Alpha-1 adrenoceptor 2. Purine receptor 3. Angiotensin II receptor 4. Vasopressin receptor 5. Beta-1 adrenoceptor 6. Dopamine receptor

Answer 96

5 - atenolol = b blocker

Question 97

The antihypertensive action of lisinopril is due to inhibition of which peripheral enzyme? 1. Kininase II 2. Renin 3. Na/K ATP-ase 4. Angiotensin Converting Enzyme (ACE) 5. DOPA decarboxylase

Answer 97

4 - pril = ACEi

Question 98

Which of the following drug side effects is less likely to be seen when treating hypertension with an angiotensin receptor blocker (ARB) rather than an ACE inhibitor? 1. Hyperkalaemia 2. Cough 3. Angioedema 4. Renal failure in the presence bilateral renal stenosis 5. Cold hands/cold feet

Answer 98

2 - doesnt disturb ACE metabolising bradykinin

Question 99

How do beta-blockers work to relieve the pain from angina pectoris? 1. Reduce O2 demand by slowing the heart rate 2. Reduce O2 demand by reducing myocardial contractility 3. Improve O2 distribution by slowing the heart rate 4. Increase O2 supply by dilating coronary arteries 5. Increase O2 supply by stimulating respiration

Answer 99

1, 2, 3 - negatively inotropic and chonotropic so better oxygen distribution - they do this by : Block reflex sympathetic responses which stress heart in HF eg block adrenaline - dilate veins, but not arteries. heart is main thing though

Question 100

What is the major mechanism by which glyceryl trintrate can relieve the pain of angina pectoris? 1. Dilatation of veins to reduce the preload on the heart 2. Dilatation of arterioles to reduce the after load on the heart 3. Dilatation of coronary arteries to increase cardiac perfusion 4. Opening of collateral blood vessels to improve cardiac perfusion 5. A positive inotropic effect

Answer 100

1

Question 101

Which of the following drugs is likely to be more suitable for the treatment of variant angina due to coronary artery vasospasm ? 1. Bumetanide 2. Losartan 3. Isosorbide 4. Amlodipine 5. Glyceryl trintrate

Answer 101

4 - variant angina = coronary spasm = prinzemetals

Question 102

variant angina = which type treatment

Answer 102

variant angina = coronary spasm = prinzemetals amlopidine (CCB)

Question 103

Which of the following drugs might be used to reduce atheromatous disease, the underlying cause of angina pectoris? 1. Atenolol 2. Amlodipine 3. Simvastatin 4. Glyceryl trinitrate 5. Enalapril

Answer 103

3 - reduces LDL cholesterol production in the liver

Question 104

hodgkin lymphoma age group: A Children B Teenagers and young adults C Middle aged (40-60 yrs) D Older aged (>60yrs)

Answer 104

B, D two peaks

Question 105

How is myeloma bone disease usually assessed? A Plain X-ray B Clinical assessment C Isotope bone scan D PET scan

Answer 105

A - looks for darker lytic lesions - PET is better for looking for solid lumps

Question 106

What is the correct mechanism of action for the anti-emetic drug Ondansetron? A Peripheral D2 antagonist B Central D2 antagonist C Anti-cholinergic D 5HT3 antagonist

Answer 106

D

Question 107

most common cause of microcytic anaemia: A B12 deficiency B Iron deficiency C Haematologic malignancy D Hereditary spherocytosis

Answer 107

B other causes= thalassemia and chronic disease

Question 108

In sickle cell anaemia what would you expect to see the reticulocyte count? Absent Low Normal Raised

Answer 108

Raised - because shorter life span

Question 109

Which best outlines the approach to the management of a patient with suspected febrile neutropaenia? A Encourage fluids and paracetamol B Perform cultures and wait for results before starting antibiotics C Perform cultures and start oral antibiotics D Perform cultures and start broad spectrum iv antibiotics

Answer 109

D emergency

Question 110

Malignant spinal cord compression usually presents with? A Back pain, ataxia and sensory neuropathy B Back pain, spastic paresis and a sensory level C Perianal numbness and urinary incontinence D Weak legs impaired joint position sense

Answer 110

B

Question 111

How does Aspirin exert its antiplatelet effect? A ADP receptor antagonist B Inhibition of Cyclooxygenase enzyme C Inhibition of Glycoprotein IIb-IIIa D Inhibition of PAR4 receptor

Answer 111

B irreversible inhibitor COX1 enzyme

Question 112

bacterial infection causes: Low lymphocytes Low neutrophils High lymphocytes High neutrophils

Answer 112

D high neutrophils virus --> lymphocytes

Question 113

chronic myeloid leukaemia - age - onset speed - cause - findings - symtpoms - treatment

Answer 113

- age = 40-60 - onset speed = slow - cause = philadelphia chromosomes (9, 22) --> new protein tyrosine kinase --> autonomous wbc proliferation - findings: often incidental: high wbc esp neutrophils, clouddy plasma, splenomegaly - symtpoms: decrease in appetitie, weight, sweat, itching - treatment: imatinib - blocks tyrosine kinase activity (specific) (mutations can stop the drug from working)

Question 114

which of these are which type of what antihypertensive class: 1) verapamil 2) amlodipine, 3) diltiazem 4) nifedipine

Answer 114

1. phenylalkylamines 2. dihydropiridines 3. benzothiazapines 4. dihydropiridines dipine in general = dihydropiridines

Question 115

verapamil causes what affect to bowel

Answer 115

constipation

Question 116

which B blockers are selective to heart, and which are non-selective (vascular affects too)

Answer 116

selective to heart = B1 - metoprolol - bisoprolol non selective = B1/B2 - propanolol - nodolol - carvedilol atenolol in between there

Question 117

hypertension step 1 hypertension step 2 hypertension step 3 hypertension step 4

Answer 117

1. if under 55 = ACEi/ARB if over 55 or A-C (any age) = CCB 2. ACEi/ARB + CCB 3. ACEi/ARB +CCB + thiazide diuretic 4. = resistant hypertension. consider adding - spironolactone - high dose thiazide diuretic - alpha blocker - beta blocker

Question 118

how do thiazide and loop diuretics work?

Answer 118

1 )block sodium and chloride reabsorption - DCT 2) loop diuretics block Na / K/ 2Cl transporter (moving Na, K, 2 Cl into cells from urine via Na movement) - loop of henle. This then reduces water outflow

Question 119

most common cause of heart failure =

Answer 119

coronary artery disease

Question 120

heart failure first line treatment

Answer 120

ACEi and B blocker others = aldosterone antagonist, ARB, nitrate, diuretics for congestions, digoxin

Question 121

what causes ANP/BNP release

Answer 121

Released by stretching of atrial and ventricular muscle cells Raised atrial or ventricular pressures Volume overload

Question 122

ANP/BNP effect

Answer 122

Increase renal excretion of sodium (natriuresis) and water (diuresis) Relax vascular smooth muscle (except efferent arterioles of renal glomeruli) Increased vascular permeability Inhibit the release or actions of: Aldosterone, angiotensin II, endothelin, anti-diuretic hormone (ADH) Counter-regulatory system to the renin-angiotensin system

Question 123

nitrates dilate arteries or beins

Answer 123

both - reduction or pre and after load

Question 124

stable angina first line

Answer 124

B blocker or CCB then combine then nitrate also : aspiring, clopidogrel, statins, GTN

Question 125

what do you give for MI pain releif

Answer 125

GTN spray | opiates - diamorphine

Question 126

anti arrythmic drugs - who is the classification system - name and examples of each class

Answer 126

Class I: Sodium channel blockers (lidocaine) Class II: Beta adrenceptor antagonists - non/selective (propanolol/bisoprolol) Class III: Prolong the action potential - (amiodarone) Class IV: Calcium channel blockers -( verapamil, diltiazem)

Question 127

Hypothalamic hormones act to mainly stimulate the release of all these hormones except ``` A ACTH B Growth hormone C TSH D Prolactin E LH ```

Answer 127

D - prolactin is inhibited by dopamine (not stimulated)

Question 128

``` which of the following is not a sign of hyperthyroidism? A palpitations B Tachycardia C Tremor D Goitre E proximal muscle weakness ```

Answer 128

A - this is a symptom, rather than a sign

Question 129

colonic cancer staging

Answer 129

Duke A - tumour in mucosa/submucosa Duke B - tumour in wall muscularis layer Duke C - tumour through muscularis layer and to the lymph nodes Duke D - metastasis

Question 130

Which is false regarding colon cancer? A Bowel cancer screening is offered to people aged 55 or over B The majority of cancers occur in the proximal colon C FAP and HNPCC are two inherited causes of colon cancer D Proximal cancers usually have a worse prognosis E Patients with PSC and UC have an increased risk of developing colon cancer

Answer 130

B - majority of cancers in distal colon (descending, sigmoidal, rectum)- sigmoidal is most - UC increases risk. UC and PSC together increase the risk to a higher degree

Question 131

A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of his disease? A Weight loss B Dysphagia to solids initially then both solids and liquids C Dysphagia to solids and liquids occurring from the start D Anaemia E Recent onset of symptom

Answer 131

C - B suggests lumen narrowed - more malignant - A, D, E are red flags

Question 132

what is key in histology to diagnose crohns/UC

Answer 132

crohns = granuloma UC = crypt abscess

Question 133

A 19 year old girl presents with abdominal pain and loose stool. Which of the features suggest that she has irritable bowel syndrome? ``` A Anaemia B Nocturnal diarrhoea C Weight loss D Blood in stool E Abdominal pain relieved by defaecation ```

Answer 133

E

Question 134

Helicobacter pylori... A It is a gram positive bacteria B HP prevalence is similar in developing and developed countries C 15% of patients with a duodenal ulcer are infected with H. Pylori D PPIs should be stopped 1 week before a H. Pylori stool antigen test E It is associated with an increased risk of gastric cancer

Answer 134

E - gram - - more prevalent in developing countries - 50% of duodenal ulcer are infected with H pylori - PPI should be stopped not 1 but 2 weeks before PPI

Question 135

H pylori - test - treatment - increases risk of?

Answer 135

stool antigen test breath test (C urea) both- no PPIs/antibiotics before h pylori increases your risk of - peptic ulcer - adenocarcinoma - mucosa-associated lymphoid tissue (MALT) lymphoma - treatment= 2 antibiotics (amoxicillin and clarithromycin) and PPI for 1week

Question 136

A 56 year old man presents with abdominal distension and shortness of breath. Examination revealed fever of 38C, a tense distended abdomen with shifting dullness. He also has dullness to percussion in the right lung base. Several spider naevi are seen on his chest. Which is the most important test in the management of this patient? A CXR B Ultrasound abdomen C Echocardiogram D Ascitic tap

Answer 136

D - this patient has liver cirrhosis - ascites - want to rule out spontaneous bacterial peritonitis as can have high mortality - ascites tap send off asap other important too, but do later: - CXR - pneumonia - US abdomen - look at liver, portal vein (to see if thrombosis) - echo - heart failure

Question 137

Which of the following features best distinguishes Ulcerative colitis from Crohn’s disease? ``` A Ileal involvement B Continuous colonic involvement on endoscopy C Non-caseating granuloma D Transmural inflammation E Perianal disease ```

Answer 137

B - A,C, D, E = Crohns. UC is colonic, doesnt get that far

Question 138

. A 68 year old lady presents with abdominal pain and distention. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Examination reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is NOT likely to be the cause of her abdominal pain and distention? ``` A Colon cancer B Adhesions C Ascites D Diverticulitis E Strangulated hernia ```

Answer 138

C - Tympanic = gas rather than fluid. ascites = dull on percussion (fluid) - diverticulitis can have perforation as a complication (gas, obstruction) - previous surgery mentioned so maybe adhesions

Question 139

A patient drinks 4 pints (568ml=1 pint) of beer (4%) a day, and 2 standard (175ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units of alcohol is he drinking per week? (round up to nearest whole number) ``` 73 units 62 units 94 units 57 units 49 units ```

Answer 139

A % x ml / 1000 Beer: 4% x 568ml x 4 x7 ÷ 1000 = 63.6 Wine: 13% x 175ml x 2 x 2 ÷ 1000 = 9.1 Total no. of units per week = 72.7 (73)

Question 140

A 71 year old man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean Sea. He was treated with a week of augmentin (co-amoxiclav) for his pneumonia. On day 7 of his admission, he started having diarrhoea 10 times a day without any blood. He feels unwell and dehydrated. He had a flexible sigmoidoscopy which showed this (yellow bumps all over tube). What is the likely organism responsible for his diarrhoea? ``` A Norovirus B Escherichia coli C Giardia lamblia D Clostridium difficile E Salmonella enteritidis ```

Answer 140

D - yellow = pseudomembranes - Norovirus: winter vomiting bug. Extremely infectious, via airborne transmission (from vomit) or contaminated food/water. - E. coli: harmful strains cause UTI, GE, meningitis. E coli 0157 strain can cause HUS (haemolytic uremic syndrome). - Giardia: protozoa infecting the small bowel causing chronic watery diarrhoea and malabsorption. Transmission via contaminated water/faecal oral route - Salmonella: from animal faeces. Chicken, eggs, contaminated fruit/veg etc. Can cause bloody diarrhoea. - C. diff: spore forming bacteria. Causes colitis when C diff replaces the normal gut flora, usually following Abx. Mainly seen in older patients , exposed to hospital environment and antimicrobials

Question 141

gastroenterisits presentation

Answer 141

GE- severe abdo cramps with bloody diarrhoea.

Question 142

C diff clinical features

Answer 142

- Abdominal pain - Watery diarrhoea, no blood - May develop bloody diarrhoea - increased WBC - Complicated by toxic megacolon and perforation

Question 143

salmonella, C diff, giardia lambia, norovirus: bloody diarrhea?

Answer 143

salmonella- yes C diff - no, watery diarrhea giardia lambia - no, watery diarrhea norovirus - no, vomitting

Question 144

A 52 year old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150 (Raised), ALP 988 (v raised), ALT 80 (slightly raised), positive AMA and a raised IgM. What is the most likely diagnosis? ``` A Simvastatin induced liver injury B Primary biliary cirrhosis C Gall stones D Autoimmune hepatitis E Primary sclerosing cholangitis ```

Answer 144

B - xanthelasma = yellow eye cholesterol deposits - RA shows other autoimmune condition so maybe autoimmune hepatitis but there are other markers (ANA, SMA) - A unlikely as she has been on the statin for a while - PBC has AMA +ve. and raised IgM. is commonly female and middle aged. associated with RA /Sjorgens. xanthalesema common - PSC is m:f and much younger (10-30), no AMA+ve, only ANCA+ve - gallstones - do have increased billirubin and raised LFTs but there is no pain/infection

Question 145

LFTs to determine whether the cause is related ti cholestasis or hepatocellular?

Answer 145

cholestasis (eg gallstones, PBC, PSC) - raised ALP, billirubin hepatocellular (eg alcohol, infection, autoimmune, drugs)- raised ALT/ AST

Question 146

PBC vs PSC - age - gender - symptoms

Answer 146

age: - PBC= 40-60 - PSC = 10-30 gender: - PBC = f>>m - PSC = f=m symptoms - PBC = fatigue, pruritus, xanthelasma (sometimes jaundice) - PSC = fatigue, pruritus, jaundice

Question 147

PBC vs PSC - associated conditions - increases the risk of what?

Answer 147

associated conditions: - PBC: RA/ sjorgens - PSC: IBD increased risk - PBC: increased risk of hepatocellular carcinoma - PSC: increased risk of cholangiocarcinoma

Question 148

PBC vs PSC - tests - where

Answer 148

test - PBC: AMA +ve, raised IgM - PSC: ANCA+ve where - PBC = intrahepatic bile duct - PSC= intra and extrahepatic bile duct. inflammation and sclerosis

Question 149

A 16 year old girl is admitted with vomiting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following test results would you NOT expect to see? ``` A Metabolic acidosis B A prolonged prothrombin time C A raised creatinine D Hyperglycaemia E ALT 1000 ```

Answer 149

D - paracetamol overdose can cause liver failure - hypoglycaemia (inhibition of gluconeogenesis) and the others are signs of liver injury - raised creatinine (renal failure) is bad sign- end stage - paracetemol overdose --> v high ALT, often over 1000

Question 150

A 68 year old unkempt and malnourished homeless man was brought to the hospital with haematemesis. Endoscopy found bleeding varices. Subsequent USS showed a coarse shrunken liver. On day 2 admission he was found to be ataxic, confused with nystagmus. What is the most likely cause of his neurological presentation? ``` A Alcohol toxicity B Alcohol withdrawal C Delirium tremens D Wernicke’s encephalopathy E Korsakoff syndrome ```

Answer 150

D - shrunken liver = cirrhosis - if you don't treat it (IV thiamine), it will go to Korsakoff syndrome (memory impairment, confabulation). this is chronic and irreversible - alcohol withdrawal looks more like agitation, insomnia, naus/vom, agitation, seizures / delerium tremors (more severe -- disorientation, tremors, impaired conciousness, sweating, visual/ auditory hallucinations). - ask about last drink. withdrawal = 6-24h. delerium tremors = 24-72h

Question 151

A 23 year old man was brought in at 2am with RIF pain and was diagnosed with acute appendicitis. He was stable and was scheduled for appendicectomy in the morning. During the ward round, he acutely deteriorated. He was immediately brought to theatre for a perforated appendix. What clinical signs would you NOT expect to see? ``` A Fever B Bowel sounds C Tachycardia D Rebound tenderness E Guarding ```

Answer 151

B - peritonitis : rebound tenderness, guarding - cant hear bowel sounds if severe - other symptoms : looks unwell, distressed, severe abdominal pain, hypotension, oliguria (shock)

Question 152

which is typical of OA? A 60 mins of early morning stiffness B painful, swelling across metacarpophalangeal joints and proximal interphalangeal joints C pain in the 1st carpo-metacarpal joints D mobile, subcutaneous nodules at points of pressure E alternating buttock pain

Answer 152

C - A - inflammatory arthritis - B more typical of RA : several joints, small joints - C is often how OA presents - D is RA - E is spondyloarthritis (sacroilitis)

Question 153

which of the following is an extra-curricular manifestaltion of RA? ``` A subcutaneous nodules B episcleritis C peripheral sensory neuropathy D pericardial effusion E all of the above ```

Answer 153

E - episcleritis : outer white of eye inflammation. quite painful and red. NSAID eyedrops - peripheral sensory neuropathy due to nerve compression - pericardial and plueral effusions are quite common - exudate -- protein rich

Question 154

subcutaneous nodules of RA histology

Answer 154

pastohistopneumonic (specific) - fibrinoid necrosis in the middle - ring of pallisading macrophages and fibroblasts - cuff of lymphocytes and plasma cells in connective tissue typically back of elbows, heels, back of hands, lungs painless but mobile

Question 155

which of the following is classic RA Xray? ``` A periarticular sclerosis B subchondral cysts C osteopohytes D periarticular erosions E new bone formation ```

Answer 155

D - inflammatory cytokines in joint break down bone - A,B, C, E = OA - E = spondyloarthritis

Question 156

mechanical back pain looks like

Answer 156

- short history - spontaneous - no trauma - maybe builder- exacerbates it - maybe bit overweight - no neurological deficits - pain not too localised - fine to give sick note, may need some exercise type thing to strengthen

Question 157

when is back X ray good/bad

Answer 157

tumour/ discitis otherwise not very useful

Question 158

what msk condition is a diet rich in dairy products good for

Answer 158

gout

Question 159

which of the following is not an autoimmune connective tissue disease? ``` A SLE B ehler danlos C primary Sjorgrens D systemic sclerosis E dermatomyositis ```

Answer 159

B - autoimmune connective tissue diseae: ANA +ve, raynauds, photosensitivity, rashes, arthritis, mouth ulcers - ehler danlos (stretchy skin, hypermobile joints, cardiac problems eg aortic aneurysm)/ marfans (long limbs, fingers, height, arched palate) are not autoimmune , they are inherited but they are connective tissue diseases

Question 160

23 y women presents with mouth ulcers, fever, painful white fingers and pleuritic chest pain. she is ANA +ve, with high ESR and leucopenic. which of the following would you not expect to see with her? ``` A deforming arthritis B photosensitive rash C seizures D pulmonary embolism E thrombocytosis ```

Answer 160

E - first step = diagnosis is SLE - white fingers = raynauds - leucopenic = low wbc - can also get sharp abdominal pain - serocytic - CRP would be normal - shape change but no erosions, correctable - seizures due to abnormal blood flow in brain - lupus associated with anti-phospholipid syndrome - clots (D) - thrombocytosis = increased platelets. lupus normally - thrombocytopenia

Question 161

which of the following is used to treat SLE? ``` A anti TNF B anti malarials C ustekinumab (IL12/23 blocker) D sulfasalzine E allopurinol ```

Answer 161

B hydroxychloroquine, chloroquine, mepacrine - good for arthritis, skin, mucosal membranes - anti TNF - RA, psoriatic arthirtis, crohns, UC, psoriasis, uveitits - antiTNF can induce lupus - ustekinumab (IL12/23 blocker) - spondyloarthritis, IBD

Question 162

cushings test: once you have established cushings syndrome, how do you determine cause?

Answer 162

assuming youve ruled out drug history etc 1. measure serum ACTH - none = adrenal tumour. so CT/ MRI/ sample to look for it - detectable = cushings disease (pit) or ectotic tumour. you distnguish between these two by ... a) high dose dexamathasone test b) CRH test - CRH given then cortisol measured 2h later - pit = cortisol rises - ectopic =

Question 163

how to confirm cushings in a patient

Answer 163

Overnight dexamethasone suppression test (1st line test) - This corticosteroid injected at night, blood cortisol measured in the morning - Normally- ACTH suppression and thus cortisol suppression (neg feedback) - No suppression in cushings syndrome 48 h dexamethasone suppression test (2nd line test- if no suppression) - Take dexamethasone 4/day for 2days - Measure blood cortisol at 0h and 48h - Cuhsings’s syndrome = no suppression not sure of the difference

Question 164

64-year-old male attends a GP practice complaining that this week he’s started experiencing some chest pain when he’s out birdwatching, it’s in the centre of his chest and eases off if he sits down for a few minutes. Which of the following would you expect to see on a stress ECG? ``` A Saddle shaped ST and PR depression B Tall Tented T waves and pathological Q waves C ST elevation D ST depression E Absent P wave ``` and what are the others =?

Answer 164

D - angina A pericarditis B hyperkalemia C STEMI E atrial fibrillation

Question 165

which heart murmur is mitral regurgitation? ``` A early diastolic B early systolic click C ejection systolic crescendo decrescendo D end diastolic E pansystolic ``` and what are the others =?

Answer 165

E A early diastolic = mitral stenosis B early systolic click = mitral valve replacement C ejection systolic crescendo decrescendo = aortic stenosis

Question 166

Trystan, a 54 year old caucasian gentleman, attends his annual diabetes check with the nurse practitioner. His blood pressure is 143/82. He’s currently on metformin and simvastatin. Which is the appropriate anti-hypertensive to give him? ``` A Amlopidine B bendroflumethiazide C candesartan D diltiazem E isomorbide mononitrate ```

Answer 166

C - ACEi/ ARB first line (current meds are not antiHTN) if under 55 and not A-C - A would be first line if patient was 55+/ A-C - D diltiazem = benzothiazapine (non-dihydropyridine CCB) acts on heart, not just vessels so not for HTN - E- nitrates not for HTN, for angina - B - diuretics are 4th line

Question 167

Heparin... A Increases cGMP and reduces intracellular Ca2+ concentration B Inhibits cyclooxygenase (COX) reducing production of thromboxane A2 C Inhibits production of vitamin-K dependent clotting factors D Inhibits thrombin and factor Xa E Induces vagal nerve stimulation

Answer 167

D E digoxin

Question 168

NSAID.. A Increases cGMP and reduces intracellular Ca2+ concentration B Inhibits cyclooxygenase (COX) reducing production of thromboxane A2 C Inhibits production of vitamin-K dependent clotting factors D Inhibits thrombin and factor Xa E Induces vagal nerve stimulation

Answer 168

B

Question 169

warfarin... A Increases cGMP and reduces intracellular Ca2+ concentration B Inhibits cyclooxygenase (COX) reducing production of thromboxane A2 C Inhibits production of vitamin-K dependent clotting factors D Inhibits thrombin and factor Xa E Induces vagal nerve stimulation

Answer 169

c

Question 170

where are the following? ``` Roth Spots Janeaway lesions Oslar nodes Splinter hemorrhages Clubbing ```

Answer 170

``` eyes hands hands hands hands ```

Question 171

step 1 and step 2 in DVT investigation

Answer 171

1. Wells score | 2. d dimer

Question 172

Diagnostic test for heart failure? ``` A Troponin I B Atrial natriuretic peptide (ANP) C Brain natriuretic peptide (BNP) D CK-MB E FBC ```

Answer 172

C

Question 173

CK-MB =

Answer 173

enzyme found in heart muscles | conc rise when damage to heart muscle eg MI

Question 174

Elliot presents to you with bloating, stinking stools which float in the pan. He thinks he might be coeliac You organise some blood tests to confirm his diagnosis, which of the following antibodies is associated with coeliac disease? ``` A Anti-DsDNA B Anti-phospholipid C ANCA D Alpha-gliadin E Rheumatoid factor ```

Answer 174

D

Question 175

SLE is associated with... ``` A Anti-DsDNA B Anti-phospholipid C ANCA D Alpha-gliadin E Rheumatoid factor ```

Answer 175

A

Question 176

vasculitis is associated with... ``` A Anti-DsDNA B Anti-phospholipid C ANCA D Alpha-gliadin E Rheumatoid factor ```

Answer 176

C

Question 177

immodium is also called

Answer 177

loperamide anti motilitic

Question 178

omeprazole =

Answer 178

PPI

Question 179

metronidazole=

Answer 179

antibiotic

Question 180

Jenny’s been non-stop to the loo and has recently been diagnosed with IBS using the Rome III criteria. She’s tried out a low FODMAP diet but her diarrhoea won’t budge. Which of the following drugs is the most appropriate pharmacological intervention for this patient? - Ferrous sulphate - Loperamide - Methotrexate - Metronidazole - Omeprazole

Answer 180

loperamide

Question 181

Which of the symptoms below would indicate that the patient was suffering from Inflammatory Bowel Disease (IBD) and not Irritable Bowel Syndrome? ``` A Smelly stools B DXA scan revealing decreased bone mineral density C Nocturnal diarrhoea D Abdominal cramps E Feeling fatigued ```

Answer 181

C

Question 182

which is false about ascending cholangitis: A Caused by bacterial infection of biliary tree B Patients experience epigastric pain C Patients present with a temperature D Patients present with yellowing of the skin and sclera E Murphy’s sign is negatuve

Answer 182

B and E - RUQ pain - fever - jaundice = charcots triad murphys sign +ve (RUQ pain not LUQ on inhalation) - gallbladder problem

Question 183

The gallbladder is supplied blood by the cystic artery. What is the cystic artery a branch of? ``` A coeliac trunk B Gastoduodenal artery C Left gastro-epiploic artery D Right hepatic artery E Splenic artery ```

Answer 183

D R hepatic comes off hepatic artery proper, which comes off common hepatic, which comes of coeliac trunk, along with gastric and splenic. L gastro epiploic comes off splenic gastroduodenal comes off common hepatic

Question 184

which hep has DNA virus

Answer 184

B

Question 185

haemochromatosis cause

Answer 185

autosomal recessive inheritence esp n europe

Question 186

uncontrolled Cu2+ = sign

Answer 186

wilsons kaiser fischer rings around pupil

Question 187

alendronic acid =

Answer 187

bisphosphonate

Question 188

positive C-urea breath test after epigastric pain following eating. what is the treatment in addition to PPI?

Answer 188

amoxicillin and clarithromycin this is H pylori peptic ulcer

Question 189

alendronic acid action.... A Cause increased bone deposition B Cause reactivation of the metaphysis and epiphysis C Inhibit osteoclast activity and cause osteoclast apoptosis D Reduce the signally pathway between osteoblasts and clasts by increasing RANK ligand E Increase removal of calcium into the haversian canal within bone

Answer 189

C alendronic acid = bisphosphonate

Question 190

A 55-year- old painter and decorator comes in to the GP. He describes aching in his hand and arm with pins and needles sensation in his thumb, index and middle fingers. Shaking his hand about in the morning gets rid of this seems to help. The most likely diagnosis is… ``` A Cervical spine fracture B Compression of median nerve C Compression of radial nerve D C8-T1 nerve lesion E Compression of ulnar nerve ```

Answer 190

B - this is carpals syndrome: median nerve compression repetitive actions - palm : thumb side = median, pinky side= ulnar - back: thumb side = radial, pinky side = ulnar

Question 191

What is the most common cause of osteomyelitis? ``` A Strep Pneumonia B Staph Aureus C Strep Pyogenes D Mycobaterium tuberculosis E. H. Influenzae ```

Answer 191

B

Question 192

Brenda, a 92 year old female, recently had a fall at home and broke her hip. Her DXA scan gave her a T score of -1.6. What does this mean?

Answer 192

osteopenia

Question 193

Otto, a 21 year-old male presents to your rheumatology clinic complaining of a 3 week history of a stiff and painful knee. On history taking you illicit he also has painful urination (urethritis) and painful eye (conjunctivitis) .Which of the following organisms is the most likely cause? ``` A    Staphylococcus aureus B    E.coli 0194 C    Streptococcus Pneumonia D    Heamophilius influenza E     Chlamydia ```

Answer 193

E

Question 194

A GP does a joint aspiration of a patient with gout and sends the fluid for microscopy which of the following best describes the results seen A    Tophi B    Needle shaped crystals which are +ve birefringent C    Needle shaped crystals which are -ve birefringent D    Rhomboid shaped/ brick like crystals which are +ve birefringent E    Rhomboid shaped/ brick like crystals which are -ve birefringent

Answer 194

C

Question 195

progressively worsening shortness of breath. He also has digital clubbing, a dry cough and diffuse fine inspiratory crackles are noted on auscultation. Pulmonary nodules are found on the lungs on CT scan. what is the diagnosis? what MSK condition is this most likely the cause?

Answer 195

pulmonary fibrosis RA

Question 196

gout relief / prevention

Answer 196

relief - a steroids (Colchine if not tolerated) prevention - xanthine oxidase inhibitors (allopurinol)

Question 197

A 71 year old lady presents to clinic with ulnar deviation, rheumatoid nodules and squaring of the thumb. She states this has been a progressive change over the last 10 years, but she has ‘just got on with things’. Which blood test would be most specific for this condition? ``` A Anti-CCP B CRP C ESR D Rheumatoid factor E Alkaline phosphatase ```

Answer 197

A - this is RA - A-D all def present but A most specific (not sure about E- a liver indicator)

Question 198

septic arthritis. joint aspirate culture grows Staph. Aureus Which antibiotic is most appropriate given that the patient reports she is allergic to penicillin? ``` A Gentamycin B Clindamycin C Ceftriaxone D flucloxacillin E fluoroquinolone ```

Answer 198

b clindamycin - flucoxacillin would have been first choice except for allergy - erythromycin would also do well - Cefotaxime for gram neg + gonococcal - Vancomycin for MRSA

Question 199

A 53 year old lady is admitted to the acute medical unit with a painful knee. It is hot and swollen. Her observations on admission include oxygen saturations of 96%, blood pressure 99/68mmHg, temperature 38.1 degrees and heart rate 101bpm. On examination there is reduced movement of the joint due to pain. She looks flushed and is concerned because she has rheumatoid arthritis and is worried this is another flare. What is the most likely cause for the above presentation? ``` A Gout B Osteoartritis C pseudogout D Rheumatoid arthritis flare E Septic Arthritis ```

Answer 199

E classic septic arthritis = triad of fever, pain, and impaired range of movement

Question 200

Mrs Jones gets a diagnosis of osteoarthritis. A few years later she returns to see the doctor for her annual review. She says she is now struggling with her hands, finding it difficult to do buttons up on clothing, and writing with a pen. Which of the following clinical signs are you most likely to identify on examination of this lady’s hands? ``` 1 Bouchard node at the DIPJ 2 Boutonniere’s deformity 3 Heberden’s nodes at the DIPJ 4 Swan neck deformity 5 Ulnar deviation ```

Answer 200

3 - bouchard = PIPJ - others (2, 4, 5) = RA

Question 201

Patient with frequency, urgency and dysuria. Whilst awaiting culture results, treat with ..... ``` A ciproloxacin B co amoxiclav c nitrofurantoin D tazocin E no antibiotic needed ```

Answer 201

C

Question 202

e coli pyelonephritis treatment and for how long

Answer 202

co amoxiclav 14 days (7 if normal UTI)

Question 203

dipstick / mircobiology for catheter bag. | is this able to give indication of infection?

Answer 203

no and no | unable to do diagnosis

Question 204

urinanalysis of pregnant lady shows leukocytes and protein. this indicates ``` A nothing, this is normal of pregnancy B pre-eclampsia C UTI D possibility of pre-eclampsia and UTI E obstetric cholestasis ```

Answer 204

D - protein - preecclampsia - leukocytes - UTI

Question 205

(along with urinary leukocytes and protein) microscopy of a pregnant urine sample shows epithelial cells but no pus cells, suggesting ``` A definite infection B pyelonephritis C pre eclampsia D sample contamination E none of the above ```

Answer 205

D so need repeat before diagnosis/ treatment

Question 206

the risk of pyelonephritis in untreated asymptomatic bacterirua in pregnancy is ``` A 5-10% B 20-40% C 50-60% D 60% E 70-75% ```

Answer 206

B

Question 207

A 64-year-old man presents to A and E with chest pain that radiates to the left shoulder, nausea, and sweating. He has no allergies and takes simvastatin for high cholesterol. Which of the following is the most appropriate initial management? A. Troponin blood test B. Full cardiac examination C. 300mg aspirin D. High flow oxygen, fluid bolus and GTN spray E. Referral for percutaneous coronary intervention

Answer 207

C

Question 208

Which of the following ECG changes is diagnostic in a patient with a myocardial infarction? ``` A. Absent P waves B. Wide QRS complex C. Tall, tented T waves D. ST depression E. QT prolongation ```

Answer 208

D MI - ST elevation/depression, T wave inversion, abnormal Q wave A = AF B = bundle block E = QT syndrome (jervel lange nielson, romano ward, hypoK, hypoCa, drugs, etc) C = hyperK

Question 209

John is a 53-year-old Swiss man who attended GP clinic 2 weeks ago for an annual checkup and recorded a blood pressure of 155/100mmHg; consequently, he was given an ambulatory blood pressure monitor for 2 weeks. His results show an average blood pressure of 138/91mmHg. What is the most appropriate management for this result? ``` A. No management needed, as this result is below 140/90mmHg B. Ramipril C. Amlodipine D. Losartan E. Bendroflumethiazide ```

Answer 209

B - A - the cut of for ABMP is 135/85 (not 140/90) - ACE i is for him as he is under 55 - ramipril (55+/A-C : CCB) - C = CCB - D = ARB (if intolerant to ACEi) - E = diuretic (if ACEi/ARB + CCB not effective

Question 210

Jane is a 68-year-old woman who has presented to her GP following a diagnosis of hypertension. She is worried that she is at increased risk of having a heart attack and wants to know how likely this is. Which framework should her GP use to calculate Jane’s risk? ``` A. CHA2DS2-VASc score B. QRISK2 score C. Wells score D. ABCD2 score E. COVID19 score ```

Answer 210

B A. CHA2DS2-VASc score = risk of stroke in AF patient B. QRISK2 score = MI C. Wells score = DVT/PE D. ABCD2 score = stroke after TIA

Question 211

Which of the following best describes the concept of relative risk in the context of a trial examining the efficacy of statins compared to placebo in reducing heart attacks? A. The risk of a heart attack in the statin group was 2.67% compared to 1.65% in the placebo group, therefore statins decrease the risk of heart attack by 1.02%. B. The risk of a heart attack in the statin group was 2.67% compared to 1.65% in the placebo group, therefore statins decrease the risk of heart attack by 36%. C. 98 patients would need to be treated with statins to prevent 1 heart attack. D. 98 patients would need to be treated with placebo to cause 1 heart attack. E. If this study was conducted 100 times, these results would occur in 95 of the 100 times

Answer 211

B - question asks about relative risk! - A is an absolute risk reduction but sentence phrases it as relative (B) - C = NNT - D = NNH

Question 212

Which of the following is the correct order for the electrical conduction of the heart? A. AV node -> atria -> SA node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles B. SA node -> ventricle -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> atria C. SA node -> bundle of His -> Purkinje fibres -> atria -> AV node -> L and R bundle branches -> ventricles D. SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles E. SA node -> atria -> AV node -> L and R bundle branches -> Purkinje fibres -> bundle of His -> ventricles

Answer 212

D

Question 213

34-y/o Judy presents with symptoms of hypertension despite being on a current regimen of antihypertensive medications. The junior doctor orders appropriate blood tests and the results come back which suggest a diagnosis of Conn’s syndrome. She is scheduled to have an operation for an adrenalectomy. What medication is prescribed prior to her operation to stabilise her BP and K+ levels? ``` A. Aspirin B. Furosemide C. Ramipril D. Spironolactone E. Warfarin ```

Answer 213

D - Conns = too much aldosterone so hypertension and low K - spironolactone = K sparing diuretic - furosemide = loop diuretic (not k) sparing

Question 214

Which of the following is NOT a cause of hypercalcaemia? ``` A. Down’s syndrome B. Familial benign hypocalciuric hypercalcaemia C. Malignancy D. Sarcoidosis E. Thyrotoxicosis ```

Answer 214

A

Question 215

. Molly has come into GP complaining of diarrhoea, heart palpations and feeling quite flushed. She has also noticed a change in mood but thinks this can due to her being recently fired from her job. What is the most likely explanation for her symptoms? ``` A. Carcinoid syndrome B. Depression C. Hypertension D. Hypothyroidism E. Pituitary tumour ```

Answer 215

A - carcinoid = Bronchospasm (maybe sob, chest pain, wheeze), Fast heart rate, palpitations, Diarrhea /const, Skin flushing- red face/neck and general cancer symptoms - looks a bit like hyperT too but that is not an option

Question 216

pancolitis

Answer 216

UC throughout large bowel

Question 217

proctitis

Answer 217

UC limited to rectum

Question 218

left sided collitis

Answer 218

UC : rectum to descending colon

Question 219

Diffuse inflammation throughout the large bowel, with evidence of granulomas and faecal leukocytes. Crypt architecture is normal. is this a picture of UC or crohns

Answer 219

– This may seem like an unclear picture of which type of IBD this is. The diffuse nature of the inflammation is not classic of Crohn’s disease, and the presence of granulomas is not classic of Ulcerative colitis. And in both Crohn’s disease and ulcerative colitis you would expect to see some crypt architecture changes. Therefore, it is important to consider other causes of inflammation. In this case, this is a clinical picture of infectious colitis.

Question 220

halitosis =

Answer 220

v bad breath

Question 221

A man comes in for a medication review. One of the medications he is on is tamsulosin to treat his BPH. Which of these is a potential side effect which you need to ask about? ``` A. Erectile dysfunction B. Haematuria C. Nausea and vomiting D. Postural hypotension E. Weight loss ```

Answer 221

D - alpha blocker - it Relaxes prostate and base of bladder (smooth mucsle) but also alpha 1 adrenoreceptors are in vasculature --> postural hypotension, dizzy, syncope

Question 222

A patient presents to A&E with left sided loin pain. An abdominal x-ray shows a stone blocking the ureter on the left side. Monitoring of the patient’s urine output shows it has been less than 0.5ml/kg/hr for over 6 hours and the medical team are worried about an AKI. Which value are they most worried about when monitoring the patient’s U&Es? ``` A. Chlorine B. Creatinine C. Potassium D. Sodium E. Urea ```

Answer 222

C - as function decreases, unable to excrete K so hyperK which is a medical emergency

Question 223

CKD GFR stages

Answer 223

Stage 1 > 90 ml/min with evidence of renal damage Stage 2 60-89 ml/min with evidence of renal damage Stage 3a 45-59 ml/min with or without renal damage Stage 3b 30-44 ml/min with or without renal damage Stage 4 15-29 ml/min with or without renal damage Stage 5 <15 ml/min, established renal failure

Question 224

Loop diuretics act where specifically

Answer 224

ascending limb of loop of henle na+/k+/2cl- transporter

Question 225

K+ sparing diuretics act where specifically

Answer 225

DCT inhibiting Na channels so no Na and water reabsoption

Question 226

thiazide diuretics act where specifically

Answer 226

DCT at Na/Cl transporter

Question 227

hodgkin lymphoma pain?

Answer 227

painless except on drinking alcohol

Question 228

difference between non/ hodgekins

Answer 228

``` hodgkin = assymettrical, young (20s) and old non = symetrical, only old ```

Question 229

Myeloma presentation

Answer 229

- Anaemia, neutropenia, thrombocytopenia due to bone marrow infiltration - Recurrent infection due to monoclonal Igs - Renal impairment due to the free light chains - Bone pain, pathological fractures and vertebral collapse due to bone lesions (increases calcium and Il-6)

Question 230

auer rods

Answer 230

Auer rods are red staining, needle-like bodies seen in the cytoplasm of myeloblasts, and/or progranulocytes in certain leukemias. AML

Question 231

reed sternburg cells

Answer 231

giant cells found with light microscopy in biopsies from individuals with Hodgkin lymphoma

Question 232

CLL/CML effect in wbc

Answer 232

raised - CLL = raised lympocytes - CML = raised myeloid wbc acute of each = variable

Question 233

AML /ALL platelets

Answer 233

low

Question 234

what do all leukamias have the same (fbc)

Answer 234

anaemia

Question 235

Ann arbor classification = used for what

Answer 235

1. Single LN region 2. >/= 2 nodal area on the same side of the diaphragm 3. Nodes on both sides of the diaphragm 4. Disseminate e.g. metastasised to the liver ‘B symptoms’ are constitutional symptoms such as fever, weight loss and night sweats A/B - B indicates systemic B symptoms (night sweats, weight loss etc) used for non hodgekins and hodgkins

Question 236

DVT gold standard investigation

Answer 236

doppler US - CT/Xray not useful - D dimer good but no specific (just sensitive) - venography good too but not as

Question 237

Which do you not see in iron deficient anaemia? ``` A. Brittle hair and nails B. Koilonychia C. Pale conjunctivae D. Pale skin E. Splenomegaly ```

Answer 237

E - conjunctiva = pull under eye down, that pink bit - koilonychia = spoon nails - E can occur but v rare

Question 238

amitryptilline side effects

Answer 238

blurred vision confusion dry mouth urinary retention these are due to anticholinergic properties- that decrease the parasympathetic system

Question 239

macrolides work how? examples of macrolides

Answer 239

inihbit bacterial protein synthesis erythomycin clarithromycin azithromycin

Question 240

quinolones work how? examples of quinolones

Answer 240

Interferes with bacterial DNA replication and transcription ``` ciprofloxacin lomefloxacin norfloxacin moxifloxacin levofloxacin ```

Question 241

Rosie is a 19-year-old female. She has been brought into A&E by her housemates as she has a severe headache and fever. The doctor suspects meningitis. Rosie is known to have suffered from angioedema when previously exposed to amoxicillin. Which of the following drugs does she have a relative contraindication to receiving? ``` A. Ceftriaxone B. Chloramphenicol C. Co-amoxiclav D. Paracetamol E. Sodium Chloride 0.9% solution for infusion ```

Answer 241

``` C = absolute contraindication A= relative contraindication ``` ?

Question 242

``` Which of the following medications are licensed for use in the UK to treat heroin addiction? A. Diclofenac B. Methadone C. Metformin D. Oxycodone E. Tramadol ```

Answer 242

B

Question 243

diclofenac =

Answer 243

nsaid

Question 244

James, a 38-year-old golfer, is diagnosed with a pheochromocytoma and is scheduled for surgery in several weeks. What is the first drug his endocrinologist will prescribe to him to prepare him for the upcoming surgery? ``` A. Atenolol B. Atorvastatin C. Carbimazole D. Insulin E. Phenoxybenzamine ```

Answer 244

E During the removal of the tumour it is possible for a large amount of catecholamine release to occur – causing refractory hypertension. Therefore, by pre-blocking the alpha receptors with phenoxybenzamine you prevent this happening. You do not use beta blockers (A) because blocking B2 mediated vasodilatation could cause uncontrolled A1 mediated vasoconstriction, again causing severe, refractory hypertension. However once alpha blockade is achieved, you may also add beta blockers prior to surgery. Atorvastatin (B) is used in the management of hypercholesterolaemia, Carbimazole (C) is used in thyrotoxicosis and Insulin (D) is used in the management of diabetes.

Question 245

diverticulitis pathogen cause

Answer 245

Diverticulitis is due to colonisation of diverticulae by enteric bacteria such as E. coli

Question 246

ischaemic collitis cause

Answer 246

no microbiology | associated with AF

Question 247

coffee ground vomitus indicates what

Answer 247

upper GI tract bleeding (blood mixes with gastric acid) - black spots in vomit

Question 248

reduced skin turgor indicates

Answer 248

dehydration eg severe diarrhea

Question 249

Which of the following organisms does not cause atypical pneumonia? ``` A. Chlamydia psittaci B. Coxiella burnetii C. Legionella pneumophila D. Mycobacterium avium complex E. Mycoplasma pneumoniae ```

Answer 249

D - D = AIDS related illness presenting similarly to pulmonary TB

Question 250

side effects of TB medication

Answer 250

Rifampicin: Red/orange discolouration of secretions e.g. urine + tears; Isoniazid: Peripheral neuropathy; Pyrazinamide: High uric acid levels → gout; Ethambutol: Colour blindness + reducedvisual acuity (EYE-thambutol)

Question 251

Which antibiotic is not indicated in Staphylococcus aureus infection? ``` A. Ampicillin B. Cefotaxime C. Clarithromycin D. Flucloxacillin E. Vancomycin ```

Answer 251

A A: indicated in UTI, respiratory infections and enterococcal infections (endocarditis, wound infection, intra-abdominal infection); B: used in severe infection eg bacterial meningitis; C: indicated in Staph infections, strep throat and atypical pneumonias; D: indicated in Staph aureus and Group A Strep e.g. cellulitis + necrotizing fasciitis; E: MRSA infection

Question 252

which heart valve is most commonly affected in IE

Answer 252

tricuspid (R) - first encountered after systemic circulation

Question 253

``` Which of the following antibiotics does not inhibit cell wall synthesis? A. Benzylpenicillin B. Cefotaxime C. Erythromycin D. Teicoplanin E. Vancomycin ```

Answer 253

C Macrolide abx such as clarithromycin and erythromycin inhibit protein synthesis. Beta lactam abx, including pencillins (BenPen) and cephalosporins (Cefotaxime), and Glycopeptide abx (Vancomycin, teicoplanin) all inhibit cell wall synthesis. - mycin = not all same - vancomycin = glycopeptide (Beta lactam, MRSA) - clarithromycin/erythromycin = macrolides

Question 254

what score is used for community acquired pneumonia

Answer 254

CURB-65 criteria – score 1 for each of: ``` Confusion; Urea > 7mmol/L; Resp rate >30/min; Blood pressure - (Sys <90mmHg, Dia <60mmHg); Age >65. ```

Question 255

first and second line for osteoperosis

Answer 255

1st = alendronic acid (bisphosphonate) and AdCal (vit D/ calcium supplement) 2nd= denosumab (monoclonal antibody)

Question 256

bisphosphonates action

Answer 256

Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity nothing RANK ligand related

Question 257

denosumab action

Answer 257

Works as a monoclonal antibody for RANK ligand leading to inhibited osteoclast activity

Question 258

A 58-year-old male presents with sudden painful inflammation of his big toe. What is the treatment? ``` A. Allopurinol B. Colchicine C. Diclofenac D. Febuxostat E. IV antibiotics ```

Answer 258

B - reduces inflammation acutely A and D = preventitive - allopurinol in flare up can make it worse!! C no longer prescribed (S/E, CI)

Question 259

haemorrhage CT appearances

Answer 259

sub arach -- star shaped sub dural -- crescent/ sickle extra dural -- lemon/ biconcave

Question 260

migraine first line treatment

Answer 260

NSAID | topiramate/ amitriptyline are for prophylaxis

Question 261

. A 41-year-old woman visits her GP complaining of recurrent headaches. She says that the pain is often just on one side of her head and feels as though her head is throbbing. She has tried to take some paracetamol which helps a little bit but not enough and these headaches are starting to interrupt her daily life. She is worried about driving because she has experienced some really strange feelings for a few minutes before the headaches start. She said these are quite hard to explain. What would be the 1st line treatment for this patient? ``` A. Amitriptyline B. Aspirin C. Ibuprofen D. Topiramate E. Withdrawal of current medication ```

Answer 261

C - this is migraine - A/D for prevention - B for tension headache

Question 262

Pseudomonas aeruginosa - causes what

Answer 262

infection to patients admitted to hospital 1w+

Question 263

is strep pneumonia or n. meningitidis more common cause for menigitis

Answer 263

strep pneumoniae

Question 264

A 19-year-old girl visits her GP because she has started experiencing some unpleasant symptoms. It started with her needing the toilet much more than usual and feeling numb in various parts of her body. She then noticed her hands have started shaking and she feels generally very weak. She is experiencing pain from random things including some pain in her eyes, and whenever she goes in the shower everything feels ten times as worse. This will occur for about a week, and then she will start to feel better again. What is the likely diagnosis based on the clinical history? ``` A. Creutzfeldt-Jakob disease B. Duchenne Muscular Dystrophy C. Motor Neurone disease D. Multiple Sclerosis E. Myasthenia Gravis ```

Answer 264

D .A very rare and usually affects people 55+. Can cause muscle weakness. B. only affects males – X-linked recessive C. symtpoms depending on where the lesion is this will present with different symptoms. motor weakness, D. symptoms depending on the lesion in the CNS. Uhthoff’s phenomenon (symptoms getting worse with heat) is very characteristic of MS, and the patient usually suffers attacks for a period of days -> weeks before remaining symptom free for a short period of time. The symptom free period decreases as the disease progresses. E. presents with muscle fatigue, but not many of the other symptoms. characteristic order = extraocular, bulbar face, neck, limb girdle and then trunk.

Question 265

postive babinski reflex in adults

Answer 265

UMN lesion

Question 266

what medicine is used to treat Huntington's chorea

Answer 266

risperidone chorea= random jerky limb movements

Question 267

what medicine is used to treat huntington's psychosis

Answer 267

haloperidol

Question 268

sertalline=

Answer 268

SSRI | depression

Question 269

gabapentin =

Answer 269

for epileptic seizures and neuropathic pain

Question 270

``` What is the treatment for Guillian-Barre syndrome? A. Low dose aspirin B. Dexamethasone C. IV immunoglobulin D. SC Sumatriptan E. Pyridostigmine ```

Answer 270

C - prevent harmful antibody damage other medicines for it = - plasma exchange - ventillation if nesc - LMW heparin and compression stocking to reduce risk of venous thrombosis

Question 271

``` A patient is complaining of a recurring headache that lasts about an hour each time and presents as a tight pain going around the head like a band. There is no nausea or vomiting, but some sensitivity to light. Which of these is NOT a cause of tension headaches? A. Depression B. Lack of sleep C. Missed meals D. Dehydration E. Stress ```

Answer 271

d

Question 272

``` A 64-year-old woman goes to A&E because she is really worried about a rash that has developed along the side of her arm. She says it is painful and she also feels quite unwell. A history is taken, and she had recently been in contact with her granddaughter who had chicken pox. Which is the most useful investigation? A. Blood culture B. CT head C. Immunofluorescence D. Lumbar puncture E. Viral PCR ```

Answer 272

E - D for meningitis/ encephalitis - C good but not as good - A helps but not complete - B not helpful

Question 273

when do you treat DVT/PE with thrombolysis?

Answer 273

if big clot (patient not so stable) otherwise - LMW heparin warfarin/DOAC long term anticoags

Question 274

Pyridoxine and TB?

Answer 274

is what you would give to prevent the peripheral neuropathy caused by isoniazid (S/E)

Question 275

. A 45-year-old man is diagnosed with TB and started on appropriate medication. 2 months into his regime, he starts to experience pins and needles in his legs and muscle weakness. His GP suggests this is likely a side effect of his current TB medication. Which of the following is the likely cause? ``` A. Rifampicin B. Isoniazid C. Pyridoxine D. Ethambutol E. Pyrazinamide ```

Answer 275

B - Rifampicin can present with red/orange discolouration of urine - Isoniazid with peripheral neuropathy, - Pyrazinamide with hyperuricaemia causing gout - Ethambutol affecting the eyes (colour blindness and visual acuity). - Pyridoxine (B6) is what you would give to prevent the peripheral neuropathy caused by isoniazid.

Question 276

pneumothorax - when is no treatment needed

Answer 276

no SOB pneumothorax is <2cm oxygen/ observation for mildly symptomatic but stable

Question 277

pneumothorax - when decompress with large bore canula vs chest drain vs needle aspiration

Answer 277

needle aspiration = primary spontaneous pneumothorax chest drain = patient unstable / secondary pneumothoraxes/ needle aspiration failed x2 large bore canula = this then develops into tension pneumothorax (trachea deviated, shock, resp failure, cardioresp arrest, medical emergency)

Question 278

talk through ABG interpretation

Answer 278

1) pH- acidic/alkali (low pH= acid) acidosis ) increase in CO2 = resp decrease in HCO3 = met alkalosis) decrease in CO2 = resp increase in HCO3 = met

Question 279

What drug group works as such “works by blocking acetylcholine receptors which when normally activated cause contraction of the bronchial smooth muscle; therefore, when blocked by this class of drug cause bronchodilation”? ``` A. H1 receptor antagonists B. Inhaled corticosteroids C. Leukotriene receptor antagonists D. Long-acting muscarinic antagonists E. Short acting beta-adrenergic receptor agonists ```

Answer 279

D - muscarinic = ACh - E acts on beta 2 receptors - A = antihistamine

Question 280

A 28-year-old woman presents with a dry cough and shortness of breath for the last 8 months. She also has a persistent rash on her shins. A chest X ray shows bilateral hilar lymphadenopathy. A biopsy is done to confirm diagnosis. Which shows non-caseating granulomas with epithelioid cells. Which of the following electrolyte disturbance is most indicative of the above diagnosis? ``` A. Hyperkalaemia B. Hypercalcaemia C. Hyponatraemia D. Hypocalcaemia E. Hypokalaemia ```

Answer 280

B - this is sarcoidosis - E - heavy GI loss (d/v, laxatives), burns, drugs - C - small cell cancer (ADH secretion --> SIADH) - D - CKD, hypoPTH, pancreatitis

Question 281

goodpastures effects where

Answer 281

glomerulus and pulmonary basement membranes

Question 282

anti smooth muscle seen in what pathology

Answer 282

autoimmune hepatitis | PBC

Question 283

6in1 vaccine contains?

Answer 283

diphtheria, tetanus, pertussis, polio, Hib and Hepatitis B

Question 284

well's score interpretation

Answer 284

DVT 2 or more = likely PE 2-6 = moderately likely 7 or more = highly likely

Question 285

normal temp/ RR/ HR

Answer 285

temp: 36.4-37.2 (37.8+- fever) RR: 12-20 HR: 60-100

Question 286

AVPU stands for

Answer 286

alert verbal pain unresponsive bit like glasgow coma scale, assess conciousness

Question 287

CHA2DS2VASc factors

Answer 287

Risk of stroke for AF - Congestive Heart Failure - Hypertension - Age (75+=2) - Diabetes - Stroke/ TIA/ Thromboembolism (2 points) - Vascular disease (prioir MI, plaque, PAD) - Age (65-74, 75+) - Sex category (female=1)

Question 288

abcd2 score factors

Answer 288

risk of stroke for TIA - age - BP - Clinical features of TIA (weakness unilateral =2, speech disturbance =1 ,other =0) - duration of symptoms (<10, 10-60, 60+) - diabetes

Question 289

wells score factors

Answer 289

DVT - active cancer - bedridden / surgery - calf swelling unilateral - superficial veins - entire leg swollen - locally tender - pitting oedema unilateral - paralysis/paresis - previous DVT - other diagnoses PE - DVT - other diagnoses - HR - immobilisation/ surgery - previous PE/DVT - hemoptysis - malignancy

Question 290

qrisk2 score factors

Answer 290

risk of heart attack/stroke in next 10 years - age - sex - ethnicity - postcode - BMI - smoking - diabetes - FH of angina/heart attack (first degree relative) - CKD - AF - blood pressure treatment - blood pressure - RA - cholesterol (total:HDL)

Question 291

hasbled factors

Answer 291

risk of bleeding with AF (on anticoagulation) - hypertension - alcohol - stroke - renal disease - liver disease - prior major bleeding/ predisposition - unstable/high INR - age - medication the predisposes to bleeding (Aspirin, clopidogrel, NSAIDs)

Question 292

collapsing pulse =

Answer 292

aortic regurgitation

Question 293

pulsus paradox =

Answer 293

BP drops during inspiration severe asthma COPD blood loss cardiac

Question 294

radio-radial delay=

Answer 294

pulse stronger in one arm coarctation of the aorta (narrow)

Question 295

An ejection systolic murmur heard loudest on inspiration would be suggestive of which valvular pathology? ``` A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis E. Pulmonary stenosis ```

Answer 295

E

Question 296

aortic stenosis murmur= | loudest when=

Answer 296

ejection systolic crescendo decrescendo murmur +slow rising narrow pulse pressure loudest on expiration

Question 297

aortic regurgitation murmur/ pulse =

Answer 297

early diastolic descrescendo murmur | collapsing pulse

Question 298

mitral stenosis murmur=

Answer 298

apical mid diastolic rumble

Question 299

3 cardinal signs of heart failure =

Answer 299

shortness of breath, fatigue, ankle oedema ``` + often orthnopnea, paroxysmal nocturnal breathing, cold peripheries, raised JVP cyanosis hypotension increased weight 3/4th heart sounds, displaced apex beat, murmurs ```

Question 300

Which of the following signs on ECG would be most indicative of a diagnosis of Right Bundle Branch Block? ``` A. R wave in V1, and Slurred S wave in V1 B. R wave in V1 and Slurred S wave in V6 C. R wave in V6 and Slurred S wave in V1 D. R wave in V6 and Slurred S wave in V6 E. Wide QRS and abnormal pattern. ```

Answer 300

B - R wave - resembles m. - Slurred S wave- resembles W. - MaRRoW. M in V1 = R wave (resembles M), W in V6 = slurred S wave (resembles W) - E = complete heart block

Question 301

Which of these isn’t a feature of tetralogy of Fallot? ``` A. Atrial septal defect B. Hypertrophy of the right ventricle C. Overriding aorta D. Pulmonary stenosis E. Ventricular septal defect ```

Answer 301

A

Question 302

tetralogy of fallot contains treatment

Answer 302

congenital - ventricular septal defect - pulmonary stenosis - R ventricle hypertrophy (higher pressure in R side that left, so R--> L shunt) - overriding aorta (aorta right over septal defect- think it says more about the septal defect than the aorta) surgery - patch ventricular septal defect - rebore pulmonary artery - maybe new pulmonary valve if regurgitated

Question 303

eisenmengers =

Answer 303

hypertrophy of arterioles (irreversible)- restrict high lung pressure can be due to VSD

Question 304

VSD / ASD direction of blood flow

Answer 304

both L to R so not blue tetralogy of fallot = R to L due to pulmonary artery flow obstructed by shunt

Question 305

AVSD= associated with?

Answer 305

hole in centre where atria and ventricles meet trisomy, Downs repair is tricky

Question 306

patent ductus arteriosus=

Answer 306

from aorta to pulmonary artery, doesnt close machinery murmur, big heart, breathless can cause eisnenmengers

Question 307

achalasia = cause

Answer 307

peristalsis reduced in oesophagus and lower oesophageal sphincter does not relax to open when swallowing so food/drink does not pass to stomach and is often vomitted back up (no blood) rarely genetic, mainly nerve issues maybe virus but not sure

Question 308

mallory weiss tear causes where presentation treatment

Answer 308

increase in intra abdominal pressure (coughin, retching, dry heaves (alcoholic)). risk factors = alcoholism, eating disorder, male, NSAIDs tear is in oesophagogastic junction results in vomitting, with blood, retching most heal spontaneously, sometimes surgery

Question 309

A 42-year-old female presents to the gastro clinic complaining of chest pain. She says that it feels like a burning sensation in the middle of her chest that gets worse when is lying or bending down. She also says that she wakes up in the evening feeling breathless. She hasn’t been vomiting any blood, had any difficulty swallowing food and drink or lost any weight. What medication would you give first to try treat this patient? ``` A. Sulfasalazine B. Omeprazole C. Amoxicillin D. Prednisolone E. Ranitidine ```

Answer 309

B - this is GORD - B = PPI - A is for UC - C = antibiotic - D = corticosteroid - E ranitidine = H2 antagonist . can be used in GORD but not the 1st line

Question 310

GORD pain presents how

Answer 310

middle of chest burning worse when lying/ bending down may wake up in evening feeling breathless no blood in vomit

Question 311

sulfasalzine

Answer 311

5 aminosalicyclic acid (like mesalazine) ``` for UC (not crohns) along with prednisolone and fluids (depending on severity) ``` also DMARD- MSK

Question 312

A patient comes in with abdominal pain, bloating, constipation. You examine the abdomen and discover a hard mass in the left iliac fossa and carry out a digital rectal examination which shows an empty rectum. What is the first line investigation in this case? ``` A. Abdominal X-ray B. Abdominal CT C. Abdominal ultrasound D. Abdominal MRI E. Full blood count ```

Answer 312

A - obstruction first line investigation = Xray - large bowel obstruction here

Question 313

Which of these is correct regarding duodenal ulcers? A. They cause pain when eating and it is relieved several hours after eating B. They cause pain several hours after eating and the pain gets better when eating C. They cause pain when the patient is hungry, and it is relieved by eating D. They cause pain when eating and are relieved by drinking E. They cause pain when the patient drinks and is relieved by eating

Answer 313

B - pain is due to acid in the duodenum so is several hours after eating (stomach empty). Relieved by eating (acid dissolves food, used up, stomach full)

Question 314

does UC or crohns have a stronger genetic link whats the deal with gender

Answer 314

crohns (higher proportion with first degree relative) crohns f>m. UC f=m

Question 315

dermatitis herpetiformis

Answer 315

rash - immunological response to gluten on skin, commonly extensor surfaces coeliac

Question 316

A 60-year-old male presents with blood and mucus in his stools for the past 3 weeks, he has had on off diarrhoea and constipation during this time. He has lost 2 stone over the 3 weeks. He smokes and reveals his father died of rectal cancer. Which is the most appropriate investigation? ``` A. Blood test: FBC, U+E, Tumour Markers etc B. Colonoscopy C. Double contrast barium enema D. CT Colonoscopy E. MRI ```

Answer 316

B - A useful for monitoring but not diagnostic - C - avoids risk of perforation but misses small lesions (Second line) - D good for older patients, esp for excluding cancer

Question 317

appendicitis pain migration

Answer 317

umbilical to right iliac fossa + fever + naus/vom often young (10-20)

Question 318

Which of these is not a cause of diverticulum? ``` A. Alcohol B. Low fibre diet C. Obesity D. NSAIDs E. Smoking ```

Answer 318

A others are

Question 319

pANCA test for what

Answer 319

UC - specific, but not sensitive PSC RA other things - polyangitis, glomerulonephritis

Question 320

Which of the following organisms is the most common cause of pyelonephritis? ``` A. Coagulate negative staphylococcus B. Enterococcus C. Escherichia coli D. Klebsiella E. Proteus ```

Answer 320

C

Question 321

prostatitis/ cystitis presentation

Answer 321

prostatitis - pelvic/perineal pain (3m+) - trauma involving nerve damage (Eg fall) - dysuria - frequency - ejaculatory pain cystitis - dysuria - frequency - urgency - urine that smells/ cloudy/ dark/ blood

Question 322

Lucy is a 30-year-old woman who is 2 months pregnant, as her GP you find that she has a lower urinary tract infection and are considering which antibiotic to prescribe her. Which of the following medications would you definitely avoid prescribing? ``` A. Amoxicillin B. Cephalexin C. Fosfomycin D. Nitrofurantoin E. Trimethoprim ```

Answer 322

E - D only contraindicated in third trimester - E is teratogenic in 1st trimester

Question 323

budd chiari = triad

Answer 323

occlusion of hepatic veins rare triad = abdominal pain, ascites, liver enlargement

Question 324

Which of the following is not a complication of polycystic kidney disease? ``` A. Cardiovascular disease B. Kidney stones C. Nephrotic syndrome D. Polycystic liver disease E. Subarachnoid haemorrhage ```

Answer 324

C - A : PKD --> hypertension - B : PKD --> slower urine, stasis - C: nephrotic syndrome causes = autoimmune, DM, infection, neoplasia, gold, NSAIDs, atopy, SLE - D : polycystic liver/ pancreas disease yes - E: PKD --> berry aneurysms --> SAH

Question 325

How is Hodgkin lymphoma (HL) clinically differentiated from Non-Hodgkin lymphoma (NHL)? A. Clinical presence of B symptoms in HL and its absence in NHL B. Disease is limited to lymph nodes in HL whilst in NHL disease can spread beyond lymph nodes C. Presence of Reed-Sternberg cells in HL on histological observation and absence of such cells in NHL D. Presence of Auer rods in HL on histological observation and absence of such cells in NHL E. Physical examination reveals lymphadenopathy in HL whilst this is not the case in NHL

Answer 325

C - A - B symptoms = systemic symptoms. they are less common in nonhodgkin but not absent - B - not true of either, can spread beyond - D = AML - E - true of both non and Hodg

Question 326

A patient presents to A&E with a fever and confusion. Upon further investigation, you find that she has AKI and her FBC reveals thrombocytopenia and anaemia. You recognise this as Thrombotic Thrombocytopenic Purpura and realise it is a medical emergency and you need to treat her immediately without waiting for diagnostic confirmation. What is the urgent gold standard treatment for someone with TTP? ``` A. Platelets B. Hydroxycarbamide C. Immunosuppressants D. Plasma exchange E. Broad spectrum antibiotics ```

Answer 326

D - this is an emergency, do not wait for confirmation - plasma exchange replenishes ADAMTS13 (what is deficient in TTP, degrades vWF) - A would increase thrombosis! bad news - B this is for polycythaemia rubra vera, sickle cell - C this is a treatment but not urgent - E there is no infection

Question 327

frax score factors

Answer 327

risk of fracture in next 10 years ``` age gender BMI previous fracture parent fractured hip smoker glucocorticoids RA secondary osteoperosis alcohol ```

Question 328

alteplase =

Answer 328

fibrinolytic drug | used mainly MI, PE, ischaemic stroke

Question 329

artesunate=

Answer 329

first line treatment for severe /complicated malaraia quinine/doxycycline are alternatives (contraindication etc)

Question 330

complicated/ uncomplicated malaria treatment

Answer 330

complicated - first line treatment for severe /complicated malaraia = artesunate - quinine/doxycycline are alternatives (contraindication etc) uncomplicated - cholorquine - artemisnin combination therapy for mixed infection primaquine for hypnozoites

Question 331

A 24-year-old male presents to General Practice complaining of a painful elbow. Upon examination the GP suspects a diagnosis of olecranon bursitis. The patient asks the GP about the pathological process that occurs in this condition. The GP explains the process of inflammation. Which of the following is not a clinical feature of acute inflammation? ``` A. Rubor B. Dolor C. Suppuration D. Tumor E. Loss of function ```

Answer 331

C also dolor (pain) suppurration (pus formation) is a potential outcome of acute inflammation

Question 332

Which of the following pathologies would result in resolution? ``` A. Acute cholecystitis B. Cerebral infarction C. Full nephrectomy D. Myocardial infarction E. Partial lobectomy ```

Answer 332

A all others are permanent - repair

Question 333

paracetomol overdose 1st line treatment

Answer 333

N -acetyl cystine

Question 334

Which of the following is not characteristic of an upper Gi bleed? ``` A. Coffee ground vomit (haematemesis) B. Diarrhoea C. Hypotension D. Melaena (black stools) E. Tachycardia ```

Answer 334

B

Question 335

Mr Jones, a 57-year-old man, presents to his GP with an intermittent pain in the right upper quadrant (RUQ), made worse when he eats, especially fatty meals. He has a BMI of 35 and on examination has yellowish sclera. Last night he had a fever and rigors (convulsive sweating and shivering). What is the likely diagnosis? ``` A. Acute pancreatitis B. Ascending Cholangitis C. Biliary colic D. Primary Biliary cholangitis E. Vincent’s angina ```

Answer 335

B - biliary colic and ascending cholangitis both have RUQ, worse with fatty food, and jaundice. ascending cholangitis also has fever +rigors. - PBC - more like lethargy, itch. not related to fatty foods - vincent's angina = ulceration of mouth and gum inflammation. commonly smokers.

Question 336

Mr Gascoigne, a 52-year-old male, is brought to the emergency department by the police after wandering confused in the street. He is a known alcoholic but from what history you can gather, it seems that he has not had a drink in the last 48 hours. Which of the following would be the most appropriate immediate pharmaceutical treatment for this patient? ``` A. Adrenaline B. Amlodipine C. Chlordiazepoxide D. Methadone E. Morphine ```

Answer 336

C chlordiazepoxide = 1st line treatment for alcohol withdrawal (We are within 72h) - adrenaline is only helpful is cardiac insufficiency - amlopidine = last resort cardioversion - methadone = opioid addiction treatment - morphine is pain killer, not appropriate for this case

Question 337

korsakoff syndrome cause

Answer 337

wernickes syndrome so also B1/ thiamine deficiency commonly in alcoholics

Question 338

Which of the following side effects is most likely to occur with Alendronic Acid use? ``` A. Cough B. Gout C. Haemolytic anaemia D. Oesophagitis E. Urinary frequency ```

Answer 338

D - this is why it is recommended to take bisphosphonates first thing in morning and remain upright for 30mins - C = side effect of sulphasalazine (DMARD), RA

Question 339

EMG is used in diagnosis of what?

Answer 339

polymyositis (idiopathic symmetrical proximal muscle weakness) - shows fibrillation EMG= electromyography

Question 340

pencil in cup deformity=

Answer 340

bone end eroded into sharpened pencil | -- psoriatic arthritis - arthritis mutilans

Question 341

Which of the following X ray signs is mostly likely to be found a patient with psoriatic arthritis? ``` A. Bamboo spine B. Pencil in cup C. Periarticular erosions D. Osteophytes E. Rhomboid crystals ```

Answer 341

B bone end eroded into sharpened pencil -- psoriatic arthritis - arthritis mutilans A - ankylosing spondylitis B - gout, RA C - OA D - pseudogout

Question 342

A 23-year-old student comes to your GP clinic complaining of back pain. He describes an aching pain that has come on over a few months and now wakes him at night. He denies weight loss, fevers or change in appetite. He has found gentle exercise to be helpful but struggles to keep up with his usual yoga class, finding the stretches difficult. Given the likely diagnosis, what is the most appropriate first line management? ``` A. Chemotherapy B. Ibuprofen C. Infliximab D. Paracetamol E. Watch and wait ```

Answer 342

b this is ankylosing spondylitis - NSAID should be used in the meantime whilst confirming with other tests (Xray, bloods) - paracetemol is not an NSAID (used if ibuprofen contraindicated) - infliximab (a monoclonal antibody, a DMARD), along with antiTNF used for severe AS (local pain relief steroid injections, surgery too)

Question 343

Beryl is an 83-year-old lady presenting to A&E with a hip fracture after falling from her chair in her care home. On examination Beryl looks frail and underweight. She suffered a stroke 4 years ago and has been left with right sided weakness and has fallen several times. Last year she broke her wrist. You are concerned about her bone health and order a DEXA scan. The T score comes back as -2.2. Which of the following is the most likely cause underlying Beryl’s fractures? ``` A. Osteoarthritis B. Osteomalacia C. Osteopenia D. Osteoporosis E. Osteosarcoma ```

Answer 343

C - not greater than -2.5 (then would be D) E more common in younger patients

Question 344

A 52-year-old man complains of an incident occurring a few hours ago ‘a black curtain suddenly coming down’ in his right eye. He says that the episode was painless and only lasted a few minutes and that his vision was back to normal after. You check his observations and note the following: RR 14, HR 70, T 36.5oC, SPO2 98% room air, BP 165/95. On listening to his neck, you can hear a bruit. He has no other past medical history other than having type 2 diabetes which is controlled with medication. What is the most likely diagnosis? ``` A. Amaurosis fugax B. Glaucoma C. Optic neuritis D. Papilledema E. Retinal vein thrombosis ```

Answer 344

A - retinal artery occlusion ``` B = painful, blurry (DM) C = painful, blurry (MS) D = headaches E = painless but resulting vision loss is prolonged ```

Question 345

A 23-year-old investment banker is admitted to A&E after having a generalised tonic-clonic seizure that was witnessed by his brother. The brother states that the patient was ironing his shirt when they seemed to gasp and fall to the floor, with their limbs then jerking for about a minute. After being unresponsive for a few minutes, the patient recovered and noticed that their tongue was bleeding.The brother claims that the patient has never had a seizure before, although when working late the patient would sometimes twitch his head or arm. There is no other significant past medical, family or medication histories. Cardiovascular and neurological examinations were normal, blood tests were normal and ECG was normal as well. What pharmacological treatment should be offered to the patient before their discharge from hospital? ``` A. Clonazepam B. Gabapentin C. Rivastigmine D. No treatment needed E. Sodium valproate ```

Answer 345

E A ? B 2nd line focal seizure C Alzheimers D unprovoked seizure needs prevention of further episodes

Question 346

. Which of the following clinical features is NOT commonly found in patients with Parkinson’s disease? A. Blank facial expressions except when told to smile B. Extremely small handwriting C. Hands shaking when trying to reach for something D. Rigid limbs and difficulty getting out of bed E. Slow walking

Answer 346

C ``` A , hypomimia - common B, micrographia - common C - implies intention tremor whereas PD has resting tremor, (which stabilises on active movement) D - rigidity - common E - bradykinesia - common ```

Question 347

A 48-year-old woman presents with a daily headache and blurred vision that has worsened over the past several months. You are worried that she could have a space-occupying lesion. Which of the following clinical features is least likely to occur in patients with brain tumours? ``` A. Ascending paralysis from the lower limbs B. Coma C. Dysdiadochokinesis D. Nausea and vomiting E. Seizures ```

Answer 347

A - A- looks like guillain barre (autoimmune and not brain tumour related) - B - late stage due to raised ICP - D- naus/vom due to raised ICP

Question 348

A 69-year-old woman presents in A&E with extreme right-sided head pain and trouble seeing things with her right-eye. She struggles to dictate her history to you, claiming that she also has jaw pain too. She claims she is normally healthy but in the recent months has become more and more drained, with aches all over her body. She also mentions weak shoulders and hips. When you examine her, her right-side scalp is very painful to the touch. Her blood tests also came back and reveal a markedly raised ESR. What is the most appropriate next step in the management of this lady? A. IM benzylpenicillin B. Oral prednisolone C. Prescribe codeine and advise plenty of bed rest at home D. Refer to ophthalmology for their input E. Urgent CT head

Answer 348

b - this is giant cell temporal arteritis (related to polymyalgia rheumatica- weakness, aches) - steroids advised esp with vision loss A - meningitis C- painrelief but not underlying cause D stabilise asap

Question 349

A 48-year-old man attends A&E with back pain. He works as a delivery driver and says that the pain started after loading a pallet into his truck. On presentation, he is in visible discomfort and is unable to walk. He also says that he has been unable to go to the toilet since the pain started. A neurological examination of his lower limbs reveals intact sensation throughout, except his perineum. Power in both his legs is also reduced throughout. A digital rectal examination reveals poor anal tone. Which of the following diagnoses is the most likely? ``` A. Cauda equina syndrome B. Compression of the spinal cord C. Musculoskeletal injury D. Nerve root compression E. Vertebral fracture ```

Answer 349

A - inability to open bowels/ urinate - reduced anal tone - saddle anaesthesia (numbness in saddle area) - prolapsed disc compresses nerves in cauda equina B - would have sensation loss below lesion, and UMN below lesion D- would have shooting pain and decreased sensation

Question 350

Which of the following best describes the mechanism of action of the drugs neostigmine and pyridostigmine that are used to treat myasthenia gravis? F. Blocks active site of acetylcholinesterase, increasing the amount of Ach available to the post-synaptic membrane A. Crosses the blood-brain barrier and is converted into dopamine which acts to reduce the neurological symptoms B. Inhibits the conversion of angiotensin I to angiotensin II C. Inhibits the conversion of arachidonic acid to prostaglandins D. Reduces intracranial pressure by setting up an osmotic gradient between the CSF and subarachnoid space

Answer 350

F ``` A = Levodopa B= ACEi C = inbuprofen , COXi D = mannitol ```

Question 351

Which of the following is least likely to be a risk factor for developing peripheral neuropathies? ``` F. Diabetes Mellitus A. Immunocompromised status B. Lymphoedema C. Systemic lupus erythematosus D. Thiamine (Vit B1) deficiency ```

Answer 351

B least involvement with nerve damage all others can be causes

Question 352

ischaemic stroke should recieve altepase in what length of time

Answer 352

<4.5h ideally CT needs to exclude haemorrhage first

Question 353

What is the commonest cause of an infective exacerbation of COPD? ``` A. Haemophilus Influenzae B. Parainfluenza Viruses C. Rhinovirus D. Staphylococcus Aureus E. Streptococcus Pneumoniae ```

Answer 353

A e also common but a more common

Question 354

COPD exacerbation. immediate investigation?

Answer 354

ABG - establish need for respiratory support / ventilation later: assess peak flow, send urine/sputum cultures

Question 355

life threatening asthma attack signs

Answer 355

``` SpO2 <92% (oxygen saturation) Pa02 <8kPa normal PaCO2 PEF <33% best/predicted altered conciousness exhaustion arrythmia hypotension cyanosis silent chest poor respiratory effort ```

Question 356

Sp02 =

Answer 356

oxygen saturation

Question 357

Jess, a 21-year-old asthmatic has come to see her GP after she noticed that she feels shaky and her heart races after she takes one of her new medications for asthma. Which medication below is most commonly associated with a fine tremor? ``` A. Beclametasone inhaler B. Montelukast oral medication C. Proprionate inhaler D. Prednisolone oral medication E. Salbutamol inhaler ```

Answer 357

E - relaxes airway smooth muscle but also acts on sympathetic heart receptors, causing tachycardia, and sympathetic receptors in skeletal muscle, causing tremor ``` A,C = inhaled steroids - oral candida, stunted growth B = leukotriene receptor antagonist ```

Question 358

. Which type of lung cancer is most commonly seen in non-smokers? ``` A. Adenocarcinoma B. Carcinoid tumour C. Large cell and differentiated carcinoma D. Small cell lung cancer E. Squamous cell carcinoma ```

Answer 358

A - still commonly smokers though too D next

Question 359

Which lung cancer is strongly associated with asbestos exposure? ``` A. Adenocarcinoma B. Large cell and differentiated carcinoma C. Mesothelioma D. Squamous carcinoma E. Small cell carcinoma ```

Answer 359

C - can get compensation - must go to coroner - asbestos also associated with fibrosis, pleural thickening, pleural plaques

Question 360

factor V leiden =

Answer 360

type of thrombophilia (inherited)