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AC1 > Formative Qs > Flashcards

Formative Qs Flashcards

1
Q

A 6 month old child is dehydrated and unconscious due to an accident that resulted in burns over their head and upper body. The child needs urgent fluid replacement. What is your preferred access route for IV infusion?

A

A cut down, 1.5cm anterior and superior to the medial malleolus

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2
Q

A 56 year old man reported the presence of a lump down below. It sits around the testicle, is non reducible, non tender, non pulsatile, soft, transilluminates and you are able to get above the swelling. What is it most likely to be?

A

Hydrocele: fluid in the tunica vaginalis

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3
Q

A 27 year old woman is having her first baby and is in need of anaesthesia. An epidural would be the preferred option but there is a large patch of infected psoriasis on the thoracolumbar region of her back. Where else could be injected to achieve anaesthesia of perineum and vaginal canal?

A

Sacral hiatus

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4
Q

Where is it best to access the radial artery when taking an arterial blood gas?

A

Lateral to the flexor carpi radialis tendon as the artery here is not covered by tendon or muscle

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5
Q

During a lumbar puncture there are 2 resistances/pops as the needle advances at L4/5 level. What structure is pierced to produce the first pop?

A

Ligamentum flavum

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6
Q

A 23 year old woman has a lump in her neck. It is located in the anterior triangle, it’s firm, smooth and subcutaneous, it does not move on swallowing and it is on the anterior border of sternocleidomastoid. What is the likely diagnosis?

A

Branchial cyst

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7
Q

In a patient with a conductive hearing loss in the right ear, what Rinne and Weber test results would you expect?

A

Rinne test: bone conduction better than air in right

Weber test: sound lateralises to right ear

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8
Q

In a lymph node biopsy, the histology report reads: germinal centres have lost polarity and are replaced by neoplastic uniform population of small lymphocytes with cleaved nuclei. Less than 5% of cells are undergoing mitosis. What is the likely diagnosis?

A

Centrocyte rich follicular lymphoma. Tumour is originating in germinal centres (follicles). Cleaved cells = centrocytes

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9
Q

3 year old boy presents with severe oral herpes simplex virus which has spread to his nostrils. He has previously had severe chicken pox at 18 months, URI which lead to viral pneumonia at 24 months, extensive wart growth on feet treated with cryotherapy at 14 months. Which cells are likely functioning abnormally?

A

T lymphocytes
Viruses are intracellular organisms recognised by T cells which co ordinate a response to infection. Abnormal T cells means reduced viral recognition and so increased severity of infections

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10
Q

Patient has a cough productive of green sputum and increasing SOB. HR 105, temp 38.1, RR 22, reduced chest expansion, crackles and dullness to percussion at left lung base. What is the likely causative organism?

A

Streptococcus pneumoniae

Community acquired pneumonia

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11
Q

28 year old homeless man has chronic cough for 3 months, haemoptysis, weight loss and drenching night sweats. Evidence of consolidation in left lung apex, chest X-ray shows cavitating lesion in left apex. What histology is likely to be present?

A

Well formed granulomas with caseous necrosis - TB

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12
Q

26 year old woman presents with a discrete breast lump. It is smooth, lobulated, rubbery and relatively mobile. No evidence of tethering or overlying skin changes. What is the most likely diagnosis?

A

Fibroadenoma - breast mice

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13
Q

Histological examination of a wide local excision of breast tissue shows focal low grade ductal carcinoma in situ. All resection margins are clear by at least 5mm. What is the management implication of these findings?

A

No further treatment required

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14
Q

Patient has mild pain on moving due to osteoarthritis. They are intolerant to NSAIDs. What other class of drugs is recommended for this type of pain in the WHO pain ladder?

A

Paracetamol

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15
Q

Ebola is an example of what type of disease?

A

Zoonosis

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16
Q

82 year old man with known SCLC has nausea, vomiting and increasing confusion. Clinically he is euvolaemic. Investigations show Na of 125mmol/L and plasma osmolality of 260mmol/kg. What type of clinical manifestation of the cancer does this acute problem likely represent?

A

Euvolaemic hyponatraemia. Differentials are SIADH, primary polydipsia and hypothyroidism. In SCLC, likely ectopic secretion of ADH from tumour causing problem - paraneoplastic effect

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17
Q

In which combination of rhesus status parents, is a baby most at risk of rhesus isoimmunisation?

A

Second pregnancy of mother who is rhesus negative and father who is rhesus positive. First pregnancy, exposure to rhesus antigen in baby would mean mum develops antibodies, second pregnancy then at risk

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18
Q

52 year old woman has eyelid drooping and double vision. She has generalised weakness which was worse recently when she had a viral illness. On examination you notice mild ptosis. What is the most likely pathological basis for this presentation?

A

Loss of function of ACh receptors: myasthenia gravis

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19
Q

74 year old retired tyre worker has visible haematuria. A cystoscopy shows multiple papillary lesions arising from bladder mucosa. Exposure to which group of chemicals is most likely to underly this presentation?

A

Aromatic amines - transitional cell carcinoma

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20
Q

A couple attend genetic counselling service seeking advice on recurrence of multifactorial cleft palate in their future offspring. What feature in the history would increase recurrence?

A

Bilateral cleft palate in proband
More severe phenotype, greater recurrence risk as proband will have greater numbers of genetic and environmental mutations associated with cleft palate

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21
Q

24 year old shows azoospermia on sperm analysis and is found to have anti sperm antibodies. On questioning the patient reveals a history of testicular trauma as an adolescent. What is the likely factor underlying this presentation?

A

Release of hidden antigens
Testes normally has a blood:testes barrier which has been breached by trauma meaning that antigens which are usually hidden have been exposed. This means that anti sperm antibodies have been generated

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22
Q

Patient is seen in clinic with suspected Haemophilia A. What blood test would be diagnostic?

A

Low plasma levels of factor VIII

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23
Q

62 year old man seen in renal clinic with high BP, RBC present on urine dip, high levels of protein in urine, high urea and creatinine. What pattern of renal disease presentation is this?

A

Nephritic syndrome

Haematuria, proteinuria, hypertension, degree of renal insufficiency

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24
Q

26 year old man has early onset emphysema and liver dysfunction. Genetic testing shows derangement in handling of alpha 1 anti trypsin. What is the pathological basis for the liver dysfunction in this patient? And for the dysfunction in the lungs?

A

Liver: Increased apoptosis. Mis-folding of protein in the liver, leading to endoplasmic reticulum stress, triggering apoptosis
Lungs: enzymatic digestion of tissues

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25
Q

A man is cannulated via the cephalic vein over the anatomical snuffbox. The procedure took 2 attempts and caused iatrogenic damage to a nearby structure. What symptom is he most likely to complain of?

A

Paraesthesia over the first dorsal interosseous

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26
Q

What is the agent responsible for tuberculosis?

A

Mycobacterium tuberculosis

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27
Q

What is the mode of transmission of Tuberculosis?

A

Airborne - droplet spread

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28
Q

What is the gold standard investigation for diagnosis of tuberculosis?

A

Discharged pus or biopsy material for direct staining and culture

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29
Q

Describe the legal position regarding a child patients refusal of treatment, especially if their parents disagree with their decision

A 
Competent child (under 16) can consent to treatment and no one can override that
Refusal of treatment is different. Possible for refusal from competent child to be overridden by someone with authority to consent eg parent
If there is parental disagreement, court can be asked to make decision on what is in child's best interests
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30
Q

List the 8 stages in managing an outbreak of a communicable disease

A 
Confirm diagnosis 
Immediate control
Convene an Outbreak Control Team
Review epidemiological and microbiological information
Case finding 
Descriptive epidemiology 
Analytical study
Declare outbreak over
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31
Q

What is a vesicle?

A

Raised lesion filled with serous fluid that measures less than 5mm in maximum diameter

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32
Q

What type of epithelium surfaces the labia minora?

A

Non keratinised stratified squamous

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33
Q

With regards to sex and sexual behaviour, what issues would you discuss with a young person with symptoms in a GUM clinic?

A 
Pregnancy 
STIs
Side effects/risks of OCP/contraceptives
Non volitional sex
Emotional distress due to heartbreak
Image sharing and consequences
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34
Q

Why should partner notification be offered to patients with STIs?

A

Reduce risk of transmission from partner to people/ reduce risk of spread to wider population
Protect patient from re infection
Offer sexual partners tests for STIs
Offer sexual partners treatment

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35
Q

What is the major determinant of the clinical manifestations of a virus?

A

The tropism of the virus for specific tissues and cell types

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36
Q

List cytopathic effects of viruses once they have entered cells

A

Prevention of critical host macromolecules
Production of degradative enzymes
Production of toxic proteins
Induction of apoptosis

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37
Q

What is the mechanism of action of a Topoisomerase inhibitor?

A

Cause permanent strand breaks in DNA by preventing resealing of nicked strands which leads to apoptosis

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38
Q

Why are chemotherapy drugs given in combination?

A

Different modes of action of drugs so more effective
Different toxicities so can tolerate better
Reduces chance of cancer resistance

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39
Q

What cell types production would be stimulated by a granulocyte colony stimulating factor drug?

A

Neutrophils
Eosinophils
Basophils

40
Q

What are the borders of the ante cubital fossa?

A

Superior: epicondylar line
Lateral: brachioradialis
Medial: pronator teres

41
Q

Which veins can be cannulated on the anterior surface of the elbow?

A

Cephalic
Basilic
Median cubital

42
Q

What things must be considered when determining what is in an unconscious patients best interests?

A

Whether they have an ADRT
Whether they have a LPA
Consider their past/present wishes, feelings, beliefs and values
Take into account views of those caring for the person
Clinical indications and consequences of the treatment

43
Q

In a paracetamol overdose, what LFT results would you expect to see in AST, albumin and PTT?

A

AST: raised
Albumin: lowered
PTT: raised

44
Q

An ABG result shows: pH 7.31, pCO2 4.6kPA, pO2 10.78kPa, HCO3 21mmol/L. State the pattern of blood gas abnormality present

A

Metabolic acidosis with partial respiratory compensation

45
Q

What act governs the removal of human organs for donation?

A

Human Tissue Act

46
Q

Name and explain the ethical principle prioritised by the opt in system of organ donation

A

Respect for autonomy
Right of an individual to decide whether or not they wish to donate organs after death, right to self determination and to decide what happens to their body

47
Q

Name 2 types of living organ donation

A

Directed donation to a specified individual
Paired donation
Pooled donation
Altruistic donation

48
Q

Give criteria that patient must meet in order for the local authority to provide housing under the statutory homelessness duty

A

Priority need
Eligible for public funds
Local connection
Unintentionally homeless

49
Q

What is a hallucination?

A

Perception experienced in the absence of an external stimulus of any modality

50
Q

Howdoesasecondorder/personauditoryhallucinationdifferfromathirdpersonauditoryhallucination?

A

Secondpersonauditoryhallucinationthevoiceisaddressing thepersonexperiencingthehallucination
Thirdpersonauditoryhallucinationthepersonhearsvoicestalking aboutthemusingthethirdperson

51
Q

Define the term social stigma

A

Attributes,behavioursorpathologicalstatesthatsetpeople apart from others that mark them as less acceptable or inferior

52
Q

A homeless person has experienced abuse from other homeless people and local residents because of his hallucinations, what type of stigma is he experiencing?

A

Enacted stigma

53
Q

State 3 purposes for which it is possible to detain a person under the mental health act

A

Holdingpowertoenableaformalpsychiatricassessmentto take place(72hours)
Psychiatricassessmentofapatientwithaviewtotreatment(28days)
Treatmentforapsychiatricdisorder(6months)

54
Q

In a patient who has cut their wrists in a suicide attempt, what hand examination findings might you expect?

A

Thenarmusclewasting
Sensoryloss/ change over lateral 3.5 digits
Laterallyrotatedthumb
Weak/absentthumbopposition

55
Q

What types of nerve injury can occur?

A

Neuropraxia: nerve stun/ bruising
Axonotmesis: internal tearing
Neurotmesis: cut or ripping of nerve

56
Q

Which type of deficiency is likely to cause a microcytic hypochromic anaemia?

A

Iron deficiency

57
Q

What type of referral is done for a patient presenting with cancer symptoms?

A

2 week wait referral

58
Q

What type of malignant neoplasm is most likely in the sigmoid colon?

A

Adenocarcinoma

59
Q

What imaging modality would be used to stage a malignant neoplasm in the sigmoid colon?

A

Contrast enhanced CT of the chest, abdomen and pelvis

60
Q

Which lymph node group is likely to be the first site of Metastasis of a sigmoid colon cancer?

A

Inferior mesenteric nodes

61
Q

A neoplasm is resected. It has breached the aerosol surface of the colon and involves several lymph nodes Whattypeofmetastaticspreaddoesbreachoftheserosalsurfaceincreasetherisk of?

A

Transcoelemic

62
Q

An ECG of a patient shows atrial fibrillation, which form of dementia are they most at risk of?

A

Vascular dementia

63
Q

Why is AF a risk factor for vascular dementia?

A

Atrialfibrillationcausesabnormalbloodflowintheatriawhich predisposestointra-atrial thrombosis which can lead to cerebral emboli

64
Q

Describe 3 ways in which dementia can impair decision making capacity with reference to the criteria in the mental capacity act

A

Dementiacanaffectshorttermmemorysothepatientmaynotbeabletoretaintherelevantinformation
Dementiacanaffectreasoningprocessesorjudgmentandsomayaffecttheabilitytounderstandrelevantinformationortoweightheinformationtomakeachoice
Inmoreadvanceddementiapatientsmaynotbeabletocommunicateandsofailthecommunicationcriteriaintheassessment

65
Q

What is the mechanism underlying HbA1C formation?

A

Haemoglobinundergoesglycationinvivoatarateproportionaltothebloodglucoseconcentration

66
Q

HbA1creflectstheglycaemiccontroloverwhattimespan?

A

2-3 months

67
Q

Give 2 ways in which diabetes is atherogenic

A

Abnormalitiesoflipidmetabolismoccurringasadirectresultofdiabetes
Glycationoflipoproteinsleadingtoalteredfunction
Endothelialdysfunction
Increasedoxidativestress

68
Q

What is characteristic of the pain of intermittent claudication?

A

Broughtonbyexerciseorrelievedbyrest

69
Q

What is concordance?

A

A negotiated, shared agreement between clinician and patients concerning treatment regimes, outcomes and behaviours

70
Q

What are important factors relating to patient prescriber relationships that influence concordance?

A

Communication
Patient’strustinprescriber
Empathyofprescribertowardspatient

71
Q

Describe how sulfonylureas increase the secretion of insulin

A

SulfonylureasinhibitATPsensitivepotassiumchannelsintheplasmamembrane
Pancreaticbetacelldepolarizationoccursaspotassiumisnotabletoeffluxleadingtoinfluxofcalciumandactivationofthe secretorymachinerythatreleasesinsulin

72
Q

Who can give consent to retention of human tissue for anatomical examination and public display?

A

Deceased person - written consent before death

73
Q

Which public policy will lead to the greatest population reduction in salt intake?

A

Regulation and marketing control

74
Q

Which component of the ECG complex does the plateau phase of the ventricular action potential correspond to?

A

ST segment

75
Q

A study stating that the risk of disease in a control group is 5% compared with risk of 3% in the intervention group. What is the relative risk reduction?

A

2/5x100 = 40%

Absolute risk reduction /control event rate

76
Q

Class 4 antiarrhythmic drugs predominantly act on which channels?

A

Calcium channels

77
Q

What type of heart block is shown by gradual prolongation of the PR interval until a QRS is skipped?

A

Second degree heart block type 1

78
Q

Movement of which ion is mainly responsible for phase 0 of the ventricular action potential?

A

Sodium channels

79
Q

Pathways involving which neurotransmitter are primarily involved in the pathogenesis of confusion?

A

Acetylcholine

80
Q

What percentage of encounters in the NHS are in general practice?

A

90%

81
Q

A 42 year old woman describes a two month history of unintentional weight loss, increased appetite and oligomenorrhoea. On examination she has bulging eyes and vitiligo. What pattern of changes of thyroid function tests would you expect to find?

A

Reduced thyrotropin releasing hormone
Reduced thyroid stimulating hormone
Increased thyroxine

82
Q

What is beta oxidation?

A

Oxidation of fatty acids in mitochondria to form Acetyl co A

83
Q

What pattern of electrolyte abnormality is likely to be seen in a patient on thiazide diuretics?

A

Decreased sodium and potassium

84
Q

What type of GLUT receptors are not insulin sensitive?

A

GLUT 2 expressed on pancreatic beta cells

High capacity but low affinity for glucose, acts as a glucose sensor

85
Q

A 21 year old man is seen by his GP. At the appointment he looks dishevelled and is withdrawn. He says he has had to give up work as the other staff had taken control of his mind to the extent that he had no control over his bodily movements. What phenomena is he describing?

A

Delusion

86
Q

What is a delusion?

A

A belief that is firmly held on inadequate grounds, not affected by rational argument or evidence to the contrary and is not a conventional belief that the person might be expected to hold given his educational, cultural and religious background

87
Q

A patient is diagnosed with schizophrenia. What will be the most important factor in reducing the patients risk of early mortality from cardiovascular disease?

A

Reduction of modifiable risk factors

88
Q

A 67 year old woman is admitted following a fall one hour ago. She is disoriented in time and place. The paramedics bring her medication which includes a thiazide diuretic. Which electrolyte abnormality is likely to account for her clinical features?

A

Hyponatraemia

89
Q

What group of mental health disorders account for the most disability adjusted life years globally?

A

Depressive and anxiety disorders

90
Q

A 52 year old patient has gradually declining cognitive function and is diagnosed as having dementia. The patient has not changed in personality and has no history of hallucinations. On genetic analysis, he has an additional copy of chromosome 21. What extracellular protein is likely to be responsible for his dementia?

A

AB amyloid

91
Q

How do class 1 antiarrhythmics such as Flecainide stabilise cardiac rhythm?

A 
Slows conduction in all parts of the heart
This is class 1c, slow dissociating sodium channel blocker
92
Q

What is the predominant physiological effect of Losartan that leads to blood pressure lowering?

A

Reduction in peripheral vascular resistance

Angiotensin II receptor blocker

93
Q

In a patient with diabetic ketoacidosis, what acid base changes are likely to be present?

A

Acidosis, low pCO2, low bicarbonate, raised anion gap

94
Q

A 66 year old man with type 2 diabetes attends clinic for his diabetic review. He is found to have isolated microscopic proteinuria. What is the likely responsible mechanism?

A

Increased intra glomerular pressure
Efferent arteriolar vasoconstriction and mesangial expansion which leads to increased pressure, capillary hypertension and proteinuria

95
Q

A 68 year old Asian man with poorly controlled hypertension and diabetes Mellitus has mild hypertensive nephrosclerosis. The patient wants to prevent further kidney damage. Which risk factor could be modified?

A

HbA1c or hypertension control

96
Q

A 45 year old woman is diagnosed with hypertension secondary to renal artery stenosis. She is found to have abnormal plasma potassium. What hormone is likely responsible for this change?

A

Aldosterone
Renal artery stenosis causes activation of RAAS
Aldosterone causes upregulation of Na/K pump into basolateral membrane in renal tubules so leads to efflux of K and therefore hypokalaemia

97
Q

A 56 year old man has a seven month history of confusion and possible cognitive impairment. They have history of urinary incontinence and problems with balance when walking. What is the likely cause of their symptoms?

A

Normal pressure hydrocephalus

AC1 (18 decks)

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