Formatives Flashcards
A patient presents with palpitations and feeling lightheaded. They are conscious but feel very unwell. On examination BP is 70/30. ECG shows broad complex tachycardia. What is the appropriate immediate course of action?
Arrange immediate electrical cardioversion under sedation
A 30 year old man presents with single sudden shaking chill and rapid rise in temperature. Within a few hours he develops sudden left sided chest pain worse on breathing and cough with rust coloured sputum. What is the most likely cause of the patient’s symptoms?
Streptococcus pneumoniae infection
A 54 year old man with long standing essential HTN presents with abrupt onset right hemiparesis (arm>leg) and right sided sensory loss. He also has an expressive dysphasia. He is right handed. What is the most appropriate initial investigation?
CT head
A 26 year old woman presents to ED with vomiting and feeling generally unwell. She has type 1 diabetes and is on insulin. Her blood glucose on admission was 30.4 and a urine dip was positive for ketones +++. Her pH on ABG was 7.2. What is the most important first step in managing this patient?
Start her on IV normal saline
A 60 year old man presents to ED with chest pain and SOB. He describes sharp left sided pain which is worse on inspiration. He was previously fit and well and returned from a holiday two days ago. He is not on any regular medications. A CT pulmonary angiogram confirms saddle PE in left main pulmonary artery. Shortly after his CTPA he feels unwell, his BP is 80/50 and pulse 120. What is the most appropriate treatment for this patient?
Thrombolysis
A 55 year old man presents to emergency department with bilateral arm weakness. He initially had paraesthesia and lower limb weakness which has progressed and now he complains of upper limb weakness. Two weeks ago he had a diarrhoeal illness. Which findings are used to confirm the diagnosis?
Ascending weakness
Reduced reflexes
Raised CSF protein
What are some upper and lower motor neurone signs?
UMN: spasticity, hyperreflexia, pyramidal weakness, babinski positive
LMN: flaccid paralysis, hyporeflexia, fasciculations, muscle atrophy
A 73 year old woman has a stroke resulting in left sided neglect, partial loss of sensation and difficulty in hand eye coordination. Where is the lesion most likely to be located?
Right parietal lobe
A 35 year old man presents with sudden onset SOB. Breath sounds absent on left hand side and trachea deviated to the right. O2 sats are 85%. Patient is unwell and is in extremis. What is the most appropriate next step?
Needle decompression
What feature of normal value would cause concern in a patient admitted with acute severe asthma?
Normal pCO2
Motor neurone disease usually develops due to pathology in which part of the spinal cord?
Anterior/ventral horns
Which parameter is characteristic and diagnostic for COPD?
Forced expiratory volume in one second
An ECG shows sinus rhythm, PR interval of 140ms, QRS duration of 160ms, largely negative complex in V1 and largely positive complex in V6. What abnormality is this ECG detecting?
Left bundle branch block
A 40 year old man presents with breathlessness on exertion. On examination he has marked clubbing of the fingers. What is the most likely diagnosis?
Pulmonary fibrosis
A 56 year old man is admitted with acute central chest pain. Troponin levels are raised and his ECG shows widespread ST elevation. He is given aspirin as an antiplatelet agent and undergoes primary PCI (angioplasty and stenting). What additional treatment should be given routinely?
Bisoprolol
