ICSM past paper errors Flashcards
What is Mobitz 1 and Mobitz 2?
Mobitz 1(Wenckebach) is progressive prolongation till a P is dropped
Mobitz 2 is where PR is consistent but not always followed by a QRS (the ratio one)
What history is typically given for allergic bronchopulmonary aspergillosis?
Bronchiectasis
Bronchoconstriction
Eosinophilia
What are the CXR findings of allergic bronchopulmonary aspergillosis?
Nil
What is the management of allergic bronchopulmonary aspergillosis?
Steroids +- itraconazole
How does EAA typically present?
Acutely (4-8hrs post exposure) with SOB, dry cough, fever
What are the CXR findings of EAA?
Upper/mid zone fibrosis
What are the types of psoriatic arthritis?
AOPSD
Arthritis mutilans Oligoarthritis (asymmetric) Polyarthritis (rheumatoid) Sacroiliitis DIP joint disease
Aside from a positive family history, what is the strongest risk factor for breast cancer?
Obesity
Which antibiotic is used to treat legionella pneumonia?
Macrolides
What is co-danthramer and when is it commonly prescribed?
A stool softener with stimulant diuretic often coprescribed with morphine
What heart sound would you hear in a patient with pericarditis?
Pericardial friction rub
Which are the most sensitive and specific antibodies for SLE?
ANA most sensitive
Anti-smith most specific
Which murmur is an aortic dissection commonly associated with?
AR
What are the commonest causes of epididymitis in men under and over 35?
Under 35 = Chlamydia
Over 35 = E.coli
How do you treat #NOFs?
Garden 1 and 2,
Cannulated screw,
Garden 3 and 4,
Aint hemi anymore,
Between greater and lesser,
DHS is better
If below the neck should fail,
Intermedullary nail
What are the classic features of GB syndrome?
Progressive weakness of all four limbs typically affecting legs before arms but with proximal muscles affected first
Sensory features are mild, and there may also be areflexia, CN involvement and autonomic involvement
What is the definitive diagnostic test for nephrotic syndrome?
Renal biopsy
What are the paraneoplastic syndromes associated with SCLC?
ACTH
ADH
Lambert Eaton
What is the management of SCLC?
Mostly picked up once metastatic so manage with chemo and radiotherapy
Which type of lung cancer is associated with PTHrP?
Squamous cell
Which antibiotic would you use to treat Klebsiella pneumonia?
Cefotaxime
Man flies from TLV -> LHR and develops chest pain. A few hours later his leg is white and pulseless. What has happened?
Aortic dissection with secondary acute limb ischaemia
When would you do an aortobifem bypass?
When there is disease at the aortic bifurcation or in both iliac arteries as well as the aorta itself
When there is disease at the aortic bifurcation or in both iliac arteries as well as the aorta itself
What is the effect of attention and stress on a Parkinsonian tremor?
Worsens the tremor
Which vessels are blocked in calf and button claudication?
Calf = Superficial femoral Buttock = Iliac (int or common)
What is the presentation of a posterior hip dislocation?
Shortened and internally rotated leg with flexion and adduction at the hip
What are the three options for managing metastatic bone pain?
Strong opioids
Radiotherapy
Bisphosphonates
What imaging technique is used in triple assessment?
<35 - USS
>35 - Mammography
If bacteria is grown from a catheter, how should this be managed?
Treat only if symptomatic
What is the threshold for blanket treatment of a paracetamol overdose?
If more than 150mg/kg has been taken this is likely toxic so no need to wait for bloods
When would you see keratoderma blenorrhagicum and circinate balanitis?
Reactive arthritis (/reiter’s syndrome)
What is the management of IIH?
Weight loss Acetazolamide Topiramate Therapeutic LPs Optic nerve sheath decompression and fenestration VP shunting
Which of varicocele and epididymal cysts transluminates?
Epididymal cysts
How might a subphrenic abscess present?
Cough
Tachypnoea
Hiccups
Anorexia
What investigation should you do in a patient with guarding and peritonism?
Erect CXR
Which pain relief options are available in NOF patients?
Paracetamol
Opioids
Fem nerve block
(NSAIDs C/I’d)
When would you feel a slow rising pulse?
AS
Which vitamin would you give someone when starting TB treatment?
B6 - Pyridoxine
How does IVC obstruction present?
Peripheral oedema of lower limbs
Tachycardia
Brown sequard on the left side, which side experiences loss of pain sensation?
Right (contralateral)
What is the management of severe falciparum malaria?
IV artesunate +- doxycycline +- exchange transfusion
What is the role for quinine and chloroquine in malaria management?
Should be used in conjunction with doxycycline. Quinine to be used when there is chloroquine resistance
Which DMARD causes retinopathy?
Hydroxychloroquine
What are the side effects of sulfasalazine?
Rashes
Oligospermia
BM suppression
Interstitial lung disease
What specifically causes ophthalmoplegia in thyroid eye disease?
Rectus muscle thickening
What are the clinical features of cataracts?
Lens opacities
Darkened red reflex
Gradual vision loss
Dazzling in bright lights
What are the causes of cartaracts?
Age UV light DM Steroids Congenital infection
What are the different stages of diabetic retinopathy?
Background = Dots, blots and hard exudates
Pre-proliferative = Cotton wool spots, venous beading, cluster haemorrhages
Proliferative = Neovascularisation
Maculopathy = location based rather than severity - Hard exudates over macula with vision loss
What is a Lisfranc injury?
Disruption of metatarsal bone from tarsal bone.
How do lung cancers spread and where?
Locally to pleura and surrounding structures
Lymphatic to mediastinal and cervical nodes
Blood to bone, brain, liver
When would a Simmonds test be positive?
In Achilles’ tendon rupture
In someone presenting with atypical chest pain, what might be used to determine pre-test probability of IHD?
Epidemiological evidence
Son of 75 year old lady requests home visit for mother who has recent behavioural changes. Sometimes gets confused and sees people in the room who aren’t there. Recent loss of appetite. Cause?
ACS
45 year old lady with spontaneous dark brown nipple discharge. Examination reveals only one duct producing discharge. What does she have?
45 year old lady with spontaneous dark brown nipple discharge. Examination reveals only one duct producing discharge. What does she have?
Tall 28 year old man with radiofemoral delay and hypertension. BP 210/110. Has rib notching. What is underlying diagnosis?
Coarctation of the aorta
Sickle cell girl with severe back pain (?) What do you do first?
IV fluid bolus
What are the four main sickle cell crises?
Thrombotic/vaso-occlusive
Sequestration
Aplastic
Haemolytic
When would you smear cells?
CLL
What should be done for patients who are stable with GI haemorrhage?
OGD within 24 hours of admission
Which antibodies are positive in PBC?
AMA
What are the histological differences between PSC and PBV?
PBC - intrahepatic granulomatous destruction
PSC - Fibrosis and strictures of intra AND extra hepatic ducts
Which opioids are preferred in renal failure patients/
Fentanyl
Buprenorphine
Someone with previous TKR, now tender, febrile, hot, swollen. No evidence of crystals on microscopy. Aspirate showed turbid fluid.
Septic arthritis
What should be given acutely in gout patients where NSAIDs are contraindicated, and what is its main side effect?
Colchicine - Diarrhoea
What is the commonest cause of corneal ulceration?
HSV infection
30+ year old lady with fever and fits. Scan shows temporal lobe necrosis. Cause?
HSV
T1DM girl on subcut insulin pump comes in with frequent episodes of SOB, palpitation and tingling of fingers. Cause?
Hyperventilation syndrome
Patient with pernicious anaemia then has ?iron def as well and gastroscopy shows ulcer in stomach. What malignancy?
Adenocarcinoma
Guy comes in with swollen legs and bilateral scrotal swelling with recent 10kg weight gain?
Peripheral oedema
Lady who recently came from Afghanistan with low calcium, raised PTH. What test to confirm Dx?
Serum Vit D levels
Guy with epilepsy and now housebound. Pain in spine and on compressing rib cage? What does he have?
Osteomalacia (linked to long term anticonvulsant therapy)
Someone with right sided hemiparesis, aphasia, some kind of visual deficit - doesn’t blink to hand waving on right side but does on left. Which artery?
MCA
Fit guy whose dad died early comes to you worried. He passes out during sports i think. What investigation?
ECG
Which part of the brachial plexus is damaged in Erbs and Klumpke’s palsies?
Erbs = Upper Klumpke = Lower
Patient has long term indwelling suprapubic catheter. Keeps getting blocked and flushed out by nurses a few times. What do you do?
Bladder washout
Lady comes back from india 3 days ago with abdo pain, diarrhoea and vomiting. What do you do?
Stool MC&S
Hypertensive Young guy with mildly raised cr and proteinuria on multiple occasions. Physical exam otherwise unremarkable. What does he have?
Nephritic syndrome 2ary to hypertensive retinopathy
Someone with Hodgkins lymphoma, mediastinal mass and night sweats. What is most appropriate treatment?
Curative chemo
Guy with pulseless electrical activity, given one dose of adrenaline/epinephrine. Still no carotid pulse. What now
Another dose of adrenaline
Ix in leaking AAA?
CT abdo
38 year old lady with cyclical breast pain.
Abnormal normal development and involution of breast (ANDI)
Patient with asthma has a short hx of yellow sputum and wheeze, was given oral amox which improved sputum but wheeze still there but afebrile, what now?
PO Pred
Which virus causes squamous cell carcinoma of the tonsils?
EBV
55 year old with 10 a day smoking history presents with 6 month Hx of white sputum and a cough - what should be done first?
CXR
Fasting glucose of 7.2 in an asymptomatic patient - what should be done next?
HbA1c
Which investigation is diagnostic for UC?
Faecal calprotectin
In a patient with UC, what feature indicates for a colectomy?
Epithelial dysplasia (intraepithelial neoplasia)
Asthmatic patient is unable to finish sentences, is hypoxic with a high PCO2 and pH 7.3. She has already been treated with IV nebulisers and prednisolone - what would you do next?
Intubate and ventilate - hypercapnia in an asthmatic patient is cause to intubate
Old guy with COPD has CO poisoning - normal sates - what type of oxygen do you give him?
15 litres non-rebreathe
Hypotensive patient is post op and have been given 500ml bolus with no sighs of HF. Has passed just 10ml of urine and is not in pain. What next?
Give more fluids
Patient with peripheral oedema, scrotal oedema and proteinuria - what diagnostic investigation do you do?
Renal biopsy
Tonsillar exudates, jaundice, upper abdo pain - what is the cause?
EBV Staph Tonsillitis Influenza Malaria
EBV
Woman calls GP about man with terminal prostate cancer who has become breathless - what do you do?
Visit them nest morning and have palliative care discussion
Woman with RA and Hx of knee replacement is having cystoscopy for urinary symptoms. Knee is now hot swollen and tender.
Pseudogout
Septic arthritis
Septic arthritis
Bilateral knee pain, stiff for 20 mins in the morning, knee is swollen at night.
Osteoarthritis
Pain in small joints and wrists, pleuritic pain, protein ++ and blood ++ - what antibodies would you expect to see?
ANA
Sudden onset chest pain, post PCI with stent for STEMI, ECG shows ST elevation widespread in anterior leads and T-wave inversion, pleuritic chest pain, worse pain on movement, quiet heart sounds and auscultation, chest clear
Pericarditis
Which arrhythmia is seen most commonly after an MI?
VF
Anti-jo antibodies seen with signs of polymyositis. Which test is diagnostic?
Muscle biopsy
Patient with CREST symptoms presents with Pleuritic CP/SOB and crackles. Which investigation would you do?
High res CT - as CREST patients also development PA HTN -> Cor pulmonate
Myelodysplasia which has gotten worse in the last few weeks. Abundant primitive cells seen on slide.
AML
SLE features + jaundice, reticulocytosis, spherocytosis and polychromatic?
AIHA
Lived reticularis and miscarriages?
Antiphospholipid syndrome
Which blood test is best for detecting dehydrated patients?
Serum urea
Old lady on second blood transfusion develops sudden breathlessness, normotensive, history of IHD, bilateral crackles and wheeze. Nurse has stopped the transfusion. What do you give?
IV furosemide
Bowel screening question. What is FOB for:
Monitoring people with existing disease
Screening for people with asymptomatic disease
Screening for symptomatic disease
Screening for people at risk of developing colonic disease
Screening for people with asymptomatic disease
Vocal cord surgery, struggling to speak, tachypnoeic 28, grip weakens when asked to grip nurses fingers What is the antidote:
Neostigmine - reverses the effects of non-depolarising muscle relents such as rocuronium at the end of an operation
21 year old female has acne, tried topical antibiotics and topical retinoids no success. DVT in past after plane. What to try next?
Lymecycline (or another tetracycline)
Old lady has a hemicolectomy. Post op her morphine epidural in situ comes out and she is in significant pain for the interim, before it is eventually replaced. She now has a pyrexia. What is the cause?
Atelectasis
Person with nephrectomy and had stone in the good kidney at PUJ and swelling of upper urinary tract on imaging. Had fever. ?Septic obs. How to manage?
Lithotripsy
Palpitations, weight loss and altered bowel habit in old lady, what nail changes are seen? What was the answer here someone please? Here - skin changes in hyperthyroid include
Onycholysis (hyperthyroid nail)
Young guy, collapses frequently during sport? with ECG - Sinus rhythm. PR or QRS 120ms, cQT 510ms
VT
Mc Murray’s positive, had twisted knee and heard a pop - Diagnosis and investigation?
Menisceal tear
MRI knee
Difference between breast feeding mastitis and abscess?
Lump
What are the features of PBC?
Early - silent, obstructive LFTs, fatigue, jaundice
Hyperpigmentation
Xanthelasmas
Clubbing
What is the most likely progression with BCCs?
Local invasion
What is the investigation of choice for acute diverticulitis?
CT abdo
What is surfer’s ear?
Otitis externa
Leg claudication and ABPI of 0.84 - next step
Structured exercise programmes
Man with dysphagia and weight loss - Squamous cell or adenocarcinoma?
Squmous cell
2cm smooth non tender swelling fixed to underlying structures
Ganglion
