Kings 2014 (Paper 1)

Question 1

Patient had hyperthyroidism. Treated with carbimazole. 2 weeks later gets a sore throat. What investigation?

Options:
Thyroid scan
FBC
Platelets
Throat swab
?

Question 2

28 year old lady with wide based gait and optic neuritis. What is the most appropriate investigation?

Options:
CT head
LP
MRI
Muscle biopsy

Question 3

. Patient has had 20mls of lidnocaine 0.5%. Max is 3mg/kg and he weighs 80kg. How much more can you give?

Options:

Question 4

Rugby tackle, anterior dislocation of shoulder. What test do you do before and after relocation?

Options:

Radial pulse
BP
Axillary nerve
Radial Nerve

Question 5

Patient ex IVDU, want to see if he has chronic Hep C. What test?

Options:
Antibody — Antigen
Assay
PCR

Question 6

Semi-dilated pupil, pain, hazy vision, headache, vomiting

Options:
Glaucoma

Question 7

Pt has MI, 2 days later new murmur and unwell. Harsh systolic murmur

Options:
Papillary muscle rupture
AS

Question 8

What makes someone cool, pale and clamy when unwell? Patient has dropping blood pressure, tachy and in shock. What is the underlying body mechanism for this response?

Options:

Sympathetic system activation.
Hypoglycaemia
Sympathetic
Inc ADH
Inc aldosterone
Cortisol

Question 9

Lady with previous mastectomy for Breast Ca 4 years ago. Has become thirsty, polyuria and constipated. Now confused. What has caused it? No focal neurology

Options:
Cerebellar mets
Hyponatraemia
Hypercalcaemia
Infection
T2DM

Question 10

Child with previous ear infection, now has acute hearing loss and “squishy BOGGY” mass behind ear. LMN signs on affected side of face. What is the cause?

Options:
Mastoiditis
Suppurative auricular lymph node
Otitis media

Question 11

40 year old woman is anaemic, raised LDH, raised bilirubin. What test?

Options:
AMA antibody
Direct coombs Liver biopsy
??

Question 12

Pt in burning building at home. 3 days later he has flashbacks, nightmares and is upset. Returns to work a week later.

Options:
PTSD
Depression
Acute stress reaction
Bereavement reaction
Psychosis

Question 13

Patient took a handful of pills with alcohol 2 days ago after an argument, now can’t remember what he’s taken. Was on antidepressant medication. LFTs showed liver impairment and raised PT. What has he taken?

Options:
Paracetamol
Aspirin,
Fluoxetine,
Amitrytiline
Venlofaxine

Question 14

Angry patient who’s upset with the porters. What do you do?

Options:
Answer was “listen, reassure and inform her we will investigate”

Question 15

What is the biggest intervention in a young person to reduce overall cancer risk?

Options:
Lose weight
Protection during sex
Stop smoking
Alcohol control
Increase exercise

Question 16

pt has headache, photophobia, neck stiffness, BP is lowish. What is the most appropriate Rx? Girl with meningitis symptoms what is the first med to give before LP. In hospital give cef, ben pen if in community.

Options:
Ceftriaxone
Acyclovir
Fluids

Question 17

Child has sore throat. 2 weeks later develops Proteinuria, dehydrated, polyuria, oedema. What is the cause?

Options:
IgA nephropathy
Iatrogenic
Post strep
Acute glomerulonephritis

Question 18

Someone has been to Africa. Lost weight and has altered bowel habits. GP thinks he has parasite. What will be raised?

Options:
Lymphocytes
Neutrophils
Basophils
Eosinophils
RBC

Question 19

Child is unwell with sore throat. RR 40, drooling massively. What is the most immediate risk? Child didn’t have immunisations.

Options:
Asphyxia
Aspiration
Septic shock
Heart failure

Question 20

Patient has low Na, Low BP, K+ is raised. What is the commonest cause?

Options:
Benign Adenoma
Auto immune
SIADH
Congenital adrenal hyperplasia
Overdose

Question 21

Old man with thigh pain. Raised ALP, all else is normal. ESR and calcium not raised.

Options:
Pagets

Question 22

Man diagnosed with T2DM (not massively raised though). No eye or feet problems. Renal profile is fine. that treatment does he need?

Options:

Metformin
Gliclazide
Orlistat
Insulin
DPP4

Question 23

Pt has raised BP on ambulatory monitoring. T1DM and proteinuria. What drug do you give?

Options:
B-Blocker
ACE
Furosemide
Bendroflumethiazide
Verapamil

Question 24

Baby is 7 weeks old. 6 days history of vomiting large amounts after feeding. Otherwise fine, afebrile and appears hungry. What is the cause?

Options:
Bowel obstruction
Pyloric stenosis
Hirschprungs

Question 25

Patient has pain on walking. Angio shows calcified distal aorta and femorals on both sides. What is the best Mx?

Options:
Stent
Aortic-bifemoral bypass graft
Embolectomy
Aortic endartherectomy

Question 26

Old man is anaemic, newly constipated and has had weight loss for 6 months. What has he got?

Options:
Sigmoid Ca
Caecal angiodysplasia
Small bowel cancer
Ulcerative colitis
Diverticulitis
NB: Caecal Ca normally causes anaemia, sigmoid Ca often fresher blood. However, caecal not an option in THIS paper (but was in other years so check)

Question 27

HIV +ve, has pneumonia, CXR showed ground glass appearance. What do you use to treat?

Options:
Doxy
Erythromycin
Gent
Co-trimaxole
Amox

Question 28

Patient has RA, has DEX and is -2.8. What is the best treatment option?

Options:
Calcium supplements
Vit D
Bisphosphonates
HRT
NB: In reality would be on ADcal D3 + bisphosphonates)

Question 29

Lady is pre-op and will need a GA. He has RA in hands, knees, hips and neck. She has HTN (150ish) and T2DM. What is the most important pre-op check?

Options:
Cervical XR
FBC
BP monitoring
Glucose finger prick
ECHO

Question 30

Patient has irregular 3cm pigmented lesion on shin with different colours. What is the most important next step?

Options:
Take pictures and follow up in 3 months
Scrapings for mycology
Biopsy
ACE level

Question 31

Terminal palliative care patient with Lung Ca. Is SOB on minimal exertion but comfortable at rest in his bed. CXR shows epic pleural effusion. What is the best management?

Options:
24 hour nursing
Furosemide
Pleural aspiration
Increase morphine
Oxygen

Question 32

Patient is post op, on 40% O2. Becomes unwell RR26 and sats drop to 86%. Type 1 respiratory failure. What is the most important first step?

Options:

Increase O2
Stop oramorph
Intubate

Question 33

Patient is on ventilator. ABG shows PaO2 is 12, PaCO2 is 9.8, pH is acidotic, bicarb is 19. What do you do?

Options:
Increase O2
Increase ventilation
IV bicarb

Question 34

Old man has bronchial carcinoma. Gets pain in his femur. XR shows lytic bone lesion (and some in spine). On good pain control. What do you do to manage this patient?

Options:
Bisphosphonates
Radiotherapy
Chemotherapy
Inc pain relief
internal fixation

Question 35

Patient has central lung mass. Turns out to be Small cell lung cancer. How do you treat?

Options:
Chemo
Palliate
Radiotherapy
Furosemide
Pneumonectomy

Question 36

Old man who’s a smoker has lost voice of last 2 weeks, become hoarse. Examination shows normal larynx and no obvious masses in neck. Palate/mouth is fine. What is the next important investigation?

Options:
Thyroid Function
Thyroid scan
CXR
CT scan
Calcium levels

Question 37

Young athlete (25) keeps fainting. ECG shows sinus rhythm with narrow QRS and long QT. What arrhythmia is happening?

Options:
Asystole
SVT
AF
Sick sinus syndrome
Irregular ventricular arrhythmia

Question 38

Patient comes in with BP 80/40, pulse 160, loads of other stuff and wide QRS. How do you manage them?

Options:
Amiodarone
Adenosine
Vasovagal
Atropine
Shock them

Question 39

Bibasal creps, gradual SOB, clubbing and some FEV/FVC results (showing restrictive picture) if you still weren’t too sure

Options:
Pulmonary fibrosis

Question 40

Patient comes in with fluid overload, drowning in fluid (crackles everywhere) and acute AF. How do you treat the AF (NB; not the fluid)?

Options:
Adenosine
B-blocker
Shock the shit out of them
Amiodarone
Vasovagal

Question 41

Patient comes in with purpuric rash, BP 80/60, tachycardic. No neck stiffness or photophobia What is the best investigation to confirm your diagnosis? NB: this patient may have had a fever, people can’t remember but hugely changes the answer

Options:
Fibrinogen degradation products
Platelets
Blood cultures

(If fever, then sepsis so BCs, if not a fever then massive bleed and possible DIC so fibrinogen?)

Question 42

Most important thing to correct in DKA?

Options:
Hyperglycaemia
Fluids
Acidosis

Question 43

Total gastrectomy, why did they get B12 deficiency?

Options:
No intrinsic factor
(other options were stupid)

Question 44

40 year old, no symptoms other than PR fresh bleed occasionally for 2 weeks. No change in bowel habits, pain or illness. Whats the investigation?

Options:
Colonoscopy
AXR
Proctosigmoidoscopy

Question 45

Patient has UC flair, on mesalazine. Abdo pain, >8 diarrhoea with blood and fever for 2 days. What treatment?

Options:
Oral pred
Inc mesalazine
IV hydrocortisone
Co-amoxiclav

Question 46

Child with downs syndrome develops cervical lymphadenopathy, is pale and bleeding. What is it?

Options:
ALL
Idiopathic thrombocytopenia
Abuse

Question 47

3 year old child bangs head on desk this morning, has a bruise. NO LOC, no vomiting. Mother brings him to GP. Has 12 bruises of different ages on shins. What is the cause?

Options:
Idiopathic thrombocytopenia pupura
Abuse
Normal child
Haemophilia

Non-accidental injury

Question 48

Specificity question from PPs. 40/60 = 67%.

Question 49

Patient has signs of High potassium, low calcium and acidosis post chemo for lymphoma. What is the best investigation?

Options:

enal failure
Urate levels
Phosphate levels
Others.

Question 50

Patient with sudden pale, cold, clamy, pulseless leg, has AF. Best management?

Options:
Embolectomy >>> Acute ischaemic limb

Question 51

Peripheral vascular disease, MI in past, had triple bypass. HTN 180/100. Creatinine is huge. What has caused his renal failure?

Options:
Malignant HTN
Renal artery stenosis
Antihypertensives
Hypovolaemia

Question 52

Teenage boy with tender lumps in breasts on both sides. What Ix?

Options:
Leave and observe
Biopsy
Mammogram
FNA
Lumpectomy

Question 53

Lady has severe dyskaryosis. What is the most appropriate next step?

Options:
Colposcopy
Cone biopsy
Hysterectomy
Waldenstroms hysterectomy

Question 54

Whats the best investigation for a patient with multiple myeloma? Bloods showed low HB, low PLT, low WCC

Options:

Protein electrophoresis
Serum ACE
Serum PSA

Question 55

Pt has tender excitation on bimanual, yellow discharge and post coital bleeding. Diagnosis

Options:

Question 56

Patient with anaemia with low MCV. What is it?

Options:

Women with iron defiency, what is the blood results expected >>> idea of questions
Iron deficiency

Question 57

Vegan child, has macrocytic anaemia. What do you give?

Options:
Hydroxocobalamin

Folic acid

Question 58

Anorexic, BMI 15. Worried about needing iron tablets. Results show macrocytic anaemia (not micro!). What do you give?

Options:
Hydroxocobalamin

Question 59

Man comes in to A+E confused, ataxic and nyastagmus. What do you need to give?

Options:
Thiamine

Question 60

Patient in bladder retention. What caused it?

Options:
Amitriptyline

Question 61

What is the antidote to TCA overdose?

Options:
IV bicarb