Kings 2014 (Paper 2)

Question 1

Patient with blurring of their vision, red eye and pain.

Options:
Scleritis

Glaucoma

Conjunctivitis

Question 2

Patient with oral ulcers, rash on face and pleuritic chest pain. What Ix?

Question 3

Child stabs himself in the eye with a pencil. He has an irregular pupil, excessive lacrimation, red eye and pain. What suggests a penetration of the globe?

Options:
Bleeding eye
Increased lacrimation
Red eye
pain
Irregular pupil

Question 4

Patient in mid 20s has sore throat, few weeks later gets several discrete scaly lesions over drunk and proximal limbs. What is it?

Options:
Atopic eczema
Eczema herpeticum
Guttate Psoriasis
Sepsis

Question 5

60 year old male has painless haematuria. Dipstick shows blood ++. What investigation do you need to do?

Options:
Cystoscopy

Question 6

21 year old girl has acne. Tried a number of treatments but still has comedones. GP prescribes Isoretanoin. What else should you prescribe?

Options:
OCP
Psoriasis meds

Question 7

Patient has severe abdo pain. Examination reveals tinkling bowel sounds, AXR shows gas under the diaphragm. What is the cause?

Options:
AAA leak
Bowel obstruction
Perforation DU
Appendicitis perforation

Question 8

Man worried about his MI risk. He has brother with high cholesterol and MI aged 45. Father died of MI aged 62. He’s a non-drinking non smoker. BMI of 32. What is the most important intervention to reduce risk of MI?

Options:
Start statin
Start aspirin
Lose weight
Start ACE
Genetic testing

Question 9

Woman aged 40(ish) with T2DM. Her BMI is 28 and HBA1C is raised (?64). What management plan?

Options:
Diet
Metformin
Sulphylnurea
Insulin

Question 10

Clear IGTT test results to interpret.

Question 11

Patient has metaclopramide IV with morphine. 10 minutes later develops upward looking eyes, neck is flexed and agitated. What do you use to treat?

Options:
Donepezil
Ondansetron
L-dopa
Procyclidine

Question 12

Old lady has fall. Presents with externally rotated and shortened leg. Where is the break?

Options:
Head of femur
Neck of femur
Femur shaft

Question 13

. Patient has dry gritty eyes. They are noted to have submandibular swellings. What is the cause?

Options:
Sjogrens
Sarcoid

Question 14

54 year old lady presents with PV bleed. Hasn’t has period in 3 years. What is the next step in Mx?

Options:
Pelvic USS
Watch and wait
Refer to gynae
start HRT

Question 15

Young adult male with back pain for 6 weeks worse in the morning. Has a number of tests, all antibodies return negative. What is the cause?

Options:
RA
Mechanical back pain
Disc prolapsed
Ank spond

Question 16

Patient with diabetes has renal and eye disease. Wakes up at night with leg pain. What is the first line treatment? NB: no option for duloextine (which would be the first line in diabetes)

Options:
Physio
Acupuncture
Amitriptyline
Morphine

Question 17

Patient presents with lung cancer in the left apex. Has Ptosis. What else would you expect from the face?

Options:
Myiadrisis
Myosis
Increased sweating
Muscle weakness

Question 18

Young adult male schizophrenic treated with risperidone. Develops bitemporal hemianopia and bilateral nipple discharge. What test would help confirm the diagnosis?

Options:
Risperidone levels
TFTs
MRI of brain
Prolactin level

Question 19

Old lady is brought in by daughter. She has been deteriorating for 3 days. Has been noticed by neighbours shouting and banging during the night and appears dishevelled. What is the cause?

Options:
Depression
Dementia
Delirium
Schizophrenia
Anxiety

Question 20

24 year old male notices a testicular lump 2 weeks ago after a football injury. It is 3cm, in the testicle hard and irregular. It does not trans-illuminate. What is it?

Options:
Hydrocele
Epidymo-orchitis
Seminoma
Teratoma

Question 21

Man has months of dribbling, incomplete voiding. PR shows prostate has one side harder than the other but smooth. His PSA is “significantly” elevated. What is it?

Options:
BPH
Prostate cancer
Prostitis

Question 22

Patient on 40% oxygen has ABG. They have PaO2 - 8, PaCO2 9, pH 7.3, Bicarb normal. What is the first thing you should do? (Patient has COPD)

Options:
Dec oxygen

Question 23

Patient presents to GP with fine tremor and weight loss after a flu like illness 3 weeks ago. They have a smooth, slightly enlarged goitre. T4 is high, TSH low. Iodine uptake suppressed after 6 hours. What is the cause?

Options:
Graves

Hashimotos
Toxic multinodular goitre

Viral thyroiditis

Question 24

Patient presents with coarse tremor and drowsiness. They have been on stable bipolar treatment for 10 years with Lithium. What test do you need to do first? She has been taking ibuprofen for back pain for last few months. She has been unsteady on her feet. What is the first ix to do?

Options:
FBC
Glucose
TFTs
Lithium levels

Question 25

**Patient has T1DM that has been well controlled. He has had vitiligo for 10 years on his arms. He presents gaining weight and drowsy. What test do you need to do?** Options: Dipstick Finger prick glucose Blood cultures TFTs HBA1c

Question 26

**Patient has leg pain on walking shown to be femoral stenosis. His ABPI is 0.84. What is the best management plan?** Options: Exercises Balloon angioplasty Vasodilators

Question 27

**Patient has “irregular” heart beat and a mid diastolic murmur. They already have heart failure. What other complication is the biggest long term risk?** Options: Left ventricular hypertrophy Infective endocarditis Systemic emboli Cerebral embolism

Question 28

**Patient presents with paroxysmal sweating and palpatations. Scan shows isolated adrenal adenoma. What test do you need to do?** Options: Catecholamines Cortisol ACTH Testosterone

Question 29

**Patient is post op. They have been given 5% dex for a 24 hours. Blood tests show low Na and they are now drowsy. Why?** Options: Cerebral oedema Demyelination Brain shrinkage (worded better in exam)

Question 30

**Patient is drinking 5-10 units a day. They do not want to stop drinking as they don’t see the point. What is the best way to get them to stop?** Options: Referral to drug and alcohol Motivation interviewing CAGE

Question 31

**28 year old painter has pain. It hurts when he grips brushes and when he paints. On examination there is pain in the lateral epicondyle. What action causes pain?** Options: Wrist flexion Thumb flexion Elbow flexion Elbow extension Wrist extension Finger flexion

Question 32

**6 week old child has palpable liver and is jaundiced. Has high unconjugated bilirubin. What is the cause?** Options: Physiological Breast milk jaundice Biliary atresia AI haem anaemia

Question 33

**Young man in new relationship with hockey girl. Notices yellow discharge from penis and is sent to GUM. What is the initial investigation they will do?** Options: MSU Urine dip Penile swab (all 3 are reasonable and depends on your interpretation of initial to be honest and how old the q is)

Question 34

**Patient has months of cough and night sweats. Haemoptysis on 3 occasions over last week. What test do you do?** Options: Blood cultures AFB Sputum culture and sensitivity

Question 35

**Young adult has come from Africa 2 weeks ago. He has fever night sweats, weight loss and a neck lump. What is the cause?** Options: EBV TB Malaria HIV

Question 36

**Man in car crash, has severe facial lacerations. What is the most important first step?** Options: Secure C-spine and airway

Question 37

**Patient has partial gastrectomy for crohns. What vitamin will they become deficient of?** Options: Folate Iron B12 Vit D NB: Yes b12 came up about 5 times over the 2 papers

Question 38

**Man with HIV has multiple ring enhancing lesions on CT head. Cause?** Options: Toxo Lymphoma Malaria Meningitis

Question 39

**Old lady has lesion on her labia majora which is ulcerated. What is the cell type on biopsy?** Options: BCC SCC

Question 40

**35 year old lady is 20 weeks pregnant and attends for the first time. Her BP is 155/80. You’re antenatal clinic very kindly check renal function which looks normal. What is the cause of the high BP?** Options: Cushings Preeclampsia? Essential HTN Conns

Question 41

**Neonate (?6 weeks) attends with RR of 28 and stridor. Given neb adrenaline and neb saline. 15 minutes later RR is 80 and recession. What do you do?** Options: IM adrenaline Neb salbutamol Call anaesthetist

Question 42

**Guy with COPD. Has FEV1 of 25%, What other finding would you expect on spirometry?** Options: Inc residual volume Dec residual volume Inc forced vital capacity

Question 43

**Man 2 days post MI on CCU, goes unresponsive and pulseless VF. First thing to do?** Options: O2 by non-rebreathe mask Amiodarone Adrenaline 2 rescue breathes Shock him to high heaven

Question 44

**Women 40, 2 weeks of \>8 diarrhoeas a day with blood. What has she got?** Options: Diverticulitis Colon cancer UC

Question 45

**Young Boy (?5) at school is failing to climb the climbing frame. Comes in, leg weakness but big calves. Where is the problem?** Options: Muscle end plate Ventral root Muscle fibre Pyramidal tracts Anterior horn cell

Question 46

**Study looking at bowel cancer. In 20 year study, 500 patients in population of 500,000 have bowel cancer. Assuming incidence was consistent throughout the 20 years, what was the incidence/100,000 per year?** Options: 50 5 10 20 25

Question 47

Patient has temperature, renal damage and “painful finger pulp”. What is it? Options: Infective endocarditis

Question 48

**Patient has bone pain and roleaux +ve on testing & High Calcium** Options: Multiple Myeloma

Question 49

**Patient has leg weakness that has spread to the arms over last day. Sensation is only minimally affected. What is the problem?** Options: Demyelinating peripheral neuropathy Destructive something Amyloid infiltration Something else reasonable but not demyelinating

Question 50

**Patient has Guillian Barré. What do you need to most look out for?** Options: renal failure Spinal cord compression Resp failure

Question 51

**Old man with pneumonia (?small cell carcinoma of lung), has low plasma sodium. Osmolality about 250. Urinary sodium is “\>50” and urine osmolality 380. What is the cause?** Options: Diabetes insipidus SIADH

Question 52

**Patient with RA, is SOB for 3 days. O/E Temp 36, dull to percussion on left. What is the cause?** Options: Cancer Effusion Pneumonia Fibrosing alveolotis (but this would be bilateral)

Question 53

**Patient has nosebleed. How do you manage?** Options: Tilt head back pinch bridge Tilt head back pinch nostrils Tilt head forward pinch bridge Tilt head back pinch nostrils Pack with tampax

Question 54

**Patient has CABG. Within 24 hours they are oligouric. Adequate fluids given. Why?** Options: Hypovolaemia ATN Glomerulonephritis

Question 55

**Patient post op for simple lap choly. Given 1000ml 0.9% NaCl and 5mg morphine. In recovery she’s agitated. Why?** Options: Bile spillage Inadequate pain relief Inadequate fluids

Question 56

**Patient has epidural (ortho op). They have BP 80/60 catheter in situ passed about 35ml urine. Hands are cold but feet are warm. What is the first step in management?** Options: Fluid challenge Stop epidural Call anaesthetist Flush Catheter

Question 58

**Old man has prostate cancer. He comes in with GCS of 12 and drowsy. BP is 120/80. Has been taking pain relief for 4 weeks. Why is he drowsy?** Options: Hyponatraemia Hypercalcaemia Peptic ulcer

Question 59

**Woman is post partum. Worried about infecting her child with germs. (same as PPs). What is it?** Options: Post partum depression Psychosis OCD

Question 60

**Old man faints at home. ECG shows HR of 45. JVP is “significantly elevated”. What is the cause?** Options: Sick sinus syndrome AF Complete Heart block Asystole

Question 61

**Study shows oral drug X has a smaller area under the curve than IV drug X. What could be the reason for this?** Options: Inc renal excretion for oral drug Dec renal excretion for IV drug First pass metabolism Inc hepatic excretion for IV drug Dec hepatic excretion for oral

Question 62

**Patient notices a bug flies in their eye. After 15 minutes, their eye swells up. Shortly after, the swelling subsides. What cell type was responsible?** Basophils Neutrophils Mast cells Macrophages Lymphocytes

Question 63

**Patient jumps during sports. Falls over and lands on right leg with it bent and twisted. Comes to A+E with leg in flexion at 30 degrees, O/E you can’t move it passively beyond 30 degrees. What's the problem?** Options: Medial collateral ligament Medial meniscus Patella # Tibeal osteochondral # Femur condyle #

Question 64

**40 year old woman who’s a non-smoker has 12 years of recurrent chest infections. She has 3 days of haemoptysis with her long standing dry cough. What is the cause?** Options: Bronchial Carcinoma PE Bronchiectasis Heart failure TB

Question 65

**Woman with green discharge, petichaie on cervix and looking under microscopic showed motile organisms. What is it?** Options: Chlamydia Bacterial vag Trich Vag Syphilis Gonorrhoea

Question 66

**Man with prostate Ca has lytic bone lesion on femur. How do you treat?** Options: Radiotherapy (vs. Bisphosphonates)

Question 67

**Patient has RUQ pain, admitted to hospital. Settles after 4 hours with morphine. Scan shows stones in a dilated (7mm) common bile duct. Discharge home and reviewed in 4 weeks. What's the best Mx?** Options: ERCP MRCP Lap choly Reassure

Question 68

**Patient on ward has IV saline drip, is drowsy and unresponsive. BM 1.8. What is the best initial management?** Options: Oral glucose gel PR glucose Glucagon 1mg IM 80ml 20% dex IV

Question 69

**Patient found on floor by neighbour, has been incontinent of urine. Renal profile shows kidneys are pretty messed up and CK is 12,000. What is the cause of the renal failure?** Options: Rhabdomylosis

Question 70

Lady visits opticians. Told she has bilateral optic disc swelling so comes to doctor. Denies any symptoms but does remember some transient visual loss when she got out of bed. What is the cause? Options:

Question 71

**Patient has bitemporal hemianopia and big hands/face. Where is the lesion?** Options: Anterior pituitary Pineal Posterior pituitary Pituitary stalk

Question 72

**Patient has cerebral mets from breast Ca aged 39. On 7.5mg dex. Develops weakness in legs and is worried about mets. Has weak proximal thighs and shoulder. No pain. What do you do?** Options: Reduce dex dosing Bone xray Inc pain relief Increase dex dose

Question 73

**Patient has sudden onset severe headache and no focal neurology, comes in to A+E 12 hours ago. Has CT scan and all is normal. What do you do?** Options: Re-CT Admit and observe LP MRI

Question 74

Women with enlarged parotid gland and flu-like symptoms. What is diagnosis? Options:

Question 75

**Man has hoarse voice and neck lump. He went to the clinic and did not return for two months. What investigation would you do?** Options:

Question 76

**Medical student on expedition to high altitude. What is the long term ABG picture? Has probs initially, but then adapts. By what physiological mechanism does this work?** Options: Respiratory alkalosis with metabolic compensation ( breathes more to breathe in more o2 but breathes off more co2; body compensates by gtn rid of hco3)

Question 78

**Finding of apical lung shadow, hemoptysis and hoarse voice. What is the finding in the face?** Options:

Question 79

**Girl turned vegan worried about iron. What would show she has low iron?** Options: Low MCV

Question 80

**Gave big description of a guy with tennis elbow. And said what the muscle affected does?** Options: Wrist flexor wrist extensor elbow flexor extensor wrist pronator

Question 81

**Child comes in with central and RIF abdo pain and nausea and vomiting. Had sore throat a few days previously.** Options:

Question 82

**Guy has been finding it difficult to walk due to leg swelling. He urine 4+ protein; 1+ haematuria. Creatining 400 urea 36. What is investigation that will lead to making specific diagnosis?** Options:

Question 83

**Easy question about ureteric colic diagnosis** Options:

Question 84

**Guy with heart failure. What is most immediate treatment to alleviate symptoms?** Options:

Question 85

**Guy had lap chole. Comes in sob and dry cough. Abg result shows t1rf. What is cause? Examination is normal.** Options:

Question 86

**What is best way of preventing VTE in guy going to ortho surgery on TEDS already?** Options:

Question 87

**Guy with sob; has reduced chest expansion on the left and reduced bs there. What is cause?** Options:

Question 88

**Patient overdosed on TCA. Ecg shows prolongation of qt but no torsades de pointes. Treatment?** Options: