Last min SBA 2

Question 1

A systematic review on the use of apixaban for left ventricular thrombus has shown a significant reduction in hospitalisation and mortality. Twenty randomised and non-randomised studies were included in the meta-analysis. The authors were concerned about the potential impact of studies with significant results being published more frequently than studies with negative findings and decided to investigate for publication bias.

What is the most appropriate method of assessing for publication bias in this study?

Forest plot

Funnel plot

GRADE analysis

Meta-regression analysis

Sensitivity analysis

Answer 1

Funnel plot for publication bias

Question 2

A 64-year-old woman presents to her GP with complaints of diffuse joint pain, which has been particularly severe in her right first interphalangeal joint and left wrist for the past six months. The pain is worse in the morning and improves as the day passes. She reports having had a sore throat one week before the onset of her symptoms.

On examination, swelling of the distal interphalangeal joints on her left hand is observed, and the whole fingers seem swollen.

What is the most likely diagnosis?

Osteoarthritis

Psoriatic arthritis

Reactive arthritis

Rheumatoid arthritis

Systemic lupus erythematosus

Answer 2

Psoriatic arthritis

Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis

Question 3

A 40-year-old woman presents to the rheumatology clinic with a 3-month history of myalgia and widespread bony tenderness. She describes increased fatigue and weakness whilst lifting heavy objects. Her past medical history includes coeliac disease.

On examination, there is tenderness over the shoulder girdle and arms. There is no associated joint stiffness. She has a waddling gait.

Blood tests are taken:

Calcium 1.9 mmol/L (2.1 - 2.6)
Phosphate 0.8 mmol/L (0.8 - 1.4)
ALP 176 u/L (30 - 100)

What is the most likely diagnosis?

Myositis

Myotonic dystrophy

Osteomalacia

Osteoporosis

Polymyalgia rheumatica

Answer 3

Osteomalacia

Question 4

dermatomyositis related to

Answer 4

malignancy

Question 5

A 58-year-old undergoes a triple assessment after finding a lump in the right upper lateral quadrant of her breast. Her last menstrual period was 8 years ago, she has never used any hormonal contraceptives or hormone replacement therapy and has no other past medical history.

A biopsy shows the presence of ductal carcinoma in situ that is progesterone receptor-negative, HER2-negative, and oestrogen receptor-positive. She is offered a lumpectomy with adjuvant radiotherapy and endocrine therapy.

What is the mechanism of action of the most likely drug she will be given?

Complete oestrogen receptor antagonism

GnRH receptor agonism

GnRH receptor antagonism

Inhibition of peripheral oestrogen synthesis

Partial oestrogen receptor antagonism

Answer 5

Inhibition of peripheral oestrogen synthesis- aromatase inhibitors

Question 6

A 48-year-old man is due to undergo a laparotomy for small bowel obstruction.

Answer 6

The correct answer is: Endotracheal intubation

Question 7

A 63-year-old man has been on the intensive care unit for a week with adult respiratory distress syndrome complicating acute pancreatitis. He has required ventilation and is still being mechanically ventilated.

Answer 7

Tracheostomy 33%

Tracheostomy is often used to facilitate long term weaning. The percutaneous devices are popular. These involve a seldinger type insertion of the tube. A second operator inserts a bronchoscope to ensure the device is not advanced through the posterior wall of the trachea. Complications include damage to adjacent structures and bleeding (contra indication in coagulopathy).

Question 8

A 47-year-old man is brought to the emergency department with a laceration on his left arm after falling at home. There was copious blood at the scene and the patient received a transfusion of one unit of packed red blood cells on arrival at the hospital.

The patient remains haemodynamically stable throughout and his wound is numbed with 10mls of 2% lidocaine prior to suturing by a junior member of the team.

Before suturing can begin the patient becomes profoundly tachycardia and hypotensive with a heart rate of 150 bpm and blood pressure of 70/40mmHg.

What is the most appropriate reversal agent?

IM glucagon

IV atropine

IV labetalol

IV lipid emulsion

IV magnesium sulfate

Answer 8

IV lipid emulsion

Question 9

which anaesthetic can cause adrenal suppression

Answer 9

Etomidate

Question 15

A 9-year-old boy is diagnosed as having Attention Deficit Hyperactivity Disorder and started on methylphenidate. Which one of the following should be monitored during treatment?

Visual acuity

Electrocardiogram to measure QRS duration every 12 months

Growth

Urinalysis

Liver function tests

Answer 15

Growth

Question 15

A 68-year-old man was recently admitted with diverticulitis. He has a past medical history of hypertension, diabetes, and atrial fibrillation and he is currently on amlodipine, metformin, gliclazide, and warfarin.

On digital rectal examination, you notice some mild minor rectal bleeding. He is otherwise haemodynamically stable.

International normalized ratio (INR) 8.2 (2.0-3.0)

What should the patient’s management plan be with regard to his warfarin treatment?

Stop warfarin, give intravenous vitamin K

Stop warfarin, give intravenous vitamin K, give prothrombin complex concentrate

Stop warfarin, give oral vitamin K

Stop warfarin, give prothrombin complex concentrate

Withhold 1 or 2 doses of warfarin

Answer 15

INR > 8.0 (minor bleeding) - stop warfarin, give intravenous vitamin K 1-3mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0

Question 15

On CT imaging, acute haematomas appear

Answer 15

bright (hyperdense) whereas chronic haematomas appear dark (hypodense).

Question 15

turners associated with

Answer 15

aortic stenosis and coarc

Question 16

A 45-year-old woman who is being treated for Hodgkin’s lymphoma with ABVD chemotherapy is reviewed on the haematology ward. She has been admitted by her GP with a fever of 38.9ºC. Her blood count from two days ago was as follows:

Hb 10.1 g/dl
Platelets 311 * 109/l
WBC 0.8 * 109/l
Neutrophils 0.35 * 109/l
Lymphocytes 0.35 * 109/l

Blood pressure is 102/66 mmHg and the heart rate is 96/min. Respiratory examination is unremarkable. You insert an intravenous cannula and take bloods including cultures.
What is the most appropriate next step in management?

A.	Start intravenous ceftriaxone + amphotericin B	
B.	Await the repeat white blood cell count then phone the haematology consultant	
C.	Start intravenous piperacillin with tazobactam (Tazocin)	
D.	Start intravenous ceftriaxone + gentamicin	
E.	Start intravenous piperacillin with tazobactam (Tazocin) + G-CSF

Answer 16

Piperacillin with tazobactam (Tazocin) is the empirical antibiotic of choice for neutropenic sepsis

G-CSF is not used routinely in neutropenic sepsis.

Question 17

Lactational amenorrhoea

Answer 17

is a reliable method of contraception as long as amenorrhoeic, baby <6 months, and breastfeeding exclusively

Question 18

Red Flags for back pain include -

Answer 18

Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity

Question 19

steroids. which can be given preterm

Answer 19

dexamethasone
betamethasone

Question 20

A 21-year-old history student is admitted to the acute medical unit with a headache. He says he has had it for the past 4 days and it is present all the time but worst when he is lying down or when he coughs. He has a temperature of 38.2ºC, a heart rate of 94 bpm and complains that bright lights hurt his vision. On examination he is drowsy, he has a Glasgow coma score of 14, opening his eyes to voice and he has neck stiffness.
Which of the following investigations should be performed first?

A.	MRI brain	
B.	CT head	
C.	Lumbar puncture	
D.	Carotid artery Doppler	
E.	Optic pressure measurement

Answer 20

CT
Headache linked to Valsalva manoeuvres = raised ICP until proven otherwise so LP is contraindicated

Question 21

A 4-year-old boy with recurrent urinary tract infections is referred to the paediatric team due to worries over reflux nephropathy.
Which of the following is the investigation of choice when it comes to diagnosing this condition?

A.	CT of the kidneys, ureters and bladder	
B.	Intravenous pyelogram	
C.	Micturating cystography	
D.	Renal ultrasound	
E.	Renal biopsy

Answer 21

Micturating cystography is the investigation of choice for reflux nephropathy

Question 22

…………. is the antibiotic of choice for GBS prophylaxis

Answer 22

Benzylpenicillin

Question 23

Heparin can cause drug induced

Answer 23

thrombocytopaenia

Question 24

which drug can precipitate digoxin toxicity

Answer 24

Yellow vision, bradycardia, nausea and vomiting are symptoms suggestive of digoxin toxicity. Digoxin toxicity can be precipitated by numerous drugs and other factors, particularly hypokalemia. As thiazide diuretics increase the likelihood of hypokalemia, they may precipitate digoxin toxicity.

Question 25

which drugs to avoid in G6PD deficiency:

Answer 25

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis

Question 26

Cushing’s syndrome metabolic result -

Answer 26

hypokalaemic metabolic alkalosis

Question 27

Anaphylactoid reactions to IV N-Acetylcysteine are generally treated by

Answer 27

stopping the infusion, then restarting at a slower rate

Question 28

penicillin allergic treatment of cellulitis

Answer 28

erythromycin

Question 29

when does time out stage occur WHO checlist

Answer 29

The ‘time out’ stage of the WHO Checklist refers to the period before the first skin incision is made

Question 30

management of acute pancreatitis

Answer 30

fluids and analgesia

Antibiotics should not be offered routinely to patients with acute pancreatitis

Question 31

Acute exacerbation of COPD:

Answer 31

BiPaP is indicated if type 2 respiratory failure develops despite medical therapy

Question 32

adrenaline for paeds anaphylaxis

Answer 32

0-6 years old: 150micrograms (0.15ml 1 in 1,000).
6-12 years old: 300micrograms (0.3ml 1 in 1,000).
13+ years old: 500micrograms (0.5ml 1 in 1,000).

Question 33

antidepressant therapy for PTSD

Answer 33

If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI

Question 34

A 29-year-old female patient has a telephone consultation with her GP, worried about an incident that occurred two days ago. She is currently 18 weeks pregnant, with no complications thus far. She works in a children’s nursery. Her boss called her today, informing her that one of the children she had cared for, two days prior, has since developed a chickenpox rash. The patient is worried about the impact that this exposure may have on her pregnancy. She feels well in herself and has no symptoms, nor rash. She is uncertain of whether or not she had chickenpox herself as a child.
What is the most appropriate management?

A.	Give oral aciclovir immediately	
B.	Give varicella-zoster immunoglobulin immediately	
C.	Perform a blood test for varicella antibodies and await the result	
D.	Give oral aciclovir 7 days post-exposure
E.	Give varicella-zoster immunoglobulin 7 days post-exposure

Answer 34

Perform a blood test for varicella antibodies and await the result