MaM Paper 10

Question 1

When should a STEMI patient considered for PCI

Answer 1

If they have present within 12 hours of symptoms onset
AND
If they can receive PCI within 2 hours

Question 2

Which of the following findings would distinguish NSTEMI from unstable angina pectoris?
A)Dynamic T Wave Inversion
B)Response to GTN Spray
C)Elevated Troponin Concentration
D)Elevated BNP
E)New Left Bundle Branch Block

Answer 2

C)Elevated Troponin Concentration

The first-line investigation in suspected ACS is an ECG, and if the patient has ST elevation or a new-onset left bundle branch block, they should be treated as a STEMI with urgent PCI or thrombolysis. If these specific ECG changes are not present, their troponin concentration will help distinguish an infarct (i.e. tissue death in NSTEMI) from ischaemia (i.e. tissue hypoxia in unstable angina). Patients with an NSTEMI or unstable angina may both have ischaemic changes on their ECG (e.g. ST depression or dynamic T wave inversion), however, only an NSTEMI would cause a rise in serum troponin concentration

Question 3

Triple therapy for eradication of H. pylori

Answer 3

Omeprazole, Metronidazole and Amoxicillin

Question 4

Murmur Aortic Stenosis

Answer 4

Systolic Murmur

Question 5

Mitral Regurgitation

Answer 5

Systolic Murmur

Heard best at the apex of the heart with radiation to the left axilla

Question 6

Mitral Stenosis

Answer 6

Diastolic Murmur

low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex.

Question 7

Aortic Regurgitation

Answer 7

Diastolic Murmur
A decrescendo blowing diastolic murmur heard best at the left lower sternal border,

Question 8

How to differentiate right and left sided murmurs?

Answer 8

The key to distinguishing left and right-sided heart murmurs is whether it is louder on inspiration or expiration.

Blood goes in to the right side of the heart so it is louder on inspiration.

Blood exits the left side of the heart so it is louder on expiration.

Question 9

Meckel’s diverticulum Imaging

Answer 9

CT Scan or Scintigraphy

Question 10

PSC antiobody

Answer 10

pANCA

Question 11

Pancreatic cancer

Answer 11

CA19-9

Question 12

Autoimmune hepatitis antibody

Answer 12

Anti-smooth muscle antibodies (ASMA)

Question 13

CSF TB

Answer 13

• Raised protein concentration,
• High lymphocyte count
• Low glucose concentration

Question 14

Viral Meningitis CSF

Answer 14

-Normal / High protein concentration
- High lymphocyte count.
- CSF glucose is not usually low.

Question 15

Bacterial Meningitis CSF

Answer 15

• Turbid CSF
• High neutrophil count
• Low CSF glucose

Question 16

WHat virus causes Herpes ZOster Opthalmicus?

Answer 16

VZV

Question 17

Amandtadine what is it used for?

Answer 17

Parkinson’s medication and anti-viral for Influenza A

Question 18

Which ECG changes would be suggestive of right heart strain secondary to a pulmonary embolism

Answer 18

T Wave Inversion in V1-3

Question 19

Treatment for unstable patient with PE?

Answer 19

Alteplase

Question 20

A 43-year-old woman is brought to A&E by her partner. She complains of generalised abdominal pain and vomiting but thinks that it is most likely due to constipation. She has requested laxatives from the nurses in the department.

She adds that she has had several episodes of upper abdominal pain in the past year which have resolved spontaneously after a few hours or days. She has not sought medical attention for these episodes as they always seem to go away by themselves.

She has not opened her bowels in 3 days and, on examination, her abdomen is significantly distended with a tympanic percussion note. An abdominal X-ray reveals distended loops of bowel with visible valvulae conniventes. She has never had any abdominal operations in the past.

What is the most likely diagnosis in this patient?A)Gallstone Ileus
B)Sigmoid Volvulus
C)Cholecystitis
D)Inguinal Hernia
E)Pancreatitis

Answer 20

A)Gallstone Ileus

Question 21

Smith fracture

Answer 21

Fractured right distal radius with volar displacement of the fractured fragment

Question 22

Colles fracture

Answer 22

A distal radius fracture with dorsal displacement of the distal fracture component is referred to as a Colles fracture. It is usually sustained following a fall on an outstretched hand

Question 23

Management of a Smith Facture

Answer 23

Reduction with analgesia/anaesthetic support is the mainstay of initial management, followed by immobilisation of the joint with a back slab and plaster of Paris.

Question 24

Colles fracture

Answer 24

A distal radial fracture is termed Colles fracture if the fractured fragment is displaced dorsally. It is commonly accompanied with an ulnar stylus fracture.

Question 25

A fracture of the mid radius accompanied by distal ulnar dislocation

Answer 25

Galeazzi fracture

Question 26

A fracture of the mid ulna accompanied with a distal radial dislocation

Answer 26

Monteggia fracture

Question 27

Leriche syndrome

Answer 27

Buttock pain, erectile dysfunction and absent femoral pulses.

The symptoms of intermittent buttock claudication and erectile dysfunction are caused by insufficient arterial flow to the gluteal muscles of the posterior thigh and the corpus cavernosum of the penis respectively.

Best medical therapy including medication (diabetic, hypertensive, statin, antiplatelet) and lifestyle changes (exercise, smoking cessation, diet change) should be initiated, as should a referral to vascular surgery.

Question 28

UTI with renal impairment treatment

Answer 28

Nitrofurantoin concentrates in the bladder and is used to great effect in the treatment of UTI, however, it is mainly excreted by the kidneys so should be avoided in renal impairment (especially if the eGFR < 45 mL/min).

Trimethoprim is a folate antagonist that inhibits bacterial DNA synthesis and is very effective in the treatment of UTI.

Question 29

Agents that trigger malignant hyperthermia

Answer 29

Inhaled anaesthetics (e.g. sevoflurane) and depolarising neuromuscular blockers (e.g. suxamethonium)