MCQ learning points

Question 1

What is the main causative organism of Ascending cholangitis?

Answer 1

E. Coli (Gram negative rod)

Question 2

The combination of Low BP, raised JVP and muffled heart sounds indicates which condition?

Answer 2

Cardiac tamponade
Triad due to gas/fluid building up around the heart

Question 3

What are the following positive antibodies indicative of:
ASMA, p-ANCA
AMA
Anti-endomysial
Anti-jo

Answer 3

ASMA, p-ANCA: Primary sclerosing cholangitis
AMA: Primary biliary cirrhosis
Anti-endomysial: coeliac disease
Anti-jo: myositis (dermato, poly)

Question 4

How does mitral stenosis and mitral regurgitaiton differ on auscultation

Answer 4

Stenosis: mid-diastolic rumble
Regurgitation: Pan-systolic murmur

Question 5

What history detail helps distinguish duodenal from gastric ulcer

Answer 5

Duodenal relieved on eating
Gastric worsens

Question 6

Which dyspepsia patients get an urgent endoscopy? What do you do if they do not qualify?

Answer 6

Endoscopy if ALARMS + > 55 years
Stool or breath test if they don’t qualify

Question 7

What is the management pathway for unspecified dyspepsia symptoms?

Answer 7

1. Trial high dose PPI for 1 month OR Investigate for H. Pylori
2. If one does not work try other
3. If H. pylori positive, eradicate with PPI + amox + clarithromycin/metronidazole
4. If fails, trial H2RA (ranitidine) or consider alternative diagnosis

Question 8

How do you distinguish an exudative from a transudative effusion and how does that sway diagnosis?

Answer 8

If fulfills one of below (lights criteria)…

• Pleural:serum protein ratio >0.5
• Pleural: serum LDH >0.6
• Pleural LDH >2/3s that of serum

…Then its exudative

Exudative: Inflammation, increased permeability due to cancer, infections, auto-immune
Transudative: increased hydrostatic pressure

Question 9

Which 4 drugs have prognostic benefit in heart failure

Answer 9

SAAB

Spironolactone

ACE inhibitors

Angiotensin II antagonists

Beta-blockers (selective) eg Metoprolol, bisoprolol, atenolol

Question 10

Which 3 drugs are of symptomatic but not prognostic benefit in heart failure?

Answer 10

Loop diuretics (eg furosemide)

Digoxin

Nitrates, hydralazine (vasodilators)

Question 11

Patient presents confused and hypotensive. HR is 114, temp 39deg and BP 95/45. They have a PMHx of gallstones and AUS confirmed multiple stones, thickened gall bladder wall and dilated ducts. Following fluids and antibiotics what would you want to do?

Answer 11

Emergency ERCP

Allows decompression and insertion of stents

Question 12

Which antibody test is most specific for autoimmune hepatitis?

Answer 12

Anti-smooth muscle antibodies

ANA is also positive but less specific as systemic sclerosis, rheumatoid arthritis and Sjogren’s all positive too

Question 13

What are the side effects of metformin?

Answer 13

Gastrointestinal upset

Lactic Acidosis is rare but fatal

Question 14

Regarding metformin’s action, which common drugs do you need to watch for?

Answer 14

Alcohol: hypoglycaemia, lactic acidosis

B-blockers: Can mas hypoglycaemia

Ketotifen (anti-allergic): can reduce platelet count

Topiramate: Increase metformin action

Question 15

Which T2DM drugs cause hypoglycaemia?

Answer 15

Sulfonylureas (glicazide, glibenclamide)

Low risk in GLP-1 mimetics

Question 16

Which diabetic drugs induce weight loss?

Answer 16

SGLT-2 inhibitors (-gliflozins)

GLP-1 mimetic (exenatide, liraglutide)

Question 17

Which diabetic drugs induce weight gain?

Answer 17

Thiazolinediones (pioglitazone)

Sulfonylurea (glicazide)

Question 18

Which diabetic drugs do not affect weight?

Answer 18

Metformin

DPP4-inhibitors (glitpins)

Question 19

Which diabetic drugs is most associated with glucosuria?

Answer 19

SGLT-2 inhibitors (gliflozins)

Question 20

Which diabetic drug is most associated with fluid retetion?

Answer 20

Thiazolidinediones (pioglitazone)

Question 21

Gliptins are part of x class of drug

Flozins are y kind of drugs

Answer 21

X: DPP-4 inhibitors

Y: SGLT-2 inhibitors

Question 22

What is the first line HTN therapy for a diabetic?

Answer 22

ACE inhibitor (ramipril, lisinopril)

Question 23

How do you manage a first miscarriage?

Answer 23

<6 weeks + painless bleeding: Repeat pregnancy test in a week

Positive repeat: Refer to EPAU

>14 days symptoms/haemorrhage/infection risk:

1st line: Vaginal misoprostol alone

1st fails or incomplete: Vaccuum or surgical removal

Question 24

What constitutes recurrent miscarriage? Once identified what should you do?

Answer 24

>=3 miscarriages before 10 weeks gestation OR >=1 normal foetal loss after 10 weeks

Advise: If no cause found then chances of term pregnancy 75%

Screen for APL antibodies, genetic abnormalities, pelvic US for pathology.

Question 25

When can a post-miscarriage woman…

a) Have sex
b) Have another pregnancy

Answer 25

a) Whenever symptoms have settled
b) When comfortable once menstruation occurs 4-8 weeks post-miscarriage

Question 26

Amenorrhea, hot flushes under 40 with raised gonadotrophins suggests what? What do you treat this with?

Answer 26

Primary ovarian failure

Uterus: COC pill until 51

No uterus: Progesterone only pill until 51

Question 27

Lower left quadrant pain, bloating, altered bowel habit with fever suggests what condition?

Answer 27

Diverticulitis

Investigate with AXR, CT is gold standard

Oral antibiotics if mild

Admit for IV if severe

Question 28

How do you screen for diabetic nephropathy?

Answer 28

Albumin creatinine ratio >70mg/mmol

Repeat with first pass morning sample if initially inadequate

Question 29

Severe colic worse after eating, weight loss and abdominal bruit suggests what diagnosis?

Answer 29

Mesenteric ischaemia