MD1+2 MCQs Flashcards
Which of the following micro-organisms is LEAST likely to cause acute bacterial meningitis?
Streptococcus pneumoniae Neisseria meningitidis Enterococcus faecalis
Enterococcus faecalis
NOT immuno-compromised, NOT pregnant, NO allergies, under 50 ; appropes empirical Rx for acute bacterial meningitis = ?
IV Ampicillin
IV Gentamicin
IV Ceftriaxone
IV Ceftriaxone
Which of the following is LEAST likely to cause community acquired pneumonia?
Streptococcus pneumoniae Staphylococcus aureus Mycopalsma
Legionella
Haemophilus In uenzae Chlamydia pneumoniae
Staphylococcus aureus
Which organism is NOT covered by Benzyl Penicillin?
Streptococcus pneumoniae Haemophilus In uenzae Pseudomonas Aeuruginosa
Pseudomonas Aeuruginosa
Which organism is NOT covered by doxycycline?
Proteus mirabilis
Mycoplasma
Chlamydia pneumoniae Legionella
Proteus mirabilis
Which of the following organisms is LEAST likely to cause a urinary tract infection?
Staphylococcus saprophyticus Staphylococcus aureus
Proteus
Klebsiella
Escherichia coli
Enterococcus faecalis
Staphylococcus aureus
Which of the following antibiotics would be LEAST reasonable for management of UTI?
Cefalexin
Nitofurantoin
Trimethoprim
Vancomycin
Vancomycin
Which of the following organisms is LEAST likely to cause cellulitis?
Streptococcus Pyogenes Klebsiella
Staphylococcus Aureus
Klebsiella
30 male (NKDA) presents w progressive R forearm skin redness, discomfort + purulent discharge; inpatient Rx choice = ?
Ceftriaxone
Gentamicin
Metronidazole
Flucloxacillin
Flucloxacillin
A 60 year old with acute right upper quadrant pain, fever and jaundice is managed as an inpatient. Which LEAST correct?
Gentamicin covers gram negatives
Ampicillin covers enterococcus
Renal function needs consideration prior to charting of gentamicin
Liver failure can be a consequence of cholangitis
Streptococcus is a common pathogenic organism of the biliary tract
Streptococcus is a common pathogenic organism of the biliary tract
Which of the following would be LEAST relevant in the work-up of a patient with working diagnosis bacterial meningitis?
Full Blood Count
Electrolytes, Urea, Creatinine Lipid studies
Coagulation studies
Blood Culture
CRP
Lipid studies
Which of the following would be LEAST relevant in the work-up of a patient with working diagnosis bacterial meningitis?
Lumbar Puncture
CT Brain
Chest x-ray
Urine Dipstick
Biliary Ultrasound
Biliary Ultrasound
Which of the following would be LEAST relevant in the work-up of working diagnosis pneumonia? Vital signs are deranged.
Full Blood Count
EUC
CRP
Coagulation Studies
Blood Culture
Venous Blood Blood Gas
Coagulation Studies
Which of the following would be LEAST relevant in the work-up of pneumonia?
Chest x-ray
CT chest
Urine Dipstick
CT chest
Which of the following would be LEAST relevant in the work-up of working diagnosis exacerbation COPD?
Patient is drowsy
Venous Blood Gas
Chest x-ray
FBC
EUC
Troponin
CRP
Troponin
Which of the following would be LEAST relevant in the work-up of working diagnosis biliary sepsis?
Lipase
BNP
Venous Blood Gas
LFTs
Biliary Ultrasound
Blood Culture
BNP
Which of the following would be LEAST relevant in the work-up of working diagnosis pyelonephritis? Creatinine is normal
Urine dipstick
FBC
EUC
Renal Tract Ultrasound
Renal Tract Ultrasound
Which of the following would be LEAST relevant in the work-up of peri-wound cellulitis for admission? Normal vitals
Full Blood Count
EUC
Wound swab
Blood culture
Blood culture
Which of the following would be LEAST relevant in the work-up of working diagnosis septic arthritis?
FBC
EUC
LFTs
Joint aspirate
Joint x-ray
Blood culture
LFTs
Which of the following would be LEAST relevant prior to emergency cholecystectomy for biliary sepsis?
FBC
EUC
ESR
Coagulation Studies
Group and Hold
LFTs
ESR
Which of the following would be LEAST relevant in the work-up of working diagnosis PID?
Pelvic Ultrasound
Urine dipstick
FBC
EUC
CRP
Coagulation Studies
Coagulation Studies
Which of the following is the SOFTEST indication for an ECG?
Chest pain
SOB in patient with T2DM on insulin
Syncope
Peripheral oedema
Epigastric pain
Palpitations
Peripheral oedema
Working diagnosis of paediatric neisseria meningitidis CNS sepsis. Which of the following is LEAST time critical?
CT Brain
Support with oxygen as needed
Support with NG or IV fl uid including glucose as needed Antibiotics
CT Brain
Which of the following is LEAST likely to cause a cardiac arrest
Severe Hypoxia
Severe Hypovolaemia
Severe Thrombocytopenia Severe Hyperkalaemia
Tension Pneumothorax
Severe Hypokalaemia
Severe Thrombocytopenia
Which of the following is LEAST likely to cause a cardiac arrest?
Severe STEMI
Severe Pulmonary Embolism Cadiac Tamponade
Severe Diverticulitis
Severe Diverticulitis
A 30 year old female presents to ED with 3 days worsening headache, photophobia,
neck stiffness and fever.
She is assessed to be septic on work-up. The patient has no allergies.
Based on the likely source of sepsis according to cluster of symptoms what would be
appropriate empirical antibiotic management:
Ceftriaxone
A 60 year old male presents to ED with worsening productive cough, pleuritic chest
pain, shortness of breath and fever.
He is assessed to be septic on work-up. The patient has no allergies.
Empirical management based on source corresponding to presentation would
include two antibiotics covering which five organisms:
Amoxicillin and/or doxycycline
Streptococcus, Haemophilus, Chlamydia, Legionella, Mycoplasma
A 50 year old female with known pancreatic cancer and past biliary stent placement
presents to ED with 5 days worsening right upper quadrant abdominal pain, jaundice
and fever. The patient has no known drug allergies.
On the presumption of sepsis, based on the presentation plus normal renal function
what would be the most likely empirical antibiotic management prior to any
indicated intervention:
Gentamicin plus Ampicillin plus Metronidazole
A 20 year old male presents with worsening confluent erythema over his right lower
limb which is judged to be infective in nature and requiring admission to hospital. He
has no prior history of MRSA. He has no allergies. What would be the most
appropriate choice of antibiotic therapy?
Flucloxacillin
A 42-year-old male with past history of recreational IV drug use presents to the ED
with back pain and fever; no other symptoms of infection.
Chest is clear to auscultation, abdomen is soft to palpation and there is no audible
cardiac murmur; no abnormal neurology at lower limbs, no evidence of sphincteric
dysfunction.
There is focal tenderness at T11 and T12 on vertebral column palpation. There is no
renal angle tenderness.
Blood culture yields positive for staphylococcus aureus subsequently on the ward.
What is the likely diagnosis and most common causative agent?
Infective discitis following bacteraemia in the setting of recreational IVDU
Staphylococcus aureus
What are the tests to assess the severity of GI bleeding
CBC: Hb, Hct, platelet count
Coagulation panel
BMP: Increased BUN/Cr ration suggests a brisk Upper GI bleed
Causes of Hyponatremia
Hypervolemic: Inappropriate upregulation of RAAS (and ADH) ie. HF, cirrhosis
Hypovolemic: Setting of appropriate upregulation of RAAS (and ADH) i.e. Addisonian crisis
Euvolemic: SIADH
Nutritional intake
Excessive water intake
Losses (sweat, diarrhoea)
Medications (thiazide diuretics)
Symptoms of hyponatremia
Can be acute or chronic
Nausea
Headache
Confusion
What might cause a falsely low serum sodium concentration (pseudohyponatremia)
Conditions with very high protein: multiple myeloma
Conditions with very high glucose levels: DKA
Stages of hyperkalemia on ECG
Peaked T waves
Prolonged PR interval
Widened QRS/conduction blocks
Causes of hyperkalemia
Renal failure
Rhabdomyolysis
Medications: Potassium-sparing diuretics (Spironolactone, ACE-Is, NSAIDs and digoxin)
Hypoaldosteronism
Hypocortisolism
Acidosis
Cell breakdown
Conditions associated with AST<ALT LFT results
Viral hepatitis
Minor fatty liver disease
Extrahepatic causes
Cholestasis
Conditions associated with AST>ALT LFT results
Alcoholic hepatitis
Decompensated cirrhosis, hepatocellular carcinoma
Liver metastases
Muscle damage
MI
Universal RBC donor blood type
O negative
Universal RBC recipient blood type
AB negative
Universal FFP recipient blood type
O
