MHU 2022 Flashcards
A 70 year old man has developed community acquired pneumonia. What symptom/sign is not a factor in the SMART-COP tool, indicating an increased likelihood for respiratory or inotrope support?
a. Multilobar involvement on chest x-ray
b. Albumin>5.4 g/dL (54 g/L)
c. Confusion
d. Systolic Blood pressure <90 mmHg
e. pH <7.35
b. Albumin>5.4 g/dL (54 g/L)
A 40 year old female had routine blood testing completed and is incidentally found to have a corrected calcium level of 3.4mmol/L. What is the next step in their management?
a. Advise patient to visit their GP in a week for repeat testing
b. Begin IV infusion of zoledronic acid
c. Begin treatment with hydrochlorothiazide
d. Rehydration with 0.9% sodium chloride 4-6 litres over 24 hours
d. Rehydration with 0.9% sodium chloride 4-6 litres over 24 hours
Mr Michael Brown is a 82 year old who has been admitted to the hospital worsening dyspnoea, fever, wheeze and a productive cough which produces yellow sputum. This is on the background of a 20-pack year history and known COPD. You suspect she has an acute infective exacerbation of COPD.
Her past medical history includes Type 2 Diabetes Mellitus which has been well managed for the last 20 years by metformin.
Her Blood Glucose Readings are usually in the range between 4.6-6.0 mmol/L, however her blood glucose level was 14.6mmol/L.
Which of the following drugs would be the most likely cause for elevated Blood Glucose Level?
a) Prednisolone
b) Salbutamol
c) Amoxicillin
d) Paracetamol
a) Prednisolone
Your patient is a 68 year old man who complains of right upper quadrant pain. On examination he has asterixis, is jaundiced, and has a large, distended abdomen with a palpable liver edge. He has a history of alcoholism. He has a Child-Pugh score of 15 (Class C).
As a complication of his disease, he has developed hepatic encephalopathy.
The most appropriate course of treatment to treat his hepatic encephalopathy is:
a) Liver Transplantation
b) Transjugular Intrahepatic Portosystemic Shunt
c) Therapeutic Paracentesis
d) Frusemide
e) Lactulose and Rifaximin
Lactulose and Rifaximin
A 30 -old male presents to his GP for a general health check-up one month post Covid-19 infection. On discussion of his history, he tells the GP that he had a previous respiratory illness when he travelled with his partner to see their family in Vietnam one year ago. On this trip he recalls he became mildly ill, coughing with a fever on and off for 3 weeks but was never seen by a doctor.
The GP orders a TB screening test (interferon gamma release assay) as a precaution. This later comes back positive, so sputum samples are taken but when cultured indicate there is no active TB infection.
Considering these results, he is considered to have a latent TB infection and is start on isoniazid, once daily for 6 months.
Which of the following is an important consideration of treatment when prescribing isoniazid?
a) Baseline vision and colour vision testing
b) Renal function
c) Co-prescription of Vitamin B6
d) Co-prescription of an SSRI
c) Co-prescription of Vitamin B6
68-year-old female patient from a residential care facility presents with a 4 day history of watery diarrhoea. She is under-weight with a BMI of 15.7 and has dry mucous membranes on examination. She has a past medical history of Crohn’s disease and recurrent urinary tract infections that were treated with a cephalosporin due to a penicillin allergy. After she is admitted and examined a CBE and stool sample is sent for testing. Her CBE results show a moderately elevated CRP and WCC and her stool sample is positive for C. difficile
The next day she records a temperature of 38.2 C, she is mildly confused, and her stool sample returns a positive result for C. difficile. She is immediately commenced on oral Vancomycin and monitored for any changes.
In this patient what is the most serious acute complication to monitor for?
a) Toxic megacolon
b) Dehydration
c) Cardiac arrhythmia
d) Sepsis
a) Toxic megacolon
64-year-old patient with known alcohol related cirrhosis presented with ascites, peripheral oedema and a temperature of 38.1OC. A diagnostic tap revealed a neutrophil count of 400/mm3 (normal <250mm3). Which of the following would be of most immediate benefit?
a) therapeutic paracentesis
b) intravenous antibiotics
c) oral spironolactone
d) trans-jugular intrahepatic porto-systemic shunt
e) fluid restriction and a no added salt diet
b) intravenous antibiotics
Which of the following is true of spontaneous bacterial peritonitis?
a) is characteristically caused by aerobic bacteria
b) is diagnosed by culture of ascitic fluid
c) A mortality rate of 50% is expected at one year
d) is due to intestinal perforation
e) Gentamicin is the treatment of choice
a) is characteristically caused by aerobic bacteria
A 62 two year old woman came to the ED with sudden onset of severe chest pain, radiating to her left arm. A 12 lead ECG was performed in the ambulance, ST elevation, in lead II, III and AVF.
Her vital as follows: BP: 90/50, Sp O 91% RA, RR: 23, Pulse: 98, temp: 36.7
Which of the following medication would be least likely to be used for the initial management of her symptoms:
A. Morphine
B. 2L Oxygen
C. Nitroglycerin (GTN)
D. Aspirin
C. Nitroglycerin (GTN)
A 71-year-old lady with a history of chronic obstructive pulmonary disease (COPD) presents with progressively worsening shortness of breath and a productive cough. She describes an increase in sputum production with the sputum colour changing from clear to yellow. His arterial blood gas (ABG) results are as follows;
Normal range
pH: 7.22
(7.35 - 7.45)
pO2: 7.4
(10 - 14)kPa
pCO2: 8.6
(4.5 - 6.0)kPa
HCO3: 30
(22 - 26)mmol/l
Her arterial blood gas shows:
a) Type 1 respiratory failure, acute on chronic respiratory acidosis
b) Type 2 respiratory failure, acute on chronic respiratory acidosis
c) Metabolic acidosis with partial respiratory compensation
d) Metabolic alkalosis with partial respiratory compensation
b) Type 2 respiratory failure, acute on chronic respiratory acidosisb) Type 2 respiratory failure, acute on chronic respiratory acidosis
Which of the following medication classes is LEAST LIKELY to reduce mortality in patients with heart failure with reduced ejection fraction?
a) ACE inhibitors
b) Beta blockers
c) Aldosterone antagonist
d) Diuretics
d) Diuretics
After presenting to ED with a minimal trauma vertebral fracture, Mrs Jones is found to have persistently raised calcium, mild kidney impairment and low haemoglobin. Which of the following investigations would be most useful to CONFIRM a diagnosis of multiple myeloma?
a) Serum protein electrophoresis
b) Urine Bence-Jones protein
c) CT skeletal survey
d) Bone marrow biopsy
d) Bone marrow biopsy
A 65-year-old female with a known history of long-standing rheumatoid arthritis presents to her GP with a 3-month history of feeling weak, fatigued, and short of breath on exertion. On examination there is pallor of the conjunctivae and palmar creases, and tachycardia. Due to her past history of an autoimmune inflammatory disease such as rheumatoid arthritis, you suspect a diagnosis of anaemia of chronic disease.
What findings on iron studies would confirm your diagnosis?
a) decreased serum iron, increased total iron-binding capacity, decreased transferrin saturation, decreased serum ferritin
b) normal serum iron, normal total iron-binding capacity, normal transferrin saturation, normal serum ferritin
c) decreased serum iron, decreased total iron-binding capacity, normal to decreased transferrin saturation, increased serum ferritin
c) decreased serum iron, decreased total iron-binding capacity, normal to decreased transferrin saturation, increased serum ferritin
A 75-year-old male presents to hospital with acute shortness of breath, palpitations, and fatigue. Once stable, you perform an examination on the patient. On examination he has pitting oedema to both calves bilaterally, a systolic flow murmur and an irregular pulse. A transthoracic echocardiogram is completed which shows a left ventricular ejection fraction of 31%. He is diagnosed with left sided systolic heart failure with reduced ejection fraction (HFeEF).
Which cardiac drug is NOT recommended for heart failure (HFrEF) management?
A. Frusemide
B. Metoprolol
C. Ramipril
D. Verapamil
E. Spironolactone
D. Verapamil
A 75-year-old male presents to hospital with acute shortness of breath, palpitations, and fatigue. Once stable, you perform an examination on the patient. On examination he has pitting oedema to both calves bilaterally, a systolic flow murmur and an irregular pulse. A transthoracic echocardiogram is completed which shows a left ventricular ejection fraction of 31%. He is diagnosed with left sided systolic heart failure with reduced ejection fraction (HFeEF).
Which cardiac drug is NOT recommended for heart failure (HFrEF) management?
A. Frusemide
B. Metoprolol
C. Ramipril
D. Diltiazem
E. Spironolactone
D. Diltiazem
A patient with newly developed End Stage Renal Failure has chosen to commence haemodialysis and it is decided they will have a fistula in their forearm. In the next few days following the procedure, what is the most appropriate vascular access for haemodialysis to occur?
a. The Radial-cephalic AV Fistula
b. Internal jugular CVC
c. PICC line
d. Tenckhoff catheter
b. Internal jugular CVC
A 65 year old man is admitted to hospital after a fall. On day 3 of his hospital admission, he is febrile, with a productive cough and raised neutrophil count. Chest X-ray confirms the diagnosis of hospital acquired pneumonia. He is currently haemodynamically stable. Which of the following antibiotics would be most appropriate for initial treatment?
A. Amoxicillin
B. Piperacillin-Tazobactam
C. Doxycycline
D. Amoxicillin-Clavulanate
E. Vancomycin
D. Amoxicillin-Clavulanate
An 8 year old Indigenous boy presents to the clinic with fever and shortness of breath. His mother says that he has recently recovered from a sore throat. Which of the following examination findings would be most consistent with this presentation?
A. A mid-systolic crescendo-decrescendo murmur heard best in the aortic region, radiating to the carotids
B. Pericardial friction rub on auscultation
C. End-inspiratory crepitations at lung bases
D. A maculopapular rash on the face
E. A pansystolic murmur heard best at the apex and radiating to the left axilla
E. A pansystolic murmur heard best at the apex and radiating to the left axilla
Which antiarrhythmic drug DOESN’T cause negative inotropic effects?
A. Amiodarone
B. Digoxin
C. Verapamil
D. Flecainide
E. Diltiazem
B. Digoxin
Which cranial nerves are most likely to be affected in lateral medullary syndrome?
A. 3, 7, 8, 10
B. 5, 7, 8, 10
C. 5, 8, 9, 10
D. 3, 8, 9, 10
C. 5, 8, 9, 10
Mrs Pearce, a 67-year-old women presented to the ED with an acute episode of chest palpitations and dizziness. An ECG was taken, which showed a HR of 145, irregularly irregular rhythm with no P waves. She is currently hemodynamically stable.
PMHx: HFrEF, Hypertension, hypercholesterolaemia, T2DM.
In selecting an acute rate control medication to manage Mr Pearce’s rapid ventricular rate, which of the following pharmacological agents should be chosen?
A) Verapamil 180mg
B) Atenolol 25mg
C) Amiodarone 200mg
D) Digoxin
C) Amiodarone 200mg
The typical murmur heard in hypertrophic obstructive cardiomyopathy (HOCM) is best described as
a. Crescendo-decrescendo systolic murmur best heard at the at the left sternal border and louder with Valsalva manoeuvre
b. Diastolic murmur best heard in the aortic area with the patient leaning forwards
c. Pansystolic murmur best heard at the left lower sternal border and increased with handgrip
d. Late systolic murmur beginning with a midsystolic click made louder by Valsalva manoeuvre
e. Crescendo-decrescendo systolic murmur best heard in the pulmonic area and made louder by handgrip
a. Crescendo-decrescendo systolic murmur best heard at the at the left sternal border and louder with Valsalva manoeuvre
A 75-year-old woman presents to the ED via ambulance following a 6-hour history of worsening headache and ataxia. On examination, you notice that the patient has right-sided ptosis, miosis, and anhidrosis, as well as left-sided loss of sensation to temperature. Further, she has a reduced gag reflex, and is struggling to swallow water when instructed. You suspect that she is likely suffering from a stroke, what artery is most likely to be affected?
a) Left PICA
b) Right PICA
c) Left AICA
d) Right AICA
e) Right MCA
a) Left PICA
A 5YO male presents to the ED with a 1-day history of headache, nausea and fever. Physical examination shows a temperature of 39.9ºC and involuntary flexion of the knees when the neck is flexed. CSF analysis shows increased neutrophils and decreased glucose, and CSF gram stain shows gram-negative diplococci. This patient is at risk of which of the following complications?
a. Acute pancreatitis
b. Adrenal insufficiency
c. Deep neck abscess
d. Temporal lobe inflammation
e. Vesicular skin rash
b. Adrenal insufficiency
