Mock 10 Flashcards
What anatomical structure or landmark lies just above the midpoint of the inguinal ligament?
Deep inguinal ring
82-year old man brought into ED due to low level of consciousness + severe headache for the last 20 hrs + very sensitive to light + temp of 39 + tachycardic at 118 + hypotensive at 80/55 + tachypneic at 32 + conscious but confused + positive Kernig’s sign + high-flow O2 and IVF were started
Most appropriate immediate action?
A. IV antibiotics B. Lumbar puncture C. CT brain D. Head MRI E. Blood culture
IV antibiotics - given Ceftriaxone or Cefotaxime; may add amoxicillin on top of ceftriaxone
A 75-year old man has urinary symptoms of frequency and nocturia. he finds it difficult to start his urine flow. Once he starts, the flow stops halfway through and starts again. He has sensation of not being able to empty his bladder.
PMH: prostate CA 11 years ago - treated and went into remission
DRE: irregular, hard, asymmetric prostate gland
Single most appropriate investigation to perform next?
A. MRI spine B. UTZ pelvis C. X-ray of pelvis D. IV Urogram E. Serum PSA
Serum PSA
***always pick PSA as the investigation of choice if you suspect prostate cancer in any patient
39-year old man + hx of swelling in the region of the submandibular region + more prominent and painful on chewing + hx of sour taste in the mouth + dry mouth + palpation - area is tender
Single most likely underlying diagnosis?
A. Chronic Sialadenitis B. Adenolymphoma C. Mikulicz’s disease D. Adenoid cystic carcinoma E. Submandibular abscess
A. Chronic sialadenitis
22-year old sexually active male + 2-day history of fever with increasing pain in the scrotal area + painful micturition + no history of trauma + red and tender scrotal skin + temp 37.8C
Single most likely diagnosis?
A. Testicular torsion B. Torsion of a pedunculated cyst of Morgagni C. Hematocele D. Epididymo-orchitis E. Spermatocele
Epididymo-orchitis
- more gradual onset
- presence of fever
- also: dysuria
Think testicular torsion if - WITH HISTORY OF TRAUMA - PREVIOUS ATTACKS OF PAIN - VOMITING Mx: urgent exploratory surgery
Think EO if - SEXUALLY ACTIVE - DULL PAIN - pain and swelling LOCALISED TO THE POSTERIOR SCROTUM Mx: antibiotics
55y/o presents to the clinic with SOB and increased daytime sleepiness + drinks 25 u of alcohol weekly + BMI is 35 kg/m2 + BP 150/70 + wife complains that he snores loudly at night
Most initial diagnostic test?
Single most appropriate investigation likely to confirm diagnosis?
Most initial - pulse oximetry
Most appropriate to confirm diagnosis - Polysomnography
44 y/o from Mozambique + 6-month hx of progressive SOB on exertion + recently moved to UK a year ago + last CXR shows straightening of left atrial appendage + audible diastolic murmur + 2D echo shows severe reduction of the mitral valve area
What is the single most likely complication associated with this condition?
A. Buerger’s disease B. Sepsis C. Pulmonary embolism D. LVH E. Cerebral infarction
Cerebral infarction
***Rheumatic Fever is the MCC of mitral stenosis. Rheumatic MVD is common in developing countries.
CXR showing straightening of left atrial appendage = LAE which is a complication of mitral stenosis (confirmed by echo)
Mitral stenosis > LAE > AF > VTE > cerebral infarction
Most common cause of mitral valve stenosis?
Rheumatic fever
Pathophysiology of mitral stenosis and how it causes RV failure
Mitral stenosis > LV filling impeded > LA pressure is increased > pulmonary congestion > decreased cardiac output (prob from decreased stroke volume) > pulmonary vasoconstriction > RV failure
Malar flush on the cheeks + atrial fibrillation + pulmonary rales + loud S1 + diastolic rumble
Mitral stenosis
Definitive management for postpartum psychosis
ECT - produces a dramatic response
45-year old man + Type 1 DM + with ulcer on his right ankle with agonising burning pain + pain worsened upon walking and during late hours of the night + not well-controlled glucose levels + currently undergoing investigation for DM retinopathy and nephropathy
Most appropriate management for pain?
Amitriptyline*
Duloxetine
Gabapentine
Pregabalin
*most preferred as it it cheaper and has simple OD dosing
Remember the mnemonic Away Goes D Neuropathic Pain
What is Away Goes D Neuropathic Pain?
Medical treatment indicated for neuropathic pain which include: Amitriptyine Gabapentin Duloxetine Pregabalin
Sites of hydroxylation of Vitamin D3
Liver (2i5er) - 25-hydroxylation
K1dney - 1,25-hyroxylation
72-year old due for a lower anterior resection of the colon due to CRCA
Single most appropriate antibiotic
Cefuroxime - cover GP and GN
Metronidazole - covers the anaerobes
